Background: Children below five years of age are an at-risk population due to their susceptibility to malnutrition. They contribute significantly for malnutrition related morbidity and mortality, especially in India. Malnutrition in under-five children belonging to middle or low-income group urban or suburban population is more severe and compounded compared to its rural counterparts. The objective of the study was to assess the nutritional status of under-five urban children. To study correlation of determinants like birth weight, exclusive breastfeeding, immunization status, maternal education and socioeconomic status with nutritional status of under five children.Methods: The prospective cross-sectional study included 315 under-five children attending paediatric outpatient department of upcoming new tertiary care hospital in Mumbai. Anthropometric assessment for underweight, wasting and stunting was calculated based on age, weight and height measurements.Results: As per WHO classification, moderate underweight (W/A) was present in 74 (23.49%) and severe underweight in 38 (18.71%). Wasting (W/H) in the form of moderate acute malnutrition (MAM) was noted in 64 (20.32%) and severe acute malnutrition (SAM) in 42 (13.33%). Height for age revealed moderate stunting in 37 (11.75%) and severe stunting in 5 (1.59%). The sociodemographic determinants birth weight, exclusive breastfeeding, immunization status, maternal education and socioeconomic status had statistically significant association with malnutrition.Conclusions: Malnutrition is common between age of 12 to 24 months. Underweight was the commonest type of malnutrition followed by wasting and stunting. None of the patient was overweight. Quality antenatal care to reduce incidence of low birth weight, exclusive breast feeding, and appropriate weaning, complete, immunization, improvement in maternal education and socioeconomic status can reduce the incidence of malnutrition.

Acquired human immunodeficiency virus (HIV) infection in a 10-year-old child, presenting with monoparesis, progressing to triplegia over 4 weeks is an extremely rare feature. The child had left upper motor neurone facial palsy with left hemiplegia, paralyzed right lower limb, grade zero power, exaggerated deep tendon reflexes and bilateral extensor plantars. Child tested positive for HIV by ELISA. CD3+ absolute count was 431. CD3+ CD4 count was 28, and CD45 absolute count was 478. Magnetic resonance imaging of brain and spine showed multiple ill-defined foci of hyperintensity in white matter suggestive of ADEM. Acute demyelinating encephalomyelitis (ADEM) is an extremely rare presenting feature of perinatally acquired HIV infection in paediatrics. Clinically child remained same even with methylprednisolone, intravenous immunoglobulin, antituberculosis therapy, trimethoprim-sulfamethoxazole prophylaxis and supportive therapy. Child had sudden clinical deterioration and death before antiretroviral therapy could be initiated. This case emphasizes that pediatricians and neurophysicians should suspect HIV as an etiology of ADEM in cases with atypical clinical presentation and social risk factors, in spite of its very rare occurrence.

On the basis of our results, we suggest that in resource-limited settings, the first level health facility may be able to look after short-stay babies that weigh more than 1500 g and that have no respiratory distress. The FRU may look after MLBW babies, with or without respiratory distress, and VLBW babies without respiratory distress by giving special care.

Pediatric neurotuberculosis manifests commonly as tuberculous meningitis and intracranial tuberculomas. The ratio of occurrence of intracranial to intraspinal tuberculoma reported is 42:1. Intramedullary tuberculomas (IMTs) are rare, and the coexistence of intramedullary and intracranial tuberculoma is extremely rare. We report a case of coexisting intramedullary and intracranial tuberculoma in a 5-year-old boy who presented with fever for 12 days, progressive motor weakness in the lower limbs for 9 days, and retention of urine and constipation for 6 days. Neurological examination revealed signs of compressive myelopathy. Magnetic resonance imaging (MRI) of the spine detected IMT at D4-D5 level of the thoracic cord with perilesional edema. MRI of brain revealed a right frontal tuberculoma. Medical management with antituberculosis therapy and steroids resulted in complete neurological recovery.

Dandy Walker Variant (DWV) is a less severe form of the spectrum of Dandy Walker Malformation (DWM). The DWM is a rare congenital intracranial posterior fossa malformation comprising cystic dilatation of the fourth ventricle, complete or partial agenesis of the cerebellar vermis and an enlarged posterior fossa. Clinically it presents with variable degrees of neurological impairment. Definitive diagnosis of DWM or DWV depends on neuroimaging as most of the clinical signs are not conclusive. This child was clinically suspected as spastic quadriplegic cerebral palsy had incidental finding of DWV on neuroimaging. Hence a definitive diagnosis of DWV was made by MRI in this case. Here we discuss the clinical and radiological aspects of this case with DWV without other associated anomalies yet presenting with clinically significant neurological impairment.