Comparative study of inhaled steroids versus inhaled steroids plus long acting beta agonists in childhood asthma: a randomized controlled study

Background: Asthma is a chronic inflammatory condition of lung airways resulting in episodic airflow obstruction causing considerable morbidity in paediatric population. The main objective of the study was to find out whether addition of long acting beta agonists to steroids provides better asthma control.Methods: This randomized controlled trial study was performed in children aged 6-15 years of age, with clinically stable and moderate persistent asthma.Results: The findings of this study indicate SABA use in Budesonide/formoterol group patients was significantly less compared to budesonide group patients (1.5±1.1 v/s 2.13±0.9, p-value 0.01). Both groups experienced decrease in night time symptoms and acute exacerbations however there was no significant difference between the two groups in these variables.Conclusions: This study showed addition of LABA to inhaled steroids in moderate persistent asthma provided better asthma control and LABA is mainly recommended to be used as add-on therapy for patients whose asthma is not controlled on low to high doses of inhaled corticosteroids.

Effect of Antiasthma Medication on Blood Eosinophil Count and Serum Immunoglobulin E Levels: A Randomized Controlled Study

Background:Asthma is a chronic inflammatory condition of lung airways resulting in episodic airflow obstruction. Aims: The main objective of this study is tofind the effect of antiasthma medication on serum IgE levels and blood eosinophil count.Study Design:Thisrandomizedcontrolled trial studywas performed in children aged 6-15 years of age, with clinically stable and moderate persistent asthma.Results:The findings of this study indicate both group(Budesonide/formoterol group and budesonide group) patients experienced a significant decrease in serum IgE levels and blood eosinophil counts over the study period.However, the difference in two groups was not statistically significant.Conclusions:Inhaled steroids are effective in controlling systemic inflammation in asthma as evidenced by a decrease in IgE levels and eosinophil counts. However addition of LABA doesn’t have any additive effect.

Infantile Thiamine Deficiency: New Insights into an Old Disease

Context: The wide spectrum of clinical presentation in infantile thiamine deficiency is difficult to recognize, and the diagnosis is frequentlymissed due to the lack of widespread awareness, and non-availability of costly and technically demanding investigations. Evidenceacquisition: The topic was searched by two independent researchers using online databases of Google scholar and PubMed. Weconsidered the related studies published in the last 20 years. The terms used for the search were ‘thiamine’, ‘thiamine deficiency’, ‘beri-beri’, ‘B-vitamins’,‘micronutrients’, ‘malnutrition’, ‘infant mortality’. ‘Wernicke’s syndrome’,‘Wernicke’s encephalopathy’, and ‘lacticacidosis’. Results: In the absence of specific diagnostic tests, a low threshold for a therapeutic thiamine challenge is currently the bestapproach to diagnose infantile thiamine deficiency in severe acute conditions. The practical approach is to consider thiamine injection asa complementary resuscitation tool in infants with severe acute conditions; more so in presence of underlying risk factors, clinicallyevident malnutrition or where a dextrose-based fluid is used for resuscitation. Further, as persistent subclinical thiamine deficiency duringinfancy can have long-term neuro-developmental effects, reasonable strategy is to treat pregnant women suspected of having thedeficiency, and to supplement thiamine in both mother and the baby during breastfeeding. Conclusions: Health care professionals in thecountry need to be sensitized to adopt a high level of clinical suspicion for thiamine deficiency and a low threshold for the administration ofthiamine, particularly when infantile thiamine deficiency is suspected.

Comparative efficacy of IV phenytoin, IV valproate and IV levetiracetam in childhood seizures

Background: Seizures are the most common pediatric neurologic disorder, with 4% to 10% of children suffering at least one seizure in the first 16 years of life objectives to compare efficacy of IV phenytoin, IV valproate, and IV levetiracetam in childhood seizures between 2months to 16 years of age.Methods: This prospective, randomized, study was done on pediatric patients in the age group of 2 months to 16 years who present actively convulsing to the emergency department of pediatrics.Results: At 24 hours seizures were controlled in 44 (88%) patients out of 50 patients in phenytoin group, 39 (78%) out of 50 patients in levetiracetam group and 46 (92%) out of 50 patients in valproate group (p-value 0.115). The relative risk of seizure recurrence for levetiracetam and phenytoin groups when compared to valproate was 2.75 and 1.5, respectively.Conclusions: Present study demonstrates that IV levetiracetam and IV valproate were comparable to IV phenytoin in terms of seizure control in acute setting. All the three are safe and efficacious. Time to regain consciousness was less in valproate group and long-term seizure control too was also better.

Changes in Cardiorespiratory Parameters during the Management of status Epilepticus in Children: A Prospective Randomized Controlled Study

Introduction: Status epilepticus is a common pediatricneurological emergency. Study aimed to compare changes inhemodynamic parameters during the management of pediatricstatus epilepticus using different first line anticonvulsants.Material and Methods: This prospective, randomized, studywas done on Pediatric patients in the age group of 2 monthsto 16 years who present actively convulsing to the emergencydepartment of pediatrics.Results: The mean time to regain consciousness in phenytoin,levetiracetam and valproate groups was 122.3(± 45.4) minutes,120.8(±42.8) minutes and 75.0(±30.7) minutes (mean±S.D)respectively. There was no significant difference in the threegroups in various vital parameters like heart rate, systolicblood pressure, spo2 and respiratory rate recorded at regularintervals in the acute stage (p value > 0.05).Conclusion: All the three anticonvulsants studied are safeand efficacious, and there is no significant difference inthe cardiorespiratory parameters of three groups, and thetime to regain consciousness was less in valproate group incomparison to other groups

Renal Scarring in Children with Primary Vesicoureteral Reflux Disease

Aims:To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR) and the possible risk factor(s), we studied 69 children (42 girls and 27boys) with VUR attending the Pediatric opd.Study Design:Prospective Observational study.Place and duration of Study:Department of pediatrics,Sher I Kashmir Institute of Medical Sciences,Srinagar, Kashmir between June 2017 to June 2018.Methodology:All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m) technetium dimercapto–succinic acid scintigraphy. Results:Grade of reflux and number of urinary tract infection (UTI) episodes (≥3) were found to be statistically significant risk factors for renal scarring (P <0.05). However,there was no significant association with gender,familial history and laterality of the disease (P >0.05). Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05).Conclusions:It was concluded that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore,identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure

Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children / Lactato no líquido cefalorraquidiano: um marcador diferencial para meningite bacteriana e meningite viral em crianças

Abstract Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut-off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2 mmol/L.

Resumo Objetivo: Estudar o desempenho do lactato no líquido cefalorraquidiano como biomarcador para diferenciar a meningite bacteriana da meningite viral em crianças, e definir uma concentração de lactato ótima no líquido cefalorraquidiano que possa ser significativa para a diferenciação. Métodos: Foram estudadas crianças com achados clínicos compatíveis com meningite. O nível de lactato no líquido cefalorraquidiano e outros parâmetros convencionais do líquido cefalorraquidiano foram registrados. Resultados: Em um valor de corte de 3 mmol/L, o lactato no líquido cefalorraquidiano apresentou uma sensibilidade de 0,90, especificidade de 1,0, valor preditivo positivo de 1,0, valor preditivo negativo de 0,963, com uma precisão de 0,972. Os índices de probabilidade positivo e negativo foram 23,6 e 0,1, respectivamente. Para comparação entre a meningite bacteriana e viral, a área abaixo da curva do lactato no líquido cefalorraquidiano foi 0,979. Conclusões: Concluímos que o lactato no líquido cefalorraquidiano possui alta sensibilidade e especificidade na diferenciação da meningite bacteriana da meningite viral. Embora em um valor de corte de 3 mmol/L o lactato no líquido cefalorraquidiano possua alta precisão de diagnóstico da meningite bacteriana, os níveis médios na meningite viral permanecem basicamente abaixo de 2 mmol/L.