Progressing Aspects in Pediatrics and Neonatology

Shubhankar Mishra*

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Juvenile myasthenia gravis (JMG) is an autoimmune disorder of neuromuscular transmission caused by production of antibodies against components of the postsynaptic membrane of the neuromuscular junction. The patients present with a wide range of symptoms-from isolated intermittent ocular symptoms to general muscle weakness with or without respiratory insufficiency. Prepubertal children in particular have a higher prevalence of isolated ocular symptoms, lower frequency of acetylcholine receptor antibodies, and a higher probability of achieving remission. It must be differentiated from congenital myasthenia which is a channelopathy rather than autoimmune disease. Treatment commonly includes anticholinesterases, corticosteroids with or without steroid-sparing agents, and newer immune modulating agents. Plasma exchange and intravenous immunogl.....

Naveen Ganapan and Charul Mehta*

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Aim: To study the disease control via pulmonary function test with usage of bronchodilators in bronchial asthma patients. Setting and design: Prospective cohort study done at Asthma clinic, Dept of pediatrics, BJ medical college, Ahmedabad. Materials and Methods: Patients enrolled in this study were from asthma clinic BJ medical college and Civil hospital. Pulmonary function test was done on total of 91 known asthma patients. Here three parameter of lung function is taken in to account. Percentage OD FEV1 of predicted, FEV1:FVC Ratio and PEFR , its effect on bronchodilators on PEFR. Results: Out of 91 patients, 72 (79.25%) patients had almost normal pulmonary function. Only 1 patient had severe restriction of pulmonary function and 18 patients had moderate restriction of lung function. All patients shows improvement in PEFR more than 2.....

Yaëlle Chaudy*, Thomas M Connolly and Brian Magowan

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Clinical Decision Support (CDS) is a growing field and the technology is increasingly used by both clinicians and patients. In maternity care, numerous guidelines exist on risk assessment and proposed care plans during pregnancy and labour. However, as new evidence arise, these guidelines are subject to change. It is time consuming for clinicians to a. Compile all this information and b. Keep it up to date. This paper presents our approach to overcoming these two issues: the SAFER (Safe Assessment Form to Evaluate Risk) maternity system. This CDS system contains rules extracted from current guidelines on maternity care and generates care plans at various stages of gestation based on patient data. The system includes a mobile application and a web interface. The mobile application can be used to visualise care plans and edit patient dat.....

Shubhankar Mishra

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Neurodegenerative disorders of childhood are complicated diseases with wide range of systematic involvement. These diseases often pose great challenge to clinicians in terms of diagnosis and management. The purpose of this article is to outline a systematic approach to a child presenting with suspected neurodevelopmental regression. Many inherited metabolic disorders present with neural regression. The clinical approach depends upon the age of presentation, site of involvement in brain. Sound clinical knowledge and better approach leads to early diagnosis, better management and above all genetic counselling. As the medical science is in the track of rapid progression several treatment modalities are in the pipeline for neurodegenerative syndromes, early diagnosis and referral to higher centres can bring a better future to the child......

Khatuna Lomauri*

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Neonatal chylothorax results from the accumulation of chyle in the pleural space and may be either congenital or an acquired condition. Congenital chylothorax is most likely due to abnormal development or obstruction of the lymphatic system and often associated with hydropsfetalis. It can be idiopathic or may be associated with various chromosomal and other genetic abnormalities. It is important to identify infants with chylothorax, as there are specific issues that need to be addressed in the management of these patients......

Wala Ben Kridis*, Ines Werda, Rim Kallel, Nabil Toumi, Tahia Boudawara, Afef Khanfir and Mounir Frikha

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Neuroblastoma is a relatively common pediatric pathology of the sympathetic nervous system. The particularity of neuroblastoma lies in its development from cells whose embryological maturation into adult sympathetic nerve cells or chromaffin cells is incomplete. In the literature, many cases of spontaneous regression of neuroblastoma have been reported, but the mechanisms for which they are responsible remain ambiguous. The specificity of our case is the benign evolution of an osteomedullary stage 4 neuroblastoma and its maturation into a ganglioneuroma 6 years after the end of chemotherapy. This transformation depends on various factors related to the tumor (such as the over expression or not of N-myc, the presence or absence of Treks and their receptors), the host (the intervention of the immune system) and to other external.....

George Gregory Buttigieg KM

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Modern medico-legal evaluation of Neonatal Cerebral Palsy (NCP) demands recognition of Neonatal Hypoxic Ischaemic Encephalopathy (NHIE) as an indispensable proof of peri-partum fetal hypoxia. Without proven NHIE, modern jurisprudence should not even consider obstetric/paediatric liability of causative peri-partum hypoxia of negligence on the grounds of medically responsible fetal/newborn hypoxia leading to Cerebral Palsy......

Santosh Kumar K*, Mangalabharathi S and Kamalarathnam CN

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Objective: To study the spectral characteristics of the phototherapy systems and to identify variations in spectral properties with changes in height, voltage, tilt and temperature output. Setting: Research laboratory at a tertiary care hospital. Methods: The spectral characteristics were measured from two compact fluorescent lamp (CFL) and eight light emitting diode (LED) phototherapy devices in a dark room with an irradiance of <0.1µW/cm2 /nm. The variations in the spectral characteristics with changes in height, tilt and voltage were measured. Heat output was documented......

İsmail Aytac

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Loeys-Dietz Syndrome is a otosomal dominant connective tissue disorder which has characteristic triad with a) Arterial tortuosity, aneurysms or dissections; b) Hypertelorism; and c) Bifid uvula or cleft palate. This review summarizes the features of anesthesia management in this syndrome.....

Elena Lanvers

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We report on a spontaneously delivered, female neonate, born in week 35+1 of gestation, weighing 2230g. It was presented pale, hypotonic, without respiratory movement and a heart rate below 100 bpm. Therapeutic treatment started with bag-mask- ventilation, followed by the installation of a pharyngeal tube and CPAP-ventilation for a total of six hours applying a PEEP of 6 millibar. The X-ray displayeda pneumomediastinum, showing elevation of both thymus lobes in the sense of an angel-wing sign (also known as spinnaker-sail sign) [1-3] (Figure 1). Ending CPAP- ventilation, treatment continued vianasal cannula without oxygen supply for one more day, resulting in a stable respiratory status. The radiographic follow-up pres.....

Volkan Sarper Erikci

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Acute scrotal conditions are common clinical concern in infants and children. The true cause is difficult to determine. There are several etiologic factors for this syndrome. These are torsion of the testis (TT), torsion of the testicular appendix (TTA), epididymo- orchitis (EO) and strangulated inguinoscrotal hernia (SIH). It is generally admitted that EO is rare in children and is associated with structural anomalies of the urinary tract. The aim of this study is to review the various causes of pediatric acute scrotal conditions and to assess management of these patients under the light of relevant literature......

MM Nasirov

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Rehabilitation of patients after anoplastic surgery is the most complex and poorly studied problem in the surgery of anorectal malformations. The process of rehabilitation should begin from the moment of diagnosis. Already in the earliest period, the question should be decided at what age a radical operation will be carried out. The second problem is always to determine the size of the outer opening of the ectopic anal canal. If the available opening is not sufficient for normal bowel evacuation, which is accompanied by signs of intestinal obstruction, this child should be given a colostomy, with which the patient will live until the moment of the radical surgery. In those cases where the external aperture of the ectopic anal canal allows unobstructed evacuation of the intestine before the radical surgery is performed, the colostomy shoul.....

Andreas Chiabi , Félicitée D Nguefack , Palma H Abouame , Seraphin Nguefack , Nelson S. Njedock , Edmond N Chiabi , Roland M Chiabi and Marie T Obama

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Knowledge and practices of mothers on the home management of diarrhea is a key element in the management of diarrhea in a child so as to intervene early and thereby avoiding complications. The knowledge and practices of mothers on the early management of diarrhea at home is important in the prevention of diarrhea related complications. Despite all the strategies put in place in communities and health facilities to reduce childhood mortality in Cameroon, the prevalence of diarrheal diseases remains high, especially in the northern regions. This study was aimed at assessing the knowledge and practices of mothers on the home management of childhood diarrhea in Ngaoundere, a town in the northern part of Cameroon where its prevalence still remains high. This was a cross sectional and analytical study in the urban zone of the Ngaoundere from Fe.....

Kana Serizawa*, Atsushi Ogihara

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Object To review the literatures on the causes of low birth weight. Method: On the Pub Med and Ichushi (Japan Medical Abstracts Society) websites, the literatures on the causes of low birth weight published between 1975 to 2011 were searched for the Results: From among the 469 original articles retrieved, 65 articles containing any description of the cause of low birth weight were identified, of which the 32 articles well-structured in the format of scientific writing were selected and reviewed. Conclusion: The suspected causes of low birth weight from pre-pregnancy risks were classified into two categories: a) Family risk factors, b) Mother herself risk factors. Further large-scale follow-up studies from birth would be needed at the prefectural level. . Keywords: Low birth weight; Risk factors; Pre-pregnancy.....

Edwin Dias*

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Alcohol and other drug use among adolescents has been a public health problem for decades. Although some substance use is developmentally routine, a number of adolescents meet the criteria for a substance use disorder and could significantly benefit from excellent treatment programs. However, parents and health care providers want confirmation of the efficacy of adolescent-specific alcohol treatment programs . The factors surrounding issues regarding the efficacy of current adolescent treatment programs are as follows, adolescent-specific treatment services specific to adolescents; the variety of therapeutic modalities; post treatment relapse and recovery rates; and the need for evidence-based, quality assessments and research. Current Adolescent alcohol treatment efforts are summarized, with regard to the efficacy of adolescent treatment.....

Shubhankar Mishra*

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Autoimmune encephalitis (AE) comprises an expanding group of clinical syndromes that can occur at all ages, but preferentially affect younger adults and children. These disorders associate with antibodies against neuronal cell surface proteins and synaptic receptors involved in synaptic transmission, plasticity, or neuronal excitability. The spectrums of symptoms include psychosis, catatonia, alterations of behaviour and memory, seizures, abnormal movements, and autonomic dysregulations. Inflammatory findings in the cerebrospinal fluid may be present. Magnetic resonance imaging (MRI) may also demonstrate abnormalities for better diagnosis, particularly on fluidattenuated inversion recovery or T2-weighted images. Patients may initially be diagnosed with idiopathic encephalitis, likely viral but with negative viral studies. Autoimmune encep.....

Rohit Vohra* and Dr. Minakshi

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Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation. It commonly affects infants from birth to 18 months of age, but the disease can be seen in children and adults of all ages. HLH can occur as a familial or sporadic disorder, and it can be triggered by a variety of events that disrupt immune homeostasis. Prompt recognition of the disease and initiation of treatment is essential for the survival of affected patients [1].....

Robert Skopec*

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A new study has uncovered how brain injury can be worsened by bacteria in the gut. The gut-brain connection is one of the more fascinating new areas of medical research. This intriguing two-way axis has been found to have numerous unexpected effects. On one hand some studies have demonstrated how magnetic brain stimulation can alter person’s gut microbiome while other studies have shown how gut bacteria could potentially play a role in the onset of PTSD (post traumatic stress syndrome) and Alzheimer’s. Studies in patients and subsequent mouse research really drive home that our gut microbiomes modulate both systemic and anti-tumor immunity, said Jennifer Wargo, a surgical oncologist and geneticist at the University of Texas MD Anderson Cancer Center. She is planning clinical trials to see if fecal transplant in cancer patients could i.....

Pramila G Menon*

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Gastrointestinal (GI) tract gets affected earlier in the development stage of cystic fibrosis due to CFTR mutations [1]. CFTR gene is present all over the intestinal epithelial cells [2]. It controls secretion of chloride, bicarbonate and fluids. CFTR mutations result in abnormal electrolyte composition leading to abnormality in fluid secretions which alters the epithelial surface. This creates a dry luminal environment and bicarbonate deficiency in the proximal small intestine [3]. This can lead to terminal ileum obstruction, which when left untreated can result in rupture and sepsis known as meconium ileus (MI) in cystic fibrosis neonates. This can also present itself as distal intestinal obstructive syndrome (DIOS). The material which is mucofeculent, adheres to mucosal surface, giving ap.....

Chuliev MS, Uglonov IM, Narbaev TT, Xotamov XN, Pulatov FT, Barotov FT and Nasirov MM*

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Despite the improvement of methods for diagnosis and treatment of bacterial lung destruction (BDL) in children, there are many cases of complicated fistula development. Bronchopleural fistulas in children mostly develops due to breakthrough into the pleural cavity of the lung abscesses communicating with the bronchus [1,2]. One of the main factors conditioning pulmonary collapse and its non-expansion, even with drainage of the pleural cavity, is the functioning of peripheral Bronchopleural fistulas (BPF) and the absence of a bronchial system due to this tightness. Principles of treatment of patients with Bronchopleural fistulas derive from an understanding of the cause of fistula development, the mechanisms of development of respiratory failure and disruption of homeostasis. The main reasons for the development of respiratory .....

Shela Akbar Ali Hirani*

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Refusal to a medically justified treatment based on cultural beliefs is one of those challenging situations that raise several ethical, moral and legal issues in the health care settings, especially in pediatric settings. This paper presents a case scenario involving a minor who required a blood transfusion, however, the cultural beliefs of child’s surrogate decision makers were against the recommended medical treatment. In view of the clinical scenario, this paper proposes positions that can be considered while encountering similar scenario and shares recommendations to improve the handling of ethical dilemmas in clinical settings......

*Hamid Yahya Hussain

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The continuing of high rates of child mortality each and every year at national , regional and global levels from preventable causes: diarrhea, pneumonia, measles, malaria, HIV/AIDS, the underlying cause of under nutrition, is keep stigmating the global health efforts . Specifically, the one related child survival in low- income settings and the interventions feasible for delivery at high coverage and high quality of required health care. It has been evidenced based that, greatest risk of childhood death occurs during the neonatal period, that extends from birth through the first month of life. As almost 60 percent of all deaths to children under age 5 and nearly two-thirds of infant deaths (birth to 12 months) occur during the neonatal period. .....

George Gregory Buttigieg*

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There is little doubt that the field of Neonatology has, and is, undergoing vast clinical changes as underlying research in all its background sciencesprogresses in leaps and bounds. ne has also to realise that this progress as in all medical disciplines is multi-dimensional, and far beyond the simple clinical end-point expression of progress in neonatal medicine, pharmacology and surgery. Among these dimensions, the medico-legal aspect, looms large and over the recent years, has loomed larger still......

Volkan Sarper Erikci* and Tunç Özdemir

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Appendicitis is the most common surgical diagnosis for children who present with abdominal pain to the emergency department. However, there are nonspecific examination findings and variable historical features during its presentation. Diagnosis of appendicitis in the pediatric patient may be challenging for the clinician dealing with these patients. It is important to have a high index of suspicion and taking a detailed history and physical examination. In diagnosis of appendicitis, adjunctive studies that may be useful are the white blood cell count, C-reactive protein, urinalysis, ultrasonography and computerized tomography when necessary. When appendicitis is suspected, patients should receive immediate surgical consultation, as well as volume replacement and antibiotics if indicated. With this timely approach it will be poss.....