BACKGROUND Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycaemia resulting from an absolute or relative deficiency of insulin. The burden of childhood diabetes is rising all over the world. METHODS This is a descriptive study conducted at a tertiary care hospital. Eighty-five children with diabetes mellitus admitted during the study period were included. Clinical details, laboratory parameters were collected from the medical records and the data was analysed using statistical tests. RESULTS Eighty-five children less than 12 years were included in this study. Female: male ratio was 1.43:1. Age wise distribution was 0-5 years (28.24%), 5-10 years (40%), 10-12 years (31.76%). Majority of them were from lower socioeconomic class (71.76%). Family history of diabetes mellitus was present in forty-one children. Majority of them presented with osmotic symptoms like polyuria (82.35%), polydipsia (80%). Forty-six children presented with diabetic ketoacidosis. Type 1 diabetes was diagnosed in 88.24% of the subjects. There were two children with Type 2 diabetes mellitus. The mean RBS at presentation was 470.42±125.02 and the mean HbA1c was 11.05 ± 1.98. There was no statistically significant difference in the duration of onset of symptoms to diagnosis between the ketotic and non ketotic group. The BMI was in the range 10 to 25, with mean value 15.09 ± 3.39. There was no mortality among the subjects. CONCLUSIONS Type 1 diabetes is still the predominant form of diabetes among children. Osmotic symptoms like polyuria, polydipsia are the most common presenting symptoms. Younger children are more prone to have diabetic ketoacidosis. Awareness of diabetes care is essential for the successful management of the disease.

BACKGROUND Meningitis is an inflammation of meninges and subarachnoid space and is often associated with cerebritis. Acute bacterial meningitis is one of the most common serious infections in children. Viral meningitis has a much more favourable prognosis. Cerebrospinal fluid analysis has got an important role in the diagnosis of neurological disorders. CSF lactate can be elevated in disorders like subarachnoid haemorrhage, bacterial meningitis, status epilepticus and inborn errors of metabolism. The aim of the present study is to evaluate the level of CSF lactate in bacterial and viral meningitis, its role in the assessment of early prognosis of bacterial meningitis and its relationship with CSF parameters like cellularity, glucose and protein in bacterial meningitis. MATERIALS AND METHODS This is a descriptive study conducted in a tertiary care hospital. In this study, 65 cases of meningitis admitted in the hospital under the Department of Paediatrics were included. Cases were grouped as bacterial meningitis and viral meningitis after clinical assessment and CSF analysis. CSF lactate estimation was done by the dry chemistry method. Using statistical methods, CSF lactate level was compared between viral and bacterial meningitis group and CSF lactate level was analysed for its association with the development of acute complications and its relationship with other routinely measured CSF parameters were analysed. RESULTS The level of CSF lactate in bacterial meningitis was higher than that in viral meningitis with statistical significance of p <0.01. The mean CSF lactate value in bacterial and viral meningitis was 7.62 ± 2.07 mmol/L and 2.08 ± 0.35 mmol/L, respectively. The mean value of CSF lactate in patients who developed complication was 9.49 ± 1.65 mmol/L, whereas it was significantly lower in those without complication 6.38 ± 1.2 mmol/L, p <0.01. The level of CSF lactate presented negative correlation with CSF glucose and positive correlation with CSF protein in bacterial meningitis, whereas no significant relation was found between CSF lactate and CSF cellularity. CONCLUSION Lactate level in CSF is significantly elevated in bacterial than that in viral meningitis. High CSF lactate level was associated with the development of acute complications and it showed a positive correlation with CSF protein and negative correlation with CSF glucose in bacterial meningitis.

BACKGROUND Diabetic ketoacidosis is a potentially life-threatening condition, which accounts for the majority of diabetes-related morbidity and mortality in children with type 1 diabetes mellitus. Early diagnosis and prompt management substantially reduces the mortality. The aim of the study is to assess the clinical characteristics and early outcome in children with diabetic ketoacidosis. MATERIALS AND METHODS This is a descriptive study done in a tertiary care hospital. Fifty two episodes of diabetic ketoacidosis in children of age ≤12 years admitted during the period 2011 to 2016 were included in the study. Clinical details, investigations and complications were recorded in a pro forma and data was analysed using statistical tests. RESULTS Fifty two episodes of diabetic ketoacidosis were included in the study. Thirty three (63.5%) children presented with DKA at first diagnosis of diabetes, whereas 19 (36.5%) were DKA among children with established diabetes. Mean age at presentation was 9.048 ± 3.24. Female-to-male ratio was (1.36:1). The mean duration of onset of symptom before hospitalisation was 10.10 ± 9.52. Most commonly observed presenting symptoms were polyuria (63.46%), polydipsia (65.38%), tiredness (61.54%), vomiting (36.54%) and pain abdomen (32.69%). Mild DKA occurred frequently than moderate and severe forms. Among these children, 40.4% had infection as the predisposing factor. Demographic variables like age, gender, socioeconomic status, family history of diabetes did not have any significant association with the severity of DKA. The clinical parameters like tachypnoea, Kussmaul breathing, shock, altered sensorium at presentation and dehydration had significant association with the severity of DKA. Similarly, hypoglycaemia, hypokalaemia, hyponatraemia, acute kidney injury and cerebral oedema had significant association with the severity of DKA. All the patients recovered with therapy. No mortality was reported. CONCLUSION Diabetic ketoacidosis can be the initial presentation of diabetes mellitus or can occur in children with established diabetes mellitus. The mortality can be reduced by timely diagnosis and proper management. Diabetes education programs and follow up care of the patients should be strengthened to reduce the incidence of DKA.

BACKGROUND The incidence of dengue fever has dramatically grown in the recent years. The increasing magnitude of the problem with its changing epidemiology is an important public health problem. The present study was undertaken to evaluate clinical profile, haematological parameters and outcome in children admitted in a tertiary care teaching hospital. MATERIALS AND METHODS This is a retrospective descriptive study. Children upto 12 years admitted with confirmed dengue fever were included in the study group. Case records were analysed to obtain data on clinical characteristics, haematological parameters, treatment received and outcome. RESULTS A total of 519 cases including 274 (52.8%) boys and 245 (47.2%) girls were included in the study. Of which 245 (47.2%) were dengue fever, 230 (44.3%) were dengue with warning signs and 44 (8.5%) with severe dengue as per the revised WHO 2009 case definition. Maximum number of cases were recorded in the year 2013. Fever was the most common presenting feature (100%) followed by vomiting (49.3%), though thrombocytopaenia was documented in 73% cases. A total of four children expired in the study group, the case fatality being 0.8%. CONCLUSION Dengue fever had got wide spectrum of clinical manifestations; prompt diagnosis and immediate treatment gives good recovery.

BACKGROUND Henoch-Schonlein purpura (HSP) is the most common systemic vasculitis in children. It can produce multisystem involvement. The disease is usually self-limited, but can occasionally produce life-threatening gastrointestinal and renal manifestations. The aim of the study is to describe the age of onset and clinical profile of HSP in children. MATERIALS AND METHODS This is a retrospective descriptive study conducted in a tertiary care hospital. 61 children below 12 years who were admitted over a 2-year period with a diagnosis of HSP based on American College of Rheumatology criteria were included in the study. The clinical details were collected from the case records and entered in a proforma. Data was analysed statistically. RESULTS The mean age of presentation was 6.7 years. The male-to-female ratio was 1.2: 1. The commonest clinical features were purpura (100%), abdominal pain (70%) and arthritis (65%). Renal involvement was seen in 5%. Anaemia was seen in 48%, raised ESR in 50% and thrombocytosis in 20%. Steroids were used in treatment in 55% of patients. CONCLUSION The clinical profile of HSP in children was similar to that found in other studies except for renal involvement, which showed much lower incidence in this study. Gastrointestinal manifestations and arthritis may occasionally be the presenting features of HSP even before appearance of rash. Steroids were used in more than half of the patients with HSP.