Effectiveness of the WHO Protocol for the Management of Shock in Children With Severe Acute Malnutrition.

Background The WHO protocol for the management of shock in children with severe acute malnutrition (SAM) is not supported by physiological evidence. In this study, we aimed to assess the effectiveness of the WHO treatment protocol in the management of shock in children with SAM. Methodology This cohort study included children aged 2-60 months with WHO-defined SAM and fulfilling the WHO criteria for identification of shock. The exclusion criteria included severe anemia (hemoglobin <4 g/dL), congenital anomalies, congenital heart defects, and chronic diseases. The WHO treatment protocol for the management of shock was used, and features of resolution of shock were assessed at eight and 24 hours. Oliguria was recorded at eight and 24 hours along with in-hospital mortality. Multiple logistic regression was used to determine predictors of mortality. Results Of 53 children, 40 (75.4%) were discharged and 13 (24.5%) expired. We observed significant resolution of features of shock at 24 hours compared to eight hours (35 (71.4%) vs. 10 (18.8%), p < 0.0001). Further analysis revealed a significant resolution of features of shock (p = 0.03) at 24 hours in both fluid-responsive (24 vs. 10) and fluid-refractory children (11 vs. 27) compared to eight hours. Multivariate analysis revealed that mechanical ventilation was positively related to death (odds ratio (OR) = 85, 95% confidence interval (CI) = 8.49, 860, p < 0.0001), and inotrope scores <20 (OR = 0.053, 95% CI = 0.004, 0.64, p = 0.021) and blood transfusion (OR = 0.025, 95% CI = 0.001, 0.61, p = 0.024) had favorable outcomes. Conclusions The WHO protocol for the management of shock in children with SAM is effective in fluid-responsive shock whereas evidence was inconclusive in fluid-refractory shock.

Clinical Profile and Outcome of COVID-19 Among Immunocompromised Children.

This retrospective study describes the clinical profile, risk of infection and outcome of coronavirus disease-19 in immuno-compromised children. It was found that children on immuno-suppressant medication has 2.89 times increased risk of infection (P=0.01). Disease manifestation was asymptomatic (P=0.01) or mild with predominant gastrointestinal symptoms (P=0.02) without alteration in immunosuppressive treatment regime.

Clinico-biochemical profile of sick children with severe acute malnutrition.

OBJECTIVE: Severe acute malnutrition (SAM) classified as edematous and marasmus, however, Kwashiorker represents the most severe phenotype of edematous malnutrition. The aim of this study was to describe the clinico-biochemical profile in sick children with severe acute malnutrition. MATERIALS AND METHODS: This is a descriptive cross-sectional study, which included children aged 6 to 60 months, fulfilling the World Health Organization (WHO) criteria of severe acute malnutrition. We collected data on demography, anthropometry, history, and clinical examination. Investigations included arterial blood gas analysis, serum electrolytes, calcium, serum albumin, and blood sugar. P value < 0.05 was considered significant. RESULTS: One hundred twenty-two children with SAM were recruited, out of which 65 (53.27%) had edematous malnutrition and 57 (46.7%) had nonedematous malnutrition. Out of total children, 90 (73.77%) were discharged from hospital, 18 (14.7%) died, and 14 (11.4%) were left against medical advice. Out of 122 children with SAM, edematous children were younger (25.7 vs. 34.5 months, P = 0.002). Children with edematous malnutrition were more likely to have pneumonia (P = 0.04), acute gastroenteritis (P < 0.001), hyponatremia (P = 0.04), metabolic acidosis (P = 0.005), and hypocalcemia (P = 0.006) when compared with nonedematous children. Edematous malnutrition has 1.3 and 1.4 times more risk of death and leave against medical advice (LAMA) respectively as compared to nonedematous malnutrition. Mortality was higher in edematous malnutrition (12, 66.6%) than nonedematous malnutrition (6, 33.3%). CONCLUSION: Edematous malnutrition was commonly prevalent in 1 to 3 years of children and clinical and biochemical abnormalities frequently co-exist with edematous malnutrition.

Mixed phenotypic presentation of autoimmune polyendocrine syndrome type II in adolescent female.

Autoimmune polyendocrine syndrome (APS) is a constellation of multiple endocrine and various autoimmune diseases. The hallmark features of APS are gradual onset, circulating autoantibodies, and tissue or organ infiltration by lymphocytes. There are genetic basis and failure of the immune system to maintain self-tolerance to a variety of molecules, which manifest as autoimmunity over a period of time. Age of onset of the syndrome may range from early infancy to adulthood, new onset of autoimmunity of the given syndrome can manifest thoughout life. We report a case of an adolescent female with endocrine and non-endocrine manifestation of APS, starting at a very young age of 7 years with nephritis and hypertension as an unusual association.

B-type Natriuretic peptide Levels and Outcome in Children With Severe Acute Malnutrition With Co-morbidity.

We studied the ability of B-type natriuretic peptide (BNP) in predicting mortality among 86 in-patients with severe acute malnutrition presenting with co-morbidity, and found that cut-off level of BNP ≥201 pg/mL in Receiver operating characteristics curve [AU-ROC 0.96 (95% CI 0.92,1.003, P<0.0001)] had high discriminative ability to distinguish between survivors and non-survivors.

Cardiac changes in children hospitalized with severe acute malnutrition: A prospective study at tertiary care center of northern India.

Severe acute malnutrition (SAM) may affect cardiac structure and function. Cardiac changes in sick children with SAM have received little attention in the literature. Children aged 6-60 months with SAM were cases, and age and sex matched children were controls. Cardiac biomarker levels were measured by the quantitative the Enzyme- linked immunosorbent assay (ELISA) method, and echocardiography was used to assess cardiac changes in all children. The study included 76 children in each group. Children with SAM had less left ventricular mass and increased myocardial performance index as compared with controls (p < 0.0001). Cardiac biomarker levels were increased in children with SAM (p < 0.0001). Cardiac changes and biomarker levels were comparable in children with edema and children without edema except creatine kinase-MB (p = 0.01).