No abstract

The objective of this study was to determine the effectiveness and safety of mild systemic hypothermia by selective head cooling in hospital born neonates with hypoxic-ischemic encephalopathy using low-cost CoolCap. The primary outcome was to determine whether selective head cooling reduces neonatal mortality and neurodevelopmental delay (NDD) at > 30 months of age. The secondary outcome was to determine the serious adverse effects during selective head cooling such as thrombocytopenia requiring platelets transfusion, renal and hepatic dysfunction, bradycardia, hypoglycemia, and dyselectrolytemia (hyperkalemia, hyponatremia, and hypocalcemia). This is a single-center randomized control trial. The risk ratios, risk differences, and numbers needed to treat plus 95% confidence interval (CI) were measured. This study was done at the tertiary care perinatal center. Inborn neonates with ≥ 37 completed weeks of gestation with indicators of perinatal asphyxia and moderate to severe clinical encephalopathy were randomly allocated to hypothermia (n = 30) or standard care (n = 30) groups. The neonates were subjected to mild systemic hypothermia via selective head cooling using ice caps, the target rectal temperature being 34 to 35°C for 72 hours. Therapeutic hypothermia reduced the risk of death and NDD at ≥ 30 months of age: 6 of 30 infants (20%) in the hypothermia group and 18 of 30 infants (60%) in the control group died or had a NDD at ≥ 30 months (risk ratio: 0.33 [95% CI: 0.15–0.72]; p = 0 0.0015). The mortality rate decreased, and the survival rate free of any sensorineural disability increased. The benefits were statistically significant in moderately asphyxiated infants. Adverse effects of hypothermia were minimal. Selective head cooling with mild systemic hypothermia in term asphyxiated neonates is safe and inexpensive in low-resource setting. Hypothermia showed statistically significant reduction in mortality and NDD at ≥ 30 months of age when commenced within 6 hours of birth and was not associated with serious adverse effects. The Institutional Clinical Trial Registry number is CNMC/ETHI/317/P.

A 7-year-old male patient with a history of recurrent abdominal pain over 1 year presented with cardiac tamponade due to massive pericardial effusion, which was percutaneously drained. Contrast-enhanced computed tomography revealed a large posterior mediastinal cyst and calcified, heterogeneous pancreatic parenchyma. Elevated amylase and lipase levels of the cyst fluid confirmed the diagnosis of pancreatic pseudocyst, which was treated with an octreotide infusion and Roux-en-Y cystojejunostomy. The child was discharged on pancreatic enzyme supplement and was asymptomatic on follow-up.

Case 1: An 8-year-old girl with a prodrome of fever and headache presented with generalized tonic clonic seizures. She had florid meningeal signs. Laboratory investigations revealed elevated liver enzymes. Cerebrospinal fluid had pleocytosis and elevated protein. Immunoglobulin M antibody against hepatitis A virus (HAV) was positive in serum. She recovered without sequelae. Case 2: A 10-year-old girl with HAV infection developed progressive pancytopenia, coagulopathy, and worsening liver function. She fulfilled the 2009 diagnostic criteria of hemophagocytic lymphohistiocytosis (HLH). She had spontaneous resolution of HLH without immunosuppressive therapy. Central nervous system involvements of HAV usually resolve without sequelae. HLH following hepatitis A is being increasingly reported and may resolve spontaneously.

Background & Objectives: With increasing incidence of Kawasaki disease and its associated complications, the need of the hour is early diagnosis. Incomplete  Kawasaki is often diagnosed late and is frequently associated with morbidities and mortalities. Our study aims to emphasize the importance of echocardiography in detection of incomplete Kawasaki disease.Materials & Methods: A total of 150 children, clinically diagnosed as Kawasaki disease were evaluated echocardiographically and involvement of coronary artery and associated cardiac involvements were studied.Results: Amongst the incomplete Kawasaki disease patients 76% were from extremes of ages and 19.2% of them had coronary involvement. Myocarditis(38.1%) was the commonest non-coronary findings.Conclusion: Atypical Kawasaki disease is more common in extremes of ages and echocardiography helps in detecting atypical disease at the earliest, thus facilitating prompt treatment and reducing complications.