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Background and Aims: Subclinical Vitamin B12 deficiency is a very common entity in the Indian subcontinent with devastating clinical and socio-economic consequences. The objective of this study was to estimate the proportion of vitamin B12 deficient children and to evaluate their clinical profile. Setting and Design: This prospective analytical study was conducted in a tertiary level care institute in Northern India. Materials and Methods: Children with clinical pallor, were included in this study. Detailed history, height, weight percentiles and characteristic features of vitamin B12 deficiency were recorded and complete blood counts, mean corpuscular volume and vitamin B12 levels were done. Statistics: For Qualitative data was analyzed using Pearson Chi square tests and quantitative data was analyzed using two sided independent samples t tests. Results: A total of 111 children were included. 64.8% (n = 72) had vitamin B12 deficiency. Lethargy (63.9%) and weight loss (62.1%), Knuckle pigmentation were common features. One-fourth of the children were on vegetarian diet. Neurological manifestations were significantly associated with fragile hair (p 0.056) and knuckle pigmentation (p 0.027). Younger children had more weight loss (p 0.001), knuckle pigmentation (p 0.019) and hypotonia (p 0.045). One fifth of children presented with neurological manifestations. Conclusions: Two-thirds of the anemic children had vitamin B12 deficiency. There was a bimodal age distribution with regard to B12 deficiency. Neurological manifestations were predominant in younger children [< 6] and hematological abnormalities were more frequent in older children [≥6 years]. Estimation of vitamin B12 levels forms an essential component while evaluating children with anemia, despite mixed dietary habits and normal MCV.

Goldenhar syndrome (GS) is a rare congenital disorder of the development of first and second branchial arches. The born neonate may exhibit orofacial, auricular, skeletal, and solid organ involvement with variable phenotypic expression. The pathogenesis and long-term implication of GS is still under study. Multidisciplinary management is the key in lifelong management of GS. There is a challenge identifying this syndrome in low-resource setting. We describe in this case report about a neonate with typical phenotypic features and late-onset Klebsiella sepsis.

Coronavirus (COVID-19) is the most dreaded pandemic of our times, which lead to a state of chaos among the mightiest nations of the world. The immune system plays a great role in response to any foreign organisms be it bacteria or viruses. Virus-based pandemics like SARS, MERS, COVID-19 have time and again been surfacing leading to mortality and morbidity worldwide. These pandemics have also resurfaced the role of public health and its modes which have been fading in the presence of lucrative hi-tech medical industry. Although Chinese system of medicine has been explored, there is still more to be done in exploring solutions from time tested Indian systems of medicine like Ayurved and Yog. Its time to rethink and explore ways to harness our immune system and look for evidence-based solutions providing the best of both medical systems to the patients, i.e., modern medicine as well as Ayurved and Yog. The present review is a narrative review wherein studies were searched from databases like PubMed, Cochrane, Scopus, and web pages. Given a paucity of studies hereby we explored existing pieces of evidence, thereby concluding that more randomized controlled trials need to be done for assessing the role of Ayurved, Yog, and other Indian systems of medicine to enrich the armamentarium in the fight against such viruses in future. Family physicians can play a vital role in not only suggesting treatment but also changes in lifestyle of the patients as well as their family. Evidence based knowledge of ancient Indian system will open a new door of integration for overall well being of patient with a scientific outlook.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB). It spreads from one person to the another through the air while coughing, spitting, speaking or sneezing. TB most commonly affects lungs but it can affect any organ system. Diagnosis of TB is made on the basis of microbiological evidence of MTB on microscopic examination, cultures and chest X-rays. Poncet’s disease is a separate entity in which joints are involved in the form of joint pain and swelling without any microbiological evidence of MTB. It usually occurs in the background setting of pulmonary TB. This case focuses on importance of considering Poncet’s disease in the differential diagnosis of paediatric polyarticular arthritis in TB endemic regions or if there is a history suggestive of TB exposure and infection.

Hemophagocytic lymphohistiocytosis is a rare and fatal systemic illness arising secondary to an immune dysregulation .Primary HLH is due to genetic defects and secondary HLH is caused due to unchecked macrophage recruitment following an acquired trigger. It is often diagnosed late in view of its rarity and similarities of presentation to sepsis and SIRS. A compelete curative solution to this problem is hematopoietic stem cell transplant, though secondary cases are often seen to have sustained remission with immune-chemotherapy COVID 19 has also been postulated to cause a HLH like scenario with blunted NK cell number and function. Recent advances in this field comprising of various immunosuppressant based regimens, myeloablative therapies preceding stem cell transplant and improved techniques of stem cell transplant have improved the outcomes. Here we try to present the pathogenesis, etiology, diagnostic criteria and the dilemmas, various treatment strategies, prognostic markers and the most recent researches regarding this rare disease.

We report a case of a 55-year-old known hypertensive female who presented with features suggestive of dementia, which, on further workup unveiled background dyslipidemia and type 2 diabetes mellitus. An magnetic resonance imaging of the brain revealed findings suggestive of Binswanger's disease. This is a discussion of this unusual disease and its presentation and the differentials of this presentation which may be encountered in general clinical practice.

Introduction: There is paucity of studies on infant feeding practices from the rural areas of garhwal Himalayas of the state of uttarakhand. The present study was designed to assess the infant feeding practices in Garhwal region. Infant feeding practices have significant implications on a child's health. Early nutritional status especially during the first year of life has been shown to have a significant effect on child health and development. Optimal infant feeding practices are crucial for nutritional status, growth, development, health, and ultimately the survival of infants and young children. The study of infant feeding practices is essential before formulation of any interventional programme. Settings and Design: A study was conducted in HNB Base Hospital and Teaching Institute with the aim to assess the infant feeding practices and the prevalence of malnutrition in the study population reporting at the hospital in garhwal region of uttarakhand. Methods and Material: This is an observational cross sectional study. 275 infants were included in the study. After taking informed consent, case study forms were filled by interviewing the infants' mothers. Weight, length and head circumference of each infant was also measured. The information thus obtained was compiled, tabulated and analysed statistically. Results: The study findings revealed that 46.4% infants in the age group 0-5 months were breastfed within 1 hour of birth. 52.8% infants aged 0-5 months of were exclusively breastfed. 33.6% infants in age group 0-5 months received prelacteal feeds. 53.12% infants in age group 6-8 months received solid, semi-solid or soft food, in addition to breast milk. 53.33% infants were partially or fully bottle fed. Age appropriate feeding was found in 56% infants. The percentage of wasting, stunting and underweight in 0-5 months was 33.6%,30.4% and 36.8% respectively . The percentage of wasting, stunting and underweight in 6-11 months was 28%, 26.5% and 30.7% respectively. There appeared to be an association between longer duration of exclusive breastfeeding and lower prevalence of stunting and underweight at 6 months of age. Conclusions: This study shows that undesirable infant feeding practices are still prevalent in the community. Lower prevalence of stunting and underweight was observed in infants with longer duration of exclusive breastfeeding. A comprehensive plan to address the problems in infant feeding should be formulated. Antenatal counselling of mothers should be done. Revitalization of the Baby Friendly Hospital Initiative(BHFI) in health facilities is recommended.

Disorders of color variation can be localized or generalized, congenital or acquired, acute or chronic. Among the various causes of generalized skin darkening encountered in the pediatric age group, acquired universal melanosis aka Carbon Baby Syndrome is an uncommon hypermelanotic condition, with a histologic appearance of extensive epidermal melanization. The authors report one such case of a 4-year old boy with progressive darkening of skin starting at the age of 1 year and involving the entire body surface in the absence of any other systemic alterations. The disease prevalence, etiology, mechanism and prognosis are still unknown.

Background: Psoriasis is an immune-mediated chronic inflammatory dermatosis with a complex interplay of environmental and genetic factors. Among the various documented triggers, drug-related psoriasis constitutes a distinct entity with exposure resulting in either induction or exacerbation of psoriasis. Here we describe the case of a 45-year-old female with telmisartan aggravated chronic plaque psoriasis previously well controlled on oral methotrexate.

Background: This study was conducted to determine the effects of iron overload on growth and correlation of serum ferritin and growth disorders in children with thalassemia. Methodology: It was a crosssectional study conducted from January to June 2019 on 70 children age up to 18 years with transfusiondependent thalassemia. Detailed history, demographics, anthropometric parameters, clinical and laboratory details were evaluated. Data was analyzed by statistical package of social sciences (SPSS) software. Logistic regression model was used to determine the correlation between serum ferritin with short stature. Results: It included 46 male and 24 female, of which 65.71% had short stature and 77% were underweight. The mean serum ferritin level was 1,560.9 μg/L, 45.71% have serum ferritin level > 2,500 μg/L, and 65.71% had hemoglobin levels of 5–8 g/dL before transfusion. The receiver operating curve value of serum ferritin was 1,107 μg/L with respect to the incidence of short stature and there was significant correlation between serum ferritin level and the incidences of short stature (P = 0.001). Conclusion: There was a significant correlation between serum ferritin level and growth disorders.

Ankylosing Spondylitis (AS) is a chronic progressive inflammatory spondyloarthropathy typically involving the axial skeleton, especially the sacroiliac joints and spine. Genetic predisposition in AS leads to its common association with certain extra-articular diseases-anterior uveitis (25-30%), psoriasis (10%) and inflammatory bowel diseases (50%). Cardiorespiratory involvement in AS is rare and is usually present in long standing disease as restrictive lung disease, conduction abnormalities or aortic insufficiency. Here, we present a case of unusual AS in a 32-year-old non-smoker male with a major involvement of peripheral joints along with spine and chronic obstructive lung disease with apical fibro-bullous cavity and right sided heart failure over a short duration of disease course. His condition was acutely stabilised with diuretics, anti-hypertensive drugs, anti-pyretics, antibiotics and oxygen inhalation followed by maintenance on Non-steroidal anti-inflammatory agents. Hence, in a patient of AS, a strong index of suspicion should be there for both usual and unusual extra-articular manifestations and a complete work-up would help in early diagnosis and treatment.

Background: Haemophilia is one of the bleeding disorders, which is inherited, in an xlinked recessive pattern. The diagnosis is by estimation of factor levels of 8 and 9. Timebound treatment for people living with Haemophilia (PWH) is factor replacement during bleeding manifestation. The prevalence of Haemophilia was mostly underestimated, and it is more so in hilly terrains like the state of Uttarakhand. Materials and Method: This is a crosssectional study by compiling the data of PWH visiting the tertiary care centre for Haemophilia in Uttarakhand. We collected data from the patients with bleeding disorder reporting to the Haemophilia centre from July 2017 to December 2018. In this manuscript, we try to describe the pattern of Haemophilia and the degree of severity and incidence of inhibitors among the sample population of PWH who represent the population of Uttarakhand. The magnitude of problems faced by PWH from this hilly terrain to assess basic treatment in case of emergency is also being depicted. Result: We reported Haemophilia A contributing about 80% of the PWH in our centre. Average distance a PWH has to travel to obtain treatment was about 131.5 km (SD ± 83.7 km). Incidence of inhibitors was about 5%. Conclusion: We infer from our study that Hemophilia A is more common than Hemophilia B. Through this manuscript we hope to spread awareness of the Haemophilia care that is ongoing, the role of prophylaxis therapy and the future role of primary care physicians that may change the care of PWH in future.

Child abuse is a social evil which has existed in our society since a long time. The awareness regarding the same has been minimal in developing countries. Many a times, punitive measures taken by parents to discipline their children turn out to be painful scars in their childhood resulting in stunting of their mental and social growth. Doctors and other health care workers have a very important role in identifying and reporting such issues. Law has also evolved over the recent past in safeguarding the future of our children. However, awareness regarding this issue has remained to be the same as before. During the current era of COVID, parents and children have been restricted to their homes. Livelihood of many families have been at risk. These issues have burdened the caretakers at home and absence of teachers who were otherwise their guardian angels have impacted the minds of these children adversely. Hence in this article we intend to provide good clarity about this social evil, and the rights of our children. We also wish to stress upon the duties of parents, doctors, teachers in molding these tender minds so as to get the best out of them.

Introduction Diabetes is a major public health problem which needs to be addressed with outmost planning in resource poor settings. Good glycaemic control and medication adherence patterns can play an important role in reducing disease related complications thereby reducing morbidity and mortality among diabetics. Disease specific camps can act as a stepping stone in providing limited care to the patients. Aim The study was planned to study the impact of diabetes camp on glycaemic control and adherence to antidiabetic medication among diabetic patients at a Government Teaching Hospital, Srinagar, Garhwal, Uttarakhand, India. Materials and methods A cross-sectional study using a medication adherence questionnaire collected from the patients participating in diabetic camps and measuring their HbA1C levels before and after the camps along with spreading awareness about the disease. Two diabetes awareness camps were organized, three month apart and the participants were imparted knowledge about the disease. A total of 50 patients with type 2 DM who had self reported history of diabetes and were on some form of oral anti diabetics confirmed by their prescriptions. The patients were called for monthly follow up in outpatient department. A six question preformed questionnaire - the Girerd's instrument was used to assess the level of adherence to the prescribed anti-diabetic drugs in 50 patients with type 2 diabetes mellitus, their HbA1C levels were estimated and the results were analysed using standard statistical methods. Results A total of 50 type 2 diabetic, 48 were studied comprising 23 (47.9%) women and 25 (52.1%) men with a mean age of 57.43 years. The average duration of diabetes among participants was 7.02 years. Poor medication adherence score was recorded in 27 participants and only 7 participants had good adherence to medication before the camp. After the camp, 19 participants had good adherence and 7 had poor medication adherence scores. As a result of improved adherence, improvement in glycaemic control was noticed by a decrease of 0.5 units in the mean HbA1C value by the end of the study. Conclusion The results clearly showed that group intervention in the form of camp combined with monthly follow-ups could improve adherence as well as glycaemic control at a government teaching hospital in a resource poor setting. This could also involve and encourage society as well as young trainees to participate collectively in the care of diabetics.

A five day old full term born baby was admitted to our Neonatal Intensive Care Unit with seizures, opisthotonous posture and was icteric upto thigh. Baby had a three day history of poor feeding, lethargy and abnormal body movements. Mother was a 29 years old primigravida and had a normal vaginal delivery at home. Sepsis profile of the patient was requested, lumbar puncture and ventricular tap was performed. Patient was put on third generation cephalosporins, aminoglycosides and phenobarbitone. Culture and sensitivity report of blood, Cerebro spinal fluid and ventricular fluid showed Proteus mirabilis. Computerized Tomography scan showed a large parenchymal lesion in the right frontal lobe and diffuse ependymal enhancement along both the lateral ventricles suggestive of meningoventriculitis. We hereby present a fatal case of neonatal meningoventriculitis due to Proteus mirabilis.

We report a case of cryptogenic brain abscess caused by infection due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a previously healthy, 2-year-old, girl child with a history of persistent headache and fever for several weeks. Headache acutely worsened the day before hospital admission with vomiting, right hemiparesis, and altered sensorium. Community-onset pyogenic brain abscess should be added to the growing list of life-threatening invasive infections caused by community-acquired S. aureus . Early diagnosis, prompt neurosurgical drainage, and appropriate medical therapy are important for management of such infections. In light of expanding community-acquired S. aureus epidemic and the life-threatening nature of the disease we recommend empirical use of vancomycin in all cases of community onset brain abscess.

Background: Candida species are the third most common blood culture isolates recovered from cases of late onset sepsis in neonatal intensive care unit (NICU). Candida parapsilosis is probably, the species that have had the largest increase in incidence since 1990, becoming the predominant agent of candidemia in certain centers. We evaluated the prevalence of neonatal candidemia due to C . parapsilosis and the main clinico-epidemiological aspects of this disease in neonates. Materials and Methods: This retrospective observational study was conducted for a period of 18 months at our rural tertiary care and referral center. Hospital records of the neonates with candidemia due to C . parapsilosis were reviewed. The Candida species isolated were identified as per standard mycological techniques. Results: Of total 163 neonates diagnosed of candidemia, 43 (26.38%) corresponded to C . parapsilosis . Failure to thrive (74.42%), abdominal distention (67.44%), and feed intolerance (65.12%) were the most common clinical presentations seen. Among the risk factors observed broad spectrum antibiotics (81.40%), total parenteral nutrition (79.07%) and indwelling catheters (79.07%) were the most common followed by prematurity (72.09%) and low birth weight (65.12%). Early mortality accounted for 20.93%, whereas late mortality accounted for 11.63% of the cases. Conclusion: Progressive shift of C . albicans to non- albicans Candida species, particularly C . parapsilosis substantiates the need of continuous monitoring of laboratory data. C . parapsilosis is an emerging fungal pathogen and the major threat for neonates in NICU. Local epidemiological knowledge is critical in terms of prevention and management of invasive Candida infections.

The clinical presentation of an adolescent man with left lung hypoplasia is described in detail including the history and clinical examination findings. On further investigation, the chest x-ray and CT scan of the chest reveal interesting findings. Generally, such conditions are brought to notice in the early years of life but the presentation of this condition at the age of 18 years make it even more interesting and unique. This is a discussion of the management of such a patient and the different types of lung hypoplasia which can be encountered in clinical practice.

A case of prominent jugular venous pulse (JVP) with a clear wave pattern and the echocardiography of the condition responsible is discussed. A 63-year-old woman living in a hilly region presented to us with a 20-day history of orthopnoea and swellings in her legs and a 1-year history of exertional dyspnoea and palpitations. She had a 1-year history of New York Heart Association (NYHA) class III cardiac failure and was being treated at a local hospital …

Background: Candida species are one of the most common causes of blood stream infections among neonates and account for 9-13% of such infections. Although Candida albicans remains the most common fungal isolate from neonatal candidemia, longitudinal studies have detected a shift towards non-albicans Candida (NAC) species. Aim: To examine the prevalence and epidemiology of candidemia among infants admitted to our hospital. Materials and Methods: Blood samples were collected from 548 neonates and only those which yielded pure growth of Candida spp. were included in the study. The isolates were identified as per standard mycological techniques and antifungal susceptibility (AFS) was done by disc diffusion method. Results: Of the total 132 neonates included in the study, NAC species were responsible for 80.30% cases with C. parapsilosis (25.0%) and C. tropicalis (21.97%) as the most predominant species; whereas 19.70% of cases were caused by C. albicans. AFS results revealed that 65.91, 73.49, and 96.21% isolates were sensitive to fluconazole (FLK), itraconazole (ITR), and amphotericin B (AMB), respectively. Conclusion: Candidemia in neonates is an ominous prognostic sign and is an important entity in our hospital. Strict infection control strategies, appropriate preventive and therapeutic measures such as prophylactic antifungal use and a restrictive policy of antibiotic use should be implemented.