Comparison between Ferrous Ascorbate and Colloidal Iron in the Treatment of Iron Deficiency Anemia in Children from Kolkata India.

Aim: To compare the efficacy and safety of ferrous ascorbate and colloidal iron in children with iron deficiency anemia. Study Design: An open, randomized, comparative, parallel-group study. Place and Duration of Study: Department of Pediatric Medicine of ‘Nilratan Sircar Medical College and Hospital’, Kolkata, India, between January 2009 and February 2010. Methodology: Children between the age group of 6 months to 12 years were included if they had anemia defined as hemoglobin <10 gm%. Children received treatment with either ferrous ascorbate or colloidal iron for 12 weeks. Each child received elemental iron 3 mg/kg body weight/day. Follow-up assessments were performed at the end of week 4, week 8 and week 12. Results: Out of the 137 children screened, 80 were included in the analysis. The mean rise in hemoglobin at the end of the 12 weeks was significantly higher in ferrous ascorbate group than colloidal iron group [3.24 ± 1.66 gm% vs. 1.42 ± 2.04 gm%; p <0.01]. Responder rate (hemoglobin ≥11.5 gm%) after 12 weeks of therapy was 53.57% in ferrous ascorbate group versus 10.34% in colloidal iron group; p<0.01. Conclusion: The study provides evidence for the role of ferrous ascorbate as an efficient oral iron supplement in the treatment of iron deficiency anemia in children.

Effectiveness of beta blockers in primary prophylaxis of variceal bleeding in children with portal hypertension.

Aim: The primary aim of our study was to assess the effectiveness of beta blockers in non bleeding portal hypertensive children. The secondary objective was to evaluate whether the newer generation beta blockers were superior compared to conventional ones. Methods: Conventional propranolol and newer generation carvedilol were administered to 31 subjects each, after stratifying them into nearly equal subgroups according to etiology (sinusoidal or presinusoidal). Results: At the end of 2 years study period, 3 children (4.83%) had breakthrough bleeding. A decrease, increase and no alteration in grade of oesophageal varices was seen in 40, 9 and 13 cases respectively. Of the 9 children with associated gastroeosophageal varices (GOV), the severity of lesions was reduced in 8 of them. Both the drugs had efficacious outcome in sinusoidal as well as presinusoidal cases, having a significant coefficient of correlation (r>0.5) with time. Carvedilol was more effective than propranolol statistically (p = 0.035 and p = 0.034 respectively), only at 4 and 5 month follow-up period. Conclusion: Beta blockers are effective in preventing variceal bleed in children with portal hypertension. Long term efficacy of carvedilol and propranolol was similar.

Eligibility criteria of Doctorate in Medicine (Medical Gastroenterology) – Is the change justified.

Eligibility criteria of Doctorate in Medicine (DM) in Medical Gastroenterology had been changed recently by Medical Council of India fromMD/DNB in General Medicine and Pediatrics to only that of General Medicine. As DM (Pediatric Gastroenterology) has not come up in a big way in India, this will only lead to shortage of skilled manpower in near future in this emerging field. Enthusiastic pediatricians will also be reluctant to take the discipline, as DM degrees in other broad (adult) superspecialities are open to them.

Profile of hepatitis A infection with atypical manifestations in children.

We assessed the clinical course and biochemical profile of symptomatic children with viral hepatitis A who had atypical manifestations. Of 229 children with hepatitis A, atypical manifestations were found in 32 (14%) subjects. Prolonged cholestasis (n = 14), acute liver failure (9), relapse (9), ascites (8), and hematological problems (8) were the common presentations. Liver histology was suggestive of chronic liver disease in six children with protracted jaundice. Patients with atypical presentations were older (7.7 [1.6] years vs. 6.5 [2.6] years; p=0.012) and had higher total serum bilirubin (13.7 [8.1] mg/dL vs. 7.2 [4.0] mg/dL; p=<0.001) than those with typical presentation. Approximately 15% of children with acute hepatitis A infection have atypical presentation which is associated with increase in morbidity.

Klebsiella pneumoniae brain abscess in two neonates.

We report two premature infants who developed multiple brain abscesses following Klebsiella pneumoniae infection. Both the cases were diagnosed by ultrasonogram (USG) and cranial tomography. Abscess had intraventricular communication in one case. One infant was managed conservatively while the other required surgical drainage.

Aetiology, clinical profile and prognostic indicators for children with acute liver failure admitted in a teaching hospital in Kolkata.

OBJECTIVE: To estimate the prevalence of hepatotropic viruses in the causation of acute liver failure in children admitted to a tertiary hospital in Kolkata. DESIGN: Analysis of clinical and laboratory parameters (including viral markers) of children with acute liver failure using a predesigned, structured proforma. SUBJECTS AND SETTINGS: Admitted patients aged from 1 through 12 years who met the criteria of acute liver failure were included in the study. RESULTS: Of the 45 patients in our study, a majority was from the southern part of West Bengal. Their mean age was 7.12 +/- 0.37 years. The male: female ratio was 1:1.25. It was possible to determine the aetiology in 35 of the 45 patients (77.7%) admitted. Of these 35, a diagnosis of hepatitis due to hepatotropic viruses was made in 30 patients. The hepatitis A virus was responsible for 16 of the 30 cases (53.3%), 9 cases attributed to HAV only. Following this was the hepatitis E virus causing ALF in 14 cases (46.6%), 7 singularly so. Hepatitis B virus caused 8 cases (26.6%), 6 singly. The survival rate during hospital stay was 51.1%. Prodrome, decreased liver span, ascites, cerebral oedema, coagulopathy, renal failure, spontaneous bacterial peritonitis, signs and symptoms of clinical sepsis (corroborated by laboratory data), severe hypoalbuminaemia and electrolyte imbalance were significantly more in patients who died. The mean age, prothrombin time, serum bilirubin level and stage of encephalopathy differed significantly between survivors and non-survivors. CONCLUSION: In southern Bengal, hepatotropic viruses are the predominant cause of acute liver failure in children. Of these, the hepatitis viruses A and E transmitted via the enteric route dominate (24 of 30 cases).

Sialidosis type I (cherry red spot-myoclonus syndrome).

Sialidosis type 1 or the cherry red spot-myoclonus syndrome (CRSM) is an autosomal recessive disorder with the onset in adolescence of myoclonus and gradual visual failure. Here, a case of CRSM in a 12-year-old Bengali Muslim girl with the history of myoclonic jerks of limbs and the body since last 2 years and gradual impairment of vision since last one year is presented with a brief review of the literature.