Background and Aims: Calcium, phosphate, and Vitamin D abnormalities are common in critically ill children, which may affect their outcome. However, data regarding the prevalence of these abnormalities are scarce from developing countries. This study assessed the prevalence of calcium, phosphate, and Vitamin D abnormalities in critically ill children and their association with the outcome. Materials and Methods: This was a prospective, cross-sectional study of children aged 1 month to 12 years admitted to the pediatric intensive care unit of a tertiary care public hospital. Relevant clinical information and PRISM III score were recorded, and blood sample for the estimation of serum calcium, phosphate, Vitamin D, and other relevant parameters were collected at admission. Children were followed up till final outcome. Results: A total of 135 children were included with a median age of 36 months. Total and ionized hypocalcemia were present in 9.6% and 22.9%, respectively, and both were associated with higher mortality (P = 0.006 and 0.03, respectively). Children with total hypocalcemia more often had sepsis and required significantly more fluid boluses and inotropes. Hypophosphatemia and hyperphosphatemia were present in 28.8% and 10.3%, respectively, and were also associated with significantly higher mortality. 85.6% of the children were Vitamin D deficient, but no significant association with severity and outcome was found. Conclusion: Calcium, phosphate, and Vitamin D abnormalities were common in critically ill children. Higher mortality was associated with hypocalcemia and abnormal phosphate levels but not with Vitamin D deficiency. There was significant association of hypocalcemia with sepsis, fluid bolus, and inotrope requirement.

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We report a 5-year-old female child who presented with fever and status epilepticus with a history of global developmental delay, patchy alopecia over the frontal region, and bilateral dermolipoma in the conjunctiva and sclera. These findings are consistent with a diagnosis of encephalocraniocutaneous lipomatosis. This is a rare condition reported infrequently across the world. The child also had the specific neurological manifestations of this condition, specifically epilepsy presenting as status epilepticus.

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Mycoplasma pneumoniae (MP) is a common organism causing pneumonia in school-going children. Although the disease is usually mild, it can rarely lead to severe extrapulmonary complications which may be life-threatening. We hereby report a case of an 8-year-old male child who presented with fever, cough, a maculopapular rash, and difficulty in breathing for 8 days who, after initially receiving treatment as community-acquired pneumonia with synpneumonic effusion, went on to develop severe autoimmune hemolytic anemia and cerebral venous thrombosis with features of vasculitis. With utilization of DNA polymerase chain reaction along with other laboratory parameters, the diagnosis of MP infection was made. The child was treated with oral clarithromycin, pulse dose methylprednisolone, low-molecular-weight heparin, and intravenous immunoglobulin while he also required mechanical ventilation, transfusions, and vasopressor support. He responded to these measures and survived with no neurological sequelae.

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Accidental poisoning in children is a common pediatric emergency. Here, we report the case of a 7-year-old girl with Amitraz poisoning. Ingestion and dermal contact with a dissolved solution of Amitraz lead to acute toxicity, which mimicked organophosphate poisoning. The patient lost consciousness which prompted their presentation to the pediatric emergency department. Limited literature is available regarding Amitraz poisoning. This case report attempts to document the findings and raise awareness to hasten identification and treatment of a rare and newer poison, Amitraz.

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Chloride has significant role in the body fluid management and action potential. It also helps in the regulation of acid–base status and facilitates oxygen unloading. Hyper- and hypo-chloremia associated with certain conditions are associated with poor outcome.

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Background: Asthma is a common chronic respiratory disease affecting 1%–18% of the population in different countries. Many factors, such as genetic predisposition, early allergen exposure, infections, diet, tobacco smoke exposure, pollution, and Vitamin D3 status, are all proposed to influence the development and severity of asthma. Vitamin D3 alters human airway smooth muscle expression of chemokines and inhibits the expression of a steroid-resistant gene. Magnesium ion has an inhibitory action on smooth muscle contraction, histamine release from mast cells, and acetylcholine release from cholinergic nerve terminals, thus influencing the function of respiratory smooth muscles. Aim: The aim is of this study is to assess serum Vitamin D3 level and serum magnesium level in children with asthma aged 5–14 years. Materials and Methods: This was a cross-sectional study involving 75 children of 5–14 years of age having asthma, who were classified into intermittent, mild, moderate, and severe asthma, and serum Vitamin D3 levels and magnesium levels were estimated. Results: Serum Vitamin D3 levels were significantly lower in children with severe asthma as compared to those with mild, moderate, or intermittent asthma, but serum magnesium levels were found to have no correlation with the severity of asthma in our study. Conclusion: Vitamin D3 insufficiency is widely prevalent in Indian children with asthma and significantly correlated with the severity of asthma. Serum magnesium levels within the normal range and correlation of the severity of asthma with serum magnesium levels cannot be established in our study.

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Objective: The aim of this study is to detect the diagnostic accuracy of microalbuminuria (MA) among sickle cell children with nephropathy. Materials and Methods: Five hundred and seven sickle cell homozygous children between 5 and 14 years of age group were enrolled after receiving written informed consent from the parents and/or caregiver. Children with preexisting kidney diseases, albuminuria, and taking any drugs that will affect renal function were excluded from the study. Sickle cell nephropathy (SCN) was diagnosed by using the National Kidney Foundation Kidney Disease Outcome Quality Initiative guidelines. Study Design: The study design involves diagnostic study Phase I. Statistical Analysis: Descriptive statistics were done using SPSS version 25.0 (IBM, NY, USA), and diagnostic statistics such as receiver operating characteristic curve (ROC) and others were done by Dxt version 1.0 software (BRTC, Vellore, India). Results: Of 507 patients, 268 (52.8%) were male and 239 (47.1%) were female. The mean age of the study population was 9.42 ± 2.56 years. Cutoff value of MA was ≥47 mg/day (sensitivity [Sn]: 73.9%, specificity [Sp]: 90.5% and area under curve was 0.841 [0.56, 0.91] with P = 0.001). Sn of MA was 76.1% (61.1%, 80.7%), Sp: 90.9% (87.8%, 93.5%), positive predictive value: 62.4% (52.2%, 71.8%), negative predictive value: 93.8% (91%–96%), likelihood ratio positive (LR+): 7.894 (5.672, 10.986), likelihood ratio negative (LR-): 0.312 (0.224, 0.436), odds ratio: 25.266 (14.277, 44.713) with diagnostic accuracy of 83.62%. Conclusions: MA can be used as a good screening tool for early detection of SCN. However, larger studies with a good level of evidence are awaited.

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Background: Bronchiolitis is a common acute respiratory illness with significant morbidity and mortality in children aged <2 years. Many risk factors have been proposed though none conclusively proven. Objective: The objective of the study is to determine the risk factors for bronchiolitis in children aged <24 months. Methodology: This was a retrospective study conducted at Karnataka Institute of Medical Sciences, Hubli, from July to September 2018 on children aged <24 months, with clinically diagnosed bronchiolitis considered as cases and age-matched children admitted during the same period for nonrespiratory causes as controls. Results: Totally, 85 children and 91 controls were included in the study with a mean age at presentation being 5.5 months (interquartile range = 2–8 months) and male-to-female ratio of 1.42:1. The most common symptoms were cough (98.8%), fever (84.7%), cold (64.7%), hurried breathing (58.8%), chest indrawing (42.2%), and noisy breathing (35.3%). On univariate analysis, low socioeconomic status (SES), overcrowding, unimmunized status, exposure to pets, and birth by cesarean section (CS) were significant risk factors. On applying multiple logistic regression (odds ratio, 95% confidence interval), low SES, unimmunized status, exposure to pets, and birth by CS were found to be significant. Conclusion: Low SES, partial/unimmunized status, exposure to pets, and birth by CS were deduced to be important significant risk factors for bronchiolitis.

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