EEG Abnormalities in Children with Speech and Language Impairment.

INTRODUCTION: Epilepsy, a chronic condition of recurrent seizures, affects language, but the extent and nature of the language disturbance varies widely according to the type, severity, and cause of the epilepsy. There is paucity of literature on the electroencephalographic abnormalities in children with speech and language impairment. The present study was therefore planned to find the association of epileptiform EEG abnormalities in children with speech and language impairment and if present, their localization and lateralization to the language areas of the brain that are present predominantly in the left hemisphere. MATERIALS AND METHODS: The study was conducted on Paediatric patients having speech and language impairment (n=94, age-2 to 8 years) selected on the basis of detailed history and neurologic examination. Video Electroencephalography (EEG) was performed as per American Clinical Neurophysiology Society guidelines using 16 channel RMS computerized EEG machine for a minimum of 40 minutes to capture both wakefulness and sleep along with activation procedures like hyperventilation (if feasible) and photic stimulation. EEG was reviewed for any abnormal EEG background, benign variants, interictal epileptiform discharges and ictal discharges. RESULTS: In our cohort, 19.7% boys and 22.2% girls presented with seizures in their infancy and this gender difference was found to be statistically significant (p<0.05). EEG was abnormal in 47.9% children (45 out of 94) with no significant gender difference. Epileptiform EEG was seen in 73.6% of children with history of seizures and 41.3% of children without history of seizures (p<0.05). The EEG abnormities included: abnormal background (64.5%), presence of generalized interictal epileptiform discharges (57.8%), focal epileptiform discharges (20%) exclusively from left hemisphere and multifocal interictal epileptiform discharges (33.3%), each occurring in isolation or associated with other abnormities. CONCLUSION: In the current study, it is definite that presence of generalized abnormalities in EEG are seen in higher frequency and focal interictal epileptiform discharges are solely seen in left hemisphere in children with speech and language impairment. Although, there is no distinct pattern of EEG abnormalities in such patients, we recommend a routine EEG in them and also brain imaging to complement the EEG findings.

ABER Assessment in Pre-school Children with Developmental Speech and Language Impairment.

INTRODUCTION: Developmental speech and language disorders (DLD) constitute a group of disorders when children with normal intelligence and hearing fail to develop language in an age-appropriate manner. There is no definite or surrogate neurophysiologic laboratory marker to quantitate the extent of speech and language impairment. The current study was designed to evaluate the abnormalities in Auditory Brainstem Evoked Responses (ABER) in children with speech and language impairment who do not have a hearing deficit or autism. MATERIALS AND METHODS: ABER recording was done in a cohort of 94 children (age 2-8 y) with DLD without overt hearing deficit or autism. The mean latencies for waves I, II, III, IV and V along with inter peak latencies for I-III, I-V, III-V and amplitude ratio of wave V/I was measured after click stimulus with intensities 110 db until 40 db and compared to age appropriate normograms. RESULTS: The peak latencies for waves I, III & V, inter-peak latencies I-III & I-V, III-V and wave amplitude ratio V/I was found within normal limits in both ears of all the children when compared to age appropriate normograms. CONCLUSION: The current study therefore emphasizes the fact that ABER may not be used/recommended as diagnostic or prognostic tool in children with speech and language impairment without autism or hearing deficit. The results and the recommendations of this study will definitely reduce the burden on electrophysiologist, laboratories and also save time and financial resources.

Fabrication and characterization of solid lipid microparticles of ketoprofen

Solid lipid microparticles (SLMs) loaded with ketoprofen were prepared by single emulsion-solvent evaporation method, in which glyceryl monostearate and Tween 80 were employed. The particle size was found to be 99.80±2.1μm. Microparticles observed by scanning electron microscope (SEM) showed spherical shape. The entrapment efficiency (EE %) and drug loading capacity (DL %) were found to be 72.60±1.6 % and 17.98±0.7% respectively. Results of stability evaluation showed relatively long term stability after storage at 4˚C for 3 months. The in-vivo study revealed slightly better per cent inhibition of pain i.e. 74% in comparison with 68% produced by plain drug(AU)

Las micropartículas lipídicas sólidas (MLS) cargadas con ketoprofeno se han preparado a través del método de evaporación del disolvente en emulsión simple, en el que se ha utilizado monoestearato de glicerilo y Tween 80. El tamaño de la partícula ha resultado ser de 99,80±2,1 μm. Las micropartículas observadas a través del microscopio electrónico de barrido (MEB) han mostrado una forma esférica. La eficacia de compresión (EC %) y la capacidad de concentración (CC %) del fármaco han resultado ser de 72,60±1,6% y 17,98±0,7% respectivamente. Los resultados de la evaluación de estabilidad han mostrado una estabilidad relativa a largo plazo después de una conservación a 4˚C durante 3 meses. El estudio in vivo ha revelado un ligero mejor porcentaje de inhibición del dolor, es decir, un 74% en comparación con un 68% producido por un fármaco corriente(AU)

The effect of transdermal nitroglycerine on intrathecal fentanyl with bupivacaine for postoperative analgesia following gynaecological surgery.

Fentanyl is a short-acting synthetic opioid with spinal analgesic properties and dose-dependent side-effects. The analgesic effect of opioids is mediated in part through activation of inhibitory descending pain pathways involving nitric oxide (as a central neurotransmitter) through the NO-cGMP system. This NO-cGMP pathway plays an important role in spinal nociception. The aim of the study was to evaluate the effect of transdermal nitroglycerine on the analgesic action of intrathecal fentanyl in patients undergoing abdominal hysterectomy. Patients (n=120) were randomised into one of four groups. All received 3 ml bupivacaine 0.5% plus 0.5 ml of an intrathecal test drug. Twenty minutes after lumbar puncture, a transdermal patch of either nitroglycerine or placebo was applied. Group B received spinal bupivacaine plus saline 0.5 ml and a placebo patch. Group B-N received bupivacaine plus saline 0.5 ml and a nitroglycerine patch. Group F received bupivacaine plus fentanyl 25 microg and a placebo patch. Group F-N received bupivacaine plus fentanyl 25 microg and a nitroglycerine patch. The duration of effective analgesia was longer in group FN (363.53 +/- 34.09 min) compared from the other groups (P < 0.001). The times to two-segment regression in group F-N and group F were 132.87 +/- 31.2 min and 126.40 +/- 26.81 min respectively. The visual analog scale pain score at the time of the first rescue analgesic was similar in all groups. We conclude that nitroglycerine does not result in postoperative analgesia but enhances the analgesic effect of intrathecal fentanyl.

Case-control study to identify factors associated with mortality among patients with methicillin-resistant Staphylococcus aureus bacteraemia.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is associated with increased mortality. Delay in appropriate antimicrobial therapy (DAAT) is an important risk factor for death, although confounding between carriage of MRSA and DAAT has not been resolved. We studied the association of risk factors with mortality and searched for specific populations vulnerable to DAAT. We conducted a case-control study comparing patients with MRSA bacteraemia who died during hospitalization (cases) with patients with MRSA bacteraemia who survived (controls) in three medical centres in two states. Patients were identified using computerized hospital databases for the years 2001-2005. Medical records were retrieved and various epidemiological data extracted. Bivariate and multivariate logistic regression analyses were performed. Overall, 388 patients with MRSA bacteraemia were included, 164 cases and 224 controls. According to bivariate analyses, cases were significantly more likely than controls to (i) be older (>65 years), (ii) have transferred from an institution, (iii) have stayed in an ICU, (iv) have had more invasive devices, (v) have a poorer prognosis on admission, (vi) have higher disease severity at the time of bacteraemia, and (vii) have a DAAT of > or = 2 days. Upon multivariate analysis, among patients >65 years, DAAT was significantly associated with increased mortality (p 0.04). Furthermore, patients >65 years with severe sepsis were much more likely to experience DAAT (p 0.02). In elderly patients with MRSA bacteraemia, DAAT is associated with increased mortality. Moreover, advanced age is a predictor for DAAT. These significant epidemiological associations mandate early coverage of MRSA in septic elderly patients.

Clinical profile of group A meningococcal outbreak in Delhi.

We present a retrospective analysis of clinical profile of 100 children admitted to a Government hospital at Delhi between April 2005 and December 2006 with group A meningococcal infection. Maximum children presented in late winter and spring. Younger children were less affected (5% children < 1 year). Fever (86%), vomiting (64%) and rash (63%) were the most common presenting symptoms. All children presented within 5 days of onset of symptoms and 52% within 24 hours. 67 % children had meningococcal meningitis; 20% had meningococcemia; and 13% had both. Overall mortality was 17%. Altered sensorium and shock at presentation significantly increased the mortality. All culture positive cases had group A Neisseria meningitides. All meningococcal isolates were sensitive to penicillin/ampicillin, ciprofloxacin, ceftriaxone, chloramphenicol and erythromycin except, one each resistant to ampicillin and erythromycin.

Epidemic of leptospirosis: an ICU experience.

AIMS: To study the clinical profile and outcome of critically ill patients suffering from leptospirosis with organ dysfunction and correlate mortality with individual risk factors. METHODS: A study of critically ill patients suffering from leptospirosis was carried out in the Medical Intensive Care Unit of a tertiary centre of a metropolitan city between 1st June 2002 and 31st May 2003. All the patients in whom diagnosis was confirmed by ELISA IgM antibody testing underwent thorough clinical examination and necessary biochemical investigations. They received standard antimicrobial therapy and extensive supportive therapy as required. Mortality was correlated with individual risk factors. RESULTS: Out of 834 total admissions in this period, 60 (7.2%) patients suffered from leptospirosis. There were 48 males and 12 females with age ranging from 12 to 60 years, mean age being 40 years. The clinical manifestations varied from fever (58 patients), jaundice (38), subconjunctival haemorrhages (24), to altered sensorium (22). All the patients had evidence of severe sepsis. Forty six patients had multiple organ dysfunction syndrome (MODS) and 26 required ventilatory support. The total mortality in leptospirosis patients was 52% which was much higher compared to the total MICU mortality (31.4%) in the same period. CONCLUSION: Leptospirosis is an important infection associated with high mortality when associated with organ dysfunction. The poor prognostic factors are preponderance of male sex, alcohol dependence, age group > 50 years, MODS, acute respiratory distress syndrome (ARDS), presence of acidosis and need for mechanical ventilation. However, timelyintervention and intensive therapy can save many young lives.

Genetic analysis of Karnal bunt (Neovossia indica) resistance in wheat.

Embryos excised from seeds of six generations (P1, P2, F1, BC1, BC2 and F2) of a cross WH 283 WH 533 were cultured on modified MS medium already inoculated with secondary sporidia of Neovossia indica. Significant variations for callusing response (CR) (54 55-75 55%) were observed among generations but the presence or absence of N. indicia did not affect callusing response. A clear inhibition zone (IZ) was formed around each embryo showing callusing. The diameter of IZ varied significantly among generations and was maximum in the resistant genotype, WH 283 (3 60 cm). Fresh weight and dry weight of calli, initiated from embryo cultured and inoculated with N. indica, varied significantly among generations. Coefficient of infection as well as percentage of infection reflected the overdominance of susceptibility. Generation mean analysis showed that the three parameter model was adequate for diameter of IZ only. Six-parameter model showed that additive (in presence of N. indica), additive and additive dominance (in absence of N. indica) effects were also significant. Complementary type of epistasis for fresh weight of calli and dominance, and dominance dominance effects for dry weight of calli were observed in the presence of N. indica. Magnitude of additive effects was higher for diameter of IZ in three parameter model. Therefore, selection might assist in improving this trait and thus indirectly help in attaining the resistance towards N. indica.

Characterization of polyvinylalcohol microspheres of diclofenac sodium: application of statistical design.

Microspheres of polyvinylalcohol (PVA) containing diclofenac sodium were prepared by an emulsion-chemical cross-linking method. A statistical design was used to study the variables that affect the preparation of microspheres and to study the release profile of diclofenac from the microspheres. To account for the drug content, a mass balance study of the process was performed. A high concentration of polyvinylalcohol, a high stirring speed, and a low level of glutaraldehyde were found to be important to obtain spherical and discrete microspheres. The concentration of polyvinylalcohol and the amount of heavy liquid paraffin were found to be critical factors in influencing the t50 value. Almost 98% of the total diclofenac sodium added was accounted for in mass balance studies.

Infants of diabetic mothers: a prospective study of neonatal complications in Harare, Zimbabwe.

Complications in 42 newborn infants of diabetic mothers (IDM), both insulin- and non-insulin-dependent, were studied prospectively over a period of 16 months at Harare Maternity Hospital. Hypoglycaemia, the most common complication observed, was present in 23 (55%): only seven of these were symptomatic. In 21 of these 23 cases, blood glucose was stabilized during the first 24 hours of life. Jaundice and transient tachypnoea were each seen in 12 cases (29%). There were no cases of respiratory distress syndrome. One infant had polycythaemia requiring partial exchange transfusion. No life-threatening congenital malformations were seen. All infants were given special care initially and in the majority of cases this could be discontinued after 24 hours. With simple interventions, the morbidity of IDM born was found to be comparable to levels reported from developed countries.

Congenital syphilis in the newborn.

We studied 53 newborn babies with congenital syphilis. The common clinical features seen were low birth weight, hepatosplenomegaly, anaemia, jaundice, and symmetrical superficial desquamation of the skin affecting palms and soles. The presence of these clinical signs is highly suggestive of early congenital syphilis. Hydrops fetalis without rhesus or ABO isoimmunisation should always arouse the suspicion of congenital syphilis.

Bilateral adrenalectomy or subdiaphragmatic vagotomy on gastric tissue histamine concentration in albino rats.

Gastric tissue histamine concentration was determined 14 days after mock subdiaphragmatic vagotomy, subdiaphragmatic vagotomy, mock bilateral adrenalectomy and bilateral adrenalectomy in four different groups of animals and the results were compared with those of control rats. The results show that neither of the experimental situations of mock subdiaphragmatic vagotomy, subdiaphragmatic vagotomy and mock bilateral adrenalectomy could bring about any significant change in gastric tissue histamine concentration fourteen days after the respective operations, whereas, following bilateral adrenalectomy, the gastric tissue histamine concentration went up to two and half times the basal level during the same period thus indicating that by removal of adrenal influences there was an increase in synthesis and storage of histamine in the stomach wall.

Effect of daily parenteral injection of betamethasone on histamine concentration of gastric tissue in albino rats.

Gastric tissue histamine concentration was determined in albino rats following daily parenteral injection of betamethasone over a period of 12 days. The result shows a highly significant fall in gastric tissue histamine concentration in comparison with that in saline-treated albino rats over a similar period.