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Background: The use of digital media (DM) is increasing among school-children, which can affect their sleep habits. The primary objective of this study was to evaluate the association of DM use with sleep habits in school-children. Methods: It was a cross-sectional study of healthy school children. Sleep habits and DM use were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and SCREENS-Q, respectively. The Pearson correlation coefficient was used to establish the correlation between the two variables. Logistic regression analysis was performed to quantify the extent of association between variables. A p-value

Objectives To review the efficacy of nebulised magnesium sulfate (MgSO4) in acute asthma in children.Methods The authors searched Medline, Embase, Web of Science and Cochrane Library for randomised controlled trials (RCTs) published until 15 December 2023. RCTs were included if they compared the efficacy and safety of nebulised MgSO4 as a second-line agent in children presenting with acute asthma exacerbation. A random-effects meta-analysis was performed, and the Risk of Bias V.2 tool was used to assess the biases among them.Results 10 RCTs enrolling 2301 children with acute asthma were included. All trials were placebo controlled and administered nebulised MgSO4/placebo and salbutamol (±ipratropium bromide). There was no significant difference in Composite Asthma Severity Score between the two groups (6 RCTs, 1953 participants; standardised mean difference: −0.09; 95% CI: −0.2 to +0.02, I2=21%). Children in the MgSO4 group have significantly better peak expiratory flow rate (% predicted) than the control group (2 RCTs, 145 participants; mean difference: 19.3; 95% CI: 8.9 to 29.8; I2=0%). There was no difference in the need for hospitalisation, intensive care unit admission or duration of hospital stay. Adverse events were minor, infrequent (7.3%) and similar among the two groups.Conclusions There is low-certainty evidence that nebulised MgSO4 as an add-on second-line therapy for acute asthma in children does not reduce asthma severity or a need for hospitalisation. However, it was associated with slightly better lung functions. The current evidence does not support the routine use of nebulised MgSO4 in paediatric acute asthma management.PROSPERO registration number CRD42022373692.

Thoracoscopic surgery was not previously accepted in the neonatal population due to inappropriate instrumentation and lack of experience. However, our experience in the last few decades has slowly yet steadily established its safety and efficacy. The major advantages that thoracoscopy offers are early recovery and fewer long-term complications. However, we are aware that this comes at the cost of a steep learning curve and the potential challenge of facing certain complications which may compel a conversion to open. There is a paucity of literature regarding intraoperative complications of neonatal thoracoscopy and its management. Conversion to open thoracotomy is appropriate, keeping patient safety in mind, and any decision made to continue management of a complication thoracoscopically is technically demanding. Iatrogenic bronchial injury is one such rare complication of thoracoscopy with a limited mention in literature. We describe below a 25-day-old patient with a bronchogenic cyst who sustained injury to the left bronchus during thoracoscopic cyst excision, which was successfully repaired thoracoscopically.

The systemic immune-inflammation index (SII) is a novel inflammatory biomarker. Simple and complicated para-pneumonic effusion (PPE) are two significant complications of pneumonia. We evaluated the efficacy of the systemic immune inflammation index (SII) to differentiate between the two. Records of all children up to 18 years of age admitted between April 2019 and September 2022 and diagnosed with Simple or complicated PPE were retrospectively evaluated. SII and other biomarkers were compared between both groups. ROC with the Youden index was used to estimate the discriminative value of SII. Fifty children were enrolled with a median (IQR) age of 81.5 (36.7, 133.5) months; 31 (62%) were male. Thirty-one (62%) had complicated PPE, and 19 (38%) had simple PPE. SII was significantly higher in complicated PPE (p=0.007). Good areas under the curve (AUCs) were found for CRP (0.771) and SII (0.736) to differentiate complicated from simple PPE. The best cut-off value for SII to differentiate complicated PPE from simple PPE was 1557×103µL, with a sensitivity of 82.4% and specificity of 57.6%. SII can be used as a screening tool to differentiate between complicated and simple PPE at the time of presentation.

Abstract Background The role of serum Procalcitonin (PCT) in adults in diagnosis of Community acquired pneumonia (CAP) is well established, however, role in pediatric CAP remains controversial. Objectives The objective of this study was to investigate the utility of serum procalcitonin in differentiating bacterial community-acquired lower respiratory tract infection from non-bacterial respiratory infection in children; radiologically confirmed pneumonia was used as the reference. In addition, we assessed the utility of adding the PCT assay to the clinical criteria for diagnosis of pneumonia. Study design Subanalysis of a larger prospective,multicentriccohort study. Participants Children, 2 months to 59 months of age, attending paediatric OPD of 5 urban tertiary care hospitals, suffering from acute respiratory infection (ARI). Intervention Detailed clinical history and examination findings of enrolled children were recorded on predesigned case record form. Samples for PCT were obtained at admission and were measured centrally at the end of the study except for one site using VIDAS® B.R.A.H.M.S PCT kit (Biomerieux SA, France). Outcomes Sensitivity and specificity of procalcitonin for diagnosis of radiologically confirmed pneumonia. Results Serum Procalcitonin was measured in 370 patients; median (IQR) age of these children being 12 (7, 22) months, 235 (63.5%) were boys. The median (IQR) serum procalcitonin concentration was 0.1(0.05, 0.4) ng/mL.Sensitivity and specificity of raised PCT (> 0.5 ng/mL) for pneumonia as per any CXR abnormalities were 29.7% and87.5%,(P 0.5 ng/mL) is significantly associated with radiographic pneumonia but not with pneumonia based on WHO criteria.However, it can act as a surrogate marker for severe pneumonia.

Introduction Acoustic change complex (ACC) is a type of event-related potential evoked in response to subtle change(s) in the continuing stimuli. In the presence of a growing number of investigations on ACC, there is a need to review the various methodologies, findings, clinical utilities, and conclusions of different studies by authors who have studied ACC. Objective The present review article is focused on the literature related to the utility of ACC as a tool to assess the auditory discrimination skill in different populations. Data Synthesis Various database providers, such as Medline, Pubmed, Google, and Google Scholar, were searched for any ACC-related reference. A total of 102 research papers were initially obtained using descriptors such as acoustic change complex, clinical utility of ACC, ACC in children, ACC in cochlear implant users, and ACC in hearing loss. The titles, authors, and year of publication were examined, and the duplicates were eliminated. A total of 31 research papers were found on ACC and were incorporated in the present review. The findings of these 31 articles were reviewed and have been reported in the present article. Conclusion The present review showed the utility of ACC as an objective tool to support various subjective tests in audiology.

Thyroid storm is a rare, life-threatening condition in children. We report the case of a 16-year-old girl who presented with fever, cough, chest pain, and breathing difficulty. On the initial evaluation, a working diagnosis of left-sided pneumonia with empyema was made. She also had persistent tachycardia which was out of proportion to fever, and a staring look. She was found to have a thyroid storm. Timely diagnosis and appropriate management of thyroid storm proved to be lifesaving.

Introduction Diabetes mellitus is a metabolic disease associated with a rise in the level of blood glucose. Individuals with diabetes mellitus are more likely to develop hearing loss, tinnitus, and dizziness due to macro- and microvascular complications. The extent to which auditory and vestibular functions are impaired in individuals with type-2 diabetes mellitus is still under debate. Objective To systematically review studies focusing on auditory and vestibular functions in individuals with type-2 diabetes mellitus. Data Synthesis A search was conducted in the PubMed, MedlinePlus, Ingenta Connect and Google Scholar databases for articles published until June 2019. A total of 15,980 articles were primarily retrieved, 33 of which were shortlisted based on the inclusion criteria set by the investigators for the systematic review. Out of 33 full-length articles, 26 evaluated the functioning of the auditory system, while 7 evaluated the functioning of the vestibular system. Most studies related to auditory functioning reported a significant effect of type-2 diabetes mellitus on the peripheral auditory system, whereas studies on vestibular functioning reported no significant effect of diabetes mellitus on the functioning of the peripheral vestibular end-organ. Conclusion Overall, the results of various audiological and peripheral vestibular tests reveal distinctive peripheral and/or central auditory and vestibular end-organ impairments in individuals with type-2 diabetes mellitus.

Background: SARS-CoV-2 infection in children frequently leads to only asymptomatic and mild infections. It has been suggested that frequent infections due to low-pathogenicity coronaviruses in children, impart immunity against SARS-CoV-2 in this age group. Methods: From a prospective birth cohort study prior to the pandemic, we identified children with proven low-pathogenicity coronavirus infections. Convalescent sera from these children were tested for antibodies against respective seasonal coronaviruses (OC43, NL63, and 229E) and SARS-CoV-2 by immunofluorescence and virus microneutralization assay respectively. Results: Forty-two children with proven seasonal coronavirus infection were included. Convalescent sera from these samples demonstrated antibodies against the respective seasonal coronaviruses. Of these, 40 serum samples showed no significant neutralization of SARS-CoV-2, while 2 samples showed inconclusive results. Conclusion: These findings suggest that the antibodies generated in low-pathogenicity coronavirus infections offer no protection from SARS-CoV-2 infection in young children.

Introduction Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies. Objective In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation. Methods A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients. Results Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body. Conclusion Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.

Background There is conflicting evidence for vitamin D supplementation in childhood asthma. We aimed to systematically synthesise the evidence on the efficacy and safety of vitamin D supplementation in childhood asthma. Methods We searched electronic databases (Medline, Embase and Web of Science) and a register (CENTRAL) for randomised controlled trials (RCTs) published until 30 September 2021. RCTs enrolling asthmatic children (1–18 years old) and comparing vitamin D against placebo/routine care were included if they met at least one of the endpoints of interest (asthma attacks, emergency visits or hospitalisation). We used the Risk of Bias 2 tool for risk of bias assessment. Random-effects meta-analysis with RevMan 5.3 software was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the level of certainty of the evidence. Results 18 RCTs (1579 participants) were included. The pooled meta-analysis did not find a significant effect of vitamin D supplementation on asthma attacks requiring rescue systemic corticosteroids (six studies with 445 participants; risk ratio (RR) 1.13, 95% CI 0.86–1.48; I2=0%) (moderate-certainty evidence). In addition, there was no significant difference in the proportion of children with asthma attacks of any severity (11 trials with 1132 participants; RR 0.84, 95% CI 0.65–1.09; I2=58%) (very low-certainty evidence). Vitamin D does not reduce the need for emergency visits (three studies with 361 participants; RR 0.97, 95% CI 0.89–1.07; I2=0%) and hospitalisation (RR: 1.38, 95% CI 0.52–3.66; I2=0%) (low-certainty evidence). Conclusion Very low- to moderate-certainty evidence suggests that vitamin D supplementation might not have any protective effect in childhood asthma.

Introduction Acute respiratory infections (ARIs) in infancy may have a long-term impact on the developing respiratory system. We planned a prospective cohort study to determine the impact of ARI during infancy on the pulmonary function test indices at 3 years of age.Methods A cohort of normal, full-term newborns were followed up 6 monthly and during ARI episodes. Infant pulmonary function tests (IPFTs) were performed at baseline and each follow-up visit using tidal breathing flow-volume loop, rapid thoracoabdominal compression (RTC) and raised volume RTC manoeuvres. During each ARI episode, nasopharyngeal aspirates were tested for respiratory pathogens by real-time PCR.Results We screened 3421 neonates; 310 were enrolled; IPFT was performed in 225 (boys: 125 (55.6%)) at 3 years. During infancy, 470 ARI episodes were documented in 173 infants. At 3 years, children with history of any ARI episode during infancy had lower forced expiratory volume in 1 s (FEV1.0), forced expiratory volume in 0.75 s (FEV0.75), forced expiratory volume in 0.5 s (FEV0.5), forced expiratory flow between 25% and 75% of FVC (FEF25–75), and maximal expiratory flow at 25% of FVC (MEF25) as compared with those without any ARI episode during infancy. The ratio of tidal expiratory flow (TEF) at 25% or 50% of tidal expiratory volume to peak TEF (TEF50 or TEF25/peak TEF) at 3 years was significantly increased in children who had ARI in infancy.Conclusions ARI during infancy is associated with impaired pulmonary function indices such as increased resistance and decreased forced expiratory flow and volume at 3 years of age.

Introduction Streptococcus pneumoniae is one of the frequently isolated organisms and an important aetiological agent of invasive bacterial diseases (IBD) like pneumonia, meningitis and sepsis. As a measure to control the burden of IBD, the Government of India introduced Pneumoccocal Conjugate Vaccine-13 (PCV-13) in the Universal Immunization Program in high burden districts of five states in a phased manner from 2017 onwards. It is essential to understand the trend of circulating pneumococcal serotypes associated with IBD in the prevaccination and postvaccination scenarios to decide on the expansion of vaccination programmes and PCV reformulation. This manuscript describes the protocol for hospital-based sentinel surveillance for S. pneumoniae and other organisms causing IBD across various geographical regions in India.Methods and analysis Hospital-based surveillance is established in selected hospitals to recruit children aged 1–59 months with symptoms of pneumonia and other IBD. Diagnostic criteria were adapted from standard WHO case definitions. Case Report Forms (CRFs) are used to collect data from the enrolled children. Blood, cerebrospinal fluid (CSF) and other normally sterile body fluids are collected and subjected to microscopy, cytology, latex agglutination, biochemistry, bacteriological culture and real-time PCR as applicable. Pneumococcal isolates are serotyped and tested for assessing antimicrobial resistance patterns. Data will be analysed by simple descriptive statistics to estimate the proportion of pneumonia and other IBD due to S. pneumoniae, Hemophilus influenzae type b and Neisseria meningitidis. Prevalence of bacterial infection, circulating pneumococcal serotypes, antibiotic resistance patterns, serotype variability across seasons and regions will be described in terms of percentage with 95% confidence interval.Ethics and dissemination The institutional review boards of the coordinating centre, all sentinel sites, regional and national reference laboratories approved the project. The results will be published in peer-reviewed journals and shared with stakeholders for deciding on revising vaccination strategy appropriately.

Introduction: Calcium is vital for the functioning of the inner ear hair cells as well as for the neurotransmitter release that triggers the generation of a nerve impulse. A reduction in calcium level could therefore impair the peripheric vestibular functioning. However, the outcome of balance assessment has rarely been explored in cases with osteopenia and osteoporosis, the medical conditions associated with reduction in calcium levels. Objective: The present study aimed to investigate the impact of osteopenia and osteoporosis on the outcomes of behavioural and objective vestibular assessment tests. Methods: The study included 12 individuals each in the healthy control group and osteopenia group, and 11 individuals were included in the osteoporosis group. The groups were divided based on the findings of bone mineral density. All the participants underwent behavioural tests (Fukuda stepping, tandem gait and subjective visual vertical) and objective assessment using cervical and ocular vestibular evoked myogenic potentials. Results: A significantly higher proportion of the individuals in the two clinical groups’ demonstrated abnormal results on the behavioural balance assessment tests (p

Abstract Introduction Parental support is important in the habilitation/rehabilitation of children using cochlear implant devices. Hence, it is important for families to know the realistic expectations regarding outcomes from CIs. Objective The objective of the present study is to know the parents' expectation from children using CIs. Methods For this study, we recruited 23 parents of children using CIs. We administered 15 questions translated in to Hindi related to communication abilities, social skills, academic achievement, change in future life, rehabilitation demand, and stress due to hearing impairment. Results The response of the questions (5-point rating scale) related to communication abilities showed that parents were expecting children using CIs to use the telephone (95%), to be able to detect soft sounds (99%), to listen in crowds (86%), to be able to easily understand others (76%), and to show improvement in communication skills (78%). Similarly, for questions related to social skills showed 90% of the parents expecting that their children with CIs should be able to easily make friends with normal hearing peers, and 80% of the parents were expecting the children to achieve high standards in their reading and writing skills. Questions related to change in future life showed 86% of the parents expecting their children with CIs to act like normal hearing children. Further, 78% parents showed positive response regarding importance of intensive training. However, 70% of the parents reported stress in the family due to the existence of the hearing impaired child. Conclusion Overall, the existing questionnaire-based study showed that parents have high expectations from their children with cochlear implant.

Subglottic hemangioma (SGH) is a rare and potentially life-threatening condition of the airway. A 3-month-old girl presented with croup which improved only partially with nebulized adrenaline and intramuscular dexamethasone. An upper airway endoscopy revealed the diagnosed of SGH. Oral propranolol was started, and following that, there was a dramatic response within 48-h of therapy, and complete remission after 1 year of therapy.

Objective: Contralateral suppression of oto acoustic emission (OAE) is referred as activation of efferent system. Previous literature mentioned about the importance of contralateral suppression of OAEs as a tool to assess efferent system in different groups of population. There is dearth of literature to explore the efferent system function in experienced musicians exposed to rock music using TEOAEs and DPOAEs. Methods: Two groups of participant (14 rock musicians and 14 non-musicians) in the age range of 18â25 years were involved in the study. Contralateral suppression of TEOAEs and DPOAEs were measured using ILO (Version 6) in both groups. Results: Descriptive statistics showed higher suppression of TEOAEs and DPOAEs in rock-musicians at most of the frequencies in comparison to non-musicians. For DPOAE measures, Mann Whitney U test results revealed significantly greater DPOAE suppression only at 1Â kHz and 3Â kHz in rock-musicians compared to non-musicians. For within group comparison, Kruskal Wallis test results revealed there were significant difference observed across most of the frequencies i.e. at 1Â kHz, 3Â kHz and 6Â kHz. For TEOAE measures, Mann Whitney U test results revealed that only at 2Â kHz, TEOAE suppression in rock-musician was significantly greater compared to non-musicians. Similarly, Kuskal Wallis test results revealed that within group there were no significant differences observed for most of the frequencies except 2Â kHz. Conclusions: Based on the above finding, present study concludes that rock musicians are having better efferent system compared to non-musicians. No suppression effect at few frequencies probably indicates more vulnerability at those frequencies. Contralateral suppression of DPOAE shows more significant finding in comparison to contralateral suppression of TEOAEs in present study. Keywords: Rock musicians, Contralateral suppression, Efferent pathway

Abstract Introduction Enhanced auditory perception in musicians is likely to result from auditory perceptual learning during several years of training and practice. Many studies have focused on biological processing of auditory stimuli among musicians. However, there is a lack of literature on temporal resolution and active auditory discrimination skills in vocal musicians. Objective The aim of the present study is to assess temporal resolution and active auditory discrimination skill in vocal musicians. Method The study participants included 15 vocal musicians with a minimum professional experience of 5 years of music exposure, within the age range of 20 to 30 years old, as the experimental group, while 15 age-matched non-musicians served as the control group. We used duration discrimination using pure-tones, pulse-train duration discrimination, and gap detection threshold tasks to assess temporal processing skills in both groups. Similarly, we assessed active auditory discrimination skill in both groups using Differential Limen of Frequency (DLF). All tasks were done using MATLab software installed in a personal computer at 40dBSL with maximum likelihood procedure. The collected data were analyzed using SPSS (version 17.0). Result Descriptive statistics showed better threshold for vocal musicians compared with non-musicians for all tasks. Further, independent t-test showed that vocal musicians performed significantly better compared with non-musicians on duration discrimination using pure tone, pulse train duration discrimination, gap detection threshold, and differential limen of frequency. Conclusion The present study showed enhanced temporal resolution ability and better (lower) active discrimination threshold in vocal musicians in comparison to non-musicians.

Abstract Introduction Mismatch Negativity is a negative component of the event-related potential (ERP) elicited by any discriminable changes in auditory stimulation. Objective The present study aimed to assess pre-attentive auditory discrimination skill with fine and gross difference between auditory stimuli. Method Seventeen normal hearing individual participated in the study. To assess pre-attentive auditory discrimination skill with fine difference between auditory stimuli, we recorded mismatch negativity (MMN) with pair of stimuli (pure tones), using /1000 Hz/ and /1010 Hz/ with /1000 Hz/ as frequent stimulus and /1010 Hz/ as infrequent stimulus. Similarly, we used /1000 Hz/ and /1100 Hz/ with /1000 Hz/ as frequent stimulus and /1100 Hz/ as infrequent stimulus to assess pre-attentive auditory discrimination skill with gross difference between auditory stimuli. The study included 17 subjects with informed consent. We analyzed MMN for onset latency, offset latency, peak latency, peak amplitude, and area under the curve parameters. Result Results revealed that MMN was present only in 64% of the individuals in both conditions. Further Multivariate Analysis of Variance (MANOVA) showed no significant difference in all measures of MMN (onset latency, offset latency, peak latency, peak amplitude, and area under the curve) in both conditions. Conclusion The present study showed similar pre-attentive skills for both conditions: fine (1000 Hz and 1010 Hz) and gross (1000 Hz and 1100 Hz) difference in auditory stimuli at a higher level (endogenous) of the auditory system.

Auditory evoked potentials serve as an objective mode for assessment to check the functioning of the auditory system and neuroplasticity. Literature has reported enhanced electrophysiological responses in musicians, which shows neuroplasticity in musicians. Various databases including PubMed, Google, Google Scholar and Medline were searched for references related to auditory evoked potentials in musicians from 1994 till date. Different auditory evoked potentials in musicians have been summarized in the present article. The findings of various studies may support as evidences for music-induced neuroplasticity which can be used for the treatment of various clinical disorders. The search results showed enhanced auditory evoked potentials in musicians compared to non-musicians from brainstem to cortical levels. Also, the present review showed enhanced attentive and pre-attentive skills in musicians compared to non-musicians.

Cystic Fibrosis (CF) is predominantly a disease of Caucasians, but it is increasingly being recognised in India. The typical presentations of CF are recurrent pneumonia and malabsorption. Atypical presentations are also increasingly being reported from India due to the differences in genotype and environmental factors. Pseudo-Bartter syndrome (PBS) is one of these atypical presentations which can present at any time after the diagnosis of CF but its presentation as an initial manifestation is rare. We hereby report three infants who presented with dehydration without obvious external losses. The investigations revealed metabolic alkalosis with hypochloraemia. A stepwise approach towards metabolic alkalosis revealed possibility of cystic fibrosis which was confirmed by sweat chloride test. All infants completely recovered with initial fluid and electrolyte therapy, following which supportive therapy for CF was started and subsequently they were discharged from the hospital.

Abstract Introduction “Diabetes mellitus is a group of metabolic disorders characterized by elevated blood sugar and abnormalities in insulin secretion and action” (American Diabetes Association). Previous literature has reported connection between diabetes mellitus and hearing impairment. There is a dearth of literature on auditory temporal resolution ability in individuals with diabetes mellitus type 2. Objective The main objective of the present study was to assess auditory temporal resolution ability through GDT (Gap Detection Threshold) in individuals with diabetes mellitus type 2 with high frequency hearing loss. Methods Fifteen subjects with diabetes mellitus type 2 with high frequency hearing loss in the age range of 30 to 40 years participated in the study as the experimental group. Fifteen age-matched non-diabetic individuals with normal hearing served as the control group. We administered the Gap Detection Threshold (GDT) test to all participants to assess their temporal resolution ability. Result We used the independent t-test to compare between groups. Results showed that the diabetic group (experimental) performed significantly poorer compared with the non-diabetic group (control). Conclusion It is possible to conclude that widening of auditory filters and changes in the central auditory nervous system contributed to poorer performance for temporal resolution task (Gap Detection Threshold) in individuals with diabetes mellitus type 2. Findings of the present study revealed the deteriorating effect of diabetes mellitus type 2 at the central auditory processing level.

Abstract Electrophysiological measures are one of the objective modes of assessment to check the integrity of the auditory function. The endogenous potentials like mismatch negativity (MMN) are responses which are due to internal events such as cognition or perception. In clinical practice and researches it was observed that MMN not present in all normal hearing individual. So, there is a need to study prevalence of MMN in normal population, which helps the researchers and clinicians in interpreting clinical findings. 50 participants recruited in the age range of 18–25 years. MMN was recorded with pair of stimuli. The pair was having /1000Hz/ and /1100Hz/ with /1000Hz/ as frequent stimulus and /1100Hz/ as the infrequent stimulus. Out of 50 normal hearing subjects, MMN was present only in 33 normal hearing subjects (66%). So clinician should be cautious during interpretation of clinical findings using MMN in abnormal population.

Bronchobiliary fistula (BBF) is a rare condition, defined by the presence of abnormal communication between biliary tract and bronchial tree. We describe a 3½-year-old child who developed BBF after rupture of liver abscess. She underwent exploratory laparotomy and peritoneal wash for ruptured liver abscess. Seven months later she presented with fever and cough with yellow-colored expectoration (bilioptysis). An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract. On follow-up child was asymptomatic and doing well.

Metal-flavanoid complexes could be of interest in the medical field. The most studied dietary phytoestrogen (plant compounds that may resemble estrogen or modify its effects in the human body) is genistein, a naturally occurring isoflavone. Zinc, an essential trace element, is involved in various physiological processes in the human body and can protect against oxidative stress in certain tissues and conditions. The formation of metal flavonoid complexes can improve the stability and bioavailability of flavonoids while influencing their biological activity. The purpose of this study is to quantify the antioxidant capabilities of the zinc-genistein complex (ZGC) compared to flavonoids alone. Zinc chloride and genistein were combined in a modified chelation process to create ZGC. FTIR (Fourier transform infrared spectroscopy), UV (ultraviolet-visible spectroscopy), 1HNMR (proton nuclear magnetic resonance), atomic absorption spectra (AAS), mass spectrometry (MS) and elemental analysis were used to characterize the metal-flavanoid complex produced. When the characterized ZGC was tested for its antioxidant activity, it was found that ZGC had an IC50 value of 119.32 mcg, while genistein had an IC50 value of 908.34 mcg. This indicates that ZGC has greater antioxidant activity than genistein alone. [ABSTRACT FROM AUTHOR]