Background: Acute Encephalitis Syndrome (AES) is defined as a person of any age, at any time of year with the acute onset of fever and a change in mental status (including symptoms such as confusion, disorientation, coma, or inability to talk) and/or new onset of seizures (excluding simple febrile seizures). Viruses have been mainly attributed to be the cause of AES in India although other etiologies such as bacteria, fungus, parasites, spirochetes, leptospira, toxoplasma, rickettsia, chemical, and toxins have also been reported over the past few years. The causative agent of AES varies with season and geographical location, owing to wide range of causative agents and the rapid neurological impairment due to pathogenesis, clinicians face the challenge of a small window period between diagnosis and treatment. The present study is dedicated to knowing the present epidemiological pattern of AES in Bihar aiming to help in diagnosis and treatment. Methods: This is a prospective study conducted in the department of pediatrics, Patna Medical College and Hospital, Patna from January 1st to December 31 st, 2016, in this study all cases which presented with acute onset of fever and a change in mental status including symptoms such as confusion, disorientation, coma or inability to talk and/ or new onset of seizures excluding simple febrile seizures were included. Demographic, etiological analysis and outcome of cases of Acute Encephalitic Syndrome as well as Japanese encephalitis were done. Results: The total number of patient diagnosed clinically with AES were 186 of them 105 were male and 81 were female. Number of cases were highest in the age group of >5-10 years amounting to 37.7% followed by 26.4% in >2-5 years age group, marked male predominance was seen in the age group 5 -10 years. A minor female predominance was observed in the age group >10 years. In May number of cases were maximum 36 (19.4%) followed by April 32 (17.2%), number of cases of AES were least in the month of December followed by November (8). Maximum number of cases were from the district of Patna and its neighboring district amounting to 58.5% with Nalanda district alone comprises 24.3%. Etiological analysis reveals that 36.5% children admitted with the clinical diagnosis of AES, 36.5% were diagnosed with Acute bacterial meningoencephalitis and 22.04% were diagnosed with Japanese Encephalitis, 7.5% Tuberculous meningitis, 6.4% Cerebral malaria, 5.4% Herpes simplex encephalitis and 3.2% with acute encephalitis syndrome unknown. Conclusions: Acute Encephalitis Syndrome remains an important cause of prolonged hospital bed occupancy with a high rate of mortality. Although in JE positive cases mortality were less, but morbidity in form of various motor deficit and cognitive impairment increases the burden on the family and society. With the introduction of effective JE vaccine and with rigorous surveillance of AES cases and social initiative taken by the Government, we can hope a better scenario. More and more extensive studies are the need of ...

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Background: An inflammatory response is a two edge sword in pneumonia as reasonable inflammatory response is required for microorganism clearance but excessive inflammation can cause ongoing local and systemic damage. Because of this, despite appropriate antibiotic therapy, adjuvant therapy that can positively modify the immune response has become a relevant approach to improve pneumonia prognosis. The objectives of this study was to document the beneficial effects of adjunctive dexamethasone therapy in patients admitted with community-acquired pneumonia (in terms of length of hospital stay) and to study what patients admitted with CAP benefit most from dexamethasone therapy, based on predefined subgroup of disease severity (PSI 1-5) and C-reactive protein level at admission as well to evaluate utility of CRP in monitoring resolution of CAP. Methods: In this prospective case-control trial, 100 children aged 1 to 14 years were enrolled randomly with confirmed community-acquired pneumonia, who presented to emergency department of paediatrics PMCH Patna. We randomly allocated patients on a one-to-one basis to adjuvant dexamethasone with antibiotics and antibiotics alone groups by drawing lots. Results: The median length of hospital-stay in both the adjuvant dexamethasone group and antibiotics alone group was 7 days with IQR in adjuvant dexamethasone group of 6.0-8.0 days and antibiotics group of 7.0-9.0 days (95% CI of difference in means 0.3-1.2 days; p = 0.001931 and was significant at p value of ≤ 0.01). There was a positive correlation between length of hospital-stay and CRP at the time of admission in adjuvant dexamethasone and antibiotics alone group with R value = 0.0261 and 0.3541 respectively. There also exist a positive correlation between length of hospital-stay and PSI at admission in adjuvant dexamethasone and antibiotics alone group with R value = 0.3555 and 0.1196 respectively. Median length of hospital-stay in those admitted with high PSI (PSI 4-5) and high CRP were 8.0 days in antibiotics alone group compared to 7.0 days in adjuvant dexamethasone group. The mean CRP on day 1, 3 and 5 was 7.734 (SEM 0.664), 3.974 (SEM 0.412) and 1.440 (SEM 0.133) respectively. Conclusions: There was no significant difference in length of hospital-stay in CAP patient treated with adjuvant dexamethasone with antibiotics and antibiotics alone. However it is clearly evident from this study that using adjuvant dexamethasone reduced the length of hospital-stay in those who admitted with higher PSI as well as higher CRP compared to antibiotics alone group. Moreover there was a definite decremental relationship between CRP and resolution of CAP. So use of adjuvant dexamethasone in those presenting with high PSI and high CRP can be consider. Since the sample size of our study was small, further evaluation is warranted.