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MISC/01(P) SCORPION STING IN CHILDREN- OUR EXPERIENCE
Shastri Vikalp, Das G , Gaur Ajay, Shingwekar A.G.
Department of Paediatrics, Kamla Raja Hospital, G.R. Medical College & J.A.Group of Hospitals,
Gwalior
[email protected]
Background: Scorpion stings are second only to snake bites as a cause of fatal envenomation.
Clinical course and outcome depend on the species. There is limited data on the outcome
following sting from the species found in the Indian subcontinent. Objective: Evaluation of
cardiovascular manifestations of scorpion sting and their relation to outcome. Material and
Methods: All children presenting to the hospital with scorpion sting over an 18 month period were
prospectively enrolled. Data was collected on a pre-designed proforma regarding details of the
sting. Management comprised of Prazosin and hemodynamic support. Details of clinical course
and outcome were recorded. Result: Eighty children were enrolled. Of these, 45% were in age
group 1-5 years. Fifty two (52%) presented in hypokinetic phase. Pulmonary edema was found to
be more (75.4%) in hypotensive patients as compared to hypertensive patients (13.6%). Six (7.5%)
succumbed despite hemodynamic support. All deaths occurred in the hypokinetic phase where as
no mortality was observed in sympathetic and parasympathetic phase. Mortality increased as the
time interval between sting and admission increased. No ECG abnormalities were observed in
48% of children with no death in that group where as prolonged QTc, ST and T wave changes
were associated with higher mortality. Conclusion: Cardiovascular compromise is the major cause
of mortality following scorpion sting. A normal ECG is a good prognostic indicator.
MISC/02(O) CLINICAL AND EPIDEMIOLOGICAL STUDY OF SCORPION STING
ENVENOMATION
Sushanth S, Basant kumar GR, M.L.Kulkarni
Department of pediatrics,.J.M.Medical college,Davangere
[email protected]
Background and objectives: Scorpion sting is a frequent, life threatening medical emergency in
children. This study was done to study the clinical profile, course, complications, outcome and
epidemiological factors responsible for high prevalence of scorpion sting in our community.
Methodology: This is an observational study of 50 cases of scorpion sting, admitted to 2 hospitals
attached to J.J.M. Medical College, Davangere. The clinical presentation, complications, outcome
and the response to our standard treatment protocol was studied. An epidemiological study was
done to determine the factors predisposing to prevalence of scorpion sting in the community.
Results: Rural male children, from lower socioeconomic groups, aged between 1-3 years (22%)
and 10-12 years, (22%) were most commonly affected. Pain at the site of sting (100%) and
restlessness (80%) were the most common presenting symptom and sign respectively. Peripheral
circulatory failure (72%) was the most common complication, while myocarditis (16%) and
pulmonary edema (22%), were also frequently encountered. Complications were more common in
younger children, in red scorpion stings, in stings on the face and scalp and in cases who received
the first dose of prazosin late(i.e. after 8 hours). Two cases succumbed to the complications (4%),
but majority of cases (92%), recovered,without sequelae. Conclusion: Scorpion sting is a serious
emergency in our area. Cardiovascular manifestations are most common and life threatening.
Scorpion stings constitute a “Occupational Hazard” for children.Early Administration of prazosin
is the single most effective intervention in preventing complications and mortality.
MISC/03(P) OSTEOGENESIS IMPERFECTA TYPE IV B : A CASE REPORT
Suruchi Bajaj; Premila Paul ; Rohit Arora; Preena Uppal
Department of Pediatrics, Safdarjung Hospital; New Delhi
[email protected]
Introduction: Osteogenesis imperfecta is a generalised connective tissue disorder due to qualitative
(structural ) or quantitative defect in Type I collagen, the primary component of extracellular
matrix of bone and skin. Case Report : A six and a half year old male child, born of nonconsanguinous marriage, with normal developmental milestones presented with complaints of not
gaining height and multiple fractures after trivial trauma since 3 years of age, because of which he
was unable to sit or stand. On examination, he had open anterior fontanelle measuring 1 cm x 1
cm, disproportionate short stature but weight for height was normal.He had multiple bony
deformities with bowing of legs, but no other features of rickets, no bony tenderness. Systemic
examination was normal. On investigations, haemoglobin was 11.4g/dl, total leucocyte count was
9800/mm3, differential count, platelet count and peripheral smear were within normal limits.
Alkaline phosphatase was markedly elevated – 2930 IU/L.Kidney function tests were normal.
Parathormone levels were 48 pg/ml. Urinary pH, glucose, calcium, phosphate and amino acids
were within normal limits.Skeletal survey showed generalised osteopenia, pencil thinning of
cortex and bilateral symmetrical fractures in long bones of upper and lower limbs.
Orthopentogram revealed changes of Dentinogenesis Imperfecta.Pure tone audiometry and
echocardiography were normal. Child was diagnosed as a case of Osteogenesis Imperfecta Type
IV B, started on oral alendronate
( bisphosphonate) and oral calcium. After two months of
therapy, child has shown some clinical improvement and is under further follow up.
MISC/04(O) SUPERIOR U – SHAPED STERNAL CLEFT: A CASE REPORT
Suruchi Bajaj; Anuj Dhama ;Sugandha Arya; Harish Chellani
46, Gujranwala Town , Part II, GT Road, Delhi-110033
[email protected]
INTRODUCTION : Sternal cleft is a rare entity. It is partial or complete absence of the sternum
due to fusion failure in the midline of the two lateral sternal bars during embryonic life with
orthotopic normal heart and normal skin coverage.CASE REPORT : A female term baby,
appropriate for gestational age, born of non – consanguinous marriage to a second gravida mother,
with one alive and healthy child who received some medication at one and a half months period of
gestation for inducing abortion, nature of which could not be ascertained, with rest of antenatal
period uneventful. Baby was born by normal vaginal delivery ,cried immediately after birth and
had a normal Apgar score. On Examination there was a midline U-shaped defect in sternal area
reaching upto xiphoid process evident as a bulge during expiration and crying and depression
during inspiration. Cardiac pulsations were visible through the defect. Vitals and systemic
examination of the child were normal. C T scan of chest revealed 3.5 cm defect between sternal
ends of clavicles. There was absence of sternal ossification centres except for the xiphoid process
suggestive of Incomplete Superior U-Shaped Sternal Cleft.. Primary direct closure of the defect
was done with silastic implant and autologous tissue flap on day 18 of life. Repair was successful.
Child is now 4 months of age and is doing well.
MISC/05(O) A CASE REPORT: THE ‘PINOCCHIO NOSE’ OR ‘CYRANO’ NOSE
Sandeep Aggarwal, Karuna Thapar, Alok Kumar Goyal
220, Basant Avenue, Opposite Gobind Park, Amritsar-143001
[email protected]
Objective: Due to rarity of case and it’s potential to cause complications such as
scarring,ulcerations and permanent disfigurement. Introduction: The 'Pinocchio' or 'Cyrano' nose is
a rare condition in which deformity of the nasal tip is produced by an underlying soft tissue
tumour usually been due to either capillary or cavernous haemangiomas (angiolipomas).The
deformity is the cause of teasing in children. There has been debate as to whether surgical
intervention is indicated, as a proportion of cases will regress spontaneously. We report a case of
'Pinocchio' nose with a haemangioma of the nasal tip and review the options for management. case
report: A ten months old male child presented with hemangiomas of the nasal tip of 5 months
duration which is large, nodular, superficial hemangiomas, especially those that exhibit a sharp,
"clifflike" border resulting in ‘Pinocchio’ or ‘Cyrano’ nose. It was gradually increasing in size.
There was no local change in color, pain or constitutional symptoms.Rest of systemic examination
was normal. Discussion: The rate and extent of haemangioma involution vary greatly among
affected children and are difficult to predict. It is especially important to recognize that in many
cases, involution does not eventuate in normal appearing skin. Nearly half of children with
hemangiomas experience residual changes such as scarring, atrophy, redundant skin, discoloration,
and telangiectasis. The risks of scarring are greatest with large, nodular, superficial hemangiomas,
especially those that exhibit a sharp, "clifflike" border. Early consultation with an experienced
plastic surgeon is reasonable. However, the benefits and risks of surgical intervention must be
carefully considered, since the surgical scar may be worse than the results of spontaneous
involution.
MISC/06(P)
A
CASE
REPORT:
COLPOCEPHALY
SCHIZENCEPHALY
Sandeep Aggarwal, Karuna Thapar, Naresh Jindal
220, Basant Avenue, Opposite Gobind Park, Amritsar-143001
[email protected]
WITH
CLOSED-LIP
Objective: Due to rarity of this combination and it’s potential to cause permanent neurological
disabilities. Introduction: Colpocephaly is a congenital brain abnormality in which the occipital
horns (the posterior or rear portion of the lateral ventricles) are larger than normal because white
matter in the posterior cerebrum has failed to develop or thicken. Schizencephaly is an extremely
rare developmental birth defect characterized by abnormal slits, or clefts, in the cerebral
hemispheres of the brain. Case report: A 2.5 year old male child was born at term to nonconsanguineous parents. Antenatal, intranatal and perinatal periods were uneventful. He presented
with global delay of motor milestones, microcephaly, mental retardation, seizures and spastic
quadriparesis. Investigation profile revealed normal blood count and hematocrit. Screening for
tuberculosis was negative. CT scan cranium showed hypogenesis of the corpus callosum, marked
dilatation of the occipital horns and trigones of the lateral ventricles and bilateral clefts in both
hemispheres with no communication with the ventricular system. Discussion: This case is a rare
combination of colpocephaly associated with hypogenesis of the corpus callosum with clefts in
both hemispheres (schizencephaly). Although the cause of colpocephaly is unknown, researchers
believe that the disorder results from some kind of disturbance in the fetal environment that occurs
between the second and sixth months of pregnancy. Schizencephaly results from an early, focal
destruction of the germinal matrix and surrounding brain before the hemispheres are fully formed.
Schizencephaly & colpocephaly probably occurs as the end result of a variety of insults occurring
at a critical time during brain development. No specific inciting or unusual prenatal events have
been identified, and reported cases are sporadic. There is no definitive treatment. Anticonvulsant
medications can be given to prevent seizures, and doctors try to prevent contractures
MISC/07(P) TWO SIBLINGS WITH VIRCHOW-SECKEL'S BIRD-HEADED
DWARFISM - A CASE REPORT
Harmeet Singh Arora, Uma Raju,Kirandeep Sodhi, A Ahluwalia, Rakesh Gupta,Ashutosh Kumar,
Vivek Gupta, Suprita Kalra
Dept of Paediatrics, Command Hospital, Pune
[email protected]
Case no 1 A 9 yr old female child, 1st product of 2nd degree CM, presented with short stature,
grossly inadequate gain in height and weight since birth.Child was born at full term through
normal vaginal delivery with birth weight of 1200 gms, with no history of birth asphyxia.The
postnatal period was uneventful except NICU admission for SGA. Severe intrauterine growth
restriction was noted antenatally with no other significant antenatal history.Gross motor
developmental delay was there;other milestones normally attained. Consuming adequate diet
.Younger sibling also presented similarly (described below). Clinically active, alert, sweet
disposition high pitched voice.Vital parameters normal. Gross proportionate short stature - height
91 cm (height for age << 3rd centile (123.2 cm)).Severely malnourished- weight 8 Kg (weight
for age = 28% of 50th centile and weight for height= 58% of 50th centile). Height age- 31.5
months (about 2.5 years). Severe microcephaly, OFC - 39 cm .Had beaked bill-like protruded
nose with bird-like facies, severe microcephaly, relatively large ears, micrognathia, crowded teeth
and receding forehead. Systemic including neurological examination essentially normal. Normal
hematological and biochemical parameters, normal chest radiograph, thyroid profile,
electrocardiography and echocardiography. Maternal TORCH titres not raised. Basal & stimulated
GH assays normal. Social age 4.2 years , mental age - 4 years IQ 45 (moderate mental
retardation). Mitomycin induced chromosomal breakages studies- no chromosomal fragility.
Insulin tolerance test for growth hormone, corisol and insulin levels normal. Final diagnosis of
Virchow-Seckel’s bird-headed dwarfism was made after ruling out other DDs including
Microcephalic Osteodysplastic Primordial Dwarfism (MOPD) type II.and I, Russel-Silver
syndrome, Meier-Gorlin syndrome, Wolf-Hirschhorn syndrome and Cerebro-Oculo-FacioSkeletal (COFS) syndrome.Case no 2 (Younger sibling) A 3 year old male toddler younger
sibling of above case also presented similarly. Height 66 cm (ht for age <<3rd centile (92.5 cm)),
proportionate short stature, weight – 4.10 kg (wt for age =27 % of 5oth centile; wt for ht = 54 % of
50th centile ), height age – 5.5 months, OFC - 36 cm (<< 3rd centile for age & height).Facial and
remaining other features were same as those of elder sibling. He was also evaluated similarly with
same results, and was also labeled as Virchow-Seckel’s bird-headed dwarfism.
MISC/08(P) A CASE REPORT: MONODACTYLY INVOLVING LEFT HAND ONLY
DUE TO AMNIOTIC BAND SYNDROME.
Sandeep Aggarwal, Karuna Thapar, Naresh Jindal
220, Basant Avenue, Opposite Gobind Park, Amritsar-143001
[email protected]
Introduction: Amniotic band syndrome is a complex collection of asymmetric congenital
anomalies, in which no two cases are exactly alike. However, several characteristic features are
relatively consistent findings. Distal ring constrictions and intrauterine amputations, are the most
common findings of ABS and are typically seen in the distal aspect of extremities.Case report: A
four years old male child presented with left upper extremity limb malformations in form of
amputation of digits except thumb (monodactyly).This small thumb is marked by constriction
rings. Thumb length was insufficient for prehension due to congenital constriction band
amputation. Prehension can be defined as "the application of functionally effective forces by the
hand to an object for a task, given numerous constraints". Since these abnormalities were
unilateral, affected child possess considerable physical capabilities without surgical or prosthetic
intervention. There was no local change in color, pain or constitutional symptoms.Rest of systemic
examination was normal. Discussion: There are several theories as to the cause of Amniotic Band
Syndrome. The most widely accepted is a rupture of the amnion occuring early in gestation. The
fibrous bands of amnion that occur from the amniotic rupture encircle the limbs, resulting in
tourniquet-like defects and intrauterine amputations. In the hand, digital amputations most
commonly involve the index, middle, and ring fingers. The thumb is rarely affected as in this case,
since it is protected by the palm during pregnancy. Amniotic band syndrome is often difficult to
detect before birth as the individual strands are small and hard to see on ultrasound. Children with
upper-limb deficiencies may benefit from surgical reconstruction.
MISC/09(O) A RARE CAUSE OF DIABETES-FRIEDREICH ATAXIA
Subhranshu Sekhar Kar,Bimal Prasad Padhy,Suresh Kumar Panda,Radha Tripathy, Renuka
Mohanty
Hi-tech Medical College, Bhubaneswar
[email protected]
CASE REPORT: A 12 year old boy presented with one episode of afebrile convulsion.He was on
insulin therapy for diabetes since last 3 years.Blood sugar on admission was 30mg%.Blood count
& electrolytes were within normal range.History revealed that-he was not able to hold pen since
last 2 years & because of progressive weakness of lower limb muscles he was not able to walk or
sit.He had scoliosis, trunkal ataxia,dysarthria,weak ness& atrophy of distal muscles of lower
limbs with pes cavus deformity & hammer toe.His intelligence was normal throughout.He was
diagnosed elsewhere as Rheumatic chorea and a case of functional disorder and treated over a
period of time without any benefit. On neurological examination,there is atrophy of distal small
muscles of hand & leg with areflexia & extensor plantars.There were also cerebellar signs,positive
Romberg’s test and loss of vibration & proprioception sense.Echocardiography revealed features
of interventricular septal hypertrophy.CPK-MB was also elevated.So, a diagnosis of Friedreich
Ataxia was made.visual evoked potential showed generalised amplitude reduction with prolonged
latency.His blood sugar is now under control & he is being treated by a medical team from
different specialities. Friedreich ataxia is an autosomal recessive trait characterized by ataxia,
nystagmus, kyphoscoliosis & pes cavus.There may be dysarthria,dysmetria ,decreased vibration
sense ,areflexia ,weakness and atrophy of lower limbs with extensor plantars.An unusually high
incidence of diabetes is seen.The diagnosis is done by determination of size of GAA repeats&
supported byVEP,ABEP & SSEP testing.Sadly,no drug therapy has been found effective.With
good supportive care,patients can live into their 40s or 50s.
MISC/10(O) EARLY COCHLEAR IMPLANTATION IMPROVES QUALITY OF LIFE IN
HEARING IMPAIRED CHILDREN
Kishore A, Kashyap N, Wadhera M, Arora R
Department of ENT and Pediatrics, Indraprastha Apollo Hospital, New Delhi
[email protected]
Introduction: Congenital hearing impairment results in poor acquisition of speech and has a
profound impact on quality of life. Cochlear implants (CI) are established as effective options in
the rehabilitation of children with hearing loss, resulting in good development of speech and
language. Objective: To determine the outcome of early CI in children with profound
sensorineural deafness. Materials and Method: Prospective cohort study conducted in Dept of
ENT and Pediatrics, Indraprastha Apollo Hospital, New Delhi. Children who underwent CI at our
centre were enrolled in the study. Preoperative assessment included a) History and examination b)
Audiological assessment – behavioral responses, auditory brainstem response, otoaccoustic
emissions and auditory steady state response c) Neuro developmental assessment d) Imaging – CT
and MRI Head. All implantees underwent regular mapping of the speech processor along with
auditory-verbal therapy. Post operative assessment comprised of a) Free field aided thresholds b)
Conditioned Audiometry c) CAP score (Category Auditory Performance) d) Speech Intelligibility
Rating (SIR) First set of scores were taken at 6 weeks after surgery and thereafter at 3, 6 and 12
months respectively. Results: Out of total 70 implantees, data is being presented on the 50 children
who have completed a follow up of 6 months. Age range 2 to 11 yrs. Mean age 5 yrs. Male 80%
Female 20%.CAP scores: While Categories 6 and 7 were achieved in 60 % of children as a whole,
the younger children scored relatively higher than their older peers. The same trend was seen in
the SIR scores, where categories 4 and 5 were achieved by 55% of the children. Etiology of
deafness does not appear to affect the outcomes, except in the postmeningitic group. Conclusions:
Early CI captures the phase of neural plasticity. Outcome depends upon the age at implantation,
duration of deafness and underlying etiology thereby stressing upon the need for earlier
intervention.
MISC/11(P) ARTHROGRYPOSIS MULTIPLEX CONGENITA: A CASE REPORT
Rajiv Kumar
E-03, Housing Complex, Batra Hospital, New Delhi - 110062
[email protected]
INTRODUCTION: Arthrogryposis Multiplex Congenita (AMC) is a rare non-progressive
musculo-skeletal disorder characterized by the presence of multiple joint contractures (limitation
of the range of motion of a joint) at birth due to the overgrowth of fibrous tissue in the joints, with
no known specific cause. The basic pathomechanism appears to be lack of fetal movement
(akinesia) due to a congenital or acquired defect in the motor unit producing weakness early
enough in fetal life to immobilize joints at various stages in their development. The first clinical
description of the disorder was published by Otto in 1841. AMC occurs in 1 out of every 3,000
live births. In most cases, AMC is not inherited and does not occur more than once in a family.
However, in about 30% of the cases, a genetic cause has been identified. We report a case of AMC
presented to us with multiple joint contractures since birth, which was non progressive with
variable degree of joint involvement involving both upper and lower limbs. Diagnosis was made
mainly on clinical parameters. CASE REPORT: A 34 week preterm male baby was born to a 26
year old G4P1A2 mother, weighing 2.3 kg, by LSCS out of a non consanguineous marriage
following an uneventful pregnancy and labor. On examination, he had deformed limbs, with
bilateral flexion contractures at elbows, bilateral talipes equinovarus (clubfeet) and bilateral
flexion contractures at wrists and knees. All 4 limbs were affected. There was extended elbow,
pronated forearm, and flexed and ulnarly deviated wrists (waiter's tip). No abnormality of any
other internal organs was detected. Radiographs of the spine and pelvis were normal. The
ultrasound head, EEG and MRI brain were non-contributory. An initial diagnosis of
arthrogryposis multiplex congenita was made. Specific inquiry regarding the presence of a similar
disorder in the family or relatives yielded a negative result. There was no history of
oligohydramnios, large fibroids, prolonged maternal pyrexia and drugs intake like phenytoin and
alcohol. There was no maternal history of myasthenia gravis and multiple sclerosis. There was
past history of miscarriages. Serological tests for TORCH were negative. Chromosome studies
were normal. A bone and skin biopsy was declined by the parents of the child. The child was
managed conservatively by multi-speciality team of surgeons, orthopedicians, physical
therapeutists and occupational rehabilitation trainers.
MISC/12(P) EPIDERMOLYSIS BULLOSA: A CASE REPORT
Ayush Manchanda,Upasana Kapoor,Praveen Kumar
Kalawati saran Children Hospital, Lady Harding Medical College, Bangla Sahib Marg, New
Delhi, 110001
[email protected]
Background: Epidermolysis bullosa is a heterogeneous group of congenital hereditary blistering
disorders. It is characterized by induction of blisters by trauma and exacerbation of blisters by
warm weather. It can be characterized by 3 major headings: Epidermolysis Bullosa Simplex,
Junctional Epidermolysis bullosa, Dystrophic Epidermolysis bullosa.Prevalence: 54 per million
live births according to National Epidermolysis bullosa RegistryPathophysiology: Defect in
central and Helical coil of keratin 5 or 14 which makes up intermediate filament of the basal
keratinocytes.Case Report: A five month old female baby presented to our hospital with blistering
lesions all over the body including hands, feet, elbows, legs. Nails and Scalp were spared. Vaginal
mucosa was also involved. We present the case with picture of the baby along with detailed
history and examination findings.
MISC/13(P) IDIOPATHIC MACROGLOSSIA(Case Report)
Samarendra Mahapatro,Subhranshu Sekhar Kar,Renuka Mohanty,
Hi-Tech Medical College, Bhubaneswar
[email protected]
A three year old male child presented with complains of drooling of saliva, difficulties in feeding
and breathing. He was unable to speak but able to produce sound. The child’s weight was 10 Kg
without visceromegaly or umbilical hernia. The tongue was too large for his age and constantly
protruding out side the oral cavity. The growth and motor developments were normal for his age.
Systemic examinations revealed no abnormalities. No other visible external congenital anomaly or
syndromic appearance of face was there. Thyroid screening, echocardiogram, USG abdomen,
routine hemogram and urine examinations were normal. So a diagnosis of idiopathic macroglossia
was made. Macroglossia is a subjective diagnosis and defined as too large a tongue for his age,
which couldn’t be retained in the oral cavity. It is a component of various syndromes like
Beckwith syndrome & Down`s syndrome etc. Also it is seen in Mucopolysaccharidosis,
Hypothyroidism, Lipoid proteinosis and Muscular dystrophy. The child may present with
difficulties in swallowing, breathing or speech. We have the case with all the symptoms which
needs surgery.
MISC/14(O) COMPUTER SKILLS IN MEDICAL STUDENTS - A SURVEY
C.S.N.Vittal
Dept. Of Pediatrics,, N.R.I.Medical College, China Kakani 522 503, Guntur
[email protected]
INTRODUCTION: Importance of computer skills is increasing enormously among medical
fraternity. An early entrant to this is always at advantage. Understanding the existing knowledge
and comfort levels of medicos help us formulate improvement in teaching methods OBJECTIVE
:To assess the computer savvy ness of present day's medicos and obtaining their felt need
regarding the inclusion of Computer Skills training in MBBS curriculum. METHOD: The study
tool was designed with 20 questions in three sections. First section dealing with medicos' felt level
of their skills in various computer applications like word processing, spread sheets, database
management, internet skills like emailing, Medline searches, etc. In the next section their
perception of utility of computers in various applications is evaluated. In last session their comfort
levels in using computers and their felt need of skills training during their medical education were
assessed. The questionnaire was given to 167 medicos (79 male, 88 Female) of two different years
of admission. RESULTS: 52 % own a computer. 46% students are good in emailing but only 21%
use Instant Messaging services regularly and 38% are active in the famous networking service
Orkut. 41 % are quite good in file and folder managements. But in all other skills as word
processing, application instillation, the percentage of students who are confident are less than
30%. Only 18% are excellent in Medline searches. While 78% think computers are very useful in
information seeking and 58% think they are good communication tools, 63% believe they are
good self education tools. Only 24% of medicos feel their comfort levels in computer usage is
very good. 50% of students use computers at home. 22% at computer centers and the rest at other
places. 69% welcome computer skills training during MBBS course, while 20% say no and 11 %
could not decide on this. CONCLUSI'ONS: Computer skills are essential in present day world.
Students of engineering, commerce, nursing, et are far ahead in these, medical students are found
wanting in this field quite often. More than 20 years ago itself the GPEP report recommended
introduction of computer skills in medical curriculum. It is time to think of introducing computer
skills training during medical education to make the furure doctors ready for the challenges of
presetn day world.
MISC/15(P) PREVALENCE AND EFFECTS
ENGINEERING SCHOOL
Rajib Ray,Gouri Padhi.Rashmi Pattnaik,
Hi-Tech Medical College, Bhubaneswar
[email protected]
OF
BULLYING
IN
A
PRIVATE
Introduction: Bullying is a wilful, conscious desire to hurt another person of lesser strength
and put him or her in stress. The victim of bullying tend to lose self-esteem, becomes
depressed and insecure. The accused may likely get engaged in antisocial behaviour in
adulthood. So there is a need to counteract bullying at an early stage. Aim: To study the
prevalence of bullying in a private engineering school. Materials & methods: A crosssectional anonymous uestionnaire survey was undertaken among students of a private
engineering school with verbal and written explanation regarding bullying. A total of 225
students participated in the survey. Results: 25% of students experienced bullying in last 1
year. The persons involved in bullying were classmates(52%) followed by seniors(37%). In
47% of cases it was verbal abuse whereas physical abuse was reported only in 1%. Only
37% took action against bullying. Out of those who didn’t report 42% thought the matter
was not that serious to be reported whereas 25% were afraid of worsening of the
situation by reporting. Conclusion: As the prevalence of bullying is high among adolescents,
the authority should address them at its outset. Studies on bullying and the factors
influencing it should be encouraged in Indian scenario where the data regarding its
prevalence is lacking.
MISC/16(P) UNUSUAL PRESENTATION OF CELPHOS POISONING IN A FEMALE
CHILD WITH HEPATORENAL FAILURE: CASE REPORT
Karuna Thapar, Naresh Jindal
Department Of Paediatrics, Government Medical College & Hospital Amritsar
[email protected]
Aluminium phosphide (ALP) poisoning (Celphos) has emerged as a common cause of accidental
poisoning in children with mortality ranging from 37-100%. We recently managed 2 cases of
celphos poisoning. One of them developed hepatorenal failure. This case is presented as a rare
complication of celphos poisoning. Case report : 2 previously healthy siblings 7 year old girl & 4
year old boy were given celphos tablets by their mother. Girl had consumed 2 tablets (6 g) & boy
1 tablet (3 g) from a sealed pack. Within 10-15 minutes, they developed persistent vomiting and
were hospitalized after 2 hours of ingestion. On examination, they were irritable, restless,
cyanosed with cool extremities. They had tachycardia, tachypnea and hypotension. They were
managed with intravenous fluids, vasopressors and magnesium sulphate. Blood pressure improved
gradually to normal and male child was discharged on 4th day. On 5th day, female child
developed generalized edema, jaundice, petechiae and anuria. Investigations revealed blood urea76.3 mg/dl, serum creatinine – 3.1 mg/dl, serum sodium – 131.7 mEq/L and serum potassium - 5.2
mEq/L, SGOT – 1015, SGPT-1330, S. bilirubin 5.7 total, 0.5 direct, PTI-43.9%. CBC, RBS & S.
Mg levels were within normal limits. Sepsis markers were negative. She was managed
conservatively on lines of hepatorenal failure. The child was discharged after 21 days and was
normal at 3 months of follow-up. Conclusion: This patient presented with the usual features of
ALP poisoning, namely, gastrointestinal upset and shock. Subsequently, the child developed
hepatic and renal failure. Hepatic and renal functions should be routinely measured in cases of
celphos poisoning. An early detection and treatment can be life saving and complete treatment
does not leave any sequelae.
MISC/17(P) PATTERN AND OUTCOME OF POISONING CASES IN CHILDREN
ADMITTED AT GOVT. MEDICAL COLLEGE, AMRITSAR
Karuna Thapar, Naresh Jindal,Gajinder Pal Singh Kaler
Department Of Paediatrics, Government Medical College & Hospital Amritsar
[email protected]
Acute poisoning is a common Pediatric emergency and a thorough knowledge about the nature
and magnitude of problem especially when associated with regional peculiarities is necessary. For
years, there has been no study on poisoning from our region. Objectives: To find out the patient
profile, the common poisons and outcome of poisoning cases in children. Materials and Methods:
A retrospective analysis of all acute poisoning cases admitted to the pediatric department of Govt.
Medical College, Amritsar from June 2005 to June 2007 was done to study the pattern of acute
poisoning. Data on age, sex, time elapsed after intake, circumstances of poisoning, name of the
poisonous substance, chemical type, hospitalization days, severity and outcome were collected and
analyzed. Results: The age of the patients varied from 1 to 7 years. The male female ratio was
1.5:1. More than three-fourth (81.8%) of patients were from 1 to 2 years age group. Most of the
cases (72.72%) were accidental exposure of children to poisons. Kerosene and diesel poisoning
was most common, followed by commonly used analgesics and sedatives. The common
insecticides used for poisoning were celphos and organophosphorus compounds. Most of the
cases (90.9%) had arrived hospital within 3 hours after exposure to the poison. The hospital stay
of the admitted patients with poisoning ranged from 1 to 25 days. The mean hospital stay was 7.1
days. During the hospital stay, five (22.72%) cases developed complications. In this study, only
one case (4.5%) had mortality. There were 2 cases of Aluminium Phosphide poisoning but
surprisingly, none of them died from this highly toxic poison. Conclusion: To conclude, keeping
drugs out of reach of children, storing the house hold fuel like kerosene safely, providing
immediate medical aid when poisoning occurs and last but not least prescribing drugs more
carefully will go along way in preventing hospital admissions and mortality .
MISC/18(P) COMPLEX HEMIHYPERTROPHY: A CASE REPORT
Surg LCdr Bal Mukund,
Armed Forces Medical College, Pune
[email protected]
Four month old infant born out of a non consanguineous marriage with no family history of
childhood malignancy and no antenatal risk factor at home, cried at birth. Child was subjectively
bigger in size and breast fed from first day, noted by the parents that the right side of the body is
bigger in size with a hyper-pigmented rash over the body predominantly over right side. Baby has
been growing well and had achieved developmental milestones appropriate for his age. There is no
history of abnormal jerky movement of the body, any abnormal mass over abdomen, weakness of
any side of body noted by the parents On examination hypertrophy of right half of body including
facial hypertrophy was present with no dysmorphic features, neurocutaneous markers. There was
hyperpigmented maculopapular, blanchable rash over the body predominantly over right side.
Systemic examination was normal. Basic investigations including blood sugar, abdominal
ultrasonography (USG) were normal. X-ray limbs didn’t reveal any discrepancy in bone age.
Magnetic resonance angiography revealed hypertrophied right half of brain parenchyma with no
associated vascular anomalies. Baby was diagnosed as a cse of Complex Hemihypertrophy.
MISC/19(P) MODULATION OF PLASMA PRO-INFLAMMATORY INTERLEUKINS BY
GRADED PHYSICAL ACTIVITY: CAN THIS HAVE AN IMPACT ON PEDIATRIC AGE
GROUP?
Ambarish V, Rashmi S. Murthy, Belawadi G B, Rajeev Sharma, Chandrashekara S, Vadiraja,
Vasanthakumar
Departments of Physiology, M S Ramaiah Medical College and Teaching Hospitals, Bangalore.
Email: [email protected]
Introduction: Physical stresses induce pro-inflammatory interleukins. It is known that these
interleukins trigger off various inflammatory disorders when they are present at very high levels.
We studied the effect of varying levels of exercise on the interleukins: - Interleukin-6 (IL-6),
Tumor Necrosis Factor- (TNF-) and Interferon Gamma (IFN-). Materials and Methods: We
observed the variations in these plasma interleukin levels with graded exercise in 54 healthy
volunteers (26 males and 28 females) in age group of 18 to 30 yrs (mean and SD = 22.87  8.44)
using Enzyme-Linked-Immunosorbent-Assay technique. Results: The interleukin levels revealed
an overall significant difference between various levels of exercise as under:
Effect of graded Exercise on plasma interleukin levels (Mean values in pg/ml)
Mode of exercise
IL-6
IFN
TNF-
Baseline (No Exercise)
10.70
43.90
85.33
83.80
91.09
95.28
43.58
107.65
74.20
1 bout
Exercise
of
Moderate 12.00
1 bout of Strenuous Exercise
1 month Moderate Exercise
13.35
8.80
Conclusion: The pro inflammatory interleukins rise after a single bout of a moderate exercise and
increase further with one bout of strenuous exercise. The plasma levels of these interleukins fall
below baseline level on completion of one-month regular moderate exercise. Hence, regular
moderate exercise done on a daily basis has health benefits by way of keeping these proinflammatory interleukins at check. Such a study in Pediatric age group could reveal similar
results. Therefore, regular moderate exercises when introduced at an early age would proffer
immense health benefits to children as they grow into adulthood.