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Introduction: Poor infant feeding practices predispose children to nutritional disorders which may persist into early childhood with life-long consequences. We aimed to find out prevalence of malnutrition among children aged less than six years and to assess infant and young children feeding practices and their impact on malnutrition. Methods: An analytic cross-sectional study was conducted between March 2021 and May 2022 among children up to six years of age registered in the Anganwadi centers of Rajkot district. Using the formula n = Z2pq/e2, a sample size of 504 was estimated, including 10% nonresponders. Samples were drawn using a multistage simple random sampling method. The z scores related to the anthropometric measurements were estimated using the World Health Organization Anthro 2011 software. We reported prevalence of different types of malnutrition and infant and young child feeding practices. A logistic regression was used to identify significant factors for stunting and wasting (P < 0.05). Results: The mean age of the children was 32.43 months (SD 18.7 months). The prevalence of stunting and wasting was found 36.7% and 30.5%, respectively. The prevalence of prelacteal feeding practices was 72.8%. Less than one-fourth (21.4%) of children were exclusively breastfed and 77.9% of the children received complementary feeding at appropriate age. The binary logistic regression model showed that stunted growth was strongly associated with exclusive breastfeeding and complementary foods’ introduction at the appropriate age. Conclusion: As compared to national, state, and district averages, the prevalence of wasting was remarkably higher among children included in the study. In addition, the study underscores the disturbingly high prevalence of prelacteal feeding practices, which can have a detrimental effect on the health of newborns.

Inflammatory myofibroblastic tumor (IMT) is a rare and histologically benign tumor that most commonly presents in pediatric patients. Abdominal IMTs often present with non-specific symptoms, and therefore they can masquerade as other more common abdominal conditions. This report describes two cases of IMT presenting as perforated appendicitis. Both cases are of young children who presented with over 48 hours of abdominal pain and who had peritonitis on examination. Pre-operative ultrasounds for both patients revealed complex free fluid. Laparoscopic evaluation demonstrated hemoperitoneum, and further exploration revealed mesenteric avulsion with abnormally thickened mesentery. Pathology confirmed IMT arising from the small bowel mesentery in both cases. Both children underwent limited bowel resection and were discharged in stable condition on a course of non-steroidal anti-inflammatory drugs (NSAIDs). Given the association of avulsed bowel to trauma, non-accidental trauma was suspected in both cases and demonstrated in one. Both patients showed complete resolution of tumor on follow-up MRI. The diagnosis of IMT must always be considered when an intra-abdominal mass is encountered as its treatment differs greatly from other neoplasms.

Background: The nasal cavity and paranasal sinuses - including the maxillary, ethmoid, sphenoid, and frontal sinuses are collectively referred to as the sinonasal tract. Fine needle aspiration (FNA) of paranasal sinus lesions for early diagnosis of neoplastic lesions is difficult due to closed architecture, and only one study has been documented in the literature. Aims: To find the efficacy of intra-operative cytology and frozen section for frequently encountered tumor and tumor-like lesions of the nose and paranasal sinuses. Materials and Methods: Thirty cases were included in this study. The material for cytologic examination and frozen sections were taken per-operatively. Cytological smears were prepared by imprint/squash methods from the representative tissue pieces and stained with Leishman-Giemsa and Papanicolaou. Frozen section and paraffin-embedded section were stained with hematoxylin and eosin stain. A rapid opinion regarding the benign or malignant nature of the lesion and the type of tumor was given. Results: The sensitivity, specificity, and positive predictive value of imprint cytology, squash cytology, and frozen section were 100%, 100%, and 100%; 100%, 96.15%, and 80.0%; and 100%, 96.15%, and 80.0%, respectively. Overall diagnostic accuracy of imprint smears, squash smears, and frozen section was100%, 96.7%, and 96.7%, respectively. Imprint smears had better specificity as cells morphology could be more accurately appreciated. Conclusions: Intra-operative cytology and frozen section examinations of lesions of nose and paranasal sinuses are useful, quick, and reliable diagnostic technique for rapid diagnosis in the operation theatre and can be used as an adjunct to histopathology for better management of patients.

Availability of fast, high throughput and low cost whole genome sequencing holds great promise within public health microbiology, with applications ranging from outbreak detection and tracking transmission events to understanding the role played by microbial communities in health and disease. Within clinical metagenomics, identifying microorganisms from a complex and host enriched background remains a central computational challenge. As proof of principle, we sequenced two metagenomic samples, a known viral mixture of 25 human pathogens and an unknown complex biological model using benchtop technology. The datasets were then analysed using a bioinformatic pipeline developed around recent fast classification methods. A targeted approach was able to detect 20 of the viruses against a background of host contamination from multiple sources and bacterial contamination. An alternative untargeted identification method was highly correlated with these classifications, and over 1,600 species were identified when applied to the complex biological model, including several species captured at over 50% genome coverage. In summary, this study demonstrates the great potential of applying metagenomics within the clinical laboratory setting and that this can be achieved using infrastructure available to nondedicated sequencing centres.

abstract

Abstract Background Necrotising enterocolitis (NEC) is a devastating bowel disease, primarily affecting premature infants, with a poorly understood aetiology. Prior studies have found associations in different cases with an overabundance of particular elements of the faecal microbiota (in particular Enterobacteriaceae or Clostridium perfringens), but there has been no explanation for the different results found in different cohorts. Immunological studies have indicated that stimulation of the TLR4 receptor is involved in development of NEC, with TLR4 signalling being antagonised by the activated TLR9 receptor. We speculated that differential stimulation of these two components of the signalling pathway by different microbiota might explain the dichotomous findings of microbiota-centered NEC studies. Here we used shotgun metagenomic sequencing and qPCR to characterise the faecal microbiota community of infants prior to NEC onset and in a set of matched controls. Bayesian regression was used to segregate cases from control samples using both microbial and clinical data. Results We found that the infants suffering from NEC fell into two groups based on their microbiota; one with low levels of CpG DNA in bacterial genomes and the other with high abundances of organisms expressing LPS. The identification of these characteristic communities was reproduced using an external metagenomic validation dataset. We propose that these two patterns represent the stimulation of a common pathway at extremes; the LPS-enriched microbiome suggesting overstimulation of TLR4, whilst a microbial community with low levels of CpG DNA suggests reduction of the counterbalance to TLR4 overstimulation. Conclusions The identified microbial community patterns support the concept of NEC resulting from TLR-mediated pathways. Identification of these signals suggests characteristics of the gastrointestinal microbial community to be avoided to prevent NEC. Potential pre- or pro-biotic treatments may be designed to optimise TLR signalling.