Clinical profile and short-term outcomes in neonates with septic shock

Background: Neonatal sepsis is a syndrome causing severe organ dysfunction triggered by a dysregulated host in response to an infection, affecting millions of neonates. In such situations, early identification and management in the initial hours dramatically improves the outcome. Hence, it was taken up to study the incidence, clinical profile and short-term outcomes of neonates with septic shock.Methods: Hospital based prospective observational study on 95 neonates admitted to neonatal intensive care unit in the department of Paediatrics at Acharya Vinobha Bhave rural hospital, Sawangi, Wardha from 1st August 2016 to 31st July 2018.Neonates diagnosed with septic refractory shock were enrolled after taking IEC approval and assent form and those with non-septic aetiology shock were excluded. Statistical analysis was done to establish correlation between neonatal variables and outcome.Results: 95 neonates fulfilled the inclusion criteria and were recruited. Out of these, 37 and 53 were outborn and inborn respectively. Maximum neonates were preterm and males. Neonates with birth weight 1000-1499 grams to those less than 1000 was 4.2:1. Normal vaginal delivery was more common as compared to lower segment caesarean section (LSCS). Blood culture positivity was in 44.2%. Age of presentation with shock ranged from 1 to 20 days and duration of shock ranged from 2 hours to 192 hours. Most infants were ventilated (84%) and it was more among those who died.Conclusions: Septic shock is the most common type, carrying high morbidity and mortality (more than 60%). Laboratory and clinical parameters (TLC, Platelet count, CRP, Blood culture, duration of shock, HR, RR, BP or arterial blood gas) (p>0.05) did not carry a prognostic value in predicting the outcome of such neonates. Early identification and intervention remains the key in managing such a challenging neonatal condition.

Transcranial Doppler Study Among Children with Sickle Cell Anaemia Vs Normal Children.

Introduction: Role of transcranial Doppler in prevention of stroke in sickle cell children has been well appreciated. Studies are being done to develop the protocol in children. Since we don’t find stroke very commonly in this part of the world, this study was done in order to see the prevalence of abnormal flow velocity in sickle children attending sickle cell clinic. The aims of this study were to measure mean flow velocity in different vessels in homozygous sickle cell patients using transcranial Doppler study, to compare the mean velocity in sickle children with age and sex matched controls and to correlate mean velocity with headache or stroke if any and also to correlate mean velocity with number of transfusions. Materials and Methods: The study was done in Paediatric wards. It was a prospective crosssectional comparative study. Twenty six children below 14yrs of age with homozygous sickle cell disease attending the Sickle cell clinic were selected as the cases. Forty cases of similar age and sex were recruited as normal control group. Transcranial Doppler was done in six different vessels in both the groups and mean flow velocity was measured. Mean flow velocity was correlated with symptoms and number of transfusions. Velocity was classified as normal (<170cm/sec), conditional (170-199cm/sec) or abnormal (>200cm/sec). Statistical analysis was done using SPSS 10 software. Results: In normal age and sex matched controls mean blood flow velocity was 50cm/sec where as in the cases of sickle cell disease was 180cm/sec. Maximum mean velocity was observed in middle and posterior cerebral artery. In two Sickle cell cases (8%) blood flow velocity was abnormal, these children had headache though received 5-10 transfusions/year. In only 4% sickle cell children flow velocity was normal and rest had conditional velocity. Among these children 39% received less than 5 and rest received 5-9 transfusions /yr and had no symptoms of stroke. Conclusions: Flow velocity measured by Transcranial Doppler is highest in middle cerebral artery and Posterior cerebral artery which appear to be the best arteries for this test in this region. Flow velocity was significantly high in children with sickle cell disease as compared to normal children. Prevalence of abnormal flow velocity in our children was 8% and children with abnormal mean flow velocity presented with headache.

Three-dimensional CT angiography in the evaluation of cerebral arteries in acute hemorrhage.

OBJECTIVE: We conducted this study to demonstrate the value of non-invasive three-dimensional CT angiography (3D CTA) in the detection of a cerebral aneurysm. MATERIAL AND METHODS: A helical CT acquisition was obtained using non-ionic contrast media in 50 patients with 1 mm per second table speed, 1 mm collimation, and pitch 1:1. Axial source images were transferred into a workstation console (Advantage windows GE) and CTA was obtained using MIP (Maximum Intensity Projection) reconstruction. Fourteen patients underwent conventional digital subtraction angiography (DSA) after 3D CTA prior to surgery. RESULTS: A total of 39 aneurysms were detected in 50 patients. All patients with an aneurysm were operated and the presence of aneurysms was confirmed. 3D CTA detected 38 of these 39 aneurysms. In 37 aneurysms, the origin of the aneurysm and aneurysm neck was adequately visualized. 3D CTA was found to be 100% specific and 97.2% sensitive in picking up cerebral aneurysms. 3D CTA was 97% specific in demonstrating the exact origin and showing the neck of the aneurysm. CONCLUSIONS: CT angiography is a simple, quick, and non-invasive technique and can replace DSA in most patients with acute subarachnoid hemorrhage aneurysm for the detection and characterization of aneurysms of the circle of Willis. The relation of the aneurysm with bony landmarks was clearly depicted.

Adult atretic parietal cephalocele.

Atretic parietal cephalocele is a congenital anomaly of childhood with poor prognostic value. The authors report an adult with associated brain malformations (interhemispheric cyst, partial corpus callosum agenesis) - but, interestingly, without any clinical symptoms related to the entity.

Lateral sacral lipomyelomeningocele : a rare anomaly.

Lateral sacral lipomyelomeningocele is a rare spinal developmental anomaly. In the case under report, the fat attached to the neural placode was blending with the gluteal fat externally. The cord was tethered at this level. Multiple bony anomalies and diastematomyelia were associated findings. A case of lateral sacral lipomyelomeningocele with excellent imaging detail provided by the multiplanar magnetic resonance (MR) scan is reported.

Duodeno-jejunal hemangiomatosis.

Diffuse duodeno-jejunal hemangiomatosis in children is a rare cause of bilious vomiting. In the clinical approach to bilious vomiting, tumors of the duodenum come at the end of the differential list--not to mention the rarity of hemangiomatosis. To our knowledge, isolated duodeno-jejunal hemangiomatosis as a cause of bilious vomiting in children is being reported for the first time. We analyse the various imaging modalities available to reach a clinical diagnosis.

Cervico-dorsal spinal enterogenous cyst.

A case of a histologically proven ventrally situated spinal enterogenous cyst of cervico-dorsal region is reported with magnetic resonance (MR) imaging features. A brief review of literature on the subject is discussed.

Orbital granulocytic sarcoma in acute myelogenous leukemia.

A five year old boy presented with progressively increasing proptosis of the left eye. CT scan showed bilateral extra-conal homogeneously enhancing soft tissue masses, larger on the left side. A possibility of granulocytic sarcoma of the orbit was considered. Diagnosis was confirmed by peripheral smear and bone marrow aspiration. Patient responded to chemotherapy.