Procalcitonin for Detecting Culture-Positive Sepsis in Neonates: A Prospective, Multicenter Study.

INTRODUCTION: It is unclear if serum procalcitonin (PCT) estimated at sepsis suspicion can help detect culture-positive sepsis in neonates. We evaluated the diagnostic performance of PCT in culture-positive sepsis in neonates. METHODS: This was a prospective study (February 2016 to September 2020) conducted in four level-3 units in India. We enrolled neonates suspected of sepsis in the first 28 days of life. Neonates with birth weight <750 g, asphyxia, shock, and major malformations were excluded. Blood for PCT assay was drawn along with the blood culture at the time of suspicion of sepsis and before antibiotic initiation. The investigators labeled the neonates as having culture-positive sepsis or "no sepsis" based on the culture reports and clinical course. PCT assay was performed by electrochemiluminescence immunoassay, and the clinicians were masked to the PCT levels while assigning the label of sepsis. Primary outcomes were the sensitivity, specificity, and likelihood ratios to identify culture-positive sepsis. RESULTS: The mean birth weight (SD) and median gestation (IQR) were 2,113 (727) g and 36 (32-38) weeks, respectively. Of the 1,204 neonates with eligible cultures, 155 (12.9%) had culture-positive sepsis. Most (79.4%) were culture-positive within 72 h of birth. The sensitivity, specificity, and positive and negative likelihood ratios at 2 ng/mL PCT threshold were 52.3% (95% confidence interval: 44.1-60.3), 64.5% (60.7-68.1), 1.47 (1.23-1.76), and 0.74 (0.62-0.88), respectively. Adding PCT to assessing neonates with 12.9% pretest probability of sepsis generated posttest probabilities of 18% and 10% for positive and negative test results, respectively. CONCLUSION: Serum PCT did not reliably identify culture-positive sepsis in neonates.

Ferritin as an indicator of disease activity in Hodgkin lymphoma in pediatric patients.

INTRODUCTION: Hodgkin lymphoma is a malignant proliferation of lymphatic system which when advanced can involve the bone marrow. It is usually indolent and responds to chemotherapy. However the prediction of rapidly progressive disease is often dependent on lot of clinicopathological parameters. Serum ferritin may act as a marker for disease activity in these patients. But the prior studies have failed to establish its role or group the patients into prognostic categories. AIMS: To study the status of serum ferritin at time of admission and after completion of chemotherapy and also iron overload induced organ involvement in the form of hepatic, cardiovascular and thyroid dysfunction in nine patients admitted in our ward with Hodgkin lymphoma and receiving treatment in the form of chemotherapy. METHODOLOGY: A spectrum of clinicopathological variables were tested at baseline and after treatment liver function test, thyroid function test, 2D echocardiography, Ultrasound abdomen, PET scan and serum ferritin level. CONCLUSION: Serum ferritin at baseline statistically correlated with disease activity however the final ferritin values reduced to significant values in patient that underwent remission, and hence grouping of patients based on serum ferritin values can serve as better outcome predictors. Although transfusion requirement was very rare in the patients the levels of serum ferritin correlated with disease activity. Serum ferritin level may act as a predictor of disease activity and remission.

Study of transfusion-related iron overload (trio) in pediatric patients with hematological malignancy and bone marrow failure syndromes.

BACKGROUND: Pediatric patients with hematological malignancy and bone marrow failure syndrome receive multiple transfusions before diagnosis and treatment. Iron overload leads to damage to vital organs like the heart, liver, thyroid, Gonads, Pancreas. MATERIALS AND METHODS: A prospective study was done from June 2017-December 2019 in a tertiary care pediatric hematology oncology unit in northern India on children diagnosed with hematological malignancy and bone marrow failure syndromes receiving packed cell transfusion. After due ethical considerations and patient consent, the details were documented in predesigned proforma. All cases were planned to be investigated with Liver function test, Thyroid function test, Serum ferritin level, 2 D Echocardiography, Ultrasonography of abdomen, and MRI of the abdomen at admission and six months of enrollment. RESULTS: Out of 58 cases enrolled, ferritin levels were high in 65% of subjects at the start of treatment and 76% at the endpoint. Mean ferritin level was 725 ng/ml at baseline and 1268 ng/ml end of 6 month follow up period. Fifty-seven percent had a ferritin level above 1000 ng/ml, which correlated to basal ferritin level (P-value 0.005). The final ferritin level correlated strongly with the final number of packed cell transfusions (P-value 0.0002). Functional derangement of the liver was evident biochemically in 13.7% before starting treatment and 31.8% at six months follow-up period. Echocardiography detected diastolic dysfunction in 2% of patients at baseline before starting treatment and increased to 22% in 6 months follow-up period. The percentage of subclinical hypothyroidism increased from 22.8% to 48.8% during treatment. CONCLUSION: Like transfusion-dependent anemias, children with hematological malignancy and bone marrow failure syndrome on chronic transfusion are at risk of transfusion-related iron overload and organ damage.

Spectrum of Multisystem Inflammatory Syndrome in Children (MIS-C)-a Report of Three Cases.

We report three cases of multisystem inflammatory syndrome in children (MIS-C) during July 2020 from a tertiary care hospital with different clinical presentations and course of management. This will guide in better management of children with MIS-C. All three patients, aged 1 to 12 years old, were critically ill. They presented with common features of MIS-C, such as fever, conjunctival congestion, gastrointestinal involvement, and skin manifestations. Clinical features were suggestive of shock, coagulopathy, and multiorgan involvement. Laboratory findings revealed raised inflammatory markers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimers (DD). All patients required intensive care with oxygen therapy, fluid resuscitation, inotropic agents, and broad-spectrum antibiotics. All patients received steroids, and two patients were given intravenous immunoglobulin. One patient died, and the remaining two patients were discharged. Our findings confirmed that COVID-19 may cause severe disease in children, and the presentation may vary, requiring early recognition and timely management.

Dialectical Behavior Therapy in Emotion Dysregulation - Report of Two Cases.

Emotion dysregulation is the inability to control and modulate one's affective state, and it might be associated with mental disorders. The development of secure attachment with significant others, in early childhood, has been theorized to be essential to the development of emotional regulation. Disruption of the formation of secure internal representations may, therefore, substantially compromise the acquisition of emotional-regulation capacities in childhood and lead to social maladjustment in later life. It is a pre-post case study design of two adolescents who presented with acts of self-harm and history indicating a provisional diagnosis of personality disorder. However, an in-depth assessment revealed emotional dysregulation. The model of Dialectical Behavior therapy (DBT) recommended for non-clinical populations was delivered in 12-16 sessions, resulting in a positive outcome that sustained for 12-24 months follow-up, improving interpersonal effectiveness. The role of DBT as an early intervention in emotional dysregulation is highlighted, as it enhances social adjustment by altering the attribution style.

Oral dextrose for analgesia in neonates during nasogastric tube insertion: a randomised controlled trial.

AIM: This study aims to determine if oral dextrose solution can mitigate the pain response to nasogastric tube (NGT) insertion in neonates. METHODS: The study was a double-blinded, placebo-controlled, randomised controlled trial. One hundred and fifty consecutive neonates were randomised into three groups to receive 25% dextrose (D25), or 10% dextrose (D10) or placebo (distilled water). An NGT was inserted after giving 2 mL of one of the solutions orally. Pain response was assessed using the Premature Infant Pain Profile (PIPP), and the duration of cry was noted within 60 s of the intervention. Total PIPP score, duration of cry, change in heart rate and oxygen saturation (SpO2 ) were compared among the three groups. RESULTS: Neonates who received D25 had significantly lesser pain response to NGT insertion in terms of lower PIPP score (P < 0.05) and duration of cry (P = 0.001) compared to D10. There was a significantly smaller increase in heart rate and decrease in SpO2 (P < 0.05). In comparison with placebo, D10 significantly decreased duration of cry (P < 0.05) but not PIPP score. CONCLUSION: Oral D25 was effective in reducing the pain response during NGT insertion in neonates when compared with oral D10 and placebo. Oral D10 was not found to have a potent analgesic effect for the same.