Resp/01(P) Bilateral Pulmonary Hydatid Cyst in a Child

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) [email protected]

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. [email protected]

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 GROUP -MANAGEMENT PRACTICES J N Goswami Graded Specialist (Paediatrics),Military Hospital Mhow,MP [email protected]

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 [email protected]

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., [email protected]

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. [email protected]

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 Cmax 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 Tmax AUC0-8 AUC0-inf t1/2 (pg/mL) (min) (pg.min/mL) (pg.min/mL) (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 [email protected]

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 4- 18 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 [email protected]

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 [email protected]

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 [email protected]

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 pre- calibrated 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 [email protected]

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 receiving concomitant therapy with other antitussives, 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 intensity 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 [email protected]

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. [email protected]

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 CASE- CONTROL STUDY Nirmal Kumar, Suman Lata, Noopur Baijal, Mohit Sahani, V. Srineevas 4, Rajpur Road, Qtr No. B-2, Tis-Hazari, Delhi-54 [email protected]

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 [email protected]

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 [email protected]

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 [email protected]

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.