No abstract

No abstract

Introduction: With the universal availability of Highly active antiretroviral therapy (HAART), HIV is increasingly recognized as a chronic manageable disease, rather than terminal illness. However the cost of increased longevity has resulted in to various metabolic abnormalities, mainly lipids. These metabolic abnormalities could be due to the HIV disease itself or due to the effects of antiretroviral therapy. Data on the prevalence of these metabolic abnormalities particularly in the pediatric population is limited, hence this study was conducted to find out the prevalence of lipid abnormalities in HIV infected children among the Indian population. Materials & Methods: This was a cross-sectional study conducted at Pediatric HIV clinic of a tertiary care hospital in western state of India from Sep 2010 to Aug 2012 among HIV infected children up to 18 years of age. After taking detail history and examination, fasting samples were taken for complete lipid profile. All enrolled HIV positive children were categorized according to clinical and immunological status as per WHO guidelines of 2010. The lipid abnormalities in HIV infected children on antiretroviral therapy & not on antiretroviral therapy were analysed. Statistical analysis was done by Z test for continuous variables and chi square test for dichotomous variables using Graph pad Prism 5 software. Results: 140 HIV positive children were enrolled, of which 93 were on ART. Mean age of the study population was 8.8 years with male to female ratio of 1.1:1. The mode of HIV transmission was vertical in 137(97.8%) children. WHO clinical categories at the time of enrolment were cat I, II, III and IV in 40%, 39%, 20% and 1%, while immune cat 42%, 18%, 16% and 24% cases respectively. Ninety three (64%) children were on antiretroviral therapy. Of the total, 80(57%) children were found to have lipid abnormalities, of which most common was high triglycerides levels in 74(52.8%) children followed by low HDL in 64(46%), high cholesterol in 19(13.5%) and high LDL in 3(2%) children. Mean levels of cholesterol, triglycerides and LDL were higher in the ART group at 156, 126, 50 and 56 mg/dl as compared to ART naive group with levels of 129, 119, 39 and 50 respectively and the association between the mean levels of cholesterol and ART was statistically significant (P value=0.0002). Conclusion: The prevalence of lipid abnormalities was higher in HIV infected children, mainly triglycerides and cholesterol. Also the prevalence was higher in HIV infected children on ART as compared to ART naïve children. These metabolic abnormalities may contribute to the increased risk of cardiovascular diseases in these children, who are likely to be facing a life time exposure to antiretroviral therapy, hence regular screening is recommended to identify and manage the abnormalities early.

No abstract

Introduction: For the diagnosis of airway anomalies, bronchoscopy is the gold standard. Infant pulmonary function testing is an emerging modality to assess airways and its utility in diagnosis and monitoring is unexplored in clinical studies. Objectives: To evaluate infant Pulmonary Function Test [Tidal Breathing Flow Volume Loop (TBFVL)] in children with airway anomalies and to correlate with bronchoscopy findings. Methods: We performed a prospective cohort study from July 2018 to April 2020 in children from 0-2 years with physician suspected airway anomalies. We performed TBFVL (graphic pattern and parameters) and bronchoscopy in these children and correlated the results. The primary outcome measure was a graphic pattern of TBFVL in children with laryngomalacia. Secondary outcome measures were bronchoscopy diagnosis of various airway anomalies, graphic pattern in children with airway anomalies other than laryngomalacia, measurement of TBFVL parameters and measurement of change in TBFVL graphic patterns and parameters at six months follow up. We compared TBFVL parameters with controls without airway anomalies. Results: We enrolled 53 children with both Infant Pulmonary Function Tests and bronchoscopy data. Isolated laryngomalacia (28, 52.8%) was the most common airway anomaly, followed by laryngo-tracheomalacia (7, 13.2%), laryngo-tracheo-bronchomalacia (6, 11.3%), and laryngomalacia with subglottic stenosis (4, 7.5%). Among isolated laryngomalacia, pattern 3 (fluttering of inspiratory limb) was most common in TBFVL, followed by pattern 4 (fluttering of inspiratory limb and flattening of expiratory limb) in 13 (46.4) and 8 (28.6%) cases, respectively. There was no strikingly predominant pattern in other groups of bronchoscopy diagnoses. Among TBFVL parameters, the ratio of Ti/Te was significantly high in children with isolated laryngomalacia compared to controls. Compared to controls, the tPTEF/tE was significantly higher in laryngomalacia plus sub-glottic stenosis. At six months of follow-up, clinical symptoms improved significantly, TBFVL pattern 1 (normal) became the most common pattern, and expiratory time increased significantly among TBFVL parameters. Conclusion: A particular type of airway anomaly may have a characteristic graphic pattern in TBFVL. Further, the TBFVL pattern may indicate improvement in the follow-up either spontaneously or after an intervention.