Clinicoetiological profile and outcome of acute febrile illness with thrombocytopenia in children: a hospital based prospective study

'Background: Thrombocytopenia is often the most commonly encountered clinical condition in this routine practice. Etiological causes being numerous, often pose a challenge in evaluating and treating the patients. The objective of this study was to find out the different causes and clinical profile of fever with thrombocytopenia in children aged 1month to 14 year who were admitted in this set up.Methods: This was a prospective study done on 200 patients with thrombocytopenia admitted IMS AND SUM Hospital, BBSR with various complaints, during the period of 01 August 2017 to 01 August 2019. This study includes age group 1months to 14 years.Results: The highest incidence of thrombocytopenia belonged to the age group 11-14 years (22.5%) followed by 6-9 years (19.5%) and 3-6 years (18%). Incidence of thrombocytopenia was more in male child (58.5%) as compared to female child (41.5%). the most common cause of thrombocytopenia was dengue (50%), Scrub typhus (34%) septicaemia (17.5%) followed by malaria (10.5%). Among the infectious aetiology severe thrombocytopenia was seen more in dengue (25%) and scrub typhus (34.5%) but evidence of bleeding was seen more in sepsis (34.2%) even with higher platelet count which may be explained by associated multi organ failure.Conclusions: Infections like malaria, dengue, leptospirosis and septicaemia were the common causes of thrombocytopenia along with scrub typhus. Whenever thrombocytopenia is detected further investigations can help us in reaching a correct diagnosis in the majority of the cases so that appropriate treatment can be given and also to avoid unnecessary platelet transfusion to prevent transfusion related complications.

Snake bite, a neglected menace: a prospective observational study in a tertiary care pediatric intensive care unit

Background: Snake bite is a neglected and underestimated public health problem in tropical and subtropical region. Snake envenomation is a well-known cause of morbidity and mortality in India. In 2009, WHO declared snake bite a neglected disease. Ophitoxaemia is an exotic term characterising the clinical spectrum of snake bite. Objective of this study was to know the outcome in paediatric snake bite cases in a tertiary care PICU (Paediatric Intensive Care Unit) with special reference to envenomation time and also to evaluate and analyse few atypical presentations of snake envenomation by proper history taking, physical examination and help start early intervention to prevent morbidity and mortality.Methods: A prospective observational study was done in Paediatric Intensive care unit of the hospital from June 2017 to June 2019.Results: Around 56.8% of 109 cases were non-poisonous snake-bites. Out of 47 cases admitted to PICU, 68.08% developed cellulitis at the site of bite with Staphylococcus aureus being the commonest organism isolated (56.25%). Anaerobes (bacteroides and clostridium) were also isolated in few cases. Edema at site of bite (hematotoxic) and ptosis(neurotoxic) were most common initial presentation. 36.17% of patients received ASV (Anti- Snake Venom) and first aid within 6 hours of snake bite. The morbidity and mortality were significantly less (p<0.05) as compared to those who didn't receive ASV. 12.76% of cases with normal CRT (Clot Retraction Time) presented with features of coagulopathy. DIC (58.33% of hematotoxic bites) and respiratory paralysis 68 (75% of neurotoxic bites) were the commonest complications. Renal replacement therapy was required in 6.38%, transfusion in 10.63% cases and case-fatality-rate was 12.7%. There were a few atypical presentations of snake bite mimicking Gullain-Barre syndrome, acute onset encephalitis with absent brainstem and pupillary reflexes, intracerebral hemorrhage and cortical blindness.Conclusions: Most snake bites are non-poisonous. Early first aid and ASV administration has better outcome. Fibrinogen levels are more reliable than CRT to diagnose coagulopathy. Acute presentations i.e, altered sensorium, paralysis, blindness and stroke like features should always be evaluated for snake envenomation in suspected cases to prevent morbidity and mortality.

Surgical outcome in relation to duct size at the porta hepatis and the use of cholagogues in patients with biliary atresia.

Background : Small ductules communicating with the bile ducts have been described at the porta hepatis in extrahepatic biliary atresia (EHBA) and these form the basis for hepatic portoenterostomy. The use of cholagogues like dehydrocholic acid (DHC) and ursodeoxycholic acid (UDCA) to enhance bile flow postoperatively has been reported. Aims : This communication describes our experience with the use of cholagogues following surgery in EHBA and attempts to correlate the outcomes with the diameter of the ductules. Material and methods : Fifty five EHBA patients treated by the Kasai procedure form the basis of this study; 35 patients treated during 1979-1986 and administered DHC (3-5mg/kg) postoperatively and 20 patients treated during 1999-2002 and administered UDCA (15mg/kg) postoperatively. The diameter of ductules was measured using an optical micrometer on 5μm serial sections; the ducts were classified as type I (no demonstrable ducts, n=14), type II (<50μm, n=22) and type III (>50μm, n=19). The clinical outcome was categorized as 1 (jaundice free survival at 5 years follow-up, n=7), 2 (initial good response but deteriorated after one year, n=27) and 3 (expired within one year following surgery, n=21). The response to surgery was monitored using biochemical liver function tests (LFT), hepatobiliary scintigraphy (HIDA scan) and occurrence of cholangitis. Results : Age did not affect the size of ducts in both DHC and UDCA groups but patients in the DHC group were older than those treated with UDCA (mean age DHC: 105.22+33.53 days, UDCA: 74.68+23.73 days; p=0.009). There was no statistically significant difference between duct size and postoperative LFT in both groups (DHC p=0.1, UDCA p=0.5). Bile excretion on HIDA scan was significantly better with larger ducts (DHC p=0.003, UDCA p=0.025); overall UDCA showed significantly better bile excretion (p=0.003) but this was not reflected in the surgical outcome. There was no significant difference in the surgical outcome of those treated with DHC or UDCA but a significantly higher incidence of cholangitis was seen with smaller ducts in the UDCA group (p=0.02). Conclusions : There was no correlation between duct diameter and postoperative LFT but type III ducts were associated with better bile flow on HIDA scan. Cholangitis was seen more often with type I and II ducts in both DHC and UDCA groups. UDCA administration seemed to be beneficial in patients with type III ducts in increasing bile flow and reducing cholangitis.

Epidemiology of poisoning fatalities in Manipal.

A twelve year retrospective review of poisoning fatalities was undertaken in the tertiary care referral hospital of Kasturba Medical College, Manipal, South India. Of the 1917 cases of forensic autopsies conducted, 372 cases (79.4%) were due to poisoning deaths. There was an increasing trend observed in the number of poisoning deaths from the period 1993-94 to 1999-2000, followed by a declining trend during 2003-04. Ninety two percent of the fatalities were due to self-poisoning, with 77% due to pesticide consumption. Majority of the cases occurred in the rural areas during winter season. Many of the decedents were men (73.1%) in their 3rd decade of life. Suggestions are being offered on the basis of this study for the control of pesticide poisoning.

Victimologic study of snakebite envenomation.

Snakebite is of grave concern in most parts of India. Being a tropical country with an extensive coastline, India is home to a variety of snakes both poisonous and non-poisonous. This is a retrospective research study conducted at Kasturba Hospital, Manipal, which is a tertiary care teaching hospital situated in Coastal Karnataka, South India. During a three-year period starting from 1st January 2001 to 31st December 2003, one hundred and twenty six cases of snakebites that were admitted at Kasturba Hospital, Manipal were studied. The commonest age group affected was 21-30 years with a male preponderance (66.7%). The victims were agriculturists in 54 cases. Most of the bites occurred during summer. Bites occurred when the victim was outdoors in 72.2% of the cases. Lower limb was commonly involved. Double fang mark was seen in 47.6% of the cases. Non-poisonous snakebite was seen in 38.1% of the cases. One hundred and twenty patients survived, and 6 persons died, representing a mortality of 4.8%.

Profile of methyl parathion poisoning in Manipal, India.

The main objective of this study was to collect data with regard to the pattern of acute methyl parathion poisoning in this part of the world. One hundred and fifty three patients with organophosphate poisoning presented to Kasturba Hospital, Manipal between January 2001 and December 2002, out of which 58 cases (37.9%) were due to methyl parathion exposure. The commonest reason for poisoning was suicide (98.2%). A significant proportion of victims were male (72.4%), many in the 21–30 years age group (43.1%). In 77.5% of the cases, the poisoning incident occurred during daytime. Manifestations were predominantly muscarinic in nature, and the median value of serum pseudocholinesterase at admission was 2407.5 IU/L. Respiratory failure was the commonest complication (41.2%). 25.8% of the cases ended in death, and 40% of these succumbed within 24 hours of exposure.

Efficacy of Chitra granule and powder (hydroxyapatite) in alveolar bone regeneration in rabbits. A histological evaluation.

The reconstruction or restoration of osseous defects caused by inflammatory periodontal disease is a continuing challenge in periodontal therapy. Great strides are being made to this effect using alloplasts such as hydroxyapatite. The present study was designed in Newzealand dwarf rabbits to observe the biologic response of periodontal tissues to synthetically prepared hydroxyapatite in both powder and granule forms by Srichitra Tirunal Institute for Medical Sciences & Technology, Trivandrum and to compare it with that of a commercially available, pure resorbable hydroxyapatite, OsteoGen (HA Resorb). The test materials were implanted in the artificially created bonydefects in the mandible via an intraoral approach. The wounds were allowed to heal upto 26 weeks postimplantation. The clinical evaluation at 12 weeks and 26 weeks postimplantation revealed neither any evidence of inflammation, infection or abscess formation nor any exposure or exfoliation of test materials. The histological examination of the implant sites at 12 and 26 weeks postimplantation revealed varying extent of formation of new osseous tissue and periodontal fibers. A comparison between test materials and control suggested that Chitra granules exhibit a relatively greater potential for newbone and periodontal fibre formation.

Pulmonary vasospasm in rabbits infused with stroma free haemoglobin solution.

Effect of infusion of stroma free haemoglobin solution into mice and rabbits was studied. Though no abnormalities were noted in mice, pulmonary vasospasm and hepatocytic necrosis were seen in all rabbits. In addition to reports that low adenosine deaminase levels in the solution could be a cause of vasoconstriction, it is proposed on the basis of present results that either denaturation of haemoglobin molecule itself or release of super oxide anion during oxygenation of haemoglobin, could cause cellular damage leading to toxicity.