Diabetes mellitus in an infant.

Onset of diabetes in the first year of life is uncommon, most cases being those of transient diabetes of the newborn. We report the case of a child who presented at 10 weeks of age with diabetic keto-acidosis, and continues to be insulin dependent at 18 months.

Spontaneous bladder rupture secondary to posterior urethral valves in a neonate.

Bladder rupture is a rare cause of ascites in neonates. A review of literature revealed about 32 cases including both iatrogenic and spontaneous rupture. This case report describes a successfully treated case of spontaneous rupture of bladder with ascites in a neonate with posterior urethral valves.

Epilepsy in children with cerebral palsy.

This article deals with the clinical profile of children with cerebral palsy and epilepsy, and to study the clinical predictors of response to anti-epileptic drugs. It is a prospective hospital based follow-up study. All the children who presented with cerebral palsy and history of seizure (other than neonatal seizures) over a period of one year were included. Seizures were classified according to ILAE classification. An EEG was obtained in all cases. Neuroimaging was done in all patients. Eighty-five patients were studied and followed for minimum of 12 months. Perinatal factors accounted for 62 (72.3%) cases. The motor deficits seen were quadriparesis (n = 64), hemiplegia (n = 12) and diplegia (n = 9). Associated mental retardation was seen in 80.9% patients with quadriparesis. A predominance of generalised epilepsy was seen with generalised tonic clonic seizures (32.9%) followed by mycolonic seizures (30.6%) and localisation related epilepsy (24.7%). The patients with quadriparesis were more likely to have generalised epilepsy and 52.4% of them required two or more anti-epileptic drugs for control of seizures. Patients with hemiplegia had localisation related epilepsy in 83.3% of cases. On multivariate analysis presence of quadriparesis, microcephaly, mental retardation and myoclonic epilepsy were found to predict the poor response to AED. Epilepsy in patients with cerebral palsy is of severe nature and difficult to control. Presence of quadriparesis, mental retardation and myoclonic seizures was predictive of poor response to anti- epileptic drugs.

Spontaneous rupture of choledochal cyst.

Choledochal cyst in an uncommon congenital anomaly with classic presentation triad of abdominal pain, jaundice and right upper abdominal mass. Presentation due to biliary peritonitis following cyst rupture is extremely rare. One such case which was successfully treated is being reported.

Safety of intrauterine administration of purified neem seed oil (Praneem Vilci) in women & effect of its co-administration with the heterospecies dimer birth control vaccine on antibody response to human chorionic gonadotropin.

Praneem Vilci (PV), purified neem oil was reported to exercise a reversible antifertility effect after a single intrauterine instillation in rodents and primates without any adverse effects. After toxicology, drug regulatory and ethical clearances, a phase I clinical trial was conducted on PV. Eighteen healthy tubectomised women were enrolled to evaluate the safety of a single intrauterine instillation of PV and to determine the effect of its co-administration on anti-hCG response to the heterospecies dimer (HSD) hCG vaccine. Eight women received PV alone and ten women were given the HSD-hCG vaccine in addition. Base-line and post-treatment haematological and biochemical profiles were determined as also the mid-luteal serum progesterone. Endometrial biopsies were examined to assess ovulatory status and the effect of intrauterine treatment with PV on the endometrium. Anti-hCG antibody titres were estimated in women who were concurrently immunized with the HSD vaccine. No untoward reaction was observed in any woman. Menstrual pattern and ovulatory status remained unaltered. Endometrial biopsy after PV instillation in one woman showed non-specific endometritis but she remained asymptomatic. Mild eosinophilia was seen in two women and this reverted to normal on its own. All women receiving PV and the HSD vaccine generated antibodies against hCG. Our data show that intrauterine administration of PV is safe and does not prevent the antibody response to HSD-hCG vaccine.

Studies on the contraceptive efficacy of Praneem polyherbal cream.

Praneem polyherbal cream, a spermicidal formulation, has been developed at the National Institute of Immunology, which makes use of Praneem, a purified extract from the dried seeds of an ancient Indian plant Azadirachta indica (Neem), extract from the pericarp of fruits of Sapindus species and quinine hydrochloride. These ingredients have a synergistic spermicidal activity and an optimised formula was derived. The components were made into a water-soluble cream base prepared by using pharmaceutically acceptable base and stabilised by addition of IP grade antioxidant and preservatives. The cream is devoid of irritation and sensitization potential, as seen with standard Draize test on normal and abraded skin of rabbits and by 21-day cumulative skin sensitivity in human volunteers. The formulation was found to be safe under subacute toxicity studies in monkeys. The formulation has shown high contraceptive efficacy in rabbits and in monkeys after intravaginal application. The shelf-life of the cream at room temperature is estimated to be 18 months by accelerated stability studies.

PIP: In India, the National Institute of Immunology has developed Praneem polyherbal cream as a vaginal spermicide. Scientists combined a purified extract from the dried seeds of an ancient Indian plant Azadirachta indica (Neem), extract from the pericarp of fruits of Sapindus species, and quinine hydrochloride with a pharmaceutically acceptable base to make a water-soluble cream base. They added IP grade antioxidant and preservatives to stabilize the cream base. They applied the cream on a shaved or abraded part of the skin of human volunteers and rabbits and inserted it into the vagina of Bonnet monkeys to test for sensitivity and irritation. They studied the dissolution characteristics of the cream after intravaginal application in the rabbits and monkeys. They compared pregnancy rates of monkeys who received intravaginal application of 2 ml cream every day with those of control monkeys. Praneem polyherbal cream did not irritate the skin of the rabbits or the human volunteers. The accelerated stability studies found the shelf-life of the cream at room temperature to be 18 months. The cream dissolves entirely within 30 minutes in the vaginal secretions of the rabbits and 40 minutes in those of the monkeys. Precoital application of the cream provided complete protection against pregnancy in rabbits in the 1st 30 minutes after application. The conception rate was acceptable at 60 minutes (7%), but thereafter it climbed to unacceptable levels (28.6% at 90 minutes and 75% at 12 hours). The conception rate of monkeys who received precoital application of Praneem polyherbal cream was only 2.27%. These results suggest that Praneem polyherbal cream can protect against pregnancy without causing irritation. Its antimicrobial properties provide another advantage.