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   Table of Contents - Current issue
Coverpage
November-December 2022
Volume 9 | Issue 6
Page Nos. 191-226

Online since Tuesday, November 22, 2022

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EDITORIALS  

Refractory status epilepticus in children: What Indian scenario needs now and future? Highly accessed article p. 191
Ramachandran Rameshkumar
DOI:10.4103/jpcc.jpcc_73_22  
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Vasoactive inotrope support score - Precarious yet pertinent! p. 193
Abinaya Kannan, Atul Jindal
DOI:10.4103/jpcc.jpcc_82_22  
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Protocolized care in sepsis: Does it improve outcomes? p. 195
Govind Benakatti, Javed Ismail
DOI:10.4103/jpcc.jpcc_83_22  
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ORIGINAL ARTICLES Top

Clinical, etiological profile and outcomes of convulsive refractory and non-refractory status epilepticus at a tertiary care centre: A prospective observational study p. 197
Nishant Gopaal, Dhan Raj Bagri, Jagdish Narayan Sharma
DOI:10.4103/jpcc.jpcc_42_22  
Introduction: Epidemiological data on childhood status epilepticus (SE) limited in India. This study depicts clinical profiles, etiology, and outcomes of convulsive refractory SE (RSE) and compares the results with cases of nonrefractory SE (NRSE). Subjects and Methods: This observational, cross-sectional study enrolled 300 children aged 1 month to 18 years, presenting with convulsive SE at a tertiary care hospital. Details of children who progressed to RSE were compared to those without RSE. Results: In the acute symptomatic etiology group, common causes for RSE were central nervous system infections (33.8%), cryptogenic etiology (13.8%), and remote symptomatic etiology (7%). RSE iwas associated with a higher rate of complications (58% Vs 24%) as compared to NRSE. Thirty percent of cases that progressed to RSE needed ventilator support as compared to only 8% of cases in the NRSE group. RSE was also associated with higher rates of shock (25%), AKI (16%), transaminitis (25%), acute liver failure (5.69%), multiple organ dysfunction score (12.6%), and acidosis (53%) as compared to NRSE. RSE was associated with higher mortality (28%) and morbidity (32%) as compared to NRSE cases. Cryptogenic etiology led to the highest mortality (33.3%) in cases of RSE while acute symptomology was associated with the highest morbidity (62%). Conclusions: RSE is a serious pediatric emergency that requires prompt recognition and management. Clinical knowledge and early administration of appropriate antiepileptic drugs at health-care facilities is the key to reduce morbidity and mortality.
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Correlation of the vasoactive-inotropic score with the length of intensive care unit stay and COVID IgG titers, in multisystem inflammatory syndrome in children: A prospective observational study p. 204
Mahantesh Matti, Mahesh B Maralihalli, Meghana Mummadi, Shilpa Reddy
DOI:10.4103/jpcc.jpcc_39_22  
Background: Children with multisystem inflammatory syndrome in children (MIS-C) often develop shock and require vasoactive agents. The vasoactive-inotropic score (VIS) is a potential scoring system to assess the amount of vasoactive agent support required. The study was conducted to correlate VIS at 6 and 12 h with the length of intensive care unit (ICU) stay and with COVID immunoglobulin G (IgG) antibody titers in cases of MIS-C with shock. Subjects and Methods: Demographic and clinical details were collected from patients with the diagnosis of MIS-C with shock requiring vasoactive agents. VIS was calculated at 6 and 12 h following initiation of the first inotropic/vasoactive agent. Results: Twenty-nine children admitted with the diagnosis of MIS-C who presented with shock or developed shock during hospital stay were the study population. On performing Spearman's correlation, a positive correlation was observed between COVID IgG titers and VIS at 6 h. There was no significant association between VIS and length of ICU stay. Conclusions: VIS had limited significance in predicting the length of ICU stay and the need for vasoactive agents required.
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The impact of adherence to the American College of Critical Care Medicine 2017 guidelines in the management of septic shock in pediatric intensive care units: A prospective observational study p. 208
Gunjan Kochar, Praveen Kumar Tripathi, Preeti Lata Rai, Prem Lochan Prasad
DOI:10.4103/jpcc.jpcc_48_22  
Background: Despite tremendous advances and new guidelines for the management of pediatric septic shock, the mortality and morbidity associated with it remain unacceptably high. This study was conducted to evaluate the impact of adherence to the American College of Critical Care Medicine (ACCM) guidelines in the management of septic shock in pediatric intensive care units (PICU). Subjects and Methods: This was a hospital-based prospective observational study conducted in the 15-bedded PICU of a tertiary care hospital in Utter Pradesh, India. Children from 1 month to 18 years of age admitted to the PICU with septic shock were included in the study as per definitions given by ACCM guidelines. The children who were managed strictly adhering to ACCM guidelines were labeled as the adherent group and those who were managed with any deviation from these guidelines were considered as the nonadherent group. The two groups were compared with respect to outcome. Results: In this study, the prevalence of septic shock was 54.4% in PICU. Out of 124 cases of septic shock, 93 were from the adherent group and 31 were from the nonadherent group. Recovery was significantly higher (p-0.012) in children among the adherent group (56 [60.21%] vs. 11 [35.48%]) than in the nonadherent group. The hemodynamic stability achieved within 48 h among the adherent group was higher in comparison to the nonadherent group (39 [56%] vs. 6 [8.5%]) making this a significant (P = 0.007) observation. Conclusions: Strict adherence to the ACCM guidelines was associated with favorable outcomes in the management of septic shock in children.
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CASE SERIES Top

Hypertensive crisis in children with chronic kidney disease after instituting antitubercular therapy: A case series p. 213
Alok Kumar, Dorchhom Khrime, Utkarsh Sharma
DOI:10.4103/jpcc.jpcc_64_22  
Tuberculosis is common in chronic kidney disease (CKD). There are reports of adults with CKD experiencing hypertensive crises and an increase in dosages and number of antihypertensive drugs after starting antitubercular therapy (ATT). Studies have demonstrated that rifampicin could increase the metabolism of beta-blockers, calcium channel blockers, and prazosin. There are no studies or reports of worsening blood pressure (BP) control in children with CKD after starting ATT. Here, we report three cases of children who developed hypertensive crises after starting ATT. All patients presented in emergency with the acute severe rise of BP with breathlessness and or visual blurring. All of them showed retinal changes suggestive of malignant hypertension. They needed parenteral therapy to control BP. They also needed the escalation of antihypertensives and the addition of other drugs. One patient needed a withdrawal of rifampicin. It is suggested that children with CKD should be monitored for BP control after instituting ATT.
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CASE REPORTS Top

Acute kidney injury following multiple wasp stings: A case report p. 216
Bijay Kumar Meher, Siddhartha Shankar Pati, Isha Panda, Sarthak Naik
DOI:10.4103/jpcc.jpcc_62_22  
Wasp and bees are venomous arthropods belonging to the order Hymenoptera, group Vespoidea. Most wasp sting victims do not seek medical attention due to the minor self-limiting and localizing nature of symptoms. Fatal anaphylaxis is rare. However, it is a common indication for emergency room visit. Acute kidney injury is the most serious complication with a mortality rate of 20%. Herein, we report the case of a 3-year 4-month-old female child, who presented with acute renal failure, after being stung by a swarm of wasps. She was managed successfully in the intensive care unit with renal replacement therapy.
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An unusual presentation of Cor-triatriatum as respiratory distress in adolescent male: A case report p. 219
Swati Pandey, Ravi Sharma, Ajay Sharma, Praveen Sharma, Rajiv Kumar Bansal
DOI:10.4103/jpcc.jpcc_59_22  
Cor triatriatum is a rare congenital heart disease (0.1% of all congenital cardiac defects). Most patients are identified shortly after birth with the evaluation of a distressed or cyanotic neonate. However, when the presentation is delayed, primary symptoms may mimic reactive airway disease. We present an 11-year-old adolescent male who presented with obstructive sleep apnea-like features initially, on further evaluation showed features of severe pneumonia. There was clinical and radiological dissociation with the findings.
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Unusual presentation of organophosphate poisoning: A case Report p. 223
Ravi Sharma, Swati Pandey, Pooja Agarwala, Rajiv Kumar Bansal
DOI:10.4103/jpcc.jpcc_58_22  
Misuse of organophosphate insecticides, even in case of domestic application, can be life threatening. We report a case of accidental consumption of organophosphorus substance by a 3-year-old female child presented to us with unconsciousness and nicotinic manifestation of organophosphate poisoning unlike classical toxidrome of muscarinic manifestation.
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BOOK REVIEW Top

Respiratory care: Cardiopulmonary anatomy and physiology p. 226
Kundan Mittal
DOI:10.4103/jpcc.jpcc_84_22  
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