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Pastore S.,University of Trieste | Berti I.,Institute of Maternal and Child Health | Longo G.,Institute of Maternal and Child Health
European Journal of Pediatrics | Year: 2013

At least 30%of children with chronic urticaria have an autoimmune aetiology with a positive autologous serum skin test (ASST). ASST is cheap, easy to perform and has good sensibility and specificity in detecting autoantibodies. In case of concern about reliability of ASST because of antihistamine medications, test transferability seems to be feasible. © Springer-Verlag Berlin Heidelberg 2012.


Jayakrishnan M.P.,Institute of Maternal and Child Health | Krishnakumar P.,Institute of Mental Health and Neurosciences IMHANS
Journal of Pediatric Neurosciences | Year: 2010

Aim: To study the clinical profile of acute disseminated encephalomyelitis (ADEM) in children. Materials and Methods: All children admitted with ADEM during a period of one and a half years were included in the study. The diagnosis of ADEM was made based on the clinical presentation and suggestive MRI findings. All children were treated with intravenous methyl prednisolone, followed by oral prednisolone and followed up for varying periods up to three and a half years. Results: The sample consisted of 14 children with 11(79%) girls and 3 (21%) boys. The oldest child was 12 years and the youngest was a six-month-old infant. Acute febrile illness preceded the onset of neurological symptoms in 64% of children. The interval between the preceding illness and symptoms of ADEM varied from 7 days to 28 days (mean 12 days). The common presenting symptoms were fever, vomiting, headache, gait disturbance and generalized seizures. Neurological manifestations included altered sensorium, multiple cranial nerve involvement, quadriplegia and paraplegia, dystonia and choreiform movements, nystagmus, bladder involvement (both incontinence and retention), speech defect and double vision. Facial nerve was the most common cranial nerve involved. Psychological manifestations included aggressive behavior, psychotic symptoms and mood changes. One child each had features of acute psychotic episode and depressive episode. All children recovered fully. One child had multiphasic disseminated encephalomyelitis (MDEM) on follow up. Conclusion: Despite the serious neuropsychiatric manifestations, ADEM in children generally has good immediate outcome. Children with ADEM need long-term follow up for cognitive impairments.


Haneesh K.,Institute of Maternal and Child Health | Krishnakumar P.,Institute of Mental Health and Neurosciences IMHANS | Sukumaran S.K.,Institute of Maternal and Child Health | Riyaz A.,Institute of Maternal and Child Health
Indian Pediatrics | Year: 2013

Aim: To identify the risk factors for scholastic backwardness in children. Participants: Children in the 6-12 year age group attending regular schools and referred to the child guidance clinic for scholastic backwardness. Setting: Tertiary care hospital in South India. Methods: Participants were compared with an age-and sexmatched group of children with good academic performance, to ascertain risk factors for scholastic backwardness. Results: There were 75 boys and 35 girls in the study group. Among them 30 (27%) children had mental retardation, 39 (36%) had borderline intelligence and 12 (11%) had microcephaly. Undernutrition was noted in 36 (33%) children and 31 (28%) had stunted growth. 28 (26%) children had a history of chronic medical problems like epilepsy, bronchial asthma and congenital heart diseases. Visual, hearing and speech defects were present in 6 (6%), 5 (5%) and 12 (11%) children, respectively. Statistically significant differences were noted in the educational level and employment status of parents of children with scholastic backwardness and those with good academic performance. Conclusion: Social and family factors have a significant influence on the academic functioning of children. © 2013 Indian Academy of Pediatrics.


Jayakrishnan M.P.,Institute of Maternal and Child Health | Krishnakumar P.,Institute of Mental Health and Neurosciences | Gauthamen R.,Institute of Maternal and Child Health | Sabitha S.,Institute of Maternal and Child Health | Devarajan E.,Medical College
Pediatric Neurology | Year: 2012

Autonomic dysreflexia occurs in patients with spinal cord injury, and is characterized by unbalanced sympathetic discharge, precipitated by noxious stimuli from a site below the spinal cord lesion. An 11-year-old boy with acute disseminated encephalomyelitis and spinal cord involvement manifested episodes of intense flushing and sweating, confined to the head and neck region, and associated with hypertension and tachycardia. His signs improved after changing a partly blocked bladder catheter. The clinical features suggested autonomic dysreflexia. Early recognition of autonomic dysreflexia is important because removal of the trigger precipitating the event may be life-saving. © 2012 Elsevier Inc. All rights reserved.


Biffi S.,Institute of Maternal and Child Health | Biffi S.,Optical Imaging Laboratory | Bortot B.,Institute of Maternal and Child Health | Carrozzi M.,Institute of Maternal and Child Health | Severini G.M.,Institute of Maternal and Child Health
Diagnostic Molecular Pathology | Year: 2011

In many mitochondrial diseases, different clinical manifestations are related to tissue-specific distribution of mutated mitochondrial DNA (mtDNA). In this study, we describe an assay for the determination of mutated mtDNA copy number in small clinical samples, using standard polymerase chain reaction (PCR) followed by SYBR Green real-time allelic-specific PCR [amplification refractory mutation system-quantitative PCR (ARMS-qPCR)]. To assess the degree of heteroplasmy in a patient harboring 2 cosegregating mtDNA mutations (4415A>G and 9922A>C) starting from picogram amounts of DNA, we first amplified the mutated target sequence by standard PCR, and then analyzed it by real-time ARMS-qPCR. To validate this method, we analyzed by real-time ARMS-qPCR the PCR amplification products derived from different mixtures containing known proportions of mutant and wild-type cloned mtDNA fragments. The correlation coefficient of 0.994 between expected and observed values for the percentage of mutant A4415G confirms that the relative proportion of mutated and wild-type mtDNA was maintained after the first PCR amplification. This method allows the precise quantification of heteroplasmic mutations in DNA samples extracted from hairs, urine, small stomach biopsies, and, more importantly, single-muscle fiber, with a limit of detection close to 0.5%. This nested real-time ARMS-PCR represents a rapid, efficient, and less expensive method for the detection and quantification of heteroplasmic mutant mtDNA, even in very small clinical samples. Copyright © 2011 by Lippincott Williams & Wilkins.


Menon P.S.N.,Jaber Al Ahmed Armed Forces Hospital | Vijayakumar M.,Institute of Maternal and Child Health
Indian Journal of Pediatrics | Year: 2014

The term 'precocious puberty' signifies the onset of secondary sexual characters before the age of 9 y in boys and 8 y in girls. Menarche before 9.5 y is also considered precocious. These definitions are constantly evolving due to the secular trends observed all over the world. It is crucial to decide whether the child has central (gonadotropin-dependent, GDPP) or peripheral (gonadotropin-independent, GIPP) form of precocious puberty. Some benign conditions such as premature thelarche and premature pubarche may mimic precocious puberty. A systematic approach with detailed history and clinical examination helps to arrive at a diagnosis in most cases. An underlying neurologic disorder is more likely in a very young boy. Basal LH level is the best screening test to diagnose GDPP. LH level less than 0.1 IU/L by a very sensitive assay indicates prepubertal stage. Stimulation tests using gonadotropin releasing hormone (GnRH) or its analog (GnRHa), leuprolide help to confirm the diagnosis of GDPP. High resolution MRI of brain helps to detect abnormalities in hypothalamus and pituitary region. GnRH analogs (GnRHa) are the only effective treatment for GDPP at present. In girls, breast size may regress; menses ceases and vaginal mucosa becomes non-estrogenized. In boys testicular volumes remain static or decrease and genital growth regresses. The effects of GnRH analogs are reversible on discontinuation of therapy, with restoration of normal function within 3 mo after stopping treatment. Treatment of GIPP however is far from satisfactory. © Dr. K C Chaudhuri Foundation 2013.


Geeta M.G.,Institute of Maternal and Child Health | Riyaz A.,Institute of Maternal and Child Health
Indian Pediatrics | Year: 2013

The likelihood of developing chronic hepatitis B infection and its complications is most when infection is transmitted vertically. Awareness of the current recommendations for managing babies of mothers who are hepatitis B carriers is not universal, resulting in failure of follow up, despite the serious long term implications, including development of hepatic carcinoma. We review the current guidelines of managing babies born to mothers who are Hepatitis B carriers. © 2013 Indian Academy of Pediatrics.


Jayakrishnan M.P.,Institute of Maternal and Child Health | Veny J.,Institute of Maternal and Child Health | Feroze M.,Institute of Maternal and Child Health
Tropical Doctor | Year: 2011

A five-year-old girl admitted with scrub typhus developed multiple organ dysfunction associated with hyperferritinaemia, hypofibrinogenaemia and hyperlipidaemia. Bonemarrowaspiration studies confirmedhaemophagocytic lymphohistiocytosis (HLH).HLHis a syndrome characterized by the uncontrolled activation and proliferation ofmacrophages andT-cells and can occur together with infections, connective tissue disorders, malignancies and genetic disorders.


PubMed | Institute of Maternal and Child Health
Type: | Journal: Minimally invasive surgery | Year: 2017

TULAA or Transumbilical Laparoscopic Assisted Appendicectomy is a minimally invasive technique described by Pelosi in 1992 for the removal of the inflamed appendix. Its main advantage is the possibility of exploring the peritoneal cavity and performing a simple and safe extracorporeal appendicectomy. Since its first description, different authors reported their experience with such technique. The aim of this review is to summarise the surgical outcomes currently reported in the literature for this minimally invasive surgical approach and compare it with standard open and laparoscopic appendicectomy.


PubMed | Institute of Maternal and Child Health
Type: Journal Article | Journal: International urology and nephrology | Year: 2016

Undescended testis is a common problem, which is prevalent in 3% of male infants. This study aimed to determine the effect of leaving the deep inguinal ring (DIR) without closure during laparoscopic orchiopexy (LO), with regard to post-operative hernia formation and other outcomes.From 2012 to 2014, 63 testicular units were managed with laparoscopy for non-palpable testis (NPT). Diagnostic laparoscopy was performed for all NPTs, and when they were intra-abdominal (42 testicular units), the DIR was left open after mobilization of the testis into the scrotum medial to the inferior epigastric vessels (Prentiss manoeuvre). We followed up these cases to check for hernia formation.The ages ranged from 10months to 11years with mean age at 3.7years. Clinically, no cases presented with hernia, hydrocele or any other complications during a mean follow-up period of 34.4months.Closing the peritoneum over the DIR might be omitted in LO with Prentiss manoeuvre, saving operative time and effort. By doing so, there is no risk of hernia formation.

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