Outcomes of Category II anti-tuberculosis treatment in Indian children.

SETTING: The emerging threat of multidrug-resistant tuberculosis (MDR-TB) has cast doubt on the efficacy of Category II anti-tuberculosis treatment in retreatment cases. Data on outcomes of treatment with the Category II regimen in children are scarce. OBJECTIVE: To study outcomes of Category II anti-tuberculosis treatment in Indian children. DESIGN: Charts belonging to patients registered between 2004 and 2012 at the Paediatric Tuberculosis Clinic, All India Institute of Medical Sciences, New Delhi, India, were reviewed, and children receiving Category II anti-tuberculosis treatment were included in the study. Outcomes were recorded as treatment success and poor outcome, which included treatment failure and default. RESULTS: A total of 125 children (mean age 101.6 months, standard deviation 42.9; girls 58 [46.4%]) were initiated on Category II anti-tuberculosis treatment, mainly due to worsening clinical conditions (36.8%) and relapse (36%). Treatment success, treatment failure and default were recorded in respectively 80 (64%), 20 (16%) and 25 (20%) children. Children who were non-adherent to previous treatment tended to default from Category II treatment as well (11.8% in previous non-defaulters vs. 37.5% in previous defaulters, P = 0.004). CONCLUSION: Category II anti-tuberculosis treatment was effective in approximately 60% of children who had failed or defaulted from the previous regimen. All efforts should be made to isolate Mycobacterium tuberculosis and perform drug susceptibility testing to identify MDR-TB in children.

Vitamin D toxicity presenting as hypercalcemia and complete heart block: An interesting case report.

Vitamin D deficiency is widely prevalent across the globe. This has lead to widespread use of vitamin D supplements in populations. We present our experience of vitamin D toxicity in a subject resulting in hypercalcemia and CHB (Complete Heart Block). A 70-year-old female, known hypertensive for thirty five years and diabetic for seven years underwent total knee replacement (TKR) for osteoarthritis left knee in December 2010. For perioperative glycemic control, multiple subcutaneous injections of insulin were advised. Patient later presented with poor glycemic control, decreased appetite and constipation for last 1 month with history of episodes of transient loss of consciousness for 15 days and recurrent vomiting. Biochemical work-up showed hypercalcemia (Serum calcium 12.4 mg/dL). Sr. albumin, ALP, Sr. phosphorus and PTH levels were normal, thus suggesting PTH independent hypercalcemia. Strong suspicion led us to check vitamin D levels in dilution which were 2016 ng/mL, thus confirming vitamin D toxicity. Retrospective analysis of treatment history revealed patient receiving 4 injections of Architol (6 Lac units im) prior to presentation. Work-up for malignancy was negative, brain imaging and EEG were normal. Holter was suggestive of intermittent CHB. Patient was given hydration, injection calcitonin 100 I.U. subcutaneously, injection pamidronate 60 mg infusion, with serum calcium levels normalizing, with relief in constipation, vomiting and behavioral improvement. However, persistence of rhythm disturbances led to permanent pacemaker placement. The present case highlights the dangers of indiscriminate vitamin D usage, exposing patients to potentially life threatening complications.

Consequences of neck manipulation performed by a non-professional.

Case report. Documentation of complication of neck manipulation by an untrained person. Tertiary care referral teaching hospital at Lucknow, India. Clinical evaluation, plain radiography of cervical spine, spinal MRI.A 30-year-old man who fainted after neck manipulation by a barber and developed spinal cord and brainstem dysfunction. His MRI revealed an extramedullary, intradural dumbbell shaped mass on the right side at C1 and C2 level compressing the spinal cord. Public awareness should be increased about the danger of neck manipulation by an untrained person especially in the communities where it is commonly practiced.