Background:Abdominal epilepsy (AE) is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG) abnormalities and favorable response to the introduction of anti-epileptic drugs (AED). We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74%) children with an abnormal EEG and 39 (26%) children with normal EEG. All children were subjected to AED (Oxcarbazepine) and 139 (92%) children responded to AED out of which 111 (74%) children had an abnormal EEG and 27 (18%) had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis.Context:Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED.Aims:To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control.Settings and Design:Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study.Materials and Methods:A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted.Results:111 (74%) of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56%) were females and 36 (32.43%) were male, majority of children were in the age of group of 9-12 years. Temporal wave discharges were 39 (35.13%) of the total abnormal EEG's. All the children were started on AEDs and those with abnormal EEG showed 100% response to treatment while 27 (18%) children with normal EEG also responded to treatment. Twelve (8%) children did not have any improvement in symptoms.Conclusions:A diagnosis of AE must be considered in children with chronic recurrent abdominal pain, especially in those with suggestive history, and an EEG can save a child from lot of unnecessary investigations and suffering.
Sirenomelia also known as the mermaid syndrome, is a rare congenital malformation of uncertain etiology. It is characterized by fusion of the lower limbs and commonly associated with severe urogenital and gastrointestinal malformations. There are approximately 300 cases reported in the literature, 15% of which are associated with twinning, most often monozygotic. The syndrome of caudal regression is thought to be the result of injury to the caudal mesoderm early in gestation.
Scorpion sting is common in villages, and is an important public health problem in India. The clinical symptoms of envenomation by scorpion sting are by sympathetic and parasympathetic stimulation, causing a variety of symptoms. The leading causes of death are cardiac dysfunction and pulmonary edema. We present herein a case of scorpion sting in a 9-year-old boy who developed pulmonary edema and gradually developed cytotoxic cerebral edema with infarct leading to motor aphasia with upper motor neuron facial palsy.
Background: Snake bite is a common acute medical emergency, which can present with atypical symptoms in the pediatric age group. Objective: The objective of the present study is to determine the outcome of patients presenting in the early morning with acute onset of atypical symptoms, no history of snake bite or bite marks be considered as a snake bite and treat with anti-snake venom (ASV) and mechanical ventilation. Materials and Methods: The prospective interventional study conducted over a 6 year period between January 2006 and December 2012 at a Rural Health Center in Maharashtra. Results: Out of 41 patients, 28 (68%) were males and 13 (32%) were females with a mean age of 8.59 ± 3.23 and 8.46 ± 2.96 years, respectively. Patients presented between 12 midnight to 7 a.m. with the maximum presentation between 2 a.m. and 4 a.m. (54%). Patients presented with vague complaints such as abdominal pain (60.97%), unconsciousness (17.07%), vomiting (12.19%) and abnormal sensation over body (7.31%) and convulsion (2.43%). All patients were treated with 15 units of ASV and needed mechanical ventilation within 6 h of admission. Duration of ventilation ranged from 36 h to 168 h with and an average of 115 ± 34.753 h. Hospital stay varied from 5 days to 17 days with a mean of 10.892 ± 3.361 days. All patients responded to treatment and there was 1 (2.43%) death owing to the aspiration pneumonitis. Conclusion: Diagnosis of possible snake bite should strongly be considered when patient presents in the early morning with acute onset of atypical symptoms and without any underlying illness, especially krait bite. The study concludes that timely interventions with a bolus dose of ASV and ventilation can de initely save many lives.
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