Immune reconstitution inflammatory syndrome in non human immunodeficiency viruses children on anti tubercular treatment

The term IRIS is almost solely used in human immunodeficiency virus seropositive patients who initiated anti-retroviral therapy (ART), the term paradoxical reaction is generally used to describe a clinical worsening of tuberculosis disease after the initiation of antituberculosis treatment. Distinguishing this paradoxical reaction (PR) from disease progression or treatment failure is an important issue in CNS tuberculosis management. Thus, one must keep a watch for neurological deterioration in a child with Central nervous system tuberculosis (CNS TB). We are presenting a case of a non-Human immunodeficiency virus (HIV) child who developed TB-IRIS while on anti-tubercular drugs, who subsequently responded to steroids along with continuation of antitubercular treatment (ATT).

Comparative study of cord blood lipid profile in preterm and post term neonates

Background: The fetal-origin hypothesis and fetal programming emphasize the profound and sustained impact of factors related to fetal health on the development of chronic disease in adulthood. Several studies suggested that low birth weight and preterm birth linked to abnormalities in cord lipid profile and higher prevalence of atherosclerotic cardiovascular disease. Authors objectives was to estimate and compare cord lipid profile in term, pre-term, and post-term neonates.Methods: In the study group, there were 200 healthy Polish newborns. Newborn characteristics included sex, gestational age at birth, Apgar score, and anthropometric data (weight and length at birth, neonatal ponderal index, head, chest and abdominal circumferences, placental weight, and placental-fetal weight ratio). Cord blood samples were collected for total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG). Information regarding selected maternal factors was collected. Neonates were classified into preterm (<37 weeks) and term (?37 weeks) based on new Ballard scoring.Results: The preterm had higher Total cholesterol compared to Term and post term and it was Statistically Significant with a p value of < 0.001. The preterm had higher Triglycerides compared to term and post term and it was statistically significant with a p value of <0.01. The preterm had higher HDL compared to Term and post term and it was statistically significant with a p value of <0.001. The preterm had higher LDL compared to Term and post term it was statistically significant with a p value of <0.001. The preterm had higher VLDL compared to Term and post term and it was statistically significant with a p value of <0.01.Conclusions: Abnormal intrauterine milieu created by maternal changes during gestation may bear a profound impact on lipid metabolism in neonates, which may account for their differences in lipid profile and anthropometry at birth.

Lingual thyroid with hypothyroidism in a child

Ectopic thyroid is an uncommon embryological abnormality characterized by the presence of thyroid tissue in a site other than its usual pretracheal location. Of all ectopic thyroids 90% are found to be lingual. Lingual thyroid is estimated to occur in 0.2 per cent of normal children, being more common in females. It is a rare congenital anomaly appearing with prevalence of 1:100000. This embryological anomaly originates from failure of thyroid gland to descend from foramen caecum to its normal pre laryngeal site. Interestingly, only 0.01% of these patients present with any overt symptoms. If symptomatic: dyspnoea dysphagia, dysphonia and stomatolalia are some common clinical features associated with it. In females these symptoms manifest during stress as in pregnancy, puberty and menstruation. Some rare clinical presentations reported in literature are hyperthyroidism, malignancy and hemoptysis. Hereby authors are reporting a 7-year-old female child who presented to our department with dysphagia who on evaluation diagnosed to have lingual thyroid with hypothyroidism.

A rare case of Goldenhar syndrome: oculo-auriculo-vertebral spectrum

Franceschetti-Goldenhar syndrome or Goldenhar syndrome, also known as facio-auricular-spectrum (FAV), first and second branchial arch syndrome, or Oculo-Auriculo-Vertebral (OAV) spectrum is a rare congenital malformation which encompasses various morphological and functional abnormalities. The incidence of Goldenhar syndrome has been reported between 1:3500 to 1:5600 children, with a male: female ratio of 3:23. The incidence is higher, about 1 in 1000 children with congenital deafness. The exact etiology is not known. However, it is possible that abnormal embryonic vascular supply, disrupted mesodermal migration or some other factors leads to defective formation of the brachial and vertebral system. Most of the cases have been sporadic. Autosomal dominant, autosomal recessive and multifactorial modes of inheritance have also been suggested. Chromosomal studies have not revealed any abnormality. Authors report a case of a neonate with hemifacial microsomia, bilateral cleft lip and cleft palate, right deformed pinna, right facial palsy, single umbilical artery and congenital heart disease.

Plasma zinc levels in normal and malnourished children with lower respiratory tract infection from 2 months to 5 years of age

Background: Acute Lower Respiratory Tract Infection (ALRI) is an important cause of morbidity and mortality in the developing world. Pneumonia is a severe form of ALRI that cause over 2 million deaths annually among children younger than 5 years of age. About 19% of all deaths, pneumonia is the leading cause of child mortality. Malnutrition is known to be associated with greater intensity of lower respiratory tract infections, higher the frequency of complications, longer episodes of infections. This study is to assess the plasma zinc levels in normal and malnourished children with LRI aged 2 months to 5 years.Methods: This is a case control study, which was carried out in the Department of Paediatrics, Sree Balaji Medical College and Hospital, the study period is one year from July 2016 to July 2017. 100 children between 2 months to 5 years of age with LRI was included in the study and children less than 2 months and more than 5 years. 50 Children with normal nutrition were taken as controls and 50 children with moderate and severe malnutrition were taken as cases. Age and sex were matched among cases and controls. Blood samples were collected for zinc estimation in both the cases and controls. All children were investigated and treated as per the department protocol for the particular condition. All statistical procedures were performed using SPSS v 21.0.Results: In present study, 66% of children had normal zinc levels, 34% of children had low zinc levels. The mean zinc level in our cases was 54.84'18.31 and in controls was 76.84'15.2, which was statistically significant (p = 0.000). Mean plasma zinc levels with respect to age and sex were not significant.Conclusions: Total 34% of children with LRI had low plasma zinc levels. Plasma zinc level were significantly low in malnourished children than normally nourished children with LRI, which is one of the most important cause of high childhood mortality in developing countries.

Comparison of diagnostic and prognostic value of serum procalcitonin and serum lactate in pediatric sepsis

Background: The clinical manifestations of sepsis are highly variable. The signs of both infection and organ dysfunction may be subtle, and thus the most recent international consensus guidelines provide a long list of warning signs of incipient sepsis. Lactic acid, which is a by-product of anaerobic metabolism, can be used as a marker of tissue hypoperfusion. It is being used widely. Procalcitonin has more recently been studied in children.Methods: Totally 60 Children admitted with Septic Shock in PICU between Ages 3 Months to 12 Years were assessed for Serum Lactate & Serum Procalcitonin levels. Evaluation of the biomarkers was done on individual and combinational basis using receiver operating characteristics curve.Results: Out of 60 children, male were 40, female were 20 children. In stage-1 serum lactate' level was 47.83 (mg/dl) sensitivity is about 35.63 and specificity was 63.82' off p-value <0.065**.In stage -2 serum procalcitonin was 49.62 (mg/dl) sensitivity is about 37.77 and specificity was 69.28' off p-value <0.549**.In stage -3 serum procalcitonin was 52.89 (mg/dl) sensitivity is about 41.63 and specificity was 73.89' off p-value <0.651**Conclusions: Early recognition of risk factors will help in timely appropriate therapy and thereby will help in reducing mortality and morbidity in pediatric septic shock. The results suggest that PCT is valid for auxiliary diagnosis of septic conditions in children and used as an indicator of the severity of patients.

Dicephalus dibrachius with anencephaly

We present a case of inferior conjunction in a rare type of conjoined twins, dicephalus in a male fetus. The male fetus was born to a 24-year-old, gravida 2, and para 0, who had medical abortion at 15 weeks of gestation due to anencephaly with meningoencephalocele revealed by ultrasound examination. The fetus was born with 2 anencephalic heads with a bifurcation of the vertebral column and presence of 2 spinal cords. The other viscera and limbs were normal in number and location as for a male singleton. This case illustrates the relationship between conjoined twining, and neural tube defect more particularly anencephaly with a male zygote, which is an unusual presentation for this type of zygote gender