Mechanical Thrombectomy Using Retrievable Stents in Pediatric Acute Ischemic Stroke

Objectives: To report efficacy and outcome of mechanical thrombectomy for treatment ofpediatric acute ischemic stroke with large vessel occlusion using stent retrievers. Methods:Retrospective record review of institutional database for patients <18 years of age. Results:Five boys aged between 6 to 17 years received reperfusion therapy using mechanicalthrombectomy for acute ischemic stroke with large vessel occlusion (2 basilar, 2 middlecerebral and 1 internal carotid artery). Pediatric National Institute of Health Stroke Scale(PedNIHSS) at onset ranged from 12 to 21. Complete recanalization as defined by themodified Treatment In Cerebral Infarction scale (mTICI 3 or 2b) was achieved in all, usingstent retreivers. Favorable outcome as per the modified Rankin scale (mRS 0-1) wasachieved in all with no peri-procedural complications. Conclusions: Mechanicalthrombectomy using retrievable stents is a safe and effective therapy for pediatric ischemicstroke due to large vessel occlusion, and may be offered in carefully selected patients.

Antibiotic associated diarrhea in children.

Context: Keeping in view the recent flooding of the Indian market with antibiotic and probiotic combinations, we decided to look at the prevalence of antibiotic associated diarrhea (AAD) and Clostridium difficile infection (CDI) in children and reviewed evidence available for use of probiotics in the prevention of AAD. Evidence acquisition: We did a PubMed, Medline and Cochrane libary search for literature available in last 25 years. Results: Prevalence of antibiotic associated diarrhea (AAD) is around 11%. Children younger than 2 years and type of antibiotics are the two risk factors identified for AAD. For the pediatric population, CDI reportedly decreased in a tertiary care hospital in India, though number of suspected samples tested increased. The incidence of community acquired CDI is increasing in the pediatric population also. Detection of toxin A and B by enzyme linked immunosorbent assay (ELISA) and detection of toxin B by tissue culture form the mainstay in the diagnosis of C. difficile. Most of the AAD would respond to only discontinuation or change of the antibiotic. Oral metronidazole or oral vancomycin are drugs of choice for CDI. Probiotics reduce the risk of AAD in children and for every 7-10 patients one less would develop AAD. Conclusion: Prevalence of AAD is low and majority will respond to discontinuation of antibiotic. CDI is uncommon in children. Probiotics will prevent AAD in only 1 in 7 children on antibiotics. We need cost effectiveness studies to decide the issue of needing a probiotic antibiotic combination to prevent AAD.