Iron deficiency is associated with impaired psychomotor and neurocognitive development as well as impaired immune function in children and often these consequences are irreversible. Identifying population groups at risk for nutritional iron deficiency at various stages of deficiency will enable proper allocation of resources and manpower. Aims: To determine the prevalence, risk factors (age, gender and nutrition status) of iron deficiency (iron deficient erythropoiesis and iron deficiency anaemia) in apparently healthy preschool children (6 to 59 months) belonging to affluent families. Settings and Design: A cross-sectional study conducted in a private teaching hospital. Methods and Material: 160 children aged 6 to 59 months, belonging to the upper middle class, who came to the pediatric outpatient department for routine visits over a period of 1 year were evaluated. Socio-Demographic data with hemoglobin, red cell indices and iron studies of blood samples were estimated. Statistical analysis used: Continuous data were described as mean and standard deviation. Odds ratio with 95% confidence interval was calculated using polytomous logistics regression. Results: Among the 160 children evaluated 48(30%) were anemic, of which 41(85.4%) had IDA, however of the remaining non anemic 60 (53.6%) had IDE, making a total of 101(63.1%) children having ID.Both IDA (p=0.84) and IDE (p=0.32) were equally distributed among boys and girls. Similarly, IDA (p=0.75) & IDE (p=0.17) among the well-nourished was not significantly different from those moderately nourished. Compared to those who had no iron deficiency at all, those who had IDA were more likely to be children below the age of 2 years (OR 6.8 95% CI 2.6-17.7), irrespective of gender and nutrition. However,IDE was spread-out equally by age, gender and nutritional status. RDW is a good indicator for IDA when compared to TIBC, MCV, MCH and MCHC. Unfortunately, none of the above could differentiate IDE from normal subjects. Conclusions: Despite National Iron Plus Programme, a very high prevalence of iron deficiency even among apparently healthy children from affluent families is of great concern and further interventions need to be planned.There is an urgent need for an improved selection and standardization of iron status indicators which are cheaper and can differentiate all stages of iron deficiency.

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Friedreich's ataxia (FRDA) is autosomal disease in which 98% patients have causative mutation as an expansion of a guanine–adenine–adenine (GAA) tri nucleotide repeat located in the first intron of the frataxin gene on chromosome 9q13. The disease affects central and peripheral nervous systems, heart, skeleton and endocrine pancreas. Ocular, auditory & vestibular dysfunction is uncommon. Here we present a case of FRDA with involvement of nervous system & pancreas leading to diabetes mellitus in 10 yrs old girl child. The child presented with diabetic ketoacidosis.

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Diabetes mellitus (DM) is known to complicate liver diseases like hepatitis. A 13-year-old boy was brought to the hospital with fever, jaundice, high coloured urine for five days and lethargy. There was tender hepatomegaly with a liver span of 12 centimetre .The child was admitted in paediatric intensive care unit with a provisional diagnosis of viral hepatitis with encephalopathy.The blood sugar was 225 mg/dl on admission. One week after discharge, the child presented with increased intensity of jaundice, abdominal pain, pruritis and high coloured urine. On examination, there was a weight loss of 2 kilograms and deep icterus.His blood sugars were abnormal (fasting 425mg/dl; post prandial 633 mg/dl). The pancreatic enzymes were normal.HbA₁C level was 10.4 which suggested that the child probably had altered glucose metabolism before the episode of acute viral hepatitis. The jaundice resolved after a brief period of cholestasis and the child is now on regular follow-up for Type-1 diabetes for the past one year.

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Background: Preadolescent acne can have a detrimental effect on the psychological wellbeing of school going children which can greatly impair their quality of life. Aim of the study: The aim of this study was to assess the impact of acne vulgaris on the Quality of life of preadolescents in Navi Mumbai through school surveys. Methods: The study was a cross sectional questionnaire based study in two higher secondary, semi-English schools in Navi Mumbai. 507 students aged between 9-14 years were included in the study. Acne vulgaris was graded using a simple grading system from Grade1-4. The participants were asked to fill in three self- reporting questionnaires: The CADI (Cardiff acne disability index), The CDLQI (Children's life quality index) and a short demographic data. Results: Out of the total of 507 higher secondary school going children (9-14 years) from class 5 to 9, only students who reported acne (216) were included into the data analysis. In our study, 51.38% were females and 48.61% were males, with equal sex distribution. Grade I acne was the most common type of acne (72.2%). There was no significant association between acne severity and gender (p< 0.8933). 55.5% of the pre- adolescents had particular difficulties in the areas of emotion (felt aggressive, frustrated) and 17.1% had social interference/difficulties. In our study, the most common Children's Dermatology Life Quality Index (CDLQI) score observed was in the range of 0-1 (no effect) in 114 (52.7%) patients and that of The Cardiff Acne Disability Index (CADI) which an acne specific questionnaire was 0-4 (low) in 190 (87.9%) patients, which implied that the majority of them had mild psychological impact as a result of acne. Significant association was noted between CDLQI and CADI scores and grades of acne (p<0.004 and p<0.001 respectively) Also there was significant correlation between the CADI scores and CDQLI scores (p<0.01) which means, students who scored highly on the CDLQI also tended to score highly on the CADI . Conclusion: The assessment of impact of acne on the QoL (Quality of life) is essential, to detect those patients who are at increased risk of being negatively affected so as to treat them in a more integrated manner. Hence it is important for health professionals to incorporate QoL measurements when managing acne patients to provide a holistic approach to their management.

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Background: Maternal and under -five children malnutrition is not only a medical problem, but a social problem too. Malnutrition in childhood is a major risk factor for death and disability worldwide. The mothers visiting NRC, IYCF Counselling centre and OPD provides a golden opportunity to assess their nutritional status, counsel them and provide required nutritional interventions in order to improve their nutritional status. Material & Methods : This is a prospective case control study done at the Department of Pediatrics, Patna Medical College and Hospital Patna. The relevant data collected in a record form having semi structured questionnaire. Socio demographic and health profiles of mothers of admitted children of SAM children were assessed by doing anthropometric measurement i.e. weight, height and mid upper arm circumference using adult MUAC tape. Results: A total of 650 mothers consisting 333 mothers of SAM children were included as Study group (Group -1) and 317 mothers of well nourished children as Control group (Group -2). Early marriage & even the utilization of free services available was very poor by mothers in study group. Discussion:- The Socio-economic status of the family has a direct relation to malnutrition in their children. . In study group 96% mothers belonged from BPL class while only 34% mothers were BPL in control group. This finding is significant ( P <0.001 ). Malnutrition has been associated with low maternal education in various studies too. The non-utilization of available free health services by the mothers in study group is a matter of great concern. Conclusion:- Maternal nutrition, their education, socio-economic background, age at first pregnancy and gap during subsequent pregnancies, utilization of health services all have consequences on the nutritional status of their babies. Mothers need much attention as a holistic approach starting from their rearing in childhood, proper formal education, marriage at appropriate time, spacing in between subsequent pregnancies, utilizing various Government schemes to uplift their socioeconomical status.

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Background: Establishment of zinc's role in treating illnesses in children has catapulted a greater involvement of researchers, especially for illnesses like acute lower respiratory tract infection (ALRTI). Thus, this study was under taken to estimate serum zinc levels in cases of ALRTI and also correlate it with clinical course of ALRTI. Materials and Methods: It was a hospital based case-control study involving 61 cases aged 2 months to 5 years with ALRTI and age, sex and nutritionally matched controls. Serum zinc level was estimated at admission. Detailed history, sociodemographic details and examination were noted along with details of clinical course like duration of stay, oxygen requirements, severity of disease and outcome. Results: The mean serum zinc level of cases was found to be significantly lower than that of controls (Cases 58.88 ± 12.40 ug/dl, Controls 85.36 ± 16.27 ug/dl)(p value = 0.0001).There was a negative correlation of zinc levels with duration of stay (r = -0.052)(p value = 0.691). The mean serum zinc levels were significantly lower in cases of severe pneumonia as compared to cases of pneumonia (WHO IMNCI grading) (p value = 0.0001).The mean serum zinc levels were also significantly lower in those requiring higher O2 concentration(p value = 0.0001)and those who died as compared to the discharged patients(p value = 0.0001). Conclusion: Lower serum zinc levels are significantly associated with ALRTI and the lower the serum zinc levels; the more is the severity of disease and duration of stay in hospital for the patient, along with increased oxygen requirement and also increased incidence of mortality.

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Abbreviations : SGOT: serum glutamic-oxaloacetic transaminase, SGPT: Serum glutamic pyruvic transaminase,GGT : gamma-glutamyl transferase ,HPC: hepatic progenitor cells,HSC: hepatic stellate cells,HMGB1: High mobility group box1,Mi RNA:microRNA,RNA: Ribonucleic acid,DNA: Deoxyribonucleic Acid,ACLF: acute on chronic liver failure,MELD: Model End Stage Liver Disease, ALF:Acute Liver failure.

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