Prevalence of Hypertension Among Schoolchildren in Shimla.

This cross-sectional study was done to find the prevalence of sustained hypertension and prehypertension among school children aged 11-17 years. A total of 1085 apparently healthy students from rural and urban schools in hills of northern India were examined using standard methods. Students with blood pressures above the 90th centile were re-examined after four weeks. The mean BMI of the students was 17.5±2.7 kg/m2, 5 (0.4%) were obese, and 39 (3.5%) overweight. After two evaluations, hypertension was identified in 62 (5.9%) children and prehypertension in 130 (12.3%). Urban and rural children had comparable rates of elevated BP (hypertension and prehypertension). Rates of elevated BP were significantly higher (46.5% vs 17%, P<0.001) among those with high BMI (overweight and obese) compared to those with normal BMI. In conclusion, nearly 20% of the school children had elevated blood pressures.

Predicting neonatal hyperbilirubinemia using first day serum bilirubin levels.

Objective. To determine the first day total serum bilirubin (TSB) value which will predict with reasonable accuracy, neonates likely to develop subsequent significant hyperbilirubinemia. Methods. Serum bilirubin was estimated for all enrolled cases within 18 to 30 hr of life by microcapillary. The babies were then followed up clinically by 2 observers for the appearance and progression of jaundice every 12 hr till discharge and then daily upto fifth day of life. TSB estimation was repeated if the clinical assessment of jaundice was more than 10 mg/dl by any observer using Kramers Rule. Hyerbilirubinemia was defined as TSB level ≥12 mg/dl between 24 to 48 hr of life ≥15 mg/dl between 48 to 72 hr of life and 17 mg/dl beyond 72 hours of life. Results. A total of 200 neonates were enrolled in the study. Of these, 24 neonates (i.e., 12%) developed hyperbilirubinemia. The mean first day TSB value in the neonates who subsequently developed hyperbilirubinemia was 7.716 mg/dl as compared to a value of 5.154 mg/dl in those who did not. The difference was significant (p=0.000). Using Receiver operating characteristic (ROC) curve analysis, a value of 6.4 mg/dl (first day TSB) was determined to have the best predictive ability for subsequent hyperbilirubinemia with a sensitivity of 87.5%, specificity of 80.11%, positive predictive value of 37.5% and a negative predictive value of 97.92%. Conclusion. First day TSB estimation can serve as a reliable screening test for neonates at risk for subsequent hyperbilirubinemia. Neonates with the first day TSB level of less than 6.4 mg/dl have minimum risk of subsequent hyperbilirubinemia.

Clinical profile of pediatric somatoform disorders.

OBJECTIVES: To study the prevalence, pattern, clinical and socio-demographic characteristics of somatoform disorders in children. METHODS: From Aug 2004 to July 2005, children up to 18 years with unexplained physical symptoms were evaluated prospectively using DSM-IV criteria. Detailed evaluation followed for those meeting criteria. RESULTS: The prevalence of Somatoform disorders was 0.59% and 0.78% among out-door and in-door patients respectively. Among 124 children (40 boys and 84 girls) meeting criteria, conversion disorder was the commonest (57.3%), followed by undifferentiated somatoform disorder (25.2%). Girls were significantly more represented among conversion disorder patients compared to other groups of somatoform disorders (78.9 vs. 52.8 %, P=0.002). In conversion disorder, 2/3rd patients presented within 3 months, whereas in other somatoform disorders, 2/3rd patients presented within 3 months after symptoms. Fainting attacks (52.1%) and ataxia (43.7%) in conversion disorder and pain abdomen (52.8%) and headache (52.8%) in other somatoform disorders, were the commonest symptoms. Stressors were identified in 73.4% and acute precipitating stressors were present in 14.4% children. Boys had significantly higher rates of poor inter-personal relations and communication problems within the family (72.5% vs. 41.7%, P=0.001), while girls had significantly higher rates of conflicts with the parents and other family members (21.4% vs. 5%, P=0.02). CONCLUSION: Somatoform disorders, particularly conversion disorder is commoner in girls. Important stressors are poor inter-personal relations and communication problems within the family in boys, and conflicts with family members among girls.

Biochemical abnormalities in neonatal seizures.

OBJECTIVE: The presence of seizure does not constitute a diagnoses but it is a symptom of an underlying central nervous system disorder due to systemic or biochemical disturbances. Biochemical disturbances occur frequently in the neonatal seizures either as an underlying cause or as an associated abnormality. In their presence, it is difficult to control seizure and there is a risk of further brain damage. Early recognition and treatment of biochemical disturbances is essential for optimal management and satisfactory long term outcome. METHODS: The present study was conducted in the department of pediatrics in IGMC Shimla on 59 neonates. Biochemical abnormalities were detected in 29 (49.15%) of cases. RESULT: Primary metabolic abnormalities occurred in 10(16.94%) cases of neonatal seizures, most common being hypocalcaemia followed by hypoglycemia, other metabolic abnormalities include hypomagnesaemia and hyponateremia. Biochemical abnormalities were seen in 19(38.77%) cases of non metabolic seizure in neonates. Associated metabolic abnormalities were observed more often with Hypoxic-ischemic-encephalopathy (11 out of 19) cases and hypoglycemia was most common in this group. CONCLUSION: No infant had hyponateremia, hyperkelemia or low zinc level.