Pancham Kumar

Primary carnitine deficiency presenting as intractable seizures.

Most intrasellar ICA aneurysms may be treated with surgical or endovascular procedures. In the four patients reported in literature, one patient successfully underwent endovascular management,[3] while in one other patient, an attempt to clip the aneurysm was unsuccessful.[2] Our patient presented with irregular menses with compression of pituitary stalk by the aneurysm and surgical resection of the large aneurysm relieved the mass effect bringing about improvement in the patient’s condition. There was no difficulty encountered while dissecting the neck and dome of the aneurysm from bilateral optic nerves and the pituitary stalk.[2] In addition, temporary clipping of the proximal anterior cerebral artery, partially excising the aneurysmal sac, and removing the intraluminal thrombus helped in applying the clip to the neck of large thrombosed intrasellar aneurysm.

Anthropometric measurements of a neonate vis-a-vis maternal nutritional status

The low birth weight babies are five times more likely to die in the perinatal period and three times more likely to die during infancy. Among 30-40% low birth weight babies, 2/3 proportion is contributed by SGA and IUGR and 1/3 by preterm babies. Factors influencing birth weight are maternal malnutrition, closely spaced pregnancies, severe anemia, adolescent pregnancies, antenatal infection, heavy workload and maternal hypertension.

D-dimer: A useful marker in neonatal sepsis

Objectives: To measure D-dimer levels in neonatal sepsis and compare D-dimer as a marker of sepsis with the gold standard that is, blood culture and other established marker of sepsis like C-reactive protein, micro-erythrocyte sedimentation rate and total leucocyte count (TLC) in predicting sepsis. Study Design: Prospective observational hospital based study. Setting: Tertiary care hospital. Subjects: From November 2010 to October 2011, 936 neonates were admitted to the neonatal unit of Indira Gandhi Medical College, Shimla, Himachal Pradesh. Out of these, 355 neonates were admitted with suspected sepsis. Out of these, only 101 term neonates were without asphyxia and blood culture positive and were enrolled as cases, and 96 term neonates without the asphyxia admitted for neonatal jaundice without sepsis were enrolled as controls. Methods: All neonates, cases and control were investigated as per the protocol at admission and simultaneously the D-dimer levels were measured. D-dimer levels were evaluated in predicting neonatal sepsis and were compared with other established markers of sepsis in predicting sepsis. Results: In the study group, age ranged from 0 to 22 days with an average of 5.58 days. In the control group, age ranged from 0 to 23 days with an average of 5.62 days. Sex distribution was almost equal in both groups. The mean value of D-dimer in the cases and control group were 1.832 mg% and 1.365 mg% respectively. The study group had significantly higher values of D-dimer (P - 0.04). Sensitivity and negative predictive value of D-dimer in predicting sepsis were 90.0% and 84.4% respectively, the highest amongst all the markers studied in sepsis. Positive predictive value and specificity of TLC in sepsis was highest in all the marker studied. Negative predictive value of various markers was comparable in sepsis. Conclusion: D-dimer is a sensitive predictor of sepsis in neonates with a high sensitivity and negative predictive value. Hence, it should be included in the septic screening of newborns.

Kasabach- Meritt Syndrome- A Rare Cause of Bleeding In a Neonate

Kasabach-Merritt Syndrome (KMS) is a rare disorder that can affect infants from the time of birth or later in infancy. Diagnosis of KMS is made based on the constellation of hemangioma, thrombocytopenia, and coagulopathy. Our case presented at birth with hemangioma on perineal area and bleeding tendancy. On evaluation thrombocytopenia and coaguloepathy were found and diagnosis KMS was established supported by histopathology. Baby was treated with oral predinisolone and showed complete resolution of hemangioma and normalization of lab parameters.