Background: Plasma glucose abnormalities were previously noted in neonatal sepsis, but data in neonates is limited and the association with mortality is not established. The aim of the study was to determine the incidence of plasma glucose abnormalities among newborns with sepsis and their association with mortality.Methods: This was a prospective observational study including 50 neonates with suspected, probable and proven sepsis. Plasma glucose level was measured within 2 hours of admission and the patients were monitored till discharge or death. The patients were divided into hyperglycaemic, hypoglycaemic and normoglycemic subgroups as per the serum glucose levels.Results: Majority (56%) were noted to have normoglycemia, followed by hypoglycaemia in 32% and 12% had hyperglycaemic. Mortality in the hypoglycemic, hyperglycemic, and normoglycemic subgroups were 50.0, 33.3, and 7.2% respectively. Mortality was high in hyperglycemic patients compared to normoglycemic patients but the difference was not statistically significant between two groups, whereas the mortality was high in hypoglycemic patients compared to normoglycemic patients and the difference was statistically significant between two groups. A significant association was noted between hypoglycemia in neonatal sepsis with mortality.Conclusions: Altered glycemic status is common in neonatal sepsis. Mortality is higher among septic neonates with hypoglycemia. We conclude that majority of septic neonates had high mortality rate when plasma glucose levels were either >145 mg/dl or <45 mg/dl. This signifies the importance of plasma glucose estimation in cases of neonatal sepsis to improve mortality outcome.

Background: Silvery Hair Syndromes (SHS), an autosomal recessive inherited disorder, includes Chediak–Higashi syndrome (CHS), Griscelli syndrome (GS), Hermansky–Pudlak syndrome (HPS), and Elejalde syndrome. Associated immunological and neurological defects and predilection for hemophagocytic lymphohistiocytosis (HLH) makes them a distinctive entity in pediatric practice. Thorough clinical examination, bedside investigations such as peripheral blood smear (PBS) and hair microscopy, and bone marrow (BM) examination are inexpensive and reliable diagnostic tools. Methods: We report 12 cases with SHS (CHS, n = 06; GS, n = 04; HPS, n = 02). Results: 8 out of 12 SHS children (CHS-05, GS-03) presented with HLH. Out of 5 cases of CHS with HLH, 2 died, 3rd is stable post-chemotherapy; 4th completed chemotherapy, underwent matched related hematopoietic stem cell transplant (HSCT), and is stable 8 months off treatment. The 5th child completed chemotherapy and is in process of transplant. One CHS child without HLH is thriving without any treatment. Of the 4 GS cases, 3 presented with HLH and received chemotherapy (HLH 2004 protocol). One lost follow-up after initial remission; another had recurrence 7 months off treatment and discontinued further treatment. The third child had recurrence 1.5 years after initial chemotherapy; HLH 2004 protocol was restarted followed by HSCT from matched sibling donor; is currently well, 2.5 years post-transplant. One child with GS had neurological features with no evidence of HLH and did not take treatment. Of 2 children with HPS, one presented with severe sepsis and the other with neurological problems. They were managed symptomatically. Conclusion: In SHS with HLH, chemotherapy followed by allogeneic hematopoietic stem cell transplantation is a promising curative option.

A BSTRACT Background: GeneXpert MTB/RIF is a test for early, rapid diagnosis of tubercular meningitis (TBM). Aim: The aim of this article was to study the clinical profile, radiological features, yield of GeneXpert, neurosurgical interventions, and outcome of TBM in children. Settings and Design: This was a retrospective and prospective observational study. Materials and Methods: Diagnosis was based on the uniform research definition criteria and was staged according to the British Medical Research Council. Mantoux test, analysis of cerebrospinal fluid (CSF), CSF GeneXpert, and radiological investigations were performed. Results: Of 36 patients, 50% were aged 1–5 years. Fever (100%), headache (82%), altered sensorium (80%), and vomiting (66%) were common features. Twelve (33%) had contact with active case of tuberculosis; 32 received Bacille Calmette Guarin vaccination. Neurological features included severe deterioration in sensorium (Glasgow Coma Scale < 8) (38%), mild and moderate deficit in sensorium (31%), hemiparesis (41%), and involvement of sixth (25%) and seventh (22%) cranial nerves. Cerebral vision impairment (25%), papilledema (25%), and dystonia (22%) were other findings. CSF GeneXpert was positive in 37% (12/33) patients. Hydrocephalus and basal exudates (75%) were noted on neuro-imaging. Surgical intervention was performed in children with hydrocephalus (13/27). Omayya reservoir was placed in seven children, of which five needed conversion to ventriculoperitoneal (VP) shunt; direct VP shunt was carried out in six (6/13). Good outcome was noted in 78% at discharge. Stage III TBM ( P = 0.0001), cerebral infarcts ( P = 0.0006), and motor deficits ( P = 0.03) were associated with poor outcome. Sequelae included learning difficulties with poor scholastic performance (31.5%). Conclusion: GeneXpert has high diagnostic specificity, but negative results do not rule out TBM. CSF GeneXpert provided quick results. Placement of Ommaya reservoir in TBM stage II and III with hydrocephalus was not successful. Hydrocephalus was managed conservatively with success (53%).

Background: Aim was to study clinical, socio- demographic and laboratory profile and outcome in children with scorpion envenomation up to 12 years of age. This study conducted to provide better insights in to the socio-demographic, clinical, laboratory profile of scorpion envenomation in rural health setting in India.Methods: This was a hospital based, prospective observational study done in children up to 12 years of age admitted in a tertiary care centre between March 2018 to April 2020 with history of scorpion envenomation, presence of sting mark or scorpion seen in vicinity of child by parents or near family members. Unknown bites or stings and cases were the clinical manifestations are not compatible with scorpion sting were excluded.Results: During the study period, 28 children were admitted for scorpion sting. Maximum number of cases were noted in the age group of 3-6 years and there is equal distribution of cases among males and females .Majority of cases from rural areas, 46.42% of the cases had black scorpion sting, most of the stings occurred during evening time and spring season. The most common sting sites were the distal part of the extremities. Pain at the sting site and local swelling were the most common presenting symptoms. The common signs noted were tachycardia. The most common ECG changes were noted in the present study was sinus tachycardia (46.42%) fallowed by ST segment changes noted in 21.4% of children. Commonest complications noted myocarditis, pulmonary edema, myocardial dysfunction, peripheral circulatory failure. One patient died due to pulmonary edema. Majority of the cases recovered without any sequale.Conclusions: Scorpion envenomation is a preventable emergency among children and closely associated with environmental condition, socioeconomic status and child activities. Supervised outdoor play, early hospitalization, close monitoring of vitals and management of complications and supportive care may reduce the mortality and morbidity.