Growth and Neurodevelopmental Outcomes of Very Low Birth Weight Infants From Southern India at Corrected Age of One Year

Objective: To assess the growth and neurodevelopmental outcome of very low birth weight (VLBW) infants at corrected age of one year. Methods: This prospective cohort study enrolled VLBW infants delivered in a tertiary care hospital, and followed up till oneyear corrected age. The WHO Anthropo version 3.2.2 software was used to calculate weight for age, length for age, and head circumference z-score during follow up. Neurodevelopmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII) at the age of one year. Results: The mean (SD) z-scores at one-year for weight for age, length for age and head circumference were -2.1 (1.1), -1.4 (1.03) and -2.2 (1.2), respectively. The mean (SD) DASII motor and mental scores were 90.8 (13.4) and 96.5 (13.2), respectively. Major and minor developmental abnormalities were noted in 9.4% and 18.2%, infants, respectively. Cerebral palsy was noted in 5.8% infants. Conclusion: VLBW infants showed impaired growth and significant developmental abnormalities at the corrected age of one year.

Association of hyperglycaemia at-admission & diabetes mellitus with 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection: A retrospective study

Background & objectives: The association between hyperglycaemia at admission, diabetes mellitus (DM) status and mortality in hospitalized SARS-CoV-2 infected patients is not clear. The purpose of this study was to determine the relationship between DM, at-admission hyperglycaemia and 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection requiring intensive care. Methods: All consecutive moderate-to-severe patients with SARS-CoV-2 infection admitted to the intensive care units (ICUs) over six months were enrolled in this single-centre, retrospective study. The predicators for 28 day mortality were analysed from the independent variables including DM status and hyperglycaemia at-admission. Results: Four hundred and fifty two patients with SARS-CoV-2 were admitted to the ICU, with a mean age of 58.5±13.4 yr, 78.5 per cent being male, HbA1c of 7.2 per cent (6.3-8.8) and 63.7 per cent having DM. Overall, 28 day mortality was 48.9 per cent. In univariate analysis, mortality in diabetes patients was comparable with non-diabetes (47.9 vs. 50.6%, P=0.58), while it was significantly higher in hyperglycaemic group (60.4 vs. 35.8%, P<0.001). In multivariate Cox regression analysis, after adjusting for age, sex and comorbidities, hyperglycaemia at-admission was an independent risk factor of mortality [hazard ratio (HR) 1.45, 95% confidence interval (CI) (1.06-1.99), P<0.05]. Interpretation & conclusions: This study showed that the presence of hyperglycaemia at-admission in critically ill SARS-CoV-2 patients was an independent predictor of 28 day mortality. However, the findings may be susceptible to unmeasured confounding, and more research from prospective studies is required.

Perinatal Transmission of Dengue: A Case Report

A single, male neonate was born at 36 weeks of gestation with birth weight of 2.62 Kg, to a 24-year-old primigravida mother by LSCS in an outside hospital. Apgar score at 1 min and 5 mins were 7 and 9 respectively and he was shifted to mother’s side. On day 4 of life, he developed respiratory distress and decreased oral intake and was referred to our neonatal tertiary care unit (NICU).Maternal antenatal history was uneventful. Mother had fever and thrombocytopenia and was diagnosed as dengue infection (Dengue NS 1 antigen and Ig M positive) 3 days before delivery and managed at same hospital.On admission, baby had respiratory rate of 64 / min, mild retractions, SpO2 of 92 % on room air and mild hepatomegaly. Cardiovascular system seemed to be normal but poor activity and sucking was there. He was started on IV fluids, antibiotics and non-invasive respiratory support. Chest X-ray was normal. Haemoglobin was 18.3 gm / dL, total leukocyte count of 4600 / mm3, absolute neutrophil count of 2681, platelet count of 1.5 lac, haematocrit of 50.8 % and C reactive protein of 7.7. Dengue NS1 antigen and IgM came out to be positive. There was no evidence of mosquito bite in neonate postnatally.Infant’s clinical condition deteriorated with increased requirement of respiratory support and SpO2 up to 40 %. Platelet count further fell to 59000 on day 2 and 13000 on day 3 of hospital stay and was managed with multiple platelet transfusions. Baby also had features of third space loss. Repeat chest X-ray suggestive of right pleural effusion and ultrasound abdomen showed mild ascites and mild hepatomegaly. But cranial ultrasound was also done which was normal. No evidence of bleeding during hospital stay. Baby was managed initially with fluids and first line antibiotics as per the unit protocol. Orogastric feeds were started as baby had clinical improvement which were built up gradually and baby switched to spoon feeds after 7 days. Baby was weaned off from respiratory support as requirement decreased. Baby was discharged with improving platelet count and absence of features of third space loss. On discharge baby was hemodynamically stable and accepting oral feed.Dengue is a systemic arthropod borne and transmitted systemic viral infection which is an emerging disease in many states of India. Major mode of transmission of dengue is mosquito bite but vertical transmission is rarely seen.1 There are some reported cases of dengue infection in pregnancy and association with many complications in neonate like low birth weight, perinatal mortality, foetal distress and preterm birth. The samples from foetal or cord blood are considered as a better source of qualifying dengue infection in utero.2 In neonates, vertical transmission of dengue from mother can produce varying symptoms ranging from fever with thrombocytopenia to intracranial haemorrhage.3As India is a resource limited country the survey for dengue cases in neonates is not done in a schematic manner, there are only a few case reports of neonatal dengue infection from India and its vertical transmission. Here we are reporting a case of vertical transmission of dengue in a neonate at our Neonatal ICU.

Supplementation with Three Different Daily Doses of Vitamin D3 in Healthy Pre-pubertal School Girls: A Cluster Randomized Trial

Objective: To compare the adequacy and efficacy of differentdoses of vitamin D3 in pre-pubertal girls.Design: Cluster Randomized controlled trial.Setting: Public school in Delhi, India, between August 2015 andFebruary 2016.Participants: 216 healthy pre-pubertal girls, aged 6.1-11.8 years.Intervention: Daily supplementation with 600 IU (n=74), 1000 IU(n=67) or 2000 IU (n=75) of vitamin D3 under supervision for 6months.Outcome measures: Primary: Rise in serum 25 hydroxy VitaminD (25(OH)D); Secondary: Change in bone formation andresorption markers.Results: Following 6 months of supplementation, the mean (SD)rise in serum 25(OH)D was maximum with 2000 IU (24.09 (8.28)ng/mL), followed by with 1000 IU (17.96 (6.55) ng/mL) and 600 IU(15.48 (7.00) ng/mL). Serum 25(OH)D levels of ?20 ng/mL wereseen in 91% in 600 IU group , 97% in 1000 IU group and 100% in2000 IU group. The overall mean (SD) rise in urinary calciumcreatinine ratio (0.05 (0.28) to 0.13 (0.12) mg/mg), and serumprocollagen type I N-terminal propeptide (538.9 (199.78) to 655.5(218.24) ng/mL), and reduction in serum carboxy-terminaltelopeptide (0.745 (0.23) to 0.382 (0.23) ng/mL) was significant(P<0.01). The change in the above parameters was comparableamong the three groups after adjustment for age.Conclusion: Daily vitamin D supplementation with 600 IU to 2000IU for 6 months results in Vitamin D sufficiency in >90% of pre-pubertal girls

Weiss criteria in large adrenocortical tumors: A validation study.

Background: Several systems including pathologic criteria alone or in combination with clinical features have been proposed to differentiate between benign and malignant adrenocortical tumors and assess their prognosis. The Weiss system appears to be the most commonly used method for assessing malignancy but there are only a few studies which have evaluated its diagnostic power. Since we see large adrenocortical carcinoma (ACC), we attempt to evaluate the diagnostic power of Weiss system in large ACC. Materials and Methods: In this study clinicopathological characteristics of 42 adrenocortical neoplasms are studied and classified into adrenocortical adenoma (ACA) and ACC based on Weiss score of less than or equal to three or greater than three. Results: The histological criteria of Weiss appeared to predict tumor prognosis accurately. Five year survival of patients with Weiss scores of less than or equal to three was 100% compared to 0% of those with Weiss scores greater than three. The average weights of ACA and ACC were 13.0 plus/minus 8.4 grams and 621.1 plus/minus 335.2 grams respectively; average sizes of ACA and ACC were 2.8 plus/minus 1.0 cmsand 13.6 plus/minus 3.7 cms respectively. Conclusion: Weiss score was found to be a good prognostic factor for tumors of the adrenal cortex.

Parathyroid lipoadenoma: case report and review of the literature.

Parathyroid lipoadenoma is a rare variant of parathyroid adenoma showing intermingling of chief/ oxyphil cells with abundant mature adipose cells, the latter comprising 20-90% of the tumour. Approximately thirty-five cases have been reported previously. We report a case of 41-year old woman who presented with clinical manifestations of primary hyperparathyroidism. She had elevated serum calcium and parathyroid hormone levels. Radiological investigations suggested presence of adenoma. Intra-operatively, parathyroid adenoma was found in the neck in an ectopic location behind the carotid sheath and extending into the superior mediastinum. Clinicopathological findings of this rare tumour are discussed.

MRI findings in Kallmann syndrome.

Kallmann syndrome (KS) is a neuronal migration disorder characterised by hypogonadotrophic hypogonadism and anosmia or hyposmia. Five patients with clinical findings suggestive of KS were evaluated with MRI. All patients had abnormalities of olfactory system. Olfactory bulbs were absent in all patients. Olfactory sulci were absent in 3 patients and hypoplastic in 2 patients. Anterior pituitary was hypoplastic in two patients. The MRI findings in KS are characteristic and MRI is a useful adjunct to the diagnosis of KS.

Pancreatitis in patients with primary hyperparathyroidism.

Records of patients undergoing parathyroidectomy at our institute in the period 1991-2003 were retrospectively analyzed. Pancreatitis was associated in six of 87 patients (6.8%) with primary hyperparathyroidism (PHPT). Pancreatitis was the presenting symptom in five patients, while it developed postoperatively in one case. All patients with a past history of pancreatitis had suffered two or more attacks. All patients had a history of renal stone disease. Four patients also had overt bone disease with multiple fractures. Parathyroid adenoma (4) or carcinoma (1) was the cause in all patients. All five patients who underwent successful parathyroidectomy had resolution of pancreatitis on conservative management and no further attacks during a mean follow up of 28 months (3-84 months). Surgical exploration for parathyroid adenoma failed in one patient; this patient has had further attacks of pancreatitis. Repeat surgical exploration for parathyroidectomy has been advised. Hyperparathyroidism is a rare but treatable cause of pancreatitis. Parathyroidectomy has a salutary effect on the course of pancreatitis.