A 12-day-old neonate presented with ill-defined dark pigmentation over the centrofacial area with flagellate pigmentation on the trunk and patchy pigmentation on the extremities. The mother had a history of fever starting a week before delivery and continuing for 3 days in the postpartum period. Together these led to consideration of a possible diagnosis of congenital chikungunya, which was confirmed according to the immunoglobulin M antibodies to chikungunya in the mother and child. The rare occurrence of cutaneous pigmentation was the only clue to the retrospective diagnosis of neonatal chikungunya. Chikungunya is an emerging viral disease that can be transmitted maternally during pregnancy and in the peripartum period. It can be added to the list of viral infections that can lead to fetal demise or, when present during labor and delivery, can cause neonatal disease with cutaneous signs.

Context:Majority of epilepsy begins in childhood. Twenty to thirty percent of patients may not respond to antiepileptic drugs. Yoga as a complementary therapy has been found to be beneficial in adults, but has not yet been studied in children with epilepsy.Aim:To study the effect of yoga on seizure and electroencephalogram (EEG) outcome in children with epilepsy.Setting and Design:A randomized controlled trial was conducted in the pediatric neurology outpatient department of a tertiary care teaching hospital.Materials and Methods:Twenty children aged 8–12 years with an unequivocal diagnosis of epilepsy on regular antiepileptic drugs were enrolled. Yoga therapy was provided to 10 children (study group) and 10 children formed the control group. Yoga therapy was given as 10 sessions of 1h each. We compared seizure frequency and EEG at baseline, 3, and 6 months. Statistical analysis was carried out using standard statistical tests. A P value of <0.05 was considered significant.Results:No children had seizures at the end of 3 and 6 months in the study group. In the control group, at 3 and 6 months, four and three children, respectively, had seizures. Eight children each in both the groups had an abnormal EEG at enrollment. At the end of 6 months, one EEG in the study group and seven in the control group were abnormal (P = 0.020).Conclusion:Yoga as an additional therapy in children with epilepsy leads to seizure freedom and significant improvement in EEG at 6 months.

In utero exposure to diclofenac may be associated with neonatal renal failure that may be transient or irreversible. We recommend that the use of diclofenac during pregnancy be avoided.

Cryptophthalmos, a very rare congenital anomaly of the eye, is characterised by skin passing continuously from the forehead to the cheek over a malformed eye. It may be isolated or more commonly as a part of Fraser syndrome. Cryptophthalmos is classified into three types: complete, incomplete and abortive. Surgical reconstruction is the modality of treatment available. We present a case of bilateral, complete, isolated cryptophthalmos, who has undergone stage 1 of reconstructive surgery.

A 5-year-old immunocompetent girl presented with fever, jaundice, hepatosplenomegaly and pancytopenia. The peripheral blood smear demonstrated mixed malaria infection (Plasmodium vivax and Plasmodium falciparum). Fever was persistent despite antimalarials in the absence of any coexisting bacterial or viral infection. Laboratory findings included cytopaenia, hyperbilirubinaemia, hyperferritinaemia, hypertriglyceridaemia, hyponatraemia, deranged partial thromboplastin time, decreasing ESR and megaloblastic changes on bone marrow aspiration. A final diagnosis of haemophagocytic lymphohistiocytosis (HLH) with megaloblastic anaemia associated with severe mixed malaria was made. There was a dramatic response to corticosteroid treatment with improvement in her clinical condition. This report endorses the use of corticosteroids in malaria-associated HLH whenever there is no clinical improvement with antimalarials alone.

Preeclampsia (PE) is a serious, unpredictable hypertensive disorder of pregnancy present in around 8–10% of all pregnancies resulting in high rate of maternal and fetal morbidity and mortality. With the pathophysiology partially known, delivery is the only cure for PE. The disease sets due to multiple pathologic processes involving endothelial cell activation, inflammation, multiorgan damage and syncytiotrophoblast stress.  Though the primary target organ is lungs in COVID‐19, other systemic manifestations which include endothelial dysfunction, dysregulated angiogenesis, thrombosis, liver injury, thrombocytopenia, hypertension and kidney damage overlap with PE. COVID‐19 patients show a higher incidence of PE as compared to their noninfected counterparts and vice versa. Similar pathophysiology and clinical features make differential diagnosis challenging. For effective and specific management, it is important to differentiate actual PE from COVID‐19 with PE like features. There are contradictory reports about the accuracy of diagnostic tools in distinguishing PE from severe COVID‐19 with PE like features. With the available data, it can only be stated that PE is a common adverse pregnancy event, which may be exacerbated by, or may exacerbate, COVID‐19. Future research should focus on cohesive understanding of the pathophysiology of the clinical manifestations, and preventive strategies during pregnancy.

Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal syndrome that results from inappropriate activation of the immune system. Many viral agents are known to trigger HLH but cytomegalovirus (CMV) associated HLH is rarely described. We report a case of CMV related HLH in a 3 month old immunocompetent male infant who presented with fever, respiratory distress and hepatosplenomegaly. He had fulminant sepsis like course in the hospital as he continued to have hectic fever spikes, progressive pneumonia, increasing hepatosplenomegaly and multiple episodes of generalized convulsions. Investigations revealed bicytopenia, biochemical hepatitis, hyperferritinemia and hypofibrinogenemia. CMV IgM serology was reactive in both infant and mother. Diagnosis of CMV-HLH was made as per HLH 2004 diagnostic protocol. Infant was successfully treated with intravenous ganciclovir along with dexamethasone and etoposide.

A ppendicitis is the most common surgical abdominal emergency seen in the casualty. Common complaints are fever, malaise, anorexia with pain in the abdomen, and vomiting. Diagnosis requires a high level of suspicion as less than 50% present with classical symptoms [1]. Ultrasonography (USG) and abdominal computerized tomography (CT) help clinch the diagnosis [2]. Delay in the diagnosis can lead to appendiceal perforation, peritonitis, septicemia, and even death. Appendicectomy remains the gold standard in the management of acute appendicitis (AA). Recent reports support a conservative approach in the management of AA with the use of intravenous (IV) antibiotics [3]. Reduced risks of surgery and anesthesia along with a shorter hospital stay and reduced cost of treatment are some other benefits of conservative management of AA [3-5]. Coronavirus disease (COVID)-19 infection presenting with gastrointestinal (GI) symptoms in the pediatric age group has been recently reported in a few studies [3-6]. Tullie et al. have reported a series of eight children presenting at a single center in the UK with COVID-19 infection [6]. Compromised lung function in a COVID-19-positive patient poses a high perioperative risk in addition to cytokine storm causing systemic inflammatory response syndrome and multiple organ dysfunction syndrome. The role of conservative management, particularly in COVID times, needs to be considered. We present the case of a COVID-19 positive child with AA, appendicular perforation, and abscess. The patient was successfully managed conservatively, supporting the role of non-operative management for AA in selected cases. CASE REPORT A 5-year-old male child was brought to the casualty with complaints of high-grade fever, gradually increasing pain in the abdomen in the past 3 days and vomiting since morning on the day of admission. The pain was gradual in onset, dull aching in nature, moderate to severe in intensity, localized over the right iliac fossa, aggravated by food, cough, or on walking, and relieved only after medications. There were four episodes of nonprojectile, non-bilious vomiting on the day of admission since morning. There was decreased oral intake due to vomiting and pain in the abdomen. There was no significant history of any illness or surgery. The patient belonged to a high-risk containment zone for COVID-19 though he had never come in direct contact with any COVID-19-positive patient. He had no symptoms other than fever and GI symptoms suggestive of COVID-19 infection. Examination of the patient was done after donning personal protective equipment. The child was ill looking but well nourished,