So. Shivbalan

Predictors of spontaneous bleeding in Dengue

Objective : To identify the predictive factors for spontaneous bleeding manifestations in Dengue illness in infants and children.Methods : 60 cases of Dengue viral infection with spontaneous skin and or mucosal bleed were compared with 72 cases without spontaneous bleed. The protean bleeding manifestations in dengue infection were recorded. Various clinical and laboratory parameters were analyzed using univariate and logistic regression analysis.Results and Conclusion : Prothombin time was abnormal only in cases with spontancous bleed. A combination of (a) biphasic pattern of fever, (b) hemoconcentration, (c) platelet count less than 50,000/ mm3 and (d) elevated ALT had a sensitivity of 79.2%, specificity of 64.7% with a positive predictive value of 70% and a negative predictive value of 75% in predicting spontaneous bleeding in dengue.

Crohn's disease.

Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract and is an important cause of morbidity in children and adolescents. In India Crohn’s disease (CD) was considered a rare disease, however, during the last 10 years CD in adults is being reported from several centers especially in Southern India. CD is characterized by transmural granulomatous inflammation involving any part of the gastrointestinal tract in a discontinuous manner. The peak incidence of Crohn’s disease occurs during the adolescent and young adult years. The clinical presentation and complications are varied and several extraintestinal manifestations have been recognized. The understanding of the pathophysiology has opened new avenues in the management. The recognition of this problem in children and adolescents by pediatricians is necessary for proper diagnosis and management.

Therapeutic misadventure with paracetamol in children

Paracetamol (acetaminophen), though considered a safe, “over the counter” analgesic and antipyretic, can cause liver injury with overdose. Therapeutic misadventure is a unique problem where the existing nomogram used for acute poisoning is not applicable. In this context, early initiation of N-acetylcysteine even before a biochemical evidence of liver injury may be beneficial. A series of 6 children with this type of paracetamol overdose are presented here to increase the awareness and understanding of this problem since no such data is available from India.

Cut-off hematocrit value for hemoconcentration in dengue hemorrhagic fever.

Dengue is emerging as a global health problem and WHO has formulated guidelines for the diagnosis and management of dengue. As per WHO guidelines hemoconcentration is one of the diagnostic criteria for dengue hemorrhagic fever (DHF). Hemoconcentration defined as a 20 per cent rise in hematocrit is difficult to ascertain with a single hematocrit value. Thus diagnosis of hemoconcentration is often retrospective. An area-specific hematocrit value would help in the early diagnosis and management in DHF.3 We undertook a study to determine the hematocrit value which could be predictive of hemoconcentration in DHF in the Indian population. Eighty-eight hospitalized cases of DHF were studied. The diagnosis and management were based on WHO guidelines. Hematocrit values were obtained at the time of admission. Subsequent values were obtained once every 12–24 h or as and when the clinical situation warranted. Children posted for elective surgery during the same time period were taken as controls and their hematocrit was estimated. Statistical analysis was carried out using SPSS package version 10. The values were analysed using the receiver operator curve (ROC) i.e. sensitivity against 1-specificity. (excerpt)

Splenic abscess in typhoid fever

1 Domino EF, Chodoff P, Corssen G. Pharmacologic effects of CI-581, a new dissociative anesthetic, in man. Clin Pharmacol Ther 1965;6:279–91 2 Chiesi C, Guerra R, Longanesi L, Fornaciari M, Morano RP. Congenital nasolacrimal duct obstruction: therapeutic management. J Pediatr Ophthalmol Strab 1999;36:326–30 3 Wilson ME, Pandey SK, Thakur J. Paediatric cataract blindness in the developing world: surgical techniques and intraocular lenses in the new millennium. Br J Ophthalmol 2003;87:14–19 4 Pun MS, Thakur J, Poudyal G, Gurung R, Rana S, Tabin G. Ketamine anaesthesia for paediatric ophthalmology surgery. Br J Ophthalmol 2003;87:535–7 5 Sandford-Smith J. Eye Surgery in Hot Climates. 2nd edn. Leichester: FA Thorpe, 2001: 54–72 6 Selbst SM. Sedation and Analgesia. In: Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 4th edn. Philadelphia: Lippincott, Williams & Wilkins, 2000: 59–70 7 Green SM, Denmark TK, Kline J, Roghair C, Abdallah S, Rothrock SG. Ketamine sedation for pediatric critical care procedures. Pediatr Emerg Care 2001;4:244–8

Fibrodysplasia ossificans progressiva.

A 2-year-old boy presented with low-grade fever and multiple progressive painful swellings over upper dorsal trunk and supraclavicular region with progressive stiffening of skin for the last 2 months. Examination revealed dysmorphic face, proximally placed thumb and bilateral hallux valgus. Hence, a diagnosis of Fibrodysplasia Ossificans Progressiva was entertainedA 2-year-old boy presented with low-grade fever and multiple progressive painful swellings over upper dorsal trunk and supraclavicular region with progressive stiffening of skin for the last 2 months. Examination revealed dysmorphic face, proximally placed thumb and bilateral hallux valgus. Hence, a diagnosis of Fibrodysplasia Ossificans Progressiva was entertained

Bronchoscopist talks to you.

Fiberoptic bronchoscopy (FBS) is an important entry in the armamentarium of procedures listed in management of respiratory problems. It is a simple and a safe procedure. FBS has a great scope for diagnosis as well as therapy in pediatric respiratory illnesses. This article gives a practical overview of FBS in pediatric practice.