Study of Epilepsy and its Correlation with Neuroimaging and Drug Therapy

Background: Thousands of people in the world suffer from epilepsy. Inspite of modern advances, it can be controlled in only 80% of treated once. Diagnosis and treatment of epilepsy is still challenged. The present study is attempted to highlight the importance of clinical findings and role of EEG and CT scan and MRI in diagnosis of epilepsy2.Aim:To study the incidence and epidemiological profile, various types of epilepsy and correlation with MRI, CT SCAN, EEG and the effectiveness of various Anti epilepticdrugs in different types of epilepsy. Settings and Design: This is a prospective study carried out at Civil Hospital, Ahmedabad.Methods:All the patients having 2 and/or more unprovoked seizures and already enrolled patients in epilepsy clinic in 1 year duration from January 1,2020 to December 31,2020 were included.Results &Conclusions:Out of 6930 total admissions, 163 patients with epilepsy were enrolled in this study from age group of 1 month to 12 years. Out of 163 patients, 97 were male and 66 were female. Most common age group affected is of 1-5 years. 128 patients (78.62%) were of generalized epilepsy and 35 patients were of partial epilepsy. Most common precipitating factor in epilepsy is inadequate drug dosages (45%). 45 patients (22.7%) have developmental delay. Abnormal EEG findings were present in 123 patients (75.46%). Abnormal MRI findings were present in 37 patients (22.7%). CT scan was done in 56 patients, 20 were abnormal. 107 patients were on monotherapy and 56 patients were on polytherapy. Valproate is most commonly used drug (76.6%).

Study on Clinico – Etiological Co-Relation and Management Modalities in Children with Pleural Effusion

Introduction: Pleural effusion, abnormal accumulation offluid in pleural space, differ Signicantly in children from adultsin relation to etiology, management and outcome. Objective ofthis study is to identify common causes of pediatric pleuraleffusions; to describe the clinic-etiological profile and itsco-relation with radiological finding and management andearly outcome of pleural effusion in children. Study Design:Prospective Hospital based Observational study.Material and Methods: Patients with pleural effusion wereevaluated by chest X-ray and USG in all cases and CT scanthorax in difficult cases. Pleural fluid samples were analyzedfor glucose, protein, cytology and culture, CBNAAT (asand when required). Intercostal tube drainage was given inempyema cases VATS and decortications Was done in specificcase.Results: Commonest etiology of pleural effusion wasempyema (52% cases), followed by tubercular pleural effusion(26% cases). Most common organism isolated from pleuraleffusion was Mycobacterium tuberculosis (21.79%) followedby staphylococcus aureus. There is signicant correlationamong age and etiology (p value 0.015), tuberculosisoccurred more in older children and empyema occurredmore in younger children. There is no signicant correlationamong weight and etiology (p value 0.200), between genderand etiology of pleural effusion (p value >.05) in our study.There is signicant correlation of pleural fluid neutrophilcount (p value 0.001), lymphocyte count (p value 0.002)with etiology, but no correlation was seen with protein (pvalue 0.060), LDH (p value 0.353), glucose (p value 0.799)in our study. The successful management of pleural effusionlines in intravenous administration of antibiotics along withintercostals drainage tube.Conclusion: Regarding etiology of pleural effusion empyemaand tuberculosis are very commonly encountered in clinicalpractice. Staphylococcus aureus is the most common pathogen.Regardless of which treatment is used in pleural effusion, theoutcome for children is generally excellent.

Study of Vit D3 Level in Lower Respiratory Tract Infection Patient

Low serum 25-hydroxyvitamin D (25[OH] D) levels have been associated with increased susceptibility to and severity of lower respiratory tract infections. Hypovitaminosis D may be a modifiable risk factor in the severity of lower respiratory illnesses. Aims and Objective: The aim is to study the association of vitamin D deficiency with lower respiratory tract infections in children from 1 month to 12 year of age admitted in civil hospital pediatric ward. Methods: All patients aged 1 month to 12 years with lower respiratory tract infections admitted as inpatient in the Department of Pediatrics, civil hospital ahmedabad has been tested for serum Vitamin D levels by standard serological test.Informed consent had taken from the parents. All data collcected with use of preformed performa. About 3 ml of blood is collected and sent for serum 25 (OH) vitamin D analysis. Results & Conclusion: Total 75 patients has been enrolled in this study. Patient from 1 month to 12 years were included. Out of 75 patients, 44 are male child and 31 are female child. Out of 75 patients, 43 patients have sufficient vitamin D level while 21 patient have vitamin D insufficiency and 11 patient have vitamin D deficiency. Vitamin D deficiency and no. of respiratory tract infections were more in male children than female children. Vitamin D levels were low in children who were exclusively breast fed for 6 months (65.6%). Vitamin D levels were low in children who had poor exposure to sunlight (78.1%). There is no significant association between lower respiratory tract infection and vit D3 level.

A Study of Clinico-Etiological Profile and Early Outcome of Neonatal Seizure

Background: Neonatal seizures are an important cause of mortality and morbidity in newborn period. This study was aimed to find out most common clinical type and etiology of neonatal seizure and their co- relation with early outcome.Methods: We prospectively reviewed the history and evaluated the newborns with seizures and also collected samples for biochemical investigations in neonatal ICU at tertiary health care centre and analysed the early outcome. Results: Total 90 newborns were recruited in the study , out of which, 38.8% newborns developed subtle seizure, followed by tonic in 32.8% , clonic in 23.3% and myoclonic in 5.5% neonates. Among the various etiological factors of seizure, birth asphyxia was the most commonly seen in 34.4% neonates. Second most common cause was septicaemia alone in 21.1%. In birth asphyxia most common type of seizure seen was subtle seizures (40.6%). Most common type of seizure in both term (58.3%) and preterm (31.8%) neonates was subtle seizure .Data suggests that the leading cause of mortality was birth asphyxia seen in 7.77% neonates and was more common in preterm neonates (4.44%) followed by septicaemia alone( 3.33%) neonates. Conclusion: According to present study, there was significant correlation between birth asphyxia and subtle seizures which was more commonly seen in preterm neonates. Also higher chances of mortality was found to be in neonates with birth asphyxia which can be prevented by adequate neonatal resusucitaion during first golden minute.

Study of ocular manifestations in children of thalassemia.

Background: Purpose of current study was to study the ocular manifestations in beta-thalassemia major patients and assess the ocular side-effects of iron chelating agents. Methods: Cross sectional study included 45 β Thalassemia major patients from age group of 6months to 12 years were taken. Full medical history, thorough physical examinations were done to all patients groups, and ophthalmological examination to determine the prevalence of ocular manifestations for all patient groups and to correlate these manifestations or changes with iron chelating agents. Results: In 45 patients (22 males and 23 females) with age ranging between 2 years to 12 years, ocular involvement is seen in 35% in the form of decreased visual acuity 26%, tortuous blood vessels in 4.5%, disc hyperemia in 4.5%, heterochromia in 2.5%, retinal pigment epithelium mottling in2.5% and this involvement were more with older age group. Conclusion: Most of the ocular changes of beta thalassemia are attributed to the course and severity of the disease. Reduction in serum iron and serum Ferritin levels by iron- chelating agents and regular ocular examination to look for side-effects of such agents can aid in preventing or delaying ocular complications.

Study of clinical profile of childhood extra pulmonary tuberculosis.

Background: Tuberculosis is the second most common cause of death from infectious disease at the global level, being second only to AIDS. Good data on the burden of all forms of TB amongst children in India is not available; most surveys conducted have focused on pulmonary TB. The present study was designed to study clinical profile of various forms of childhood EPTB. Objective of current study was to study clinico-epidemiological profile of various forms of childhood EPTB. Methods: Retrospective analysis of clinical profile of 100 patients of childhood EPTB in the age group of 6 months to 12 years. Results: Age distribution in our study showed that 62% cases falling in the age 0-5 years and 38% cases in 5-12 years (P = 0.041) with male to female ratio of 1.9:1. 96% (P = 0.016) of the patients belonged to the lower socio-economic class (P = 0.01). The distribution of EPTB was - TBME (46%), disseminated TB (21%), pleural effusion (12%), abdominal TB (10%), TB lymphadenitis (7%), Osteoarticular (4%). 28% of the patients had mild to moderate malnutrition (PEM Grade-I,II) and 46% (PEM Grade-III,IV) were severely malnourished. 66% of the patient were BCG vaccinated & history of Koch’s contact were present in 28% of the all cases. In CNS tuberculosis, fever was present in 97% followed by altered sensorium & convulsion in 80%, tonic posturing in 60% & abnormal movements in 4% and in most common sign was tonic posturing in 60%, crack pot sign positive in 41%. In abdominal tuberculosis - fever (100%), anorexia (90%), weight loss (80%) abdominal pain (50%) & hepatomegaly was common finding seen in 100% of abdominal tuberculosis. Conclusion: Childhood EPTB is commonly seen in children age more than 1 year, lower socioeconomic class & in severely malnourished. CNS tuberculosis commonly present with fever, altered sensorium, convulsion, abnormal movements while abdominal TB present with fever, anorexia, weight loss & abdominal pain.