Open thoracotomy is the standard procedure for various thoracic diseases against which other procedures are compared. Currently Video Assisted Thoracoscopic Surgery (VATS) has gained widespread acceptance in the management of a variety of thoracic disorders. It decreases the morbidity and duration of hospital stay. A total of 133 children with various thoracic diseases who presented at a University Teaching Hospital in the Department of Pediatric Surgery, from June 2000 to December 2007, were included. Of the 133 patients, 116 patients had empyema, all of whom were subjected to VATS, and an attempt at debridement/decortication and drainage was made. Other thoracic disorders treated included lung abscesses, lung biopsies, hydatid cysts, and so on. Patients with empyema were treated according to their stage of disease. Of the 116 patients who underwent thoracoscopy, 16 had to be converted to open surgery due to various reasons. The mean duration for removal of drain was three days and the average total duration of hospital stay was six days. Similarly the application of VATS was advantageous in other thoracic diseases.

Objectives: To assess the clinical characteristics, laboratory parameters and outcomes in paediatric patients with COVID-19. Method:Case records of all paediatric patients admitted with COVID-19 were included in the study. Data regarding mode of presentation, presence of comorbid conditions, severity of COVID-19, laboratory investigations and management were noted.Results: A total of 32 children was admitted with COVID-19 infection in our institute. COVID-19 infection was mild in 16 (50%) patients, moderate in 6 (18.8%) and severe in 10 (31.3%). Ages of the children ranged from 6 months to 16 years with a mean age of 10.75 years. Of them 17 (53%) were boys and 15 (47%) were girls. Pre-existing comorbidities were present in 8 (25%) children. Respiratory symptoms were the commonest presenting complaints, being observed in 18 (59%) cases. Atypical presentation of COVID-19 (other than respiratory) was seen in 31% of cases. Presence of undernutrition and elevated C-reactive protein (CRP) were associated with severe Covid-19 illness (p<0.05). Eleven (34%) cases required intensive care and mechanical ventilation was required in 2 (6.3%) cases. Out of the 32 cases only 1 patient expired giving a case fatality rate of 3.1%. Conclusions:Atypical presentation of COVID-19 with varied manifestations involving systems other than respiratory was observed in children as a separate entity from hyper-inflammatory syndrome. Presence of undernutrition and elevated CRP was associated with severe illness.

Introduction: Most common adrenocortical biosynthetic defect is 21-hydroxylase deciency usually presenting as atypical genitalia at birth in girls and adrenal crisis in males at 2-3 weeks of age. We present to you a case series of congenital adrenal hyperplasia(CAH) with heterogeneous presentation at varied ages.Case 1:Thirty-six-day old baby presented with atypical genitalia, failure to thrive and shock. Laboratory evaluation revealed:hyperkalemia, hyponatremia, markedly elevated 17OH-progesterone(24200ng/dl)and karyotype 46XX.Case 2: One-year-4-month old boy known case of salt-wasting CAH who was on regular oral hydrocortisone and udrocortisone brought with the acute gastroenteritis. Investigations revealed elevated markers for sepsis, hypocortisolemia(1.37 mcg/dl) and high 17-OH-progesterone(588 ng/dl). Case 3: Five-year10-month old boy, known case of salt-wasting CAH on irregular medication and poor compliance presented with enlarged penile length. On evaluation his SMR staging=A1P3TV4/4ml, Height age:7.6 year and bone-age was 11.6 years. Endocrine evaluation demonstrated gonadotropinindependent precocity(Testosterone=109ng/dl, FSH=0.31 IU/ml, LH<0.10 IU/ml, 17-OH-Progesterone:25400ng/dl).Scrotal ultrasound showed hypoechoic areas in rete-testis suggestive of probable tesicular-adrenal-rest-tumor(TART).All patients were treated with hydrocortisone, udrocortisone and uid resuscitation.Conclusion:Diagnosis of CAH doesn't always depend on atypical genitalia. Continued adherence to the optimal dose of steroids, regular monitoring and strict advice during illness is as important as appropriate and timely management of the adrenal crisis.

Background: Antibiotic resistance has become an emerging issue worldwide due to the rampant and excessive use of antibiotics for any and every condition. At present, antibiotics are the most commonly sold drugs in the developing countries which have been the cause for escalation of antibiotic resistance. Lack of knowledge, awareness and practice among parents regarding antibiotics use is the most important cause for antibiotic misuse.Methods: Cross sectional hospital based questionnaire study conducted among 200 parents of children attending the outpatient or inpatient department at Yenepoya Medical College Hospital, Mangalore; using personal interview method. Parents were asked to answer the statements on a 5-point Likert scale (“strongly agree”, “agree”, “uncertain”, “disagree”, “strongly disagree” or “never”, “sometimes”, “often”, “most of the time”, “always”). Statistical Package of social science (SPSS) software was used for analysis of data.Results: Out of the 200 parent’s majority of the respondents (69%) were mothers. There was very little difference in percentage of respondents that disagreed with notion that antibiotics must be administered in any case of fever (43.3%). 42.3% mentioned that antibiotics were always necessary in ARI. Most common symptoms to visit pediatrician included cough (23.4%), followed by ear pain (18.1%) and nasal discharge (12.9%). 17.5% of parents never questioned the pediatricians if antibiotic administration was necessary and more than 2/3rd of the parents declared that pediatricians provided sufficient information regarding diagnosis and therapy.Conclusions: Majority of parents admitted to self-administration of antibiotics. There is a need of intervention to increase awareness regarding judicious use of antibiotics and to check un-prescribed dispensing of antibiotics. Strategies for effective communication with patients and prudent prescription of antibiotics should be included in physician education to ensure patients’ adherence to advice and consequently to reduce self-medication with antibiotics.