Search

The authors have reported one case of near-hanging by a window blind cord, in the hope of heightening awareness of these potentially fatal injuries among community practitioners. Parents and childcare providers need to be more aware to the potential hazards and safety measures needs to be adhered to at home, and practitioners in contact with families-can help by raising this issue with them.

Objectives To report an outbreak of invasive meningococcal disease from Meghalaya, in the north east India, from January 2008 through June 2009. Methods Retrospective review of case sheets was done. One hundred ten patients with invasive meningococcal disease were included for the study. Results Of the total patients, 61.8 % were boys and 38.2 % were girls (boy to girl ratio = 1.62:1). The average age of presentation was 8.48 ± 5.09 y. Meningococcal meningitis was seen in 61.8 % of cases, meningococcemia in 20 % and 18.2 % had both. Fever was the most common manifestation (100 %) followed by meningeal signs (78.2 %), headache (56.4 %), vomiting (53.6 %), shock (38.2 %), low Glasgow coma scale (GCS) (25.5 %), purpura and rashes (23.6 %), seizures (9.1 %), abdominal symptoms (4.5 %), irritability and excessive crying (4.5 %) and bulging anterior fontanalle (23 %) in those below 18 mo of age. Raised intracranial pressure (ICP) was the most common complication (28.2 %) followed by coagulopathy (16.4 %), hepatopathy (10 %), herpes labialis (9.1 %), syndrome of inappropriate ADH secretion (SIADH) (8 %), pneumonia (7 %), arthritis (6 %), purpura fulminans, respiratory failure, sixth nerve palsy and diabetes insipidus in 4.5 % each, subdural empyema, optic neuritis, ARDS and ARF in 1.8 % each, cerebral salt wasting syndrome, third nerve palsy, cerebritis and hearing impairment in 0.9 % each. Culture was positive in 35.5 %. Patients were treated initially with ceftriaxone and dexamethasone but later on with chloramphenicol due to clinical drug resistance. Mortality was 6.4 %. Conclusions This is the first epidemic report of invasive meningococcal disease from the north east India. Chloramphenicol acts well in areas with penicillin or cephalosporin resistance. Mortality reduces significantly with early diagnosis and prompt intervention.

Parents often request a consultation for health questions about a new baby such as ‘reddish stains’ in the nappy. Often such cases are benign, but parents may need reassurance. A reddish stain in the nappy often raises great concern because its colour is suggestive of blood. Thorough history-taking, followed by a clinical examination is necessary to rule out a serious cause. It is important to establish the exact nature of the stain and ensure that there is no blood on the nappy.

Background Coeliac disease (CD) is an immune mediated systemic disorder elicited by the ingestion of gluten and related prolamines in genetically susceptible individuals. Diagnosis has been based on small bowel histology as per ESPGHAN guidelines. In 2012 ESPGHAN guidelines1 were modified and recommend that in symptomatic patients a diagnosis of CD can be made without small-bowel biopsy if anti-tissue transglutaminase antibody (TTG) titre is greater than 10 times upper limit of normal (>10ULN), together with presence of HLA-DQ2 and/or DQ8. This study aimed to examine the relationship between TTG levels and the corresponding histological features. Methods Data was collected prospectively at diagnosis of CD from 126 consecutive children between June’ 2011 – May’ 2012. TTG was measured using ELISA technique. Histological samples were obtained from endoscopic small-bowel biopsies and interpreted by paediatric histopathologists. The relationship between the modified Marsh criteria histological findings and contemporaneous TTG levels was analysed. Results Out of 126 children, 13(10.5%) had positive TTG but no documented titres. In 12(10%) histological report did not specify Marsh classification. Complete data of histological report and TTG level were therefore available from 104 children (82%). The data (table) shows an association between TTG level and histological staging of CD. 58 (48%) children had TTG >10ULN (>100U/ml). 57/58 of these patients had biopsy proven CD. The sensitivity of the TTG level >100U/ml alone in correctly diagnosing CD in this cohort was 98.3%. Conclusion 98.3% of children with TTG >100U/ml had histologically confirmed CD although total villous atrophy was associated more often with TTG level of >200U/ml. It is essential to report TTG titres by all laboratories. This study supports the new ESPGHAN guidelines for the selective use of high TTG levels in diagnosing CD in symptomatic children without a biopsy. Reference Husby S, et al . J Pediatr Gastroenterol Nutr . 2012;54(1):136–60

Background In 5–15% of children diagnosed with inflammatory bowel disease (IBD), the histological picture at diagnosis doesn’t fit in with either ulcerative colitis (UC) or Crohn9s disease (CD) and is classified as unclassified-IBD (IBDU) or indeterminate colitis. 1 The aim of this prospective study is to determine whether IBDU evolves into UC or CD. Methods Prospective data has been collected on all the newly diagnosed children with IBD at the only regional paediatric gastroenterology centre covering southwest of England. All patients suspected of IBD had upper and lower gastrointestinal endoscopy and MRE scan or barium meal as recommended by BSPGHAN. 2 Patients diagnosed with IBDU during 2004–2011 were included in the study and followed up for a minimum of 2 years (range 2–9 years). The patient notes were reviewed in 2013 and any changes in diagnosis recorded. Results 333 children were diagnosed with IBD between 2004–2011: 193 (58%) had CD, 115 (34.5%) UC and 25 (7.5%) IBDU. Age (mean) at diagnosis: 10.2 years (IBDU), 11.5 years (CD) and 11.6 years (UC). 7/26 (27%) IBDU had pan-colitis and 19/26 (63%) had patchy or left-sided colitis on lower gastrointestinal endoscopy. After 2 to 9 years, IBDU evolved into CD in 5 patients (22.8%), UC in 3 (13.6%) and remained IBDU in 14 patients (63.6%). Latest data was unavailable for 3 (11.6%) because of transfer to distant adult services. ANCA was positive in 3 out of 4 patients whose diagnosis was revised as CD. Conclusion This large prospective study has documented that over 2–9 years, 22.8% IBDU evolved into CD, 13.6% into UC and 63.6% remained IBDU. IBDU patients tended to be younger at diagnosis. Positive ANCA was not an useful predictive marker. This has implications for management of IBDU patients especially where surgical treatment is considered. References De Bie CL, et al. (2012). J Pediatr Gastroenterol Nutr . 54(3):374-80 Sandhu BK, et al. (2010). J Pediatr Gastroenterol Nutr . 50:S1-S13

Functional abdominal pain is common in children and a proportion of these children suffer from chronic abdominal wall pain (CAWP). CAWP is suggested when a positive Carnett's sign is elicited in a child where the pain gets worsened by movement. Analgesics are generally not helpful in children with CAWP. We describe a novel approach with physiotherapy (by core stability programme) for managing children with this condition. The therapy was delivered by a paediatric therapist after other organic causes of abdominal pain were ruled out. Forty two out of 49 children (85%) showed improvement with this therapy. As the improvement was noticed during the therapy and sustained thereafter we suggest that this therapy is helpful in children in CAWP.

Antipyretic agents such as paracetamol or ibuprofen are routinely used in paediatric practice. They are sometimes used in combination, or even prophylactically, because of concerns about hyperthermia causing adverse events—such as febrile seizures or distress to the child. Available evidence published by the National Institute for Health and Clinical Excellence (NICE) suggests that antipyretic agents do not prevent febrile convulsions, and should not be used specifically for this purpose (NICE, 2010). It is also suggested not to administer paracetamol and ibuprofen at the same time, but to consider using the alternative agent if the child does not respond to the first drug (NICE, 2010).