Post-COVID Pediatric Budd-Chiari Syndrome

Introduction: Budd-Chiari syndrome (BCS) is rare in children. Underlying etiologies, natural history and management differ in children and adults. Treatment options like liver transplantation and transjugular intrahepatic portosystemic shunt have also been less well-studied in children. Presented here is the case of a male child with BCS after coronavirus disease 2019 (COVID-19) infection. Case presentation: A 3-year-old male child presented with complaints of gradually increasing abdominal distension, constipation, decreased urine output, visible veins over abdomen and swelling in lower limbs and periorbital edema since last 15 days. He was diagnosed as BCS after multiple imaging investigations, including triple phase contrast-enhanced computed tomography (CECT) abdomen. His COVID antibody tested positive. Conclusion: Practice guidelines for children with BCS should be formulated, expert group recommendations should be reviewed and a consensus statement should be issued. Underlying etiology remains obscure despite extensive work-up in most of the children. Association of COVID-19 with BCS may be incidental but should be studied further as COVID is known to cause thrombotic complications

Clinico-aetiological profile and outcome patterns of neonatal seizures at a tertiary care centre

Background: Neonatal seizures are a major risk factor for neonatal mortality and subsequent neurological disability. The incidence of seizure varies from 1.5-3.7/1000 live birth; while in NICU it can be up to 5/1000 live birth.Methods: This Descriptive type of observational study aimed to study clinical profile, aetiology in neonatal seizures and short term outcome was done in all Neonatal units attached to paediatric Department of SMS Medical College, Jaipur.Results: In the 100 cases Majority of neonates had onset of seizure <3 days (<72 hours) 53% and remaining 47% neonates had onset of seizure >3 days (>72 hours). Most common type of neonatal seizure was subtle(75%), other types were tonic seizure (17.3%), clonic seizure (5.1%) and least common type was myoclonic (2.5%). Most common cause of neonates seizure noted was birth asphyxia (73%) second common cause is pyomeningitis and third common cause is hypoglycaemia. Most common cause of neonatal seizure both in full term (71.17%) and preterm (25%) is birth asphyxia. Second most common cause of neonatal seizure in full term is pyomeningitis (8.70%) and in preterm is pyomeningitis and hypoglycaemia (25%). Most common cause of neonatal seizure both in onset of seizure <3 days (<72 hours) 53% and in onset of seizure >3 days (>72 hours).Conclusions: Out of total 100 cases, neonates with normal birth weight 92% and low birth weight 8%. Majority of neonates had onset of seizure <3 days (<72 hours) 53% and remaining 47% neonates had onset of seizure >3 days (>72 hours). Majority of neonates with seizure delivered by vaginal route (86%) and remaining 14% neonates were delivered by LSCS.

Assessment Of Examination Stress And HRV in Adolescents.

Objective.The present study was designed to define and evaluate examination stress among ,adolescents in the age group of 12–18 years in relation to heart rate variability (HRV), an index of sympathovagal interplay, one of the sensitive neurophysiological axes to be influenced initially, when an individual is exposed to any stressor.Methods. Hari’s stress inventory for students was used to qualify examination stress was collected on 69 healthy school students, free from any acute or chronic ailment, one month and seven days before the start of final examinations along with acquisition of short – term HRV to profile the sympathovagal interplay, a sensitive index of both physical and mental stress. Results. The stress inventory depicted that the sample population was under an enhanced mental stress 7 days before the examination as compared to that observed 1 month before the ratios of HRV 1month and 7 days before the final examination. Significant appreciable difference could also be appreciated in the values of SDANN in time domain and amplitude of the waveforms in HF, LF on the frequency domain of HRV.Conclusion. An enhanced sympathetic outflow as discerned through increase in LF/HF ratio and LF power with a concomitant decrease in HF power along with significant decrease in SDANN values profiling a decreased vagal outflow of the student population denotes an autonomic neurophysiological status that needs a specialist attention in terms of proper and adequate guidance and counselling.