A 2-year-old female child from South India presented with persistent fever for 3 weeks, pallor and hepatosplenomegaly. There was no history of contact with tuberculosis (TB) and BCG scar was absent. Tests for TB (Mantoux and gastric aspirate) were negative. Blood and bone marrow tests for other infections, inflammation and infiltration were inconclusive. Chest X-ray was normal. Ultrasound study (USS) of abdomen showed multiple microabscesses in the liver and spleen. USS-guided fine needle aspiration cytology from splenic lesion demonstrated epithelioid granuloma while bacteriology was negative. Commencement of anti-tubercular therapy (ATT) resulted in remarkable clinical improvement in a week with resolution of lesions on follow-up USS in 2 months. Isolated hepatosplenic TB in children, though rare, has a wide, non-specific clinical spectrum and potential of delaying diagnosis. Probability diagnosis and therapeutic trials of ATT are accepted approaches, using treatment response as indirect confirmation of the likely cause.
Background: Asthma is a heterogeneous disease characterized by cough, wheeze and shortness of breath that vary in intensity and time with variable expiratory airflow limitation, associated with chronic airway inflammation. Aim of the study was to assess the usefulness of Peak Expiratory Flow Rate [PEFR] and oxygen saturation in determining severity of acute asthma, to measure objective change in PEFR and oxygen saturation following bronchodilator therapy and the role of chest X-rays in acute asthma.Methods: A prospective study of 50 children above 5 years with acute asthma who presented to the emergency department in a tertiary care hospital were included. PEFR and oxygen saturation before and after bronchodilator therapy was measured. Indication for chest X-rays, its clinical correlation and change in standard treatment of acute asthma based on X-ray reports was noted.Results: The mean PEFR and PEFR % of expected was lower in severe asthma when compared to moderate asthma and was statistically significant (p<0.001). The % of expected PEFR before salbutamol therapy was 48.78±14.36, which improved significantly to 67.13±14.22 after treatment (p<0.001). Oxygen saturation before and after salbutamol therapy was 94.96 ± 4.11 and 96.96±2.87 respectively with the change being significant (p value <0.001). Chest X-rays were performed in 12 (24%) children as per standard guidelines, of which 1(9%) was abnormal showing right basal consolidation. Chest X-ray correlated with clinical findings in 1 child and the findings on chest X-ray altered the ongoing treatment by addition of antibiotic.Conclusions: PEFR and oxygen saturation is useful in the emergency department to objectively assess the severity of acute asthma and the response to initial bronchodilator therapy. Chest X-rays are not routinely indicated in the standard treatment of acute asthma.
Background: Febrile seizures are the most common seizures in childhood and are often associated with nutritional deficiencies. The present study was done to find any correlation of serum zinc levels in children with simple febrile seizures.Methods: This study was a hospital based prospective case control study, involving 60 children (30 cases and 30 controls) aged between 6 months to 60 months. Serum zinc level was measured in all subjects by atomic absorption spectrophotometer. Data was analysed by using frequency, percentage and Pearson’s chi square test..Results: Most cases (80%) had serum zinc levels <90 mcg/dl, in comparison with children in the control group where only 30% had serum zinc levels <90 mcg/dl. The mean serum zinc level was 78.9±14.26 mcg/dl in cases with simple febrile seizures and 96.7±12.12 mcg/dl in the control group.Conclusions: The mean serum zinc level was significantly lower in children with simple febrile seizures in comparison with controls.
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