Indian Pediatrics
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Item Risk Factors for Procedural Complications of Pediatric Flexible Bronchoscopy: Experience From a Tertiary Care Centre in Northern India(The Indian Academy of Pediatrics, 2024-09) Manoharan, Aravindhan; Jat, Kana Ram; Dhochak, Nitin; Lodha, Rakesh; Sankar, JhumaWe analyzed the records of 869 children who underwent flexible bronchoscopy. We found procedural complications in 6.7% (n = 59), with severe events in 3.2% (n = 28). Age < 1 y, recurrent respiratory papillomatosis, and finding lower airway malacia on bronchoscopy were identified as independent risk factors for developing complications with adjusted odds ratio (95% CI) of 2.6 (1.3, 4.9); P = 0.004; 5.4 (1.7, 17.6); P = 0.005 and 2.1 (1.1, 4.0); P = 0.031, respectively.Item Normative Values of Cerebral Blood Flow Velocities in Very Low Birth Weight Neonates During First 28 Days of Life(The Indian Academy of Pediatrics, 2024-09) Thakur, Anup; Jain, Parul; Modi, Manoj; Singh, Anita; Kansal, Bharat; Kler, NeelamObjective: To determine the normative values of cerebral blood flow (CBF) velocities in very low birth weight (VLBW) neonates during the first 28 days of life. Methods: In this prospective observational study, doppler assessment of CBF velocities was performed from the anterior cerebral artery (ACA), middle cerebral artery (MCA) and basilar artery (BA) at 2-8 hours, 24 hours, day 3, 7, 14 and 28 of life. Neonates with gross congenital malformations, those requiring extensive resuscitation at birth, mechanical ventilation with mean airway pressure >12 mbar, requiring inotropes, or those who developed intraventricular hemorrhage (grade II or more) were excluded. Results: A total of 103 VLBW neonates were enrolled, in whom 1178 doppler measurements were recorded. The mean (SD) peak systolic velocity, end diastolic velocity and mean velocity (cm/s) in ACA increased from 26.53 (8.56) to 51.35 (9.36), 9.22 (2.91) to 13.9 (3.24) and 17.75 (3.97) to 25.84 (3.27) respectively from 2 to 8 hours to day 28 of life. In MCA and BA also, CBF velocities increased with post-natal age. Conclusion: We report normative data of CBF velocities in VLBW neonates in first 28 days of life.Item Comparative Efficacy of Interventions for Analgesia During Heel Prick in Newborn Infants - A Systematic Review and Network Meta-Analysis(The Indian Academy of Pediatrics, 2024-09) Abiramalatha, Thangaraj; Ramaswamy, Viraraghavan Vadakkencherry; Anne, Rajendra Prasad; Amuji, Nalina; Thinesh, Jayaraman; Venkateshwarlu, Vardhelli; Rao, Vadije Praveen; Shaik, Nasreen Banu; Pullattayil, Abdul Kareem; Balachander, Bharathi; Sivanandhan, Sindhu; Kumar, Jogender; Gupta, Neeraj; Chawla, Deepak; Kumar, Praveen; Rao, SumanContext: Heel prick is one among the common painful procedures in neonates. We performed a systematic review and network meta- analysis (NMA) to compare the efficacy of different interventions for analgesia during heel prick in neonates. Evidence acquisition: Medline, Cochrane, Embase and CINAHL databases were searched from inception until February 2023. Randomized and quasi-randomized trials that evaluated different pharmacological and non-pharmacological interventions for analgesia during heel prick for neonates were included. Data from the included trials were extracted in duplicate. A NMA with a frequentist random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. We adhered to the PRISMA-NMA guidelines. Results: One-hundred-and-three trials comparing 51 different analgesic measures were included. Among the 38 interventions, for pain “during” heel prick, non-nutritive suckling (NNS) plus sucrose [SMD -3.15 (-2.62, -3.69)], followed by breastfeeding, glucose, expressed breast milk (EBM), sucrose, NNS and touch massage, had a high certainty of evidence (CoE) to reduce pain scores when compared to no intervention. Among the 23 interventions for pain at 30 seconds after heel-prick, moderate CoE was noted for facilitated tucking plus NNS plus music, glucose, NNS plus sucrose, sucrose plus swaddling, mother holding, EBM, sucrose and NNS. Conclusions: Oral sucrose 2 minutes before combined with NNS during the procedure, was the best intervention for reducing pain during heel prick. It also effectively reduced pain scores 30 seconds and 1 minute after the procedure. Other interventions with moderate to high CoE for a significant reduction in pain during and at 30 seconds after heel prick are oral sucrose, oral glucose, EBM and NNS. All these are low-cost and feasible interventions for most of the settings.Item Effect of Perioperative Active Warming on Postoperative Pain and Shivering in Preschool Pediatric Patients: A Randomized Controlled Trial(The Indian Academy of Pediatrics, 2024-09) Çiftci, Cansu; Kara, Inci; Büyükcavlak, Mustafa; Aslanlar, EmineObjective: To evaluate the effects of perioperative active warming on the core body temperature, postoperative pain, shivering and agitation in pediatric patients. Method: Children aged 2-6 years undergoing elective surgery, including orthopedic soft tissue surgeries, ear nose throat surgical procedures and general surgical interventions, all performed under general anesthesia, were randomized to receive either active warming (using the forced-air warming gowns, Bair Hugger, in the pre- and postoperative period, and a carbon fiber blanket in intraoperative period; Group A), or conventional warming using green blankets pre-and post-operatively and a carbon fiber blanket intraoperatively (Group B). Children undergoing emergency surgery, surgeries involving major body cavities (abdominal, thoracic, cranial surgery), or those with endocrinological pathologies, or baseline fever, were excluded. Core body temperature (t-core), postoperative pain, shivering and agitation scores were compared between the two groups. Results: Seventy children were included, with 35 in each group. No significant difference was observed between the groups in t-core values at 0 and 15 minutes preoperatively (P > 0.05). However, the value at 30 minutes preoperatively and all subsequent t-core values were higher in Group A (P < 0.001). Postoperative pain and shivering scores at 0 minutes, 30 minutes and 6 hours were significantly lower in Group A compared to Group B. No significant difference was observed in agitation scores in the immediate postoperative period, although, Group A showed reduced agitation at 30 minutes (P = 0.03). Conclusion: Active warming in the pre- and post-operative period significantly maintained higher core temperatures and reduced postoperative pain and shivering in children undergoing surgery compared to those receiving conventional passive warming measures in the pre- and post-operative period.Item Monocytic Human Leukocyte Antigen-DR Expression Levels to Predict Outcome in Children With Severe Sepsis(The Indian Academy of Pediatrics, 2024-09) Thangavel, Nanmaaran Periyannan; Parameswaran, Narayanan; Manivannan, Prabhu; Ramamoorthy, Jaikumar GovindaswamyObjectives: To assess the association between monocytic Human Leukocyte Antigen-DR (mHLA-DR) expression and outcome in children with severe sepsis. Methods: Consecutive children, aged 29 days to 15 years, who were admitted with severe sepsis or septic shock in the pediatric intensive care unit (PICU) were enrolled. mHLA-DR expression [antigen bound per cell (ABC)] was assessed on two time points: between 72 to 120 hours (P1) and 121 to 168 hours (P2), of stay in PICU and the difference between the two was calculated as delta mHLA-DR. Outcomes were noted for survival, mortality and secondary infection during the hospital stay. Results: Forty-seven children with median (IQR) age 24 (10, 96) months and a median (IQR) duration of illness of 3 (3, 5) days, were enrolled consecutively. Pediatric Logistic Organ Dysfunction (PELOD) score >10 was observed in 63.8% children. 18 children succumbed. The median mHLA-DR levels (ABC) at P1 were significantly higher in children who survived as compared with those who expired (7409 vs. 2509, P = 0.004). Similarly, the median mHLA-DR levels (ABC) at P2 were higher in those who survived than the expired group (14728 vs. 2085, P = 0.001). The median delta mHLA-DR levels (ABC) were 4574 and 309 for the survived and expired group, respectively (P = 0.012). mHLA-DR at P1 (P = 0.004), mHLA-DR at P2 (P = 0.001) and delta mHLA-DR (P = 0.012) was significantly associated with mortality but not associated with secondary infection. A negative correlation was observed between PELOD score and mHLA-DR at P1 (r = -0.25, P = 0.46), at P2 (r = -0.425, P = 0.018) and delta mHLA-DR (r = -0.27, P = 0.41). The area under curve (95%CI) of mHLA-DR expression (ABC) at P2 for a cutoff of < 6631 was 0.966 (0.907, 1.0) to predict mortality in severe sepsis. Conclusion: mHLA-DR levels were significantly lower in children who succumbed than those who survived at both time points. mHLA-DR levels can be a useful biomarker to diagnose immune-paralysed state.Item Clinical Profile of Children with Adenovirus Infection A Hospital-based Observational Study(The Indian Academy of Pediatrics, 2024-09) Varadarajan, Poovazhagi; Subramanian, Ramesh; Srividya, Gomathy; Rangabashyam, Nisha; Subramani, SeenivasanObjectives: To describe the clinical profile and determine the factors affecting mortality of children admitted with adenovirus infection in a tertiary care centre in South India. Methods: In this observational study, respiratory specimens (nasopharyngeal swab / endotracheal aspirate) were collected from all hospitalized pediatric patients presenting with fever, cough, breathlessness, gastrointestinal symptoms, unexplained encephalopathy or multisystem involvement, between February 2023 and August 2023. Infection with adenovirus was determined by viral pathogen panel based on polymerase chain reaction (PCR) technique. Those referred from elsewhere with positive adenovirus report but non- availability of treatment details and children with coinfections were excluded. The clinical and laboratory profile of children with adenovirus infection were collected and predictors for in-hospital mortality were determined by logistic regression analysis. Results: Out of 527 children who were screened, 130 children with a median (IQR) age of 18 (10, 48) months, had adenovirus infection. 84.5% were aged below 5 years. 62 (41.33%) children required intensive care admission. Abnormal chest radiograph, multisystem involvement and non-respiratory illness were present in 90 (69.2%), 97 (74.62%) and 26 (20%) children. Complications included acute respiratory distress syndrome (n = 8), hemophagocytic lymphohistiocytosis (n = 7), left ventricular dysfunction (n = 11), acute liver cell failure (n = 7), acute kidney injury (n = 13), and multiorgan dysfunction (n = 16). Overall mortality was 13%. Acute kidney injury, left ventricular dysfunction and pancytopenia were identified as factors that may be significantly associated with death. Conclusions: Multisystem involvement was observed in majority of children presenting with adenovirus infection. Non-respiratory presentation is seen in a fifth of children with adenovirus infection.Item Over Investigation: An Ethical Debate(The Indian Academy of Pediatrics, 2024-08) Dsouza, Nikith Austin; HC, Girish; Kore, Mahesh; Amdekar, Yeshwant Krishna; Kinikar, Aarti AvinashOver investigations contribute to escalating health costs driven by multiple factors including physician decisions, patient requests, information overload, technological advances, marketing, hospital management policies, insurance requirements and defensive practices. The reconciliation between knowledge and clinical wisdom while dealing with uncertainties in medicine is the primary way forward through this ethical maze. A case scenario illustrates what pediatricians need to reflect upon while facing decisions on rational investigations to maximize beneficence while being aware of economics of healthcare delivery.Item Splenic Dysfunction in Children With Sickle Cell Disease: A Single Centre Experience From Central India(The Indian Academy of Pediatrics, 2024-09) Johns, Juliet; Goel, Anil Kumar; Jondhale, Sunil; Venkatesan, Dilip Kumar; Ravina, Mudalsha; Shah, Seema; Syal, SimranObjective: To assess the prevalence and predictors of splenic dysfunction in children with sickle cell disease (SCD). Methods: A cross-sectional study was conducted between June 2019 and December 2020 where children aged 1 to 15 years of age with SCD were screened for splenic dysfunction. Children who were splenectomised, those with other diseases known to affect splenic function like congenital malformations, immunodeficiencies, and chronic diseases like tuberculosis, nephrotic syndrome, diabetes mellitus, chronic liver disease, celiac disease or malignancy were excluded. Splenic size was assessed by clinical examination and ultrasonography. Splenic dysfunction was assessed by Technetium-99m (99mTc) labeled autologous RBCs and by the presence of Howell Jolly bodies in the peripheral smear. Laboratory and clinical predictors of splenic dysfunction were assessed by multiple logistic regression. Results: We evaluated 66 children with SCD with a mean (SD) age of 7.41 (3.3) years. Impaired and absent splenic function as assessed by 99mTc scintigraphy was found in 13 (19.7%), and 3 (4.6%) children, respectively. Howell Jolly bodies in peripheral smear were found in 5 (7.5%) children; 3 of them had abnormal uptake on scintigraphy; all five had splenomegaly. Age > 5 years, > 4 episodes of vaso-occlusive crisis (VOC), > 3 hospitalization events in the past, > 5 blood transfusions, children not receiving hydroxyurea, reticulocyte count > 4%, and HbS > 70% were independent predictors of splenic dysfunction. Conclusion: The prevalence of splenic dysfunction in children with SCD in Central India is lower than that reported from the West. The decision to start antibiotic prophylaxis can be individualized in these children.Item Hepcidin Levels in Response to Oral Iron Therapy in Children with Anemia(The Indian Academy of Pediatrics, 2024-09) Singh, Tanya; Arora, Shilpa Khanna; Goyal, Parul; Hemal, AlokObjective: To estimate the change in serum hepcidin levels and its correlation with change in hemoglobin (Hb) level during the initial two weeks of oral iron therapy in children with iron deficiency anemia (IDA). Methods: A prospective observational study was carried out in children aged 2-12 years with IDA. Children with severe anemia (Hb < 7 g/dL), those with fever, infections, history of oral iron intake or blood transfusion within the preceding three months, or intolerant to oral iron were excluded. Serum hepcidin-25 was assessed using ELISA-based kits on day 0 (pre-therapy), after 24 hours and 14 days of starting oral iron therapy. Results: Out of 78 children who were screened, we included 64 children with IDA with a mean (SD) hemoglobin of 8.81 (1.22) g/dL. The baseline mean (SD) serum hepcidin-25 levels [7.81 (4.88) ng/mL] increased significantly to 8.38 (4.96) ng/mL at 24 hours and 9.51 (5.2) ng/mL on day 14 of oral iron therapy (P < 0.001). 63 children showed a good response to oral iron therapy. No significant correlation was observed between baseline hepcidin levels with change in hemoglobin on day 1 (r = -0.10, P = 0.40) or day 14 (r = - 0.10, P = 0.43) of therapy. Conclusion: Serum hepcidin levels rise significantly as early as 24 hours after starting oral iron therapy and should be explored to assess response to oral iron therapy in children with anemia.Item Understanding and Expanding the Role of Pediatricians in Child Adoption in the Backdrop of Emerging Regulations in India: A Contemporary Review(The Indian Academy of Pediatrics, 2024-09) Bharti, Bhavneet; Malhi, PrahbhjotAdoption provides a unique opportunity to establish stable family relationships and enhance the social safety net. In India, adoptions are governed by the Hindu Adoption and Maintenance Act, 1956, and the Juvenile Justice (Care and Protection of Children) Act, 2015, each with distinct eligibility criteria. Currently, approximately 33,870 Indian couples are registered as prospective adoptive parents (PAPs), and this number is rising. The Central Adoption Resource Authority (CARA) website lists 2,140 children available for adoption, with 731 being categorized as normal and 1,409 as special needs. CARA, under the Ministry of Women and Child Development, oversees both domestic and international adoptions of legally free orphaned, abandoned, and surrendered children. The scope of adoption has expanded from primarily young infants to include older children, children with special needs, and foster care, in line with the National Child Policy. Pediatricians play a crucial role in the adoption process, understanding medical aspects within the legislative framework and acting in the child’s best interests. This involves collaborating with multiple stakeholders, conducting comprehensive pre-adoption medical examinations, and providing ongoing medical and behavioral support post-adoption. This review emphasizes recent changes in adoption practices in India and highlights the evolving role of pediatricians as champions for these children and their adoptive families.Item Congenital Diaphragmatic Hernia at a Non-ECMO Center in Jordan(The Indian Academy of Pediatrics, 2024-01) Al-Iede, Montaha; Badran, Eman; Al-Taher, Raed; Al-Ammouri, Iyad; Ashour, Omar; Ghazi, Tara; Zahra, Mahmoud Abu; Alhanbali, Abdulrahman; Qutishat, Hebah; Al-Zayadneh, Enas; Al-Lawama, ManarObjectives: We studied the clinical characteristics and outcomes of neonates with congenital diaphragmatic hernia (CDH) admitted to a non-extracorporeal membrane oxygenation (ECMO) center. Methods: A retrospective chart review of neonates with CDH admitted to a University Hospital, in Amman, Jordan, between 2005 and 2019. Demographic characteristics and their management details were extracted and factors associated with survival were analyzed. Results: A total of 28 neonates born with CDH were included; their survival rate was 39.3%. Onset of respiratory distress, pre-operative ventilation, and length of hospitalization were significantly associated with mortality. Survival after surgery was significantly associated with a higher gestational age and a longer hospital stay. Conclusion: Our study showed a high mortality rate for CDH patients. Decreasing the health inequity and improved clinical interventions could improve outcomes.Item Learning Agreements for Teaching Communication Skills to Postgraduate Students in Pediatrics(The Indian Academy of Pediatrics, 2024-08) Gupta, Priyanka; Chandra, JagdishThis study evaluated learning agreements (LA) as a teaching-learning tool when administered to eleven postgraduate students in Pediatrics, with each learner moving at an individual pace. After LA, the median (IQR) Gap-Kalamazoo Communication Skills Assessment Score (GKCSAC) of students increased from 14 (11, 14) to 27 (27, 33); P = 0.003. The scores on all the nine distinct components of the GKCSAC exhibited a statistically significant increase (P < 0.01). Additionally, all students perceived themselves as more competent and confident in their communication skills.Item Development and Validation of E-portfolio for Undergraduate Medical Students in Pediatrics(The Indian Academy of Pediatrics, 2024-08) Khound, Murchana; Das, Bipul Kumar; Kaushik, Jaya ShankarObjective: To develop and validate e-portfolios for undergraduate medical students in the subject of Pediatrics. Methods: A descriptive study was conducted among the second year medical undergraduate students. A core committee validated the e-portfolio created on the Google platform. The students were sensitized, trained on the platform, and encouraged to innovate by designing the e-portfolios themselves, and record their clinical experiences under the mentorship of faculty. The feedback was collected using a validated student and faculty questionnaire with closed and open ended questions. Satisfaction index was calculated based on the responses to closed ended questions using Likert scale. Open ended questions were analyzed using thematic approach. Results: The study enrolled 34 students and 12 faculty members. Students recorded a high satisfaction index on their experience to be interesting (97%), well structured (85%), user-friendly (82%), and on being able to archive their clinical experiences (100%). Faculty members recorded a high satisfaction index (100%) in students’ ability to record their clinical knowledge and reflect on their learning and innovation; all were motivated to use e-portfolios in their specialty. The thematic analysis highlighted student satisfaction with accessibility and organized record-keeping, while faculty praised e-portfolios for nurturing creativity and aiding memory retention. Concerns included resource intensiveness, design prioritization, and privacy issues. Conclusion: E-portfolios are rated as promising tools to record comprehensive clinical experience in pediatric by undergraduate students and faculty. Addressing identified challenges will further optimize their adoption in medical curricula, facilitating informed integration decisions.Item Reflection: A Tool for Learning and Assessment in Competency- Based Curriculum(The Indian Academy of Pediatrics, 2024-08) Shah, Nilima; Gupta, Piyush; Singh, TejinderReflection helps us learn from experiences, build good doctor-patient relationships and a professional identity. It also holds an important place in the competency-based curriculum as a tool for assessment, especially for competencies that cannot be assessed by conventional means. To embed reflection in the curriculum, we need to explicitly teach how to reflect, make it a habit by integrating it into the various curricular activities, assess reflections formatively, and provide an environment that allows guided reflections, taking care of ethical and emotional aspects. In the Indian scenario, reflection is taught in faculty development programs and as a part of short- term implementation projects. A more robust and nuanced effort is required to make reflection an inseparable component of the curriculum that will empower the graduates to be competent in the true sense.Item Basal and FSH-stimulated Inhibin B in Precocious Puberty(The Indian Academy of Pediatrics, 2024-08) Chaudhary, Shakun; Walia, Rama; Bhansali, Anil; Dayal, Devi; Sachdeva, Naresh; Singh, Tulika; Bhadada, Sanjay KumarObjective: To evaluate the role of basal and follicle-stimulating hormone (FSH)-stimulated inhibin B in differentiating premature thelarche from gonadotropin-dependent precocious puberty (GDPP). Method: This was a prospective interventional study. Basal and FSH-stimulated inhibin B levels were estimated in girls presenting with thelarche < 8 years age (n = 10), healthy girls with normal pubertal development (pubertal control) (n = 8) and healthy prepubertal girls (prepubertal control) (n = 7). Girls with early puberty were classified as premature thelarche or GDPP based on GnRH agonist stimulation test. Results: Median (IQR) basal inhibin B levels (pg/mL) in premature thelarche was 5.42 (2.91, 30.58) and FSH-stimulated inhibin B was 236.72 (111.53, 4431.73) (P = 0.043). Median (IQR) basal inhibin B in GDPP was 64.11 (24.96, 792.45) pg/mL and FSH- stimulated inhibin B was 833.66 (500.11-1266.18) pg/mL (P = 0.043). Basal inhibin B was discriminatory between GDPP and premature thelarche (P = 0.032). Median (IQR) basal inhibin B in prepubertal and pubertal controls was 20.36 (9.61, 29.12) and 75.48 (58.55, 165.55) pg/mL, respectively. Conclusion: Basal inhibin B is useful in differentiation of premature thelarche from GDPP while the role of FSH-stimulated inhibin B needs to be further explored in large sample size.Item Iron Supplementation in Children with Attention Deficit Hyperactivity Disorder: A Single Centre Study(The Indian Academy of Pediatrics, 2024-08) Kumar, Varun; Juneja, Monica; Kaushik, Smita; Gupta, ArpitaObjective: To assess the effect of iron supplementation on symptoms in children with attention deficit hyperactivity disease (ADHD). Method: A prospective single arm intervention study was conducted on children aged 4-12 years, newly diagnosed with ADHD, attending the child development clinic in a tertiary centre in Northern India. A baseline hemogram and serum ferritin levels were assessed in all children. ADHD symptom severity was assessed with age-appropriate neuropsychometric questionnaires, and objective tests of attention at baseline and after six weeks of oral iron therapy. Results: Out of 32 participants, 23 were found to be ferritin sufficient (serum ferritin > 30 ng/mL) at enrolment. There was no difference in the median scores of neuropsychometric tests at the baseline of ferritin sufficient and ferritin deficient children. A statistically significant change in median scores of inattention and hyperactivity subscale on Conner’s Rating Scale (P = 0.036) as well as significant improvement on tests of attention; Children’s Color Trails Test (CCTT) (P = 0.006) were observed after six weeks of iron therapy in all children. Conclusion: The study showed promising results of iron supplementation in the treatment of ADHD symptoms in children.Item Global Initiative for Asthma Guidelines 2024: An Update(The Indian Academy of Pediatrics, 2024-08) Rajvanshi, Nikhil; Kumar, Prawin; Goyal, Jagdish PrasadAsthma poses significant challenges in pediatric care, particularly in resource-limited settings. The Global Initiative for Asthma (GINA) 2024 guidelines represents a crucial step forward in addressing these challenges. This review critically evaluates the guidelines, focusing on their implementation and impact in developing countries like India. There have been certain key updates including a revised diagnostic flow chart and emphasis on alternative tools like peak flow meters. Challenges related to bronchodilator reversibility and interpreting FEV1/FVC are also explored. The article further addresses the implications of bronchial provocation testing in pediatric asthma. Detailed insights into cough-variant asthma highlight its rising recognition and management strategies. The GINA 2024 guidelines reflect updated criteria for commencing a particular step of therapy, aiming to optimize management and outcomes in pediatric asthma care. The guidelines have updated the role of allergen immunotherapy in pediatric asthma based on emerging evidence of efficacy and safety. Overall, the GINA 2024 guidelines offer a realistic approach to pediatric asthma care, with a potential for broader applications pending further research and adaptation.Item Procalcitonin as Point-of-Care Testing Modality for the Diagnosis of Pneumonia in Children With Influenza-like Illness(The Indian Academy of Pediatrics, 2024-01) Hernández-Bou, Susanna; Trenchs, Victoria; Guirado, Cristina; Castrillón, Ignacio; Luaces, CarlesObjective: To evaluate the usefulness of procalcitonin (PCT) as a point-of-care testing to screen for radiographic pneumonia among children with influenza-like illness (ILI) and prolonged fever. Methods: A prospective cohort study conducted at the pediatric emergency department of a tertiary hospital. Point-of-care testing for PCT was determined for 185 children aged 3 months to < 18 years with ILI and fever lasting > 4 days seen during the flu season in 2020. A chest radiograph (CXR) was performed for patients with PCT > 0.5 ng/mL. Results: PCT value was > 0.5 ng/mL in 46 (24.9%) patients; a CXR was ordered in all cases except one and 14 (31.1%) of them had radiographic pneumonia (all had a PCT value > 0.7 ng/mL). Among the 139 (75.1%) patients with a PCT value ? 0.5 ng/mL, 137 (98.6%) were managed in the outpatient with symptomatic treatment; the remaining two cases warranted a CXR which was unremarkable in both. At evolution, no radiographic pneumonia was diagnosted in any of them. Conclusion: PCT is a useful tool for point-of-care testing in patients with ILI and fever > 4 days to guide the indication for CXR to rule out radiographic pneumonia and helps in avoiding unnecessary radiation exposure.Item Peer-Assisted Learning Versus Faculty-Led Teaching of Interviewing Skills: A Comparative Study(The Indian Academy of Pediatrics, 2024-08) Abdulrahman, Sameerah; Alkhateeb, Nazdar Ezzaddin; Othman, Samir MahmoodObjectives: To assess the impact of peer-assisted learning (PAL) on students’ proficiency in patient interviewing skills and to explore medical students’ perception on peer tutors in educational setting. Methods: A cross-sectional observational study was performed in the College of Medicine, Hawler Medical University, Erbil, Iraq, between September 2021 and November 2021. The participants included second year medical students who were attending the Integrated Basic Sciences (IBS) module. The peer tutors were chosen from a group of sixth year medical students who had completed an intensive 18-hour communication skills course. The summative video assessment marks of study participants and their perceptions on the process were compared between the faculty-led group and the peer-assisted learning (PAL) group. Results: Peer-assisted learning group (n = 83) had significantly higher mean (SD) scores compared to those in the faculty-led group (n = 92), [74.6 (8.1) vs 70.4 (7.1), P < 0.001]. Encouraging feedback was received from students regarding the PAL sessions with the most positive feedback regarding the ease in asking questions. Conclusion: Peer-assisted learning improved students’ performance in patient interviewing skills and fostered positive perceptions of the learning experience.Item Mitochondrial Dysfunction, Oxidative Stress and Premature Aging in Children With Nutritional Rickets(The Indian Academy of Pediatrics, 2024-08) Lakshmi, Raaj; Aaradhana; Mehndiratta, Mohit; Shah, Dheeraj; Gupta, PiyushObjective: To assess the mitochondrial dysfunction, oxidative stress and premature aging in children with nutritional rickets. Methods: This cross-sectional study enrolled children aged 6 months - 5 years with nutritional rickets attending a tertiary care hospital between January 2021 and August 2022. Mitochondrial dysfunction, oxidative stress and premature aging were assessed by measuring the mitochondrial DNA (mtDNA) content, total antioxidant status (TAOS) and telomere length (TL) in 40 children with nutritional rickets and 40 age- and sex- matched healthy children without rickets (controls). Results: The median (IQR) mtDNA content was significantly higher in children with rickets as compared to controls [152.27 (111.83, 218.66) vs 93.7 (72.5, 134.14); P < 0.001], implying mitochondrial dysfunction attributed to increased mitochondrial biogenesis in children with rickets. The median (IQR) TAOS ( mM Trolox equiv.) was significantly lower in children with rickets than controls [4.54 (3.93, 5.73) vs 7.86 (5.09, 9.58); P < 0.001)]. The median (IQR) TL in cases was significantly longer in children with rickets compared to controls [417.31 (111.83,218.66) vs 93.7 (72.5,134.14); P < 0.001] implying that children with rickets do not have premature aging. Conclusion: Children with rickets have high oxidative stress and mitochondrial dysfunction but no evidence of premature aging.