Himalayan Institute of Medical Sciences
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Item Dual fluid silhouette in X-ray of the abdomen: a diagnostic flag for neurogenic bladder with urinary ascites(PUBMED, 2024-06-04) Brajendra Singh; Chinmay Chetan; Aisha Naaz; Girish GuptaA neonate presented with abdominal distension and decreased urinary output. X-ray revealed dual abdominal fluid condition-ascites with a distended bladder, along with vertebral anomalies. The possibility of urinary ascites and neurogenic bladder was kept, which was further confirmed on evaluation. Here, we emphasise the crucial role of abdominal X-ray as a diagnostic tool in uncovering this intricate medical puzzle. By detailing the clinical presentation, diagnostic approach and treatment strategy, the report contributes insights into the rare and complex abdominal condition.Item Alarming medication error with prostaglandin E1 (PGE1) in a term neonate with critical congenital heart disease(BMJ case report, 2024-04-08) Saikat Patra; Prachi Patwal; Chinmay Chetan; Girish GuptaAn outborn full-term female newborn with birth weight 2.45kg was admitted to our centre at 24 hours of life with respiratory distress and cyanosis. The baby had tachycardia and oxygen saturation (SpO2 ) 40% at admission to neonatal intensive care unit (NICU). She was mechanically ventilated on synchronized intermittent mandatory ventilation (SIMV) mode. Clinical evaluation raised suspicion of critical congenital heart disease; echocardiogram revealed transposition of the great arteries with 6mm ostium secundum atrial septal defect and small patent ductus arteriosus. The baby was started only on intravenous prostaglandin E1 (PGE1) as per unit protocol, where 1 ampoule (500 µg) of PGE1 is mixed in 49mL of 5% dextrose yielding a concentration of 10 µg/mL and is then started using an infusion pump at a rate of 0.6mL/kg/hour to provide a dose of 0.1 µg/kg/min. She developed tachycardia along with confluent erythematous macules over the scalp, face, neck and trunk, 10 hours after starting PGE1 infusion (figure 1). There was no associated fever or hypertension, while lowest blood pressure recorded was 52/30mm Hg. The skin rash, characterised by bright erythematous macular lesions, rapidly spread to the extremities. It was noticed that PGE1 was wrongly administered at 10 times the expected dose for the last 2hours prior to the cutaneous manifestation. The infusion was immediately stopped, and the baby was givenItem Role of point-of-care ultrasound in the management of congenital diaphragmatic palsy(PUBMED, 2025-06-27) Ravleen Kaur; Kanishka Bahuguna; Chinmay Chetan; Saikat PatraIn newborns, brachial plexus injury is the most common peripheral nerve injury during the delivery. It may also lead to phrenic nerve injury causing diaphragmatic palsy. Conservative management remains the mainstay of treatment for congenital diaphragmatic palsies. Surgical plication is a potential management strategy for the persistent cases, but the timing and outcomes are not clear. Here, we present a case where diaphragmatic palsy was diagnosed and monitored using point-of-care ultrasound. The surgical intervention was avoided by serial monitoring of diaphragmatic excursion on ultrasound, which revealed improvement despite persistent requirement of respiratory support.Item Usefulness of skills in point of care ultrasound and simulation-based training as essential competencies in acute management of neonatal cardiac tamponade(BMJ Publishing Group, 2023-12-29) Ankit Jain; Saikat Patra; Chinmay Chetan; Girish GuptaPeripherally inserted central catheter (PICC) insertion is a routine procedure in the neonatal intensive care unit required for prolonged intravenous fluid, nutrition and medication support. Neonatal cardiac tamponade is a serious and rare complication of PICC line insertion. Early detection by point of care ultrasound (POCUS) and management by pericardiocentesis improves the chances of survival. Regular simulation-based training sessions on a mannequin, along with knowledge of POCUS, can assist neonatologists and paediatricians for a quick and appropriate response in this emergency condition.