Aortic aneurysm in a child with tuberous sclerosis.
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Biomedical subjects
Publications and source records attributed to S B Bavdekar.
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Rheumatic fever (RF) and rheumatic heart disease (RHD) are major public health problems in developing countries. A prospective study carried out in a large general hospital showed that carditis was the predominant feature in first attack and also the recurrence of RF but that recurrence was associated with more severe manifestations. Echocardiography picked up cases of subclinical carditis. Presence of congestive cardiac failure in association with carditis always led to chronic RHD. Recurrence occurred only when patient defaulted penicillin prophylaxis. The overall recurrence rate was 0.026 per patient.
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This prospective study comprised 120 children brought to the hospital with the history of acute poisoning. Poisonings occurred accidentally in 116 cases (96.7%) and 78 cases (65%) were children aged 1-4 years. Medical aid was sought earliest in case of children with animal bite and in infants. Kerosene and medications accounted for 72 cases (60%) of poisoning exposures. None of the care-takers of children received any instruction regarding prevention of accidents and poisoning prior to the episode, in spite of multiple contacts with health-care providers. Role of health education and other preventive measures are stressed.
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A study was conducted in two slum areas in a Bombay suburb covering a total population of 4879. One hundred and fifty-three mothers having children below two years were interviewed. Ninety six per cent infants below the age of 4 months received breast milk, though exclusive breastfeeding was practised only in 37% infants. Timely complementary feeding rate was only 0.48. Twenty three per cent of mothers used bottle for administration of supplementary food or water. Only 15.7% of mothers used commercial milk formula and 8.5% used commercial weaning food.
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Early neonatal hypocalcemia is a common problem in prematurely born infants. To prevent it, therapy with intravenous calcium is often advised. We compared the efficacy and side-effects of intravenous and oral calcium supplementation in preterm and low birth-weight babies. Both the groups were comparable for birth weight, gestational age and cord blood calcium level. Oral calcium administration was as efficacious as intravenous administration in babies of all gestational age groups and birth-weight groups. Side effects associated with therapy were less common and of lesser severity in oral supplementation group. Lower cost and ease of administration were additional benefits.
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A prospective study enrolling 50 mother-infant pairs was undertaken to determine the effect of maternal antibodies on poliovirus antibody titres and seroconversion rates in infants and to determine the difference in titres and seroconversion rates following three and five doses of oral poliovaccine (OPV). Cord blood samples and samples collected 4 weeks after 3rd and 5th doses of trivalent oral poliovaccine were processed for estimation of anti-poliovirus antibody titres. These were expressed as geometric mean titres (GMT). Significance was analyzed using unpaired 't' test. The relationship between maternal antibody titres and seroconversion was determined by correlation coefficient test. Post OPV5 titres were significantly higher than post OPV3 titres for type 1 and type 2 polioviruses. Seroconversion rates against type 1, 2 and 3 polioviruses were 92.9%, 100.0% and 92.9% following OPV3 and 100.0%, 100.0% and 93.2% following OPV5. The cord blood titres did not have any relation to post-OPV3 or post-OPV5 titres. Although there is significant passive transfer of poliovirus antibodies across the placenta, this does not affect titres achieved after immunization. Post-OPV5 titres against type 1 and type 2 viruses are significantly higher than post-OPV3 titres. The seroconversion rates following OPV5 are higher than those obtained post-OPV3 but this difference is not statistically significant.
A longitudinal study of feeding practices of and morbidity in 537 infants was undertaken. Feeding practices were assessed at monthly follow-up visits. All infants were initially exclusively breastfed but their percentage dropped to 59.8% and 35.3% at the end of 3 months and 6 months respectively. Exclusively breastfed babies were three-times less likely to fall sick than artificially fed babies. Exclusive breastfeeding was also associated with significantly lowered rate of serious illnesses as shown by fewer rate of hospitalisation (0.52/100 children months vs 4.5/100 children months). Premature introduction of supplementary feeding diluted the protective effects of breastmilk.
Intramedullary spinal cord abscess is a treatable cause of paraparesis. Magnetic resonance imaging is an important diagnostic modality. Combination of antimicrobial therapy and surgical intervention can provide good results in patients with subacute presentation.
Kawasaki disease (KD) is an acute systemic vasculitis of unknown aetiology that has largely replaced rheumatic heart disease as a cause of acquired heart disease in children of many developed countries. We report a case of incomplete KD in a five-year-old girl. The diagnosis of incomplete KD was made after exclusion of conditions with similar presentation. She was treated with intravenous immunoglobulin following which she made an uneventful recovery but demonstrated thrombocytosis in the second week of convalescence. During the six-month follow up period, she had two episodes of recurrent skin peeling a phenomenon, which is recently reported with KD but not with atypical or incomplete KD. It is important for the treating physicians to become aware of the incomplete KD as prompt diagnosis and early treatment of these patients with intravenous immunoglobulin is vital for the prevention of lethal coronary complications. Physicians need to have a "high index of suspicion" for KD and even, higher for IKD.
Malabsorption is a well-known complication of infection with Giardia lamblia. However, selective protein-losing enteropathy is rare. We report a child with anasarca due to hypoalbuminemia as a result of gastrointestinal protein loss. Investigations established giardiasis as the etiology. The child returned to normal health after treatment with metronidazole.
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