മാഷ്

9 year old girl   2 nd child born out of non-consanguineous marriage  with uneventful antenatal history, with a birth weight of 2.5 kg with nohistory of  NICU admission was discharged on post natal day  2. She was readmitted with frequent episodes of non bilious vomiting and Jaundice on post natal day  3 and diagnosed as duodenal web.  Duodeno-duodenostomy was done.  She was found to have some dysmorphic facial features which were subtle. Noticeable one was   bifid thumb on left hand. There was no significant malformations in the family. She was found to have abnormal cardiac findings on follow up, was investigated and found to have Osteum secundum ASD 8mm size . She was breast fed , was attaining weight and her developmental milestones at par with her peers.  At 4 years had and episode of hematemesis  There was  no other bleeding manifestations other than malena which followed next two days. At admission her vitals were stable,no features of hepatic enceph

12 year old boy presented to pediatrician with history of fever vomiting and abdominal pain, two days back. Pediatrician was my old student and he contacted me yesterday as this boy did nt pass urine for almost 24 hours and his renal function deteriorating. He developed conjuctival bleed and his coagulation parameters abnormal. He considered possibility of leptospirosis and was put on injection crystalline penicillin and ceftriaxone yesterday itself. He was send to us  daybefore yesterday night.  The investigation results done from outside were Total count 30000,with neurtophilia  Hemoglobin 14 gm/ dl Platelet 1.5 lakh Liver function test Total bilirubin 0.9 mg/dl,direct 0.2mg , SGPT 60 iu,SGOT 46 iu,Total protein normal  Coagulation parameters INR 3 , APTT 60  Blood urea 90mg/dl , Creatinin 4.3 mg/dl ESR 26 mms /hour  Lepto igM was negative On arrival ,  he was conscious , Blood pressure normal and capillary refill time 3 sec.periphery warm. On arrival he pass