Intermittent Short Course Therapy for Pediatric Tuberculosis.

We conducted this study to assess the efficacy of intermittent short course therapy in all forms of pediatric tuberculosis using a coordinated approach with Revised National Tuberculosis Control Programme (RNTCP). Sixty-five children were treated using RNTCP protocols with some modifications, such as dose adjustments or prolongation of treatment in selected children. Overall response rate was 95% (pulmonary 94% and extra pulmonary 97%). There was one case with possible relapse. With dynamic inputs from both the treating pediatrician and personnel from Directly Observed Treatment – Short-course (DOTS) centers, we could successfully implement RNTCP protocols in childhood tuberculosis.

Do the length-based (Broselow) Tape, APLS, Argall and Nelson's formulae accurately estimate weight of Indian children?

This study was aimed at validating the usefulness of a length based pediatric emergency tape (Broselow) in an Indian population. The secondary objective was to validate age based weight estimation formulae (Nelson, Argalls, APLS) for emergency needs (doses, sizes). This cross sectional study was done at a tertiary teaching hospital on a sample of 500 children attending outpatient clinic. Inclusion criteria was age between 1 month to 12 years. Children who were unstable, uncooperative or critically ill requiring emergency care and those measuring more than 145 cm in length or weighing more than 35 kg weight were excluded from the study. Measurement of actual weights, calculation of weight, adrenaline dose, fluid bolus and endotracheal tube size was done by all four methods. Results indicated good positive correlation between actual measured weights and weights estimated using Broselow Tape (r = 0.974), APLS (r = 0.902), Argalls modification (r = 0.902), and combined Nelson formulae (0.935). However, specific Nelson formulas for 7-12 yr and 3-12 mo were especially poor in correlation. Bland-Altman Plots comparing actual weight showed least mean bias for Broselow Tape estimations in < 15 kg group (0.080 +/- 0.96 kg) and maximum bias with Nelsons formula for 7 to12 yr (5.204 +/- 4.272 kg). For adrenaline doses and fluid bolus calculations, Broselow estimations were valid estimates. Broselow tape did underestimate endotracheal tube size (mean bias -0.53 +/- 0.18). To conclude, length based pediatric emergency tape (Broselow) correlates well with overall emergency decision making process in our setting. This is especially validated in the age group 0.1 to 6.7 yr weighing less than 15 kg.

Partial albinism, immunodeficiency, hypergammaglobulinemia and Dandy-Walker cyst--a Griscelli syndrome variant.

A 6-year-old girl presented with recurrent infections, seizures, regression of milestones, silvery hair and organomegaly. A diagnosis of Griscelli syndrome with unusual features of a Dandy Walker cyst and hypergammaglobulinemia, not previously described in literature, was made. The child was treated with supportive measures.

Teaching medical ethics in a medical college in India.

To the best of our knowledge, medical ethics is not taught as a separate subject in Indian medical colleges. St John's Medical College has a programme for teaching medical ethics to its undergraduate students. We describe here the structure of our programme, the syllabus and the teaching methodology. We feel that we have an effective way of teaching medical ethics at our medical college and would encourage other medical colleges to introduce the subject in their curriculum.

Densidade mineral óssea vertebral e femoral de 724 mulheres brancas brasileiras: influência da idade e do peso corporal / Vertebral and femoral bone mineral sessity of 724 caucasian Brazilian woman: influence of age and body weight

Objetivo. Estudar a densidade mineral óssea (BMD) vertebral (L2-L4) e femoral (colo do fêmur) de mulheres brancas, normais. Material e Método. Mediu-se o BMD de 724 mulheres (40-79 Kg; 20-69 anos de idade) por dual-energy x-ray absorptiometry e analisaram-se os dados em funçao da idade e peso corporal (PC). Resultados. As mulheres mais leves (40-49 Kg) atingiram o BMD maximo (BMDm) vertebral e femoral aos 30-39 anos de idade, enquanto as mais pesadas (60-79 Kg) apresentaram BMDm aos 20 anos. No fêmur, houve uma correlaçao significativa entre BMDm e PC (r=0,97, p<0,001; slope=0,72 por cento/Kg). Em L2-L4, apenas as mulheres com 40-49Kg apresentaram BMDm menor do que as demais(p<0,001). A diminuiçao do BMD vertebral foi mais intensa (-8,3 vs. -5,7 por cento/década) e iniciou mais cedo (quarta vs. quinta década) nas mulheres pesando 40-59Kg do que nas pesando 60-79Kg. A diminuiçao do BMD femoral iniciou logo após o BMDm ser atingido e, até os 69 anos, as mulheres mais pesadas apresentaram um decréscimo 5,3 por cento menor do que aquelas pesando 40-49Kg. O BMD vertebral das mulheres brasileiras foi praticamente o mesmo de uma populaçao norte-americana previamente descrita. Conclusoes. 1) O BMD vertebral e femoral das brasileiras estudadas comportou-se, em funçao da idade, de forma semelhante a de outras populaçoes brancas; 2) havendo o cuidado de corrigir o PC, o BMD das mulheres brasileiras é comparavel ao de mulheres norte-americanas; e 3) o PC é importante na aquisiçao e diminuiçao da massa óssea, além de influenciar a relaçao BMD-idade.

Comparison of rectal and axillary temperatures in neonates admitted to a neonatal unit.

To determine whether axillary temperature could be used as an alternative to rectal temperature, 45 neonates were subjected to simultaneous rectal temperature and axillary temperature recordings. Each baby had an average of 10 recordings over the first 72 hours. The mean of these readings was taken and subjected to regression analysis and the 't' paired test. The overall mean difference between the rectal and axillary temperature was 0.3 degrees F. The mean difference was least in preterm small for date (SFD) babies (0.2 degrees F) and most in preterm appropriate for date (AFD) babies (0.5 degrees F). The mean difference was less in incubator babies (0.2 degrees F) compared to those in warmer cradles (0.4 degrees F). The regression analysis showed that the correlation was good in all groups except the term small for date babies. We conclude that axillary temperature could be used as an alternative to rectal temperature in neonates.