A Study on the Clinical profile and the Outcome of Treatment of Congenital Hypothyroidism in Children– Early versus Late diagnosis

Hypothyroidism is one of the most common diseases in pediatric endocrinology. Congenital hypothyroidism in this vital period will result in mental retardation and other neurological sequelae and is one of the commonest causes of preventable mental retardation and hence early diagnosis and treatment is mandatory. Methods: The prospective, observational study was conducted in Department of Pediatrics, Institute of Maternal and Child Health, Calicut Medical College for a period of two years on the Clinical profile and the outcome of treatment of Congenital hypothyroidism in children based on their age at diagnosis (below one year versus above one year) . After getting informed consent, history was taken. Physical and systemic examination was done. Anthropometric measurements were taken and laboratory investigations were done. Treatment was given and followed up to see the effect. Results are expressed in terms of frequencies and means. Data is analyzed using SPSS. Results: Delayed passage of meconium, constipation, prolonged physiological jaundice, wide fontanels and umbilical hernia were the clinical features present in a statistically significant proportion in the early treated group. Microcephaly, short stature, macroglossia, dry skin, and delayed bone age was high in the late diagnosis group. Treatment outcome was comparable in both groupsexcept for improvement in coarse facies and development quotient. Conclusion: Developmental delay at diagnosis is a significant problem even in the early diagnosis group, emphasizing the need of new born screening program. Irrespective of the age at diagnosis, thyroxine replacement helps to attain a comparable intellectual and physical development.

Management of pain in leukemic children using the WHO analgesic ladder.

Objective. To ascertain the effectiveness of WHO analgesic ladder in pain management in children with leukemia. Methods. Children with leukemia who were referred to a pain and palliative care clinic attached to the Department of Pediatrics of a medical teaching hospital during a period of 6 months, were included in the study. Results. Thirty nine (39) children, who constituted 64% of children on treatment for leukemia, required referral to pain and palliative care services during the study period. Of these 92% had Acute Lymphocytic Leukemia (ALL) and 8% had Acute Non Lymphocytic Leukemia (ANLL). 95% of children had nociceptive pain and 5% had neuropathic pain. Step – 1 analgesia was effective in 12 (31%) children and 21 (54%) could be managed with Step – 2 analgesia. Step – 3 analgesia was required in only 6 (15%) children. Step 3 analgesia was required in children with neuropathic pain and bone pain. Conclusions. WHO analgesic ladder is effective in managing pain in children with leukemia. Majority of cases of cancer pain in children could be managed by the treating physician using non-opioids, weak opioids and adjuvants as per the WHO guidelines. Children with bone pain and neuropathic pain may require referral to specialist services and use of strong opioids like morphine. The study emphasizes the need for establishing specialist pain management services in all centres where children with cancer are treated.

Thiamine responsive megaloblastic anemia.

This report describes a female child with thiamine responsive megaloblastic anemia syndrome (Rogers syndrome), presenting with anemia and diabetes mellitus responding to thiamine. She also had retinitis pigmentosa. The anemia improved and blood sugar was controlled with daily oral thiamine. Previously unreported olfactory abnormalities, as described in Wolfram syndrome, were also present in our patient.

Temperamental traits and psychological problems of children with bronchial asthma.

Children with persistent asthma were compared with an age and sex matched control group for psychological problems and temperamental traits. Childhood Psychopathology Measurement Schedule (CPMS) and Temperament Measurement Schedule were used to assess psychological problems and temperamental traits, respectively. 69% of children in the study group scored more than the cut-off score on the CPMS compared to 13% in the control group (P < 0.01). Children in the study group showed significantly more behavior problems, conduct symptoms, anxiety, depression and emotional problems compared to children in the control group. Children with asthma also received significantly low score on the temperament dimension of rhythmicity.

Intrathecal tetanus immunoglobulins in the management of tetanus.

OBJECTIVE: To study the clinical profile, treatment and outcome of tetanus in children treated with intrathecal tetanus immunoglobulin. (TIG) METHODS: Retrospective analysis of hospital records of tetaus cases admitted to the pediatric ICU during the five year period between 1999 to 2004 was done. RESULTS: There were 66 cases of tetanus treated with intrathecal TIG. Children below 5 years formed 53% of cases and 47% were above 5 years. Totally unimmunized children constituted 82% of cases and 18% partially immunized children. The portal of entry was otogenic in 58% of cases and injury in30% of cases. The common complications observed included thrombophlebitis, aspiration pneumonia, laryngospasm and autonomic system involvement. There were no complications specific to intrathecal administration of TIG. The mortality due to tetanus was 9%. DISCUSSION: Mortality and morbidity due to tetanus was less in the present study compared to other centers where TIG is given intramuscularly. CONCLUSION: Intrathecal TIG is effective in the treatment of mild and moderate tetanus. Randomized controlled clinical trials are needed to evaluate the efficacy of intrathecal TIG in the management of severe tetanus.

Temperamental traits associated with conversion disorder.

The aim of this study was to analyze the temperamental traits associated with conversion disorder in children. Thirty children with conversion disorder attending a child guidance clinic were compared with an age and sex matched control group of normal children for life stresses and temperament dimensions. The temperament measurement schedule (TMS) and the life event scale for Indian children (LESIC) were used for evaluating the temperament dimensions and life stresses respectively. Children with conversion disorder experienced significantly more stressful life events compared to the children in the control group. The stress factors included scholastic difficulties, examination failures, punishment by teacher, conflict with peers, parental disharmony and family problems and sibling rivalry. The characteristic temperamental traits associated with conversion disorder were low emotionality and low threshold of responsiveness.