Criggler-Najjar syndrome. Report of a case.
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Biomedical subjects
Publications and source records attributed to S K Mittal.
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The reported efficiency of B.C.G. vaccine in prevention of primary childhood or sputum positive adult tuberculosis vary widely but it is believed to offer significant protection against hematogenous forms of tuberculosis. The present hospital-based, case control study was aimed at evaluation of impact of B.C.G. vaccination on one of the hematogenous forms of tuberculosis i.e. Tuberculous meningitis (TBM). Records of cases of TBM admitted in the pediatric wards of Lok Nayak Hospital, Delhi, over one year were analyzed retrospectively for B.C.G. positivity status and age distribution. The results were compared with similar data obtained from a control group comprising of non-TBM cases in pediatric wards of same hospital, recruited on 2 days, separated by an interval of three weeks. No statistically significant difference was found in B.C.G. positivity status of cases and control groups. However, there was an obvious trend in age distribution among cases of TBM with respect to the B.C.G. status, with a significantly higher proportion of B.C.G. vaccinated children in over 5-year age group, as compared to those in under 5 year age group. The results, therefore, indicate probable effectiveness of B.C.G. against TBM only for a limited duration i.e. single B.C.G. immunization only postpones rather than prevent the occurrence of TBM.
Syndrome of prolonged diarrhea is quite frequent in tropical children. Careful clinical appraisal can help in separating these children into distinct clinical entities which have different underlying etiological factors. In most cases diagnosis is possible on clinical grounds supplemented by simple investigations. A step by step approach as outlined is extremely helpful in planning a rational management.
Upper GI endoscopies were done in 236 children (upto 12 years of age) presenting with history of hemetemesis. Varices were the commonest lesions (in 39.41%) followed by esophagitis (23.73%). Gastritis, gastric ulcer, duodenal ulcer and oesophageal ulcers were identified in 7.20%, 1.27%, 0.42% and 0.42% cases respectively. Cause of bleeding could not be ascertained in 27.54% cases. No significant premedication or procedure related complications were observed. Upper GI endoscopy is thus a safe and useful mode of investigation in cases of hemetemesis in children.
The retrospective data on childhood poisoning from eight regional hospitals in India has been reviewed. The demographic features and types of poisonings encountered have been compared. The analysis of the data indicated that pediatric poisonings constituted 0.23-3.3% of the total poisoning. The mortality ranged from 0.64-11.6% with highest being from Shimla. Accidental poisoning was common involving 50-90% of children below 5 years of age and males outnumbered the females. Suicidal poisoning was seen after 13 years of age and was due to drugs and household chemicals. One of the hospitals in Delhi recorded a very high incidence (66.6%) of drug poisoning in children. The drugs consumed belonged to phenothiazines, antiepileptics and antipyretics. Iron poisoning was seen in younger children. Kerosene was one of the causes of accidental poisoning at all hospitals except Shimla and rural Maharashtra were probably wood charcoal is widely used. Pesticide poisoning was more prevalent in Punjab and West Bengal whereas plant poisoning was very common in Shimla. Significant number of snake envenomation has been recorded from rural Maharashtra. Other less common accidental poisonings in children included alcohol, corrosives, heavy metals, rodenticides, detergents and disinfectants. Thus various regions in the country showed some variation in types and frequency of childhood poisoning which could be attributed to different geographical and socio-economic background.
In an attempt to making norms of renal volume (RV) in Indian children, 240 children (137 boys and 103 girls) below 5 years of age were subjected to sonographic examination in supine position. Left RV in female children increased from 18.04 mm3 in early infancy to 48.36 mm3 in 4-5 year age group. Similar increase was observed in the right RV. There was no significant left vs. right difference in RV in boys and girls (p > 0.05). Similarly, the RV did not differ significantly in both sexes (p > 0.05, in all age groups except 4-5 years, p = 0.04).
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Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P < 0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.
Development of recombinant DNA vaccine against hepatitis B grown on cultured yeast cell has made it possible to mount a world-wide effort to control and eradicate Hepatitis B infection. However, the currently recommended schedules (0, 1 & 2 months, and 0-1 and 6 months) do not coincide with the scheduled visits for other E.P.I. vaccines, and necessitate additional visits for Hepatitis B vaccination. This study was therefore carried out to find out if adequate seroconversion occurs to Hepatitis B vaccine when given with other EPI vaccines or not? Thirty nine infants born to Australia antigen positive mothers from among 850 screened pregnant mothers were recruited to receive Hepatitis B vaccine (Engerix B-10 micro gram each) at 0, 6 and 14 wks (group A) or at 0, 1 and 2 months (group B). Thirty-one infants were recruited in group A and 8 in group B. The cord blood was collected and the first dose of vaccine was given within 48 hours of birth. Simultaneous B.C.G. was given at the left deltoid. Other E.P.I. vaccines were given qt 6, 10 and 14 wks in group A and at 2, 3 and 4 months in group B. Repeat blood samples were collected prior to giving each dose of Hepatitis B vaccine, and 4 weeks after the last dose. All blood samples were assayed for HBsAg and HBsAb at the National Institute Of Communicable Diseases, utilizing standard ELISA kits. The seroconversion rates following one, two and three doses of Hepatitis B vaccine were 3.33%, 55.5%, 96.15% and 0%, 62.5% and 100% in group A and B respectively.(ABSTRACT TRUNCATED AT 250 WORDS)