Scurvy is seldom encountered in modern day clinical practice. Children can present with nonspecific features which can mimic several other common conditions. We describe here a four-year-old child who presented with severe pain and weakness of bilateral lower limbs and found to be severely malnourished. The diagnosis of scurvy was suspected in the context of underlying malnutrition after excluding other ominous pathologies. Pathognomic radiological changes clinched the diagnosis, and the best supportive evidence was the dramatic response to vitamin C supplementation.

Objective To evaluate the efficacy and safety of nebulized magnesium sulphate as a bronchodilator in young children aged 1-24 mo with moderate to severe bronchiolitis in comparison to standard therapy. Methods This was an open labeled randomized controlled trial comprising 60 children with moderate to severe bronchiolitis which was randomly assigned to 2 groups. Intervention group received nebulization with 3 mL of 3.2% magnesium sulphate (MgSO 4 ) (iso-osmolar) every 4 hourly for 24 h in addition to standard care and the control group received standard care alone. The primary outcome measure was to compare the improvement of bronchiolitis severity score (BSS) and length of hospitalization. The secondary outcome was to measure the need for noninvasive ventilation, need for admission to intensive care unit (ICU) in the initial visit, to evaluate the safety of magnesium sulphate and need for clinic revisit, hospital readmission and ICU readmission within 2 wk after discharge in both the groups. Results The mean age of children allocated in the control group was 7.4 ± 5.1 mo and 7.7 ± 4.5 mo in the intervention group. There was no significant difference with respect to improvement of BSS or reduced length of hospitalization in both the groups (p > 0.05). BSS monitored sequentially after enrollment at 1, 2, 4, 8, 12, 16, and 24 h did not show statistically significant differences between the groups. Mean length of hospital stay was 2.89 ± 2.25 d in treatment group and 2.96 ± 1.86 d in control group (p = 0.902). No adverse events were observed in both the groups. Conclusion Nebulized magnesium sulphate is not superior to standard therapy in children with moderate to severe bronchiolitis.

No abstract

A bstract Background Sepsis in children is a conundrum of diagnostic and therapeutic challenges. There is an exigent need for a novel biomarker that can serve as a clear distinguisher of sepsis from other non-septic inflammatory conditions. The role of presepsin as a biomarker of sepsis in children is still a matter of scientific inquiry. Aim and objectives To evaluate the diagnostic accuracy of presepsin for the prediction of septic shock, in children aged 1 month to 18 years. Materials and methods This prospective cohort study was conducted in the pediatric emergency, ward, and intensive care unit of a tertiary care hospital. We enrolled all consecutive admissions aged 1 month to 18 years with a diagnosis of sepsis and compared the presepsin, procalcitonin, and C-reactive protein (CRP) levels on admission (day 1) and 72 hours later (day 4) with the clinical outcomes. Results The mean (±SD) presepsin values in blood culture-proven sepsis patients at admission and 72 hours later were 609.77 ± 417.30 and 839 ± 748.07, respectively. The procalcitonin and presepsin levels at 72 hours in sepsis patients with shock were significantly elevated (38.2 ± 45.55 and 1129.1 ± 1133.80, respectively) as compared to those without shock (10.7 ± 25.42 and 472.5 ± 507.81, respectively), p <0.05. The receiver operating characteristic (ROC) curve analysis of presepsin at 72 hours had an area under curve (AUC) of 0.730, suggesting a fair diagnostic accuracy. Conclusion Elevated presepsin levels may indicate greater severity of sepsis, particularly in those with shock. However, it lacks diagnostic ability early in the disease and has limited prognostic potential in predicting mortality. How to cite this article Khera D, Toteja N, Singh S, Singh S, Kumar P, Sharma P, et al . Is There a Role of Presepsin as a Novel Biomarker in Pediatric Sepsis? Indian J Crit Care Med 2022;26(6):712–716.

No abstract

The aim of this study was to evaluate the role of serum ferritin (SF) and PRISM-III (Pediatric Risk of Mortality) score in predicting mortality in critically ill children aged 6 months to 15 years diagnosed with acute encephalitis syndrome (AES) admitted to the pediatric intensive care unit (PICU). This prospective observational study was conducted in the PICU of a tertiary teaching hospital in Northern India between July 2018 and June 2019. The primary outcome was to determine the association of admission SF levels with mortality. Secondary outcomes included estimating the prevalence of hyperferritinemia and comparing SF with PRISM-III scores in predicting mortality. Etiology could be established in 85.5% (n = 219) of the 256 children enrolled. Scrub typhus accounted for nearly two-thirds of the cases (60.5%), while dengue and Japanese encephalitis were the next common diagnoses. The median [interquartile range] SF at admission was significantly higher among the nonsurvivors than survivors: 514 [260–1,857] and 318 [189–699] µg/L, respectively (p = 0.029). SF and PRISM-III independently predicted mortality in AES. However, both had poor discriminatory power with area under receiver operating curve (95% confidence interval) of 0.61 (0.51–0.72) and 0.67 (0.56–0.77), respectively. Elevated SF and higher PRISM-III scores independently predicted mortality in children admitted to PICU with AES.

No abstract

We describe here an interesting case of a 7-day-old male infant brought with parental concerns of inability to extend both knees. Clinical evaluation revealed dysplastic fingernails, bilateral abnormal patellae, triangular lunules in conjunction with pathognomic iliac horns on pelvic radiographs suggesting the possibility of nail-patella syndrome (NPS). Other competing diagnoses with similar phenotypic features were considered and sequentially excluded. A definitive diagnosis was established by the identification of the principal mutation at the LMX1B gene locus of chromosome 9. NPS is seldom diagnosed in neonates due to the heterogeneity of clinical presentations as well as the subtlety of clinical clues in this population. NPS is a dominantly inherited disorder that is predominantly familial in origin and thus carries important implications for the prenatal diagnosis of future pregnancies as well as pre-emptive surveillance of nephropathy in the index child.