Dieulafoy’s Lesion – An unusual cause of acute abdominal pain in a child

Dieulafoy’s disease is a rare cause of abdominal pain and G I bleeding. A 10 year old girl having recurrent abdominal pain, GI bleeding and epistaxis. Ileal nodularity and prominent submucosal vessels seen in CT angiogram. Child underwent surgical treatment with favorable outcome. Diuelafoy’s disease can cause bleeding at multiple sites due to abnormal dilated vessels.

Iron Deficiency as a Risk Factor for Simple Febrile Seizures–A Case Control Study.

Objective: To study the role of iron deficiency as a risk factor for simple febrile seizures. Design: Case control study. Setting: Pediatric department of a tertiary care teaching hospital. Participants: 154 cases and 154 controls were included in the study. Consecutive cases and concurrent controls were selected. Cases were children of age group 6 months to 3 years presenting with simple febrile seizures. Controls were children of same age group presenting with short febrile illness but without any seizures. Methods: After informed consent, detailed history was taken and clinical examination done in both cases and controls and blood investigations were done to diagnose iron-deficiency in both cases and controls. Iron deficiency was diagnosed as per WHO criteria (hemoglobin value <11g%, red cell distribution width of >15% and serum ferritin value < 12ng/mL). Other explanatory variables, which can be the potential confounders were also included in the study and considered for analysis. Results: Highly significant association was found between iron deficiency and simple febrile seizures in both univariate and multivariate analysis. Crude odds ratio was 5.34 (CI 3.27- 8.73, P<0.001) and adjusted odds ratio in the logistic regression analysis was 4.5 (CI 2.69- 7.53, P <0.001). Conclusions: Iron deficiency is a significant risk factor for simple febrile seizures in children of age group 6 months to 3 years.

Diagnostic Re-evaluation of Children with Congenital Hypothyroidism.

Objectives: To investigate the causes of congenital hypothyroidism in children more than 3 years of age and to document the frequency of transient vs permanent hypothyroidism. Design: Hospital based observational study. Setting: Pediatric endocrine clinic of a medical college. Patients: Children over 3 years of age, on treatment for congenital hypothyroidism. Intervention: Thyroid function test (TFT) and thyroid ultrasound was done. Children with agenesis or hemiagenesis in thyroid ultrasound were identified. In children with normal or equivocal thyroid ultrasound, thyroxine was stopped and followed. Children with abnormal TFT on follow up had thyroid scintigraphy with or without potassium perchlorate discharge, after which, thyroid hormone supplement was restarted. Children who remained euthyroid on follow up were labeled as having transient hypothyroidism. Main Outcome Measure: Proportion of children with transient hypothyroidism. Results: Among 36 children studied (20 boys and 16 girls), eighteen (50%) had transient hypothyroidism and fifteen (41.7%) had thyroid agenesis. There was one with hemiagenesis, one with ectopic thyroid and another with dyshormonogenesis (2.8% each). Initial TSH level at the time of diagnosis was higher in permanent hypothyroidism as compared with transient group (83.0 ± 31.6 vs 47.0 ± 33.1 mIU/mL; P= 0.002). Conclusions: Thyroid hormone supplementation could be discontinued in 50% of children diagnosed with congenital hypothyroidism.

The newborn with seizures -- a follow-up study.

OBJECTIVE: To determine the sequelae of neonatal seizures in a cohort of newborns, recruited over a six month period. DESIGN: Prospective hospital based study. SETTING: The neonatal intensive care unit (NICU) of a tertiary care hospital. PARTICIPANTS: 135 babies were recruited of whom 10 died and 25 were lost to follow up. METHODS: The cases were followed up over four months. RESULTS: 68% of the babies followed up were normal; 32% had an abnormal neurological outcome. Seven (7%) developed post-neonatal epilepsy. Hypocalcemia was significantly associated with mortality (OR: 21.9; 95% CI: 1.2-391.2). No risk factors could be identified for post neonatal epilepsy. Presence of spike waves in the EEG was significantly related to abnormal neurological outcome (OR: 3.5; 95% C.I. 1.2-10.8). CONCLUSIONS: Majority of neonates with seizures have a normal outcome with no developmental delay or neurological deficit. Predominantly spike waves in the EEG is predictive of abnormal neurological outcome.