To determine the demographic and systemic parameters in children with solid malignancies and to ascertain which of them affected the delay in diagnosis, a retrospective study was performed on 315 children diagnosed with a solid tumor at our hospital, including epidemiological, social, and medical issues concerning the family, the child, the medical system, and the tumor. Lag time, defined as the interval between onset of symptoms and final diagnosis, including parent delay and physician delay, was estimated for each child. Mean lag time: 15.75 weeks (w), median: 7 w, range: 0-208 w. Lowest mean values appeared in kidney tumors, highest in epithelial, brain and soft tissue sarcomas. Mean parent delay: 4.42 w, median: 1 w, range: 0-130 w. Mean physician delay: 11.17 w, median: 4 w, range: 0-206 w. Among the demographic and personal parameters, the best predictors for diagnosis delay were age of child and father's ethnic origin. Several factors influenced diagnosis delay of childhood solid tumors. Recognizing these factors could minimize the delay, thereby improving the child's chances of survival.

640 Delay in diagnosis of children with cancer: a retrospective study of 315 children

Environmental, dietary and case-control study of Nodding Syndrome in Uganda: A post-measles brain disorder triggered by malnutrition?

Inosine pranobex (IP), commonly known as inosine acedoben dimepranol, isoprinosine and methisoprinol, has been proven to positively impact the host's immune system, by enhancing T-cell lymphocyte proliferation and activity of natural killer cells, increasing levels of pro-inflammatory cytokines, and thereby restoring deficient responses in immunosuppressed patients. At the same time, it has been shown that it can affect viral RNA levels and hence inhibit growth of several viruses. Due to its immunomodulatory and antiviral properties, and its safety profile, it has been widely used since 1971 against viral infections and diseases, among which subacute sclerosis panencephalitis, herpes simplex virus, human papilloma virus, human immunodeficiency virus, influenza and acute respiratory infections, cytomegalovirus and Epstein-Barr virus infections. Following an analysis of almost five decades of scientific literature since its original approval, we here summarize in vivo and in vitro studies manifesting the means in which IP impacts the host's immune system. We also provide a synopsis of therapeutic trials in the majority of which IP was found to have a beneficial effect. Lastly, positive results from limited studies, suggesting the putative future use of IP in new therapeutic indications are briefly described. In order to support use of IP against viral infections apart from those already approved, and to establish its use in clinical practice, further well-designed and executed trials are warranted.Funding: Ewopharma International.

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Inosine Pranobex: A Key Player in the Game Against a Wide Range of Viral Infections and Non-Infectious Diseases

Subacute sclerosing panencephalitis is a progressive neurodegenerative disease. It usually occurs 7–10 years after measles infection. The clinical course is characterized by progressive cognitive decline and behavior changes followed by focal or generalized seizures as well as myoclonus, ataxia, visual disturbance, and later vegetative state, eventually leading to death. It is diagnosed on the basis of Dyken’s criteria. There is no known cure for subacute sclerosing panencephalitis to date, but it is preventable by ensuring that an effective vaccine program for measles is made compulsory for all children younger than 5 years in endemic countries.

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Subacute sclerosing panencephalitis - current perspectives.

Post-infectious cerebellitis is an acute form of inflammatory encephalitis mainly limited to the cerebellum. It is commonly found in children, especially after viral infections such as Epstein-Barr virus. Post-infectious cerebellitis presents with acute onset dysarthria and ataxia. To the best of our knowledge, this is the first case report of post-infectious cerebellitis in a patient with both dengue and Epstein-Barr viral infection confirmed on serology. A 43-year-old Sri Lankan Sinhala man presented with an acute febrile illness associated with thrombocytopenia. While being managed as uncomplicated dengue fever, our patient developed dysarthria, ataxia and cerebellar signs. Our patient's infectious disease screen was positive for both dengue and Epstein-Barr specific immunoglobulin M. A cerebrospinal fluid analysis was suggestive of viral meningoencephalitis while cerebrospinal fluid serology was positive for dengue immunoglobulin G. T2-weighted magnetic resonance images were consistent with post-viral cerebellitis. The patient was given full supportive care and he made an uneventful complete recovery. There have been no previously reported cases of post-infectious cerebellitis associated with both Epstein-Barr and dengue viral infections confirmed by serology. Our patient's clinical features and findings on the imaging studies were consistent with post-viral cerebellitis. This report highlights the need to screen for other possible more common etiologies of a particular presentation before coming to a specific diagnosis based on initial findings. Uncomplicated cases of cerebellitis can be successfully managed with appropriate supportive measures with good prognosis, as in this case.

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Epstein-Barr virus co-infection in a patient with dengue fever presenting with post-infectious cerebellitis: a case report

Objective To determine the clinical and demographic characteristics of children diagnosed with Subacute sclerosing panencephalitis (SSPE). Study design Case series. Place and duration of study The Aga Khan University Hospital, Karachi, from January 2000 to June 2012. Methodology A retrospective analysis was done, regarding medical charts of 43 children under the age of 16 years with a discharge diagnosis of SSPE. Demographic and clinical characteristics were recorded. RESULTS were expressed as percentages. Results Most of the 43 patients were male (72%). The average age at presentation was 8.7 years with average duration of symptoms being 100.6 days. History of measles was present in 17 patients (39.5%). All children had seizures at presentation and 65% had cognitive impairment. Most patients required poly therapy for control of seizures. Sodium valproate was the most commonly used anti-epileptic agent; Isoprinosine was tried in 22 (51%) patients. CSF for antimeasles antibodies was positive in approximately 86% of the 40 (93%) children. EEG showed burst suppression pattern in 36 (83.7%) cases. Forty-two patients (97.6%) were discharged home in a vegetative state. Conclusion SSPE is progressive neurodegenerative disorder. It can be prevented by timely immunization against measles. Measles antibody in the CSF is diagnostic for SSPE and is helpful in early diagnosis. Most patients experience a gradual but progressive decline in motor and cognitive functions.

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Subacute sclerosing panencephalitis: clinical and demographic characteristics

1.5 Results A total of 102 medical charts were reviewed for children aged 1 month to 16 years presenting to the ED with clinical or laboratory suspicion of Leukemia. The median age of the children was 4.75 years with majority of them below 5 years of age (57.8%) . Males (66.7%) were the dominant population with Fever (92.2%) the common presentation followed by weight loss (51%) and pallor (51%). B-Cell ALL was the most common sub-type followed by T-Cell ALL.

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Clinical Presentations of Acute Leukemia in Pediatric Emergency Department of Pakistan

We report a case of an 8 years old child who presented with sudden onset of headache and vomiting. He had broad-based gait and intention tremors on admission. MRI brain revealed isointense signals on T1-weighted imaging and hyperintense signals on T2-weighted imaging. Cerebellar swelling was also identified with significant mass effect obliterating the fourth ventricle. CT head showed prominent third and lateral ventricles. He was treated with high dose corticosteroids and required an external ventricular drain (EVD) insertion. He made an uneventful recovery and suffered no neurologic deficit. The clinical and radiologic findings in this boy were consistent with cerebellitis complicated by hydrocephalus.

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Acute cerebellitis with hydrocephalus.

Baker's cysts or popliteal cysts are common cystic lesions surrounding the knee joint. These are prevalent among the adult population but rare in children. These are asymptomatic in majority of cases, and are identified incidentally by the parent or physician. We report a case of 15-year boy who presented to the emergency room with symptoms of calf pain and swelling for two weeks. He was in good health previously, and had no underlying knee pathology. Prior to presenting in emergency department (ED), he was suspected as deep vein thrombosis (DVT), and referred for evaluation and management. During his evaluation for DVT, the diagnosis of ruptured Baker's cyst was made on ultrasound. This was further confirmed with magnetic resonance imaging (MRI) of knee joint. He responded to conservative management and was discharged home after reassurance.

Nida Amjad

Papers

Subacute sclerosing panencephalitis: clinical and demographic characteristics

Clinical Presentations of Acute Leukemia in Pediatric Emergency Department of Pakistan

Acute cerebellitis with hydrocephalus.

Ruptured Baker's Cyst in a 15-Year Boy.