Iatrogenic Intraspinal Epidermal Inclusion Cyst with Secondary Infection: A Cause for Acute Paraparesis.

INTRODUCTION: Lumbar puncture with unstyletted needle or any other spine trauma can cause implantation of skin fragments inside the dura and can cause acquired intraspinal epidermoid tumors. There is significant delay found between the episode of lumbar puncture and the presentation of the tumor. To the best of our knowledge, there is no reported case of intraspinal epidermoid tumor presenting as acute paraparesis secondary to infection of the tumor in the literature. CASE REPORT: A 19-month-old boy presented with acute paraparesis with acute bowel bladder involvement following an episode of fever cough and diarrhea. Investigations revealed that he had an intradural tumor with a secondary infection which caused the problem. Child was treated surgically with complete neural recovery. He has been under follow-up for possible recurrence. CONCLUSION: Use of unstyletted needle for lumbar puncture is a possible cause for intraspinal epidermoid tumors. To the best of our knowledge, there is no reported case of intraspinal epidermoid tumor with secondary infection presenting as acute paraparesis, in the literature.

Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children.

JUSTIFICATION: The need to revise Indian Academy of Pediatrics (IAP) growth charts for 5- to 18-year-old Indian children and adolescents was felt as India is in nutrition transition and previous IAP charts are based on data which are over two decades old. PROCESS: The Growth Chart Committee was formed by IAP in January 2014 to design revised growth charts. Consultative meeting was held in November 2014 in Mumbai. Studies performed on Indian children's growth, nutritional assessment and anthropometry from upper and middle socioeconomic classes in last decade were identified. Committee contacted 13 study groups; total number of children in the age group of 5 to 18 years were 87022 (54086 boys). Data from fourteen cities (Agartala, Ahmadabad, Chandigarh, Chennai, Delhi, Hyderabad, Kochi, Kolkata, Madurai, Mumbai, Mysore, Pune, Raipur and Surat) in India were collated. Data of children with weight for height Z scores >2 SD were removed from analyses. Data on 33148 children (18170 males, 14978 females) were used to construct growth charts using Cole's LMS method. OBJECTIVE: To construct revised IAP growth charts for 5-18 year old Indian children based on collated national data from published studies performed on apparently healthy children and adolescents in the last 10 years. RECOMMENDATIONS: The IAP growth chart committee recommends these revised growth charts for height, weight and body mass index (BMI) for assessment of growth of 5-18 year old Indian children to replace the previous IAP charts; rest of the recommendations for monitoring height and weight remain as per the IAP guidelines published in 2007. To define overweight and obesity in children from 5-18 years of age, adult equivalent of 23 and 27 cut-offs presented in BMI charts may be used. IAP recommends use of WHO standards for growth assessment of children below 5 years of age.

Prevalence of obesity and overweight in urban school children in Kerala, India.

The objective of this study was to examine the prevalence of obesity and overweight in urban school children in Kochi, Kerala, South India. Three schools from the city were selected representing upper, middle and lower socioeconomic groups and the children aged 6-15 years of age were interviewed. The prevalence of obesity was 3.0% for boys and 5.3% for girls. The prevalence of obesity (7.5%) and overweight (21.9%) were highest among high income group and lowest (1.5% and 2.5%) among low income group. Prevalence of obesity and overweight was found to be higher in the high income group and among girls.

Impact of pediatric epilepsy on Indian families: influence of psychopathology and seizure related variables.

The impact of epilepsy on families has been little studied in the developing countries, where it is the most common neurological disorder among children. In Vellore, India, the impact on 132 families who had a child with epilepsy was rated with the Impact of Pediatric Epilepsy on the Family Scale (IPES). An adverse impact was experienced by 42% of families. Multivariate statistical analysis revealed four factors that were significantly associated with high impact: fewer years since diagnosis (OR=0.81, 95% CI=0.71-0.93), fewer months since last seizure (OR=0.58, 95% CI=0.39-0.87), treatment with multiple antiepileptic drugs (OR=4.34, 95% CI=1.22-15.52), and increased behavior problem scores on the Child Behavior Checklist (OR=1.10, 95% CI=1.05-1.14). Factor analysis of the IPES was also conducted as a comparison with earlier findings in a developed country. We suggest that early monotherapy should be employed whenever possible and that early recognition and treatment of associated psychological problems may help to reduce the burden on families.

Behaviour problems in children and adolescents with seizure disorder: associations and risk factors.

PROBLEM: Fifty million people worldwide have epilepsy of whom 33 million are children. Children and adolescents with epilepsy are known to have high rates of behaviour problems and psychiatric co-morbidity. No studies on this topic have been conducted in developing countries, although 90% of such children live in the developing world. METHODS: The current study, set in Vellore in India, assessed the prevalence of psychopathology and its associations in children and adolescents with seizure disorder. One hundred and thirty two children were rated for psychopathology on the Child Behaviours Check List, and those who qualified as psychiatric cases were compared with those who did not. RESULTS: Seizure disorder was associated with significant psychopathology in 53.8% children. Belonging to a higher income group and living in an urban area (OR: 7.61, 95% CI: 2.78-20.8, p=0.0001), having longer than 3 years of illness (OR: 2.39, 95% CI: 2.18-5.67, p=0.03) and being treated by more than one anti-epileptic drug (OR: 3.08, 95% CI: 1.09-8.72, p=0.03) independently predicted psychopathology. CONCLUSIONS: Psychopathology reflected a complex interaction of seizures, socio-demographic factors and treatment related variables, in accord with studies in industrialised countries. Clinicians should be sensitive to identifying psychopathology since this may lead to effective interventions for this group of children.

Temperament of children and adolescents presenting with unexplained physcial symtoms.

The aims of the study were (1) To analyse the temperament of children and adolescents presenting with Somatoform disorder and Dissociative (conversion) disorder and (2) To evaluate the nosological status of conversion disorder from the angle of temperament. Temperament of 30 children and adolescents having the diagnosis of either Dissociative (Conversion) disorder or Somatoform disorder were compared with temperament of 30 matched normal control groupTemperament was assessed by using Temperament Measurement Schedule (Malhotra, 1982). We found that children with Somatoform disorder and Dissociative (conversion) disorder had characteristic temperaments of low activity, low emotionality, low rhythmicity and low distractibility. Children with Somatoform disorder were less approachable than children with Conversion disorder, otherwise temperamentally there were no differences between these two disorders.