Journal of Tropical Pediatrics - Advance Access

Development and Dysmorphism in Joubert Syndrome--Short Case Series from India

Koshy, B., Oommen, S. P., Jasper, S., Danda, S., Surendrababu, N. R.S. — Mon, 09 Nov 2009 03:38:17 PST

Five children with Joubert syndrome (JS), who fulfilled the criteria and had molar tooth sign (MTS) on magnetic resonance imaging were included in the study. Prominent forehead, open mouth and low set ears were consistent facial features. Severe developmental delay was seen in three children (66%). A differential developmental delay was noticed in all children and was independent of the radiological features. The children who had complications in the neonatal period were found to have more developmental delay on follow-up. The optimal control of sleep disturbances and hyperkinesis in one child resulted in a better cognitive performance. A regular neuro-developmental follow-up and interventions can optimize the potential of children with JS. In addition to the regular screening for retinal, renal and hepatic functions in JS, there is a need to monitor cognitive functions, sleep and behavior.

Association of Celiac Disease with Cardiomyopathy and Pulmonary Hemosiderosis

Narula, N., Rawal, P., Manoj Kumar, R., Ram Thapa, B. — Fri, 06 Nov 2009 20:54:06 PST

Celiac disease is predominantly a disease of the small intestine characterized by chronic malabsorption in genetically susceptible individuals who ingest grains containing gluten, such as wheat, barley and rye. Although previously believed to be uncommon, celiac disease may be present in up to 1% of the general population. Celiac disease is frequently associated with many extraintestinal disorders, but rarely with cardiomyopathy. We describe a patient with celiac disease associated with cardiomyopathy and pulmonary hemosiderosis.

Schistosomiasis haematobium prevalence and risk factors in a school-age population of peri-urban Lusaka, Zambia

Agnew-Blais, J., Carnevale, J., Gropper, A., Shilika, E., Bail, R., Ngoma, M. — Thu, 05 Nov 2009 07:23:13 PST

Given association of the parasite Schistosoma haematobium with coastal and rural/agricultural populations, there is little documentation to date of infection patterns in today’s rapidly urbanizing non-coastal regions. We conducted an observational study of 5–17-year-old school children (N = 1583) in peri-urban compounds of Lusaka, Zambia. Demographic information, medical history, physical examination findings and urinalysis results were recorded. Prevalence of schistosomiasis in the population was 20.72%. Significant risk factors for infection were male gender [odds ratio (OR) 2.42], age of 9–12 years or 13–17 years (OR 3.33 and 3.26, respectively, compared with 5–8-year-olds) and single and/or double orphan status (OR 1.43). Clinical officers detected schistosomiasis with a sensitivity of 24.70% and a specificity of 98.17% after history and physical examination. These results reveal that peri-urban populations have a significant but under-recognized vulnerability to infection, and suggest that only history and physical examination are inadequate for identifying a treatment population.

Effect of Season of Inoculation on Immune Response to Rubella Vaccine in Children

Wed, 04 Nov 2009 05:36:03 PST

The yearly seasons are marked by changes in the amount of sunlight. Ultraviolet radiation (UVR) is known to adversely affect the course of viral infections, immunologic memory and cellular and humoral immune responses. Our objectives were to investigate potential differences in the immune response of the rubella vaccine after 3–4 years by season of inoculation. Children aged 4–5 years attending four kindergartens in villages in northern Israel, all of whom had been vaccinated at 1 year of age, were enrolled in the study. Participants were divided into three groups by season of the year in which the inoculation was performed: summer (N = 63), winter (N = 36) and intermediate (N = 104). Main outcome measures were mean geometrical titer of rubella antibodies and complete, partial or no immunity to rubella by season of inoculation. Of the 203 children tested, 186 (91.6%) had adequate antibody levels, 7 (3.4%) had equivocal levels and 10 (4.9%) had inadequate levels. Significantly higher mean geometrical titers were found in the winter-inoculated compared with the summer-inoculated group (73.0 ± 2.6 vs 47.6 ± 2.8; p < 0.05). The same tendency was noted in the percent of infants properly immunized. This preliminary study shows a strong correlation between the immune response to rubella vaccine and the season of vaccination. Immunogenicity may be improved by inoculating children during seasons of less sunlight or by reducing the children's exposure to sunlight following inoculation. This practice is especially important in areas with extreme seasonal variability in solar radiation and tropical areas. Further studies are needed to corroborate and expand these findings.

Haplotype of IL-8 -251T and 781C is associated with the Susceptibility to Respiratory Syncytial Virus

Lu, A., Wang, L., Zhang, X. — Tue, 03 Nov 2009 06:13:50 PST

Objective: To study the association of haplotypes of IL-8 -251T/A and 781 C/T single nucleotide polymorphisms (SNPs) with the susceptibility of respiratory syncytial virus (RSV).

Methods: This study included 101 hospitalized patients under 2 years who suffered from RSV pneumonia and108 hospitalized patients under 2 years who suffered only from pneumonia without RSV infection. Genotypes of two SNP loci in all enrolled persons were defined by allele-specific polymerase chain reaction. The allele’s frequencies of SNPs were analyzed with case–control study, linkage of two loci and haplotypes composed by the two loci were also studied.

Results: (i) The frequency of IL-8 -251T in cases was dramatically high (OR = 2.08, p = 0.0002). (ii) Haplotype of TC was significantly high in cases (p = 0.01).

Conclusion: These findings support that haplotype of TC composed by IL-8 -251T and 781C is associated with the susceptibility of RSV.

Skin Sensitization and Classroom Exposure to Dermatophagoides Pteronyssinus and Dermatophagoides Farinae Allergens in Andean Ecuadorian Students

Fri, 30 Oct 2009 04:50:09 PDT

Association of Maternal Nutritional Status, Body Composition and Socio-economic Variables with Low Birth Weight in India

Sen, J., Roy, A., Mondal, N. — Fri, 30 Oct 2009 04:50:08 PDT

The present cross-sectional study examines the association of maternal nutritional status, body composition and socio-economic status with newborn low birth weight (LBW). It was conducted on 503 mothers and their singleton newborns in an urban hospital in Siliguri, West Bengal, India. The maternal anthropometric measurements (weight, height, mid-upper arm circumference and triceps skinfold), socio-economic variables (education, household income, occupation and birth order) and newborn birth weight were recorded. The average birth weight was 2.746 (±0.40) kg and 17.30% of the newborns had LBW. The multinomial regression analysis showed maternal age, height, weight nutritional status, birth order and household income to have significant associations with newborn LBW. The receiver operating characteristic curve–area under curve analysis showed maternal weight and mid-upper arm circumference to be the best surrogate measures of LBW.

Toxocariasis: Incidence, Prevalence and the Time Serum remains Positive in School Children from Campinas, SP, Brazil

Correa, C. R. S., Bismarck, C. M. — Thu, 22 Oct 2009 08:08:01 PDT

A Pilot Study of Comparison of BCPAP vs. VCPAP in Preterm Infants with Early Onset Respiratory Distress

Tagare, A., Kadam, S., Vaidya, U., Pandit, A., Patole, S. — Tue, 20 Oct 2009 06:48:51 PDT

Background: Bubble continuous positive airway pressure (BCPAP) is a low-cost nasal CPAP delivery system with potential benefits for developing nations. The objective of the study was to compare the efficacy and safety of BCPAP with ventilator CPAP (VCPAP) in preterm neonates with moderate respiratory distress.

Methods: In a pilot randomized controlled trial, 30 preterm neonates (gestation <37 weeks) with Silverman–Anderson score between 5 to 7 and oxygen requirement >30% within first 6 h of life were randomly allocated to BCPAP or VCPAP after informed parental consent. Proportion of neonates with success or failure, while using the allocated mode of CPAP delivery (primary outcome) was compared.

Results: The success rate was comparable [VCPAP: 80% (12/15) vs. BCPAP: 87% (13/15)] between the two groups. Dislodgement was commonest problem with equal frequency [10/15, (67%)] in each group.

Conclusion: BCPAP appears to be a promising method of CPAP delivery in preterm neonates with moderate respiratory distress.

Haematology: Clinical Cases Uncovered, 2nd Edition. Mc Cann S., Foa R., Smith O. and Conneally E.

Ebrahim, G. J. — Wed, 14 Oct 2009 05:40:25 PDT

Increased Umbilical Cord Plasma Interleukin-1{beta} Levels was Correlated with Adverse Outcomes of Neonatal Hypoxic-ischemic Encephalopathy

Liu, J., Feng, Z.-C. — Mon, 12 Oct 2009 01:38:44 PDT

To explore whether or not the umbilical blood levels of cytokines can be used to indicate the adverse outcomes of hypoxic-ischemic encephalopathy (HIE) patients. Umbilical artery blood and peripheral venous blood samples were collected on the 1st, 3rd and 7th days after birth to detect the levels of IL-1β, IL-8 and TNF-. Neurological examination and Denver developmental screening test (DDST-II) were performed at the 6 and 12 months evaluations to detect any neurodevelopmental abnormalities. The results showed: (i) the serum concentrations of IL-1β, IL-8 and TNF- in umbilical and peripheral blood were significantly higher in HIE patients than control groups; (ii) the umbilical blood concentrations of IL-1β exhibited the best positive correlation with HIE grades, when compared with IL-8 and TNF-; and (iii) abnormal neurological outcomes at 6 and 12 months of age were best predicted by umbilical levels of IL-1β. Thus, umbilical concentrations of IL-1β were associated with the grades and adverse outcomes of HIE.

Assessment of Cardiac Functions in Sickle Cell Anemia with Doppler Myocardial Performance Index

Arslankoylu, A. E., Hallioglu, O., Yilgor, E., Duzovali, O. — Fri, 09 Oct 2009 08:51:37 PDT

Background: The purpose of this study was to evaluate left and right ventricular functions by using the Doppler myocardial performance index (MPI), in children with sickle cell anemia (SCA).

Methods: We examined 32 patients with SCA and 30 age-matched healthy children. Echocardiography and Doppler examinations were completed for each of the subjects. MPI was calculated from the Doppler tracings.

Results: Compared with controls, left ventricle (LV) end-diastolic diameter, end-systolic diameter, early-diastolic mitral flow velocity and late-diastolic mitral flow velocity were significantly higher in the patients with SCA. Although, the LV ejection fractions were in the normal ranges in patients and controls, both LV and right ventricle (RV) MPI were significantly higher in patients than those in normal children.

Conclusion: MPI may be a useful noninvasive and sensitive tool for assessing the sub-clinical cardiac LV and RV dysfunctions in patients with SCA.

Prevention of Mother to Child Transmission of HIV in Burkina Faso: Breastfeeding and Wet Nursing

Nacro, B., Barro, M., Gaudreault, S., Dao, B. — Wed, 07 Oct 2009 06:58:00 PDT

Objective: A survey of the knowledge of women about HIV and breastfeeding.

Method and Patients: The study employed a voluntary questionnaire. Data were analyzed using Epi info 6 with ² test and P < 0.05 was considered as statistically significant.

Results: Three hundred women agreed to participate in the study. Only 82 realized that HIV could be transmitted by breastmilk. After information about HIV transmission, 37 stated that they would still breastfeed. On the other hand, 220 (74.1%) stated that they would accept breastfeeding by a wet nurse. Two hundred and eighty (69.8%) would accept to serve as the wet nurse for an infant born to an HIV-infected woman. There was an association between acceptance of HIV screening and willingness to breastfeed (P = 0.00206529).

Conclusion: Appropriate Prevention of Mother-To-Child Transmission (PMTCT) measures must be made available to HIV-infected women. Detailed studies must be performed to evaluate the feasibility of this approach in resource limited settings.

Self-reported weight status rather than BMI may be closely related to psychopathological symptoms among Mainland Chinese adolescents

Huang, L., Tao, F.-B., Wan, Y.-H., Xing, C., Hao, J., Su, P.-Y., Xing, X.-Y. — Thu, 01 Oct 2009 05:24:42 PDT

Evidence in respect of the psychological consequences of child and adolescent obesity is mixed. More studies indicated that mental health appears to be more strongly associated with concern about weight and shape, regardless of body mass index (BMI). Using the data from a national large school-based cohort (N = 10 403), we examined the association between obesity, perceived obesity and mental health. There was no relationship between BMI weight status and psychopathological symptoms after adjusting for weight perception and other factors for both genders. More importantly, it was determined that perception of weight as either underweight or overweight was related to higher behavioral symptoms and social adaptation problems. In conclusion, psychological well-being of adolescents is more related to weight perception than BMI is.

Residual Goiter in Semirom; Iodine Status and Thiocyanate Overload Do Not Play a Role

Thu, 01 Oct 2009 05:24:41 PDT

This study was performed to investigate the role of thiocyanate overload in the etiology of endemic goiter in schoolchildren of Semirom, Iran. A total of 1828 schoolchildren were selected by multi-stage random sampling. Urinary iodine concentration (UIC) and urinary thiocyanate (USCN) were measured in a group of these children. The median UIC was 18.5 µg/dl. The mean ± SD of USCN in goitrous and nongoitrous subjects did not differ significantly (0.75 ± 0.78 mg/dl vs. 0.63 ± 0.40 mg/dl; p = 0.30). Finally, we concluded that neither iodine deficiency nor thiocyanate overload contributed to the high prevalence of goiter in Semirom. The role of other goitrogenic factors should be investigated in this region.

Do Children with Adenotonsillar Hypertrophy have Lower IGF-1 and Ghrelin Levels than the Normal Children?

Sen, T., Aycicek, A. — Thu, 01 Oct 2009 05:24:40 PDT

Objective: This study was designed to determine serum insulin-like growth factor-1 (IGF-1) and plasma ghrelin levels in male children with adenoid and tonsillar hypertrophy and compare them with healthy controls.

Methods: This study included 29 male prepubertal children between the ages of 6.5 and10 years (mean age 8.8 ± 2.5 years) with obstructive adenoid and tonsillar hypertrophy and 20 normal male controls between the ages of 5.7 and 10.8 years (mean age 8.2 ± 2.9 years). Plasma ghrelin and serum IGF-1 levels were measured at 8.30, in the morning.

Results: Children with adenoid and tonsillar hypertrophy had significantly depressed serum IGF-1 levels (203 ± 150 ng ml^–1) and plasma ghrelin levels (175 ± 66 pg ml^–1) compared with healthy controls (354 ± 242 ng ml^–1 and 243 ± 93 pg ml^–1, respectively, P < 0.05).

Conclusion: Depressed levels of ghrelin in children with adenoid and tonsillar hypertrophy lead to decreased appetite and insufficient energy intake. Lower serum levels of IGF-1 in children with adenoid and tonsillar hypertrophy may be secondary to deficient growth hormone stimulation by ghrelin.

Prevalence of Rotavirus in Acute Diarrhea and its Association with Clinical Signs and Symptoms

Wed, 30 Sep 2009 08:31:37 PDT

Rotaviruses are the main etiological agents of acute infectious diarrhea in children. Thus, the objective of this study is to contribute to the information about the rotavirus variants circulating in Brazil. A cross-sectional study was conducted on 124 fecal samples collected from children up to the age of 5 years, with acute gastroenteritis. Thirty-one samples were positive for rotavirus A. Regarding the G genotyping, 16 (80%) were classified as G1 and regarding P genotyping all strains were classified as P[8]. The determination of the prevalence of rotavirus infection and the characterization of the viral strains circulating are expected to contribute to the information we have about the molecular biology and epidemiology of disease.

Prevalence of Proteinuria Among HIV-infected Children Attending a Tertiary Hospital in Lagos, Nigeria

Wed, 30 Sep 2009 08:31:37 PDT

Sub-Saharan Africa is the epicentre of the HIV pandemic but there are few reports of HIV-related kidney diseases in children in this region. This study aimed to determine the prevalence of proteinuria in HIV-infected children at the Lagos University Teaching Hospital. Proteinuria was determined using urine protein–creatinine ratio. CD4+ cell count was determined for all the HIV-infected children. The mean age of the HIV-infected children was 74.4 ± 35.6 months with a male: female ratio of 3:2. Compared with 6% of the 50 controls 20.5% of the 88 HIV-infected children had proteinuria (p = 0.026). Of 20 children with advanced clinical stage 40% had proteinuria compared with 14.7% of 68 children with milder stage (p = 0.004). Similarly, proteinuria was commoner among those with severe immunosuppression (p = 0.014). HAART use was not associated with significant difference in proteinuria prevalence (p = 0.491). Proteinuria was frequent among HIV-infected children, especially among those with advanced disease.

Evaluating a Simple Method of Neuroprotective Hypothermia for Newborn Infants

Horn, A.R., Harrison, M.C., Linley, L.L. — Wed, 30 Sep 2009 08:31:36 PDT

This study describes and evaluates a simple method of neuroprotective hypothermia for infants with hypoxic-ischaemic encephalopathy (HIE). Five term infants with HIE were cooled by applying soft, cold gel bags to the head. A radiant warmer, set to 34°C, servo-controlled the temperature measured at a probe between the infant’s back and the mattress. The infants’ heads were shielded from the warmer. After 72 h, the infants were re-warmed by 0.2°C per hour, by adjusting the radiant warmer. A rectal temperature of 34°C was attained in a median time of 45 min. Mean rectal temperatures during cooling were 33.9 ± 0.3°C. There was good correlation between insulated back temperatures and deep rectal temperatures (r = 0.76). There were no major or irreversible adverse events during cooling. This method of cooling achieved rectal temperatures within the target range of 33–34°C and re-warming was effective.

World Report on Child Injury Prevention * M. Peden, K. Oyebite, J. Ozanne-Smith, A.A. Hyder, C. Branche, F. AKM Rahman, F. Rivara, K. Bartolomeos (eds)

Ebrahim, G. J. — Wed, 30 Sep 2009 08:31:35 PDT

WHO Child Growth Standards. Growth Velocity Based on Weight, Length and Head Circumference. * Methods and Development

Ebrahim, G. J. — Wed, 30 Sep 2009 08:31:35 PDT

Medical Pharmacology at a Glance - 6th Edn. Neal M. J. (ed.)

Ebrahim, G. J. — Tue, 22 Sep 2009 08:32:50 PDT

The Accuracy of National Body Fat Cutoff Levels in the Prediction of Elevated Blood Pressure among Brazilian Male Adolescents

Tue, 15 Sep 2009 07:49:54 PDT

Objective: To assess viability of the development of percentage body fat cutoffs based on blood pressure values in Brazilian adolescents.

Methods: A cross-sectional study was conducted with a sample of 358 male subjects from 8 to 18 years old. Blood pressure was measured by the oscilometric method, and body composition was measured by dual-energy X-ray absorptiometry (DXA).

Results: For the identification of elevated blood pressure, these nationally developed body fat cutoffs presented relative accuracy. The cutoffs were significantly associated with elevated blood pressure [odds ratio = 5.91 (95% confidence interval: 3.54–9.86)].

Conclusions: Development of national body fat cutoffs is viable, because presence of high accuracy is an indication of elevated blood pressure.

Molecular and Epidemiological Trend of Sapovirus, and Astrovirus Infection in Japan

Fri, 11 Sep 2009 03:10:19 PDT

Antibiotic Resistance Patterns and Serotype Distribution in Streptococcus pneumoniae from Hospitalized Pediatric Patients with Respiratory Infections in Suzhou, China

Chen, R., Chen, Y., Black, S., Hao, C.-L., Ding, Y.-F., Zhang, T., Zhao, G.-M. — Fri, 11 Sep 2009 03:10:18 PDT

Behaviour Profiles After Tuberculous Meningitis

Wait, J. W., Schoeman, J. F. — Wed, 26 Aug 2009 08:11:35 PDT

The purpose of the study was to investigate child behaviour in children who recovered from tuberculous meningitis (TBM) and to compare behaviour profiles of stage II and stage III patients. The mean age of the cohort of 74 children at the time of evaluation was 10 years and 7 months. At follow-up all patients underwent a thorough neurological examination and a psychometric test battery, which included intellectual assessment and evaluation of behaviour by means of the CBCL/6–18. Results indicated elevated mean scores (T > 60) on CBCL/6–18 scales which measure problems with anxiety, depression, attention, social relationships, disruptive and rule-breaking behaviour. Mean CBCL scores of stage III patients were significantly higher than the mean scores of stage II patients on scales which measure social problems, disruptive and rule-breaking behaviour. In addition, problems with conduct, attention, attention-deficit/hyperactivity problems, affective problems as well as the total problem scores were more pronounced in the patients with stage III TBM. We conclude that general behavioural disinhibitions as well as internalized emotional disorder probably are long-term complications in more than 10% of the survivors of TBM.

Low Rates of Hepatotoxicity in HIV-infected Children on Anti-retroviral Therapy with and Without Isoniazid Prophylaxis

Wed, 26 Aug 2009 08:11:34 PDT

This study investigates the incidence of hepatotoxicity in HIV-infected children during anti-retroviral therapy (ART) and the impact of concomitant use of isoniazid preventive therapy. It is a retrospective cohort analysis of HIV-infected children who commenced ART or were followed up between September 1998 and November 2005. Alanine transferase levels were measured at baseline, at 1, 3 and 6 months and then 6 monthly thereafter. Of the 598 children included in the study, 425 were taking ART alone, 73 ART and isoniazid, 39 isoniazid alone and 61 neither isoniazid nor ART. There was no increased risk of hepatotoxicity with ART with or without isoniazid compared to the control group over a 2-year period. Grade 3 or 4 ALT elevations occurred in 19 (3.4%) children, with no cases of fulminant hepatic failure. Severe hepatic events are uncommon in children on ART or isoniazid. There is no increased risk of hepatotoxicity with ART and concurrent isoniazid preventive therapy.

Management of Scorpion Sting: Prazosin or Dobutamine

Gupta, B. D., Parakh, M., Purohit, A. — Wed, 26 Aug 2009 08:11:33 PDT

Objective: To compare the efficacy of Dobutamine and Prazosin in the management of cases with scorpion sting.

Setting: Pediatric intensive care unit of an affiliated hospital of a medical university.

Subjects: Forty-two children with scorpion sting.

Intervention: The involved victims were divided alternatively into two groups. Twenty-one patients were treated with intravenous Dobutamine infusion and other 21 received oral Prazosin.

Outcome measures: Percent-rise in left-ventricular ejection fraction in first 24 h after institution of the therapy, time taken in recovery from pulmonary edema, requirement of any additional drug and supportive measures, and mortality.

Results: The time taken in recovery from pulmonary edema was significantly shorter in cases treated with prazosin (28 ± 18.3 vs. 72 ± 0 h), the p-value being <0.05. Faster improvement of various parameters was observed in prazosin group in comparison to the dobutamine group. Mortality in both the groups was equal.

Conclusion: Prazosin and dobutamine, both are useful drugs for management of cardiovascular features of scorpion envenomation, nevertheless, prazosin is slightly better than dobutamine in terms of faster recovery, and also because of its ease of administration and low cost of therapy.

Association between Constipation and Stressful Life Events in a Cohort of Sri Lankan Children and Adolescents

Devanarayana, N. M., Rajindrajith, S. — Thu, 20 Aug 2009 09:02:41 PDT

Emotional stress is associated with some functional gastrointestinal diseases, but its role in aetiology of functional constipation is unclear. This island-wide, questionnaire-based, cross-sectional survey was conducted to assess the association between constipation and emotional stress, in 10–16-year-olds. Constipation was defined using Rome III criteria. Out of 2699 children included in the analysis, 416 (15.4%) had constipation. Constipation was higher in those exposed to stressful events (odds ratio 2.52, p < 0.0001). Separation from the best friend, failure in an examination, severe illness of a family member, loss of job by a parent, frequent punishment by parents and living in an area affected by separatist war remained independently associated with constipation (p < 0.05). In conclusion, constipation was significantly higher in children exposed to stressful life events. Modulation of gut motility through brain–gut axis probably alters colonic transit and ano-rectal functions, causing constipation.

Participation in a Parent Education Programme in the Dominican Republic: Utilization and Barriers

Farrelly, A. C., McLennan, J. D. — Mon, 10 Aug 2009 08:00:14 PDT

There has been a limited assessment of the extent of participation in parent education programmes and the factors influencing attendance. This is particularly the case for low- and middle-income countries. Experiences with an eight-session education programme offered to caregivers of malnourished children in the Dominican Republic were examined. Overall, 57% of a total of 143 caregivers completed more than half of the programme. This value increased from 41% to 79% following a midstream change in service delivery, which entailed concentrating the programme into a shorter period of time and pairing it with a more intensive child nutrition component. Other hypothesized variables did not predict attendance. Key barriers to attendance identified in qualitative interviews included lack of money for transportation, lack of an acceptable babysitter for other children and competing demands on the caregivers’ time. Efforts to eliminate caregiver identified barriers may improve participation levels.

A Modification in the Infusion System that Reduced Septicaemia in Newborn Infants

Lusyati, S., Harahap, F., Hulzebos, C. V., Sauer, P. J. — Mon, 10 Aug 2009 08:00:13 PDT

Rickettsial meningoencephalitis in a child--A case report

Tikare, N. V., Shahapur, P. R., Bidari, L. H., Mantur, B. G. — Mon, 10 Aug 2009 08:00:12 PDT

Severe central nervous system involvement has been reported in adults with Rickettsia conorii infection but rarely in children. We report here a serologically documented case of meningoencephalitis in a child caused by spotted group R. conorii. Rickettsial infection is a relatively under-diagnosed entity in children with fever and rash, probably due to low index of suspicion and the lack of definitive diagnostic facilities. Rickettsial infections can be treated effectively with anti-microbials; if they remain undiagnosed and untreated, they are associated with significant morbidity and mortality. This differential diagnosis should be considered when a child is seen with fever and rash.

The Burden of Pediatric Malignant Solid Tumors in a Developing Country

Ekenze, S. O., Ekwunife, H., Eze, B. I., Ikefuna, A., Amah, C. C., Emodi, I. J. — Wed, 05 Aug 2009 06:26:29 PDT

Objective: This study evaluates the burden of pediatric malignant solid tumors (PMST) in southeastern Nigeria.

Methods: Analysis of 174 cases of PMST managed at the University of Nigeria Teaching Hospital Enugu, from January 2002 to November 2007.

Results: PMST comprised 2.8% of pediatric admissions. Tumors encountered were lymphomas 77 (44.3%), Wilms’ tumor 35 (20.1%), sarcomas 20 (11.5%), neuroblastoma 15 (8.6%), retinoblastoma 14 (8.0%), teratomas 8 (4.6%) and hepatoma 5 (2.9%). Mean time for diagnosis was 3.3 ± 2.4 months. Advanced disease occurred in 135 (77.6%), while 39 (22.4%) had early disease. Only 166 (95.4%) commenced planned therapy, with 67 (40.4%) lost to follow-up. Of 99 children available for evaluation, 43 died (11 treatment related and 32 from relapse). Overall, 56 (56.6%) were alive after a mean follow-up of 20.7 ± 10.5 months.

Conclusion: PMST are enormous challenge in our setting. Delayed presentation, poor treatment compliance and healthcare funding have to be addressed to improve outcomes.

Detection of Artemisinin-resistant Plasmodium falciparum in Malarial Infection: A Brief Review of Methods

Quashie, N. B. — Wed, 05 Aug 2009 06:26:28 PDT

The WHO has recommended artemisinin-based combination therapy (ACT) for the treatment of malaria in disease endemic countries. In an attempt to assess the sensitivity of Plasmodium falciparum to the drug, various methods have been used. It is the purpose of this short review to critically examine these methods and give recommendations.

Successful Treatment of Childhood Cutaneous Leishmaniasis with Liposomal Amphotericin B: Report of Two Cases

del Rosal, T., Artigao, F. B., Miguel, M. J. G., de Lucas, R., del Castillo, F. — Wed, 05 Aug 2009 06:26:27 PDT

Treatment of cutaneous leishmaniasis is sometimes difficult. No single ideal therapy has yet been identified and some of the drugs that are currently used are associated with significant toxicity. We present two cases of cutaneous leishmaniasis in children, one caused by Leishmania infantum and the other by Leishmania braziliensis. Both of them were successfully treated with intravenous liposomal amphotericin B.

Attention Deficit Hyperactivity and Oppositional Defiance Disorder in HIV-Infected South African Children

Zeegers, I., Rabie, H., Swanevelder, S., Edson, C., Cotton, M., van Toorn, R. — Wed, 05 Aug 2009 06:26:27 PDT

Objective: To determine the prevalence of attention deficit-hyperactivity disorder (ADHD) and oppositional defiance disorder (ODD) in HIV-infected South African children.

Methods: Swanson, Nolan and Pelham (SNAP-IV) questionnaires were used to determine ADHD and ODD severity and a draw-a-person (DAP) test was used to screen for developmental disorders. Associations between behavioural subtypes, psychological functioning, demographic and health variables were investigated.

Results: The SNAP-IV caregiver questionnaires showed a 26% prevalence of ADHD inattentive type; 38% hyperactive type and 24% combined type. The prevalence of ODD was 12% on parent questionnaires and 9.5% on teacher's questionnaires.

Conclusions: Parents/caregiver-only SNAP-IV questionnaires indicate a high prevalence of significant ADHD (all subtypes) and ODD in HIV-infected children. No significant differences were found between the severity of HIV disease and the presence of a behavioural disorder. The SNAP IV questionnaires and DAP test may prove valuable screening tools in HIV children with behavioural problems.

Nineteen Cases of Symptomatic Neonatal Hypocalcemia Secondary to Vitamin D Deficiency: A 2-Year Study

Teaema, F. H., Al Ansari, K. — Tue, 21 Jul 2009 08:49:28 PDT

Vitamin D deficiency can develop very early in infancy, and be characterized by severe hypocalcemic symptoms. This study was done to determine the relation between symptomatic hypocalcemia and vitamin D deficiency in newborn infants and their mothers in the state of Qatar. This is a retrospective study for all newborns presented to the Pediatric Emergency Centers in Qatar with symptomatic hypocalcemia from 1 January 2006 to 31 December 2007. Nineteen newborn infants during the study period presented with symptomatic hypocalcemia. Vitamin D deficiency with or without relative hypoparathyroidism was the attributed cause. Vitamin D deficiency in newborn infants secondary to maternal vitamin D deficiency leading to hypocalcemic symptoms is not uncommon in the state of Qatar. Therefore, vitamin D supplementation in pregnant and lactating mothers in the state of Qatar should be considered after proper screening.

Importance of Information Sharing to Improve Immunization Coverage for the Expanded Programme on Immunization in Lao People's Democratic Republic

Tue, 21 Jul 2009 08:49:28 PDT

Nosocomial Sepsis Risk Score for Preterm Infants in Low-resource Settings

Tue, 21 Jul 2009 08:49:27 PDT

Sepsis is a leading cause of mortality for neonates in developing countries; however, little research has focused on clinical predictors of nosocomial infection of preterm neonates in the low-resource setting. We sought to validate the only existing feasible score introduced by Singh et al. in 2003 and to create an improved score. In a secondary analysis of daily evaluations of 497 neonates ≤33 weeks gestational age admitted to a tertiary care NICU in Dhaka, Bangladesh, we tested the Singh score and then constructed and internally validated our own bedside predictive score. The Singh score had low sensitivity of 56.6% but good positive predictive value (PPV) of 78.1% in our sample. Our five-sign model requiring at least one clinical sign of infection (apnea, hepatomegaly, jaundice, lethargy and pallor) had an area under the receiver operating characteristic of 0.70, sensitivity of 77.1%, and PPV of 64.9%. Our clinical sepsis score is the first bedside clinical screen exclusively for hospitalized, very premature neonates in a low-resource setting, and warrants external validation.

Severe Vitamin B12 Deficiency in a Breast Fed Infant with Pancytopenia

Citak, F. E., Citak, E. C. — Fri, 17 Jul 2009 02:44:25 PDT

We report the case of a 7-month-old breast fed infant who presented with a nose bleed and bruises. Investigation showed severe nutritional B12 deficiency anemia with a pancytopenia. It is important to take the nutritional history of both the infant and the mother for early prevention and treatment.

Risk Factors for Extended-Spectrum {beta}-Lactamase Producing Escherichia Coli and Klebsiella Pneumoniae Acquisition in a Neonatal Intensive Care Unit

Shakil, S., Ali, S. Z., Akram, M., Ali, S. M., Khan, A. U. — Thu, 16 Jul 2009 07:19:00 PDT

This study was made to find the prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichea coli and Klebsiella pneumoniae in neonatal intensive care unit (NICU) and to identify the risk factors associated with the acquisition of these organisms. Risk factors associated with ESBL-producing E. coli and/or K. pneumoniae acquisition status of neonates were assessed. Of 253 neonates admitted, 238 entered the active surveillance system. ESBL-producing K. pneumoniae was responsible for 7 infections and 51 colonizations while ESBL-producing E. coli was responsible for 9 infections and 88 colonizations. Concurrent isolation of both the organisms occurred in 30 neonates. The logistic regression model identified ‘length of stay in the NICU’ as the single independent risk factor. Imipenem, cefepime and amikacin can be suggested as the drugs of choice in our study.

Adherence to Oral Rehydration Therapy among In-Patient Children Aged 1-59 Months with Some or No Dehydration

Migowa, A. N., Gatinu, B., Nduati, R. W. — Tue, 14 Jul 2009 09:37:57 PDT

Objective: To determine adherence to oral rehydration solution (ORS) among in-patients aged 1–59 months suffering from gastroenteritis and having some dehydration (SD) or no dehydration (ND) in two rural hospitals in Kenya.

Methods: Children aged 1–59 months suffering from acute gastroenteritis with (SD) or (ND) were enrolled into the study, examined and medical records reviewed. On the second and third day of follow up, children were re-examined to ascertain hydration status and care-takers interviewed.

Results: Ninety-nine children were enrolled. Forty-five (75%) of the 60 children with SD received a correct prescription for ORS but only 12 (20%) received the correct amount. Among the 39 children with ND, 23 (59%) received a correct prescription for ORS, however only 16 (41%) received the correct amount. On the 3rd day, 9 (15%) of the 60 children with SD at baseline and 2 (5%) of the 39 with ND were classified as having SD.

Conclusion: Four in five children with SD and 6 in 10 children with ND fail to receive the correct amounts of ORS.

The Factors that have a Role in Variability for Temperature

Yalcin, S. S., Aydemir, O., Erkul, E., Karabulut, E., Akca, T. — Tue, 14 Jul 2009 09:37:57 PDT

Our objective was to determine the factors that affect (i) the rectal–axillary temperature measurement difference (RATD) for digital and mercury-in-glass thermometers and (ii) the difference between mercury-in-glass and digital thermometer readings taken by the rectal and axillary routes. Children (between the ages of 2 and 48 months) who were admitted to Hacettepe University Children Hospital and Çorum Children's Hospital in 2 months period were included in this study. Two measurements were taken from each patient within 2 days at two different occasions including day/night and sleep/awake by the same physician. A total of 135 patients were enrolled. RATD was 0.61 + 0.54°C in the mercury-in-glass thermometer, and 0.81 ± 0.57°C in the digital thermometer. The mean differences between digital and mercury-in-glass thermometers were 0.16°C for rectal routes and –0.02°C for axillary routes. Children at older age with hypoalbuminemia and children exposed to higher ambient temperatures had lower values of RATD than others. Temperature recordings from different sites might change with ambient temperature and individual characteristics of children.

Severe Infections in HIV-Exposed Uninfected Infants: Clinical Evidence of Immunodeficiency

Slogrove, A. L., Cotton, M. F., Esser, M. M. — Tue, 14 Jul 2009 09:37:56 PDT

We describe the clinical and basic immunological findings of eight HIV-exposed uninfected infants hospitalized with serious infectious morbidity and referred for immunological evaluation. The median age at presentation was 5.5 (1.5–15) months. Infections included Pneumocystis jiroveci pneumonia (three), cytomegalovirus colitis with perforation (one), Pseudomonas sepsis (two), hemorrhagic varicella (one) and Group A streptococcal meningitis and endocarditis (one). Five required intensive care, four for assisted ventilation and one for post-surgical care. Follow-up to 36 months suggested resolution of a transient immunodeficiency in two infants, one of whom had CD4 and the other B-cell depletion. Further studies are indicated in HIV-exposed uninfected infants.

Evaluation of a 5-year Programme to Prevent Mother-to-child Transmission of HIV Infection in Northern Uganda

Mon, 13 Jul 2009 22:50:46 PDT

Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed 2000-05 data from mother-infant pairs in our PMTCT programme in rural Uganda, examining programme utilization and outcomes, HIV transmission rates and predictors of death or loss to follow-up (LFU). Out of 19 017 women, 1 037 (5.5%) attending antenatal care services tested HIV positive. Of these, 517 (50%) enrolled in the PMTCT programme and gave birth to 567 infants. Before tracing, 303 (53%) mother–infant pairs were LFU. Reasons for dropout were infant death and lack of understanding of importance of follow-up. Risk of death or LFU was higher among infants with no or incomplete intrapartum prophylaxis (OR = 1.90, 95% CI 1.07–3.36) and of weaning age <6 months (OR 2.55, 95% CI 1.42–4.58), and lower in infants with diagnosed acute illness (OR 0.30, 95% CI 0.16–0.55). Mother-to-child HIV cumulative transmission rate was 8.3%, and 15.5% when HIV-related deaths were considered. Improved tracking of HIV-exposed infants is needed in PMTCT programmes where access to early infant diagnosis is still limited.

Evaluation of a Rapid Immunochromatography Strip Test for Detection of Astrovirus in Stool Specimens

Fri, 03 Jul 2009 08:46:39 PDT

Neurofibromatosis Type 1 with Overlap Turner Syndrome and Klinefelter Syndrome

Hatipoglu, N., Kurtoglu, S., Kendirci, M., Keskin, M., per, H. — Fri, 03 Jul 2009 08:46:38 PDT

Turner's syndrome is a sex chromosome disorder. Klinefelter's syndrome is one of the most severe genetic diseases. Neurofibromatosis is an autosomal dominant disorder characterized by cafe-au-lait spots and fibromatous tumors of the skin. In this article, we report the overlap of neurofibromatosis-1 with Turner and Klinefelter syndromes. Thus, these disorders might overlap within the same patient. Due to these cases, we suggest that each patient with Turner-like symptoms or Klinefelter's-like syndrome, be carefully examined for café au lait macules before the initiation of hormone replacement treatment.

Paediatric Handbook, 8th edn Thomson K., Tey D., Marks M. (eds)

Ebrahim, G. J. — Mon, 29 Jun 2009 05:41:57 PDT

The Incidence Rate of Premature Rupture of Membranes and its Influence on Fetal-neonatal Health: A Report From Mainland China

Liu, J., Feng, Z.-C., Wu, J. — Fri, 19 Jun 2009 05:56:24 PDT

Premature rupture of membranes (PROM) is a common pregnancy complication and is associated with significant risks of fetal and neonatal morbidity and mortality. However, there is a lack of data concerning PROM in China. We investigated the incidence rate and analysed the influence of PROM on fetal and neonatal health. This used data from five specialist hospitals and one general hospital in mainland China. The total number of deliveries and the number of those complicated by PROM were recorded between January 2003 and December 2007. The time from initiation of PROM until delivery (latent period), the volume of amniotic fluid at delivery, fetal conditions and neonatal clinical conditions were recorded. The results suggest that the incidence of PROM was 19.53% and it could influence various aspects of the health of fetuses and neonates, including platelet parameters, erythrocyte parameters, neonatal jaundice and myocardial injury.

Myocardial Dysfunction in Severe Falciparum Malaria

Kumar, P. P., Kumar, C. D., Shaik, F. A. R., Ghanta, S. B. — Fri, 12 Jun 2009 06:30:34 PDT

Severe malaria causes multiorgan dysfunction, which is the predominant reason for mortality in these children. Cardiac enzymes have been elevated and cardiac involvement has been suspected in some of these children, however, clear cut echocardiographic evidence for it was not possible. There were isolated reports of myocardial dysfunction in malaria in adults but none in children. We present two such children with cardiac involvement and myocardial dysfunction.

Subcutaneous Phycomycosis--Fungal Infection Mimicking a Soft Tissue Tumor: A Case Report and Review of Literature

Thotan, S. P., Kumar, V., Gupta, A., Mallya, A., Rao, S. — Thu, 11 Jun 2009 05:24:07 PDT

Subcutaneous phycomycosis is a rare fungal infection of the deeper layers of skin. We describe a representative case. A 10-year-old boy presented with a large swelling on the back of 3 months duration. Biopsy of the lesion confirmed the diagnosis of subcutaneous phycomycosis. There was complete resolution of the lesion after treatment with oral potassium iodide for 3 months.

Normal Reference Values for Serum Lipid Levels in Chinese Adolescents Between 12 and 18 Years of Age

Hu, C., Tao, F., Wan, Y., Hao, J., Ye, D. — Mon, 08 Jun 2009 09:05:10 PDT

The purpose of this study was to develop representative gender- and age-specific percentile reference data for serum lipids for Chinese adolescents between 12 and 18 years of age. Blood samples were obtained from 2998 boys and 3225 girls in nine provinces from the mainland of China, including rural and urban areas. The data for serum lipid levels, including TC, TG, HDL-C and LDL-C, were calculated and measured between March and June 2008. Gender- and age-specific percentiles of serum lipid levels were calculated. Gender- and age-specific percentile-based reference data for serum lipids is presented for Chinese adolescents for the first time. The 95th percentile for the TC, TG and LDL-C levels was 5.07, 1.90 and 3.32 mmol/l, and the 5th percentile for the HDL-C level was 0.92 mmol/l among all the students. These reference values can be used to plan and implement preventive policies, and to study temporal trends.

Clinical Responses to a Mega-dose of Vitamin D3 in Infants and Toddlers With Vitamin D Deficiency Rickets

Mon, 08 Jun 2009 09:05:09 PDT

Objectives: Was to investigate the effect of treatment with an IM injection, a mega dose of vitamin D3 (10 000 IU/kg) on the clinical, biochemical and radiological parameters of 40 rachitic children with vitamin D deficiency (VDD) over a period of 3 months.

Design: In this prospective study we evaluated the clinical, biochemical and radiological responses of an IM injection of cholecalciferol (10 000 IU/kg) for 3 months.

Results: At presentation, the most frequent manifestations were enlarged wrist joints, hypotonia, irritability, cranial bossing, wide anterior fontanel, bow legs, delayed teething and walking and Harrison's sulcus with chest rosaries. Short stature (length SDS < –2) was recorded in 30% of patients. Craniotabes and hypocalcemic tetany were the least common presentations. In VDD children the most frequent biochemical abnormality was high alkaline phosphatase (ALP) (100%), followed by low phosphate (PO₄) (75%) and low calcium (Ca) (12.5%). One month after treatment, serum Ca, PO₄ and 25(OH)D concentrations were normal. Three months after the injection, serum level of ALP and parathormone (PTH) decreased to normal. The majority of patients (87.5%) had serum 25(OH)D level ≥ 20 ng/ml, but some (12.5%) had level <20 ng/ml. Hypercalcemia was not recorded in any patient during the 3-month-period. Significant cure of all symptoms and signs related to vitamin D deficiency had been achieved in all children. Leg bowing showed significant improvement in all patients but was still evident in one third. Complete healing of the radiological evidence of rickets was achieved in 95% of all children.

Conclusion: An IM injection of a mega dose of cholecalciferol is a safe and effective therapy for treatment of VDD rickets in infants and toddlers with normalization of all the biochemical parameters and healing of radiological manifestations. Measurement of serum 25(OH)D level is highly recommended in all short children with a clear need for a general vitamin D supplementation for all infants and young children in Qatar.

Vitamin A and Vitamin B-12 Concentrations in Relation to Mortality and Morbidity among Children Born to HIV-Infected Women

Fri, 05 Jun 2009 21:23:04 PDT

Vitamin A supplementation starting at 6 months of age is an important child survival intervention; however, not much is known about the association between vitamin A status before 6 months and mortality among children born to HIV-infected women. Plasma concentrations of vitamins A and B-12 were available at 6 weeks of age (n = 576 and 529, respectively) for children born to HIV-infected women and they were followed up for morbidity and survival status until 24 months after birth. Children in the highest quartile of vitamin A had a 49% lower risk of death by 24 months of age compared to the lowest quartile (HR: 0.51, 95% CI: 0.29–0.90; P-value for trend = 0.01). Higher vitamin A levels were protective in the sub-groups of HIV-infected and un-infected children but this was statistically significant only in the HIV-uninfected subgroup. Higher vitamin A concentrations in plasma are protective against mortality in children born to HIV-infected women.

Hypokalemic Paralysis Following Severe Vomiting in a Child with Intestinal Obstruction Due to Round Worms

Nagotkar, L., Shanbag, P., Shenoy, P. — Fri, 05 Jun 2009 21:23:04 PDT

Ascariasis is one of the most common helminthic infestations in humans. Massive infestation can give rise to serious complications such as intestinal obstruction. We present a 4-year-old boy, who presented with acute flaccid quadriparesis due to the hypokalemic alkalosis induced by severe vomiting. Severe vomiting was due to intestinal obstruction caused by round worms.

High Prevalence of Soil-transmitted Helminths in Western Kenya: Failure to Implement Deworming Guidelines in Rural Nyanza Province

Riesel, J. N., Ochieng', F. O., Wright, P., Vermund, S. H., Davidson, M. — Fri, 05 Jun 2009 21:23:03 PDT

Soil-transmitted helminth (STH) infections affect an estimated 2 billion people world wide. Children experience the greatest morbidity, limiting their potential in academic and physical endeavors. Our study assessed the prevalence of STH infections in primary school-aged children in a rural village in the Nyanza Province of Kenya. Over two-thirds (68%) of the sampled population tested positive using a direct smear microscopic analysis of single stool samples. Only heavy worm infections would be detected with this technique; thus 68% is a minimum estimate of prevalence. Prior to our study, there were no deworming programs in this village, despite WHO and Kenyan government guidelines supporting regular deworming programs. Our study demonstrates the significant burden of STH infections in a rural Kenyan village and highlights the need for deworming programs in similar venues. We also demonstrate that with basic infrastructure and community involvement, regular deworming can be implemented effectively in remote, rural communities.

Incidence and Etiology of Neonatal Hyperbilirubinemia

Sarici, S. U. — Fri, 05 Jun 2009 21:23:03 PDT

Hypothermia in Children with Severe Malnutrition: Low Prevalence on the Tropical Coast of Kenya

Talbert, A., Atkinson, S., Karisa, J., Ignas, J., Chesaro, C., Maitland, K. — Tue, 02 Jun 2009 09:25:00 PDT

Hypothermia is stated as a common complication of severe malnutrition although there are little primary data to support this. We performed a prospective study of children with severe acute malnutrition (SAM) admitted to a district hospital in Kenya. We documented the prevalence of hypothermia and examined its association with outcome and ambient temperature. During a 2-year period 667 children were recruited. Hypothermia was recorded in only 12 out of 15 191 (0.08%) temperature observations and as a single event in 12 children (2% of cases). There was no correlation with ambient temperature. Although mortality rates were higher in children with hypothermia (4/12, 33%) than those without (121/655, 18%), the timing of hypothermia did not coincide with clinical deterioration. Hypothermia was a rare marker of severity in our setting. We recommend that other observations be highlighted to identify high risk groups and that routine temperature observations be reduced wherever staff are few.

Serum Levels of Ghrelin, Tumor Necrosis Factor-{alpha} and Interleukin-6 in Infants and Children with Congenital Heart Disease

Afify, M. F., Mohamed, G. B., El-Maboud, M. A., Abdel-Latif, E. A. — Tue, 02 Jun 2009 09:24:59 PDT

Objective: To estimate serum levels of ghrelin, tumor necrosis factor- (TNF-) and interleukin-6 (IL-6) in infants and children with congenital heart disease (CHD), compared with levels in age-matched controls, and to correlate the levels of ghrelin with TNF- and IL-6.

Design: Case–control study.

Setting: Suzan Moubarak Hospital of Al-Minya University, Egypt.

Patients: We measured serum ghrelin, TNF- and IL-6 levels using ELISA in 60 patients with CHD (40 acyanotic and 20 cyanotic) and in 20 control subjects.

Results: Our results showed that patients with CHD, regardless of the presence or absence of cyanosis, had significantly higher serum ghrelin, TNF- and IL-6 than controls (p = 0.000). Serum levels of ghrelin and TNF- in the acyanotic patients were significantly higher than in the cyanotic patients (p = 0.000). On the other hand, there was no significant difference in serum levels of IL-6 between the acyanotic and the cyanotic patients (p = 0.126). In acyanotic and cyanotic patients with CHD, there was a positive correlation between ghrelin and TNF- (r = 0.424; p = 0.006 and r = 0.577; p = 0.008, respectively). Ghrelin levels were not correlated to IL-6 in the acyanotic and cyanotic patients with CHD (r = –0.211; p = 0.216 and r = –0.341; p = 0.08, respectively).

Conclusion: Serum ghrelin, TNF- and IL-6 levels are elevated in patients with CHD whether acyanotic or cyanotic. Increased ghrelin levels represent malnutrition and growth retardation in these patients. The relation of ghrelin with TNF- may be explained by the possible effect of chronic congestive heart failure and chronic shunt hypoxemia.

Nutritional Quality and Osmolality of Home-made Enteral Diets, and Follow-up of Growth of Severely Disabled Children Receiving Home Enteral Nutrition Therapy

Santos, V. F. N., Morais, T. B. — Tue, 19 May 2009 05:30:22 PDT

This study evaluated the nutritional quality of home-made enteral diets and their effect on growth parameters. Thirty pediatric patients receiving only homemade enteral diets were enrolled. Samples of milk-based (MB) and soup-based (SP) feeds were taken for chemical analises. The chidren's anthropometric indexes were assessed. In the MB, the measured values for the macronutrients and energy corresponded to approximately 70% of the prescribed values. Conversely, the SP measured values corresponded to less than 50% of the prescribed values, except for carbohydrate. The prevalence of underweight was 30% (9/30) at the time of entry into home nutritional therapy and declined to 20% (6/30) at the time of the study (p = 0.007). Stunting increased throughout the follow up, from 30% (9/30) to 53% (16/30; p = 0.511). Obesity prevalence fell from 17% (4/23) to 9% (2/23; p < 0.001). Despite their inconsistent levels of macronutrients and energy, home-made enteral diets had no negative effect on the patients' weights.

Relationship of CD4+ T-cell counts and plasma HIV-1 RNA levels with serological HBeAg/anti-HBe patterns obtained in West-African HBV-HIV-1-co-infected children

Fri, 15 May 2009 02:29:16 PDT

HBeAg/anti-HBe and hepatitis B virus (HBV) DNA from 34 HIV-1-infected children from Ivory Coast with chronic hepatitis B (CHB) were longitudinally analyzed according to CD4 and HIV-1 RNA. The mean CD4% value was significantly (p = 0.03) lower in 59 (52.7%) samples showing a usual CHB (HBeAg-positive/anti-HBe-negative and HBV DNA-positive), as compared with 30 (26.8%) HBeAg-positive/anti-HBe-positive and HBV DNA-positive and 23 (20.5%) HBeAg-negative/anti-HBe-positive and HBV DNA-negative (15.1% vs. 18.5% and 20.0%). The mean HIV-1 RNA concentrations were significantly (p = 0.01) higher in specimens HBV DNA-positive (4.47 and 4.30 log₁₀/ml, respectively) vs. HBV DNA-negative (3.43 log₁₀/ml). HIV-1 has a significant impact on CHB acquired in childhood.

Assessment of nutritional status in the Amazigh children of Amizmiz (Azgour Valley, High Atlas and Morocco)

Fri, 15 May 2009 02:29:15 PDT

The Berbers of the High Atlas (Amazigh) live in very severe socio-economic and climatic conditions, which expose children to the risk of malnutrition. In this study we used anthropometry and bioelectrical impedance analysis for the assessment of nutritional status. Height, weight and bioelectrical parameters were taken on 71 children (28 boys and 43 girls). Height and BMI were standardized using the 2007 WHO reference. The results show that 36.6% of the children were classified as stunted and 8.5% as wasted. Based on the Bioelectrical Impedance Vector Analysis, children from the High Atlas had an adequate body cell mass, but a high risk of dehydration (42.3%).

Screening of 18-24-Month-Old Children for Autism in a Semi-Urban Community in Sri Lanka

Perera, H., Wijewardena, K., Aluthwelage, R. — Tue, 28 Apr 2009 07:51:42 PDT

All children aged 18–24 months in a defined geographical area were initially screened for autism, using ‘Red Flag’ criteria. All the children with one or more positive ‘Red Flag’ signs were further screened using Modified Checklist for Autism in Toddlers (M-CHAT) translated to Sinhala, followed by a comprehensive clinical assessment. Of a sample of 374 children, ‘Red Flag’ signs were positive in 28 (7.4%). Four children received a diagnosis of autism on clinical assessment giving a prevalence of 1.07% or 1 per 93 in the 18–24-month age group. Sensitivity of M-CHAT was only 25%, and specificity 70%. The high prevalence detected strongly justifies early community-based screening, but a culturally sensitive screening tool needs to be developed for Sri Lanka.

Severe Pneumonia in Mozambican Young Children: Clinical and Radiological Characteristics and Risk Factors

Tue, 28 Apr 2009 07:51:42 PDT

Background: Pneumonia is a leading cause of hospitalization and death among children in Africa. We describe the clinical presentation of severe pneumonia among hospitalized children in a malaria endemic area with a high prevalence of HIV infection. Methods: As part of a 2-year prospective study of radiologically confirmed pneumonia, chest radiographs, malaria parasite counts and bacterial blood cultures were systematically performed for children 0–23 months admitted with severe pneumonia. Radiographs were interpreted according to WHO guidelines. HIV tests were performed during a 12-month period. Results: Severe pneumonia accounted for 16% of 4838 hospital admissions among children 0–23 months; 43% of episodes had endpoint consolidation, 15% were associated with bacteremia and 11% were fatal. Fever, cough >3 days, crepitations, hypoxemia and absence of malaria parasitemia were associated with radiologically confirmed pneumonia. Nineteen per cent of children with severe pneumonia and 27% with radiologically confirmed pneumonia had clinical malaria. HIV-prevalence was 26% among children hospitalized with severe pneumonia and HIV-testing results. HIV infection, anaemia, malnutrition, hypoxemia and bacteremia were associated with fatal episodes of severe pneumonia. Conclusion: Treatment of admitted children with severe pneumonia is complicated in settings with prevalent HIV and malaria. Children with severe pneumonia and clinical malaria require antibiotic and antimalarial treatment. In addition to vertical programs, integrated approaches may greatly contribute to reduction of pneumonia-related mortality.

Coagulation Status and Platelet Functions in Children with Severe Falciparum Malaria and their Correlation of Outcome

Prasad, R., Das, B. K., Pengoria, R., Mishra, O. P., Shukla, J., Singh, T. B. — Tue, 28 Apr 2009 07:51:41 PDT

This study was undertaken to observe the changes in coagulation and platelet profile, and findings were correlated with their outcome. Forty consecutive children with severe falciparum malaria were studied for their coagulation status, i.e. prothrombin time (PT), activated thromboplastin time (APTT), thrombin time (TT) and anti-thrombin-III (AT-III), platelet profile (platelet count, platelet aggregation with adenine diphosphate (ADP) and ADR and PF3 availability). Derangements in the coagulation profile in the form of increased PT, APTT and/or TT were seen in 47.5, 35 and 62.5% cases, respectively, but bleeding was seen in only six cases. Thrombocytopenia was found in 34 patients. Platelet aggregation with ADP and ADR revealed hypoaggregation in 95.3 and 97.5% cases, respectively, and were statistically significant. Platelet factor-3 availability was also significantly prolonged. Patients with prolonged PT, PF-3 and hypoaggregation with adrenaline had 1.4, 1.7 and 1.45 times higher risk of mortality.

Human Bocavirus in Very Young Infants Hospitalized with Acute Respiratory Infection in Northeast Brazil

Tue, 28 Apr 2009 07:51:40 PDT

A cross-sectional study was carried out over a period of 12 months to investigate the occurrence of human bocavirus (HBoV) infection in infants hospitalized for respiratory infections in a teaching hospital in Salvador, Brazil, and to describe the clinical manifestations of this infection. Nasopharyngeal aspirates were collected from the children and immunofluorescence and polymerase chain reaction were performed to investigate the presence of respiratory viruses. HBoV was detected in 4 out of 66 patients. Two of the HBoV-positive infants were co-infected with other viruses. The principal clinical findings in HBoV-positive children were: nasal obstruction, catarrh, cough, fever and dyspnea. This study revealed HBoV infection in children aged <2 months, suggesting that the infection may occur at a very early age.

Comparison of the Use of Liquid Crystal Thermometers with Glass Mercury Thermometers in Febrile Children in a Children's Ward at Port Moresby General Hospital, Papua New Guinea

Mauta, L., Vince, J., Ripa, P. — Fri, 24 Apr 2009 08:04:21 PDT

We compared the temperatures recorded, in febrile children admitted to a children's ward at Port Moresby General Hospital, by a doctor and by a group of nurses using glass mercury thermometers (GMT) and liquid crystal thermometers (LCT, Nextemp^R and Traxit^R). The mean difference (with 95% confidence intervals) in temperatures between GMT and Nextemp^R were –0.12°C (–0.16°C to –0.08°C) for the doctor and 0.12°C (0.04–0.20°C) for nurses. The mean difference in temperatures between GMT and Traxit^R were –0.05°C (–0.09°C to –0.01°C) for the doctor and 0.19°C (0.10–0.28°C) for the nurses. A similar result was obtained when one of the Nextemp^R thermometers used in the initial study was compared with GMT on a small sample of patients by the doctor 8 months later. Limited evaluation showed nursing staff were in favour of using the LCTs. Nextemp^R and Traxit^R thermometers can be used interchangeably with GMT in this setting.

Subtyping and env C2/V3 Sequence Analysis of HIV-1 Isolated from HIV-Infected Children Hospitalized in Children Hospital 1, Vietnam during 2004-2005

Mon, 20 Apr 2009 02:07:45 PDT

A molecular epidemiological study was conducted on 104 HIV-1 strains isolated from HIV-infected children hospitalized in Children Hospital 1 in Ho Chi Minh City, Vietnam during 2004–2005. Genetic subtyping based on env C2/V3 sequences revealed that CRF01-AE was the sole circulating recombinant form found in this study. Sequence analysis of the V3 loop showed that GPGQ tetramer was the most common V3 loop core motif identified in the HIV-1 strains studied (89.5%). The findings raise great concern about HIV-infected children in Vietnam and provide up-to-date molecular epidemiological information of HIV-1 circulating in Vietnam during the study period.

Oxidative Stress and Antioxidant Status in Neonates Born to Pre-eclamptic Mother

Howlader, Md. Z. H., Parveen, S., Tamanna, S., Khan, T. A., Begum, F. — Mon, 20 Apr 2009 02:07:44 PDT

Objective: Pre-eclampsia is a significant health problem and is the leading cause of maternal and perinatal mortality and morbidity. Low birth weight and prematurity are very common in pre-eclamptic mothers. Pre-eclampsia is associated with oxidative stress in the maternal circulation. To observe the effect of pre-eclampsia on neonates, this study was designed to explore oxidative stress and anti-oxidant status in the fetal circulation in pre-eclampsia.

Materials and Methods: For this purpose, we collected cord bloods during delivery from Bangabandhu Sheikh Mujib Medical University. Twenty samples were collected from uncomplicated (normotensive) mothers and 15 samples were collected from pre-eclamptic mothers (maternal age matched). Thiobarbituric acid reactive substances (TBARS), lipid hydroperoxide, protein carbonyl value, lipid profile, total anti-oxidant status (TAS), vitamin C, serum total protein and albumin were measured.

Results: It was observed that TBARS and lipid hydroperoxide were significantly (P < 0.001) increased, protein carbonyl content were also significantly (P < 0.001) increased but total anti-oxidant status (P < 0.001) and vitamin C level were significantly (P < 0.05) decreased in cord blood from pre-eclamptic mother compared to control group. Cholesterol, TG, LDL level was elevated and HDL were lowered in cord blood in pre-eclamptic group compared to normotensive group. In pre-eclamptic group, cord blood total protein, albumin and globulin level were significantly decreased compared to control group.

Conclusions: As pre-eclampsia is associated with increased oxidative stress and decreased anti-oxidant status, the results of these investigations suggest that oxidative stress and antioxidant status are altered towards proatherogenic level in cord blood of pre-eclamptic women which may ultimately be responsible for different complications of newborn babies of pre-eclamptic mothers.

A Cross-sectional Study of the Growth Characteristics of Nigerian Infants from Birth to 2 Years of Age

VanderJagt, D. J., Waymire, L., Obadofin, M. O., Marjon, N., Glew, R. H. — Thu, 16 Apr 2009 04:54:49 PDT

Malnutrition compromises the growth of children in sub-Saharan Africa. In Nigeria, the prevalence of childhood malnutrition approaches 40%. There are few reports relating the growth characteristics of breast-fed Nigerian infants to the anthropometric properties of their mothers. A total of 100 urban and rural mother/baby pairs were recruited. The mean BMI values of the urban and rural mothers were 24.2 and 21.3 kg m^–2, respectively. The mean length, weight and head circumference of the rural infants were significantly lower than those of the urban infants. Z-scores based on World Health Organization standards showed: (i) length-for-age z-score <–2 in urban (27%) and rural (33%) children; (ii) a higher incidence of underweight and small HC in rural (33%; and 13%) versus urban children (12% and 0%); and (iii) positive correlations between all three z-scores and maternal BMI. Negative correlations were observed between infant age and z-scores for length-for-age, weight-for-age and HC-for-age.

Hypercalcemia due to Hypervitaminosis D: Report of Seven Patients

Joshi, R. — Wed, 01 Apr 2009 09:58:32 PDT

We retrospectively studied seven children (six girls, one boy) aged from 7.5 to 25 months who presented to our institution after taking large doses of vitamin D (900 000–4 000 000 U) prescribed by medical practitioners for wrong indications like failure to thrive, etc. The clinical manifestations were constipation, decreased appetite, lethargy, polyuria, dehydration and failure to thrive. All patients had hypercalcemia (serum calcium ranging from 12 to 16.8 mg/dl), high 25[OH]D levels (ranging from 96 to >150 ng/ml), suppressed intact parathyroid hormone (ranging from <3 to 8.1 pg/ml). Hypercalciuria (urinary calcium/creatinine ranging from 1 to 2.45) was found in all patients, while nephrocalcinosis was present in five patients. All were treated with intravenous fluids, oral prednisolone, restriction of calcium in diet, while four patients received pamidronate infusion for reducing hypercalcemia.

A Study of Profile of Ventilator-associated Pneumonia in Children in Punjab

Sharma, H., Singh, D., Pooni, P., Mohan, U. — Tue, 17 Mar 2009 22:39:41 PDT

Objectives: To determine incidence, related factors, outcome, bacterial organisms and their sensitivity patterns with regard to ventilator-associated pneumonia (VAP) in children.

Setting: Level III PICU of a tertiary care center.

Design: Prospective cohort study.

Methods: Children in the age group of 1 month to 15 years, admitted to the pediatric intensive care unit requiring ventilatory support (V.I.P.BIRD infant-Pediatric ventilator) for at least 48 h. Clinical criteria used to define VAPs were the same as used by and Elward et al. and Salata et al.

Results: Forty patients met the inclusion criteria and 8 (20%) had VAP. The risk factor significantly related with development of VAP was the use of H₂ blockers (Ranitidine) for >2 days. All other related factors were not significantly related to occurrence of VAP.

Conclusion: Use of H₂ blockers (Ranitidne) is associated with higher incidence of VAP in children.