Objectives:To compare the efficacy of IV phenytoin and IV levetiracetam in acute seizures.Design:Randomized controlled trial.Setting:Tertiary care hospital, November 2012 to April 2014.Patients:100 children aged 3–12 yrs of age presenting with acute seizures.Intervention:Participants randomly received either IV phenytoin 20 mg/kg (n = 50) or IV levetiracetam 30 mg/kg (n = 50). Patients who were had seizures at presentation received IV diazepam prior to these drugs.Outcome Measures:Primary: Absence of seizure activity within next 24 hrs.Secondary: Stopping of clinical seizure activity within 20 mins of first intervention, change in cardiorespiratory parameters, and achievement of therapeutic drug levels.Results:Two groups were comparable in patient characteristics and seizure type (P > 0.05). Of the 100 children, 3 in levetiracetam and 2 in phenytoin group had a repeat seizure in 24 hrs, efficacy was comparable (94% vs 96%, P > 0.05). Of these, 18 (36%) in phenytoin and 12 (24%) in levetiracetam group received diazepam. Sedation time was 178.80 ±97.534 mins in phenytoin and 145.50 ±105.208 mins in levetiracetam group (P = 0.346). Changes in cardiorespiratory parameters were similar in both groups except a lower diastolic blood pressure with phenytoin (P = 0.023). Therapeutic drug levels were achieved in 38 (76%) children both at 4 and 24 hrs with phenytoin, compared to 50 (100%) and 48 (98%) at 1 and 24 hrs with levetiracetam (P < 0.05).Conclusion:Intravenous levetiracetam and phenytoin have similar efficacy in preventing seizure recurrences for 24 hrs in children 3–12 years presenting with acute seizures.

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We reviewed the records of 95 consecutive patients with spontaneous pneumothorax. The children, 75 boys and 20 girls, ranged in age from newborn to 12 years. The average duration of symptoms, cough, chest pain and breathlessness, was 5 days. Pyogenic lung infection (74.8%) and pulmonary tuberculosis (21%) were the commonest underlying causes of pneumothorax. All children underwent tube thoracostomy drainage along with supportive treatment. Five died owing to sever infection present at the time of admission. Except for the five (5.21%) who died, all children (94.79%) had full relief of pneumothorax. We conclude that pyogenic pulmonary infection and pulmonary tuberculosis are still the commonest causes of pneumothorax in the tropics. Tube thoracostomy drainage is very successful and thoracotomy in selected patients is safe.

Objectives Partial arterial pressure of oxygen/fraction of oxygen in inspired air (PaO2/FiO2) ratio has been used as a predictor of outcome in some neonatal conditions, but has not been used in meconium aspiration syndrome (MAS). This study was conducted with the objective to study if the PaO2/FiO2 ratio of < 200 at 6, 12, and 24 hours of life can predict mortality in neonates with MAS. Study Design Two hundred neonates with MAS were included in the study. PaO2/FiO2 ratio was calculated at 6, 12, and 24 hours of life. Sensitivity, specificity, predictive values, and likelihood ratio at cut-off < 200 to predict mortality was calculated. Results PaO2/FiO2 ratio at cut-off of < 200 was found to predict mortality in neonates with MAS with 94.1% sensitivity and 96.6% specificity. It was also able to predict development of severe MAS. Conclusion PaO2/FiO2 at < 200 can predict all-cause mortality in neonates with MAS. It can be used as vital tool in identifying newborns at high risk, thus helping in focused care.