Burden of Rotavirus Diarrhea in Under-five Indian Children.

Need and purpose: Rotavirus is the most common cause of severe diarrhea in infants and young children worldwide. The burden of rotavirus diarrhea in Indian children is not well established. The present study reviewed the epidemiology of rotavirus diarrhea in hospitalized children and in the community, molecular serotyping and under-five mortality caused by rotavirus diarrhea. Methods: Publications, reporting rotavirus diarrhea in Indian children, were retrieved through a systematic search of databases including Medline, PubMed, IndMed, websites of WHO, UNICEF, National Family Health Survey, Ministry of Health and Family Welfare, and Government of India. ‘Human’ studies in ‘English’ language were included. Age group selected was 0 month to 5 years. No restrictions were applied in terms of study design and time frame. Conclusions: Stool sample positivity varied from 4.6% in Kolkata to 89.8% in Manipur, among hospitalized children, and from 4% in Delhi to 33.7% in Manipur in community. Most cases of rotavirus diarrhea in India are caused by G1, G2, and G untypeable strains with distinct regional variations. Rotavirus was identified as an etiological agent in 5.2 to 80.5% cases of nosocomial diarrhea. Data are lacking for rotavirus mortality.

Comparison of cerebrospinal fluid Cytochrome-c and Caspase-9 as biomarkers for newborns with hypoxic ischemic encephalopathy with non-asphyxiated babies and followup of these biomarkers after day 7.

Background: There are very less previous study for cytochrome–c and caspase-9, the key players in apoptotic cell death, in human newborns. The objective was to measure the level of cerebrospinal fluid biomarkers cytochrome –c and caspase -9 in newborns with hypoxic ischemic encephalopathy and comparison with clinically suspected sepsis controls and to compare these after 7 days. Methods: We compared 50 hypoxic babies with 20 newborns with clinically suspected sepsis at median age of day-3 and 9 in cases and day-1 in controls. Results: In the present study in sample-1 we observed a significant increase in the levels of cases cytochrome c (1.46 ± 0.71 ng⁄mL) and caspase- 9 (0.29 ± 0.27 ng⁄mL) when compared to controls cytochrome-c (1.02+0.27 ng⁄mL) and caspase -9 (0.13+0.16 ng⁄mL) with significant p-value of 0.001 and 0.009 respectively. In sample -1 Cytochrome-c, P- value was significant when compared stage –III (1.74 ± 0.68) with stage-I (0.82 ± 0.43) and stage –II (0.99 ± 0.18). Similarly in Caspas-9 P-value was significant when compared between stage-III (0.38 ± 0.30) with stage-I (0.11 ± 0.07). In sample -2 P- value was significant when compared stage –III (1.68 ± 0.50) with stage-I (1.01 ± 0.14) and stage –II (0.94 ± 0.38). Similarly in Caspas-9 P-value was significant when compared between stage-III (4.84 ± 2.44) with stage-I (0.13 ± 0.10) and stage –II (0.13 ± 0.11). Conclusions: First time done in human newborns with asphyxia, showing that CSF Cytochrome- c and Caspase 9 increases significantly. In sample-2, the caspase 9 levels showed a further increase, whereas cytochrome c levels decreased from the sample 1 value indicating that neuroprotection time should be increased.

Zinc Supplementation for Neonatal Hyperbilirubinemia: A Randomized Controlled Trial.

Objectives: To determine the efficacy of oral zinc for treatment of idiopathic neonatal hyperbilirubinemia in near-term and term (35- 41 weeks) neonates. Design: Randomized placebo-controlled trial. Setting: Tertiary-care teaching hospital Participants: Eighty newborns with idiopathic neonatal hyperbilirubinemia. Intervention: Neonates were randomized to receive either oral zinc sulfate (10 mg/d) or placebo for 7 days. Main outcome measures: Primary: total serum bilirubin levels at 48 (±12) h, 96 (±12) h and 144 (±12) h after intervention. Secondary: duration of phototherapy, and serum zinc and copper levels. Results: Baseline mean (SD) total serum bilirubin levels were 14.8 (3.8) and 14.4 (3.5) mg/dL in zinc and placebo groups, respectively. No significant differences were observed in total bilirubin levels between the two groups after the intervention. Mean (SD) total serum bilirubin levels in zinc and placebo groups were 13.9 (2.5) vs. 13.4 (1.9) mg/dL (mean difference 0.566; 95% CI -0.535, 1.668, P=0.038) at 48 h, 13.1 (2.7) vs. 12.8 (2.3) mg/dL (mean difference 0.234; 95% CI -1.011, 1.479, P =0.708) at 96 h and 8.0 (2.0) vs. 8.6 (1.2) mg/dL (mean difference -0.569, 95% CI -1.382, 0.242, P=0.166) at 144 h. Although the mean duration of phototherapy in the zinc group was less by 21.3 h (95% CI 11.6, 30.9, P=0.052), the difference was not significant. Postintervention, serum zinc levels were significantly higher in the zinc-supplemented group while serum copper levels were comparable between the two groups. Conclusions: Oral zinc sulfate, in a dose of 10 mg/day, is not effective in the management of idiopathic neonatal hyperbilirubinemia.

Antioxidant levels in cord blood of low birth weight newborns.

We evaluated the antioxidant status of 82 healthy term low birth weight (LBW) newborns and equal number of gestation and sex matched controls weighing <2500 g by measuring vitamin A and E, superoxide dismutase, catalase and glutathione peroxidase in cord serum. Levels of vitamin A and E, superoxide dismutase and catalase were significantly lower and glutathione peroxidase significantly higher in LBW babies compared to controls, with the lowest levels found in babies showing more severe growth restriction (<2000 g). We conclude that LBW newborns are deficient in several important antioxidants which may predispose them to higher oxidative stress.

Outcome of teenage pregnancy.

OBJECTIVE: The objective of the study was to evaluate the obstetric, fetal and neonatal outcomes of teenage pregnancy in a tertiary care teaching hospital. METHODS: A retrospective case control study was performed over a period of 5 years. Data were retrieved from hospital records. All teenage mothers (aged 13-19 completed years at delivery) delivering in the University Hospital were taken as cases. Next 3 consecutive deliveries in the age group of 20-30 year were selected as controls for each case. For statistical analysis the cases were further subdivided into 2 groups, 17 years (Group A) and 18 -19 years (Group B). Groups were compared for obstetric complications and neonatal outcome. Statistical analysis was done by software package SPSS 10. RESULTS: The incidence of teenage deliveries in hospital over last 5 years was 4.1%. Majority of the teenagers were primigravida (83.2% vs. 41.4%, p< 0.01). Complications like pregnancy induced hypertension (PIH) (11.4% vs 2.2%, p< 0.01), pre-eclamptic toxemia (PET) (4.3% vs 0.6%, p< 0.01) eclampsia (4.9% vs 0.6%, p< 0.01) and premature onset of labor (26.1% vs 14.6%, p< 0.01) occurred more commonly in teenagers compared to controls. Teenage mothers also had increased incidence of low birth weight (LBW) (50.4% vs 32.3%, p< 0.01), premature delivery (51.8% vs 17.5%, p< 0.01) and neonatal morbidities like perinatal asphyxia (11.7% vs 1.9%, p< 0.01), jaundice (5.7% vs 1.2%, p< 0.01) and respiratory distress syndrome (1.9% vs 0.3%, p< 0.05). Teenage pregnancy was also associated with higher fetal (1.9% vs 0.3%, p< 0.05) and neonatal mortality (3.8% vs 0.5%, p< 0.05). CONCLUSION: Teenage pregnancy was associated with a significantly higher risk of PIH, PET, eclampsia, premature onset of labor, fetal deaths and premature delivery. Increased neonatal morbidity and mortality were also seen in babies delivered to teenage mothers. Younger teenager group (17 years) was most vulnerable to adverse obstetric and neonatal outcomes.

Newer diagnostic tests for bacterial diseases.

In diagnosing bacterial infections, the rapid identification of bacteremia at an early stage of the disease is critical for a favorable outcome. Furthermore, it is important that exact information be obtained on the stage of the disease rapidly in order to choose and initiate the appropriate therapy. In recent years many new techniques have been added in the diagnostic tools. During the past decade, there has been unprecedented progress in molecular biology as well as in the application of nucleic acid technology to the study of the epidemiology of human infection. Highly sensitive molecular techniques are found to be capable of detecting minute amounts of specific microbial DNA sequences and their complex genetic variations. Moreover, altered levels of biomarkers such as procalcitonin, C-reactive protein, tumor necrosis factor alpha and several interleukins are also found to be promising to define systemic inflammatory response syndrome as indirect evidences of bacterial infections. Lastly, many rapid culture methods are coming up to achieve faster bacterial diagnosis. In this review we will focus on these three newer methods for the early diagnosis of bacterial infections. These approaches will help to expedite the diagnosis of especially early infections and might be a further step towards the improvement of therapeutic methods.