Introduction: Beta-thalassemia major is the most common chronic hemolytic anemia. It is a well-comprehended fact that the toxic effects of iron overload particularly the cardiomyopathy are the major complication that roots from beta-thalassemia major children. Therefore, timely diagnosis is crucial to optimize the long-term gain. Objective: The objective of the study is to find the cutoff level of serum ferritin for early diagnosis of cardiac iron overload. Materials and Methods: This study was an observational analytical cross-sectional diagnostic study which was conducted from November 2016 to October 2018. With due approval of Institutional Ethics Committee and after taking proper informed consent from the parents and/or legal heir, 105 thalassemic children were enrolled in the study by simple consecutive sampling after satisfying the pre-defined inclusion and exclusion criteria. In this study, two-dimensional Doppler echocardiography was used to detect cardiac iron overload. Serum ferritin levels were estimated, and cutoff values were calculated for each of the echocardiographic parameters of cardiac iron overload, i.e. ejection fraction (EF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD) by receiver operating characteristic curve analysis. Sensitivity (Sn), specificity (Sp), positive predictive value, and negative predictive value were calculated with considering p<0.05 as statistically significant. Results: The mean age of the study participants was 9±3 years. Cutoff value of serum ferritin for detecting abnormality in EF was 3286 ng/ml with Sn of 76.1% and Sp of 88.1%. Similarly, for detecting abnormal LVEDD, cutoff value of serum ferritin was 4640 ng/ml with Sn of 70.1% and Sp of 98.6%, and for LVESD, it was 3286 ng/ml with Sn of 90% and Sp of 70.5%. Conclusion: The serum ferritin level can be used as a reliable marker of myocardial iron overload among childhood beta-thalassemia and hence can be used as an important screening tool.

Introduction: There are certain risk factors or predictors that can be used for early detection of cardiac iron overload to improve the long-term gains in beta-thalassemic children. Objective: The aim of the study was to consider the predictive abilities of some of the clinical attributes of the beta-thalassemia patients regarding cardiac iron overload to identify at risk patients. Materials and Methods: This current observational study was conducted in the Department of Pediatrics, VIMSAR, Burla from November 2016 to October 2018. A total of 105 thalassemic children were enrolled in the study after satisfying the inclusion criteria (multi-transfused beta-thalassemia children in the age group of 6–14 years). All the relevant data were collected and correlation-regression statistics were done using computer-based software. Results: Serum ferritin has weak negative correlation with left ventricular end diastolic diameter (LVEDD) (r=–0.511, p=0.000), good negative correlation with ejection fraction (EF) (r=–0.604, p=0.000), and weak positive correlation with left ventricular end systolic diameter (LVESD) (r=0.084, p=0.393). Number of units of packed red cell transfusion has strong negative correlation with EF (r=–0.785, p=0.000), weak negative correlation with LVEDD (r=–0.297, p=0.005), and weak positive correlation with LVESD (r=0.413, p=0.000). Corrected logistic regression equation, i.e., cardiac iron overload=1.997 (age in years) –3.119 (gender) –0.078 (units of packed red blood cells [PRBC]) +0.003 (serum ferritin in ng/ml) –0.149 (LVEDD in mm) –0.235 (weight in kg) –10.928 with prediction of 94.3%. Conclusions: Age of the patient, serum ferritin level, and number of units of PRBCs transfused, LVEDD and weight of the child are good predictors of myocardial iron overload among childhood beta-thalassemic and hence can be used as indices for monitoring of onset of cardiac iron overload.

Introduction: Pneumonia is still the leading cause of morbidity and mortality of our country, approximately 16% of deaths among children under 5 years of age globally and as per NITI Aayog report 2015; the under-five mortality rate (U5M R) of Odisha is 39 and the most common causes of under-five mortality being pneumonia. M any studies have been done on pneumonic children but currently survival analysis of these children is rare. Methods: The present observational, analytical, hospital based prospective cohort study was conducted over a period of 12 months in a tertiary hospital of western Odisha. Total 152 children were included in the study after satisfying the predefined inclusion and exclusion criteria and ethical committee approval by simple consecutive sampling method. CRF was used to record all relevant data of the study participants and SPSS v25 was used for survival analysis. Results: M edian duration of survival in days of children with severe pneumonia (8.0, 6.60 to 9.39) is not significantly higher than the children with very severe pneumonia (7.0, 4.89 to 9.10) as evidenced by Breslow chi-square = 3.93 (1), p = 0.057. There is no overall difference in survival among gender, immunization status, breast feeding status, exposure to smoke, socio economic groups and gestational age as evidenced by p > 0.05. Conclusion: Disease survival (time to event analysis) is not affected by the severity (severe vs very severe pneumonia) of the illness, which may be due to the fact that late diagnosis and late referral from the peripheral centre. So the skill of the health workers and the health technologies should be strengthened at the primary level.

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