Impact of lockdown due to COVID-19 pandemic on neurobehavioral profile of children aged 6-12 years (NeuBeC study).

Background: The lockdown due to the COVID-19 pandemic has affected the lives of children and resulted in behavioral and emotional disturbances in children. This study was planned to identify the prevalence of these problems in Indian children. The aim of the study was to estimate the effect of lockdown on the neurobehavioral profile of children 6-12 years of age by using the Child Behavior Checklist (CBCL) scale. CBCL is the most widely used validated scientific tool to detect behavioral and emotional problems in children. Materials and Methods: All children 6-12 years of age who were fulfilling the inclusion criteria of the study were included from all over India through an online Google form link. The children attending the outpatient department (OPD) at our tertiary-level care medical college were also included in offline mode. Data were collected and entered in an Excel sheet and analyzed statistically. Results: A total of 173 children in the age group 6-12 years were enrolled. The mean standard deviation (SD) age of all children was 8.88 (1.84) years, out of which males were of a mean age of 9.2 (1.84) years and females were 8.44 (1.74) years. Total CBCL T-scores (mean (SD)) for internalizing, externalizing, and total scores were 63.07 (7.98), 63.95 (6.51), and 62.39 (4.9), respectively. Conclusion: Lockdown has resulted in neurobehavioral changes in normal children. The independent predictors found were the increase in screen-based media use, sleep issues, or behavioral changes like aggression due to restriction of their mobility or confinement. Females exhibited more internalizing problems, and males exhibited more externalizing problems.

Prevalence and Predictors of Effective Face Mask Usage Among Children During the COVID-19 Pandemic.

A total of 320 children, aged 1 to 14 years were observed to ascertain the prevalence of face mask usage and the factors affecting the same. 67% of children used face masks, but only 25% of them used them correctly. Factors such as age, type of school, socioeconomic status, maternal education, history of allergic diseases, COVID vaccination status of the parents, and having a sibling were significantly associated with the use of face masks. Age-appropriate targeted health interventions should be implemented to improve proper mask usage.

Efficacy of oral mefenamic acid versus paracetamol as a prophylactic analgesic for needle pain in children receiving vaccination: a three-arm, parallel, triple-blind, placebo-controlled MAP VaC randomized controlled trial.

Background: Needle pain due to routine vaccination is an important factor contributing to low vaccine adherence and immunization coverage. Prophylactic oral analgesics can address this important issue of needle pain related to vaccination. Paracetamol and mefenamic acid are commonly used nonsteroidal anti-inflammatory drugs for pain relief, but there is little published literature on whether the same can be used for needle pain related to vaccination. Objectives: This study was planned to compare the efficacy of oral mefenamic acid and paracetamol over placebo as a prophylactic analgesic during vaccination and prophylactic antipyretic during the post-vaccination period. Designs: Three-arm, triple-blind, randomized controlled trial. Methods: This study was conducted at the outpatient department of a tertiary-level medical college in South India from January 2021 to June 2022. In this three-arm interventional trial, each arm had either a single dose of placebo or mefenamic acid (4 mg/kg/dose) or paracetamol (10 mg/kg/dose). These medicines were administered orally 30 min before vaccination to reduce needle pain. Main outcome and measures: Outcome was measured with the change of FLACC (Face, Leg, Activity, Cry, Consolability) scoring at the time of vaccination, subsequently at 15 and 30 min of vaccination in all three groups. Appearance of fever, grade of fever, and need for antipyretics 24 h after vaccination were also noted. Results: There was a significant difference in FLACC scores at the time of administration (p = 0.010) and at 15 min (p = 0.014) with mefenamic acid compared to placebo. Although the paracetamol group showed a difference when compared to the placebo, it was not significant at the time of administration (p = 0.401), at 15 min (p = 0.451), or 30 min (p = 0.892) post-vaccination. The appearance of fever, grade of fever, and use of antipyretic up to 24 h post-vaccination had no significant difference among any of the three groups. Conclusion: Mefenamic acid was more potent than placebo for pre-vaccination pain prophylaxis in children. There was no difference in the appearance of fever and its grade among the three groups. The promising results from this trial warrant further large-scale studies to recommend a single oral dose of mefenamic acid to tackle needle pain related to vaccination in children to improve vaccine adherence and coverage. Trial registration: CTRI (Clinical trials registry-India) (CTRI/2021/01/030239). [Date of Commencement: 13 Jan 2021, Date of last recruitment: 30 June 2022 (now closed for new participants)].

Risperidone-induced respiratory depression in a neonate through breast milk.

Risperidone is commonly used in postnatal mothers for depression and psychotic symptoms in spite of little data on its safety profile in neonates. It is reported previously that 6 mg/day can be used in mothers without having any untoward in breastfed neonates. Excretion of risperidone is dependent on the enzyme CYP2D6 whose activity varies as per individual phenotype. Maximum therapeutic levels are achieved at 2 h of administration of the drug. We are reporting a case of preterm breastfed neonate who presented with respiratory depression twice due to risperidone usage in its mother. This is the first reported case where 1 mg/day dosage of risperidone in nursing mother was associated with acute adverse effects such as respiratory depression in her neonate. The Naranjo Adverse Drug Reaction Probability Assessment Scale scored to 8 which suggests probable relation between the drug and its reaction in neonates. It underscores cautious use in mothers and close monitoring of neonates when risperidone is prescribed irrespective of dosage.

Carpal tunnel syndrome ascribed to low-dose combined oral contraceptive pills.

Carpal tunnel syndrome (CTS) is the most prevalent compressive focal mononeuropathy brought on by median nerve compression, and common manifestations include pain in the wrist joint, decreased sensations along the distribution of the median nerve, a reduction in two-point discrimination, nighttime awakening, and, in more advanced stages, thenar muscle wasting and weakening. CTS, although common, yet underreported adverse effects of oral contraceptives. We report a case of 21-year-old female who developed CTS after using low-dose combined oral contraceptive pills for irregular cycles with polycystic ovary disease.

Are doctors allowed to cry at work?

This article recounts a poignant interaction between the author and a mother of a child with cerebral palsy. The mother's remarkable strength and optimism in the face of adversity deeply moved the author, leading to a tearful moment which prompted a comforting response from the mother. The ongoing debate regarding whether doctors are allowed to display emotions in their professional lives centers around the challenge of balancing professionalism with the emotional impact of providing healthcare to patients. While doctors are expected to uphold professionalism and make sound decisions in their work environment, simultaneous expression of emotions, empathy, and vulnerabilities becomes inevitable.

Development and validation of structured training module for healthcare workers involved in managing pediatric patients during COVID-19 pandemic using "Objective Structured Clinical Examination" (OSCE).

BACKGROUND: COVID-19 (Coronavirus disease-19) is an ongoing pandemic. COVID vaccine administration in adults has provided some degree of protection from infection but children are still susceptible So, we have to be prepared to handle COVID-19 infection in children by training our healthcare workers by updating both their knowledge and skills. We developed a training module to train our healthcare workers in all domains of learning and also planned related assessment methods to know the effectiveness of the module. MATERIALS AND METHODS: This was a quasi-experimental study with pre- and post-intervention conducted at a tertiary-level teaching medical college in southern India from July to September 2021. The training module was developed as per the "ADDIE" model of the development process module. It was further validated by five experts before implementation. In addition to the quasi-experimental method of evaluation like pre- and post-test, Observed Skill clinical examination (OSCE) had been also used as an assessment tool at the completion of training. A total of 92 participants have been trained as per this module in our tertiary-level care hospital. The association between continuous and categorical variables was assessed using an independent t-test and ANOVA, and paired t-test was used for comparing the difference between pre- and post-test scores. RESULTS: Pre-test scores had no association with years of experience (P = 0.803) and previous training status of participants (P = 0.350). The mean difference of pre- and post-test scores was 3.8 and it was statistically significant (P value < 0.001) A weak positive correlation between pre- and post-test was present by the Spearmen correlation test (r = 0.337). The correlation between post-test score and OSCE score does not have a significant correlation. CONCLUSION: Structured training module was effective in training the participants. Multimode assessment method (Pre-test, Post-test, and OSCE) is an important step to evaluate any training program as compared to only the pre- and post-test methods of evaluation.

Utility of telemedicine for providing Obstetrics and Gynecology services during the COVID-19 pandemic-A single center experience from a tertiary care teaching hospital located in South India.

BACKGROUND: The COVID-19 pandemic greatly impeded the provision of public healthcare within a healthcare system that was already under considerable strain. Routine patient care services were impacted during that time, leading to the promotion of telemedicine as a means of maintaining uninterrupted healthcare services. Telemedicine involves the utilization of electronic technology and communication to provide health-related information and medical care to individuals who are physically separated from healthcare professionals. MATERIALS AND METHODS: To assess the feasibility of utilizing telemedicine for providing women's health services, we conducted a six-month analysis of data collected from the Department of Obstetrics and Gynecology's teleconsultation application at AIIMS, Mangalagiri. Our objective was to evaluate the practicality of telemedicine in delivering diverse healthcare services to women. Our institution offered two types of telehealth services: a "call-based"approach and an "app-based" approach. We examined several parameters within the data, including the distribution of ages, the geographic locations of teleconsultation registrations, whether the registrations were new or follow-up cases, the various presenting complaints, the recommended treatments, the number of consultations (single or multiple), and whether cases required in-person or hospital visits. Additionally, we also compared patient responses between these two modalities. RESULTS: The "call-based" consultation method was preferred by the majority of our patients (94%). The registered cases included both related to obstetrics and gynecology, with a higher proportion of complaints relating to gynecological issues (82.5%). We were able to make a diagnosis in 77% of cases, while in 20% of cases, additional physical examinations and diagnostic tests were necessary. Follow-up appointments were recommended for 53% of patients. The success rate of consultations for patients seeking obstetrics and gynecology services showed a statistically significant difference (P value < 0.001). The vast majority of patients (99%) expressed high satisfaction with the consultation process. CONCLUSION: During the COVID-19 pandemic, telemedicine proved to be an effective approach in mitigating the overcrowding of hospitals and preventing the spread of infection. Its success suggests that telemedicine can be a viable option for managing elective gynecology matters and low-risk obstetric cases in the future, thereby alleviating the strain on healthcare systems.

Screen-Based Media Use Among Children During the COVID-19 Pandemic.

This questionnaire-based study was conducted to assess screen-based media use during the coronavirus disease 2019 (COVID-19) pandemic in children (n=278) aged between 1 to 12 years. Television was the most common media available for use (246, 88.5%), and mobile was the next most commonly available media (230, 82.7%). Daily screen time exposure and use of television (P<0.001), computer/Laptop (P<0.001), and tablet (P=0.001) were significantly more common in those aged 5-12 years. Majority (214, 76.9%) were using screen-based media for educational purposes.

Clinical profile and predictors of severity in paediatric scrub typhus with pulmonary involvement.

Pulmonary involvement is common in children with scrub typhus. Our paper outlines the clinical characteristics of pulmonary involvement and analyses the predictors of its severity. All scrub typhus serology-positive (optical density >0.5) children with pulmonary symptoms were included. Of 506 serology-positive scrub typhus cases, 256 (50.5%) had pulmonary symptoms, of whom 50 (9.8%) were severe. These severe cases were compared with non-severe cases. Interstitial pneumonitis was the commonest chest radiographic finding. Logistic regression analysis identified 'fever clearance time' >48 h, facial puffiness, maculopapular rash and anaemia to be significantly associated with severe pulmonary involvement.