We investigated the prevalence and risk factors for wheezing and asthma in young Amazonian children. A population-based cross-sectional survey of 606 children aged 6–59 months was performed in two small towns in Acre State, Northwestern Brazil. Information on outcome variables (recent wheezing and medical diagnosis of asthma) and demographic, socioeconomic, environmental, maternal and nutritional variables was obtained by interviewing children’s mothers or guardians. Infections with intestinal parasites and antibodies to the zoonotic nematode Toxocara were diagnosed using standard laboratory techniques. Multiple unconditional logistic regression models were used to describe associations between independent variables and outcomes. The prevalence of recent wheezing (one or more reported episodes in the past 12 months) was 42.6%, but only 19.8% of wheezing children were also reported to have a medical diagnosis of asthma (prevalence, 8.5%); 21.5% of the children examined had antibodies to Toxocara. Increased risk of asthma was independently associated with early introduction of bottle feeding, defined as

Fat Patterning of Santhal Children–a Tribal Population of West Bengal, India
A cross sectional study was undertaken to examine the body composition including fat patterning among 1012 Santal children, aged 5–12 years, in Puruliya district of West Bengal, India. The anthropometric variable measured included height, weight and skinfold thickness of triceps and subscapular. The body mass index (BMI) was also calculated. The measurements were used to estimate body fat percent (%BF) and fat-free mass (FFM) from skinfolds. Fat mass and FFM were each divided by height squared to produce the fat mass index (FMI) and fat-free mass index (FFMI). Maximum gaining of %BF and FFM was found at ages 11–12 years in both sexes. Difference of-FFM between 5 and 12 years of age was found to be highest in girls (18.7 kg) than in boys (14.92 kg). Body fat percentage of girls was significantly (p < 0.05) higher (except in 8 and 9 years old) than that of boys. FMI and FFMI of girls showed different pattern than that of boys. FFM and %BF showed significant (p < 0.01) relationship with all anthropometric variables. Results suggests a clear evidence of sexual dimorphism in fat patterning; girls showing a greater subcutaneous adiposity in comparison with boys. FMI and FFMI, both indices indicate an age-and sex-related variation among Santal children. The data of the present study could be serving as reference data in other studies of Santal children.

Current Trends in the Prevalence and Aetiology of Childhood Congestive Cardiac Failure in Sagamu
Congestive cardiac failure (CCF) is a common paediatric emergency with diverse aetiologies. The objective of this study is to define the current prevalence rate and common causes of CCF among children hospitalized in a Nigerian Tertiary Hospital. The study was prospectively done over a 1-year period in the Paediatric Wards of the hospital. Consecutive children aged 0–14 years, who fulfilled the standard diagnostic criteria for CCF were recruited. Data obtained from them included the age, sex, duration of illness and the socioeconomic status of the parents. Each subject was given a specific diagnosis based on the clinical, laboratory and radiological features. Out of a total of 1552 admissions, 109 had CCF giving the prevalence of 7.02%. The mean age of children with CCF was mean of 2 3.1 years (range: 1 day to 14 years). Ninety-five (91%) of them were concentrated in the lower socioeconomic classes III–V. The aetiologies of CCF identified in this study were as follows: severe anaemia occurring alone (48; 46%), lower respiratory tract infections (LRTI) (30; 29%), anaemia with LRTI (12; 11.5%), congenital heart diseases (CHD) (11; 10.5%), rheumatic heart disease (1; 1%), myocarditis (1; 1%) and chronic renal disease (1; 1%). Malaria was the commonest cause of anaemia while bronchopneumonia was the commonest form of LRTI in the subjects. Measles infection was associated with LRTI in 10 (23.8%) children. Three children had HIV-related anaemia. Infants formed the bulk of the subjects with CCF due to anaemia, LRTI and CHD. Ventricular septal defect was the commonest CHD identified. The prevalence obtained from this study was higher than rates obtained from some previous studies in the country. Severe anaemia is the commonest cause of CCF probably from the effects of severe malaria and increasing poverty. Stringent attention to poverty alleviation and malaria control may reduce the burden of CCF among Nigerian children.

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Scaling up of Facility-Based Neonatal Care–A District health System Experience
With proportion of neonatal mortality increasing within under-five deaths, innovative approaches and stronger health systems are needed in neonatal care. We present data of a scaled-up neonatal facility in a District Government Headquarters hospital in Southern India. The special care neonatal unit (SCNU) was a community propelled, public private partnership worked out on the principles of private funding of public institutions and effective budgeting of the public health care system. In the first phase the unit was optimized over 3 years with non-governmental organizations (NGO) and government support from a basic nursery to a SCNU. The unit was operational through fixed maintenance budget from government and mobilized funds from NGOs and beneficiaries. Community health workers were motivated for effective utilization. In the second phase the unit’s performance was studied and statistically analyzed in two time frames before and 5 years into the upgradation process. Neonatal admissions from the district increased by 14.65%. Hospital stillbirth, early neonatal and perinatal mortality rates showed significant decline (p < 0.05). There was a 48.59% (CI: 25.46–77.80) increase in antenatal referrals from community health centers. Caesarian sections for neonatal parameters that affect obstetric decisions showed percent changes of 163.25 (CI: 31.18–430.45) and 73.4 (CI: 14.15–164.39) for prematurity and low birth weight (LBW), respectively. Significant decline in case fatality rates for LBW, sepsis and birth asphyxia (p < 0.001) were observed. The district perinatal mortality rate showed a decline. Within the purview of financial constraints of the public health system, private funding, public–private cooperation and effective budgeting may become significant. Motivation of health workers and community to effectively utilize public health care services sets an evolutionary process of referral and vertical linkage of health care system.

Tuberculosis of the Breast in an Adolescent Girl: A Rare Presentation
Tuberculosis (TB) of the breast is a rare condition and usually affects women in the reproductive age group. Its further rarity in children, even in India, where TB is rampant, poses challenges in its diagnosis. Histopathology plays an important role in the diagnosis of this condition. We report a case of TB of the breast in a 15-year-old girl proven by histopathological study.

The correlation between myocardial function and cerebral hemodynamics in term infants with hypoxic-ischemic encephalopathy

Oxidant and Non-enzymatic Antioxidant Status in Measles
Measles is a highly contagious viral disease of childhood associated with serious complications and significant morbidity and mortality. In the present study, antioxidant and oxidant status was investigated in children with measles. Our aim was to evaluate the possible changes in non-enzymatic antioxidant levels and their relationship to the oxidative stress in measles. According to our knowledge, there are no data about the blood levels of malondialdehyde (MDA), reduced glutathione (GSH) and vitamin C in measles. We measured the whole blood MDA (as a marker of lipid peroxidation) and GSH, and serum -carotene, retinol, -tocopherol and ascorbic acid levels in all subjects. There was a statistically significant difference between the groups for all parameters (p < 0.05). Non-enzymatic antioxidant status was found to be decreased but, lipid peroxidation was increased in the study group. As a conclusion, these findings suggested that oxidant and antioxidant defence system were altered in children with measles.

Perinatal Tuberculosis a Case Series
Perinatal tuberculosis is insufficiently understood and has been rarely reported even in areas endemic for the disease, and unless a high index of suspicion is maintained the diagnosis can be missed. Differentiation of congenital from early postnatally acquired tuberculosis is only of epidemiological importance. We hereby report one case of congenital tuberculosis and three cases of perinatal tuberculosis, and problems faced during investigation and management and emphasize need for improved screening of women at risk and sensitization of the medical community about this entity.

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