Hyperbilirubinemia and appendicular perforation peritonitis

Background: This study aims to assess the relationship between appendiceal perforation peritonitis and serum bilirubin levels, as has been reported previously in the literature.Methods: A retrospective observational study was conducted at tertiary care hospital of India, namely Government Medical College-Srinagar, Maulana Azad Medical College-Delhi and Government Medical College-Jammu over a period of five years (January 2014 to December 2018). Authors collected and analysed the data of 306 patients, who had reported to the surgery emergency of the afore mentioned hospitals with complaints of acute abdominal pain and were later confirmed and managed as appendiceal perforation peritonitis (localized or generalized). Also, liver function tests of these 306 patients had been sent at the time of admission.Results: Authors had 202 males and 104 females with an average age of 35 years in this study group. Hyperbilirubinemia was noted in 226 patients, with an average serum bilirubin level 1.8 mg/dl. In patients having total leucocyte counts higher than 11000 cells/cumm, the average serum bilirubin level was 2 mg/dl.Conclusions: It may be safely concluded that a pre-operative evaluation of serum bilirubin levels may help us in better diagnosing appendiceal perforation when used in conjunction with other routine and advanced diagnostic modalities.

Profound hypernatremia due to central diabetes insipidus

Diabetes insipidus is a rare endocrine disorder in paediatric patients. Polyuria is a cardinal manifestation that is extremely difficult to recognize in diapered infants. Careful urine quantification is the key to diagnosis in appropriate clinical setting. We report a case of a 4 months old infant presenting with an acute life threatening event following an episode of vomiting and decreased oral intake. She had profound hypernatremia which persisted after stabilization. Polyuria unrecognized by the mother was revealed by 24-hour urine output measurement. A diagnosis of diabetes insipidus was made after appropriate laboratory investigations including serum and urine osmolality. The central nature of the disease was confirmed by neuroimaging which showed holoprosencephaly

Moyamoya disease

A 4 years old boy presented with acute left hemiplegia. Preliminary neuroimaging suggested an arterial ischemic process. Clinical and laboratory evaluation excluded haematologic, metabolic and vasculitic causes. Cerebral angiography confirmed the diagnosis of Moyamoya disease. Treatment included physiotherapy and close follow-up for recurrence