Indian pediatrics
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A 12-year-old boy presented with fever and sore throat of 6 days duration followed by vomiting and altered sensorium. He had received 4 doses of antirabies vaccine following a dog bite 4 weeks back. Rabies immunoglobulin was not given. ⋯ The possibilities of rabies encephalitis and vaccine induced acute disseminated encephalomyelitis (ADEM) were considered. MRI brain showed exclusive grey matter changes characteristic of rabies. The diagnosis was further confirmed by serological tests.
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Nosocomial pneumonia (NP) is the second most common hospital acquired infection. Understanding the pattern of occurrence, risk factors and etiological agents of NP in a PICU, is essential for developing effective infection control measures. This prospective observational study was conducted in a PICU of a tertiary care teaching hospital, to determine the incidence, etiology and risk factors for NP. ⋯ NP developed in nearly one third of the intubated patients; Gram negative organisms were the predominant etiological agents and associated with high mortality. Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis, reintubation was the only independent risk factor for NP.
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Ventriculo peritoneal shunt is the preferred surgical management for hydrocephalus. Various sites namely cardiac atrium, pleural cavity, ureter, fallopian tubes, bladder and gastric lumen have been used as alternative for distal CSF flow. Gallbladder has been used sparingly in the past as a reservoir of CSF diversion. We report our experience with ventriculo-cholecystic (VC) shunt in 2 cases and recommend it as a simple and safe alternative .for CSF drainage particularly in the situations where serosal surface of abdomen is unfit or unavailable for absorption.