Intussusception in southern Indian children: lack of association with diarrheal disease and oral polio vaccine immunization.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in young children and has been reported as a complication of a recently withdrawn tetravalent reassortant rotavirus vaccine. METHODS: We studied the history, clinical presentation, management and outcome of intussusception presenting to a tertiary care hospital in southern India over a 10-year period, in order to assess potential association with diarrheal disease and immunization. RESULTS: Data from 137 index cases and 280 control subjects indicated that the risk of diarrheal disease or oral polio vaccine administration in the month prior to presentation was similar in the index cases and controls. Mean time to presentation to hospital after developing symptoms was 1.8 days, and 77.3% of patients required surgery, with 47.4% undergoing intestinal resection. Mortality was 0.006%. CONCLUSIONS: No association could be demonstrated between gastroenteritis or oral poliovirus vaccine immunization and intussusception in southern Indian children. These children presented later and required operative intervention more frequently than has been reported in other studies, but had a good outcome with low mortality.

Atelectasis in children.

BACKGROUND: In children with lower respiratory tract symptoms, the elicited signs are not enough to distinguish common diagnosis like pneumonic consolidation, foreign body aspiration and atelectasis. Radiology and bronchoscopy would identify the true nature of the etiology. DESIGN: Prospective study. SUBJECTS: Thirty five children with both acute and chronic lower respiratory tract symptomatology, were analyzed for clinical and radiological signs of atelectasis. RESULTS: There were 23 cases in the acute group and 12 in chronic group. Acute group included cases of pneumonia, foreign body aspiration and mucus plug syndrome. Chronic group included cases of congenital heart disease, endobronchial tuberculosis and bronchial stenosis. Clinical recognition of atelectasis on the basis of localized loss of breath sounds and mediastinal shift was seen only in a minority of cases (8/35). The presence of atelectasis in children with pneumonia, missed clinically were diagnosed by the presence of tracheal shift, elevated hemidiaphragm and silhouette sign. In 21 cases, silhouette sign was positive making it an important radiological sign. Twenty one children underwent either diagnostic or/and therapeutic bronchoscopy. Findings included foreign bodies (n = 5), mucus plugs (n = 4), narrowing of main bronchus (n = 4) and inflammatory mucoid secretions and narrowing of lumen (n = 8). There were no major complications. CONCLUSION: The diagnosis of atelectasis in children may pose difficulties and there is a need to have a high index of suspicion to exclude atelectasis in children with either acute or chronic respiratory tract symptomatology.

Factors influencing seasonal and monthly changes in the group size of chital or axis deer in southern India.

Chital or axis deer (Axis axis) form fluid groups that change in size temporally and in relation to habitat. Predictions of hypotheses relating animal density, rainfall, habitat structure, and breeding seasonality, to changes in chital group size were assessed simultaneously using multiple regression models of monthly data collected over a 2 yr period in Guindy National Park, in southern India. Over 2,700 detections of chital groups were made during four seasons in three habitats (forest, scrubland and grassland). In scrubland and grassland, chital group size was positively related to animal density, which increased with rainfall. This suggests that in these habitats, chital density increases in relation to food availability, and group sizes increase due to higher encounter rate and fusion of groups. The density of chital in forest was inversely related to rainfall, but positively to the number of fruiting tree species and availability of fallen litter, their forage in this habitat. There was little change in mean group size in the forest, although chital density more than doubled during the dry season and summer. Dispersion of food items or the closed nature of the forest may preclude formation of larger groups. At low densities, group sizes in all three habitats were similar. Group sizes increased with chital density in scrubland and grassland, but more rapidly in the latter–leading to a positive relationship between openness and mean group size at higher densities. It is not clear, however, that this relationship is solely because of the influence of habitat structure. The rutting index (monthly percentage of adult males in hard antler) was positively related to mean group size in forest and scrubland, probably reflecting the increase in group size due to solitary males joining with females during the rut. The fission-fusion system of group formation in chital is thus interactively influenced by several factors. Aspects that need further study, such as interannual variability, are highlighted.