Clinical profile and severity of Plasmodium vivax and falciparum malaria in hospitalized children from North India.

BACKGROUND & OBJECTIVES: Malaria is the most common parasitic infection in children and the most common cause of mortality by vector-borne disease in tropical countries. In these endemic countries there is limited published literature on the clinical profile and severity of Plasmodium vivax malaria in children. We highlight the clinical presentations and severity of malaria in children belonging to Uttar Pradesh, North India Methods: This observational study was conducted in a tertiary care hospital, in Moradabad, western Uttar Pradesh, India. Children (aged 6 months-18 years) hospitalized from June 2019 to May 2020 with a clinical picture consistent with malaria along with a positive rapid malaria antigen test (RMAT) and/or positive peripheral blood smear for malaria were enrolled. All data about the clinical profile and laboratory features were recorded. Results were analyzed for significance using appropriate statistical tests for continuous and categorical data. RESULTS: One hundred children were enrolled in this study; 59 cases had Plasmodium vivax (PV) malaria, 33 cases had Plasmodium falciparum (PF) malaria, and 8 cases had mixed infections (both PV and PF). Among 59 children with P V malaria, 44 (74%) had severe malaria and 15 (26%) had uncomplicated malaria. Severe malarial anaemia (43.2%), followed by jaundice (36.4%), impaired renal function (21.6%), significant bleeding (18.9%), shock (18.9%), and prostration (16.2%), were the main severity parameters of malaria among these hospitalised children. Impaired renal function (P-value = 0.01) and unconsciousness (P-value = 0.02) were more frequent in Plasmodium falciparum cases. Other severity parameters were not significant between the vivax and falciparum species. INTERPRETATION & CONCLUSION: We conclude that a significant proportion of severe malaria was caused by Plasmodium vivax in this region, where both species coexist. Plasmodium vivax malaria is no longer the benign entity it was around ten years ago in hospitalised children. Severe malarial anaemia was the most common severity parameter found in both Plasmodium vivax and P. falciparum species. The clinical presentation and a change in the severity parameters in vivax malaria indicate a recent shift in the disease severity from benign to fatal.

Machine learning-based heart disease prediction system for Indian population: An exploratory study done in South India.

BACKGROUND: In India, huge mortality occurs due to cardiovascular diseases (CVDs) as these diseases are not diagnosed in early stages. Machine learning (ML) algorithms can be used to build efficient and economical prediction system for early diagnosis of CVDs in India. METHODS: A total of 1670 anonymized medical records were collected from a tertiary hospital in South India. Seventy percent of the collected data were used to train the prediction system. Five state-of-the-art ML algorithms (k-Nearest Neighbours, Naïve Bayes, Logistic Regression, AdaBoost and Random Forest [RF]) were applied using Python programming language to develop the prediction system. The performance was evaluated over remaining 30% of data. The prediction system was later deployed in the cloud for easy accessibility via Internet. RESULTS: ML effectively predicted the risk of heart disease. The best performing (RF) prediction system correctly classified 470 out of 501 medical records thus attaining a diagnostic accuracy of 93.8%. Sensitivity and specificity were observed to be 92.8% and 94.6%, respectively. The prediction system attained positive predictive value of 94% and negative predictive value of 93.6%. The prediction model developed in this study can be accessed at http://das.southeastasia.cloudapp.azure.com/predict/. CONCLUSIONS: ML-based prediction system developed in this study performs well in early diagnosis of CVDs and can be accessed via Internet. This study offers promising results suggesting potential use of ML-based heart disease prediction system as a screening tool to diagnose heart diseases in primary healthcare centres in India, which would otherwise get undetected.

Retinopathy of prematurity: risk factors and role of antenatal betamethasone in Indian preterm newborn babies.

BACKGROUND: Increase in the survival of preterm neonates has led to increased incidence of retinopathy of prematurity (ROP). Among various risk factors, only prematurity is well-established and role of others is still not clear. Effect of antenatal betamethasone on ROP severity is also controversial. Available literature from India has a paucity of information. OBJECTIVES: (a) The primary aim of the following study is to find the incidence and risk factors of ROP and (b) secondary aim is to assess the effect of antenatal betamethasone on ROP. DESIGN: prospective, observational cohort study. SETTING: Tertiary level neonatal care unit. MATERIALS AND METHODS: A total of 148 infants ≤ 34 weeks gestation at birth, completed the study protocol. Severe ROP was defined as stage II and higher (including plus disease) of ROP. Various perinatal factors including antenatal betamethasone were analyzed by univariate followed by multivariate analysis. RESULTS: overall incidence of ROP (any stage) was 44.6%. Severe ROP was mainly detected in <1200 g birth weight and/or <30 weeks gestational age. Antenatal betamethasone was associated with non-severe form of ROP (P < 0.05) on univariate analysis, but could not pass multivariate logistic regression analysis. Among other perinatal factors studied, low birth weight (<1200 g) (odds ratio [OR]: 19.699, 95% confidence interval [CI]: 2.42-160.17, P = 0.005), low gestational age (<30 weeks) (OR: 36.52, 95% CI: 3.76-354.3, P = 0.002), acidosis (OR: 6.932, 95% CI: 1.16-41.33, P = 0.034) and blood transfusion (OR: 14.11, 95% CI: 1.494-133.5, P = 0.021) were associated with babies in severe ROP in an independent manner. CONCLUSIONS: Low birth weight and low gestational age emerged as independent significant risk factors along with blood transfusion and acidosis. Antenatal betamethasone may be preventive for severe ROP. More studies are however recommended.

Schizencephaly of open and closed lip type in the same patient: An extremely rare occurrence.

Neuronal migration defects are rare causes of seizure disorder and developmental problems. Schizencephaly the most severe form is an extremely rare entity. Here a rare case of bilateral schizencephaly (open and closed type in the same patient) is reported.

Septic shock due to tuberculosis in Down syndrome.

Both Immune dysfunction and deficiency, are known in Down syndrome. Tuberculosis commonly presents as insidious illness and septicemic shock is its rare presentation, mostly in immunocompromized patients. We report a 16 year old boy with Down syndrome presenting with septicemic shock due to tuberculosis.

A rare clinical case of an unfortunately current pathology - foreign bodies.

Medication errors can cause various complications and some of these are fatal also. A very unusual complication, an esophageal foreign body, is described herein. It was a single tablet with intact wrapper, cut out from a blister pack which was unknowingly ingested by a child in toto. She was not instructed properly regarding administration of the drug. The peculiarity of this case concerns the type, location of the foreign body and need of clear instructions to be given to the patient for taking a medication.

Pediatric autoimmune neuropsychiatric disorders after streptococcus infection.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS) is a group of disorders recently recognized as a clinical entity. A case of PANDAS is described here, which remitted after 1 month of treatment. Recent Group A beta-hemolytic streptococcus infection should be considered in a child who presents with a sudden explosive onset of tics or obsessive compulsive symptoms.

Sjogren-Larsson syndrome: A case report of a rare disease.

We report a case of Sjogren-Larsson syndrome with clinical profile (spastic diplegia, icthyosis, mental retardation) and imaging findings on magnetic resonance imaging.