Familial Monosomy 7 Syndrome Associated with Myelodysplasia

Indian Journal of Pediatrics -     

Levofloxacin in enteric fever--a study

Typhoid fever is an important cause of morbidity and mortality in patients especially in developing country. Therapy with conventional drugs is associated with increasing resistance, non-compliance to therapy and toxicity. Oral fluoroquinolones have been shown to be effective compared to parenteral broad-spectrum cephalosporins in the treatment of uncomplicated typhoid. However, there is no data available regarding the use of levofloxacin in the treatment of typhoid fever in spite of the susceptibility of Salmonella species to levofloxacin. The present study was undertaken to evaluate the efficacy, safety and tolerability of oral levofloxacin 750 mg once daily in the treatment of typhoid fever. Results indicated that levofloxacin 750 mg administered orally once daily was an effective, safe, well-tolerated and cost-effective option in the treatment of typhoid fever in adult Indian males and non-pregnant females.     

Genetic analysis of lethal congenital malformations causing perinatal mortality at Nizwa Hospital, Oman

An analysis of lethal congenital malformations (LCM) - which contributed to perinatal mortality at Nizwa Hospital, Oman - is presented for a 10-year period from January 1993 through December 2002. Single gene, chromosomal or multifactorial inheritance accounted for 86.1% of the cases. LCM-related perinatal deaths were higher in Omani, compared to those in non-Omani births (p < 0.001). This could possibly be attributed to high consanguinity, low female literacy and high fertility rates in the Omani population. Forty per cent of LCM-related perinatal deaths in the study had potential options for prevention. Integration of a community-based genetic service into the existing health-care delivery system is suggested.     

A randomised comparison of the Ambu® AuraGain™ and the LMA® supreme in infants and children

We conducted a randomised trial in 100 children in order to compare the clinical performance of the Ambu^® AuraGain^? and the LMA^® Supreme^* for airway maintenance during mechanical ventilation. The primary outcomes were initial and 10‐min airway leak pressures. Ease, time and success rates for device and gastric tube insertion, fibreoptic grades of view, airway quality during anaesthetic maintenance, and complications were also assessed. There were no differences in the initial and ten min airway leak pressures between the Ambu AuraGain and LMA Supreme, median (IQR [range]) initial: 19 (16–22 [10–34]) vs 18 (14–24 [8–40]) cmH₂O, p = 0.4; and ten min: 22 (18–26 [11–40]) vs 20 (16–26 [12–40]) cmH₂O, p = 0.08, respectively. Ease, time and success rates for device placement, gastric tube insertion and complications were also not significantly different. Children receiving the LMA Supreme required more airway manouevers (7 vs 1 patient, p = 0.06) to maintain a patent airway. Our results suggest that the Ambu AuraGain may be a useful alternative to the LMA Supreme, as demonstrated by comparable overall clinical performance in children.     

Changing spectrum of neonatal omphalitis

STUDY OBJECTIVE: Risk factors and clinical and bacteriologic profile of neonates with omphalitis were studied during a 5-year period (January 1994 through December 1998). DESIGN AND SETTING: Prospective observational study in a Special Care Baby Unit of a regional referral hospital in Oman. PATIENTS: Consecutive cases of neonatal omphalitis admitted at a regional special care baby unit during a 5-year period formed the study cohort; 207 cases of omphalitis among 11 260 births (9528 hospital births and 1732 home births) were studied. METHODS: Proportional risk factors and clinical, bacteriologic and relevant investigational profiles and outcomes were studied in neonates with omphalitis. For the study purpose omphalitis was classified into four categories based on severity. RESULTS: The incidence of omphalitis was higher in home births (P < 0.001), in neonates with an intrapartum setup for sepsis (P < 0.05) and in low birth weight (weight <2500 grams) neonates (P < 0.05). Staphylococcus aureus was the most common pathogen isolated from umbilical swabs followed by Escherichia coli and Klebsiella spp. The incidence and severity of omphalitis showed a proportionate decline with reduction of home births during the 5-year study period. CONCLUSION: The spectrum and severity of neonatal omphalitis are on the decline in conformity with the decline in home births and septic deliveries besides general improvement in maternal and child health care delivery in Oman.     

Anesthetic management of a pediatric patient with neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is a rare disorder which is clinically similar to malignant hyperthermia (MH). It is characterized by hyperthermia, autonomic instability, muscle rigidity, coma, rhabdomyolysis, and acidosis. Without immediate and appropriate therapy, mortality may result. NMS is associated with administration of antipsychotic medications, anti-emetic medications, and changes in the dosage of anti-parkinsonian drugs. As several similarities exist between NMS and MH, differentiating between them can be a challenge for the clinician. We report anesthetic care during magnetic resonance imaging of the brain of a 14-year-old female with bipolar and schizoaffective disorders and the recent onset of NMS.     

Airway management options in a prone achondroplastic dwarf with a difficult airway after unintentional tracheal extubation during a wake-up test for spinal fusion: To flip or not to flip?

Purpose

To present a case of unintentional tracheal extubation in a prone positioned patient with a known difficult airway.

Clinical features

This case report describes the unintended tracheal extubation of an achondroplastic dwarf with kyphosis undergoing spinal fusion and instrumentation. The patient had a history of obstructive sleep apnea and a difficult airway requiring fibreoptic-guided tracheal intubation through an air-Q? supraglottic airway device. Abrupt head movement during a wake-up test to evaluate lost motor-evoked potential signals resulted in dislodgement of the tracheal tube. Airway obstruction was evidenced by rapid oxygen desaturation and the absence of end-tidal capnography waveforms despite apparent chest excursions. An air-Q was used for successfully rescuing the airway and quickly re-establishing oxygenation and ventilation, which eliminated the need for emergent supine positioning for airway management. The air-Q was then used as a conduit for fibreoptic-guided tracheal intubation while the patient remained in the prone position.

Conclusion

This case highlights some of the safety advantages of supraglottic airway devices for airway rescue and subsequent tracheal intubation even with the patient in the prone position. The use of an air-Q may have the advantages of not requiring an intubation introducer technique and allowing for direct tracheal intubation with an appropriately sized cuffed tracheal tube.