BackgroundThe prevalence of malnutrition among children in developing countries is very high. As a step towards reducing the prevalence of malnutrition, there is a need to identify the important determinants of malnutrition in the specific population so that preventive and control measures can be implemented.The objective of the study is to determine the risk factors for malnutrition among preschool children in Rural Karnataka, South India.MethodsA case-control study was carried out among preschool children, aged between three to six years, attending the Anganwadi centers and their mothers’ in Udupi district of Karnataka, India. A total of 570 children (190 cases and 380 controls) were selected by multistage cluster sampling technique. A semi-structured risk factors questionnaire was used to identify the risk factors for malnutrition among children.ResultsThe majority (45.8 and 45.5%) of the children in the study were in the age group of 3.0 to 4.0 years in case and control groups respectively. There was a slight preponderance of illiterate parents among cases in comparison to the controls. Largely, 87.4% of the children belonged to poor socio-economic status in the case groups compared to 82.4% in the control group. After adjusting for the confounders, underweight was significantly associated with socio-economic status of the parents (aOR: 2.05, 95% CI: 1.06, 3.96), birth weight < 2000 g (aOR: 25, 95% CI: 0.10, 0.59), recurrent diarrhoea (aOR: 2.74, 95% CI: 1.56, 4.83), recurrent cold and cough (aOR: 3.88, 95% CI: 1.96, 7.67), worm infestation (aOR: 2.0, 95% CI: 1.19, 3.38) and prelacteal feed given (aOR: 3.64, 95% CI: 2.27, 5.86).ConclusionParental education, childhood illness, short birth interval, open defecation, type of weaning and complimentary food given to children were some of the significant determinants of underweight that were found in the study. Information, Education and Communication (IEC) campaigns alleviating food habits and taboos and promoting birth spacing is the need of the hour for preventing the occurrence of undernutrition among preschool children.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5124-3) contains supplementary material, which is available to authorized users.

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Introduction. Primary thrombocytosis is very rare in children; reactive thrombocytosis is frequently observed in children with infections, anemia, and many other causes. Aims and Objectives. To identify the etiology of thrombocytosis in children and to analyze platelet indices (MPV, PDW, and PCT) in children with thrombocytosis. Study Design. A prospective observational study. Material and Methods. A total of 1000 patients with thrombocytosis (platelet > 400 × 109/L) were studied over a period of 2 years. Platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit (PCT) were noted. Results. Of 1000 patients, 99.8% had secondary thrombocytosis and only two children had primary thrombocytosis (chronic myeloid leukemia and acute myelogenous leukemia, M7). The majority of the children belonged to the age group of 1month to 2 years (39.7%) and male to female ratio was 1.6 : 1. Infection with anemia (48.3%) was the most common cause of secondary thrombocytosis followed by iron deficiency alone (17.2%) and infection alone (16.2%). Respiratory infection (28.3%) was the predominant infectious cause observed. Thrombocytosis was commonly associated with IDA among all causes of anemia and severity of thrombocytosis increased with severity of anemia (P = 0.021). With increasing platelet count, there was a decrease in MPV (<0.001). Platelet count and mean PDW among children with infection and anemia were significantly higher than those among children with infection alone and anemia alone. None were observed to have thromboembolic manifestations. Conclusions. Primary thrombocytosis is extremely rare in children than secondary thrombocytosis. Infections in association with anemia are most commonly associated with reactive thrombocytosis and severity of thrombocytosis increases with severity of anemia.

Background: Research on critically ill adult patients has shown the usefulness of albumin as a predictor of increased morbidity and mortality. There is a paucity of similar data in pediatric age group. Objective: The objective of the study was to know the incidence of hypoalbuminemia in children admitted to pediatric intensive care unit (PICU) and its correlation to disease severity and clinical outcome. Materials and Methods: This was a prospective observational study conducted at the PICU of a tertiary care hospital. Children of age group 1 month – 18 years admitted to the PICU were included in the study. Serum albumin levels were estimated at the time of admission to PICU. Pediatric index of mortality 2 (PIM2) scoring system was used to assess the severity of illness at admission and to calculate the predicted death rate (PDR). The independent sample t-test and Fisher’s exact test were used to compare the albumin levels with PDR and duration of hospital or PICU stay. Mortality risk was computed using Pearson’s Chi-square test. Multivariate regression analysis was performed to evaluate whether hypoalbuminemia is an independent predictor of mortality. Results: Mean serum albumin level in this study was 3.38±0.89 g/dL. The incidence of hypoalbuminemia was 44.1%. The PDR (calculated using PIM2 score) was increased in children with hypoalbuminemia compared with the normal albumin level group (p=0.004). As compared to children with normal albumin levels, children with hypoalbuminemia had longer duration of PICU stay (95% confidence interval (CI) for difference 0.86–3.03; p=0.05), higher need for ventilator support (odds ratio (OR) 4.2, p=0.003) and higher mortality (OR 0.16, p=0.002). The association of serum albumin levels with mortality remained significant even after adjusting for age and PDR by PIM2 score (OR=3.68; 95% CI, 1.76–7.74; p<0.001). Conclusion: Hypoalbuminemia is a significant predictor of mortality and morbidity in critically ill children.

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CaSe 1A seven-year-old boy with fever and persisting seizures (generalized tonic-clonic seizures) on multiple anti-epileptic medications {phenytoin (6 mg/kg/day), phenobarbitone (6 mg/kg/day) and valproate (20 mg/kg/day)} was referred to our hospital. At admission, he was in generalized convulsive status epilepticus. Blood investi gations were normal. The dosage of antiepileptic medications was optimized. Cerebrospinal Fluid (CSF) analysis was suggestive of viral meningoencephalitis (lymphocytic leukocytosis, mildly elevated protein, normal glucose with sterile culture) however, specific cultivable viral titers in CSF (Japanese Encephalitis, Herpes Simplex Virus, Dengue, Enterovirus) were negative. Magnetic Resonance Imaging (MRI) brain with contrast showed increased meningeal enhancement and Electroencephalogram (EEG) showed generalized epileptiform activity. He persisted in having seizures on second line Anti-Epileptics Drugs (AEDs) {valproate 40 mg/ kg/day, levetiracetam 60 mg/kg/day} and hence was started on midazolam infusion and mechanically ventilated. Thiopental was added on, following which he remained seizure free for 120 hours with EEG showing burst suppression. Thiopental was gradually tapered and stopped however he had a recurrence of seizures. He was continued on intravenous midazolam, AEDs (Phenytoin 6 mg/kg/day, phenobarbitone 6 mg/kg/day, valproate, levetiracetam, clobazam (10 mg/day) and zonisamide 400 mg/day). He required tracheostomy for prolonged ventilation and had other comorbidities like ventilator-associated pneumonia which were managed accordingly. CSF analysis for Anti-NMDAR and voltage-gated potassium channels were negative. He gradually improved, and seizures subsided with normal EEG.At follow up he had persistent residual neurological deficits (cognition deficits and spasticity) with occasional breakthrough seizures (generalized tonic-clonic seizures). AEDs were gradually tapered and continued on levetiracetam and clobazam. He was under regular follow up for 40 months. CaSe 2A seven-year-old girl with a history of fever and persisting seizures (generalized tonic-clonic seizures) was admitted. We hereby reported three cases of super refractory seizures as they posed a therapeutic challenge. All three children were aged 6-7 years with prior normal developmental history and no medical illness. Viral meningoencephalitis, fever induced refractory status epilepticus, and auto-immune encephalitis was the probable aetiology in the cases studied. Midazolam, pentobarbital, and ketamine are the most commonly used anaesthetic agents. Phenytoin, phenobarbitone, valproate and levetiracetam are the most commonly used antiepileptic agents. All three cases had residual neurological deficits and morbidities like pneumonia and sepsis. SRSE is associated with high rates of mortality and morbidity necessitating immediate treatment.and CSF analysis including viral titers were normal. MRI brain with contrast showed subtle enhancement along the sulci. EEG showed slow waves with suppressed background [Table...

Purpura Fulminans is a life threatening condition characterised by cutaneous haemorrhage and gangrenous necrosis. We present such a case in an eight year old child.