Prevalence of cholera in pediatric patients with acute dehydrating diarrhea.

Objective. To estimate the prevalence of culture-confirmed cholera in patients with acute dehydrating diarrhea, at a tertiary care center in north India, during a 6-month period from March to August, 2006. Methods. We studied 145 children, who presented to the pediatric emergency services of a tertiary care teaching hospital in north India with acute dehydrating diarrhea. Each patient had his/her stool sample collected for Vibrio cholerae culture and hanging drop preparation for darting motility. The stool specimen for hanging drop analysis was immediately transported to the emergency laboratory, where a trained technician prepared the slides and examined them for darting motility characteristic of Vibrio cholerae. Results. V. cholerae was isolated in 36 (24.8%) patients. Forty-nine (33.7%) patients had a positive hanging drop examination. Hanging drop examination had a sensitivity and specificity of 85.8% and 81.7%, respectively. Severe dehydration (OR 4.3; P<0.01) and hanging drop positivity (OR 12.42; P<0.001) were associated with higher odds of cholera after adjustment for other risk factors. Conclusion. Cholera is an important cause of acute watery diarrhea in pediatric patients in urban north India and should be ruled out in all children presenting with acute dehydrating diarrhea, particularly those with severe dehydration. Hanging drop test is useful for diagnosis in the emergency setting.

Profile of childhood poisoning at a tertiary care centre in North India.

OBJECTIVES: To determine the profile and outcome (discharge from emergency room after observation, admission or death) of pediatric patients presenting with acute poisoning to a tertiary care centre in north India. METHODS: We retrospectively reviewed the last 2 year (July, 2004 to July, 2006) hospital records of pediatric emergency room to profile all cases of pediatric poisoning during that period and noted their outcome. All cases age < or = 12 years with definite history of poisoning were included. RESULTS: 111 patients presented to the pediatric emergency during the study period. Mean age of our patients was 3.12 +/- 2.04 yrs (SD). Majority of our patients (63.9%) was in the 1-3 yr age group. Males outnumbered females by a factor of two; majority of our patients resided in urban areas. Kerosene (27.9%), drugs (19.8%) and insecticides (11.7%) were the agents most frequently implicated. Almost all (96.9%) ingestions were accidental in nature. Thirty six patients (32.4%) were asymptomatic after 6 hr of observation in the emergency ward; 75 patients (67.6%) developed symptoms related to toxic ingestion. The common serious symptoms included altered sensorium, respiratory distress, seizures, ataxia, hypotension, cyanosis and burns; three patients required intubation and mechanical ventilation. Almost one third of our patients underwent gastric lavage; no patient with kerosene poisoning or any other inappropriate indication underwent the same. CONCLUSION: The trends for pediatric poisoning noted at our centre are not very different from those observed in hospital-based studies conducted more than a decade ago, despite the rapid socioeconomic development in our country. In sharp contrast to developing countries, where majority of poisonings are due to common non-toxic household products, most of our patients require hospitalization because of severe symptoms related to dangerous nature of toxins ingested. Consultation with the poison cell results in improved patient management.

Familial systemic lupus erythematosus with hypercalcemia.

An 8-yr-old girl with familial systemic lupus erythematosus and several severe manifestations, including persistent thrombocytopenia, rapidly progressive renal failure and hepatic failure is described. The course was complicated by the occurrence of hypercalcemia, hypophosphatemia and elevated levels of parathormone, an association not previously reported in children.

Persistent thrombocytopenia following dengue shock syndrome.

Though thrombocytopenia is one of the hallmarks of dengue hemorrhagic fever/ dengue shock syndrome, persistence of the same is rare. We report an 11 year-old child with dengue shock syndrome, who developed persistent thrombocytopenia. The possible mechanisms are discussed.

Validation of the PELOD Score for Multiple Organ Dysfunction in Children.

We conducted a prospective study to identify the children having multiple organ dysfunction at admission using the PELOD score, and its impact on the mortality in a pediatric intensive care unit of a tertiary care hospital in north India over a 13 month period. Data were collected in a predesigned collection sheet and the PELOD score was calculated. 209 patients were admitted. In 37.2% primary indication of admission was severe sepsis/ septic shock. Ninety-one percentage of children admitted had multiple organ dysfunction. The area under the curve for predicting death using PELOD score equation was 0.80.

Idiopathic neonatal aortic thrombosis.

We report a term neonate with severe aortic thrombosis involving the aorto-iliac segment and leading to renal failure. This patient did not have any predisposing risk factors. The authors have also reviewed the literature on neonatal aortic thrombosis and discuss the need for evolving evidence based consensus guidelines for management of this catastrophe.