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Indian Pediatr 2014;51: 242
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K Rajeshwari
Email:
[email protected]
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Nano silver for soft tissue defects (J Med Assoc Thai.
2013;96:S177-84)
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In a complex wound — with exposed tendon, joint or bone — soft tissue
reconstruction is required to obtain function and aesthetic coverage.
The authors report their experience using nanocrystalline silver, with
or without vacuum assisted wound closure, to salvage the exposed vital
structures such as bone, joint or tendon in traumatic wounds. They
studied 12 patients with 15 wounds that exposed vital structures,
especially in the lower extremities. After adequate debridement, four
wounds were treated with nanocrystalline silver dressing and vacuum
assisted wound closure, and ten wounds were treated in an out-patient
program using nanocrystalline silver dressing. A preliminary evidence of
impressive result was achieved with subsided infection and complete bony
coverage by granulation tissue after treatment. Subsequently, a
secondary healing or a split thickness skin graft was applied.
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Congenital talipes : current treatment
(Practitioner. 2013; 257:15-8)
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Congenital talipes equinovarus (CTEV) is a condition of the lower limb
in which there is fixed structural cavus, forefoot adductus, hindfoot
varus and ankle equinus. It is important to differentiate CTEV from a
non-structural or positional talipes that is fully correctable. This
positional variant occurs about five times as commonly as CTEV and does
not require casting or surgical treatment. The majority of CTEV cases
are picked up at the early baby check or on prenatal ultrasound, and
referred to the orthopedicians. However, some cases are mistaken early
on as the positional variant, and may therefore present late. Urgent
referral is warranted as the Ponseti treatment should be started early.
The feet must be examined directly to see if the components of the
deformity are fixed, defining CTEV. The hips (stability, length
equivalence, range and symmetry of abduction) and spine must also be
examined. The boots and bar splintage is a vital part of the Ponseti
technique and relapse is strongly correlated with non-compliance. The
technique involves a series of manipulations and casts, usually on a
weekly basis, in which the foot is brought round to a corrected
position. Over the past 25 years there has been a dramatic shift away
from extensive surgical releases to manipulative methods/serial casting
such as the Ponseti technique.
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CSF ferritin in bacterial meningitis (Br J Biomed Sci.
2013;70:101-3)
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Bacterial meningitis is still one of the significant causes of morbidity
and mortality in children. Rapid differentiation between bacterial and
aseptic meningitis, and the need for immediate antibiotic treatment in
the former, is crucial in the prognosis of these patients. The present
study on 42 patients evaluated the diagnostic capability of CSF ferritin
in differentiating bacterial and viral meningitis. Ferritin and other
routine determinants (i.e., leucocytes, protein and glucose) were
compared between those having bacterial or viral meningitis. Ferritin
concentration in the bacterial meningitis group was considerably higher
than in the viral meningitis group. Mean CSF protein concentration and
cell count showed a positive correlation with CSF ferritin. The
study provides preliminary evidence of usefulness of measuring CSF
ferritin concentration for the early differentiation of bacterial and
aseptic meningitis.
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Sertaconazole for seborrheic dermatitis (Ann Parasitol. 2013;59:73-7)
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The treatment of seborrheic dermatitis (SD) includes topical antifungal
agents to eradicate Malassezia spp., corticosteroids to treat the
inflammatory component of the disease, and keratolytics to remove scale
and crust. The aim of this study was to compare the efficiency of
sertaconazole 2% cream and tacrolimus 0.03% cream in the treatment of
seborrheic dermatitis. In this clinical trial, thirty patients received
local sertaconazole 2% cream, and the other thirty patients received
tacrolimus 0.03% cream, twice a day for four weeks. At the time of
referral, and 2 and 4 weeks after first visit, the patients were
examined by a dermatologist to check the improvement of clinical
symptoms. A higher level of satisfaction was observed 28 days after
sertaconazole in comparison to tacrolimus (90% vs. 83%).
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Withdrawal of antiepileptic drugs (Epilepsia 2013;54
Suppl 7:2-12)
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The Italian League Against Epilepsy has issued evidence-based guidelines
to help practicing physicians in their decision to stop or withhold
antiepileptic drugs (AEDs) in patients achieving a prolonged period of
seizure freedom. Eight neurologists, critically appraised 128 published
reports and provided graded recommendations answering 15 key questions,
including length of the seizure-free period, electroencephalography
(EEG) pattern at the time of discontinuation, etiology of epilepsy and
seizure type. The following recommendations were outlined: (1)
antiepileptic treatment might be discontinued after a minimum period of
2 years of seizure freedom; (2) factors, such as abnormal EEG at the
time of treatment discontinuation, a documented etiology of seizures
(including mental retardation, perinatal insults, and abnormal
neurologic examination), partial seizures, or an older age
at disease onset, enhance the risk of relapse; however, patients should
not be discouraged to withhold treatment unless a combination of two or
more of these factors is present; (3) female sex, family history of
epilepsy, history of febrile seizures, disease length/severity, and
number and type of drugs taken should not influence the decision to stop
treatment; (4) epilepsy syndrome should be always included in the
decision process; (5) slow (at least 6 months) AED discontinuation
should be encouraged; and (6) patient discontinuing treatment should be
followed for at least 2 years.
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