Suneel C Mundkur

Clinicohematological Study of Thrombocytosis in Children

Introduction. Primary thrombocytosis is very rare in children; reactive thrombocytosis is frequently observed in children with infections, anemia, and many other causes. Aims and Objectives. To identify the etiology of thrombocytosis in children and to analyze platelet indices (MPV, PDW, and PCT) in children with thrombocytosis. Study Design. A prospective observational study. Material and Methods. A total of 1000 patients with thrombocytosis (platelet > 400 × 109/L) were studied over a period of 2 years. Platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit (PCT) were noted. Results. Of 1000 patients, 99.8% had secondary thrombocytosis and only two children had primary thrombocytosis (chronic myeloid leukemia and acute myelogenous leukemia, M7). The majority of the children belonged to the age group of 1month to 2 years (39.7%) and male to female ratio was 1.6 : 1. Infection with anemia (48.3%) was the most common cause of secondary thrombocytosis followed by iron deficiency alone (17.2%) and infection alone (16.2%). Respiratory infection (28.3%) was the predominant infectious cause observed. Thrombocytosis was commonly associated with IDA among all causes of anemia and severity of thrombocytosis increased with severity of anemia (P = 0.021). With increasing platelet count, there was a decrease in MPV (<0.001). Platelet count and mean PDW among children with infection and anemia were significantly higher than those among children with infection alone and anemia alone. None were observed to have thromboembolic manifestations. Conclusions. Primary thrombocytosis is extremely rare in children than secondary thrombocytosis. Infections in association with anemia are most commonly associated with reactive thrombocytosis and severity of thrombocytosis increases with severity of anemia.

Purpura fulminans in a child: a case report.

Purpura Fulminans is a life threatening condition characterised by cutaneous haemorrhage and gangrenous necrosis. We present such a case in an eight year old child.

Super-refractory status epilepticus: A therapeutic challenge in paediatrics

A status epilepticus which persists for 24 hours or more after starting treatment with anaesthesia or has recurred inspite of general anaesthesia is known as Super-Refractory Status Epilepticus (SRSE). It includes cases where status epilepticus recurs on reduction or withdrawal of anaesthesia. SRSE, though infrequently seen, constitutes a medical emergency due to the associated high morbidity and mortality. No clear cut guidelines are available till date for the management of SRSE. Most of the published literature was case reports and expert opinion. We hereby reported three cases of super refractory seizures as they posed a therapeutic challenge. All three children were aged 6-7 years with prior normal developmental history and no medical illness. Viral meningoencephalitis, fever induced refractory status epilepticus, and auto-immune encephalitis was the probable aetiology in the cases studied. Midazolam, pentobarbital, and ketamine are the most commonly used anaesthetic agents. Phenytoin, phenobarbitone, valproate and levetiracetam are the most commonly used antiepileptic agents. All three cases had residual neurological deficits and morbidities like pneumonia and sepsis. SRSE is associated with high rates of mortality and morbidity necessitating immediate treatment.

Acute naphthalene toxicity presenting with metabolic acidosis: a rare complication

Naphthalene moth ball poisoning in children can present with diagnostic and therapeutic challenges. A 2 year old boy who had accidentally consumed unknown number of moth balls presented 3 d later with vomiting, seizures, methemoglobinemia, hemolytic anemia and altered sensorium. He was managed with red blood cell transfusion, IV Methylene blue and Sodium bicarbonate. Clinical and laboratory parameters normalized. We describe this case as ingestional naphthalene poisoning with rare manifestation of metabolic acidosis, with a good outcome after treatment.

Merosin-deficient congenital muscular dystrophy with cerebral white matter changes: a clue to its diagnosis beyond infancy.

A 6-year-old boy born by a third-degree consanguineous marriage presented with progressive muscle weakness and delayed motor milestones noticed in early infancy with preserved language and social milestones. Examination revealed generalised hypotonia and hyporeflexia. Baseline haematological and biochemical investigations were normal except for mildly elevated creatine kinase. Provisional diagnosis of congenital myopathy was entertained. We performed brain imaging to look for abnormalities associated with congenital muscular dystrophy even though there were only features of myopathy with normal mentation. An MRI of the brain revealed periventricular and subcortical white matter hyperintensities suggestive of leucoencephalopathy. Muscle biopsy findings were consistent with degenerative muscle changes and immunohistochemical staining for merosin was negative, thus confirming the diagnosis of merosin-deficient congenital muscular dystrophy. Supportive care in the form of physiotherapy was initiated. The family was offered genetic counselling in their second pregnancy and immunohistochemistry at 12 weeks confirmed the fetus to be affected, which was then terminated.

Bilateral Type-I Duane Syndrome with Multiple Anamolies: A Case Report

The Duane syndrome is a strabismus syndrome which is characterized by congenital non-progressive horizontal ophthalmoplegia which primarily affects the abducens nerve. Approximately 70% of the individuals with the Duane syndrome have an isolated disease. We have described here, a case of bilateral Duane syndrome with associated anamolies.

Blue Rubber-Bleb Nevus Syndrome which was Associated with an Atrial Septal Defect: A Case Report

The Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare cause of persisting gastrointestinal bleeding. We are presenting a case which was associated with an atrial septal defect.

Mothers knowledge on malnutrition: Community based cross sectional study

Malnutrition is the major cause of many diseases and is a burden in developing countries. A childs intake can have a great impact on her/his growth and development. The mothers’ knowledge on nutrition can play a vital role in childs intake to improve nutritional status.

A portrayal of childhood injury among under- five year children

Introduction:Children and injuries are always closely associated. Injuries to children irrespective of its seriousness will affect the whole family function. One of the major reasons for childhood morbidity and mortality are injuries. Method: A cross sectional house to house survey was conducted in Udupi Taluk to identify the major types of childhood injuries. The study also tried to find the association between the age of the child and the common injuries.Results:The present study used a sample subject of 2040 for the survey. The mean age of children included in the study were 2.60 (SD + 1.16) years. Majority of children included in the survey were males 52.5%. The overall injury identified in survey was 14%. Fall from stairs (92%), burn with hot water/food (41%), injury with a sharp knife (72%), accidental ingestion of medicine (3%), injury during play (94%) and foreign body in ear and nose (79%) were identified as the most common injuries among children of 2 to 5 years.Conclusion:This article establishes the need for a detailed prevalence survey. A detailed survey will help in planning an intervention for caregivers which can reduce the injuries in children.

Antigolgi antibodies in a case of autoimmune haemolytic anemia: a case report

Abstract Antibodies against the Golgi complex (AGAs) have been reported rarely and are associated with disorders like systemic lupus erythematosus, Sjogrens syndrome and rheumatoid arthritis. We report a case of autoimmune haemolytic anemia with Antigolgi antibodies, the first such case in medical literature.