Demographic and Clinical Profile of Children with Severe Acute Malnutrition – An Experience from Nutritional Rehabilitation Centre in Jammu

Background: Childhood undernutrition remains a key public health challenge in India and is a significant contributor of Under-5mortality as these children have significantly higher risk of mortality and morbidity. Nutritional rehabilitation centres have beenset up by Government of India at facility level to provide medical and nutritional care to Severe Acute Malnourshied childrenunder the age of 5 years who have medical complications.Materials and Methods: Retrospective record based observational study conducted in NRC located at SMGS Hospital, GMCJammu. All the children upto 60 months of age, admitted in NRC during the study period, from September2018 to February2019 were included in the study.Aims and Objectives: To know the demographic details and clinical profile of comorbidities in children with Severe AcuteMalnutrition and to assess the outcome of these children.Results: A total of 118 children were admitted in the Nutritional Rehablitation Center during the study period 60% werefemales. 60% of the children were less than 12 months of age 20 % were between 13 and 24 months of life.Children belongedto all the districts, 22% from Jammu, 18% Reasi, 16% Udhampur, 15% Rajouri, 8% Kathua, 7% Poonch and 6% Samba.Bronchopneumonia (39.8%), Diarrhoea (30.5% ) and skin infections(11%) were the commonest morbidities. 73.5% of thechildren had associated anemia. Other comorbidities were septicemia (10.1%), CSOM (5.9%), UTI (5%), measles (5%) andtuberculosis (2.5%).Conclusion: Early diagnosis and standardized protocol based treatment in the NRCs has been very effective in reducing themorbidity and mortality in SAM patients.

Clinical Profile of Patients with Cerebral Palsy – A Hospital-based Study

Background: Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide with the greatest burdenfound in developing countries. Motor impairments are the hallmarks of CP, but in many individuals, other impairments suchas vision, hearing, speech, cognition, behavior, and epilepsy may at times produce even greater activity limitation in daily life.Early diagnosis and comprehensive management with a multidisciplinary approach are required for satisfactory managementof a child with CP. In low- and middle-income countries, there are gaps in knowledge especially in spheres of epidemiologicalresearch, intervention, and service utilization.Materials and Methods: This cross-sectional observational study was conducted among the children coming to the inpatientand outpatient Department of Paediatrics SMGS Hospital, Government Medical College Jammu.Aims and Objectives: The aim of the study was to study the clinical pattern and etiological factors of CP and to determine the prevalenceof associated disabilities or handicaps in CP. Our study population included 100 cases of diagnosed CP up to 18 years of age.Results: A total of 100 children of CP were evaluated of which 59% were boys and 41% were girls. CP patients belonged tovarious age groups as, <2 years (46%), 2–4 years (30%), 4–6 years (12%), 6–12 years (10%), and 12–18 years (2%). CP patientscoming to our hospital belonged to various districts such as Jammu (27%), Rajouri (20%), Doda (17%), Reasi (11%), Udhampur(8%), Kathua (7%), Poonch (5%), and Samba (5%). The most common etiological factors were birth asphyxia (48%). The spastictype was the most common (65%), followed by ataxic (15%), dyskinetic (10%), and mixed (10%). Among the spastic quadriplegic,subtype was seen in 69%, diplegia in 23%, and hemiplegia in 8%. Speech delay was the most common associated problem(80%), followed by seizures (56%), feeding difficulty (46%), and contractures and deformities (20%). Formal vision assessmenthad been done in only 48% of the patients, among them, 30% had normal vision, 9% had refractive error, 7% were havingstrabismus, and 2% were blind. Spectacles were being used by only three patients. A mere 30% of the patients had undergonehearing assessment; among them, 6% were having moderate to profound hearing loss. Hearing aid was being used by twopatients. Physiotherapy services were being availed by 47% of patients. Early intervention and appropriate rehabilitation servicesshould be provided to such children to limit the disability. Medical college hospitals of India, where a number of these childrenreport with their various problems, can play an important role as nodal centers for evaluation and registration of such patients.

Evaluation of the WHO/UNICEF algorithm for integrated management of childhood illness

Background: The present study was designed to evaluate the feasibility and utility of the integrated management of the childhood illness (IMCI) algorithm to diagnose the illnesses in children under the age of 2 months to 5 years.Methods: The study was conducted on 300 children, aged 2 months to 5 years, who presented with a fresh episode of any illness to the out-patient Department of the SMGS Hospital over a period of 9 months. Within these initial selection criteria, the WHO/UNICEF algorithm for management of the sick child was referred to, children were assessed and classified as per "IMCI" algorithm and treatments required were identified. The final diagnosis was made and appropriate therapy instituted served as the "Gold standard". The diagnostic and therapeutic agreements between the 'gold standard' and the IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed.Results: Among all 300 subjects, more than one illness was present in 207 (69%) of subjects as per Gold standard diagnosis. The corresponding, figures for IMCI module were 141 (47%) and 222 (74%) for low and high malaria algorithms respectively. The mean illnesses per child were 2.12, 182 and 2.21, respectively. The subjects who would have been referred as per IMCI module had a greater co-existence of illnesses than those who would not have been referred (mean 2.5 versus 1.5 illnesses per child respectively). The specificity for general danger signs was 66% while the sensitivity was 71%.Conclusions: In conclusion, the performance of the IMCI algorithm is significantly better than the vertical disease specific algorithm. In addition, the IMCI algorithm incorporates an element of preventive care in the form of immunization and feeding advice.

Acute bilirubin encephalopathy in term neonates: a hospital-based study

Background: Acute Bilirubin Encephalopathy and kernicterus is an important cause of cerebral palsy, developmental delay and hearing impairment in low-middle income countries. Interventions such as universal screening for neonatal jaundice, Rhesus immunoglobulins, intensive phototherapy and exchange transfusion have made kernicterus rare in high income countries, but in our set up such cases continue to be reported.  Methods: Retrospective observational study where case records of term neonates brought to the neonatal ICU with signs and symptoms of acute bilirubin encephalopathy during the years 2016 and 2017 were sought and analysed.Results: A total of ten term babies reported to the neonatal unit with severe hyperbilirubinemia along with signs and symptoms of bilirubin encephalopathy of which 60% were females. 90% had a birth weight of more than 2.5 kg and mean birth weight was 2.7±0.25 kgs. All the babies were out born. A 4 babies were born at home of which 3 pregnancies were completely unsupervised during the antenatal period. 90% of the babies were from the rural areas, 6 of the cases were from the districts Rajouri, Poonch and Reasi where the terrain is hilly, 2 from rural areas of Jammu and 1 from Kathua. Only 1 was from the Jammu city. The age at admission ranged from 3-9 days and serum bilirubin from 24 to 43.3 mg %. A 5 babies had ABO incompatibility, 1 Rh incompatibility, 1 sepsis, while no cause could be found in 3.Conclusions: Neonatal jaundice is often not easily appreciated by mothers and caregivers in the home setting until it becomes severe enough, at which point neurological damage may have already occurred. There is an urgent need to train the primary health care personnel in assessment and early identification of risk factors for severe neonatal hyperbilirubinemia. They can help the families to seek prompt treatment for this preventable cause of cerebral palsy and mental retardation.

Neurotoxic Snakebite In Jammu Region: Is It Cobra Or Krait

Background: The aim of this study is to analyze the clinical profile and outcome of the neurotoxic envenomation in children inJammu region and to identify the species based on the syndromic approach developed by WHO.Materials and Methods: A retrospective hospital record based descriptive study which analyses the case records of childrenreporting to pediatric emergency with signs and symptoms of neurotoxic envenomation.Results: A total of 22 cases of the neurotoxic envenomation reported between April 15 and October 15. These included 14males and 8 females between the age group of 2.5 years and 16 years. The highest incidence of snakebite was observed inthe age group of 4–8 years. A total of seven cases presented neuroparalytic symptoms and local signs suggesting cobra bite.Bite was reported in the afternoon or evening hours between 12.30 pm and 10.30 pm and 83% bites were outdoors. A total of15 children presented with neuroparalytic symptoms with no local signs suggesting krait bite. 86% of the bites were indoor withonset of symptoms between 12 am and 7 am.Conclusion: Both cobra and krait cause neurotoxic envenomation in children in Jammu region with krait bite accounting for 68%of the total cases. Most of these cases are brought to the pediatric emergency late. Training of the peripheral doctors regardingearly recognition of neurotoxic snakebite, species diagnosis as per the WHO syndromic approach, prompt institution of initialmanagement with neostigmine and after visit summary, endotracheal intubations and AMBU bag ventilation, and quick referralto a center with ventilator facility should help in reducing the morbidity and mortality due to krait and cobra bite in children.

Vitamin D Dependent RicketsType ll : Late Onset Disease associated with Double Inlet Left Ventricle and Facial Dysmorphism.

Vitamin D dependent rickets type II is a rare autosomal recessive disorder. It is characterised by end organ resistance to 1,25 dihydroxy cholecalciferol. Patients present with early onset rickets, alopecia, severe hypocalcemia and secondary hyperparathyroidism. We report a 7 year old girl who presented with this disorder in association with congenital cyanotic heart disease and dysmorphic facies. Such an association has not been reported in literature.

Esophageal Diverticulum Secondary to Impacted Foreign Body.

We report a two year old child who developed a large esophageal diverticulum over a period of ten months following ingestion of a multispiked leaf of Quercus semicarpipholia.Though the endoscopic removal of foreign body was successful, it did not relieve the symptoms and patient required surgical resection of the diverticulum. Patient is asymptomatic after 4 months of follow up.

Post- Intercostal Intubation Chylothorax.

Chylothorax is a rare condition in childhood . It usually occurs as a post operative complication following cardiac surgery for heart diseases . we report a 16 months old girl with atrial septal defect and severe pulmonary stenosis, hospitalised for empyema and who developed chylothorax following intercostal drainage, an entity which has never been reported.

Congenital varicella syndrome/ vericella zoster virus (VZV) fetopathy.

An 18 hour old female newborn born to a 3rd gravida HIV-ve mother, presented with a large erythematous patch of skin on right forehead and hazy right eye since birth.There was history of chicken pox in mother during fourteenth week of pregnancy.