BACKGROUND: India houses highest number of malnourished children next to African countries. Malnutrition is lethal in combination with Tuberculosis. Efficacy of BCG vaccination, a part of Universal Immunization Programme in preventing TB infection and utility of TST in detection of TB infection in malnourished children needs to be studied. OBJECTIVE: 1. To obtain the morbidity pattern of tuberculosis. 2. To study the role of BCG vaccination and reliability of TST in under five children with severe acute malnutrition. MATERIAL AND METHODS: DESIGN: A prospective study. SETTING: Severe malnutrition unit in a tertiary level referral hospital in central India. PARTICIPANTS: Under five children with severe acute malnutrition in SMTU. OUTCOME MEASURES: 1. Presence of tuberculosis in SAM children. 2. Morbidity pattern of tuberculosis in SAM children. 3. Presence of BCG scar in diseased children. 4. Reactivity status of TST in diseased children. RESULTS: Tuberculosis was diagnosed in 22% of severe acute malnutrition cases. Seventy eight percent (78.50%) of the pulmonary tuberculosis cases were younger than 1 year. In children of 13-26 months of age, 50% of cases were pulmonary tuberculosis while neuro-tuberculosis and disseminated tuberculosis contributed 25% each. BCG scar was present in 86.6% of malnourished children with pulmonary tuberculosis while only 28.4% of extra pulmonary seriously ill cases had BCG scar. Positive tuberculin reaction was seen in only 8.0% children, 50% of them had 10-15mm induration. CONCLUSION: Tuberculosis is one of the treatable causes of malnutrition and there is high prevalence of tuberculosis infection among SAM children. Identifying adult cases and giving proper treatment as well as screening their malnourished children will help in early identification and preventing spread of pulmonary TB among children.
Background: Acute respiratory infections are a leading cause of morbidity and mortality in under-five children in developing countries. Hence, the present study was undertaken to study the various demographic risk factors which predispose to acute lower respiratory tract infections (ALRI) in children aged 2 month to 5 year. Objective; Demographic factors associated with acute lower respiratory tract infections in children aged 2 months to 5 years. Methods: 100 ALRI cases fulfilling WHO criteria for pneumonia, in the age group of 2 month to 5 years were evaluated for demographic risk factors and clinical profile as per a predesigned proforma in a rural medical college. Results: Sociodemographic risk factors like parental illiteracy, overcrowding, partial immunisation and low socioeconomic status were potential risk factors; similarly nutritional risk factors like early and late weaning, anaemia and malnutrition were associated with ALRI. Significant environmental risk factors were use of biomass fuels, inadequate ventilation at home, and lack of separate kitchen. Conclusion: The present study has identified various socio-demographic, nutritional and environmental risk factors for ALRI which can be tackled by effective health education of the community and effective training of peripheral health personnel.
Background: Early referral to proper level of neonatal care is vital for neonatal survival. Deranged physiological status studied at the time of admission can be predictive of neonatal outcome. The present study was done in an attempt to discover statistically significant, more objective and feasible variables easily assessable by simple low cost devices for identification of sick newborns in need of stabilization and referral to tertiary facility based care. Primary objective was to study predictors of deranged neonatal percentage saturation of oxygen in blood as well as for neonatal hypoglycemia. Secondary objective was to develop a scoring system comprising of both subjective and objective variables to assess neonatal outcome.Methods: It was a prospective cohort observational study conducted at outborn neonatal intensive care unit in a tertiary level care hospital in Central India. Participants were all outborn neonates of age less than or equal to 28 days from March 2013 to May 2013 admitted in NICU.Results: A significant association was found between percentage saturation of oxygen in blood (SpO2) and other deranged neonatal pathophysiological variables i.e. hypothermia (p=0.001); delayed CRT (p=0.001); gestational age (p=0.002); cyanosis (p=0.003); respiratory distress (p=0.001). On applying multivariate binary logistic regression, hypothermia was found to be an important predictor of hypoglycaemia. The survival percentage was 91.5%, 87.7%, 76.5% and 20% with the scores of less than 5, score 6-10, score 11-16 and score >16 respectively.Conclusions: The scoring system based on both subjective and objective predictors is useful for timely identification and early referral of high risk neonates from primary and secondary level care to higher level. A high score predicts a poor outcome.
Background: Neonatal sepsis (NS) is the most common cause of neonatal mortality responsible for about 30–50% of total neonatal deaths in developing countries. Surveillance of causative organisms and their antibiotic sensitivity pattern promotes the rational use of antibiotics and antibiotic stewardship. Objectives: The objectives of this study were to study the prevalence of NS in newborn intensive care unit of a tertiary hospital of Central India and to isolate the most common organism involved in sepsis in our setting. Materials and Methods: A retrospective study was conducted and relevant data of the neonates diagnosed with culture-positive sepsis were obtained from the case records during the period from February 2018 to February 2019. Culture-positive sepsis was defined as the isolation of bacterial pathogen from blood in neonates with clinical suspicion of sepsis. Results: A total of 223 neonates were enrolled. The major morbidities were hyperbilirubinemia (23.3%), birth asphyxia (14.3%), sepsis (53.8%), and respiratory distress (32.7%). The main causes of neonatal mortality were birth asphyxia (9.8%), prematurity (18.83%), sepsis (32.23), hyaline membrane disease (13.4%), and meconium aspiration syndrome (13.9%). A total of 120 cultures were found to be positive. The most common organism isolated was Staphylococcus aureus (39.3%) followed by Klebsiella pneumoniae (34%). Candida albicans was also isolated. Conclusion: Culture-positive NS accounted for 53.8% of all cases and is the major cause of mortality (32.28%) in the present study. Sepsis caused by Gram-positive bacteria was the most common among the neonates, although mortality was more in Gram-negative sepsis. Therefore, empirical regimen should be modified based on antibiogram of the isolates.
Introduction: Corticosteroids play a pivotal role in the treatment of the asthma. They rapidly reduce the number of eosinophils in the blood and tissues and inhibit their degranulation, suggesting that sputum eosinophilia could be a good predictor of response to inhaled corticosteroids. Chronic diseases like asthma have significant effects on patients' health-related quality of life (HRQoL). HRQoL measures additional indices as compared to objective measurements like spirometry. Objective: To assess and compare disease-specific quality of life in asthma patients using St. George's Respiratory Questionnaire (SGRQ) receiving inhaled corticosteroids. Material and Methods: Patients were enquired for their duration of illness, other co morbidities (if present), history of smoking and familial history of the illness. Pattern of asthma was duly assessed. For Health-related Quality of life assessment, Saint George's Respiratory Questionnaire (SGRQ) was used in the study after obtaining due permission from the concerned authority at St George's, University of London. Results: Mean age of the study population was found to be 36.17 ± 18.77 years. Mean duration of illness for the asthmatics was 10.19 ± 11.08 years. Majority i.e. 69% denied of having any familial history of asthma, while 31% confirmed having the same. Smoking status was enquired among the study subjects, which revealed that 85% were non-smokers, while 9% were past smokers and 6% were current smokers. Pattern of asthma was found to be seasonal for 65% patients while perennial for 35% patients. Baseline symptoms score was 61.45± 15.78, which was reduced to 48.19±18.73 after 3 months on inhaled corticosteroids therapy. Baseline activity score was 49.67± 15.34, which was reduced to 41.51±18.52 after 3 months on inhaled corticosteroids therapy. Baseline impact score was 48.79± 16.85, which was reduced to 38.69±18.14 after 3 months on inhaled corticosteroids therapy. Conclusion: There was evidence for an early QoL improvement on inhaled corticosteroids in moderate and severe persistent asthma.
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