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

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

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

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

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

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

Background: Breakthrough seizures occur in 37% of epilepsy patients even though remission has been attained. Counseling on precipitating factors form an integral part of treatment along with anti-epileptic drugs (AEDs). Identification of precipitating factors may help in reducing unnecessary hospitalization and complications of breakthrough seizures. Materials and Methods: This retrospective study was conducted in a tertiary healthcare center in Puducherry. All children with epilepsy admitted with breakthrough seizures from January 2017 to December 2019 were included in the study. Those with neonatal seizures, diagnosis of either Neurocysticercosis or tuberculoma, cases without seizure free period of 6 months and case records without adequate details were excluded. Data regarding precipitating factors were collected from case records and analyzed using SPSS version 24.0 software. Results: Of the 80 children included in the study, mean age was 4.98 (±3.52) years and 56.3% were less than 5 years of age. In total, 90% (n = 72) of the participants had generalized epilepsy, of which 67 had generalized seizures, four had absence seizures and one had atonic seizures. Majority (85%) reported at least one possible precipitating factor for breakthrough seizures and common ones were fever (27.5%) and non-compliance to medication (26.25%). Most common reason for non-compliance was forgetting to take medication (38%). Also illiterate mothers and multiple AEDs had a significant association with non-compliance (P < 0.05). Conclusion: The results of our study stress the need on adequate counseling about possible precipitants and prescription on minimum AEDs whenever possible. Parents need to ensure strict adherence to AEDs and avoidance of trigger factors. [ABSTRACT FROM AUTHOR]

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing inflammatory central nervous system disorder. Patients either have antibodies to aquaporin 4 (AQ4)/myelin oligodendrocyte glycoprotein (MOG) or are double seronegatives (DSN). Aim: We aimed at comparing the clinico-epidemiological features and outcome of the subgroups of NMOSD. Design: Prospective longitudinal observational study. Materials and Methods: NMOSD was diagnosed by using the 2006 Wingerchuk criteria. Patients diagnosed between September 2016 and August 2018 were prospectively followed up to July 2020. Acute episodes were treated with steroids, and immunomodulators were started in patients with aquaporin 4 IgG (anti-AQ4+) and in relapsing cases of anti- MOG+ and DSN groups. Disability was assessed by using the Expanded Disability Status Scale (EDSS). Comparisons were made between patients who were anti-AQ4 and anti-MOG positive and those with DSN. Statistical analysis was done by SPSS 20.0 software. Results: Among 13 patients, the female: male ratio was 1.16:1, and the mean age of disease onset was 9.65 ± 3.25 years. Overall, 15.38% patients were anti-AQ4+, 30.67% were anti-MOG+, 53.86% were DSN, 69.2% had relapsing disease, and 30.8% had monophasic disease (P = 0.11). The mean to relapse was 13.16±3.5 months; 61.5% patients had long segment myelitis and 53.86% had optic neuritis on their first presentation (P = 0.99). Cerebral syndrome occurred among one patient with anti-MOG+ and in three patients with DSN. The EDSS scores were significantly lower among patients who were anti-MOG+. Conclusion: The female: male ratio was more equitable and the age of disease onset was lower in our cohort compared with western data. There was no significant difference in the clinico-demographic characteristics among the three groups; however, outcome was better in the anti-MOG+ group. Rituximab was effective for recurrent relapses. [ABSTRACT FROM AUTHOR]

Background: Seizures due to an underlying metabolic abnormality form an important subset of acute symptomatic seizures in that they are treatable and do not require long-term anticonvulsants. The objective of this study is to determine the clinical and etiological profile of children with metabolic seizures. Materials and Methods: A prospective observational study done in children admitted with acute symptomatic seizures who had an underlying metabolic abnormality as the cause of seizures from January 2018 to December 2019 in a tertiary care hospital of South India. Demographic and clinical parameters were noted and relevant investigations including biochemical, neuro imaging, cerebro spinal fluid analysis, electro encephalography were carried out accordingly. Results: Among 1256 children admitted with new onset seizures, 408 (32.5%) had acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures, of which 46 (3.7%) were found to have an underlying metabolic abnormality and were analyzed. The ratio of male to female was 1.4:1 and the peak age was infancy, accounting for 62.5%. The leading causes of metabolic seizures included hypocalcemia in 28 (60.9%), hypoglycemia in 16 (34.8%), and hyponatremia in 2 (4.3%). Vitamin D deficiency in 21(75%) was found to be the commonest cause for hypocalcemia, followed by hypomagnesemia, hypoparathyroidism, osteopetrosis, and renal failure. The various causes of hypoglycemia were Addisons disease in 6(37.5%), hyperinsulinemic hypoglycemia, idiopathic ketotic hypoglycemia, glycogen storage disorder, and fatty acid oxidation defect, congenital adrenal hyperplasia, and Laron syndrome. Both children with hyponatremia were diagnosed as congenital adrenal hyperplasia. Conclusion: Metabolic seizures accounted for 3.7% of new onset seizures and 11.3% of acute symptomatic seizures in our study. Hypocalcemia (60.9%) was found to be the commonest cause of metabolic seizures in children with the majority due to vitamin D deficiency (75%). Addison's disease (37.5%) was found to be the common cause for hypoglycemia. It is reasonable to estimate serum calcium, magnesium, electrolytes, and glucose in all children presenting with new onset seizures. [ABSTRACT FROM AUTHOR]

Background and Aim: Psychological and biochemical factors are responsible for the behavioral problems in children with epilepsy. A study was conducted to find the prevalence of behavioral problems in children with epilepsy and also to identify the relation among socioeconomic status, age of onset of seizure, and frequency of seizure attacks with the prevalence of behavioral problems. Materials and Methods: It was a prospective observational study conducted in the Department of Pediatrics, Kakatiya Medical College, Warangal. Convenient sampling was considered; the study was conducted for 2 years. Children aged 1–12 years, admitted with epilepsy to pediatric intensive care unit and pediatric wards, were included in this study. Those were having intellectual problems, cerebral palsy, developmental delay, and metabolic and neurodegenerative disorder were excluded from the study. Sociodemographic information was collected from the parents in a standard pro forma. Diagnostic and Statistical Manual of Mental Disorders-oriented scales for different ages were used for the assessment of behavior by translating into regional language. Chi-square test was used; P < 0.05 was considered statistically significant. Results: A total of 112 children were included; male: female ratio was 1.39; 41 (36.6%) children had behavioral problems; age-wise, there was significant difference; gender-wise, there was no significant difference. Attention-deficit/hyperactivity problems were identified to be the predominant. Statistically, there was no significant difference between behavioral problems either with mother education or with parent's socioeconomic status, respectively. When brain imaging was done, normal studies were revealed in 32% of children with behavior problem. Conclusion: Each and every child with epilepsy aged <5 years and frequency of seizure attack >1 time/year needs thorough screening for behavioral problems irrespective of gender and family characteristics. [ABSTRACT FROM AUTHOR]

Malnutrition among children is one of the greatest public health problems in India. School age is the active growing phase of childhood and primary school age is the period of physical growth as well as mental development of the child. The present nutritional status of School age children in India is unsatisfactory. 1) To assess the nutritional status of children between 5-15 years of age. 2) To analyse the factors associated with malnutrition among school-age children. [ABSTRACT FROM AUTHOR]

Background: Adenovirus affects mainly the respiratory system, leading to life-threatening pneumonia. This study was aimed to describe the epidemiological, clinical, biochemical, and radiological profile and respiratory sequelae during follow-up among children with severe adenoviral pneumonia (ADVP) admitted in a tertiary care pediatric intensive care unit (PICU). Subjects and Methods: This is a single-center, prospective study conducted in PICU from eastern India from December 2018 to August 2021. Children less than 10 years of age, admitted with features suggestive of lower respiratory tract infection (LRTI)/pneumonia and positive for adenovirus by respiratory polymerase chain reaction during the study period were included. All children were managed symptomatically. Antibiotics were used in all children and respiratory support was given according to the severity as per standard management protocol. Results: Among 96 children with adenoviral pneumonia, 33 (34.4%) had severe ADVP and required PICU care. Among them, 28 (84.8%) were males and 24 (72.7%) had SPO2 <90% at the time of admission. Twenty (60%) children needed some respiratory support beyond simple oxygen therapy. Among 33 children, 9 (27.3%) died, 2 left against medical advice, and 22 (66.7%) survived and were discharged. Among discharged, 2 (9%) were lost in follow-up and 20 (91%) children were followed up for the next 2.5 years. During the follow-up, 18 (90%) had recurrent symptoms, and high-resolution computed tomography showed features suggestive of postinfective bronchiolitis obliterans in most of them. Conclusions: Unlike other respiratory viruses, ADVP had a longer course of illness, seemed to be more severe, and had more long-term sequelae. [ABSTRACT FROM AUTHOR]

Background: The Composite Index of Anthropometric Failure (CIAF) has its multifaceted application in understanding child undernutrition. The nationwide data of Community National Nutrition Survey (CNNS) 2016-18 in India has unfolded this opportunity to reexamine the use of CIAF and its determinants. One recent study showed significant differences in child undernutrition between rich and poor wealth index households using this CNNS -16-18 data. But the study did not consider regional as well as state-wise CIAF variation. However, it is a fact that regional understanding of child undernutrition is equally vital for national and regional health and nutritional planning, specifically in India. Therefore, the present study aims to understand the geographical region and state-wise distribution of CIAF and determine some selected determinants of CIAF. Methods: The study used secondary data set from the Community National Nutrition Survey (CNNS), India undertaken in 2016-18. The study sample comprised of 32941 children aged 0-59 months. The multivariate logistic regression models were used to explore the determinants of CIAF. Results: The results revealed that nearly half of the under-five children suffered from undernutrition (CIAF-46.71%). The final adjusted multivariate regression models showed that the higher CIAF prevalence was mainly confined in the central region states like Madhya Pradesh (56.0%) and Uttar Pradesh (52.0%). Besides, the Jharkhand state in the eastern region showed the highest percentage of CIAF (57.0%). The prevalence of child undernutrition was more elevated in poor economic households and Muslim households. Children in the age group =12 months, boys, who did not consume milk other than breast milk and lived in rural areas, had a higher prevalence of undernutrition. In the case of mother characteristics, mother's age at birth < 20 years, mother never attended school and mother did not watch television had a higher number of undernourished children. Despite several significant determinants associated with child undernutrition, the considerable impact of the region was consistent throughout the statistical models. Conclusion: Therefore, the vulnerable geographical regions and states in terms of child undernutrition should prioritise nutrition-sensitive interventions in India and consider the involvement of other key risk factors. [ABSTRACT FROM AUTHOR]

Introduction: Adolescence as a life stage is associated with physical and psychological changes with an interplay of biological, social, and environmental factors. The aim of this study was to determine the prevalence of aggression among children and the factors associated with aggression. Methods: This was an analytical cross-sectional study conducted in schools of Bhopal, Madhya Pradesh, India, between 2017 and 2019 among higher and higher secondary class children. All children from high and higher secondary classes were included, resulting in a sample of 192. Information on sociodemographic, family, psychosocial, lifestyle, addiction factors, aggression (Buss–Perry Aggression Questionnaire), self-esteem (Rosenberg self-esteem scale), and resilience (Nicholson McBride Resilience Questionnaire) were obtained. Results: The prevalence of aggression among children from Classes 9th to 12th was 49.5%; physical aggression was 42.7%, verbal aggression was 31.8%, anger was 44.3%, and hostility was 44.8%. Almost half (44.3%) of the children had self-esteem and only 1.6% of children had an established level of resilience. Of the sociodemographic factors considered, type of school, gender, parents' education; of the family factors considered, family members taking alcohol/drugs, parents having frequent arguments, parents hitting children and using abusive language; of the psychosocial, lifestyle and addiction factors considered, feeling neglected, grade, watching TV and practice of reading books were significantly associated with the presence of aggression in children (P < 0.05). Conclusion: Overall findings suggest the need for strengthening life skills education, positive immediate environment, coping at the individual level, social intelligence, and cautious approach toward boosting self-esteem. [ABSTRACT FROM AUTHOR]

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

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

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

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

Health at birth is an important indicator of human capital development over the life course. This paper uses longitudinal data from the Young Lives survey and employs instrumental variable regression models to estimate the effect of birth weight on cognitive development during childhood in India. We find that a 10 per cent increase in birth weight increases cognitive test scores by 0.11 standard deviations at 5–8 years of age. Low birth weight infants experience a lower test score compared with normal birth weight infants. The positive effect of birth weight on a cognitive test score is larger for girls, children from rural households and those with less educated mothers. Our findings suggest that health policies designed to improve birth weight could improve human capital in resource‐poor settings. [ABSTRACT FROM AUTHOR]

Background: Accurate estimation of body composition, particularly, Body Cell Mass (BCM), which is independent of hydration status is important in children with cancer. This study aimed to accurately measure the anthropometry and body composition of children with Acute Lymphoblastic Leukaemia (ALL) at diagnosis and compare them with healthy children from South India., Methods: This was a cross-sectional study in children aged 2 to 8 y with ALL from St. John's Medical College Hospital, Bengaluru, and age and sex-matched, normal-weight children recruited as controls from communities. Anthropometry (weight, height, circumferences), skinfolds and body composition measurements using a whole-body potassium counter were performed. Body mass index-for-age, weight and height for age z-scores were calculated using WHO child growth standards. Biochemical markers, dietary intake and physical activity details were recorded. Categorical and continuous variables were analyzed by chi-square and independent t-tests respectively.     Results: The mean age of the children with ALL (n = 39) was 4.6±1.9 y and control group (n=39) was 4.7±1.9 y; 61.5% were boys. The prevalence of underweight, overweight/obesity and stunting were 17.9%, 7.7%, and 10.3% respectively. The mean weight and height, of children with ALL and children in the control group were 16.8±6.2 kg and 16.4±4.1 kg, 104.3±14.9 cm and 105.1±12.2 cm, respectively with no statistical difference. Children with ALL showed lower body cell mass index kg/m2 (4.6± 0.8), compared to children in the control group (4.7±0.9) p=0.527, but higher fat mass index kg/m2 (3.6±1.1 vs. 3.4±0.8) p=0.276., Conclusion: At diagnosis, anthropometric and body composition measurements were similar between children with ALL and children in the control group. The BCM showed a non-significant trend of being lower in children with ALL, which requires close monitoring during treatment. Evaluating early-stage nutritional status and body composition can help in planning appropriate interventions during treatment to prevent long term non-communicable diseases.

Experiences in early childhood form the bedrock of future human potential. In impoverished settings, structured early childhood education (ECE) in preschool years can augment overall childhood and later human abilities. The current study evaluates preschool learning exposure and childhood cognition, using longitudinal follow-up of a community-based birth cohort in Vellore, south India. The birth cohort study site in Vellore recruited 251 newborns between 2010 and 2012 from dense urban settlements and further followed up into childhood. Preschool enrolment details were obtained from parents. Childhood cognition was assessed by Weschler's preschool primary scale of intelligence (WPPSI) and Malin's intelligence scale for Indian Children (MISIC) at 5 and 9 years of age respectively. Bivariate and multivariate regression analyses were performed with adjustments for socio-economic status (SES), maternal education, stunting status and home environment. Out of 251 new-borns recruited into the MAL-ED birth cohort, 212 (84.46%) and 205 (81.7%) children were available for the 5 year and 9 year follow-up respectively. At 5 years, structured ECE of 18 to 24 months duration was significantly associated with higher cognition scores, with the highest increase in processing speed [β: 19.55 (11.26-27.77)], followed by full-scale intelligence [β: 6.75 (2.96-10.550)], even after adjustments for SES, maternal cognition, home factors and early childhood stunting status. Similarly adjusted analysis at 9 years showed that children who attended 1.5-2 years of structured ECE persisted to have higher cognition, especially in the performance domain [β: 8.82 (2.60-15.03)], followed by the full-scale intelligence [β: 7.24 (2.52-11.90)]. Follow-up of an Indian birth cohort showed that structured ECE exposure was associated with better school entry cognition as well as mid-childhood cognition. Strengthening ECE through a multi-pronged approach could facilitate to maximize cognitive potential of human capital., (© 2024. The Author(s).)

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

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

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

India is currently facing a double burden of severe dengue and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Co-infection/complication due to these viruses can result in severe morbidity. We present five cases of severe dengue with multisystem inflammatory syndrome in children (MIS-C) due to SARS-CoV-2 infection in children. All children presented with shock with variable degrees of plasma leakage. They were treated initially as severe dengue cases; however, due to refractory symptoms such as persistent fever and inotropic requirement, an alternate diagnosis was suspected and established. They were successfully managed according to the World Health Organization Dengue Shock Syndrome and MIS-C Guidelines with intravenous (IV) fluids, methylprednisolone, aspirin, and IV immunoglobulin. Severe dengue in endemic regions overlapping with MIS-C makes it difficult to diagnose which needs early recognition and appropriate management. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus is relatively less common among infants but found to have a mentionable association with multiple organ dysfunction and turbulent course. The aim of this study was to delineate the clinicolaboratory profile of infantile scrub typhus, complication, course of illness, and responsiveness to therapy. Subjects and Methods: This retrospective observational study was undertaken in two tertiary care pediatric teaching centers in eastern India among infants with diagnosis of scrub typhus. Clinical features, especially pattern of organ dysfunction, laboratory findings with emphasis on hyperferritinemia, and treatment schedules with responsiveness to therapy, were analyzed retrospectively. Results: A total of 272 cases of scrub typhus had been admitted during the study period. Among them, 17 kids (6.25%) were infants. All of them presented with lethargy and poor feeding as a common complaint along with seizures and respiratory distress. Seven out of 17 (41%) were identified early. Fifteen (88%) were critically ill and required pediatric intensive care unit admission, out of which 13 (76.4%) patients were put on ventilator support. Thirteen (76.4%) of them developed hyperferritinemia with multi-organ dysfunction syndrome (MODS) and required additional immunotherapy. Sixteen of them recovered completely without any sequelae. Severe complications such as acute respiratory distress syndrome and MODS were significantly high (P = 0.001 and 0.004, respectively) and hospital stay was longer (P-0.04) in infants in comparison to older children. Conclusion: We conclude that infantile scrub typhus, though not very common, should be considered an important differential in infants presenting with an acute febrile illness with hyperferritinemia and MODS. Infants with scrub typhus can have a more stormy disease course compared to their older counterparts. [ABSTRACT FROM AUTHOR]

Diarrheal disease is a significant public health problem leading to mortality and morbidity among children aged 0–59 months in rural India. Therefore, the rationale of this study was to identify the sociodemographic and environmental predictors associated with diarrhea among under-five children in rural India. A total of 188,521 living children (0–59 months) were studied from the National Family Health Survey-4, (NFHS-4) 2015–2016. Bivariate and binary logistic regression models were carried out from the available NFHS-4 data for selected sociodemographic and environmental predictors to identify the relationship of occurrence of diarrhea using STATA 13.1. In rural India, children aged 12–23 months, 24–35 months, 36–47 months, and 48–59 months were significantly improbable to suffer diarrheal disease. Children of the female sex, as well as children of scheduled tribes (ST) and other backward classes (OBC), were less likely to experience diarrhea. The disease was more likely to occur among children of scheduled castes (SC); Muslim or other religions; children belonging to central, eastern, and western regions; children with low birth weight; as well as children with improper stool disposal and rudimentary roof materials. In the rural parts of India, sociodemographic and household environmental factors were most influential. Effective community education; improved handwashing practices; pure water supply; and proper waste disposal, including building and utilizing latrines, would help reduce the burden of diarrheal disease in children. [ABSTRACT FROM AUTHOR]

Fe deficiency has negative effects on voluntary physical activity (PA); however, the impact of consuming Fe-biofortified staple foods on voluntary PA remains unclear. This study compared the effects of consuming Fe-biofortified pearl millet or a conventional pearl millet on measures of voluntary PA in Indian schoolchildren (ages 12–16 years) during a 6-month randomised controlled feeding trial. PA data were collected from 130 children using Actigraph GT3X accelerometers for 6 d at baseline and endline. Minutes spent in light and in moderate-to-vigorous PA were calculated from accelerometer counts using Crouter's refined two-regression model for children. Mixed regression models adjusting for covariates were used to assess relationships between intervention treatment or change in Fe status and PA. Children who consumed Fe-biofortified pearl millet performed 22·3 (95 % CI 1·8, 42·8, P = 0·034) more minutes of light PA each day compared with conventional pearl millet. There was no effect of treatment on moderate-to-vigorous PA. The amount of Fe consumed from pearl millet was related to minutes spent in light PA (estimate 3·4 min/mg Fe (95 % CI 0·3, 6·5, P = 0·031)) and inversely related to daily sedentary minutes (estimate −5·4 min/mg Fe (95 % CI –9·9, −0·9, P = 0·020)). Consuming Fe-biofortified pearl millet increased light PA and decreased sedentary time in Indian schoolchildren in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Background: Childhood diarrhea remains a major disease burden, particularly in developing countries, and is a leading cause of death in children aged < 5 years, worldwide. Treatment of acute diarrhea now includes probiotics to potentially reduce the duration and severity of the illness. This phase 3, randomized, placebo-controlled, double-blind study assessed the efficacy and safety of four strains (O/C, N/R, SIN, T) of Bacillus clausii probiotic (Enterogermina®) plus oral rehydration therapy (ORT) and zinc, versus placebo plus ORT and zinc, in infants and children in India with acute moderate diarrhea. Methods: Patients aged 6 months to 5 years with acute moderate diarrhea (WHO 2005 definition) of < 48 h' duration were randomly assigned to receive one mini bottle of either polyantibiotic-resistant B. clausii (oral suspension of 2 billion spores per 5 mL bottle) or matching placebo twice daily (morning and evening) for 5 days. Exclusion criteria included known hypersensitivity to B. clausii or excipients in the study treatment, or to other probiotics. Patients were admitted to hospital from Day 1 and discharged ≥6 h after diarrhea resolution, or a maximum of 5 days. The primary endpoint was duration of acute diarrhea from randomization to recovery. Secondary endpoints included frequency of stools, diapers with stools, or dehydration status. Results: In total, 457 patients were randomized; 454 were treated. Similar proportions of patients showed recovery from diarrhea over the 120 h after randomization (97.0% in the B. clausii group [n = 227]; 98.0% on placebo [n = 227]). Median time to recovery was also similar: 42.83 (95% CI: 40.90–44.90) hours for B. clausii and 42.13 (95% CI: 39.80–43.87) hours for placebo. However, no statistically significant difference was observed between groups (hazard ratio = 0.93 [95% CI: 0.77–1.13]; p = 0.6968); nor were there statistically significant differences between groups for the secondary endpoints. Treatment with B. clausii was well tolerated with incidence of adverse events (9.7%) similar to that for placebo (12.3%). Conclusions: No significant difference in efficacy between B. clausii and placebo was demonstrated. Sample size may have been inadequate to allow detection of a between-group difference in efficacy, given the mild/moderate severity (only ~ 20% of patients had nausea/vomiting or abdominal pains) and short duration of disease among subjects, the relatively late start of treatment (most were already on Day 2 of their disease episode when study treatment started) and the effectiveness of the standard of care with ORT and zinc in both treatment groups. Trial registration: CTRI number CTRI/2018/10/016053. Registered on 17 October 2018. EudraCT number 2016-005165-31. Registered 14 May 2020 (retrospectively registered). [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Background: Children with attention-deficit hyperactivity disorder (ADHD) have severe impairment in their social functioning, and such literature from their sibling relations is limited. Sibling relations have several dimensions to them and a more detailed assessment into their impairment in ADHD is needed. We compared quality of sibling relations among ADHD sibling dyads and healthy controls. We also correlated the quality of sibling relations with severity of inattention and hyperactivity in ADHD. Materials and Methods: The present case-control study enrolled 30 cases of ADHD and 30 healthy controls from a child guidance clinic. The quality of their sibling relations was assessed by parent-rated version of the sibling relationship questionnaire (SRQ) on four domains of warmth, power struggle, conflict, and rivalry as well as their respective sub-domains. Their severity of inattention and hyperactivity was assessed using the Vanderbilt ADHD Diagnostic Parents Rating Scale (VADPRS). Results: ADHD sibling pairs had significantly lower warmth, prosocial behavior, affection, companionship, and competition as compared to their healthy counterparts. ADHD child was admired less by the sibling, and they were also seen to nurture each other less. The most significant difference was seen in affection (r = 0.59), followed by nurturance (r = 0.56). Intersibling conflict correlated positively with hyperactivity scores on VADPRS (p = 0.410, P = 0.04). Conclusions: Sibling relations are significantly affected in ADHD, with lower warmth and nurturance. Most significant impairment is noted in affection followed by nurturance. Intersibling conflict correlates significantly with severity of hyperactivity. [ABSTRACT FROM AUTHOR]

Background: Worldwide, more than 1.2 billion population is adolescents. Nutrition, physical activity, psychological health, and sanitations are few areas that affect adolescents, making them more vulnerable to diseases and contributing in disease burden. The present study was part of the Indian Council of Medical Research's (ICMR) school based health program Mission SHAKTTI which focused, and reported on adolescents' awareness and health literacy about nutrition, physical activity, and sanitation in Delhi. Methods: A cross-sectional qualitative study was conducted with students (aged 11-19 years), and the Mission SHAKTTI program was devised using the pillars of Gandhi's teachings for good health. Data were collected using a pre-tested open ended questionnaire (n=1796). For data analysis, deductive approach was adopted, and thematic content analysis was done with 95% confidence intervals (CI). Results: The study showed that students were somewhat aware of various healthrelated issues pertaining to Mahatma Gandhi's ideology of health, with 49.5% (CI: 46.72-51.39) reported that Gandhiji's mantra for staying healthy was simply a clean environment and proper sanitation. A gap between their understanding and perceptions of a balanced diet was observed, since many felt that merely eating enough food could labelled as balanced diet (36.46%; CI: 34.24-38.74). Conclusions: Findings may be useful in developing a suitable health-based educational program to inculcate knowledge about healthy practices among school-aged children through Gandhian health ideology. This may also help in forging a stronger and more aware foundation of nation leading to prevention of numerous diseases in the near future. [ABSTRACT FROM AUTHOR]

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

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

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

Purpose: This research aimed to explore the deaf identity development process and to compare the identity status of deaf children in India, based on their exposure to inclusive and segregated educational institutions. The first section of the paper presents the Deaf Identity Development Models proposed by other researchers, while the second section deals with the information acquired from the deaf students in the study sample. Method: Forty pre-lingual deaf students were selected through a purposive sampling technique. The study tool was an adapted version of the Deaf Identity Development scale. The data was analysed qualitatively through content analysis. Identified themes were presented along with the verbatim statements. Results: The findings revealed that the age of onset of hearing loss, degree of hearing impairment, parents' hearing ability, family's socio-economic status, parents' education, family environment, the attitude of parents, social exposure, present and past experiences and social acceptance of the deaf child contribute tremendously to the development of an identity. The study also found that most of the deaf students who had not attended special schools possessed a culturally marginal identity, whereas students with prior special school experience possessed a bicultural identity and were better adjusted in the inclusive schools as compared to their counterparts. Conclusion: Further research is suggested, with a special focus on how people with different degrees of congenital hearing impairment experience and negotiate their identity in context. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

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

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

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