International Journal of Contemporary Pediatrics

Dysglycaemia in Nigerian neonates with hypoxic ischemic encephalopathy

2026-04-23T19:56:58+0530

Background: To investigate the prevalence and associated outcomes of dysglycaemia in neonates with hypoxic ischemic encephalopathy (HIE).

Methods: This was a retrospective analysis of neonates with HIE over one year. The point of admission blood glucose level was measured. Dysglycaemia is defined as a blood glucose level <45 mg/dl or >145 mg/dl, and its association with short-term outcomes was determined.

Results: Dysglycaemia was observed in 4/22(18%) of the neonates with stage 1 HIE, 6/32 (28.1%), and 1/5(20%) with stage 3 (p>0.05). Thirty-eight neonates survived, while 21 (35.6%) died. Death was observed in 15 (33.3%) normoglycemic neonates, and 6/14 (42.9%) with dysglycaemia (p>0.05). After controlling for birth weight, hypothermia, hypoxia, and HIE stage, dysglycaemia was not significantly related to mortality (AOR=0.64, 95% CI= 0.16–2.63, p=0.537).

Conclusions: Dysglycaemia occurred in about one in four neonates with HIE. They were associated with higher mortality, though the association was not significant. Continuous glucose monitoring during treatment of asphyxiated neonates will enable early detection and prompt treatment of glucose alterations, thereby improving outcomes. Expanding access to advanced neuroprotective care, such as therapeutic hypothermia, could further reduce mortality in similar settings.

Impact of mirabegron on nocturnal enuresis in children with overactive bladder

2026-04-23T19:56:57+0530

Background: Nocturnal enuresis associated with overactive bladder (OAB) is a common pediatric voiding disorder that can disrupt daily life and psychosocial well-being. Mirabegron, a β3-adrenergic receptor agonist, has emerged as an alternative to antimuscarinic therapy for OAB. This study aimed to evaluate the therapeutic effect of mirabegron on nocturnal enuresis in children with OAB.

Methods: This quasi-experimental study was conducted over 18 months in the Department of Pediatric Nephrology at the National Institute of Kidney Diseases and Urology, Dhaka. Thirty children aged 6–15 years with nocturnal enuresis and OAB were enrolled following informed consent. Clinical, demographic, urodynamic, and laboratory data were recorded. All participants received mirabegron 25 mg at bedtime for 3 months. Bedwetting frequency, urgency, and overall treatment response were assessed at baseline and at monthly follow-up visits.

Results: The mean age of participants was 11.33±2.44 years, and 70% were male. Urodynamic evaluation showed that 60% had small-capacity, reduced-compliance OAB. The mean number of bedwetting episodes decreased significantly from 7.3±3.4 per month at baseline to 4.7±3.6, 0.33±0.66, and 0.1±0.3 at the 1st, 2nd, and 3rd follow-ups, respectively. Urgency also decreased progressively, with 90% of children achieving complete symptom resolution by the end of treatment. No adverse effects were reported.

Conclusions: Mirabegron demonstrated marked effectiveness in reducing nocturnal enuresis among children with OAB, with significant improvement in both bedwetting frequency and urgency. Larger multicenter studies are recommended.

Comparative study of prednisolone and deflazacort in the treatment of initial attack nephrotic syndrome in a tertiary care hospital

2026-04-23T19:56:55+0530

Background: Idiopathic nephrotic syndrome is a common chronic kidney disease in children and is conventionally treated with prednisolone. Deflazacort, a synthetic glucocorticoid with comparable anti-inflammatory efficacy and a potentially better safety profile, has emerged as an alternative option.

Methods: This double-blind randomized controlled trial was conducted at Dhaka Medical College Hospital over 12 months. Eighty children aged 2–12 years with first-episode idiopathic nephrotic syndrome were randomly assigned to receive deflazacort (n=41) or prednisolone (n=39) according to standard treatment protocols and were followed for six months. Primary outcomes included time to remission, duration of remission, and relapse rate. Secondary outcomes included growth parameters, blood pressure, biochemical profile, and steroid-related adverse effects.

Results: Baseline demographic and clinical characteristics were comparable between the two groups. Children treated with deflazacort achieved significantly faster remission (6.7±2.8 vs 8.4±2.1 days; p=0.005), longer remission duration (154.3±19.7 vs 120.2±36.1 days; p<0.001), and fewer frequent relapses (≥2 relapses: 12.2% vs 41.1%; p=0.027). Prednisolone was associated with higher rates of hypertension and hypertrichosis and significantly higher follow-up blood pressure. Serum cholesterol levels declined in both groups, with a greater reduction observed in the deflazacort group, while random blood glucose levels remained comparable.

Conclusions: Deflazacort demonstrated superior efficacy and a more favorable adverse-effect profile compared with prednisolone, supporting its use as preferable first-line corticosteroid in children with idiopathic nephrotic syndrome.

Risk factors for relapse of steroid-sensitive nephrotic syndrome in children

2026-04-23T19:56:40+0530

Background: The management of nephrotic syndrome (NS) is often challenged in relapse cases. Authors aimed to find out the risk factors for relapse of steroid-sensitive nephrotic Syndrome.

Methods: This cross-sectional study was carried out in the department of pediatrics, ICMH, Dhaka, from July 2020 to June 2021. A total of 40 admitted as well as follow-up relapse cases of steroid-sensitive NS were enrolled and proceeded to clinical and laboratory evaluation.

Results: The mean onset of NS was 3.86±2.35 years. Frequently relapsing NS (FRNS) was found in 14 (35.0%) cases and infrequently relapsing NS (IFRNS) was 26 (65.0%) cases. The majority of children responded within 7 days to initial steroid therapy (75% in IFRNS group and 50% from FRNS group); again, 50% of children with FRNS needed a longer time (≥7 days) to respond to initial steroid therapy. RTI and UTI were higher in FRNS, whereas viral fever and diarrhea were higher in IFRNS. The age of onset of NS, mean serum albumin, serum cholesterol and serum creatinine were not statistically significant compared with the type of relapse. Time needed to respond with initial steroid therapy at 1st attack of NS had a statistically significant difference when compared with the type of relapse in children with SSNS.

Conclusions: RTI and UTI were seen to occur in higher frequency in relapse cases of NS. A longer time taken to achieve remission during the first episode was significantly associated with FRNS.

Clinical profile and infection burden among children with nephrotic syndrome

2026-04-23T19:56:29+0530

Background: Nephrotic syndrome is a common chronic kidney disorder in children and is frequently complicated by infections, which contribute significantly to morbidity and hospitalization. Understanding the clinical profile and infection burden is essential for improving management and outcomes.

Methods: This cross-sectional study was conducted in the Department of Pediatric Nephrology at Dhaka Shishu (Children) Hospital from January 2010 to November 2010. This study included 115 children aged 1-13 years diagnosed with nephrotic syndrome. Detailed clinical evaluation and relevant laboratory investigations were performed. Sociodemographic characteristics, presenting features and infectious complications were recorded and analyzed using appropriate statistical methods.

Results: The majority of children were between 2-6 years of age, with a mean age of 5.29±2.7 years. Male predominance was observed, with 70.43% (81) males and 29.57% (34) females (male-female ratio 2.3:1). Most patients were from rural areas (73.91%) and 52.17% belonged to poor socioeconomic backgrounds. Almost all patients presented with generalized edema, proteinuria and oliguria. Fever was present in 26.10% of cases and abdominal pain in 1.70%. Infection was a major complication. Urinary tract infection (UTI) was the most common infection, affecting 44.35% of patients, followed by pneumonia (6.09%), septicemia (4.35%), cellulitis (3.48%) and peritonitis (1.74%).

Conclusions: Nephrotic syndrome predominantly affects young male children and is associated with a considerable infection burden, particularly UTI. Early recognition and prompt management of infections are crucial to reduce morbidity and improve clinical outcomes.

Comparative study between modified Mathieu technique and tubularized incised plate technique in primary repair of distal hypospadias

2026-04-23T19:56:43+0530

Background: Hypospadias is a congenital anomaly in which the urethral opening is located on the ventral surface of the penis proximal to the glans tip. Among various surgical options, tubularized incised plate (TIP) urethroplasty is widely used. However, anatomical factors such as a narrow urethral plate and shallow glans may limit its success and increase complications. A modified technique combining features of TIP and the Mathieu procedure has been proposed to address these limitations. This study aimed to compare outcomes of the Modified Mathieu (Mathieu-IP) technique and TIP urethroplasty in primary distal hypospadias repair.

Methods: This study was conducted at DMCH from January 2021 to June 2022, including 44 patients aged 1-12 years with primary distal hypospadias. Patients were purposively divided into two groups: 22 underwent the Modified Mathieu technique and 22 underwent TIP repair. Follow-up was done on postoperative days 7 and 14, and at 1 and 3 months (excluding four patients lost to follow-up). Data on perioperative variables and complications were analyzed using Student’s t-test, Chi-square test, and Fisher’s exact test, with p<0.05 considered significant.

Results: No significant difference was observed in neo-meatus formation. Meatal stenosis occurred in two (10%) TIP patients. Urethrocutaneous fistula was seen in five (25%) TIP patients and three (15%) Modified Mathieu patients. Splayed urinary stream occurred in 15% and 25% of patients, respectively, while 10% of TIP patients had a narrow stream. These differences were not statistically significant (p=0.219).

Conclusions: No significant difference was found between the Modified Mathieu and TIP techniques in primary distal hypospadias repair.

Knowledge, attitude, and practices of medical practitioners toward vitamin A prophylaxis in the under-six population: a cross-sectional study on the awareness-knowledge-practice gap

2026-04-08T07:12:18+0530

Background: The national prophylaxis programme against nutritional blindness due to vitamin A deficiency (VAD) was launched in 1970 as a remedial measure to reduce the blindness due to xerophthalmia and VAD. A decline in the trend of VAD has been documented in India. We investigated the current knowledge, attitude and practices towards vitamin A supplementation in different group of health care practitioners.

Methods: A descriptive cross-sectional study was conducted at MGM Medical College and Hospital. Data was collected from medical professionals via a structured Google Forms questionnaire focusing on the dosage, frequency, and practice of clinical implementation of vitamin A prophylaxis.

Results: The majority of participants practiced in urban/city areas (89.2%) and were based in Institutional Teaching settings (56.6%). While general awareness of the vitamin A prophylaxis program was nearly universal (92.8%) and most correctly identified the oral route (97.6%), significant knowledge gaps existed regarding specific protocols. Only 10.8% correctly identified the standard 2,00,000 IU dose for the target age group, and only 46.9% agreed on a 6-month schedule. Statistical analysis showed no significant association between the type of institute and awareness (p=0.304) or prescribing habits (p=0.603). However, a statistically significant difference was found in the ability to enumerate laboratory tests for documenting deficiency (p=0.004), with practitioners in teaching institutes showing a higher deficit in specific diagnostic knowledge compared to private practitioners.

Conclusions: This study concludes that while pediatricians and medical practitioners have high awareness of vitamin A prophylaxis, there is a clear need for reformation of vitamin A prophylaxis program reinforcement. The presence of clinical Bitot’s spots in daily practice highlights that VAD is still a concern. As there is an ongoing debate about the policy implementation, it is best recommended for medical practitioners to be well aware and educated about the administration of vitamin A prophylaxis. Strengthening food-based strategies and fortification may offer a long-term path forward, but the current clinical reliance on prophylaxis suggests that the transition must be managed carefully to avoid a resurgence of nutritional blindness.

An observational study to assess the effect of novel human milk oligosaccharides based human milk fortifier containing lactoferrin, docosahexaenoic acid and arachidonic acid on growth of preterm infants with birth weight of 700-1800 gm

2026-04-23T19:56:46+0530

Background: Preterm infants with low birth weight (LBW) have increased nutritional needs and are at high risk of postnatal growth failure. While human milk is the optimal source of nutrition, it often requires fortification to meet the demands of preterm infants. Novel human milk fortifiers enriched with human milk oligosaccharides (HMOs), lactoferrin, docosahexaenoic acid (DHA), and arachidonic acid (ARA) may offer added benefits in supporting growth and feeding tolerance.

Methods: This observational study was conducted in the neonatal intensive care unit of a tertiary care hospital over one year. Preterm infants with birth weight 700-1800 g and/or gestational age <36 weeks, intended to receive exclusive human milk, were enrolled. A novel HMO-based human milk fortifier containing lactoferrin, DHA, and ARA was initiated once enteral feeds reached 100 ml/kg/day. Growth parameters including weight, length, and head circumference were monitored, along with feeding tolerance and clinical outcomes. Descriptive statistical analysis was performed.

Results: A total of 100 preterm infants were included. The mean gestational age was 32.68±2.83 weeks and mean birth weight was 1430.11±270.02 g. Fortification was initiated at a mean age of 9.42±1.44 days. The mean weight gain was 21±11 g/day, mean length gain was 1±0.1 cm/day, and mean head circumference gain was 0.73±0.05 cm/day. The fortifier was well tolerated, with no significant adverse effects observed.

Conclusions: The novel HMO-based human milk fortifier was safe, well tolerated, and associated with satisfactory growth in preterm infants, suggesting its potential role in optimizing neonatal nutrition.

Assess the prevalence of needle stick injury in a tertiary care hospital in Western Maharashtra

2026-04-23T19:56:30+0530

Background: A needlestick injury is a penetration of the skin by a needle or other sharp object that has been in contact with another person’s blood, tissue or other body fluid before the injury. A retrospective record based cross sectional study was conducted among healthcare workers at a tertiary care hospital to study the prevalence, demography and epidemiology of needlestick injuries.

Methods: A retrospective observational study among the health care workers at a tertiary care facility in Western Maharashtra was conducted over a 12-month period. Data from 51 reported NSI cases was tabulated and analyzed for socio-demographic and epidemiological details.

Results: The overall needlestick injuries prevalence among the 331 healthcare workers was 15.40%. Nurses were the most affected healthcare worker group (43.1%). Injuries most commonly occurred during injection administration (27.5%) using hollow bore needles (78.4%). Most injuries were superficial (74.5%) and occurred while wearing a single pair of gloves (70.6%). A statistically significant association was observed between job category and gender (p=0.022), type of contact (p=0.020), purpose of needle used (p=0.014) and glove usage (p=0.000). No significant differences were found based on age or gender alone.

Conclusions: The study found a 15.4% prevalence of needlestick injuries among healthcare workers. Nurses were the most affected while administering injections with hollow bore needles. Focused training, robust reporting and post-exposure management are essential to reduce occurrence of needlestick injuries.

Association between hypercalciuria and urinary tract infection in children

2026-04-23T19:56:42+0530

Background: Urinary tract infection (UTI) is a common bacterial infection in children and a significant cause of morbidity, particularly in infants and young children. Hypercalciuria, a metabolic abnormality characterized by excessive urinary calcium excretion, may predispose children to UTIs by facilitating uroepithelial irritation and bacterial colonization. Understanding the association between hypercalciuria and pediatric UTI can improve diagnosis and management. This study aimed to evaluate the association between hypercalciuria and urinary tract infection in children.

Methods: This case-control study was conducted at the Department of Paediatric Nephrology, National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, over 18 months from December 2020 to May 2022. Ninety children aged 1-12 years were enrolled, including 45 cases with confirmed UTI and 45 age- and sex-matched healthy controls. Demographic data, urinary biochemical parameters (urinary calcium, creatinine, spot Ca/Cr ratio), and pyuria were assessed. Hypercalciuria was defined by elevated spot urinary calcium-to-creatinine ratio. Statistical analysis was performed using chi-square and independent t-tests, with p<0.05 considered significant.

Results: The mean age of cases and controls was 5.23±3.32 and 5.83±3.32 years, respectively, with a female predominance among cases (60%). Urinary calcium levels (1.35±2.01 mg/dl vs. 0.28±0.17 mg/dl, p=0.001) and spot Ca/Cr ratios (0.068±0.106 vs. 0.015±0.012, p=0.002) were significantly higher in UTI cases compared to controls. Hypercalciuria was present in 44.4% of cases versus 15.6% of controls (p=0.003). Pyuria was markedly elevated in cases, with 75.6% showing >10 pus cells/HPF, compared to 57.8% of controls having nil pus cells (p<0.001). No significant association was observed between hypercalciuria and UTI recurrence (p=0.420).

Conclusions: Pediatric UTIs predominantly affect younger children, especially females and those from rural areas. Hypercalciuria is significantly associated with UTI, independent of recurrence, highlighting the importance of metabolic evaluation in children presenting with UTI. Early detection and management of hypercalciuria may reduce susceptibility to infection and improve long-term outcomes.

Autoimmune conundrum in children with type 1 diabetes mellitus: a case series of uncommon associations

2026-04-23T19:56:41+0530

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder commonly associated with other autoimmune conditions, particularly autoimmune thyroid disease and celiac disease. However, involvement of non-classical organs such as the liver, hematologic system and parathyroid glands is uncommon in children and often under-recognized. We report three pediatric cases illustrating diverse autoimmune associations with T1DM. The first case is a 9-year-old boy with T1DM who after four months of T1DM diagnosis, developed recurrent jaundice, ascites and splenomegaly and was diagnosed with biopsy-proven autoimmune hepatitis. The second case is a 7-year-old girl with chronic immune thrombocytopenic purpura (ITP) from early childhood who subsequently developed T1DM 4 years later. The third case is an 8-year-old girl with T1DM who presented after two years with hypocalcemic tetany due to autoimmune hypoparathyroidism and recurrent mucocutaneous candidiasis, suggestive of an autoimmune polyglandular syndrome type 1–like phenotype. These cases highlight the expanding spectrum of autoimmune disorders associated with pediatric T1DM beyond classical endocrine conditions. Restricting evaluation to routine screening alone may result in delayed diagnosis and increased morbidity. Clinicians should maintain a high index of suspicion for atypical autoimmune manifestations in children with T1DM to enable early diagnosis, appropriate management and improved long-term outcomes.

Evidence in every squeeze: a scoping review of pediatric oral care

2026-04-23T19:56:44+0530

One of the most common chronic diseases affecting children globally is still early childhood caries. Clinicians and parents are faced with a variety of sometimes contradictory recommendations due to the growing market for fluoride and non-fluoride dentifrices, including biomimetic and remineralizing formulations. To direct pediatric practice, a thorough synthesis of the available data is necessary. The goal is to map and critically summarize the most recent research on pediatric oral care products, with an emphasis on fluoride concentration, substitute remineralizing agents, caries prevention effectiveness, and child safety. In compliance with PRISMA-ScR guidelines, a scoping review was carried out. A systematic search was conducted for studies published between 2010 and 2025 using electronic databases (PubMed, Scopus, and Google Scholar). Included were original studies, randomized controlled trials, and systematic reviews assessing oral hygiene products for Children ages 0-14. Data were organized and charted according to safety parameters, clinical outcomes, study design, and type of intervention. Seventy-eight studies satisfied the requirements for inclusion. Across all age groups, fluoride toothpaste (1000–1450 ppm) continuously showed notable caries-prevention benefits. New innovations like nano-hydroxyapatite and other biomimetic substances as viable substitutes with similar remineralization potential and advantageous safety characteristics. Direct comparability was, however constrained by variations in fluoride concentrations, outcome measures, and follow-up periods. Effectiveness was found to be significantly influenced by parental supervision and education. The main role of preventing dental cavities in children is still fluoride toothpaste. Enhancing evidence-based recommendations can maximize preventative measures and enhance the oral health of children everywhere.

Nutritional management of oral mucositis in pediatric cancer patients: a narrative review

2026-04-23T19:56:25+0530

Oral mucositis is a frequent and debilitating chemotherapy complication that significantly impairs oral intake and worsens nutritional status, particularly in children undergoing cancer treatment who are already nutritionally vulnerable. While numerous studies in the literature focus on the therapeutic management and prevention of mucositis, nutritional management remains an overlooked area, especially in pediatric oncology. This review aims to address this gap by examining current evidence on nutritional strategies for the management of oral mucositis in pediatric oncology, including dietary modifications tailored to disease severity and the potential role of functional foods and nutrient-based supplements. A structured literature search was conducted for studies published between January 2000 and October 2025 using suitable search terminologies and phrases. Eligible studies included randomized and non-randomized clinical trials, reviews, and primary research published in English. A two-stage screening process identified 41 studies eligible for inclusion in the final analysis. The analysis indicated that glutamine demonstrated consistent benefits in reducing the incidence and severity of oral mucositis in children receiving chemotherapy, while honey was associated with shorter duration and reduced severity of mucositis episodes. Evidence for other interventions, including vitamins, zinc, olive oil, aloe vera, and probiotics, was more heterogeneous and limited. Given the lack of clear guidance on nutritional management across mucositis severity, this review also proposes a practical severity-based dietary modification framework to support clinical care. Collectively, the findings suggest that integrating functional foods and targeted nutritional strategies may help alleviate symptoms, support oral intake, and improve supportive care in pediatric oncology patients.

Evolving pituitary abnormalities in a child with newly diagnosed ROHHAD syndrome

2026-04-23T19:56:47+0530

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD) is a rare pediatric disease with a high rate of morbidity and mortality. Most reported cases of ROHHAD demonstrate normal magnetic resonance imaging (MRI) findings despite hypothalamic-pituitary abnormalities; only a few describe interval structural changes. We describe a 17-month-old female with rapid-onset obesity, central hypothyroidism, and developmental delay who presented with polyuria and irritability. Laboratory evaluation confirmed central diabetes insipidus, and repeat MRI revealed loss of the posterior pituitary bright spot compared to a normal study five months earlier. She was treated with desmopressin and did not demonstrate any additional pituitary dysfunction. This case supports the need for close monitoring and follow up in children with suspicion of ROHHAD, as the clinical course has the potential to evolve quickly. Repeat imaging and hormonal evaluation are key in the early detection and management of disease progression. The evolving pituitary findings also suggest a possible autoimmune etiology of ROHHAD warranting further research into its pathogenesis and the need for biomarkers to assess disease progression.

A preterm infant with intraventricular hemorrhage (IVH stage 2), central nervous system injury and hydrocephalus: case report and literature review

2026-04-23T19:56:28+0530

Intraventricular hemorrhage (IVH) is a type of bleeding in newborns that occurs after germinal matrix hemorrhage. The aim of this report is to determine the causes and pathologies associated with HIV and the postoperative outcomes with conventional or surgical management, based on bleeding findings through neurographic diagnostic means and care in the intensive care unit (ICU) during the development of the disease. A spontaneously born premature infant at 27 weeks gestation, delivered in cephalic presentation, was admitted to the emergency department with ruptured membranes and two umbilical cord entanglements. There was no spontaneous breathing. Resuscitation was performed in the delivery room with mask ventilation for 1 minute and intubation for 2 minutes. Surfactant replacement therapy was administered with positive results. The Apgar score was 3/4/5, and weight was 1190 g. The infant was transferred to the NICU for further care and monitoring. A premature infant was transferred to the neonatal unit at 1 month and 14 days of age (33 weeks gestation) in moderate condition due to respiratory distress; oxygen dependence due to bronchopulmonary dysplasia (BPD); neurological symptoms, including central nervous system depression syndrome due to hypoxic-hemorrhagic CNS damage; and ventriculomegaly.

Fahr’s syndrome secondary to idiopathic hypoparathyroidism: a report of two adolescent cases

2026-04-23T19:56:56+0530

Fahr’s syndrome is a rare neurological disease characterized by calcification of basal ganglia and/or other areas of brain controlling motor activity. It occurs secondary to an identifiable condition, most commonly hypoparathyroidism. Hypoparathyroidism is an uncommon endocrinopathy with a wide range of presentations. We describe two adolescent cases presenting with seizures, neuropsychiatric manifestations and extra-pyramidal symptoms with bilateral basal ganglia calcification on neuroimaging. Both had hypo-calcemia, hyper-phosphatemia and low parathyroid levels. Vitamin D and calcium supplementation with or without phosphate binders is the mainstay of treatment with limited role of antiepileptics. Despite being rare, clinicians need to consider Fahr’s syndrome as a differential in such cases. Good response is seen after treatment of underlying hypo-parathyroidism.

Infant dicyclomine overdose: a case report

2026-04-23T19:56:54+0530

We report a case of dicyclomine poisoning in a 45-day-old baby given at 15 mg/kg over 6 hours. The patient presented with complaints of decerebrate posturing of all four limbs. At presentation, the GCS was 8/15, with tachycardia (HR: 168 bpm) and tachypnea (RR: 68 bpm) present. During the hospital stay, the patient developed catecholamine-refractory shock, recurrent apnea, intraventricular hemorrhage and eventually succumbed to death.

Empyema of gall bladder with missed CBD calculus in a child with heart disease: a rarity

2026-04-23T19:56:53+0530

Empyema of the gall bladder is a rare condition, especially in the paediatric age group. We report a case of a 12-year-old male with empyema of the gall bladder who was previously operated on for transposition of the great arteries with ASD at 2 months of age. After initial resuscitation, open cholecystectomy was done. But symptoms persisted. So, the patient was again operated on for retained calculus in CBD and ERCP with retrieval of calculus and stenting was done. Now the patient is asymptomatic.

Double dens invaginatus in maxillary lateral incisor of a 12-year-old child: report of an unusual case

2026-04-23T19:56:45+0530

Amongst the anatomic anomalies of shape of the teeth, dens invaginatus shows infolding of enamel organ into dental papilla whereas shoveling represents infolding of mesial and distal margins on lingual side. Clinically and radiographically, both are associated anomalies, common in anterior teeth, also known as “tooth within tooth” and as a “scoop.” Present case showed permanent maxillary right lateral incisor, with a talon’s cusp like anatomy seen clinically and two separate teeth like structures within the crown seen radiographically, diagnosed as dens invaginatus. Intraoral periapical (IOPA) showed sshoveling in both central incisor and left lateral incisor teeth. As no pathological signs and symptoms were present, conservative treatment with composite restoration was done in carious lateral incisor while pit and fissure sealant were carried out in other incisors as a precaution. Periodic check-up was advised which includes preventive strategies. Management of dental anomalies depends on the extent of defect and requires clinical and radiographic investigations along with preventive treatment plan. Thorough examination, early detection, treatment and periodic follow-ups are important to prevent complications in anomalous teeth.

Disseminated tuberculosis in an immunocompetent adolescent girl presenting without fever: a master clinical conundrum

2026-04-23T19:56:39+0530

Disseminated tuberculosis (TB) in immunocompetent child is rare and poses a diagnostic challenge, especially in the absence of typical systemic features. We present a 14-year-old previously healthy girl with no history of fever, cough, or weight loss, who developed progressive lower limb weakness, constipation, and urinary retention. Imaging revealed spinal intramedullary tuberculoma, multiple brain tuberculomas, and pulmonary involvement. Microbiological confirmation was achieved via bronchoscopy. This case emphasizes the importance of high clinical suspicion, early imaging, and microbiological workup in atypical presentations of TB.

Post-dengue encephalitic sequelae in a child: significant functional recovery with ayurvedic intervention-a case report

2026-04-23T19:56:33+0530

Dengue encephalitis is a rare and severe neurological complication of dengue viral infection, often resulting in debilitating long-term deficits characterized by viral neuro-invasion, cerebral edema, and in severe cases herniation. As mentioned in ayurvedic texts, Jwara (fever) can lead to Raktapitta (Hemorrhagic conditions) and can further cause dhatukshaya (depletion of dhatus) leading to shosha (emaciation). We present a case of a 6-year-old boy with marked physical and neuropsychological impairments after dengue encephalitis at age 4. Despite initial emergency care, the patient exhibited significant motor weakness, speech and cognitive delays and functional dependence. Following comprehensive Ayurvedic therapy on the treatment principle of santarpana (restoring strength, nourishment and tissue integrity) and brimhana (nourishing therapy), he demonstrated remarkable recovery in over 9 months with restoration of motor skills, cognition and social functioning. This case highlights the potential benefits of a comprehensive ayurvedic rehabilitative approach in chronic post-dengue neurological sequelae.

Tubercular splenic abscess in an immunocompetent child: an unusual manifestation of abdominal tuberculosis

2026-04-23T19:56:32+0530

Tuberculosis remains one of the most common infectious diseases worldwide with significant morbidity due to its varied pulmonary and extrapulmonary presentation. An extremely uncommon and rare manifestation of gastrointestinal tuberculosis in children is tubercular splenic abscess especially in an immunocompetent child. A nine year old immunocompetent girl presented with fever, weight loss and abdominal pain for two months. She had a strong positive history of tubercular contact. Examination revealed body mass index below the third percentile, pallor, hepatosplenomegaly with left upper quadrant tenderness. While gastric aspirate for acid fast bacilli (GA For AFB) and GeneXpert was negative, she had a strong ulcerative reaction to Tuberculin test with 15mm induration. Contrast enhanced computed tomography (CECT) of abdomen was suggestive of extensive lymphadenopathy and a splenic abscess measuring 57×42×69 mm. GeneXpert of aspirated pus reported detection of Mycobacterium tubercular bacilli (MTB) confirming splenic abscess as tubercular. The patient received antitubercular therapy and underwent percutaneous drainage with good clinical and radiological response. Splenic abscess is itself very rarely encountered in children, making tubercular splenic abscess extremely rare. But lack of awareness regarding the same and delay in diagnosis may lead to serious morbidity and mortality.

Iatrogenic pneumothorax in pediatric practice: a preventable complication

2026-04-23T19:56:31+0530

Iatrogenic pneumothorax is an uncommon but potentially life- threatening complication in paediatric practice. Children are particularly vulnerable due to anatomical and physiological differences We report two cases of iatrogenic tension pneumothorax in children following airway and neurosurgical procedures. A one year 2-month-old male child was admitted with complaints of prolonged fever was diagnosed with third ventricle space occupying lesion causing obstructive hydrocephalus. Following craniotomy, he developed sudden desaturations and subcutaneous emphysema. Bilateral tension pneumothorax was confirmed and managed with bilateral intercostal drain (ICD) insertion. A term 37 week born with birth weight 1.7 kilograms small for gestation baby with congenital stridor and respiratory distress a diagnostic laryngoscopy was done. Intraoperative during tracheostomy the baby developed desaturations and tachycardia. Immediate ICD insertion resulted in stabilization. Children are particularly susceptible to pneumothorax because of its smaller airway anatomy, thin pleura, immature fragile lungs, complaint chest wall, higher exposure to positive pressure ventilation. Early recognition and preventive strategies are critical to reducing morbidity and mortality.

Thoracic Ewing sarcoma (Askin tumor) presenting with severe respiratory distress in a four-year-old child: a case report

2026-04-23T19:56:26+0530

Ewing sarcoma is an aggressive malignant small round cell tumor that primarily affects children and adolescents. Thoracic involvement, known as Askin tumor, represents a rare variant arising from the chest wall and may mimic infectious or mediastinal pathologies, often leading to delayed diagnosis. We report the case of a four-year-old female child who presented with progressive left-sided chest wall swelling and severe respiratory distress. Imaging revealed a large soft-tissue mass occupying the left hemithorax with rib destruction and mediastinal shift. Histopathological confirmation was challenging due to inadequate core biopsy sampling; however, fine-needle aspiration cytology suggested a small round cell tumor consistent with Ewing sarcoma. Given the patient’s critical clinical condition, neoadjuvant chemotherapy was initiated based on clinicoradiological and cytological findings. Following initiation of chemotherapy with vincristine, doxorubicin, and cyclophosphamide, the child demonstrated rapid clinical stabilization and significant improvement in respiratory distress. This case highlights the diagnostic challenges of thoracic Ewing sarcoma in critically ill pediatric patients and underscores the importance of early imaging, pragmatic diagnostic strategies, and prompt initiation of multimodal therapy.

Appendiceal entrapment of an ingested metallic nail in a 10-year-old boy: a case report

2026-04-23T19:56:24+0530

Foreign body (FB) ingestion is a frequent pediatric concern. While most objects pass spontaneously, a small percentage becomes impacted at anatomical narrowings. The appendix is an exceptionally rare site for FB entrapment, representing approximately 0.05% of cases. A 10-year-old boy presented with a metallic nail ingestion one month prior. He was largely asymptomatic except for mild periumbilical pain. Serial radiographs over 11 days showed the nail stationary in the right lower quadrant, initially suggesting ileocecal valve impaction. After 12 days of failed conservative management, exploratory laparotomy and intraoperative C-arm imaging localized the nail within a non-inflamed appendix. An appendectomy was performed, leading to an uneventful recovery. Appendiceal foreign bodies are diagnostically challenging as they may remain dormant or mimic acute appendicitis. Sharp objects, such as nails, pose a high risk of perforation (up to 75% in some series). Standard imaging often fails to differentiate between an object in the terminal ileum versus the appendiceal lumen. Given the risks of delayed inflammation or perforation, prophylactic appendectomy is the recommended management for stationary appendiceal FBs. A radiopaque foreign body that remains stationary in the right lower quadrant on serial imaging should raise clinical suspicion of appendiceal entrapment. Early surgical intervention is vital to prevent complications, even in asymptomatic patients.

Silent maternal autoimmunity unmasked by neonatal atrioventricular block: a case of neonatal lupus

2026-04-23T19:56:23+0530

Neonatal lupus erythematosus (NLE) is a rare autoimmune condition resulting from transplacental transfer of maternal autoantibodies, most commonly anti-Ro/SSA and anti-La/SSB, and may present with cardiac, cutaneous, or hematological manifestations. We report a late preterm male neonate who presented on day one of life with respiratory distress and persistent bradycardia. Electrocardiogram revealed atrioventricular block with 2:1 conduction, while echocardiography showed no structural cardiac abnormalities. Autoimmune evaluation demonstrated elevated antinuclear antibodies, anti-Ro, anti-La, and anti-dsDNA antibodies, confirming the diagnosis of neonatal lupus. The neonate was managed with isoprenaline infusion followed by oral beta-blocker therapy, resulting in stabilization of heart rate. In view of these findings, the asymptomatic mother was evaluated and found to have elevated ANA, anti-Ro, and anti-La antibodies, suggestive of subclinical systemic lupus erythematosus. The infant remained clinically stable on follow-up, with appropriate neurodevelopment and later development of hypopigmented skin lesions, and is planned for pacemaker insertion at a later stage. This case highlights the importance of considering neonatal lupus in cases of unexplained neonatal bradycardia and emphasizes the need for evaluation of maternal autoimmune status even in the absence of symptoms.