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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 9 | Issue 4
Page Nos. 121-162

Online since Wednesday, December 22, 2021

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EDITORIAL  

Search for cause of autism spectrum disorder p. 121
Asok Kumar Datta
DOI:10.4103/jpai.jpai_29_21  
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REVIEW ARTICLES Top

Bed side neurosonogram – As essential tools in neonatal intensive care units p. 122
Nakul Kothari
DOI:10.4103/jpai.jpai_31_20  
In neonatal intensive care units (NICUs), almost all babies have one or more risk factors for the development of intracranial abnormalities or intracranial bleeds. Early identification of any such lesion is very important in treatment, prognostication, and directing further therapy in such high-risk babies. As NICU care in India is advancing, we should evolve and adapt the new strategies to help us serve our babies better. Neurosonogram is one such tool, which now is essential in any tertiary NICU. Neurosonogram is an ideal tool for the primary screening of the neonatal brain. It can demonstrate many unsuspected cranial abnormalities. It has to be emphasized about its use as a screening modality for preterm and birth asphyxia neonates influencing their neurodevelopmental outcome. This is particularly important in the anticipation of potential preventive, protective, and rehabilitative strategies for the management of critically ill newborn infants.
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Approach to feeding problems in children p. 127
Santosh Kondekar, Shweta Shettiwar, Charmi Bhanushali, Rishi Bothara, Abhishek Mandal
DOI:10.4103/jpai.jpai_15_21  
Feeding small children had been a daunting experience by most parents, particularly for those having behavioural issues. Several patterns have been reported. History taking is considered invaluable in these cases. Many patterns have been described. Of interest is when associated with autism spectrum disorder. Behaviour modification and counseling with patience are rewarding. It is important to rule out organic causes of feeding difficulties while planning for definitive intervention.
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ORIGINAL RESEARCH Top

Comorbidities in children with epilepsy p. 131
Larissa Dabre, N Revathi, Harshita Shah
DOI:10.4103/jpai.jpai_32_20  
Aims and Objectives: Children with epilepsy can have other coexisting issues related to the disease, drugs, or social factors. The spectrum and prevalence of these comorbidities are seldom considered. The aim of this study was to study the presence and type of comorbid factors in epileptic children and to determine the association between the age at diagnosis, duration, and type of epilepsy with comorbidities. Materials and Methods: It is a cross-sectional observational study conducted over a period of 18 months in a tertiary care hospital in Navi-Mumbai. Children with epilepsy, satisfying the inclusion criteria, were examined for the presence of comorbidities such as developmental delay, sleep disorders, hyperactivity, autism, and school performance. Standard screening questionnaire were used for each of the above conditions. Results: Sixty children with epilepsy were enrolled in our study. Fifty-two percent of these children were found to have multiple comorbidities, the most common being autism. Younger age at onset of epilepsy, polytherapy with anticonvulsant medications, generalized tonic-clonic seizures, higher frequency, and prolonged duration of epilepsy were found to be risk factors of comorbidities. Conclusion: From our study, we demonstrate that the risk of multiple comorbidities in children with epilepsy is high. Identifying these comorbidities can improve the quality of life in epileptic patients and hence should be a part of epilepsy management.
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Success of bubble continuous positive airway pressure in preterm neonates admitted with respiratory distress syndrome at tertiary care center p. 135
Ajay K Keshwani, Ankush D Maindad
DOI:10.4103/jpai.jpai_11_21  
Background: Application of continuous positive airway pressure (CPAP) in neonate with respiratory distress is associated with reduction of respiratory failure, complications, and mortality. Bubble CPAP (B-CPAP) is a most popular CPAP mode, but studies on B-CPAP as respiratory support for neonates are few. Therefore, the present study was conducted to assess the effectiveness of B-CPAP on immediate outcome of preterm infants of gestational age 28–36 weeks with respiratory distress syndrome (RDS) and to identify the risk factors associated with its failure. Materials and Methods: This longitudinal study was conducted in neonates admitted in the newborn unit with respiratory distress with Downe's score 4–6, SPO2 < 85% even with supplemental oxygen during a period from August 1, 2019 to July 31, 2020. Investigations to diagnose the cause of respiratory distress were done including radiograph of the chest in all cases. Results: Out of total 330 neonates, 245 babies weaned from CPAP ventilation and discharged while 85 babies succumbed to the illness. Mortality was high in male babies, weighing <1.5 kg and babies with septicemia. At day 0 of administration of B-CPAP, 25.75% had Downes score 4, 33.03% were in score 5, and 41.21% were in score 6. All parameters such as cyanosis, grunting, tachypnea, chest indrawing, and air entry improved with B-CPAP administration. The various causes of respiratory distress were asphyxia, RDS, apnea of prematurity, meconium aspiration syndrome (MAS), and bronchopneumonia sepsis. Out of this, 22 babies with RDS and all babies with MAS and sepsis had significant radiological findings. Conclusion: We concluded that, this form of therapy should be adopted even by the smaller hospitals to improve the survival of neonates with respiratory distress.
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Association of asymptomatic structural cardiac defects in neonates with transient tachypnea at birth: A case-control study p. 140
Gurpreet Kaur Dhillon, Shankar Narayan, Ananthakrishnan Ramamoorthy, Harpreet Singh Dhillon, Shibu Sasidharan
DOI:10.4103/jpai.jpai_5_21  
Background: Transient tachypnea of the newborn (TTNB) has been documented as the most common cause of neonatal respiratory distress, accounting for more than 40 percent of cases. Materials and Methods: This study was a prospective study on 75 patients (neonates who were born with TTNB) who underwent two-dimensional (2D) echocardiography (Echo) after tachypnea subsided. The controls (neonates who did not manifest tachypnea) were matched for birth weight, period of gestation, mode of delivery, and sex. Appropriate Chi-square tests were done for categorical variables, while Student's t-test was done for continuous variables. Results: Incidence of asymptomatic structural cardiac lesions detected by 2D Echo was significantly higher in neonates in the study group (n = 38; 50.66%) as compared to the control group (n = 7; 9.33%). This difference was statistically significant P < 0.0000002 (odds ratio 9.4586; 95% confidence interval 3.84–23.27). The most common cardiac lesion in both groups was atrial septal defect. Conclusion: The incidence of asymptomatic structural cardiac defects was found to be approximately five times higher in neonates manifesting TTNB (50.66% vs. 9.33%). Based on the findings of this study, screening for structural cardiac lesions by 2D echo is recommended in all neonates who manifest with TTNB.
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Proposed clinical and radiological grading system in pediatric adenoid hypertrophy p. 146
Santosh V Kondekar, Swarada Sunil Phatale, Tanya Manish Arickatt, Anushri Soni
DOI:10.4103/jpai.jpai_19_21  
Background: Adenoid hypertrophy is an extremely common cause of upper airway obstruction in the pediatric population. Its high prevalence in children and the complications associated with its delayed diagnosis mandate a timely detection for its early and complete management. Aims & Objectives: The purpose of this study was to 1) detect the prevalence of adenoid hypertrophy in the pediatric population, 2) devise a clinical and radiological severity grading and determine the correlation between the two to develop an undemanding diagnostic approach. Materials and Methods: A total of 62 patients visiting the pediatric respiratory clinic were examined for signs and symptoms of adenoid hypertrophy like adenoid faces, mouth breathing, and runny nose. Their radiological reports were assessed for findings like flattening or convexity on the posterior pharyngeal wall and reduction in the width of the nasopharyngeal cavity. Results: A prevalence of 83.87% and 79.03% was seen based on the clinical and radiological findings respectively. A moderate positive correlation was also noted between the clinical and radiological grades, which was statistically significant. Conclusion: The ease of diagnosis associated with the clinical approach opens the possibility of detection of adenoid hypertrophy in large groups of children in resource-constrained areas, and negates the complications associated with other methods of diagnosis like endoscopy and radiography which are deemed more reliable by some clinicians.
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Changing serotypes of rotavirus in Western India and clinical severity of diarrhoea p. 151
Kshitija Rane, Pankhuri Kothari, Mansi Thakur, Dattatraya Joshi, Nitin Kadam, Nimain Mohanty
DOI:10.4103/jpai.jpai_6_21  
Introduction: Rotavirus and Norovirus diarrhea pose highest threat to neonates and toddlers all over the world. Diarrhoea happens to be the second most common cause of under-5 mortality in India after Pneumonia. India has the highest incidence of rotavirus diarrhoea, contributing to about 1,50,000 inder-5 deaths annually. Virus serotypes do undergo constant changes, varying in different regions, thought of responding to vaccines differently. Objecive: A prospective observational study was undertaken in Kamothe, Navimumbai (India); enlisting 207 cases of acute watery diarrhoea among under-5 children to study incidence of Rotavirus and Norovirus as causal agents and their serotypes. Efforts were made to understand if virus positivity and their types were related to clinical severity of diarrhoea. Method: Stool samples were collected and tested for rotavirus and norovirus from cases of acte diarrhoea on clinical presentation and after excluding cases of dysentery on clinical presentation. 10.62% cases were found positive for rotavirus RNA by ELISA and 4.83% by Electropherotyping. Cases of acute watery diarrhoea having rotavirus positive and negative stool showed remarkable difference with diarrhoea severity assessed by Vesikary scores. Severe dehydration, stool frequency, vomiting and weight loss were associated with rotavirus infection in younger age group. Long electropherotypes were more prevalent (86.36%) and were associated with higher clinical severity of diarrhoea. P[8] was predominant (77.27%) followed by P[4] (13.63%) genotypes. Neither P[6] nor P[11] was detected. Those found positive for rotavirus in their stool samples, were negative in their serum by eletropherotyping. Only 0.48% of diarrhoea stool samples were found positive for Norovirus by ELISA. Conclusion: Rotavirus diarrhoes shown a decreasing trend in Navimumbai area as compared to previous years. Incidence of Norovirus infection was found very low. Rotavirus positive cases, particularly of long arm electropherotypes, showed clinical severity of diarrhoea as compared to short-arm types and in those found negative for rotavirus or Norovirus.
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CASE REPORTS Top

Arterial thrombosis complicating respiratory syncytial virus infection p. 157
Vipul Chechani, Himanshu Tadvi, Umesh Bhimani
DOI:10.4103/jpai.jpai_27_21  
Respiratory syncytial virus (RSV) is the most important respiratory pathogen of early childhood. Here, we present the case of a 3-year-old child with RSV pneumonia who developed brachial artery thrombosis while on treatment. Child was admitted with pneumonia, confirmed as human RSV on real-time polymerase chain reaction panel that showed gradual improvement on symptomatic treatment. However, on day 9 of illness, he developed cyanosis of left upper limb fingers, with cold extremity distal to elbow. Doppler flow showed complete occlusion of the distal part of brachial artery with absent blood flow in the forearm and palm. Intravenous unfractionated heparin was started along with oral aspirin in the anticoagulant dose. It was continued for 48 h with 6 hourly activated partial thromboplastin time monitoring. Child responded well to conservative management after which he was shifted to low molecular weight heparin followed by oral acenocoumarol. After 6 weeks of anticoagulation therapy, now the vessel has almost fully recanalized.
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Co-existence of russell–silver syndrome with arnold–chiari type 1: A new syndrome or just an association p. 160
Joydeep Das, Krishnendu Choudhury, Shweta Kothari, Navneet Jeevan Nayek
DOI:10.4103/jpai.jpai_20_21  
Hemihypertrophy is not uncommon in pediatrics, a triad of short stature of prenatal onset, skeletal asymmetry, and clinodactyly is characteristic of Russell–Silver syndrome. Association of posterior fossa malformation of Chiari Type 1 with whole length syringomyelia is not reported in literature. We present a case with a combined feature of both syndromes.
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