Factors associated with knowledge of diagnosis, prognosis & distress in cancer patients receiving palliative care – A retrospective cohort analysis

Background & objectives: Demographic attributes of cancer patients are associated with the awareness of diagnosis, the prognosis of cancer and their associated psychological distress. This study was aimed to assess the knowledge of diagnosis, prognosis and psychological distress among patients reporting to the pain and palliative care department in a tertiary cancer hospital, south India. Methods: Data of all patients visiting the palliative care outpatient department of a tertiary cancer centre in south India between January and June 2018 were included in the study (n=754). A structured pro forma was used to collect information on the sociodemographic details and clinical aspects and a distress thermometer was used to assess the level of distress. Information, thus collected, were analysed using descriptive statistics and logistic regression. Results: Around 16.2 per cent of the patients were unaware of their diagnosis while two third (68%) were unaware of the prognosis. More than half of the patients reported significant distress (54.1%). Gender, education, not working and being diagnosed with head-and-neck cancers were associated with knowledge of diagnosis, while educational level predicted the knowledge of prognosis. Younger age group, head-and-neck cancer, haematology cancer, state of being unaware of diagnosis and prognosis were found to be associated with distress. Interpretation & conclusions: Higher educational levels and better socio-economic status increase the likelihood of patients being aware of their diagnosis and prognosis. Being unaware of the prognosis remains associated with the higher level of distress

Neutrophil-Lymphocyte Ratio for Predicting Coronary Artery Lesions in Children With Kawasaki Disease

Background: Coronary artery lesions (CAL) are a specific feature of Kawasaki disease (KD), and develop during the second week of illness. This study was conducted to determine whether Neutrophil: Lymphocyte Ratio (NLR), assessed between the fourth and sixth day of fever onset in children with KD, can predict coronary artery lesion (CAL) development. Methods: In this review of hospital records, data of patients with KD admitted at our center between January, 2016 and January, 2020 was retrieved. The patients were divided into two groups based on the presence of CAL, and clinical characteristics of patients were compared between the two groups. Results: Out of the 79 patients enrolled, CAL was found in 40 (50.6%) patients and intravenous immunoglobulin (IVIg) resistance was seen in 13 (16.5%) patients. Multivariate logistic regression revealed NLR as an independent predictor of CAL [OR (95% CI) 2.0 (1.2-3.1); P<0.001], and erythrocyte sedimentation rate (ESR) [OR (95% CI) 1.03 (1.001-1.1) P=0.04], as an independent predictor of IVIg resistance. NLR ?2.08 was 82% sensitive and 80% specific in predicting CAL. ESR ?88 mm/h was 85% sensitive and 64% specific in predicting IVIg resistance. Conclusions: NLR is an independent predictor of CAL in KD. NLR ?2.08 done between the fourth and sixth day of fever onset may identify children with KD at risk of CAL.

A case of successfully treated self-ingested yellow phosphorous poisoning in a known case of epilepsy

Ratol is a rodenticide (rat killer paste) that contains yellow phosphorus, a dangerous toxin that harms the gastrointestinal, hepatic, cardiovascular, and renal systems both locally and systemically. The liver is one of these that is most frequently injured, and the most terrifying result is acute liver failure with coagulopathy. A 25-year-old male who is a known case of epilepsy and was on medication was brought to the Emergency Department by his mother with an alleged history of consuming approximately 15 g of Ratol paste mixed in water 5 days before presentation to our hospital at around 5 pm at his residence. The patient sustained nausea and vomiting during the following day of consumption and was treated for the same in a nearby hospital. The main element in lowering morbidity and death is the provision of effective and timely supportive care.

Association between Stress Depression Anxiety and Coping Styles among Indian University Students during COVID-19 Outbreak

Introduction : Psychiatric illnesses such as Depression and Anxiety can have a substantial impact on one’s mental health. Depression is the most common psychiatric condition diagnosed among students. Objectives : To find out the association of factors which are linked to Stress, Depression, Anxiety and coping styles among Indian University students during COVID-19 outbreak. Methods : A self-administered questionnaire consisting of socio-demographic, DASS-21 and Brief-COPE inventory were used. Results : The study comprised a total of 201 University students ranging in age from 17 to 36 years old. Female students (n=150) were the most common responses, followed by male students (n=51). Depression, anxiety and stress correlated with active coping, planning, positive reframing, acceptance, humor, emotional support, instrumental support, self-distraction, denial, venting, substance use, behavioral disengagement, selfblame and religion. Conclusion : Venting, behavioural disengagement and self-blame are all examples of maladaptive coping techniques that have a significant impact on University students’ Stress, Anxiety and Depression levels. This research will provide a better understanding of the underlying influence of coping methods on Stress, Depression, and Anxiety among university students during the COVID-19 outbreak, enabling for early intervention and improved outcomes

An unusual case of methemoglobinemia resulting from self-administration of nitrobenzene in a psychiatric patient

Nitrobenzene, when consumed in large enough doses, can cause methemoglobinemia. By reducing oxygen unloading and oxygen binding, methemoglobinemia reduces oxygen delivery. This is a case of 55-year-old man who is a known case of psychiatric disorder was brought to the emergency room with an alleged history of deliberate consumption of nitrobenzene liquid approximately 10 mL in the morning of the day at his residence. He also instilled 2 drops in the right ear and was taken to a private hospital where the initial management with gastric lavage, multidose activated charcoal and methylene blue was given. He was then referred to the government tertiary care setting for further management. Prompt intravenous methylene blue treatment increases PaO2 in patients with methemoglobinemia.

Threshold of Inotropic Score and Vasoactive–Inotropic Score for Predicting Mortality in Pediatric Septic Shock

Objective To determine the threshold of the inotropic score (IS) and vasoactive–inotropic score (VIS) for predicting mortality in pediatric septic shock. Method This retrospective cohort study included children aged 1 mo to 13 y with septic shock, requiring vasoactive medication. The area under curve receiver operating characteristic (AUROC) was calculated using mean IS and mean VIS to predict PICU mortality, and Youden index cut points were generated. Sensitivity, specifcity, and binary regression analysis were performed. Results A total of 176 patients were enrolled (survivor, n=72, 41% and nonsurvivor, n=104, 59%). For predicting the PICU mortality, AUROC (95% CI) of IS was 0.80 (0.74–0.86) [sensitivity of 88.5 (80.7–94) and specifcity of 58.3 (46.1–69.8)] and AUROC of VIS was 0.88 (0.82–0.92) [sensitivity of 83.7 (75.1–90.2) and specifcity of 80.6 (69.5–89)]. The respective cutof scores of IS and VIS were 28 and 42.5. On regression analysis (adjusted odds ratio, 95% CI), illness severity (PRISM-III) (1.12, 1.05–1.12), worst lactate value (1.31, 1.08–1.58), IS (>28) (3.98, 1.24–12.80), and VIS (>42.5) (4.66, 1.57–13.87) independently predicted the PICU mortality (r 2=0.625). Conclusion Threshold of inotropic score (>28) and vasoactive–inotropic score (>42.5) were independently associated with PICU mortality. In addition to IS and VIS, severity and worst lactate value independently predicted septic shock mortality in PICU.

Current Overview for Chemical Disinfection of Dental Impressions and Models based on its Criteria of Usage: A Microbiological Study

Objectives: The aims of this study were to compare the efficacy of two proven chemical disinfectants, glutaraldehyde and povidone iodine on dental impression and models by determining the reduction in the microbial load, and to compare changes in the physical properties of the models after adding the disinfectants. Materials and Methods: Irreversible hydrocolloid upper impressions of 90 patients were made and divided into 3 groups of 30 samples each; Group A––Control group; Impressions were run under clean tap water before pouring the model. Group B––2% Glutaraldehyde sprayed on the impression and left in situ for 10 min before pouring the model. Group C –10 ml of (5%) povidone iodine incorporated into the gypsum before pouring the model. Models from all three groups were subjected to microbiological assessment at three different time intervals, T0––24 h, T1––1 month and T2––3 months of storage by comparing the colony forming units (CFUs) of bacteria and fungi. The compressive strength of 5 models from each group was also analyzed in Newton’s/mm2. Results: 2% Glutaraldehyde proved more effective than povidone iodine after 24 h of storage (T1), however at the end of 1 month (T1) and 3 months (T2) the Povidone group showed the maximum disinfection. Both the disinfectants caused a reduction in the compressive strength of the model with the povidone iodine group showing the maximum reduction. Conclusion: Although povidone iodine was the most effective disinfectant after 3 months, it showed a significant reduction in the compressive strength and caused discoloration of the model. 2% Glutaraldehyde proved to be the choice of disinfectant with minimal adverse effects

Financial burden and financial aid for medical students in Singapore: a national survey across all three medical schools

INTRODUCTION@#Singapore has had three medical schools since 2013. We undertook a cross-sectional quantitative national survey to determine the financial impact of medical education on medical students in Singapore.@*METHODS@#All 1,829 medical students in Singapore were invited to participate in this study. Information on demographics, financial aid utilisation and outside work was collected and analysed.@*RESULTS@#1,241 (67.9%) of 1,829 students participated in the survey. While the overall proportion of students from households with monthly incomes < SGD 3,000 was only 21.2% compared to the national figure of 31.4%, 85.4% of medical students expected to graduate with debts > SGD 75,000. There were significant differences in per capita incomes among the schools, with 54.5%, 23.3% and 7.8% of Duke-NUS Medical School (Duke-NUS), NUS Yong Loo Lin School of Medicine (NUS Medicine) and Lee Kong Chian School of Medicine (LKCMedicine) students, respectively, reporting a per capita income of < SGD 1,000 (p < 0.001). There were significant differences in financial support: 75.0%, 34.1% and 38.8% of Duke-NUS, NUS Medicine and LKCMedicine students, respectively, received financial aid (p < 0.001). The top reasons for not applying for aid included a troublesome application process (21.4%) and the perception that it would be too difficult to obtain (21.0%).@*CONCLUSION@#Students in the three medical schools in Singapore differ in their financial needs and levels of financial support received. A national approach to funding medical education may be needed to ensure that financial burdens do not hamper the optimal training of doctors for Singapore's future.

Empathetic Dentistry: Noble Opportunity to Restore Broken Hearts of Malaysian Homes

@#Dentistry is not only about restoring teeth and beauty and there is more to it. One such unexplored dimension is the empathetic side of intimate partner violence victims attending dental hospitals. In Malaysian context, recent figures are staggering and 40% were victims; especially women. One must agree that family physician is the first person that victims contact and serving their best. Unfortunately, violence against women is almost universally under-reported to authorities. Thereby the prevalence of intimate partner violence is more than what is being projected in statistics. In such circumstances, it would be reasonable to investigate if dentists have anything to contribute in this regard. The honest truth that should urge dentists to screen intimate partner violence victims are the one being oro-facial injuries and other their close association with intra-oral anatomy. Given these facts, more opportunities exist to restore broken hearts of Malaysian homes.

Environmental surface sampling of SARS-CoV-2 in selected hospitals in Malaysia

@#COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals’ strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.

Foreign body in vagina: a cause of persistent vaginal discharge in a prepubescent child

Vaginal discharge in prepubertal children is mainly due to hypoestrogenic state of vaginal mucosa making it thin and alkaline leading to mucosal invasion by pathogen. In paediatric case persistent foul smelling, blood stained discharge not responding to medical therapy should arouse suspicion of foreign body. Authors report an interesting case of 2 years old child who presented with persistent vaginal discharge and was found to have a retained foreign body in the vaginaneonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted.

Fabrication of Non-Ionic Surfactant Vesicular Gel for Effective Treatment of Rheumatoid Arthritis.

Rheumatoid Arthritis (RA) is a chronic, inflammatory auto immune disorder with unknown aetiology. Though various efficacious treatment options are currently available to treat RA, failure to cure is unpredictable. Hence the present study aimed to evaluate Piroxicam (PC) loaded non-ionic surfactant vesicular carrier as transdermal patches. MethodsTransdermal patches of PC- niosomes were formulated by solvent casting method using different polymers. The prepared formulation was examined for physico - chemical and morphological characteristics and drug release studies were performed by Franz diffusion cell method. ResultsThe results of physico-chemical characterizations show that all formulations were with optimum range and morphological characterization shows that the prepared niosomes are spherical in shape. Drug release characteristic of all formulations was performed and the result exhibits that formulation TN4 (PC encapsulated niosomal gel transdermal patch) shows highest % drug release (95.13%) when compared to other formulation. The release data was fitted with release kinetics and results shows zero order with non Fickian diffusion mechanism. ConclusionsPC encapsulated vesicular carrier as transdermal patches is a promising drug delivery system to enhance the solubility of poorly soluble drugs. It also enhances the residence time of drug at absorption site. Hence this approach could be beneficial for the effective management of RA.

Association of N-terminal-Pro-B-type Natriuretic Peptide with Localization of Thrombus and Clinical Outcome in Acute Pulmonary Embolism

Introduction: Pulmonary Embolism is a major health problemwhich is associated with significant mortality and morbidity. Itis a common and lethal condition. This study was undertakento find the association between NT-Pro-BNP levels and thelocalisation of thrombus in acute Pulmonary Embolism and toprognosticate the patients.Material and methods: Prospective study conducted ata tertiary care hospital.Thirty patients with PulmonaryEmbolism of various etiologies, confirmed with clinicalfeatures, laboratory investigations and imaging and fulfillingthe inclusion and exclusion criteria were included. Aftergetting informed consent, Blood samples for assessmentof NT-Pro-BNP levels were collected within 24 hours ofadmission.Results: In 19 patients, the thrombus was located centrally(in main pulmonary artery) whereas in 11 patients, thethrombus was located in the peripherally (in segmental andsubsegmental pulmonary arteries). 22 participants of thestudy had normal clinical outcome. 5 patients were morbid(oxygen dependant/ heart failure) whereas 3 patients died.Patients with central pulmonary embolus had higher NT-ProBNP levels whereas patients with pulmonary embolus in thesegmental or subsegmental pulmonary arteries had relativelyless NTPro-BNP levels. Patients with high NT-Pro-BNPlevels had complicated in-hospital course/ mortality whereas,patients with relatively lower NT-Pro-BNP had uncomplicatedin-hospital course.Conclusion: This study shows that higher NT-Pro-BNPlevels indicate higher probability of a more central locationof thrombus in pulmonary embolism and also right ventricularoverload. Also patients with higher NT-Pro-BNP levels had acomplicated in hospital course.

Gastric lipoma: a rare cause of upper gastrointestinal bleed

Lipoma is a rare mesenchymal tumour of stomach (less than 1% of gastric tumours) to present as gastrointestinal bleed. We report a case of upper gastrointestinal bleed from a gastric lipoma in a 42 year male patient who underwent distal gastrectomy for resection of the large submucosal tumour situated in antropyloric region. Most common age of presentation of gastric lipoma is fifth or sixth decade of life and most of these are located in submucosal plane (90% cases) and in antropyloric region (75% cases). Gastric lipomas can be diagnosed by endoscopic means but most often with CT scan which shows characteristic fat attenuation. Small asymptomatic incidentally diagnosed can be safely observed while larger symptomatic tumours are treated by endoscopic or surgical resection which offers cure from this benign lesion.

Impact of type 2 diabetes variants identified through genome-wide association studies in early-onset type 2 diabetes from South Indian population

The prevalence of early-onset type 2 diabetes (EOT2D) is increasing in Asian countries. Genome-wide association studies performed in European and various other populations have identified associations of numerous variants with type 2 diabetes in adults. However, the genetic component of EOT2D which is still unexplored could have similarities with late-onset type 2 diabetes. Here in the present study we aim to identify the association of variants with EOT2D in South Indian population. Twenty-five variants from 18 gene loci were genotyped in 1,188 EOT2D and 1,183 normal glucose tolerant subjects using the MassARRAY technology. We confirm the association of the HHEX variant rs1111875 with EOT2D in this South Indian population and also the association of CDKN2A/2B (rs7020996) and TCF7L2 (rs4506565) with EOT2D. Logistic regression analyses of the TCF7L2 variant rs4506565(A/T), showed that the heterozygous and homozygous carriers for allele ‘T’ have odds ratios of 1.47 (95% confidence interval [CI], 1.17 to 1.83; p = 0.001) and 1.65 (95% CI, 1.19 to 2.28, p = 0.003) respectively, relative to AA homozygote. For the HHEX variant rs1111875 (T/C), heterozygous and homozygous carriers for allele ‘C’ have odds ratios of 1.13 (95% CI, 0.91 to 1.41; p = 0.003) and 1.58 (95% CI, 1.17 to 2.12; p = 0.003) respectively, relative to the TT homozygote. For CDKN2A/2B variant rs7020996, the heterozygous and homozygous carriers of allele ‘C’ were protective with odds ratios of 0.65 (95% CI, 0.51 to 0.83; p = 0.0004) and 0.62 (95% CI, 0.27 to 1.39; p = 0.24) respectively, relative to TT homozygote. This is the first study to report on the association of HHEX variant rs1111875 with EOT2D in this population.

Impact of type 2 diabetes variants identified through genome-wide association studies in early-onset type 2 diabetes from South Indian population

The prevalence of early-onset type 2 diabetes (EOT2D) is increasing in Asian countries. Genome-wide association studies performed in European and various other populations have identified associations of numerous variants with type 2 diabetes in adults. However, the genetic component of EOT2D which is still unexplored could have similarities with late-onset type 2 diabetes. Here in the present study we aim to identify the association of variants with EOT2D in South Indian population. Twenty-five variants from 18 gene loci were genotyped in 1,188 EOT2D and 1,183 normal glucose tolerant subjects using the MassARRAY technology. We confirm the association of the HHEX variant rs1111875 with EOT2D in this South Indian population and also the association of CDKN2A/2B (rs7020996) and TCF7L2 (rs4506565) with EOT2D. Logistic regression analyses of the TCF7L2 variant rs4506565(A/T), showed that the heterozygous and homozygous carriers for allele ‘T’ have odds ratios of 1.47 (95% confidence interval [CI], 1.17 to 1.83; p = 0.001) and 1.65 (95% CI, 1.19 to 2.28, p = 0.003) respectively, relative to AA homozygote. For the HHEX variant rs1111875 (T/C), heterozygous and homozygous carriers for allele ‘C’ have odds ratios of 1.13 (95% CI, 0.91 to 1.41; p = 0.003) and 1.58 (95% CI, 1.17 to 2.12; p = 0.003) respectively, relative to the TT homozygote. For CDKN2A/2B variant rs7020996, the heterozygous and homozygous carriers of allele ‘C’ were protective with odds ratios of 0.65 (95% CI, 0.51 to 0.83; p = 0.0004) and 0.62 (95% CI, 0.27 to 1.39; p = 0.24) respectively, relative to TT homozygote. This is the first study to report on the association of HHEX variant rs1111875 with EOT2D in this population.

Prevalence of possible depression and associated biosocial risk factors among adolescents in a private school in Chennai, South India

Background: Depression among adolescents is often undetected because of lack of awareness in mental health. Schools are the best place to study, analyze and report adolescent depression. The objective of this survey is to find out the prevalence of possible depression and associated bio-social risk factors among high school going adolescents aged 15 and 16 years. This can help reform school curriculum based on the prevalence of depression.Methods: A school based cross-sectional study done by randomly selecting 10 classrooms from the 11th standard high school compartment in a private school. Data was collected using a pre-designed and structured questionnaire based on Kutcher's Adolescent Depression Scale. The results were analyzed using R Studio software with Pearson Chi-square test and a p-value of <0.05 was considered statistically significant.Results: Out of 486 students included in the study, 164(33.7%) have 'possible depression' and adolescents aged 16 years(39.5%) has higher proportion of possible depression than adolescents aged 15 years(29.2%), which is statistically significant(p=0.016). About 46.2% of adolescents having illiterate mothers had a possibility of depression. With regards to physical activity 28.1% who played for 3 hours and more had depressive signs and adolescents who played less had 37.2%. This difference is statistically significant (p=0.039).Conclusions: Being a dormant and hidden disease, depression is one such disease that must be probed by regular health screening. Mother's literacy status and a modifiable factor 'physical activity' have shown promising statistical significance. Adequate physical activity must be included in school curriculum to reduce the risk of depression.

Antimicrobial Profile of Clinical Isolates in Intensive Car e Unit at a Tertiary Care Hospital

Introduction: Intensive Care Units (ICU’s) provides a suitable environment for the proliferation and persistence of multidrug organisms. The burden of nosocomial infections among critically ill patients is much higher in developing countries. Aims and Objectives: The present study was conducted to know the prevalence of bacterial pathogens from various ICU’s of a tertiary care hospital and to determine their resistance profile. Materials and methods: A retrospective study was done on 188 isolates collected over a period of 10 months from January 2018 to October 2018. The isolates were identified by the conventional biochemical method and antimicrobial susceptibility testing was performed by Kirby bauer disc diffusion method. Results: The most common gram negative isolate obtained in this study was Klebsiella spp. About 90/188 (47.87%), followed by Pseudomonas aeruginosa 22/188 (11.70%), Acinetobacter spp. 21/188 (11.17%), and E. coli 20/188 (10.64%). The predominant gram positive cocci isolated were Enterococcus spp. 9/188 (4.79%). All gram negative bacilli were sensitive to Imipenem. About 23.33% of Klebsiella isolates were resistant to Piperacillin tazobactam and 18.89% to Cefoperazone sulbactam. The most effective drugs against gram negative bacilli were Imipenem, Piperacillin tazobactam, and Cefoperazone sulbactam. Conclusion: This study showed the prevalence of multidrug resistant Klebsiella spp. from various ICU’s. These isolates were resistant to third generation cephalosporins, quinolones, and aminoglycosides and were sensitive to carbapenems. Among the non-fermenting gram negative bacilli, the resistant rates were higher for Acinetobacter isolates compared to Pseudomonas aeruginosa.

Outcome of delayed adjustable strabismus surgery in children using a bow-tie optional adjustable technique

Purpose: The aim of this article is to study the feasibility of a delayed adjustable technique of strabismus surgery in children using an optional adjustable suture technique. Methods: The retrospective study included patients <12 years of age. Recessions were done using an optional adjustable bow-tie technique and resections were done by the conventional technique. Patients were evaluated on the third postoperative day and adjustments done when needed. Statistical analysis was done using Microsoft Excel 2010�. Results: The study included 11 patients with exotropia and 16 patients with esotropia. The mean age of the patients was 5.2 years (range 1� years). The mean preoperative distance deviation was 46.7 � 10.4 prism diopters (PD) for exotropic patients and 47.1 � 16.9 PD for esotropic patients. The mean preoperative near deviation was 46.6 � 11 PD for exotropic patients and 52.4 � 17.1 PD for esotropia. Two patients with exotropia (18.2%) and four patients with esotropia (25%) were adjusted under intravenous ketamine in the operating room under anesthetist supervision. No difficulty was encountered in advancing/recessing the muscles. The success rate at 1 month was 100% for exotropia and 87.5% for esotropia. The success rate at the final follow-up was 81.8% for patients with exotropia and 68.7% for patients with esotropia. Conclusions: This delayed optional adjustable strabismus surgery technique provides good short-term results and lower adjustment rates.

Achalasia Cardia In Indian Children– Experience From A Tertiary Care Institute In Chennai, India

Introduction:Achalasia cardia a rare oesophageal motility disorder is not uncommon in children. Aim and objectives:To describe the clinical profile of achalasia from a single pediatric tertiary care centre. Materials and Methods: Retrospective analysis of case records over a period of 10 years from March 2008 to March 2018 at institute of child health and hospital for children, Chennai, India. Results: 26 children had achalasia and 11 (42.3%) were males. The mean age was 42.08±36.33 months and 19 (73.07%) were less than five years at diagnosis. Vomiting was the most common symptom (88.4%) followed by failure to thrive (80.77%). Six had features of Allgrove syndrome. Heller's cardiomyotomy with or without fundoplication was done in 24 (92.3%) and pneumatic dilatation in two. Conclusion: Achalasia cardia is not uncommon and should be considered in children presenting with vomiting, dysphagia and failure to thrive. Surgery remains to be safe and effective.