Navodaya Medical College

BACKGROUND Primary nephrotic syndrome ranks among the more frequently encountered conditions by a pediatrician. Managing this condition is rarely straightforward, involving an array of drugs which has the tendency for ototoxicity. 1 Adding to this, there are well documented studies showing evidence of vitamin D deficiency associated. 2 Metabolic disturbance and treatment of nephrotic syndrome with ototoxic potential threatens child’s auditory health. Aim of our study is to assess whether these children are at a risk of hearing impairment and if any association exists with Vitamin D. MATERIALS AND METHODS: Thirty pediatric patients with ages ranging from 5 year to 18 years carrying confirmed diagnosis of primary nephrotic syndrome are included in the study. Children are treated accordingly by International Study of Kidney Disease in Children (ISKDC) regimen 11 and treatment details are noted. Pure tone audiometry (PTA) is done, and Vitamin D levels are assessed once in relapse state and once in remission state. Hearing assessment and its correlation with Vitamin D was done. RESULTS Of the 30 children diagnosed with Primary Nephrotic Syndrome 13(43%) presented with first episode, 11(37%) were Infrequent relapse, 2(7%) were Frequent relapsers and 4(13.3%) belonged to Steroid Dependent Nephrotic Syndrome (SDNS). Audiological assessment in Relapse phase revealed mild SNHL in 2 children (6.6%). Of the 2 children both the children had SNHL at 250 Hz and 1 child had SNHL at 500 Hz, 1000Hz, 2000Hz and 4000Hz respectively. On comparing the pure tone audiometry (PTA) between Relapse and Remission phase, two children demonstrated normalization of of hearing thresholds during remission, while other continued to exhibit mild SNHL. Analysis of relationship between PTA and vitamin D levels during the relpase phase did not yield any statistical significance. Patient remission phase showed hearing improvement and rise in Vitamin D levels was noted. This is suggestive of meaningful relationship Vitamin D status and auditory recovery. CONCLUSION Primary nephrotic syndrome pediatric patients demonstrated an increased susceptibility to hearing impairment, with frequent relapsers and those with SDNS bearing a disproportionately higher risk compared to the disease subgroups.

Objectives: Admission of a child to the paediatric intensive care unit (PICU) is associated with significant psychological stress among parents due to exposure to invasive procedures, unfamiliar environment and uncertainty regarding outcomes. Several studies have reported substantial parental stress in such settings. The objective of the study is to assess parental stress among parents of children admitted to the PICU and to evaluate the influence of clinical and sociodemographic factors on stress levels. Material and Methods: This cross-sectional study was conducted among 100 parents of children aged 1 month to 15 years admitted to a PICU. Parents of children admitted for at least 24 h were included. Parental stress was assessed using the Parental Stressor Scale–PICU, with minor contextual modifications. Sociodemographic variables and clinical factors including duration of PICU stay were recorded. Data were analysed using descriptive statistics and Pearson correlation. Results: The mean duration of PICU stay was 7.05 ± 2.8 days. A weak but statistically significant positive correlation was observed between duration of PICU stay and parental stress (r = 0.24, p = 0.0159). Higher stress scores were associated with invasive procedures, environmental factors such as alarms, presence of tubes, suctioning and parental role alteration. Parents with lower educational and socioeconomic status demonstrated higher stress levels. Conclusion: Parents of children admitted to the PICU experience considerable psychological stress influenced by both clinical and sociodemographic factors. Identification of key stressors may help in developing strategies to improve family-centred care and provide better psychosocial support.

BACKGROUND:Dental anxiety is a significant barrier in pediatric dentistry, particularly in children with Frankel's negative behavior ratings. Sedation through the intranasal route offers a rapid and noninvasive alternative with high bioavailability. Among various sedatives, the relative efficacy and acceptance of midazolam and dexmedetomidine in pediatric dental care remain underexplored. Hence, the purpose of the study was to compare the sedative effect, acceptance, and side effects of intranasal dexmedetomidine and intranasal midazolam in anxious children undergoing invasive dental procedures. METHODOLOGY:A triple-blind, split-mouth, crossover randomized clinical trial was conducted on 40 children aged 4-10 years who required either bilateral pulpectomy or extraction. The study was conducted from September 2024 to October 2025. Participants received intranasal midazolam (0.3 mg/kg) and dexmedetomidine (3 mcg/kg) in separate appointments, with a 2-week washout period between them. Behavior was assessed using the Houpt behavioral rating scale, whereas drug acceptance and side effects were recorded using the al-Rakaf scale. Statistical analysis included the Wilcoxon signed-rank test and Friedman test, with P < 0.05 considered statistically significant. RESULTS:Midazolam demonstrated significantly higher patient acceptance compared to dexmedetomidine. Behavior scores were significantly greater with midazolam across preoperative, intraoperative, and postoperative phases ( P < 0.002). Both agents showed minimal and nonsignificant differences in side effects, with occasional sneezing and nasal irritation observed. No serious adverse effects or carryover effects were noted. CONCLUSION:Intranasal midazolam demonstrated relatively effectiveness in comparison to dexmedetomidine regarding patient acceptance and behavioral results, with both drugs having acceptable safety profiles.

Ventricular tachycardia (VT) is a fatal arrhythmia, often managed with implantable cardioverter-defibrillators (ICDs). Many patients, however, present without an ICD. The role of catheter ablation in this high-risk group is unclear, particularly for short-term in-hospital outcomes. We assessed associations between ablation and in-hospital outcomes among ICD-naive VT patients using a large national dataset. We conducted a retrospective study using the National Inpatient Sample (2016-2021), identifying adult hospitalizations with VT. Patients with prior ICDs or ICD implantation during the same admission were excluded. The cohort was divided into those who underwent catheter ablation versus those managed without ablation. Multivariable logistic regression and 1:1 propensity score matching (PSM) adjusted for demographic, clinical, and hospital factors. The primary outcome was in-hospital mortality; secondary outcomes included ST-elevation myocardial infarction (STEMI), sepsis, major adverse cardiac events (MACEs) (death, STEMI, or cardiogenic shock), cardiogenic shock, tamponade, mechanical circulatory support (MCS), acute heart failure, and prolonged hospitalization (≥7 days). Of 2,214,424 VT hospitalizations, 32,640 (1.5%) underwent catheter ablation. After PSM (n = 12,668), ablation was associated with significantly lower rates of in-hospital mortality (3.17% vs. 8.98%; P < .001), STEMI (6.82% vs. 18.83%; P < .001), sepsis (3.38% vs. 10.34%; P < .001), and MACEs (15.82% vs. 28.40%; P < .001). However, ablation was associated with higher rates of cardiac tamponade (1.78% vs. 0.43%; P < .001), cardiogenic shock (9.14% vs. 7.12%; P < .001), and MCS use (5.04% vs. 3.71%; P < .001). Rates of acute heart failure and prolonged hospitalization were comparable. In ICD-naive VT patients, catheter ablation was associated with improved in-hospital survival and fewer complications, albeit with higher procedural risks.