Pancytopenia in celiac disease-A case series of 20 children.

Pancytopenia in children with celiac disease (CeD) is postulated to be due to nutritional deficiency such as vitamin B12, folate and copper or an autoimmune process resulting in aplastic anemia with hypoplastic marrow. In the present case series, we report the profile and explore the etiology of pancytopenia among children with CeD. There are only a few case reports of pancytopenia in children with CeD. We enrolled newly diagnosed cases of CeD and pancytopenia presenting in the celiac disease clinic over three years. Detailed evaluation was carried out for the cause of pancytopenia. We followed up on the cases for compliance and response to gluten-free diet at three months, six months and 12 months. Twenty patients were eligible for inclusion. They were divided into two groups: one with aplastic anemia with hypoplastic marrow labeled as Gp CeD-AA and the other with megaloblastic/nutritional anemia labeled as Gp CeD-MA. Patients in Gp CeD-MA presented with classical symptoms of CeD as recurrent diarrhea, abdomen distension, pallor and poor weight gain. They had none or just one transfusion requirement and had an early and complete recovery from pancytopenia. Patients in Gp CeD-AA presented with atypical symptoms such as epistaxis, short stature, fever, pallor and weakness. They had a multiple blood transfusion requirement and had delayed and partial recovery from pancytopenia. Pancytopenia is not a disease in itself but is the presentation of an underlying disease. It can occur due to various coexisting disorders in children with CeD, which can be as simple as nutritional deficiencies to as complex as an autoimmune process or malignancy. CeD should be included in the differential diagnosis of aplastic anemia as CeD and aplastic anemia both have a similar pathological process involving T cell destruction of tissues.

A Hospital-Based Multi-Centric Study to Determine the Clinico-Epidemiological Profile of Intussusception in Children < 2 Years in Rajasthan, India.

OBJECTIVE: To determine the clinical and epidemiological profile of Intussusception in children aged <2 y after introduction of rotavirus vaccine in Universal Immunization Programme of Rajasthan. METHOD: This was a hospital-based multi-centric surveillance study conducted at three tertiary care sentinel sites in Rajasthan over a period of 2 y. Children <2 y of age admitted with intussusception as per Brighton's criteria 1 were enrolled. Demographic details including age, sex, clinical presentation, diagnostic methods, duration of symptoms, mode of treatment, and complications were recorded and analyzed. RESULTS: During the study period of 2 y, the authors identified 164 cases of intussusception based on level-1 Brighton's criteria. Median age at presentation was 7 mo [Interquartile range (IQR) 5-10 mo] with a male to female ratio of 2:1. Pain abdomen and blood stained stool were the commonest presenting complaints (88.4% and 81.7%, respectively). Commonest site of intussusception was Ileocolic (82.32%). Pathological lead point was identified in 18.9% cases. Distinct seasonality was observed as maximum cases of intussusception were detected in the months of Jan-March (34.1%). Surgical intervention was required in the 89.63% cases. The median time duration between onset of symptoms and admission at sentinel site was 2 d (IQR 1-3 d). Proportion of cases that required surgery increased as the time interval between onset of symptoms and admission increases. CONCLUSION: Intussusception is a common surgical condition among children under-two years of age with majority of cases occurring during infancy. Case management is dependent primarily on time duration elapsed between symptoms onset and admission to tertiary care centre. Early case detection and timely referral may provide an opportunity to avoid surgical interventions.

Post Vaccination Epidemiology and Genotyping of Rotavirus Gastroenteritis at a Tertiary Care Centre of North-East Rajasthan.

OBJECTIVES: To estimate the proportion of rotavirus diarrhea among hospitalized children aged under-five years, to determine the circulating rotavirus genotypes and to know impact rotavirus vaccine on prevalence and severity of rotavirus diarrhea. METHODS: This study was a hospital based cross-sectional observational study conducted over a period of 29 mo (September 2017 through January 2020). Stool samples were collected from children who fall within the age range of 0-59 mo with acute diarrhea attending emergency or needing admission. Stool samples were tested for rotavirus by the enzyme linked immune-sorbent assay (ELISA) and genotyped using published methods. RESULTS: Out of 1480 samples, 360 (24.32%) cases were positive for rotavirus by ELISA, majority of them were male (62.97%). Maximum rotavirus positivity was found in the age group of <11 mo (55.27%). Statistically significance difference was seen in episodes of diarrhea and experience of vomiting in rotavirus diarrhea cases. Highest prevalence has been seen during winter season. The most prevalent G and P type combinations were G3P [8] strains [122 (34.08%)], G2P [4] [83 (23.18%)], G1P [8] [27 (7.54%)] and G9P [4] [20 (5.59%)]. Mixed strains contribute a significant proportion of stool sample. CONCLUSIONS: Rotavirus is an important cause of diarrhea in hospitalized children. There is continued circulation of G9 and G12 strains and the emergence of G3P [8] as most common strain.