Impact of Pediatric Dentistry Residents Posted in Pediatrics Department: A Retrospective Assessment of 6 Years.

AIM: To measure the influence of rotatory pediatrics postings for dental residents on the outpatient census of the pediatric dentistry department. The secondary aims were to assess the change in trend toward the number of preschool children visiting the department before and after the initiation of pediatrics posting and also to find the percentage of children affected with caries among children visiting the pediatricians. MATERIALS AND METHODS: Retrospectively, the census of the pediatric dentistry department was calculated from 2010 to 2016. The number of preschool children who visited the pediatric dentistry department during this period was determined. From the pediatrics posting records, the dental status of the children, the number screened, the number referred, and the number reported to dentistry following referral were tabulated. Descriptive statistics and Chi-square tests were performed. RESULTS: After the initiation of pediatrics postings for residents, the outpatient census has increased by 26%. There was a significant increase in the number of preschool children visiting the pediatric dentist. About 57.09% of children screened in the pediatrics department had dental disease. CONCLUSION: There is an increase in the patient flow of the pediatric dentistry department with a greater number of preschool children visiting the pediatric dentist after initiation of the pediatrics postings for residents. More than half the children visiting pediatricians had dental disease requiring professional care. CLINICAL SIGNIFICANCE: Pediatrics postings for residents can be used in teaching centers as an opportunity to spread awareness and increase the number of preschool children visiting pediatric dentists, thereby increasing prevention and early intervention of early childhood caries. HOW TO CITE THIS ARTICLE: Mohan A, Muthu MS, Ramachandran P, et al. Impact of Pediatric Dentistry Residents Posted in Pediatrics Department: A Retrospective Assessment of 6 Years. Int J Clin Pediatr Dent 2021;14(1):84-87.

Impact of the introduction of the Haemophilus influenzae type b conjugate vaccine in an urban setting in southern India.

INTRODUCTION: Haemophilus influenzae type b was the leading cause of bacterial meningitis in infants and children below the age of two years prior to the introduction of H. influenzae type b conjugate vaccines. In December 2011, the Indian government introduced H. influenzae b vaccine in the state of Tamilnadu. A prospective surveillance for bacterial meningitis was established at the Institute of Child Health in Chennai to evaluate the etiology of meningitis and impact of the vaccine. MATERIAL AND METHODS: Infants aged one to 23 months who were admitted to the hospital with symptoms of suspected bacterial meningitis were enrolled and lumbar puncture was performed. Cerebrospinal fluid samples were analyzed for white blood cells, protein, and glucose. Bacterial culture and a latex agglutination test for common bacterial pathogens were performed. RESULTS: Between January 2009 and March 2014, 4,770 children with suspected bacterial meningitis were enrolled. Prior to the introduction of the vaccine, an average of 11.7 cases of H. influenzae b meningitis and 31.1 cases of probable meningitis with no etiology were identified each year. After introduction, the number of cases were reduced by 79% and 44% respectively. The average H. influenzae b vaccine coverage after introduction was 69% among all children with clinically suspected meningitis. In contrast, the mean number of aseptic meningitis and pneumococcal meningitis cases remained stable throughout the pre and post vaccination period; 28.2 and 4.8 per year, respectively. CONCLUSIONS: H. influenzae b conjugate vaccine reduced the number of cases of H. influenzae b meningitis and probable meningitis within the first two years of its introduction. The impact against meningitis was higher than the vaccination rate, indicating indirect effects of the vaccine. India has recently scaled up the use of Hib conjugate vaccine throughout the country which should substantially reduce childhood meningitis rates further in the country.

Bacterial meningitis in children <2 years of age in a tertiary care hospital in South India: an assessment of clinical and laboratory features.

OBJECTIVES: To assess the clinical and laboratory features of suspected meningitis to assist in the accurate diagnosis of bacterial meningitis in young Indian children. STUDY DESIGN: Children <2 years of age with clinical suspicion of meningitis were enrolled. Clinical and laboratory information was collected, and cases were classified based on cerebrospinal fluid findings as clinical, aseptic, or probable and confirmed bacterial meningitis. RESULTS: A total of 2564 children with suspected meningitis were enrolled over 45 months; 156 cases of aseptic and 51 cases of bacterial meningitis were identified. Stiff neck and bulging fontanelle were more common in bacterial meningitis (P < .05), but were present in <15% of patients. The World Health Organization and American Academy of Pediatrics classifications for high suspicion of bacterial meningitis were met in 84% and 88% of cases of bacterial meningitis, respectively, but were also present in 54% and 74% cases of aseptic meningitis. Culture and gram stain were positive in 7 (14%) and 4 (8%) cases of bacterial meningitis. CONCLUSIONS: Signs of bacterial meningitis and proposed criteria for high suspicion of bacterial meningitis are non-specific in this population. Standard microbiological tests for bacteria are insensitive in this setting, necessitating highly sensitive methods to identify bacterial meningitis.

Prospective multi-centre sentinel surveillance for Haemophilus influenzae type b & other bacterial meningitis in Indian children.

BACKGROUND & OBJECTIVES: Haemophilus influenzae type b (Hib) is one of the leading bacterial causes of invasive disease in populations without access to Hib conjugate vaccines (Hib-CV). India has recently decided to introduce Hib-CV into the routine immunization programme in selected States. Longitudinal data quantifying the burden of bacterial meningitis and the proportion of disease caused by various bacteria are needed to track the impact of Hib-CV once introduced. A hospital-based sentinel surveillance network was established at four places in the country and this study reports the results of this ongoing surveillance. METHODS: Children aged 1 to 23 months with suspected bacterial meningitis were enrolled in Chennai, Lucknow, New Delhi, and Vellore between July 2008 and June 2010. All cerebrospinal fluid (CSF) samples were tested using cytological, biochemical, and culture methods. Samples with abnormal CSF (≥10 WBC per µl) were tested by latex agglutination test for common paediatric bacterial meningitis pathogens. RESULTS: A total of 708 patients with abnormal CSF were identified, 89 of whom had a bacterial pathogen confirmed. Hib accounted for the majority of bacteriologically confirmed cases, 62 (70%), while Streptococcus pneumoniae and group B Streptococcus were identified in 12 (13%) and seven (8%) cases, respectively. The other eight cases were a mix of other bacteria. The proportion of abnormal CSF and probable bacterial meningitis that was caused by Hib was 74 and 58 per cent lower at Christian Medical College (CMC), Vellore, which had a 41 per cent coverage of Hib-CV among all suspected meningitis cases, compared to the combined average proportion at the other three centres where a coverage between 1 and 8 per cent was seen (P<0.001 and P= 0.05, respectively). INTERPRETATION & CONCLUSIONS: Hib was found to be the predominant cause of bacterial meningitis in young children in diverse geographic locations in India. Possible indications of herd immunity was seen at CMC compared to sites with low immunization coverage with Hib-CV. As Hib is the most common pathogen in bacterial meningitis, Hib-CV would have a large impact on bacterial meningitis in Indian children.

Risk factors for mortality in community acquired pneumonia among children aged 1-59 months admitted in a referral hospital.

OBJECTIVE: To determine the case fatality rate and factors for death in community acquired pneumonia among children aged 1 month to 59 months admitted in a referral Hospital. DESIGN: Hospital based retrospective study. SETTING: Institute of Child Health and Hospital for Children, Chennai. PATIENTS: Case records of children aged 1 month to 59 months of age with pneumonia (clinically diagnosed pneumonia, radiologically diagnosed pneumonia, and clinically and radiologically diagnosed pneumonia), from January 2006 to December 2008. Outcome measures Case fatality rate (CFR) was calculated. Risk factors for mortality analyzed were young age of 1 to 6 months old, female sex, wheeze, respiratory rate >70/min, chest indrawing, altered level of consciousness, convulsions, shock, associated heart disease, recent measles, weight for age <-2 Z score and need for assisted ventilation. The association of risk factors to mortality was arrived at for all three categories of pneumonia cases separately. RESULTS: Case fatality rate was 8.2% (95% CI: 7.37- 8.99%). There was no significant difference in the CFR among the three study groups. Need for assisted ventilation alone was found to be an independent risk factor for mortality in children with pneumonia among all the study groups. Other risk factors like young age, weight for age <-2 Z score, altered level of consciousness, and congenital heart disease were also observed among these groups. CONCLUSION: Among 1 month to 59 months old hospitalized children with pneumonia, CFR was 8.2%. Need for assisted ventilation was a significant risk factor associated with mortality.

Clinical profile of scrub typhus in children.

OBJECTIVE: To study the clinical profile and outcome of scrub typhus cases admitted in an urban referral centre. METHODS: This descriptive study describes the clinical profile of 67 children with scrub typhus, who were admitted in an urban referral centre(ICH & HC,Chennai) during the period between October 2010 and March 2011.The diagnosis was confirmed by IgM ELISA. RESULTS: All children presented with fever. Eschar and rash were present in 46% and 35% cases, respectively. Cough, vomiting, altered sensorium and oliguria were present in 73%,59%,58% and 43%, respectively. Hepatosplenomegaly and pallor were the commonest findings encountered in more than 80% children. Other findings were edema, lymphadenopathy and icterus.Thrombocytopenia, elevated liver enzymes and leukocytosis were seen in 77%, 64% and 49% cases, respectively. Pleural effusion, ascites, shock and respiratory failure were seen in 61%, 47%,45%,34% cases, respectively. Acute renal failure, hepatic failure, multiorgan dysfunction syndrome (MODS), meningoencephalitis and acute respiratory distress syndrome(ARDS) were seen in 10%,10%,7%,6% and 4% cases, respectively. Doxycycline and azithromycin were the antibiotics used. The overall mortality rate was 11.94%. Causes of death were shock, ARDS, acute renal failure(ARF), MODS and disseminated intravascular coagulation(DIVC). CONCLUSIONS: When a child presents with acute febrile illness, maculopapular or erythematous rash, hepatosplenomegaly, lymphadenopathy, thrombocytopenia and features suggestive of capillary leak, diagnosis of Scrub typhus must be considered and the child should be started on empirical therapy with doxycycline or azithromycin which is life saving.