Utility of lung ultrasound in childhood pneumonia in a tertiary care center

Background: Pneumonia is a major cause of childhood mortality and morbidity worldwide. Chest radiography has been used as a modality for diagnosing but has the disadvantage of radiation exposure and inter-observer variability. Hence studies have explored the possibility of using lung ultrasound in the diagnosis of pneumonia. To assess lung ultrasound (LUS) findings in childhood pneumonia and to correlate lung ultrasound findings with clinical findings.Methods: 210 children between 2 months to 5 years admitted in the hospital with diagnosis of pneumonia were enrolled in the study. They underwent LUS within 24 hours of admission and the results were analysed.Results: Out of the 210 patients enrolled in the study, 41 (19.5%) had positive LUS findings. However, LUS findings correlated well with clinical findings in cases with very severe pneumonia.Conclusions: This study showed that lung ultrasound cannot be used a sole diagnostic tool in childhood pneumonia, but it has a valuable role in detection of complications. Lung ultrasound will require more training for detection of early indicators of pneumonia.

Clinicopathological profile of rickettsial fever in tertiary healthcare centre: a prospective case study

Background: Rickettsia are obligate intracellular proteobacteria spread by eukaryotic vectors like ticks, mites, fleas and lice. Rickettsial infections are generally incapacitating and difficult to diagnose; Case fatality rates up to 45 percent is seen in cases with multiple organ dysfunction. The disease continues to be under diagnosed and treated. Objective of this study was to study the clinicopathological profile and outcome of children admitted with rickettsial fever. To study the correlation between Rathi-Goodman-Aghai score and Weil-Felix test. To study the response of rickettsial fever to Doxycycline.''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''Methods: This study is a prospective observational study conducted from December 2017 to April 2019 at a tertiary health care center in South India, involving patients admitted between 2 months to 18 years of age with a diagnosis of Rickettsial fever. Clinical data and investigations were collected and analysed. The response to doxycycline was recorded.'''''''''''''''''''''''''''''''''''''''''''''''' '''''''''Results: Total of 49 patients were enrolled in the study. Most common age group affected was between 1 to 5 years accounting for 32.7% of the cases. 78% of the patients hailed from rural background. Most common presentation being fever, present in 100% of the cases. 81.6% of patients had significant Rathi-Goodman-Aghai score of >14. Weil felix showed significant titres (1:80) in 97.9% out of which serology suggestive of scrub typhus was found in 79.6% patients. There was no statistical significance between rickettsial score and Weil-Felix test (p value= 0.736). 26.5% of the cases required respiratory support and 2% cases required dialysis. 10.2% cases succumbed and 89.8% cases improved.Conclusions: Rickettsial infection is re-emerging with propensity for life threatening complications. There is no statistical significant correlation between Rickettsial score and Weil Felix test. Early treatment has better outcome.

Evaluation of factors, associated with defaulting routine immunization in children

Background: India was one of the first countries to adopt the World Health Organization's Expanded Programme of Immunization (EPI). The program started globally in 1974 and was initiated in India in 1978. Immunization is considered to be one of the most important cost-effective and a powerful public health intervention. Achieving maximum coverage, however, has been a challenge due to many reasons, including high rates of defaulters from the program. The term 'defaulter' is used to refer a child who misses the scheduled vaccinations for any reason. The objective of this study was to explore the reasons behind defaulting from the routine immunization program.Methods: A study was conducted in Bowring and Lady Curzon Hospital, Bangalore between January 2012 and December 2012. A total of sixty six children's' details were gathered from mothers of defaulted children. Children below 5 years attending OPD were included in the study. Children above 5 years and inpatients were excluded. Observations and review of relevant documents was done.Results: Of the 66 children, in our study, males were more than females. Children in the age group of 2 years to 5 years were 17(25%) as compared to those between 1 to 2 years. Mothers were more literate than fathers. Muslim children had the best immunization coverage. The main determinant of defaulting was lack of knowledge and awareness regarding immunization by the mothers (21/31%) followed by sickness in children (11/16%), causing them to default immunization schedulesConclusions: The main reason for defaulting from the immunization program was lack of awareness, regarding immunization by mothers in the community.

Correlation of serum creatine phosphokinase and serum cholinesterase in organophosphate poisoning in children

Background: Organophosphate (OP) poisoning is one of the most common pesticide poisoning in India in adolescents because of its easy availability. Serum pseudocholinesterase levels are commonly used to assess the severity and to know the prognosis in OP compound poisoning. Serum creatine phosphokinase (CPK) levels is another lab parameter which gets deranged in OP poisoning and has been tried in adults to assess the severity and to know the prognosis.'Authors objective was to study the correlation of serum pseudocholinesterase and serum CPK in organophosphate poisoning at admission and to compare outcome with serum CPK levels.Methods: All the children in the age group of 1 month to 18 yrs, who were admitted with the history of suspected OP compound poisoning were enrolled for the study. Estimation of cholinesterase and CPK levels were done at admission and after 1 week. Patients were categorised in to latent, mild, moderate and severe cases based on the S. Cholinesterase levels. These values were analysed to see the correlation.Results: Among 34 OP poisoning cases,13(38%) were males and 21(62%) were females. Mean age of study population was12.6+4.25 yrs. The median CPK values in latent, mild, moderate and severe cases were 121.5 IU/L,276.5 IU/L, 308IU/L and 467IU/L respectively (p=0.015). Spearman's rho Correlation coefficient was -0.522 between S. Cholinesterase and S CPK at admission which was significant. The median serum CPK level after 1week in non survivors was 2498.0IU/L and in survivors was 201.0IU/L (p0.014).Conclusions: There was a strong negative relationship between serum cholinesterase and serum CPK at admission in OP poisoning. Follow up values at 1 week showed that significantly high serum CPK and low cholinesterase, which was also significant and was associated with mortality.

Predictors of treatment failure in severe pneumonia treated with Ampicillin in tertiary care center

Background: Pneumonia affects 156 million children under five years every year and is the leading cause of mortality in this age group. It emphasizes the need to identify high risk factors for Treatment Failure so as to treat them aggressively. The objective of this study was to assess factors influencing treatment failure in severe pneumonia treated with Ampicillin.Methods: Prospective observational study, in which 235 children with severe pneumonia between 2 months to 60 months were enrolled and started with intravenous Ampicillin as per WHO protocol. If no clinical improvement was seen after 48 hours, it was taken as treatment failure and managed accordingly.Results: Among 235 children, 43(18.2%) did not respond to Ampicillin. Among treatment failure cases males were 20 (46.5%) and females were 23 (53.6%). All the following parameters were statistically significant(p<0.05). Majority of 23(53.4%) were between 2 to 12 months. 13(30.2%) were incompletely immunized. MAM were 23(53.4%) and 22(51.1%) cases had signs of Rickets. 34(79.1%) had Anemia out of which 22(64%) had moderate anemia. 39(90.6%) children had fever and hypoxia at admission.Conclusions: Infancy, malnutrition, severity of anemia, rickets, lack of immunization, hypoxia at baseline were significant predictors of treatment failure in severe pneumonia. Strengthening immunization and improving nutritional status may improve the outcome. Children with above risk factors require vigilant monitoring.

Clinical profile of hypernatremia in exclusively breast-fed neonates

Background: Neonatal hypernatremia is a potentially lethal condition. This study was planned to find out the predisposing factors and outcome of hypernatremia in breast feed late preterm and term neonates.Methods: In defined study period, neonates with serum sodium level >145mmol/L, who satisfies all the inclusion criteria are included in the study.' The data was collected using a proforma which included clinical symptoms, risk factors for neonatal hypernatremia in addition to laboratory data.Results: The results demonstrated hypernatremia in 63 neonates with mean age of presentation being 4.5 days, mean sodium level of 154.2 and average weight loss was 13.2%. Neonates admitted at older age >7days had higher sodium concentration with mean of 162.5mmol/L. Serum sodium levels correlates positively with percentage of weight loss and correlates negatively with birth weight and was statistically significant with p value <0.05. 41(65%) of mothers were primipara, 37(58%) had delivered by LSCS and 39(62%) had lactation issues postnatally. Most common presenting symptom was jaundice in 44(71%), followed by fever in 38(61%).Conclusions: Hypernatremic dehydration can be prevented by counselling about importance of breast feeding for the mothers starting from antenatal period, early initiation of breast feeding, addressing lactation issues and monitoring daily weight.