Clinical profile and complication of nephrotic syndrome in a tertiary health care center in central India

Background: Nephrotic syndrome (NS) is a common renal disease that is characterized by episodes of relapses and remissions, with variations in the outcome. It is an important cause of chronic renal disease. Objective: The objective of the study was to access the clinical presentation, investigation profile, associated complication, and therapeutic response in children with NS. Materials and Methods: This prospective observational study was conducted from March 2017 to June 2018 in the department of pediatrics of a tertiary care institution of Central India. A total of 107 children diagnosed with NS were included in the study. Detailed information on age, sex, age at first episode, presenting complaint, history of presenting illness, social, and family history was taken. Detailed general physical examination, systemic examination, investigation profile, and response to management were recorded on a pro forma and correlated statistically. Results: of 107 cases of NS, the most common age group was 5–7 years (54.2%). There were 73 (68.2%) males and 34 (31.7%) females with a male-to-female ratio of 2.1:1. It was found that 39 (36.4%) subjects were newly diagnosed and 68 (63.6%) were relapse cases. A total of 95 (88.8%) patients were steroid-sensitive while 12 (11.2%) had initial steroid resistance NS. Conclusion: In our study, clinical presentation and response to treatment in cases with NS did not differ significantly from other studies

Radiological examination of impact of edentulism on the articular eminence inclination using orthopantomogram

Background: Occlusion is an important component of the temporomandibular joint (TMJ). Little is known about the association between missing teeth and TMJ changes. The objective of this study was to compare inclination of the articular eminence (AE) between dentulous and edentulous arch. Method: A total of 500 patients were divided into group A (dentulous) and group B (edentulous). Group B was further divided into subgroups based on years of edentulism into group 1, group 2 and group 3. On patient’s panoramic radiograph, the sagittal outline of the AE and glenoid fossa were traced, and a sagittal condylar path inclination was constructed by joining the crest of the glenoid fossa and the crest of AE. This was then related to the constructed Frankfurt’s horizontal plane to determine the inclination of AE. Results: The mean measured value for the AE inclination was varying with all the groups. The mean and standard deviation value (combining right & left) for Group A was 42.8+/-6.83 degrees, Group B was 30.45+/-6.55degrees, Group 1 was 30.2+/-7.23degrees, Group 2 was 31.2+/-4.75 degrees, and Group 3 was 27.5+/-9.3 degrees. Significant differences were found in AE inclination between the dentulous and edentulous groups (P <0.05). Conclusion: A significant difference in the AE inclination was found between dentulous and edentulous groups as well as with increase in the period of edentulism

Vaccination in preterm infants: An Indian prospective

Although available literature on vaccination in preterm infants supports timely vaccination without any correction for birth weight or gestation, a delay is still noted. Unfortunately, this group often suffers from various vaccine-preventable diseases with increased severity, especially in lower-middle-income countries. All this could be attributed to unavailability of robust evidence and clear guidelines related to vaccination. A current review article summarizes the available evidence on the use of these vaccines, their immune response, common myths and facts about vaccination in preterm infants in the Indian context. Authors conclude that the vaccines in preterm infants are equally safe, effective, and immunogenic as compared to full-term infants; hence, they should be vaccinated following the same schedule as of their counterparts who born full term. Only exception to this is hepatitis B vaccine, where additional doses should be administered to infants with weight <2000 g, apart from the birth dose

Intranasal midazolam for the treatment of seizures in children in rural India

Background: About 5% of healthy children experience at least one convulsive episode in their lifetime with onset during childhood in more than half the cases. The current evidence suggests that prolonged seizures are best stopped with early treatment. Objective: The objective of the study was to assess the role of intranasal administration of midazolam for seizure cessation at home by caregiver in semi-urban and rural settings. Materials and Methods: A total of 50 children in the age group of 6 months–14 years were included in the study, who previously had a history of convulsions and were on regular follow-up. The study was conducted over a period of 6 months. The parents were instructed to give intranasal midazolam (INM) if seizure activity lasted for more than 3 minutes and the need of giving it 2nd time if the seizure was not aborted and to bring the child to nearest pediatrics emergency set up for the further management. Results: The subjects were divided into three groups according to age: Group A consisted of children between 6 months and 4 years, Group B of 4 and 9 years, and Group C had 9 and 14 years old children. Average duration of aborting seizures before INM use was 16.22 min and after its use was 4.66 min. Seizures were aborted in 45 children within 10 min. Conclusion: INM is safe and efficacious in aborting seizures at home in semi-urban and rural settings

The risk associated with iron deficiency anemia for simple febrile seizures in children: A case–control study

Background: Studies have postulated iron deficiency state to be a risk factor for febrile convulsions as it changes the threshold of neurons excitation which may lower the threshold for seizures in children. However, many other studies have reported a protective role for febrile convulsions by increasing the neuronal threshold. Objective: The objective of the study was to evaluate the association of iron deficiency anemia (IDA) as a risk factor for the occurrence of simple febrile seizures (FS) in children. Material and Methods: A case-control study was conducted in a tertiary teaching hospital from September 2015 to February 2017. A total of 240 cases with fever and simple FS were enrolled according to the inclusion and exclusion criteria. Another 100 cases of children without seizure but with short duration of fever were enrolled as controls. Blood samples were then taken for assessing the hematological indices of these patients. The results were statistically analyzed. Results: Incidence of IDA was found to be more in children with simple FS than controls but was not statistically significant (p=0.35). Furthermore, no association was found with other hematological indices with FS occurrence. Conclusion: We could not find any association of IDA as a risk factor for a simple FS

An uncommon twist to a common event – Isolated enteric splenic infarcts and abscesses

Isolated splenic abscess associated with enteric fever is uncommon with very few reported cases in the literature. Till recently, the condition was more frequently diagnosed at necropsy. Splenic abscess is mostly encountered solitarily rather than being multiple and can be fatal if untreated. Various conditions interfere with the prognosis of splenic abscess such as underlying diseases, abscess number and size, organism spectra, and general conditions. This unusual and potentially life-threatening disease is a diagnostic challenge due to its non-specific clinical picture. High index of suspicion and liberal use of imaging studies are essential for timely diagnosis. We report a case of enteric splenic abscess in an immunocompetent patient without any comorbidities, which was diagnosed by blood tests, ultrasonography, and computed tomography scan and successfully managed conservatively with antibiotics

Primary plasma cell leukemia: A rare case report

Plasma cell leukemia (PCL) is a rare form of plasma cell dyscrasia. Between 2% and 4% of malignant PCD cases are PCL. The presentation may be primary, de novo, or secondary, evolving from an existing case of myeloma as part of the terminal phase of the disease. The median age of patients is 50-60 years with an equal incidence in males and females. Here, we report a case of primary PCL, presenting at the age of 62 years

Community acquired recurrent urinary tract infection caused by Pseudomonas aeruginosa in a public health institute in eastern india: A case report

Urinary tract infection (UTI) is common in childhood with no gender preponderance. Often the diagnosis is missed or cases are neglected, and improperly treated. Common pathogens in community-acquired UTI are Escherichia coli, K. pneumoniae and Proteus spp.P. aeruginosa is quite rare as auropathogen in the community. A case of recurrent UTI was encountered in our Urban Health Centre where an eight-year-old male child had presented with urgency and frequency of urination without fever for the last one year. His urine culture revealed infection with highly drug-resistant P. aeruginosa. A history of contact with a relative who died of urosepsis at home several months back was traced. This is a serious instance of the spread of deadly strains of the bacteria into the society posing a great threat to the community particularly the vulnerable group like children

Acute pancreatitis associated with cholera

Acute Pancreatitis (AP) is the inflammation of the pancreas, common causes being gall stones, alcohol, iatrogenic and trauma. Infections, mainly viral, are a rare cause of acute pancreatitis, mainly reported as case reports or series in the literature. Cholera caused by Vibrio Cholera, though rare these days, is characterized by vomiting and profuse watery diarrhea. We present an interesting case of Cholera complicated by mild pancreatitis with no other obvious cause following admission which was managed conservatively with full recovery. We are highlighting an unheard complication of cholera

Unilateral breast abscess due to nalidixic acid resistant salmonella enteric serovar typhi

A breast abscess is a rare complication of Salmonella bacteremia; especially, in immunocompetent patients. In the era of antimicrobial resistance, untreated or resistant Salmonella can lead to abscess formation in various organs of the body. The authors report a case of unilateral breast abscess due to Nalidixic Acid Resistant Salmonella enterica serovar Typhi (NARST) in a 30-year-old immunocompetent female. This case report highlights the importance of culture & sensitivity of breast abscesses especially in patients residing in endemic areas or those with a recent history of typhoid fever