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.

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Background: Childhood under nutrition is a critical public health and development challenge in many developing countries including India. Nearly half of all deaths in children under-5 age group are attributable to under-nutrition. One of the key reasons for under-nutrition in early life is the faulty and sub-optimal infant and young child feeding practices.Methods: 295 children under the age of 5 years residing in rural areas of Udaipur were studied. Feeding pattern and various demographic factors were taken into account, considering age at which breastfeeding was initiated, practice of exclusive breastfeeding up to 6 months, colostrum given or not, any pre-lacteal feed given or not. Assessment of anthropometric measurements was done and children were categorized as per classification of malnutrition by the WHO.Results: Total of 295 children were studied, out of which 59% (174) children were malnourished. 23.2% of SAM children received exclusive breastfeeding up to 6 months compared to 52.1% of control group, which was statistically significant. Difference between severely malnourished and control group children who received pre-lacteal feed was also significant. Only 21% of severely malnourished children were started with breastfeeding within 1st hour of birth.Conclusions: Most of the children who were not given breastfeeding up to 6 months, offered pre-lacteal feed, deprived of colostrum at birth, not started complementary feeding at appropriate time were severely malnourished.

Background: Recurrent abdominal pain (RAP) is very common and the most troublesome health related issue in school aged children affecting up to 10-20%, but very rare below 5 years and above 15 years. Objective of this study was to assess clinico-etiological profile and ultrasonographic finding in children with recurrent abdominal pain at tertiary care hospital in southern Rajasthan.Methods: This prospective observational study was carried out at tertiary care hospital Udaipur, from January 2019 to June 2020. Total 57 children aged 5 years and above who fulfilled the Apley’s criteria for recurrent abdominal pain were enrolled. Patient’s detailed history and physical examination including detailed per abdominal examination were recorded on pre-structured Performa. All patient underwent for routine investigation which consists of complete blood count, urine routine and microscopy with culture, stool examination and USG of abdomen and pelvis.Results: Mean age of children with recurrent abdominal pain in this study was 9.9 years with SD±2.86 with male to female ratio was 1.28:1. Out of 57 children, organic cause was found in 21 (36.84%) children and in 36 (63.16%) children no organic cause was found for recurrent abdominal pain. Most common organic cause was urinary tract infection in 8 (38.09%) children. Total 19 (33.33%) children had mesenteric lymphadenopathy on ultrasonography, out of which organic cause was present in 10 (52.64%) children and no cause was found in 9 (47.36%) children (p value>0.05).Conclusions: Recurrent abdominal pain might occur either due to organic or non-organic causes. Urinary tract infection is one of the most common organic cause in this study. Mesenteric lymphadenopathy was the most common ultrasonography finding in children presented with recurrent abdominal pain.

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Background: Acute febrile encephalopathy (AFE) is a medical emergency as well as diagnostic and therapeutic challenge in children. Objective of this study was to assess clinico-aetiological profile and outcome in children with AFE.Methods: This prospective observational study was carried out at tertiary care hospital Udaipur, from January 2020 to July 2021. Total 61 children aged 1 month to 18 years who were admitted in PICU with fever ≤2 weeks duration and altered sensorium either at onset or following fever were enrolled. Patient’s detailed history and physical examination including detailed neurological examinations were recorded on pre-structured performa. The investigations included CBC with PBF, ESR, malarial parasite, dengue, scrub typhus, typhi-dot, blood sugar, KFT, electrolytes, LFT, calcium, CSF examination, urine examination, X-ray chest. ABG, serum ammonia, blood culture for bacteriological studies and CT/MRI brain were performed whenever required.Results: 61 patients were admitted with fever and loss of sensorium. The most common clinical sign was the pallor (63.9%) and vomiting (55.7%) was the most common clinical symptom. Cerebral malaria was the commonest cause (31.1%) of AFE followed by suspected viral encephalitis (14.7%) and pyogenic meningitis 9 (14.7%). Out of total 61 patients, 45 (73.8%) patients were discharged and 16 (26.2%) patients were expired. Maximum mortalities were seen in Reye’s syndrome (5 out of 6 cases) and was most in age group <5 years of age (26 cases).Conclusions: Cerebral malaria was the leading cause of AFE followed by suspected viral encephalitis and pyogenic meningitis. While determining the aetiology of AFE in a malarial endemic area, cerebral malaria should be considered in all patients. Reye’s syndrome should also be considered in patients of AFE should be evaluated to diagnose or rule out this entity.