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BackgroundThe residual abscess on ultrasound after clinical resolution in children creates psychological fear among parents and diagnostic dilemma among physicians. Unlike in adults, there are no studies on resolution time of liver abscess in children.ObjectivesTo determine the time taken for clinical and ultrasonological resolution of abscess, and estimate the frequency of unfavourable outcomes and assess the clinico-biochemical parameters that influence the occurrence of unfavourable outcomes in children.MethodsA descriptive longitudinal study was conducted in the department of Pediatrics in a tertiary care hospital in North India in which 60 children (aged 1–18 years) with clinical features of fever and pain abdomen with a liver abscess on ultrasound were followed up clinically and by serial ultrasounds till complete ultrasonological resolution. These children with liver abscess on ultrasound were admitted and treated with intravenous antibiotics after appropriate blood tests. Percutaneous needle aspiration and/or surgical drainage (pigtail insertion/laparotomy) was attempted in children not responding to the initial conservative management or those showing signs of impending rupture on ultrasound.ResultsThe mean ± S.D ultrasonological resolution time was 7.9 ± 3.53 weeks whereas the clinical resolution time was 10.64 ± 4.77 days. Initial conservative management failed in 21 (37.5%) children, 2 (3.6%) children were readmitted and 18 (32.4%) children had complications. There were no deaths in our study. TLC and abscess size were the two clinico-biochemical parameters associated with the occurrence of unfavourable outcomes (p<0.05).ConclusionClinical resolution of liver abscess in children takes an average of 10 days, whereas it takes about 8 weeks for ultrasonographic changes to resolve completely.

Background Infantile colic is a common problem during the first three months of life. This randomized, double-blind, placebo-controlled trial conducted in an urban hospital in Delhi, India evaluated the efficacy and safety of oral lactase in management of infantile colic. Methods One hundred sixty-two clinically healthy infants aged < 5 months age [mean (SD) = 63.5 (30.5) days] fulfilling the Rome-IV diagnostic criteria for infantile colic were enrolled. Eligible children were randomly allocated to receive 5 drops of lactase (600 FCC units/mL) ( n  = 80) or placebo ( n  = 82) mixed with breast milk or formula feed four times a day for a duration of 4 weeks. Primary outcomes were duration of crying or fussing (min/d), and number of days with colic lasting > 3 h/d; secondary outcomes were parental satisfaction and adverse events. Results At the end of four weeks, mean (SD) crying or fussing time (min/d) was significantly shorter in infants receiving lactase in comparison to placebo [89.9 (115.2) vs .178.5 (153.2); P  = 0.001]. The mean (SD) number of days with colic was also significantly less in the lactase group as compared to placebo group at the end of the treatment [12.1 (7.8) vs 17.6 (8.4); P  < 0.001]. By the end of 4 th week, parental satisfaction in terms of infant’s mood, activity, alertness, comfort and oral intake was better in intervention group. The adverse event profile was comparable between two groups. Conclusions Oral lactase treatment in infantile colic results in symptomatic relief in terms of shortening of duration of crying or fussing, and better parental satisfaction. Trial registration Clinical trial registry of India (CTRI/2017/12/010930) registered on 20/12/2017.

There are limited prospective clinical studies that use the functional SYNTAX score (FSS) to determine treatment strategies, as compared to the anatomical SYNTAX score (ASS), in patients with multivessel disease (MVD). We sought to compare the change in treatment strategy and healthcare cost benefits between ASS and FSS in patients with chronic stable angina and/or recent acute coronary syndrome with MVD. This was a prospective, multicenter, multi-country, open-label study that enrolled 577 patients from 16 sites across Thailand, India, and Hong Kong. After angiographic assessment, the first treatment strategy was decided based on ASS information. Thereafter, the second treatment strategy was decided based on FSS. Subsequently, the physicians were asked to document the actual treatment received by the patient. The primary endpoint was a proportional change in treatment strategy based on FSS evaluated using κ-statistics and the Bowker–McNemar test. A total of 577 patients with 1833 lesions were assessed. The overall mean ASS was 17.0 ± 8.5, and the mean FSS score was 11.2 ± 9.6. FSS reclassified 28.1% of patients from the high-risk group toward the low-risk group. FSS reclassified more than one-third of patients with ASS > 22 to FSS  ≤  22. FSS-based decision making led to a statistically significant change ( p  < 0.0001) in treatment strategy for 53% of the patients. This change reduced the procedure-related cost by 10%. The overall major adverse cardiovascular events rate at 1-year follow-up was 4.5%. In the real-world setting, FSS significantly influenced the determination of appropriate treatment options among MVD patients and led to a reduction in procedure-related costs.

is an important cause of diarrhea in children under five, often missed by conventional laboratory methods. Blood in stools has always been a syndromic indicator for diarrhea, but most cases present with watery diarrhea without blood. This study aimed to determine the frequency of detected by molecular and conventional methods in children under five. Additionally, we aimed to study the clinical profile and outcome of children with diarrhea managed as per current diarrhea treatment guidelines. In this hospital-based prospective observational study, stool samples from 150 children (age range: one month to five years) with acute diarrhea (duration < seven days) were subjected to routine microscopic examination, stool culture, and DNA extraction. The extracted DNA from stored stool samples was subjected to polymerase chain reaction (PCR) amplification using a specific primer for the invasion plasmid antigen H gene sequence (ipaH) gene at 424 bp. Results were interpreted in the context of the percentage of isolation of by molecular (PCR) and conventional methods (stool microscopy and culture) and the follow-up outcome in terms of recurrence of diarrhea or dysentery and growth faltering over three months after discharge. infection was diagnosed in stool samples by PCR from 13 (8.7%) children, whereas it was isolated by conventional stool culture in only one (0.7%) child. The sensitivity of culture was only 7.7% against PCR for the diagnosis of infection, whereas blood in stools had a sensitivity of 15.4%. The majority of PCR-positive cases (11 out of 13) presented with non-bloody diarrhea. None of the evaluated clinical predictors had a significant association with the infection. No statistically significant difference was found between PCR-positive and PCR-negative children at the end of follow-up (P>0.05). The majority of children with infection present with watery diarrhea rather than bloody diarrhea, and a history of blood in stools is a poor marker for the diagnosis of shigellosis. The diagnostic performance of stool culture is also very low compared to stool PCR for the diagnosis of diarrhea.

Antiseizure drug valproate alters thyroid functions. Magnesium is implicated in the pathogenesis of epilepsy and it may affect the efficacy of valproate and thyroid functions. To study the effect of six months of valproate monotherapy on thyroid functions and serum magnesium levels. To study the association among these levels and the effects of clinicodemographic profile. Children aged three to 12 years presenting with newly diagnosed epilepsy were enrolled. A venous blood sample was collected for estimation of thyroid function test (TFT), magnesium, and valproate levels at onset and after six months of valproate monotherapy. Valproate levels and TFT were analyzed by chemiluminescence and magnesium by colorimetric method. Thyroid stimulating hormone (TSH) increased significantly from 2.14±1.64 µIU/ml at enrollment to 3.64±2.15 µIU/ml at six months (p<0.001), free thyroxine (FT4) decreased significantly (p<0.001). Serum magnesium (Mg) decreased from 2.30±0.29 mg/dl to 1.94±0.28 mg/dl (p<0.001). At six months, eight out of 45 (17.77%) participants had significantly increased mean TSH levels (p=0.008). Serum valproate levels were not associated significantly with TFT and Mg (p<0.05). There was no effect of age, sex, or repeat seizures on the measured parameters. The TFT and Mg levels are altered by six months of valproate monotherapy in children with epilepsy. Hence we suggest monitoring and supplementation if required.

 Epidemiological studies suggest that coronavirus disease 2019 (COVID-19) has a less severe disease course and a more favorable prognosis among children. Childhood vaccines and heterologous immunity have been suggested as reasons for this. Additionally, the structural similarity between the measles, rubella, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus particles may affect immune responses. The objective of this study was to compare COVID-19 antibody titers and disease severity between measles-rubella (MR) vaccinated and unvaccinated children. Additionally, we aimed to evaluate and compare the antibody response in recipients of a single dose and two doses of the MR vaccine.  The study was prospective and comparative and included 90 COVID-19-positive children aged nine months to 12 years. The study was registered under the clinical trials registry of India (CTRI/2021/01/030363). COVID-19 antibody titers were measured at two weeks, six weeks, and 12 weeks, along with the assessment of MR antibody titers. COVID-19 antibody titers and disease severity were compared between MR-vaccinated and MR-unvaccinated children. The comparison of COVID-19 antibody titers between recipients of a single dose and two doses of MR vaccine was also conducted. The results showed significantly higher median COVID-19 antibody titers at all time points during follow-up in the MR-vaccinated group (P<0.05). However, the two groups had no significant difference in the disease severity. Moreover, there was no difference in the antibody titers of MR one dose and two dose recipients. Exposure to even a single dose of MR-containing vaccine enhances the antibody response against COVID-19. However, randomized trials are necessary to further explore this subject.

A descriptive study was conducted with an objective to determine the predictors of mortality among referred neonates and to ascertain their transport characteristics. A total of 300 consecutive neonates who were transferred to the centre were enrolled in the study. Following information were recorded: maternal details, birth details, interventions before transportation, details of transportation and neonatal condition at arrival. Detailed clinical assessment and management was done as per standard neonatal protocols. Birth weight <1 kg (OR 0.04; 95% CI: 0.006-0.295, P<0.01) and transportation time >1 hour (OR 5.58; 95% CI: 1.41-22.01, P=0.01) were found to be significant predictors for mortality among the transported neonate. Transport characteristics reflect road transport with limited utility of ambulances and lack of trained health personal. Hence to conclude, extreme low birth weight and prolonged transportation time were found to be significant predictors of neonatal mortality among the transported neonate.

Objectives To determine the prevalence of celiac disease and its predictors in children with constipation. Methods A hospital-based cross-sectional comparative study was conducted between November, 2018 to April, 2020. Children aged 1–12 years were screened for the presence of constipation as per ROME IV criteria and designated as cases. Age and sex matched healthy children with normal bowel habits were enrolled as comparison group. Participants underwent a detailed history and examination, and were screened for celiac disease by estimating serum anti-tissue transglutaminase IgA antibody levels (tTG-IgA). Upper gastrointestinal endoscopy and duodenal biopsy were performed in all participants who tested positive on screening (serum tTG-IgA ≥ 20 U/mL). The prevalence of celiac disease and associated factors were compared between the two groups. Results A total of 460 children (230 in each group) with mean (SD) age 64.08 (37.12) months were enrolled. Twenty-one (4.6%) children screened positive for anti tTG antibodies, among these 15 (75%) children had biopsy features suggestive of celiac disease (Marsh grade III). Children with constipation had significantly higher prevalence of celiac disease (5.65% vs 0.87%, P = 0.004) compared to children without constipation. Wasting and stunting were significantly associated with celiac disease in constipated children ( P < 0.001). Conclusion Children with constipation and associated growth failure have a high prevalence of celiac disease.