The mainstay of treatment in severe asthma is β2 agonist therapy. During its treatment, toxicity may occur especially with the use of oral albuterol or its prolonged nebulization. The clinical manifestations of albuterol toxicity include tachycardia, hypokalemia, tremors, and hyperglycemia. Toxicity occurring due to the use of metered-dose inhaler is less common. Moreover, levalbuterol is believed to have a better safety profile than albuterol, making it a very unusual culprit for toxicity. We report an 8-year-old asthmatic boy who developed severe tachycardia, and agitation and exhibited signs of levalbuterol toxicity. He had been inadvertently administered 50 puffs of levalbuterol via metered drug inhaler at home for an acute exacerbation of asthma. With supportive management, his condition stabilized in 36 hours. This case illustrates that a large dose of levalbuterol administered with a metered-dose inhaler can lead to toxicity, which resolves with discontinuation of β2 agonist therapy and supportive treatment.
Introduction: Febrile seizures are the most common type of seizure in children occurring in 2-5 % of them with a peak incidence in 16-18 months. Various factors have been described in the pathophysiology of febrile seizures like susceptibility of the immature brain to temperature, an association between interleukins, circulating toxins, and trace elements deficiency. Aim: To study the association between serum levels of trace elements (Iron, zinc, copper, calcium and magnesium) in children with febrile seizures. Study Design: An observational cross-sectional study. Place and Duration of Study: Department of Pediatrics of PGIMER, Dr RML Hospital, New Delhi between November 2016 and March 2018. Methodology: This study was conducted at a tertiary care centre and enrolled 75 children of which 55 were febrile seizures and 20 patients were controls. The serum specimen was collected with all aseptic techniques, and all due precautions were taken for the blood sample to protect them from sunlight exposure, haemolysis and contamination. Then samples were centrifuged at 3,000 rpm for 5 minutes and were stored at -20 c until the final assay. Serum Iron, Zinc, Copper and Magnesium levels were measured using a fully automated chemistry analyser (AU400). Data was entered in MS Excel spreadsheets and analysed using the statistical package for social science (SPSS) version 21.0. Results: Children with febrile seizures (cases) were found to have significant iron deficiency (higher TIBC, higher UIBC and lower Ferritin) than the controls (P<0.001). There was no significant difference in the serum levels of copper, zinc, magnesium, and ionized calcium in the two groups. There was no difference in serum levels of trace elements in cases with simple or complex febrile seizure. Conclusion: Children with febrile seizures showed significant iron deficiency (higher TIBC, higher UIBC and lower Ferritin) in cases than those with controls. But, there was no significant association between other serum trace elements (zinc, copper, calcium, magnesium) and febrile seizure. However, further large multi-centric trials are required to suggest any association between them.
Introduction: Tubercular tenosynovitis of the wrist and hand, although rare, presents a diagnostic dilemma primarily due to its non-specific clinical presentation, insidious course, and the large number of differentials that mimic it. When the diagnosis is late or delayed, significant bone and tendon complications occur. Large progressive swelling around the wrist in TB endemic countries should raise an early suspicion of being of tubercular etiology and should be high on the list of differential diagnoses. Case Report: A 48-year-old female presented with a large progressive swelling on the volar aspect of the left wrist and palm for 7 months, associated with increasing pain, stiffness, limited wrist range of movements, and weakened grip strength. Magnetic resonance imaging (MRI) revealed synovitis and fluid within flexor tendon synovial sheaths. The patient underwent an excision of the mass in toto and the cut section revealed an irregularly thickened wall with rice bodies within. Histopathological examination was indicative of a large ganglion cyst. GeneXpert MTB/RIF assay detected Mycobacterium tuberculosis. Despite histopathology being inconclusive, a diagnosis of TTS was considered due to the patient’s clinical presentation, MRI, and operative findings. The patient was started on an antitubercular drug regimen for a 1-year duration. The patient regained a complete range of movements of fingers and wrist and normal grip strength at the 3rd month follow-up. Conclusion: TTS is a challenging diagnosis entity. The diagnostic confirmation was achieved either by histopathology or detection of the organism either by culture or GeneXpert MTB/RIF assay. When the diagnosis is unsupported, drug therapy can be initiated empirically on strong suspicion of tuberculosis, especially in TB endemic areas.
Background: As there is a risk for infant anaemia, early cord clamping which is usually performed at 10-15 seconds of delivery was changed to delayed cord clamping for at least for 30 seconds Delayed cord clamping (DCC) increases the blood volume and haemoglobin levels in newborns and reduces risk of iron deficiency anaemia in both term and preterm infants.Early clamping allows cord blood collection in benefit for transplantation of stem cells. Research Objective: To compare levels of haemoglobin, hematocrit and serum ferritin at birth and 4 weeks of age in babies as well as neonatal outcome following early and delayed cord clamping in births associated with anaemia in pregnancy. Study Design: An observational study. Participants: Anaemic pregnant women with period of gestation 32-40 weeks admitted in labour room for delivery were enrolled. Intervention: Grouping of the patients was done according to the timing of the umbilical cord clamping. 1. Early cord clamping (< 60 seconds) 2. Delayed cord clamping (1 – 3 minutes) Of which 58 subjects were in ECC (early cord clamping)and 62 were in DCC (delayed cord clamping)group Results: There was no significance of ECC or DCC in developing polycythemia, IVH or hyperbilirubinemia or increased need of blood transfusion. The levels of haemoglobin, hematocrit and ferritin levels were showing significant increased among DCC as compared to ECC Conclusion: Delayed cord clamping significantly increases the levels of haemoglobin, Serum ferritin and hematocrit at 4 weeks of age. It should be recommended in routine practice where it is not contraindicated especially in resource- poor settings.
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