Impact of COVID-19 pandemic on vaccinations in children in a primary health centre in Northern India

Background: Pandemics and disease outbreaks necessitate the continuation of routine immunization and vaccination for a specific age group along with safety measures for healthcare professionals. India witnessed the COVID-19 pandemic with a drastic rise in the number of cases across the states and union territories in 2020. Routine childhood immunizations suffered mainly because of an overburdened health system coupled with the fear of COVID-19 infection. The present audit is aimed to study the impact of the interventions made to improve routine immunization in the post-COVID-19 period in children in the age group of 0-16 years suitable for immunization under the National Immunization Scheme. Methods: A cross sectional study was conducted by retrieving records in the PHC for the impact of COVID-19 on routine immunizations for vaccine preventable disease in the 0-16 age group. Data were retrieved and collected in a predesigned proforma. Archives of each of the years 2019, 2020, 2021, and 2022 for the month of April. The effect of the interventions for improving vaccine coverage in the rural population was evaluated. Results: A comparison of pre-covid and covid periods showed a significant drop in routine immunization (p=0.007). Higher immunization rates were observed in post covid compared to the COVID period indicating the positive effect of interventions (p=0.0000014) Conclusions: Vaccination rates improved significantly following interventions in the rural population. Health education on safety precautions for COVID-19 and the importance of routine immunization in the pediatric age group has helped to improve vaccination status.

Isolation and Screening of Bacterial Isolates in UTI Patients in Different age and Gender Groups in Namakkal District, Tamil Nadu.

Approximately 1 in 3 women will require antimicrobial treatment for a urinary tract infection (UTI). Forty to fifty percentage of the woman will have a UTI before the age of twenty four during their life time. UTI’S in male patients are rare but once infected considered to be complicated. Infection of urinary tract is amongst the most common bacterial infections that prompt patient’s to seek medical advice second only to infection of respiratory tract In the present study, the isolation of urinary tract infecting pathogens from patients of different gender and age group revealed that Escherichia coli was the dominant isolate followed by Klebsiella, Enterobacter, Pseudomonas, Proteus, Acinetobacter, and Staphylococcus aureus.

Atypical mucocutaneous involvement with Leishmania donovani.

Mucocutaneous leishmaniasis has rarely been reported from India. The usual causative organisms of this infection are Leishmania braziliensis and L. tropica. Another species, L. donovani, which usually causes visceral leishmaniasis, has recently been reported to cause mucocutaneous disease in a few patients from Sri Lanka. We report two patients who had undiagnosed chronic skin lesions for several years. Skin biopsies revealed Leishmania and the species was characterized as L. donovani in both patients. There was considerable improvement in the skin lesions following treatment with liposomal amphotericin B.

In Search of an Ideal Test for Diagnosis and Prognosis of Kala-azar.

The latex agglutination test (KAtex), direct agglutination test (DAT), and the rK39 immuno-chromatographic strip test (dipstick test) were evaluated for their role in the diagnosis and prognosis of visceral leishmaniasis (kala-azar) in India. Sera and urine samples from 455 subjects—150 confirmed visceral leishmaniasis cases, 160 endemic controls, 100 non-endemic controls, and 45 other febrile diseases—were included in the study. The sensitivity of the KAtex, DAT, and rK39 strip test was 87% [95% confidence interval (CI) 80-96], 93.3% (95% CI 88-100), and 98% (95% CI 93-100) respectively. The specificity of these tests was 98% (95% CI 93-100), 93% (95% CI 87-100), and 89% (95% CI 82-97) for the KAtex, DAT, and rK39 strip test respectively. Fifty cases were followed up and subjected to the KAtex, DAT, and rK39 strip test after 30 days of successful treatment. The DAT and rK39 strip test showed positive results in all the 50 cases whereas the KAtex showed no positive reaction in any case. Based on the results, it is concluded that the sensitivity and specificity of the DAT and rK39 strip test are comparable but the greater convenience of use of the strip test makes it a better tool for the diagnosis of visceral leishmaniasis in the peripheral areas of endemic regions whereas the sensitivity of the KAtex needs to be improved to promote its use as a first-line diagnostic test in the field-setting. It may be used for the prognosis of the disease as antigen becomes undetectable in urine after 30 days of the completion of the treatment. Alternatively, it can be used as an adjunct with rK39 for sero-epidemiological surveys.

Correlation between clinical features and degree of immunosuppression in HIV infected children.

We conducted this study to find out correlation of CD4% with clinical status in 102 HIV infected antiretroviral naive children. Mean age of presentation was 4.8 years. Perinatal transmission was the commonest mode of transmission (94%). Fever (53%), chronic diarrhea (36%), and cough (29%) were the commonest presenting symptoms. Protein energy malnutrition was seen in 56.7% of children. 33.3% children were asymptomatic, whereas 45.1% were in WHO clinical stages III and IV at the time of presentation. The most common opportunistic infection was tuberculosis. CD4% correlated significantly with the deterioration of the WHO clinical stages (P<0.01) and increasing grades of protein energy malnutrition (P< 0.05).

Uso do Índice de Qualidade da Dieta Infantil Revisado para avaliar a dieta alimentar de pré-escolares, seus preditores sociodemográficos e sua associação com peso corporal / Use of the Revised Children's Diet Quality Index to assess preschooler's diet quality, its sociodemographic predictors, and its association with body weight status

OBJETIVO: Determinar o nível de qualidade global da dieta, preditores sociodemográficos de qualidade da dieta e a associação entre qualidade da dieta e peso corporal em uma amostra nacionalmente representativa de pré-escolares. MÉTODOS: Estudo transversal utilizando uma amostra de crianças de 2 a 5 anos com dados sociodemográficos, alimentares e antropométricos (n = 1.521) do National Health and Examination Survey 1999-2002. A qualidade global da dieta foi determinada através do Índice de Qualidade da Dieta Infantil Revisado. Preditores sociodemográficos (idade, sexo, grupo sociodemográfico e étnico, renda domiciliar, freqüência escolar, participação em programa federal de alimentação) de qualidade da dieta foram determinados através de modelos de regressão linear múltipla na amostra total e estratificados por renda domiciliar para aquelas elegíveis no programa Food Stamp (< 1,3 da razão pobreza/renda) ou no Special Supplemental Program for Women, Infants, and Children (razão pobreza/renda < 1,85). A associação entre qualidade da dieta e a prevalência de obesidade infantil foi avaliada através dos testes de qui-quadrado de Pearson. Significância estatística foi estabelecida em p £ 0,05. Toda a análise foi conduzida por meio de rotinas complexas de delineamento da pesquisa. RESULTADOS: Em média, os pré-escolares consumiram níveis sub-ótimos de grãos integrais, frutas, vegetais e laticínios. A qualidade global da dieta diminuiu proporcionalmente ao aumento de idade (coeficiente beta: -2,38, p < 0,001), mas melhorou proporcionalmente ao aumento de renda domiciliar na amostra integral (coeficiente beta: 1,22, p < 0,001), mas não nas sub-populações de baixa renda. Crianças méxico-americanas apresentaram melhor qualidade de dieta do que crianças brancas não-hispânicas (coeficiente de beta: 2,18, p < 0,033), principalmente no grupo de baixa renda (coeficiente de beta: 3,57, p < 0,006). A prevalência de obesidade infantil diminuiu significativamente...

OBJECTIVE: To determine the level of overall diet quality, sociodemographic predictors of diet quality, and the association between diet quality and body weight status in a nationally representative sample of preschoolers. METHODS: Cross-sectional study using a sample of 2-5 years old with sociodemographic, dietary, and anthropometric data (n = 1,521) in the National Health and Examination Survey 1999-2002. Overall diet quality was determined using the Revised Children's Diet Quality Index. Sociodemographic predictors (age, sex, sociodemographic, ethnic group, household income, preschool attendance, federal food program participation) of diet quality were determined using multiple linear regression models in the total sample and stratified by household income for Food Stamp eligible (< 1.3 of the poverty income ratio) or Special Supplemental Program for Women, Infants, and Children eligible (poverty income ratio < 1.85). Association between diet quality and prevalence of childhood obesity was assessed with Pearson chi-square tests. Statistical significance was assumed at p £ 0.05. All analysis was conducted using complex survey design routines. RESULTS: On average, preschooler consumed suboptimal levels of whole grains, fruits, vegetables, and dairy. Overall diet quality decreased with increasing age (beta-coefficient: -2.38, p < 0.001) but improved with increasing family income in the full sample (beta-coefficient: 1.22, p < 0.001) but not in the low-income subpopulations. Mexican American children had significantly better diet quality than non-Hispanic white children (beta-coefficient: 2.18, p < 0.033) especially in the low income group (beta-coefficient: 3.57, p < 0.006). Childhood obesity prevalence decreased significantly with increasing diet quality. CONCLUSIONS: Preschooler's diet quality needs to be improved to support the prevention of childhood obesity early in life.

Malignant myelomatous pleural effusion with good response to combination chemotherapy.

Malignant pleural effusion in myeloma is a rare terminal event with 91 cases reported so far. Majority of the patients survive less than 4 months. We are presenting a short series of four such cases, who had a good clinical response to combination chemotherapy.

Study on clinico-epidemiological profile of HIV patients in eastern India.

In this study, 438 HIV positive patients attending the HIV clinic of Sir Sundar Lal Hospital, IMS, BHU were enrolled. Of these 354 were males (mean CD4 count 179 +/- 9.3 cells/microl) and 84 were females (mean CD4 count 323 +/- 28.26 cells/microl). The mean age of the study subjects at the time of diagnosis was 32.6 years. Heterosexual contact was the commonest mode of transmission in 352 (80.4%) patients followed by blood transfusion in 2.5%.History suggestive of a risk factor for HIV transmission could not be elicited in 62 (14.1%) patients. Among male patients, 71.5% were migrant workers. Fever (70.6%), weight loss (53.3%), chronic diarrhea (43.9%) and cough (40.3%) were the common presenting symptoms. Out of the 438 patients, 66.4% had opportunistic infections at the time of reporting to the hospital. The most common opportunistic infection was tuberculosis (38.8%) followed by oropharyngeal candidiasis (20.3%) and diarrhea (12.7%). CD4 counts of the patients were significantly inversely correlated with the number of symptoms and the number of opportunistic infections (correlation coefficient were -.289 and -.236 respectively).

Visceral leishmaniasis (kala-azar): challenges ahead.

Indian visceral leishmaniasis (VL) is a parasitic disease caused by a haemoflagellete Leishmania donovani and transmitted by the bite of sand fly Phlebotomus argentipes. It affects various age groups. In India about 1,00,000 cases of VL are estimated to occur annually; of these, the State of Bihar accounts for over than 90 per cent of the cases. Diagnosis of VL typically relies on microscopic examination of tissue smears but serology and molecular methods are better alternatives currently. Notwithstanding the growing incidence of resistance, pentavalent antimony complex has been the mainstay for the treatment of VL during the last several decades. The second line drugs such as amphotericin B, lipid formulations of amphotericin B, paromomycin and recently developed miltefosine are the other alternatives. In spite of significant development in various areas of Leishmania research, there is a pressing need for the technological advancement in the understanding of immune response, drug resistance and the pathogenesis of leishmaniasis that could be translated into field applicable and affordable methods for diagnosis, treatment, and control of the disease.

Management of visceral leishmaniasis: Indian perspective.

Diagnosis and treatment of Indian visceral leishmaniasis (VL) is extremely unsatisfactory. For diagnosis, demonstration of parasites in splenic/marrow smears remains the gold standard, though k39 rapid strip test is a useful method in regions where access to parasite demonstration is difficult. pentavalent antimony remains the mainstay for the treatment of all forms of leishmaniasis globally; however, development of large-scale antimony resistance in Bihar has necessitated search for alternative drugs. Amphotericin B is the most effective, though toxic, drug for patients with refractory VL. Lipid formulations of amphotericin B, though safe and effective, are too expensive to be useful for poor patients of this region. These hold advantage as large quantity of the drug can safely be given over a short period of time, thus leading to a decrease in the hospital stay to a few days instead of several weeks. Oral miltefosine, an alkyl phospholipid, has recently been approved and marketed in India for the treatment of VL. Miltefosine cures 94% patients with VL if given in a daily dose of 50-100 mg for 28 days. Most common adverse events are mild vomiting and diarrhea. Paromomycin, an amino glycoside, is undergoing a pivotal phase-III clinical trial, and is likely to be approved and available to patients with VL at an affordable cost. To protect the already scarce inventory of antileishmanial drugs, it is time that combination chemotherapy is introduced for the treatment of VL in India.

Non-Hodgkin's lymphoma with pure red cell aplasia.

Pure red cell aplasia (PRCA) associated with non-Hodgkin's lymphoma, is an extremely rare condition, with few cases reported worldwide. More commonly PRCA is associated with thymoma or viral infections. Steroids and other immunosuppressive drugs are the preferred treatment of PRCA.

Low dose cyclosporine-a therapy in severe aplastic anaemia.

OBJECTIVE: The present study was conducted to evaluate the efficacy of low dose cyclosporine-A in the patients of severe aplastic anaemia, who cannot afford allogenic bone marrow transplantation and immunosuppressive therapy with antithymocyte globulin. METHODS: The diagnosis of severe aplastic anaemia was established by standard criteria. Twelve patients were given cyclosporine-A orally at a dose of 6 mg/kg body weight in divided doses in two daily equal proportions for six months. Eleven patients were put on oral stanozolol in the dosage of 1 mg/kg body weight/day in divided doses. All surviving patients were evaluated at three and six months. RESULTS: At the end of six months, 41.66% of twelve patients responded to cyclosporine-A. One patient had complete response and four patients had partial response. Only one out of 11 patients receiving stanozolol responded. CONCLUSIONS: i) Cyclosporine-A is a viable therapeutic option in the treatment of severe aplastic anaemia, ii) Low dose cyclosporine-A is able to slow down the stormy course of the severe aplastic anaemia, iii) Androgens have very little effect on the survival of patients of severe aplastic anaemia.

A simple and inexpensive "cell dissociation sieve-tissue grinder" apparatus.

A simple and inexpensive cell dissociation sieve-tissue grinder apparatus consisting essentially of stainless steel sieve (the one popularly used for sieving tea leaves) and a glass syringe plunger acting as pestle, is described for making single cell suspension.

Amphotericin B lipid complex in the management of antimony unresponsive Indian visceral leishmaniasis.

Fifty-eight Indian patients with visceral leishmaniasis who did not respond or relapsed after 30 days of consecutive sodium stibogluconate therapy were randomised to treatment with amphotericin B lipid complex (ABLC) using a total dose of 7.5 or 10 mg/kg. Treatment induced a prompt clinical response in all patients with resolution of fever and regression in spleen size. Fever and chills developed during ABLC infusion, but it diminished with successive infusions. Fourteen days after treatment, 26 of 28 (93%) patients in the 7.5 mg/kg group and all 30 (100%) in the 10 mg/kg group had splenic aspirate parasite density scores of 0 and were considered apparent clinical and parasitologic responders. Four and three patients in the 7.5 and 10 mg/kg groups respectively relapsed during six months of followup; thus, overall 22 of 28 (79%) patients treated with 7.5 mg/kg and 27 of 30 (90%) treated with 10 mg/kg were definitive cures. All initial non-responders and relapses were retreated successfully with higher dose of ABLC. These results confirm the efficacy of short-course ABLC therapy for antimony-unresponsive Indian patients with visceral leishmaniasis. Since treatment with a total dose of 7.5 mg/kg did not appear to increase efficacy (79% vs. 84% induced by 5 mg/kg in a prior study), initial treatment with a total dose of 5 mg/kg followed by retreatment of any non-responders represents a potentially less costly approach in patients who fail antimony therapy. Though high cure rates are achieved with > or = 10 mg/kg total dose of ABLC, treatment using lower doses with retreatment of non-responders or relapses with higher dose can result in considerable savings.

Pediatric renal transplantation--Indian experience.

OBJECTIVE: To analyze our experience with renal transplantation in children with end-stage renal disease (ESRD) in India. DESIGN: Retrospective study. METHODS: Over the last 7.5 years, 27 renal transplants were performed on children below 12 years of age, 8 children were less than 6 years old, 19 were between 6 and 12 years of age. Sixteen children had underlying glomerular disease while eleven had tubulointerstitial renal disease. Transperitoneal approach was used in smaller recipients weighing less than 12 kg. Extraperitoneal approach was used in the remainder. Triple immunosuppression with Cyclosporine, Azathioprine and Steroids was used in all cases. RESULTS: Follow-up period ranged from 6 months to 7.5 years (mean 3.7 years). There were 10 episodes of acute rejection. Three cases of acute rejection failed to respond to therapy. No surgical complications were encountered. Graft survival was 73.2% at one year and 71% at two years. Satisfactory rehabilitation was achieved in children with functioning grafts. CONCLUSIONS: Renal transplantation in children in India offers an acceptable choice in ESRD as anywhere in the world.