Paediatrics

Background: Approximately 5-35% of neonates develop jaundice requiring treatment during the 1st week of life. Prebiotics, a mixture of Galacto-oligosaccharides (GOS) and Fructo-oligosaccharides (FOS), has been postulated to reduce serum bilirubin levels on principle of interruption of entero-hepatic circulation. Objective: To evaluate the effect of oral supplementation with prebiotics (Fructo-oligosaccharides) in the management of neonatal jaundice. Subjects and Methods: Design & Setting: Open Label, Randomized Control Trial at Level II NICU in public hospital over one year. Participants: Term exclusively breast-fed neonates with Jaundice requiring phototherapy. Intervention: Randomisation of Sixty eligible neonates into Control and Prebiotic groups (n= 30 each). Both groups received phototherapy, and Prebiotic group received additional oral prebiotics. Outcome: Primary outcome measure was a reduction in total serum bilirubin levels (TSB) and duration of phototherapy. The secondary outcome measure was the change in the frequency of stools. Results: Baseline Features were similar in both groups. Overall serum bilirubin levels decreased significantly from enrolment till the omission of phototherapy (17.24 + 1.16 vs. 12.74 + 0.48; P: 0.00). ANOVA depicted no statistical difference between the groups in 12 hourly reductions of TSB (F [3, 232] = 0.14, P: 0.94). Mean duration of phototherapy (in hours) required in prebiotic and control group was similar (50.40 + 9.66 vs. 47.60 + 8.62; P = 0.24). Secondary outcome measures were also similar in both groups. Conclusion: Prebiotics, containing only fructo-oligosaccharides, administered for upto three days, do not have any additional effect on reduction of serum bilirubin levels in neonates with jaundice receiving conventional treatment.

Duchene muscular dystrophy (DMD) is one of the most common muscular dystrophy in children. DMD is an x – linked mediated, musculoskeletal disorder common in males which occurs due to mutations in gene of dystrophin, a muscle protein. It is characterised by progressive muscle weakness and muscle wasting due to absence of dystrophin protein that causes degeneration of skeletal and cardiac muscle. The children with DMD show muscle weakness and calf hypertrophy. In this condition there is a usual delay of motor development. The patients with DMD usually become wheel chair bound by the age of 12 years and they undergo premature death from respiratory or cardiac complications. The treatment modalities for DMD are corticosteroid therapy and use of intermittent positive pressure ventilation to provide improvements in function, ambulation, quality of life and life expectancy. Here, a case of DMD presented in a 7 years male child who admitted in hospital with complaints of difficulty in getting up from sitting position since 4 months and is gradually progressing. He has calf hypertrophy since 4 months, which is not associated with pain. His parents did not have consanguinous marriage, his three elder sisters were all healthy; no other family members were similarly affected.

The progressive myoclonic epilepsies are a rare group of debilitating epileptic encephalopathies characterized by myoclonic seizures, progressive neurological dysfunction and dementia. In the past year advances in gene mapping have isolated gene loci for the majority of progressive myoclonic disorders, paving the way for specific diagnosis, more accurate prognosis and risk calculation, as well as opening the potential for prenatal and pre-symptomatic diagnosis in at risk families.

Objective: To determine whether infants with chronic lung disease (CLD), ready for neonatal unit discharge, maintain cardiorespiratory stability while sleeping supine. Methods: Subjects were 15 infants born <32 weeks gestational age (GA) and ready for discharge from the regional tertiary neonatal intensive care unit. Polysomnography recordings of sleep state, heart rate, arterial oxygen saturation, respiratory effort and nasal/oral airflow were taken prone and supine for up to 3 h post feed with the first position randomly allocated. The main outcome measures were oxygen saturation and apnoea hypopnoea index (AHI). Results: Seven infants (median GA 27 weeks, birthweight 945 g) had CLD and eight infants (median GA 29 weeks, birthweight 1160 g) did not. CLD infants were more mature at study than non-CLD infants (median 39 vs 36 weeks, P = 0.019). Neither oxygen saturation nor AHI were position dependent and no group differences were noted with respect to CLD status. There was a significant interaction of GA and sleep position with less-mature infants spending less time in quiet sleep (QS) in supine position (P = 0.006). These less-mature infants also had a higher AHI (P = 0.033). As expected, the AHI and arousal index (AI) were higher in active sleep (P ≤ 0.001, P = 0.013, respectively) and mean oxygen saturation was lower (P = 0.001). Conclusions: The supine position appears appropriate for very preterm infants with CLD going home from the neonatal unit. Respiratory instability on neonatal discharge is more likely to be associated with immaturity than CLD.

An investigation into the feature extraction and selection of infant cry with asphyxia is presented in this paper. The feature of the cry signal was extracted using mel frequency cepstrum coefficient (MFCC) analysis and the significant coefficients were selected using orthogonal least square (OLS) algorithm. The effect of varying the number of MFCC filter banks on the feature selection was examined. It was found that the best set of coefficients could be achieved when 40 filter banks were used.

An 8months female child came to our Dept. of Paediatrics, M.K.C.G. Medical College, Berhampur, Odisha, India for evaluation of motor delay with history of cyanotic spell with features of Apert Syndrome. Apert syndrome is a rare type 1 acrocephalosyndactyly syndrome characterized by dysmorphic facial features, craniosynostosis and severe syndactyly of hands and feet. It represents an autosomal dominant inheritance and occurs due to the gene mutations in the receptors of the fibroblast growth factor 2(FGFR2).

Introduction: To evaluate the efficacy of cycled oral cyclophosphamide therapy in recurrent and advanced ovarian cancer patients. Materials and Method: Recurrent and advanced ovarian cancer patients who are unfit for intensive chemotherapy were prescribed oral cyclophosphamide at the dose of 50 mg twice daily for 10 days, cycled every 28 days. Treatment-related toxicity was assessed by National cancer institute – common terminology criteria for adverse events(NCI-CTCAE) and response to treatment were assessed by Response evaluation criteria in solid tumours (RECIST) and clinical assessment. Progression-free (PFS), and overall survival (OS) were assessed using Kaplan meier survival analysis. Results: 71 patients of ovarian cancer admitted to our centre from January 2012 to March 2015 with mean age of 61.2±0.74 years were analyzed: 44 patients (61.9%) were platinum refractory/resistant, while 26 patients (36.6%) were platinum sensitive; 60 patients (84%) had received atleast one previous chemotherapy before starting MOC. The objective response rate (ORR) (complete and partial response) was 20%. Stable disease was seen in 22 patients (30.9%) and 17patients had response duration ≥6 months, 8 patients had continued response for more than 1 year. Progression during treatment was observed in 49 patients (69.01%). Median PFS was 5 months (range 2 – 25 months), and the 12-month PFS was 11%; and the 12-month OS was 26% Median PFS for patients who responded to MOC was 9 months whereas 2 months for those who progressed (p = 0.01). Median OS of responding patients was 14 months whereas it was 8 months for patients progressive on MOC (p = 0.02). No significant toxicity was observed. Conclusions: MOC is an effective therapy in the treatment of recurrent and advanced ovarian cancer patients, unfit for intensive chemotherapy.

Introduction The World Health Organization (WHO) defined stillbirth as the death of a fetus with a birth weight of at least 500g or if birth weight is unavailable [1,2], a gestational age beyond the age of viability. The stillbirth rate, as the perinatal mortality rate, is an important indicator of the quality of antenatal care and obstetric care during labor and delivery [3]. Knowledge of the causes and risk factors of this unfortunate problem will help in designing preventive measures to reduce its incidence [4]. Stillbirths are common and devastating, and in developed countries, about one-third has been shown to be of unknown or unexplained origin [5]. Some Abstract Background: Stillbirths have always been a contributor to psychological morbidity amongst women. Diabetes mellitus remains a significant risk factor for its occurrence. Knowledge of the causes and risk factors of this unfortunate problem will help in designing preventive measures to reduce its incidence.

Objective: To determine the source of medical advice to parents and treatment administered at home for children admitted to hospital with acute gastroenteritis. Methodology: A questionnaire was completed by the parents of 231 children admitted during a 12 month period. Results: The majority of children had seen their family doctor or an after-hours doctor prior to admission. Clear fluids were used for two-thirds but an oral rehydration solution (ORS) was used in only one-third of children. Medications were used for half, including antibiotics (19%), antidiarrhoeals (9%), antiemetics (7%) and paracetamol (27%). Inpatient assessment suggested that the majority of children had no or mild dehydration.

Background: Hypoglycemia is a medical emergency. Unless promptly identified and treated, it can lead to irreversible brain damage with risk of long term neurologic sequelae or death. Objectives: To determine the prevalence of hypoglycemia among children presenting to the Emergency Paediatric Unit (EPU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Methods: This was a descriptive cross sectional study conducted between 1 st June and 31 st August, 2013. Blood glucose, in addition to other relevant laboratory investigations, was measured for each patient at the time of admission into EPU using rapid glucose test strips mounted in a glucometer. Result: Of the 152 children that were admitted into EPU during the study period, 7 patients had hypoglycemia (<2.2mmo/l), giving a prevalence of 4.6%. Six (85.7%) of the 7 children with hypoglycaemia were under the age of 5 years (mean age 18.6 ± 14.7 months), with significant female preponderance (1:2.5). Hypoglycaemia occurred in children with severe malaria, diarrheal disease and protein energy malnutrition. Overall mortality rate was 7.9%, but no death occurred in those with hypoglycaemia. Conclusion: Hypoglycaemia does occur especially in sick under-five children presenting to our paediatric emergency unit. Routine blood glucose monitoring of at risk patients at the time of admission is therefore recommended.

Large medical image datasets form a rich source of anatomical descriptions for research into pathology and clinical biomarkers. Many features may be extracted from data such as MR images to provide, through manifold learning methods, new representations of the population's anatomy. However, the ability of any individual feature to fully capture all aspects morphology is limited. We propose a framework for deriving a representation from multiple features or measures which can be chosen to suit the application and are processed using separate manifold-learning steps. The results are then combined to give a single set of embedding coordinates for the data. We illustrate the framework in a population study of neonatal brain MR images and show how consistent representations, correlating well with clinical data, are given by measures of shape and of appearance. These particular measures were chosen as the developing neonatal brain undergoes rapid changes in shape and MR appearance and were derived from extracted cortical surfaces, non-rigid deformations and image similarities. Combined single embeddings show improved correlations demonstrating their benefit for further studies such as identifying patterns in the trajectories of brain development. The results also suggest a lasting effect of age at birth on brain morphology, coinciding with previous clinical studies.

To determine the cost of the dialytic management of paediatric acute kidney injury in a low-income country. All children under the age of 15 years, who had either peritoneal dialysis or haemodialysis for acute kidney injury in Aminu Kano Teaching Hospital over a 1-year period, were studied. The average cost of each dialysis modality was estimated. Of 20 children, who had dialysis for acute kidney injury, 12 (60%) had haemodialysis and 8 (40%) had peritoneal dialysis. The mean cost for haemodialysis exceeded that of peritoneal dialysis ($363.33 vs. $311.66, t = 1.04, P = 0.313) with the mean cost of consumables significantly accounting for most of the cost variation ($248.49 vs. $164.73, t = 2.91, P = 0.009). Mean costs of nephrologist visit and nursing were not found to be significant. Peritoneal dialysis is the less costly alternative for managing acute kidney injury in children in our environment.

Primary Sinonasal Small Cell Carcinomas, Neuroendocrine type (SCCNET) are rare tumours. Few cases have been reported in the head and neck region of adult patients. They have a fair response to multimodality therapy; but the prognosis remains poor.
Case report
We report here a case of SCCNET in a 5 year old child. He presented with swelling in his right eye with diminution of vision and right sided neck swelling. Cervical lymph node biopsy revealed poorly differentiated metastatic neuroendocrine carcinoma; confirmed by immunohistochemistry. 18 FDG- PET CT scan revealed a nasopharyngeal mass extending to other paranasal sinuses and base of frontal lobe with bilateral extensive cervical lymphadenopathies. He was treated with neoadjuvant platinum based combination chemotherapy followed by radical radiotherapy. At 17 months post diagnosis he is alive but on palliative care.
Conclusion
SCCNETs have an unfavourable outcome. Further improvements in our understanding of the pathology and treatment strategies are needed to combat the disease.

Objective: To assess the impact of the implementation of a daily goals sheet upon nursing perception of communication in an academic, tertiary care paediatric intensive care unit (PICU). Design: Prospective, longitudinal, before-and-after intervention surveys. Setting: University affiliated 12-bed PICU. Subjects: Bedside nurses. Interventions: A questionnaire was administered to PICU nurses addressing their perception of communication. Following this questionnaire, the use of a daily goals sheet was instituted. A second questionnaire was administered one year later. Mann-Whitney Rank Sum Test was used to compare differences of the graded outcome variables. Measurements and main results: The primary outcome was the perception of communication taken from a nursing perspective. Eighty-five percent of nurses felt the daily goals sheet led to improved communication between physicians and nurses in the PICU. All questions related to communication demonstrated a positive influence of the goals sheet, with the perception of the PICU staff working as a team reaching statistical significance (p = 0.05). The perception of the care of one surgical service being attending physician directed also significantly improved after the institution of the goals sheet (p = 0.04). Conclusion: The institution of a daily goals sheet led to an improvement in nursing perception of communication. Future studies are required to determine if this The use of a daily goals sheet to improve communication in the paediatric intensive care unit 265 change in process has a demonstrable effect on health care outcomes of critically ill children, or whether this tool can have the same beneficial effects in other academic and non-academic PICUs.

Background of Study: Competence in motor performance skills is important in enabling children to be physically literate. Plyometric-based training has been suggested as an effective means to enhance motor performance skills in young athletes. However, no studies have reported the effects of a whole body plyometric-based program integrated into physical education on motor performance skills with young children. Objective: This study aims to examine the effect of a plyometric-based program on primary school students' motor performance skills, upper and lower body muscular power, and reactive strength index. Method: The sample was composed of 61 primary school students, 29 girls and 32 boys, aged 7-8 years old, from two secondgrade Physical Education (PE) classes. Both groups participated in their regular eight-week PE lessons (50-minute classes twice a week). During the study, the plyometric group performed a plyometric-based program in the 15-minute warmup of each class, while the comparison group performed regular warmup activities. Student's motor performance skill proficiency, reactive strength index, lower and upper body muscular power were assessed before and after the eight weeks of PE lessons. The data were analysed using a two-way analysis of variance, followed by pairwise comparisons with the Bonferroni adjustment. Results: The data analysis indicated significant increases in motor performance skill proficiency, upper and lower body muscular power in the plyometric group vs comparison group (p ≤ 0.05). Conclusion: These results suggest that including a plyometric-based program in the PE warmup phase of the lessons may improve motor performance skills and muscular power in primary school students.

Antinuclear antibody (ANA) immunofluorescence tests, using HEp-2 cells, were performed on 100 children without a history of connective tissue disease. Eighteen (18%) were positive at titres greater than or equal to 1:40, nine (9%) being greater than 1:160. Interlaboratory variability was demonstrated with some specimens. No association with possible intercurrent infection was found to account for positive results. Of 44 children with proven infections five (11%) were positive. Antinuclear antibody may be found in some normal children when using the sensitive HEp-2 cell substrate, and in the absence of clinical features should not necessarily suggest the presence of a connective tissue disease.

The 'hybrid' procedure is an alternative to the Norwood operation in classical hypoplastic left heart syndrome to support the systemic circulation until subsequent palliation. This approach has been extended to infants with the borderline development of left heart structures. We investigated whether or not a hybrid procedure for 'borderline' cases of underdevelopment of the left heart would lead to any improvement in the growth of those structures relative to body size or would impact on eventual repair.

Introduction. The influence of the environment on wellness, not only for patients themselves
but for all care-givers as well, refers to the humanisation principles of spaces of
care. Commencing with an analysis of existing paediatric hospices, the paper examines
design suggestions for prosthetic environments, considered as a fundamental component
in the healing process.
Methodology. A prosthetic environment can be created only through a specific knowledge
of the real needs of users. Therefore, some scholars have conducted research work
for defining the best practices for healing environments, supported by an assessment and
comparison of case studies. The methodology is based on two phases: the first is based
on interviews with experts in hospice design and management and the second, through
the application of a questionnaire to several users.
Discussion and Results. The output of the work is the achievement of a logical, sequential
and participatory broad-spectrum process in the design of health facilities in order to
cause a sustainable awareness in paediatric hospices.
Conclusion. Starting from the research work, it is necessary to define a scientific method
for implementing knowledge on health, psychological, perceptual and behavioural needs
to contribute towards proper planning for meeting the real requirements of users.

A versatile eccentric-spheres model of the human head is used in this paper to investigate radio-wave absorption. Numerical results, obtained by use of an exact analytical solution, are presented for the total, percentage, and gram-specific absorption. Interest is mainly in the brain and in the eyes of an adult or an infant head. Our model comprises a host sphere and several spherical inclusions, all concentrically stratified with respect to their own center. Any number of inclusions and any number of concentric layers for the host sphere and each one of the inclusions can be considered. Excitation is provided either by a plane-wave or by a nearby electric dipole. The analytical solution is obtained by use of the indirect-mode matching method. The theory of this paper and the accompanying computer code constitute a versatile tool for analytical studies of cellular-phone interactions with the human head. Specific absorption rate maps in a horizontal cross section of the head model manifest the existence of hot spots in the eyes and near the center of the brain.

The purpose of this qualitative study was to explore and describe the extent to which registered nurses’ practice was affected by emergency department overcrowding. Participants were recruited from a tertiary hospital by using the purpose sampling method. Data collection was done using a semi-structured interview guide. Individual interviews were conducted with eight registered nurses working in the paediatric emergency department. Data analysis was conducted using thematic content analysis and Yin’s (2003:178) five-phase cycle. The study findings revealed that the lack of professional nurse leadership and the difficult existing relationship with the physicians were obstacles that had to be obviated if the paediatric ED were to function optimally and best practice were to be achieved. It was revealed that a problematic issue in the setting was that the most critical decisions on allocating where patients should be treated were made by physicians who have more authority than nurses. ...

The pathway to universal health coverage is interlaced by numerous heterogeneous health challenges. The deficit in health workforce and particularly, the skilled professionals is a huge set back in Africa. The insufficient number of health professionals has recently been worsened by economic strain and fragmentary health service reforms. In this short communication, the causes and possible solutions to depleting human resource for health in Africa is discussed.

t has been long speculated by staff working in paediatric emergency medicine that children with unusual first names are more likely to be admitted to hospital compared with other children.
What this study adds

This paper demonstrates that for some categories of first names, this speculation is correct.

Our names send a message about who we are. According to psychologist Albert Mehrabian, a name is ‘like an appendage’ carried for life that ‘can make a distinct pattern of . . . impressions on others’.1 Sigmund Freud went further, asserting that ‘a human being's name is the principal component in her person, perhaps a piece of her soul’.2 Mehrabian suggests that the naming of a child is ‘by far, the single most important element for a parent to consider in his or her efforts to manage the impressions the child makes on the outside world’. After a number of years working in paediatrics, and particularly in paediatric emergency medicine, it has been our anecdotal impression that children with unusual first (or given) names may be over-represented in the patients admitted for inpatient care after presenting to the emergency department (ED) of our paediatric tertiary hospital.
Could it be that a child's name might influence the outcome of a medical consultation or be predictive of the likelihood of admission?

Abstract
Background: Cerebral Palsy (CP) is associated with disorders of movement, posture and intellectual activities which are due to a non-progressive lesion or damage to the immature brain and can be range from mild to profound.

Objective: The aim of this literature review is to investigate and analyze the effectiveness of four new – in the last twenty years - modern therapeutic interventions (Hippotherapy, Virtual Reality, Aquatic Therapy and Adeli Suit Therapy) in the trunk and improvement of posture in children with cerebral palsy.

Methods: After searching databases like Pubmed, Science Direct, Medline, Pedro, QMU e-Library and Cochrane Library for the period of 1995 to 2015, the total of 250 papers were retrieved. The studies consisted of children of all ages, diagnosed with CP. Only 73 of the studies were meeting the inclusion criteria.

Results: Forty-four trials were indentified. Four intervention categories were distinguished (virtual reality therapy, hippotherapy, aquatic therapy and Adeli or Thera suit therapy). The results showed that each of the four therapies analyzed can be effective in improving trunk control and posture with or without additional physical therapy. However, further research is needed due to the diversity among types and severity of CP.

Conclusion: Aquatic Therapy, Hippotherapy, Virtual Reality and Adeli/Thera Suit showed efficiency in treatment programs of children with CP. Future research studies must accommodate the effectiveness of these techniques and should improve the ability to target them at community and family levels.

Exclusive breastfeeding for the first 6 months of life is recommended as the optimal way to feed infants. This paper reviews the measurement of exclusive breastfeeding in Australian studies over the past 10 years. Only half the studies identified that claimed to measure exclusive breastfeeding used a definition consistent with the World Health Organisation. Three studies used 24-h or 7-day recall indicators that have been shown to produce overestimations of the prevalence of exclusive breastfeeding. Measurement of exclusive breastfeeding with a valid and consistent definition is vital for monitoring rates and trends, for comparison between different studies and countries and to reach conclusions on various health benefits. Any future measurement of exclusive breastfeeding in Australia should use the World Health Organisation definition and the 24 h recall study design should not be used for this purpose.

Background: Pressure ulcer (PU) risk assessment tools are an important component of good nursing care; however, it is essential that these tools offer a good sensitivity and specificity, in addition to clinical utility in the population being assessed. Objectives: The aim of this study was to examine how the lowest Braden Q score recorded in the first 24 h of paediatric intensive care unit admission related to the risk of PU development in an English PICU (paediatric intensive care unit). Methods: A retrospective cohort study was undertaken over 12 months in a single PICU in the North West of England. 891 critically ill children with a Braden Q score were evaluated. The lowest Braden Q score within the first 24 h of PICU admission was matched to reported PU development and grade. Results: The Braden Q score was found to perform well in children aged 3 weeks to 8 years without congenital heart disease (CHD), which is the population it was validated on. At a cut off score of ≤16 it yielded a sensitivity of 100% specificity of 73.1%, positive predictive value (PPV) 2.56 and a negative predictive value (NPV) of 100 and an area under the curve (AUC) of 0.87(0.75-0.98). When used in other age groups and when it included children with CHD, it performed less well with lower AUC and wider confidence intervals, but it performed moderately well in the group of term to 14 years with a sensitivity of 75% specificity of 72.6%, PPV 1.5 and a NPV of 99.8 and AUC of 0.74 (0.49-0.98). Conclusion: Our results in a heterogeneous UK PICU population found the Braden Q score performed well in the specific population it was validated for (PICU children aged 3 weeks to 8 years without CHD), however, it performed moderately well in the more heterogonous PICU population of term to 14 years including children with CHD.

Το Ευρετήριο Ισχύουσας Νομοθεσίας για την Κακοποίηση και Παραμέληση Παιδιών περιλαμβάνει μια σύνοψη των βασικών νομικών κανόνων που ρυθμίζουν τις σχέσεις γονέα και παιδιού, την προστασία του παιδιού-θύματος και την υποχρέωση αναφοράς στις αρχές, καθώς και των αδικημάτων που σχετίζονται με την κακοποίηση παιδιών.

Objectives: Severe Acute Malnutrition is a significant cause of mortality in children under the age of 5 years in low-resource settings, including Northern Nigeria. The study aimed to determine the associations between selected risk factors and mortality outcomes in children admitted with SAM in a facility in Katsina State, Northern Nigeria. Methods: A prospective observational cohort of 201 children aged 6 to 59 months who were admitted with severe acute malnutrition (SAM) in stabilization centers in Katsina State, Northern Nigeria between May 18, 2021, and July 20, 2021, (63 days) were assessed followed up. Outcomes were analyzed using Kaplan-Meir analysis to estimate time to death, and Cox proportional-hazard regression model was used to determine predictors of mortality. Results: The log-rank test showed significant differences in the probability of death between categories of diarrheal status (logrank statistic = 9.760, P = .021) and presence of existing disease (comorbidity) (log-rank statistic = 5.338, P = .021). The study identified that severely malnourished children admitted with comorbidities showed significant association with time to event (death) (AHR: 4.109, 95% CI: 1.51, 32.60). The estimated mean time until death was 57.9 days (±3.0) for children without comorbidities and 20.1 (±3.0) days for children with comorbidities. The median survival time was 18 days for children with comorbidities. Conclusion: The presence of comorbidities was significantly associated with mortality. Severely malnourished children with comorbidities had 4 times higher mortality risk than severely malnourished children admitted without comorbidities. Clinicians and health workers should give due emphasis to the early detection and effective management of comorbidities in children with severe acute malnutrition.

Gastroschisis and exomphalos are the most common types of neonatal anterior abdominal wall defects. The aetiology of these two distinct abnormalities is unclear and their pathogenesis is controversial. 1 A higher risk of associated malformations, chromosomal abnormalities and neonatal death is reported in fetuses with exomphalos. 2 However, despite the frequent presence of oligohydramnios and intra-uterine growth retardation, the outcome of fetuses with gastroschisis is good because the associated malformations are uncommon and not life threatening. 2,3 Current data suggest that in the absence of significant associated malformations (e.g. structural heart defect), the outcome for fetuses with exomphalos is similar to that for fetuses with gastroschisis. 4 Recently, the incidence of gastroschisis has increased in many parts of the world, necessitating attention towards neonatal mortality and morbidity related with these defects. The aim of the present study was to assess neonatal outcomes associated with gastroschisis and exomphalos.

We present a novel method for estimating respiratory rate in real-time from the photoplethysmogram (PPG) obtained from pulse oximetry. Three respiratory induced variations (frequency, intensity, and amplitude) are extracted from the PPG using the Incremental-Merge Segmentation algorithm. Frequency content of each respiratory induced variation is analyzed using Fast Fourier Transforms. The proposed Smart Fusion method then combines the results of the three respiratory induced variations using a transparent mean calculation. It automatically eliminates estimations considered to be unreliable because of detected presence of artifacts in the PPG or disagreement between the different individual respiratory rate estimations.

The convergence of game technology (software and hardware), the Internet, and rehabilitation science forms the second-generation virtual rehabilitation framework. This reduced-cost and patient/therapist familiarity facilitate adoption in clinical practice. This paper presents a PlayStation 3-based hand physical rehabilitation system for children with hemiplegia due to perinatal brain injury (hemiplegic cerebral palsy) or later childhood stroke. Unlike precursor systems aimed at providing hand training for post-stroke adults in a clinical setting, the experimental system described here was developed for in-home tele-rehabilitation on a game console for children and adults with chronic hemiplegia after stroke or other focal brain injury. Significant improvements in Activities of Daily Living function followed three months of training at home on the system. Clinical trials are ongoing at this time.

Background: Nutrition plays a key role in physical, mental and emotional development of children and much emphasis has been given to provide good nutrition to growing populations especially in the formative years of life. Methodology: Multistage stratified sampling technique was used for selecting the sample. In second stage two Anganwadi centers were selected. In third stage 50 children were selected from nearby areas, such children were below 6 years and were not attending Anganwadi. Results: A total of 80 cases were taken for study purpose. Majority of children (46%) were of 5 years of age followed by 26.0% of 4 years of age and minimum 8.0% were of 6 years of age similar pattern was also observed among non ICDS group majority of children (40.0%) were of 5 years of age, followed by 36.0% of 4 years of age and minimum 6.0% were of years of age. 48% of ICDS children and 54% of Non ICDS group had BMI more than 20, they were normal while 52% of ICDS and 46% of Non ICDS children had BMI less than 20 and they were underweight.

Rubella infection is most devastating to the women of reproductive age group and can cause wide range of congenital malformation and even death and abortion when infected during pregnancy. The present study was a cross sectional study to estimate the sero-prevalence of Rubella amongst girls aged <18 years and to determine the risk factors involved in rubella seroprevalence. It was conducted in the. The study included 405 girls of age group of 1-18 years who were selected from the OPD and wards of JN Medical College, Aligarh. Girls were divided in 4 groups as per age at the time of blood sampling. Blood samples were then analysed for Rubella specific IgG antibody. Overall seropositivity of Rubella in the study population was 68.2% and the susceptibility was 31.2%. Mean antibody titre of the population was 12.97 ± 6.7. Rubella seropositivity and mean antibody titre increases with age and similarly susceptibility decreases. Only anthropometric parameter which was related statistically to rubella seroprevalence was mid upper arm circumference; seropositivity was higher in those with MUAC < 11.5cm and was also associated with rubella seroprevalence. Seropositivity was much higher in school going children than non-school going children. Overcrowding and inadequate ventilation was also found to be associated with rubella Lower socio economic class was found to be significantly associated with rubella.