Aim: Fever with rash is a common presentation in paediatric patients with a variety of differential diagnosis ranging from minor to life-threatening illnesses. Establishing an early diagnosis particularly of dengue infection, especially in a resource-limited setting is essential to reduce morbidity and mortality. The aim of this study is to evaluate the clinico-aetiological profile of children admitted with fever and rash and to find out different clinical and laboratory parameters for diagnosing dengue infection using screening tests. Methods: It is an observational cross-sectional study. All consecutive patients admitted to tertiary care centre during the study period (n = 120) between age group 1 month and 12 years were evaluated with detailed history and clinical examination and relevant investigations. For screening dengue infection, various clinical and laboratory parameters were used to find the best combination comprising the desired sensitivity, specificity, positive and negative predictive values (NPV) and likelihood ratio. Results: The most commonly affected age group was below 5 years. Among 120 patients, 64% had a laboratory-confirmed diagnosis out of which 45% patients were of viral aetiology, 10% patients had bacterial aetiology and 9% had non-infectious aetiology. Among viral infections, 18 patients were diagnosed as dengue immunoglobulin M enzyme-linked immunosorbent assay positive. Headache (100%), was the most common symptom followed by diarrhoea (83.3%), vomiting (83.3%) and altered sensorium (72.2%) in dengue-positive patients. All dengue patients had thrombocytopenia, 88.9% had leucopenia and liver function tests deranged in 77.8% of patients. The highest sensitivity and specificity values were found in the combination of fever, maculopapular rash, headache, absence of cough and thrombocytopenia (55.6% and 94.12%, respectively), followed by fever, maculopapular rash, headache, no cough, thrombocytopenia and leucopenia (with 50% sensitivity and 100% specificity). Both combinations also showed the highest values for positive and NPVs, positive likelihood ratio and maximum area under the curve using a receiver operating characteristic. Conclusion: Establishing the diagnosis of fever with rash in children can be challenging. A combination of parameters such as fever, maculopapular rash, headache, absence of cough, thrombocytopenia and leucopenia can be used as a screening tool for early diagnosis of dengue infection in a resource-limited setting.

BackgroundElectroencephalography (EEG) is an important tool to evaluate infant with symptoms refer to central nervous system. The objective of the work was to study the predictive value of EEG for developmental outcome in full term neonates with seizures at 6 month of age.MethodsThis was prospective observational study at tertiary care centre, Gandhi Medical College, Bhopal. The participants were full term hospitalised neonates with documented seizures. Newborns admitted for complaints other than seizures, hypoxic ischaemic encephalopathy (HIE) stage 1, preterm and neonates born to mother on antiepileptic therapy were excluded from the study.ResultsOut of total 108 registered neonates 14 expired and 10 lost to follow up. In remaining 84 cases, 36 (42.9%) had generalised discharge, 16 (19%) had focal and 6 (7.1%) had multifocal discharge while 44 (52.3%) had normal EEG patterns. HIE being the most common cause and subtle seizure being the most common type of seizures. On follow up at 6 month, all neonates with normal EEG pattern (n=44) had normal developmental outcome. Out of 40 neonates with abnormal EEG discharges, 26 (65%) had developmental delay, while 14 (35%) had normal development for age.ConclusionsEEG could be a simple and cost effective prognostic tool where neonates presenting with seizure. Newborn with abnormal discharge should be closely monitored on DDST for early identification and early intervention.

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Introduction: The incidence of neonatal sepsis in India is 38 per 1000 live births. Many authorsfound an association between altered thyroid hormone levels and septic shock in neonates and itmay be of prognostic importance in septic shock treatment. This study has been conducted to findthe relationship between thyroid profile and septic shock in neonates and also to compare thethyroid profile in survivor and non-survivor groups of septic shock patients. Methods: Thisanalytical prospective cohort study was conducted in the NICU of a tertiary care teaching institutionin central India. Full-term neonates with late-onset sepsis were included in this study and estimationof thyroid hormones (TSH, T3, T4, fT3, and fT4) was performed. These neonates were divided intothose with and without septic shock patients and levels of thyroid hormones were correlatedbetween these patients to find significant relations. The Vasoactive-Inotropic Score (VIS) score wascalculated. Results: A total of 195 full-term neonates were included in the study. The mean value ofTSH, T3, T4, fT3, and fT4 among neonates with septic shock were 5.27 μg/ml, 80.01 ng/dl, 6.36μg/dl, 1.40 pg/ml, and 1.40 μg/dl, respectively while the values were 5.29 μg/ml, 94.4 ng/dl, 7.25μg/dl, 1.84 pg/ml, and 1.43 μg/dl, respectively in septic neonates without shock. This difference wasstatistically significant except for TSH (p>0.05). The mean value of TSH, T3, T4, fT3, and fT4 amongseptic shock survivors were 5.27 μg/ml, 80.01 ng/dl, 6.36 μg/dl, 1.40 pg/ml, and 1.40 μg/dl and inseptic shock non-survivors were 2.40 μg/ml, 37.33 ng/dl, 3.86 μg/dl, 0.99 pg/ml, and 0.84 μg/dl,respectively (p<0.0001). Only T3 was found to be significantly co-related with VIS in septic shock inall the groups (<0.001). Conclusion: Our study suggests that TSH, T3, T4, fT3, and fT4 levels aresignificantly low in patients suffering from the septic shock which may vary in the case of TSH. Also,there is a significant decrease in thyroid profile among septic shock non-survivors as compared tosurvivors.