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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.