Background: Snake bite can result in local as well as systemic manifestations. Major systemic complications include acute renal failure, neurological symptoms requiring ventilator support and coagulation disorders. The coagulation disorders lead to various serious systemic complications like haemorrhage, infarction and even death if the diagnosis and treatment are delayed. Objectives: To describe the clinical profile of the snake bitten patients who developed coagulopathy and the role of coagulation markers to evaluate the morbidity and mortality of the victims. Method: A cross-sectional hospital based study was done on patients aged 12 years or less having local or systemic signs of envenomation and no history of bleeding or coagulation disorders. The coagulation profile was assessed by peripheral blood sampling and urine analysis. Results: In the present study haemorrhagic manifestations seen included bleeding from injection site (46.7%), haematemesis (5%), haematuria (33.3%), bleeding gums (11.7%), epistaxis (1.7%), and haemoptysis (3.3%). Haemoglobin estimation revealed anaemia in 53.3% cases. The 20 minute whole blood clotting time (WBCT20) was positive in 86.4% of vasculotoxic snakebites and negative in all neuro-paralytic bites. Leucocytosis was observed in 60% cases with relative neutrophilia in 63.3%, thrombocytopenia was observed in 8.3%, bleeding time was prolonged in 13.3% and clotting time was prolonged in 56.7%.

A BSTRACT Context: Growing pain (GP) is a common presentation in primary care settings. Aims: To find out the prevalence of GP and to observe its characteristics and associations. Settings and Design: General paediatric outpatient department (OPD). Methods and Material: Children coming to the general paediatric OPD of a tertiary centre in India between April 2019 and March 2020 for ‘chronic leg pains’ were screened with Peterson’s criteria. Patients with systemic illness were excluded. All received vitamin D and calcium supplementation. Patients with haemoglobin less than 11 gm% received additional 3 mg/kg iron supplementation. Then, patients were asked for follow-up. Statistical Analysis Used: Chi-square test. Results: A total of 333 children were diagnosed as GP out of the total OPD attendance of 26750. The prevalence was 1.24% and 72.7% among the children with chronic leg pain. Highest prevalence was in winter (1.74%). The mean age of the patients was 7.88 years. The mean duration of symptoms was 10.92 months. After 3 months, 267 patients could be followed up. Seventy-two out of 107 (67.3%) children, who received iron became symptom-free. Only 43 (28.8%) patients became symptom-free out of 160, who received only calcium and vitamin D3 and did not receive iron. The difference was highly significant statistically ( P < 0.0001). Conclusions: The prevalence of GP in the OPD was 1.24% and 72.7% among the children with chronic leg pain. Iron supplementation along with vitamin D3 and calcium was associated with faster resolution of the symptoms.

Introduction: Neonatal seizures are common but can be manifestations of serious underlying disorders and sometimes have a grave prognosis. Predictors for adverse outcomes are important for early referral and advanced interventions. Aim: To study the incidence and factors associated with neonatal seizure and to determine the predictors of adverse outcomes. Materials and Methods: This was a longitudinal study, conducted from April 2020 to March 2021 at a Rural Medical College (Midnapore Medical College and Hospital, West Bengal) in Eastern India. All the admitted newborns (N=143) in the Special Newborn Care Unit (SNCU), who had clinically evident seizures, were included in the study. Data were collected regarding the perinatal history, gestational age, type of delivery, birth weight, APGAR score at 1 and 5 minutes, and need for resuscitation at birth. The onset of the seizure, seizure type, investigation findings, possible aetiological diagnosis, and final outcome was noted. The management of neonatal seizures was as per the institutional protocol. Babies were followed up for a minimum of 28 days or throughout their hospital stay till discharge/death. The outcome was categorised into two categories: ‘favourable’ when there was a normal neurological examination and ‘unfavourable’ when there was any neurological impairment or death. Statistical analyses were performed using the Statistical Package for Social Sciences software version 25 (SPSS Inc., Chicago, IL, USA). Risk factors were determined by analysing outcomes using simple and multivariate logistic regression analysis. The p-values less than 0.05 were considered as statistically significant. Results: A total of 143 newborns had seizures out of 3126, making the incidence of neonatal seizures 4.57%. Males outnumbered females. Total 64.33% were preterm. Five minutes APGAR score <7 was noticed in 44.75%. The most common type was subtle seizure. Advanced resuscitation manoeuvre was required for 46.8% cases whereas mechanical ventilation was required in 11.88%. The most common aetiology was birth asphyxia (46.15%), and the cranial ultrasound showed Hypoxic Ishchaemic Encephalopathy (HIE) changes in 30.77% of cases. Multiple logistic regressions revealed only four factors, namely, preterm delivery (OR 5.82), need for extensive resuscitation manoeuvre (OR 6.21), presence of status epilepticus (OR 3.49) and abnormal cranial ultrasound (OR 1.02) to be the independent risk factors for unfavourable outcome. Conclusion: Clinical diagnosis of neonatal seizure could be useful in resource poor centers, where video-Electroencephalogram (EEG) is not available. Premature delivery, need for extensive resuscitation, presence of status epilepticus and abnormal cranial ultrasound were associated with poor short-term outcome.

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