Usage of Cartridge Based Nucleic Acid Amplification Test (CB-NAAT/GeneXpert) test as diagnostic modality for pediatric tuberculosis; case series from Mangalore, South India.

BACKGROUND: Diagnosis of Tuberculosis in children is challenging. Hereby we report a case series of 4 patients where Cartridge Based Nucleic Acid Amplification Test (CB NAAT) helped us in early diagnosis. CASE CHARACTERISTICS: Case 1 was a 14-year old girl who was on anti-tuberculous therapy (ATT) for 2 months without any improvement; sputum CBNAAT detected multi-drug resistant tuberculosis (MDR-TB). Case 2 was a 9-year old boy with history and examination findings suggestive of meningitis; CB-NAAT of the cerebrospinal fluid (CSF) was positive. Case 3 was a 1-year old child having fever, cough of 1 month duration with Mantoux positive. CB-NAAT of gastric lavage was positive. Case 4 was a 3- month old child who presented with severe respiratory distress of 11 days duration. Chest x-ray showed miliary mottling; CB-NAAT of gastric lavage was positive. CONCLUSION: CB-NAAT testing was very useful in making an early and definitive diagnosis of tuberculosis, including MDR-TB.

Management practices of tuberculosis in children among pediatric practitioners in Mangalore, South India.

INTRODUCTION: In spite of having BCG vaccination and tuberculosis control program for the last 50 years, prevalence of tuberculosis continues to be high in India. Inadequate diagnostic methods, suboptimal treatment and monitoring, and the lack of vigilant reporting system are some of the contributing factors for the failure of TB control. OBJECTIVES: To know the current practices among local pediatricians regarding management of TB. MATERIALS AND METHODS: Field based cross sectional study. All the registered pediatricians who were practicing in Mangalore, (list - local IAP branch) were included in the study. A structured Questionnaire on signs and symptoms of TB, diagnosis, strategies adopted in treatment, MDR tuberculosis and reporting of cases to RNTCP was asked. Management practice standards according to the Updated National Guidelines for Pediatric Tuberculosis in India, 2012, RNTCP guidelines in consensus with IAP, latest at the time of the study. RESULTS: 50 pediatricians participated in the study with 62% having an attachment to the teaching institution. More than 50% identified all the symptoms of TB. 64% were sending chest X-ray, Mantoux test and gastric lavage/induced sputum examination for AFB to diagnose TB. 22% were not stressing for AFB examination. Still 16% told serological tests as one of the diagnostic modality. 52% were not aware about the diagnosis of latent TB. In 16% of their cases ATT was on a trial basis. Only 52% of the clinicians are adhering to updated national (RNTCP) guidelines. 30% felt still there are drawbacks in the current RNTCP guidelines. 72% knew the correct definition of MDR tuberculosis. But only 36% of them knew the diagnostic method (gene expert/CB NAAT) of confirming the MDR TB. CONCLUSION: Management practices are found to be still suboptimum. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.

Doppler indices of superior thyroid artery in clinically euthyroid adults.

CONTEXT: Ultrasonography of thyroid gland is a frequently performed investigation. Many of the diffuse thyroid pathologies are associated with altered vascularity. In view of potential applications and scant available data, there is a need to find normal values of Doppler indices of superior thyroid artery (STA). AIMS: To find the normal range of Doppler indices like mean peak systolic velocity (PSV), resistivity index (RI), and pulsatility index (PI) of STA in clinically euthyroid adult individuals. SETTINGS AND DESIGN: Prospective cross-sectional observational study. MATERIALS AND METHODS: A study was done in the Department of Radiodiagnosis of a tertiary care hospital, involving clinically euthyroid adult volunteers. Ultrasonography of the thyroid gland with Doppler of bilateral STAs was performed and mean values of PSV, RI, and PI were calculated. RESULTS: A total of 208 subjects, with a mean age of 37.7 years, underwent Doppler evaluation of STA; 148 of them were women and 60 were men. The mean PSV obtained was 16.94 ± 5.3 cm/s. Mean PI and RI were 0.93 ± 0.31 and 0.5 ± 0.13, respectively. There was no significant difference in the values obtained among both the genders. CONCLUSION: Mean values of Doppler indices of STA in euthyroid individuals have been found in this study.

Screening Mammography: A Pilot Study on Its Pertinence in Indian Population by Means of a Camp.

INTRODUCTION: Breast cancer incidence and related mortality is increasing in Indian women. Indian ladies hesitate to seek medical care for breast related issues. Screening mammography, proved to effectively reduce mortality, has been deemed not feasible in Indian context due to cost considerations. The suggested alternatives have not been proven to improve mortality rates. AIM: To find the relevance of screening mammography camp among Indian women. MATERIALS AND METHODS: A week long screening mammography camp was organized in a tertiary care hospital. Clinical examination was done followed by bilateral mammography. Mammograms were reported as per American College of Radiology-Breast Imaging Reporting and Data Systems (ACR-BIRADS) 5th edition specifications. Lesions deemed BIRADS 4 and 5 were biopsied. BIRADS 3 category findings were suggested short interval follow up. RESULTS: A total of 118 women, ranging from 35 to 64 years of age with mean age of 49.6 years underwent mammography. Thirty ladies with dense breast compositions further underwent sono-mammography. Six (5.1%) new cases of breast carcinomas were detected during this study and 28 (23.7%) cases with probably benign findings were advised short interval follow up. CONCLUSION: Mammography, being a proven screening modality effective in reducing mortality, needs incorporation into the nationwide program for breast cancer detection, inspite of financial considerations. Organizing mammography camps will help create awareness and encourage public to utilize services.

Association of cord blood and maternal lipid profile

Background: Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity with dyslipidemia as an important contributing risk factor. Objective of the study was to determine whether there is an association between maternal lipid profile and the cord blood lipid profile of their newborns.Methods: This was a hospital-based Cross-sectional study on 60 mothers and their respective newborns (30 term and 30 preterm) conducted in Yenepoya medical college hospital from August to November 2019. Umbilical cord blood samples from the newborns were collected after birth and the mother's venous blood was collected in the fasting state (8hrs of fasting) before delivery. The levels of total cholesterol, triglycerides, HDL, LDL and VLDL were determined in mothers and their newborns by an enzymatic colorimetric method. Data obtained was analyzed by the SSPS software 23.0 version and Pearson's correlation was done.Results: There was a significant correlation between the mean concentration of maternal Triglycerides and the Triglycerides and HDL levels of neonates (p-value <0.05).Conclusions: There was a significant association of cord blood and maternal lipid profile, hence changes in maternal lipid levels might influence the lipid levels in the cord blood of newborns.

A study to assess the prevalence of hypertension in children with nephrotic syndrome

Background: Hypertension is been one of the most common co morbidity of this disease. It was mostly attributed to sodium retention, which is a major clinical feature of nephrotic syndrome. These mechanisms likely have a role in the development of hypertension in nephrotic syndrome, where hypertension may be difficult to control, and provide new therapeutic options for the management of blood pressure in the setting of nephrotic syndrome. Objective of study the prevalence of hypertension in children with NS and also the number of antihypertensive required to control it.Method: A Retrospective study of the hospital records of 100 children diagnosed with nephrotic syndrome admitted to Pediatric and Nephrology Ward at YMCH was accessed.Results: In our study 35 (35%) of them were Infrequent relapse nephrotic syndrome (IFNS) and 35(35%) were' Frequent relapse nephrotic syndrome (FRNS) ,while 30 cases (30%) were First episode nephrotic syndrome (FENS). 65 cases were steroid sensitive, while 28 and 7 of them were steroid dependent and resistant respectively. Of the 100 study population 54 of them had hypertension while 46 of them did not develop it .Of the 54 hypertensive nephrotic syndrome children, 15 of them (28.%) required three anti hypertensives to control the pressure, while 19 (35%) and 20 (37%) required single and dual anti hypertensives respectively.Conclusion: Prevalence of hypertension is increasing among the children with nephrotic syndrome. Its more prevalent among the male then female FRNS, SRNS and SDNS are more prone to develop hypertension and also they needed two or more antihypertensives to control the hypertension, whereas hypertension in SSNS could be managed with single drug.