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

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 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]

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]

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]

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 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]

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]

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: 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: 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]

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: Health during childhood plays a vital role in the overall development of human being. Though significant progress has been made globally to improve child health, yet vast disparities exist across communities and countries. The present study was conducted to understand the health of the children and its association with socio-economic conditions of mothers. Method: A community based crosssectional study was conducted in 7 randomly selected tea garden areas of Jorhat district of Assam. Data on overall child health, birth-weight, breast feeding practices and socioeconomic conditions were collected from each mother. Different anthropometric measurements of each child were also collected. Result: The present study shows that the frequency of underweight, stunting and wasting was 36.67 percent, 40.59 percent and 14.42 percent respectively. 38.63 percent of the children have low birth weight and 13.93 percent of children are suffering from different illness. Conclusion: Educational level of mothers and income level have a positive association with overall health of children. Maternal education is also found to have a significant association with the birth weight of children. Under-nutrition is a serious health concern among the Adivasi children of tea garden areas of Jorhat district. [ABSTRACT FROM AUTHOR]

Background: Epidemiology of maxillofacial injuries vary depending on geographic location, culture and socioeconomic condition. This study assessed etiology and pattern of facial fractures in children reported at Burdwan Dental College and Hospital, Burdwan, West Bengal, India. Method: Clinical files of 206 children with facial fractures were evaluated retrospectively. Diagnosis of fractures were confirmed by radiographic examination. Study period was from July 2018 to June 2022. Data collected were age and sex of the patient, site of fracture, and etiology of trauma. Descriptive statistics were used for statistical analysis with a P-value less than 0.05. Results: There were 127 (61.7%) males and 79 (38.3%) females with a male to female ratio of 1.6:1. Within the study sample, the majority of facial fractures (n = 146, 70.9%) belonged to 6-to-9-year age group. Overall, falls (44.2%) and motor vehicles accidents (31.5%) were the two leading causes of trauma. Mandible fracture was the most common, accounting for 72.8% of cases. 74 patients (35.9%) with facial fracture had dental injuries. Conclusion: Male predominance in facial fracture is seen. With age, frequency of facial fractures tends to increase. Falls are the main cause of facial fracture and mandible is the most common anatomic location. [ABSTRACT FROM AUTHOR]

Background and Need for the Study: Spastic diplegic cerebral palsy is the most prevalent and common form of the cerebral palsy. Gait, balance, and coordination are all negatively impacted because it mostly affects the bilateral lower extremities. Purpose of the Study: The purpose of the research was to find out the effectiveness of task specific circuit training on gait and functional mobility in children with spastic diplegic cerebral palsy. Methods: In this research, selected 30 children according to inclusion and exclusion criteria. All the Children participating in the study were separated into two groups, Task specific circuit training group and Conventional group, children's parents were explained about the safety and procedure. Inform assent was provided to the children's parents after explaining about the intervention and study procedure. Results: Pre-test measurements and Post-test measurements of the gait and functional independence, assessed using the Edinburgh visual gait scale (EVGS) and GMFM-88. Paired t-test and unpaired t-tests were used for calculating the mean and standard deviation. Conclusion: The research eventually reached the conclusion that task-specific circuit training is an efficient method for improving gait and functional mobility when used in conjunction with regular physiotherapy. [ABSTRACT FROM AUTHOR]

Background: Normal growth and development, emotional wellness, and immune function all require adequate sleep. Sleep is commonly thought to be a time when the mind and body relax and recover, but in reality, sleep is a period of significant neuronal and physiological activity. This study intends to find the prevalence of sleep disturbance in typically developing infants. Methodology:The study included 60 participants. The parents of the participants who met the studycriteria were administered aquestionnaire including demographic details of the child and questions pertaining to the sleep behaviour of their child during the first 12 months of life. The data collected was subjected to appropriate statistical analysis. Result: The study included 60 participants of either gender in the age group of 12-24 months. The mean birth weight of all the children was 2891.6 (±553.9) grams. The mean age of sleep development of all participants was 4.18 (±2.61) months. Pearson's correlation analysis revealed that there was no statistical significance between mother's age at delivery and birth weights or sleep development ageof children. Also,the birth weight and sleep development age of children didn't correlate with each other. A large number [50(83%)] of children developed the sleep pattern by 6 months of age, which was significant at a z-value of 7.303 at p-value of <0.00001. Discussion: The mean birth weight of boys was higher than the girls. The boys also developed the circadian sleep wake cycle slightly later than girls. However, no significant correlation was found between birth weights and sleep development ages of children. Majority of the infants developed the sleep rhythm in first 6 months of life whereas a small proportion developed it later till 12 months of age. Conclusion: The boysdeveloped the circadian sleep wake cycle slightly later than the girls. However,maximum children developed the sleep pattern by 6 months. [ABSTRACT FROM AUTHOR]

Background and Aim: According to the World Health Organization, close to 21% of India's population may be affected by intestinal parasites, accounting for 39 million disability-adjusted life years, which may likely be due to substandard sanitation practices and insufficient personal hygiene standards. This research was conducted with the aim of determining the prevalence of helminthic infections among school-aged children in the South Canara district of India. Materials and Methods: We conducted a cross-sectional study involving school children from nursery to the 8th Grade in the South Canara district of Karnataka, India. The presence of various intestinal parasites in different age groups was determined by performing routine stool microscopy. Modified acid-fast staining was performed for stool samples collected from children <5 years of age for the detection of intestinal coccidian parasites. Statistical analysis was carried out to analyze age-related trends in relation to the prevalence of commonly detected intestinal parasites. Results: Intestinal parasites were identified in 10 of the 253 students (3.9%), with the highest incidence observed in the age group of 7-10 years (1.9%). The most prevalent parasite identified was the cysts of Giardia lamblia, with a prevalence of 7.54%, followed by Ascaris lumbricoides and hookworm, each having a prevalence of 5.66%. Of the 253 students, 92.2% practiced handwashing with soap after defecation, while 7.8% did not use soap. The handwashing practices did not significantly vary across different age groups. Clinically, pallor was observed in 64.2% of the individuals. Conclusion: Giardiasis was the most common parasitic infection, followed by soil-transmitted helminths such as Ascariasis and hookworm. The level of hygiene practices among children exceeded the prevailing national and state standards. [ABSTRACT FROM AUTHOR]

Background and Aim: Kidney dysfunction is reported in significant number of beta thalassemia major children. The aim of this study was to determine the prevalence of glomerular dysfunction in beta-thalassemia major children on regular blood transfusion (BT) and chelation therapy, and to find the correlation between glomerular filtration rate (GFR) estimated by Schwartz formula and Technetium 99m diethylenetriaminepentaacetic acid (99mTc-DTPA) renogram with ferritin level and cumulative transfusion load. Materials and Methods: An observational cross-sectional study conducted was done on 110 children diagnosed with beta-thalassemia major receiving regular BT and chelation therapy. Clinical examination, biochemical investigations (serum creatinine, ferritin) and DTPA renal scan were done. Estimated GFR calculation was done by Schwartz method and 99mTc-DTPA scan. The normal values of GFR were taken from the standard value as per KDIGO guidelines. P < 0.05 was considered statistically significant. Results: The prevalence of glomerular dysfunction by Schwartz formula and DTPA renogram was 44% and 24%, respectively. The GFR calculation (Schwartz formula and DTPA renogram) were weakly positively correlated (r = 0.126, P = 0.547). There was significant association between GFR Schwartz and duration of iron chelation, as children with abnormal GFR had significantly more duration of iron chelation >5 years (28% vs. 4%, P = 0.003). GFR (Schwartz formula and DTPA renogram) showed no association with cumulative transfusion load and disease duration (P > 0.05). GFR Schwartz formula and GFR-DTPA showed no correlation with serum ferritin with r = 0.179, (P = 0.392) and r = 0.278 (P = 0.178). Conclusion: There is a significant derangement in the renal function of children of beta-thalassemia major on chronic BT and iron chelation therapy. GFR holds a direct correlation with the increasing duration of iron chelation. [ABSTRACT FROM AUTHOR]

Background: Juvenile myelomonocytic leukemia (JMML), previously known as juvenile chronic myeloid leukaemia, is a rare, unique, and aggressive myeloproliferative neoplasm of early childhood. Making a diagnosis of JMML is challenging because of the overlapping clinical and haematological features with other myeloproliferative neoplasms (MPN). However, some unique features like monocytosis, the absence of BCR-ABL translocation, and the presence of specific mutations (PTPN-11, K-RAS, N-RAS, CBL, or NF1) clinch the correct diagnosis. Methods: A prospective analysis of six JMML patients with variable clinical features treated with injection azacytidine as frontline therapy during the study period of 2 years. Results: The median age was 4.5 years with male:female ratio 2:4. Pallor and splenomegaly were the most common presenting signs. Four patients (66.67%) achieved complete remission (CR), two patients (33.33%) had partial remission (PR), and one patient (16.67%) had progressive disease (PD). The overall survival rate was 66.67% (four out of six), and the mortality rate was 33.33%. Conclusion: Azacitidine is an effective treatment option as upfront therapy for JMML, especially in resource poor developing countries. [ABSTRACT FROM AUTHOR]

Background: Congenital heart disease (CHD) is one of the commonly seen malformations, with incidence varying from 7 to 8/1000 live birth. Causes are multifactorial. Routine examination of neonates may miss more than 50% of cases. Pulse oximetry is a simple, noninvasive, bedside test which estimates the percentage of oxygen bound to hemoglobin (oxygen saturation [SpO2]). Detection of critical CHD (CCHD) has been possible with SpO2 screening. Many countries included SpO2 as part of newborn screening due to this. As a primary approach, both pre- and post-ductal extremity SpO2 is measured after 24 h of life. Echocardiography (ECHO) will be done on neonates with SpO2 readings <95%. Neonates born in high-altitude regions, studies have suggest to use adjusted threshold values. In India, there are limited studies. Aims: The aim of this study was to determine the usefulness of pulse oximetry as a screening tool for early detection of CHD in otherwise asymptomatic newborns. To determine, the accuracy of SpO2 for detecting clinically unrecognized CCHD in newborns. Materials and Methods: This is a prospective observational study done in the department of pediatrics in a tertiary hospital. The study was conducted over 12 months. During the study period, all neonates born who fulfilled the inclusion criteria were included in the study. After 24 h of life, neonates were examined clinically and the pre- and post-ductal SpO2 was measured. Neonates with SpO2 <90% in room air were excluded from the study. If the SpO2 was between 90% and 94%, clinical examination was repeated, if suspicious of CHD, they were referred for ECHO. If there was no suspicion of CHD, SpO2 was repeated after 6 h and ECHO was done if SpO2 ≤95. The difference of SpO2 >3% between the right upper limb and right lower limb was considered positive. Positive neonates were evaluated with two-dimensional echocardiograph. Inclusion criteria - All hemodynamically stable neonates were born during the study period. Exclusion criteria (1) Antenatally diagnosed cardiac anomalies, (2) Outborn neonates, (3) Parents/guardians are not willing to participate in the study and/or further investigation, (4) Sick neonates and those with SpO2 <90% at birth. Results: 1117 (83.7%) were eligible for the study out of 1333 neonates born. 669 (59.9%) were born by cesarean section and 448 (40.1%) by vaginal delivery. 996 (89.2%) were born at term (≥37 weeks of gestation) and 121 (10.8%) were preterm (<37 weeks of gestation). The male-to-female ratio was 1.03:1. The mean birth weight of the neonates was 2.91 ± 0.46 kg (mean ± standard deviation). The mean SPO2 in the right upper limb was 96.62 ± 1.73, in the right lower limb was 96.87 ± 1.76, in the left upper limb was 96.59 ± 1.90, and in the left lower limb was 97.06 ± 1.74. The average SPO2 difference between the right upper limb and right lower limb was 1.04 ± 1.07. Based on SpO2, 858 (76.8%) cases were not suspected of having CHD and 259 (23.3%) were suspected of having CHD and were evaluated with ECHO. Six (0.5%) neonates had CHD in whom echo was done. In our study, for detecting CCHD, SPO2 cutoff value of ≤90% showed 90% sensitivity, 99.94% specificity, 75% positive predictive value, and 99.98% negative predictive value. Conclusions: This study emphasizes noninvasive SPO2 as reliable and feasible, with good negative predictive value screening for CHD in neonates. [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]

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]

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]

Introduction: Preterm infants' thermoregulation in the first few minutes after birth remains a contentious issue, but studies show that focusing on the issue and developing a guideline can reduce hypothermia in these patients. By implementing the thermoregulation bundle, this study aims to reduce the incidence of hypothermia on admission to the neonatal intensive care unit (NICU) by 50% in infants born at 32 weeks' gestation or less. Materials and Methods: Neonatology unit at a private medical college in the Chennai district was studied for 6 months from July 2021 to December 2021. The Plan-Do-Study-Act cycle from the "WHO Point-of-Care Quality Improvement Model" was used. Thermoregulation bundle was used to standardize thermoregulation management from predelivery through admission to the NICU. Results: The NICU temperature had spiked significantly to 36.38°C ± 0.67°C (P < 0.001) from the previous two readings, which was statistically significant (P = 0.001). Results from Bonferroni corrections show that the temperature induced during implementation had a statistically significant increase in temperature (23°C vs. 34°C, respectively) from the delivery point to the point of baby shifting (P = 0.001) which accounted for a 67% reduction of hypothermia. Conclusion: The present study successfully achieved its objective of reducing hypothermia by more than 50%, with a rate of 67%. Premature infants can be saved from hypothermia by implementing a standard protocol in the delivery room at the time of baby transfer and admission to the NICU. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effectiveness of a nutrition education intervention between the control and experimental groups of school-going girls. Methods: Using multistage random sampling, a school-based pre-post quasi-experimental study was conducted among 472,10-19-year-old adolescent girls in Lucknow, India. The respondents were divided into a control group (CG) and an experimental group (EG). EG was exposed to a self-designed documentary on topics related to a balanced diet, while CG was not. Results: Most girls had inadequate knowledge pre-intervention (t(471) =10.8,p<.001) in both CG and EG. Post-intervention scores improved significantly [t(471)=8.496,p=.00]. The number of respondents with "inadequate" knowledge decreased from 130 to 79 in EG, while those with "adequate" knowledge increased from 34 to 86. Conclusion: Overall, the findings underscore the effectiveness of audio-visual aid in filling the knowledge gap among adolescent girls in a school setting. It also emphasizes the need to implement customised and targeted nutrition education programmes for adolescent girls. The results show that knowledge levels of respondents were below average, which upon nutrition education intervention, improved. Hence, the same can effectively improve nutrition literacy among adolescents. [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]

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: The Pediatric Sequential Organ Failure Assessment (pSOFA) score is a scoring system used to assess the severity of organ dysfunction in critically ill children. The aim of this study was to evaluate the effectiveness of the pSOFA lactate (pSOFA-L) score in predicting the clinical outcome of critically ill children. Subjects and Methods: This hospital-based, prospective, observational study was conducted in the pediatric intensive care unit of medical college from North India. A total of 100 children were included. Parameters pertaining to the various organ systems as designated in the pSOFA-L score were studied and compared the score with the clinical outcome. Results: In this study, there were 56 survivors and 44 nonsurvivors. On receiver operating characteristics curve analysis, the cutoff value of the pSOFA-L score in predicting mortality was 10 with a sensitivity of 81.8% and specificity of 85.7% and area under the curve: 0.882, which is statistically significant (P < 0.001). In the present study, the mortality rate was 11.3%, 18.2%, and 70.5% in children with pSOFA-L score <9, 9-11, and >11, respectively. On bivariate analysis of the survivor and nonsurvivor group, nonsurvivors had a significantly higher pSOFA-L score (P = 0.000). The mean lactate level was significantly higher among nonsurvivor group (3.02 ± 1.59 vs. 1.75 ± 1.19, P = 0.000). Conclusions: pSOFA-L score is accurate in predicting mortality, with a higher score indicating a poor outcome. The study also found a significant relationship between serum lactate levels and the pSOFA-L score, with higher lactate levels indicating a poor prognosis. [ABSTRACT FROM AUTHOR]

Background: Acupressure, which is related to acupuncture, is a noninvasive therapy suitable for use in children. However, data examining acupressure's effects on the pain of local anesthetic injection in children are sparse. Objectives: The purpose of this study was to evaluate acupressure's effects on the pain of local anesthetic injection in children. Methods: This randomized, double-blind, parallel-group clinical study included 37 5-to 10-year-olds who had an inferior alveolar nerve block (IANB) for a mandibular extraction and were randomized to one of two groups: acupressure (study group) or non-acupressure (control group). The Wong-Baker FACES Pain Rating Scale (WBFPS) and the Sound, Eye, Motor (SEM) scale were utilized for subjective and objective pain assessment during injection. Results: The objective and subjective assessment of pain during injection significantly differed between the groups, with the acupressure group displaying lower scores. Conclusion: Acupressure at the extra one point (EX-HN1) reduced pain during IANB injection in 5- to 10-year-olds and can be used as an adjunct to conventional measures like topical anesthesia to reduce pain. [ABSTRACT FROM AUTHOR]

Air pollutants are known to trigger asthma and wheezing-associated lower respiratory infections in children, but evidence regarding their effect on hospital admissions in India is limited. We conducted a time-series study over a period of five years to assess the role of ambient air pollutants in daily asthma-related hospital admissions in children in Mysore, India. Daily asthma and wheeze (associated with lower respiratory infections) admissions were modelled using a generalised additive model (GAM) to examine the non-linear effects and generalised linear models (GLM) for linear effects, if any. Models were adjusted by day of the week and lag days, with smooth terms for time, maximum temperature, and relative humidity, and they were stratified by sex and age group. Of the 362 children admitted, more than 50% were boys, and the mean age was 5.34 years (±4.66). The GAMs showed non-linear associations between NO2, PM2.5, and NH3. For example, a 10 µgm−3 (or 10%) increase in NO2 increased admissions by 2.42. These non-linear effects were more pronounced in boys. A linear effect was detected for PM10 with a relative risk (95% CI) of 1.028, 1.013, and 1.043 with admission. Further research is needed to explore whether these findings can be replicated in different cities in India. Air pollution needs to be controlled, and policies that focus on lower cut-off levels for vulnerable populations are necessary. [ABSTRACT FROM AUTHOR]

Background: Visual perception (VP) plays a vital role across various occupations, such as daily activities, academic performance, and social interaction. Many children are referred to occupational therapy with VP dysfunction, often accompanied by diagnoses such as developmental delay, learning difficulties, or neurological impairments. In India, health-care professionals, particularly occupational therapists, increasingly utilize the motor-free VP test-4 (MVPT-4), a test originally standardized among Western populations, to identify VP difficulties in children. However, studies suggest that using assessments standardized in different cultures may lead to inaccurate evaluations of visual perceptual skills, potentially underestimating or overestimating of these abilities. This underscores the importance of investigating the cultural influence on the visual perceptual abilities of Chennai children by comparing the performance of Chennai children with norms of MVPT-4. Objectives: The main purpose of this study was (a) To compare the performance of children from Chennai with norms of MVPT-4 and (b) To identify the influence of gender on MVPT-4. Study Design: This study employed a quantitative cross-sectional research design. Methods: A total of 150 children, aged 6.0-10.11 years, were selected from the community in Chennai using a convenience sampling approach. Children with good visual foundation skills were administered with MVPT-4. Results: Independent t-test revealed that there was a statistically significant difference between the performance of children from Chennai and the norms of MVPT-4 in the age groups of 6.0-10.11 years. Notably, the results indicated that there was no statistically significant difference between genders on MVPT-4 among Chennai children. Conclusions: The study findings indicate that the performance of Chennai children is substantially better than the norms of MVPT-4. [ABSTRACT FROM AUTHOR]

Background: To assess the effectiveness of educational intervention to reduce the weight of school bags. Material and Methods: The study design was one group pre- and posttest experimental Research design. Place and Duration of Study: Government Senior Secondary School Dhanas, Chandigarh, and Shri Guru Harkrishan Model Senior Secondary School Sector-38D, Chandigarh (A private school) between July and November 2018. Names of the schools can be avoided. Total 760 students from selected sections nursery to 10th class of school were enrolled in the study. At baseline and end line weight of children, school bags and its content were weighed using weighing scale. Length of bag strap, breath of bag, torso of children, and their shoulders size were measured by measuring tape. Bag carrying style, posture, etc., were observed by observation checklist. Interviewed children (5th to 10th class) were using Nordic musculoskeletal questionnaire for musculoskeletal system assessment. Educational intervention was provided to the children for one month to reduce weight of school bag by teaching in assembly and displaying the charts in school. (Use of softbound thin textbooks, breaking thin books in 2-3 thin softbound books, use lightweight bag, pencil box, lunch box, and water bottles. Pack bag as per timetable.) Result: The result revealed that heavy school bags were carrying 69.7% children from government school and 80.2% from private school. Children carrying heavy bags reported musculoskeletal problems 5 times higher than their counterparts. After intervention, there was significant reduction in the weight of school bags (P < 0.001 as per paired t-test). Provide the weight of the bags before and after intervention in addition to the P value. Conclusion: Children carrying heavy bags were suffering from musculoskeletal problems. Intervention helped in reducing the weight of school bag. [ABSTRACT FROM AUTHOR]

Background: Lower gut bleeding is an alarming sign among caregivers. Determining the etiology is of utmost importance for further management. This is the first study conducted in northernmost India. Methods: This cross-sectional study was conducted at the Department of Pediatrics, Government Medical College, Srinagar. This study aimed to describe the etiology of lower gastrointestinal bleeding in the age group of 1-18 years over the past 5 years from June 2017 to June 2022. Results: A total of 310 children presented with hematochezia (53.5%), blood mixed with loose stools for > 2 weeks (39.3%), melena (1.9%), and occult blood in stools (0.3%). The mean age was 5.12 years. The age group of 1-6 years was 73.5 %. The most common findings were rectosigmoid polyps n = 104 (33.5%), anal fissure n = 47 (15.1%), lymphoid nodular hyperplasia (LNH) n = 38 (12.2%), trichuris dysentery syndrome n = 30(9.7%), cow's milk protein allergy n = 27(8.7%), non-specific colitis n = 18(5.8%), solitary rectal ulcer syndrome n = 14(4.5%), inflammatory bowel disease n = 6 (1.9%),intestinal tuberculosis n = 3(0.9%), duodenal dieulafoy lesion 1(0.3%), and blue bleb nevus rubber syndrome n = 1(0.3%). 21 patients had a normal colonoscopy. The colonoscopy yield was 93.3 %. Among the colonoscopy-negative patients, 6(1.6%) had Meckel's diverticulum, and 1(0.3%) had a duodenal dieulafoy lesion. Conclusion: Lower GI bleeding most commonly presents as hematochezia, and the most common cause is a rectosigmoid polyp. Colonoscopy is the procedure of choice to evaluate the etiology of lower GI bleeding. Anal fissures, LNH, Trichuris trichiura, and cow's milk protein allergy are other common causes of lower gut bleeding in Kashmir, northernmost India. [ABSTRACT FROM AUTHOR]

Background: As the COVID-19 epidemic began in 2019 in Wuhan, China, and spread quickly to numerous nations. Therefore, in order to curb the spread of this disease, the government has implemented various preventative measures, such as social distance, using napkins when sneezing or coughing, avoid hand contact with those who are ill, etc. Children attending large gatherings since schools have resumed operations as per government directives, making them susceptible to the transmission of Covid-19. In order to stop the spread of the pandemic among children, it is important to evaluate how school-aged children understand the respiratory exercises and preventative measures recommended by the Government of India. Methodology: The knowledge and attitudes of school-going youngsters were evaluated using a cross-sectional survey research. A thorough assessment of the literature led to the formulation of the survey's google form questionnaire, which included 17 questions in the knowledge and attitude domains. Snowball sampling was used to distribute the survey questionnaire to 800 students in North Indian schools. Only 673 students were included in the survey due to the inclusion and exclusion criteria. Results: Among 673 students, 404 students were females (22.965±2.899) and rest were males (22.186±3.772). Our study shows that both the domains' knowledge (t-stat 3.024) and attitude (t-stat 3.420) are highly significant as the p-value is <0.001. The correlation between both domains shows that both domains are positively and highly significantly correlated as the r-value is 0.44. Conclusion: The precautionary steps that the Indian government implemented have had a positive influence on students' lives and knowledge, and they are taking excellent care of themselves. [ABSTRACT FROM AUTHOR]

Introduction: The assessment of growth is essential during preschool age, more particularly in pediatric neurological examination, where measurement of the head circumference plays a vital role. Head circumference (HC) is a simple and non-invasive anthropometric measure. Also known as the frontal occipital circumference, HC has been cautiously used to assess the frequencies of undernutrition among preschool children. Material & Methods: The current study was done on 782 preschool children (boys= 384, girls = 398) aged 24-60 months ICDS beneficiaries of Jalpaiguri by using WHO (2007) recommended cut-off points for head circumference for age. Statistical analyses were also done to determine age and sex variations in Head Circumference. Results: Age combined rates of Head Circumference based moderate undernutrition for boys was 21.87 % and for girls was 25.37 %. Age-combined severe undernutrition among boys and girls were 5.72% and 6.53 %, respectively. The higher percentage of malnourished girls was seen in the previous study done on Midnapore and Bangalkot and a higher percentage of malnourished boys was seen than the Midnapore children. The present study reveals Girls were more affected by moderate and severe undernutrition compared to boys. Conclusion: Head Circumference is an indicator of brain development so initiative should be taken for regular monitoring of ICDS beneficiaries to improve the nutritional condition of preschool children. [ABSTRACT FROM AUTHOR]