Aims:The disease burden of enteric fever has increased due to overwhelming resistance of Salmonella.The objectives of this study were to assess different clinico-epidemiological factors and biochemical profiles of blood-culture positive cases as well as to detect the antibiogram for its treatment. Materials & Methods: Based on inclusion and exclusion criteria, 50 children of age 1-12 years out of 239 screened were culture positive and constituted the study group. Across- sectional observational study was conducted for a period of one year. A detailed clinical examination, blood culture and antibiogram were performed.The total duration of treatment with antibiotics was two weeks. The clinical course was monitored and the period of defervescence noted in the study subjects. Results: School-going children (56%) were mainly affected though incidence is increasing in under-5 age group (24%). The pattern of fever was predominantly continuous (48%) and high grade. Prior exposure to antibiotics was statistically significantly (p=0.03) in the cases < 5 years. S. typhi was 92% and 89.5% sensitive to Azithromycin and Cefixime while in S. paratyphi the sensitivity was 91.7% and 100% respectively. Occurrence of S. paratyphi Ainfection and early defervescence was statistically significant (p=0.03). Conclusion:Lower socioeconomic status was responsible for higher incidence rate. Widal test with moderate sensitivity and specificity is still a useful diagnostic tool. It was re-established that Ceftriaxone, Cefixime and Azithromycin were the most effective anti-salmonella agents.Re-emergence of chloramphenicol susceptibility and resistance to ciprofloxacin was observed, thereby emphasizing rational drug use in enteric fever.

Background: Acute liver failure (ALF) is a rapidly progressive, potentially fatal syndrome resulting from rapid death or injury to a large proportion of hepatocytes, caused by a variety of insult, leaving insufficient hepatic parenchymal mass to sustain liver function. The aetiology of ALF varies according to the age of patient and development of the country. The outcome of ALF also varies according to aetiology: survival is better in paracetamol poisoning whereas it is poor in metabolic diseases. Objective: The present study was undertaken to observe the underlying aetiology and outcome of ALF in children under 16 years of age admitted at the department of Paediatric Gastroenterology & Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Methods: It was a retrospective review of medical records from November 2013 through February 2016. Results: During this period a total of 55 patients were diagnosed to have ALF. Aetiology was established in 42 (76.4%) cases. Wilson's Disease (WD) was found in 23 (41.8%) cases, Viral hepatitis in 17 (30.9%), where as no identifiable cause was found in 13(23.6%) cases. After treatment 21 (38.2%) ALF patients survived, 17 (30.9%) left hospital with risk bond (DORB), and 17 (30.9%) patients died. The study showed that among the 17 death patients, 8 (29.4%) had viral hepatitis, 7 (41.2%) Wilson's disease, and in 5 (29.4 %) no cause could be identified. Conclusion: Wilson's disease was found as the most common causes of Acute Liver Failure, around 38% cases of acute liver failure survived with supportive management in this study.Future studies with larger sample size are required to know the actual causes&outcome of acute liver failure in children.

To describe the dermatological manifestations noted in multitransfused beta thalassemia major patients aged between two to twelve years and also to find out any correlation with their serum ferritine level, this study was done. A total 56 thalassemia children were examined for dermatological manifestatios and their serum ferritin levels were measured. Amongst the patients, male to female ratio was 1:1. Most of the study subjects belonged to the Muslim community (64.3%). Dermatological changes were found amongst 94.6% study children and were more frequently seen in females (96.4%). Children belonging to older age group showed increased frequency (100% in >8years) of dermato-logical changes. Xerosis and Hyperpigmentation were the two most common dermatological changes noted in 66.1% and 53.6% study subjects. Pityriasis versicolor and alba (12.5%), urticaria (5.4%), acanthosis nigricans (8.9%) were other common dermatological manifestation. Besides generalised hyperpigmentation, some subjects (12.1%) were foud to have isolated forehead hyperpigmentation. Less common dermatological changes noted were moluscum contagiosum, diffuse hair loss, nail brittleness, mucosal hyperpigmentation, freckles, acneform eruption, milliaria and pompholyx. The study showed there was a statistically significant correlation between urticaria and the level of serum ferritin(p<0.05). Hyperpigmentation and pityriasis (versicolor & alba) were also more frequent among study groups with higher level of serum ferritin level. However, the statistically significant correlation could not be established due to paucity of data.

Aims & Objective :The objectives of this study were to examine how the neonatal morbidities, related to prematurity, persist into early term gestation in our set up. Aim was also to know the early neonatal (within first 7 days of life) morbidities, in early terms infants in comparison to their full term counterparts. Materials and Methods : It was a prospective, observational & comparative study. Consecutively born, 1000 intramural newborns were examined and only term babies were included in the study. They were observed for any morbidity for first 7 days of life. Multiple birth, congenital malformations, genetic disorders, inborn metabolic disorders and pre and post term infants were excluded. Results : 761 term babies were included in the study, out of which 244 were early term & 517 were full term. NICU/SNCU admission rates were higher for babies born at an earlier gestational age (14.69% v/s 8.53%) than babies born later. Incidence of morbidities like jaundice requiring phototherapy (4.9% v/s 1.6%), need for resuscitation (6.9% v/s 3.3%), hypoglycemia on admission (4.9% v/s 1.6%), respiratory morbidities (2.9% v/s 1.6%), need for mechanical ventilation (1.2% v/s 0.4%), clinical sepsis (6.9% v/s 3.4%), confirmed sepsis (4.5% v/s 1.7%), need for intravenous antibiotics (10.6% v/s 6.0%), need for intravenous fluid (12.7% v/s 6.8%) were significantly higher in early terms than full terms during the first one week of life. Conclusion : Neonatal morbidity decreases with delivery at later gestational ages and that infants delivered at 37 and 38 weeks' gestation, are at increased risk for morbidity compared to infants delivered at 39 weeks or later. So, to reduce early term deliveries and its influence on health care system we should carefully consider the optimal timing and route of delivery

Objectives- To compare the efficacy of oral propranolol, Prednisolone and propanolol with prednisolone in the treatment of infantile hemangiomas and to standardise the dose of propranolol. Design - Prospective randomized comparative study. Setting - Pediatrics Surgery Department of a Tertiary care hospital. Study period - September 2012 to December 2014. Participants - Infants below 8 months of age with cosmetically disfiguring or functionally deranging hemangiomas. Results - The mean size reduction (%) based on visual Analogue scale for propranolol treated group at 3 months, 6 months, 1 year, and 1.5 years were 58.21+19.50, 71.21+18.35, 85+11.32 and 89.883+10.26 respectively. For the group treated with prednisolone at the same period the size reduction was 36.57+18.97, 46.94+26.84, 66.25+31.21 and 66.64+32.36 respectively. For the group treated with Prednisolone and Propranolol the reduction the above age were 49.99+19.25, 71.07+17.69, 79.19+13.95 and 82.64+10.36 respectively. The side effects are more with prednisolone group and prednisolone with prepranolol group. Conclusion - Propranolol should be considered as first line agent in therapy for infantile hemangioma for its safety and efficacy. 2 mg/kg/day in two divided doses considered to be optimal.

Objective: To investigate the infant and young child feeding practices among mothers attending Pediatric OPD of a District Hospital in Gurugram. Methods: A total of 85 mother-infant (6 months) dyads attending Pediatric OPD of District Civil Hospital, Gurugram were selected purposively. Infants aged 6±0.5 months, single birth, normal birth weight, full term, breastfed infants andinfants without any severe chronic disease or disorder were enrolled. A questionnaire was developed to record the participants' socio-demographic profile and information on IYCF. Retrospective data was collected for early and exclusive breastfeeding practices. Results: It was highlighted that only 38.8% of the infants were breastfed within one hour of birth even after 95.3% institutional delivery rate. Exclusive breastfeeding for six months was reported amongst only 30.6% of infants. The main reason for discontinuing breastfeeding before six months was lack of breastmilk. Top-feeding and complementary feeding was documented amongst 65% of the infants, of which 18.8% infants received complementary feeding at an appropriate age of 6 months. Complementary foods commonly given included semi-solid foods (21.2%) mainly cerelac, animal milk (20%), daalkapaani (14.1%) and infant formula milk (9.4%). Conclusion: IYCF practices in India are extremely poor which maybe because of the lower literacy rates, lack of IYCF education among mothers and dearth of IYCF counseling and support. Mothers also bears wrong perceptions and false beliefs of towards the age for initiating the complementary feeding which exhibits lack of IYCF education.Community level campaigns should be organized so as to create mass level awareness amongst the caretakers.

Introduction: The incidence of Congenital TTP (Thrombotic Thrombocytopenic Purpura) i.e. Upshaw Schulman syndrome is less than 1/1,000,000person/year.It may leadto thromboembolic phenomena which may cause end organ damage and is life threatening condition. Prothrombotic conditions remain one of the major causes for paediatric recurrent stroke. Case Summary: A five year old male child presented with recurrent episodes of stroke, anaemia and thrombocytopenia. On analysing the clinical presentation and laboratory investigations, diagnosis of Congenital TTP was accomplished. Child responded to Plasmapheresis with improvement in chief complaint of right sided hemiparesis. Discussion: Neurological symptoms occur in 35% of the cases of TTP. Patients with Congenital TTP remain asymptomatic until an acute precipitating event (fever, infectionsand vaccinations) occurs. The diagnosis of Congenital TTP must be considered in a child presenting with unexplained thrombocytopenia and stroke. With timely intervention and treatment, this disorder can be dealt with, as occurred in described case.

Cornelia de-Lange syndrome is characterized by distinctive facial dysmorphism, primordial short stature, hirsutism, and upper limb reduction defects that range from subtle phalangeal abnormalities to oligodactyly. Craniofacial features include synophrys, arched eyebrows, long eyelashes, small widely spaced teeth and microcephaly. IQ ranges from between 30 and 102 with an average of 53. Many individuals demonstrate autistic and self-destructive tendencies. It is an autosomal dominant disorder caused by specific gene mutations and occurrence is one in 10,000 to 50,000 children. This is a case report of a 2 1/2-year-old female child with Cornelia de-Lange syndrome phenotype.