Management of patients after a first seizure

Neuroimaging evaluation in patients after a first seizure could be easily determined on the basis of seizure history, neurological examination, blood sample analysis and electroencephalography. The main objectives of the initial work-up are to differentiate a true seizure event from seizure-like symptoms, to exclude a single seizure as a manifestation of non organic cause and finally to consider the seizure as a result of cerebral lesion or inaugurate epilepsy. When a new onset seizure is diagnosed, urgent neuroimaging is recommended only in patients with focal neurological deficit, persistent or worsening alteration in the level of consciousness and when clinical and biological data lead to a suspected vascular or infectious etiology. Brain CT scan is usually more available in emergency to identify the cause of seizure. It may have an important role for the therapeutic strategy and may defer MRI investigation. Nevertheless, brain MRI must be performed in emergency when CT scan is not conclusive despite a severe clinical condition or in case of cerebral venous thrombosis. Imaging modalities depend on clinical data, patient age and suspected epilepsy type.     

Poly-epsilon-caprolactone microspheres and nanospheres: an overview

Poly-epsilon-caprolactone (PCL) is a biodegradable, biocompatible and semicrystalline polymer having a very low glass transition temperature. Due to its slow degradation, PCL is ideally suitable for long-term delivery extending over a period of more than one year. This has led to its application in the preparation of different delivery systems in the form of microspheres, nanospheres and implants. Various categories of drugs have been encapsulated in PCL for targeted drug delivery and for controlled drug release. Microspheres of PCL either alone or of PCL copolymers have been prepared to obtain the drug release characteristics. This article reviews the advancements made in PCL-based microspheres and nanospheres with special reference to the method of preparation of these and their suitability in developing effective delivery systems.     

Formulation, characterization, and in vitro evaluation of silymarin-loaded lipid microspheres

The objective of our study was to incorporate and evaluate Silymarin, a chemically defined natural hepatoprotective agent, in lipid microstructured systems. Various constituents of lipid microspheres—namely, internal oily core; surfactant such as soyabean lecithin; and cosurfactants such as span 20, tween 20, tween 80, and propylene glycol—were tried in different concentrations to optimize the final formulation characteristics such as globule size range, structural integrity, sustainability, and percent drug-holding capacity. The final formulation (formulation A) was characterized with respect to size and morphology using transmission electron microscopy and laser diffraction technique. The enhanced mean percent release of 56.70 ± 2.03% was observed in 36 hr from silymarin-loaded lipid microspheres (formulation A), as compared to 18.67 ± 0.192% with silymarin solution (formulation B). Thus, a stable delivery system having synergistic hepatoprotective effect of silymarin and soyabean lecithin could successively be produced for passive targeting to the liver.     

Preoperative aspiration for anterior mediastinal cyst with respiratory distress

We report a 5-month-old boy who presented with an anterior mediastinal cystic teratoma. Pre-operative symptoms of respiratory distress secondary to airway obstruction were markedly reduced by percutaneous aspiration. Aspiration was also beneficial in easily ventilating the baby during the surgical procedure.     

Clinico-haematological profile of pure red cell aplasia in children

Pure red cell aplasia (PRCA) is a rare disorder, characterized by isolated failure of erythropoiesis. The clinico-haematological profile of 16 patients with PRCA is presented in this communication. Fourteen patients had Diamond-Blackfan anaemia (DBA), one had transient erythroblastopenia of childhood, and one patient had PRCA secondary to carbamazepine. Physical abnormalities were observed in 50 per cent of patients with DBA. Of the nine patients with DBA who were administered prednisolone and had a regular follow-up, four (44.4 per cent) had no response, three (33.3 per cent) responded fully, and two (22.2 per cent) were steroid dependent.