Behavioral Problems and Intelligence Quotient Changes in Pediatric Epilepsy: A Case-Control Study

Background

Epilepsy is the most common chronic neurological disease and has neurological impairment as an important comorbidity.

Objective

To find behavioral problems and intelligence quotient (IQ) changes associated with epilepsy and to know the association of variables such as frequency, type of seizures, and duration of disease with cognitive impairment.

Materials and Methods

A descriptive cross sectional study, consisting of 50 cases (patients of epilepsy) and 50 controls (other patients of same socioeconomic status) was conducted at S.P. Medical College, Bikaner. The patients were subjected to detailed clinical history, thorough examination, Pediatric Symptom Checklist, and Bhatia's Battery of Performance intelligence Test. Data analysis was carried out with the help of SPSS 22 software.

Results

The prevalence of behavioral problems in generalized and partial seizure group was high (42% and 53.8%) as compared to control group (9%). Low IQ was present more in the patients (44%) of generalized and partial seizure group as compared with the control group, and results were statistically significant. Furthermore, behavioral problems were more in patients who were having more number of seizures (≥3 per year) with significant P values (χ² = 5.067, P = 0.024).

Conclusion

We conclusively found that behavioral problems and cognitive factors, apart from control of seizures, must be kept in mind to determine how well a child with epilepsy progresses toward independence.

Mechanisms of hypoxemia

Oxygen is an essential element for life and without oxygen humans can survive for few minutes only. There should be a balance between oxygen demand and delivery in order to maintain homeostasis within the body. The two main organ systems responsible for oxygen delivery in the body and maintaining homeostasis are respiratory and cardiovascular system. Abnormal function of any of these two would lead to the development of hypoxemia and its detrimental consequences. There are various mechanisms of hypoxemia but ventilation/perfusion mismatch is the most common underlying mechanism of hypoxemia. The present review will focus on definition, various causes, mechanisms, and approach of hypoxemia in human.

Perianal Paget's disease: a diagnostic dilemma

Perianal Paget's disease (PPD) is part of the spectrum of pagetoid skin lesions occurring outside the region of the nipple/areolar complex that are collectively referred to as extramammary Paget's disease (EMPD). However, unlike Paget's disease of the breast, which in the vast majority of cases is invariably associated with an underlying ductal carcinoma, most cases of EMPD occur as either insitu or invasive adenocarcinomas with visceral malignancy being a rare entity. We present a case of a 50-year-old man who was referred to us with PPD. This case highlights the difficulties associated with making a clinical diagnosis of this condition. Furthermore, investigative workup to exclude possible malignancy with associated metastatic spread as well as the treatment options available are also discussed. In addition, this case highlights the need for a multidisciplinary team approach when dealing with this difficult problem.

Structured assessment of microsurgery skills in the clinical setting

Microsurgery is an essential component in plastic surgery training. Competence has become an important issue in current surgical practice and training. The complexity of microsurgery requires detailed assessment and feedback on skills components. This article proposes a method of Structured Assessment of Microsurgery Skills (SAMS) in a clinical setting. Three types of assessment (i.e., modified Global Rating Score, errors list and summative rating) were incorporated to develop the SAMS method. Clinical anastomoses were recorded on videos using a digital microscope system and were rated by three consultants independently and in a blinded fashion. Fifteen clinical cases of microvascular anastomoses performed by trainees and a consultant microsurgeon were assessed using SAMS. The consultant had consistently the highest scores. Construct validity was also demonstrated by improvement of SAMS scores of microsurgery trainees. The overall inter-rater reliability was strong (alpha=0.78). The SAMS method provides both formative and summative assessment of microsurgery skills. It is demonstrated to be a valid, reliable and feasible assessment tool of operating room performance to provide systematic and comprehensive feedback as part of the learning cycle.

A case of toxic shock syndrome following a DIEP breast reconstruction

Mastectomy with immediate breast reconstruction has become the standard treatment for Carcinoma breast in UK and many parts of the world. Autologus reconstruction with muscle sparing TRAM/ DIEP is the 'Gold Standard' for assessing the newer options for breast reconstruction. Toxic Shock Syndrome (TSS) is a rare but fatal condition particularly seen in the female population. Few cases of TSS have been reported in the Plastic Surgery literature following Silicone implant based reconstruction. We report a case of TSS following Deep Inferior Epigastric Perforator flap (DIEP)reconstruction. Due to the aggressive nature of TSS, the European Society of Intensive Care Medicine (ESICM) has initiated the 'Surviving Sepsis' campaign to propagate, information and management guidelines for the general public and health professionals. We present a case report with the pathophysiology of TSS.

Immediate vulvar and vaginal reconstruction using the gluteal-fold flap: long-term results

The gluteal-fold flap was used to reconstruct vulvar and posterior vaginal wall defects in 40 patients. This is a fasciocutaneous, islanded flap based on the internal pudendal artery and vein perforators. The flap is robust and has the advantage of being away from the pathway of carcinoma spread. In addition it has minimal donor-site morbidity as the scar is hidden in a natural crease.

Non-melanoma skin cancer in renal transplant recipients: the extent of the problem and a strategy for management

Over the past 2 years, we have examined all patients with a functioning renal allograft attending a regional nephrology unit. A total of 291 patients were examined. 172 (59%) were found to have cutaneous warts, and 64 (21.9%) had non-melanoma skin cancer (NMSC). The proportion of patients with both warts and NMSC increased with time from transplantation: 40% of patients who had been transplanted for more than 9 years had NMSC. Fifteen patients had extensive dysplastic change in all sun-exposed areas, particularly the dorsal aspect of the hands. This subgroup of patients develop large numbers of tumours, particularly squamous cell carcinomas (SCC), and require close surveillance and frequent surgery. One patient has died as a result of rapidly evolving metastases from an SCC on the dorsum of the hand. Excision and grafting of the backs of the hands in four patients, and long term etretinate therapy in 6 patients have led to a marked reduction in the frequency of surgery to remove tumours. The very high rate of NMSC, frequently multiple, found in this study of UK residents is a source of concern and indicates the need for close dermatological monitoring of allograft recipients, with intensive surveillance of patients with extensive dysplasia, who may develop tumours requiring surgery every few weeks.