A case report of acute disseminated encephalomyelitis following severe dengue in a child.

INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is a rare neurological complication seen in association with severe dengue infection. Here we report a case of a six-year-old male child with ADEM following dengue fever. CASE REPORT: A six-year-old boy was admitted with fever, hematuria, and melena of five days duration. On evaluation, the child had shock and features of coagulopathy. Dengue NS 1 antigen and IgM ELISA were positive. The child received treatment as per the 2009 WHO dengue protocol. On day seven of illness, he developed neurological symptoms. Magnetic resonance imaging (MRI) done on day eight of illness showed T2/FLAIR hyperintensities in bilateral frontoparietal subcortical deep white matter, occipital periventricular white matter, pons and cerebellar hemispheres, diagnostic of ADEM. He responded to intravenous methylprednisolone. He was discharged 2 weeks after hospitalization. His neurological examination was normal at follow up after a month. CONCLUSIONS: Early recognition and prompt treatment of ADEM in dengue can lead to a successful outcome without neurological deficits.

Light Emitting Diode (LED) Phototherapy versus Conventional Phototherapy in Neonatal Hyperbilirubinemia: A Single Blinded Randomized Control Trial from Coastal India.

Neonatal hyperbilirubinemia is a common problem with potentiality to cause irreversible brain damage. Reduction of serum bilirubin level is essential to minimize such damage. Compact fluorescent tubes, halogen bulbs, fiber optic blankets, and LEDs are commonly used light sources for phototherapy with varying efficacies. This study aimed at evaluating the effect of LED versus conventional phototherapy on (a) rate of reduction in total serum bilirubin levels, (b) effect on urinary lumirubin excretion, and (c) comparing side effects of phototherapies among neonates with hyperbilirubinemia. In this randomized control trial, 166 neonates ≥ 35 weeks of age requiring phototherapy were recruited and further divided into 2 groups [LED (83) and conventional (83)] by using computer generated random numbers. Serial total serum bilirubin levels and random urinary lumirubin levels were collected and side effects of phototherapy were noted. Rate of fall in total serum bilirubin levels (TSB, µmol/L/hour) and random urinary lumirubin levels were computed. Data were collected using a pretested proforma. Analysis was done with Statistical Package for Social Sciences (SPSS) version 11.5. Independent sample "t" test and Chi-square tests were used with p value of <0.05 being significant. Significant difference was documented in mean rate of decrease of TSB (µmol/L/hour) in LED group (5.3 ± 2.91) when compared to conventional group (3.76 ± 2.39) (p <0.001). A significant increase in mean random urinary lumirubin levels (arbitrary units) was observed in LED group (129.01 ± 33.18) when compared to conventional group (114.44 ± 44.84) (p = 0.021). Side effects were minimal and comparable in both groups. This study concludes the rates of decrease in total serum bilirubin levels and increase in urinary lumirubin levels were significant with LED when compared with conventional phototherapy, implying LED to be more efficacious.

Bilateral Giant Hydronephrosis in a Ten-Year-Old Male.

We describe a ten-year-old male with bilateral giant hydronephrosis due to pelviureteric junction obstruction presenting with abdominal distension and renal failure. The diagnosis was confirmed on computed tomography and required a two-stage procedure, initially percutaneous nephrostomy followed by Anderson-Hynes pyeloplasty with recovery of kidney function.

Neonatal Airway Compromise by a Giant Cervicothoracic Venous Haemangioma.

Haemangiomas are most common non-malignant vascular tumours of infancy. Here, we describe an antenatally detected mass over the neck causing compressive respiratory compromise at birth requiring resuscitative measures at birth. The mass showed increased vascularity on Contrast Enhanced Computed Tomography (CECT) with extension upto superior mediastinum. Surgical excision was required following failure to medical measures with steroids and propranolol. Histopathology confirmed it to be a venous haemangioma. This case highlights that these benign lesions may reach large sizes and antenatal detection may help in planning effective delivery and resuscitative measures.

Perceptions and Practices regarding Breastfeeding among Postnatal Women at a District Tertiary Referral Government Hospital in Southern India.

Background. Breastfeeding is the optimal method for achieving a normal growth and development of the baby. This study aimed to study mothers' perceptions and practices regarding breastfeeding in Mangalore, India. Methodology. A cross-sectional study of 188 mothers was conducted using a structured proforma. Results. Importance of breast feeding was known to most mothers. While initiation of breast feeding within one hour of birth was done by majority of mothers, few had discarded colostrum and adopted prelacteal feeding. Mothers opined that breast feeding is healthy for their babies (96.3%) and easier than infant feeding (79.8%), does not affect marital relationship (51%), and decreases family expenditure (61.1%). However, there were poor perceptions regarding the advantages of breast milk with respect to nutritive value, immune effect, and disease protection. Few respondents reported discontinuation of breastfeeding in previous child if the baby had fever/cold (6%) or diarrhea (18%) and vomiting (26%). There was a statistically significant association between mother's educational level and perceived importance of breastfeeding and also between the mode of delivery and initiation of breast feeding (p < 0.05). Conclusion. Importance of breast feeding was known to most mothers. Few perceptions related to breast milk and feeding along with myths and disbeliefs should be rectified by health education.

Neonate subcapsular splenic hematoma.

Splenic hematoma is an unusual event in newborn babies. The present study report a two day old infant who presented to us in shok with severe pallor and abdominal distension. Initially ultrasonography of evaluation by ultrasound (US) revealed a left adrenal hemorrhage but was subsequently confirmed to be a subcapsular splenic hematoma by computed tomography (CT) scan of the abdomen. This article highlights the utility of CT scan in diagnosis although review of literature shows ultrasonography to be primary screening investigative modality for abdominal visceral bleeds in the neonatal period.

Neonatal arrhythmia with diaphragmatic eventration.

Supraventricular tachycardia is the most common symptomatic arrhythmia in young patients, frequently associated with Wolff-Parkinson-White (WPW) syndrome. We report a case of supraventricular tachycardia with Wolff-Parkinson-White (WPW) syndrome associated with partial eventration of a diaphragm in a neonate.