Landfill leachate a new threat to water quality: a case study from the Temperate Himalayas.

Landfills are commonly seen as the most cost-efficient and practical approach to waste management in various regions around the world. Nonetheless, the infiltration of hazardous materials from poorly managed dumping sites remains a significant environmental issue in most developing countries such as India. Leachate serves as a prominent point source of contamination in many environmental media like soil, groundwater, and surface water around the world. So the prime issues humans are experiencing are associated with water quality. Thus, the investigation was undertaken to assess the impact of leachate from the Achan landfill on surface water quality in the Temperate Himalayas. Monitoring was done during in all four seasons, viz., spring, summer, autumn, and winter. Among the sites, the leachate outflow site was found to have the highest mean value of pH (7.95), EC (2.16 dS/m), total nitrogen (2.64 mg/l), P (4.75 mg/l), K (1.41 mg/l), Ca (107.45 mg/l), Mg (54.93 mg/l), Zn (0.8 mg/l), Fe (1.78 mg/l), Cu (0.66 mg/l), Mn (0.81 mg/l), BOD (21.47 mg/l), COD (66.24 mg/l), temperature (14.22 °C), turbidity (14.29 NTU), while lowest mean values of all parameters were recorded at control site. Among the seasons, summer season was found to have maximum value of pH (7.9), EC (2.36 dS/m), total nitrogen (2.54 mg/l), P (4.0 mg/l), K (0.89 mg/l), Ca (85.94 mg/l), Mg (43.91 mg/l), Fe (1.4 mg/l), Cu (0.52 mg/l), Mn (0.64 mg/l), BOD (22.82 mg/l), COD (65.87 mg/l), temperature (18.99 °C), and turbidity (8.49 NTU). The maximum mean value of Zn (0.66 mg/l) was recorded during winter season, while other parameters were found to be minimum during winter season. From this study, we concluded that a decreasing trend was observed during all the seasons in the concentration of all physico-chemical parameters with an increase in distance from the landfill. So it is recommended that the leachate should be treated at the source before disposing into the water body and the landfill should be lined properly to prevent the entry of leachate into water sources.

Vehicular emission and its impact on heavy metal accumulation and photosynthetic pigments on pine needles in Pahalgam forest ecosystem.

Human interference is rising day by day which adds more problems to conserve valuable forest resources. Vehicular exhausts are the main source of heavy metals that have detrimental impacts on the vegetation. The research provides comprehension about the increase in vehicular traffic along the Pahalgam highway, which is disturbing the balance of the forest ecosystem. The concentration of heavy metals and leaf pigments were determined in the leaf tissues collected along with the roadside pine trees in the Pahalgam resort. A total of 25 samples at each sampling site were collected in 100 m diameter along main road. High vehicular movements in summer correlated with the high accumulation of heavy metals such as Pb2+ (0.563 mg/kg), Ni2+ (0.271 mg/kg), and Cu2+ (0.202 mg/kg) in pine needles. However, Zn2+ exhibited higher concentration (0.468 mg/kg) at Batakote and Cd2+ (0.05 mg/kg) at Pahalgam in autumn. Moreover, total chlorophyll content determined low (1.97 mg/g) at Pahalgam in autumn and high (3.81 mg/g) at Chandanwari in summer. In general, the chlorophyll content in the pine needles was certainly affected by the accumulation of heavy metals which indicating a negative correlation of chlorophyll content with heavy metals. Thus, the increase in traffic movement and tourist influx significantly affects the accumulation of heavy metals and decreases the pigment content in the pine needles. Rapid tourist influx in world-famous health resorts is dramatically influencing the forest ecosystem. Therefore, the need is to use green fuel or ban the old vehicles which can be helpful in maintaining the balance of the forest ecosystem.

Enhancing respiratory disease diagnosis by bronchoalveolar lavage in Kashmir: an audit of findings.

OBJECTIVE: To study bronchoalveolar lavage (BAL) findings in various respiratory diseases in children in Kashmir India. DESIGN: Prospective observational study. SETTING: Paediatric department of the tertiary care hospital. PATIENTS: Children of both genders from 1 month to 17 years of age INTERVENTION: All studied patients underwent flexible bronchoscopy and BAL. OUTCOME MEASURE: To observe the BAL findings in various respiratory diseases in the studied population. RESULTS: A total of 283 patients underwent BAL procedure. The positive BAL report was received in 131 (46%) patients. Out of these, 55 (42%) patients had positive BAL culture/ microscopy for different bacterial (50) and fungal species (Candida spp (3), Mucormycosis (1) and Aspergillus (1)). MTB was isolated in 25 (19%) patients. Twenty-three (17.5%) patients had bronchoalveolar lavage fluid (BALF) positive for pulmonary hydatidosis. Foamy macrophages were seen in 13 patients, significant eosinophilia in nine patients and hemosiderin-laden macrophages were seen in three patients. CONCLUSION: We found BALF a very useful sample for the evaluation of many infective and non-infective respiratory diseases in our region, which otherwise lacks high end diagnostics. 46% of our patients had some abnormalities in the BAL specimen. It provided us with valuable information regarding organism profile and drug sensitivity in case of lung infection. BALF analysis was also found useful in the diagnosis of some non-infective pulmonary disorders like acute eosinophilic pneumonia, aspiration syndromes and bronchial asthma.

Study on the effect of vehicular pollution on the ambient concentrations of particulate matter and carbon dioxide in Srinagar City.

The present study was carried out to monitor the ambient concentrations of particulate matter and carbon dioxide caused by vehicular pollution in Srinagar City of Jammu and Kashmir, India, for a period of 12 months from June 2019 to May 2020 as the major contributions in these areas are due to vehicular movement. Out of five, four locations (viz. Dalgate, Jehangir Chowk, Parimpora and Pantha Chowk) had highest traffic density in the city and the fifth location (Shalimar) had low traffic volume. The sampling was done on every fortnight using AEROCET 831-aerosol mass monitor and CDM 901-CO2 monitor with each sampling being carried out three times a day, i.e. morning (9:00 am-10:30 am), afternoon (1:00 pm-2:30 pm) and evening (4:30 pm-6:00 pm) with three replications at each site based on the peak traffic hours. The results show that during the whole period, average PM1 concentrations ranged from 15.10 to 108.9 µg/m3, PM2.5 (28.70-577.50 µg/m3), PM4 (44.50-780.87 µg/m3), PM10 (57.13-1225.53 µg/m3), total suspended particulates (77.77-1410.27 µg/m3) and CO2 (332.4-655.0 ppm). The average concentrations of these parameters showed that the maximum PM1 concentration was found at Dalgate (53.77 µg/m3) and PM2.5 had its maximum average concentration at Jehangir Chowk (140.13 µg/m3). Other parameters like PM4, PM10, TSP and CO2 had a maximum average values at Jehangir Chowk (240.23 µg/m3, 633.40 µg/m3, 853.50 µg/m3 and 533.20 ppm, respectively). The pollution load was observed to be maximum during winter season followed by autumn, summer and spring. The lowest concentration of all pollutants except CO2 was observed in April 2020 and this might be due to COVID-19 lockdown observed in the country during the same period.

Role of procalcitonin in diagnosis of community acquired pneumonia in Children.

BACKGROUND: The role of serum Procalcitonin (PCT) in adults in diagnosis of Community acquired pneumonia (CAP) is well established, however, role in pediatric CAP remains controversial. OBJECTIVES: The objective of this study was to investigate the utility of serum procalcitonin in differentiating bacterial community-acquired lower respiratory tract infection from non-bacterial respiratory infection in children; radiologically confirmed pneumonia was used as the reference. In addition, we assessed the utility of adding the PCT assay to the clinical criteria for diagnosis of pneumonia. STUDY DESIGN: Subanalysis of a larger prospective,multicentriccohort study. PARTICIPANTS: Children, 2 months to 59 months of age, attending paediatric OPD of 5 urban tertiary care hospitals, suffering from acute respiratory infection (ARI). INTERVENTION: Detailed clinical history and examination findings of enrolled children were recorded on predesigned case record form. Samples for PCT were obtained at admission and were measured centrally at the end of the study except for one site using VIDAS® B.R.A.H.M.S PCT kit (Biomerieux SA, France). OUTCOMES: Sensitivity and specificity of procalcitonin for diagnosis of radiologically confirmed pneumonia. RESULTS: Serum Procalcitonin was measured in 370 patients; median (IQR) age of these children being 12 (7, 22) months, 235 (63.5%) were boys. The median (IQR) serum procalcitonin concentration was 0.1(0.05, 0.4) ng/mL.Sensitivity and specificity of raised PCT (> 0.5 ng/mL) for pneumonia as per any CXR abnormalities were 29.7% and87.5%,(P < 0.001) respectively. Raised PCT was also significantly associated with consolidation (34.5%,79.2%,P < 0.02)and pleural effusion(54.6%,79%,P < 001). Adding PCT to the existing clinical criteria of WHO did not improve the sensitivity for diagnosis of pneumonia. PCT was significantly higher in children with severe pneumonia. CONCLUSION: Positive PCT (> 0.5 ng/mL) is significantly associated with radiographic pneumonia but not with pneumonia based on WHO criteria.However, it can act as a surrogate marker for severe pneumonia.

Risk of Hospitalization in Under-five Children With Community-Acquired Pneumonia: A Multicentric Prospective Cohort Study.

OBJECTIVE: To evaluate factors associated with risk of hospitalization in children with community-acquired pneumonia (CAP). DESIGN: Prospective cohort study. SETTING: Multi-site hospital based study. INTERVENTION: A separate acute respiratory tract infection (ARI) treatment unit (ATU) was established. The revised WHO case definition for ARI was used across all the study sites to ensure uniformity in management of ARI patients (2-59 months). Clinical history, examination findings and investigations of enrolled patients were recorded on a predesigned case record form. Children were followed up at 1 week (± 1 day). MAIN OUTCOME MEASURE: Risk factors for hospitalization among pneumonia patients. RESULTS: A total of 7026 children with the diagnosis of ARI were enrolled. Pneumonia was diagnosed in 938 (13.4%) patients (median (IQR) age: 15 (8, 25) months; 63.5% boys). Hospitalization was needed in 56.8% of pneumonia patients. On multi-variate analysis, factors associated with risk of hospitalization were: Oxygen saturation on pulse oximetry (SpO2) <92% in room air (OR 7.04; 95% CI 1.6, 30.8, P=0.01), procalcitonin level >0.5 ng/mL (OR: 7.5, 95% CI: 1.0, 57.7, P=0.05), and lower weight for height z-score (OR 0.8; 95% CI: 0.6, 0.9, P=0.02). CONCLUSION: Present study found SpO2 <92% at room air, serum procalcitonin level >0.5 ng/mL and lower weight for height z-score to be predictors for risk of hospitalization in under-five children presenting with community acquired pneumonia. These factors can be utilized to assess a child with CAP regarding the need of hospitalization.

Role of Clinical Criteria and Oxygen Saturation Monitoring in Diagnosis of Childhood Pneumonia in Children Aged 2 to 59 Months.

BACKGROUND: Current WHO algorithm has retained the signs and symptoms used in the older version for classifying severity of childhood pneumonia. OBJECTIVE: To study the role of clinical features (including that of current WHO criteria), and oxygen saturation (SpO2) in the diagnosis of childhood pneumonia. STUDY DESIGN: Multicenter prospective cohort study. PARTICIPANTS: Children, 2 to 59 months of age, suffering from acute respiratory infection (ARI). OUTCOME MEASURES: Sensitivity, specificity, and likelihood ratios were calculated for clinical features, and SpO2. RESULTS: Of a total 7026 children with ARI enrolled, 13.4% had pneumonia (37% of them had severe pneumonia), according to WHO criteria. Based on any abnormality on chest x ray (CXR), 46% had pneumonia. The sensitivity and specificity of the existing WHO criteria for diagnosis of pneumonia was 56.5% and 66.2%, respectively, when compared against abnormalities in CXR. Cough and fever, each had sensitivity of >80%. Audible wheeze and breathing difficulty, each had a specificity of >80%. Sensitivity and specificity of tachypnoea were 58.7% and 63.3%, respectively. None of the clinical features alone had a sensitivity and specificity of >80%. Addition of SpO2 of <92% to chest indrawing alone or WHO criteria increased the likelihood of diagnosis of pneumonia. CONCLUSIONS: Current WHO criteria based on rapid respiratory rate and/or chest indrawing has modest sensitivity and specificity, considering CXR abnormalities as gold standard for diagnosis of pneumonia. Addition of SpO2 of <92% to chest indrawing alone or WHO criteria increases the probability of pneumonia diagnosis, and is important in the management of a child with pneumonia.

Risk Factors for the Development of Pneumonia and Severe Pneumonia in Children.

OBJECTIVE: To identify the risk factors for pneumonia and severe pneumonia in children. DESIGN: Prospective cohort study. SETTING: Five tertiary-care teaching hospitals in India. PARTICIPANTS: Children 2 to 59 months of age suffering from acute respiratory infection (ARI). MAIN OUTCOME MEASURES: Risk factors for the development of WHO defined pneumonia and severe pneumonia. RESULT: A total of 18159 children screened, and 7026 (39%) children with ARI were enrolled. According to the WHO criteria, 938 (13.4%) and 6088 (86.6%) of the enrolled children had pneumonia and no pneumonia, respectively. Out of 938 children with pneumonia, 347 (36.9%) had severe pneumonia. On univariate analysis, younger age, male gender and low weight for height, were significant risk factors for pneumonia. On multivariate analysis, one-unit increase in age in months (OR = 0.97; 95% CI: 0.97-0.98) and weight for height z-score (OR = 0.76; 95% CI: 0.72-0.79) had a protective effect. CONCLUSIONS: Young age and undernutrition (low weight for height/length) in children are significant independent risk factors for pneumonia.

Airway Microbiology in Children with Cystic Fibrosis: A Prospective Cohort Study from Northern India.

OBJECTIVE: The objective of this study is to find the organism profile and antimicrobial susceptibility patterns in children with cystic fibrosis (CF). DESIGN: Prospective cohort study. SETTING: Hospital-based study. INTERVENTION: Sputum cultures/throat swabs were collected from the study population. Relevant details like anthropometry, systemic examination findings and investigations were entered in a pre-designed format. Sputum culture was subjected to microbiological analysis at the hospital microbiology laboratory. MAIN OUTCOME MEASURE: Prevalence of positive sputum/cough swab culture in CF patients, their organism profile and antibiotic sensitivity. RESULTS: A total of 63 patients were enrolled in the study. A total of 136 organisms were grown in our study population. Thirteen different organisms were isolated, which included five gram-positive bacteria, six gram-negative bacteria, eight Candida spp. and one filamentous. Antibiotic sensitivity profile of the Pseudomonas aeruginosa showed excellent sensitivity to all the aminoglycosides, piperacillin-tazobacteum and polymixin, similarly methicillin-sensitive Staphylococcus aureus, methicillin-resistant S. aureus and Enterococcus spp. were uniformly sensitive to vancomycin, linezolid and teicoplanin. Fungal isolates showed 100% sensitivity to all the antifungals tested including azoles and amphotericin B. CONCLUSION: We observed 61% of culture positivity for different organisms in our study. Staphylococcus aureus and P. aeruginosa were the most frequently isolated organisms. Pseudomonas aeruginosa isolates were largely sensitive to aminoglycosides, carbapenems and polymixin. We found an unusually higher incidence of enterococcal infection in our study cohort with few vancomycin-resistant isolates.

Clinical Profile and Risk Factors for Severe Disease in 402 Children Hospitalized with SARS-CoV-2 from India: Collaborative Indian Pediatric COVID Study Group.

INTRODUCTION: There is a lack of large multicentric studies in children with COVID-19 from developing countries. We aimed to describe the clinical profile and risk factors for severe disease in children hospitalized with COVID-19 from India. METHODS: In this multicentric retrospective study, we retrieved data related to demographic details, clinical features, including the severity of disease, laboratory investigations and outcome. RESULTS: We included 402 children with a median (IQR) age of 7 (2-11) years. Fever was the most common symptom, present in 38.2% of children. About 44% had underlying comorbidity. The majority were asymptomatic (144, 35.8%) or mildly symptomatic (219, 54.5%). There were 39 (9.7%) moderate-severe cases and 13 (3.2%) deaths. The laboratory abnormalities included lymphopenia 25.4%, thrombocytopenia 22.1%, transaminitis 26.4%, low total serum protein 34.7%, low serum albumin 37.9% and low alkaline phosphatase 40%. Out of those who were tested, raised inflammatory markers were ferritin 58.9% (56/95), c-reactive protein 33.3% (41/123), procalcitonin 53.5% (46/86) and interleukin-6 (IL-6) 76%. The presence of fever, rash, vomiting, underlying comorbidity, increased total leucocyte count, thrombocytopenia, high urea, low total serum protein and raised c-reactive protein was factors associated with moderate to severe disease. CONCLUSION: Fever was the commonest symptom. We identified additional laboratory abnormalities, namely lymphopenia, low total serum protein and albumin and low alkaline phosphatase. The majority of the children were asymptomatic or mildly symptomatic. We found high urea and low total serum protein as risk factors for moderate to severe disease for the first time.

Role of Flexible Bronchoscopy in Ventilator-Dependent Neonates.

OBJECTIVE: To assess the usefulness and safety of flexible bronchoscopy in ventilated neonates with extubation failure. METHODS: This was a prospective observational study. Flexible bronchoscopy was done in eligible patients with failure of extubation form invasive ventilation. The main outcome measure was to find the presence of any anatomic or dynamic abnormalities of the airways of these patients and the organism profile of bronchoalveolar lavage (BAL) fluid. RESULTS: Forty-eight babies (68.8% preterm) were enrolled in the study. The most common finding on bronchoscopy was airway edema seen in 13 (27%) patients. BAL culture was positive in 29 (74%) patients. Overall treatment was modified in 35 (73%) patients based on bronchoscopy findings/BAL culture. Majority of infants (83.3%) tolerated the procedure very well. CONCLUSIONS: Flexible bronchoscopy provides useful information in the management of newborn babies with extubation failure.

Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals.

OBJECTIVE: Intussusception has been linked with rotavirus vaccine (RVV) as a rare adverse reaction. In view of limited background data on intussusception in India and in preparation for RVV introduction, a surveillance network was established to document the epidemiology of intussusception cases in Indian children. METHODS: Intussusception in children 2-23 months were documented at 19 nationally representative sentinel hospitals through a retrospective surveillance for 69 months (July 2010 to March 2016). For each case clinical, hospital course, treatment and outcome data were collected. RESULTS: Among the 1588 intussusception cases, 54.5% were from South India and 66.3% were boys. The median age was 8 months (IQR 6, 12) with 34.6% aged 2-6 months. Seasonal variation with higher cases were documented during March-June period. The most common symptoms and signs were vomiting (63.4%), bloody stool (49.1%), abdominal pain (46.9%) and excessive crying (42.8%). The classical triad (vomiting, abdominal pain, and blood in stools) was observed in 25.6% cases. 96.4% cases were diagnosed by ultrasound with ileocolic location as the commonest (85.3%). Management was done by reduction (50.8%) and surgery (41.1%) and only 1% of the patients' died. 91.1% cases met Brighton criteria level 1 and 3.3% Level 2. Between 2010 and 2015, the case load and case ratio increased across all regions. CONCLUSION: Intussusception cases have occurred in children across all parts of the country, with low case fatality in the settings studied. The progressive rise cases could indicate an increasing awareness and availability of diagnostic facilities.

Proceduralist Given Sedation is Safe and Feasible in Pediatric Flexible Bronchoscopy.

The objective of this research was to study the effectiveness and safety of proceduralist given sedation in pediatric flexible bronchoscopy. Flexible bronchoscopy was performed in all 267 patients. All patients received midazolam and/or ketamine. The median (interquartile range [IQR]) age of the studied population was 16 (18) months. The indication of bronchoscopy varied. The mean ± standard deviation (SD) dose of midazolam was 0.109 (0.03) mg/kg and that of ketamine was 1.17 (0.43) mg/kg. We observed minor side effects of procedural sedation. All patients underwent procedure successfully. Flexible bronchoscopy in children can be safely performed under sedation using a combination of midazolam and ketamine.

Vitamin D status correlates with the markers of cystic fibrosis-related pulmonary disease.

BACKGROUND: The prevalence of Vitamin D deficiency remains high in cystic fibrosis despite daily supplementation. Vitamin D as an immunomodulator has been related to lower respiratory tract infections in children. The present study was undertaken to examine the association between vitamin D status and markers of cystic fibrosis-related pulmonary disease including exacerbations, bacterial colonization and pulmonary function. METHODS: The study includes review of records of 51 cystic fibrosis patients. Baseline patient variables and serum vitamin D levels were recorded. Based on vitamin D levels study patients were divided into three groups: vitamin-D sufficient (≥20 ng/mL), vitamin-D insufficient (12 to 20 ng/mL), and vitamin D-deficient (≤12 ng/ml). RESULTS: The proportion of children with deficient, insufficient and sufficient vitamin D levels were 47.1%, 15.7%, and 37.2%, respectively. Female sex, bacterial colonization and a greater number of exacerbations were associated with highest odds of developing vitamin D deficiency in patients with CF with 1.77 (0.22-4.61) (p = 0.002), 2.9(0.57-14.82) (p = 0.011), and 5.12 (1.28-20.50) (p = 0.021) respectively. The comparison of vitamin-D levels taken during exacerbations, colonization and during routine follow-up were significant [16.04 (7.42-27.91), 24.3 (15.5-32.4) and 48.54 (18.37-78.7) ng/ml, p < 0.001]. The FEV1 was determined in 24 patients; the comparison was significant between vitamin D-deficient and -sufficient groups [0.75 (0.717-0.777) vs. 0.82 (0.74-0.92) p < 0.05]. CONCLUSION: We concluded that vitamin D deficiency was highly prevalent in children with CF, despite daily supplementation of the vitamin in diet. Further, vitamin D deficiency was associated with a higher rate of pulmonary exacerbations and higher incidence of pulmonary bacterial colonization. In addition, in younger patients, low vitamin D levels were associated with reduced pulmonary function.

Vehicular stress a cause for heavy metal accumulation and change in physico-chemical characteristics of road side soils in Pahalgam.

In an effort to determine vehicular impact on soil quality, soil samples were collected from three different zones (Pahalgam, Batakote, and Chandanwari) in Pahalgam forest ecosystem. Results showed that a significant decrease in moisture content, organic carbon, available nitrogen, and potassium was observed in nearby road side soils. However, pH was observed to be on neutral side and available phosphorus recorded high concentration. The concentration of heavy metals Pb2+, Cu2+, Zn2+, Ni2+, and Cd2+ estimated was also significantly high. Furthermore, concentration of Pb2+ at high vehicular load subzones was observed to be highest (1.168 mg/Kg) followed by Zn2+ (0.896 mg/Kg), Ni2+ (0.649 mg/Kg), Cu2+ (0.415 mg/Kg), and Cd2+ (0.079 mg/Kg). An inter-zone analysis revealed that the concentration of the heavy metals (Pb2+ > Ni2+ > Cd2+) was observed to follow the trend, Z-I > Z-II > Z-III. Variation along the temporal gradient and the impact on soil qualities were notably higher in summer. Vehicular pollution to a great extent impacts physico-chemical characteristics and more interestingly adds substantial concentration of heavy metals in soils.

Prevalence of Depression among Caregivers of Indian Children with Cystic Fibrosis.

OBJECTIVE: To study the prevalence of depression among caregivers of children with cystic fibrosis and its impact on the health and well being of these children. METHODS: This cross-sectional study was conducted in a tertiary care hospital from September 2015 through August 2016. Forty one parents of children receiving treatment at the Cystic fibrosis (CF) clinic were approached to be part of the study. Six families declined the request resulting in 85% recruitment rate. The Centre for Epidemiological Studies Depression Scale (CES-D) was used to assess depression score among caregivers. The CES-D provides clinical cut-off scores of ≥16 that help in identifying persons at risk for depression. CES-D was completed by the parent closely associated with care of the affected child. Main outcome measure was to find the number of caregivers of patients who has score of ≥16 on CES-D scale, and its effect on growth and respiratory exacerbations of the affected child. RESULTS: A total of 23 fathers and 12 mothers participated in the study. The mean age of male and female caregivers was 30.9 ± 5.4 and 27.8 ± 4.7 y respectively. Eighteen (51.4%) caregivers scored above the clinical cut-off on the CES-D in the index study with mean score of 22.0 ± 4.0. The mean CES-D score among non-depressive caregivers was 7.76 ± 4.2. Significant negative association was found between parental depression and child's health. Children with high parental CES-D score suffered significantly more respiratory exacerbations (3.83 ± 1.2 episodes) in last six months than parents with low CES-D score (2.18 ± 1.28 episodes) (p value = 0.00). Similarly, stunting was more commonly seen in patients with high caregiver CES-D score (15 vs. 7; P value = 0.01). CONCLUSIONS: A very high prevalence of caregiver depression was found in cystic fibrosis, which negatively impacted care and well being of the affected patients. Depression was more common in families with poor economic and education level.

The Diagnostic Dilemma of Traumatic Lumbar Puncture: Current Standing of Cerebrospinal Fluid Leukocyte Corrections and Our Experience With Cerebrospinal Fluid Biomarkers.

OBJECTIVE: To assess the diagnostic efficiency of cerebrospinal fluid markers of procalcitonin, lactate, and cerebrospinal fluid/serum lactate ratio for detecting bacterial meningitis during traumatic lumbar puncture, and to compare these markers with routinely used uncorrected and corrected leukocyte measurements. METHODS: Infants aged ≤90 days with traumatic lumbar puncture were prospectively studied. The diagnostic characteristics of cerebrospinal fluid assays of uncorrected and corrected leukocyte count, procalcitonin, lactate, and lactate ratio were described and compared. RESULTS: Considering the area under the curve (95% CI) analysis and standard cutoff values, the lactate-ratio (0.985 [0.964-0.989] at cutoff 1.2) had the best test indexes for identifying meningitis, followed by lactate (0.964 [0.945-0.984] at cutoff 2.2 mmol/L) and procalcitonin (0.939 [0.891-0.986] at cutoff 0.33 ng/mL) measurement, whereas the corrected total leukocyte count assay (0.906 [0.850-0.962] at cutoff 350 cells/mm3) had diagnostic properties moderately superior to uncorrected total leukocyte count measurement (0.870 [0.798-0.943] at cutoff 430 cells/mm3). CONCLUSION: Cerebrospinal fluid levels of procalcitonin, lactate, and lactate-ratio are reliable markers to diagnose bacterial meningitis in blood-contaminated cerebrospinal fluid.

Wernicke's encephalopathy in exclusive breastfed infants.

BACKGROUND: Kashmir has a population that largely consumes polished rice which is deficient in thiamine. Furthermore, lactating women in this region are prone to severe thiamine deficiency because of their traditional food avoidance practices. Infantile beriberi is common in exclusively breastfed infants of thiamine deficient mothers in Kashmir. METHODS: This was a one year prospective hospital-based study. We included 50 exclusively breastfed infants in our study. All patients were evaluated as per unit protocol including complete septic workup and metabolic workup. Most of our patients belonged to low and middle income group families, and mothers were on customary dietary restriction. Demographic and anthropometric data were collected from all the study participants. In addition, data regarding the treatments received by the study population and overall mortality were collected. RESULTS: The mean age, male:female ratio, and mean weight of the study population were 3.15±0.97 months, 1.5:1, and 5.1±1.1 kg, respectively. Traditional food avoidance practices were followed by 80% of the mothers. Irritability was observed in 40 (80%) patients. Blepharoptosis was observed in 30 (60%). Septic workup including cerebro spinal fluid analysis was normal in all patients. Predominant magnetic resonance imaging finding was bilateral basal ganglia hyperintensity. Whole blood thiamine diphosphate levels showed a drastic decrease (10-49 nmol/L). Ten percent of the study infants died. CONCLUSION: In exclusively breastfed infants, we observed acute infantile encephalopathy with epidemiological, clinical, biochemical, and radiological features suggestive of infantile Wernicke's encephalopathy and a favourable therapeutic response to thiamine supplementation during the acute stage.