Introduction: Severe Acute Malnutrition (SAM) is a unique type of severe malnutrition and is different from severe underweight and severe stunting. This study evaluated the clinical manifestations among the children admitted to the SCB medical college and SVP PGIP and elucidated further the factors associated with severe malnutrition among the undernourished children and finally the outcome in terms of cured or mortality. Materials and Methods: This hospitalbased cross-sectional time-bound study with follow-up component was conducted by using technique of sampling without replacement. Children aged 1-60 months admitted to SCB MCH and SVPPGIP during September 2013 to September 2015, having features of SAM were considered for the study population. After detailed history and physical examination, relevant investigations were done and critical analysis made. Results: Total 130 patients with SAM constituted the study population. The overall prevalence of SAM was 2.5%. Majority were non edematous SAM (Marasmus) (77%) and rest were oedematous (Kwashiorkor).There was no variation in sex as both male and female patients were with equal percentage (50%). About 12.3% of children with SAM were less than 2 months, 47.7% between 2 to 12 months, and 40% were above 12 months. Conclusion: Malnutrition is predicted by age less than two years, living with single parent, taking unbalanced diet, lack or incomplete immunization and low level of maternal education. Comorbidities associated with malnutrition were pneumonia, pulmonary tuberculosis, urinary tract infection. Mortality is predicted by age less than one year, peasant parents, having severe malnutrition, dehydration, hypothermia, and hypoglycemia.

The main aim is to find out the clinical feature and outcome of status epilepticus (SE) in children managed in a teaching hospital. The secondary aim is to identify the risk factors influencing the adverse outcomes. Methods In this prospective cohort, children aged 1 month to 14 years with SE as per the International League Against Epilepsy's new guideline (2016) who presented to the emergency department during the period of November 2017 to October 2019 were enrolled. Clinical profile, treatment, and outcome of cases (n = 94) were noted. Results The majority of children, 60 (63.82%), were less than five years of age. Prior history of seizures was present in 33 (35.1%) cases, whereas 61 (64.9%) cases presented with SE as the first episode of seizure. In 14 (42.4%) previous seizure cases, SE was due to drug default. No response to first-line antiepileptic drug (AED) was seen in 84 (89.37%) cases. Acute symptomatic etiology was the commonest etiology of SE in 64 (68%) cases, of which neuro-infections accounted for 44 (46.80%) cases. Longer duration (>60 minutes) of status (p < 0.01), ventilator support (p < 0.0001), and circulatory impairment (p < 0.0001) were attributable risk factors for mortality. A total of 28 children died (mortality rate, 29.8%), and 11 showed the persistence of their neuro-deficit. Conclusions Neuro-infection is the most common etiology of SE in children. Longer duration of SE, more lag time for receiving the first AED, respiratory failure, and presence of shock are independent predictors for poor outcome. Hence, cessation of convulsion at the earliest leads to improved outcomes.

Background: Lower respiratory tract infections (LRTI) contribute significantly in terms of hospital admission and mortality. Along with attempts to improve treatment modalities, it is imperative to identify risk factors that will aid in prevention of these infections.Methods: This was a case-control study done in tertiary care hospital, Cuttack, enrolling inpatients between 2 months to 5 years with symptoms suggestive of LRTI as cases. Those with tuberculosis, aspiration pneumonia, asthma and nosocomial infections were excluded. After obtaining consent, questionnaire was administered to parents, regarding their socio-demographic and other relevant details. Data analysis was done using statistical software Epi Info™, version 6 and association of each variable with LRTI assessed with chi-square test.Results: A total of 314 children were enrolled in the study, with 158 being cases. The case-fatality rate was 23% and 53.8% suffered from complications, the most common being respiratory failure. A significant association was seen between LRTI and social variables namely maternal literacy(p-value<0.005), socioeconomic status (p-value<0.001) and number of children (p-value<0.001), housing pattern (p-value<0.001), fuel used at home (p-value=0.003), ventilation adequacy (p-value=0.004), presence of separate kitchen at home (p-value=0.0009) and presence of overcrowding (p-value<0.001) and individual factors improper breastfeeding(p-value<0.005) and weaning(p-value=0.03), malnutrition (p-value<0.001), vitamin A deficiency(p-value=0.03) and history of respiratory infection in mother (p-value=0.025) or siblings(p-value=0.048).Conclusions: The burden of lower respiratory tract infections can be substantially reduced by prevention using the identification of risk factors such as housing patterns, education of parents and improved nutrition of the children, and measures to combat the same, at each level.

Background: Hepatosplenomegaly is the simultaneous enlargement of liver and spleen. Hepatosplenomegaly is a sign seen in various disease processes in infants and children. So, an attempt was made in the present study to know the various etiological factors and clinical features and clinical outcome of hepatosplenomegaly in the cases admitted in SVPPGIP and SCB Medical College and Hospital, Cuttack.Methods: A tertiary care hospital based prospective study was carried out in 150 children between1 month to 14 year of age for a period of 2 years.Results: The most common presenting features was anemia (79.3%) followed by fever (78%) and jaundice (38.7%). Infectious (50%) causes are commonest aetiology of hepatosplenomegaly followed by haematological (36%) and congestive (6%) causes. Infectious etiology was commonly constituted by malaria (25.2%) due to high prevalence of malaria in rural Odisha. Mortality is significant in infectious and congestive aetiologies among younger age groups whereas haematological causes have favorable outcome.Conclusions: A detailed history and thorough physical examination should be carried out in every case of hepatosplenomegaly to reach a diagnosis and determine further management plans. Since clinical outcome of children with infectious and congestive aetiologies are overwhelmingly poor, it can be improved by intervention at earliest time possible and aggressive treatment.

Objective To know the rotavirus burden associated with acute gastroenteritis along with circulating genotypes among under-five children and to find out possible associations with different demographic and clinical predictors in a tertiary care teaching hospital in Bhubaneswar, Odisha. Methods A prospective acute gastroenteritis surveillance conducted from February 2016 to June 2019 at a tertiary care pediatric hospital in Bhubaneswar has enrolled 850 children under five years of age. The stool samples were tested for VP6 antigen of rotavirus by enzyme immunoassay (EIA) and hemi-nested multiplex PCR to find out VP7 (G type) and VP4 (P type) genes. The data was presented using mean ± SD, median (IQR) along with frequencies and percentages. Results Rotavirus positivity was found in 246 children (28.9%) with male : female ratio of 3:1. An increasing trend of rotaviral diarrheal cases was seen during the winter months. History of vomiting for 2 d, age group of 12-23 mo, and fever were significantly associated with rotavirus diarrhea having odd ratios of 1.80 (95% CI , 1.48, and 1.69, respectively. Among the genotypes, G3 and P8 were found to be most common in the present study. Conclusion With the introduction of Rotavac in the state the overall rotaviral distribution has significantly changed. Children of 6-23 mo were the most affected age group in the study indicating the necessity of this vaccine in the early months of life. Response to Reviewers:We have modified the manuscript as desired. Methodology part was rewritten to avoid

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Introduction: There is a high incidence of acute kidney injury (AKI) among asphyxiated term. AKI manifests by changes in urine output and blood chemistries & can have serious clinical consequences. Oliguria has been reported in higher number of neonates affecting nearly 25%-70% babies. Methodology: This study was undertaken to study renal failure in asphyxiated neonates. This is a prospective case controlled study done over a period of two years. Various clinical, biochemical and radiographic parameters pertaining to renal injury among asphyxiated neonates were studied. Results: About 64 asphyxiated newborns were studied. Majority (53.12%) was term weighing between 2.5-3 kg & most of them were in HIE-2 grade (43.75%). Oliguria was mostly noted among HIE-3 (31.57%). Birth asphyxia and subsequent acute renal failure was more in babies delivered vaginally. Biochemical parameters also showed correlation with the severity of asphyxia. Premature babies were more prone to develop renal failure secondary to asphyxia. Mortality was directly related to severity of perinatal asphyxia and presence of oliguria. Conclusion: The incidence of acute renal failure due to perinatal asphyxia was high. Incidence with oliguria was high in severe asphyxia. Prevention of asphyxia & prompt management of morbidities like ARF can improve the outcome of perinatal asphyxia.

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