Pediatric Education and Research

Background: The rapid and deadly spread of the novel coronavirus in Mumbai necessitated population wide seroprevalence analysis including the paediatric subset. This would assist in healthcare interventions and shaping of public policies amidst the raging pandemic. Methods: This observational, cross-sectional study was conducted across twenty-four wards of Mumbai using left over blood samples from individuals younger than 18 years from public and private laboratories, during the delta wave. Chemiluminescence assay (CLIA) was performed to detect anti-nucleocapsid IgG (anti-N IgG); anti-N IgG negative samples were subsequently tested for anti-spike protein S1-receptor binding domain IgG (anti-S1RBD IgG). The primary outcome of presence of either anti-N IgG or anti-S1 RBD IgG, was reported using Chi–squared test of equal proportions to determine the strength of association. The 95% confidence interval of the seroprevalence was calculated using Clopper Pearson exact method. Results: 51.5% of the 2172 samples tested were seropositive for either anti-N IgG or anti-S1 RBD IgG antibodies. Samples collected from public facilities showed higher seropositivity than those from private facilities. There was no significant difference in seropositivity based on gender or age alone. Conclusion: The results of this study suggest that half of the children living in Mumbai had antibodies to SARS-CoV-2 during the Delta wave. The study highlights the involvement of the paediatric population in community transmission despite school closures and lockdown measures. With the evolution of SARS-CoV-2 into Omicron, it is safe to assume that the virulence of SARS-CoV-2 has the potential to alter. Therefore, the physical, mental and social well-being of children must be weighed into every public health policy moving forward.

Hypospadias with Megameatus intact prepuce has variable anatomy which is hidden by intact prepuce. Although considered akin to Hypospadias in clinical features and presentation, they are a different entity wherein the defect in the urethra is masked by the intact prepuce surrounding it. The embryology behind this defect appears to be different compared to the embryology behind hypospadias. They often present late. As in a case of hypospadias, local anatomy of the defect guides the appropriate surgical procedure for correction. The variable position of the meatus, level of urethral defect, status of the glans and the glans groove are the anatomical aspects which determine the choice of the procedure. We recently managed a case of a grown-up child having Hypospadias with Megameatus intact prepuce. The clinical and surgical detail of this case is presented with emphasis on the need of early detection, case specific surgical intervention, and need for evaluation on follow-ups.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a significant cause of invasive infections in the pediatric population. While community acquired MRSA (CA-MRSA) is often associated with skin and soft tissue infections, it can present with life-threatening systemic manifestations, including sepsis, pneumonia, osteomyelitis, and septic arthritis. Case Report: An 11-year-old previously healthy boy presented with a 10-day history of leg pain following minor trauma, fever, generalized vesicular rash, and progressive inability to stand. Initial evaluation suggested viral myositis, but the patient deteriorated rapidly with respiratory distress and signs of systemic inflammation. Imaging revealed bilateral pneumonia and pericardial effusion. Laboratory investigations showed leukocytosis, thrombocytopenia, elevated CK-MB, and inflammatory markers. He was managed with intravenous fluids, acyclovir, and empiric antibiotics. However, persistent fever and worsening hip pain prompted further imaging, which revealed osteomyelitis of the right femur with adjacent soft tissue collection and right hip joint infective synovitis. Blood culture grew MRSA, and antibiotics were escalated to vancomycin and clindamycin. Surgical debridement and drainage were performed, and the child improved significantly thereafter. Conclusion: This case highlights the aggressive nature of CA-MRSA and its potential to mimic viral illness initially. It emphasizes the importance of early imaging, culture guided antibiotic escalation, and timely surgical intervention in managing pediatric MRSA osteoarticular infections.

Pneumomediastinum in the paediatric age group is anuncommon condition associated with severe trauma, infection, structural lung pathology or iatrogenic injury to the trachea or esophagus. Severe pneumomediastinum may coexist with pneumothorax and subcutaneous emphysemaleading to serious complications like airway obstruction and cardiac tamponade. Therefore, early diagnosis and timely management are essential to look for the etiology and prevent further damage. Here, we present a case of spontaneous pneumomediastinum and subcutaneous emphysema secondary to trivial trauma to highlight the pathogenesis and suggest therapeutic strategies.

Tuberculosis (TB) is significantly associated with mortality and morbidity worldwide. Although there is significant reduction in the incidence and mortality, the disease burden of TB still poses a public health concern. India is committed to achieving the United Nations sustainable development goals (SDGs) of ending TB by 2030. Under the National Strategic Plan (NSP) of the National TB Elimination Program (NTEP) during 2017-2025, India planned to achieve the target by implementing four pillars of “detect treat prevent build (DTPB)”. Multipronged dynamic strategies are currently employed by the Government of India to maintain the momentum in the direction of TB-free India. Active case detection, prompt treatment, preventive therapy, sustained availability of antitubercular drugs, and community engagement are key challenges need augmentation. A strong political will, active community engagement involving all stakeholders, increased spending on TB research and innovation, and easy and undisturbed access to diagnostics testing and medication can drive the way forward for achieving a TB-free India in the near future.