BackgroundThiamine deficiency is an important cause of adverse maternal and neonatal outcomes. It is especially common among women who follow customary dietary restrictions.AimTo estimate the prevalence of subclinical thiamine deficiency among lactating mothers following customary dietary restrictions and to compare it with age-matched controls.MethodA community-based cross-sectional study, conducted on healthy lactating mothers. Study subjects consisted of two groups namely "Exposure group" (mothers on customary dietary restrictions and "Control group" (mothers consuming more diverse diet). Relevant demographic and clinical information were noted. Thiamine status was checked by blood thiamine diphosphate (TDP) estimation using high-performance liquid chromatography. A TDP concentration below 90 nmol/L was considered as thiamine deficiency.ResultsExposure group mothers significantly belonged to lower socioeconomic class and had fewer years of formal education. Mean Maternal TDP level was lower in the Exposure group (148.5 ± 62.9 nmol/L) compared to the Control group (183.5 ± 76.1 nmol/L). 11.64% of mothers in the Exposure group and 3.5% of mothers in the Control group were found to be thiamine-deficient. There was a significant correlation between maternal and infant blood TDP levels.ConclusionWomen following customary dietary restrictions significantly belonged to lower socioeconomic class and had fewer years of formal education. The prevalence of subclinical thiamine deficiency was higher in the Exposure group mothers. These findings highlight the need for awareness campaigns to educate women of childbearing age on the importance of a diverse, balanced diet and thiamine supplementation during pregnancy and lactation.

The LATCH score is a reliable tool for assessing breastfeeding efficiency. The objectives of this study were to identify risk factors for hypernatremic dehydration in exclusively breastfed neonates, including the correlation between serum sodium levels and LATCH scores. This single-center, hospital-based, case-control study (February 2022 to March 2024) enrolled 37 exclusively breastfed neonates with hypernatremic dehydration as cases, and 37 healthy, exclusively breastfed neonates without any signs or symptoms of dehydration and with normal serum sodium levels as controls. LATCH scores were assessed and correlated with serum sodium levels. The mean ± SD serum sodium levels were 171 ± 9.95 mEq/L in cases and 143 ± 3.53 mEq/L in controls. Univariate analysis revealed that poor attachment, delayed initiation of breastfeeding, lower feeding frequency, jaundice, irritability, convulsions, hypertonia, poor suck, and a hyper alert state were significantly associated with hypernatremic dehydration. Poor attachment/sucking at the breast, irritability and hyper alert state emerged as independent predictors of hypernatremia. A higher proportion of babies with hypernatremic dehydration (54%) had poor LATCH scores (<7) as compared to controls (45.95%). Among cases, a moderate negative correlation ( r = –0.400) was observed between serum sodium levels and LATCH scores. Moderate inverse correlations were also observed with the T (–0.41) and C (–0.43) components, while the L (–0.10) and H (–0.23) components showed weak correlations. No correlation was noted with the A component (–0.02). Hypernatremic dehydration in exclusively breastfed neonates is significantly associated with poor feeding behaviors and certain clinical signs. A combination of clinical vigilance and breastfeeding assessment (including tools like the LATCH score) can aid in the early identification and prevention of this potentially serious condition.

Relevant data utilised in the preparation of this manuscript are provided in the main manuscript.

BACKGROUND:Thiamine deficiency disease may occur in infants from thiamine-deficient mothers in developing countries, as well as in infants fed solely with soy-based formula. Thiamine deficiency in infants may present with acute neurological manifestations of infantile encephalitic beriberi.OBJECTIVE:To review the role of noncontrast CT brain findings in infantile encephalitic beriberi in early diagnosis.MATERIALS AND METHODS:A retrospective review of noncontrast CT scans of the brain in 21 infants with acute-onset infantile encephalitic beriberi was carried out.RESULTS:On noncontrast-enhanced CT brain, hypodense lesions were seen symmetrically in the putamen in all the babies; symmetric hypodensities were seen in the caudate nuclei in 14/21 (67%), in dorsomedial thalami/hypothalamic/subthalamic area in 4/21 (19%), and in the globi pallidi in 2/21 (9.5%) of the infants.CONCLUSION:Recognition of symmetrical hypodense lesions in the basal ganglia and medial thalami/hypothalamic/subthalamic area on noncontrast CT scan of the brain are important early features to recognize in encephalitic beriberi in at-risk infants.ADVANCES IN KNOWLEDGE:IEBB is a cause of hypodense bilateral basal ganglia and may be identified by this finding in the appropriate clinical settings.

Objective Neonatal bronchiolitis is not well characterized. We studied the profile of acute bronchiolitis in term newborns during a respiratory syncytial virus (RSV) surge following relaxation in coronavirus disease 2019 (COVID-19) appropriate behavior.Methods This was a retrospective descriptive study performed in the neonatology division of a tertiary care pediatric hospital at Srinagar, Jammu and Kashmir, India. Term neonates (born at =37 completed gestational weeks) from 7 up to 28 days of life admitted with bronchiolitis over a 1-month period (November 2021) were included.Results Out of total 480 neonatal admissions over a month, 35 (7%) had acute bronchiolitis. Eight neonates were excluded. Out of 27 included neonates, 13 were males. Mean age at presentation was 20 days. All neonates were born at term (=37 completed gestational weeks). Cough (26), rapid breathing (20), and lower chest indrawing (20) were the predominant presenting features. Median SPO2 was 87% (interquartile range 85-92%). Fourteen (52%) neonates needed admission to neonatal intensive care unit. Respiratory support was needed in the form of oxygen through nasal prongs in 24 (89%) newborns. Heated humidified high-flow nasal cannula (HHHFNC) and bubble continuous positive airway pressure were used in five neonates each. Two neonates were mechanically ventilated. The mean duration of the hospital stay was 6.2 days. All neonates survived.Conclusion A series of 27 term neonates with bronchiolitis during an RSV surge is reported in the aftermath of lifting of COVID-19 restrictions. Many of these neonates were sick enough to require significant respiratory support. The outcome was good in all neonates.

Thiamine is an essential water-soluble vitamin that plays an important role in energy metabolism. Thiamine deficiency presents many challenges to clinicians, in part due to the broad clinical spectrum, referred to as thiamine deficiency disorders (TDDs), affecting the metabolic, neurologic, cardiovascular, respiratory, gastrointestinal, and musculoskeletal systems. Concurrent illnesses and overlapping signs and symptoms with other disorders can further complicate this. As such, TDDs are frequently misdiagnosed and treatment opportunities missed, with fatal consequences or permanent neurologic sequelae. In the absence of specific diagnostic tests, a low threshold of clinical suspicion and early therapeutic thiamine is currently the best approach. Even in severe cases, rapid clinical improvement can occur within hours or days, with neurological involvement possibly requiring higher doses and a longer recovery time. Active research aims to help better identify patients with thiamine-responsive disorders and future research is needed to determine effective dosing regimens for the various clinical presentations of TDDs. Understanding the clinical diagnosis and global burden of thiamine deficiency will help to implement national surveillance and population-level prevention programs, with education to sensitize clinicians to TDDs. With concerted effort, the morbidity and mortality related to thiamine deficiency can be reduced.

OBJECTIVES:Thiamine deficiency (TD) is frequently suspected and treated at our hospital. In our retrospective study, we aimed at finding the clinical and laboratory spectrum of infantile TD presenting to a single center over a period of time. METHODS:The diagnosis was made on criterion standard of response to thiamine challenge. RESULTS:TD was suspected in 189 infants at admission; 43 infants were diagnosed as having TD in three distinct forms and a fourth group with mixed presentation. The first group (n = 30), which was the youngest (mean age = 67 d), was always associated with lactic acidosis. They had history of reflux and suddenly became irritable and developed acidotic breathing. This further worsened into shock (46%) and acute respiratory failure (50%). The second group (n = 5) presented with pulmonary arterial hypertension. They had hoarseness of voice and irritability. Chest radiograph showed prominent pulmonary conus. Their clinical course was complicated by congestive heart failure in three. Echocardiographic response to thiamine was uniformly seen within 3 d in this group. The clinical presentation of infants with Wernicke's encephalopathy (n = 5) who were the oldest of all (mean age = 190 d) was constantly marked by presence of bilateral ptosis and encephalopathy preceded by occurrence of vomiting. Their head ultrasonography showed presence of hyperechoic basal ganglia. CONCLUSIONS:Three clinically distinct forms of TD were recognized. Lactic acidosis was a universal finding in acidotic form. Infants with pulmonary hypertension as primary presentation are typically associated with aphonia. Infants with Wernicke's encephalopathy can be clinically diagnosed by presence of encephalopathy and ophthalmic signs (ptosis).

Purpose: Late onset neonatal hypocalcemia (LNH) is defined as hypocalcemia detected after day 3 of life. Its occurrence in babies fed with cow’s milk is well understood. Since the advent of modern-day formulas, the incidence has however decreased. Methods: A prospective descriptive study (January 2017 to December 2017) of LNH seizures in neonates was conducted. LNH was defined as the total serum calcium of less than 7 mg/dL in preterm or less than 8 mg/dL in term newborns after 72 h of life. Results: 14 neonates were presented with myoclonic and focal seizures due to late hypocalcemia. All were formula fed. Their mean serum calcium, phosphorus, alkaline phosphatase, magnesium, 25-OH vitamin D, intact PTH levels were 4.93 mg/dL, 9.19 mg/dL, 244 U/L, 1.2 mg/dL, 30 nmol/L, 38.6 pg/mL, respectively. Mean maternal vitamin D levels were 43 nmol/L. Mean hospital stay was 4 days. Clinical response to treatment was brisk in those who were able to shift to total breast feeding early. Conclusions: LNH in formula-fed and vitamin D deficient babies is not uncommon. Emphasis should be laid on exclusive breast feeding even in vitamin D deplete mothers. However, mothers at risk should be supplemented with vitamin D during pregnancy.

Objectives: To assess the epidemiological profile of asthma in school going children in Srinagar, Kashmir. Study design: Cross-sectional study. Setting: Thirty-one schools with proportionate representation from both government and private schools as well as from primary, middle, and high schools. Participants: School children aged 10–16 years with equal representation of sex and all ages. Main Outcome Measure: Prevalence of current and past asthma. Methods and Results: After administering a modified pretested questionnaire, peak expiratory flow measurement was carried. Children who had asthma-like symptoms or positive family history of asthma or physician-labeled asthma were subjected to spirometry and bronchodilator reversibility. Out of 806 children, bronchial asthma was seen in 60 (prevalence of 7.4%) which included 34 boys and 26 girls. Majority of asthmatic children (78.3% [n = 47]) had probable asthma; 6.7% (n = 4) had definite asthma; and 15% (n = 9) had physician-diagnosed asthma. Majority of children had intermittent asthma (78.3% [n = 47]). Mild persistent asthma was seen in 12.7% (n = 7) and 10% (n = 6) had moderate persistent asthma. None of the children had severe persistent asthma. The prevalence of current asthma was 3.2% (n = 26). On univariate analysis, the factors found to be statistically significant were family history of asthma (odds ratio [OR] =8.174; confidence interval [CI] =4.403–15.178), seasonal cough (OR = 4.266; CI = 2.336–7.791), allergic rhinitis (OR = 2.877; CI = 1.414–5.852), atopic dermatitis (OR = 6.597; CI = 2.72–16.004), and obesity (OR = 6.074; CI = 2.308–18.034). On multivariate analysis, family history, seasonal cough, allergic rhinitis, atopic dermatitis, and obesity were found to be significant independent risk factors. Conclusions: Srinagar qualifies as a low prevalence area for bronchial asthma in the age group of 10–16 years. Majority of children had mild intermittent asthma resulting in under diagnosis and wrong treatment.

OBJECTIVE:To study the effect of thiamine administration on the resolution of pulmonary hypertension in exclusively breastfed infants.DESIGN:Prospective cohort study.SETTING:Hospital based study of a tertiary care hospital.PATIENTS:A total of 29 infants with 17 males (58.6%) and 12 females (41.4%) were included in the study.INTERVENTION:In addition to the management of shock, right heart failure and renal failure, patients received intravenous thiamine 100mg/kg IV followed by 10mg/day till introduction of supplementary feeds.MAIN OUTCOMES MEASURES:Resolution of shock, metabolic complications and pulmonary hypertension.RESULTS:Mean age at presentation was 78.45±30.7 days. All infants were exclusively breastfed. 86.2% of mothers were on customary dietary restrictions. Biventricular failure and tachycardia was commonly present. There were four deaths in our series. Acute metabolic acidosis was a universal feature with a mean pH of 7.21±0.15. Pulmonary hypertension was present in all patients on admission. Intravenous thiamine 100mg/kg IV stat was given immediately after documenting pulmonary hypertension. Repeat echocardiography showed complete resolution of pulmonary hypertension.CONCLUSION:Many infants present to us with Shoshin beriberi with unusually high pulmonary pressures. These patients respond to thiamine challenge with prompt resolution of metabolic complications and reversal of pulmonary hypertension. We believe this is first of its kind from the region, which is reported.

Background: Acute life threatening metabolic acidosis in exclusively breast fed infants due to thiamine deficiency is not described. Kashmir valley, a north Indian state has a population that largely consumes polished rice.Methods: A six months prospective descriptive study of infants who presented with acute life threatening metabolic acidosis (Blood pH <= 7.0) due to thiamine deficiency.Results: Twenty three infants (Eleven male; Twelve female) in the age range of 32 days to 4 months had a pH of <= 7 at admission. Onset of moaning was immediate (2-24 hours). Blood lactate levels were more than 15mmol/L. Blood thiamine levels of six infants in whom it was done ranged from 11 69 nmol/L (control 78-185 nmol/L). All infants were exclusively breast fed. Maternal staple diet consisted of polished rice. All mothers consumed rice after washing it thrice. Twelve lactating mothers were on customary dietary restrictions. Practice of straining rice after cooking was observed in thirteen. The commonest symptoms were irritability (82%) and reflux (56%). Commonest signs were tachycardia (100%) and moaning (73%). At presentation 52% were in cardiogenic shock. Response to thiamine was dramatic with moaning and irritability subsiding in two hours and tachycardia in four hours. Adequate perfusion was achieved in one hour. Eighteen patients seen at six months follow up had normal neurodevelopment.Conclusions: Thiamine deficiency in an infant can present as sudden onset metabolic acidosis. If treated early, metabolic acidosis due to thiamine deficiency is associated with good immediate and long term prognosis even if pH is less than 7 at presentation. (C) 2016 Elsevier Inc. All rights reserved.

Maintaining behaviorally relevant information in spatial working memory (SWM) requires functional synchrony between the dorsal hippocampus and medial prefrontal cortex (mPFC). However, the mechanism that regulates synchrony between these structures remains unknown. Here, we used a unique dual-task approach to compare hippocampal–prefrontal synchrony while rats switched between an SWM-dependent task and an SWM-independent task within a single behavioral session. We show that task-specific representations in mPFC neuronal populations are accompanied by SWM-specific oscillatory synchrony and directionality between the dorsal hippocampus and mPFC. We then demonstrate that transient inactivation of the reuniens and rhomboid (Re/Rh) nuclei of the ventral midline thalamus abolished only the SWM-specific activity patterns that were seen during dual-task sessions within the hippocampal–prefrontal circuit. These findings demonstrate that Re/Rh facilitate bidirectional communication between the dorsal hippocampus and mPFC during SWM, providing evidence for a causal role of Re/Rh in regulating hippocampal–prefrontal synchrony and SWM-directed behavior. SIGNIFICANCE STATEMENT Hippocampal–prefrontal synchrony has long been thought to be critical for spatial working memory (SWM) and the ventral midline thalamic reuniens and rhomboid nuclei (Re/Rh) have long been considered a potential site for synchronizing the hippocampus and medial prefrontal cortex. However, the hypothesis that Re/Rh are critical for hippocampal–prefrontal synchrony and SWM has not been tested. We first used a dual-task approach to identify SWM-specific patterns of hippocampal–prefrontal synchrony. We then demonstrated that Re/Rh inactivation concurrently disrupted SWM-specific behavior and the SWM-specific patterns of hippocampal–prefrontal synchrony seen during dual-task performance. These results provide the first direct evidence that Re/Rh contribute to SWM by modulating hippocampal–prefrontal synchrony.

Objective To assess the clinical and demographic profile of Systemic Inflammatory Response Syndrome (SIRS) and sepsis, among newly admitted children in different age groups in a hospital in North India. Methods This prospective study was conducted at a referral care centre in Northern India. All children, age group 0 to <18 y, admitted on days selected for study were screened and those with abnormal temperature and abnormal leukocyte count were included for further assessment. A total of twenty “24 h” periods were randomly chosen during the study period. Patients were assessed according to age specific vital signs and laboratory values to diagnose Systemic Inflammatory Response Syndrome (SIRS) and sepsis and to gain clinical and demographic data. The criteria laid at International consensus conference, 2002, were used to define patients as SIRS, Sepsis, Severe sepsis and Septic shock. Results During the study period, a total of 865 patients were screened for SIRS. Prevalence of SIRS amongst hospitalised children was 23 % ( n = 201). Seventy nine percent ( n = 159) of patients had infection associated SIRS and 21 % (42) had non-infective SIRS. Sixty four percent ( n = 129) SIRS patients had uncomplicated sepsis, 15 % ( n = 30) patients fulfilled criteria for severe sepsis. Out of the latter 30, 19 had septic shock. Organ dysfunction in SIRS was noted in 25 % ( n = 51). 37.25 % ( n = 19) had multiple organ dysfunction syndrome (MODS). The most common organism isolated was Staphylococcus aureus ( n = 9). Focus of infection in majority was pulmonary (44 %). Mean duration of antibiotic therapy and hospital stay in the SIRS group were 6.4 and 6.5 d respectively. In the group without SIRS, mean duration were 2.44 d and 3.07 d respectively The differences were statistically significant. Conclusions In conclusion, the proportion of sepsis contributing to SIRS is high in a tertiary care hospital. Therefore rapid recognition of SIRS is essential. Goal directed treatment of sepsis is also important so that high mortality associated with severe sepsis and septic shock are prevented.

Thiamine deficiency in infants is still encountered in developing countries. It may present with acute neurological manifestations of infantile encephalitic beriberi.

Protection through immunization against vaccine preventable diseases, disabilities and death is the right of every child. The impact of the Universal Immunization Programme (UIP) is measured in terms of the vaccine preventable disease (VPD) burden. Inspite of having the immunization programme in place for several decades, the stated goals are not fully achieved. Immunization coverage of an area gives a true picture about the implementation of the immunization programme at the ground level. This study tried to estimate the overall immunization coverage among children aged 12-23 months in block Hazratbal of District Srinagar. A cross-sectional study was carried out in block Hazratbal, Srinagar using a 30 cluster sampling technique. Mothers or caregivers of seven children aged 12-23 months were interviewed from each cluster using a pre- tested WHO proforma, thus giving us the sample size of 210. Out of the total 210 children, 111 (52.98%) were males and 99 (47.02%) were females. 72.38% children were fully immunized against all the vaccine preventable diseases, with 75% of boys and 70.4% of girls fully immunized. Coverage was highest for DPT-3 and OPV-3 (99.04%) and lowest for HBV-3 (74.76%). For BCG, coverage was 96.66% and for Measles it was 96.19%. Coverage figures for all vaccines were higher among males as compared to females. DPT-3 and OPV-3 dropout rate was 1.43% and that for HBV-3 was 15.38%. Thus the immunization coverage in the area was less than 85%, which was primarily due to less coverage of Hepatitis B vaccine. Keywords : Immunization Coverage, Cluster Sampling, Vaccine preventable disease.

A three year retrospective study was done to study snakebite envenomation among Kashmiri children. Ten children were admitted with snakebite. Snakebite was vasculotoxic in seven and mixed in two. Levantine viper bites were seen in five who had Grade 3 bites with severe local signs, severe coagulopathy and hypotension. Both environmental risk and seasonal incidence was observed.

Fluid collections around the kidneys on cross-sectional imaging may be caused by urine, blood, pus, lymph, or plasma. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) can not only show and characterize the fluid, but also may help determine the underlying cause of the perinephric fluid collection, such as ureteric obstruction, kidney injury, infection, or renal lymphangiectasia. Renal lymphangiectasia is characterized by abnormal and ectatic lymphatic vessels within and around the kidneys. Dilated lymphatics may result in peripelvic cysts (intrarenal lymphangiectasia) and perinephric fluid collections (extrarenal lymphangiectasia), which can be visualized using US, CT, and MRI. Proper diagnosis on imaging helps in planning a conservative management approach to this benign condition, which requires intervention for only significant symptoms or complications. We describe a 60-year-old man with normal kidney function and bilateral perinephric fluid collections in whom renal lymphangiectasia was diagnosed noninvasively on the basis of characteristic findings on US, CT, and MRI.