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New Delhi, India

Agarwal A.,Chacha Nehru Bal Chikitsalaya | Aggarwal A.N.,UCMS and GTB Hospital
Indian Journal of Pediatrics

The pathological invasion of a joint and subsequent inflammation is known as septic arthritis. The knee and hip are the most frequently involved joints. Staphylococcus aureus is the most common cause of septic arthritis in children. An acute onset of illness with an inflamed painful joint and restricted movements and inability to use joint (pseudoparalysis) clinically indicates septic arthritis. The diagnosis is difficult in a neonate or young child where refusal to feed, crying, discomfort during change of diaper (if hip is involved) or attempted joint movement may be the only findings. Fever and other systemic signs may also be absent in neonates. Septic arthritis is diagnosed clinically, supported by appropriate radiological and laboratory investigations. The peripheral blood white cell count is frequently raised with a predominance of polymorphonuclear cells. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often markedly raised. Ultrasonography and MRI are preferred investigations in pediatric septic arthritis. Determination of infecting organism in septic arthritis is the key to the correct antibiotic choice, treatment duration and overall management. Joint aspirate and/or blood culture should be obtained before starting antibiotic treatment. Several effective antibiotic regimes are available for managing septic arthritis in children. Presence of large collections, thick pus, joint loculations and pus evacuating into surrounding soft tissues are main indications for surgical drainage. Joint aspiration can be a practical alternative in case the lesion is diagnosed early, with uncomplicated presentations and superficial joints. © 2015 Dr. K C Chaudhuri Foundation Source

Agarwal A.,CNBC | Agarwal R.,UCMS and GTB Hospital
Education for Health: Change in Learning and Practice

Context: Traditional bonesetting is an art that in the face of urbanization, lack of public attention and lack of modern facilities has survived more than 3,000 years. This article explores the role of bonesetters in the developing world, their successes and failures and possible utilization of their services as part of the healthcare system of a country. Methods: Articles depicting working or techniques of bonesetters or those related to training and education issues of traditional bonesetters, especially in developing countries, were reviewed. The current scenario of healthcare delivery and medical education along with existing socioeconomic conditions prevailing in India were analyzed with generalization of findings to the healthcare delivery systems of other developing countries. Findings: Bonesetting has its strengths and weaknesses. With current socioeconomic conditions and the types of health needs prevailing in developing countries, it would be difficult to abolish traditional bonesetting. These providers have widespread community acceptance and support. Complications can be minimized and practice potentially improved with training and education. Conclusions: Pending infrastructure and socioeconomic development, it appears that traditional bonesetters will remain providers of healthcare. Their methodology utilizes regional resources and is commonly believed to be cheaper and effective. Although the deficiencies of traditional bonesetters have been shown, with adequate training in the basics of orthopaedic care, they can be utilized to provide useful health services at the primary care level. © A Agarwal, R Agarwal, 2010. Source

Patra S.,UCMS and GTB Hospital | Sharma S.,LRS Institute of Tuberculosis and Respiratory Diseases | Behera D.,PGi
Indian Journal of Tuberculosis

Background: Passive smoking and biomass fuel use most probably are more harmful to children than adults for two reasons. The first one is children's respiratory and immune systems are not fully developed. Secondly, they spend more time at home and are, therefore, likely to experience more intense and prolonged smoke exposure. Aims: This study was planned to find out if there is any association between childhood tuberculosis and exposure to passive smoking and biomass fuel. Methods: A hospital-based case control study was done. All registered consecutive newly diagnosed pediatric tuberculosis cases (0-14 years) from the outpatient department of a tertiary care hospital were recruited as cases. Age and sex matched controls were recruited from a public general hospital of the same locality. A semi-structured, pre-coded interview schedule was administered to parents or legal caregivers of all subjects after obtaining informed written consent. Results: A total of 200 cases and 200 controls were recruited in the study period. The factors which were significantly associated with development of tuberculosis were education of the mother, (OR 1.411, 95% CI 0.888-2.243, p-0.001), a family member having tuberculosis in the last two years and residing in the same house (OR 2.797, 95% CI 1.353-5.789; p-0.004), being a passive smoker (OR 1.725, 95% CI 1.142-2.605; p-0.009). No association between biomass cooking fuel use and development of tuberculosis was found. Conclusion: Passive smoking is associated with development of childhood tuberculosis. This requires health education programmes and medical antitobacco advice and services. Source

Agarwal A.,Chacha Nehru Bal Chikitsalaya | Aggarwal A.N.,UCMS and GTB Hospital
Indian Journal of Pediatrics

Acute hematogenous osteomyelitis (AHO) is one of the commonest bone infection in childhood. Staphylococcus aureus is the commonest organism causing AHO. With use of advanced diagnostic methods, fastidious Kingella kingae is increasingly becoming an important organism in etiology of osteoarticular infections in children under the age of 3 y. The diagnosis of AHO is primarily clinical. The main clinical symptom and sign in AHO is pain and tenderness over the affected bone especially in the metaphyseal region. However, in a neonate the clinical presentation may be subtle and misleading. Laboratory and radiological investigations supplement the clinical findings. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are frequently elevated. Ultrasonography and MRI are key imaging modalities for early detection of AHO. Determination of infecting organism in AHO is the key to the correct antibiotic choice, treatment duration and overall management and therefore, organism isolation using blood cultures and site aspiration should be attempted. Several effective antibiotics regimes are available for managing AHO in children. The choice of antibiotic and its duration and mode of delivery requires individualization depending upon severity of infection, causative organism, regional sensitivity patterns, time elapsed between onset of symptoms and child’s presentation and the clinical and laboratory response to the treatment. If pus has been evidenced in the soft tissues or bone region, surgical decompression of abscess is mandatory. © 2015 Dr. K C Chaudhuri Foundation Source

Shekhar S.,UCMS and GTB Hospital | Shah D.,UCMS and GTB Hospital
Indian Pediatrics

This study aimed to assess the sensitivity, specificity, predictive values, and Youden index for mid-upper-arm-circumference cutoff of 115 mm to diagnose severe wasting (as defined by the revised WHO standards) in 346 underweight children aged 6 months to 5 years from an outpatient setting. A cut-off of 115 mm had a better performance (sensitivity 43.2%, specificity 90%, Youden index 0.32) than 110 mm (sensitivity 26.4%, specificity 95.9%, Youden index 0.22) in diagnosing severe wasting. The best performance in terms of a balance between sensitivity and specificity was that of 120 mm (sensitivity 74.4%, specificity 77.8%, Youden index 0.52). Source

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