Chellam Kirubakaran

Intermittent clobazam therapy in febrile seizures.

Objective: To evaluate the efficacy of intermittent clobazam therapy in preventing the recurrence of febrile seizures and to assess its safety.Methods: The study was a prospective, randomized, double-blind placebo-controlled trial conducted in the Department of Child Health, Christian Medical College Hospital, Vellore between July 2001 and September 2002. Neurologically normal children between 6 months and 3 years of age with a history of febrile seizures and no evidence of acute CNS infection or EEG abnormality were included into the study. 19 children in a clobazam group and 20 in the placebo group were randomly allocated. Temperature reduction measures with paractamol and tepid sponging were advised to all children. In addition the dispensed medication was to be administered at the onset of fever and continued for 48 hours irrespective of the duration of fever. The children were then monitored for seizures and adverse effects of clobazam. The children were followed up for a mean period of 9.9 months. The analysis was done on the number of febrile episodes in both the groups.Results: There were a total of 110 episodes of fever during the study period. Mean number of febrile episodes in the clobazam group was 3.1 and in placebo group 2.56. Six (12.5%) of the 48 episodes in placebo group and one (1.7%) of 60 episodes in clobazam group had seizure recurrence. This was statistically significant (p=0.01). Drowsiness and weakness were present equally in both clobazam and placebo group whereas ataxia was present only in the clobazam group, the difference being statistically significant (p=0.04).Conclusion: Intermittent clobazam therapy is an effective measure in the prevention of recurrence of febrile seizures. The ataxia due to clobazam was much lower than that reported with diazepam.

Comparison of blood gas values in arterial and venous blood.

Objective : To compare pH and PCO2 values of simultaneously obtained arterial, arterialized capillary, and venous blood samples and also to compare oxygen saturation (ASaO2) measured in arterial blood and oxygen saturation by pulse oximetry (PSaO2).Methods: Prospective study was done in the children admitted in the Pediatric Intensive Care Unit of Christian Medical College Hospital Vellore, requiring critical care. All the three blood gas samples (arterial, capillary and venous) were taken simultaneously and analyzed. Oxygen saturation by pulse oximetry was also recorded.Results: 50 children aged 14 days to 12 years were included in the study. Arterial and capillary pH values were highly correlated (r2=0.9024, p < 0.0001). Out of 16 children with arterial acidosis 9(56%) were identified by capillary blood gas. Arterial and venous pH values also showed good correlation (r2=0.8449, p eric 0.0001). The PCO2 values of arterial and capillary blood gases were found to be highly correlated (r2=0.9534, p < 0.0001). The capillary blood gas accurately reflected the arterial PCO2 in 41 (82%) patients. Arterial and venous blood gas PCO2 values had less correlation (r2=0.5917, p=0.011). The arterial oxygen saturation (ASaO2) and oxygen saturation by pulse oximetry (PSaO2) were correlated moderately (r2=0.7241, p eric 0.0001).Conclusion: Even though arterial blood gas analysis is the gold standard, and when an arterial blood gas sample cannot be obtained, a combination of arterialized capillary blood gas and pulse oximetry can be effectively used in acutely ill children of all ages. Venous samples have a good correlation with arterial samples for pH but are not useful for monitoring blood gas status in acutely ill children.

Quantitation of proteinuria by spot urine sampling

Few studies have shown that calculation of protein/creatinine ratio in a spot urine sample correlates well with the 24-hour urine collection. A study was conducted to compare the accuracy of a spot urinary protein/creatinine ratio (P/C ratio) and urinary dipstick (albustix) with the 24-hour urine protein (24-HUP). Fifty samples from 26 patients were collected. This included a 24-hour urine sample followed by the next voided spot sample. The protein/creatinine ratio was calculated and dipstick (albustix) was performed on the spot sample. This was compared with the 24-hour urine protein excretion. The correlation between the three samples was statistically highly significant (p=<0.001) for all levels of proteinuria. The normal value of protein/creatinine ratio in Indian children was also estimated on 100 normal children attending the OPD and was calculated to be 0.053 (S.E of mean±0.003).

Non-01 Vibrio cholerae septicemia and meningitis in a neonate

Non-01 Vibrio cholerae is known to cause diarrhoea as well as extra-intestinal infections in adults and children. However meningitis in children is a rare occurrence. We report a neonate who developed septicemia and meningitis due toNon-01 Vibrio cholerae.

Malignant otitis externa in an infant with selective IgA deficiency: a case report.

The occurrence of malignant otitis externa (MOE) in infancy is rare. We report a case of MOE in a neonate who was later identified to have selective IgA deficiency. She was successfully treated with oral ciprofloxacin, but developed external auditory canal stenosis, a deformed pinna, persistent facial nerve palsy, temporal bone erosion and hearing loss. No cases of MOE in selective IgA deficiency have been reported in literature. This is also the first report on the use of ciprofloxacin in infants with MOE.

Atypical copper cirrhosis in Indian children.

In addition to ten children with Wilsons disease and one with Indian childhood cirrhosis, nine Indian children, aged from 4 to 15 years, with cryptogenic cirrhosis had significant deposits of stainable copper in their hepatocytes. These nine children had normal or elevated serum caeruloplasmin levels, absence of Kayser-Fleischer rings and a history of sibling death owing to liver disease in four cases. Histologically, fatty change was absent from all the biopsies but Mallorys hyaline, pericellular fibrosis and ballooning of hepatocytes were present in some. Since these children did not conform to the accepted clinical or histological definitions of either Indian childhood cirrhosis or Wilsons disease, they were designated as having atypical copper cirrhosis. The relationship of this group of cases to other types of copper cirrhosis is unknown.

Malnutrition and hypernatraemia in breastfed babies

Summary Despite the well-known advantages of breast-feeding to both mother and infant, malnutrition of breastfed infants does occur. We report two term neonates who presented in the 3rd week of life with severe wasting, hypernatraemic dehydration and pre-renal failure while being exclusively breastfed. Breast milk sodium levels were markedly elevated on admission. Both infants recovered following adequate hydration and showed excellent catch-up growth during follow-up while exclusive breast-feeding was maintained. The critical malnutrition in both cases was detected by the family physician during routine postnatal visits. Both mothers were well motivated toward breast-feeding and were unaware of the severity of the babys illness.

The pattern of liver disease in Indian children: a review of 128 biopsied cases.

We report the pattern of childhood liver disease revealed by a study of 134 biopsies obtained from 128 infants and children below the age of 16 years seen in this hospital during a 3-year period. The most common histological diagnoses were neonatal hepatitis syndrome in 23, storage disorders in 11, and cirrhosis in 26 children. Less common diagnoses included Reyes syndrome in four, fatty liver in seven, granulomas in four, and chronic active hepatitis, fulminant hepatitis, congenital hepatic fibrosis and neoplasms in two children each. Miscellaneous specific diagnoses were made in 16 cases. Twenty-three per cent of the liver biopsies were non-diagnostic. The study has provided background information on the occurrence of specific histological diagnoses in liver biopsies in infants and children in this tropical region and identifies a group with cirrhosis and copper deposition which was not typical of either Indian childhood cirrhosis or Wilsons disease.

Pyknodysostosis : a report of two siblings with unusual manifestations

We report pyknodysostosis presenting as extramedullary haematopoiesis in one of two siblings and as obstructive airway disease in the other. Visceral manifestations are rare and have been reported in only two cases in the Indian literature. They have often been mistaken for osteopetrosis, haemolytic anaemia and other osteochondrodystrophies. The cases we report illustrate that, though the physical characteristics may be similar, it is the radiological features that are typical and help establish the diagnosis.

Disappearing CT lesions in focal seizures

A case of focal seizures with right hemiparesis in a 6-year-old Indian girl is presented. CT scan showed four ring-enhancing lesions in the left cortex. She was treated with phenytoin and a course of praziquantel. The hemiparesis recovered in 3 weeks and a repeat CT scan after 2 months was normal. Arbitrary use of anti-tuberculous therapy in Indian children with focal lesions in the brain is not recommended as the lesions are often due to cysticercosis.