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Objectives: To study the Hepatitis A virus (HAV) infection-related pediatric liver diseaseburden. Methods: Hospitalrecords of 431 children (age <18 y) diagnosed to be sufferingfrom acute HAV infection during 2011 to 2018 were extracted and analyzed. Additionally, aseroprevalence study was done on 2599 participants (696 children and 1903 adults).Results: HAV infection accounted for about half (48.6% of acute hepatitis and 46.5% (92/198) of acute liver failure cases) of all acute onset icteric illness, with significant morbidity andmortality. As per seroprevalence data, 16.2% of children between 10-18 years of age, and10.3% of adults aged 18-30 years remained susceptible to HAV infection. Conclusion: HAVinfection is the major contributor the overall pediatric liver disease burden. A significantproportion of subjects remain susceptible to HAV infection even after 10 years of age.Population-based studies are required to further delineate the epidemiology of HAV infectionin India for deciding introduction of HAV vaccine in the national immunization schedule.
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Objectives: To find association of pediatric NAFLD with metabolicrisk factors, and Patatin-like phospholipase domain-containingprotein 3 (PNPLA3) gene polymorphism.Design: Cross-sectional studySetting: Pediatric Hepatology unit of a tertiary care hospitalParticipants: Overweight/obese children (<18 years) with (69patients) or without (30 patients) NAFLD (ultrasonographybased), and their parents.Intervention: Metabolic screening, PNPLA3 gene polymorphism,and transient elastographyOutcome measure: Association of pediatric NAFLD with parentalmetabolic risk factors and PNPLA3 gene polymorphism.Results: In the NAFLD group, there was high parental incidenceof metabolic diseases, fatty liver (80%) and low high-densitylipoproteins levels (84%). Family history of NAFLD (in any parent),higher alanine aminotransferase levels and higher totalcholesterol levels in the child independently predicted possibilityof NAFLD, but similar results could not be replicated for PNPLA3gene polymorphism. Controlled attenuation parametermeasurement (by transient elastography) had high sensitivity andspecificity to diagnose steatosis.Conclusion: There is high familial incidence of metabolicdiseases in children with NAFLD. Controlled attenuationparameter can be useful as a non-invasive modality to screen fattyliver in children.
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Analysis of pediatric tetanus cases was carried out to study the predictors of mortality and role of tetanus immunoglobulin (TIG). Shorter incubation period, onset time and autonomic dysfunction were significantly associated with mortality and may be used to stratify patients requiring intensive care. TIG may not have independent role in decreasing mortality in sick patients.