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Nosocomial spread of adenovirus infection has been reported in neonatal, pediatric and adult medical units. This nonenveloped and hardy virus is resistant to numerous disinfectants thus posing a challenge for control and prevention of adenovirus infections in health care settings.An epidemiologic outbreak investigation revealed an adenoviral outbreak in the neonatal nursery as well as in the neonatal screening outpatient department for Retinopathy of Prematurity (ROP). All suspected cases (94 neonates) underwent adenoviral conventional polymerase chain reaction (PCR) and representative samples underwent sequencing by Sanger's method. The clinical features and disease course were studied. Infected babies were started on tobramycin eye drops. Topical steroid eye drops were added for those who developed pseudomembranes.We found 58 cases of laboratory-confirmed neonatal adenovirus conjunctivitis (between July 10 and October 24, 2019). Redness (96%) was the most common presentation followed by discharge (68.9%) and lid edema (51.7%). Pseudomembrane were seen in 77.5% of the infected neonates. Prior ROP examination was carried out in 38 (65.5%) neonates. Respiratory symptoms were present in 7 (12.06%) neonates. Sequencing revealed serotype 8 as the cause of the outbreak. Control measures were strictly implemented. Standard Operating Procedures (SOPs) for ROP screening were revisited, revised and reinforced to prevent future outbreaks.We observed ROP screening as a risk factor for the development of adenoviral conjunctivitis in neonatal care units. Neonates present with different clinical manifestations as compared with adults. Prompt control measures were implemented to control the adenoviral outbreak.

Framing an appropriate research question is the most critical and fundamental part of a study. This helps in developing a hypothesis, formulating aims and objectives and methodological execution of the study. Research questions are usually generated by literature backed thorough analysis of the gaps in previous studies and funnelling it to a specific focussed issue. The research question should be framed using the PICO (Population, Intervention/Exposure, Comparator and Outcome) format and should fulfil the FINER (feasible, interesting, novel, ethically sound, and relevant) criteria for practical aspects. Objectives should always be framed in alignment of the research question using SMART (specific, measurable, achievable, realistic and time defined) approach. Outcomes are classified as primary and secondary. It is advisable to have only one primary objective while secondary objectives can be multiple (usually not exceeding five). This paper describes a cascade approach starting from framing the research question and then deciding on the outcomes and study objectives.

Justification In view of new developments in vaccinology and the availability of new vaccines, there is a need to revise/review the existing immunization recommendations. Process Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics (IAP) had a physical meeting in March, 2020 followed by online meetings (September-October, 2020), to discuss the updates and new recommendations. Opinion of each member was sought on the various recommendations and updates, following which an evidence-based consensus was reached. Objectives To review and revise the IAP recommendations for 2020–21 and issue recommendations on existing and new vaccines. Recommendations The major changes include recommendation of a booster dose of injectable polio vaccine (IPV) at 4–6 years for children who have received the initial IPV doses as per the ACVIP/IAP schedule, re-emphasis on the importance of IPV in the primary immunization schedule, preferred timing of second dose of varicella vaccine at 3–6 months after the first dose, and uniform dosing recommendation of 0.5 mL (15 µg HA) for inactivated influenza vaccines.

Posterior mediastinal enterogenous cyst is a rare entity in neonate. The neonate can present with severe cardio-respiratory compromise in the form of respiratory distress, shock, cardiac failure or arrhythmia soon after birth which may require immediate surgical intervention. Antenatal screening can demonstrate the cystic mass in fetus early and can help in quick postnatal management. Multidisciplinary management with aspiration of the cysts was life-saving in the present case.

Background: Pediatric Risk of Mortality (PRISM) III score is one of the widely used scoring systems to quantify critical illness in the pediatric age group. This study was carried out to find the association of PRISM III score with the outcome (discharge/mortality) and also hospital stay in survivors and nonsurvivors. Setting: The study was conducted in a tertiary care hospital from January 2014 to June 2015. Materials and Methods: A total of 524 patients were admitted, and after excluding the patients who met the exclusion criteria, 486 patients were analyzed. Statistical Analysis: Logistic regression was used to find the association of variables under the PRISM III score with mortality. Linear regression was used to find the association of PRISM III score with length of stay. Results: Mortality was 31%; male: female ratio was 1.5:1. Maximum patients presented with respiratory system involvement (26.3%), and maximum mortality (20.3%) was observed in the patients with respiratory involvement. Discrimination by the model between mortality and survival was excellent (receiver operating characteristic curve [0.903]). Maximum risk of mortality was noticed in mechanically ventilated patients (odds ratio [OR]: 10.87) followed by lower systolic blood pressure (OR: 2.72), deranged prothrombin time, partial thromboplastin time (OR: 1.50), deranged mental status (OR: 1.41), and tachycardia (OR: 1.37). Length of stay (LOS) in patients increased till PRISM III score of 25. Average LOS in survivors was 4.327 days which was not accounted by difference in PRISM III score between different patients. With each unit increase in PRISM III score, LOS increased by 5 h. Conclusions: PRISM III score has excellent capacity to discriminate between survival and mortality. PRISM III score can be used to predict LOS among survivors.

Data generated after the first wave has revealed that some children with coronavirus 19 (COVID-19) can become seriously ill. Multi-inflammatory syndrome in children (MIS-C) and long COVID cause significant morbidity in children. Prolonged school closures and quarantine have played havoc with the psychosocial health of children. Many countries in the world have issued emergency use authorisation (EUA) of selected Covid-19 vaccines for use in children. In India, a Subject Expert Committee (SEC) has recommended the use of Covaxin (Bharat Biotech) for children from the ages of 2-18 years. The recommendation has been given to the Drugs Controller General of India (DCGI) for final approval.To provide an evidence-based document to guide the pediatricians on the recommendation to administer COVID vaccines to children, as and when they are available for use.Formulation of key questions was done by the committee, followed by review of literature on epidemiology and burden of Covid-19 in children, review of the studies on COVID vaccines in children, and the IAP stand on Covid-19 vaccination in children. The available data was discussed in the ACVIP focused WhatsApp group followed by an online meeting on 24 October, 2021, wherein the document was discussed in detail and finalized.The IAP supports the Government of India's decision to extend the COVID-19 vaccination program to children between 2-18 years of age. Children with high-risk conditions may be immunized on a priority basis. The IAP and its members should be a partner with the Government of India, in the implementation of this program and the surveillance that is necessary following the roll-out.

Neonates born somewhere else (outborn) and treated in a referral centre have different microbiological profile. We report the microorganism's profile and antimicrobial resistance (AMR) in blood culture proven sepsis in outborn neonates.Culture positive neonatal sepsis from a neonatal unit of a referral institute catering to outborn neonates was studied over an 18 months duration. Data from the hospital information system were used to analyse the culture positivity rates, the spectrum of the microorganisms isolated and AMR pattern.Out of 5258 admitted neonates, 3687 blood samples were sent for suspect sepsis. The blood cultures were positive in 537 (14.6%) samples from 514 neonates. Gram-positive cocci (GPC) were the most common [240 (45%)] followed by gram-negative bacilli (GNB) [233 (43.4%)] and fungi [64 (11.9%)]. Coagulase negative staphylococcus (CONS) contributed to two-thirds of GPC followed by Klebsiella [93 (17.3%)] and Acinetobacter species [52 (9.7%)]. In 403 (75%) neonates, organisms grew in the samples sent at or within 24 h of admission. The case fatality rate was significantly higher in those with culture positive sepsis. The resistance to meropenem and imipenem was documented in 57.1% and 49.7%, respectively and 48% of the GNB was multidrug resistant.CONS followed by Klebsiella species were the most common organisms isolated. Three-fourths of the neonates had organisms grown at or within 24 h from admission. More than half of the GNB were multidrug resistant. The case fatality rate was significantly higher in those with culture positive sepsis.Sepsis is the third most common cause of neonatal mortality globally. Outborn neonates differ in their microorganisms’ profile and antimicrobial resistance (AMR) pattern in comparison to inborn neonates. In this study, we report the microorganisms profile and their AMR pattern in blood culture proven sepsis in a large cohort of outborn (extramural) neonates admitted to the index institute. We have also presented the state-wise profile and have compared their AMR pattern. Out of the 5258 admitted neonates, 3687 blood samples were sent for culture for suspect sepsis. The blood cultures were positive in 537 (14.6%) samples from 514 neonates. Coagulase-negative staphylococcus (CONS) followed by Klebsiella species were the most common organisms isolated from this large cohort of outborn neonates. More than 75% of the neonates grew the organisms within 24 h from admission indicating that many of them harboured the organisms at admission. Case fatality rate was significantly higher in those neonates with culture positive sepsis in comparison to culture negative sepsis. Close to 50% of the gram-negative bacilli isolates were multidrug resistant and half of them were extensively drug resistant. A significant between-state difference in organism profile and their AMR patterns were observed.

Justification In India, till recently, breastfeeding women have been excluded from the coronavirus disease (COVID-19) vaccination program, rendering a significant population of the country, including frontline workers, ineligible to derive the benefits of the COVID-19 vaccine rollout. Objective The objective of this recommendation is production of an evidence-based document to guide the pediatricians to give advice to breastfeeding mothers regarding the safety of COVID-19 vaccines in lactating women. Process Formulation of key question was done under the chairmanship of president of the IAP. It was followed by review of literature regarding efficacy and safety of COVID-19 vaccines in breastfeeding women. The recommendations of other international and national professional bodies were also deliberated in detail. The available data was discussed in the ACVIP focused WhatsApp group. Opinion of all members was taken and the final document was prepared after achieving consensus. Recommendations The IAP/ACVIP recommends the administration of COVID-19 vaccines to all breastfeeding women. The IAP/ACVIP endorses the recent recommendation of the Government of India, to consider all breastfeeding women as eligible for COVID-19 vaccination.

During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, immunization practices of all age groups, especially routine childhood vaccines, have been interrupted. Immunization is considered an essential health activity, which needs to be resumed as early as possible. This pandemic has created several unique issues related to routine immunization of individual children at clinics, which needs to be addressed. In this communication, the Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics addresses the common questions and issues related to SARS-CoV-2 and routine immunization services. This also includes the recommendations for routine immunization of SARS-CoV-2 suspect and positive children, and for the logistics to be followed for immunization services.

During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, immunization practices of all age groups, especially routine childhood vaccines, have been interrupted. Immunization is considered an essential health activity, which needs to be resumed as early as possible. This pandemic has created several unique issues related to routine immunization of individual children at clinics, which needs to be addressed. In this communication, the Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics addresses the common questions and issues related to SARS-CoV-2 and routine immunization services. This also includes the recommendations for routine immunization of SARS-CoV-2 suspect and positive children, and for the logistics to be followed for immunization services.

ObjectiveThe objective of this study is to systematically synthesize the currently available literature on various modes of transmission (congenital, intrapartum, and postpartum), clinical features and outcomes of SARS-CoV-2 infection in neonates.MethodsWe conducted a comprehensive literature search using PubMed, EMBASE, and Web of Science until 9 June 2020. A combination of keywords and MeSH terms, such as COVID-19, coronavirus, SARS-CoV-2, 2019-nCoV, severe acute respiratory syndrome coronavirus 2, neonates, newborn, infant, pregnancy, obstetrics, vertical transmission, maternal–foetal transmission and intrauterine transmission, were used in the search strategy. We included studies reporting neonatal outcomes of SARS-CoV-2 proven pregnancies or neonatal cases diagnosed with SARS-CoV-2 infection.ResultsEighty-six publications (45 case series and 41 case reports) were included in this review. Forty-five case series reported 1992 pregnant women, of which 1125 (56.5%) gave birth to 1141 neonates. A total of 281 (25%) neonates were preterm, and caesarean section (66%) was the preferred mode of delivery. Forty-one case reports describe 43 mother-baby dyads of which 16 were preterm, 9 were low birth weight and 27 were born by caesarean section. Overall, 58 neonates were reported with SARS-CoV-2 infection (4 had a congenital infection), of which 29 (50%) were symptomatic (23 required ICU) with respiratory symptoms being the predominant manifestation (70%). No mortality was reported in SARS-CoV-2-positive neonates.ConclusionThe limited low-quality evidence suggests that the risk of SARS-CoV-2 infections in neonates is extremely low. Unlike children, most COVID-positive neonates were symptomatic and required intensive care. Postpartum acquisition was the commonest mode of infection in neonates, although a few cases of congenital infection have also been reported.

E-learning, or learning and teaching facilitated and supported through the application of technology, is presently being used widely in all fields of education, and also being utilized extensively in medical education. This narrative review aims to introduce the concept of e-learning, and discuss its need and scope in medical education in India. Experience shows that students and faculty are mostly in favor of adopting e-learning side-by-side with traditional learning, and the advantages far outweigh the likely discomfort associated with adoption of this new method.

Background: One of the major causes of concern in medical world is rapid development of antibiotic resistance. World Health Organisation started an initiative in 2011 with a policy designed to curb this danger of antibiotic resistance. This study was designed to know the knowledge, attitude and belief of community regarding antibiotic use so that data can be generated in this region for the proper designing and implementation of awareness campaigns for the community. Methods: A single point cross sectional study was conducted in 1500 adults attending the Out Patient Department of a tertiary care hospital in Northern India. The tool used for the study was a predesigned questionnaire. The data was evaluated using descriptive statistical analysis. Results: In our study 92.8% participants admitted of having used an antibiotic at any time in their lifetime. The most common reason for use of antibiotics was common cold (36.2%). The most common antibiotic used by the participants was amoxycillin. The most common source of information regarding antibiotics and their use (63.2%) was physicians. 78.6% of the participants believed that they have awareness about rational use of antibiotics. 68.6% respondents were of the view that antibiotics are effective against both viral and bacterial infections. 52.3% of the participants believed antibiotics are not safe to use. Conclusions: The existence of a significant gap between practice of antibiotic usage and knowledge about their usage was found prevalently in the community. After noting the results of this study it is believed that there is a dire necessity to take steps to curb the menace of rapid development of resistance to antibiotics.

Background: Faulty or lack of intranatal care can lead to a number of morbidities in the neonatal period. Newborn care in any community is influenced by cultural practices prevalent in that area apart from medical and economic causes. In India, morbidity and mortality of mother and child directly or indirectly is governed by the customs prevalent in their society. Infant feeding and rearing practices vary across communities, depending on social customs. This study was planned to give us an insight about the neonatal rearing and feeding practices among mothers and the factors influencing their practices in Punjab. Methods: This facility based one point cross sectional descriptive study was done in Pediatrics wards and postnatal wards of Guru Gobind Singh Medical College, Faridkot. The newborn rearing practices were interviewed from the families accompanying the babies with age less than four weeks using structured questionnaire. Results: 965 babies were enrolled for the study. The mean age of the mother was 28.3 ± 3.5 years and 51% of the mothers practiced exclusive breastfeeding. High proportion of neonates (70%) was given prelacteals feeding, honey being most common. Oil massage to the baby was practiced by 99% of the mothers. Bath after 24 hours of delivery was given to 74% newborns. 89% of the babies were vaccinated after birth. Conclusions: People like to follow their rituals and customs eliminating potentially harmful practices should be tried keeping those in mind. The strengthening of the information, education and the communication to improve the existing neonatal rearing practices is the need of the day.

Senior Loken Syndrome (SLS) is a rare genetic disorder having juvenile nephronophthisis and retinal degeneration progressing to blindness and end stage renal disease. The present case report is about two sisters who presented with decreased visual acuity and end stage renal disease. Both had decreased vision, pallor, deranged renal function test and chronic malnutrition. Investigations revealed anaemia, uraemia, raised creatinine, low Glomerular Filteration Rate (GFR). Ophthalmology examination revealed nystagmus, retinal examination depicted pale optic disc and pigmentary changes in the retina. Renal ultrasound showed grade III renal parenchymal changes and bilateral cortico-medullary cysts. These cases are presented to highlight the importance of timely recognition of renal derangement in patients with retinal disease to delay end stage renal disease.

Background: Insulin-dependent (type 1) diabetes mellitus is associated with different degrees of neuropathies affecting peripheral as well as central neural pathways. The subclinical neurological involvement in diabetic children can be assessed by changes appearing in the electrophysiological parameters like Visual Evoked Potentials (VEPs). The objective of the study was to assess the effect of type I diabetes melitus on the visual evoked potentials in children.Methods: This cross-sectional case-control study was done on 30 children with type 1 diabetes mellitus of minimum two years duration as cases and 30 age and gender matched euglycemic children with normal HbA1c taken as controls. Visual Evoked Potentials (VEPs) were done on both the groups of children and the latencies (ms) of waves -N75, P100, N145 and amplitude (μV) of wave P100 were recorded. The data was compiled in the pre-designed proforma and statistically analysed using student t-test.Results: The increase in the mean latencies of waveforms of VEPs N75, P100 and amplitude P100 were found to be highly significant statistically (p0.05).Conclusions: The type 1 diabetes does affect the visual pathways in children. Visual Evoked Potentials are helpful in the detection of early changes in the conduction across the neural pathways in the sub-clinical diseases.

Background: Technology-enhanced learning is reliable, established, and effective teaching tool for better understanding of the subject. This study addresses an important issue in medical education, namely, the enhancement of the widely criticized lecture style of teaching by engaging students more actively during class through the use of videos or animations. This study describes the development, implementation, and evaluation of a traditional anatomy lecture series combined with technology. Aim and Objectives: The aim of the study is (a) to combine three-dimensional (3D) videos and animations with traditional embryology lectures and (b) to evaluate the 1st-year MBBS students' perception about this method of learning of embryology. Methodology: This qualitative study was conducted in the Department of Anatomy at Guru Gobind Singh Medical College, Faridkot, during the theory classes of embryology over a period of approximately 3 months among 100 1st-year MBBS students. The students were shown 3D videos and animations of embryology during traditional didactic lecture to explain all the aspects of the development of different systems of the body in 25 classes, of 1-h duration each. Feedback was taken using a structured questionnaire to know the perception of students toward this exercise of using technology during lecture of embryology. Results: A total of 100 MBBS first professional students took part in the study and submitted questionnaire. The students were satisfied with this method of technology-enhanced learning and described better understanding of the concepts with improved learning. More than 90% of the students found that combining 3D videos and animations with traditional lecture helped in solving the confusion and misconceptions regarding topic and did make the topic more interesting. They further added that they wanted to have such type of technology (videos)-enhanced lectures in all other topics of anatomy and in other subjects as well. Conclusions: Technology used in the form of 3D videos and animations changed their attitude toward learning and their learning was improved. It provided satisfaction to students in terms of better learning and understanding of the subject.

Background. Publication misconduct is a commonly reported finding among researchers from various backgrounds including those from the medical sciences. The reasons for such events are diverse and people address them differently. Methods. The opinions and experiences of 72 medical educators enrolled in an online discussion forum for faculty development were analysed to ascertain possible reasons and ways to address publication misconduct. Results. Of the 50 educators who participated in the discussion, 46 had one or more experiences of publication misconduct to share. Twelve participants felt that almost all kinds of publication misconduct, i.e. fabrication and falsification of data, plagiarism and authorship issues were a universal phenomenon. In the experience of majority of the participants, publication misconduct was common and often no action was taken. Lack of knowledge and awareness among teachers and students, personal gains, pressure for professional advancement and lack of monitoring and control were identified as the reasons for such misconduct. Several solutions were offered by the participants to address the problem, the most common was to have a formal training programme along with stringent monitoring and control mechanisms at the institutional level. Conclusion. Publication misconduct occurs and people indulge in it for a variety of reasons. Institutional-level policies may be able to address some of these.

Introduction: The change in the hormonal levels during the three phases of menstrual cycle, namely, menstrual phase (hormonal withdrawal), proliferative phase (estrogen peak), and secretory phase (progesterone peak), influences the conduction velocities in the central auditory pathways. Variable findings of brainstem auditory evoked response (BAER) have been reported during different phases of menstrual cycle by different researchers. Aim: To study the effect of different phases of menstrual cycle on BAER. Methodology: A prospective observational study on 80 audiometrically normal, healthy, eumenorrheic female students in age group of 18–24 years was done at a medical college of northern India. BAER was recorded across the three phases of the menstrual cycle, i.e., menstrual phase (day 1–3), proliferative phase (day 10–12), and secretory phase (day 20–22). Recordings of peak latencies, interpeak latencies, and amplitude of waves of BAER were taken and statistically analyzed. Results: In this study, significant decrease in the latencies of wave III, wave V, and interpeak latency I-III and a trend of decrease in latencies of wave I and interpeak latency I-V (which was statistically insignificant) were observed in proliferative (estrogen peak) phase as compared to menstrual and secretory phase. However, there was no statistically significant difference found in the amplitude of waves of BAER during all the three phases of menstrual cycle. Conclusion: The hormonal changes during different phases of menstrual cycle do seem to influence BAER.

Context: Tutor assessment is sometimes also considered as an exercise of power by the assessor over assesses. Student self-assessment is the process by which the students gather information about and reflect on their own learning and is considered to be a very important component of learning. Aim: The primary objective of this study was to analyze the impact of self-assessment by undergraduate medical students on their subsequent academic performance. The secondary objective was to obtain the perception of students and faculty about self-assessment as a tool for enhanced learning. Materials and Methods: The study was based on the evaluation of two theory tests consisting of both essay type and short answer questions, administered to students of the 1st year MBBS (n = 89). They self-assessed their performance after 3 days of the first test followed by marking of faculty and feedback. Then, a nonidentical theory test on the same topic with the same difficulty level was conducted after 7 days and assessed by the teachers. The feedback about the perception of students and faculty about this intervention was obtained. Results: Significant improvement in the academic performance after the process of self-assessment was observed (P < 0.001). There was a significantly positive correlation between student and teacher marking (r = 0.79). Both students and faculty perceived it to be helpful for developing self-directed learning skills. Conclusions: Self-assessment can increase the interest and motivation level of students for the subjects leading to enhanced learning and better academic performance, helping them in development of critical skills for analysis of their own work.