Posters 316 stress (serious quarrel with classmates, physical activities) have been observed. The patients had no coronary risk factors. Their average blood pressure was 150/90 mmHg and heart rate was 120 beats/ min. ST-segment elevations and T-wave inversions were registered on electrocardiograms of teenagers. Dysfunction and dyskinesia of the left ventricle apex and interventricular septum was detected on echocardiography. The levels of creatine kinase-MB and troponin I did not increase. Occlusions and anomalies of vessels were not demonstrated by aortocoronarography. Tako-Tsubo cardiomyopathy was diagnosed in all cases. Symptomatic medical treatment had been administered and the function of heart was normalized within 3-4 weeks. Conclusions:Tako-Tsubo cardiomyopathy may occur not only in adults, but in teenagers too. Therefore increased awareness of Tako-Tsubo cardiomyopathy will lead to its more frequent diagnosing, which will result in adequate medical management. (3) and Branch Pulmonary Stenosis( 2). 6 of these (31%) with significant lesions were referred to tertiary cardiac centre for further assessment/intervention. 617 Conclusion:Childhood murmurs are sometimes transient and vast majority of persistent murmurs are innocent. Asymptomatic murmurs after infancy could be reviewed by paediatricians and persistent or symptomatic ones referred to paediatric cardiac clinic. Facility to perform an echocardiography at district general hospital will help in confirming innocent murmurs and more importantly reassuring anxious parents. It also has a role in detecting few, yet significant, congenital heart conditions that could then be referred on to tertiary centre. SIGNIFICANCE OF MURMURS IN INFANCY
We report a baby with an unusual umbilical cord swelling. On the antenatal scans, a cystic area within the umbilical cord near its insertion onto the abdominal wall was detected. Postnatally an unusually thick umbilical cord with a yellow fluid filled cyst at the base was noted. The fluid from the cyst was confirmed as urine and ultrasound confirmed patent urachus. The baby underwent a cystoscopy and excision of patent urachus with associated allantoic cyst. Allantoic cyst is a rare swelling formed at the base of umbilicus associated with a patent urachus which results from an allantoic remnant. Paediatricians need to be aware about this condition as investigation is required to differentiate allantois cysts from umbilical pseudocysts. A patent urachus with allantoic cyst requires surgical excision.
Prevalence of CM in the study group is high compared to other countries in the region. Emphasis on preventing CM is recommended and public health actions is required in improving well-being of affected babies.
Congenital tuberculosis is a rare disease. Only 21 cases have been reported in English language journals since 2001. Subdural haematoma associated with congenital tuberculosis has never been reported. A 26-year-old cachectic looking, Asian lady presented acutely in labour at 33 weeks. She had an uneventful antenatal period and normal antenatal scans. Fetal distress and a suboptimal cardiotocogram led to emergency caesarean section. Abnormal caseating peritoneal material was noted during the Caesarean section raising suspicion of maternal tuberculosis. The preterm baby girl was born in poor condition and needed resuscitation including mechanical ventilation. Following admission to neonatal intensive care, she was noted to have deranged clotting, thrombocytopenia and anaemia. She received fresh frozen plasma, platelet and packed cell transfusions. Antituberculous treatment was added to the antibiotics, with a suspicion of congenital tuberculosis. Cerebrospinal fluid analysis was highly suggestive of tuberculous meningitis. Following an abnormal cranial ultrasound scan, CT brain confirmed a large left subdural parieto-temporal collection with a significant mass effect. The baby was immediately transferred to the nearest tertiary centre and the subdural collection was urgently evacuated by neurosurgeons. This lead to a dramatic improvement in clinical condition followed by extubation on day 6. Congenital tuberculosis was confirmed by microbiological evidence from baby's gastric aspirate and mother's peritoneal fluid. In this case, the presence of acid-fast bacilli on microscopic examination of the nasogastric aspirate suggests possible ingestion of infected amniotic fluid by the fetus. Secondly, the biochemical and microbiological analysis of cerebrospinal fluid is highly suggestive of tuberculosis meningitis which suggests haematogenous spread of infection from mother. Significant inflammation and disseminated intravascular coagulopathy in tuberculosis could cause subdural haematoma. Early imaging in conjunction to clinical suspicion is the key in managing this complication.
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