Online ISSN: 2515-8260

Keywords : pediatrics


A comparative study of ropivacaine and bupivacaine for caudal epidural anaesthesia in children undergoing lower abdominal surgery

Dr. Marie Ninu, Dr. Jagadish Basumatary, Dr. Sangeeta Deka .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5330-5339

Background: Caudal epidural anaesthesia blocks dermatomes below the level of the umbilicus  in children.
Objectives:This study intends to compareropivacaine and bupivacaine for caudal anaesthesia in children undergoing lower abdominal surgery.
Materials and methods: After the hospital ethics committee approval, 60 (ASA I–II) children scheduled for lower abdominal surgery were included in this study. Group A (n=30) patients received ropivacaine 0.25% and group B (n = 30) patients received bupivacaine 0.25% via the caudal route. We assessed the demographic and clinical characteristics, AIIMS pain score at 1, 2, 4, 8, 12, 16 and 24 hours after operation and level of residual motor block (Bromage Scale)immediately after surgery and at 1, 2 and 3 hours post operatively.Data analysis was performed using one way ANOVA test.P value less than 0.05 was considered significant.
Results and conclusion: There were no statistically significant differences in AIIMS pain scores between groups A and B at all postoperative time points –1hr, 2hr, 4hr, 8hr, 12hr, 16hr and 24hr(P < 0.00001). The quality and duration of analgesia were comparable in both the groups. However, degree of motor block was significantly less in the ropivacaine group. After 3 hours there was no significant difference in the level of residual motor block.
The single shot caudal epidural block with 1ml/kg ropivacaine 0.25% is a safe and effective, long lasting dose for postoperative analgesia in paediatric lower abdominal surgery, producing less duration of motor block than bupivacaine 0.25%.

Management of pediatric femoral shaft fractures with elastic stable intramedullary nailing (ESIN)

Dr. Usman Khan, Dr. Jafar Khan, Dr. Jignesh Kumar, Dr. Saurabh Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 566-571

Diaphyseal femur fractures in children account for 1.4-1.7% of all fractures, and 7.6% of those involving the long bones. Diaphyseal femur fractures ratio between males and females is 2.6:1.Non-operative treatments such as Pavlik harness, traction, and Spica casting, and operative treatments such as sub muscular plating, elastic nails, rigid nails, as well as internal and external fixation. Elastic stable intramedullary nailing is getting popular for management of femoral fractures for children 5 years and older.
In this study, 35 children aged between 6-15 years with diaphyseal femur shaft fractures were treated with elastic stable intramedullary nailing (ES1N). All patients successfully completed one-year follow-up and were included in the analysis. All the patients were managed with titanium nails. We based on our experience and results thus conclude that Titanium elastic nails can be considered better method of treatment regarding lesser rate of surgical wound complications.

Teamwork, Targets, Technology, and Tight Control-The 4T Study-Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes

1Rajesh Kumar Padhi, 2Susant Mishra, 3Abhay Sahoo, 4Monalisa Khuntia, 5Hariballav Mahapatra .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 3294-3308

Many teenagers and youths with type 1 diabetes (T1D) do not meet their haemoglobin A1c (HbA1c) goals. In India, the average HbA1c of young people is greater than in much of the industrialised world. Other countries' mean HbA1c levels have been effectively changed using benchmarking and quality improvement techniques. We present the revolutionary 4T strategy to diabetes care in kids with new-onset T1D in this review, which includes teamwork, targets, technology, and tight control.The diabetes care team (physicians, nurse practitioners, certified diabetes educators, dieticians, social workers, psychologists, and exercise physiologists) collaborate closely in this approach to provide diabetes education beginning with diagnosis. Early integration of technology, notably continuous glucose monitoring (CGM), and establishing a curriculum around using the CGM to maintain tight control and maximisethe quality of life are both parts of the education curriculum.

To study the effect of rituximab in patients with frequently relapsing/ steroid-dependent nephrotic syndrome

1Rohit Prabha Gaude, 2Shashi Bhusan Rout, 3Sarat Kumar Parida .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 3344-3350

Background: Corticosteroids have had a central role in the treatment of nephrotic syndrome. The management of these patients who become dependent on steroids is complex, involving different immunosuppressive drugs patterns. The monoclonal antibody anti CD20, Rituximab, is likely to have beneficial effects in cases of steroid-dependent nephrotic syndrome patients with no easy resolution, even when we cannot make a statement about the specific role in the impact. We bring our personal experience with pediatric patients treated with this medication during the last years, to provide a thorough overview and useful information about the role of Rituximab in this pathology.
Methods: Retrospective study in patients with steroid-dependent idiopathic nephrotic syndrome controlled in Dept. of Nephrology & renal Transplantation SCBMCH, Cuttack in those patients who had received at least one treatment cycle of Rituximab, at any moment along the evolution of the disease.
Results and Conclusion: In the Rituximab group more patients were 6-10 years old compared to the Control group and this was not statistically significant. The majority of patients were male in the Rituximab group compared to the Control group. This was not statistically significant. A higher proportion of patients had CR 6m in the control group compared to the Rituximab group but this was not statistically significant. The majority of patients who had CR 12m were found in the Rituximab group compared to the control group and this was not statistically significant.Only Rituximab group patients had PR 6m and this was also statistically significant.We observed that only Rituximab Group patients had NR at 12m and another side no patients had NR at 12m in the control group and this also was statistically significant.A higher number of age group patients were located in the control group compared to the Rituximab Group, but this was not statistically significant.More patients who had higher Se Creatinine at 0m were shown in the control group compared to the Rituximab Group this was also not statistically significant

MANAGEMENT OF SUPRACONDYLAR FRACTURE OF HUMERUS USING CROSSED LATERAL PINNING IN PEDIATRICS

Mousa Mohamed Dabboub,Abdallah Attia Mohammad, Ashraf Abd El Dayem Mohammad,Hossam Fathi Mahmoud

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 4645-4652

Background: A sufficient background and careful initial clinical evaluation are needed for the assessment and treatment of the supracondylar fracture of the humerus. The study aimed to evaluate the results of cross lateral ascending and descending pinning in pediatric supracondylar fractures humerus. Patients and methods: This study included 18 children with supracondylar humerous fractures who underwent lateral pinning in the pediatric department, the hospitals of Zagazig University, and the hospital of teaching Ibnsina. Surgical technique was performed and outcomes were recorded. Results: Regarding cosmetic score, more than half of the studied group (55.6%) had excellent, (27.7%) of them had good and (11.1%) had fair and (5.6%) had poor cosmetic score respectively. Concerning Flynn's Score, more than half of the studied group (55.6%) had excellent functional outcome, (27.7%) of them had good functional outcome and (11.1%& 5.6%) had fair and poor functional outcome respectively.There was statistically significant difference between patients with satisfactory and unsatisfactory outcome regarding presence of complications and mechanism of injury with better outcome in injury due to FD and patients with satisfactory outcomehad no complications. Conclusion: Near manipulation and percutaneous attachment in the paediatric age group is an appropriate and conclusive treatment procedure with two crossing-lateral K wire of Gartland type II and III supracondylar fractures with less complications.
 

Complex Approach To The Diagnosis Of Cystic Fibrosis In Children

Shohsanam Bahromovna Uzakova; Furkat Mukhitdinovach Shamsiev; Nargis Khayrullaevna Mirsalikhova; Nigora Davlyatovna Azizova; Rano Anvarbekovna Musajanova; Nilufar Irgashevna Karimova

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 3003-3007

The aim of the study was to study the clinical and diagnostic features of cystic fibrosis in children in Uzbekistan. The study included 120 patients with cystic fibrosis at the age of 0 months. up to 14 years old, who were inpatient treatment in the department of pulmonology, pathology of early age and gastroenterology. In children with cystic fibrosis, the main clinical symptoms of the bronchopulmonary system were: cough, shortness of breath, oral wheezing, lethargy and loss of appetite. Upon admission to the hospital, the general condition of the patients was most of all regarded as severe. The most common causative agents of the disease exacerbation were S. aureus - 32%, Str. pyogenus - 26%. Based on the results of the study, the frequency of mutations in the CFTR gene and their influence on the nature of the course were determined. A significant role has been revealed for the 4 most common gene mutations in Uzbekistan, CFTR-F508del, CFTR-2143delT, R709X, Y569D.

Modern Approaches To The Selection Of Protected Cephalosporins Iii For Therapy Of Community-Acquired Pneumonia In Children

Mukhlisakhon Ravshanhanovna Kurbanova; Furkat Mukhitdinovach Shamsiev; Rano Anvarbekovna Musajavova

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 3008-3014

The aim of the study was to study the effectiveness of the use of protected cephalosporin III generation Extum in the treatment of community-acquired pneumonia in children. The study included 100 children with community-acquired pneumonia at the age from 1 to 15 years, who were observed and treated in the department of pulmonology. In the process of complex clinical and laboratory examination of children, biochemical, microbiological and immunological research methods were used. Microbiological studies have shown that in children with community-acquired pneumonia, S. Pneumonia occupies a significant place in the etiological structure and accounts for 42.0% of cases, a high sensitivity of pneumococcus to injectable cephalosporin of the third generation has been established. When included in complex treatment, protected cephalosporin of the third generation Extum leads to a decrease in the frequency of repeated acute respiratory infections and their complications by 2.2 times, the frequency of recurrent bronchitis and pneumonia by 1.7 times, which indicates a high therapeutic effectiveness of the proposed treatment

ADVANCED NEUROIMAGING TECHNIQUES IN EVALUATING PEDIATRIC EPILEPSY

K. Sree Kala Priyadharsini; Lakshminarayanan Arivarasu

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 376-382

Accurate localization of the seizure onset zone is important for better seizure outcomes and preventing
deficits following epilepsy surgery. Recent advances in neuroimaging techniques have increased our
understanding of the underlying etiology and improved our ability to noninvasively identify the seizure
onset zone. Using epilepsy-specific magnetic resonance imaging (MRI) protocols, structural MRI allows
better detection of the seizure onset zone, particularly when it is interpreted by experienced
neuroradiologists. Ultra-high-field imaging and postprocessing analysis with automated machine learning
algorithms can detect subtle structural abnormalities in MRI-negative patients. Tractography derived from
diffusion tensor imaging can delineate white matter connections associated with epilepsy or eloquent
function, thus, preventing deficits after epilepsy surgery. Arterial spin-labeling perfusion MRI,
simultaneous electroencephalography (EEG)-functional MRI (fMRI), and magnetoencephalography
(MEG) are noninvasive imaging modalities that can be used to localize the epileptogenic foci and assist in
planning epilepsy surgery with positron emission tomography, ictal single-photon emission computed
tomography, and intracranial EEG monitoring. These advanced structural and functional imaging
modalities can be combined with postprocessing methods to better understand the epileptic network and
obtain valuable clinical information for predicting long-term outcomes in pediatric epilepsy.