Correlations between serum vitamin B12 and folate levels among mother-infant dyads in Punjab state, North-West India.

AIM: Adequate vitamin B12 levels in infancy are crucial for normal psychomotor and cognitive development of infants. Our aim was to examine serum vitamin B12, folate and ferritin levels in exclusively breastfed healthy full-term infants (age group: 1-6 months), and also investigate their correlation with maternal markers. METHODS: A cross-sectional study was conducted on 100 exclusively breastfed healthy full-term infants (age group: 1-6 months) along with their lactating mothers. Serum vitamin B12, folate and ferritin levels were determined for each mother-infant dyad using enzyme-linked immunosorbent assay. RESULTS: The mean serum vitamin B12, folate and ferritin levels were 512 vs. 535 pg/mL, 15 vs. 12 ng/mL and 313 vs. 114 ng/mL in infants and mothers, respectively. Among 100 infants, 26 (26%) had lower vitamin B12 levels and 5 (5%) had inadequate folate levels. In addition, 22 (22%) of 100 lactating mothers were deficient in vitamin B12 levels and 14 (14%) had inadequate folate levels. We found a statistically significant positive correlation between infant and maternal vitamin B12 (r = 0.659, P < 0.001) and folate levels (r = 0.51, P < 0.001). CONCLUSION: Vitamin B12 deficiency was observed in 26% of infants and 22% of lactating mothers. Vitamin B12 and folate levels of infants were positively correlated with maternal levels in the state of Punjab, North-West India. Our findings support that maternal vitamin B12 status can be used as a valuable predictor of infant vitamin B12 status.

Indian Academy of Pediatrics Consensus Guidelines on Preconception Care.

JUSTIFICATION: The preconception period is the earliest window of opportunity to ensure optimal human development.  Pregnancy and childbirth outcomes can be improved by interventions offered to support the health and well-being of women and couples prior to conception. Thus, preconception care is essential in preparing for the first thousand days of life. Adolescence, the stage of life that typically comes before the preconception stage, is characterized by various high-risk behaviors like substance abuse, sexual experimentation, injuries, obesity, and mental health issues which can adversely affect their health in adult life. Thus, a Consensus Guideline for pediatricians on providing preconception care to adolescents and young adults can go a long way in making the generations to come, healthier and more productive. OBJECTIVES: The purpose of these recommendations is to formulate an evidence-based Consensus Statement that can serve as a guidance for medical professionals to provide preconception care for young adults and adolescents. INTENDED USERS: All obstetric, pediatric, and adolescent health care providers. TARGET POPULATION: Adolescents and young adults. PROCESS: A large proportion of adolescents seek care from pediatricians and there is a lack of Consensus Guidelines on preconception care. Therefore, the Indian Academy of Pediatrics called an online National Consultative Meeting on April 03, 2023, under the chairmanship of Dr MKC Nair and the National Convenor Dr Himabindu Singh. A group of pediatricians with wide experience and expertise in adolescent health care were assigned the task of formulating evidence-based guidelines on preconception care. The group conducted a comprehensive review of existing evidence by searching resources including PubMed and Cochrane databases. Subsequently, a physical meeting was held at Amritsar on October 07, 2023 during which the consensus was reached through discussions and voting. The level of evidence (LoE) of each recommendation was graded as per the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011. RECOMMENDATIONS: Every woman planning a pregnancy needs to attain and maintain a eumetabolic state. Prospective couples need to be counselled on the importance of a healthy lifestyle including a nutritious diet, avoidance of substance abuse, and timely screening for genetic disorders. Screening for and management of sexually transmitted diseases in males and females, appropriate vaccination and addressing mental health concerns are also recommended.

Psycho-Social Effects of Pet Dog Ownership on Mentally Challenged Children.

AIM: Mental retardation is a social stigma and children affected by this condition always require love and compassion. Pets have a positive role in human life to relieve stress and anxiety. Pets are therefore considered to be a very important aspect of psychological therapy. Those children who are suffering from mental retardation have to be given regular stress and anxiety-relieving sessions. Hence this study aims to analyze the psychosocial effects of pet dog ownership on mentally challenged children. METHODOLOGY: A total of 112 children were included in the study and were counseled at the Department of Pediatrics, District Hospital, Amritsar. Twenty patients were lost to follow up and pet ownership materialized in 52 patients. The study was divided into 2 groups, the compliant group (n=52) and the non-compliant group (n=40). Hamilton anxiety scale (HAM-A) was applied to all the children before pet dog ownership (PRE) and after 3-6 months with a pet dog (POST). The pre and post-scores of all the children were recorded and subjected to statistical analysis. RESULTS: The HAM-A score before pet ownership was comparable, before pet ownership (p=.825), but after 3-6 months of pet ownership significant difference was observed between compliant and non-compliant groups (p<.001). Also, the HAM-A score in children with mild mental retardation (mild MR) and moderate mental retardation (moderate MR) was significantly less than the non-compliant group after 3-6 months. We also observed that the decrease in the anxiety levels was comparable in children who owned local breeds and foreign breeds. CONCLUSION: This short-term follow-up research highlights the potential advantages of keeping a companion dog for youngsters with mental problems in terms of improving their lives. Many of these long-term gains might be attributed to lessening tensions within families.

Knowledge, attitude and practice in parents of chronically transfused thalassemic patients regarding thalassemia in thalassemia day care unit in government medical college, Amritsar, Punjab, India

Background: Thalassemia is a chronic debilitating disease that affects nearly 200 million people worldwide. A caregiver who has good knowledge regarding the disease can not only provide a better quality of care to his/her ward but also may spread knowledge in the society in which he/she lives which helps immensely in raising community awareness related to the disease.Methods: 50 caregivers (either mother or father) of chronically transfused thalassemic children were questioned regarding their knowledge, attitude and practice towards this disease, using a self-constructed questionnaire.Results: It was found that despite adequate knowledge regarding every aspect of this disease, there is a lack of attitude of practice towards prevention of this disease in their subsequent child or in their near and dear ones.Conclusions: There is a need to promote an attitude of practice in prevention of the birth of thalassemic children as mere knowledge regarding the disease is not enough in the present scenario where the disease burden is increasing as is the financial and emotional burden on the families. Role of Government sponsorship, a social worker and a child psychologist in the Thalassemia day care unit cannot be minimized.

A Study of Hyponatremia in Lower Respiratory Infections in Children Aged 2months to 5 Years

We studied serum sodium levels within 2 hours of admission of 100 children aged 2months to 5 years admitted with diagnosis of lower respiratory infections(pneumonia,bronchiolitis, bronchitis, empyema and WALRI). Methods: In our study out of these 100 cases 33(33%) cases were having hyponatremia (s.sodium<135mEq/L) &0ut of33(33%) cases 17(51.5%) cases had mild hyponatremia i.e. s.sodium 131-134mEq/L, 14(42.5%) cases had moderate hyponatremia i.e. s.sodium 126-130mEq/L & 2(6%)cases had severe hyponatremia i.e. s.sodium <125mEq/L. These Children with hyponatremia were evaluated for plasma osmolality, urinary sodium and osmolality on day of admission and after appropriate fluid therapy. Results: Out of these 33 cases, the probable cause of hyponatremia was the syndrome of inappropriate secretion of antidiuretic hormone in 27(81.8%) cases (as suggested by their plasma osmolality,urinary sodium and urine osmolality). Symptoms and signs indicative of severe LRIs were about one and a half times more frequent and the mean duration of hospital stay was 49.2% longer in children with hyponatremia than with isonatremia. Two children (2%) with severe hyponatremia had complications in the form of convulsions associated with transitory altered sensorium for 2-3 days. The recovery from hyponatremia with timely intervention showed a good improvement in clinical symptomology of respiratory distress and there was no mortality in the studied cases. Conclusion: Thus it is concluded that,presence of hyponatremia in LRI’s increases the morbidity of these patients in the form of prolonged hospital stay and occurrence of complications like seizures followed by deranged sensorium in some cases.