Indian Journal of Trauma and Emergency Pediatrics

 Pheochromocytomas are rare tumors of childhood usually presenting as the clinical triad of headaches, tachycardia, and sweating. It can also present with unusual findings like hypertensive retinopathy. We present a case of pheochromocytoma in an adolescent boy, who presented with diminution of vision due to hypertensive retinopathy as shown by fundus examination.

Keywords: Hypertensive Retinopathy; Pheochromocytoma.

 Pelvic fractures in the pediatric population are rare. The skeletally immature pelvis is flexible and therefore a pelvic fracture in an immature skeleton suggests significant force with a high probability of associated concomitant injuries. Despite these being potentially devastating injuries, there are no clear guidelines with respect to the investigation, classification and management of these fractures. Here we present a case of 4 years female who presented to us with complex pelvis with shock.The patient was managed by a team of specialty trauma surgeons with good short terms results. 

Keywords: Shock; Pelvic Fracture; Pediatric Pelvic Fracture; Management of Pelvic Fracture.

 Hydrocephalus (from Greek hydro­, meaning “water”, and kephalos, meaning “head”) is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the brain. This causes increased intracranial pressure inside the skull and may cause progressive enlargement of the head if it occurs in childhood, potentially causing convulsion, tunnel vision, and mental disability. It was once informally called “Water on the brain”[1].

Keywords: Hydrocephalus; Cerebrospinal Fluid.

Bacillus Calmette-­Guérin (BCG) related regional lymphadenitis is not an uncommon complication following BCG vaccination. We report a six month male child who presented with fever and swelling in left axilla .The earlier diagnosis at this age may help in better management of the condition and prevent further complication and have better prognosis.

Keywords: BCG; Vaccination; Lymphadenitis.

 Colloid cysts are benign tumor arising from third ventricle, very rare in children. Unlike in adults they present with aggressive behavior due to their rapid growth of tumor, late detection, and rapid development of the manifestations in children. Clinical features vary from asymptomatic to acute obstruction of third ventricle, leading to sudden death.

Keywords: Colloid Cyst; Third Ventricle; Acute Hydrocephalus; Sudden Death.

 Albendazole tablet aspiration represents a rare cause of symptomatic endobronchial foreign body in pediatric emergency department. We present a patient who developed status epileptics and cardiorespiratory arrest shortly after aspiration of albendazole tablet. Seizures were controlled but the child sustained hypoxic cerebral injury. This case calls attention to the importance of cautious use of tablet formulations in children and need for public action at the scene to save a life with quality.

Keywords: Foreign Body Aspiration; Status Epilepticus; Albendazole.

 Intradiploic epidermoid cysts, an uncommon benign lesions that variably affect the two tables of calvaria. The clinical manifestations are usually related to mass effect. Here we report a case of intradiploic epidermoid cyst in right parietal bone with intracranial rupture causing acute bacterial meningitis as per cerebrospinal fluid analysis and cranial tomograph. To the best of our knowledge, acute bacterial meningitis as complication has never been described in the existing literature.

Keywords: Epidermoid Cyst; Intradiploic; Meningitis.

 Encephalocele represents herniation of cranial contents through a congenital defect in the cranium.Herniation of cerebrospinal fluid (CSF) and meninges , is termed as a meningocele. A meningoencephalocele is herniation of both neural elements and meninges. There are various anaesthetic challenges in management of occipital meningoencephalocele these include securing the airway with intubation in lateral position, intraoperative prone position and complications associated with it , careful securing of the endotracheal tube and accurate assessment of blood loss. We report a case of a giant occipital meningoencephalocele and discuss its treatment.

Keyword: Meningoencephalocele.

 Acute ischemic stroke in a pediatric patient is a complex disease with a variety of etiologies that differ from adults. Though rare, they are a real phenomenon with potentially devastating consequences. Stroke is relatively rare in children, but can lead to significant morbidity and mortality. Understanding that children with strokes present differently than adults and often present with unique risk factors will optimize outcomes in children. Despite an increased incidence of pediatric stroke, there is often a delay in diagnosis, and cases may still remain under­ or misdiagnosed. Clinical presentation will vary based on the child’s age, and children will have risk factors for stroke that are less common than in adults. Management strategies in children are extrapolated primarily from adult studies, but with different considerations regarding short term anticoagulation and guarded recommendations regarding thrombolytics. Although most recommendations for management are extrapolated from adult populations, they still remain useful, in conjunction with pediatric­specific considerations. Available literature, which is limited to case reports and retrospective reviews of databases, clouds this topic with both positive and negative outcomes.

Keywords: Acute Ischemic Stroke; Children; Anticoagulation; Thrombolysis.

 One of the rare causes of asymmetric crying facies in newborn is Congenital hypoplasia of depressor angularis oris muscle (CHDAOM). In 45­70% of cases with this facial defect have been reported to be associated Major congenital anomalies [1,2]. This should always be differentiated from facial nerve palsy. We report a case of CHDAOM in a neonate.

Keywords: Congenital Anomaly; Facial Defect; Asymmetric Crying; Depressor Angularis Oris.

 Congenital lobar emphysema (CLE) is a rare entity which presents as acute respiratory distress during infancy. In CLE, there is inspiratory air entry into the affected lobe but collapse of the narrow bronchial lumen during expiration. There is hyperinflation of the lung lobe with compression of the normal lung parenchyma and contra lateral displacement of the mediastinum . We report a case of 3 day old baby with respiratory distress.

Keywords: Congenital Lobar Emphysema; Lobar Hyperinflation; Mediastinal Shift.

 While breastfeeding is nearly universal and it is first immunization for the baby. Health professionals recommend that breastfeeding begin within the first hour of a baby’s life and it be allowed as often and as much as the baby wants. It helps to improve immunity and to address mortality and morbidity related to major problems e.g. malnutrition, neonatal infections, diarrhea, jaundice and pneumonia etc.

Keywords: Newborn Care; Infant Feeding; Breast Feeding.

 Health is a right that requires responsible individual actions. Oral health corresponds to an important part of general health, even if for a large majority of people healthy teeth are equal with beautiful teeth. For children and adolescents having an attractive smile is synonymous with social acceptance and success. Dental decay has a high incidence in children in our country and progress in decay prevention, diagnosis and treatment is not reflected in children and adolescents oral health. The time invested in prevention during childhood represents a real benefit for the future adult’s oral health. Many a dental problems can be avoided if dental decay management relies on the link between medical science and every day practice. It is established by studies conducted by dentists and psychologists that dental problems (caries, malocclusion) can affect the quality of life by modulating specific eating behaviours, particular ways of speech or smile and unfortunately pain. The adolescent patient is influenced by many factors during their growth and development, which can give rise to some deviation from the normal behaviour and growth patterns. This review addresses the unique dental needs of adolescents and proposes general recommendations for their management.

Keywords: Adolescent; Caries; Dental; Health.

 Recurrent meningitis encompasses a variety of conditions, some of which are life threatening, some spontaneously remitting, and some representing exacerbations of chronic infections. Recurrent meningitis may, thus, represent episodes of bacterial meningitis, recurrent episodes of viral meningitis, chemical meningitis due to rupture of dermoid or parasitic cysts, or meningitis in response to nonsteroidal or other agents. In some instances, as in protracted cases of meningitis due to Cryptococcus neoformans, which appears to be recurrent meningitis, may actually represent periodic exacerbation of a chronic, ongoing infectious process. Recurrent bacterial meningitis is a much less common phenomenon but poses a considerable diagnostic challenge. The early diagnosis of any underlying pathology is crucial to prevent further episodes and improve the overall outcome for the affected individual.

Keywords: Recurrent; Meningitis; Diagnosis.

 Emergencies due to scorpion sting is very common in subtropical areas having dry hot climate. A large number of different species of scorpion exist but venomatous ones are all from Buthidae family. Different parts of world have different species like Bhuthus in middle east and para buthus in western and southern Africa. Mesobuthus species is found throughout Asia .Tunisia is the most affected country in the world and among Asian counties India is the most affected country. Most toxic species Mesobhus tamulus also called Indian red scorpion is found in India[1,2]. In some parts of India, black scorpion (Palamneus gravimanus) is found but it is less toxic than Mesobuthus tamulus [3]. Actual prevalence of scorpion sting in India is not known due to poor reporting and many patients still are being treated by faith healers. Present article reviews literature from Pubmed , Medline, Embase and other articles related to subject and their references. Main emphasis is on the risk factors, the course after scorpion sting and management strategies including scorpion anti venom. This article will be of use to all those managing scorpion sting.

Keywords: Scorpion Sting; Autonomic Storm; Envenomation.

 Moyamoya disease is a cerebrovascular occlusive disease of rare incidence. We report a case series of 8 patients who were diagnosed as Moyamoya disease at a tertiary care hospital. Median age of presentation was 6 years. Stroke was the commonest presentation. Neuroimaging revealed bilateral vascular involvement in all 8 patients. In one patient there was associated involvement of common carotid artery and vertebral artery. Only 2 patients underwent surgery, remaining were managed conservatively. All the patients left with neurological deficits. Conservative management (aspirin/ calcium channel blockers/ physiotherapy), and surgical revascularization procedures are the mainstay of treatment.

Keywords: Moyamoya; Stroke; Magnetic Resonance Angiography.

 Background: Neck pain is a common painful musculoskeletal condition affecting up to 70% of individuals at some point in their lives. It is the second largest cause of disability and time off work; after low back pain. The disease impacts upon activities of daily living ultimately leading to a loss of functional independence and quality of life. Purpose: The main purpose of this study was to assess the results of nondrug non invasive treatment in the management of neck pain. Materials and Methods: This study was conducted in the Department of Orthopaedic Surgery in SMS&R, Sharda University Greater Noida UP India from December 2010 to December 2013. Two hundred forty­six outpatients of neck pain with a mean age of 45 years were studied. They were managed with noninvasive treatment and were followed for 24 months. Results: Physician global evaluations up to the age of 40 years at 2 years were excellent. At 40 to 60 years of age, it was good to excellent. Over the age of 60 years, it was good. The patient global evaluation were found very good up to the age of 40 years at 2­year follow up, good to very good between 40 to 60 years and over the age of 60 years it was good. Conclusion: Nondrug non invasive interventions can reduce pain and improve function in neck pain.

Keywords: Medical Problem; Non­Invasive; Neck Pain; Treatment.

 Introduction: A FS is defined by the International League Against Epilepsy (ILAE)as a seizure occurring in association with a febrile illness (FI) in the absence of a Central Nervous System (CNS) infection or acute electrolyte imbalance in children older than 1 month of age without prior afebrile seizures. Methodology: The data was collected from parents/guardian of children of age group 6 months to 5 years coming to pediatric emergency ward of VIMS, Bellary with Febrile Seizures. Results: In our study 37% cases were 6­ - 12 months. 25% cases were 1­2 years. 16% cases were 2­3 years. 10% cases were 3­4 years. 12% cases were 4­5 years. The mean age of cases was 34 months. Conclusion: Overwhelming 89% cases had generalized tonic -­clonic seizures and focal seizures were reported in only 11% of cases.

Keywords: Febrile Convulsion; Children; Seizures.

 Background: As improved treatments for congenital heart disease (CHD) have increased life expectancy, neurodevelopmental impairments have been observed in many survivors. These impairments include developmental delays, difficulty in school, and challenges living independently. Understanding the causes of these impairments and minimizing their impact are important goals to allow survivors to have the best possible quality of life. Aim and Objectives: To evaluate the developmental status of children with congenital heart disease. Materials and Methods: The study type is a observational type time bound study. Congenital heart disease confirmed by echocardigraphy in children aged 6­30months were included in the study. Children with genetic disorders, post cardiac surgery children were excluded. Methods: We enrolled consecutive children aged 6­30 months with echocardiographically­confirmed CHD. Children with clinically recognizable genetic syndromes or disorders; visual and/or hearing deficits, and microcephaly; and postcardiac surgery children were excluded. Development was assessed by Developmental Assessment Scale for Indian Infants (DASII) and Developmental delay defined as Development Quotient (DQ) <70 in either the mental or motor scale. Results: The study was analysed using appropriate statistical tests. Both cyanotic and acyanotic congenital heart disease were seen in children. Both conditions showed children had developmental delay. Gross motor delay was present in 62% children and fine motor in 56% of children. Conclusion: Children having congenital heart disease are more prone to developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.

Keywords: Congenital Heart Defect; Neurodevelopmental Delay; Outcome.

 Introduction: Urinary infections may be confined to the urethra, bladder or kidneys, the level of infection being determined by the size of the inoculums of the introduced bacteria, host resistance or defense factors and the virulence factors of the infecting strain. Methodology: The data was collected from parents/guardian of children of age group 6 months to 5 years coming to pediatric emergency ward of VIMS, Bellary with Febrile Seizures. Results: Among the 9% children who had UTI, 3% were boys and 6% were girls. All patients with UTI had simple FC. Most children with FC and UTI were < 12 months of age. Conclusion: Most children with FC and UTI were < 12 months of age.

Keywords: UTI; Children; Febrile Convulsion.

 Objectives: To use the Paediatric Epilepsy Side Effects Questionnaire (PESQ) for identifying adverse effects of anti epileptic drugs (AEDs) in children with epilepsy. Methods: Patients meeting the inclusion criteria (patients of epilepsy aged 2­20 years, newly diagnosed, already under treatment) filled the PESQ during their first and subsequent visits. The two sets of data were compared & statistically analysed. Results: 57 patients completed the study. The PESQ scores: the total score and the scores of the 5 individual scales were calculated and compared. The occurrence of each adverse effect was noted for the first and subsequent visit. Conclusion: the PESQ doesn’t take time, is cheap, easy to use for the identification, quantification and assessment of adverse effects.

Keywords: PESQ; Epilepsy; Adverse Effects; Quality of Life (QOL); Paediatric Epilepsy; Epilepsy
Questionnaire

 Introduction: Jaundice is observed during first week of life in approximately 60% of term neonates and 80% of preterm neonates. Phototherapy is one of the routine methods for management of hyperbilirubinemia. It can produce adverse effects such as skin rashes, loose stools, hypocalcemia and many other complications. In our study serum calcium level measured 48 hours after phototherapy in study­group and without phototherapy in control­group. Aims: 1) To study effect of phototherapy on serum calcium level. 2) To study symptomatic hypocalcemia after phototherapy. Method: Ninty term babies were included in study, seventy babies in study group and twenty in control group. Study group was selected as babies requiring phototherapy and control group as those not requiring. The study group was managed with phototherapy and not control group. Serum calcium levels measured before and after 48 hours of phototherapy and of control. Result: 50/70 neonates (71%) term babies developed hypocalcemia after photoherapy. No baby from control group developed hypocalcemia. Fifty percent babies of study group had symptomatic hypocalcemia. Conclusion: Neonates requiring phototherapy are at a higher risk of developing hypocalcemia. Therefore, it is suggested that calcium should be given in newborn requiring phototherapy.

Keywords: Phototherapy; Hyperbilirubinemia; Hypocalcemia; Jaundice.

 Introduction: Opportunistic infections are generally seen in children with severe depression of the CD4 count. Young children generally have primary infection and, lacking prior immunity often have a more fulminant course of disease. The peak incidence of PCP occurs at age 3–6 months with the highest mortality rate in children <1 year of age. Methods: All the children who fit to inclusion criteria were clinically evaluated and investigated. Data was collected by using a pre tested semi structured questionnaire. Results: All the 24 symptomatic children experienced weight loss and fever, making them the most common symptomatology. Conclusion: Oral thrush (fungal), diarrheal disease and tuberculosis predominated the picture in the HIV positive children of this region.

Keywords: HIV; Opportunistic Infections; Children.

 Background: Severe Dengue is associated with varied organ involvement and high mortality. Aims and Objectives: To study clinical profile and outcome of Severe Dengue in a tertiary care Pediatric ICU. Materials and Methods: Consecutive patients diagnosed as Severe Dengue were enrolled retrospectively over 6 months period (1st June 2015 to 30th November 2015). All patients were NS1 and/ or IgM positive for Dengue infection. The clinical presentation, laboratory parameters and patient outcomes were studied. Results: A total of 33 patients with Severe Dengue were included in the study (19 females, 57.5%). The common clinical presentations were with­ fever (100%), vomiting (51.51%), abdominal pain (45.45%) and bleeding (45.45%). Central nervous system (CNS) features included ­ altered sensorium (33.33%) and seizures (24.24%). On admission, hypotension (96.96%), tachycardia (90.90%) and respiratory distress (63.63%) were seen. 63.63% cases had hepatomegaly, 48.48% had pleural effusion and 39.39% had ascites. Common laboratory findings included­ thrombocytopenia (< 1 lakh/cumm) in 72.72%, hematocrit > 40 in 33.33% and SGPT > 150 IU/L in 44% of cases. Complications included­ acute respiratory distress syndrome (ARDS­ 18.18%) and disseminated intravascular coagulation (DIC­ 21.21%). Colloids were used in 81.81% and ionotropes in 93.93% of patients. All the patients underwent mechanical ventilation. Packed red cells and platelets were given in 30.3% and 33.3% of cases. Case fatality was 42.42%. Altered sensorium (p = 0.024), seizures (p = 0.0473), DIC (p = 0.026) and ARDS (p = 0.0027) were significant predictors of mortality. Conclusions: Mortality in Severe Dengue was high in our study (probably due to late referrals and more severe illness). Altered sensorium, seizures, DIC and ARDS were predictors of mortality. CNS presentation was seen in about one third of cases. Hepatomegaly, raised liver enzymes and thrombocytopenia were seen in most of the cases.

Keywords: ARDS; Critical; Dengue; Intensive; Liver; Seizures; Shock; Ventilation.

Introduction: Mother to children transmission of HIV is the major source of transmission of HIV to children and continues to be a global public health problem with the WHO statistics estimating that as of 2001­02, nearly 1600 babies worldwide becoming infected everyday. Methodology: All the children who fits to inclusion criteria were clinically evaluated and investigated. Data was collected by using a pre tested semi structured questionnaire. Results: Maximum number of children with in the age group of 18 months to three years i.e. 11 (45.8%), followed by 4 to 6 years with a total of 10 children (41.6%) and children aged 7 and above years constitute 16.6%. Conclusion: The order of symptomatology in most common occurrence were fever, weight loss and wasting was present in all the children with symptomatic HIV disease.

 Background: Urinary tract infection is the third most common bacterial infection in infants and children. Incidence varies with age and sex. Various anatomical, functional and immunological factors predispose to urinary tract infections like structural abnormalities of urinary tract. Varied spectrum of clinical features are seen in this infections. This study was done to find out the major predisposing factors and the commonest signs and symptoms of urinary tract infections. Methods: This case control study included fifty children between 1 month to 5 years of age with symptoms suggestive of urinary tract infection with positive urine culture. Fifty age and sex matched children with normal urine culture results were taken as controls. Radiological evaluation carried out in all cases of UTI. MCU was advised in all children less than 2 years of age with UTI. Data was analyzed using the Statistical Package for Social Science (SPSS). The independent ­test was used for comparison of data between two groups. Results: The maximum number of cases were in the age group of 1month – 1year Female to male ratio of 1:0.88. 80) of cases were first episode of UTI and there were 70% of simple UTI. Fever was the main symptom. In 80% cases E coli was isolated by culture and sensitivity. The major abnormal findings in ultrasound was bilateral hydronephrosis. Conclusions: The majority of children with UTI were in one month to one year age group with male preponderance. Majority of children had simple UTI and ultrasound evaluation was normal. Timely management of constipation, voiding dysfunction, attention to perineal hygine and treatment of pinworm infestations are recommended. The importance of exclusive breast feeding and circumcision in the prevention of UTI also needs to be emphasized.

Keywords: UTI; Predisposing Factors; Dysuria; Hydronephrosis; Under Five Children.

 Postoperative infections are common side effect of any surgical procedure. Orthopaedic surgeries in specific have an increased chance of postoperative infections as complications due to the implant being introduced and placed at the operative site. By following simple inexpensive methods this post operative infections can be reduced. 50 Patients with closed fractures of the tibial shaft were chosen. Patients with closed tibial shaft fractures operated on Monday, Wednesday and Friday were operated with povidone iodine painted intramedullary interlocking nails for fracture fixation. The patients with closed fractures of tibial shaft operated on Tuesday, Thursday and Saturday were operated with plain intramedullary nails for fracture fixation . It was noted that, in patients operated with plain intramedullary nails for fracture fixation, the incidence of postoperative infections was about 4% where as the incidence of postoperative infection rate with povidone iodine painted intramedullary nails was zero. With the use of povidone iodine painted nails the emphasis is on reduction of even the 1­2% infection rates postoperatively. There is a considerable reduction in the incidence of infections postoperatively after intramedullary nailing of closed fractures of tibial shaft by using povidone iodine treated intramedullary nails. Simplicity,easy availabilty and cost effectiveness of this small step would make a noteworthy difference.

Keywords: Tibial Fractures; Povidone; Intramedullary Nail; Infections.

 Point of care ultrasound is a quick and focused ultrasonography of any patient bedside and is helpful in managing patients in certain emergency situations like blunt abdominal trauma, cardiogenic shock and chest conditions like pleural effusion and hemothorax. It should be widely used bedside in pediatric emergency to improve patient care.

 Keywords: Point of Care Ultrasound; Pediatric Emergency; Developing Countries.