Development and Validation of e-Portfolio for Undergraduate Medical Students in Pediatrics.

OBJECTIVE: To develop and validate e-portfolios for undergraduate medical students in the subject of Pediatrics. METHODS: A descriptive study was conducted among the second year medical undergraduate students. A core committee validated the E-portfolio created on the Google platform. The students were sensitized, trained on the platform, and encouraged to innovate by designing the e-portfolios themselves, and record their clinical experiences under the mentorship of faculty. The feedback was collected using a validated student and faculty questionnaire with closed and open ended questions. Satisfaction index was calculated based on the responses to closed ended questions using Likert scale. Open ended questions were analyzed using thematic approach. RESULTS: The study enrolled 34 students and 12 faculty members. Students recorded a high satisfaction index on their experience to be interesting (97%), well structured (85%), user-friendly (82%), and on being able to archive their clinical experiences (100%). Faculty members recorded a high satisfaction index (100%) in students' ability to record their clinical knowledge and reflect on their learning and innovation; all were motivated to use e-portfolios in their specialty. The thematic analysis highlighted student satisfaction with accessibility and organized record-keeping, while faculty praised e-portfolios for nurturing creativity and aiding memory retention. Concerns included resource intensiveness, design prioritization, and privacy issues. CONCLUSION: E-portfolios are rated as promising tools to record comprehensive clinical experience in pediatric by undergraduate students and faculty. Addressing identified challenges will further optimize their adoption in medical curriculum, facilitating informed integration decisions.

Sequential Treatment with Modified Atkins Diet and Low Glycemic Index Treatment for Drug-Resistant Epilepsy in Children.

OBJECTIVES: The present study was designed to study the efficacy of sequential dietary therapy with a modified Atkins diet (mAD) followed by low glycemic index treatment (LGIT) in treating drug-resistant epilepsy in children. METHODS: This interventional study was conducted from February 2021 to February 2022 among children aged 6 months to 5 years who had failed to respond to more than two conventional and correctly chosen antiseizure medications. The primary endpoint was the proportion of good responders, that is, children with more than 50% seizure reduction. Secondary outcome measures were the proportion of children with seizure freedom, > 90% seizure reduction, and the nature of parent-reported adverse events. RESULTS: A total of 45 children were recruited for the study, with 6 children being lost to follow-up at 12 weeks. At 12 weeks, 30 of 39 (76.9%) children were good responders with more than 50% seizure reduction. Of these 30 children, 11 (24.4%) had more than 90% seizure reduction, with 9 (20%) achieving complete spasm freedom. Constipation was the most common side effect of the diet among the enrolled subjects. CONCLUSION: Clinicians can consider sequential dietary therapy with a mAD in the first month followed by LGIT in the next 2 months for treating children who could not tolerate mAD beyond 1 month.

Parent's Perspective of Problems Faced during the COVID-19 Pandemic Lockdown on the Care of Children with Epilepsy: A Qualitative Study.

Background: COVID-19 has significantly impacted the care of children with chronic illness. There is a paucity of data on issues faced by parents of children with epilepsy (CWE) in an Indian setup. Objectives: The objective was to describe the parental perspective of the problems faced by them on the care of their CWE during the first wave of the COVID-19 pandemic. Materials and Methods: Parents of CWE who physically visited the clinic for their follow-up visit were asked to narrate their experiences about the problems they faced during the first lockdown due to COVID-19. The narratives were audio recorded, and transcripts were analyzed using thematic analysis to arrive at broad themes. Results: Four broad themes were identified: transport-related issues, medication-related issues, issues related to doctor consultation, and diagnostic delay. Limited transportation facilities, lack of appropriate social distancing norms in public transport and outpatient units, rigorous frisking by personnel during travel, fear of viral transmission during outpatient visits, nonavailability of antiseizure medications (ASMs) in local markets, lack of discounts by pharmacy, change of brands of ASM, and inability to undergo scheduled diagnostic investigations were some of the major issues raised by parents of CWE. Conclusion: Parents of CWE had trouble in transport to the hospital, inadequate access to ASMs, difficulties in doctor consultation, and delays in diagnostic investigations during the first COVID-19 pandemic lockdown.

Change in Apo B100/A1 Ratio in Children With Epilepsy on Monotherapy With Sodium Valproate, Oxcarbazepine or Levetiracetam.

A prospective longitudinal study was conducted to assess the Apo B100/A1 ratio as a marker of cardiovascular risk in children with epilepsy aged 5-14 years on long-term anti-seizure medication monotherapy with either sodium valproate, oxcarbazepine, or levetiracetam. Apo B100/A1 ratio showed an increase after six months of monotherapy with oxcarbazepine (P=0.05).

Modified Atkins Diet vs. Ketogenic Diet in the Management of Children with Epileptic Spasms Refractory to First Line Treatment: An Open Labelled, Randomized Controlled Trial.

OBJECTIVE: To compare the efficacy and tolerability of modified Atkins diet (mAD) and ketogenic diet (KD) among children aged 9 mo to 3 y with epileptic spasms refractory to the first line treatment. METHODS: An open labelled, randomized controlled trial with parallel group assignment was conducted among children aged 9 mo to 3 y with epileptic spasms refractory to the first line treatment. They were randomized to either receive the mAD along with conventional anti-seizure medications (n = 20) or KD with conventional anti-seizure medications (n = 20). Primary outcome measure was proportion of children who achieved "spasm freedom" at 4 wk and 12 wk. Secondary outcome measures were proportion of children who achieved >50% and >90% reduction in spasms at 4 wk and 12 wk, nature and proportion of the adverse effects as per parental reports. RESULTS: Proportion of children achieving spasm freedom [mAD {4 (20%)} vs. KD {3 (15%)}: OR (95% CI) 1.42 (0.27-7.34); P = 0.67], >50% spasm reduction [mAD {3 (15%)} vs. KD {5 (25%)}: OR (95% CI) 0.53 (0.11-2.59); P = 0.63] and >90% spasm reduction [mAD {4 (20%)} vs. KD {2 (10%)}: OR (95% CI) 2.25 (0.36-13.97); P = 0.41] was comparable between the two groups at 12 wk. The diet was well tolerated in both the groups with vomiting and constipation being the most common reported adverse effect. CONCLUSIONS: mAD is an effective alternative to KD in the management of children with epileptic spasms refractory to first line treatment. However, further studies with adequately powered sample size and longer follow-up are required. TRIAL REGISTRATION: CTRI/2020/03/023791.

Fourteen Days vs 28 Days of Albendazole Therapy for Neurocysticercosis in Children: An Open Label Randomized Controlled Trial.

BACKGROUND: There is a paucity of literature to support 14-days albendazole therapy for neurocysticercosis (NCC). OBJECTIVE: To compare the efficacy of 14-day and 28-day albendazole therapy in the management of children with newly diagnosed active NCC. STUDY DESIGN: Open-labelled randomized controlled trial. PARTICIPANTS: Children aged 1-14 years with newly diagnosed active neurocysticercosis. INTERVENTION: Albendazole (15 mg/kg/day) for either 14 days or 28 days. OUTCOME: The primary outcome measure was proportion of children with radiological resolution of active lesion at 6-month follow up. Secondary outcome measures were proportion of children with seizure recurrence, duration to seizure recurrence and calcification on follow up imaging. RESULTS: 65 children with newly diagnosed NCC were rando-mized to receive albendazole therapy for 14 days (n=32) or 28 days (n=33). The proportion of children with complete resolution was comparable between the two groups [6 (18.8%) vs. 9 (27.3%); OR (95%CI):0.61 (0.19 to 1.98); P=0.56]. Similarly, proportion of children with seizure recurrence [5(15.6%) vs 2(6.1%); OR (95%CI): 2.87(0.51-16.0); P=0.26] and proportion of children with calcification on follow-up imaging [26(81.2%) vs 23(69.7%); OR (95%CI): 1.88 (0.59-5.99); P=0.39] were also comparable. There were no major side-effects noted during the study. CONCLUSION: 14-day treatment with albendazole therapy is as effective as 28-day treatment in achieving radiological resolution at six-month follow up. However, high rate of calcification in both the groups indicates need for further evaluation with an adequately powered study and longer follow up.

Delivering Electives the Clerkship Way: Consolidating the Student Doctor Method of Training.

Student doctor method of clinical training or clinical clerkship provides students with exposure to the entire longitudinal illness of the patient. The students participate in patient care as a part of treating team and can refine their clinical, communication and procedural skills. It provides them with an opportunity to work with the faculty and experience the future workplace. Although the graduate medical education regulations (GMER) provide for student doctor method of training, the time provided is too little and opportunistic. Electives have also been recently added to the new curriculum for the first time. We propose a model to deliver the electives using the clerkship method, so as to consolidate what students learn from the ongoing clerkship. This model is feasible, practical and can be introduced in the current GMER for Indian medical undergraduates without any major disruptions.

Referencing Made Easy: Reference Management Softwares.

Reference management softwares are a powerful tool in the researchers' armamentarium. They primarily help in re-sequencing, re-styling and reformatting of the citation content in the research manuscripts. They also enable multi-user collaboration on research and allow the researcher to manage database searches and digital libraries. Using these softwares allows synchronization of cloud based digital libraries on multiple electronic devices enabling remote access, and also allows for management of online portfolios. We, herein, describe the basic principles, functions, and limitations of various reference management softwares.

Association of Child Neurology (AOCN) Consensus Statement on the Diagnosis and Management of Febrile Seizures.

JUSTIFICATION: Febrile seizures are quite common in children but there are controversies in many aspects of their diagnosis and management. METHODS: An expert group consisting of pediatric neurologists and pediatricians was constituted. The modified Delphi method was used to develop consensus on the issues of definitions and investigations. The writing group members reviewed the literature and identified the contentious issues under these subheadings. The questions were framed, pruned, and discussed among the writing group members. The final questions were circulated to all experts during the first round of Delphi consensus. The results of the first round were considered to have arrived at a consensus if more than 75% experts agreed. Contentious issues that reached a 50-75% agreement was discussed further in online meetings and subsequently voting was done over an online platform to arrive at a consensus. Three rounds of Delphi were conducted to arrive at final statements. RESULTS: The expert group arrived at a consensus on 52 statements. These statements pertain to definitions of febrile seizures, role of blood investigations, urine investigations, neuroimaging, electroencephalography (EEG), cerebrospinal fluid analysis and screening for micronutrient deficiency. In addition, role of rescue medications, intermittent anti-seizure medication and continuous prophylaxis, antipyretic medication and micronutrient supplementation have been covered. CONCLUSIONS: This consensus statement addresses various contentious issues pertaining to the diagnosis and management of febrile seizures. Adoption of these statements in office practice will improve and standardize the care of children with this disorder.

Depression, Anxiety, and Parenting Stress among Mothers of Children with West Syndrome.

The present cross-sectional study was designed to determine the prevalence of depression, anxiety, and parenting stress in mothers of children aged 6 mo to 5 y with West syndrome compared to mothers of healthy children. The enrolled mothers were subjected to interview-based administration of the Hamilton Anxiety Scale (HAS), Beck Depression Inventory (BDI-II), and Parenting Stress Scale (PSS). Maternal anxiety [HAM score: 9 (5, 14) vs. 1 (0, 2.2); p < 0.01], depression [BDI score: 11 (7, 19) vs. 1 (0, 3); p < 0.01], and parental stress [PSS score: 40 (32, 45) vs. 22 (20, 24); p < 0.01] were significantly higher among mothers of children with West syndrome when compared to controls. Logistic regression revealed maternal education to be a significant predictor of depression among mothers of children with West syndrome. Anxiety, depression, and parental stress were higher among mothers of children with West syndrome and they should be additionally screened.