Cholestasis is a rare distinct complication of hepatitis A infection. Usually it runs a long indolent course with significant pruritus and malabsorption lasting for few months. A 9-year-old boy presented with yellowish discolouration of eye for 1 month. Liver function test showed conjugated hyperbilirubinaemia. Serology was positive for hepatitis A IgM antibody. Liver biopsy showed features of hepatitis with cholestasis. Child successfully treated with oral steroids.
To the Editor: Dengue infection has emerged as an endemic in almost all states of India [1]. Children share a disproportionate burden in the prevalence and are especially vulnerable to complications [2,3]. Clinical audit serves as a reliable tool in gauging the effectiveness and performance of care provided as compared to standard of care [4]. We performed a clinical audit of pediatric dengue case management at our emergency department.This was a retrospective record-based descriptive study conducted from September 2018 to January 2019. Data extraction was done by two clinicians independently. For each case, the accessors marked the compliance to the latest WHO protocol for assessment, diagnosis, treatment, and discharges with comments. During the study period, 408 children presented with complaints of fever, of whom, 160 were treated as dengue fever on clinical suspicion; however, 81% (131) children had laboratory evidence of dengue. We found 94% compliance in initial assessment, 95% (67/71) documenting correct diagnosis; conversely, 3% children were overdiagnosed to a severe category and 2% of children were recorded to have a less severe category. Treatment compliance for initial fluid therapy was 85% (62/73), for colloids 75% (3/4), and for platelets transfusion was 100% (4/4). Colloid solution was not used for 1 patient when it was indicated. The common error identified was initiating a low fluid rate (3 mL/ kg/h) as compared to 5-7 mL/kg/h in children with warning signs; 93% of children were advised about fluid therapy and Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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