Background: Status epilepticus is a major medical and neurological emergency. Despite advances in treatment, it is still associated with significant morbidity and mortality. The objective of the study was to compare the efficacy of levetiracetam versus phenytoin in treatment of convulsive status epilepticus.Methods: A Randomized control trial, was conducted at tertiary care hospital, Udaipur, Rajasthan, over a period of March 2017 to September 2018. Total 250 patients (age group 6 months to 18 years) who were presented with status epilepticus in PICU, were enrolled. These patients were divided into two groups by simple randomization. Levetiracetam was given to one group, while phenytoin was given to another group. Efficacy was decided by cessation of clinical seizure activity within 30 minutes of starting of drug infusion and patient was observed for recurrence of seizure within 24 hours.Results: A total of 250 patients were enrolled in this study. Seizure terminated in 107 patients in phenytoin group (85.6%) and in 114 patients in levetiracetam group (91.2%). The difference was significant. Recurrence of seizure (with in 24 hour) was high in phenytoin group (14.4%) in comparison with levetiracetam group (8.8%). Most common adverse effect in both the groups on treatment was hypotension, though in phenytoin group it was significantly higher than patients on levetiracetam group (7.2% v/v 2.4%).Conclusions: Levetiracetam may be an effective alternative to phenytoin as a second line drug in the management of benzodiazepine resistant convulsive status epilepticus in children.

Background: Celiac disease (CD) is the most common genetically related food intolerance, worldwide. The objective of this study was to study the prevalence and clinical profile of malnourished children. Methods: It was a prospective and observational study. The present study was conducted in the Department of Paediatrics, Geetanjali Medical College and Hospital, Udaipur, Rajasthan. Two hundred and one children were studied. All malnourished children were initially selected and those fulfilling inclusion criteria were included in the study. A detailed interview of all the children/parents was conducted regarding symptoms commonly associated with celiac disease. All cases found positive for t-TGA (>10au/ml) were subjected to upper GI Endoscopy. Subjects were labelled as celiac disease if tissue trans-glutaminase IgA antibodies were >10 au/ml and histopathology was suggestive. Statistical analysis was done by one way ANOVA test and Chi-square as per requirements also Fisher exact and Man Whitney were applied. Results: Celiac disease was present in 23.9% of malnourished patients. Most common presenting symptoms were diarrhoea (40.2%), abdominal distension (39.9%) and abdominal pain (36.8%) and most common clinical sign was pallor, which was present in more than three-fourth of the patients (85.9%) followed by multivitamin deficiency (25.4%). Conclusions: There is a high prevalence of Celiac disease in malnourished children. Screening for Celiac disease (especially in presence of diarrhoea and abdominal distension, pain abdomen) should be an essential part of work-up in all malnourished children.

Background: Neonatal sepsis is a major cause of neonatal morbidity and mortality. Blood culture and sensitivity is gold standard for the diagnosis of neonatal sepsis. Low sensitivity of blood culture especially in newborn is due to small volume of blood sample collected from neonates and antibiotics given before sampling. The aim was to evaluate the use of umbilical cord blood culture in the diagnosis of early onset neonatal sepsis as compared to Peripheral vein blood culture. Methods: Eighty neonates with two or more risk factors for early onset neonatal sepsis were included in the study. Blood samples were collected from umbilical cord and peripheral vein for culture. Sepsis screen was done to corroborate the diagnosis of neonatal sepsis. Results: Sepsis screen was positive in twenty three babies. Among these four had grown organism on Umbilical cord blood culture only. While two babies had both positive, Umbilical cord bloods culture and peripheral vein blood culture. Organisms grown on culture were E.Coli, Pseudomonas, Klebsiella and Acinetobacter. Conclusions: Umbilical cord blood culture is simple and convenient method for the diagnosis of early onset neonatal sepsis compared to peripheral venous blood culture. Organisms grown are comparable to peripheral venous blood culture sample.

Objectives: To know the prevalence of sickle cell disease in 0-15 years old children of tribal area and to study its clinical and hematological profile. Materials and Methods: This cross sectional study was conducted between May 2014 and December 2015 in children below 15 years of age from tribal area of Sirohi and Udaipur district in South Rajasthan. Results: A total of 1090 children in tribal area were screened for sickle cell disease. Prevalence of sickle cell disease was found to be 8.53% of which 0.77% children were suffering from sickle cell anemia (HbSS), whereas 7.7% were having sickle cell traits (HbAS). Common morbidities were anemia, pain, infection, and splenomegaly. Conclusion: Sickle cell disease is prevalent in this area. Screening for sickling in this area is suggested for early diagnosis and to promote preventive measures so as to decrease morbidity and mortality.

Background: Simple febrile seizure (FS) is the most common type of childhood seizure. Iron plays an important role in brain metabolism, neurotransmitter function, and myelination. Iron deficiency anemia (IDA) has been found to be associated with an increased incidence of FS. Objective: The objective of the study was to study the prevalence of IDA in simple FS patients and febrile patients without seizure. Materials and Methods: All admitted febrile children between 6 months and 5 years were enrolled in the study according to the inclusion and exclusion criteria and a detailed clinical examination was done. Blood samples were collected for complete blood count, blood indices, and serum ferritin. Results: IDA was present in 28 out of 50 patients in the case group and 18 of 50 patients in the control group (p<0.05). Mean hemoglobin and mean serum ferritin levels were significantly lower in the case group when compared to the control group (p<0.05). Conclusion: All the investigations carried out to evaluate the IDA were significantly lower in the case group as compared to the control group. This suggested that iron-deficient children were more prone to get FS.

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed disorders of childhood (3-5%). The main characteristics of attention deficit hyperactivity disorder are inattention, hyperactivity, and impulsivity.  The Objective of this study was to study prevalence of ADHD in school aged children.Methods: A cross sectional descriptive school-based study was conducted in a private school of Udaipur from January 2017 to September 2018.  All eligible students were included. Total 1200 students were enrolled. They were assessed for the presence of ADHD using INCLEN diagnostic tool and those found positive were further assessed for the presence of co-morbid conditions using child behavior checklist (CBCL).Results: In present study out of total 1200 students 730(60.83%) were male and 470(39.17%) were female. 76 (6.3%) students out of 1200 were ADHD Positive. ADHD was more common in male students (73.7%), urban locality (57.89%), in age group 6 to 9 years (44.7%) and higher economic class (46.1%). Hyperactivity-Impulsivity type was most common type (51.32%). Male students had predominance of hyperactivity (60.7%) whereas in female student’s inattention type was predominant (45%). Aggressive Behavior (19.6%) and rule breaking behavior (80.4%) was more common in male. Somatic complaints were more common in females (60%). Oppositional defiant disorder was observed in male (21.4%) and female (10%) students. 15.8% of ADHD students had learning disorder.Conclusions: Present study shows 6.3% prevalence of ADHD. Hyperactivity type of ADHD was more common in boys, while Inattention type was more common in girls. Among associated co morbid conditions - aggressive behavior, rule breaking behavior and oppositional defiant disorder (ODD) was found to be more prevalent in boys while anxious behavior, somatic complaints and social problems were more commonly found in girls. Thought problems, learning disorders and conduct disorders are also observed in ADHD students.

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Background: Enteric fever remains a major concern in developing countries caused by Salmonella typhi. Recently, an upsurge in antimicrobial resistant strains has complicated the management. The present study was undertaken to evaluate the clinical profile, compare typhidot test with blood culture and determine antimicrobial susceptibility pattern.Methods: Single centre descriptive study was conducted by enrolling children who presented with fever and who were either blood culture positive for S. typhi or typhidot positive. The clinico-laboratory data and antibiogram was studied.Results: Out of 76 cases, blood culture was positive in 35 (46%) cases. Typhidot test showed 92.11% positivity. Abdominal pain (78%), vomiting (68%), hepatomegaly (68%) and splenomegaly (43%) were most commonly observed. The sensitivity for classical drugs chloramphenicol, ampicillin and cotrimoxazole was 88.57%, 74.28% and 77.14%. High susceptibility to ceftriaxone (97.14%) and high resistance to ciprofloxacin (55.14%) was observed.Conclusions: Prompt diagnosis of enteric fever is essential for appropriate management therefore, important to have conventional tests like typhidot test. There is re-emergence of sensitivity to the classical drugs. Ceftriaxone as monotherapy is quite effective. Effective vaccination strategy and hygienic practices can decrease the burden of this disease.