Jagadeesh Menon

Kawasaki disease presenting as acute intestinal obstruction

Kawasaki disease (KD) is an acute febrile illness of childhood associated with vasculitis of medium-sized arteries especially the coronary arteries. Typical clinical features involving the skin, mucous surfaces, etc., occur sequentially over a few days. We report a rare presentation of KD as a surgical abdomen in a 2-year-old boy. Awareness of this presentation is important as it can otherwise lead to a delay in starting potentially life-saving intervention like intravenous immunoglobulins for cardiac complications kept cryptic by the manifest acute abdomen.

Acceptability and Efficacy of Locally Produced Ready-to-Use Therapeutic Food Nutreal in the Management of Severe Acute Malnutrition in Comparison With Defined Food: A Randomized Control Trial

Background: Severe acute malnutrition (SAM) is a salient health problem in India. Federation of Indian Chamber of Commerce and Industry (FICCI) Research and Analysis Centre, New Delhi, prepared nutreal equivalent to ready-to-use therapeutic food by World Health Organization (WHO) for the management of SAM and defined food like homemade diet. Objective: To compare acceptability and efficacy of nutreal over defined food for the management of SAM. Methods: One hundred twelve children aged less than 5 years with SAM were enrolled as per the standard of WHO. Children were randomized into 2 groups to receive nutreal (n = 56) and defined food (n = 56) in unlimited amounts for 42 consecutive days and extended by 2 weeks as per demand. Calorie and protein intake, weight, and mid-upper arm circumference (MUAC) were recorded daily. Results: Age range was 8 to 45 months. Ninety-three percent of children eagerly accepted nutreal but 7% does not. Whereas in the defined food group, 68% accepted eagerly, 30% did not accept eagerly, and 1.8% accepted poorly (P = .004). At enrollment, mean weight in the nutreal group was 6.44 ± 1.60 kg and in the defined food group was 8.69 ± 1.76 kg, with MUAC in the nutreal group being 11.12 ± 0.47 cm and in the defined food group being 11.54 ± 0.34 cm. Mean weight in the nutreal and defined food groups at eighth week of intervention was 7.97 ± 1.8 kg and 9.71 ± 1.8 kg (P < .001), respectively. Mid-upper arm circumference at eighth week was 12.10 ± 0.29 cm in the nutreal group and 12.49 ± 0.50 cm in the defined group (P < .001). Conclusion: Acceptability, mean weight gain, and MUAC in the nutreal group are greater than the defined food.

Bertiella studeri Infection—A Rare Cause of Chronic Abdominal Pain in a Child from North India

Bertiella is a common parasite seen in non-human primates. It is rarely seen in humans. We present the case of a 2-year-old child with bertiellosis. He had recurrent abdominal pain, and worm fragments were found in stool, which were refractory to albendazole therapy.

Cognitive Development of Toddlers: Does Parental Stimulation Matter?

ObjectiveTo examine the impact of quality of early stimulation on cognitive functioning of toddlers living in a developing country.MethodsThe developmental functioning of 150 toddlers in the age range of 12–30 mo (53% boys; Mean = 1.76 y, SD = 0.48) was assessed by the mental developmental index of the Developmental Assessment Scale for Indian Infants (DASII). The StimQ questionnaire- toddler version was used to measure cognitive stimulation at home. The questionnaire consists of four subscales including availability of learning materials (ALM), reading activities (READ), parent involvement in developmental activities (PIDA), and parent verbal responsivity (PVR). Multivariate regression analysis was used to predict cognitive scores using demographic (age of child), socio-economic status (SES) (income, parental education), and home environment (subscale scores of StimQ) as independent variables.ResultsMean Mental Development Index (MDI) score was 91.5 (SD = 13.41), nearly one-fifth (17.3%) of the toddlers had MDI scores less than 80 (cognitive delay). Children with cognitive delay, relative to typically developing (TD, MDI score ≥ 80) cohort of toddlers, had significantly lower scores on all the subscales of StimQ and the total StimQ score. Despite the overall paucity of learning materials available to toddlers, typical developing toddlers were significantly more likely to have access to symbolic toys (P = 0.004), art materials (P = 0.032), adaptive/fine motor toys (P = 0.018), and life size toys (P = 0.036). Multivariate regression analysis results indicated that controlling for confounding socio-economic status variables, higher parental involvement in developmental activities (PIDA score) and higher parental verbal responsivity (PVR score) emerged as significant predictors of higher MDI scores and explained 34% of variance in MDI scores (F = 23.66, P = 0.001).ConclusionsDisparities in child development emerge fairly early and these differences are not all linked to economic disparities. There is a need to develop evidence-based parenting interventions for primary prevention of developmental problems, especially in resource poor countries.

Intraperitoneal lipomatosis: a rare clinicoradiological entity in a child.

A 13-year-old boy, having had constipation, lower abdominal pain and abdominal distension for all of his life, as well as episodic bloody stools, presented with symptoms suggesting an acute colitis with a short duration of fever and stools mixed with blood and mucus. On examination, he showed acute-on-chronic malnutrition (weight, 25.8 kg; height, 113.5 cms; z score <-3) with abdominal distension, and a massive splenomegaly (12 cm below the lower costal margin) but no hepatomegaly nor signs of chronic liver disease. On deep palpation, an ill-defined firm mass with minimal mobility was felt in the hypogastrium, extending towards the right iliac fossa. There were features of hypersplenism, with a haemoglobin level of 90 g/L, a platelet count of 58 000/mL, and a total leukocyte count of 3300/mL. Abdominal ultrasound scan demonstrated an enlarged spleen of 20 cm with Gamna-Gandy bodies and features of EHPVO involving the main portal vein, splenic vein and superior mesenteric veins with multiple collaterals. Increased mesenteric fat was seen conglomerating into a mass. Computed tomography (CT) (Figure 1a and 1b) and magnetic resonance venography (Figure 1c and 1d) showed EHPVO as well as diffuse peritoneal fat proliferation in the abdomen and pelvis with no post-contrast enhancement. Fine needle aspiration cytology of the fatty lesion showed lobules of mature adipocytes and few stromal fragments, but no evidence of malignancy. Once the colitis symptoms had settled, a colonoscopy was carried out; this showed hyperaemia and aphthous ulceration throughout, and biopsies showed acute nonspecific colitis without any underlying evidence of chronic colitis on histological examination. The child was treated with intravenous Ceftriaxone (50mg/kg/ dose twice daily) for 5 days followed by bulk laxatives following which both colitis and constipation improved. A pro-coagulant work-up was non-contributory. In view of the malnutrition and hypersplenism which was attributed to EHPVO, the child was counselled for a planned debulking procedure and splenectomy with devascularisation, but the procedure has been deferred due to logistical reasons on the patient’s side.

Trivial and fatal complications of esophageal foreign bodies in neonates

Esophageal foreign bodies in children are one of the most common GI emergencies and require prompt attention. Neonatal esophageal foreign bodies are relatively uncommon and pose significant challenge in detection and management, owing to lack of appropriate clinical history. We encountered two neonates with esophageal FBs, with a trivial dysphagia managed immediately with endoscopic retrieval and another case with multitude of complications, with critical illness. Absolute dysphagia, aspiration into respiratory tract, severe pneumonia, significant delay in detection and probably lack of awareness in primary care physician led to complications in second case. These cases highlight the importance of appropriate historical details and high index of suspicion in managing such patients.