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The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6–59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS‐4 [2015–2016] and NFHS‐5 [2019–2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference‐in‐differences (DID) approach. Utilization of ICDS increased from 58% in 2015–2016 to 71% in 2019–2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%–12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6–59 months in this period. Key messages: Utilization of ICDS services among children aged 6–59 months increased from 58% (2015–2016) to 71% (2019–2021) nationally. The programme's expansion was prominent in urban areas, showcasing progress across states.The prevalence of underweight among children in India declined by 5 percentage points from 2016 to 2021, but almost one‐third of children are still underweight.Increase in coverage and service delivery strengthening of ICDS explained 9%–12% of the observed reduction in underweight between 2016 and 2021.The findings suggest that optimizing quality of interventions under ICDS can have a modest but meaningful contribution in reducing childhood underweight in India. [ABSTRACT FROM AUTHOR]

INTRODUCTION India has unique tobacco-free film and TV rules designed to prevent tobacco uptake. In this study, we examined the potential influence of exposure to smoking imagery in regionally famous films, on susceptibility to smoke in teenagers enrolled in schools in a district in Southern India. METHODS A longitudinal survey of students, in grades 6 to 8 at baseline in 2017 and grades 7 to 9 one year later in 2018, ascertained prospective incident susceptibility to smoking during the study period in relation to baseline exposure to 27 locally popular films with actual or implied smoking imagery. RESULTS We analyzed linked data from 33676 participants, and 3973 (11.8%) of the adolescents reported incident susceptibility. There was a significant increase in susceptibility to smoking with increasing exposure at baseline to smoking imagery in films on univariable analysis, highest tertile of exposure relative to no exposure (OR=1.4; 95% CI: 1.0 -2.1, ptrend<0.001), and this trend remained significant (p=0.022) after mutual adjustment for recognized confounders, highest vs no exposure (AOR=1.3; 95% CI: 0.9-1.8). We found no statistically significant association between exposure to tobacco-free film rules and change in susceptibility. CONCLUSIONS Prospectively, watching films featuring smoking imagery increases adolescents' vulnerability to smoking. Further research revealed no difference in susceptibility change between youth who saw partially compliant films and those who watched non-compliant films. Our findings, thus, underscore the need to incorporate comprehensive approaches to prevent the inclusion of smoking imagery in films. [ABSTRACT FROM AUTHOR]

Introduction: Mid-upper arm circumference (MUAC) measures the arm muscle and fat area. The use of MUAC as a screening measure for assessing undernutrition has the following advantages; it makes use of a simple equipment, is easy to carry at the field sites, and requires minimal training. In India, "mid-upper arm circumference" is widely used and accepted in many nutritional programs. Objectives: This study was conducted with the primary objective to compare different anthropometric parameters of children and to validate the usefulness and limitations of MUAC to screen out undernourished children. Subject and Methods: Anthropometric measurements were recorded for all the anganwadi centers of the selected sub-center that comes under the field practice area of our department. The measurements like weight, height, MUAC were done according to the standard guidelines as per WHO, and further, calculations were done with the help of "Anthro software 3.2.2." Comparisons were done between categorization of MUAC tape and Weight-for-Height Z-scores (WHZ), and hence, the sensitivity and specificity of the MUAC tape to screen the malnourished child were found out. Results: Sensitivity of MUAC to categorize a child in red/yellow was only 9.03%, negative predictive value (NPV) was 40.75%, specificity came 95.10%, and positive predictive value was 73.68% on taking WHZ as the gold standard. Conclusion: MUAC has a limited role in screening out an undernourished child (red/yellow category), whereas it has a good role in screening healthy children (green category). [ABSTRACT FROM AUTHOR]

Malnourished children are at higher risk of mortality and morbidity following diarrheal illness and certain enteropathogens have been associated with malnutrition in children. Very few studies have comprehensively looked at the etiology of diarrhea in malnourished children and most have used conventional diagnostic methods with suboptimal sensitivity. We used a highly sensitive molecular approach against a broad range of pathogens causing diarrhea and examined their association with malnutrition. In addition, we looked at the pathogen diversity of pediatric diarrhea, three years after the nationwide rotavirus vaccine introduction to understand the evolving landscape of pathogens, which is crucial for planning strategies to further reduce the diarrhea burden. Clinical details and diarrheal stool samples were collected from hospitalized children aged < 5 years from three sentinel sites in India for a period of one year. The samples were tested by qPCR for 16 established causes of diarrhea using TaqMan Array Cards. A total of 772 children were enrolled, from whom 482 (62.4%) stool specimens were tested. No specific pathogen was associated with diarrhea among children with acute or chronic malnutrition compared to those with better nutritional status. Overall, adenovirus was the leading pathogen (attributable fraction (AF) 16.9%; 95% CI 14.1 to 19.2) followed by rotavirus (AF 12.6%; 95% CI 11.8 to 13.1) and Shigella (AF 10.9%; 95% CI 8.4 to 16.4). The majority of diarrhea requiring hospitalization in children aged < 2 years could be attributed to viruses, while Shigella was the most common pathogen among children aged > 2 years. These data on the prevalence and epidemiology of enteropathogens identified potential pathogens for public health interventions. [ABSTRACT FROM AUTHOR]

Background and Aim: Postural stability is monitored by a circuitous system, particularly visual perception, vestibular apparatus, and somatosensory organs. The ability to maintain balance is significantly compromised in children with visual impairment and has higher risks of falls than the normal sighted children. Children with visual disability reported delayed motor dexterity such as eye-hand coordination, gross and fine motor control involving struggle in gait procurement and postural control. Vestibular rehabilitation is the relevant therapy to restitute for maintaining postural control in the absence of visual information. This study aimed to find the effect of vestibular rehabilitation on postural stability in children with visual impairment. Methods: A quasi-experimental study was done in pre and post-test type design on 30 boys in the age group of 7-16 years' children with visual impairment. Vestibular rehabilitation therapy was used as the exercise protocol to improve functional balance and reduction of falls in children with visual impairment for six weeks. Results: Statistical analysis was done between pre-test and post-test readings with SPSS 20 and there is a significant difference between the pre-test and post-test of total score and individual scores of Pediatric Balance Scale (PBS) after the intervention, since (p<0.05). Conclusion: Vestibular rehabilitation therapy improved the capability of postural controlling and reduces the risk of falls to an extent in children with visual impairment. [ABSTRACT FROM AUTHOR]

Background: Undernutrition is an important public health problem affecting one-third of under five-year-old children in India. Objectives: To assess the nutritional status of under five-year-old children along with child feeding practices. Materials and Methods: We adopted a systematic sampling procedure to carry out this community-based, cross-sectional study in all the districts of Haryana. Data was collected on socioeconomic and demographic particulars along with anthropometric measurements. Analysis was done using SPSS Windows 23. Results: The overall prevalence of stunting, underweight, and wasting was 34%, 27.5%, and 11%, while that of severe undernutrition was 11%, 8%, and 3%, respectively. The odds of underweight were significantly higher among children of the Muslim religion, children of scheduled caste, children of illiterate mothers, lower per capita income, HHs without electricity, landless HHs, low birth weight, no ANC care, and those early ages at complementary feeding. Stunting was significantly higher among children whose mothers were illiterate, children whose fathers were laborers, among landless HHs, with no separate kitchen and lower birth weight, while wasting was higher among children of Muslim religion, children of scheduled caste, with no sanitary latrine facility, low-birth-weight children and early initiation of complementary feeding. Conclusions: Undernutrition is observed to be associated with religion, community, education of mother, per capita income, land holding status, birth weight, and age at complementary feeding. Thus, improving maternal nutrition can improve birth weight, improving maternal knowledge about child feeding, and the household's socio-economic status may improve the nutritional status of children. [ABSTRACT FROM AUTHOR]

Background: Identification of mental health disorders during childhood is crucial for healthy 'adult roles' in the society, so this study aimed to estimate the magnitude of 'any mental health disorder' and to find out its correlates among children attending the pediatric out-patient department (OPD) of a medical college in West Bengal and to estimate parental stress among their parents. Materials and Methods: It was a descriptive cross-sectional study done in the pediatric OPD of Burdwan Medical College, West Bengal, during July--December, 2021. The calculated size of 288 children aged between 4 and 12 years and attending with either of their parents was selected through systematic random sampling. One of their parents (preferably mother) was interviewed using a schedule, containing a pre-validated pediatric symptom checklist and parental stress scale. Ethical clearance was obtained from the Institutional Ethics Committee. Data were analyzed using SPSS-v23. Results: The median age of the children was 7 years (5--8 y.). The majority of them were male (57.6%), lived in urban areas (59.0%), and lived in joint families (57.6%). One-fifth (20.5%) of the children were found to have any mental health disorder (AMHD). Living in an urban area (aOR = 2.5, 95% CI: 1.1--5.7), belonging to a nuclear family (aOR = 3.6, 95% CI: 1.7--8.1), and belonging to a family with social problems (aOR = 7.8, 95% CI: 2.3--27.2) were significant correlates of AMHD. Parental stress [median: 60 (55--63)] was found significantly higher (P < 0.001) among parents of children with AMHD as compared to the parents of others. Conclusion: The magnitude of AMHD was high in this study, indicating toward the necessity of implementing opportunistic screening and appropriate public health action. [ABSTRACT FROM AUTHOR]

Objectives: The present study examined the clinical profile of COVID-19, related morbidity and mortality in children at a tertiary care hospital in Uttarakhand. Understanding the clinical profile of the disease in this specific population is vital for better preparedness and targeted interventions to safeguard the health of children during future outbreaks. This is the first study from this region in this Methods: The present study was a hospital based observational study carried out on patients aged 1 month-18 years who tested covid-19 positive and were admitted to Department of Pediatrics at a tertiary care center in Garhwal region of Uttarakhand during study period July 2020 to May 2023 after getting ethical clearance from Institutional Review Committee and informed consent from patient or patient relatives. Statistical testing has been conducted using R Studio Software version 4. Results: A total of 51 patients with Covid-19 infection, tested positive by either rapid antigen test (RAT) or reverse transcriptase polymerase chain reaction (RTPCR) were admitted to our hospital during the study period. History of covid contact was positive in 11% patients. Comorbidities were seen in 10% patients. Respiratory system (41%) was most commonly involved followed by central nervous system (febrile seizures). Fever (70%) followed by cough (33%) were the most common symptoms. Raised ESR levels was the most common laboratory finding. Conclusions: The infection in children is usually mild, with low mortality rate (2%). Respiratory system was most commonly involved and fever and cough were the most common symptoms. [ABSTRACT FROM AUTHOR]

Research on vitamin D status in Indian children has been confined to studies conducted on small samples from certain regions and using non-standard techniques to quantify 25(OH)D3. Vitamin D insufficiency was observed in this multicenter research that used a standardized technique to evaluate 25(OH)D3 concentrations from dried blood spots (DBS) in children and adolescents from 5 to 18 years old in India. This school-based cross-sectional observational research used a multi-stage stratified random sampling technique. We picked a city and its surrounding hamlet from six states in India, which span a lot of ground. Data was gathered on demographics, anthropometry, body composition, food intakes, and DBS samples. Liquid chromatography with tandem-mass spectrometry was used to evaluate 25(OH)D3 in DBS. A total of 2450 youngsters had their vitamin D level checked, with a subset (n = 672) having extra data obtained for the purpose of evaluating predictors. In the study, 36.8% of participants had adequate vitamin-D levels (> 50 nmol/L), with greater concentrations seen in rural respondents and boys (p < 0.05). The mean vitamin-D concentration was 45.8 ± 23.9 nmol/L. [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: Treatment of depressive episodes in young patients is challenging owing to several reasons such as poor diagnostic stability and atypical presentation. Evidence regarding treating such patients with antidepressants such as selective serotonin reuptake inhibitor (SSRI) is not clear. Methods: Fifty patients aged 10-24 years diagnosed with depressive episodes and drug-free for at least 3 months were rated on Beck's Depression Inventory (BDI), The Mood Disorder Questionnaire (MDQ), and Beck Scale for Suicidal Ideation (BSS). The scores of BSS and BDI were compared across four timeframes (weeks 0, 2, 4, and 6) for MDQ-positive and negative patients by using the generalized estimating equations model. Results: Patients who were MDQ-positive (11 patients) tended to score higher on BDI (at weeks 2 and 4) and BSS (at weeks 2, 4, and 6) as compared to MDQ-negative patients (39 patients). After being started on SSRI, MDQ-positive patients showed a poorer response as compared to the other group. The small sample size and short follow-up duration were the major limitations. Conclusions: Close clinical monitoring with regular follow-up during antidepressant initiation is recommended to reduce the risk of suicidality. [ABSTRACT FROM AUTHOR]

Background: The pandemic has put at risk the social and emotional development of children on account of the paucity of arenas for social interaction. This study from Kerala, India was conducted to assess the resilience factors, behavioural concerns, psychological distress symptoms among the children aged 3 to 5 years. We also tried to look into the lost opportunities that could have aided the social and emotional development of children like peer interaction, child care hours. Methods: The cross-sectional study was conducted among the children aged 3 to 5 years. A total of 535 children attending the immunisation clinics were enrolled by consecutive sampling. Devereux Early Childhood Assessment P2 (DECA P2) questionnaire was used to assess the levels of resilient factors and behavioural concerns in the study population. Results: We observed a high proportion of children in the area of need category of protective factors under DECA P2. The proportion of children falling under area of concern was 64.5%, 49%, 68.4% for attachment/relationship, self-regulation, and initiative respectively. 24.9% study subjects have a behavioural concern score that puts them in the area of need category. The logistic regression model we created identified 'Male Gender,' 'Mothers could spend only less time for child care' and 'electronic devices used as pacifier' as significant predictors for belonging to Area of need Behavioural Concerns T score category. Conclusion: A large proportion of children aged between 3 to 5 years with reported behavioural concerns and lack of protective factors for socioemotional development. This can be attributed partly to the ongoing pandemic and its associated restrictions. The increased child care hours invested by parents or grandparents could have sized down the full impact that the pandemic would have had on the socio emotional development of the child. Increased time spent using electronic devices coupled with dwindled opportunities for interaction with peers have been notable challenges. [ABSTRACT FROM AUTHOR]

Background: Low immunization coverage in India attributes to many factors including sociodemographic factors and people's behavior. COVID-19 pandemic resulted in disruptions in achieving optimum availability and utilization of immunization services. This study was carried out to find out the immunization status of children in the post COVID era and various factors responsible for non-immunization during the pandemic. Methods: This cross-sectional study included parents of 225 admitted children aged 1–6 years were interviewed using a semi-structured open-ended questionnaire. Children were classified as completely immunized, partially immunized and unimmunized on the basis of vaccines missed given under first year of life. Reasons for non-immunization and delay/missed vaccination during COVID-19 pandemic were recorded. Results: Of the 225 children, 162 (72%; 95% CI 66–78%) were completely immunized, 55 (24.4%; 95% CI 19–30%) were partially immunized and 8 (3.6%; 95% CI 1–6%) were unimmunized. Parents with hospital deliveries, higher education level and lesser birth order were more likely to have children with better immunization status (p < 0.05). First dose of measles scheduled at 9 months and 3rd dose of pentavalent vaccine/OPV/Rotavirus vaccine scheduled at 14 weeks were most commonly missed vaccines among partially immunized. Lack of awareness (n = 36, 57.1%; 95% CI 45–70%) was the common reason for partial and non-immunization followed by illness of child (n = 21, 33.3%; 95% CI 21–45%) and COVID-19 pandemic (n = 11, 17.4%; 95% CI 8–27%). Pandemic was reason for delay in 50 (22.2%; 95% CI 17–28%) children. Restrictions of movement (64%; 95% CI 50–78%), fear of being exposed to COVID-19 (52%; 95% CI 38–66%) were the most common reasons for delay during the pandemic. Of the 50 children who had delay due to pandemic, 39 children (17.3%; 95% CI 12–22%) received their catch-up immunization after the pandemic. No child remained completely unimmunized due to COVID-19 pandemic. Conclusions: Although COVID-19 pandemic resulted in disruptions in routine immunization services, sociodemographic factors such as awareness for immunization, parental education and various beliefs for immunization were responsible for the children remaining unimmunized or partially immunized after the pandemic. [ABSTRACT FROM AUTHOR]

Background: Sparse data are available regarding congenital heart disease (CHD) from southern India. This study was designed to document the sociodemographic factors, clinical profile and pattern of CHD at a referral centre. Methods: A cross-sectional observational study was done by direct interview method and review of medical records of 414 participants using internally validated, pre-defined proforma. Results: More than half of the cases (54.6%) referred were within 1 year of age. Wasting was present in 45%. Most of the cases belonged to middle and lower socio-economic status group (79%) and were referred by paediatricians (70%); 48% had travelled more than 500 km to avail cardiac services. Predominant symptoms of referral were respiratory distress (61.8%), feeding difficulties (50%), cyanosis (43.7%) and palpitation (24.9%). Major abnormalities detected were ventricular septal defect (31.2%) and tetralogy of Fallot (21.7%). Conclusions: This study highlights the need of prioritising and planning for the implementation of affordable and accessible cardiac infrastructure to people from rural areas with low socio-economic background. [ABSTRACT FROM AUTHOR]

Aim: To determine the bacteriological conversion rate after 6 months of Delamanid (DLM) based treatment in children with drug-resistant tuberculosis (DR-TB) and determine factors associated with bacteriological conversion. Methods: This is a descriptive retrospective study done in children between the age of 6-17 years with DR-TB who received DLM-based therapy from October 2018 to May 2021. The drug resistance pattern of TB was detected using Xpert RIF/MTB and phenotypic drug sensitivity testing (DST) on TB-MGIT culture reports. Follow-up sputum TB MGIT culture was carried out monthly after DLM initiation for 6 months. Factors associated with sputum bacteriological conversion such as age, gender, pulmonary TB (PTB) versus disseminated TB, unilateral or bilateral lung involvement, type of DR-TB, prior treatment failure, and type of DR-TB regimen were analyzed. Results: Sixty patients received DLM of which two had extrapulmonary TB (EPTB) and sputum conversion could not be assessed. The mean age at presentation was 12.69 ± 3.03 years. Five patients (8.3%) died while on DLM treatment. On follow-up, 8 (13.7%) out of 58 patients had no sputum bacteriological conversion after 6 months of DLM initiation of which three patients were on salvage therapy; 46 (79.3%) had sputum bacteriological conversion within 6 months of DLM initiation. Conclusion: Sputum bacteriological conversion rate was almost 80% at the end of 6 months of DLM-based treatment. [ABSTRACT FROM AUTHOR]

Background: To compare the morbidity and treatment-seeking pattern of low birth weight (LBW) and normal birth weight (NBW) infants during the first six months. Material and Methods: A prospective cohort study was conducted in the service areas of eight urban primary health centers of Puducherry from October 2019 to July 2021. Details of LBW and sex-matched NBW infants were obtained from the birth registers of selected PHCs. Data were collected using a structured interview schedule on completion of the first, third, and sixth months at their homes. For comparison, Mid-p exact test was used for incidence rates, t-test/Mann-Whitney for continuous variables and the Chi-square/Fisher's exact test for the categorical variables. Results: Ninety-four pairs of LBWS and NBW infants were recruited. The incidence of morbidity during the first six months among LBW and NBW infants was 37.5 and 33.3 episodes per 100 child months, respectively (P value 0.118). Though the incidence of all-cause morbidity was similar, skin infections were significantly higher among LBW (3.10 vs 1.21 per 100 child months, P = 0.04). The incidence of all-cause morbidity was high in LBW infants with poor weight gain. Conclusion: Birth weight was associated with all-cause morbidity during the first three months. However, this association varied in age points and infants' weight gain. [ABSTRACT FROM AUTHOR]

Background: Immunization is a cost-effective weapon against vaccine preventable diseases. Children of migrant workers suffer from lack of immunization because of frequent shift of places, poor knowledge, and low socioeconomic status. To assess the immunization status of children 12--36 months of age of migrant workers and factors associated it. To identify the reasons for non-immunization or partial immunization among these children. Material and Methods: A cross-sectional study was conducted among 500 migrant workers' children aged 12--36 months residing in Urban Bangalore east from February 2019 to August 2020. A cluster sampling method was incorporated. The data were collected using pre-tested semi-structured questionnaire. Data were analyzed using Epi-info™ Version 7.2.1 and SPSS version-21. Data were summarized in percentages, mean, standard deviation, and logistic regression. Results: The mean age of the children was 25.2340 ± 8.42 months. Out of 500 children, 88.60% were fully immunized, 11.40% were partially immunized, and no child was unimmunized. Significant predictors of immunization status of children were education of father and immunization card. Common reasons for dropout were inconvenient time (80.70%), unaware of need (77.19%), and busy schedule of parents (75.44%). The dropout rate of BCG to MR-1, Penta-1 to Penta-3, and Penta1to MR-1 was 6.49%, 0.85%, and 2.12%, respectively. Conclusions: Immunization coverage in the present study was 88.60%. Inconvenient time was the main reason behind partial immunization. [ABSTRACT FROM AUTHOR]

Background: India experienced three coronavirus disease (COVID-19) waves, with the third attributed to the highly contagious Omicron variant. Before the national vaccination rollout for children above 6, understanding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) positivity in the pediatric population was essential. This study aims to assess the burden of Covid-19 infection and to estimate the seroprevalence in children aged 6 to 14 years in the state of Karnataka. Material and Methods: We surveyed 5,358 children aged 6-14 across Karnataka using 232 health facilities, from June 6 to 14, 2022. We determined the sample size using the PPS (Population Proportional to Size) technique and employed cluster sampling. We tested all participants for SARS-CoV-2 IgG with an enzyme-linked immunosorbent assay (ELISA) kit and SARS-CoV-2 RNA with reverse transcription-polymerase chain reaction (RT-PCR). We sequenced samples with a cycle threshold (CT) value below 25 using whole genomic sequencing (WGS). Result: We found an adjusted seroprevalence of IgG at 75.38% statewide, and we found 0.04% of children RT-PCR positive for COVID-19. We determined a case-to-infection ratio of 1:37 and identified the SARS-CoV-2 strains as Omicron, BA.5, and BA.2.10. Conclusion: The study showed a high seroprevalence of IgG among children with low active infection. Omicron, BA. 5, and BA. 2.10 variants were detected through WGS. [ABSTRACT FROM AUTHOR]

Introduction: Public awareness of the COVID-19 pandemic has resulted in a reduction in healthcare utilisation for other diseases. Understanding how the COVID-19 pandemic affects hospital admissions and the disease patterns is crucial for proper triaging and planning of health resources in future pandemics. Aim: To compare the clinical spectrum of paediatric inpatients in the post-COVID-19, pre-COVID-19 and during COVID-19 pandemic periods in a tertiary level teaching centre. Materials and Methods: This ambispective study was conducted at the Paediatrics Department of SAT, Govt. Medical College, Thiruvananthapuram, Kerala, India. The analysis included all cases hospitalised from April 2019 to March 2022, with the data divided into three time periods. The discharge diagnoses of all cases admitted during the study period were coded according to the ICD-10 criteria and included in the analysis. Differences in admissions, disease patterns, and ICU admissions during the three time periods (pre-COVID-19, post-COVID-19, and during COVID-19) were compared using oneway ANOVA and Tukey's post-hoc test. Results: In the present study, ward admissions (p-value <0.001), respiratory infections (p-value 0.031), asthma (p-value 0.009), and chronic systemic diseases (p-value 0.018) decreased in the post-COVID-19 period compared to the pre-COVID-19 period, whereas ICU admissions (p-value 0.010) and Diabetic Ketoacidosis (DKA) (p-value 0.002) increased. When comparing COVID-19 and post-COVID-19 periods, there was an increase in ward admissions (p-value 0.01), respiratory infections (p-value 0.018), and diarrhoea (p-value 0.029), but a decrease in the proportion of ICU admissions (p-value 0.01). There was no significant difference in mortality among the three time periods. Conclusion: There was a significant difference in the clinical spectrum of paediatric inpatients. The significant decrease in admissions of chronic systemic diseases, which require regular follow-up for management changes, raises concerns about the potential impact on patient care. [ABSTRACT FROM AUTHOR]

Introduction: The success of root canal procedures depends on cleaning and shaping of canals. There are several instrumentation techniques available for root canal preparation. Recently, exclusive rotary file systems called Kedo-SG Blue and Prime-Pedo have been introduced for root canal preparation in primary teeth. The inherent flexibility of these files allows them to preserve the anatomy of curved canals in primary molars. Aim: To compare the instrumentation time, obturation time, and quality of obturation using two paediatric rotary file systems, Kedo-SG BlueTM and Prime-PedoTM, in mandibular primary molars. Materials and Methods: A randomised clinical trial was conducted in the outpatient Department of Paediatric and Preventive Dentistry, Narayana Dental College and Hospital, Nellore Andhra Pradesh, India, from February 1, 2019 to January 20, 2020. Fifty primary molars with necrotic pulp were included and randomly divided into two groups, with 25 teeth in each group. Group 1 and Group 2 were instrumented with Kedo-SG BlueTM and Prime-PedoTM, respectively. The time taken for instrumentation and obturation was noted in minutes, and the quality of root canal filling was recorded as optimal, underfilled, or overfilled. The data were statistically analysed using an independent Student's t-test for time measurements and a Chi-square test for the quality of obturation. Results: There was a statistically significant difference in instrumentation time and obturation time between the two groups (p-value=0.009; 0.011). The Kedo-SG BlueTM rotary system showed a better quality of obturation compared to the Prime-PedoTM rotary system, although the difference was not statistically significant (p-value=0.22). Conclusion: The Kedo-SG BlueTM rotary system demonstrated shorter instrumentation and obturation times, as well as a higher number of optimally filled canals compared to the Prime-PedoTM rotary system. Therefore, the Kedo-SG BlueTM rotary system exhibited better clinical performance in primary molars than the Prime-PedoTM rotary system. [ABSTRACT FROM AUTHOR]

Aims: Intussusception is a common pediatric surgical emergency and an indicator for primary healthcare. We report our experience with childhood intussusception at a tertiary care hospital in the private sector in Central Kerala and add our refinement to the technique of hydrostatic saline reduction which had more desirable outcome. Settings and Design: Children presenting with the diagnosis of intussusception which were managed in our department of pediatric surgery at a private hospital in Kerala, India. Subjects and Methods: Eighty children, up to 15 years of age, (43 boys, 37 girls) confirmed to have intussusception on ultrasound and managed in our institution from October 2016 to July 2020 with hydrostatic saline reduction. Sixty-two (77%) of them were aged 3 months to 3 years (numbers <10 to be written in words); the age of idiopathic intussusception. Statistical Analysis Used: SPSS V25. Association between variables using Chi square test and independent t test. Results: A total of 80 children met the criteria out of that (n = 79) had successful nonoperative reduction. Hydrostatic saline enema 73, One Barium and five air enema. A child presented in shock was taken up for laparotomy and reduced operatively. Six recurred within 24 h (7% early recurrence) and a second attempt at nonoperative reduction succeeded in all six of them. (numbers <10 in words). Eleven children (14%) had a late recurrence, the attempt at saline hydrostatic reduction was successful in only 3 (27%) and 8 went on to have surgery. Six were successfully reduced operatively and 2 had resection anastomosis. Conclusions: After excluding those who need surgery on clinical grounds, we report a 98.7% success with nonoperative reduction for the first instance of intussusception, a 24 h recurrence of 7%, with successful repeat reductions in all. With the refinement in the technique, we could achieve a desirable outcome. At the first presentation, surgery was indicated in 1 of the 80 children. We report a late recurrence rate of 14%, with a 27% success rate for nonoperative reduction. No pathological lead points were identified even in this group. All the children had an uneventful and a faster recovery. In our series, we had 97.5% follow up rate. [ABSTRACT FROM AUTHOR]

The article focuses on the Indo-United Kingdom (UK) collaboration in mental health, highlighting the growth of the initiative from a pilot involving 2 National Health Service (NHS) organizations to over 20 organizations across England and Wales. Topics include developing a long-term sustainable partnership; recent advances in clinical research in India and the UK; and strengths and challenges of the UK-India partnership in mental health.

Introduction and Objectives: Cystic fibrosis is the most common life-limiting genetic condition in Caucasians, affecting 1 in 2500 births. The study examined the percentage of cystic fibrosis patients in paediatric respiratory clinics with pancreatic insufficiency. To compare the clinical and demographic parameters of pancreatic insufficiency and sufficient cystic fibrosis children. Methods: This study was conducted on children with cystic fibrosis, specifically targeting individuals aged 0 to 15 years. It was an observational study aimed at describing and analyzing the characteristics of the participants. This study was conducted at the, Department of Pediatrics, Ayaan Institute of Medical Sciences, Moinabad, Telangana, India, between the November 2022 to December 2023. Pancreatic insufficiency was established when the faecal elastase level was below 200 micrograms per gramme of stool. The prevalence of pancreatic insufficiency was determined by calculating the percentage along with a 95% confidence interval. Results: Pancreatic insufficiency was observed in 62.4% of a group of 20 children. The faecal elastase test identified an additional 19% of patients with pancreatic insufficiency compared to relying solely on the standard history of steatoorhoea for diagnosis. All patients experienced recurrent respiratory infections and 78.8% had a weight below the 5th centile on the growth chart. Only a small proportion of patients had additional characteristic symptoms of cystic fibrosis, such as meconium ileus, rectal prolapse, and nasal polyposis. The pancreatic insufficient group had a higher prevalence of foul-smelling stool, frequent bowel movements, and lower Cooperman score, in comparison to both the pancreatic sufficient group. This disparity was shown to be statistically significant. Conclusions: From the above study it can be concluded two risk factors identified for calculating a clinical score to predict pancreatic insufficiency were a history of foulsmelling stool and frequent bowel movements. To generate this score, a more extensive investigation with a larger sample size will be necessary. [ABSTRACT FROM AUTHOR]

Introduction: Dietary acid load (DAL), which reflects the balance between acid- and alkaline-forming foods, is a modifiable risk factor for metabolic acidosis in CKD. Owing to the paucity of data in the Indian context, we undertook this cross-sectional study to estimate DAL and assess acid and alkaline food consumption in children with CKD2-5D (Chronic kidney disease stage 2 to 5 and 5D-those on hemodialysis). Methods: Clinical profile, dietary assessment of energy, protein intake/deficits, and macronutrients were noted and computed using software created by the division of nutrition, St John's research institute based on Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines in clinically stable children with CKD2-5D. DAL was estimated using potential renal acid load (PRAL in mEq/day) = (0.49 x protein intake in g/day) + (0.037 x phosphorus-intake in mg/day) - (0.02 x potassium intake in mg/day) - (0.013 x calcium intake in mg/day) - (0.027 x magnesium intake in mg/day). A positive dietary PRAL (>0) favors acidic content and negative (<0) favors alkaline content. PRAL was stratified into quartiles for analysis. The association of various clinical and dietary parameters were analysed across these quartiles. Results: Eighty-one children [of mean age 122 ± 47 months; 56 (69%) boys, 29 (36%) on dialysis, 62 (77%) non-vegetarians] were studied. Twenty-eight (34%) were on bicarbonate supplements. A positive PRAL (9.97 ± 7.7 mEq/day) was observed in 74/81 (91%) children with comparable proportions in those with CKD2-5 and 5D [47/52 (90%) vs. 27/29 (93%) respectively, P > 0.05]. Protein intake was significantly higher in the highest quartile compared to the lowest quartile of PRAL in CKD2-5 (55 ± 16 g/day vs. 40 ± 14 g/day, P < 0.001) and 5D groups (47 ± 15 g/day vs. 25 ± 11 g/day, P = 0.002). A majority of the participants 60/81 (74%) consumed highly acidic and minimal alkali foods. Conclusion: In children with CKD2-5D, PRAL estimation revealed high DAL in the majority with a high consumption of acidic foods. These findings provide implications for appropriate dietary counseling in children with CKD. [ABSTRACT FROM AUTHOR]

Introduction: Psychocutaneous disorders in children have been a gray zone in dermatology practice. It can be secondary to some primary dermatological disorder or can be a presentation of underlying primary psychiatric illness. There is a paucity of data regarding the occurrence of these disorders in the pediatric population. The present study was carried out to assess the proportion of primary psychiatric dermatoses in the pediatric population seeking dermatological care. Materials and Methods: This was a hospital-based cross-sectional observational study done over 6 months. All consecutive children <14 years old presenting with primary psychiatric disorders (PPDs) to the dermatology outpatient department were recruited in the study. Results: PPDs were found in 0.41% of the pediatric patients attending the outpatient department. Dermatitis artefacta was the most common PPD in our study (47.05%). Other less frequently observed PPDs were trichotillomania, lip-licking dermatitis, and nail-biting. Underlying psychiatric illness was found in 41.17% of affected children. Conclusion: Primary psychiatric dermatoses in children could go undiagnosed because of its rarity but early diagnosis is essential as it can be an early sign or a harbinger of underlying severe psychiatric illness. [ABSTRACT FROM AUTHOR]

Background : Open-heart surgery is challenging in preterm neonates and infants, and its feasibility in low-resource settings has not been defined. We describe our institutional experience with open-heart surgeries performed on consecutive preterm infants. Materials, Methods and Results : This was a single-center retrospective cohort from a tertiary hospital in Southern India and included consecutive preterm neonates (<37 weeks) admitted for open-heart surgery. This report is limited to babies who were <3 months at the surgery. The salient features of the 15 preterm included twin gestation: 7 (46.7%); median gestational age at birth: 35 weeks (28-36 weeks); median corrected gestational age at surgery: 37 weeks (33-40 weeks); birth weight: 1.75 kg (1.0-2.6 kg); weight at surgery: 1.8 kg (1.2-2.9 kg); and small for gestational age: 12 (80%). The heart defects included transposition of the great arteries (7), total anomalous pulmonary venous return (3), large ventricular septal defect (VSD) (1), and VSD with coarctation of the aorta (4). Eleven (73%) were mechanically ventilated preoperatively and five had preoperative sepsis. The mean cardiopulmonary bypass time was 169.7 ± 61.5 min, and cross-clamp time was 99.7 ± 43.8 min. There was no inhospital mortality; one baby expired during follow-up at 1 month. Postoperative mechanical ventilation duration was 126.50 h (84.25-231.50 h), and intensive care unit stay was 13.5 days (9-20.8). The total hospital stay was 39 days (11-95 days). Two children (13.3%) had postoperative sepsis. Conclusion : Through collaborative multidisciplinary management, excellent outcomes are feasible in low-resource environments for selected preterm neonates undergoing corrective open-heart operations. [ABSTRACT FROM AUTHOR]

Background and Objectives: The occurrence of Down syndrome and chromosomal nondysjunction is more prevalent in the progeny of mothers who conceive at an advanced age. The primary objectives of the study were to investigate the prevalence of Vitamin D deficiency through the evaluation of 25(OH) Vitamin D levels in children diagnosed with Down syndrome. Material and Methods: This study employed a prospective descriptive design. The research was carried out at the Department of Pediatrics, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, Andhra Pradesh, which is a medical center providing specialized care in India. The study spanned from May 2022 to April 2023. A total of 50 children who were thought to have Down syndrome were subjected to examinations. Results: A total of 50 youngsters who were thought to have Down syndrome were subjected to interviews. Two individuals exhibited a cytogenetic profile consistent with Down syndrome; nevertheless, they expressed a lack of willingness to undergo additional diagnostic pro cedures. Three individuals exhibited clinical characteristics consistent with Down syndrome, however, they declined to provide a blood sample for subsequent diagnostic testing and verification. The cytogenetic study of the youngster, consisting of 50 samples, did not reveal any evidence of Down syndrome. The analysis comprised a total of 50 children, consisting of 40 boys and 10 girls. The following table and graph provide an overview of the demographic composition of the children in terms of age and gender. Conclusion: Children with Down syndrome had a prevalence of 25 (OH) Vitamin D deficiency of 26.8%. Deficiencies in 25 (OH) Vitamin D had no appreciable effect on these children's height, bone age, or other biochemical indicators. [ABSTRACT FROM AUTHOR]

Background: To determine the prevalence of anisometropia and its association with stereopsis and amblyopia in Goan school children. Methods: A cross-sectional study was conducted on students between 9 and 14 years of age from two randomly selected schools in Goa. All students underwent an assessment of uncorrected and best-corrected visual acuity, stereo acuity, and complete ophthalmic examination. Children with refractive errors without any other coexisting ocular pathologies were included. Refractive correction of children with a best-corrected visual acuity of logMAR 0.0 was measured using a manual lensometer. Subjects with visual acuity greater than logMAR 0.2, further improving with pinhole, were subjected to objective and subjective refraction. The prevalence of anisometropia, anisometropic amblyopia, and degree of stereo acuity in anisometropic children was assessed. Results: Four hundred and six children were screened for refractive errors. Sixty-four children were found to have refractive errors, of which 58 students (90.6%) were myopic, and six (9.4%) were hyperopic. The prevalence of anisometropia of ≥1.0 D spherical equivalent was found in 12 students (18.75%), among whom myopia was the most common refractive error (9.75%). Anisometropic amblyopia was noted in eight students (66.6%), five of whom were myopes and three hyperopes. All three hyperopic anisometropes (100%) had amblyopia. Seventy-five percent of children with poor stereo acuity, ranging from ≥160 seconds of arc, belonged to the hyperopic anisometropia group. Conclusion: Amblyopia is more prevalent among anisometropes than isometropes, with hyperopic anisometropes having poor stereoacuity and being more likely to develop amblyopia. Hence, early identification and treatment of anisometropia will significantly reduce the risk of amblyopia in school children. [ABSTRACT FROM AUTHOR]

Aims: This study aims to explore the prevalence of mobile phone use among young children aged 6 months to 4 years. We studied the usage patterns, optimal age for use, and the attitudes of parents toward their child's mobile phone use. Methods: We conducted a cross-sectional study in a pediatric OPD of a tertiary teaching hospital for a period of 2-months. Ethics committee approval and informed consent was taken before conducting the research. A predesigned and validated questionnaire was used to collect data. We calculated a sample size of 90 children at a 95% confidence level. Chi-square test and Fischer's exact test were used as a test of significance at 5% level of significance. Results: We observed that 73.34% of children were using mobile phones and mobile phone usage increased with age. Children used mobile phones for educational purposes (43.9%), and for less than an hour a day (57.6%). In the 3-4 year age group, 19% used mobile phones for 3 hours or more.While 93.3% of parents felt they shouldn't give their child a phone, 71.4% children of these parents still used one. Conclusions: Our study highlights a high prevalence of mobile phone use among young children aged 6 months to 4 years. Although parents aimed to limit their child's phone usage, the reality was different. We recommend that guidelines on mobile phone use be followed in India. [ABSTRACT FROM AUTHOR]

Timely screening and surveillance of children for developmental delay and social–emotional learning difficulties are essential in Low- and Middle-Income Countries like India. Screening measures like the Parents' Evaluation of Developmental Status (PEDS) and Strength and Difficulties Questionnaire (SDQ) are considered suitable for India due to their low cost, easy accessibility, and no training requirement for administration. However, India lacks validated screening measures, and the PEDS and SDQ have yet to be validated for children in India. The study aimed to translate the PEDS and SDQ from English to Hindi and psychometrically evaluate the same measures on children aged 4–8 years in India. The original PEDS and SDQ forms and their translations were pilot tested on 55 participants and evaluated using data from 407 children with typical development (TD) and 59 children with developmental disability (DD). Parents and teachers reported no meaningful discrepancy between the original and translated (Hindi) questionnaires. Internal consistency for the PEDS was acceptable, but unacceptable for most subscales on the SDQ, for both TD and DD samples. Test–retest reliability was poor for the PEDS but adequate for the SDQ. Results from known-group validity testing showed that the PEDS scores could be used to distinguish between the TD and DD samples. The results from this study provide further support for the use of the PEDS and SDQ in developing countries like India. [ABSTRACT FROM AUTHOR]

Background: About two billion people in the world’s population are affected by the soiltransmitted helminth infection, with children being the most affected with Soil Transmitted Helminth infection.[1] India alone contributes nearly 25% to the total global cases, with 220.6 million children in need of preventive chemotherapy. [2] In view of the above context, the present study was conducted with the aim and objective of to the prevalence of soiltransmitted helminth (STH) infection and its risk factors. Material and Methods: Study Design: A Cross-sectional Observational Study Study Setting: Department of Microbiology, AIIMS, Raipur, from January 1 to June 30, 2023 (6 months). Sample Size: 384 (n=Z2 1-ά/2 P(1-P)/d2). P=50%, CI=95%, d=5% Absolute Precision. Results: STH prevalence was 13.3%, more in males (68.8%), and significantly high (62.5%). P < 0.05) in school-going children between 6 and 12 years of age. The predominant STH was Ancylostoma duodenale (56.2%); STH infection was much less (12.5%) in those practising handwashing with soap. Fifty percent of children had an STH infection even after receiving deworming within the past six months. More egg counts—216 eggs per gramme of faeces—were found in 29 cases by the KK method. Entamoeba histolytica (56.5%) was predominant among non-STH infections. Conclusion: Contrary to the assumption of 50% prevalence, the actual prevalence was very low, only about 13.3%. School-going children aged 6–12 years were more affected, and handwashing with soap was the key factor in preventing STH infection. The proportion of participants having toilet facilities and using footwear regularly had no role in STH prevention. [ABSTRACT FROM AUTHOR]

Background: Dengue virus infection has become a major public health concern in recent years due to an increase in its complex and unusual symptoms. Hepatomegaly increased liver enzymes to fulminant hepatic failure are just a few of the diverse signs of dengue's hepatic involvement. Material and Methods: At the Department of Paediatrics, Vishwanharathi Medical College & General Hospital, R T Nagar Near Penchikalapadu, Kurnool, Andhra Pradesh, India, this was the prospective Cohort Study that was planned. The study used 50 people who were treated with a Dengue infection and had a positive test for Dengue. Patients with a Dengue Sero positive are chosen and checked for hepatomegaly and jaundice. They also get a full blood count, Liver function tests, and an ultrasound of the abdomen, PT, APTT, HBsAg, HCV and Widal. Study was done between February 2022 to January 2023. Results: Early detection of dengue's hepatic dysfunction could help determine how serious the condition is. Massive hemorrhage and other life-threatening consequences could be avoided with early management. Future research should test the role of hepatoprotective medications in dengue to promote early recovery and lower morbidity and mortality. Conclusion: There have been various reports of dengue outbreaks increasing hepatic involvement in emerging nations like India. Early detection of hepatic dysfunction should help to prevent lifethreatening consequences because it is temporary and reversible in dengue. [ABSTRACT FROM AUTHOR]

Background: Stunting is a significant public health problem in childhood in developing countries. Sustainable Developmental Goals have mandated that each country reduce stunting by 50% by 2030. However, despite various nutrition and health programs, India still faces a massive burden of stunting. With the increasing urbanization in the country and its typical challenges related to health and nutrition, chronic malnutrition is a massive problem in urban areas, especially among people in the lower wealth quintile. Hence, current study has attempted to estimate the prevalence of stunting among children (0–6 years) and its determinants. Methodology: A cross-sectional study was conducted in the Urban Anganwadi centers of Rishikesh, Uttarakhand, for 6 months, from December 2021 to May 2022. Three hundred ten children from 13 selected Anganwadi centers were included using random sampling. Data were collected using a semi-structured validated and pretested questionnaire using Epicollect 5.0. Data were analyzed using the SPSS 23.0 version to estimate the prevalence of stunting and associated risk factors. Results: Out of 310 participants, 71 (22.9%) were stunted. Female children were slightly more stunted (24.7%) than males (21.1%). Maximum stunting (33.4%) was observed among children in the 5–6-year age group, and children with higher birth order were much more stunted. Stunting was reported more in children who were breastfed on demand (33.8%) than those fed every 2 hours (19.3%). Conclusion: Stunting prevalence in urban areas of Rishikesh is 22.9%, which is almost similar to the state average of 24.3% for urban areas; however, it was higher in comparison to the SDG 2030 global target of ending malnutrition of all forms. Stunting was significantly associated with feeding on demand and eating frequency less than twice a day. [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]

Introduction: Malrotation is a congenital anatomical anomaly that affects the normal positioning of the intestines. Traditional management of malrotation, as described by Ladd, consists of detorsion of the volvulus if present, division of Ladd's bands, widening of the mesenteric root, proper positioning of the small and large bowels, and a prophylactic appendectomy. This study was done to determine whether appendectomy should be an integral part of the Ladds procedure or if it can be avoided. Materials and Methods: This retrospective observational study was conducted in one pediatric surgical unit in the tertiary care center of North India. All the cases of malrotation of the gut managed from January 2008 to December 2018 were reviewed. The details of the patients were recovered from the electronic data recording system of the hospital and manual operation theater records. The cases that have a follow-up of <5 years were not included in the study. The details were charted in an Excel Sheet for the analysis. No statistical test was performed because there was no event in patients in whom prophylactic appendectomy was not done. Results: The data analysis revealed that a total of 66 malrotation patients were managed during this period, those who fulfilled the inclusion criteria. Among 66 cases included in the study, in 41 cases, prophylactic appendectomy was done, whereas in the rest 25, prophylactic appendectomy was not done. During the follow-up, none of the patients in whom the appendix was preserved presented with signs or symptoms related to appendicitis or any other complications. Conclusion: Ladds procedure without appendectomy can be performed in view of the potential use of the appendix in the future, and with the fact that in the current era of advanced medicine, appendicitis can be diagnosed early due to the advancement of imaging and better record keeping. [ABSTRACT FROM AUTHOR]

There is an increasing burden of noncommunicable diseases (NCDs) in India which may be related to changing dietary patterns. We aimed to assess dietary patterns in children since they have time to change unhealthy patterns before NCDs develop. Participants were 665 children, 9–12 years old, born with low birth weight and 77 similarly aged normal birth weight controls. We collected data on sociodemography, anthropometry, body composition, and markers of risk for NCDs: grip strength, long jump, hemoglobin A1c (HbA1c). A food frequency questionnaire was used to collect dietary data from which dietary patterns were derived using principal component analysis (PCA). Fourteen food groups were included in the PCA analysis, resulting in three components: 'fruits and vegetables', 'protein', and 'sugar and fat'. Higher socioeconomic status and maternal education were associated with lower adherence to the fruit and vegetable pattern and higher adherence to the protein and sugar and fat patterns. Adherence to the fruits and vegetables pattern was associated with lower height‐for‐age, whereas the fat and sugar pattern was associated with higher indicators of body fat. In linear regression analyses adjusted for age, sex, religion, socioeconomic status, maternal education, and season of data collection, adherence to the 'fruits and vegetables' pattern was associated with lower grip strength, shorter long jump, and lower HbA1c. Adherence to the other patterns was not associated with NCD risk factors. Higher consumption of fruits and vegetables, achievable even by poorer families in the cohort, may lower HbA1c, a risk factor for diabetes. [ABSTRACT FROM AUTHOR]

In response to the survey among early career pediatric cardiologists from India and the accompanying editorial, we invited comments and suggestions from thought leaders and senior functionaries in the field. We have summarized the thoughts and suggestions as a mini-symposium. [ABSTRACT FROM AUTHOR]

Objective: To study the applicability of on table extubation (OTE) protocol following congenital cardiac surgery in a low-resource setting and its impact on the length of intensive care unit (ICU) stay, hospital stay, hospitalization cost, parental anxiety, and nurse anxiety. Materials and Methods: In this prospective, nonrandomized, observational single-center study, we included all children above 1 year of age undergoing congenital cardiac surgery. We evaluated them for the feasibility of OTE using a prespecified protocol following separation from cardiopulmonary bypass. The data were prospectively collected on 60 children more than 1 year of age, belonging to the Risk Adjustment for Congenital Heart Surgery 1, 2, 3, and 4 groups and divided into two groups: those who underwent successful OTE and those who were ventilated for any duration postoperatively (30 children in each group). Duration of hospital stay, ICU stay, and total hospital cost were collected. Anxiety levels of the primary caregiver (nurse) in the ICU and the mother were assessed immediately after the arrival of the child in the ICU using the State Trait Anxiety Inventory (STAI). Results: Children who were extubated immediately following congenital cardiac surgery had significantly shorter ICU stay (median 20 [19, 22] h vs. 22 [20, 43] h [P < 0.05]). Patients extubated on table had a significant reduction in hospital cost {median Rs. 161,000 (138,330; 211,900), approximately USD 1970 (P < 0.05)} when compared to children who were ventilated postoperatively {median Rs. 201,422 (151,211; 211,900), approximately USD 2464}. The anxiety level in mothers was significantly less when their child was extubated in the operating room (STAI 36.5 ± 5.4 vs. 47.4 ± 7.4, P < 0.001). However, for the same subset of patients, anxiety level was significantly higher in the ICU nurse (STAI 46.0 ± 5.6 vs. 37.8 ± 4.1, P < 0.05). Conclusion: OTE following congenital cardiac surgery is associated with a shorter duration of ICU stay and hospital stay. It also reduces the total hospital cost and the anxiety level in mothers of children undergoing congenital heart surgery. However, the primary bedside caregiver during the child's ICU stay had increased anxiety managing patients with OTE. [ABSTRACT FROM AUTHOR]

Cystic hygroma of the neck, a congenital benign tumor of the lymphatic system, is a potential cause of neonatal airway obstruction leading to stridor. Meticulous airway evaluation, case appropriate preparation, and use of advanced technology, including videolaryngoscope and ultrasonography, can facilitate the safe management of the difficult airway. [ABSTRACT FROM AUTHOR]

A quasiexperimental field study was undertaken in 576 exclusively breastfed (EBF) infants from 0 to 14 weeks in Gujarat, India to assess the effect of the use of appropriate breastfeeding techniques on daily weight gain rate and on reducing the underweight rate in early infancy. The interventions were delivered through the existing health system and focused primarily on counselling pregnant women during antenatal and post‐natal sessions for ensuring 'effective breastfeeding' by adoption of the technique of 'cross cradle hold', appropriate breast attachment, emptying of one breast before shifting to the other along with conducting regular monitoring of infant's weight. The intervention care group (ICG) of 300 EBF infants were compared with 276 EBF infants in the control standard care group (SCG). The findings revealed that median weight gain per day between 0 and 14 weeks was significantly higher (p = 0.000) in ICG (32.7 g) as compared with SCG (28.05 g). The median weight‐for‐age Z at 14 weeks of age was also significantly higher in ICG compared with SCG (p = 0.000). Underweight prevalence was three times lower in ICG (5.3%) compared with SCG (16.7%) at 14 weeks of age. Infants in the ICG were noted to be 2.65‐fold more likely to achieve a weight gain of 30 g or more per day compared with infants in SCG. Nutrition interventions, therefore, must aim not only on mere promotion of EBF for up to 6 months but stress on ensuring EBF is 'effective' for optimum transfer of breastmilk through adoption of appropriate techniques, including cross‐cradle hold, by mothers. Key messages: Breastfeeding, even if exclusive, can be suboptimal if the skills of mothers are not appropriate resulting in poor breastmilk transfer and poor intake of nutrients by a baby.Effective counselling on appropriate attachment to the breast, hold and positioning, is important to increase secretion of milk and optimise the transfer of breastmilk and thus improve infant nutritional status.This study shows that counselling mothers on cross cradle hold technique of breastfeeding during antenatal and post‐natal care periods combined with the frequent weighing of infants significantly escalates daily weight gain to over 30 g/day in 0–14 weeks of age. [ABSTRACT FROM AUTHOR]

Background: India is the home to almost 30% of total children aged 13 to 19 years. Road traffic injury dominates over all causes of unintentional injuries. Children's road safety is neglected issue in the planning and designing of roads in the urban towns of India where a third of a billion children travel to school every day. As India is motorizing rapidly, road traffic injuries are projected to increase in near future. In the present study, awareness regarding road safety issues and prevalence of self-reported road traffic injury incurred while commute to school was estimated in the school going children aged 14 to 18 years. Methods: A Crosssectional questionnaire-based survey was conducted among three schools in Pune, Maharashtra India. The information was collected about mode of commute to/ from school including distance from home and understanding about road safety issues. The data was also collected about any road traffic injury incurred during commute to school in the past 12 months. Results: Total 398 children participated in the study of which 212 (53.3%) respondents were male. The mean age of the respondents was 15.5years (SD 1.1 years). The overall prevalence of selfreported road injury during journey to school in the last 12 months was 17.3% (95% CI, 13.75-21.42). A higher proportion of boys (18.9%) reported road injury than girls(15.6%).Children who walk (OR = 2.79; 95% CI 1.04-7.52) or travelled by autorickshaw (OR = 2.37; 95% CI 0.78-7.24) to school were more likely to report road injury than those who travelled by school bus/school van. Conclusions: A sixth of the children reported a road traffic injury in the past 12 months during school journeys in Pune district, Maharashtra. Road safety education may be made part of the syllabus of school going children. Children's road safety should be given utmost priority in any urban planning of roads, schools and streets in India. [ABSTRACT FROM AUTHOR]

Background: Psoriasis begins in childhood in around one-third of the cases. There has been conflicting evidence regarding the association of paediatric psoriasis with comorbidities. Aims and Objectives: The objective of this study was to find out various comorbidities (abnormal body mass index, metabolic syndrome, lipid abnormalities, diabetes mellitus, and raised blood glucose) associated with paediatric psoriasis. Materials and Methods: All patients of psoriasis (age <18 years) who visited the Paediatric Psoriasis clinic from January 2017 to September 2021 were recruited in this record-based study. Results: Records of 100 patients were analysed, with female to male ratio of 1:1. The age group ranged from 11 months to 18 years. The average body surface area involved was 5.43%. The average psoriasis area and severity index was 2.47. Joint involvement was seen in 7% of patients in our study. A total of 52 (52%) patients had abnormal body mass index, out of which 21 patients were overweight and 31 were obese. At least one lipid abnormality was found in 66 (66%) patients. The most common lipid abnormality was decreased high-density lipoprotein, followed by raised total cholesterol, raised total triglycerides and raised low-density lipoprotein. 8 (8%) patients were found to have raised blood glucose levels. Out of which, six had impaired fasting glucose and two were diagnosed with diabetes mellitus. 5 (5%) patients were diagnosed with metabolic syndrome. Conclusion: Paediatric psoriasis is a chronic disfiguring disease and may have profound emotional and psychological effects. There is a lack of studies from India on the prevalence of these comorbidities in paediatric psoriasis. More studies are required from different parts of the world for a better understanding of paediatric psoriasis. [ABSTRACT FROM AUTHOR]

Backgrounds: The Universal Immunization Program of India is one of the most cost-effective interventions in public health. Missing or delaying vaccination may elicit an uncertain immune response in the body, making the population susceptible to vaccine-preventable diseases. The objectives of this study were to determine the coverage of newborn immunization for birth doses under the National Immunization Schedule and its epidemiological determinants in the rural areas of the Dehradun district, Uttarakhand. Materials and Methods: A community-based cross-sectional study was conducted for a period of one year with a sample size of 570. World Health Organization (WHO) 30 Cluster sampling technique was used with 19 children in each cluster. The data on determinants were collected using a semi-structured, pre-designed schedule through a house-to-house survey. Multivariate analysis was conducted to identify factors associated with immunization coverage, taking the significance level as P < 0.05. Results: The coverage of the Bacillus Calmette-Guérin vaccine, oral polio vaccine zero dose and hepatitis B birth dose were 100%, 91.9%, and 58.8%, respectively in the study area with an overall prevalence of incomplete coverage of newborn immunization as 42.5%. The most cited reason for children being unimmunized with birth doses was the unavailability of vaccines at the birthplace center (29.6%). Conclusions: The prevalence of incomplete coverage of newborn immunization was quite high, which was undermining the holistic approach of the National Immunization Program. Vaccine availability and accessibility at the birthplace with capacity building and training of the healthcare workers may be considered to ensure coverage of birth doses. [ABSTRACT FROM AUTHOR]

Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood injuries, with a focus on unintentional injuries, among children 5-14 years of age and to suggest approaches to prevention that can be adopted in the Indian context. This systematic review was conducted with the standard approach and use of keywords. A total of 33 studies which were found to be relevant were analyzed. Road traffic accidents (RTAs) contribute to nearly 85% of all unintentional injuries and related deaths and 90% of disability-adjusted life years (DALYs) lost in developing countries. Poor traffic regulation, heavy traffic load, and poor skill of identifying the dangerous road crossing sites make the children's age group vulnerable and prone to RTA. Children with poor skill of identification and response to dangerous road crossing sites, along with heavy unregulated traffic were found to be the major reasons for such accidents and make this age group more vulnerable. Public health-based prevention approaches need to be based upon legislation, regulation, and enforcement, as well as environmental modification, education and skill development, emergency medical care using levels of prevention, and principles of targeted prevention to effectively address child health challenges. Addressing child injuries should be a key component of all endeavors aimed at enhancing child mortality and morbidity rates, as well as the overall welfare of children, both at the national and global levels. It is imperative to prioritize policies focused on preventing unintentional injuries across all age groups, with particular attention to children. [ABSTRACT FROM AUTHOR]

Aims: Childhood constipation is presenting with increasing frequency at pediatric surgical clinics. The caregiver's role in prevention and management is pivotal. This study aimed at determining mothers' knowledge, attitudes, and practices with regard to childhood constipation and the association of these with demographic variables. Materials and Methods: This was a survey-based descriptive study conducted at a tertiary care hospital in South India. Randomly selected mothers of children aged 1--10 years consulting for any problem other than constipation were included in the study. Data collection was done by means of a pretested and prevalidated questionnaire. Results: There were 169 mothers with a median age of 30 years. Over half were homemakers and of a rural background. Urban mothers scored better than their rural counterparts in the attitude section (P = 0.034). Mothers with greater knowledge had better attitude (P = 0.001) and practice (P = 0.020) scores. Those with higher attitude scores also fared better in the practice section (P = 0.04). Conclusions: Knowledge, attitude and practice concerning childhood constipation are connected to each other. South Indian mothers are sufficiently aware of the nuances surrounding childhood constipation, but focused large-scale outreach programs and health education are necessary to bridge the gaps. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD), sickle cell anemia (SCA), and sickle beta-thalassemia (SBT) are due to a mutated gene of hemoglobin (Hb), which makes the red blood cells sickle-shaped and decreases their oxygen-carrying capacity. The disease is prevalent in the rural population of Odisha. Clinical presentation of SCA and SBT is similar, though there is a difference in treatment modality for both the entities. However, there are a few studies to delineate between these two diseases in children below 15 years. Aim: A hospital-based prospective study was conducted in eastern India to assess the clinicohematological profile of children with SSA and SBT. Methods: The prospective study was conducted in Srirama Chandra Bhanja Medical College, Cuttack, Odisha, from January to December 2020. A total of 43 confirmed cases by Hb electrophoresis of SCD were enrolled. Detailed clinical manifestations and hematological and biochemical tests were recorded as per the pro forma. Results: Clinical findings validated the major manifestations of SCD as splenomegaly, hepatomegaly, jaundice, fever, abdominal pain, crisis, and myopathy. Most of the SCD patients have severe anemia (range; 2.7-12.4 g/dL) at presentation. Splenomegaly was found in 43.8% of SCA versus 85.2% of SBT cases. Jaundice was more marked in SCA (62.5%) compared to SBT (48.1%) cases. Both the mean corpuscular Hb and mean corpuscular volume are more in SCA compared to SBT. Conclusions: Presentation of SCA is more severe compared to SBT. Enhanced implementation of newborn screening programs in Odisha state will help in reduction of the disease burden and morbidity due to SCD. [ABSTRACT FROM AUTHOR]

Background: Non-genetic factors like microbial dysbiosis may be contributing to the increasing incidence/progression of type 1 diabetes mellitus (T1DM). Objectives: To analyse the gut microbiota profile in Indian children with T1DM and its effect on glycaemic control. Methodology: Faecal samples of 29 children with T1DM were collected and faecal microbial DNA was extracted and subjected to 16S rRNA (ribosomal RNA) sequencing and further analysis. Results: The dominant phyla in children with T1DM were Firmicutes and Bacteroidetes. Butyrate-producing bacteria Blautia and Ruminococcus showed a significant negative correlation with the glycosylated haemoglobin (HbA1C) levels (p < 0.05). Coprococcus and Propionibacterium were important negative predictors of glycaemic control (p < 0.05). Conclusion: Our study suggests that Indian children with T1DM have a distinct gut microbiome taxonomic composition and that short-chain fatty acid-producing bacteria like Ruminococcus and Blautia (butyrate-producing) may play an important role in the glycaemic control of subjects with T1DM. [ABSTRACT FROM AUTHOR]

Subacute sclerosing panencephalitis (SSPE) is a progressive neurodegenerative disease of children and young adults that may occur as an uncommon complication 7-10 years after a measles infection. In measles - endemic countries like India, the incidence of this fatal disease is high and more number of new cases are detected in recent times. In this case series, we have presented three cases of SSPE between the 4 and 5 years age group, presented with abnormal movement and neuroregression and diagnosed by characteristic clinical features, raised anti-measles antibody titer in CSF, and typical Electroencephalography findings. All of them had a history of measles infection before the vaccination and very short latency period between measles infection and the development of SSPE. They were discharged in stable condition after the treatment with oral Isoprinosine and intrathecal Interferon alfa 2b. Early age of presentation, short latency period, and apparently good response to treatment for the time being prompted us to present these cases. [ABSTRACT FROM AUTHOR]