Indian Journal of Neonatal Medicine & Research

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Variations in the Shape and Dimension of the Suprascapular Notch in Dried Human Scapula-An Osteological Study with its Clinical Implications

Apurba Patra, Manjeet Singh, Harsimarjit Kaur

Introduction: The suprascapular notch is a depression on the superior border of scapula which gives passage to the suprascapular nerve to enter the supraspinatus fossa. During its course there is a chance of entrapment of the nerve while in the notch due to its variant shapes and dimensions which leads to suprascapular nerve entrapment syndrome Aim: The purpose of the study was to determine the variations of the shape and dimensions of suprascapular notch of scapula because these parameters may be the causative factors in nerve compression. Materials and Methods: A total 110 dried human scapula of both sides were included in the study. First they were grossly examined for variations in shape of the notches. Then vertical and transverse dimensions of the notches were measured with the help of digital vernier calliper. Results: As per classification by shape we found 43 ‘J’ shaped (39.09%), 35 ‘U’ shaped (31.81%), 10 ‘V’ shaped (9.09%), indentation in eight cases (7.27%), absent in five (4.54%), partial ossification of STSL in four (3.63%) and complete ossification in five (4.54%) scapulae. The results were also analysed according to Natsis classification after excluding the Scapulae with indentation and partial ossification of ligament. Five (5.1%) scapulae Type I, sixty six scapulae (67.34%) had Type II, 14 scapulae (14.28%) had Type III, five (5.1%) had Type IV and none (0%) had Type V. We also found eight scapulae (8.16%) with transverse diameter equal to the vertical diameter (Td=Vl). Conclusion: The present study showed various types of suprascapular notches. Out of these Iqbal type ‘U’ and Natsis type II were most predominant. In both the cases chance of suprascapular nerve compression is less as more space is available to the nerve. The present study also showed five cases of completely ossified STSL where chances of impingement are higher. Since, these anatomical variations are not uncommon in population so there is a need for clinicians to have precise anatomical knowledge of SSN before making proper diagnosis and planning for surgical interventions of suprascapular nerve entrapment syndrome. We hope our study will be helpful in providing anatomical knowledge to the clinicians.

Multislice Computed Tomography Imaging with Clinical Outcome in Inflammatory Appendiceal Masses

Varsha Rangankar, Abhijit Pawar, Aditi Dongre, Brig Hariqbal Singh

Introduction: Appendicular lump is a serious complication of appendicitis presenting clinically with right iliac fossa mass which has a range of differential diagnosis. Diagnosis of complicated appendicitis and appendicular lump is often difficult and challenging. Computed tomography imaging has an important role in diagnosis and differentiation of appendicular mass. Aim: The purpose of this study was to assess the computed tomography imaging features of inflammatory appendiceal masses. Materials and Methods: Multislice computed tomography (MSCT) images of total 56 patients of inflammatory appendiceal masses were retrospectively analyzed during the period of October 2011 to November 2015. Contiguous axial CT sections obtained before and after injection of iodinated intravenous contrast medium were analyzed. Oral and rectal contrast was also administered in all patients to opacify the bowel. Images were evaluated for inflammed appendix, appendicolith, extraluminal fluid collections, inflammatory phlegmon formation, extraluminal air, fat inflammation, fascial thickening, bowel aggregation, bowel wall thickening and enlarged lymph nodes. Results: Fifty six patients of inflammatory appendiceal masses with mean age 41-50 years were identified which included 31(55%) men and 25 (45%) women. The inflamed appendix could be identified in the inflammatory mass in 22 cases (39%) with appendicolith seen in 12 cases (21%). Extraluminal fluid collections were seen in 35 patients (62.5%) with walled-off collections with enhancing walls labelled as abscesses were seen in 26 cases (46%). Inflammatory phlegmonous mass was seen in 38 cases (68 %) while adjacent ileocecal wall thickening was seen 22 cases (39%). Omental thickening and fat inflammation was present in 46 out of 56 cases (82%) with adjoining aggregated small bowel loops were seen in 36 cases (64%). Extraluminal air pockets were seen in 31 patients (55%). Out of 35 patients with extraluminal fluid collections, 24 were drained percutaneously under image guidance which included 15 patients labelled as abscess. In five patients, the collections were small in size and resolved with conservative treatment. Nineteen patients including four patients with large abscesses and pelvic extensions underwent laparotomy. Conclusion: Appendicular mass is a serious complication resulting from perforation of inflammed appendix, showing inflammatory phlegmon and/or extraluminal fluid collection with associated imaging findings. Computed tomography is highly useful in diagnosis and differentiation of appendiceal masses and deciding the management approach.

Analysis of Retinal Nerve Fibre Layer and Optic Nerve Head by Optical Coherence Tomography in POAG

Incidence of Acute Renal Failure (ARF) in Birth Asphyxia and its Correlation with Hypoxic Ischemic Encephalopathy (HIE) Staging

Ganavi Ramagopal, Ganesh Narayana, R. Premalatha, Gangadhar B. Belavadi

Introduction: Acute kidney injury (AKI) previously known as Acute renal failure is a recognized complication of neonates with perinatal asphyxia. In all asphyxiated neonates emphasis must be laid on early recognition of AKF, so that it paves a way for timely and appropriately management thereby preventing consequences of irreversible renal failure. Aim: To determine the incidence of Acute renal failure in birth asphyxia and to correlate the severity of renal failure with and HIE grading of asphyxiated neonates. Materials and Methods: A case control study was conducted for a period of 1 year, where 100 term (37-42 wks) neonates born with Apgar score of 7/<7 at 5 minutes after birth were selected as cases and 50 normal term (37-42 wks) neonates as controls. Sarnat and Sarnat staging was used for HIE. After 72 hrs and before 96 hrs of life blood was collected and sent for relevant investigations and clinical condition of the baby and urine output was monitored and data was collected in predesigned proforma after informed consent. Results: Incidence of ARF is significantly more in cases (75.0% vs. 4.0%) 18.4 times more likely when compared to controls. Among the 75 cases which had acute renal failure , 64 (85.3%) had pre-renal ARF and 11(14.6%) had intrinsic ARF , and based on urine output 24 (32.0%) had oliguric ARF and 51 (68.0%) had non oliguric ARF and among the 50 controls 2 neonates had pre-renal and non-oliguric type of ARF. Incidence of ARF had a strong correlation with HIE staging. Conclusion: ARF in birth asphyxia is predominantly pre-renal ARF and responds to fluid challenge and it is of non oliguric type. ARF in birth asphyxia correlates well with HIE staging. Mortality is more in intrinsic ARF. Early diagnosis and management of renal failure helps in prevention of intrinsic renal failure and its consequences.

USG Doppler Study of Uterine, Umbilical and Foetal Middle Cerebral Arteries Among Severe Pre-Eclamptic Women and their Relation to Perinatal Outcomes

K.S. Vedaraju, Suresh S Kanakannavar

Introduction: Pre-eclampsia is a condition in pregnancy characterized by the onset of hypertension and proteinuria after 20 weeks of gestation. This affects multiple organs in mother and also has a significant impact on the fetus. The extensive changes caused by pre-eclampsia result in complications leading to fetal jeopardy, such as placental abruption, fetal growth restriction, pre-term birth, respiratory distress and Intra uterine demise (IUD). The definitive treatment of pre-eclampsia is termination of pregnancy and initiation of treatment is crucial. Doppler ultrasonography (USG) is non-invasive and can be done along with the routine obstetric scans and is therefore considered safe and suitable for the study of blood flow alterations caused by severe pre-eclampsia. Not only would it serve as a predictive tool, it would also help plan subsequent management of the pregnancy, based on fetal health. Aim: To study the changes in uterine, umbilical and foetal middle cerebral arteries in severe pre-eclampsia, using Doppler ultrasonography and to provide basis for use of Doppler tests in directing treatment protocol of severe pre-eclampsia Materials and Methods: In this study, women with severe pre-eclampsia near term were selected based onset criteria and detailed history was obtained. USG Doppler was performed for each of the patients and the results were recorded. They were further followed till parturition to study the perinatal outcomes. Doppler study results and perinatal outcomes were considered together to find a correlation. Results: It was found that 21 out of 26 patients (81%) showed abnormal Doppler results and 19 out of 26 cases (73%) suffered from adverse perinatal outcomes. 5 of them (19%) had suffered from intra uterine demise (IUD). Uterine artery showed restricted flow in 6 cases (23%), umbilical artery showed reduced flow in 12 cases (46%) and foetal MCA showed abnormal flow in 20 cases (77%). Conclusion: There is a good correlation between doppler results and adverse perinatal outcomes and we have found that the umbilical artery flow velocimetry is the most sensitive to predict the same.A treatment plan can be initiated based on the findings to keep both mother and child safe.

Atypical Brain Calcifications Causing Seizure-Imaging Appearances

Nellaiappan Chelliah

Introduction: Brain calcification causing seizure disorder is a common clinical condition. Calcification may be single or multiple. Seizure cases with calcifications reported in our institute are analysed in this article. There is diagnostic challenge if calcifications are multiple or in atypical locations. The Imaging appearances of calcification in CT, MRI help a lot to arrive at definitive diagnosis. Aim: To analyse the imaging appearances of brain calcifications causing seizure and to find out the commonest etiology and age group most commonal affected. Materials and Methods: This is a retrospective analytical study of six months period from June 2015 to November 2015. The study was done in the Radiodiagnosis Department of Tirunelveli Medical College Hospital. In our institute, 3600 cases of CT brain have been taken in above period for various conditions. In which seizure patients with pathological calcifications who also underwent MRI brain were selected for the study i.e. sample selection. Total 78 patients were selected for analysis. The findings were analyzed and hereby are presented. Results: Most of pathological calcifications belong to age group 21-40. Tuberculomas and tumors account for about 50% of cases. Both genders are equally affected. In MRI, T2*GRE sequence plays major role in identifying areas of calcification. Rare cases like unilateral hemispheric multiple cavernous angiomas, hypoparathyroidism and hemophilia sequlae are noted in this study. Conclusion: The location of calcifications, extent, perilesional changes in the scans help to narrow down the differential diagnosis. MRI confirms the cavernous malformations. CT-scan is helpful for detecting calcifications. MRI is useful for diagnosing pericalcific parenchymal changes. Metabolic disorders should be ruled out if there is extensive bilateral cerebral and cerebellar calcification. Clinical history is very important for imaging interpretation as evident by the hemophiliac case.

The Role of Magnetic Resonance Imaging in the Evaluation of Trigeminal Neuralgia

Introducation: Trigeminal neuralgia is characterized by electric shock-like pain, abrupt in onset and brief, in the distribution of one or more divisions of the trigeminal nerve. Trigeminal neuralgia can occur due to lesions affecting trigeminal nerve, either vascular, neoplastic, infectious or inflammatory. Neurovascular compression is found to be the cause in most cases. Aim: The aim of this study is to study and classify brain magnetic resonance imaging findings in patients aged >18 years who presented with clinical symptoms of trigeminal neuralgia. Materials and Methods: Clinical records and imaging studies of 75 patients between the ages of 18-60 years who presented to the Dept of Radio-diagnosis, BMCRI for brain magnetic resonance imaging during May 2014 to May 2015 were analyzed retrospectively. Results: Neurovascular compression at the root entry zone was found to be the most common cause of trigeminal neuralgia in our study. Some of the other causes that were identified in our study include cerebellopontine (CP) angle tumors, brain stem infarct, multiple sclerosis (MS), etc. Conclusion: The role of magnetic resonance imaging in the evaluation of trigeminal neuralgia is to identify those causes that are amenable to surgical treatment such as neurovascular compression and tumors.

Role of 64- Slice MDCT-Coronary Angiography in the Evaluation of Various Coronary Artery Pathologies: Comparison with Catheter Coronary Angiography

Introduction: MDCT-Coronary angiography is one of the common investigative modality used for evaluation for coronary artery pathologies like coronary artery diseases, coronary artery anomalies and postoperative cases like coronary artery bypass graft. In this study we compared the findings of MDCT coronary angiography with the gold standard catheter angiography in evaluation of various coronary artery pathologies. Aim: To evaluate the role of 64- slice MDCT-Coronary angiography in the evaluation of various pathologies involving coronary arteries and to compare the findings with catheter coronary angiography. Materials and Methods: This was a prospective study and 40 patients were randomly selected for CT- coronary angiography who also underwent catheter coronary angiography within 7 days. The results of CT-coronary angiography were compared with that of catheter coronary angiography. CT studies were done on 64- slice CT scanner. Results: There were 28 cases of coronary artery disease, 4 cases of abnormalities of origin and course of coronary arteries, 1 case of coronary artery aneurysm, 2 cases of post coronary bypass surgery, 1 case of coronary stenting and 4 cases were completely normal. The overall sensitivity, specificity, positive predictive value and negative predictive value for detection of more than 50 % stenosis by coronary CT angiography were found to be 88 %, 92 %, 91% and 88% respectively. Conclusion: Non invasive 64-slice CT coronary angiography as a vascular imaging technique can be performed rapidly and safely for the assessment of many different pathologies involving coronary arteries. There are only few studies available in literature using 128-Slice CT which says 128-Slice CT has only slightly increased sensitivity and specificity values when compared to 64- Slice CT. The results obtained with 64 slice CT are comparable to that of 128-Slice CT-scan.

Ultrasound-Guided Percutaneous Nephrostomy: How to Select Technique?

Huan Wang, Chuang Cao, Chang-hui Wang, Xing-qiu Fan, Jiang-ya Zhong

Introduction: Ultrasound guided percutaneous nephrostomy (PCN) is a safe and effective treatment option for obstructive uropathy. Several techniques have been described in documents. However, the recommendation of PCN technique has not been proposed. Aim: To determine the success and complication rates of ultrasound guided PCN. Meanwhile, we attempt to determine a baseline value in order to orient surgeon to select an optimal technique preoperatively. Materials and Methods: This was a retrospective study conducted at Department of Urology of the First People’s Hospital of Yueyang City, China. Total 150 PCNs under ultrasound guidance were analyzed. Two puncture techniques were used. In Seldinger technique (ST), ultrasound-guided puncture needle was inserted into the calyx; a drainage catheter was placed following the guidewire. In one-step technique (OT), the drainage catheter set was inserted directly into the collecting system under ultrasound guidance. Statistical Analysis: A statistical analysis was performed using the SPSS software package (versions 19.0). Results: Total 53 PCNs were performed using Seldinger technique, and 97 PCNs were performed using one-step technique. The ST group had higher technical success rate (100% vs 87.6%, p =0.008). The ST group also obtained higher success rate in <3 cm hydronephrosis subgroup (100% vs 44.4%, p<0.05). The success rate in =3cm subgroup was similar (100% vs 97.5%). The overall complication rate was 15.1% in ST group and 43.3% in OT group (p<0.05). The major complication rate was 1.9% vs. 13.4% (p<0.05). The minor complication rate was 13.3% vs 29.9% (p<0.05). Conclusion: Ultrasound-guided PCN is an effective and safe treatment method for obstructive uropathy. The Seldinger technique can effectively achieve success in all possible situations and is superior to the one-step technique when hydronephrosis is <3cm. One-step PCN is an effective and safe procedure in selected patients with hydronephrosis =3cm. We recommend 3cm of hydronephrosis should be an acceptable baseline for technique selection.

Role of Cranial Ultrasonography in Evaluation of Brain Injuries in Preterm Neoanates

Introduction: Preterm neonates have more likelihood of having neurological abnormalities due to intracranial hemorrhages, perinatal asphyxia and congenital anomalies. Early recognition of these conditions is important for proper management. Cranial ultrasonography can be used to diagnose such conditions at the bedside. Aim: The present study was undertaken with objective of detecting and grading brain injuries using neurosonogram and to evaluate the possible use in determining the prognosis and outcome at the end of the study. Materials and Methods: This was a prospective study conducted over a one year period in the pediatric Hospital, tertiary care Institute in North West part of Rajasthan (Bikaner). A total of 62 preterm babies with suspected neurological injuries were included in this study. Neurosonogram was carried out within 1 week of birth and at the end of 1 month follow-up scan was done. Results: Incidence of CUS abnormalities in preterm neonates is 16.1% in the present study. There were 62.9% male and 37.1% female neonates.11.2% of these had evidence of intracranial bleed, 1.6% periventricular echogenecity, 1.6% had ventriculomegaly and 1.6% had periventricular leukomalacia. Most common clinical presentation was seizures followed by absent suckling and lethargy. Brain injuries were found mostly in babies born before 32 weeks. The most common abnormality was grade I GMH (about 27.4%). Conclusion: Neurosonogram is the best initial method of investigation for preterm babies with suspected neurological injuries. It is best toper form neurosonogram studies on preterm babies within 1st week of birth and follow-up scan at the end of 1st month. It is non-invasive, non-ionising, widely available, cheap and repeatable.

Morphological Analysis of Proximal Gastrocnemius Muscle – A Study in Thirty Adult Human Cadavers

Upasna, Amandeep Singh Nar, Ashwani Kumar, Atul Mishra, Ashvind Bawa

Introduction: The calf mussles are formed by large gastrocnemius muscle and smaller soleus muscles. The “belly” of calf muscle is an example of fusiform muscle. It is formed by gastrocnemius muscle which is having two heads called caput mediale and caput laterale. The present study of proximal attachments of heads of gastrocnemius muscles in thirty adult human cadavers was done to discuss surgical relevance of morphological variations in the origin of gastrocnemius. Correlation of length of muscle belly with the muscle flaps for defects over anterior tibia and knee joint has been discussed. Aim: To discuss surgical relevance of morphological variations in the origin of gastrocnemius. Materials and Methods: Material comprised of 60 lower limbs belonging to 30 embalmed adult cadavers of known sex obtained from Government Medical College, Amritsar. The muscles of posterior compartment of leg were exposed by dissection steps provided by Cunningham’s manual of practical anatomy. Origin of both the heads was traced as well as their lengths were taken. An attempt was made to explain the variants. Results: There was musculotendinous origin from the posterior aspect of head of fibula (6.6%), fibres were merging with the fibres of plantaris in 13.3% cases, however, its origin was not from the lateral supracondylar line in 3.3% cases. Sesamoid bone was observed within proximal attachment of lateral head of Gastrocnemius in 13.3% caeses. Fibres of medial head of gastrocnemius were observed to have an origin from fascia over Adductor magnus in 6.6% cases. Medial head was normal in origin in rest of the limbs. The medial head was longer than the lateral head in 48(80%) limbs with an average length of 16.25 cm. Conclusion: Anomalous proximal attachments of Gastrocnemius muscle and accessory slips can be there at the level of knee joint. Both MRI and ultrasound can detect anatomical variants. Length of muscle bellies can be a useful guide to the surgeon performing myocutaneous flaps and limb salvage procedures around knee joint. be a useful guide to the surgeon performing myocutaneous flaps and limb salvage procedures around knee joint.

Accuracy of Leukocyte Count and C-Reactive Protein in the Diagnosis of Acute Appendicitis –A Prospective Study

Srikanataiah Hiremath, Kishan A V, Kiran Kailas, Mahendra Kumar T

Introduction: Acute appendicitis is the most common abdominal surgical emergency. Misdiagnosis has a major impact in health care systems, as well as important legal consequences. The diagnosis of Appendicitis still remains a clinical dilemma. Even with the advances in medical field, there is no definitive method or tool to diagnose acute appendicitis. Aim: To evaluate the accuracy of Total Leukocyte Count and C - reactive protein (CRP) in the diagnosis of acute appendicitis. Materials and Methods: A prospective observational studywas conducted and 50 patients who underwent emergency appendicectomy were considered for the study. The sensitivity and specificity of TLC, CRP and HPE reports of the ressected specimens were tabulated. of 50 cases which underwent emergency appendicectomy. Chi-square/ Fisher exact test has been used to find the significance of study parameters. Results: Increased Total leucocyte count was seen in 88% cases and CRP in 80%. These values were also correlated with the histopathology reports to aid in the diagnosis. Conclusion: This study aims at taking into account TLC and CRP in the diagnosis of acute appendicitis, it also helps in analyzing how specific and sensitive an indicator it is in the prediction of acute appendicitis. The values of TLC and CRP will be compared with the histopathology reports of the resected appendix specimen.

Cadaveric Study of Lateral Circumflex Femoral Artery

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Study of Prognostic Indicators in Patients with Pseudoexfoliation Syndrome Undergoing Cataract Surgery

Imaging Appearances in a Case of Tumoral Calcinosis

Sushil G. Kachewar, Devidas S. Kulkarni

Tumoral calcinosis is an uncommon entity characterised by calcified para-articular masses as demonstrated most often on radiographs. It can occur at any age and is inherited as an autosomal dominant mode that has a variable clinical expression. Its biochemical hallmarks are hyperphosphataemia with normocalcaemia and normal renal function. It is only rarely that one comes across a disease which is so obvious in its clinical manifestations that it should easily be recognized and yet which is frequently misdiagnosed and dismissed as something else for example “foreign body reactions”, “old trauma”, “sebaceous cysts with secondary calcification”, “periarticular giant cell tumours” and “unknown embryonic tumours” to quote a few examples. As it has a potential to produce tumours weighing as much as 4,000 g, which are often multiple and cause pressure symptoms, which may necrose, recur after removal, cause considerable pain and morbidity and, may even endanger the of the patient, it is entitled to a little more “respect”. Unfamiliarity with tumoral calcinosis as well as the disease processes that mimic this condition; impedes the correct diagnosis thereby delaying the treatment, and an undue alarm could be raised, possibly leading to unwarranted surgical procedures. Hence, we all need to be familiar with this entity

An Unusual Finding of Double Fused Y-Shaped Loop of Ansa Cervicalis and its Clinical Significance

Shilpi Agarwal, Pooja Bhadoria, Neelam Vasudeva

The ansa cervicalis (AC) is a neural loop formed by union of superior root derived from ventral ramus of C1 through hypoglossal nerve and inferior root derived from ventral rami of C2 and C3. The aim of this case report is to emphasize the anatomical description and surgical importance of a rare variation of AC owing to its closeness with major vessels and nerves of neck. An unusual double fused Y-shaped loop pattern of ansa cervicalis was observed on the right side of the neck of a 50 years old male cadaver in which the inferior root had separate C2 and C3 components. The C2 component joined the superior root of AC to form the Y-shaped superior loop. The stem of the superior loop joined the ventral rami of C3 root to form the inferior loop. Knowledge of variations in origin, course and pattern of distribution of ansa cervicalis is important since the branches of ansa cervicalis are often chosen for laryngeal reinnervation of the laryngeal muscles following recurrent laryngeal nerve palsy and also to avoid iatrogenic injuries during surgical procedures of the neck.

Malignant Cystic Melanoma Metastasis to Brain

Mamata Singh, Prabhat Nalini Rautray, Lalatendu Swain

Metastatic cystic melanoma though rare having a distinctive imaging characteristic due to presence of melanin and hemorrhage. We described a 43-yearsold man presented with reeling of head, short term memory disturbance, ataxia and absence of appetite for one month, gradually developed altered sensorium and vomiting. No past medical history evident. No neurological deficit evident. On primary investigation CT scan shows intra-axial cystic tumor mass over the left temporal region. The patient received total extirpation of the lesion microscopically, followed by chemotherapy and radiotherapy. The pathologic review revealed cystic malignant melanoma metastasis to brain. Patient was doing his normal habit for one month. Suddenly collapse in his home town.

Congenital Lumbar Hernia Associated with Duodenal Atresia and Lumbo-costo-vertebral Syndrome

Kamal Nain Rattan, Arushi Agarwal, Ankur Dhiman, Ananta Rattan

Congenital lumbar hernia is associated with a multitude of congenital anomalies involving various other organ systems of the body. These involve the ribs, spine, muscles, kidneys, and spinal meninges. We are reporting a case of one day old male child with congenital lumbar hernia associated with duodenal atresia and lumbo-costo-vertebral syndrome. We failed to find this association in literature. This prompted us to report this rare case.

Methylmalonic Acidemia- A Rare Inborn Error of Metabolism

The methylmalonic acidemias (MMA) are a heterogeneous group of autosomal recessive inborn errors of organic acid metabolism. The hallmark of MMA is hyperammonemia, encephalopathy and metabolic acidosis in infancy and especially so in neonatal age group. Management of such cases is often challenging and is associated with variable outcome. We present a nine day old male child who was referred to us with vomiting, lethargy and myoclonic seizures. Organic acidemia was thought of, because the neonate had metabolic acidosis with increased anion gap along with hyperammonemia, ketonuria and hypoglycemia. Tandem mass spectrometry along with Gas Chromatography-Mass Spectrophotometry helped us to clinch the diagnosis of methylmalonic acidema in our neonate. Patient was symptomatically managed along with carnitine and multivitamin supplements. He was sent home with advice of regular follow-up.

Smart Use of Smartphone in Neonatology

Ankit Soni, Sandeep Kadam, Sanjay Patole, Anand Pandit

Physicians are increasingly using smartphone to support education and clinical practice, and improve procedural skills through various ‘applications’ on the device. Prompt detection and management of the underlying condition/s and preventing further deterioration is important in the management of critically ill neonates. Smartphones can facilitate neonatal emergency management and stabilization, especially in resource limited settings where access to expert advice is often difficult/not available. Smartphones are effective in coordination and ongoing communication during transport, with potential to improve neonatal outcomes. We present our experience with a series of critically ill neonates where the use of smartphone resulted in significant benefits such as avoidance of an intercostal drain, prompt diagnosis and treatment of cardiac arrhythmia avoiding transfer and safe transport, and prompt patient management on arrival at the referral centre. The need for prospectively evaluating the benefits of smartphones in neonatal intensive care is emphasized.

Large Subcapsular Hematoma of the Spleen Complicating Acute Pancreatitis

Manish Kumar Pandey, Utpal Anand, Ramesh Kumar