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Objectives To compare the epidemiological, clinical profle, intensive care needs and outcome of children hospitalized with SARS-CoV-2 infection during the frst and second waves of the pandemic. Methods This was a retrospective study of all children between 1 mo and 14 y, admitted to a dedicated COVID-19 hospital (DCH) during the frst (1st June to 31st December 2020) and second waves (1st March to 30th June 2021). Results Of 217 children, 104 (48%) and 113 (52%) were admitted during the frst and second waves respectively. One hundred ffty-two (70%) had incidentally detected SARS-CoV-2 infection, while 65 (30%) had symptomatic COVID-19. Comorbidities were noted in 137 (63%) children. Fifty-nine (27%) and 66 (30%) children required high-dependency unit (HDU) and ICU care respectively. Severity of infection and ICU needs were similar during both waves. High-fow oxygen (n=5, 2%), noninvasive ventilation [CPAP (n=34, 16%) and BiPAP (n=8, 5%)] and invasive ventilation (n=45, 21%) were respiratory support therapies needed. NIV use was more during the second wave (26% vs. 13%; p=0.02). The median (IQR) length (days) of DCH stay among survivors was longer during the frst wave [8 (6–10) vs. 5.5 (3–8); p=0.0001]. Conclusions Disease severity, associated comorbidities, PICU and organ support need and mortality were similar in the frst and second waves of the pandemic. Children admitted during the second wave were younger, had higher proportion of NIV use and shorter length of COVID-19 hospital stay.
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This retrospective analysis was done to ascertain the SARS-CoV-2-positivity rate in children (0-12 yr) with severe acute respiratory infection (SARI) and compare it to those without SARI to determine the need for running a dedicated SARI isolation facility for paediatric COVID-19 care. The case records of 8780 children (0-12 yr) admitted and/or tested for SARS-CoV-2 between June 2020 and May 2021 at a tertiary care centre in north India were analyzed. The overall SARS-CoV-2 reverse transcription (RT)-PCR positivity rate was 3.0 per cent (262/8780). There were 1155 (13.15%) children with SARI. Fifty of these 1155 (4.3%) children with SARI, as against 212 of the 7625 (2.8%) children without SARI, tested positive for COVID-19. The absolute difference in the positivity rate among SARI and non-SARI groups was only 1.54 per cent which translates to cohorting and isolating 65 children with SARI to pick up one extra SARS-CoV-2-positive child (compared to those without SARI). The positive predictive value of SARI as a screening test was 4.3 per cent. Our findings suggest that isolation of children with SARI as a transmission-prevention strategy for COVID-19 may not be required. This is particularly relevant in resource-limited settings.
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Background & objectives: The safety of the ChAdOx1 nCoV-19 vaccine is a cause of concern for many who have been vaccinated. The people have multiple concerns and fear regarding the adverse events of the vaccine. Thus, this study was undertaken to establish the safety profile of ChAdOx1 nCoV-19 Corona Virus Vaccine (Recombinant) among the healthcare professionals. Methods: This was a descriptive cross-sectional survey. After taking clearance from the institutional ethics committee 1500 healthcare professionals, who had their vaccination in the past two weeks were selected. They were provided with an online survey proforma regarding adverse events following immunization (AEFIs) of COVID-19 vaccine developed using google forms with an informed consent form affixed to it. Results: A total of 1036 individuals participated in the study. The mean and median (inter quartile range) age of the participants was 37.7 ±11.25 and 35 (29-46) yr, respectively. Of these, 52.1 per cent were female, 29.3 per cent were doctors, 33.4 per cent were nurses and 9.5 per cent were paramedical staff. Forty six per cent participants experienced one or more minor AEFIs such as pain, tenderness, redness, etc. at the injection site. Fatigue (31.75%), generalized feeling of unwell (28.57%), muscle pain (23.16%) and fever (21.71%) were the most commonly reported systemic AEFIs followed by headache (20.07%), dizziness (10.03%) and joint pains (15.25%). Most of them experienced these AEFIs within 24 h of the first dose of administration. About 42 per cent of the participants took oral antipyretics/analgesics for managing the AEFIs. Interpretation & conclusions: ChAdOx1 nCoV-19 Corona Virus Vaccine was found to be associated with mild local and systemic AEFIs that were more common after the first dose as compared to the second dose. There adverse events could be dealt with oral over-the-counter medications, with no requirement of hospitalization
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Justification: Data generated after the first wave has revealed that some children with coronavirus 19 (COVID-19) can become seriously ill. Multi-inflammatory syndrome in children (MIS-C) and long COVID cause significant morbidity in children. Prolonged school closures and quarantine have played havoc with the psychosocial health of children. Many countries in the world have issued emergency use authorisation (EUA) of selected COVID-19 vaccines for use in children. In India, a Subject Expert Committee (SEC) has recommended the use of Covaxin (Bharat Biotech) for children from the ages of 2-18 years. The recommendation has been given to the Drugs Controller General of India (DCGI) for final approval. Objective: To provide an evidence-based document to guide the pediatricians on the recommendation to administer COVID vaccines to children, as and when they are available for use. Process: Formulation of key questions was done by the committee, followed by review of literature on epidemiology and burden of COVID-19 in children, review of the studies on COVID vaccines in children, and the IAP stand on COVID-19 vaccination in children. The available data was discussed in the ACVIP focused WhatsApp group followed by an online meeting on 24 October, 2021, wherein the document was discussed in detail and finalized. Recommendations: The IAP supports the Government of India’s decision to extend the COVID-19 vaccination program to children between 2-18 years of age. Children with high-risk conditions may be immunized on a priority basis. The IAP and its members should be a partner with the Government of India, in the implementation of this program and the surveillance that is necessary following the roll-out.
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Background: India has the maximum burden of both non MDR tuberculosis (TB) and Multidrug-Resistant (MDR) TB, as per data reported in Global TB Report 2018 and tuberculosis is remains one of the most common cause of pleural effusions.Methods: This was a cross-sectional study conducted in Department of Respiratory Diseases and a total of 110 patients with pleural effusion were included in the study, which were enrolled for treatment from July 2018 to June 2019.Results: One hundred and ten patients with pleural effusion were enrolled during the study period. There were 65 males (59%) and 45 (40.9%) females. The overall mean age for males and females were 44.4±18.84 years (35-87 years) and 38.28±17.66 years (35-87 years) respectively. Tuberculous Pleural Effusion group (TPE) seen in 82 patients. Right sided pleural effusion (69.5 %) were more common than left sided (30.4 %). In TPE group the mean pleural fluid ADA level were 86.41±38.08 IU/L (range: 14-195 IU/L). The Malignant Pleural Effusion (MPE) group included 21 patients. In MPE group the mean pleural fluid ADA level were 34.10±32.88 IU/L (range: 8-144 IU/L). The difference in pleural fluid ADA levels between TPE and MPE group was statistically highly significant.Conclusions: Tuberculous pleural effusion was the most common cause of pleural effusion in present study and observed in 74.5% cases.
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Background: Worldwide, Chronic obstructive pulmonary disease (COPD) is the one of the leading cause of chronic morbidity and mortality. COPD is one of the diseases in which smoking is the common and important risk factor when it is associated with Metabolic syndrome (MetS). The individual components of MetS, i.e., obesity, dyslipidemia, fasting hyperglycaemia, and hypertension were independently associated with impairment of lung function too. The objective of this study is to find out the prevalence of metabolic syndrome among COPD patients.Methods: This was a cross-sectional study conducted in department of Respiratory Diseases and a total of 70 COPD patients were included in the study, which were enrolled for treatment from July 2016 to July 2017. The severity level in patients with COPD were determined according to GOLD (Global Initiative for Chronic Obstructive Lung Disease), 2015 guideline. International Diabetes Federation (IDF) guideline; (2005) was used in diagnosis of metabolic syndrome.Results: Seventy patients with COPD were enrolled during the study period. There were 45 males (64.2%) and 25(35.7%) females. Mean age of male patients was 58.67±9.87 years, while mean age of female patients was 57.23±10.4 years (35-87 years). Mean BMI of male was 24.33±6.64 kg/m2, while in case of female it was 30.07±6.95 kg/m2 and overall mean BMI of study population was 26.22±7.22 kg/m2. The mean waist circumference of male was 86.91±13.31 cm while in female it was 87.18±14.51 cm. The Overall prevalence of metabolic syndrome was 31.34% and most common in GOLD stage-3 (47.06%), followed by stage-2 (40%), followed by stage-4 (25.71%) and 7.4 % in GOLD stage -1.Conclusions: The presence of metabolic syndrome is common in patients with COPD and, all COPD patients should be considered for screening for it.
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Background: Quality of life (QOL) is important in patients of epilepsy as it is affected both by disease as well as therapy. QOL is the most overlooked component of antiepileptic treatment.Methods: An observational analytical study was conducted in the Department of Pharmacology in collaboration with Department of Neurology of Himalayan Institute of Medical Science, Dehradun over 12 months. 80 patients satisfying inclusion criteria were enrolled and divided into two groups based on physician discretion and followed up for 12 weeks. Patients were evaluated at 0 and 12 weeks for quality of life using QOLIE-10 self-administered questionnaire, they were also assessed for seizure control and drug related adverse effects.Results: 60 patients were enrolled and divided into two treatment groups as per physician discretion, levetiracetam (30) and valproic acid (30) groups. Study groups showed significant improvement in QOL (mean change in QOL17.95�527 for LEV and 11.56�540 for VPA). Levetiracetam (LEV) group showed significant improvement over valproic acid (VPA) group (p=0.05) at 12 weeks. Patients who achieved total seizure control at 6 weeks were 93.33% patients in levetiracetam and 90% in valproic acid group, reason being non adherence which was 6.67% and 10% respectively. Adverse event recorded with levetiracetam (03), most common being drowsiness and with valproic acid (08), with most common being anorexia.Conclusions: Levetiracetam therapy has led to better quality of life and has the same seizure control as valproic acid, and has shown to have lower incidence of adverse effect.
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Background: Diabetes mellitus is major public health issue facing the world in present century and the prevalence of type 2 diabetes is increasing explosively. There are various diabetes related complications, one of which is low testosterone levels in men. This study was designed to estimate the serum testosterone level in male patients of type 2 diabetes mellitus.Methods: The patients of type -2 diabetes mellitus were picked up from out-patient and in-patients section of the hospital at random.Results: Seventy male patients with type 2 diabetes mellitus were enrolled during the study period. The mean age of study population was 56.36±10.26 years (range 36-70), while that of control group patients was found to be 39.80±7.92years. Family history of diabetes was present in 14 (22.2%) patients. The mean HbA1c in study group was 8.83±1.95 %, which was significantly higher as compared to control group with HbA1c 4.82±0.40 %. Among study group, lower serum total testosterone level was observed in 85.7 % cases and normal level in 14.3 % cases. Among control group, lower serum total testosterone level was observed in 6.7 % cases and normal level in 93.3 % cases.Conclusions: The present study highlighted that significant difference in serum total testosterone level has been observed between cases and control groups (X2 =55.7, P=0.0001).
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Audiovisual (AV) recording of the informed consent process in a clinical or vaccine trial to document the consent process of participants (especially from vulnerable populations), ensures preservation of their rights and well-being. This paper describes the AV consent process during a phase III rotavirus vaccine trial among healthy infants in Chandigarh and examines its effects. Out of 155 parents/guardians of participating infants who were contacted to be a part of the study, 50 were reluctant to participate in the study trial (not necessarily in the AV consenting process). Among 105 parents/guardians of participating infants who expressed initial willingness to participate in the trial, all agreed to undergo the AV consenting process; and 100 finally consented to participate and were enrolled in the study. So, the participation rate was 64.5% (100/155) among those who were contacted, and 95.2% (100/105) among those who underwent the AV consenting process. AV recordings of these 100 patient representatives were transcribed and later translated into English for a thematic analysis of the text. A total of 105 queries were raised by 55 participants. All queries were patiently listened to and addressed, allaying most fears, especially those related to adverse events following intervention. The AV process ensured transparency and accountability of the investigators, responsive referral mechanism in case of adverse events, building an initial rapport with the participant, complete vaccination of the trial subjects, and provision for free private care consultation depending upon the willingness of the parents. These benefits of the AV consent process might have led to a higher participation rate
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Objective: To find out seropositivity rates at 4-6 and 9-12 years of age; among those whoreceived one-dose measles at 9 months and one-dose MMR at 15 months of age. Methods:80 healthy children (53 males) at 4-6 or 9-12 years of age, attending outpatient departmentfor vaccination were enrolled. Antibody titers were estimated using commercially availablequantitative-IgG ELISA kits. Results: The seropositivity rates against measles, mumps,rubella were 80% (40/50), 86% (43/50), and 96% (48/50), respectively at 4-6 years, and83.3% (25/30), 96.7% (29/30) and 96.7% (29/30), respectively at 9-12 years of age.Conclusion: Single dose of rubella vaccine seems to provide adequate long-termprotection; however, measles vaccine requires more doses for similar protection.
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Background: Quality of life plays an important role in patients of epilepsy and is the most neglected part during management. The antiepileptic drugs treatment results in seizure control but adversely affect the quality of life in patients.Methods: An observational analytical study was conducted in the Department of pharmacology with Department of Neurology of Himalayan Institute of Medical Sciences, Dehradun over 12 months. 85 patients fulfilling the inclusion criteria with diagnosis of generalized tonic clonic seizures (GTCS) were enrolled and divided into two groups based on physicians discretion and followed up for 12 weeks. Patients were evaluated for quality of life by QOLIE-10 self administered questionnaire at 0 and 12 weeks, assessed for seizure control and drug related adverse effects.Results: 85 patients were enrolled and divided into two treatment arms as per physician discretion, levetiracetam (41) and valproic acid group (44). Study drugs showed significant improvement in quality of life, levetiracetam showed mean change that was significantly greater than valproic acid (p=0.003) at 12 weeks. Patients who failed to achieve seizure control at 6 weeks were 17% patients in levetiracetam and 20% in valproic acid group, reason being non-adherence which was 17% and 20% respectively. Adverse events recorded with Levetiracetam (10), most common being increased sleep and with valproic acid (18), with most common being increased sleep and weight gain.Conclusions: Levetiracetam treatment resulted in better quality of life, with similar seizure control but decreased number of adverse effect then Valproic acid.
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The purpose of this research was to determine the effect of electronic gadgets on cognitive milestones of children below 2 years of age. While conducting the research methods used were, 100 children of age group 6 months - 2 years were taken and divided in 2 groups - group 1 included 25 children of normal milestones up to 2 years. Group 2 included 75 children who attained normal milestones according to their age and then they were introduced with electronic gadgets (mostly mobile /play games) at different age. For minimum of 4-5 hours a day. Children were followed up at 2 months interval up to 2 years. The result of the study showed, Group 1 children attained normal milestones – physical as well as cognitive up to 2 years of age; While Group 2 children who were introduced electronic gadgets, 63 children attained normal physical milestones as well as cognitive milestones, but 12 of them had developed delayed cognitive milestones with normal physical milestones. Out of these 12 children, 5 of them had more impact of electronic gadgets i.e. they had shown delayed or regression of cognitive milestones. Overall the research concluded that, Electronic gadgets do affect the cognitive milestones of children from 6 months onwards.
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Inorganic mercury poisoning is uncommon, but when it occurs it can result in severe, life threatening features and acute renal failure. A 2-year old well thriving child presented with alleged history of accidental ingestion of inorganic mercury chloride. He presented with evidence of corrosive trauma to the gastrointestinal tract mucosa, but with normal renal function at admission, which was managed with BAL and other supportive treatment. But he developed non-oliguric renal failure after admission, which also improved gradually. On follow-up, two months later, the patient’s renal function was normal; indicating that renal failure caused by acute inorganic mercury poisoning produced no permanent renal damage. We have hereby presented a case of mercury intoxication in a 2-year old child, with an excellent clinical improvement and normalization of laboratory results.
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Galactosemia is one of the rare inborn errors of metabolism, which if detected early can be treated effectively. Galactosemic infants have a significant increased risk of developing sepsis. E. coli sepsis is a known entity, and also an important cause of early mortality in these children. But fungal sepsis in these patients is rarely reported. Here is a case of 45 day-old child who presented with fungal sepsis, which on investigation turned out to be galactosemia.
Subject(s)
Antifungal Agents/therapeutic use , Candida/isolation & purification , Fluconazole/therapeutic use , Fungemia/complications , Fungemia/genetics , Fungemia/microbiology , Fungemia/therapy , Galactosemias/complications , Galactosemias/diagnosis , Galactosemias/genetics , Galactosemias/therapy , Genetic Heterogeneity , Humans , Infant , Male , Mutation , Soy Milk , Treatment OutcomeABSTRACT
Lacquer thinner, commonly used for removing household paints is known to contain mixture of various arometic hydrocarbons; halogenated hydrocarbons and naptha, if ingested may rarely cause methemoglobinemia. We report a 3 year old child who presented to us with history of accidental ingestion of thinner, used for removing household paint. Child was having cyanosis with minimal tachypnoea & the colour of his blood was chocolate brown. Later methemoglibulin level estimations were also done, which were suggestive of this diagnosis. Child was managed conservatively with oxygen therapy & vital monitoring, which lead to complete recovery and discharge from hospital later.
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Child, Preschool , Cyanosis/complications , Diagnosis, Differential , Female , Humans , Lacquer , Methemoglobinemia/chemically induced , Methemoglobinemia/diagnosis , Methemoglobinemia/therapy , Oxygen Inhalation Therapy , Poisoning/etiology , Poisoning/therapy , Solvents/administration & dosage , Solvents/poisoningABSTRACT
Chylothorax is a life-threatening form of pleural effusion with a varied aetiology. In this report, we describe the case of a child who developed bilateral chylothorax following minor trauma which responded well to conservative management.
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Child , Chylothorax/diagnosis , Humans , Male , Thoracic Injuries/complicationsABSTRACT
Allan-Herndon-Dudley Syndrome (AHDS) is a rare X-linked disorder caused by mutation in the gene encoding the monocarboxylate transporter-8. Abnormal transport function is reflected by elevated free T3 and decreased free T4 levels along with clinical features characterized by neurological abnormalities including global developmental delay, central hypotonia, rotatory nystagmus, impaired hearing, spasticity and contractures of joints. We report a child with classical clinical features along with confirmatory deranged thyroid levels in blood.