Comprehensive Management of Autism: Current Evidence.

Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and nonverbal communication, and restricted repetitive behavior. The goals of treatment are to target core behaviors, improve social interactions and communication, and reduce disruptive behavior. The present paper discusses the role of applied behavioral analysis and pharmacotherapy.

Comparative Study of Ultrasonographic and Anthropometric Measurements of Regional Adiposity in Metabolic Syndrome.

INTRODUCTION: Metabolic syndrome is complex disorder unifying dyslipidemia, insulin resistance and hyper insulinemia. Rising global epidemic of obesity has tremendous impact on metabolic syndrome. Ultrasound is becoming widely utilized modality for measuring the visceral adiposity. AIM: To determine the usefulness of ultrasonographic measurements in the estimation of regional adiposity and to compare them with anthropometric measurements and to correlate ultrasonographic measurements of regional adiposity and metabolic syndrome. MATERIALS AND METHODS: A cross-sectional study was conducted to compare anthropometry and ultrasonography in assessing the regional adiposity in metabolic syndrome. A total of 105 consecutive participants were included in the study after scrutinizing them for various definable factors of metabolic syndrome. Body Mass Index (BMI) of all participants was calculated and their available serological investigations were gathered. Primarily participants were subjected for anthropometric measurements like waist circumference and hip circumference, further waist/hip ratio was calculated. Following which all participants underwent sonological examination and sonographic indices like intraabdominal fat thickness, preperitoneal fat thickness, minimum and maximum subcutaneous fat thicknesses were measured. Abdominal wall fat index was calculated as ratio of maximum preperitoneal fat thickness to minimum subcutaneous fat thickness. Statistical analysis was performed using SPSS (Statistical Package Social Science, version-10.0.5) software. A p-value was calculated and values <0.05 were considered as statistically significant. RESULTS: Significant correlation was established between the BMI and waist and hip circumferences. Mild positive correlation was obtained between BMI and sonographic indices like IAF, SCF and PPF with Pearson correlation (r) values of 0.324, 0.585 and 0.211 respectively. Anthropometric measurements showed higher r-values (WC- 0.624 and HC- 0.825) than sonographic indices; indicating anthropometry is better in assessing the regional adiposity than the sonography. CONCLUSION: Sonography can be considered as one of the reliable imaging modality for assessing the regional adiposity but not as better as waist or hip circumferences.

Soft Tissue Foreign Body: Utility of High Resolution Ultrasonography.

INTRODUCTION: Minor percentage of wooden foreign bodies is radio-opaque. High Resolution Ultrasonography (HRUSG) though existing is sparsely used as a primary imaging modality for diagnosis and localization of retained foreign body. AIM: To evaluate the diagnostic accuracy of High Resolution Ultrasonography (HRUSG) in diagnoses and localization of retained foreign body. MATERIALS AND METHODS: A prospective study with registered 46 patients with history of foreign body injury which were initially imaged with conventional radiography was enrolled. Later patients were subjected for high resolution USG of the diseased part with a linear transducer. Surface marking was done for all subjects to assist the surgical exploration. Ultrasound findings were correlated with surgical exploration and histopathological findings. RESULTS: Out of 46 patients, forty one showed foreign body with foreign body inflammatory reaction in the form of abscess and/or granulation tissue on high resolution ultrasonography. No foreign body was detected in five patients but they showed focal hypoechogenicity which represented abscess and/or haematoma. On surgical exploration, two out of 41 patients did not reveal foreign body where as rest were found to have foreign body with foreign body inflammatory reaction. Sensitivity and negative predictive value of the current study is 100%. CONCLUSION: High resolution USG is not only an efficient modality in diagnosing and localizing the foreign body in soft tissue, but can also be utilized for guiding the foreign body removal.

Comparison of the severity of lower extremity arterial disease in smokers and patients with diabetes using a novel duplex Doppler scoring system.

PURPOSE: The aim of this study was to validate the diagnostic feasibility of a novel scoring system of peripheral arterial disease (PAD) in smokers and patients with diabetes depending on duplex Doppler sonographic features. METHODS: Patients presenting with the symptomatology of PAD were divided into three groups: diabetes only, smoking only, and smokers with diabetes. The patients were clinically examined, a clinical severity score was obtained, and the subjects were categorized into the three extrapolated categories of mild, moderate, and severe. All 106 subjects also underwent a thorough duplex Doppler examination, and various aspects of PAD were assessed and tabulated. These components were used to create a novel duplex Doppler scoring system. Depending on the scores obtained, each individual was categorized as having mild, moderate, or severe illness. The Cohen kappa value was used to assess interobserver agreement between the two scoring systems. RESULTS: Interobserver agreement between the traditional Rutherford clinical scoring system and the newly invented duplex Doppler scoring system showed a kappa value of 0.83, indicating significant agreement between the two scoring systems (P<0.001). CONCLUSION: Duplex Doppler imaging is an effective screening investigation for lower extremity arterial disease, as it not only helps in its diagnosis, but also in the staging and grading of the disease, providing information that can be utilized for future management and treatment planning.

Rare Case of Polymicrobial Keratitis With Balantidium coli.

PURPOSE: To report a rare case of polymicrobial keratitis due to Balantidium coli and gram-negative bacteria, Pseudomonas aeruginosa and Klebsiella pneumoniae, in a soft contact lens (CL) wearer. METHODS: We report a case of CL-related keratitis due to B. coli, P. aeruginosa, and K. pneumoniae. RESULTS: The culture of the corneal scrapings, the CL cleaning solution, and the CL revealed the growth of a rare ciliated parasite, B. coli, along with gram-negative bacteria, namely, P. aeruginosa and K. pneumoniae. The patient was successfully treated with topical broad-spectrum antibiotics and intravenous metronidazole. CONCLUSIONS: Polymicrobial keratitis has seldom been reported with B. coli as the causative agent. CL wear can be a risk factor for this infection. Treatment with topical antibiotics may not suffice, and the intravenous route of antiprotozoal drugs may be a useful adjunct. Increasing awareness, early diagnosis, and treatment may improve the final visual outcome.

Bordetella pertussis infection in a child with completed primary immunization: A case report.

A 20 mo old male child, born at 31 weeks, presented to an out-of-hours General Practitioner (GP) with a 7 d history of cough and fever. There was history of post-tussive vomiting. On assessment a pernasal swab was cultured from which B. pertussis was isolated. This child had received a complete course of primary immunization. In the light of recent increase in Pertussis cases in the United Kingdom we would like to use this case report to increase the awareness among clinicians to the possibility of a diagnosis of whooping cough even in children with completed primary immunization and particularly in preterm infants.