Status epilepticus in Indian children in a tertiary care center

Objective: To study the clinical profile, immediate outcome and possible risk factors of SE in pediatric age group admitted to pediatric intensive care unit (PICU) in a tertiary care center.Methods: A retrospective study of case records of 451 neuroemergency patients admitted in PICU in a tertiary care center between January 1993 to April 2000, out of which 30 patients had status epilepticus. They were evaluated for their clinical presentation, laboratory parameters, treatment profile and immediate outcome.Results: The age group varied from 1 to 120 months with mean of 56.6±46.5 months. Seventeen patients were less than 60 months. Sixteen patients (53.3%) presented with SE as first presentation without prior history of seizure activity. Nine patients died (30%) during hospital course. Seizure duration >45 minutes (p-0.001) and presence of septic shock (p-0.001) were associated with significantly more mortality.Conclusion: There is a need to abort seizure activity at the earliest and this improves immediate outcome.     

儿童艾滋病四例

母婴传播的儿童艾滋病（AIDS）已成为潜在威胁我国儿童健康的重要危险因素。2005年5月至2006年5月我院共收治4例,现报告如下。[第一段]     

Pericardial effusion in children: Experience from tertiary care center in Northern India

Objective

To describe profile and outcome in children with significant pericardial effusion.

Methods

Hospital records of 25 children admitted with significant pericardial effusion during January 2010 to March 2013 were analyzed.

Results

Thirteen (52%) children had tubercular, 6 (24%) had bacterial, 3 viral, 2 recurrent idiopathic and one had malignant pericardial effusion. Only 3 children in our series required surgical drainage.

Conclusions

Echocardiography guided percutaneous pericardiocentesis and pigtail catheter placement was found to be safe and effective.     

Accidental poisoning of children in Japan: A report from the Japan Poison Information Center

The Japan Poison Information Center (JPIC) was founded only 6 years ago as a result of co-operation between the Ministry of Health and Welfare, the Japanese Association for Acute Medicine, the Japan Pediatric Society and other related medical organizations. The JPIC is the only poison information center admitted by the Ministry of Health and Welfare to provide toxicological information to medical personnel and the general public, and has two offices on duty in alternating 24 h shifts. Every year, JPIC receives about 30 000 inquiries. About 82% of these inquiries are from the general public and 84% of the patients are children 5 years and younger. We contrasted the data in the fiscal year 1991 with the data of the American Association of Poison Control Centers (AAPCC). Child poison exposure in Japan is characterized by a high exposure rate of children under 1 year of age to (mostly) household products. The JPIC also analyzed the cause of tobacco ingestion. It is considered that the Japanese lifestyle causes differences from those reported by AAPCC. We report the accidental poisoning of children in Japan.     

Pediatric autoimmune myelofibrosis: Experience from a large pediatric tertiary care center

Autoimmune myelofibrosis (AIMF) is a rare disorder characterized by cytopenias and autoimmunity, with characteristic bone marrow findings that include lymphocytic infiltration and fibrosis. AIMF is described predominantly in adult populations who have systemic lupus erythematosis (SLE), with scant pediatric cases described mainly in older adolescents with SLE. Here, we described the largest single-center pediatric experience of pediatric autoimmune myelofibrosis (PAIMF) series, demonstrating both similarities and distinctions from the adult experience. Patients overall respond well to steroid therapy, but these patients were significantly younger, infrequently carried a diagnosis of SLE, and causative genetic lesions were identified in many cases.     

Pediatric tracheotomy: 3-year experience at a tertiary care center with 54 children

The aim of this study was to evaluate the indications, complications and outcomes of pediatric tracheotomies at a tertiary care center. Data were obtained retrospectively from 54 patients who underwent tracheotomy from July 2007 to May 2010. Over the three-year period, 54 tracheotomies were performed. Thirty-two patients (59.3%) were male and 22 (40.7%) were female. The mean and median ages of the patients were 54 and 14 months (6 days-17 years), respectively. Twenty-six patients (48.1%) were under 1 year of age. The most common indication for tracheotomy was prolonged intubation (87%), followed by upper airway obstruction (13%). Five patients (9.2%) underwent tracheotomy under semiurgent settings. The overall complication rate was 29.6% (16/54). Early complications occurred in 7 patients (13%), including accidental decannulation in 2 patients, subcutaneous emphysema in 4 patients and hemorrhage in 1 patient. Late complications occurred in 9 patients (16.7%) (stomal granulation in 7 patients and stomal infection in 2 patients). Eight patients (14.8%) were decannulated successfully. No tracheotomy-related deaths occurred, with an overall mortality rate of 27.7% (15/54). Pediatric tracheotomy is a relatively safe procedure with a low incidence of procedure-related morbidities. The indication for the majority of the procedures was prolonged intubation (87%). The lower decannulation rate is related to the higher percentage of patients needing assisted ventilation and the relatively short follow-up period.     

Cost of neonatal intensive care in a tertiary care center

BACKGROUND: The number of neonatal intensive care units (NICUs) in India has increased substantially over the last decade; yet many more are required. There is limited information on the actual costs of setting up and running an NICU in India. OBJECTIVE: Systematic and comprehensive calculation and analysis of the costs of neonatal intensive care in a tertiary care teaching hospital. METHODS: The costs were compiled by studying the detailed records of various hospital departments and prospectively documenting the costs of drugs, consumables and investigations for a representative group of 30 babies. RESULTS: The total cost of establishing a 16 bed level III tertiary care NICU was Rs 3.78 crore (Rs. 37.8 million, USdollar 860,000) (2003). Equipment cost formed two-thirds of the establishment cost. The running cost of NICU care per patient per day was Rs 5450 (USdollar 125). NICU and ancillary personnel salary comprised the largest proportion of the running costs. The average total cost of care for a baby less than 1000 grams was Rs. 168000 (USdollar 3800), Rs. 88300 (USdollar 2000) for babies 1000 g to 1250 g. and Rs. 41700 (USdollar 950) for those between 1250 to 1500 g. The family had to bear only 25 percent; rest was subsidized. CONCLUSIONS: Equipment and personnel salary form the biggest proportion of establishment and running costs. The costs of treatment for a baby in NICU should be seen in context with costs of other types of health care and the number of useful life years gained.     

儿童糖原累积病4例报告

糖原累积病(glycogen storage disease,GSD)是一类由于先天性酶缺陷造成的糖原代谢障碍疾病,它可以出现机体能量代谢障碍和糖原异常堆积[1].多数属常染色体隐性遗传,少数属X连锁隐性遗传.Von Gierke在1929年首先描述了糖原累积病的临床表现和患者肝、肾组织中糖原堆积的病理改变.根据欧洲资料,其发病率为1/(2万～2.5万).现将我院近年收治的4例糖原累积病报告如下.     

Intestinal ascariasis: the commonest cause of bowel obstruction in children at a tertiary care center in Kashmir

Background  

Ascariasis is the commonest intestinal nematodal infestation in man. Ascariasis commonly inhabits small bowel although it can migrate to biliary tree and other orifices. The aim of this study is to analyze the presentation, diagnosis, management of bowel obstruction caused by Ascaris lumbricoides and to study various surgical complications.     

Venous thromboembolism in pediatric patients: epidemiologic data from a pediatric tertiary care center in Alabama

Venous thrombosis is an infrequent but serious cause of hospitalization in children. The epidemiology and natural history remains incompletely defined, especially in geographically distinct regions of the United States. We thus evaluated thrombosis in a single children's hospital over a 3-year period. Of 41,906 hospitalizations, 92 children were identified for review. The incidence of thrombosis was 21.9 per 10,000 admissions (0.22%). Venous thrombosis was of equal incidence in African-American and white patients. Locations of thrombosis included deep venous (51%), pulmonary (21%), renal vein (8%), intrahepatic (8%), and intracranial (12%). Risk factors for thrombosis included central catheter (32%), malignancy (18%), systemic infection (21%), neurologic disability (9%), cardiac (4%), nephrotic syndrome (3%), and autoimmune (6%). Six of 92 patients (7%) had thrombophilia. Positive family history of venous thromboembolism (VTE) or thrombophilic disorder predicted an abnormal test. Treatment included low-molecular-weight heparin (n=53), coumadin (n=12), heparin (n=10), tissue plasminogen activator (n=6), argatroban (n=1), thrombectomy (n=2), inferior vena cava filter (n=2), and no treatment (n=23). Seventy-seven percent demonstrated resolution of the VTE, 14% had persistent or recurrent VTE, and 9% died. Causes of death were malignancy, prematurity, septicemia, and congenital heart disease. Venous thrombosis is a serious comorbidity in hospitalized children. In our population, African-Americans had an equal incidence of VTE as whites. Positive family history predicted thrombophilia.