Emergent "Bloody Diarrhea" Associated with the Use of Oral Cefdinir in Young Children: A Brief Report and Review of Literature.

BACKGROUND: Cefdinir is an extended-spectrum, third-generation, oral cephalosporin widely used in pediatric population to treat common bacterial infections, including otitis media and streptococcal pharyngitis. It is considered a safe and well-tolerated alternative to penicillin and macrolides. CASE REPORT: This report describes a case series of 3 infants presenting to the emergency department for evaluation of "bloody diarrhea." The parents noticed red stools when their children were started on oral cefdinir when they were previously receiving iron-containing preparations. Reddish-colored heme-negative stools observed in all cases were due to the interaction of the drug with supplemental iron or iron-containing formula feeds. This adverse effect was reversible on discontinuation of cefdinir. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Red stools due to cefdinir is an underreported benign adverse drug reaction with fewer than 10 cases described in the literature. Thorough history taking with an appropriate focus on diet and drug history are essential to avoid parental anxiety, unnecessary patient workup, and economic burden to the caregivers in these cases. Awareness of this unusual adverse effect among emergency physicians could prevent further inconvenience for already overburdened health systems.

A 1-year randomized controlled trial to compare the outcome of primary repair of hypospadias with vascular cover using tunica vaginalis flap with those using preputial dartos fascia.

BACKGROUND: : Tubularized incised plate (TIP) urethroplasty is the most common technique noted to correct hypospadias. However, urethrocutaneous fistula (UCF) is still one of the most common complications of this technique. Several techniques of providing vascularized flaps to the neourethra have been recommended to decrease this complication rate. The aim of the study was to assess the outcome of primary repair of hypospadias using tunica vaginalis (TV) flap with those using preputial dartos (PD) fascia. PATIENTS AND METHODS: : Children diagnosed with hypospadias between the age group of 9 months to 18 years, who fulfilled the criteria were randomly divided into two groups by computerized randomization technique. Initially, TIP urethroplasty was done. Children with PD vascular cover were included in Group A and those with TV vascular cover were included in Group B. All the patients were followed up for a minimum of 6 months after surgery. RESULTS: : Two (10%) patients in Group A developed UCF and one (5%) patient developed stricture urethra in the follow-up period. None of the patients developed UCF in the Group B. One (5%) patient had stricture urethra in Group B. Two (10%) patient developed meatal stenosis in Group A. Two (10%) patient in Group B developed meatal stenosis. CONCLUSIONS: TV flap could be an alternative to PD flap as a vascular cover of neourethra in patients undergoing primary hypospadias repair by TIP urethroplasty.

A rare case of cleft number nine associated with atypical cleft number two.

The incidence of the craniofacial cleft is rare ranging between 1.43 and 4.85/100,000 births. Tessier number nine cleft being the rarest, there are a few reports of detailed ophthalmologic examinations performed in them. In this study, 1-day-old female neonate delivered by normal vaginal delivery at term, weighing 1480 g presented with right eye dystopia, cleft extending through the lateral third of the upper eyelid, brow ending at the temporal region, conjunctival congestion, clear cornea 10 mm in diameter, normal anterior chamber, pupil 2 mm reactive to light, clear lens, and normal fundus. Cleft extended downward from the right medial canthus involving the nasal ala and left forearm had an oblique-crease with camptodactyly. We thus report a case of anterior segment abnormality with an oblique craniofacial cleft. The cause of which is unclear, amniotic band syndrome being a possible cause.

Laparoscopic excision of intra-abdominal oesophageal duplication cyst in a child.

Duplication cysts are congenital cystic malformation of the alimentary tract consisting of a duplication of the segment to which it is adjacent. It can occur anywhere from mouth to anus. Oesophageal duplication cysts comprise 4% of the same. Of these, total intra-abdominal oesophageal duplication cysts are extremely rare. On review of literature, only 3 case reports of total intra-abdominal oesophageal duplication managed laparoscopically are found. All these cases were adults. We report the first paediatric case of intra-abdominal oesophageal duplication cyst excised laparoscopically.

A retrospective analysis of early experience with modified complete primary repair of exstrophy bladder (CPRE) in neonates and children.

OBJECTIVE: To study the problems faced during the surgery and follow-up of modified complete primary repair of exstrophy (CPRE) technique. Initial experience with CPRE and its short- and long-term outcomes with respect to continence status and psychosocial impact are reported. MATERIALS AND METHODS: A retrospective review of the hospital case records from March 2008 to September 2012 was performed. Data of patients with bladder exstrophy managed by a single paediatric surgeon using modified CPRE technique were analysed. Quality of life and psychosocial impact of the surgery were assessed using Pediatric Quality of Life Inventory (PedsQL 4.0) and compared with those of typical peers. RESULTS: Eight children (age 4 days-12 years) underwent CPRE using modified Mitchell's technique. Two patients (25%) experienced early postoperative complications, with infection and fistula developing in one each. All the patients were doing well on follow-up, with variable continence rates and good cosmesis. Mean duration of follow-up was 18.5 months (range 6 months-4 years). Five out of seven (71%) children were continent or partially continent. One case was lost to follow-up. PedsQL scores were comparable with those of age-matched peers in all domains except the social functioning domain in 8-12 years age group (83.53 ± 9.70 vs. 77.86 ± 10.22, P < 0.05). CONCLUSION: Our preliminary results with modified CPRE in neonates and children have been encouraging. No major complications were observed. Continence rate was satisfactory and cosmetic results were good. Though the technique is being practiced at several Indian centres, there is a paucity of comprehensive Indian data on CPRE.

Pyloric atresia in association with multiple colonic atresias in a neonate: an unreported association.

Pyloric atresia is rare cause of gastrointestinal obstruction in neonates and usually occurs as an isolated anomaly. They have been associated with multiple small bowel and colonic atresias but not reported in association with isolated multiple colonic atresias. A case of pyloric atresia occurring in association with multiple colonic atresias is being reported here.