South Indian Children Research Articles

Assessment of Handwriting Skill in South Indian Children with Developmental Coordination Disorder

Assessment of Handwriting Skill in South Indian Children with Developmental Coordination Disorder

Peak expiratory flow rate assessment to screen for asthma in children with allergic rhinitis

Background: Allergic rhinitis is a common disease affecting around 10-25% of the population worldwide. There is a temporal relationship between the onset of allergic rhinitis and asthma and the ‘unified airway hypothesis’ explains this. Many researchers have demonstrated bronchial hyper-responsiveness prior to onset of asthma symptoms further validating this hypothesis. Further many studies favour treating allergic rhinitis may prevent the onset of asthma. So, detecting allergic rhinitis earlier and treating it adequately is of vital importance. The aims and objectives of this study is to identify bronchial hyper responsiveness in children with allergic rhinitis, prior to the onset of asthmatic symptoms, by measuring PEFR and its clinical correlates.Methods: A prospective observational study was conducted in Department of Paediatrics in Sree Balaji Medical College and Hospital. Inclusion and Exclusion Criteria were defined, and the study was conducted on a total of 85 children. After taking informed consent from parents, the children coming under the study population were analyzed for their baseline characteristics and PEFR is measured using a low reading Mini Wright peak flow meter and compared with mean value of south Indian children using the formula, PEFR= {(HEIGHT IN CM-100) X5} +100.Results: The mean PEFR as expressed in percentage of expected PEFR is 77.28% in males and 83.34% in females. The mean percentage of expressed PEFR does not vary significantly between different age groups. Of the 85 children,48(56.5%) have mild intermittent allergic rhinitis,28(32.9%) have mild persistent allergic rhinitis,5(5.9%) have moderate-severe intermittent allergic rhinitis and 4(4.7%) have moderate-severe persistent allergic rhinitis. There were 37(43.5%) blockers (with predominant nose block) and 48(56.5%) runners (with predominant rhinorrhea).Conclusions: PEFR is abnormal in 41.2% of children with allergic rhinitis. PEFR reduces linearly as the severity of allergic rhinitis increases. PEFR decreases as the number of cardinal symptoms increases. PEFR increases significantly after treatment of allergic rhinitis alone.

Incidence of tuberculosis and the influence of surveillance strategy on tuberculosis case-finding and all-cause mortality: a cluster randomised trial in Indian neonates vaccinated with BCG

IntroductionAccurate tuberculosis (TB) incidence and optimal surveillance strategies are pertinent to TB vaccine trial design. Infants are a targeted population for new TB vaccines, but data from India, with the...

Evaluation of Visual Proprioceptive Skill in South Indian Children with Developmental Coordination Disorder

Evaluation of Visual Proprioceptive Skill in South Indian Children with Developmental Coordination Disorder

Effect of Maternal Vitamin B12 Supplementation on Cognitive Outcomes in South Indian Children: A Randomized Controlled Clinical Trial.

Objectives To examine the effects of oral maternal vitamin B12 supplementation during pregnancy and early lactation on cognitive development in children. Method We studied 218 children born to mothers enrolled in a placebo-controlled, randomized trial of vitamin B12 supplementation during pregnancy through 6 weeks post-partum. Cognitive functions were assessed at 30 months using the Bayley Scales of Infant Development- 3rd edition (BSID III). The association of maternal sociodemographic characteristics, maternal biochemical status during pregnancy, birth weight and home environment with each sub-domain of BSID-III was examined using linear regression analysis. Separate multiple linear regression analyses for each of the BSID-III sub-domains with maternal trimester specific nutritional biomarker status was conducted. Results Children of mothers who received oral vitamin B12 supplementation had significantly higher scores on expressive language compared to children of mothers who received placebo (β = 0.14, P = 0.03). Children of mothers with elevated serum total homocysteine (tHcy) in the second and third trimesters of pregnancy had significantly lower scores on expressive language (β = - 0.18, P = 0.03 and β = - 0.19, P = 0.02, respectively) and gross motor domains (β = - 0.23, P = 0.008 and β = - 0.30, P = 0.001, respectively) of BSID-III adjusted for treatment arm and multiple confounders, compared with children whose mothers did not have elevated tHcy. Conclusions for practice Maternal B12 supplementation during pregnancy was associated with higher expressive language scores in children at 30 months. Elevated maternal tHcy levels during pregnancy had negative associations with expressive language and gross motor domains of BSID-III. Larger trials of maternal B12 supplementation are needed to confirm these findings.

The key informant strategy to determine the prevalence and causes of functional low vision among children in South India

ABSTRACTPurpose: To report the prevalence and causes of functional low vision (FLV) in school-age children in Coimbatore District, Tamil Nadu, India and to report our experience using the key informant (KI) method in this setting.Methods: Children suspected of having low vision were identified by KIs or Aravind Eye Hospital personnel in Coimbatore District. All identified children underwent a cycloplegic refraction and full eye exam. A primary cause of decreased vision was determined for each child. The prevalence of FLV was calculated for children 6–14 years old. Spectacles and low vision devices were provided free of charge.Results: 345 children aged 6–14 years were referred and 231 had FLV. The positive-predictive value of KI referrals was 64.5%. The prevalence of FLV was 0.071% (7.1 per 10,000; 95% CI 0.062–0.080%) and ranged from 0.026% to 0.141% across the district’s blocks. Older children (age 11–14 years; OR 1.41; 95% CI 1.09–1.82) and males (OR 1.52; 95% CI 1.16–1.98) had greater odds of being diagnosed with FLV. The most common causes of FLV were retinal disorders (30.0%) and amblyopia (25.5%). Low vision devices were provided to 169 children who had a mean near and distance visual acuity improvement of 0.31 and 0.63 logMAR, respectively (p < 0.001).Conclusions: This study reports a moderate prevalence of FLV and demonstrates the ability of KIs to identify school-age children with FLV in South India. The provision of basic low vision services can improve visual outcomes in this population.

Electrocardiographic Analysis of Repolarization Changes in South Indian Children with Kawasaki Disease after the Acute Phase of Illness.

Background Cardiac involvement in children with Kawasaki disease (KD) may present with repolarization abnormalities which are associated with increased risk of ventricular arrhythmias and sudden cardiac events. Methods Twenty children with history of KD without cardiac involvement in the acute phase were recruited along with age and sex-matched controls. Twelve-lead ECG was obtained from both groups using CARDIART 610T ECG system at 25 mm/sec and 50 mm/sec paper speed. ECG was repeated in 19 children in the study group after 9 ± 2 months. Measurements (QT dispersion (QTd), T-wave peak to end (Tp-Te) interval, and Tp-Te/QT ratio) were made using standard digital calipers. Statistical analysis was performed with student t-test and analysis of variance (ANOVA) using SSPS version 17.0. Results The mean value of QTd in the first ECG in cases was significantly high: 43.15 ± 14.13 versus 29.47 ± 8.637 in the controls (p = 0.001). The follow-up ECG in 19 cases showed a mean value of 46.26 ± 16.25 versus 43.89 + −14.53 at baseline (p = 0.440). QTd was increased in the follow-up ECG but was not statistically significant. There was no statistical significance seen in the Tp-Te interval and Tp-Te/Qt ratio as observed in Lead II and Lead V5. Conclusion Significant increase in the QTd in children with KD indicates repolarization changes in the myocardium even in the absence of clinical carditis. The persistence of this change on follow-up could indicate a possible increased risk for ventricular arrhythmia and warrants long term assessment of the cardiovascular status.

Evaluation of McNamara’s analysis in South Indian (Tamil Nadu) children between 8–12 years of age using lateral cephalograms

Evaluation of McNamara’s analysis in South Indian (Tamil Nadu) children between 8–12 years of age using lateral cephalograms

A pragmatic study on efficacy, tolerability and long term acceptance of ketogenic diet therapy in 74 South Indian children with pharmacoresistant epilepsy

PurposeSignificant challenges exist for Ketogenic Diet (KD) programs in many populations, mainly due to the variations in local dietary preferences. Here we report a single center experience of KD therapy in a cohort of South Indian children with pharmaco-resistant epilepsies. MethodsChildren aged 0–18 years, enrolled in the KD program for pharmacoresistant epilepsies of Amrita institute of Medical Sciences, Kochi, Kerala, India (2010 − 2015) were included in this pragmatic study. Diet efficacy was evaluated according to reduction in seizure frequency and in the number of antiepileptic drugs (AED). Duration of retention, reasons for discontinuation and the rate of adverse events were used for assessing KD tolerability. ResultsSeventy four children were enrolled in the KD program. Four children could not complete the initiation process. Median age at KD initiation was 4.2years. 53 children had developmental delay. 89% were on 3 or more AEDs. Baseline seizure frequency was >5/day in 52 children. KD was continued for a median duration of 10.43 months. At the last contact, 59.4% reported seizure reduction of more than 50%. More than 90% reduction was noted in 25 children (33.7%). 6(8.1%) of them became completely seizure free. Four children expired during the study period and four children reported major adverse events necessitating KD withdrawal. Main reasons for discontinuation of KD were poor compliance, lack of response to diet and relapse of seizures. ConclusionKD may be a safe and effective option for children with pharmacoresistant epilepsies even while on a traditional carbohydrate rich South Indian diet.

Association between ENAM polymorphisms and dental caries in children.

AimDental enamel, the most rigid biological tissue of the tooth known to mankind, is the most integral and fundamental part of the tooth. Enamel matrixes compile 5% of Enamelin peptides and at the time of tooth development, they are considered to effect the formation and elongation of enamel crystallites. ENAM plays critical role in enamel formation. Any changes in ENAM may affect the thickness of enamel and may lead to dental caries. The present study is aimed to evaluate the association of ENAM gene polymorphisms and susceptibility of dental caries development risk.Material and methodsThe present study was carried out on 168 South Indian children, children’s with dental caries were included in study. Written consent was taken from their parents/guardians. Additionally 193 healthy individuals were enrolled as controls. Sampling was done after dental examination of the individuals. Three ENAM gene single nucleotide polymorphisms (SNPs) were rs7671281, rs3796704 and rs12640848 was genotyped to check their role in susceptibility of dental caries development risk.ResultsOut of three SNPs rs7671281 showed statistically significant risk association with dental caries susceptibility in this ethnic population at heterozygous allele CT (OR: 1.939, p = .01865) and with minor allele T (OR: 1.451, p = .001292). SNP rs3796704 showed significant protective association with dental caries in Indian population at heterozygous allele GA (OR: 0.409, p = .0192) and with minor allele A (OR: 0.645, p = .00875). SNP rs12640848 showed significant protective association with dental caries in Indian population at heterozygous allele AG (OR: 3.041, p = .00642) and with minor allele G (OR: 1.478, p = .02184). Preliminary insilico analysis also showed that rs7671281 (Ile648Thr) amino acid change will cause the structural and functional changes in ENAM protein.ConclusionsIn the present study significant association was observed between ENAM gene SNP rs7671281 and dental caries susceptibility in South Indian children. These results suggested that ENAM gene variants may contribute to dental caries in children.

The role of familial and sibling factors on abdominal adiposity: a study of south Indian urban children.

Childhood obesity is increasing in urban India. This study aimed to examine the associations of younger siblings abdominal adiposity with individual, familial and environmental factors, in urban school aged siblings. Weight, height and waist circumference of 2906 siblings aged 3-16 years were measured along with details on demographics, diet, lifestyle, behavior and reported parental anthropometrics. Abdominal adiposity was classified as waist circumference above the age and sex specific 75th percentile value. The associations of various factors with abdominal adiposity in the younger siblings were examined through logistic regression analyses. Sibling, familial factors and environmental factors had significant associations with abdominal adiposity. The odds of a younger sibling having abdominal adiposity was greatest (OR=3.16, 95% confidence interval (95% CI): 2.27 to 4.42), when the older sibling had abdominal adiposity, followed by the odds ratio of both parents being overweight (OR=1.63, 95% CI: 1.33 to 1.99) compared to neither being overweight. The influence of abdominal adiposity of the older sibling was greater when the siblings were of the same sex (OR=3.55, 95% CI: 2.24 to 5.65) than when they were of different sex (OR=2.73, 95% CI: 1.67 to 4.46); the odds ratio being highest when both siblings were males. The younger sibling's abdominal adiposity is associated with that of his/her sibling and parental obesity, in addition to other known risk factors in urban south Indian families. Interventions to prevent childhood obesity need to also consider the sibling effect along with the other known factors.

Morbidity profile of orphan children in Southern India.

Background:Orphan children globally and in India are increasing. Magnitude of their health problems is unknown. The present study was carried out to assess the morbidity pattern of orphan children aged 10–16 years, assess their knowledge about signs and symptoms of common childhood morbidities and treatment-seeking practices.Methods:One hundred institutionalized orphan children aged 10–16 years were studied for 6 months. Data was collected by trained investigators regarding sociodemographic background, awareness about common morbidities and treatment seeking practices. Thorough clinical examination and anthropometric measurements were done. Distribution of morbidities was shown.Results:80% of the boys and 68% of the girls had low BMI. 78% suffered from multiple morbidities of which 76% had infections of skin and appendages while 74% had ear problems. 26% had diarrhea and 21% had B-complex deficiency. The mean duration of all diseases was 7±1.1 days. Awareness about diseases and their complications was low; and self-care was highly prevalent for most health problems.Conclusions:Orphan children in South India suffer from many morbidities about which their awareness and treatment seeking is low.

Oral health and glycosylated hemoglobin among type 1 diabetes children in South India

The study was an attempt to evaluate the relationship between oral health status and the level of glycemic control in type 1 diabetes patients. The study was carried out in 87 children with type 1 diabetes, aged 8-16 years, attending a diabetes specialty hospital. The oral health of these patients was measured using the WHO 1997 Oral Health Survey criteria for diagnosis of dental caries, gingival index, and plaque index. Samples were then divided into two groups as controlled (≤6.99% glycosylated hemoglobin [HbA1c]) and uncontrolled (≥7% HbA1c) diabetes as per the guidelines for glycemic control in diabetics given by the American Diabetes Association. The oral health between the groups was compared. Data were statistically analyzed using student t-test. Results showed a significant difference in decayed, missing, and filled surface component (P = 0.043) and gingival index scores (P< 0.001) in the permanent dentition between controlled and uncontrolled groups but not in case of the primary dentition. The data findings suggest that metabolic control had an impact on caries prevalence and gingival health of these patients, in case of permanent dentition. As the glycemic control became poorer, the caries prevalence and gingival inflammation increased. When primary dentition was taken into consideration, the correlation was not significant.

Objective and subjective parameters of oral health in South Indian children: A cross-sectional study.

Oral health of schoolchildren is a strong predictor of their overall well-being. This study was planned to assess and compare the objective and subjective parameters of oral health of South Indian school children. Three hundred and sixty school children participated in this cross-sectional study. Their oral hygiene status, dental caries status, and treatment needs were assessed. Two questionnaires were filled by these children, to assess their oral health-related quality of life (OHRQoL) and their knowledge on oral health. Their academic scores were collected from the schools. Statistical analysis was done using Kruskal-Wallis ANOVA test and Spearman correlation test appropriately. Children with no caries had better OHRQoL (P = 0.02). There was a negative correlation between dental caries status and OHRQoL score (P = 0.003) and dental caries treatment needs and OHRQoL score (P = 0.01). There was a positive correlation between knowledge on oral health and OHRQoL score (P = 0.02). Children with no caries had a better OHRQoL when compared to children with caries. Children with caries had more treatment needs, poor oral hygiene, low quality of life, and performed lesser in academics. However, they had adequate knowledge on oral health. Hence, both objective and subjective parameters of oral health should be given importance while treating children.

Clinical Profile of Scrub Typhus Meningoencephalitis among South Indian Children.

Re-emerging scrub typhus is gaining recognition as an important cause of paediatric meningoencephalitis in tropics. We studied the clinical profile of scrub typhus meningoencephalitis (STME) in children <12 years. Of 270 serology-confirmed cases of scrub typhus, 14 (5%) had features consistent with STME and 9 (64%) of these children were between 5 and 12 years of age; 12 (85%) children presented to the hospital during the second week of illness. Fever, headache and altered sensorium were observed in all children, while meningeal signs, papilledema and seizures were observed in 8 (57%), 7 (50%) and 6 (43%) children, respectively. The mean CSF protein level, glucose level, cell count and percentage of lymphocytes were 75mg/dl, 46mg/dl, 41 cells and 86%, respectively. STME should be considered in febrile children from endemic area with neurological features, such as headache or altered sensorium. Lumbar puncture is mandatory to confirm STME and rule out close differential diagnosis, such as pyogenic and tubercular meningitis.

Factors Affecting Peak Expiratory Flow Rates in Children of 9–12 Years of Age

Introduction: Documentation of peak expiratory flow rate (PEFR) variability may be used to support the diagnosis of asthma and other respiratory disorders. Methodology: This study was carried to measure PEFR of 510 children age group 9 to 12 years of both sexes using a Mini WrightTM Peak Flow Meter. Results were analyzed to find out the normal values of peak expiratory flow rate at each age and either sex. The results were also analyzed to find out what factors influence the peak expiratory flow rate. Effect of age, sex, height, weight, chest circumference, socioeconomic status, passive smoking, cooking fuel, history of contact with tuberculosis and bronchial asthma in family were analyzed separately. Results: The average peak expiratory flow rate in boys was 272±53.16 L/min and for girls was 252±45.09 L/min. For the given age boys have higher peak expiratory flow rate than girls. The peak expiratory flow rate shows very good correlation with height and weight in both sexes. A History of contact with tuberculosis is associated with lower peak expiratory flow rate. Children coming from homes with firewood being used as a fuel and passive smoking had lower peak expiratory flow-rate. No significant relation has been found between peak expiratory flow rate and socioeconomic status and family history of bronchial asthma. Conclusions:The peak expiratory flow rate values of children in study region were comparatively low to those of North Indian and Western children but more compared to urban south Indian children.

Disclosure of HIV Status to Infected Children in South India: Perspectives of Caregivers

This study was designed to examine the rates of HIV serostatus disclosure in a sample of HIV-infected children in the state of Karnataka in South India, their reactions to learning their HIV-positive status and the reasons for and barriers to disclosure from the point of view of their caregivers. We enrolled 233 HIV-infected children, aged 5-18 years and their caregivers between July 2011 and February 2013 at HIV clinics in three tertiary care centers. Caregiver interviews included information about demographic characteristics, medical history, type of disclosure to the child and other related factors, including disclosure barriers. Three quarters (n = 185) of the caregivers reported that there had been no disclosure to the child, 15.4% (n = 38) reported partial disclosure (e.g. telling the child he or she had a 'chronic illness') and only 9.7% (n = 24) reported full disclosure, at a mean age of 10.9 (SD: 2.5) years. Caregivers, who planned to disclose in the future, stated on average that 16 years would be the right age. Those who favored a later disclosure reported that they feared strong negative emotional reactions from the child (p = 0.03) and social isolation (p < 0.001) following disclosure. These results show that that the level of full disclosure is low among South Indian youth living with HIV, and that when disclosure occurs, it is most likely to be partial. The majority of children who learned their status had been informed by a health-care provider, possibly reflecting the difficulty for a caregiver of having this conversation. The caregivers reported multiple disadvantages of disclosure, mostly because of fears of stigma and discrimination. Despite some evidence from the literature that disclosure can have positive effects on a child's health, it is thus clear that we need to develop, implement and evaluate community-based stigma reduction programs to reduce the social barriers to disclosure.

Spectrum of cutaneous manifestations in Wilson’s disease in children in a tertiary care center in South India: a prospective study

Background: Wilson’s disease in children is the most common inherited disorder of copper metabolism in India with varied clinical manifestations secondary to deposition of copper in various organs including skin. Methods: The aim of the study was to study various cutaneous manifestations of Wilson’s disease in south Indian children. A prospective study for a period of one year was conducted at Dermatology and Pediatric Gastroenterology clinic in Government Rajiv Gandhi Hospital, Chennai. Clinical, demographic details, various cutaneous manifestations and results of skin biopsy were analysed. Results: Out of the total 30 children with Wilson’s disease, 93.3% had at least one cutaneous, mucosal, hair or nail findings but not statistically significant between naive and on treatment group. Cutaneous findings, mucosal involvement, hair changes and nail findings were observed in 90%, 36.7%, 46.7% and 60% respectively. Cutaneous findings were more common in liver disease (P value&lt;0.05). Xerosis was the most common cutaneous manifestation seen in 63.3% patients, followed by pigmentation in 36.7% and infection in 30%. KF ring was noted in 53.3%. Icterus and pruritus were seen in one fifth of study children and majority had portal hypertension. Vascular changes like spider nevi, purpura and other features of portal hypertension were noted in 16.6% of study population. Trichomegaly was one of the common hair manifestation found in 9 (30% especially in children already on treatment (p value &lt;0.05). There was no evidence of stainable copper on skin biopsy. Conclusions: The physicians should be aware of various cutaneous manifestations of Wilson’s disease in children.

Clinical Features, Laboratory Findings and Complications of Scrub Typhus in South Indian Children

Introduction: Scrub typhus clinical features are non-specific and resemble other tropical infections like malaria, dengue and typhoid fever. Therefore appropriate gold standard laboratory tests are necessary to confirm the diagnosis of scrub typhus. Aim of this study was to determine the incidence, clinical features, laboratory data and complications of scrub typhus in South Indian Children.Materials and Methods: Children with fever of more than seven days who were tested negative for common tropical infections were subjected to IgM-IFA for scrub typhus.Results: Out of 857 children, 74 were eligible for IFA test. Out of these, 27(3.1%) tested positive for scrub typhus. Clinical features included hepatomegaly (96.3%), generalized lymphadenopathy (81.5%), splenomegaly (81.5%), hypotension (59.3%), rash (14.8%), eschar (7.4%), thrombocytopenia (66.7%), elevation of SGOT (85.2%) and SGPT (81.5%). Complications include hepatitis (14.8%), pneumonia (14.8%), myocarditis (14.8%) meningoencephalitis (3.7%) and MODS (3.7%).Conclusion: Scrub typhus should be considered in the differential diagnosis of a febrile child having hepatosplenomegaly, lymphadenopathy, liver dysfunction and thrombocytopenia.

Short term outcome of ADEM: Results from a retrospective cohort study from South India

IntroductionAcute disseminated encephalomyelitis (ADEM), an immune mediated inflammatory disease is common in children. The profile and immediate outcome of children hospitalized with ADEM is scarce in the available literature. ObjectivesWe aimed to study the clinical profile of children with ADEM and to look for prognostic factors for outcome at discharge from hospital MethodsWe chose a retrospective cohort study of all children diagnosed with ADEM at our institution between January 2006 and December 2015, and they were evaluated, after excluding other diagnoses when they were summoned for a follow up visit. The major outcome variables were the modified Rankin Scale (mRS), the Kurtzke Expanded Disability Status Scale (EDSS) and the Glasgow outcome score (GOS) ResultsThere were 102 children (with a mean follow up of 4.81 ± 2.78 years) and mean age at presentation, 6.16 ± 3.1 years. Pyramidal signs, ataxia, fever at onset, brain stem signs, seizures, myelitis and headache were the commoner clinical manifestations. Movement disorders particularly disabling tremor was seen in 12%. Only 52% had MRI lesions confined to supratentorial region, with 20% having thalamic lesions, 14% with corpus callosal lesions and 28% with brain stem hyperintensities. Three patients expired during the acute stage of the disease, the rest recovering with a mean mRS score of 1.92 ± 1.7 and EDSS score of 2.96 ± 3.05. On multivariable regression analysis, using mRS, presence of fever at admission, myelopathy with a definite sensory level and ventilator associated pneumonia were associated with a bad outcome. Using EDSS score (multivariable regression), presence of myelopathy with a definite sensory level and coma were associated with a bad outcome. Using GOS score (multivariable regression), presence of myelitis with a definite sensory level, signs of meningeal irritation and encephalomyeloradiculoneuropathy type of ADEM were associated with a bad outcome and headache with a good prognosis. The mean of the number of hours of altered sensorium and the mean duration of hospital stay in days had a significant association using the mRS, EDSS score and GOS. ConclusionThis study shows a profile of ADEM in South Indian children at admission and at discharge from hospital. ADEM has a good immediate outcome though death during the nadir of disease has been recorded in this study and in the literature and effort should be taken for optimal life support for these children who would have a good outcome if life support is successful. We have been able to show that, presence of myelopathy, the mean number of hours of altered sensorium and the mean duration of hospital stay were associated with a bad prognosis using three different outcome scales. Fever at admission, ventilator associated pneumonia, more profound altered sensorium at nadir of disease, signs of meningeal irritation at presentation and lower motor neuron involvement also, during the course of disease were associated with an immediate bad outcome using one of the outcome scores used in our study. Future studies should also address the question of why children with myelopathy, signs of lower motor involvement and fever at onset have a bad immediate outcome.