Unusual complication of fulminant congenital cytomegalovirus infection.

Persistent pulmonary hypertension of newborn (PPHN) is a very rare manifestation of congenital cytomegalovirus (CMV) infection. PPHN associated with CMV can be severe but is usually transient and responds well to antiviral therapy. We report a rare case of PPHN that occurred in the setting of fulminant congenital CMV infection and successful treatment with antiviral therapy along with review of the very few cases reported in literature. A male appropriate for gestational Age (AGA) newborn developed rapidly progressive respiratory distress starting at 11 hours of life requiring ventilatory support and 100% oxygen. He developed hypotension and wide difference between pre and postductal saturations. Echocardiography revealed findings consistent with severe PPHN. Examination also revealed multiple purpuric skin lesions and soft hepatosplenomegaly. MRI Brain showed intraventricular hemorrhage, bilateral periventricular calcification, bilateral cerebral and cerebellar intraparenchymal hemorrhage. Complete Cell Count (CBC) revealed severe thrombocytopenia and blood serum showed positive Immunoglobulin M (IgM) for CMV and Urinary CMV was positive by nucleic acid test. He was treated with ganciclovir, inhaled nitric oxide and inotropes. He recovered and was discharged on day 24 of life. Severe PPHN is a rare manifestation of congenital CMV infection and carries a high risk of morbidity and mortality. Congenital CMV should be considered in neonates with PPHN of unknown etiology. Early institution of antiviral therapy in these babies is associated with favorable outcome.

Are tomorrow's doctors aware of the code of medical ethics?

BACKGROUND: The purpose of this study was to evaluate the awareness of the 'ethical code of conduct for medical practitioners' among medical undergraduate students. SETTING: Tertiary care medical college and hospital. MATERIALS AND METHODS: This study covered 172 medical students in a private medical school in Pondicherry, located in southern India. They were administered a questionnaire, containing ten scenarios, which was based on the 'medical code of ethics' as set out in the chapters on 'unethical acts' and 'misconduct' of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002. The students were given the option of responding with a 'yes,' 'no' or 'don't know.' RESULTS: Only 128 (74.4%) of the 172 medical undergraduates enrolled in the study returned the completed questionnaire. None of them answered all the questions correctly. The overall mean score was 6.13 out of 10, with an SD of 1.36. There were no significant differences between second-, third- or final-year students. There was no significant difference in the performance of boys and girls. Most of the students erred in scenarios related to decision-making and communication. CONCLUSION: There are major deficiencies in the understanding of medical ethics among medical undergraduates. Including medical ethics as a mandatory and separate subject in the first few years of under graduation can help students understand and follow ethical principles.

Prophylactic topical heparin can prevent or postpone intravenous cannula induced superficial thrombophlebitis.

Intravenous cannulation is a cornerstone of today's medical practice. Maintaining a single indwelling intravenous (IV) cannula for long duration is limited by the development of superficial thrombophlebitis (ST). It is a self limiting inflammation and thrombosis of superficial veins. ST presents with fever, pain, erythema, tenderness and cord like swelling. The incidence of ST is high and usually occurs within 72h of IV cannula insertion. The current standard medical therapy for ST is topical heparin application for 7 days. Heparin acts by preventing coagulation rather than lysing a formed clot. So, if topical heparin is started prophylactically even before ST sets in, i.e. from day 1 of IV cannula insertion it can prevent or postpone ST more effectively. It increases the indwelling time of a single IV cannula and can be very useful in high risk groups requiring IV cannulation like patients receiving cancer chemotherapy, ICU patients and infants. It decreases the need for recurrent cannulations and associated morbidity thereby improving patient compliance. It also prevents extended hospital stay due to ST and related complications. High incidence of ST justifies the use of prophylactic topical heparin with all IV cannulations. Prophylaxis will be better than treatment in managing patients with IV cannulas.

Shaken baby syndrome.

A 35-day-old male infant with presumed shaken baby syndrome is reported. This first born child to mother educated upto middle school and father tailor by occupation was brought from a remote village 180 kms away from JIPMER. Poor feeding, focal clonic seizures were the initial symptoms. The fundus examination revealed fresh preretinal and vitreous hemorrhages. CT Brain showed right sided subdural hemorrhage with subarachnoid extension and midline shift. He had a normal platelet count and coagulation profile. The sensorium deteriorated and infant expired despite adequate ventilatory support.