VBR/04. PREDICTORS OF MORTALITY IN DENGUE SHOCK SYNDROME
M. Venkatakrishna, Aarthi Mani
Kanchi Kamakoti Childs Trust Hospital, 12 –A, Nageswara Road, Nungambakkam, Chennai – 34
Aim & Objectives: To identify predictive factors of mortality in DSS. Design: Retrospective case
controle study. Setting: Pediatric tertiary care hospital. Materials & Methods: 149 children with DSS
who were hospitalized and treated during the period jan2000-dec2004 were analysed. Data regarding
bleeding manifestations, Complete Blood Counts, Serum Transaminases PT/PTT and Serum
electrolytes, GCS, duration of illness prior to onset of shock, acidosis, sepsis, treatment prior to
admission, blood component transfusions, Renal Dysfunction, Peritoneal Dialysis, ARDS, pulmonary
edema, MODS and Encephalopathy were analysed Results: The various significant univariate factors
associated with mortality in DSS in our study were Multi organ Dysfunction, Renal Dysfunction, Grade
at admission, Bleeding manifestations, Hepatitis, pulmonary edema, Encephalopathy, and Acidosis.
Age, Gender, duration of illness before onset of shock, treatment received prior to admission, complete
blood counts, abnormal PT / PTT, Presence of sepsis, transfusions or comorbid conditions were not
found to be of significance on univariate regression model. On multiple regression analysis the
following parameters were found to be statistically significant (1) Major bleeding manifestations (2)
Grading 4 at admission and (3) Encephalopathy. Conclusions: The presence of major bleeding
manifestations (hematemesis, malena, Intracranial bleed) grade 4 DHF and encephalopathy are the
important predictors of mortality in DSS. Presence of MODS, renal dysfunction, pulmonary edema,
severe hepatitis and acidosis can adversely affect the outcome of the children with DSS. Our findings
reemphasize the need for early recognition and treatment of DSS for a better outcome.
VBR/07. ORODENTAL HEALTH IN CHILDREN WITH ASTHMA AND THE EFFECTS OF
PHARMACOTHERAPY
Raghvendra Singh
Department of Pediatrics, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat
Singh Marg, Delhi
Bronchial asthma is one of the most common chronic respiratory disorder of children. Drugs used by
inhalational route have become the predominant form of drug usage with fewer systemic side effects but
their effects on the oral cavity and dentition is not well defined. Design: hospital based case-control
study. Setting and Methods 260 cases and controls each from asthma clinic and pediatrics OPD.
respectively of Kalawati Saran children’s Hospital and Lady Hardinge Medical College .History and
clinical examination with particular reference to orodental examination and treatment history recorded.
Decayed ,Missing and Filled tooth index (DMF Score) was used to assess the severity of caries in both
cases and controls. Further subset sampling was done for salivary pH and blood and salivary calcium,
fluoride and phosphate levels from cases and controls. Results: The prevalence of caries in cases was
found to be at 53.1% compared to 36.2% in controls, the difference being statistically significant
(p.000). The difference in the prevalence of caries in reference to type of dentition among cases and
controls were found to be significant in primary and mixed dentition age groups. The Mean DFM index
(df+DFM) was estimated at 2.33±2.68 for cases and 1.32±1.79 for controls and difference was
statistically significant ( p 0.000). This increment in the caries with the increasing severity of disease
was found to be statistically significant(p .000). A statistically significant relationship also existed
between the frequency of drugs used and its effect on the distribution of children with caries. The
children receiving higher frequency of drugs when compared in their own groups had a significantly
increased risk of having caries. the salivary and blood parameters of calcium, phosphate and fluoride
ions were compared between the cases and controls ,no statistical difference was observed. Conclusions
: Asthmatic children seem to be at a higher risk for oro-dental problems than their normal counterparts
and possible preventive steps need to be taken at an earlier stage to offset these problems.
Pharmacotherapy seems to play a central role in this increased risk
VBR/08. DEVELOPMENTAL PROFILE IN CHILDREN IN IRON DEFICIENCY ANEMIA
AND ITS CHANGES AFTER THERAPEUTIC IRON SUPPLEMENTATION
Saurabh Kumar Gupta, Deepak Bansal
C/o D. Bansal, Assistant Professor, Dept. of Pediatrics, Advance Pediatric Center, Postgraduate Institute
of Medical Education and Research, Chandigarh 160012
Introduction: Iron deficiency anemia (IDA), by far the commonest nutritional disorder in the world, has
been postulated to have deleterious effects on body physiology, particularly the CNS. Detrimental
effects on brain maturation resulting in suboptimal development and behaviour are the feared adverse
effects of this widely prevalent disorder. Objectives: To evaluate the developmental profile of children
with iron deficiency anemia and the changes following therapeutic iron supplementation. Design:
Prospective cohort study. Setting: Tertiary care teaching institution. Subjects: Children, 6 months to 5
years of age, with iron deficiency anemia proven by hematological parameters and iron studies.
Methods: Complete blood counts and iron studies (serum iron. Serum ferritin, total iron binding
capacity) were performed at the beginning and after 3 months therapy with iron. Simultaneously
development was assessed by DP II, which was interpreted using IQ equivalent (IQE) scores and
fractional months differential (FMD). Results: Thirty-five children fulfilled predetermined inclusion
criteria. The mean age was 22.3±13.4 months. Majority i.e. 25 (71.4%) had moderate anemia, while 5
(14.3%) each had mild and severe anemia. Significant developmental delay was observed in iron
deficient children. Maximum delay was observed in academic and communication domains. Six
(17.2%) failed developmental screening, with IQE scores of less than 70. Significant improvement in
DP II scores was noticed following therapy. Although some gain in IQE scores was noticed in the
Interpretation of DP II by fractional months differential (FMD) revealed significant improvement in all
the domains as well. Conclusions: Children with iron deficiency anemia have suboptimal developmental
scores. The delayed development is variably reversible after oral iron therapy. Hb <7 g/dl and age > 24
months predicts suboptimal outcome. Fractional months differential (FMD) is a useful method of
interpreting DP II.
VBR/09. TREATING CHILDHOOD TUBERCULOSIS- HOW DOES INTERMITTENT
THERAPY COMPARE WITH THE DAILY THERAPY?
Ilin Kinimi
B-6/99, Safdarjang Enclave, New Delhi
Background: The treatment strategy for TB has undergone a major change all over the World. India has
effected major changes in the treatment policy and Directly Observed Treatment Short course(DOTS)
regime under the Revised National Tuberculsis Control Program (RNTCP) is the current standard for all
forms of tuberculosis at all ages. It involves standard diagnosis and categorization of patients,
intermittent therapy under observation and assured drug supply. However, there are no controlled trials
comparing the intermittent therapy as used under the program with conventional daily regimes for
childhood TB. To fulfill this need, the present study was conducted to compare: (a) the efficacy and
safety of intermittent regimen with daily regime using similar drug combinations, and (b) the efficiency
of the unsupervised daily treatment with the supervised intermittent treatment (DOTS) among children.
Methods: A total of 247 children with previously untreated TB (all forms) were studied. The children
were allocated into 2 regimes – Daily unsupervised (n=124) and intermittent DOTS (n=123),
Categorization of the disease and drug regimen prescribed was as per the RNTCP-IAP consensus
guidelines. Results: Two hundred ten (86.6%) patients completed treatment and were cured while 31
(12.6%) patients defaulted, 4 (1.6%) failed and 2 (0.8%) patients expired during the course of the
treatment. In this study, Pulmonary involvement was commonest followed by Lymph node disease.
The mean age of the patients was 6.42 yrs in the Daily group and 9.64 yrs in the DOTS group. The
intermittent treatment was found to be as efficacious as the daily therapy (94% (95/99 vs 100%
(115/115) efficacy – Daily vs DOTS group, P>0.05). Extension of treatment was required in 18 (7.2%)
cases. Hepatotoxicity was noted in 2 (1.6%) of the patients in the daily group. The supervision and
defaulter retrieval mechanisms in DOT group led to a better efficiency as compared to the unsupervised
therapy (Treatment success rate 93.5% vs 76.6%, p<0.001). Conclusion: Intermittent drug therapy in
childhood TB is as efficacious as the conventional daily treatment. The treatment outcomes are further
improved by DOTS strategy.