Profile of Children with Kawasaki Disease Associated with Tropical Infections

Objective To describe various infectious triggers for Kawasaki disease (KD) in India. Methods A series of 10 children with diagnosed infections who developed KD during their course of illness has been presented. They were diagnosed by the American Heart Association (AHA) 2017 guidelines. Echocardiography was done to check for coronary artery dilation. Treatment was instituted as per standard protocol. Results Kawasaki disease was diagnosed in 8 boys and 2 girls, aged 1 mo to 11 y. These children were being treated for dengue, chikungunya, SARS-CoV-2, hepatitis A, tuberculosis, brucellosis, disseminated staphylococcal sepsis, scrub typhus, and enteric fever. Conclusions Kawasaki disease has been associated with infectious triggers. It should be considered in febrile patients with mucocutaneous involvement or in nonresponsive sepsis, despite adequate therapy.

Clinical Profile of COVID-19 Illness in Children—Experience from a Tertiary Care Hospital

Objective To detail clinical profle and outcome in children infected with SARS-CoV-2. Methods This retrospective study was undertaken at a tertiary care pediatric teaching hospital in Northern India. The data on clinical characteristics and outcome of children (<18 y) with COVID-19 illness from April 2020–October 2020 were reviewed and analyzed. Results A total of 2919 children with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness were tested for novel COVID-19 virus in the fu emergency (n=1744), severe acute respiratory infection (SARI) ward (n=825), and non-COVID area (n=350) of the hospital. 8.73% (255/2919) children tested positive for SARS-CoV-2 infection. Of the 255 positive cases, 144 (56.47%) were managed on an outpatient basis and 100 (59 boys) required admission in COVID ward. The mortality rate of patients with SARS-CoV-2 was 11.4% (29/255). Majority of children admitted with COVID-19 had severe to critical illness due to the presence of malnutrition and underlying comorbidities. Conclusions Children of all age groups were susceptible to COVID-19 illness with a slight male preponderance. Amongst infected, two-third were asymptomatic or had mild symptoms that required outpatient management and home isolation. The adverse outcomes were more commonly seen in infants and children>10 y of age with malnutrition and comorbid illness.

Diagnosis of Non-Neoplastic Haematological Disorders using Bone Marrow Aspiration and Trephine Biopsy

Introduction: Proper diagnosis of various hematologicaland non-hematological disorders is important in the fieldof haematology. Bone marrow examination is consideredas valuable diagnostic tool for evaluation and diagnosis ofvarious hematological and non-hematological disorders.Therefore present study aimed to diagnose non-neoplastichaematological disease through bone marrow aspiration orbiopsy and also to explain the prognosis of different diseases.Material and method: Present study was conducted indepartment of pathology, GSVM Medical College, Kanpur,on 30 patients suffering from chronic haematological disease.The relevant history of patients was recorded and informedconsent was taken. Patients were investigated for completeblood count, coagulation profile, reticulocyte count andperipheral blood film (PBF) examination. Bone marrowaspiration and Bone marrow biopsy were done under asepticprecautions.Results: Out of 30 cases, 11 (36.66%) are having nonneoplastic haematological diseases and most common diseaseis iron deficiency anaemia. In iron deficiency and megaloblasticanaemia, bone marrow aspiration findings are more useful anddiagnostic. In aplastic anaemia, final conclusive diagnosis wasmade by bone marrow biopsy.Conclusion: In some haematological disease, Bone marrowaspiration study alone fails to demonstrate disease processes,therefore trephine biopsy is essential. Hypocellular marrow,unexplained pancytopenias and marrow fibrosis are alsostrong indications for Bone marrow biopsy.

Access to healthcare among the Empowered Action Group (EAG) states of India: Current status and impeding factors .

Background. Access to healthcare is crucial for meeting the health needs of Indians. We explored factors impeding access to public sources of healthcare among the Empowered Action Group (EAG) states of India. We also examined the extent to which Indians depend on public and private sources of healthcare in the EAG states. Methods. Our study is based on the unit-level records of 9988 ailing persons, who were surveyed among the EAG states in the 71stround of the National Sample Survey (NSS), conducted during January–June 2014 on the theme ‘Social consumption: Health’. To analyse the socioeconomic factors, we did logistic regression using STATA version 12.0. Results. Despite a vast public health infrastructure in the EAG states, around three-fourths of inpatients are dependent on private sources of healthcare in both rural (70%) and urban (78%) areas. Poor quality and long waiting time in accessing healthcare from public health facilities remain big concerns for inpatients of the EAG states. Conclusion. To make public health services more accessible, there is a need to improve the quality of services, enlarge infrastructure to reduce waiting time, and enhance the physical reach to inpatients in the EAG states of India. Public health services will then be able to compete with those in the private sector. Natl Med J India 2016;29:267–73

Epidural ropivacaine combined with fentanyl or in combination with clonidine in infraumblical surgeries: a comparative study.

Background: The addition of an adjuvant, like clonidine and fentanyl, in epidural blockade has enhanced the effectiveness of local anaesthetics as they not only help in intensifying and prolonging the blockade effect but also help in the reduction of the dose of local anaesthetics. Methods: Our study had 45 patients, all patients belonged to ASA grade-I or II, between 20 and 55 years of age requiring neuraxial blockade for lower abdominal surgeries. All the patients were randomly allocated into two groups. Group-I: Epidural ropivacaine 0.75% (14.5ml) + Fentanyl 50 μgm (1 ml) + 0.5 ml distilled water. Group-II: Epidural ropivacaine 0.75% (14.5ml) + Fentanyl 50 μgm (1 ml) + clonidine 50 μgm. Patients were monitored for sensory and motor blockade, hemodynamic parameters, rescue analgesia and adverse effects in perioperative period. Results: Highest level of sensory and motor blockade was found to be insignificant (p>0.05) in both the groups. Mean time for regression of sensory blockade to T10 was significantly longer (p<0.05) in group II as compared to group I. The duration of motor blockade was significantly (p<0.001) higher in patients of Group-II as compared to Group-I. The addition of clonidine to epidural Ropivacaine and fentanyl (Group-II) produces longer duration of analgesia as compared to Group-I. Haemodynamically the patients in both the groups behaved similarly. The patients, in whom epidural fentanyl was used, had slightly higher incidence of nausea, vomiting, dry mouth and pruritus. Conclusions: So this study re-established the fact, that the fentanyl and clonidine when added as adjuvant to epidural ropivacaine, significantly prolongs the analgesic duration without causing significant hemodynamic and respiratory changes.

Additional right renal veins: clinical implication.

Background: Each kidney is drained by single renal vein on each side. Right renal vein is shorter than left renal vein and both veins drain into inferior vena cava. The aim of our study is to find the variation in renal vasculature at the renal hilum. Methods: The present study was conducted on the 30 embalmed cadavers (20 males and 10 females) in the Department of Anatomy of SRMS IMS, Bareilly from 2006 to 2015. Results: The present study revealed the presence of two additional renal veins on the right side along with the normal right renal vein in one cadaver (3.33%). Conclusion: Therefore, it is crucial to understand the variation of renal vein as this is important for the designing of catheter, angiography, renovascular hypertension, treatment of renal trauma and renal artery embolization. Therefore, the variation of renal vein should be kept in mind during transplantation and to prevent bleeding by an accidental trauma when operating in the retroperitoneal region.

Physicochemical and antioxidant properties of kiwifruit as a function of cultivar and fruit harvested month

The present study was carried out to find the effect of fruit harvesting stage (October, November and December) on the physicochemical and antioxidant properties in five kiwi cultivars (Abbot, Bruno, Allison, Hayward, Monty). Results showed that soluble solid content (SSC) and pH increased while ascorbic acid (Vit C), titrated acidity (TAD) and SSC/TAD decreased in all the cultivars with delay in harvesting. Total polyphenols (TP) were decreased while total flavonoids (TF) increased in all tested cultivars with delay in harvesting. The highest concentration of TP (2.02 mg gallic acid equivalent/g fresh weight) and TF (51.12 mg catechin equivalent/100g FW) were found in cultivar 'Allison' in the month of October and December, respectively. Antioxidant activities (AA) were genotype depended and no trend was observed with month of harvesting. Principal component analysis (PCA) showed strong correlation between Vit C, TP and antioxidant activities. Two major clusters were computed using agglomerative hierarchical clustering (AHC). All the studied important traits may be used in the breeding programmes to increase the variability for different physiochemical and antioxidative characteristics and to make suitable selections that could be acceptable to consumers.

Variations in suprascapular notch morphology and its clinical importance.

Background: Suprascapular notch (SSN) is present towards the medial end of superior border of scapula. The morphometric variations of the SSN have been identified. The suprascapular nerve compression is commonly noted at the site of SSN. Methods: The study was carried out in the department of anatomy, SRMS-IMS medical college, Bareilly and SGRRIM-HS Dehradun. The 120 dried scapulae were randomly selected. The age, sex and race of the scapulae were not known. The scapulae were observed carefully for the different shapes of the suprascapular notch. The various dimensions of suprascapular notch were taken by using a digital vernior caliper. Results: In the present study six types of SSN were noted based on the description by Rengachary SS. et al.22 Type I (15.83%); type II (41.66%); type III (25.00%); type iv (12.50%); type v (1.67%) and type VI (3.33%). We also classified the SSN based on the description by M. Polguj et al. 2011,28 the frequencies were: type I (MVD>STD), 20%; type II (MVD=STD=MTD), 3.33%; type III (STD >MVD), 55.83%; type IV (bony foramen), 3.33% and type V (Without a discrete notch), 17.5%. Conclusion: The suprascapular neuropathy may occur at the various anatomical locations of its course and has a variety of causes. Our study is important for clinician because the narrow SSN increase the risk of suprascapular entrapment neuropathy. So the knowledge of these variations should be kept in the mind of clinicians in the diagnosis and treatment of suprascapular neuropathies.

Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1): An experience from a tertiary care center in north India.

Objectives To describe our experience in children hospitalized with the pandemic Influenza A (H1N1) from Northern India. Methods The retrospective case study was conducted at the Pediatric ward and Pediatric Intensive Care Unit (PICU) dedicated to the children (aged 18 years or younger) with influenza-like illness (ILI) with positive laboratory test results for pandemic H1N1 by reverse-transcriptase polymerasechain- reaction assay. Results Between August 2009 and January 2010, a total of 100 children were hospitalized with suspected 2009 H1N1 influenza with Category “C” as described by the Government of India. Twenty five patients were positive for H1N1 and 9 for seasonal influenza A. The most common presentation (H1N1 positive) was with fever (100%), cough (100%), coryza (52%), respiratory distress (88%), vomiting (28%) and diarrhea (16%). One child presented with hypernatremic dehydration and seizures (Serum sodium 174 meq/l). Of the H1N1 positive hospitalized children, 7 (28%) had respiratory failure and required PICU admission, 4 (16%) required mechanical ventilation, and 3 (12%) died. The major radiological findings were bilateral pulmonary infiltrates and consolidation. All patients were treated with oral Oseltamivir suspension or capsule as per appropriate weigh band and supportive care as required. Two deaths were caused by refractory hypoxemia and one by refractory shock. Conclusions The exact incidence of Pandemic 2009 H1N1 influenza on morbidity and mortality is difficult to calculate since only Category “C” patients were screened.

Proton magnetic resonance spectroscopy of brain to study the cerebral metabolic abnormalities in COPD patients: a case control study in north India.

BACKGROUND: To investigate changes in the cerebral metabolism of nondiabetic and normolipidaemic patients with chronic obstructive pulmonary disease (COPD) using localised in vivo proton magnetic resonance spectroscopy (1H MRS), and to correlate these with the severity of disease. METHODS: Twenty-eight symptomatic COPD patients and 19 healthy controls underwent 1H MRS of brain, pulmonary function testing and respiratory muscle strength evaluation. The parieto-temporal and occipital regions were localised for 1H MRS. The metabolic ratios of N-acetyl aspartate to cretinine (NAA/Cr) and choline containing compound to creatinine (Cho/Cr) were calculated by integrating area under the each peak. RESULTS: The mean value of NAA/Cr and Cho/Cr in parieto-temporal area in COPD patients were (1.86 +/- 0.54) and (0.77 +/- 0.23), respectively. The mean values of NAA/Cr and Cho/Cr in occipital area in COPD patients were (1.75 +/- 0.44) and (0.61 +/- 0.25), respectively. Compared with healthy control subjects, the mean values of Cho/Cr in COPD patients were lower, both in parieto-temporal (0.77 +/- 0.23 vs. 0.89 +/- 0.35; p = 0.17) and occipital (0.61 +/- 0.25 +/- vs. 0.67 +/- 0.08; p = 0.36) areas of the brain. CONCLUSIONS: The cerebral metabolism, pulmonary function testing and respiratory muscle strength altered in symptomatic COPD patients. The clinical significance of cerebral metabolic changes in COPD patients needs to be further investigated.

Tubercular splenic abscess in an immunocompetent patient--a rare entity.

Tubercular splenic abscess is an uncommon entity. It has been reported in association with immunodeficiency states. Tubercular splenic abscess in an immunocompetent patient is extremely rare. A 24 year old female who had already received a complete course of anti-tubercular therapy (ATT) for pulmonary tuberculosis was diagnosed as having tubercular splenic abscess. She was successfully managed by performing splenectomy. Operative findings and histopathological examinations confirmed the diagnosis.