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Diet-induced models of chronic kidney disease (CKD) offer several advantages, including clinical relevance and animal welfare, compared with surgical models. Oxalate is a plant-based, terminal toxic metabolite that is eliminated by the kidneys through glomerular filtration and tubular secretion. An increased load of dietary oxalate leads to supersaturation, calcium oxalate crystal formation, renal tubular obstruction, and eventually CKD. Dahl-Salt-Sensitive (SS) rats are a common strain used to study hypertensive renal disease; however, the characterization of other diet-induced models on this background would allow for comparative studies of CKD within the same strain. In the present study, we hypothesized that SS rats on a low-salt, oxalate rich diet would have increased renal injury and serve as novel, clinically relevant and reproducible CKD rat models. Ten-week-old male SS rats were fed either 0.2% salt normal chow (SS-NC) or a 0.2% salt diet containing 0.67% sodium oxalate (SS-OX) for five weeks.Real-time PCR demonstrated an increased expression of inflammatory marker interleukin-6 (IL-6) (p < 0.0001) and fibrotic marker Timp-1 metalloproteinase (p < 0.0001) in the renal cortex of SS-OX rat kidneys compared with SS-NC. The immunohistochemistry of kidney tissue demonstrated an increase in CD-68 levels, a marker of macrophage infiltration in SS-OX rats (p < 0.001). In addition, SS-OX rats displayed increased 24 h urinary protein excretion (UPE) (p < 0.01) as well as significant elevations in plasma Cystatin C (p < 0.01). Furthermore, the oxalate diet induced hypertension (p < 0.05). A renin–angiotensin–aldosterone system (RAAS) profiling (via liquid chromatography–mass spectrometry; LC–MS) in the SS-OX plasma showed significant (p < 0.05) increases in multiple RAAS metabolites including angiotensin (1–5), angiotensin (1–7), and aldosterone. The oxalate diet induces significant renal inflammation, fibrosis, and renal dysfunction as well as RAAS activation and hypertension in SS rats compared with a normal chow diet. This study introduces a novel diet-induced model to study hypertension and CKD that is more clinically translatable and reproducible than the currently available models.

Background: The present study aimed to describe mortality and its correlation with diagnostic tests and treatment modalities among children admitted as a case multisystem inflammatory syndrome in children (MIS-C) in Indira Gandhi Medical College, Shimla. Materials and Methods: We conducted a cross-sectional study for MIS-C from January to July 2021, in the pediatric ward of a tertiary care hospital in North India. All children admitted with the diagnosis of MIS-C were included in the study. Data regarding sociodemographic factors and mortality were extracted and analyzed using Epi Info V7 software. Results: In the present study, a total of 31 children admitted as a case of MIS-C were included in the study. Of these, 23 (74.2%) were discharged after full recovery, 5 (16.1%) died during treatment, and 3 (9.7%) left the hospital against medical advice. Children presenting with severe illness, acidosis, azotemia, Hb

Background: Globally, Prematurity or preterm birth is the leading cause of death in under the age of 5 years but this has been often overlooked and neglected problem. The present study aimed to study the trends of preterm birth in Shimla district of Himachal Pradesh, India. Methods: Retrospective review of records of Kamla Nehru Hospital, Shimla covering the period January 2016 to December 2020 was conducted. The total number of preterm birth were retrieved. Results: A total of 34769 live birth took place in Kamla Nehru Hospital, Shimla from 2016 to 2020. Among the total live births, 5654(16.26%) were premature birth (

Background: Multisystem inflammatory syndrome in children (MIS-C), while being rare and treatable, is the dreadful and mysterious face of the COVID-19 pandemic among children. This study aimed to describe, Management among children admitted as Multisystem Inflammatory Syndrome in Children (MIS-C) in Indira Gandhi Medical College, Shimla in Northern India. Material & Methods: We conducted a cross sectional study of MIS-C from January to July 2021, in pediatric ward of Indira Gandhi Medical College Shimla in Himachal Pradesh. All children admitted with MISC were included. Data regarding socio-demographic factors& management was extracted and analyzed using Epi Info V7 software. Results: In the present study, a total of 31 children admitted as MIS-C were included. Mean age of these patients was 7.12±4.78 years. Among the total 16(51.6%) were males while 15(48.4%) were females. In the present study, 24 (77.4%) patients were given IVIG, among these 22(91.67%) received 2 gm/kg while 2(8.33%) received between 1-2gm/kg.10(32.3%) children received low dose methylprednisolone, 21(67.7%) received, methylprednisolone in high doses. low molecular weight heparin (LoMoH) was given to 17(54.8%) patients. 23 (74.2%) were given Aspirin, among these 21 (91.30%) were given adequate doses, while 2(8.70%) were given between half to full doses of aspirin. Only 1(3.2%) patient had drug reaction and that was fever. Respiratory support was given to 25(80.6%), Oxygen to 18(58.1%), ventilatory support was required by 7(22.6%) and inotropic support was given to 18 (58.1%) children. Conclusion: Besides symptomatic treatment, IVIG, Methylprednisolone, Aspirin, LoMoH, O2, respiratory support and inotropic support were the most important components of management. Comprehensive studies are required to understand the pathogenesis of MIS-C and determine the treatment regimens clearly. Keywords: Management, Multisystem Inflammatory Syndrome in Children (MIS-C), Inotropes, Respiratory support, IVIG

BACKGROUND The high incidence of global neonatal mortality has triggered several efforts to improve facility-based neonatal care but despite these many advances in perinatal and neonatal care, the outcomes achievable at different levels are comparable. This study was undertaken to compare the mortality pattern among both the inborn and outborn neonates admitted to the special new born care units (SNCU)s of tertiary care hospital of Shimla city, in the hilly state of Himachal Pradesh. METHODS A cross-sectional study involving a record review of all neonates admitted to the specialized neonatal care units of the paediatric ward of IGMC, Shimla & Kamla Nehru Hospital (KNH) over five years from January 2016 to December 2020 was conducted. The most important causes of mortality and its associated factors were analysed, and a statistical inference was made. RESULTS Among the 4018 outborn neonates admitted to the SNCU of the pediatric ward of IGMC, Shimla, 2440 (60.73 %) were males and 1578 (39.27 %) were females while 6607 inborn neonates were admitted to the SNCU of KNH Shimla and among them 3655 (55.32 %) were males and 2952 (44.68 %) were females. In the outborn SNCU of IGMC Shimla, 307 (7.64 %) died while in the inborn SNCU of KNH Shimla, 366 (5.54 %) neonates died over a span of 5 years. In outborn SNCU of IGMC Shimla, a maximum of 110 (35.83 %) neonates died due to sepsis/pneumonia/meningitis, followed by 60 (19.54 %) due to respiratory distress syndrome and 50 (16.29 %) due to HIE/moderate-severe birth asphyxia while in case of inborn SNCU of KNH, maximum deaths of 115 (31.42 %) were due to respiratory distress syndrome, followed by 93 (25.41 %) due to sepsis/pneumonia/meningitis and 69 (18.85 %) due to HIE/moderate-severe birth asphyxia. At outborn SNCU of IGMC, Shimla, most of the neonates who died 118 (38.44 %) weighed about 1500-2499 gm, while in inborn SNCU of KNH, Shimla, most of the neonates 147 (40.16 %) had weight between 1000-1499 gm. At outborn SNCU of IGMC Shimla, 131 (42.67 %) were preterm while at inborn SNCU of KNH, 305 (83.3 %) were preterm. CONCLUSIONS Sepsis, birth asphyxia and RDS are the important causes of mortality, which must be urgently addressed. Improving antenatal care, improved access to health facilities, early identification of danger signs, timely referral, capacity building, can reduce neonatal mortality. KEY WORDS Comparison, Neonatal Mortality, SNCUs, Tertiary Care Hospital, Inborn Neonate, Outborn Neonate.

Introduction: Ventilator-associated pneumonia (VAP) continues to pose serious complications in patients in patients who are on mechanical ventilators especially for neonates. The present study has been conducted to evaluate the Ventilator-Associated Pneumonia as well as the socio- demographic prole of children admitted to the Neonatal and Pediatric Intensive Care Unit in IGMC Shimla. Material & Methods: This prospective observational study has been conducted for a tenure of 365 days (1st July 2015 till June 2016), in the intensive care units (NICU and PICU) of the Department of Pediatrics, IGMC, Shimla. All patients admitted to PICU and NICU, who required mechanical ventilator support for 48 hours or more were included in the study. Center of disease control and prevention criteria has been taken to diagnose VAP. Results: Out of 1750 children (0-18 years) who were admitted in NICU and PICU of children ward of IGMC, Shimla in the study period, 85 required ventilatory support. Out of these 85 cases, only 10 fullled the diagnostic criteria. So the incidence of VAP observed was 11.7 %. Incidence of VAP in Newborns was found to be signicantly high (23.3%) compared to (3.2%) infants between 1 Month to 1 year of age (p = 0.020). Among diagnosed cases majority were males, with a male: female ratio of 3:2, however, the gender difference was statistically not signicant. Conclusion: The results of this present study point that hospital stay duration and mechanical ventilation of children (neonates, infants, and children 1 to18 yrs) admitted in Neonatal and Pediatric Intensive Care unit because these factors have a critical association with Ventilator- Associated Pneumonia and its complications. It clearly emphasizes that proper selection of antibiotics targeted on predominant bacteria present in a clinical setting, information based on examination of pulmonary secretions is crucial to minimize the hospital stay and thereby decrease morbidity and mortality.

Background: The rate of cesarean births in India is steadily rising. It has already crossed the World Health Organization (WHO) threshold of 15 percent. The present study aimed to study the trends of cesarean birth in the Shimla district of Himachal Pradesh, India. Methods:Aretrospective review of records of Kamla Nehru Hospital, Shimla covering the period January 2016 to December 2020 was conducted. The total number of deliveries and cesarean deliveries conducted were retrieved. Results:Atotal of 34,799 deliveries were conducted in Kamla Nehru Hospital, Shimla from 2016 to 2020. There was a continuous increase in the number of deliveries conducted in Kamla Nehru Hospital, Shimla from 2016 to 2020. A total of 6476 deliveries were conducted in 2016, 6539 in 2017, 6926 in 2018, 7339 in 2019, and 7519 in 2020. Among the total deliveries, 9848 were done through cesarean section. On average, 28.30 % of deliveries were conducted through cesarean section. There was a constant increase in cesarean deliveries in Kamla Nehru Hospital, Shimla from 2016 to 2020. A total of 1820 (28.1%) deliveries conducted through cesarean section in 2016, 1947(29.78%)in 2017, 1964(28.36%) in 2018, 1978(26.95%)in 2019 and 2139(28.45%) in 2020. Conclusions: The study concluded that over 5 years there has been a rise in institutional deliveries in Himachal Pradesh. Trend analysis for the cesarean section has also shown an increasing trend.

Background: The aim of the study was to determine the practices of face mask use and associated factors during the COVID-19 pandemic among school-going children in Shimla city.Methods: An observational study was performed in October 2021 to November 2021, with 703 students chosen using a simple random sampling procedure in Shimla city. Data was collected based on observation and analyzed using Epi info version 7. To predict the relationship between the student mask-wearing compliance and its associated factors, a univariate analysis was done.Results: A total of 703 students, 41.8% (n=294) were males while 58.2% (n=409) were females, 40.5% (n=285) 15 years of age. 97.2% (n=683) were Hindu and 72% (n=506) were studying in Government schools. All of the observed (100%) were wearing masks. 76.2% (n=536) students were using cloth mask, 12.1% (n=85) N95 masks while 11.7% (n=82) surgical masks. 81.8% (n=575) covered their mouth, as well as nose, 3.7% (n=26), had masks below the chin, 2.6% (n=18) had only their mouth covered while 11.9% (n=84) had partially covered their nose. Cloth mask was considerably more used by girls besides that there was no significant difference in the type of face mask according to age, standard of class, father’s occupation and type of school. The face mask was significantly more appropriately used by the students

Background: Intense anxiety experienced by the parents and their children regarding venous cannulation may result in non-adherence to the recommended procedure. The aim of present study was to compare the effects of eutectic mixture of topical anesthetics, amethocaine and 4% lignocaine on pain responses during venous cannulation in children up to 3 years. Methods: The present hospital based, prospective, randomized comparative study was conducted from December 2019 to November 2020 at KNH and IGMC, Shimla. The study population was divided in to two groups, group I (less than one month) and group II (one month to three years) and were further divided into three groups (amethocaine, EMLA and 4% lignocaine). NIPS and FLACC score for 3 events (pre procedural, immediately after cannulation and three minutes after cannulation) were noted.Results: 99 children were enrolled in our study (59 in group one and 40 in group two) and all were fulfilling inclusion criteria. NIPS score was highest for lignocaine before, immediate and after cannula followed by EMLA and was least for amethocaine. FLACC score was highest for lignocaine before, immediate and after cannulation. FLACC score was lowest for amethocaine, immediately and after cannulation and for EMLA before cannulation.Conclusions: Amethocaine significantly reduces the pain response as compared to EMLA and 4% lignocaine group specifically immediately after cannulation and three minutes post cannulation.

Background: Study was aimed to describe the oxygen requirements among children admitted as multisystem inflammatory syndrome in children (MIS-C) in Indira Gandhi Medical College, Shimla.Methods: We conducted a cross-sectional study, from January 2021 to July 2021, in the pediatric ward of Indira Gandhi Medical College (IGMC), Shimla. Children admitted with a diagnosis of MIS-C were included. Data regarding socio-demographic factors and oxygen requirements were extracted and analyzed using Epi Info V7 software.Results: A total 31 children diagnosed as MIS-C were included. Tachypnea was present in 18 (58.1%) respiratory distress in 15 (48.4%). Optimal oxygen saturation (SpO2) more than 94% in 9 (25.8%), 93-94% in 8 (25.8%), 91-92% in 5 (16.1%), 86-90% in 2 (6.5%), 81-85% in 4 (12.9%), 75-80% in 1 (3.2%), 71-75% in 1 (3.2%) and

Background: The aim of palliative care is most certainly the improvement of quality of life of patients suffering from various haematological diseases like leukaemia, haemophilia, thalassemia owing to the importance of palliative care in ensuring quality end-of-life care, provision of palliative care has been identified as an international human right. The objective of this study was to asses palliative care in chronic haematological conditions using Paediatrics palliative screening scale (PaPaS).Methods: 71 cases who fulfilled inclusion and exclusion criteria were included in the study for assessment of palliative care. Then, the data was analysed using the Statistical Package for Social Sciences (SPSS) software (version 13) and descriptive and interferential statistics were used.Results: In leukaemia patients the mean PaPaS score was reported to be 23.58 (SD: 7.43). Nineteen participants (61.29%) had a PaPaS score of >25 and 12 participants (38.71%) had PaPaS score of less than 25. In thalassemia patients the mean PaPaS score was reported to be 27.42 (SD: 6.54). Twenty participants (64.52%) had a PaPaS score of >25 and 11 participants or 35.48% had PaPaS score less than 25. In haemophilia patients the mean PaPaS score was reported to be 32.88 (SD: 4.94). Seven participants (87.5%) had a PaPaS score of >25 and only single participants or 12.5% had PaPaS score less than 25. In lymphoma patient the PaPaS score was 34.Conclusions: Chronic hematological diseases have lot of unmet needs of palliative care and study calls for creation of hospice and palliative care facility in all hospitals to meet the unmet needs of palliative care.

Introduction The impact of third molars in occurrence of secondary mandibular incisor crowding has been a disputable subject and is reviewed in the dental literature for many years. The relationships between lower third molar angulation, eruption level, and eruption space to lower anterior crowding are not completely understood. Aim To evaluate the relation between the third molar angulations, eruption space, eruption level, and mandibular anterior crowding. Materials and Methods Pretreatment plaster study models (mandibular dental arches) and orthopantomograph of 40 individuals, aged between 12 and 22 years, were part of the study. The whole sample was divided into two groups based on the Little's index of irregularity: group I—control group (n = 20) composed of patients with index 0 to 3 mm, and group II—study group (n = 20) composed of patients with index > 3 mm. Calculations were made for the third molar eruption depth, eruption space, and angulation. Statistical Analysis Mean values were compared for selected dimensions between the control and study groups with Student's t-test. Results Statistically significant differences for Ganss ratio in right side between the control and study groups with a p-value of 0.049 were observed. Statistically insignificant difference was seen between the control and study groups for other parameters. Eruption level B was found for maximum molars in the study group, 95% on right and 85% on left side. Conclusion It was inferred that no strong relation exists between the third molar eruption level, space, and angulations to mandibular anterior crowding.

Background: MIS-C as a disease has varied symptoms and signs that affect multiple organs and systems in the body. The present study aimed to describe the clinical presentation among children admitted as a case of multisystem inflammatory syndrome in children in Indira Gandhi Medical College, Shimla.Methods: We conducted a cross sectional study of children with MIS-C from January to July 2021, in the pediatric ward of Indira Gandhi Medical College Shimla in Himachal Pradesh. All children admitted with a diagnosis of MISC were included in the study. Data regarding clinical presentation was extracted and analyzed using Epi Info V7 software.Results: In the present study, a total of 31 children diagnosed and admitted as a case of multisystem inflammatory syndrome in children (MIS-C) were included. Mean age of these children was 7.12±4.78 years. Among the total 16 (51.6%) were males while 15 (48.4%) were females. All 31 patients had presented with fever and 13 (41.9%) patients had fever with rash. 5 (16.1%) had cough, 1 (3.2%) child presented with hematemesis, 18 (58.1%) had tachypnea at presentation and 15 (48.4%) patients had respiratory distress. 16 (51.6%) children had complaints of vomiting, 1 (3.2%) presented with bleeding diathesis and 12 (38.7%) had hematuria, 5 (16.1%) had seizures and 8 (25.8%) presented with encephalopathy. 19 (61.3%) children had hypotension, 15 (48.4%) had hepatomegaly and 15 (48.4%) had splenomegaly.Conclusions: It is very essential to characterize this syndrome to fully understand its spectrum, therefore we need to be continuously watchful for its varied clinical presentations, both for ensuring an early diagnosis and treatment of patients suffering from MIS-C.

Background: Low birth weight (LBW) is a serious public health problem and a leading cause of death in the first month of life. The present study aimed to study the trends of low birth weight in Shimla district of Himachal Pradesh, India.Methods: Retrospective review of records of Kamla Nehru Hospital, Shimla covering the period January 2016 to December 2020 was done. The total number of low-birth-weight babies each year were retrieved.Results: A total of 34769 live births took place in Kamla Nehru Hospital, Shimla from 2016 to 2020. Among the total live births, 8479 (24.39%) were having low birth weight (2500 gm). Out of total 8479 LBW Babies, 7148 (84.3%) were LBW (

Meningiomas are the most common primary intracranial tumor accounting for almost 37% of all CNS tumors. Malignant meningiomas are uncommon, accounting for 0.5% of all meningiomas. Malignant meningioma that is metastatic outside the cranium/skull is even rarer, with only a few case reports. Metastases to the lung and abdomen have been reported and thought to travel via venous drainage. WHO Grading suggest that Grade III meningiomas have the greatest potential to metastasize extra-cranially. We present the case for the 47-year-old Senegalese American man with biopsy proven Grade II meningioma metastatic to his lungs with resultant hypercapnic respiratory failure.

VACTERL (Vertebral, anal, cardiac, tracheoesophageal, renal and limb) is an acronym for cluster of congenital malformations including Vertebral or Vascular anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula/Esophageal atresia, Renal and Limb defects. It is a rare association with sporadic and non-random occurrence where multiple organs are affected due to developmental defect during blastogenesis. Exact cause is unknown but multiple environmental and genetic factors have been implicated. For diagnosis, three components of VACTERL association are needed however patient may have other congenital malformations also. Here we report a newborn with VACTERL association born to a healthy mother by cesarean section for polyhydramnios with unstable lie.