ABSTRACT
OBJECTIVE: To assess clinical profile and short term treatment outcomes of pediatric status epilepticus (SE) at a tertiary-care center in northern India. METHODS: Prospective cohort study enrolled children aged 1 month to 18 years presenting with SE to the emergency department. Enrolled children (109) were treated as per hospital protocols. Clinical features during hospitalization were noted. Pediatric overall performance category (POPC) scale was used for classification of outcome at the time of discharge. RESULTS: Acute symptomatic etiology was identified in 66 (60.6%) cases (CNS infections were predominant). Previous diagnosis of epilepsy was found in 32 (29.4%) children; and benzodiazepine responsive SE were seen in 65 (59.6%) children. Predictors of unfavorable outcome were acute symptomatic etiology (adjusted OR 4.50; 95% CI 1.49, 13.62) and no treatment administered prior to hospital (adjusted OR 3.97; 95% CI 1.06, 14.81). CONCLUSIONS: Acute symptomatic etiology, mainly acute CNS infections, is the leading cause of SE in this region. Early and pre-hospital management with benzodiazepines may improve SE outcome.
Subject(s)
Status Epilepticus/diagnosis , Status Epilepticus/therapy , Acute Disease , Adolescent , Anticonvulsants/therapeutic use , Child , Child, Preschool , Combined Modality Therapy , Female , Hospitalization , Humans , India , Infant , Logistic Models , Male , Prospective Studies , Status Epilepticus/etiology , Status Epilepticus/mortality , Tertiary Care Centers , Treatment OutcomeABSTRACT
The emergence of visceral leishmaniasis (VL) in nonendemic areas is a matter of great concern. We conducted a study and present a brief description of six nonmigrant children with VL from the nonendemic area of Uttarakhand, diagnosed in our tertiary teaching hospital from February 2012 to June 2013. We also present here a geographic distribution of these cases to assess the impact of global warming and climate change on the spread of the disease. Patients were diagnosed as VL by clinical findings and confirmed by demonstration of Leishmania donovani bodies in the bone marrow or a positive serum rK39 test. Four cases were treated successfully with amphotericin B. One patient died during treatment and one patient was discharged on persistent request. Clinicians should suspect and investigate for VL in patients with pyrexia of unknown origin, even in nonmigrant patients from nonendemic regions, for an early diagnosis.