Evaluation of malnutrition as a predictor of adverse outcomes in febrile neutropenia associated with paediatric haematological malignancies.

AIM: Malnutrition has been reported in the literature to be adversely associated with outcomes in paediatric malignancies. Our objective in this paper was to evaluate malnutrition as a potential predictor for adverse outcomes in febrile neutropenia associated with haematological malignancies. METHODS: A prospective observational study was performed in a tertiary care teaching hospital of Kolkata, India. Forty-eight participants, suffering from haematological malignancy, were included. Participants were included if they experienced at least one episode of febrile neutropenia. For children aged <5 years, weight for height, height for age and weight for age were used as criteria for defining malnutrition, while body mass index for age was used in children ≥5 years. A total of 162 episodes of febrile neutropenia were studied. RESULTS: Thirty patients (30/48, 62.5%) included in the study had malnutrition. In bivariate analyses at patient level, there is a strong association between malnutrition and death (odds ratio (OR) 7.286, 95% confidence interval (CI) 0.838-63.345, one-tailed P = 0.044), and life-threatening complications show a moderate trend towards significance (OR 3.333, 95% CI 0.791-14.052, one-tailed P = 0.084). Survival functions were significantly different between malnourished and non-malnourished children (log rank test χ(2) = 4.609, degree of freedom = 1, P = 0.032). Wasting was associated with life-threatening complications in children aged <5 years (OR 14, 95% CI 1.135-172.642, one-tailed P = 0.036). Logistic regression analyses at episode level revealed that phase of treatment and respiratory system involvement were significant predictors of death, while malnutrition was not. CONCLUSION: Malnutrition may be a potential predictor of mortality in febrile neutropenia.

Role of Enteric Supplementation of Probiotics on Late-onset Sepsis by Candida species in Preterm Low Birth Weight Neonates: A Randomized, Double Blind, Placebo-controlled Trial.

BACKGROUND: The increase in invasive fungal infections (IFIs) in neonatal intensive care unit (NICU) is jeopardizing the survival of preterm neonates. Probiotics modulating the intestinal microflora of preterm neonates may minimize enteral fungal colonization. AIMS: This study was to examine whether probiotic supplementation in neonates reduced fungal septicemia. MATERIALS AND METHODS: This prospective, randomized, double blind trial investigating the supplementation of preterm infants with a probiotic was done from May 2012 to April 2013, with 112 subjects randomized into two groups. PRIMARY OUTCOME: Decreased fungal colonization in gastrointestinal tract. Others: Incidence of late onset septicemia; duration of the primary hospital admission; number of days until full enteral feeds established. RESULTS: Full feed establishment was earlier in probiotics group compared to placebo group (P = 0.016). The duration of hospitalization was less in the probiotic group (P = 0.002). Stool fungal colonization, an important outcome parameter was 3.03 ± 2.33 × 10(5) colony formation units (CFU) in the probiotics group compared to 3 ± 1.5 × 10(5) CFU in the placebo group (P = 0.03). Fungal infection is less in the study group (P = 0.001). CONCLUSION: The key features of our study were reduced enteral fungal colonization, reduce invasive fungal sepsis, earlier establishment of full enteral feeds, and reduced duration of hospital stay in the probiotics group.

Profile of hepatic involvement by dengue virus in dengue infected children.

BACKGROUND: The spectrum of liver dysfunction in children with dengue infection is wide and has been associated with disease severity. AIMS: This study was undertaken to estimate the range of hepatic involvement in dengue infection in children. MATERIALS AND METHODS: This study assessed the biochemical and clinical profile of hepatic involvement by dengue virus in 120 children with serologically positive dengue fever (DF), aged 2 months to 14 years. RESULTS: All cases were grouped into DF without warning signs (Group 1), DF with warning signs (Group 2) and severe dengue (Group 3) according to revised World Health Organization 2009 criteria. The spectrum of hepatic manifestations included hepatomegaly (80.8%), hepatic tenderness (46.3%), jaundice (60%), raised aspartate transaminase (AST), alanine transaminase (ALT) and prolonged prothrombin time (41.7%) and reduced serum albumin (56%). CONCLUSIONS: Hepatic dysfunction was observed more in Groups 2 and 3. There was 84.4% and 93.75% ALT and AST elevation respectively in Group 2 and 94.5% and 95.9% ALT and AST elevation respectively in Group 3 and fulminant hepatic failure was observed in Group 3. Therefore in a child with fever, jaundice, hepatomegaly and altered liver function tests, the diagnosis of dengue infection should be strongly considered in areas where dengue infection is endemic.

Rhizomelic chondrodysplasia punctata with maternal systemic lupus erythromatosus.

We report Rhizomelic Chondrodysplasia Punctata (RDCP), a rare, autosomal recessive disorder with rhizomelic shortening of limbs, congenital cataracts and seizures but without any biochemical abnormality. The mother of the baby developed Systemic Lupus Erythromatosus (SLE) with Ro/SSA antibodies 11 months after delivery. Ro/SSA antibodies may generate calreticulin antibodies causing characteristic skeletal changes.

Deep vein thrombosis associated with dengue fever.

BACKGROUND: Hemorrhagic manifestations are common with Dengue but thrombotic events are uncommonly reported. CASE CHARACTERISTICS: 11-year-old boy who presented with ileo-femoral deep vein thrombosis associated with serologically confirmed infection with DEN1 dengue virus. OBSERVATION: There was no other history or investigation suggestive of a procoagulant state. OUTCOME: Successfully treated with enoxaparin and warfarin. MESSAGE: Thrombotic complications are possible with dengue infection.

Successful outcome in a HIV infected child presenting with Pre-B Acute Lymphoblastic Leukemia.

The present case is a 5 y old child with Pre-B Acute Lymphoblastic Leukemia (ALL), presenting with fever, pallor, purpuric spots, hepato-splenomegaly and lymphadenopathy of 20 d duration. During re-induction chemotherapy, he developed atypical skin lesions diagnosed as Varicella Zoster infection. He and his parents tested positive for anti HIV antibody. He entered complete remission and Anti-retroviral therapy (ART) along with maintenance chemotherapy has been initiated 3 mon ago. Acute leukemia is rare in HIV and probably this is the first case of Pre-B Acute Leukemia in association with perinatally transmitted HIV.

Anterior segment optical coherence tomography characteristics in an Asian population.

PURPOSE: To quantify the angle characteristics in an Indian population, and determine the prevalence of eyes at risk of angle closure. MATERIALS AND METHODS: This population-based cohort study was carried out to evaluate individuals, 40 to 59 years of age, clinically. The individuals underwent anterior segment optical coherence tomography of their right eyes in the horizontal meridian, using the enhanced protocol. RESULTS: The mean scleral spur angle for the population was 24.2±10.2 degrees, and a manually measured angle recess was 23.2±10.2 degrees, with a κ value of agreement of 0.78, 85.7%. An angle of <20 degrees was seen in 154 eyes, 38.7%, 20 to 30 degrees in 154 eyes, 38.7%, and >30 degrees in 90 eyes, 22.6%. An anterior chamber angle of <20 degrees was significantly associated with age, sex, and a steep iris configuration.The scleral spur angle and the manually recorded anterior chamber angle recess correlated very well with all angle ultrasound biomicroscopy parameters, but showed the highest receiver operating characteristic curve with trabecular iris space area 500, r=0.989 and angle opening distance 750, r=0.943. On multivariate analysis, there was a significant correlation with trabecular iris space area, angle opening distance, and height. CONCLUSIONS: Of individuals, 38.7%, 40 to 60 years of age, were found to have an anterior chamber angle of <20 degrees, reflecting the high prevalence of primary angle closure and primary angle closure glaucoma in India.

Granulocyte Colony-stimulating Factor for Preterms with Sepsis and Neutropenia: A Randomized Controlled Trial.

BACKGROUND: Bacterial sepsis is one of the major causes of mortality in newborn infants. Mortality increases when sepsis is associated with neutropenia. MATERIALS AND METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled trial of recombinant human granulocyte colony-stimulating factor on preterm neonates (gestational age (GA) <34 weeks) with sepsis and absolute neutrophil count (ANC) of <1500 cells/mm(3). Mortality, duration of Neonatal Intensive Care Unit (NICU) stay, hematological parameters (ANC, platelet count, and total leukocyte count) were compared between the two groups. The GCSF group (n=39) received GCSF intravenously in a single daily dose of 10 µg/kg/day in a 5% dextrose solution over 20-40 min for three consecutive days, while the control group (n=39) received placebo of an equivalent volume of 5% dextrose. RESULTS: Baseline demographic profile among the two groups was comparable. Mortality rate in the GCSF group was significantly lower than in the control group (10% vs. 35%; P<0.05). By day 3 of treatment, ANC in the GCSF group was significantly higher (3521±327) compared to 2094±460 in the control group, with P value being <0.05. Duration of NICU stay also decreased significantly in the GCSF group. CONCLUSION: The administration of GCSF in preterms with septicemia and neutropenia resulted in lower mortality rates. Further studies are required to confirm our results and establish this adjunctive therapy in neonatal sepsis.

Developing nomogram to estimate birth weight from head circumference and mid-upper arm circumference.

BACKGROUND: Despite the huge proportion of the babies in the developing world being born low birthweight, only about half of the newborns are weighed at birth as weighing scales often tend to be either non-available or defective. OBJECTIVE: Designing a nomogram for estimation of birthweight from head circumference (HC) and mid-upper arm circumference (MUAC). METHOD: Birthweight, HC and MUAC of 500 newborns who were admitted in the baby nursery of Medical College and Hospital, Kolkata between July 2010 to December 2010 were measured. RESULTS: Multiple linear regression equation for prediction of birth weight from MUAC and HC was derived and a nomogram was constructed from the same. CONCLUSION: The birthweight estimation nomogram is an inexpensive and convenient tool for use in the community setting where weighing machines may not be always available and may thus allow prompt and early referral.

Designing colour-coded measuring tapes based on mid-arm and chest circumference to predict low birth weight in the field.

BACKGROUND: In developing countries, 80% of the births take place in the community. METHODS: Birthweight, mid-arm and chest circumferences were measured in 294 newborns admitted in a tertiary-level hospital in Kolkata between April and August 2010. Colour-coded measuring tapes were devised using receiver operating characteristic curves to calculate the most sensitive and specific cut-off values to identify birthweight <2.5 and 1.8 kg. RESULT: There is no significant difference in accuracy of Mid-arm circumference (MAC) and Chest circumference (CC) for prediction of low birth weight and birthweight <1.8 kg. The tape has three zones, green [weight (wt) > 2.5 kg, MAC > 8.4 cm, CC > 30 cm], yellow (wt 2.5-1.8 kg, MAC 8.4-6.7 cm, CC 30-25.5 cm) indicating some risk, and red (wt < 1.8 kg, MAC < 6.7 cm, CC < 25.5 cm) indicating babies needing referral and admission in Level II neonatal care unit.

Dengue infection with multi-organ involvement.

Fever, headache, body aches, retro-orbital pain, haemorrhage and shock are well known manifestations of dengue infection. We report the case of a 4-y-old child with dengue who presented with meningo-encephalitis and subsequently developed myelitis, hepatitis, glomerulonephritis and bone marrow suppression. Complete recovery occurred within 3 weeks.