Pediatric Education and Research

This article discusses Indian burn prevention and first aid knowledge, attitudes, and practises. Rural and quasi-urban societies face preventative and first-aid issues. Poverty, over population, mysticism, and modernization coexist. This article on preventive measures should sensitise, educate, and foster communication between health care providers and the community. This could help provide clear and practical clinical guidelines for resource limited societies.

Context: One of the most important chronic clinical conditions seen in preterm babies is Bronchopulmonary Dysplasia (BPD) With improvement in technology and available therapeutic options, the survival rates have dramatically improved over time, how ever, the incidence of BPD still continues to remain the same even today. The injury resulting in BPD likely begins as altered lung development before delivery in many infants and can be initiated by resuscitation at birth and then amplified by postnatal exposures. The multifactorial pathogenesis implicated in the development of BPD necessitates a multidimensional therapeutic approach, to manage all the complex manifestations of the disorder. Aims: The presently used approaches for prevention as well as management are being used for more than a decade, and lack definite evidence. The aim of this literature review is to gather evidence on the presently available prevention and management approaches for bronchopulmoanry dysplasia, as well as newer, promising therapeutic agents being experimented, in order to provide data to help optimize strategies in the NICU as well as OPD settings and help reduce the incidence of BPD and promote more definitive studies. Methods and Materials: We carried out an extensive series of searches on PubMed database and tried to capture as many citations as possible for Bronchopulmonary dysplasia in preterm neonates, with peer-reviewed publications from 2000-2022. Approximately 96 studies, including animal studies, RCTs and systematic review and meta-analyses were considered. On going experiments were queried from Clinical Trials.gov. The searches were carried out using the terms: “Bronchopulmonary dysplasia”, “BPD”, “Preterm neonates”, “low birth weight”, “pathogenesis”, “diagnosis”,”prevention”,”treatment”. Further manual assessment was also done to include other relevant publications. Results: Prevention of prematurity, systematic use of non-aggressive ventilator measures, avoiding supraphysiologic oxygen exposure and administration of surfactant, caffeine and vitamin A, antenatal glucorticosteroids, and pharmacotherapeutics agents like diuretics, vasodilators, nitric oxide etc. can significantly reduce the risk of BPD development. MSC therapy, IGF-1 and clara cell protein administration are the most fascinating new measure to address the lung damage due to BPD. Conclusion: Despite advancement in technology and availability of a myriad of treatment options, the multifactorial nature of BPD makes it a persistently challenging disorder to treat and even more so to prevent. While multiple therapies are used routinely either alone or in combination (potentially increasing drug–drug interactions and associated side effects), there is insufficient evidence supporting short and longer-term use of many of these agents. There is continued need for future meta-analyses and prospective randomized controlled studies designed to measure clinically meaningful outcomes, and an even greater need to design trials evaluating the safety, efficacy, and dosing of pharmacologic agents in this population. Stem cell treatment and other such innovative strategies may be the beginning of a new era in the treatment of BPD. New ways of preventing or modulating BPD are on the horizon, and will hopefully lead to continued improvement of long-term outcome of prematurely born infants.

Beta Thalassemia is a hereditary blood disorder characterized by defect in synthesis of beta chains of haemoglobin requiring regular blood transfusion and chelation therapy. Blood transfusions can lead to many complications of which transfusion transmitted infections like HCV, HBsAg, HIV etc are possible. Iron overload is another complication of repeated blood transfusion which further predisposes them to many infections like Mycobacterium Tuberculosis. Hemophagocytic Lymphohistiocytosis (HLH) is one of the rare complication where there is abnormal activation of immune system which results in cytokine storm. Here we present a case of transfusion dependent thalassemia patient, who developed HCV and Pulmonary Kochs complicated with HLH all at the same time and was managed successfully.

Primary ciliary dyskinesia (PCD) is a genetic disorder of cilia structure, function and biogenesis leading to chronic infections of the respiratory tract, due to congenital impairment of mucociliary clearance. Mutation in genes coding components of cilia can result in primary ciliary dyskinesia. Learning disabilities are the disorders that affect the acquisition, retention, comprehension or the application of verbal and or nonverbal information. Our patient presented with recurrent respiratory tract infection requiring nebulization with antibiotics treatment on Out patient department basis. Child's Radiological investigation and Genetic study were planned and done which later confirmed the diagnosis. Child also had poor Scholastic performance along with behavioral issues for which detailed psychiatric evaluation was done which was suggestive of border line intellectual deficit with learning disability and Attention Deficit Hyperactive Disorder (ADHD) for which child was started on treatment along with behavioral therapy.