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Background: Music learning induces significant neural changes, enhancing auditory, verbal, and visuospatial skills, IQ, and speech perception. Research studies reveal structural and functional brain plasticity due to music training in adults and children. While musical abilities are linked to formal training, the existence of "musical sleepers" with heightened speech perception without formal training is noteworthy in adults. This study addresses the gap in understanding such phenomena in children, exploring psychophysical abilities in musically adept children, and aiming to impact rehabilitation models. Materials and method: A pre-experimental study involved 164 typically developing children (mean age: 9.93) without musical training. Musical abilities were evaluated using the abbreviated version of Montreal Battery for Evaluation of Musical Abilities (MBEMA) test in DMDX software, covering melody, rhythm, and memory subtests. Psychophysical tests in MATLAB assessed temporal, frequency, intensity, timbre, and binaural resolution. Results: Using a median split based on MBEMA test scores (median: 42), 84 children exhibited poor musical abilities, while 80 showed good ones. Descriptive statistics for MBEMA scores and psychophysical tests were conducted. As data did not follow normal distribution, non-parametric inferential statistics were employed. Mann–Whitney U tests revealed significant differences favouring good musical abilities in all assessments: gap deduction (p = 0.01), pitch discrimination at 500 Hz and 4 kHz (p = 0.00), intensity discrimination at 500 Hz (p = 0.00) and 4 kHz (p = 0.01), profile analysis (p = 0.01), interaural level difference (p = 0.023), and interaural time difference (p = 0.038). Spearman correlation showed highest correlation with pitch discrimination at 500 Hz (r = − 0.538), 4 kHz (− 0.416), intensity discrimination at 4 kHz (r = − 0.367), and 500 Hz (r = − 0.311), profile analysis (r = − 0.313), interaural level difference (r = − 0.276), and gap deduction (r = − 0.235). All were significant (p < 0.01), except for the interaural time difference. Conclusion: Children excelling in music surpassed those with weaker abilities in psychophysical tasks. This echoes past research, underscoring auditory discrimination's influence on musical skills in untrained children. These results potentially support the concept of musical sleepers in children. Key predictors include pitch discrimination, while interaural time difference exhibited minimal correlation. Utilising such assessments may predict musical training outcomes for children with auditory disorders, but additional robust statistical investigation is necessary. [ABSTRACT FROM AUTHOR]

Objectives: To compare the urinary bisphenol A (BPA) levels in bottle-fed and never bottle-fed infants among the under-five children and to determine the impact of bottle-feeding practices and sociodemographic factors on urinary BPA levels in under-five children. Methods: A community-based cross-sectional study was carried out on children aged between 2 to 60 months attending the Anganwadi centres in Chandigarh. Results: Urine samples were collected from 184 children, out of which 94.56% (n = 174) children had detectable urinary BPA levels. The mean (SD) BPA level was 2.74 (2.60) ng/ml and BPA was detected in 93.9% of 'ever' bottle-fed children (n = 93/99) and 95.3% of 'never' bottle-fed children (n = 81/85) (P = 0.69). On multivariate regression analysis, there were no significant predictors for high (≥ 75th percentile) urinary BPA levels. Still, the odds of urinary BPA levels ≥ 75th percentile showed higher trend for significance among children from middle/higher socioeconomic background in reference to lower socioeconomic stratum (adjusted OR 7.02; 95% CI 1.24, 133.25; P = 0.07) and among children whose feeding bottles were brushed once or twice daily in reference to group with no daily brushing (adjusted OR 3.92, 95% CI 0.95, 20.56; P = 0.07). Conclusions: Although feeding with plastic bottle did not emerge as a statistically significant risk factor for BPA exposure, yet detection of BPA levels among majority of study children signals an urgent need for unmasking exposure to other sources given the potential long-term toxicity of BPA among infants and young children. [ABSTRACT FROM AUTHOR]

Objective: Acute encephalitis syndrome (AES) in children results in significant neurocognitive deficits or mortality. It is pertinent to study the AES patterns periodically to identify the changes in the etiological trends and outcomes. Our objective was to find the etiological agents of AES, mode of diagnosis, treatment given, and outcomes. Methods: We reviewed the electronic records of children aged 1 month to 15 years who were admitted with AES in our centre from January 2015 to December 2019. We analyzed the the clinical, laboratory, and radiological profile of these children and adolescents in relation to their outcome. Poor outcome was defined as death, discharge against medical advice with neurological deficits, or Glasgow Outcome Score Extended (GOS-E) d≤ 5 at the time of discharge. Results: Among 250 patients admitted with AES during the study period, a definitive etiological diagnosis was established in 56.4% of children (30.4% viral, 22% bacterial). Scrub typhus (11.2%) and dengue (9%) were the two most common underlying illnesses. Serology helped in clinching the diagnosis in 30% of children. A surge in AES cases in the post-monsoon season was observed in our cohort. Third-generation cephalosporin drugs (85.7%) and acyclovir (77.7%) were the most commonly used empiric antimicrobial drugs. About one-third of children (n = 80) had a poor outcome. GCS ≤ 8 at presentation and requirement for invasive ventilation were found to be significant predictors of poor outcome. Conclusion: A definitive diagnosis was obtained in about half of the children with AES. Viral (30.4%) and rickettsial infections (22%) were the common etiologies identified. Poor outcome was observed in 32 % of patients. [ABSTRACT FROM AUTHOR]

Context: Children with human immunodeficiency virus (HIV) infection frequently present with opportunistic infections of the lung that may be associated with high mortality rate. There is no study, to the best of our knowledge, correlating specific radiographic patterns of chest infections with CD4 levels of immunity in HIV-infected children of Indian subcontinent (where prevalence of respiratory tuberculosis is very high). Aims: To study the radiological patterns of chest infections in HIV-infected children, and to correlate these radiological findings with CD4 cell count and final diagnosis. Methods: Forty-five HIV-infected children (1–18 years of age) with suspected chest infections were included in the study. The baseline and the most recent CD4 counts were recorded for each patient. Chest X-ray (CXR) was obtained in all the patients, and multi-detector computed tomography (MDCT) chest was done in 27 patients having clinical suspicion of infection with normal or equivocal findings on CXR. Chest radiographs and MDCT chest were analyzed for different radiological patterns of chest infections. Imaging findings were correlated with CD4 count range for disease spectrum. The final etiopathological diagnosis was achieved in combination with clinico-radiological findings, laboratory data, cytohistopathology and follow-up imaging. Results: Out of 45 children confirmed to be HIV-infected, 27 (60%) had bacterial infection, 14 (31.11%) had tuberculosis, and four (8.89%) had fungal infection. Consolidation on CXR/CT strongly suggested bacterial etiology (P < 0.05). Mediastinal/hilar lymphadenopathy (with or without necrosis) strongly suggested tubercular etiology (P value < 0.05). Diffuse GGO/haziness on CXR/CT strongly suggested fungal etiology (P value < 0.05). On correlation with CD4 count (cells/mm3), the bacterial infections occurred at early stages of HIV infection when immune status was relatively preserved, and most of the patients with tubercular infection had moderate immunosuppression. On the other hand, all patients of fungal infection showed severe immunosuppression. Conclusion: A wide spectrum of pulmonary disease encountered in HIV-infected children warrants an integrated approach of image interpretation. Familiarity with the imaging patterns, combined with relevant clinical/laboratory details, may greatly help to improve the diagnostic confidence and to reach to a more meaningful differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: This commentary explores the landscape of non-nutritive sweeteners, further delves into the historical trajectory and the contemporary surge in the consumption of non-nutritive sweeteners (NNS), along with the accompanying controversies concerning their safety. Objective: The aim is to provide a comprehensive understanding of the influences of NNS, drawn from global studies and diverse perspectives. Methods: The commentary synthesizes findings from global studies, notably the NutriNet-Santé cohort, exploring associations between specific NNS and health consequences such as cerebrovascular events and malignancies. Additionally, it examines the research on consequences of NNS on gut microbiota and explores concerns linked to gestational diabetes, fetal exposure, and health of the offspring. Results: While caution is advised during pregnancy and fetal development due to potential risks, NNS show promise in weight management and short-term dietary goals when used cautiously in lower amounts. The commentary underscores the necessity for inclusive, long-term studies to guide evidence-driven policies and guidelines. Conclusion: While the article underscores the complexities and debates surrounding non-nutritive sweeteners (NNS), it also sheds light on the positive aspects. In the Indian context, where the intake of sweeteners is relatively low and mainly limited to beverages (tea or coffee), NNS appear to be safe, but prudent use is advocated. The article emphasizes the value of public education on NNS usage and concludes that, overall, NNS are reasonably safe when consumed in moderation. Continued research is needed to elucidate their intricate effects on health and impact on global health outcomes. Implications: The article concludes with clear guidelines for using NNS in India, highlighting the need for informed decision-making and ongoing research to elucidate their broader health consequences. [ABSTRACT FROM AUTHOR]

Background: Dengue fever (DF) is a viral illness caused by the dengue virus transmitted by Aedes aegypti mosquitoe. It manifests with a range of symptoms, from mild DF to severe forms like dengue hemorrhagic fever and dengue shock syndrome. Common symptoms include fever, headache, rash, muscle and joint pain, and itching. The relationship between itching and clinical improvement in dengue patients remains unclear. Case presentation: A retrospective analysis was conducted on hospital data from a tertiary care centre in South India from April 2021 to April 2023. Patients diagnosed with dengue fever (confirmed by Immunoglobulin (Ig) M and Non-Structural protein (NS) 1 positivity) who experienced itching were included. Clinical details, age, sex, and laboratory findings were collected. A total of 261 patients were examined. Itching typically occurred around day eight from fever onset and was associated with improved platelet count and hematocrit levels. Conclusions: Dengue fever, caused by the dengue virus, presents with various symptoms, including itching during the recovery phase. Studies suggest a correlation between itching and clinical improvement in dengue patients, indicating itching as a potential prognostic marker. Possible mechanisms for itching include direct viral infection of skin cells and cytokine release. However, further research is needed to understand this association fully. Despite limitations such as retrospective analysis, these findings highlight the significance of itching in dengue prognosis and emphasise the need for large-scale studies. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of late-presenting Perthes disease with extrusion is controversial and debatable. One of the options available is the labral shelf acetabuloplasty (LSA). Aim: The aim of the study was to evaluate the results of LSA in late-presenting Perthes disease in terms of clinic-radiological outcome measures. Materials and Methods: A retrospective analysis of prospectively collected data of patients with late presenting Perthes disease (Elizabethtown stage 2B onwards) treated by LSA by 2 experienced paediatric orthopaedic surgeons was performed. Data was collected of clinical parameters such as hip range of motion(ROM) and Harris Hip score and radiological parameters such as acetabular height, width and volume, shelf width, Centre Edge angle(CEA) and the lateral extrusion. Results: Thirty-five patients (28 males and 7 females) treated between 2012 to 2019 were analyzed. Majority were in Elizabethtown stage 3A (23) followed by 2B and 3B (12 each). At a mean follow up of 36 months, the hip ROM and the Harris Hip Score (from 65 ± 3.5 to 81.33 ± 7.12) improved significantly and there was a statistically significant improvement in terms of all radiological parameters. Majority of the hips were in Stulberg grade 3 (20) followed by grade 1 and 2 (7 each) and Stulberg 4 (1). There were no major complications in any of the patients of the series. Conclusion: Labral support shelf acetabuloplasty is a valuable surgery for late presenting Perthes disease and helps in maintenance of good coverage and allows restoration of range of motion over time. [ABSTRACT FROM AUTHOR]

Purpose: To study the physical, emotional and social impact of clubfoot on the lives of affected children and their families. Methods: A purposive sample of children with treated idiopathic clubfoot and their parents was recruited from two geographical locations—the United Kingdom (UK) and India. Children were divided into age groups of 5–7 and 8–11 years. Questionnaires were administered separately to children and parents; the former comprised multiple-choice questions scored using an 'emoji' system, and the latter included open-ended questions divided into pre-defined themes of daily limitations, social life, general health, emotional barriers and family impact. Results: Thirty-four children and parents participated from UK; 96 children and parents participated from India. The majority of children (> 80%) reported no problems in daily activities, although 32.8% reported having pain. Difficulty finding appropriate footwear and limitation in sports were more common among UK children, whereas difficulty in squatting was more problematic for Indian children. Self and emotional perceptions regarding their appearance/condition were lower among older as compared to younger children in both countries. Parents' responses mirrored those of children; additionally they reported emotional and financial difficulties during initial treatment phase, and ongoing concerns about the future during the maintenance phase. Conclusion: Treated clubfoot continues to impact the lives of affected children and families. Perceptions of the condition and its impact vary between population groups; this needs to be appreciated when collecting and analysing outcomes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine the evolution of Legg–Calvé–Perthes' disease (LCPD) among children from British Columbia (BC), Canada who were treated non-operatively and to compare the results to a previously conducted study in India. Methods: This was a retrospective review of patients treated non-operatively for LCPD in BC between 1990 and 2006 compared with a cohort from India. Demographic and treatment information were collected from medical records. Radiographs were assigned modified Waldenstrom, Catterall, Salter–Thompson and Herring classifications and intra- and interobserver reliability were assessed. We evaluated epiphyseal extrusion (EE) and metaphyseal width (MW), and assessed radiographs using the Mose and modified Stulberg classifications. Results: 102 hips (90 patients) had radiographs available for evaluation. 95% of the BC cohort presented as Waldenstrom stages I and II, whereas, 90% of the Indian cohort presented as IIIa. Final EE was similar for both groups (BC 26.8%, India 27.3%) and final MW was 119% in both groups. Modified Waldenstrom and Herring classifications had substantial intra- and interobserver reliability, while Salter–Thompson and Catterall classifications had moderate agreement at best. Most hips were Catterall IV (80%) and Herring C (89%) for the BC cohort compared to only 44% and 43% of Indian hips, respectively. Most hips were irregular according to the Mose classification (BC 43%, India 52%) and aspherical according to the Stulberg classification (BC 78%). Conclusions: We found similar radiographic progression and final radiographic appearances of LCPD in India and BC though differences in the distribution of the classification systems warrant further study. [ABSTRACT FROM AUTHOR]

Hemophilia A is a hereditary bleeding disorder due to coagulation factor VIII deficiency. Septic arthritis is in itself a dreaded infective condition of the joint. It is much more common in hemophilia patients than the general population and is associated with considerably higher morbidity. It presents as a difficult clinical and therapeutic problem, necessitating prompt diagnosis and intensive therapy. There was under-diagnosis of blood coagulation disorders in developing countries like India which has improved in the present time. But there is still considerable uncertainty about proper management guidelines, protocols and resources settings for treating this complication in hemophilia patients. Hereby we present a case of a 9-year-old hemophilia A patient with septic arthritis of knee joint treated at a tertiary hospital centre with available present recommended guidelines in literature, and stress upon the necessity of further formulating and improvising management guidelines for treatment and prevention of this complication in Hemophilia. [ABSTRACT FROM AUTHOR]

Objectives: Indian children are known to have variations in the tibiofemoral angle as compared to children of other ethnicities. There is no study describing radiographic angles in coronal plane in Indian children. Our aim was to evaluate coronal plane alignment in Indian children. Methods: Database of radiographs between January 2011 and December 2019 was searched. Full-length standing radiographs of patients younger than 16 years with unilateral congenital or post-traumatic or post-infective deformity were included. The radiographs were measured for mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), tibiofemoral angle (TFA), hip–knee–ankle (HKA) angle, lateral distal tibial angle, mechanical axis deviation (MAD), and mechanical lateral proximal femoral angle. Results: Analysis of 221 lower limbs of 177 children is presented. There were 103 (58.2%) boys and 74 (41.8%) girls. Mean age was 8 years, 6 months (range: 2 years, 1 month to 15 years, 11 months). The mean mLDFA remained constant between 87° and 88° after the age of 5 years. The mean MPTA remained around 88° after 8 years of age. The mean MAD remained within 4 mm of the midpoint of the knee after the age of 8 years. The adult value of TFA was achieved after 8 years of age. The mLDFA, MPTA, and mLPFA are significant predictors of change in the TFA. Conclusion: The development of tibiofemoral angle in Indian children is slightly different than children of other ethnicities. We recommend using age-specific values for Indian children younger than 8 years of age. [ABSTRACT FROM AUTHOR]

An editorial is presented on initiating unique DDH screening and preventive programmes in paediatric population. Topics include right from basic sciences to embryology, to screening and prevention, and investigative and treatment modalities including the management of adolescent dysplasia; and lack of awareness, access, knowledge, competence, resources & legislation being endemic to India's healthcare system.

Background: Developmental dysplasia of hip (DDH) is a common disorder of childhood and has a good prognosis when treated at an early age. In spite of being a significant concern, many children with DDH are not picked early and present late at walking age. In our country, it is presumed to be due to absence of a national policy for screening of DDH. Screening programmes including the combination of clinical and radiological methods in different ways have been suggested. However, the exact method of screening is controversial. Purpose: To analyze effectiveness and cost-effectiveness of various screening methods for DDH. Study Design: Systematic review. Methods: This review was conducted in accordance with PRISMA guidelines. Medline database was explored for original case series and randomized clinical trials. Inclusion criteria were English language, screening for DDH in neonates, sample size more than 500, and studies with minimum duration of one year. Results: Thirty-four studies were selected to write the manuscript. This included 23 studies looking for effectiveness of a screening programme and 11 studies comparing various outcomes of different screening strategies. A trend favoring universal ultrasound screening was observed Conclusion: The literature supports universal ultrasound screening and has proved its cost-effectiveness. However, considering the logistic and financial challenges in our country, immediate implementation of universal ultrasound screening seems impractical. In the absence of any current guidelines for screening for DDH in India, we suggest professional organizations involved in the care of children and public health policy-makers to come together to develop national screening guidelines for DDH. [ABSTRACT FROM AUTHOR]