Parapagus dicephalus conjoined twin: a case report

A conjoined twin is a rare event. As per recent literature, 60% of conjoined twins are aborted spontaneously and hence true incidence of conjoined twin is approximately 1 in 200,000 live births. Classification is based upon site of attachment out of which parapagus with dicephalic variety is extremely rare (0.5% amongst reported cases). Author report a case of dicephalic twin born at 36 weeks of gestation to a multigravida mother in central India.

Hypoalbuminemia in critically sick children

Background: Hypoalbuminemia at admission is a common finding in patients admitted to the Paediatric Intensive Care Unit (PICU) and may predict morbidity and mortality.Methods: Patients of age more than 1 year and less than 12 years diagnosed with hypoalbuminemia on the grounds of the inclusion criteria who were admitted in the Paediatric Intensive Care Unit (PICU) were enrolled in the study as 'cases' and patients with normal levels of serum albumin and otherwise similar characteristics to cases were included in the study as 'controls'. Detailed clinical examination and required investigations were done. Above collected information was utilized to select two groups for the study i.e., those with hypoalbuminemia and others with no hypoalbuminemia. Both these groups were further followed up till discharge or death and the outcome in terms of morbidity and mortality was noted.Results: Incidences of MODS and degree of severity of illness as judged by PRISM III score in cases and control showed that, a lower serum albumin concentration correlated well with higher rates of complications such as ventilator dependence and development of new infections leading longer stay in the critical care unit. The mean length of PICU stay in cases group was statistically longer than in the control group. Although we did not observe a difference in fatal outcome in patients managed with either Human Albumin or Fresh Frozen Plasma compared to those managed conservatively in this study, we did observe a decreased mean length of PICU stay and rate of complications in the patients treated with either Human Albumin or Fresh Frozen Plasma, thus achieving a faster rate of recovery with lesser rate of complications and thus alleviating the morbidity, though still not being able to affect the overall mortality.Conclusions: Hypoalbuminemia at admission was a predictive factor of poor outcome in critically ill children. It is associated with a higher mortality, a longer length of stay in the PICU, as well as longer ventilator use.

Infantile Hepatic Hemangioendothelioma (IHHE) – An Unusual Presentation.

Hepatic tumours are relatively rare in children, accounting for 1% - 4% of all paediatric solid tumors, commonest amongst them are hepatoblastoma, neuroblastoma, and vascular tumors (hemangioendothelioma/haemangiomas). Infantile Hepatic hemangioendothelioma (IHHE) is classically characterised by hepatomegaly, jaundice, congestive cardiac failure with high cardiac output, skin haemangiomas, haemolytic anemia, thrombocytopenia(kasabach – Merritt syndrome), normal Alfafeto protein (AFP) levels and hypothyroidism. We report a case of infantile hemangioendothelioma in a 5 day old female neonate with high output cardiac failure, unusually high alpha-fetoproteins, thrombocytosis and polycythaemia, which posed a diagnostic dilemma. Diffuse IHHE is a rapidly growing benign tumor which can lead to poor clinical outcome if not identified early. Serum AFP can’t be relied to exclude IHHE.

Correlation between Iron Deficiency Anemia and Cognitive Achievement in School Aged Children.

Background: Iron Deficiency Anemia (IDA) is the most prevalent hematologic disorder in childhood. Most correlational studies have found association between iron-deficiency anemia and poor cognitive functions in children, however sufficient studies were not found in Indian children. This study was planned to find effect of iron deficiency anemia on cognitive achievements in school aged children. Methods: Thirty children with iron deficiency anemia and 30 age and sex matched healthy controls underwent IQ testing by Wechsler Intelligence scale for children (WISC). Iron deficiency anemia was defined as Hb <11 gm% and Transferrin Saturation (TS) < 16%. Results: Mean IQ were found to be significantly low in Iron deficient anemic children (91.5±2.3) as compared to controls (97.5±3.2) (Value of unpaired T 0.066 significant at p<0.05). Performance IQ scores were lower (89±2.1) as compared to Verbal IQ scores (94±2.6) in iron deficiency anemia. Conclusion: This indicates that iron deficiency anemia affects the cognitive performance in school children.

Isolated Nonsyndromic Hemimegalencephaly Presenting at Neonatal Age - A Case Report.

Hemimegalencephaly (HME) is a relatively rare sporadic brain malformation characterized by enlargement of one cerebral hemisphere. It has a variable presentation and may include partial seizures to epileptic encephalopathy, hemiparesis and psychomotor retardation. Epilepsy associated with HME is usually refractory to antiepileptic drugs and requires surgical intervention. Diagnosis of HME may be delayed in the absence of detailed examination and high index of suspicion giving rise to poor quality of life prior to surgery. We report, a case of a male neonate, with radiological features of HME picked up within seven days after birth. This was possible as antenatal ultrasonography was showing dilatation of the right lateral ventricle of the fetus. Baby had macrocephaly at birth and refractory convulsions from day two of life. Convulsions were managed successfully. Baby was discharged on necessary treatment and parents were given appropriate counseling. Careful examination and high index of suspicion can help in early diagnosis and better outcome. Our review of the literature did not yield any reports of patients with isolated non-syndromic HME presenting with refractory seizures as initial presentation in the neonatal age group. To our knowledge, this is the first report of its kind.