Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

Background: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden.

Methods And Findings: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size).

Fractured tracheostomy tube as foreign body bronchus: our experience with three cases.

Objective: Tracheostomy tubes are extensively used in paediatric age group for airway issues. Their fracture and lodgement into trachea is an acute emergency requiring urgent intervention.

Cases: We report three such paediatric cases having tracheostomy tube fracture and aspiration into trachea with different presentations and treatment outcomes.

Characteristics of pediatric scrub typhus during an outbreak in the North Eastern region of India: peculiarities in clinical presentation, laboratory findings and complications.

Objective: To identify and report a recent outbreak of scrub typhus cases recorded from October 2009 to January 2010 in the state of Meghalaya, India.

Methods: The case sheets of all the children were retrieved and reviewed retrospectively. Twenty four (24) patients, who were both clinically and serologically confirmed as scrub typhus cases were included in the study.

Empyema thoracis: analysis of 150 cases from a tertiary care centre in North East India.

Objectives: To analyze the clinical characteristics, microbiological profile, management, complications and outcome of cases with empyema thoracis.

Methods: All cases diagnosed as 'empyema thoracis' over a period from January 2006 through June 2010 were identified from the inpatient records and discharge summaries. Of the 160 cases identified, 150 cases were taken up for analysis and the rest 10 cases, of which two had significant predisposing co-morbidity and eight cases diagnosed as tubercular empyema thoracis were excluded from the analysis.

Immune complex reaction after successful treatment of meningococcal disease: an excellent response to IVIG.

The convalescence phase of severe meningococcal sepsis is complicated by immune complex reactions with arthritis being the commonest. No standard guidelines exist for management of such complications, but non-steroidal anti-inflammatory drugs and steroids have been used with varying success. We report excellent response to intravenous immunoglobulin in a child with immune complex reaction following meningococcal sepsis.

Unusual presentations of malaria in children: an experience from a tertiary care center in North East India.

Objective: To identify cases of malaria with unusual presentations.

Methods: The medical record of all the cases of malaria admitted to PICU and pediatric general ward from Oct 2006 to Sep 2009, were reviewed and cases with unusual presentations were identified. The study design was retrospective descriptive study.

Macrophage activation syndrome in malaria.

Macrophage activation syndrome (MAS) is a clinical syndrome caused by an excessive proliferation of T lymphocytes and well-differentiated macrophages; an entity distinct from malignant histiocytosis. Although rheumatologic conditions are the common cause of MAS, a wide range of infections are also seen to cause MAS. We report an adolescent with severe Plasmodium falciparum malaria and MAS.

Transfusion associated graft versus host disease.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a dreaded complication in immunocompromized hosts. The diagnosis is often delayed because of lack of awareness and the non-specific clinical features. More than 90% patients succumb to refractory infections.

Toxic shock syndrome.

The authors present two children who had fever >or=38.9 degree C, diffuse rash, hypotension, deranged renal and hepatic functions, disseminated intravascular coagulation, altered sensorium and inflamed oral mucosa. They responded to fluids, inotropes, antibiotics and intravenous immunoglobulin (2 g/kg).

Parvovirus B19-induced multisystem disease simulating systemic vasculitis in a young child.

Parvovirus B19 mostly presents as a transient viral illness or as pure red cell aplasia. However, this virus can sometimes cause an illness that may pose diagnostic difficulties. We describe one such patient who had clinical features simulating a vasculitic disorder secondary to parvovirus B19 infection.

Varicella glomerulonephritis mimicking microscopic polyangiitis.

Varicella in childhood is usually a self-limiting illness with few complications. Varicella nephritis is an uncommon entity and seen mostly in immunocompromized individuals. We report a 14-year-old boy with juvenile rheumatoid arthritis who developed varicella nephritis and in whom the renal manifestations preceded the skin lesions by 1 week.

Hyponatraemia and hypovolemic shock with tuberculous meningitis.

A 12-year-old boy with tuberculous meningitis and hydrocephalous, after undergoing revision of ventriculo-peritoneal shunt had persistent impairment of sensorium and episodes of hyponatremia (serum sodium 104 to 125 mmol/l), accompanied by polyuria, signs of poor peripheral, perfusion hypotension and low CVP, and high urinary sodium excretion (114-60 mmol/l). A diagnosis of cerebral salt wasting syndrome (CSWS) was made and was treated with saline replacement and fludrocortisone (10 microg/kg/day). Within next 3 days the sensorium, signs of shock, urine output and serum and urinary sodium returned to normal.

Status epilepticus: emergency management.

Status Epilepticus (SE) is a medical emergency and requires prompt and aggressive treatment. Stabilization of airway, breathing and circulation and expeditious termination of seizures are immediate goals. Intravenous benzodiazepines-diazepam, midazolam or lorazepam and phenytoin are the first line drugs recommended for termination of seizures.

Clinical approach to vasculitides.

The term vasculitis refers to inflammation and necrosis of blood vessels. The vasculitides are best classified according to the size of the involved vessels into large, medium and small vessel vasculitis. As a group the disorders are not uncommon even in children but the diagnosis of a given condition can often get delayed, or ever be entirely missed, because of multi-system involvement and the consequent protean clinical manifestations.