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Fever and pain are among the most common reasons for pediatric consultations, requiring effective and safe management strategies. Mefenamic acid, a well-established member of the nonsteroidal anti-inflammatory drug (NSAID) class, offers distinct advantages due to its unique pharmacological profile, including preferential cyclooxygenase-2 (COX-2) inhibition, E-type prostanoid (EP) receptor blockade, and nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome inhibition. These properties enable it to address both inflammatory and non-inflammatory fevers, providing comprehensive symptom relief. Despite its proven efficacy, the absence of pediatric-specific guidelines and perceived concerns about safety have limited its routine use in pediatric practice. This consensus paper, developed through a structured modified Delphi process involving 21 expert pediatricians across India, aims to address these gaps. The paper evaluates the safety, efficacy, and clinical applications of mefenamic acid, providing evidence-based best-practice recommendations. Highlights include its superior antipyretic efficacy compared to paracetamol and ibuprofen, with preclinical and limited clinical data suggesting potential antiviral activity, and a possible role in the management of febrile seizures and inflammatory conditions. While mefenamic acid demonstrates a favorable safety profile with appropriate use, further research is necessary to strengthen the evidence on long-term safety and expand its therapeutic scope. This consensus provides a comprehensive framework for optimizing the use of mefenamic acid in pediatric practice, ensuring improved patient outcomes. The long-term safety of mefenamic acid in children is still unclear, due to the limited availability of robust, longitudinal safety data. Future research should prioritize well-powered clinical trials, particularly in children aged six months to five years, using standardized outcome measures and long-term follow-up protocols. Addressing these evidence gaps is important to inform safe and effective use in pediatric practice.

Gastric acid-reducing medications (ARMs) such as proton pump inhibitors (PPIs) and histamine type 2 receptor blockers (H2 blockers) are crucial in pediatric care for treating various gastrointestinal conditions. These medications are frequently used to treat erosive esophagitis, peptic ulcer disease, and gastroesophageal reflux disease (GERD). ARMs are essential to the administration of eosinophilic esophagitis and infection. Additionally, literature also supports its use in alleviating drug-induced dyspepsia, preventing stress-related mucosal damage, and lowering the risk of acid aspiration syndrome during anesthesia in critical care settings. Despite the widespread indications of ARMs, PPIs, the most potent acid suppressants, present concerns regarding safety and their inappropriate use in pediatrics. This paper aims to address these gaps by providing comprehensive, practical recommendations for ARM use in pediatric settings. The methodology involved a structured literature review and opinions from 24 pediatric specialists across India, including neonatologists, general pediatricians, pediatric gastroenterologists, a pediatric hepatologist, pediatric nephrologists, a pediatric pulmonologist, and a pediatric intensivist on the appropriate choice of ARM use in various clinical scenarios. They emphasized the benefits of H2 receptor antagonists (H2RAs) over PPIs, particularly in neonates and infants, where H2RAs offer a safer alternative due to their lower risk of adverse effects. The paper outlines the effective application of H2RAs in managing GERD, preventing stress ulcers, and treating drug-induced dyspepsia. It also provides guidelines for appropriate ARM use, stressing the need for careful patient evaluation to minimize the risk of unnecessary ARM use. Pediatricians also provided a view on the use of H2RAs beyond gastrointestinal indications, such as in urticaria, where they show promising clinical application when combined with H1-antihistamines. This paper offers valuable insights and recommendations for optimizing the use of ARM in pediatric practice. By highlighting the advantages of H2RAs and addressing the limitations and risks associated with PPIs, the paper aims to guide clinicians in making informed, evidence-based decisions. The goal is to improve clinical outcomes, promote the rational use of ARM, and enhance the quality of pediatric care.

Background: Infantile colic is characterized by prolonged periods of inconsolable, incessant crying and persistent fussing in an otherwise healthy infant. It is a self-limiting condition, but causes significant stress to mothers. AIM: To observe the role of Lactobacillus reuteriDSM 17938 in reducing crying time in colicky infants in routine clinical practice. Methods: This was a prospective observational multicentric clinic-based study. Each practitioner included approximately 30 infants < 5 months of age with infantile colic who were prescribed L. reuteri DSM 17938 for a period of 21 days. There were four physical consultations and two telephonic consultations. The parents were given a daily diary to record the duration of crying and fussing episodes and a questionnaire was administered during the consultations. Results: A total of 120 infants with a mean age of 56.9 ± 34.2 days were included in this 28-day study. The mean crying time as reported by the parents in the subject diary reduced from 248.2 ± 101.2 min, 95% CI: 229.45, 266.94 at baseline to 45.6 ± 79.1 min 95% CI: 31.02, 60.31 at study end (P < 0.01). The clinical response (defined as reduction of 50% in crying time) was observed in 85% of subjects at study end. The fussiness and parental perception of colic recorded during the consultations were reduced by 66% and 72%, respectively, at study end. The maternal depression scores were reduced to 63% at study end. Conclusion: L. reuteri DSM 17938 was associated with a significant reduction in crying time in colicky infants, and showed improvement in maternal depression.

Justification In view of new developments in vaccinology and the availability of new vaccines, there is a need to revise/review the existing immunization recommendations. Process The Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics (IAP) had a physical meeting on March 25, 2023, at Vaccicon, Kolkata, followed by online meetings to discuss the updates and new recommendations. Opinion of each member was sought on the various recommendations and updates, following which an evidence-based consensus was reached. The contents were finalized on September 8, 2023, during the National Conference of Pediatric - Infectious Diseases (NCPID) at Aurangabad. An online meeting of all members was held on November 15, 2023 and the recommendations were finalized. Objectives To review and revise the IAP immunization recommendations of 2020–21 and issue recommendations on existing and new vaccines. Recommendations The major changes include recommendation of HPV vaccine for boys; a 2-dose schedule of 9vHPV for boys and girls aged 9–14 y; a dose of Td vaccine at 16–18 y; guidance for injectable polio vaccine (IPV) for those patients who are changing from National Immunization Program to IAP schedule.

Abiraterone acetate plus prednisone and enzalutamide are both used for the treatment of metastatic castration-resistant prostate cancer. We aimed to determine the best sequence in which to use both drugs, as well as their second-line efficacy. In this multicentre, randomised, open-label, phase 2, crossover trial done in six cancer centres in British Columbia, Canada, we recruited patients aged 18 years or older with newly-diagnosed metastatic castration-resistant prostate cancer without neuroendocrine differentiation and Eastern Cooperative Oncology Group performance status 2 or less. Patients were randomly assigned (1:1) using a computer-generated random number table to receive either abiraterone acetate 1000 mg orally once daily plus prednisone 5 mg orally twice daily until PSA progression followed by crossover to enzalutamide 160 mg orally once daily (group A), or the opposite sequence (group B). Treatment was not masked to investigators or participants. Primary endpoints were time to second PSA progression and PSA response (≥30% decline from baseline) on second-line therapy, analysed by intention-to-treat in all randomly assigned patients and in patients who crossed over, respectively. The trial is registered with ClinicalTrials.gov, NCT02125357. Between Oct 21, 2014, and Dec 13, 2016, 202 patients were enrolled and randomly assigned to either group A (n=101) or group B (n=101). At the time of data cutoff, 73 (72%) patients in group A and 75 (74%) patients in group B had crossed over. Time to second PSA progression was longer in group A than in group B (median 19·3 months [95% CI 16·0–30·5] vs 15·2 months [95% CI 11·9–19·8] months; hazard ratio 0·66, 95% CI 0·45–0·97, p=0·036), at a median follow-up of 22·8 months (IQR 10·3–33·4). PSA responses to second-line therapy were seen in 26 (36%) of 73 patients for enzalutamide and three (4%) of 75 for abiraterone (χ2 p<0·0001). The most common grade 3–4 adverse events throughout the trial were hypertension (27 [27%] of 101 patients in group A vs 18 [18%] of 101 patients in group B) and fatigue (six [10%] vs four [4%]). Serious adverse events were reported in 15 (15%) of 101 patients in group A and 20 (20%) of 101 patients in group B. There were no treatment-related deaths. Enzalutamide showed activity as a second-line novel androgen receptor pathway inhibitor, whereas abiraterone acetate did not, leading to a longer time to second PSA progression for the sequence of abiraterone followed by enzalutamide than with the opposite treatment sequence. Our data suggest that using a sequencing strategy of abiraterone acetate followed by enzalutamide provides the greatest clinical benefit. Canadian Cancer Society Research Institute, Prostate Cancer Canada, Movember Foundation, Prostate Cancer Foundation, Terry Fox New Frontiers Program, BC Cancer Foundation, Jane and Aatos Erkko Foundation, Janssen, and Astellas.

Prostate cancer frequently goes undetected at its early stage and it’s a major concern in the male population. To address this challenge, we provide a new approach based on electrochemical biosensing for the efficient detection of prostate cancer using PCA3 DNA biomarkers. Screen-printed paper electrodes were fabricated and modified with gold graphene quantum dots (Au-GQD), which were synthesized by an established domestic microwave method. Au-GQD, with their unique properties, find applications in various fields, including sensing, biomedicine, and catalysis, due to their enhanced catalytic activity, biocompatibility, and optical properties. Further, a PCA3 probe DNA was immobilized and characterized by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). The developed sensing platform exhibits an excellent limit of detection (LoD) of 1.37 fM and 1.41 fM by CV and EIS, respectively. The limit of quantification (LoQ) is 4.08 and 4.27 by CV and EIS, respectively, within a linear range of detection (100 nM–100 fM). The stability of the developed sensor was found to be around 30 days with a hybridization time of 1 min. The proposed sensor effectively recognized PCA3 biomarkers in real urine amidst various interferents. In the future, the sensing platform could improve the prognosis of the disease by enabling early-stage identification.

•Patients with rheumatic heart disease (RHD) have a high risk of mortality due to heart failure (HF).•There are no proven treatments for improving clinical outcomes in these patients.•The Digoxin in RHD is the first RCT to evaluate the impact of digoxin on mortality and HF in RHD. Rheumatic heart disease (RHD), is a public health problem in low and middle-income countries. It causes high morbidity and mortality due to heart failure (HF), but there are no randomized trials of HF-treatments in these patients. Digoxin is an inexpensive drug that is widely used in RHD despite a lack of data on its effect on clinical outcomes. The Digoxin in RHD (Dig-RHD) trial will evaluate the impact of the drug on clinical outcomes in patients with RHD. The Dig-RHD trial is an investigator-initiated multicenter, pragmatic, randomized placebo-controlled, parallel-arm, superiority trial. Symptomatic adult patients with RHD were randomized to receive oral digoxin or matching placebo on a background of usual care. The primary outcome is a composite of all-cause death, new-onset or worsening HF. Key secondary outcomes are, all-cause death, HF-related death, hospitalization for HF, sudden death, and self-reported quality of life. Patients were enrolled at 12 academic medical centers in India, beginning in February 2022. Enrolment of 1769 patients was completed in August 2024. One interim review of the data by the independent Data Safety Monitoring Board, after half the primary outcome events had accrued, indicated no safety signals. The last follow-up visits are scheduled to complete in December 2025. Dig-RHD is the first randomized trial of digoxin in RHD powered for clinical outcomes, and the results will have major implications for the routine management of patients with RHD. (Clinical trial registration: CTRI/2021/04/032858)

Study of 35 days was conducted to evaluate citric acid (CA) as an additive in poultry broiler feed with lower mineral content of calcium (Ca) and total phosphorus (TP) in commercial broiler poultry birds for its effect on growth, nutrient utilization, carcass characteristics, and economics. Vancobb-400 strain day old broiler chicks were divided into four main treatment groups T0, T1, T2, and T3. Treatment groups were further divided into eight replicates with ten chicks in each. T0 served as control, given standard corn-soy flakes-based ration (Pre-starter %: Crude protein (CP)-23, Ca-1.00, TP-0.70; Starter %: CP-22, Ca-1.10, TP-0.72, and Finisher %: CP-20, Ca-0.99, TP-0.70). Treatment T1 served as positive control with added 0.5% CA (Pre-starter %: CP-23, Ca-1.00, TP-0.70; Starter %: CP-22, Ca-1.10, TP-0.72 and Finisher %: CP-20, Ca-0.99, TP-0.70). Treatment T2 was given feed containing 0.5% CA with low Ca and TP content (Pre-starter %: CP-23, Ca-0.90, TP-0.66; Starter %: CP-22, Ca-0.99, TP-0.71 and Finisher %: CP-20, Ca-0.90, TP-0.69), whereas treatment T3 was given feed containing 0.5% CA with moderately low Ca and TP content (Pre-starter %: CP-23, Ca-0.80, TP-0.65; Starter %: CP-22, Ca-0.88, TP-0.70 and Finisher %: CP-20, Ca-0.79, TP-0.68). Birds offered moderately low Ca and TP with 0.5% CA addition, exhibited higher growth rate (P < 0.05), better nutrient utilization with positive influence on dressing percentage and forequarters weight. Economics of broiler feeding revealed that 0.5% CA supplementation fetched highest gross return above feed cost in broiler birds offered feed with moderately low Ca and TP content whereas lowest profit was recorded in feed with low content of Ca and TP. In conclusion, supplementation of 0.5% CA in feed with low and moderately low Ca and TP content positively influenced overall growth, and carcass characteristics. Economics of broiler feeding with moderately low Ca and TP content revealed highest profit with CA (0.5%) supplementation.