ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 17 (1)
Volume: 17  Issue: 1 - 2012
1.Characteristics of patients with ADHD in psychiatric and pediatric ADHD clinics
Dusan Kolar, Lily Hechtman, Emmett Francoeur, Jodi Paterson
Pages 1 - 10
This study explores whether the child psychiatry ADHD clinic and the pediatric ADHD clinic serve different population of patients regarding the patient characteristics, severity of ADHD symptoms and comorbid disorders, thereby testing the efficacy of a triage system set up to direct patients referred for Attention Deficit Disorder symptoms to the appropriate clinics. Charts of 163 children and adolescents treated in two clinical settings were analyzed with regard to demographic characteristics, family structure, DSM-IV diagnosis of ADHD, and a variety of comorbid characteristics assessed through the Child Symptom Inventory-4 or Adolescent Symptom Inventory-4. Patients in the child psychiatry ADHD clinic were older and consequently have more years of schooling. Child psychiatry ADHD clinic had a greater number of patients with combined subtype of ADHD than the pediatric ADHD clinic. Likewise, the child psychiatry clinic had a higher number of patients with comorbid disorders. The child psychiatry ADHD clinic received patients who were older and had more comorbid psychiatric disorders. The study suggests that there exists an appropriate division of labour in that a third line specialty psychiatry clinic receives the more difficult complex cases.

2.Antibacterial activity of methanol root extract of Indigofera lupatana Baker F.
Sospeter Njerua Ngoci, Josphat C. Matasyoh
Pages 11 - 16
Indigofera lupatana Baker F. (locally known as Mugiti) has been used by Mbeere community of Kenya to treat cough, diarrhea, pleurisy and gonorrhea. These infectious diseases are caused by pathogenic micro-organisms such as, Klebsiella pneumoniae, Salmonella typhi, Escherichia coli, and Neisseria gonorrhea, among others. Infectious diseases are a cause of morbidity and mortality in humans and animals. Their effects are further aggravated by drug resistance, making it difficult to contain these infections. This calls for search of new drugs that will mitigate these problems. Indigenous plants are promising as a cheap alternative source of new therapeutic agents. Powdered sample of I. lupatana Baker F. roots were extracted using methanol solvent. The resultant extract was subjected to anti-microbial assay. The extract showed the highest activity against Bacillus subtilis (28.0 mm), Bacillus cereus (22.0 mm), Escherichia coli (21.7mm), Staphylococcus aureus (16.7 mm), Klebsiella pneumonia (15.3 mm) and Proteus mirabilis (12.3 mm), Pseudomonas aeruginosa (11.7 mm), Salmonella typhimurium (11.3 mm). The phytochemical studies of extract fractions showed presence of phenolics, flavonoids, tannins, saponins, terpenoids, cardiac glycosides, steroids and phlobatannins. These compounds are responsible for the bioactivity of the sample fractions. The activity was greater among the Gram positive bacteria than Gram negative bacteria. The MIC ranged from between 25 to 400mg/ml.

3.Effects of hearing loss on vocal fold vibrations: an electroglottographic analysis
Suman Kumar, Nilanjan Paul, Shriya Basu, Indranil Chatterjee
Pages 17 - 23
Pre-lingually hearing impaired persons have abnormal pattern of vocal fold vibration and electroglottography has been used to qualitatively describe these anomalies. However quantitative parameterization using the contact quotient and contact index lacks in literature and necessitates the present study. Three groups of moderately severe, severe and profound pre-lingual hearing impaired children were subjected to Electroglottographic analysis by vowel prolongation and the derived contact quotient and contact index data were compared with that of a control group. Results demonstrated statistically significant deviancies of contact quotient and contact index with increasing hearing loss. It was concluded that improper acoustic feedback in hearing impaired leads to a vibratory cycle with a longer than normal and more symmetrical closed phase leading to a breathy, creaky, falsetto voice with little adduction, which increases with increasing hearing loss. The study highlighted the importance of contact quotient and contact index in both evaluative and therapeutic domains.

4.Contribution of influenza viruses, human metapneumovirus and respiratory syncytial virus to acute respiratory infections in children in northern Greece, 2008 – 2010
E. Chatzopoulou, A. Melidou, G. Gioula, M. Exindari, D. Chatzidimitriou, F. Chatzopoulou, N. Malisiovas
Pages 24 - 29
Influenza viruses, respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are the most common pathogens that cause acute respiratory disease in children. The aim of this study is to present the contribution of the above three pathogens to influenza-like illness (ILI) in children (aged <6 years old) during 2-year (2008-2010) influenza seasons in N. Greece. 430 pharyngeal swabs from children younger than 6 years, presented as ILI infections during the last two influenza seasons (2008-2009 and 2009-2010) were examined for influenza A and B, RSV and hMPV, by one step Real-time RT-PCR. Influenza viruses were detected in 122 (28.3%) of the 430 spesimens, RSV in 45 (10.4%) samples and hMPV in 28 (6.5%). RSV and influenza viruses' co-infections were observed in eight cases, RSV and hMPV co-infections in four cases and hMPV with influenza viruses was found in one case. The majority of the patients (67.7%) were between 3 and 6 years old. Our results demonstrate that influenza viruses, RSV and hMPV contribute to ILI presenting infections at a rate of 45.2% in children younger than 6 years old.

5.Effect of fortification of breast milk on the growth of preterm neonates
Geeta Gathwala, Chandan Kumar Shaw, Prachi Shaw, Rajesh Batra
Pages 30 - 35
Human milk fortifiers (HMF) make up for the nutrient deficit required by preterm, low birth weight neonates. With the availability of a new HMF in India, it was pertinent to test this nutritional advantage in the Indian preterms fed with fortified human milk in terms the bioavailability of the important nutrients. METHODS: Sixty preterm neonates were randomly assigned in two groups of comparable gestational age and weight, the first fed with breast milk fortified with Lactodex fortifier and the second fed with EBM only. The changes in the mean levels of serum total protein and electrolytes (calcium, sodium, potassium (Na+, K+) and phosphorus), and blood urea in the two groups after two weeks were compared using the student’s t - test. RESULTS: After two weeks of fortification the mean total serum protein (study group 5.65±0.27 gm/L compared to 5.39±0.25 gm/L in the control group, p<0.001), serum calcium (study group at 9.24±0.32 mg/dl compared to 8.87±0.25 mg/dl in the control group p<0.001), phosphate (5.54±0.18 mg/dl in the study group versus 5.31±0.24 mg/dl in the control group, p<0.001) and Na+, K+ levels were significantly higher than the control group. The fortification was well tolerated. We concluded that using the new fortifier not only provides all the advantages of breast milk but also provides higher amounts of proteins and calcium necessary for sustaining growth and achieving intra-uterine accretion rates in the preterm neonates and is well tolerated.

6.Landau-kleffner syndrome-A rare experience
Ramnath Santosh Ramanathan, Tina Ahluwalia, Ankush Sharma
Pages 36 - 39
Landau Kleffner syndrome (LKS)/Acquired epileptic aphasia (AEA) typically develops in healthy children who acutely or progressively lose receptive and expressive language ability coincident with the appearance of paroxysmal EEG changes. In most cases described in detail, a clearly normal period of motor and language development occurs before LKS symptoms appear. The same was the case with our patient also. LKS should be differentiated from autism with minimal language regression, especially when it is associated with isolated EEG abnormalities. Currently LKS is considered as part of the syndrome of electrical status epilepticus of sleep (ESES) by many, which is also known as continuous spike and wave of slow-wave sleep (CSWS). We also have increasing evidence that the language disorder is directly caused by epileptic discharges in critical language areas which must be viewed as a special kind of epileptic aphasia. We present a case of 5-year-old child admitted with sudden loss of speech along with seizures in the form of staring look and classical EEG abnormalities of Landau Kleffner syndrome. We started our patients on high dose oral steroids following failure of intravenous immunoglobulin trial. There are small numbers of publications reviewing Landau-Kleffner syndrome in the literature hence making it one of those rarer entities.

7.Meningococcal disease: a case report and discussion of clinical presentation and management
PK Sethi, R Thukral, NK Sethi, J Torgovnick, E Arsura, A Wasterlain
Pages 40 - 45
Meningococcal disease caused by the gram negative diplococcus Neisseria meningitidis is a relatively common infectious disease in developing countries of Asia and Africa. Infection usually starts with a non-specific prodrome of fever, vomiting, malaise and lethargy followed by signs of septicemia and shock (tachycardia, tachypnea, cyanosis, oliguria, hypotension) and/or meningitis (stiff neck, headache, photophobia and impaired sensorium). Characteristic meningococcal rash may not appear early in the disease course, potentially delaying the diagnosis and institution of appropriate antibiotic therapy in the patient and isolation and chemoprophylaxis in close contacts. We present here a patient who presented with meningococcal shock associated with characteristic skin lesions of meningococcemia and discuss the clinical presentation and management. The importance of early identification of the characteristic skin lesions of meningococcemia and timely institution of appropriate antibiotic therapy is emphasized.

8.Strangulated right inguinal hernia containing torsion of the greater omentum
Parwez Sajad Khan, Humera Hayat
Pages 46 - 47
Torsion of the greater omentum is a rare condition in which the omentum twists on its long axis to such an extent that its viability is compromised. It is classified as primary or secondary. The secondary cases are usually the outcome of a trapped omental segment in postoperative scarring or wounds or a hernia sac. We report a case of strangulated right inguinal hernia containing torsion of the greater omentum as its contents. Exploration of right inguinal canal revealed indirect inguinal hernia with torsion of the greater omentum within the hernia sac. Though omental torsion is a rare cause of strangulated inguinal hernia but should be included in the differential diagnoses of acute painful inguino-scrotal swellings.

9.Brucellar spondylodiscitis in a case with spondylolisthesis
Ihsan Anık, Meliha Meric Koc, Yonca Anık, Kenan Koc, Safiye Sanem Dereli Bulut, Savas Ceylan
Pages 48 - 52
Spondylodiscitis with epidural abscess complication in Brucella infection is quite rare. Spondylolisthesis with spondylolysis at two levels is very unusual. Herein a case of spondylodiscitis with epidural and anterior paravertebral abscess due to Brucella with spondylolytic spondylolisthesis altogether in 54-years old female, is reported. Clinical, laboratory and radiological findings of brucellar spondylodiscitis with differential diagnosis are discussed. Brucellar spondylodiscitis diagnosis was based on clinical history supported by serology and blood culture and MRI. Spondylolisthesis was demonstrated by plain radiograph and MRI. This is a unique case of brucellar spondylodiscitis along with two level spondylolytic spondylolisthesis.

10.Can agricultural drugs be used against lice? accident, suicide or truth? case presentations
Ataman Kose, Cuma Yildirim, Beril Kose, Nurullah Gunay, Suat Zengin
Pages 53 - 58
Agriculture is an important source of living in our country. Therefore, poisoning with agricultural drugs is quite common. 4,6 dinitro-ocresol nitrophenol (C7H6N2O5) is a pesticide, which belongs to the nitrophenol group, is used on fruit trees in winter and is known as the “yellow” drug among the public. In our country, intoxication with nitrophenols has not been reported previously in the literature. However, they may be lethal even by dermal route. This rare type of intoxication should be recognized and kept in mind by physicians. A careful and detailed history should be taken in all cases of intoxication and the treatment should be based on the type of intoxication. The aim of the present study is to evaluate 5 cases of serious toxicity that occurred accidentally and/or because the drug was applied on hair for anti-louse purposes in our region, where agriculture and breeding animals are important sources of life.

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