Composition of Common Junk Food Items and Their Contribution to the Dietary Requirement of Children and Adolescents

Objective: To estimate the carbohydrate, energy, fat, protein, and sodium content of commonly consumed junk food items and to compare these to the Recommended Dietary Allowance (RDA) and Estimated Average Requirements (EAR) of children. Methods: A list of eight common junk food categories was made, and the median nutritional content of carbohydrate, energy, fat, protein and sodium was determined from the commonly consumed brands in these categories. It was compared to the RDA and EAR for two different age groups viz., age 4-6 year, and male adolescents aged 13-15 years. Results: The junk food groups with the highest carbo-hydrate were packaged potato chips and cakes, the group with the highest fat content was packaged potato chips, and the groups with the highest salt content were burgers and packaged potato chips. The %EAR of one packet of some items was 80-90% of daily fat requirement, and more than 60% of daily sodium requirement. Conclusions: Junk foods contribute substantially to the daily intake of carbohydrates, free sugars, total fats, saturated fats, and sodium of children.

Diagnosis and Management of Global Development Delay: Consensus Guidelines of Growth, Development and Behavioral Pediatrics Chapter, Neurology Chapter and Neurodevelopment Pediatrics Chapter of the Indian Academy of Pediatrics

Justification: Global developmental delay (GDD) is a relatively common neurodevelopmental disorder; however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. Process: Seven subcommittees of subject experts comprising of writing and expert group from among members of Indian Academy of Pediatrics (IAP) and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of IAP. Guidelines: GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/ hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.

Role of procalcitonin in diagnosis of neonatal sepsis and procalcitonin guided duration of antibiotic therapy

Background: Neonatal sepsis is one of the important causes of neonatal morbidity and mortality particularly in the developing countries. Accurate and quick diagnosis is difficult because clinical presentation is non-specific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Procalcitonin (PCT) is often reported to be more superior to C-reactive protein (CRP), being more sensitive and specific, starts to rise earlier and returns to normal concentration more rapidly than CRP.Methods: It is a hospital based prospective observational study. Blood samples were obtained and analyzed for blood culture, septic screen including serum CRP and PCT. Neonates were categorized into proven sepsis (n=39), probable sepsis (n=21) and clinical sepsis (n=40) groups on the basis of laboratory findings and risk factors. Data was analyzed by using standard statistical tests using SPSS 16.Results: Out of 100 cases, elevated PCT level >0.5 ng/dl was detected in 75 and >2 ng/dl was detected in 51 whereas CRP was positive only in 61 cases. Among the 39 culture positive cases, elevated serum PCT level was noticed in 39 (100%) cases whereas CRP level was noticed in 30 (76.9%) cases. Mean PCT levels were significantly high according to infection severity (P<0.01). Procalcitonin (sensitivity 87.2%, specificity 72.13%, positive predictive value 66.7% and negative predictive value 89.8% and with p value of <0.001) is more superior than CRP to predict sepsis in neonate. The mean duration of antibiotic therapy was 12.46±4.62 days in definite sepsis, 4.53±1.78 days in probable sepsis group and in clinical sepsis group 3.75±1.33 days by serial PCT measurement.Conclusions: Serum PCT levels >2 ng/dl has got a better sensitivity and NPV, which help us not only in the early diagnosis but also in the prognosis and duration of antibiotic therapy.

Undergraduate Medical Students’ Experience with Foundation Course at a Public Medical College in India

The study aimed to explore the perception and knowledge-gainof undergraduate medical students during the Medical Council ofIndia-mandated one month foundation course in August, 2019. Atotal of 129 consenting students who underwent the foundationcourse were enrolled and their feedback collected using anemail-based structured questionnaire. A majority (>60%) hadpositive attitudes towards various aspects of the course, withgood scores obtained in the post-test by the majority of thestudents. The information reported will assist in the planning offuture foundation course programs

Antisense Oligonucleotides: A Unique Treatment Approach

Synthetic Antisense oligonucleotides (ASOs) are novel and efficient laboratory tools to regulate the expression of specific genes, andhave only recently come into clinical use. These are synthetic single-stranded DNA analogs, whose sequence is complementary to atarget nucleotide and alter protein synthesis by several mechanisms. We herein provide a primer on the topic for pediatricians, as thisgroup of drugs is likely to see many more drugs for previously incurable diseases.

Children’s Color Trail Test for Objective Assessment of Attention in Children with Attention Deficit Hyperactivity Disorder: A Diagnostic Accuracy Study

Objective: To compare the Children’s Color Trail Test scores in children with and withoutAttention Deficit Hyperactivity Disorder to assess its diagnostic performance in assessingattention-deficit. Methods: 50 children with Attention Deficit Hyperactivity Disorder(diagnosed as per Diagnostic and Statistical Manual, 5th edition) and 50 age- and sex-matched children underwent Test 1 and Test 2 of the Children’s Color Trail Test. A ReceiverOperating Characteristics curve was constructed for the diagnostic accuracy of Children’sColor Trail Test in Attention Deficit Hyperactivity Disorder. Results: The Receiver OperatingCharacteristics curve showed a score ≤32 for Children’s Color Trail Test 1 [AUC: 0.8 (0.71 to0.87); P<0.001] and score ≤40 for Children’s Color Trail Test 2 [AUC: 0.85 (0.77 to 0.92);P<0.001] as the best cut-off for diagnosing Attention Deficit Hyperactivity Disorder.Conclusion: Children’s Color Trail Test is a promising tool for diagnosing attention deficit,and could be used in settings where parent or teacher reports are not available

The 3-Question Approach: A Simplified Framework for Selecting Study Designs

Conventional algorithms for selecting study designs are difficult to use for a novice researcher, especially the postgraduate students. Aninherent limitation of using the existing algorithms is the requirement of a priori knowledge of the characteristics of various study designs.We propose a simple and novel 3-question approach to select study designs. The questions are asked in a stepwise manner with answersin ‘yes’ or ‘no’. The responses to each of these questions lead the researcher towards choosing the appropriate study design. We believethat this 3-question approach would be useful for unexperienced researchers in selecting study designs, besides serving as a tool toteach-learn selection of study designs

ILAE Classification of Seizures and Epilepsies: An Update for the Pediatrician

The International League Against Epilepsy (ILAE) recently published an updated classification of seizures and epilepsy. This updatedclassification aims to have a better organized classification and ensure better understanding of terms, in addition to including new seizuretypes. As both seizures and epilepsy are important childhood conditions, we herein list some of the important aspects of the updatedclassification for the benefit of the general pediatricians. The full classifications are available at the ILAE website.

Diagnostic Accuracy of International Epidemiology Network (INCLEN) Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) in Comparison with Diagnostic and Statistical Manual of Mental Dis- orders-5 (DSM-5)

Objective: To compare the diagnostic accuracy of INCLEN Diagnostic Tool for AutismSpectrum Disorder (INDT-ASD) against Diagnostic and Statistical Manual of MentalDisorders – 5 (DSM-5) for the diagnosis of Autism Spectrum Disorder (ASD). Methods: 118children aged 2-9 years with symptoms suggestive of ASD were assessed by INDT-ASDand DSM-Vby trained personnel. ASD diagnosis by INDT-ASD was compared against theexpert’s DSM-5 diagnosis. Results: INDT-ASD had a sensitivity and specificity of 100% and75%, respectively against DSM-5 for the diagnosis of ASD; specificity for Autistic Disorderwas 87%. Conclusion: The INDT-ASD has a good sensitivity and specificity against DSM-5,and can continue to be used for the diagnosis of ASD even after the adoption of DSM-5criteria

Blowing Your Own Trumpet: How to Increase the Online Visibility of Your Publication?

After seeing one’s manuscript in the print form in a journal, the author feels a sense of elation which is indescribable. However, if one reallywant peers and other researchers to take note of the work, some more effort is needed. With the massive increase in the number ofbiomedical journals in print – supplemented by another large chunk online – quite a few published papers remain unread by majority of thereaders. The availability of social sites, persistent identifiers, and manuscript-sharing sites has simplified the job of increasing the impactof an article. We herein share some of these tricks-of-the-trade

Etiology and Short-term Outcome of First Seizure in Hospitalized Infants.

We enrolled 75 consecutive infants presenting with history of first seizure at a tertiary-care hospital in New Delhi, India. Clinical and biochemical work-up for etiology, and electroencephalography were performed in all infants. Developmental assessment was done 3-month after discharge. 72% had generalized seizures, and fever was the commonest co-morbidity (57.3%). 68% had provoked seizures, mainly due to hypocalcemia (34.3%) or neuro-infections (29.3%). Seven (9.3%) infants died during hospital stay; mostly those with neuro-infections. 13 (20.3%) infants had developmental delay.

Retinopathy as a Prognostic Marker in Cerebral Malaria.

Objectives: To study the association between fundal changes (malarial retinopathy) and mortality in children with cerebral malaria. Methods: 50 consecutive children (mean age 8.4 y, 23 males) with cerebral malaria (acute febrile encephalopathy and either peripheral smear or Rapid diagnostic test positive for malaria) were evaluated by a single ophthalmologist for any changes of retinopathy. Children were managed as per standard guidelines for treatment of cerebral malaria. Results: P. vivax infection was seen in one child, P. falciparum infection in 42 children, and a mixed infection in 7. Retinopathy was present in 48% of the children. 13 children died during hospital stay. The mean interval from admission to fundus examination was 11.6 (4.64) h. Presence of ‘any retinopathy’ (P=0.02), and either of papilledema (P=0.02), hemorrhages (P=0.005) or vessel changes (P=0.01), were associated with a significantly higher risk of death. Conclusions: Malarial retinopathy is significantly associated with mortality in children with cerebral malaria. It may be used for both prognostication, and triaging for optimum utilization of intensive care facilities in these children.

Neurodevelopmental Status of Children Aged 6-30 Months with Congenital Heart Disease.

Background: Children with congenital heart diseases (CHD) are considered to be at high-risk for neurodevelopmental delay, but scant Indian data are available. Objective: To evaluate the neurodevelopmental status of children with CHD. Methods: We enrolled consecutive children aged 6-30 months with echocardiographically-confirmed CHD between June 2013 and January 2014. Children with clinically recognizable genetic syndromes or disorders; visual and/or hearing deficits, and microcephaly; and post-cardiac surgery children were excluded. Development was assessed by Developmental Assessment Scale for Indian Infants (DASII) and Developmental delay defined as Development Quotient (DQ) <70 in either the mental or motor scale. Results: 75 children (53 males) with CHD were enrolled. Acyanotic CHD was seen in 51 children (VSD in 47%), and Tetralogy of Fallot was the commonest cyanotic CHD (25%). Developmental delay was seen in 25% of these children, more in the motor domain (48%) than in mental (12%). Mean motor and mental DQ in acyanotic CHD was 77 and 84, respectively; and 65 and 85, respectively in cyanotic CHD. Mean motor DQ was significantly less than mental DQ in both acyanotic and cyanotic CHD children (P=0.048). Conclusion: Children with CHD are at an increased risk for developmental delay. Periodic surveillance, screening and evaluation should be instituted in them for early identification and appropriate interventions to enhance later academic, behavioral, psycho-social and adaptive function.

Ophelia Syndrome: Hodgkin Lymphoma with Limbic Encephalitis.

Background: Limbic encephalitis, an immune-mediated encephalitis, results from inflammation in the medial temporal lobes. The paraneoplastic form is rare in pediatric population, and frequently precedes tumor diagnosis. Case characteristics: A 9-year-old boy receiving chemotherapy for Hodgkin lymphoma, developed headache, temporal lobe seizures, anxiety, hallucinations, short-term memory loss and autonomic disturbances. Magnetic resonance imaging of brain showed features suggestive of limbic encephalitis. Electro-encephalography showed diffuse slowing with no epileptiform discharges. Outcome: We diagnosed paraneoplastic form of limbic encephalitis. Treatment with steroids and intravenous immunoglobulin failed, and the child died 4 weeks after onset of symptoms. Message: Limbic encephalitis should be kept as differential diagnosis in a child with sub-acutely evolving neuropsychiatric symptoms.

Benign Infantile Seizures.

Background: Benign infantile seizures are a common form of idiopathic seizures in infants, but infrequently reported. Case characteristics: Four cases identified over a 9-month period. Observation: All had a cluster of focal seizures, normal development and no abnormality on hematological and biochemical work-up. Outcome: No recurrence of seizures over a follow-up of 5 to 9 months. Message: Identification of this syndrome has important therapeutic and prognostic implications.

Consensus Guidelines on Management of Childhood Convulsive Status Epilepticus.

Justification: Status epilepticus has a wide etiological spectrum, and significant morbidity and mortality. Management using a pre-determined uniform protocol leads to better outcomes. Multiple protocols for management of childhood status epilepticus are available, without much consensus. Process: A ‘Multi-disciplinary Consensus Development Workshop on Management of Status Epilepticus in Children in India’ was organized. The invited experts included Pediatricians, Pediatric neurologists, Neurologists, Epileptologists, and Pediatric intensive care specialists from India, with experience in the relevant field. Experts had previously been divided into focus groups and had interacted on telephone and e-mail regarding their group recommendations, and developed consensus on the topic. During the meeting, each group presented their recommendations, which were deliberated upon by the house and a consensus was reached on various issues; the document was finalized after incorporating suggestions of experts on the draft document. Objective: To provide consensus guidelines on evaluation and management of convulsive status epilepticus in children in India (excluding neonatal and super-refractory status epilepticus). Recommendations: Each institution should use a predetermined protocol for management of status epilepticus; prehospital management and early stabilization is the key to a satisfactory outcome of status epilepticus. Pharmacotherapy should not be delayed for any investigations; the initial management should consist of a parenteral benzodiazepine by any route feasible. Subsequent management has been detailed. The group also felt the need for more epidemiological research on status epilepticus from India, and identified certain research areas for the purpose.