Objective: Breastfeeding (BF) has been accepted as the most vital intervention for reducing infant mortality and ensuring optimal growth and development of a child. A major barrier to successful BF is inconsistency in information and improper cultural practices. To assess the knowledge, attitude, and practices toward BF among nursing mothers following up in a tertiary care center in Navi Mumbai, Maharashtra. Methods: A community-based cross-sectional study was conducted among 512 mothers in Navi Mumbai in the state of Maharashtra, India, between January 2016 and June 2016 using a pre-set questionnaire. The mothers with children under the age of 2 years were interviewed following which descriptive statistics were obtained. Results: Our study highlights the growing awareness of the advantages of BF. Of the 512 mothers enrolled in our study, 78.9% believed in exclusive BF (EBF) till 6 months while 51% actually practiced EBF. Nearly 78% mothers felt shy to feed in public places. BF was initiated <1 h of delivery in 35.9% mothers while insufficient milk was the predominant reason (41.4%) in mothers to stop BF before 2 years. Conclusion: The majority of our participants had adequate knowledge and a positive attitude toward EBF, with right posture practiced while feeding.

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Henoch-Schonlein purpura (HSP) is the most common vasculitis of childhood and is characterized by leukocytoclastic vasculitis and immunoglobulin A deposition in the small vessels in the skin, joints, gastrointestinal tract and kidney. We report a 6 year old female child presented with rashes over both legs and buttocks along with joint pain and abdominal pain and multiple episodes of vomiting. Patient was diagnosed with HSP and treated with oral prednisolone followed by methylprednisolone and other supportive care.

Tracheobronchial Foreign Body Aspiration (FBA) remains a significant cause of morbidity and mortality in children less than three years of age. High index of suspicion leads to early diagnosis and treatment thus preventing further deleterious complications. This case report is about a 15-month-old female child who presented with intermittent low-grade fever, cough, cold for 20 days and rapid breathing since one day. On examination, she had pallor, grade 3 protein energy malnutrition according to Indian Academy of Paediatrics classification, heart rate was 128/min, respiratory rate was 44/min, oxygen saturation was 88% on room air with nasal flaring, intercostal and subcostal retractions. Bilateral rhonchi with reduced air entry was present in all areas of the lung. Bilateral bronchopneumonia was seen on chest X-ray and tuberculosis work up was negative. Child was started on oxygen, antibiotics, nebulisations and intravenous fluids. On day two of admission child developed rigorous bouts of cough associated with hypoxia, bradycardia, cyanosis and listlessness which improved on bag and mask ventilation. Following a strong suspicion of obstruction in the tracheobronchial tree, a Computed Tomography (CT) neck and chest was done which was suggestive of either an intratracheal or intrabronchial foreign body. Child was urgently taken up for rigid bronchoscopy and a ground nut was found in the right main bronchus. The FBA as a differential diagnosis of chronic cough in children should always be ruled out.

Subacute Sclerosing Panencephalitis (SSPE) is a chronic complication of measles. It is a neurodegenerative disorder characterized by cognitive and memory deterioration, behaviour abnormalities, involuntary movements and repetitive myoclonic jerks and a steady motor decline. We report a case of a 7-year-old girl with subacute sclerosing panencephalitis presenting with myoclonic jerks, regression of motor milestones and speech. The child was not immunised for measles. Magnetic resonance imaging revealed multiple variable-sized ill-defined T2W and FLAIR hyperintense areas are seen involving the white matter of the bilateral fronto-parietal lobes. Electroencephalograph findings and CSF analysis confirmed the diagnosis of subacute sclerosing panencephalitis.

N ephrotic syndrome (NS) is a primary glomerular disease. The earliest recorded description of NS was from the 15 th century. The concept of "nephritis in contrast to nephrosis" was further popularized by Volhard et al. It was used to describe a major classification of bilateral renal disease. Now, NS is recognized as a common chronic illness in childhood. It is characterized by proteinuria defined by urine protein >3.5 g/24 h or urine protein-creatinine ratio >2 mg protein/mg creatinine, edema, hyperlipidemia (>200 mg/dl), and hypoalbuminemia. Hypoalbuminemia causes increased production of coagulation factors in the liver which leads to a hypercoagulable state and an increased risk of thrombotic events, including pulmonary embolism (PE) [1,2]. NS is a hypercoagulable state associated with venous and rarely, arterial thromboembolism with an estimated risk of up to 1.8-5% [3,4]. It involves abnormalities in fibrin formation and platelet aggregation, vascular stasis, loss of antithrombin III, Protein C and S in urine, and increased production of fibrinogen [5]. Thromboembolic events can occur in both venous and arterial territories. The more frequently involved are the cerebral venous sinuses and middle cerebral arteries, deep veins of the lower limbs, vena cava, renal and hepatic veins, pulmonary, and mesenteric artery [6]. PE may present with minimal clinical signs or may be asymptomatic for life and lead to sudden death. Here, we describe the subtle presentation of a massive PE in a boy with steroid-dependent NS. CASE REPORT A 10-year-old male child who was a known case of NS reported to our department with edema over bilateral eyelids and lower limbs and cough and cold for 7 days which was associated with intermittent episodes of chest pain and shortness of breath. He was diagnosed with NS at 2 years and had started with prednisolone. Since then, the patient had three episodes of relapse. The patient was on prednisolone therapy with a dosage of 40 mg/m 2 daily at the time of admission. On physical examination, the patient had mild edema at the extremities and tachypnea (respiratory rate 36/min). The body temperature was 37°C, blood pressure 106/72 mm-Hg, heart rate 85-95 bpm, and oxygen saturation were 98% (at room air). Urinalysis showed 4+ of protein on the dipstick and urinary protein/creatinine ratio was 14 mg/mg. Blood investigations revealed hemoglobin of 15.6 g/dL with hematocrit 45.2%, platelet count 173000/μL, total leukocyte count 11400/mm 3 , low serum albumin 2 g/dl, raised total cholesterol 598 mg/dl, and raised serum triglycerides 300 mg/dl. There was difficulty in breathing. Chest X-ray was suggestive of bilateral hilar prominence which led to a differential diagnosis of PE which is a known complication of NS. Hence, D-dimer test was done where elevated levels of 9.98 μg/mL (<0.5 μg/mL) were observed, along with a coagulation profile which was normal with prothrombin time 13.3 s, activated partial thromboplastin time 32, and international normalized ratio

Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is a disorder with raised intracranial pressure, headache, papilledema, visual disturbances with a normal cerebrospinal fluid examination, and normal neuroimaging. It is rare in the pediatric population and may occur as a manifestation of underlying disorders. Vitamin D deficiency is a common deficiency in the pediatric age group. However, neurological manifestations are rare. Here, we present the case of a 5-year-old male child who presented with headache, vomiting, and hypertension; however, the neurological examination was normal but the neuroimaging was suggestive of pseudotumor cerebri. Appropriate investigations were done. The most likely cause of pseudotumor cerebri in this patient was the deficiency of Vitamin D. We have reported this case as pseudotumor cerebri is a rare neurological manifestation of Vitamin D deficiency.