Sunil Kumar Agarwalla

Abstract

Congestive heart failure (CHF) occurs when the heart doesn’t pump blood to meet the oxygen demand of the various organs. Usually congenital heart disease (CHD) like VSD, PDA, CoA, TGA physiology, ECD, Ebstein anomaly present with CHF before U5 age. In India most common cause of CHF from 5 to 15 yrs. age is due to Rheumatic Fever / RHD. We also get cases like pericardial effusion, constrictive pericarditis, DCM, AR in rheumatic disease, iron overload causing myocardial failure in Thalassemia and anemia presenting as CHF as in more than 5-year children. CHF cases contribute to about 10% of mortality in children. We conducted a Hospital based descriptive and cross-sectional study from November 2018 to October 2020 at Pediatric department of M.K.C.G Medical College Hospital, Berhampur. All pediatric patients with signs and symptoms of CHF as per clinical diagnosis in the age group of 1 month to 14 year were included in our study. The study population was 136. Out of the total cardiac cases, 57% were CHD, 43% were acquired. Among the total 105 cardiac cases of CHF, CHD were 60(57.2%). Out of the total CHD, acyanotic heart diseases were 46.7% and acquired heart diseases constituted 42.8%. Out of total 136 cases 87(63.2%) were discharged, 23(17.6%) died, 19 cases (14%) were referred to higher centre. After data collection detail analysis was made by SPSS software. An initiative regarding addressing the problematic Congestive heart failure along with its clinical management will definitely help the future generation and researchers.   Keywords: Congestive Heart Failure, CHD, RHD, DCM

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Abstract

Seizure in children are generally indicating a potentially serious underlying systemic or CNS disorders that require thorough clinical examination, investigation and management. It is therefore important to establish accurate diagnosis of seizure and its etiology to manage such patients appropriately. We carried out this study to evaluate different etiology of seizures and its correlation with abnormal EEG & abnormal neuroimaging in the age group of 2mo to 14 years. 200 children presented with seizure to our department from January 2019 to November 2020 were enrolled in this prospective hospital-based study. Detailed history, clinical examination, investigation with special emphasis to EEG & neuroimaging was done and different correlation was drawn by using SSPS 18.0 statistical analysis. Among 200 cases, 6 to 10yr. age group constituted maximum (49%) number of cases. Male to female ratio is 1.5:1. GTCS is the predominant pattern of seizure (60%) in all age groups. EEG abnormality is found in 45%, mostly in focal seizure type. Neuroimaging abnormality found in 29%. Maximum cases (30%) had infectious etiology. Childhood seizure needs detailed history taking and careful examination. Vedio recording shown by parents / caregivers really help towards differentiating seizure from seizure mimics. EEG has a role in specific seizure type; Neuroimaging at times helps in diagnosis. There are few studies that describe neuroimaging [Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)] and Electroencephalogram (EEG) data in children who present with new-onset seizures. The EEG is recommended as a part of the neurodiagnostic evaluation of the child with an apparent first unprovoked seizure.   Keywords: Seizure, GTCS, EEG, Neuroimaging.

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Abstract

A seizure in the neonatal period is an emergency that reflects potentially significant insults to the immature brain. Seizure represents the most distinctive signal of neurological disease in the newborn period and they are most frequent of the major manifestation of neonatal neurological disorder. It is critical to recognise neonatal seizures, determine their etiology and to treat them promptly. The neonatal period is one of high seizure hazard for a number of reasons. The last trimester and early neonatal period are characterized by rapid brain growth and development; both structure and function undergo substantial changes in relatively short time. This process has specific metabolic demand, substrate requirements and the need to proceed under relatively ideal conditions. Unfortunately the neonatal period is also characterised by a wide range of factors that can negatively impact this process; there are many diverse pathological process and disorders that may occur frequently and that may cause brain dysfunction. In addition the relative excitability of the immature brain compared with that of older children or adults make the neonate more prone to seizure. As regards the aetiological factors in neonatal seizures they are many; some of them require multiple sophisticated investigations, while others can be diagnosed clinically with a few simple investigation. Thus in present perspective, neonatal seizure deserves intensive investigation and comprehensive research. Keywords: Neonatal seizure, Etiology, Research.

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