Treatment of acute infectious purpura fulminans with activated protein C.

Infectious purpura fulminans is associated with high mortality and morbidity despite standard antimicrobial therapy. We report satisfactory clinical outcome in two children with sepsis associated purpura fulminans who were treated with activated protein C (APC). There is need for proper evaluation of the efficacy of this extremely expensive therapeutic modality by randomized controlled trials before it is made standard of care in childhood infectious purpura fulminans.

Red cell exchange using cell separator (therapeutic erythrocytapheresis) in two children with acute severe malaria.

Red cell exchange using a cell separator (therapeutic erythrocytapheresis) has been used successfully in a large number of clinical conditions including acute severe cases of malaria. We report two children suffering from severe malaria (Plasmodium falciparum) with infestation rates of 75% and 67% respectively. They were treated successfully with erythrocytapheresis in combination with antimalarial treatment.

Molecular diagnosis of cystic fibrosis in Indian patients--a preliminary report.

AIM: The aim of the study was to screen for the common deltaF508 mutation and the poly T polymorphism and to determine their frequency in the cystic fibrosis transmembrane conductance regulator (CFTR) gene among the suspected CF cases referred to our clinical care centre for sweat chloride tests. METHODOLOGY: Sweat and EDTA blood samples were obtained from 23 clinically suspected cystic fibrosis (CF) cases. Sweat was estimated by pilocarpine iontophoresis procedure. Poly T polymorphism was detected by the multiplex-PCR based on ARMSTM technique and deltaF508 mutation by PCR-mediated site-directed mutagenesis method. RESULTS: Five cases, mainly with respiratory abnormalities and followed by steatorrhea had elevated sweat chloride levels (> 60 mmol/l), three of them, each with nutritional, respiratory and pancreatic abnormalities were borderline (40-60 mmol/l) and the remaining 15 clinically suspected CF cases had normal sweat chloride levels (< 40 mmol/l). The 9T variant was frequently observed (75%) in cases with elevated sweat chloride, including those exhibiting borderline values; with no 5T variant. The 7T was the most common variant (77%) observed in the cases with normal sweat chloride, with only one 5T variant (33%). Of the five cases with high sweat chloride, four cases were homozygous for deltaF508, whereas one was heterozygous with borderline sweat chloride, thus showing an overall frequency of 56.25% in the CF chromosome. DeltaF508 was found to be present with the 9T variant in all the instances. CONCLUSION: The presence of the 9T variant along with elevated sweat chloride levels can be used to predict a high risk of the individual harboring the severe deltaF508 mutation. It would be advisable to test for to the deltaF508 mutation along with the sweat chloride estimation in all the critically suspected CF cases diagnose CF with a higher degree certainty.

Feeding in the PICU.

Nutrition plays a vital role in maintaining and enhancing the health of an individual. As mortality within intensive care units declines because of increased expertise and better equipment, attention is being focused on better methods of feeding the critically ill child. Feeding the child is one aspect that has been relegated to the back burner of the typically busy PICU. Evidence that feeding enhances immunity, protects the gut and shortens recovery time forces us to learn to feed our patients in more effective and safer ways. This article reviews the importance of feeding, especially that of enteral feeding, in the intensive care setting. The reactions of a stressed metabolism are outlined; separate nutritional components are discussed and requirements in specific conditions are given. Parenteral nutrition remains fraught with practical difficulties in India. Metabolic and infective complications are frequent and constant monitoring coupled with the cost of these solutions raises cost beyond affordable levels. Hence the emphasis on enteral feeding, with it's proven safety, routes of administration and ready availability. The immunity enhancing properties of enteral feeding is another aspect that has gained interest in recent years. Ecoimmunonutrition is a new concept that keeps the ecology of the stressed GI tract intact while providing adequately balanced formulae along with micronutrients and fibre.