A 5-year-old girl was admitted with pallor, hypopigmented sparse hair, tongue ulcers, atrophic nail changes, hypoplastic anemia and bilateral exudative retinopathy. A diagnosis of Revesz syndrome was made. She had the additional features of retinal detachment and retinitis pigmentosa, which are hitherto unreported in this syndrome.
Enteric fever is predominantly a tropical disease caused by Salmonella typhi and paratyphi. Enteric fever commonly presents with altered liver function tests, but Salmonella is a rare cause for acute hepatitis presentation. Also Salmonella lead to acute pancreatitis with rhabdomyolysis leading to renal failure. We report an otherwise immunocompetent adult male who presented with acute hepatitis with coagulopathy, acute pancreatitis along with rhabdomyolysis, renal failure and delirium which finally turned out to be a case of Salmonella typhi causing enteric fever.
Background: Sepsis caused by infection remains a major cause of mortality and morbidity among children. Blood culture though gold standard requires lot of time for diagnosis, hence it’s necessary to rely on early diagnostic markers such as blood counts, micro-ESR, CRP, Procalcitonin. The objective of this study is to evaluate the serum levels of CRP, Procalcitonin as reliable and as early marker of sepsis in pediatric patients above neonatal age group.Methods: Children aged above neonatal age group with clinically suspected sepsis as per the definition given by the International Paediatric sepsis Consensus Conference were selected. Patients were classified as those with sirs, sepsis, severe sepsis and septic shock. Patients were divided into two groups one with culture proven sepsis and the other with non-culture proven sepsis. All patients had CRP, Procalcitonin levels measured at admission and 24hrs after admission. The primary outcome was to determine reliable marker in differentiating between the culture proven and non-culture proven sepsis, and to determine the early marker of sepsis.Results: Total 104 patients formed the study group, of which 42 belonged to SIRS group, 26 were sepsis, 19 were severe sepsis and 17 were septic shock. A total of 36 cases had culture positive. In present study PCT was found to be more reliable marker of sepsis as the sensitivity and specificity of PCT was more than CRP and AUC for PCT was significantly higher than CRP. PCT was found to be early marker as the AUC for CRP at 24hrs was significantly more than AUC for CRP at admission and there was no statistically significant difference between AUC for PCT at admission and 24 hours after admission.Conclusions: Both CRP and PCT levels have favourable test performance but PCT is more reliable. PCT is earlier to rise compared to CRP.
Background: Megaloblastic anaemia is still a common and preventable cause of anaemia in children.Invasive procedure like bone marrow examination and expensive investigation like estimation of serum vitamin B12 and folic acid levels are the definitive diagnostic tools. Their non availability at peripheral centre lead to a great deal of interest in other simple biochemical investigations like estimation of serum LDH levels. Design/methods: Children aged between 6 months to 14 yrs with clinically suspected megaloblastic anaemia formed the study group. A detailed clinical history and examination was done. All subjects had complete blood counts. Serum LDH levels, serum levels of vitamin B12 and folic acid levels were done. Serial measurements of serum LDH levels were done on day 14 and day 30 of treatment and were correlated with the haemoglobin and MCV levels. Results: A total of 48 patients formed the study group. All cases were anaemic with mean HB level of 5.25g/dl, mean MCV was 100.15fl. All cases had megaloblastic changes on peripheral smear.42 cases had low vitamin B12 levels and 6 cases had low folic acid levels. Serum LDH levels were elevated in all cases with mean level of 3423 IU/L. There was a significant negative correlation between HB levels and serum LDH levels (r = -.923, p<0.001) a significant positive correlation between MCV and serum LDH levels(r = +0.810, p<0.001). One month after treatment HB levels and MCV improved (mean HB-10.3g/dl and mean MCV-88.3fl/l). There was also a significantly fall in the serum levels of LDH 14 days and one month after treatment (p<0.001, p<0.001 respectively). Conclusion: Serum LDH levelis an important investigation in the diagnosis and in monitoring the response to treatment in megaloblastic anaemia.
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