Bacterial Profile Of Blood Culture And Their Anti-Microbial Susceptibility Pattern In Pediatric Patients Of A Tertiary Care Hospital

Introduction: Blood stream infection are very common in the pediatric age group and these are one of the common causes of morbidity and mortality in children. In developing countries ,the rate of blood stream infection in children is about 20-50%.The present study was undertaken to determine the etiological agents causing blood stream infection and their antibiotic susceptibility pattern in pediatric patients. Patients with bacteremia may have either a transient bacteremia or persistent bacteremia which can be self-limited without development of focal infection or sequelae or may progress to a more serious fatal infection or toxic effects. The present study in a hospital basedMethodology: single centred, Observational study, of 3 years. Blood sample were collected in BacTec bottle and standard microbiological protocol were applied for the isolation identification of bacteria strains. Antimicrobial susceptibility test was performed by the Kirby Bauer Disc Diffusion Method as per CLSI 2019 guidelines. Out of total 350 bloodResults: samples received for culture,87(23.14%)were culture positive, out of which 42/87(48.27%) were Gram positive organisms and 39/87(44.82%) were Gram-negative organisms and 6 /87(6.89%) were candida spp. The most common organism was Staphylococcus aureus(31.03%) the predominant organism followed by Klebsiella pneumoniae(21.83%) and Streptococcus pneumoniae (9.19%), Escherichia coli, Enterobacter cloacae each (5.74%). All Gram positive bacteria were susceptibile to vancomycin, teicoplanin and linezolid. 11/27(40.74% )of Staphylococcus aureus were Methicillin resistant Staphylococcus aureus (MRSA) strains. All Gram negative bacteria were susceptibility to amikacin, Colistin,Tigecycline. Staphylococcus aureus is the leading cause ofConclusion: childhood septicemia in this locale, has been decline in susceptibility of the pathogens to common antibiotics which ultimately stresses on the need for continuous screening and surveillance for antibiotic resistance in the pediatric ward and calls for increased efforts to ensure more rational use of these drugs.

A Case of Neonatal Severe Hyperparathyroidism: Challenges in Management

Neonatal severe hyperparathyroidism is a rare disorder arising from inherited defects in the calcium sensing receptor (CaSR) that presents early in life with severe hypercalcemia, failure to thrive, and developmental retardation. The authors describe an infant with neonatal severe hyperparathyroidism due to homozygous CaSR gene mutation presenting with recurrent episodes of severe hypercalcemia, growth retardation, and developmental delay. Medical management served as an efective bridge therapy to surgery. Total parathyroidectomy with right hemithyroidectomy was performed at 7 mo of age and resulted in successful cure and normalization of growth and developmental milestones. Timely medical and surgical management can help prevent mortality and morbidity in the form of neurodevelopmental sequelae. Life-long monitoring and treatment is mandatory for the resultant hypoparathyroidism.

A comprehensive yoga programme for weight reduction in children & adolescents with obesity: A randomized controlled trial

Background & objectives: Obesity is a rising pandemic in childhood. There is scarcity of evidence on the efficacy of yoga in achieving weight loss in overweight/obese children. The objective of this study was to assess the efficacy of family-based comprehensive yoga intervention in the reduction of body mass index (BMI) in overweight/obese children, in comparison to standard dietary and lifestyle counselling and control group. Methods: This was an open-label randomized controlled study. Children aged 8-15 yr who were overweight or had obesity were randomized to one of the three arms for 18 wk; standard weight management (group 1), yoga with dietary modification (group 2) and control (no intervention; group 3). Reduction in BMI and improvement in physiological, biochemical and psychological parameters from baseline to 18 wk was compared between the three arms. Late follow up was also done at 6-12 months. Results: A total of 165 children with mean±standard deviation (SD) age of 11.6±1.8 yr and mean BMI 26.3±4.2 kg/m2 were enrolled. Outcome analysis at 18 wk was performed for 109 children. Improved diet quality and reduced intake were observed in both intervention arms. The median (IQR) reduction in BMI in standard and yoga arms was similar [?1.4 (?3.1, ?0.5) kg/m2 and ?1.2 (?2.3, ?0.6) kg/m2, respectively], while it increased by +0.3 (?0.3, 0.1) in the control arm. In the yoga arm, mean systolic BP reduced from 118 (10) to 114 (8) mmHg, (P=0.019). In the standard arm, significant improvement in psychological scores was noted. In group 3, the mean fasting glucose increased from 93±10 to 102±12 mg/dl (P<0.001). Interpretation & conclusions: The findings of the present study suggest that yoga in conjunction with dietary modification is equally effective as the standard weight management for BMI reduction in the paediatric age group.

Molecular Characterization and Management of Congenital Hyperinsulinism: A Tertiary Centre Experience

Background: There is limited data from India regarding medical management of congenital hyperinsulinism (CHI). Objective: To study the molecular diagnosis, medical management and outcomes of children with CHI. Study design: Ambispective. Participants: Children with CHI admitted in from December, 2011 till March, 2020 at a tertiary care referral hospital. Outcomes: Clinical and genetic profile, treatment, and response Results: 42 children with a median age of 3 days (range 1 day to 6 years) were enrolled, of which 23 (54.7%) were diazoxideresponsive. Mutations were identified in 28 out of 41 (68.2%) patients. The commonest gene affected was ABCC8 in 22 patients. The pathogenic variant c.331G>A in ABCC8 gene was identified in 6 unrelated cases from one community. Good response to daily octreotide was seen in 13 of the 19 (68.4%) diazoxide-unresponsive patients. Monthly long-acting octreotide was initiated and daily octreotide could be stopped or tapered in 9 patients. Sirolimus was tried with variable response in 6 patients but was discontinued in 5 due to adverse effects. Four patients had focal CHI, of which one underwent partial pancreatic resection. The disease severity reduced with age and neurodevelopment was good in the patients with identifiable genetic defects who were optimally managed. Conclusions: Medical management of CHI is effective, if compliance can be ensured, with good quality of life and neurological outcomes.

Management of Infants with Congenital Adrenal Hyperplasia

Treatment of congenital adrenal hyperplasia (CAH) requires lifelong replacement of glucocorticoids with regular follow up to manageassociated morbidities. The current review focuses on follow-up and management of infants diagnosed with classical CAH pertinent toIndian context. Early initiation of oral hydrocortisone in divided doses is recommended after diagnosis in newborn period, infancy andchildhood. Fludrocortisone is recommended for all infants with classical CAH. All infants should be monitored as per protocol fordisease and treatment related complications. The role of prenatal steroids to pregnant women with previous history of CAH affectedinfant for prevention of virilization of female fetus is controversial.

Newborn Screening and Diagnosis of Infants with Congenital Adrenal Hyperplasia

Congenital adrenal hyperplasia (CAH) is an autosomal recessive endocrine disorder which can manifest after birth with ambiguousgenitalia and salt-wasting crisis. However, genital ambiguity is not seen in male babies and may be mild in female babies, leading to amissed diagnosis of classical CAH at birth. In this review, we provide a standard operating protocol for routine newborn screening forCAH in Indian settings. A standardization of first tier screening tests with a single consistent set of cut-off values stratified by gestationalage is also suggested. The protocol also recommends a two-tier protocol of initial immunoassay/time resolved fluoroimmunoassayfollowed by liquid chromatography tandem mass spectrometry for confirmation of screen positive babies, wherever feasible. Routinemolecular and genetic testing is not essential for establishing the diagnosis in all screen positive babies, but has significant utility inprenatal diagnosis and genetic counseling for future pregnancy.

Pseudohypoaldosteronism Type 1: Management Issues.

We report a newborn girl with life-threatening hyperkalemia and salt wasting crisis due to severe autosomal recessive multiple target organ dysfunction pseudohypoaldosteronism type 1 (MTOD PHA1). She was aggressively managed with intravenous fluids, potassiumlowering agents, high-dose sodium chloride supplementation and peritoneal dialysis. Genetic analysis revealed a homozygous mutation of the α- ENaC (epithelial Na+ channel) gene. She had a stormy clinical course with refractory hyperkalemia and prolonged hospitalization. Eventually, she succumbed to pneumonia and septicemia at 4 months of age. This is probably the first case of PHA1 confirmed by genetic analysis from India.

Structured Clinical Case Presentation for Assessment of Undergraduates during Initial Clinical Postings.

Structured Clinical Case Presentation (SCCP) was designed as a modification of the long case to more objectively and systematically assess the communication, examination and analytical skills of undergraduate students. Students’ perception of the assessment by the long case or SCCP was noted using questionnaires and feedback collected from the examining faculty regarding the strengths and limitations of the new method.

Fetal euthyroid goiter.

We present a very unusual case of a baby born with antenatally diagnosed large neck swelling causing compression of trachea on imaging, who was euthyroid. There was no history of any thyroid disease in the mother and no history of exposure to known goitrogens. The goiter gradually reduced in size and baby’s thyroid function as well as neurodevelopment remained completely normal during follow-up.

Bilateral breast enlargement in a male toddler: An unusual cause.

We report a case of a two and a half yr old boy who presented with complaint of bilateral asymmetrical breast enlargement since infancy. On examination, he had features of neurofibromatosis type 1 (NF1). Complete endocrinological evaluation was normal. Trucut biopsy of the breast revealed overgrowth of fibrocollagenous and adipose tissue without hyperplasia of breast parenchyma. Thus a diagnosis of NF1 with pseudogynecomastia was made.

Prevalence of extended spectrum beta lactamase and AmpC beta lactamase producers among Escherichia coli isolates in a tertiary care hospital in Jaipur.

Resistance to broad spectrum beta lactams, mediated by extended spectrum beta lactamase (ESbetaL) and AmpC betaL enzymes is an increasing problem worldwide. Presence of these in clinical infections can result in treatment failure if one of the second or third generation cephalosporins is used. Therefore, it is recommended that any ESbetaL-producing organism according to the National Committee for Clinical Laboratory Standards (NCCLS) criteria can be reported as resistant to all extended spectrum beta lactam antibiotics regardless of the susceptibility test results. In this study, a total of 250 Escherichia coli (E. coli) isolates were subjected to Double disc test and AmpC disc test for the detection of ESbetaL- and AmpC betaL-producing strains, respectively. Prevalence of ESbetaL- and AmpC betaL-producing strains among E. coli isolates, over a 3-month-period in the hospital-based population of Jaipur, was 64.80% (162/250). AmpC betaL producers were 24.00% (60/250) and co-existence of ESbetaL and AmpC betaL was detected in 8.00% (20/250) of the isolates.

Multicentric Castleman's disease in two cases.

Castleman's disease is an atypical lymphoproliferative disorder having two types of presentation--the localized and the multicentric form. The localized form presents as a slowly growing mass with a relatively benign course. Multicentric Castleman's disease has a more aggressive clinical course with diffuse lymph node enlargement and systemic illness. It is rarely seen in childhood and only thirteen cases have been reported in literature. This is the first report of 2 cases from the Indian subcontinent with a maximum follow-up of 44 months one of whom had asplenia.

Gastropleural fistula as a complication of empyema thoracis.

Gastropleural fistula is an uncommon entity, especially in children. Here we report a 7-year-old child who developed gastropleural fistula as a complication of empyema thoracis. The child was also diagnosed to have chronic granulomatous disease.