Biography:

Ganga S. Pilli is a Professor, Department of Pathology from KLE University, India.

Abstract:

Biography:

Robert Weiss is a retired aerospace systems engineer with a BME from CCNY and an MS from UCLA. Robert retired from his 41-year employment as aerospace systems engineer and manager to learn about lymphedema and its treatment to find informed medical care for his wife Pearl, then a 5-year survivor of breast cancer with lymphedema. He found his way through the medical and insurance wilderness where lymphedema was a condition that was mostly unknown, misdiagnosed, undertreated and underinsured. Bob used the knowledge he gained to become a lymphedema patient advocate and activist and continues to provide assistance to hundreds of cancer survivors and Medicare Beneficiaries with this chronic condition. Robert has assisted in the drafting and passage of lymphedema treatment laws in California, Connecticut, Georgia, Maryland, Massachusetts, New York and Virginia, and conducts research and writes on the cost-efficacy of lymphedema treatment.

Abstract:

Statement of the Problem. Treatment of chronic illness accounts for over 90% of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters’ estimations of expected claim costs for a larger general population with a range of severities, or for legislators’ evaluations of the costs of proposed mandates to cover treatment of lymphedema.

Methodology. The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004–2019, representing 80% of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate.  

Findings. The average actual annual lymphedema claim cost was $2.03 per individual contract and $3.54 per group contract for the years reported, representing 0.05 and 0.08 % of average total claims. The estimated premium impact ranged 0.16–0.32% of total average premium for all mandated coverage contracts. Office visits decreased 6.49% and hospitalizations decreased 16.47% over the 16-year period.

Conclusions. Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that treatment of lymphedema reduces costs of office visits and hospitalizations due to lymphedema and lymphedema-related cellulitis. Lymphedema treatment is a potent tool for reduction in healthcare costs while improving the quality of care for cancer survivors and others suffering with this chronic progressive condition.

Biography:

Steven Boon is from University of Michigan, USA 

Abstract:

In recent years, there has been a trend toward the protocolization of neonatal intensive care. While this may be beneficial in some areas such as feeding and infection control, it is potentially harmful with respect to ventilator management. Each baby is unique, and neonatal respiratory diseases are diverse and exhibit varying pathophysiology. Treating a very low birth weight infant with respiratory distress syndrome (RDS) the same way as a large, term baby with meconium aspiration syndrome (MAS) does at least one of them, if not both, a disservice. A ten-step pathophysiology-based approach to ventilator management will be presented to evaluate and treat newborn infants with respiratory failure. The emphasis will be on matching the therapeutic strategy to the underlying pathophysiology.

Biography:

Rana Alissa has completed her MD at the age of 24 years from Damascus University and pediatrics residency from University of Florida (UF) College of Medicine Jacksonville. She is an assistant professor  in the Pediatric department, division of neonatology. She is a third year fellow in Medical Informatics at UF. She published 8 papers majority about the health of newborns. She loves teaching and she earned numerous teaching awards. She created 43-page guide book for resident survival in the newborn nursery. She brought the oral glucose gel and donor milk to the newborn nursery which helped increasing breastfeeding rates 3-folds.  

Abstract:

Objectives: Whether optimizing physicians notes save time for patient care, improve providers satisfaction and patient safety.

Methods: 4 note types were optimized in our Mother-Baby Unit (MBU): History and Physical (H&P), Discharge (DC) summary, progress notes (PN), and hand-off list. Free text elements documented elsewhere in medical records (e.g. delivery information, maternal data, lab result...) were identified and replaced with dynamic “SmartLinks” that populate portions of the note. Remaining free text elements that could be replaced with “SmartLists” were identified. The new note templates (NT) were given new SmartLinks to improve accessibility.                                                                                                                                9373 infants admitted to MBU between 1/2016-9/2019. Average Length of Stay (LOS) was 2 days. Every infant averages 4 notes: H&P, PN, DC summary and hand-off. New and old NT were completed for same infant by 10 residents. Actions taken (clicks, keystrokes, transitions and mouse-Keyboard switches) were documented.                                                                  Survey was sent to providers regarding satisfaction. Incident reporting was tracked.                        

Results: 69 actions were saved when comparing the new and old NT completion. H&P: 11, PN: 8, D/C summary: 18, Handoff: 32. Time spent was documented in seconds.                                                                                         

The new NT took shorter time. Time saved was divided by the number of actions saved: 20 seconds saved per action.                                                                    

Discussion: Introducing Electronic Health Records into health care intended to improve patient care and organizational efficiency. However, not optimized NT require spending longer hours behind computers, shorter time with patients, suboptimal patient safety, providers dissatisfaction and physicians burnout.

Conclusion: Optimizing physicians notes saved time, improved providers satisfaction and patient safety.

Biography:

Steven M. Donn is from University of Michigan, USA. 

Abstract:

Bronchopulmonary Dysplasia is the most common long-term respiratory morbidity of preterm infants.  While its pathophysiologic and histologic features have changed over time as neonatal demographics and respiratory therapies have evolved, it is now thought to be characterized by impaired distal lung growth and abnormal pulmonary microvascular development.  It is believed to result from inflammatory and mechanical/oxidative injury from chronic ventilatory support in fragile, premature lungs susceptible to injury from surfactant deficiency, structural abnormalities, inadequate antioxidant defenses, and a chest wall that is more compliant than the lung. In addition, non-pulmonary issues may adversely affect lung development, including systemic infections and insufficient nutrition.  Once BPD has developed, its management often involves treatment with a wide variety of agents despite an alarming lack of evidence for either safety or efficacy, including anti-inflammatories, diuretics, steroids, pulmonary vasodilators, antioxidants, and molecules involved in the cell signaling cascade.

Biography:

Abstract:

Aims

A young man was admitted to the ward with serious injuries acquired while ‘tombstoning’. Several of his friends were also airlifted to a nearby intensive care unit. This lead us to conduct a literature review in order to analyse the risks and injuries associated with this activity.

Tombstoning is an unregulated activity whereby individuals jump or dive from a height, often sea-cliffs, piers or bridges into water. The aim is to enter the water upright and straight, like a tombstone.

Methods

We used the pubmed search terms ‘tombstoning’ and ‘cliff jumping’. We also used newspaper articles and analysed their data sources.

Results

There were very few specific tombstoning injuries reported in the medical literature, however there were many reports in the ‘popular press’ and ‘social media’.

• Tombstoning is a popular activity amongst thrill seeking adolescents across the world, and is deemed to be a high-risk, high-impact activity, being described as a ‘dare-devil activity’ or ‘deadly craze’
• It may be difficult for jumpers to gauge water depth which can be unpredictable and alter with the tide, being shallower than initially thought
• Submerged objects such as rocks or other sharp objects may not be visible and may cause serious impact injuries
• Cold water shock can make it difficult to swim and strong currents can rapidly sweep people away
• Many are persuaded to jump as a result of peer pressure and may do so under the influence of alcohol or drugs, which may further affect judgement, and ability to get out of the water
• Trying stunts may make the practice more perilous
• News reports frequently recount life-changing injuries (head, neck, limb, spinal), many occurring in teenagers. In the UK there have been over 20 fatalities since 2005, with many more requiring an emergency response

Conclusion

Tombstoning is a potentially dangerous activity. Health professionals should educate adolescents about its potential risks – ‘don’t jump into the unknown’ and ‘consider the dangers before you take the plunge’.

Biography:

Aditi Desai is from NHS England, UK

Abstract:

Statement of the Problem: In UK, retained swabs after vaginal birth and perineal suturing are classed“Never events.1 Retained vaginal swabs have accounted for around 30% of retained foreign object -‘never events’(events that should never happen) reported annually for a number of years.2  Retained vaginal swab post-delivery could cause significant morbidity .The patient may experience serious physical and psychological complications including infection, secondary post-partum haemorrhage, sepsis, depression, lack of bonding with their baby and loss of trust in the healthcare system.3

Although it is a rare event, there has been a case report of a maternal death from it. A retained swab is a ‘Never event’.NHS improvement data (2019)-retained foreign object is the second most commonly reported never event. Vaginal swabs are the most common retained foreign object reported and the surgical swabs, the second most common.

Solution: iCount is a docking device anchoring all the swabs thereby making it impossible to leave a swab behind. It provides a seatbelt plug-in system whereby each swab tail has a plastic clip at the end which plugs into the device displaying a green indicator when all are plugged in and a red indicator when one or more are disconnected. The aim is to ensure that all swabs are returned and not retained in the patient.

Cost Consequence Analysis(CCA):

Cost consequence analysis (CCA) is an economic evaluation type which assesses a wide range of costs and consequences of the intervention. It includes all types of effects including health non-health negative and positive effects of patients and other parties giving decision-makers a comprehensive summary of the costs and effects.

Advantages: Simple broken-down (disaggregated) summary of costs and effects of the device. Includes a broader range of effects than other analyses, such as user experience and convenience of care

Disadvantage: may be less generalizable because the choice of relevant costs and effects and the weighting attached to them is often context-specific.

References

1. NHS England. Never Events List 2018/2019.
2. NHS Improvement. Never Events reported as occurring between 1 April 2017 and 31 March 2018 – final update. 2019.
3. Mahran, M. A., Toeima, E. & Morris, E. P. (2013) The recurring problem of retained swabs and instrument . Best Practice and Research: Clinical Obstetrics and Gynaecology, 27 (4): 489-495.
4. Health and Safety Executive. (2019) Frequently asked questions- what is the hierarchy of control? [Online] Available at: http://www.hse.gov.uk/risk/faq.htm#hierarchy
5. NIHR article on Cost consequence analysis

Decision Problem, Model structure and pathways

Population: Women undergoing vaginal birth, Alternative population of people undergoing abdominal surgery available in the model

Intervention: iCount device system with surgical swabs/surgical tampon

 Comparator: Standard care comprising of standard 5 surgical swabs

Perspective: NHS- Outcomes Costs, Economically justifiable price of the device   (break-even price)

The unit costs included within the model were taken from national databases, including:

PSSRU for the costs of contact with various healthcare providers

National Schedule of NHS costs for appointments in secondary care

BNF for the costs of drugs

Litigation costs are based on data provided in response to a freedom of information request (FOI reference number 3352 NHSLA litigation claims)

This model was presented in a focus group of Obstetricians, Midwives and Nurses. The data was modified to represent some probabilities more realistically and a graph was plotted:

Limitations: this model uses many inputs which have values based on assumptions(usual with an early model). The model takes an NHS perspective and does not capture cost borne by the patients i.e. personal legal costs. It also assumes that there are no longer term impacts such as mental health disorders. Successful litigation claims may increase hospital payments to NHS resolution which have not been accounted.

Conclusion

This will help the decision maker understand how iCount compares to standard care for each individual cost and effect component by understanding the incremental differences. The CCA helps to refine economic methods, identify relevant costs and outcomes and generate hypotheses for definitive cost-effectiveness studies. It provides a broader and richer source of economic information increasingly needed by NHS decision makers. It will help to focus further health economic evaluation.

Biography:

Geetanjali Sageena is an Assistant Professor in Department of Environmental Studies in Keshav Mahavidyalaya at University of Delhi, India. Her research interests are focused on Human Health, Sustainability, Environmental Changes, behaviors and other related aspects.

Abstract:

Biography:

Abstract:

Statement of the Problem: Metabolic changes in Type-2 Diabetes-Mellitus (T2DM) make patients more prone to develop osteoporosis and delayed bone healing. We hypothesize that microRNAs could be involved in the underlying mechanism and used as biomarkers in this context. To test this hypothesis, we analyzed microRNAs in samples from Zucker Diabetic Fatty (ZDF) rats, a T2DM model with reduced bone healing and bone mass. Methodology & Theoretical Orientation: 11-week-old male ZDF and wildtype rats with an induction of bone healing by a femur subcritical defect were treated with placebo, anti-sclerostin, PTH and insulin treatments for 12 weeks and serum and ulna samples were then obtained (n = 5-8 per group). RNA isolation and small RNA next generation sequencing (NGS) were performed using serum and ulna samples for untargeted genome-wide miRNA analysis. Significantly (adj. p<0.05) regulated miRNAs identified by NGS were validated by RT-qPCR. 2-way ANOVA analysis was applied to test for regulation in respect to T2DM and anti-osteoporosis treatment (p<0.05). Pearson correlation analysis was performed to identify correlation between microRNA levels and metabolic data and bone imaging by micro-CT (p<0.05). Conclusion & Significance: Significant increases in serum levels of miR-122-5p, a liver-enriched microRNA linked to T2DM, were observed in ZDF rats, supporting previous findings. In ZDF diabetic rats, miR-375 showed the highest up-regulation (up to 4-fold) in serum. In ulna samples, similar expression patterns (Figure 1) were observed, and miR-375 levels were found to be negatively correlated (p<0.05) to several bone structural parameters, suggesting that the de-regulation of miR-375 could contribute to decreased bone quality in T2DM.

Biography:

Albert Lee is Professor of Public Health and Primary Care and Founding Director of Centre for Health Education and Health Promotion of the Chinese University of Hong Kong.  He also holds Honorary Professorship at Faculty of Education of University of Hong Kong and Adjunct Professorship of Applied Health Science at Indiana University, USA.  Albert qualified as medical doctor at University of London, UK in 1984 and possesses higher professional and academic qualifications in Public Health, Family Medicine, Education, Law and Dispute Resolution, Legal Medicine from academic colleges and institutions in Australia, Britain, Hong Kong, Ireland, USA.  Albert’s research interests include community-based care, health equity, healthy cities and healthy school, legal medicine, human rights, conflict management, legal issues in education and social care, and quality of life with over 250 publications in peer review journals. Albert was elected as international member (academician) of National Academy of Medicine USA in 2012.  He served as Member of Forum for Investing in Young Children Globally (iYCG) of NAM during the period 2013-16 and chaired the iYCG workshop in Hong Kong in 2015.  He was elected as Honorary Fellow of UK Faculty of Public Health, UK. Albert also obtained law degree at Univerity of London in 2015 and completed legal practical training in Australia and admitted as Lawyer by New South Wales Supreme Court in 2021.

Abstract:

Brief outline of presentation

Shattuck lecture by Freiden discussed the future of public health pyramid (Frieden, 2015) addressing the complexity of public health problems resulting from social, economic, political, biological, genetic and environmental causes. Intersectoral collaboration, community participation, innovation, and setting approach are important instruments to initiate and promote changes. The “Healthy Setting” approach attempts to make changes for better health in the context of their living environment where they live, work, study and seek initial help for health issues.  It can provide a framework in which policy, environment, social matters, behavioural and biomedical interventions can take their rightful place side by side.  The review by Sir Michael Marmot of health inequalities in England identified the importance of linking knowledge to action to ensure all children, young people and adults maximising their capabilities and having control over their lives; and creating and developing healthy and sustainable places and communities as well as strengthen the impact of ill-health prevention (Marmot, 2012). “Healthy setting” would facilitate policies development along this direction in promoting health in settings such as Health Promoting School and Healthy Cities.  Indicators are needed to establish evidence-based health promotion for children and adolescents and their families in school and community setting (Lee et al, 2019; Lee and Nakamura, 2021).  This can facilitate building the concept of “Health Setting” into day to day operation of the respective setting so “Health in All” policies can be implemented effectively.  This can also help to achieve the United Nation Sustainable Development Goals 2030 (UN, 2015).

Biography:

Syeda Asma Sherazi is currently working in a tertiary care hospital where she gets exposure of different kind and severity of pediatric patients. She has special interest in malnutrition as this is one of the leading cause of morbidity and mortality in developing countries. She firmly believes that well nourish child in early years of life can contribute towards a healthy society and nation building in future with focused, appropriate planning, effective intervention and execution. This need more attention on national as well as international level.

Abstract:

Malnutrition is one of the major risk factors related to pneumonia in children younger than 5 years of age. Undernutrition in a child with severe pneumonia requiring hospitalization can be associated with a diminished metabolic capacity to overcome physical and physiological demands of the illness, such as increased temperature, cardiac output, and work of breathing. Consequently, the presence of severe acute malnutrition can increase mortality from pneumonia. Worldwide there are about 60 million children, with moderate acute and 13 million with severe acute malnutrition. About 9% of sub-Saharan African and 15% of south Asian children have moderate acute malnutrition. ⁽¹⁾⁽²⁾ Globally, pneumonia is the leading cause of death in young children and burden of disease is disproportionately high in South East Asia.⁽³⁾ Pneumonia is common in malnourished children and is frequently associated with fatal outcome especially in children younger than 24 months of age.⁽⁴⁾

The aim of this study is, improved understanding of the critical links between pneumonia and undernutrition.

Methodology: All children of either gender with admitting diagnoses of pneumonia and younger than 5 years of age and more than one month of age were included.  Demographic features were recorded on a pre-designed proforma and WHO calculator used for standard deviation.

Results: Among 381 children enrolled in this study, females were 120 (32%) while 261 (68%) were males. Infants (one month to 12 months of age) were 225 (60%) while 156 (40%) were more than 12 months to 60 months of age. Presence of stunting was observed in 75 (20%), wasting in 95 (25%), underweight in 147 (39%) and over-weight in 9 (3%).

In this study, stunting, wasting and under-weight was more prevalent in females. Comparison of leading factors with respect to baseline characteristics was done.  Children younger than 5 years of age (infants and older children) both were under weight but compared to infants (one month to 12 months age), older children (more than 12 months) were found to be more under weight.

Conclusions: Most of the children were under-weight followed by wasting, stunting and over-weight. Malnutrition including moderate and severe malnutrition, was important risk factor in children younger than 5 years of age admitted with pneumonia in tertiary care Aga Khan University Hospital.

Increased attention, and most important is resources directed at improving prevention as well as early identification and treatment of undernourished children with pneumonia is crucial. These children need close follow up to record the improvement after the intervention. Maternal and paternal education is must in this regard.

Biography:

Graeme O’Connor, Great Ormond Street Hospital Foundation Trust, London. Marie Watson, Sheffield Children's NHS Foundation Trust, Sheffield. Martha Van Der Linde,  Herefordshire and Worcestershire Health and Care NHS Trustr. Rita Shergill Bonner and Julia Hopkins, Evelina London Children's Hospital, London. Sharan Saduera, Nestle Health Science, Gatwick.

Abstract:

Blended foods via a feeding tube is becoming popular amongst parents of children requiring long term tube feeding¹. A tolerance and acceptability study for a new paediatric tube feed with food derived ingredients - Isosource Junior Mix (ISJMIX) was conducted in 2018 and found improvements in stool consistency/ frequency, retching and reflux ². A follow up study RICIMIX was conducted during March 2021 to July 2021 across four National Health Services Trusts (UK). Microsoft forms was used to capture anthropometric and gastrointestinal outcomes over a month period when patients switched feed to ISJMIX. Data was completed for 35 children, 19% had cerebral palsy and 19% had epilepsy as primary diagnosis.  The common route of feeding was bolus (57%) via a PEG tube (57%). Improvements seen with switch to ISJMIX included gagging, reflux and retching for 16 (46%) children; 13 (37%) gas/ bloating, 8 (23%) vomiting, 8 (23%) loose stools. Six (17%) children saw improvements with constipation resulting in a reduction or cessation of medication.  13 (37%) children reported improved weight within the one month study period. Interestingly, 12 (34%) children saw changes in feeding patterns such as less time spent on feeding, simplified feeding regimens enabling families to go on holidays. 29 (83%) of dietitians felt the new feed achieved tolerance goals for children. 30 (85%) of children experienced an improvement in feed tolerance within one week. Our clinical experience in this real-world evidence-type study showed meaningful improvements in paediatric patients fed with food derived  enteral formula.

Biography:

Abstract:

Nutrition of the child has a pivotal role in growth and development. Globally, 22.2% of the world’s children under five years are affected by stunting and 7.5% are wasted. The first two years of life are critically important. Multiple factors including maternal education, less access to basic health facilities, cultural norms, food myths, traditional practices without scientific basis, feeding diversity, and patterns influence complementary feeding in Pakistan resulting in sub-optimal feeding. The purpose of this study was to determine the frequency & reasons for early & late weaning and their association with wasting, being underweight, and stunting.

Methodology: All children of either gender from 6 months to 24 months who presented in outpatient clinics of Aga Khan University Hospital Karachi were enrolled. IYCF module was used for data recording.

Findings: Weaning was started at 6 months of age in 124 (59.9%) children, 39 (18.9%) children were started on weaning diet at <6 months of age while 44 (21.2%) children were started on weaning diet at >6 months of age.133 (64.3%) children were of normal weight, wasting was present in 1 (0.5%) children and 73 (35.3%) children were underweight.Stunting was seen in 44 (21.3%) children whereas, 163 (78.7%) children were of normal height.Most common reason of early weaning was difficulty in feeding 50 (24.2%) children, whereas most common reason for late weaning was bottle feeding that was seen in 45 (21.7%) children.

Conclusion: Malnutrition in the form of stunting and underweight was present in our children, despite of the fact that majority of mothers started weaning at appropriate age. Provision of maternal education and knowledge about feeding practices along with proper timing of weaning can significantly improve height, weight, and cognition of children.

Biography:

Ganga Pilli is from KLE University, India.

Abstract:

Biography:

George Guiton is an F2 Doctor in Dorset County Hospital NHS Foundation Trust, United Kingdom.

Abstract:

Aims

Wild water swimming in lakes, resevoirs, rivers and canals is becoming increasingly popular with both adults and adolescents, particularly with Covid restrictions limiting swimming pool use.

A literature review was conducted to look at the risks of this activity.

Results

There were few relevant studies in the medical literature, although there were many educational articles in the media, outlining potential hazards.

• Although the number of accidental drowning deaths in the UK has fallen over recent years, there has been an increase in inland downing with over 150 deaths per year.
• There are more inland drownings than costal drownings
• Drowning is a male dominated issue, with a ratio of seven males to one female, and many victims are teenagers
• Individuals with alcohol or drugs in their system are at increased risk
• Unregulated environment with varying conditions  - spots that are safe for swimming one day may be treacherous the next
• Cold water and hypothermia – swimming in cold water reduces body heat, reduces swimming ability and impairs judgement. Reduced swimming capability is the major cause of drowning, particularly in lakes where swimmers may attempt to reach the other side but be unable to do so
• Cold-shock – a series of cardio-respiratory responses occur as body enters very cold water, particularly when diving into deep water. Effects are potentially fatal
• Weeds – common in slow, warm lowland rivers and lakes and have the potential to entangle a swimmer’s legs. This may result in a panic reaction with subsequent drowning
• Currents - if unable to swim upstream against the flow of water in a river, a swimmer will be unable to get back to their entry point, and may struggle to get out of the water due to downstream obstructions. Identifying an exit point before getting into the water is important. Currents can be especially powerful directly under large waterfalls or weirs, with water flowing in two directions with breaking waves, and the potential for rip-tides developing, which may be dangerous
• Jumping and diving – water depth may vary and there may be underwater obstructions such as rocks, fallen trees, or rubbish which may trap swimmers or be hazardous to land on. Undercurrents directly below large waterfalls or weirs may hold swimmers underwater, which may prove fatal
• Skin rashes - cercarial dermatitis may occur as a result of contact with small snails that live on the reeds around marshy lakes and stagnant ponds. It may cause intense itching but does not require specific treatment. Blue–green algae, found in lowland lakes may multiply after warm wet weather,  with ‘blooms’ collecting which may cause irritation of the eyes and skin
• Leptospirosis – Weil’s disease may occur as a result of swimming in a river, canal or lake that contains urine from infected rats. Open wounds should be covered and eyes, nose and mouth should be kept out of the water as much as possible. If flu or jaundice occurs after swimming in high risk water, investigations for leptospirosis should be undertake. If untreated Weil’s disease may be fatal.

Conclusion

The risk profiles of wild water swims varies. Some warm shallow lakes and river pools are quite warm in the summer, with still water and are relatively safe. Other waters may be very cold and have strong currents. Individuals should be free to swim wild, but should make a ‘risk assessment’, each time they go swimming. Both adolsecents and adults should be advised of the potential risks and taught some basic rescue skills, to help reduce the number of lives lost unnecessarily to water.

Biography:

Abstract:

Biography:

Saheli Dasgupta is a Senior register in department of neonatology in AMRI hospitals, Mukundapur(2019 – 2020) Senior resident in department of pediatrics in South Howrah State General Hospital(2018 – 2021).

Abstract:

Scrub typhus is a life threatening zoonosis caused by Orientia tsutsugamushi transmitted by the larvae of trombiculid mites. It is characterised by focal or disseminated vasculitis and perivasculitis involving the lungs, liver, spleen and central nervous system. Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal syndrome resulting from dysregulated activation and proliferation of lymphocytes. Infections like cytomegalo virus (CMV) and Epstein-Barr virus (EBV) are important triggers for hemophagocytosis. Here we present an 8 year old boy with fever, maculopapular rash, hepatosplenomegaly and lymphadenopathy who was admitted in our institution and diagnosed with Scrub typhus. Physical and laboratory data showed hepatosplenomegaly, bicytopenia, hyperferritinemia, and hypofibrinogenemia. Secondary HLH was diagnosed and the child was managed with IVIG and steroids. In view of history of rash followed by lymphadenopathy and hepatosplenomegaly EBV serology was also sent as a cause of HLH. Surprisingly, EBV panel was also positive (EBV IgM, EBV IgG, EBCA, EBEA, EBNA). Our study concluded that EBV triggered secondary HLH in scrub typhus positive child This phenomenon is supported in few adult studies. Another hypothesis is EBV can be triggered in critically ill patients. To the best of our knowledge this is the first such case in the pediatric population reported in the English literature till date.