To study ultrasound and chest X-ray findings and their role in the diagnosis of dengue fever in children.

Introduction: Dengue fever is a fatal viral illness affecting almost all age groups and is seen in almost all tropical countries. Ultrasonography (USG) can be a useful tool for the assessment and diagnosis of dengue fever. Objectives: The study aimed to evaluate X-ray and ultrasound findings in children with dengue fever. Material and Methods: This was a prospective and cross-sectional study that was carried out in a hospital in Mumbai for over one year. All relevant data were collected, validated, and analyzed statistically on the software Epi Info 7. Results: Abnormal X-ray findings noticed were pleural effusion, pneumonia, and bilateral nodular opacities. Pleural effusion and respiratory complications were more common in severe dengue (P < 0.05). Out of the 37 patients on whom USG was done, 33 (89.18%) had abnormal and 4 (10.81%) had normal USG findings. Of the 17 patients with dengue who showed warning signs, 16 (89.9%) had abnormal USG findings. Plasma leakage in the form of ascites and effusion was commonly seen. One hundred percent of patients with severe dengue had abnormal USG findings. The abnormal USG findings were more commonly detected between 5-7 days and were more commonly associated with IgG + IgM-positive serology. Conclusion: Ultrasonography is a good modality for the diagnosis and evaluation of dengue patients. Serial ultrasound should be done for the assessment and evaluation of said patients.

Human Milk Bank in a Rural Setup - A Success Story.

Background: This article describes the experience of a rural human milk bank, with the problems faced in first 6 months including the coronavirus disease (COVID) crisis and interventions leading to success. Methods: The study included individual counselling by dedicated counsellors, focused counselling of primipara mothers seeking the help of obstetricians, counselling of pre-term mothers by neo-natal nurses, periodically delivered information in post-natal wards, and counselling of grandmothers and husbands. Results: The COVID crisis was dealt with donations from reverse transcriptase-polymerase chain reaction-negative mothers with social distancing and mask use. Younger, educated, working mothers with normal delivery and from middle-income families were easy to counsel. Periodic announcements in wards significantly increased awareness about milk banks and donation. Pre-term mothers could be motivated when their baby was nil by mouth or they saw other babies in need of milk. Lactation support to mothers with breast problems, especially in primipara, helps in getting more donors. Counselling of fathers was easier than that of grandmothers. Conclusions: Structured awareness programs and counselling strategies along with education of grandmothers and husbands were very effective in increasing human milk donation.

Femoral Artery Thrombosis: Rare Sequelae of a Common Entity.

Neonatal hypernatremic dehydration (NHD) is a common complication in breastfed neonates which if not recognized early can lead to life-threatening complications. Only a few cases of NHD leading to peripheral gangrene have been reported in the literature. We report a case of a 14-day-old neonate with complaints of dyspnoea, poor oral intake, and gangrenous changes in the left leg. There was a 28% weight loss since birth due to inadequate feeding. The baby was diagnosed with severe hypernatremic dehydration with Kidney Disease Improving Global Outcomes (KDIGO) stage 4 acute kidney injury requiring peritoneal dialysis. Ultrasonography of the left lower extremity revealed a distal femoral artery thrombus leading to dry gangrene requiring amputation. There were neurological signs like altered sensorium and drug-resistant seizures which were suspicious for intracranial pathology like cerebral venous sinus thrombosis. Prevention and early diagnosis of NHD are essential to prevent the occurrences of such grave complications. It can be easily achieved by improving the vigilance regarding the adequacy of feeds subjectively by the mother if the baby is at home and objectively by physicians in the hospital setting. These simple interventions have the potential to prevent readmissions due to not only simple feeding complications but grave complications as mentioned above as well and save precious lives.

A Rare Presentation of Posterior Reversible Encephalopathy Syndrome in Recovery Phase of Guillain-Barré Syndrome.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome, in which a patient presents with neurological symptoms, including headache, seizures, altered sensorium, and loss of vision, and accompanied with characteristic magnetic resonance imaging findings which are likely to be reversible. Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy presumably related to immunological mechanisms. Here, we describe a patient who had PRES in recovery phase of GBS while he was neither on any immunomodulator nor was having hypertension. He recovered completely clinically as well as radiologically.

Concurrent diabetic ketoacidosis and pancreatitis in Paediatric acute lymphoblastic leukemia receiving L-asparaginase.

BACKGROUND: Although hyperglycemia and pancreatitis are known side effects of L-asparaginase, both contributing to the development of diabetic ketoacidosis (DKA) is unfamiliar in literature. CASE PRESENTATION: We report a case of an adolescent girl, recently diagnosed with ALL, who presented with pain in abdomen and breathing difficulty following chemotherapy with L-asparaginase. On subsequent evaluation, she was found to have high anion gap metabolic acidosis, hyperglycemia and ketonuria. Ultrasonogram showed bulky pancreas. DKA was managed with fluid correction and insulin infusion. Pancreatitis was managed conservatively. She recovered completely with resolution of symptoms and without any major adverse events despite having such severe complications. CONCLUSION: We conclude that the combination of DKA and pancreatitis is a rare occurrence with significant morbidity and mortality. We recommend a close monitoring of blood glucose levels for hyperglycemia as well as a high index of clinical suspicion for pancreatitis in patients with ALL receiving L-asparaginase.

Curse of Fluorosis.

Fluoride was identified to have caries preventive properties and was widely used for fluoridation of water since 1940, especially in developed countries. After this there was sudden increase in the use of fluorides in food items and in oral medicinal products like toothpastes and mouth washes. Inadvertent use of above has lead to increase in fluorosis as a public health problem. In many places high fluorides are naturally present in earth crust leading to high water fluoride content increasing the risk of fluorosis. Maintaining a fine balance of fluorides in the body is mandatory for exploiting its advantages. World Health Organization (WHO) has fixed permissible limit of fluorides in water to 1.5 mg/L as a preventive step to contain fluorosis. Fluorosis has three clinical components: Dental, Skeletal and Non-Skeletal Fluorosis. It occurs with increasing level of fluorides in the body. Acute toxicity due to fluorides is also known and occurs as a result of sudden exposure to high levels of fluorides, usually by ingestion. Once fluorosis occurs it is irreversible without any cure. Only symptomatic and supportive management is possible. Hence prevention is the mainstay of management. Prevention is by using alternative sources of water or its de-fluoridation. National Program for Prevention and Control of Fluorosis (NPPCF) was launched in 2008-9 to identify areas with high fluoride content of water, manage the water bodies, screen schools and community for fluorosis and comprehensive management of cases. Improving quality of drinking water as per standards and improving nutritional status of children are also important components of prevention of fluorosis.

Semilobarholoprosencephaly - A Dreading Congenital Anomaly.

Holoprosencephaly (HPE) is a group of structural abnormalities of brain that is an important cause of childhood mortality and morbidity. They usually occur due to impaired midline cleavage of embryonic forebrain i.e., failure of differentiation of the prosencephalon into the telecephalon and diencephalon. De Myer classified this anomaly ranging from alobar to semilobar and lobar type. It can be associated with microcephaly and midline facial anomalies. We present a case of semilobar holoprosencephaly with corpus callosal agenesis.

Suboptimal Performance in Cleft Lip/Palate Children- Who is Responsible?

Information in this article is from an observational study comparing intelligence in children with cleft lip and palate with normal children. Both groups performed "draw a man test", the investigator noted the attitude and behaviour of children and their parents. The study shows low, but normal intelligence quotient in children with oral defects as compared to normal. The probable reason for sub-normal performance appeared to be overprotective attitude of parents and poor self esteem of children with oral defects.

An Arrow Poison (Abrus Precatorius) Causing Fatal Poisoning in a Child.

Ingestion of whole seeds of Abrus precatorius often does not produce serious illness. It generally presents initially with gastrointestinal manifestations. Haemolysis, acute renal damage, hepatotoxicity and seizures are the other manifestations. Herewith we report a child with accidental ingestion of abrus precatorius seeds who presented with altered sensorium and convulsions. The case is being reported on account of its rarity in its initial neurological manifestation and has not been reported earlier in paediatric age group.

Lizard Bite Masquerading as Scorpion Sting Envenomation.

Lizard bite is very infrequent in children. Lizards tend to avoid confrontation. Bites are only inflicted when they are manipulated or when they are cornered and feel threatened. Lizard bites may be frightening but most do not cause serious health problems. The wall lizard or gecko, found in most homes, is not poisonous at all. It only checks insect population. A two-year-old boy was brought with history of lizard bite over right hand when he was trying to capture it. The child had experienced excessive sweating and irritability within two hours of bite. He was treated with supportive care. Prazosin hydrochloride was administered in the dose of 30µ/kg as his symptoms mimicked the autonomic storm which is typically seen with scorpion sting envenomation. To the best of our knowledge autonomic storm following lizard bite has not been reported in the Indian literature so far.

Is MRI Necessary for Skeletal Evaluation in Sickle Cell Disease.

BACKGROUND: More than 50% of the world's cases of sickle cell anaemia are in India with an estimated population of 1.27 billion as against estimated world's population of 7.24 billion. AIM: MRI of 103 patients of sickle cell disease were evaluated to assess the skeletal changes in proven cases of sickle cell disease and to find the incidence of bony infarcts in such patients. The conversion of red marrow to yellow marrow in these patients were also studied. MATERIALS AND METHODS: Sickle cell patients with musculoskeletal pain as well as asymptomatic sickle cell patients were evaluated by MRI. The standard sequences used wereT1WI, T2WI, STIR, T1WI + Gd Contrast. RESULTS: Persistent Red marrow was seen in axial and appendicular skeleton (62 cases). Extramedullary haematopoiesis was found in 4 cases, avascular necrosis of femur head (32 cases) and bone infarcts (46 cases) were also observed in our study. Osteomyelitis, septic arthritis and tubercular infections were associated with sickle cell disease in our study. CONCLUSION: MRI is very sensitive in detecting early stages of avascular necrosis, red marrow persistence, extramedullary haematopoiesis, changes of arthritis, infections and joint effusion.

Traumatic dural sinus thrombosis causing persistent headache in a child.

Dural venous sinus thrombosis following a mild head injury is increasingly recognized. We report case of a 9-year-old male child presented with progressive headache and vomiting following a minor fall. A diagnosis of sinus venous thrombosis was suspected on nonenhancing computed tomography, and that was confirmed with magnetic resonance venography. The child was managed with intravenous fluids, anticoagulation (injection heparin followed by oral anticoagulants-tab coumarin), antiedema measures (mannitol), and antiepileptics (phenytoin) with good outcome.