Pediatric Education and Research

Background: Kawasaki disease is a well known entity in pediatric age group and so is its counterpart Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C term became more popular during covid era as the infection started to affect pediatric age group. Now, a large number pediatricians have seencases of MIS-C. Reactivation of BCG scar is less commonly seen in Kawasaki disease and rare to never in a case of MIS-C. Case Presentation: We report a 6-month-old male child who presented with cold and fever. Covid Rapid Antigen Test (RAT) and Covid RTPCR were negative. He continued to have high grade feverwhich is unusual for a case of bronchiolitis and started on antibiotics. Clinical suspicion of MIS-C made and started to work up for the same. Examination revealed reactivation at BCG site with pealing of skin. Further investigations showed elevated CRP and d-dimer with positive anti-SARS COV2 antibody. Diagnosis of MIS-C confirmed and treated with methylprednisolone and IVIG. Conclusion: Reactivation at BCG site is well known entity in Kawasaki disease and as a post vaccination immune cross reactivity. But never reported in a case of MIS-C as less known abouthuman immunological response towards Covid-19 infection and its sequel. It can be considered as an early diagnostic tool in resource poor settings and at community level.

Introduction: Osteogenesis Imperfecta also known as a brittle bone disease is a heterogeneous disorder which is rare and characterized by bone fragility, multiple fracture, bone deformity and short stature.1 It has varying degree of classification based on varying degree of fragility and various clinical presentations.2 Osteogenesis imperfecta (OI) is a rare skeletal dysplasia, with an incidence of 1/15,000–20,000.3 Case report: A 7-month-old male child visited our hospital for fever cough, cold & breathlessness. Ultrasonography at the 8th month revealed mild polyhydramnios with Fetal growth retardation and shortening of fetal long bones of upper and lower limb & 9th month Ultrasonography revealed moderated Polyhydramnios with short limb Dwarfism. On head to toe examination, patient had triangular shaped face with broad forehead, blue sclera, short neck short statured limbs with cylindrical like appearance that is circumferential fat pads, both the hips and knees were flexed and rotated inwards. Barrel shaped rib cage was present. Discussion: OI, commonly known as brittle bone disease, is a hereditary ailment that includes a diverse range of illnesses. It is characterised by a propensity for bone fractures, which can range in severity from a minor break to a prenatal fracture. Blue sclera, DI, hyperlaxity of ligaments and skin, hearing impairment, small height, and bone abnormalities are further characteristic clinical symptoms.11 Sillence et al categorized OI into four kinds based on their clinical severity and genetic characteristics because OI is a diverse disease with different clinical presentations.12 Conclusion: In conclusion, experimental treatments including gene based therapy and bone marrow and stem cell transplantation offer prospective treatments for OI. But these methods are not yet prepared for clinical testing.15 There should be the availability of these approaches in each tertiary care center for better diagnosis & treatment of osteogenesis imperfecta.

Introduction: Neonatal Respiratory Distress (NRD) is the most frequent reason for admissions to NICUs. Studies on this topic are limited in our setup and mostly focused on finding the incidence of NRD. The aim of this study was to find the incidence and the most common causes of neonatal respiratory distress in our setting to better prepare treatment protocols and improve overall outcomes. Methodology: A cross-sectional study was conducted in a tertiary care medical college hospital from February 2022 to October 2022. Data of all neonates admitted with respiratory distress during this term was collected and analyzed. Results: A total of 550 neonates were admitted to the NICU out of which 207(37.6%) developed respiratory distress. The most common cause of NRD was Respiratory Distress Syndrome 129 cases (62.3%) followed by Pneumonia 25 cases (12.1%), Birth Asphyxia 21 cases (10.1%), and Sepsis 17 cases (8.21%). The highest mortality was observed in cases with RDS (8.35%). Conclusion: The study highlights the importance of NRD which has a high incidence rate in NICUs and a mortality rate of 7.2%. The most common causes are also preventable and treatable, and suggestions have been made to help reduce incidence and mortality and improve outcomes.

Severe burn injury and it's clinical outcomes a major concern in the prediction of mortality of patients. Multiple models have been formulated to overcome the concern related to this. Advancements in burn management over the years have significantly decreased burn mortality. But, implementing these advancements has become a huge concern in developing countries. Therefore, for routine evaluation and management to tackle mortality issue this scoring should be implemented at the earliest. There are various scoring systems that are formularized in predicting mortality in burns. In this article we would like to describe our study in using Belgian outcome in burn injury scoring system in predicting mortality in burns patients.