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To the Editor: Depression in children and adolescents has been increasing worldwide and despite its high prevalence and its substantial global impact, the detection and its treatment in primary care setting have been suboptimal [1]. It... more
To the Editor: Depression in children and adolescents has been increasing worldwide and despite its high prevalence and its substantial global impact, the detection and its treatment in primary care setting have been suboptimal [1]. It can have a significant adverse effect on a youth’s emotional, social, and cognitive development. Its occurrence at an early age increases the risk of substance abuse, suicide attempts, impairment in relationships, recurrent depressive episodes, educational underachievement, and poor quality of life [2]. We did a cross-sectional study after ethical committee approval among 400 participants 8 to 17 y of age presenting to the outpatient department in our hospital. A three-step process on diagnosis was involved. Step 1: Screening for psychiatric and behavioral morbidities using standardized Strengths and Difficulties Questionnaire [3]. Step 2: Those scoring > 19 were subjected to a screening test for depression using Center for Epidemiological Studies ...
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Background: This study was conducted to study the clinical profile of hypoglycemia in newborn and to determine the prevalence of hypoglycemia among neonates admitted in NICU. Methods: All newborns admitted in NICU were examined and those... more
Background: This study was conducted to study the clinical profile of hypoglycemia in newborn and to determine the prevalence of hypoglycemia among neonates admitted in NICU. Methods: All newborns admitted in NICU were examined and those with hypoglycemia (GMR<45 mg/dl) were included in the study and observed. In neonates with risk factors blood sugar was screened at 2, 6, 12, 24, 48 and 72 hours of life or whenever symptoms suggestive of hypoglycemia developed in any neonates and for critically sick neonates blood sugar was screened in every 6 hour in active phase of illness. Any neonates with blood glucose level less than 45 mg/dl were analysed for maternal risk factors, neonatal risk factors and course in the NICU. Results: The prevalence of neonatal hypoglycemia was 14.9% among NICU admissions. The maternal risk factors were GDM, PIH, and PROM. The neonatal risk factors were prematurity, SGA, LGA and comorbid conditions which include perinatal asphyxia, sepsis, polycythemia, ...
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A conjoined twin is a rare event. As per recent literature, 60% of conjoined twins are aborted spontaneously and hence true incidence of conjoined twin is approximately 1 in 200,000 live births. Classification is based upon site of... more
A conjoined twin is a rare event. As per recent literature, 60% of conjoined twins are aborted spontaneously and hence true incidence of conjoined twin is approximately 1 in 200,000 live births. Classification is based upon site of attachment out of which parapagus with dicephalic variety is extremely rare (0.5% amongst reported cases). Author report a case of dicephalic twin born at 36 weeks of gestation to a multigravida mother in central India.
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Background: The objective of the study was to evaluate and analyze the role of preceding early warning signs at admission in children with severe dengue infection.Methods: All children (0-12 y of age) diagnosed and confirmed as dengue... more
Background: The objective of the study was to evaluate and analyze the role of preceding early warning signs at admission in children with severe dengue infection.Methods: All children (0-12 y of age) diagnosed and confirmed as dengue fever admitted at a tertiary care hospital at Puducherry were retrospectively analysed from hospital case records as per the revised World Health Organization(WHO) guidelines 2009 for dengue fever. The data was analysed by descriptive statistics using SPSS 16.0 statistical software. Early warning signs were analyzed by logistic regression and a P-value of…
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Sir, Gas-driven jet nebulization in patients in supine position in Intensive Care Units (ICUs) and operation theaters during acute respiratory events is usually done by “T”-piece nebulization[1] through the circuit while maintaining... more
Sir, Gas-driven jet nebulization in patients in supine position in Intensive Care Units (ICUs) and operation theaters during acute respiratory events is usually done by “T”-piece nebulization[1] through the circuit while maintaining ventilation under general anaesthesia. But, improper aerosolization (drug gets accumulated on one side rather than at the base of chamber due to gravity) and drug spillage (drug chamber parallel to ground) with bottom-loading or partially front-loading masks [Figure 1a] is a major setback during jet-nebulisation in patients under regional anethesia in the OTs or in supine patients in ICUs. Trying to make chamber straight by turning patient’s head to one side compromises mask fit and aerosol loss and may be contraindicated in specific ICU patients. Usage of multiple connectors between mask and chamber to straighten the chamber may cause turbulent flow and also drug condensation at angles [Figure 1c and d].
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The indications for platelet transfusion in dengue fever are clearly defined in World Health Organization (WHO) guidelines (2011) for dengue fever, but physicians face practical difficulty in its implementation in an epidemic setting. On... more
The indications for platelet transfusion in dengue fever are clearly defined in World Health Organization (WHO) guidelines (2011) for dengue fever, but physicians face practical difficulty in its implementation in an epidemic setting. On one hand there is an intense social pressure created by the panic-struck parents to transfuse platelets in presence of bleeding and on the other hand there is a need for its judicious use as the requirement is more than its availability. The study was aimed to assess the clinico-hematological parameters, and the requirement and need for platelet transfusion in children with dengue fever. All children (0-12 yr of age) diagnosed and confirmed with dengue fever at a tertiary care hospital in Puducherry between 1 August 2012 and 31 January 2015 were reviewed retrospectively from hospital case records as per the revised WHO guidelines for dengue fever. The diagnosis was confirmed by NS1 antigen- based ELISA test or dengue serology for IgM and IgG antibod...
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Radiographic and MR findings of two cases of hereditary sensory and autonomic neuropathy type I are reported. This rare disease has a non-specific radiographic and MR appearance. Differential diagnosis includes other types of hereditary... more
Radiographic and MR findings of two cases of hereditary sensory and autonomic neuropathy type I are reported. This rare disease has a non-specific radiographic and MR appearance. Differential diagnosis includes other types of hereditary and acquired sensory neuropathies affecting small myelinated and unmyelinated nerve fibers, as well as vascular abnormalities and lesions of the spinal cord.
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Dengue fever is a major public health problem worldwide. The 2011 revised World Health Organization (WHO) guidelines have emphasized on early diagnosis and intervention to reduce the case fatality rate due to dengue fever. Rapid... more
Dengue fever is a major public health problem worldwide. The 2011 revised World Health Organization (WHO) guidelines have emphasized on early diagnosis and intervention to reduce the case fatality rate due to dengue fever. Rapid diagnostic tests like NS1 antigen assays have improved the detection of cases in early clinical phase of illness but its role as a predictor of severe dengue infection is not very clear. To evaluate the utility of NS1 Ag assay as an early diagnostic marker and predictor of severe dengue infection. All children (0-12 years of age) diagnosed and confirmed with dengue fever at a tertiary care hospital in Puducherry between 01(st) August 2012 and 31(st) July 2015 were reviewed retrospectively from hospital case records as per the revised WHO guidelines for dengue fever. The diagnosis was confirmed by NS1antigen-based ELISA test or dengue serology for IgM and IgG antibodies and the data were analysed using SPSS 16.0 statistical software. After collecting all the ...
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To study the role of ultrasound in children with dengue fever and determine its role in predicting the severity of the disease. This was a retrospective hospital based study conducted from 1(st) August 2012 to January 31(st) 2015 at a... more
To study the role of ultrasound in children with dengue fever and determine its role in predicting the severity of the disease. This was a retrospective hospital based study conducted from 1(st) August 2012 to January 31(st) 2015 at a tertiary care hospital in Puducherry. Two hundred and fifty four children were admitted with dengue fever and among them non-severe dengue and severe dengue were seen in 62.6 % and 37.4 % respectively. Mean age of presentation was 7.0 (3.3) years. M: F ratio was 1.2:1 Ultrasound was performed on all children with dengue fever during the critical period of illness as an early sign of plasma leakage and at the time of discharge. The diagnosis was confirmed by NS1 antigen and dengue serology. Ultrasonography showed positive findings in 156 cases (61.4 %) during the critical period of illness. Ultrasound findings were analyzed using logistic regression among severe and non-severe dengue and P value of &amp;amp;amp;amp;lt;0.05 was taken as significant. The common ultrasound findings that were significantly associated with severe dengue infection on univariate analysis were gall bladder wall thickening, ascites, pleural effusion, pericardial effusion, pericholecystic fluid, hepatomegaly, splenomegaly and mesenteric adenopathy. On multivariate analysis, gall bladder thickening and hepatomegaly were significantly associated with severe dengue infection. Gall bladder wall thickening (GBWT) with honeycombing pattern was the most specific finding in severe dengue infection in the study and significantly associated with severe thrombocytopenia (Platelet count &amp;amp;amp;amp;lt;50,000/mm(3)). The clinical improvement coincided with resolving of the ultrasound findings at the time of discharge. Ultrasound can be used as an early predictor as well as an important prognostic sign for severe dengue infection especially during an epidemic.
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Gastro esophageal reflux disease is one of the rare causes of bronchiectasis in children. However, to the best of knowledge its association with pulmonary aspergillosis has not been reported till date in the medical literature [1] .We... more
Gastro esophageal reflux disease is one of the rare causes of bronchiectasis in children. However, to the best of knowledge its association with pulmonary aspergillosis has not been reported till date in the medical literature [1] .We report a child with gastro esophageal reflux disease with bronchiectasis and pulmonary aspergillosis.
Parapagus dicephalus tribrachii bipedus conjoined twin is uncommon. We report a case with a single body fused anterolaterally with two heads ,two fully formed upper limbs and a rudimentary limb between the heads which was delivered by... more
Parapagus dicephalus tribrachii bipedus conjoined twin is uncommon. We report a case with a single body fused anterolaterally with two heads ,two fully formed upper limbs and a rudimentary limb between the heads which was delivered by caesarean section. Introduction:
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Congenital factor X deficiency is a rare autosomal recessive disorder that usually presents with variable bleeding tendency, prolonged prothrombin time and partial thromboplastin time. Therefore, it may be misdiagnosed as hemorrhagic... more
Congenital factor X deficiency is a rare autosomal recessive disorder that usually presents with variable bleeding tendency, prolonged prothrombin time and partial thromboplastin time. Therefore, it may be misdiagnosed as hemorrhagic disease of the newborn. We describe a patient with factor X deficiency who had recurrent haematomas with intracranial hemorrhage.
Hyperimmunoglobin E syndrome is a rare primary immunodeficiency disease characterized by recurrent infections, eosinophilia and high titre of IgE. Although 200 cases has been reported worldwide, to the best of our knowledge its... more
Hyperimmunoglobin E syndrome is a rare primary immunodeficiency disease characterized by recurrent infections, eosinophilia and high titre of IgE. Although 200 cases has been reported worldwide, to the best of our knowledge its association with chronic diarrhea has not been reported till date in Indian literature and hence this case report.
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Hiatal Hernia is rarely seen in a neonate. The mode of presentation in the neonatal period can be confused with the possibility of a congenital diaphragmatic hernia and other chest pathologies. The upper gastrointestinal tract contrast... more
Hiatal Hernia is rarely seen in a neonate. The mode of presentation in the neonatal period can be confused with the possibility of a congenital diaphragmatic hernia and other chest pathologies. The upper gastrointestinal tract contrast study is diagnostic in this disease, but careful viewing of the plain X-ray of the chest can also suggest the diagnosis.
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Severe neurological complications are associated with falciparum malaria. We describe the case of an eight-year-old male child with severe falciparum malaria with high-level parasitemia and severe thrombocytopenia. There were features of... more
Severe neurological complications are associated with falciparum malaria. We describe the case of an eight-year-old male child with severe falciparum malaria with high-level parasitemia and severe thrombocytopenia. There were features of abnormal gait, speech difficulty and altered behavior pattern during the recovery phase. This occurred even after receiving antimalarial therapy. MRI showed bilateral cerebellar atrophy.
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To study the clinical profile and outcome of children screened and diagnosed for Swine flu at a tertiary care hospital. All Children with suspicion of swine flu infection attending our hospital during the epidemic from August 2009 through... more
To study the clinical profile and outcome of children screened and diagnosed for Swine flu at a tertiary care hospital. All Children with suspicion of swine flu infection attending our hospital during the epidemic from August 2009 through January 2010 were screened and categorized into A, B and C as per guidelines of National Health and family welfare. Patients in Category A were advised home quarantine, Category B tested and treated with ostelamivir and Category C were hospitalized. Among 424 cases screened for Swine flu, 79 were children in the age group 0-12 years of age (18.6%). The median age of presentation was 5 years. Children belonging to Category A were 43(54.4%), Category B were 31(39.2%) and Category C were 5(6.3%). Out of the cases that were screened, 19 children were confirmed positive for H1N1 infection(30.2%).Out of positive cases 8 were in category A (42%), eight were in category B (42%) and five were in category C (26.3%). During the epidemic of swine flu at puduch...
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Radiographic and MR findings of two cases of hereditary sensory and autonomic neuropathy type I are reported. This rare disease has a non-specific radiographic and MR appearance. Differential diagnosis includes other types of hereditary... more
Radiographic and MR findings of two cases of hereditary sensory and autonomic neuropathy type I are reported. This rare disease has a non-specific radiographic and MR appearance. Differential diagnosis includes other types of hereditary and acquired sensory neuropathies affecting small myelinated and unmyelinated nerve fibers, as well as vascular abnormalities and lesions of the spinal cord.
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... Wilson&amp;#x27;s disease with Heterotaxy syndrome: A Case Report Sriram P, Shanmuga Arumugaswamy, Nivedita Mondal, Bharat Chaudary, Arun GK ... Sriram/ Arumugaswamy,/ Mondal/ Chaudary/ Arun. 146 ... 2. Taly AB, Meenakshi-Sundaram... more
... Wilson&amp;#x27;s disease with Heterotaxy syndrome: A Case Report Sriram P, Shanmuga Arumugaswamy, Nivedita Mondal, Bharat Chaudary, Arun GK ... Sriram/ Arumugaswamy,/ Mondal/ Chaudary/ Arun. 146 ... 2. Taly AB, Meenakshi-Sundaram S, Sinha S, Swamy HS, Arunodaya GR. ...