INTRODUCTIONDengue is a mosquito borne febrile viral illness. Dengue virus belongs to the family Flaviviridae (single stranded non segmental RNA viruses) and has four distinct serotypes: DEN-1, DEN-2, DEN-3 and DEN-4. Humans are the main reservoir for the dengue virus. Urbanization, substandard living conditions, lack of vector control and climatic changes are some of the important causes for dengue infection. Once considered an urban problem, it ABSTRACT Background: Dengue fever is an arboviral disease which is endemic in tropical countries and is of major concern with its morbidity and mortality. WHO classified dengue into three categories: undifferentiated fever, dengue fever (DF) and dengue haemorrhagic fever (DHF). Severe dengue is also regularly observed during primary infection of infants born to dengue-immune mothers. The objective of present study was to assess the clinical profile, laboratory profile and associated risk factors related to outcome of children less than 15 years of age. The outcome of the children and their management protocols were also assessed in the study. Methods: A prospective cross sectional study with 174 confirmed cases of dengue in children <15 years were enrolled and classified as per WHO guidelines. The demographic data, clinical history, laboratory parameters were noted in a separate questionnaire form. Hematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done and observations noted. Cases were managed as per WHO protocol and risk factors were observed. The outcomes of the cases were noted as discharge or death of the case. Results: A total of 174 children with 149 non-severe dengue and 25 severe dengue cases with 95 males and 79 females were enrolled in the study. 6-10 years was the most common age group. The mean age of children admitted with severe dengue fever was 5.81yrs.and without severe dengue fever was 7yrs.The mean duration of hospitalization was 5.21 days in severe dengue and 3.4 days in non-severe dengue cases. Fever was the most common presenting symptom and hepatomegaly was the common clinical finding in the study. Bleeding manifestations were seen in cases of severe dengue with raised haematocrit levels, raised SGOT levels and severe thrombocytopenia. Pleural effusion and gall bladder wall thickening with ascites was seen in severe dengue cases. Management was by administration of colloids and crystalloids. Conclusions: Dengue is a dreadful fever among pediatric age group which needs to be considered with great caution in management. Understanding the risk factors helps in predicting the mortality which helps in management and better outcome of the fever.

Background: WHO estimated burden of respiratory tract infections in 2010, estimates four and half million deaths due to respiratory tract infections among children every year. In India, 1.2 million deaths have been reported among children due to RTI among 5.9 million deaths globally. Lower respiratory tract infections are most common causes of death than upper respiratory tract infections. Pneumonia and Bronchiolitis are most common types of LRTI in children. Pneumonia accounts for most of the deaths in children < 5 years of age. The present study was undertaken with an objective to know the various types of lower respiratory tract infections in children less than 12 years of age. The study also aims to know the various bacterial agents causing respiratory tract infections with their antibiotic susceptibility.Methods: Hospital based, prospective cross-sectional study was conducted for a period of one year and 375 children were enrolled. Demographic, clinical history and examination was done and signs and symptoms noted. All necessary investigations were performed and followed regularly for management and outcome.Results: Incidence of LRTI in the study was 9.76% with male preponderance (65.33%) and most common among children in 1-4 years age group. Ratio of males to females was 1.9:1. 73.6% of cases were in low socio-economic group, 35.2% were found with PEM-I grade and 18.13% had no immunization coverage. Cough and breathlessness were the major symptoms and respiratory distress and clubbing were major signs in the study. Bronchopneumonia was the commonest cause (38.7%) followed by bronchiolitis and Allergic bronchitis. 18.45 of cases had anemia and Leucocytosis was also present. Pulmonary infiltration was the major finding in the X-ray of chest. Streptococcus pneumoniae and Klebsiella pneumoniae were the common bacterial pathogens isolated.Conclusions: To conclude, our study clearly highlighted the various types of clinical presentations, risk factors and different types of LRTI in children <12 years of age. Understanding a clear knowledge of the etiology and bacterial pathogens clearly provides guidance for the physician in management and clinical outcome.

Background: Seizures are the most frequent clinical manifestation of central nervous system dysfunction in the newborn with the incidence varying from 1-5%. Neonatal seizures often signal an underlying ominous neurological condition, most commonly hypoxia-ischemia, and others include stroke, intraventricular hemorrhage or intraparenchymal hemorrhage, meningitis, sepsis, and metabolic disorders. Neonatal seizures can permanently disrupt neuronal development, induce synaptic reorganization, alter plasticity and "prime" the brain to increased damage from seizures later in life. The present study was undertaken to delineate the various aspects of neonatal seizures, with special reference to etiology, clinical spectrum, and outcome in the Neonatal Intensive Care Unit (NICU) of a tertiary care Hospital.Methods: A prospective cross sectional study was conducted in an NICU of a tertiary care hospital with 65 neonates in the study group for a period of 2 years. Gestational age assessment is done by modified Ballard’s scoring system and detailed neurological assessment was done. Antenatal history of mother, demographic data, and clinical history of neonate was noted and evaluated. Laboratory investigations were done and results noted and outcome was recorded.Results: Subtle seizure was the commonest (40%) clinical seizures in our study followed by tonic (21.5%). Tonic seizures were common in preterm and in full term subtle seizures. Babies with myoclonic seizures had 100% mortality. Hypoxic ischemic encephalopathy was the commonest cause (41.5%) of mortality in our study. The worst outcome was with CNS malformation (50%). A total of 10 deaths were recorded (15.4%) with maximum association in cases with history of onset 7 days (100%).Conclusions: Neonatal seizures are common and may be the first manifestation of neurological dysfunction after a variety of insults. Seizures may interfere with cardio-respiratory function and nutrition and may have detrimental effects on cerebral development. Global cerebral hypoxia-ischemia is the most common etiology of neonatal seizures, followed by intracranial bleed, hypoglycemia, septicemia, hypocalcemia, BE, CNS malformations.

Background: Malaria caused by Plasmodium species and transmitted by Female anopheles mosquito, still remains as a major public health concern around the world. India is one of the major contributors of malaria cases in South East Asia. Malaria accounts for 205,000 deaths with 55,000 deaths occurring in early childhood. In endemic areas, children under 5 years are particularly susceptible to infection, illness and death. The present study was aimed to study the clinical, epidemiological profile of malaria cases among children (<12 years) attending a tertiary care hospital. We also assessed the complications associated with non-severe and severe malaria. Methods: The study was conducted at a tertiary care hospital for a period of two years and all children <12 years of age diagnosed with malaria were enrolled in the study. The demographic, clinical and laboratory parameters were observed and noted. Cases were categorized into severe and non-severe malaria based on the WHO guidelines.Results: A total of 2420 cases were observed and 250 cases of malaria were diagnosed, of which 136 were p. vivax mono infections, 82 falciparum malaria and 32 had evidence of mixed infections. Males were predominant in the study (58.8%) and 1-5 years was the common age group. Fever was the most common symptom (100%) in all cases and pallor, edema was common in falciparum malaria. jaundice was observed in 62% of mixed infections and altered sensorium in 43% of mixed infections. Severe malaria was observed almost equally in vivax and falciparum cases. Hyperparasitemia, cerebral malaria was common in falciparum cases than vivax. Thrombocytopenia, hypoglycemia and impaired consciousness were more common in mixed infections than falciparum and vivax cases.Conclusions: Present study finally concludes that there is a significant change in the trends of vivax malaria in this region where both species coexist. The spectrum of complications seen in vivax and falciparum follow a similar pattern, then mentioned earlier that complications are less frequently seen in vivax than falciparum malaria. Hence more number of studies is required to generate the differing patterns associated with vivax and compare them with different studies from geographic regions.