Acute lymphoblastic leukemia with eosinophilia and strongyloides stercoralis hyperinfection

Acute lymphoblastic leukemia [ALL] is the most common malignancy in children. Bone pain is an important symptom that can be severe. Eosinophilia without any other abnormal laboratory findings is rare in ALL. Strongyloides stercoralis in ALL causes disseminated fatal disease. This 9-year-old girl presented with bone pain in lumbar region. Bone pain was the only symptom. The patient didn't have organomegaly. The BM samples were studied by flow cytometry, which showed pre-B cell ALL. Larva of Strongyloides stercoralis was found in fecal examination. Plain chest x ray showed bilateral para-cardiac infiltration. Strongyloidiasis was treated before starting chemotherapy. After two days treatment with Mebendazol the patient developed cough, dyspnea, respiratory distress and fever. The treatment changed to Ivermectin for 2 days. Chemotherapy started five days after diagnosis of leukemia. The patient complained merely of bone pain in lumbar region without any other signs and symptoms. Peripheral blood smear showed eosinophilia without any other abnormality. Stool examination showed Strongyloides stercoralis larvae. We suggest that all patients diagnosed as ALL in tropical and subtropical regions should be evaluated for parasitic infection especially with Strongyloides stercoralis

[Assessment of bilirubin to albumin ratio as a criterion for exchange transfusion in severe neonatal hyperbilirubinemia]

Total Serum Bilirubin level [TSB] has been the gold standard indicator for exchange transfusion [ET] in the neonates for many years. This study was designed to assess the bilirubin/albumin [B/A] ratio as an indicator for ET in comparison with TSB. In the NICU and newborn services at Amirkola Children's Hospital [ACH] in the north of Iran, 90 neonates in 3 groups were selected. The first group was 30 neonates who required exchange transfusion [ET], because of severe hyperbilirubinemia [HB] based on the TSB according to the ACH protocol .The second group was 30 neonates, treated with phototherapy due to pathologic HB and the Other 30 neonates had only physiologic neonatal jaundice. Blood samples were checked for serum bilirubin, albumin and B/A ratio in addition to the routine lab tests for HB. Sensitivity, specificity, negative predictive value, positive predictive value, and relative risk were assessed for B/A ratio as a determinant to do ET. The mean +/- SD of B/A ratio was 6.0847 +/- 0.9870 in blood exchange group, 4.1680 +/- 0.5480 in phototherapy group and 1.7677 +/- 0.5061 in healthy neonate group. "Cut off level" of B/A ratio calculated to do ET was 4.50.The B/A ratio of 4.5 has a "positive predictive value" of 75% and a "negative predictive value" of 100%. A B/A ratio equal to 4.5 among newborns Who required exchange transfusion has a high value as a criterion to do ET, although further study is required to recommend it alone in clinical practice. So we recommend doing B/A ratio in accompaniment with TSB as an adjunctive test

Early surgical intervention for diaphragmatic paralysis in a neonate; report of a case and literature review

Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can cause respiratory failure necessitating prolonged mechanical ventilation and subsequent extubation failure. We present a two-hour-old male newborn with a birth weight of 4500 grams who had a right-sided brachial plexus palsy and right diaphragmatic paralysis due to shoulder dystocia. He developed respiratory distress due to isolated paralysis of the right hemi diaphragm. The clinical course was progressive, his condition worsening despite oxygen application. Physical examination, chest X-rays and M-mode ultrasonography of the diaphragm confirmed the diagnosis diaphragmatic paralysis. Surgical plication of diaphragm was done earlier than the usual time because of recurrent extubation failure. Diaphragmatic plication led to rapid improvement of pulmonary function and allowed discontinuation of mechanical ventilation in less than 3 days. Early diaphragmatic plication enhances weaning process and may prevent or minimize the morbidity associated with long-term mechanical ventilation in a neonate with diaphragmatic paralysis

Aplasia cutis congenita: a case report

Aplasia cutis congenital [ACC] is a congenital absence of skin most commonly affecting the scalp. No definite etiology is available but multiple causes such as intrauterine infection, fetal exposure to cocaine, heroin, alcohol or antithyroid drugs, vascular disruption, genetic causes, syndromes and teratogens have been suggested. We present an infant with symmetrical type of aplasia cutis on the trunk and proximal limbs. She was product of triple pregnancy with two fetuses papyraceous at 12th week of gestational age and at birth. She is treated by non surgical management despite remarkable extent of the lesion. ACC of the trunk is less common than of scalp. Lesion often is symmetric and seen after fetus papyraceous in multiple pregnancies

Comparison of the rate of exclusively breast-feeding rate between pacifier suckers and non-sucker infants

Pacifier as a non-nutritive and comforting object instead of mother's breast is used widespread in civilised societies. The most possible risks of this habit are increased incidence of oral thrush; dental deformities, recurrent acute otitis media and dental caries, but there are still some reports on its beneficial effects. We carried out this study to compare the rate of exclusive breast-feeding during the first six months of life between the pacifier sucker and non-sucker infants. The study was designed as a case-control study on infants who came to outpatient clinic in a primary health care center, affiliated to Babol University of medical sciences during 2003-4. Inclusion criteria were: infants aged 6-12 months, born at term via normal vaginal delivery with a normal birth weight. We divided them into pacifier suckers as case group [n=100] and non-suckers as control group [n=120] by frequency matching. Pacifier suckers were given by their mothers a pacifier to suck as a soothing object before 2 month of life. Outcome characteristics including exclusive breast-feeding, rate of early weaning and substitution of mother milk with a non-mother milk in infants who were pacifier suckers were compared with those of the infants who were not used to suck a pacifier. A p-value less than 0.05 was considered being significant. Success rate of exclusive breast-feeding in pacifier suckers was 30% [n=30], in non-suckers 64% [n=77], [CI: 2.3-7.3; OR=1.24; P<0.001]. The rate of early cessation of breast-feeding among pacifier suckers was 16% and non-suckers 0.01% [p<0.001]. To promote successful breast-feeding and to reduce early cessation of breast-feeding, the use of pacifiers should be avoided or restricted

effect of human recombinant erythropoietin on prevention of anemia of prematurity

Premature infants often develop significant anemia that requires blood transfusion, this carries significant risks. This study was carried out to determine the effect of recombinant human erythropoietin [r-HuEPO] on prevention of anemia of prematurity. From April 2001 to March 2002, 24 neonates in newborn services at Amirkola children's hospital randomly were assigned to erythropoietin group and control [no treatment] group. Inclusion criteria were birth weight of

effect of topical application of human milk, ethyl alcohol 96% and silver sulfadiazine on umbilical cord separation time in newborn infants

Several agents have been used for neonatal umbilical cord care, but we did not find any study evaluating the effect of human milk on umbilical cord separation time. The purpose of this study was to compare the effect of topical application of human milk, ethyl alcohol 96%, and silver sulfadiazine on umbilical cord separation time in newborn infants. This study was undertaken place at a primary-level newborn nursery at a university teaching hospital and a private hospital. Of 373 singleton near- to full-term newborns enrolled in the study, 312 completed the study. Newborns from birth were randomized to either: 1] mother's milk group, 2] alcohol group, 3] silver sulfadiazine group, and 4] control [no treatment] group. Mother's milk for group 1, ethyl alcohol for group 2, and silver sulfadiazine ointment for group 3 were applied to the umbilical stump three hours after birth and continued every eight hours until two days after umbilical cord separation. The time to umbilical cord separation and any discomfort such as infection, hemorrhage, and granuloma formation were reported by mothers. Nothing was applied to the umbilical stump of the control group and they received dry cord care only. It was observed a significant difference in the mean cord separation time among the four group. No significant complications were observed in any group. Breast milk could be substituted for other topical agents for umbilical cord care, but a multicenter study is required in order to advise it for routine umbilical cord care