This experience demonstrates that non-operative treatment can be used successfully in a general hospital. Adherence to protocol guidelines was found to be variable and the protocol has therefore been simplified. This study highlights the need for an accurate diagnosis and the importance of follow-up endoscopy.

Introduction:Cerebral palsy (CP) is the most common physical disorder of children. Causes like jaundice and birth injury though are decreasing; complications resulting from the survival of low birth weight babies are replacing some of the older etiologies. Hence, this study was planned.Objectives:The objective was to study the clinical patterns, predisposing factors, and co-morbidities in children with CP.Materials and Methods:The present study is a hospital based prospective study conducted from January 2012 to January 2013 in children presenting to neurodevelopmental clinic at a tertiary care teaching hospital in India. Hundred cases with clinical features suggestive of CP were included in the study. Cases were evaluated by history, clinical examination, and necessary investigations.Results:Results of the study showed 81% of spastic, 12% of hypotonic, 5% of dystonic, and 2% of mixed CP cases. The mean age of presentation was 2 year, 2 month, and male to female ratio of 1:2. Pregnancy-induced hypertension (PIH) was the most common antenatal complication observed in 6%. Four percent had neonatal sepsis and 19% were born premature. Associated co-morbidities were mental retardation (55%), seizure disorder (46%), visual problems (26%), hearing problems (19%), and failure to thrive (47%).Discussion:Sex distribution observed in our study was male to female ratio of 1.2, which was comparable with a multicenter study in Europe. PIH was observed in 6% of cases, which was comparable with prior studies. Birth asphyxia was observed in 43% of cases. Eighty-one percent of the cases constituted a spastic variety of CP which was comparable to other studies.Conclusion:Perinatal asphyxia was the important etiological factor. We found preventable intranatal causes (60%) and antenatal causes (20%) forming a significant proportion. Co-morbidities were significantly observed in our study.

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Only few reports of failure of intradermal postexposure prophylaxis for rabies following cat scratch exist in the published literature. We are reporting such a case in a 15-year-old girl. The child had category III cat scratch on her face. She presented with progressive paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. She received intra-dermal anti-rabies cell culture vaccine. She did not receive anti-rabies immunoglobulin. The girl succumbed on the 10th day of weakness. Diagnosis of rabies was confirmed by isolation of rabies virus RNA in cerebrospinal fluid and skin biopsy sample by reverse transcription polymerase chain reaction.

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A major physiological role of retinoids is the regulation of epithelial and epidermal cell differentiation. A total of 285 patients with clinically and histopathologically confirmed diagnosis of various carcinomas (untreated) were selected for the study. The control values of serum beta-carotene and vitamin A levels were established from 50 subjects free of any known pathology. The controls were matched for age and sex. The mean serum levels of beta-carotene and vitamin A have shown a significant difference (p less than 0.001) in all the cancers compared with the controls. In cancer of the oral cavity, the males showed significantly lower levels (p less than 0.01) compared with their female counterparts. In cancer of the lung, however, the mean serum levels of beta-carotene and vitamin A were higher in males compared with females (p less than 0.02). Our results suggest a possible association between vitamin A and epithelial cancer, but whether the deficiency is the cause of the disease or if it is due to the tumor remains unknown.

Objective: To study the etiology and clinical profile of non-traumatic coma in children at tertiary care center and to determine the predictors of outcome. Methods: One hundred and four consecutive children between 2 mo-12 yr were studied. The clinical signs at admission; vital signs, Glasgow coma scale, respiratory pattern, papillary reflex, extra-ocular movements, fundus picture and motor deficits were recorded. Etiology of coma was determined by clinical history, examination and relevant investigations. Their progress was monitored clinically, biochemically and with multi-system monitors. Outcome was recorded as survived or died. Results: Etiology of coma in 65% cases was intracranial infections; other causes were metabolic (20%). Sixty-seven percent recovered completely, 16% had residual neurodeficits, 16% died. Survival was better in children with intracranial infections (13%) as compared to metabolic coma (33%). On multivariate logistic regression, bradycardia, hypotension, abnormal respiratory pattern (especially, ataxic type), duration of coma more than 48 h, Glasgow coma scale < 7 at admission, unequal and non-reactive pupils, papilledema, abnormal extra-ocular movements, motor deficits, signs of meningitis correlated with mortality. Requirement of ventilatory support and abnormal computerized tomography findings correlated with mortality. Conclusions: Intracranial infections were the most common cause of non-traumatic coma in children; the most common cause of death being metabolic coma. Simple clinical signs and relevant investigations served as prognostic indicators of outcome.

A 3-month-old female infant, presented with high grade fever for four days and rashes and vomiting for one day. She had a generalised seizure just before admission (no past history of seizures) and was in postictal state. Physical examination revealed pulse rate of 120 bpm, good volume, Capillary filling time < 3seconds, Blood Pressure (BP) 94/60 mm Hg, Respiratory Rate (RR) 38 breaths/min, temperature 99°F, pallor, pitting oedema of all the limbs along with discrete, palpable, purpuric rash [Table/ Fig-1] all over the body excluding palms and soles, which appeared on the 4 th day of illness.There was no eschar. Abdominal examination showed haepatomegaly. Spleen was not palpable and there was no evidence of free fluid. Respiratory system examination showed crepitation in bilateral lung fields. There was no focal deficits and the rickettsial score was 15. Gangrene was developed in fingers, toes and ear lobes on second day of admission [Table/ Fig-2]. She needed intubation and ventilation along with inotrope support from day 3 of admission due to respiratory distress, severe metabolic acidosis and shock, respectively.She was treated with ceftriaxone (75 mg/kg/day), in view of suspected sepsis. Azithromycin (10 mg/kg/day) was started in view of suspected ricketssial infection and given for two days. Then gangrene was gradually extended upto the middle phalanx of the three middle fingers of the right hand, so doxycycline (2.2mg/kg/ day) was added later (day 5). Mechanical ventilation was needed for three days with ionotropes. Child responded to doxycycline within 48 hours; fever subsided and progression of gangrene was stopped. She was gradually weaned off from inotrope and ventilator and was discharged in a stable condition on day 15. Surgical opinion was AbStrACtRickettsial diseases comprise a wide spectrum of diseases which are reported from different parts of India quiet long ago. Many cases of rickettsial diseases go undiagnos due to lack of diagnostic techniques and the reported incidence and prevalence may be an underestimation of the actual burden of the disease. A higher index of suspicion, clinical awareness and proper use of available diagnostic tools would increase the frequency of diagnosis. Gangrene is an uncommon complication in cases of rickettsial fever. Extensive gangrene of the digits or whole limb, even requiring amputation has been more commonly reported with Rocky Mountain spotted fever. These cases are being reported to highlight the occurrence of gangrene in rickettsial fever and the importance of appropriate management at the earliest.sought, intervention was not considered essential. There was autoamputation of right index and middle fingers up to middle phalanx and other gangrenous areas resolved over 10-20 days with peeling of skin. CASE 2A 2-year-old male child presented with fever, purpuric rashes involving palms and soles for 4 days duration. Rashes appeared on the 4 th day of illness and there was no eschar. Physical examination revealed pulse rate of 100 bpm, normal volume, CFT<3 se...