RESP/01(P) BILATERAL PULMONARY HYDATID CYST IN A CHILD
Ravinder K. Gupta
Department of Pediatrics, Acharya Shri Chander College of Medical Sciences (ASCOMS), Sidhra,
Jammu. (J&K)
drrk_gupta2000@yahoo.com
Case: A 4 year old male child was admitted in our ward with history of recurrent chest infections
and low grade fever for 6 months. The child did not have any history of hemoptysis, ingestion of
foreign body, respiratory distress or cyanosis. There used to be history of sneezing off and on. The
appetite was adequate. As per parents the child was not growing properly when compared with
other sibs. The child belonged to far flung village in border area. The family had big farm, which
included pet animals. The child was first in order born to consangious marriage with uneventful
antenatal and immediate postnatal history. There was no significant history of prolonged cough.
The child was partially immunized. On examination child was conscious, cooperative and well
oriented and average built. The general physical examination did not reveal any thing abnormal
except mold pallor and was having grade II malnutrition as per IAP classification. Systemic
examination did not reveal anything abnormal. The child was subjected to laboratory
investigations. The hemoglobin being 10.5 gm%, TLC – 11,500 /mm3, DLC - P61 L32 E7, AEC –
770/mm3, ESR – 22mm1st hr, PBF – normocytic hypochromic. Urine and stool examination was
within normal limits. Monteux test was negative after 72 hours; RFT and LFT were within normal
limits. Chest skiagram did reveal two large well defined soft density opacities in both paracardiac
regions. No calcification or air filled levels were seen. Apices and costophrenic angles were clear.
Cardiac shadow was normal. The ultrasound abdomen was normal. Liver revealed normal
echopattern and size. CT Scan mediastinum revealed multiple large well defined intra pulmonary
cystic
masses
(AV + 4 – 11HV) in both lower lobes. No septations, solid component or clacification was seen.
Mass lesions were causing displacements of the surrounding bronchovascular structures. Rest
mediastinal structures were normal. Elisa for echinococus was positive. With above radiological
finding and serology a clinical impression of bilateral pulmonary hydatid cystic disease was made.
Besides nutritional rehabilation, the child was put on albendazole (15 mg / Kg) and hematinics and
was advised to come for follow up. Conclusion: Hydatid disease of lungs is not so uncommon an
entity in Pediatric Practice. Once diagnosed need long term follow up. Screening of all children
for hydatid is not feasible.
RESP/02(P) CLINICAL PROFILE OF EMPYEMA THORACIS IN CHILDREN.
Ajit Chhetri, Himesh Barman, Rashna Dass, Pankaj Jain, Dhrubojyoti Sharma, Bhaskar Saikia
Asstt. Professor (Pediatrics), NEIGRIHMS, Mawdiangdiang, Shillong 793018.
drjeetsingh@yahoo.co.in
Introduction: Empyema thoracis is a common disease in children and causes significant morbidity
and mortality. Aims and Objectives: To study the clinical profile of empyema in children. Material
and Methods: Eighteen children with empyema admitted to Pediatrics Department, NEIGRIHMS,
Shillong over one year were studied retrospectively. Results and observation: The mean age of
presentation was 55 months (2yrs to 12 yrs). Two third of the children were under 5. At
presentation, 83 percent had significant symptoms of more than 1 week. Most (66.7%) of the
children had received treatment before admission to our institute. Empirical antibiotics and
intercostal chest tube drainage by resident pediatricians was the mainstay of therapy. The initial
empirical antibiotic mostly constituted of third generation cephalosporin, aminoglycoside and
antistaphylococcal antibiotic. The antibiotics were later revised based on either culture report or
clinical response. The chest tube was inserted on day one in most cases and kept in situ for a mean
of 16.5 (7-36) days. The mean duration of hospital stay was 23 (5-53) days. Organism could be
isolated in only 3 cases. Eight (44.4%) children were diagnosed as tuberculosis with secondary
bacterial infection based on raised pleural fluid ADA and clinical grounds. None of the children
died. Complications encountered were pleural thickening (4), pericardial effusion (5), respiratory
failure (1) and bronchopleural fistula (1).Conclusion: Along with appropriate antibiotic therapy,
chest tube drainage by pediatricians is safe and effective in managing empyema thoracis. High
incidence of tuberculosis is a matter of grave concern.
RESP/03(P) RHINORRHEA IN PEDIATRIC AGE
PRACTICES
J N Goswami
Graded Specialist (Paediatrics),Military Hospital Mhow,MP
jngoswami@rediffmail.com
GROUP
-MANAGEMENT
Introduction:Isolated rhinorrhea is a common symptom in pediatric age group, encountered in
daily practice. Aim: To study management practices of rhinorrhea practiced by primary care
doctors.Material and methods:Children between 1 to 12 years with isolated rhinorrhea, seen at
least once by a general practitioner and brought to pediatric OPD of a military hospital
.Retrospective analysis carried out. Results:50 subjects were studied over a three month period.
Majority were between the age group of 3-6 years.60% were offered some over-the –counter
treatment by parents. 30% patients were diagnosed to have allergic rhinitis, 20% as asthmatic
bronchitis, 2% as pneumonia, 40% as upper respiratory tract infection, 3% as bronchial asthma
.3% were referred to otorhinolaryngologist. 70% patients were advised to undergo hematological
investigations (all results within normal limits), 2% underwent radiological investigations.100%
patients were prescribed antibiotics and the common antibiotics in the order of usage included
amoxicillin,roxithromycin, erythromycin, ciprofloxacin, and cotrimoxazole. None were advised
admission.30% were advised oral ronchodilators and 90% were prescribed anti histaminics. No
parent had been explained about the nature of the disease.68% parents were not satisfied with the
treatment Conclusions:(a) Rhinitis in children is often under diagnosed at primary care level. (b)
Antibiotic usagefor the same is rampant.
RESP/04(P) PREVALENCE OF ASTHMA IN SCHOOL CHILDREN EXPOSED TO
BIOMASS FUEL – RURAL AND URBAN AREAS OF AJMER
Sidharth.S, Ramakant. D., Kalpana D.
Samarpan Child Clinic & Department of Respiratory Medicine, J L N Medical College, Ajmer
dr_sidharth@rediffmail.com
Aim: To study exposure to smoke of biomass fuel as a risk factor for development of asthma in
children from urban and rural areas of Ajmer district. 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 assess the prevalence rate
of asthma modified questionnaire was adopted. PEFR was also noted in all the children. Results:
The number of children exposed to biomass fuel in urban areas of Ajmer was 278 (6.1%.) The
prevalence of asthma symptoms in children exposed to biomass fuel was found to be 8 (4.3%).
The number of male asthmatic exposed to biomass fuel was 2 (2.7%) and females 6 (2.8%).
In
Rural areas 1177 children (48.7%) were exposed to biomass fuel. Out these 349 (28%) were males
and 828 (71%) females. A total of 71 children (6.03%) were found to asthmatic. Asthma was
found in 5 male children (1.4%) and 66 females (7.9%). Conclusions: Exposure to smoke of
biomass fuel could be significant risk factor in female children of rural areas as they were
involved in cooking using biomass fuel. Exposure to smoke of biomass fuel was not a significant
risk factor in urban area as in most of the homes LPG is used for working
RESP/05(P) COMPARISON BETWEEN PREVALENCE RATE OF ASTHMA IN
CHILDREN HAVING ALLERGIC CONDITION AND IN CHILDREN HAVING NO
ALLERGIC CONDITION IN RURAL AND URBAN AREAS OF AJMER
Sidharth.S, Kalpana D.,Ramakant.D.,
dr_sidharth@rediffmail.com
Aim: To compare the prevalence rate of asthma in children with allergic conditions and children
with no allergic conditions in rural and urban areas of Ajmer. 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 assess the prevalence rate
of asthma modified questionnaire was adopted. PEFR was also noted in all the children.
Observations: In urban male children, 81 (4.5%) had allergic conjunctivitis, 90 (5%) allergic
rhinitis, 29 (1.6%) eczema and 4 (0.2%) had food and other allergies. In female children 163
(5.9%) had allergic conjunctivitis 184 (6.7%) allergic rhinitis, 86 (3.1%) eczema and 8 (0.3) had
food allergy. The total number of children having asthma was 168 (26%) out of which 55 were
males (27%) and 113 females (25%) Thus the prevalence rate of asthma is almost same in male
and female children. In rural area in male children 8 (0.6%) had allergic conjunctivitis, 31 (2.48%)
allergic rhinitis and 13 (1.04%) had eczema. In female children 12 (1.02%) had allergic
conjunctivitis, 53 (4.5%) allergic rhinitis and 6 (0.5%) had eczema. Out of which, the number of
male children having asthma was 21 (40.03%) and 34 (47.8%) females. As compared to males the
prevalence of asthma was higher in female children. Results: In Urban areas over all rate was
higher in children having allergic conditions (26%) as compared to children not having allergic
condition (0.8%). In Rural areas The prevalence of asthma in children with allergic conditions
(44.7%)was significantly higher as compared to the children with no allergy (1.2%). Conclusion:
Prevalence rate of asthma was higher in both urban and rural areas of children with allergic
conditions. Thus allergy is an important risk factor in development of asthma in children of both
urban and rural areas of Ajmer.
RESP/06(O) PHARMACOKINETICS AND TOLERABILITY OF A NOVEL
SUBMICRON PARTICLE FORMULATION OF BUDESONIDE FOR NEBULIZED
DELIVERY IN ASTHMA
S.B. Shrewsbury, A.P. Bosco, P. Uster
MAP Pharmaceuticals Inc, Mountain View, California, USA.
sshrewsbury@mappharma.com
Rationale: Budesonide delivery by nebulization is popular but problematic. Lengthy treatment
time, poor cooperation in young children, device inefficiency and concerns about systemic effects
have been considered in the development of a novel submicron particle budesonide suspension.
Methods: 16 healthy adult volunteers (8M, 8F) randomized, to double blind, active controlled, 4
period, 4 way crossover study. Three doses of Unit Dose Budesonide (UDB; 0.24, 0.12 and
0.06mg/2mL) compared to Pulmicort Respules (PR; 0.25mg/2 mL). Spirometry, vital signs,
oximetry and adverse events (AEs) monitored for 8 hrs. Blood collected pre and post 8 hrs dosing
for PK. Results: All 4 treatments well tolerated; no drug related AEs, no significant change in vital
signs, oximetry and no bronchospasm. Three females had low, fluctuating hemoglobin unrelated
to study drug with no other lab abnormality reported. One subject failed to receive a 0.06mg dose
of UDB due to equipment failure. Conclusions: UDB is safe and well tolerated in healthy adults.
Tmax was faster for all UDB doses with greater C max at the equivalent label dose. UDB is now in a
Phase 2 clinical program in 1-18 yr old asthmatic children to confirm efficacy and safety.
Cmax
(pg/mL)
Tmax
(min)
AUC0-8
(pg.min/mL)
AUC0-inf
(pg.min/mL)
t1/2
(min)
PR 0.25mg
Mean
303.5
9.063
29040
31480
145.4
UDB 0.06mg
Mean
106.2
4.467
3978
4391
73.02
UDB 0.12mg
Mean
239.9
3.125
8626
7842
78.35
UDB 0.24mg
Mean
434.5
3.688
22130
25290
140.0
RESP/07(O) PHARMACOKINETICS OF A NOVEL SUBMICRON PARTICLE
FORMULATION OF BUDESONIDE FOR NEBULIZED DELIVERY IN ASTHMATIC
CHILDREN
Shrewsbury SB, Siddiqui S
MAP Pharmaceuticals Inc, Mountain View, California, USA
sshrewsbury@mappharma.com
Rationale: This double-blind, placebo-controlled study was conducted to investigate efficacy,
tolerability and PK over 6 weeks of twice-daily dosing with either 0.25mg, 0.135mg Unit Dose
Budesonide (UDB, a novel submicron, particle formulation of budesonide) or placebo in asthmatic
children and adolescents aged 1-18 years. Methods: Stable, symptomatic asthmatic patients were
enrolled into a 28 day run in. PK collections were obtained in subsets of 4-7 and 8-18 year olds at
first dose and after 6 weeks dosing. Bioanalysis by validated LC/MS-MS of 24 actively-treated
subjects in each treatment arm at each dose was conducted. Results: PK samples collected from 3
and 13 subjects aged 4-7 and 8-18 years at both visits after dosing with UDB 0.135mg and 3 and 6
patients on both visits on UDB 0.25mg. PK parameters showed an unanticipated increase in
absorption over time Cmax increasing from 214.4 to 672.1pg/mL (for 15 children on 0.135mg
between first dose and day 42) and 320.7 (n=10) to 745.9 (n=8) pg/mL for the 0.25mg dose. The
AUC0-inf also increased from 10,238 to 22,071 min*pg/mL and 11,128 to 26,206 min*pg/mL
respectively for the two doses, without accumulation (predose levels BLQ for majority of subjects
at day 42). Conclusions: UDB showed increased absorption (Cmax ~ 2.3 to 3.1 fold greater; AUC ~
1.6 to 2.8 fold greater) between first dose and day 42 in asthmatic children and adolescents aged 418 years.
RESP/08(O) EFFICACY AND SAFETY OF A NOVEL SUBMICRON PARTICLE
FORMULATION OF BUDESONIDE FOR NEBULIZED DELIVERY IN ASTHMATIC
CHILDREN
Shrewsbury SB, Siddiqui S
MAP Pharmaceuticals Inc, Mountain View, California, USA
sshrewsbury@mappharma.com
Rationale: This double- blind, placebo-controlled study investigated efficacy, tolerability and PK
over 6 weeks of twice-daily dosing in asthmatic children and adolescents aged 1-18 years with a
submicron budesonide particle suspension (UDB). Methods: Stable, symptomatic asthmatics were
enrolled into a 28 day run-in during which cough, wheeze, breathlessness (scale 0-3) and peak
flow (PEF) (if able) were recorded. Subjects with a minimum total symptom score (SS) of 4 in the
last 5 days were evenly randomized to one of 3 double-blind treatments, dosed under supervision
and followed for 6 weeks with spirometry (on days 0, 14, 28 and 42), twice-daily SS and PEF.
Results: 208 children/adolescents randomized, 204 treated: UDB 0.25mg (68), UDB 0.135mg (67)
or placebo (69). Discontinuation rates: 17.4%, 14.3%, 34.8% respectively (from asthma
deterioration: 10.1%, 2.9%, 15.9% respectively). Total baseline nighttime SS similar between
groups: 2.7, 2.4, 2.4 and improved by adjusted means of 0.5, 1.3 (p=0.002) and 0.5 respectively.
Daytime SS improvements: 0.7, 1.5, 0.7. FEV1 in a subset with baseline <80% predicted and ≥
12% reversibility improved by: 6.2%, 6.7%, 2.3% respectively. UDB was well-tolerated with no
SAEs on treatment. At least one AE was reported by 50.7%, 32.8%, 55.1% respectively. Morning
serum cortisols rose by an adjusted mean of 0.2, 1.1, 0.5g/dL respectively. Conclusions: UDB is
safe and well-tolerated in asthmatic children and adolescents with statistically significant
improvements in nighttime and daytime symptoms at the 0.135mg dose.
RESP/09(P) UNUSUAL ROENTGENOGRAPHIC PRESENTATION OF A CONGENITAL
CYSTIC MALFORMATION OF THE LUNG: CASE REPORT
Karuna Thapar, Naresh Jindal
Department Of Paediatrics, Government Medical College & Hospital Amritsar
kthapar2000@yahoo.com
Congenital cystic adenomatoid malformation (CCAM) of the lung is an uncommon fetal
development anomaly of the terminal respiratory structures. Several patterns of clinical
presentation have been observed: (i) still birth or neonatal death frequently associated with fetal
hydrops, (ii) acute progressive respiratory distress in a newborn, (iii) an indolent course
characterized by recurrent pulmonary infections, (iv) rarely pneumothorax. We describe here an
infant with few lung cysts in right lower lobe and hyperinflation of adjacent lung tissue. Case
report: We report a case of CCAM presenting as multiple cysts in the right lower pulmonary lobe
with adjacent emphysema in a 7 months old female. She presented to us for persistent cough and
breathing difficulty. Chest radiograph showed hyper-inflated lung with mediastinal shift and
multiple cysts in right lower lobe of lung. Computed tomographic scan confirmed the
intrapulmonary localization of cysts and a diagnosis of CCAM was made. Child was referred to
cardiovascular and thoracic surgery unit for surgical management. Conclusion: The combination
of cysts and ectatic emphysema suggests bronchial collapse and airway obstruction as a
contributory mechanism for this unusual roentgenographic presentation of a congenital cystic
malformation of the lung.
RESP/10(P) AN UNUSUAL FOREIGN BODY ASPIRATION IN A 2 MONTH OLD
CHILD
Rashmi Patnaik, Suresh Panda, Bimal Padhi, Renuka Mohanty
Dept of Pediatrics,Hi-Tech Medical College, Bhubaneswar
drrajib2007@rediffmail.com
A 2 month old female child of lower socioeconomic status family was admitted to the
paediatric department of Hitech Medical College and hospital with complaints of
respiratory distress for 7 days. Prior to admission she was treated with antibiotics and
bronchodilators but in vain. On examination the child was dyspnoeic with respiratory rate
74/min, nasal flaring, intercostals recession, subcostal indrawing with inspiratory grunting
without cyanosis. On auscultation there was bilateral vesicular breath sound with coarse
crepitations. Chest x-ray revealed a radiopaque object in larynx and blood count was on
higher side of normal. The object was removed under direct laryngoscopy after sedation.
The distress was decreased .She was given antibiotic and a short course steroid and was
discharged after 5 days. Retrospectively, it was discovered that child aspirated an earring
which was given to him by his elder sister who is 3 yrs old without the knowledge of
the mother.
RESP/11(P) CORRELATION OF ANTHROPOMETRIC PARAMETERS WITH PFT IN
BRONCHIAL ASTHMA
Meena Singh, A Raina, A Garg, V.Agarwal,
1/210, S. C. Sarkar Road, Professor’s Colony, Hari Parvat, Agra 282002
Objective : To evaluate the changes in PFT in bronchial asthma and its correlation with various
physical parameters. Introduction : The normal physiological values for lung functions are not
uniform amongst the different races or sex and even the different age group. The present study
was therefore designed to determine the correlation of various physical parameter that are weight,
height, chest circumference, body surface area with PFT in bronchial asthma. Methodology: The
study was conducted in the department of Pediatrics & department of Physiology, S.N.Medical
College, Agra. Multistage systemic sampling technique was used for selection of sample. The
study material comprised of 50 asthmatic children of either sex from 6-12 years of age. All the
patient were thoroughly evaluated on the basis of detailed history, physical examination and
laboratory investigation including radiological examination. Selection of cases was based on
clinical diagnosis of bronchial asthma spirometry testing was done in all the cases. A precalibrated computerized spirometer named as Medspiror was used and the lung volumes
(FVC,FEV 0.5, FEF1 & FEV3) and flow rates (PEFR,FEF 25-75%,FEF25% & FEF75%) were assessed
in all the cases and correlated with age and anthropometric measurements. Results : Increase in
lung volumes and flow rate with weight was statistically significant (p<0.05) except for FEV0.5,
PEFR, FEF 25-75%, FEF 0.2-1.2, FEF25%, FEF50%,FEF75%,in female children and FEF 25-75% in male
children (p>0.05). A statistically positive correlation between height of all the children with the
lung volumes and flow rates was observed (p<0.001) except for FEV0.5,FEF25-75%,FEF50%,FEF75%
in female children and FEF 25-75% in male children (>0.05). A statistically significant positive
correlation (p<0.001) of lung volume and flow rate to chest circumference was noted in males
except for mean value of FEF25-75% and FEF50%. The lung volume and flow rates were statistically
significant (p<0.01) with body surface area except for FEF 25-75%,FEF0.2-1.2 in male children and
FEV0.5,PEFR,FEF25-75%,FEF0.2-1.2, FEF25%FEF50%,FEF75% in female children. So a statistical
significant positive correlation of all the physical parameter with the lung volumes and flow rates
in both male as well as female children were observed in the study (p<0.001). Among the lung
volumes and flow rates FEV3 was highly correlated with all the physical parameter and FEF 25-75%
showed the least positive correlation with all the physical parameter when compared to other flow
rates and volumes. Conclusion: All the lung volumes and flow rates in anthropometric
measurements.
RESP/12(P) COMPARISON OF PULMONARY FUNCTION TESTS IN NORMAL
VERSUS ASTHMATIC CHILDREN.
Meena Singh, A.Raina, A.Garg, V.Agarwal
1/210, S. C. Sarkar Road, Professor’s Colony, Hari Parvat, Agra 282002
Objective : To compare the pulmonary function tests in normal versus asthmatic children.
Introduction : Pulmonary function test (PFT) is an important mean based on non-invasive
technique to assess the respiratory functions. These tests are important for initial evaluation,
planning therapy and predicting prognosis in asthmatic children. Methodology: The study was
conducted in the department of Pediatrics, S.N.Medical College, Agra. Multistage systematic
sampling technique was used for selection of sample. The study material comprised of 100
children of either sex from 6-12 years of age which included 50 normal and 50 asthmatic children.
All the patients were evaluated with detailed history, thorough physical examination and
laboratory investigation including chest radiography. Selection of controls was based on criteria
as recommended by Snow bird workshop and Gap conference (1978). Selection of cases was
based on clinical diagnosis of bronchial asthma. A pre-calibrated computerized spirometer named
as Medspiror was used and the lung volumes (FVC, FEV 0.5, FEV1 & FEV3) and flow rates
(PEFR, FEF 25-75%, FEF25% & FEF75%) were assed in all the cases. Results : The lung volumes
were statistically reduced in asthmatic children when compared to normal children (p<0.001),
mean value of FEV 0.5 & FEV1 were significantly reduced in asthmatic children as compared to
normal children. FEF 0.5/FVC & FEV1/FVC ratio were significantly reduced in asthmatic
children. In the mean values of flow rates statistically significant correlation was observed
(p<0.001), mean values of PEFR & FEF25% were significantly reduced in asthmatic children as
compared to normal children. Conclusion: FEV1, though a sensitive indicator is not specific for
bronchial asthma where as FEV1/FVC ratio was sensitive as well as specific for asthma.
RESP/13(O) EFFICACY AND SAFETY OF LEVODROPROPIZINE IN CHILDREN 6-12
YEARS OF AGE WITH NON-PRODUCTIVE COUGH
Parveen Mittal, Mohinder Singh, Deepak, Neha Garg
37,KHALSA COLLEGE COLONY, PATIALA – 147001
doc_parveen@yahoo.co.in
INTRODUCTION : A wide variety of antitussive drugs are now available and most of them
having central mechanism of action with resultant side effects. Levodropropizine, the levo isomer
of dropropizine, is a nonopiod effective antitussive agent with peripheral mechanism of action
without CNS side effects AIMS AND OBJECTIVES:To study efficacy and safety of
Levodropropizine in children aged 6 to 12 years. MATERIALS AND METHODS: . Efficacy
and tolerability of Levoproprizine syrup administered in children (6-12 year) having
nonproductive cough was evaluated.Cases and Controls : 50 children aged 6-12 years, both
sexes, having nonproductive cough of various etiologies, frequencies and intensities were
included in this study as cases. 50 age and sex matched children with similar illness, who
were given placebo, were taken as controls.Patients with severe respiratory failure,
tuberculosis, asthma, patients with impaired cardiac, renal or hepatic functions and patients
2 agonists, anti histamines and
steroids were excluded from the study.Treatment : Levodropropizine (Syrup Rapitus, 0.6%)
was administered orally at the doses of 2mg/Kg/dose, 3 times a day for total 5 days. Controls
were given placebo.Efficacy evaluation : Cough frequency, cough intensity and night time
awaking were recorded before and 2 days after starting the treatment (on day 3 rd ) in both
groups).Cough frequency classes were defined as mild (<5 cough spells/hr), moderate (5 -10
cough spells/hr), Severe (11-20 spells/hr) and very severe (>20 spells/hr). Cough intensit y
was scored as mild (Cough with no strain and no noise), moderate (with moderate strain and
no noise) and severe (with much strain and noise).Tolerability evaluation : It was assessed
by any adverse event occurring during the study observed directly or reported by parents
with particular attention to drowsiness.RESULT:Most frequent pathologies in both groups
were upper and lower respiratory tract disorders including acute pharyngitis, laryngitis,
chronic sinusitis pneumonia etc.There was significant difference between two groups (cases
and controls) in relation to reduction of cough frequency (Cases; 43 out of 50, 86%. Controls
; 7 out of 50, 14% and P<0.001), cough intensity (Cases; 41 out of 50, 82%. Controls ; 6 out
of 50, 12% and P<0.001) and night time awaking (Cases; 45 out of 50, 90%). Controls; 9 out
of 50, 18% and P<0.001).On the other hand, on average cough frequency (spells/hr) reduced
by 67% and night-time awaking reduced by 88%.Drowsiness was complaint only by 2
patients (4%), which was not significant (P>.05).CONCLUSION:Results obtained in this
study confirm the antitussive efficacy as well as tolerability of Levodropropizine in children
aged 6-12 years having non-productive cough.
RESP/14(P) PULMONARY ALVEOLAR MICROLITHIASIS
Manisha Mukhija, Shobha Sharma
Lilavati Hospital and Research Centre, Bandra, Mumbai
manishamukhija@yahoo.com
Introduction: In India an X-ray chest showing multiple bilateral infiltrates with a miliary pattern,
along with complaints of breathlessness and cough often results in a diagnosis of miliary
tuberculosis and treatment for the same. However the diagnosis may actually be something else as
illustrated in this case report. A 15 years old boy presented with complaints of cough and
breathlessness, which were progressively increasing since four years. X-ray chest showed bilateral
small infiltrates with a micronodular pattern. AKT was started and continued for two years as
there was no improvement. At the end of two years patient underwent investigations again
including an X-ray chest which showed the same miliary pattern and a sputum AFB which was
negative, hence a further couse of AKT was given without any improvement in the symptoms or
the radiological picture. At the end of 4 years patient had persistent dry cough with occasional
mucoid expectoration and dyspnea at rest. His X-ray chest continued to show the same
micronodular infiltrates. Mantoux test and sputum AFB were negative. CT-chest showed evidence
of extreme septal thickening and calcification throughout the lung fields, bilateral bulky hilae
without lymphadenopathy or cavitation. Serum IgE and ACE levels were elevated. Hence a
diagnosis of Pulmonary Alveolar Microlithiasis secondary to sarcoidosis was made. Patient was
started on oral and inhaled steroids and showed marginal improvement in symptoms. After 6
months Etidronate-sodium was also added with some improvement. Thus all miliary lesions on an
X-ray chest may not be because of miliary tuberculosis.
RESP/15(O) ANTIBIOTIC PRESCRIPTION PATTERNS FOR CHILDREN WITH
UPPER RESPIRATORY TRACT INFECTIONS OR DIARRHEA
Miti Maniar, Ira Shah, Sudha Rao
Department of Pediatrics, B.J.Wadia Hospital for Children, Parel, Mumbai- 400 012.
irashah@pediatriconcall.com
AIM: To determine the antibiotic prescription pattern for children suffering with Upper respiratory
tract infections (URTI) or diarrhea STUDY DESIGN: A cross sectional study of prospectively
collected data. SETTING: Pediatric outpatient department (OPD) at B.J. Wadia Children’s
Hospital, Mumbai. METHODS AND MATERIALS: 140 children under 15 years of age suffering
from with URTI and/or diarrhea who visited the OPD over a period of one month were enrolled
for the study. URTI was classified into nasopharyngitis, pharyngitis and/or tonsillitis and patients
with diarrhea were classified into those suffering from acute diarrhea, dysentery and chronic
diarrhea based on the clinical signs and symptoms. The prescriptions were noted. The presumed
diagnosis and the antibiotics prescribed along with duration, dosage and dosage schedule were
analyzed. RESULTS: Patients with Nasopharyngitis were 75(54%), with Pharyngitis were
12(8.6%), with Tonsillitis were 7(5%), with Acute diarrhea were 31(22.4%), with Dysentery were
8(5.7%) and with Chronic diarrhea were 6(4.3%). URTI (55.3%) was more common in the age
group of 1-5 years and diarrhea (55.3%) was seen more in the age group of < 1 year [p value =
0.036]. 44(31%) patients received antibiotics of which 5 (11.3%) patients received combination
antibiotics. 18(24%) patients with nasopharyngitis, 2(16%) patients with pharyngitis, 7(100%)
patients with tonsillitis, 7(22.5%) patients with acute diarrhea, 5(62.5%) patients with dysentery
and 5(83%) patients with chronic diarrhea received antibiotics (p value=0.014). Amoxicillin
(33%) and macrolides (44%) are preferred for nasopharyngitis and only macrolides are used for
pharyngitis (100%), while cefixime is used predominantly for acute diarrhea (29%) and
dysentery(40%) where as Metronidazole (60%) is the preferred antibiotic for chronic diarrhea (p
value=0.014). Common combinations of antibiotics used are norfloxacin + metronidazole in 3
patients, ofloxacin + ornidazole and cefixime + metronidazole in 1 patient each. All five (11%)
combination antibiotics prescriptions were for diarrhea and no combinations were given for URTI
[p value = 0.003]. From 110 children having symptoms < 1week, only 30 (27%) were given
antibiotics while out of 29 children having symptoms for > 1week, 14 (48%) were given
antibiotics (p value=0.031). CONCLUSION: Antibiotic prescriptions were judicious and seen in
31% of children with URTI and diarrhea. However use of antibiotics in nasopharyngitis should be
minimized. Also use of combination antibiotics especially in children with diarrhea should be
discouraged.
RESP/16(O) CALCIUM METABOLISM IN BRONCHIOLITIS-A PROSPECTIVE CASECONTROL STUDY
Nirmal Kumar, Suman Lata, Noopur Baijal, Mohit Sahani, V. Srineevas
4, Rajpur Road, Qtr No. B-2, Tis-Hazari, Delhi-54
nsk9_2000@yahoo.com
Introduction: Vitamin D deficiency is associated with immunological and neutrophil function
defect and associated with lower respiratory tract infection. Bronchilolitis is one of the common
cause of lower respiratory tract infection in infants. Vitamin D is important for calcium
metabolism, it’s estimation is costly and it is not easily available laboratory test. Calcium,
phosphorus and alkaline phosphatase levels are primarily related to vitamin D. Aims To see the
association of calcium metabolism in Bronchiolitis infants. Material and Methods: A case control
prospective study for two consecutive year (October to April) in hospital admitted infants ( 12
months). The serum levels of Calcium, Phosphorus, Alkaline phosphatase and albumin measured
in all admitted infants (after consent of parent) irrespective of disease and comparison was done
between two groups i.e. Bronchiolitis Vs Non-Bronchiolitis groups. Results: Bronchiolitis
comprises 30% of total admitted infants during above mentioned period. Total number of infants
included in study was 446.Comparing Bronchiolitis (n = 223) Vs Non- Bronchiolitis group (n =
223) group. Mean Calcium in Bronchiolitis was 8.70 mg/dl and in control 9.09 mg/dl, P valule
0.037 and mean difference 0.29 (95% CI – 0.008 to 0.21) statistically significant.Comparing
Calcium, phosphorus, alkaline phosphatase and albumin in two age group i.e.  6 month and > 6
months. It was observed that below 6 months of age, there was no statistical significant difference
between Bronchiolitis and Non-Bronchiolitis group for serum calcium, phosphorus, alkaline
phosphatase and albumin. Above 6 month of Age mean calcium and phosphorus was 9.01 mg/dl
and 5.25 mg/dl in control, 8.25 mg and 4.72 mg/dl in Bronchiolitis group. P-value for Calcium
was 0.03 and 0.003 for phosphorus, statistically significant.3 Exposure to sunlight. Mean Calcium
in control was 8.83 mg/dl (not exposed) and 9.36 mg/dl (exposed) P-value 0.007, whereas in
Bronchiolitis there was no difference.Conclusion: Calcium and phosphorus is low in Bronchilitis
infants above 6 month of age. Infants needs calcium and Vitamin D supplementation before 6
month of age.
RESP/17(P) TRACHEAL ATRESIA- A CASE REPORT
Jayashankar Kaushik, Deepika Harit, MMA Faridi
Department of Pediatrics, UCMS and GTB hospital, Delhi-110095
deepikaharit@yahoo.com
Agenesis, aplasia or atresia of the trachea is a rare congenital anomaly that is almost always fatal
and most of the infants die within 24 hours of birth. Tracheal atresia is a congenital absence of a
normal passage that does not imply a particular length of involvement. Tracheal atresia
encompasses cases of agenesis (total absence of trachea) as well as varying lengths of tracheal
mal-development. We report here a case who had tracheal agenesis. A female baby born at 41
weeks of POG to an unbooked primigravida by LSCS was born vigorous but had very weak cry.
Baby had no gross congenital anomaly or dysmorphism. At about 1 and a half minute after birth
suddenly baby developed central cyanosis and started gasping and required IPPV with 100%
oxygen for 2 mins of IPPV, after which she had spontaneous regular respiration, no cyanosis but
with severe respiratory distress. At 20 min of life baby again started gasping. IPPV was given
initially with bag and mask and subsequently endotracheal intubation attempted. ET tube could
not be passed beyond vocal cords. Bag and mask ventilation was continued. Urgent dye study was
done which revealed no passage of dye beyond larynx, a collapsed right lung and spill over of dye
from esophagus to left bronchus suggesting a fistula. Baby expired at 4 hours of age before any
surgical intervention could be done. Clinical details and contrast study radiographs will be
discussed.
RESP/18(O) AN OBSERVATIONAL STUDY ON RELATIONSHIP BETWEEN ASTHMA
AND OBESITY IN SCHOOL GOING CHILDREN OF AJMER
Kalpana Dixit, Ramakant Dixit, Sidharth Sharma
Samarpan Child Clinic & Department of Respiratory Medicine, J L N Medical College, Ajmer
dr_sidharth@rediffmail.com
Introduction: Epidemiological data indicates a relationship between obesity and asthma. Obesity
has been identified as a risk factor for asthma during early childhood. Aims & objectives:
Whether, the obesity also impacts asthma control and the response to standard asthma
therapeutics, we plan this study. Materials & methods: School going asthmatic children aged 8 to
18 years were enrolled into two study groups- Group (A) asthmatic children with normal BMI;
Group (B) asthmatic children with BMI greater than for their age & sex. Both the groups were
compared on various parameters i.e. asthma severity, asthma control and response to standard
asthma therapy using clinical asthma severity score, asthma control questionnaire score, and
pulmonary function testing etc. Results: Of the 77 school going children with asthma (51 male and
26 female), 46 patients constituted Group A and 31 Group B. The asthma symptoms and
especially the nocturnal cough was significantly more common in Group B patients having higher
BMI; OR 1.50 (95% CI 1.03 to 2.20) (p value 0.035). More than half of these patients (57.1%)
required oral montelukast as add on therapy to standard treatment for asthma control. This
association was more in obese male children than obese female children (p value 0.001). The
FEV1 was also significantly lower in Group B patients than Group A patients; OR 2.04 (95% CI
1.23 to 3.36). Conclusions: The asthma is not only more common among obese children but also
more severe, especially in males. Asthma also appears to be more difficult to control in obese than
lean asthmatic children. Montelukast may be considered for better asthma control in overweight
children. Treatment of such patients should always include a weight control programme.
RESP/19(O) PEAK EXPIRATORY FLOW RATE IN SCHOOLCHILDREN OF
BHUBANESWAR, COMPARISON BETWEEN MALE AND FEMALE CHILDREN.
Jayanti Mishra
Assoc Prof, Physiology, KIMS, Bhubaneswar
jayantimishra@indiatimes.com
Introduction Peak expiratory flow rate (PEFR) has been shown to be very useful in the routine
monitoring of respiratory function. Ventilatory function studies in adult population from different
parts of India are well documented Similar data in children is limited. Information on ventilatory
function among children of Orissa is scantily available in the Indian literature. In the present
study, we evaluated the peak expiratory flow rate (PEFR) in a group of school going children in
Bhubaneswar of Orissa state and compared between male and female children. Subjects and
methods Of 900 children randomly selected from four primary schools of Bhubaneswar, 500 (250
girls and 250 boys) within age range 5-12 years, fulfilled the selection criteria. Peak expiratory
flow rate (PEFR) was recorded in a standing position using a mini-Wright peak flow meter.
Anthropometric measurements, weight, height, head circumference and mid-upper-arm
circumference were recorded and surface area and body mass index were calculated. Mean PEFR
of the male children was compared with that of female children. RESULT. The mean PEFR of the
boys was significantly higher than that for the girls (P < 0.001) There was no significant difference
between the mean age of the boys and girls. Girls were heavier than boys (P < 0.05). The findings
showed PEFR to be significantly related to height P < 0.001. Values are presented as mean ±
standard error of the mean. An unpaired Student t-test was used to test the differences between the
means.