Spectrum of Primary Immunodeficiency Disorders in Hospitalized Children: Multicentric Data From Kolkata.

OBJECTIVE: To evaluate the incidence and types of primary immunodeficiency diseases (PIDs) in hospitalized children with infection. METHODS: This prospective study was conducted in five tertiary-care facilities in Kolkata over two consecutive years between November 1, 2018 and October 31, 2020. We included all children aged upto 12years who were hospitalized and screened them for PID. Children were screened for suspected IPD using Jeffrey Modell Foundation (JMF) Criteria; any child who satisfied at least 2 out of 10 warning signs was further evaluated for PIDs. RESULTS: Out of 33,204 hospital admissions, 50 children satisfied JMF criteria. Out of 50 children screened during the study period, 27 were finally diagnosed with an underlying PID, with a prevalence of 1 in 1000 hospitalized children. Majority (37.03%) of them had antibody deficiency followed by phagocytic defect (33.3%). Chronic granulomatous disease was the commonest PID followed by common variable immunodeficiency. Around 62.97% children presented with respiratory infections and overall Acinetobacter baumannii was the commonest isolated organism. CONCLUSION: Our study presents the first cohort of PID from eastern India. A methodical step-wise clinical and diagnostic approach can facilitate early diagnosis and timely therapeutic interventions.

Clinical profile and predictors of therapeutic outcome with azithromycin in pediatric scrub typhus: A study from Eastern India.

In this prospective study, children from 1-month to 12-years, admitted with positive IgM ELISA testing for scrub typhus, were enrolled over 1-year and administered an empirical single dose of azithromycin (10 mg/kg). All 189 (median age 4.84-years) children had fever with median duration of 8 days at admission. Shortness of breath, altered sensorium, headache, lymphadenopathy, hepatosplenomegaly, pallor, oedema and hypotension were the most prominent symptoms/signs. About 46% of children developed complications, among them hepatic, neurological and cardiovascular were most common. Our study showed a remarkable response to azithromycin, with mean defervescence of 32 h and no mortality. The presence of shortness of breath, headache, altered sensorium, hepatosplenomegaly, meningeal signs, severe anemia, leucocytosis, hyponatremia along with/without any of above mentioned three systemic complications were independent predictors for delayed treatment response by multivariate logistic regression analysis. Hepatic, neurological and cardiovascular complications are an emerging trend. Empiric azithromycin based on clinical suspicion of scrub typhus can be lifesaving.

Clinico-demographic Profile and Predictors of Intensive Care Need in Children with Respiratory Syncytial Virus-associated Acute Lower Respiratory Illness during Its Recent Outbreak alongside Ongoing COVID-19 Pandemic: An Eastern Indian Perspective.

Introduction: The objective was to delineate the clinico-epidemiological characteristics of hospitalized children with respiratory syncytial virus (RSV)-associated acute lower respiratory tract infection (RSV-ALRI) during its recent outbreak and to find out the independent predictors of pediatric intensive care unit (PICU) admission. Materials and methods: Children aged between 1 month and 12 years who tested positive for RSV were included. Multivariate analysis was performed to identify the independent predictors and predictive scores were developed from the ß-coefficients. Receiver operating characteristic curve (ROC) was generated and the area under the curve (AUC) was calculated to assess the overall precision. The performance of sum scores in predicting PICU need, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR-) were calculated for each cutoff value. Results: The proportion of RSV positivity was 72.58%. A total of 127 children were included with a median [interquartile range (IQR)] age of 6 (2-12) months, of whom 61.42% were males and 33.07% had underlying comorbidity. Tachypnea, cough, rhinorrhea, and fever were predominant clinical presentations while hypoxia and extrapulmonary manifestations were present in 30.71% and 14.96% of children, respectively. About 30% required PICU admission, and 24.41% developed complications. Premature birth, age below 1 year, presence of underlying CHD, and hypoxia were independent predictors. The AUC [95% confidence interval (CI)] was 0.869 (0.843-0.935). Sum score below 4 had 97.3% sensitivity and 97.1% NPV whereas sum score above 6 had 98.9% specificity, 89.7% PPV, 81.3% NPV, 46.2 LR+, and 0.83 LR- to predict PICU needs. Conclusion: Awareness of these independent predictors and application of the novel scoring system will be beneficial for busy clinicians in planning the level of care needed, thereby optimizing PICU resource utilization. How to cite this article: Ghosh A, Annigeri S, Hemram SK, Dey PK, Mazumder S. Clinico-demographic Profile and Predictors of Intensive Care Need in Children with Respiratory Syncytial Virus-associated Acute Lower Respiratory Illness during Its Recent Outbreak alongside Ongoing COVID-19 Pandemic: An Eastern Indian Perspective. Indian J Crit Care Med 2022;26(11):1210-1217.

Celiac disease with pure red cell aplasia: an unusual hematologic association in pediatric age group.

Anemia in Celiac disease (CD) is usually hypoproliferative, reflecting impaired absorption of essential nutrients like iron and various vitamins. We report a 2-year-old boy with Celiac disease and severe anemia due to pure red cell aplasia, diagnosed by bone marrow biopsy. This rare, unexplained extra digestive manifestation responded to gluten free diet.

Atypical respiratory distress in a newborn: a diagnostic dilemma.

Neonatal respiratory distress is a very common problem in our practice. The causes may be respiratory, cardiovascular, central, metabolic, haematological and surgical. The cause of distress due to transient myocardial depression is not very common in mild asphyxia. We present a case having transient myocardial depression with severe respiratory distress and features of shock in a mild asphyxiated baby.

Association of Body Mass Index (BMI) with Lung Function Parameters in Non-asthmatics Identified by Spirometric Protocols.

INTRODUCTION: Association between obesity and asthma has been reported widely, with disparity between males and females. Epidemiological data which indicate that obesity precedes development of asthma and increases the prevalence and incidence of asthma, raises the possibility of a causal association. AIM: To find out the association, including gender differences, between Body Mass Index (BMI) and lung functions in non-asthmatics identified by spirometric protocols. METHODS: A retrospective analysis was conducted of the spirometry results obtained between October 2012 and March 2013 for six months. Participants were referred by a variety of medical specialties to the pulmonary function laboratory in Physiology department, R.G. Kar Medical College, Kolkata, India of the 590 test results recorded in the study database 424 non-asthmatic subjects were reviewed. RESULTS: Significant differences in the spirometric parameters, measured as a percentage of predicted were evident between male and female. Among obese subjects significant correlation is found between BMI and pulmonary function values, FEV1(r = -0.531, p=0.009); FEF25-75% (r= -0.653, p=0.001); FEV1/FVC (r= - 0.603, p=0.002). Significant association was found between BMI and lung function in obese female but not in obese male. CONCLUSION: Association was found between indices of spirometry and BMI in non-asthmatic obese group along with a gender disparity.

Assessment of lung function by spirometry and diffusion study and effect of glycemic control on pulmonary function in type 2 diabetes mellitus patients of the eastern India.

INTRODUCTION: There are so many complications involving eyes, kidneys, lungs and nerves associated with diabetes. But, pulmonary complications are poorly characterized among eastern Indian diabetic populations. AIMS AND OBJECTIVES: To assess pulmonary function in patients with type 2 diabetes mellitus. To find out correlation of the pulmonary functions test variables with Glycemic control. MATERIALS AND METHODS: Total of 60 type 2 diabetes patient of age between 35-55 y and same number of age and sex matched apparently healthy control individual were included in the present study. All subjects were evaluated for PFT by flow sensitive spirometer (RMS HELIOS-401), the spirometric parameters were measured as a percentage of predicted and DLCO (by single breath technique). HBA1c of all cases were measured and they were grouped according to HBA1c level (Group-a =>7%, Group-b =6%-7%, Group-c =<6%). RESULTS: Significant differences in the spirometric parameters (FVC, FEV1/FVC) and diffusion capacity (DLCO% and DL/VA%) existed between cases and controls. There was a significant decrease in FVC, DLCO and DL/VA and significant increase in FEV1/FVC in that groups having HBA1c level >7% than the other groups. FEV1, FVC, DLCO, and DL/VA were negatively correlated with HbA1c where as FEV1/FVC has positive association with HbA1c. CONCLUSION: Significant deterioration of lung function and diffusing capacity was observed in type 2 diabetes patients with poor glycemic control.

Internal jugular vein phlebectasia presenting with hoarseness of voice.

Internal jugular phlebectasia presents as a soft cystic mass in the neck that appears on straining. We present a case of a 7-year-old girl who presented with a painless soft cystic mass in the neck associated with hoarseness of voice. Based on clinical examination and CT image, diagnosis of right internal jugular phlebectasia was made.