Allergy Testing – An Overview

Childhood allergies pose huge economic burden and adverse effects on quality of life. Serum IgE has been considered a surrogate allergymarker for decades. Availability of several over-the-counter allergy tests add to confusion of partially trained caregivers. The presentreview focuses on current status of allergy testing in Indian scenario. Various in-vitro and in-vivo diagnostic modalities are available forallergy detection. Skin prick tests are useful for aero-allergies whereas oral challenge tests are best for identifying suspected foodallergies. An allergy test should be individualized based on clinical features, diagnostic efficacy, and cost-benefit analysis.

Flexible Fiberoptic Bronchoscopy Directed Interventions in Neonatal Intensive Care Unit

Objective: To describe the utility of flexible fiberoptic bronchoscopy for the diagnosis andmanagement in the neonatal ICU. Methods: A retrospective, medical chart review wasconducted in neonates who underwent flexible fiberoptic bronchoscopy over a period of 7years. Besides demographic data and diagnostic findings, the results of medical and/orsurgical interventions done by treating neonatologist were recorded. Results: 88bronchoscopies were performed in 83 neonates, of which 37 were done throughendotracheal tube. Indications included persistent need for mechanical ventilation (32),persistent atelectasis (21), and stridor (27). Most common airway anomalies diagnosedincluded tracheobronchomalacia (20), laryngomalacia (18), subglottic stenosis (7), choanalatresia (4), laryngeal cleft (4), and tracheoesophageal fistula (4). Surgical interventions wereundertaken in 17 cases (9 tracheostomies and 2 cases of slide tracheoplasty). Conclusion:Flexible fiberoptic bronchoscopy can be beneficial for the diagnosis and management ofneonates with persistent or undiagnosed respiratory problems.

Flexible Fiberoptic Bronchoscopy in Pediatric Practice

Flexible fiberopticbronchoscopy a vital diagnostic and therapeutic procedure for assessing the airway. Its logistics, clinical indicationsand utility need to be elucidated in pediatric context. Pediatric flexible fibreoptic bronchoscopy is useful for diagnosis of airwayanomalies, bronchoalveolar lavage for diagnostic and therapeutic purposes, and interventions like foreign body removal. Newer ultra-thin bronchoscopes can be used to perform this procedure in children of all ages. Pediatric flexible bronchoscopy is a valuablediagnostic and therapeutic tool in the hands of skilled personnel when used judiciously

Outcome Prediction Value of Red Cell Distribution Width in Critically- ill Childre

Objective: To study the association between red cell distribution width (RDW) and mortalityin critically-ill children admitted in a Pediatric intensive care unit (PICU). Methods: 101participants were recruited consecutively over 3 months. Data collected includeddemographics, vital parameters, laboratory values, severity and organ failure scores, RDWfor the first 5 days of admission, duration of PICU stay and survival outcome. Results: 11patients died during study period. High RDW at admission (RDW D1) correlated significantlywith mortality (P=0.007). The odds of death increased by 15 to 23 times with rise in RDW D1from 18% to >21%. The optimal RDW D1 cut-off value for mortality was 18.6%, which yieldedsensitivity 90.9%, specificity 70.8%, positive predictive value 27.8%, negative predictivevalue 98.4%, and area under curve (AUC) 0.83 (95%CI 0.737, 0.925). 29 out of 60 (48.3%)patients with RDW D4 >18% had PICU stay of ?7 days. Conclusion: High (?18.6%) RDW atadmission and its persistent high levels are associated with high mortality and prolonged stayin PICU, respectively

Lipoid Pneumonia - An Unusual Cause of Acute Respiratory Distress Syndrome.

Background: Lipoid pneumonia is a rare form of pneumonia caused by aspiration of fatty substances. Case characteristics: Acute respiratory distress syndrome in an infant due to accidental aspiration of baby oil massage. Intervention: Large volume bronchoalveolar lavage. Outcome: Gradual recovery over a period of 5 months. Message: Aspiration of lipids cause prolonged and refractory hypoxemia.

Pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis is a rare cause of respiratory distress in neonates. We present a 4-month-old infant who presented with progressive respiratory distress since birth and failure to thrive. He was initially treated as a case of diffuse alveolar disease but on open lung biopsy was diagnosed as pulmonary alveolar proteinosis. The child expired at 7 months of age.