BACKGROUNDScrub typhus (Tsutsugamushi fever) is a zoonotic disease among Rickettsial infections, wherein man is an accidental host. Scrub typhus is an important and widespread cause of acute febrile illness in rural areas of Asian and Northern Australia. In the preantibiotic era, the mortality rates as high as 42% were reported. Scrub typhus is very responsive to treatment with timely and appropriate antibiotics. The disease still causes a significant rise of death in rural areas, where effective treatment is unavailable or delayed. Scrub typhus is grossly underdiagnosed, especially in India due to lack of awareness among clinicians and also due to lack of diagnostic tests. In our study, we studied the investigatory profile and treatment outcome in paediatric Scrub typhus patients.

BACKGROUND Breath holding spells are common in non-epileptic, repetitive, paroxysmal events in young infants and children often considered as seizure mimics/ confused with seizure disorder can be a frightening experience for parents and demands a good history of the sequence of events, because the diagnosis is made clinically. Aims and Objectives-To study the disease spectrum of Breath holding spells in infants and children in terms of clinical and epidemiological profile (i.e. age, sex, family history, parental consanguinity, triggering factors, associated comorbidities such as anaemia etc.). MATERIALS AND METHODSThis case series study was conducted in our Child health clinics. A total of 125 children below 6 years with Breath holding spells were enrolled between May 2012 and April 2017, out of which 10 children were excluded from the study due to various causes. Remaining 115 children diagnosed as Breath holding spells by typical history, clinical examination and after ruling out other causes which mimic Breath holding spells are included in the study. RESULTSIn the present study, a total of 115 children aged between 6 months and below 6 years were diagnosed as having Breath holding spells. In 73 (63.41%) cases Breath holding spells began during the first 24 months of age. Most common triggering factor bei ng anger (45.2%) and pain (41.7%). A positive family history was found in 27% and parental consanguinity was found in 30.43% of cases. The spells were cyanotic in 62.6% and 76.52% were anaemic. CONCLUSIONThe result of this study suggests a new data regarding the natural history of Breath holding spells and is important for identifying interventional strategies and parental counselling and could serve as baseline data for future approaches on this paediatric clinical entity. KEYWORDSBreath Holding Spells, Cyanotic, Pallid, Anaemia. HOW TO CITE THIS ARTICLE: Bhavanishankar R, Ramu P, Chaitanya N. Clinical and epidemiological profile of breath holding spells (BHS)-an analysis of 115 cases. J. Evolution Med. Dent. Sci. 2018;7(04):534-539, DOI: 10.14260/jemds/2018/119 BACKGROUND Breath holding spells are common in non-epileptic, repetitive, reflexive events described under "behavioural disorders" of children and are initiated by provocative events that cause anger, frustration or pain causing the child to cry. The term Breath holding spells is actually a misnomer, as these are not self-induced but results from immaturity of autonomic system and occurs in two different forms. The first type is pallid Breath holding spells. The second type is the cyanotic or blue Breath holding spells. Episodes usually start with a cry (often in the case of pallid type, a silent cry with marked pallor) and progress to apnoea and cyanosis. Some authors have described third variety as mixed Breath holding spells,

BACKGROUND Neonatal seizures defined as seizures occurring in first 28 days of life are one of the most common morbidity factors of admission in NICU. Incidence is 1.5 -14/ 1000 neonates. Seizures often signify serious damage or malfunction of the immature developing central nervous system and contribute to sequelae in later life. Neonatal seizures may arise as a result of diverse aetiologies and can have varied presentations. Aims and Objectives-Our study is aimed at finding the incidence, aetiological factors and time of onset, clinical types and various biochemical abnormalities and outcome of babies admitted with seizures in our NICU. Pradesh. A total of 150 neonates with neonatal seizures who fulfilled the inclusion criteria were included in the study. RESULTSDuring the study period a total no. of 150 babies were admitted with neonatal seizures in our NICU, of which males were 91 (60.67%) and females were 59 (39.33%). Most of the babies with seizures were admitted within 24 hrs. of life, i.e. 77 (51.33%) followed by 48 -72 hrs. 31 (20.67%) and the rest after 72 hrs. by 28 days 42 (28%). Commonest type of seizures observed were focal clonic seizures 59 (39.33%) followed by subtle 43 (28.66), myoclonic 27 (18%), tonic 10 (6%), multifocal 6 (4%) and GTCS 5 (35). Among the various aetiological causes of seizures, HIE is the commonest cause 79 (52.67%) followed by ICH 20 (13.33%), meningitis 18 (12%), hypoglycaemia 17 (11.33%), hypocalcaemia 12 (8%), hypomagnesaemia 5 (3.33%) and others 9 (6%). Commonest organism isolated was E. coli 44.5%. The total neonatal mortality rate of babies admitted with seizures was 12 (8%), of which HIE is the commonest cause 6 (50%) followed by ICH 3 (25%) and others 3 (25%). CONCLUSIONThe present study shows that perinatal asphyxia is the most common cause of neonatal seizures among neonates admitted for seizures in our NICU. The other causes followed in order are IVH, sepsis, metabolic (hypoglycaemia, hypocalcaemia) and brain malformations. Early identification of at-risk pregnancies, institutional delivery and aseptic precautions with timely resuscitation is recommended to reduce morbidity and mortality due to neonatal seizures.

BACKGROUNDScrub typhus is an important cause of acute febrile illness caused by Orientia tsutsugamushi with uncertain pathogenesis, but presents as a systemic vasculitis like infection resulting in wide range of clinical manifestations and complications. Though it is endemic in many parts of India, Scrub typhus is grossly underdiagnosed partly because of lack of awareness among clinicians and partly due to poor availability of standardized diagnostic tests in tropical areas. We studied the clinical and epidemiological profile of paediatric scrub typhus patients.