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  Citation statistics : Table of Contents
   2014| January-April  | Volume 9 | Issue 1  
    Online since April 25, 2014

 
 
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CASE REPORTS
Paroxysmal vascular events in Sturge– Weber syndrome: Role of aspirin
Jyoti Sanghvi, Sudhir Mehta, Swati Mulye
January-April 2014, 9(1):39-41
DOI:10.4103/1817-1745.131483  PMID:24891902
Sturge-Weber syndrome (SWS) is a rare, sporadically occurring neurocutaneous disorder with a frequency of approximately 1 per 50,000. The hallmark is an intracranial leptomeningeal vascular angioma in association with a port wine nevus, usually involving ophthalmic or maxillary distribution of trigeminal nerve. Other clinical findings associated with SWS are seizures, glaucoma, hemiparesis and mental retardation. The radiological hallmark is "Tram-line" or "Gyri-form" calcification. 25 to 56% of patients experience recurrent episodes of paroxysmal focal neurological deficits in form of transient hemiparesis, which may be due to vascular ischemia or postictal in origin. EEG helps to differentiate the exact etiology, as it is normal in former. Aspirin prophylaxis in those, due to ischemia decreases their recurrences and improves overall neurological prognosis. We report a 25-month-old child of SWS with recurrent episodes of transient hemiparesis and atypical midline location of facial vascular nevus.
  1 2,338 144
LETTERS TO THE EDITOR
Baclofen induced coma in an infant
Syed Ahmed Zaki, Yogesh Gopalrao Khanage
January-April 2014, 9(1):86-88
DOI:10.4103/1817-1745.131500  PMID:24891918
  1 1,381 116
CASE REPORTS
Unusual presentation of poststreptococcal glomerulonephritis as posterior reversible encephalopathy syndrome
Syed Ahmed Zaki, Preeti Shanbag
January-April 2014, 9(1):42-44
DOI:10.4103/1817-1745.131484  PMID:24891903
Posterior reversible encephalopathy syndrome (PRES) is a rare clinicoradiologic condition manifesting with headache, seizures, altered sensorium, visual disturbances, and characteristic lesions on neuroimaging predominantly affecting the posterior regions of the brain. We report a case of an 8-year-old boy with poststreptococcal glomerulonephritis, presenting as PRES. A magnetic resonance imaging showed hyperintense lesions in bilateral frontal and parietooccipital parenchyma on fluid-attenuated inversion recovery and T2-weighted images, suggestive of "PRES." Patient made a complete neurological recovery without any deficit.
  - 1,855 154
Cerebral astroblastoma: A radiopathological diagnosis
Deepak Kumar Singh, Neha Singh, Ragini Singh, Nuzhat Husain
January-April 2014, 9(1):45-47
DOI:10.4103/1817-1745.131485  PMID:24891904
Astroblastoma is a rare glial neoplasm whose histogenesis has been clarified recently. It primarily occurs in children and young adults. We are reporting a case of 12-year-old girl child who presented with features of raised intracranial tension and generalized tonic-clonic seizures. Brain magnetic resonance imaging revealed a large well-circumscribed, cystic lesion without perifocal edema, and enhancing mural nodule in right parietal region. A radiological differential diagnosis of pilocytic astrocytoma and cerebral astroblastoma was made. A complete excision was done and histologically the lesion turned out to be an astroblastoma. We review the histology, immunohistochemistry, and imaging features of astroblastoma and survey the current literature, treatment strategies, and prognostic aspects for the management of this rare neoplasm.
  - 2,208 116
Desmoplastic infantile ganglioglioma: Report of an unusual case with a cranial defect
Recep Basaran, Fatma Betul Cakir, Nejat Isik, Aydin Sav, Ilhan Elmaci
January-April 2014, 9(1):48-51
DOI:10.4103/1817-1745.131486  PMID:24891905
Desmoplastic infantile ganglioglioma (DIG) is a rare tumor that typically occurs in infants under the age of 24 months. These tumors commonly have a good prognosis after surgical resection despite their aggressive radiological appearances. Clinical signs are due to the large size of the tumor and include increased head circumference, bulging fontanel, sunset sign and seizures. We report an unusual DIG case who presented with parietal bulging associated with a bony defect. The patient was thought to have a leptomeningeal cystic formation, but on his cranial magnetic resonance imaging (MRI), we observed a centrally and homogeneously gadolinium-enhanced lesion fixed to the dura by its solid component. A surgical gross total resection was performed, and no residual tumor was observed on follow-up.
  - 1,970 110
Intrinsic brainstem white epidermoid cyst: An unusual case report
Sudhansu Sekhar Mishra, Souvagya Panigrahi, Manmath Kumar Dhir, Acharya Suryakant Pattajoshi
January-April 2014, 9(1):52-54
DOI:10.4103/1817-1745.131487  PMID:24891906
Epidermoid cysts involving the brainstem are extremely rare, with only 18 reported cases in the literature and only five purely intrinsic epidermoid cysts within this group. "White epidermoids", a rare entity, have high protein content and show reversed signal intensity on magnetic resonance images. In contrast to the classical variety, these cysts show high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. Here, we report an interesting case of intrinsic brainstem "white epidermoid cyst" in a 15-year-old girl and discuss its clinical characteristics, radiological features, and surgical treatment. The girl presented with a one-year history of progressive quadriparesis, and features of multiple cranial nerve involvement. Because the cyst was purely intrinsic and had altered signal intensity, the diagnosis was initially unclear until definitive neuroimaging was performed using diffusion-weighted magnetic resonance imaging (DW-MRI) sequences.
  - 1,645 102
Very severe spinal muscular atrophy: Type 0 with Dandy-Walker variant
Geeta Gathwala, Joginder Silayach, Bhanu Kiran Bhakhari, Varun Narwal
January-April 2014, 9(1):55-56
DOI:10.4103/1817-1745.131488  PMID:24891907
Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by degeneration of alpha motor neurons in the spinal cord, resulting in progressive proximal muscle weakness and paralysis. In addition to the three classical SMA types, a new form known as type 0 with intrauterine onset, profound hypotonia and a progressive and early fatal course has been described. Herein we report a case of type 0 SMA with a Dandy Walker variant anomaly, which has not hitherto been reported in the world literature.
  - 1,656 113
Catatonia as presenting clinical feature of subacute sclerosing panencephalitis
Prabhoo Dayal, Yatan Pal Singh Balhara
January-April 2014, 9(1):57-59
DOI:10.4103/1817-1745.131489  PMID:24891908
Catatonia is not a usual clinical presentation of subacute sclerosing panencephalitis (SSPE), especially in the initial stages of illness. However, there is only one reported case of SSPE presenting as catatonia among children. In this report, however, there were SSPE-specific changes on EEG and the catatonia failed to respond to lorazepam. We describe a case of SSPE in a child presenting as catatonia that presented with clinical features of catatonia and did not have typical EEG findings when assessed at first contact. He responded to lorazepam and EEG changes emerged during the course of follow-up.
  - 1,421 113
Auto cannibalism in mental retardation
Rohit Verma, Shaily Mina, Ankur Sachdeva
January-April 2014, 9(1):60-62
DOI:10.4103/1817-1745.131491  PMID:24891909
Mental retardation (MR) deems an individual more vulnerable to psychopathologies. The individual may develop an array of behavioral disturbances manifesting themselves in the form of aggressive and destructive conduct, violent fits of anger, stereotyped, or self-injuring behavior. Self-injurious behavior is heterogeneous in nature ranging from mild to severe variant. We report a case of a 7-year-old boy with MR with self-inflicted severe oral injuries of cannibalistic nature presenting as cleft lip and palate. A more extensive research is needed on the problem behaviors in mentally retarded patients for early detection and effective and timely intervention leading to a better outcome.
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A distinct phenotype of childhood leukodystrophy presenting as absence seizure
Imad Mohammad Dweikat, Nadera Damsah, Reham Khalaf
January-April 2014, 9(1):63-65
DOI:10.4103/1817-1745.131492  PMID:24891910
Leukoencephalopathy refers to any disease of the white matter including hereditary as well as acquired and toxic causes. Inherited leukodystrophies are diseases of myelin including abnormal myelin development, hypomyelination, or degeneration of myelin. We report a 6-year old female who presented with absence seizure at the age of 4 years. Cerebral magnetic resonance imaging (MRI) of the brain showed bilateral periventricular confluent high signal intensity. The seizure responded to anticonvulsant therapy, and the clinical course was characterized by normal development and neurological examination.
  - 1,470 101
Garcia-Hafner-Happle syndrome: A case report and review of a rare sub-type of epidermal nevus syndrome
Soaham Dilip Desai, Rita Vora, Sheela Bharani
January-April 2014, 9(1):66-69
DOI:10.4103/1817-1745.131493  PMID:24891911
Garcia-Hafner-Happle syndrome, also known as Fibroblast growth factor receptor 3 epidermal nevus syndrome, is a new neurocutaneous phenotype, which has been identified in 2008 by Garcý'a-Vargas et al. The disorder is caused by a mosaic R248C mutation of the FGFR3 gene, which is characterized by a keratinocytic epidermal nevus, acanthosis nigricans, and neurological abnormalities like seizures, intellectual impairment, cortical atrophy, and underdevelopment of corpus callosum. The epidermal nevus syndromes represent a group of distinct disorders in which an epidermal nevus is associated with abnormalities in other organ systems like central nervous system, cardiovascular system, genitourinary system, eyes, and bone. Recently, nine well-defined different epidermal nevus syndromes (ENSs) have been identified on clinical, histopathologic, and molecular basis. We present here the details of a patient with the clinical features and skin biopsy findings suggestive of Garcia-Hafner-Happle syndrome.
  - 6,030 162
Infected lumbar dermoid cyst mimicking intramedullary spinal cord tumor: Observations and outcomes
Sudhakar Vadivelu, Sohum K Desai, Anna Illner, Thomas G Luerssen, Andrew Jea
January-April 2014, 9(1):21-26
DOI:10.4103/1817-1745.131475  PMID:24891897
We report two unusual cases of a 17-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an intradural dermoid cyst and holocord edema or syrinx, presenting with paraparesis and sphincter dysfunction secondary to an intramedullary abscess and a 26-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an infected dermoid cyst and intramedullary abscess, presenting with recurrent episodes of meningitis and hydrocephalus. Pre-operative magnetic resonance imaging (MRI) studies in these patients were initially confused for an intramedullary spinal cord tumor; however, the presence of an associated dermal sinus tract made this diagnosis of neoplasm less likely. Total excision of the dermal sinus tract, debulking of the dermoid cyst and drainage of the intramedullary abscess through an L1-L5 osteoplastic laminoplasty and midline myelotomy, followed by long-term antibiotic therapy resulted in a good functional recovery. Post-operative MRI of the spine showed removal of the dermoid cyst, decreased inflammatory granulation tissue and resolution of the holocord edema or syrinx. We also performed a literature review to determine the cumulative experience of management of intramedullary abscess in this rare clinical setting.
  - 4,942 159
Aplasia cutis congenita associated with type I split cord malformation: Unusual case
Bashar Abuzayed, Pamir Erdincler
January-April 2014, 9(1):27-29
DOI:10.4103/1817-1745.131477  PMID:24891898
A full-term newborn girl born with large skin, muscle, bone and dural defect in the lumbo-sacral area. The lesion included a split spinal cord by a perpendicular bony spur and connected from its tip to the upper lamina. Patient was diagnosed with aplasia cutis congenita (ACC) associated with type I split cord malformation (SCM). Neurological examination of the lower extremities was normal. Spinal X-rays showed a bony spur on the L2 vertebral column and laminar defect in the lumbo-sacral area. Lesion was operated and closed according to anatomic layers. Clinical and intraoperative findings of this extremely rare case are discussed.
  - 1,492 104
Thoracic congenital dermal sinus associated with intramedullary spinal dermoid cyst
Sudhansu Sekhar Mishra, Souvagya Panigrahi
January-April 2014, 9(1):30-32
DOI:10.4103/1817-1745.131478  PMID:24891899
Dorsal dermal sinus is a rare, congenital lesion found most frequently in the lumbosacral followed by the occipital regions. It is rarely localized at the thoracic level. We report a rare case of thoracic congenital dermal sinus (CDS) associated with an intramedullary dermoid cyst in a 2-year-old male child, who presented with a 3 month history of motor weakness of both the lower extremities. Magnetic resonance imaging (MRI) of spine showed an intramedullary dermoid cyst extending from the lower border of T4 to upper border of T7, which was connected with the skin dimple along the sinus tract. Total excision of the dermoid cyst and the sinus tract with T5-7 laminectomy resulted in good functional recovery.
  - 3,117 94
Craniosynostosis in a child with I-cell disease: The need for genetic analysis before contemplating surgery in craniosynostosis
Lakshmanarao Chittem, Suchanda Bhattacharjee, Prajnya Ranganath
January-April 2014, 9(1):33-35
DOI:10.4103/1817-1745.131480  PMID:24891900
We are reporting a rare case of I-cell disease presenting with craniosynostosis. An 11-month-old child presented with abnormal head shape, developmental delay and bent bones. We planned for corrective surgery for craniosynostosis, but on genetic analysis I-cell disease was confirmed. After explaining the prognosis of I-cell disease, parents denied surgery. This case report emphasizes the fact that syndromic evaluation of craniosynostosis is very much essential before proceeding for corrective surgery.
  - 1,656 101
Unusual phenotype of glucose transport protein type 1 deficiency syndrome: A case report and literature review
Annio Posar, Margherita Santucci
January-April 2014, 9(1):36-38
DOI:10.4103/1817-1745.131481  PMID:24891901
The glucose transport protein type 1 (GLUT1) deficit causes a chronic brain energy failure. The classic phenotype of GLUT1 deficiency syndrome is characterized by: Mild to severe motor delay and mental retardation; infantile-onset epilepsy; head growth deceleration; movement disorders (ataxia, dystonia, spasticity); and non-epileptic paroxysmal events (intermittent ataxia, periodic confusion, recurrent headaches). During last years the classic phenotype of this syndrome, as originally reported, has expanded. We report the atypical phenotype of a boy with GLUT1 deficiency syndrome, characterized by mild mental retardation and drug-resistant absence seizures with onset at the age of 6 years, without movement disorders nor decrease of head circumference. A prompt diagnosis of this disorder is mandatory since the ketogenic diet might represent an effective treatment.
  - 19,795 683
Pontocerebellar hypoplasia type 1 with a milder phenotype in a two-year-old girl
Puneet Jain, Suvasini Sharma, Atin Kumar, Satinder Aneja
January-April 2014, 9(1):70-72
DOI:10.4103/1817-1745.131494  PMID:24891912
The rare association of pontocerebellar hypoplasia with anterior horn cell involvement has been classified as pontocerebellar hypoplasia type 1. Its classic phenotype is usually severe. However, the pontocerebellar hypoplasia type 1 may have wider variability in clinical and radiological features. There may be a genetic heterogeneity as well. We described here a young girl with relatively milder clinical phenotype with cerebellar atrophy with absent pontine involvement, further adding to the clinical phenotype.
  - 1,924 90
Giant primary cerebral hydatid cyst: A rare cause of childhood seizure
Shilpa Khanna Arora, Anju Aggarwal, Varsha Datta
January-April 2014, 9(1):73-75
DOI:10.4103/1817-1745.131495  PMID:24891913
We report a 9-year-old girl who presented with focal seizures, hemiparesis, headache, vomiting and bilateral optic atrophy. CT scan revealed a giant solitary cyst in the left parietal lobe. Serology and histopathology of the excised cyst confirmed the diagnosis of neurohydatidosis which is a rare cause of childhood seizure.
  - 1,515 111
Pediatric bilateral large concurrent thalamic glioblastoma: An unusual case report
Nityanand Pandey, Pankaj Kumar Singh, Ashok K Mahapatra, Aanchal Kakkar, Bhawani Shankar Sharma
January-April 2014, 9(1):76-78
DOI:10.4103/1817-1745.131496  PMID:24891914
Bilateral thalamic tumors are rare. Pediatric bilateral thalamic glioblastomas are even rarer, only five cases reported in the English literature till date. The clinical presentation, natural history, and prognosis of pediatric thalamic tumors are still relatively obscure. In this article, we report an 8-year-old patient with large bilateral thalamic glioblastomas and briefly discuss its clinical presentation, possible modalities of management, and prognosis, in the light of available literature.
  - 2,579 108
A new clinical feature associated with familial early-onset of dystonic-guttural tics: An unusual diagnosis of PANDAS
Giovanna Vitaliti, Rosario R Trifiletti, Raffaele Falsaperla, Enrico Parano, Alberto Spalice, Piero Pavone
January-April 2014, 9(1):79-81
DOI:10.4103/1817-1745.131497  PMID:24891915
Until today there is a large debate about the existence of PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) or PANS (pediatric acute onset neuropsychiatric syndrome). These children usually have dramatic, "overnight" onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions. In addition to these symptoms, children may also have comorbid features of associated disorders. Herein, we report a family with an early onset of tics, with exclusively dystonic and guttural tics. All patients had a particularly strong excitement trigger. Two of the patients were shown to have signs suggestive of PANDAS and all family members were Group A beta-hemolytic Streptococcus (GABHS) carriers. The PANDAS spectrum is probably a group of disorders. We have described a PANDAS variant, in which the family seems to share common autoimmune pattern and may be viewed in the large spectrum of PANDAS.
  - 2,539 86
Recurrent encephalopathy? No I'm a sleeping beauty!
Mehtab Iqbal, Manish Prasad, Christopher Ritey
January-April 2014, 9(1):82-84
DOI:10.4103/1817-1745.131498  PMID:24891916
To describe the clinical presentation of 'Kleine-Levin (sleeping beauty) syndrome' in a child, who presented with recurrent episodes consistent with encephalopathy, associated with excessive sleepiness, cognitive and behavioural disturbance and hyper sexuality. 14 years old boy presented acutely with excessive tiredness, sleeping excessively, abnormal behaviour and hypersexuality following a viral throat infection. On examination he was sleepy but easily arousable. His GCS (15/15) and rest of the neurological examination including fundoscopy and other systemic examination was completely unremarkable. All his initial investigations including electrolytes, LFTs, CSF, virology screen and MRI brain scan were normal. Detailed autoimmune screening was also negative. EEG showed non-specific diffuse slowing consistent with encephalopathy. His excessive sleepiness gradually improved together with his altered behaviour in about two weeks after presentation. Hyper sexuality became more overt during this phase. All these symptoms completely disappeared three weeks after his presentation and he attended school as before. He was readmitted six weeks later with exactly similar presentation and again only positive result being diffuse non-specific slowing of EEG. His recovery was also similar and he was completely back to his normal self in three weeks time. His recurrent symptoms were consistent with 'Kleine-Levin syndrome (KLS)' or 'sleeping beauty syndrome'. KLS is a rare disorder which mainly affects adolescent males. Common symptoms include hypersomnia (100%), cognitive changes (96%), eating disturbances (80%), hypersexuality, compulsions, and depressed mood. The syndrome usually lasts for 8 years, with on an average seven episode of 10 days each recurring every 3.5 months. It is most frequently precipitated by infections and somnolence decreases using stimulants in nearly 40% of cases.
  - 2,081 93
LETTERS TO THE EDITOR
Pfeiffer syndrome
Mitul B Kalathia, Yogesh N Parikh, Meera D Dhami, Palak T Hapani
January-April 2014, 9(1):85-86
DOI:10.4103/1817-1745.131499  PMID:24891917
  - 2,001 112
A novel case of 'muscle eye brain disease' in an immigrant family in India
Vikram S Kumar, VB Sangeeta, KS Shubrata, AV Nagaraja
January-April 2014, 9(1):88-89
DOI:10.4103/1817-1745.131501  PMID:24891919
  - 1,296 104
Traumatic enlargement of an intradiploic cavernous hemangioma
Amit Mahore, Raghvendra Ramdasi, Anvita Pauranik, Naina Goel
January-April 2014, 9(1):90-91
DOI:10.4103/1817-1745.131502  PMID:24891920
  - 1,563 94
Tectal glioma with hydrocephalus presenting with spastic and ataxic quadriparesis
Dhaval Shukla, Parayil Sankaran Bindu, Bhagvatula Indira Devi
January-April 2014, 9(1):91-93
DOI:10.4103/1817-1745.131505  PMID:24891921
  - 1,355 90
ORIGINAL ARTICLES
Menkes disease – An important cause of early onset refractory seizures
Puneet Jain, Lakshminarayanan Kannan, Biswaroop Chakrabarty, Atin Kumar, Neerja Gupta, Madhulika Kabra, Sheffali Gulati
January-April 2014, 9(1):11-16
DOI:10.4103/1817-1745.131471  PMID:24891895
Context: Menkes disease is an X-linked multisystem disorder characterized by early onset of cerebral and cerebellar neurodegeneration, fair skin, hypopigmented sparse hair and connective tissue abnormalities. Aims: We aimed to evaluate the clinical, electrophysiological and radiological features of children with Menkes disease seen at our institute. Setting/Design: The medical records of children diagnosed with Menkes disease admitted in the pediatric neurology ward or attending the special pediatric neurology clinic at a tertiary care and a referral hospital in North India, from January 2010 to December 2012, were retrospectively reviewed. The clinical data of each case was subsequently summarized and reported. Statistical analysis used: Descriptive statistics were used. Results: During the study period, 1174 children were seen. Out of these, 6 cases were diagnosed as Menkes disease on the basis of clinical phenotype, low serum copper and ceruloplasmin and supportive neuroimaging. All the children were males and had disease onset within 3 months of age, with 4 children presenting in the neonatal period. Global developmental delay and refractory seizures were the predominant clinical symptoms. Two children had symptomatic West syndrome. Other seizure semiologies included tonic-clonic (4), myoclonic (2) and tonic seizures (1). The electroencephalographic abnormalities included hypsarrythmia (2) and multifocal epileptiform discharges (3). The salient radiological features included white matter changes, temporal lobe abnormalities, global atrophy, subdural hygromas and tortuous cerebral blood vessels. Conclusions: Menkes disease should be suspected in a case of refractory early onset seizures especially in the presence of subtle clinical clues. The neuroimaging findings may further support the diagnosis.
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Assessment of parent reported quality of life in children with epilepsy from Northern India: A cross-sectional study
Vandana Arya, Virender Kumar Gehlawat, Jaya Shankar Kaushik, Geeta Gathwala
January-April 2014, 9(1):17-20
DOI:10.4103/1817-1745.131473  PMID:24891896
Objective: The objective of the following study is to assess parent reported quality of life (QOL) in children with epilepsy and to assess the demographic and clinical factors, which influence the QOL in children with epilepsy. Study Participants: We consecutively enrolled 40 children aged from 2 years to 14 years with active epilepsy who had undergone a comprehensive evaluation for epilepsy. Materials and Methods: Parents were enquired on baseline demographic variables including age, gender, socio-economic status and parental education. Clinical details of epilepsy including the type of epilepsy, seizure frequency were assessed. QOL was evaluated with the parent reported quality of life in childhood epilepsy (QOLCE) questionnaire. Results: A total of 40 children were enrolled of which 55% (22/40) were males and the mean (standard deviation [SD]) age of enrolled children was 10.6 (2.7) years. The majority came from a rural background (80% [32/40]), were from lower (15 [37.5%]) or middle (23 [57.5%]) socio-economic status, with almost half (22 [55%]) of mothers being educated until high school. The overall mean (SD) QOL score was 66.7 (4.83). Lowest mean (SD) scores were observed in self-esteem (45.2 [7.3]) subscale and subscales with higher QOL scores included control/helplessness (82.1 [8.51]), anxiety (81.6 [12.55]) and social stigma (95.0 [11.6]). Parental education, socio-economic status (P = 0.96), frequency of seizure (P = 0.34) or type of epilepsy (P = 0.92) did not significantly affect the overall QOL among children with epilepsy. Conclusion: Our study concluded that overall QOL was compromised in Indian children with epilepsy. Demographic factors like parental education, socio-economic status and clinical factors like frequency of seizure or type of seizure did not significantly affect the QOL of epileptic children.
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Umbilical artery pH at birth and neurobehavioral outcome in early preterm infants: A cohort study
Bhavna Seth, Vikram Datta, Bhanu Kiran Bhakhri
January-April 2014, 9(1):7-10
DOI:10.4103/1817-1745.131470  PMID:24891894
Objective: The objective of the following study is to determine the effect of umbilical artery pH at birth on early neurobehavioral outcome of preterm infants as assessed by Neurobehavioral Assessment of Preterm Infants (NAPI) tool. Materials and Methods: Prospective cohort study conducted at the neonatal unit in a tertiary care center in North India. Preterm neonates < 34 weeks of gestation were enrolled at birth and divided into cases (umbilical artery pH < 7.2) and controls (umbilical artery pH > 7.2). At 34 weeks postconceptional age, the motor development and vigor (MDV) and alertness and orientation (AO) domains of neurobehavior were assessed by NAPI and compared among groups. Results: Hundred preterm neonates were enrolled in the study out of which 76 (30 cases and 46 controls) were finally analyzed. The groups were comparable in terms of gestational age, mode of delivery, birth weight and requirement of resuscitative measures at birth. There was no significant difference in incidence of meningitis, intraventricular hemorrhage, jaundice and hypoxic ischemic encephalopathy among the groups; however hypoglycemia was observed more commonly among cases. The MDV score (mean ± standard deviation [SD] [95% confidence interval]) was found to be significantly lower among cases compared to controls (37.0713 ± 13.616 [32.099-42.0431] vs. 47.506 ± 14.0692 [43.367-51.655]) (P = 0.002). Similarly, lower AO scores were observed among the cases. Conclusion: A low umbilical artery pH at birth is a predictor of poor early neurobehavioral outcome in preterm neonates.
  - 2,050 201
REVIEW ARTICLE
Procedural sedation and analgesia in pediatric patients
Charu Mahajan, Hari Hara Dash
January-April 2014, 9(1):1-6
DOI:10.4103/1817-1745.131469  PMID:24891893
A spectrum of conditions requires sedation and analgesia in pediatric population. Ineffective treatment of pain may result in physiological and behavioral responses that can adversely affect the developing nociceptive system. The recognition of pain in children can be facilitated by different pain scales. This article reviews the procedural sedation and analgesia (PSA) practices in children along with pharmacology of the drugs used for this purpose.
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