Pediatric Research and Reviews

  • Myths and Misconceptions about Communication Disorders: A Survey in North Karnataka region

    Introduction: Communication disorders are highly prevalent in India especially in children. Early identification and treatment can prevent children from falling behind academically, socially, and in other key areas. However, identifying children with communication disorders and providing rehabilitation at an early stage is challenging in Indian scenario. Though 21st century has progressed drastically towards the rehabilitation of various communication disorders effectively, not all the regions in India are accepting the scientific rehabilitation. Due of lack of awareness, ignorance and stigma related to communication disorders, some open prejudices still persist in our country, making it difficult for people with communication disorders to have their condition recognized and to seek rehabilitation. However beforehand it is important to know the origin and degree of the problem so that appropriate remedy can be sought. Hence the present study makes one such effort, to study the extent of myths widely spread over north Karnataka region. Materials and Methods: A questionnaire consisting of 10 questions which focus on myths and misbelieves regarding communication disorders was administered on a total of Six hundred participants in the age range of 18 to 80 years. Results: Results indicted presence of myths in rural population with respect to communication disorders compared to urban population. Compared to younger group older group showed more misconceptions. Conclusion: From the results it can be concluded that further necessary programs needs to be implemented in rural areas and for older age groups of North Karnataka region to create awareness in this regard.

  • Identification Of Parasitic Infections In Food Handlers And The Imminent Risks Of Transmission To School-Aged Children

    Introduction: Most diseases transmitted by food contaminated by protozoa and/or helminths are originated from food improper handling. This fact is related to poor hygiene conditions in the food handling environment or the practices of food handlers. Objective: The aim of this study was to identify parasitic diseases in food handlers, as well as the risk of transmission to school-aged children. Methods: This is a literature review accomplished through researchers in Pubmed, Academic OneFile, SciELO and Google Scholar. The review comprised 40 articles published in the period from 2009 to 2019. In order effect the review, were included in this study literature reviews and original articles, identified in the aforementioned databases and which met the inclusion criteria: having their publication in indexed journals, articles with abstracts and full texts available online, articles published in Portuguese, English or Spanish in the last ten years. Studies whose year of publication was less than 2009 were excluded. Results: Enteroparasitosis are a serious public health problem that affects the world population. This fact is mainly related to the ingestion of contaminated food, having a direct connection with those who handle it. Conclusion: Therefore, food handlers have an important role in the transmissibility of diseases and food security.

  • Brazilian Infectious and Parasitic Diseases Child Mortality between 2014 and 2018

    Objectives: Determinate which children are more likely to die due to infectious and parasitic diseases in order to indicate which groups require more attention from the health system. Methods: Data from the Mortality Information System (SIM) by the Informatics Department of the Unified Health System (DATASUS) regarding deaths from infectious and parasitic diseases were collected. All records by year and region of death and race and sex of children between 0 and 19 years were considered. Results: In the 5 years, 14,659 infant deaths due to infectious and parasitic diseases were recorded in Brazil, an average of 2,931.8 (± 323.8) per year. There is a 19.5% reduction between 2018 and 2014, that is, 5 years. The highest concentration of records is in the Northeast region, close to Southeast, with 33.2% and 32.4% respectively. Children under 1 year old are majority, with 52.1% while 5 to 9 years old are minority, 7.2%. As for sex, there is a small difference, 54.8% of the records are male. Most children are brow, 49.7%, followed by white, with considerably less, 34%. Conclusions: Brown children, under 1 year old and residents of the Northeast or Southeast are, according to statistics, more prone to fatal outcome of infectious and parasitic diseases. From this profile, it can be inferred that race and age are determining factors for child survival. Measures such as guidance to parents during prenatal care on preventing infections and parasites should be instituted, as well as childcare control and child vaccination in primary care.

  • Preparing A University Hospital Neonatal Intensive Care Unit for Covid-19 Pandemic and Country Lockdown

    Jordan is one of the earliest countries that took a very strict approach to contain COVID-19 pandemic by declaring a country lock down. Our neonatal intensive care unit is a level three 30 beds unit. The shortage of neonatal nurses, doctors, and of respiratory support devices are the major existing challenges. During COVID-19 pandemic, those two issues were magnified. This paper will shortly discuss the measures taken as a preparedness for COVID-19 Pandemic in our unit. Team development and work schedule: The medical knowledge about COVID-19 was foggy, however; teamwork is the only ev-ident thing. Our team included, the neonatologists, pediatric intensivist, pediatric pul-monologists, in addition to the infectious disease specialist. The team also included three of our senior residents, and the neonatal unit head nurse. To enhance communication, we created a WhatsApp group (Peds COVID -19). Among this group, unidentified Patients’ information, in addition to recent publications and sci-entific opinions, were shared. Meeting with the obstetric department was done to famil-iarize both teams with the measures taken on both sides. The neonatal care is provided by two neonatologists. The in-house care providers are the pediatric residents. Senior residents are well-trained on neonatal resuscitation, endotra-cheal intubation, and umbilical venous catheterization. During COVID-19 lock down, residents were split into separate teams. Neonatal team, the pediatric floor team, and the emergency room team, each team had their sleeping room and lounges. The consultants did rounds daily, the in-house team consisted of two senior residents, and a junior resident. they did a 24-hour shift every four days and are off duty for the next three days. Regarding the nursing staff schedule, their work schedule changed from an 8- hour shift to a 12- hour shifts schedule. The aim was to promote staff well-being, minimize the number of staff who could potentially be exposed…

  • Fever is not a symptom in COVID -19. None of the diseases require fever as its symptom

    We have been hearing for centuries that ‘fever is not a disease but a symptom’. Physicians say that fever is a symptom of diseases like flu to cancer. The conservative fever definition, diagnosis, and treatments are based on fever as a symptom. All the studies related to fever as a symptom of a disease have been done without knowing the Purpose of the temperature of fever is. In the current COVID -19 epidemic situation, it has great importance. Because Fever is considered as an important part of Corona disease. Not knowing the purpose of temperature of fever, how can fever included as a symptom in COVID -19? What is the symptom in COVID -19 according to symptom definition? In COVID -19 up to 80% of patients have no fever. Why up to 80% of patients with the COVID -19 virus have no fever? Is it because there is no need for the care of fever or is it because the disease is free of symptoms? Without knowing the Purpose of the temperature of fever, how can fever included in the symptom definition? Any evidence to establish that fever is a symptom in COVID -19? Is temperature between 38o to 41o centigrade can be symptom of a disease? Most of the diseases may not have fever. Sometimes it disappears. Then, is fever a symptom of which disease? Is fever a symptom? what are the scientific criteria or parameters necessary for a Symptom? What we will do to prove a symptom? Symptom Definition? What is the use of Symptom Definition? As with any or all other definitions, symptom definition should describe the symptom scientifically. If it cannot describe clearly, there is no use of a symptom definition.

  • Non-Contact Respiratory Rate Monitoring with raybaby in an NICU: An Observational Study

    Objectives: This study aimed at evaluating the reliability of respiratory rate obtained by a non-contact technology with respect to a medically validated monitor among preterm babies. Design: This observational study compared the respiratory rates from raybaby’s non-contact technology and FDA approved Earlysense unit for the same instants of time through 760 hours of monitoring. 18 preterm babies in the NICU of a paediatric specialty hospital in India were considered for the study. The raybaby device was installed in front of the incubator and the contact-free FDA approved device was placed below the mattress of the incubator. The Respiratory Rate monitored was displayed on the device’s monitoring screen. Respiratory rates from both devices were compared to calculate the agreement between the values. Correlation, Accuracy, Hit Percentage and Fit Curves for the non-contact technology of raybaby with respect to the clinically certified device. Results: With 760 hours of monitoring, 37404 breathing instances were analysed. This yielded an accuracy of 98%. 95% of the data points fell within the +/- 5 units error range which is usually followed by medical devices. Conclusions: Raybaby uses a non-contact technology for monitoring Respiratory Rate. The average breathing rate observed was 33 to 43 breaths per minute, which falls within the breathing range of 30-60 breaths per minute. From the 37404 data points analysed, raybaby® establishes further proof for the breathing range and trend found in babies. The accuracy of non-contact technology for respiratory monitoring establishes great potential for making health monitoring less intrusive and efficient for use. This renders the technology as a hopeful tool for respiratory monitoring to deploy at observation units during the pandemic.

  • Importance of Psychoanalysis of Childhood Drawings for Prediagnosis of Mental Diseases

    Psychoanalysis and its application in the biological area. The area of Psychology already presents a lot of research in the context, looking for artificial and laboratory situations; however, the importance of contextual analysis of the individual as a whole, of their daily activities and, from this, the understanding of their perceptions. Through psychoanalysis it is possible to observe widely the subject as a whole, not focusing on the presence of organic or genetic disorders, Ansermet (2003) addresses this problem by stating that “We cannot see the subject only as someone who manifests an organic or mental defect, according to the logic of disability”. The systems that compose and organize the environment, according to Bronfenbrenner (1996), are constituted by the fitting of concentric structures called microsystem, what presents itself as the most active and direct contact environments, such as family, school or social work relationships; mesosystem referring to two or more environments of active social participation; exosystem, understood as environments that influence events that take place in the immediate environment of social relationship; and macrosystem, which comprise, in addition to the behavior of individuals, the connections between other people, the nature of bonds and the direct or indirect influence on the developing individual in the contexts in which they live and act actively. The use of psychoanalysis as a tool to decipher possible mental disorders has become essential, since it is intrinsically linked to the biological look for the diagnosis of a patient. Autism, attention deficit disorder, depression and hyperactivity (ADHD), among other diseases that can be diagnosed during childhood or late they are psychosocial disorders that have their diagnoses complemented by psychoanalysis. In this way, it is possible to perceive the challenges that psychoanalysis faces in terms of complementing the diagnosis of mental disorders in children, as well as the…

  • Consequences of Covid 19 Pandemic on Children

    The Pandemic of SARS COV 2 popularly known as ‘Corona Virus19’ has affected 213 countries and territories around the world since the beginning of year 2020. All the countries have focused their attention acutely on the higher fatality rate the virus has caused among the elderly and launched a scientific enquiry on why children have emerged relatively unaffected. This pandemic has already amplified existing social fractures and inequalities and it is expected that all most all countries may take 5-10 years to return to their socio-economic status of 2019. Most importantly people are losing trust in healthcare system. As the Global tally of cases crosses 28 million cases and nearly 0.9 million deaths on 10th September 2020, with the highest daily case of 300,683 on 4 September 2020 and deaths of 8513 on 17 April 2020. However, the proportion or absolute number of cases and deaths in children is not readily available at Global, National, or even at local levels. In the beginning it was estimated that the children under 14 years contributed less than 0.5% and therefore the Children were not the face of this pandemic. The sub-national data in states reporting desegregated data in USA and India indicate that the children contribute between 0.1% to 10% in the recent weeks. The pandemic of COVID-19 initially appeared to cause only a mild illness in children and immediate health impact, or mortality rates were not alarming. A few weeks following the peak of COVID-19 epidemic in the US and the European Union, a novel systemic illness called Multisystem inflammatory syndrome in children (MIS-C) has been reported with devastating effect. Most importantly children’s risk being among its biggest victims, their lives are being changed in profound ways. What has escaped our attention is the long-term damage the cascading effect of COVID-19…

  • The Use of a Rapid Fluid Infusion System in Children

    Fluid resuscitation is the cornerstone of treatment for pediatric shock caused by conditions such as sepsis, dehydration, trauma, and anaphylaxis. Children presenting to the Emergency Department (ED) in shock have a high risk of mortality, and each hour of delay in shock reversal doubles the odds of death1,2. Pediatric Advanced Life Support (PALS) guidelines emphasize the importance of providing rapid fluid resuscitation to prevent the progression to hypotensive or refractory shock3. PALS and other septic shock guidelines recommend that patients receive a 20 mL/kg bolus of crystalloid immediately upon recognition of hypovolemic or distributive shock, with 20 mL/kg to be delivered within 5 minutes and up to 60 mL/kg within the first 15-60 minutes3-6. Studies based on these guidelines show that earlier fluid delivery directed at reversal of shock reversal leads to decreased morbidity7-9, mortality2,7,9-12, and hospital length of stay (LOS)9,11-13. Unfortunately, timely fluid delivery is often not achieved due to the technical challenges of obtaining adequate vascular access and delivering fluid boluses quickly in patients with shock or hypotension11,14-16. Current methods of fluid bolus delivery in the pediatric emergency care setting include infusion pumps, gravity drip, pressure bags, rapid infusers, and the push-pull syringe technique17,18. Each of these methods are limited by speed, ease of use, or safety concerns. Infusion pumps provide a maximum rate of 999 mL per hour, which for a 25kg child would provide a 60 mL/kg bolus in 90 minutes. In most patients, infusion pumps are therefore too slow to provide adequate fluid resuscitation. Gravity drip rates are unpredictable and inadequate for the treatment of shock and hypotension. For example, up to 50 minutes are required for one liter of fluid to flow through a 22G intravenous (IV) line, and up to 200 minutes via the intraosseous (IO) route19-22. A pressure cuff may speed flow…

  • Maternal obesity and first trimester iodine levels are associated with the risk of congenital malformations in Assam, Northeast India

    Purpose of the study: To assess body mass index (BMI) and trimester specific iodine status among pregnant women of Assam and study their association with congenital malformations (CM). Methods: Anthropometric, obstetric and socioeconomic data was obtained from pregnant women and apparently healthy women attending Assam Medical College and Hospital, Dibrugarh. Urinary iodine (UI) level was estimated in each trimester. BMI was classified based on Asian criteria suggested by WHO and the iodine intake was classified using WHO reference medians. Student’s t-test and univariate logistic regression analysis were used to determine the risk factors. Results: 156 pregnant women (age 18-35 years) and 160 controls were enrolled in the study. 55.8% pregnant women were underweight and 3.8% were overweight. Malformations were observed in 16 babies. The median urinary iodine concentration (MUIC) of pregnant women in their 1st trimester was 170 µg/l (IQR 100 µg/l) which increased to 275 µg/l (IQR 166 µg/l) during the 2nd trimester and decreased to 265 µg/l (IQR 160 µg/l) at the 3rd trimester. In the univariate analysis, maternal BMI > 23 kg/m2 (OR 3.67, 95% CI 0.20-67.65) and MUIC