Systemic autoinflammatory diseases comprise a diverse group of disorders unified by a state of sterile inflammation. These conditions are poorly recognized and often mistaken for chronic infections, particularly in settings like ours with a high burden of infections. The paradigm of these diseases is evolving. Sixty-five monogenic autoinflammatory diseases have been described to date, with a varied spectrum of clinical features, ranging from recurrent febrile episodes to multisystem manifestations, such as arthralgias, abdominal pain, ocular, and cutaneous symptoms. There is often a delay in the diagnosis of these conditions owing to limited awareness, which leads to disease-related morbidity and mortality. Timely recognition of these disorders can be facilitated by identifying suggestive features on history, examination, and laboratory evaluation.
Team-based learning (TBL) is a learner-centered instructional strategy that promotes collaboration, accountability, and teamwork skills among students. This educational evaluation among Phase III MBBS students at a public teaching institution in North India assessed teamwork attitudes and perceptions after four TBL sessions using a retrospective pre–post questionnaire adapted from the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ). The questionnaire assessed team structure, leadership, situation monitoring, mutual support, and communication. Of 124 eligible students, 122 responded. TBL significantly improved attitudes and perceptions across all domains (P < 0.001), thereby supporting the development of teamwork during undergraduate medical training.
A double-blind randomized placebo-controlled trial aimed to evaluate the effect of oral zinc supplementation on reducing relapse frequency in children aged 1–12 years with steroid-sensitive nephrotic syndrome (SSNS). 84 participants were randomized to receive oral zinc (7 mg/day for 1–3 years and 10 mg/day for 4–12 years), or placebo for six months along with standard therapy. Although median (q1, q3) number of relapses during the 6-month study period was similar in zinc and placebo groups [1 (0, 1.5) vs 1 (1, 1); P = 0.575], infection-related relapses were less frequent in the zinc group (57
For a child, "well-being" is not just about feeling happy, but about feeling safe, loved, and secure, and having supportive relationships that help them understand and regulate their emotions. Child well-being includes positive relations with caregivers and peers, a growing sense of self-worth, physical and emotional energy for play, learning, and exploration. It reflects an overall balance in the child's life, where distress is expected, but the child feels supported and capable of coping. A strong sense of well-being helps children develop confidence, resilience, and optimism, enabling healthy learning and developmental progress. Music therapy is an integrative technique in healthcare that uses evidence-based musical interventions to achieve therapeutic, non-musical goals like overall well-being. This narrative reviews the existing literature on the effects of music therapy on children's physical, emotional, and psychological well-being.
Pediatric empyema thoracis is a serious complication of bacterial pneumonia, and poses management challenges due to the absence of evidence-based guidelines on optimal treatment approaches. Intrapleural fibrinolytic agents are frequently used to enhance pleural drainage and avoid surgical intervention in pediatric empyema thoracis; however, the comparative efficacy, safety, and cost-effectiveness of different fibrinolytic agents remain uncertain. To systematically evaluate and compare the efficacy, safety, and cost of different intrapleural fibrinolytic agents in children with empyema thoracis, to develop evidence-based recommendations for informing clinical decision-making. A systematic search of PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, ProQuest, OpenGrey, and four clinical trial registries was done, from their inception. Studies were eligible for inclusion in the systematic review if they were randomized controlled trials (RCT) including children under 18 years old with empyema thoracis (defined by any standard definition), comparing different fibrinolytic agents such as streptokinase, urokinase, and tissue plasminogen activator. The main outcomes included treatment failure, need for surgery, serious adverse events, and short-term clinical outcomes. Other outcomes were length of hospital stay, symptom duration, and cost. A total of 3110 records was identified; after de-duplication, 2022 unique citations were screened. A three-step screening process identified no RCT meeting the eligibility criteria. The available studies had other study designs, or lacked pediatric data. Current evidence is insufficient to determine the most effective and safe fibrinolytic agent for pediatric empyema thoracis. There is an urgent need for well-designed, comparative pediatric trials to support evidence-based treatment guidelines.
Intrapleural fibrinolytic therapy (IPFT) is frequently used in empyema thoracis as the initial treatment modality. However, some pediatricians prefer video-assisted thoracoscopic surgery (VATS). The optimal strategy is unclear. This systematic review was undertaken to compare IPFT versus VATS as the initial treatment modality in children with empyema thoracis, to support an evidence-based guideline recommendation. Literature search was conducted in seven electronic databases and four trial registries, seeking randomized controlled trials (RCT) comparing IPFT versus VATS in children with empyema thoracis. The critical outcomes were failure of therapy, need for thoracotomy, clinical outcomes within three months of discharge, and serious adverse events. Other outcomes were mortality, clinical outcomes at ≥ 12mo of discharge and pulmonary function after discharge. Methodological quality was assessed using Cochrane RoB 2 tool. GRADE was used to assess the overall certainty of evidence. Amongst 7,738 citations, five RCTs were included. Failure of therapy (4 studies, n = 235) was comparable between IPFT versus VATS; OR 1.01, 95
Accurate weight estimation is essential for drug dosing and equipment selection in pediatric emergencies. A new Pediatric Advanced Life Support (ALS) tape was developed using Indian growth references. The present study was performed to validate its performance in critically ill children across multiple centers in India. A prospective, cross-sectional, multicenter observational study was conducted in 13 pediatric intensive care units (PICUs) across five zones of India in children aged < 12 years. Recumbent length was measured using the new ALS tape, and color-band-based estimated weight recorded. Weight was measured using a digital scale. The primary outcomes were bias, precision, and accuracy of the tape in predicting weight. Secondary outcomes included correlation between estimated and measured weight, agreement using Bland–Altman analysis, center-wise subgroup analyses, and interrater reliability for color-band assignment. Out of 2740 children measured, 2253 were included in the final analysis. Correct color-band concordance was observed in 79.9
The National Family Health Survey-6 fact sheets (NFHS-6, 2023–2024) released by the Ministry of Health and Family Welfare, Government of India, reveal persistent undernutrition, rising urban overweight, widening rural–urban and tribal inequities, and declining exclusive breastfeeding rates, albeit with significant progress in national immunization coverage, antenatal care, and reduction in common childhood illnesses like diarrhea and pneumonia. The absence of mortality indicators limits comprehensive analysis of healthcare utilization and its impact. Persistent regional inequities and gaps in quality of care seen in this data should guide urgent, targeted action.
To characterize the genotypic and phenotypic spectrum of children with genetically confirmed hereditary spastic paraplegia (HSP) at a tertiary care center in Northern India. This prospective case series included patients with genetically confirmed (whole exome sequencing or clinical exome sequencing) HSP attending the Medical Genetics Clinic of a tertiary care center in Northern India between 2018 and 2023. Neurological and radiological assessments were also conducted. A total of 21 patients from 16 families were included. The median (q1, q3) age of onset of symptoms was 5 (1.5, 8.5) years, and the median (q1, q3) age of diagnosis was 8 (5, 13.5) years. The most common features at diagnosis were toe walking with progressive spasticity of lower limbs. Genetic testing identified 18 variants across eight different genes, including six pathogenic variants, 10 likely pathogenic variants, and two variants of uncertain significance (VUS). Thirteen families had autosomal recessive (AR) HSP, two had autosomal dominant (AD) HSP, and one had X-linked HSP. The most frequently identified subtype was SPG35 (spastic paraplegia type 35), observed in six families, followed by SPG11 in three families and SPG52 in two families. There was one family each with SPG18B, SPG15, CSPSD (cataracts, spastic paraplegia, and speech delay), SPG4, and SPG2. Hereditary spastic paraplegia exhibits genotypic and phenotypic heterogeneity with a predominance of AR inheritance. Five novel variants and some recurrent variants, suggesting potential founder effects, were noted. HSP should be suspected in cases with slowly progressive spasticity in lower limbs, even without a family history, which may mimic cerebral palsy.
To compare the clinical, laboratory, and treatment characteristics of classical, common variable immunodeficiency (CVID)-related, and syndromic agammaglobulinemia in children with profound hypogammaglobulinemia. We retrospectively reviewed 25 children with profound hypogammaglobulinemia evaluated between 2005 and 2023. Patients were classified as classical (G1), CVID-related (G2a), or syndromic (G2b) agammaglobulinemia, and their clinical presentation, laboratory findings, and treatment outcomes were compared. Of the 25 children, 20 (80
To describe the clinical features and a structure, non-invasive induction protocol performed during video electroencephalography (V-EEG) of children with functional neurological symptom disorder (FNSD). This observational study conducted over 1 year (November 2024–November 2025) enrolled children aged 6–14 years with clinically suspected FNSD. The children underwent V-EEG followed by a stepwise, non-invasive induction protocol. The study assessed the success of event induction, distress during induction, time taken to induce events, and dissociative symptoms using the Childhood Dissociative Checklist (CDC). A total of 58 children (39 girls) with FNSD were included. Motor symptoms were the most common presentation (n = 20, 34.5
India bears a high burden of thalassemia, underscoring the need for enhanced awareness, systematic screening, and standardized, high-quality care. In the absence of indigenous guidelines, gaps remain in knowledge and care delivery. To address this, the Pediatric Hematology Oncology Chapter of the Indian Academy of Pediatrics (IAP-PHO) is issuing evidence-based regional guidelines tailored to the Indian context. The primary objective of these guidelines is to establish nationally accepted standards for the diagnosis, comprehensive management, and prevention of thalassemia syndromes, incorporating the latest and locally relevant evidence. These evidence-based guidelines were developed through structured deliberations by 67 national experts under the IAP-PHO, incorporating iterative literature review, expert consensus, and context-specific considerations for India. The evidence quality (levels A-D, X) and strength of recommendation (strong, moderate, weak) are graded using the updated American Academy of Pediatrics framework. These guidelines provide a comprehensive, evidence-based framework for thalassemia care in India, encompassing prevention, diagnosis, transfusion and chelation, complication management, curative therapies and systems-based care, including day-care services and transition to adult care. Regular transfusion therapy with leukodepleted packed red cells to maintain pre-transfusion hemoglobin of 9.5–10.5 g/dL is the cornerstone of management in transfusion-dependent thalassemia (TDT), with individualized adjustment in special situations such as cardiac dysfunction. Iron chelation therapy should be initiated after 10–20 transfusions or when serum ferritin (SF) exceeds 1000 ng/mL; oral deferasirox is the preferred first-line agent. Combination therapy using deferasirox, and/or deferiprone and/or desferrioxamine is recommended when monotherapy with either deferasirox or deferiprone fails to reduce SF to < 2500 ng/mL or in the case of poor tolerance to one agent or when there is evidence of significant organ iron overload on T2*MRI (magnetic resonance imaging); de-escalation of chelation is recommended when SF approaches < 500 ng/mL. Comprehensive multidisciplinary care, incorporating systematic screening and timely interventions for cardiac, hepatic, endocrine, and skeletal complications, is strongly recommended. Early counseling for hematopoietic stem cell transplantation (HSCT) should be offered at diagnosis, with transplantation preferably performed at a younger age. Universal antenatal screening, cascade screening, and access to prenatal diagnosis, are critical to reducing disease burden. Emerging disease-modifying therapies may be considered in selected patients, with evolving pediatric data. Delivery of care through dedicated thalassemia day-care centers and structured transition to adult services is recommended to ensure continuity of care and best quality of life.
Small for gestational age (SGA) neonates are known to have altered cardiovascular adaptation; however, data on cardiac function during the early transitional period in preterm neonates remain limited. This study aimed to compare cardiac function during the first 72 h of life between preterm SGA and appropriate for gestational age (AGA) neonates. In this prospective study done at an Indian tertiary care neonatal centre, cardiac function by echocardiography was compared at three predefined time points during the first 72 h of life between hemodynamically stable preterm (28 0/6–34 6/7) SGA and AGA neonates. A total of 57 SGA and 91 AGA neonates were studied. On descriptive analysis, systolic and diastolic filling parameters were comparable between SGA and AGA neonates across time points. On repeated measures analysis adjusted for gestational age, sex, maternal factors, and antenatal doppler findings, there was no significant group difference in the left ventricular output (primary outcome variable). Among the secondary outcome variables, ejection fraction and isovolumic relaxation time showed significant differences on initial analysis; however, these did not remain significant after Bonferroni correction for multiple comparisons. Perfusion index demonstrated a significant time effect that persisted after Bonferroni correction, indicating dynamic changes during the early transitional period. Hemodynamically stable SGA and AGA neonates had comparable left ventricular output and other systolic and diastolic functional parameters, except for a time-related change in perfusion index, likely reflecting physiological transition.
