Serum Periostin Level in Children with Asthma

Objectives To determine the average serum periostin level in children with asthma between 6 and 16 y of age, and to fnd out if the levels correlated with markers of eosinophilic infammation, asthma control, and severity. Methods Children under follow-up at a tertiary care centre were enrolled. Children with conditions causing elevated serum periostin other than asthma, or history of systemic steroid use in the past 6 mo were excluded. Serum total IgE and periostin were estimated by ELISA. Results The median (IQR) serum periostin level was 52.6 (45.4, 58.3) ng/mL. Levels did not vary with age, gender, duration of symptoms, positive family history, or history of exacerbations in the last 6 mo. There was no signifcant correlation with anthropometric parameters or their z scores, or markers of eosinophilic infammation in blood including serum total IgE, eosinophil percentage or absolute eosinophil count. There was no diference in median periostin levels of children with diferent asthma symptom control or asthma severity. Conclusions In a group of 26 Indian children with physician-diagnosed asthma, serum periostin showed no signifcant correlation to markers of eosinophilic infammation.

Demographic profile of patients seeking teleophthalmology consultations through e-Sanjeevani: Retrospective analysis of 5138 patients from North India

Purpose: To report the demographic profile of patients registered through e?Sanjeevani OPD seeking teleophthalmology services. Methods: This was a cross?sectional data analysis of patients with ocular complaints registered through the e?Sanjeevani platform at a tertiary care center. It was a doctor?to?doctor consultation, where teleophthalmology consultants provided teleconsultation services at subcenters (SCs), primary health centers (PHCs), and community health centers (CHCs). Data regarding the patient’s age, gender, residential address, provisional diagnosis, and treatment prescribed were recorded from May 2021 to February 2022 (9 months). Results: In total, 5138 patients were teleconsulted from the mean age of the patients was 37.64 ± 19.34 years. Among these patients, 44% were males and 56% were females. Most of the teleconsultation calls were made from Palwal district (19.8%), followed by Hisar (14.5%) and Sonipat. The most common provisional diagnosis was dry eyes (21%), followed by allergic conjunctivitis (18%), refractive error (15%), and cataract (14%). These constituted approximately 70% of the diagnosis made through teleconsultations. The rest of the eye problems were diagnosed as stye, blepharitis, nasolacrimal duct obstruction, pterygium, subconjunctival hemorrhage, etc., The majority of the patients were managed medically (56.6%) and approximately 11.6% of the patients were referred for surgical intervention. Conclusion: e?Sanjeevani is an effective way to provide teleconsultations to patients in remote locations. The majority of the patients seeking ophthalmology consultations can be managed conservatively. Patients requiring surgical intervention can be referred timely, thus avoiding any delay in treatment

Multisystem Inflammatory Syndrome Associated With COVID-19 in Children (MIS-C): A Systematic Review of Studies From India

Background: With wide clinical spectrum, multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) in children (MIS-C) is a relatively novel condition occurring weeks to months’ post SARS-CoV-2 infection. The aim was to systematically review data on clinical features, laboratory parameters and therapeutics of MIS-C from India. Methods: This systematic review was done as per the PRISMA guidelines, and quality assessment was done using NIH tool for case-series. A systematic search through databases yielded studies whose data was pooled to calculate the mean frequencies with standard deviation using GraphPad software. Results: Screening of 2548 articles published till December, 2021, yielded 11 case-series. World Health Organization case definition was used widely. There was a slight preponderance of males (57%), median (IQR) age was 7 (6,7) years, 63% (n=305) required intensive care unit admissions, and mortality rate was 10% (n=261). Clinical features included fever, mucocutaneous features (72%), and gastrointestinal problems (62%) in majority. Widely used treatment was corticosteroids (76%) and intravenous immunoglobulin (62%) with other options depending on patient’s state. An increased level of inflammatory markers and derangement in other parameters corroborated with disease status. Kawasaki disease like features, not reported in many studies, ranged from 4-76% of patients. Conclusion: MIS-C presents with a wide spectrum clinical features, increased inflammatory markers and managed as per the disease course and presentation. Future studies monitoring the long-term effects of MIS-C are recommended.

Systematic Identification and Critical Appraisal of Pediatric COVID-19 Guidelines Applicable in India

Objective To systematically identify and critically appraise the methodological quality of pediatric guidelines applicable to management of COVID-19 in India. Methods Pediatric COVID-19 guidelines applicable to India, published until 30 April 2021, were identifed through a systematic search across ten databases. Each was critically appraised for methodological quality using the AGREE-II tool, by at least two appraisers. Median (interquartile range) of the total score and domain-wise scores were calculated, and compared for Indian vs. foreign guidelines, updated vs. original versions of guidelines, and those developed earlier vs. later in the pandemic. Results A total of 62 guidelines was identifed. Only 8 (12.9%) were published in India. The overall AGREE-II score ranged from 4.7% to 72.8%; with median (IQR) 37.9% (29.4, 48.6). This suggested overall low(er) methodological quality. The median (IQR) domain-wise scores were as follows: Scope and Purpose 66.7% (58.3, 83.3), Stakeholder Involvement 41.7% (30.6, 83.3), Rigor of Development 23.4% (14.8, 37.5), Clarity of Presentation 59.7% (50.0, 75.0), Applicability 27.1% (18.8, 33.3), and Editorial Independence 8.3% (0.0, 45.8). This suggested diversity in quality of diferent aspects of the guidelines, with very low quality in the critical domain of methodological rigor. There were no statistically signifcant diferences in the overall scores of Indian vs. foreign guidelines, updated versions vs. original versions, and those developed earlier vs. later in the pandemic. Conclusion The currently available pediatric COVID-19 guidelines have low methodological quality, adversely afecting their credibility, validity, and applicability. Urgent corrective strategies are presented for consideration.

Efficacy and Safety of Pidotimod in Persistent Asthma: A Randomized Triple-Blinded Placebo-Controlled Trial

Objective: To study whether addition of pidotimod to inhaled corticosteroid (ICS) therapy enhances control in children with persistent asthma, as compared to ICS therapy alone. Design: Triple-blinded, randomized controlled trial. Setting: Allergy and Asthma Clinic, Department of Pediatrics, at a tertiary care hospital between May, 2018 and June, 2019. Patients: 79 children (5-12 years) with newly diagnosed persistent asthma as per Global Initiative for Asthma guidelines. Interventions: Children received 7 mL twice-a-day for 15 day, followed by 7 mL once-a-day for 45 days of either pidotimod (n=39) or placebo (n=40). In addition, both groups received inhaled budesonide via metered dose inhaler and spacer, throughout the study. Children were followed up every 4 weeks for a total of 12 weeks. At each follow-up visit, peak expiratory flow (PEF) and asthma symptom score and medicine adverse effects were recorded. Main outcome measures: Change in PEF at 12 weeks compared to baseline. Secondary outcomes were PEF at each follow-up visit, asthma symptom score at each visit, change in asthma symptom score at 12 weeks, and adverse event profile. Results: The median (IQR) change in PEF (from baseline to 12 weeks) was 13.0% (0.8%, 28.3%) in pidotimod group (n=35) vs 17.7% (4.3%, 35.2%) in placebo group (n=35) (P=0.69). All the secondary outcomes were also comparable between the two groups. There were no significant adverse effects observed. Conclusions: Addition of pidotimod for 8 weeks to standard ICS therapy did not enhance asthma control compared to placebo.

An Infant with Interstitial Lung Disease

Interstitial lung disease in infants, unlike older children and adults, has diverse etiology, including infective, metabolic, autoimmune,genetic, malignant and idiopathic causes. Clinical recognition of the interstitial pattern of lung involvement is important as the etiology andmanagement is entirely different from that of recurrent or chronic lung parenchymal pathologies. We discuss the clinical and pathologicalfindings of an infant with interstitial pneumonia, who succumbed to hospital-acquired sepsis.

Naso-pharyngeal Carriage of Organisms in Children Aged 3-59 months Diagnosed with Severe Community-acquired Pneumonia.

Objective: To study the naso-pharyngeal carriage of organisms in children diagnosed with severe pneumonia. Methods: Nasopharyngeal aspirate and swabs for microbiological analyses were collected from 377 children aged 3-59 months with severe pneumonia. Results: 28.6% of the samples were positive for S. pneumoniae, 9.6% were positive for H. influenzae, and 8.5% were positive for both the organisms. Respiratory syncytial virus was detected in 27% of samples. The rate of isolation of S. pneumonia and H. influenzae was significantly more in the age group of 12-59 months. Conclusions: In children with severe pneumonia, most common organisms isolated/detected from naso-pharyngeal aspirates were S.pneumoniae and Respiratory Syncytial Virus.

Cutaneous mucormycosis of scalp and eyelids in a child with type I diabetes mellitus.

Scalp mucormycosis in children is extremely rare. We present a case of pediatric scalp mucormycosis caused by Rhizopus oryzae in a 9-year-old diabetic girl who was successfully diagnosed and treated with amphotericin B deoxycholate and wound debridement. At 3 months follow up, the patient was stable although she had lost her vision.

Primary Lung Abscess in Early Infancy.

Background: Lung abscess is rare in early infancy. Case characteristics: We report two infants with lung abscess, who presented with short respiratory illness.Intervention: Infants were managed with broad spectrum antibiotics including Clindamycin. Needle aspiration was attempted in one case. Message: High index of suspicion in infants with respiratory distress of prolonged duration can help in reaching the diagnosis.

Putting the humanities back into medicine: some suggestions.

The practice of medicine is an art as well as a science. As doctors diagnose illness and treat patients day after day, they constantly interweave the social, psychological, ethical and scientific aspects of clinical practice. However, the humanistic values necessary for this approach are generally perceived to be lacking in today’s medical practice.

Current situation of availability and cost effectiveness analysis of selected drugs in Anantapur, AP, India.

World Health Organization (WHO) and Health Action International (HAI) recognized the need for a standard methodology to measure medicine prices in countries so that a clearer picture of what patients actually pay for medicines in low and middle-income countries could be obtained. These two organizations jointly published a manual, which described a methodology for collecting data and measuring medicine prices in various countries. By adopting this methodology, in present study we focused to obtain 1. Baseline data for the availability of medicines in the public and private sectors, 2. Cost Effectiveness Analysis or Affordability of model treatment regimen and 3. Comparison of national Most Sold Generics/MSGs in Anantapur. We did our survey in four phases namely survey planning and preparation, sampling, selection of medicines, MSG equivalents, affordability/ cost effectiveness analysis and availability. The results of the study provided stable baseline interventions to improve the availability of medicines in the public sector and reduce the prices in private sector.

Primary tubercular osteomyelitis of mandible: Rare presentation of a common disease.

Summary: Secondary tuberculosis of mandible is an uncommon complication of primary tuberculosis elsewhere in the body, most frequently, in the lungs. Primary tuberculosis of the mandible is a very rare entity, of which only eight cases have been reported in literature till date. A case of primary tuberculosis of mandible in a 9-year-old girl is presented here.

Butea frondosa as a gastro protective against induced gastric lesions

The study was undertaken to evaluate the potential of alcoholic extract of Butea frondosa Koen. ex Roxb against gastric lesions induced in rats using acetic acid plus pyloric ligation. The impact of alcoholic extract of Butea frondosa in doses of 100, 200 and 400 mg/kg as single dose schedules and 200 mg/kg for 7, 14, 21 and 28 days was determined. Parameters assessed were ulcer index, total acidity, acid volume, total protein and pH, non protein sulfhydryls and gastric wall mucus. Extract in dose of 400 mg/kg as a single schedule signifi cantly reduced ulcer severity, total protein and pH as against the control (p<0.05). Concurrent fi ndings were also observed with 200 mg/kg administered for 21 and 28 days. Treatment with 400 mg/kg of the extract as a single dose and 200 mg/kg for 28 days produced an elevation in the content on non protein sulfhydryls. Gastric wall mucus was enhanced with 200 mg/kg of the extract administered for 28 days with a value of 186±2.74 ìg Alcian blue/g wet weight compared with the control (p<0.05). A palpable decline in incidence of ulcers was observed with the extract which might be largely due to the presence of fl avonoids.