RESP/01 (R) AN UNUSUAL CYST IN THE CHEST
K R Lahiri; S V Kondekar, R K Vasvani, Pravin Dharaskar
Department of pediatrics, Seth G S Medical College and KEM Hospital Mumbai 400012
Various congenital cysts of lungs are known viz: pulmonary sequestration, congenital cystic adenomatoid malformation, lobar hyperinflation and bronchogenic cyst. Hereby we present a case of a 5 month old boy in who the diagnosis of a similar cyst was missed. He presented with low fever, cough & sudden onset breathlessness since 2 days. There was no other significant history. On examination apart from tachypnea and tachycardia, there were chest retractions, but no cyanosis.
Chest movements and cry fremitus was decreased on right side with hyper-resonant note on percussion over same area. On auscultation, air entry was decreased over right side of chest. A clinical diagnosis of pneumothorax was made and an intercostal drain was put, that could not collapse the pneumothorax. Further, CT showed a sharply marginated, nonenhancing mass; diagnostic of a bronchogenic cyst; that warranted complete excision of cyst. On microscopic examination cyst was lined by ciliated pseudostratified columnar epithelium with wall containing mucous glands, cartilage, elastic and smooth muscles. Bronchogenic cysts are uncommon respiratory tract cysts (15%), those usually develop during the formation of foregut and usually are central and pedunculated. The unusual presentation of a bronchogenic cyst filling whole of right hemithorax is not yet documented. And due to this weird presentation, it was falsely interpreted as pneumothorax, and the chest scan was delayed and so was the cystectomy. All cysts should be operated to avoid infection and/or malignant change. Treatment options are cyst excision, by video assisted thoracoscopic surgery or Open thoracotomy.

RESP/02 (P) EMPYEMA IN CHILDREN : A CASE SERIES
U C Rajput, L S Deshmukh,
Department of Pediatrics, Government Medical College and Hospital, Aurangabad 431 001
In developing countries like India, empyema is still a major problem in children with pneumonia, contributed by factors like malnutrition, delay in diagnosis and treatment. The study present analysis of empyema in children. Design : A retrospective case series. Setting and Methods : Study was carried out on 61 patients of empyema admitted and treated in pediatric ward at Government
Medical College and Hospital, Aurangabad during January 2003 to March 2006. Detail data regarding age, sex, clinical features, pleural fluid study, radiological examination, treatment and outcome were recorded. Detail analysis was done. Results : Total 61 patients were studied in present study having male to female ratio of 1.3:1. Most common age group was between 0 to 3 years (49.18%) with mean duration of hospital stay was 17.38 days. Most common symptom observed was fever followed by cough, breathlessness, feeding difficulty and chest pain. Majority of children were malnourished (81.96%) with severe malnutrition (Grade III and IV) present in
29.5%. Most common organism isolated was Klebsiella followed E. coli, Pseudomonas,
Staphylococcus . Average duration of intercostals drain was 21.58 days (Range 0 to 40 days). Nine patients required decortications. Conclusions : Empyema in children is most common in 0 to3 years of age group. Early diagnosis and treatment including, intercostals drainage prevents long term complications.
RESP/03(P)PULMONARY TUBERCULOSIS IN ADOLESCENTS.
Trupti G Velapure, Meena Malkani
Department of Paediatrics, Grant Medical College, Sir J.J, Group of Hospitals, Mumbai
The objective of the study is to analyze the clinical presentation of pulmonary tuberculosis in adolescence (10-19 years). As against younger paediatric patients in whom extra-pulmonary tuberculosis (T.B) is seen, adolescents usually have pulmonary lesions with an adult pattern of presentation. DESIGN- A cross-sectional, hospital based study with random selection of study group. MATERIALS AND METHODS- 30 adolescent patients visiting the out-patient department of J.J. Hospital, Mumbai were included in this study. The gender of the patients, past history of T.B, history of T.B contact, sputum smear results, X-ray features and management were taken into account. OBSERVATIONS- Out of 30 patients, 22 (73%) were girls and 8 (27%) were boys. All were between 10-15 years of age. Of all the 30 patients the X-ray features showed fibrocavitatory apical lesions in 19 cases (63%). 50% were sputum positive and majority of them were girls. 60% of sputum positive cases were multidrug resistant T.B. A significant number had past history of TB and history of TB contact. CONLUSIONS- Adolescent females are more susceptible to pulmonary tuberculosis than males. Sputum smear positivity is found in a large proportion in adolescents. On radiology adolescents have adult pattern of disease demonstrated by presence of apical cavitatory lesions.

RESP/04(O)EVALUATION OF THE USE OF TECHNIQUE OF INHALATION DEVICES
IN CHILDREN WITH ASTHMA.
Vaswani Rk, Mulgund Rs, Lahiri Kr
Dept of Pediatric Medicine, GS Medical College and KEM Hospital, Parel, Mumbai-400012
OBJECTIVES: Inhaled medications, being the current strategy of asthma therapy, we desired to find out the common errors made by children while using inhalation devices as well as assess the significance of demonstration of inhalation technique to parents and children. METHODS: Forty consecutive children diagnosed to have asthma and on regular inhalation therapy for minimum three months were enrolled in this prospective cohort study. The child was asked to demonstrate use of his/her particular inhalation device pre and post demonstration. Their technique was assessed stepwise and compared with the recommended technique. RESULTS: Prior to demonstration,
87.5% of the subjects made errors in two or more steps whereas post demonstration it was only
37.5% which was statistically significant (p<0.0001). The two most common errors made by the subjects were failure to hold breath for 5-10s at Total Lung Capacity after the inspiration (Predemonstration: incorrect-80%; Post-demonstration: incorrect-32.5%; p<0.0001) and failure to exhale breath to Functional Residual Capacity / Residual volume before actuating the inhaler (Pre- demonstration: incorrect-80%; Post-demonstration: incorrect-35%; p<0.0001). CONCLUSIONS:
The low percentage of errors made by children post demonstration indicates the significance of technique demonstration. So we recommend that demonstration of the technique once or more to the child-parent pair and reinforcement of the technique on repeated visits is utmost essential to achieve maximum benefit from inhaled medications.
RESP/05(P)PREVALENCE OF ASTHMA IN RURAL AND URBAN CHILDREN
OF AJMER DISTRICT
Sidharth.S, Ramakant.D, Kalpana.D
Objective : To define any differences between prevalence of asthma in rural and urban children and to define the cause of such differences. Material and Methods: In all 6959 school children of Urban and Rural area of Ajmer district were included in the study. The age ranged from 5-15 years. They were divided in two groups : 5-10 years and 11-15 years. To assess the prevalence rate of asthma modified questionnaire was adopted. PEFR was also noted in all the children. Results: The total number of children in urban schools was 4553. The number of children aged 5-10 years children was 1949, which included 745 Male and 1204 Females. The male to female ratio is 1:1.6.The number of children aged 11-15 years was 2594. Out of these 1040 were Males and1554 were
Females. The male to female ratio is 1:1.49. The total number of children of rural school was 2416.
Out of these 1111 aged 5-10 years. (567 boys and 544 girls). The male to female ratio is 1:0.95. The number of children who belonged to 11-15 years was 1305 (682 males and 623 females). The male to female ratio is 1:0.91. In the urban children of age group 5-10 yrs, in male children, the prevalence of asthma was 5.3% and in females it was 3.7%. In children belonging to 11-15 yrs, the prevalence of asthma in males and females was 2.5% and 3.3% respectively. In rural areas in the children of age group 5-10 yrs, the prevalence rates in male & female children were 4.2% and
2.9% respectively and in children of age group 11-15 yrs the prevalence of asthma in male and females were 3.2% and 3.3% respectively. Conclusion: Thus the prevalence of asthma was higher in male children of urban areas of Ajmer district.

RESP/06(P)PREVALENCE OF ASTHMA IN CHILDREN VACCINATED WITH BCG IN
URBAN AND RURAL AREAS
Sidharth.S, Kalpana.D, Ramakant.D
Aim: To see prevalence of asthma in children vaccinated with BCG in urban and rural areas
Material and Method: In all 6959 school children of Urban and Rural area of Ajmer district were included in the study. The age ranged from 5-15 years. They were divided in two groups : 5-10 years and 11-15 years. To ass Clinical examination and PEFR was done for all the students ess the prevalence rate of asthma modified questionnaire was adopted. BCG status was seen by presence or absence of scar mark on arm. Results: In total urban children 4416 (96.9%) were vaccinated for
BCG as seen by scar mark on arm. Out of these 197 were asthmatic (4.46%). The number of children, non-vaccinated was 137 (3.1%), out of which 5 were found to have asthma. In urban and rural areas the rates of prevalence of asthma in children vaccinated for BCG were 4.46% and
3.34% respectively. In children not vaccinated, the rate of prevalence of asthma was 3.6% in urban children and 4.1% in rural children. Conclusion: Thus in the present study status of BCG vaccination did not effect the prevalence of asthma in both urban & rural areas.
RESP/07(R)EFFECT OF NOVEL HOME MANAGEMENT ON CHILDHOOD ASTHMA.
Vimal Jayswal
Email: drvimaljaiswal@rediffmail.com
Novel home management plan(HMP) for asthma control is considered essential for optimum management & better outcome of the disorder .Home management is almost nonexistence in our country in contrast to west.an ideal HMP should be individualized, easy to imp lent without the need of measuring PEFR during home use, reliably predicting the actual severity based on the presence or absence or symptoms with an essential component of prediction of future risk of sever asthma episodes. Design non randomize control study. Methods 100 non asthma cases diagnosed 1 year back of age group 1-16 year visiting out Paediatric Department of NSCB Medical College were subject of the study. Each of these was under close follow-up for 1 year also acted as its on control. Age sex social backgrounds / medical history, duration of asthma, triggering factor, physical activity, diurnal symptoms FEV
1
, present asthma treatment & reversibility of airways after nebulization were recorded on a predisigned proforma. Severity GINA was also recorded. Result : in this study 72% were male, severity of sever persistent cases was 10% thus underestimating the severity of disease. After UPDATED GINA devised by the present study the number of cases categorized as sever persistent increase to 48%. UPDATED GINA was found to be significantly associated with decreased no. of hospitalization emergency visit oral steroid use with increase use of inhaled steroid & quality of life. Conclusion : The present study has devised a updated GINA which is undoublty more useful & cost effective. The updated GINA helps in future risk categorization with appropriate and timely treatment. The Future Risk Category Score (FRCS) is found to reduced hospitalization. A written management plan with future risk characterized was found to be more effective.

RESP/08 (R) ACQUIRED SUBGLOTTIC STENOSIS
Mona Gajre, Surekha Joshi,Yogesh Waikar,Surbhi Rathi, Sushma Malik, Jyoti Dabholkar
242,9479 Kanamwar Nagar-2, Vikhroli(E), Mumbai-81
CASE HISTORY: A 1 year old female weighing 7 kg was admitted with biphasic stridor, respiratory distress, and bilateral crepitations with reduced air entry. She was in impending respiratory failure, repeated endotracheal intubation attempts failed as the tube failed to negotiate beyond the glottis. Emergency tracheostomy was carried out and patient ventilated for 18 hours.
Child was admitted 2 months prior for post measles bronchopneumonia requiring ventilation for 3 days. However the child did not have symptoms of stridor in the intervening period. Investigations revealed normal blood counts, X-Ray neck showed positive steeple sign. Clinical impression was of an upper airway obstruction possibly croup.CT scan neck demonstrated glottic and subglottic stenosis with soft tissue edema with areas of focal consolidation in bilateral lung fields. On day 7 of admission direct laryngoscopy was done which confirmed the diagnosis of subglottic stenosis with surrounding granulomatous tissue. Biopsy revealed laryngeal papilloma secondary to human papilloma virus (HPV).Mitomycin application was done and at present patient is on long term tracheostomy tube till laser excision is planned. DISCUSSION:Chronic subglottic stenosis is the most common cause of tracheal stenosis. Acquired stenosis can be because of external laryngeal trauma (common in adults) and internal laryngeal injury (more in children).The latter is iatrogenic secondary to prolonged endotracheal intubation. In children the subglottic area is prone as it is the narrowest part of the airway. Size of the tube and duration of intubation are the important factors. In this case the possible etiology to subglottic stenosis is Human Papilloma Virus infection with squamous papilloma.This is common in children presenting as either multiple laryngeal papillomatosis or single papilloma. Treatment is usually removal by direct laryngoscopy with laser, radiation or podophyllin treatment. Recurrences are common remission is usually post pubertal age.
In our case laser excision under direct laryngoscopy with complete weaning from the tracheostomy is planned.

RESP/09(P)COMPARISON OF THROAT SWAB / OROPHARYNGEAL SECRETIONS
WITH AND WITHOUT CHEST PHYSIOTHERAPY IN SMALL CHILDREN UNABLE TO
EXPECTORATE IN ABSENCE OF INVASIVE METHODS IN LOWER RESPIRATORY
INFECTIONS.
Karuna Thapar, Sandeep Aggarwal,Naresh Jindal, Usha Arora.
Department Of Paediatrics, Government Medical College & Hospital Amritsar
Objective : In lower respiratory tract infections in children it is important to identify pathogens in lower airways for effective antibiotic therapy. Except sputum collection, other techniques are invasive. Young children cannot expectorate. This study demonstrates the importance of throat swab and oropharyngeal secretions in diagnosing micro-organisms in small children with lower respiratory tract infections especially after physiotherapy. Design : A prospective hospital based study. Setting and Methods : 15 out of 65 children aged 1-1.5 years admitted with respiratory distress in the Pediatrics Department of Government Medical College Amritsar from January 2006 to March 2006 were the subjects of the study after excluding cases with recurrent attacks and cases receiving antibiotics just before admission. Throat swab was collected by gently rubbing a sterile swab stick over pharyngeal wall and replacing the same in sterile vials. Oropharyngeal secretions was collected by gentle suctioning by sterile and disposable neonatal mucus sucker attached to gentle suction machine to avoid contamination. For samples after physiotherapy, child was given chest physiotherapy and samples were collected thereafter. Results : During the study period, a total of 60 samples from 15 patients were collected, 46% (28/60 samples) were positive for pathogens. Mean age of patients was 5.6 months. Out of positive cultures 39% (11/28 samples) were of Streptococcus pneumoniae, 28.5% for kleibsella pneumoniae,21% for enterobactor,10% for
Staphylococcus aureus and 7% for Pseudomonas aeruginosa. Out of positive cultures 67.8% (19/28 samples) were after physiotherapy as compare to 32% (9/28 samples) before physiotherapy.
Conclusion: We conclude that throat swab and oropharyngeal secretions after physiotherapy can be used reliably for identification of lower airway pathogens. Physiotherapy helps in loosening up of secretions in the lower airways and facilitates the movement of the same towards upper airway.
RESP/10 (P) CONCERNS REGARDING BRONCHIAL ASTHMA
KK Locham, Manpreet Sodhi, Kamaljeet Kaur, Seema Rai
Deptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001
Bronchial asthma is a common chronic disease with significant morbidity. There are lot of concerns of parents and pediatricians regarding the disease. Objective : To study the clinical profile of bronchial asthma in our set up.Setting and Methods : 30 children with bronchial asthma admitted to
Department of Pediatrics, Govt. Medical College, Patiala were the subjects of the study. Age, sex, place of residence, frequency of attacks, family history, type of asthma, treatment received. general physical and systemic examination were recorded on a pretested proforma. The data so obtained was analysed. Results : Maximum number (43.3%) of children were in the age group of 1-3 years followed by 33.3% in 0-1 year and 13.3% in 3-6 years age group. There were 2 children in 6-9 years group. There was a single children in 9-12 years age group. 53.3% of children had urban background. 14 children had more than two attacks whereas 6 reported to the hospital with 2 nd attack. 10 children presented with first attack. Family history of allergic diseases was present in 17 children. Paternal history was positive in 10 children and maternal was present in 10 cases. 1 case had positive history both in mother and father. One child had asthma in first degree relative. 25 children had hospital stay for 1 week during the attack. 10 children had moderate persistent asthma.
Severe persistent variety was reported in 4 cases. 6 children had mild asthma. History of diurnal variation was present in 16 cases. 6(20%) asthmatic children had short stature. Conclusion:
Maximum number of children were in age group of 1-3 years. Family history of allergic disorders was present in 56.6% of cases. 50% children presented with moderate persistent asthma.

RESP/11(P)RISK FACTORS FOR SEVERE ACUTE LOWER RESPIRATORY TRACT
INFECTION IN CHILDREN OF KANPUR NAGAR
Rachana Kathuria, VN Tripathi, RP Singh, GC Upadhyay, SP Mathur
Department of Pediatrics, Microbiology, and RadiologyGSVM Medical College, Kanpur
Introduction : Along with diarrhoea and malnutrition, lower respiratory tract infection is a major cause of morbidity & mortality in under 5 year children in developing countries. Objectives : To find out the various risk factors associated with increased morbidity and mortality in children suffering from severe acute lower respiratory tract infections (ALRTI). Design : Prospective
Hospital based study. Setting : Department of Pediatrics, Microbiology & Radiology, GSVM
Medical College, Kanpur. Method : 250 children between 1 month to 5 years of age were studied with special reference to their age, sex, feeding, immunization status and living conditions. The data gathered through preplanned questionnaire were statistically analysed. Results : Infants in the age group of >1 month to <1 year of age were found to be affected more (62.4%) than older children.
Out of the 250 children included in the study, 174 (69.6%) were found to be males. 111 children
(44.4%) were incompletely immunized for their age and 223 cases (89.2%) lived in overcrowded conditions. More than two children at home were found in 136 cases (54.4%). 106 cases (42.4%) were found to be breast fed for < 6 months & 70 children (28.0%) were not fed with breast milk at all. Conclusion : The understanding of risk factors associated with acute lower respiratory tract infection in children is essential for primary prevention of the disease. Younger age, male sex, incomplete immunization for age, living in overcrowded conditions and lack of adequate breast feeding are some of the risk factors associated with this illness.
RESP/12 (P) BOOP - MANY QUESTIONS??? NO ANSWERS!
Zaki Ahmed Sayyed, Vaishali More, Preeti Shanbag, Arpita Thakkar
Department of Pediatrics, Lokmanya Tilak Municipal Medical College & General Hospital, Sion,
Mumbai-400022
BOOP – Many Questions??? No Answers. Bronchiolitis obliterans and organizing pneumonia
(BOOP) is a rare condition in the pediatric and infant age groups. We hereby present two cases of this relatively rare entity. Patient 1: A 6-year-old male child presented with recurrent episodes of cough, cold, fever and breathlessness since the age of 3 years, requiring frequent nebulisations.
Inhaled therapy was started, but compliance was poor. The child had measles at the age of 3 years, following which the above complaints started. There was no history of contact with tuberculosis.
On admission he had severe respiratory distress with a respiratory rate of 90/minute, peripheral cyanosis and grade 2 clubbing. On respiratory system examination a pigeon-chest deformity and bilateral rhonchi were present. Chest -X ray showed bilateral infiltrates. Arterial blood gases showed hypoxemia. High-resolution CT scan of the chest was suggestive of bronchiolitis obliterans with organizing pneumonia (BOOP) with a differential diagnosis of bronchopulmonary aspergillosis (ABPA), which was ruled out as serum IgE levels were normal. The patient is presently on supportive treatment. Patient 2: An 18- month-old female child presented with cough, cold, fever and breathlessness for 15 days. She had measles 1 month back. There was no contact with tuberculosis and no prior history of recurrent breathlessness. On examination child had severe respiratory distress with a respiratory rate of 72/minute and grade 1 clubbing. On respiratory system examination there were bilateral rhonchi. Chest X-ray was suggestive of bilateral patchy infiltrates.
Arterial blood gases showed hypoxemia. High-resolution CT scan showed features of BOOP. The patient required intubation and ventilation soon after admission. Despite supportive care, the patient expired.

RESP/13(R)AN UNUSUAL CASE OF CHRONIC LUNG DISEASE
Arpita Thakkar, Zaki Ahmed Sayyed, Vaishali More, Preeti Shanbag,
Department of Pediatrics, Lokmanya Tilak Municipal Medical College & General Hospital, Sion,
Mumbai-400022
A thirteen-month-old female child was brought to us with, failure to thrive (FTT) since birth and cough, fever, breathlessness and refusal to feed since two days. There was no history of convulsions, oliguria, otorrhea or contact with tuberculosis. There was no history of cyanosis.
Patient had been investigated for FTT but investigations for tuberculosis done six months prior to admission were negative except for a chest X-ray that showed an opacity in the right mid-zone. The child had received oral antibiotics and responded temporarily. The baby was preterm with low birth weight born to a mother having gestational diabetes and a bad obstetric history. At birth, the patient required admission to a neonatal intensive care unit for respiratory distress but all investigations done then including 2 D Echo were normal. On admission to our ward, the patient had respiratory distress with a respiratory rate of 82/minute and a heart rate of 200/minute. Her length was 69 cm, weight 5.4 kg and head circumference 43 cms, suggestive of severe FTT. She also had peripheral and central cyanosis with grade 3 clubbing. On respiratory system examination patient had bilateral crepititions and rhonchi. The cardiovascular system was normal. Abdominal examination revealed a liver and spleen, which were 4 cms and 2 cms below the sub-costal margin respectively. Our impression on admission was chronic lung disease or cyanotic congenital heart disease. An immunocompromised state and disseminated tuberculosis were also considered.A chest X-ray showed bronchopneumonia. Arterial blood gases showed hypoxemia. 2D Echo showed a normal heart. HIV Elisa was negative. In view of the above clinical picture high-resolution CT scan of the chest was done which showed chronic pneumonitis of infancy. The patient was started on methyl prednisone and chloroquine but the patient had a progressively downhill course and expired after 3 months in the hospital.

RESP/14 (P) RETROSPECTIVE ANALYSIS OF BRONCHIOLITIS- A HOSPITAL BASED
STUDY
C.T Deshmukh, Jyoti Suvarna, Tejasvi Chaudhari, Suhas Bendrikar, Sachin Moggawar
Department of Pediatrics, Seth G. S. Medical College & KEM Hospital, Mumbai.
Introduction: Bronchiolitis is one of the common respiratory conditions seen in children. Most cases are mild, but many require admissions. Aim: To study the clinical profile, seasonal pattern and outcome of admitted patients of bronchiolitis. Material and Methods: A retrospective analysis was done of all cases of bronchiolitis (age group 2 months- 2 years) admitted from August 2005 to July
2006 in pediatric wards of KEM Hospital (a tertiary care centre). Results: Forty cases of bronchiolitis were admitted (1.6% of total pediatric admissions), 52.5% presented in summer months (February- May). All patients were infants (2 to 12 months), with 85% being males.
Presenting symptoms in all patients were fever, cough and breathlessness for an average duration of
3-4 days. Immunization for age was completed in 45% cases. Moderate respiratory distress seen in
78% and severe in 22% cases, with 12% requiring PICU care. None required mechanical ventilation. Chest X- ray showed hyperinflation in 40%, bilateral infiltrates in 22%, streaking in
10%, and normal in 42% cases. Eighteen patients (45%) required blood gas analysis. Mild hypoxemia (PO2 60-80) was seen in 22%, respiratory alkalosis in 11% and respiratory acidosis in none. Pallor (Hb <10 gm %) was seen in 52% with 9% requiring blood transfusion and leucocytosis
(>12000/cmm) in 45% cases. All the patients received humidified oxygen & nebulized salbutamol,
45% patients with inadequate response received injectable terbutaline. Steroids was administered in
67.5% (inhaled route commonest) and antibiotics in 47.5% patients. Most of the patients (65%) recovered within 72 hours. There was no mortality. Conclusion: All our cases presented during infancy with significant male predilection and seasonal variation. Most patients recovered in less than 72 hours with bronchodilator therapy alone with many requiring steroids also. 12 % required
PICU care. Antibiotics although not required, high percentage of antibiotic usage was seen.

RESP/15(P)STUDY OF THE INCIDENCE OF GROUP A STREPTOCOCCAL (GAS)
PHARYANGITIS IN CHILDREN BETWEEN 3-15 YEARS OF AGE IN A TEACHING
HOSPITAL
Srikanta Basu, Sita Ram Choudhary, Veena R Parmar, Varsha Gupta
Department of Pediatrics, Govt. Medical College & Hospital, Sector-32, Chandigarh.
Introduction: The group A streptococci has remained a significant pathogen causing variety of infections. Acute Rheumatic fever and post streptococcal glomerulonephritis are serious sequele and continues to be a major cause of morbidity in children. In India the incidence of Rheumatic fever range from 0.17 to 0.7 per 1000 and prevalence of Rheumatic heart disease range from 1 to
5.4 / 1000. Primary prevention remains a major intervention and requires early recognition and prompt treatment of streptococcal throat infection to prevent this life crippling sequele. Material and
Methods: Study was conducted from January, 2004 to September, 2005 and in patients 3-12 years of age. All the children attending Pediatrics department with features of upper respiratory tract infection (URTI) formed the study group whereas the children without the URTI were taken as controls. Following investigations were carried out: On Day 1-Throat swab culture and sensitivity,
ASO titre and total blood count. Day 15-21-Repeat ASO titre. ASO titre > 200 IU/ L or two dilution rise in titre between acute and convalescent sera was considered significant. Statistical analysis was done by chi square test. Results: 112 patients were enrolled in the study group (male 78 and female
34) and 54 in the control group (M 39 and F 15) (p>0.5). 62.5% of study group children between 3-
6 yrs., 25.8% from 7-9 yrs. and 9.8% in 10-12 yrs. 19.6% children in study group were positive for group A streptococci in their throat swab culture (p>0.1). Fever >102 o F, throat pain, pharyngeal congestion and tender lymphadenopathy had significant correlation with streptococcal sore throat.
In the study group ASO titre positivity was significantly higher in older age group (>7 yrs.) as compared to younger age group (p<0.5). In study group 22 children who had +ve throat culture also had high ASO titre whereas none of the children in the control group had elevated ASO titre. Throat culture positivity was also observed more in winter season (Dec, Jan & Feb) both in control and study group. Conclusion: The incidence of GAS Pharyngitis was 19.6% in children between 3-15 yrs. of age. Significantly high positive association of high-grade fever, throat pain, tonsillar enlargement, exudates and lymphadenitis was observed with a positive throat cultural for GAS pharyngitis.

RESP/16(P)EVALUATION OF ANGIOTENSIN CONVERTING ENZYME (ACE)GENE
INSERTION /DELETION POLYMORPHISM AS A GENETIC RISK FACTOR FOR
ASTHMA IN CHILDREN OF KANPUR DISTRICT.
K. Rajan, V.N.Tripathi, S.Ganesh, V.Gupta.
Dept of Pediatrics, GSVM Medical College, Kanpur
Angiotensin converting enzyme (ACE) is a zinc metallopeptidase which converts angiotensin I into angiotensinII. ACE is expressed at high levels in lungs and plays a role in metabolism of angiotensin II, bradykinin, substance P all of which are potentially involved in pathogenesis of asthma. ACE could contribute to the pathogenesis of asthma by causing proliferation and increased contractility of airway smooth muscle thus favoring excessive airway obstruction. An insertion / deletion polymorphism (I/D) of ACE gene has been shown to be associated with asthma in different ethnic population. OBJECTIVES: A study was undertaken to examine the association between ACE gene I/D polymorphism and asthma in children of Kanpur district. DESIGN: A case-control study.
SETTING AND METHODS 151 asthmatic children including 85 males and 66 females and 146 non-asthmatic controls including 91 males and 51 females,from the age group 3-18 years, attending both Outpatient and Inpatient Pediatrics Department GSVM Medical College were taken for analysis. DNA was extracted from peripheral blood following the standard protocols. Genotypic pattern of ACE I /D polymorphism was assessed by PCR-RFLP method. Association analyses were performed using chi-square tests RESULTS: There was no statistically significant difference in the allelic (55.0% vs 49.6% for I, P > 0.05 and 45.0% vs 50.3% for D, P> 0.05) or genotypic frequencies (37.7% vs 37.7% for I/I, P > 0.05 and 27.8% vs 38.3% for D/D, P>0.05) of ACE I/D polymorphism between asthmatic patients and controls. CONCLUSION: Our results do not confirm the association of ACE I/D polymorphism with asthma in Kanpur children.
RESP/17 (O) PROGNOSTIC FACTORS IN CHILDREN WITH PNEUMONIA
Parag Tamhankar, Suman Poddar and SB Bavdekar
Department of Pediatrics, Seth GS Medical College & KEM Hospital, Mumbai
Introduction: Appropriate assessment of severity of pneumonia in children is important to ensure that children with severe pneumonia are cared for in a suitably equipped center. Aims: To identify prognostic factors in children with pneumonia and determine the sensitivity of WHO Guidelines in identifying life-threatening pneumonia. Materials and methods: Consecutive children aged 1mo-
12years hospitalized for pneumonia, were enrolled in this prospective study carried out in a tertiary care center. Pneumonia was diagnosed on the basis of clinical manifestations and radiographic features and classified into four categories according to WHO guidelines. Chi-square test was used to determine the association of age, gender, presence of diarrhea and other co-morbid conditions and poor feeding with severe pneumonia. Results: Ninetythree eligible subjects were enrolled.
Fifty(53.8%) patients were infants while 24(25.8%) were aged 1–5years. Twenty-five subjects developed life-threatening pneumonia, all of whom required artificial ventilation and 20(80%) required inotropic support. Age [1mo-1year (χ
2
=2.788, df=1, P=0.095) or 1–5years(χ2= 1.495, df=1, P=0.221)] and gender (χ 2 =0.005, df=1, P=0.946) were not significant prognostic factors.
Presence of feeding difficulties (χ 2
=16.480, df=1, P=4.92E-05), diarrhea (χ
2
=5.650, df=1, P=0.017), and presence of other co-morbid conditions (χ
2
=5.650, df=1, P=0.017) demonstrated significant association with life-threatening pneumonia. WHO guidelines for diagnosis of pneumonia correctly identified 22(88%) children with severe pneumonia. However, these criteria labeled 4 children with life-threatening pneumonia as “no pneumonia”. Conclusions: Children with feeding difficulties, loose motions and other co-morbid conditions at presentation demonstrated significant association with life-threatening pneumonia. WHO guidelines have a low sensitivity of 88% in diagnosing lifethreatening pneumonia.

RESP/18(O)EFFICACY OF NEBULISED SALBUTAMOL THERAPY IN MANAGEMENT
OF ACUTE BRONCHIOLITIS
Krishna Nikam, Suja Moorthy, Surbhi Rathi, Mukesh Agrawal
Department of Pediatrics , T.N. Medical College & B.Y.L. Nair Hospital.
Introduction: Although widely practiced, the efficacy of nebulized bronchodilators e.g. Salbutamol in treatment of acute bronchiolitis is controversial. Objectives: To evaluate the efficacy of nebulized salbutamol therapy in acute bronchiolitis. Methods: In a double-blind trial, 60 consecutively hospitalized children with moderately severe acute bronchiolitis (2-24 mo) were enrolled and randomly allocated in two groups. Group A (n=31) received three doses of nebulized salbutamol at
20 min interval followed by 3-hrly nebulizations till next 24 hrs. Group B (n=29) received Normal saline nebulizations as Placebo with same frequency. All cases were evaluated periodically from 30 min onwards till achievement of a Pre-defined response, taken as end point of the study. Primary evaluation parameters included sequential changes in a clinical respiratory distress score (CRDS) and SaO
2 changes; while the time required to achieve pre-defined response i.e. Response time was taken as the secondary parameter. Supportive therapy was continued as per regular practice. Results were compared using student t test or Chi-square test as applicable. Results: After initiation of therapy, both groups showed comparable improvement in CRDS from 3 hrs onwards. Earliest individual CRDS parameters to improve were Respiratory rate and appearance, followed by wheeze and lastly use of accessory muscles. In both groups, SaO2 deteriorated during first hr of therapy, before gradual improvement. Response time was marginally but not statistically shorter in placebo group than salbutamol group. Conclusion: Present study concludes that Salbutamol nebulizations have no role in the management of moderately severe bronchiolitis and should be used with discretion.
RESP/19 (P) PULMONARY MANIFESTATIONS OF PEDIATRIC HIV/AIDS
Gangadhara.B.C, Vykuntraju.K.N, Shivananda
Indira Gandhi Institute of Child Health, Bangalore. A Prospective study.
Objectives: To study Pulmonary manifestations of Pediatric HIV/AIDS Methods: 177 children diagnosed with HIV/AIDS are enrolled in this study between September 2004 and August
2006.History, Examination, relevant investigations done and classified according to WHO, CDC,
Immunological stages Results: M: F= 60:40, most common age group is 1-5 years (40 %). Most common pulmonary symptoms are cough and (54.5%), Ear discharge(20%),hurried breathing
25%.Most common clinical signs are tachypnea 36%,retractions in 33%,cyanosis20% , clubbing
18%.chest X ray shows 26% of pneumonia, emphysema and bronchiectasis 2.8% each, Interstitial lung disease 30%.pulmonary TB 13%, Milliary 1%.PCP in 26%.LIP in 2.2%,fungal pneumonia
0.5%. All children weigh less than 50 th
percentile and 96.6% of children less than 50 th
Percentile in their height40% of them are in stage IV of WHO and 31% of them in stage III of WHO. 46% in category B of CDC. Hemoglobin is normal in only 10% of children. Thrombocytopenia in 30% increased ESR in 90%. Mild immuno-suppression is seen in 63.8%. Summary and Conclusion.
Common age group 1-5 years and 60% of them are boys, 97.7% acquired by vertical transmission.
Common pulmonary presentations are recurrent URTI’s, Bacterial pneumonia, ILD, PCP, TB. Rare presentations are LIP, fungal pneumonia,empyema and bronchiectasis Common CXR findings interstitial lung disease. 71% in WHO stage III and IV, 2/3 rd
had normal CD4.

RESP/20 (P) CLINICAL PROFILE AND OUTCOME OF 115 EMPYEMA THORACIS IN
CHILDREN
Abbas Hyderi, Vykuntaraju, Soumya, Shivanada
Senior resident in Pediatrics, IGICH, Bangalore
Background and objectives: Empyema Thoracis, is a collection of pus in the pleural cavity,most of whom complicate underling pneumonia. Management modalities are available, n but the fact remains ideal management is still a gray area and has no consensus yet. Hence, this study conducted to delineate clinical, radiological profiles, redefine course & outcome ,evolving best management strategies. Objective were (1) To study the clinical profile of Empyema Thoracis in children. (2) To assess the therapeutic outcome of Empyema with appropriate medical surgical therapy . Methods:
One hundred and fifteen prospective cases studied in children less than 12 years who were diagnosed Empyema Thoracis during the study period (September-2004 to August 2006 ).
Transudative cases were excluded & cases classified using ‘Modified Lights Classification’ .
Management modalities included Antibiotics ,Tube thoracostomy ,thoracoscopic decortication
,(VATS), Lobectomy ,Pneumonectomy .Data analysed using SPSS 10.0 package,chi-square ,student t test .p<0.05(significant).Results: The commonest age group was age 1- 4yrs , higher in males & lower socioeconomic ,malnourished, anemic. Pneumonia and Otitis media were most commonest pre-disposing factors Fever,cough and breathlessness were commonest complaints whereas commonest organism was staphylococcus aureus. More the LDH greater the severity ,all chronic cases had ph less than 7 Average days of ICD tube insertion was 9 days ,22 days in acute and chronic respectively . ICD in complicated cases averaged 29 days . Average ICD alone
,Thoracotomy were 10 and 20 days respectively .Shortest stay of 7 days in group with
Thoracoscopic debridement . Interpretation and Conclusion: Empyema continues to be a prevalent problem in India. & indiscriminate use of antibiotics has caused resist ant organisms (chronic empyema) Empyema fluid is diagnostic but varies on the stage, severity ,antibiotics .USG is the ideal 1 st
investigation ,though CT is preffered .Starting an antibiotic with staphylocoocus coverage may be prudent .Further,in non loculated ICD is the standard option .Decortication should be considered in multiple septations / loculations or failed primary therapy .Thoracoscopic breaking of loculi would be ideal for Empyema with few loculations.

RESP/21(P)MYSTERIOUS INTERMITTENT LIFE THREATENING STRIDOR:
CONGENITAL NASOPHARYNGEAL TERATOMA AS CULPRIT
Lokesh Kumar Tiwari, Noopur Baijal, Madhulika Sharma, Nirmal Kumar, Jacob M Puliyel.
Department of Pediatrics and Neonatalogy, Otorhynolaryngology, St. Stephens Hospital, Tis
Hazari, Delhi-54
Introduction: Teratomas are very rare congenital neoplasms with incidence of 1 in 40,000 live births. Head and neck teratomas account for less than 5% of the total. We report a rare case of a congenital nasopharyngeal teratoma in a full term female neonate which presented with repeated episodes of apnea and cyanosis. The pedunculated tumour would disappear above the soft palate on direct laryngoscopy. Case Report :A term neonate was transferred to neonatal intensive care unit at one hour of life with an episode of cyanosis and stridor. This settled soon afterwards. Subsequently baby had inspiratory stridor with signs of respiratory distress and intermittent episodes of apnea and cyanosis for that she was electively ventilated. No anatomical abnormality was detected on direct laryngoscopy. Baby was extubated after 12 hours when problem recurred. Direct laryngoscopy was repeated and this time while withdrawing the blade of laryngoscope a tongue like mass of about 2 x
1 cm was visualized hanging down from nasopharynx. Magnetic Resonance Scan done confirmed paramedially located mass compromising the adjoining airway column. Surgical excision was done and histopathological examination was consistent with mature teratoma. She had no further episode of stridor, apnea, cyanosis or respiratory distress and was discharged home on day 6 of life.
Discussion:Although teratoma is a well recognized benign clinical and histopathological entity, but nasopharyngeal teratoma is an unique condition that can be lifethreatening to the neonate due to its mass effect so prompt recognition and management is desirable. In the index case special anatomical location of teratoma made it unique as during laryngoscopy while soft palate was tense it could not be visualised but while the blade was withdrawn palate became softer and mass was seen hanging from nasopharynx.