INTRODUCTION:Paediatric orbital tumours include a broad spectrum of benign and malignant lesions that range from developmental anomalies to primary and metastatic orbital malignancies. Sometimes, clinical signs and symptoms are not enough to differentiate between orbital lesions; hence, MRI plays a crucial role in cases where clinical and historical findings are inconclusive. AIMS AND OBJECTIVES:The aim of the study is to evaluate the different orbital tumours in paediatric patients by magnetic resonance imaging and their pathological correlation. MATERIALS AND METHODS:We conducted a prospective observation study of 64 paediatric patients (38 males and 26 females), with an age range of one month to 15 years and a mean of 4.6 years, who underwent orbital MRI for suspected tumors at Indira Gandhi Institute of Medical Science, Patna, a tertiary care center, over a period of one year. RESULTS:Of 64 patients (mean age 4.6 years), 38 (59.3%) were boys and 26 (40.7%) were girls. The most common presentation in our study is leukocoria (white pupillary reflex), and out of 64 cases, 37 (57.8%) were found malignant and 27 (42.2%) were benign lesions. The most common diagnosis was retinoblastoma (32 cases, 50%). Common benign tumours include dermoid cyst, capillary hemangioma, epidermal inclusion cyst and lipodermoid cyst. CONCLUSION:As symptoms are not well appreciated in paediatric orbital tumours, for early diagnosis and staging, excellent imaging (MRI ) and histopathological examination are necessary in order for timely detection and to prevent advanced stage at presentation.

Background: Hand hygiene is a critical global healthcare issue and a proven cost-effective measure to reduce healthcare-associated infections. Assessing awareness and compliance among healthcare workers is therefore essential. Aim was to evaluate the knowledge, attitude, and practice (KAP) of hand hygiene among final-year medical students and its association with selected variables. Methods: A cross-sectional study was conducted among 270 final-year medical students at a tertiary care teaching hospital in Indore, central India. Knowledge, attitude, and practices related to hand hygiene among previously trained and untrained participants were assessed using a self-administered questionnaire, including the WHO hand hygiene knowledge assessment tool. Data were entered into Microsoft Excel and analyzed using the Chi-square test. A p value <0.05 was considered statistically significant. Results: Overall, participants demonstrated moderate knowledge, attitude, and practice of hand hygiene. Among trained students, 55.7% had adequate knowledge compared to 49.6% of untrained students. Similarly, a positive attitude was observed in 61% of trained versus 51.7% of untrained students. Practice compliance was also higher among trained participants (59.5%) than untrained ones (56.8%). Although both groups showed moderate responses, trained students consistently outperformed untrained peers. Conclusions: The study highlighted the need for rigorous and comprehensive training programs on hand hygiene. Regular reinforcement of hand hygiene techniques can motivate medical students and ensure they remain updated on current best practices. Effective training during medical education may significantly improve compliance and reduce healthcare-associated infections.

Background Fetal growth restriction (FGR) is a significant perinatal concern associated with increased neonatal morbidity and long-term pediatric complications. Maternal high-risk factors such as hypertension, diabetes, malnutrition, and infections are known contributors to FGR. Objectives - To clarify the relationship between maternal high-risk variables and the pediatric effects of FGR. - To evaluate the pediatric outcome after 1-year follow-up. Methods A prospective observational study was conducted at IGIMS, Patna, over 1.5 years involving 92 FGR neonates. Maternal risk factors and neonatal outcomes were recorded, with follow-up assessments up to 12 months to evaluate growth and development. Results A total of 92 neonates with fetal growth restriction (FGR) born to high-risk mothers were enrolled. The mean maternal age was 28.4 ± 4.7 years; 48.9% were primiparous. Hypertensive disorders (52.2%) and diabetes mellitus (19.6%) were the most common maternal risk factors. Neonatal outcomes included hypoglycemia (37.0%), respiratory distress (31.5%), and NICU admission (55.4%). Significant correlations were found between maternal hypertension and NICU admission (p=0.003), and between diabetes and neonatal hypoglycemia (p=0.001). At 12-month follow-up, 29.3% had delayed developmental milestones, and 33.7% showed persistent growth impairment, indicating a strong association between maternal risks and adverse pediatric outcomes. Conclusion Maternal high-risk conditions significantly affect both immediate and long-term outcomes in FGR neonates. Early antenatal intervention and structured pediatric follow-up are essential to improve prognosis.

Introduction: Portal hypertension in children is associated with the emergence of myriad complications. Esophagogastroduodenoscopy, though, has the upper hand in diagnosing portal hypertension and varices over the Doppler study, yet it is an invasive technique. The study was intended to assess the prospects of transient elastography (FibroScan) and explore its relationship with clinical, sonographic, biochemical, and endoscopic findings. Materials and Methods: This cross-sectional, single-center study included 23 pediatric patients with portal hypertension. The objectives were to assess the role of biochemical markers and transient elastography in pediatric portal hypertension patients and to determine the correlation between transient elastography and upper gastrointestinal endoscopic findings. Unpaired t-test, Wilcoxon–Mann–Whitney U test, and Spearman correlation tests were used to assess the relationships between variceal grading, liver stiffness, biochemical markers, and physical clinical findings. Results: The mean of median stiffness of the liver recorded was 19.67 ± 14.85 kPa, with a female predominance, showing a higher degree of fibrosis. A positive association was detected between higher grading of fibrosis with total bilirubin (rho = 0.42, P = 0.045), alanine transaminase (rho = 0.5, P = 0.038), and gamma-glutamyl transferase (GGT) (rho = 0.43, P = 0.038). Esophageal varices were observed in all patients, with higher variceal grading being associated with a greater degree of fibrosis, but it was not found to have a statistically significant association. Conclusion: Transient elastography values correlate with clinical features, etiology, and biochemical parameters and can be used as a noninvasive diagnostic tool in pediatric portal hypertension patients.

Background & objectives Studies suggest hypothyroidism is responsible for female infertility. This review aimed to determine the pooled prevalence of hypothyroidism in Indian infertile women so that hypothyroidism screening can be initiated, and policies are designed for prevalence reduction. Methods Electronic databases including PubMed, Google Scholar and Cochrane library were searched to obtain the relevant articles. Studies that reported the proportion of hypothyroidism in Indian infertile women were selected. Systematic procedures for study selection and data extraction were followed. Each study was evaluated for quality using the Joanna Briggs institute (JBI) critical appraisal checklist. To pool the effect sizes, a random effects model was utilized. Funnel plot and Egger’s test were used to assess publication bias. To quantify heterogeneity among studies, I2 statistics were utilized. Subgroup and meta-regression analyses were used to further investigate the heterogeneity of pooled estimates. The sensitivity analysis done whereby each study was excluded in order to examine the influence of that study in the pooled estimate. A P-value of 0.05 or less was considered statistically significant. Results Out of 198 articles, a total of 20 studies involving 2396 cases met the inclusion criteria. The pooled prevalence of hypothyroidism in women with infertility was 28 per cent [95% confidence interval (CI): 20% to 36%] which was highest in Telangana at 62 per cent (n=1; 95% CI 48% to 74%) and lowest in Karnataka at 14 per cent (n=2; 95% CI: 10% to 18%). Interpretation & conclusions Infertile women have high proportion of hypothyroidism, suggesting that screening programmes during diagnostic workup for infertility may provide optimal care. The result of this meta-analysis will help design guidelines and earmark highest prevalence regions to initiate preventive and diagnostic measures for prevalence reduction in future.

Mixed connective tissue disease (MCTD) is one of the rarest connective tissue diseases. Incidence is around 2–3 cases per 100,000 people. The diagnosis is often difficult due to multiple diagnostic criteria and overlapping features with other connective tissue diseases such as systemic lupus erythematosus, systemic sclerosis, and juvenile idiopathic arthritis (JIA). An accurate diagnosis is important for proper treatment and follow-up. We report two pediatric cases, who initially presented with common diseases such as nephrotic syndrome and JIA, but later turned out to have MCTD after completing the workup. Both patients had strongly positive anti-U1-ribonucleoprotein (RNP) antibodies. The first patient had features of Raynaud’s phenomenon as supportive evidence of MCTD. The second patient had hand edema, aseptic meningitis, and myositis as the supporting evidence in addition to clinical features and strongly positive anti-U1-RNP antibodies. Both patients showed good improvement after proper treatment and are under our follow-up.

INTRODUCTION:Rabies continues to be a significant concern in India, with lots of deaths reported annually. Approximately one million people undergo post-exposure prophylaxis treatment annually, despite nearly two million dog bites occurring across the country. Notably, dogs are responsible for more than 99% of these bites. Public understanding of rabies treatment remains limited, with many incorrectly believing that it involves 14 injections following a dog bite. However, there is limited awareness about the potential severity of the disease if dog bites are not properly managed. Rabies, an ancient ailment, remains the most dreaded among all contagious diseases. AIM:This study aimed to assess the knowledge, attitudes, and practices (KAP) of the people residing in rural Patna and also to identify the sociodemographic factors that might influence KAP regarding dog bites and their management. METHODOLOGY:A field-based cross-sectional study was carried out in the rural field practice area of Indira Gandhi Institute of Medical Sciences (IGIMS), Patna. The study population comprised the patients attending the outpatient department (OPD) at the Rural Health Training Centre (RHTC), Maner, during the study period. The study duration was about six months, that is, from November 2023 to April 2024. RESULT:The majority (56.4%) of the study population were of the age group 18-40 years. The major bulk of the study population was male, and most of them were illiterate, that is, 67.6%; only 5.2% of the study population were graduate and above. A higher percentage (30.9%) of the study population were farmers or laborers by occupation. About 53.9% of the study population belonged to the upper middle class. A significant difference was seen among age groups in knowledge concerning the cause of rabies (p=0.023), the spread of rabies by dogs (p=0.001), symptoms of rabies such as altered personality (p=0.001), the possibility of rabies cure (p=0.001), and the importance of seeking medical help promptly after a dog bite (p=0.004). Generally, younger patients showed higher awareness and knowledge regarding these aspects compared to older age groups. CONCLUSION:The present study showed a significant knowledge gap with respect to cases of dog bite management in rural Patna. Even though awareness of rabies is present, there is an alarming lacuna in this awareness being converted to wound-washing practices and timely seeking of medical care. To decrease the risk associated with dog bites and rabies transmission, structured educational campaigns and community-level interventions are important. These measures can significantly improve rabies prevention in general and rural areas in particular.

Nephrotic syndrome, the most common renal disease in pediatric age group, is responsible for frequent hospitalization of children. As parents are the most responsible person for care of their children, it is necessary for them to be aware and have knowledge regarding strict adherence to therapeutic regimen, about the disease recurrence and measures for adequate care of their child’s health. An information booklet on nephrotic syndrome can help the caregivers in understanding the disease process and in maintaing their child’s health. Effect of an information booklet on nephrotic syndrome regarding knowledge and attitude of caregivers towards care of children with nephrotic syndrome in tertiary level centre of BiharThis cross sectional study was carried out on admitted patients in Indira Gandhi Institute of Medical Science, Bihar from January 2021 to December 2021. An information booklet on nephrotic syndrome was given to caregivers of children diagnosed with nephrotic syndrome. About 50 parents/caregivers were interviewed with a preformed structured questionnaire before and after reading the information booklet.Of 50 respondents, an overall improvement in knowledge increased from 18% in pretest to 80% in post test. This result proves that the information booklet helped in improving the knowledge of caregivers towards care of their children. The present study concluded that there was significant improvement in knowledge of caregivers after administrating information booklet.

Celiac disease (CD) is a multisystem chronic inflammatory disorder with an autoimmune component in genetically susceptible individuals elicited by gluten and related prolamines. CD is becoming a common disorder arising at any age with a broad spectrum of symptoms ranging from intestinal to extraintestinal manifestations. Extraintestinal symptoms being more common after 2 years of life, can affect various systems and organs of the body. Knowledge of the extraintestinal manifestations of celiac disease is of utmost importance for the diagnosis of CD. Owing to the high risk of complications among the undiagnosed cases of CD, patients with extraintestinal manifestations should undergo appropriate diagnosis and treatment for CD.

Background: Urinary Neutrophil Gelatinase Associated Lipocalin (uNGAL) has been demonstrated to be a powerful marker of progression in chronic kidney disease. The present study was done to find out the ability of uNGAL as a biomarker to differentiate steroid-sensitive nephrotic syndrome (SSNS), steroid-dependent nephrotic syndrome (SDNS), and steroid-resistant nephrotic syndrome (SRNS) from each other.Method: The cross-sectional study included 45 patients with Idiopathic Nephrotic Syndrome (INS) (15 each of SSNS, SDNS, and SRNS). uNGAL was measured by ELISA. Demographic profile of patients with INS, lab parameters including Serum albumin, cholesterol, urinary albumin, creatinine, etc., were estimated using standard laboratory methods. Various statistical methods were used to assay the usefulness of NGAL as a diagnostic marker.Results: Among the three groups, the median value of uNGAL was 8.68 ng/ml in SSNS, higher in SDNS (32.8 ng/ml), and highest in the SRNS group (50 ng/ml). The receiver operating curve (ROC) was generated for uNGAL to differentiate between SDNS and SSNS. Cut-off 13.26 ng/ml had a sensitivity of 86.7% and specificity of 97.4%, PPV 92.9%, and NPV 87.5 % with an area under the curve (AUC) of 0.958. Another ROC was generated for uNGAL to differentiate between SRNS and SDNS, and cut-off 40.02 ng/ml had a sensitivity of 80% and specificity of 86.7% with an AUC of 0.907. A similar result was observed when ROC was generated to differentiate SRNS from SSNS and SDNS combined.Conclusion: uNGAL can distinguish between SSNS, SDNS, and SRNS.

Introduction: Immunization-a successful and cost-effective measure-to protect children is facing the growing challenge of vaccine hesitancy (VH), especially for countries seeking to close the immunization gap. Objective: The objective of this study was to determine the prevalence of VH and its determinants. Methods: A cross-sectional study was conducted in an immunization clinic, KIMS, Bhubaneswar, from May to July 2019. Data were collected by interviewing parents accompanying their children. Parents were classified as pro-vaccine, vaccine-hesitant, or anti-vaccine on self-reports (as per fixed researcher-made operational definition). Of 117 participants contacted, 29 refused for any vaccine administration and were hence excluded, making a total sample of 88. Results: Of 88 participants, 39.8% were pro-vaccine and 60.2% vaccine-hesitant; the proportion of VH being 45.3%; although most pro-vaccine and hesitant parents agreed about the benefits of vaccinations. The mean age of the children was 3.65 ± 1.96 years. Family pediatricians were considered a reliable source of information by most pro-vaccine and hesitant parents (56.1% and 43.9%, respectively). The main factors which had a statistically significant association with VH were education of the father (P = 0.03), education of the mother (P = 0.036), and socioeconomic status (P = 0.0016). Conclusion: Vaccine safety is perceived as a concern by all parents, although more so by hesitant parents. Training health professionals and providing homogenous information about vaccination, in line with national recommendations can help in responding to their concerns.

Objectives: The study was planned with the objectives to assess the under-two immunization coverage and to identify determinants and reasons for non-utilization.Methodology: It was a cross-sectional study which was undertaken in urban slums under field practice area of a medical college, over a span of 4 months among 100 mothers with children 12–23 months of age. Descriptive statistics was used and Fisher’s exact test as the test of association; taking p<0.05 as statistically significant.Results: Mean age of the children was 17.63 months±3.43.72% were fully immunized, 28% partially, and none in unimmunized category. Mother’s literacy status (p=0.03) and father’s literacy status (p=0.0001) were found to be significantly associated with the immunization status of the child. The immunization coverage based on card and history was – BCG (93%), OPV1 (88%), OPV2 (86%), OPV3 (82%), pentavalent 1 (88%), pentavalent 2 (84%), pentavalent 3 (82%), and measles (84%). Waiting time (85.71%) and lack of adequate information (67.86%) were reasons cited for partial immunization.Conclusion: The overall immunization coverage was good with none unimmunized. The literacy status of the parents played a major role in determining the immunization status of the children. Waiting time and lack of information were some of the identified barriers.

Background Hospital-acquired infections (HAIs) are the most severe complications of intensive care stay, especially in pediatric patients. Proper hand hygiene (HH) is the cheapest, simplest, but often neglected method to prevent HAIs. The World Health Organization (WHO) has formulated and promoted a standardized recommendation for HH. Both the WHO and the Centers for Disease Control and Prevention (CDC) recommend the use of soap and water for handwashing whenever there is visible dirt on the hands. In all other situations, an alcohol-based hand rub is an effective alternative. The quality improvement (QI) methodology has been widely followed in many countries to improve basic and advanced healthcare systems. The QI strategy follows the plan-do-study-act (PDSA) method. Methodology This quasi-experimental (pre- and post-intervention), prospective, QI study was conducted at the neonatal intensive care unit and pediatric intensive care unit of the pediatrics department in a tertiary care hospital in Bihar, India. A QI team was formed. The study was divided into four phases. WHO charts for assessing HH compliance were used for observation and data collection. The EQUATOR Checklist (Squire Checklist) was used to accurately report the QI work. Epi Info™ (version 7.2.5) was used for statistical analysis. The chi-square test was used to measure the statistical difference between pre- and post-intervention HH compliance (proportions). Results In the pre-intervention phase, a total of 106 HH opportunities were observed. The HH compliance at this stage was 40.6%. The QI team conducted several meetings, and a root cause analysis was performed with the help of the Fishbone diagram. It was decided to target three probable causes, namely, (a) less awareness, (b) inconvenient locations of hand rub dispensers, and (c) forgetfulness. The QI team decided to run three PDSA cycles. In the last phase, 212 HH opportunities were observed with a compliance percentage of 69.8%. There was a significant improvement when data of pre- and post-intervention HH compliance were compared in all categories of healthcare workers (HCWs), except doctors, where the improvement was not statistically significant. When the cumulative data of all subtypes of HCWs were analyzed, there was a significant improvement (p < 0.0001). Run charts and box plots were used for the easy depiction of the results. Conclusions Adopting proper HH methods remains the most effective way of preventing nosocomial infections, especially in intensive care units. We used the WHO model of HH in our study. The pre-intervention HH compliance was 40.6%. QI methodology using root cause analysis and implementation of three PDSA cycles were used to increase the HH compliance percentage. Post-intervention HH compliance increased to 69.8% and the effect was sustained. The study highlights the usefulness of the QI methodology in bringing small but important changes in clinical practice for better patient care.

Introduction: Speech and language development is an important indicator of a child's overall development and intellectual functioning. There is a large amount of data on the prevalence and risk factors of speech and language delay from the West, but relatively scanty data from India. Language Evaluation Scale Trivandrum (LEST) is a screening tool for use in outpatient clinics and communities for identifying language delay in toddlers. Materials and Methods: A descriptive study of the cross-sectional design was done on 350 children between 0 and 36 months attending outpatient and immunization clinics. A proforma with demographic details of parents, antenatal, and perinatal risk factors were completed. All caregivers were asked for a home screening questionnaire to assess the home environment. Language delay was identified using the LEST scale. The association of language delay with antenatal, perinatal risk factors, socioeconomic status, and home environment were analyzed. Results: The prevalence of language delay was 7%. No association was found between language delay and type of family, place of residence, antenatal complications, perinatal complications, gestational age, birth weight, and socioeconomic status. A negative home environment and second birth order were significantly associated with language delay.

Korku Tribe is one of the poorer and most deprived tribal group in India mostly residing in Maharashtra and Madhya Pradesh region. The Korku tribe resides majorly in the Melghat region of Maharashtra which is very much famous for the backwardness in development. The lower socio-economic status has impacted them very badly as most of these tribes are malnourished and the cases of child mortality is very common. The Korku tribes of this region still do not have the proper health care facilities due to which their indigenous medicinal practices are very common. To maintain the better health among Korku tribes of Melghat region, Amravati, the people belonging to this community uses plants, leaf, stems, seeds, fruits, roots etc. This paper will discuss the use of indigenous medicinal practices which are practiced by the Korku Tribe of Melghat, Amravati region.

Introduction: Neurological disorders are characterized by dysfunction in any part of the nervous system and are a major cause of disability among children and adolescents in developing countries, just as it is in India. There is a lack of information on the prevalence of neurological disorders in developing countries due to the lack of quality health information and a lack of awareness of these disorders. This local study aims to provide an understanding of the profile and characteristics of neurological disorders in children that will aid in the development and implementation of preventive healthcare strategies. Methods: A retrospective observational study was conducted in the Department of Pediatrics. All pediatric neurology patients' data were retrieved from January 2020 to December 2020. Results: Of the 12,782 children seen in the pediatric outpatient department (OPD), 133 (1.04%) had neurological disorders and about 65% were male. Childhood seizures 92 (69%) and developmental delay 13 (9.7%) were the most common neurological conditions, although there was an overlap of the conditions. Conclusion: This study provides some valuable information about common neurological disorders in children. Seizures, cerebral palsy, and developmental delay were the most common neurological disorders in children.

Background This study aimed to determine the clinical and echocardiography profile of congenital heart diseases (CHDs) among admitted children as well as patients presenting to the outpatient department of the Indira Gandhi Institute of Medical Sciences, Patna, which is a tertiary care and apex institute located in Bihar, India. Methodology A retrospective, cross-sectional study was conducted in a tertiary care hospital from January 2019 to January 2021. In total, 200 patients aged 0-12 were enrolled in the study. The study design was exploratory, with a proforma drafted to study patients with features suggestive of CHDs. All pediatric echocardiography was performed by a trained cardiologist. Records were obtained from the departmental record-keeping register, and reports were available for analyzing the data. For data collection, cardiology and pediatric department registers were reviewed and all CHD data were collected. Data analysis was done using SPSS software version 25.0 (IBM Corp., Armonk, NY, USA). Results Of the 200 children with CHDs, 142 were diagnosed to have acyanotic heart disease (ACHD), while 58 had cyanotic congenital heart disease (CCHD). Among 200 cases of CHD, ventricular septal defect (VSD) constituted 62 cases comprising 31% of the total CHD cases and 44% of all ACHD cases. Atrial septal defect (ASD) was the second most common CHD comprising 23% of all CHD cases. Tetralogy of Fallot (TOF) constituted 23 cases accounting for 11.5% of all CHD cases. It was the most common CCHD. Based on the age at the time of presentation, 90 (45%) cases were diagnosed below one year of age. Congestive heart failure (CHF) was most common in ACHD comprising 30% compared to CCHD in which only 7% of cases had CHF. This finding was statistically significant (p < 0.05). Analyzing the symptoms of different CHDs, of both ACHDs and CCHDs, the common symptoms were fast breathing (38%). Conclusions Among ACHD patients, 31% VSD and 21% ASD were noted. In CCHD, TOF was the most common with 11.5% of cases. Respiratory tract conditions were the most common comorbidities encountered. Because this is one of the first studies conducted in Bihar in the pediatric age group, it can help know the prevalence of CHDs in this region and will be useful for developing policies by stakeholders.