A six-month-old female infant, first born out of nonconsangunious marriage was brought with fever of 3 days and history of fast breathing and refusal to feed for one day with history of cough, cold on and off since one month for which treatment was taken on outpatient basis with a local practitioner and no investigations done.Antenatal and perinatal history were uneventful with baby being term with birth weight of 2.6 kg and no Neonatal Intensive Care Unit (NICU) admissions, developmental milestones were normal and immunized till date. The mother was operated for atrial septal defect during her childhood.On examination, the baby was irritable, tachypnoeic with nasal flaring, intercostal and subcostal retractions and grunting. The SpO 2 was 90% in room air at the time of admission. Systemic examination revealed crepitations bilateral lung fields and air entry was reduced on left side with tachycardia and no murmurs or gallops.Her initial blood tests showed haemoglobin of 10g/dl and leucocytosis with neutrophilic predominance and arterial blood gases showed hypoxia for which oxygen was delivered Non Re- Isolated Unilateral hypoplasia or agenesis of a branch of pulmonary artery is very rare. It is usually seen associated with congenital heart diseases such as tetralogy of Fallot, atrial septal defect, coarctation of the aorta, right aortic arch, truncus arteriosus, patent ductus arteriosus and pulmonary atresia. It occurs as a result of lack of embryological development of either the left or right sixth aortic arch and has been found to present itself with various clinical manifestations as during childhood it presents as contralateral pulmonary hypertension and in adults as haemoptysis. Early diagnosis and early surgical indication avoids the evolution of pulmonary hypertension to unfavourble state of more severe and progressive degrees and also prevents the development of pulmonary systemic collateral circulation, which is mainly responsible for subsequent haemoptysis in the adulthood. We hereby, report the case of an infant who presented with features of lower respiratory tract infection and later diagnosed as isolated congenital hypoplasia of left pulmonary artery and hence planned for proper follow-up for early surgery thereby preventing complications in the future. KeywordsBreather Mask (NRBM) and SpO 2 of 99% was maintained. Chest x-ray taken [ Further chest computed tomography [Table/ Fig-3a,b] showed a hypoplastic left lung along with left pulmonary artery hypoplasia. There was reduced vascularity of the left lung. The right pulmonary artery was dilated. Computed Tomography (CT) Thorax had incidentally picked up agenesis of left lobe of thyroid [Table /Fig-4]. FreeT4 (0.92ng/dl) and T3 levels (3.4pg/ml) were normal but Thyroid Stimulating Hormone (TSH) level was 7.67uIU/ml slightly above the range (0.8-7.09) so, she was not started on any medications but was counseled for radionucleotide scan which the patient refused. The patient was treated symptomatically and her pneumonia resolved. She improved gradual...
Transcatheter closure of atrial septal defects (ASDs) using nickel titanium Naval Ordnance Laboratory (Nitinol)-containing devices (Amplatzer, AGA Medical, Golden Valley, Minnetosa) is being widely practiced. Controversies still exist regarding the release of nickel from these devices and the allergy and other ill effects of nickel and also the duration of antiplatelet therapy to aid endothelization of the device. Objective: To study the nickel levels in patients who underwent ASD closure with platinum-coated Nitinol-containing Amplatzer septal occluder. Methodology: A prospective study was conducted on 25 patients, between 6 years and 40 years of age who underwent ASD closure with Amplatzer septal occlude sizes ranging from 12 to 36 mm from January 2009 to January 2010. Blood nickel levels were estimated using atomic absorption photometry before and 24 h after the procedure and later at 1 month, 3 months, and 6 months postprocedure. A value of <2 mcg/dl was considered to be normal. Statistical analysis was performed by the use of the Wilcoxon test. Results: The blood nickel levels at mean baseline, 24 h, 1 month, 3 months, and 6 months postprocedure were 1.05, 1.39, 0.98, 0.79, and 0.74 (mcg/dl), respectively. Conclusions: Percutaneous ASD closure using Nitinol devices can be carried out safely without any significant ill effects related to nickel release.
Background: Children with malnutrition usually exhibit several alterations in the body composition, one of them being a loss of cardiac muscle and its consequences. Aim: The aim of this study is to detect the incidence of cardiac involvement among malnourished schoolchildren as shown by clinical examination and corresponding investigations. Methodology: This is a prospective case-control study conducted on 15 children between 5 and 15 years of age with malnutrition. Inclusion criteria were children who fall under the definition of moderate malnutrition as per the World Health Organization (WHO) Z-score based on the WHO Child Growth Standards. Children with known congenital/acquired heart diseases were excluded from the study. Thesechildren were assessed by echocardiography and estimation of cardiac troponin T (cTn T) levels for cardiac involvement that was compared with 12 healthy controls. Results: The mean left ventricular mass (LVM) was 16.74 units higher in children with normal nutritional status compared with malnourished children (p=0.092, 95% confidence interval=2.91-36.40).The mean LVM index was 4.76 units higher in children with normal nutritional status compared with kids with malnutrition indicating the reduction of cardiac muscle mass. Conclusion: As cardiac muscle mass is reduced in children with malnutrition leading to various complications, they need early detection, monitoring, and appropriate management.
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