Medicine

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Presentation of disseminated neuroblastoma mimicking Bell’s palsy: a case report
(BioMed Central, 2025-01) Gunawardana, S.; Jogaprajahpan, G.; Dayasiri, K.
BACKGROUND Neuroblastoma is an embryological malignancy of neural crest cells that may have diverse presentations owing to direct effects, metastases, or paraneoplastic syndromes. Facial nerve palsy is an extremely rare presentation of neuroblastoma.CASE PRESENTATION A previously healthy 1-year-and-10-month-old Sinhalese girl presented with difficulty in closing her left eye for 2 weeks, preceded by deviation of her mouth to opposite side. Initial physical examination was normal, apart from left lower-motor-type facial nerve palsy. Initial laboratory investigations were also normal. A tentative diagnosis of Bell's palsy was made. However, magnetic resonance imaging of the brain was performed owing to the incidental detection of a painless bulge in the left zygomatic region with overlying skin bruising, in the absence of any preceding trauma. Magnetic resonance imaging of the brain revealed a soft-tissue mass in the left lateral orbital wall, extending to the body of the sphenoid and bulging into the left anterior fossa. Contrast-enhanced computed tomography of the abdomen, performed subsequently, showed an intra-abdominal large paravertebral soft-tissue mass. Histology of the abdominal mass confirmed poorly differentiated neuroblastoma.CONCLUSION Facial nerve palsy is well recognized to have a myriad of underlying etiologies, including hematological malignancies, solid tumors, and paraneoplastic syndromes. However, its timely diagnosis is often challenging in the absence of other supportive clinical features. These children need careful and thorough evaluation for malignancies before commencing steroids, especially when underlying malignancy is likely.
Internal biliary diversion for medically refractory pruritus in a child with Alagille syndrome: a novel alternative for liver transplantation
(Sri Lanka College of Paediatricians, 2024-12) Tillakaratne, S.; Fernando, M.; Batepola, T.; Gunetilleke, B.; Appuhamy, C.; Weerasuriya, A.; Siriwardana, R.
No abstract available
Acute hemolytic crisis complicated with ischemic cardiac injury and methemoglobinaemia following ingestion of naphthalene: a case report
(BioMed Central, 2024-12) Dayasiri, K.; Pathiraja, H.; Thadchanamoorthy, V.
BACKGROUND Naphthalene is an aromatic hydrocarbon that potentially produces methemoglobinaemia but rarely causes hemolysis, especially in children with underlying glucose-6-phosphate dehydrogenase deficiency. Although ingestion of a single moth ball by an older child may not be life threatening, it can be fatal if ingested by a toddler. CASE PRESENTATION A 2-year-old Singhalese boy developed acute severe hemolysis and methemoglobinaemia following ingestion of a mothball. On admission, the patient was ill and pale. The child was tachycardic and tachypnoiec with oxygen saturation of 76% on air. Blood investigations showed significant anemia, elevated reticulocytes, and evidence of hemolysis in a blood picture, along with elevated lactate dehydrogenase and indirect bilirubin. Child also had ST depressions on electrocardiogram examination with negative troponin-I. He was given four packed red blood cell (PRBC) transfusions and was successfully discharged in 3 days time following optimal supportive treatment. A glucose-6-phosphate dehydrogenase assay confirmed the diagnosis of glucose-6-phosphate dehydrogenase deficiency in this child: 0.9 U/gHb (4.0-13.0 U/gHb).CONCLUSION This case report highlights a rare life-threatening presentation of naphthalene ingestion in a child with previously undiagnosed glucose-6-phosphate dehydrogenase deficiency. Ingestion of even a single moth ball can be fatal in vulnerable children given the altered toxicokinetics of naphthalene in children.
Telehealth services for children with neuro-developmental disabilities in the Asia-Pacific region: A systematic review
(Oxford, 2024) Devagiri, B.; Ariyasena, A.D.K.; Siriwardhana, D.D.; Sumanasena, S.
BACKGROUND: In recent years telehealth became a popular and a rational health service delivery approach, especially amidst multiple challenges posed while providing health care interventions during the COVID-19 pandemic. AIM: We synthesized available evidence on telehealth for managing children with NDDs in the Asia-Pacific region with the aim of identifying successful methods. METHODOLOGY: We systematically reviewed six electronic databases: MEDLINE, AMED, EMBASE, PsychInfo, Web of Science, and (CINAHL plus) using the keywords and database-specific subject headings from their inception to 25th August 2021. Review findings were synthesized narratively, and harvest plots were used to demonstrate the effect of interventions. The protocol and reporting the findings of this review adhered to PRISMA 2020 guidelines. PROSPERO registration: CRD 340690. RESULTS: We harvested 30,823 records; 17,563 duplicates were removed, and 196 full-text articles were assessed for eligibility. 16 studies with multiple research designs were included in the review. Eight were from the Pacific region and eight represented Asia. The interventions targeted families and children with a variety of NDDs (autism spectrum disorder, Down syndrome, cleft lip and palate, hearing impairment, cerebral palsy etc.) via telehealth. Telehealth packages consisted of direct and indirect methods of synchronous, asynchronous, and hybrid approaches. All studies used parent-led intervention strategies. Telehealth reported a positive effect in 7/16 studies while five showed a neutral effect. CONCLUSIONS: According to published evidence telehealth for children with NDDs is an evolving, evidence-based service facilitation modality in the Asia-Pacific region, with only a few published randomized controlled trials. The systematic review shows promising telehealth practices emerging across the region despite the diversity in NDDs studied.

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