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Background: The prevalence and the pattern of birth defects help in devising strategies to reduce the burden of preventable birth defects. The study aimed to find out the pattern of various congenital anomalies in babies born at ESICMC & PGIMSR Hospital, Bangalore and to identify the associated risk factors, if any. Material and Methods: This hospital-based observational study was conducted in the Department of OBG during the period from 2016 to 2019. The data were collected from records and history taken from the antenatal patients with diagnosis of congenital abnormalities delivering at ESICMC & PGIMSR Hospital, Bangalore. Babies born were also assessed for congenital anomalies. Details of maternal age, parity, consanguinity, occupation, and maternal complications like diabetes were collected. The nature and severity of congenital abnormalities were recorded. Results: Out of total 11,469 deliveries in the study period, 77 babies were born with congenital anomalies (Prevalence 0.67%). The most common congenital anomalies involved the craniospinal system (53.2%), followed by the musculoskeletal system (19.5%). Multiple anomalies were present in 14.3% children. Anencephaly was the most common CNS anomaly. A history of abortions was present in 26% of women carrying anomalous fetuses. Majority of the anomalies were detected within 24 weeks of gestation (54.5%). A past h/o anomalous fetus or intrauterine fetal demise was present in 7% women. Conclusions: Our study observed that previous h/o abortions, history of consanguineous marriage, diabetes mellitus, and previous h/o anomalous fetus/IUD are prevalent among the women with anomalous babies in the study setting. Awareness to a large extent needs to be generated regarding the role of consanguinity as a risk factor for congenital anomalies. The importance of folic acid intake and early diagnosis and management of diabetes also needs to be emphasized. Prenatal diagnosis may be recommended to detect malformations early and plan management accordingly.

Median cleft or midline cleft is a congenital vertical cleft through the center of the upper lip. Median facial anomalies are broadly divided into those with a deficiency of tissue and those with normal or excessive amount of tissue. The main objective of concern during surgery is both functional and esthetics.

Background: The prevalence and the pattern of birth defects help in devising strategies to reduce the burden of preventable birth defects. The study aimed to find out the pattern of various congenital anomalies in babies born at ESICMC & PGIMSR Hospital, Bangalore and to identify the associated risk factors, if any. Material and Methods: This hospital-based observational study was conducted in the Department of OBG during the period from 2016 to 2019. The data were collected from records and history taken from the antenatal patients with diagnosis of congenital abnormalities delivering at ESICMC & PGIMSR Hospital, Bangalore. Babies born were also assessed for congenital anomalies. Details of maternal age, parity, consanguinity, occupation, and maternal complications like diabetes were collected. The nature and severity of congenital abnormalities were recorded. Results: Out of total 11,469 deliveries in the study period, 77 babies were born with congenital anomalies (Prevalence 0.67%). The most common congenital anomalies involved the craniospinal system (53.2%), followed by the musculoskeletal system (19.5%). Multiple anomalies were present in 14.3% children. Anencephaly was the most common CNS anomaly. A history of abortions was present in 26% of women carrying anomalous fetuses. Majority of the anomalies were detected within 24 weeks of gestation (54.5%). A past h/o anomalous fetus or intrauterine fetal demise was present in 7% women. Conclusions: Our study observed that previous h/o abortions, history of consanguineous marriage, diabetes mellitus, and previous h/o anomalous fetus/IUD are prevalent among the women with anomalous babies in the study setting. Awareness to a large extent needs to be generated regarding the role of consanguinity as a risk factor for congenital anomalies. The importance of folic acid intake and early diagnosis and management of diabetes also needs to be emphasized. Prenatal diagnosis may be recommended to detect malformations early and plan management accordingly. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors have none to declare.

Background: Hepatitis C virus (HCV) infection is a global public health problem and also generates a significant case load in children and adolescents. With the introduction of directly acting antivirals (DAA), the treatment and care of HCV-infected patients have progressed significantly. The available treatment options in children are limited, and this review aims to provide an overview of treatment of HCV infection in children and adolescents with the current available DAA regimens., Data Sources: This comprehensive review was undertaken after searching the PubMed/Medline and Embase databases for the available up-to-date literature on pediatric HCV infection and treatment using hepatitis C virus infection/HCV, directly acting antivirals/DAA, natural history, treatment, pediatrics, children, and adolescents as keywords., Results: Combination therapies with highly effective DAA regimes, such as sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, glecaprevir/pibrentasvir, sofosbuvir/daclatasvir, sofosbuvir/ribavirin and others, are available for use in children. Most of the DAA regimens have either received or are pending to receive regulatory approval by different medical/drug agencies for use in children and adolescents. Pan-genotypic regimens are also available in children and adolescents, and these regimens can be used while skipping genotype testing., Conclusion: The literature on different DAA regimens for use in children shows that these regimens have higher cure rates with minimal side effects and shorter duration of therapy., (© 2022. Children's Hospital, Zhejiang University School of Medicine.)

Background: The functional and morphological recovery following an episode of acute pancreatitis (AP) in children still remains ill understood as research exploring this is limited. We aimed to characterize the morphological and functional changes in pancreas following AP and ARP (acute recurrent pancreatitis) in children., Methods: Children with AP were followed prospectively and assessed at two time points at least 3 months apart, with the first assessment at least 3 months after the AP episode. Exocrine and endocrine functions were measured using fecal elastase and fasting blood sugar/HbA1c levels respectively. Morphological assessment was done using endoscopic ultrasound (EUS) and magnetic resonance imaging and cholangiopancreatography (MRI/MRCP)., Results: Seventy-three children (boys:59%; mean age:8.4 ± 3.2years) were studied and 21 of them (29%) progressed to ARP. Altered glucose homeostasis was seen in 19 (26%) at first and 16 (22%) at second assessment and it was significantly more in ARP group than the AP group at first (42.8%vs19.2%; p = 0.03) as well as second assessment (38.1%vs15.3%; p = 0.03). Twenty-one children (28.7%) at first and 24 (32.8%) at second assessment developed biochemical exocrine pancreatic insufficiency. EUS detected indeterminate and suggestive changes of chronic pancreatitis in 21% at first (n = 38) and 27.6% at second assessment (n = 58). On MRCP, main pancreatic duct and side branch dilatation were seen in 15 (20.5%) and 2 (2.7%) children respectively., Conclusions: More than one-quarter of children have evidence of altered glucose homeostasis and biochemical exocrine pancreatic insufficiency following an episode of AP. Similarly, morphological features of chronicity seen in some of the children suggest that a fraction of subjects may develop chronic pancreatitis on longer follow-up., Competing Interests: Declaration of competing interest None., (Copyright © 2022 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Background: Liver abscess (LA), a common problem in children in the tropics, is believed to be mostly pyogenic (PLA), sometimes amebic (ALA). We aimed to analyze the clinical profile, etiology, risk factors for complications, management and outcomes of LA in children., Methods: The details of 81 children with LA managed in a tertiary set up over a period of 3 years were analyzed. A comparison of different parameters was performed with respect to etiology and complications., Results: ALA, PLA and mixed infection LA were diagnosed in 40 (49.4%), 32 (39.5%) and 9 (11.1%) children. The triad of fever, hepatomegaly and right upper quadrant tenderness was seen in 65 (80.2%). Coagulopathy was observed in 60 (77%) and jaundice in 12 (14.8%). Majority (71.6%) had a single LA in the right lobe (69%). Conservative, percutaneous needle aspiration, percutaneous catheter drainage and surgical drainage were done in 11.1%, 3.7%, 82.7% and 2.5%, respectively. Forty-three (53.1%) had complicated LA with rupture in 55.8% and vascular thrombosis in 16.2%. Children with complicated LA had higher alanine transaminase, prolonged prothrombin time/international normalized ratio, low serum protein and albumin levels (P < 0.05). Median duration of follow-up was 2 months and mean time to resolution of LA was 48.5 ± 18 days., Conclusions: ALA is the commonest cause of pediatric LA in endemic regions and is difficult to differentiate from PLA clinically. Percutaneous catheter drainage is safe and effective modality for the management of LA in children. A higher alanine transaminase, prolonged prothrombin time/international normalized ratio and low serum albumin levels (<3 g/dL) at presentation identify complicated LA., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Pancreatic ascites (PA) and pleural effusion (PPE) are rarely encountered in children. They develop due to disruption of the pancreatic duct (PD) or leakage from an associated pancreatic fluid collection (PFC). The literature on childhood PA/PPE and its management is scarce., Methods: A retrospective review of children with PA/PPE diagnosed and managed at our center over the last 4 years was performed. The clinical, biochemical, radiological and management profiles were analyzed. Conservative management included nil per oral, octreotide and drainage using either percutaneous catheter or repeated paracentesis. Endotherapy included endoscopic retrograde cholangiopancreatography (ERCP) and transpapillary stenting., Results: Of the 214 children with pancreatitis, 15 (7%) had PA/PPE. Median age was 9 years with a third under 2 years. Median ascitic fluid amylase was 8840 U/L and all had elevated protein (>2.5 g/dl) and low serum ascites-albumin gradient ascites (<1.1). While PA/PPE was the first manifestation of underlying chronic pancreatitis (CP) in 10 children (67%), trauma was seen in 4 (26%) and hypertriglyceridemia in 1 (7%). On imaging, PD disruption could be identified in 10 (67%) children. ERCP and stenting was done in 10 children. Conservative management alone (n = 4) and endotherapy (n = 10) was successful in 93% with only one requiring surgery. The younger children (n = 4), were managed conservatively and only 1 of them required surgery. Resolution of PA/PPE was achieved in all with no recurrences., Conclusions: Conservative management and ERCP plus transpapillary stenting results in resolution of majority of pediatric PA/PPE. Children presenting with PA/PPE needs to be evaluated for CP., Competing Interests: Declaration of competing interest None., (Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Background & Aims: Acute Pancreatitis (AP) tends to have a benign course in children. However there is a paucity of information with respect to severity of AP in children, the categorization of collections viz., walled off necrosis (WON)& pseudocyst and their natural history & outcomes., Methods: A retrospective medical record review of 187 children with pancreatitis diagnosed and managed at our centre was performed., Results: 101 children (59% boys, Median age 9yrs) had AP of which 37.6%, 60.4% and 2% had mild, moderately severe and severe AP. 61.4%(62) had PFC at diagnosis; 34%(21) acute pancreatic fluid collections (APFC) and 66%(41) acute necrotic collections (ANC). 52.3%(11of21) of APFC evolved into pseudocysts & 68.2%(28of41) of ANC into WON's. Drainage was required in 31%(12of39) of persisting collections, more frequently in children with traumatic AP. Percutaneous catheter drainage (PCD) was done in 6 children and endoscopic ultrasound (EUS) guided cystogastrostomy with placement of plastic or self expanding metal stents (SEMS) in 6 children., Conclusions: Moderately severe AP is common in hospitalized children with AP with PFC developing in 61.4%, majority being APFC. 48% of APFC and 32% of ANC will resolve and the rest evolve into pseudocyst or WON. Spontaneous resolution is more likely in children with non -traumatic AP having pseudocysts rather than WON's., Competing Interests: Declaration of competing interest None., (Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Aim: The present study aimed to evaluate the sealing potential and marginal adaptation of different root canal sealers to dentin., Materials and Methods: A total of sixty human lower premolars of the permanent dentition that were extracted were used for this study. The visible debris and calculus were removed from the extracted teeth ultrasonically and were kept for 2 hours in 2.5% sodium hypochlorite and stored in normal saline till next use. A low-speed diamond disc was used to section all the teeth samples at the cementoenamel junction. Later, cleaning and shaping of the canals was done. Based on the sealer used, the samples (each group consisting of 20 samples) were divided randomly into three groups: group I-bioceramic sealer, group II-resin-based sealer, group III-MTA-based sealer. All split samples were visualized under scanning electron microscope (SEM) at apical and coronal thirds of root canal, the marginal gap at root dentin and sealer interface were assessed., Results: The highest marginal adaptation (5.60 ± 0.12) was demonstrated by EndoSequence BC sealer, followed immediately by ProRoot MTA sealer (4.48 ± 0.12) and EndoREZ sealer (2.10 ± 0.54). A statistically significant difference ( p = 0.001) was seen between the EndoSequence BC and ProRoot MTA sealer for apical and coronal marginal adaptation. Also, a statistically significant difference ( p < 0.05) was found between EndoSequence BC sealer vs EndoREZ sealer at coronal and EndoSequence BC sealer vs EndoREZ sealer and EndoREZ sealer vs ProRoot MTA sealer at apical third., Conclusion: The present study concluded that significant and better sealing ability and marginal adaptation was demonstrated by EndoSequence BC (bioceramic sealer) when compared to ProRoot MTA sealer (MTA-based sealer) and EndoREZ sealer (resin-based sealer)., Clinical Significance: Numerous endodontic sealers enter the market with various factors to attain acceptable seal. According to current study bioceramic sealer, is the appropriate sealer that hermetically seals all the margins.

Background: Body temperature of a neonate continues to be under-documented, under-recognized, and under-managed, even though studies have shown that neonatal hypothermia increases mortality and morbidity. We aimed to reduce neonatal hypothermia (body temperature <36.5 °C) at 1 h following normal vaginal delivery in term and late preterm neonates in delivery room from 50% at baseline to less than 10% by 6 weeks., Methods: We implemented a quality improvement (QI) initiative using the rapid-cycle Plan-Do-Study-Act approach (PDSA) improvement model and the project was conducted from 15 Jan 2017 to 25 Feb 2017. All singleton neonates with gestational ages above 34 completed weeks born by vaginal delivery were targeted. Exclusion criteria included neonates needing any form of resuscitation, those developing respiratory distress after birth needing any form of respiratory support or observation in NICU. We ran PDSA cycles (including pre-warmed cloths, skin to skin care with mother, early breast feeding, delaying weight check by 1 h and checklist of planned steps), every week, after taking the baseline data in the first week., Results: A total of 46 neonates were studied. After 4 PDSA cycles, incidence of neonatal hypothermia at 1 h of birth dropped to zero from 50% at baseline and we were able to sustain 100% normal temperature (36.5-37.5 °C) since then., Conclusion: This QI project has significantly reduced the incidence of hypothermia in term and late preterm neonates born by vaginal delivery in our institute.