Role of computed tomography angiography in the evaluation of haemoptysis in children: Decoding the abnormal vessels

Background & objectives: Haemoptysis in children is potentially life-threatening. In most cases, the bleeding arises from the systemic circulation, and in 5-10 per cent of cases, it arises from the pulmonary circulation. The role of computed tomography angiography (CTA) in this setting is important. This study was undertaken (i) to study the role of single-phase split-bolus dual energy contrast-enhanced multidetector row CTA (DECTA) in the evaluation of haemoptysis in children; (ii) to analyze the patterns of abnormal vascular supply in the various aetiologies encountered. Methods: A retrospective study of 86 patients who underwent split bolus DECTA for the evaluation of haemoptysis was performed. Final diagnoses were categorized as normal computed tomography, active tuberculosis (TB), post-infectious sequelae, non-TB active infection, cystic fibrosis (CF), non-CF bronchiectasis, congenital heart disease (CHD), interstitial lung disease, vasculitis, pulmonary thromboembolism and idiopathic pulmonary haemosiderosis. Abnormal bronchial arteries (BAs) and non-bronchial systemic collateral arteries (NBSCs) were assessed for number and site and their correlation with underlying aetiologies. Results: A total of 86 patients (45 males, age from 0.3 to 18 yr, mean 13.88 yr) were included in the study; among these only two patients were less than five years of age. The most common cause of haemoptysis was active infection (n=30), followed by bronchiectasis (n=18), post-infectious sequelae (n=17) and CHD (n=7). One hundred and sixty five abnormal arteries were identified (108 BA and 57 NBSC), and were more marked in bronchiectasis group. Interpretation & conclusions: Active infections and bronchiectasis are the most common causes of haemoptysis in children. While post-infectious sequelae are less common, in patients with haemoptysis, the presence of any abnormal arteries correlates with a more frequent diagnosis of bronchiectasis. NBSCs are more common in post-infectious sequelae and CHD

A Prospective Study on Mycology of Eye Infection in a Tertiary Care Teaching Hospital

Background: Objectives: Fungi are commonly found in the environment and most of them are either commensals or nonpathogenic. Eye infections are caused by bacteria, viruses and less commonly by fungi, therefore not given much attention by the practitioners and also by ophthalmolog ists. In the last one - decade incidence of fungal eye infections has increased due to increase in the number of patients with poor immunity. Common conditions which impair the immunity are prolonged use of steroids and antibacterial broad - spectrum antibioti cs, use of immunosuppressive drugs in cancer patients, in patients with organ transplant and some infections like AIDS. Candida, Fusarium and Aspergillus are the fungi frequently found to be associated with fungal eye infections. Trauma is the most signifi cant predisposing factor particularly when accompanied by contamination with vegetable matter. Methods: Samples such as corneal scrapings, Conjunctival swab, Vitreous & Aqueous aspirates were collected aseptically and sent to microbiology laboratory for KO H wet mount examination and fungal culture. KOH preparation was examined directly under microscope and culture were done on SDA, incubated at 25° c for three weeks. Results: Males were more commonly infected (66.5%) as compared to females (33.5%) The overall positivity in direct microscopy ( KOH preparation) was 32% while positivity in culture was 51%.The most frequently isolated fungus was Fusarium (16) followed by A. flavus ( 07), A. fumigatus (06), Candida sp.(06) and Curvalaria (03) Conclusion: If medical therapy fails to control the infection, surgery should be considered to save the eye visual function before the progression of disease.

Comparing the efficacy of nano crystalline silver dressing versus betadine dressing in management of diabetic foot ulcer

Background: The incidence of diabetes and its complications is rising as a result of the lifestyle changes. The foot is most frequent site for complication in patients with diabetes. Dressings have a vital part to play in the management of wounds. The ideal antiseptic is one that is lethal to all forms of bacteria, has no deleterious effect on healing tissues, delineates the operative areas, easily applied and has wide spectrum of activity and absence of acquired bacterial resistance. Nanotechnology makes it possible to expand the surface area of silver particles markedly to nanoscale. They expand the surface area of silver particles increasing their contact with bacteria.Methods: In the proposed study, over a period of 18 months, 60 cases (30-30 in 2 groups) of diabetic foot ulcers were studied with respect to response (healing) to nano silver dressing and betadine dressing after dividing them randomly. Assessment was based on various parameters like size reduction, healthy granulation tissue, etc.Results: It was seen that percentage reduction in size, was more in nano silver group as compared to betadine group. Wounds were managed successfully, early in nano silver group and wound healing was better in nano silver group as compared to betadine group. Also, nano silver was better antimicrobial.Conclusions: The prospective study showed nano silver gel is safe and effective in wound management and gives better efficacy and faster response as compared to traditional betadine dressing.

Diagnosis of Non-Neoplastic Haematological Disorders using Bone Marrow Aspiration and Trephine Biopsy

Introduction: Proper diagnosis of various hematologicaland non-hematological disorders is important in the fieldof haematology. Bone marrow examination is consideredas valuable diagnostic tool for evaluation and diagnosis ofvarious hematological and non-hematological disorders.Therefore present study aimed to diagnose non-neoplastichaematological disease through bone marrow aspiration orbiopsy and also to explain the prognosis of different diseases.Material and method: Present study was conducted indepartment of pathology, GSVM Medical College, Kanpur,on 30 patients suffering from chronic haematological disease.The relevant history of patients was recorded and informedconsent was taken. Patients were investigated for completeblood count, coagulation profile, reticulocyte count andperipheral blood film (PBF) examination. Bone marrowaspiration and Bone marrow biopsy were done under asepticprecautions.Results: Out of 30 cases, 11 (36.66%) are having nonneoplastic haematological diseases and most common diseaseis iron deficiency anaemia. In iron deficiency and megaloblasticanaemia, bone marrow aspiration findings are more useful anddiagnostic. In aplastic anaemia, final conclusive diagnosis wasmade by bone marrow biopsy.Conclusion: In some haematological disease, Bone marrowaspiration study alone fails to demonstrate disease processes,therefore trephine biopsy is essential. Hypocellular marrow,unexplained pancytopenias and marrow fibrosis are alsostrong indications for Bone marrow biopsy.

Tubularized incised plate urethroplasty with de-epithelialized flap

Aim: To improve the results of tubularized plate urethroplasty by adding de-epithelized flap. Patients and Methods: Twenty-five cases of hypospadias who underwent Snodgrass urethroplasty using de-epithelialized flap were studied. The minimum period of follow-up in this series was 1 year. Results: The resultant neo-meatus was vertically oriented and slit like. Glans was conical which is cosmetically well accepted. Penile raphe was in the midline. None of the patient had residual chordee; penile torsion; or glans dehiscence. Excellent cosmetic results were observed in all cases. The complication rate in our series was 8(two cases). Two patients developed fistula. Conclusion: De-epithelialized flap is a simple method to provide additional covering to the constructed neourethra after Snodgrass urethroplasty. It achieves our goal of noncrossing suture lines and providing maximum vascularity

Incidence of hepatocellular carcinoma among Indian patients with cirrhosis of liver: an experience from a tertiary care center in northern India.

BACKGROUND/AIM: Despite bearing the main burden of HCC, prospective studies from developing countries are lacking. This prospective observational study was designed to estimate the incidence of HCC among Indian patients with hepatic cirrhosis. METHODS: Between April 2001 and November 2004, we enrolled 301 patients with liver cirrhosis. Patients found to be free of HCC using baseline abdominal ultrasound, triple-phase computed tomography (TPCT) and serum alpha-fetoprotein (AFP) levels were followed up prospectively for detection of HCC using ultrasound and AFP every 6 months, and TPCT annually. RESULTS: Among the 194 patients (mean age [SD] 45.1 [+/-13.1] years; male:female 6.1:1.0) followed up, 154 had Child's A and 40 had Child's B disease. The causes of cirrhosis were: hepatitis B-71 (36.6%), hepatitis C-54 (27.8%), dual infection with hepatitis B and C-12 (6.2%) and others including autoimmune, alcoholic and cryptogenic cirrhosis 57 (29.4%). During a cumulative follow up period of 563.4 person-years, 9 cases of HCC were detected, with an incidence rate of 1.60 per 100 person-years. CONCLUSION: In our study, the incidence of HCC among patients with liver cirrhosis was intermediate, being lower than that in Japan but higher than that reported from Europe.

Growth pattern and skeletal maturation following growth hormone therapy in growth hormone deficiency: factors influencing outcome.

OBJECTIVE: To evaluate pattern of growth and skeletal maturation following growth hormone (GH) therapy in children with GH deficiency (GHD) with special emphasis on factors influencing outcome. METHODS: Records of ninety-six children (67 boys, 29 girls) with GHD treated with GH for 2.3 +/-2.1 years were reviewed. RESULTS: Height SDS at the end of treatment was significantly higher than that at initiation (-3.4 +/- 1.7 versus -4.8 +/-1.6, P < 0.001); it was however lower than target height SDS (corrected height SDS (1.8 +/- 1.6, P < 0.001). The greatest increase in height SDS was observed during the first two years of treatment. Kaplan Meier survival analysis showed that 92%; of all subjects achieving end height SDS in the target height range did so within the first two years of treatment. Height SDS for bone age increased by 0.7 +/-0.9 during treatment (from -2.5 +/- 1.0 to -1.8 +/- 1.5, P < 0.001); the increase was however lower compared to that for height SDS for chronological age (P < 0.01) suggesting inadvertent skeletal maturation. End height SDS was influenced by duration of treatment and corrected height SDS on multivariate analysis. CONCLUSION: GH treatment improves growth parameters in GHD; height however still remains compromised. Most of the catch-up growth occurs within two years of treatment emphasizing the need of optimal treatment during this period. Inadvertent skeletal maturation during treatment indicates a need for evaluating the role of agents effective in retarding skeletal maturation.

Imaging of congenital anomalies of the gastrointestinal tract.

The radiological imaging plays a vital role in the evaluation of patients with congenital anomalies of the gastrointestinal tract. The evaluation of these patients, most of which present early after birth, frequently requires the use of various imaging modalities for making the correct diagnosis and planning surgical correction. This article reviews the common congenital anomalies of the gastrointestinal tract including obstructive lesions, anomalies of rotation and fixation, anorectal anomalies, and intestinal duplications. The plain radiograph is often diagnostic in neonates with complete gastric of upper intestinal obstruction and further radiologic evaluation may be unnecessary. An upper gastrointestinal series should be performed in all patients with incomplete intestinal obstruction. Sonography is useful in the evaluation of many congenital anomalies affecting pediatric gastrointestinal tract especially hypertrophic pyloric stenosis, enteric duplication cysts, midgut malrotation, meconium ileus and meconium peritonitis. Moreover, CT and MRI has assumed a greater importance as these provide excellent anatomic details which may be necessary for correct diagnosis as well as treatment planning. This is particularly true in evaluation of congenital anomalies such as esophageal/enteric duplications, vascular rings and anorectal anomalies. It is important to be familiar with the role nad usefulness of the various imaging modalities so that these can be used judiciously to avoid unnecessary radiation exposure while minimizing the patient discomfort.

Blount's disease: a lesser known cause of bowlegs mandating early differentiation from physiological bowing.

We present a 16-month-old child, with progressively increasing bowing of legs, having a normal serum calcium, phosphorus and alkaline phosphatase level; lower limb radiographs revealed bilateral medial tibial metaphyseal beaking. Based on these findings, a diagnosis of Blount's disease (infantile tibia vara) was made and an orthotic management program was instituted for the child.