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Rash and fever are some of the most common chief complaints present in paediatric dermatology emergencies. The spectrum of differential diagnosis is broad, including many different infectious and some non-infectious agents. A systematic approach involving detailed history taking, careful clinical examination along with particular attention to epidemiological features are the most important factors to make a diagnosis. This article reviews the morphological patterns of various causes of fever with rash in children, including infectious as well as non-infectious causes, with special emphasis on the Indian scenario. We intend to highlight the clinical characteristics of each cause, which will not only help make a clinical diagnosis but also distinguish benign versus life-threatening causes of skin rash in febrile paediatric patients and provide early medical intervention. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD) is a common acute vasculitis of childhood that may lead to coronary artery abnormalities in about 25% of patients if left untreated. KD is reported as the leading cause of acquired heart disease in children replacing rheumatic feverin developed countries. Strong epidemiological data are not available from developing countries, but it is increasingly recognized in rapidly industrializing countries of Asia including India, where it might has replaced rheumatic heart disease as the most common cause of acquired heart disease. This increasing recognition could be due to actual rise in number of KD cases or due to more diagnosis following increased awareness. The status of KD in Bangladesh is not known. But unpublished data from Bangabandhu Sheikh Mujib Medical University (BSMMU) show a sustained and significant increase in the number of KD cases over the years. The reasons for this increase may be similar to our neighbouring country India. Aetiology of KD still remains unknown. But there have been many hypotheses including infection, immune dysregulation, superantigen and genetic factors. The diagnosis of KD is based on the presence of e" 5 days of fever and the presence of e"4 of the 5 principal clinical features (1.Extremity Changes, 2. Conjunctival injection, 3.Oral changes 4.Exanthem/Rash, and 5. Lymphadenopathy). The diagnosis of KD may be very challenging for even a very experienced paediatrician. It must be considered in a child with prolonged fever, undue irritability and sequential appearance of principal clinical features. KD patients should be managed timely with intravenous immunoglobulin (IVIG) and aspirin in proper dose. It is to be remembered that KD is no longer considered as a onetime disease of childhood, as it can be associated with significant long term sequelae. [ABSTRACT FROM AUTHOR]

Introduction: The paediatric population is prone to developing cutaneous adverse drug reactions. However, the incidence of Severe Cutaneous Adverse Drug Reactions (SCAR) is rare in this age group, with few studies describing such reactions in detail. Aim: To describe the clinico-epidemiological factors, drug profile, laboratory parameters, and treatment outcomes of SCAR in children admitted to a tertiary care centre in South India. Materials and Methods: A retrospective cohort study was carried out over a 10-year period, including paediatric patients (0-18 years) admitted to Dermatology, Medicine, and Paediatric wards in the tertiary care centre. Demographic details, suspected drugs, comorbidities, personal and family history of drug reactions, physical examination, laboratory parameters, treatment received along with its duration, and the state of morbidity and mortality were recorded. SPSS version 18.0 was used for analysis. Descriptive statistics were used to summarise the demographics and clinical characteristics of the patients. Results: Among all the patients admitted with SCAR, 27 (15%) belonged to the paediatric age group. The median age was 15 years, and the female-to-male ratio was 1.25. Nineteen (70.3%) were diagnosed with Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN), and eight (29.6%) were diagnosed with Drug Reaction with Eosinophilia and Systemic Symptom (DRESS). There were no cases of Acute Generalised Exanthematous Pustulosis (AGEP). The most common class of drugs implicated was antiepileptics (62.8%). Two patients (7%) had a family history of drug reactions. All patients had mucosal involvement. The majority of the children responded to intravenous steroids, and two required additional intravenous immunoglobulin injections for clinical improvement. All cases were cured with no mortality or long-term sequelae. Conclusion: The incidence of SCAR in the paediatric age group is significant. Anticonvulsants, particularly phenytoin, carbamazepine, and lamotrigine, need to be used with caution in this age group. Prompt diagnosis and treatment with systemic steroids can reduce mortality, morbidity, and long-term sequelae. [ABSTRACT FROM AUTHOR]

Background: Connective tissue diseases (CTDs) are chronic in nature and carry a high risk of morbidity, disability, and mortality if not recognized and treated promptly. Data on clinical spectrum of CTDs in the pediatric age group are sparse from developing countries such as India. Objective: To study the clinicoepidemiological spectrum of CTDs in the pediatric age group. Methodology: A hospital-based, cross-sectional, observational study was undertaken over a period of 16 months from January 2021 to June 2022 in the dermatology outpatient department and pediatric rheumatology clinic in a tertiary care hospital in North India. Clinical and laboratory findings were recorded. Results: A total of 100 children diagnosed with a CTD were included in the study. The mean age was 11.11 ± 4.20 years. Out of 100 children, 55% were female and 45% were male with a male-to-female ratio of 1:1.2. Our study included 63% juvenile idiopathic arthritis, 17% systemic lupus erythematosus, 7% juvenile dermatomyositis, 6% Kawasaki disease, 3% systemic sclerosis, and 2% Henoch-Schonlein purpura and mixed CTD patients each. Mucocutaneous features commonly seen were rash (40%), oral ulcers (22%), and photosensitivity (18%). Commonly seen systemic features were joint pain (77%), followed by fever (63%). Conclusion: Mucocutaneous manifestations are frequently seen in CTDs and constitute a frequent and an early manifestation of CTD. Early recognition of CTD in the pediatric age group will help in timely initiation of treatment to prevent disabilities and mortality. [ABSTRACT FROM AUTHOR]

Background: cardiac disease in pregnancy is a high-risk pregnancy and major problem worldwide particularly developing countries. Present scenario the incidence of pregnancy with congenital heart disease is high in developed countries. While developing countries like India incidence of RHD is still high. Aims of this study is to find out incidence of cardiac disease in pregnancy and to access fetomaternal outcome of this high risk pregnancy. Material & Methods: Analysis of maternal and fetal outcome in 100 cases of cardiac disease in pregnancy was carried out in the department of Obstetrics and Gynecology in B.J. Medical College civil Hospital, Ahmedabad at a tertiary care center from 01/08/2016 to 31/07/2018. Result: In the present study prevalence of cardiac disease 0.67%. Among them the RHD was highest contributing lesion (63%) and Mitral stenosis is main causes in valvualr lesion. Majority delivered vaginally (48.9%). Complications of this type of pregnancy were congestive cardiac failure, thromboemlosim and 4% ratio of maternal mortality occurred. Conclusion: Cardiac disease has major impact on pregnancy and its outcome. It is a team effort by obstetricians, cardiologist, neonatologist to achieve successful pregnancy. Regular antenatal checkup and strict vigilance during the risk period when patient may develop complications as a result of hemodynamic changes can avoid the complication. [ABSTRACT FROM AUTHOR]

Background: In the tropics, scrub typhus is a growing health risk. Acute meningoencephalitis, enteric fever, Kawasaki disease, and dengue can all have similar clinical characteristics. Early intervention and a high index of suspicion help to avoid mortality and morbidity. The preferred medications are Doxycycline or Azithromycin, both intravenous and oral. Aims and objectives: The aim of thepresent study was to present clinical manifestation, laboratoryfindings and treatment outcomes of pediatric scrub typhus ina tertiary care setting. Methods: The present study was prospective observational study. A total of 45 cases detected with positive for Scrub Typhuswere includedin the study. Study was conducted from May to October 2023 in the Department of Paediatric Medicine, RG Kar Medical College, Kolkata, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: A total of 45 cases were detected to be positive for Scrub Typhus. Their age ranged from 1½years to 12 years, mean being 7 ½ years. There was no sex predilection, 21 (47%) were male and 24 (53%) were female. Fever was the chief complaint in all of them. During hospital stay, the average temperature recorded was 101ºF. Eighteen cases presented with exanthematous fever. The rash was erythematous maculopapular, mostly appearing in the limbs and sometimes over the trunk. Eschar was found only in ‘5’ cases case even after thorough searching. Other findings include organomegaly, generalized lymphadenopathy and constitutional symptoms. Conclusion :Scrub typhus do exist around Kolkata in the suburban and rural areas. Hence awareness is very important. They need to be detected early by high index of clinical suspicion and screening test followed by rapid onset of treatment by Azithromycin and Doxycycline. [ABSTRACT FROM AUTHOR]

Background: India has now become the diabetic capital of the world, with over 30 million diabetic individuals. Cardiac involvement in diabetes commonly manifest as coronary artery disease. Invasive diagnostic modality like Coronary Angiography serves as a diagnostic as well as therapeutic aid in the management of coronary artery disease and it remains the gold standard technique. Objectives: Present study is an attempt to find out how coronary artery involvement in diabetics differs from that of non-diabetics with special interest in their electrocardiography and angiographic profile. Methodology: 50 patients having acute coronary syndrome undergoing coronary angiography, aged 18-60 years, were included in present study, and grouped into 2; group A having diabetes (n=25) and group B without diabetes (n=25). Angiographic extent, type of vessel, number of vessels, severity involving coronary artery and its branches in patients with acute coronary syndrome (ACS) were studied and compared in both groups. RESULTS: Significantly higher differences in age, sedentary lifestyle, and hypertension were seen among diabetics than non-diabetics. Significantly higher diabetic cases had ST-T changes. Diabetic patients had more multivessel, multi-lesion, extensive and small vessel disease than nondiabetic patients. Conclusion: According to the present study, severe forms of coronary artery lesions were found common among diabetic patients as compared to non-diabetic patients. [ABSTRACT FROM AUTHOR]

Introduction: Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 caused significant health concerns worldwide. In our center, we had encountered the first wave of MIS-C from June 2020 to January 2021, whereas the second wave surged up from April 2021 to August 2021. In this study, we have done a comparative analysis of different phenotypes of MIS-C seen during these two waves. Subjects and Methods: This was a single-center observational study where the children fulfilled the WHO criteria for MIS-C were included in the study. Clinical and laboratory findings, course of the illness, treatment, and outcome were noted down, and the patients were followed up. Depending on the presentations, cases were classified in four different phenotypes (Type 1: MIS-C overlapping with acute COVID-19, Type 2: MIS-C with shock/MIS-C with multiple organ dysfunction syndrome (MODS), Type 3: MIS-C Kawasaki disease phenotype, Type 4: Mild MIS-C/Febrile inflammatory state), and a comparative analysis of these phenotypes in the two waves was done. Results: There were 86 cases in 7 months during the first wave, whereas 102 cases in 5-month duration during the second wave. The clinical manifestations and laboratory findings were compared, type 2 phenotypes increased in proportion requiring more pediatric intensive care unit admissions. Mortality was seen during the 2nd wave which was absent in our cohort during the first wave. Conclusions: MIS-C typically showed a spectrum of disease manifestations starting from a mild febrile inflammatory state to full-blown MODS. Early phenotypic differentiation and targeted immunomodulatory therapy depending on the phenotype had shown to be useful. [ABSTRACT FROM AUTHOR]

Objectives: To assess the risk factors of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) and to evaluate the performance of the three Japanese risk-scoring systems, namely the Kobayashi, Egami, and Sano scores in predicting IVIG resistance among the Indian patients. Methods: Prospective observational study on children admitted with KD at Institute of Child Health, Kolkata, over a period of 16 months, from January 2019 to April 2020. The study included 70 KD patients all of whom were treated with IVIG. Clinical parameters, laboratory variables, and risk scores were compared between the IVIG-responsive and the IVIG-resistant groups. Results: A total of 31.4% were IVIG non-responders. Skin rash was found to be significantly associated with IVIG-resistant KD. The IVIG-resistant group had higher total bilirubin, lower albumin, higher CRP levels, and higher ALT and AST levels. High Kobayashi score, high Egami score, and high Sano score were significantly associated with IVIG resistance, individually. Sano score had the highest sensitivity (81.8%) and Kobayashi score had the highest specificity (77.1%) in our cohort. Conclusion: The presence of skin rash, high total bilirubin, high CRP, high AST, high ALT, and low albumin were important predictors of IVIG resistance in our population. Among the three scores, Sano score is the most reliable in identifying potential non-responders to IVIG. But Sano score lacked good specificity. Therefore, Indian KD patients may need an exclusive scoring system to predict non-responsiveness to IVIG so that a more aggressive therapy can be instituted at the earliest. Key points • Early prediction of IVIG-resistant KD is necessary to limit cardiac injuries. • Sano score has high sensitivity to predict IVIG resistance in Indian population. [ABSTRACT FROM AUTHOR]

Background: Heart disease complicating pregnancy is an important indirect cause of maternal mortality and morbidity. Heart disease in pregnancy is still a major problem worldwide, particularly in low resource country like India. Its reported incidence varies between 0.1 to 4%. Heart disease complicates 1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. Heart disease in pregnancy is associated with adverse fetomaternal outcome and has re-emerged as one of the leading causes of maternal mortality. The maternal mortality rate in women with cardiac disease is 7% and morbidity is 30% during pregnancy in India. Methods: This study was a prospective observational study conducted in the IPGMER & SSKM Hospital, Kolkata, West Bengal from December 2021 to February 2022. 72 Pregnant women with heart disease were taken as study group. Multiple pregnancy and any other medical disorder like GDM, PIH, were excluded from study. Fetomaternal outcome, mode of delivery, prematurity, LBW, NICU admission and maternal and neonatal mortality were compared. Template was generated in MS excel sheet and analysis was done on SPSS software. Results: Among 72 patients majority 28 (38.89%) patients belonged to age group 25-29 years. Majority 26 (36.11%) patients belonged to lower middle class Majority 38 (52.78%) patients were P0+0 and 18 (25%) were P1+0 parity group. Majority 20 (55.56%) belong to gravida G1. 20 (27.78%) patients had CHD and RHD. 40 (55.56%) were normal delivery. 26 (36.11%) of babies were underweight. Maternal death occurred in 4 (5.56%) cases and neonatal death was 2 (2.78%). Conclusions: Feto-maternal outcome can be improved appreciably by antenatal care, early diagnosis and management [ABSTRACT FROM AUTHOR]

Background: Kawasaki disease is a pediatric, systemic, vasculitic disorder. Its exact etiology is still unknown. Genetic polymorphisms are being investigated as susceptibility factor for this disorder. These are likely to vary among different populations. Aim: To investigate the association of single nucleotide polymorphism (SNP) rs113420705 of CASP3 in Kawasaki disease (KD) from North India. Settings and Design: Observational, case–control study. Methods: Polymerase chain reaction and bidirectional Sanger sequencing was used for determining genotypes of SNP rs113420705 in 45 cases of KD and 50 healthy age- and sex-matched controls. Allele and genotype frequencies were assessed and compared between the groups. Results: Among 45 cases, 32 had TT (71.1%), 13 had CT (28.9%) and none had CC genotype of SNP rs113420705. No significant differences in allele, genotype, or carrier frequencies of rs113420705 were found between the two groups. A comparison was also made between subgroups of KD with coronary abnormality (7 children; 15.5%) and KD with normal coronaries (38 children; 84.4%). The C allele was significantly overexpressed in KD with coronary abnormality group (P = 0.005). However, no difference was noted in the genotype frequencies. Conclusion: CT genotype of rs113420705 of CASP3 showed a trend to significance with the occurrence of KD in children in North India. However, we could not establish any association between minor allele C and susceptibility to KD. C allele appeared to be over expressed in children with KD with coronary abnormalities. Larger studies will help us to reach conclusive evidence applicable to all ethnicities. [ABSTRACT FROM AUTHOR]

Coronary artery anomalies (CAAs) are a diverse group of disorders with varied clinical presentation and pathophysiological mechanisms. A majority of these anomalies are asymptomatic and often an incidental finding on coronary angiogram or autopsy. This retrospective study included 28,800 patients who underwent coronary angiography from 2016 to 2020. The coronary angiograms were reviewed by two independent reviewers and CAAs were documented. CAAs were classified into i) anomalies of coronary artery connection, ii) anomalies of intrinsic coronary arterial anatomy and iii) anomalies of myocardial/coronary artery interaction as proposed by the European Society of Cardiology. Of the 28,800 coronary angiograms, CAAs were present in 4.12% with anomalies in the left coronary artery (LCA) being most common. Anomalies of coronary artery connection were most common (48.48%) followed by anomalies of myocardial/coronary artery interaction (34.49%) and anomalies of intrinsic coronary artery anatomy (17.03%). Among anomalies of coronary artery connection, absent left main trunk or split LCA with separate origins of left anterior descending coronary artery and left circumflex coronary artery from the left coronary sinus of Valsalva (22.59%) was most common. An intramural course or "myocardial bridge" had an incidence of 1.16% while incidence of coronary artery fistulae (CAF) was 0.115%. [ABSTRACT FROM AUTHOR]

Background: With wide clinical spectrum, multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) in children (MIS-C) is a relatively novel condition occurring weeks to months' post SARS-CoV-2 infection. The aim was to systematically review data on clinical features, laboratory parameters and therapeutics of MIS-C from India. Methods: This systematic review was done as per the PRISMA guidelines, and quality assessment was done using NIH tool for case-series. A systematic search through databases yielded studies whose data was pooled to calculate the mean frequencies with standard deviation using GraphPad software. Results: Screening of 2548 articles published till December, 2021, yielded 11 case-series. World Health Organization case definition was used widely. There was a slight preponderance of males (57%), median (IQR) age was 7 (6,7) years, 63% (n=305) required intensive care unit admissions, and mortality rate was 10% (n=261). Clinical features included fever, mucocutaneous features (72%), and gastrointestinal problems (62%) in majority. Widely used treatment was corticosteroids (76%) and intravenous immunoglobulin (62%) with other options depending on patient's state. An increased level of inflammatory markers and derangement in other parameters corroborated with disease status. Kawasaki disease like features, not reported in many studies, ranged from 4-76% of patients. Conclusion: MIS-C presents with a wide spectrum clinical features, increased inflammatory markers and managed as per the disease course and presentation. Future studies monitoring the long-term effects of MIS-C are recommended. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical presentation, risk factors and outcomes of young patients (≤45 years) presenting with ST segment-elevation myocardial infarction (STEMI) with older STEMI patients in the Tamil Nadu STEMI program (TN-STEMI).Methods: A total of 2,420 patients were enrolled in the TN-STEMI program, which is a pre-implementation and post-implementation quality of care study. The cohort of patients was divided into young STEMI patients (≤45 years) and compared with those aged >45 years.Results: A total of 591(24.4%) patients in this cohort were aged ≤45 years; 92.5% of the young STEMI were males. Smoking was the most common risk factor and its use was significantly more in younger myocardial infarction (MI) patients than in older patients (57% vs 31%; p<0.001). Compared with their older counterparts, younger patients had a lower prevalence of hypertension (14.2% vs 28.3%; p<0.001) and diabetes mellitus (13.2% vs 29.7%; p<0.001). Total ischaemic time was shorter for younger patients (235 vs 255 mins; p=0.03). Young STEMI patients more frequently presented with single vessel disease and the left anterior descending coronary artery was the most common infarct-related artery; they also had a higher thrombus load. Young MI patients had reduced mortality, both in-hospital (3.4% vs 6.4%; p=0.005) and at one year (7.6% vs 17.6%; p<0.001). Younger male STEMI patients also showed lower mortality than younger female patients.Conclusions: Young STEMI patients compared with older STEMI patients had lower prevalence of traditional risk factors, shorter ischaemic time and reduced mortality. Young female STEMI patients had higher mortality than young male STEMI patients. [ABSTRACT FROM AUTHOR]

Objective: Even with the immense progress achieved in the field of percutaneous coronary interventions (PCIs), treatment of diffuse long atherosclerotic coronary artery disease continues to remain a challenge for durable outcomes. The downstream reduction in diameter along the lesion length of a coronary artery may compel the cardiologist to use either 2 overlapping stents of different diameters or a single long stent leading to stent-vessel mismatch at the edges. Recently, Meril Life Sciences Pvt. Ltd., India, has introduced a long-tapered sirolimus-eluting stent (SES) system, BioMime Morph, which conforms to the normal tapered geometry of coronary arteries along with adequate lesion coverage. In this study, we aimed to provide real world experience regarding the safety and efficacy of the BioMime Morph SES over a follow-up of one year. Methods: This was a single center, retrospective study involving 172 participants who underwent PCI with the BioMime Morph SES. Mean length of the target lesion was 34.4±10.4 mm, and mean stent length was 53.2±8.7 mm. The most frequent revascularized vessel was the left anterior descending artery (LAD) in 97 lesions (54.4%). Results: Major adverse cardiac events (MACE) (defined as a composite of target vessel myocardial infarction, target lesion revascularization, and death due to a cardiac cause) at 1, 6, and 12 months were seen in 4 (2.3%), 7 (4.0%), and 8 (4.7%) patients, respectively. Overall, 5 cardiac deaths and 2 definite stent thrombosis were observed in the study. Conclusion: The study suggests that the novel BioMime Morph SES is an effective and a safe option for PCI in the treatment of long diffuse atherosclerotic lesions. [ABSTRACT FROM AUTHOR]

Aim : The aim of this study was to evaluate presenting symptoms, clinical features, and laboratory tests for the diagnosis of Kawasaki disease (KD) in children and their short-term follow-up at a tertiary care hospital of North India from April 2017 to March 2020. Materials and Methods : A total of 31 children (23 boys and 8 girls) up to 10 years of age were included in this study. The diagnosis of KD was made as per the American Heart Association 2017 guidelines. Clinical features, laboratory parameters, and coronary involvement were compared between the complete and incomplete KD groups. Results : The incidence of complete versus incomplete KD was 19 (61.2%) versus 12 (38.7%) children, respectively. Change in extremities and oral mucosal changes were more encountered in the complete KD group as compared to the incomplete KD group (100% vs. 58.3%, P = 0.004, and 78.9% vs. 33.3%, P = 0.002, respectively). Coronary artery aneurysm was seen in 54% of the patients on echocardiography which was greater in the incomplete KD group (83.3%) as compared to the complete KD group (36.8%). The median time from the onset of symptoms to intravenous immunoglobulin infusion was <10 days in 84.2% of the patients with complete KD versus 41.7% with incomplete KD which was statistically significant. Fifty percent of the children with coronary ectasia and small aneurysm had normal coronaries at follow-up of 6 months. Conclusion : KD is probably underdiagnosed in most developing countries, like that of ours, and requires a high index of suspicion. [ABSTRACT FROM AUTHOR]

Objectives To carry out a review of clinical characteristics, laboratory profiles, management and outcomes of patients with Kawasaki disease (KD) and macrophage activation syndrome (MAS). Methods Medical records of patients treated for KD and MAS between January 1994 and December 2019 were reviewed. Patient demographics, clinical signs, laboratory values, coronary artery abnormalities, treatments and outcomes of patients with KD and MAS were recorded. We also performed a review published studies on the subject. Results Of the 950 cases with KD, 12 (1.3%; 10 boys, 2 girls) were diagnosed with MAS. The median age at diagnosis was 4 years (range 9 months–7.5 years). The median interval between onset of fever and diagnosis of KD was 11 days (range 6–30). Thrombocytopenia was seen in 11 patients. The median pro-brain natriuretic peptide value was 2101 pg/ml (range 164–75 911). Coronary artery abnormalities were seen in 5 (41.7%) patients; 2 had dilatation of the left main coronary artery (LMCA), 1 had dilatation of both the LMCA and right coronary artery (RCA), 1 had dilatation of the RCA and 1 had bright coronary arteries. All patients received IVIG as first-line therapy for KD. MAS was treated with i.v. methylprednisolone pulses followed by tapering doses of oral prednisolone. Additional therapy included i.v. infliximab (n  = 4), second-dose IVIG (n  = 1) and oral ciclosporin (n  = 1). Conclusion MAS is an unusual and underrecognized complication of KD. In our cohort of 950 patients with KD, 1.3% had developed MAS. KD with MAS is associated with an increased propensity towards development of coronary artery abnormalities. [ABSTRACT FROM AUTHOR]

Background and Aim: Henoch-Schönlein purpura (HSP) is the most common childhood vasculitis characterized by leukocytoclastic vasculitis. This study was done to describe the presentation and immediate outcome of children admitted to HSP at our Institute. Methods: This retrospective study was conducted on children with HSP admitted to our department over a period of 7 years (January 2010 until December 2016). Results: Twenty-three children with a diagnosis of HSP were identified during the study period. The mean age was 9.4 years (4 years to 16 years). There were 15 girls and 8 boys with a male: female ratio of 1:1.9. The youngest child was 4 years old and most of the children (73.9%) were in the age group 5-12 years. Forty percent of the children presented between January and March. Major manifestations were rash (100%), joint pain (52%), renal involvement (52%), and abdominal pain (47.8%). Three (13.0%) children presented with systemic manifestations before the appearance of the rash. One child had MPGN 2 years before the onset of rash. There was no mortality. Most of the children recovered well; six (26%) had persistent hypertension and three (13%) had persistent proteinuria. Hypertensive emergency was seen in two children. One child had intussusception that resolved spontaneously. Conclusion: This study is the first study of Henoch Schonlein purpura from northeast India documenting certain peculiarities in the presentation. The results indicate a wide spectrum of presentations in HSP. [ABSTRACT FROM AUTHOR]

Background: Platelet activation is an integral part of pathogenesis of Kawasaki disease (KD). However, there is paucity of literature on flow-cytometry based assessment of platelet activation in KD. We aimed to analyse monocyte-platelet aggregates (MPAs), one of the sensitive markers for platelet activation, by flow cytometry in children with KD. Findings: In this single-centre prospective study, we have enrolled 14 children with KD and results were compared with age-matched febrile (n = 15) and healthy (n = 13) controls. After gating monocytes in side-scatter plot, MPAs were identified based on CD14 and CD41 expression. Two (2) ml of blood samples for children with KD were collected at 3 phases of illness- acute stage before start of intravenous immunoglobulin or aspirin, 24 h after completion of IVIg infusion, and 3 months after acute episode of KD. Children with KD had a significantly higher MPA% values [Median (IQR)- 41.3% (26.6, 52.7)] when compared with febrile [Median (IQR)- 5.98% (2.98-9.72)] and normal [Median (IQR)- 4.48% (2.57-5.59)] controls, p<0.01. On follow-up, the MPA% showed a gradual decline in children with KD, but even at 3 months, the value [Median (IQR)- 7.55% (4.15-14.6)] was higher compared to healthy controls [Median (IQR)- 4.48% (2.57-5.59)]. Conclusions: Our results suggest that MPA% was significantly elevated in acute stages in children with KD and activated platelets may continue to persist even after systemic inflammation has subsided. Future studies are warranted whether objective evidence of platelet activation may guide the use of immunomodulatory and anti-platelet therapy in KD. [ABSTRACT FROM AUTHOR]

Aim: This is a retrospective study to report our experience with a cohort of 73 patients with Kawasaki disease (KD) over 2.5 years. Method: The study was conducted in the Department of Pediatrics. Data were retrieved from medical records of Pediatric Rheumatology and Immunodeficiency Clinic collected from April 2017 to October 2019 and analyzed. Results: Male‐to‐female ratio in our cohort was 2:1. The median age at diagnosis of KD was 3 years (IQR, 4.25). Fever was present in all patients. Oral mucosal changes are the second most common symptom (N = 64, 87%) followed by extremity changes (N = 58, 79%), and rash (N = 56, 76%). Nineteen (26%) children had cardiovascular complications like coronary artery abnormalities (N = 15, 20%), cardiac tamponade (N = 2, 2%), and shock (N = 1, 1%). The effusion in the patients with cardiac tamponade contained inflammatory cells and plenty of red blood cells. Sixty‐eight (93%) patients with KD had received treatment with IVIg. Patients in our cohort had completed a mean follow‐up of 13.6 ± 9.4 months. No fatality or any long term adverse effects were observed on follow‐up. Conclusion: Kawasaki disease is a common rheumatological disorder in children at our center with diverse clinical presentations. The disease needs to be considered as a differential diagnosis in an acute febrile illness in children persisting up to 5 days. [ABSTRACT FROM AUTHOR]

Chikungunya is a common tropical viral infection in India. The majority of patients have limited systemic manifestations. Neurological manifestations of chikungunya may be due to direct viral infection or immune mediated. We present a case of a 45-year-old male who presented with acute onset paraplegia with diminution of vision in the right eye. A detailed evaluation revealed a diagnosis of chikungunya myeloradiculitis with viral keratitis. The patient was treated with steroids followed by intravenous immunoglobulin and had a good recovery. [ABSTRACT FROM AUTHOR]

Background: Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) has spread globally. India is now 2nd worst affected country after USA. In central India, little is known about the clinical spectrum and severity of COVID-19 in children. Aim: To assess the clinical characteristics of hospitalized COVID-19 infected children below 14 years of age and to describe atypical presentations of COVID-19 in children. Design: Prospective observational study Setting: Tertiary care centre and a dedicated COVID hospital in central India. Participants: All the children with RT-PCR confirmed COVID-19 (Nasopharyngeal or oropharyngeal swabs) or a positive SARS-CoV-2 antibody test between 14th April to 30th October 2020 were enrolled in this study. Clinical presentation, progression, course, and outcomes of these children were assessed. Results: Total 45 children were admitted with COVID-19.The median age of children with COVID-19 was 5.5 years (3 days-14 years). The cohort was predominantly male (66.6%) and only 5 (11%) children had co-morbidities (4 children had malnutrition and 1 had congenital heart disease). The route of transmission was either by close contact with family members with COVID-19 33 (73%) or a history of exposure to epidemic areas 33 (73%). The most common presenting symptoms were fever in 16 (35.5%), cough in 10 (22%), breathing difficulty in 8 (18%), nausea and vomiting in 8 (18%) and seizures in 6 (13.3%) patients. Twenty-three (51%) children were asymptomatic, 8 (17%) children had mild symptoms, 4 (8.8%) had moderate disease and 10 children were admitted with severe/critical disease requiring admission in critical care unit. Of the severe/critical patients, septic shock with respiratory failure was seen in 4 (8.8%), Guillain Barre Syndrome (GBS) in 1 (2%), encephalitis in 2 (4%), Kawasaki disease (KD) in 1 (2%) and acute respiratory distress syndrome (ARDS) in 2 (4%) children. Three (6.6%) children died, and all were in the age group between 2-3 months. Out out of 10 critical patients, 8 had high neutrophil lymphocyte ratio (NLR), 6 had high d-dimers and high ferritin levels. Conclusion: Our study shows that pediatrics patients with COVID-19 have a simple transmission mode, either by close contact with infected adults or by exposure to epidemic areas. Most children are asymptomatic. Atypical or severe manifestations can be seen in 22% of children and require intensive monitoring. Severe life-threatening illnesses in the form of ARDS, GBS, KD and other multisystem involvement are seen in these patients. Therefore, it is mandatory in current scenario to have a high degree of suspicion for COVID-19 in children admitted in pediatric intensive care units (PICUs) with an unexplained diagnosis, persistent fever and high levels of inflammatory markers. [ABSTRACT FROM AUTHOR]

Hepatitis A virus is a common cause of acute viral hepatitis in India, due to lack of clean water and sanitation. Usual presentations include gastroenteritis or a viral respiratory infection. Hepatitis A has a variety of extra-hepatic manifestations which, if failed to be recognized, evades diagnosis. A 28-year-old lady presented with pain abdomen for 1 week, fever with rashes for 1 day. Patient was febrile at the time of examination. Rash was maculopapular with irregular edges, tender. On examining abdomen, tenderness noted in right hypochondrium and epigastrium with hepatomegaly. Patient was then admitted. Working diagnosis was Viral hepatitis for evaluation. Hepatitis A serology was sent which came positive for Ig M. Patient was treated with IV fluids, bile acid sequestrants, IV PPI, IV and oral antibiotics, antihistamines and 3 doses of injection Vit K. Calamine lotion was also given for skin care. Patient improved symptomatically in 2 days and was discharged after 3 days of hospital stay. In our case, the maculopapular rash spreading to the whole body was the major presenting symptom. The presentation of Hepatitis A with rashes maybe seen in around 10% of patients with extrahepatic manifestations along with arthralgia. Differential diagnosis in this case should be erythema multiforme which is the most common maculopapular eruptive rash. Other viral hepatitis causing agents (Hepatitis B&E) have been documented to present with rashes. SLE and Kawasaki disease rarely present with fever with rash with nonspecific multisystemic involvement. Borrelia, Leptospira also have icterus in their presentations. Early diagnosis and management in this case prevented complication such as autoimmune hepatitis, pleural effusion, ascites acute kidney injury. This case presentation urges the need to consider Hepatitis A to be an important differential diagnosis of fever with rash especially in tropical/sub-tropical countries with poor sanitation. [ABSTRACT FROM AUTHOR]

Background: Kawasaki disease (KD) is emerging as the most common medium vessel vasculitis in children. Recurrence of KD (0.8%‐3.0%) is unusual and not commonly reported. Objective: To study the clinico‐laboratory profile of children with recurrent KD. Methods: Case records of 714 children with KD, registered from January 1994 to April 2018 in the Pediatric Rheumatology Clinic at the Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research Chandigarh, were reviewed and data were analyzed for children having had recurrent KD. Results: Seven (0.98%) children (five boys; two girls) had recurrent KD in our cohort of 714 patients. Mean age at diagnosis was 4.3 years (range, 2‐9 years). Six (85.7%) had recurrence of KD within 1.5 years. Incomplete KD was more common during recurrence (71.4%) as compared to the first episode (33.3%). Five children with recurrent KD developed desquamation during the first week of illness. Laboratory investigations did not show any significant difference during the two episodes of KD. Six of the seven children in the first episode received treatment with intravenous immunoglobulin (IVIG). Five of the seven children received IVIG during recurrence. One child had transient left main coronary artery ectasia during the first episode of KD as well as during recurrence and it normalized after treatment on both occasions. Conclusion: Recurrences in KD are unusual. Over a period of 24 years the recurrence rate in our cohort of children with KD was 0.98%. Further, children with recurrences tended to have milder and incomplete form of the disease. [ABSTRACT FROM AUTHOR]

The article describes the case of a 13-year-old boy with fever, loose stools, vomiting, redness of eyes and a generalized maculopapular rash for a week and developed peeling of skin over palms and soles. Topics discussed include findings on his systemic examination, his diagnosis of Kawasaki disease, and the separation of his nails which suggested onchomadesis.

Kawasaki disease (KD) is recognized as a leading cause of acquired heart disease in children in developed countries. Although global in distribution, Japan records the highest incidence of KD in the world. Epidemiological reports from the two most populous countries in the world, namely China and India, indicate that KD is now being increasingly recognized. Whether this increased reporting is due to increased ascertainment, or is due to a true increase in incidence, remains a matter of conjecture. The diagnosis and management of KD in developing countries is a challenging proposition. In this review we highlight some of the difficulties faced by physicians in managing children with KD in resource-constrained settings. [ABSTRACT FROM AUTHOR]

The aim of this study was to estimate incidence of Kawasaki disease (KD) in Chandigarh, North India, during 2009-2014. Diagnosis of KD was based on American Heart Association guidelines. Records of all children diagnosed with KD below 15 years at a large tertiary care referral centre from North India for paediatric immunology were analysed from January 2009 to December 2014. Children residing in Chandigarh were identified. Incidence rates were calculated based on population of Chandigarh in National Census 2011. Methodology was similar to our previously reported study from 1994 to 2008. Incidence of KD in children below 5 was also computed. A total of 258 children were diagnosed to have KD. Of these, 54 (43 boys, 11 girls) resided in Chandigarh. Coronary artery abnormalities on echocardiography were noted in 6. Incidence rate varied between 1.11 (in 2012) and 4.71/100,000 children below 15 (in 2009). In children below 5, incidence rate varied between 1.0 (in 2012) and 9.1/100,000 (in 2009). Peak incidence of KD was in third year of life. There was clustering of cases in February, April, June and October with a nadir in July. While the overall number of KD cases has increased, the 2009-2014 Chandigarh incidence is comparable to our previous figures. Our study is based on hospitalized children with KD and may be missing patients diagnosed elsewhere but that number is likely to be small. Further, patients in whom the diagnosis has never been made would also be missed. Median age at diagnosis has reduced as compared to our previous study. This is probably a reflection of increased awareness about KD amongst paediatricians and physicians in the region as a result of which the proportion of infants and young children diagnosed to have KD has shown a significant increase. Seasonal pattern of occurrence of KD is consistent with our previous observation. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD) is now the commonest cause of acquired heart disease in children in developed countries. KD occurs all over the world, including developing countries. The present study steps out to explore our hypothesis, driven by clinical observation over the last 18 years, whether children with KD in North India are of a higher socioeconomic status than children with other rheumatologic diseases. One hundred consecutive children with KD, registered in Pediatric Rheumatology Clinic before January 2011, were enrolled as cases. Children with other rheumatologic diseases were taken as controls. Assessment of socioeconomic status was done by administering the Aggarwal scale. Data were collected through interview. Statistical analysis was done using SPSS package version 16. On univariate analysis, male sex, higher educational status of parents, urban residence, immunization status being complete, and higher scores on Aggarwal scale were found to be significantly associated with KD. On multivariate analysis, only male sex and urban residence were found to be significantly associated with KD ( p < 0.001). Families of children with KD tend to have a better sociodemographic profile when compared with other pediatric rheumatologic disorders in North India. These results, however, need to be replicated in a multicentric study for any firm conclusions to be drawn. [ABSTRACT FROM AUTHOR]

Over the last 20 years, Kawasaki disease is being increasingly recognized in India and it may soon replace acute rheumatic fever to become the commonest cause of acquired heart disease amongst children. However, the vast majority of children with Kawasaki disease in India are still not being diagnosed. Diagnosis of Kawasaki disease is based on a constellation of clinical findings which have a typical temporal sequence. All pediatricians must we familiar with the nuances involved in arriving at a diagnosis of Kawasaki disease. With early diagnosis and prompt treatment, the risk of coronary artery abnormalities can be significantly reduced. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD) is a common cause of cardiovascular morbidity in young children. No study has attempted to stratify risk factors for coronary artery involvement in Indian children. We attempted to study prospectively the risk factors for coronary involvement in children with KD in a tertiary care hospital between October 2009 and November 2011. The clinical details and investigations for all children admitted with KD were tabulated, and echocardiography was performed; 37 children were admitted with KD; and 8 children (21%) had coronary artery abnormalities. Prolonged fever, wider dispersion of symptoms, and pyuria were significantly associated with the development of coronary lesions. Clinical factors such as wider dispersion of symptoms and prolonged fever along with presence of pyuria can increase the risk of coronary lesions. The presence of these factors may help direct aggressive management and prevent loss of precious time. [ABSTRACT FROM PUBLISHER]

Aim Kawasaki disease ( KD) has been associated with abnormal lipid profiles. The latter, in turn, have been linked to changes in subcutaneous fat. In this comparative cross-sectional study we have quantified distribution of subcutaneous fat during follow-up of a cohort of North Indian children with KD. Method We compared 35 KD children (at least 2 years after disease) and 33 healthy controls. Study parameters included weight, height and skinfold thickness ( SFT) over biceps, triceps, midaxillary, subscapular, medial calf and suprailiac areas. Waist and hip circumferences were also recorded. All parameters were measured four times at 6-monthly intervals using standardized techniques. Serum lipids were assayed in the study group. Results Study children were enrolled 3.7 ± 2.5 years after KD and mean age at enrolment was 8.26 ± 3.65 years. Suprailiac SFT measured higher in boys with KD ( P ≤ 0.05). Biceps SFT was higher in the study group, but the difference was not significant. Other SFT were not affected. Waist and hip circumference was higher in the study group than controls ( P ≤ 0.05). Waist/hip circumference ratio was not affected. Serum low-density lipoprotein cholesterol (LDL-C) and triglycerides were higher in the study group as compared to historical controls (95.60 ± 36.12 and 129.40 ± 64.62 mg/dL vs. 80.10 ± 2.20 and 91.1 ± 29.85; P ≤ 0.05). Total cholesterol and high-density lipoprotein cholesterol levels remained unaffected. Conclusion Children with KD (especially boys) had increased subcutaneous fat deposition in the suprailiac region and waist, during follow-up. Serum LDL-C and triglycerides were elevated. KD children may have a tendency to develop central obesity. Further studies, with longer follow-up, would be necessary to show whether this has implications for development of coronary artery disease later in life. [ABSTRACT FROM AUTHOR]

We read with interest the recently published IAP position paper on Kawasaki Disease (KD) [1]. INDIAN PEDIATRICS 292 VOLUME 58 MARCH 15, 2021 CORRESPONDENCE lower stage of disease, could be of sampling error and data collection from non-heterogeneous population (predominantly stage 1). The definition of recurrent KD would essentially mean a recurrence after documented remission of the first episode of KD (clinically, echocardiography and laboratory). AUTHORS' REPLY We are in agreement with the author that NT Pro BNP is not a well established tool for the diagnosis of KD. [Extracted from the article]

Severe acute respiratory syndrome-coronavirus-2 (SARS CoV-2) is a novel virus. There has been an increasing number of case reports on multisystem inflammatory syndrome in children (MIS-C) but the global and population-specific incidence of MIS-C particularly in Asian countries, its causal relationship with SARS-CoV-2 and its immunopathogenesis remain unknown. Emerging questions on how the pathophysiology of MIS-C differs from that of Kawasaki disease (KD) and non-KD inflammatory syndromes need to be answered. Genetic factors influencing the incidence of MIS-C in the different ethnic populations are to be explored. What happens to the children with MIS-C, in the long run, remains unknown to date. Multicenter clinical trials are needed to establish optimal treatment and follow-up for MIS-C. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate the epidemiologic trends (1993–2008) in Kawasaki disease (KD) and Henoch Schonlein purpura (HSP) among children as seen in a tertiary care north Indian hospital. A hospital-based retrospective chart analysis of all the patients diagnosed with KD and HSP in our pediatric rheumatology clinic from January 1993 to December 2008 was performed. The diagnosis of KD and HSP was based on the American Heart Association and American College of Rheumatology criteria respectively. The collected data were analyzed for any yearly or seasonal trends in the incidence of the two diseases. KD was diagnosed in 196 patients (135 males, 61 females, ratio 2.21:1), while HSP was diagnosed in 209 patients (155 males, 54 females, ratio 2.87:1). The median age at the time of diagnosis was 5.1 ± 3.04 years (range 4 months–14 years) for KD and 6.9 ± 2.98 years (range 1–17 years) for HSP. Over this 16-year period, the number of patients diagnosed with KD progressively increased from 1993 to 2008 ( p < 0.001, chi-square test) with a clear majority of these (162 cases, 82.6%) being diagnosed in the last 8 years. The number of children diagnosed with HSP progressively increased from 1993 to 1997, after which it has remained relatively uniform, and only 93 cases (44.5%) were diagnosed in the last 8-year period ( p > 0.05, chi-square test). However, both the diseases exhibited a comparable seasonal trend in the distribution with a noticeable peak being discernible in the months of October and November. KD has shown a rising trend over the recent years in our hospital. Since 2004; the annual number of KD cases has outnumbered the HSP cases. Seasonal predilection is noticeable for both conditions. This is the first hospital-based report on epidemiological trends of KD and HSP from a developing country. [ABSTRACT FROM AUTHOR]

A report on Kawasaki disease (KD) is presented. It explains that KD is an acute medium vessel vasculitis which affects coronary arteries and is the leading cause of acquired heart disease in children in developed countries. The clinical presentation of KD in India was studied to examine differences compared to Japan and Western countries and to determine whether these differences affect adaptive and cognitive behaviour functioning in children.

Mucocutaneous findings in 150 HIV+ve cases (F, 79; M, 71) were evaluated over a one-year period. Mucocutaneous manifestations were seen in 96% with 2.9 mean number of dermatoses and mean cluster of differentiation (CD4) count of 196.33 cells/mm3. The highest number of mean dermatoses, 3.29, was seen in individuals with severe immunosuppression. The most common mucocutaneous manifestation seen was candidiasis (35.33%), followed by seborrhoeic dermatitis (31.33%), oral pigmentation (29.33%), xerosis/ichthyosis (22.67%), pyodermas (22%), periodontitis (17.33%) and nail pigmentation (16.67%). Patient stratification according to the WHO immunological staging, according to CD4 counts, showed a statistically significant association (P < 0.05) for candidiasis, scabies, paronychia, oral pigmentation and diffuse hair loss. Nail and oral pigmentary changes, trichomegaly and subcutaneous fungal infections caused by dermatophytes were highlights of the study. Incidences of xerosis/ ichthyosis, pyodermas, scabies and molluscum contagiosum reported in our study were higher and pruritic popular eruptions was lower than those in previous Indian studies. Cutaneous neoplasms were not seen in the present study. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD) was first reported from Japan in 1967 by a young pediatrician, Tomisaku Kawasaki, while working at the Red Cross Hospital in Tokyo. Soon thereafter, Marian Melish independently reported children with a similar clinical profile from Hawaii in the United States. KD has now been reported from all parts of the world, including several centers in India. Based on the epidemiology and clinical features, an infectious etiology has been suspected for long but no definitive causative agent has been implicated so far. Like many other vasculitides, the diagnosis of this condition is based on the recognition of a temporal sequence of clinical features, none of which is pathognomonic in isolation. KD is believed to be the commonest vasculitic disorder of children. Incidence rates as high as 60-150 per 100,000 children below 5 years of age have been reported from several countries. In India (as also perhaps in many other developing countries), however, majority of children with KD continue to remain undiagnosed probably because of the lack of awareness amongst pediatricians. The clinical features of KD can be confused with other common conditions like scarlet fever and the Stevens Johnson syndrome, if the clinician is not careful. Development of coronary artery abnormalities (CAA) is the hallmark of KD and accounts for most of the morbidity and mortality associated with the disease. Prompt recognition of the disease and early initiation of treatment with intravenous immunoglobulin (IVIG) results in significant reduction in the occurrence of CAA. It is, therefore, imperative for the pediatrician to diagnose and treat KD expeditiously. KD should be considered in the differential diagnosis of all febrile illnesses in young children where the fever persists for more than 5-7 days. [ABSTRACT FROM AUTHOR]

Reports of Kawasaki disease (KD) throughout India are increasing. This article addresses the question of whether the increased diagnosis of KD in India represents the emerging recognition of an illness that had been previously obscured by misdiagnosis, or whether KD is new to India and is increasing in incidence.Whichever answer turns out to be correct, the burden of KD is likely to pose a significant challenge to the health-care system in India in the coming years, due to the high cost of treatment and the potential for lifelong cardiovascular sequelae. Moreover, elucidating the factors that have contributed to the increased recognition of KD in India may provide useful insights for the continuing search for the etiology of KD worldwide. [ABSTRACT FROM AUTHOR]

A study of organ-specific and organ-nonspecific autoantibodies was carried out in 21 children being followed up after a diagnosis of Kawasaki disease at a tertiary care center of North India. Anti-nuclear antibodies were detected in 9.5% patients while anti-thyroid microsomal antibodies were detected in 23.9% patients. Other autoantibodies (e.g. anti-parietal cell antibody, anti-liver kidney microsomal antibody anti-neutrophil cytoplasmic antibody, anti-mitochondrial antibody and anti-smooth muscle antibody) were not detected in any of our patients. Children with Kawasaki disease need to be monitored for the development of autoantibodies during follow-up. [ABSTRACT FROM AUTHOR]

A retrospective analysis was carried out to identify factors associated with delay in diagnosis of Kawasaki disease in a tertiary care pediatric hospital setting in Chennai, India. Over a period of 2 years, a total of 37 cases were studied. The cases were divided into Early Diagnosis Group (EDG) and Delayed Diagnosis Group (DDG) with the cut-off for early diagnosis being ten days. A greater proportion of cases in the EDG presented primarily to our institution ( P=0.004). In the DDG group greater number of cases had received medical attention from practicing pediatricians prior to referral. There was greater interval in onset of individual symptoms in the DDG group. There was no difference between the two groups with regard to age, gender, total blood counts, CRP, liver enzymes, urine analysis or serum albumin values. Platelet counts were higher in the DDG compared to the EDG ( P=0.004).Coronary abnormalities were more common in the DDG ( P=0.05). Our findings suggest that children presenting primarily to a tertiary care centre with symptoms of Kawasaki disease are more likely to be associated with early diagnosis and delay in onset of neck swelling or oral lesions may be associated with delayed diagnosis. There is a need for creating more awareness about Kawasaki disease among practicing pediatricians in India. [ABSTRACT FROM AUTHOR]

Kawasaki disease also known as mucocutaneous lymph node syndrome is a generalised vasculitis of unknown etiology. Presenting a review of the literature and using our cases for illustration we discuss some of the pertinent features in the evaluation and management of patients with this condition. 2 cases of Kawasaki disease have been evaluated and treated in the department of ENT and Paediatrics who responded satisfactorily to treatment with I. V. Immunoglobulin and Aspirin. The case reports have been presented in view of the rarity of reporting of similar cases in India and the need for early diagnosis and prompt treatment to prevent coronary artery aneurysm and other serious complications. [ABSTRACT FROM AUTHOR]

Objective To estimate incidence of Kawasaki disease (KD) over time among children in the city of Chandigarh, North India. Patients and methods We analysed records of all children with KD below 15 years of age at the Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, from January 1994 to December 2008. Diagnosis and treatment of KD were based on American Heart Association criteria. Among these cases, children residing in Chandigarh were identified. Yearly incidence was calculated and compared from 1994 to 2008. Results During this period, 196 children were diagnosed as KD. Of these, 80 (40.8%; 48 boys, 32 girls) resided in Chandigarh. Four among these had coronary artery abnormalities (CAA) on echocardiography, while two had mitral regurgitation. Comparison of yearly data revealed increasing incidence of disease from 0.51 cases in 1994 to 4.54 cases per 100 000 children below 15 years of age in 2007. Majority (93.7%) of cases occurred in children ≤10 years of age with the highest incidence reported in the seventh year of life. Monthly distribution of disease showed two peaks with a maximum number of cases presenting in October followed by a second peak in May with a nadir in the month of February. Conclusion Increasing incidence of KD in Chandigarh could be due to increasing clinical recognition as a result of greater awareness among paediatricians in the city, or may represent an actual increase in numbers. Striking differences from KD series reported from other countries include the older median age of our patients, low rate of CAA and a different bimodal seasonality, which may be epidemiologic clues to the nature of this vasculitis. [ABSTRACT FROM AUTHOR]