Epidemiological analysis of central nervous system tumors in pediatric patients from a tertiary care centre in India

Background: Tumors of the nervous system are the second most common childhood cancer after leukemia. The diagnosis of CNS tumors is challenging due to non-specific symptoms in children which mimic other less serious illness.Methods: This was a retrospective analysis of case records of patients from 0-18 years of age, who were diagnosed with CNS tumors for a period of 7 years.Results: Out of total 64 patients included in this study, 32 were females and 24 were males. The mean age was 13.2 years. The most common clinical presentation in patients with brain tumors was headache (92.3%) followed by visual symptoms in the form of blurring or loss of vision (42.3%) and swaying while walking (32.6%). The overall mean symptom interval for all patients was 274.8 days (approx. 9 months) ranging from 7-1820 days. In the present study out of total 64 patients, 54 were brain tumors (35 supratentorial and 19 infratentorial) and 10 were spinal tumors. The most common tumor location was cerebellum (21.8%) followed by cerebral cortex, spine and sellar area. Based on histopathology the most common tumor type in our study was astrocytoma. There was no significant correlation of symptom interval with age and gender but was significantly associated with location and tumor grade.Conclusions: Early referral to centers with appropriate facilities will help, as many pediatric CNS tumors are low grade with better survival.

Cleistanthus collinus poisoning: experience at a medical intensive care unit in a tertiary care hospital in south India.

Background & objectives: Ingestion of Cleistanthus collinus causes hypokalemia and cardiac arrhythmias leading to mortality in most cases. We undertook this retrospective study to evaluate the clinical presentation and predictors of outcome in critically ill patients admitted with C. collinus poisoning. Methods: The case records of 56 patients admitted to the medical intensive care unit (MICU) of a tertiary care teaching hospital in south India (2000-2014) with C. collinus poisoning were retrospectively analysed. Results: The mean age of patients was 36.7±13.3 yr; there were 30 males. Salient clinical manifestations included hypokalemia (58%), neutrophilic leucocytosis (48.2%), acute kidney injury (AKI) (42.9%), acute respiratory failure requiring mechanical ventilation (AcRFMv) (32.1%), shock (21.4%); cardiac arrhythmias and neuromuscular weakness (19.6% each); 21 patients (37.5%) had adverse outcome. Longer time-lapsed from consumption to reaching emergency room [median (interquartile range)] (hours) [49 (22-97) vs. 28 (7-56), P=0.038]; higher acute physiology and chronic health evaluation II (APACHE II) score at presentation [14 (8.25-14.75) vs. 2 (0-6) P<0.001]; and presence of the following [odds ratio (95% confidence intervals)] at initial presentation: shock [37.40 (4.29-325.98), P=0.001]; AcRFMv [26.67 (5.86-121.39), P<0.001]; elevated alanine aminotransferase [5.71 (1.30-25.03), P=0.021]; metabolic acidosis [5.48 (1.68-17.89), P=0.005]; acute kidney injury (AKI) [5 (1.55-16.06), P=0.007]; hyponatremia [4.67 (1.25-17.44), P=0.022]; and neutrophilic leucocytosis [3.80 (1.02-14.21), P=0.047] predicted death. A significant (P<0.001) increasing trend in mortality was observed with increasing International Program on Chemical Safety Poisoning Severity Score (IPCS-CSS) grade. Interpretation & conclusions: C. collinus is a lethal poison associated with high mortality for which there is no specific antidote. Careful search and meticulous monitoring of the predictors of death and initiating appropriate corrective measures can be life saving.

Effect of oral hypoglycaemic agents on bone metabolism in patients with type 2 diabetes mellitus & occurrence of osteoporosis.

Background & objectives: Type 2 diabetes mellitus (T2DM) is considered to be a protective factor against development of osteoporosis. But oral hypoglycaemic agents (OHA) are likely to increase the risk of osteoporosis. This study was carried out to evaluate the effect of various OHA on bone mineral density (BMD) in patients with T2DM. Methods: Forty one patients (study group) with T2DM (mean age 51.9±5.5 yr; 31 females) receiving treatment with oral hypoglycaemic agents (OHA) [thiazolidinediones alone (n=14) or in combination with other OHA (n=27)] for a period of at least three consecutive years and 41 age- and gender-matched healthy controls (mean age 51.4±5.1 yr) were included in the study. A detailed clinical history was taken and all were subjected to physical examination and recording of anthropometric data. BMD was assessed for both patients and controls. Results: The mean body mass index (kg/m2) (26.5±4.90 vs 27.3 ±5.33) and median [inter-quartile range (IQR)] duration of menopause (yr) among women [6(2-12) vs 6(1-13)] were comparable between both groups. The bone mineral density (BMD; g/cm2) at the level of neck of femur (NOF) (0.761±0.112 vs 0.762±0.110), lumbar spine antero-posterior view (LSAP) (0.849±0.127 vs 0.854±0.135); median Z-score NOF {0.100[(-0.850)-(0.550)] vs -0.200[(-0.800)-(0.600)]}, LSAP {-1.200[(-1.700)-(-0.200)] vs -1.300 [(-1.85)-(-0.400)]} were also similar in study and control groups. Presence of normal BMD (9/41 vs 8/41), osteopenia (16/41 vs 18/41) and osteoporosis (16/41 vs 15/41) were comparable between the study and control groups. No significant difference was observed in the BMD, T-scores and Z-scores at NOF and LSAP among T2DM patients treated with thiazolidinediones; those treated with other OHA and controls. Interpretation & conclusions: The present findings show that the use of OHA for a period of three years or more does not significantly affect the BMD in patients with T2DM.

Subclinical atherosclerosis in patients with rheumatoid arthritis by utilizing carotid intima-media thickness as a surrogate marker.

Background & objectives: Patients with rheumatoid arthritis (RA) are more prone for accelerated atherosclerosis and Asian Indians as an ethnic group are predisposed to a high risk of premature atherosclerosis. However, sparse data are available regarding the burden of atherosclerosis among asymptomatic adult patients with RA in south India. We studied the burden of asymptomatic atherosclerosis in adult south Indian patients with RA at Tirupati, Andhra Pradesh, India, utilizing carotid intima-media thickness (CIMT) as a surrogate marker. Methods: Ultrasound examination of the carotids and CIMT measurement (mm) were carried out in 32  patients with RA, 32 age- and gender-matched normal controls, and 32  patients with atherosclerosis and angiographically proven coronary artery disease. The CIMT values in patients with CAD and normal controls were used to derive the appropriate cut-off value of CIMT for defining atherosclerosis that would be applicable for the ethnic population studied. Results: Patients with RA had a higher mean CIMT (mm) compared with normal control subjects (0.598 ± 0.131 vs 0.501 ± 0.081; p = 0.001). Carotid plaque was found more frequently among the cases compared with normal controls [5/32 (15.6%) vs 0/32 (0%), p=0.020]. Using this cut-off value derived by the receiver operator characteristic curve method (≥ 0.57 mm; sensitivity 84.4; specificity 90.6%) and the 75th percentile value among normal controls (≥ 0.55 mm) as surrogate markers, the presence of subclinical atherosclerosis was significantly more among asymptomatic patients with RA compared with normal controls [(59.3 vs 12.5%; p<0.001) and (62.5 vs 25%; Pp<0.001) respectively]. Interpretation & conclusions: Based on the present findings CIMT appears to be a useful surrogate marker for detecting subclinical atherosclerosis in adult Indian patients with RA.

Clinical profile of carcinoma stomach at a tertiary care hospital in south India.

Carcinoma of the stomach is an important cause of mortality due to cancer. Carcinoma of the stomach is common in the southern region of India. We conducted a retrospective study on the epidemiological, clinical and survival patterns among the patients with carcinoma of the stomach, attending our hospital from June 19, 1995 to 1st January 2003. All the patients had histopathological confirmation of malignancy. Patients with gastrooesophageal junction lesions were excluded. Surgery was performed with curative as well as palliative intent in suitable patients. Chemotherapy has been incorporated in to the combined modality treatment in our hospital since July 2000. Postoperative chemotherapy comprised commonly used intravenous chemotherapy regimens, while oral chemotherapy (etoposide) was given to patients with disease not amenable to surgery, and those having poor performance and nutritional status. Oral etoposide was given in a dose of 50 mg/day for 14 days, in a 28 day cycle. Quality of life was assessed in the oral chemotherapy group. Out of the 1749 cancer patients seen during the period, 151 had gastric malignancy (8.6%). The median age was 55 years (range 15-84 years). The male to female ratio was 4:1. Adenocarcinoma was found in 148 patients, 2 had stromal tumours and 1 had non-Hodgkin lymphoma. Stage disribution was as follows; stage 2-1 patient , stage 3a-25, stage3b-49, stage4-3 1, Metastatic-28. Staging was not completed in 17 patients. Eighty-nine patients underwent surgery. Fifty-nine patients (39%) did not have surgery. One patient underwent polypectomy. Curative gastrectomy was performed in 11 patients. Thirty-nine patients underwent palliative tumour resection. Palliative gastro-jejunostomy for relief of symptoms was performed in 26 patients and exploratory laparotomy alone was perforaied in 13. Thirty-eight patients received chemotherapy. Out of these, only 2 patients had prior complete resection of the tumour and 36 received palliative chemotherapy. Intravenous chemotherapy was given to 17 patients and oral chemotherapy to 19; All the patients who received oral etoposide did not experience any toxicity. Patients who received intravenous chemotherapy (n=17) had the following toxicities: grade 3 emesis in 4 (20%), discoloration of the skin and nails in 6(31%), alopecia in 8 (50%), grade 3 diarrhoea in 3 (15%) and neutropenic fever in 4 patients (20%). Median survival for the cohort was 10.4 months. Quality of life parameters, such as sleep, appetite, weight, pain, work and general sense of ill health showed improvement. In conclusion, 8.6% of all cancers at our hospital were due to cancer of stomach, in whom distal gastric tumor were more frequent and most were non-resectable. Median survival was 10.4 months. Oral etoposide was found to be safe, improved the quality of life and may play a role in the palliative management of advanced carcinoma of the stomach.

Impact of mid day meal program on educational and nutritional status of school children in Karnataka.

OBJECTIVE: To assess the effect of the Mid Day Meal (MDM) Program on enrollment, attendance, dropout rate and retention rate in the schools and its impact on nutritional status as well as on school performance. DESIGN: Comparison by multistage random sampling. SUBJECTS: Primary school children, who are attending the school in the MDM and non-MDM areas. RESULTS: A total of 2,694 children (MDM: 1361; Non-MDM : 1333) from 60 schools were covered in the study. Results of the study indicated better enrollment (p<0.05) and attendance (p<0.001), higher retention rate with reduced dropout rate (p<0.001) a marginally higher scholastic performance and marginally higher growth performance of MDM children. CONCLUSION: MDM program is associated with a better educational and nutritional status of school children in Karnataka.

Prediction of birth weights from body weights of newborns.

OBJECTIVE: To evaluate the accuracy of prediction of birth weights from body weights of newborns till six days after birth. DESIGN: Prospective follow-up. SETTING: Four villages near Hyderabad. METHODS: Weights of 47 newborns were recorded daily from the day of birth for seven days. The birth weights were regressed on the weights of the babies taken on the 2nd day to the 7th day. Specificity and sensitivity of the predicted birth weights to arrive at the prevalence of low birth weight (LBW) were computed. RESULTS: The co-efficient of determination (R-square) for between the days measurements decreased from 95% on the second day to 86% on seventh day with an increase in the standard error of the estimate from 84 g to 154 g. Based on the "predicted birth weights", the prevalence of LBW in the community was arrived at and compared with the actual observation. The sensitivity and specificity of these regression equations was high and ranged from 0.95 to 0.85 and 0.96 to 0.93, respectively. CONCLUSIONS: In situations where the birth weight cannot be recorded, weight of the baby taken within the first week after birth may be reliably utilized to assess the "birth weight", particularly in relation to categorization as LBW. This methodology can serve as a tool to monitor various developmental programs aimed at improving birth weights.

Acceptability trials with ready to eat foods in a rural area.

Acceptability trials with three types of recipes was carried out on 184 young preschoolers (6 months to 35 months) residing in four nearby villages around Hyderabad. Results of this study indicated that among the 3 types of supplementary foods (Sweet Ready Mix, Sweet Ready Mix with Amylase and Therapeutic food tested here, the Therapeutic food was more acceptable (taste, smell and bulk) to the children. The criteria for acceptability of the food was defined as the ability of 75% of the children to consume 75% or more of the food supplement at one sitting for 70% of the days of the trial. The Therapeutic food, a calorie dense supplement, met the above criteria. The acceptability was poor for the Sweet Ready Mix and Sweet Ready Mix with Amylase (< 4%) mainly due to quantity rather than taste and smell as revealed by the mothers. The mothers of the children also liked the taste and smell of the therapeutic food better. Consumption of the therapeutic food caused minimal side effects like diarrhea and vomiting when compared to side effects after eating Sweet Ready Mix and Sweet Ready Mix with Amylase in children.

Nutrition, health and psychosocial profile of institutionalized children.

A study was undertaken to assess the health, nutrition and psychosocial profile of Institutionalized children in four States--Uttar Pradesh, Andhra Pradesh, Karnataka and West Bengal. A sample of 3,822 children from 70 institutions in 6-18 years age group formed the subjects of the study. It was observed that the destitute children were mainly taken care of in three types of institutions, viz, Voluntary, Government Aided and Government run institutions. Calorie deficiency and deficiency of Vitamins and minerals characterized the diets of these children. In general, there was no deficit of protein in their diets. Growth wise, these children were retarded both in height and weight compared to standards. However, they fared better in comparison to their age and sex counterparts in the rural and urban poor. Psychosocial profile of these children indicated that the prevailing environment in the institutions is less conducive for intellectual stimulation but not so for the development of skills of self-help, locomotion, socialization and imagery.