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MISC/1 (P) UNUSUAL PRESENTATION OF EVENTRATION OF DIAPHRAGM
P Kumar, K L Barik , S Ghosh, M K Ghosh, S Basu, S De
Department of Pediatrics, Burdwan Medical Hospital, Burdwan
Email: [email protected]
Eventration of diaphragm is an abnormal elevation of an intact hemidiaphragm. A report of 6
mo/F having Suspected pneumatocele ,On further investigation comes to be eventration of
diaphragm, for which unnecessary antibiotics not needed.Introduction:-Eventration of
diaphragm , an abnormal elevation of an intact part or whole of the hemidiaphragm, occurs as
an isolated entity and characterised by a developmental1 abnormality of the musculature of
diaphragm.It usually remains asymptomatic in early life and present latter with respiratory
complications.It can be associated with other congenital anomalies and acquired secondary to
trauma, inflammation ,neoplastic invasion of phrenic nerve. We report a case of congenital
partial eventration of the left hemidiaphragm that mimic as pneumatocele. Case Report:-A 6
mo/F admitted in the pediatric indoor of Burdwan Medical College And Hospital, with lower
respiratory infection for 7 days and diagnosed as lobar pneumonia . H/o similar complain
two month ago .Perinatal history insignificant, without obvious congenital anomalies. On
routine investigation, TC- 12,000 with mild Neutrophilic leukocytosis ,and on chest
skiagram pneumatocele of 3 × 3 cm in left lower zone was revealed (fig1). Than treated
with appropriate antimicrobials and subsequently condition improved. Check CXR on
completion of drug course , revealed no change in size of pneumatocele and another course
of antimicrobials prescribed .Persisting lung cyst need further investigation like CT scan
thorax. Than patient was discharged on normal clinical background and adviced to attend
chest medicine with CT thorax, which suggest eventration of left hemidiaphragm , under
which gut loop looks like pneumatocele(fig 2) . So this patient is diagnosed as pneumonia
with pneumatocele and treated for the same, while actually it is an unusual presentation of
eventration of left hemidiaphragm, for which unnecessary antimicrobial not required , only
patient cauncelling is necessary, and marked it …..so that in future there is no confusion for
it…..
Chest Skiagram- Gas filled cystic lesion in Lt lower zone
CT thorax - Lt.eventration of diaphragm, containing intestinal loop which previously , seems
to be cystic lesion ( pneumatocele) on skiagram.Disscussion:- Eventration of diaphragm
consists of the thinned but intact diaphragmatic muscle producing elevation of the entire or
part of the hemidiaphragm,more common on left side.Generally an isolated intity, but can be
associated with other congenital anomalies and syndromes like Kabuki make up syndrome,
Beck with wiedmann syndrome5, poland syndrome3, jarcho levin syndrome, infection like
fetal rubella, CMV infection, trisomies,chromosomal abnormalities, and other cong
abnormalities like pulm hypoplasia, CHD, tracheomasia, cerebral agenesis, renal ectopia,
malrotation, deformaties of pinna, meckel’s diverticulum and werding hoffman disease6.
Imaging modality for diagnosis of eventration are USG, which shows slower movement of
diaphragm; Fluoroscopy,also compares bilateral cupula movement simultaneously;CT scan
,clearly detect original pathology,and remove our doubts.
MISC/2 (P) TYROSINEMIA A RARE CASE
Prabhat Kumar, K. L. Barik, A. K. Singh
Department of Pediatrics Burdwan Medical College & Hospital, Burdwan, West Bengal
Email: [email protected]
Introduction: Tyrosine is precursor of Dopamine, NE, Epi, Melanin& thyroxine.
Hypertyrosinemia may be due to deficiency of Tyrosine aminotransferase, 4Hydroxyphenpyruvate dioxygenase (4-HPPD), Fumarylacetoacetate hydrolase (FAH).
Tyrosinemia type 1: Def. of FAH, presenting age 2 to 6 month, mainly involve liver, kidney,
peripheral n., c/f – fever, vomitting, hepatomegaly, jaundice, high serum transaminases,
Clotting abnormality, Boiled cabbage like odour. Presentation: Subhajit mondal, a 8 month
old male Hindu, presented with yellowish discoloration of eyes, urine with fever & vomiting
for 15 days, with bluish spot all over body for 2 days. H/o clay colour stool. Family history:
His elder sister died due to similar type of illness at the age of 11 month.
Clinical examination: O/E: Icterus ++, Echymosis/ Hmgic spot over back, Liver 4 cm, spleen
3 cm, Fundus normal. INVESTIGATION: TSB 6.02 mg/dl, D- 4.70, ID- 1.32,Alk P1418,HBsAg-ve, PT-26 s (control-11.9s), INR-2.2, USG Abd - intrahepatic biliary radicles
not dilated, Alk p- 1045, SGPT (N), SGOT(N), TSB-13.3mg/dl, D-7.6, ID-5.7, Protein
5.5gm%, Alb-2.8, Glo-2.7,PT-18s (control-14s), INR-1.5, APTT-55s (control-26s), Urine for
Metabolic screening test, Reducing substance –ve, Ferric chloride test- Green colour
(suggest PKU), TORCH screening CMV IgG high (250), CT brain-Normal study, AFP4923ng/ml (normal range <10). Conclusion: It is included in D/D of persistent
hyperbilirubinemia, one can diagnosed by proper approach and if confirm than easily treated
by medication & tyrosine free diet. Report of his elder sibling: 7 month/F with similar
features, On 07/12/09 TC-40900, BT-5’10”, CT-7’30” N-80%, L-18%, PT-37.1 s (control12), INR-3.1, APTT-50.8s (control-34.0). Baby died before establishment of diagnosis.
Treated with low protein diet along with Nitisinone, now condition improves.
MISC/3 (P) EFFECTIVENESS OF ANTI-SCORPION VENOM IN CHILDREN WITH
RED SCORPION ENVENOMATION
Deepak Dwivedi, Santosh Kait, Jyoti Singh, H.P. Singh
Assistant Professor Paediatrics, D-2/8 Doctors Colony, GMH Campus, Rewa (M.P.) –
486001
Email: [email protected]
Introduction Scorpion sting is common and important health problem among children in
Vindhya region of M.P. mostly due to Indian red scorpion. The present study has been carried
out retrospectively in Department of Paediatrics, SSMC and GMH Rewa (M.P) to know the
usefulness of anti-scorpion venom in children. Aims and objective To study effectiveness of
anti-scorpion venom in stabilization of vitals, reducing requirement of vasopressor drugs,
reducing duration of hospital stay & reducing mortality in children with red scorpion
envenomation. Material & methods Children with red scorpion envenomation confirmed by
definite history of red scorpion sting, with symptoms and signs of red scorpion
envenomation (n=62) were included in study. Those received anti scorpion venom were
labelled Group A (n=27) & others Group B (n=35). Those with signs and symptoms of
scorpion sting but without definite history, CCS < 5 & children with associated co-morbid
conditions were excluded. The groups were compared using χ2 test or Fisher’s exact test for
categorical variables, unpaired t test for normally distributed continuous variables. Statistical
analysis was done by Graph Pad Software version 3.0. Results: In group A Rate of fall in
mean Heart rate (p<0.001) & Mean respiratory rate to normal (p<0.001) was faster as
compared to group B. Although other vital parameters were not affected significantly.
Patients in group A had significantly less requirement of vasopressors (p=0.016) . As
compared to group B patients duration of hospital stay was significantly less in patients with
group A(P= 0.0089). Mortality rate was less in group A although it was not stastically
significant. Conclusions: Thus it can be concluded from present study that Early treatment of
red scorpion envenomation with anti scorpion venom along with prazosin hastens the
recovery and hence significantly decreases the duration of hospital stay.
MISC/4 (P) CLINICO-EPIDEMIOLOGICAL PROFILE AND RISK FACTORS
ASSOCIATED WITH SEVERITY OF ATOPIC DERMATITIS IN EASTERN
INDIAN CHILDREN
Mani Kant Kumar, Punit Kumar Singh, Mohammad Mahtab Ali Tahir
Department of Pediatrics, Narayan Medical College and Hospital, Jamuhar, Sasaram, DistRohtas, Bihar -821305
Email: [email protected]
Objective: To Study the clinical features and various epidemiological risk factors and their
correlation with severity of atopic dermatitis in Eastern Indian children. Design: Prospective
hospital based study. Settings: Pediatrics OPD and Dermatology OPD of a tertiary care
teaching hospital located in Rohtas district of Bihar. The study was carried out over a period
of 2 year during January 2010 to December 2011. Participants: One hundred thirty two
Children ages zero month to 15 years diagnosed with Atopic dermatitis. Main Outcome:
Demographic profile, Common clinical features, various risk factors and their correlation
with severity of atopic dermatitis in Eastern Indian children. Results: Out of a total 1829
pediatric patients ages zero month to 15 years with some pediatric dermatoses, 132 (7.21 %)
had Atopic dermatitis. Of 132 patients, 57 were boys and 75 were girls, with a male to
female ratio 1: 1.3. Of these 29 were infants and 103 were children. Personal history, family
history and both personal and family history of atopy was present 43.18 %, 33.34 % and 12.1
% respectively. Majority (89.4 %) of patients had onset before five years of age. In infantile
AD, mean age ± SD at onset was 5.2 ± 3.01months. In infantile group 27.6 % had mild, 48.3
% moderate and 24.1 % had severe atopic dermatitis. Infantile AD had statistically
significant higher SCORAD Index score in all three grade of severity of the disease. One
hundred three patients had childhood AD, out of which 40 were boys and 63 were girls. In
Childhood AD, Mean age ± SD at onset of the disease was 3.47 Years ± 3.02. In the first six
months of life Forty (30.3 %) children had been exclusive breast fed, 81 (61.36 %) had been
mixed fed and 11 (8.33 %) had been exclusively bottle fed. Mixed fed and bottle fed children
had higher risk to developed moderate and severe AD with odd ratio of 2.24 (95 % CI 0.588.3) and 2.741 (95% CI 0.397- 18.9) respectively. In winter season, statistically significant
risk to had moderate and severe form atopic dermatitis. Conclusion: Although the prevalence
of AD is considered to be increasing, it still remains low in comparison to developed
countries. In Indian children, the disease is relatively milder than children of developed
countries. This study identified winter season, bottle feeding during first six months of life
and infantile AD as risk factors for moderate and severe AD. Exclusively breast fed children
more likely to have mild AD.
MISC/5 (P) KNOWLEDGE AND ATTITUDE OF THE PEDIATRICIANS IN
NORTHERN INDIA, REGARDING FEVER MANAGEMENT
Chakrabarti Raktima, Wazir Sanjay, Yadav BS
Tower-4 Flat # 1402, Escape Nirvana Country, Sector 50, Gurgaon - 122018
Email: [email protected]
Introduction: Fever is one of the commonest complaints addressed by the pediatricians and
most worrisome to the parents. Aims and objectives: To assess the knowledge and attitude
regarding fever and its management amongst pediatricians based in the urban area of northern
India. Materials and methods: This cross sectional survey study was conducted at Apollo
Cradle hospital, Gurgaon between March 2012 and June 2012. An 18 item based
questionnaire regarding fever definition, its effects, antipyretic toxicity etc was mailed
electronically via survey monkey software to 200 pediatricians chosen randomly from
pediatricians’ register. 120 pediatricians sent back their reply which was directly entered to
survey monkey software and analyzed statistically through that program. Appropriateness of
responses to questions was determined by the current medical literature Results: Forty six
percent of the respondents were in practice for more than 10 years. The survey showed that
43.3% pediatricians defined temperature above 100.4 F (38 C) as fever and 81.4% treat when
it crosses 100.4 F. 97% of the surveyed pediatricians administer the commonest medicine
paracetamol orally though there was variation of drug administration protocol. Thirty nine
percent believe that antipyretics decreases the chance of recurrence of febrile seizure, and
most of them are not prepared to handle paracetamol toxicity. Conclusion: Inconsistencies
regarding fever, its effects and management is quite common amongst pediatricians.
Educational interventions for pediatricians are needed to decrease confusion amongst parents
and be better prepared for handling toxicities.
MISC/6 (P) HOME RELATED INJURIES DURING INFANCY
Ravinder K. Gupta
Child Care Clinic, Nai Basti, Jammu Cantt. J&K-180003
Email: [email protected]
Objective: To study various types of injuries encountered during infancy at home. Design:
Prospective study. Setting: Pediatric Clinic. Methods and Subjects: The study was conducted
at a Pediatric Clinic from Jan. 2011 to Dec.2011. Two hundred infants who had sustained
different types of injuries at home were considered for the study. The mothers were
interviewed thoroughly regarding age, sex, family size, educational status etc. Detailed
information in respect of circumstances (time and place), activity of infant at the time of
injury, nature of injury and its immediate consequence were obtained. Health education
regarding preventive aspect was imparted. Results: There was significant male preponderance
(M: F=1.5:1). There were 10 neonates. Sixty percent of infants belonged to nuclear families.
About 35% mothers were graduates, while rest had education up to higher secondary. Fifty
four percent were working mothers. The most common injury was due to fall (60%). The fall
was from walker (37.5%), furniture / bed (27.5%), stairs (20%), tricycle (7.5%), attendant’s
lap (7.5%) etc. Toys, sharp edged instruments like knife, scissors, safety pins, pen / pencil etc
were responsible for about 29% injuries. Burns / scalds and electric burns were seen in 11%
of children. Out of 120 children who had history of fall, 55% had sustained trauma on scalp
in form of hematoma, 25% had lacerated or incised wounds on various parts of the body,
15% had fractures of bone at various sites. Out of the 58 child who had suffered injuries
because of sharp edges instruments, majority (80%) had incised or lacerated wounds on
various sites, while rest had puncturing wound or hematoma. Majority of injuries occurred
between 9:00 AM to 9:00 PM especially when infants were busy in playing. Conclusion:
Home related injuries during infancy are quiet common. Short family size and working
parents are major contributing factors in causation of injuries. Fall is quiet common. Toys too
can cause problems. Health education regarding preventive aspect should be imparted by the
pediatricians.
MISC/7 (P) TOPICAL BETA BLOCKER TO PREVENT THE PROLIFERATIVE
STAGE OF INFANTILE HEMANGIOMA
Sandeep Aggarwal, Shallu Aggarwal
Consultant Child Specialist at Civil Hospital, Amritsar, Punjab-143001
Email: [email protected]
Objective: to create awareness regarding use of topical 0.5% Timolol in Infantile
Hemangioma. Introduction: Infantile hemangiomas are benign vascular tumours of infancy
with a prevalence of 4-5%. IH become evident within the first few weeks and characterized
by proliferative phase and then a period of minimal growth or involution. Although
frequently benign, hemangiomas can occur in locations to cause functional impairment of
vital organs, can lead to ulcerations, scarring or disfigurement. Case report: We treated 5
children with superficial hemangiomas without previous intervention. All parents were
instructed to gently spread 2 to 3 drops of timolol maleate, 0.5%, solution (liquid) topically
onto the surface of the hemangioma using a fingertip twice daily. In all 5 children, the
tumours decreased in size and volume varied from 35% to 85% and faded in colour from
bright red to light pink or normal skin tone. Response times ranged from 4 to 8 weeks. All
patients were monitored by heart rates before and after timolol application during their
visits. No local or systemic adverse effects were observed. Discussion: Management of
problematic IH includes laser, systemic corticosteroids, interferon, Vincristine, surgery, and
recently systemic propranolol. All currently available treatment modalities are associated
with adverse local or systemic effects. Intralesional corticosteroids are associated with
disfiguring changes, while oral steroids cause systemic risk. Surgical excision is associated
with potential haemorrhage. Oral propranolol is associated with systemic adverse effects,
including
bronchospasm,
hypotension,
congestive
heart
failure,
and
hypoglycaemia. Application of topical timolol, provides a safe and effective alternative
treatment for superficial hemangiomas and may have fewer systemic effects. While the
mechanism(s) by which timolol reduces hemangiomas is unclear, β-blockade–mediated
vasoconstriction, decreased vascular endothelial growth factor expression, and endothelial
cell apoptosis may all be contributory.
MISC/8 (P) CORRELATION BETWEEN PARENTAL ATTITUDES TOWARDS
DISABILITY AND PARENTAL STRESS
Samir H. Dalwai, Sohini Chatterjee, Veena Hari, Sandhya Kulkarni, Nita Mehta
Saira Mansion, Pahadi Municipal School Road # 2, Goregoan (East), Mumbai- 400063
Email: [email protected]
Introduction: Research indicates that societal attitudes towards persons with disabilities are
largely negative but there is also evidence that attitudes toward disability are improving
worldwide. Objectives: To study the changing trend of attitudes towards disability and its
subsequent effect on parental distress. Study Design: This study hypothesized that negative
parental attitudes towards disability will be correlated with high parental stress in parents
who have a child with disability. Participants and Setting: Sixty parents of children with
disability who are currently receiving therapy at New Horizons Child Development Centre
(Mumbai). Material and Methods: All participants successfully filled in the Form – O of
Attitudes Towards Disabled Persons (ATDP-O: Yuker and Block, 1986) and the Parental
Stress Scale (PSS: Berry and Jones, 1995). Results: A correlation was computed on the pairs
scores obtained from the two scales. The Pearson’s r obtained was -0.403 (p=0.002) showing
a significant negative correlation between parental attitudes towards disability and parental
stress. Conclusion: Parental stress and attitudes are key factors affecting the final outcome of
the child’s therapy thus studying parental attitude and subsequent stress in the light of
recommended therapeutic intervention should be the focus of future research.
MISC/9 (P) ESOPHAGEAL FOREIGN BODY IN A ONE MONTH OLD BABY
PRESENTING WITH RESPIRATORY DISTRESS- A CASE REPORT
Parveen Mittal, Shinu Singla
House No.37, Khalsa College Colony, Near Saket Hospital, Patiala
Email: [email protected]
Introduction - Ingestion of foreign body is a common but a serious problem in pediatric
population. Most common age of presentation is between 6months – 3 years.Curiosity and
preference to oral exploration are two key factors in its prevalence.Esophageal ingestion of
foreign body in neonates is very unusual and rare occurrence. In the following article, we
present a rare case of 2 glass marbles logged as FB in the cervical oesophagus in a one
month-old neonate. The unique age of the patient and associated respiratory manifestations
merits discussion. The Case - A one month old female baby was brought to us with
respiratory distress and excessive drooling and secretions for one day .Child was delivered as
full term healthy baby , was on breast feed .Child was absolutely well for 1 month after birth.
On examination, respiratory rate was 70/min with chest indrawing. On auscultation B/L
rhonchi were present. Child was having blood stained secretions in throat , mouth and needed
aspiration every 1 hr. There was no history of foreign body ingestion. X-ray neck and chest
was done . X ray neck showed two rounded foreign bodies in neck (fig. 1)
Foreign bodies were removed under General Anaesthesia. They came out to be glass marbles
(kanche) – 2 in number lying in the oesophagus of the child .Child continued to have
respiratory distress, excessive secretions and stridor for 2 days after removal of foreign
bodies and then recovered gradually with treatment, was discharged in satisfactory condition
after 10 days. To find out the cause of foreign bodies in a neonate, when mother was
questioned, she told that on the day of the illness child was with her grandmother as she
herself was busy in household chores. She further told that child’s grandmother was upset
due to the birth of a female child . Surprisingly, this child had two elder siblings- both male
.They were away to school when child got ill. Discussion- In neonates ,foreign bodies
ingestion are very rare. Various foreign bodies like stone, safety pin ,ornament ring ,button
have been described in literature. Etiology behind these foreign bodies may be negligence or
homicidal attempt for unwanted child. Classically
foreign bodies swallowed into
oesophagus presents with dysphagia . However oesophageal foreign bodies in neonate can
presents with paradoxical respiratory symptoms .The causes of respiratory embarrassment are
multiple .Ellis and Ardran has postulated that oesophageal foreign bodies press post. Tracheal
wall ,causes irritation of respiratory tract. The oesophageal foreign body can also cause
pushing forward of soft cricoid lamina of neonate and leading to resp. obstruction.
Perioesophageal reaction and oedema of laryngeal inlet may also play a role. Endoscopic
removal is the preferred method for esophageal foreign body in neonates .These can be
removed by using Mc. gill`s forceps under direct laryngoscopy. Esophageal foreign body has
been removed by using optical forceps in Rigid bronchoscope . Failure of removal of
impacted foreign body by these approaches can be managed by cervical exploration. In the
end, we suggest that we must exclude foreign body as a cause of respiratory Distress in a
neonate and should not think that it is beyond the reach of neonate.
MISC/10 (P) A RARE CASE OF THALASSEMIA MAJOR WITH STURGE WEBER
SYNDROME
Ashwini B Kundalwal, Jaikumar S Patel.
C/O Baban K Kundalwal, Rumkai Niwas, House # 5/13/78, B/H Ganesh Kirana Stores,
Padampura Aurangabad, Maharashtra
Email: [email protected]
Case: An 18 months old female child born of 3rddegree consanginous marriage was brought
by mother with c/o increasing paleness of body since 6months and fever, cough since 2days.
Patient had history of 2episodes of convulsion each associated with fever and diagnosed as
febrile convulsion by private practitioner.Developmentally patient had mild mental
retardation. On examination patient had huge hepatospleenomegaly, portwine stain
hemangioma on right side of face. On blood investigation patient had Hb of 3gm%,
microcytic hypochromic picture with low retic count.Hb-electrophoresis was suggestive of
beta thalassemia major. Patient during hospital stay had 1episode of convulsion which was
left sided tonic clonic followed by neurological deficit(left sided hemiparesis) which was
transient and recoverd within 48hrs. Patient on ophthalmic examination had bilateral hazy
cornea and was diagnosed as having b/l buphthalmos. CSF examination was normal. X-ray
skull didnot show any significant findings. CT brain was done which was suggestive of
intracranial calcification in both cortical region, mild cerebral atrophy, ipsilateral choroid
plexus enlargement with no intracranial angiomas. Patient was given packed cell transfusion
and treated for URI and advised regular follow up and packed cell transfusion. Patient was
started on anticonvulsant and topical beta blocker to reduce intraocular tension. Patient’s
seizures at present are controlled and taking regular packed cell transfusion. Conclusion: We
are reporting a case with rare combination of β-thalassemia major and Sturge Weber
syndrome.
MISC/11 (P) EXTENSIVE CUTANEOUS NECROSIS IN A GIRL: AN UNUSUAL
COMPLICATION OF SECONDARY COLD AGGLUTININ DISEASE.
Kirtisudha Mishra, Shilpy Singla, Vineeta Vijay Batra, Srikanta Basu, Praveen Kumar
Department of Pediatrics, Lady Hardinge Medical College & Associated Kalawati Saran
Childrens’ Hospital, New Delhi
Email: [email protected]
Abstract: Cold agglutinin disease (CAD) secondary to infections is a known, but relatively
rare clinical condition, commonly presenting with anaemia and some skin changes like
acrocyanosis and Raynaud’s phenomenon. We report an unusual case of secondary CAD
presenting with extensive cutaneous necrosis. A 12 year old girl presented with fever for 7
days with blackish plaques over face, buttocks and upper limbs for 3-4 days. On examination,
the patient was febrile with pallor, mild icterus and hepatospenomegaly. She exhibited
recurrent transient acrocyanosis with dry gangrene of little finger. There were bluish black,
necrotic areas distributed over bilateral malar areas, nose tip, ear margin, left forearm,
dorsum of both hands and extensive involvement of bilateral buttocks. Investigations showed
low hemoglobin, unconjugated hyperbilirubinemia and a highly positive direct Coomb’s test
due to cold agglutinins of IgM type with anti-i specificity with titres strongly positive at
1:512 dilution at 4℃. Bone marrow examination and coagulation profile were normal and
cryoglobulins were negative. Skin biopsy showed fibrin and IgM deposits. The fever resolved
within a week, skin lesions regressed without any recurrences thereafter. Cold agglutinins
were undetectable 3 months later, ruling out a primary CAD. Our patient was thus diagnosed
as a case of secondary CAD due to an acute infectious febrile illness, manifesting as
widespread cutaneous necrosis. To conclude, cold antibodies released even during a brief
self-limited febrile illness, can cause widespread cutaneous gangrene and mutilating
consequences, rarely reported in literature in adults. This is to the best of our knowledge the
first to be reported in the pediatric age group.
MISC/12 (P) PULMONARY FUNCTION AND NUTRITIONAL STATUS OF
CHILDREN EXPOSED TO SMALL SCALE AGATE INDUSTRIAL UNITS IN
SHAKARPUR, GUJARAT - INDIA
A.S. Nimbalkar, D.V. Patel, A.R. Sethi, A. Patel, A.G. Phatak, S.M. Nimbalkar
Department of Pediatrics, Pramukhswami Medical College, Karamsad-Anand-Gujarat
Email: [email protected]
Background: In Shakarpur of Khambhat, a coastal city of Gujarat, India, several small agate
polishing units operate from individual houses. Prevalence of Silicosis and other co-morbid
conditions is systematically documented recently. Aim: Effect of environmental exposure on
nutritional status and pulmonary function (PFTs) of children in this area was assessed.
Methods: Cross sectional study was conducted in schools of this area. Weight was measured
using standard digital bathroom scale while height was measured using Stadiometer (Seca).
PFTs were measured for Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1st
second (FEV1) using digital spirometer (One Flow FVC memo kit). Out of School children
were not assessed. Results: 240 children (128 Boys and 112 Girls) in the age group of 10 –
16 years participated. 5 children (2 boys and 3 girls below 15 years of age) were working in
agate industry. As per WHO growth standards 56.3% boys and 45.5% girls were stunted
whereas 47.7% boys and 36.6% girls were undernourished. (Body Mass Index less than -
2SD). The mean (SD) FVC [1.82(0.64) for boys vs. 1.83(0.63) for girls] and mean (SD)
FEV1 [1.26(0.33) for boys vs. 1.29(0.34) for girls] was comparable across gender. No
statistically significant difference was found in PFTs of children exposed to in house or
neighboring agate industry as compared to unexposed children. Conclusion: PFTs are
decreased in the entire population of children as compared to standards in Gujarat Population
but agate exposed children did not show worse PFTs. Prevalence of undernutrition in children
was high. Keywords: Pulmonary Function Test, Nutritional Status, Agate, Environmental
Exposure
MISC/13 (P) ACCEPTABILITY AND IMPLEMENTATION OF FIMNCI BY
MEDICAL OFFICERS AND STAFF NURSES IN GOVERNMENT HEALTH
INSTITUTIONS OF WESTERN INDIA
Dipen Patel, Somashekhar Nimbalkar, Uday Shankar Singh, Nikhil Kharod
Department of Pediatrics, Pramukhswami Medical College, Karamsad-Anand-Gujarat
Email: [email protected]
Introduction: FIMNCI (Facility based Integrated Management of Neonatal and Childhood
Illnesses) course has been launched by Government of India to train Medical Officers (MOs)
and Staff Nurses (SNs) of Government Institutions from year 2010 onwards. FIMNCI deals
with intensive care of serious illnesses in children below 5 years. Aim: Would FIMNCI
training impart the confidence and skills required for implementation of this training were our
research questions. Methods:
Cross-sectional Questionnaire based survey from 53
participants of three FIMNCI trainings. MOs and SNs belonged the Primary Health Centres
(PHCs), Community health Centres (CHCs) and Civil hospitals. Questions related to
availability of facilities at their working place; confidence in ability to perform skill based
procedures and acceptability and implementation of FIMNCI. Results: The PHCs and CHCs
have adequate facilities to treat non critical problems but most lack facilities for intensive
care. Most MOs (84.2%) and SNs (79.4%) are confident of triage in emergency room as well
as providing positive pressure ventilation. All MOs and most SNs (61.9%) were confident in
treating sick children at CHC while most MOs (66.6%) and SNs (83.3%) were not confident
at PHC. Most participants preferred that FIMNCI training should be of longer duration. SNs
preferred training in local language. Most MOs were not confident in monitoring of sick
children. Conclusion: More focused training should be provided for the staff of PHCs and
CHCs like ETAT and CPR. Advanced care for various serious illnesses in children cannot be
imparted by short training courses. Keywords: FIMNCI, Medical Officers, Training, Nursing
Staff, Intensive Care
MISC/14 (P) OSTEOMYLITIS PRESENTING AS FRACTURE OF LIMB
KiranMasal, Sameer Wankhede, PayalShah, KailashPatra.
ESIC PGIMRS, Paediatric Department, Andheri, Mumbai.
Email: [email protected]
Introduction- Bone infections in children are relatively common. Staphylococcus aureus is
the most common infecting organism in all age groups, including newborns. Case History - 1
year female child came with history of fever since 5 days,cough and cold since 3days.He
was having difficulty in moving left upper limb .There wasno history fall/injury, history of
joint pains or history of weight loss. We started patient on syp. amoxclav for upper
respiratory tract infection and referred patient to orthopedic surgeon for expert opinion , with
the X-ray of left upper limb which was reported as fracture of lower end of radius. The child
was sent home with posterior slab from orthopedic OPD.After seven days patient again came
withfever and increased pain in left forearm. We investigated Patient with x- ray ofelbow
and wrist jointwhich suggested of osteomylitic changes in lower end of radius. Other
Investigations- revealed as follows: WBC-17500 Neutrophil 87%, lymphocytes 9%,Hb-9.8
gm%, platlet – adequate, ESR raised, CRP- positive with no growth in Blood culture.
Above Xrayshowing osteomylitic changes.
Treatment – -- Patient started on injection vancomycin. Fever responded after 4 days. ESR
and CRP normalized after 7 days. We repeated xray at interval of 7 days which showed
gradual improvement. We continued vancomycin for 28 days.
X ray showing healing while on vancomycin.
x ray showing complete healing.
Discussion- Bone infections in children are relatively common and important because of their
potential to cause permanent disability. Early recognition of osteomyelitis in young patients
before extensive infection develops and prompt institution of appropriate medical and
surgical therapy minimize permanent damage. Long bones are principally involved in
osteomyelitis,the femur and tibia are equally affected and together constitute almost half of
all cases.Radius is involved in 5% cases.
MISC/15 (P) BREATH HOLDING SPELLS IN CHILDREN: A SOCIODEMOGRAPHIC PROFILE
Ravinder K Gupta
Department of Pediatrics, Acharya Shri Chander College of Medical Sciences (ASCOMS),
Jammu, J&K 180017
Email: - [email protected]
Objective: - To study the socio-demographic profile of breath holding spells (BHS) in
children and to see the prescribing pattern regarding use of Electroencephalography (EEG) in
its diagnosis .Design and Setting: - Prospective cross-sectional study conducted at private
medical college. Methods: - All patients of breath holding spells attending outdoor wing of
Department of Pediatrics Acharya Shri Chander College of Medical Sciences (ASCOMS) ,
Jammu from may 2011 to April 2012 constituted the study group. . A structured interview
was under taken at the time of initial consultation to confirm BHS and its type, associated
phenomenon, family history, sex, age, family size and type, various triggering factors for
initiation of spells. All the patients were reviewed to look for presence of tonic clonic
movements with the spell, any previous EEG records, progression of the illness and any other
relevant history. All the children were evaluated for iron deficiency anemia and adequately
treated .The parents were asked regarding previous consultations for this event and various
treatment modalities .All the patients were followed for at least six months. Health education
was imparted. Results :- About 60 children were enrolled for the study. The age ranged from
4 - 36 months with median age of 15 months. In 70 % children BHS began during first 12
months. The males outnumbered females (M: F = 4:1). About 70% of children belonged to
joint families. Pain ( due to fall and some injection), anger and scolding by the parents
constituted various triggering factors for initiation of BHS. The BHS were seen more
frequently in first born. The spells were cyanotic (60%), pallid (28.3%) and mixed (11.7%)
type. About 40 (66%) children had consulted one or more health professionals before
attending the outdoor wing and 28 had undergone EEG. Twelve children were on
anticonvulsants. EEG was done more commonly in those with onset in infancy, with family
history of seizures, attending unqualified health professionals, having associated tonic-clonic
movements and having mixed type of BHS. Conclusions:- BHS are seen more common
during infancy, in first born, males and children belonging to joint families. The spells are
mostly Cyanotic .Majority of primary health professionals continue to requisition EEGs in
the diagnostic work up of BHS. There is need to educate the health professionals regarding
the futility of EEG in the management of BHS.
MISC/16 (P) INADVERANT USE OF DRUG IN CHILDREN
Asha Mukherjee, Somosri Ray, Arghya Kusum Pal, Monomit Halder, Pallavi
31 Lake Temple Road, Kolkata- 700029
Email: [email protected]
Abstract: Introduction: We are sharing our experiences in two children one at 4 years of age
and other at 5 years of age, presented with bleeding duodenal ulcer after taking aceclofenac
and paracetamol combination formulation for 6 days. Both required endoscopic hemostasis
and one of them required several units of packed cell transfusion for severe hematemesis and
melaena. More awareness is required not to use aceclofenac in children,because it is
contraindicated in this age group. Aims And Objectives: 1) To Raise Awareness About Not
To Use Nsaids Combination inadverantly in children. Materials And Methods: These two
children were presented with acute onset hematemesis and melaena following use of
aceclofenac and paracetamol combinations for 5-7 days for pyrexia.Apart from complete
bood count,coagulation profile and liver function test ,both were undergone upper GI
endoscopy and biopsy. Results: Hb% was 4-6 gm% on admission.LFT,PT,APTT were
normal. Rapid urease test and biopsy for H.PYLORI was negative.Endoscopy revealed
multiple bleeding ulcer at stomach and duodenum,needing sclerotherapy and PPI infusion.
Conclusion: The two most important causes of peptic ulcer disease are H. pylori infection and
NSAIDs, accounting for more than 90% . The prevalence of H. pylori positive ulcers has
declined, and NSAIDs-induced ulcers has emerged in Western countries in adults. Among the
drugs, NSAIDs are now often widely used as antipyretic agents in children.The risk of an
ulcer bleeding due to use of NSAIDs is dependent on the dose, duration, and the individual
NSAIDs like aceclofenac which has no recommendation to use in children. Considering the
fact that rapid urease test was negative and histological examination of biopsy specimens
revealed no evidence of H. pylori infection, it is safe to say that NSAID (aceclofenac) was the
cause of duodenal ulcer in these patients.
MISC/17 (P) CHANGING SCENARIO OF CHILDHOOD POISONING: A STUDY
FROM A TERTIARY CARE CENTRE IN KOLKATA
Chaitali Patra, Malay Kr. Dasgupta, Abhijit Dutta, Shatanik Sarkar, Prativa Biswas
Department of Paediatric Medicine, R. G. Kar Medical College & Hospital, Kolkata
E-mail ID: [email protected]; [email protected]
Abstract: Introduction: Poisoning forms a major problem in developing countries.Profile of
poisoning varies from one place to another and it may change over a period of time
depending upon a variety of factors. Early diagnosis, treatment and prevention are crucial in
reducing the burden of poisoning. Aims & Objectives: To determine the profile and outcome
of poisoning in paediatrics and to know the changing trends from the earlier days. Material &
Methods: Retrospective analysis of hospital records of pediatric patients under 12 years of
age, admitted with acute poisoning from January 2009 to December 2011.All stings and bites
cases and drug reactions were excluded from our study.Data were collected in a pre-designed
proforma according to age, sex, poison consumed and outcome and analysed. Results:
Complete data were obtained from 495 admitted paediatric patients with H/O ingestion of
poisonous substances (4.07% of total admissions) & among them, children aged 0-4years
(60.8%) were most susceptible. The overall male:female ratio was 1.3:1,with
kerosene(52.73%) being the most common household agent followed by
medicines(10.3%).The mortality was 1.62%. Conclusion: The trend of pediatric poisoning
noted in our study are quite different from those reported in various other Indian studies done
earlier.The incidence of acute poisoning in children has also been increased and kerosene is
still the leading cause.Ingestion of medicines has taken the 2nd place which was occupied by
insecticides in earlier study. Preventive strategies need to be adopted at a national level to
spread awareness among parents.
MISC/18 (P) NON-RESPIRATORY PRESENTATION OF CHILDHOOD
SARCOIDOSIS
Shatanik Sarkar, Malay Kr. Dasgupta
Department of Paediatric Medicine, R. G. Kar Medical College & Hospital, Kolkata
E-mail ID: [email protected]
Abstract: Sarcoidosis is a chronic, multisystem, granulomatous disorder of unknown etiology.
Pediatric sarcoidosis is rare with an incidence of 0.22-0.27 per 1,00,000 children per year. In
developing countries like India, sarcoidosis is underreported probably due to lack of
awareness and the presence of other more prevalent granulomatous diseases, especially
tuberculosis. 8 year old female child presented with H/O occasional low grade fever, gross
anorexia, pain abdomen and gradual loss of vision for last 6 months. On examination, there
was firm, smooth hepatomegaly and bilateral corneal opacities noted at the lower parts with
distortion of both the pupils. While primary investigations were inconclusive, CT scan
abdomen showed multiple small granulomatous lesions in the liver with evidence of
retroperitoneal lymphadenopathy, and later, liver biopsy corroborated with that. Ocular slit
lamp examination also revealed granulomatous iridocyclitis. After confirming the diagnosis
of sarcoidosis with other supportive evidences, she was treated with oral prednisolone. There
was definite subjective improvement and restriction of disease activity as noted in the
subsequent follow-ups. Infants and children younger than 5 years usually present with the
triad of skin, joint, and eye involvement without the typical lung disease. However, older
children have involvement of the lungs, lymph nodes, and eyes like their adult counterparts.
Undoubtedly, respiratory symptoms are the commonest presenting symptoms in older
children and adults, with hilar lymphadenopathy being the commonest radiographic finding
(71%). But, to our surprise, this child had a non-respiratory presentation unlike the previously
published cases in India.
MISC/19 (P) A STUDY OF ANIMAL BITE IN CHILDREN: RURAL INDIA
PERSPECTIVE
Ankit Shah, Rakesh Mondal, Toshibananda Bag, Goutam Das
Department of Pediatrics, North Bengal Medical College
Email: [email protected]
Introduction: Animal bite is a common public health problem in rural India and children are
most vulnerable population. Rabies, the deadly fatal disease results from animal bites, mainly
dogs. The exact epidemiological profiles of animal bites in children from rural area are still
not known. Aims and objectives: To study clinical and epidemiological profile of children
presenting with animal bite to rural hospital. Methods: All children admitted to pediatric ward
of NBMCH from 1st January 2012 to 30th September 2012 with history of animal bite were
included in study. Detailed history of time of bite, category of bite, myths associated with
bites, and immunization status was taken. Results: A total of 122 children were enrolled in
this study. Male: female ratio was 1.9:1 and 54% were less than 6 years. History of scratch
was present in 62.3%. Dog was the most common animal (77%). 82% were by stray animal,
95% were by unimmunized and 76% were unprovoked bite. 39% were on upper part of body
with most of them < 6 years old (chi square 27.021, df 1, p< 0.001, significant). 43% cases
had category 1 bite while category 2 and 3 had 38% and 19% respectively. 16 % had myths
with lime application most common (6.5%) while 52.5% did wound toilet with soap and
water. Conclusions: Majority of bites is unprovoked and by stray, unimmunized animals.
Younger children are significantly (p< 0.001) more at risk of having bite in upper torso.
Almost half of the cases had knowledge of immediate wound care with soap and water.
MISC/20 (P) EPIDERMOLYSIS BULLOSA HERLITZ TYPE
Amarpreet, Harsh Vardhan Gupta, Gurmeet Kaur Sethi
Department Of Pediatrics, GGS Medical College & Hospital Faridkot
Email: [email protected]
Male infant presenting at birth with bullous erosions with fresh blood oozing out of them on
the scalp, thigh, buttocks and periumbilical area in addition to nail abnormalities in form of
absent nails in one or two fingers with large yellow coloured nails in rest of fingers. Routine
investigations and septic profile at birth was done, TLC -10900/mm3, DLC-Polymorphs 65,
Lymphocytes 29, Eosinophils 2, Monocytes 3, Basophils 1. Serum Sodium 141 meq/L,
Serum potassium 5.5 meq/L. CRP – Negative (<5), Blood culture –No Growth, Culture from
the site of lesion –Shows No Growth, culture of maternal vaginal swab came to be No
Growth, there was no history of any drug exposure as the lesion were present right from
birth. The baby had positive family history in terms of similar lesions at birth in his two
previously born siblings. Both were females born at home having similar type of lesions and
first one died on second day of life and second died on fifth day of life. Ultrastructural studies
were done which demonstrated a split through the lamina lucida with poorly formed
hemidesmosomes and no clearly defined subbasal dense plates, so diagnosis of “
epidermolysis bullosa herlitz type” was made. The case was managed on lines of mimimal
touch technique with avoidance of friction as even minimal friction results in development of
new lesions. Regular liquid paraffin dressings were done. Owing to presence of mouth
lesions baby was started on orogastric feed on second day of life. After one month and 7
days patient was discharged in comparatively good condition although 1-2 small lesions were
still present in buttock area so advised follow up.
MISC/21 (P) COMPLETE RIGHT LUNG AGENESIS WITH DEXTROCARDIA -AN
UNUSUAL CAUSE OF RESPIRATORY DISTRESS
Devki Nandan, Girish Chandra Bhatt, Vivek Dewan, Imkongkumzuk Pongener
Department of Pediatrics, PGIMER, Dr RML Hospital, New Delhi.
Email- [email protected]
Abstract: Introduction: Lung agenesis or aplasia is a very rare with reported prevalence of 34
per 10 lac hospital admissions .We report an infant of right lung agenesis with dextrocardia
with absent right sided pulmonary vessels-a rare cause of respiratory distress. Case report: A
four months old infant presented with history of fever cough and respiratory distress.
Antenatal maternal ultrasonography at 32 weeks revealed severe oligohydramnios. Child was
full term born by normal vaginal delivery, cried immediately after birth and developed
respiratory distress after birth for which he was hospitalized outside and treated as a case of
pneumonia and discharged after fifteen days. Patient remained asymptomatic for 2 months
and admitted to our hospital with above mentioned symptoms. Examination revealed, heart
rate of 120/min, respiratory rate of 65/min, subcostal, intercostals retractions and nasal flaring
with saturation of 94% on oxygen. Chest examination revealed absent air entry on right side
with left sided crepts. Apex beat was present in 4th intercostals area in the right side with
normal heart sounds. Examination of other system was unremarkable. Investigations revealed
hemoglobin 9.7gm%, total leucocyte count 12,000/mm3( Polymorphs 38%, lymphocytes
55%, eosinophils 2% and monocytes 5%).Chest X-ray showed right sided homogenous
opacity with mediastinal shift with herniation of left lung(fig 1). Patient was given
conservative management. Bronchoscopy was done which revealed that trachea continued as
left main bronchus without any stenosis or compression with thick bronchial secretions.
CECT chest showed agenesis of right lung(fig 2) and non visualization of right pulmonary
artery and vein (fig 3) in CT angiography. Echocardiography revealed dextrocardia. Barium
swallow examination showed mild stasis of contrast in right hemithorax. A diagnosis of right
lung agenesis was made and child was discharged after 20 days of hospitalization and doing
well on follow up. Conclusion: Thus, in cases of repeated chest infections with opacification
of right hemithorax and herniation of left lung to affected side, this rare entity must be kept in
mind.
Fig.1: Chest X-ray showed right sided homogenous
opacity with mediastinal shift with herniation of
left lung
Fig.2: Computed tomography of chest showed agenesis of
right lung with non visualization of right pulmonary artery
and vein
Fig 3: CT angiography of 4 months old male child with right
lung agenesis showing absent right pulmonary artery ( Red
arrow) with normal
left pulmonary artery
MISC/22 (P) BRONCHOESOPHAGEAL FISTULA IN A CASE OF HEMOPHILIA A:
RARE ENTITY
NehaJobanputra, Sushma Save, AlpanaSomale, Sandeep Bavdekar
Flat No 402, OMKAR CHS., 511/B R.P. Masani Rd., Matunga, Mumbai 400 019
[email protected]
Introduction: Bronchoesophageal (BE) fistula, as the name suggests, is a communication
between bronchus and esophagus. It may be congenital or acquired. Congenital BE fistula has
been reported to be 25–50% less common than tracheoesophageal fistula, 1 while the
incidence of acquired BE fistula is not known. Acquired causes of BE fistula include
malignancies, infections, and traumatic factors like prolonged endotracheal intubation2 and
blunt chest injury.3 Esophageal foreign bodies resulting in tracheoesophageal fistula have
been reported,4 but association between endoscopy/esophageal foreign body and BE fistula
has been scarcely documented in literature Tracheo-oesophageal (TE) fistulas caused by
Mycobacterium tuberculosis are rare and usually require both surgical treatment and medical
treatment with anti tuberculosis drugs. We present a case with a known hemophilia
superimposed with tuberculosis leading to a Bronchoesophageal fistula. Case Summary: An
eleven year old boy with severe hemophilia presented with breathlessness. This child with
respiratory distress was noted to have decreased breath sounds on parts of right hemithorax.
Chest Radiograph revealed moderate right sided pleural effusion along with persistent
paroxysmal vomiting characteristically post feeding with CT scan and Barium swallow
suggestive of bronchoesophageal fistulae with necrotic mediastinal lymphadenopathy. Patient
was started on ATT. Subsequently Thoracotomy and fistula ligation was done.
Postoperatively child is asymptomatic with weight gain on follow up. Discussion:
Bronchoesophageal fistula (BEF) is due to trauma or infection, most common being
granulomatous disease. To our knowledge, less than 30 patients with tuberculous
bronchoesophageal fistulae have been described .The combination of mediastinal
lymphadenopathy, cough following intake of food should alert the treating clinicians about
possibility of tuberculous bronchoesophageal fistula. Conventionally, BEF require surgical
resection of the fistulous tract. However tuberculous BEF can be effectively treated with
medical line of management alone. Diagnostic delay of bronchoesophageal fistulae has
significant morbidity in children. Conclusion: A high index of suspicion and early referral are
essential in preventing such complications. However there is no association has been
mentioned between Hemophilia A and BEF.
MISC/23 (P) STUDY OF THE INCIDENCE AND CHARACTERISTICS OF TEMPER
TANTRUMS IN CHILDREN 2-6 YEARS OF AGE: A SCHOOL BASED STUDY
Swagat Das
Plot # 18 Budhanagar, Kalpana Square, Bhubaneswar, Khurda-751006, Orissa
Email: [email protected]
Introduction: A temper tantrum (tirade or hissy fit) is an emotional outburst typically
characterised by stubborness,crying,yelling,screaming,defiance,a resistance to attempts at
pacification and in some cases violence. Objective: To study the incidence,associated
behavioural problems and draw inferences on the possible causes and appropriate
management required. Materials and methods: The study was conducted at two play schools
in Cuttack during the months of July and August,2012.The parents of the children were
subjected to a questionarre and answers were noted and inferences drawn accordingly.
Results :Of a total of 57 children (aged 2-6 years),32(56%) were found to have temper
tantrums.They were found to be most common at 2-3 years(63%),less common at 3-5
years(21%) and least common at 5-6 years(16%).They were common in children of upper
social class and Boys:Girls ratio is 3.1:1. Conclusion: This study identifies the causes to be
parental overprotection or parental negligence. Associated behavioural problems include
thumbsucking,enerusis,tics,sleep disturbances,and hyperkinesis. It is most commonly found
in children of 2-3 years of age who have begun going to play school or who are left alone at
home by working parents.Delaying schoolgoing upto 4 years of age and staying with
grandparents greatly reduces the chances of temper tantrums.
MISC/24 (P) HYPOTRICHOSIS AND ALOPECIA IN CHILDREN
Jaswir Singh, Manpreet Sodhi, Kamaldeep
Deptt. Of Pediatrics, Govt. medical college/Rajindra Hospital, Patiala (Punjab)-147001
Email: [email protected]
Aims & objectives: To study the probable etiology of hypotrichosis and alopecia. Material
and Methods: The study included 15 children admitted to Deptt. Of Pediatrics, Government
Medical College, Patiala. Age, sex, grade and type of malnutrition, pattern of hair loss,
pluckability, hair color, general physical and systemic examination were noted on a
predesigned proforma. Various investigations were done to know the systemic illnesses and
localized diseases of hair. Results: Majority of the children (8) were infants, 5 were between
1-3yrs of age, there was only one child each of 6 and 9 yrs of age. There were 8 male and 7
female children. 9(60%) children had malnutrition. Grade І and II malnutrition was present in
3(20%) children each. Two (13.3%) children had grade III and one (6.6%) child had grade IV
malnutrition. Seven (46.6%) children had hair loss from parietal area, 4(26.6%) from
occipital area, 2(13.3%) each from temporal and frontal area & one (6.6%) had
circumferential alopecia. Hypotrichosis was observed in 5 cases, Three (60%) had both
malnutrition and anemia, one (20%) had only anemia and one (20%) had hydronephrosis
.Systemic infection was present in only one patient. Alopecia was observed in 10 cases, 7
(70%) had infections (5 systemic &2 localised), 2 (20%) had seborrheic dermatitis; one
(10%) had traumatic alopecia. One (10%) case of alopecia had Cerebral Palsy. There was no
case with congenital and hereditary alopecia. Conclusion: The predominant etiology of
hypotrichiosis was malnutrition whereas that of alopecia was systemic infection.
MISC/25 (P) ROLE OF BEHAVIOURAL MODIFICATION & STIMULATION IN
AUTISTIC CHILDREN
Baljinder Kaur, Yadawinder Singh, Sheenu Singla
197 Sewak Colony, Patiala, Punjab
Email: [email protected]
Introduction: Language delay & lack of social communication are the major concerns in
autistic children hence the need to study. Aims & Objectives : To study role of behavioural
modification & stimulation in autistic children.
Design: A Prospective study.
Material&Methods: 50 children falling in autistic spectrum,visiting outdoor of Department of
Paediatrics,Government Medical College & Rajindra Hospital were the subjects of study.
Study was conducted for period of 1 year 5 months.Name,Age,Gender,Presenting
complaints,General Physical examination,systemic examination, Developmental assessment,
Parental training, Response to Treatment in form of visually enforced stimulation for
language behavioural modification with imitation play &group activities were recorded on
predesigned ,pretested proforma& data so observed was analysed. Results : 30[60%]
Children were males while 20[40%] children were females. Language delay was the
presenting complaint in 80% of children while lack of protodeclarative pointing was observed
by
25[50%]
of
of
Parents,5[10%]
parents
observed
repetitive
motor
behaviour&rage.Quarterly assessment after stimulation aids& behavioural modification
therapy showed improvement in cognition& language skills in 100% of children while 60%
of children showed improvement in interaction ;However learning skills as per healthy
preschool children were not achieved. Conclusion: There is role of behavioural modification
&stimulation activity in autistic children
MISC/26 (P) EPIDEMIOLOGY OF NON-TRAUMATIC MUSCULOSKELETAL
PAIN IN SCHOOL GOING CHILDREN
Abhishek Saren, Rakesh Mondal, Tapas Sabui, Indira Banerjee, Parthapratim Pan
Dept. of Pediatrics, North Bengal Medical College and Hospital, Susrutanagar, Darjeeling
Email: [email protected]
Abstract: Introduction: Musculoskeletal pain is a common complain of children. Few studies
available in world literature to know the epidemiology of it. From India there are few
attempts to know about it. So we studied the epidemiological picture of various causes of
musculoskeletal pain in school going children. Method: This is a cross-sectional study,
conducted over one year. All school going children of age 3-12yrs of schools around Siliguri,
Darjeeling district and Gangtok , having complain of non traumatic musculoskeletal pains
were examined thoroughly and the data were recorded in a separate pre-designed proforma.
Relevant investigations were done and those having problems were followed up in outpatient
clinic. Result: We have enrolled 3356 school going children. There were 1784 boys and 1572
girls. Complains of non-traumatic musculoskeletal pain were 294( 8.76%) with a male:female
ratio is nearly equal. Among them 188(63.946%) children were suffering from growing
pains, 14( 4.762%) children from hypermobility, 9(3.061%) from idiopathic pain syndrome,
6(2. 041%) from reactive arthritis, 6(2. 041 %) from planter fasciitis, 4(1. 361%) from
apophysitis of symphysis pubis, 4 (1. 361 %)from functional pain, 3(1.02%) from
inflammatory myositis, 2(0.68%) from JIA(enthesitis related), 2(0.68%) from psychogenic
pain, 1(0.34%) from allergic vasculatis, and 55 from mechanical pains(18.707%). Among the
mechanical pains 65.455% cases were found in hills. Conclusion: Musculoskeletal pain is a
common finding in school going children. Most common of them is growing pains.
Mechanical pains is significantly found to common in hills. Large population based
multicentric studies are needed for better delineation of the problem.
MISC/27 (P) JATROPHA POISONING – CASE REPORT
Devpura B, Manjunath, Ravi M.D
Department of Pediatrics, JSS Medical College And University, Mysore, Karnataka.
Email: [email protected]
3 young boys were admitted with complaints of vomiting, abdominal pain and burning
sensation in throat following consumption of Jatropha seeds. The seeds were consumed out of
curiosity while playing. Within 10 minutes all developed burning sensation in the throat.
Within 30 minutes, all had severe vomiting and abdominal pain. One boy had diarrhea too.
The vital signs in all boys were normal. All were given gastric lavage and treated
symptomatically with i.v. fluids and oral rehydration. The recovery time was 6-8 hrs and
children were discharged after 24 hours of observation. The poisonous property of the plant is
mainly due to the toxialbumin called curcin and cyanic acid. Though all parts of the plant are
poisonous, seeds have highest concentration of toxin. The adverse effects in our patients were
consistent with the presentations described in earlier reports. Depression and circulatory
collapse and miosis have also been reported in children. The condition of vomiting, diarrhea
with miosis may mimic OP poisoning. The toxic dose is not known in humans. Treatment is
essentially symptomatic and supportive. There is no specific antidote. Gastric lavage is
indicated when ingestion is recent and activated charcoal may be given. Specific therapy is
required for hemorrhagic G1 symptoms, hemoglobinuria and CNS depression. Accidental
pediatric poisoning is a global problem. Despite its medicinal and other uses, Jatropha plant is
highly poisonous. The very purpose of this article is to make the practitioners and general
population aware of the potential toxicological dangers of this common plant.
MISC/28 (P) HYPOXIA, NECROSIS…NEPHROCALCINOSIS! (A RARE CAUSE OF
PHROCALCINOSIS IN AN INFANT)
Rachel R Peterson, Prashant Kumar S, Neena John, Spurgeon R
Department of Pediatrics, Bangalore Baptist Hospital, Bellary Road, Bangalore -24.
Email: [email protected]
A 37 day old infant born by emergency LSCS to a primi mother with gestational
hypertension presented with lethargy and poor feeding. There was history of meconium
aspiration and birth asphyxia at birth. On examination, he was dehydrated, hard
subcutaneous nodules were present on the entire back and posterior aspect of limbs. On
investigation, S.Calcium was elevated at16.7mg %, S.phosphate was 2.2mg/dl, S. creatinine
1.3 mg%, urinary Calcium/creatinine ratio was elevated and ultrasound abdomen showed
bilateral nephrocalcinosis. 25- hydroxyVit D level was <3 pg/ml, S.Parathyroid hormone
was <0.1pg/ml.S. Calcium levels of both parents was normal. Biopsy of the subcutaneous
nodule showed focal fat necrosis multinucleate foreign body type giant cells and focal
calcification.suggestive of subcutaneous fat necrosis (SCFN). A diagnosis of hypercalcemia
secondary to SCFN was made.He was treated with hyper hydration, frusemide,prednisolone
and later given Inj.Pamidronate 1mg/kg in view of persistent hypercalcemia . Serum calcium
normalized after 80 hours and renal failure also resolved. Discussion: SCFN is a self limiting
panniculitis which affects healthy term neonates usually following obstetric trauma,
meconium aspiration, birth asphyxia , hypothermia, and gestational hypertension in the
mother. Hypercalcemia. is a rare and life threatening complication with a mortality of 15% if
left undetected. Infants with hypercalcemia may be asymptomatic or manifest with vague
symptoms like refusal to feed,lethargy, irritability, vomiting, polydipsia or polyuria.
Conclusion : In infants presenting with hypercalcemia ,hypercalciuria and nephrocalcinosis
SCFN should be considered. Regular monitoring of S. calcium levels in infants with SCFN
is essential to prevent complications like nephrocalcinosis.
MISC/29 (P) QUALITATIVE ANALYSIS OF POSTMORTEM DATA INTO THE
UNNATURAL DEATHS OF CHILDREN AND ADOLESCENTS
Shivani Deswal, Pradeep Debata, Manish Kumath, K.C Aggarwal
Department of Pediatrics, Safdarjung hospital & V.M.M.C, New Delhi
Email: [email protected]
Introduction- Deaths in children particularly in under five are due to the common childhood
problems like diarrhoea, ARI, malnutrition and others. As the age goes up and the child
becomes an adolescent, the cause differs. About 10.3% of all deaths in children are due to
unnatural deaths. Post mortem data provides a valuable source of information on the
aetiology of unnatural deaths and analysis of these records may help elucidate potential areas
for intervention. Aims & Objective - To survey unnatural deaths among 1-19 years in a
tertiary care referral hospital of northern India and to suggest preventive measures. Material
& Methods-All unnatural deaths in age group 1-19years in year 2009-10 were identified in
the databases of the Department of Forensic Medicine in Safdarjung hospital, New Delhi, a
major referral hospital of Northern India. Results- 434 unnatural deaths were found of which
224(51.6%) were female and 210(48.4%) were males. 48 (11%) were from 1 to 5 year, 63
(14.5%)were from6 to 10 year and 323 (74.5 %) were above 10 years to 19years.Major
unnatural causes in all ages were burns ,Road traffic accidents and poisonings while fall was
2ndmost common cause in 1-5 years and electric burns were seen predominantly in >11yrs
boys. Drowning (0.46%) and Chemical burns (0.23%) were least common. ConclusionUnnatural childhood deaths are a growing global concern, one that falls disproportionately on
developing countries where public health systems are least prepared to address this problem
and execute preventive measures. The study shows how mortality among young people could
potentially be markedly reduced if proper counseling and road traffic precautions are
emphasized and among toddlers, if falls can be prevented.
MISC/30 (P) TRICHOBEZOAR IN ADOLESCENT GIRL – A RARE CAUSE OF
BOWEL OBSTRUCTION
Hardik Gandhi, Madhur Gupta, Varsha Shah, Bhairavi Shah
Department of pediatrics, Dhiraj Hospital, Pipariya, Gujarat
Email: [email protected]
A bezoar is an intraluminal mass formed by agglomeration of undigested material in the
gastrointestinal track. A tricobezoar(hair ball) is made up of hair and seen in young women
with trichotillomania and trichotillophagia. It is usually formed in the stomach. Occasionally,
they have a tail that extends to the cardia, pylorus, and duodenum, or even further to jejunum
and ileum. When the entire small intestine is involved, the disorder is called Rapunzel
syndrome. In trichobezoar symptoms include epigastric pain, nausea, loss of appetite and
bowel or gastric outlet obstruction. Trichobezoars are a rare cause of bowel obstruction of the
proximal gastrointestinal tract. Trichobezoar most commonly seen in patients less than 30
years of age with the most dominant fraction of age is compromised between 15 and 20 years
old with 90% females. Case : We report a 14 year old girl with no medical past history with
complain of fever, abdominal Pain and vomiting of acute origin admitted to pediatric ward.
On examination patient had hepatomegaly with lump in left hypochondrium. So,by two
senior consultant two possibilities made- 1)spenomegaly 2)bezoar. Blood picture shows
hemoglobin-10.4g/dl , total count-18,000/cu mm, with sickling positive. On Hbelectrophoresis showed sickle cell trait. Ultrasonography done twice which showed
hepatomegaly with inflamed mesenteric lymph nodes with no evidence of bezoar. But
clinically lump was present so CT scan was done which showed gross distention of stomach,
duodenum and proximal jejunal loops noted with internal soft tissue, fatty material feeling
defect suggestive of gastric bezoar with multiple mesenteric nodes p/o reactive lympadenitis
with mucosal thickening of distal jejunal loops due to inflammation with mild hepatomegaly.
After that for confirmation upper GI endoscopy performed which showed the presence of
large bunch of hair fibers mixed with food particles along with contour of stomach and
extending into pylorus, a large ulcer crater is noted at the fundus due to presence of hair fiber
with stomach mucosa shows feature of acute gastritis. At that time there was no history of
hair loss or hair eating. Patient needed surgical intervention ,so referred to surgeons for
further management.Exploratory laparotomy was done and mass removed which was 900
gmand 40 inch longwhich showed macroscopically hair ball and that was sent for
histopathology which showed hemorrhage, necrosis and inflammation in pylorus of stomach.
After that patient was discharged with psychiatry reference and favorable outcome. Though
we couldn’t have history of hair eating, after the operation was done her parents agreed that
she had a habit of hair eating. Further follow up was done and now she becomes free from
symptoms.
MISC/31 (P) CHRONIC IMPACTED OESOPHAGEAL FOREIGN BODY AT
UNUSUAL AGE
Satish Ashtekar, Uday Rajput, Nikhil Kadam, .S.S.Wagh, Bhavesh Shah
Government Medical College, Miraj, Sangli- 416410, Maharashtra
Email: [email protected]
Abstract: Foreign body ingestion is a common problem in children.Most of swallowed
foreign bodies will pass spontaneously and in many instances may go unrecognized
especially in children. About 10-20% of swallowed foreign bodies will be impacted in GI
tract.(1)(2) Especially chronic Esophageal FB is a common problem especially among infants
, children who are mentally retarded,with developmental delay(who cannot communicate
about it).(3)(4) However we come across chronic foreign body impacted in oesophagus in a 7
yr old child with normal intelligence, which is an unusual age to be present as impacted
foreign body. Our patient is 7 year boy,case of HIV on antiretroviral therapy since last 4
years.He is a school going child with average performance in studies. He presented with 6-8
episodes of daily vomitting for the past 4 months, associated with dysphagia and drooling of
saliva for the last two months.He was tolerating only lliquids. Patient was completely
investigated for vomiting in view of HIV status (drug induced gastritis or pancreatitis.
Conservative management with prokinetic agents and fluids was initiated. Barium swallow
revealed a filling defect at the lower end of esophagus. Subsequent esophagoscopy showed a
date seed impacted against middle esophagus Conclusions- Only a single report exists of
chronic vegetative esophageal foreign body impacted in the middle esophagus(3) (5).with
best of our literature search we have not come across any case of older child presenting as
chronic impacted foreign body for long duration. In our case, a vegetative foreign body
remained impacted in the middle of esophagus removed endoscopically. The stricture noted
may be prior to or might have occurred secondary to the impactions.
MISC/32 (P) SCORPION STING: A RARE CASE PRESENTED WITH
MYOCARDITIS, ENCEPHALAOPATHY AND COAGULATION DERANGEMENT
SIMULTANEOUSLY.
U. Rajput, N.Kadam N. Darvhekar, S. Wagh
Department of pediatrics Government medical college, Miraj, Sangli- 416410, Maharashtra
Email: [email protected]
Abstract: Scorpion sting is a very common problem in rural India. Patient with scorpion sting
is known to present with different complication depending on the venom of the species, age
of scorpion and the season. Many cases of scorpion sting had been reported with autonomic
storm and myocarditis. Rarely scorpion sting can present with encephalopathy and intra
cranial bleeding/ thrombosis. We report a case of seven year old female child presented with
autonomic storm, myocarditis with rare accompaniment of encephalopathy and coagulation
derangement after scorpion sting. Seven year female child present with history of scorpion
sting .and started with tablet prazocin 30 microgram/kg. patient develop altered sensorium
with GCS of 9 with signs s/o diffuse cortical involvement indicating encephalopathy. Patient
had persistent tachycardia and gallop rhythm. ECG showed QTc of 0.5. Cpk- MB was raised
(68) but blood pressure was maintained. X ray chest suggestive of borderline cardiomegaly.
Patient was started with iv fluids and dobutamin by 10 micro. Gm/kg/min.Pateint also had
hematemesis with deranged PT/INR.Pateint has been transfused with FFP. Diagnosis was
kept as scorpion sting with myocarditis with encephalopathy with coagulopathy. CT scan was
suggestive of mild cerebral edema. Patient starts improving from day 4 of hospitalization.
Bleeding manifestation stopped, consciousness improved. 2 D Echo at the time of discharge
was within normal limit. QTc interval normalized. Patient improved completely without any
deficit and was discharged.
MISC/33 (P) GENU RECUVATUMCONGENITUM – A CASE REPORT
Vinay Mishra, BijalMistry, Pradeep Kumar Ranabijuli, SitaKumari, KaifiSiddiqui
1004 Sunbeam Swastik Park, Near WMI Cranes, Village Road, Nahur West Mumbai 400078,
Maharashtra
Email – [email protected]
Abstract: Introduction: Congenital genu recurvatum is a rare malformation of knee joint
characterized by excessive hyperextension at tibiofemoral joint. It is also calledknee
hyperextension and back knee. Incidence of this condition is 17 per million live births and is
more common in females(M:F- 1:2.3). Here we present a case of a neonate born
withcongenital genu recurvatum of right knee and managed conservatively with
physiotherapy and regular follow-ups. Case report: A full term male neonate was born
vaginally by vertex presentationto twenty-two years primigravida with history of pregnancy
induced hypertension and oligohydramnios (amniotic fluid index-6 at 37 weeks of gestation).
Delivery was uneventful, baby cried immediately after birth and birth weight was 2500gms.
On examination there was abnormal hyperextension at right knee joint. Left knee and both
the hip joints were normal. Systemic examination was normal and there were no other
external congenital anomalies. Plain radiographs of right knee joint revealed no bony
pathology or joint dislocation.There was no evidence of dislocation or dysplasia of both the
hip joints. Patient was managed conservatively with muscle strengthening exercises around
the right knee joint and one to one counseling of caregivers to allay anxiety and explain the
benign nature of the condition. The infant was kept under close follow-up to assess the effect
of physiotherapy. The infant is now five months of age with normal movements around right
knee joint. Discussion: Congenital genu recurvatum, first reported in 1922 is an uncommon
condition that can present in three different forms, namely, congenital hyperextension,
congenital hyperextension with anterior subluxation of the tibia on the femur, and congenital
hyperextension with anterior dislocation of the knee joint on the tibia. It is commonly seen in
breech deliveries.Diagnosis is made by physicalfindings of hyperextension of knee joint and
radiographs confirm the diagnosis.The treatment depends on the severity of thedislocation
and the age of the patient.Early manipulation and physiotherapy is the mainstay of treatment.
Late presentations and severe dislocations require surgical corrections. Conclusions: 1)
Congenital genu recurvatum is ominous to look but benign in nature. 2) Treatment is mainly
conservative. 3) Counseling of caregivers has an effect on overall outcome of the condition.
MISC/34 (P) RISK FACTORS FOR CHILDHOOD DENTAL CARIES: AN
OBSERVATIONAL STUDY
Nakul Kothari, Parul Khanduja, Vikram Patra, Bageshree Seth, Vivasvan Parekh, Sohil
Singhai
Department of Pediatrics, M.G.M hospital, Kalamboli, New Bombay
Email: [email protected]
Dental caries is a significant pediatric problem which is often neglected which leads to
morbidity later in life. Also, dental treatments are expensive. An awareness of risk factors
will help prevent this. There are not many published studies related to analysis of risk factors
& protective factors causing dental caries in our country. Hence, we conducted a study to
analyze the prevalence & risk factors for dental caries. Aims & objectives : 1) To study the
prevalence of dental caries in children aged 1 – 8 yrs. 2) To assess common risk factors for
dental caries. Materials & Methods: Study design – Cross-sectional observational study. 100
children aged 1 – 8 yrs coming to pediatric OPD in a tertiary care hospital were examined for
dental caries & their parents were questioned & findings were recorded in a pre-structured
proforma. Results: Dental caries was seen in 49% of observed cases. Both sexes were equally
affected. Most affected were children in the age group of 3-5yrs (49%). Prematurity is also a
significant risk factor as 60% preterms in our study had dental caries. However, LBW babies
were not at increased risk. 40% of affected children had mothers with dental problems. Spoon
and utensil sharing was seen in 63%. Prolonged exclusive breast feeding has been associated
with higher risk (60%) and equally the risk is seen with night time bottle feeds. 89% and 96%
of cases gave history of snacking in between meals and consumed chocolates daily
respectively. Initiation of brushing lately after the age of 2 yrs predisposes to dental caries
(61%). 76% children who developed caries were not supervised while brushing. Conclusion:
Avoiding frequent snacking, reducing chocolate consumption, not sharing spoons, early
initiation & supervised brushing can reduce development of dental caries.
MISC/35 (P) PATENT VITELLO-INTESTINAL DUCT
Rathod.A.D, Somasekharan.R, Sharma.B, Patil.C
Prof Of Pediatrics, Bldg-1, Flat # 15, Sir JJ Hospital Campus, Byculla, Mumbai- 400008,
Maharashtra
Email: [email protected]
Abstract:-During the 3rd week of intrauterine life there is a communication between the
intraembryonic gut and the yolk sac. As the development proceeds this communication
narrows into a tube known as the vitellointestinal duct (VID) OR omphalo-mesentric duct.
With the establishment of placental nutrition this duct usually becomes obliterated by the end
of the 7th week of intrauterine life. In about 2% of humans this duct persists and gives rise to
a group of anomalies of which Meckel's diverticulum is the commonest and complete patency
of the duct is the rarest. We present a case of 17 day old neonate came with complaints of a
red mass protruding from umbilicus and discharge through the same. On examination vitals
were stable no signs of sepsis, a reddish mass protruding through umbilicus with
serosanguinous discharge coming through it;Mass was expansile on crying and irreducible
,skin around umbilicus –normal.infant feeding tube was passed through the opening which
went 6-7 cm inside and was bile stained s/o remnant ofvitello intestinal duct.Explorative
laparotomy was planned and Dye study done during laparotomy revealed patent
vitellointestinal duct so excision of the duct with ileo-ileal anastomosis was done.
Postoperatively child is doing well clinically.
MISC/36 (P) TEXT MESSAGE INJURY / SUPER THUMB GENERATION
Joeimon. J. L., Srinivas. P., N. Ganga, V. Vairavan
Department of Paediatrics, Vinayaka Mission’s Medical College and Hospital, Karaikal
Email: [email protected]
(a) Introduction: Modernisation decreased manpower and increased machine power. Era of
transition characterized by life style health hazards. Kids are no exception. Percentage of
population access mobile: 25 %. Percentage of population who text message: 12.5%.
Percentage of population with text message injury (TMI): 6.2%. (b) Aims & Objectives: 1)
To draw a Comparison between user and non-user of mobile text messaging. 2) To access
compromise to the thumb muscles. 3) To create an awareness about text message injury. (c)
Material & Methods: 4 groups of 50 adolescents each in age group 15-16 yrs without
physical impairment were selected by informal interview. The control group was mobile text
users who used only when necessary. The 3 study groups were non mobile text message
users, moderate mobile text message users and heavy mobile text message users. 20-40
messages alternate days was taken as moderate usage criteria and 80-100 messages per day
was taken as heavy message users criteria. Each group were exposed to Activity Based
Assessment such as card test, coin test, inflate test, screw & unscrew test, paper tear test, text
message test and results formulated on % of subjects completing task to the level of control
group. (d) Results:
Tests
Group 1 (%)
Group 2 (%)
Group 3 (%)
Card Test
57
96
41
Coin Test
74
86
43
Inflate Test
81
84
38
Screw & Unscrew Test 60
100
48
Paper Tear Test
70
70
60
Text Message Test
17
85
90
(e) Conclusions: This study shows that there is a compromise in muscle activities of thumb
due to heavy text messaging (Text Message Injury) and an enhancement in muscle activities
due to moderate text messaging (Super Thumb) which can be attributed to activity mimicry.
Text message injury is a preventable lifestyle disease. Awareness is to be created.
MISC/37 (P) LATE MANIFESTATION OF DIAPHRAGMATIC HERNIA
Tago N, Nayak L, Das L, Mohanty N
Deptt. Of Pediatrics SVPPGIP & SCB Medical college, Cuttack Odisha
Email: [email protected]
Background: Congenital diaphragmatic hernia (CDH) in most cases presents immediately or
within hours after birth with signs of respiratory failure,dyspnoea,tachypnoea and cyanosis.
Late presentation of CDH ( i . e beyond the neonatal period ) is less common and represents
a diagnostic challenge. Incidence of CDH is 0.1 – 1 /10,000 and < 10% presents after the
neonatal period. The prognosis is better in cases with late presentation of CDH because
pulmonary hypoplasiadoesn’t develop. Case: A 3½ year Mch presented with chief complaints
of mild fever, cough and cold and some respiratory distress for 22 days.The child was treated
for the same symptoms at a primary health centre with oral antibiotics for 7 days. The
symptoms did not subside and the chest radiograph radio opacity did not resolve. The patient
was started on empirical anti tuberculosis treatment for 15 days. But the symptoms and the
radio opacity did not resolve, so the patient referred to our institute.The patient had history of
repeated chest infection in the past. On examination air entry was reduced on left side. The
chest radiograph showed radio opacity on left side with mediastinal shift to right side and
some lesions like pneumotoceles. A HRCT scan chest was done on the child. The HRCT
chest showed herniation of small bowel and large bowel loops within the right hemithorax
causing mass effect-compression of left lung and mediastinal shift to right side suggesting
diaphragmatic hernia mostly of Bochdalek type. Discussion: In 90% cases of Bochdalek type
of CDH, presentation is immediately after birth with severe respiratory distress. Delayed
presentation can cause diagnostic difficulties as symptoms are vague and non-specific.
MISC/38 (P) CHYLOTHORAX AFTER REPAIR OF CONGENITAL
DIAPHRAGMATIC HERNIA – A CASE REPORT
Abhay B Mahindre, Ravi, R Kishore Kumar, S Ramesh, Nandini Nagar, Suma
Neonatal Department, Cloudnine Hospital, 1533, 9th Main, 3rd Block Jayanagar, Bangalore –
560011, INDIA
Email: [email protected]
Introduction: Chylothorax following repair of congenital diaphragmatic hernia (CDH) was
first reported by Wiener et al in 1973. It was not until recently that chylothorax was
recognised as a relatively common cause of effusion after repair of CDH. We describe one
such case treated conservatively. Case report: G4P1A2L1 mother’s antenatal scan showed
left CDH, delivered a baby boy by Caesarean section with a birth weight of 3.24 kg, was
electively intubated @ birth. Chest radiograph confirmed the presence of left CDH. Surgical
correction was done @ 40 hours of life after stabilisation. Intra-operatively, a large
posterolateral defect of the left hemidiaphragm with entire stomach, spleen, large & small
intestines herniating into the chest and hypoplastic left lung noted. Baby was extubated on the
11th post-operative day. His recovery was uneventful, feeding was gradually introduced.
However, on day 14 baby developed progressive respiratory distress. Ultrasound showed
bilateral accummulation of fluid in pleural cavity. Hence, bilateral intercostals drainage tubes
were placed. The gross appearance of this fluid was suggestive of chyle and biochemical
analysis confirmed high triglyceride (351 mg/dL). Baby was put on full enteral nutrition and
occasional breastfeeding. Chylous effusion gradually became less and the chest tube was
removed after ten days. The baby was discharged at one month of age, after attaining
satisfactory weight gain, established full enteral feeding with the high medium-chain
triglyceride formula (Simyl MCT) and had no re-accumulation of chylous effusion. At four
months of age, he was symptom-free and ultrasonography showed a complete resolution of
chylous effusion.
MISC/39 (P) UNCOMMON FATAL COMPLICATION OF ORAL PHENYTOIN
TOXICITY: VENTRICULAR TACHYARRYTHMIA
Kundan Mittal, Nikhil Vinayak, Haripal Kashyap, Jaya Shankar Kaushik
DISC-department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences,
Rohtak, Haryana, India-124001
Email: [email protected]
Abstract: Background: Phenytoin toxicity usually manifests in children with confusion,
nystagmus and ataxia. Cardiac complications such as arrhythmias and hypotension are rarely
observed with oral overdose although it is well known with rapid administration of
intravenous phenytoin. We report a case of a child with acute oral phenytoin toxicity who
succumbed due to ventricular fibrillation. Case report: A eighteen month old boy presented
with a history of accidental ingestion of twenty 100mg phenytoin tablets (total 2 gm, 285
mg/kg) following which he had multiple episodes of vomiting and altered sensorium. The
child came to casualty with a delay of 8 hours following ingestion of tablets. There was no
history of abnormal movements of limbs or respiratory distress. On examination the boy was
malnourished, sick looking, normal vital signs. Respiratory, cardiovascular and abdominal
examination was normal. The child had altered sensorium with GCS of 9/15, intermittent
decerebrate posturing with brisk DTR and extensor plantar reflex. Child remained
hemodynamically stable and seizure free during hospital stay. Initial investigation revealed
anemia (Hb 7.2 g/dl), SGPT of 53 U/L. Serum electrolytes, Calcium and ABG was normal.
Serum phenytoin levels at admission were 43.2 mg/L. Baseline 12 lead ECG was normal.
Within 6 hrs of admission the child’s condition suddenly detoriated with ECG showing
changes consistent with ventricular fibrillation. Defibrillation and amiodarone was given but
the patient could not be revived. Conclusion: Oral phenytoin toxicity can rarely present with
rhythm disturbances like ventricular fibrillation. Such rhythm disturbances although rare
should be anticipated among children admitted with phenytoin toxicity following oral
overdosage.
MISC/40 (P) AMC (ARTHROGRYPOSIS MULTIPLEX CONGENITA) RARE CASE
S.K.Murmu, Nagajyothi S, Manoj Kumar Acharya, Praveen Nayak.
Department of Pediatrics, VSS Medical College & Hospital, Burla, Sambalpur, Odisha
Email: [email protected]
Abstract: A Rare condition charactersied by congenital multiple joint contractures .Incidence
being 1/3000 live births. These occur as a result of decreased/lack of intrauterine fetal
movements which may be due to abnormal shape of the uterus /oligohydraminos /muscular /
neurologic pathology .This decreased movements leading to development of extraconnective
tissue around joint
forming contractures. The most common form of AMC is
AMYLOPLASIA , characterized by typical position of the limbs, absent muscle tissue ,
midfacial haemangioma , Dimple at the joint due to lack of movements ,abdominal structural
anomalies . Case Report: A First order full term newborn delivered by LSCS was admitted to
NICU with multiple anomalies . Birth weight being 2.6kg with round face , low set ears
,micrognatia , slender limbs , absent creases on palms and soles , hypaplastic nails
,undescended testis , jejunal atresia ,abdmonial distension . POSITION OF LIMBS : Upper
limbs :Bilateral Shoulders rounded and internally rotated ,elbows extended , wrists flexed,
slender upper limbs. Lower limbs : Bilateral Hips flexed ,abducted ,externally rotated ,knees
flexed , ankle talinoequinovarus position. Thus the diagnosis of amyloplasia variety of AMC
was made.
MISC/41 (P) A RARE ASSOCIATION OF RADIAL ARTERY STENOSIS
Sreeraj R., Sheeja Sugunan, Bindu G.S., Geetha S., K.E. Elizabeth
Sat Hospital, Thiruvananthapuram
Email: [email protected]
A 6yr old male child was admitted to our ER with c/o coldness in the right hand since 5days,
bluish discoloration of the palm since 5days and pain in the right hand since 3 days. On
clinical evaluation his right hand was cold & cyanosis over finger tips was visible. His right
radial & ulnar arteries were not palpable but his right brachial was palpable. All other
peripheral pulses were palpable. His Cardiovascular examination was non-contributory, and
all his other systems appeared to be within normal limits. Our routine investigations revealed
normal counts and values. An emergency Doppler that the patient meanwhile underwent
showed normal triphasic flow in brachial but the ulnar & radial showed only biphasic flow
with non-dilated deep veins. His Echocardiogram turned out to be normal. A CT angiogram
was taken which showed short segment focal stenosis at the distal radial artery just proximal
to distal radioulnar joint and gradual tapering of ulnar artery in the middle & distal 1/3rd with
poor distal run off. On further evaluation regarding possible etiopathogenesis, there turned
out to be decreased Protein S 15%. Literature has described the existence of Renal, Vertebral
and Carotid artery stenosis associated with Protein C and S deficiency, though the exact
mechanism hasn’t been elucidated. This is probably a very rare case of Protein S associated
with Radial artery stenosis.
MISC/42 (P) MEDICATION ERRORS IN CHILDREN;NEED FOR A
COMPREHENSIVE APPROACH
Rajesh Kaul, Sanjeev Kumar Digra, Brij Mohan Gupta, ,Subhash Singh Slathia, ZahidGilanil
Department of Pharmacology, Govt. Medical College Jammu
Email: [email protected]
A medication error may be defined as an error in drug ordering, transcribing, dispensing,
administering, or monitoring. Some are caused by errors and classified as preventable, while
others are not preventable Childrens are at greater risk than because of immature physiology
& developmental limitations that affect their ability to communicate and self-administer
medications. Giving an adult dose to a child without considering the child's weight, age, and
clinical condition can cause an overdose and may result in toxicity and death. In case of
children in India the situation is more serious since the documentation is grossly inadequate
and it is not only qualified people who prescribe drugs to children.Though advances have
been made, a lot still needs to be done. Healthcare institutions should formulate strategies that
are appropriate to their resources and limitations.A motivated staff, active involvement of
parents in correctly understanding the medications are mandatory. If the doctors spend a little
more time with the parents, it will significantly reduce these errors. Among hospital therapies
complexity of protocols are the main reason. Illegible handwriting being the overall main
reason. Prescriptions should be printed by hand or computer. Availability of competent
nurses, overseen by pharmacologists ensuring computerized order systems for correct
dosage schdules&recording adverse events . Use of technology for records, standardized
protocols, and ability to manage situations involving unusual medication. Caregivers have a
responsibility in identifying contributing factors to medication errors and to use that
information to further reduce their occurrence. Current approaches to preventing medication
errors are inadequate and require a shift in emphasis to a scientific investigation of
preventable patient harm.These skills should be a part of the medical teaching curriculum
from the undergraduate level itself. Though there is still a long way to go in this regard, the
goal is not unrealistic and can be achieved through dedicated and sustained efforts. .
MISC/43 (P) CLINICAL PROFILE OF SCORPION STING PATIENTS IN
RELATION TO URINARY CATECHOLAMINE LEVEL
J.P. Soni, Suyog, Sushil Choudhary, Rakesh Jora, Pramod Sharma
Shivam Hospital, Mahaveer Colony, Ratanada, Jodhpur
E-mail-: [email protected]; [email protected]
Introduction: Scorpion stings are major public health problem in many tropical and
subtropical countries. The clinical manifestations produce following scorpion sting are
related to autonomic storm resulting from pouring of large amount of adrenaline and noradrenaline in circulation. The present study aimed to find out relation between elevated
urinary catecholamine level and varied clinical manifestation of scorpion sting patients.
Methods: This was a prospective study.All cases admitted to umaid hospital jodhpur
between Sep2010 to Aug 2011 with history of scorpion sting were analysed. On admission,
particulars of the patient ,detailed history were noted followed by thorough physical
examination. All the patients were catheterised for 24hours urinary collection and estimation
of 24 hours urinary catecholamine level done by ELISA. Results: A total of 25 cases were
reported during the study period. Of this 21 (84%) were from rural region and 4(16%) were
from urban region. The victims were predominantly male and aged 1-5 years. In our study
group, cold extremities, sweating were observed in all 25 (100%) patients.Number of
hypertensive, hypotensive and normotensive patients were 17 (68%), 3 (12%),and 5 (20%)
respectively . The normotensive patients of scorpion sting was have normal urinary
catecholamine level while hypertensive or hypotensive patients was having significantly
higher urinary catecholamine (adrenaline as well as nor adrenaline ) with statistically
significant difference (p<0.05). More the urinary catecholamine level more was the time
duration for recovery. The mortality rate in our study was 6.5%. Conclusion: 24 hours urinary
catecholamine level is well correlated with the cardiovascular manifestation. The severity of
the clinical manifestation was directly proportionate to the amount of rise in the level of
adrenaline and noradrenaline after catecholamine storm.
MISC/44 (P) RELATION OF SCHOOL ABSENTEEISM WITH ADDICTION
HABITS AND ABUSE: A STUDY FROM SOUTHERN RAJASTHAN
Umang Upadhyay, Nitin goyal, Abhishek Ojha, Nitesh kumar, Suhel Abbas, Aditya Goyal,
Akber ali, Devendra Sareen
C/o Dr. Devendra Sareen 27 F New Fatehpura Udaipur
Email: [email protected]
Introduction: School absenteeism is a very critical problem of a school going child. It is also
related to the performance of a child in the school. The better the attendance, the better the
achievements and vice versa. There are various factors that are related to school absenteeism.
Aims And Objectives: The present study was planned to find the prevalence of school
absenteeism and its relationship with addiction and abuse or scolding. Materials And
Methods: The present cross sectional study was carried out in 5000 children of Udaipur
district. Age group studied was from 8 years to 18 years. The school absenteeism was
checked by attendance register of each class and was verified by class teacher, principal and
parents. A detailed assessment of the educational status of the parents was done. All these
findings were recorded in printed protocol and data analysis was done. Observations: We
observed that though addiction in father and mother contributed to absenteeism in students,
its incidence was surprisingly lower than the overall rate of absenteeism. On the other hand
rate of absenteeism was alarmingly higher in students who’s siblings were addicted (27.11%)
and who were either addicted themselves or had addicted friends (35.45%). These students
were more interested in procuring the substances used for addiction, which had a negative
effect on their school attendance and achievement. Abuse / scolding at home (17.53%) and/
or school (35.73%) had a major bearing on school absenteeism (25.30%). To conclude, such
counterproductive practices should be severely criticized to ensure optimum school
attendance and achievement.
MISC/45 (P) GRATIFICATION DISORDER: A CASE REPORT IN A 18 MONTH
CHILD
Bal Mukund
Department Of Pediatrics, Inhs Jeevanti, Vasco Da Gam – 403802, Goa
Email: [email protected]
Introduction: In general little have been published about masturbatory behavior in infantile &
preschool age group in literature. Timely identification and and home video helps in avoiding
unnecessary investigation and are reassuring for parents. Case Report: A 18 month old male
toddler, only product of non-consanguinous marriage was referred from a nearby unit MI
room with history suggestive of seizure since last one month. Parents gave history of dystonic
posturing with one lower limb placed on other lasting for aroud 5 minutes, 2-3 times per
week in last one month or so. They denied any history of eye deviation, frothing from mouth,
invol passage of urine/stool, fall or loss of consciousness and sleep after the episode.The
child used to recover after the episode completely. There was no history of fever, history of
similar complaint in past. Parents denied any histpry of epilepsy or neurological illness in
family. On examination he was clinically stable with normal general and systemic
examination including detailed neurological examination. Prior to referral EEG was done at
previous consultation was normal. A provisional diagnosis of Idiopathic Infantile Dyskinesia
was made. Parents were asked to video shoot the event and review. The parents mailed a
video shoot of the episode after two days confirming the diagnosis. Parents were reassured
about the benign nature of episode and have been kept for follow-up. 2 months since then
child still have 2-3 episodes in a month. Conclusion: Idiopthic Infantile Dyskinesia is a rare
benign disorder of self gratificationin children. Most of such patients are either investigated
for seizures or missed the diagnosis. Most important step in diagnosis is video clipping of the
infantile gratification movement which gives correct diagnosis. Management is conservative
as they remit over the time. Child can be stooped during these gratification however with
some frustration behavior in the child.
MISC/46 (P) BUNKING SCHOOL
GROWING CONCERN AMONG TEENS
EFFECT AND OUTCOME AMONG CHILDREN
Manju Lata Sharma
II-E-265, J.N.V.Colony, Bikaner – 334003
Email: [email protected]
Abstract: Children study now is a major career deciding factor & dominates the life of
children often they discover the fun of bunking school. It may start out by accidentally
missing one lecture and then they end up performing poorly in exams, indulging in other
activities Bunking is a habit that needs to be nipped in the bud. Aims & Objectives – 1) To
highlight the effect of bunking its impact and various problem and outcome. 2) To highlight
the adolescent problems so as to stimulate re-thinking of adolescent care. Material & Method:
150 children of150 children of15 to 18 yrs, 100 girls and 50 boys with their parents were
interviewed with the help of pre-set questionnaire. Information analyzed. Observations: 150
children of 15 -21 Yrs,100 girls & 50 boys to Various way to know children doing bunking
by seeing notification from child's school -, Checking child's notebooks, poor scholastic
performance. Various reasons for bunking , Bullying, just for the fun on bunking off, lack of
parental support, parents that do not value learning, , drug and alcohol abuse, sexual
exploitation, child neglect and so on. 35 % children to have fun,50% gang culture, peer
pressure,Family problem ,25% school problem Poor teaching or an inappropriate curriculum
and lack of personalised learning, , indulge in some other activity,25 % to improve
performance. Impacts on health and school study bunking makes children lazy, unfocussed
and less ambition - decreased alertness change in mood 30%,difficulty in focus and learning
20%,decrese in scholastic performance This is a very grave situation lead to serious problems
such as drug abuse and addition, gambling or even visiting commercial sex workers. runs
away from home due to pressures or disharmony of any kind absenteeism. Conclusion: the
study clearly bring out that, there is strong influence & impact on the mental health and
school study It is therefore extremely important for parents to be constantly in touch with the
teachers about the child's progress to avoid such situations and save a young life from being
ruined., Bunking can be controlled timely by parents with trust and open
and adolescent counseling
communication
MISC/47 (P) OSTEOPETROSIS IN TWO SIBLINGS: CASE REPORT
Yadav S, Chalise S, Dhawan N, Chaudhary S, Shah G, Gupta MK
Department of Paediatrics, BPKIHS, Nepal
Email: [email protected]
Case description: An 8 year male child was admitted to the department of pediatrics with
irregular low grade fever and gradually increasing mass in abdomen for last 3 years. He also
had history of hearing loss and not able to speak since beginning. There was no past history
or family history of blood transfusion or hematological disease. There was no consanguinity
and birth history was normal. Among other two siblings, the eldest one was 12 years old and
normal and alive. The youngest one was 5 years old and had similar type of complain which
is included in this case report. On examination, the siblings were moderately pale with poor
nutritional status, short stature, frontal bossing and altered craniofacial morphology. The
second sibling had splenohepatomegaly whereas younger one had splenomegaly only. Brain
stem evoked response audiometer (BERA) revealed hearing loss in both patients.
Ophthalmological examination showed normal except nystigmus in younger sibling. Blood
investigation reveled anemia and peripheral blood smear showed leucoerythroblastic picture
in both siblings. Calcium and phosphorous were normal. Alkaline phosphatase was increased
in second sibling whereas it was normal in younger one. Serology for malaria and rK39 were
negative. X-ray skull showed calvarian thickening with increase density of the bone with
poor development of sinus. There was homogeneous increase density of bone without
trabiculous with little differentiation between cortex and medulla in long bone and ribs. X-ray
of vertebra showed sclerosis of vertebral endplates resulting in “sandwich vertebrae”
appearance. These radiological features were present in both siblings.USG of both siblings
revealed gross splenomegaly. Conclusion: This case is presented to develop awareness about
the presence of this rare disease in children.
MISC/48 (P) IMMATURE RETROPERITONEAL TERATOMA PRESENTING AS
HEMATURIA IN A NEWBORN-AN UNUSUAL PRESENTATION
Dileep K, Swapna, Reddy N, Shenoy J
S/O K Paruateesam, Day & Night Medical Store, Day & Night Junction, Srikakulam-532001,
Andhra Pradesh
Email: [email protected]
Abstract: Retroperitoneal teratomas are very rare tumors accounting for only 5% of all
teratomas in children. We report case of a large immature retroperitoneal teratoma in
newborn who presented with hematuria, an unusual clinical scenario not documented so far.
The baby was noticed to have an abdominal mass. His clinical examination revealed a non
tender, mobile mass occupying umbilical and right iliac region. Abdominal ultrasound and
MRI revealed a heterogenous mass extending across midline to the left and compressing
aorta, inferior vena cava and right kidney causing right pelviureteric obstruction. Fine needle
aspiration cytology of the mass showed predominantly mature squamous cells and anucleate
squamous cells along with inflammatory infiltrate. During exploratory laparotomy only 50%
of mass could be excised. The baby was started on chemotherapy (bleomycin, cisplatin and
etoposide) as histopathology of mass showed immature elements and alpha-fetoprotein levels
were markedly elevated and advised for follow up.
MISC/49 (P) BULLOUS CONGENITAL ICHTHYOSIFORM ERYTHRODERMA
Ashok Rathod, Spoorthi Jagadish, Vasudha N R, Sushant Mane
Prof Of Pediatrics, Bldg # 1, Flat # 15, Sir Jj Hospital Campus, Byculla Mumbai-400008,
Maharashtra
Email: [email protected]
Bullous congenital ichthyosiform erythroderma is a rare autosomal dominant genodermatosis
seen in 1/3,00,000 live births which presents at birth or shortly thereafter with erythema and
peeling.There is mutation in keratin 1 and 10 genes leading to formation of defective keratin
proteins leading to skin cell collapse and blistering.There is hyperkeratosis, vacuolar
degeneration of upper dermis. Complications are secondary infections,electrolyte imbalances
and dehydration. It is a lifelong condition which tends to improve with age. Our patient was a
22hour old,full term,2.2 kg, male child with complaints of scaling and peeling of skin 6 hours
after birth. At birth baby appeared normal with some scaly lesions on trunk. Baby was
otherwise asymptomatic and feeding well. No significant antenatal history, elder sibling is
normal. Father has Darrier’s disease, no treatment was taken. There was extensive peeling of
skin involving bilateral feet, back, buttock region exposing underlying raw areas with scaling
of remaining skin. Oral mucosa was spared. Systemic examination was normal. Complete
blood count and septic screen was normal. Skin biopsy fron normal area showed vacuolar
degeneration of upper dermis with marked hyperkeratosis and keratohyaline granules.Blood
culture showed no growth. Baby was nursed on banana leaf, with prophylactic antibiotics, IV
fluids to maintain normal electrolytes and adequate hydration and emollients like paraffin,
retinoic acid. The lesions started healing and near normal skin generated at third week of life .
On follow up child has some scaling with no active peeling.
MISC/50 (P) ACUTE HEMMORHAGIC OEDEMA OF INFANCY
Ashok Rathod, Spoorthi Jagadish, Shruti Dhale
Prof Of Pediatrics, Bldg # 1, Flat # 15, Sir Jj Hospital Campus, Byculla Mumbai-400008,
Maharashtra
Email: [email protected]
Acute hemorrhagic edema of infancy (AHEI) is a very rare, self limiting disorder with
unknown incidence, preceded by upper respiratory infection or antibiotic intake and presents
as palpable purpuric lesions, ecchymosis, oedema of extremities and face and acute fever. It
thought as a variant of HSP. It is an acute cutaneous leukocytoclastic vasculitis affecting
children < 24 months,with a triad of fever, purpuric skin lesions and edema. Histopathology
shows small blood vessels in dermis with perivascular neutrophilic infiltrate with scattered
nuclear fragments called nuclear dust. IgA deposition is seen rarely. Use of steroids are
controversial. Our patient, a 15 month old male child came with URTI since 4 days, fever,
oedema of all 4 limbs since 2 days and rash over face and limbs since 1 day. No drug intake,
haematuria, malaena, loose stools or other systemic symptoms.patient was irritable, but
feeding well, febrile, with tender oedema on face, extremities and several palpable purpurae
and ecchymosis on face, limbs and trunk. Mucosa was spared, systemic examination was
normal. Platelet counts, renal and liver function tests were all normal.urine and stool
examination were normal. Skin biopsy revealed acute leucocytoclastic vasculitis with Blood
vessels showing plump endothelial lining surrounded by intact polymorphs and fragmented
nuclear debris. The dermis shows mixed inflammatory infiltrate mainly in the perivascular
and periadnexal area. Fever subsided in 2 days.The patient was put on intravenous steroids,
lesions and oedema subsided in 1 week and patient was discharged.
MISC/51 (P) CASE OF SICKLE CELL DISEASE
Kiranraj H
S/O Hk Naik, Ashirwad 3rd Cross, Purlakki Bena, Post Vandige, Ankola, UttaraKannad581357 Karnataka
Email: [email protected]
Prathik, 4yr old male child 2nd born to NCM couple, hailing from Thirthahalli, presented with
complaints of,Cough – 3 days,Fever – 3 days,Hurried breathing – 1 day,Pain in both feet and
toes – 1 day,Easy fatiguability – 1 day with Past history : no similar complaints / any
previous admissions and blood tranfusions.Family history of elder sibling died at the age of
11yrs of similar illness in our hospital.Uneventful ante natal/neonatal history, Born full term
with average birth wt,diet deficient in 20% caloric intake, Immunized upto date with normal
development, good scholastic performance,belonging to upper middle socioeconomic status.
On examination pallor and icterus present, febrile ,tachypnea and tachycardia with RS : B/L
air entry equal, B/L crepts , B/L rhonchi,CVS : S1 and S2 + , tachycardia +,no murmurs,P/A
: non tender, hepatomegaly 3 cm below RCM with a span of 9cm and no spleen
palpable.CNS-NAD.Investigations -TC – 18,300/cu mm,Hb – 6.9 g %,Hct – 19.6%,Platelets
– 4,33,000/cu mm,DC –60%,L – 32.9%, M- 5.7%,E – 0.7%,MCV – 81.7%,MCH –
28.8%,MCHC – 35.2%,LFT-Normal,HbsAg-negative,Chest X ray -right paracardiac non
homogenous opacity seen,Rest of the lung fields was normal.No cardiomegaly. Peripheral
smear : Microcytic hypochromic, Few target cells,many sickle cells with pointed ends,
marked anisopoikilocytosis +.WBCs : neutrophilic leucocytosis.SICKLING TEST :
POSITIVE, Hb electrophoresis – capillary electrophoresis,HbF – 18.1% ( >1yr – 0to 2%),
Hb A2 – 2.6% ( >1yr – 1.5 to 3.3%)RBCs . Impression--Double Heterozygous Hb D and S.
Family screening by electrophoresis , Father- sickle cell trait, Mother-HbD trait.
MISC/52(P)
DIAGNOSTIC SENSITIVITY AND SPECIFICITY OF SPECTRAL COLOR
DOPPLER ULTRASOUND INDICES IN DIAGNOSING ARTHRITIS IN JUVENILE
IDIOPATHIC ARTHRITIS PATIENTS.'
Tribhuvan Pal Yadav, Devesh kumar Bhagwani
H 1571 Ground Floor, Chittaranjan Park, New Delhi-110019
Email: [email protected]
Introduction: Subjective variation in assessment by clinical parameters in diagnosing arthritis
has led to the use of Power color and spectral Doppler Ultrasonography (USG) to objectively
assess synovitis by two indices , Resistive index and color fraction. Cut off level for these
have not been derived in Juvenile Idiopathic Arthritis patients. Aims & Objectives: This
study was performed in JIA patients to determine diagnostic cut off values of color fraction
and resistive index in diagnosing arthritis. Material and methods: In a cross sectional
observational study ,forty children of JIA having active arthritis and thirty four age and sex
matched healthy controls were evaluated by power color and spectral USG and their mean
color fraction and resistive index (RI) derived and compared . Using ROC curve, cut off level
of these indices was derived. Sensitivity, specificity, positive predictive value (PPV) and
negative predictive value (NPV) of these cut off values were derived. Results: 187 diseased
joints and 200 healthy joints were studied. Resistive Index was significantly lower and color
fraction higher in diseased joints. The cut off value for Resistive Index and color fraction to
diagnose arthritis was 0.711 and 1.00 respectively; when all joints were pooled together with
a sensitivity and specificity of 93.6% and 94% for Resistive Index and 92.5% and 91% for
color fraction. Similarly cut off value for these two indices with sensitivity, specificity, PPV
and NPV were derived for individual joint groups. Conclusion: A highly significant
difference was observed in color fraction and RI between cases and controls. Color Fraction
and RI were found to be very sensitive and specific in diagnosing arthritis in JIA patients
with very high PPV and NPV. Key words:Juvenile idiopathic arthritis, color fraction,
resistive index, sensitivity, specificity,negative predictive value, positive predictive value.
MISC/53 (P) INTRAUTERINE AMPUTATIONS AND MALFORMATIONS- AN
UNCOMMON ENTITY
Manju Kumari, Sushma Malik, Charusheela Warke, Ashwin Saboo, Sujay Kumar
Pediatric Resident, Department of Pediatrics, 1st Floor, College Building, TNMC & BYL
Nair Hospital, Mumbai Central, Mumbai-400008
Email- [email protected]
Introduction: Intrauterine fetal amputations and anomalies are due to a rare condition called
as amniotic band syndrome (ABS) or constriction ring syndrome. This entity can lead to a
spectrum of deformities ranging from minor defects like constriction rings, major anomalies,
amputations of limbs to fetal-infant deaths. We report five such rare cases, that we
encountered in our neonatal intensive care unit. Materials and Methods: Five neonates with
varied deformities and / or amputations with constriction rings with a diagnosis of amniotic
band syndrome who were admitted over the last three years in our tertiary care NICU were
analyzed. Result: In our series of five ABS, all were born to non consanguineous marriage
with no family history of ABS. Four were full term and one preterm neonate and two were
born to primipara and three to multigravida mothers. All of them had typical constriction
rings, four had amputations (3 of distal fingers and 2 had complete amputation of a limb), two
had visible fibrous bands, and one of five cases had other multiple systemic anomalies.
Amongst our cases three survived and two died. Conservative management was initially
given with an advice to follow up for further surgical intervention and rehabilitation.
Discussion: ABS is a set of congenital birth defects caused by entrapment of fetal parts due to
fibrous amniotic bands while in utero. The exact etiopathogenesis is still unknown and the
intrinsic theory postulates defective germ cell lines and extrinsic theory proposes that rupture
of amnion and its separation from the chorion results in fibrous bands that entangle the
developing fetus. ABS can be diagnosed prenatally by ultrasound and 3D MRI and postnatal
examination clinches the diagnosis. ABS must be considered in differential diagnosis of all
complex or asymmetric malformations. Prenatal ABS treatment involves foetoscopic laser
cutting of amniotic bands and postnatal therapy of ABS is mostly surgical. Due to complexity
of ABS, the treatment and follow-up of these children requires interdisciplinary approach to
improve morbidity and mortality.