Congenital absence of ribs: a rare association in infant of diabetic mother.

Maternal diabetes, type1, type 2 or gestational diabetes has an increased risk of congenital malformation in fetus. It is also the most common cause of perinatal mortality in these infants. Although various malformation reported in literature, our case of congenital absence of ribs and adjacent intercostal muscles in an infant of diabetic mother is not reported earlier. Poor glycemic control may be the cause of teratogenesis. Asymptomatic single rib absence is managed conservatively but for absence of multiple ribs, surgical repair is required.

Childhood multiple sclerosis mimicking acute disseminated encephalomyelitis.

Multiple sclerosis is a demyelinating disease affecting people in early to middle adulthood and is uncommon in childhood. Here we report a patient of multiple sclerosis who presented much before 10 years of age with features suggestive of acute disseminated encephalomyelitis and altered sensorium which is quite different from the features of multiple sclerosis in adults. Diagnosis in this patient was made on the basis of predominant white matter involvement with clinically remitting and relapsing course of the disease on follow up over 31/2 years, substantiated by finding multiple areas of demyelinating plaques in magnetic resonance imaging, while visual evoked potential and cerebrospinal fluid study supported demyelination. Hence, children with initial diagnosis of acute disseminated encephalomyelitis need long term follow up as they may develop multiple sclerosis.

Efficacy of oral rehydration therapy in dehydrating diarrhoea of children.

Establishment of diarrhoea treatment and training units (DTTUs) in all major health facilities for promotion of appropriate oral rehydration therapy (ORT) is an important strategy for control of diarrhoeal diseases (CDD) in children in this country. Univariate analysis of mortality experiences of a random sample of 225 diarrhoea cases among children treated at DTTU in the department of paediatric medicine, RG Kar Medical College, Kolkata revealed that case fatality rate (CFR) of diarrhoea was much higher among children treated with parenteral fluid therapy with or without drugs (20.6% and 20.9% respectively), compared to those treated with oral rehydration solution (ORS) only (0.75%). Certain child care practices, like immunisation, breastfeeding and use of ORS at home also favourably influenced survival of children suffering from diarrhoea. The CFR of diarrhoea cases did not depend on type of diarrhoea or nutritional status of the child. Thus, promotion of correct practice of ORT merits attention through all possible means.