A 9-year-old boy presented with unbalanced gait, back pain and lower limb weakness. His physical examination revealed almost absent lower limbs reflexes and cerebro-spinal fluid (CSF) showed albuminocytologic dissociation. The brain and spine MRI with contrast illustrated abnormal enhancement—suggestive of Guillain-Barré syndrome.The case had limited distribution and it did not progress beyond the presenting clinical involvements. They did not need immunotherapy, self-recovered, managed conservatively using painkillers and gabapentin along with physiotherapy—with a wait and see approach. The child is now almost back to normal after 8–12 weeks.

Background Diabetes mellitus is the most common metabolic disease globally, while glucose-6-phosphate dehydrogenase deficiency, an X-linked inherited disorder, is the most common erythrocyte enzyme defect. The association between the two in children has been infrequently reported. Case presentation We report the case of a 10-year-old boy of Iraqi descent who presented to our emergency department with new-onset type 1 diabetes mellitus without Diabetic Keto Acidosis. He was treated with subcutaneous insulin and discharged. Eleven days after hospitalization, he was found to be jaundiced during his home visit. Hence, he was referred to the pediatric unit, and his hemoglobin had declined from 130 g/L at the previous admission to 81 g/L. Blood tests revealed low haptoglobin, and his peripheral blood film showed anisocytosis, polychromasia, and occasional red cell fragments suggestive of acute hemolysis. His glucose-6-phosphate dehydrogenase activity was very low, and his subsequent genetic tests confirmed Mediterranean-type glucose-6-phosphate dehydrogenase deficiency. Conclusion Glucose-6-phosphate dehydrogenase deficiency in people with diabetes mellitus has been underreported in the literature so far, and screening of glucose-6-phosphate dehydrogenase deficiency should be considered on diagnosis of diabetes mellitus, especially in boys of African, Mediterranean, or Asian descent.

No abstract

We report a term male neonate, born to consanguineous parents through a difficult labour who needed resuscitation at birth, followed by ventilation for respiratory distress. In view of suspected Hypoxic Ischemic Injury, he was started on whole body cooling for 72 hours. He was treated as suspected sepsis with 5 days of intravenous antibiotics. On day 6, he was noted to have hard, painless skin nodules of his back and left arm which was clinically diagnosed as subcutaneous fat necrosis. His serum calcium and phosphate levels remained normal throughout hospital stay. His full blood counts and bone profile were monitored regularly. During follow-up at 6 weeks, his white cell counts continued to be high with 69% lymphocytes. To our knowledge, this is the first case of SCFN of a neonate associated with persistent leucocytosis. Haematological and metabolic complications should be closely monitored in a neonate with subcutaneous fat necrosis.

performed by a paediatric cardiologist and anaesthetist respectively. Evaluation of outcomes for patients who had received an echocardiogram prior to surgery vs those who hadn't, could then be performed according to severity of defects. Evaluation of sensitivity and specificity of various preoperative assessments was also performed to guide future echocardiogram requesting. Results Across the 5-year period 532 procedures were performed on 457 patients. 214 preoperative echocardiograms were completed, and 40 postoperative, in total 111 were found to be abnormal, and subsequently classified as -4 severe, 8 moderate and 99 mild (Summarised in table 1). Perioperatively the group who received echocardiography had 4 intraoperative cardiac arrests and 14 received intraoperative inotropes, compared to the 203 patients who did not receive echocardiography where 0 had cardiac arrests and 3 received intraoperative inotropes. A Fisher exact test analysis demonstrated a strong association between echo-defined severe CHD and instability under GA.The assessment criteria for whether or not echocardiography is required prior to surgery were defined as: antenatal scan (A), medical conditions (M), surgical conditions (S) and clinical and radiological signs (C). Using the AMSC criteria combined there was a 100% sensitivity for finding moderate or severe CHD on echo and a 95% sensitivity for predicting instability under general anaesthesia.