Comparative study of inhaled steroids versus inhaled steroids plus long acting beta agonists in childhood asthma: a randomized controlled study

Background: Asthma is a chronic inflammatory condition of lung airways resulting in episodic airflow obstruction causing considerable morbidity in paediatric population. The main objective of the study was to find out whether addition of long acting beta agonists to steroids provides better asthma control.Methods: This randomized controlled trial study was performed in children aged 6-15 years of age, with clinically stable and moderate persistent asthma.Results: The findings of this study indicate SABA use in Budesonide/formoterol group patients was significantly less compared to budesonide group patients (1.5±1.1 v/s 2.13±0.9, p-value 0.01). Both groups experienced decrease in night time symptoms and acute exacerbations however there was no significant difference between the two groups in these variables.Conclusions: This study showed addition of LABA to inhaled steroids in moderate persistent asthma provided better asthma control and LABA is mainly recommended to be used as add-on therapy for patients whose asthma is not controlled on low to high doses of inhaled corticosteroids

Dataset for forensic analysis of B-tree file system

Since B-tree file system (Btrfs) is set to become de facto standard file system on Linux (and Linux based) operating systems, Btrfs dataset for forensic analysis is of great interest and immense value to forensic community. This article presents a novel dataset for forensic analysis of Btrfs that was collected using a proposed data-recovery procedure. The dataset identifies various generalized and common file system layouts and operations, specific node-balancing mechanisms triggered, logical addresses of various data structures, on-disk records, recovered-data as directory entries and extent data from leaf and internal nodes, and percentage of data recovered

Sociodemographic Profile, Semiology, and Etiology of Patients with Status Epilepticus: A Study from a Tertiary Care Hospital in North India

Background and Objectives: Despite advance in treatment of status epilepticus (SE), a major neurological emergency, it is still associated with mortality and morbidity. The objective of our study was to estimate sociodemographic profile, semiology, and etiology in the children with SE admitted in pediatric intensive care. Materials and Methods: Children between 1 month and 18 years with continuous seizure activity of >5 min or two or more sequential seizures without full recovery of consciousness between seizures, admitted in the Pediatric Intensive Care Unit of the Department of Pediatrics, Government Medical College, Srinagar, were included in the study. A semi-structured tool was designed to record the sociodemographic details. Detailed history, clinical examination, and investigations (including neuroimaging as and when needed) were used to determine the type of seizure and etiology. Results: A total of 51 patients were included in our study. Most of the patients were 1-year age group. Males (60.80%) outnumbered females. Thirty-nine patients (76.47%) belonged to “known” or “symptomatic” group with 35 (68.60%) of them presenting with SE as their fresh seizure. Thirty-nine (76.47%) of our patients had generalized tonic–clonic seizure (GTCS) type of SE. Conclusion: Most of the children (90%) were below the age of 5 years with male predominance. Most of the patients had SE as their first seizure without prior history of seizures with GTCSs was the most frequent seizure type

“Acute versus chronic hemodynamic response of Carvedilol in Chronic Liver Disease with Portal hypertension”

Background: Hemodynamic studies give objective method to measure the response but need to be repeated during the course of therapy. Data comparing acute with chronic hemodynamic response of Carvedilol is scarce and needs to be studied further to elucidate the course and predictors of response, so the single hemodynamic study envisages the long-term response. Aims and Objectives: The purpose of this study was 1.To assess and compare the acute and chronic hemodynamic response to Carvedilol along with their predictors in Cirrhotic patients.2.To evaluate if acute response is maintained long term. Methods: In one hundred two consecutive patients of chronic liver disease with esophageal varices, Hepatic Venous Pressure Gradient (HVPG) was measured at baseline and 90 minutes after initial administration of 12.5 mg of Carvedilol to assess the acute response. These patients were reassessed at 3 months of dose optimization for chronic response. The acute responders were compared with chronic responders. Results: Acute response was seen in 51% and chronic in 62% patients. Most of the patients who responded to optimized therapy after no acute response belonged to CTP A. Mean reduction of HVPG in responders was 4.5± 2.2 mmHg to loading dose and 5. 5± 1.7 mmHg at 3 months. Low Cardiac output (CO), more than 2.5 mmHg drop acutely and dose optimization were independent predictors of response for acute, chronic and chronic response with no acute response respectively. Conclusion: Acute response assessed by hemodynamic study at initiation of treatment is important predictor of chronic response and is maintained over period of time. Dose optimization to achieve response is more appropriate for CTP A then B and C

Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children

Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis (BM) from viral meningitis (VM) in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut‐off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between BM and VM, the area under the curve (AUC) for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut‐off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for BM, mean levels in VM remain essentially below 2 mmol/L

Vitamin D status correlates with the markers of cystic fibrosis-related pulmonary disease

Background: The prevalence of Vitamin D deficiency remains high in cystic fibrosis despite daily supplementation. Vitamin D as an immunomodulator has been related to lower respiratory tract infections in children. The present study was undertaken to examine the association between vitamin D status and markers of cystic fibrosis-related pulmonary disease including exacerbations, bacterial colonization and pulmonary function. Methods: The study includes review of records of 51 cystic fibrosis patients. Baseline patient variables and serum vitamin D levels were recorded. Based on vitamin D levels study patients were divided into three groups: vitamin-D sufficient (≥20 ng/mL), vitamin-D insufficient (12 to 20 ng/mL), and vitamin D-deficient (≤12 ng/ml). Results: The proportion of children with deficient, insufficient and sufficient vitamin D levels were 47.1%, 15.7%, and 37.2%, respectively. Female sex, bacterial colonization and a greater number of exacerbations were associated with highest odds of developing vitamin D deficiency in patients with CF with 1.77 (0.22–4.61) (p = 0.002), 2.9(0.57−14.82) (p = 0.011), and 5.12 (1.28−20.50) (p = 0.021) respectively. The comparison of vitamin-D levels taken during exacerbations, colonization and during routine follow-up were significant [16.04 (7.42−27.91), 24.3 (15.5−32.4) and 48.54 (18.37−78.7) ng/ml, p < 0.001]. The FEV1 was determined in 24 patients; the comparison was significant between vitamin D-deficient and -sufficient groups [0.75 (0.717−0.777) vs. 0.82 (0.74−0.92) p < 0.05]. Conclusion: We concluded that vitamin D deficiency was highly prevalent in children with CF, despite daily supplementation of the vitamin in diet. Further, vitamin D deficiency was associated with a higher rate of pulmonary exacerbations and higher incidence of pulmonary bacterial colonization. In addition, in younger patients, low vitamin D levels were associated with reduced pulmonary function. Key Words: bacterial colonization, cystic fibrosis, lung function, pulmonary exacerbation, vitamin D deficienc

Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children

Abstract Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut-off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2 mmol/L

Hysterectomy in a male? A rare case report

INTRODUCTION: Persistent Mullerian duct syndrome is a rare form of male pseudo-hermaphroditism characterized by the presence of Mullerian duct structures in an otherwise phenotypically, as well as genotypically, normal man; only a few cases have been reported in the worldwide literature. A great variety of organs have been found in indirect inguinal hernial sacs. PRESENTATION OF CASE: We report a case of 70 year old man, father of 4 children with unilateral cryptorchidism on the right side and left-sided obstructed inguinal hernia containing uterus and fallopian tube (that is, hernia uteri inguinalis; type I male form of persistent Mullerian duct syndrome) coincidentally detected during an operation for an obstructed left inguinal hernia. DISCUSSION: PMDS is usually coincidently detected during surgical operation, as was in our case. However pre-operative ultrasonography, computerized tomography and MRI allow possible pre-operative diagnosis.3 CONCLUSION: In cases of unilateral or bilateral cryptorchidism associated with hernia, as in our patient's case, the possibility of PMDS should be kept in mind

Clinical spectrum of disorders of sex development: A cross-sectional observational study

Objective: Disorders of sex development (DSD) constitutes a small but difficult and equally important area of endocrinology. It is often a social emergency as the decision regarding sex assignment in these cases is extremely disturbing and difficult to both families and healthcare professionals. Our study was devised to assess the clinical and chromosomal profile of patients with suspected DSD and classify them according to the new DSD consensus document. Subjects and Methods: This study was a cross-sectional observational study carried out in the department of pediatrics of a tertiary care hospital from August 2012 to August 2014. All patients with suspected DSD in the age group of 0–19 years were included. After detailed history and examination, karyotyping, abdominal sonography, and hormonal analysis were done. Additional studies like gonadal biopsy, laparoscopy, and hormone stimulation tests were done in selected cases. Results: About 41 patients were included in the study. The mean age of presentation was 87 months (1 day to 16 years). Only seven (13.7%) patients presented in neonatal period. In total, 25 patients had ambiguous genitalia; 46, XX DSD were diagnosed in 24 (58.5%) patients, 46, XY DSD in 10 (24.4%) patients, and sex chromosome DSD in 7 (17.1%). Congenital adrenal hyperplasia (CAH) was the commonest disease diagnosed in 21 (51.2%) patients. Turner syndrome, Klinefelter syndrome, androgen insensitivity syndrome, 46, XX ovotesticular disorder, and 46, XY gonadal dysgenesis were diagnosed in 3, 3, 4, 3, and 5 patients, respectively. Eleven patients with CAH presented in shock and six had history of sib deaths. Conclusion: 46, XX DSD were the commonest etiological group in our study and CAH was the commonest individual disease. There is a need for educating general public and practitioners regarding DSD to allow early intervention. Moreover, there is a need to introduce routine neonatal screening for CAH in our country