An Observational Study of Clinical Profile & Short-Term Outcome with Use of Pulse Therapy of Methylprednisolone Alone Vs Methylprednisolone and Intravenous Immunoglobulin In Multisystem Inflammatory Syndrome In Children

Background: Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. There is persistent fever along with inflammation, which can lead to medical emergencies and neonates and children may require critical care. Aims and objectives: This study evaluates use of pulse therapy of methyl prednisolone versus prednisolone and intravenous immunoglobulin (IVIG) in multisystem inflammatory syndrome in children (MISC). Methodology: This analytical study was carried out in 30 children with history of SARS-CoV-19 or MISC attending the PICU or NICU of the Tertiary care centre of DVVPF's Medical College, Ahmednagar. The study was carried out from January 2021 to December 2021.Results: Total of 30 patients were studied with male majority (60%), and mean age of 7.35 years. 28 were kept in the ICU (93.33%). GI symptoms were seen in 24 cases (80%), Mucocutaneous manifestation in 25 cases (83.33%), Multiorgan involvement (>3 organs) in 23 cases (76.67%). D Dimer was raised in 29 cases (96.67%), Thrombocytopenia was seen in 24 cases (80%). CNS involvement in 14 cases (46.67%) with headaches in 7 (23.33%), encephalopathy in 5 cases (16.67%) and seizures in 4 cases (13.33%). Respiratory system involvement was seen in 16 cases (53.33%). We observed that the outcome characteristic features were better in the Methylprednisolone pulse therapy plus IVIG group. (p<0.05) Out of 15 patients in the two groups, 3 patients died in Methylprednisolone pulse therapy group (20%) while there was one death in the Methylprednisolone pulse therapy plus IVIG group. Significant difference was seen in the survival of the two groups. (p = 0.04). Conclusion: There is improvement in both the groups which received the treatment with either Methylprednisolone pulse therapy or Methylprednisolone pulse therapy plus IVIG. Comparatively there was less ICU stay, less complications and better patient survival in Methylprednisolone pulse therapy plus IVIG group.

Neonatal & Paediatric Point Of Care Ultrasound (Pocus): A Novel Standard Practice

An ever expanding branch of applications have been developed for ultrasound, including its goal directed use at the bedside, often called point-of-care ultrasound (POCUS). Although neonatologist-performed functional echocardiography has been at the frontline of the worldwide growth of POCUS, a rapidly growing body of evidence has also demonstrated the importance of non-cardiac applications, including guidance of placement of central catheterisation and lumbar puncture, endotracheal tube localisation as well as rapid estimation of the brain, lungs, bladder and bowel. Ultrasonography has become a pivotal adjunct to the care of neonates in the neonatal intensive care unit (NICU); but a full appreciation for its diagnostic capabilities in the NICU is lacking. Ultrasonography (USG) is no longer the exclusive domain of radiologists and cardiologists. With appropriate training, clinician performed ultrasound (CPU) is now practised widely in obstetrics, emergency medicine and adult intensive care .In many developed countries, it is standard practice in neonatology. In this review, we will discuss neonatal & paediatric point of care ultrasound (POCUS) as a novel standard practice & its clinical application for assessment of the head, heart, lung, gut and bladder for vascular line localization & for endotracheal tube placement. As new applications and adoption of point-of-care ultrasound continues to gain acceptance in paediatric and neonatal medicine throughout the world, a rapidly growing body of evidence suggests that the result will be faster, safer and more successful diagnosis and treatment of our patients.

Primary Autoimmune Hemolytic Anemia Due To Warm Reactive Autoantibodies: A Rare Case Report

Autoimmune hemolytic anemia (AIHA) is an acquired form of hemolytic anemia in which autoantibodies target red blood cell (RBC) membrane antigens, inducing cell rupture (lysis). It affects both pediatric and adult populations, although its presentation in childhood is relatively rare, with the annual incidence [3]estimated to be approximately 0.8 per 100,000 individuals under 18 years old . Here we report one such a rare case of autoimmune hemolytic anemia due to primary warm reactive autoantibodies in a 3 year old female child. As there was presence of hemolysis in peripheral blood smear & other investigations also, Direct coomb's test was done & it came out to be positive which was suggestive of autoimmune hemolytic anemia, as following laboratory reports are suggestive of continuous destruction of RBC & after introduction of steroids parameters of hemolysis came out to be normal suggestive of warm reactive autoantibodies type of AIHA. Clinically also patient improved & her urine colour also became normal after when prednisolone started. Patient also did not have any features of secondary causes of warm autoantibody like Systemic lupus erythematous, immunodeficiency disorders, ulcerative colitis & lymphoproliferative disorders so it was considered primary or idiopathic. W-AIHAtends to have a chronic course and is not expected to subside without treatment. It can be a fatal disease, with a mortality rate of up to 4% in children, either because of the acuity of the presentation or because of being refractory to treatment and requiring multiple lines of therapy with frequently associated toxicity. Fortunately, our patient responded to steroid therapy.

Beta Thalassemia Major with Diabetes Mellitus: A Case Report

Thalassemia occurs due to defects in normal hemoglobin production. Globally it is most common inherited anaemia. Diabetes is a complication of b-thalassemia major. We report a case of Diabetes mellitus in a known case of beta thalassemia major. Patient had undergone splenectomy 1 year back. Patient is taking chelating agent Defasirox 1000mg orally once a day in the morning. Family history reveals, born through third degree consanguineous marriage. The patient was then subjected for laboratory examination reveals BSLwas 490, urine ketone 2+, urine sugar 3+, ABG was normal, HbA1c was 13 & 3 month old report of serum ferritin 1200 ng/dl. TFTand GH studies normal. Multidisciplinary management was instituted. Blood sugar level got controlled over subcutaneous insulin. Patient may have landed in Diabetic ketoacidosis but was promptly diagnosed & treated. This case is presented for its rarity. Due to increase in life expectancy of patient with thalassemia major, patient will expose more years of hyperglycemia and diabetes. Sustaining metabolic control and controlling cardiovascular risk factors helps to prevent future complications.