Anti-HBs Titers Following Pentavalent Immunization (DTwP- HBV-Hib) in Term Normal Weight vs Low Birthweight Infants

Objective: To compare anti-HBs titers between term low birthweight (1800-2499 g) infants and normal birthweight infants, 6weeks after last dose of primary immunization with pentavalentvaccine, and to study adverse events following immunization(AEFI) with pentavalent vaccine.Design: Cohort study.Setting: Tertiary-care hospital predominantly catering to urbanpoor population of East Delhi.Participants: 265 low birthweight (1800-2499 g) and 265 normalbirthweight (2500-4000 g) infants. Monovalent Hepatitis B vaccinewas administered within 24 hours of birth followed by three primarydoses of pentavalent vaccine at 6, 10 and 14 weeks. Anti-HBstiters were estimated after 6 weeks of third dose of pentavalentvaccine. Adverse events following immunization (AEFI) monthwere observed for a month after each dose of pentavalent vaccine.Main outcome measures: Anti HBs antibody titers after 6 weeksof primary immunization, and AEFI.Result: 443 (83.5%) infants (225 low birthweight and 218 normalbirthweight infants) completed the follow-up. Seroprotectionagainst hepatitis B virus was achieved in both groups afterpentavalent vaccine administration. Anti HBs GMTs in lowbirthweight infants (194.8 mIU/mL) and normal birthweight infants(204.2 mIU/mL) were comparable (P = 0.17). No serious adverseevents were observed in either group.Conclusion: Three primary doses of pentavalent vaccineadministered along with zero dose of Hepatitis B vaccine at birthprovide good seroprotection. The vaccine appears to be safe inboth low birth weight and normal birthweight infants born at term.

Vitamin D Supplementation for Treatment and Prevention of Pneumonia in Under-five Children: A Randomized Double-blind Placebo Controlled Trial.

Objective: To evaluate the efficacy of single oral mega-dose of Vitamin D3 for treatment and prevention of pneumonia in under-five children. Design: Randomized, double blind, placebo-controlled trial. Setting: Tertiary-care hospital. Participants: 324 children (of 980 assessed) between 6 mo-5 y age (median (IQR): 12 (7,19.8) mo) with WHO-defined severe pneumonia. Of these, 126 (39%) were vitamin D deficient (serum 25(OH)D <12 ng/mL). Intervention: 100,000 IU of oral cholecalciferol (n= 162) or placebo (n= 162) in single dose, administered at enrolment. Outcome variables: Primary: Time to resolution of severe pneumonia and proportion of children having recurrence of pneumonia in next 6 months; Secondary: Change in serum levels of 25(OH)D; immunoglobulins IgA, IgG, IgM, and cathelicidin 2 weeks following supplementation; and time taken for overall resolution of illness. Results: Median (95% CI) time for resolution of severe pneumonia was 30 (29, 31) h in the vitamin D group as compared to 31 (29,33) h in the placebo group [adjusted hazard ratio (95% CI): 1·39 (1·11, 1·76); P=0·005]. The risk of recurrence of pneumonia in next 6 months was comparable in the two groups [placebo: 36/158 (22·8%); vitamin D: 39/156 (25%); RR (95% CI): 1·13 (0·67,1·90); P=0·69]. Proportion of vitamin D deficient children declined from 38% to 4% in the supplementation group, and from 41% to 33% in the placebo group, two weeks after supplementation. There was no significant effect of vitamin D supplementation on serum levels of cathelicidin, IgA and IgG. The time taken for complete recovery from pneumonia, duration of hospitalization, and fever clearance time were comparable for the two groups. No adverse event was noted related to the intervention. Conclusion: There is no robust evidence of a definite biological benefit, either for therapy or prevention, to suggest a routine megadose supplement of vitamin D3 for under-five children with severe pneumonia.

Application of a stool antigen test to evaluate the burden of Helicobacter pylori infection in dyspepsia patients.

Helicobacter pylori (HP) is causally associated with peptic ulcer disease and gastric carcinoma. Determination of the prevalence of HP infection in dyspepsia patients’ in particular geographical area is imperative for the appropriate management of dyspepsia. HP antigen detection in stool is a noninvasive diagnostic test of HP infection. This prospective study was conducted to find out the prevalence of HP infection based on stool antigen testing in dyspeptic patients who had also undergone upper gastrointestinal (GI) endoscopy. This study highlights the high prevalence of HP infection in dyspeptic Indian patients, particularly males, and emphasizes the growing importance of the bacterium causing infection among children. We also found HP stool antigen testing to be superior to upper GI endoscopy for detecting HP infection. Hence, we recommend initial testing for HP stool antigen in dyspeptic patients before initiating treatment and before carrying out any invasive procedure such as endoscopy.

Species distribution and antifungal susceptibility profile of Candida isolated from urine samples.

Background: Candiduria is a common finding in hospitalized patients. The isolation of Candida from urine is challenging for both clinician and microbiologist as to whether the candiduria represents colonization or, lower or upper urinary tract infection including ascending pyelonephritis and renal candidiasis with sepsis. Although Candida albicans is the major cause of candiduria, non-albicans Candida (NAC) has emerged as an important opportunist pathogen. The NAC spp. are not only well adapted to the urinary tract but also are difficult to eradicate than C. albicans. Aims & Objective: The present study aimed to determine the clinico-mycological profile of candiduria in a tertiary care hospital. Material and Methods: A total of 218 Candida spp. isolated from urine samples were included in the study. Speciation of Candida was done by conventional methods and colony colour on HICHROM Candida agar. Antifungal susceptibility testing of the isolates was performed by disc diffusion method on glucose methylene Mueller- Hinton agar (GM-MH). Results: In both the sexes maximum patients belong to age group >50 years. Urinary catheterization, use of broad spectrum antibiotics and diabetes mellitus were the major risks. Isolation of NAC spp. was more. Maximum resistance was seen to fluconazole. Conclusion: The shift towards the NAC spp. as the causative agent of candiduria has generated the concern. Since several NAC spp. are inherently resistant to common antifungal agents, the rapid identification of Candida isolates upto species level along with its in-vitro antifungal susceptibility pattern is important for treatment and management of candiduria.

Role of newer methods of diagnosing genital tuberculosis in infertile women.

Genital tuberculosis is an important under-diagnosed factor of infertility. A vast majority of cases are asymptomatic and diagnosing them will help in treating such patients. We conducted a retrospective study in a tertiary care hospital of Delhi with an aim to compare different methods i.e., histopathological examination (HPE), acid-fast bacilli (AFB) smears, Lowenstein-Jensen (LJ) culture, BACTEC culture and polymerase chain reaction deoxyribonucleic acid (PCR-DNA) for diagnosing endometrial tuberculosis in infertile women. The data from 546 samples of endometrial biopsy histopathology, AFB smears and LJ culture was collected and then analyzed. Of these, HPE for tuberculosis was positive in 13, LJ culture in 10, AFB smear was positive in one case. BACTEC and PCR-DNA were feasible for 90 patients and PCR-DNA was positive in 20 and BACTEC in eight patients. Out of 20 patients with PCR positive results, 15 were only PCR positive and were subjected to hyster-laparoscopy and fi ve had evidence of tuberculosis. Thus, none of the available tests can pick up all cases of genital tuberculosis, but conventional methods i.e., histopathology and LJ culture still has an important role in the diagnosis of endometrial tuberculosis in government setups where BACTEC and PCR are not performed routinely due to lack of resources.

Effect of Helicobacter pylori eradication therapy in iron deficiency anaemia of pregnancy – A pilot study.

Background & objectives: Despite routine iron supplementation and promotion of diet modification, iron deficiency anaemia (IDA) remains widely prevalent in our antenatal population. Recent studies in pediatric population have highlighted the role of Helicobacter pylori infection in IDA. This study was undertaken to study the effect of eradication therapy in H. pylori infected pregnant women with IDA. Methods: Randomized placebo-controlled double blind clinical trial was done on 40 antenatal women between 14-30 wk gestation, with mild to moderate IDA and having H. pylori infection, as detected by stool antigen test. These women were randomly divided into group I (n=20): H. pylori treatment group (amoxicillin, clarithromycin, omeprazole for 2 wk) and group II (n=20): placebo group. Both groups received therapeutic doses of iron and folic acid. Outcome measures were improvement in haematological parameters and serum iron profile after 6 wk of oral iron therapy. Results: The prevalence of iron deficiency in pregnant women with mild to moderate anaemia was 39.8 per cent (95% CI 35.7, 44.3); and 62.5 per cent (95% CI 52, 73) of these pregnant women with IDA were infected with H. pylori. After 6 wk of therapeutic oral iron and folic acid supplementation, the rise in haemoglobin, packed cell volume, serum iron and percentage transferrin saturation was significantly (P<0.05) higher in the group given H. pylori eradication therapy as compared to the placebo group. Interpretation & conclusions: Our results showed a high occurrence of H. pylori infection in pregnant women with IDA. Eradication therapy resulted in significantly better response to oral iron supplementation among H. pylori infected pregnant women with IDA.

Pattern of Candida isolates in hospitalized children.

Nosocomial candidemia is the 4(th) most common pathogen in blood stream infection. Emergence of non-albicans Candida species with often intrinsically resistance fluconazole pattern may lead to difficulty in management of septicemia. Although the present study isolated 80% of non albicans candida species with C.tropicalis as the most common (35%) species, 96% of our Candida species isolated were sensitive to fluconazole. The probable causes of low resistance pattern to fluconazole in our institute are discussed. It is however necessary to identify the complete clinical response to the given treatment. Therefore, appropriate identification of species with susceptibility testing would be advisable before start of anti-fungals. This would prevent emergence of fluconazole resistance.

Trend of antibiotic resistance of Vibrio cholerae strains from East Delhi.

BACKGROUND & OBJECTIVE: Epidemics of cholera caused by toxigenic Vibrio cholerae O1 and O139 (Bengal strain) represent a major public health problem in most developing countries. In view of the reported shift in epidemiology and pattern of antibiotic resistance in this was study carried out to assess the development of resistance to essential drugs like fluoroquinolones during treatment of cholera and cholera like cases in Delhi. METHODS: Faecal specimens collected from 1184 patients with cholera and cholera like illness between 2001-2006 admitted to Guru Teg Bahadur hospital, East Delhi were subjected to culture isolation. Antimicrobial susceptibility testing of V. cholerae isolates was done by disc diffusion method. RESULTS: Of the 1184 faecal samples examined, 670 (56.6%) were positive for V. cholera from 2001- 2006. V. cholerae El Tor Ogawa (54.6%) was more common than serotype Inaba (32.5%). During 2004-2006 V. cholerae Inaba emerged as the predominant serotype. Resistance to nalidixic acid, furazolidone and co-trimoxazole was constantly high (100%). Multiple antibiotic resistance (MAR) V. cholerae O1 Inaba isolates exhibited increased resistance to ciprofloxacin with MIC >4 microg/ml, but largely all remained susceptible to other antibiotics like, gentamicin, tetracycline and chloramphenicol. INTERPRETATION & CONCLUSION: V. cholerae have a permanent existence in the environment and during the quiescent period, their survival in water bodies allows dissipation of resistance patterns to different serotypes or strains of V. cholerae O1 and therefore there is need for constant observation.

A pilot study on the effects of curd (dahi) & leaf protein concentrate in children with protein energy malnutrition (PEM).

BACKGROUND & OBJECTIVE: In protein-energy malnutrition (PEM) there is a significant impairment of immunity, both cell-mediated and humoral, which may be reversed with nutritional rehabilitation. With the use of probiotics like curd (dahi) and micronutrient-rich leaf protein concentrate (LPC), this immune recovery may be hastened. This study was conducted to assess the impact of supplementation of curd and LPC on nutritional status, and immunity as assessed by anthropometry, haemoglobin, ferritin levels, T- cell subpopulation and C-reactive protein (CRP), in children suffering from PEM. METHODS: Eighty moderate to severely malnourished children (1-5 yr) were randomized to receive either curd or LPC in addition to WHO recommended two-step diet over 15 days. Nutritional, immunological and haematological parameters were measured before and after supplementation and compared within the groups. RESULTS: The change in weight, haemoglobin level and CD4:CD8 T-cell subpopulation was significant in both the groups after supplementation. Response of CRP was blunted in PEM. Serum ferritin decreased significantly after supplementation in both groups. INTERPRETATION & CONCLUSION: Curd and LPC when added to diet of malnourished children, may have therapeutic value by accelerating immune recovery. More studies need to be done on a larger sample to confirm these findings.

Bacterial vaginosis and vaginal anaerobes in preterm labour.

Maternal genital infections, particularly bacterial vaginosis has been implicated as a cause for preterm labour and adverse pregnancy outcomes. This prospective study aimed to study the association of bacterial vaginosis with preterm labour. The prevalence of bacterial vaginosis was studied in 60 women in preterm labour who had no recognisable cause for prematurity and in 60 term labour controls. Demographic factors, pregnancy outcome and reproductive history were also studied. Vaginal specimens for Gram-stain and culture were collected from posterior vaginal fomix and bacterial vaginosis was defined by evaluation of Gram-stained smear by Spiegel criteria. Bacterial vaginosis was diagnosed in 31.6% of women in preterm labour and in 15% of term labour controls ( p<0.05). In preterm labour group, preterm delivery occurred in 48 women (80%) out of which 18 women had bacterial vaginosis and term delivery occurred in only one woman with the condition. Anaerobes were significantly associated with bacterial vaginosis ( p<0.01) and were more common in women with preterm labour ( b>0.05). The results indicates that bacterial vaginosis has a significant association with preterm labour and adverse pregnancy outcome.

Prevalence of Helicobactor pylori in patients with perforated duodenal ulcer.

It is believed that Helicobacter pylori (H. Pylori) plays an important role in the causation of peptic ulcer. However, its role in duodenal ulcer perforation (DUP) has not been investigated extensively and the results are conflicting. The aim of this study was to determine the prevalence of H. pylori in patients with DUP patients as compared to normal healthy volunteers (NHV). Eighty-six consecutives patients with DUP and 30 NHV were included in the study. The NHV, drawn from the Surgery outpatient, were subjected to upper gastrointestinal (UGI) endoscopy and multiple gastric mucosal biopsies. Gastric mucosal biopsies among patients with DUP were obtained during laparotomy by passing a biopsy forcep through the perforation site. Biopsy specimens were put in urea broth for the rapid urease test (RUT), brucella broth (used as a transport medium) for culture and 10% formalin for histopathology. The results were analysed as the percentage of positive cases. The mean (+/-SD) age of patients with DUP (39.4+/-15.5 years) and of the NHV (36.0+/-13.9 years) were comparable (p= 0.290). Sixty-one (70.9%)patients with DUP had used NSAIDs prior to perforation. Only 7 patients with DUP (8.14%) had a past history of symptoms of duodenal ulcer and had been treated for it. A positive history of smoking, alcoholism and tobacco use was present in 68 (78.9%), 59 (68.6%) and 41(47.7%) patient with DUP, respectively. No culture was positive. Histology was positive for H. pylori in 29 patients with DUP and in 2 (6.7%)NHV. RUT was positive for H. pylori in 43(50%) patients with DUP and 5 NHV (16.7%). The present study documented a markedly higher association of H. Pylori infection with perforated duodenal ulcer.

Iron status of children aged 9-36 months in an urban slum Integrated Child Development Services project in Delhi.

OBJECTIVE: To assess the magnitude/severity and possible etiology of anemia and iron deficiency among children 9-36 months of age. METHODS: A population-based study on the prevalence, etiology of anemia and iron status in 545 children, 9-36 months of age, was conducted in an urban slum ICDS (Integrated Child Development Services) project in North-East Delhi. Hemoglobin and serum ferritin was estimated and information on socio-economic, demographic, parasitic infection/infestation and dietary intake was collected. RESULTS: Prevalence of anemia (using WHO cut-off values of Hb >11.0 g/dl) among children, 9-36 months of age, was 64%, of these 7.8% had severe anemia (Hb >7.0 g/dl). Using 10.0 g/dl as the Hb cut-off point 44% children less than 18 months of age in the present study population were anemic. On a sub-sample study, 88% children were estimated to be iron deficient, with serum ferritin concentration less than 12 microg/L. The peripheral smear red cell morphology showed 33.9% as microcytic-hypochromic and 37.1% as dimorphic. Dimorphic anemia was 55% in moderate anemia group. The energy and iron intakes were 56% and 45%, respectively of the Recommended Dietary Allowances (RDA). The parasitic infestation/infection was not related to the prevalence or severity of anemia. CONCLUSION: In Delhi, high prevalence of moderate to severe anemia and iron deficiency with vitamins folate and/or B12 among children under 3 years of age in an ICDS block in operation for 20 years is of concern. Dietary origin was the main cause of anemia in this age group.