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.     

Intranasal Clonidine vs. Midazolam as Premedication in Children: A Randomized Controlled Trial

Objectives

To compare anxiolysis produced by intranasal clonidine with intranasal midazolam as premedication in children undergoing surgery.

Design

Double-blind randomized controlled study.

Setting

Tertiary-care hospital, July 2009 to June 2010.

Patients

60 American Society of Anesthesiologists physical status I–II surgical patients aged 1–10 yr.

Intervention

Participants randomly allocated to receive either intranasal clonidine 4 mcg/kg (Group I) with atropine or intranasal midazolam 0.3 mg/kg (Group II).

Outcome Measures

Primary: satisfactory anxiolysis at 30 min after drug administration. Secondary: satisfactory mask acceptance, times of onset of sedation and anxiolysis, drug acceptance, level of sedation, wake-up score and side effects.

Results

All children achieved satisfactory anxiolysis at 30 min. Group I fared significantly better than Group-II on mask acceptance (100% in Group I vs. 80% in Group II; P=0.024), drug acceptance (93% vs. 13%; P<0.001) and proportion of patients with satisfactory wake-up scores (100% vs. 53%; P<0.001). Group II patients had significantly faster onset of sedation (median 10 min vs. 15 min; P<0.05) but not that of anxiolysis compared to Group-I (median 10 min for both groups; P>0.05). Side effects were significantly more frequent in Group II.

Conclusions

Though intranasal midazolam produced faster sedation, both the drugs produced satisfactory anxiolysis at 30 min.     

Maximal expiratory pressure in residential and non-residential school children

Objective :Maximal Expiratory Pressure (MEP) is a powerful indicator for respiratory muscle strength, which reflects the ability of a person to cough effectively.Methods: The present study was designed on healthy respiratory symptom free children of a Residential – Sainik (50) and Non-Residential (44) school children (aged 12-14 yrs) of Bijapur, to evaluate MEP in relation to their physical anthropometry. MEP (mm Hg) was determined by using a modified Black’s apparatus, which is significantly higher in Residential-Sainik school children in comparison to Non-Residential school children (p<0.01).Results: In both groups, MEP showed positive correlation with height (Residential, r=0.72, p<0.001; Non-Residential, r=0.73, p<0.001); weight (Residential, r=0.73, p<0.001; Non-Residential, r=0.69, p<0.001), BSA (Residential, r=0.79, p<0.001; Non-Residential, r=0.72, p<0.001) and BMI (Residential, r = 0.48, p<0.01; Non-Residential,r=0.34, p<0.05), and also revealed a higher MEP in children with greater chest expansion.Conclusion: Possibly, routine physical exercise in residential Sainik school children attribute to their better respiratory muscle strength.     

Outcome of teenage pregnancy

Objective The objective of the study was to evaluate the obstetric, fetal and neonatal outcomes of teenage pregnancy in a tertiary care teaching hospital. Methods A retrospective case control study was performed over a period of 5 years. Data were retrieved from hospital records. All teenage mothers (aged 13–19 completed years at delivery) delivering in the University Hospital were taken as cases. Next 3 consecutive deliveries in the age group of 20–30 year were selected as controls for each case. For statistical analysis the cases were further subdivided into 2 groups, ≤17 years (Group A) and 18–19 years (Group B). Groups were compared for obstetric complications and neonatal outcome. Statistical analysis was done by software package SPSS 10. Results The incidence of teenage deliveries in hospital over last 5 years was 4.1%. Majority of the teenagers were primigravida (83.2% vs. 41.4%, p<0.01). Complications like pregnancy induced hypertension (PIH) (11.4% vs 2.2%, p<0.01), pre-eclamptic toxemia (PET) (4.3% vs 0.6%, p<0.01) eclampsia (4.9% vs 0.6%, p<0.01) and premature onset of labor (26.1% vs 14.6%, p<0.01) occurred more commonly in teenagers compared to controls. Teenage mothers also had increased incidence of low birth weight (LBW) (50.4% vs 32.3%, p<0.01), premature delivery (51.8% vs 17.5%, p<0.01) and neonatal morbidities like perinatal asphyxia (11.7% vs 1.9%, p<0.01), jaundice (5.7% vs 1.2%, p<0.01) and respiratory distress syndrome (1.9% vs 0.3%, p<0.05). Teenage pregnancy was also associated with higher fetal (1.9% vs 0.3%, p<0.05) and neonatal mortality (3.8% vs 0.5%, p<0.05). Conclusion Teenage pregnancy was associated with a significantly higher risk of PIH, PET, eclampsia, premature onset of labor, fetal deaths and premature delivery. Increased neonatal morbidity and mortality were also seen in babies delivered to teenage mothers. Younger teenager group (≤17 years) was most vulnerable to adverse obstetric and neonatal outcomes.     

Ketamine and midazolam for invasive procedures in children with malignancy: a comparison of routes of intravenous, oral, and rectal administration

We investigated the efficacy of a combination of ketamine and midazolam, comparing intravenous, oral, and rectal administrations for invasive procedures in children with malignancy. Seventy-three children under 5 years of age, who were scheduled for invasive procedure, were assigned to one of three groups: IV group (n = 25), ketamine 1 mg/kg and midazolam 0.05-0.1 mg/kg were given intravenously; PO group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg were given orally; and PR group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg given rectally. Vital signs including blood pressure, pulse rate, respiratory rate, and oxygen saturation were monitored, and patients were observed for side-effects. Optimal sedation (drowsy and asleep) was provided in 78 per cent of all patients and no statistical difference was observed among the three groups. No severe complications were observed in all groups. Recovery time from sedation was significantly longer in the intravenous group (>120 min in two patients). Hallucination was noted in three (12 per cent) patients given intravenous medication, but not in those given oral or rectal medications. It is concluded that intravenous, oral, and rectal midazolam/ketamine are equally effective for invasive procedures in children with malignancy. The use of intravenous ketamine/midazolam may produce prolonged sedation and psychedelic effects in children. These adverse effects may alter the child's comfort and parental satisfaction.     

Zespół hemolityczno-mocznicowy u dzieci w latach 1971–2010; doświadczenia jednego ośrodka dializ dla dzieci

Hemolytic uremic syndrome (HUS) is thrombotic microangiopathy witch recognized by hemolytic anemia, thrombocytopenia and acute renal failure. In 90% of children HUS is a consequence of enteral infection caused by, most commonly verotoxin, producing Escerichia coli. In remaining 10% of cases not preceded by diarrhea atypical HUS is recognized.AimAim of the study was to assess the frequency and clinical course of HUS in 140 children hospitalized in years 1971–2010 in the Department of Pediatrics and Nephrology, Medical University of Warsaw.Material and MethodsThe patients were analyzed in 2 groups: hospitalized in years 1971–1992 (group I; n=94) and 1993–2010 (group II; n=46). The division was based on the change of mode of therapy, because since 1993 plasmaphereses have been used in the treatment of atypical and severe cases of HUS.ResultsAge of children was significantly higher in group II compared to group I (4.48±4.46 vs 1.43±1.97 year, p<0.0001). In this group also atypical HUS was diagnosed more commonly (26% vs 6.38%; p<0.02). In both groups the incidence of atypical HUS was significantly higher in winter. In treatment red blood cell transfusions and plasma infusions were used. 87% of children from group I and 56% from group II required renal replacement therapy. The result of the treatment of acute phase of the disease was recovery of normal renal function in 65.7% of children from group I and 95.6% from group II. 6.6% of children from group I and 2.2% from group II required chronic dialysis. Unfavourable outcome (death) was observed in 27.7% from group I and 2.2% from group II.ConclusionThe treatment with plasmaphereses and plasma infusions improved outcome and decreased the requirement for chronic renal replacement therapy in children hospitalized with HUS in years 1993–2010.     

Comparative study of intranasal midazolam and intravenous diazepam sedation for procedures and seizures

Objective To evaluate the safety and efficacy of intranasal midazolam for seizures and various procedures. Methods Prospective randomized study. Total 125 children of all ages of either sex, for seizure episode (n-76) and various invasive and non-invasive procedures (n-49) received either intranasal midazolam (0.2 mg/Kg) or intravenous diazepam (0.3 mg/Kg). Results Mean time from arrival at hospital to starting treatment was significantly shorter in midazolam group compared to diazepam group [2.34±0.90; minute vs 4.61±1.08 minute p<0.001]. Mean time to control seizures after arrival in hospital was significantly shorter in midazolam group compared to diazepam group [5.25±0.86 minute vs 6.51±1.06 minute p<0.001]. Conclusion Midazolam by the intranasal route provides safe and equally effective non-invasive method of sedation for procedures and seizures.     

Intramuscular midazolam vs intravenous diazepam for acute seizures

Objective : To determine effectiveness of intramuscular midazolam to control acute seizures in children as compared to intravenous diazepam.Methods: 115 children in the age group of 1 month to 12 years who presented with acute convulsions were enrolled in the study. Patients who already had an intravenous access present were treated intravenous diazepam. Patients without an IV access at the time of convulsions were randomised into 2 groups and treated with either intramuscular midazolam or intravenous diazepam for control of seizures. Time interval from administration of drug to cessation of seizures was compared. Effectiveness of IM midazolam in various age groups, types of convulsions and etiology of convulsions was analyzed. Side effects of both drugs were evaluated.Results: the mean interval to cessation of convulsions with IM midazolam was 97.22 seconds whereas in diazepam group without prior IV access it was 250.35 seconds and in diazepam group with prior IV access it was 119.4 seconds. IM midazolam acted faster in all age groups and in patients with febrile convulsions, which was statistically significant. IM midazolam was equally effective in various types of convulsions be it GTC or focal convulsions. 7 patients (10.8%) had thrombophlebitis associated with IV diazepam administration whereas none of the patients in the midazolam group had any side effects, which was statistically significant.Conclusion: IM midazolam is an effective agent for controlling acute convulsions in children especially in children with febrile convulsions. It has relatively no side effects as compared to Intravenous diazepam and can be used as a first line agent for treatment of acute convulsions in patients with difficult intravenous access.     

Pain response of neonates to venipuncture

Objective: To study the physiological and behavioral response to pain.Methods: 80 healthy neonates requiring bilirubin estimation, blood sugar etc. were randomly assigned to receive a venous puncture. All parameters were recorded 10 minutes prior, during and 10 minutes after the procedure. Evaluated NIPS score and RR., HR, NIBP and 02 saturation observed on Datex-Ohmeda multimonitor.Results : After the venepuncture, heart rate (p<0.001 ) and blood pressure (p<0.001 ) were significantly increased in both the groups but more significant increase was present in Group l(>2.5kg) as compared to Group II (>2.5kg). Respiratory rate was also increased but more significant in Group II(p<0.001) whereas Oxygen saturation was decreased in both the groups but more significant in Group I (p<0.001). Median Neonatal Infant Pain Scale (NIPS) score was higher in both the Groups (p<0.001 ).Conclusion : The outcome measures appear to be reliable indices of term neonates responses to painful stimulation. NIPS are suitable instruments for neonatal pain evaluation.     

Intranasal versus intravenous administration of midazolam to children undergoing small bowel biopsy

Sixty-three children under the age of 9 years were randomized to receive intravenous (group A, n = 33) or intranasal (group B, n = 30) midazolam as sedation for small bowel biopsy. Mean doses of midazolam given to produce adequate sedation were 0.31 mg (kg body weight)⁻¹ in group A and 0.34 mg (kg body weight)⁻¹ in group B (NS). Four children in group A and 10 children in group B required additional doses to maintain adequate sedation throughout the biopsy procedure (p <0.05). There was no significant difference between the groups regarding the median procedure time (7 min in group A, 8.5 min in group B) or median fluoroscopy time (5 s in group A, 4 s in group B). All children in group B showed signs of discomfort from the nose when given midazolam intranasally. In conclusion, this study indicates that intravenous administration of midazolam is preferable to the intranasal route.     

Cognition in specific learning disability

Objective : To compare the cognition abilities of children with specific learning disability (SpLD) viz. dyslexia, dysgraphia and dyscalculia with those of non-impaired children.Methods : The study group consisted of 95 newly diagnosed SpLD children (aged 9–14 years) and the control group consisted of 125 non-impaired children (aged 9–14 years). An academic achievement of two years below the actual grade placement on educational assessment with a Curriculum-Based test was considered diagnostic of SpLD. A battery of 13 cognition function tests based on Guilford’s Structure of Intellect Model was administered individually on each child in four areas of information viz. fieural, symbolic, semantic and behavioral. Mean scores ±SD obtained in these four areas were calculated in both groups and compared using Independent Samples t-test. A P value < 0.05 was considered significant.Results : Children with SpLD had significantly lower scores (mean ±SD) in all four areas of information: maximally in the symbolic area (18.66 ±4.83 vs. 28.30 ±4.29, mean difference 9.64, P< 0.0001, df = 218,95% Cl 8.43-10.86), followed by semantic (18.72 ±5.07vs 27.36 ±4.17, mean difference 8.64, P< 0.0001, df=218, 95% Cl 7.40 9.87), figurai (17.10 ±5.24 vs 25.14 ±3.36, mean difference 8.04, P< 0.0001, df=218, 95% CI 6.89-9.19), and behavioral (5.68 ±2.10vs 7.54 ±1.46, mean difference 1.86, P< 0.0001, df = 218, 95% C11.39-2.33) areas.Conclusion : Cognition abilities are significantly impaired in children with SpLD.     

Oral ketamine for radiotherapy in children with cancer

Children coming for radiotherapy under sedation usually get repeated injections, which cause distress to both the child and the parents. A prospective study was conducted to evaluate the efficacy of oral ketamine for sedation for radiotherapy (RT) in children with cancer. Ten children who received 49 sittings of RT were given 8–15 mg/kg body weight of oral ketamine. The onset time, recovery time, efficacy of sedation and incidence of abnormal movements were compared with another group of 8 children, who received intramuscular ketamine in the dose of 6 mg/kg for a total of 28 sittings of RT. Onset time and recovery time were significantly longer in oral ketamine group as compared to the intramuscular group (p<0.001). Limb movements in patients receiving oral ketamine necessitated further supplement of sedation and interruption of RT. These drawbacks discourage use of oral ketamine as a good sedative for radiotherapy treatment in paediatric oncology patients.     

镇痛镇静策略在PICU机械通气患儿中的应用

目的探讨不同镇静、镇痛策略对机械通气患儿的辅助治疗效果及不良反应。方法将80例进行机械通气且需镇静镇痛治疗的危重患儿随机分为咪达唑仑组(40例)和瑞芬太尼+咪达唑仑组(40例),采用Ramsay及FLACC量表评估镇静、镇痛效果,记录治疗期间生命体征、呼吸机参数动态变化、脏器功能指标、瑞芬太尼及咪达唑仑应用总量、机械通气时间、PICU住院时间及费用、不良反应发生情况等。结果 2组患儿均能达到满意镇痛镇静效果。与咪达唑仑组比较,瑞芬太尼+咪达唑仑组达到镇静镇痛效果所需时间更短,Ramsay评估3~4级所占百分比增高,咪达唑仑用量降低,差异均有统计学意义(P0.05)。2组患儿治疗后心率、平均动脉压及自主呼吸频率均降低,但瑞芬太尼+咪达唑仑组在用药后3~24 h的心率、3~12 h的平均动脉压和自主呼吸频率下降更明显(P0.05)。与咪达唑仑组比较,瑞芬太尼+咪达唑仑组患儿用药后的6 h和12 h呼吸机潮气量及经皮氧饱和度均明显增高,呼气末二氧化碳水平明显降低,差异有统计学意义(P0.05)。瑞芬太尼+咪达唑仑组停药至苏醒的时间、拔管时间、机械通气以及PICU住院时间均明显低于咪达唑仑组(P0.05)。2组患儿PICU住院费用、不良反应发生率以及用药前后肝肾功能差异均无统计学意义(P0.05),但空腹血糖比镇静前明显降低(P0.05)。结论 PICU机械通气患儿采用瑞芬太尼+咪达唑仑治疗方案能迅速达到镇痛、镇静目标,改善通气效果,减少镇静剂用量,耐受性良好。     

Maternal estimates of mental age in developmental assessment

Objective: To examine the accuracy and clinical utility of maternal estimates of mental age in young children referred for developmental assessment.Methods : Mothers of 100 children aged 16 to 60 months referred for developmental evaluation to psychology services of Department of Pediatrics of a tertiary care teaching hospital were asked to estimate the mental age of their child. Maternal estimates were converted to intelligence quotient (IQ) and were compared to results from developmental tests of cognitive and adaptive behavior functioning which were administered to all children.Results : Maternal estimate IQ was highly correlated with IQ calculated from Developmental Profile II (r=.83, p&lt;.001) and social quotient (SQ) calculated from Vineland Social Maturity Scale (r=.81, p&lt;.001). Maternal estimate IQ was 82% sensitive to cognitive delay and 81% specific in identifying children likely to have normal development. Twenty seven percent of the maternal estimates were within ±5 IQ points of actual IQ. Mothers were more likely to overestimate their child’s functioning. Maternal IQ (Mean=62.1, S.D. =25.8) was significantly higher (t=2.93, p&lt;.004) than the actual IQ (Mean=57.9, S.D.=21.9). Step-wise multiple regression analysis revealed that the child’s IQ and SQ explained 10% of the variance (F=6.40, p&lt;.001) in maternal accuracy. The lower the SQ and IQ of the child, more accurate the estimates.Conclusion : Maternal estimates of mental age provide an accurate measure of developmental functioning in young children and may be used as a screening technique to identify a subset of children who need more detailed evaluation.     

Intramuscular antibiotic treatment of urinary tract infection

Objective: This study had been carried out to investigate the effects of intramuscular daily single dose antibiotic treatment during five days in the outpatient clinics in children having lower UTI and to observe the effects to the disease course in infants and toddlers.Methodology: 36 children (12 boys) at the ages of between 5–68 months were enrolled into the study. Regarding the antibiogram suitability, single dose ceftriaxon or amikacin is prescribed to the patients for five days.Result: In the urine culturesE. Coli was most commonly isolated. There was correlation between leukocytosis and insufficient weight gain (p< 0.05). A correlation was also noted between recurrence of the disease and urinary tract abnormalities detected on the ultrasonography (p< 0.05). Reenfection were detected in 1 of the infants and in 2 of the older children. There was no correlation between the recurrence and the therapy given.Conclusion: We consider that five-day intramuscular antibiotic therapy could be effective in the treatment of lower UTI and it can be recommended as a safe treatment modality in patients representing unwillingness to come to follow-up visits     

不同年龄段儿童Delta变异株感染所致新型冠状病毒感染的临床特征分析

目的 分析不同年龄段儿童Delta变异株感染所致新型冠状病毒感染患儿的临床特征,为儿童新型冠状病毒感染的临床诊疗提供参考。方法 将2021年11月17日—12月17日河南省定点救治医院收治的Delta变异株感染所致的新型冠状病毒感染患儿45例分为3组(<6岁组16例,6～13岁组16例,>13岁组13例),比较3组患儿的临床特征及实验室检查结果。结果 各年龄组均以轻型病例为主,均以咳嗽、咳痰为主要临床表现,发热仅在6～13岁组中出现。<6岁组血清天冬氨酸氨基转移酶、乳酸脱氢酶、肌酸激酶同工酶水平高于其他两组(P<0.05)。6～13岁组血肌酐水平升高患儿比例最高,达50%。仅>13岁组中4例患儿出现血清C反应蛋白增高。在3个年龄组中,6～13岁组外周血CD3⁺CD4⁺淋巴细胞、CD3⁺CD8⁺淋巴细胞及自然杀伤细胞计数均最低。>13岁组入院时SARS-CoV-2 IgG阳性率高于其他两组(P<0.05)。3组患儿胸部CT影像学表现差异无统计学意义(P>...     

The Efficacy of Dihydrotestosterone Transdermal Gel Pretreatment in Primary Hypospadias Surgery: A Prospective,Controlled Randomized Study

PurposeEfficacy evaluation of transdermal dihydrotestosterone (DHT) treatment based on the results of hypospadias repair in children with primary hypospadias.Material and MethodsBetween September 2004 and April 2006, a randomized total of 75 children with primary hypospadias with a mean age of 33.4±3.7 months were evaluated. While 37 children (Group 1) were treated with a daily application of 2.5% DHT transdermal gel for 3 months, 38 children of group 2 did not receive DHT before operation. All children underwent hypospadias repair using tubularized incised plate urethroplasty. Postoperative complications of the children were analysed using the Mann-Whitney U test with respect to fistula, urethral strictures, meatal stenosis, glandular dehiscence and scar formation.Results4 patients (10.5%) of group 2 developed urethrocutaneous fistulae compared to group 1 in which only one fistula was found (2.7% p>0.05). While 3 patients (7.8%) in group 2 had glandular dehiscence, no patients in the DHT group had one (p<0.05). There were 2 cases with meatal stenosis in group 2 (5.2%), but no patient with meatal stenosis in group 1 (p>0.05). There were 16 cases (42.1%) with moderate to severe scar formation in group 2, whereas only two children (5.4%) had scar formation in the DHT group (p<0.05). There was a significant difference between the overall re-operation rates of group 2 (23.8%, 9 patients) and group 1 (2.7%, one patient) (p<0.05).ConclusionsPretreatment with DHT transdermal gel was found to be effective in decreasing the complications and improving the cosmetic results after hypospadias repair.     

Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under general anaesthesia

Dental treatment in children who are too young or too apprehensive to cooperate is often performed under sedation. In Sweden, the tradition has been to administer sedatives rectally in small children, but oral liquid sedation is now increasingly used. AIM: To compare the sedative effects of oral and rectal administration of midazolam in children undergoing dental treatment under general anaesthesia and to assess acceptance of sedative administration, acceptance of application of the facemask, and amnesia. METHODS: Fifty children aged 2-7 y were randomly allocated to receive either liquid oral or rectal sedation, with 25 children in each group. RESULTS: The sedative effect of rectal administration was higher, but not statistically significantly, than that of oral administration (p = 0.07). No significant differences in acceptance of sedative administration, acceptance of mask application or amnesia were found between the groups. CONCLUSION: Both the oral and the rectal routes can in most cases be appropriate. However, the better sedative effect of rectal administration of midazolam makes it a more favourable route in pre-cooperative and non-compliant children.     

Mupirocin vs terbinafine in impetigo

Objevtive: Terbinafine is an antifungal drug known to have also antibacterial activity against certain Gram-positive and Gram-negative bacteria. It seems that antibacterial and antifungal activity of terbinafine may have an advantage in the treatment of mixed fungal and bacterial superficial skin infections. Nevertheless, clinical relevance of the antibacterial part of its action has not been investigated efficiently. To compare the efficacy and safety of terbinafine with those of mupirocin, which has already proven antibacterial action, in the treatment of impetigo.Methods: Children clinically diagnosed as having impetigo were treated with topical mupirocin or topical terbinafine in a randomized fashion. Patients’ lesions were examined clinically on days 0,4, 7,10 and bacteriologic cultures were obtained on days 0 and 10.Results: A total of 62 patients were included in the study. Forty-eight of these patients were eligible for the efficacy and safety analysis. Twenty-five and 23 patients were treated with mupirocin and terbinafine, respectively. The clinical cure rates were 100% for the mupirocin group and 70% for the terbinafine group (p< 0.05). The bacteriological eradication rate for mupirocin-treated children was 100% and that for terbinafine-treated children was 78%(p< 0.05). Presence of bullous lesions appeared to be a factor for poor clinical outcome in the terbinafine group. Mild local adverse effects were noted in a small percentage of patients in each group.Conclusion : Antibacterial activity of terbinafine is not strong enough to be an alternative in the treatment of impertigo. It is advisable that terbinafine could be used in combination with an antibacterial drug for superficial skin enfections caused by both fungi and bacteria.     

Cytokine expression in meconium-induced lungs

Objective : In this article the authors present relationship between meconium exposure and inflammatory cytokine release in newborn lungs.Methods : The authors used forty 2-week-old rabbit pups for the study. One-half of the group were instilled with meconium and the other half with saline. Rabbits were sacrificed at 0, 2, 4, 8, and 24 hrs after installation and lung lavage was obtained and was examined for cytokine mRNA expression using RT-PCR and for cytokine proteins using ELISA technique. The data were collected in each of the study group.Results : Meconium instillation caused significant expression of inflammatory cytokines TNFα, IL-6, and IL-8 (p<0.05) with a peak at 8 hrs after meconium instillation. Levels of IL-10 were insignificant (p> 0.05). Also, we found significant increase in necrotic cells and neutrophils (p<0.05), compared to the control, saline instilled rabbit lungs.Conclusion: The present studies demonstrates that meconium induces inflammatory response and cytokines gene and protein expression in the lungs.