The Efficacy of Different Triptans for the Treatment of Acute Headache in Pediatric Migraine: A Systematic Review

Background: Serotonin receptors 5-HT1B and 5-HT1D in the cerebral arteries are activated by the 5-hydroxytryptophan agonists (triptans) to relieve the discomfort associated with migraines. Even though triptans are often used to treat acute migraines, there is some debate over their effectiveness. Objective: Our systematic review aimed to evaluate the effectiveness of triptans for acute treatment of migraine in young individuals. Methods: Utilizing the databases of Google Scholar, Cochrane Library, and PubMed, a literature search was conducted, and all papers published till July 2022 were included. This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. In addition to the Boolean operators AND, OR, and NOT, the following descriptive terms were also used: “Triptans,” “Pediatric Migraine,” “Migraine disorders,” “Headache,” “Children,” and “Adolescent.” Results: A total of 1047 studies were identified, and 25 articles were finally included in the study. 17 of them were RCTs while the remaining were non-randomized trials. Most studies recruited participants aged between 12-17 years. Among 25 studies, 7 reported sumatriptan use, 3 assessed a combination of sumatriptan and naproxen, 4 were on almotriptan, 1 on eletriptan, 6 on rizatriptan, and 4 on zolmitriptan use. Conclusion: We found that rizatriptan (good tolerability profile with a dose of 5 mg) and sumatriptan (nasal spray, 10 mg and 20 mg) had higher efficiency as compared to other triptans. Regardless of type or dose, all triptans are generally well tolerated by patients, but a few adverse effects such as light-headedness (sumatriptan), nasopharyngitis, and, muscular spasms (sumatriptan/ naproxen), somnolence, and dry mouth (rizatriptan), and dizziness (zolmitriptan group) were reported with the triptans.

Comparison of Full Outline of Unresponsiveness Score and Glasgow Coma Scale for Assessment of Consciousness in Children With Acute Encephalitis Syndrome

Objectives: To correlate the Full outline of unresponsiveness (FOUR) score and Glasgow coma scale (GCS) in the assessment of children with acute encephalitis syndrome (AES). Method: This observational study was conducted in the department of pediatrics of a public sector tertiary care center from January, 2019 to March, 2020. All consecutive patients of AES admitted during the study period (n=150) were recruited. Subjects were analyzed using the FOUR score and GCS on admission, and then 12-hourly till discharge/ death. Treatment-related and demographic variables were collected and analyzed. Correlation between FOUR score and GCS scores was calculated using spearman correlation coefficient. Results: Positive correlation was observed between the GCS score and the FOUR score (n=0.82; P<0.001). Conclusion: FOUR score and GCS were comparable to assess the level of consciousness in patients with AES. The possibility of using FOUR score as an alternative to GCS in children with AES needs to be considered.

Risk Factors of Delirium in Children in Pediatric Intensive Care Unit

Objectives: To determine the prevalence of delirium and its risk factors among children admitted to a Pediatric intensive care unit (PICU). Method: A descriptive study in which consecutive patients admitted to the PICU over a period of 12 months were screened daily for delirium using the Cornell Assessment of Pediatric Delirium (CAPD) score. Treatmentrelated and demographic variables were collected and analyzed. The statistically significant risk factors for delirium were analyzed by multivariable logistic regression for independent associations. Results: Among the 476 screened patients, 96 (20.2%) developed delirium. The independent risk factors associated with the development of delirium were respiratory failure (P<0.001), administration of benzodiazepines during PICU stay (P<0.001), and presence of multiple (?2) risk factors for delirium (P<0.001). The mean length of PICU stay was significantly higher among delirious subjects with P<0.001. Conclusion: Delirium is a frequent complication in critically ill children, and recognition of associated factors may assist in early diagnosis and focussed management.

Unusual Occurrence Of Brain Hydatid Disease In A Patient With Previous Surgical Intervention For Hemorrhagic Venous Infarct

Hydatid disease is an endemic parasitic disease and can occur anywhere in the body and has a variable presentation. On imaging, the lesions have varied appearance ranging from cystic to solid appearing lesions, solitary to multiples. We present a case of 35-year-old female who underwent decompression craniectomy for right temporoparietal hemorrhagic venous infarct and now presented with acute onset of right-sided weakness. Magnetic resonance imaging was suggestive of cerebral hydatid disease. The presented case emphasizes that hydatid cyst should be considered as a possibility whenever a cystic lesion is encountered during imaging

Harlequin Icthyosis: A Rare Disorder.

Harlequin ichthyosis (HI) is the rarest and the most severe form of congenital ichthyosis. It is inherited in an autosomal recessive manner and associated with mutations in gene ABCA12. There have been reports of several families with siblings affected with harlequin icthyosis. Affected infants have severe ectropion, eclabium, diffuse decreased range of motion, thick, dry hyperkeratotic plates, over entire body and scalp and associated deep erythematous fissures. Infants with HI have historically succumbed in the perinatal period to sepsis, respiratory failure and infections, poor nutrition and electrolyte imbalances. It is a rare entity. We report here a case of harlequin Icthyosis infant born to consanguineous parents whose 3 siblings were also affected with the same disorder. Keywo

Microfilaria in malignant pleural effusion: an unusual incidental finding or causative association.

Lymphatic filariasis is common in tropical countries and is endemic in India. Filaria has a wide spectrum of presentation. Filarial lung involvement is usually in the form of tropical pulmonary eosinophilia with pulmonary infiltrates and peripheral eosinophilia. Filariasis presenting with pleural effusion is an unusual presentation. Malignancy in association with filarial pleural effusion is extremely rare and its role in tumorigenesis is controversial. In this context, we hereby report a case of 60 year old male, chronic smoker, who presented with left sided chest pain, cough, breathlessness, generalized weakness and swelling over left infrascapular region. Pleural fluid cytology repeated thrice due to degenerative changes, finally revealed malignant cells along with microfilaria. FNAC from left infrascapular swelling showed cytological features suggestive of metastatic deposits of Adenocarcinoma.

Simpus Apus Sirenomelia – A case report of a rare congenital anomaly.

Sirenomelia, also known as “mermaid syndrome”, is a rare congenital deformity of uncertain etiology. Sirenomelia is characterized by complete or partial fusion of lower limbs, giving the appearance of the tail of a ‘mermaid’. This syndrome is almost always lethal due to associated congenital visceral abnormalities such as severe lung hypoplasia, and abnormalities of the kidneys, large intestines, and genitalia. We hereby, report a case of sirenomeila due to rarity of this condition and term live birth.

Mucopolysaccharidosis type II (Hunter syndrome) – A case report.

Hunter syndrome or mucopolysaccharidosis (MPS) type II is an X-linked recessive disorder caused by a defect in the metabolism of glycosaminoglycans (GAGs). We present a rare case of MPS with a typical presentation of coarse facies, short stature, mild mental retardation and absence of corneal clouding. His radiographic findings were suggestive of MPS and diagnosis was confirmed by demonstrating deficient Iduronate-2-sulphatase enzyme in plasma. We present this case to highlight the distinctive manifestations as well as radiological and definitive diagnostic findings of the Hunter syndrome.

Multidrug-resistant Tubercular Liver Abscess in β-thalassemia.

Background: Liver abscesses in thalassemics are predominantly pyogenic. Case characteristics: 12-year-old thalassemic boy with abdominal pain and high grade fever for 15 days. Observation: CT abdomen revealed multiple liver abscesses. Pus culture and sensitivity showed multidrug-resistant mycobacteria. Patient was started on second line anti-tubercular drugs. Outcome: He responded well with symptomatic improvement and is doing well after 6 months of follow-up. Message: Liver abscess in patients with thalassemia rarely can be tubercular.

Lytic Skeletal Metastasis from Lung Cancer.

We discuss imaging findings in a case of skull and pelvic metastasis from a lung cancer, in a 40-year-old man, who presented with painless parietal scalp swelling.

Acute Demyelinating Encephalomyelitis in a Child Following Malaria.

Acute demyelinating encephalomyelitis usually follows viral infections and its occurrence following malarial infection is very uncommon. We report a 12-year-old girl who presented with encephalopathy and generalized convulsions following complete recovery from the Plasmodium falciparum infection. Diagnosis of ADEM was made on the basis of brain MRI findings.

Therapeutic Applications of Vasopressin in Pediatric Patients.

Context: Reports of successful use of vasopressin in various shock states and cardiac arrest has lead to the emergence of vasopressin therapy as a potentially major advancement in the management of critically ill children. Objective: To provide an overview of physiology of vasopressin, rationale of its use and dose schedule in different disease states with special focus on recent advances in the therapeutic applications of vasopressin. Data Source: MEDLINE search (1966-September 2011) using terms “vasopressin”, “terlipressin”, “arginine-vasopressin”, “shock”, “septic shock”, “vasodilatory shock”, “cardiac arrest”, and “resuscitation” for reports on vasopressin/terlipressin use in children and manual review of article bibliographies. Search was restricted to human studies. Randomized controlled trials, cohort studies, evaluation studies, case series, and case reports on vasopressin/terlipressin use in children (preterm neonates to 21 years of age) were included. Outcome measures were analysed using following clinical questions: indication, dose and duration of vasopressin/terlipressin use, main effects especially on systemic blood pressure, catecholamine requirement, urine output, serum lactate, adverse effects, and mortality. Results: 51 reports on vasopressin (30 reports) and terlipressin (21 reports) use in pediatric population were identified. A total of 602 patients received vasopressin/terlipressin as vasopressors in various catecholamine-resistant states (septic - 176, post-cardiotomy - 136, other vasodilatory/mixed shock - 199, and cardiac arrest - 101). Commonly reported responses include rapid improvement in systemic blood pressure, decline in concurrent catecholamine requirement, and increase in urine output; despite these effects, the mortality rates remained high. Conclusion: In view of the limited clinical experience, and paucity of randomized controlled trials evaluating these drugs in pediatric population, currently no definitive recommendations on vasopressin/terlipressin use can be laid down. Nevertheless, available clinical data supports the use of vasopressin in critically ill children as a rescue therapy in refractory shock and cardiac arrest.

The use of silane-coated industrial glass fibers in splinting periodontally mobile teeth.

In the past, direct stabilization and splinting of teeth using an adhesive technique required the use of wires, pins, or mesh grids. Problems with the current fiber reinforcement materials are their inherent thickness when embedded within composite resin, their availability in fixed widths and their high cost. This paper discusses the use of silane-coated industrial grade glass fibers, which can be bundled in the form of ribbon according to the required thickness and length. Of the three patients discussed in this paper, none has exhibited debonding or recurrent caries over 1-year period. By reinforcing composite splints with these industrial grade glass fibers, dentists can provide patients with restorations and splints that are economical, fracture resistant, and more durable than most alternative splinting materials of the past.

A randomized clinical study to assess the reliability and reproducibility of "Sign Grading System".

Background: Signs such as +, ++ and +++ for mild, moderate and severe stains/calculus are being used in India effectively for more than four decades. However, there are no standardized criteria for grading, and no data regarding how and when this system was introduced, but it became very popular throughout India and is being used since then. Aims and Objectives: An attempt was made here to standardize the criteria on which the grades would be given and designate it as "Sign Grading System". Along with this, the objective of this paper was to evaluate whether this index/system satisfies all the requirements of an ideal index, particularly reliability and reproducibility. Settings and Design: Inter-examiner and intra-examiner reliability and reproducibility of this index was assessed through a randomized clinical study. Patients were recruited from an institutional setting by random selection from the outpatient department. Materials and Methods: One month of training was conducted before the actual start of study. The clinical aspect of the study involved 3 investigators and 50 patients of whom 45 patients were reassessed. All the data were kept blind by a research assistant to reduce bias. Necessary measures were taken to reduce/eliminate the confounding variables, which could have affected the outcome of this study. Cohen's kappa and Fleiss' kappa statistics were employed for statistical analysis. Results and Conclusion: The index fulfills most of the ideal requirements of an index along with a high degree of reliability and reproducibility.

Comparison of intrathecal sufentanil and morphine in addition to bupivacaine for caesarean section under spinal anesthesia

Co-administration of small dose of opioids with bupivacaine for spinal analgesia is advocated because of synergistic action between local anaesthetics and opioids, leading to reduction in doses, intraoperative discomfort and postoperative analgesic requirement. We compared the effects of intrathecal sufentanil with intrathecal morphine, when added to bupivacaine for caesarean sections, Sixty ASA I and II parturients, undergoing caesarean section under spinal anaesthesia, were randomly allocated into three groups of 20 each to receive either injection [inj.] bupivacaine 12 mg [Group I], which was labelled as the control group; inj. bupavacaine 12mg + inj sufentanil lOmcg [Group II] or inj. bupavacaine 12 mg + morphine 0.2mg [Group III] in a double blind clinical trial. The parameters studied were the time of onset, sensory level of the block achieved, total duration of analgesia, any need of rescue analgesics, maternal side effects and foetal outcome. Mean duration of analgesia [hrs] was higher in group III as compared to group I and group II [15.9 +/- 0.96 VS. 1.95 +/- 0.55 and 5.83 +/- 0.39 respectively]; total duration of analgesia was significantly longer with the use of sufentanil and morphine as compared to control [5.83 +/- 0.39 and 15.91 +/- 0.96 vs. 1.95 +/- 0.55]. Onset of block was significantly faster with use of sufentanil in Group II [1.92+0.27] vs. Group I and II [4.64 +/- 0.28 and 4.50 +/- 0.22 respectively]. Analgesia was significantly better with the use of opioids compared to control as no additional analgesic were required in both groups. Side effects with insignificant difference noted were hypotension, nausea, and shivering. However, vomiting had a higher incidence in Group I [8[40%] vs. 1[5%] and 6[30%]]; and the incidence of pruritis and somnolence was higher [6[30%]] in Group II as compared to Group III [2[10%] and 1[5%] respectively]. No adverse effects on foetus were seen with use of opioids and comparable Apgar scores were noted. Addition of small doses of sufentanil or morphine to intrathecal bupivacaine is suitable for use in caesarean section, providing rapid onset and prolonged analgesia but with some side effects like pruritis and somnolence