Ira Shah

Intramuscular midazolam vs intravenous diazepam for acute seizures

Objective : To determine effectiveness of intramuscular midazolam to control acute seizures in children as compared to intravenous diazepam.Methods: 115 children in the age group of 1 month to 12 years who presented with acute convulsions were enrolled in the study. Patients who already had an intravenous access present were treated intravenous diazepam. Patients without an IV access at the time of convulsions were randomised into 2 groups and treated with either intramuscular midazolam or intravenous diazepam for control of seizures. Time interval from administration of drug to cessation of seizures was compared. Effectiveness of IM midazolam in various age groups, types of convulsions and etiology of convulsions was analyzed. Side effects of both drugs were evaluated.Results: the mean interval to cessation of convulsions with IM midazolam was 97.22 seconds whereas in diazepam group without prior IV access it was 250.35 seconds and in diazepam group with prior IV access it was 119.4 seconds. IM midazolam acted faster in all age groups and in patients with febrile convulsions, which was statistically significant. IM midazolam was equally effective in various types of convulsions be it GTC or focal convulsions. 7 patients (10.8%) had thrombophlebitis associated with IV diazepam administration whereas none of the patients in the midazolam group had any side effects, which was statistically significant.Conclusion: IM midazolam is an effective agent for controlling acute convulsions in children especially in children with febrile convulsions. It has relatively no side effects as compared to Intravenous diazepam and can be used as a first line agent for treatment of acute convulsions in patients with difficult intravenous access.

Aplastic anemia in an HIV infected child.

Hematologic manifestations of HIV in children are common and include anemia, neutropenia, lymphocytopenia, thrombocytopenia that may occur due to many reasons. However, aplastic anemia due to HIV infection is rare and even more so in children. Though anemia is seen with advanced disease and associated with poor prognosis it is treated with various therapeutic modalities. Our patient with aplastic anemia due to HIV infection responded to antiretroviral therapy

Clinical profile of drug resistant tuberculosis in children.

This Cross-sectional observational study was conducted to determine the clinical profile of drug-resistant tuberculosis in children. Patients were classified as monoresistant TB, polyresistant TB, multidrug resistant (MDR)-TB and extensively drug resistant (XDR — TB). We coined a term called as Partial XDR-TB when isolates of Mycobacterium tuberculosis were confirmed to be resistant in vitro to be MDR along with either a fluoroquinolone or an aminoglycoside resistance (apart from streptomycin). Of 500 children analysed, 34 (6.8%) had drug resistant TB. Mean age of presentation was 6.8±3.2 years (Male: Female ratio 13:21). 18 (52.9%) children had been treated for tuberculosis in the past (1 defaulted), 7 patients had been in contact with an adult suffering from drug resistant TB and 3 patients (10.3%) were HIV co-infected. Fourteen children (41.2 %) had MDR TB, 11 (32.4 %) had Partial XDR, 1 each (2.9 %) had polyresistant TB and XDR TB. Clinical features of DR-TB are similar in all age groups. Past history of TB with treatment with antitubercular agents, and contact with adults suffering with drug-resistant TB are important risk factors in development of drug-resistant -TB in children.

Liver Abscess in a Newborn Leading to Portal Vein Thrombosis

We report a male neonate who had liver abscess that resolved with intravenous antibiotics and surgical drainage. However, the child developed complete thrombosis of portal vein with cavernous formation within 16 days of therapy and portal hypertension subsequently. The child is now 2 1/2 years and has extra hepatic portal hypertension but is otherwise asymptomatic.

Antenatal diagnostic problem of congenital rubella.

We present a preterm neonate who developed congenital rubella syndrome in a mother who had rubella at 5 months of gestation. An amniocentesis was done in the mother at that time but amniotic fluid rubella PCR was negative. Thus, inspite of prenatal screening, one cannot definitely conclude absence of perinatal transmission of rubella.

Biliary Atresia and Cytomegalovirus and Response to Valganciclovir

Biliary atresia has been commonly reported with cytomegalovirus (CMV) infection. CMV positive patients may present with a later onset however long term outcome is similar to non-CMV patients. There are very few case reports of role of antivirals in CMV and biliary atresia. We treated a 2 month old girl with biliary atresia who underwent portoduodenostomy at 2½ months of age but continued to have jaundice (bilirubin = 23.6 mg/dl) even after 1 month of Kasai’s surgery and subsequently was treated with valganciclovir for 6 weeks following which her jaundice resolved.

Lymphoma in HIV patients: Varied presentations.

Although lymphomas have been reported in patients with acquired immunodeficiency syndrome, it has rarely been reported from the Indian subcontinent. We present three human immunodeficiency virus-infected patients (two adults and one child) who had non-Hodgkin’s lymphoma - plasmablastic variety, Hodgkin’s lymphoma - nodular sclerosis type II and B cell lymphoma, respectively.

Fetal valproate syndrome

Antenatal use of anticonvulsant valproic acid can result in a well-recognized cluster of facial dysmorphism, congenital anomalies and neurodevelopmental retardation. In this report, we describe a case with typical features of fetal valproate syndrome (FVS). A 26-year-old female with epilepsy controlled on sodium valproate 800 mg/day since 3 years, gave birth to a male child with characteristic features of FVS. She also had 3 spontaneous first-trimester abortions during those 3 years. Sodium valproate, a widely used anticonvulsant and mood regulator, is a well-recognized teratogen that can result in facial dysmorphism, craniosynostosis, neural tube defects, and neurodevelopmental retardation. Therefore, we strongly recommend avoidance of valproic acid and supplementation of folic acid during pregnancy.

Neonatal Hepatitis with Toxoplasmosis

Congenital toxoplasmosis may be subclinical, or may present with multisystem involvement. Most of the symptomatic cases have either ocular or neurological manifestations. A case of congenital toxoplasmosis presenting as isolated hepatitis is reported.

Prophylactic zinc supplementation for prevention of acute respiratory infections in infants and young children

Acute respiratory infection (ARI) is a leading cause of morbidity and mortality among young children in lowand middle-income countries. Specifically, pneumonia – an infection of the lower respiratory tract – resulted in 120 million episodes in 2010 and 1.3 million deaths in 2011, among children under five years of age [1]. Approximately 81% of pneumonia deaths occur during the first two years of life [1], underscoring the need for preventive interventions in infancy and early childhood. Randomized controlled trials (RCTs) have demonstrated the efficacy of prophylactic zinc supplementation on reducing the incidence and severity of acute lower respiratory infections (ALRI) among young children in developing countries [2,3]; the majority of evidence, however, has stemmed from studies of routine supplementation with daily zinc doses for an extended period of at least 3 months. Additional research on the efficacy of shortcourse zinc supplementation for ≤14 days is therefore warranted in order to inform the policy-related question of whether interventions of shorter intervals can achieve comparable results to those achieved with routine supplementation [2].