Diagnostic Accuracy of Rapid Antibody Detection Test for Scrub Typhus

OBJECTIVE

To detect the diagnostic accuracy of rapid antibody detection test using IgM immunochromatography for scrub typhus in children.

METHODS

This cross-sectional study enrolled children aged 2 months-18 years hospitalized over a period of 18 months with undifferentiated fever of duration five days or more. The blood samples were subjected to serological tests like Weil-Felix, Scrub IgM ELISA, immunofluroscence assay (IFA) and rapid diagnostic test (IgM Immunochromatography). Diagnostic accuracy was measured against IFA as the gold standard.

RESULTS

A total of 90 children were included in the study, among which 43 children were positive for gold standard test IFA. Rapid diagnostic test showed sensitivity of 88.3%, specificity of 89.3%, positive predictive value of 88.3% and negative predictive value of 89.3%. The sensitivity, specificity, PPV and NPV of Weil-Felix test was 39.5%, 84.2%, 58.6 and 71.1%, respectively and of IgM ELISA was 93%, 89.3%,88.8% and 93.3%, respectively.

CONCLUSION

IgM immunochromatography had good diagnostic accuracy for scrub typhus in children with acute undifferentiated fever.

Diagnostic Accuracy of Rapid Antibody Detection Test for Scrub Typhus

OBJECTIVE

To detect the diagnostic accuracy of rapid antibody detection test using IgM immunochromatography for scrub typhus in children.

METHODS

This cross-sectional study enrolled children aged 2 months-18 years hospitalized over a period of 18 months with undifferentiated fever of duration five days or more. The blood samples were subjected to serological tests like Weil-Felix, Scrub IgM ELISA, immunofluroscence assay (IFA) and rapid diagnostic test (IgM Immunochromatography). Diagnostic accuracy was measured against IFA as the gold standard.

RESULTS

A total of 90 children were included in the study, among which 43 children were positive for gold standard test IFA. Rapid diagnostic test showed sensitivity of 88.3%, specificity of 89.3%, positive predictive value of 88.3% and negative predictive value of 89.3%. The sensitivity, specificity, PPV and NPV of Weil-Felix test was 39.5%, 84.2%, 58.6 and 71.1%, respectively and of IgM ELISA was 93%, 89.3%,88.8% and 93.3%, respectively.

CONCLUSION

IgM immunochromatography had good diagnostic accuracy for scrub typhus in children with acute undifferentiated fever.

Effect of Neonatal Factors on the Eruption of Primary Teeth in Children: A Longitudinal Prospective Cohort Study

Introduction

Eruption of first primary teeth is a normal physiological process. Antenatal nutritional deficiency and prenatal and neonatal factors play an important role in eruption of primary teeth. Neonatal factors, such as gestational age (GA), degree of prematurity, severity of neonatal illness, and birth weight are primarily related to eruption of primary teeth. The relation between neonatal factors and the timing of eruption of primary teeth has not been studied prospectively among Indian preterm infants.

Aims

To evaluate the influence of neonatal factors on the eruption of primary teeth in children born preterm.

Materials and methods

A prospective longitudinal cohort study design was adopted. A total of 150 subjects were recruited by simple random sampling. Each child was followed up from birth up to 36 months. Intraoral examination was done and the teeth present in each visit were recorded. Data were statistically analyzed and interpreted.

Statistical analysis used

Descriptive statistics, t-tests for independent sample, and Pearson's chi-squared tests were applied. Tooth showing statistically significant difference in mean age of eruption between term and preterm categories was studied for the effect of maternal and neonatal characteristics on eruption using multivariate regression analysis.

Results

The mandibular central incisor was the first tooth to erupt. Significant determinant of eruption of mandibular incisor in term children was found to be parity, weight for GA, and complementary feeding, whereas for preterm children, significant determinants were parity, birth weight birth length, weight for GA, and complementary feeding.

Conclusion

Neonatal factors, such as birth weight, birth length, weight for GA, and introduction of complementary feeding have a strong significant association with the eruption of primary teeth.

Clinical significance

The findings of this study will guide in the preventive management of oral health in preterm children.

How to cite this article

Indira MD, Nandlal B, Narayanappa D, et al. Effect of Neonatal Factors on the Eruption of Primary Teeth in Children: A Longitudinal Prospective Cohort Study. Int J Clin Pediatr Dent 2023;16(2):321-326.

It is just not short stature

Russell-Silver syndrome, also called asymmetric dwarf dysgenesis syndrome is an uncommon genetic disorder presenting with low birth weight, failure to thrive and growth retardation (short stature), developmental delay, facial dysmorphism and hemihypertrophy. The estimated incidence is between 1 case in 3,000 to 1 case in 100,000. We are hereby reporting one such case of postnatal growth retardation with facial dysmorphism and several other features of Russell-Silver syndrome and confirmed by genetic analysis.

Influence of gestational age on eruption of primary teeth in Indian children - A prospective longitudinal study

Context

Eruption of primary teeth is the most anticipated event in a child's life. Genetics, gender, socio-economic status, gestational age are a few of the determinants of the primary teeth eruption. However, the effect of gestational age on the timing of primary teeth eruption among the Indian population has not been explored to date.

Aim

The study was conducted to evaluate the influence of gestational age on time and sequence of eruption of primary teeth among children of Mysore.

Settings and Design

A prospective longitudinal cohort study design was conducted at 'Baby Oral Health Promotion Clinic' at the Department of Paediatrics, JSS Hospital, Mysore.

Methods and Material

150 newborn babies were recruited by simple random sampling and followed up from birth to 36 months. Teeth present during each visit were recorded. Data were statistically analysed and interpreted.

Statistical Analysis Used

Descriptive statistics, t-test for an independent sample, and Pearson's Chi-squared test were applied.

Results

The mandibular central incisor was the first tooth to erupt. Statistically insignificant early eruption in males was noted in both term and preterm children. When the chronological ages were compared, the preterm group showed a statistically significant delay in the eruption of all the teeth. However, when the age was adjusted for prematurity, only the central incisors and second molars showed a statistically significant delay.

Conclusions

Gestational age has a strong significant association with the eruption of primary teeth and maybe one of the strong predictors for delayed eruption among children of Mysore.

Prevalence of overweight and obesity among school children in Mysuru, Karnataka

Childhood obesity has become a major public health challenge in developing countries including India due to the changes in the lifestyle and food habits of children owing to the influence of urban culture and technological growth. The present study is a cross-sectional, school-based study conducted to assess the prevalence of obesity and to determine the demographic variables influencing the obesity among school children.

The Spectrum of Congenital Central Nervous System Anomalies Among Stillborn: An Autopsy Based Study

Background:

Congenital central nervous system (CNS) anomalies are the structural or functional abnormalities of the brain and spinal cord that occur during the intrauterine developmental process.

Purpose:

The present study aims to detect the prevalence of congenital CNS anomalies among stillborn fetuses, the association between congenital anomalies and maternal factors, and also the association between autopsy and ultrasound findings.

Methods:

This study was conducted on 50 stillborn fetuses, obtained from the Department of Obstetrics and Gynecology at JSS Medical College and Hospital, Mysuru. The fetuses were fixed in 10% formalin and autopsies were performed as per the standard fetal autopsy protocol. The congenital CNS anomalies were studied in detail.

Results:

CNS anomalies were the most common congenital anomalies observed. Out of the total 50 stillborn fetuses studied, CNS anomalies were found in 17 fetuses and their occurrence was more common among male stillborn than females. Meningomyelocele was the most common anomaly, followed by anencephaly. The other anomalies documented were meningocele, encephalocele, meningoencephalocele, agenesis of the corpus callosum, craniorachischisis, bifid cerebellum with hypoplastic vermis, holoprosencephaly, and sirenomelia.

Fisher’s exact test showed a significant association between maternal hypothyroidism and congenital CNS anomalies (P < .05). The autopsy confirmed the ultrasound findings in 40 (80%) fetuses. There were significant additional findings observed in seven (14%) fetal autopsies and ultrasound diagnosis completely changed in three (6%) cases, after the final autopsy procedure.

Conclusion:

The fetal autopsy is the single most directly evident investigation, which gives information that changes or significantly improves the clinical diagnosis. A multidisciplinary holistic approach toward pregnancy will help to detect any kind of abnormality in the fetus and thus to take a timely decision toward the management.

Profile of Congenital Cardiovascular Anomalies among Stillborns at a Tertiary Care Hospital

Introduction: Congenital cardiovascular anomalies refer to anatomic malformation of the heart and great vessels occurring during the intrauterine developmental process. Aim: To determine the pattern of distribution of cardiovascular anomalies through autopsy and to find an association between maternal factors and congenital anomalies, and also an association between autopsy and ultrasound findings. Materials and Methods: This was a descriptive cross-sectional study, which consisted of 50 stillborn foetuses. The foetuses were obtained from the Department of Obstetrics and Gynaecology at a JSS Medical College and Hospital, Mysuru, Karnataka, India. The foetus was fixed in 10% formalin and the autopsies were carried out as per standard foetal autopsy protocol. The cardiovascular anomalies were studied in detail. Data collected were entered in MS Excel 2010 and analysed using Statistical Package for the Social Sciences (SPSS) version 22 to obtain relevant statistics. Descriptive measures like percentages were calculated and the distribution of birth weight, gestational age, maternal age, gravida of the mother, and socioeconomic status of parents among the stillborn foetuses were studied. Fisher’s-exact test was done to find out the association between maternal diabetes and cardiovascular anomalies. The results were interpreted as statistically significant at p<0.05. Results: Out of the total 50 stillborn foetuses studied, cardiovascular anomalies were present in five cases. The ventricular septal defect was the most common anomaly. Other anomalies were an atrial septal defect, tetralogy of fallot, and pulmonary stenosis. The occurrence of cardiovascular anomalies was four times more common in male foetuses than in the female. Each stillborn foetus was classified, based on birth weight, gestational age, maternal age, gravidity of the mother, and socioeconomic status of parents. Maximum foetuses 29 (58%) were having a birth weight between 500-1000 grams. Maximum foetuses 20 (40%) were from the gestational age group of 22-26 weeks. The maximum number of foetuses 24 (48%) were born to mothers in the age group of 26-30 years and 22 (44%) mothers were primigravida. The maximum number of stillborns 25 (50%) belonged to the lower middle class of socioeconomic status according to Kuppuswamy’s socioeconomic scale. History of consanguinity was present in 10 (20%) mothers. Fisher’s-exact test showed a significant association between maternal diabetes and cardiovascular anomalies (p<0.016). The autopsy confirmed the antenatal ultrasound findings in 40 (80%) of the cases. There were significant additional findings observed in 7 (14%) cases and ultrasound diagnosis was completely changed in 3 (6%) cases, after the final autopsy procedure. Conclusion: This study focuses on the importance of concomitant foetal autopsy in providing accurate genetic counseling. It is mandatory to have an autopsy study for all the stillborn foetuses to predict and counsel for safe future pregnancy outcomes. The preventive measures for maternal diabetes should be taken care of to avoid cardiovascular anomalies in the antenatal period and future pregnancies.

A Phase III open-label, randomized, active controlled clinical study to assess safety, immunogenicity and lot-to-lot consistency of a bovine-human reassortant pentavalent rotavirus vaccine in Indian infants

BACKGROUND

A heat-stable bovine-human rotavirus reassortant pentavalent vaccine (BRV-PV, ROTASIIL®) was developed in India. In this study, the vaccine was tested for safety, immunogenicity and clinical lot-to-lot consistency.

METHODS

This was a Phase III, open label, randomized, equivalence design study. The primary objective was to demonstrate lot-to-lot consistency of BRV-PV. Subjects were randomized into four arms, three arms received Lots A, B, and C of BRV-PV and the control arm, received Rotarix®. Three doses of BRV-PV or two doses of Rotarix® and one dose of placebo were given at 6, 10, and 14 weeks of age. Blood samples were collected four weeks after the third dose to assess rotavirus IgA antibody levels. The three lots of BRV-PV were equivalent if the 95% Confidence Intervals (CIs) of the geometric mean concentration (GMC) ratios were between 0.5 and 2. Solicited reactions were collected by using diary cards.

RESULTS

The study was conducted in 1500 randomized infants, of which 1341 infants completed the study. The IgA GMC ratios among the three lots were around 1 (Lot A versus Lot B: 1.07; Lot A versus Lot C: 1.06; and Lot B versus Lot C: 0.99). The 95% CIs for the GMC ratios were between 0.78 and 1.36. The IgA GMCs were: BRV-PV group 19.16 (95% CI 17.37-21.14) and Rotarix® group 10.92 (95% CI 9.36-12.74) (GMC ratio 1.75; 90% CI 1.51-2.04). Seropositivity rates were 46.98% (95% CI 43.86-50.11) and 31.12% (95% CI 26.17-36.41). The incidence of solicited reactions was comparable across the four arms. No serious adverse events were associated with the study vaccines, except two gastroenteritis events in the BRV-PV groups.

CONCLUSION

Lot-to-lot consistency of BRV-PV was demonstrated in terms of GMC ratios of IgA antibodies. The vaccine safety and immunogenicity profiles were similar to those of Rotarix®. Clinical Trials.Gov [NCT02584816] and Clinical Trial Registry of India [CTRI/2015/07/006034].

Non-interference of Bovine-Human reassortant pentavalent rotavirus vaccine ROTASIIL® with the immunogenicity of infant vaccines in comparison with a licensed rotavirus vaccine

Background

A newly developed bovine-human reassortant pentavalent vaccine (BRV-PV, ROTASIIL®) was tested for its potential effect on the immunogenicity of concomitantly administered EPI vaccines in infants in a randomized controlled study in India.

Methods

In this Phase III, multicenter, open label, randomized, controlled study, three doses of BRV-PV or two doses of Rotarix® and one dose of placebo were given to healthy infants at 6, 10, and 14 weeks of age. Subjects also received three doses of DTwP-HepB-Hib (diphtheria, tetanus, whole-cell pertussis, hepatitis B, and haemophilus influenzae type b conjugate – pentavalent vaccine) and oral polio vaccine concomitantly at 6, 10, and 14 weeks of age and a single dose of inactivated polio vaccine at 14 weeks of age. Blood samples were collected four weeks after the final vaccination to assess immune responses to all the vaccines administered. For diphtheria, tetanus, hepatitis B, Hib, polio type 1, and polio type 3 antibodies, non-interference was to be supported if the lower limit of the two-sided 90% confidence interval (CI) for the seroprotection rate difference for the BRV-PV group minus the Rotarix® group was >10.0%. For pertussis antibodies, non-interference was to be supported if the lower limit of the two-sided 90% CI for the ratio of geometric mean concentrations (GMCs) was >0.5.

Results

A total of 1500 infants were randomized to either BRV-PV (1125 infants) or Rotarix® (375 infants), of which 1341 completed the study as per the protocol. More than 97% of subjects achieved seroprotective antibody titres against diphtheria, tetanus, hepatitis B, Hib, polio type 1, and polio type 3 in both groups. The difference in seroprotection rates between the BRV-PV group and the Rotarix® group for all these antibodies was less than 1%. The ratio of GMCs of anti-pertussis IgG concentrations for the BRV-PV group versus Rotarix® was 1.04 [90% CI: 0.90; 1.19].

Conclusion

BRV-PV does not interfere with the immunogenicity of concomitantly administered routine infants vaccines.

Adverse Drug Reactions in Hospitalized Pediatric Patients: A Prospective Observational Study

OBJECTIVES

To determine the incidence, pattern, causality, preventability, severity and predictors of adverse drug reactions (ADRs) in pediatric population.

METHODS

It was a prospective, observational study that included patients of either sex, of any age treated in the pediatric wards of a tertiary care hospital. Study patients were followed throughout their hospital stay. Whenever an ADR was detected, all the required data was collected and analyzed. Data was analyzed for incidence, causality (by using WHO Probability scale and Naranjo's algorithm), preventability (by using Modified Shumock and Thornton scale), severity (by using Modified Hartwig and Siegel scale) and predictors of ADRs.

RESULTS

Of the 1775 children admitted in the pediatrics ward, 1082 patients met study criteria and were enrolled into the study. A total of 64 ADRs were identified from 54 patients. The incidence of ADRs was 4.99 %. Male patients experienced majority (68.52 %) of ADRs. Drugs most commonly implicated in ADRs were amoxicillin + clavulanate (21.87 %) followed by ceftriaxone (20.31 %). Most (51.56 %) of the ADRs reported belonged to the system organ class, gastrointestinal system disorders. Among the ADRs reported, 82.85 % of ADRs were mild. Majority (87.5 %) of the ADRs were of 'probable' causality category and 96.9 % were not preventable. There was a significant association between occurrence of ADRs and the use of ≥4 number of medications, age (infants) and gender (male).

CONCLUSIONS

Among the pediatric population, infants, male gender and those receiving ≥4 number of medications are at risk of developing ADRs. Constant monitoring is required to address the safety issue in pediatric population especially in infants and patients receiving ≥4 drugs.

Indian parents prefer vaccinating their daughters against HPV at older ages

BACKGROUND

Increasing uptake of human papillomavirus (HPV) vaccine should be a priority in developing countries since they suffer 88% of the world's cervical cancer burden. In many countries studies show that age at vaccination is an important determinate of parental acceptability. This study explores parental preferences on age-to-vaccinate for adolescent school-going girls.

MATERIALS AND METHODS

The sample was selected using a two-stage probability proportional to size cluster sampling methodology. Questionnaires were sent home with a random sample of 800 adolescent girls attending 12 schools in Mysore to be completed by parents. Descriptive statistics including frequencies, percentages and proportions were generated for independent variables and bivariate analyses (Chi square test) were used to assess the relationship between independent and appropriate age-to-vaccinate.

RESULTS

HPV vaccination acceptability was high at 71%. While 5.3% of parents felt girls should be vaccinated by 10 years or younger; 38.3% said 11-15 years; 14.8% said 16-18 years; 5.8% suggested over 19 years; and 33% didn't know. Only 2.8% of parents would not vaccinate their daughters.

CONCLUSIONS

Delaying HPV vaccination until later ages may significantly increase uptake of the HPV vaccine in India.

A Case of Ocular Torticollis

A 1-year-and-2-month-old male baby was brought to Pediatric out patient department with head tilt to left side, chin rotated to right side with full range of neck movement, right eye hypertropia increased on left gaze, and not associated with any other musculoskeletal abnormalities. Diagnosis of ocular torticollis secondary to right superior oblique muscle palsy was made.

Clinico-bacteriological profile and outcome of empyema

Empyema thoracis is a common cause of morbidity in children. We conducted a prospective observational study in 50 children (age 0-15 y) diagnosed with empyema to study its clinico-bacteriological profile and outcome in a referral hospital. Staphylococcus aureus was the most common causative organism, most of them being MRSA, followed by Pneumococcus and Pseudomonas. Primary video-assisted thoracoscopy appeared to be a good mode of management with lesser duration of hospital stay. However, the number of children undergoing this procedure was very less, to come to any conclusion.

Mutations of TFAP2B in congenital heart disease patients in Mysore, South India

BACKGROUND & OBJECTIVES

Cardiac malformations in the young constitute a major portion of clinically significant birth defects. Congenital heart disease (CHD) is a common congenital cardiac birth defect, affecting nearly 1 per cent of all live births. Patent ductus arteriosus (PDA) is clinically significant foetal circulation anomaly, second most common form of CHD which constitutes approximately 10 per cent of total CHDs. The study aimed to screen for TFAP2B mutations in CHD patients of Mysore.

METHODS

With informed consent, 100 clinically diagnosed CHD patients and 50 healthy controls in Mysore, south India, were recruited for the analysis of screening of mutations. MassARRAY analysis of 5 prominent mutations of TFAP2B was performed.

RESULTS

The analysis did not show any of the five mutations of TFAP2B screened by massARRAY in patients and controls, indicating that these mutations were not involved in the manifestation of CHD in the patients at Mysore, south India.

INTERPRETATION & CONCLUSIONS

The findings suggest the lack of involvement of known mutations of TFAP2B with syndromic or nonsyndromic CHDs in Mysore patients.

Prevalence of prediabetes in school-going children

OBJECTIVE

To study the prevalence of prediabetes among school children in Mysore city.

DESIGN

Cross sectional study.

SETTINGS

Children aged 5-10 years from three schools in Mysore city were included. Study was done over a period of 1 year during 2006-2007.

PARTICIPANTS

726 children (59.8%; males).

MAIN OUTCOME

Prevalence of prediabetes. Prediabetes was defined as fasting blood sugar level between 100-125 mg/dL.

RESULTS

The prevalence of prediabetes was 3.7%;. No statistically significant association was observed with major risk factors of diabetes.

CONCLUSIONS

Efforts must be made to recognize type 2 diabetes in the asymptomatic prediabetes state.

Randomized double blinded controlled trial to evaluate the efficacy and safety of Bifilac in patients with acute viral diarrhea

OBJECTIVE

To evaluate the efficacy and safety of Bifilac on reducing the episodes (frequency) and duration of diarrhea induced by rotaviral infection and to evaluate the efficacy of Bifilac to ameliorate the associated symptoms like dehydration and duration of rotaviral shedding in faeces.

METHODS

80 children aged between 3 months and 3 years were enrolled and divided into 2 groups, one group received standard therapy + placebo, the other group received standard therapy + probiotic (Bifilac) randomly. Children assessed for frequency and duration of diarrhea. Degree of dehydration, duration and volume of oral rehydration salt [ORS] therapy, duration and volume of Intra venous fluids and duration of rotaviral shedding.

RESULTS

When compared to the placebo, Bifilac showed clinical as well as statistically significant reduction in Number of episodes (frequency) of diarrhea in a day, mean duration of diarrhea (in days) degree of dehydration, duration and volume of oral rehydration salt [ORS] therapy, duration and volume of intravenous fluid [IVF] therapy, duration of rotaviral shedding (P<0.01).

CONCLUSION

The synbiotic, bifilac, appears to be a safe and very effective adjuvant in the management of acute rotaviral diarrhea.

Audit of aminoglycosides usage

OBJECTIVE

This study was aimed to evaluate the usage patterns of aminoglycosides in pediatric patients for their appropriateness.

METHODS

A retrospective review was conducted over a period of six months at J.S.S. Hospital, Mysore. Patients who received parenteral aminoglycosides and below the age of 12 years were included in this study.

RESULTS

A total of 197 pediatric patients were evaluated for the appropriateness and was found to be 72%, 86%, 85%, 43% & 53% for indication, dose, duration, safety and cost effectiveness respectively. Majority of the patients were treated with gentamicin (53%). The most frequent indication was respiratory tract infections (50%).

CONCLUSION

Effort was made to encourage judicious and quality use of aminoglycosides among the pediatricians of J.S.S. Hospital to ensure better patient care by implementation of the aminoglycosides guidelines.

Antibacterial acivity of the essential oil of lippie nodiflora

The plant Lippia nodiflora (Family-Verbenaceae) has medicinal properties and particularly used as an antidandruff agent. The essential oil of the plant was tested for its antibacterial activity against both gram positive and Gram negative bacteria. It showed good activity and compared with standard neomycin sulphate. However, it was inactive in the case of shigella flexneri.