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.

Systemic melioidosis presenting as suppurative parotitis.

A 3 year old child was brought with fever, left parotid swelling and altered sensorium. Cultures from blood, pus and throat swab grew Burkholderia pseudomallei. A diagnosis of septicemic melioidosis with encephalopathy was made. She recovered following treatment with parenteral ceftazidime for 14 days, and 6 months of oral co trimoxazole and amoxycillin clavulanate. She is doing well on follow-up.

Nocturnal cough and esophagogastric polyp: causal or casual association?

A 6-year-old boy presented with nocturnal cough of 8 months duration. Upper gastrointestinal endoscopy (UGIE) showed an esophagogastric polyp and esophagitis. The 24 hours ambulatory pH recording revealed moderate gastro esophageal reflux (GER) and esophageal manometry demonstrated hypotensive lower esophageal sphincter (LES). A diagnosis of gastroesophagel reflux disease (GERD) with hypotensive LES and inflammatory esophagogastric polyp was made. The child's symptoms subsided with antireflux treatment.

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.

A reappraisal of the criteria to diagnose plasma leakage in dengue hemorrhagic fever.

A study was undertaken to analyze the usefulness of radiographic and ultrasonographic findings and area specific hematocrit cut off values in Dengue Hemorrhagic Fever (DHF). Of the 65 cases, 35 were DHF and 30 were Dengue Fever as per the WHO case definition. Among the DHF cases, hemoconcentration (>20%) was detected in 20 cases (57.14%), hypoproteinemia in 11 (31.42%) and clinical evidence of pleural effusion and or ascites in 25 (71.42%). Hemoconcentration based on area specific hematocrit cut off values was observed in 32 cases (91.42%). Ultrasonographic evidence of plasma leakage was seen in 32 cases (91.42%). In detecting plasma leakage, area specific hematocrit cut off values and ultrasonography had the highest sensitivity (91.42%), while ultrasonography had the highest negative predictive value of 84.21%. Clinical evidence of plasma leakage was more frequent than hemoconcentration or hypoproteinuria. Ultrasonography is an ideal non-invasive investigation to detect plasma leakage and area specific hematocrit values are useful as evidence of plasma leakage.

Hypocalcemia due to vitamin D deficiency in exclusively breastfed infants.

This report is based on observations during the conduct of a study of hypocalcemia in infants and children. In a study of 50 cases, 13 exclusively breast fed infants manifesting with hypocalcemic seizures were confirmed to have vitamin D deficiency. None of the 13 infants had received vitamin D supplementation. All of them had biochemical evidence of hyperparathyroidism and low levels of 25 (OH) Vit D3 and promptly responded to therapy with vitamin D and calcium. All the mothers of these 13 infants had low levels of 25 (OH) Vit D3. Mothers of 5 infants had reported reduced exposure to sunlight due to religious reasons. This report emphasizes the need to supplement Vitamin D in exclusively breast fed infants and also to encourage exposure to sunlight in them and their mothers.

Chest physiotherapy in pediatric practice.

Chest physiotherapy (CPT) in children is generally considered as a separate and specialized treatment modality that should be rendered only by a physiotherapist. Actually this is not difficult if one has a proper understanding of the basic concept and principle behind the maneuver. This article aims at making CPT simple, so that it could be incorporated in routine pediatric practice for managing respiratory ailments.

Myelofibrosis and vitamin D deficient rickets--a rare association.

Myelofibrosis is a rare hematological condition in infancy. We report a case of a 6-month-old infant who was diagnosed to have myelofibrosis due to Vitamin D deficient rickets. This rare association of myelofibrosis and rickets is discussed here with a review of relevant literature.

Pediatric Crohn's disease in South India.

Crohn's disease is a chronic inflammatory bowel disorder characterized by discontinuous, transmural, granulomatous inflammation involving any location of the gastrointestinal tract. A retrospective analysis of 10 children diagnosed as Crohn's disease (CD) is presented from Chennai, South India. The children were between 5-15 years of age and majority had primary colonic involvement. Complications such as stricture and fistula were identified. These children were managed medically except one who underwent surgery.

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.

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 entertained.

MURCS association.

The MURCS association i.e. MUllerian duct aplasia, Renal aplasia, Cervicothoracic Somite dysplasia is a rare developmental disorder. The authors report a case of MURCS association with supernumerary ribs in a 7-month-old infant who presented with failure to thrive.