Objective: To compare the efficacy and safety of intravenous Levetiracetam and Phenobarbitone in the treatment of neonatal seizures. Design: Open labelled, Randomized controlled trial. Setting: Level III Neonatal Intensive Care Unit (NICU). Participants: 100 neonates (0-28 days) with clinical seizures. Intervention: If seizures persisted even after correction of hypoglycemia and hypocalcemia, participants were randomized to receive either Levetiracetam (20 mg/kg) or Phenobarbitone (20 mg/kg) intravenously. The dose of same drug was repeated if seizures persisted (20 mg/kg of Levetiracetam or 10 mg/kg of Phenobarbitone) and changeover to other drug occurred if the seizures persisted even after second dose of same drug. Main outcome measures: Cessation of seizures with one or two doses of the first drug, and remaining seizure-free for the next 24 hours. Results: Seizures stoped in 43 (86%) and 31 (62%) neonates in Levetiracetam and Phenobarbitone group, respectively (RR 0.37; 95%CI 0.17, 0.80, P<0.01). 10 neonates had adverse reactions in the phenobarbitone group (hypotension in 5, bradycardia in 3 and requirement of mechanical ventilation in 2 neonates) while none had any adverse reaction in Levetiracatam group. Conclusion: Levetiracetam achieves better control than Phenobarbitone for neonatal seizures when used as first-line antiepileptic drug, and is not associated with adverse drug reactions.

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Myocardial iron deposition causes cardiac hypertrophy and dilatation and degeneration of myocardial fibres. The unbound iron generates toxic oxygen free radicals resulting in further injury to the myocytes. Patients develop conductive disturbances and progressive heart failure. 2 Regular monitoring for cardiac dysfunction and ABSTRACT Background: Thalassemias are a group of inherited disorders of haemoglobin synthesis, with significant morbidity and mortality. The leading cause of death in transfused thalassemia major children is myocardial haemosiderosis. Echocardiographic estimation of left ventricular function may reveal abnormalities before there is any clinical evidence of cardiac disease. The aim of the study was to determine the magnitude and nature of cardiac involvement in children with thalassemia major with respect to various serum ferritin levels. Methods: A prospective study was done on 30 cases of Thalassemia major attending our tertiary referral centre for a period of two yrs. The relationship of blood transfusion and serum ferritin with the parameters PWT-d, PWT-s, LViedd, LViesd, septal thickness, E/A and ES were studied. Results: Out of 30 patients studied, mean age was 4.02 yrs, mean number of transfusions was 28.97 and mean serum ferritin level was 1475. Mean serum ferritin levels of the patients receiving transfusions were estimated in various groups, ferritin levels were higher (2610 ±115.33) in patients who had received more than 50 transfusions.3 of our patients had features of left ventricular hypertrophy in ECG, rest were normal and none of them had evidence of cardiac arrhythmia. Echo parameters were compared; an increase in LViesd was noted in cases when compared to controls which was statistically significant (0.006). Conclusions: Persistent ferritin levels greater than 2500 mcg/ml and assessment of annual blood requirement can assist in prediction of development of cardiac disease. Thus, regular monitoring for cardiac dysfunction and arrhythmias with annual echocardiogram and ECG is extremely important.

A 3-d-old female baby presented with bilateral congenital absence of breast tissue, areolae and nipples. No other anomalies were noted. There was also a history of absence of nipples, areolae and breast tissue in the mother and two other family members of maternal side. Investigations done during the hospital stay including ultrasound of the chest wall, abdomen and head were all normal. Congenital isolated bilateral amastia was diagnosed after complete investigations.

We aimed to study the diagnostic utility of cerebrospinal fluid (CSF) procalcitonin (PCT) in neonates with meningitis. All the neonates with sepsis who qualified for lumbar puncture were prospectively evaluated. The neonates were classified into Meningitis and No meningitis group based on predefined criteria. CSF PCT was estimated in these neonates along with cytological and biochemical parameters. A total of 113 neonates were included in the study with 29 in the meningitis group and 84 in the no meningitis group. The median PCT levels were higher in babies with meningitis as compared to those without meningitis [0.194 (0.034–0.534) in meningitis group vs. 0.012 (0.012–0.012) ng/ml in no meningitis group, p &lt; 0.001]. The area under curve for CSF PCT was 0.867 (0.77–0.95) and at a cut-off level of 0.120 ng/ml CSF PCT had a sensitivity of 83%, specificity of 84% and positive and negative predictive likelihood ratios of 5.35 and 0.20, respectively for the diagnosis of meningitis. CSF PCT has a good diagnostic accuracy similar to other parameters in the diagnosis of neonatal meningitis and can be considered as an additional diagnostic marker particularly when CSF culture is negative and cytochemical analysis is inconclusive.

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Background: Rheumatic diseases are characterised by inflammation of the joints, muscles, bones and skin. The musculoskeletal system is commonly involved in rheumatic diseases but ocular involvement, which can lead to loss of vision, may be a clue to the diagnosis or may add to the severity of disease. There is paucity of data regarding ophthalmic findings in children with rheumatic diseases, especially in India.Objectives: To describe the clinical spectrum of ocular manifestations in paediatric rheumatic diseases in a tertiary level paediatric hospital in South India. Method:A hospital-based cross-sectional, observational study was conducted in which 220 children diagnosed with rheumatic diseases were subjected to complete ophthalmic evaluation between January 2019 and June 2020 and the different ocular manifestations were documented. Results:Of the 220 children with rheumatic disease, 29 (13.2%) had ocular involvement. Anterior uveitis was the most common ocular finding occurring in 8 (29.6%) cases. Duration of the disease and HLA B 27 had significant association with abnormal ophthalmic findings. _________________________________________ 1