ABSTRACT
ABSTRACT Lymphangiomas are rare benign tumors that mainly involve the head and neck region in pediatric patients. Lymphangiomas of the small bowel mesentery in adults are rarer. We present two cases of mesenteric lymphangioma with acute abdominal pain on presentation. Case 1: A 38-year-old female presented with abdominal pain, vomiting, fever, and difficult evacuation. On abdominal examination, she had an ill-defined, tender lump, and radiological findings raised a possibility of perforation peritonitis. Thus, exploratory laparotomy was planned. Per-operatively, a mesenteric mass was found, which, on histopathological evaluation, was found to be a mesenteric lymphangioma involving the bowel. Case 2: A 27-year-old male presented with abdominal pain and difficult evacuation. Radiological evaluation revealed a multilobulated lesion involving the mesentery and with differential diagnoses of mesenteric fibromatoses and inflammatory pseudotumor. Histopathological assessment of the resected mass revealed a lymphangioma that was limited to the mesentery. Owing to their rarity and non-specific presentation, mesenteric lymphangiomas are often misdiagnosed on clinical examination and imaging. Thus, histopathological examination is the gold standard to reach a definitive diagnosis.
ABSTRACT
Objectives: To assess intelligence Quotient (IQ) in transfusion dependent ?-thalassemia major patients using Malin Intelligence Scale for Indian Children (MISIC) and to correlate verbal IQ (VIQ), performance IQ (PIQ) and full scale IQ (FSIQ) with serum ferritin levels and annual blood transfusion requirements. Methods: Cross-sectional study design, enrolling 100 patients of transfusion-dependent ?-thalassemia aged 6 years to 15 years 11 months. IQ was assessed using MISIC. Results: Mean (SD) full scale IQ was 95.96 (7.23). IQ was ‘average’ in most of the patients. There was a significant negative correlation of serum ferritin levels with object assembly (r=-0.215, P=0.034) component of PIQ; annual blood requirement with general comprehension component of VIQ (r=-0.275, P=0.006) and age at diagnosis with PIQ (r=-0.273, P=0.006). There was a significant linear correlation of PIQ (r=0.280, P=0.005) and FSIQ (r=0.274, P=0.006) with pre-transfusion hemoglobin. Conclusion: IQ correlates with age at diagnosis and average annual pre-transfusion hemoglobin. This highlights the importance of early diagnosis and maintenance of satisfactory hemoglobin levels
ABSTRACT
Objectives: To evaluate the AIIMS Modified INCLEN tool for the diagnosis of epilepsy. Methods: This cross-sectional study enrolled 250 children aged 1 month to 18 years presenting with complaints of abnormal body movements to either the pediatric or neurology outpatient departments in our institution between October 1, 2018 and June 30, 2020. The All India Institute of Medical Sciences (AIIMS) modified International Clinical Epidemiology Network (INCLEN) diagnostic tool for epilepsy (AIIMS modified INDT-EPI) was administered and a diagnosis was made, which was further verified by a pediatrician or a neurologist. Specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: The study tool had a sensitivity of 87.6% and specificity of 84.0%. The PPV and NPV of the study tool were 86.8% and 84.9%, respectively. Conclusion: The study tool has good psychometric properties for physician assessment with regard to diagnosis of epilepsy.
ABSTRACT
Justification: Global developmental delay (GDD) is a relatively common neurodevelopmental disorder; however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. Process: Seven subcommittees of subject experts comprising of writing and expert group from among members of Indian Academy of Pediatrics (IAP) and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of IAP. Guidelines: GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/ hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.
ABSTRACT
Post-Void Residual (PVR) volume of urine is the amount of urine retained in the bladder after a voluntary void that is measured by catheterization or non-invasively by ultrasonography. The increased value of PVR act as a diagnostic tool in a urological pathology such as a neurological disease/injury to the bladder, mechanical obstruction, infection or medication induced urinary retention. A PVR less than 50ml signifies adequate bladder emptying. The present case is of 3.1mm non-obstructing left renal calculus and Grade III prostatomegaly with increased Post Void Residual urine (91ml). Renal calculi and prostatomegaly, both are common obstructive uropathies which interferes with the normal outflow of urine. Treatment is aimed at relieving the symptoms and to treat the underlying cause as well. The treatment strategies that can be followed are catheterization, stenting, surgery, lithotripsy, hormonal therapy and antibiotic therapy. The Ayurvedic formulation, Varunadi Kashaya and Dashmool Churna are Vata kapha pacifying drugs. With its Mutrala, Deepana, Anulomana, Shothghana, Shoolghana properties, it had successfully eliminated renal calculus, decreased the prostate size and ultimately, lowered the PVR value as evidenced in USG report. There is a considerable relief in the troublesome urological symptoms- dysuria, dribbling micturition, weak urine stream, inadequate bladder emptying and abdominal pain.
ABSTRACT
Background: The World Health Organization (WHO) recommends promotion of nurturing care for early childhood development (NCECD) by focusing on five essential components viz., good health, adequate nutrition, promotion of early childhood learning, responsive caregiving, and safety and security. Indian medical graduates and pediatricians are the keys to successful delivery and propagation of NC-ECD in the community. Their training therefore needs to include skills and knowledge needed to promote and practice ECD. Objective: To evaluate the existing undergraduate (UG) and postgraduate (PG) curricula of pediatrics for components related to early childhood development, assess gaps in the training essential to practice and promote ECD, and suggest recommendations to incorporate NC-ECD in the UG and PG curricula. Process: Indian Academy of Pediatrics created a task force to review the UG/PG medical curricula, consisting of experts from pediatrics and medical education. The task force deliberated on 20 March, 2021 and identified the gaps in current curricula and provided suggestions to strengthen it. The recommendations of the task force are presented here. Recommendations: Taskforce identified that the UG/PG medical curricula are lacking training for propagating early childhood learning, responsive caregiving, caregiver support, and ensuring safety and security of children. The taskforce provided a list of competencies related to ECD that need to be included in both UG and PG curriculum. NC-ECD should also be included in topics for integrated teaching. Postgraduates also need to be exposed to hands-on-training at anganwadis, creches, and in domestic setting.
ABSTRACT
The disabling mental illness anxiety is gradually affecting the modern society in any age group worldwide. The searchfor novel bioactive entity from herbal origin for different disorders has become the center of attraction significantlyfrom the past few decades. Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter known tobe responsible for the anxiolytic activity of most of the potent anxiolytic agents. All the available data of pongamol1-(4-methoxybenzofuran-5-yl)-3-phenylpropane-1, 3-dione (MPD) were based on natural or semi-synthetic source.The synthetic routes were using easily available source and quick, cost-effective, and high yielding process. MPD hastraditionally been acquired from natural sources mainly from the extracts of fruits of Pongamia pinnata and Pongamiaglabra, where the yield value and the yield time are the main drawbacks. Keeping in view of the above aspects in thepresent research, it was approached to synthesize and evaluate the anxiolytic potential 1-(methoxybenzofuran-5yl)-3-phenylpropane-1, 3-dione on experimental animals and docking procedure after its synthesis. The study of MPDon the gross behavior of mice showed a significant Central Nervous System (CNS) depressant effect. Furthermore,its anxiolytic activity was confirmed by observing its reduced locomotion of mice using actophotometer and elevatedplus-maze apparatus. The highest docking score was observed to be −3.22 than the diazepam (−3.21) against GammaAmino Butyric Acid-A (GABAA). The present study provides a promising anxiolytic agent, MPD, which has itspotency due to the GABAA receptor binding and causing the mitigation of the symptoms of anxiety.
ABSTRACT
Background: Hypertensive diseases are commonly seen during pregnancy and remain one of the leading causes of maternal morbidity and mortality. Mostly commonly preferred drugs by health care providers for treatment of severe hypertension during pregnancy are labetalol and hydralazine. However, they require proper storage, intravenous access, and adequately trained staff for usage. Oral nifedipine in contrast is easier to use and widely available. Objective of this study was to report the efficacy and safety of oral nifedipine as compared to intravenous labetalol for treatment of severe hypertension during pregnancy.Methods: It was an open label randomized controlled trial in which 100 women with severe hypertension during pregnancy were enrolled. They were randomized to receive either incremental doses of intravenous labetalol every 20 minutes (total 300 mg) or 10 mg oral nifedipine every 20 minutes (up to 50 mg) to lower the blood pressure to safer levels.Results: Women receiving oral nifedipine took significantly less time to achieve target blood pressure [(37.6±23.3) minutes (SD) as compared to those receiving intravenous labetalol (52.0 minutes±27.95 (SD)]. Women receiving nifedipine for treatment also required significantly lesser doses to control the blood pressure [mean dose 1.8±1.1 (SD) versus 2.6±1.2 (SD) p=0.006]. There were two failures in labetalol group and one failure in nifedipine group. No serious adverse events were reported in either group.Conclusions: Oral nifedipine is equally efficacious to I.V. labetalol for treatment of severe hypertension during pregnancy and is easier to use in low resource settings.
ABSTRACT
Caroli’s disease and Caroli’s syndrome are rare congenital disorders. Caroli’s disease is characterized by multiple sequential cystic or saccular dilatations of the large intrahepatic biliary ducts while Caroli’s syndrome has small bile duct involvement and congenital hepatic fibrosis. The incidence of Caroli’s disease is as low as 1/1,000,000 people. The average age of presentation is early adolescence. Magnetic resonance cholangiopancreatography is a most valuable investigation in diagnosis. Here, we report the case of Caroli’s Type II without renal involvement as late as 6 years of age with severe portal hypertension and hypersplenism. The child had no history of jaundice or recurrent abdominal pain in the past.
ABSTRACT
Bluish discoloration of the skin and mucous membrane is known as cyanosis which is a clinical sign that occurs in many diseases. The causes of central cyanosis are cardiac shunts causing mixing of oxygenated and deoxygenated blood, lung diseases with ventilation-perfusion mismatch, polycythemia, and methemoglobinemia. Methemoglobin is the oxidized form of hemoglobin, which does not bind oxygen and increases the affinity of oxygen for the partially oxidized portion of hemoglobin. Methemoglobinemia may be congenital or acquired (usually drug induced). Congenital methemoglobinemia is a very rarely reported disease that is caused by a deficiency of nicotinamide adenine dinucleotide phosphate-cytochrome b5 reductase enzyme deficiency or by an abnormal hemoglobin called hemoglobin H. Acquired methemoglobinemia is caused by drugs, namely the sulfonamide group and local anesthetics such as benzocaine and prilocaine. Here, we present the case of a 4-year-old girl who presented with complaints of bluishness of the fingers and lips without any other associated symptoms and later on diagnosed as congenital methemoglobinemia.
ABSTRACT
Interprofessional education (IPE) approach allows learners from different health professions viz. – medical, dental, nursing,physiotherapy, psychotherapy, psychology etc., learn from, learn with, and learn about, each other. The scope of learning depends uponthe requirements and curriculum. Interprofessional education can help in creating a workforce that learns to perform collaborativepractice thereby ensuring better health-care outcomes. Medical educators’ and practitioners’ understanding about teaching, learning,and assessment of IPE is rudimentary. Strategies to incorporate IPE in regular curricula need to be debated and barriers associated withits implementation require to be identified. This review highlights the teaching-learning and assessment tools for IPE and discussespotential challenges in its implementation.
ABSTRACT
Background: The objective of this work was to study the anticonvulsant activity of calcium channel blockers verapamil and amlodipine and their interaction with an established antiepileptic drug diphenylhydantoin (DPH) in experimental model of epilepsy in albino rats. Methods: Maximal electroshock (MES) convulsions were induced by electroconvulsiometer and different phases of MES were noted in control and drug treated groups. Effect of different doses of verapamil (dose-5, 10 and 15 mg/kg), amlodipine (dose-2.5, 3 and 3.5 mg/kg) and DPH (dose-0.5 and 1 mg/100 g) on MES was studied. Finally, effect of combined treatment consisting of non-protective dose of DPH with different doses of verapamil and amlodipine were also studied on MES induced seizures. Results: Combination of non-protective dose (0.5 mg/100 g) of DPH with all the three doses of verapamil and amlodipine offered significant protection against MES induced seizures. Conclusions: From the present investigation, it may be concluded that the dose of DPH may be reduced in an antiepileptic individual who is on verapamil and amlodipine therapy.
ABSTRACT
Tablets containing zidovudine and lamivudine (ZILA) were prepared by direct compression method. Optimization studies were done for the selection of glidant, lubricant and coating materials. Evaluation of granuleswere done on the basis of preformulation studies. The prepared tablets were evaluated for physicochemical properties. The in- vitro release studies were performed as per USP and compared with marketed product. The release of zidovudine and lamivudine were analysed by high performance liquid chromatography (HPLC). The ZILA tablets exhibited better release characteristics than the marketed product. Stabilities studies were performed in both blister as well as cold form blister packings. Stabilities studies revealed the suitability of blister package in comparison to the cold form blister packing. From the study it was concluded that the selected composition can be used for the preparation of tablets that can be used for the treatment of HIV-1 and Hepatitis-B after performing studies on animals for its suitability and efficacy.
ABSTRACT
An accumulation of data from in vitro to in vivo model system has established a pivotal role of three crucial ligand activated nuclear receptors RXR, LXR-α and VDR for their ability to regulate an array of genes involved in regulation of fundamental cellular processes to patho-physiological situations. Keeping in view RXR as a common heterodimeric partner for LXR-α and VDR, the present study was designed to dissect the interrelationship between these three nuclear receptors in peripheral blood mononuclear cellular model. The present study revealed that all the three nuclear receptors displayed auto regulation in response to their specific ligands; Both LXR-α and VDR regulated the expression of their heterodimeric partner RXR; and VDR was regulated by LXR-α through its ability to modulate SREBP response element present in the promoter region of VDR gene. Based on these findings, the role of these nuclear receptors could be better understood in various nuclear receptor mediated pathological processes.
ABSTRACT
Leydig cell tumor is a benign tumor of the testis and malignant transformation, if present, is rare. The case presented here showed certain features of malignancy but no infiltration beyond the capsule or metastasis. The case could not be labeled as benign or malignant and patient is on follow-up. Differential diagnosis and clinical implications of a case in the borderline zone are discussed.
ABSTRACT
We report a case of an 18 month old child who presented with sever eosinophilic pneumonia requiring ventilation as a result of round worm infestation. This child presented with symptoms alike acute severe asthma and had high absolute eosinophil count of 9,234/cmm.A course of steroids, albendazole and diethylcarbazine were followed by rapid recovery and a decrease in eosinophil counts to 616/cmm within one month of treatment. This is the first reported case of a child with severe eosinophilic pneumonia requiring ventilation as a result of roundworm infection.