The Effect of Multi-source Feedback on Core Competencies of Pediatric Residents

Objective: The study was conducted to evaluate impact of multisource feedback in pediatric residency training. Methods: A crossover study of pediatric residents at Wadia Children’s Hospital was conducted with assessment of core competencies like knowledge, practice-based learning, system-based practice, professionalism, communication skills and interpersonal interaction. After randomization both groups (A and B) were given MSF and traditional feedback, respectively and later the groups were crossed over to other method of feedback. Control faculty assessed both groups at three points – Pre-intervention, after first and after second intervention. Results: There were 16 residents in each group (13,7,7 in first, second and third year of residency, respectively). Both groups had comparable scores in all six competencies at entry point. Group A after MSF showed significant improvement in all six competencies (all P<0.01). No significant improvement was observed in group B after traditional feedback. After cross-over to MSF, group B showed statistically significant improvement in all core competencies. Traditional feedback to group A after crossover showed statistically significant improvement only in knowledge, professionalism and system based practice. Outcome: MSF was beneficial in improving competency based performance scores in pediatric residents.

A Study to Evaluate the Clinical Profile of Patients with West Syndrome

Background: West Syndrome is an epilepsy syndromecomprising the triad of infantile spasms, an interictalelectroencephalogram (EEG) pattern termed hypsarrhythmiaand neurological regression. The aim of the present study tostudy the clinical profile of patients with West Syndrome.Materials and Methods: The present study was conductedamong 100 patients at B. J. Wadia Hospital for children, atertiary care teaching hospital at Parel, Mumbai over a periodof 18-24 months. Complete history was taken. Based onetiology West syndrome was classified as symptomatic (knownetiology) or cryptogenic (unknown etiology). Following tests willbe used to find correlation between different parameters withthe above outcome – one-way ANNOVA, unpaired t- test,Mean Whitney test, chi-square test and Kruskal Wallis.Results: In the present study total number of patients studiedincluded in the study were 100.The mean age at which patientswith infantile spasms presented to our hospital was 8.9 monthswhile the age of onset of spasms were 6 months. Male: Femaleratio was 3.5:1. Etiology of West syndrome was identified in74% children (Symptomatic) and 26% remained cryptogenicand idiopathic. The etiology of infantile spasms commonestbeing birth asphyxia (HIE) ;4 patients had history of meningitisin neonatal period; 2 were diagnosed with tuberous sclerosisand 4 with some brain deformity based on neuroimaging; and 1with TORCH infection. Frequency distribution of behaviourabnormalities and other evolving seizure types (over the followup years) among the patients was less.Conclusion: Our study concluded that Symptomatic WestSyndrome was the most common type, hypoxic ischaemicencephalopathy being the commonest etiology of it.

Syncope in children clinicoetiological correlation

Background: Syncope is the abrupt cessation of cerebral blood flow leading to temporary loss of consciousness. Identification of etiology is utmost important as any syncopal event may be life threatening. Aim was to correlate the clinical and etiological causes of syncope in children and to note their investigational profile.Methods: Among 40 patients presenting with syncope and presyncope were studied. History of the event, precipitating factors were noted. They were investigated with the help of blood pressure, Electrocardiogram (ECG), 2D Echocardiogram and Electroencephalogram (EEG).Results: Out of the 40 patients of syncope 65% were above the age of 10 years with male preponderance (60%). Vasovagal syncope (57%) was the most common cause of syncope followed by orthostatic hypotension (15%), neurological (15%), and cardiac etiology (6%). In the neurological etiology the EEG showed diffuse slow background with occasional sharp bursts in right frontal area in 2 patients while in 4 patients sharp bursts were present in the centero-temporal region. 17% were classified as presyncope, 60% as mild and 22% as having severe syncope. There was a significant correlation of etiology of syncope with duration of hospitalization of more than 4 days and with recurrence of syncope. There was significant correlation of Evaluation of Guidelines in Syncope (EGSYS) score >3 with cardiogenic syncope. On follow up, neurological syncope patients had significant decrease in the number of syncopal episodes as they were immediately started on antiepileptics.Conclusions: Electrocardiogram, 2D Echocardiogram and Electroencephalogram are important tools for the early management and treatment of cardiac and neurological etiology of syncope.

Cerebrotendinous Xanthomatosis Without Skin Changes: Diagnostic Delay and Confirmation by Genetic Analysis.

Background: Cerebrotendinous xanthomatosis is an inherited lipid storage disease manifesting with infantile onset diarrhea, cataracts, xanthomas and adult-onset neurological dysfunction with cerebellar signs and neuropathy. Case: 10-year-old boy presented with progressive ataxia, neuropathy and cataracts. Over 6 years, he developed dementia, kyphoscoliosis with worsening ataxia, and neuropathy. Outcome: Sterol analysis and CYP27A1 sequencing confirmed the diagnosis.Message: The condition should be considered in childhood onset cerebellar ataxia with cataracts, even in the absence of skin signs.

Experiences from Garbha-Swasthya Helpline.

Garbha-Swasthya helpline is a telephone helpline run by a tertiary care private hospital to address issues related to pregnancy and its complications. A review of the helpline data from September 2010 to December 2012 was conducted to study caller characteristics, number of calls and related information, and the reasons to call. Out of the total 696 voice calls, 421 were new callers and 275 were repeat callers and they comprised mainly pregnant women (73.3%), their relatives (24.8%), and medical professionals (1.9%). Most calls were related to fi rst pregnancy and were mainly from Pune and other cities of Maharashtra. All calls by the medical professionals were regarding drug safety in pregnancy. The commonest category of questions (27.4%) was about exposures (drugs, alcohol, eclipse, radiation, etc.) and preexisting medical illness followed by pregnancy complications (18.5%), common medical issues such as nausea/vomiting during pregnancy, and delivery and postpartum period (14% each). Although the total number of calls received has steadily increased, efforts to create public and professional awareness to increase the usage of this helpline are warranted.

Hemifacial seizures and cerebellar tumor: a rare co-existence.

We report a 4-year-old boy with multiple daily episodes of abnormal eye movements, hemifacial spasms. Neuro-imaging revealed a cerebellar tumor. We believe that this association constitutes a rare but important syndrome of epilepsy characterized by seizures of cerebellar origin.