Human Milk Bank in a Rural Setup - A Success Story.

Background: This article describes the experience of a rural human milk bank, with the problems faced in first 6 months including the coronavirus disease (COVID) crisis and interventions leading to success. Methods: The study included individual counselling by dedicated counsellors, focused counselling of primipara mothers seeking the help of obstetricians, counselling of pre-term mothers by neo-natal nurses, periodically delivered information in post-natal wards, and counselling of grandmothers and husbands. Results: The COVID crisis was dealt with donations from reverse transcriptase-polymerase chain reaction-negative mothers with social distancing and mask use. Younger, educated, working mothers with normal delivery and from middle-income families were easy to counsel. Periodic announcements in wards significantly increased awareness about milk banks and donation. Pre-term mothers could be motivated when their baby was nil by mouth or they saw other babies in need of milk. Lactation support to mothers with breast problems, especially in primipara, helps in getting more donors. Counselling of fathers was easier than that of grandmothers. Conclusions: Structured awareness programs and counselling strategies along with education of grandmothers and husbands were very effective in increasing human milk donation.

Choroid plexus carcinoma in an adolescent male: a case report.

INTRODUCTION/BACKGROUND: Although central nervous system tumors are the most common etiology of malignancies in the pediatric age group, choroid plexus carcinomas are rare, with an annual incidence rate of 0.10 per 100,000 children. CASE PRESENTATION: We report the case of an adolescent male belonging to central India who had presented with a history of persistent headache, projectile vomiting, neck stiffness, and an episode of generalized tonic-clonic seizure. Neurological examination was suggestive of a space-occupying lesion. Further neuroimaging was suggestive of a large left-sided choroid plexus carcinoma, later confirmed on pathological examination. Gross total resection was achieved and followed by radiation therapy. His recovery was satisfactory without any major events despite suffering from such a malignancy with a poor prognosis. CONCLUSION: In the absence of a global consensus on choroid plexus carcinoma management, our patient underwent a successful gross total resection and received postoperative radiotherapy. He made a satisfactory recovery with a further plan to review with gadolinium-enhanced neuroimaging at a later date. We conclude that, when possible, achieving gross total resection is of utmost importance.

A Rare Presentation of Posterior Reversible Encephalopathy Syndrome in Recovery Phase of Guillain-Barré Syndrome.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome, in which a patient presents with neurological symptoms, including headache, seizures, altered sensorium, and loss of vision, and accompanied with characteristic magnetic resonance imaging findings which are likely to be reversible. Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy presumably related to immunological mechanisms. Here, we describe a patient who had PRES in recovery phase of GBS while he was neither on any immunomodulator nor was having hypertension. He recovered completely clinically as well as radiologically.

Predictive Efficacy of Pediatric Logistic Organ Dysfunction-2 Score in Pediatric Intensive Care Unit of Rural Hospital.

AIMS AND OBJECTIVES: Utility of pediatric logistic organ dysfunction-2 (PELOD-2) score on day 1 within 1 hour of admission in predicting mortality in children admitted in pediatric intensive care unit (PICU). BACKGROUND: Various scoring systems aid to evaluate the patient's mortality risk in the intensive care unit (ICU) by assigning a score and predicting the outcome. Critically ill children are characterized by large variations in the normal body homeostasis. These variations can be estimated by the change of the physiological variables from the normal range. Various scores are constructed from deviations of these changed variables. One such score, the PELOD-2 score, is used to predict mortality of patients admitted in PICU. MATERIALS AND METHODS: This study was carried out at a tertiary care center in central India to study the utility of PELOD-2 score within 1 hour of admission to predict mortality in patients admitted in PICU. RESULTS: Total 129 patients were included in this study with mean age of 67 months. The system with highest admission was central nervous system with 42 children and 16.6% mortality, whereas those 7 patients with hematological system involvement had highest mortality of 28.5%. The mortality rate was 15.55%. In our study for PELOD-2 within 24 hours of admission, the area under receiver operating curve was 0.87 and the Hosmer-Lemeshow test was p = 0.42. CONCLUSION: Pediatric logistic organ dysfunction-2 score in our study had significant association with mortality along with the Hosmer-Lemeshow goodness-of-fit test showing a good prediction of mortality. HOW TO CITE THIS ARTICLE: Deshmukh T, Varma A, Damke S, Meshram R. Predictive Efficacy of Pediatric Logistic Organ Dysfunction-2 Score in Pediatric Intensive Care Unit of Rural Hospital. Indian J Crit Care Med 2020;24(8):701-704.

A Rare Case Report of Guillain-Barré Syndrome Presenting as Unilateral Facial Palsy with Isolated acute Bulbar Palsy.

Guillain-Barré syndrome (GBS) is an immune-mediated acute inflammatory polyradiculoneuropathy and it is the most common cause of acute flaccid paralysis worldwide. There are some rare variants of GBS, which may be easily missed unless suspected. Here we present a case of GBS presenting as isolated acute bulbar palsy. A 10-month-old infant, known case of tricuspid atresia with pulmonary stenosis, presented with left-sided lower motor neuron type of facial palsy and palsy of bilateral glossopharyngeal and vagus nerve of 2 weeks' duration. On detailed neurological examination, motor and sensory system were normal. Nerve conduction study showed demyelinating motor neuropathy and hence the diagnosis of GBS was made. To the best of our knowledge, no case of isolated bulbar palsy due to GBS in infancy has been reported.

Concurrent diabetic ketoacidosis and pancreatitis in Paediatric acute lymphoblastic leukemia receiving L-asparaginase.

BACKGROUND: Although hyperglycemia and pancreatitis are known side effects of L-asparaginase, both contributing to the development of diabetic ketoacidosis (DKA) is unfamiliar in literature. CASE PRESENTATION: We report a case of an adolescent girl, recently diagnosed with ALL, who presented with pain in abdomen and breathing difficulty following chemotherapy with L-asparaginase. On subsequent evaluation, she was found to have high anion gap metabolic acidosis, hyperglycemia and ketonuria. Ultrasonogram showed bulky pancreas. DKA was managed with fluid correction and insulin infusion. Pancreatitis was managed conservatively. She recovered completely with resolution of symptoms and without any major adverse events despite having such severe complications. CONCLUSION: We conclude that the combination of DKA and pancreatitis is a rare occurrence with significant morbidity and mortality. We recommend a close monitoring of blood glucose levels for hyperglycemia as well as a high index of clinical suspicion for pancreatitis in patients with ALL receiving L-asparaginase.

A 5-year hospital prevalence of child and adolescent psychiatric disorders from central India.

OBJECTIVE: To examine the 5-year hospital prevalence of child and adolescent mental disorders from Central India. METHODS: Using systemic random sampling method, of the 4410 families screened, 4278 children (607 aged 0 to 3 y and 3671 between 4 to 16 y) attending outpatient services of department of pediatrics at the tertiary rural hospital from June 2006 through December 2010 were evaluated. Standardized appropriate psychometric tools were used for both groups. Diagnostic interviews were administered and DSM-IV diagnoses were determined by consensus between two psychiatrists. A comprehensive hospital registration system provided the denominator. RESULTS: Of the 4410 families screened, 4278 (97 %) of the subjects completed interviews. The overall prevalence of psychiatric disorders was found to be 20.8 %. Most common psychiatric disorders in group A were mental retardation (5.6 %) followed by epilepsy (2 %) whereas in group B, depressive disorder (3.73 %) were followed by non-organic enuresis (2.18 %) and ADHD (1.7 %). Eighty one percent of the parents from group A and 83 % of parents from group B of the children affected with psychiatric disorders and neurobehavioral problems had reported that they have had never thought of taking psychiatric consultation for their children. CONCLUSIONS: The results of the study have helped in bridging and supporting the propositions in child epidemiology in India and also have implications for clinical training and practice.