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Objective:This study aimed to estimate placental weight (EPW) antenatally in the third trimester and to evaluate its role in predicting adverse fetal outcome. Study Design:A total of 190 antenatal women from 28 to 40 weeks of gestation, expected to deliver within 72 hours of examination, were included. The placental length, breadth, thickness, and estimated fetal weight (EFW) were noted in ultrasound. After delivery, the placental dimensions, including fetal weight, were recorded. The fetal outcome was noted. Multivariate regression was used for antenatal EPW calculation, and its correlation with actual placental weight (APW) was done. Results:The mean age of women was 27.9 ± 3.9 years. The mean estimated and actual placental lengths at term were 15.0 ± 2.69 cm (range 9-22.8 cm) and 14.4 ± 2.70 cm (range 8-21.2 cm). The Spearman coefficient of correlation (ρ) between all placental dimensions was found to be statistically significant (p = 0.001); the best correlation was observed between EPW and APW (ρ = 0.840). The centile chart of placental weight was drawn using multivariate regression analysis. The EPW and placental length was significantly less at all gestations in cases with adverse fetal outcome compared with normal outcome; however, the area under curve (AUC) for EPW at 30 to 34 weeks was the best (p = 960), taking the EPW cut-off of 345 g; the sensitivity and specificity of predicting adverse fetal outcome were 80 and 100%, respectively. Conclusion:To the best of our knowledge, it is the first study to attempt antenatal estimation of placental weight, and has shown it to be valuable in predicting adverse fetal outcome. Key Points:· Novel study to attempt antenatal estimation of placental weight.. · Third trimester assessment of placental weight was done with good accuracy.. · Placental weight had good accuracy in predicting adverse fetal outcome..
Background: Pneumocystis jirovecii causes a potentially fatal interstitial pneumonia, especially in immunosuppressed hosts. It was the most common cause of death in children with leukaemia, before the introduction of prophylaxis. Aims: In this study, we evaluated the clinical and demographic characteristics of proven PJP cases in children with haematological malignancy on chemotherapy. The study also determined the association of PJP characteristics with various phases of chemotherapy. Methods: This was a retrospective study conducted at a tertiary care teaching hospital in Delhi. Cases included 13 children less than 12 years of age with leukaemia on chemotherapy with proven PJP diagnosis, according to the EORTC/MSGERC guidelines. For microbiological diagnosis, direct immunofluorescence was performed using the Merifluor® Pneumocystis kit manufactured by Meridian Bioscience Inc. Results: B-cell acute lymphoblastic leukaemia was the most common haematological malignancy seen in these cases. Most of the PJP cases were seen in the maintenance phase of chemotherapy. The clinical profile of the PJP cases includes fever, cough, cytopenia, hypoxaemia, coryza, dyspnoea, and hepatitis. The radiological findings of the PJP cases include bilateral diffuse ground-glass opacification, perihilar infiltrates, and unilateral infiltrates. The mortality rate of the PJP cases was 15.4%. Conclusions: Pneumocystis jirovecii causes a potentially life-threatening pneumonia, especially in immunocompromised individuals such as children with leukaemia on chemotherapy. PJP presents more severely with rapid progression and higher mortality rate in children with leukaemia than in HIV-positive cases. Therefore, early diagnosis and prompt treatment initiation is paramount in reducing morbidity and mortality in these cases.
BackgroundAnnually, an estimated 2.3 million infants die within their first month of life, primarily in sub-Saharan Africa and South Asia. Infections, including sepsis are among the major contributors to these deaths. Effective interventions added to standard antimicrobial therapy can reduce sepsis mortality. A recent meta-analysis suggests that adjunct zinc treatment of young infants with sepsis could reduce case fatality risk. This study evaluated the efficacy of zinc as an adjunct to antibiotics in young infants with suspected sepsis, defined as clinical severe infection (CSI).Methods and findingsWe conducted a randomized, double-blind, placebo-controlled trial across seven hospitals in India and Nepal from February 28, 2017, to February 22, 2022. Infants aged 3-59 days hospitalized with suspected sepsis, defined as CSI, adapted from the WHO Integrated Management of Childhood Illness (IMCI) criteria, were randomly assigned to receive 10 mg of elemental zinc daily or placebo orally for 14 days, in addition to standard of care. The primary outcomes were death during hospitalization and death within 12 weeks after enrollment. Among 3,153 enrolled infants (1,203 [38%] females), the median age at enrollment was 25 days (interquartile range 13-41 days), and the mean weight was 2.9 kg (standard deviation 0.8). During the hospital stay, 64 (4.1%) of 1,576 infants died in the zinc arm compared to 77 (4.9%) of 1,577 in the placebo arm (relative risk [RR] 0.83 (95% CI [0.60, 1.15]; p = 0.267)). Among those who completed 12 weeks of follow-up, 140 of 1,554 infants (9.0%) died in the zinc arm, and 133 of 1,550 (8.6%) in the placebo arm (RR 1.05 (95% CI [0.84, 1.32]; p = 0.674)). Adverse events were similar across trial arms, except for a slight increase in vomiting in the zinc arm; no events were attributed to the intervention. The main limitation of the study is that it was underpowered due to lower-than-anticipated event rates and a shortfall in the achieved sample size.ConclusionsIn this setting, we found little evidence for an effect of adjunct zinc therapy on young infants with CSI on the risk of dying during hospitalization or for the subsequent 3 months. Our findings contrast previous studies that used more specific case definitions. This underscores the need for further RCTs to evaluate the effect of zinc in young infant sepsis before it can be recommended in treatment guidelines.Trial registrationClinical Trials Registry-India (CTRI/2017/02/007966) on February 27, 2017, and Universal Trial Number is U1111-1187-6479.
BACKGROUND AND OBJECTIVES:Children with overweight/obesity are at increased risk of vitamin D deficiency. This study compares the efficacy and safety of 4000 International Units (IU)/day vs. 6000 IU/day oral vitamin D3 over 12 weeks for treating vitamin D deficiency and evaluates its impact on metabolic parameters. METHODS:In this open-label randomized controlled trial, 90 children (5-18 years) with overweight/obesity and vitamin D deficiency (25 [OH]D < 50 nmol/L) were randomized to receive 4000 IU/day (Group A, n = 45) or 6000 IU/day (Group B, n = 45) along with calcium. Efficacy (25 [OH]D ≥ 50 nmol/L), safety (hypercalcemia, hypercalciuria, hypervitaminosis D), and metabolic impact (HbA1c, lipids) were assessed over 12 weeks. Trial registered with CTRI/2021/02/031591. RESULTS:Sixty-eight children completed the study. Both groups showed significant increases in serum calcium and reductions in alkaline phosphatase and parathormone, with no inter-group differences. Group B showed a faster rise in 25(OH)D levels, with higher means at 4 weeks [66.3 (3.12) vs. 55.6 (2.92)] and 12 weeks [100.6 (3.42) vs. 79.3 (3.17) nmol/L]. At 12 weeks, sufficiency was achieved in 91.4 % (Group A) and 93.4 % (Group B). Mild, asymptomatic hypercalcemia was noted in 7 children (Group A-3, Group B-4; p = 0.70) and resolved spontaneously. No significant metabolic changes were observed in either group. CONCLUSIONS:Both 4000 IU/day and 6000 IU/day of vitamin D3 were effective and safe for treating vitamin D deficiency in overweight or obese children, with no observed effect on metabolic parameters in either group. Higher doses may accelerate sufficiency; however, standard dosing remains effective, emphasizing the need for individualized treatment and monitoring. IMPACT STATEMENT:Comparing 4000 IU/day to 6000 IU/day of vitamin D3 in children with overweight or obesity showed that both regimens were safe and effective in achieving sufficiency without either regimen influencing metabolic parameters. The higher doses allowed for a quicker attainment of optimal levels. While both doses effectively establish vitamin D sufficiency in the short term, long-term data are necessary to confirm their ongoing efficacy and safety over extended periods. CLINICAL TRIAL REGISTRATION NO:CTRI (Clinical Trial Registry India) (CTRI/2021/02/031591). The protocol can be accessed at https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTI2NTM=&Enc=&userName=.
