Unusual manifestation of Marden-Walker syndrome.

Marden-Walker syndrome (MWS) is characterized by multiple joint contractures, a mask-like face with blepharophimosis, micrognathia, high-arched or cleft palate, low-set ears, decreased muscular bulk, arachnodactyly, and kyphoscoliosis. We report a case of MWS along with unusual manifestation of neurological, cardiovascular, and genitourinary system.

Neonatal genital prolapse.

Neonatal genital prolapse is a rare condition, usually associated with congenital spinal defects and is often resistant to simple reduction. A case of complete uterine prolapse which was noted shortly after birth in a female baby with a meningocele at the lumbar region with rectal prolapse is reported. The vagina and uterus was restored to their normal position but came out immediately after reduction.

Renal abscess in a child with sickle cell anemia.

Renal abscess is rare in children and the usual presenting features include fever, lumbar pain, abdominal pain and occasional flank mass. Renal ultrasonography facilitates an early diagnosis and helps in percutaneous drainage. We herewith report on a child with sickle cell anemia who developed a renal abscess.

Infantile blount disease: a case report.

Blount disease is an acquired growth disorder of the medial aspect of the proximal tibial physis, epiphysis and metaphysis. Infantile Blount disease present with bowing and length discrepancy in the lower limbs. The deformed medial tibial metaphysis represent as nontender bony protuberance can be palpated along the medial aspect of the proximal tibia. Here, we present an 18-month-old boy presented with the complaints of bilateral bowing of lower limb with normal biochemical investigation and radiological survey revealed Blount disease.

OEIS complex with major cardiac malformation: a case report.

OEIS Complex is a rare congenital multisystem defect that consists of omphalocele, exstrophy, imperforate anus and spinal defects. We report a case of such complex with additional major cardiac and other multisystem anomalies which are rarely described in literature. The authors give a review of literature on this infrequent complex along with a discussion on its pathogenesis, differential diagnosis and prenatal diagnosis.

Post-varicella myasthenia gravis.

Myasthenia gravis is an autoimmune disease of neuromuscular junctions. We report a three-year-old boy with post-varicella myasthenia gravis. This patient, to the best of our knowledge, is the youngest in age and second reported case of the condition. The patient presented with drooping of both eyelids which increased as the day progressed, two weeks after varicella infection. Repetitive nerve stimulation tests showed decremental response in action potential, and the child responded dramatically to test doses of neostigmine. A diagnosis of post-varicella myasthenia gravis was made and the patient was started on oral pyridostigmine. He is doing well at follow-up and there is no recurrence of symptoms to date.

Predictor of low birth weight babies by anthropometry.

OBJECTIVE: The present study was undertaken to find out the best simple anthropometric parameter for identifying low birth weight (LBW) babies. STUDY DESIGN: Hospital-based cross-sectional study. PARTICIPANTS: Newborn babies born in KHS hospital, Sevagram. RESULTS: In the present study, out of 868 newborn babies studied, 52.2% were male. Total 12.6% of them were birth weight < 2000 g and 44.6% were birth weight < 2500 g. Birth weight was significantly correlated (p < 0.001) with thigh circumference (TC), mid-arm circumference (MAC), calf circumference (CFC) and head circumference (HC). All anthropometric indicators had a statistically significant sensitivity, specificity and predictive value (p < 0.001) for identifying < or =2500 g birth weight babies. Receiver operating curve (ROC) analysis was done to identify the optimal cut-off points of these anthropometric measures separately for LBW babies and <2000 g birth weight babies. CONCLUSION: HC and TC appears to be better indicators for picking up LBW babies and MAC and CFC appears to be better in picking up very LBW babies.

Pain response of neonates to venipuncture.

OBJECTIVE: To study the physiological and behavioral response to pain. METHODS: 80 healthy neonates requiring bilirubin estimation, blood sugar etc, were randomly assigned to receive a venous puncture. All parameters were recorded 10 minutes prior, during and 10 minutes after the procedure. Evaluated NIPS score and RR. HR, NIBP and O2 saturation observed on Datex-Ohmeda multimonitor. RESULTS: After the venepuncture, heart rate (p<0.001) and blood pressure (p<0.001) were significantly increased in both the groups but more significant increase was present in Group I (>2.5 kg) as compared to Group II (>2.5 kg). Respiratory rate was also increased but more significant in Group II (p<0.001) whereas oxygen saturation was decreased in both the groups but more significant in Group I (p<0.001). Median Neonatal Infant Pain Scale (NIPS) score was higher in both the Groups (p<0.001). CONCLUSION: The outcome measures appear to be reliable indices of term neonates responses to painful stimulation. NIPS are suitable instruments for neonatal pain evaluation.

Acute acalculous cholecystitis in a child with Plasmodium falciparum malaria.

We report a 7-year-old girl who presented with features of acute acalculous cholecystitis. She was found to be positive for Plasmodium falciparum. To the best of our knowledge, this is the first report of acalculous cholecystitis caused by P. falciparum in a child.

Comparison of axillary temperature with rectal or oral temperature and determination of optimum placement time in children.

The present study was done to compare axillary temperature (AT) with rectal temperature (RT) in 100 infants and with oral temperature (OT) in 100 children agd 6 to 12 years and also to find out the optimum placement time of the mercury thermometer at the above sites. Simultaneous AT and RT recording was done in infants while sequential AT and OT recording was done in older children by different investigators using calibrated Hick thermometers. The placement time recorded was when 3 consecutive readings at one minute interval remained unchanged. Significant correlation was observed between RT and AT (r=0.95, p <0.01) and between OT & AT (r = 0.97, p 0 <0.01). Equations were derived to calculate RT & AT from AT. The mean placement time for RT, AT and OT was 2.3 minutes, 4.8 minutes and 3.1 minutes respectively. The study showed a high degree of correlation between OT or RT and AT.

Reliability of perception of fever by touch.

OBJECTIVE: To assess the reliability of touch to predict fever in children. METHODS: 200 children who reported with fever formed the study material. Group I consisted of 100 children between 0-1 year of age and Group II consisted of 100 children between 6-12 years of age. Preterm, neonates under warming device, tachypnoeic and hypothermic were excluded from the study. The caregiver (CG) and the medical staffs (MS) response regarding presence or absence of fever by touch was noted in each child. Both were blinded to each other's response. Immediately temperature was recorded by calibrated rectal thermometer in Group I and calibrated axillary thermometer in Group II. RESULTS: The CG's touch had a sensitivity of 70.5% specificity of 40.9%, PPV of 38% NPV of 72.9%, PLR was 1.16 and NLR was 0.75. The MS's touch had a sensitivity of 78.0%, specificity of 63.6%, PPV of 38.0% NPV 84.8%, PLR of 2.08 and NLR of 0.36. There is over and under diagnosis of fever by both, the former being more by the CG reflecting the parental anxiety. The MS's touch is better to affirm or negative fever as compared to CG. The best site to palpate for presence of fever was abdomen, neck and forehead. CONCLUSION: Touch is not a valid screening test for fever. It is recommended that a thermometer must always be used by the MS to record fever and CG must be motivated for the same.