A rare case of aggressive primary pulmonary synovial sarcoma: A case report

Synovial sarcoma is a malignant mesenchymal tumour which mostly affects young adults and is mostly seen in extremities. Primary synovial sarcoma arising from the lung is rare, accounting for less than 0.5% of all lung carcinomas. Most commonly it arises from the lung followed by pleura and mediastinum. Primary pulmonary synovial sarcoma is an extremely aggressive malignant tumour that can invade adjacent organs and give distant metastasis. Histologically it is of two main types – monophasic and biphasic. IHC is a must for diagnosis following clinical examination and imaging. Here we report a case of an elderly male with right lung mass lesion infiltrating the visceral and mediastinal pleura. PET – computerized tomography (CT) guided biopsy was s/o synovial sarcoma monophasic type which was further confirmed by IHC. The multimodality treated for this includes wide resection, chemotherapy and radiotherapy. Synovial sarcoma is relatively chemosensitive though it is considered as a high grade tumour with a poor prognosis. Because of the advanced stage of the disease our patient was not a candidate for surgery and was taken up for chemotherapy. He had a survival of 6 months but had succumbed due to non – cancer related cause.

Acute ileocolitis as a presentation of Sars Cov-2 infection in children- A case report

As COVID-19 continues to spread in India and other countries, the impact of the disease among children, initially considered less important, is becoming more relevant. The extent of the diversity of clinical presentation of COVID-19 in children are still unclear. We have already seen a new clinical picture of SARS-CoV-2 in children manifesting as a hyper-inflammatory syndrome, with multi-organ involvement similar to Kawasaki Disease and with potential evolution to a shock syndrome. This represented a new phenomenon affecting previously asymptomatic children with SARS-CoV-2 infection. COVID-19 may also manifest as viral hepatitis, acute pancreatitis, acute liver injury, acute kidney injury, ARDS, Sepsis, septic shock and meningo-encephalitis and cerebellar ataxia. The Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection occurs weeks after infection and may evolve unnoticed. MIS-Cs pathophysiology remains unclear. However, it appears to be a postinfectious hyperimmune response that may occur during or following asymptomatic or symptomatic infection. COVID-19 infection in children may lead to a potentially life threatening condition that we may not be aware of. We are in need of reporting of the diverse presentation of SARS CoV-2 virus in children. Here we describe a case of a previously normal 14-year-old boy who manifested with severe pain abdomen after SARS CoV-2 infection and was diagnosed as Acute Ileocolitis secondary to COVID-19. Child improved with steroid therapy and was asymptomatic after 3 weeks of treatment.

Prevalence of urinary tract infection in febrile children of less than five years of age

To determine the prevalence of urinary tract infection in febrile children, less than 5 years of age. To assess the validity of microscopic urine analysis and urine culture in the diagnosis of urinary tract infection.Prospective study. Children attending the department of paediatrics, Dr.V.R.K. Women’s Medical College, Teaching Hospital & Research Centre, with febrile illness during June 2019-June 2020.370 children between 1 month to 5 years of age.Data related to age, sex, nutritional status, socioeconomic status and predisposing risk factors like urethral instrumentation, bowel habits etc, were noted. A thorough physical examination with relevant investigations were carried out in all these patients. Routine urinary microscopy was done in all patients and urine culture was done in those who showed pyuria of >5 pus cells/HPF in centrifuged urine sample.In our study, overall prevalence of UTI was 3.5% in children between 1 month to 5 yrs and 4.1% in children <2yrs and 7% in Children <1 year of age with M:F ratio of 1:1in children <2yrs. Prevalence of culture positivity was 44% in those who showed >10 pus cells/HPF in centrifuged sample of urine and 2.5% in those who showed >5pus cells/HPF.The presence of obvious source of fever such as upper respiratory tract infection or otitis media is not reliable in excluding urinary tract infection. Overall prevalence of UTI in our study was low (3.5%) and prevalence among children <2yrs was 4.1% and <1 year of age was 7%. Pyuria of >5pus cells/HPF (centrifuged urine sample) should be considered as significant and further evaluation should be done to initiate prompt treatment.

Fecal Calprotectin as early predictor for screening and relapse in pediatric chronic diarrhea in India

: IBS and IBD are two abdomen ailments commonly seen in children. IBD is a life-long disorder that includes two major forms of chronic illness UC and CD, IBS may occur when the bowel is sensitive to specific foods or other triggers like stress. The aims of the study is to investigate clinical usefulness of FC as early predictor for screening and differentiating IBD and IBS and to monitor the treatment for relapse and remission in pediatric Indian population. This was hospital based observational cohort study, conducted over a period of twelve months from January 2019 to December 2019 Total 325 patients attending OPD were included in the study, in children between 1-18years in which FC was measured using commercially available CLIA kit. HB, ESR, Hscrp were also assessed, these patients were followed up. Patients were grouped asGroup I: IBS: 115(50:65M/F), Group II: 185 IBD, had Subgroup I:116 CD(48:68M/F);Group A: 62.7% presented with relapse Group B: 37.3% had disease in remission Subgroup II: 69 patients had UC(31:38 M/F); Group A: 60.9% had relapse and Group B: 39.1% in remission after follow up. Subgroup III: Others were 25(7.7%). In Study I: Levels of FC were significantly lower in patients with group I when compared to group II. In Subgroup I & Subgroup II Group A had higher FC levels when compared to group B. In Study II: A significant difference (P<0.001) and lower values of the FC, ESR, Hs-crp, frequency of stools in IBS than in CD and UC patients were observed. In Study III: FC in IBD has positive correlation (p<0.01), with the activity of the inflammatory disorder, HB, ESR, Hs-CRP and with increased frequency of diarrhea. In Study IV Fecal calprotectin value of ≥100 ug/g was diagnostic of IBD with sensitivity of 94.1%, specificity of 82.2%, PPV of 86.32%, NPV of 80.39%. The present study showed that the determination of FC assists to differentiate between IBD and IBS also useful in monitoring of remission and in early prediction of relapse in pediatric IBD.

Knowledge evaluation of clinical case management in IMNCI among trained and untrained accredited social health activists in two districts of Uttar Pradesh, India

IMNCI was launched in Uttar Pradesh, India in 2005 for integrated management of under 5 children. Success of IMNCI depends to a large scale on the performance of ASHAs. The performance of ASHAs will in turn depend on their knowledge and skills. There is a paucity of research describing and comparing the knowledge of ASHAs who are trained in IMNCI to those who are not trained. The present study was done to compare and describe the knowledge of non-trainees and the follow up knowledge of the trainees regarding clinical case management of IMNCI in two districts of Uttar Pradesh of India. This study indirectly assessed the effects of IMNCI training in the improvement of knowledge of health care personnel. It was a Cross-sectional comparative study conducted in two districts Kanpur & Kannauj of Uttar Pradesh and specifically Shivrajpur and Jalalabad blocks of Kanpur and Kannauj respectively over a duration of one year from March 2019 to February 2020. hivrajpur block of Kanpur had 122 ASHAs and none of them had received 10 days IMNCI/CCSP training. Jalalabad block of Kannauj had 153 ASHAs and all of them had received 10 days IMNCI/CCSP training(as per NRHM UP data). 108 ASHAs from Kanpur and 94 ASHAs from Kannauj participated in the study. CHI-Square test was done to test whether the finding that knowledge difference between the ASHAs of Kanpur Nagar and Kannauj was real or merely a chance finding. The results were pooled form the two districts against each of the 26 variables. The proportion of trained in IMNCI module and untrained was calculated. Results show that clinical case management of IMNCI training status had an association with knowledge score. This study testified much higher knowledge score among trained personnel than their counterparts.

Acute cerebellar ataxia: a rare presentation of scrub typhus in pediatric age group

Scrub typhus is known to cause local and systemic vasculitic response in almost all the systems of the body. Scrub typhus very rarely presents itself with CNS manifestations. In central nervous system it most commonly causes meningitis and encephalitis although several other atypical presentations have been documented. Cerebellar ataxia, which is the lack of coordination, has a number of causes none of which are as uncommon or unheard of as Scrub Typhus. We report a case of a 15 years old child presenting with fever and isolated acute cerebellitis. Scrub Typhus was diagnosed by serum IgM ELISA. Patient showed rapid response to doxycycline therapy.

Co-relation between high resolution computerised tomography (HRCT) score and effectiveness of remdesivir treatment in covid-19 positive pregnant patients

To evaluate the effectiveness of Remdesivir in COVID-19 POSITIVE PREGNANT patients & its co-relation with their HRCT score (with abdominal lead shield) at the time of admission at our institute. It was a retrospective observational study including 93 COVID -19 POSITIVE pregnant patients at varied weeks of gestation admitted and treated at our institute from March 2020 till June 2021. Out of these 15 patients required INTENSIVE CARE UNIT (ICU) admission due to their disease severity and received Remdesivir after physician consultation. Remaining 78 patients had HRCT SCORE of 7 or less (MILD CATEGORY) and did not require ICU admission and hence were excluded from receiving remdesivir.They were divided into 2 groups – Group A and Group B. Group A (MODERATE CATEGORY) including covid -19 positive pregnant patients with HRCT score of 8 to <17/25 had 8 patients and Group B (SEVERE CATEGORY) including covid -19 positive pregnant patients with high HRCT Score of >17/25 had 7 patients. The primary outcome was to evaluate difference in both groups for clinical improvement after 5 days of initiation of Remdisivir therapy in terms of (a) Oxygen requirement (b) Spo2 levels (c) length of hospital stay (d) Death rate (e) HRCT score on day 10 after initiation of remdesivir therapy. Secondary outcome was to evaluate side effects of the drug on the mother and its effect on the baby while in-utero and after delivery. Covid-19 positive pregnant patients with HRCT Score of 8 to <17/25(Group A) showed good prognosis & recovery with rapid decline in Oxygen requirements & improving Spo2 levels after initiation of Remdesivir. They had significantly lower duration of hospital stay (Mean stay of 10.4 + 2.1 days, p < 0.05) and significantly lower death rates (0%, p < 0.05) compared to Group B. Whereas covid -19 positive pregnant patients with high HRCT Score of >17/25 (Group B) did not respond even to prolonged Remdesivir therapy (10 days) and had significantly longer hospital stay (26 + 5.6 days, p <0.05) with significantly higher death rate (42.86% , p<0.05). Patients tolerated Remdesivir well without any side effects. Patients delivered healthy babies with no signs of respiratory illness or any untoward side effects on the baby due to use of Remdesivir. Early referral of COVID -19 positive pregnant patient to hospital when lung lesions are still mild to moderate can be effectively treated with Remdesivir. But severe Covid -19 infection in pregnancy with rampant and excessive ground glass opacities on HRCT at the time of admission is difficult to treat and may not respond to Remdesivir therapy.

Late onset congenital adrenal hyperplasia in pregnancy

Congenital adrenal Hyperplasia (CAH) is a rare disorder to manage in pregnancy as CAH is known to cause infertility. Late onset CAH is more so with 21-hydroxylase deficiency being the most common enzyme deficiency for the same. The mainstay of management in pregnancy is multidisciplinary team management with a consultant Obstetrician and Medical Endocrinologist, steroid treatment and avoiding virilisation of the female patient in early pregnancy is important continuation of dexamethasone is controversial with conflicting evidence and also precipitating or worsening hyperemesis in pregnancy.

Needle as foreign body in urethra: Successful removal

: Self-inserted foreign bodies in the lower urinary tract are rare among children. The treatment of foreign bodies in the urethra is determined by their type, size, location, shape, and mobility. : We describe here a 10-year-old boy who had self inserted a needle into his urethra. Initial attempts to remove the needle from the urethra by inserting a cystoscope failed. The patient presented to our institution with bleeding per urethra with feeding tube insitu per urethra. As already attempted for urethroscopic removal, direct removal of needle done under general aneathesia done.: Per Rectal examination plays an important role and gives adequate information and timely management of the child leads to uneventful hospital stay Psychiatric evaluation is mandatory to detect an underlying mental disorder.