Evaluation of Micronutrients and Pro-Inflammatory Cytokines Levels in Nutritionally Deprived Children-A Tertiary Care Hospital-Based Study.

BACKGROUND: Severe acute malnutrition (SAM) is a significant public health problem in developing countries, including India, where a significant proportion of children suffer from malnutrition. OBJECTIVE: This research aims to investigate the factors contributing to severe acute malnutrition (SAM). Additionally, the study seeks to explore the relationship between micronutrient levels and pro-inflammatory cytokines in SAM children with and without clinical complications. Furthermore, the effectiveness of antibiotic treatment in SAM children without complications is evaluated. METHODS: The study involved three groups comprising 66 subjects each: a healthy control group, SAM children with complications, and SAM children without complications. Blood samples were collected, and various analyses were conducted, including biochemical, hematological, micronutrient, and pro-inflammatory marker quantification. The data were analyzed using SPSS version 22.0. RESULTS: The results indicate that the levels of IL-6, CRP, and TNF-α were significantly higher in the SAM group with complications compared to both the control group and the SAM group without complications. Zinc and copper levels were significantly lower in both SAM groups compared to the control group, and a negative correlation was observed between zinc levels and inflammatory markers. The study also assessed the efficacy of antibiotic treatment in SAM children without complications by comparing their weight, height, weight-for-height, and weight-for-age at baseline and after a 15-day follow-up period. Significant improvements in these parameters were observed in both the group receiving antibiotic treatment and the group not receiving antibiotic treatment. CONCLUSION: The findings suggest that a combination of antibiotic treatment and nutritional support can lead to significant clinical improvements in SAM children without complications. This study has important implications for the management and treatment of SAM in India and other developing countries.

A Randomized Controlled Trial on Comparison of Clinical Outcome in Uncomplicated SAM Managed with and without Antibiotics.

OBJECTIVES: To assess the clinical outcome of management of uncomplicated severe acute malnutrition (SAM) at community level with antibiotics vs. without antibiotics. METHODS: A randomized controlled trial was conducted on children aged 6 to 59 mo with uncomplicated SAM, selected randomly from rural areas of Kanpur. A total of 100 children were enroled and were randomized into two groups, the intervention group who were given antibiotics for a week and the control group who were not given antibiotics. Rest of the management was same. Demographic, clinical and anthropometric details of each child were taken. RESULTS: Gender and socio-economic status was comparable in both the groups. Anthropometric parameters (mean weight for age, height for age and weight for height) in both the groups were not significantly different at the time of enrolment and also at two weeks follow-up. At 2 wk follow-up, weight/height Z score in the intervention and control group were -1.29±0.84 and -1.45±0.93, respectively (p value = 0.436). CONCLUSIONS: It was concluded that whether antibiotics were given or not in the management of children with uncomplicated SAM, improvement in clinical and anthropometric parameters was seen without any significant difference.

Significance of Vitamin D on the Susceptibility of Gestational Diabetes Mellitus - A Meta-Analysis.

Vitamin D plays an important role in glucose tolerance by stimulating insulin secretion and evidences suggest a contradictory result on the association between vitamin D status and risk of developing gestational diabetes mellitus (GDM). The present updated meta-analysis has been undertaken to find out the joined effect of vitamin D status on the risk of effect GDM considering previously published articles. Data were collected through literature search using electronic databases to retrieve relevant published research articles using various combinations of the following keywords, "vitamin D," "vitamin D deficiency," "cholecalciferol," "25-hydroxyvitamin D," "25(OH) D," "gestational diabetes mellitus," and "GDM." A total of 36 studies including 7,596 GDM cases and 23,377 non-GDM controls were involved in this study. Overall, pooled meta-analysis showed that pregnant women diagnosed with GDM have 18% higher risk of GDM risk when compared with controls [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.10-1.25; P = 0.00] with high heterogeneity (I2 = 73.29). The mean difference was also significantly different between cases and controls (OR = -0.18, 95% CI - 0.22 to - 0.14; P = 0.00). Subgroup analysis showed significant results with age more than 30 years, Asian and European regions, and case-control, cross-sectional, and nested case-control study design. Low concentration of vitamin D is associated with the development of GDM. Although in future more studies especially systematically designed clinical trials based on vitamin D supplementation with large sample size on different population are needed to elucidate the exact concentration of vitamin D during pregnancy as well as before and after pregnancy.

Risk Factors of Recurrence of Febrile Seizures in Children in a Tertiary Care Hospital in Kanpur: A One Year Follow Up Study.

BACKGROUND: Febrile seizures are commonly seen in children and about one-third of the children develop a recurrence of febrile seizures. OBJECTIVES: The main objective is to study the risk factors associated with recurrence of febrile seizures in Indian children. METHODS: This prospective, longitudinal study was carried out in the Department of Pediatrics, GSVM Medical College, Kanpur. All children, 6 months to 5 years of age, attending the department from February 2015 to January 2016 presenting with first febrile seizures were included in the study and followed up for recurrence. RESULTS: Of 528 children, 174 (32.9%) had recurrence and 354 (67.1%) had a single episode of febrile seizures. Recurrence was more in children <18 months (41.3%) as compared to children ≥18 months (24.1%). Children with temperature 101°F during the seizure had a recurrence rate of 52.5% while recurrence was seen in only 17.2% in children with temperature ≥105°F. There was a significant declining trend of recurrence with increase in temperature. Recurrence was significantly more common in children with a family history of febrile seizures (45.5%) as compared to those without family history (27.8%). Multiple logistic regression analysis revealed that younger age at onset of first seizure, lower temperature during the seizure, brief duration between the onset of fever and the initial seizure, and family history of febrile seizures were risk factors significantly associated with recurrence of febrile seizures in children. CONCLUSION: Younger age at first seizure, short duration of fever before the onset of first febrile seizure, lower temperature at onset, and family history of febrile seizures are risk factors of recurrence of febrile seizures in children.

Anthropometric indicators as predictor of pre-diabetes in Indian adolescents.

INTRODUCTION: In India, there are approximately 41 million diabetics to date. Impaired glucose tolerance or pre-diabetes may occur as early as adolescence. OBJECTIVE: To find out the cut-off values of body mass index (BMI) and waist circumference to predict pre-diabetes in adolescents in north India. METHODS: A cross-sectional study was conducted among 526 students aged 17-19 years, in the Institute of Paramedical Sciences, Chatrapati Shahuji Maharaj University, Kanpur. A pre-tested questionnaire was used and the diagnostic criteria of the American Diabetic Association were applied. Receiver operating characteristic(ROC) analysis was used to assess the cut-offs of BMI and waist circumference for predicting prediabetes. RESULTS: ROC analysis showed that BMI is a good predictor of prediabetes for both boys and girls.Area under the ROC curve was 0.828 for boys and 0.838 for girls, respectively. The cut-off values of BMI for predicting prediabetes were identified as ≥22.8kg/m2 in boys and ≥20.5kg/m2 in girls. Upon ROC analysis for waist circumference, it was observed that it was a good predictor of prediabetes both for boys (area under the curve 0.804) and girls (area under the curve 0.795). The cut-offs for waist circumference for predicting prediabetes were found to be ≥82.5cm for boys and ≥80.3cm for girls. CONCLUSION: BMI and waist circumference estimation can be done for early detection of prediabetes in adolescents for further diagnostic evaluation and management.

Increment in vitamin D level and bone mineral accrual in children with vitamin D deficiency.

PURPOSE: To compare different regimens of vitamin D with respect to its serum increment levels and bone mineral accrual in vitamin D-deficient children. METHODS: Children identified as being vitamin D deficient (serum levels<20 ng/mL) were divided into 3 treatment groups by stratified block randomization (group 1, 4,000 IU/day of vitamin D3 plus 50 mg/kg/day calcium for 12 weeks; group 2, 30,000 IU/wk of vitamin D3 plus 50 mg/kg/day calcium for 12 weeks; and group 3, 300,000 IU of vitamin D3 once intramuscularly plus 50 mg/kg/day calcium). After regimen completion, each child received a maintenance dose of 400 IU/day vitamin D3 plus 50 mg/kg/day calcium. Their serum vitamin D level was measured after 3 and 12 months. Total body less head bone mineral concentration (BMC) and total body less head bone mineral density (BMD) were measured after 12 months. RESULTS: The mean increment in serum vitamin D levels from baseline to 3 months was significantly higher in group 3 than in groups 1 and 2, but the levels from 3 to 12 months were almost similar among all 3 groups. There were no significant differences among the 3 groups with respect to percentage increase of BMD and BMC. CONCLUSION: The injectable form of vitamin D was more efficacious than the oral forms in increasing the serum level to the normal range. All 3 regimens were equally effective in increasing the BMC and BMD. The 400 IU/day maintenance dose was sufficient to keep the serum level within the normal range.

Correlation between hypertension and hyperglycemia among young adults in India.

AIM: To assess the correlation between blood pressure levels and fasting plasma glucose levels among young adults attending Chatrapati Shahuji Maharaj University, Kanpur, India. METHODS: The present study was cross-sectional in nature, conducted among students in the Institute of Paramedical Sciences, Chatrapati Shahuji Maharaj University, Kanpur. Study subjects included 185 young adults. Among them, 94 were males and 91 were females, in the age group 17 to 19 years. RESULTS: Mean age among males was 18.5 ± 1.5 years and among females was 17.9 ± 1.8 years. Of the total 185 study subjects, 61 (32.9%) were classified as pre-diabetic and 20 (10.8%) as pre-hypertensive. Mean waist circumference, systolic blood pressure and serum high density lipoprotein did not vary significantly between normoglycemic and pre-diabetic subjects. However, the mean diastolic blood pressure of pre-diabetics (82 ± 5 mmHg) was significantly higher than normoglycemics (79 ± 6 mmHg). Mean serum cholesterol, serum triglycerides, serum low density lipoprotein (LDL) and serum very low density lipoprotein was also higher among pre-diabetic subjects in comparison to normoglycemic subjects and the difference was statistically significant. Upon multiple linear regression analysis, it was observed that body mass index (BMI) (ß = 0.149), diastolic blood pressure (ß = 0.375) and serum LDL (ß = 0.483) were significantly associated with fasting plasma glucose. Multiple linear regression with diastolic blood pressure as the outcome variable showed that BMI (ß = 0.219), fasting blood glucose (ß = 0.247) and systolic blood pressure (ß = 0.510) were significantly associated. CONCLUSION: A significant prevalence of pre-diabetes and pre-hypertension in young adults is a matter of concern therefore all young adults need to be targeted for screening of diabetes and hypertension and lifestyle modification.

Cut-off of body mass index and waist circumference to predict hypertension in Indian adults.

AIM: To determine the cut-off values of body mass index (BMI) and waist circumference to predict hypertension in adults in north India. METHODS: A community based cross-sectional study was conducted in 801 subjects in Kanpur, aged 20 years and above, using multistage stratified random sampling technique. A pre-tested structured questionnaire was used to elicit the required information from the study participants and the diagnostic criteria for hypertension were taken according to the Seventh Joint National Committee Report on Hypertension (JNC-7). Receiver operating characteristic (ROC) analysis was used to estimate the cut-off values of BMI and waist circumference to predict hypertension. RESULTS: The ROC analysis revealed that BMI is a good predictor of hypertension for both men (area under the ROC curve 0.714) and women (area under the ROC curve 0.821). The cut-off values of BMI for predicting hypertension were identified as ≥ 24.5 kg/m(2) in men and ≥ 24.9 kg/m(2) in women. Similarly, the ROC analysis for waist circumference showed that it is a good predictor of hypertension both for men (area under the ROC curve 0.784) and women (area under the ROC curve 0.815). The cut-offs for waist circumference for predicting hypertension were estimated as ≥ 83 cm for men and ≥ 78 cm for women. Adults with high BMI or high waist circumference had a higher prevalence of hypertension, respectively. CONCLUSION: Simple anthropometric measurements such as BMI and waist circumference can be used for screening people at increased risk of hypertension in order to refer them for more careful and early diagnostic evaluation. Policies and programs are required for primary and secondary prevention of hypertension.

Recurrent hyperphosphatemic tumoural calcinosis.

Tumoural calcinosis (TC) is a benign gradually developing disorder that can occur in a variety of clinical settings, characterised by subcutaneous deposition of calcium phosphate with or without giant cell reaction. We describe a case of 11-year-old girl presenting with recurrent hard swellings in the vicinity of shoulder and hip joints associated with elevated serum phosphate and normal serum calcium levels. TC has been mainly reported from Africa, with very few cases reported from India. After the diagnosis of hyperphosphatemic TC was established, the patient was treated with oral sevelamer and is under constant follow-up to detect recurrence, if any. The present case highlights the fact that although an uncommon lesion, TC must be considered in the differential diagnosis of subcutaneous hard lump in the vicinity of a joint.

Clinical predictors of hypoxemia in Indian children with acute respiratory tract infection presenting to pediatric emergency department.

BACKGROUND: In developing countries, facilities for measuring arterial oxygen saturation are not available in most settings, which make it difficult for health providers to detect hypoxemia in children with acute respiratory tract infection (ARI). Most health providers rely on symptoms and signs to identify hypoxemia and start oxygen therapy. Therefore, this study was conducted to determine the clinical predictors of hypoxemia in children with ARI. METHODS: It was a cross-sectional study carried out at the Pediatric Emergency Department of GSVM Medical College, Kanpur, India in children in the age group between 2 months and 5 years, presenting with ARI. All children with ARI attending the pediatric emergency department from April 2007 to September 2008 were included in the study. Clinical signs and symptoms including fever, cough, nasal flaring, inability to feed/drink, cyanosis, chest wall retraction, wheezing, grunting, tachypnea and crepitations were noted and oxygen saturation (SpO(2)) was measured. Hypoxemia was defined as SpO(2) <90%. RESULTS: Of the 261 children included in the study, 62 (23.8%) had hypoxemia. Chest wall retraction (sensitivity=90%), crepitations (sensitivity=87%), nasal flaring (sensitivity=84%), tachypnea (sensitivity=81%) and inability to feed (sensitivity=81%) were observed to be the most sensitive indicators of hypoxemia while the best predictors were cyanosis [positive predictive value (PPV)=88%] and nasal flaring (PPV=53%). CONCLUSIONS: Chest wall retraction was found to be the most sensitive indicator, and cyanosis was the most specific indicator for hypoxemia. Of all the clinical signs and symptoms of hypoxemia, none had all the attributes of being a good predictor. A new hypoxemia score has been designed using a combination of clinical signs and symptoms to predict the need for supplemental oxygen therapy.

Childhood obesity in India: a meta-analysis.

Developing countries are now facing the double burden of childhood underweight and obesity. Childhood obesity is a recent epidemic with a high magnitude in India. Therefore, the authors decided to assess the prevalence of overweight and obesity among Indian children. Studies were identified through computer-based and manual searches. Estimates of prevalence were studied using random effects meta-analysis. Nine studies including 92,862 subjects were identified and analysed. The prevalence of overweight was estimated to be 12.64% (95% CI 8.48-16.80%) and that of obesity to be 3.39% (95% CI 2.58-4.21%). Current evidence suggests that policies and interventions for children should prioritize reduction of obesity and overweight.

Prevalence and determinants of obesity in the adult population of Kanpur district -- a population-based study.

Worldwide, obesity is the most prevalent form of malnutrition. It is one of the most significant contributors to ill health and an indirect cause of morbidity and mortality resulting from hyperlipidaemia and glucose intolerance. Very few studies on the prevalence of obesity have been reported from developing countries like India. The present study was therefore undertaken to determine the prevalence of obesity and its predictors in the Indian community. The objectives are: (1) To determine the prevalence of obesity, (2) to study the relationship of obesity with age, (3) to identify the predictors of obesity. This community-based cross-sectional study was conducted on 801 subjects, aged 20 years and above in Kanpur District, using multistage stratified random sampling technique. Data was analysed using the software statistical package for social sciences 10.0.1 for windows. Prevalence of obesity was found to be 4.7%. An increase in body mass index was seen with increasing age. A higher prevalence of obesity was seen in the urban population and in women. Age, gender and daily intake of saturated fatty acids were found to be the main predictors of the obesity. An increase in the level of physical activity resulted in a decrease in the prevalence of obesity (odd's ratio = 0.36). Obesity is an emerging public health problem in the Indian population which indicates that intervention at the primary healthcare level, especially in diet and activity, are important for its prevention.