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Background: Acute Kidney Injury is a common condition in critically ill children, and it is independently associated with increased mortality. Etiology of AKI in admitted patients is multi factorial. The present study was conducted to determine possible etiologies and to know short term outcome.Methods: A prospective case series study was conducted in our PICU from Nov 2014 to October 2015. The cases fulfilling criteria as AKI, as per definition were included in study. The urine output was monitored, base line blood urea and serum creatinine was estimated at admission and on alternate days till recovery. Investigations were done to know exact etiology of prerenal, renal or post renal AKI. Cases were managed accordingly and short term outcome was noted.Results: Out of 150 cases studied, 87(58%) were boys and 63(42%) were girls.' Ninety three cases (62%) had oliguria and remaining patients had non-oliguric AKI. Majority of cases in the study belonged to prerenal AKI, followed by renal and post renal AKI. Amongst 150 cases,136 children managed conservatively,11 cases required hemodialysis and 3 cases peritoneal dialysis. In our study, 16 cases succumbed with mortality of 10.66%.Conclusion: AKI is common associated condition in children admitted to PICU. AKI is commonly seen with acute gastroenteritis with severe dehydration, sepsis, glomerulonephritis and dengue shock syndrome. Most of these conditions are easily preventable. Early and effective management of hypovolemic shock and sepsis is also crucial in prevention of AKI.
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Background: Congenital heart disease (CHD) is a defect in the cardiovascular structure and function and represents a heterogeneous group of defects with little known cause. Most of them are diagnosed in newborn period, yet some may be missed only to be diagnosed later. CHDs present with little or no symptoms and hence are under diagnosed in centres with inadequate facilities. So, this study was conducted to find the prevalence of CHDs in neonates delivered in our centre.Methods: The study was conducted in an urban community centre from May 2018 to January 2019. Babies delivered here were subjected to clinical examination, pulse oximetry at our centre and detailed ECHO examination was done at a nearby PHC where a trained cardiologist was available.Results: There were 783 babies delivered during the study period, of which 436 babies underwent echo and formed the study group. Totally 35 (8%) babies had some abnormality on echo. Clinically murmurs were present in 10 newborns. Critical congenital heart disease was seen in 3(0.6%) babies. These babies were diagnosed with severe PS, Bicuspid aortic valve with severe AS and pulmonary atresia. VSD was the commonest malformation followed by ASD and PDA.Conclusions: Screening of CHD helps to detect defects which otherwise would have been missed. Critical CHD could be diagnosed which enabled us to refer the babies for early surgery.
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Background: High-frequency ventilation is defined as ventilation at a frequency greater than four times normal respiratory rate. HFOV has been used as alternative to conventional ventilation and in respiratory failure of various etiologies. The aim of the study was to identify the indications of neonates receiving HFOV, following failure of conventional ventilation.Methods: Total 93 neonates were enrolled in the study who received HFOV. The criteria for starting HFOV, the ventilator settings, CBG and ABG analysis, oxygenation index (OI), duration of ventilation and complications of ventilation were recorded during CMV and subsequently when shifted over to HFOV. Outcomes such as oxygenation, lung recruitment and ventilation and survival were monitored.Results: Total 66 neonates (71%) were term babies. Among the 27 preterm 18 (18.4%) were 33-34'6 weeks of gestational age. Male were 50 in number (53.8%) and female were 43 (46.2%). The male: female ratio was 50:43. Disease specific survival analysis revealed more than 50% survival in cases of pneumonia, collapse, air leak, MAS and pulmonary hemorrhage. 16 out of 33 babies (48.5%) with PPHN survived. All 3 babies with CDH expired. Of the 93 neonates included in the study, 53 (57%) of them were discharged home. The major complications noted while on HFOV were- 38 neonates (40.8%) had air leaks. Instead of, ventilator associated pneumonia was present in 42 of them (45.1%) and none of them developed IVH or NTB (Necrotising tracheo bronchitis).Conclusions: HFOV is a safe and effective technique in the treatment of neonates with respiratory failure in whom CMV fails. The results of present study show that rescue HFOV improved oxygenation, ventilation and lung recruitment and there was no increased incidence of IVH.
ABSTRACT
In July 1994, a 27 year-old man presented with a twice recurrent, pigmented tumor on his left wrist. Wide excision and histological examination showed a pigmented dermatofibrosarcoma protuberans (PDFSP) or Bednar tumor with foci of fibrosarcomatous (FS) change. Immunohistochemistry helped to distinguish it from cellular blue nevus and malignant melanoma. In January 1997, he presented with 3 swellings on his thighs which showed features of fibrosarcoma. In March 1998, he developed multiple tumors on his thighs, chest wall, supraclavicular region, parapharyngeal region and two lung nodules. To the best of our knowledge, there are only 3 previously published reports of metastases in patients with Bednar tumor. We present the fourth such case.