Thirunavukkarasu Arun Babu

Cefotaxime-induced near-fatal anaphylaxis in a neonate: A case report and review of literature

A case of 7-day-old male neonate with cefotaxime-induced near-fatal anaphylaxis is being reported. Child was started on intravenous cefotaxime on day 3 of life in view of early-onset sepsis with pneumonia, following which there was clinical improvement. Child was then shifted out of intensive care to general ward for completion of antibiotic course. One day prior to the planned discharge, child suddenly developed poor sensorium, flaccidity, apnea, and cyanosis within seconds of receiving intravenous cefotaxime and was found to have bradypnea with bradycardia. Prompt resuscitation was carried out with artificial ventilation, adrenaline, and steroids. Spontaneous breathing reappeared and the clinical condition improved.

Gianotti-Crosti Syndrome following immunization in an 18 months old child.

Gianotti-Crosti syndrome (GCS) is an uncommon dermatological condition characterized by distinct, self-limiting, symmetrical, erythematous, papulovesicular eruptions distributed mainly on the extremities, buttocks and face in young children. Although GCS is commonly attributed to viral infections, vaccinations too can rarely precipitate this condition. We report a rare case of GCS following diptheria, pertussis, and tetanus (DPT) and oral polio immunisation in an 18-month-old child along with a review of similar vaccine-induced GCS cases reported in the literature.

Idiopathic intracranial hypertension secondary to ingestion of Morinda coreia and Azadirachta indica leaves extract in infant

We report a case of idiopathic intracranial hypertension (IIH) secondary to ingestion of Morinda coreia (Nonan) and Azadirachta indica (Neem) leaves extract in a nine months old child. This herbal extract is believed to accelerate weight gain in infants and is commonly used in South India.

Buclizine is back again! This time as a pediatric appetite stimulant

Sir, Buclizine is an antihistaminic drug which has been tried in several medical conditions with few or no success. These include motion sickness, allergic conditions, vomiting, migraine, diabetes, insomnia, etc.[1,2] Recently, we came across a campaign by a well-known pharmaceutical company for this forgotten drug, for an entirely different indication. The syrup formulation of this drug is being promoted as an incredible appetite stimulant for weight gain in children. Although this drug was introduced for this indication a few years back, it was not extensively marketed until earlier this year. The representatives issued a promotional literature containing scientific evidence in support of using this drug. The pamphlet mentioned three trials including the one which compares the weight gain due to cyproheptadine. All the three trials were underpowered with doubtful methodology and exaggerated claims and the most recent one of them was published in the year 1991.[3,4] No articles were published from indexed journals. There were no trials conducted thereafter for almost 20 years now. We did an unbiased literature search to check if buclizine is really indicated for this purpose. A Pubmed search revealed no published articles on buclizine and weight gain in the last 40 years, and only a very few before 1970, mostly untraceable non-English articles.[5] None of the standard textbooks of Pharmacology mentioned that this drug is indicated for appetite stimulation. We concluded that there is no convincing literature regarding the use of this drug. There are few questions to be answered. Do children require appetite stimulant at all? This is still a matter of debate, but most authors do not accept using appetite stimulants routinely for all children to enhance growth. Even in children with failure to thrive, appetite stimulants are never a management option.[6] Is the available proof enough to market this drug? Though Buclizine has been used for this indication for some years now, the current spurt in promotional activity may be due to a recent change in brands ownership. By any standards of evidence-based medicine, the currently available evidence is grossly insufficient to recommend its use. Why were no trials conducted recently? On what basis the Drugs Controller General of India (DCGI) would have approved this drug? Buclizine has been licensed for marketing in India long time back probably for another indication. This is being misused now, as the marketing approvals were not indication specific during that time. Though DCGI has no further role here as the drug is already marketed, it does however have the moral authority to check irrational and exaggerated claims. Since most of the mothers complain about their childs weight in spite of normal weight gain, prescriptions of drugs like buclizine are likely to increase. In addition, there is a risk of this drug being used “over the counter.ȁ Evidence from large-scale multicentric randomized controlled clinical trials are needed before this drug can be used as a pediatric appetite stimulant. Until then the onus is on the prescribing doctor to decide if the available evidence justifies use of pediatric appetite stimulants in general and buclizine in particular.

Characteristics of Pediatric Scrub Typhus Eschar in South Indian Children

Knowledge of anatomic location of eschar is useful in diagnosing scrub typhus early in children and to initiate appropriate treatment.

A rare case of complete second arch branchial fistula in a 7-year-old child

Branchial fistulae are formed due to the abnormal persistence of the embryonic branchial clefts. Complete branchial fistula with internal and external opening is extremely rare. We report a rare case of complete second arch branchial fistulae in a 7-year-old boy, which was confirmed by a fistulogram. The tract was completely excised and the patient was successfully treated.

Neurobehavior of term neonates with neonatal hyperbilirubinemia.

Objective: To find the effect of neonatal hyperbilirubinemia on neurobehavior of term infants. Materials and Methods: This study was undertaken in the neonatal unit of our tertiary care hospital. Term neonates who developed jaundice with serum bilirubin value of above 15 mg/dl within 1st week of life were enrolled in the study. Peak total serum bilirubin (PSB) levels of cases were recorded. Age and sex matched normal controls were assigned to every case. Both the groups were assessed by Brazelton′s neurobehavioral assessment scale (NBAS) and the scores of the individual clusters were compared. Results: Habituation, range of state, autonomic regulation and regulation of state clusters were significantly altered in the case group, while motor organization cluster was mainly affected in neonates with severe jaundice (PSB > 25 mg/dl). No differences were noted in the reflex and orientation NBAS clusters. Conclusion: Neonatal hyperbilirubinemia causes definite alteration in the neonatal neurobehavior.

Predictors of Severity in Pediatric Scrub Typhus

ObjectiveTo identify the factors that can predict the severity of scrub typhus in children.MethodsThis prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children <12y of age admitted with fever for more than 7d and positive IgM ELISA for scrub typhus were included in the study. These children were followed during the hospital course and their laboratory results, response to treatment and complications were documented. Cases of ‘severe scrub typhus’ were identified based on criteria from published adult and pediatric studies.ResultsOut of 930 children with fever for more than 7d, IgM ELISA for scrub typhus was positive in 230 children. Ninety one (40.6%) cases fulfilled the criteria of ‘severe scrub typhus’ in children. Out of 45 factors, 27 potential factors were studied. The multivariate analysis identified 5 factors, breathlessness (OR: 6.85, 95%CI: 2.69 to 9.87), altered sensorium (OR: 11.48, 95% CI 3.43 to 10.19), leucocytosis (OR: 3.38, 95% CI 1.12 to 10.16), hypoalbuminemia (OR: 10.78, 95% CI 2.66 to 48.76), and hyponatremia (OR: 10.08, 95% CI 2.11 to 23.42) to be significantly associated with the ‘severe scrub typhus’ cases.ConclusionsBreathlessness, altered sensorium, leucocytosis, hypoalbuminemia, and hyponatremia predict severity in childhood scrub typhus. Presence of these factors should alert the treating physician regarding the need for intensive monitoring, treatment or referral.

Congenital intraoral Fordyce spots

A term newborn boy born to primigravida by spontaneous vaginal delivery presented with poor feeding and small blisters in the lower lip and oral mucosa. The mother had an uneventful antenatal period. Examination revealed multiple vesicles containing clear fluid in the oral mucosa, especially on the inner aspect of his …

Oral contraceptive pills induced hemichorea in an adolescent female with polycystic ovarian disease

Chorea is a neurological adverse effect of oral contraceptive pills (OCPs). The onset of chorea following OCPs usage varies widely from few weeks to several years. We report a rare case of chorea which developed within a week of starting OCPs in an adolescent girl with polycystic ovarian disease.