Background: Early diagnosis and prompt treatment of ascitic fluid infection (AFI) is vital to shorten hospital stays and reduce mortality in patients with cirrhosis. The gold standard for diagnosing AFI is ascitic fluid analysis, but it is invasive. Procalcitonin (PCT) has been studied as a noninvasive diagnostic tool in adult cirrhotic patients. Pediatric literature is limited. Hence, we prospectively evaluated the role of serum PCT levels in predicting AFI in hospitalized cirrhotic children between November 2017 and December 2019. Methods: We prospectively evaluated all consecutive children <18 years of age with decompensated chronic liver disease (CLD) who had ascites at presentation and who did not receive antibiotics in the last 7 days. The clinical features and laboratory parameters were evaluated. Ascitic fluid analysis and serum PCT estimation (cutoff value <0.5 ng/mL) were done in all patients. Results: A total of 30 children {20 boys, median age 9.1 years [interquartile range (IQR) 3.6–10.5]} with decompensated CLD were evaluated. Wilson disease was the most common etiology followed by cryptogenic cirrhosis. Seven (23.3%) children had AFI (1 spontaneous bacterial peritonitis, 6 culture-negative neutrocytic ascites). The mean [± standard deviation (SD)] serum PCT was 2.57 ± 1.2 ng/mL in the infected group and 1.4 ± 1.0 ng/mL in noninfected group (p < 0.05). Receiver-operator characteristic (ROC) curve showed that serum PCT of ≥2.02 ng/mL had an area under ROC of 0.807, sensitivity of 71.4%, specificity of 74%, positive predictive value (PPV) of 45.5%, and negative predictive value (NPV) 89.5% for the diagnosis of AFI. Conclusion: PCT can be a useful, noninvasive tool for the diagnosis of AFI in cirrhotic children.

Magnet ingestion, especially ingestion of multiple magnets and rare-earth magnets (neodymium), has the potential to cause several complications. Ingestion of multiple magnets causes attraction between the loops of bowel, leading to perforation, obstruction, or fistulization. Children often require endoscopic or surgical intervention to retrieve the magnets and repair the damage created by the magnets. We report a toddler with multiple magnet beads ingestion, its associated complications, and management. Discussion includes management guidelines.

Aim and background: Foreign bodies in esophagus have been reported to have a variable presentation. Presentation with chronic symptoms may occur whenever the event of ingestion goes unnoticed. Case description: This paper presents an interesting case of chronic recurrent vomiting and dysphagia for past 5 years in an 11-year-old boy child who was found to have an unrecognized foreign body lodged in the esophagus. The dysphagia and vomiting were resolved immediately after removal of foreign body. Conclusion: Foreign body should be considered even in the absence of history of foreign body ingestion, vomiting, dysphagia, odynophagia, drooling of saliva, cough, shortness of breath, stridor, etc. are present. Clinical significance: Safety precautions for a young child should be imparted through continuous educational programs, especially in rural areas.

Urea cycle defect (UCD) has widely been studied for its clinical manifestation as an acute metabolic crisis. Now with the advancement in medical sciences, the survival rate of such cases has increased and has led us to know more about the varied acute and chronic clinical presentation. Here with this article, we aim to highlight some gastrointestinal manifestations of UCD.