Meningitis due to Neisseria meningitidis Serogroup B in India.

Invasive meningococcal disease has a fulminant course and high mortality. Neisseria meningitidis serogroup A is predominantly responsible for meningococcal disease in India and the developing countries. Group B meningococcus, which is prevalent in the developing world is uncommon in India. We herein report the second case of group B meningococcal infection from the country, two decades after the reporting of the first case. Ineffective vaccines against serogroup B warrant the need for close surveillance of this disease.

Reversible Posterior Leucoencephalopathy Syndrome in Post Streptococcal Glomerulonephritis.

Reversible posterior leukoencephalopathy syndrome is characterized by an acute, usually reversible encephalopathy, with radiological findings that mainly involve the white or grey matter of the parieto-occipital lobes. We report a case of post streptococcal glomerulonephritis presenting as reversible leukoencephalopathy syndrome. Immediate control of hypertension resulted in rapid and complete neurological recovery.

Antipyretic effects of nimesulide, paracetamol and ibuprofen-paracetamol.

The antipyretic effect of nimesulide has not been adequately compared with paracetamol and ibuprofen-paracetamol combination in children. Hence, a randomized, double blind, and parallel groups' design and multicenter study was conducted on children with respiratory tract infections. Eighty-nine patients with temperatures above 38.5 degrees C were randomly administered nimesulide (1.5 mg/kg/dose), paracetamol (10.0 mg/kg/dose), or ibuprofen-patients combination (10.0 mg/kg/dose), thrice daily for five days. The axillary temperature was recorded at the baseline and at different time intervals post administration of drugs. The hematological and biochemical investigations were performed at the basal level and at the end of the treatment period. The adverse drug reactions were monitored during the trial. All the drugs produced a significant fall in temperature as compared to their respective basal values (p < 0.001). However, on looking at the change in temperatures at different time intervals from the respective basal levels, no significant difference was found among all the drugs. Surprisingly, nimesulide had a tendency to raise serum glutamate pyruvate transaminase and serum glutamate oxaloacetate transaminase levels as compared to its baseline values. There was no marked adverse effect of the drugs on other hematological and biochemical parameters investigated. No other serious adverse reaction occurred in the study. Ibuprofen-paracetamol combination, nimesulide, and paracetamol had almost similar antipyretic effects in children.

Diagnostic utility of ELISA test using antigen A60 in suspected cases of tuberculous meningitis in paediatric age group.

The aim of the study was evaluation of the utility of ELISA test using antigen A60 for rapid diagnosis of tuberculous menigitis (TBM) in paediatric age group. ELISA test based on mycrobacterial antigen A60 (Anda biological, France) was used to estimate specific IgM and IgG antibodies in the sera and CSF of 20 suspected cases of TBM which were selected on the basis of numerous parameters and were smear negative on concentrated smear of CSF. Sera of 20 Montoux negative healthy children was taken as control by detecting IgM and IgG antibodies to A60 antigen. Response to anti-tubercular treatment was observed in all the suspected cases of TBM. This study showed that specificity for diagnosis of TBM by detecting IgM and IgG antibodies in sera was 90% and 80% respectively. Sensitivity of the test by detecting IgM and IgG antibodies in sera was 85% and 80% respectively with positive predictive value of 89.47% for IgM antibody and 80% for IgG antibody. In CSF IgM and IgG antibodies were found in 75% and 60% cases respectively. Both were positive only in 60% of cases. It is concluded from this study that 80-85% cases of TBM in paediatric age group have eigher IgM or IgG antibodies in sera whereas 60-75% have antibodies in CSF.

Urodynamic study of children with voiding problems.

Twenty high risk children aged 5-12 years with various voiding problems were studied prospectively by urodynamics to evaluate the function of their urinary bladder and its continence mechanism. None of them had neuropathic bladder or any obstruction distal to bladder neck. Fourteen out of twenty (70%) had abnormal findings on urodynamics evaluation; 8 (40%) had non-neurogenic neurogenic bladder (NNNB); 3 (15%) had small capacity hypertonic bladder (SCHB); 2 (10%) had atonic bladder (AB) and 1 (5%) had hyperreflexic bladder (HB). We conclude that urodynamic abnormalities are as frequent in high risk Indian children as they are in developed countries. The high risk children should be subjected to urodynamic studies more frequently than being done hitherto and be directed to proper therapeutic modality.

Urinary calcium creatinine ratio and hypercalciuria.

Random urine samples of 352 children in the age group of 5-12 yrs were studied for urinary calcium-creatinine ratio (Uca/Ucr mg/mg). None had any predisposing factor for secondary hypercalciuria. Calcium and creatinine both were estimated by colorimetric method. We observed that Uca/Ucr in the general pediatric population was skewed, the pattern was similar to that described in western children and it was independent of age and sex. The mean and standard deviation (SD) of Uca/Ucr was 0.10 +/- 0.094. Considering mean +2SD as the upper limit of normal, which was 0.29 in this series, the prevalence of hypercalciuria was 6.5%.

Desferrioxamine induced urinary iron excretion in thalassemia.

Twenty one children of beta thalassemia major aged between 2 and 14 years of age on regular blood transfusion were given subcutaneous desferrioxamine. Their serum ferritin, 24 hours baseline urinary iron excretion and subcutaneous desferrioxamine induced urinary iron excretion were measured. The result showed a close correlation between serum ferritin and amount of blood transfusions received by the patient. There was good correlation between serum ferritin and desferrioxamine induced urinary iron excretion. A negative iron balance could be achieved in 15 out of 21 children with one dose of desferrioxamine therapy.

Serum enzyme abnormalities in protein energy malnutrition.

Six serum enzymes, alkaline phosphatase, cholinesterase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transpeptidase were studied in 30 cases of protein energy malnutrition (PEM). The mean serum values of alkaline phosphatase, cholinesterase and lactate dehydrogenase in cases of PEM were significantly lower than the controls, lowering being maximum in PEM Grade IV. The mean serum values of aspartate aminotransferase and alanine aminotransferase in patients with PEM were significantly higher than the controls. The mean serum values of gamma-glutamyl transpeptidase showed similar significant rise in all but PEM Grade IV. The degree of increase in the serum values of these three enzymes were maximum in cases with PEM Grade I. These findings suggest that abnormalities in blood levels of these enzymes occur in any form of PEM and these are related to the severity of the disease.