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Background: Complicated malaria caused by Plasmodium falciparum alone or with P. vivax can lead to multi organ dysfunction. There is a paucity of studies about hepatic dysfunction in children with complicated malaria. Hence, this retrospective study was done to find out the clinico-biochemical profile of children with complicated malarial hepatic dysfunction from a malaria endemic region of India. Further, liver function test (LFT) response to Artemisinin-based combination therapy (ACT) i.e. artesunate + sulfadoxine-pyrimethamine therapy in the malarial hepatic dysfunction children was assessed. Methods: Out of 203 children confirmed to have malaria, 60 children were found to have complicated malaria with jaundice as per WHO malaria guidelines (total serum bilirubin >3 mg%). Physical examination, malaria related biochemical and ultra-sonographic findings were noted. All the children were found to be uniformly on ACT as per institute protocol adapted from WHO guidelines. Biochemical parameters of hepatic function were compared between day 1 and 4. Results: Presentations were fever, pallor and clinical jaundice in 100%, reddish urine in 63.3%, tender hepatomegaly in 100% and splenomegaly in 81.7% of the study population. Liver function test showed mild to moderate elevation of serum bilirubin and enzymes with remarkable recovery noticed with the use of ACT in all the study subjects. Conclusions: Clinical presentations of malarial hepatic dysfunction although mimics viral hepatitis, LFT showed mild to moderate elevation only. Further, ACT therapy was found effective in the management of all children with hepatic dysfunction in complicated malaria.

Background: Children with malnutrition usually exhibit several alterations in the body composition, one of them being a loss of cardiac muscle and its consequences. Aim: The aim of this study is to detect the incidence of cardiac involvement among malnourished schoolchildren as shown by clinical examination and corresponding investigations. Methodology: This is a prospective case-control study conducted on 15 children between 5 and 15 years of age with malnutrition. Inclusion criteria were children who fall under the definition of moderate malnutrition as per the World Health Organization (WHO) Z-score based on the WHO Child Growth Standards. Children with known congenital/acquired heart diseases were excluded from the study. Thesechildren were assessed by echocardiography and estimation of cardiac troponin T (cTn T) levels for cardiac involvement that was compared with 12 healthy controls. Results: The mean left ventricular mass (LVM) was 16.74 units higher in children with normal nutritional status compared with malnourished children (p=0.092, 95% confidence interval=2.91-36.40).The mean LVM index was 4.76 units higher in children with normal nutritional status compared with kids with malnutrition indicating the reduction of cardiac muscle mass. Conclusion: As cardiac muscle mass is reduced in children with malnutrition leading to various complications, they need early detection, monitoring, and appropriate management.