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This study examined the impact of iPad integration on student motivation, engagement, and learning skills in a mathematics program. Subjects included 143 students aged 8 to 14 years old and 63 parents in an Indian-based school in Dubai where the national curriculum required the use of tablets be integrated into school subjects starting at grade three. All subjects responded to questions about how iPads could support learning math and the kind of challenges students faced. Classes were technology-driven using individualized learning groups and a variety of computer apps. Around 80 percent of the students indicated they understood new concepts better, were able to solve difficult math problems, and expected themselves to score better on their tests. It was found that providing instant access to a wide array of applications, resources, hands-on activities, and instant feedback can engage students and help them remain on task, especially those with special educational needs.

This ethnographic case study presents findings of an 18-month research study focusing on the ways in which families residing in an urban slum were using mobile phones and how this use supported literacy practices. Data collection included participant observations and interviews with 42 participants including parents, children and community members. Results of the data analysis indicated that in this urban slum, most participants owned a mobile phone which provided multiple entry points to learning. The phones ushered in new ways of brokering knowledge where children acted as 'experts' and enabled parents to perform everyday tasks while parents mediated as cultural brokers and fostered religious and cultural practices and knowledge of the mother tongue. The implications of the study point to the evolving nature of literacy practices, the versatility of the device, the uneven landscape of smartphone use and the limitations posed by the schooling contexts.

Background: Increasingly researchers are recognising the importance of including the perspectives of children and young people in research and in the development of interventions and innovations, in order to understand children's lives on their own terms. Purpose: This article reflects on the potential risks posed to children and young people in research and the role of gatekeepers in granting access and, in direct field activities, especially where the research could be deemed as 'sensitive'. Research Design: Using a combined descriptive and autoethnographic research design, questionnaires and reflections were gathered from the field experiences of researchers in four countries (India, Jamaica, Uganda and the UK) conducting research on children's experiences of violence victimisation as part of a gender-based violence prevention project. Data was collected retrospectively and analysed thematically with the aid of QSR NVivo. Results: Based on the five themes that emerged: accessing schools; approach to access; accessing participants; lessons learnt; and advice for other researchers, the overall findings indicate that researching sensitive topics with children and young people is necessarily problematic in order to safeguard them. This is especially the case in contexts where discrimination and stigma relating to certain topics may be a significant barrier to children's participation. Conclusion: Research planning requires attention to gatekeeper power, safeguarding children and young people, and understanding how processes and attitudes concerning the status and rights of children at national and institutional levels might influence the research process.

This study was conducted to explore the experiences of educators with mealtime behaviours of children with a diagnosis of Autism Spectrum Disorders (ASD) in schools, and to explore the strategies undertaken in schools to improve nutrition among these children. In-depth interviews were conducted with 13 educators of various special schools across Mumbai. They described their experiences with 3-11 year-old children with a diagnosis of ASD. Four themes emerged from this study: reasons for disruptive mealtime behaviours, using mealtimes as opportunities for indirect learning, strategies used to avoid disruptive mealtime behaviours, and school policies regarding food and nutrition. The presence of sensory stressors, changes in break-time schedules, and inability to communicate hunger were identified as main reasons for disruptive mealtime behaviours in the classroom. Strategies to tackle these behaviours were discussed. Most educators reported that their school followed a strict 'no junk-food' policy. The perspective of educators is important to understand the mealtime behaviours of children with ASD in school settings. The initiatives taken at the school-level are valuable as they provide a different approach and diverse strategies that may work to improve the food intake and nutrition of children with ASD.

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

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: Solid pseudopapillary neoplasm (SPN) of the pancreas in children is a rare tumor with low malignant potential. Some tumors, however, behave aggressively. There is very little literature on managing these variants, especially in children. We share our experience of managing large and recurrent SPN and explore the clinicopathological findings correlating to the risk of recurrence. Methods: This is a retrospective study of children treated for SPN between 2012 and 2022 at a tertiary care center in India. The clinicopathological features and management strategies in these children were evaluated. Results: Sixteen children with SPN were treated during this period (88% of girls). The median age of presentation was 12 years (interquartile range [IQR]: 9-14). All children presented with abdominal pain. Computed tomography gave a definitive diagnosis in 81% of cases. The tumor predominantly involved the head of the pancreas (n = 9, 56%). Eight of nine children classified as high-grade (HG) malignant had a benign course. One child had a recurrence of the tumor 4 years after the initial resection and further recurrence on chemotherapy. She required radiation therapy in addition to reoperation following which she was disease free for 77 months. The overall median follow-up was 46 months (IQR: 18-72 months). Conclusion: Complete resection of the tumor provides a cure in most patients with SPN. Recurrent tumors require a multi-modality approach. Long-term survival is good. There is a need for clear definitions of the components within the WHO criteria for HG malignancy. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to highlight the pathology, clinical spectrum, and approach considerations in abdominoscrotal hydrocele (ASH). Materials and Methods: Our study included eight children with ASH from 2015 to 2022. The demographics, clinical presentation, investigations, operative details, and postoperative outcome were collected retrospectively from case files. Results: The age of presentation ranged from 11 months to 2 1/2 years. Six lesions were on the right side and two were on the left side. One child presented with an acute scrotum and underwent emergency inguinal exploration, revealing hemorrhagic fluid after trauma. Others presented with tense inguinoscrotal swelling, which was fully reducible but refilled promptly after emptying. Preoperative ultrasound showed the abdominal component in 50%, while others were detected intraoperatively. All of them were approached inguinally, and the hydrocele sac was traced proximally to the abdominal component through the internal ring. This was drained and a partial excision of the extraperitoneal sac was done. An additional patent processus vaginalis (PPV) was identified in 87%, dissected up to the deep ring, and ligated. On follow-up, there was no recurrence. Conclusion: ASH is an uncommon condition that should be identified and dealt with appropriately. Physical examination and ultrasonography are usually sufficient for diagnosis. The inguinal approach is a safe, simple method and an extension of the standard operation for the hydrocele. One must keep in mind to explore for an additional narrow PPV to prevent the recurrence of hydrocele. [ABSTRACT FROM AUTHOR]

Background: Acute diarrhoeal diseases (ADD) account for a large number of preventable deaths in India, especially in children less than five years who are more at risk than adults with respect to the degree of dehydration and complications. (1) To measure the incidence of ADD among children under 5 years; (2) Determine risk factors associated among children; (3) Study treatment-seeking behaviour of their mothers. Community-based, prospective, longitudinal study conducted in an urban area of Goa. Material and Methods: 250 children enrolled in the study with their mothers by stratified random sampling technique, conducted house-to-house visits every three months and mothers were interviewed with pre-tested semi-structured questionnaire. The duration of study was one year from January to December 2018. Data entered using EpiData Entry Client®, Analysed using SPSS® software version 22. Student's t-tests and Chi-square tests were used. Results: The incidence of ADD was 0.124 episodes/child/year. Significant association was noted between ADD in children and certain socio-demographic factors like child's sex, birth order, birth weight, immunization status, malnutrition, mother's age group, mother's education, and mothers' hygiene practices. Conclusions: Efforts should be made to educate all mothers about the seeking timely treatment, awareness about home-based management and their types, awareness of ORS, zinc, importance of hygienic practices like hand washing for mother and child. [ABSTRACT FROM AUTHOR]

Skeletal radiographs along with dental examination are frequently used for age estimation in medicolegal cases where documentary evidence pertaining to age is not available. Wrist and hand radiographs are the most common skeletal radiograph considered for age estimation. Other parts imaged are elbow, shoulder, knee, and hip according to suspected age categories. Age estimation by wrist radiographs is usually done by the Tanner-Whitehouse method where the maturity level of each bone is categorized into stages and a final total score is calculated that is then transformed into the bone age. Careful assessment and interpretation at multiple joints are needed to minimize the error and categorize into age-group. In this article, we aimed to summarize a suitable radiographic examination and interpretation for bone age estimation in living children, adolescents, young adults, and adults for medicolegal purposes. [ABSTRACT FROM AUTHOR]

Background Trauma is a significant cause of morbidity and mortality worldwide among children. Nonoperative management is the standard of care in hemodynamically stable children with blunt abdominal solid organ injury. Embolization is a potential pathway, which has shown increasing evidence for benefit in adult trauma patients. However, the data in children is limited. Materials and Methods A retrospective analysis of hospital data of all children (<18 years of age), presenting to a tertiary-care trauma center in India, with history of blunt trauma from January 2021 to June 2023, was performed. Preprocedural imaging, angiographic and embolization details, number of blood transfusions, and length of hospital stay were assessed. Results Two hundred and sixteen children (average age: 11.65 years) presented with a history of abdominal trauma during the study period. Eighty four children were FAST positive, out of whom, 67 patients had abdominal solid organ injury on computed tomography. Liver was the most commonly injured solid organ (n = 45), followed by the spleen and kidney. Ten children had solid abdominal organ arterial injuries for which eight children underwent embolization. The average length of hospital stay in embolization group (n = 8) was 4 days, as compared to 11 days in children undergoing operative management (n = 2). At 6 months follow-up, all children were asymptomatic. Conclusion Superselective embolization is a safe and feasible procedure in appropriately selected children with abdominal injury. [ABSTRACT FROM AUTHOR]

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]

Background: Respiratory infections, particularly bronchopneumonia, pose a significant health challenge in paediatric populations, often leading to respiratory distress and compromised well-being. In the context of managing bronchopneumonia in children, exploring non-invasive interventions becomes beneficial. The application of thoracic kinesiotaping is hypothesized to positively impact lung volumes by assisting respiratory function and facilitating breathing pattern. Methodology: To determine the effectiveness of thoracic kinesiotaping on the functional capacities in children with bronchopneumonia, a group of 32 children aged 5 to 12 years were selected adhering to specific inclusion criteria. These participants were then randomly assigned to two groups. Group A underwent conventional respiratory physiotherapy exclusively while Group B participants received a combination of thoracic kinesiotaping and conventional respiratory physiotherapy. Pre-intervention assessment included baseline data, pulmonary function tests (PFT), Paediatric Dyspnea Scale (PDS) and Chest expansion. The treatment protocol spanned a period of three days. Analysis of data was done through Instat software. Conclusion: The analysis revealed a notable increase in Forced Expiratory Volume in 1 second (FEV1) and the FEV1/Forced Vital Capacity (FVC) Ratio during pulmonary function testing (PFT), accompanied by a marginal improvement in chest expansion. These findings suggest a positive impact of kinesiotaping on respiratory parameters, indicating potential benefits for children with pulmonary conditions. [ABSTRACT FROM AUTHOR]

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

Statement of the Problem: It is essential to address caries risk at an early stage for the prevention of dental caries. Mobile application CaRisk is designed in a particular way to self-assess the dental caries risk by the individual’s themselves. Purpose: The current study aimed to assess the dental caries risk among age groups 5-6 and 35-44 using self-assessment caries risk mobile application CaRisk and compare it with the deft and DMFT values. Materials and Method: This cross-sectional study was conducted in Chennai, India; to evaluate the risk of dental caries in children aged 5 to 6 and adults aged 35 to 44. The scores of the mobile application CaRisk and the decayed- extracted-filled teeth (deft)/ decayed-missing-filled-teeth (DMFT) caries risk assessment were evaluated. Descriptive statistics were performed. The risk category was determined by frequency. Chi-square analysis was done to determine whether the DMFT scores and the CaRisk mobile app were associated. The correlation was performed between the CaRisk mobile application and DMFT scores. Results: Association was found between the caries risk assessment score of the mobile application CaRisk and the DMFT and deft scores of the adults and children for both the age groups 5-6 and 35-44 years respectively and it indicates that it was found to be statistically significant. Pearson’s correlation was performed to assess the strength of association and R-values obtained for the age group 5-6 and 35-44 years respectively, which was statistically significant (0.892 and 0.840). Conclusion: This CaRisk mobile application scores correlate with the deft and DMFT scores and it is an effective self-diagnosis tool for assessing dental caries risk assessment. Further, it is suggested that the mobile application CaRisk should be tested among a huge population. [ABSTRACT FROM AUTHOR]

Rash and fever are some of the most common chief complaints present in paediatric dermatology emergencies. The spectrum of differential diagnosis is broad, including many different infectious and some non-infectious agents. A systematic approach involving detailed history taking, careful clinical examination along with particular attention to epidemiological features are the most important factors to make a diagnosis. This article reviews the morphological patterns of various causes of fever with rash in children, including infectious as well as non-infectious causes, with special emphasis on the Indian scenario. We intend to highlight the clinical characteristics of each cause, which will not only help make a clinical diagnosis but also distinguish benign versus life-threatening causes of skin rash in febrile paediatric patients and provide early medical intervention. [ABSTRACT FROM AUTHOR]

Background: Accidental ingestion of foreign bodies in children is critical, as the inability to effectively communicate can potentially lead to devastating consequences. We aimed to determine the epidemiology of foreign body ingestion and variability according to age, gender, type, and location of foreign body, and describe its management. Aim and Objective: The aim was to study the various types of foreign body ingestions in children admitted to pediatric surgery and their management. Materials and Methods: A retrospective study was conducted from January 2020 to June 2022 on children under the age of 12 years with a confirmed diagnosis of foreign body ingestion. Patients were clinically and radiologically assessed, after which standard protocols were followed wherein patients were followed by either observation or emergent management. Emergent management included removal of the foreign body by either endoscopy or surgery. Comparisons among multiple age groups, gender, type of foreign body, location of foreign body, and their management were analyzed. Results: Out of 99 subjects in our study, there were 76 boys and 23 girls. The median age of presentation was 5 years. Most children were asymptomatic at presentation. The most frequently ingested foreign body was a coin in all age groups. The majority of the foreign bodies were suspected to be in the small bowel. The foreign bodies that had crossed the duodenojejunal flexure (n = 74, 74.7%) were managed conservatively with the observation of a variable period of a minimum of 24 h and a maximum of 48 h. 21 cases were managed by endoscopic removal, while three cases required surgical intervention. Conclusions: Overall, the most common gastrointestinal foreign body was a coin in all age groups. Button battery is the most worrisome foreign body; however, depending on its position, it can be managed conservatively. Upper GI foreign bodies can be safely removed endoscopically. Parental counseling is very important for the prevention of ingestion of foreign bodies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to study the correlation between age at surgery and functional recovery after infant pyeloplasty. Materials and Methods: All infants who underwent pyeloplasty were analyzed retrospectively in this multicenter study. Anteroposterior diameter (APD) >2 cm, split renal function (SRF) <40%, and Society of Fetal Urology (SFu) grade 3-4 were surgical indications. Based on the age at pyeloplasty, they were divided into Group 1 (1-3 months) and Group 2 (4-12 months). APD and SRF were compared before and after surgery in both groups. The fractional recoverable function (post-SRF-pre-SRF)/(50-pre-SRF) ><100 was correlated with age. Results: Fifty-one infants underwent pyeloplasty (mean age: 1.6 months - Group 1 and 7.2 months - Group 2). The mean APD decreased from 3 cm to 1.2 cm in Group 1 while 2.8 cm to 2 cm in Group 2 (P = 0.001). The mean SRF increased from 32.28% to 42.81% in Group 1 while 31%-34.18% in Group 2. SRF recovery was significantly higher in Group 1 compared to Group 2 (P = 0.001). Regression analysis showed a weak negative correlation (r = -0.2792) between age at surgery and renal function improvement. Conclusion: Functional recovery after pyeloplasty is better when done earlier (1-3 months), as this gives the growing kidney the best opportunity to recover. [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]

Background: Acid-base disorders are common in critically ill patients and contribute significantly to mortality and morbidity. Metabolic acidosis (MA) can be measured by pH, base deficit, serum bicarbonate, and anion gap. A study was conducted to determine the incidence and type of MA among children admitted to the pediatric intensive care unit (PICU) and to assess its roles as a predictor of outcomes in them. Subjects and Methods: Over 1 year, 100 children between 1 month and 12 years of age who presented to the PICU with an MA or developed it within 24 h of admission were prospectively enrolled. Clinicodemographic data, pediatric sequential organ failure assessment score at admission, clinical outcome, and serial measurements of anion gap, serum lactate, and bicarbonate level were recorded. Results: The incidence of MA was 60.2% with a majority (52%) being high anion gap metabolic acidosis(HAGMA). The predominant condition (39%) leading to MA was catecholamine-resistant shock with organ dysfunction. Peak lactate value and bicarbonate nadir had a significant positive correlation with the duration of mechanical ventilation and inotropic support, but only peak lactate value was significantly associated with mortality. A peak lactate value of 2.19 mmol/L yielded the highest sensitivity and specificity for predicting mortality. There was no association was found between peak anion gap and morbidity or mortality. Conclusions: MA was observed in 60% of children in PICU, with HAGMA being the most common type. Peak lactate value and bicarbonate nadir were correlated with high morbidity, but only peak lactate value was significantly associated with mortality [ABSTRACT FROM AUTHOR]

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

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]

A rich and long-standing history of creative arts as an instrument for healing, growth, and self-expression, especially amongst children and youth, has been well-documented across time and cultures. Arts-based therapies within the mental health community have also garnered increasing support for positively contributing to the well-being of various groups and individuals. Therefore, this article further examines the use of arts-based therapy in an eight-session therapeutic group with children. Five children in the age range of 9–12 years met weekly for a course of two months at a child and adolescent mental health service in Delhi-NCR, India. Over the course of these 8 sessions, the individual and collective journey of the group members witnessed many ebbs and flows, eventually leading to a positive shift in the inter-group dynamics. In addition, various therapeutic gains were observed and reported for the group members, showing an increased sense of collaboration, confidence, and community. [ABSTRACT FROM AUTHOR]

Introduction: The environment poses an important risk in the causation of injuries in children. Simple measures in improving the safety of the domestic and peri-domestic environment can go a long way in preventing injuries. This study was conducted to assess the effect of training of the adolescents in the families, on the household environmental safety regarding childhood injuries. Materials and Methods: A pre- and post-intervention study was conducted over 16 months, on 116 families of two villages of Delhi. Data were collected regarding domestic and peri-domestic environments along with danger points with respect to injuries, of the enrolled houses, during the pre- and post-intervention phases of 4 months each. The intervention comprised training of the eldest adolescent of the family, on causes of common injuries and role of environment in injury causation. Scores were assigned to all relevant aspects, and the total environmental safety scores were calculated. The comparison was made between pre- and post-intervention scores of the two areas. Results: Environmental safety scores were more than 70% in both areas at the baseline with no difference between the two areas. In the intervention area, there was statistically significant improvement of scores after the intervention, in the domestic environment and danger signs within the houses. Conclusion: Training adolescents about the prevention of injuries and motivating them to remain vigilant over domestic environment are effective in bringing about significant change in the household environment with regard to safety from injuries in children. Repeated visits by health workers also increase awareness and change the household environment making it safer for children. [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]

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

Introduction: Permanent pacemaker implantation (PPI) in neonates is challenging with respect to indications, device selection, implantation technique, and long-term outcomes. Complex anatomy, the need for long-term pacing with high rates, and a problematic postoperative period are the major problems. Methods: We prospectively followed up 22 newborns who underwent PPI below 28 days of life at our institute. Results: The median age at implantation was 2 days (interquartile range 1-9 days), and 9% were born preterm. The average heart rate before implantation was 46.4 ± 7.2 bpm. Maternal lupus antibodies were positive in 8 (36.4%) neonates, whereas 11 (50.0%) had associated congenital heart disease. Nineteen neonates underwent single chamber (VVI) and three underwent dual chamber (DDD) pacemaker implantation. Over a median follow-up of 46 months (range 2-123 months), the average ventricular pacing percentage was 87.5 ± 24.9%, with a stable pacing threshold. Seven children underwent pulse generator replacement due to battery depletion at a median age of 47 months. Pacing-induced ventricular dysfunction was seen in five children at a median age of 23.6 months, and two underwent upgradation to cardiac resynchronization therapy. Overall mortality was 13.6%, all due to tissue hypoperfusion and lactic acidosis in the postimplantation period. Conclusions: PPI in neonates has a favorable outcome with excellent lead survival. Overall mortality is 13.6%, which is predominantly in the postimplantation period and related to myocardial dysfunction. [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: Recent studies on the Full Outline of UnResponsiveness (FOUR) score suggest that it can overcome the limitations of the Glasgow Coma Scale (GCS). Hence, this study was planned to predict the outcome of children with altered sensorium using the FOUR score and to compare it with the GCS score. Subjects and Methods: This was a single-center prospective observational study conducted in children in the age group of ≥2 months--12 years with altered sensorium included in this study. Admission GCS and FOUR scores were collected. Data were analyzed to compare the FOUR score to GCS in relation to outcome (survivors/nonsurvivors). Results: Out of 90 cases with altered sensorium, 12 expired (13.3%). The mean (standard deviation [SD]) of age (years) was 4.69 (3.72) and the maximum in the age group of 1--5 years (n = 42). The mean (SD), median (interquartile range), and range for GCS at admission for survivors versus nonsurvivors were 11.58 (1.62) versus 6.08 (1.08), 12 (11--13) versus 6 (5.75--7), and 7--17 versus 4--8, and for FOUR score, 13.51 (1.46) versus 8.67 (1.50), 13 (13--15) versus 8 (7.75--10), and 9--16 versus 7--11 were observed, P < 0.001. Admission GCS score of ≤8 (12 out of 15) and FOUR score <11 (10 out of 12) died, P < 0.001. ROC curve analysis for mortality prediction, the area under the curve for GCS (cutoff of 8) was 0.992, and for the FOUR score (cutoff of 11), 0.989 was observed, P < 0.001. Conclusions: Admission FOUR and GCS scores are comparable for the prediction of mortality in children with altered sensorium. The FOUR score of ≤11 strongly correlated with mortality. [ABSTRACT FROM AUTHOR]

Background: Invasive fungal disease is common in immunocompromised children, although rare in children suffering from viral pneumonia. Recently, it was our observation that a large number of children who were otherwise normal were suffering from invasive fungal disease along with viral pneumonia. The aim of our study is to determine the epidemiological and clinical profile of fungal infection in children suffering from viral pneumonia. Subjects and Methods: It was a retrospective study of medical records of children between January 2023 and March 2023 from pediatric intensive care unit (PICU) tertiary care hospital from Eastern India. Children with suspected fungal disease as per inclusion criteria were included in the study. A total of 27 patients were enrolled in this study. The serum galactomannan and beta-D-glucan (BDG) were measured. Clinical profile and outcome were compared between children with and without invasive fungal disease. Results: Out of 27 subjects, 16 (59%) had invasive fungal disease. All had adenovirus pneumonia. Seven (4.44%) had acute respiratory distress syndrome while four (25%) had shock and multiple organ dysfunction syndrome each. The duration of mechanical ventilation (P = 0.01), duration of PICU stay (P = 0.02), and duration of hospital stay (P = 0.004) were significantly higher in children with invasive fungal disease. These children had significantly higher rates of complications (P = 0.001) and higher mortality (P = 0.04). Conclusions: The serum galactomannan and BDG can diagnose invasive fungal disease in patients of viral pneumonia with persistent symptoms for more than 2 weeks. The invasive fungal disease is associated with higher morbidity and mortality in these children. [ABSTRACT FROM AUTHOR]

This document summarizes a study conducted in a tertiary care center in South India on children with congenital adrenal hyperplasia (CAH). The study found that growth was more compromised in children with salt wasting (SW) CAH compared to simple virilizing (SV) CAH, and higher doses of hydrocortisone were associated with greater growth faltering. The study emphasizes the importance of accurate growth assessment and optimizing steroid therapy for children with CAH. The document also mentions that diagnosis is often delayed in male infants, leading to increased morbidity and mortality, and acknowledges the need for further research due to limitations in sample size. [Extracted from the article]

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

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: 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]