Indian Journal of Pediatrics

Malhotra, Savita; Singh, Gagandeep

doi: 10.1007/bf02859376pmid: 11929031

Chronic illnesses in children and adolescents have devastating influence on them and their families. The patients have to cope up with illness, medication and it’s influence on their development. Consequently a large number of them have emotional disorders which influence the course and outcome of physical disorder. In recent few years, research has shifted its focus from merely figuring out the prevalence of the emotional disorders to understanding the adjustment to chronic illness under defined theoretical constructs. Apart from temperamental variation, family burden and functioning have been identified as factors operating in determining adjustment. Distress experienced by the family and disturbed family functioning directly influences the emotional outcome in physically disordered children. Comprehensive coordinated care services are required for integration of these patients into the community.

Ray, Munni; Marwaha, R K; Trehan, Amita

doi: 10.1007/bf02859383pmid: 11929036

Neurotoxicity is a common complication during cancer chemotherapy. It is estimated that 3–10% of children with acute lymphoblastic leukemia (ALL) experience acute, transient neurotoxicity during induction chemotherapy. Fatal acute neurotoxicity is rarely encountered. Neurological evaluation of children with ALL at diagnosis and during treatment is of value in order to diagnose neurological complications early so that appropriate intervention can be adopted. This communication describes the profile of two children with unexpected, acute fatal neurologic toxicity during induction chemotherapy for ALL.

Tyagi, A.; Rautela, R S; Bhattacharya, A.

doi: 10.1007/bf02859389pmid: 11929040

Arora, N K; Ganguly, S.; Mathur, P.; Ahuja, A.; Patwari, A.

doi: 10.1007/bf02859378pmid: 11929033

Upper gastrointestinal bleeding is a potentially fatal condition at times due to loss of large volumes of blood. Common sources of upper gastrointestinal bleeding in children include mucosal lesions and variceal hemorrhage (most commonly extra hepatic portal venous obstruction) and, in intensive care settings infections and drugs are other etiological factors associated with bleeding. Massive upper Gl bleeding is life threatening and requires immediate resuscitation measures in the form of protection of the airways, oxygen administration, immediate volume replacement with ringer lactate or normal saline, transfusion of whole blood or packed cells and also monitoring the adequacy of volume replacement by central venous lines and urine output. Upper Gl endoscopy is an effective initial diagnostic modality to localize the site and cause of bleeding in almost 85–90% of patients. Antacids supplemented by H2-receptor antagonists, proton pump inhibitors and sucralfate are the mainstay in the treatment of bleeding from mucosal lesion. For variceal bleeds, emergency endoscopy is the treatment of choice after initial haemodynamic stabilization of patient. If facilities for endoscopic sclerotherapy (EST) are not available, pharmacotherapy which decreases the portal pressure is almost equally effective and should be resorted to. Shunt surgery is reserved for patients who do not respond to the above therapy. β blockers combined with sclerotherapy have been shown to be the most effective therapy in significantly reducing the risk of recurrent rebleeding from varices as well as the death rates, as compared to any other modality of treatment. Based on studies among adult patients, presence of shock, co-morbidities, underlying diagnosis, presence of stigmata of recent hemorrhage on endoscopy and rebleeding are independent risk factors for mortality due to upper Gl bleeding. Rebleeding is more likely to occur if the patient has hematemesis, liver disease, coagulopathy, hypotension and or anemia. There is a great need for conducting therapeutic trials as well as identifying predictors of outcome of upper Gl bleeding in children to develop evidence based management protocols.

Singh, Meharban

doi: 10.1007/BF02859374pmid: N/A

Patwari, A K; Bajaj, Pramila; Kashyp, Ravi; Anand, V K; Gangil, Ashutosh; Jain, Amit; Kapoor, Gaurav

doi: 10.1007/bf02859372pmid: 11929028

Objective : To evaluate commonly utilized diagnostic modalities to detecting Gastroesophageal Reflux (GER).Methods : Sixty children aged 1–72 months (mean age 14.7 months) with symptoms suggestive of Gastroesosphageal Reflux (GER) were investigated and subjected to upper gastrointestinal endoscopy and esophageal biopsy (EB), gastroesophageal scintiscanning (GS) and 24 hour ambulatory pH monitoring.Result : GER was detected in 28 (46.7 %) cases by one or more diagnostic modalities. Ambulatory 24 hour pH monitoring was positive in higher proportion (43.3 %) of cases in comparison to other modalities, followed by EB (38.3%) and GS (30%). Considering 24 hour pH monitoring as the gold standard, esophageal biopsy was positive in 22/26 cases (84.6%) detected by 24 hour pH monitoring with a specificity of 97.1% as compared to 17/26 cases (65.4%) by gastroesophageal scintiscanning with a specificity of 97.1%. When compared with EB results, amongst various parameters measured during 24 hour pH monitoring, Reflux index (Rl) ranked highest (sensitivity 95.6 % and specificity 89.2 %) followed by duration of longest episode > 20 minutes and Euler Byrne score. Oscillatory index, calculated from tracings of pH monitoring, even though ranked lower because of its low sensitivity helped to pick up 2 cases missed by EB and Rl.Conclusion : Our results suggest that a combination of diagnostic modalities may be required to diagnose GER in young children. Ambulatory 24 hour pH monitoring appears to be the single best investigation and combining it with EB and/or GS can help to detect maximum number of cases.

Shanbag, Preeti; Govindakumar, Preetha T.; Vaidya, Mamta; Joshi, Vareha; Shahid, Sukhbir Kaur

doi: 10.1007/bf02859375pmid: 11929030

Objective : The long QT syndrome (LQTS) is a disorder of the electrical system of the heart, due to dysfunction of the ion channels and involving the repolarisation process. The inherited form occurs when there is a mutation in one of the genes which encode the making of a channel. Prolongation of the QT interval renders the patient vulnerable to an arrythmia calledtorsade de pointes, resulting in syncope and sudden death.Methods : Three children with the congenital long QT syndrome presented to the pediatric department, one of them also having a 2:1 atrio-ventricular block. The parents and siblings of these children were screened for the long QT syndrome with an electrocardiogram. 2D echocardiography was done to rule out structural abnormalities and audiometry for deafness.Results : Four family members were identified on screening to have LQTS. Propranolol was started on all children with LQTS. The child with heart block also received a pacemaker. LQTS must be considered in all patients presenting with syncope especially if associated with deafness and/or a family history of sudden deaths in infancy or childhood.Conclusion : The corrected QT interval must be determined in all children with heart block since the two conditions are often associated.

Foroutan, Hamid; Ghafari, Masomeh

doi: 10.1007/BF02859373pmid: 11929029

Objective : Gastroesophageal reflux (GER) is a relatively common disorder in infants and children. It maybe associated with severe complications. The coexistence of GER and a wide range of respiratory symptoms has been reported. The purpose of our study was to investigate the relationship between chronic respiratory symptoms and GERD as an underlying cause. To our knowledge, there is not a method known study for identifying this relationship and prevalence in our area. Methods : The study group consists of fifty-two (4 months-10 years) children who were referred to pediatric surgery ward for evaluation of GERD as a cause of chronic respiratory symptoms by 24 hours PH monitoring. Additionally, 10 patients with only one episode of pneumonia were evaluated as the control group. Chronic respiratory presentations include the following: chronic cough, recurrent pneumonia, asthma, and respiratory distress. Results : 24 hour esophageal PH monitoring revealed GER in 22 (42.2%) patients as a cause of their chronic respiratory symptoms, while (30 (57.7%) children did not show any evidence of GER. GER was detected in 11 of 24 (45.7%) patients with chronic cough. Thirty-three patients presented with recurrent pneumonia, 13(39.9%) of whom had GER. In 8 patients with asthma, GER was found in 4 cases. None of the 6 patients with respiratory distress had GERD. Conclusion : The possibility of GERD was significantly higher in study group (children with chronic respiratory symptoms) compared to control group (p-value<0.01). All patients with chronic cough, recurrent pneumonia and asthma should be aggressively investigated for the possibility of GER. Documenting abnormal gastroesophageal reflux helps direct appropriate therapy before occurrence of major complications.

Sheth, Jayesh J.; Sheth, Frenny J.; Bhattacharya, Raktima

doi: 10.1007/bf02859371pmid: N/A

Gürüyener, Kivilcim; Çitak, Elvan Çaglar; Elli, Murat; Serdaroglu, Ayse; Çitak, Funda Erkasar

doi: 10.1007/bf02859388pmid: 11929039

Primary infection with varicella zoster is characterized by a generalized vesicular rash usually without significant systemic illness. Encephalitis, pneumonitis, pancreatitis, nephritis, Reye and Guillan-Barre syndrome transvers myelitis, myocarditis have been reported before, but there is not any case having all these system to be involved during the same infection in a sequential manner ending up with multiorgan failure. We wanted to represent 21-month-old boy had a multiorgan failure due to varicella zoster infection.