Naso-pharyngeal Carriage of Organisms in Children Aged 3-59 months Diagnosed with Severe Community-acquired Pneumonia.

Objective: To study the naso-pharyngeal carriage of organisms in children diagnosed with severe pneumonia. Methods: Nasopharyngeal aspirate and swabs for microbiological analyses were collected from 377 children aged 3-59 months with severe pneumonia. Results: 28.6% of the samples were positive for S. pneumoniae, 9.6% were positive for H. influenzae, and 8.5% were positive for both the organisms. Respiratory syncytial virus was detected in 27% of samples. The rate of isolation of S. pneumonia and H. influenzae was significantly more in the age group of 12-59 months. Conclusions: In children with severe pneumonia, most common organisms isolated/detected from naso-pharyngeal aspirates were S.pneumoniae and Respiratory Syncytial Virus.

Thoracic neuroblastoma presenting as recurrent empyema.

Neuroblastoma is the most common intra-abdominal and extracranial solid tumour in children, accounting for 7%–8% of all childhood cancers. It is a malignant tumour of the autonomic nervous system derived from the neural crest. Most children with neuroblastoma have distant metastatic disease at the time of diagnosis. Pulmonary metastasis at the time of diagnosis is rare, and rarer is the presence of associated pleural effusion. We present the case of a child with recurrent empyema, who was diagnosed to have a thoracic neuroblastoma.

A case of bilateral tibial hemimelia type VIIa.

Congenital absence of tibia is a rare anomaly, and may be total or partial, unilateral or bilateral. Total absence is more frequent than partial, unilateral absence occurs more often than bilateral, with right limb more commonly affected than the left. In partial defect, almost always the distal end of the bone is affected, and of the bilateral cases, there may be total absence on both sides, or total on one side and partial on the other. Males are slightly more commonly affected than the females. Though, the family history is usually negative for congenital abnormalities and other diseases, there is a considerable chance of occurrence of congenital defect of the tibia or of other abnormalities, in near or remote relatives. We report a case of newborn having bilateral tibial hemimelia type VIIa.

Clinical Profile and Outcome of Swine Flu in Indian Children.

Objective: To describe the clinical characteristics and outcome of Indian children infected with 2009 H1N1 influenza virus. Study design: Retrospective chart review. Setting: Outpatient department and hospitalized patients in a tertiary care hospital. Methods: Clinical details of 85 children (positive for the 2009 H1N1 virus infection tested by real-time reversetranscriptase– polymerase-chain-reaction assay) were analyzed from medical charts. Results: Of the 85 (55 boys) children positive for 2009 H1N1 virus infection, 64.7% were between 5 years to 16 years, and 35.3% were below 5 years age. The mean age of these children was 7.5±3.5 yr. Contact history was positive only in 22 (26%) cases. High grade fever was the most common symptom, followed by cough and rhinorrhea. Twenty-nine (34%) patients had an underlying co-morbid condition. Of the 34 patients who underwent chest radiography during evaluation, 18 children (52.9%) had findings consistent with lower respiratory tract infection. Antiviral therapy was initiated in 76 patients. Hospitalization was required in 30 (35.3%) children. Risk factors for hospitalization included underlying co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph. Mean length of hospitalization was 131+76 hours, irrespective of underlying disease. Three children developed Acute Respiratory Distress Syndrome and died. Conclusions: Clinical features and routine laboratory investigations in children with swine origin influenza were non-specific. Children with co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph were at higher risk of hospitalization.

Utility of telemedicine for children in India.

Objective. To show utility of telemedicine for children in Indian subcontinent. Methods. Retrospective analysis of data on 306 consecutive patients (age range 0–15 yr) managed between yr 2005-2008 in telemedicine centre of a tertiary care hospital in North India. The patient consultations were conducted using two customized soft wares – Televital and Sanjeevani. Data was extracted on a predesigned Performa. Results. The data included clinical details, investigations and radiological images. Ten percent of children were critically ill and could not have been in a position to be transported safely. Twelve percent of the consultations resulted in videoconferencing. There was a paucity of feedback back and follow up of these consultations. Conclusion. It is possible to provide e-health care through telemedicine to children in Indian rural and semi-urban setting. The e-health can be extended to critically ill children including newborns on a restricted basis.