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K Rajeshwari
Email:
[email protected]
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Treatment of Graves disease in children. (Ann
Pediatr Endocrinol Metab 2014;19:197-201)
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Graves disease is the most common cause of hyperthyroidism in children.
Inorganic iodide has been used in combination with antithyroid drugs for
more effective normalization of thyroid hormones in some cases of severe
thyrotoxicosis. This study aimed to investigate clinical characteristics
of childhood thyrotoxicosis and efficacy of inorganic iodide in the
early phase of treatment. Sixty-seven pediatric patients with newly
diagnosed thyrotoxicosis due to Graves disease were recruited.
Forty-nine patients were treated with antithyroid drugs alone, while 18
patients were treated with combination of antithyroid drugs and
potassium iodide. Initial thyroid function tests and levels of thyroid
antibodies were recorded for all patients. Thyroid function tests were
repeated 2 and 8 weeks after the initiation of treatment. After two
weeks of treatment, mean triiodothyronine and free thyroxine levels were
significantly lower in the group receiving combined therapy of
antithyroid drugs and potassium iodide compared to the patients
receiving antithyroid drugs alone. Eight weeks after the initiation of
treatment, thyroid function tests in the two groups did not show
significant differences. Results from this study suggest that the use of
potassium iodide in combination with antithyroid drug is effective for
more rapid normalization of thyroid hormones in the early phase
treatment of childhood thyrotoxicosis.
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Pregabalin for childhood epilepsy. (Iran J Child
Neurol. 2014;8:62-5.)
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The prevalence of active epilepsy is about 0.5-1%, and approximately 70%
of patients are cured with first anti-epileptic drugs; remaining need
multiple drugs. Pregabalin as an add-on therapy that has a postive
effect on control of refractory seizures in adults. The objective of
this study was to evaluate the effects of pregabalin in the reduction of
seizures for refractory epilepsy. Forty patients with refractory
seizures were included in this study. A questionnaire based on type of
seizure, clinical signs, EEG record, imaging report, drugs that had been
used, drugs currently being used, and the number of seizures before and
after Pregabalin treatment was recorded. The number of seizures after
one and four months was noted. After one month, 26.8% of patients had
more than a 50% reduction in seizures and 14.6% of these patients were
seizure-free; 12.2% had a 25-50% reduction; and approximately 61% had
less than a 25% reduction or no change in seizures. After the fourth
month, 34.1% of patients had more than a 50% reduction in seizures and
24.4% of these patients were seizure-free. Additionally, 65.9% of
patients had less than 50% reduction in seizures.
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Presepsin to predict bacterial meningitis. (J Clin
Microbiol. 2015;Feb 4:pii:JCM.03052-14.)
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Children with temporary external ventricular drains (EVD) are prone to
nosocomial infections. Diagnosis of bacterial meningitis/ventriculitis
in these children is challenging due to frequent blood contamination of
cerebrospinal fluid (CSF) and the presence of chemical ventriculitis.
The aim of the study was to compare diagnostic accuracy of presepsin, a
novel biomarker of bacterial infection in CSF, to predict bacterial
infection in comparison to established biomarkers like biochemical
analysis of CSF. Eighteen children with suspected bacterial meningitis/ventriculitis
who had 66 episodes of disease were prospectively studied. CSF samples
were taken from external ventricular drainage. Infection was clinically
confirmed in 57 (86%) episodes of suspected meningitis/ventriculitis.
Chemical ventriculitis was diagnosed in 9 (14%) episodes of suspected
meningitis/ventriculitis. Diagnostic accuracies of presepsin were
superior in comparison to leucocytes or proteins in CSF. This marker
seems to have the potential to be used in every day clinical practice to
improve etiological diagnosis of meningitis/ventriculitis, and to
prescribe more appropriate antibiotics.
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Predicting subsequent risk of renal
involvement in children with Henoch-Schonlein purpura? (Pediatr
Nephrol. 2014; Dec 28. [Epub ahead of print])
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The aim of this analytical cohort study was to evaluate the potential of
serum pentraxin 3 (PTX3) values as an early predictor of subsequent
renal involvement in patients with Henoch-Schönlein purpura (HSP) with
no abnormalities on urinary examination and in renal function tests at
disease onset. Sixty children (age range 3-15 years) with HSP and sixty
age- and sex-matched healthy controls were followed up for at least
18 months. Clinical findings were recorded for all patients at first
examination, and blood samples for routine laboratory parameters and
PTX3 value as well as skin biopsy specimens were obtained from each
subject. Of the 60 patients with HSP, 29 (48.3%) developed subsequent
renal involvement, of whom four underwent kidney biopsy. The mean serum
PTX3 level of patients with subsequent renal involvement was
significantly higher than those of patients without renal involvement
and of the controls (P=0.004). Immunofluorescence evaluation of
skin biopsy revealed that in addition to immunoglobulin A (IgA)
deposition, the IgM deposition was significantly associated with
subsequent renal involvement (P=0.008). A high PTX3 level and IgM
staining in skin biopsies from HSP patients may be harbingers of
subsequent renal involvement.
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Fruit and Vegetable intake during infancy. (Pediatrics
2014;134 Suppl 1:S63-9.)
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This study examined the association of timing of introduction and
frequency of fruit and vegetable intake during infancy with frequency of
fruit and vegetable intake at age 6 years, in a cohort of US children.
This study analyzed data on fruit and vegetable intake during late
infancy, age of fruit and vegetable introduction, and frequency of fruit
and vegetable intake at 6 years . The percent of 6-year-old children
consuming fruits and vegetables less than once per day was determined
and associations with infant fruit and vegetable intake was studied
using logistic regression modeling. Based on maternal report, 31.9% of
6-year-old children consumed fruit less than once daily, and 19.0%
consumed vegetables less than once daily. In adjusted analyses, children
who consumed fruits and vegetables less than once daily during late
infancy had increased odds of eating fruits and vegetables less than
once daily at age 6 years. This study suggests that infrequent intake of
fruits and vegetables during late infancy is associated with infrequent
intake of these foods at 6 years of age. These findings highlight the
importance of infant feeding guidelines that encourages intake of fruits
and vegetables, and the need to examine barriers to fruit and vegetable
intake during infancy.
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