Children’s Color Trail Test for Objective Assessment of Attention in Children with Attention Deficit Hyperactivity Disorder: A Diagnostic Accuracy Study

Objective: To compare the Children’s Color Trail Test scores in children with and withoutAttention Deficit Hyperactivity Disorder to assess its diagnostic performance in assessingattention-deficit. Methods: 50 children with Attention Deficit Hyperactivity Disorder(diagnosed as per Diagnostic and Statistical Manual, 5th edition) and 50 age- and sex-matched children underwent Test 1 and Test 2 of the Children’s Color Trail Test. A ReceiverOperating Characteristics curve was constructed for the diagnostic accuracy of Children’sColor Trail Test in Attention Deficit Hyperactivity Disorder. Results: The Receiver OperatingCharacteristics curve showed a score ≤32 for Children’s Color Trail Test 1 [AUC: 0.8 (0.71 to0.87); P<0.001] and score ≤40 for Children’s Color Trail Test 2 [AUC: 0.85 (0.77 to 0.92);P<0.001] as the best cut-off for diagnosing Attention Deficit Hyperactivity Disorder.Conclusion: Children’s Color Trail Test is a promising tool for diagnosing attention deficit,and could be used in settings where parent or teacher reports are not available

Autism Spectrum Disorders and Celiac Disease: Is there an Association?

We included 150 children aged 2-12 years with Autism SpectrumDisorders and normal serum total IgA levels, and screened themfor celiac disease using anti-tissue transglutaminase IgA levels.All the children were screen negative, suggesting lack ofpositive association between Autism Spectrum Disorders andCeliac disease.

Intestinal Obstruction in Pediatric Age Group: A Clinico- Pathological Study.

Background: Intestinal obstruction is one of the commonest surgical emergencies seen in pediatric patients. In last few decades, the scenario of diagnosis and management of pediatric intestinal obstruction has been changed due to better understanding of pathophysiology, improvement in diagnostic methods, availability of better antibiotics, safer pediatric anesthesia and advanced pre and post operative intensive care. Objectives: To study the epidemiology, clinical features and outcome of intestinal obstruction in paediatric patients. Methods: The present prospective study was conducted in department of General Surgery, Index Medical College, Indore in paediatric patients admitted with clinical features and diagnosis of intestinal obstruction between July 2014 to June 2016 (2 years). Results: Majority of cases of intestinal obstruction in our study were in age group of 0-1 years (70.2%), followed by the age group of 1-5 years (20.2%) and more than 5 years (9.6%). Conclusion: Majority of patients (70.2%) were of less than one year age, and male to female ratio was found to be 3.5:1. Congenial causes of intestinal obstruction were more common (61.7%) than the acquired causes. Intussusception (18.1%) was the commonest cause of intestinal obstruction in this series.

Delayed Diagnosis of Dopa-responsive Dystonia in Two Siblings.

Background: Dopa responsive dystonia is characterized by progressive disabling dystonia, diurnal variation and a dramatic response to Levodopa. Case characteristics: Two siblings presented with regression of motor milestones and hypertonia in lower limbs. History of diurnal variation was present in elder sibling. Outcome: Both responded dramatically to Levodopa. The genomic DNA analysis of elder sibling revealed a novel mutation. Message: A trial of Levodopa should be considered in a child with motor regression with diurnal variation, in the presence of extrapyramidal features.

Health-related Quality of Life in Children with Cerebral Palsy and Their Families.

Objective: To determine the health-related quality of life in children with cerebral palsy and their families. Methods: One hundred children (3-10 years of age) receiving regular rehabilitation therapy for cerebral palsy for last 1 year at a Child Development Centrer were enrolled and the Lifestyle assessment questionnaire – cerebral palsy was administered to the parents. Results: 9% had good, 24% had mildly-affected, 37% had moderately-affected and 30% had severely-affected healthrelated quality of life. The physical independence, mobility and social integration dimensions were much more severely affected than the clinical burden, economic burden and schooling dimensions. Conclusion: Health-related quality of child is affected in most children with cerebral palsy.

Attention Deficit Hyperactivity Disorder in Adolescent School Children.

The prevalence of Attention deficit hyperactivity disorder was estimated in 500 adolescents using Conners’ parents and teachers rating scales. Thirty six (7.2%) adolescents had positive scores on both the scales. The parents and teachers also completed a Diagnostic and Statistical Manual-IV based questionnaire which showed good agreement with Conners’ rating scales.

Solubility enhancement of poorly water soluble drug by using nano-suspension technology.

Solubility is an essential factor for drug effectiveness, independent of the route of administration. Poorly soluble drugs are often a challenging task for formulators in the industry. Conventional approaches for enhancement of solubility have limited applicability, especially when the drugs are poorly soluble simultaneously in aqueous and in non-aqueous media. Nanosuspension technology can be used to improve the stability as well as the bioavailability of poorly soluble drugs. The problem is even more complex for drugs like itraconazole, simvastatin, and carbamazepine which are poorly soluble in both aqueous and nonaqueous media, belonging to BCS class II as classified by biopharmaceutical classification system. Formulation as nanosuspension is an attractive and promising alternative to solve these problems. Nanosuspension consists of the pure poorly water-soluble drug without any matrix material suspended in dispersion. Preparation of nanosuspension is simple and applicable to all drugs which are water insoluble. A nanosuspension not only solves the problems of poor solubility and bioavailability, but also alters the pharmacokinetics of drug and thus improves drug safety and efficacy. This review article describes the preparation methods, characterization, and applications of the nanosuspension.

Ages and Stages Questionnaire as a Screening Tool for Developmental Delay in Indian Children.

Objective: To evaluate the ability of ‘Ages and Stages Questionnaire’, a parent completed developmental screening questionnaire to detect developmental delay in Indian children. Design: Cross-sectional study. Setting: Child Development Clinic of a tertiary care center located in Northern India Participants and Methods: 200 children, 50 each in the age groups of 4±1, 10±1, 18±1 and 24±1 months were recruited (20 high risks and 30 low risks in each age group). The Ages and Stages Questionnaire (ASQ) was translated into Hindi and administered to the parents, followed by standardized development assessment using Developmental Assessment Scale for Indian Infants (DASII). Results: 102 (51%) children failed on ASQ and 90 (45%) children failed on DASII. The overall sensitivity of ASQ for detecting developmental delay was 83.3% and specificity was 75.4%. The sensitivity was best for the 24-months questionnaire (94.7%) and specificity was best for the 4-month questionnaire (86.4%). The sensitivity of ASQ was much higher in the high risk group (92.3%) as compared to the low risk group (60%). Conclusion: ASQ has strong test characteristics for detecting developmental delay in Indian children, especially in high risk cases. It may be easily converted into other Indian languages and used widely for developmental screening.

Add-on Lamotrigine in Pediatric Epilepsy in India.

Lamotrigine is a newer antiepileptic drug useful as oral adjunctive therapy in refractory epilepsy. Indian data on use of lamotrigine is limited. This study was conducted to evaluate add-on lamotrigine in Indian children with epilepsy. Twenty children (median age 90 months) receiving lamotrigine as add-on therapy for mean 26.7 (19.1) months, were followed for a median period of 7.9 (6-10) months. Follow-up was done every two weeks. The most common seizures types were either generalized tonic-clonic (6, 30%) or myoclonic (8, 40%). The average dose used was 3.86 mg/kg/day (with concomitant valproate). Good response (>50% reduction) or complete seizure control was seen in 72% patients. Side effects were seen in 27.5% patients and were ‘mild’ in more than half of these. Lamotrigine was stopped in two patients due to adverse reactions, which resolved on stopping the drug. Lamotrigine was observed to be an effective, add-on, broad-spectrum antiepileptic with ‘mild’ side effects in Indian children.

Res ipsa loquitor in post mortem examination.

The doctrine of Res ipsa loquitor means that “facts or thing speaks for itself”. It signifies that further details are unnecessary; the facts of the case are self-evident. This doctrine is applied when there is gross medical negligence on the part of treating doctor. It is often being presented when the damage resulted from teamwork where the doctor and some other persons were involved. In such circumstances, the doctor himself being ignorant about the cause of damage and the person actually responsible may find it difficult to prove his innocence, though he may actually be innocent. I am presenting here a case report of year 2008, which is a new type of example of Res Ipsa Loquitor in which an expert opinion was given by a board of medical doctors about medical negligence as per orders of Hon’ High Court on the basis of documents forwarded by Police.

Iron Deficiency in Indian Children with Attention Deficit Hyperactivity Disorder.

A case control study was conducted at the Child Development and Early Intervention Clinic to determine the body iron status of children with ADHD, and study the correlation between the body iron status and ADHD symptoms. Serum ferritin was measured in newly diagnosed cases with ADHD and compared with that of controls. Correlation was studied between serum ferritin levels and the severity of ADHD symptoms as determined by Conners’ Rating Scale. Serum ferritin was found to be significantly lower in children with ADHD (6.04 ± 3.85 ng/ mL) as compared to controls (48.96 ± 41.64 ng/mL, P value<0.001). There was a significant negative correlation between serum ferritin levels and oppositional subscore on Conners’ Rating Scale.

Locked-in syndrome: A rare manifestation of pediatric stroke.

Locked-in syndrome is characterized by upper motor neuron quadriplegia, paralysis of lower cranial nerves, bilateral horizontal gaze palsy and anarthria, with preserved consciousness. It is due to a ventral pontine lesion following a basilar artery occlusion. We report the first Indian case report of locked-in syndrome, a 10-year old girl in whom the syndome was preceded by a ‘herald hemiparesis’. Although the exact etiology for the basilar artery occlusion could not be determined, treatment with low molecular weight heparin and warfarin was followed by partial recovery.

Morphometric evaluation of nucleolar organiser regions in reactive and neoplastic lymph node lesions.

Argyrophilic nucleolar organiser regions (AgNORs) have widely been used for making diagnostic as well as prognostic statements in neoplastic lesions. The present study was aimed at the quantitative and morphometric analysis of AgNORs in various lesions of lymph node. Thirty cases consisting 10 cases each of reactive lymphadenitis, non-Hodgkin's lymphoma (NHL) and metastatic deposits from carcinoma breast were included in the present study. Out of the ten cases of NHL, there were four cases of low grade and six cases of high grade lymphoma. The quantification of AgNOR dots and their morphometric evaluation were done using a specific programme of an automatic image analyser. The results revealed that mean AgNOR count was maximum in metastatic lymph nodes (5.37 +/- 0.35) when compared with NHL (high grade 5.12 +/- 0.27; low grade 4.61 +/- 0.13) and reactive lymphadenitis (2.45 +/- 0.49). The mean area of single AgNOR dot in metastatic lymph node, high grade lymphoma, low grade lymphoma and reactive lymphadenitis were 123.3 +/- 26.1, 95.3 +/- 12.2, 99.6 +/- 6.53 and 87.4 +/- 8.45 respectively. Similarly, the mean of total AgNOR area in metastatic lymph nodes was highest (668.4 +/- 169.9) followed by NHL (high grade 496.35 +/- 53.2; low grade 459.25 +/- 37.35) and reactive lymph node (215.0 +/- 37). However, the ratio of single AgNOR area to nuclear area was maximum in reactive lymphadenitis (0.132 +/- 0.001) followed by low grade NHL (0.083 +/- 0.0096), high grade NHL (0.073 +/- 0.0098) and metastatic lymph nodes (0.064 +/- 0.001). The ratio of total AgNOR area to nuclear area was also minimum in reactive lymph node when compared with other neoplastic lesions. Statistically, the p-value revealed a highly significant difference among all these lesions. Thus, it can be concluded from the present study that AgNOR count and other morphometric parameters are significantly altered in different lesions of lymph node which may aid in differentiation of problematic cases.