Ethical Challenges and Guidance Related to Adolescent Pregnancy.

An emergency team was challenged with ethical issues while managing an unmarried adolescent girl who presented with an acute abdomen wherein a ruptured ectopic pregnancy was suspected. Consent remained at the center of this dilemma given the age of the patient and the nature of the issues. Herein, we deliberate upon the challenges faced by the treating team in accessing the reproductive history, obtaining consent for performing pregnancy tests and for therapeutic interventions.

Infantile osteopetrosis with delayed development, organomegaly and wandering eyes: case report.

Osteopetrosis encompasses rare inherited metabolic bone disorders with defect in the osteoclast activity. Severe forms of presentation such as malignant infantile osteopetrosis are seen in infants and milder forms in older children. The clinical presentation includes failure to thrive, severe pallor, optic atrophy and hepatosplenomegaly. The disorder is characterised by dense bone on radiography, hence the name marble bone disease. A 10-month-old boy who presented with developmental delay, failure to thrive, nystagmus (which the mother described as wandering eye movements), splenomegaly of 16 cm and hepatomegaly of 8 cm. Investigations demonstrated severe anaemia (5.7 g/dL) and thrombocytopenia (34 x 109/L). Radiological signs which help in the diagnosis include diffuse sclerosis, bone within bone appearance, sandwich vertebrae and Erlenmeyer flask deformity. Plain radiography is an easily available and cost effective tool which can aid in the diagnosis of osteopetrosis.

Ethics of Managing an Adolescent Living with Disability.

An ethical challenge arose when the parents of an adolescent girl living with severe intellectual disability requested for a permanent surgical intervention (hysterectomy) that would cause cessation of menstruation and reduce the possibility of pregnancy following nonconsensual sex. The family background was rural with poor access to extended family/community support, financial and social welfare resources. The parental distress was real with the adolescent incompetent to give informed consent. Is a non-therapeutic hysterectomy in an adolescent living with severe intellectual disability ethical? Views of a pediatrician, adolescent specialist, nurse, and an ethicist referring to literature suggesting an approach to an ethical decision are discussed herein.

Considering Family Resources When Making Medical Recommendations.

Poor families without health insurance present unique challenges for pediatricians who want to do what is best for the children who are their patients. Families are often willing to make tremendous sacrifices to pay for recommended and needed medical care. Physicians may have to decide whether, or how strongly to, recommend expensive treatments, especially when any good outcomes associated with such treatments are not guaranteed. How should we balance the considerations of justice and of the child's best interest with the grim realities facing poor families? In this article, we present a case from a tertiary care hospital in India in which doctors and parents struggled to figure out the best options for a young man with end stage renal disease.

Clinical profile and outcome of clinical BCG disease in infants.

OBJECTIVE: To describe the clinical profile, immunological status and outcome of BCG disease in infants. METHODS: All infants with a diagnosis of BCG disease in a period of 17 months were followed up. RESULTS: Among 25 infants with BCG disease; 19 had local/regional involvement and 6 had suspected or confirmed distant/disseminated disease, Mean (range) age of presentation was 3.6 (1.5-9) months. Two of 6 infants with disseminated disease required second-line anti-tubercular treatment. One infant with confirmed disseminated disease had INFg R1 receptor deficiency. There was no mortality. CONCLUSION: Most infants with BCG- related disease have local or regional disease.

Severe lipoid pneumonia following aspiration of machine oil: successful treatment with steroids.

Lipoid pneumonia in children follows mineral oil aspiration and may result in acute respiratory failure. Majority of the patients recover without long-term morbidity, though a few may be left with residual damage to the lungs. We report a case of a two-and-a-half-year-old child with persistent lipoid pneumonia following accidental inhalation of machine oil, who was successfully treated with steroids.

Congenital Nephrotic Syndrome with adrenal calcification and cardiac malformation.

Congenital Nephrotic Syndrome (CNS) with adrenal calcification and CNS with congenital heart disease (CHD) have rarely been reported. However, CNS with both these rare associations has never been previously reported. Here we report a case of CNS with both rare associations, perhaps the first report from India to the best of our knowledge.