Open and closed lip schizencephaly in Seckel syndrome: a case report

Seckel syndrome (Online Mendelian Inheritance in Man database Number 210600) is the classic prototype of primordial bird-headed dwarfism. In addition to the characteristic craniofacial dysmorphism and skeletal defects, abnormalities of the cardiovascular, hematopoietic, endocrine, and central nervous systems are described. The full phenotypic spectrum of this clinically and genetically heterogeneous syndrome is yet to be delineated. Presented herein is a boy 2 years and 5 months old, with Seckel syndrome, born to second-degree consanguineous Muslim parents. In addition to the classic phenotype of the disorder, this patient had both, an open and a closed lip schizencephaly detected on cranial computed tomography (CT) scan. To our knowledge, the association of schizencephaly and Seckel syndrome is not described previously in the English language literature. In addition, presented briefly is a review of the anatomical cerebral cortical malformations associated with this syndrome.

Refractive Error, Srabismus and Amblyopia in Congenital Ptosis

INTRODUCTION: Congenital ptosis is often associated with visual impairment. The aim of the study is to find out the pattern of refractive error,strabismus and amblyopia in patients with congenital ptosis in a hospital setting. METHODS: This is a hospital based prospective and descriptive study conducted at Tribhuvan University, B P Koirala Lion's Centre for Ophthalmic studies in Nepal from February 2003 to July 2004. All the consecutive cases with congenital ptosis were included and cases with pseudoptosis were excluded from the study. RESULTS: Among the 78 cases (95 eyes) of congenital ptosis, refractive error was present in 13 cases (16.7%) with astigmatism as the commonestrefractive error (8.9%). Strabismus was found in 23 cases (26.9%) of congenital ptosis. Among the strabismus, combined exotropia with hypotropia was found in the majority of cases (16.7%). Visual impairment due to amblyopia was found in 15 cases (19.2%) of congenital ptosis with mixed strabismic and refractive etiology as the commonest one (46.7%) followed by pure strabismic (26.7%), pure refractive (20%) and stimulus deprivationamblyopia (6.7%). CONCLUSIONS: Patients with congenital ptosis have higher rate of amblyopia due to greater prevalence of strabismus and refractive errors although stimulus deprivation amblyopia is less common. Early ophthalmic evaluation and timely treatment of these conditions may help prevent the irreversible visual impairment in case of congenital ptosis. Keywords: amblyopia, congenital ptosis, refractive error, strabismus.

Understanding how women's groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study

Women's groups, working through participatory learning and action, can improve maternal and newborn survival. We describe how they stimulated change in rural Nepal and the factors influencing their effectiveness. We collected data from 19 women's group members, 2 group facilitators, 16 health volunteers, 2 community leaders, 21 local men, and 23 women not attending the women's groups, through semi-structured interviews, group interviews, focus group discussions and unstructured observation of groups. Participants took photographs of their locality for discussion in focus groups using photoelicitation methods. Framework analysis procedures were used, and data fed back to respondents. When group members were compared with 11 184 women who had recently delivered, we found that they were of similar socioeconomic status, despite the context of poverty, and caste inequalities. Four mechanisms explain the women's group impact on health outcomes: the groups learned about health, developed confidence, disseminated information in their communities, and built community capacity to take action. Women's groups enable the development of a broader understanding of health problems, and build community capacity to bring health and development benefit.

Seckel syndrome with asymptomatic tonsillar herniation and congenital mirror movements

Seckel syndrome is a rare genetic disorder of recessive inheritance characterized by prenatal-onset growth retardation, abnormally small head, varying degrees of mental retardation and an unusual ''beak-like'' protrusion of the nose. Additionally, it is associated with multiple organ system anomalies, including that of the central nervous system. An 8-year-old male child with typical features of Seckel syndrome and asymptomatic cerebellar tonsillar herniation diagnosed by magnetic resonance imaging associated with congenital mirror movements of the upper extremities is described. The child, additionally, had agenesis of the corpus callosum. Previously reported central nervous system anomalies associated with congenital mirror movements include corpus callosal agenesis and cranio-vertebral anomalies, both of which were present in this child. To the best of our knowledge, this is the first report of congenital mirror movements occurring in association with Seckel syndrome.

Refractive error, strabismus and amblyopia in congenital ptosis

INTRODUCTION

Congenital ptosis is often associated with visual impairment. The aim of the study is to find out the pattern of refractive error, strabismus and amblyopia in patients with congenital ptosis in a hospital setting.

METHODS

This is a hospital based prospective and descriptive study conducted at Tribhuvan University, B P Koirala Lion's Centre for Ophthalmic studies in Nepal from February 2003 to July 2004. All the consecutive cases with congenital ptosis were included and cases with pseudoptosis were excluded from the study.

RESULTS

Among the 78 cases (95 eyes) of congenital ptosis, refractive error was present in 13 cases (16.7%) with astigmatism as the commonest refractive error (8.9%). Strabismus was found in 23 cases (26.9%) of congenital ptosis. Among the strabismus, combined exotropia with hypotropia was found in the majority of cases (16.7%). Visual impairment due to amblyopia was found in 15 cases (19.2%) of congenital ptosis with mixed strabismic and refractive etiology as the commonest one (46.7%) followed by pure strabismic (26.7%), pure refractive (20%) and stimulus deprivation amblyopia (6.7%).

CONCLUSIONS

Patients with congenital ptosis have higher rate of amblyopia due to greater prevalence of strabismus and refractive errors although stimulus deprivation amblyopia is less common. Early ophthalmic evaluation and timely treatment of these conditions may help prevent the irreversible visual impairment in case of congenital ptosis.

Waardenburg syndrome associated with laryngomalacia

Waardenburg syndrome (WS) is a rare autosomal dominant condition characterised by sensorineural hearing loss, in conjunction with pigmentary abnormalities and defects of the neural crest-derived tissues. Depending on the additional phenotypic characteristics, WS is classified into four types, viz. WS1, WS2, WS3 and WS4. We report a 45-day-old male infant with WS1, who presented with inspiratory stridor associated with difficulty in respiration. Direct flexible laryngoscopic examination during evaluation confirmed laryngomalacia as the cause of the symptoms. The baby was managed conservatively and was discharged with appropriate advice to the mother, including the need for evaluation at regular intervals. There was gradual improvement in his symptoms, and by one year of age, he was completely symptom free. To our knowledge, laryngomalacia as a part of WS has not been documented to date in the English literature. We also briefly discussed the probable embryological basis for the observed association.

Central retinal vein occlusion in young women: rare cases with oral contraceptive pills as a risk factor

Central retinal vein occlusion in young people is a rare entity. Here we present two cases of central retinal vein occlusion in young women using oral contraceptive pills. We found no other systemic problems and all routine investigations were within normal limits. The cases were managed with further avoidance of oral contraceptives and intravitreal injections of Bevacizumab (Avastin) to reduce the macular edema.

Childhood mefloquine-induced mania and psychosis: a case report

Mefloquine, a commonly used oral antimalarial is occasionally associated with severe, neuropsychiatric adverse effects, especially in adults. Such events are extremely rare in children. The authors report on an 11-year-old, otherwise healthy girl from Eastern India, a malaria-endemic region, who developed mania and psychosis following intake of a therapeutic dose of mefloquine for Plasmodium falciparum malaria. She recovered satisfactorily with risperidone therapy. To our knowledge, there is only one documented instance of mefloquine-induced psychosis in the pediatric literature to date. Those caring for children need to realize that severe neuropsychiatric manifestations may be seen in the pediatric age group. A positive history of intake of the offending drug with careful exclusion of other etiologies usually clinches the diagnosis.

Pharyngeal-cervical-brachial variant of pediatric Guillain-Barré syndrome with antecedent acute hepatitis A virus infection

Pharyngeal-cervical-brachial weakness is considered a variant of Guillain-Barré syndrome with limited oropharyngeal, neck, and upper limb muscle involvement. The authors report on a 7-year-old boy, who developed pharyngeal-cervical-brachial type of Guillain-Barré syndrome following an antecedent episode of acute hepatitis A virus infection, 2 weeks prior to admission. The presentation was characterized by acute onset dysphagia, loss of head control, and bilateral arm weakness. The diagnosis was confirmed by acute motor axonal changes in the arm and albuminocytologic dissociation of the cerebrospinal fluid. The child was treated with intravenous immunoglobulin, which resulted in gradual improvement over 3 weeks. Documented instances of this form of Guillain-Barré syndrome remain rare in the pediatric age group, with none existing following antecedent hepatitis A virus infection. The authors emphasize that acute hepatitis A virus infection be included in the triggers responsible for Guillain-Barré syndrome in children.

Childhood Plasmodium falciparum malaria complicated by splenic abscess

We report on an 8-year-old girl with Plasmodium falciparum malaria complicated by splenic abscess during the course of her infection. The diagnosis of malaria was based upon the demonstration of trophozoites of P. falciparum in the peripheral blood smear. The trophozoites of the same organism were visualized on the Giemsa-stained smear prepared from the percutaneous splenic aspirate specimen. The patient failed to respond to parenteral Artesunate alone, which demanded emergent splenectomy. To our knowledge, this is the first report of splenic abscess complicating the course of childhood P. falciparum malaria in the English literature.

Childhood cutaneous polyarteritis nodosa: an unusual presentation

A 6-year-old boy presented with post-burn like cutaneous scars over the buttocks and the back of thighs, following skin ulceration. Cutaneous polyarteritis (CPA) was diagnosed based on the histopathological examination of the skin biopsy specimen from one of the scars. Such a presentation of childhood CPA, to our knowledge, is not documented in the English literature.

Outcome of pneumatic retinopexy at a tertiary eye care centre in Nepal

BACKGROUND

Rhegmatogenous retinal detachment is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple and minimally invasive procedure for retinal reattachment.

AIM

This study aimed to assess the outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment at our facility.

STUDY DESIGN

This was a retrospective- prospective, interventional case series.

MATERIALS AND METHODS

All subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy at Tilganga Eye Centre of Nepal from January 2002 to June 2007 were included in this study.

RESULTS

A total of 32 cases were included in the study. The mean age of patients was 55.2 year (SD=11.0). The majority of cases (62.5%) presented within two weeks of symptoms with blurring of vision in 90% of cases. Pre-operatively, 56.3% (18) patients had a best corrected distance visual acuity of <6/60. Retinal detachment involving less than two quadrants consisted of 37.5% (12). A single retinal break was present in 78.1% (25) of cases and 87.5% (28) of the retinal breaks were located in the superotemporal quadrant. The macula was attached in 37.5% (12) of the cases. Sulfurhexafluoride and Perfluoropropane were used in 68.8% (22) and 31.3% (10) respectively. The average follow up period was 1.02 years (range one month to four years). The retina was completely attached in 81.3% (26) of cases at the last follow up. The best corrected distance visual acuity of 6/18-6/60 was found in 40.6% (13) of subjects in the last follow up. There was a transient rise in intraocular pressure in 6.3% (2) of subjects after the procedure.

CONCLUSION

The anatomical success rate following pneumatic retinopexy is quite high (81.3%) with good visual recovery and less morbidity translating to higher productivity for the patient. This procedure, being quicker than the alternatives, will also save surgeon's time making PR a good choice for managing primary rhegmatogenous retinal detachment in countries like Nepal where resources are scarce.

Recurrent limb weakness in a 17-year-old boy

Wilson disease is a relatively rare inherited disorder of copper accumulation and toxicity, caused by a defect in an enzyme that is part of the pathway of biliary excretion of excess copper. A 17-year-old boy presented with numerous episodes of hypokalemic weakness of the lower limbs of undetermined etiology since 12 years of age. Clinically, lower-motor neuron type of weakness of the limbs with preserved reflexes and paucity of sensory abnormalities were prominent. The investigations revealed distal renal tubular acidosis, hepatitis, and bilateral Kayser-Fleischer ring. The diagnosis of Wilson disease was confirmed by the demonstration of low serum ceruloplasmin, high serum copper, and high urinary copper excretion per se and after penicillamine challenge. He responded satisfactorily to penicillamine and zinc. Careful search of an underlying etiology in children presenting with hypokalemic weakness of the limbs in the face of metabolic acidosis and unexplained hepatitis may reveal Wilson disease.

Unilateral palatal and abducens palsy in childhood hepatitis A virus infection

Isolated cranial nerve paresis in childhood hepatitis A virus infection is rare. The authors report an instance of concomitant right-hand side palatal and abducens palsy, developing in the course of an otherwise uncomplicated hepatitis A virus infection in a 5-year-old girl. The neurological complications were transient, and she recovered completely with supportive therapy.