Vitamin B12 is essential for DNA synthesis and is necessary for the development of the central nervous system. Vitamin B12 deficiency occurs in babies who are exclusively breast-fed by mothers with insufficient stores of vitamin B12. In vitamin B12 deficiency, the clinical features are mainly hematological and neurological. Megaloblastic anemia is the characteristic feature of vitamin B12 insufficiency. Rare haematological manifestations include pancytopenia and hemolytic anemia. The other clinical spectrum of vitamin B12 deficiency comprises vomiting, lethargy, failure to thrive, hypotonia, and retrogression of developmental milestones. We reported a 7-month-old infant with vitamin B12 deficiency who presented with loss of weight and regression of social smile since one month of age. Her weight, length, and head circumference were in the less than 3rd centile range according to the World Health Organisation (WHO) growth chart. She had severe pallor, hyperpigmentation of palms, soles, and knuckles, brownish depigmented brown sparse hair, and hepato-splenomegaly of 4 cm each. The laboratory results revealed Hb of 3.5gm/dl, Mean Corpuscular Volume (MCV) of 99fl, thrombocytopenia, normal ferritin levels, and peripheral smear showed polychromatophils, 19 nucleated Red Blood Cell (RBCs)/100White Blood Cells (WBCs), macrocytes, leucocytes shift to the left with 21% hypersegmented neutrophils, suggestive of hemolytic anemia. Vitamin B12 levels were 146pg/ml [N=200-900 pg/ml]. The baby started smiling 2 days after the vitamin B12 injection, gained 700 g during the follow-up of 3 months, and the pigmentation disappeared from the palms and soles.

ABSTRACT Gallstones (GSs) are rare in children. The incidence of GSs has been increasing due to the utility of sonography in modern practice. Common causes of GSs in children include hemolytic anemias, obesity, metabolic syndrome, prematurity, necrotizing enterocolitis, cystic fibrosis, and total parenteral nutrition. Several studies evaluated the association between hepatic viral infection and GSs. There is a significantly increased risk of GSs among hepatitis C virus-infected patients and no significant association with hepatitis B virus infection. We report a child with acute hepatitis A infection who also had GS, which did not clear even after resolution of jaundice; probably, the detection of GS was coincidental rather than due to hepatitis A.

The burden due to Type-1 diabetes is increasing at an alarming rate in recent years. Projections from various studies predict that the incidence of Type-1 diabetes increases from 8.4 million cases globally in the year 2021 to 17.4 million cases by the year 2040. Furthermore, the predictions have highlighted the importance of early detection to manage this disease effectively. However, sensitive and specific markers for the very early detection and risk prediction of Type-1 diabetes are very minimal. The existing methods detect autoantibodies and glycated proteins that usually reflect the late stage of the disease, wherein more than 90 % of insulin producing pancreatic beta-cells have been lost. Therefore, there is an immediate requirement for developing an early detection marker to predict the individuals at risk. Recent studies have highlighted that oxidative stress is one of the major mechanisms by which Type-1 diabetes manifests its complications. Preliminary studies have mentioned that serum malondialdehyde (MDA) and xanthine oxidase (XO) can serve as potential markers for monitoring the progressive complications. But the suitability of these markers for predicting the severity and early detection of Type-1 diabetes require large cohort studies, necessitating the need for large clinical validation of these markers or identify a new set of markers that strongly correlates with the disease severity. Addressing these research gaps, we have measured the expression of key enzyme markers of oxidative stress viz., Superoxide dismutase (SOD) and Catalase (Cat) and correlated the data with the ability of serum to reduce ferric ions in to ferrous ions (an indicator of antioxidant potential). Analysis of the data showed that among various markers, the activity of Catalase found to be significantly high in Type-1 diabetic pediatric population compared to healthy young children. Since our data showed a strong association between CAT and the severity of diabetes, it is proposed that CAT might serve as an additional marker for the early deterction of disease, however, further studies validating the clinical utility of CAT as a predictive biomarker are needed to confirm our findings.

Purpose:To describe a case of periorbital cellulitis as the manifestation of Kawasaki disease (KD). Methods:A single case report. Results:A 15-month-old child presented with fever and swelling around the eyes, initially diagnosed as orbital cellulitis. On examination, the child exhibited bilateral orbital swelling with conjunctival congestion, strawberry tongue, cracked lips, significant bilateral cervical lymphadenopathy, and perianal excoriation. Although many clinical features were compatible with KD, the diagnostic criteria for KD were not fully met. Despite 48 h of antibiotic therapy, the child continued to experience high-grade fever spikes. Consequently, the diagnosis was reviewed and reclassified as incomplete KD. The child was then administered intravenous immunoglobulin (IVIG) at a dosage of 2 g/kg over 10 h. Within 48 h of IVIG administration, the fever subsided and the periorbital swelling decreased. Conclusions:The diagnosis of incomplete KD requires a high index of suspicion as the delay in diagnosis may lead to coronary involvement. Any young child with orbital cellulitis unresponsive to antibiotic therapy should be investigated for underlying KD.

Metoclopramide is a dopamine-2 antagonist and is generally used as an antiemetic in clinical practice. Extrapyramidal reactions are the important adverse effects of metoclopramide which are reported in 0.2% of cases. In young children, the incidence can extend up to 25%. Metoclopramide-induced EPS include acute dystonia, tardive dyskinesia, parkinsonism, akathisia, and malignant neuroleptic syndrome. We are reporting a single dose of metoclopramide induced acute dystonia in an adolescent girl, which caused lot of anxiety in the patient and the parents which responded to oral diphenhydramine.

Background: Acute, acute recurrent and chronic pancreatitis cause significant health problems in the paediatric population. In view of the small number of patients, it is difficult to evaluate outcomes, genetic causes, treatments, prognostic indicators, severity, and epidemiologic factors in childhood in a prospective way. Objectives: To determine the characteristics of patients with pancreatitis (acute, chronic and recurrent) presenting to us. Method: This was a retrospective descriptive study of consecutive paediatric patients admitted between January 2017 and December 2020 (4 years) in our paediatric department with a diagnosis of pancreatitis. Patient characteristics, laboratory and imaging results, identified aetiology of pancreatitis, and recurrence rates were recorded and evaluated.Results: There were 34 visits, of which 28 were for acute pancreatitis (including 3 with acute on chronic pancreatitis), and 6 for an episode of recurrent pancreatitis. The median age for all visits was 9 years (range 2-16). Of the acute cases, 14 had uncertain or undetermined aetiologies, 3 had systemic diseases, 2 were associated with medications, most common being valproic acid, 3 were cholelithiasis-related, 5 were due to other infections and one was due to trauma; one child with 3 recurrent episodes was suspected to have a genetic basis and 1 child was diagnosed to have Rapunzel syndrome (trichobezoar). There were five patients with chronic pancreatitis, of which 3 had acute on chronic pancreatitis.Conclusions: Abdominal pain, nausea, vomiting, fever and jaundice were the common clinical presentations of acute pancreatitis in children. The common aetiological factors identified were infections (18%), systemic illness (11%), drug induced (7%) and obstructive/ cholelithiasis (7%); in 46% the aetiology was unknown.

Almost 56% of Indian adolescent girls aged 15–19 years suffer from anemia. Adolescent age is a period of many significant physiological changes that increase nutritional demand, and they remain at risk for nutritional deficiencies. Our aim is to assess the prevalence of Vitamin B12 deficiency among school-going adolescent girls aged 13–16 years of rural Mysore. This study was a cross-sectional study, conducted in two high schools in rural Mysuru. Adolescent girls aged 13–16 years were included. The chosen subjects underwent complete hemogram, peripheral smear examination, and vitamin B12 level estimation. Out of 98 subjects enrolled, 40.81% were found to be deficient in vitamin B12. Macrocytes and hyper-segmented neutrophils were found to have statistically significant ( P value < 0.001) relationship with vitamin B12 deficiency. The relationship between vitamin B12 deficiency with either type of diet and anemia was statically insignificant ( P > 0.05). The prevalence of vitamin B12 deficiency among rural adolescent girls in Mysuru is high. Other causes of nutritional anemia apart from iron deficiency, such as vitamin B12 deficiency, must be considered in the etiology of anemia and optimally treated. It is recommended to further strengthen the adolescent national health programs and food fortification programs.

Pulmonary Arteriovenous Malformations (AVMs) are abnormal connections between the pulmonary arteries and veins, leading to a direct shunting of blood without passing through the normal capillary bed.These AVMs can be associated with a rare genetic disorder called Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome.HHT is an autosomal dominant disorder characterized by the development of fragile telangiectasias in various organs, including the skin and mucous membranes.These telangiectasias are prone to bleeding, leading to recurrent nosebleeds and mucocutaneous bleeding.In patients with HHT, the most common site of AVMs is in the lungs.Pulmonary AVMs can cause significant health risks due to the right-to-left shunting of blood, leading to hypoxemia and possible complications like stroke, cerebral abscesses, and heart failure.

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.

Background Febrile seizures (FSs) are the common presentations of seizures in childhood. Activation of cytokine network plays a significant role in the genesis of FSs. Interleukin (IL)-6 is often considered as key cytokine in the generation of FSs. Objectives To compare the serum IL-6 levels in children between simple febrile seizures (SFSs) and febrile controls (FCs). Materials and Methods This hospital-based prospective cross-sectional study was conducted in JSS Hospital, Mysuru, during a period of 21 months. A total of 83 children were included in the study. Out of which, 38 were cases of SFSs and 45 were FCs without seizures. Serum IL-6 levels were estimated in both SFS and FC groups. Results Serum IL-6 levels were increased among children with SFSs (mean = 608.15 pg/mL) when compared with FCs (mean = 342 pg/mL), but the results are not statistically significant (p = 0.165). In SFS and FC groups, percentage of subjects with IL-6 levels >50 pg/mL is 31.6 and 44.4%, respectively (p = 0.16). Conclusion Serum IL-6 levels are higher in children with SFSs compared with FCs. However, this difference did not reach statistical significance.

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.

Hemophagocytic lymphohistiocytosis (HLH) is an uncommon life-threatening immune disorder that may be either primary or secondary to infection, malignancy, or rheumatological disease. In tropical countries like India, secondary HLH is more commonly seen. Both Dengue fever and scrub typhus, which result in more than half of all acute undifferentiated febrile illnesses in tropics, can occasionally result in HLH. Early diagnosis of HLH and institution of appropriate treatment can result in a good outcome. Although coinfections are common in tropical countries, HLH due to coinfections is rare. We are reporting a child diagnosed with HLH associated with coinfection with scrub typhus and Dengue fever that received early supportive treatment and recovered without needing chemotherapy.

Introduction: Iron overload in thalassemia catalyses the production of a variety of reactive oxygen species leading to cumulative cell damage. Ischemia modified albumin (IMA) is an end product of oxidative stress. It is imperative to pick up oxidative stress early in order to prevent the organ damage in thalassemia. Therefore this study was undertaken to estimate IMA levels and to see the correlation between ferritin and IMA to establish whether ferritin can be a proxy marker for oxidative stress. Methods: A total of 76 children were included in the study out of which 46 were diagnosed cases of β- Thalassemia major and 30 formed the healthy controls. Pre transfusion haemoglobin, AST, ALT, ferritin and IMA levels were estimated and compared with healthy control children. Correlation was drawn between haemoglobin, AST, ALT, ferritin with IMA. Results: There is significant elevation in the level of IMA and ferritin in children with Thalassemia major as compared to the healthy controls (p = < 0.001). There was a significant positive correlation between ferritin and IMA and a significant negative correlation between haemoglobin % and IMA. Regression relationship between ferritin and IMA established that IMA (ng/ mL) = 246.118 + 0.829 (Ferritin ng/dL). Conclusions: IMA levels were significantly elevated in β- thalassemia major children and correlated positively with ferritin levels. By establishing a regression relationship between ferritin and IMA levels, we can fairly estimate the levels of IMA. Hence, we can utilise ferritin as a proxy marker of oxidative stress instead of IMA.

AbstractCroup is an acute inflammatory condition affecting upper airways and commonly seen in children with younger age group. Croup is most commonly due to acute viral infection and rarely because of bacterial and atypical agents. Here, we report a 3-month-old child who presented to us with classic signs and symptoms of croup and was also positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Child's mother also tested positive for SARS-CoV-2. SARS-CoV-2 infection presenting with stridor and croup is very rare and probably represents a new manifestation which should be considered in a young infant presenting with croup.

Rare diseases (RD) of genetic origin are raising public health concern contributing to a massive economic burden in India. Establishing Specialty Centers to bridge the RD community with apex centers is felt as a need in developing countries. Hence a Comprehensive Rare Disease Care (CRDC) model was set up at the department of pediatrics under Center for Human Genomics and Counseling at a medical college hospital in South India. The patients suspected to have genetic disease were evaluated as per the work flow of the designed model. The utilization statistics depict the outcome of this model. In the face of limited resources, it was possible to establish a functional RD unit with meticulous planning, supportive administration and trained interdisciplinary staff. A scalable prototype that could be replicated in other Medical colleges and Hospitals of India is described.

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.

DOI https://doi.org/ 10.1055/s-0040-1715768 ISSN 2213-6320. © 2020. Indian Epilepsy Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit.

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.