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Background: Unavailability of healthcare resources can lead to poor patient outcomes. The latter is true for infants with hearing loss and require early hearing detection and intervention (EHDI). Aim: To determine the availability and distribution of resources for EHDI in state hospitals in the Eastern Cape (EC) province, South Africa. Setting: Sixteen state hospitals (nine district, four regional and three tertiary hospitals). Methods: Descriptive cross-sectional survey completed between July 2022 and October 2022. Results: Thirteen hospitals had audiologists (n = 4) or speech therapists and audiologists (n = 9). Specific to equipment, 10 hospitals had a screening otoacoustic emissions or automated auditory brainstem response, 8 hospitals had diagnostic middle ear analysers and only 3 hospitals had diagnostic auditory brainstem response and/or auditory steady state response. Twelve hospitals did not have visual response audiometry (VRA) and 94% had no hearing aid verification systems. Budget allocations were uneven, with only 10 hospitals, i.e., 4 districts, all regional and 2 tertiary hospitals being allocated varying amounts. Subsequently, only 50% provided newborn hearing screening, 56% provided diagnostic evaluations and 14 hospitals fitted hearing aids. Conclusion: Results revealed a limited and uneven distribution of resources, which negatively impacted the provision of EHDI. Even distribution of healthcare resources and further research aimed at strengthening hearing health services is recommended as these could potentially improve equitable access to EHDI and the overall quality of healthcare provided. Contribution: This study highlights the need for even distribution of resources and strengthening of health systems, especially in the dawn of the National Health Insurance.
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Humans , Male , Female , Child, PreschoolABSTRACT
This report discusses a rare case of a soft palate deformity in a young girl due to lipofibromatosis (LPF). This rare benign pediatric soft tissue tumour usually arises in the distal extremities. We believe this case represents the first report of lipofibromatosis involving only the maxillary bone.
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Treatment of children with end-stage kidney disease (ESKD), requiring maintenance dialysis, poses unique challenges. In low- and middle-income countries, lifelong treatment leads to significant stress on the overall family unit. Families face serious financial, social and psychological consequences despite free treatment. This pilot study, utilising primarily quantitative methods, supplemented by two case studies, is set in Sindh Institute of Urology and Transplantation, a tertiary care hospital in Karachi, Pakistan, providing free medical treatment. Fifty-two caretakers of children receiving haemodialysis for more than five years participated in the quantitative arm. Findings reveal that additional financial challenges may send the entire household into financial catastrophe. Social problems include migration from native cities, impact on the education of the sick child along with changes in lives of siblings. One-third of primary caretakers screened positive for anxiety/depression. Healthcare professionals 'practising' in developing countries face considerable ethical dilemmas in their practice when offering “free” paediatric dialysis services knowing the financial and psychological burden imposed on families.
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The effects of global warming and climate change are happening at a faster rate than expected, and they are going to get worse. Global climate change has already started to show the effects on environment—fast melting glaciers, accelerated sea level rise and base shifting of native flora and fauna. There has been an increase in temperature globally with a few countries already showing intense heat waves and extreme cold temperatures. The interrelation between dentistry, environmental impact and human health is still in its nascent stage, but studies in medicine show that the healthcare industry contributes to greenhouse gas emissions and climate change, poor air quality, food and water insecurity, extreme weather events and vector?borne illnesses. The concept of eco?friendly dentistry has evolved in this context for providing environmentally feasible dental solutions. Paediatric dentistry is no exception. The concept of prevention has to be promoted more in paediatric dentistry to provide a positive impact on environment. The prevention of oral diseases will lead to less travel to paediatric dental clinics, less use of dental materials, lesser energy usage, minimal use of single?use plastics and less use of nitrous oxide/general anaesthesia for behaviour management. The greenhouse gases have an effect on teeth of children in relation to early childhood caries (ECC). Here, we discuss the impact of climate change on paediatric dentistry and what changes can be made to provide environment?friendly solutions
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Background: Traumatic cataracts present in multiple and different forms. Based on the nature of injury, it necessitates a customized approach for individual case. Capsulorhexis and in the bag intraocular lens (IOL) placement are vital for long term centration of pediatric IOLs. Paediatric lenses having elastic capsule provide more challenges to perform optimum rhexis and the surgery becomes further complicated, when it is subluxated or fibrosed. Here is a pediatric case with such challenges managed using capsular tension ring (CTR) and capsular tension segment (CTS). Purpose: To demonstrate the making of optimum rhexis in a fibrosed capsule in subluxated lens and placing the IOL along with fixation of bag using CTR and CTS. Synopsis: A 13?year?old boy sustained an injury in the right eye from an air pistol, underwent lid tear repair in a local hospital, and presented to us one month post trauma with visual acuity of 6/60 in the right eye and 6/6 in the left eye. On examination, there was more than 180° temporal zonular dialysis with fibrosis of the anterior capsule. In this situation, creating an intact capsulorhexis was a challenge which was solved using micro?scissors and micro?vitreo?retinal forceps, in addition to routine instruments. After removing the lens material, CTS was placed initially in the bag to stabilize it while introducing CTR. The CTS was then fixated to the sclera. Foldable IOL was placed in the bag. Technique and tips to make intact rhexis and easy passage of suture are demonstrated. Highlights: This video shows tips and different methods adopted in each step of the surgery for successful placement of IOL in bag along with fixation of bag using CTR and CTS in a case of traumatic subluxated cataract with shrunken anterior lens capsule.
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Resumen Introducción: los niños con tetralogía de Fallot afrontan grandes desafíos durante su etapa posoperatoria, por lo cual es necesario que el personal de enfermería reconozca los mecanismos involucrados en este proceso con el fin de contribuir a que estos alcancen un nivel de adaptación fisiológico y psicosocial integrado. Objetivo: establecer las intervenciones de enfermería para niños en posoperatorio paliativo o correctivo de tetralogía de Fallot. Materiales y método: a través de la metodología propuesta por Fawcett et al. y el Instituto Joanna Briggs, se realizó una búsqueda en diez bases de datos y motores de búsqueda de artículos publicados del 2014 al 2019 utilizando dos fórmulas: Pediatric AND Tetralogy of Fallot AND Postoperative y Pediatric AND Tetralogy of Fallot AND Postoperative AND Psychosocial Adaptation. Resultados: se obtuvieron 1.901 estudios, de los cuales 56 cumplieron todos los criterios de elegibilidad. Los resultados se estructuraron según el plan de atención de enfermería y se enmarcaron en los modos de adaptación y necesidades del modelo de adaptación de Callista Roy. Con la información obtenida, se construyeron doce diagnósticos NANDA correspondientes al modo de adaptación fisiológico y once al modo psicosocial. Conclusión: existe información relevante que permite establecer las intervenciones de cuidado desde el campo de acción para enfermería en este contexto de unidad de cuidado intensivo pediátrico, ya que se obtuvieron intervenciones para abordar todas las necesidades que el modelo epistemológico plantea.
Abstract Introduction: children with tetralogy of Fallot face great challenges during their postoperative stage, so it is necessary for nurses to recognize the mechanisms involved in this process, in order to help them reach an integrated physiological and psychosocial level of adaptation. Objective: to establish nursing interventions for children in palliative or corrective postoperative tetralogía de Fallot. Materials and method: using the methodology proposed by Fawcett et al. and the Joanna Briggs Institute, we searched 10 databases and search engines for articles published from 2014 to 2019 using 2 formulas: Pediatric AND Tetralogy of Fallot AND Postoperative; and Pediatric AND Tetralogy of Fallot AND Postoperative AND Psychosocial Adaptation. Results: 1.901 studies were obtained, of which 56 met all eligibility criteria. The results were structured according to the nursing care plan, and were framed within the modes of adaptation and needs of Callista Roys adaptation model. With the information obtained, 12 NANDA diagnoses corresponding to the physiological mode of adaptation and 11 to the psychosocial mode were constructed. Conclusion: There is relevant information that allows us to establish care interventions from the field of action for nursing in this paediatric intensive care unit context, as interventions were obtained to address all the needs that the epistemological model proposes.
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Background & objectives: Readmissions are often considered as an indicator of poor quality of care during previous hospitalization, although many of these are unavoidable or unrelated to the past admission. The identification of high-risk cases for readmissions and appropriate interventions will help not only reduce the hospital burden but also to establish the credibility of the hospital. So this study aimed to determine the readmission percentage in the paediatric wards of a tertiary care hospital and to identify the reasons and risk factors that can help minimize preventable re-hospitalizations. Methods: This prospective study from a public hospital included 563 hospitalized children, classified as first admission or readmissions. Readmissions were defined as one or more hospitalizations within preceding six months, excluding scheduled admissions for investigations or treatment. Reason-wise, the readmissions were classified into various categories, based on the opinion of three paediatricians. Results: The percentage of children getting readmitted within six, three and one month time from the index admission was 18.8, 11.1 and 6.4 per cent, respectively. Among readmissions, 61.2 per cent were disease-related, 16.5 per cent unrelated, 15.5 per cent patient-related, 3.8 per cent medication/procedure-related and 2.9 per cent physician-related causes. Patient- and physician-related causes were deemed preventable, contributing to 18.4 per cent. The proximity of residence, undernutrition, poor education of the caretaker and non-infectious diseases were associated with increased risk of readmission. Interpretation & conclusions: The findings of this study suggest that readmissions pose a substantial burden on the hospital services. The primary disease process and certain sociodemographic factors are the major determinants for the increased risk of readmissions among paediatric patients.
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Background & objectives: Intranasal midazolam-fentanyl is commonly used as pre-medication in paediatric patients, but there is a risk of respiratory depression with this combination. Dexmedetomidine is a drug that preserves respiratory function. The objective of this study was to compare the efficacy of intranasal midazolam-fentanyl and dexmedetomidine-fentanyl in paediatric patients undergoing elective surgeries. Methods: Hundred children in the age group of 3-8 yr of American Society of Anaesthesiologists physical status grade 1 were randomized into two groups- group A received intranasal midazolam (0.2 mg/kg)-fentanyl (2 ?g/kg) and group B received intranasal dexmedetomidine (1 ?g/kg)-fentanyl (2 ?g/kg) 20 min before induction of general anaesthesia. Heart rate and SpO2 were monitored. Sedation score, parental separation and response to intravenous cannulation were seen after 20 min. Children were monitored for 2 h for post-operative analgesia by Oucher’s Facial Pain Scale. Results: Sedation scores were satisfactory in both groups, although children in group A were more sedated than in group B. Parental separation and response to intravenous cannulation were comparable in both the groups. The two groups were also haemodynamically comparable intraoperatively. Post-operative heart rate was also comparable at all-time intervals in both the groups except for heart rate at 100 and 120 min which were more in group A. Group A experienced more post-operative pain as assessed by Oucher’s Facial Pain Scale as compared to group B. Children receiving intranasal dexmedetomidine- fentanyl had better post-operative analgesia as compared to those who received intranasal midazolam-fentanyl. Interpretation & conclusions: Both intranasal midazolam with fentanyl and intranasal dexmedetomidine with fentanyl provided satisfactory sedation. Both groups were comparable in separation reaction and response to intravenous cannulation with better post-operative analgesia in children receiving intranasal dexmedetomidine-fentanyl.
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@#Introduction: Neglected Club Foot deformity is not an uncommon limb anomaly encountered by orthopaedic surgeons. Many treatment methods have been proposed. Ilizarov apparatus is one of the techniques used to correct this deformity. Materials and methods: In this cross-sectional study 47 patients (56 feet) between the ages of 5 and 10 years with clubfoot deformity were treated using the Ilizarov external fixator. Age, sex, type of deformity, and radiographic parameters were measured on foot radiographs. Also, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Dimeglio classification were recorded for each patient before and after treatment. Results: The treatment was unilateral in 38 patients and bilateral in 9 patients. 39 patients (69.6%) were male, and 17 patients (30.4%) were female with a mean age of 7.86 ± 1.4 years. Plantar angles of ankle flexion and ankle flexion curve increased from 20.12±6.52 and -16.51±8.36 to 25.89±6.44 and 6.19±6.42, respectively. There was also an improvement in the talocalcaneal and tibiocalcaneal angles. Also, the angle between the first metatarsus and the talus in the front and side views improved (P<0.00). Additionally, the mean AOFAS score and Dimeglio classification significantly improved. Three cases were complicated with distal tibial physeal separation that were treated with additional open surgeries. Conclusion: Ilizarov technique without osteotomies and soft tissue release could be considered a less invasive and successful method of treatment for neglected clubfoot deformity in patient five to ten years old that are not good candidate for Ponseti method.
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@#Introduction: Forearm fractures are common in children. The remodelling capacity of growing long bones in children makes these potentially forgiving injuries, recovering with good outcomes despite minimal intervention. Clinicians rely on radiological characteristics that vary with age to guide treatment decisions and minimise adverse sequelae. The purpose of this review was to consolidate the evidence base of radiological indications for intervention in paediatric midshaft forearm fractures. Materials and methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed for this review. Citable research output reporting radiological criteria for mid-shaft forearm fractures in paediatric patients (age ≤16 years) was screened and analysed to ascertain acceptable radiological criteria for nonoperative management. Results: A total of 2,059 papers were initially identified; 14 were selected following screening. Sagittal angulation >15°, coronal angulation >10°, and/or >50% (or >1cm) translation were the most common radiological indications for intervention in children aged 0 to 10 years. For children over 10 years of age, the most common radiological indication for intervention was sagittal angulation >10°, coronal angulation >10°, and/or >50% (or >1cm) translation. Conclusion: This study revealed a scarcity of high-quality evidence to guide management and significant variation in outcome reporting throughout the published literature. Since Noonan and Price's 1998 recommendations, there has been no significant evolution in the evidence-base guided threshold for intervention in paediatric mid-shaft forearm fractures. There remains a pressing need for a robust multicentre observational study using the patient-reported outcome measurement information system (PROMIS) to address this complex and controversial area of uncertainty in paediatric trauma management.
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@#Introduction: Malaysian Paediatricians suffer from psychological challenges and stresses, but unfortunately, their quality of work life (QWL) has yet to be studied. This study aims to explore the QWL score and its predictors among the qualified paediatricians of Universiti Sains Malaysia (USM). Methods: A cross-sectional study using a validated QWL questionnaire was performed from June to December 2022. The graduates of Master of Medicine in Paediatrics (USM) were invited to participate in the study, through an online built QWL questionnaire. Reminders were sent a few times to increase the response rate. The QWL was used due to a good internal consistency with Cronbach alpha of 0.95. Descriptive statistics were used to analyse the sociodemographic characteristics. The variables for QWL were determined using logistic regression analysis. Results: The study included the participation of 123 paediatricians. Majority of the participants were Malay (87.8%), Muslim (90%) and married (78%). Among all participants, 53.6% has good QWL score. Factors that associated with good QWL were married status (p= 0.02) and higher salary (p=0.012). Individuals whose are married and having higher income are 3.2 and 5.2 times respectively more likely to have good QWL. Conclusion: More than half of qualified paediatricians had good QWL and necessary steps should be strived at improving these factors for a better work-life balance.
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There are more than 7,000 paediatric genetic diseases (PGDs) but less than 5% have treatment options. Treatment strategies targeting different levels of the biological process of the disease have led to optimal health outcomes in a subset of patients with PGDs, where treatment is available. In the past 3 decades, there has been rapid advancement in the development of novel therapies, including gene therapy, for many PGDs. The therapeutic success of treatment relies heavily on knowledge of the genetic basis and the disease mechanism. Specifically, gene therapy has been shown to be effective in various clinical trials, and indeed, these trials have led to regulatory approvals, paving the way for gene therapies for other types of PGDs. In this review, we provide an overview of the treatment strategies and focus on some of the recent advancements in therapeutics for PGDs.
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Child , Humans , Genetic Diseases, Inborn/therapy , Genetic TherapyABSTRACT
Introduction: Plain radiography is the first line of radiological examination used for the evaluation of paediatric chest, and also a rapid imaging technique that allows lung abnormality to be identified. X-ray is used to diagnose conditions of the thoracic cavity, including airways, ribs, lungs, heart, and diaphragm. Chest x-ray has a high sensitivity for pulmonary tuberculosis and thus is a valuable tool to identify a differential diagnosis for a patient. Methodology: Two hundred and eleven paediatrics chest x-ray reports were studied between February 2017 to September 2018. Data were collected retrospectively from the hospital archives using a data capture sheet. Results: Two hundred and eleven radiographs were assessed and the age of patients whose radiographs participated in the study ranged from 0-15 years. Also, a greater number of male patients 133(63.03%) participated in the study than female patients 78(36.97%). Among all the radiographs used in this study, the most common age group for this study ranged from 0-3 years. Results from the study also revealed that bronchopneumonia was the most common finding totaling 105(49.76%) followed by radiographs which are normal findings 77(36.49), pulmonary tuberculosis, 19(9.00%), congestive heart failure 4(1.90%), pleural effusion 3(1.42%), enlarged adenoid 2(0.95%) and dextrocardia 1(0.47%). Conclusion: This study report bronchopneumonia was the most common paediatrics radiographic finding in a chest x-ray. Plain radiography is an effective tool to examine various respiratory and cardiac pathologies and is the first line of investigation for chest pathologies.
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Outpatients , Mass Chest X-Ray , Tuberculosis, Extrapulmonary , Bronchopneumonia , Integrative PediatricsABSTRACT
RESUMEN Introducción: Desde 1980 se conocen casos de síndromes neuropsiquiátricos infantiles en el mundo y su concepto ha evolucionado con cambios en las definiciones de 1995 (PITANDS: trastornos neuropsiquiátricos pediátricos autoinmunes precipitados por infección), 1998 (PANDAS: síndrome neuropsiquiátrico autoinmune pediátrico asociado con la infección por estreptococos), 2010 (PANS: síndrome pediátrico neuropsiquiátrico de inicio agudo) y 2012 (CANS: síndromes neuropsiquiátricos agudos de los niños). A pesar de que se conoce desde hace más de 20 años, aún es una enfermedad que suele pasar inadvertida para muchos profesionales de la salud. Objetivo: Sensibilizar a la comunidad médica acerca de la identificación de la enfermedad y disminuir la morbilidad asociada con un diagnóstico tardío. Caso clínico: Una niña de 6 años consultó a urgencias por trastorno de rechazo alimentario. En el tratamiento hospitalario se identificó historia clínica con criterios diagnósticos de PANS-PANDAS. Mostraba un curso clínico recurrente-remitente, tal y como describe la literatura, con pobre respuesta a los tratamientos de primera línea. Conclusiones: En todo niño en edad escolar que se presente con trastorno obsesivo compulsivo o trastornos alimentarios, con sin otros síntomas, se debe evaluar y descartar su asociación con PANS-CANS.
ABSTRACT Introduction: Since 1980, there have been known cases of childhood neuropsychiatric syndromes in the world and its concept has evolved with changes in the definitions in 1995 (PITANDs - paediatric infection-triggered autoimmune neuropsychiatric disorders), 1998 (PANDAS - paediatric autoimmune neuropsychiatric syndrome associated with streptococci infection), 2010 (PANS - paediatric acute-onset neuropsychiatric syndrome) and 2012 (CANS - childhood acute neuropsychiatric syndrome). Despite being known for more than 20 years, it is still an illness that often goes unnoticed by many health professionals. Objective: To sensitise the medical community about the identification of the disease and reduce the morbidity associated with a late diagnosis. Clinical case: A 6-year-old schoolgirl brought to the emergency department due to her refusal to eat. In the hospital treatment, a clinical history was identified with PANS-PANDAS diagnostic criteria. She exhibited a relapsing-remitting clinical course, as described in the literature, with poor response to first-line treatments. Conclusions: In all school-age child presenting with obsessive compulsive disorder or eating disorders, with other symptoms or not, a possible link to PANS-CANS should be evaluated and ruled out.
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Aim: To compare the pre-clinical and clinical students` perceptions about the non-pharmacological behaviour management techniques in paediatric dentistry and to investigate the influence of the dental curriculum on the students` knowledge regarding this issue. Methods: A total of 283 students from the IV-and X-semester completed a questionnaire, consisted of 12 statements, describing the nonpharmacological behaviour management techniques for the treatment of paediatric dental patients. The acceptability rate was evaluated with a Likert scale ranging from 1 to 5. Results: The students from all courses demonstrated high acceptance for Reinforcement and Desensitization techniques and low for the Negative reinforcement and Physical restraint. The comparison between the perceptions of the pre-clinical and clinical students demonstrated a statistically significant increase in the acceptance of the physical restraint, along with Nonverbal communication, Modelling and Parental presence/absence (p<0.05). Conclusion: The results provide information about the students' knowledge and skills in behaviour management techniques together with some insights about how the educational process can modify the students` perceptions and views in dealing with paediatric dental patients
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Humans , Male , Female , Students, Dental , Behavior , Surveys and Questionnaires , Pediatric Dentistry , MethodsABSTRACT
Introduction: Blood stream infection are very common in the pediatric age group and these are one of the common causes of morbidity and mortality in children. In developing countries ,the rate of blood stream infection in children is about 20-50%.The present study was undertaken to determine the etiological agents causing blood stream infection and their antibiotic susceptibility pattern in pediatric patients. Patients with bacteremia may have either a transient bacteremia or persistent bacteremia which can be self-limited without development of focal infection or sequelae or may progress to a more serious fatal infection or toxic effects. The present study in a hospital basedMethodology: single centred, Observational study, of 3 years. Blood sample were collected in BacTec bottle and standard microbiological protocol were applied for the isolation identification of bacteria strains. Antimicrobial susceptibility test was performed by the Kirby Bauer Disc Diffusion Method as per CLSI 2019 guidelines. Out of total 350 bloodResults: samples received for culture,87(23.14%)were culture positive, out of which 42/87(48.27%) were Gram positive organisms and 39/87(44.82%) were Gram-negative organisms and 6 /87(6.89%) were candida spp. The most common organism was Staphylococcus aureus(31.03%) the predominant organism followed by Klebsiella pneumoniae(21.83%) and Streptococcus pneumoniae (9.19%), Escherichia coli, Enterobacter cloacae each (5.74%). All Gram positive bacteria were susceptibile to vancomycin, teicoplanin and linezolid. 11/27(40.74% )of Staphylococcus aureus were Methicillin resistant Staphylococcus aureus (MRSA) strains. All Gram negative bacteria were susceptibility to amikacin, Colistin,Tigecycline. Staphylococcus aureus is the leading cause ofConclusion: childhood septicemia in this locale, has been decline in susceptibility of the pathogens to common antibiotics which ultimately stresses on the need for continuous screening and surveillance for antibiotic resistance in the pediatric ward and calls for increased efforts to ensure more rational use of these drugs.
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A few cases of posterior uveitis following COVID-19 vaccination have been reported but none in the pediatric age group. A 15-year-old girl presented with history of headache and bilateral blurred vision of five days duration. The symptoms developed five days after vaccination with the first dose of Covaxin (inactivated SARS-CoV-2 vaccine). Her anterior segment was normal in both eyes (BE), whereas the posterior segment showed mild vitritis with disc edema and multiple yellowish lesions at the level of choroid clustered at the macula and associated with multiple serous detachments. BE uveitis resolved, and the vision was completely recovered three weeks after treatment with steroids. Hence, ophthalmologists should be aware of uveitis following vaccination—a condition that is usually benign, transient, and results in excellent outcomes with timely diagnosis and early treatment with steroids.
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Introduction: Paediatric medico-legal cases are important public health problems in the paediatric casualty in India. These cases are among the leading causes of paediatric disabilities and deaths. We conducted a study to evaluate the demographic features of the medico-legal cases who presented to our paediatric casualty. Methodology: In a total of two-year study period, 120 patients were presented in casualty as medico-legal cases. Information about the patients was obtained from hospital records and analysed by us from casualty. Results: 70 male (58.3%) and 50 female (41.6%) patients were included in our study. The majority of the patients were between 10- 14 years of age (n=30; 25.0%). Fall from height was the major complaint (n= 60; 50%) of our patients. Winter was the most common season (n= 37; 30.6%) and January (n=13; 11%) was the most common month for medico-legal admissions. The majority of the patients (n=42; 35%) presented to our emergency room between 18-24 hours. 78 cases (65%) had health risks at the time of presentation. Conclusion: Developing effective & preventive strategies is essential to prevent child injuries. Majority of cases were males and adolescents. There is an urgent need to focus more on this vulnerable age group i.e., adolescent age group. There should be increased awareness among paediatricians about these medico legal cases and improving counselling skills to handle relatives of patients
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Background : The most common major Paediatric injuries treated by Orthopaedic Surgeons are Femoral Shaft Fractures. Early reduction and hip spica are used to treat young children under five years old, whereas intramedullary interlocking nail is used to treat young teenagers over 15 years old. Objectives : To know prevalence of Femoral Fractures in paediatric age groups, to classify fracture type, mode of injury, course of healing and to evaluate the result of low cost-least invasive Ender抯 Nail Fixation in Paediatric patients in developing country. Materials and Methods : It is prospective study with 15 patients of 6-15 years age group with Femur Diaphyseal Fracture were treated with retrograde Ender抯 Nail in our Orthopaedic Department with minimum 6 months follow up. Fracture location was in the upper third of the femur in four cases (26.66%), mid shaft in nine (60%) and (13.34%) lower third in two. Results : All patients had union within an average of twelve weeks (8 to 16 weeks ). Skin irritation caused by a nail was found in one case. Twelve patients achieved excellent results, while three individuals good results, according to Flynn criteria. Conclusion : Enders nailing is recommended for Femoral Diaphyseal Fracture Fixation because it is safe, simple to apply and economical with a lower rate of complications.
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Background : Telemedicine is the delivery of Health Care Services using information and communication technologies. Most models of Telemedicine in developed countries involve high-cost infrastructure. The COVID-19 pandemic imposed lockdowns and travel restrictions have highlighted the importance and the necessity of an economically viable model of telemedicine for resource-poor countries like India. Methods : We conducted a prospective study to assess the feasibility, acceptability and effectiveness of low-cost model of Telemedicine services for regular follow-up as well as for triaging. A combination of WhatsApp/email using smartphones and Electronic Medical Records (EMR) system was used to provide Telemedicine services. At the end of the e-consult, the patient/ parents were asked to rate their experience on a scale of 0 to 10. Results : A total of 155 children and 865 consults were included. The mean age of the children was 8.5 years. Forty-four consultations were given to 12 (7.7%) International patients. Thirty-eight (24.5%) patients were seen for the first time via Teleconsultation and the remaining 117 (75.5%) were follow-up patients. The most common diagnosis was Nephrotic Syndrome (51.6%) followed by Chronic Kidney Disease (21.9%), Urinary Tract Infection (10.3%), Kidney-transplant follow-up (6.4%), Acute Glomerulonephritis (3.8%), and Acute Kidney Injury (2.6%). Twenty-three patients were advised admission after the Teleconsultation and the remaining 122 children were advised follow-up e-consults. The mean satisfaction score reported for e-consults was 9.4. Conclusion : Our low-cost Telemedicine model offered a viable modality for delivery of Paediatric Nephrology Services during lockdown period and can be replicated by pediatricians practicing other subspecialties as well