Thalassemia patients require multiple transfusions. Iron overload and hepatitis C are known complications due to transfusions. Iron overload is treated with iron chelators. Hepatitis C treatment is rapidly evolving in children. This review discusses the management of these patients in light of newly available direct-acting antiviral agents. Early diagnosis and treatment remains the cornerstone in the management of this triple disease.

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Introduction: A large number of Down syndrome (DS) children are born every year in India and are the leading cause of morbidity and mortality in infants. The aim of the present study was to evaluate the possible risk factors in mothers for having DS. Methodology: A total of 217 DS cases were collected, and lymphocyte culturing was performed to confirm aneuploidy. Mothers having DS children (n = 213) with confirmed trisomy 21 and age-matched controls (n = 220) with normal children were collected. Results: Of 217 cases, 213 had confirmed trisomy 21 in children, and free trisomy 21 was observed in 91.71%, followed by mosaics in 3.68% and Robertsonian translocations in 2.30% of the cases. A double aneuploidy with chromosomal constitution 48, XXY,+21 (0.46%) was also seen. The mean maternal age in cases was 27.34 ± 5.2 years, while in controls, it was 27.75 ± 4.9 years. Logistic regression analysis showed that intake of folic acid (P < 0.0001) was associated with reduced risk while decreased parity (P = 0.01), intake of drugs in mothers (P = 0.002), and alcohol intake in fathers (0.032) were significantly associated with an increased risk of a DS child. Nearly 30.62% of the mothers experienced miscarriage before the birth of DS child but was not associated with an increased risk of trisomy 21. Conclusions: DS children were born to mothers younger than 30 years; intake of folic acid significantly reduced the risk, while intake of drugs in mothers and intake of alcohol in fathers significantly increased the risk of a DS child.

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Introduction: Ascaris lumbricoides induced intestinal obstruction is a sequel of this parasitic infestation. It presents as colic, vomiting (bilious or nonbilious), abdominal distention, and at times peritonitis. Management includes indoor admission, intravenous fluids, rectal enemas, and serial clinical and radiological assessment for detecting any indication of surgery. We, in our study, we analyzed the outcome of conservative management and the use of oral administration of 76% gastrograffin. Materials and Methods: Clinical parameters of all these patients were recorded and kept under close monitoring of the clinical parameters. Patients were initially subjected to conservative treatment whereby patients were advised nil per oral, nasogastric tube aspiration, intravenous fluid, rectal enemas, and antibiotics as indicated. In some patients, without signs of peritonitis and severe obstruction, contrast agent Gastrograffin was administered either per oral or vie6a nasogastric tube. Serial abdominal radiographs were taken. Surgical intervention was performed if worms were not expelled after 48–72 h of conservative treatment or contrast gets held up after 24–36 h in small intestines or clinical deterioration. Data were analyzed statistically. Results: A total of 240 patients were included in this study. The abdominal pain 156 (65%) was the most common symptom followed by distension in 168 (70%). Among patients, 65% were boys (n = 156) and 35% girls (n = 84). The clinical signs included abdominal distention in 168 (70%), tenderness in 28 (11%), rigidity 34 (14%), palpable worm masses in 115 (48%), and visible gut loops in 29 (23%). Most of the patients 204 (85%) responded to conservative management. Among 36 patients who needed surgery, 10 patients had received oral contrast. The peroperative findings included-impacted worms in 14 cases, impacted worm mass with gangrene 6 cases, intussusceptions without gangrene 7 cases, and gut volvulus with gangrene in 9 cases. The average hospital stay was 4.40 ± 2.25 days in cases managed conservatively, whereas about 10.35 ± 6.24 days in cases needing surgical intervention. There was no mortality in our series. Conclusions: Ascaris-induced worm obstruction should be managed conservatively; surgery is indicated if conservative management does not result in clinical improvement. The addition of Gastrograffin orally in some patients without complete obstruction significantly decreases the hospital stay and reduces the time period between admission to the expulsion of the worms.

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Objectives: This study was conducted to observe the incidence of adverse events following immunization (AEFI) in children ≤6 years of age. Material and Methods: An observational study was conducted in the department of pediatrics of our hospital from November 2018 to November 2019. A total of 20,414 children who attended the well-baby clinic for immunization over a period of one year were enrolled and observed for adverse events. Parents of the children were telephonically contacted for the observation of any type of adverse reaction that has followed by the administration of the vaccine. Results: Among 20,414 children, 8246 AEFI were reported during the study period. Majority of the AEFI were reported in the age group <1 week, followed by 6 weeks. Female children (56.7%) had reported more AEFI compared to male children (43.3%) with a ratio of 1.3:1 (F:M). The most common AEFI reported was fever (n = 4195 cases), followed by swelling (n = 2933 cases). Penta + IPV + OPV + Rota (38.2%) was majorly responsible for AEFI, followed by BCG + Hep-B + OPV (35.5%). Most of the AEFI (93.3%) were reported within 1 day of vaccine administration (n = 7691 cases). Conclusion: Our findings revealed that most of the adverse events were observed on day-1 after vaccine administration. Thus, after identifying the vaccines responsible for adverse events and the characteristics of the events, we may continue to consider vaccines as safe biological products. We also recommend that all AEFI should be documented and reported to the Central Drug Standard Control Organization (CDSCO) in real-time regarding vaccine use and awareness of vaccine safety.

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Nail is rightly regarded as a mirror to systemic diseases. Nails serve as a valuable diagnostic tool as it is very easy to examine all 20 of them quickly. A careful examination of nails may give vital clues to underlying sinister diseases evidenced by alteration of their shape, size, color, or texture. This review may help pediatricians to suspect an underlying serious systemic disease just by a careful examination of nails.

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Dystonia is a movement disorder characterized by involuntary muscle contractions. It may involve muscles of the neck, jaw, tongue, or the entire body. Dystonia could be a manifestation of an underlying central nervous system disorder or due to drugs. The list of drugs causing dystonia has been increasing as new drugs are becoming available. There are reported cases of levosulpiride-induced dystonia in adults. We report one such drug which caused dystonia in a pediatric patient due to an irrational drug prescription.

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Objectives: Febrile Seizure is the most common form of seizure in childhood. There are conflicting evidence regarding the association between iron deficiency and febrile seizure. Hence, this study was undertaken to find out the association between different indicators of iron deficiency with febrile seizure in children admitted in the Pediatric Emergency Ward of Burdwan Medical College, Burdwan. Methodology: A total of 159 children were selected by the complete enumeration method. Parameters of iron deficiency were estimated in them and age, sex-matched controls. Mann–Whitney U test and Spearman's rank-order correlation coefficient were used to find out the association between indicators of iron deficiency with febrile seizure. The binary logistic regression method was used to find out the adjusted odds ratio. P < 0.01 was considered statistically significant. Results: About 53.5% of the study population (mean age: 3.01 ± 1.37 years) was male. Mean hemoglobin, serum iron, serum ferritin, mean corpuscular volume, and mean corpuscular hemoglobin concentration were significantly higher in the control group, while the reverse is true for serum total iron-binding capacity. Serum ferritin became the most significant parameter, responsible for 57.3%–76.4% variability of febrile seizure. Overall, our model correctly predicted 50% variance of the dependent/outcome variable. Conclusion: Iron deficiency is more common among children with febrile seizure. Hence, iron prophylaxis may be given to children with febrile seizure. Further research (preferable multi-centric) should be conducted.

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Feeding small children had been a daunting experience by most parents, particularly for those having behavioural issues. Several patterns have been reported. History taking is considered invaluable in these cases. Many patterns have been described. Of interest is when associated with autism spectrum disorder. Behaviour modification and counseling with patience are rewarding. It is important to rule out organic causes of feeding difficulties while planning for definitive intervention.

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Introduction: Venomous scorpion sting is a medical emergency. The clinical manifestations vary widely between the children and adult group. Aims: The aims of the study were to study the profile of scorpion sting in children admitted in the pediatric intensive care unit (PICU). Materials and Methods: Sixty-one cases of scorpion sting admitted in PICU of MGM Medical College were studied. A detailed history was taken, and a thorough clinical examination was done in all patients. All patients with cold extremities, sweating, and tachycardia were given prazosin. Patients with features of shock were treated with oral prazosin plus dobutamine. Patients with features of shock and myocarditis were treated with prazosin plus dobutamine plus antiscorpion venom therapy. Results: Of 61 cases enrolled in our study, scorpion sting was more common in monsoon followed by summer season. The sting was more prevalent in the lower limb. The most common symptom was pain followed by cold extremities. Dyspnea due to pulmonary edema and bradycardia were less common. Tachycardia was frequently noted (80%). Two patients presented after 12 h had developed pulmonary edema and died. Conclusion: Prazosin had good outcomes in all patients with scorpion sting when administered at the time of admission. The study throws light on the common clinical features and complications of scorpion sting.

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With staged unlocking, physical opening of classes and schools is not distant. There is an urgent need to revise all salient points of this infection in children. Infection spreads mainly via droplets, fomites and contact with infected surfaces even though feco-oral route of transmission has also been reported. Majority of cases are asymptomatic or have mild illness. Children who have been diagnosed as positive usually have familial clustering. A positive history of exposure and clinical symptoms are more helpful for screening. Confirmation of the diagnosis is on the basis of a positive RT-PCR. Most common symptoms having been reported are fever and cough. Complete blood counts are suggestive of leucopenia with relative lymphopenia. Management of COVID 19 in children is primarily supportive. Prevention is the key to successful outcome in patients with COVID-19

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Background: Adenoid hypertrophy is an extremely common cause of upper airway obstruction in the pediatric population. Its high prevalence in children and the complications associated with its delayed diagnosis mandate a timely detection for its early and complete management. Aims & Objectives: The purpose of this study was to 1) detect the prevalence of adenoid hypertrophy in the pediatric population, 2) devise a clinical and radiological severity grading and determine the correlation between the two to develop an undemanding diagnostic approach. Materials and Methods: A total of 62 patients visiting the pediatric respiratory clinic were examined for signs and symptoms of adenoid hypertrophy like adenoid faces, mouth breathing, and runny nose. Their radiological reports were assessed for findings like flattening or convexity on the posterior pharyngeal wall and reduction in the width of the nasopharyngeal cavity. Results: A prevalence of 83.87% and 79.03% was seen based on the clinical and radiological findings respectively. A moderate positive correlation was also noted between the clinical and radiological grades, which was statistically significant. Conclusion: The ease of diagnosis associated with the clinical approach opens the possibility of detection of adenoid hypertrophy in large groups of children in resource-constrained areas, and negates the complications associated with other methods of diagnosis like endoscopy and radiography which are deemed more reliable by some clinicians.

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A 1-year-old child presented with generalized tonic–clonic convulsion and delayed developmental milestones. Hypopigmented streaks were noted on the right side of the body that ended abruptly in the midline. Magnetic resonance imaging of the brain shows paucity of sulci in both parietal areas and the right-sided cerebral hemisphere larger than the left. The child is clinically diagnosed with a case of hypomelanosis of ito.

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Miliary tuberculosis (TB) is a pathological name describing millet seed-sized (1–2 mm) granulomas in the various organs affected by tubercle bacilli. Miliary TB has a spectrum of manifestations that still perplex the most erudite and experienced clinicians and is a diagnostic and therapeutic challenge. Despite effective therapy being available, mortality from this disease has remained high. In children with miliary TB, chills, night sweats, hemoptysis, and productive cough have been reported less frequently, whereas peripheral lymphadenopathy and hepatosplenomegaly are more common compared with adults. Hereby, we present a case report of multiple tuberculoma and choroid tubercles in a child with miliary TB.

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Objectives: The objectives of the study are to estimate the incidence of respiratory distress (RD) with etiology and associated risk factors in newborns admitted to neonatal intensive care units and to propose adequate management plan for better clinical outcome. Study Design: This was a hospital-based prospective, longitudinal study. Setting: The study was conducted in a tertiary care teaching hospital of Odisha between November 2015 and October 2017. Study Population: A total of 202 newborns, born with RD, constitute the study population. The risk factors are delineated with outcome. Results: Out of 202 newborns with RD, 107 (53%) were males and 95 (47%) were females. Based on birth weight and gestational age, 35% were of very low birth weight (< 2000 grams; VLBW) and 19.8% were of low birth weight (2000 to <2500 grams; LBW). Both these groups accounted for 54.9% of all babies under the study. Pre-terms were 50.5% among VLBW and 9.9% among normal birth weight (NBW) babies. Most common etiology was found to be RD syndrome (RDS, 39.6%). 95% of cases survived while 5% resulted in death. 60% of the death was contributed by RDS and prematurity, while 40% of deaths were seen in term gestation with NBW resulting from birth asphyxia in this study. Although the death ratios in each group of newborns VLBW, LBW, and NBW were almost equal, the etiology of RD and death in the respective groups was different. Conclusion: The study shows an association between mortality and onset of RD. Early onset of RD increases mortality. Antenatal steroid administration has a positive outcome. VLBW and LBW newborns succumb more to RD. The etiology of RD is different in different categories of birth weight. Continuous positive airway pressure is the cornerstone in management of RDS.

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Objectives: To assess the cardiac changes in moderately malnourished (MAM) and severe acute malnutrition (SAM) children. Methodology: A cross-sectional, observational study conducted over a period of 1 year. The study included 150 children, 50 from each group, first being children with SAM, second being MAM children, and third group included normally nourished, age-matched children between 6 and 60 months, admitted in the pediatric ward. Structural and functional echocardiography parameters were compared in these groups. Statistical analysis was conducted using the SPSS software version 20. Results: SAM children showed significant reduction of structural (except left ventricular internal diameter [LVID]) and functional cardiac parameters as compared to other groups. Major anthropometric parameters including body surface area (BSA) were correlated with all structural cardiac parameters; left ventricular mass (LVM) strongly correlated (r = 0.773) but no correlation was found with functional cardiac parameters. Conclusion: Structural (except LVID) and functional cardiac changes were significantly reduced with malnourishment. We had also concluded BSA of children strongly correlated with structural cardiac parameters such as LVM and interventricular septum thickness with specific age and sex.

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Anemia is a condition in which the number of red blood cells, and consequently, their oxygen-carrying capacity is insufficient to meet the body's physiologic needs. The mean hemoglobin level at the time of delivery in full-term normal infants is 16.5 ± 3 gm% in cord blood. After rising in the first 24 h, it then starts falling progressively to reach a nadir of 12.0 ± 1 gm% by 1 year of age. Anemia is one of the leading causes of mortality and morbidity in under-five children, as high incidence has been noted among them. Early screening, diagnosis, and interventions are helpful to prevent the consequences associated with it. Nutritional anemia was diagnosed as the most common cause of anemia in the Indian subcontinent. It is common in infancy and in female children. Malnutrition and splenomegaly were common signs in anemic children. There are wide variations in etiology and clinical features in hospitalized children depending on various factors.

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Introduction: Diarrhoea is the second most common cause of deaths among children less than 5 years of age (15%) and half of the cases occur from 6 to 12 months of age. Deaths among hospitalised children, are mostly among the malnurished, demanding urgent diagnostic, therapeutic and nutritional intervention. Aim: To sensitise practicing pediatricians about such double dangers as high index of suspicion helps in early diagnosis and prompt intervention. Case: Eight month old baby presented with acute gastroenteritis (AGE) for 2 days. Exclusively breast-ded upto 6 monts of age. The child was treated with WHO recommended standard of care for AD such as oral rehydration solution (ORS), Zinc and usual complimentary feeds, including formula milk which the baby was on for last 2 months. Did show some initial improvemnt but worsened by week end; with large explossive stools, abdominal distension and perianal excoriation. Managed as secondary lactose intolerance post-viral AGE. Cow's milk protein allergy (CMPA) was thought unlikely in absence of any history of diarrhoea despite top feeds. Continued Zinc and complimentary feeding, but replaced formula milk with soy based feed. Th baby improved over next 4 days, started gaining weight and was discharged. Conclusion: Formula-fed infants with secondary lactose intolerance, when changed to lactose-free diet, may have early resolution of diarrhea and less scope of treatment failure. Being cheaper, Soy is considered a better alternative for short-term use in selected cases in developing countries as ours.

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Coronavirus infection, or COVID 19, was originally identified in Wuhan, China, in December 2019, but quickly spread over the world, resulting in a pandemic. Remdesivir, an antiviral agent by inhibiting viral RNA-dependent polymerase enzyme and was earlier used against Ebola, HIV etc, was presumed useful in the quest for a remedy against SARS-CoV-2. Several investigations had shown its promising antiviral properties in vitro and in vivo against severe acute respiratory syndrome due to coronavirus (SARS-CoV-1). Hence, Remdesivir was approved by the US FDA in the second half of 2020, followed by DCGI, for treatment in adults and children with SARS-CoV-2, requiring hospitalisation with moderate to severe symptoms. Pivotal trials (ACTT 1, SIMPLE Severe trial) showed a faster median time to recovery in these patients. However, several studies found no statistically significant difference in time to clinical improvement or mortality between patients who got remdesivir and those who did not. Although it was hailed as a "Miracle medicine" when it was first launched for COVID-19, its limited efficacy may not justify its status as such. The goal of this review is to outline the evidence and clinical studies of remdesivir, as well as its rise and decline as a treatment option.

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Introduction: Gallstone disease is being increasingly diagnosed as a cause of pediatric pain abdomen, requiring cholecystectomy. Most cases are idiopathic, while uncommon etiologic associations nowadays include obesity and hemolytic anemias/hemoglobinopathies; prolonged disease and high fat diet are predisposing factors. Management aspect is similar to adults. Aim: This study aims to compare the profile, interventions, and outcomes of pediatric gallstone disease patients, having undergone cholecystectomy, between two surgeons working at separate centers in India. Materials and Methods: Case records of all pediatric patients (≤15 years' age) having undergone cholecystectomy at both the centers by the respective surgeons (AP = 43 and KA = 17; total = 60 cases), between August 2015 and November 2019, were examined. Data were tabulated and inferences were drawn. Results: Male patients outnumbered female patients in both the studies (AP – M: F = 24:19, KA – M: F = 12:5). Anemia/hypoproteinemia and obesity were prevalent among the operated children (AP = 6 and KA = 3). Biliary pancreatitis (AP = 2 and KA = 2)/choledocholithiasis (AP = 7 and KA = 3) was the uncommon presentation; common bile duct obstruction with cholangitis/sepsis was rarer still. Laparoscopic cholecystectomy was the commonly performed procedure (AP lap: open = 41:2 and KA lap: open = 10:7). Choledocholithiasis patients underwent prior endoscopic retrograde cholangio-pancreatography (AP = 7 and KA = 3). Most patients had cholesterol/mixed gallstones. Complications were minimal, comparable with adult procedures. Conclusion: Pediatric gallstone disease is understated in literature and underestimated in clinical practice. Early diagnosis and timely referral to a surgeon for appropriate treatment can help prevent complications and reduce time–work–loss to child/parent.

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In neonatal intensive care units (NICUs), almost all babies have one or more risk factors for the development of intracranial abnormalities or intracranial bleeds. Early identification of any such lesion is very important in treatment, prognostication, and directing further therapy in such high-risk babies. As NICU care in India is advancing, we should evolve and adapt the new strategies to help us serve our babies better. Neurosonogram is one such tool, which now is essential in any tertiary NICU. Neurosonogram is an ideal tool for the primary screening of the neonatal brain. It can demonstrate many unsuspected cranial abnormalities. It has to be emphasized about its use as a screening modality for preterm and birth asphyxia neonates influencing their neurodevelopmental outcome. This is particularly important in the anticipation of potential preventive, protective, and rehabilitative strategies for the management of critically ill newborn infants.

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Background: Transient tachypnea of the newborn (TTNB) has been documented as the most common cause of neonatal respiratory distress, accounting for more than 40 percent of cases. Materials and Methods: This study was a prospective study on 75 patients (neonates who were born with TTNB) who underwent two-dimensional (2D) echocardiography (Echo) after tachypnea subsided. The controls (neonates who did not manifest tachypnea) were matched for birth weight, period of gestation, mode of delivery, and sex. Appropriate Chi-square tests were done for categorical variables, while Student's t-test was done for continuous variables. Results: Incidence of asymptomatic structural cardiac lesions detected by 2D Echo was significantly higher in neonates in the study group (n = 38; 50.66%) as compared to the control group (n = 7; 9.33%). This difference was statistically significant P < 0.0000002 (odds ratio 9.4586; 95% confidence interval 3.84–23.27). The most common cardiac lesion in both groups was atrial septal defect. Conclusion: The incidence of asymptomatic structural cardiac defects was found to be approximately five times higher in neonates manifesting TTNB (50.66% vs. 9.33%). Based on the findings of this study, screening for structural cardiac lesions by 2D echo is recommended in all neonates who manifest with TTNB.

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