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   Table of Contents - Current issue
May-June 2022
Volume 9 | Issue 3
Page Nos. 73-107

Online since Thursday, May 12, 2022

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COVID antibodies: An innocent bystander or a harbinger of ongoing inflammation and immune dysfunction p. 73
Namita Ravikumar, Karthi Nallasamy
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Scrub typhus in infants: Food for thought p. 75
A R Mullai Baalaaji
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Estimating i-gel supraglottic airway size by thenar eminence dimensions versus weight-based method in the pediatric patient: Do they “gel” with each other? p. 77
Kumaran Senthil, Vijay Srinivasan
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Inhaled magnesium sulfate in bronchiolitis: No magic bullet yet p. 79
Ankit Mehta
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Effect of severe acute respiratory syndrome coronavirus 2 antibodies on outcomes of dengue infected children: A retrospective observational study p. 80
Sravani Kolla, Lokeswari Balleda, Chandra Sekhara Reddy Thimmapuram
Background: Dengue virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) share similar antigenic properties. In some studies, it has been shown that immunological memory/antibodies to dengue virus in endemic countries reduces the severity and spread of COVID-19. It is not known whether SARS-CoV-2 antibodies reduce or augment the severity of dengue viral infections. This study aims to evaluate the effects of SARS-CoV-2 antibodies on the outcomes of dengue infection in children. Subjects and Methods: This was a retrospective observational study conducted at the pediatric emergency and intensive care units and wards of a tertiary care teaching hospital in Andhra Pradesh, India, between August and November 2021. Results: About 400 children with dengue infection were admitted to our hospital, of which 96 children also had SARS-CoV-2 antibody titers estimated. In 50 (52.08%) of these 96 children, SARS-CoV-2 antibodies (IgG and/or IgM) were positive. In these 96 children, clinical severity and outcomes of dengue infection were compared between the two groups, i.e., with and without SARS-CoV-2 antibody positivity. Conclusions: The present study provides preliminary evidence that outcome and severity of dengue infection in children are not affected by the SARS-CoV-2 antibody positivity.
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Severe scrub typhus infection in infancy with multiple organ dysfunction: A retrospective observational study from Eastern India p. 84
Sanchari Ghosh, Satyabrata Roychowdhoury, Prabhas Prasun Giri, Ankika Basu, Mihir Sarkar
Background: Scrub typhus is relatively less common among infants but found to have a mentionable association with multiple organ dysfunction and turbulent course. The aim of this study was to delineate the clinicolaboratory profile of infantile scrub typhus, complication, course of illness, and responsiveness to therapy. Subjects and Methods: This retrospective observational study was undertaken in two tertiary care pediatric teaching centers in eastern India among infants with diagnosis of scrub typhus. Clinical features, especially pattern of organ dysfunction, laboratory findings with emphasis on hyperferritinemia, and treatment schedules with responsiveness to therapy, were analyzed retrospectively. Results: A total of 272 cases of scrub typhus had been admitted during the study period. Among them, 17 kids (6.25%) were infants. All of them presented with lethargy and poor feeding as a common complaint along with seizures and respiratory distress. Seven out of 17 (41%) were identified early. Fifteen (88%) were critically ill and required pediatric intensive care unit admission, out of which 13 (76.4%) patients were put on ventilator support. Thirteen (76.4%) of them developed hyperferritinemia with multi-organ dysfunction syndrome (MODS) and required additional immunotherapy. Sixteen of them recovered completely without any sequelae. Severe complications such as acute respiratory distress syndrome and MODS were significantly high (P = 0.001 and 0.004, respectively) and hospital stay was longer (P-0.04) in infants in comparison to older children. Conclusion: We conclude that infantile scrub typhus, though not very common, should be considered an important differential in infants presenting with an acute febrile illness with hyperferritinemia and MODS. Infants with scrub typhus can have a more stormy disease course compared to their older counterparts.
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Efficacy of nebulized magnesium sulfate in moderate bronchiolitis Highly accessed article p. 90
N Guruprasad, C A Gopalakrishna Mithra, Vinod H Ratageri
Background: Bronchiolitis is a common cause of illness and hospitalization in infants and young children. The effectiveness of various bronchodilators remains unclear. This study was conducted to assess the efficacy of nebulized magnesium sulfate in hospitalized children with moderate bronchiolitis in the age group of 1–24 months. Subjects and Methods: This was a prospective observational study done from December 2018 to June 2020. All children with moderate bronchiolitis (clinical severity score [CSS]-4–8) meeting inclusion/exclusion criteria were enrolled. A detailed history, demographic profile, CSS and oxygen saturation in room air, and heart rate were recorded. They were given two doses of magnesium sulfate in the form of nebulization for 10 min each, at 30 min apart. The children were assessed for CSS at 0 h, 1 h, and 4 h after nebulization. The children were considered improved if CSS <4 at the end of 4 h. The children were monitored for adverse reactions of magnesium sulfate. Results: Sixty children were enrolled. The mean age was 7.5 ± 6.47 months. Most children (51.7%) were in 1–6 months. The mean CSS scores at 0 h, 1 h, and 4 h were 6 ± 1.008, 2.95 ± 1.395, and 2.40 ± 1.564, respectively (P = < 0.001). Fifty-three (88.3%) children improved and seven (11.7%) children did not improve. In nonimproved group, subanalysis was done and found hypoxia (odds ratio − 12.6) as a significant risk factor. Flushing was the most common adverse effect noticed in eight (13.3%) children. Conclusions: Children with moderate bronchiolitis were improved with nebulized magnesium sulfate.
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A randomized trial to compare thenar eminence dimensions-based method with body weight method to determine I-gel size in pediatric patients p. 95
Smita R Engineer, B Sivashankari, K T Sreekanth Balagopal
Background: In pediatric daycare surgery, I gel has been used safely and effectively in anesthetized children. I-gel size is determined routinely by the manufacture's recommended weight-based method. The dimension of thenar eminence can help in determining I-gel size. The aim of this study was to compare the weight-based method and thenar eminence dimension method in the selection of I gel. Subjects and Methods: The prospective, randomized, single-blind study included 80 patients of the age group 6 months to 12 years, the American Society of Anesthesiologists class I, II, and III of either gender who were undergoing surgery under general anesthesia. Group 1– (n = 40) recommended weight-based method and group 2 – (n = 40) thenar eminence-based method. Parameters observed were proper placement, adequate ventilation, leak fraction (LF), and number of attempts. Results: Proper placement and adequate ventilation were comparable between two groups. LF is statistically higher in group 1 compared to group 2 (P = 0.003). The mean insertion time was 17 s in each group. The number of attempts, hemodynamic parameters, and ease of insertion were all comparable between two groups. Conclusions: Thenar eminence dimension can be the better method for the recommended weight-based method, especially in the emergency situations when the weight cannot be determined.
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Overlap of severe dengue with multisystem inflammatory syndrome in children due to SARS-CoV-2 infection: A case series from a tertiary care center of Central India p. 100
Krishna Chaitanya, Duggirala Avani, Ramya Keerty, T Srinidhi
India is currently facing a double burden of severe dengue and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Co-infection/complication due to these viruses can result in severe morbidity. We present five cases of severe dengue with multisystem inflammatory syndrome in children (MIS-C) due to SARS-CoV-2 infection in children. All children presented with shock with variable degrees of plasma leakage. They were treated initially as severe dengue cases; however, due to refractory symptoms such as persistent fever and inotropic requirement, an alternate diagnosis was suspected and established. They were successfully managed according to the World Health Organization Dengue Shock Syndrome and MIS-C Guidelines with intravenous (IV) fluids, methylprednisolone, aspirin, and IV immunoglobulin. Severe dengue in endemic regions overlapping with MIS-C makes it difficult to diagnose which needs early recognition and appropriate management.
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Transient cardiomyopathy after the indoor lightning strike p. 104
Rahul Kailashnath Tandon, Krutika Rahul Tandon, Aradhana Gohil, Prachi Vani, Sandip Mori
Lightning injury can also affect young child by indoor penetration of lightning strike and in spite of cardiac involvement good supportive intensive care may change the outcome. Herein we report one case of lightning with cardiac complication admitted in our pediatric intensive care unit.
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Infectious diseases and antimicrobial stewardship in critical care medicine (4th edition) p. 107
Kundan Mittal
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