MISC/01(P).ADOPTION:REASONS AND KNOWLEDGE ABOUT ADOPTION..
Dept. of pediatrics,SKIMS Medical College Bemina Sgr.Kashmir.
Adoption is the act of lawfully assuming the parental rights and responsibilities of another person,usually a child under 18.Adopted children have same legal status as biological children.Design:A prospective hospital based study.Setting and Methods:48 adopted babies visiting outpatient pediatric Deptt.of SKIMS Medical College were subject of study.Age,weight,sex and birth order were recorded on a predisigned proforma.Reasons for adopting babies both by adoptive and biological parents were also recorded.Results: 66.7% adpted babies were males and only 33.3% females. 66.7% belonged to urban areas.41.7% and 58.3% adoptive parents belonged to lower and middle socioeconomic classes respectively and none from upper elite class.Age of adoption varied from 1 day to 1 month (58.3% ),1 to 6 months (25%),and 6 to 24 months (16.7%).So the weight of these babies also varied from 2.64 +/- 0.58, 5.0 +/- 1.0, 9.75 +/- 1.47 kgs in three groups respectively.Most of these babies (29.2%) were 5th in birth order and 12.5% 1st in birth order.20.8% were twin babies.Poverty with too many children were main reasons ( 62.5%) for biological parents to give their babies for adoption. 8.3% and 4.2% babies had their father and mother dead respectively immediately after birth.Whereas main reason (62.5%) for adoptive parents was having no issue ranging from 3-15 years after marriage.Only 16.7% and 20.8% parents had reasons of already having only male and female children respectively.None of the parents had received pre-adoption counseling and most of ( 62.5%) the babies were adopted through middle man or hospital workers paying them a sum ranging from Rs 3000-10,000.Adoption was arranged among relatives directly in 37.5% cases.No parent had any legal concept about adoption and none was registerd legally.75% babies were on dry powderd milk whereas,12.5% each were on cows milk or on both respectively.62.5% mothers had no conception about proper dilution and feeding technique.87.5% babies received complete immunization as per UIP shedule , whereas only 20.8% and 12.5% babies received Hep-B and HIB vaccines respectively.Conclusion: Poverty and multiple births were main reasons for biological parents for giving for adoption and having no issue many years after marriage was main reason for adoption for adoptive parents.No adoptive parent had any knowledge about legal aspects of adoption and none had received pre-adoptive counselling.
MISC/02(P).MANAGING DIFFICULT PARENTS
Ramakrishna Seva Pratisthan and Vivekananda Institute of Medical Sciences, 99 Sarat Bose Road, KOKATA- 700026
OBJECTIVE: To evaluate the cause of dissatisfaction when a child is admitted. Systemic approach to resolve the dissatisfaction. MATERIAL AND METHOD: A series of parents whose children were admitted to the hospital with critical illness. Their cause of dissatisfaction was carefully assessed through questionnaires. RESULTS: ‘Heartsink’ situations occur where the demands of parents exceed the ability of staff to satisfy them. Where distress is badly handled, it can easily turn to anger. Individuals may become fairly blamed. Continuity is important. Parents need to feel that they have a key person they can trust in the process of their child’s illness. Information should be given freely, sensitively and in packages, that patients and parents are capable of taking in. Parents should feel that they have a role in their child’s care. Major decisions are best taken by parents and staff together. CONCLUSION: Empathy and reasonable attitude on the part of the staff help to resolve the cause of dissatisfaction in most of our cases.
MISC/03(R).ACASE OF SECKLE SYNDROME WITH SYRINGOMYELIA
Institute of Child Health,11 Dr.B.Guha Street.Kolkata-700017.
Introduction:Seckle syndrome is an autosomal recessive disorder charecterised by LBW primordial dwarfism,severe growth and mental retardation,microcephaly and craniofacial dysmorphism.It could affect many organ system but syringomyelia is very uncommon and to best of our knowledge seckle syndrome with syringomyelia is not reported earlier. Incedence is believed to be 1 in 10,000 live born children.Diagnosis is eatablished on the basis of charecterestic clinical features. Case:9 years old male child born out of non consanguineous marriage was under evaluation for stunted growth since last 3yrs presented with severe microcephaly,extreme short stature and abnormal facies.There was no physical stigmata of any systemic disease responsible for severe growth failure. Anthopometry shows HC-38 cm,<<3rd centile,HT-66.5CM,<<3rd centile,Wt-6.75kg,<<3rd centile.,a proportionate short stature. Craniofacial:Microcephaly with mild hypoplastic maxilla,moderate beaking of nose , marked micrognathia with posteriorly placed malformed ear,high arch palate,malocclusion of teeth with enamel hypoplasia. Central nervous system:Mental retardation without any seizure. Upper extremities:Clinodactyle of fifth finger with absence of epiphysis of metacarpals. Lower extremities:Increased gap between 1st and 2nd toewith normal hip and pelvis. Bone age:between 2-3 yrs,chronological age being 9yrs. MRI Brain shows communicating hydrocephalus with cervical syringomyelia.,which is very rare finding in a case of seckle syndrome.Echocardiography and USG (Abd) does not shows any anomaly. Conclusion:Because of the varied clinical picture, it is not yet established whether all these patients represent a single genetic disorder or a heterogenous group of disorders with only microcephaly and short stature in common.According to literature the condition is transmitted as an autosomal recessive pattern or may be due to a mutant gene.
MISC/04(P).MALE ALIVE CONJOINT TWINS NORMAL DELIVERED
Paper Details & Summary: An interesting anatomical unique to multiple pregnancy is conjoint twins. The incidence is 1 in 50000 to 1in 100000. This rare disorder affects 1 in 200 monozygous twin pregnancy & 1 in 900 twin pregnancy. Definition: Incomplete division of embryonic disc after 13 days & with in 2weeks post conception results in twins & resultant fusion with shared body parts. Case H/O: Male twins born on 16th July 2006 to 25yr old mother out of a non consanguineous marriage with a married life of 6 yr with no significant antenatal events . No H/O of twin pregnancy from both maternal & paternal side. Delivery was conducted by four local dais first head is delivered than second head delivered thinking that there were two babies after which chest , abdomen & limbs delivered later on .Babies had two umbilical cord and single placenta .It was noted that babies are joint from thorax to umbilicus .Twins has present weight of 6.2kg, clinical,general & systemic examination had not much abnormal finding except conjoint with thorax and abdomen. Both children were anemic but other pathological investigation was within normal limits. Cranial USG was normal & CT abdomen showed fusion of anterior surface of thorax and abdomen .Echo of one conjoint twin shows small ASD size (0.752 cm) with right to left flow & Echo of 2nd twin normal.
Department Of Pediatrics, Pravara Institute Of Medical Sciences,(D.U), Loni, Tal-Rahata, Dist-Ahmednagar,
INTRODUCTION: Snakebite poisoning predominantly a rural problem correlates with agrarian base and seasonal variations of tropics. Seven year (July1999 to August 2006) study is presented.AIMS:1. To determine incidence of snake envenomation in a rural hospital. 2. To determine outcome in a rural tertiary care hospital.OBJECTIVES 1.To emphasize early first aid.2.Need for community based urgent transport system. MATERIALS.Children up to 12 years with history of snake bite .METHODS: Fang marks formed part of clinical evaluation. RESULTS:143 cases i.e. (0.93%) of pediatric admissions studied, of which 92 were poisonous and 51 were nonpoisonous bites.Males accounted for 94 cases of bites, with maximum incidence in monsoon. Of 92 poisonous bites 79 were neuroparalytic and 13 were vasculotoxic. Respiratory paralysis developed in 51 of 79 neuroparalytic bites.Among vasculotoxic bites 4 patients developed acute renal failure, 6 had disseminated intravascular coagulation.Anaphylaxis observed in 11 of 92 cases receiving ASV.Polyvalent anti snake venom administered to symptomatic patients AST. Slow bolus of 40 units administered intravenously followed by 40 units in drip 6-8 hourly. Fresh blood transfusion administered in bleeding diathesis.CONCLUSIONS:Ptosis and abdominal pain were common early manifestations among neuroparalytic bites; swelling, cellulitis and ecchymosis were common features of vasculotoxicity. 64.5% neurotoxic bites needed mechanical ventilation.Mortality was one case in each of vasculotoxic and neurotoxic bites.RECOMMENDATIONS.1) Appropriate tourniquet application. 2) ASV availability- inclusion in national rural health policy. 3) Timely ventilator support for morbidity reduction.4) Prevention includes appropriate footwear, adequate illumination, avoiding habitats.5)Snake identification chart in casualty.6) Tread with respect, they bite only when harmed.
MISC/06(P).CONGENITAL STEMAL CLEFT ASSOCIATED WITH PECTUS EXCAVATUM.
Department Of Paediatrics, Government Medical College & Hospital Amritsar (Punjab)
Objective and design: Due to rarity of case. Introduction: Congenital Sternal Cleft is a very rare anomaly. In embryonic life, the sternum has its origin in the lateral plate mesoderm. Cells from mesoderm on either side of anterior chest wall migrate towards the midline forming the sternum. Very rarely, the sternal bars fail to join in the midline and sternal cleft occurs. Case report: A 3 day old male neonate presented with a Sternal cleft associated with Pectus excavatum, a congenital condition. In addition to cosmetic concern, there was a constant fear of trauma. Physical examination revealed a gap at the site of sternum and pectus excavatum. Pulsations of heart could be easily seen through the defect which was covered only by a white thin membranous layer of skin. Perinatal history was uneventful and anthropometric measurements were within normal limits. Chest radiography confirmed the findings of the physical examination. Other intrathoracic structures were reported to be normal. Patient was advised surgical correction in collaboration with Department of Surgery and Department of Cosmetic Surgery, Government Medical College, Amritsar.
MISC/07(R).GIANT CONGENITAL MELANOCYTIC NEVUS
Kirandeep Sodhi,Uma Raju,Rsgrewal Harmeet Singh Arora, Sc Shaw, R. K. Gupta
Congenital nevi are present at birth and result from a proliferation of benign melanocytes in the dermis, epidermis, or both .Congenital nevi are one of several known risk factors for the eventual development of melanoma . Congenital nevi have been stratified into small , medium and giant nevi according to size. Giant nevi are more than 20 cms in diameter and are often surrounded by several smaller satellite nevi.Patients with giant nevi of larger diameter and more satellite lesions are at a higher risk of developing melanoma . These nevi may be associated with asymptomatic leptomeningeal cysts in 30 % of cases. They may have features of raised intracranial tension , hydrocephalus , mental retardation and motor deficits . We report here a three years old boy with a giant congenital melanocytic nevus . There was associated mental retardation and seizure disorder . The nevus was deeply pigmented , hairy and spread over the lower abdomen, back and upper part of right lower limb . There were also extensive deeply pigmented satellite lesions over the rest of the trunk , extremities and few lesions over the face . Skin biopsy was done which showed dermal proliferation of melanocytes .
Department of Neonatology,Government Kasturba Gandhi Hospital for women and children,Chennai-600005.
This female baby is born to 26 years old primi mother of non-consanguineous marriage after long period of infertility. Baby had microcephaly with gross facial malformations like single median orbit, anophthalmia, absence of nostrils, micrognathia and preauricular tags. Birth weight-2.25 kg; length-31 cm; HC- 24 CM; CC-29 cm. CNS examination revealed generalized hypotonia and absent NNR. Lower respiratory system normal whereas upper airway absent. Other systems normal. USG cranium showed single large ventricle, absent falx cerebri and normal posterior fossa. CT & MRI in addition showed absent septum pellucidum and corpus callosum, no cerebral hemispheres, fused thalami, structurally normal cerebellum and spinal cord and single midline orbit. TORCH screening revealed IgG positivity for CMV and Toxoplasma. Karyotype 46 XX. Baby survived for 31 days before succumbing to sepsis. The diagnosis of Cyclopia, extreme form of alobar Holoprosencephaly is made. It is a complex brain maldevelopment due to incomplete cleavage of prosencephalon affecting both forebrain and face. Incidence is 1 in 20,000 livebirths but 1 in 250 conceptuses. Heterogeneous etiology with interplay of both genetic and environmental factors, the damage occurring before 6th week of gestation. Genetic causes include both AD and AR syndromes, associated Trisomy 13 and 18, mutations involving several genes especially Sonic hedgehog at 7q36 were implicated. Environmental agents include infections (CMV, Toxoplasma, Rubella), drugs (Phenytoin, Salicylates), metabolic (Diabetes), toxins (Alcohol, herbal toxins-Cyclopamine and Jervine). Recently inhibitors of cholesterol biosynthesis have been recognized to induce Cyclopia. Cyclopia is invariably lethal. Early antenatal diagnosis and termination of pregnancy is advised. This case is presented for its rarity and psychosocial impact.
Shrinivas Tambe, Milind S. Tullu, Radha G. Ghildiyal, Asmita Advirkar, Sunil Jumnake
Department of Pediatrics, T.N. Medical College & BYL Nair Hospital, Mumbai 400008, India.
Introduction: Familial hypertriglyceridemia (FH) is an autosomal dominant disorder characterized by moderately elevated triglycerides in the absence of significant hypercholesterolemia (incidence 1 in 500). Case Report: An eight-month-old boy, born of non-consanguineous marriage was admitted with fever for 8 days. On examination, he had pallor, hepatomegaly (6cm with span of 10cm) and splenomegaly (spleen 5cm). Peripheral smear showed P. vivax malaria (index <1%) blood examination showed anemia (Hb 6.7 g%) with milky plasma. Patient’s lipid profile revealed serum triglycerides of 1031 mg/dl (normal 30-86 mg/dl) and serum cholesterol of 143 mg/dl (normal 45-182 mg/dl). The patients parent’s lipid profiles were normal but his six-year-old elder sibling had raised levels of serum triglycerides (293 mg/dl) with normal cholesterol. Lipid electrophoresis did not reveal chylomicron band. HDL level of all family members (including the patient) was normal. The child was treated symptomatically (including antimalarials) and fat restricted diet. On follow up after 1 month, the repeat serum triglycerides level is 117 mg/dl and serum chlolesterol is 101 mg/dl. Discussion: The triglyceride levels in FH usually range from 250-1000 mg/dl with normal or mildly increased cholesterol levels. Most children are asymptomatic. The diagnosis is suggested by elevated triglyceride levels in the patient with hypertriglyceridemia in at least one first degree relative.