Changing Profile of Severe Malaria in North Indian Children

Objective  

To look for profile of severe malaria and contribution of vivax infection to malarial morbidity in North Indian children.     

Immune Thrombocytopenia in Children: Consensus and Controversies

Indian Journal of Pediatrics - Newly diagnosed immune thrombocytopenia (ITP) is a relatively common disorder of childhood that does not require an exhaustive laboratory workup for diagnosis. A...     

Clinical Course of Children with HIV Associated Thrombocytopenia

Objectives  

To study the clinical profile of HIV associated thrombocytopenia, co-relation between thrombocytopenia and immune status and the effect of the anti-retroviral therapy (ART) on platelet count.     

Human Bertiellosis from North India

A 4-y-old boy presented with a history of episodes of gripping abdominal pain and intermittent shedding of segments of a worm in stool, which used to actively change in size and shape. On the basis of measurements of the segments and characteristic features of the eggs, the worm was identified as Bertiella studeri. The characteristic morphological details of the worm, the pitfalls in its identification and the zoonotic potential of this rare cestodal infection are discussed here.     

ITP-QoL Questionnaire for Children with Immune Thrombocytopenia: Italian Version validation's

Background: The ITP-QoL is a disease-specific questionnaire for the assessment of health-related quality of life (HRQoL) in children with immune thrombocytopenia (ITP) and their parents. The aim of this study was to test the psychometric characteristics of the ITP-QoL in the Italian pediatric population in terms of validity and reliability. Procedure: Children aged 8–16 years with acute or chronic ITP and their parents were recruited in Italy. Participants completed the ITP-QoL together with other patient-reported outcomes (PROs). Reliability was calculated using Cronbach's alpha. Convergent validity was determined by means of the Pearson correlation coefficients. Results: A total of 91 ITP patients, mean age of 12.11 ± 2.47 years, and their parents participated; 61.5% of the patients were female. Two patients had acute ITP and 30.2% had a moderate to severe status of ITP. Cutaneous symptoms were more frequent than mucosal symptoms. Due to item and scale analyses 20 items were deleted from the original ITP-QoL. Internal consistency of the ITP-QoL was found to be good with Cronbach's alpha exceeding α = 0.70 for all but one subscale. Concerning convergent validity “moderate” to “high” negative correlations were found between ITP-QoL and KINDL subscales. The ITP-QoL was able to discriminate between clinical subgroups such as number of days lost at school due to ITP and hospitalization. Conclusions: Our study was able to demonstrate that the Italian version of ITP-QoL (for children aged 8–16 years) is a valid and reliable instrument for the assessment of HRQoL in children with ITP.     

疟疾儿童血液学分析

目的探讨疟疾患儿外周血三系、血沉及骨髓像变化。方法使用希森美康KX-21血液分析仪检测22例疟疾患儿血细胞,血沉用魏氏法,骨髓进行人工形态学分析。结果疟疾患儿22例Hb<110g/L占68.2%;WBC<4×109/L占41.0%;PLT<100×109/L占77.3%;至少2项低于正常水平占63.6%,3项指标均低占36.4%。血沉增高占95.5%。增生性贫血骨髓像占59.1%,继发性血小板减少骨髓像占77.3%;两者合并占54.5%。结论疟疾患儿外周血3系改变较大。其中PLT和Hb降低最为突出;血沉极大多数增高。骨髓多呈增生性贫血及继发性血小板减少性骨髓像。     

Clinicohematological Profile and Platelet Trends in Children with Dengue During 2010 Epidemic in North India

Objective  

To study the clinicohematological profile and the platelet trends in children presenting with dengue infection during the 2010 dengue epidemic in north India and to compare the it with previous epidemics.     

Malaria in India: Past,present and future

Malaria existed in ancient India even centuries before Christ. With the introduction of DDT as a residual insecticide, malaria control in India was attempted in 1953. It was converted into an eradication programme in 1958. With the help of DDT and chloroquine, the number of malaria cases came down sharply and only 0·1 million cases were recorded in 1965. Since then there had been a setback and cases went on increasing till 1976 when 6·4 million cases of malaria were recorded. by national malaria eradication programme. The eradication programme was converted into a control programme in 1977 by the introduction of modified plan of operations. Cases of malaria have shown progressive decline since 1977. But the most disturbing feature is the resurgence of P. falciparum malaria with appearance of chloroquine resistance in this species. The situation needs to be tackled urgently.     

Cardiac Spectrum,Cytogenetic Analysis and Thyroid Profile of 418 Children with Down Syndrome from South India: A Cross-sectional Study

Objective

To describe the spectrum of congenital heart disease in children with Down syndrome and their cytogenetic profile (and that of parents of those with translocation), and thyroid profile.

Methods

A cross sectional study was conducted in 418 consecutive patients with Down syndrome attending the Department of Pediatric Genetics from a tertiary care centre in Kerala with a comprehensive Pediatric Cardiac Program, from November 2005 through April 2012. All children were offered cytogenetic analysis and were subjected to echocardiography. Parental karyotyping was offered for children with translocation type of Down syndrome. The thyroid profiles of all children were checked at the first visit and once every 6 mo during follow up.

Results

Congenital heart disease was present in 256 (63.4 %) of 404 children with Down syndrome. Ventricular septal defect (72; 28.1 %) was the commonest, followed by atrio-ventricular septal defect (70; 27.3 %) and patent ductus arteriosus (43; 16.8 %). Surgical correction was accomplished in 104 (40.6 %) with excellent intermediate-term outcomes. Three hundred eighty seven of 418 children (92.6 %) underwent cytogenetic tests. The abnormalities included non-disjunction (340, 87.8 %), translocation (33, 8.5 %) and mosaicism (12, 3.1 %). Hypothyroidism was detected in 57 children (13.6 %).

Conclusions

The prevalence of congenital heart disease in children with Down syndrome in Kerala is the highest reported (63.4 %). Ventricular septal defect is the most common heart disease in the present study. The results highlight the changing attitudes of families towards the surgical correction of congenital heart disease in children with Down syndrome. Prevalence of hypothyroidism in Down syndrome in Kerala is 13.6 %.     

Scrub Typhus in Children at a Tertiary Hospital in North India: Clinical Profile and Complications

Objective: To study the clinical profile and complications of childhood scrub typhus. Methods: Prospective observational study of 66 children with scrub typhus, admitted to a tertiary hospital in north India, during the period between January 2011 and December 2012. The diagnosis was confirmed by serology. Findings : All children presented with fever. Other common symptoms were vomiting (56%), facial swelling (52%), cough (35%), abdominal pain (33%), breathlessness (29%) and decreased urine output (29%). High grade fever (>101 ^oF) was recorded in 91% of children. Other common signs were hepatomegaly, splenomegaly, edema, tender lymphadenopathy and hypotension, observed in 82%, 59%, 39%, 38% and 36% of cases, respectively. An eschar and a maculopapular rash each were observed in 20% of patients. Meningoencephalitis (30.3%), severe thrombocytopenia (27.2%), shock (25.8%), acute kidney injury (16.7%) and hepatitis (13.6%) were the most common complications observed in these children. Other common complications were acute respiratory distress syndrome, respiratory failure requiring ventilation, bronchopneumonia and myocarditis. Ninety percent of children became afebrile within 48 hours of initiating an appropriate antibiotic. Median time to defervescence was 22 hours. The overall mortality rate was 7.5%. Causes of death were refractory shock, meningoencephalitis, acute respiratory distress syndrome, bronchopneumonia, acute kidney injury and myocarditis. Conclusion: Pediatricians should keep a high index of suspicion for scrub typhus in any febrile child having a maculopapular rash, hepatosplenomegaly, tender lymphadenopathy, thrombocytopenia and features suggestive of capillary leak. Pending serological confirmation, empirical therapy with doxycycline or azithromycin should be started, as delay in treatment would result in life threatening complications.Key Words: Scrub Typhus, Mite, Eschar, Rash, Meningoencephalitis     

严重脓毒症患儿血小板减少原因及处理对策

目的结合血常规、凝血功能及骨髓细胞学检查,探讨严重脓毒症患儿PLT减少的原因及临床处理措施。方法选取严重脓毒症患儿72例,根据预后分为存活组和死亡组,对2组患儿的PLT计数与预后关系进行分析;分析PLT减少患儿入院时脏器累及情况;结合凝血功能监测与骨髓细胞学检查分析PLT减少的原因及其处理对策。结果死亡组入院当天及入院后7 d PLT计数与存活组相比有统计学差异。PLT<80×109L-129例患儿入院时受累器官数目≥3个19例(65.5%),死亡8例(27.6%);而PLT<50×109L-113例中受累器官数目≥3个10例(76.9%),死亡6例(46.2%)。14例死亡患儿中因PLT重度减低/DIC致重要脏器出血死亡6例(42.9%)。29例PLT减少患儿中,20例(69.0%)伴有凝血功能异常,9例(31.0%)伴骨髓巨核系成熟障碍。13例PLT<50×109L-1患儿中给予积极处理11例(84.6%),死亡4例(36.4%);未能积极处理2例(15.4%),全部死亡。结论PLT持续进行性下降提示预后差;针对PLT减少病因积极处理可显著改善预后。     

重组人白细胞介素-11防治神经母细胞瘤患儿强烈化疗后血小板减少的自身对照研究

目的研究白细胞介素11(IL-11)防治化疗后血小板减少的作用。方法选择初治的Ⅳ期神经母细胞瘤14例患儿,以3次CDV化疗后为研究对象,随机分为对照组;第1组:化疗结束后d1开始用IL-11,25μg/(kg·d),皮下注射,连用10~14d;第2组:IL-11,50μg/(kg·d),用药方法及时间同第1组。3组观察外周血小板数目至化疗后21d。结果对照组血小板在化疗2周时降至最低点(21±14)×109/L,血小板低于30×109/L持续时间为(7.28±2.80)d,血小板输注次数为(2.67±1.01)次,第1组血小板最低值、血小板低于30×109/L持续时间、21d时血小板数及血小板输注次数分别为(24±17)×109/L、(6.78±3.4)d。(111±39)×109/L和(2.71±1.23)次,上述指标与对照组均无显著差异(P>0.05);第2组血小板最低值、血小板低于30×109/L天数及血小板输注次数分别为(42±20)×109/L、(1.79±2.30)d及(0.71±0.99)次,与对照组比较均有显著性差异(P<0.05),且外周血小板数量在化疗10d即较其他两组高(P<0.05)。化疗后3周时3组血小板数量无差异。结论神经母细胞瘤患儿强烈化疗后IL-11用量在50μg/(kg·d)时可有效刺激血小板生成,升高外周血小板数量。