ABSTRACT

Learning Objectives:

1: Recognize the difference between vomiting due to medical and that related to surgical pathology

2: Discuss  the different causes of surgical vomiting

3: Review the impact of  bilious vomiting and its significance

Vomiting in children is common and mostly related to medical condition. However there are surgical conditions associated with vomiting  which needs to be acknowledge and diagnosed early. Bilious vomiting is an ominous symptom and needs to be taken seriously. Any baby who vomits bile should be considered as having an underlying intestinal obstruction until proved otherwise.

ABSTRACT

Pre-natal and post-natal chemical exposures and co-exposures from a variety of sources including contaminated air, water, soil, and food are common and associated with poorer birth and child health outcomes. Poor diet is a contributing factor in the development of child behavioral disorders. Child behavior and learning can be adversely impacted when gene expression is altered by dietary transcription factors such as zinc insufficiency or deficiency or by exposure to toxic substances permitted in our food supply such as mercury, lead, or organophosphate pesticide residue. Children with autism spectrum disorder and attention deficit hyperactivity disorders exhibit decreased or impaired PON1 gene activity which is needed by the body to metabolize and excrete neurotoxic organophosphate pesticides. In this current review we present an updated macroepigenetic model that explains how dietary inorganic mercury and lead exposures from unhealthy diet may lead to elevated blood mercury and/or lead levels and the development of symptoms associated with the autism and attention deficit-hyperactivity disorders. PON1 gene activity may be suppressed by inadequate dietary calcium, selenium, and fatty acid intake or exposures to lead or mercury. The model may assist clinicians in diagnosing and treating the symptoms associated with these childhood neurodevelopmental disorders. Recommendations for future research are provided based on the updated model and review of recently published literature.

ABSTRACT

Acute Myocardial Infarction (AMI) is a challenging presentation in neonates, infants, and childhood. It has varied etiologies and vague clinical picture that leads to its misdiagnosis. Risk factors predominating in children for AMI are coronary artery anomalies (ALCAPA), presence of congenital and acquired heart disease and Kawasaki disease. Ischemic chest pain may occur secondary to acute coronary syndrome, including unstable angina, ST-segment elevation MI (STEMI), and Non-STEMI. Paediatrician should have a high index of clinical suspicion for AMI to avoid critical delays in diagnosis and treatment. Prompt evaluation by electrocardiographic, echocardiographic, coronary angiography and enzymatic diagnostic criteria is of utmost importance. Although not well defined in children may pose some difficulties leading to risk for sudden cardiac death with high early mortality depending on etiology, speed of diagnosis, and availability of therapeutic interventions.
Try to detect it: CATH IT!

ABSTRACT

The modern medicine has evolved very rapidly in present era and substantial evolution in perinatology and neonatology has culminated into improved survival of preterm babies, extremely low birth weight (ELBW), very low birth weight (VLBW), intrauterine growth retardation (IUGR) and neonates with various systemic diseases etc. The survival of these delicate creatures is associated with many challenges including long hospital-stay and it is frequently associated with inadequate nutrition and extra-uterine growth restriction (EUGR), these result into adverse outcome. The frequency of inadequate growth in preterm and VLBW babies is found to be unacceptably high viz. about 80% weighed <10th percentile at 36wk.[i] A significant number of these babies remain underweight and small for age twenty months corrected age, and that VLBW males babies did not achieve full adult weight and height. Increased likelihood of infections, more requirement for mechanical ventilation, and the chances of BPD were found in undernourished babies.[ii]

ABSTRACT

Statement of the Problem: Nuisance pigmentation like the Acquired bilateral nevus of Ota-like macule (ABNOM), or Hori’s Nevus is a common dermal melanocytes hyper-pigmentation, affecting predominantly female Mongoloid Asian, female, occasionally in teenager but usually appearing in early twenties onward, aggravated with each subsequent pregnancy, or those lady on oral contraceptive (OCP) or hormone replacement (HRT). Lesion appear symmetrically on bilateral cheeks, occasionally forehead, temple, eyelids, alae of the nose and root of the nose, 2-4mm diameter macules with fairly defined margin, brown-gray to brown-blue discolouration, usually 10-20 in number on each side. Occasionally less well defined and smaller in sizes. Cream is commonly used but can only lighten partially, reappearing if stopped applying. Peeling & mesotherapy are less effective. Q-switched Nd:Yag laser (QSNdYL) can remove pigment effectively after some 10-15 sessions treatment, 2-4 weeks apart. Once removed, it will not usually come back unless getting pregnant again, or on OCP or HRT.

Methodology & Theoretical Orientation:

Utilising a commonly used objective clinical analysis and, subjectively by consultation, reviewing literature, clinical history taking & examination, interview & observation, treatment & follow-up assessment. Sample size of 25 female, 2 male, aged 25-65, Fitzpatrick type 3-4 were chosen. Given pigment can be effectively removed by dedicated QSNdYL laser, over multiple sessions, often permanently unless affecting factors remain.

Finding:

Pre-laser 1-2 week & post-laser Kligman or modified triple formula application shorten recovery with lesser but light degree of PIH was possible. The ABNOM can be treated effectively using QSNdYL MedLite4 laser using 1064nm with low fluence setting at 2.3- 2.8 J/cm(2) with 6mm spot size, followed by 4-6 J/cm(2) using 4mm spot size. 

The number of treatment session required is 10-15, with clinical improvement (subjectively by interview) of 75-100% in 14 patients (51.9%), 50-75% improvement in 9 (33.3%), 25-50% improvement in 4 (14.8%).

Post-therapy dyschromia like hypo- and hyper pigmentation were rare. However, PIH during treatment were common but disappear after 3-6th session.

Conclusion & Significance:

It is suggested that QSNdYL with low fluence gave an easy to treat, short downtime, effective treatment algorithm in many cases of Asian with ABNOM.

ABSTRACT

The impact of COVID-19 has affected billions of people affecting nearly all domains of life, including patient's healthcare needs. Due to constrained dental services during lockdown, paediatric dental needs were severely compromised therefore, parental attitude and practices of maintaining child's oral hygiene impose significant impact on child's oral hygiene. Importantly children in developing countries and disadvantaged populations in the developed world are known to suffer disproportionately from the burden of caries and periodontal disease. And while the majority of such children lack adequate formal dental care because of multiple factors, including cost and limited access, much of the poor oral health from which they suffer is largely preventable when they have access to simple knowledge and are taught inexpensive health care practices. It is evident that the more positive is the parents' attitudes; the better will be the oral health of their children. Moreover paediatric dental patients in the need of dental care were also restricted from approaching the Paediatric dentist due to fear of contracting infection and official unavailability of dental services at many places.  This has lead to the need of most vigilance of their child's oral health and implementation of aids for maintenance of better oral hygiene.  Therefore, parental education and implementation of preventive measures for maintenance of oral hygiene is considered as the only boon during these times for paediatric patients.

ABSTRACT

Oral health is a key indicator of overall health, well-being and quality of life. It encompasses a range of diseases and conditions that include dental caries, periodontal disease, tooth loss, oral cancer, oral manifestations of HIV infection, oro-dental trauma, noma and birth defects such as cleft lip and palate. Healthy mouth is a unique and priceless treasure, and it is regarded as a fundamental human right to maintain a good oral health. Disease burden is an impact of health problem on a given population that can be measured using variety of indicators. Dental decay are one of the most common chronic diseases of childhood globally. Untreated cavities can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. Children who have poor oral health often miss more school and receive lower grades than children who don’t. About 1 of 5 (20%) children aged 5 to 11 years have at least one untreated decayed tooth. 1 of 7 (13%) adolescents aged 12 to 19 years have at least one untreated decayed tooth. Children aged 5 to 19 years from low-income families are twice as likely (25%) to have cavities, compared with children from higher-income households. Proper guidance is essential for the growing children regarding oral hygiene and effectively planning and implementing comprehensive oral health care programme for children. To plan such great initiatives first we need to know about the recent oral health data among the children. Hence to know about the burden of oral disease among children can make it a powerful tool to rectify the present condition for better future.

ABSTRACT

Human birth defects arise from many etiologies, including single-gene disorders, chromosome aberrations, exposure to teratogens and sporadic conditions of unknown cause. The most common of these birth defects is cleft lip/and or palate, a complex trait caused by multiple genetic and environmental factors.

In historical times there were numerous theories and misbelieves that were  associated with clefting. Some thought that it was due to effect of solar eclipse, while other thought it to be a bad omen and message of anger from the god and so such children were killed or they and their families were banished from the tribe. However, now the concept has changed with the scientific knowledge of embryology of cleft. But the etiology of cleft lip and palate still remains a mystery although various reasons and postulations have been put forward.

Cleft lip and palate are the most common facial deformity. It may involve lip only, lip and palate and palate only. The main reasons of clefting in infants may be either environmental (such as poor nutrition) or genetic factors (such as familial factors and chromosomes). Cleft of lip and palate are most common serial congenital anomalies to affect the orofacial region. It can occur isolated or together in various combination and/or along with other congenital deformities particularly congenital heart diseases. Patient with oro-facial cleft deformity needs to be treated at right time and at right age to achieve functional and esthetic well being. Successful management of the child born with a cleft lip and palate requires coordinated care provided by a number of different specialties including oral/maxillofacial surgery, otolaryngology, genetics/dysmorphology, speech/language pathology, orthodontics, prosthodontics, and other.

ABSTRACT

Child abuse is a global problem with serious life long consequences. Any intentional harm or mistreatment to a child under 18 years is considered as child abuse. As many as 1.28 lakh cases of crime against children were registered in 2020 according to ' crime in India 2020’ report published by NCRB. Child abuse and neglect, is the extent to which society is not well known, most of the times they are hidden, many more victims does not mention it as a public problem. When children are taught that they are special and have the right to be safe, they are less likely to think abuse is their fault and most likely to report the offender. This seminar presents characteristics of child abuse, a review of current laws and appropriate methods for intervention.

ABSTRACT

Congenital heart defects (CHDs) refer to abnormalities in the heart function that arise at the fetal stages. It is the most common birth defect that affects 0.8% of all liveborn infants. There is an increase in the incidence of congenital heart disease in monochorionic twin gestation. A six-fold increase in CHDs exists among monochorionic twins especially in association with twin-twin transfusion syndrome (TTTS) compared to dichorionic twin pregnancy. In this review article, we discussed the epidemiology, the role of genetics like protein-coding genes, epigenetics, placenta, hemodynamics and environmental factors in the etiology of CHD in twins.

We conducted a literature search in PubMed indexed journals using the medical terms "twin pregnancy" and "congenital heart defect" to provide an overview of the uptrend in CHD in twin pregnancies, primarily due to assisted reproductive technologies (ARTs) and multiple other factors. Both the heart and placenta are vascular and share a common development window; therefore, CHD can develop secondary to placental pathologies. Among environmental factors, the strongest association of maternal smoking with CHD has been seen. We studied the causative factors to suggest improvement in echocardiographic skills in case of abnormal findings in twin gestations to decrease the CHD-associated morbidity and mortality, as early diagnosis allows doctors to precisely determine the risk of CHD. Systemic ultrasound scanning with five transverse views is very effective in diagnosing fetal CHD in twin pregnancy. In the case of genetics, prenatal counseling allows the expectant to understand the full ramifications of possible events after the pregnancy. The pathological basis of malformations specific to conjoined twinning and twin reversed arterial perfusion sequence is addressed. Also, there is evidence that folate supplementation may be protective against CHD but more research is needed to clarify the mechanisms.

We concluded from the literature that monochorionic twins are at high risk of CHD. Chorionicity seems to play a more vital role than zygosity. Even the type of heart defect in monochorial twin pregnancies was unique from single, dizygotic, or dichorionic twin pregnancies. We also emphasize improving echocardiographic skills of technicians in referring ART dichorionic twin fetuses with suspicious findings to fetal cardiologists and performing postnatal scans in the case of TTTS. To understand the role of the placenta, making use of newer technologies and examining the placenta both during pregnancy and beyond delivery will play a vital role in understanding the etiology. Even identifying early signals impacting the heart and placental vasculature and correcting them using advanced technology could downtrend the incidence in coming years. Increased maternal age as well as multiple pregnancies increasing the risk of CHD has also been implicated. For more clarity on the role of genetics, the cost of DNA sequencing needs to decrease. This will enable whole-genome sequencing in the future thus helping to discover the gene responsible for CHD ultimately proving beneficial for future generations. For environmental factors, we have to rely on observational studies to assess the risk to the unborn child. There is difficulty in studying natural factors due to the unreliability of exposure to contaminants like pesticides and air pollution.

ABSTRACT

A habit is a, tongue thrusting, lip biting, or lip sucking, bruxism, mouth breathing can produce destructive effects on the dentoalveolar structures. Oral habits, if persist repetitive action that is being done automatically. The mouth is the primary and permanent location for expression of emotions and is a source of relief in passion and anxiety in both children and adults. Various oral habits such as thumb sucking, finger biting, or finger suckingbeyond certain developmental age, can pose great harm to the developing teeth, occlusion, and surrounding oral tissues. In the formative years, almost all children engage in some non-nutritive sucking habits. Clinicians, by proper differential diagnosis and thorough understanding of natural growth and developmental processes, should take a decision for intervening.

ABSTRACT

We discuss the current indications, technical variation and procedure-related complications of percutaneous umbilical cord blood sampling (PUBS). The term PUBS is commonly used in the United States. Cordocentesis and funipuncture are equivalent terms. A needle guided by ultrasound is introduced into a blood vessel (usually the vein) of the umbilical cord to collect fetal specimen in PUBS.

We conducted a literature search in PubMed indexed journals and analyzed all related articles on PUBS and cordocentesis. We chose this subject because it is a relatively new but convenient method that has both diagnostic and therapeutic value in fetal medicine. At present the only procedure that provides direct access to fetal circulation is PUBS. The most common clinical indication for PUBS is suspected fetal anemia. Other major indications for PUBS are the diagnosis of congenital infections, cytogenetic analysis, metabolic disorders, fetal growth restriction and hematologic disorders. Therapeutic applications of cordocentesis or puncture of the umbilical cord are in utero transfusions for rhesus alloimmunization and medication administration. PUBS also provides a direct assessment of fetal thyroid function diagnosing fetal thyroid disorders and helps administer therapy in utero. 

Literature demonstrates a low incidence of complications associated with percutaneous umbilical blood sampling. For PUBS, the true complication rate related to the method of sampling remains unclear. A few cases reported complications conducted PUBS for therapeutic purposes which naturally has a higher accident rate compared to diagnostic purposes. Although life-threatening complications are rare, there are potential risks that include bleeding from the puncture site, fetal bradycardia, vertical transmission of maternal infection. Therefore, PUBS should be performed at perinatal care centers by experienced physicians and the best time is between 17 to 40 weeks of gestation. There are three methods used to approach the umbilical cord that includes direct, indirect and free puncture. Anteriorly placed placenta allows an easier approach to the umbilical cord. The danger of abruption of placenta must be kept in mind while using this technique. The number of punctures should be limited to a maximum of 3 to reduce complications. According to a case series report, the mean time required for the procedure was 4 minutes with a fall in duration seen with increased experience.

In conclusion, percutaneous blood sampling allows direct access to fetal circulation thus opening up new areas of prenatal diagnosis and therapy. PUBS is now a well-codified procedure. It is clear from our literature review that risks directly related to the technique are small. The indication of the procedure must be carefully chosen as the risk of complications of umbilical cord puncture is directly related to the severity of the condition. Complications such as bleeding and hematoma formation are related to duration and number of punctures which are operator-dependent. Thus, only highly trained personnel should conduct the procedure. The list of indications is extensive and growing. Nevertheless, this technique shows potential to open up new realms in the area of fetal medicine.