Efficacy and safety of fixed dose combination of arterolane maleate and piperaquine phosphate in comparison with chloroquine phosphate in children with acute uncomplicated Plasmodium vivax malaria: A phase III, randomised, multicentric study.

BACKGROUND & OBJECTIVES: In India, the burden of Plasmodium vivax malaria has been projected to be highest in some areas. This study investigated the efficacy and safety of fixed dose combination (FDC) of arterolane maleate (AM) 37.5 mg and piperaquine phosphate 187.5 mg (PQP) dispersible tablets and (not with) chloroquine in the treatment of uncomplicated vivax malaria in pediatric patients. METHODS: This multicentric, open-label trial was carried out at 12 sites in India. A total of 164 patients aged 6 months to 12 years with P. vivax malaria were randomized in a ratio of 2:1 to AM-PQP (111 patients) or chloroquine (53 patients) arms. The duration of follow up was 42 days. RESULTS: At 72 hours, the proportion of a parasitaemic and afebrile patients was 100% in both treatment arms in per protocol (PP) population, and 98.2% and 100% [95% CI: -1.8 (-6.33 to 5.08)] in AM-PQP and chloroquine arms, respectively, in intent to treat (ITT) population. The efficacy and safety of AM-PQP was found to be comparable to chloroquine in the treatment of uncomplicated P. vivax malaria in pediatric patients. Overall, the cure rate at Day 28 and 42 was >95% for both AM-PQP or CQ. The commonly reported clinical adverse event was vomiting. No patient was discontinued for any QTc abnormality. INTERPRETATION & CONCLUSION: The efficacy and safety of FDC of arterolane maleate and piperaquine phosphate was found to be comparable to chloroquine for treatment of uncomplicated P. vivax malaria in pediatric patients.

A cross-sectional study on clinical characteristics and severity of children with COVID-19 admitted to a teaching institute in North India.

Background: SARS-CoV-2 infection presentation in children is usually milder than in adults but can be severe and fatal as well. Data on the pediatric population regarding severity and clinical presentation are still limited, and there is a need to have a better understanding of clinical features, severity, and laboratory parameters. Aims and Objective: To document clinical and laboratory characteristics and outcomes of children with SARS-CoV-2 in a low-middle-income country and to evaluate clinicodemographic factors and biochemical markers associated with severity and mortality. Materials and Methods: A hospital-based cross-sectional study was conducted among 112 COVID-19-positive children at a designated Level-3 center in North India. Clinical characteristics, laboratory parameters, and severity of COVID-19 cases as well as factors associated with the severity of the disease, were analyzed by descriptive statistics and a Chi-square test. Results: The adolescent age group (age 12-18 years) was affected most (64.3%). Male patients accounted for 56.3% of total cases. Fever was the most common symptom (41.1%) followed by cough. Presenting complaints were highest from the respiratory system (32.1%) followed by the gastrointestinal (8.9%) and the neurological system (7.1%). Majority of patients had mild disease (87%) while 13% had the moderate-severe disease. Spo2 < 95% (P = 0.00001), neutrophilia (P < 0.000001), lymphopenia (P < 0.000001), elevated values of C-reactive protein (P < 0.00001), Interleukin-6 (P = 0.002), D- dimer (P = 0.00014) and respiratory symptoms as presenting complaints (P < 0.000001) were found to be significantly associated with severity of disease. Conclusion: The male and adolescent age group was affected most. Presenting complaints were highest from the respiratory system. Unusual presentation may have gastrointestinal or neurological presentation. Most children with COVID-19 had mild disease. Moderate to severe disease was not uncommon. Factors including neutrophilia, lymphopenia, elevated lab values of C-reactive protein, D-dimer, and interleukin-6 had a significant association with the severity of the disease. These biomarkers can help predict the severity of the disease.

Longitudinally extensive transverse myelitis following dengue virus infection: A rare entity.

Association of dengue fever with longitudinally extensive transverse myelitis in pediatric age group is a rare entity. We describe a case of 15 year old adolescent male who presented with dengue fever and in whom symptoms of transverse myelitis developed 4 weeks after fever (post-infectious stage). Magnetic resonance imaging confirmed the diagnosis of longitudinally extensive transverse myelitis involving dorso-lumbar cord. Patient recovered almost completely with minimal residual neurological deficit after a six weeks course of corticosteroids and supportive management including physiotherapy.

L'association de la dengue avec une myélite transversale longitudinale étendue dans un groupe d'âge pédiatrique est une entité rare. Nous décrivons un cas d'un adolescent de 15 ans qui présentaient une dengue et chez lesquels des symptômes de myélite transversale se sont développés 4 semaines après la fièvre (stade post-infectieux). L'imagerie par résonance magnétique a confirmé le diagnostic de myélite transversale longitudinale étendue impliquant le cordon dorso-lombaire. Le patient s'est rétabli presque complètement avec un déficit neurologique résiduel minimal après un traitement de corticostéroïdes de six semaines et une prise en charge, y compris la physiothérapie. Mots-clés: La fièvre de la dengue, la myélite transversale longitudinalement étendue, le virus neurotroptique.

Right sided facial nevus with contralateral cavernous angioma in a child with Sturge Weber syndrome

Sturge Weber syndrome is a rare sporadic neurocutaneous syndrome. It has extra -oral manifestations mostly in form of unilateral port wine stain on face that are ipsilateral to intra-cranial lesions (mostly lepto-meningeal angioma), seizures, glaucoma and intra-orally by hemangioma of ipsilateral gingiva. We case report a child with Sturge Weber syndrome with facial nevus opposite to intra-cranial lesion, intra-oral port wine stain and gum hypertrophy. Other than contralateral intracranial lesion and facial nevus, challenge was whether to see gingival manifestations as part of syndrome or as drug side effect, as child was also on phenytoin, an anti-epileptic drug widely related to this condition.

Levosalbutamol vs racemic salbutamol in the treatment of acute exacerbation of asthma.

OBJECTIVE: To compare efficacy and tolerability of levosalbutamol (Group 1) and racemic salbutamol (Group 2) for the treatment of acute exacerbation of asthma in children age 5 to 18 yr. METHODS: A randomized double blind clinical study involving 60 children was undertaken between October' 06 to December' 07. RESULTS: The following baseline clinical characteristic were recorded initially and after giving 3 nebulizations at 20 min intervals in the Ist hour of presentation viz respiratory rate (RR), heart rate (HR), oxygen saturation in room air SPO2, PEFR (peak expiratory flow rate), serum K+ level and asthma score. In Group 1 patients (levosalbutamol), there was significant increment in SPO2 and PEFR (P<0.05) values with decrease in tachypnea and asthma score while no significant difference was found in pre and post treatment HR & Serum K+ levels. In Group 2 patients although there was clinical improvement in terms of SPO2, PEFR, RR and asthma score, it resulted in significant tachycardia and decrease in K+ levels. CONCLUSION: Levosalbutamol appears to be more efficacious than racemic salbutamol in terms of improvement in PEFR, SPO2 and asthma score while deleterious effects of tachycardia and fall in serum K+ were seen with racemic salbutamol.