Search

Ampulla of Vater (AOV) is typically located in the second part of the duodenum. There are few reported cases of ectopic AOV over the line extending from the pylorus of the stomach down to the distal part of the duodenum. However, to the best of our knowledge, there are only five cases reported in the English literature of an ectopic AOV in the fourth part of the duodenum, with only one of them having adenocarcinoma of the ampulla. Hereby, we report the first case of ectopic AOV in the fourth part of the duodenum, presenting with obstructive due to adenocarcinoma with focal squamous differentiation. This is the case a 42-year-old lady who had a sleeve gastrectomy for morbid obesity in the past. She presented with right upper quadrant pain for one month associated with subjective fever, unintentional weight loss, pale stool, and dark urine. The physical examination revealed a deeply jaundiced lady with an unremarkable abdominal exam. A computed tomography scan of the abdomen revealed intrahepatic and extrahepatic biliary dilation with ectopic insertion of the distal CBD into the fourth part of the duodenum with no evidence of biliary stones. She underwent pancreaticoduodenectomy after difficult biliary decompression. Histopathological diagnosis was moderately differentiated adenocarcinoma, pancreaticobiliary type with focal squamous differentiation. Ectopic AOV is a very rare entity, especially when it is associated with adenosquamous carcinoma changes. [ABSTRACT FROM AUTHOR]

A previously healthy 70-year-old woman underwent cyanoacrylate closure of an incompetent left small saphenous vein. Six days later, grade 2 treatment-induced thrombosis occurred at the sapheno-popliteal junction. Three days later, the patient presented with pale, cold pain in the left lower extremity. Diffuse thrombosis of the left lower extremity involved the small and great saphenous and deep veins. The patient was admitted and immediately administered heparin with anticoagulant factors, with symptoms began resolving 1 d later. The superficial vein thrombi were resolved. Although a deep venous thrombus remained, symptoms disappeared, and the patient was discharged. [ABSTRACT FROM AUTHOR]

Hexokinase deficiency is a rare autosomal recessive disorder that causes congenital haemolytic anaemia. It affects the initial glycolytic enzymes, causing premature haemolysis of blood cells, leading to severe and chronic nonspherocytic haemolytic anaemia, often accompanied by jaundice. This condition was less frequent and did not reveal spherocytosis. Here, we present the case of an infant with a 4-month history of progressive pallor and jaundice accompanied by hepatosplenomegaly. Thorough investigations have ruled out conditions such as thalassaemia, hereditary spherocytosis, and autoimmune haemolytic anaemia. Whole exome sequencing was eventually performed as a last resort to identify the possibility of an inherited defect presenting with complaints, and a final diagnosis of haemolytic anaemia due to hexokinase 1 deficiency was arrived at, with homozygosity for the defect located on exon 16 and the variant c.2252G>C (p.Gly751Ala). [ABSTRACT FROM AUTHOR]

Although optic disc cupping is mostly seen in glaucoma patients, it can occur in non-glaucomatous optic neuropathies (NGON). The characteristics of NGON are cupping toxic optic neuropathies, optic neuritis, compressive ischemia, and hereditary nature. The basic components of optic disc cupping are prelaminar and laminar. Prelaminar thinning, which seemed to be non-specific, occurs in all types of retinal ganglion cell axon loss; such as compressive, ischemic, and inflammatory events; glaucoma; and aging. This form of cupping is usually shallow, with less excavation of the optic disc. Laminar type of cupping which is a clinically profound type of cupping, may damage peripapillary scleral and lamina cribrosa. Sometimes experienced clinicians cannot clearly distinguish glaucomatous from non-glaucomatous cupping. The non-glaucomatous optic neuropathy has more neuroretinal rim pallor with less excavation of the disc than in glaucoma. It also involves central visual acuity and color vision in primary levels with visual field defects aligned vertically and respecting the midline. Evaluation of the patient’s medical records, disease presentation, ocular function, and examination are also crucial. Secondary examinations, including visual field examination and optical coherence tomography (OCT) or neuroimaging, facilitate the disease’s differentiation. This review presents the methods of examining a patient with an increased cup-to-disc ratio.

Background: Moderate acute malnutrition (MAM) is a leading cause of childhood morbidity and mortality globally. The morbidity pattern of underfives with this condition is yet to be described. Objective: To describe the morbidity pattern of underfives with MAM Method: A cross sectional study was conducted in two Primary Health Centres in Uruan Local Government Area of Akwa Ibom State. Caregivers’ brought children aged 6- 59 months to the health facilities following community mobilization. Eligible children were recruited into the study after obtaining parental consent. A validated proforma was used to obtain the biodata and symptoms of common illnesses in the children. A general physical examination, anthropometric measurements and systemic examination were performed. Results: A total of 162 children were recruited into the study. Their mean (±SD) age was 20.4 ± 13.0 months. Over 70% of them were 6 - 23 months of age. Their mean (±SD) length/height was 77.3 ± 29.6 cm, mean (±SD) weight was 8.3 ± 3.4 kg and mean (±SD) mid upper arm circumference was 12.4 ± 4.5 cm. The main symptoms noted in the children were; fever 99 (61.1%), cough 84 (51.9%), weight loss 81 (50.0%), diarrhoea 40 (24.7%) and vomiting 40 (24.7%) while pallor 77 (47.5%), lymphadenopathy 56 (34.6%), hair changes 49 (30.2%), skin changes 27 (16.6%) were the main signs in them. Conclusion: The main symptomatology of underfives with MAM were fever, cough and weight loss while pallor, lymphadenopathy and hair changes were the topmost signs. This morbidity pattern is related to interactions between malnutrition and infection in childhood.

Background:Anemia is a condition in which the hemoglobin concentration of a women during pregnancy is <11g/dL. More than 50% of pregnant women suffer from anemia and it is the second leading cause(20%) of total maternal deaths. Aim of the study: was to estimate the prevalence and causes of anemia among pregnant women admitted in a tertiary care hospital in North India, and to determine its association with maternal and fetal outcomes. Study design: Cross-sectional study which included 200 consecutive participants fulfilling the inclusion criteria. Results: 200 females were evaluated out of which 171(85.5%) were anemic. 47% had mild, 37% patients had moderate and 1.5% had severe anemia. There was statistically significant association between anemia and age(p<0.001), parity(p<0.001), low birth weight(LBW)(p=0.05), presence of pallor(p<0.001), lethargy(p<0.001), palpitations(p=0.001), breathlessness(p=0.007) and lack of IFA intake(p<0.001). Anemic participants had significantly higher proportion of microcytic hypochromic presentation(p=0.011), lower serum iron concentration(p<0.001), higher Total Iron Binding Concentration(TIBC)(p<0.001), lower serum ferritin(p<0.001), lower serum folate(p<0.001), lower serum B12(p<0.001) as compared to non anemic participants. No statistically significant association was observed between anemia and BMI, educational level, socioeconomic status, residence(urban/rural), trimester, gap between child birth. Conclusion: Iron deficiency anemia amongst pregnant females is highly prevalent; and to improve maternal and fetal outcomes; prevention, early diagnosis and treatment of anemia in pregnancy is to be given priority. [ABSTRACT FROM AUTHOR]

Background: Anemia is a condition in which the hemoglobin concentration of a women during pregnancy is

Although optic disc cupping is mostly seen in glaucoma patients, it can occur in non-glaucomatous optic neuropathies (NGON). The characteristics of NGON are cupping toxic optic neuropathies, optic neuritis, compressive ischemia, and hereditary nature. The basic components of optic disc cupping are prelaminar and laminar. Prelaminar thinning, which seemed to be non-specific, occurs in all types of retinal ganglion cell axon loss; such as compressive, ischemic, and inflammatory events; glaucoma; and aging. This form of cupping is usually shallow, with less excavation of the optic disc. Laminar type of cupping which is a clinically profound type of cupping, may damage peripapillary scleral and lamina cribrosa. Sometimes experienced clinicians cannot clearly distinguish glaucomatous from non-glaucomatous cupping. The non-glaucomatous optic neuropathy has more neuroretinal rim pallor with less excavation of the disc than in glaucoma. It also involves central visual acuity and color vision in primary levels with visual field defects aligned vertically and respecting the midline. Evaluation of the patient's medical records, disease presentation, ocular function, and examination are also crucial. Secondary examinations, including visual field examination and optical coherence tomography (OCT) or neuroimaging, facilitate the disease's differentiation. This review presents the methods of examining a patient with an increased cup-to-disc ratio. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Anemia is a common health problem with nonspecific symptoms often overlooked leading to adverse health outcomes. This study aims to assess the clinical profile, types, and etiologies of anemia. MATERIAL AND METHODS: In this hospital based cross-sectional study, patients with anemia were enrolled through convenience sampling. Relevant history, physical examination, and investigations were performed. Statistical package for social sciences software version 20 was used to enter and analyze the data. Categorical variables were expressed as frequencies and percentages. Continuous variables were expressed as median (range). The associations were analyzed by using Fisher's exact test or Chi-square test, as appropriate. RESULTS: Out of 193 patients, 151 (78.2%) were females. The median age was 49 years (range 18-87 years). Most frequent symptoms were easy fatiguability (76.2%), breathlessness on exertion (30.1%), and light headedness (21.8%). Most frequent signs were pallor (75.6%), tachycardia (23.8%), glossitis (16.1%), and nail changes (15.5%). Majority (79.3%) had moderate and 17.1% had severe anemia. Iron deficiency (59.1%) and anemia of inflammation (28%) were common etiologies. Iron deficiency anemia was most commonly due to nutritional deficiency. Age was significantly associated with the type and etiology of anemia. CONCLUSION: Moderate anemia was the most common presentation. Easy fatiguability, breathlessness on exertion, and light headedness were most common symptoms, while pallor, tachycardia, glossitis, and nail changes were the most common signs. Iron deficiency anemia and anemia of inflammation were most common etiologies. Iron deficiency anemia was more common in younger patients, while anemia of inflammation was more common in older patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sickle cell disease (SCD) is a major public health problem in certain states of India associated with morbidity and mortality in children. The characteristics and clinical features of SCD are different in India as compared to those in developed countries with considerable clinical diversity. AIMS: This study aimed to describe clinical features in patients with SCD at the time of diagnosis and first visit. SETTING AND DESIGN: Department of Pediatrics at tertiary care hospital or Sickle-Thal Society Amravati,India (Both Collectively called as Unit). Design: Cross sectional Study. MATERIALS AND METHODS: All SCD patients 0–18 years, attending unit from October 1, 2019, to March 31, 2021, were included in the study. Data collected were based on history, clinical examination, and review of old records. The sample size was 153. STATISTICAL ANALYSIS: Data was analyzed by using software statistical packages in social sciences (SPSS) version 16. Mean, standard deviation (SD), proportions were calculated and Chi -square test of significance was used. RESULTS: Of 157 SCD patients (145 families), 90 (57.32%) were males and 67 (42.68%) females. The mean age of diagnosis and unit visit was 53.59 and 115.74 months, respectively. At diagnosis, paleness (68%), pain (54%), and fever (45%) were common complaints with other nonspecific complaints. Pallor (97.45%) and palpable spleen (53.90%) were common signs at the first unit visit. The spleen was palpable in 65 (42.48%) even after 5 years. CONCLUSION: SCD patients had paleness, pain, and fever as the most common complaints. Palpable spleen was seen even after 5 years of age. Early suspicion is key for diagnosis.

Dermatologic depictions in film are often used to symbolize evil. To ascertain whether certain dermatologic characteristics are more representative of evil in movies, skin findings in film characters before and after evil transformation were compared using the Good Movie Characters Turned Bad poll courtesy of The Internet Movie Database (IMDb). The poll ranked the 35 most remarkable moral transformations in cinema. Data was analyzed from 27 characters who met study criteria and there was a statistically significant, greater number of dermatologic features seen in characters after an evil transformation. Periorbital hyperpigmentation, infraorbital edema, alopecia, pallor, and nonspecific hyperpigmented skin abnormalities (telangiectasias, ecchymosis) were dermatologic traits that were found at a statistically significantly higher frequency post-evil transformation. This work suggests an effort should be made to educate audiences and film makers that skin conditions in reality are not a marker of evil intent.

Purpose: Ethambutol (EMB) is one of the first-line drugs used for treating tuberculosis. Vision loss due to optic nerve toxicity is a well-known potential side effect of the drug. Our aim was to evaluate the clinical features and visual outcomes of patients with EMB optic neuropathy (EON).Methods: A retrospective, observational, single-center study of all patients who were diagnosed to have EON during January 2017-December 2019 was done. All these patients were screened in the Department of Neuro-ophthalmology at a referral tertiary eye care institution in India. Clinical features, visual outcomes, and neuroimaging findings of these patients were analyzed.Results: Two hundred and fifty-six eyes of 128 patients were included. Of these, 73 were male and 55 were female. Mean age was 50.55 ± 15 years. Mean visual acuity at presentation was 1.12 ± 0.45 logarithm of the minimum angle of resolution (logMAR). One hundred and forty three eyes had normal optic disk on presentation, 111 had disk pallor, and two eyes had disk edema. The most common field defect was central/paracentral scotoma (26.2%) followed by temporal defects (24.6%). Magnetic resonance imaging (MRI) brain and orbit showed optic nerve signals in 19.6% and chiasmal signals in 5.2%. At the final follow-up, a ≥2-line vision improvement was noted in 161 eyes (62.9%), which was statistically significant.Conclusion: Multiple prognostic factors were analyzed to predict the visual recovery of EON. We observed that patients presenting with visual acuity worse than 6/60 had poor visual outcome and long duration of follow-up showed better visual recovery, proving the possibility of a gradual recovery pattern of EON. Interestingly, we found in our study that the chances of favorable visual outcome were directly proportionate to early diagnosis and cessation of EMB. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of Iron Deficiency (ID) in children without clinical pallor using serum ferritin and the new parameters, soluble transferrin receptor (sTfR) & the ratio of sTfR/log10 serum ferritin (sTfR-F index), as suggested by WHO. Also to assess whether these new parameters could individually predict the presence of ID., Methods: Consecutive 230 healthy children aged 9-11 y without clinical pallor underwent estimation of Hemoglobin (Hb), C-Reactive Protein (CRP), serum ferritin, sTfR, and sTfR-F index levels in their blood. The abilities of the sTfR and sTfR-F index in predicting ID were determined by comparing with the gold standard (normal CRP and less serum ferritin), plotting Receiver-operating characteristic (ROC) curve, and noting the area under the curve (AUC)., Results: The blood reports of 114 boys and 106 girls (total = 220) were available for analysis. Overall, 57 (31 girls, 26 boys) children had ID; among children with low CRP, 45 had ID, as suggested by low serum ferritin levels. Among children with high CRP, 12 had evidence of ID as evidenced by elevated sTfR and/or sTfR-F index. The positive predictive values of both sTfR and sTfR-F were low (32.9% and 35.9%, respectively) than the negative predictive values (85.6% and 95.3%, respectively)., Conclusions: The proportion of children identified to have ID using serum ferritin, sTfR, and sTfR-index was 25.9%. sTfR and/or sTfR-F index are unlikely to be ideal individual predictors of ID., (© 2023. The Author(s), under exclusive licence to Dr. K C Chaudhuri Foundation.)

Summary: The objective findings of phalangeal T2‐weighted hyperintense and T1‐weighted hypointense bone marrow signal on MRI without features of seronegative arthropathy or osteomyelitis may assist clinicians in making a diagnosis in the appropriate clinical context. [ABSTRACT FROM AUTHOR]

Introduction: Pancytopenia is a trio of results caused by numerous medical conditions in which all blood cell lineages, such as leukocytes, erythrocytes, and platelets, are diminished in blood. Causes of pancytopenia seem to vary widely in different country and also in different regions within a country. Knowing common cause and common presentation of pancytopenia is of immense importance to determine the diagnosis, especially in resource-constraint areas. Aim: To assess the aetiology, clinical profile of pancytopenia in a tertiary hospital in northern part of West Bengal. Materials and Methods: This hospital-based, cross-sectional, study was conducted in North Bengal Medical College and Hospital, Sushrutanagar, West Bengal, India, from July 2012 to June 2013. Patients having pancytopenia, on primary haematological investigation, admitted in the Paediatric Department of the hospital were included in the study. Patients already on definitive treatment for disease causing pancytopenia like kala-azar, leukaemia were excluded from the study. A physical examination was performed after obtaining a relevant clinical history, followed by a full blood count, including Peripheral Blood Smear (PBS) examination, and appropriate biochemical assays. An aspiration and evaluation of the bone marrow was performed. Statistical Program for Social Sciences (SPSS) Version 16.0 for windows (SPSS 16) was used. Results: There were 50 children, and the mean age of presentation was 7.3 years. Females constituted 52% and males were 48%. Aplastic anaemia was noted in 44% cases, 30% cases were diagnosed as megaloblastic anaemia, Kalaazar in 18%, ALL in 6% and ITP in 2%, respectively. Mean age of presentation in aplastic anaemia was 7.6 years, while that in megaloblastic anaemia was 6.9 years. Female predominance was seen in both aplastic anaemia (59%) and megaloblastic anaemia (60%), while male preponderance was seen in ALL (66%). Generalised weakness was the most prevalent presenting symptom (100%) followed by fever (80%). Pallor (100%) was the most prevalent presenting sign, followed by glossitis (30%), which is commonly ignored. Conclusion: Though aplastic anaemia is an important cause of pancytopenia, treatable causes like megaloblastic anaemia, Kala-azar should always be looked for as other possible aetiologies for pancytopenia. [ABSTRACT FROM AUTHOR]

Brief resolved unexplained events (BRUE) are concerning episodes of short duration (typically < 1 min) characterized by a change in breathing, consciousness, muscle tone (hyper- or hypotonia), and/or skin color (cyanosis or pallor). The episodes occur in a normal-appearing infant in the first year of life, self-resolve, and have no readily identifiable explanation for the cause of the event. Previously called apparent life-threatening events (ALTE), the term BRUE was first defined by the American Academy of Pediatrics (AAP) in 2016. The criteria for BRUE carry greater specificity compared to that of ALTE and additionally are indicative of a diagnosis of exclusion. While most patients with BRUE will have a benign clinical course, important etiologies, including airway, cardiac, gastrointestinal, genetic, infectious, neurologic, and traumatic conditions (including nonaccidental), must be carefully considered. A BRUE is classified as either lower- or higher-risk based on patient age, corrected gestational age, event duration, number of events, and performance of cardiopulmonary resuscitation at the scene. The AAP clinical practice guideline provides recommendations for the management of lower-risk BRUEs, advocating against routine admission, blood testing, and imaging for infants with these events, though a short period of observation and/or an electrocardiogram may be advisable. While guidance exists for higher-risk BRUE, more data are required to better identify proportions and risk factors for serious outcomes among these patients. Conclusion: BRUE is a diagnosis with greater specificity relative to prior definitions and is now a diagnosis of exclusion. Additional research is needed, particularly in the evaluation of higher-risk events. Recent data suggest that the AAP guidelines for the management of lower-risk infants can be safely implemented.This review article summarizes the history, definitional changes, current guideline recommendations, and future research needs for BRUE. What is Known: • BRUE, first described in 2016, is a diagnosis used to describe a well-appearing infant who presents with change in breathing, consciousness, muscle tone (hyper- or hypotonia), and/or skin color (cyanosis or pallor). • BRUE can be divided into higher- and lower-risk events. Guidelines have been published for lower-risk events, with expert recommendations for higher-risk BRUE. What is New: • BRUE carries a low rate of serious diagnoses (< 5%), with the most common representing seizures and airway abnormalities. • Prior BRUE events are associated with serious diagnoses and episode recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Pancytopenia is a trio of results caused by numerous medical conditions in which all blood cell lineages, such as leukocytes, erythrocytes, and platelets, are diminished in blood. Causes of pancytopenia seem to vary widely in different country and also in different regions within a country. Knowing common cause and common presentation of pancytopenia is of immense importance to determine the diagnosis, especially in resource-constraint areas. Aim: To assess the aetiology, clinical profile of pancytopenia in a tertiary hospital in northern part of West Bengal. Materials and Methods: This hospital-based, cross-sectional, study was conducted in North Bengal Medical College and Hospital, Sushrutanagar, West Bengal, India, from July 2012 to June 2013. Patients having pancytopenia, on primary haematological investigation, admitted in the Paediatric Department of the hospital were included in the study. Patients already on definitive treatment for disease causing pancytopenia like kala-azar, leukaemia were excluded from the study. A physical examination was performed after obtaining a relevant clinical history, followed by a full blood count, including Peripheral Blood Smear (PBS) examination, and appropriate biochemical assays. An aspiration and evaluation of the bone marrow was performed. Statistical Package for Social Sciences (SPSS) Version 16.0 for windows (SPSS 16) was used. Results: There were 50 children, and the mean age of presentation was 7.3 years. Females constituted 52% and males were 48%. Aplastic anaemia was noted in 44% cases, 30% cases were diagnosed as megaloblastic anaemia, kala-azar in 18%, Acute Lymphoblastic Leukaemia (ALL) in 6% and Idiopathic Thrombocytopenic Purpura (ITP) in 2%, respectively. Mean age of presentation in aplastic anaemia was 7.6 years, while that in megaloblastic anaemia was 6.9 years. Female predominance was seen in both aplastic anaemia (59%) and megaloblastic anaemia (60%), while male preponderance was seen in ALL (66%). Generalised weakness was the most prevalent presenting symptom (100%) followed by fever (80%). Pallor (100%) was the most prevalent presenting sign, followed by glossitis (30%), which is commonly ignored. Conclusion: Though aplastic anaemia is an important cause of pancytopenia, treatable causes like megaloblastic anaemia, kala-azar should always be looked for as other possible aetiologies for pancytopenia.

BackgroundCommunity-acquired pneumonia (CAP) is the leading cause of under-five mortality in India. An increased risk of mortality has been reported in cases of hypoxic pneumonia.MethodsThe primary objective of this study was to assess the proportion of children aged 2–59 months, hospitalized with hypoxic CAP, as well as socio-demographic, clinical, and radiological features associated with it. The secondary objective was to determine the risk of mortality among hospitalized cases of hypoxic CAP. This prospective, observational study was conducted in four districts of Northern India, between January 2015 and April 2021. A hospital-based surveillance network was established. Inclusion criteria were as follows: (a) child between 2 and 59 months, (b) hospitalization with symptoms of WHO-defined CAP, (c) resident of project district, (d) illness of

With minimal resources and trained labour, digital image processing techniques can be used for diagnostic support system in illness identification at an early stage. These methods can also aid doctors during clinical evaluations by removing the need for invasive pathological investigations. By just viewing the colour content of the image of the pallor site, various blood components such as hemoglobin and billirubin can be analysed and classed in terms of the colour properties of the image. This research effort is an attempt to propose an image based method of quantifying hemoglobin(Hb) by examining the brightness, red component and texture of the patient's palpebral conjunctiva image after image super resolution. According to WHO recommendations, a computational model based on network of neurons is employed to relate the hemoglobin level to be measured with the level measured by the conventional invasive technique. Furthermore, based on the models' testing results, patients with Hb concentrations below 11g/dL were identified as anemic. The predicted categorization findings were then compared to the actual Hb value acquired from an invasive test using a confusion matrix. The proposed algorithm is shown to have a sensitivity of 91 percent and a specificity of 99 percent in diagnosing anemia. The proposed approach is useful not only for detecting severe but moderate anemia too and will be valuable in assisting medical practitioners in making accurate anemia diagnosis in clinics with limited available resources for healthcare using non invasive procedure. [ABSTRACT FROM AUTHOR]

BACKGROUND: The onus of red blood cell transfusions in the pediatric emergency rooms (ERs) is paramount, with no specified guidelines, and almost all current policies are based on the obtainable adult facts. OBJECTIVES: The aims were to study the current practice and indications of blood transfusion in pediatric ER. PATIENTS AND METHODS: This is a cross-sectional study that included 50 pediatric patients who were admitted to the ER of Children Welfare Teaching Hospital, Medical City, Baghdad, from February to May 2017. The patients were admitted to the ER for different complaints and during their admission, they received a blood transfusion. The decision of blood transfusion was made by the most senior physician at different times. Patient data were tabulated and processed using Statistical Package for the Social Sciences (SPSS) for Windows. RESULTS: The age ranged from 15 days to 13 years, with a mean of 4.9 years. The main complaint was pallor in 26%, followed by bleeding (14%). Hemolysis due to presumptive glucose-6-phosphate dehydrogenase was the major diagnosis in 16 (32%) patients. The hemoglobin ranged from 2 to 11 g/dl, and the mean was 5.6 g/dl. The majority of decisions (28 cases, 56.0%) were made by the third-year resident, who is the second call on duties. Seven patients were below 4 months of age (14%), one of them received transfusion without logical indication. Forty-three (86%) patients were older than 4 months of age, of whom 13 (26%) patients received transfusion without logical scientific bases. The stay in ER ranged from 5 h to 5 days, and the mean was 26.5 h. The duration of transfusion was ranging from 60 min to about 6 h, with a mean of 3 h. CONCLUSIONS: The study showed major pitfalls in the management of patients with anemia. The main obstacles to implementation are the lack of trained staff.

Progressive pallor with hepatosplenomegaly is an alarming constellation of signs in children indicating a serious, ongoing disease process which has to be investigated for. Anemia and hepatosplenomegaly can be caused by a wide spectrum of conditions ranging from benign to life-threatening ones. We report the case of a 4-year-old child who presented with progressive pallor and hepatosplenomegaly along with diagnostic approach and review of literature. The child was diagnosed to have Gaucher disease.

Introduction: The diagnosis and management of anemia largely depends on clinical assessment of pallor. There are varied opinions regarding the subjective variation in the assessment of pallor. Objective: The objective is to study the interobserver agreement of pallor between two independent observers. Methodology: This observational study done in a medical college hospital on 50 children in the age group of 6 months to 5 years. Pallor was assessed in four sites namely conjunctiva, tongue, nail bed, and palm. When pallor was present, it was graded as definitely present and borderline. Second examiner independently assessed the pallor at all four sites within an hour. Statistical analysis was done by percentage and kappa value. Results: Out of 50 children aged between 6 months to 5 years, 30 were male and 20 were female. Eleven were infants of 6 months to 12 months, 19 children were between 1 and 3 years and 20 children were 3–5 years of age group. Twenty-eight children had anemia with hemoglobin

Vitamin B12 deficiency in early childhood is an important cause of neurodevelopmental delay and regression. Most of these cases occur in exclusively breast-fed infants of deficient mothers. Symptoms and signs of vitamin B12 deficiency appear between the ages of 2 to 12 months and include vomiting, lethargy, failure to thrive, hypotonia, and arrest or regression of developmental skills. Approximately one half of this cases exhibit abnormal movements, variously described as tremors, twitches, chorea, or myoclonus. Urinary concentrations of methylmalonic acid and homocysteine are characteristically elevated in vitamin B12 deficiency. Hyperglycinuria is sometimes present. The early diagnosis and treatment of vitamin B12 deficiency is crucial for significant neurological impairment and long-term prognosis. Treatment with vitamin B12 corrects these metabolic abnormalities very rapidly (within a few days). Vitamin B12 supplementation of pregnant women may prevent neurological and neuroradiological findings of the infants. Because of the importance of vitamin B12 in the development of the foetal and neonatal brain, vegetarian and vegan mothers should be aware of the severe and not fully-reversible damages caused by insufficient nutritional intake of vitamin B12 during pregnancy and lactation. Therefore, efforts should be directed to prevent its deficiency in pregnant and breastfeeding women on vegan diets and their infants. It is also important to take the nutritional history of both infants and their mothers for the early prevention and treatment. Here an interesting case of vitamin B12 deficiency in a 10-month-old boy presented with psychomotor regression, hypotonia and lethargy.

Local anesthesia techniques are widely used in dentistry because of their numerous advantages, including safety. Several articles have been published on local and systemic complications stemming from the use of local anesthesia, one of which is accidental intravascular injection, usually reported during inferior alveolar nerve blocks. A 58-year-old man presented to the dental office for extraction of the lower left first molar. During delivery of a supplemental injection in the buccal vestibular mucosa to anesthetize the buccal nerve, an accidental intra-arterial injection to the facial artery occurred, causing sudden sharp pain and immediate pallor along the course of the facial artery. The pallor resolved in approximately 20 minutes. Buccal infiltration was repeated successfully, and the tooth was extracted uneventfully. This case appears to be the first report in the literature to describe the accidental intravascular injection of local anesthetic involving the facial artery and discuss its clinical implications. [ABSTRACT FROM AUTHOR]

Vitamin B12 deficiency in early childhood is an important cause of neurodevelopmental delay and regression. Most of these cases occur in exclusively breast-fed infants of deficient mothers. Symptoms and signs of vitamin B12 deficiency appear between the ages of 2 to 12 months and include vomiting, lethargy, failure to thrive, hypotonia, and arrest or regression of developmental skills. Approximately one half of this cases exhibit abnormal movements, variously described as tremors, twitches, chorea, or myoclonus. Urinary concentrations of methylmalonic acid and homocysteine are characteristically elevated in vitamin B12 deficiency. Hyperglycinuria is sometimes present. The early diagnosis and treatment of vitamin B12 deficiency is crucial for significant neurological impairment and long-term prognosis. Treatment with vitamin B12 corrects these metabolic abnormalities very rapidly (within a few days). Vitamin B12 supplementation of pregnant women may prevent neurological and neuroradiological findings of the infants. Because of the importance of vitamin B12 in the development of the foetal and neonatal brain, vegetarian and vegan mothers should be aware of the severe and not fullyreversible damages caused by insufficient nutritional intake of vitamin B12 during pregnancy and lactation. Therefore, efforts should be directed to prevent its deficiency in pregnant and breastfeeding women on vegan diets and their infants. It is also important to take the nutritional history of both infants and their mothers for the early prevention and treatment. Here an interesting case of vitamin B12 deficiency in a 10-month-old boy presented with psychomotor regression, hypotonia and lethargy. [ABSTRACT FROM AUTHOR]

Introduction: Anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP-mAbs) have recently been approved for the prevention of migraine, and their safety profile is not fully characterized., Objective: The aim of this study was to evaluate the adverse drug reactions (ADRs) of anti-CGRP-mAbs through the analysis of individual case safety reports (ICSRs) collected in the EudraVigilance (EV) database, with a specific focus on cardiovascular (CV) ADRs., Methods: Data on ICSRs recorded between July 2018 and December 2022 in the EV database, involving one of the anti-CGRP-mAbs for migraine prevention-erenumab (ERE), galcanezumab (GMB), fremanezumab (FMB), and eptinezumab (EPT)-were included in the analysis. All ICSRs reporting at least one CV ADR, as identified within the MedDRA ® System Organ Classes (SOCs) "cardiac disorders" or "vascular disorders," were selected for the analysis. The frequency of disproportionate reporting was expressed as the reporting odds ratio (ROR) with its 95% confidence interval (CI), to evaluate the frequency of reporting of CV ADRs for each anti-CGRP-mAb compared with all other monoclonal antibodies (mAbs). A case-by-case analysis was conducted paying particular attention to serious CV ADR reports, focusing on the type of seriousness, age group, sex, and concomitant drugs., Results: A total of 9441 ICSRs were recorded in the EV database from 2018 to 2022, of which more than half were related to ERE (58.9%), followed by GMB (21.4%), FMB (19.0%), and EPT (0.7%). CV ICSRs accounted for 1205 cases (12.8%), with a total of 1599 CV ADRs. The CV ICSRs were mainly related to female patients (82.6%) aged 18-64 years (73.4%). Of the reported CV ADRs, 67.5% were considered serious. Among the total number of ICSRs related to each anti-CGRP-mAb, those associated with FMB had a higher percentage of CV ADRs (n = 253; 14.1%), followed by ERE (n = 707; 12.7%), EPT (n = 8; 12.7%), and GMB (n = 237; 11.7%). A higher frequency of reporting hypertension was shown for ERE (ROR = 1.45; 95% CI = 1.14-1.85). Pallor was mainly observed with FMB (5.00; 1.68-14.89), as well as deep vein thrombosis (3.86; 1.57-9.51), hot flush (2.16; 1.43-3.25), and palpitations (1.48; 1.05-2.08). Atrial fibrillation (2.36; 1.02-5.46) and myocardial infarction (2.21; 1.37-3.58) were mostly reported for GMB., Conclusion: The analysis of anti-CGRP-related CV ADRs was consistent with the information reported in the literature. However, hypertension with ERE, atrial fibrillation and myocardial infarction with GMB, as well as pallor, deep vein thrombosis, hot flush, and palpitations with FMB were not reported in the Summary of Product Characteristics (SmPCs). Considering this, more post-marketing analyses are needed to improve knowledge on the CV safety profiles of anti-CGRP-mAbs, especially for the last approved medication, EPT., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

In Brazil, the fatality rate for visceral leishmaniasis is high, and it is important to investigate its associated factors. The aim of this study was to analyze the clinical-epidemiological profile and prognostic factors associated with death from visceral leishmaniasis (VL) in the Central-West region of Brazil, between 2010 and 2019. A study of series of VL cases was carried out using data obtained from the Sistema de Informação de Agravos de Notificação (SINAN). Multivariate logistic regression was performed to identify variables associated with deaths. Male (64.96%); age group ≤5 years (28.51%); mixed race/color (59.20%); and level of education incomplete primary education (45.16%) were the most affected. The most frequent symptoms were fever (87.65%), weakness (77.56%), enlarged spleen (70.22%) and liver (67.33%), weight loss (67.22%) and pallor (63.41%). Co-infection with HIV was observed in 15.84% of patients. The parasitological diagnosis was positive in 74.17% and the Indirect Immunofluorescence (IIF) in 82.80%. The drug most used for treatment was pentavalent antimony (41.96%). Regarding the evolution of VL, cure was recorded for 82.90% of patients and death from VL in 8.30%. Factors associated with death from VL were: age group ≥20 and <60 (OR 2.95; 95% CI 1.98-4.38) and ≥60 (OR 5.84; 95% CI 3.63-9.38), edema (OR 2.27; 95% CI 1.64-3.13), pallor (OR 1.53; 95% CI 1.06-2.20), infectious condition (OR 1.56; 95% CI 1.12-2.15) and hemorrhagic phenomena (OR 2.87; 95% CI 2.02-4.08). New studies are needed in order to better manage VL control, monitoring, prevention and primary care strategies., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

β-thalassaemia is one of the most prevalent autosomal disorders worldwide. Mutations/deletions in globin gene underlie deficiencies in Haemoglobin (Hb) production, which can interfere with oxygen delivery by Hb, resulting in thalassaemias causing anaemias with a wide range of disease severity. Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is a genetic abnormality resulting in inadequate amount of G6PD in the Red Blood Cells (RBCs). In patients with G6PD deficiency, the reduced or absent activity of the enzyme in RBCs causes premature haemolysis and symptomatic anaemia. The marked oxidative stress caused by homozygous β-thalassaemia is apparently incompatible with G6PD deficiency. Here, a rare case of six-month-old male child is described who presented with severe pallor hepato-splenomegaly and these two conditions co-existed in this patient.

Neonatal thrombosis is a relatively common disease/condition and most often associated with predisposing genetic factors, underlying medical disorders and acquired trigger factors, such as iatrogenic interventions. Perinatal femoral artery thrombosis with no underlying risk factors has not been presented in the international literature. There has been no evidence of perinatal artery thrombosis with no underlying risk factors in the international literature. In this case presentation, a neonate was born via normal vaginal delivery at 39+4 weeks of gestation, in an otherwise uncomplicated pregnancy without risk factors, with marked discoloration of right lower abdomen and right lower limb, initially pale and eventually evolving to cyanotic. At the time of birth, such clinical presentation was a challenge to clinicians regarding diagnosis. The absence of right-sided palpable femoral pulses raised suspicion and led to a diagnostic approach primarily including ultrasonography. A right femoral blood clot blocking blood flow and resulting in the pale right lower limb was revealed via Doppler ultrasound. Screening test for thrombophilia was negative and neonatal arterial patency was achieved after administration of Low Molecular Weight Heparin (LMWH). After a 6-week course of treatment, vascular latency was fully restored and confirmed by ultrasound on day 10 post-partum. Clinicians should be aware of this unusual event that can be detrimental and endanger limb survival if immediate further action is not taken. Neonatal thrombosis can occur even at the time of birth; thus, clinicians should be alert in cases of neonates born with pale extremities. Low-risk cases could still pose a great threat to the survival of an extremity if appropriate action is not taken.

In developing nations, the adolescent group is progressively exposed to health issues and young girls are increasingly weak due to anemia. An observational study was conducted to assess the prevalence of anemia among the adolescent girls in a selected college in Kanchipuram. The objectives were to assess the sociodemographic variables of the adolescent girls, to assess the prevalence of anemia among the adolescent girls and to associate the prevalence of anemia and the socio-demographic variables of the adolescent girls. The cross sectional design was used to conduct the study. The setting of the study was a selected Allied Health Science college in Chennai. Adolescents in the age group of 17 to 19 years were selected as samples for the study. The convenience sample technique was used to select the samples. The sample size was 32. The results showed that 16 (50.0%) of the participants belong to the age 17 years and 18 years equally and the majority of the study participants 27 (84.0%) belong to nuclear family and 05 (16.0%) of the population belong to joint family and the 08 (25.0%) of the study participants were vegetarian and 24 (75.0%) of them were non vegetarian. The level of hemoglobin showed that majority of the study participants 22 (56.0%) suffer low hemoglobin level. [ABSTRACT FROM AUTHOR]

Abstract A 7-year-old girl presented with severe pallor, cough, and massive hemoptysis. She had been previously hospitalized twice within the time span of 2 years for severe pallor and hemoptysis, each time requiring 2U of blood transfusion. In the recent episode, blood examination was suggestive of iron deficiency anemia, chest radiograph yielded bilateral pulmonary infiltrate, computed tomography scan of lungs showed ground glass pattern, and bronchoalveolar lavage revealed hemosiderin-laden macrophages. Investigations to exclude any secondary causes of pulmonary hemosiderosis were negative. The child was diagnosed as a case of idiopathic pulmonary hemosiderosis and treated with prednisolone.

To determine the pattern of clinical presentation, pattern of cytopenias, and haematological parameters of megaloblastic anemia in our setup. Study Design: Cross Sectional Descriptive study. Setting: Pathology Department, Khyber Teaching Hospital, Peshawar. Period: January 2016 to December 2016 (one year period). Materials and Methods: A total of 337 patients underwent bone marrow biopsy during the study period, out of which 46 patients were diagnosed as having megaloblastic anemia on bone marrow aspirate and B12 levels. The clinical features and hematological parameters of these patients were recorded in a proforma and the results were drawn accordingly. All cell counts were done on automated counter machine. Results: Out of 337 patients referred to pathology department for bone marrow aspiration, about 45 cases had megaloblastic anemia. These 45 cases were included in the study. Age of the study sample ranged from 1 year to 90 years (mean 32.2 years ± 12.1 SD). There were 35 (78%) males and 10 (22%) females, with male to female ratio of 3.5:1. Commonest clinical feature was generalized weakness and loose motion, while commonest physical sign was pallor, which were seen in 36 (80%), 36 (80%) and 40 (88%) cases respectively. About 28 (62%) patients had pancytopenia, 9 (20%) patients had bicytopenia (low hemoglobin and platelet count), and 8 (18%) cases had isolated anemia. Low Hb was present in all the 45 (100%) patients. Both the mean hemoglobin level and platelet count were reduced (7.4g/dL and 128x109/L. respectively) while mean white cell count in study sample was normal (mean 5.0x109/L). Conclusion: Megaloblastic anemia may presents as anemia, bicytopenia or pancytopenia. The cytopenias are important feature of megaloblastic anemia. Generalized weakness, and lethargy are the common clinical presentation, while pallor is common physical finding. Patients presenting with a constellation of generalized weakness, pallor and pancytopenia should be suspected of megaloblastic anemia and should be investigated accordingly. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of optic disc pallor in fundus photographs may be frequently misinterpreted due to the subjective nature of interpretation. We developed a fully automatic computer‐aided detection (CAD) system for optic disc pallor using colour fundus photographs and evaluated the accuracy of the system. Methods: A newly proposed CAD system was developed for automated segmentation and image analysis of optic disc pallor, and a logistic regression model was developed for risk analysis. A total of 230 photographs with variable degree of optic disc pallor, and 123 normal optic discs confirmed by optical coherence tomography were tested for validation of the software. Sensitivity and specificity of the CAD system in automatic detection of optic disc pallor using colour fundus photographs were evaluated. The results of manual detection of optic disc pallor on fundus photographs by two independent ophthalmologists were compared with the efficacy of the CAD system. Results: The fully automated CAD system achieved a sensitivity of 95.3% and a specificity of 96.7% for detecting optic disc pallor in colour fundus images. The overall accuracy of the CAD system was 96.1%, which was superior to the results of manual detection by individual examiners. Conclusions: We developed an automated CAD system that successfully detected optic disc pallor in fundus photographs. The proposed algorithm can assist the clinical judgement of ophthalmologists for detecting optic disc pallor in fundus photographs. [ABSTRACT FROM AUTHOR]

Summary: Background: Dermatologic complications are common in patients with end‐stage renal disease and also have a high diversity. Objectives: This meta‐analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran. Materials and Methods: Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran‐Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random‐effect meta‐analysis model. Results: We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random‐effect meta‐analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half‐and‐half nail in hemodialysis patients were 48.03% (95% CI: 45.09‐51.01), 52.85% (95%CI: 49.23‐56.47), 19.88 (95% CI: 17.57‐22.19), 51.14% (95% CI: 48.25‐54.02), and 18.50% (95% CI: 16.0‐21.0), respectively. Conclusions: his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common. [ABSTRACT FROM AUTHOR]