reserved for severe cases . The exact pathogenic mechanism of corticosteroid-associated epidural lipo- matosis is unclear. Although it likely represents a sub- type of iatrogenic Cushing syndrome, it remains to be explained why only a small percentage of individuals on chronic corticosteroid treatment develop an accu- mulation of fatty tissue at this particular anatomic site. Whereas epidural lipomatosis in adults has been subject to relatively large studies , only case reports [1,5-14] and three small series [15-17] have dealt with this entity in the pediatric age group. We now present a new pediatric case of corticosteroid-associated spinal epidural lipomatosis and an updated analysis of the pediatric cases published in the international literature.
Purpose: To investigate the epidemiology of strabismus in cases of pediatric cataracts. To assess visual outcome fol- lowing orthoptic treatment for amblyopia in cases of cataracts in the pediatric age group. Methods: This was a retrospective cohort study. We investigated a consecutive series of pediatric patients with congenital, developing, or traumatic cataracts who underwent surgery between January 1999 and April 2012 at our center. Patient demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. Results: In total, 1331 eyes of 1043 children were included: unilateral cataracts were present in 785 (59%) eyes. There were 605 (45.5%) traumatic and 726 (54.5%) non-traumatic cases. Ages at surgery ranged from 1 to 215 months. All eyes were examined for ocular alignment; 66 (5%) were found to manifest strabismus. Deviation was significantly associated with age at intervention (p < 0.001), sensory nystagmus (p < 0.001), and etiology of cataracts (p < 0.001). We found significant differences in visual outcome following amblyopia therapy (p < 0.001). Conclusions: Surgical treatment with intraocular lens implantation in children with congenital, developmental, or traumatic cataracts is effective for visual rehabilitation. Orthoptic treatment made a significant difference in visual outcome (p < 0.001).
Mast cells are claimed to be an important element in the cellular infiltration in the course of gastric mucosal inflammation due to H. pylori infection . There is only little data in literature concerning the number of mast cells in chronic inflammation of the gastric mucosa in pediatric age group and existing data have rather con- flicting results.
Acute pyogenic meningitis (APM) is one of the most severe infectious dis- eases in pediatric age group. Case-fatality rates vary with age at the time of illness and the species of bacterium causing infection, but typically range between 37 and 60% in developing countries. Up to 54% of survivors are left with disability due to bacterial meningitis, including deafness, mental retardation and neurological sequelae 1 .
The field of pediatric dermatology has gained significant recognition in the past several years.  Skin diseases in childhood are common and may constitute at least 30% of all outpatient visits to pediatricians and 30% of all visits to a dermatologist involve children.  Vesiculobullous disorders are common in children. Primary vesiculobullous disorders include vesicles, bullae and pustules. It can either be very benign or potentially fatal in some cases. They can be either inherited or acquired depending on the etiology.  Only limited information is available about frequency of specific skin diseases in children and due to the rare incidence of each of these diseases in children, most of the cases have been reported as case reports and there are only a few studies in Indian literature regarding the pattern of vesiculobullous diseases exclusively in pediatric age group.
The incidence of pediatric ocular trauma in our study was found to be 18.9% (350/66) in a one-year period. Three hundred and ﬁ fty children presented in the outpati- ent department during the study period with various ocular problems. Sixty-six children had ocular injury. Singh et al noted the incidence of pediatric ocular trauma in the cen- tral Indian population as 12.8%. 11 Saxena recorded the incidence in a tertiary eye care center in the duration of 6 months as 20.8%. 3 Maurya (in an epidemiological study from the northern part of India) showed about 30.35% of ocular trauma occurred in the pediatric age group. 21 Wadeai et al noted an increase in the childhood trauma to the extent of 49.7% in the Egyptian population. 22 In the Nigerian population, the proportion of eye injuries in children was 26.4%. 15 A study from an Arabian country demonstrated a high incidence of pediatric trauma to the tune of 58.5%. 13 China found the incidence of pediatric ocular injury in the Chaoshan region to be 23.6%. 23 Five percent of all admissions in developed countries 24 and 12.9% from developing countries result from eye injuries. 12 The variability in the documentation of ocular trauma incidence in pediatric population could be due to vast differences in cultural and social factors and study design. It also depends on the referral services and the facilities available for the treatment in the hospital.
Psoriasis is one of the most common dermatological diseases, characterized by erythe- matous papules or plaques, mostly covered by silvery micaceous scales. The most common va- riant of the disease is plaque type. Onset of psoriasis is most common in the second to fourth decade of life, though it can appear just after birth or in old age, also. A high familial occurrence of psoriasis i.e. 7% to 36%, suggests that genetic factors may also play a role in its aetiology. Clinical features of Psoriasis resembles with EkaKushtha, one of the KshudraKushtha described in Ayurveda. Herein, a seven year old female child, diagnosed with plaque psoriasis with lesions on the extensor aspects of both the arms, both legs, back and abdomen along with severe itching and dryness since birth, with positive family history, is reported. Management of the case was through Vamanakarma with appropriate modifications while conducting this Panchakarma pro- cedure in a milder manner for the child which was followed by Raktamokshana. After the treat- ment there was improvement in the signs and symptoms with no recurrence in the follow up pe- riod of the trial.
Our center follows the Children’s Oncology Group (COG) ACNS0122 trial for NGGCT patients, which uses neoadjuvant combination of carboplatin/etoposide (Cycles 1, 3, and 5) alternating with ifosfamide/etoposide (Cycles 2, 4, and 6) for a total of 6 induction cycles. The duration of the induction period is approximately 18 weeks unless delay occurs due to myelosuppression or other toxicities. Response is evaluated by MRI brain/spine and tumor markers after each 3 cycles. After end of induction patient is evaluated for either the start or radiotherapy or a second look surgery and irradiation thereafter (Figure 1). The protocol details and doses are mentioned elsewhere under ClinicalTrials.gov Identifier NCT00047320.
Even though it was not statistically significant, still we observed a higher mean ± SD value for VEGFR-1 and VEGFR-2 in B-ALL (76.35% ± 12.98% and 40.64% ± 23.52%, respectively) than in T-ALL (69.73% ± 20.59% and 29.72% ± 26.72%, respectively) (p = 0.17). The same expression patterns were detected by El-Obeid et al. , who reported that both VEGFR-1 and VEGFR-2 are concomitantly ex- pressed in both ALL phenotype cell lines but primary in precursor B-ALL using flow cytometry and added that their expression is limited to the intra-cytoplasmic compartment which may suggest either internalization of the receptors or a block in trafficking of the receptor to the surface . Also, another study re- ported that notably, pre-B ALL patients had significantly increased expression of VEGFR-1 compared with no expression in the nonmalignant group .
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There is little data available in medical literature regarding the prevalence of aspiration pneumonia. It has been reported that 1 5% of adult patients with community-acquired pnemonia admitted to the Intensive Care Units have aspiration pneumonia 13,15 . Literature on pediatric patients is even more scant and mostly based on penoperative patients.
A careful and detailed dermatological and systemic examination with necessary investigations was conducted methodically. Patients up to fourteen years of age, were examined for distribution and nature of scales, presence of erythroderma, and blisters along with a note of associated disorders if any. Referral to other specialties like neurology and opthalmology were done to confirm or to rule out associated features of some syndromes as and when suspected.
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Increasing PLHIV age was associated with LTFU, with the elderly age group (> 65 years) at higher risk of LTFU than the pediatric age group (1–9 years);this aligns with findings from a previous study [24, 25] but is incon- gruent with results from a case–control study done in Ethiopia’s Oromia region, which showed that patients aged 15–24 years were about 19 times more likely to be LTFU on ART treatment compared to those patients aged above 55 years . Nigeria’s vital registration sys- tems (birth and death registration) is shaky and many deaths are likely captured as LTFU, among the elderly (> 65 years) this could be a factor especially in relation to all-cause vs AIDS-related mortality. Further research of age specific LTFU rate especially amongst adolescents living with HIV who are transiting into adult HIV care should also be explored.
reduction is indicated we often prefer the use of more stable methods of fixation that is micro or mini plates and screws. Advantages of plate and screw fixation that are especially beneficial in the pediatric age group are no need for maxillomandibular fixation, decreased necessity for tracheostomy for airway management in polytrauma cases, early mobilization of patients with associated condylar fractures, minimal chance of damaging tooth buds compared to transosseous wiring, early return to normal oral feeding especially in an age group where metabolic and nutritional demands are high, and early mobilization of patients leading to less risk of ankylosis in cases of condylar fracture.
Celiac Disease (CD) is a systemic chronic immune-mediated disorder triggered after the ingestion of gluten protein in genetically susceptible individuals . CD is manifested by a variety of clinical signs and symptoms . There are four types of celiac disease: 1- typical (classical) CD is common in the pediatric age group with gastrointestinal symptoms, positive celiac antibodies and abnormal small intestine biopsy results; 2- silent CD manifests with no gastrointestinal symptoms but with positive celiac antibodies and abnormal small intestinal biopsy results; 3- latent (potential) CD manifests with no gastrointestinal symptoms or positive celiac antibodies but with normal small intestinal biopsy results; and 4- atypical (non-classical) CD is presented with fatigue, constipation, anemia, osteoporosis, dermatitis herpetiformis (rash), neuropathy, infertility, etc. Classical CD is common in children less than 2 years old and is manifested by symptoms of malabsorption such as chronic diarrhea, poor appetite, vomiting, weight loss and failure to thrive. On the other hand, non-classical CD is more common in older children and adolescents with extraintestinal symptoms such as iron deficiency anemia, decreased bone mineralization, neuropathy, and unexplained increases in liver enzymes .
Material and methods: A retrospective analysis of children between age group of 1month to 12 years with neurotuberculosis admitted in a tertiary care teaching hospital from Mumbai over a period of 3 years from Jan 2013 to December 2015. Fourty one children with neurotuberculosis diagnosed based on predefined criteria were included for analysis. The demographic and clinical parameters such as presenting symptoms and signs, Glasgow coma scale (GCS), intracranial pressure, staging of TBM as per British Medical Council staging system were entered from records .Mantoux test ,BCG immunisation, nutritional status, cerebrospinal fluid(CSF) analysis ,neuroimaging and other investigations to confirm tuberculosis were noted along with treatment and outcome as survival or death. Statistical analysis was done using SPSS(version ).Various risk factors were determined using Chi square tests.
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METHODS: We set out to evaluate empirically the age ranges of chil- dren, and age-subgroup analyses thereof, reported in recent pediatric randomized clinical trials (RCTs) and meta-analyses. First, we screened 24 RCTs published in Pediatrics during the ﬁ rst 6 months of 2011; second, we screened 188 pediatric RCTs published in 2007 in the Cochrane Central Register of Controlled Trials; third, we screened 48 pediatric meta-analyses published in the Cochrane Database of Systematic Reviews in 2011. We extracted information on age ranges and age-subgroups considered and age-subgroup differences reported. RESULTS: The age range of children in RCTs published in Pediatrics varied from 0.1 to 17.5 years (median age: 5; interquartile range: 1.8 – 10.2) and only 25% of those presented age-subgroup analyses. Large variability was also detected for age ranges in 188 RCTs from the Cochrane Central Register of Controlled Trials, and only 28 of those analyzed age-subgroups. Moreover, only 11 of 48 meta-analyses had age-subgroup analyses, and in 6 of those, only different studies were included. Furthermore, most of these observed differences were not beyond chance.
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indications for VCUG include hydronephrosis, pediatric febrile urinary tract infection (UTI), or bladder diverticulum . VCUG is the most common method of diagnosing vesicoureteral reflux (VUR) and/or posterior urethral valves . RNC is a nuclear imaging study used mainly in the follow-up of known VUR, as it requires significantly lower radiation doses to detect VUR but does not provide the anatomical resolution necessary for reliable diagnosis of posterior urethral valves or grading of reflux [2,3].
intensive care unit (PICU), pediatric surgery, pediatric orthopedics and oncology day care unit of Jehangir hospital over a period of 12 months (Nov 2016 to Oct 2017 ). The clinical profile of the patient that is demographic data, history, examination, diagnosis and lab parameters were noted down in the set proforma. Other relevant investigations were also recorded depending on clinical situation which may be hematological, microbiological, biochemical, or radiological (x-ray, USG, CT scan, MRI scan) etc. The informed consent of parents/relatives was taken before enrolling them in the study . The indication for FFP transfusion and the clinical scenario and diagnosis , pre and post transfusion parameters were noted down. All the particulars like bag no, grouping, cross matching confirmation, date of packing and date of expiry were noted . The recipients were monitored throughout the transfusion and observed for any transfusion reactions. If there were any transfusion reactions - it was noted and recorded in the set proforma. Transfusion recipient was monitored clinically for vitals (HR, RR, BP, Spo2), perfusion (CFT, distal pulse) looked for signs and symptoms of transfusion reactions if any (fever, chills, rashes, breathlessness). The outcome of the patient after receiving FFP for which he/ she received FFP were also documented. The entire study group was divided into 2 groups, neonatal (aged < 1month) and pediatric (aged from 1month to 16 years ). Indication for the FFP transfusion was noted down and compared with the standard guidelines set by BCHS 10 for its appropriateness. As per World Health Organization(WHO), appropriate use of blood products is defined as “the transfusion of safe blood products only to treat a condition leading to significant morbidity or mortality that cannot be prevented or managed effectively by other means” 5,6
Files of all patients admitted in the PICU of Aga Khan University Hospital, from January 2010 to December 2011, aged one month to 15 yrs were reviewed. The study was approved by Ethical Review Committee of Aga Khan University Hospital for the review of patients medical record. (2736-PED-ERC-13) As per policy of PICU, blood and urine cultures of all cases were sent at the time of admission to PICU. CSF cultures were sent for all sick infants <3 months of age and in older children if signs and symptoms of meningitis were present. Tracheal cultures were sent by tracheal aspiration for all ventilated patients after 48 hours of intubation or earlier if clinical signs are suggestive of chest infection were present.
Pediatric Quality of Life inventory (PedsQL™ 4.0™ 4.0) Generic Core Scales was applied for evaluating quality of life scores in participants. Persian version of this questionnaire was proved valid in Iranian pediatric samples in prior stud- ies . Health-Related Quality of Life (HRQoL) of the stu- dents was assessed using the Adolescent Core version of the Pediatric Quality of Life (PedsQL). PedsQL is a self-reporting questionnaire comprising 23 items; and its four main scales included physical functioning (8 items), emotional functioning (5 items), social functioning (5 items) and school functioning (5 items). These 23 items were eval- uated as a list, and the student was required to clarify the degree to which each item has been bothering him/her dur- ing past one month. Each statement was scored from 0 (participant has never had a problem regarding the state- ment during past month) to 4 (participant almost always has had a problem regarding the statement during past month). Total scale score was calculated from the mean of all 23 items, and a psychosocial score was also derived from the mean of social, emotional and school functioning scales (15 items) scores.
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