Indian Journal of Trauma and Emergency Pediatrics

Antiglomerular basement membrane (anti-GBM) disease is a rare small vessel vasculitis caused by auto-antibodies targeting auto-antigen expressed in basement membranes of capillary beds in lungs and kidneys. A six-year-old male presented with fever, cough, and generalized weakness for three days with respiratory distress for one day. The child had three prior admissions with similar complaints and was treated as a case of lower respiratory tract infection with severe iron deficiency anemia in the past. Multiple packed red cell transfusions were required in these past admissions. In this current admission, he had tachycardia, tachypnea, severe pallor, right-sided lung crepitations & bronchial breath sounds. The hemogram showed severe anemia and leukocytosis. Urine examination showed mild proteinuria and microscopic hematuria. Chest X-ray (current admission) showed right middle and lower zone consolidation. HRCT of the chest revealed an interstitial pattern. A lung biopsy showed pulmonary hemorrhage and positive Prussian blue staining. Raised anti-GBM titers confirmed diagnosis of anti-GBM disease. Renal biopsy revealed normal glomerular morphology on histopathology; with immune fluorescence showing linear positivity for IgG (3+), Kappa (3+), and Lambda (3+). Electron microscopy reported mild effacement of visceral epithelial foot processes and subepithelial/intramembranous electron-dense deposits. He was treated with intravenous methylprednisone for 5 days followed by oral prednisolone for one month, which was thereafter tapered to a lower maintenance dose for 18 months. The child received six cycles of intravenous cyclophosphamide along with a daily low dose of steroids. Currently, the child is asymptomatic after one year of follow-up with seroconversion (antiGBM titers decreased) and normalization of the chest radiograph.

This article describes the evaluation and management of a child with severe burns in a tertiary care center with a dedicated tertiary-level burns unit. An 8-year-old child with 25% Second-degree scald burns was evaluated and treated with ATLS, WHO Guidelines, and assessed with Abbreviated Burn Severity Index (ABSI) score. We have used routine blood investigations, and microbiological investigations. The child was treated with intravenous fluids and antibiotics. In addition, regenerative treatment modalities were used to improve wound healing.

Introduction: In developing countries like India, the incidence of TBI is very high. The pathophysiology, clinical presentations and management are different as compared to adults. Hence the need to have a focused study to evaluate etiology and outcomes in Pediatric traumatic head injury.

Material and Method: We retrospectively studied 45 cases of pediatric traumatic head injury upto age 14 years presenting to our institute. The study period was of 1 year from june 2022 to june 2023. Demographic data and clinical features were noted and severity was assessed by GCS scale on admission. CT scan was done in all cases.

Result: The number of males were 62.2% while 37.7% were females. The mean age of presentation was 5.7 years. The most common etiology in our study was fall (64%) followed by RTA (24%) and sports and others constituting the least (7%). The most common presenting feature was headache (66.6%), vomitting (63.4%) followed seizures (26.4) and loss of consciousness (6%). On basis of GCS, 90% cases were mild in severity and 8% moderate and 2% severe. CT was normal in 32% cases and abnormal in 68% cases with Fractures being more common finding. The short term outcome was good in 95.6% and 4.4% had neurodeficit. Anti convulsants were prescribed to 26% case.

Conclusion: There is a urgent need to have studies focused on pediatric head injury cases. In present study we try to contribute to the current literature available in Indian settings. We also want to increase awareness about preventable cases as most of the head injury cases can be avoided by vigilance and care by the parents.