Acute bilirubin encephalopathy in term neonates: a hospital-based study

Background: Acute Bilirubin Encephalopathy and kernicterus is an important cause of cerebral palsy, developmental delay and hearing impairment in low-middle income countries. Interventions such as universal screening for neonatal jaundice, Rhesus immunoglobulins, intensive phototherapy and exchange transfusion have made kernicterus rare in high income countries, but in our set up such cases continue to be reported.  Methods: Retrospective observational study where case records of term neonates brought to the neonatal ICU with signs and symptoms of acute bilirubin encephalopathy during the years 2016 and 2017 were sought and analysed.Results: A total of ten term babies reported to the neonatal unit with severe hyperbilirubinemia along with signs and symptoms of bilirubin encephalopathy of which 60% were females. 90% had a birth weight of more than 2.5 kg and mean birth weight was 2.7±0.25 kgs. All the babies were out born. A 4 babies were born at home of which 3 pregnancies were completely unsupervised during the antenatal period. 90% of the babies were from the rural areas, 6 of the cases were from the districts Rajouri, Poonch and Reasi where the terrain is hilly, 2 from rural areas of Jammu and 1 from Kathua. Only 1 was from the Jammu city. The age at admission ranged from 3-9 days and serum bilirubin from 24 to 43.3 mg %. A 5 babies had ABO incompatibility, 1 Rh incompatibility, 1 sepsis, while no cause could be found in 3.Conclusions: Neonatal jaundice is often not easily appreciated by mothers and caregivers in the home setting until it becomes severe enough, at which point neurological damage may have already occurred. There is an urgent need to train the primary health care personnel in assessment and early identification of risk factors for severe neonatal hyperbilirubinemia. They can help the families to seek prompt treatment for this preventable cause of cerebral palsy and mental retardation

Angiomatous nasal polyp: Clinical diagnostic dilemma

Angiomatous polyp (Angiectatic nasal polyps) is rare and its incidence is 4-5% of all nasal polyps. As it occurs with variable clinical features and there is no confirmatory preoperative investigation, clinical diagnosis can be a dilemma. Clinical picture of angiofibroma, simple antrochoanal polyp and inverted papilloma may resemble with each other. As polyps invade surrounding bone, these should be distinguished from a malignant mass. We present an interesting case of an infarcted angiectatic nasal polyp with extensive surrounding bony destruction. Correct preoperative radiological diagnosis is important to avoid unnecessary extensive surgery. Histopathological evaluation of polyps is mandatory since they require different treatment due to difference in the prognosis

Homozygous familial hypercholesterolemia

Familial hypercholesterolema (FH) is an inherited autosomal dominant disorder of lipid metabolism. We report a 3 years old female child who presented with multiple eruptive xanthomatosis of skin since 6 months of age and had deranged lipid profile consistent with FH

Angiomatous nasal polyp: Clinical diagnostic dilemma

Angiomatous polyp (Angiectatic nasal polyps) is rare and its incidence is 4-5% of all nasal polyps. As it occurs with variable clinical features and there is no confirmatory preoperative investigation, clinical diagnosis can be a dilemma. Clinical picture of angiofibroma, simple antrochoanal polyp and inverted papilloma may resemble with each other. As polyps invade surrounding bone, these should be distinguished from a malignant mass. We present an interesting case of an infarcted angiectatic nasal polyp with extensive surrounding bony destruction. Correct preoperative radiological diagnosis is important to avoid unnecessary extensive surgery. Histopathological evaluation of polyps is mandatory since they require different treatment due to difference in the prognosis.</p

Treatment response and short-term outcomes in children admitted as multisystem inflammatory syndrome in children

Background: Multisystem inflammatory syndrome in children (MIS-C) is a postviral complication that has been described among children after 2–6 weeks of exposure to the COVID-19 virus from various parts of the world. Published literature regarding MIS-C in children is limited. The aim of this study was to investigate the disease management and clinical outcomes of a larger group of children from North India presenting with features of MIS-C. Materials and Methods: This is an observational study of children with MIS-C, admitted to the pediatric intensive care unit (PICU) between March 1, 2021, and August 31, 2021, during the second wave of SARS-CoV-2 infection in India. Results: Out of the 37 children presenting with MIS-C, 62% of patients were male and 37% were female patients. Vasoactive medications were required in 14 patients. Eighteen patients required respiratory support, of which 17 received noninvasive ventilation and only one patient required invasive mechanical ventilation. Methylprednisolone and intravenous immunoglobulin (IVIG) were used in the majority of patients. No patient required remdesivir. Thirty-six patients were discharged home with a median duration of 4 days in PICU and a hospital stay of 10 days, only 1 (2.7%) patient died during the treatment. Thirty-five (94.5%) patients received IVIG alone, and five patients (13.5%) received IVIG along with methylprednisolone. Patients who received a combination of steroids and IVIG had greater severity of illness, deranged laboratory parameters, highly raised inflammatory markers, requiring higher inotropes, respiratory support, PICU requirement, and length of stay in hospital. Conclusions: The decision to treat MIS-C patients with IVIG plus methylprednisolone or IVIG alone must be reviewed on an individual basis. IVIG in conjunction with methylprednisolone should be considered for patients with severe MIS-C and hypotension who have been admitted to the PICU

Deltamethrin ingestion with suicidal intent: A fatal outcome

Deltamethrin intoxication is uncommon throughout the globe and more so the oral ingestion. The toxicity of pyrethroids is considered much less than the intoxication caused by other insecticides, especially organophosphates. This report describes a case of a 14-year-old female child who was admitted to the emergency room (ER) with dyspnea, cyanosis, tetany, seizures and coma following deltamethrin ingestion in a suicidal attempt. Deltamethrin ingestion should be considered as a differential diagnosis in patients presenting to ER with nonspecific neurological symptoms

Prevalence of metabolic syndrome in adolescents aged 10-18 years in Jammu, J and K

Objective: To estimate the prevalence of metabolic syndrome among adolescents attending school in the Jammu region, India. Materials and Methods: This is a cross-sectional study conducted between November 2009 and December 2010, among a total of 1160 school-going adolescents of both sexes aged 10-18 years. Relevant metabolic and anthropometric variables were analyzed and criteria suggested by National Cholesterol Education Program Adult Treatment Panel Third (NCEP-ATP III) modified for age was used to define metabolic syndrome. Results: The overall prevalence of metabolic syndrome was 2.6%. Prevalence of metabolic syndrome was higher in males (3.84%) than in females (1.6%) and slightly higher in urban area (2.80%) than in rural area (2.52%), whereas prevalence of metabolic syndrome among centrally obese subjects was as high as 33.33%. High density lipoprotein cholesterol was the most common and high blood pressure was the least common constituent of metabolic syndrome. Metabolic syndrome was most prevalent in 16-18 years age group (4.79%). Conclusion : This study demonstrates that metabolic syndrome phenotype exists in substantial number (up to 3%) of adolescent population in the Jammu region, India, and particularly 33% of obese adolescents are at risk to develop metabolic syndrome. These findings pose a serious threat to the current and future health of these young people

Prevalence of Insomnia among Paediatric Cancer Patients: A Hospital-based Observational Study

Introduction: Insomnia and other sleep disturbances are the common occurrences in paediatric patients suffering from cancer. These may be attributed to the disease itself or its treatment and accompanying psychosocial stress. Sleep disorders including insomnia are known to have a detrimental effect on the quality of life in these patients. Aim: To estimate the prevalence of insomnia among cancer patients aged 1-15 years admitted in the paediatric oncology ward. Materials and Methods: A prospective observational, hospital-based study was conducted in the Paediatric Oncology ward, Shri Maharaja Gulab Singh (SMGS) Hospital, Government. Medical College (tertiary care institute), Jammu, India, from June 2022 to August 2022. A total of 50 patients, in the age group of 1-15 years, diagnosed with malignancies like leukaemia, lymphoma, aplastic anaemia, hepatoblastoma, etc., were enrolled after taking informed consent from their parents. Insomnia Severity Index (ISI) was administered to parents of children below 10 years age and to patients themselves who were between 10-15 years to screen for symptoms of insomnia with the help of their parents/investigators as and when required. Continuous variables were expressed as mean±Standard Deviation (SD) and categorical variables were summarised as frequencies and percentages. Results: The study subjects were distributed according to their age into three groups, as 1-5 years (n=26), 6-10 years (n=16), and 11-15 years (n=8). There were 24 (48%) males and 26 (52%) females. In this study, 32 (64%) study subjects did not have insomnia, 5 (10%) had subthreshold insomnia,13 (26%) had moderate insomnia and none had severe insomnia. Conclusion: The prevalence of insomnia found in the study was 26%. Insomnia is common in paediatric cancer patients necessitating its recognition and management for improved quality of life