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Children with intestinal failure have had improved survival, particularly those with extreme short bowel syndrome, over the last 10-15 y. This has been attributed to better understanding of the pathophysiology of intestinal failure, improvement in line care, recognition of the importance of a team approach as well as the progress of intestinal transplant as a viable option. Parenteral nutrition remains the cornerstone for the continual survival of these patients. This review will cover contemporary approaches to intestinal failure including post surgical approaches, non-transplant surgery, dietetic and medication approaches during the adaptation process, considerations for home parenteral nutrition and latest in intestinal transplantation. [ABSTRACT FROM AUTHOR]

Preprocedure sera of thirty one neonates requiring exchange transfusion were tested for serological markers of HBV, HCV, CMV, HIV and LFT. All the babies were investigated for these parameters one week and two months after transfusion to evaluate the risk of transmission of viral infection. Serological markers for these viral infections were also studied in the mothers and donors' blood to establish the route of infection. Donors' blood used for transfusion was pretested for HBsAg, VDRL and anti-HIV. HBsAg was detected one week post exchange in one baby and two months post exchange in two babies. Exchange transfusion was implicated in two of them, where one donor had HBsAg and the other anti-HBc. Vertical transmission accounted for the remaining one. Out of these HbsAg positive cases, one showed evidence of recently acquired CMV infection. Vertical transmission of anti-HCV was observed in one case. None of the neonates, mothers and donors were positive for anti-HIV. In view of probable serious consequences of HBV and HCV infections, blood used for exchange transfusion ought to be screened for anti-HBc and anti-HCV, besides routine HBsAg, VDRL and anti-HIV screening. [ABSTRACT FROM AUTHOR]

Study includes fifty O blood group mothers delivering A or B group infants suffering from jaundice and a control group consisting of thirty one O group mothers of non-jaundiced infants. Lytic ability of maternal IgG anti-A/anti-B was determined by 51Cr ADCC assay in which cord blood monocytes were used as effector cells. In control series mean% specific lysis (SL) was 18 +/- 3.1 for IgG anti-A and 17.9 +/- 3.1 for IgG anti-B. In jaundiced series IgG anti-A was more lytic than IgG anti-B. However, the increase in ADCC lysis was statistically insignificant. Even though > 1:32 titre was more often associated with > 35% SL, in general the immune A/B antibody titre showed poor correlation with ADCC lysis. Majority of the severe ABO-HDN cases had > 35% ADCC lysis. [ABSTRACT FROM AUTHOR]

Disorders of sexual development (DSD) are a complex group of disorders to manage, not only because the diagnosis is difficult, but also because it involves many factors related to the psychosexual well being, the social stigma associated with the disorder, confusion and reluctance on the part of medical professionals in dealing with this issue, catastrophic experience of parents of these children and difficult interpersonal relationships between parents and children born with this disorder. This brief review attempts to throw light on the recent advances in understanding and management of these disorders to help improve immediate and long term care of these patients and their families. [ABSTRACT FROM AUTHOR]

Objective: To analyse the factors associated with increased mortality among Indian Children with H1N1. Methods: Data were abstracted from available hospital records of children less than 12 y of age, who were admitted to Sassoon General Hospital in Pune, India, with confirmed pandemic 2009 H1N1 influenza infection from August 2009 through January 2010. Logistic regression analysis was used to identify clinical characteristics associated with mortality. Results: Of 775 pediatric cases admitted with Influenza Like Illness (ILI), 92 (11.8%) had confirmed H1N1 influenza infection. The median age of HIN1 cases was 2.5 y; 13 (14%) had an associated co-morbid condition. Median duration of symptoms was 4 d (interquartile range (IQR), 3-7 d). All 92 H1N1 cases received oseltamivir and empiric antimicrobials on admission. Intensive care unit (ICU) admission was required for 88 (96%) children, and 20 (23%) required mechanical ventilation.Fifteen children (16%) died; mortality was associated with presence of diffuse alveolar infiltrate on admission chest radiography (odds ratio (OR) 45, 95%CI :5.4-370; p < 0.001), use of corticosteroids in ARDS in children who required mechanical ventilation (OR 8.12, 95%CI: 2.44-27.05; p = 0.001), SpO <80% on admission (OR 32.8, 95% CI: 5.8-185.5; p < 0.001) and presence of ARDS (OR 345.3, 95% CI :33.5-3564.1; p < 0.001). Necropsy from all children who died showed 9 (60%) had ARDS pattern and necrotizing pneumonitis, diffuse hemorrhage and interstitial pneumonia ( n = 4 each, 27%) with gram positive organisms consistent with severe viral and bacterial co-infection. Conclusions: Hypoxia, ARDS and use of corticosteroids in children with ARDS who were mechanically ventilated were the factors associated with increased odds of mortality. Necropsy also suggested bacterial co-infection as a risk factor. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of an indigenously assembled Nasal Bubble CPAP (NB-CPAP) in children during present swine flu pandemic presenting with acute hypoxemic respiratory failure; in improving gas exchange and vital signs; and assess method safety. Methods: Thirty Six children with acute hypoxemic respiratory failure admitted to swine flu ICU during the present H1NI pandemic were included (18 confirmed H1N1 positive and 18 confirmed H1N1 negative). After a baseline Arterial Blood Gas, all children received Oxygen via indigenous NB-CPAP Circuit which gave expiratory positive airway pressure of 5 cm water and delivered an FiO of around 70%. Vital signs, pH, PaO, PaCO, PO/FiO and O saturation were recorded at start and at 6 h into the study. Results: Median age of the patients was 18 months (58% males, 42% females). Respiratory rate and heart rate improved significantly with indigenous NB-CPAP after 6 h of treatment compared with admission ( p < 0.0001 and p < 0.001), respectively. At the end of 6 h on NB-CPAP,PaO ( p < 0.0001), PCO ( p < 0.0001), PO/FiO ( p < 0.0002) and O saturation ( p < 0.001) improved significantly. Median duration of NB-CPAP use was 2 days and none required endotracheal intubation. The median hospital stay was 7 days. Conclusions: Indigenous NB-CPAP improves hypoxemia and signs and symptoms in hemodynamically stable children with acute respiratory failure due to influenza like illness. It is a cost-effective, safe, well tolerated circuit in highly demanding pandemic situations and may prevent progression to intubation. [ABSTRACT FROM AUTHOR]

Erythrocyte membrane enzyme 'acetyl cholinesterase' (AChE) was estimated in 200 cases of neonatal jaundice. The enzyme levels were reduced in jaundiced infants in comparison to normal infants (mean 34.5±19.8 units vs 48.8±25.2 units/gm Hb, P<0.05). The levels of the enzyme were not greatly altered in neonatal jaundice due to Rh incompatibility, G-6-PD deficiency and prematurity. Lower levels were observed in cases of ABO hemolytic disease in relation to ABO compatible unexplained cases of neonatal jaundice (27.9±13.4 units vs 37.2±21.2 units/gm Hb, P<0.05). However these findings were not of anv diagnostic value, as low levels of AChE were not associated with spherocytosis and increased osmotic fragility. [ABSTRACT FROM AUTHOR]

One hundred and five children suffering from chronic diarrhoea were investigated for the type of anaemia and marrow morphology. Anaemia was mild in 30%, moderate in 65% and severe in 5% patients. Red cell morphology showed evidence of iron deficiency in 55% children and macrocytosis in 25%. The erythropoiesis was normoblastic, purely iron deficient and frankly megaloblastic in about an equal number of patients. Dimorphic anaemia was seen in 18 patients. The relationship between the type of deficiency anaemia observed and the aetiological factor is discussed. [ABSTRACT FROM AUTHOR]

Two typical cases of gargoylism are presented. The disease could not be traced to the previous generations but siblings of both the cases appeared to be affected. A brief resume' of the relevant literature is given. [ABSTRACT FROM AUTHOR]

Observations on 149 children with tuberculosis are presented and discussed with special reference to the available data from India. The majority of the cases were young males and belonged to the low socio-economic group. Only 15% had a definite history of contact; nearly half of the patients gave a history of measles, whooping cough or chicken pox in the recent past. The over-all incidence of the primary complex was 43%; 7.3% of these cases had associated pulmonary complications. Pleural effusion accounted for 4.0% of the cases, superficial lymphadenopathy 20.0%, meningitis 8.0%, intra-abodominal tuberculosis 11%, skeletal tuberculosis 8.0% and chronic pulmonary tuberculosis 6.0%. [ABSTRACT FROM AUTHOR]