Subdural empyema, mastoiditis, and sinus venous thrombosis are rare infections that may lead to serious and potentially life-threatening complications. A 2-year-old male patient with no known underlying disease presented with a 2-day history of ear pain, sore throat, and fever. Physical examination revealed no significant pathology other than hyperemia of the left tympanic membrane. Intravenous ceftriaxone was initiated, and the patient was hospitalized because of persistent fever and poor oral intake. However, despite 3 days of treatment, the fever persisted, and an increase in acute phase reactants was observed. Subsequently, the patient developed hyperemia, swelling, and warmth in the area corresponding to the left mastoid region. Clindamycin was then added to the treatment regimen. Streptococcus pyogenes was isolated from the patient’s blood culture. Brain magnetic resonance imaging revealed a partial thrombus in the left transverse sinus and a 2.5-cm subdural empyema in the lateral aspect of the left cerebellar hemisphere. Antithrombotic therapy was initiated for the patient. Ceftriaxone was administered intravenously for 14 days and clindamycin for 11 days. The total duration of oral and intravenous antibiotic therapy was completed in 6 weeks, and enoxaparin sodium was given for 3 months. This case highlights the need for awareness of the rare complications of persistent otitis media in pediatric patients. Conditions such as subdural empyema, mastoiditis, and sinus venous thrombosis can be successfully managed with timely diagnosis and appropriate treatment. Such complications should be considered in cases that do not respond clinically to appropriate antibiotic therapy.
A novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to coronavirus disease 2019 (COVID-19), which is a global health problem that occurred in waves and resulted in high mortality globally. This is a single-center retrospective study conducted in a Medical College's dedicated COVID-19 hospital in India during the first wave (March-November 2020) and second wave (March-May 2021) of the COVID-19 pandemic on 104 children below 18 years of age to compare the clinical characteristics and outcome of COVID-19 patients during the first and second waves. During the first wave (n = 57, 54.8%), the majority of children (n = 36, 63.16%) were between 5-18 years, but during the second wave (n = 47, 62.09%), the majority of children (n = 29, 61.70%) were below 5 years. Neonates outnumbered during the second wave (n = 11, 23.4% vs. n = 1, 1.8%). Asymptomatic patients (n = 24, 42.1%) were common during the first wave, while severe-grade patients (n = 19, 40.4%) were common during the second wave. During both waves, fever and respiratory distress were the common symptoms followed by cough. Respiratory distress (p = 0.0003), C-reactive protein (p = 0.008), peripheral oxygen saturation <94% (p = 0.00002), and acidosis (p = 0.001) were significantly higher during the second wave. Use of steroids and low-molecular-weight heparin was similar in two waves, but intensive care unit (ICU) admission (p = 0.0031), oxygen via nasal prongs (p = 0.0003), use of CPAP/BIPAP (p = 0.031), blood and blood products (p = 0.044), comorbidity (p = 0.017), and mortality (p = 0.008) were significantly higher during second wave. ICU admission, use of blood and blood products, mechanical ventilation, comorbidity, and mortality were found to be higher during the second wave.
Zinc supplementation is recommended in both acute and persistent diarrhea; however, comparative data on longitudinal biochemical response between these conditions are limited. This prospective observational study was conducted at the pediatric department of a tertiary care center in Northern India, which enrolled 72 children: 36 with acute diarrhea (group A) and 36 with persistent diarrhea (group B). All participants received oral zinc sulfate syrup providing 20 mg elemental zinc daily for 14 days. Serum zinc was measured at Day 1, 14, and 28. Longitudinal analysis was performed using a linear mixed effects model with time and group as fixed effects and subject as a random effect. A gradual increase in serum zinc was observed in both groups. No statistically significant group-time interaction was detected, indicating similar trajectories. Zinc supplementation resulted in a modest but consistent increase in serum zinc levels in both groups. No significant difference was detected between acute and persistent diarrhea. These findings do not suggest a need for higher dosing; however, further adequately powered studies are warranted.
This study aimed to evaluate the impact of introducing neonatal resuscitation training into the undergraduate medical curriculum at Sultan Qaboos University on students’ knowledge and confidence during paediatric clinical rotations. Our hybrid curriculum incorporates online lectures, neonatal resuscitation program texts, and high-fidelity simulation training. Knowledge acquisition was assessed through the utilization of multiple-choice assessments as well as pre- and post-examinations. The research focused on statistical variables, specifically the mean, median, SD, and interquartile range, encompassing the 25th, 50th, and 75th percentiles. In addition, psychomotor skills were assessed using a structured instrument, and self-assessment questionnaires were used to evaluate students’ satisfaction and confidence. After completing the course, it was observed that all 24 participants showed a significant improvement in their test performance. The mean score increased substantially from 39.58 to 93.75 out of a maximum of 100, while the median increased from 42.4 to 95, indicating a significant improvement in performance. This change was statistically significant, as indicated by a p-value of 0.0001. Furthermore, they achieved perfection in their psychomotor skills and demonstrated heightened satisfaction and confidence when dealing with neonatal emergencies. Newborn resuscitation training improved students’ knowledge, skills, and confidence, and should be integrated into the curriculum. This inclusion is crucial to enhance patient safety during clinical rotations and promote more cohesive teamwork among healthcare professionals.
Cholera remains a significant global health concern, especially in areas with limited access to safe drinking water, poor sanitation, inadequate hygiene practices, and fragile health infrastructure. The etiology is Vibrio cholerae, a bacterium with multiple serotypes of varying degrees of pathogenicity. It typically presents as acute, severe watery diarrhea leading to dehydration. Cholera is endemic in several African countries, including Sudan. This study aimed to describe the clinical features and outcomes of cholera in patients admitted to a hospital in Khartoum, Sudan. A descriptive cross-sectional study was conducted between January 1 and June 30, 2025, at a regional hospital in Khartoum State. Data were obtained through structured interviews and medical record reviews, covering demographic and clinical characteristics, complications, management, and outcomes. A total of 211 patients, aged from 6 to 71 years, were enrolled. Females made up 52.1% of the group. Most patients (75.8%) came from rural areas, and 65.9% were of low socio economic status. None had received a cholera vaccination. The main symptoms at presentation were diarrhea, vomiting, and abdominal cramps. Major complications included severe dehydration, hypokalemia, hypoglycemia, and acute kidney injury. Overall, 173 patients (82%) recovered and were discharged, whereas 38 patients (18%) died during hospitalization. Cholera continues to pose a substantial threat to public health in Sudan. Strengthening preventive measures, such as improving safe water supply, promoting sanitation and hygiene practices, and implementing mass vaccination during outbreaks, is essential to reducing disease burden and preventing future epidemics.
Dear Editor, We write to provide an update regarding the diagnosis and treatment of rheumatic heart disease. Echocardiographic screening revealed a significant global burden of undetected rheumatic heart disease (RHD) over a decade ago [1]. The medical community\'s reaction to the World Heart Federation\'s (WHF) 2012 publication of a set of criteria for the echocardiographic diagnosis of RHD was astounding. But in 2023, these standards were carefully revised, transforming RHD screening from a research and epidemiology tool to a useful public health strategy. By embracing the success of task-shifting RHD screening to a variety of nontraditional clinicians, the amended criteria eventually expand reach into low-resource regions of the world. Furthermore, the WHF\'s 2023 guidelines removed the terms \"definite RHD\" and \"borderline RHD,\" which had caused confusion regarding the diagnosis of RHD since 2012 [2]. Instead, they were more consistent with an A-D classification based on progression risk and offer recommendations for treating RHD in its early stages. The development of integrated models for RHD screening has also advanced during the last four years. The goal of Uganda\'s ADUNU initiative, or \"heart in the local language Lango,\" is to include it in the country\'s public healthcare system [3]. This was created in collaboration with the Uganda Ministry of Health and was intended to be carried out by the regional district health offices under the direction of their tertiary cardiac center. ADUNU employs a variety of screening techniques that have proven effective in the past, such as screening at medical institutions and schools, and incorporating them into community outreach and health activities. Additionally, ADUNU incorporates the ACT RHD Registry Tool, a dynamic, registry-based care platform created with a grant from the American Heart Association and currently Uganda\'s RHD clinical registry. ACT aims to bring RHD care closer to communities by shifting from a centralized, passive care delivery model to a decentralized, active, and scalable one. This includes elements that guarantee a sufficient supply of drugs at institutions, enhance prophylactic adherence and retention in care, and use quality dashboards and the RHD Care Cascade to implement continuous quality improvement. Finally, efforts are underway to support RHD screening using artificial intelligence [4]. For inexperienced scanners, navigational assistance can provide real-time guidance for probe insertion and image acquisition. These studies are ongoing and being evaluated to improve access to RHD screening and diagnosis globally. The GOAL trial, published in 2022, found that echocardiographic screening and initiation of secondary prophylaxis resulted in substantially less disease progression among children with mild RHD, with a number needed to treat of only 13 to prevent one child from progressing [5]. These results have immediately informed public health recommendations for the treatment of RHD in the 2023 WHF guidelines. To improve treatment approaches, particularly the duration of prophylaxis, more work is needed. There are still unanswered questions, such as the duration of prophylactic treatment for children whose echocardiograms return to normal following an initial diagnosis. High rates of regression, both on and off prophylaxis, have been shown in the trial. Good adherence to penicillin for secondary prophylaxis decreased the risk of rheumatic fever or RHD development by up to 71% compared with poor adherence, according to a 2024 comprehensive review and meta-analysis [6]. Another worldwide issue where research is making some progress is achieving high adherence to secondary prophylaxis. With new initiatives emerging to offer culturally relevant and efficient support, ongoing community engagement, and patient-centered approaches to understanding hurdles, these efforts have been expanding. The development of new penicillin prophylactic formulations is curre
Hyperferritinemia is increasingly recognized as a marker of inflammation and severity in sepsis. This study aimed to ascertain the level of ferritin as a predictor of septic shock (SS) and its association with outcome. A prospective observational study was conducted on 123 children diagnosed with severe sepsis and SS at a tertiary care hospital of North India. Serum ferritin levels were measured, with hyperferritinemia defined as levels >500 ng/ml. Good outcome was defined as discharge or improving clinical status, and bad outcome was defined as death or clinical deterioration. The association of hyperferritinemia with SS and clinical outcomes was analyzed and statistically evaluated. Analysis of the area under the curve (AUC) and the receiver operating characteristic (ROC) curve was constructed to assess the predictive strength of ferritin as a marker of SS. Sensitivity, specificity, and positive and negative likelihood ratios were calculated at different cutoff values of serum ferritin. Hyperferritinemia was found in 66.6% of patients, with significantly higher levels in SS (1,624.67 ± 1,522.02 ng/ml) than sepsis (727.02 ± 1,081.12 ng/ml, p = 0.005). Hyperferritinemia (serum ferritin ≥ 730 ng/ml) was a predictor of SS (AUC = 0.80; 95% CI = 0.72-0.89; p value = 0.02). Mortality was higher in patients with hyperferritinemia (odd ratio = 12.9; 95% CI = 1.67-99.90; p value = 0.001). Serum ferritin at a level of 2,214 ng/ml was found to be predictive of secondary hemophagocytic lymphohistiocytosis (sensitivity of 100% and specificity of 94.8%). Hyperferritinemia is prevalent in pediatric sepsis and SS and is significantly associated with higher mortality. Serum ferritin may serve as a potential prognostic marker for identifying high-risk patients.
Neonatal pain is a critical yet often under-recognized clinical issue, particularly in preterm infants who demonstrate heightened sensitivity due to neurological immaturity. Procedural pain, including vaccination, may have both immediate physiological effects and long-term neurodevelopmental consequences. The present study aims to compare the effectiveness of facilitated tucking and kangaroo mother care (KMC) in reducing pain during Bacillus Calmette-Guérin vaccination in preterm neonates with corrected gestational age ≥34 weeks. This randomized controlled trial was conducted in a tertiary neonatal intensive care unit (NICU) between 2022 and 2024. A total of 164 preterm neonates were randomized into facilitated tucking (n = 82) and KMC (n = 82) groups. Pain was assessed using the Neonatal Infant Pain Scale (NIPS), and physiological parameters were recorded. Statistical analysis was performed using Student's t-test, with p < 0.05 considered significant. Mean NIPS scores were significantly lower in the facilitated tucking group (1.9 ± 0.7) compared to the KMC group (3.2 ± 0.9) (p = 0.004). A greater proportion of neonates experienced no pain in the facilitated tucking group (52.4%) compared to KMC (35.3%). No significant differences were observed in physiological parameters. Facilitated tucking is more effective than KMC in alleviating vaccination-related pain in preterm neonates and can be recommended as a routine non-pharmacological intervention in NICUs.
Hemolytic disease of the fetus and newborn, which normally presents with unconjugated hyperbilirubinemia, has been known to cause cholestatic jaundice, albeit in rare circumstances; seen especially in the setting of Rhesus (Rh) hemolytic disease or when the mother has received intrauterine transfusion(s). Infants presenting with cholestatic jaundice in the setting of hemolytic anemia pose a clinical dilemma with regard to investigative approach and management. There are no evidence-based guidelines as to whether such infants should be managed conservatively or investigated comprehensively for other causes of cholestasis. Furthermore, whether such babies should receive chelation therapy besides supportive treatment is not known. We describe one such case where a neonate with Rh hemolytic disease presented with cholestasis and acute liver failure.
Emphysematous osteomyelitis is a rare and potentially life-threatening form of osteomyelitis characterized by intraosseous gas. In the absence of prior surgery or open fracture, it is most commonly seen in immunocompromised adults and associated with gram-negative organisms. We report a rare case of acetabular emphysematous osteomyelitis in a 12-year-old immunocompetent male child. Marrow signal alteration with soft tissue collection involving the right acetabular area of pelvic bones was seen on contrast enhanced magnetic resonance imaging. Computed tomography (CT) demonstrated intraosseous air foci with the characteristic pumice stone sign, confirming the diagnosis. Culture grew methicillin-sensitive Staphylococcus aureus. The patient was successfully managed with surgical debridement and antibiotic therapy. Early CT based diagnosis and prompt management are crucial for improving outcomes in this rare condition.
Celiac disease (CD) is an immune-mediated enteropathy triggered by dietary gluten in genetically susceptible individuals. Refractory iron deficiency anemia (RIDA) may be the sole presentation of CD in children. This study aimed to investigate the prevalence of CD in this group of patients. This prospective observational study was conducted over a period of 1 year at a tertiary care center of North India. Children aged 6 months to 14 years with refractory IDA were enrolled. Those with positive serology for CD underwent upper gastrointestinal endoscopy and histopathological examination. Out of 65 enrolled RIDA cases, the prevalence of CD was 23.0% (15/65). Significantly higher proportion of celiac RIDA had stunting (93.3% vs. 44.0%) and wasting (93.3% vs. 40.0%) as compared to undifferentiated RIDA. Clinical features such as lethargy, refusal to feed, vomiting, chronic diarrhea, failure to thrive, short stature, and abdominal distention were more frequent in Celiac RIDA cases. Anti-transglutaminase levels between celiac RIDA cases and undifferentiated RIDA cases were found to be statistically significant (p value < 0.001). Abnormal endoscopic findings were observed in 15 out of 23 cases (65.21%) consistent with CD, while the remaining 8 (34.78 %) had normal upper GI endoscopy findings. A significant proportion of children with refractory IDA have underlying CD, often without classical gastrointestinal manifestations. This significant prevalence value justifies the practice of testing patients with RIDA for CD.
This letter discusses critical methodological limitations in the recent study by Elseed et al. on cerebral palsy (CP). While addressing an important public health issue, the study\'s conclusions are weakened by the absence of a control group from the same catchment area, making it impossible to establish true risk factors. Furthermore, a severe selection bias is present due to the tertiary center setting. The exceptionally high consanguinity rate (76.7%) heavily confounds the results, as genetic etiologies were not ruled out. Finally, major statistical inconsistencies regarding patient age and clinical classifications, along with significant recall bias for children up to 16 years, further reduce data reliability. Methodological refinements are suggested for future studies.
Congenital diaphragmatic hernia (CDH) is a severe developmental anomaly with variable clinical outcomes, influenced by factors such as liver herniation, pulmonary hypertension, and associated anomalies. While familial clustering of CDH has been described, its occurrence in monozygotic twins remains rare. We report the case of premature monozygotic female twins diagnosed prenatally with left-sided CDH, delivered at 30 weeks and 1 day of gestation due to maternal hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. Both infants required immediate intubation and surgical correction. Twin A had no liver herniation or pulmonary hypertension and was discharged on day 66 with a relatively uncomplicated course, despite an episode of ileus that resolved conservatively. In contrast, Twin B presented with liver herniation, persistent pulmonary hypertension of the newborn (PPHN), and a hemodynamically significant patent ductus arteriosus (PDA). Despite PDA ligation, pulmonary pressures remained elevated, and cardiac catheterization revealed left pulmonary artery stenosis. Twin B also experienced reherniation of abdominal organs, necessitating a second diaphragmatic repair, and was discharged after 224 days with home oxygen therapy. This report illustrates the divergent clinical trajectories of genetically identical infants with CDH and highlights liver herniation, PPHN, and vascular anomalies as key prognostic factors. It underscores the importance of early prenatal diagnosis, individualized perinatal management, and the potential need for genetic evaluation in twin CDH cases.
