Extensive Muscle Spasms After Unprovoked Dog Bite: Is It Rabies?

We report a 7-year-old incompletely immunized male child who presented with intermittent dyspnea, fever, and extensive muscle spasms following an alleged history of unprovoked Category III dog bite 20 days back with inadequate post-exposure prophylaxis. This case highlights the importance of detailed clinical evaluation including minor signs such as trismus, persistent tetanic muscle contraction in intervening period between muscle spasms and preservation of normal sensorium in the absence of aerophagia and hydrophobia in ruling out a possible diagnosis of rabies in this child, and establishment of diagnosis of less sinister treatable disease with better prognosis

Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia.

OBJECTIVE: To study the utility of red cell distribution width (RDW) in the diagnosis of iron deficiency among children with microcytic hypochromic anemia. METHODS: 151 children (6 months-12 years) with microcytic (MCV<75 fl) anemia were classified into iron deficient (IDA) and non-iron deficient anemia (non-IDA) on the basis of serum ferritin and total iron binding capacity (TIBC). RDW values were obtained on an automated hematology analyzer. Receiver operator curves (ROC) were constructed and the utility of RDW in diagnosis of iron deficiency was studied. RESULTS: The mean RDW value was 18.37+/-2.22% in IDA group (97 children) compared to 16.55+/-1.51 % in the non-IDA group (54 children) (p<0.0001, unpaired t test). In IDA group, the mean RDW value was 16.60+/-1.78%, 17.95+/-1.91% and 20.55+/-1.32% among mild, moderate and severely anemic children (p<0.0001, ANOVA test). The corresponding values in non-IDA group were 16.03+/-1.25%, 16.76+/-1.20% and 16.77+/-2.68% respectively (p=0.269, ANOVA test). At a cut-off value of 17.4%, as obtained from the ROC curve, the sensitivity and specificity of RDW in diagnosis of IDA were 81.0% and 53.4% and a positive and negative predictive value of 63.0% and 72.2% respectively. CONCLUSION: RDW has a limited specificity for diagnosis of IDA among children with microcytic hypochromic anemia.

Strategies for minimizing corticosteroid toxicity: a review.

Glucocorticoids (GCs) are used commonly for the treatment of various pediatric inflammatory and autoimmune diseases. Although potent and generally effective, they are not without risks for producing serious adverse effects, especially when used in high doses for prolonged periods of time. For proper use of systemic glucocortcoids, a basic knowledge of the pharmacology, clinical usage guidelines, and adverse reactions of these agents is imperative. This review article emphasis on the commonly observed side-effects encountered with GC use in children and their underlying basic pathophysiological mechanisms. The appropriate anticipation of these side-effects with timely implementation of the suggested evidencebased guidelines has the potential significantly to prevent, minimize and treat common and disabling complications of glucocortcoid therapy.