Indian Journal of Trauma and Emergency Pediatrics

Langerhans Cell Histiocytosis is a rare non malignant disease characterized by a clonal proliferation of pathologic cells with the characteristic Langerhans cells in single or multiple sites and an unpredictable course. The clinical presentation is heterogenous ranging from single system involvement to a multisystem life threatening disease. We report a case of LCH in 2 yr old female child with clinical signs of portal hypertension and hepatic involvement.

Keywords: Langerhans Cell Histiocytosis; Portal Hypertension; Hemetemesis.

Sex cord stromal tumours in adolescence account for less than 3% of ovarian neoplasm in this age group. Juvenile granulosa cell tumour are sex cord stromal tumours occurring in young age group. Clinical presentations of JGCT include precocious puberty, abnormal uterine bleeding, abdominal pain, and abdominal distension. Acute onset of pain may be result of ovarian torsion. Tumour markers for granulosa cell tumour are estradiol, inhibin and anti-mullerian hormone. JGCT are characterized by a prolonged natural history and a tendency to late recurrence. Conservative approach involves unilateral salpingo-oophorectomy with emphasis on fertility preservation. Long-term follow-up is required as JGCTs are associated with late recurrence.

Keywords: Sex Cord Stromal Cells; Juvenile Ganulosa Cell Tumours; Inhibin; Anti-Mullerian Hormone. 

Introduction: Blood transfusion has demonstrated its efficacy in saving life in the primary and secondary health care settings in developing countries. There is hence a need to develop policies and strategies to reduce unnecessary blood and component transfusions and ensure the safe and appropriate use of blood and blood products. Towards this there is further need to develop specific guidelines for the transfusion of blood components. Materials and Methods: Place of Study: Navodaya Medical College Hospital and Research. Centre. Study Period: 1 year. Sample: All children between the age of 1 to 15 years admitted to PICU. Included those cases with clinical and laboratory evidence of viral hemorrhagic fever had received blood component therapy and clinical and laboratory evidence of sepsis who had received blood component therapy. Results: Age profile of the study cases: The difference was statistically significant (p=0.117). Gender distribution of patients: The differences were again significant (p=0.075). Blood component therapy in Acute Systemic Infections: Of 38 platelet transfusions, 54% received the transfusion for platelet counts of less than 20000/cumm, while the remainder (46%) received it for platelet counts of >20000/cumm. Fresh frozen plasma transfusions: 24 children (40%) received FFP for altered coagulation profile of which 81% were found to be suffering from VHF. Red Blood Cell Transfusion: 3 cases received transfusion for hemoglobin of >8gm/dl. Conclusion: Regular audit of blood and blood components is an essential part of transfusion services, so that necessary remedial measures can be taken to maximize appropriate and judicious use of each component.

Keywords: PRBC, FFP, PLATLETS, Blood Transfusion. 

The spleen is an organ found in virtually all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The spleen plays important roles in regard to red blood cells (also referred to as erythrocytes) and the immune system. It removes old red blood cells and holds a reserve of blood, which can be valuable in case of hemorrhagic shock, and also recycles iron. As a part of the mononuclear phagocyte system, it metabolizes hemoglobin removed from senescentred blood cells (erythrocyte). The spleen is brownish in color and is located in the left upper quadrant of the abdomen. The purpose of this study was to establish guidelines for normal splenic size at different ages by using a simple and reproducible sonographic method. In our study span of 1 year we examined spleen on children from 1 to 6 year who had sonography because of abdominal and/or pelvic problems unrelated to the spleen. Findings on sonograms of the liver and kidneys were normal in all cases. Splenic size was measured by obtaining a coronal view that included the hilum, while the patient was breathing quietly. The greatest longitudinal distance between the dome of the spleen and the tip (splenic length) was measured and correlated with age, height, and weight. The following guidelines are proposed for the upper limit of normal splenic length based on this simple, easy to use, one-measurement technique: 7.0 cm at 12 months, 8.0 cm at 2 years, 9.0 at 4 years, 9.5 cm at 6 years. Normal values of a single measurement of the greatest longitudinal diameter of the spleen, from the dome to the tip measured at the hilum in the coronal plane, were obtained in patients from 1 to 6 years.

Keywords: Spleen; Ultrasonography. 

Cerebral palsy (CP) is a group of persistent (but not necessarily unchanged), movement, posture, muscle tone and motor skills disorders non-progressive, with early onset, due to non-progressive impairments, occurring on an immature brain or a brain under development (prenatal, perinatal, postnatal during the first 3-4 years of life). It is associated to a variable extent with: cognitive disorders, epilepsy, sensory deficits, behaviour disorders. Aims and Objectives: To study the co morbidities associated in cerebral Palsy patients. Materials and Methods:A hospital based prospective observational study carried out during the period of June 2016 to June 2017 at the Department of Pediatrics in Dr. VikhePatil Institute of medical sciences. All the children suffering from cerebral Palsy were included in the study. The patients were examined thoroughly and comorbidities associated were recorded. Results: Fifty-five cerebral palsy children were included in the study. 34 (61.8%) patients were male and 21 (38.2%) were females. There were 50 (90.9%) spastic CP. 3 (5.4%) hypotonic CP and 2 (3.7%) dyskinetic CP. Out of the 50 spastic CP patients 30(60%) were diplegic, 14 (28%) were quadriplegic, 5(10%) were hemiplegic and 1 (2%) was paraplegic. The commonest co morbidity associated with these patients was severe malnutrition. Intellectual Disability and language delay were the second commonest associations. Other comorbidties associated were seizures (38.2%) , drooling (58%), dysphagia (50%), GERD, constipation (43%), strabismus (54%), refractive errors (12.7%), hearing loss (29.1%), contractures (60%), urinary tract infections (49.1%), sleep disorders (38.2%), dental caries (56.4%) and behavioral problems (32.7%). Conclusion: While managing the cases of Cerebral Palsy, it is imperative to ascertain the comorbidities associated with effective and better management. Most children with developmental disability have lifelong impairments. The primary physician caring for these children is at the core of care provision.

Keywords: Cerebral Palsy; Comorbidities 

Aim: In the present study an attempt has been made to detect the sensitivity of ADA activity in diagnosing Tuberculous Meningitis. Materials and Methods: A total of 47 children aged 2 months to 12 years admitted. 21 of these patients had tuberculous meningitis, 10 had bacterial meningitis, another 7 considered to have encephalitis were included and a group of 9 patients who did not have meningitis, but are admitted to pediatric wards for other complaints like epilepsy, febrile seizures and to surgical wards for either inguinal hernia or hydrocele repair who underwent surgery under spinal anesthesia were taken. The patients were divided into four group. Results: Adenosine Deaminase activity is measured in cerebro spinal fluid of 21 cases of Tuberculosis Meningitis, 10 Cases of Bacterial Meningitis, 7 cases of Encephalitis and 9 cases of controls. The mean C.S.F ADA level was significantly raised (p<0.001) in Tuberculosis Meningitis patients as compared to other study groups. i.e, pyogenic Meningitis Encephalitis and non inflammatory conditions of C.N.S. A cut – off C.S.F ADA level of > 5 LU/L was considered for the diagnosis of Tuberculosis Meningitis and the tests showed a sensitivity and specificity of 95.24% and 88.4% respectively. The ADA activity in TBM cases had significantly correlation with cell count and protein concentration. Conclusion: Overall it was found to be a single better test in comprasion to any other tests for the diagnosis of Tuberculous Meningitis.

Keywords: Tuberculous Meningitis; Adenosine Deaminase; Encephalities. 

Background: Neonatal sepsis is one of the major health problems throughout the world. The neonate is immunocompromised with incomplete development of multiple components of the immune system specially quantitative and qualitative deficiencies of the phagocyte systems. Vitamin C helps in eliminating, neutralizing and antagonizing toxins and mediators, by anti-inflammatory substances, and by immunomodulation. Objective: The aim of the study was to reduce the neonatal mortality from infection by using Vitamin C as an adjuvant therapy along with antibiotics. Settings and Design: This Randomized control trial was carried out in Dhaka Shishu (Children) Hospital during the period 1 April 2013-30th September 2014. Methodology: Neonates of 36 wks. or more gestational age and weighinge 2.5kg, presented with signs and symptoms of sepsis supported by positive CRP and or blood culture were assessed. All study patients were randomly divided into intervention group (Group A) and control group (Group B). In intervention group vitamin C, 100mg/kg was given for two consecutive days. Results: During the study period, total 279 neonates were assessed for eligibility and finally 137(68 in intervention group and 69 in control group) were enrolled after exclusion. There was significant difference in terms of cure (Both clinical and biochemical) was seen in 74.5% in group A and 25.5% in group B.) Mean decrease of CRP level ingroup A was 42.44 (84.94%) mg/dl and in-group B was 14.39 (35.25%). There was statistically significant (P<0.001) decrease in CRP level in Intervention group along with clinical improvement. Conclusion: Vitamin C appears to be effective as an adjuvant therapy in neonatal sepsis. It may be used as adjunct therapy in neonatal sepsis to reduce mortality and morbidity.

Keywords: Vitamin C.; Neonatal Sepsis; Adjuvant. 

Patients with isolated severe head injury with diffuse axonal injury and without any surgical lesion poses challenging task, this patient’s need airway control in view of low Glasgow coma scale and possibility of aspiration pneumonia, which increases mortality. One hundred and forty patients with GCS score below 10 werecategorized into four groups. Group A – patients with GCS 7-10 and tracheostomy done within 3 days, Group B- patients with GCS 7-10 and tracheostomy was done after 5 days, Group C- patients with GCS below 6 and tracheostomy done within 3days, and Group D- patients with GCS below 6 and tracheostomy was done after 5 days. The characteristics of these four groups were compared based on the day on which patient was weaned from the ventilator support and connected to T-piece, development of fresh lower respiratory tract infection and death during hospital stay. Results: out of the 140 patients of isolated head injury with diffuse axonal injury without any surgical lesion the average day when patients were weaned from ventilator and connected to T- piece was 4th day in group A, 7th day in group B, 12th day in group C and 19th day in group D. The incidence of lower respiratory tract infectionwas 20% in group A, 31% in group B, 80% in group C and 52.5% in group D. And the mortality while in our hospital was 6.6% in group A, 14% in group B, 40% in group C and 52.5% in group D. Conclusions: Tracheostomy offer advantages in the management of patients of isolated head injury with diffuse axonal injury without any surgical lesion on mechanical ventilation, in this population early tracheostomy can facilitate weaning, safely reducing patient exposure to the risks of MV, and therefore has a positive impact on mortality.

Keywords: Diffuse Axonal Injury; Tracheostomy; Mechanical Ventilation