Autoimmune hemolytic anemia: mixed type-a case report.

Mixed autoimmune haemolytic anemia (AIHA) is defined by the presence of both warm and cold auto antibodies. Diagnosis is based on detection of autoantibodies by monospecific direct antiglobulin test showing a pattern of IgG and complement C3d and presence of cold agglutinins. We report a rare case of primary mixed AIHA in a 12 year old girl who responded to corticosteroids.

INCIDENCE AND ETIOLOGY OF RESPIRATORY DISTRESS IN NEWBORN.

Screening of 1986 consecutive live births was done for evidence of Respiratory Distress by administering Downe's scoring in a prospective study at level II nursery of a medical college. A detailed antenatal, natal and postnatal history along with detailed examination supported by relevant investigations was carried out to arrive at the etiological diagnosis of Respiratory Distress Syndrome (RDS). RESULTS: 48 newborns developed RDS during the observation period. The incidence of RDS was 2.42%. Out of these 40.4% were <1500g, 16.6% above 2500 g and the rest between 1500-2500 g. Preterm were thirty times more prone to develop RDS than full term neonates. There was no significant difference in incidence of RDS in male and female neonates. The commonest cause of RDS was hyaline membrane disease (HMD) 18.8% followed by transient tachyopnea of the newborn (TTNB) 14.5% and meconium aspiration syndrome (MAS) 12.5%. HMD was predominantly seen in the preterm in the gestational age of 29 to 32 weeks, TTNB was seen equally in term as well as preterm neonates, where as MAS was common in the term than in the preterm neonates.

LOW BIRTH WEIGHT BABIES : INCIDENCE AND RISK FACTORS.

In a prospective hospital based study, during the period from Jan 95 to Dec 96, 3100 consecutively delivered live newborns were studied for the incidence of low birth weight neonates and to evaluate the associated risk factors. One thousand fourteen newborns were classified as low birth weight babies. The incidence expressed per 1000 live births was 327 (32.7%). Of these, 815 (80.4%) were small for gestational age neonates and 199 (19.6%) were preterm neonates. Five hundred seventy small for gestational age neonates (70%) were weighing between 2001 to 2500 gms. Mothers belonging to the age group of 19-25 years delivered the maximum number of low birth weight babies (618/1014) and of these 82.8% were small for gestational age neonates. There were 48 neonates with low birth weight born to mothers below the age of 18 years. Primiparous mothers were found to contribute higher number of low birth weight neonates (414/1014). Spacing as a factor did not show any major difference. Two hundred sixty two low birth weight neonates were born to mothers with significant obstetrical problems such as pregnancy induced hypertension, bad obstetrical history and premature rupture of membranes. The incidence of 32.7% of low birth weight babies is high enough to ring alarm bells.

TUBERCULOSIS IN BCG VACCINATED AND UNVACCINATED CHILDREN.

One hundred, non-consecutive, non-randomized, cases of tuberculosis divided in 2 groups i.e. Group A including 50 BCG vaccinated children and Group B including 50 unvaccinated children were studied to determine the pattern of tuberculosis and the role of protein energy malnutrition in the pathogenesis of tuberculosis. Thirty four per cent of Group A and 52 per cent of Group B had severe protein energy malnutrition. Sixty eight per cent in Group A and 76 per cent in Group B had intrathoracic forms of tuberculosis. Twelve (24%) patients in Group A and 11 (22%) in Group B suffered from serious forms of tuberculosis including tubercular meningitis, miliary tuberculosis and disseminated tuberculosis. The difference was not statistically different (p>0.05). However, in severe form of tuberculosis, the morbidity in vaccinated group was less. Sixty six per cent of vaccinated children with disseminated forms of tuberculosis had features of severe protein energy malnutrition. BCG is not effective in preventing tubercular infection in children of preschool age. It is effective to a certain extent in localizing the infection to a particular organ. Severe protein energy malnutrition is a contributing factor in the genesis of tuberculosis in preschool children vaccinated with BCG at or immediately after birth.