Pediatric Education and Research

Digoxin plays an important role in management of pediatric heart failure. Digoxin toxicity can occur even at thereupatic doses. We are reporting a case of 47 day old male baby who presented with vomiting, letharginess and first degree heart block on electrocardiogram. Toxicity was confirmed with serum level of 4.82 ng/mL. Baby was managed conservatively, by stopping digoxin and monitoring of heart rate. Baby improved on its own by day 6 of admission.

Keywords: Digoxin Toxicity; Heart Block. 

Introduction: Adolescents are young people between the age group 10- 19 yrs. The term Adolescence is derived from the Latin word, adolescere, meaning “growing into maturity” [1,2]. It is a period where people undergo dramatic changes in physical appearance as well as rapid changes in physiologic, psychological and social functioning[3]. Methods: After obtaining valid consents from authorities and parents of adolescents, interview was done for adolescents based on Teen Screen Questionaire-Mental health (TSQ-M) validated by child development centre, Trivandrum in all Jayadeva Shivarathreeshwara preuniversity colleges of Mysore city between 1/12/2013 to 1/12/2015. The data was entered in Excel format and analyzed using Epi-Info Software. Results: In this cross sectional population based study which included 500 Ist and IInd PUC students, with majority of males (61%) were screened for mental health issues in particular anxiety, depression and suicidal tendency. Our study revealed that 57% of these adolescents had possible anxiety/depression/suicidal tendency or mixture of them (mental health issues). Out of that 32% were depressed, 20% were anxious, 5.2% had suicidal tendency. In further, significant mental health issue was found in adolescents coming from lower socioeconomic status or with single parent. In these adolescents, substance abuse, financial problem and broken homes were the statistically significant risk factors. Discussion: In Comparision to other studies, our study also revealed alarming proportion of adolescents were having bad mental health status. In contrast to other studies academic performance and gender were not contributing much differences in proportion of bad mental health status. Conclusion: Out of 500 adolescents enrolled in our study 57% (285) had mental health issue. Among them adolescents belonging to Lowe socio economic and single parent group had statistically significant mental health issue .Further substance abuse, financial oroblems and broken home were the statistically significant risk factors for mental health problems in them. In view of this study report we encourage futhher big cross sectional study involving all other preuniversity colleges of mysore and other cities to arrive at significant conclusion.

Keywords: Adolescence; Anxiety; Depression; Suicide. 

Introduction: The Millennium Development Goals (MDG) report of 2012 says that almost one in five children below the age of five years in developing countries is underweight.The prevalence of malnutrition in India is high and almost one third of worlds malnourished children are from India. The present study was aimed at finding the nutritional deficiencies and comorbid conditions in children with PEM. Aim of the Study: To study the prevalence of nutritional deficiencies and common comorbid conditions in undernourished hospital visiting paediatric patients. Materials and Methods: This wasaprospective study carried out in the department of Paediatrics forover a period of 20 months. Patients attending the Paediatrics out-patient department during the study period were selected based on inclusion criteria. They were studied for the prevalence of common nutritional deficiency diseases and anemias. Detailed clinical history and complete examination with specific emphasis on signs of nutritional deficiencies and anthropometry was done for all the cases. Grading of PEM was done based on WHO classification. Results: Moderate PEM was more common than severe PEM in both genders. Vitamin B complex, vitamin A and vitamin C deficiency were seen in 23.3%,9.0% and 1.1%children respectively. Anemias were more common in girls (34.7%) than in boys (14%). Among the comorbidities, nutritional deficiencies and anemias were common and were seen in 22.6% and 23% cases. Conclusion: Protein energy malnutrition is a very common problem in paediatric practice in India. Very often children with PEM present with comorbid conditions and multiple nutritional deficiencies and anemia. Regular health checkups can detect PEM at an earlier stage.

Keywords: PEM; Comorbidities in PEM; Vitamin A, C, B Complex Deficiency; Nutritional Deficiency. 

Background: Pulmonary Hypertension is a complex problem characterized by non-specific signs and symptoms and having multiple potential causes. Delays in the diagnosis of PAH lead to postponement of treatment and thus may have deleterious effects. Aims: To determine the accuracy of physical examination (palpable second heart sound, dullness over pulmonary area, loud second heart sound) for diagnosing pulmonary hypertension in Congenital Heart Disease Children. Materials and Methods: A Cross Sectional Study in Department of Pediatrics at AVBRH, Sawangi , Wardha. 3 pediatric residents, trained by a cardiologist for detection of Pulmonary Hypertension in CHD cases assessed 140 clinically suspected CHD cases, looked for palpable second heart sound (P2), Dullness over pulmonary area, Loud second heart sound on auscultation. Their findings were correlated with 2 Dimensional Echocardiography. Data was entered into SPSS for Windows, Version 22 and Graph pad Prism 6.0 version for statistical analysis. To know the true positive cases, true negative cases, probability that the cases with positive physical examination truly have PAH probability that the cases with negative physical examination truly don’t have PAH for which 2x2 contingency tables were formed. Results: Out of 140 cases of CHDs, 41 cases (29.2%) had Pulmonary hypertension. All the Physical markers are equally effective in analyzing pulmonary hypertension as predictive values are nearly equal, and there is no significant difference in their findings. Conclusions: we demonstrate that physical examination are effective in diagnosing the presence of PAH in CHD children.

Keywords: Pulmonary Hypertension; Heart Sound; Palpable Second Heart Sound (P2); Echocardiography. 

Background: The Health problems of adolescent girls has been neglected, as they are considered generally less vulnerable to Disease than younger children. Therefore the first step to improve adolescent girls reproductive and sexual health is to acknowledge the importance of multidimensional approach and the importance of holistic perspective. This study was carried out to assess the magnitude of Physical, Reproductive and Psychological health problems during menstruation among adolescent girls of urban slums. Material & Methods: This is a observational community based cross –sectional study carried -out on all the Adolescent girls married and unmarried from the age group above 13 to 19 years residing in the defined area. House to house survey of the eligible subjects was done by the researcher herself using a pre-designed and pretested schedule. Results: Our study showed that the maximum (45.74%) adolescent girls in the study group were from 15 to 17 years age group, mean age of girls was 15.5 years. Most (33.51%) of the girls had education up to secondary school, 91.22% perceived physical change during puberty was development of breast. Adolescent girls perceived foul smelling discharge as main reproductive health problem during menstruation. Conclusion: Adolescent girls undergo physical, emotional and psychological changes. Many doubts and questions arise in their minds especially regarding reproductive and sexual health leading to worries and anxieties.

Keywords: Adolescent Girls; Physical; Reproductive; Psychological Health Problems. 

Background: Transfusion of packed red blood cells is an important aspect of care in the critically ill children. The decision to administer PRC should be taken only after weighing the benefits and the risks of PRC transfusion against those of anaemia. Aims: To study the outcome of PRC transfusion in pediatric intensive care unit. Settings and Design: Prospective observational study, conducted in PICU of the Dept. of Pediatrics in AVBRH. Material and Method: In a study period of 2 years, out of 1565 patients admitted in the PICU, 164 patients required PRC transfusion were included in the study. Detailed history was taken and baseline clinical informations, investigations and administration of PRC with its indications and outcome were done. Statistical Analysis: Statistical analysis was done by using SPSS 17.0, p<0.05 is considered as level of significance. Results: The mean age of our patient population was 6.62±4.81 yrs. Maximum 18.9% of patients had hematological and 18.9% had cardiovascular involvement. Mean pre-transfusion Hb was 8.11±2.70 g/dl. The average days of PICU stay for patients transfused with PRC was 5.9 days. Most common indication was Anemia (35.97%), while the mortality rate was 33.54%. Conclusions: Anemia was a common co - morbidity in critically ill pediatric patients. The PRC transfusion was associated with higher mortality in PICU.

Keywords: Anemia; Transfusion; Intensive Care.