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Higher incidence of pulmonary tuberculosis in BCG vaccinated group was not statistically significant. However, high incidence of neuro-tuberculosis in BCG unvaccinated group was statistically significant. The underlying risk factors were poor socio-economic status, malnutrition and poor immunization coverage and should be taken into consideration in order to prevent morbidity and mortality due to tuberculosis in children.

Introduction: Many of the parameters utilised in scoring systems used to predict disease severity in respiratory distress in neonates are not readily available in the primary care facility of developing countries. This study was carried out to assess the utility of birth weight, gestational age, APGAR score at 5 min, baseline oxygen saturation and Downe’s score in prediction of requirement of respiratory support and mortality in neonates with respiratory distress.Material and Methods: A prospective study was carried out in the neonatal intensive care unit of a tertiary teaching hospital. 165 consecutively admitted neonates presenting with respiratory symptoms were included in the study. The relevant parameters and investigations were documented in a structured performa. The neonates were followed up for outcomes which included requirement of respiratory support and mortality.Results: A higher mortality was associated with birth weight of < 1620 grams, gestational age of < 31 weeks, APGAR score of < 6, Downe’s score of > 3 and baseline oxygen saturation of < 86 % (p values < 0.001). The requirement of mechanical ventilation was more with birth weight of < 2000 grams, gestational age of < 32 weeks, APGAR score of < 7, Downe’s score of > 4 and baseline oxygen saturation of < 87 % (p value < 0.001). The requirement of any respiratory support at 72 hours was associated with birth weight of < 1894 grams, gestational age of < 37 weeks, APGAR score of < 7, Downe’s score of > 3 and baseline oxygen saturation of < 89 % ( p-value <0.001).Conclusions: Readily available parameters like birth weight, gestational age, APGAR score, oxygen saturation and Downe’s score could together be used to predict mortality and requirement of respiratory support in the resource limited setting. J Nepal Paediatr Soc 2015;35(1):31-37

A nine year old male child was a known case of single kidney (Lt) with vesicoureteric reflux (ureteric reimplantation done) with chronic kidney disease (CKD) stage IV since early infancy. He was on conservative care for CKD. He was admitted with complaints of excessive gain of weight for last three months. There was no history of developmental delay, lethargy, poor scholastic performance, prolonged steroid intake or decreased urine output. On examination, he was normotensive, had proportionate short stature (height-110 cm), weight-30 Kg (75th centile), bilateral non-pitting pedal oedema and rounded facies (Figure 1). Mild goitre was present. Investigations revealed serum albumin 3.2 g/dL, serum creatinine-2.8 mg/dL (eGFR of 21 mL/min/1.73 m 2 BSA), serum calcium 8 mg/dL, Phosphorous 4 mg/dL, Alk phosphatase 340 IU/L, random plasma glucose 80 mg/dL. Lipid profile was normal. Bone age was delayed, estimated at 6 years. Ultrasonography of neck showed presence of normal thyroid gland. Thyroid function study revealed low levels of free T3-1.7 pg/mL (normal 2.3-4.2) and free T4-0.29 ng/dL (normal 0.71-1.85), while TSH was raised to 150 μIU/mL. Serum thyroid peroxidase antibodies and antithyroglobulin antibodies were negative. Serum cortisol level at 8 AM was 8.42 μg/dL (normal). He was diagnosed to have hypothyroidism and was started on tablet thyroxine 75 μg daily. Presently child is on follow-up and has lost 8 Kg weight and gained 2 cm height in last 6 months. His TSH is 12.8 μIU/mL presently. Third Case: An eight year old girl, a known case of steroid resistant nephrotic syndrome with chronic kidney disease was being managed conservatively since one and half year age. Her serum creatinine level was 3.5 mg/dL and eGFR was

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