Background: Rickettsial diseases including Scrub Typhus are emerging as an important cause of acute undifferentiated febrile illness throughout the Asia-Pacific region. The objectives of the study are to study the clinical profile, complications and outcome of Scrub Typhus cases admitted in rural medical college.Methods: This prospective descriptive study was done at Government Dharmapuri Medical College Hospital, Tamilnadu, between Jul’2015 and Jan’2016. The children who were positive for Scrub Typhus by IgM Elisa were analyzed.Results: During the study period, 151 children (40% of fever cases) were positive for Scrub Typhus. All the children were presented with fever. High-grade fever, chills, vomiting, cough, head ache, were seen in 83%, 41%, 57%, 56% and 32% respectively. 54% of children had lethargy and 10% children brought with convulsions to hospital. Eschar was seen in 68% of children. Lymphadenopathy (70%) and hepatosplenomegaly (more than 56%) were common findings. Shock, respiratory distress, pleural effusion and ascites were seen in 46%, 36%, 40% and 37% respectively. Anemia (74%) and thrombocytopenia (81%) were common lab findings. Shock (46%), ARDS (12%), Meningoencephalitis (10%) and MODS (1.3%) were complications reported. Doxycycline (53%), Azithromycin (11%) and both drugs (36%) were used. Along with fluids, Dopamine (38%), nor-adrenaline (12%), Oxygen through Jackson-Rees Circuit (28%), Non-invasive ventilation (9%) was needed to treat the complications.Conclusions: When a child presents with acute febrile illness, hepatospleenomegaly, lymphadenopathy, anemia with thrombocytopenia and features suggestive of capilary leak diagnosis of Scrub Typhus must be considered. Doxycycline or Azithromycin, proper fluid boluses, Inotropes and O2 through Jackson-Rees Circuit are life saving for scrub typhus and its complications.

Background: Nephrotic syndrome (NS) generally tends to follow a benign and chronic relapsing course. Relapses are a major problem in children with steroid sensitive NS (SSNS). Objective: To identify the risk factors for frequent relapse (FR) in the first episode childhood SSNS. Methods: This prospective study was conducted in the Government Dharmapuri Medical College Hospital, Tamil Nadu, between July 2013 and January 2016. Children aged 9 months - 12 years with a diagnosis of SSNS (first episode) who came for follow-up for at least 12 months in the pediatric nephrology clinic were included. The enrolled cases were divided into 2 groups: (1) frequent relapser (FR) and (2) infrequent relapser (IFR). 9 factors were studied as possible risk factorsfor relapse. The data collected were analyzed using Chi-square test and Student’s t-test. Results: Of 160 SSNS children, there were 92 (57.5%) cases of IFR and 68 (42.5%) cases of FR. There were 97 males (60.6%) and 63 females (39.4%) with a male to female ratio of 1.5:1. The mean age of presentation was 4.37±2.32 years. The mean time taken to achieve remission during the first episode was 1.94±1.04 weeks. The interval between remission and first relapse was 5.56±4.51 months. Incidence of infection and hypertension was 31.9% and 37.5%, respectively. Risk factors significantly associated with FR were: Time taken to achieveremission during the first episode (>14 days) (p<0.0001), mean duration of interval between remission and first relapse (within 6 months) (p<0.0001), associated infections (p<0.0001) and hypertension (p<0.0001). Age at onset, sex, serum albumin, 24 h urine protein, and azotemia did not influence the FR in our study. Conclusion: More than 14 days to achieve remission during the first episode, relapse within first 6 months, associated infections and hypertension were the factors associated with FRs.

Introduction: Mental health of rural adolescents is often neglected and their problems are grossly under reported. Though there are many studies available in the literature that describe the mental health status of urban adolescents, there are only a very few studies available to describe the mental health status of the rural adolescents. Aim: To assess the mental health status of adolescent boys and girls in rural schools in India. Materials and Methods: This cross-sectional descriptive study was conducted on 151 boys and girls in late adolescence period in two rural schools. The study tool used was Strength and Difficulties Questionnaire-Youth Report 1 (SDQ-YR1) which consists of five subscales- emotional, hyperactivity, peer relationship, conduct problems and prosocial behaviours. All continuous data were described using mean and standard deviation or median and interquartile range based on the distribution. To study the association of different subscales with gender, Chi-square test or Fisher’s-exact test was applied based on the expected frequency. The p-value was considered significant at 5% level of significance for all comparisons. Results: The prevalence of mental health problems as observed by the abnormal total difficulties score was 14% (n=20). The most common high risk clinically significant mental health abnormality observed was in emotional subscale which was observed in 21% of the participants. Conduct problems and hyperactivity problems were each seen in 11% of the participants. Peer problems were less often seen among the participants (6%). The abnormality in prosocial behaviour was seen in only one participant. The total difficulty score which is a sum of the emotional, conduct, hyperactivity and peer problems scale was normal in 65% of the participants, was border line in 21% and was abnormal in 14%. On the analysis of the gender variations in mental health status, a greater number of boys were found to have abnormal scores than the girls. Conclusion: This study had observed a 14% prevalence of mental health problems in rural adolescents. The mental health problems were more common in the boys than the girls. The early identification of the mental health problems by the teachers can be done by using the SDQ scale which is simple and short.

Background: Perinatal Asphyxia is a multi-system disorder and its effects are not limited to central Nervous System. MODS determine the early outcome of asphyxiated neonate. Cardiac impairment occurs in about 25% of neonates with asphyxia. Often cardiac impairment is overlooked due to the lack of sensitive diagnostic test.Methods: A hospital based prospective analytical study performed over 50 Asphyxiated neonates admitted in our NICU from September 2016 to January 2017 myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac troponin-T card test.Results: In the present study, among the 50 neonates 32 had clinical evidence of myocardial injury. Troponin T card test has the highest sensitivity of about 84.37%, positive predictive value of 93.1% and negative predictive value of 76% in diagnosing myocardial injury in contrast to ECG and ECHO. In terms of Specificity ECHO has the highest specificity of about 94.4% when compared to ECG and Trop T. Among all the diagnostic modalities used in this study, Troponin T best predicts the severity and outcome of Perinatal asphyxia. Conclusions: Troponin T card test is a valuable tool for early detection of myocardial injury due to perinatal asphyxia. In resource limited setting where the accessibility to 12 lead ECG, ECHO, and aid of cardiologist are not available, Trop T card test will serve as an effective handy screening tool in diagnosing myocardial injury

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