Bibek Talukdar

Neurocysticercosis in children: clinical findings and response to albendazole therapy in a randomized, double-blind, placebo-controlled trial in newly diagnosed cases.

The clinical findings of neurocysticercosis, diagnosed primarily on the basis of computed tomography (CT), and response to albendazole therapy in a randomized, double-blind, placebo-controlled trial were studied in 72 newly diagnosed children aged 1.5-12 years admitted to hospital in New Delhi, India, during March to July 2000. The lesions by initial CT were mostly single with perilesional oedema, and were located in the parietal lobes. The most common clinical finding was partial seizure (79.2%). The outcome of the albendazole trial was assessed through changes in CT lesions and status of seizure after 6 months of follow-up; about 55% of the lesions had disappeared and about 80% of the children were seizure-free. The frequency of healing of CT lesions in the albendazole-treated group and placebo group was 54.2% and 55.2%, respectively, and the frequency of a seizure-free state in the albendazole-treated group and placebo group was 87.5% and 77.5%, respectively; the differences were not statistically significant. Changes in lesions by CT and the recurrence of seizures after 6 months of follow-up were not related to the number of lesions by initial CT and albendazole was not beneficial in neurocysticercosis in children with ring-enhancing lesions in CT.

Efficacy of buccal midazolam compared to intravenous diazepam in controlling convulsions in children: A randomized controlled trial

A study was done to examine the efficacy of buccal midazolam in controlling convulsion in children by comparing it with intravenous diazepam, a standard mode of treating convulsions. One hundred and twenty cases presenting with convulsions to emergency were treated randomly with either buccal midazolam (in a dose of 0.2mg/kg) or intravenous diazepam (in a dose of 0.3mg/kg). Partial seizures, generalized tonic, clonic and tonic-clonic convulsions were included irrespective of duration or cause. One episode per child only was included. The frequency of overall control of convulsive episodes within 5 min were 85% and 93.3% in buccal midazolam and intravenous diazepam groups, respectively; the difference was, however, not statistically significant (p=0.142). The mean time needed for controlling the convulsive episodes after administration of the drugs was significantly less with intravenous diazepam (p=<0.001). The mean time for initiation of treatment was significantly less with buccal midazolam (p=<0.001). The mean time for controlling the convulsive episodes after noticing these first were significantly less with buccal midazolam than with intravenous diazepam (p=0.004) that is likely to be due to longer time needed for initiating treatment with intravenous diazepam in preparing the injection and establishing an IV line. There was no significant side effect in both the groups. The findings suggest that buccal midazolam can be used as an alternative to intravenous diazepam especially when getting an IV line becomes difficult. In situations where establishing an IV line is a problem, buccal midazolam may be the first choice.

Antipyretic Effects of Nimesulide, Paracetamol and Ibuprofen-Paracetamol

The antipyretic effect of nimesulide has not been adequately compared with paracetamol and ibuprofenparacetamol combination in children. Hence, a randomized, double blind, and parallel groups’ design and multicenter study was conducted on children with respiratory tract infections. Eighty-nine patients with temperatures above 38.5°C were randomly administered nimesulide (1.5 mgJkgJdose), paracetamol (10.0 mgJkgJdose), or ibuprofen-patients combination (10.0 mgJkgJdose), thrice daily for five days. The axillary temperature was recorded at the baseline and at different time intervals post administration of drugs. The hematological and biochemical investigations were performed at the basal level and at the end of the treatment period. The adverse drug reactions were monitored during the trial. All the drugs produced a significant fall in temperature as compared to their respective basal values (p<0.001). However, on looking at the change in temperatures at different time intervals from the respective basal levels, no significant difference was found among all the drugs. Surprisingly, nimesulide had a tendency to raise serum glutamate pyruvate transaminase and serum glutamate oxaloacetate transaminase levels as compared to its baseline values. There was no marked adverse effect of the drugs on other hematological and biochemical parameters investigated. No other serious adverse reaction occurred in the study. Ibuprofen-paracetamol combination, nimesulide, and paracetamol had almost similar antipyretic effects in children.

Neurocysticercosis in children: clinical characteristics and outcome

Abstract A study was undertaken on 176 children with neurocysticercosis to determine the clinical behaviour and long-term outcome of cases. The children were followed up prospectively in the paediatric neurology clinic for 6 years. Diagnosis was based primarily on CT scans. All the CT lesions were parenchymal and mostly single (87%) with ring enhancement and peri-lesional oedema. Partial seizure was the predominant presenting seizure type. About 65% of cases had recurrences at varying intervals during treatment. Albendazole therapy given to some cases did not appear to have any beneficial effect on seizure control. Repeat CTs done at varying intervals after the first seizures showed disappearance of the lesions in about 50% of cases. The majority of lesions disappeared without the use of albendazole. Recurrence of seizures after withdrawal of anti-epileptic medication was observed in 19% of the cases. Parenchymal neurocysticercosis in children commonly presents with partial seizures and ring lesions on CT. The disease can be managed well by anti-epileptic medication alone and the prognosis is good.

Cushing Syndrome in an Infant Due to Cortisol Secreting Adrenal Pheochromocytoma: A Rare Association

ABSTRACT Adrenocortical tumors are the most common cause of endogenous Cushing syndrome in infancy and early childhood. Cushing syndrome resulting from ectopic adrenocorticotrophic hormone (ACTH) producing tumor has been infrequently reported in adults. Cortisol secreting pheochromocytoma is rarely reported in literature. We report an eleven month old child presenting to us as Cushing syndrome with hypertension due to left adrenal tumor. He was treated with antihypertensives and left adrenalectomy was done under perioperative glucocorticoid coverage. Diagnosis of pheochromocytoma was made only after histopathology. Despite the rare association of Cushing syndrome and pheochromocytoma, preoperative diagnosis of pheochromocytoma is required for appropriate perioperative medical and anaesthetic management to prevent life threatening complications.

Vitamin B12 deficiency in children: a treatable cause of neurodevelopmental delay.

Vitamin B12 deficiency in children can rarely cause neurologic manifestations. In this series, 14 pediatric cases (median age 11 months) have been described in whom association of vitamin B12 deficiency with developmental delay or regression was observed. Severe to profound delay was present in 8 (57%) patients. All the patients were exclusively or predominantly breast-fed and 10 of 12 mothers had low serum vitamin B12 levels. Three to 6 months after treatment, a mean gain of development quotient of 38.8 points was seen in 7 follow-ups. In settings with a high prevalence of vitamin B12 deficiency, this association should be actively searched for.

Newer methods over the conventional diagnostic tests for tuberculous meningitis: do they really help? :

Rapid diagnosis of tuberculous meningitis (TBM) is crucial as the disease outcome depends on the stage at which the treatment is initiated. The reliability of the available tests has not been established; thus, the present study was conducted to evaluate the conventional diagnostic tests as compared to the newer methods. Cerebrospinal fluid was collected from 100 children, and analyzed for various biochemical and cytological tests. The samples were subjected to Ziehl-Neelsen (Z-N) staining, Lowenstein-Jensen (L-J) culture, BACTEC culture and polymerase chain reaction (PCR). Twenty-two patients could be identified as definitive TBM based on the demonstration of Mycobacterium tuberculosis by BACTEC culture and PCR. Of these 22 cases, Z-N staining was positive in only two and L-J culture in six cases. Both the BACTEC culture and PCR had 100% agreement in the diagnosis of TBM. However, BACTEC culture could be a better diagnostic test as drug sensitivity can also be performed by this method.

Pulseless disease with renal amyloidosis

because of financial difficulties. Five returned mortally sick from acidosis and septicaemia. The pressure on staff in trying to treat these children when their parents seek to discharge them for financial reasons is great, and many prefer to concentrate on their education. Dialysis is expensive and transplantation is impossible for us. Rather we should concentrate on early diagnosis and adequate treatment using simple methods, such as urine examination, blood pressure recording, clean intermittent catheterisation and ultrasonography [ 1 ]. 129

Effect of yoga training on plasma lipid profile, R.B.C. membrane lipid peroxidation and Na+K+ ATPase activity in patients of essential hypertension

We conducted a controlled study on effect of selected yoga practive in the control and management of 50 cases of essential hypertension and equal number of healthy (nonhypertensive) controls. Free radical cellular damage is considered to be the underlying common biological factor in essential hypertension. We, therefore, investigated lipid profile lipid peroxidation and Na+K+ ATPase activities of plasma membrane of subjects with essential hypertension. It was found that hypertensive subjects had an elevated lipid peroxidation and decreased Na+K+ ATPase activity in plasma membrane as compared to normotensive healthy controls, the specific yoga training protocol which was administered not only helped to decrease blood pressure but also retard the progression of ceellular damage due to free radicals.

A rare neurological complication of typhoid fever: Guillain-Barre' syndrome

Guillain-Barre’ syndrome is a rare complication of typhoid fever, and only a few such cases have been reported in the pediatric age group. We report a young boy with blood culture proven typhoid fever that developed this very rare neurological complication quite early in the course of the disease. Following treatment with intravenous antibiotics and intravenous immunoglobulin, he improved.