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Introduction: Seizures are one of the most common neurological causes of childhood hospitalization having significant mortality and morbidity. There is limited data regarding acute seizures episodes in the pediatric population from developing countries. Aims: The current study aims to find the common etiologies of first episode seizure in children, and classify their types and outcomes in various age groups presenting to a tertiary center in Assam, North East India. Settings & design: A hospital-based prospective study was carried out in the Department of Pediatrics, Assam Medical College, Dibrugarh from 1 st October 2015 to 31 st March 2016, and all children aged 1 month to 12 years admitted with the first episode of seizures over this six-month period, were evaluated. Methods and materials: A pre-designed structured proforma was filled up for each subject and the variables studied were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and outcome. The data was analyzed using SPSS for Windows version 16, and p value at <.05 was considered significant. Results: A total of 65 patients were admitted for seizures with 40 (61.5%) males and 25 (38.5%) females. Among these patients, 45 (69.2%) presented with fever and 53 (81.5%) of children were less than 5 years of age. Generalized tonic-clonic seizures was the most common seizure type (73.8%). Febrile seizures (40%), seizure disorder (12.3%), CNS infections and neurocysticercosis were common etiologies. Abnormal brain images were noted in 7 (43.75%) of 16 patients in whom neuroimaging was done, and most common abnormality was neurocysticercosis in 4 (25%). Conclusion: Febrile convulsions and CNS infections were common causes of seizures in febrile children, whereas seizure disorder and neurocysticercosis were the commonest causes in afebrile children. EEG and neuroimaging should be advised in all afebrile children for the diagnosis of seizure disorder and neurocysticercosis respectively. In afebrile children less than five years of age, seizure disorder was commonly diagnosed, whereas NCC was more common in the greater than five year old children. Children diagnosed as seizure disorder require long term follow up studies including neurophysiologic studies.

BACKGROUNDGlucose-6-Phosphate Dehydrogenase (G6PD) is an enzyme essential for basic cellular functions including protection of red cell proteins from oxidative damage. Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is the commonest red cell enzyme abnormality associated with haemolysis leading to Neonatal Jaundice (NNJ). It is a genetically inherited X-linked abnormality.

HOW TO CITE THIS ARTICLE: PRESENTATION OF CASEA 10-year-old boy presented with complaints of pain abdomen for 8 months, which had increased in severity for 15 days prior to admission along with fever, difficulty in respiration and right-sided dull aching chest pain. On examination, he was pale and tachypnoeic with a normal nutritional status. The trachea was shifted towards left, stony dullness was noted on percussion and breath sounds were decreased on the right side of the chest. Tenderness was present over epigastrium and right hypochondrium. CLINICAL DIAGNOSISClinically, the case was diagnosed as right-sided bacterial pleural effusion with chronic abdominal pain. Further investigations were planned to confirm the diagnosis and to find out the aetiology. DIFFERENTIAL DIAGNOSISDifferential diagnoses can be tubercular pleural effusion or haemorrhagic pleural effusion (rare). Differential diagnoses of pain abdomen can be hepatic abscess, right subphrenic abscess, pancreatic pseudocyst and acute or chronic pancreatitis. So immediate chest x-ray and pleural tapping were planned. PATHOLOGICAL AND RADIOLOGICAL DISCUSSIONRoutine blood examination showed Hb 12.3 gm%, TLC 18,800/mm3 with 87% neutrophils and ESR 30 mm AEFH. Chest X-ray showed total homogenous opacification of the right hemithorax with gross mediastinal shift towards the left. On aspiration, pleural fluid was found to be haemorrhagic. Pleural fluid analysis showed protein 3.8 gm/dL, sugar 40 mg/dL, cell count 580 cells/cumm, mostly lymphocytes and presence of plenty of RBCs. There were no malignant cells. ADA was normal. Culture of pleural fluid showed growth of Acinetobacter baumannii. Tuberculin test was negative. PT, APTT, INR and platelet count were normal. Common causes of haemorrhagic pleural effusion are malignant effusion (most commonly Lymphoma), traumatic effusion, tubercular effusion or bleeding diathesis. The patient was started empirically on Vancomycin, which was changed to Imipenem later as per the sensitivity report.