Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children: A prospective randomized study

Objective: To study and compare the efficacy and safety of intranasal midazolam and intravenous diazepam for treatment of children with acute seizures. Subjects: Children beyond neonatal period hospitalized with acute seizures. A total of hundred seizure episodes, 50 in either midazolam or diazepam group. Interventions: Intranasal midazolam (0.2 mg/kg) and intravenous diazepam (0.3 mg/kg). Results: In the midazolam group, the treatment was initiated within 30s in 78% of the patients as compared to 24% in the diazepam group. There was a significant difference between mean time taken from contact with physician to drug administration between the midazolam (29.02 ± 32.64s) and diazepam group (51.92 ± 33.61s) [p < 0.01]. The mean time of contact with physician to cessation of seizure was almost comparable between the two groups (93.07 ± 74.23s Vs 95.74 ± 79.79s). No significant adverse events were noted in either group. Conclusions: Treatment could be initiated quickly with intranasal midazolam and was efficacious for seizure control. As it is easy to administer, it can be safely recommended for use in domiciliary and home settings for control of acute seizures in children.

Physiological Variables, Psychosocial Factors and Age at Menarche Among Punjabi Girls.

The term menarche signifying the onset of menstruation is merely one manifestation of puberty. The age at menarche has been getting earlier all over the world with varying rates. An average decline of about 4 months per decade has been reported from the United States and in Western Europe over the period 1830–1960, while that in Eastern Europe since the late nineteenth century. There have been reports that there is a fairly good correlation between the age of menarche of mothers’ and their daughters’ (1, 2). The objective of this study was to find out the present age at menarche among Punjabi girls and correlate it with relevant variables. The age at menarche in the present study has been found to be significantly less as compared to data from the same region (Punjab, India). The decline in the mean age at menarche between the mothers and the daughters was statistically highly significant. There was a positive correlation between menarche and weight, height, triceps skinfold thickness, body mass index and maternal age at menarche. No significant correlation was obtained between menarche and income class and a negative correlation was obtained between menarche and birth order.

Perinatal mortality at a tertiary care hospital in Punjab.

The present report is a comparative analysis of perinatal mortality rate (PNMR) over two different periods of seven years each viz. 1982-1988 and 1989-1995. Data of all the perinatal deaths in babies born at Christian Medical College and Hospital, Ludhiana from January 1989 to December 1995 was collected. The cause of death was ascertained by a detailed history, clinical examination and whenever possible, by autopsy and analysed by modified Wigglesworth's classification. The PNMR during both the study periods was exactly the same i.e. 74/1000. There was a significant decline in the early neonatal mortality rate from 32/1000 to 25/1000. This was mainly due to improved survival of preterms as there were better life support measures available in the latter part of study period. In contrast, the still birth rate increased significantly from 42/1000 to 49/1000, thus neutralizing the fall of neonatal mortality. There was no change in the pattern of causes of death. Macerated still births occurring mainly in growth retarded babies and asphyxia remained the major causes of death. Mere provision of health services is not going to decrease PNMR. There is a need to educate 'the ultimate' consumers i.e. the women, for better utilization of these services. There is also an urgent need to sensitize and involve the medical practitioners imparting obstetrical services for solving these issues.

Prevalence of anemia among urban school children of Punjab.

OBJECTIVE: To assess the prevalence of anemia among urban school children of Punjab. DESIGN: Cross sectional study. SETTING: Urban schools of Ludhiana, Punjab. SUBJECTS: Two thousand school children of 5-15 years age. METHODS: Relevant history was taken and a complete physical examination done in all the children. Hemoglobin was estimated using cynmethemoglobin method and peripheral blood smears were also examined. Anemia was diagnosed when hemoglobin was less than 11 g/dl for children of 5-6 years age and 12 g/dl for more than 6 years age. RESULTS: Overall prevalence of anemia was 51.5%. Girls had a significantly higher prevalence of anemia except at 5 years and 10-12 years age. More menarcheal girls were anemic as compared to non-menarcheal ones. The prevalence of anemia was high (38%) even in higher socioeconomic groups. Nearly half (47.6%) of well nourished children were anemic. The mean Hb also was lower than expected normal values in both nutritional groups. Compared to non-vegetarians (38%), more vegetarians (65.9%) were anemic. The commonest blood picture seen was microcytic hypochromic (55.4%). CONCLUSIONS: The present study revealed a high prevalence of anemia among healthy urban school children of higher socio-economic classes. Vegetarians and girls, especially after menarche were more at risk to develop anemia.

Poisoning in children: Indian scenario.

The retrospective data on childhood poisoning from eight regional hospitals in India has been reviewed. The demographic features and types of poisonings encountered have been compared. The analysis of the data indicated that pediatric poisonings constituted 0.23-3.3% of the total poisoning. The mortality ranged from 0.64-11.6% with highest being from Shimla. Accidental poisoning was common involving 50-90% of children below 5 years of age and males outnumbered the females. Suicidal poisoning was seen after 13 years of age and was due to drugs and household chemicals. One of the hospitals in Delhi recorded a very high incidence (66.6%) of drug poisoning in children. The drugs consumed belonged to phenothiazines, antiepileptics and antipyretics. Iron poisoning was seen in younger children. Kerosene was one of the causes of accidental poisoning at all hospitals except Shimla and rural Maharashtra were probably wood charcoal is widely used. Pesticide poisoning was more prevalent in Punjab and West Bengal whereas plant poisoning was very common in Shimla. Significant number of snake envenomation has been recorded from rural Maharashtra. Other less common accidental poisonings in children included alcohol, corrosives, heavy metals, rodenticides, detergents and disinfectants. Thus various regions in the country showed some variation in types and frequency of childhood poisoning which could be attributed to different geographical and socio-economic background.

Predictive utility of clinical and stool parameters in bacterial diarrhoea in children.

A prospective one year study was conducted on children between the ages of 1 month to 5 years hospitalised in the pediatric ward of Christian Medical College, Ludhiana, with the aim of determining the predictive utility of certain clinical and stool parameters in diagnosing bacterial diarrhoea. Among the 204 children enrolled in the study, fever was observed in 40% in both the culture positive and negative groups. Clinical features such as abdominal distension, vomiting and oliguria although had low positive predictive values, their negative predictive values were high. Among the stool parameters, watery consistency and pus cells > 5 HPF were significantly more often observed in culture positive cases. The presence of mucus and pus cells > 5 HPF had good sensitivity (70-80%) but poor specificity (27-40%), while the reverse was true of blood (sensitivity 23%, specificity 89%). Again the positive predictive values were uniformly low while the negative ones were high. In conclusion the clinical and stool parameters were found to be more useful by their absence than by their presence in excluding a positive stool culture.

Biophysical profile of blood pressure in school children.

The study was conducted in an industrial and prosperous city of Punjab to evaluate the biophysical profile of blood pressure (BP) in apparently healthy school children. A total of 2560 children between the ages of 5-15 years were enrolled. Their age, religion, dietary and family history were recorded. Weight and height of all children were measured and body mass index (BMI) calculated. A value of 2.26 or more was taken as obesity. BP measurements were made as per recommendations of the American Heart Association. Systolic as well as diastolic BP increased with age in both sexes, correlation coefficients being 0.59 and 0.6, respectively. A statistically significant linear relationship between BP and weight and height was noted. Children with BMI of > 2.26 had a significantly higher BP (P < 0.01). The mean BP did not vary among different religions. The BP of vegetarians and also non- vegetarians also did not differ. A family history of hypertension was associated significantly with elevated BP (p < 0.01). It is concluded that obesity and a family history of hypertension in children are associated with elevated BP and such children may be at risk for developing hypertension at a later date. They should be followed up and considered for modification of risk factors.

Antenatal period: an educational opportunity.

In this study the impact of an educational programme during antenatal period was evaluated. Pregnant women attending the antenatal clinic formed the study material. The first 100 mothers who were not given health education served as controls. The subsequent 201 cases constituted the study group and were given health education on certain aspects of maternal and child care. The control and study groups were well matched for age, parity, education, income and number of antenatal visits. The results indicated that the mothers in study group gained statistically significant knowledge regarding the purpose of antenatal care, hematinics and tetanus toxoid vaccination. The awareness regarding breast feeding and its advantages also increased significantly in the study group. The knowledge about individual vaccine especially measles and DPT was poor which increased significantly after the educational intervention in the study group. It is recommended that the antenatal period should be optimally utilized to impart health education on the various aspects of maternal and child health.

Waning of post vaccinial allergy after neonatal BCG vaccination.

Tuberculin sensitivity or post vaccinial allergy (PVA) is widely used as an indicator of successful BCG vaccination. The protection conferred by BCG vaccination, the duration of post-vaccinial allergy and the relationship between the two remain a subject of controversy. The present study was conducted with the aim of finding the duration of PVA and evaluate the need for revaccination. One thousand newborns were given BCG under controlled conditions and followed up for PVA by serial PPD (5TU) injection at 3, 6, 12, 24, 30 and 36 months. An induration of 5 mm or less was recorded as negative and no subsequent testing was done. At 3 month, all the infants were given PPD and 95.3% showed a positive response. The positivity rate declined significantly (p < 0.01) to 19% by 3 years of age. A statistically significant (p < 0.01) fall in the mean PPD induration size was also noted. At 3 months, the mean induration size was 10.68 mm but by 3 years it had decreased to 3.86 mm. The distribution of PPD size also showed that with the increase in age, there was a shift towards the smaller size. At 3 years of age, none of the children had an induration of more than 10 mm. The booster effect due to repeated PPD testing was seen in a small percentage and only at 6 and 12 months test. Subsequently no increase in PPD induration was noted. Sex of the child did not influence the PPD induration size significantly (p > 0.05). At 3, 6 and 12 months of age, significant correlation between BCG lesion and PVA was noted, the co-efficient of correlation being 6.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal conjunctivitis: a profile.

Neonatal conjunctivitis is one of the commonest infections encountered in the newborn. A prospective study was conducted on all babies born over a period of one year. No prophylactic ocular medication was instilled routinely in newborns. Babies developing purulent eye discharge were diagnosed to have conjunctivitis. Eye Swab from the neonates and maternal vaginal/cervical swabs were sent for culture. Chloromycetin eye drops were used for treatment and in case of no response, changed as per sensitivity report or to gentamicin eye drops. Oral erthromycin was given for dacryocystitis or when there was no response to topical therapy. The incidence of conjunctivitis was 7.2%. Two seasonal peaks, namely, February and then May and June, were noted. In 91.6% of the babies, conjunctivitis developed within the first week. A prolonged rupture of membranes was associated with a significantly higher incidence of conjunctivitis (p < 0.01). The most common organism grown from conjunctival swab was Staph aureus (35.2%) followed by Enterococcus (4.3%), Klebsiella (3.5%) and E. coli (2.8%). From vaginal/cervical swabs, E. coli was the most common organism isolated. No concurrence of organisms was noted between eye swabs and vaginal/cervical swabs. A uniformly good response to chloromycetin eye drops was noted with only 3.5% requiring a change of therapy. It is concluded that neonatal conjunctivitis is commonly acquired postnatally and responds well to topical chloromycetin therapy. Oral erythromycin may be used in resistant cases which will cover the chlamydial infection also.

Refractive errors in preterm babies.

Fifty preterm neonates were followed up at the age of 6 months and 1 year. In addition to developmental assessment, a complete ophthalmological examination was done on both visits. The largest (62%) gestational age group was of 34-36 weeks. At 6 months, none of the infants had normal vision. At 1 year of age, 64% of the babies had normal vision while incidence of myopia and hypermetropia was 16% and 20%, respectively. There was an inverse relationship noted between gestation and incidence of refractive errors. It was also noted that with decreasing weight, the incidence of myopia increased. Myopia was seen exclusively among infants of birth weight of 2000 g or less. Birth weight had a significant positive correlation with astigmatism. No correlation of asphyxia with refractive errors was observed. It is recommended that all preterm babies should have an ophthalmological examination at one year of age with follow up later on.

Obesity and hypertension in children.

A study was conducted on two thousand five hundred and sixty school children to evaluate the prevalence of hypertension in apparently healthy school children of a prosperous, industrialized city of Punjab. The children belonged to 5-15 years age group of both sexes. The weight (kg) was taken by a standardized weighing machine while height was measured using a calibrated bar. For diagnosing obesity, the body mass index (BMI) was calculated by the formula: [formula: see text] A value of > or = 2.26 was considered as obesity. Blood pressure (BP) measurements were taken by a a mercury sphygmomanometer as per the recommendations of American Heart Association. Hypertension was diagnosed if blood pressure was more than 95th percentile for the age. Family history of hypertension was enquired from the parents of children. The BP of the hypertensive children was reassessed after six and nine months. The prevalence of hypertension was 2.8% at the first screening but decreased to 1.3% and 1.1% by 6 and 9 months, respectively. This fall was statistically significant (p < 0.01). There was no significant difference in the prevalence of hypertension between the two sexes. At the final screening, only children of 11 years or above were hypertensive. A statistically significant correlation with positive family history of hypertension was noted; 85.7% of hypertensive children had positive family history. The prevalence of hypertension was much higher in obese as compared to non-obese children (13.7% vs 0.4%). The correlation between obesity and hypertension was statistically significant (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Safe motherhood: when to begin.

Two thousand five hundred college girls were assessed for their knowledge and attitudes regarding sex, pregnancy and child rearing with the help of a pretested questionnaire. The site of menstruation was known to only 35.3% of the girls. The knowledge about the time and site of conception was 25.3% and 58.2%, respectively. Only 16.3% of the respondents knew the normal route of delivery although the duration of normal pregnancy was known to majority (87.7%). The girls were aware of the ideal timing of abortion (67.5%) but the safe method and legality were poorly known facts. Only 5% of the girls believed in pre-marital sex. More than half (54.9%) of the girls knew about some form of contraceptive, Copper-T being the best known. Nearly one fifth of the girls were either undecided or wished family members to decide about antenatal check-ups. The need for better diet and injections during pregnancy was well known although few (15.2%) were aware of the injections being tetanus toxoid. Only about 10% wanted a home delivery but one fourth felt that a Dai or a relative was suitable for conducting the delivery. An overwhelming majority of the students stated that knowledge about above facts was important and they would like to learn about them preferably during college education. It is recommended that 'Family life education' be provided during pre-adolescent and adolescent years to ensure a safe motherhood and a healthy child.

Perinatal mortality in Ludhiana, Punjab--a seven year hospital study.

Perinatal deaths occurring over a seven year period were studied in a teaching hospital in Punjab. Causes of death were analysed as per Wigglesworth's classification. We have further modified this by correlating different gestations and weight groups with causes of death. The perinatal mortality rate (PNMR) in the present study was 74/1000 and showed a downward trend secondary to a statistically significant fall of early neonatal mortality. There was a decline in PNMR among babies of 1500-2000 g. birth weight and 33-36 weeks gestation. Asphyxia and macerated still births were found to be the two main causes of death. Macerated still births were seen more commonly among babies of lower weight at all gestations. The PNMR of babies born to booked mothers was 22/1000 as compared to 152/1000 among unbooked mothers. It was concluded that to bring down the PNMR, economic development alone is not enough. Provision of adequate antenatal care to all mothers, health education and timely referral of high risk mothers is very essential.