Rodenticides remain an important cause of morbidity and mortality among patients with deliberate self-harm. Yellow phosphorus is an important class of rodenticide due to its high toxic nature and is associated with a high mortality rate. The absence of any specific antidote is an important factor for poor prognosis among those who consume this poison. We report a case of acute liver injury secondary to yellow phosphorus poisoning which was successfully managed with intravenous N-acetylcysteine.

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Scrub typhus is a mite-borne acute febrile illness caused by Orientia tsutsugamushi, and is transmitted by the bite of the trombiculid mite. It presents with high-grade fever which may be associated with nonspecific signs and symptoms such as rash, muscle and abdominal pain, headache, and lymph node enlargement. Scrub typhus is, therefore, one of the differential diagnoses to be considered in a child with acute undifferentiated febrile illness, especially if the disease is endemic to the region. The presence of a painless eschar at the site of the bite is an important pointer to the diagnosis. The illness responds well to antibiotics, usually within 48 h.

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Background: Scrub typhus and dengue are two major causes of acute undifferentiated febrile illness in many parts of India and are difficult to differentiate at initial presentation. Materials and Methods: This retrospective observational study was conducted in a large emergency department (ED) between September 2014 and December 2014. The clinical score to differentiate scrub typhus and dengue (CSSD) was validated on confirmed cases of scrub typhus and dengue who presented during the study period. The six variables used in CSSD were SpO₂, hemoglobin, total white blood cell count, serum glutamic oxaloacetic transaminase level, serum bilirubin, and sensorium. Results: During the study period, 134 confirmed cases of scrub typhus and dengue were included in the analysis, of which 68 were scrub typhus and 66 were dengue. A male predominance was seen in dengue (60.6%), whereas females comprised the majority in scrub typhus (58.8%). Among 68 confirmed cases of scrub typhus, 32 patients have CSSD score <13, favoring scrub typhus. Among 66 confirmed cases of dengue, 64 patients have CSSD score ≥13, favoring dengue. CSSD has high specificity (97%) and positive predictive value (94%) for scrub typhus patients. CSSD score has high sensitivity (97%) and negative predictive value (94%) for dengue patients. Conclusion: The CSSD is a simple and inexpensive score that can be done rapidly at initial presentation of the patient to the ED. It has a high specificity and positive predictive value for scrub typhus and high sensitivity and negative predictive value for dengue and can be used to differentiate scrub typhus and dengue within a few hours of presentation to the hospital.

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Langerhans cell histiocytosis is a group of disorders caused by proliferation of the histiocytes. This is a rare neoplastic disease with multisystem involvement. We present a case of an adult male with intermittent fever, recurrent jaundice suggestive of predominant liver involvement. He had undergone multiple courses of anti-tuberculosis treatment with no improvement. Biopsy of the lymph node in our hospital showed Langerhan's cell histiocytosis and liver biopsy showed bridging fibrosis. This case report highlights liver involvement in Langerhans cell histiocytosis with lung and lymph node involvement occurring later, which is an uncommon presentation of this rare disease.

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The history of Physical Medicine and Rehabilitation (PM&R) in India is intertwined with the personal story of Dr. Mary Verghese. The tragedy of a road traffic accident that rendered her paraplegic inspired her to establish a department of PM&R in Vellore and a Rehabilitation Institute, the first of its kind in the country. The Rehabilitation Institute which she pioneered is today one of the premier institutes for the rehabilitation of people with disabilities and stands as a testimony to the transforming power of her faith and resilience.

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The planning process while considering initiation of nonformal or formal education in children with autistic behavior should take into consideration the extent of the autistic profile of a child, comorbidities, response to therapy, language and learning progress a child makes, and the adaptations which a teacher is willing to make in the classroom. The schooling options for such children include regular schools with a special learning environment, special schools, and the open schooling system. An early learning program that bridges home and school can help children adapt to a school program and also provides periodic supplementation and support for their learning process. The involvement of school teachers, parents and siblings is an important contribution to the learning process.

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Children account for about 5% of new TB cases in India but this may be an underestimate, as clinical signs of TB are subtle in children. Pulmonary TB is the most common form in children but diagnosis is challenging due to various factors including difficulty in collecting specimens from young children who tend to swallow sputum and produce fewer TB bacilli in specimens compared to adults. Tests such as the AFB smear used in adults are therefore often negative in children. A high index of suspicion needs to be maintained in order to make the diagnosis. Symptoms such as persistent fever and non-remitting cough are highly specific for a diagnosis of TB. The chest radiograph is the most important investigation for making an early diagnosis of in pediatric pulmonary TB. When starting empiric anti-tuberculous therapy in children, it is essential to monitor the treatment response in the form of resolution of symptoms and gain in weight. A poor clinical response to treatment should alert one to the possibility of poor adherence to therapy, incorrect doses of antituberculous drugs, presence of TB resistant to first-line drugs or an incorrect diagnosis of tuberculosis in the first place.

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Dengue fever is often a self-limiting illness of viral origin and is transmitted by mosquitoes. Children, especially those under 2 years of age and those with comorbid illnesses are particularly vulnerable. A small percentage of individuals with the infection may develop features of severe dengue (SD) which is potentially life threatening. Warning signs often precede the development of SD. The recognition of symptoms of SD fever and optimal fluid management are key factors in the treatment of this illness.

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