Deterioration, a continuous process of all items, may be low or high for different items. This paper develops an inventory model for stock-dependent demand and time varying holding cost under different trade credits, considering four different situations. The second order approximations are used for exponential terms. Optimal solutions are obtained using Mathematica 9.0 software. Numerical examples and sensitivity analysis are provided to illustrate the proposed model.

World Health Organization-recommended rehydration solution for malnourished children (ReSoMal) for rehydrating severe acute malnourished children is not available in India. In present study, 110 consecutive children aged 6-59 months with severely acute malnourishment and acute diarrhea were randomized to low-osmolarity oral rehydration solution (ORS) (osmolarity: 245, sodium: 75) with added potassium (20 mmol/l) or modified ReSoMal (osmolarity: 300, sodium: 45). In all, 15.4% of modified ReSoMal group developed hyponatremia as compared with 1.9% in low-osmolarity ORS, but none developed severe hyponatremia or hypernatremia. Both groups had equal number of successful rehydration (52 each). Both types of ORS were effective in correcting hypokalemia and dehydration, but rehydration was achieved in shorter duration with modified ReSoMal.

BACKGROUND/OBJECTIVES:Data on performance of QuantiFERON-TB Gold In-Tube test (QFT) and tuberculin skin test (TST) in children with active tuberculosis from high burden countries in the context of micronutrient deficiency are scarce. The objective of this study was to evaluate the effect of micronutrient deficiency on the performance of TST and QFT in children with intrathoracic tuberculosis.SUBJECTS/METHODS:Children with probable intrathoracic tuberculosis underwent TST, QFT, gastric lavages and induced sputum examination for AFB (Acid-Fast Bacilli) smear and culture. Zinc, copper, ferritin and vitamin D were measured on stored serum samples. The study used cross-sectional data at initiation of anti-tubercular therapy.RESULTS:Three hundred and sixty-two children (median age 115.5 months (interquartile range: 73, 144), 200 (55.3%) girls) were enrolled in the study. Microbiological confirmation of tuberculosis could be obtained in 128 patients. TST and QFT were positive in 337 (93%) and 297 (82%) children, respectively. Performance of both the tests was unaffected by weight-for-age and height-for-age 'z-scores' or by serum copper levels. TST was not affected by serum zinc and ferritin levels. Children with negative QFT results had lower mean serum zinc level (P=0.01) and higher ferritin levels (P=0.007) as compared to those with positive test. Higher proportion of children with positive TST were vitamin D deficient/insufficient (P=0.003).CONCLUSION:Micronutrient status, especially serum levels of zinc, may influence the performance of QFT in children with intrathoracic tuberculosis. Considering the high prevalence of zinc deficiency in developing countries, QFT should be used cautiously for diagnosing tuberculosis.

Background: Metabolic syndrome is a well recognized complication of valpraote therapy. However there is paucity of data on the prevalence of metabolic syndrome in children with epilepsy on valpraote monotherapy.

Type 1 renal tubular acidosis presenting as hypokalemic paralysis in Sjogren syndrome has been reported globally.[3] It may be the first presentation of Sjogren syndrome despite long duration of exocrine gland involvement or it may precede the sicca symptoms. Chen et al.[4] found that renal tubular acidosis was the initial manifestation of primary Sjogren’s syndrome in 75% out of a series of eight cases. The disease duration was shorter in patients with renal involvement than in those with normal acidification results.[5] Therefore, in patients presenting as hypokalemic paralysis a clinical suspicion can unmask a sub clinical Sjogren syndrome.

Dengue, the most common arboviral disease is fast emerging as a global health problem. The incidence and geographical distribution of dengue have greatly increased in recent years. Neurological manifestations are considered a rare complication of dengue infection, although a wide range of them have been reported in literature. The exact incidence of various neurological complications is uncertain. The pathogenesis of neurological complications can be related to the systemic effects of the infection, neurotropic effect of the virus and immune mediated. Detection of IgM in CSF using ELISA has a high specificity. Mortality due to neurological involvement is low and patients die due to other multisystem involvement. In dengue-endemic areas, it is prudent and justified to include dengue in the differential diagnosis of patients with fever and acute neurological manifestations.

Syringomyelia refers to the presence of cavities within the spinal cord or a dilatation of the central spinal cord canal. In 90% of cases, syringomyelia is associated with a Chiari I malformation. The association of syringomyelia with tethered cord is well known but syrinxes associated with these defects are usually below vertebral level T6. Holocord syrinx associated with tethered cord is rare and is almost always associated with Chiari 1 malformation. To the best of our knowledge, only a single case report of holocord syrinx with tethered cord has been reported, but this patient had multiple overt lumbosacral defects (tethered cord, meningocele and diastematomyelia). We are reporting a three year old child with holocord syrinx with tethered cord and diastematomyelia and no evidence of Chiari malformation, meningocele or any overt spinal malformation and minimal neurological abnormalities. J Nepal Paediatr Soc 2012;32(2):169-171 doi: http://dx.doi.org/10.3126/jnps.v32i2.6098

To study the clinical profile of HIV associated thrombocytopenia, co-relation between thrombocytopenia and immune status and the effect of the anti-retroviral therapy (ART) on platelet count.

Edward’s syndrome was first described as a clinical entity in 1960 as a disorder of trisomy 18 (47 XX/XY; + 18) in babies with particular pattern of malformations. The Karyotype found in our case was (47 XX + 18 add (22) (p13) which has not been published so far in the literature. The less common findings noted in the baby were rocker bottom feet, syndactyly of 2nd and 3rd toes, microcephaly and corneal opacities. Though we didn’t find any significant association between phenotypic ranges with genotypic variation in literature, but further research is needed for it. We are reporting this case as the genotype is found to be novel. Keywords: Edward’s syndrome, karyotype, neonate. DOI: http://dx.doi.org/10.3329/bjms.v10i3.8368 BJMS 2011; 10(3): 211-212

Objective: Comparison of efficacy and safety of two different regimens of vitamin D-600000 IU as a single intramuscular dose, and 60 000IU orally once a week for 10 weeks-in treatment of nutritional rickets.Methods: Children with nutritional rickets (age: 0.5-5 years, n = 61) were randomized to receive either 60 000IU vitamin D orally once a week for 10 weeks or 600 000IU single intramuscular injection. Serum calcium, phosphate, alkaline phosphatase, urinary calcium/creatinine ratio, serum 25 hydroxy vitamin D and radiological score were compared at 12-week follow-up.Results: No difference was found in efficacy of the two regimens on comparing biochemical and radiological parameters. Serum 25 hydroxy vitamin D > 100 ng/ml was found in two children in the oral group and one child in the intramuscular group. No child developed hypercalcemia or hypercalciuria after starting treatment.Conclusion: Staggered oral and one-time intramuscular administrations of 600 000IU vitamin D are equally effective and safe in treatment of nutritional rickets.

Background: Hypocalcemia accounts for a majority of seizures in infants reporting to the emergency ward of our hospital.Objective: To evaluate the role of Vitamin D deficiency in the etiology of hypocalcemic seizures in infancy.Design and Setting: Cross sectional hospital based study, from April 2006-March 2007.Subjects: 60 infants with hypocalcemic seizures and their mothers (study group) and 60 healthy breastfed infants with their lactating mothers (control group).Measurements: Vitamin D [25(OH) D] and intact parathormone levels.Results: High prevalence of hypovitaminosis D [25(OH)D levels <10 ng/mL] was observed in study mothers (85%), control mothers (50%); study infants (90%), and control infants (41.7%). Mean serum 25(OH) D values in study mothers and their infants (6.54 +/- 5.32 ng/mL and 4.92 +/- 4.62 ng/mL) were significantly lower than those of mother-infant pairs (9.06 +/- 4.78 ng/mL and 9.03 +/- 4.63 ng/mL) in the control group (P<0.001). A strong positive correlation of 25(OH) D levels between mothers and their infants was seen in both the study and control populations (P<0.001). Of the 54 study infants who had 25(OH)D levels <10ng/mL, 48 (89%) were born to mothers who also had 25(OH) D levels <10ng/mL.Conclusions: Vitamin D deficiency is a major cause of hypocalcemic seizures in infants. Infants born to vitamin D deficient mothers are at a significantly higher risk to develop hypocalcemic seizures.

We present a case of presumed amniotic fluid embolism in a 33-year-old parturient at 30 weeks of gestation, which occurred just before she was due to receive spinal anaesthesia for urgent caesarean section. While sitting, the woman suddenly lost consciousness, started having convulsions and finally suffered cardiorespiratory collapse. She was resuscitated and a live baby was delivered by emergency caesarean section. An echocardiogram performed postoperatively showed a large atrial septal defect and severe right ventricular dysfunction with moderate pulmonary hypertension. Paradoxical amniotic fluid embolism was diagnosed. After extubation she was aphasic and had a right hemiparesis. She made a good recovery and was discharged from hospital 24 days later, at which time she had a slight weakness on her right side. Three months later she had a normal gait with no obvious neurological deficit.

BACKGROUND:Vitamin D nutrition has a profound effect on the development of an infant. Vitamin D status of mothers and their infants are closely correlated. While hypovitaminosis D has emerged as a significant public health problem across all age groups, there is limited information of this condition in lactating mothers and their breast fed infants. AIM:To evaluate the vitamin D status of lactating mothers and their breast fed infants. SUBJECTS AND METHODS:180 healthy lactating mothers and exclusively breast fed infants, 2-24 weeks old, were recruited for the study. The mother-infant pairs underwent concurrent clinical, biochemical and hormonal evaluation for calcium-vitamin D-PTH axis. RESULTS:The mean serum 25(OH)D values in lactating mothers was 27.2 +/- 14.6 nmol/l (10.9 +/- 5.8 ng/ml), while that of their infants was 28.9 +/- 20.8 nmol/l (11.6 +/- 8.3 ng/ml). Serum 25(OH)D levels <25 nmol/l (10 ng/ml) were found in 47.8% of the mothers and 43.2% of the infants. Among these, elevated PTH levels (>54 pg/ml) were seen in 59.3% of the mothers and 69.6% of the infants. A highly significant negative correlation was found between serum 25(OH)D and PTH in mothers (r = -0.480, p = 0.01) and their infants (r = -0.431, p = 0.01). A strong positive correlation was seen of 25(OH)D levels in mother-infant pairs (r = 0.324, p = 0.001). CONCLUSIONS:A high prevalence of vitamin D deficiency was found in lactating mothers and their exclusively breast fed infants. Infants born to mothers with hypovitaminosis D had 3.8 times higher risk of developing hypovitaminosis D as compared to those born to mothers with normal vitamin D levels.

Berardinelli-Seip congenital lipodystrophy (BSCL) is a very rare genetic disorder characterized by lipoatrophy, hypertriglyceridemia, hepatomegaly and acromegaloid features. On the basis of mutational and haplotype analysis, BSCL families have been classified into three types BSCL 1, BSCL2 and BSCLX. We report Berardinelli-Seip congenital lipodystrophy (BSCL2 type) in three subjects from two unrelated Indian families (family1 and family2). The mutation (c.IVS2 11 A GT G ) found in affected members of family1 is a newly identified mutation. We also report the association of renal anomaly with this new mutation.

*Neuropharmacology Lab, All India Institute of Medical Sciences, New Delhi, India; Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India EBPS Workshop Abstracts: Neurodegeneration: basic mechanisms of motor and cognitive dysfunctions Cracow, 2–4 September 2006