Pediatric oral vitiligo: Case report and literature review / Vitiligo oral pediátrico: reporte de caso y revisión de la literatura

ABSTRACT: Vitiligo is an acquired hypomelanotic disorder of the skin resulting from loss of functional melanoctyes and it affects approximately 0.5-1% of individuals. 25% of vitiligo in children are diagnosed before 10 years of age. The age of onset of vitiligo in children ranges between 4 to 8 years. Depigmentation in oral cavity can be easily noted and awareness about the condition can be created if they are not aware about vitiligo elsewhere in their body and can be guided for the treatment.

RESUMEN: El vitíligo es un trastorno hipomelanótico en la piel que resulta de la pérdida de melanocitos funcionales y afecta aproximadamente al 0,5-1% de los individuos. El 25% de los casos de vitiligo en niños se diagnostican antes de los 10 años. La edad de aparición del vitiligo en los niños oscila entre los 4 y los 8 años. La despigmentación en la cavidad oral se puede notar fácilmente y se puede crear conciencia sobre la afección, si no son conscientes del vitiligo en otras partes de su cuerpo, y pueden ser guiados para el tratamiento.

Diagnosis of ventilator-associated pneumonia: Comparison between ante-mortem and post-mortem cultures in trauma patients.

Purpose: To evaluate the diagnostic utility of ante‑mortem tracheal aspirates for diagnosis of ventilator‑associated pneumonia (VAP). Trauma victims represent an otherwise healthy population, who are on multiple invasive life‑support devices, which predispose them to severe infections like VAP. The diagnosis of VAP is challenging, due to the difficulty in obtaining a representative sample from lungs. We studied the diagnostic utility of tracheal aspirates by comparing its results with the post‑mortem lung cultures. Materials and Methods: A total of 106 fatal trauma patients were included in the study. Lung samples and cardiac blood were taken for culture at the time of autopsy. The results of ante‑mortem and post‑mortem cultures were compared. Results: Septicemia was the cause of death in 51 (48%) of the fatal cases and VAP was identified in 36 (34%) cases. A total of 96 (90.5%) cases had pathogens isolated from lung samples. In 62 (58%) cases, the same organism was isolated from ante‑mortem and post‑mortem respiratory samples. Conclusions: Culture results of a properly collected tracheal aspirate should be taken into consideration along with Centre for Disease Control and Prevention (CDC’s) diagnostic criteria to maximise the diagnosis of VAP.

Sociodemographic and clinical profile of aluminium phosphide poisoning in Jaipur, Rajasthan.

Aluminium phosphide pellets are inexpensive and widely available for grain fumigation and preservation. Their free availability has led to an epidemic-like situation in some parts of India due to its intentional (suicidal or homicidal) or accidental ingestion. There is a steady year-wise increment in the number of deaths due to this poison, and it is the single most frequent suicidal agent in Jaipur, Rajasthan. Eighty nine patients with acute aluminium phosphide poisoning were studied in SMS Hospital Jaipur, during the period September 2009 to September 2010. Out of these, 74 patients died (83.15%). The sociodemographic and clinical profile of aluminium phosphide poisoning are discussed in this paper.

A review of second medical opinion cases and its attribute to medical negligence: A retrospective study.

Today the number of cases of medical litigation is increasing and already it has become a great problem for surgeons, anaesthetists and obstetricians. The general practitioners and physicians are also facing the problem and in coming years the profession may turn into a nightmare. SMS Medical College is the biggest and oldest medical teaching institution in Rajasthan. The department of Forensic Medicine handles all types of medico legal works and there is a separate established Medical Board under the chairmanship of the Head of the department. Here we receive second opinion cases from different law enforcing agencies including the hospital and public administration. In this paper we have reviewed the second opinion cases with a primary focus on medical negligence cases in the time period of 2005 t 2009. Total 55 cases were identified out of which 42 were dead and 13 were alive. Maximum numbers of cases were observed in the age group of 21-30years. The number of female cases outnumbered the number of males. Maximum numbers of cases were related to surgical practice (OG-21, Surgery-8, Ortho-6, Neurosurgery-3, ENT-2, Opthal-1 and Urology-1).

Hypereosinophilic syndrome.

Hypereosinophilic syndrome is a leukoproliferative disease characterised by sustained overproduction of eosinophils. The three diagnostic criteria for this disorder are (1) Eosinophilia of greater than 1500 cells/ml, persisting for longer than 6 months, (2) lack of another diagnosis to explain the eosinophilia and (3) signs and symptoms of organ involvement. We report a 15-year-old boy who was diagnosed as Hypereosinophilic syndrome based on these criteria.

Diagnosis of mucopolysaccharidoses: how to avoid false positives and false negatives.

OBJECTIVE: This paper advocates a complete procedure, which includes both quantitative and qualitative analysis of urinary GAGs in the diagnosis of MPS in a clinically suspected population. METHODS: Urine samples from 219 clinically suspected mucopolysaccharidoses (MPS) patients and 91 controls were analysed using a combination of methods. Quantitation of isolated urinary glycosaminoglycans (GAGs) were carried out using acid alcian blue complex formation method and qualitative urinary GAG analysis by multisolvent sequential thin layer chromatography RESULTS: Of the 219 patients analysed, 131 were confirmed to be suffering from MPS. Quantitation of urinary GAGs alone would have missed 60 low GAG excreting MPS patients and misdiagnosed 26 high GAG excreting nonMPS as MPS patients. Further qualitative analysis and enzyme estimation were needed to identify these 60 low GAG excreting MPS patients and 26 high GAG excreting non MPS patients. CONCLUSION: These results emphasize that quantitation of urinary GAGs alone cannot diagnose MPS patients, it should be coupled with qualitative analysis and enzyme estimations for differential/definitive diagnosis.

Sino-bronchial syndrome in children with asthma.

Thirty children in the age group of 2 to 12 years were brought with a history of recurrent non-seasonal moderate to severe wheezy episodes associated with symptoms of nasal congestion, sneezing and occasional headache. All of them had maxillary or pan sinusitis with 26 having associated right, left or bilateral lower lobe pneumonitis or bronchiectasis. Serum immunoglobulins were normal in 22 and was not done in eight. There was positive (2 to 4+ above negative control) skin test response to dust and dust mite in 15 of the 22 children tested. Throat swabs/sputum or nasal secretions grew B-hemolytic streptococcus or streptococcus pneumoniae in twenty-seven. All the children were put on bactericidal drugs for 6 to 8 weeks and bronchodilators were used when needed. At the end of 6 to 8 weeks follow-up X-ray of sinuses and chest showed significant clearing of the lesions which coincided with marked clinical improvement. Sinus X-ray should be considered in bronchial asthma resistant to medical management since untreated bacterial sinusitis can be an underlying cause of chronic poorly controlled asthma.