Pediatric Rheumatological Diseases in a Tertiary Care Hospital of Central India: A Retrospective Clinico-Epidemiological Profile.

Introduction: Infectious diseases account for the major health problem in developing countries like India. Though non-infectious diseases like rheumatological disorders are not very common, the burden of these disorders as a group is high in society due to the huge population size. The rheumatological disorders have varied presentations which may mimic other infectious pathologies leading to a significant time lag in the diagnosis. There is inadequate data on the exact burden of these diseases. The spectrum of rheumatological disorders in developing countries is different as compared to the Western world. Hence this study was carried out with the aim of studying the clinical, epidemiological, and laboratory profile of rheumatological disorders in the pediatric age group in a tertiary care hospital. Methods: It was a retrospective study. Data of patients admitted with the diagnosis of rheumatological disorder in the age group of one month to 15 years during the period from June 2018 to December 2022 were reviewed. Results: A total of 35 patients were identified with 20 being female. The mean age of the patients was 8.42± 3.95 years. The most common disease was juvenile idiopathic arthritis (JIA)- 10(28.57%) with an equal proportion of polyarticular JIA and systemic-onset JIA, followed by systemic lupus erythematosus (SLE) nine (25.71%) and Kawasaki Disease (KD)- eight (22.85%). The commonest presenting complaint was fever followed by a rash, whereas the most common findings were pallor and rash. Anemia was present in 25 (71.42%). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were high in 20 (57.14%) and 22 (62.85%), respectively. Antinuclear antibodies (ANA) were positive in 10 (28.57%) and rheumatoid factor (RA) factor in only one (2.85%) case. Conclusions: The most common rheumatological disorder identified was JIA. Fever and rash were the common presenting complaints. Pallor was the commonest sign whereas anemia was the commonest hematological abnormality.

Faecal calprotectin as an inflammatory biomarker to distinguish between bacterial and viral causes of childhood diarrhoea in Indian settings.

OBJECTIVES: The purpose of this study was to determine the value of faecal calprotectin (f-CP) in distinguishing between bacterial and viral aetiologies of infective diarrhoea in children attending a tertiary care hospital in Central India. METHODS: Stool samples from children aged 3 months to 10 years who had acute or persistent diarrhoea were processed for microscopy, bacterial culture, and viral antigen detection (Rotavirus and Norovirus). The remaining samples, as well as stool samples from 20 healthy controls, were tested for f-CP using the enzyme linked immunosorbent assay. RESULTS: Among 48 patients, 21 (43.7%) had bacterial diarrhoea, 14 (29.2%) had viral diarrhoea, and 13 (27.1%) had an unidentified aetiology. The median f-CP values were significantly (p â€‹= â€‹0.004) higher in children with bacterial diarrhoea (75.2 â€‹µg/g; IQR-18.75-239.15) than in children with viral diarrhoea (75.2 â€‹µg/g; IQR-123.5-1987.5). Bacterial aetiology could be reliably predicted at the optimum f-CP concentrations of >541 â€‹µg/g and >238.4 â€‹µg/g in children aged 1 and 1-4 years, with an area under the curve of 0.767 and 0.867, respectively, using receiver-operator characteristic analysis. CONCLUSIONS: Faecal calprotectin could reliably distinguish between bacterial and viral aetiologies of diarrhoea in children aged up to four years, but at relatively higher age-specified cut off values.

A Novel Mutation in Cystic Fibrosis Presenting as Pseudo Bartter Syndrome: A Case Report.

Pseudo-Bartter's (PB) syndrome is characterized by hypokalemic metabolic alkalosis and failure to thrive which constitutes a rare but typical presentation of cystic fibrosis (CF) in children. The most common mutation of CF is F508del, due to loss of 3 base pairs, causing deletion of phenylalanine, at position 508. We present a case of CF presenting with failure to thrive, dehydration, PB syndrome associated with urosepsis and primo-colonization with Escherichia coli suggesting the role of epigenetic factors. The heterozygous state for Phe508del mutation in Exon 11 combination with Glu92Ala in Exon 4 resulted in epigenetic effect on atypical phenotype as PBS, a novel mutation identified in our case.

Social and Demographic Factors Associated With Obese Children in the Age Group of 6-12 Years Attending a Tertiary Care Institute in Central India and the Prevalence of Depression in These Children: An Observational Study.

INTRODUCTION: Childhood obesity in India is on the rise and is rarely raised as a concern. In the central Indian states, focus is largely on undernutrition. Thus, studies related to risk factors for being overweight and obese and the impact of obesity on the psychology of children are lacking. Hence, a hospital-based study with objectives to identify social and demographic factors associated with obesity and the estimation of the prevalence of depression among these children was conducted. METHODS: This observational study was conducted in a tertiary care institute in the state of Chhattisgarh from July 2020 to October 2021. Children with obesity as per the WHO (> 95th percentile for the BMI) in the age group of 6-12 years were included after due consent. A proforma was administered targeting the objectives of the study and the Childhood Depression Rating Scale (CDR-S) and clinical evaluation identified the depressed. RESULTS: Among the 5,019 children screened during the study period, 54 met the inclusion criteria (1.07%). Fifty percent of children were from the upper middle class as per the Kuppuswamy scale. Seventy percent consumed junk food more than three times a week. Twenty-three children (42.6%) engaged in physical activity of > 1 hour and 49(90.7%) had a screen time of > 2 hours. The prevalence of depression among these children stood at 5.6% with the mean age being 11.67 years. Multiple logistic regression showed an inverse association of depression with physical activity. CONCLUSION: Obesity is prevalent in higher socioeconomic groups. Many risk factors like screen time, junk food consumption, and physical activity are modifiable. The prevalence of depression increased with age. Physical activity showed an inverse relation to depression in obese children.

Teacher-led versus student-led seminar blended with portfolio for "assessment of learning": An interventional study.

BACKGROUND: Increase in competitive demands has led to the promotion of seminar presentation by the students to increase active learning and for the assessment of learning. Portfolios are an important tool for assessment for learning. The objectives of the study were to compare the gain in knowledge among the conventional and the blended seminar groups (intervention group), analyze the working portfolios to assess for learning, and to gather the perception of students. MATERIALS AND METHODS: This was an interventional study (2016) with convenience sampling that included 27 students each in the conventional and interventional groups. It was conducted in a medical college in central India. The conventional group was teacher led and the blended seminar group was student led with interaction with the students regarding the contents of the portfolio. Student's unpaired and paired t tests were used for statistical analysis. P < 0.05 was considered as the level of significance. Class average normalized gain (g) was used as a measure of effectiveness of the intervention. Quantitative questions were analyzed using percentages and qualitative data using categorization. RESULTS: Significant difference was found between the conventional and intervention groups (P < 0.05) with gain "g" being 0.52 for the intervention group. On evaluation of the feedback, students commented regarding its interactive nature and progress during the learning process. The reflections were coded as text as the unit of coding and student as the unit of coding. It was also found that the students who were critical reflectors were the ones who scored > 50% in the posttest scores. CONCLUSION: The present study showed that seminar when blended with portfolio yielded positive results in the process of learning, and hence was effective in assessment for learning.

Evaluation of an in-house PCR for diagnosing scrub typhus along with a preliminary study of genotypic characterization of Orientia tsutshugamushi circulating in Chhattisgarh: A prospective clinico-microbiological study.

PURPOSE: Scrub typhus, caused by Orientia tsutsugamushi (O. tsutsugamushi) present nonspecific clinical features during manifestation of acute undifferentiated febrile illness (AUFI) to render its early diagnosis difficult. Accordingly, this study was undertaken to assess an in-house groEL PCR versus IgM ELISA for the diagnosis of scrub typhus and to genotypically characterise the randomly selected scrub typhus positive cases. METHODS: Blood samples, collected from two hundred twenty one (221) AUFI cases were subjected to groEL PCR and IgM ELISA for diagnosis of scrub typhus. Eleven randomly selected PCR positive cases were processed for DNA sequencing to determine the genetic diversity of O. tsutsugamushi in Chhattisgarh. RESULTS: Scrub typhus prevalence of 35.2% were detected among AUFI cases using both in-house groEL PCR and IgM ELISA. PCR alone showed sensitivity, specificity, positive and negative predictive values of 66.6% (CI: 55.08-76.94), 100% (CI: 90 to 100),100% (CI: 93.15 to 100) and 57.37% (CI: 44.05 to 69.96) while for IgM ELISA, these parameters were 62.8% (CI: 51.13-73.50), 100% (CI: 90 to 100), 100% (CI: 92.75 to 100) and 54.68% (CI: 41.75 to 67.18) respectively. PCR and ELISA could detect scrub typhus in 37.2% and 33.3% cases, when tested alone. groEL PCR detected the O. tsutsugamushi throughout the course of infection. Phylogenetic analysis depicted 5 of 11 positive cases belonged to Kuroki, Japan strain of O. tsutsugamushi, followed by Gilliam and Karp strain in 4 and 2 cases respectively. CONCLUSION: Scrub typhus should be considered in differential diagnosis of AUFI. groEL PCR may aid on to IgM ELISA test for optimum laboratory diagnosis of scrub typhus by its implementation especially in seronegative cases. Predominance of Kuroki-like strain followed by Gillian and Karp strains of O. tsutsugamushi in Chhattisgarh confirm variable geographical distribution of O. tsutsugamushi and provide the baseline epidemiological data which will eventually be used to help the researchers for developing better diagnostic tests and vaccine covering the predominant genotypes.

Blood group discrepancy in mixed-type autoimmune hemolytic anemia in a pediatric patient.

Autoimmune hemolytic anemia (AIHA) is characterized by the presence of antibodies directed against self-antigens on red blood cells (RBCs) leading to progressive RBC destruction along with reduced red cell survival. Mixed-type AIHA is characterized by the presence of both warm and cold-autoantibodies. These autoantibodies may cause blood-group discrepancy or cross-match incompatibility leading to delay in arranging suitable blood unit for transfusion. The detection of autoantibodies by monospecific-direct antiglobulin test showing positive reaction on immunoglobulin G and C3d and presence of cold-agglutinins leads to the diagnosis. We report a rare case of mixed AIHA in a 15 years female showing severe anemia, blood group discrepancy, and cross-match incompatibility. She received transfusion of least incompatible packed RBCs without any untoward effect.

Scrub typhus and leptospirosis in rural and urban settings of central India: a preliminary evaluation.

Scrub typhus and leptospirosis are bacterial zoonotic diseases reported from different parts of India, whose prevalence in Chhattisgarh is unknown. Our study was carried out to delineate the prevalence of these illnesses there and to assess the clinical profiles of rural and urban patients. A total of 169 patients with acute febrile illnesses (AFI) was enrolled in our study from May to December 2018, of whom 35 (20.7%) tested positive for scrub typhus and only one tested positive for leptospirosis by respective IgM ELISA. Scrub typhus seropositivity was higher in rural patients (25.0%) than in urban (18.1%). Patients in the age group 16-30 years were the most commonly affected. The commonest presenting symptoms were fever with headache (68.57%), extreme weakness (57.14%), myalgia/arthralgia (54.29%) and abdominal pain (51.43%). The preliminary evidence for the presence of scrub typhus in Chhattisgarh necessitates its inclusion in the panel of tests for AFI.

Medical Education Terminologies: Do These Really Percolate to the Level of Medical Students? A Survey.

INTRODUCTION: In Medical Education Technology, many terminologies are embodied in faculty training programs; used by teachers in daily practice like learning objectives, curriculum, and domains, formative and summative assessments. The awareness and knowledge of students regarding these terminologies, is questionable. AIM: To assess the awareness and knowledge of the students of all phases of MBBS - regarding terminologies in medical education. MATERIALS AND METHODS: The study was questionnaire based survey at a private medical college in rural setting. Participants were the students from first, second, third Part I and third part II MBBS. Sample size included 175, 161,150 and 162 participants of first, second, third Part I and third Part II MBBS respectively. The questionnaire included 10 closed and one open ended questions which included the themes in educational spiral like: learning objectives, teaching-learning and assessment.Statistical data analysis was done by using descriptive and inferential statistics (Chi-square test) and p<0.05 was considered as level of significance. Qualitative data was analysed using coding and categorization. RESULTS: Percentage of students participated for first, second, third Part I and third Part II MBBS were 87.5%, 80.09%, 93.16% and 90% respectively. The students were aware of some terms like learning objectives, its importance, curriculum; but knowledge component was missing. For some terms like cognitive, psychomotor, affective domain, simulation, formative, summative assessment; awareness as well as knowledge was missing. The methods suggested by students regarding the terminologies ranged from explanation of importance of these terms to its application. CONCLUSION: Efforts should be made in the direction to increase the awareness and knowledge of the basic terminologies used in medical education technology.

Perception of Medical Students about Communication Skills Laboratory (CSL) in a Rural Medical College of Central India.

INTRODUCTION: "The art of medicine is intricately tied to the art of communication." In traditional medical curriculum, communication is not taught formally and this leads to a gap in reliability and consistency of the teaching. Few studies have shown that much litigation against doctors is due to lack of communication and not because of lack of clinical expertise. Considering the importance of training in communication skills, it was included in the curriculum of students of DMIMS (DU), which has got probably the first communication skills lab in a medical college in India. AIM: To study the perception of medical students about usefulness of communication skills lab. MATERIALS AND METHODS: This observational study was carried out at Communication Skills Lab (CSL) of Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharasthra. Feedback was obtained with the help of a prevalidated questionnaire from 65 final MBBS students about their perception about utility of the module taught in the CSL including factors which helped and which hindered in learning. Descriptive statistics was used for the quantitative data and categorization for qualitative data. RESULTS: A total of 78.46% students were of the idea that CSL posting is must for all medical undergraduates. A 93.83% perceive that the module taught was very relevant and useful and were satisfied with the duration of posting (81.47%). A 78.46% students experienced improvement in their communication skills. They opined that more emphasis should be given on communication between doctor and patient (61.53%). CONCLUSION: The students found communication skills lab very useful. They desired more emphasis on communication between doctor and patient and sought more interactivity, video demonstrations to be part of the module.

A 5-year hospital prevalence of child and adolescent psychiatric disorders from central India.

OBJECTIVE: To examine the 5-year hospital prevalence of child and adolescent mental disorders from Central India. METHODS: Using systemic random sampling method, of the 4410 families screened, 4278 children (607 aged 0 to 3 y and 3671 between 4 to 16 y) attending outpatient services of department of pediatrics at the tertiary rural hospital from June 2006 through December 2010 were evaluated. Standardized appropriate psychometric tools were used for both groups. Diagnostic interviews were administered and DSM-IV diagnoses were determined by consensus between two psychiatrists. A comprehensive hospital registration system provided the denominator. RESULTS: Of the 4410 families screened, 4278 (97 %) of the subjects completed interviews. The overall prevalence of psychiatric disorders was found to be 20.8 %. Most common psychiatric disorders in group A were mental retardation (5.6 %) followed by epilepsy (2 %) whereas in group B, depressive disorder (3.73 %) were followed by non-organic enuresis (2.18 %) and ADHD (1.7 %). Eighty one percent of the parents from group A and 83 % of parents from group B of the children affected with psychiatric disorders and neurobehavioral problems had reported that they have had never thought of taking psychiatric consultation for their children. CONCLUSIONS: The results of the study have helped in bridging and supporting the propositions in child epidemiology in India and also have implications for clinical training and practice.