Epidemiology and clinical course of bronchiolitis in hospitalized children in tertiary care hospital in Kashmir

Background: Bronchiolitis is the commonest lower respiratory tract infection in children < 2 years of age and is responsible for the majority of their pediatrician visits and hospital admission during the winter season. The aim of this study was to describe the epidemiological data, seasonal trends, clinical characteristics, and outcomes of children admitted with bronchiolitis in pediatric hospital GMC Srinagar.Methods: This was a retrospective observational study in children less than 2 years of age admitted in department of pediatrics in GMC Srinagar. Data were collected through review of the medical records of patients with a diagnosis of bronchiolitis on discharge and analyzed through SPSS 20.Results: A total of 228 infants were enrolled in the study. The majority were males (60.08%). The median age on admission was 5.5 months, exclusive breastfeeding was the mode of feeding in majority and 8.77% were ex-preterm. Respiratory syncytial virus (RSV) was identified in majority (103) and admission peak was from October to March. Most of the patients presented on day 3 of the illness. Most patients 45.17% were having feeding difficulties and chest auscultation was normal in about 22% of the children. Oxygen supplementation was administered to 85.52% of the children. The 32 children (14.03%) required admission to PICU. Mechanical ventilation was required in 6 children (18.75%). No death occurred in infants while in the hospital.Conclusions: RSV has been found to be the main responsible virus. Management of bronchiolitis is usually symptomatic as recommended by most of the guidelines.

Incidence of nasal trauma in nasal continuous positive airway pressure versus heated humidified high flow nasal cannula in neonates, our experience in Government Medical College Srinagar

Background: The nCPAP (nasal continuous positive airway pressure) is noninvasive mode of ventilation that decreases the need for mechanical ventilation in neonates. The newer device heated humidified high flow nasal cannula (HHHFNC) delivers heated (to body temperature, 37 °C) and humidified (near 100% relative humidity) gas at flow rates of more than 1 liter/min through small bi-nasal prongs, that is more physiological.Methods: This was a retrospective study conducted in neonatal intensive care unit. The eligible neonates who were put on HHHFNC or nCPAP depending upon the availability of any of these devices at the time of admission. The details regarding complications were recorded from the admission files of these patients from medical record section of the hospital.Results: There was no statistically significant difference in complications like shock, NEC, pulmonary air leak, apnea, PDA, ROP, IVH or PVL for nCPAP or HHHFNC. However, nasal trauma was present in 18 (18%) patients in nCPAP group but in no patient in HHHFNC.Conclusions: There is no significant differences in complication in nCPAP vs HHHFNC except nasal trauma which is more common in nCPAP.

Clinical profile of mumps in children in a tertiary care hospital in Kashmir

Background Mumps is one of the oldest human illnesses known to humans. Mumps is caused by a paramyxovirus, which is a single-strand RNA virus. Mumps is characterized by painful, unilateral, or bilateral swelling of the salivary glands, in particular, the parotid glands.Methods: This is a hospital-based prospective observational study. All children of age ?18 years, both males and females with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland without other apparent cause.Results: Of the 150 clinically diagnosed mumps cases, 87 (58%) were male and 63 (42%) were female (male-to-female ratio of 1.4:1). There was no case below 1 year but there were 40 cases between 1 and 5 years. The 40% belonged to the lower middle class of socioeconomic status as per Kuppuswamy’s scale, followed by the upper-middle and lower-middle class. Only 15 patients (10%) were completely immunized whereas the immunization status of 8% patients was not known, and the rest of the patients were non immunized (82%). Fever was the most common presentation (150 patients;100%), followed by parotid involvement. Parotitis was present in 146 (97.3%) cases at some point during the illness, 36 patients (24%) had unilateral and 110 patients (73.3%) had bilateral involvement. 16% of patients had multiple salivary gland involvement. Mean duration of illness was 9.0±2 days.Conclusions: Mumps is a significant public health problem to warrant investment in prevention through vaccination.

Non-nutritional causes of severe anemia in Kashmiri children

Background: Anemia is one of the leading causes of mortality and morbidity in children. The etiology of anemia is multifactorial including nutritional anemia, hemolytic anemia, aplastic anemia, storage disorders, hematological malignancies, anemia secondary to some chronic diseases. Methods: The study is an observational study. Physical signs of severe anemia were looked in patients attending outpatient department or admitted in hospital. Children with hemoglobin levels <7 g/dl and in the age group 6 months to 6 years were recruited in study. The aim is to look for non-nutritional etiology of severe anemia in children in Kashmir. Results: Out of 192 children, 97 (50.52%) females and 95 (49.48%) males, with a male, female ratio of around 1:1. A total of 147 (76.56%) children in our study were having nutritional and 45 (23.44%) were having non nutritional causes. Among non-nutritional anemia 30 cases were hemolytic anemia, 11 hypoplastic anemia, 3 leukemia and 1 patient were diagnosed as Osteopetrosis. Conclusions: Though nutritional deficiency anemias are predominant; it may not always be the case. Hemolytic anemia and leukemias should be ruled out while evaluating a patient of severe anemia and pancytopenia. Bone marrow failure syndrome, storage disorders should be ruled out in patients with skeletal anomalies.