Indian Journal of Trauma and Emergency Pediatrics

 Meckel-Gruber syndrome, also known as ‘Dysencephalia splanchnocystica’, is a rare lethal autosomal recessive disorder consisting of central nervous system malformation- mainly posterior encephalocele (80%), multicystic kidneys (95%) and polydactyly (75%). Besides the classic triad of neural tube defects, polydactyly and cystic dysplasia of the kidneys, other abnormalities can occur in association with the syndrome, which may be detected sonographically include micrognathia, cardiac abnormalities, syndactyly, clinodactyly and clubbed foot. The worldwide incidence varies from 1 in 13,250 to 1 in 140,000 live births. Highest incidence was reported in Gujarati Indians.We report a case of a 26-year-old woman with previous LSCS referred from a private practitioner with abnormal ultrasonographic findings. She was diagnosed to have Meckel-Gruber syndrome. Woman and her husband were counseled regarding this lethal condition incompatible with life and after proper consent and information, pregnancy was terminated.   

 Hepatoblastoma is the most common primary malignancy of the liver encountered in children. Primary tumors of the liver account for approximately 1% of malignancies in children. 50-60% of hepatic tumors in children are malignant, with >65% of these malignancies being hepatoblastomas. Hepatoblastoma occurs predominantly in children <3 yr of age. We present a 9 years old girl, who presented to our emergency ward with Jaundice and abdominal distension since 3 months. Examination showed pallor, icterus, hepatomegaly and ascites. Laboratory investigations revealed hyperbilirubinemia(TB:16.6, DB: 9) with thrombocytopenia (80000 cells/cumm). USG abdomen showed a mass lesion in right lobe of liver with irregular and nodular. CECT abdomen revealed a mass lesion of size 6.8x 5.5 x 5.9 cm in segment of right lobe with cirrhosis and metastatic nodules in the liver with moderate ascites and right pleural effusion. Spleen was moderately enlarged measuring 14 cm with infarcts. USG guided liver biopsy was done to confirm the diagnosis which showed histology pattern suggestive of Small Cell Undifferentiated Variant of Hepatoblastoma. Even a short period of history of jaundice and abdominal mass should rise the suspicion of hepatoblastoma, which help in early diagnosis and treatment.   

 Penile strangulation is a rare pediatric emergency among children. Its usually anaccidental event than intentional. We report a case of 4yr old boy with accidental insertion of metallic encircling body onto the penis as an act of play. As per Bhat et al classification it was a grade 2 and was managed by string technique with no complications.

 It is the obligation of Indian Government to serve the rural poor. Modification in the Indian Medical Education system is the need of the decade in order to fulfill this obligation and bridge the national urbanrural gap in health care. The recent introduction and subsequent withdrawl of rural posting after the basic medical education course (MBBS) in India introduced a new controversy to the medical education system. A 7-year integrated MBBS-MD course-MBBS (4 year) + MD (3 years) may bring much needed respite to the students aimimg for post-graduate medical education within India and a clinical posting of 3- onths duration (depending on the intern’s choice/availability) during internship may facilitate the interns/fresh medical graduates to get a better exposure to their chosen speciality, medical problems, management and technology. Introducing 3 or 6 month rural posting(s) during/at end of the integrated curriculum might be welcome as it would facilitate learning about community and social problems in India and to get good exposure of the countries’ medical problems. Adequate provision of newer technologies and diagnostics in rural setups through NRHM and state/central/NGO fund will benefit the rural population as well as the medical recruits in continuing medical education. The community work in our country may be further  addressed through increase in rural posts and better service regulations, which may be achieved by setting up of additional Rural Health Service (RHS) Cadre or the Rural Medical Service (RMS) Cadre with additional benefits for those opting for it. Provision of optional/voluntary rural posting clause in the existing services, with additional service benefits, may be another option to strengthen the rural healthcare sector.  

The state of medical education in India presents a scenario marked by rhetoric and wishful thinking rather than concrete steps in right direction. The search for a need-based curriculum is not new. It has been felt for ages, but the curriculum has not really changed. It is an oft-repeated criticism that our medical colleges are producing graduates who are not well equipped to tackle the health care needs of the society. In India, a medical college is an educational institution that provides medical education. These institutions may vary from stand-alone colleges that train doctors to conglomerates that offer training related in all aspects of medical care. The Medical Council of India (MCI) is a statutory body with the responsibility of establishing and maintaining high standards of medical education and recognition of medical qualifications in India. It registers doctors to practice in India, in order to protect and promote the health and safety of the public by ensuring proper standards in the practice of medicine.