Pediatric Department Research Articles

Clinical and laboratory profile and outcome in children with Wilson disease: an observational study in South India

ABSTRACT Background Wilson disease is an autosomal recessive disorder owing to defective copper metabolism which causes abnormal accumulation of copper and damage to the liver, brain, kidneys and other organs. Aim To describe the clinical features, laboratory investigations and outcome of Wilson disease in children. Methods A retrospective observational study was conducted in the paediatric department of a tertiary- care hospital in South India by reviewing medical records between January 2018 and March 2023. The diagnosis of Wilson disease was confirmed by the presence of low serum ceruloplasmin and/or high urine copper excretion in combination with clinical and ophthalmological features. Results A total of 32 cases were analysed. The mean (SD) age at presentation was 110 (36) months with a M:F ratio of 1.6:1. Isolated hepatic involvement was seen in 19 (60%) patients while 13 (40%) patients had a neurological presentation, either as an isolated entity or in combination with hepatic manifestations. Low serum ceruloplasmin levels were detected in 31 (96%) patients. Urine copper levels were elevated in all patients. Twenty-one patients were commenced on D penicillamine while 11 patients were treated with a combination chelation therapy with zinc. Eighteen patients (56%) were on regular follow-up. Conclusion The clinical presentation of Wilson disease in children is diverse, varying from the more common hepatic or neurological manifestations to the less common atypical forms of the disease. Diagnosis is based on clinical and ophthalmological features in combination with biochemical abnormalities in the form of low ceruloplasmin and high urinary copper. The majority of patients can be medically managed with chelation therapy.

Profile of asthma in a pediatric setting at the paediatric department of the Ignace National Hospital in Conakry

Introduction: Asthma is a chronic inflammatory disease, common in pediatrics, often underdiagnosed and poorly documented in our context. The objective was to contribute to the study of the frequency and associated atopias of asthma in children aged 3 to 15 years in the paediatric department of the Ignace Deen National Hospital. Methodology: The study was observational for six months (May 1 to October 31, 2019) in the pediatric department of the Ignace Deen National Hospital, Conakry covering all children admitted for asthma. Results: Out of 4225 children received, we had recorded 105 asthmatics, i.e. a hospital frequency of (2.48%), largely dominated by young children (3-6 years), 51 cases (48.57%). The mean age was 7.51 ± 2.99 years, with a sex ratio of 1.02 (male 53(50.50%)). The suggestive symptoms reported by children ≤ 5 years were cough (100%) and dyspnoea (77.42%). Cough (90.54%) and chest tightness (58.11%) were also reported by ages over 5 years. Personal atopic comorbidities were dominated by allergic rhinitis (63.80%). Familial nuclear atopy reported was allergic rhinitis in nearly half (48.57%) and asthma (28.57%) of cases. Obesity was found in (6.70%) of children. The (58.10%) cases were not known to have asthmatics. The others (41.9%) were former asthmatics among whom (47.70%) were not on disease-modifying treatment. Intermittent asthma was most common in naïve children (52.44%) and (69.55%) of children had controlled asthma on disease-modifying treatments. Conclusion: This study shows a low frequency that testifies to the underdiagnosis of the condition in our context. An analytical study on underdiagnosis will identify the associated factors. Keywords: asthma profile, paediatric setting, Ignace Deen, Conakry.

The effect of dexmedetomidine on emergence delirium of postanesthesia events in pediatric department: A systematic review and meta-analysis of randomized controlled trials.

Emergence delirium (ED) is a common occurrence in pediatric postanesthesia events, leading to negative outcomes. Dexmedetomidine (DEX), as an anesthesia adjuvant, has shown promise in preventing ED in adult surgeries, and it has been increasingly used in pediatric surgical settings. However, its effectiveness in other postanesthesia events, such as MRI examinations and ambulatory surgery centers, remains unclear. This meta-analysis aims to assess the safety and efficacy of DEX in preventing ED in various pediatric postanesthesia events beyond surgery. Prospective randomized controlled trials were searched in Pubmed, Web of Science, and EBSCO until October 13, 2023. Comparisons were made between DEX and other sedatives or analgesics in different postanesthesia events (including surgery operations, the examination of MRI, day surgery, and invasive action). Subgroup analyses were conducted based on drug delivery methods, medication timing, DEX dosages, use of analgesics, event types, and recovery time. A total of 33 trials involving 3395 patients were included. DEX significantly reduced the incidence of ED (odds ratios [OR] = 0.23, 95% confidence interval [CI]: 0.19-0.27, I2 = 37%, P < .00001). Intranasal delivery of DEX was the most effective (OR 0.18, 95% CI: 0.10-0.32, P < .00001, I2 = 0%). DEX also showed benefits in day surgery and mask insertion events (OR 0.30, 95% CI: 0.14-0.26, P = .001, I2 = 0%). DEX demonstrates superior efficacy in preventing ED in pediatric postanesthesia events compared to other sedatives and analgesics. Its use is recommended in various settings for its safety and effectiveness in managing ED.

Advanced Practice Providers in Pediatric Surgery: A 10-Year Analysis of Clinical Productivity

Introduction: Advanced practice providers (APPs) are integral to nonsurgical and surgical fields. In surgical settings, APPs work autonomously alongside surgeons to enhance continuity of care. While small-scale studies across various surgical specialties have explored APP utilization, literature specific to the pediatric population is limited. This study assesses the impact of increased APP utilization on productivity within one of the largest pediatric surgery departments in the United States. Methods: Data was sourced from the Surgery Department Executive Committee (SDEC) annual reports. Descriptive analyses were performed to delineate trends in clinical volumes, OR cases, gross charges, work relative value units (wRVUs), and provider full-time equivalents (FTEs) between October 2011 and September 2023. Secondary analyses were performed from 2016 to 2023, after APP roles were refined in each division. Results: Since 2012, an upward trend is observed in total clinic visits, total OR cases, and OR cases per MD. In 2016, APPs saw 1 clinic patient for every 2.2 seen by MDs, decreasing to a 1:1 ratio by 2023. The MD surgical conversion rate has increased by 20.5% since 2016, while the conversion rate per total clinic volume has decreased by 7.3% over the same period. Total wRVUs and gross charges increased across the department and per provider, despite fewer overall providers since 2021. Conclusion: Increased utilization of APPs within the department of surgery may enhance procedural productivity for surgeons while ensuring continued patient access to care. This study highlights the importance of developing care models that optimize the full skillset of APPs.

Use of ultrasound for vascular access during cardiac catheterisation in children with congenital heart disease: a Swiss multicentre cohort study.

Our study aimed to assess the first-attempt success rate of ultrasound (US) and anatomical landmark (ALM) guidance for vascular cannulation in children with congenital heart disease in Switzerland. A prospective observational multicentre study was conducted from January 2022 to January 2023 in three university hospitals in Switzerland. We included patients with congenital heart disease aged 0 to 18 years who were scheduled for elective cardiac catheterisation. Periprocedural data were collected anonymously. The choice of vessel and guidance technique were at the operator's discretion. 177 arterial and 240 venous cannulations in 253 patients were analysed. The median age and weight were 4.4 years (interquartile range [IQR] 1.2-8.8) and 15 kg (IQR 8-27), respectively. Nearly all operators, 97.5%, were deemed experienced. The femoral artery and femoral vein were the most preferred vessels. US guidance was used in 62% of procedures, predominantly within populations who were younger, smaller and of lower weight.The success rate at the first attempt was notably higher with US guidance for arterial cannulation (US: 80%, ALM: 37%, p <0.001) and venous cannulation (US: 78% vs ALM: 47%, p <0.001). Overall success rates for venous and arterial cannulation were comparable between ultrasound and anatomical landmark guidance. A total of 45 complications (10.5%) occurred, with immediate uncomplicated haematoma being the most frequent. US guidance is preferred for the localisation and cannulation of vessels during cardiac catheterisation within paediatric cardiology departments in Switzerland. Given its high success rate for first-attempt cannulation, US warrants additional research to evaluate its potential in reducing complications.

Coronary artery complications in patients with Kawasaki disease who successfully responded to the standard initial IVIG treatment

ObjectivesTo identify clinical characteristics of patients with non-refractory Kawasaki disease (KD), which were defined as those who successfully responded to the standard initial intravenous immunoglobulin (IVIG) treatment (2 g/kg/day, single...

Olfactory neuroblastoma in children: clinical analysis of five cases

The clinical data of five patients diagnosed with olfactory neuroblastoma (ONB) who were admitted to the Department of Pediatrics, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2012 to January 2024 were retrospectively analyzed. Two males and three females aged 6.2 (5.7-15.8) years were included. The symptoms mainly covered nasal congestion, increased nasal secretions, headache, decreased vision and so on. Pathological grade Ⅱ, Ⅲ and Ⅳ was identified in two cases, one case and two cases, respectively. Modified Kadish stage B, C and D was detected in one case, two cases and two cases, respectively. All patients underwent surgery, chemotherapy, and radiation therapy. Among the five patients, four survived and one died. The follow-up time was 22.3 (10.4-56.4) months, and the recurrence rate was 0. ONB should be suspected when tumors are presented in the upper and middle parts of the nasal cavity, especially dumbbell shaped masses that grow towards the nasal cavity and intracranial area based on imaging. The multimodality therapy of ONB comprising of surgery and chemotherapy, can achieve good therapeutic effects and prognosis, but long-term follow-up is required.

Congenital bile acid synthetic disorder type 3 caused by CYP7B1 gene variation in 2 cases and literature review

Objective: To summarize the clinical features and genetic characteristics of Congenital bile acid synthetic disorder type 3 (BASD3) disorder caused by CYP7B1 gene variation. Methods: This was a case series study. Clinical data and genetic results of 2 cases of congenital bile acid synthetic disorder type 3 caused by CYP7B1 gene variations in the Department of Infectious Diseases, Children's Hospital of Fudan University at Xiamen and Department of Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University from January 2021 to December 2023 were retrospectively collected and analyzed. Literature up to December 2023 was searched from electronic databases of China National Knowledge Infrastructure (CNKI), Wanfang Data and PubMed with the combined keywords of " Congenital bile acid synthetic disorder type 3""Oxysterol 7-alpha-hydroxylase""Oxysterol 7α-Hydroxylase Deficiency""BASD3" and "CYP7B1 liver" both in Chinese and English. The main clinical features and genetic characteristics of BASD3 disorder caused by CYP7B1 gene variations were summarized. Results: Two BASD3 patients, 1 male and 1 female, were admitted at the ages of 3 months and 18 days, and 2 months and 7 days, respectively. Both patients presented with neonatal cholestasis and hepatomegaly. Biochemical evidence indicated direct hyper-bilirubinemia with elevated aminotransferase levels, while gamma-glutamyltransferase (GGT) and total bile acid levels were normal or nearly normal. Patient 1 was a compound heterozygotes of the CYP7B1 gene variants c.525-526insCAAGTTGG(p.Asp176GInfs*15) and c.334C>T(p.Arg112Ter). Patient 1 jaundice resolved and liver function tests normalized after oral administration of chenodeoxycholic acid (CDCA). Patient 2 was homozygous for variant c.334C>T(p.Arg112Ter) in CYP7B1 gene. Patient 2 was in liver failure status already and not reactive to oral CDCA administration. Patient 2 received living-related liver transplantation for enhanced abdominal CT revealed a liver tumor likely vascular origin. Literature review revealed no cases of BASD3 reported in Chinese literature, including 2 patients in this study, while 12 patients (9 males and 3 females) were reported in 9 English literatures. All of the 12 manifested jaundice and hepatosplenomegaly in infancy, with cirrhosis, liver failure, kidney enlargement, hypoglycemia, and spontaneous bleeding in some cases, polycystic kidney disease was demonstrated in 5 cases of them. The c.334C>T (p.Arg112Ter) of the CYP7B1 gene was homozygous in 4 cases and compound heterozygous in 2 cases. Among the 12 children, 6 cases received CDCA treatment, while 6 cases not. Four survived with their native liver in the 6 cases who received CDCA therapy, while none in the 6 cases not received CDCA therapy. Conclusions: BASD3 is a rare hereditary cholestatic disorder. Markedly elevated levels of conjugated bilirubin and aminotransferases, with normal or nearly normal GGT and total bile acid levels can serve as diagnostic clue. c.334C>T is the most common pathogenic variant of the CYP7B1 gene. Timely administration of CDCA may save the liver.

Belimumab in the treatment of systemic lupus erythematosus with juvenile onset: Results of a single-center retrospective study

The treatment of systemic lupus erythematosus with juvenile onset (jSLE) remains a difficult task, taking into account the more aggressive course of the disease, requiring the appointment of various therapy regimens, including mainly a combination of high doses of glucocorticoids (GC) with immunosuppressive drugs, which on the one hand improves control by the course of the disease, but on the other hand leads to an increase in serious adverse effects from therapy. Modern therapy capabilities have improved significantly with the advent of the belimumab – first and alone registered biologics for children with SLE.The aim of the study – based on an open single-center retrospective study, to analyze the efficacy and safety of belimumab in children with SLE.Material and methods. The study included all patients with jSLE who were observed in the pediatric department of V.A. Na sonova Research Institute of Rheumatology and received at least 1 infusion of belimumab. Diagnosis of SLE based on 2012 SLICC (Systemic Lupus Erythematosus International Collaborating Clinics) criteria. The efficacy of therapy was evaluated among patients who received belimumab for 6 months or more, and safety in all who received at least 1 infusion.Results. The study included 31 patients, 24 girls/7 boys. The median (Me) age at onset of the disease was 12.6 [10.18; 13.5] years, the Me duration of the disease at the time of initiation of belimumab therapy was 2.15 [0.9; 4.4] years. The Me activity on the SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) at the time of diagnosis verification was 12 [9; 17.5], at the time of start of belimumab – 8 [6; 12], 35.5% patients had severe activity, 51.6% – moderate, 12.9% – mild activity. The dose of GC per os at start of belimumab was 15 [10; 21.25] mg/day, 32.26% of patients received a high dose of GC, 54.84% – moderate dose, 12.9% – low dose. 9 patients had SDI (Systemic Lupus International Collaborating Clinics Damage Index) ≥1, Me – 1 [1; 2]. After 6 months of therapy, the Me of disease activity according to SLEDAI was 4 [2; 6], the dose of GC per os was reduced to 10 [8.25; 17.5] mg/day. In 15 patients, a decrease in antiDNA was recorded (57.7% of those who initially had elevated values of antiDNA), in 9 the level of complement was normalized (50% of those who initially had hypocomplementemia). After 12 months of therapy, the Me of SLEDAI was 4 [2; 4] (p=0.034), the dose of GC per os was 5 [5; 8.125] mg/day (p=0.012). 5 patients completed therapy within 12 months or more: 1 patient – remission, 4 patients – secondary inefficiency. Belimumab treatment was well tolerated, with the exception of three cases of serious adverse reactions (9.7%): prolonged diarrheal syndrome (after the 1st infusion), Lyell’s syndrome (after the 2nd infusion), infusion reaction (during the 2nd infusion). During the therapy of belimumab, no new damage were recorded; in 2 patients there was a decrease in the SDI.Conclusion. Belimumab therapy in patients with jSLE demonstrated high efficacy with a decrease in the activity of the disease according to SLEDAI, normalization of antiDNA and complement, the possibility of a significant reduction the dose of GC, the absence of progression of the SDI with a good safety profile in the vast majority of patients.

A Study On The Screening Of Congenital Heart Disease Using Pulse Oximetry In Asymptomatic Newborns Delivered In Tertiary Care Centre

Introduction: Congenital Heart Disease is the most common congenital abnormality in newborns and has been recognized as one of the leading causes of death in the first year of life. The global incidence of CHD is estimated at 8 per 1000 live births. Using pulse oximetry critical and many of the asymptomatic CHD can be identified in the immediate post natal period. This strategy will help in early identification and its intervention. Objective: To assess the effectiveness of pulse oximetry as a screening tool for detection of CHD in asymptomatic newborn. Methods: It was a Hospital based Cross sectional study conducted in the Department of Obstetrics and Gynaecology, in collaboration with the Department of Paediatrics, of a tertiary hospital in North Eastern State from May 2022 to April 2024. Results: The mean birth weights of the neonates were2.93±0.29 Kg and the mean gestational age was 37.74±1.56 weeks. 4% of all neonates screened with pulse oximetry showed positive result. Among them 4 (2%) neonate were diagnosed with CHD. Out of the 4 neonates diagnosed with CHD, 3 were diagnosed with VSD and 1 with PDA. Conclusion: Eight (8) i.e 4% of the neonates were screened with positive pulse oximetry and out of which four (4) were diagnosed with CHD. Proportion of neonates who were screened positive in pulse oximetry with positive echocardiographic findings were significantly higher than those who screened negative (p value &lt;0.001). Therefore, the pulse oximetry screening for detection of CHD among asymptomatic neonates in our study showed a moderate sensitivity (75%), high specificity (97.4%) and negative predictive value (99.47%) and a reasonably low positive predictive value (37.5%), respectively

Serum Albumin and Its Influence on Immediate Outcomes in Children with Congenital Heart Disease Undergoing Cardiac Surgery

Background: Hypoalbuminemia is associated with morbidity and mortality in critically ill children and is a well-recognized predictor of general surgical risk. It frequently occurs in patients with congenital heart disease (CHD). Moreover, cardiopulmonary bypass (CPB)-induces an inflammatory response, and the overall surgical stress can affect albumin concentration greatly Objective: To estimate pre-operative, per-operative and post-operative serum albumin level and to see its influence on immediate outcomes in children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass Methods: This cross-sectional observational study was conducted in Paediatric cardiology department, BSMMU in a view to find out the influence of pre-operative, per-operative and post-operative serum albumin level on immediate outcomes in children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass(CPB).The study included total 48 patients of CHD who underwent CPB. Patients were selected according to inclusion and exclusion criteria. Result: Mean pre-operative serum albumin was 3.5±0.9 mg/dl whereas per-operative and post-operative serum albumin was 3.3±0.7mg/dl and 3.1±0.7 mg/dl respectively.CPB time was a bit higher in study population (98.4± 29.1min) where as other outcome parameters were within normal range. Duration of hospital stay was 12.2±3.1days. 22 patient (45.8%) developed valvular regurgitation and 6 patient (12.5%) developed pericardial effusion in post-operative echocardiography. Infection was evident by positive blood culture in 7 patients (14.8%). Pre, per and post-operative hypoalbuminaemia was associated with poor outcome after CPB. Conclusion: Pre, per and post-operative hypoalbuminaemia is a prudent indicator for speculating poor immediate outcome following CPB in children with CHD. (Bangladesh Heart Journal 2024; 39(2): 121-126

Acquired Demyelination Syndrome in Children and Adolescents: 10 Years Experience from a Tertiary Care Centre in North India.

The childhood central nervous system (CNS) acquired demyelinating syndromes (ADS) can be monophasic or recurrent, with both having considerable overlap in the first decade of life. The objective of the study was to describe clinical and radiological features, immunological characteristics, response to therapy and difference between monophasic and first episode of recurrent disorders of pediatric-onset CNS ADS. Case records of all patients presenting with CNS ADS to the Department of Pediatrics between January 2009 to December 2018 were retrospectively reviewed. Those with complete records and at least 12 months follow up were included for analysis. Overall 95 case records were reviewed (66 monophasic: 20 ADEM and 46 CIS, 29 recurrent: 18 MS, 9 NMOSD, and 2 multiphasic ADEM). The median age of the cohort was 7 years (range: 1-12) and nearly two-thirds (62/95) were males. All acute cases were treated with intravenous pulse followed by tapering oral steroid therapy. All the recurrent entities received azathioprine with rituximab in few. Certain clinical and radiological features of CIS and immune and inflammatory characteristics in CSF were found to be significantly different in monophasic cases compared to first episode of recurrent cases. The CNS ADS show favourable response to immunotherapy. Azathioprine may be an effective long term immunomodulator, particularly in resource limited settings. Certain clinical, radiological and immunological features may differentiate monophasic illness from first episode of recurrent disorder.

High fiber diet versus polyethylene glycol in management of chronic constipation in children with cerebral palsy: A randomized controlled trial.

Constipation is one of the most common gastrointestinal symptoms in patients with cerebral palsy. This study was conducted with the aim to compare the efficacy of a high fiber diet and polyethylene glycol in the management of chronic constipation in children with cerebral palsy. An open-label randomized controlled trial was conducted in the Department of Pediatrics of a tertiary care hospital in Northern India among cerebral palsy children aged 1-6 years having chronic constipation. Seventy children were enrolled in the study (35 in each group). Group A children received high fiber diet as per the diet chart prepared by the dietician. Group B received polyethylene glycol (0.5-1 g/kg/day) for a period of three months. At the end of four weeks and three months, all children were assessed for clinical improvement and both groups were compared in terms of stool frequency, consistency of stool, fecal incontinence, palpation of hard stool per abdomen, blood in stool, pain on defecation and overall satisfactory outcome. Satisfactory outcome was defined as defecation > two times weekly, soft stool, no pain on defecation, no palpation of hard stool on abdominal examination, no fecal incontinence, and no blood in stools. Children were also assessed for any adverse effects. Baseline parameters and GMFCS were comparable in the two groups. Both group patients showed significant improvement in symptoms of constipation at the end of four weeks and three months compared to baseline. However, there was no significant difference between the two groups in terms of satisfactory outcome and parameters like frequency of stool, consistency of stool, palpation of hard stool, fecal incontinence, and blood in stools. A high fiber diet can be considered a good alternative to polyethylene glycol for the management of chronic constipation in children with cerebral palsy.

Predictors of quality of life (QOL) and treatment adherence among children with nephrotic syndrome.

Any significant changes in the growth and development of any aspect of life will ultimately affect the health-related quality of life (HRQOL) of children with nephrotic syndrome. Various factors can influence treatment adherence, which can promote or decline the child's quality of life (QOL). Objective: To assess the quality of life and adherence to treatment regimen and to identify the predictors of QOL and adherence to treatment regimen among children with nephrotic syndrome. A cross-sectional study was conducted among 59 children with nephrotic syndrome who attended the Paediatric Department of AIIMS, Bhubaneswar, using the PedsQL 4.0 generic core scale to assess the quality of life and adherence response scale. Both descriptive and inferential statistics were performed using the SPSS 20 version. The overall QOL median score was 93.48, with an IQR of 18.48, which indicated good QOL. A median score of treatment adherence was 16 with IQR 5, which indicated that the overall treatment adherence was good. Type of nephrotic syndrome (P = 0.014), developmental stage (P = 0.018), education of mother (P = 0.026), and occupation of mother (P = 0.026) were the variables predicted QOL. Duration of disease (P = 0.006) and duration of therapy (P = 0.005) significantly predicted treatment adherence. Children need continuous reinforcement on treatment adherence strategies to attain and maintain good QOL so that it can help to reduce the disease severity. Controlling the predictors that influence the QOL and treatment adherence has to be counseled among the parents so that their adherence can be sustained throughout the disease process to maintain good QOL.

TCM practitioners’ attitudes and perceptions regarding the use of Ephedra sinica Stapf: An observational study

ObjectiveTo understand the attitudes and perceptions of traditional Chinese medicine (TCM) practitioners in Beijing TCM hospitals regarding the use of Ephedra sinica Stapf (E. sinica, Ma Huang). MethodsA two-stage cross-sectional study was conducted using a questionnaire survey of TCM practitioners in Beijing TCM hospitals between April 2023 and March 2024. The questionnaire included demographic information, the clinical background of TCM practitioners, and the clinical application of E. sinica. Logistic regression analysis was used to analyze the relevant influencing factors when using E. sinica. ResultsOf the 465 questionnaires collected, 441 were valid. Among these, 84.81% (374/441) reported having used E. sinica in clinical practice at least once. The commonly used doses of E. sinica—excluding the pediatric department—were 10 g for high doses, 6 g for medium, and 3 g for low. The three most frequently used formulas for E. sinica included Maxing Shigan decoction, Mahuang decoction, and Xiao Qing Long decoction. The most common TCM patterns treated with a high dose of E. sinica were wind-cold fettering the exterior, wind-cold invading the lung, and cold congealing in the meridian. The top three Western medical diagnoses when using E. sinica for treatment were common cold, pneumonia, and upper respiratory tract infections. Nearly half of the respondents reported experiencing adverse reactions from the oral administration of E. sinica, with the most common being palpitations, insomnia, and restlessness. Starting with a low dose and gradually increasing it as appropriate was identified as an effective approach. According to the respondents, the most important factor affecting the efficacy of E. sinica is the dose used. ConclusionThis study investigated the attitudes and perceptions of TCM practitioners in Beijing TCM hospitals regarding the dose–efficacy–adverse reaction relationship of E. sinica, providing a reference for the safe and effective clinical use of E. sinica.

Poison Severity Score of Accidental Acute Pediatric Intoxication among Cases Presenting to the Pediatric Department in Damietta General Hospital

Poison Severity Score of Accidental Acute Pediatric Intoxication among Cases Presenting to the Pediatric Department in Damietta General Hospital

Evaluation of clinical and radiographic success rate of a pulpotomy in primary molar teeth treated in pediatric department of the faculty of dentistry

Evaluation of clinical and radiographic success rate of a pulpotomy in primary molar teeth treated in pediatric department of the faculty of dentistry

Exclusive Breastfeeding Practice and Associated Factors among Mothers of Infants under 6-Months of Age

The consequences of poor feeding practices might exhibit in the form of poor nutritional status in the early part of life whereas delayed mental as well as motor developmental disorders are some most commonly exhibited long term consequences. Objective: To determine the prevalence and associated factors of exclusive breastfeeding (EBF) among mothers of infants below six months of age. Methods: This cross-sectional study was done at the Department of Pediatrics, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot, Azad Kashmir, Pakistan from August 2022 to January 2023. Results: In a total of 237 mothers, the mean age was 27.15 ± 3.87 years. The EBF was reported by 151 (63.7 %) mothers. High socio-economic status (adjusted odds ratio = 5.87, p = 0.003), having fewer than 4 antenatal visits (adjusted odds ratio = 4.15, p &lt; 0.001), cesarean delivery (adjusted odds ratio = 5.57, p &lt; 0.001). the absence of postnatal advice on EBF (adjusted odds ratio = 3.06, p = 0.004), and children aged 4-6 months (adjusted odds ratio = 8.58, p &lt; 0.001) had significantly higher odds of absence of EBF. Conclusions: It was concluded that the exclusive breastfeeding was practiced by 63.7% mothers. High socio-economic status, fewer antenatal visits, cesarean section, absence of postnatal advice on exclusive breastfeeding, and relatively older age of the infant were associated with lack of exclusive breastfeeding practices.

Study of Nutritional Anemia in Children Admitted to Pediatric Department in Rural Teaching Hospital of Telangana

Abstract Background: Globally, around 600 million preschool and school aged children are affected by anemia. According to World Health Organization, 65.5% of preschool children in southeast asia are anemic. Nutritional anemia is the commonest cause of anemia resulting from deficiencies of nutrients essential for red blood cell formation. Iron deficiency anemia is the most common nutritional deficiency amounting to 50%, followed by vitamin B12 and folate deficiency. This study is conducted to study the incidence of nutritional anemia among hospitalised children in a territory care teaching hospital in rural Telangana, in the age group of 6 months to 18 years and to bring awareness regarding the diet requirements in children in order to prevent deficiencies thereby the consequences of nutritional deficiencies. Method: This was a prospective hospital-based study conducted to study the incidence of Nutritional anemia along with clinical and hematological profile of nutritional anemia amongst children admitted to the Department of pediatrics in the age group of 6 months to 18 years at Mediciti Institute of Medical Sciences, Ghanpur, Telangana, from January 1st 2020 to June 30th 2021. All the children who had satisfied the inclusion criteria after taking consent from their parents were included in the study. Result: The incidence of nutritional anemia in the present study was found to be 52.08%, with both males and females equally affected. The age group of 6–12 years was particularly impacted, accounting for 49.3% of the cases. A significant 94% of the cases were associated with inadequate protein intake as per ICMR guidelines. Children from socio-economic classes 2 and 3, as per the Kuppuswamy scale, were more frequently affected. Severe anemia was observed in 8.7% of the cases. Peripheral smear analysis revealed microcytic, hypochromic red blood cells in 64.4% of the cases, with 94% of the children showing decreased serum iron levels. Conclusion: Nutritional anemia is the major cause of anemia in hospitalised children affecting majorly children in the age group of 6-12 years. Inadequate protein intake is the major contributor accounting to 94%, which can be prevented with proper dietary measures

Assessment of Hybrid Problem Oriented Approach in teaching AETCOM module 4.9 in final MBBS curriculum

Background: AETCOM module 4.9 aims to sensitize students to legal aspects of care including negligence. It is a major public health issue related to patient safety. Aims &amp; Objectives: This study was done to assess the effectiveness of the hybrid problem-oriented approach in teaching this module among phase 3 part-2 MBBS students and its perception among students and faculty. Methodology: Module-based educational prospective interventional study involving final MBBS students and faculty of Pediatrics Department. AETCOM Module was implemented as per NMC (National Medical Commission), India suggestions involving 1 hour of sensitization, 3 hours of self-directed learning 1 hour of role play and interactive lecture, and 1 hour of panel discussion. Pre- and post-test scores of pre-validated MCQs to assess knowledge, case closure, reflections and Likert’s scale for perception were recorded. Results: 115 final MBBS students and 6 faculty of the Department of Pediatrics participated. Significant improvement in post-test score of MCQ (mean 6.2 to 7.2 p&lt;0.0001 on Wilcoxon signed rank test) and score on case closure (n=97, 84.3% scoring &gt;80%) was observed. It was well received by students (n=112, 97.4%- satisfied or very satisfied) and faculty (n=5, 83.3%- very satisfied). They also found it useful (n=4, 66.7%). Majority of students strongly agreed that it enhanced understanding (n=88, 76.5%), it was practical (n=92, 80%), interesting (n=88, 76.5%), interactive (n=91, 79.1%) and promoted learning retention (n=78, 67.8%). Conclusion: A hybrid problem-based approach for teaching AETCOM module 4.9 was found to be effective in imparting knowledge and comprehension and it was well appreciated by students and faculty members.