Pedaitrics

We report five cases of HIV infected children, who presented with flu-like symptoms and were diagnosed to have H1N1 infection (swine origin influenza). Four of these children were admitted with respiratory distress and pneumonia and were managed in swine flu isolation ICU. Two children required nonivasive ventilatory support. All children recovered completely and at discharge were referred for initiation of ART.

We measured hair and plasma concentrations of isoniazid among sixteen children with tuberculosis who underwent personal or video-assisted directly observed therapy and thus had 100% adherence. This study therefore defined typical isoniazid exposure parameters after two months of treatment among fully-adherent patients in both hair and plasma (plasma area under the concentration-time curve, AUC, estimated using pharmacokinetic data collected 0, 2, 4, and 6 hours after drug administration). We found that INH levels in hair among highly-adherent individuals did not correlate well with plasma AUC or trough concentrations, suggesting that each measure may provide incremental and complementary information regarding drug exposure in the context of TB treatment.

Antibiotic resistance mechanisms originating in low- and middle- income countries are among the most common worldwide. Reducing unnecessary antibiotic use in India, the world's largest antibiotic consumer is crucial to control antimicrobial resistance globally. Limited data describing factors influencing Indian clinicians to start or stop antibiotics is available. Febrile adults and children admitted to a public tertiary care hospital in Pune, India were enrolled. Antibiotic usage and clinical history were recorded. Immunoassays for mosquito-borne disease and bacterial cultures were performed by protocol and clinician directed testing. Clinical factors were assessed for association with empiric antibiotic initiation and discontinuation by day 5 using multivariable logistic regression and propensity score matched Cox proportional hazard models. Among 1486 participants, 683 (82%) adults and 614 (94%) children received empiric antibiotics. Participants suspected of having mosquito-...

Acute febrile illness (AFI) is a major cause of morbidity and mortality in India and other resource-limited settings, yet systematic etiologic characterization of AFI has been limited. We prospectively enrolled adults (= 970) and children (age 6 months to 12 years,= 755) admitted with fever from the community to Sassoon General Hospital in Pune, India, from July 2013 to December 2015. We systematically performed a standardized clinical history, clinical laboratories, and diagnostics. Results from additional testing ordered by treating clinicians were also recorded. A microbiological diagnosis was found in 549 (32%) participants; 211 (12%) met standardized case definitions for pneumonia and meningitis without an identified organism; 559 (32%) were assigned a clinical diagnosis in the absence of a confirmed diagnosis; and 406 (24%) had no diagnosis. Vector-borne diseases were the most common cause of AFI in adults including dengue (= 188, 19%), malaria (= 74, 8%), chikungunya (= 15, 2...

There is limited validation of self-reported measures for secondhand smoke (SHS) exposure in low- and middle-income countries. We evaluated the validity of standard self-reported measures among women and children in urban India. Structured questionnaires were administered, and household air and hair samples were analyzed for nicotine concentration. In total, 141 households of 70 child and 71 adult participants were included. Air nicotine was detected in 72 (51%) homes, and 35 (75%) child and 12 (56%) adult participants had detectable hair nicotine. Correlation between air and hair nicotine was significant in children (= 0.5;= .0002) but not in adults (= -0.1;= .57). Poor correlation was found between self-reported measures of exposure and both air and hair nicotine. No questions were significantly correlated with hair nicotine, and the highest-magnitude correlation with air nicotine was for how often someone smoked inside for adults (= 0.4;= .10) and for home preparation of mishri (...

Preterm birth (PTB) rates are high in HIV-infected populations, even when on treatment. Still, only a subset of all births in HIV-infected pregnant women result in PTB, suggesting risk factors other than HIV infection itself are also important. Inflammation is a known risk factor in uninfected populations but their role in HIV-infected population have not been studied; in addition, the immune pathways involved are not clear and non-invasive immune markers with predictive value are lacking. Our objective was to determine the association of select markers of inflammation with PTB in HIV-1-infected pregnant women. Within a randomized trial of pregnant women receiving Nevirapine (SWEN trial), we nested a case-control study (n=107; 26 cases, 81 controls) to determine the association of maternal inflammation with PTB. Cases were defined as PTB (<37 weeks gestational age (GA)). We assessed inflammation by measuring plasma levels of markers of general inflammation (C-reactive protein (CR...