Effect of Mycobacterium w on IL-6 and Oxygen Requirement in COVID-19

The efficacy and safety of heat-killed Mycobacterium w (Mw) in severe COVID-19 were evaluated. Twenty-five hospitalized patients (mean age, 52.9 ± 13.1 years) with severe COVID-19 and having multiple comorbidities were intradermally injected with 0.3 mL of Mw daily for three consecutive days. Changes in leukocyte and platelet counts; C-reactive protein (CRP), interleukin-6 (IL-6), serum creatinine, and liver enzyme levels; and oxygen saturation were compared before and after treatment. An ordinal scale assessed the clinical response. There were significant improvements in the IL-6 level and oxygen saturation following treatment (p < 0.001). There were marked improvements in the platelet count, CRP level, serum aspartate transaminase level, and ordinal scale score. Eighty percent of patients who were on oxygen support were successfully shifted to room air within 5.6 days of treatment and discharged. No systemic adverse events were noted. Thus, Mw treatment could be a promising therapeutic modality in severe COVID-19.

Probiotics for woman’s health focus on urogenital infections and reproductive outcomes

Depletion in vaginal Lactobacilli colonization is associated with poor urogenital health and adverse pregnancy outcomes. Probiotic supplements containing lactobacilli, when administered in adequate amounts, increased vaginal and gut colonization of Lactobacilli, reduced the incidence of bacterial vaginosis and other urogenital infections. Probiotic Lactobacilli reduced preterm births and improved fertility rates in women following in vitro fertilization. Probiotics may also improve implantation rate and live-birth rate in women undergoing IVF. The purpose of this review was to critically analyse the available literature for synthesizing evidence on the use of probiotics and its effect on urogenital and reproductive health in women.

An Unusual Association of Aplasia Cutis Congenita with Twin Pregnancy and Maternal Varicella.

We report an unusual case of aplasia cutis congenita associated with twin pregnancy and history of maternal varicella in first trimester, occurring over the extremity of one of the twins while other twin was perfectly normal.

Prevalence of Asthma in Urban School Children in Jaipur, Rajasthan.

A cross sectional survey of 3321 school going children (5-15 years) using modified ISAAC questionnaire in Jaipur city showed 7.59% children to have asthma (in last 12 months) and 8.4% wheezing in last 12 months. Only 5.3 % children had “physician diagnosed asthma ever” suggesting under diagnoses.

Antenatal and Perinatal Care in an ICDS Area: Progress Made in 19 Years.

ICDS program has made significant improvement in availability and utilization of antenatal and natal care including IFA supplementation, TT administration and delivery by trained personnel. However, postnatal care and promotion and initiation of breastfeeding within 2 hours of birth still remain deficit areas.

Serodiagnosis of celiac disease in children referred for evaluation of anemia: A pediatric hematology unit's experience.

Background: Children presenting with typical clinical features of celiac disease (CD) are diagnosed relatively easily, however, diagnosis remains challenging and is often delayed when they present with 'difficult to treat anemia' without overt gastrointestinal manifestations. Index study was undertaken to report profile of patients referred to pediatric hematology unit with 'difficult anemia' who subsequently were diagnosed with CD. Materials and Methods: The records of 83 patients (1988-2008) with CD were scrutinized retrospectively who had presented with predominant hematological manifestations. Results: CD was confirmed histologically in 31 (37%), while 52 (63%) were diagnosed by serology alone. The mean age at diagnosis was 8.0 ± 2.8 years. The mean duration of symptom-diagnosis interval was 40.9 ± 30.6 months. Eighty-one (98%) children had anemia (Hb < 11 g/dl) and 55 (66%) had received iron supplements without discernible benefit. Thirty-nine (47%) patients received a blood transfusion. Thirty-six (43%) patients did not have diarrhea. Majority of the patients had either a microcytic-hypochromic (48%) or dimorphic (43%) anemia. Twenty-four (33%) had thrombocytosis, while 5 (7%) had thrombocytopenia. Mean duration of follow-up for patients on roll in the clinic for more than six months was 17.7 ± 20.9 months. Conclusion: Pediatricians and hematologists need to be aware of the extra-intestinal manifestations of CD. Prolonged duration of symptoms and a diagnosis at a relatively older age is striking in children presenting with predominantly hematological manifestations. Investigations for CD are recommended in children presenting with iron deficiency anemia refractory to hematinics or who have coexisting growth retardation. Necessity for biopsy in overtly symptomatic cases is discussed.

Breast feeding and insulin levels in low birth weight neonates: A randomized study.

Objective. To evaluate the influence of early infancy feeding practices on fasting insulin levels, as marker of insulin resistance, in low birthweight neonates. Methods. Eighty successive low birth weight (<2.5 kg) neonates <10 days of age born at >38 wk of gestation at this tertiary care centre, were successively invited for participation in the study; parents of 52 (65%) consented to participate. Group 1 children (n=26) were randomized to receive only breast feeding and Group 2 (n=26) received fortified breast feeding with a commercially available human milk fortifier. Routine anthropometry and evaluation of health status was performed. The babies were followed-up every 15 day up to three months. 4-hour fasting glucose and insulin levels were measured at baseline and at 3 month. Statistical analyses were performed using t-test and Mann-Whitney test. Results. In excusively breast-fed Group 1 neonates vs Group 2 the mean birthweight was similar (1.99+0.23 vs 1.87+0.30 kg). There was no difference in body length, head circumference and chest circumference. Mean hemoglobin levels, fasting glucose (63.9+9.8 vs 64.3+8.0 mg/dl) and fasting insulin levels (1.44+1.19 vs 1.73+1.38 μU/ml), were also similar. At three month follow-up in Group 1 children receiving exclusive breast feeding, there was significantly lower weight as compared to Group 2 (3.40+0.3 vs 4.75+0.5 kg, p<0.01). This was associated with significantly lower fasting glucose (79.0+9.4 vs 85.6+8.4 mg/dl) and fasting insulin levels (6.95+4.27 vs 15.73+3.29 μU/ml) (p<0.001).The difference persisted even after adjustment for weight gain in Group 2 (weight adjusted insulin 11.26+3.3 μU/ml; p<0.001). Conclusions. Low birthweight neonates fed fortified breast milk had greater fasting insulin levels compared to those with exclusive breast feeding, at three month of age. The difference persisted after adjustment for excessive gain in fortified milk fed neonates and, suggests adverse glucometabolic programming.

Kangaroo Mother Care (KMC) in LBW infants--a western Rajasthan experience.

OBJECTIVE: This study was taken to study the various beneficial effects of KMC in LBW babies. METHODS: 50 LBW babies (birth weight> 2 kg) two who delivered at Umaid Hospital, RIMCH Jodhpur included in this study and they have given KMC 4-6 hours/day in 3-4 settings. Maternal & Neonatal characteristics and complications prospectively recorded. RESULTS: Of 50 LBW babies enrolled, M:F ratio was 1.5:1 and mean birth weight was 1.487 +/- 0.175 kg. The mean age at which KMC started was 4+/-1.738 days. The mean weight gain was 29 +/- 3.52 g, mean age of discharge 23.6 +/- 3.52 days and mean duration of hospital stay was 15.5 +/- 11.3 days. CONCLUSION: KMC is effective and safe in stable preterm infants and as effective on traditional care with incubators. KMC because of its simplicity may have a place in home care of LBW babies.

Low birth weight and insulin resistance in mid and late childhood.

OBJECTIVE: Low birth weight is associated with adult insulin resistance and diabetes. We conducted this study to correlate low birth weight with insulin resistance in mid and late childhood. METHODS: Children whose birth weight records were available were successively enrolled from middle and low socioeconomic status urban schools in western India. 600 children in age groups 5-16 years were screened for availability of recorded birth weight in six schools. Detailed birth records were available for 158 children born full term. Parents of 134 (84.8%) agreed to participate in the study after informed consent. These children were evaluated for various anthropometric indices and fasting blood was obtained for determination of glucose and insulin levels. Insulin resistance was determined using homeostasis model assessment (HOMA) and HOMA-2 formula. Comparative, univariate and multivariate statistical analyses were performed. RESULTS: The mean age of the children was 10.0 +/- 2.4 years. Maternal diabetes was present in 3 (2.2%). Mean weight at birth was 2.84 +/- 0.61 kg and low birth weight (<2.5 kg) was in 49 children (36.6%). There was no significant statistical difference in current height, weight, body mass index, waist, hip, waist hip ratio, mid upper arm circumference, and systolic and diastolic blood pressure in children born with low or normal birth weight (P >0.10). In low birth weight as compared to normal birthweight children mean fasting blood glucose (80.1 +/- 16.1 vs. 70.1 +/- 14.8 mg/dL; P = 0.042), median (interquartile range) fasting insulin levels (10. 18, 6.08-18.54 vs. 2.12, 0.02-7.45 microU/mL; Mann Whitney U test, p<0.0001), and HOMA-derived insulin resistance (1.88, 1.06-4.52, vs. 0.35, 0.02-1.52, P < 0.0001) were significantly greater. There was a significant negative correlation of birth weight with fasting insulin levels after multifactorial adjustments (partial correlation coefficient r = -0.436, P <0.001). Multivariate conditional logistic regression analysis revealed that birthweight was significant determinant of fasting insulin levels after adjusting for age, gender, body mass index, waist and waist hip ratio (odds ratio 3.82, 95% confidence intervals 1.16-12.63, P = 0.028). CONCLUSIONS: Children born with low birth weight have significantly greater fasting glucose, fasting insulin levels and insulin resistance at mid and late childhood.

Lung hypoplasia with dilated cardiomyopathy: coincidence or association?

Pulmonary hypoplasia or aplasia is part of the spectrum of malformations characterized by incomplete development of lung tissue. In more than 50% of these cases, coexisting cardiac, gastrointestinal, genitourinary, and skeletal malformations are present, as well as the variations in bronchopulmonary vasculature. In literature there is no reported case describing lung hypoplasia with dilated cardiomyopathy without structural heart disease. Here, it is presented a 6-month girl, referred to us for persistent homogenous opacity in left hemithorax detected on chest X-ray. Subsequently, she was found to have dilated cardiomyopathy without structural congenital heart disease and congenital hypoplasia of left lung.

Evidence based review on levosalbutamol.

Salbutamol, the most commonly used bronchodilator, is a chiral drug with R (levosalbutamol) and S-isomers (also known as enantiomer). The commonly used formulation is a racemic mixture that contains equal amounts of both R and S isomers. Levosalbutamol is the therapeutically active isomer and has all the beta 2 agonist activity. Until recently S-salbutamol was considered inert filler in the racemic mixture but animal as well as human studies have shown that S-salbutamol is not inert rather it may have some deleterious effects. Enantioselective metabolism of salbutamol leads to higher and sustained plasma levels of S-salbutamol with repeated dosing. There has been concern that chronic use of racemic salbutamol may lead to loss of effectiveness and clinical deterioration. Formulation of salbutamol containing only R- isomer (levosalbutamol) has been available in international market since last few years. Clinical trials in acute as well as chronic asthma in adults as well as children have shown that it has therapeutic advantage over racemic salbutamol and also is more cost effective. But, large multicenter trials are needed to prove its therapeutic superiority and cost-effectiveness in long term.

Keratomalacia in a neonate secondary to maternal vitamin A deficiency.

A 40-day-old male child was admitted with complaints of not opening eyes from 2-3 days after birth. A diagnosis of X3-B keratomalacia was made. The treatment was done with vitamin-A to which the patient had responded. The mother of the baby had a history of night blindness throughout the pregnancy for which she was also treated. Keratomalacia secondary to vitamin-A deficiency is rare in neonates, although in children it is reported form developing countries.

Insulin levels in low birth weight neonates.

BACKGROUND & OBJECTIVES: Foetal undernutrition may have important role in adult insulin resistance and diabetes but insulin kinetics in very early life has not been well studied. The present study was undertaken to determine insulin levels in low birth weight neonates and compare with the levels in normal weight and high birth weight neonates. METHODS: Ten 7 day old children each of low birth weight (< 2500 g, Group 1), normal birth weight (2500-3500 g, Group 2) and high birth weight (> 3500 g, Group 3) selected successively over a period of one month were studied. All children were normally delivered at full term and were not suffering from any major illness. Detailed anthropometry was performed, a 6 h fasting blood sample was obtained for blood glucose, lipids, insulin and C-peptide estimation; 60 min after an intravenous glucose load a second sample was obtained for glucose and insulin. Insulin resistance was calculated using the homeostasis model assessment (HOMA). RESULTS: Levels of total cholesterol, triglycerides, low density and high density lipoprotein cholesterol and glucose were not significantly different in the three groups. Mean fasting and post-glucose load insulin levels (microU/ml) were 2.78 +/- 2.23 and 3.28 +/- 2.04 in Group 1, 1.67 +/- 1.20 and 2.60 +/- 2.32 in Group 2 and 3.37 +/- 2.08 and 4.40 +/- 3.05 in Group 3 and fasting C-peptide levels (microg/ml) were 0.296 +/- 0.22, 0.208 +/- 0.09 and 0.327 +/- 0.23 respectively. There was no inter-group difference in insulin-glucose ratio, insulin levels adjusted for ponderal index and HOMA indices. A significant inverse quadratic correlation (U-shaped curve) of body weight with insulin (fasting and post-glucose) and C-peptide levels was observed (P < 0.05). INTERPRETATION & CONCLUSION: Both low and high birth weight term neonates have high fasting and post-glucose insulin levels. This U-shaped trend suggests influence of foetal undernutrition (environmental) as well as genetic factors in these children.