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Background: The presence of calcified lesions in chronic kidney disease (CKD) patients adversely affects the outcomes of percutaneous coronary interventions (PCIs). Lesion modification using rotational atherectomy (RA) followed by drug-eluting stent (DES) implantation may, therefore, be a suitable strategy to treat heavily calcified coronary lesions in CKD patients. Aim: The aim of the study was to compare the effectiveness and safety of PCI using RA and new-generation DES for treating calcified coronary lesions in patients with mild versus moderate-to-severe CKD. Methods: This was a single-center, retrospective study. Data were collected from the medical records of all CKD patients with calcified coronary artery lesions who underwent RA + DES implantation from November 2014 to October 2019. The primary outcomes were the rates of in-stent restenosis (ISR), repeat revascularization (RR), and major adverse cardiovascular and cerebrovascular events. Secondary outcomes included procedural success, death after intervention, and procedural/in-hospital complications. Results: A total of 77 and 126 patients with mild and moderate-to-severe CKD were treated with RA + DES. Patients with moderate-to-severe CKD were significantly older when compared to patients with mild CKD (mean age: 66.6 ± 8.2 vs. 59.5 ± 7.7 years, respectively, P < 0.0001). Body mass index was significantly lower in moderate-to-severe CKD group compared to the mild CKD group. The number of patients in whom postdilatation was performed after stent implantation was significantly higher in the moderate-to-severe CKD group compared to the mild CKD group (100% vs. 96%, P = 0.025). Overall procedural success was 97.5% with minimal periprocedural complications. The rates of ISR and RR were not significantly different between patients with mild and moderate-to-severe CKD. The two groups did not differ significantly in terms of procedural success, postprocedural complications, and procedural mortality. Conclusion: RA followed by DES implantation is an effective and safe strategy to treat calcified coronary artery lesions in patients with CKD, regardless of the degree of renal dysfunction. [ABSTRACT FROM AUTHOR]

The pandemic declaration of Covid-19 disease by World Health Organization (WHO) and subsequent widespread morbidities and mortalities in almost all countries of the world led to the research and development to find out a vaccine against SARS-CoV2 virus. Normally any new vaccine development takes 10–15 y time but the search for vaccine against SARS-CoV2 is going on at a very fast pace resulting in almost breakthrough in vaccine development by several research institutions and vaccine manufacturers. In pandemic situation, however, the entire process of vaccine development including clinical trials gets shortened and may be fast tracked to 15–18 mo time. It is expected that there shall be simultaneous marketing of several vaccines by the beginning of 2021. There are more than 164 candidate vaccines which are in the process of development and among them 24 vaccines are in advanced stages of development. This review aims at highlighting the present stages of development of vaccines and discussing the challenges that may be faced with these novel vaccines. [ABSTRACT FROM AUTHOR]

Introduction: Meningococcal disease caused by Neisseria meningitidis has a high case fatality rate. Of 12 distinct serogroups, A, B, C, W-135 (W) and Y cause the majority of infections. The meningococcal disease burden and epidemiology in India are not reliably known. Hence, we performed a narrative review with a systematically conducted search to summarize information on meningococcal disease burden and epidemiology and vaccination recommendations for meningococcal disease in India. Methods: A search of Medline and Embase databases was undertaken to identify relevant publications published in the last 25 years. Results: Results from 32 original publications, 11 of which were case reports, suggest a significant burden of meningococcal disease and related complications. Meningococcal disease is increasingly reported among adolescents and adults, and large outbreaks have been reported in this population. Meningococcal disease in India is caused almost exclusively by serogroup A; serogroups B, C, W and Y have also been documented. Meningococcal disease burden data remain unreliable because of limited disease surveillance, insufficient laboratory capacity, misdiagnosis and prevalence of extensive antibiotic use in India. Lack of access to healthcare also increases under-reporting, thus bringing the reliability of the data into question. Conjugate meningococcal vaccines are being used for disease prevention by national governments and immunization programs globally. In India, meningococcal vaccination is recommended only for certain high-risk groups, during outbreaks and for international travelers such as Hajj pilgrims and students pursuing studies abroad. Conclusion: Meningococcal disease is prevalent in India but remains grossly underestimated and under-reported. Available literature largely presents outbreak data related to serogroup A disease; however, non-A serogroup disease cases have been reported. Reliable epidemiologic data are urgently needed to inform the true burden of endemic disease. Further research into the significance of meningococcal disease burden can be used to improve public health policy in India. [ABSTRACT FROM AUTHOR]

SARS CoV2 virus is responsible for the pandemic of COVID-19 disease and has devastated the entire world. The COVID-19 disease has been responsible for huge number of morbidity and mortality in the world including India. Since there is no specific drug to cure this disease, research and development is going on to find a safe and effective vaccine to prevent the disease. According to the World Health Organization, there are 24 candidate vaccines which are in advance stages of development and 142 are in preclinical stages. There are various platforms in which this novel coronavirus vaccines are underdevelopment, for example, nonreplicating viral vector, RNA, DNA, inactivated, and subunit. In normal situation, it takes minimum 10-year time to develop a new vaccine from conception to first use in the market. In case of SARS CoV2 vaccine, all out efforts are made by all institutions and vaccine manufacturing companies with the help of respective regulatory authorities to reduce the time frame. In all probabilities, few vaccines would be developed in record time and expected to be in the market by the beginning of 2021. In India, there are six candidate vaccines which are in development and all are in various stages. There are several challenges during development and later once it becomes available for human use. This review is an attempt to briefly cover the present stages of development of various vaccines and the challenges that are likely to be encountered. [ABSTRACT FROM AUTHOR]

Natural killer (NK) cells provide the first line of defense against malaria parasite infection. However, the molecular mechanisms through which NK cells are activated by parasites are largely unknown, so is the molecular basis underlying the variation in NK cell responses to malaria infection in the human population. Here, we compared transcriptional profiles of responding and non-responding NK cells following exposure to Plasmodium-infected red blood cells (iRBCs) and identified MDA5, a RIG-I-like receptor involved in sensing cytosolic RNAs, to be differentially expressed. Knockout of MDA5 in responding human NK cells by CRISPR/cas9 abolished NK cell activation, IFN-γ secretion, lysis of iRBCs. Similarly, inhibition of TBK1/IKKε, an effector molecule downstream of MDA5, also inhibited activation of responding NK cells. Conversely, activation of MDA5 by liposome-packaged poly I:C restored non-responding NK cells to lyse iRBCs. We further show that microvesicles containing large parasite RNAs from iRBCs activated NK cells by fusing with NK cells. These findings suggest that NK cells are activated through the MDA5 pathway by parasite RNAs that are delivered to the cytoplasm of NK cells by microvesicles from iRBCs. The difference in MDA5 expression between responding and non-responding NK cells following exposure to iRBCs likely contributes to the variation in NK cell responses to malaria infection in the human population. [ABSTRACT FROM AUTHOR]

Background: Poisoning among commuters is becoming a major health hazard day by day in Bangladesh. Few studies were done in Bangladesh regarding this problem. The study aims at describing the clinico-epidemiological features of patients with suspected intentional poisoning during travel for robbery. Method: This was a prospective observational study, conducted in medicine department of Chittagong Medical College Hospital, Bangladesh during March 2010 to September 2010. 40 patients were selected. Out of whom, 15 who had GCS < 8 at presentation were selected for urine analysis by detection kits for a few substances in the urine. Detailed demographic data were collected from the informant in a structured case report form. Clinical examination of the patient was done at presentation and urine was collected in selected patients. Routine patient follow-ups were carried out and the outcome was recorded. Results: Victims were males of 31.23±7.6 years age, most of whom were married (80%), and businessmen (40%). Most of them were brought to hospital by their relatives (80%). Their financial loss by the incidence did not exceed 50,000 tk (i.e., 18937 Tk). They were mainly from middle class family, usually poisoned by beverage (55%), food (30%), and inhalation (5%). Most of them presented with unconsciousness (75%), having GCS 10 on average. Their pupils usually remained constricted bilaterally (75%) with intact light reflex in 35% of the cases. There was no papilledema, and cranial nerves were usually intact in those who could be examined (25%). Patients were usually depressed with absent planter reflex (70%) or flexor (30%). Within 2.5 days, most of them could walk without support and could be discharged. There was neither any case fatality reported or any long term disability recorded. Only 7.5% of the patients had substance examined by kit in their urine. Conclusion: We can come to the conclusion that people who carried money on themselves were victimized by the miscreant and they usually used a substance which had a short onset of action and which could sedate people for a short time with depressive neurological findings. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of hyponatremia between hypotonic and isotonic parenteral maintenance solutions (PMS) administered to children with very severe pneumonia, admitted in the general pediatric ward.Methods: A randomized controlled open label trial was conducted in the pediatrics department of a tertiary care medical college hospital including euvolemic children 2 mo to 5 y of age, fulfilling the WHO clinical definition of very severe pneumonia and requiring PMS. They were randomized to receive either isotonic PMS (0.9% saline in 5% dextrose and potassium chloride 20 meq/L) or hypotonic PMS (0.18% saline in 5% dextrose and potassium chloride 20 meq/L) at standard rates for next 24 h.Results: A total of 119 children were randomized (59: Isotonic; 60: Hypototonic PMS). Nine (15%) children in the isotonic PMS group and 29 (48%) in the hypotonic PMS group developed hyponatremia during the study period, (p <0.001) with a relative risk being 3.16 (95% CI 1.64 to 6.09). Mean serum sodium was significantly lower in the hypotonic group compared to the isotonic group (p < 0.001 each at 6, 12 and 24 h). The difference in mean change in serum sodium from baseline was also significant at 12 and 24 h (5.4 and 5.8 meq/L respectively; p < 0.001 each).Conclusions: This study demonstrates the rationality of the use of isotonic PMS in children with respiratory infections, a condition regularly encountered by most pediatricians. [ABSTRACT FROM AUTHOR]

Objective: To find the appropriate type of intravenous fluid (isotonic vs. hypotonic saline in 5 % dextrose) for empiric maintenance fluid therapy in children with central nervous system (CNS) infections that reduces the incidence of hospital acquired hyponatremia. Methods: This blinded randomized controlled trial included hospitalized children aged 3 mo to 5 y with suspected CNS infections requiring intravenous maintenance fluid for at least 24 h. The subjects were randomized to receive 0.9 % saline (Group-A), 0.45 % saline (Group-B) and 0.18 % saline (Group-C) at standard maintenance rate. The outcome measures were proportion of patients developing hyponatremia (serum sodium < 135 mmol/L) after 24 h and serum sodium values at 6, 12, 18, 24 h of receiving maintenance fluids. Results: Of the 92 patients enroled, 31, 30 and 31 patients were randomized to Group A, B and C, respectively. Majority (60.7 %) of the patients in Group-C developed hyponatremia compared with 7.1 % of the children in Group-A and 46.1 % in Group-B. During first 24 h of fluid administration successive fall in the serum sodium values was observed in patients receiving hypotonic fluids. The risk of developing hyponatremia was nearly 6½ (95 % confidence interval (CI) 1.6-26) to 8.5 (95 % CI 2.16-33.39) times more in patients who received hypotonic saline compared to those who received isotonic saline. Conclusions: Administration of 0.9 % saline in 5 % dextrose as intravenous maintenance fluid in children with CNS infection leads to significantly less incidence of hyponatremia when compared to that with hypotonic fluids. [ABSTRACT FROM AUTHOR]

Background: In 2010, there was an increase in the severity of malaria admissions to Kalawati Saran Children's Hospital, New Delhi and this report describes the morbidity and mortality profile. Method: A retrospective chart review of patients admitted with parasitologically confirmed malaria between January and December 2010. Results: There were 156 cases: P. vivax 105 (67·3%), P. falciparum 39 (25%) and mixed infections 12 (7·7%). Thrombocytopenia (platelet count <150×109/L) was present in 90 (85·7%) patients with P. vivax mono-infection. There were 91 (58·3%) patients with severe malaria: P. vivax mono-infection 46 (50·5%), P. falciparum mono-infection 35 (38·5%) and mixed 10 (11%). Severe anaemia and severe thrombocytopenia (platelet count <20×109/L) were detected significantly more often in P. falciparum and P. vivax mono-infection, respectively. Complications including cerebral malaria, acute renal failure, shock, acute respiratory distress syndrome (ARDS) and multiple-organ dysfunction syndrome (MODS) were similar in both groups. The mortality rate of around 20% was similar in severe P. vivax and P. falciparum mono-infection. Risk of mortality in vivax malaria was highest in patients with ARDS followed by MODS and shock. Conclusion: Increased morbidity owing to P. vivax malaria was observed and risk of mortality was highest in patients with ARDS and MODS. [ABSTRACT FROM AUTHOR]

Objective: To look for profile of severe malaria and contribution of vivax infection to malarial morbidity in North Indian children. Methods: Detailed clinical, biochemical and hematological characteristics of children hospitalized with severe malaria over last 3 y were recorded. Presence of malarial parasite on peripheral smear and/or positive antigen test was considered as diagnostic for malaria. Results: A total of 131(55.3%) patients with Plasmodium vivax (Pv), 79 (33.3%) with Plasmodium falciparum (Pf) and 27 (11.4%) with mixed infections were admitted. Cerebral malaria, severe anemia and shock were significantly more frequently observed in Pf group, while hepatic, renal, respiratory, and bleeding complications were more commonly seen in Pv patients. Malaria mortality was highest in mixed infection (11.1%), followed by Pf (7.6%) and Pv (3%) group. Conclusions: Severe and fatal vivax malaria is an emerging recognized entity and challenges the perception of Pv as a benign disease. Further clinical studies and molecular research is required to understand emergence of severe malaria in vivax mono-infection. [ABSTRACT FROM AUTHOR]

Objective: To study the outcome of HIV exposed infants in terms of mortality, morbidity, nutritional status and HIV infection status. Methods: Retrospective analysis of data on 162 HIV exposed infants registered at Regional Pediatric Center for HIV, Delhi and meeting the inclusion criteria, was done. Results: Median age at presentation was 6 wk. 17.4% mothers were on ART while 44.1% received NVP prophylaxis. 61.7% babies received NVP prophylaxis. Thirty-three percent of infants were symptomatic at presentation. Feeding strategy followed was breast-feeding in 18.7%, replacement feeding 71.6% and mixed feeding 9.7%. At presentation, 50.6% infants were wasted, 48.8% stunted and 39.4% had microcephaly. A progressive increase in proportion of children with under-nutrition, stunting and microcephaly was noted with increasing age at presentation. Of the enrolled infants, 81 (50%) were alive and under follow-up. Among these, HIV infection was excluded in 65 infants (80.2% of those alive, 40.1% of the cohort). Thirty-four (21%) infants died and 47 (29%) were lost to follow-up. HIV infection was diagnosed in 24 (14.8%, 14 definite, 10 presumed). Of these 13 were alive and on ART, while 11 died. HIV status was not ascertained for the infants lost to follow-up and 23 infants who died. Conclusions: HIV infection is being under-diagnosed during pregnancy. Exposed infants have a high mortality and high prevalence of malnutrition. There is an urgent need for standardizing care of exposed infants to promote follow-up and prevent mortality by offering feeding counseling and ensuring early infection detection. [ABSTRACT FROM AUTHOR]

Objectives: To determine the population at risk, risk factors, and outcome of occupational exposure to blood and body fluids in health care providers. Materials and Methods: Retrospective review of two and half year data of ongoing surveillance of occupational exposure to blood and body fluids in a tertiary care hospital. Results: 103 Health Care Providers (HCP) reported an occupational exposure to blood and body fluids during the period under review. These comprised 72 (69.9%) doctors, 20 (19.4%) nursing personnel, and 11 (10.6%) cleaning staff. Of the doctors, 65% were interns. 53.4% HCP had work experience of less than one year. Circumstances of exposure included clinical procedures (48%), sweeping/handling used sharps (29%), recapping (16%), and surgery (6.9%). 74.3% of the exposures were due to non-compliance with universal precautions and were thus preventable. The device most frequently implicated in causing injury was hollow bore needle (n=85, 82.5%). Human Immunodeficiency Virus (HIV) status of the source was positive in 6.8% cases, negative in 53.4% cases, and unknown in remaining 39.8% cases. Postexposure prophylaxis (PEP) was indicated in 100 (97.08%) cases and was initiated within 2 h of exposure in 26.8% HCP. In 23.2% HCP, PEP initiation was delayed beyond 72 h of exposure due to late reporting. Thirteen HCP received expanded and the remaining received basic regime. Of the 82 HCP followed up, 15 completed the full course, while 55 stopped PEP after the first dose due to negative source status. Twelve HCP with exposure to blood of unknown HIV status discontinued PEP despite counseling. Complete follow-up for seroconversion was very poor among the HCP. HIV status at 6 month of exposure is not known for any HCP. Conclusions: Failure to follow universal precautions including improper disposal of waste was responsible for majority of occupational exposures. HCP need to be sensitized regarding hospital waste management, management of occupational exposure, need for PEP, and continued follow-up. [ABSTRACT FROM AUTHOR]

India has the world's greatest burden of neonatal and under- five mortality. In 2008, approximately 1.8 million under five children, including 1 million neonates, died. At the current rate of progress, India will not be able to achieve the MDG 4 target of reduction of under- five mortality to 38 per 1,000 live births by 2015. The Reproductive and Child Health programme (RCH) II under the National Rural Health Mission (NRHM) comprehensively integrates interventions that improve child health and addresses factors contributing to infant and under-five mortality. Under the RCH II National Programme-Implementation Plan, IMNCI approach is the major instrument of newborn and child health strategy. IMNCI clinical guidelines focus on assessment, classification and providing treatment according to disease severity. Severe illnesses (red classification) require urgent referral after pre-referral treatment. Further diagnosis and management is dependent on the skills of health workers of the referral hospital. Therefore, capacity building of professionals for providing optimum care for sick children in referral units is an obvious path to optimize the benefits of IMNCI on child survival. With these objectives, F-IMNCI (Facility based IMNCI) package was developed by a committee of experts constituted by the Ministry of Health and Family welfare, Government of India. [ABSTRACT FROM AUTHOR]

The health related indices in our country are far from satisfactory and the country still bears an enormous share of the global disease burden. The lack of accessibility, scarce availability and the poor quality of health services and personnel in the remote rural and underdeveloped urban areas have been the major obstacles to the delivery of quality health care services in a vast and culturally diverse country with inter- and intra-regional variations and inequalities. The already over-stretched public health care system has been grappling with the deficiencies in linkage with the collateral health determinants, gross shortage and non utilization of infrastructure, financial and human resources. Revitalizing the existing primary health care infrastructure under the National Rural Health Mission (NRHM) will bring about the long overdue architectural corrections in the health care sector and be able to provide accessible, affordable, accountable, effective and reliable health care especially to the under-privileged sections of the society. NRHM is based on the principles of decentralisation of the health system, empowerment of the community and the panchayati raj institutions. Effective integration of health concerns with other health determinants like sanitation, hygiene and nutrition through district health plan is being made. [ABSTRACT FROM AUTHOR]

Malaria is a major vector borne disease in India with significant morbidity and mortality. The official figure of 1.5 million cases annually is a gross under-estimation of the true incidence and the actual figures are estimated to be 10-100 times higher. The National Vector Borne Disease Control Programme (NVBDCP) directorate is the main body responsible for malaria control in India. Newer strategies including insecticide treated bednets, longlasting insecticidal bednets and rapid diagnostic tests have been used for malaria control in the last decade. Global assistance has come from the World Bank and Global fund in the form of Enhanced Malaria Control Programme(EMCP) and Intensified Malaria Control Programme(IMCP) respectively. Despite years of concerted global and national efforts, control of malaria continues to be a challenge. The emergence of drug resistance to anti-malarial drugs has been a major hurdle in its control. The NVBDCP has formulated new treatment guidelines for malaria in 2010 which recommend artemisinin based combination therapy (ACT) as the first-line drugs for P. falciparum malaria in the country. The article discusses the recent national drug policy for malaria and the rationale for its use. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of 3% saline and 0.9% saline infusion as initial resuscitative fluid therapy in children with septic shock. Methods: Sixty children between 2 to 12 years of age with septic shock were randomized to receive normal saline or 3% saline as initial resuscitative fluid. Fluid resuscitation was done with 0.9% saline in boluses of 20 ml/kg, each bolus over a duration of 15 min with a maximum of 2 boluses. Fluid resuscitation with 3% saline was given as a single bolus of 15 ml/kg over 30 min. After initial fluid bolus completion, if hemodynamic stability was not achieved then further fluid boluses of 0.9% saline were given in volumes of 5-10 ml/kg guided by CVP. Results: There were 30 patients in both the groups. Both the groups were identical with respect to age, gender, primary diagnosis, laboratory parameters, initial hemodynamic parameters and PRISM score at time of admission. The amount of total fluid bolus required for resuscitation was approximately half in the group who received 3% saline as compared to the group who received 0.9% saline. The use of vasopressor drugs, shock reversal time, ICU stay and mortality rate were similar in both the groups. No adverse effects related to fluid therapy were observed in any of the groups. Conclusions: Both normal saline and hypertonic saline were equally effective as resuscitation fluid with respect to restoration of hemodynamic stability, average duration of ICU stay and mortality. Hypertonic saline appears to be a promising fluid for resuscitation of septic shock. [ABSTRACT FROM AUTHOR]

Objectives: To describe our experience in children hospitalized with the pandemic Influenza A (H1N1) from Northern India. Methods: The retrospective case study was conducted at the Pediatric ward and Pediatric Intensive Care Unit (PICU) dedicated to the children (aged 18 years or younger) with influenza-like illness (ILI) with positive laboratory test results for pandemic H1N1 by reverse-transcriptase polymerase-chain-reaction assay. Results: Between August 2009 and January 2010, a total of 100 children were hospitalized with suspected 2009 H1N1 influenza with Category 'C' as described by the Government of India. Twenty five patients were positive for H1N1 and 9 for seasonal influenza A. The most common presentation (H1N1 positive) was with fever (100%), cough (100%), coryza (52%), respiratory distress (88%), vomiting (28%) and diarrhea (16%). One child presented with hypernatremic dehydration and seizures (Serum sodium 174 meq/l). Of the H1N1 positive hospitalized children, 7 (28%) had respiratory failure and required PICU admission, 4 (16%) required mechanical ventilation, and 3 (12%) died. The major radiological findings were bilateral pulmonary infiltrates and consolidation. All patients were treated with oral Oseltamivir suspension or capsule as per appropriate weigh band and supportive care as required. Two deaths were caused by refractory hypoxemia and one by refractory shock. Conclusions: The exact incidence of Pandemic 2009 H1N1 influenza on morbidity and mortality is difficult to calculate since only Category 'C' patients were screened. [ABSTRACT FROM AUTHOR]

Neonatal mortality in developing countries is one of the most important problems that need immediate attention in order to achieve Millennium Development Goals. About 4 million newborns die in the world every year, 90% of them in the developing world. Most of these deaths are preventable by simple interventions in the community. However, in most of the target countries, the implementation of essential newborn care has been very poor. The home based or community care packages include maternal care, essential newborn care, improving the behavior change communication of the community, resuscitation of newborn babies at the time of home delivery, and management of sick newborns with antibiotics at home. Studies have reported one-third to two-third reduction of mortality among newborns after home based care interventions. However, when translated into scaling up of home based newborn care in the worst affected districts of the country, the results are not very rewarding. Identification of limiting factors and effective up scaling of the home-based packages will prove to be of enormous benefit in reducing neonatal mortality. [ABSTRACT FROM AUTHOR]

Sero-epidemiological features of measles in Delhi were studied in 369 children. The study included 60 children who had history of measles in the past. Out of 369 random sera of children upto 8 years, 59·07% were found to be positive for measles antibody. The past history of measles was shown to be quite reliable as 91·6% of children with history of measles, showed high level of antibody for measles. However, 44·8% of 127 children with no positive history of measles were seropositive indicating previous sub-clinical infection. From the study it is concluded that the optimal age for vaccination in children is above 9 months. [ABSTRACT FROM AUTHOR]

Tetanus remains endemic in India. A retrospective hospital-based study was conducted to review the profile of all children admitted with diagnosis of tetanus betweenJanuary 2009 and December 2010. Atotal of 140 cases of tetanus were admitted;45 cases of neonatal tetanus (NT) and 77 cases of post-neonatal tetanus (PNT) were studied. Age of presentation of NTwas 9.4+1.2 days. Home-delivered children accounted for 86.7% of cases, with 77.8% being attended by untrained birth attendants. Unimmunizedmothers accounted for 93.4%. In PNT, otogenic route of infection and traumawere present in 58.4% and 23.3% of cases, respectively.The rate of hospital admission of tetanus remains high. Unlike previously published reports, otogenic route is themost common mode of PNT infection in this study. Improving immunization, increasing deliveries by skilled birth attendants and prompt treatment of suppurative otitismedia are themain areas in which public health initiatives need to be focused. [ABSTRACT FROM AUTHOR]

Congenital hyperinsulinism (CHI) is the most frequent cause of severe, persistent hypoglycemia in infancy and childhood. We report a case of CHI with diffuse pancreatic abnormality diagnosed preoperatively using the 68Ga octreotide (DOTA NOC) positron emission tomography scan. Genetic analysis revealed homozygous ABCC8 splicing mutation. Subtotal (95%) pancreatectomy was done, and the infant remained euglycemic and was discharged on breast feeds. The patient is continuously followed up and is asymptomatic until 9 months. [ABSTRACT FROM AUTHOR]

Delayed sexual maturation is a known complication of celiac disease (CD). There is paucity of data regarding the effect of gluten-free diet (GFD) on sexual maturity in patients with CD in India. We did a cross-sectional observational study to assess the sexual maturity in 30 adolescents with CD on GFD for at least 1 year, and evaluated factors which affect their sexual maturity. Sexual maturation was assessed using Tanner's stages of sexual development. All adolescents had completed 2 years of GFD and 53 % had completed 4 years of GFD. Sexual maturation was delayed in 30 %. Age at initiation of GFD was associated with attaining appropriate sexual maturity ( p = 0.048). We conclude that delayed sexual maturation is not uncommon in adolescents with CD and may be corrected by early diagnosis and initiation of GFD. [ABSTRACT FROM AUTHOR]

nemia is common during adolescence. However, severe anemia is uncommon and can have varied etiology. This study was conducted to find out the profile of adolescents (10-18 years) admitted for severe anemia. The Case records of children between 10 and 18 years old admitted during the year 2008 in Kalawati Saran Children's Hospital for severe anemia as admitting diagnosis were reviewed. There were 40 patients admitted with severe anemia during the year 2008. This constituted 3.37% of all the admissions. Mean age of these patients was 12 (+/−2.5) years and mean hemoglobin at admission was 3.6 (+/−1.4) g%. Megaloblastic anemia was most common type of anemia (42.5%) followed by aplastic anemia (27.5%) and 15% cases were due to severe iron deficiency anemia. Although iron deficiency anemia is the most common type of anemia, but in adolescents megaloblastic anemia and aplastic anemia should be looked for whenever the adolescents present with severe anemia. [ABSTRACT FROM AUTHOR]

Kimura's disease is a rare cause of a progressive neck swelling associated with blood and tissue eosinophilia. Though it is a benign disease, however, its unrelating course and unpredictable response to the therapeutic interventions, poses a great challenge to the treating physician, the patients and the caregiver. Here is one such case of Kimura's disease. [ABSTRACT FROM AUTHOR]

Kimura’s disease is a rare cause of a progressive neck swelling associated with blood and tissue esinophilia. Though it is a benign disease, however, its unrelating course and unpredictable response to the therapeutic interventions, poses a great challenge to the treating physician, the patients and the caregiver. Here is one such case of Kimura’s disease. [ABSTRACT FROM AUTHOR]

Two cases of idiopathic pulmonary hemosiderosis in children are reported. Both cases presented with a combination of acute/recurrent respiratory symptoms along with iron deficiency anemia. In one case diagnosis was delayed for 18 months after onset of symptoms. After initial stabilisation with corticosteroid therapy, both cases were put on chloroquine therapy and showed improvement. Various other forms of therapy and outcome are discussed. It is suggested that in cases with recurrent respiratory symptoms, idiopathic pulmonary hemosiderosis should also be considered after excluding infectious etiology. [ABSTRACT FROM AUTHOR]