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Abstract Background Although hyperglycemia and pancreatitis are known side effects of L-asparaginase, both contributing to the development of diabetic ketoacidosis (DKA) is unfamiliar in literature. Case presentation We report a case of an adolescent girl, recently diagnosed with ALL, who presented with pain in abdomen and breathing difficulty following chemotherapy with L-asparaginase. On subsequent evaluation, she was found to have high anion gap metabolic acidosis, hyperglycemia and ketonuria. Ultrasonogram showed bulky pancreas. DKA was managed with fluid correction and insulin infusion. Pancreatitis was managed conservatively. She recovered completely with resolution of symptoms and without any major adverse events despite having such severe complications. Conclusion We conclude that the combination of DKA and pancreatitis is a rare occurrence with significant morbidity and mortality. We recommend a close monitoring of blood glucose levels for hyperglycemia as well as a high index of clinical suspicion for pancreatitis in patients with ALL receiving L-asparaginase.

Background: Sickle cell disease is characterized by repeated crisis and need for frequent transfusions. Abdominal crisis are common and potentially can damage any abdominal organ. Screening for organ involvement will lead to early detection and better patient care. Aim and Objectives: To see whether ultrasound can be a better noninvasive technique for early detection of organ involvement. Material and Methods: Prospective cross sectional observational study done on patients admitted in pediatric ward of a medical college. Total of 150 patients, already diagnosed to have sickle cell anemia (homozygous 110 and heterozygous 40) was included in the study. All the patients were in steady state. Demographic, clinical biochemical details were noted and were subjected to ultrasonography. Renal artery, Being end artery, Doppler study was also done. All the modalities were compared for early detection. Results: Majority of patients (77%) were between 1 to 30 years with male female ratio of 2:1. Recurrent fever (64%) and recurrent abdominal pain (47%) were most common symptoms and anemia (66%), hepatomegaly (62%), splenomegaly (21%) were most common signs. When clinical examination, biochemical tests and ultrasonography were compared for organ detection, ultrasound significantly detected more patients (p=

Introduction: Scorpion sting is a serious health problem in the world, especially in developing countries like India. It is often associated with serious clinical manifestations. As children have a small body surface area, they are prone to more serious cardiac, respiratory and neurological complications. Prazosin, an alpha-blocker, is the drug of choice for the treatment of scorpion envenomation. With the increasing incidence of paediatric scorpion envenomation in rural India, there is a need to optimise prazosin dosing protocols to improve outcomes and reduce hospital stays. Aim: To evaluate and compare the efficacy and safety of standard-dose versus high-dose prazosin protocols in managing paediatric scorpion envenomation in a tertiary care hospital in North Karnataka, India. Materials and Methods: A single-blinded randomised controlled study was conducted in Paediatric Intensive Care Unit (PICU) at BLDE DU Shri BM Patil Medical College Hospital and Research Centre, Vijayapur, Karnataka, India, from January 2017 to December 2022. Children below 18 years of age admitted to the hospital with history of scorpion sting with severity grades II and III were enrolled. Children were randomised into three groups: Group A: 30 μg/kg every three hours; Group B: 60 μg/kg initially, followed by 30 μg/kg every three hours; and Group C: 90 μg/kg initially, followed by 30 μg/kg every three hours. They were monitored for sweating, cold or warm extremities, the appearance and disappearance of pain, vital parameters and priapism (in male children) hourly until stabilised, then every third hourly for 24 hours and then sixth hourly til discharged from the PICU. After the patient was haemodynamically stable for 24 hours shifted to a high-dependency unit. The time interval between sting and treatment, various vital parameters, duration of the PICU stay and hospital stay were noted. Categorical variables were compared using the Chi-square test and continuous variables were analysed using the Student’s t-test. Results: A total of 86 children were recruited. The standard protocol (Group A) had 26, Group B had 29 and Group C had 31 children. Forty-eight (56%) of the children were over five years old (12, 21 and 15 were in Groups A, B and C, respectively). The male-to-female ratio of 1.8:1, 2.6:1 and 1.8:1 in Groups A, B and C, respectively. The sting-to-symptom interval, priapism, duration of hypertension and duration of hospital stay were higher in Group B compared to Group A. The duration of hypertension, cardiac involvement and priapism were higher in Group C, whereas a shorter sting-to-symptom interval and symptom-to-prazosin initiation were noted in Group C compared to Group A. Conclusion: High-dose prazosin is a safe and effective treatment for scorpion envenomation in children, offering a potential advantage over the standard dosing protocol.

Information in this article is from an observational study comparing intelligence in children with cleft lip and palate with normal children. Both groups performed “draw a man test”, the investigator noted the attitude and behaviour of children and their parents. The study shows low, but normal intelligence quotient in children with oral defects as compared to normal. The probable reason for sub-normal performance appeared to be overprotective attitude of parents and poor self esteem of children with oral defects.

Holoprosencephaly (HPE) is a group of structural abnormalities of brain that is an important cause of childhood mortality and morbidity. They usually occur due to impaired midline cleavage of embryonic forebrain i.e., failure of differentiation of the prosencephalon into the telecephalon and diencephalon. De Myer classified this anomaly ranging from alobar to semilobar and lobar type. It can be associated with microcephaly and midline facial anomalies. We present a case of semilobar holoprosencephaly with corpus callosal agenesis.

Background: More than 50% of the world’s cases of sickle cell anaemia are in India with an estimated population of 1.27 billion as against estimated world’s population of 7.24 billion. Aim: MRI of 103 patients of sickle cell disease were evaluated to assess the skeletal changes in proven cases of sickle cell disease and to find the incidence of bony infarcts in such patients. The conversion of red marrow to yellow marrow in these patients were also studied. Materials and Methods: Sickle cell patients with musculoskeletal pain as well as asymptomatic sickle cell patients were evaluated by MRI. The standard sequences used wereT1WI, T2WI, STIR, T1WI + Gd Contrast. Results: Persistent Red marrow was seen in axial and appendicular skeleton (62 cases). Extramedullary haematopoiesis was found in 4 cases, avascular necrosis of femur head (32 cases) and bone infarcts (46 cases) were also observed in our study. Osteomyelitis, septic arthritis and tubercular infections were associated with sickle cell disease in our study. Conclusion: MRI is very sensitive in detecting early stages of avascular necrosis, red marrow persistence, extramedullary haematopoiesis, changes of arthritis, infections and joint effusion.

Introduction: Dengue fever is a fatal viral illness affecting almost all age groups and is seen in almost all tropical countries. Ultrasonography (USG) can be a useful tool for the assessment and diagnosis of dengue fever., Objectives: The study aimed to evaluate X-ray and ultrasound findings in children with dengue fever., Material and Methods: This was a prospective and cross-sectional study that was carried out in a hospital in Mumbai for over one year. All relevant data were collected, validated, and analyzed statistically on the software Epi Info 7., Results: Abnormal X-ray findings noticed were pleural effusion, pneumonia, and bilateral nodular opacities. Pleural effusion and respiratory complications were more common in severe dengue ( P < 0.05). Out of the 37 patients on whom USG was done, 33 (89.18%) had abnormal and 4 (10.81%) had normal USG findings. Of the 17 patients with dengue who showed warning signs, 16 (89.9%) had abnormal USG findings. Plasma leakage in the form of ascites and effusion was commonly seen. One hundred percent of patients with severe dengue had abnormal USG findings. The abnormal USG findings were more commonly detected between 5-7 days and were more commonly associated with IgG + IgM-positive serology., Conclusion: Ultrasonography is a good modality for the diagnosis and evaluation of dengue patients. Serial ultrasound should be done for the assessment and evaluation of said patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family Medicine and Primary Care.)

Background: This article describes the experience of a rural human milk bank, with the problems faced in first 6 months including the coronavirus disease (COVID) crisis and interventions leading to success., Methods: The study included individual counselling by dedicated counsellors, focused counselling of primipara mothers seeking the help of obstetricians, counselling of pre-term mothers by neo-natal nurses, periodically delivered information in post-natal wards, and counselling of grandmothers and husbands., Results: The COVID crisis was dealt with donations from reverse transcriptase-polymerase chain reaction-negative mothers with social distancing and mask use. Younger, educated, working mothers with normal delivery and from middle-income families were easy to counsel. Periodic announcements in wards significantly increased awareness about milk banks and donation. Pre-term mothers could be motivated when their baby was nil by mouth or they saw other babies in need of milk. Lactation support to mothers with breast problems, especially in primipara, helps in getting more donors. Counselling of fathers was easier than that of grandmothers., Conclusions: Structured awareness programs and counselling strategies along with education of grandmothers and husbands were very effective in increasing human milk donation., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Community Medicine.)

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome, in which a patient presents with neurological symptoms, including headache, seizures, altered sensorium, and loss of vision, and accompanied with characteristic magnetic resonance imaging findings which are likely to be reversible. Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy presumably related to immunological mechanisms. Here, we describe a patient who had PRES in recovery phase of GBS while he was neither on any immunomodulator nor was having hypertension. He recovered completely clinically as well as radiologically., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 International Journal of Applied and Basic Medical Research.)

Lizard bite is very infrequent in children. Lizards tend to avoid confrontation. Bites are only inflicted when they are manipulated or when they are cornered and feel threatened. Lizard bites may be frightening but most do not cause serious health problems. The wall lizard or gecko, found in most homes, is not poisonous at all. It only checks insect population. A two-year-old boy was brought with history of lizard bite over right hand when he was trying to capture it. The child had experienced excessive sweating and irritability within two hours of bite. He was treated with supportive care. Prazosin hydrochloride was administered in the dose of 30μ/kg as his symptoms mimicked the autonomic storm which is typically seen with scorpion sting envenomation. To the best of our knowledge autonomic storm following lizard bite has not been reported in the Indian literature so far.

Ingestion of whole seeds of Abrus precatorius often does not produce serious illness. It generally presents initially with gastrointestinal manifestations. Haemolysis, acute renal damage, hepatotoxicity and seizures are the other manifestations. Herewith we report a child with accidental ingestion of abrus precatorius seeds who presented with altered sensorium and convulsions. The case is being reported on account of its rarity in its initial neurological manifestation and has not been reported earlier in paediatric age group.

Dural venous sinus thrombosis following a mild head injury is increasingly recognized. We report case of a 9-year-old male child presented with progressive headache and vomiting following a minor fall. A diagnosis of sinus venous thrombosis was suspected on nonenhancing computed tomography, and that was confirmed with magnetic resonance venography. The child was managed with intravenous fluids, anticoagulation (injection heparin followed by oral anticoagulants-tab coumarin), antiedema measures (mannitol), and antiepileptics (phenytoin) with good outcome.