Serum ionic calcium levels and hypocalcemia in dengue fever in children and its correlation with its severity: case control study

Background: Dengue fever (DF) is a major health problem, 90% of dengue hemorrhagic fever (DHF) occurring in children <5 years and mortality of 2.5%. Abnormalities like metabolic acidosis, hyponatremia and hypocalcemia can occur in severe dengue especially in dengue shock patients. Alterations in calcium homeostasis, may play a role in the pathogenesis of dengue shock. Objectives is to evaluate serum ionic calcium (Ca2+) levels in children aged 1-18yrs with dengue fever and correlate it with severity and outcomeMethods: The study was prospective hospital based case-control study. Case group had 75 children with dengue fever with equal number of controls. Cases were classified according to WHO classification. Serum Ca2+ levels were estimated within 24 hours of admission.Results: Majority of children with dengue were in the age-group of 6-15 years (71.4%). Out of 75 cases,16% were dengue without warning signs, 54.7% dengue with warning signs and 29.3% were severe dengue cases. Mean Ca2+ level (in mmol/l) was 1.2009 ('0.09) among controls and 1.0911 ('0.10) in dengue cases (p=0.0001). Mean Ca2+ level in dengue without warning signs was 1.0950 mmol/l, dengue with warning signs was 1.1088 mmol/l and severe dengue was 1.0559 mmol/l. Mean Ca2+ level in severe dengue was significantly lower compared to dengue with warning signs (p=0.04). Hypocalcemia was seen in 56% of dengue cases but only 14% among controls. Seven children with severe dengue who died had hypocalemia.Conclusions: Hypocalcemia is common in dengue fever. Lower levels of ionic calcium correlate with severity of dengue illness and may be considered as a prognostic indicator of poor outcome.

Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study.

Background: Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF). Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE) during cardiac surgery under hypothermic cardiopulmonary bypass (CPB). Methodology: Thirty‑five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP), cardiac output (CO), SMABF, superior mesenteric artery (SMA) diameter, superior mesentric artery blood flow over cardiac output (SMA/CO) ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure. Results: SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO-decreased significantly (P < 0.0001) between T0 and T1, increased significantly (P ≤ 0.001) between T1 and T2 and no significant change (P > 0.05) between T0 and T2. Lactates increased progressively from T0 to T2. Conclusion: Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period.

Role of perioperative transesophageal echocardiography in the management of adolescent truncus arteriosus: Rare case report.

Truncus arteriosus (TA) is a rare congenital heart disease defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. The truncal valve in majority of the cases is tricuspid though quadricuspid and bicuspid valves have been reported. Patients with TA typically have a large nonrestrictive sub truncal ventricular septal defect. Survival of these infants beyond 1‑year is uncommon. Here, we report a unique case of 12‑year‑old female patient with persistent TA who underwent surgical repair by using transesophageal echocardiography as a monitoring device during the perioperative management.

Prevalence and Annual Risk of Tuberculosis Infection in Rural Mysore.

We carried out a tuberculin survey among 5-10 years old children in rural Mysore (n=1026) to estimate the annual risk of tuberculosis infection (ARTI). 90.8%of them had BCG scar.The prevalence of infection was estimated as 13.3% with 95% CI of 11.4-15.5 and ARTI as 1.38% .These figures are comparatively higher than what is reported from other places in India.

Burkitt's lymphoma in leukemic phase in an Indian boy.

Burkitt's lymphoma (BL) is the most common childhood cancer in Africa and is most prevalent in areas endemic for malaria. The disease, a malignant growth of lymphoid tissue, usually presents itself as a large tumor of the jaw. It is however, a rarity in the Indian subcontinent. Through an extensive literary survey, it is seen that only a few cases of BL have been reported, accounting for only 0.76% of solid malignant tumors among Indian children. Here we present a case of BL of mandible extending to maxilla in a 13-year-old boy of Indian origin.

Maxillary hyperplasia and hyperostosis cranialis. A rare manifestation of renal osteodystrophy in a patient with hyperparathyroidism secondary to chronic renal failure

This case report describes a 21-year-old female patient with a complex medical condition of end-stage chronic renal failure and secondary hyperparathyroidism presenting with a history of gradual enlargement of the facial bones over a period of one year. The facial enlargement primarily involves the maxilla causing a bizarre facial and dental deformity. Based on the clinical, radiographic, and laboratory investigations the facial deformity was confirmed as a rare manifestation of renal osteodystrophy presenting as maxillary hyperplasia and hyperostosis cranialis