Fourteen Days vs 28 Days of Albendazole Therapy for Neurocysticercosis in Children: An Open Label Randomized Controlled Trial

Background: There is a paucity of literature to support 14-days albendazole therapy for neurocysticercosis (NCC). Objective: To compare the efficacy of 14-day and 28-day albendazole therapy in the management of children with newly diagnosed active NCC. Study design: Open-labelled randomized controlled trial Participants: Children aged 1-14 years with newly diagnosed active neurocysticercosis. Intervention: Albendazole (15 mg/kg/day) for either 14 days or 28 days. Outcome: The primary outcome measure was proportion of children with radiological resolution of active lesion at 6-month follow up. Secondary outcome measures were proportion of children with seizure recurrence, duration to seizure recurrence and calcification on follow up imaging. Results: 65 children with newly diagnosed NCC were randomized to receive albendazole therapy for 14 days (n=32) or 28 days (n=33). The proportion of children with complete resolution was comparable between the two groups [6 (18.8%) vs. 9 (27.3%); OR (95%CI):0.61 (0.19 to 1.98); P=0.56]. Similarly, proportion of children with seizure recurrence [5(15.6%) vs 2(6.1%); OR (95%CI): 2.87(0.51-16.0); P=0.26] and proportion of children with calcification on follow-up imaging [26(81.2%) vs 23(69.7%); OR (95%CI): 1.88 (0.59-5.99); P=0.39] were also comparable. There were no major side-effects noted during the study. Conclusion: 14-day treatment with albendazole therapy is as effective as 28-day treatment in achieving radiological resolution at six-month follow up. However, high rate of calcification in both the groups indicates need for further evaluation with an adequately powered study and longer follow up

Delivering Electives the Clerkship Way: Consolidating the Student Doctor Method of Training

Student doctor method of clinical training or clinical clerkship provides students with exposure to the entire longitudinal illness of the patient. The students participate in patient care as a part of treating team and can refine their clinical, communication and procedural skills. It provides them with an opportunity to work with the faculty and experience the future workplace. Although the graduate medical education regulations (GMER) provide for student doctor method of training, the time provided is too little and opportunistic. Electives have also been recently added to the new curriculum for the first time. We propose a model to deliver the electives using the clerkship method, so as to consolidate what students learn from the ongoing clerkship. This model is feasible, practical and can be introduced in the current GMER for Indian medical undergraduates without any major disruptions.

Association of Child Neurology (AOCN) Consensus Statement on the Diagnosis and Management of Febrile Seizures

Justification: Febrile seizures are quite common in children but there are controversies in many aspects of their diagnosis and management. Methods: An expert group consisting of pediatric neurologists and pediatricians was constituted. The modified Delphi method was used to develop consensus on the issues of definitions and investigations. The writing group members reviewed the literature and identified the contentious issues under these subheadings. The questions were framed, pruned, and discussed among the writing group members. The final questions were circulated to all experts during the first round of Delphi consensus. The results of the first round were considered to have arrived at a consensus if more than 75% experts agreed. Contentious issues that reached a 50- 75% agreement was discussed further in online meetings and subsequently voting was done over an online platform to arrive at a consensus. Three rounds of Delphi were conducted to arrive at final statements. Results: The expert group arrived at a consensus on 52 statements. These statements pertain to definitions of febrile seizures, role of blood investigations, urine investigations, neuroimaging, electroencephalography (EEG), cerebrospinal fluid analysis and screening for micronutrient deficiency. In addition, role of rescue medications, intermittent anti-seizure medication and continuous prophylaxis, antipyretic medication and micronutrient supplementation have been covered. Conclusion: This consensus statement addresses various contentious issues pertaining to the diagnosis and management of febrile seizures. Adoption of these statements in office practice will improve and standardize the care of children with this disorder.

Referencing Made Easy: Reference Management Softwares

Reference management softwares are a powerful tool in the researchers’ armamentarium. They primarily help in re-sequencing, restyling and reformatting of the citation content in the research manuscripts. They also enable multi-user collaboration on research and allow the researcher to manage database searches and digital libraries. Using these softwares allows synchronization of cloud based digital libraries on multiple electronic devices enabling remote access, and also allows for management of online portfolios. We, herein, describe the basic principles, functions, and limitations of various reference management softwares.

Audience Response System Technology for Pediatric Postgraduate Training

We report our experience of using Audience Response Systemamong 21 pediatric postgraduate residents in pediatrics as amode of teaching. Apart from significant improvement in testscores, three-fourth of the participants felt it was an interestingway to learn actively and was better than the traditional audio-visual presentation during lectures

Approach to Handling a Problem Resident

Many medical postgraduate teaching programs have residents with professional and personal problems that may limit theirperformance. A Problem resident is the one who does not meet the expectations of the training program owing to deficits in knowledge,skill or attitude. Medical administration and faculty of every institution must have a system that is sensitized to handle a difficult learner.Problems need to be addressed before they escalate or result in compromise of patient care. The present review discusses a broadapproach to recognizing a Problem resident and provides suggestions on remedial measures

Electroencephalography in Pediatric Epilepsy

Surface electroencephalography (EEG) is a useful electrophysiological investigation for evaluating a paroxysmal event in children. Itmeasures the electro potential difference between two points on the scalp. It is a non-invasive tool that analyzes neuronal maturation andabnormal cortical excitability. EEG helps in differentiating epileptic from non-epileptic clinical event and focal seizures from generalizedseizure. This review is to discuss the rational use of interictal scalp EEG in diagnosis of epilepsy and different types of epilepsy syndromesin children. It further highlights its role in febrile seizure, first unprovoked seizure, status epilepticus and unexplained coma

Quality of Life in Symptomatic HIV Infected Children.

We conducted a case control study to compare the quality of life (QOL) in 40 cases of HIV infected children and 40 demographically matched controls with other chronic ailments at a referral hospital in Northern India. Quality of life among HIV infected children was significantly better in psychosocial (P=0.008), emotional (P=0.001) and school (P=0.039) functioning. Factors including age (P=0.07), gender (P=0.44), socioeconomic status (P=0.99), clinical (P=0.18) and immunological staging (P=-0.91) of HIV infection did not significantly influence QOL scores. Hence, quality of life in HIV infected children of North India was better than those suffering from other childhood chronic illness.

Predictors of mortality among the neonates transported to referral centre in Delhi, India.

A descriptive study was conducted with an objective to determine the predictors of mortality among referred neonates and to ascertain their transport characteristics. A total of 300 consecutive neonates who were transferred to the centre were enrolled in the study. Following information were recorded: maternal details, birth details, interventions before transportation, details of transportation and neonatal condition at arrival. Detailed clinical assessment and management was done as per standard neonatal protocols. Birth weight <1 kg (OR 0.04; 95% CI: 0.006-0.295, P<0.01) and transportation time >1 hour (OR 5.58; 95% CI: 1.41-22.01, P=0.01) were found to be significant predictors for mortality among the transported neonate. Transport characteristics reflect road transport with limited utility of ambulances and lack of trained health personal. Hence to conclude, extreme low birth weight and prolonged transportation time were found to be significant predictors of neonatal mortality among the transported neonate.

Clinical and Epidemiological Profiles of Severe Malaria in Children from Delhi, India.

Plasmodium vivax is traditionally known to cause benign tertian malaria, although recent reports suggest that P. vivax can also cause severe life-threatening disease analogous to severe infection due to P. falciparum. There are limited published data on the clinical and epidemiological profiles of children suffering from ‘severe malaria’ in an urban setting of India. To assess the clinical and epidemiological profiles of children with severe malaria, a prospective study was carried out during June 2008–December 2008 in the Department of Pediatrics, Guru Teg Bahadur Hospital, a tertiary hospital located in East Delhi, India. Data on children aged ≤12 years, diagnosed with severe malaria, were analyzed for their demographic, clinical and laboratory parameters. All patients were categorized and treated as per the guidelines of the World Health Organization. In total, 1,680 children were screened for malaria at the paediatric outpatient and casualty facilities of the hospital. Thirty-eight children tested positive for malaria on peripheral smear examination (2.26% slide positivity rate). Of these, 27 (71%) were admitted and categorized as severe malaria as per the definition of the WHO while another 11 (29%) received treatment on outpatient basis. Most (24/27; 88.8%) cases of severe malaria (n=27) were infected with P. vivax. Among the cases of severe malaria caused by Plasmodium vivax (n=24), 12 (50%) presented with altered sensorium (cerebral malaria), seven (29.1%) had severe anaemia (haemoglobin <5 g/dL), and 17 (70.8%) had thrombocytopaenia, of which two had spontaneous bleeding (epistaxis). Cases of severe vivax malaria are clinically indistinguishable from severe falciparum malaria. Our study demonstrated that majority (88.8%) of severe malaria cases in children from Delhi and adjoining districts of Uttar Pradesh were due to P. vivax-associated infection. P. vivax should, thus, be regarded as an important causative agent for severe malaria in children.

Informed Consent in Pediatric Practice.

Informed consent is a communication process of providing the patient/parents/guardians with relevant information regarding the treatment and the diagnosis, so that they can make informed decisions. The process of informed consent in pediatric patients is not well understood. The amount of information to be disclosed in an informed consent is a matter of debate. There are four basic elements to the content of informed consent form: nature of procedure, risks, benefits and alternatives. The article delineates the essential elements and legal implications of informed consent in pediatric practice.