Blood Pressure-to-Height Ratio as a Screening Tool for Hypertension in Children.

Objective: To test whether blood pressure-to-height ratio (BPHR) can be used to screen for hypertension in children. Methods: Data regarding blood pressure and other variables was recorded for 2702 school children between the ages of 10-16 years as a part of a nutritional survey. Results: The optimal thresholds for defining hypertension in boys were 0.76 for systolic BPHR and 0.50 for diastolic BPHR; the respective threshold in girls were 0.80 and 0.52. Conclusion: BPHR can be used as an effective screening test for diagnosing both hypertension and prehypertension in children aged 10-16 years.

Clinical and Mutation Profile of Children with Cystic Fibrosis in Jammu and Kashmir.

Objective: To study the clinical and mutation profiles of children with cystic fibrosis in Jammu and Kashmir Methods: One hundred consecutive patients presenting with one or more phenotypic features suggestive of cystic fibrosis (CF) were screened by quantitative sweat chloride testing. For patients with positive/equivocal test result on two occasions, CFTR gene mutation analysis was done by polymerase chain reaction. Results: Of the 100 patients, 18 (10 females) were diagnosed to have CF at a median age of 10.5 y (IQR 4.75-15.25 y) while the median age at the onset of symptoms was 12 mo (IQR 4-63 mo) with a delay in diagnosis by 102.4±80.5 months. Clinical features at presentation included failure to thrive (94.4%), chronic cough (78%), recurrent pneumonia (61%), persistent pneumonia (11%), and chronic diarrhea (50%). Positive sweat chloride (>60 meq/L) was seen in 14 (14%) patients and 4 (4%) patients had equivocal (40-60 meq/L) value on two different occasions. Mutational analysis done in 15 patients showed DeltaF508 mutation in 20% (3/15) patients in homozygous form and in 13% (2/15) patients in heterozygous form. Intron 19 mutation 3849+10kb C>T was found in 40% (6/15) in heterozygous form. One (6.6%) patient had DeltaF508 and 3849+10kbC>T mutations in compound heterozygous form. Patients with equivocal sweat chloride and 3849+10kbC>T mutation had delayed onset of pulmonary involvement. Conclusion: 3849 +10kbC>T mutation appears to be common in children with cystic fibrosis in Jammu and Kashmir followed by DeltaF508, although the data are quite limited. Although presentation is delayed and sweat chloride is in the equivocal range, severe lung involvement may occur in these patients.

Effect of Second Dose of Measles Vaccine on Measles Antibody Status: A Randomized Controlled Trial.

Objective: To evaluate the effect of the second dose of measles vaccine on measles antibody status during childhood. Setting: Immunization centre of Under-five Clinic of the Department of Community Medicine at a tertiary-hospital. Design: Randomized Controlled trial. Methods: Blood samples were collected from all subjects for baseline measles serology by heel puncture at 9-12 months of age. All subjects were given the first dose of measels vaccine. At second visit (3-5 months later), after collecting the blood sample from all, half the children were randomized to receive the second dose of measles vaccine (study group), followed by collection of the third sample six weeks later in all the subjects. Results: A total of 78 children were enrolled and 30 children in each group could be analyzed. 11(36.6%) children in the study group and 13 (43.3%) children in the control group had protective levels of measles IgG at baseline. Around 93.3 % of children in the study group had protective measles antibody titers as against 50% in the control group at the end of the trial. The Geometric Mean Titre (GMT) of measles IgG increased from 14.8 NTU/mL to 18.2 NTU/mL from baseline to six weeks following receipt of the second dose of the vaccine in the study group, as compared to a decrease from 16.8 NTU/mL to 12.8 NTU/mL in the control group. Conclusions: A second dose of measles vaccine boosts the measles antibody status in the study population as compared to those who receive only a single dose.

Acute Intermittent Porphyria with Transient Cortical Blindness.

Acute intermittent porphyria is a hereditary disorder characterized by deficient activity of the enzyme porphobilinogen deaminase. It manifests with occasional neurovisceral crises due to overproduction of porphyrin precursors. We report a 12 year old male child with acute intermittent porphyria, who presented with encephalopathy and transient blindness of cerebral origin.