Tribhuvan Pal Yadav

Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial

BACKGROUND The study stemmed from an incidental observation of improvement in 2 patients with pityriasis rosea while receiving erythromycin. OBJECTIVE The purpose of the study was to evaluate the efficacy of erythromycin in patients with pityriasis rosea. METHODS A double-blind, placebo-controlled clinical study was performed in an outpatient setting in a major hospital. Ninety patients over a period of 2 years were alternatively assigned to treatment group or placebo group. Patients in the treatment group received erythromycin in divided doses for 14 days. The response was categorized as complete response, partial response, or no response. All patients were followed up for 6 weeks. RESULTS Both groups were comparable with regard to age at presentation, sex, and average duration of disease at the time of reporting to the clinic. Upper respiratory tract infection before the appearance of skin lesions was reported in 68.8% of all patients. Complete response was observed in 33 patients (73.33%) in the treatment group and none in the placebo group (P <.0001). CONCLUSION Oral erythromycin was effective in treating patients with pityriasis rosea.

Risk factors of dengue shock syndrome in children

This retrospective hospital-based study was conducted to evaluate the various risk factors associated with dengue shock syndrome (DSS) in patients (≤18 years of age) of dengue hemorrhagic fever (DHF). Medical records of these 483 patients with DHF (IgM serology positive) were analyzed with reference to shock for various clinical and biochemical parameters. Of the 483 children, 405 were categorized in DHF group (grade I, 282 children; grade II, 123 children) and 78 in DSS group (grade III, 59 children; grade IV, 19 children). Using univariate and multivariate logistic regression and p-value of <0.05 as significant, the presence of spontaneous bleeding, hepatomegaly, signs of capillary leakage like ascitis and pleural effusion, leucopenia <4000 mm(3) and age >5 years were found out to be significant risk factors of shock in pediatrics patients of DHF.

Measurement of Bone Mineral Density by Dual Energy X-ray Absorptiometry in Juvenile Idiopathic Arthritis

ObjectiveTo evaluate bone mineral density using dual X-ray absorptiometry in Juvenile Idiopathic Arthritis (JIA) patients and factors affecting it, if any.MethodsA cross sectional study was conducted by enrolling thirty five patients of JIA and age and sex matched controls. Bone Mineral Density (BMD) and Z score of whole body, total body less head, lumbar spine and distal radius were obtained and adjusted for age, sex, weight and BMI in both cases and controls. Dietary intake of calcium, vitamin D intake, sunlight exposure, weight bearing physical activity, age of onset, duration of disease, disease activity score and treatment received (prednisolone and methotrexate) were recorded.ResultsBMD was significantly lower among patients as compared to controls. Decreased dietary intake of vitamin D and calcium, decreased weight bearing physical activity and sunlight exposure were the major factors for low BMD. Use of steroid also decreased BMD to some extent, whereas use of methotrexate, disease duration and severity did not have a significant correlation with BMD.ConclusionsApart from disease control, it is important to improve the dietary intake of calcium, vitamin D and encourage more physical activities and exposure to sunlight in JIA patients.

Leflunomide in Systemic Onset Juvenile Idiopathic Arthritis.

Methotrexate, the mainstay of treatment in Juvenile idiopathic arthritis, might not be effective in a few patients of polyarticular and systemic onset juvenile idiopathic arthritis. Use of biologicals like TNF-α blockers, the next line of preferred drugs is constrained by the high cost. We successfully used leflunomide in four patients.

A Study of School Adjustment, Self-concept, Self-esteem, General Wellbeing and Parent Child Relationship in Juvenile Idiopathic Arthritis

ObjectiveTo assess school adjustment, self-concept, self-esteem, general wellbeing and parent–child relationship in children with Juvenile Idiopathic Arthritis (JIA)and to study the correlation of these parameters with chronicity of disease, number of active joints, laboratory parameters of disease activity and JIA subtypes.MethodsA total of 64 children (32 cases and 32 controls) were recruited for analysis. Self report questionnaires which included PGI General Wellbeing Measure, Adjustment Inventory for School Students, Parent Child Relationship Scale, Self Esteem Inventory and Self Concept Questionnaires were used to assess all the enrolled subjects.ResultsCases had significantly lower general physical well being (p < 0.001), self- esteem (p = 0.039), social self-concept (p = 0.023) and poorer social (p = 0.002), educational (p = 0.002) and overall (p = 0.006) adjustment as compared to controls. Both parents of cases were significantly more demanding (p = 0.028, p = 0.004)and mothers were over protective (p = 0.009) and pampering with object rewards (p = 0.02). PGI wellbeing score (p = 0.042, p = 0.019) and self concept (p = 0.002, for social SCQ p = 0.030) correlated well with number of active joints and ESR. As the disease duration increased, fathers tended to neglect their children (p = 0.043) and with persistent disease activity (reflected by CRP positivity) even resorted to punishment (p = 0.022) or remained indifferent (p = 0.048).ConclusionsJIA significantly hampers the child’s self-esteem, self-concept, adjustment in school, general wellbeing and evokes disturbed parent–child relationship.

Phenytoin toxicity presenting as acute meningo-encephalitis in children

Phenytoin can produce significant dose-related toxicity because of its zero order pharmacokinetics and is an important issue in pediatric emergency medicine. It is important to differentiate phenytoin toxicity manifesting with symptoms like fever, vomiting, seizures, ataxia masquerading as acute meningo-encephalitic illness, more so at centers where facilities to measure serum phenytoin levels are not available. Here we describe two children with phenytoin toxicity, presenting to the emergency department with features suggestive of acute meningo-encephalitis.

[Idiopathic musculoskeletal pain in Indian Children-prevalence and impact on daily routine].

OBJECTIVES To study the prevalence of idiopathic musculoskeletal pain (IMSP) in school going children and its impact on daily life. METHODS One thousand eighteen apparently healthy school children aged 5-16 years were assessed and analysed for IMSP and its associated problems. Standard tests for significance were applied. RESULTS One hundred and sixty-five (16.2%) children mostly males (55.2%) reported IMSP. Lower limbs (52.1%) were the most common location of pain. More than 1 year of pain history was present in 15%. Thirty-seven percent children complained of discomfort during walking, 30.9%, had pain during physical exercise, 29.2% had difficulty attending lessons and 4.2% had interference in pursuing hobbies. The children were also further sub grouped into preadolescents and adolescents. There was significant difference in pain duration and duration of each pain episode in the two groups (p=0.01). A significant number of children (21.2%) with IMSP reported school absenteeism (p<0.001). A significant number of adolescents had history positive for contact sports (p=0.001). Sleep disturbances were also reported to be higher in children with IMSP (29% vs. 5.7%, p=0.001). Other associated problems in children with IMSP found were day time tiredness (51.1%), headache (47.3%) and abdominal pain (24.8%). CONCLUSIONS Prevalence of IMSP in school children aged 5-16 yrs was found to be 16.2% and a significant percentage of these children experience interference with daily activities including school absenteeism.

Henoch Schonlein Purpura Mimicking Lupus Nephritis-A Rare Case -

Introduction Henoch Schonlien Purpura(HSP ),the most common non granulomatous ,immune complex mediated small vessel vasculitis in children involves multiple organs [1–2]. In adults and infants less than 2 years it tends to have an atypical course with higher rate of gastrointestinal and renal complications [1]. HSP nephritis is reported to occur in 20-80% of patients and characterized by mesangial or mesangioproliferative glomerulonephritis with varying degree of hypercelullarity Rapidly progressive glomerulonephritis is rare in children with HSP. One to seven percent patients suffer from end stage renal disease [3,4]. On Imunofluoroscence renal biopsy shows, predominantly granular deposits of IgA in the mesangium and to a lesser extent IgG or IgM deposits [5]. Full house on inmmunofluorosence is the term given to the characteristic histological findings in lupus nephritis which include glomerular deposits of IgG, IgM, IgA, C3, C4 and C1q [6]. We report a case of HSP who presented with edema over dorsum of hands and feet, arthritis and immune complex mediated rapidly progressive nephritis with full house picture on immunofluoroscencea rare occurrence. Abstract

Odontotrichodysplasia: A Case Report with a Review of Conditions Combining Ectodermal Dysplasia (Subgroup 1–2) with Skin Manifestations

We report a 5‐year‐old girl with partial anodontia, hypotrichosis, hyperpigmentation of the skin, absence of pilosebaceous structures, and long thin fingers. There has as yet been, to the best of our knowledge, no report of such a combination of features. A review of conditions combining ectodermal dysplasia (subgroup 1–2) with skin manifestations is presented.