Pub Date : 2025-09-01DOI: 10.1016/j.mjafi.2024.11.018
Madhu Sudan Barthwal , Siri Vineeth Anuraag Ganta , Manosri Mandadi , Kundan Mehta
Parapneumonic effusion, a common complication of bacterial pneumonia in children, often requires intervention when conventional treatment fails. This case highlights the treatment of a complicated parapneumonic effusion in a 2-year-old female patient. After unsuccessful drainage of effusion, the patient was subjected to the use of intrapleural fibrinolytic therapy (IPFT) with Streptokinase. A single cycle of IPFT showed the removal of a substantial amount of fluid from the pleural cavity without any adverse reactions. A complete radiological resolution was noted. This case signifies the importance of IPFT as a cost-effective alternative for surgery and the first line of management after antibiotics and percutaneous drainage, particularly in resource-limited settings.
{"title":"Intrapleural fibrinolytic therapy in a two-year-old: A case report","authors":"Madhu Sudan Barthwal , Siri Vineeth Anuraag Ganta , Manosri Mandadi , Kundan Mehta","doi":"10.1016/j.mjafi.2024.11.018","DOIUrl":"10.1016/j.mjafi.2024.11.018","url":null,"abstract":"<div><div><span>Parapneumonic effusion, a common complication of bacterial pneumonia in children, often requires intervention when conventional treatment fails. This case highlights the treatment of a complicated parapneumonic effusion in a 2-year-old female patient. After unsuccessful drainage of effusion, the patient was subjected to the use of intrapleural </span>fibrinolytic therapy<span><span> (IPFT) with Streptokinase. A single cycle of IPFT showed the removal of a substantial amount of fluid from the </span>pleural cavity<span> without any adverse reactions<span>. A complete radiological resolution was noted. This case signifies the importance of IPFT as a cost-effective alternative for surgery and the first line of management after antibiotics and percutaneous drainage, particularly in resource-limited settings.</span></span></span></div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 5","pages":"Pages 610-613"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mjafi.2025.04.016
Jishnu Sathees Lalu , Kaushik Roy , Kiran Kumar Maramraj , Santosh Kumar Swain , Arjun Dutta , Dilip Raghavan , Rajat Shukla
Background
On the 2nd and 3rd December 2023, a cluster of nine acute febrile illnesses with parotidomegaly was reported among students of a kindergarten in a South-West coastal district of India. We investigated the outbreak to identify the illness, to describe the outbreak in terms of time, place and person, to identify the factors responsible for the spread, and to control the disease.
Methods
The investigation was conducted in a military setting at a South-West coastal district of India from December 2023 to January 2024. Clinical and epidemiological data of the initial cases were captured using a data abstraction sheet from healthcare establishments, kindergartens and schools to make operational case definitions. We did an active house to house surveillance to detect additional cases till 26 January 2024, i.e. for six weeks after the last case was detected. The descriptive analysis was done by calculating the incidence as per age, gender and vaccination status, plotting of an epidemic curve and preparation of spot maps to understand the spread of cases. We also conducted a matched case–control study to test the hypothesis that clustering of unvaccinated kindergarten students was the cause of this Mumps outbreak.
Results
The index case was identified as Mumps on 02 December 2023 in the Paediatric department of the hospital. A total of 52 cases of Mumps occurred with an attack rate of 1.8%. Forty-five out of the 52 affected children were from Kindergarten and the rest from primary and middle school. The outbreak started on 02 November 2023, peaked on 04 December 2023 and ended on 15 December 2023 after rapid institution of control measures. The incidence was highest (5.5%) in children aged four and five years. There was clustering of cases in kindergarten. Nearly 60% of the cases were unvaccinated against Mumps. Vaccination against Mumps was found to be protective against Mumps.
Conclusion
This outbreak of Mumps was probably due to close interaction of unvaccinated children in the kindergarten. Students contracting Mumps lose classes and the disease is known to cause complications when occurring later in life. Hence, we recommend Mumps vaccination during childhood to prevent such outbreaks.
{"title":"Outbreak of Mumps among school children in a military setting in a South-West coastal district of India: November-December 2023","authors":"Jishnu Sathees Lalu , Kaushik Roy , Kiran Kumar Maramraj , Santosh Kumar Swain , Arjun Dutta , Dilip Raghavan , Rajat Shukla","doi":"10.1016/j.mjafi.2025.04.016","DOIUrl":"10.1016/j.mjafi.2025.04.016","url":null,"abstract":"<div><h3>Background</h3><div>On the 2nd and 3rd December 2023, a cluster of nine acute febrile illnesses with parotidomegaly was reported among students of a kindergarten in a South-West coastal district of India. We investigated the outbreak to identify the illness, to describe the outbreak in terms of time, place and person, to identify the factors responsible for the spread, and to control the disease.</div></div><div><h3>Methods</h3><div>The investigation was conducted in a military setting at a South-West coastal district of India from December 2023 to January 2024. Clinical and epidemiological data of the initial cases were captured using a data abstraction sheet from healthcare establishments, kindergartens and schools to make operational case definitions. We did an active house to house surveillance to detect additional cases till 26 January 2024, <em>i.e.</em><span> for six weeks after the last case was detected. The descriptive analysis was done by calculating the incidence as per age, gender and vaccination status, plotting of an epidemic curve and preparation of spot maps to understand the spread of cases. We also conducted a matched case–control study to test the hypothesis that clustering of unvaccinated kindergarten students was the cause of this Mumps outbreak.</span></div></div><div><h3>Results</h3><div>The index case was identified as Mumps on 02 December 2023 in the Paediatric department of the hospital. A total of 52 cases of Mumps occurred with an attack rate of 1.8%. Forty-five out of the 52 affected children were from Kindergarten and the rest from primary and middle school. The outbreak started on 02 November 2023, peaked on 04 December 2023 and ended on 15 December 2023 after rapid institution of control measures. The incidence was highest (5.5%) in children aged four and five years. There was clustering of cases in kindergarten. Nearly 60% of the cases were unvaccinated against Mumps. Vaccination against Mumps was found to be protective against Mumps.</div></div><div><h3>Conclusion</h3><div>This outbreak of Mumps was probably due to close interaction of unvaccinated children in the kindergarten. Students contracting Mumps lose classes and the disease is known to cause complications when occurring later in life. Hence, we recommend Mumps vaccination during childhood to prevent such outbreaks.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 5","pages":"Pages 551-556"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Snakebite in children is a medical emergency of significant public health concern. Owing to physiological differences, the potential of snake venom causing tissue damage and long-term sequelae is more pronounced in paediatric age group. We aimed to determine the clinical profile and outcome in children suffering with snake envenomation.
Methods
The retrospective observational study reviewed the clinical case records of children aged 0–18 years, admitted with features of snake envenomation from January 2021 to December 2022 Demographic profile, clinical features, treatment and outcome were analysed using descriptive statistics.
Results
Eleven children with snakebite were admitted during the study period. The mean age of study population was 11.63 (±3.9) years. Nine children (81.8%) were residing in rural area, majority (72.7%) of the children experienced the snakebite between May and August. Extremities were the most commonly affected site as seen in seven (63.6%) children. Pain and swelling at the bite site were the commonest symptoms seen in nine (81.8%) children, neurotoxic features were evident in seven (54.5%) cases, while four (36.3%) cases manifested vasculotoxic features. Invasive ventilatory support was required in four (36.3%) cases and all such children were extubated with successful outcome. Anti-snake venom (ASV) was administered in all 11 children and no adverse reactions were observed. No mortality was reported during the study.
Conclusion
Envenomation toxidrome depends on the prevalent snake species inhabiting the various geographic regions within the same country.
{"title":"Snake envenomation in children: Experience from a tertiary care hospital in Northern India","authors":"Ruchika Bhatnagar , Rakesh Gupta , Brajendra Singh , Sujaya Mukhopadhyay , Sanju Yadav","doi":"10.1016/j.mjafi.2024.04.014","DOIUrl":"10.1016/j.mjafi.2024.04.014","url":null,"abstract":"<div><h3>Background</h3><div><span>Snakebite<span><span> in children is a medical emergency of significant public health concern. Owing to physiological differences, the potential of </span>snake venom causing </span></span>tissue damage<span><span> and long-term sequelae is more pronounced in </span>paediatric<span> age group. We aimed to determine the clinical profile and outcome in children suffering with snake envenomation.</span></span></div></div><div><h3>Methods</h3><div>The retrospective observational study reviewed the clinical case records of children aged 0–18 years, admitted with features of snake envenomation<span> from January 2021 to December 2022 Demographic profile, clinical features, treatment and outcome were analysed using descriptive statistics.</span></div></div><div><h3>Results</h3><div>Eleven children with snakebite were admitted during the study period. The mean age of study population was 11.63 (±3.9) years. Nine children (81.8%) were residing in rural area, majority (72.7%) of the children experienced the snakebite between May and August. Extremities were the most commonly affected site as seen in seven (63.6%) children. Pain and swelling at the bite site were the commonest symptoms seen in nine (81.8%) children, neurotoxic features were evident in seven (54.5%) cases, while four (36.3%) cases manifested vasculotoxic features. Invasive ventilatory support was required in four (36.3%) cases and all such children were extubated with successful outcome. Anti-snake venom (ASV) was administered in all 11 children and no adverse reactions were observed. No mortality was reported during the study.</div></div><div><h3>Conclusion</h3><div>Envenomation toxidrome depends on the prevalent snake species inhabiting the various geographic regions within the same country.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 5","pages":"Pages 571-576"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prevalence of anaemia is 67% in children between 6 and 59 months of age. There is a discrepancy in prevalence of anaemia in view of various cutoffs and capillary versus venous sampling. Prevalence studies at various levels are mandated for planning and implementation of policies to control anaemia.
Methods
This cross-sectional observational hospital-based multi-centric study enrolled apparently healthy eligible children aged between 6 and 59 months from Armed Forces Medical Services hospitals and estimated the prevalence of anaemia in “venous blood samples”. Demographic and anthropometric details and a questionnaire-based survey to study individual and community-related risk factors associated with anaemia were noted.
Results
A total of 10,814 children from 20 hospitals were eligible. A total of 2231 children (56.9% male) were analyzed. The prevalence of anaemia was 49.4% (95% confidence interval [CI]: 47.3–51.5) as defined by the World Health Organization (mild: 24.1%, moderate: 23.5%, and severe: 1.8%) and 19.6% (95%CI:18–21.3) as per the Comprehensive National Nutrition Survey. Majority of anaemia was microcytic (67.2%). Presumptive iron-deficiency anaemia was seen in 55.7%. In binary logistic regression analysis, age<24 months, inadequacy of nutrition and poor maternal education were the associated risk factors in all children with anaemia, while not giving exclusive breast feed till 6 months was an additional risk factor in children with moderate to severe anaemia.
Conclusions
We report a high prevalence (49.4%) of anaemia in children aged between 6 and 59 months, with predominantly lower-middle socioeconomic status. Individual factors such as age<24 months, inadequate nutrition, and community-related risk factors such as poor maternal education and not giving exclusive breast feed for 6 months were associated with anaemia in our cohort.
{"title":"A multi-centric study to estimate prevalence of anaemia in apparently healthy children between 6 and 59 months of age","authors":"Sanjeev Khera , Daljit Singh , R.W. Thergaonkar , Sandeep Dhingra , Ashish Kumar Simalti , Ritu Agarwal , Mohan KR , Vishal Vishnu Tewari , Sajith Surendran , Aniruddha Bhattacharjee","doi":"10.1016/j.mjafi.2023.11.005","DOIUrl":"10.1016/j.mjafi.2023.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Prevalence of anaemia is 67% in children between 6 and 59 months of age. There is a discrepancy in prevalence of anaemia in view of various cutoffs and capillary versus venous sampling. Prevalence studies at various levels are mandated for planning and implementation of policies to control anaemia.</div></div><div><h3>Methods</h3><div>This cross-sectional observational hospital-based multi-centric study enrolled apparently healthy eligible children aged between 6 and 59 months from Armed Forces Medical Services hospitals and estimated the prevalence of anaemia in “venous blood samples”. Demographic and anthropometric details and a questionnaire-based survey to study individual and community-related risk factors associated with anaemia were noted.</div></div><div><h3>Results</h3><div>A total of 10,814 children from 20 hospitals were eligible. A total of 2231 children (56.9% male) were analyzed. The prevalence of anaemia was 49.4% (95% confidence interval [CI]: 47.3–51.5) as defined by the World Health Organization (mild: 24.1%, moderate: 23.5%, and severe: 1.8%) and 19.6% (95%CI:18–21.3) as per the Comprehensive National Nutrition Survey. Majority of anaemia was microcytic (67.2%). Presumptive iron-deficiency anaemia was seen in 55.7%. In binary logistic regression analysis, age<24 months, inadequacy of nutrition and poor maternal education were the associated risk factors in all children with anaemia, while not giving exclusive breast feed till 6 months was an additional risk factor in children with moderate to severe anaemia.</div></div><div><h3>Conclusions</h3><div>We report a high prevalence (49.4%) of anaemia in children aged between 6 and 59 months, with predominantly lower-middle socioeconomic status. Individual factors such as age<24 months, inadequate nutrition, and community-related risk factors such as poor maternal education and not giving exclusive breast feed for 6 months were associated with anaemia in our cohort.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 5","pages":"Pages 520-527"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139636706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biliary atresia (BA) is a progressive, fibro-inflammatory cholangiopathy of infants with Kasai portoenterostomy (KPE) as the first-line surgical treatment. Most children eventually develop end-stage liver disease requiring liver transplantation (LT). Some infants are treated with primary LT (PLT), but the majority undergo KPE with a subsequent salvage LT (KPSLT). This aim was to study the clinical profile and outcome of infants with BA in the era of LT.
Methods
In this retrospective study from a tertiary care hospital of North India, all infants with BA who presented from January 2021 to October 2023 were included. The age at onset, disease severity based on Child-Pugh and Pediatric End-stage Liver Disease score, presence of cholangitis, decompensation, and complications were assessed. The age of undergoing KPE, need of primary or subsequent LT, and survival in patients of KPE with native liver (KPNL), KPSLT, and those with PLT were compared.
Results
Of 30 patients with BA, 19 (63.3%) underwent KPE, while 10 (33.33%) underwent PLT. One patient died before undergoing any surgical treatment. Subsequent salvage LT was done in 9/19 (47.3%) of patients with KPE. The 1-year survival was 8/10 (80%) in KPNL group, 6/9 (66.7%) in KPSLT group, and 9/10 (90.0%) in PLT group. The overall survival of KPE group with native liver was 42.1% (8/19). The median age of presentation was higher in the PLT group compared with KPNL group (p < 0.001).
Conclusion
Patients with BA with PLT have comparable outcome to those with KPSLT. Younger age of KPE correlates with better survival outcome.
{"title":"Clinical profile and outcome of infants with biliary atresia in the era of liver transplantation","authors":"Aradhana Aneja , Sandeep Dhingra , Amit Pandey , Sumesh Kaistha","doi":"10.1016/j.mjafi.2024.12.005","DOIUrl":"10.1016/j.mjafi.2024.12.005","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Biliary atresia (BA) is a progressive, fibro-inflammatory </span>cholangiopathy of infants with Kasai </span>portoenterostomy<span> (KPE) as the first-line surgical treatment. Most children eventually develop end-stage liver disease requiring liver transplantation (LT). Some infants are treated with primary LT (PLT), but the majority undergo KPE with a subsequent salvage LT (KPSLT). This aim was to study the clinical profile and outcome of infants with BA in the era of LT.</span></div></div><div><h3>Methods</h3><div>In this retrospective study from a tertiary care hospital of North India, all infants with BA who presented from January 2021 to October 2023 were included. The age at onset, disease severity based on Child-Pugh and Pediatric<span> End-stage Liver Disease score, presence of cholangitis<span>, decompensation, and complications were assessed. The age of undergoing KPE, need of primary or subsequent LT, and survival in patients of KPE with native liver (KPNL), KPSLT, and those with PLT were compared.</span></span></div></div><div><h3>Results</h3><div><span>Of 30 patients with BA, 19 (63.3%) underwent KPE, while 10 (33.33%) underwent PLT. One patient died before undergoing any surgical treatment. Subsequent salvage LT was done in 9/19 (47.3%) of patients with KPE. The 1-year survival was 8/10 (80%) in KPNL group, 6/9 (66.7%) in KPSLT group, and 9/10 (90.0%) in PLT group. The overall survival of KPE group with native liver was 42.1% (8/19). The median age of presentation was higher in the PLT group compared with KPNL group (</span><em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Patients with BA with PLT have comparable outcome to those with KPSLT. Younger age of KPE correlates with better survival outcome.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 5","pages":"Pages 514-519"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mjafi.2025.03.005
H. Ravi Ramamurthy , Alok Kumar , Arvind Mishra , Vivek Kumar , H.S. Arora , Nikhil Tiwari
Background
The corrective surgery of transposition of great arteries with intact interventricular septum (TGA-IVS) is an arterial switch operation (ASO), and this requires a neonate with hemodynamic stability, absence of infection, and left ventricle (LV) prepared to take the afterload. ASO is carried out at 2-3 weeks of life at our center thus making stabilization procedures like balloon atrial septostomy (BAS) essential. We hypothesized that in neonates with TGA-IVS with restrictive interatrial communication requiring BAS, simultaneous stenting of the patent ductus arteriosus (PDA) will maintain an adequate left ventricular load so that the LV is prepared to undergo ASO. We present our experience of combined BAS with PDA stenting as a first-stage procedure prior to ASO and compare the data with those who did not undergo PDA stenting.
Methods
A single-center, retrospective study of neonates with TGA-IVS with restrictive interatrial communication who underwent BAS with PDA stenting as stage 1 procedure was done. These neonates underwent ASO in stage 2. Echocardiographic assessment of the LV volumes, mass, geometry, and free wall thickness was performed prior to stage 1 and stage 2 and compared. After surgery and the postoperative clinical, hemodynamic and morbidity parameters were analyzed.
Results
Five neonates were included in the BAS with PDA stenting group and six patients were included in the non–PDA stenting group controls. Study neonates after stage I procedure had favorable LV geometry with significant improvement in LV mass from 36.7 ± 2.6 to 56.3 ± 3.1 g/m2 (p < 0.0001), posterior wall thickness in systole from 0.49 ± 0.08 mm to 0.54 + 0.08 mm (p = 0.002), LV end-diastolic volume from 14.7 + 7.4 ml to 24.2 + 8.6 ml (p = 0.001), good ejection fraction, and favorable LV geometry. A “limited” BAS was associated with consistent saturations above 84%. All patients underwent ASO subsequently with favorable outcomes to discharge. The control patients without a PDA stent had no significant changes in LV mass after BAS alone and had longer requirement of postoperative ventilation; one patient required extracorporeal membrane oxygenation.
Conclusion
Combined BAS with PDA stenting is a safe and effective stage 1 procedure to pretrain the LV in TGA-IVS while simultaneously maintaining adequate saturations till ASO.
{"title":"A novel approach to preparation of neonates with transposition of great arteries with intact ventricular septum for successful arterial switch operation: Combined balloon atrial septostomy and patent ductus arteriosus stenting","authors":"H. Ravi Ramamurthy , Alok Kumar , Arvind Mishra , Vivek Kumar , H.S. Arora , Nikhil Tiwari","doi":"10.1016/j.mjafi.2025.03.005","DOIUrl":"10.1016/j.mjafi.2025.03.005","url":null,"abstract":"<div><h3>Background</h3><div><span><span><span>The corrective surgery of transposition of great arteries with intact </span>interventricular septum (TGA-IVS) is an </span>arterial switch operation (ASO), and this requires a neonate with </span>hemodynamic<span><span> stability, absence of infection, and left ventricle (LV) prepared to take the afterload. ASO is carried out at 2-3 weeks of life at our center thus making stabilization procedures like balloon atrial septostomy (BAS) essential. We hypothesized that in neonates with TGA-IVS with restrictive interatrial communication requiring BAS, simultaneous stenting of the </span>patent ductus arteriosus (PDA) will maintain an adequate left ventricular load so that the LV is prepared to undergo ASO. We present our experience of combined BAS with PDA stenting as a first-stage procedure prior to ASO and compare the data with those who did not undergo PDA stenting.</span></div></div><div><h3>Methods</h3><div>A single-center, retrospective study of neonates with TGA-IVS with restrictive interatrial communication who underwent BAS with PDA stenting as stage 1 procedure was done. These neonates underwent ASO in stage 2. Echocardiographic assessment of the LV volumes, mass, geometry, and free wall thickness was performed prior to stage 1 and stage 2 and compared. After surgery and the postoperative clinical, hemodynamic and morbidity parameters were analyzed.</div></div><div><h3>Results</h3><div>Five neonates were included in the BAS with PDA stenting group and six patients were included in the non–PDA stenting group controls. Study neonates after stage I procedure had favorable LV geometry with significant improvement in LV mass from 36.7 ± 2.6 to 56.3 ± 3.1 g/m<sup>2</sup><span> (p < 0.0001), posterior wall thickness in systole from 0.49 ± 0.08 mm to 0.54 + 0.08 mm (p = 0.002), LV end-diastolic volume from 14.7 + 7.4 ml to 24.2 + 8.6 ml (p = 0.001), good ejection fraction<span>, and favorable LV geometry. A “limited” BAS was associated with consistent saturations above 84%. All patients underwent ASO subsequently with favorable outcomes to discharge. The control patients without a PDA stent had no significant changes in LV mass after BAS alone and had longer requirement of postoperative ventilation; one patient required extracorporeal membrane oxygenation.</span></span></div></div><div><h3>Conclusion</h3><div>Combined BAS with PDA stenting is a safe and effective stage 1 procedure to pretrain the LV in TGA-IVS while simultaneously maintaining adequate saturations till ASO.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 5","pages":"Pages 557-563"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mjafi.2025.08.011
Bani Jolly , Vinod Scaria
Genomic newborn screening (gNBS) is a new concept that leverages genomic sequencing for newborn screening (NBS) of genetic diseases, a subtle departure from the traditional biochemical approaches. gNBS is swiftly moving from small and isolated proof-of-concept studies to large-scale public health studies and implementation programs worldwide. Over the past decade, advances in sequencing technology, bioinformatics, and clinical genetics have expanded the scope of conditions that can be detected early, enabling timely interventions that improve outcomes. While traditional biochemical approaches for NBS have undoubtedly improved outcomes for many metabolic and endocrine disorders, they fail to detect conditions that do not have early biochemical markers and are also unable to scale up to a slew of new treatment approaches currently available for many genetic diseases. gNBS, therefore, provides a unique opportunity to diagnose early and identify actionable genetic risks, where early intervention can improve prognosis. Globally, pilot and implementation programs in the United Kingdom, the United States, Europe, and Australia are demonstrating feasibility, diagnostic yield, and public health value. India has a unique set of factors, including large birth cohorts, established health delivery systems, increasing rare-disease initiatives, and developing national genomic databases. These create a rare chance to create and test a gNBS program in India that focuses on actionable results. This review discusses the rationale, current global landscape, operational and ethical considerations, and India-specific opportunities and challenges for implementing gNBS as part of the national health strategy.
{"title":"Genomic newborn screening in India: Opportunities, evidence, and roadmap","authors":"Bani Jolly , Vinod Scaria","doi":"10.1016/j.mjafi.2025.08.011","DOIUrl":"10.1016/j.mjafi.2025.08.011","url":null,"abstract":"<div><div>Genomic newborn screening (gNBS) is a new concept that leverages genomic sequencing for newborn screening (NBS) of genetic diseases, a subtle departure from the traditional biochemical approaches. gNBS is swiftly moving from small and isolated proof-of-concept studies to large-scale public health studies and implementation programs worldwide. Over the past decade, advances in sequencing technology, bioinformatics, and clinical genetics have expanded the scope of conditions that can be detected early, enabling timely interventions that improve outcomes. While traditional biochemical approaches for NBS have undoubtedly improved outcomes for many metabolic and endocrine disorders, they fail to detect conditions that do not have early biochemical markers and are also unable to scale up to a slew of new treatment approaches currently available for many genetic diseases. gNBS, therefore, provides a unique opportunity to diagnose early and identify actionable genetic risks, where early intervention can improve prognosis. Globally, pilot and implementation programs in the United Kingdom, the United States, Europe, and Australia are demonstrating feasibility, diagnostic yield, and public health value. India has a unique set of factors, including large birth cohorts, established health delivery systems, increasing rare-disease initiatives, and developing national genomic databases. These create a rare chance to create and test a gNBS program in India that focuses on actionable results. This review discusses the rationale, current global landscape, operational and ethical considerations, and India-specific opportunities and challenges for implementing gNBS as part of the national health strategy.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 5","pages":"Pages 495-500"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145098664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mjafi.2025.04.013
Chaitanya Dinesh , Sarvesh Kohli , G. Shridhar , Karthik Ram Mohan , Shuvendu Roy , K.M. Adhikari
Background
Current opinion is divided on the ideal growth chart for classifying neonates at birth, and few studies have compared the accuracy of Fenton vs New AIIMS Growth Charts for the same. The aim of this study was to compare New All India Institute of Medical Sciences (AIIMS) versus Fenton growth charts for classification of small-for-gestational-age (SGA) neonates at birth and to assess the short term adverse outcomes; neonatal mortality, neonatal intensive care unit (NICU) stay of more than 48 hours; symptomatic polycythemia; symptomatic hypoglycemia and neonatal hyperbilirubinemia requiring phototherapy.
Methods
This was a prospective observational study of diagnostic accuracy of New AIIMS and Fenton growth charts. Neonates were classified based on birthweight and gestational age on the two charts and their short-term adverse outcomes compared.
Results
Among 600 neonates enrolled in the study, mean (±SD) gestational age was 37.99 (± 1.26) weeks and mean birth weight was 2779.24 (± 453.15) g. 152 neonates (25.3%) were classified as SGA by Fenton, against 82 (13.7%) by New AIIMS charts. Accuracy of New AIIMS Chart in predicting adverse outcomes was 71.50% (95% CI: 67.70% to 75.08%), while for the Fenton Chart was 66.00% (95% CI: 62.05% to 69.79%).
Conclusion
The Fenton chart identifies a higher proportion of neonates as SGA compared to New AIIMS growth chart, though their short-term adverse outcomes showed no significant differences.
{"title":"Comparison between New AIIMS growth chart versus Fenton growth chart for classification of small-for-gestational-age neonates at birth: A prospective observational study","authors":"Chaitanya Dinesh , Sarvesh Kohli , G. Shridhar , Karthik Ram Mohan , Shuvendu Roy , K.M. Adhikari","doi":"10.1016/j.mjafi.2025.04.013","DOIUrl":"10.1016/j.mjafi.2025.04.013","url":null,"abstract":"<div><h3>Background</h3><div>Current opinion is divided on the ideal growth chart for classifying neonates at birth, and few studies have compared the accuracy of Fenton vs New AIIMS Growth Charts for the same. The aim of this study was to compare New All India Institute of Medical Sciences (AIIMS) versus Fenton growth charts for classification of small-for-gestational-age (SGA) neonates at birth and to assess the short term adverse outcomes<span><span><span><span>; neonatal mortality, </span>neonatal intensive care unit (NICU) stay of more than 48 hours; symptomatic </span>polycythemia; symptomatic hypoglycemia and </span>neonatal hyperbilirubinemia<span> requiring phototherapy.</span></span></div></div><div><h3>Methods</h3><div>This was a prospective observational study of diagnostic accuracy of New AIIMS and Fenton growth charts. Neonates were classified based on birthweight and gestational age on the two charts and their short-term adverse outcomes compared.</div></div><div><h3>Results</h3><div>Among 600 neonates enrolled in the study, mean (±SD) gestational age was 37.99 (± 1.26) weeks and mean birth weight was 2779.24 (± 453.15) g. 152 neonates (25.3%) were classified as SGA by Fenton, against 82 (13.7%) by New AIIMS charts. Accuracy of New AIIMS Chart in predicting adverse outcomes was 71.50% (95% CI: 67.70% to 75.08%), while for the Fenton Chart was 66.00% (95% CI: 62.05% to 69.79%).</div></div><div><h3>Conclusion</h3><div>The Fenton chart identifies a higher proportion of neonates as SGA compared to New AIIMS growth chart, though their short-term adverse outcomes showed no significant differences.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 5","pages":"Pages 536-541"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.mjafi.2024.06.003
Sanjeev Khera , Jasdeep Singh , Amit Kumar , Rajiv Kumar , Rajan Kapoor
Background
Literature on bone health in childhood acute lymphoblastic leukemia survivors (cALLS) is conflicting with most studies suggesting an adverse effect on bone mineral density (BMD).
Methods
This cross-sectional study enrolled cALLS>7 years of age. BMD was measured using dual-energy x-ray absorptiometry (DEXA) scan [Lumbo-sacral (LS-BMD) and whole-body (WB-BMD)]. Low BMD was defined as an LS-BMD ≤2 z-score. Demographic, anthropometry-related, therapy/disease-related and endocrine factors affecting LS-BMD were noted in two groups: low verses normal BMD.
Results
Fifty-nine cALLS were analyzed with a median age of 66 months (range: 6–212) at diagnosis and a median duration postcompletion of therapy for 14 months (range 1–113). Two-thirds were male, and 25/59 (42%) had Tanner staging>1. Low LS-BMD was seen in 15/59 (25%), and a low WB-BMD in 3/59 (5%). The mean therapeutic doses of steroids and methotrexate were comparable in two groups. In univariate analysis, age at diagnosis >10 years was associated with low BMD (p = 0.02), while high adiposity was seen commonly with normal BMD (p = 0.01). On multivariate analysis, high adiposity was the single-most factor associated with normal BMD, with an odds ratio of 5.2. The correlation between LS-BMD and WB-BMD was statistically significant (r = 0.55).The median values of hormonal and mineral assays affecting calcium and vitamin D homeostasis and BMD in the two groups were comparable.
Conclusion
We report a high prevalence of low LS-BMD (25%) in our cohort. Out of the studied demographics, therapy-related, disease-related, and endocrine factors; high adiposity as defined by a high body fat percentage, was protective against low BMD. We also found a significant correlation between LS-BMD and WB-BMD.
{"title":"Bone mineral density in childhood acute lymphoblastic leukaemia survivors and factors affecting it","authors":"Sanjeev Khera , Jasdeep Singh , Amit Kumar , Rajiv Kumar , Rajan Kapoor","doi":"10.1016/j.mjafi.2024.06.003","DOIUrl":"10.1016/j.mjafi.2024.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Literature on bone health in childhood acute lymphoblastic leukemia<span> survivors (cALLS) is conflicting with most studies suggesting an adverse effect on bone mineral density (BMD).</span></div></div><div><h3>Methods</h3><div>This cross-sectional study enrolled cALLS>7 years of age. BMD was measured using dual-energy x-ray absorptiometry (DEXA) scan [Lumbo-sacral (LS-BMD) and whole-body (WB-BMD)]. Low BMD was defined as an LS-BMD ≤2 z-score. Demographic, anthropometry-related, therapy/disease-related and endocrine factors affecting LS-BMD were noted in two groups: low verses normal BMD.</div></div><div><h3>Results</h3><div><span>Fifty-nine cALLS were analyzed with a median age of 66 months (range: 6–212) at diagnosis and a median duration postcompletion of therapy for 14 months (range 1–113). Two-thirds were male, and 25/59 (42%) had Tanner staging>1. Low LS-BMD was seen in 15/59 (25%), and a low WB-BMD in 3/59 (5%). The mean therapeutic doses of steroids and methotrexate were comparable in two groups. In </span>univariate analysis<span><span>, age at diagnosis >10 years was associated with low BMD (p = 0.02), while high adiposity was seen commonly with normal BMD (p = 0.01). On multivariate analysis, high adiposity was the single-most factor associated with normal BMD, with an odds ratio of 5.2. The correlation between LS-BMD and WB-BMD was statistically significant (r = 0.55).The median values of hormonal and mineral assays affecting calcium and </span>vitamin D<span> homeostasis and BMD in the two groups were comparable.</span></span></div></div><div><h3>Conclusion</h3><div>We report a high prevalence of low LS-BMD (25%) in our cohort. Out of the studied demographics, therapy-related, disease-related, and endocrine factors; high adiposity as defined by a high body fat percentage, was protective against low BMD. We also found a significant correlation between LS-BMD and WB-BMD.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 ","pages":"Pages S84-S89"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号