Postnatal outcomes of infants affected by rhesus hemolytic disease in a tertiary care center in Northern India

Background: Advances in prenatal and postnatal care of neonates with rhesus hemolytic disease of the newborn (RHDN) have led to improved outcomes. Studies evaluating the postnatal outcomes in rhesus (Rh) isoimmunized infants from developing countries are limited. Objective: The objective of this study was to evaluate the postnatal outcomes of neonates ≥32 weeks gestation with RHDN. Methods: A prospective observational study was conducted from July 2014 to June 2016 in a tertiary care neonatal unit in North India. Neonates affected by RHDN were managed as per the standard protocol and were followed up for the first 6 months of life. Primary outcomes were the duration of phototherapy (PT), need for exchange transfusion (ET), occurrence of late-onset anemia, and need for top-up transfusions. Results: A total of 33 newborns with RHDN were included in the study. Median duration of PT was 138 h (interquartile range 64–188) and was inversely correlated with intrauterine transfusion number (Spearman correlation coefficient −0.46; p=0.02). Of 33 neonates with RHDN, 14 (42.4%) neonates required ET. Late-onset anemia was seen in 25 (75.7%) neonates and 17 (51.5%) required at least one top-up transfusion. Cholestasis was seen in 5 (15.1%) neonates. Conclusions: Despite advances in care, short-term morbidities in neonates affected by RHDN are common and require intensive management

Esophageal exclusion and bypass for corrosive injury: The lessons learnt

While it is always preferable to excise and replace the diseased esophagus in corrosive injuries, the surgeon may be compelled to exclude and bypass it by a substernal conduit in select situations wherein excision is technically hazardous. This case illustrates the lessons learnt from a potentially life-threatening complication of bipolar esophageal exclusion

Cardiac calcification in acute intermittent porphyria

Aetiology of pericardial calcifications can be multifactorial. Tuberculosis has been reported as the most common cause. Other known causes include uraemia, asbestosis, post-traumatic or postoperative. We report a rare case of pericardial calcification seen in a patient with established acute intermittent porphyria. A direct causal relationship cannot be established between porphyria and pericardial calcification, but it may be due to deposition of the porphyrin in the pericardium

Acute cardiogenic shock in a girl with systemic lupus erythematosus

Cardiac involvement is one of the main complications substantially contributing to the morbidity and mortality of patients suffering from systemic lupus erythematous (SLE). However, clinically important myocarditis is an unusual feature in SLE. We describe the clinical characteristics, management, and outcome of a 15-year young girl with SLE who developed severe left ventricular dysfunction

Acute cardiogenic shock in a girl with systemic lupus erythematosus

Cardiac involvement is one of the main complications substantially contributing to the morbidity and mortality of patients suffering from systemic lupus erythematous (SLE). However, clinically important myocarditis is an unusual feature in SLE. We describe the clinical characteristics, management, and outcome of a 15-year young girl with SLE who developed severe left ventricular dysfunction