Background: Vitamin B12 and folate are essential micronutrients which are critical especially during infancy and early childhood as these are periods of rapid growth, development, and increased demand. Malnutrition further increases the risk of these micronutrient deficiency due to poor socioeconomic status, inadequate intake and poor absorption. Aim of present work was to study the cobalamin and folate status in malnourished children.Methods: A hospital based observational study on 80 children suffering from severe acute malnutrition (SAM) aged 6-60 months. Detailed socio-economic, feeding and development history with complete anthropometric evaluation was done. Blood samples sent for measurement of plasma vitamin B12 and serum folate levels. Statistical analysis was done using SPSS version 20.0.Results: Mean age of SAM children was 17.25±12.60 months. 30 (37.5%) had vitamin B12 deficiency (vitamin B12 levels<100pg/ml) and 9 (11.25%) had borderline vitamin B12 levels (100-200pg/ml). Folate deficiency was found in only 7 (8.75%) children. Mean vitamin B12 and folate levels were found to be 353.65±330.76pg/ml, 11.18±4.17ng/ml respectively. Among vitamin B12 deficient children, majority (26, 86.66%) belong to lower socio-economic status, 17 (56.66%) were still predominantly on breast feeding and 11 (36.66%) had delayed introduction of complementary feeding. Among B12 deficient children 23 (76.66%) had delayed development (DQ <70). 100% of B12 deficient children were anemic with majority (21,70%) having severe anemia. 17 (56.66%) B12 deficient children also had associated thrombocytopenia (PC <1.5 lakh/cumm).Conclusions: There was a high prevalence of vitamin B12 deficiency among malnourished children. Folate deficiency was found only in few. Efforts should be directed to prevent its deficiency in pregnant and breastfeeding women and their infants with special attention on malnourished children.

Background: Malnutrition is one of the most common global health problem. It produces notable morphological changes in the brains which damage the intellectual potential and leads to reduced brain size, inferred from measurements of head circumference(HC). Aim is to study the impact of malnutrition on head size and development quotient(DQ) in children suffering with malnutrition.Methods: It is a hospital based study on 120 children including 100 moderates to severely malnourished children and 20 healthy controls aged 6-60 months admitted in malnutrition treatment center. Statistical analysis of head circumference and development quotient was done with severity of malnutrition and with each other.Results: Out of 120 children, 80 were severely malnourished (SAM) and 20 were moderately malnourished (MAM) and 20 age and sex matched controls were taken. Mean age was 19.00±8.54 months. 36.25% of severely malnourished, 5% of moderately malnourished children and none in control had microcephaly (HC<-3SD). Mean DQ was 57.46±14.98, 78.35±6.60 and 94.45±3.96 in SAM, MAM and control children respectively. Statistically significant association was found for head circumference and development quotient with severity of malnutrition and with each other.Conclusions: SAM adversely affects the developing brain of children as evidenced in our study by reduced head size and low DQ scores in children suffering from malnutrition. As seen in this study, prevalence of microcephaly and lower DQ scores increases with severity of malnutrition. Therefore, the study emphasizes the importance of early and timely intervention in such children before the severity of malnutrition increases to an extent of irreversible effects on brain and development.

Empyema thoracis is a rare complication of congenital pneumonia in neonates. Case characteristics: A newborn presented with severe respiratory distress had empyema thoracis. Outcome: patient was managed with chest tube insertion and antibiotics. Message: empyema can be a rare complication of congenital pneumonia and along with appropriate antibiotics, chest tube drainage is required for successful management.

Background: India has 57 million or more than a third of the world's 146 million undernourished children. Protein energy malnutrition is associated with cerebral atrophy 2 which may be detrimental to intellectual development. The aim and objective of this stusy was to study the changes in the brain by cranial imaging in children with malnutrition aged 6 months to 5 years and to correlate these changes with severity of malnutrition.Methods: It was a hospital based prospective study done in Bal Chikitsalay, Maharana Bhupal government hospital, Udaipur during the study period July 2015 to July 2016. Total 120 children were enrolled, out of which 80 were severely malnourished, 20 were moderately malnourished and 20 normally nourished children undergoing neuroimaging for some other reason taken as controls. All the cases were subjected to CT scan and the following parameters were noted. Central atrophy was evaluated by bifrontal index (BFR) and bicaudate index (BCR). Cortical atrophy was evaluated by width of sylvian fissure (SFW) and widening of interhemispheric fissure (IHD). These parameters were then compared with the severity of malnutrition and among controls. Data was analysed with standard software of biostatics using parametric tests, Pearson’s correlation analysis, ANOVA test and student’s t test.Results: On an average 80% of SAM and 10% of MAM had various degree of cerebral atrophy while none of the controls showed significant degree of cerebral atrophy.Conclusions: Effect of malnutrition on brain can be objectively assessed by CT indices, BFR, BCR, SFW and IHD to define the degree of cerebral atrophy in the malnourished population.

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