BackgroundKikuchi–Fujimoto disease (KFD) presents with painful cervical lymphadenopathy, persistent high-grade fever, leukopenia, and deranged liver function tests. KFD usually has a benign course and is self-limiting but may sometimes cause fatal complications such as secondary histiocytic lymphohistiocytosis (HLH).Case reportWe report a 13-year-old boy, a known case of thalassemia major on regular blood transfusions with post-splenectomy status and on chelators. He presented with persistent high-grade fever and cervical lymphadenopathy. The initial diagnosis of KFD was confirmed by lymph node biopsy. Given persistent fever, bicytopenia, and high ferritin levels, HLH was considered. Lymph node biopsy confirmed the diagnosis of KFD with secondary HLH. The child had neurological manifestations in the form of convulsions. He recovered with steroids and supportive care.ConclusionsThis case report emphasizes that although KFD is benign, complications, including secondary HLH and neurological complications, may occur that need to be recognized and managed.

Laboratories with a well-established diagnostic stewardship program for culture and the antimicrobial susceptibility test (C-AST) play a key role in guiding clinicians to institute specific targeted therapy. Blood culture is one of the most critical investigations performed at a microbiology laboratory. Therefore, it is particularly important to develop a robust diagnostic stewardship model for the blood culture laboratory division. Aiming at this hypothesis, this hospital-based clinical audit carried out within the Department of General Medicine, centered on the critical domain of antimicrobial stewardship (AMSP). The audit's primary objective was to systematically evaluate prevailing practices and pinpoint areas necessitating refinement in the administration of antimicrobial agents. Employing a meticulous approach involving exhaustive data scrutiny and feedback mechanisms, the audit unearthed strategic opportunities to optimize prescription patterns, curtail unwarranted antimicrobial utilization, and fortify adherence to established guidelines. The subsequent execution of targeted interventions, encompassing educational initiatives and routine performance feedback, culminated in a noteworthy enhancement of antimicrobial prescribing practices. These outcomes unequivocally underscore the efficacy of the audit in cultivating a milieu of judicious antimicrobial utilization, thereby augmenting patient care and mitigating antibiotic resistance within the department.

Context:Eruption of primary teeth is the most anticipated event in a child's life. Genetics, gender, socio-economic status, gestational age are a few of the determinants of the primary teeth eruption. However, the effect of gestational age on the timing of primary teeth eruption among the Indian population has not been explored to date.Aim:The study was conducted to evaluate the influence of gestational age on time and sequence of eruption of primary teeth among children of Mysore.Settings and Design:A prospective longitudinal cohort study design was conducted at 'Baby Oral Health Promotion Clinic' at the Department of Paediatrics, JSS Hospital, Mysore.Methods and Material:150 newborn babies were recruited by simple random sampling and followed up from birth to 36 months. Teeth present during each visit were recorded. Data were statistically analysed and interpreted.Statistical Analysis Used:Descriptive statistics, t-test for an independent sample, and Pearson's Chi-squared test were applied.Results:The mandibular central incisor was the first tooth to erupt. Statistically insignificant early eruption in males was noted in both term and preterm children. When the chronological ages were compared, the preterm group showed a statistically significant delay in the eruption of all the teeth. However, when the age was adjusted for prematurity, only the central incisors and second molars showed a statistically significant delay.Conclusions:Gestational age has a strong significant association with the eruption of primary teeth and maybe one of the strong predictors for delayed eruption among children of Mysore.

Childhood obesity has become a major public health challenge in developing countries including India due to the changes in the lifestyle and food habits of children owing to the influence of urban culture and technological growth. The present study is a cross-sectional, school-based study conducted to assess the prevalence of obesity and to determine the demographic variables influencing the obesity among school children. Methods: The study included 440 students (Boys: 240, Girls: 200) from two randomly selected schools of Mysuru city, Karnataka. WHO Standard Age and Sex specific Growth Reference charts were used for defining overweight and obesity. Modified Kuppuswamy's socioeconomic scale (2019) was adopted to assess the socioeconomic status of the family. Results: Obesity prevalence among the study subjects was 3.86% and overweight was 12.27%. The mean body mass index (BMI) among boys was 18.13 and girls was 18.80. The difference in the distribution of BMI between male and female groups was statistically significant (P = 0.023). Age and obesity status of the children was found to have a significant association (P = 0.022). Prevalence of overweight and obesity was more among children from higher socioeconomic class (P = 0.01). Conclusion: Prevalence of obesity and overweight among school children is comparatively higher. The higher familial income, dietary patterns, parental history of obesity and diabetes and having urban residence were identified as the major factors which influenced the obesity status of the school children.

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Introduction: Fever without a focus constitutes a major problem in children in the age group of three months to 36 months. Majority have viral infections but around 1.6 - 2% can have occult serious bacterial infection which needs early identification and treatment. The study was done to evaluate combination of CRP with Procalcitonin (PCT) as a marker of SBI in children (Three months - 36 months) with fever without focus in comparison with only PCT or CRP done separately. Methods: In this hospital based explorative study, 31 children between three months to 36 months of age with fever without any localising signs were enrolled. Relevant investigations were done to diagnose or rule out serious bacterial infection. Cut off of > 10 mg/dl for CRP and > 0.5 ng/ml for PCT was considered. Appropriate statistical analysis was done. Results: Among 31 recruited cases, 14 had occult serious bacterial infection with urinary tract infection being the most common cause. The combination PCT with CRP had sensitivity of 78.5%, specificity of 100%, and positive predictive value of 100% and negative predictive value of 85%. Diagnostic accuracy was 90.32% which did not have any statistically significant difference compared to PCT alone but significant compared to CRP alone. Conclusions: Combining CRP with procalcitonin did not have any added advantage over procalcitonin alone but combination of CRP and PCT and PCT alone is useful in detecting occult serious bacterial infections in children with fever without focus compared to CRP alone.

Introduction: Congenital cardiovascular anomalies refer to anatomic malformation of the heart and great vessels occurring during the intrauterine developmental process. Aim: To determine the pattern of distribution of cardiovascular anomalies through autopsy and to find an association between maternal factors and congenital anomalies, and also an association between autopsy and ultrasound findings. Materials and Methods: This was a descriptive cross-sectional study, which consisted of 50 stillborn foetuses. The foetuses were obtained from the Department of Obstetrics and Gynaecology at a JSS Medical College and Hospital, Mysuru, Karnataka, India. The foetus was fixed in 10% formalin and the autopsies were carried out as per standard foetal autopsy protocol. The cardiovascular anomalies were studied in detail. Data collected were entered in MS Excel 2010 and analysed using Statistical Package for the Social Sciences (SPSS) version 22 to obtain relevant statistics. Descriptive measures like percentages were calculated and the distribution of birth weight, gestational age, maternal age, gravida of the mother, and socioeconomic status of parents among the stillborn foetuses were studied. Fisher’s-exact test was done to find out the association between maternal diabetes and cardiovascular anomalies. The results were interpreted as statistically significant at p<0.05. Results: Out of the total 50 stillborn foetuses studied, cardiovascular anomalies were present in five cases. The ventricular septal defect was the most common anomaly. Other anomalies were an atrial septal defect, tetralogy of fallot, and pulmonary stenosis. The occurrence of cardiovascular anomalies was four times more common in male foetuses than in the female. Each stillborn foetus was classified, based on birth weight, gestational age, maternal age, gravidity of the mother, and socioeconomic status of parents. Maximum foetuses 29 (58%) were having a birth weight between 500-1000 grams. Maximum foetuses 20 (40%) were from the gestational age group of 22-26 weeks. The maximum number of foetuses 24 (48%) were born to mothers in the age group of 26-30 years and 22 (44%) mothers were primigravida. The maximum number of stillborns 25 (50%) belonged to the lower middle class of socioeconomic status according to Kuppuswamy’s socioeconomic scale. History of consanguinity was present in 10 (20%) mothers. Fisher’s-exact test showed a significant association between maternal diabetes and cardiovascular anomalies (p<0.016). The autopsy confirmed the antenatal ultrasound findings in 40 (80%) of the cases. There were significant additional findings observed in 7 (14%) cases and ultrasound diagnosis was completely changed in 3 (6%) cases, after the final autopsy procedure. Conclusion: This study focuses on the importance of concomitant foetal autopsy in providing accurate genetic counseling. It is mandatory to have an autopsy study for all the stillborn foetuses to predict and counsel for safe future pregnancy outcomes. The preventive measures for maternal diabetes should be taken care of to avoid cardiovascular anomalies in the antenatal period and future pregnancies.

Background: There are no guidelines and recommendations for routine universal newborn screening for congenital heart diseases using pulse oximetry in India. Objectives: To evaluate the knowledge, attitude, practices among health care professionals regarding screening for congenital heart disease (CHD) in newborns. Methods: Email invitations as well as individual emails in the form of questionnaire using Google forms were sent to 500 healthcare professionals in India. The questionnaire consisted of multiple-choice questions. Two reminders for non-responders were sent by email after the initial invitation. Results: Out of 500 e mails sent, a total of 178 responses (35.6%) were received. In terms of work experience, 10.2% of the respondents had more than 20 years, 28.2% had 10 to 20 years, 28.2% had 5 to 10 years, and 33.4% had less than 5 years of experience. 98.7% of them agreed that mortality and morbidity due to CHD in newborns can be reduced by early diagnosis of CHD. In terms protocol followed in their units, 100% opined that all newborns are examined by pediatrician before discharge, only 2.9% reported that newborns get a pulse oximetry screening done and none reported the use of echocardiography for screening. Only 2.3% of the respondents felt that current practice was sufficient in detecting signii¬cant CHD. The overall mandate for pulse oximetry screening was 69.2%. Conclusions: Health care professionals agree that current practice is not adequate for detecting signii¬cant CHD in newborns. 69.2% in this study recognized that universal routine pulse oximetry screening is mandated in newborns to detect CHD.

BACKGROUND:Congenital central nervous system (CNS) anomalies are the structural or functional abnormalities of the brain and spinal cord that occur during the intrauterine developmental process.PURPOSE:The present study aims to detect the prevalence of congenital CNS anomalies among stillborn fetuses, the association between congenital anomalies and maternal factors, and also the association between autopsy and ultrasound findings.METHODS:This study was conducted on 50 stillborn fetuses, obtained from the Department of Obstetrics and Gynecology at JSS Medical College and Hospital, Mysuru. The fetuses were fixed in 10% formalin and autopsies were performed as per the standard fetal autopsy protocol. The congenital CNS anomalies were studied in detail.RESULTS:CNS anomalies were the most common congenital anomalies observed. Out of the total 50 stillborn fetuses studied, CNS anomalies were found in 17 fetuses and their occurrence was more common among male stillborn than females. Meningomyelocele was the most common anomaly, followed by anencephaly. The other anomalies documented were meningocele, encephalocele, meningoencephalocele, agenesis of the corpus callosum, craniorachischisis, bifid cerebellum with hypoplastic vermis, holoprosencephaly, and sirenomelia.Fisher's exact test showed a significant association between maternal hypothyroidism and congenital CNS anomalies (P < .05). The autopsy confirmed the ultrasound findings in 40 (80%) fetuses. There were significant additional findings observed in seven (14%) fetal autopsies and ultrasound diagnosis completely changed in three (6%) cases, after the final autopsy procedure.CONCLUSION:The fetal autopsy is the single most directly evident investigation, which gives information that changes or significantly improves the clinical diagnosis. A multidisciplinary holistic approach toward pregnancy will help to detect any kind of abnormality in the fetus and thus to take a timely decision toward the management.

A 3 year old male child, first born of a consanguineous marriage diagnosed previously as cerebral palsy with epilepsy due to birth asphyxia presented to us with breakthrough seizures.He had global developmental delay, microcephaly, irregular breathing with intermittent hyperpnoea, horizontal nystagmus, strabismus and oculomotor apraxia.Fundus examination was normal.CT brain showed partial vermian hypoplasia with elongated superior cerebellar peduncles giving a 'Molar Tooth Sign' in the midbrain, hypoplastic corpus callosum and thinned out brain stem (Figure 1).Ultrasound abdomen was normal.

Background: Oral health is considered as a gateway for general health.Compromised oral health possibly will have a sizeable bearing on the general health status and quality of life.Underlying medical condition in hospitalized children might prevent the care givers to pay attention towards oral health, which can sometimes lead to life-threatening complications.Hence this study was conducted to know status of oral health during hospitalization and perception of parents toward oral hygiene.Methods: An observational cross sectional study was conducted over a period of one month at in patient ward of department of pediatrics.All the subjects were examined for oral health status and their parent's knowledge attitude and practices were assessed through a validated questionnaire.Results: Caries prevalence was high.42.6 % of children had 1 or more teeth decayed, filled or extracted.The mean dmft /DMFT score was 3.58 ± 1.75 and DMFT score was 1.43 ± 2.51 overall.There was a significant decrease in the plaque score from the date of admission to date of discharge.Only 42.6% of the parents of hospitalized children were aware about the oral health status of their wards.Conclusions: It was found that the parents of hospitalized children were very much aware of importance of oral health.Hence, preventive strategies involving care givers/guardians, with timely reinforcements would help in reduction of caries experience and improvement in gingival/oral health of these individuals Original research

Introduction: Dermatoses are common among schoolgoing children, more so in a tribal area and cause significant morbidity. Objective: The present study was conducted to study the point prevalence and pattern of dermatoses in Jenukuruba tribal children in Mysore district. Materials and Methods: A cross-sectional study was conducted on 4207 Jenukuruba tribal children in Mysore district. Diagnosis of various dermatoses was made on the basis of detailed clinical examination. Results: The point prevalence of dermatoses was 71.5%. Majority had single skin lesion. Nearly 43% had more than one skin lesion. Among skin infections and infestations, pyoderma (33.4%) and scabies (19.8%) were most prevalent. Among the noninfective conditions, xerosis (71.5%), pityriasis alba (16.7%), acne (8.6%), and hyperpigmentation (54.5%) were most prevalent. Conclusions: The point prevalence of dermatoses in tribal schoolchildren in Mysore district is very high. Health education of children and caregivers regarding the signs and symptoms of dermatoses is warranted for early detection, timely intervention, and prevention.

Cardiogenesis starts at around the third week of gestation and require precise gene signalling through various transcription factors. Irregularities in gene signalling lead to various types of Congenital Heart Diseases (CHDs). Since the Ventricular Septal Defects (VSDs) are more frequent in Indians, to unravel the possible genetic players in VSD cases, the whole exome sequence data was generated and analysed. Whole exome sequencing was carried using the Illumina platform and data was analysed with specific softwares. The analysis identified a frameshift deletion (GGCATGT) in Hairy/Enhancer-of-split related with YRPW motif protein 1(HEY1) in transcript NM_001282851 with rs142613628 and in HEY2, a nonsynonymous damaging variant, A370G in the transcript NM_012259 with rs549151246. Further, it was observed that HEY proteins interacted with NOTCH1, GATA4, ZFPM1, NCoR1, MEF2A, JAG1 and HDAC9 proteins which are involved in cardiogenesis. This suggests that variants in HEY genes are involved in manifestation of VSDs and Tetralogy of Fallots (TOFs) indicating their role in heart development.

Introduction: Mycoplasma pneumoniae is the most common causative agent of community acquired pneumonia. Rapid and reliable method for the diagnosis of Mycoplasma pneumoniae infection is important for the appropriate treatment. Aim: To determine the rapid diagnosis of Mycoplasma pneumoniae pneumonia in a clinically suspected CommunityAcquired Pneumonia (CAP) cases. Materials and Methods: A cross-sectional study was carried out in the Department of Microbiology, JSS Hospital, Mysuru, Karnataka, India, for a period of two years from January 2016- January 2018. All the suspected cases of CAP from inpatients and outpatients attending JSS Hospital were enrolled in the study. The samples were subjected to Enzyme Linked Immunosorbent Assay (ELISA) and Indirect Immunofluorescence Assay (IFA) for the detection of IgM antibodies against Mycoplasma pneumoniae. Results: A total of 200 patients were enrolled in this study. Among which 123 (61.5%) were paediatric population and 77 (38.5%) were adults respectively. A total of 60 samples were positive for IgM antimycoplasma antibody. Out of 60 samples 11 samples were positive by ELISA and 60 samples were positive by IFA. Sensitivity and specificity was found to be 100% and 74.1% of the tests. The prevalence of Mycoplasma pneumonia in the present study was found to be 30%. The most common symptom was cough followed by fever. Conclusion: Mycoplasma pneumoniae pneumonia constituted to about 30% of CAP in our study. Combination of tests must be carried out along with significant suggestive clinical signs in the clinically suspected cases for the CAP for the better management and early diagnosis of the disease.

Purpose: To study the prescribing pattern of AEDs for a different type of seizures in the pediatric population and disease conditions other than epilepsy and to identify the drug interactions with the use of AEDs among the study population. Methods: This six months long prospective observational study was conducted at in-patient wards of JSS Hospital. The case sheets of all in-patients were reviewed daily and enrolled the patient's who met the study criteria. Enrolled children were followed until discharge to identify the usage pattern of AEDs and other drug therapy and any drug interactions involved in the use of AEDs. Results: Total number of the study population was 294, and the mean age of the study population was 8.64 +/- 3.7 years, and the majority of the then were infants [1 month - 1 year (35.03%)], followed by toddlers [1-2 years (32.6%)]. In our study, the majority of children were on monotherapy (64.96%) followed by dual therapy (26.53%). Clobazam was the highly prescribed drug as monotherapy (39.79%), and fosphenytoin + clobazam was majorly used dual therapy (26.92%) combination. A total of 39 treatment charts had AED - AED interactions, but none of those were clinically significant. Conclusion: Among the study population, only 64.96% responded to monotherapy while others required combination therapy due to the seizure type and co-morbid conditions. We couldn't identify any drug-related problems among the study population as the AED therapy was more judicious and wherever necessary the pediatricians have taken the advice of neurologists to avoid any errors.