BACKGROUND:Iron deficiency and allergic diseases are significant global health problems, particularly among children. Iron deficiency may contribute to immune dysregulation, which has been implicated in the pathogenesis and exacerbation of atopic diseases. This study examined the relationship between iron deficiency, as indicated by transferrin saturation (TSAT), and acute exacerbation of allergic diseases among children. METHODS:A cross-sectional observational study was conducted over a 24-month period (March 2023 to February 2025) at the Department of Pediatrics, KIMS, Bhubaneswar. A total of 240 children aged six months to 18 years were enrolled and divided into three groups (n = 80 each): Group 1 (atopic with acute exacerbation), Group 2 (atopic without exacerbation), and Group 3 (non-atopic controls). Hematological indices and iron profile parameters, including TSAT, were measured. TSAT <16% was defined as iron deficiency. Binary logistic regression analysis was performed, and predicted probabilities of acute exacerbation at varying TSAT thresholds were estimated. RESULTS:Iron deficiency was highest in the exacerbation group (51.25%) compared with stable atopic children (42.5%) and controls (23.75%). Children with acute exacerbation experienced much lower mean TSAT (15.45 ± 4.47%) compared to those with no exacerbation (17.45 ± 4.18%) and controls (18.37 ± 4.68%) (p = 0.0002). Children with acute exacerbations were 3.38 times more likely to have iron deficiency than non-atopic controls (OR = 3.38; 95% CI: 1.72-6.64; p = 0.0004). Binary logistic regression identified TSAT as an important predictor of allergy flare-ups, with each 1% decrease linked to a 12% higher risk of exacerbation. CONCLUSION:Iron deficiency, particularly low TSAT, is associated with acute allergic exacerbations in children. Routine TSAT screening in pediatric patients with atopic diseases may help identify children at increased risk of exacerbations and facilitate early intervention.

Introduction: The study evaluate the impact of an educational intervention on the knowledge, attitude, and practice (KAP) of parents of children with beta thalassemia. The study involved 147 participants, providing a comprehensive overview of how targeted educational efforts can enhance understanding and management of the disease. Overall, the study emphasizes the value of education as a tool for enhancing health literacy and promoting proactive health behaviours among parents of children with beta thalassemia. By continuing to invest in and develop such educational initiatives, we can significantly improve the quality of life for affected families and contribute to better disease management and prevention strategies. Material And Method: A hospital based Prospective Quasi-experimental Pre- Post test design to evaluate the Effectiveness of an educational intervention. Beta-thalassemia Children of age 6 month to 14 years with their parents (care giver) presented to MKCG Medical College & Hospital for regular blood transfusion This prospective quasi-experimental study was conducted in the department of paediatrics, MKCG, MCH, Berhampur from the period of October 2022 to September 2024. Study population included parents or care givers of thalassemia children of age group 6 month to 14 year. Result: More number of questionnaire regarding KAP about thalassemia will helpful on strength of the study. Scoring or Grading of KAP could may give more light on the performance of the Study. Long term follow up will yield better result in assessing KAP of thalassemia parents. Smaller sampling size will give more bias in the study and large size of the sample will give better result in KAP assessment regarding thalassemia. Conclusion: Study concludes; More significant improvement of knowledge of parents and care givers observed in different aspects regarding thalassemia disease like about general awareness, symptoms, disease transmission, screening and diagnosis and healthy living and treatment. Overall, the study emphasizes the value of education as a tool for enhancing health literacy and promoting proactive health behaviours among parents of children with beta thalassemia. By continuing to invest in and develop such educational initiatives, we can significantly improve the quality of life for affected families and contribute to better disease management and prevention strategies.

BACKGROUND:Sepsis continues to be a leading cause of illness and mortality in children around the world. Various scoring systems have been devised to predict the outcome of pediatric sepsis. Pediatric sequential organ failure assessment (p SOFA) and lactate clearance are the two commonly used methods. OBJECTIVE:The aim of this study was to compare the p SOFA score with lactate clearance as predictors of morbidity and mortality in pediatric sepsis, to compare the initial plasma lactate level and lactate clearance, and to know which is better to predict outcomes in sepsis and septic shock. METHODS:This prospective observational study was conducted in a pediatric intensive care unit of a tertiary care teaching hospital from July 2022 to June 2024. The blood lactate level and p SOFA score were assessed at admission and at 24 and 48 hours, and lactate clearance was calculated at 24 and 48 hours of admission. The receiver operating characteristic (ROC) curve was plotted to predict deaths using p SOFA, lactate level, and lactate clearance. RESULTS:A total of 71 children were enrolled in the study. All children were divided into two groups, 58 (82%) survivors and 13 (18%) non-survivors. The most common diagnosis was pneumonia, observed in 31 (43.6%) children. Compared to survivors, non-survivors had a higher prevalence of multiple organ dysfunction syndrome (MODS). The most common organ system involved was the cardiovascular, in 50 (70%) cases. For predicting mortality, p SOFA scores were statistically significant at admission and at 24 and 48 hours with a high area under the curve (AUC) at 48 hours (0.985). Lactate clearance at 24 hours was a better predictor of mortality than at 48 hours with a higher AUC (0.958). CONCLUSION:Both p SOFA score at 48 hours and lactate clearance at 24 hours were significant predictors of mortality. Among both parameters, lactate clearance at 24 hours was superior in predicting mortality early.

Chromosomal deletion syndromes are a rare group of genetic disorders with variable manifestations depending on deletion size, location, and gene content. We report a 16-month-old boy with severe growth retardation, global developmental delay, and various dysmorphic features and absent dentition. Ophthalmological evaluation showed right disc coloboma and left optic atrophy. He also had profound left-sided hearing loss. The child had recurrent hypoglycemia manifesting within three hours of feeding. On evaluation for hypoglycemia, a critical sample revealed low insulin and C-peptide but normal thyroid and growth hormone function. MRI revealed a hypoplastic pituitary gland. Chromosomal microarray identified a de novo 4.9 Mb deletion of 4q13.2–4q21.2 encompassing genes linked to dentition, growth retardation, intellectual disability and hypoglycemia. This case broadens the phenotypic spectrum of proximal 4q deletion syndrome and underscores the importance of early genetic diagnosis for tailored management and counselling.

BACKGROUND:Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a strong female predisposition. pSLE often results in a worse prognosis compared to adult SLE. Studies on pSLE from the Indian subcontinent are scarce. OBJECTIVE:This study aims to describe the clinical manifestations, laboratory and serological parameters, management, and outcomes of pSLE patients from a premier tertiary care institute in Eastern India. METHODS:This prospective observational study was conducted at Kalinga Institute of Medical Sciences, Bhubaneswar, from September 2020 to October 2023. Children aged 1-14 years fulfilling the Systemic Lupus International Collaborating Clinics criteria for SLE were included. A detailed history, clinical examination, and laboratory investigations were performed. Data on complications, treatment, and outcomes were collected. Statistical analysis was done using SPSS Statistics version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). RESULTS:Out of 114,009 patients (outdoor and indoor), 40 were diagnosed with pSLE, resulting in an incidence of 0.35 per 1000 children. The female-to-male ratio was 7:1. The mean age of presentation was 11.67 ± 2.37 years. Among the predominant symptoms observed, mucocutaneous manifestations were seen in 39 (97.5%), followed by pallor in 36 (90%), and fever in 33 (82.5%). The most common organ system involved was mucocutaneous, observed in 39 (97.5%) patients, followed by hematological in 36 (90%) and renal in 19 (47.5%). Lupus nephritis was observed in 19 (47.5%) patients, with class IV being the most common. Anti-nuclear antibody and anti-double-stranded DNA were positive in 39 (97.5%) and 27 (68%) of children, respectively. Complete remission was achieved in 14 (35%), improvement in 16 (40%), and flare-ups in 3 (7.5%) patients. CONCLUSION:pSLE is an uncommon but severe autoimmune disease with significant multi-system involvement. Early identification and prompt treatment are crucial to minimizing adverse outcomes. This study provides detailed insights into the clinical and immunological profile of pSLE in Eastern India, underscoring the need for larger multicentric studies with long-term follow-ups.

Background Empyema thoracis is a complication of bacterial pneumonia, which can cause significant morbidity and mortality in children. Timely diagnosis and adequate treatment of pneumonia is essential. Objective To determine clinico-bacteriological profile of children admitted with empyema thoracis and to study their outcome and short-term follow-up. Materials and Methods This study was a prospective observational study, performed in age group of 1 month to 14 years admitted in a Tertiary Care Hospital of Odisha over a period of 3 years (March 2020 to February 2023). Results Of 95 patients, most (45) were of age from 1 to 5 years with a mean age of 68.46 ± 39.33 months and male to female ratio of 1.3:1. The peak of cases was seen during the month of March to July. Most common presentation was fever (99%) followed by cough (97%). On pleural fluid analysis organisms were isolated in 45 cases, staphylococcus aureus being commonest (21). Eighty children (84.5%) were treated with antibiotics and intercostal drainage tube, whereas 8 cases (8.5%) needed aspiration and antibiotics. Seven cases (7%) required surgical treatment in the form of decortication or thoracotomy and Video Assisted Thoracoscopic Surgery (VATS). Most common complication was pyopneumothorax, found in 34 cases (36%). Out of 95, 81 (85.3%) were cured, 3(3.2%) died and 4 (4.2%) left against medical advice. Four cases at 15 days follow-up and 2 cases at 2 months follow-up showed restrictive pattern of Pulmonary Function Test. Conclusion Empyema thoracis in children is a dreaded complication of pneumonia. Early diagnosis and effective treatment of pneumonia can decrease morbidity and mortality.

Sepsis continues to be a major contributor to illness and death in children, necessitating effective risk assessment tools. Incidence of pediatric sepsis in intensive care units is on increasing trend. Over the years, the concept of sepsis scoring systems has evolved to enhance the prediction of outcomes and mortality in pediatric age group. To better identify sepsis and septic shock status in the pediatric age group, various sepsis scores were developed. Properly applying these scores can significantly enhance timely decision making and ultimately reduce mortality rates. Selecting appropriate score should match the settings where they were designed. Scoring system is broadly categorized into two types - prognostic scores and descriptive or outcome scores. To improve care for critically ill children, it is important to develop tools that can better predict long-term mortality and morbidity and identify factors related to intensive care related events. This review article aims to discuss the evolution of various sepsis scoring systems, highlighting their development over time and their practical utility in clinical settings.

Metronidazole-induced encephalopathy is a rare cause of toxic encephalopathy in children. Although many cases have been reported in adults, it is rarely reported in the pediatric population. Here, we report a case of an 11-year-old boy who presented with acute-onset encephalopathy with slurring of speech after receiving metronidazole for treatment of acute gastroenteritis. Neuroimaging is the cornerstone in the diagnosis of this entity with typical involvement of cerebellum, brain stem, and splenium of the corpus callosum. In our case, magnetic resonance imaging of the brain revealed hyperintensity of the splenium of the corpus callosum on the fluid-attenuated inversion recovery sequence along with diffusion restriction in the diffusion-weighted imaging and apparent diffusion coefficient images. Rapid complete neurological and radiological recovery with supportive treatment is key in making the diagnosis. Although a safer and commonly used drug, new-onset encephalopathy after the use of metronidazole must be considered.

Introduction: Cardiac functional abnormalities are common in patients with cirrhosis of the liver. Nonetheless, the effect of portal hypertension and liver disorder on cardiac abnormalities is yet to be investigated. The current study evaluated the contribution of cirrhotic and non-cirrhotic portal hypertension as the potential cause of cardiac abnormalities. Methods: The present study was a cross-sectional observational study. After excluding known heart diseases, 128 patients with portal hypertension from different causes were enrolled in the study. Cardiac functional activity was assessed by electrocardiogram (ECG) and transthoracic echocardiography (TTE). Results: This study included a total of 128 patients, out of which 24 had extrahepatic portal vein obstruction (EHPVO), four patients had Budd-Chiari syndrome and 100 had liver cirrhosis. Normal ventricular function was observed in patients with EHPVO and Budd-Chiari syndrome. Sixty-eight percent of cases had liver cirrhosis diastolic abnormalities. The mean QTc interval in patients with cirrhotic cardiomyopathy (CCM) was 0.49 +/- 0.05 sec which was significantly increased when compared to patients without CCM with 0.432 +/- 0.07 at p=0.0016. The Child Turcotte Pugh (CTP) score and MELD (Model for End-Stage Liver Disease) score in patients with CCM were significantly higher as compared to patients without CCM. All alcoholic cirrhotic and non-alcoholic cirrhotic patients had equal prevalence of diastolic dysfunction (p-value >0.05). Conclusion: Patients with Child class C or a high MELD score are associated with a higher prevalence rate of CCM while normal cardiac function was observed among patients having portal hypertension due to extrahepatic causes. We recommend cardiac evaluation by echocardiography in all cirrhotic patients. Institution of specific medical therapy and early referral for liver transplantation should be considered to improve survival in patients with decompensated cirrhosis.

An 11-year-old boy with marfanoid habitus and high myopia presented with multiple episodes of seizures. He was found to have arachnodactyly, hypermobile joints, ectopia lentis, cerebral venous sinus thrombosis (CVST) with very high serum methionine and homocysteine. Genetic evaluation unveiled homocystinuria due to cystathionine beta-synthase deficiency. The patient was treated with high-dose pyridoxine, methionine restricted diet, anticonvulsants, warfarin, and correction of ectopia lentis. Homocystinuria should be suspected in patients with tall stature and pathological myopia. Early treatment can prevent thromboembolic complications.

Snakebite is a commonly seen problem in tropical countries like India. Early morning neuroparalytic syndrome and cranial nerve palsies are the usual presentations. Locked-in syndrome (LIS) is a rare presentation. We present a 1-year and 6-month-old female toddler with acute onset of weakness in all four limbs, who developed LIS. The patient was given anti-snake venom on day 3 of admission and fully recovered after 3 weeks of ventilation. Snakebite should be suspected in any child presenting with early-onset neuroparalytic syndrome or LIS even if there is no history of snakebite or any bite mark.

Initial presentation of childhood systemic lupus erythematosus (SLE) as antiphospholipid syndrome (APS) is uncommon; moreover, APS presenting with both hemorrhage and thrombosis is very rare.We report a case of a previously healthy eight-year-old boy, without any significant past or family history, who presented with ecchymotic patches, epistaxis, and right-side hemiparesis. Investigation showed severe thrombocytopenia and isolated high activated partial thromboplastin time (aPTT) not corrected by mixing study. During his hospital stay, the child developed left-sided focal seizure and digital gangrene as thrombotic events.Neuroimaging revealed initially hemorrhagic stroke and subsequently bilateral infarct of middle cerebral artery (MCA) territory. The child was diagnosed as a case of SLE with APS based on Systemic Lupus International Collaboration Clinics (SLICC) criteria, revised APS classification, clinicoimmunological profile and neuroimaging. As the child was progressing towards catastrophic APS, he was treated aggressively with intravenous pulse methylprednisolone, intravenous cyclophosphamide and plasmapheresis with successful recovery.A simple bleeding manifestation may mask a serious disorder. A simple test like mixing study is helpful in diagnosis and in avoiding unnecessary investigations. A combination of both hemorrhage and thrombosis is an unusual presentation of APS and should always be suspected in case of autoimmune disorder, especially in SLE.

Scrub typhus is one of the re-emerging infectious diseases in India, whereas hemophagocytic lymphohistiocytosis (HLH) results from an uncontrolled and ineffective hyperinflammatory response to a variety of triggers. HLH is categorized into primary and secondary type with infection being one of the leading causes of secondary HLH. Here, we report a case of 3-month-old girl diagnosed with scrub typhus associated with secondary HLH as both the age of presentation and the association are rarely reported in literature.

Introduction In April 2020, a group of children with hyperinflammatory shock were reported in England. Now many cases have been reported from across the world. We here report a case of Multisystem Inflammatory Syndrome in Children (MIS-C) detected in the Odisha state of India. © 2021, Sri Lanka Journal of Child Health. All Rights Reserved.

Background: Kawasaki disease (KD) is a medium-vessel vasculitis having coronary predilection, usually affecting under-5 children presenting as acute febrile illness. Despite being a disease with long-term grievous outcome, only few published literature are available from India, even lesser from its eastern region. Methods: From January 2016 to December 2020, 30 case records of children with a discharge diagnosis of KD were enrolled in this study. Demographic profile, clinical manifestations, laboratory data, echocardiographic findings, and treatment done were extracted from the case records. Laboratory investigations were done at admission and repeated after 24 h of intravenous immunoglobulin administration as per the American Heart Association Guidelines 2004. Echocardiography was carried out at diagnosis, at 2 weeks, and at 6 weeks. Results: Out of 30 children diagnosed with KD, majority belong to 1–5 years of age group (72%) with male predominance. Complete KD was seen in 77% of children. The most common presentation was fever >5 days (100%) followed by oral changes in 26 (87%), conjunctivitis in 25 (83%), extremity changes in 23 (77%), and rash in 21 (70%) children. Desquamation of perineum and reactivation of bacillus Calmette–Guérin scar were seen in 10%. No children with complete KD and three children with incomplete KD developed coronary artery Abnormalities (CAA). Conclusion: Infants with incomplete KD have a higher incidence of CAA. Aggressive management results in better outcome.

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome-coronavirus-2 is a new life-threatening entity whose diagnosis and management warrant awareness and in-depth knowledge. This study intends to estimate the knowledge, attitudes, and practice toward MIS-C among pediatricians of eastern India. Subjects and Methods: A descriptive, web-based cross-sectional survey was conducted among pediatricians of eastern India between January 1 and March 31, 2021, where they were invited to participate irrespective of their experience in treating COVID-positive children. Results: The majority of pediatricians (≥95%) are aware of the terminology MIS-C, its clinical features, presence of raised inflammatory markers, its treatment, and follow-up. Although 75% were aware of the vulnerable age group, only 50% knew the exact timing of occurrence. Fever as a mandatory criterion for diagnosis was known to 62.6%. The majority (75%) agreed that positivity of any of the tests (reverse transcription polymerase chain reaction, antigen, or antibody) or history of contact with COVID is necessary for diagnosis. Kawasaki Disease and Toxic Shock Syndrome as a common differential diagnosis of MIS-C were agreed upon by 86%. Pediatricians working in COVID hospital were more confident in managing MIS-C than who are not working (72.8% vs. 38.6%). Steroid and intravenous immunoglobulin used as first-line treatment by 94% and 72%, respectively. Conclusion: Although the majority of pediatricians are now aware of MIS-C, still there is need for continuing medical education (CME) and interactive sessions with experts, to make them suspect, detect early and manage it more effectively.

Diabetic ketoacidosis is an acute life-threatening complication of type 1 diabetes. Sometimes it is the first presentation in an undiagnosed child. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) and diabetes mellitus are very much interrelated as diabetes mellitus is associated with an increased risk of severe COVID19 at the same time, many cases of new-onset diabetes had been diagnosed. Hyperglycemia, metabolic acidosis, and ketonemia are classical presentations. It is essential to correct the acidosis and fluid correction and insulin therapy in these patients, leading to vital organ dysfunction. In refractory metabolic acidosis, renal replacement therapy may help

The pediatric population is relatively less affected by novel coronavirus disease 2019 (COVID-19) compared with adults, both in numbers and severity. However, evolution of a new entity, named multisystem inflammatory syndrome in children (MIS-C), has led to significant number of children being admitted to hospital, especially to intensive care units. Case definitions of MIS-C have been defined by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) separately. Autoantibodies and antibody-dependent enhancement (ADE) are the key factors proposed in pathogenesis, leading to immune dysregulation, and cytokine storm. Three distinct clinical types are observed as follows: (1) fever and elevated inflammatory markers with no end-organ damage; (2) shock with severe myocardial dysfunction similar to toxic shock syndrome (155); and (3) with mucocutaneous features like Kawasaki's disease (KD). Cardiovascular and gastrointestinal symptoms are the predominant presentations. Inflammatory markers like C-reactive protein (CRP), ferritin, and interleukin (IL)-6 are raised along with high D-dimer and lactate dehydrogenase (LDH). Echocardiography may demonstrate low left ventricular ejection fraction (<50%) and/or coronary aneurysms. Reverse-transcription polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is usually negative, with most having antibodies against the virus. KD, KD shock syndrome (KDSS), and toxic shock syndrome (TSS) are the important differential diagnoses to be considered. Immunomodulatory therapy is the cornerstone of the management. Intravenous immunoglobulin (IVIg) is preferred, the next option being steroids. Supportive care, antiplatelet, and anticoagulation medications, when indicated, are also vital aspects of treatment plan. The prognosis is favorable with low mortality but meticulous cardiac monitoring and follow-up by a multidisciplinary team is very important. Being an evolving disease, future research may reveal different manifestations, newer diagnostic modalities, and better treatment options.

Biotinidase deficiency (BTD) is a rare inherited metabolic disorder with predominant dermatogical and neurological manifestations, which if untreated leads to severe neurological sequelae. Early diagnosis and prompt treatment with biotin prevents further progression of neurological symptoms and resolution of cutaneous features. We report an interesting case of four and half year male child presenting with seizures, developmental delay with non resolving extensive skin lesions and alopecia, diagnosed as BTD and successfully treated.

Introduction: Following an asymptomatic or mildly symptomatic coronavirus disease (COVID-19), otherwise healthy children may develop serious manifestations in the form of cardiac, neurological, respiratory, gastrointestinal, and dermatologic dysfunction. Many such cases were being observed in Odisha, an eastern state of India, and have been reported from different health-care facilities. We related these unexplained serious manifestations to multisystem inflammatory syndrome associated with COVID-19 (MIS-C) and planned this study. Methods: This retrospective observational study was carried out at the following three tertiary care centers: Kalinga Institute of Medical Sciences, Bhubaneswar; MKCG Medical College, Berhampur; and Jagannath Hospital, Bhubaneswar. The study population included all children aged from 1 month to 18 years admitted to the hospitals with MIS-C according to the WHO diagnostic criteria. All the data were analyzed by SPSS software. Results: A total of 21 children were included in our study. Majority of the cases were male (76.2%), and the predominant age group was 6–10 years (47.6%). Common symptoms and signs in our observation included fever, pain abdomen, seizure, and hypotension. Most of these cases were positive for severe acute respiratory syndrome coronavirus antibody (80.95%). Response to immunotherapy was dramatic. Mortality (9%) of our study was higher than 1.8%–3% from that of Western literature. None of our patients had coronary abnormality, while two patients had mild cardiac dysfunction at discharge comparable to that of other studies. Conclusion: MIS-C following exposure to COVID-19 infection in children is a clinical syndrome, which needs early suspicion and appropriate intervention to prevent mortality.