Sanjay Verma

Hypocalcemia nutritional rickets: a curable cause of dilated cardiomyopathy.

Dilated cardiomyopathy is an important cause of heart failure in children. Often it requires transplantation, but on rare occasions it is curable by micronutrient supplementation. Hypocalcemic nutritional rickets was found to be a cause for dilated cardiomyopathy in a 15-month-old child. The patient responded to calcium and vitamin D supplementation promptly and left ventricular systolic function normalized after 3 months of treatment. Nutritional rickets must the considered as an important curable cause for dilated cardiomyopathy among children especially in regions where nutritional rickets is still common.

Thinner Intoxication Manifesting as Methemoglobinemia

Lacquer thinner, commonly used for removing household paints is known to contain mixture of various arometic hydrocarbons; halogenated hydrocarbons and naptha, if ingested may rarely cause methemoglobinemia. We report a 3 year old child who presented to us with history of accidental ingestion of thinner, used for removing household paint. Child was having cyanosis with minimal tachypnoea & the colour of his blood was cholcolate brown. Later methemoglibulin level estimations were also done, which were suggestive of this daignosis. Child was managed conservatively with oxygen therapy & vital monitoring, which lead to complete recovery and discharge from hospital later.

Association of fungal sepsis and galactosemia

Galactosemia is one of the rare inborn errors of metabolism, which if detected early can be treated effectively. Galactosemic infants have a significant increased risk of developing sepsis. E. coli sepsis is a known entity, and also an important cause of early mortality in these children. But fungal sepsis in these patients is rarely reported. Here is a case of 45 day-old child who presented with fungal sepsis, which on investigation turned out to be galactosemia.

Accidental Inorganic Mercury Chloride Poisoning in a 2-Year Old Child

Inorganic mercury poisoning is uncommon, but when it occurs it can result in severe, life threatening features and acute renal failure. A 2-year old well thriving child presented with alleged history of accidental ingestion of inorganic mercury chloride. He presented with evidence of corrosive trauma to the gastrointestinal tract mucosa, but with normal renal function at admission, which was managed with BAL and other supportive treatment. But he developed non-oliguric renal failure after admission, which also improved gradually. On follow-up, two months later, the patient’s renal function was normal; indicating that renal failure caused by acute inorganic mercury poisoning produced no permanent renal damage. We have hereby presented a case of mercury intoxication in a 2-year old child, with an excellent clinical improvement and normalization of laboratory results.

Tropical Pyomyositis in Children: 10 Years Experience of a Tertiary Care Hospital in Northern India

Tropical pyomyositis (TP) is characterized by suppuration within skeletal muscles, manifesting as single or multiple abscesses. It has been reported frequently from Africa and Latin America. However, there are only a few cases reported in children from India. Between January 2002 and December 2011, 40 children with TP were admitted to our hospital, and their retrospective review formed the study material. TP is not an uncommon disease in children in Northern India, especially during rainy seasons. Most of the patients were admitted with short history of fever, pain and localized swelling. Pus drainage was done in 87.5% cases, with the amount of pus varying from 5 to 2000 ml. The pus grew methicillin-sensitive Staphylococcus aureus (MSSA) in 42.5% cases, whereas initial blood cultures were sterile. All received antibiotics along with surgical drainage, and recovered. It is important for health professionals to have a high index of suspicion and familiarity with this imminently treatable disease entity.

Immune Thrombocytopenic Purpura due to Mixed Viral Infections

An 11-year-old boy presented with epistaxis, petechial hemorrhages, easy bruising, and purpuric rash. He was diagnosed to have immune thrombocytopenic purpura and evidence of concomitant parvovirus B19 and dengue viral infection.

Iodopovidone Pleurodesis for Isolated Pulmonary Langerhan’s Cell Histiocytosis in a Two Year Old Child

Isolated pulmonary involvement in Langerhans Cell Histiocytosis (LCH) is rare in childhood. The authors report a 2-y-old boy who presented with acute history of fever, cough and respiratory distress; later developed pneumothorax; whose CT thorax showed diffuse pulmonary cystic lucencies bilaterally. Lung biopsy confirmed pulmonary LCH with CD1a positivity. Recurrent spontaneous pneumothoraces are common in patients of pulmonary LCH; which necessitates rapid intervention. The authors share their experience of successfully using iodopovidone in pleurodesis for repeated pneumothorax episodes in this child with rare diagnosis of isolated pulmonary LCH.

Pertussis and Rotavirus Vaccines – Controversies and Solutions

Pertussis and rotavirus vaccines have been the subject of several controversies over the years. In this paper the authors discuss facts and myths behind these controversies and also suggest solutions to overcome some limitations of these vaccines. The whole-cell pertussis vaccine (wPV) came into disrepute due to the associated adverse reactions, resulting in its replacement by acellular pertussis vaccine (aPV) in industrialized nations in 1990s. Although wPV is known to have more side effects; but they are usually minor. Whole-cell pertussis containing vaccine is being used safely in the National Immunization programme in India from many years. Another controversy erupted during 2009–2010, when there were reports of resurgence of pertussis cases among adolescents and adults, from developed nations. Present literature review raises doubts about long term protection offered by aPV, when compared with wPV. In spite of prevailing controversy, acellular pertussis containing vaccines should be acceptable, if timely delivery of primary and booster doses is ensured; including vaccination of adolescents and pregnant women. Initial rotavirus vaccine was withdrawn from the market because of increased risk of intussusception. Although three new generation rotavirus vaccines are currently available for use in India, but doubts about their efficacy, long term protection and safety still exists. Present literature review found them to be safe and moderately efficacious because of reasonable good cross protection. Even a moderately efficacious vaccine like rotavirus vaccine could significantly improve the outcome if disease burden is high. Therefore, it is being included in National Immunization Programme of India.

Rabies in India: where do we stand?:

Dear Sir, Rabies is a fully preventable disease, yet it causes nearly 61,000 deaths per year worldwide. India accounts for approximately one-third of these deaths. According to a survey published in 2007, in few Asian countries, including Thailand, Sri Lanka and the Philippines, has the incidence of rabies has declined. There are reports of thousands of rabies cases per year from countries such as India, Pakistan and Bangladesh. The incidence of rabies in India has remained unchanged for the past ten years. This incidence might actually be underestimated because rabies is still not a notifiable disease in this country. Despite huge economic development, rabies is still a major health problem in India because of a general unawareness about preventive measures and post-exposure prophylaxis, inadequate dog vaccination, the presence of legions of stray dogs and a discontinuous supply of anti-rabies vaccine and immunoglobulin. Surprisingly, even physicians often have insufficient knowledge about adequate prophylactic steps following dog bites. To tackle this tragic situation, the Government of India has planned to implement a National Rabies Control Programme in nine states. The government has allocated 500 million rupees (£5.62 m) to this programme in its 12th five-year plan to reduce disease rabies. The highlight of this campaign is the timely administration of post-exposure prophylaxis and rabies immunoglobulins, improving community awareness through information, education and communication, and making facilities of post-exposure prophylaxis also available to primary healthcare services.

Long-term Seroprotection Rates Following Second Dose of Measles as MMR Vaccine at 15 months in Indian Children

ObjectiveTo find out seropositivity rates at 4-6 and 9-12 years of age; among those who received one-dose measles at 9 months and one-dose MMR at 15 months of age.Methods80 healthy children (53 males) at 4-6 or 9-12 years of age, attending outpatient department for vaccination were enrolled. Antibody titers were estimated using commercially available quantitative-IgG ELISA kits.ResultsThe seropositivity rates against measles, mumps, rubella were 80% (40/50), 86% (43/50), and 96% (48/50), respectively at 4-6 years, and 83.3% (25/30), 96.7% (29/30) and 96.7% (29/30), respectively at 9-12 years of age.ConclusionSingle dose of rubella vaccine seems to provide adequate long-term protection; however, measles vaccine requires more doses for similar protection.