Educational provisions and learning disability

Objective To assess the impact of the provisions of the Maharashtra government on the academic performance of children with specific learning disability (SpLD) at the Secondary School Certificate (SSC) board examination. Methods The academic performance of 60 children (45 boys, 15 girls) at the SSC board examination with benefit of chosen provisions was compared with their performance at their last annual school examination before diagnosis of SpLD. Results There was a significant improvement in their mean percentage (%) total marks scored at the SSC board examination as compared with the mean % total marks scored by them at their last annual school examination before the diagnosis (63.48 ±7.86 vs. 40.95±7.23) [mean±SD, mean % difference=22.53, 95% CI=19.8–25.26, P<0.0001, using studient's t test]. Also, children who had availed exemption of one language or opted for lower grade of mathematics had scored significantly better marks in their optional subjects (P<0.0001 and P=0.0009, respectively). Conclusion Children with SpLD who availed the benefit of provisions showed a significant improvement in their academic performance at the SSC board examination.     

Fat-modified diets during pregnancy and lactation and serum lipids after birth

Objective : This study investigated the influence of modifying the maternal dietary fat on the serum lipids of infants at birth and at one year of age.Methods : This single-blind randomized clinical trial was done on 180 4-month-pregnant women. All subjects proved to have a fat-unmodified diet through a 4-day food record dietary questionnaire. They were divided randomly into two groups. The intervention group was kept on a fat-modified diet including saturated fatty acid (SFA) <10%, monounsaturated fatty acids: (MUFA) 10-5%, polyunsaturated fatty acid (PUFA) upto 10% and cholesterol <300 mg/day with dietary advice for the pregnancy period. The control group was given only the latter advice. All subjects were followed up monthly. The serum lipids including total cholesterol (T.cho), triglyceride (TG), and HDL cholesterol (HDL-C) were analyzed through enzymatic methods. The level of LDL-cholesterol (LDL-C) was calculated by Friedewald formula. The comparison of mean cord and one-year-old infant serum lipids were done through unpaired T-test in two groups.Results: The mean level of T.cho in the intervention and control group was (70.3±15.9, vs 81.4±17.2, P<0.009), TG (85.3 ± 16.7 vs 97.5 ± 18.2, P<0.007), LDL-C (27.8 ± 15.2 vs 34.8 ±17.1, P<0.04) and non-HDL-C (44.5±7.2 vs 54.5 ± 8.1, P<0.02) and in one year old infant the comparison of serum lipids were as follows. T.cho (145.7 ± 51.4 vs 161.4 + 56.2, P<0.003), TG (90.1 ± 31.8 vs 98.3 ± 33.1, P<0.02), LDL-C (85.6 ± 20.4 vs 92.3 ± 19.6, P<0,05) and non-HDL-C (113.6 ± 30.2 vs 128.8 ± 34.8, P<0.04). However, there was no significant difference in HDL-C of both groups.Conclusion : There is a significant decrease of T.cho, TG, LDL-C and non-HDL-C levels with no significant increase of HDL-C in the intervention group with the fat-modified diet. Maternal fatmodified diet could be suitable way to prevent cardiovascular disease among infants from the beginning of the life.     

Oxidized LDL metabolites with high family risk for premature cardiovascular disease

Objective: Considering the importance of primary prevention of Cardiovascular Disease (CVD) from childhood, especially in children with high family risk for premature atherosclerosis, and also the importance of oxidized LDL in the process of atherosclerosis, the main metabolites of ox-LDL i.e. Malondialdehyde (MDA) and Conjugated diene (CDE) have been measured in children of high risk families and compared with a control group.Methods: Children and adolescents (6–18 years) of parents with premature myocardial infarction (Ml ≤ 55y in men and ≤ 65y in women), were selected as the case group. The control group included neighbors of the case group matched for age and socioeconomic status. All samples have been selected by simple random sampling. Both the case and control groups were divided in two subgroups : those with a total cholesterol and/or LDL-C ≥95th centile and those with normal lipid levels. Each subgroup consisted of 32 subjects, so 128 subjects were studied (64 in the case and 64 in the control group). MDA and CDE were measured by spectrophotometry using molar absorbivity. Data were analyzed by SPSS_v10/Win software using ANOVA, Bon-ferroni, Scheffe-Duncan, Tukey-HSD, and the Student’s t-test.Result: The mean MDA value in the case and control groups was significantly different (1.84 ± 0.43 vs. 1.67 ± 0.41 Μmol/L, p=0.03), but this difference was not significant regarding the mean CDE level (0.50 ± 0.05 vs. 0.47 ± 0.04 Μmol/ L, p>0.05). The mean MDA level in the case group with hyperlipidemia was significantly higher than that in the case group without hyperlipidemia (1.985 ± 0.516 vs. 1.690 ± 0.366, Μmol/L, P=0.02) and also higher than control group with or without hyperiipidemia (1.985 ± 0.516 vs. 1.720 ± 0.389,1.615 ± 0.429 Μmol/L respectivety, P<0.05). The mean CDE level in the case group with hyperiipidemia was significantly higher than the case group without hyperlipidemia (0.542 ± 0.034 vs. 0.494 ± 0.049 Μmol/L, P=0.04) and higher than the control group with or without hyperiipidemia (0.542 ± 0.034 vs. 0.464 ± 0.051, 0.484 ±0.048 Μmol/L respectively, p<0.05). In case boys with hyperiipidemia, the mean MDA (2.03 ± 0.2 Μmol/L) and the mean of CDE (0.56 ± 0.04 Μmol/L) was significantly higher than other subgroups (P<0.05).Conclusion: Considering the increased susceptibility of LDL to oxidation in children with high family risk for premature CVD, special attention should be paid to consumption of foods and seasoning containing antioxidants from childhood especially in high risk families.     

Melamine‐tainted milk product‐associated urinary stones in children

Background: An outbreak of urinary stones related to consumption of melamine‐tainted milk products (MTMP) occurred in China in 2008. The aim of the present study was to evaluate such children to identify their clinical features and risk factors. Methods: Renal ultrasound was performed for 7328 children who presented to a Sichuan teaching hospital between 13 September and 15 October 2008 due to concern of such stones. Clinical data, family information, feeding history and urinary stones were analyzed. Results: Of the 7328 children, 189 (2.58%) had ultrasound findings of urinary stones, and 51 were admitted. Age (mean ± SD) was 27.4 ± 25.5 months, and 101 were male and 88, female. The odds ratio (OR) for urinary stones for infants and young children (1–3 years) as compared to older children (>3 years), was 2.42 (95% confidence interval [CI], 1.64–3.56; P < 0.0001) and 1.95 (95%CI, 1.31–2.89; P < 0.0011), respectively. Independent risk factors associated with urinary stones included consumption of MTMP with melamine at >5500 mg/kg (OR, 13.3; 95%CI, 6.8–26.1, P < 0.0001) as compared to that with melamine at <200 mg/kg, and younger father (P = 0.0006). On logistic regression, the only risk factor associated with inpatient care was lower family income per person (OR, 4.4; 95%CI, 1.2–15.9, P = 0.02). Repeat ultrasound for 51 children at mean follow up of 15.3 ± 8.9 days found that 33 passed out all stones, which was associated with a larger number of smaller stones (P = 0.003). Urinary stones contained melamine and uric acid, but no cyanuric acid. Conclusions: MTMP‐associated urinary stones were more frequent in young children and more severe in children from poorer families.     

Helicobacter pylori colonization in children with gastritis and peptic ulcer. I. The colonization rate and effects of colonization on mucin content and mucosal inflammation in the antrum

The incidence of Helicobacter pylori infection and effects of H. pylori colonization on mucin content and mucosal inflammation of the antral mucosa were studied quantitatively in 55 Japanese children with suspected gastritis and peptic ulcers (aged 6–16 years, mean 12.3 years). H. pylori was detected, using Warthin-Starry stain, in nine of the 22 cases (41%) with antral histological gastritis, but in none of the 33 histologically normal cases. Five out of seven duodenal ulcer cases showed histological gastritis, and all five cases were H. pylori positive. Severity of gastritis, evaluated by means of gastritis score, was significantly higher in H. pylori positive gastritis cases than in H. pylori negative gastritis cases (5.4 ± 1.0 vs 3.1 ± 0.3, P< 0.001). A PAS-AB index, a proportion of the periodic acid Schiff-alcian blue (PAS-AB) positive mucin area to the total epithelial area, was significantly lower in H. pylori positive cases than in H. pylori negative cases, irrespective of the existence of histological gastritis (23.5±7.6% vs 40.4±5.5%, 43.5±4.2%, P< 0.001). The decreased mucin content of gastric mucosa is likely to lead to weakening of an important defensive factor of gastric mucosa. These findings suggest that H. pylori plays an important role in gastritis and peptic ulcers in children, especially in cases with duodenal ulcer.     

Influence of infant-feeding practices on nutritional status of under-five children

Objectives: To study the nutritional status of under-five children and to assess whether infant feeding practices are associated with the undernutrition in anganwari (AW) areas of urban Allahabad.Methods: Under-five-years children and their mothers in selected four anganwari areas of urban Allahbad (UP) participated in the study. Nutritional assessment by WHO criterion (SD- classification) using summary indices of nutritional status: weight-for-age, height-for-age and weight-for-height was done. Normal test of proportions, Chi-square test for testing association of nutritional status with different characteristics and risk analysis using odds ratios with 95% confidence intervals was also done.Results: Among all under five children surveyed, 36.4% underweight (<2SD weight- for-age), 51.6% stunted (<2SD height- for-age), and 10.6% wasted (<2SD weight- for-height). Proportions of underweight (45.5%) and stunting (81.8%) were found maximum among children aged 13–24 months. Wasting was most prevalent (18.2%) among children aged 37–48 months. Initiation of breast-feeding after six hours of birth, deprivation from colostrum and improper complementary feeding were found significant (P<0.05) risk factors for underweight. Wasting was not significantly associated (P>0.10) with any infant feeding practice studied. ICDS benefits received by children failed to improve the nutritional status of children.Conclusion: Delayed initiation of breast-feeding, deprivation from colostrum, and improper weaning are significant risk factors for undernutrition among under-fives. There is need for promotion and protection of optimal infant feeding practices for improving nutritional status of children.     

Recovery Kinetics of Oxygen Uptake Is Abnormally Prolonged in Patients with Mustard/Senning Repair for Transposition of the Great Arteries

The aim of this study was to evaluate the ability to recover from exercise in patients with a Mustard/Senning (M/S) repair for transposition of the great arteries and to identify the major determinants. A total of 40 consecutive patients with a M/S repair at a mean age of 10.0 ± 9.8 months underwent maximal cardiopulmonary exercise testing at 19.5 ± 11.3 years of age. Results were compared to those of a cohort of 153 healthy individuals. Decay of oxygen uptake (VO₂), CO₂ (VCO₂), minute ventilation (VE), heart rate (HR) was calculated for the first minute of recovery. M/S patients had reduced peak VO₂ (22.9 ± 7.2 vs 34.2 ± 9.5 ml O₂/kg/min, p < 0.0001) and VO₂ slope (0.27 ± 0.10 vs 0.47 ± 0.2 L O₂/min, p < 0.0001), Peak O₂ pulse (p < 0.0001) and peak HR (p = 0.001) were reduced. VCO₂ and VE slopes were reduced (p < 0.0001 for both), whereas HR slope was similar (p = 0.38). In M/S patients, the only independent determinants of VO₂ slope during recovery were pulse O₂ slope (p < 0.0001) and VCO₂ slope (p < 0.0001). In M/S patients, a limited cardiopulmonary reserve affects not only maximal exercise responses but also the recovery phase. A prolonged recovery of O₂ pulse and a prolonged CO₂ retention with subsequent prolonged hyperpnea are the main determinants of the delayed recovery.     

Immune status with empyema thoracis

Objective: To evaluate the humoral and cell mediated immune status of children with empyema thoracis.Methods: Serum IgG, IgA, IgM, Complement C₃ assay and cell mediated immunity (CMI) tests were performed in 33 patients of empyema thoracis, and 14 healthy age matched controls.Results: The mean serum IgG and IgA levels in empyema thoracis and its subgroups were significantly raised as compared to controls. The overall values of IgG and IgA were 104% (P<0.001) and 114% (P<0.01) of normal mean, respectively. The mean serum IgM and complement C₃ levels did not differ significantly in both the groups. The frequency of negative skin reaction to purified protein derivative (PPD) was significantly higher in children with empyema thoracis as compared to controls (P<0.05). The mean absolute lymphocyte count (ALC) was significantly decreased and serum adenosine deaminase (ADA) activity was significantly raised in empyema thoracis in comparison to controls. The overall ALC was 76.1% (P<0.01) and serum ADA activity was 169.4% (P<0.001) of normal mean, respectively. No significant differences were observed in the mean levels of immunoglobulins, complement C₃ and CMI tests between pyothorax and pyopneumothorax and pleural fluid culture positive and negative cases.Conclusions: Thus, both humoral and cell mediated immunity were affected in empyema thoracis patients. However, CMI demonstrated more pronounced change in comparison to humoral immunity     

Insulin glulisine for continuous subcutaneous insulin infusion in pediatric type 1 diabetes

We evaluated the efficacy and safety of insulin glulisine (GLU) used for continuous s.c. insulin infusion (CSII) in 20 children with type 1 diabetes after 1 year of GLU treatment. There were no significant differences in mean plasma glucose before breakfast and before dinner between before and after using GLU, but the levels after breakfast and after dinner significantly improved, from 192.5 ± 31.7 to 162.0 ± 27.3 mg/dL for breakfast, and from 191.1 ± 33.3 to 161.1 ± 24.5 mg/dL for dinner (P < 0.01). Mean hemoglobin A1c significantly decreased (from 8.0 ± 0.8 to 7.7 ± 0.8%, P < 0.05), and the mean frequency of hypoglycemia significantly reduced after using GLU (from 8.3 ± 4.9 to 6.0 ± 3.4/month, P < 0.05). In conclusion, the use of GLU rather than other rapid‐acting analogues for CSII might be an effective treatment option in children with type 1 diabetes.     

Reduced exercise capacity in non-cystic fibrosis bronchiectasis

Objective : Bronchiectasis not due to cystic fibrosis is usually a consequence of severe bacterial or tuberculous infection of the lungs, which is commonly seen in children in developing countries. Our aim was to study its functional sequelae and affect on work capacity in children.Methods : Seventeen children (7-17 years of age) with clinical and radiological evidence of bronchiectasis of one or both lungs were studied at the Cardiopulmonary Unit of the Tuberculosis Research Centre. Pulmonary function tests including spirometry and lung volume measurements were performed. Incremental exercise stress test was done on a treadmill, and ventilatory and cardiac parameters were monitored. Control values were taken from a previous study.Results : Children with bronchiectasis had lower forced vital capacity (FVC) (1.1 + 0.4 L versus 1.5 + 0.4 L, p=0.003) and FEV, (0.95 ±0.2 L versus 1.4 ±0.3 L, p<0.002) compared to age- and sex-matched healthy controls. The patient group had significantly higher residual lung volumes (0.7 ±0.3 L versus 0.4 + 0.1 L, p<0.02). At maximal exercise, they had lower aerobic capacity (28 +- 6 ml/min/kg versus 38 ±5 ml/min/kg, p<0.0001) and maximal ventilation (24 ±8 L/min versus 39 ±10 L/min, p<0.001). At maximal exercise, while none of the controls desaturated, oxygen saturation fell below 88% in eight of 17 patients.Conclusion : The findings show that children and adolescents with non-cystic fibrosis bronchiectasis have abnormal pulmonary function and reduced exercise capacity. This is likely to interfere with their life as well as future work capacity. Efforts should be made to minimize lung damage in childhood by ensuring early diagnosis and instituting appropriate treatment of respiratory infections.     

Efficacy of caudal butorphanol

Objective: To evaluate the efficacy of butorphanol with or without bupivacaine for caudal epidural anesthesia in children undergoing infraumbilical surgery.Methods: Sixty ASA physical status I and II patients of either sex aged 1–10 yr were randomized to one of three groups. Group L received 1 ml/kg of 0.25% bupivacaine; Group B received 1 ml/kg of 25 μg/kg butorphanol diluted in normal saline; and Group LB received 1 ml/kg of 25 μg/kg butorphanol in combination with 0.25% patients. Sedation score, pain score, and requirement of rescue analgesia were recorded at preset time intervals alongwith postoperative complications.Results: There was no difference among the groups regarding sedation scores, requirement of rescue analgesia and post-operative complications. Mean duration of analgesia was maximum in group BL (14.5±3.5 hr, P<0.001), than in group L (8.8±4.8 hr) and group B (6.8±2.9 hr).Conclusion: The, addition of 25 μg/kg butorphanol to bupivacaine resulted in superior analgesia with a longer period compared with caudal bupivacaine and butorphanol alone, without an increase of side effects.     

Fat-Soluble Antioxidant Vitamins,Iron Overload and Chronic Malnutrition in β-Thalassemia Major

Objective

To assess the antioxidant vitamins A (retinol) and E (α-tocopherol) levels, iron status and growth retardation in children with β-thalassemia major in Odisha, an eastern state of India.

Methods

Forty three children aged 1–15 y diagnosed with β-thalassemia major (28 males and 15 females) and 42 age-matched healthy controls (22 males and 20 females) were studied. β-thalassemia was detected by using Bio-rad variant assay. Measurement of blood hemoglobin (Hb), hematocrit, serum vitamins (A and E) and ferritin was carried out by standard methods.

Results

Mean hemoglobin (6.60?±?1.84 vs. 11.8?±?2.29 g/dL, p?<?0.01), serum retinol (28.0?±?17.67 vs. 54.4?±?36.56 μg/dL, p?<?0.001) and α-tocopherol (0.2?±?0.34 vs. 1.1?±?0.82 mg/dL, p?<?0.001) were significantly lower in children with thalassemia compared with control group, however, serum ferritin (storage iron) was elevated in thalassemia patients (553.7?±?176.80 vs. 57.3?±?40.73 ng/mL, p?<?0.001). Vitamin E had significantly correlated with hemoglobin and hematocrit values in the patients. Growth retardation in terms of stunting (79 % vs. 24 %, p?<?0.0001) and thinness (32.6 % vs. 9.5 %, p?<?0.05) was significantly higher in thalassemic children compared with normal children.

Conclusions

This study shows that children with β-thalas-semia major are in a state of oxidative stress of hyperfer-ritinemia with deprived antioxidant vitamins (A and E) and poor growth status suggesting a possible need for reduction in iron overload and additional antioxidant supplementation.     

What are parents of obese children concerned about in their children?

We retrospectively examined the issues that concern parents of obese children to determine the most effective means of motivating them to seek treatment for obesity in their children. Children with an obesity index > 40%, aged six to 12 years, were screened in Kagoshima City in 1992. Parents were notified if their children needed an evaluation that included a family history and measurements of the blood pressure, total cholesterol, high density lipoprotein (HDL)-cholesterol, atherogenic index (ASI), triglycerides, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Parents were informed of the results of the evaluation and invited to attend a lecture on the treatment of obesity in children. A total of 378 obese children were evaluated. However, the parents of only 39 children attended the lecture. Children whose parents attended had higher mean total levels of cholesterol (190 ± 25 vs 175 ± 28, P < 0.01) and ASI values (3.2 ± 0.9 vs 2.7 ± 0.9, P < 0.02) than those whose parents did not attend. There were no significant differences in other factors. Only 4.2% of parents whose children showed no abnormal values, except for obesity, attended the lecture, compared with 20.3% (P< 0.01) or 16.9% (P< 0.05) of parents whose children had abnormal levels of cholesterol or abnormal ASI. Parents may be more concerned about hypercholesterolemia or arteriosclerosis than obesity per se. We should perhaps use the total cholesterol or ASI values, not just the severity of obesity, to motivate parents to enter their children into treatment programs for obesity.     

Effect of clofibrate in jaundiced term newborns

Objective: Clofibrate is a glucuronosyl transferase inducer that has been proposed to increase the elimination of bilirubin in neonates with hyperbilirubinemia. The aim of this study was to characterize the therapeutic effect of clofibrate in neonates born at full term and present with non-hemolytic jaundice.Methods: A clinical controlled study was performed in two groups of healthy full term neonates. Thirty neonates were treated with a single oral dose of clofibrate (100 mg/kg) plus phototherapy (clofibrate-treated group) while another 30 neonates (control group) received only phototherapy.Result: The mean plasma total bilirubin levels of 12^th, 24^th and 48^th hours were significantly lower in the clofibrate-treated group as compared with the control group (P<0.0001, P<0.0001 and P=0.004, respectively). Treatment with clofibrate also resulted in a shorter duration of jaundice and a decreased use of phototherapy (P<0.0001). No side effects were observed.Conclusion: Although other pharmacological agents such as metalloporphyrins and Sn-mesoporphyrin also seem to be effective in decreasing bilirubin production, these products are not available for routine use and cannot be used because the safety of these drugs has to be confirmed prior to their widespread use. Therefore, clofibrate is now the only available pharmacological treatment of neonatal jaundice.     

Indications for surgical treatment of funnel chest by chest radiograph

Forty-seven children with funnel chest (FC) who underwent sternal elevation and 210 normal children were examined to determine the indications for surgical treatment using the vertebral index (VI) and frontosagittal index (FSI). In normal children VI gradually increased and FSI gradually decreased with age. Both indices changed significantly at 3 years of age. Although the VI of FC patients decreased significantly from 33.8 ± 7.6 (n=40) to 24.4 ± 3.9 (n=38) postoperatively (P < 0.0001), it was significantly larger than that of normal children over 3 years of age (20.2 ± 2.2, n=150) (P < 0.0001), and although the FSI of FC patients increased significantly from 22.0 ± 7.0 (n=40) to 34.5 ± 6.5 (n=38) postoperatively (P < 0.0001), it was significantly smaller than that of normal children over 3 years of age (41.1 ± 4.0, n=150) (P < 0.0001). Since many patients had a thin and flat chest despite excellent correction, their postoperative indices were not normal. There was a correlation between VI and FSI in normal children and a high degree of correlation between VI and FSI both before and after operation in FC patients. We conclude that a VI of more than 27 and/or a FSI of less than 29 are indications for surgical treatment based on the mean VI + 3SD and FSI − 3SD of normal children over 3 years of age. These values are almost equal to the mean VI − SD and FSI + SD of patients with physical, cosmetic, and/or psychological disturbances. However, it is not necessary to measure both indices simultaneously. Postoperative VI and FSI did not always reflect the degree of chest-wall depression in FC patients because of their flat chests. Accepted: 25 July 2000     

Comparison of synchronized and conventional intermittent mandatory ventilation in neonates

Between October 1993 and April 1995, a total of 77 neonates requiring mechanical ventilation were enrolled in this study and were randomly divided into two groups. Group A consisted of 31 premature infants (mean birthweight 1.36 ± 0.29 kg) with respiratory distress syndrome (RDS) and seven neonates (mean birthweight 3.2 ± 0.5 kg) with meconium aspiration syndrome (MAS). Group B consisted of 31 premature infants (mean birthweight 1.31 ± 0.3 kg) with RDS and eight neonates (mean birthweight 3.3 ± 0.5 kg) with MAS. Infants in group A received synchronized intermittent mandatory ventilation (SIMV) and infants in group B received conventional intermittent mandatory ventilation (CIMV) therapy. In premature infants with RDS, our data showed: (i) the duration of ventilation was significantly shorter (P < 0.05) in the synchronized group (156 ± 122 h) compared to the conventional group (242 ± 175 h); (ii) significantly fewer (P <0.05) patients required reintubation in the synchronized group than in the conventional group (three vs 11 patients); (iii) incidence of severe intraventricular hemorrhage (grades 3 and 4) was significantly lower (P < 0.05) in the synchronized group compared to the conventional group (one vs seven patients); (iv) incidence of bronchopulmonary dysplasia was significantly lower (P < 0.05) in the synchronized group than in the control group (one vs seven patients). In neonates with MAS, our data showed no significant difference (P > 0.05) on duration of ventilation, incidence of reintubation, incidence of pneumothorax or mortality rate between synchronized and control groups.     

Bone metabolism alteration on antiepileptic drug therapy

Objective  To investigate whether serum total alkaline phosphatase (ALP), bone-specific ALP (bone ALP), calcium, phosphorus, 25-hydroxyvitamin D (25-OHvit D) concentrations are altered early in the course of treatment with carbamazepine or valproic acid monotherapy in ambulatory children with adequate sun exposure; and to determine the effectiveness of simultaneous supplementation with calcium and 25-OHvit D at recommended dietary allowance doses on these biochemical parameters. Methods  For each drug, children were divided into two groups (Group A: without supplementation; and Group B: with supplementation) and serum biochemical parameters estimated at 0, 30, 60, and 90 days of starting treatment. Statistical analysis: Serial changes in serum biochemical parameters (mean ± SD) were compared within each of the four groups using student’s paired t test. Also for each drug, serum biochemical parameters were compared between Groups A and B at 0, 30, 60, and 90 days of starting treatment using student’s unpaired t test. Results  For both drugs, in Group A, serum total ALP levels were significantly increased above the normal range (P<0.0001) by 90 days of starting treatment; however, serum bone ALP level was significantly increased (P=0.002) only in children on valproic acid. For both drugs when serum biochemical parameters were compared between Groups A and B, supplementation resulted in a significant decrease in serum total ALP (P<0.0001) and bone ALP levels (P<0.001), and a significant increase in serum calcium (P<0.0001) and 25-OHvit D levels (P<0.0001) by 90 days of starting treatment. Conclusion  Serum biochemical changes which indicate predisposition to development of rickets or osteomalacia appear within 90 days of starting carbamazepine or valproic acid monotherapy. However simultaneous supplementation with oral calcium and 25-OHvit D is effective in preventing the development of these adverse biochemical changes.     

Usefulness of Pulsed Wave Tissue Doppler Imaging in Assessment of Left Ventricular Functions in Children with Beta-Thalassemia Major

Objective

To evaluate the changes in the LV systolic and diastolic function in children with beta-thalassemia major (β-TM) using pulsed wave tissue doppler (TD) echocardiography.

Methods

Clinical, conventional echo doppler and pulsed wave tissue doppler imaging parameters were compared in 40 beta-thalassemia major patients (mean age, 6.52?±?3.5 y) and 25 age and sex matched normal subjects (mean age, 6.5?±?2.7 y).

Results

There were no significant statistical differences between mean fractional shortening (FS) and ejection fraction (EF) of left ventricle (LV) of the patients and control group. Children with beta-thalassemia had significantly lower E′ wave velocities measured at the left ventricular septal annulus (8.1?±?3.3 vs. 13?±?2.5, P?<?0.001), lateral margin of the mitral annulus (9.1?±?5.4 vs. 13.3?±?2.5, P?<?0.001) and lateral margin of the tricuspid annulus (9.3?±?3.9 vs. 13.3?±?2.5, P?<?0.001) when compared to the control group. Furthermore children with beta-thalassemia had significantly lower E′/A′ wave ratio at the left ventricular septal annulus (0.76?±?0.34 vs. 1.36?±?0.23), lateral margin of the mitral annulus (0.83?±?0.17 vs. 1.28?±?0.22), and lateral margin of the tricuspid annulus ((0.90?±?0.27 vs. 1.26?±?0.23, (P?<?0.05) when compared to the control group.

Conclusions

This study showed that patients with beta-thalassemia major and normal conventional echo doppler parameters had statistically significant changes detected by pulsed wave tissue doppler imaging.     

Exhaled carbon monoxide levels in preschool‐age children with episodic asthma

Background: The concentration of exhaled carbon monoxide (eCO) in young children with stable asthma and during acute asthma attack is not known. Methods: A sampling bag was developed to collect the exhaled air of preschool children. A total of 257 preschool‐age children (≥3 years and ≤6 years old) were studied; 111 had a diagnosis of asthma (43 suffering a mild asthma attack and 68 without active asthmatic symptom), 99 had upper respiratory infection (URI) and 47 were healthy. Results: In preschool‐age children, eCO levels of those with asthma attacks (mean ± SE, 2.7 ± 0.3 p.p.m., n= 43) were significantly higher than those of subjects with asymptomatic asthma (0.5 ± 0.1 p.p.m., P < 0.05), URI (0.8 ± 0.1 p.p.m., P < 0.05) and healthy children (0.4 ± 0.1 p.p.m., P < 0.05). A multivariate linear regression model showed that eCO was higher in children with asthma attacks independent of age and gender. In 33 asthmatic children followed before and after treatment, eCO levels during asthma attacks significantly decreased after inhalation therapy with a combination of salbutamol and sodium cromoglycate (before therapy, 2.9 ± 0.4 p.p.m.; after therapy, 0.6 ± 0.1 p.p.m., P < 0.0001). Conclusions: The measurement of eCO using a novel collecting system is useful in the recognition of asthma in preschool children.     

Oral midazolam and oral butorphanol premedication

Objective: To evaluate the efficacy of oral midazolam and oral butorphanol for their sedative analgesic effects in children.Methods: Sixty children, aged 2 to 10 yrs, of ASA physical status I and II, scheduled for surgical procedures of 1 to 2 hrs duration were randomized to one of the two groups. Group I : children received midazolam 0.5mg/kg orally and Group II : children received butorphanol 0.2mg/kg orally. Score of the children was assessed every 5 minutes till the induction of anesthesia. Intraoperative and postoperative analgesic requirement was recorded alongwith postoperative recovery and complications.Results: The groups were identical regarding the patient’s characteristics, hemodynamic variables, duration of surgery and awakening time. Less time was required for the onset and time of maximum sedation in the butorphanol group (p<0.05). Sedation scores were similar among the groups at all time intervals, while the scores were higher in the butorphanol group at the time of induction (p<0.05). Less number of children required intraoperative and postoperative rescue analgesia in the butorphanol group (p<0.05). Statistically significant difference was found among the groups in respect to complete amnesia (50% in group Ivs 80% I group II, p<0.05) and recollection (40% in group Ivs 10% in group II, p<0.05).Conclusion: Oral butorphhanol is comparable to oral midazolam in children but analgesia alongwith sedation is an additional advantage which makes it better than midazolam without a significant increase in side effects.