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Preview: Journal of Tropical Pediatrics - current issue

Journal of Tropical Pediatrics Current Issue

Published: Mon, 28 Nov 2016 00:00:00 GMT

Last Build Date: Fri, 16 Dec 2016 03:44:16 GMT


In this issue 62/6


Acute Abdominal Pain as a Presenting Symptom of Beriberi in a Pediatric Patient


Vitamin B1 (thiamine) plays a fundamental role in the proper functioning of the nervous and cardiovascular systems and in glucose metabolism. Because of the inability of the human body to store large amounts of vitamin, continuous restoration through diet is necessary. In the pediatric population, thiamine deficiency has a broad spectrum of clinical presentations, making diagnosis difficult. In this article, we report the case of a 7-month-old child with thiamine deficiency presented with neurological symptoms and simulation of acute abdomen. The patient received thiamine replacement, which resulted in rapid reversal of metabolic alterations and significant improvement in the signs and symptoms. A detailed investigation of dietary history and careful nutritional assessment of every critically ill pediatric patient is necessary, regardless of the primary cause of hospitalization.

Histoplasma capsulatum Infection with Extensive Lytic Bone Lesions Mimicking LCH


Multiple lytic bone lesions in a child can be a manifestation of various diseases like Langerhans cell histiocytosis, metastatic neuroblastoma, leukemia, hyperparathyroidism, multifocal osteomyelitis and histoplasmosis. Disseminated histoplasmosis caused by Histoplasma capsulatum var. duboisii is well known to present with multiple osteolytic lesions in immunocompromised adults and is mostly restricted to the African subcontinent. Histoplasmosis seen in American and Asian countries is caused by Histoplasma capsulatum var. capsulatum, which presents with pulmonary and systemic manifestations and rarely bone involvement. We report a case of histoplasmosis, caused by H. capsulatum var. capsulatum with extensive lytic bone lesions in a 13 year old immunocompetent boy who presented with prolonged fever, weight loss and multiple boggy swellings. He responded to amphotericin and is currently on Itraconazole. This case is unique for extensive osteolytic lesions with H. capsulatum var. capsulatum infection in an immunocompetent child.

Assessment of Adequacy of Supplementation of Vitamin D in Very Low Birth Weight Preterm Neonates: A Randomized Controlled Trial


Objectives: To compare the effect of 400 IU and 1000 IU vitamin D for 6 weeks in very low birth weight preterm neonates.Design: Randomized, double-blinded controlled trial in a teaching hospital.Participants: Fifty very low birth weight preterm neonates.Intervention: Vitamin D 400 IU/day (Group 1) or 1000 IU/day (Group 2).Outcome measures: Change in serum calcium, phosphate, alkaline phosphatase (ALP), 25-hydroxy vitamin D (25-OHD), parathormone, incidence of skeletal hypomineralization and growth.Results: After 6 weeks of supplementation, the mean serum calcium and 25-OHD levels were significantly higher (p  <  0.001 each), while ALP and parathormone levels significantly lower (p  <  0.001 each) in group 2. Skeletal hypomineralization was lesser and growth better in group 2.Conclusion: Vitamin D supplementation in a dose of 1000 IU/day is more effective in maintaining serum calcium, phosphate, ALP, 25-OHD and parathormone levels with lower incidence of skeletal hypomineralization and better growth.

Is the WHO Guide on Essential Practice of Postpartum Newborn Care Used in a District Health Care Facility?


Background: It is unclear whether algorithms with evidence-based interventions are used in a setting where the work load is high and qualified staff is scarce to identify neonates with life-threatening conditions.Methods: The nurse-midwives’ knowledge and opinion about the World Health Organization (WHO) guide on postpartum newborn care were assessed in a hospital in Tanzania before and after training. Their adherence to this guide was evaluated by analysing 100 neonatal records. Results: Before training, 44% of the nurse-midwives were familiar with the WHO guide. All nurse-midwives supported the implementation of the guide. In all, 21% of the postpartum record forms were fully completed. Risk factors for illness were missed in 27%. Conclusion: Nurse-midwives’ expertise in the WHO guide on postpartum newborn care cannot be taken for granted. The complexity of this guide demands expertise and makes its use time-consuming and thus its practicability disputable in a setting with limited resources.

Association between the Specific UGT1A1 Promoter Sequence Variant (c-3279T>G) and Unconjugated Neonatal Hyperbilirubinemia


We investigated the association between c-3279T>G and unconjugated neonatal hyperbilirubinemia. In all, 141 neonates were recruited; 63 had hyperbilirubinemia necessitating treatment, and 78 with bilirubin < 7 mg/dl served as the control group. The frequency of occurrence of c-3279T > G allele was significantly higher in the hyperbilirubinemic (49.2%) than in the control group (25.6%). The homozygous (p = 0.001, OR = 17.7 and CI = 3.9–79.3) rather than the heterozygous state (p = 0.3, OR = 0.7 and CI = 0.3–1.6) was associated with hyperbilirubinemia. Among the hyperbilirubinemic group, comparison between the three genotypes, homozygous mutation, heterozygous mutation and the normal allele, revealed that the former was associated with significantly higher mean peak total serum bilirubin [mean ±  standard deviation (SD): 33.7 ± 8.2, 26.9 ± 2.8 and 21± 2.7, respectively, p-value = 0.0001], higher bilirubin/albumin ratio (p = 0.000) and a longer duration of hospital stay (p = 0.001). Homozygous c-3279T > G mutation represents an important risk factor for the development of neonatal hyperbilirubinemia.

Hematological Differences among Malaria Patients in Rural and Urban Ghana


Background: Scarce studies have addressed hematological differences of malaria in urban and rural regions.Methods: Full or complete blood cell counts from 46 and 75 individuals (age range from < 1 to 92 years) with uncomplicated malaria infection living in urban (Accra) and rural (Dodowa) Ghana, respectively, were assessed. Sickle cell trait and patients were excluded from the study.Results: Between overall groups, patients from Accra had significantly lower parasite count (p < 0.0001) and granulocyte number (p = 0.026). Children in Accra had a significantly lower parasitemia (p = 0.0013), hemoglobin (p = 0.0254), platelet count (p = 0.0148) and red blood cell levels (p = 0.0080) when compared with the children of Dodowa. In adults, mean cell hemoglobin (p = 0.0086) and parasite count (p < 0.0001) were significantly higher in Dodowa.Conclusion: These results indicate that children living in urban setting may experience a greater anemic effect to malaria as compared with those living in a rural setting.

Alarmingly High Incidence of Eosinophilia in Barabanki and Neighboring Districts of Eastern Uttar Pradesh: A Prospective Hospital-Based Study


Eosinophilia is very common among rural poulation in Barabanki and neighbouring districts with no access to hygienic mode of stool disposition. Significant proportions of these children are suffering from anemia, undernutrition, anorexia, pain abdomen, cough and hence long term morbidity. This adds to the DALY of a developing country like India. All these chronic problems are preventable and treatable with simple corrective steps of which the most important ones are access to safe drinking water and toilet. The present study was conducted to study clinical and laboratory profile of patients with eosinophilia and to identify possible causes

Efficacy and Safety of Saccharomyces boulardii in Acute Rotavirus Diarrhea: Double Blind Randomized Controlled Trial from a Developing Country


Objective: To study the efficacy and safety of Saccharomyces boulardii (SB) in acute childhood rotavirus diarrhea.Methods: Children (3 months to 5 years) with WHO-defined acute watery diarrhea and stool rotavirus positive (n  =  60) were randomized into intervention (n  =  30) and control (n  =  30) groups. The intervention group received SB (500 mg/day) for 5 days.Results: The median duration (hours) of diarrhea was significantly shorter in the intervention group (60 vs. 89; 95% CI: −41.2 to − 16.8). A significantly shorter duration of hospitalization (74 vs. 91; 95% CI: −33.46 to − 0.54) was also seen in the intervention group, but no significant difference was seen for fever and vomiting. There was also no difference between the two groups in the proportion of children requiring parenteral rehydration and persistence of diarrhea lasting beyond day 7. There was no report of any adverse events.Conclusions: The present trial showed that SB is effective and safe in acute rotavirus diarrhea.

Impact of Telemedicine in the Screening for Congenital Heart Disease in a Center from Northeast Brazil


Objectives: To describe the incidence of congenital heart disease before and after the establishment of a telemedicine screening program, in a reference center from Northeast Brazil.Methods: This is a descriptive, retrospective and comparative study based on the institutional data from a reference center in perinatology for a period of 16 years. Institutional data were collected from a 16-year period (2001–15). Data were divided into two periods: prior to (2001–11) and after (2012–15) the establishment of a telemedicine screening program.Results: After the implementation of the screening process, almost all kinds of heart disease showed a significant increase in their incidence (p  <  0.05). With this, the incidence of major heart diseases approached those specified in developed regions.Conclusion: The implementation of a screening process model for congenital heart diseases can change the context of patients with congenital heart diseases in poor regions.

N-acetylcysteine in Cleistanthus collinus Poisoning: A Report of Two Cases in Children


Cleistanthus collinus, also known as Oduvanthalai in Tamil, is the most commonly encountered plant poison in southern India. The leaves are used for poisoning humans (suicide or homicide) and animals (cattle and fish) and as an abortifacient, especially in rural south India. Although this poisoning is commonly reported in adults, data regarding the use of N-acetylcysteine in pediatric poisoning is lacking. We report two previously healthy male siblings of pediatric age group who ingested the liquid extracted from crushed leaves of this plant given to them by their mother as a means of deliberate harm. Both patients developed distal renal tubular acidosis, with hypokalemia. The younger sibling also developed myocardial toxicity. Other significant findings noted include hypocalcemia, hypomagnesemia and elevated liver enzymes. Both patients received supportive care along with N-acetylcysteine infusion, and showed complete recovery within 10 days.

A Community-based Study on Growth and Development of Under-Five Children in an Urbanized Village of South Delhi


Background: Optimal development of children in their early months and years has a bearing on their achievement levels later in life.Objectives: To assess the socio-emotional and cognitive development in children 0–5 years and to find out the proportion of children having developmental delay and its associated factors.Methods: A community-based cross-sectional study was carried out in 520 children in Delhi. Development was assessed using the Indian Council for Medical Research Development Screening Test.Results: In all, 10.6% of children <5 years old were found to be developmentally delayed. Maximum number of children (10.1%) were found to have a delay in the do main of ‘hearing language, concept development’. Of all the factors, the strongest association was found with stunting, paternal education, alcohol abuse, attendance in anganwadi/playschool.Conclusions: The study concludes that developmental delay is present in a sizable proportion of children <5 years of age and may be a significant factor in the overall achievement of life’s potential in them.