Indian pediatrics最新文献

Context: Pediatric feeding disorder (PFD) is characterized by age-inappropriate oral intake associated with dysfunction in feeding skills, medical, nutritional, or psychosocial domains. Children with developmental disabilities (DD), such as cerebral palsy (CP), often meet the criteria for PFD due to underlying neurological, motor, and sensory impairments, compounded by psychosocial stressors. These challenges contribute to undernutrition, poor growth, and adverse developmental outcomes, but remain undiagnosed. This review evaluates the burden and spectrum of feeding problems in children with developmental disabilities and aims to bridge gaps in clinical awareness, assessment, and intervention. Evidence acquisition A literature search was conducted using PubMed, Scopus, and Google Scholar for studies published between January 2015 and January 2025. Keywords included: "children" OR "childhood" AND "feeding problems" OR "feeding disorders" OR "malnutrition" OR "dysphagia" OR "drooling" OR "food aversion" OR "oral sensory processing disorders" AND "cerebral palsy" OR "developmental disabilities" OR "neurological impairment."

Results: Forty studies were included wherein feeding disorders were observed in 33-80% of these children. Physical anomalies, swallowing dysfunction, restricted diets, and socio-cultural factors were observed to be responsible for feeding difficulties which ranged from dysphagia, swallowing dysfunction, gastroesophageal reflux disease, constipation, sensory issues and food aversions. A systematic approach-objective assessment of nutritional status, calculating dietary needs, evaluating safety and efficiency of oral feeding, optimizing intake, considering enteral nutrition when indicated-can improve outcomes.

Conclusion: Feeding disorders are a significant yet modifiable source of morbidity in children with DD. Early recognition and multidisciplinary, evidence-based approach are critical to improving their quality of life.

Objectives: To establish age-specific normative reference values for mean testicular volume and serum testosterone levels in apparently healthy north Indian boys aged 5-20 years (with centile curves extended to 4-20 years), and to evaluate their associations with anthropometric, biochemical, and pubertal indicators.

Methods: In this observational cross sectional study, apparently healthy boys aged 5-20 years were recruited from schools and community centers in northern India (2019-2023). Testicular volume was measured using Prader's orchidometer, and serum testosterone via chemiluminescence immunoassay. Secondary measures included anthropometry, biochemical markers [luteinizing hormone (LH), follicle-stimulating hormone (FSH), vitamin D, albumin], and body composition by bioelectrical impedance analysis (BIA).

Results: In a total of 1,022 boys, both testicular volume and serum testosterone levels exhibited significant age-related increases (most marked progression between 11 and 15 years. After adjusting for age, higher testicular volume was significantly associated with increased BMI, LH, FSH, muscle mass, and bone mass (P < 0.001), while no significant association was found with vitamin D or albumin levels. Age-specific centile curves for both parameters were generated using the LMS method.

Conclusions: This large-scale study provides age-specific normative reference values for testicular volume and serum testosterone in apparently healthy boys from a single center in northern India. These values are clinically valuable for assessing pubertal progression and managing growth and endocrine disorders in Indian populations.

Ultra long-acting beta-agonists (ULABAs) have emerged as key therapeutic agents in the management of chronic obstructive pulmonary disease (COPD) and asthma, offering prolonged bronchodilation and symptom control in adults. Their extended duration of action, often exceeding 24 h, reduces the need for frequent dosing, enhancing adherence and simplifying treatment regimens. However, the use of ULABAs in children presents unique challenges, including age-specific pharmacodynamics, safety concerns, and the need for appropriate combination therapies with inhaled corticosteroids. Current research suggests potential benefits in improving lung function and the quality of life, yet robust evidence remains limited. Regulatory guidelines vary, emphasizing the cautious application of ULABAs in children, particularly under 12 years, due to concerns about adverse effects and optimal dosing. Future research should address these gaps, focusing on long-term safety, efficacy, and the role of personalized approaches to optimize asthma outcomes in this vulnerable population.

This was hospital record-based study of prevalence and patterns of surgically correctable congenital anomalies in children enrolled from July 2019 to June 2024 at a tertiary care center in Bihar under Rashtriya Bal Swasthya Karyakram (RBSK). A total of 1678 children were beneficiaries of the scheme. Neural tube defects were the most common deformity (n = 292), followed by cleft lip and palate (n = 220) and congenital cataract (n = 208).

Objective: To assess the safety, efficacy and outcomes of therapeutic plasma exchange (TPE) in children at a tertiary care hospital.

Methods: Data of children who underwent TPE between January 2020 and July 2024 at a tertiary care hospital in Eastern part of India, were collected from the hospital records and analyzed.

Results: Forty children with mean (SD) age of 7.5 (3) years underwent 184 cycles of TPE during the study period. Liver disease was the commonest indication (n=14, 35%) followed by renal diseases (n=11, 27.5%) and secondary hemophagocytic lymphohistiocytosis (HLH, n=9, 22.5%). Out of 40 children,16 were discharged, 21 succumbed to the illness and 3 left against medical advice. Children with autoimmune encephalitis and renal diseases with American Society for Apheresis (ASFA) category I indication for TPE had an excellent outcome as compared to others. However, a high mortality was observed in view of delayed presentation with organ failure and lack of liver transplant facility.

Conclusion: TPE is an effective treatment in hemolytic uremic syndrome (HUS) and anti-N-methyl-D-aspartate receptor encephalitis. TPE can be performed safely and effectively for renal and non-renal indications.

Medical education often struggles with quality assurance (QA) becoming a "box-ticking" exercise, primarily driven by the pressure to maintain accreditation rather than a genuine commitment to improvement. This behavior is attributed to extrinsic motivation, an overemphasis on structural inputs over actual student competence, a lack of faculty ownership in QA processes, and underutilization of collected data. To overcome these challenges, the article highlights three concepts. The seven-level outcomes framework offers a comprehensive approach, expanding the Kirkpatrick model to guide planning from student participation and satisfaction to crucial long-term patient and population health outcomes, shifting focus to societal impact. In addition, the four pillars of quality (planning, assurance, control, improvement) are aligned with the iterative Plan-Do-Check-Act (PDCA) cycle, providing a dynamic roadmap for continuous enhancement in medical education, curricula, teaching, learning, and assessment. By adopting these, institutions can transition from mere compliance to fostering true excellence and producing competent, caring graduates.