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Amlodipine and atenolol fixed‐dose combination (FDC) overdoses pose significant clinical challenges due to their synergistic effects on cardiovascular function. We present the case of a 17‐year‐old girl with schizophrenia who intentionally ingested 20 tablets of an FDC containing 5 mg amlodipine and 50 mg atenolol per tablet, resulting in profound hypotension (BP 60/32 mmHg) and metabolic acidosis. Standard interventions, including gastric lavage and crystalloid resuscitation, failed to stabilize her condition, necessitating escalation to vasopressor therapy with norepinephrine, adrenaline, and vasopressin, which led to hemodynamic improvement. Notably, she developed transudative pleural effusions on Day 4, a rare complication of amlodipine overdose, managed effectively with intravenous furosemide and fluid restriction. Additionally, hypocalcemia and hyponatremia emerged during her hospital course, requiring targeted electrolyte replacement. The patient achieved full recovery without the need for high‐dose insulin or glucagon therapy. This case underscores the efficacy of early vasopressor support in severe calcium channel blocker and beta‐blocker overdose and highlights pleural effusion as a rare but treatable complication. Prompt multidisciplinary intervention, including psychiatric care, was essential in ensuring a favorable outcome and preventing recurrence. Further studies are warranted to explore optimal management strategies in such complex toxicological cases.

Background Admission hypothermia is still an underappreciated major challenge for new-born survival in low-resource settings. The WHO recommends skin-to-skin contact as the simplest and safest way for maintaining the body temperature even during transportation. Quality improvement initiatives for hospitalised new-borns have shown benefits like a reduction in neonatal morbidity and mortality. This study was undertaken in a resource-constrained public hospital in southern India with an aim to reduce neonatal hypothermia at admission to <20%. Method It was a prospective, quality improvement study undertaken over 20 weeks. All neonates born in the selected delivery room (DR), requiring transportation to the neonatal intensive care unit, were included. The primary outcome indicators were the mean axillary temperature of neonates measured upon arrival at the neonatal intensive care unit and the percentage of neonates with hypothermia at admission. Improving the thermoregulatory practices and ambient DR temperature to >25˚C, transportation by the kangaroo method, and a portable infant warmer (PIW) were implemented in three successive Plan-Do-Study-Act (PDSA) cycles. Result In the third PDSA cycle, the mean admission temperature (36.51˚C ±0.82) was significantly (p<0.0001) higher when compared with the baseline phase (35.41˚C ±1.09), and there was a significant (p<0.001) reduction in hypothermia (33.33%). The aim was achieved in the last two weeks of the third cycle with a reduction in hypothermia to 17.6%. Conclusion Implementation of appropriate thermoregulatory practices and low-cost strategies like the kangaroo method and PIW using quality improvement methodology significantly reduced admission hypothermia.

Objective: This study was done with the main objective of evaluating the effect of antihypertensive medications on the quality of life in patients who were previously untreated. Methods: In this prospective study, 114 patients were included. WHO-QOL BREF questionnaire was used to evaluate the quality of life. Results: The study reported no significant difference in any of the four domains from baseline to end of the study scores. Although there was an increase in physical health and psychological function domain scores, the increase was not statistically significant. The results also noted that patient's perception of overall quality of life did not significantly improve over the study period. However, the patient's perception of satisfaction with health significantly improved over the study period. The domain scores had a positive correlation with hypertension control. Physical health and environmental condition domains showed a statistically significant correlation with mean change in blood pressure. The quality of life did not vary significantly in different age groups. The quality of life did not significantly differ between different classes of antihypertensive drugs used. Conclusion: The quality of life in hypertensive patients who were previously untreated significantly correlated with hypertension control. There was no difference among different classes of drugs or different age group as for as the effect on quality of life is concerned.

Vertebral artery dissection is one of the common causes of childhood stroke. It can be either spontaneous or traumatic. It commonly occurs after a strenuous exercise. Clinical examination will not provide any evidence of the condition as the condition may be asymptomatic or present with only mild symptoms. The gold standard for detection is angiography. The treatment involves antithrombotic medications. Here we present the case of a 16-year-old female child who presented with sudden onset of paralysis secondary to vertebrobasilar ischemic stroke due to arterial dissection.

Objectives To test whether Kangaroo mother care (KMC) aids in transfer of favourable skin microbiome from mother to infant by comparing the microbiome composition before and after KMC. Methods A prospective cohort pilot study was conducted in a Level III neonatal intensive care unit (NICU) in South India, recruiting 30 preterm infants with gestation <32 wk from October 2020 through December 2020. Neonatal skin involving the area in contact with the mother during KMC i.e ., axilla, chest and abdomen was swabbed at the end of first week of life, prior to initiation of KMC. The 2nd swab involving the same areas was taken following KMC for 7 d for at least 6 h a day. The swabs were analysed using Next Generation Sequencing (NGS) - 16sRNA and abundance of organisms isolated were mapped. Statistical analyses using t-test and PERMANOVA were performed to compare phyla and genera of bacterial abundance pre-KMC and post-KMC. Results KMC at phyla level increased the relative abundance of Firmicutes ( p =0.52) and significantly decreased Proteobacteria ( p =0.02). At species level, KMC decreased pathogenic bacterial count of Escherichia ( p =0.05), while counts of S. hemolyticus ( p =0.01) and S. hominis ( p =.002) significantly increased post KMC. Conclusions KMC has a potential role in altering the neonatal skin microbiota towards a more favourable microenvironment. The clinical significance of these novel findings needs to be validated with larger studies.

Objective Knowledge, Attitude, and Acceptance regarding Bone marrow transplantation in caregivers of beta-thalassemia major patients. Methods A cross-sectional study was conducted among the caregivers of pediatric patients with betathalassemia major in blood transfusion centres in Bangalore, India. Their knowledge, attitude, and acceptance regarding bone marrow transplantation were assessed using a validated questionnaire. The study aimed to identify factors that influence caregivers’ decision about bone marrow transplantation. Results The knowledge, attitude, and acceptance of the caregivers towards bone marrow transplantation are shown to depend on gender, education and socio-economic status. The results of this study reveal that male caregivers generally exhibited higher levels of knowledge and had a better attitude towards it as compared to their female counterparts. Higher education and socio-economic status were associated with better knowledge, more favourable attitudes and a higher acceptance towards the procedure.

Background Measles remains a significant contributor to illness and death among young children, despite the presence of a safe and efficacious vaccine. One of the most highly transmissible viruses affecting humans is measles, which can be almost entirely prevented through vaccination. The recent surge in measles cases worldwide has been particularly notable in India. A total of 172 confirmed outbreaks of measles were recorded between October 2021 and September 2022, resulting in 12,589 cases. Measles, being highly contagious, is transmitted through the respiratory route. The disease affects 75 to 90% of susceptible household contacts, reaching peak infectivity three days before the rash emerges. The recent measles outbreak observed since January 2023 holds significance, as Bangalore district alone has reported around 500 cases. Therefore, the current study aims to evaluate the clinical and sociodemographic characteristics of measles in pediatric patients. Methods This was a retrospective study conducted over seven months. Data pertaining to demographics such as age, gender, parental occupation, parental educational background, and housing situation were gathered. Details regarding the child's immunization status, the onset of fever, and the onset of rash were also documented. Descriptive data was represented using mean, standard deviation, and percentage or proportion. Results Over the study period of seven months, 53 children were admitted due to measles. The majority of the individuals were female, accounting for 28 cases (52.8%). The typical clinical manifestations of measles such as cough, coryza, and conjunctivitis were documented in 45 (84.90%), 43 (81.13%), and 32 (60.37%) children, respectively. Specifically, two (3.77%), 14 (26.41%), 20 (37.73%), and 17 (32.07%) individuals were categorized as belonging to the upper middle, lower middle, upper lower, and lower socioeconomic strata. Six children in the nine- to 12-month age range had not received the measles-rubella (MR) vaccination. Thirteen (54.16%) out of 24 children aged one to five years had not received a single dose of the vaccine, while the children who had received at least one dose did not experience any complications. Among children aged less than nine months, nine to 12 months, and more than 12 months, three (100%), two (66.6%), and three (75%) respectively, experienced complications. All the patients recovered completely and were discharged from the hospital. Conclusion Measles is re-emerging as an infectious disease among children, as evidenced by the current outbreak. Study indicates that measles tends to impact infants and under five children more frequently. Through prompt and suitable medical intervention, all affected children experienced full recovery. It was observed that immunized children had fewer complications in comparison to their non-immunized counterparts. Acquiring a thorough understanding of the clinical profile of the illness is crucial for policymakers in developing essential guidelines for measles immunization coverage.

ObjectiveTo examine the feasibility of early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy (HIE).DesignDouble-blind pilot randomised controlled trial.SettingEight neonatal units in South Asia.PatientsNeonates (≥36 weeks) with moderate or severe HIE admitted between 31 December 2022 and 3 May 2023.InterventionsErythropoietin (500 U/kg daily) or to the placebo (sham injections using a screen) within 6 hours of birth and continued for 9 days. MRI at 2 weeks of age.Main outcomes and measuresFeasibility of randomisation, drug administration and assessment of brain injury using MRI.ResultsOf the 154 neonates screened, 56 were eligible; 6 declined consent and 50 were recruited; 43 (86%) were inborn. Mean (SD) age at first dose was 4.4 (1.2) hours in erythropoietin and 4.1 (1.0) hours in placebo. Overall mortality at hospital discharge occurred in 5 (19%) vs 11 (46%) (p=0.06), and 3 (13%) vs 9 (40.9%) (p=0.04) among those with moderate encephalopathy in the erythropoietin and placebo groups. Moderate or severe injury to basal ganglia, white matter and cortex occurred in 5 (25%) vs 5 (38.5%); 14 (70%) vs 11 (85%); and 6 (30%) vs 2 (15.4%) in the erythropoietin and placebo group, respectively. Sinus venous thrombosis was seen in two (10%) neonates in the erythropoietin group and none in the control group.ConclusionsBrain injury and mortality after moderate or severe HIE are high in South Asia. Evaluation of erythropoietin monotherapy using MRI to examine treatment effects is feasible in these settings.Trial registration number NCT05395195.