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Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10–19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016–2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age‐ and sex‐specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%–46%; boys 11%–28%) and state (girls 7%–62%; boys 4%–32%). Iron deficiency (ferritin < 15 μg/L) was the strongest predictor of anaemia (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [3.21,6.83]), followed by haemoglobinopathies (HbA2 > 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol <20 ng/ml) (OR: 1.86, 95% CI: [1.23,2.80]) and zinc deficiency (serum zinc < 70 μg/L) (OR: 1.32, 95% CI: [1.02,1.72]). Regional models show heterogeneity in the strength of association between factors and anaemia by region. Adolescent anaemia control programmes in India should continue to address iron deficiency, strengthen strategies to identify haemoglobinopathies and other micronutrient deficiencies, and further explore geographic variation in associated factors. Key messages: The Comprehensive National Nutrition Survey (CNNS) 2016–2018 is the only nationally representative survey to measure haemoglobin, haemoglobinopathies, biomarkers of micronutrient deficiencies, diet and social factors in Indian adolescents aged 10–19 years.Using CNNS data, we found that 28.5% of adolescents (girls: 39.6%, boys: 17.6%) were anaemic, with variation by region or state.Our prevalence estimates translate to 72 million adolescents being anaemic, with Uttar Pradesh having twice as many anaemic adolescents as any other state.Iron deficiency, haemoglobinopathies, vitamin A deficiency and zinc deficiency were associated with an increased risk of anaemia; these associations may vary subnationally. [ABSTRACT FROM AUTHOR]

Background: The economic burden of autism is substantial and includes a range of costs, including healthcare, education, productivity losses, informal care and respite care, among others. In India, approximately, 2 million children aged 2-9 years have autism. Given the likely substantial burden of illness and the need to identify effective and cost-effective interventions, this research aimed to produce a comprehensive cost of illness inventory (COII) suitable for children with autism in South Asia (India) to support future research.Methods: A structured and iterative design process was followed to create the COII, including literature reviews, interviews with caregivers, pilot testing and translation. Across the development of the COII, thirty-two families were involved in the design and piloting of the tool. The COII was forward translated (from English to Hindi) and back translated. Each stage of the process of development of the COII resulted in the further refinement of the tool.Results: Domains covered in the final COII include education, childcare, relocation, healthcare contacts (outpatient, inpatient, medical emergencies, investigations and medication), religious retreats and rituals, specialist equipment, workshops and training, special diet, support and care, certification, occupational adjustments and government rebates/schemes. Administration and completion of the COII determined it to be feasible to complete in 35 minutes by qualified and trained researchers. The final COII is hosted by REDCap Cloud and is a bilingual instrument (Hindi and English).Conclusions: The COII was developed using experiences gathered from an iterative process in a metropolitan area within the context of one low- and middle-income country (LMIC) setting, India. Compared to COII tools used for children with autism in high-income country settings, additional domains were required, such as complimentary medication (e.g. religious retreats and homeopathy). The COII will allow future research to quantify the cost of illness of autism in India from a broad perspective and will support relevant economic evaluations. Understanding the process of developing the questionnaire will help researchers working in LMICs needing to adapt the current COII or developing similar questionnaires. [ABSTRACT FROM AUTHOR]

Introduction: The infection potential of Coronavirus Disease 2019 (COVID-19) is remarkable due to its airborne transmission through droplets and aerosols. Paediatric dental needs were severely compromised during the COVID-19 lockdown period. Aim: To assess parents' attitudes and concerns towards approaching paediatric dentists during the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted in Department of Paediatric and Preventive Dentistry at Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India, from August 2021 to October 2021. The study included 200 parents to assess the attitudes and concerns towards approaching Paediatric dentists during the COVID-19 pandemic. A structured questionnaire was used through Google forms to collect from parents, information regarding precautions, mode of transmission of the virus and type of treatment option. The Chi-square test and Fischer-exact test were used to compare the parameters such as education and occupation with parents' attitude and knowledge. Results: Out of the 200 parents, 37 were males and 163 were females with mean age of the parents was 34.8 years. Out of total 200, 153 (76.5%) of the parents were worried to visit a Paediatric dentist. Only 56 (28%) of the children suffered from toothache during the pandemic. About 28 (14%) of parents believed that the virus is transmitted through the air and 70% of the parents preferred teledentistry. A 152 (76%) of them were willing to pay extra costs and 123 (61.5%) of respondents expected to treat the emergency condition alone. A statistically significant difference was not observed between different occupation in the answers given about transmission paths of a virus (p-value=0.39), extra payment (p-value=0.77), and preference of approach (p-value=0.223). Conclusion: Majority parents were worried to visit a Paediatric dentist and preferred teledentistry. They were ready to pay extra costs for the sanitisation. [ABSTRACT FROM AUTHOR]

Aim: A study was conducted to explore the characteristics of the videos on pediatric inguinal hernia repair on YouTube and compare the most popular videos (MPV) with the least popular ones in terms of educative value vis-a-vis their popularity. Materials and Methods: The term "Pediatric inguinal hernia repair" was searched for on YouTube on August 15, 2021, with the filter set to "view rate." Pertinent data were collected from the 50 MPV and the 50 least popular videos (LPV) and then compared. The h-index and affiliation of the surgeon were obtained from the Scopus database, and their affiliation was further categorized as academic or nonacademic. Results: One hundred and seventy-five videos were found with median views of MPV: LPV being 9270 (interquartile range [IQR] – 12099):127 (IQR – 194), respectively (P < 0.0001). Most of the videos in the MPV and LPV groups were uploaded from the United States of America (USA) (MPV – 17 and LPV – 13) and India (MPV – 15 and LPV – 15). The MPV were on YouTube for a median duration of 3.1 (IQR – 5.5) years as compared to 1.2 (IQR – 2.3) years for the LPV (P < 0.0001). Ninety-two surgeons were identified. The median h-index of the surgeons of MPV was 3 (IQR – 12) in comparison to 1 (IQR – 10) of LPV (P = 0.13). The ratio of academic versus nonacademic affiliation among MPV and LPV was almost equal in both the groups. Conclusions: On either end of the spectrum of popularity, the majority of the pediatric inguinal hernia videos on YouTube were surgical videos uploaded from the USA and India. The educative value of these videos was found to be low and widely dispersed. Surgeons from both academic and nonacademic affiliations had contributed similarly. [ABSTRACT FROM AUTHOR]

CONTEXT: High prevalence of Vitamin D deficiency (VDD) has been reported in the pediatric population from the different parts of the country. However, there is a lacuna of data on the Vitamin D status of children from the north-eastern part of the country. AIMS: The aim of this study is to assess the serum Vitamin D level and also to find out the prevalence of VDD among children and adolescents in Agartala, a major city in North-east India. SETTINGS AND DESIGN: Cross-sectional descriptive study. MATERIALS AND METHODS: The serum 25 (OH) D levels of 258 children from age 1 to below 18 years, attending the outpatient clinics of the hospital were analyzed from June 2020 to June 2021. STATISTICAL ANALYSIS USED: Data being nonparametric was presented as median and inter quartile range. The group differences were computed by the Mann-Whitney U-test. P < 0.05 was considered statistically significant. RESULTS: Sixty percentage of the study population had insufficient levels of Vitamin D, with girls having significantly lower levels of serum Vitamin D. Only 27% of adolescents had optimum level of serum Vitamin D. CONCLUSION: A high prevalence of Vitamin D insufficiency and VDD was found among the children living in the urban and sub urban areas of Agartala city in North-east India. [ABSTRACT FROM AUTHOR]

Introduction: The overall incidence of cholecystitis in children appears to be increasing although the exact frequency of acute and chronic cholecystitis among children in India or worldwide remains unknown. The frequency of paediatric cholecystitis has proportionally increased with the childhood obesity and intake of habitual fatty food. Aim: To present the histopathological concordance of Laparoscopic Cholecystectomy (LC) performed among children for a clinical diagnosis of Gallbladder (GB) disease. Materials and Methods: A single centre retrospective study was performed including histopathological and relevant clinical data of all paediatric LC performed at Career Institute Of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India, between January 2019 to January 2022. Paediatric patients who had undergone LC in the designated time period for a clinical diagnosis of cholelithiasis and/or inflammatory GB disease with classical signs of inflammation were included. Study population with LC procedure submitted for histological evaluation were identified by performing an electronic search through the archives of Department of Pathology, Career Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India, followed by a manual review of GB specimens, histopathology slides and reports. Results: Among 265 patients who underwent LC during this period, there were 62 (23.4%) children. The average age of presentation was 13 years (range 5-18 years), Forty nine (79%) were girls and 13 (21%) were boys. The clinical diagnosis for which paediatric LCs were performed were cholelithiasis among 51% and cholecystitis among 48%. On histopathological concordance these turned out to be chronic cholecystitis among 98.4% children among which 51% were associated with cholelithiasis. Calculous cholecystitis was more frequent than acalculous cholecystitis. Chronic cholecystitis with cholelithiasis and cholesterolosis was more frequent among adolescent girls. Conclusion: This study suggests that chronic cholecystitis accounts for the majority of inflammatory diseases among children undergoing LC for a GB disease and may or may not be associated with cholelithiasis. Chronic cholecystitis with cholelithiasis and cholesterolosis seem more frequent among adolescent girls. [ABSTRACT FROM AUTHOR]

Psoriasis is a common, chronic, immune-mediated, multisystem, inflammatory disorder. It affects all age groups, including infancy. In one-third of the cases, the onset of the disease is in the first and second decades of life. Childhood psoriasis significantly affects the quality of life of the child as well as that of the entire family. Pediatric psoriasis has distinct clinical presentations and evolves with time. Like in adults, chronic plaque psoriasis has been found to be the most common type of childhood psoriasis. Psoriatic plaques in children are less pruritic, smaller and thinner with less prominent scaling. In pigmented skin, the erythema is less prominent and plaques appear violaceous or hyperpigmented. Pediatric psoriasis can be associated with arthritis, metabolic syndrome, depression and anxiety. Hence all children should be screened routinely for associated comorbidities. Management of pediatric psoriasis is challenging owing to the limitation of approved therapies. 'Proactive therapy' is a recent approach in childhood-onset psoriasis that would help to prevent the severity of flare-ups, thus improving the quality of life. [ABSTRACT FROM AUTHOR]

There is a lack of national-level estimates on the magnitude of asthma among children in India. Hence, we undertook a systematic review and meta-analysis to estimate the prevalence of asthma among children in India. We searched PubMed, Embase, Cochrane Library, and Google Scholar, and included cross-sectional studies reporting data on the prevalence of asthma among children in India. A random-effects model was used to estimate the pooled prevalence of asthma. In the 33 selected studies (pooled sample of 167,626 children), the estimated prevalence of asthma was 7.9% (95% confidence interval: 6.3–9.6%), I2 = 99.1% (P < 0.001). The prevalence was higher among boys and in urban areas. Appropriate training and resources should be made available at the primary healthcare level for early detection and management of asthma in children. A nationwide population-based survey is indicated to provide reliable estimates of the burden of asthma. [ABSTRACT FROM AUTHOR]

Context: The American Academy of Pediatrics had recommended that children younger than 2 years should avoid digital media. However, in the Indian context, it was less explored. Aims: The study aimed to determine the relationship between touch screen device (TSD) usage and sleep of infants, toddlers. Methodology: Using a cross-sectional design, 76 parents of infants and toddlers attending well-baby clinic of a tertiary care hospital in Eastern India were approached, and 57 parents who fulfilled the eligibility criteria were selected using a nonprobability convenient sampling technique. Data were collected using a pretested validated tool including TSD usage pattern, the brief infant sleep questionnaire. Descriptive statistics and Pearson correlation were used to analyze the data. Results: The mean age of TSD usage was 15.6 ± 5.8 months with a mean duration of 65 ± 9.6 min/day. Mothers (51%) reported circumstances to offer TSD was feeding the child. There was a significant negative relationship between night sleep and TSD usage among children (r = −0.35, P < 0.01). Conclusions: TSD usage time significantly affects the nighttime duration of sleep of infants and toddlers. Parents to be educated on proper usage and ill effects of TSD to prevent sleep issues. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is on the increasing trend among children, which leads to many co-morbidities. Obesity which was once a health problem of developed countries has now swept developing countries like India. As the home environment has a powerful influence on the health of a child it is very essential to intervene early in childhood and adolescence to prevent obesity/overweight. Aim: To assess the Knowledge Attitude and Practice (KAP) among mothers regarding obesity in children. Materials and Methods: This was a cross-sectional descriptive study conducted from October 2019 to March 2020. The sample size included 220 mothers with children aged between 6 to 14 years, who have attended the Paediatric outpatient department, Sree Balaji Medical College and Hospital in Tamil Nadu, India. After obtaining ethical clearance from the Institutional ethics committee, a predesigned questionnaire was used to collect the socio-demographic variables which included mother's education and occupation, residence, family income, and the total number of family members, and for assessing KAP among mothers. Statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS, version 22.0). Results: The prevalence of childhood overweight and obesity was 52 (23.63%), with overweight representing 23 (10.45%) and obesity 29 (13.18%). There was a statistical significance difference when comparing mother's knowledge of children with overweight/obesity versus normal weight regarding physical inactivity (p=0.01) and eating unhealthy foods (p=0.01), an attitude that a child being obese was not a problem (p=0.03), the practice of mothers who allowed seeing television while eating (p=0.001), not restricting media usage (p=0.01), not allowing children to play outdoors every day (p=0.001), and allowed children to eat junk foods (p=0.001). Conclusion: Overweight and obesity were significant in children whose mothers were unaware of the risk factors like eating unhealthy foods and physical inactivity. Health education and interventional programs have to be planned to educate mothers as they play a major role in preventing obesity in children. [ABSTRACT FROM AUTHOR]

Objective: Persistent shock (PS) or recurrent shock (RS) after initial fluids and vasoactives can be secondary to myriad complex mechanisms, and these patients can have a high mortality. We developed a noninvasive tiered hemodynamic monitoring approach which included, in addition to basic echocardiography, cardiac output monitoring and advanced Doppler studies to determine the etiology and provide targeted therapy of PS/RS. Design: Prospective observational study. Setting: Tertiary Care Pediatric Intensive Care Unit, India. Methods: A pilot conceptual report describing the clinical presentation of 10 children with PS/RS using advanced ultrasound and noninvasive cardiac output monitoring. Children with PS/RS after initial fluids and vasoactive agents despite basic echocardiography underwent BESTFIT + T3 (Basic Echocardiography in Shock Therapy for Fluid and Inotrope Titration) with lung ultrasound and advanced 3-tiered monitoring (T1-3). Results: Among 10/53 children with septic shock and PS/RS over a 24-month study period, BESTFIT + T3 revealed combinations of right ventricular dysfunction, diastolic dysfunction (DD), altered vascular tone, and venous congestion (VC). By integrating information obtained by BESTFIT + T1-3 and the clinical context, we were able to modify the therapeutic regimen and successfully reverse shock in 8/10 patients. Conclusion: We present our pilot results with BESTFIT + T3, a novel approach that can noninvasively interrogate major cardiac, arterial, and venous systems that may be particularly useful in regions where expensive rescue therapies are out of reach. We suggest that, with practice, intensivists already experienced in bedside POCUS can use the information obtained by BESTFIT + T3 to direct time-sensitive precision cardiovascular therapy in persistent/recurrent pediatric septic shock. [ABSTRACT FROM AUTHOR]

Background: Nasal obstruction is a common symptom among children with numerous causes. Congenital or acquired nasal septal deviation may cause nasal obstruction in children. Deviated nasal septum (DNS) may also result in sinusitis, headache, epistaxis and hyposmia which increase the morbidity of the child and hamper the quality of life. The present study investigated the clinical details of the DNS among children at a tertiary care teaching hospital. Methods: This is a retrospective study was conducted at a tertiary care teaching hospital between November 2016 and December 2021. History of nasal obstruction, mouth breathing, nasal bleeding and sinusitis among children with DNS was noted. Anterior rhinoscopy, fiberoptic endoscopic examinations of both nostrils and imaging such as computed tomography were done in all participating children with DNS. Results: Out of 652 children who attended the outpatient department of otorhinolaryngology, 128 (19.6%) were diagnosed with DNS. Out of 128 children with DNS, 72 (56.3%) were male; male:female ratio was 1.28:1. Out of 128 children, 54 (42.2%) children showed C-shaped DNS, 27 (21.1%) showed anterior dislocation, 21 (16.4%) showed S-shaped DNS, 15 (11.8%) showed spur and 11 (8.6%) showed nasal septal thickening. Conclusions: DNS and its impact on nasal breathing impairment in children are often underestimated by clinicians. Clinicians often are unaware on the impact of DNS and its clinical manifestations in children and its appropriate management. Early intervention for DNS in children is helpful to prevent morbid symptoms and their complications. [ABSTRACT FROM AUTHOR]

Introduction: The etiopathogenesis of pelviureteric junction obstruction (PUJO) has been debated. Recently, the role of interstitial cells of Cajal-like cells (ICC-LC) has been studied and reported to be the cause of this functional obstruction. We studied the histopathology and ICC-LC density at PUJ and compared it with that of PUJ of the control group and distal ureteric margin of the study group. Methods: A prospective study was conducted which included PUJO patients in the study group and the renal tumor patients in the control group. Histopathological examination (muscle hypertrophy and fibrosis) and immunohistochemistry (ICC-LC density) were done. The muscle hypertrophy, fibrosis, and ICC-LC density at the PUJ in both the groups were compared. A similar comparison was performed between the findings at the PUJ and the distal margin in the study group. Results: The study and control groups included 37 PUJO patients and 13 Wilms tumor patients. The ICC-LC density at PUJ in the study group was significantly lower than that in the control group (P < 0.001) and that at the distal resected margin of the study group (P < 0.001). Significantly increased muscle hypertrophy (P < 0.001) and fibrosis (P = 0.002) were seen at PUJ in the study group compared to the control group. No significant association was noted between the ICC-LC density and muscle hypertrophy at PUJ and the distal resected margin in the study group. Conclusion: A significant decrease in the density of ICC-LC and increased fibrosis and muscle hypertrophy at PUJ in children with PUJO play a role in the etiopathogenesis of the disease. [ABSTRACT FROM AUTHOR]

Background: Most centers in developing countries prefer chelation therapy with D-penicillamine for the management of Wilson's disease (WD) because of its easy availability and affordability. Neurological worsening following treatment with D-penicillamine is not uncommon. However, there is a paucity of Indian data on the incidence of neurological worsening in children and adolescents with WD following chelation therapy. Our study objectives were to identify the prevalence of neurological worsening in children and adolescents with WD following chelation with D–penicillamine therapy and to describe the management options and outcomes in these patients. Materials and Methods: In this retrospective chart review, children and adolescents with an established diagnosis of WD from 2010 to 2020 were identified from the hospital electronic database. Among these patients, data of children and adolescents with neurological worsening following D–penicillamine therapy were extracted and analyzed. Results: Neurological worsening was observed in 27/122 (22.1%) children and adolescents with WD on chelation therapy with D-penicillamine. Fifteen patients with neurological worsening following D-penicillamine therapy were managed with zinc monotherapy. Four patients were managed with a combination therapy of zinc and trientine. Five patients were treated with trientine monotherapy. Re-challenging with D-penicillamine at a lower dose followed by a slow dose escalation was attempted in three patients. Gradual clinical and functional status improvement was observed in 24 cases while one patient succumbed to pneumonia. Conclusion: Children and adolescents with WD who had neurological worsening on D-penicillamine therapy may be managed with trientine. Zinc monotherapy with copper restricted diet was also found to be effective in non-affordable patients. [ABSTRACT FROM AUTHOR]

There is limited information on the feeding practices of 9.42 million children living within institution‐based care (IBC) worldwide. Poor feeding practices can predispose or exacerbate malnutrition, illness and disability. Here we describe the feeding practices of children living within IBC based on a retrospective analysis of records from 3335 children, 0–18 years old, participating in Holt International's Child Nutrition Program (CNP), from 36 sites in six countries. Data analysed included demographic information on age, sex, feeding practices, disabilities and feeding difficulties. Descriptive statistics were produced. A generalised linear model explored associations between feeding difficulties and disability and 2 × 2 tables examined feeding difficulties over time. An additional set of feeding observations with qualitative and quantitative data was analysed. At baseline, the median age of children was 16 months (0.66–68 months) with 1650/3335 (49.5%) females. There were 757/3335 (22.7%) children with disabilities; 550/984 (55.9%) were low birth weight; 311/784 (39.7%) were premature; 447/3113 (14.4%) had low body mass index and 378/3335 (11.3%) had feeding difficulties. The adjusted risk of having a feeding difficulty was 5.08 ([95% confidence interval: 2.65–9.7], p ≤ 0.001) times greater in children with disabilities than those without. Many children saw their feeding difficulties resolve after 1‐year in CNP, 54/163 (33.1%) for children with disabilities and 57/106 (53.8%) for those without disabilities. Suboptimal hygiene, dietary and feeding practices were reported. In conclusion, feeding difficulties were common in IBC, especially among children with disabilities. Supporting safe interactive mealtimes for children living within IBC should be prioritised, to ensure overall health and development. Key points: Feeding difficulties are common among children living in institution‐based care (IBC), particularly but not exclusively among those children with disabilities.Suboptimal feeding practices were common in IBC and encompassed inadequate hygiene, limited support for self‐feeding, reading children's feeding cues (especially around pacing and satiety), addressing feeding difficulties, such as difficulty chewing or swallowing. These should be prioritised in training and supervision for caregivers.Addressing the needs of this vulnerable group should include support for safe feeding techniques. These should be prioritised to help ease the transition into eventual family‐based care if we are to move towards deinstitutionalizing children and strengthening families. [ABSTRACT FROM AUTHOR]

Background: Weather and the susceptibility of children to SARS-CoV-2 infection is still a debated question particularly in view of important decisions regarding opening schools. Therefore, we planned this cross-sectional analysis of antiSARS-CoV-2 Immunoglobulin-G (IgG) antibodies in children with known household exposure to SARS-CoV-2. This serosurveillance, to find the presence of IgG antibodies among children of probable household exposure of confirmed COVID-19 cases will help in the better understanding of the immune response after COVID-19 infection/exposure. Aims and Objectives: The aim of the study was to investigate the prevalence of anti-SARS-CoV-2 antibodies in children among the families who had confirm case/cases of COVID 19 during the second wave of the COVID-19 pandemic. This study is designed as a cross-sectional serosurveillance study in Kota, Rajasthan India. Materials and Methods: Population-based serosurveillance among children with probable household exposure to confirmed COVID-19 cases who was admitted in Govt. Medical College attached COVID 19 dedicated hospital was carried out during October 2021 to December 2021 using the COVID IgG Antibody Detection Enzyme-Linked Immunosorbent Assay kits. Seropositivity among children was measured and with various other factors to understand the immunity status among COVID-19 cases. Descriptive statistical analysis done. Results: 156/1285 eligible candidates (19.53%) having a total of 251 household contacts of <17 years age group agreed to participate in study while rest of them refused. Anti-SARSCoV-2 IgG antibodies were present in 127/251 household contacts (50.59%). Among them maximum 28.68% of seropositive were from age group 11–17 years age, symptoms were observed in 29.13% IgG positive contacts, maximum seropositivity was seen when only one family member was hospitalized, 63% seropositivity was seen when primary relative of child was hospitalized as compared to secondary. Maximum seroreactivity (55.9%) was seen when the Chest CT score of index case was high, that is, 14–25. max reactivity was observed 76/127 (59.84%) when hospital duration of index case is <1 week. 118/127 (92.91%) of seroreactive children were found when the index case was unvaccinated or partially vaccinated. Conclusion: Seropositivity of 50.59% suggests that all the cases may not have IgG antibodies. Among the seronegative cases, the antibodies either not developed, or are undetectable, or have disappeared during the post COVID period. Seropositivity based on gender difference is statistically not significant. Proportion of positivity shows an increasing trend with increasing age among pediatric household contacts. Complete COVID-19 vaccination is an effective tool to minimize the disease frequency/severity. Severe disease patients with high CT score transmits the infection to household contacts more efficiently. [ABSTRACT FROM AUTHOR]

Background: To describe the clinical profile, risk factors, and outcomes that are associated with candida infection among critically ill children. Patients and methods: A retrospective case-control study wherein 109 children admitted to the pediatric intensive care unit (PICU) in the years between 2015 and 2017 with the growth of candida from blood, urine, endotracheal (ET) aspirate, and pus swabs were included and compared to 97 age and sex-matched controls chosen from the same time period. Results: Of the 124 candida isolates from 109 children, 37% were from blood, 24% from urine, and 14% in pus; 40% of the isolates were from ET aspirate. Candida non-albicans types (70%) predominated with Candida tropicalis causing 50% of the infections. Risk factors for candida infection were neutropenia [OR 20.01, 95% CI (0.94-422.32)], mechanical ventilation [OR 5.97, 95% CI (2.44-14.62)], peritoneal dialysis [OR 5.81, 95% CI (1.27-26.50)], institution of amino acids [OR 5.41, 95% CI (0.85-34.13)], presence of central venous catheter [OR 3.83, 95% CI (1.59-9.19)], antibiotic use >5 days [OR 3.58, 95% CI (1.38-9.29)]. Candida Cases (95.4%) had a septic shock with acute kidney injury in 34% and had significantly lower survival than controls [72 (66%) of 109 vs. 74 (80%) of 92] (p = 0.023). Conclusions: The rate of candida infection in our PICU was 4.2% of PICU admissions. The most common species was C. tropicalis. The independent risk factors for candida infection were neutropenia, antibiotic duration >5 days, peritoneal dialysis, amino acid administration, mechanical ventilation, and presence of a central venous catheter (CVC). [ABSTRACT FROM AUTHOR]

Background: The prevalence of stress in schoolaged children is reported to be an astonishing 88%. The literature supports an association between functional vision and stress. The objective of this study was to evaluate visual function skills and their association with stress in school-aged children in Mumbai. Methods:A cross-sectional study was conducted on students aged 9 to 15 years in Mumbai. Subjects with no history of ocular disease, surgery, trauma, systemic disease, or ocular or systemic drug use that might induce stress were included. Prediagnosed cases of depression, anxiety, and any systemic or ocular syndrome were excluded from the study. All subjects underwent detailed ocular examination that included slit lamp evaluation, subjective and objective refraction, and undilated retinal evaluation. Subjects were then assessed for colour vision, stereoscopic acuity, contrast sensitivity, and confrontation visual fields, followed by the Stress in Children (SiC) questionnaire. Results: One hundred subjects (mean age 12.3 ± 2.1 years) completed the study; 59% were females. Global mean score (GMS) showed a similar level of stress in females (1.95 GMS) and males (1.94 GMS). Increased stress was correlated with an increase (improvement) in the contrast sensitivity (r = 0.007) and stereo acuity (r = 0.096). GMS scores between astigmatism (2.11 ± 0.37), myopia (1.96 ± 0.24), emmetropia (1.94 ± 0.32), and hyperopia (1.81 ± 0.19) showed no statistical significance (p = 0.549) but were clinically significant. There was no difference found in colour vision and visual field throughout the sample population. Conclusions: Increase in stress was found to be correlated with an improvement in contrast sensitivity and stereo acuity. However, there were no changes found in colour vision and visual fields. Based on refractive error, those with astigmatism showed the highest level of stress, followed by myopia, emmetropia, and hyperopia, respectively. [ABSTRACT FROM AUTHOR]

Background: Estimating seroepidemiolgical prevalence of SARS-CoV-2 antibody is an essential public health strategy. There is insufficient evidence of prevalence among those belonging to young age population in India. Objective: To compare the SARS-CoV-2 seropositivity rate between children and adults in selected sites from India. Materials and Methods: This was a multicentric population-based seroepidemiological study conducted in selected urban and rural areas of five sites selected from four states (Delhi, Odisha, Uttar Pradesh, Tripura) of India. Participants aged ≥1 year were included from different clusters of each area. Total serum antibody against SARS-CoV-2 virus was assessed qualitatively by using a standard enzyme-linked immunosorbent assay (ELISA) kit.Results: Data collection period was from 15 March 2021 to 10 June 2021. Total available data was of 4509 participants, of whom 700 were <18 years of age and 3809 were ≥18 years of age. The site-wise number of available data among those aged 2–17 years was 92, 189, 165, 146 and 108 for the sites of Delhi urban, Delhi rural, Bhubaneswar rural, Gorakhpur rural and Agartala rural area, respectively. The seroprevalence was 55.7% in the <18 years age group and 63.5% in the ≥18 years age group. The prevalence among female children was 58% and among male children was 53%. Conclusion: SARS-CoV-2 seropositivity rate among children was high and comparable to that of the adult population. Hence, it is unlikely that any future third wave by prevailing SARS-CoV-2 variant would disproportionately infect children 2 years or older. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of the study were to characterize the clinical profile of childhood leprosy presenting at tertiary leprosy care hospitals in the states of Bihar, West Bengal and Uttar Pradesh in India, and to determine the possible risk factors associated with disabilities at presentation.Methods: Subjects were children with newly diagnosed leprosy registered for treatment at tertiary Leprosy Mission Hospitals in Muzaffarpur (Bihar), Purulia (West Bengal) and Faizabad (Uttar Pradesh), India, between June and December 2019. Demographic and leprosy characteristics were collected at the time of diagnosis. Parents/guardians were interviewed on reasons for delay in presenting at the hospital. Associations between various factors and delay in diagnosis were assessed.Results: Among the 84 children, the mean (SD) age was 10 (3) years with a range of 4-14 years. There were more boys (58%) and most children were currently in school (93%), resident in rural areas (90%) and belonged to a lower socioeconomic status (68%). More children were diagnosed with multibacillary leprosy (69%), one-third of them being skin smear positive for Mycobacterium leprae. On presentation, 17% had deformity (5% grade 1 deformity and 12% grade 2), 29% had nerve involvement and skin lesions were spread across the body in half of the children. Mean (SD) duration of delay was 10.5 (9.8) months. Delayed presentation was more in boys (43% vs. 17%; P = 0.01), those without a history of migration for work compared to those who had a history of migration (40% vs. 9%; P = 0.008) and in those children who were from a poor economic status compared with those that came from a better economic status (44% vs. 7%; P = 0.001) Limitations: Because our study was conducted at tertiary care hospitals, the findings are not representative of the situation in the field. Furthermore, a comparison group of newly diagnosed adult leprosy patients with disability could have been included in the study.Conclusion: Childhood leprosy continues to occur in endemic pockets in India and a substantial number present with skin smear positivity and deformity. Guardians of these children cite many reasons for the delay in presentation. [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]

Background: Gastrointestinal (GI) malformations have varied short-term and long-term outcomes reported across various neonatal units in India. Methods: This descriptive study was done to study the clinical profile, outcomes and predictors of mortality in neonates operated for congenital GI malformations in a tertiary neonatal care unit in South India between years 2011 and 2020. Details were collected by retrospective review of the case sheets. Results: Total of 68 neonates were included with esophageal atresia (EA) in 10, infantile hypertrophic pyloric stenosis (IHPS) in 9, duodenal atresia (DA) in 10, ileal atresia in 8, jejunal atresia in 5, anorectal malformations (ARM) in 11, meconium ileus/peritonitis in 9, malrotation in 2, and Hirschsprung's disease (HD) in 4. Antenatal diagnosis was highest in DA (80%). Associated anomalies were maximum in EA (50%), the most common being vertebral, anal atresia, cardiac defects, tracheoesophageal fistula, renal and radial abnormalities, and limb abnormalities association (VACTERL). Overall mortality was 15%. IHPS, DA, Malrotation, HD and ARM had 100 % survival while ileal atresia had the least survival (38%). Gestational age <32 weeks (odds ratio [OR] 12.77 [1.96, 82.89]) and outborn babies (OR 5.55 [1.01, 30.33]) were significant predictors of mortality in babies operated for small intestinal anomalies. None of the surviving infants were moderately or severely underweight at follow-up. Conclusion: Overall survival of surgically correctable GI anomalies is good. Among the predictors for mortality, modifiable factors such as in-utero referral of antenatally diagnosed congenital anomalies need attention. One-fifth had associated anomalies highlighting the need to actively look for the same. Although these neonates are vulnerable for growth failure, they had optimal growth on follow-up possibly due to standardized total parenteral nutritional policy during neonatal intensive care unit stay. [ABSTRACT FROM AUTHOR]

Linear IgA disease is a subepidermal autoimmune blistering disorder with linear IgA deposit along the basement membrane zone. Clinically it presents as tense blister surrounding erythematous plaques, the so-called 'crown of jewels'1 appearance. Many authors believe that linear IgA disease and bullous pemphigoid are two ends of same clinical spectrum.1 Mixed immunobullous disorder was the name given to IgA, IgG, C3 positivity. However, a linear pattern of IgA deposit in the basement membrane zone on direct immunoflorescence is the gold standard for diagnosis. The first line treatment consists of corticosteroid and dapsone. We report a unique case of 4-year-old Indian boy, having second degree consanguinous parents, who presented to our outpatient dermatology department with multiple moderately pruritic erythematous plaque and tense blisters over the previous 10-12 days. Most of the blisters appeared with the classical 'string of pearls' appearance over the perioral region, gluteal region, inner side of the thigh, palms, soles, penis, feet, hands and hard palate (Fig 1). The blister was ruptured by the boy himself during itching. It was his first episode. No family history of similar disease or drug history was present and the boy was vaccinated up to date according to the national immunisation schedule of India. A skin biopsy with 4 mm punch had been done and simultaneously he was started on 15 mg prednisolone (weight 11 kg) and 25 mg dapsone after doing G6PD report. His routine blood test showed eosinophillia and lymphocytosis. Other blood reports were within normal limits. HPE reports showed subepidermal bullaand many micro-abscesses in the dermal papillae containing neutrophils and eosinophils. DIF showed linear deposition of both IgG and IgA with IgG predominance and no C3 deposition. We diagnosed linear IgA dermatoses based upon its clinical features and HPE features despite IgG predominance. The patient responded drastically to dapsone and prednisolone. Within 11 days of starting medications the existing lesions healed with hypopigmentation and no new blisters appeared. Linear IgA disease or chronic bullous disorder is a rare bullous disorder of childhood characterised by linear IgA deposition at dermoepidermal junction. The major target antigen is the ectodomain of BP180. It has bifocal age predilection: in children it occurs between 6 months and 10 years and in adult after 60 years. Diagnosis is mainly based on HPE and immunological reports. We report this case for its uniqueness and to emphasise the fact that although the condition is termed linear IgA dermatoses it can present with IgG predominance; the disease course and response to treatment are the same as in IgA predominance, as shown here and as previously shown by Powell et al. [ABSTRACT FROM AUTHOR]

Background: Nutritional rehabilitation centers (NRCs) were established with the objective of providing institutional care to malnourished children and building the capacity of the primary caregivers of these children. Objectives and Methodology: The objective of this study was to assess the effect of nutritional interventional measures undertaken at NRCs in improving the nutritional status of admitted children; a retrospective facility-based descriptive study was conducted using the monthly performance reports (March 2015 to November 2019) of all NRCs in Dhamtari district, Chhattisgarh. Results: Of the 3171 children registered in the NRCs, the majority were 1--3 years of age (59.22%), female children (55.50%), and from Other Backward Class caste category (56.79%). The district records a cure rate of 56.12%, death rate of 0.03%, and defaulter rate of 4.71%, with an average length of stay being 16.5 days. NRCs of Dhamtari district had less than acceptable level of recovery/cure rate though death rate and defaulter rate were within acceptable standards. Conclusion: Lower cure rate along with lower defaulter rate and death rate with more than recommended length of stay reflects the below-average performance of the NRCs in the district. [ABSTRACT FROM AUTHOR]

Aim: The aim of our study was to study and compare the impact and efficacy of medical nutrition therapy (MNT) with that of the standard nutrition therapy(SNT) in children diagnosed with Severe thiness in the age group of 5-10 years and diagnosed as severely thin. Study Design: It was a prospective comparative study, conducted over a period of 18 months at the Nutrition Rehabilitation, Research and Training Centre (NRRTC) associated with a tertiary care hospital in India. Methods and Materials: A total of 113 children in the age group of 5 to 10 years with severe thinness were enrolled and divided into 2 groups-58 were placed in the MNT group and 55 in the SNT group for a period of 8 weeks. The children in both groups received MNT and SNT diet over the said period of 8 weeks. Primary outcome variables were weight gain and body mass index (BMI) (i.e., change in nutritional status). Results: At the end of 8 weeks, the rate of weight gain (gm/ kg/day) was significantly greater in the MNT group, that is, 2.35 gm/kg/day as compared with the SNT group, that is, 0.73 gm/kg/day, and the change in nutritional status was significantly better in the MNT group (p < 0.001) with 62.1% achieving normal nutritional status, 32.8% remaining thin, and 5.2% remaining severely thin as compared to the SNT group in which 9.1% achieved normal nutritional status, 65.5% remained thin, and 25.5% remained severely thin. Conclusion: To conclude, MNT is superior to SNT for the treatment of severe thinness (ST). [ABSTRACT FROM AUTHOR]

Context: Childhood injuries are a less explored area of public health. In the presence of public health problems such as communicable and noncommunicable diseases, childhood injury has gained less attention from the health system. Aims: The aim of the study was to assess the prevalence of various types of unintentional injuries (UI) amongst children and to assess the factors associated with same. Settings and Design: The study was conducted at Ahmedabad District of Gujarat State, and this is a cross-sectional sStudy. Subjects and Methods: The current study was a part of a multicentric national level research supported by Indian Council of Medical Research. Total 11 sites were selected across India, which all followed a uniform methodology. One of the selected sites was Dholka taluka of Ahmedabad district, Gujarat. This cross-sectional study was conducted in 2341 households. The study participants were children aged from 6 months up to 18 years. A total of 3018 children and their caretakers were interviewed using software-based questionnaire. Statistical Analysis Used: Statistical analysis was performed by frequencies and Percentage, Chi-square Test, Z-Test. Results: The overall prevalence of injuries was 7.62%. Gender and area of residence were significantly associated with UI. Fall-related injuries had the highest prevalence (3.38%), followed by road traffic injuries (RTI) (1.62%). The prevalence of burn-related injuries and poisoning was higher among females compared to males. No mortality was observed due to UI. Conclusions: Majority of the injuries were of minor or trivial type. Fall-related injury and RTI were the most common types of UIs among children. [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]

The article focuses on management of issues relating to marriage, mental illness, and Indian legislation.

Background: Acute respiratory distress syndrome (ARDS) associated with COVID-19 in children is not well described in the literature, so this study was designed to assess the severity, clinical course, different treatment measures, and outcome of this group of patients. Patients and methods: This descriptive study was performed by retrospective chart review of children admitted in pediatric intensive care unit (PICU) in the age-group of 1 month to 12 years over the period of 6 months (July--December 2020) in a tertiary care pediatric COVID facility in eastern India. Severity of ARDS, ventilator settings, oxygenation and laboratory parameters, and outcomes were documented. Predictors associated with severe ARDS were evaluated. Results: Among 128 laboratory-confirmed pediatric COVID-19 cases admitted in PICU, 18 (14%) developed ARDS, 6 (33.3%) had severe ARDS, and 3 (16.6%) succumbed to death. Outcome was measured by median hospital stay [20 days (IQR 19, 21)], PICU stay [13 days (IQR 10, 16)], and 28-day ventilator-free days [14 days (IQR 13, 22)]. Half (n = 9) of our study cohort had different comorbidities and congenital heart disease being the most common (4, 22.2%). Median positive end-expiratory pressure requirement was 10 cm H2O (9, 11) for invasively ventilated children (n = 13, 72.2%) along with peak inspiratory pressure of 24 cm H2O (20, 29) and mean airway pressure of 17 cm H2O (14, 20). Median oxygenation index was 13.3 (10.5, 18.6). Nine (69.2%) out of 13 intubated children had undergone prone ventilation. C-reactive protein (CRP) and D-dimer levels were significantly high in children with severe ARDS alongside pSOFA and lung USG score. Conclusion: Incidence of ARDS in pediatric COVID-19 though less but is not rare. Elevated CRP, D-dimer values, and high lung USG scores were associated with severe ARDS. Those who died had significant comorbidity. [ABSTRACT FROM AUTHOR]

Aim: The aim is to study the impact of nutritional status on outcomes and treatment-related complications in patients of neuroblastoma. Materials and Methods: Anthropometry (height, weight, weight for height [in <5 years], mid-arm circumference [MAC] [in <5 years], and body mass index [BMI]), hemoglobin level, and serum albumin level were recorded. Results: Twenty-four neuroblastoma patients, 16 males and 8 females, with a mean age of 42.7 months were treated and followed up over a period of 0.03–170 months. Of 24 patients, 16 survived (complete response - 9, partial response - 2, no response - 2, progressive disease - 3). Height <2 standard deviation [SD] was seen in 12.5% (3/24). Mortality and complications were found in 66.7% (2/3) and 100% (3/3), respectively. Weight <2SD was seen in 37.5% (9/24). Mortality and complications were found in 33.3% (3/9) and 67% (6/9), respectively. Weight for height <2 SD was seen in 35% (7/20). Mortality and complications were found in 42.9% (3/7) and 71.4% (5/7), respectively. MAC <2 SD was seen in 15.8% (3/19). Mortality and complications were found in 66.7% (2/3) and 66.7% (2/3). BMI <2SD was seen in 29.2% (7/24). Mortality and complications were found in 42.8% (3/7) and 28.6% (2/7). Anemia was seen in 62.5% (15/24), of which nine survived. Complications were seen in 58.3% (14/24) (P = 0.001). Hypoproteinemia was seen in 20.8% (5/24). Mortality and complications were 40% (2/5) and 80% (4/5). Conclusion: Neuroblastoma has poor outcome in Indian children, and there does not appear to be a major role played by nutrition in determining the response to treatment and survival. [ABSTRACT FROM AUTHOR]

Background: The role of children in transmitting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is difficult to ascertain and the consequences remain unclear. This is necessary for public health or infection control purposes. The objective of this study was to describe the epidemiological, month-wise trends and clinical characteristics of coronavirus disease 2019 (COVID-19) infection among children in a tertiary care hospital. Materials and Methods: A cross-sectional study was performed on all pediatric samples of suspected cases of SARS-CoV-2 infection. The samples were received from the adjoining districts and our Institution in the Department of Microbiology from June to November 2020. Cases were then confirmed by real-time reverse transcriptase-polymerase chain reaction. Results: Of the total 62,030 pediatric samples tested, 847 (1.3%) were SARS-CoV-2 positive. The majority of positive cases were between the ages of 11–15 years. The median age of confirmed patients was 14 years. The male to female ratio was 1.5:1. Infants represented 1.6% of the positive cases. About 62.1% of all positive cases were asymptomatic. Childhood cases increased from June 2020 and peaked in September 2020 before declining. Conclusion: Children of all ages appeared susceptible to COVID-19 and accounted for a very small proportion of confirmed cases. Mostly, children were found to be asymptomatic. Young children can be important transmitters of SARS-CoV-2 infection in the general population. This population can be important for targeting immunization efforts throughout a rapidly evolving situation. Our findings provide further evidence of the distribution of infection in children and the transmission of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study is to assess parents' experiences and associate demographic characteristics of parents and children with temper tantrum behavior characteristics of preschool children. Methods: A descriptive survey approach was used to conduct this study. A non-probability purposive sampling technique was adopted to recruit 121 parents of children aged between 3-6 years visiting a selected tertiary care hospital in India. All parents completed the parents' experience of temper tantrums in the children's questionnaire. The analysis of results was carried out on IBM SPSS Software version 23.0. Results: A moderate level of temper tantrums showed on the mother's age, education, occupation, marital status, program attendance, and medical and mental illness in the family, whereas a family's monthly income above 50,000 indicated a severe level of temper tantrums, and half of the children experienced tantrum behavior to get the attention of their parents, hungry and tired. The most frequently reported tantrum behavior was throwing things and hitting parents and siblings, and most tantrums occurred in public places and in vehicles. The majority of the parents adopted strategies to distract their child's attention by helping the child talk about the causes of anger. A significant association was found between temper tantrum behavior and demographic characteristics of the marital status of parents (x2 = 15.340, p = 0.002) and the awareness program attended regarding temper tantrums in children (x2 = 4.491, p = 0.034). Conclusion: As temper tantrums peak in the toddler age group, the present study found that parental involvement is a necessity to manage temper tantrums in preschoolers as well. The main parent's strategies to control the tantrum were distraction of child attention and helped them to talk about the causes of tantrum. Therefore, the study emphasizes the necessity of the involvement of parents and family members. [ABSTRACT FROM AUTHOR]

Introduction: Viruses are common etiological agents of severe acute respiratory illness in under five children. Very few studies are available considering the profile of children with viral pneumonia admitted to paediatric intensive care unit (PICU) in our setting. Hence this study was done to describe the clinico- radiological profile and outcome of children diagnosed with viral pneumonia admitted to PICU. Methods: This was a retrospective descriptive study done in the PICU of a tertiary care hospital in South India. The presenting clinical features, blood parameters, chest radiography findings, course during the hospital stay and outcome of children with viral pneumonia (RT- PCR Positive) admitted to PICU were studied. Results: The aetiological profile of 28 children included - Influenza virus - 14 cases, Respiratory Syncytial Virus - 6 cases, Adeno virus - 4 cases, Human Boca virus - 2 cases, Human Rhino Virus - 1 case and Human metapneumo Virus - 1 case. Majority of children (50%) presented with severe respiratory distress. Predominant radiological picture included bilateral interstitial infiltrates followed by patchy alveolar consolidation. Eight children required mechanical ventilation. Complications included septic shock and MODS (n = 5), pneumothorax (n = 2), myocarditis (n = 2), pleural effusion (n = 1), ventilator associated pneumonia (n = 2) and pulmonary artery hypertension (n = 2). Mortality was observed in seven (25%) children. SpO2 / FiO2 ratio < 300, shock at admission, neutrophil leucocyte ratio > 2 and hypoalbuminemia were found to be significant predictors of mortality. Conclusions: Malnutrition and iron deficiency analmia were the common risk factors. Patchy alveolar consolidation is also a common radiological finding along with interstitial infiltrates. Hypoalbuminemia was a common finding among non-survivors [ABSTRACT FROM AUTHOR]

Background: Despite concentrated global efforts to bring about reduction in malnutrition among children, it continues to remain a public health concern, especially in developing countries such as India. While substantial reduction in the levels of stunting has taken place over the years, high levels of variation exist in distribution of stunting across the country. Objective: The study aimed to identify the determinants of stunting in early childhood and their contribution to change in levels of stunting across India. It also compared the socioeconomic disparity in the levels of stunting and changes therein over the last decade. Methods: The study utilizes data from the National Family Health Survey (NFHS-3 and NFHS-4) on children aged under-2 years. Bivariate and multivariate logistic regression identified determinants of early childhood stunting followed by Oaxaca decomposition model to assess the contribution of each of the factors to reduction in levels of stunting over the years. Concentration index was used to study the socioeconomic disparity in early childhood stunting. Results: Nearly 19% decrease in early childhood stunting can be attributed to increase in institutional deliveries, 14% to increase in maternal schooling, and 10% to improvement in maternal body mass index. In spite of an overall decrease, very little change is seen in socioeconomic disparity of childhood stunting. Conclusions: The study identifies institutional deliveries, maternal schooling, and maternal health as major contributors of decrease in early childhood stunting. It identifies persisting socioeconomic disparity in childhood stunting over the last decade. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic pseudocysts (PPCs) and walled-off necrosis (WON) in children following acute pancreatitis are uncommon. The various modalities of therapy possible are conservative treatment, external drainage, endoscopic stenting, and internal surgical drainage procedures. There are no existing guidelines for the management of PPC in children. We evaluate the outcomes of laparoscopic cystogastrostomy (LCG) performed at our center. Materials and Methods: Eight children (median age: 10 years) underwent LCG for large PPC (median size: 12.5 cm). There were seven patients with PPC and one with WON. Seven underwent LCG by a transgastric approach and one underwent LCG by a retrogastric approach. Results: Seven out of the eight patients had complete resolution of symptoms and the PPC. The median follow-up period was 32 months (interquartile range: 9.5–55.5 months). There were no conversions. There was one patient with a WON who developed a recurrence. Conclusion: LCG is a safe and effective treatment option for large PPC/WON in children. A posterior retrogastric approach, when indicated, is a safe approach with a comparable outcome. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was o define the preoperative diagnostic clinical and radiological features in girls with congenital pouch colon (CPC). Materials and Methods: Records of 47 girls with CPC, managed from 1996 to 2018, were reviewed. There were two age groups: Group A (newborn to 12 months; n = 26) and Group B (>12 months to 20 years; n = 21). The important clinical and radiologic features to help in a preoperative diagnosis were noted. Results: The most common subtype was Type II (57.4%), followed by Type I (23.4%) and Type III (12.8%). The features common to both the groups were abdominal distension (A = 53.8%; B = 9.52%), severe perineal excoriation (A = 19.2%; B = 23/8%), and urinary incontinence (A = 30.7%; B = 85.7%). In addition, in Group B, fecaloma on abdominal palpation was noted in 28.6% of patients. The characteristic appearance of the perineum including external genitalia and findings on plain abdominal X-ray (AXR) were 100% accurate and hence diagnostic. These unique features helped us formulate an algorithm for preoperative diagnosis of this uncommon form of anorectal malformation in girls seen in North India. Conclusions: The characteristic features on clinical examination should alert one to the presence of CPC in the outpatient clinic. The AXR was diagnostic in 100% of cases and is mandatory. If any doubt persists, examination of the genitalia under anesthesia with more retraction of the labial folds and endoscopy can be performed for confirmation. These measures should enable a clinician to make an accurate preoperative diagnosis in every girl with CPC. [ABSTRACT FROM AUTHOR]

Purpose - This study was carried out to ascertain parents' attitude about reading related activities of children, to discover parents' efforts for instilling the reading habit in their children, to understand the challenges faced by parents in inculcating reading habit in their children, and to suggest possible solutions to the parents' difficulties related to their children's reading habits. Design/Methodology - The research was conducted using the Survey method, with Focus Group Discussion used as the data collection tool. The research sample was 24 parents of pupils who were studying in the primary and secondary Marathi medium schools in Nashik district. An anonymous data was collected Qualitative descriptive analysis was carried out of the collected data. Findings - It was observed that parents knew that pleasure reading was important for the overall behavioral development of their children. However, less than half of them performed any substantial activities to instill the reading habit in their children. Children's excessive usage of the internet, time constraints, children's disinterest in reading, and parents' incognizance about the effective reading material were the main challenges faced. Originality/Value - This study is one of the first one of its kind in the Indian scenario. Uniquely collecting parents' real experiences through focus group interviews, this paper provides concrete solutions to the difficulties of parents in inculcating reading habits among their children. [ABSTRACT FROM AUTHOR]

Background: Chronic suppurative otitis media (CSOM) is a major health problem throughout the world in underdeveloped and developing countries including India. The present study was conducted to assess the risk factors of chronic suppurative otitis media in children. Materials & Methods: 320 patients of chronic suppurative otitis media of age ranged 6-15 years of both genders were included. Otoscopic examination was done. Pure tone audiometry was performed. Clinical risk factors and predisposing factors were recorded. Results: There were 180 males and 140 females. Families with >5 children were seen in 32%, smoking father in 41%, illiterate mother in 21%, bathing in dirty pond water in 17%, family history of ear discharge in 22% and living in congested houses in 15%. Socioeconomic status (SES) was lower in 14%, upper‑lower in 46%, lower‑middle in 30%, upper‑middle in 4%, high in 6%. Other risk factors were upper respiratory infection in 2%, nasal allergy in 4%, chronic tonsillitis in 12% and sinusitis in 7%. Conclusion: Common risk factors for CSOM in children were families with >5 children, smoking father, illiterate mother, bathing in dirty pond water, family history of ear discharge and living congested houses. [ABSTRACT FROM AUTHOR]

BACKGROUND: Multi-transfused thalassemic children are at higher risk of acquiring transfusion-transmitted infections (TTIs). There are limited data available on TTIs among thalassemic children, especially on its impact on their quality of life (QoL). AIM: The aim of this study is to find out the proportion of multi-transfused β-thalassemia major (β-TM) children suffering from TTIs, its risk factors and impact on QoL. METHODS: This was a hospital-based, analytical observational study, cross-sectional in design, conducted among 328 β-TM children and their caregivers attending thalassemia day care unit of a medical college during May 2015–April 2016, with a structured schedule. Data were analyzed with appropriate statistical methods using the Statistical Package for the Social Sciences. RESULTS: Two-fifth (39.9%) of them were found to have TTIs with hepatitis C being the most common (34.5%), followed by hepatitis B (4.5%) and human immunodeficiency virus (1.8%). In the multivariable model, place of residence (adjusted odds ratio [AOR] – 2.23 [1.19–4.17]), per capita monthly family income (AOR – 1.84 [1.10–3.07]), and blood transfusion frequency (AOR – 1.19 [1.10–1.29]) were significant predictors of TTIs adjusted with their age, age at diagnosis, last pretransfusional hemoglobin level, size of spleen, and caregivers knowledge regarding the disease. The study participants with TTIs had a lower QoL compared to others as there were significant differences in between the total QoL scores ([49.9 ± 15.6 vs. 57.4 ± 15.5], P ≤ 0.001) and its various domains. CONCLUSION: There was high burden of TTIs among multi-transfused β-TM children and it has significant negative impact on their quality of lives. [ABSTRACT FROM AUTHOR]

Nutritional status during preschool period is a paramount importance because of their rapid growth and this period is the foundation for lifetime health, strength and intellectual vitality. Given the above fact, present review has been undertaken to get an impression of the overall MUAC based undernutrition and sex variation of undernutrition among the preschool children of India as recommended by WHO guideline. International and national databases were searched using Google search engine, and PubMed etc. This review showed that the prevalence of MUAC based undernutrition was very high among the preschool children of India. It is recommended that the policy maker may implement measurement of MUAC at primary health care level to identify severe and moderate acute malnutrition as measurement of MUAC is a very simple and very much inexpensive and non-invasive method to assess nutritional status among the young children. [ABSTRACT FROM AUTHOR]

One of the important aspects of today's research in the area of public health is the nutritional health of children populations which has been suffering from decades and now became a burning issue in public health. Scholars worldwide appointed themselves to understand the role of multiple factors working behind it such as demographic imbalance, socio-economic factors, food impurity, parental unconsciousness etc. Likewise, the present study is a small attempt to understand the nutritional health of the children of a particular population, residing in a peri-urban region of North 24 Parganas district, West Bengal, India, in light of maternal knowledge and practices regarding child's health and nutrition. A total of 96 under-five children have been accounted for in this study through random sampling from the ICDS centers of Madhyamgram town. Data on children's HAZ, BAZ, birth weight and maternal knowledge and practices has been collected through anthropometric measurements of children and interviews of mothers. Study reveals that according to HAZ they are in a satisfying condition as their prevalence percentage in low HAZ shows 3.12% but in case of low BAZ, the prevalence percentage shows unsatisfactory result (36.46%) as found in case of low-birth-weight (39.58%). The study also found insignificant association between children's socio-economic background and their nutritional failure but found some disparity among maternal knowledge and its practices. The study concludes that the studied children population is in unsatisfying nutritional condition only in terms of their BAZ which might be the result of inconsistency in the knowledge and it's practices of mothers. [ABSTRACT FROM AUTHOR]

Objective: To study impact of COVID-19 pandemic on frequency, clinical/electrophysiological profile and treatment outcomes in pediatric Guillain-Barré syndrome (GBS). Background: GBS is the most frequent cause of pediatric acute flaccid paralysis. The effect of the COVID-19 pandemic on pediatric GBS is unclear in the literature. Methods: We conducted an ambispective, multicentric, cohort study involving 12 of 27 centres in GBS Consortium, during two periods: pre-COVID-19 (March-August 2019) and during COVID-19 (March-August 2020). Children <12 years who satisfied National Institute of Neurological Diseases and Stroke criteria for GBS/variants were enrolled. Details pertaining to clinical/laboratory parameters, treatment and outcomes (modified Rankin Scale (mRS) at discharge, GBS Disability score at discharge and 3 months) were analysed. Results: We enrolled 33 children in 2019 and 10 in 2020. Children in 2020 were older (median 10.4 [interquartile range 6.75-11.25] years versus 5 (2.5-8.4) years; P = 0.022) and had more sensory symptoms (50% versus 18.2%; P = 0.043). The 2020 group had relatively favourable mRS at discharge (median 1 (1-3.5) versus 3 (2-4); P = 0.042) and GBS disability score at 3 months (median 0 (0-0.75) versus 2 (0-3); P = 0.009) compared to 2019. Multivariate analysis revealed bowel involvement (P = 0.000) and ventilatory support (P = 0.001) as independent predictors of disability. No child in 2020 had preceding/concurrent SARS-CoV2 infection. Conclusions: The COVID-19 pandemic led to a marked decline in pediatric GBS presenting to hospitals. Antecedent illnesses, clinical and electrophysiological profile of GBS remained largely unchanged from the pre-pandemic era. [ABSTRACT FROM AUTHOR]

Introduction: Renal dysfunction and progression to end stage renal disease is well known in human immunodeficiency virus (HIV) infection. We studied the role of microalbuminuria and urinary NGAL levels in children with HIV infection for the prediction of renal dysfunction. Design and Methods: A cross-sectional study was carried out and 60 HIV infected children, aged (18 months to 15 years) were screened for microalbuminuria by nephelometry and for uNGAL by ELISA. Thirty healthy children were screened for uNGAL for normative data in Indian children. Results: The prevalence of microalbuminuria in studied population was 3.3%. The mean uNGAL and uNGAL/creatinine in study population was higher than controls (26.94 ± 93.12 ng/ml vs. 88.94 ± 345.20 mcg/g, and 15.53 ± 37.52 ng/ml vs. 30.12 ± 78.66 ng/ml; P = 0.003, P = 0.002). Children with lower CD4 counts had significant higher mean Albumin Creatinine Ratio (ACR) and mean uNGAL; P = 0.03, P = 0.01. Conclusions: uNGAL and urine microalbumin are useful biomarkers of early tubular and glomerular injury in children with HIV infection. [ABSTRACT FROM AUTHOR]

Hepatitis A virus (HAV) infection is one of the important causes of hepatitis in developing countries. It is transmitted through feco-oral route. This poses major health problems in children. Serum samples of the patients from pediatrics department suspected of acute viral hepatitis presenting with clinical features like fever, nausea, vomiting, and jaundice werecollected and analyzed by using commercially available mini VIDAS 307 (Biomeriux) to detect anti HAV IgM antibodies. A nine months prospective study was conducted in the Department of Microbiology and immunology of Shri Guru Ram Rai Institute of Medical and health science Dehradun, India. Of the 47 serum samples received during the study period, 23 (48.93%) were found tobe positive for anti-HAV IgM (VIDAS 307 Biomeriux). The prevalence was found to be more in male patients than in female patients, that is, 14 (60.8%) and 9 (39.13%) respectively, and was predominantly seen in the 5-10 years of the age group (60%). Peak cases were found in the month of October and November. The study showed a high positivity (48.93%) of HAV in this sub-Himalayan region indicating the role of preventive measures including safe drinking water, improved sanitation and vaccination in preventing infection. Thus, detection of anti-HAV IgM becomes the cornerstone entity for diagnosis. [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]

Aim: To study the effect of vitamin D supplementation in severity and control of bronchial asthma in children in Bihar region Methods: A cross-sectional, prospective study was conducted in the Department of pediatrics, Vardhman institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for 1 year, after taking the approval of the protocol review committee and institutional ethics committee. 53 asthmatic patients and 53 healthy controls were included in this study. The level of serum vitamin D in both groups was measured by radioimmunoassay (RIA) method at the reference lab and was categorized as sufficient (> 30 ng/ml), insufficient (20 to 30 ng/ml), or deficient (< 20 ng/ml). The severity of asthma was also stratified according to the asthma guideline into four grades of intermittent or mild, moderate, severe persistent. Results: Regarding rate of admission, 13.2% of patients were hospitalized once, 9.4% of patients were hospitalized twice, and 1.9% of them were also hospitalized three times. In the patients group and regarding the severity of asthma, 11.3% were classified as mild asthma, 45.3% as moderate asthma, and 43.4% as severe asthma. Also regarding control status of asthma, the disease was controlled in 18.9 %, partially controlled in 34.0 %, and uncontrolled in 47.2 %. According to the level of disease attack risk, 5 of 31 children aged less than 5 years (16.1%) classified as high-risk, while 7 of 22 children older than 5 years (31.8%) classified as high risk. Assessing the serum level of vitamin D showed that the asthmatic children had significantly lower level of vitamin D compared to normal cases (14.53 ± 8.10 ng.ml versus 22.45 ± 13.46 ng/ml, p < 0.001). Also, in the groups with and without asthma, the prevalence of vitamin D deficiency was 73.6 and 49.1%, and the prevalence of vitamin D insufficiency was 18.9 and 18.9 %, while normal vitamin D level was revealed in 7.5 and 32.1%, respectively with a significant difference (p = 0.005). In this regard, mean serum level of vitamin D in the patients with mild asthma was 12.85 ± 7.06 ng/ml, in the group with moderate asthma was 16.98 ± 8.63 ng/ml, in the patients with severe asthma was 12.42 ± 7.52 ng/ml, and in those with persistent asthma was 12.01 ± 5.00 ng/ml (p = 0.25). Conclusion: Vitamin D deficiency and insufficiency is a common finding among asthmatic children that may be associated by the physiological mechanism of this phenomenon. In fact, it seems that the use of supplement vitamin D can prevent progression of childhood asthma. [ABSTRACT FROM AUTHOR]

Background: Uttar Pradesh (UP), India continues to have a high burden of mortality among young children despite recent improvement. Therefore, it is vital to understand the risk factors associated with under-five (U5) deaths and episodes of severe illness in order to deliver programs targeted at decreasing mortality among U5 children in UP. However, in rural UP, almost every child has one or more commonly described risk factors, such as low socioeconomic status or undernutrition. Determining how risk factors for childhood illness and death are understood by community members, community health workers and facility staff in rural UP is important so that programs can identify the most vulnerable children.Methods: This qualitative study was completed in three districts of UP that were part of a larger child health program. Twelve semi-structured interviews and 21 focus group discussions with 182 participants were conducted with community members (mothers and heads of households with U5 children), community health workers (CHWs; Accredited Social Health Activists and Auxiliary Nurse Midwives) and facility staff (medical officers and staff nurses). All interactions were recorded, transcribed and translated into English, coded and clustered by theme for analysis. The data presented are thematic areas that emerged around perceived risk factors for childhood illness and death.Results: There were key differences among the three groups regarding the explanatory perspectives for identified risk factors. Some perspectives were completely divergent, such as why the location of the housing was a risk factor, whereas others were convergent, including the impact of seasonality and certain occupational factors. The classic explanatory risk factors for childhood illness and death identified in household surveys were often perceived as key risk factors by facility staff but not community members. However, overlapping views were frequently expressed by two of the groups with the CHWs bridging the perspectives of the community members and facility staff.Conclusion: The bridging views of the CHWs can be leveraged to identify and focus their activities on the most vulnerable children in the communities they serve, link them to facilities when they become ill and drive innovations in program delivery throughout the community-facility continuum. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to describe the clinico-virological profile, treatment details, intensive care needs, and outcome of infants with acute viral bronchiolitis (AVB). Methodology: In this prospective observational study, 173 infants with AVB admitted to the pediatric emergency room and pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during November 2019 to February 2020 were enrolled. The data collection included clinical features, viruses detected [respiratory syncytial virus (RSV), rhinovirus, influenza A virus, parainfluenza virus (PIV) 2 and 3, and human metapneumovirus (hMPV)], complications, intensive care needs, treatment, and outcomes. Multivariate analysis was performed to determine independent predictors for PICU admission. Results: Most common symptoms were rapid breathing (98.8%), cough (98.3%), and fever (74%). On examination, tachypnea (98.8%), chest retractions (93.6%), respiratory failure (84.4%), wheezing (49.7%), and crepitations (23.1%) were observed. RSV and rhinovirus were the predominant isolates. Complications were noted in 25% of cases as encephalopathy (17.3%), transaminitis (14.3%), shock (13.9%), acute kidney injury (AKI) (7.5%), myocarditis (6.4%), multiple organ dysfunction syndrome (MODS) (5.8%), and acute respiratory distress syndrome (ARDS) (4.6%). More than one-third of cases required PICU admission. The treatment details included nasal cannula oxygen (11%), continuous positive airway pressure (51.4%), high-flow nasal cannula (14.5%), mechanical ventilation (23.1%), nebulization (74%), antibiotics (35.9%), and vasoactive drugs (13.9%). The mortality was 8.1%. Underlying comorbidity, chest retractions, respiratory failure at admission, presence of shock, and need for mechanical ventilation were independent predictors of PICU admission. Isolation of virus or coinfection was not associated with disease severity, intensive care needs, and outcomes. Conclusion: Among infants with AVB, RSV and rhinovirus were predominant. One-third infants with AVB needed PICU admission. The presence of comorbidity, chest retractions, respiratory failure, shock, and need for mechanical ventilation independently predicted PICU admission. [ABSTRACT FROM AUTHOR]