Indian Journal of Trauma and Emergency Pediatrics

Background: Transient loss of consciousness may be due to cardiac cause. Arrhythmias may lead to syncope or to sudden death. Long QT syndrome (LQTS) is a genetically transmitted cardiac arrhythmia caused by ion channel protein abnormalities. It is characterized by electrocardiographic abnormalities and a high incidence of sudden cardiac death. Case Report: We report a case of long QT syndrome in a 10-year girl child who was treated for refractory seizures with multiple antiepileptic drugs. Simple electrocardiography confirmed the diagnosis. Conclusion: Child was treated with non-selective beta blocker and showed dramatic response.

Keywords: Arrhythmia; Beta blocker; LQTS; Refractory seizure; Syncope.

Turner's syndrome is the most common cause of primary amenorrhea seen in clinical practice. The syndrome is characterized by absence of one X chromosome [45X0]. About 50% of the Turner syndrome have mosaic forms such as 45X0/46XX or 45X0/46XY. In a female presenting with primary amenorrhea or short stature, possibility of Turner's syndrome must be ruled out. Turner's syndrome is the only monosomy compatible with life. Patients face manifold difficulties which increase over the lifespan. It is also the most common aneuploidy in first trimester losses. Incidence of Turner's syndrome is estimated to be 1 in 2500. Estrogen therapy is indicated lifelong in a patient with Turner's syndrome.

Keywords: Turner's syndrome; Amenorrhea; Karyotype; Short Stature; Estrogen.

Kerosene oil poisoning is a preventable health problem in children, common in developing countries. Kerosene oil has high volatility, low viscosity and low surface tension, increasing its risk of aspiration. The physical properties of kerosene oil also make it more likely to penetrate and spread deeper into lower airways increasing chances of severe lung injury. Risk factors which increase likelihood of accidental ingestion includ male gender, age below 3 years, summer season, storage in drinking water bottles and in areas of easy access (in and around the kitchen and stairs), and rural/ lower socioeconomic population. Most common presentation after kerosene poisoning is with fever, cough, tachypnea and vomiting. While pneumonia is the commonest complication, central nervous system manifestations such as drowsiness, restlessness, stupor or convulsions may occur. Early diagnosis, avoidance of harmful first aid practices, observation for symptoms/ complications, supportive care and appropriate treatment of pneumonia are necessary to reduce the morbidity and mortality. Recommendations such as education of community and parents, use of childresistant containers, appropriate safe storage areas and adequate parental supervision can reduce the incidence of kerosene poisoning in children.

Keywords: Aspiration; Children; Hydrocarbon; Kerosene; Morbidity; Poisoning; Pneumonia.

Introduction: Epilepsy is the commonest chronic neurologic disorder in children, affecting about 10.5 million children in the world. Successful management of epilepsy begins with an accurate diagnosis, followed by treatment with an appropriate antiepileptic drug (AED) with proper dose and duration. Treatment gap and dropout is a barrier to control this disease. Objectives:To asertain the difficulties and challenges for the optimum management of childhood epilepsy. Methods: This retrospective observational study was conducted in an epilepsy clinic of Paediatric Neuroscience Department of Dhaka Shishu (Children) Hospital (DSH) over a period of 3 years from January 2013 to December 2015. During this period 1 year follow up record of each patient was analyzed. Information on biodemographic data, clinical and developmental assesment made by a multidisciplinary team was analyzed. Result: Out of 120 patients, 37 (31%) were reported with controlled epilepsy, whereas 40 (33%) were uncontrolled. The major difficulties among total respondents were found non adherence (50%) to drugs and dropped out (35.8%) from the treatment. After association of different predictors with drop out from treatment only medium adherence 16.9%, low adherence 69.8% to drug found as significant predictor (p < 0.001). Among the challenges feeding difficulties (28%), malnutrition (24%) and ignorance (20%) were the leading causes. Conclusion: Management of childhood epilepsy in underdeveloped country is very challenging. To overcome the difficulties appropriate counseling and education is needed at first. Secondly, by ensuring the cheap and high-quality drugs, this difficulty can be overcome.

Keywords: Antiepileptic drug (AED); Epilepsy; Drug non-compliance; Dropout.

Background: Scorpion sting is a frequent, lifethreatening medical emergency in children. They constitute a significant public health problem in many underdeveloped countries, including India. A case series type of study was conducted to study the prevalence of scorpion stings in pediatric age group. Method: This is an observational study of 35 cases of scorpion sting, admitted to our hospital. An 11- month case series type of study was done to study the prevalence of scorpion sting in pediatric age group. Result: Maximum admissions were in the 3–10 age group (56%) followed by 28% in 1–3 years age group. Prevalence was very low in children less than 1 year of age group. Males were affected more than females, M:F ratio 5:2. Mortality was mainly in 1–3 years age group and 3–10 years age group. Percentage wise mortality more in 1–3 years age group (28.5%) than 3–10 years age group (14.28%). Conclusion: Scorpion stings is a serious, potentially fatal emergency in our area. Cardiovascular manifestations are most common and life threatening. Scorpion stings constitute an “Occupational Hazard”for children employed as agricultural laborers. Administration of prazosin, as early as possible, is probably, the single most effective intervention in preventing complications and mortality.

Keywords: Scorpion bite; Prevalence; Age group; Mortality.

Clonidine, an alpha-2-adrenergic agonist, have a clinically relevant analgesic action but also a hypotensive action, when administered spinally. In this study, therefore, the analgesic, hemodynamic effects of intrathecal clonidine were studied in patients undergoing lower abdominal and lower limb surgery under spinal anaesthesia. Sixty patients of ASA I-II were randomly divided to two groups. One group received clonidine 15 μg mixed with 15.5 mg 0.5% bupivacaine and the other group an identical saline volume mixed with bupivacaine as above, in a double-blind fashion. Onset and duration of sensory and motor block, blood pressure, heart rate and sedation were followed during and after the operation. The duration of sensory analgesia (regression of the block to L2) was longer in the clonidine group (mean 178 min) than in the control group. Duration of motor blockade was also longer in the clonidine group compared to the control group. Mean arterial pressure and heart rate were significantly lower in the clonidine group compared to the control group. Postoperative the clonidine patients needed less doses of diclofenac sodium than those in the control group. More patients in the clonidine group were sedated 3–4 hr than control group (p < 0.05). Addition of clonidine prolonged the bupivacaine spinal block.

Keywords: Clonidin; Bupivacaine spinal block alpha-2-adrenergic agonist.