A 3-year-old boy presented to our atoll hospital in H.A Alif Dhidhoo, with severe pallor, jaundice, easy fatigability and recurrent episodes of passage of dark-colored urine for past 3 days. He was born mature at 39 weeks of gestation with no past significant medical history. Recent history revealed the consumption of 2 cans of fava beans and application of some medicinal herbs. On admission, physical examination revealed fever of 101 degree Fahrenheit, severe pallor, jaundice, cervical lymphadenopathy and mild hepatomegaly. Laboratory investigation results showed a hemoglobin level of 5.4 g/dl with a hemolytic blood picture and serum Bilirubin of 6mg/dl. The patient's G6PD level was measured which showed marked deficiency. Other causes of hemolytic anemia were excluded. Patient required urgent packed RBC transfusion and antibiotics for infection. He responded well to the treatment and was discharged in a stable condition. Parents were appropriately advised on the condition and the importance of avoiding certain foods and medication. Folic acid was prescribed for maintaining normal hemoglobin concentration. This is a first case report in North Maldives of G6PD presenting with severe hemolytic anemia requiring blood transfusion.

In 2019, an outbreak of hand, foot and mouth disease (HFMD)occurred in Maldives and many patients presented with onychomadesis following HFMD. Here we present a study of 33 cases out of which a total of 06 cases developed onychomadesis. Patients varied in clinical presentations ranging from mild to severe form of HFMD and during follow up 06 cases presented with peroidic shedding of nails involving both fingernails and toenails. All the patients were observed 4 to 6 weeks after diagnosis of HMFD was made. It was observed that onychomadesis developed was not related to the severity of disease. Patients required only symptomatic treatmentfor HFMD and observation with assurance for onychomadesis as course was self limited. Nailchanges were temporary in nature and spontaneous regrowth occurred after shedding of the nails. Parental counselling played a cruicial role in management.

WHO defines health inequities as avoidable inequalities between groups of people within countries and between the countries: Similarly, various global health agencies have provided an extract where Inequity and inequality is clearly defined. These two terms are confusing at times however they are not interchangeable. Health inequity is a situation where differences can be avoided but due to mass corruption, poor governance and in some instances cultural compulsion and exclusion leads to inequity. Health inequity is socially produced therefore it is unfair and avoidable. Example of health inequity between countries are, the infant mortality rate in Iceland is 2 per 1000 live births while it is 120 per 1000 live births in Mozambique. On the other hand health inequality is an unavoidable condition that results due to uneven distribution of health or resources or biological variations of genetic or other factors e.g. Elderly people, who are more likely to die than young adults and children. This case report of a child with PEM is aimed to highlight the issue of health inequity in a Paediatric age group in Kashmir, India. Keywords: PEM (Protein Energy Malnutrition), WHO (World Health Organization), PMJAY (Prime Minister Jan Arogya Yojana).

Canavan disease is a rare autosomal recessive disorder characterized by progressive leukodystrophy involving white matter of the brain. Disease leads to severe psychomotor retardation, seizures and premature death. More prevalent among Jewish population. Among non-Jewish population incidence is approximately 1:100000. Prognosis is guarded with current management only symptomatic and supportive. There is no effective treatment, however early gene therapy has improved the quality of life of patients. Furthermore, Lithium citrate has also shown certain positive results in experimental models using rats. Even few human studies have also been done, however promising results require larger controlled trials. Keywords: MRI: Magnetic Resonance and Imaging, EEG: Electro Encephalogram, CD: Canavan Disease, ASPA: acetyl aspartate, LUCS: Lower Uterine Cesarean Section, OFC: Occipito Frontal Circumference, NAA: N-acetyl aspartate