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The incidence and risk of morality is high under the age of five years is due to diarrhoea. In India twenty percentages of paediatric deaths is due to diarrhoeal disease. It is the second cause of leading mortality in children after acute respiratory infections. Following on from the GEMS study when we looked at the data in the management of bacterial diarrhoea the primary treatments included oral rehydration solution, oral zinc probiotics and antibiotics. Anecdotally we noted that a lot of children were treated with oral antibiotics and the majority of them were treated with fluoroquinolones like Ofloxacin and drugs like Metronidazole there are multiple side-effects associated with the usage of fluoroquinolones and a major side-effect of that is the risk to the growing cartilage. We also noticed that irrational combinations such as imidazole like metronidazole have shown more problems than solutions .usage of Ofloxacin in children should be discouraged for all the side-effects plus the infectivity in the management of bacterial diarrhoea. The duration of treatment have paved the way for usage of drugs such as new molecules in paediatric i.e. rifaximin comes under the group of oral non-absorbable GI antibiotics broad-spectrum agents with antibacterial activity against gram positive and gram negative aerobes and Anaerobes makes Rifaximin a bactericidal drug in nature. Rifaximin is particularly recommended in children above the age of two years in acute infectious diarrhoea the mechanism of action of rifaximin is by inhibition of bacterial protein synthesis by reversibly binding to bacterial DNA dependent RNA polymerase. In this review we discussed the “phrma” behind rifaximin, clinical experience of rifaximin in children and indications and dosage of rifaximin in paediatric.

A 7-year-old girl with recurrent episodes of pancreatitis with risk factor of poorly controlled hyperglyceridemia presented with an acute episode of pancreatitis. She was managed conservatively and underwent whole exome sequencing which showed a likely pathogenic LPL gene mutation. Incidentally, she was diagnosed with COVID-19 on screening, which we hypothesize to have triggered the recent episode. On further examination, she was found to have bilateral cataracts. Her hypercholesterolemia was effectively managed with dietary therapy, high dose omega 3, and gemfibrozil. Our case report sensitizes the clinician to use a modern diagnostic tool such as whole exome sequencing in children with recurrent pancreatitis where hypertriglyceridemia is a known risk factor. This child is the first case of LPL mutation reported in India.

Aims: To compare nutritional status of chronic ill children before and after using chicken-based formula (CBF). Design: A retrospective, case note based, observational study of the use of CBF in various clinical indications were noted and results critically analysed. Study Design: In this study, out patients aged 1 to 36 months who were prescribed CBF from 2018-2020 were included. The indications for using the formula and the outcomes were noted. All subjects, consumed the prescribed formula for a minimum of six months. The pre and post - therapy nutritional status were assessed. The collected data was analysed using SPSS Version 20. Methodology: Children between the ages 1 to 36 months who presented with chronic diarrhoea in whom CBF was prescribed either as primary source of nutrition or an nutritional adjunct were included in the study. Children who were allergic to the CBF or any of its ingredients were excluded from the study. Results: 34 children were prescribed CBF for various indications including Cow’s milk protein allergy (n=18, 52%), underweight (n=8, 23.5%), Chronic Diarrhoea (n=8, 23.5%). The age range was 0-6 months n=13 (38.2%), 6-12 months n=14 (41.2%) and 12-36 months=7 (20.6%).The nutritional assessment prior to commencing feeds showed 52.9% (n=18) were underweight, 44.1% (n=15) were well nourished and 2.9% (n=1) was overweight. Post feeding nutritional status showed-20.58% (n= 7) remained underweight, 76.4% (n=26) were well nourished and 2.9 % (n= 1) overweight. Weight gain was significant in selected subjects (

The plant material in the diet that is resistant to enzymatic digestion is defined as “dietary fibre”. The primary ingredients that are classified as dietary fibres are cellulose, hemicellulose, pectic substances, gums, mucilages and lignin etc. Dietary fibre naturally exist in foods that are consumed daily viz.,cereals, fruits, vegetables and nuts. The diets with high content of fibre have shown benefits in multiple areas and systems in maintaining a mileu’-interior. Processing of foods leads to various changes in physical, chemical, enzymatic and thermal treatments, which may affect the composition of total fiber present in the diet.Fibres included in the diet leads to various changes in the qualitative aspects of the food that is processed. Favourable outcomes have been reported in various commodities such as cereals,bread,yoghurt and beverages. The importance and the uses of fibres in diet is an area of constant interest which needs to be explored further and our paper reviews and explains the relation between dietary fibres and their benefits, primarily in children [1]

The use of therapeutic agents in medicine has lead to the development of resistant strains of many pathogens. As an alternative medicine, many herbal formulations were introduced. From ancient times, various medicinal plants have been used as a treatment agent for various diseases due to their alarming herbal properties. Turmeric, a rhizome of curcumin long a is one among them which has anti-infective and anti-inflammatory properties. Due to its novel properties, it is used in various treatments options for oral health and systemic health. Curcumin, due to its complex interaction between inflammation, immunity and oxidative stress, it was used in various oral and neck pathologies also apart from general health benefits. Curcumin suppresses pro-inflammatory cytokines in head and neck pathologies showing various changes in salivary Ph and salivary stress biomarkers. In dentistry, curcumin has been proved to have antiplaque efficiency in various studies, but long term study is required to substantiate its properties. Recently nanostructured lipid carrier containing curcumin was used in dentistry to bring about bone regeneration. This article depicts various properties, applications of curcumin in healthcare and its pharmacological action for systemic and oral health.

Introduction: The unprecedented pandemic of COVID-19 has put a huge strain on the global health system and stress on the mental health of health-care professionals. We ventured to perform a virtual analysis of the mental health of our colleagues via an online assessment and sent a questionnaire-based survey. Materials and Methods: A 31-question-based survey was sent to health-care professionals including medical and paramedical staff. This Survey was then sent as an online questionnaire using google forms®. Questions were based on three categories, namely their general health, interpersonal support, and resilience. The General Health Questionnaire, Interpersonal Support Evaluation List-12, and Brief Resilience Scale were used to formulate the questionnaire. Results: The results did not show or highlight any area of significant concern currently, although a repeat survey will be very crucial to assess the impact of the pandemic on the mental health of health-care professionals postpandemic and how it has affected their general health, resilience, and an assessment of the support system. Conclusion: The Covid 19 pandemic as expected is taking a toll on the Health Care Workers and this requires ongoing evaluation and intervention.

Background: Functional abdominal pain (FAP) in children is a common problem encountered by clinicians. The etiology of FAP is multifactorial and this study explains the correlates of FAP to certain behavioral patterns in children. This is the first Indian study which looks into this area. Methods: Eighteen participants between 4 and 18 years old who had consulted pediatric gastroenterologist with abdominal pain in one single multi-specialty hospital were included. A written consent was obtained from parents. The Child Behavior Checklist (CBCL) was given to the parents to understand the various behavioral problems in the children; and intelligence quotient (IQ) assessments were done in all children. A 5-point Likert scale was used to assess anxiety in children which was rated by the child. Results: The CBCL identified the stressors reported by children such as academic pressure, difficulty to comprehend, need for affection from parents, interpersonal problems at home (frequent arguments between parents, comparison with a brighter sibling) and poor self-esteem. It is observed that 11/18 (61%) children had average or above average IQ and 7/18 (39%) children had low average or dull IQ. The anxiety levels of children in majority, 16 out of 18 children (88.8%) who presented with FAP, were found to be high or very high on a Likert scale. Conclusions: Children with FAP have variable IQ levels and high anxiety levels. The need for clinicians to counsel parents and children in order to address the stressors at home and school is warranted as this may help in management of FAP in children. Further multi-centric research is necessary to understand these findings in Indian children. Int J Clin Pediatr. 2020;9(2):31-34 doi: https://doi.org/10.14740/ijcp371

Ranitidine plays a pivotal role in routine pediatric practice. The multi-dimensional use and safety of ranitidine are not supported by any practical guidelines, which led to recommendations convened by a group of experts based on evidence and the clinical experience of experts. A group of general pediatricians and pediatric gastroenterologists from India were part of this panel. This group of experts reviewed the literature on topics that were unanimously agreed upon, for which no recommendations were available. The Delphi method was implemented to reach unified decisions, which led to the development of evidence-based recommendations. Gastritis and gastroesophageal reflux disease (GERD) are common conditions seen in pediatric practice. Ranitidine has a rapid onset of action compared to proton pump inhibitors (PPIs). It is a preferred drug for on-demand use for gastritis and managing stress-induced gastric lesions in critically ill pediatric patients. Ranitidine has an established role in the management of GERD, and it also prevents nocturnal acid reflux effectively. It helps in reducing gastric fluid volume when used as preoperative prophylaxis. Also, ranitidine has a better safety profile in comparison to PPIs. Recommendations on the use and safety of ranitidine in pediatrics were developed which will be a guiding tool for all practicing clinicians, highlighting the strength and benefits of ranitidine as a better and safe alternative to PPIs in short-term acid suppression for multiple indications.

A previously well 8-year-old girl presented with recurrent bouts of upper abdominal pain mostly post-prandial in nature. She was seen on multiple occasions with recurrent episodes of the same and was treated as “Acute gastritis “with multiple courses of Proton pump inhibitors (PPI). Her response to the pain was short lived and re-occurred frequently only to be prescribed again with another course of PPI’s. Her evaluation by the paediatric gastroenterologist showed a Complete blood count, Liver function tests, Serum Amylase and Lipase were all within normal limits. Upper Gastrointestinal Endoscopy revealed a normal mucosa up to the 2nd part of Duodenum and her biopsy of the Oesophagus, antrum and Duodenum were all normal. Her upper Gastrointestinal Endoscopy revealed two ducts of Pancreas which indicated the likelihood of a probable pancreatic divisum. The child underwent a MRCP (Magnetic resonance cholangiopancreatography) which revealed a filamentous accessory pancreatic duct and a Main pancreatic duct which confirmed the diagnosis of Type 3 pancreatic divisum. She was prescribed oral pancreatic supplements and is being followed up for monitoring her growth and prevention of recurrence.

Aims & Objectives: Nutrition plays a very important role in the Immunity and Immunoregulation in children. The risk of acquiring an infection is very high in malnourished and underweight children, which is what we venture out to find out in our study by researching the susceptibility for COVID-19 in children and comparing it with their nutritional status. Materials & Methods: Our Tertiary Childrens hospital had 46 COVID positive children admitted in 2020, the nutritional status analysis, showed that there were four children 8.6% (n=4) in Obese category, 19.5%, nine (n=9) children were Overweight, 17.39 %, 8 children Underweight (n=8) and 25 children were 54.3% well nourished. Results: This case series describes the various features in COVID-19 in children with and without co-morbidities primarily focusing on the nutritional profile. This is the first single centre case series globally on COVID-19. Our cohort showed no significant relation between COVID-19 and the nutritional status. We saw an equal distribution of COVID-19 in children irrespective of their nutritional status at admission. Conclusions: We did not notice any statistical significance in the age group or the nutritional status in children infected with COVID-19

Vitamin D, sometimes called the “sunshine vitamin” is produced in our skin in response to sunlight.It’s a fat-soluble vitamin in a family of compounds that includes vitamins D-1, D-2, and D-3.Our bodyproduces vitamin D naturally when it’s directly exposed to sunlight. Vitamin D has several importantfunctions. Perhaps the most vital are regulating the absorption of calcium and phosphorus, and facilitatingnormal immune system function. Getting a sufficient amount of vitamin D is important for normal growthand development of bones and teeth, as well as improved resistance against certain diseases. Nowadays,Vitamin D deficiency patients are identified in various medical fields and it is necessary to understand thesymptoms, pathophysiology and therapeutic measures to overcome the deficiency of this vitamin in variousage groups from pediatric to geriatric.

Objectives Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer health benefits to the host. Probiotics are currently being recommended and considered for many medical conditions. The Asia-Pacific region contributes to more than 40% of the global industry. Quality of commercial probiotics remains a challenge globally and has been a major concern in various countries in Europe, South Africa, Taiwan, India, Pakistan, and the USA. Research from these countries indicate that the contents do not correspond to the label information in terms of identity, viability, number of microorganisms or purity. The objective of this study is to assess the commercial probiotic bacterial contents and their label accuracy in India. No previous research has been done in this area in India, on commercial probiotics that are sold as "pharmaceuticals". Methods A random selection of the most prescribed probiotics for various clinical indications were chosen with a minimum shelf life of 12 months. The probiotics were single and multiple strains and these were evaluated by culture, viable plate count, DNA isolation and targeted metagenomics. Our study is the first step in scrutinizing probiotics in terms of quality and quantity analysis which are used across various age groups for multiple indications. Results Out of the 20 chosen probiotics eight products were single strain and 12 products were multiple strains. These probiotics showed very poor correlation between the declared contents on the pack and lab values in viable cell count colonies, the genus and species strain identification, presence of contaminants and these were confirmed with 16s RNA and next generation sequencing. Conclusion Poor correlation in the quality and quantity of probiotics proves that the label claim and actual claim of these "drugs" show exceptionally poor correlation and raises safety concerns in clinical use, especially in vulnerable age groups such as neonates, children and the elderly. Our study shows that "policing" of these probiotics is essential in protecting these patients who are at risk and ensuring quality control and helping clinicians making the right choice.

Background and objective Bowel preparation (BP) is a major determinant of accurate and successful colonoscopy and its outcomes in children and adults. The present study aimed to evaluate the effectiveness and safety of a senna alkaloid and probiotic-based BP in children undergoing elective colonoscopy. Methods Children aged 2-15 years who underwent esophagogastroduodenoscopy (OGD) and colonoscopy for various indications from December 2018 to May 2019 at the Apollo Children's Hospital who were prescribed a senna and probiotic-based [Bacillus coagulans (B. coagulans)] preparation before the procedure were included in the study. The effectiveness of the bowel preparation was assessed using the Boston Bowel Preparation Scale (BBPS). Safety assessment was performed by recording adverse events in the study. Results Successful bowel preparation was observed in all patients according to BBPS, and the mean BBPS score was 2.93 ±0.25, indicating good bowel clearance. About 29 (96.67%) patients showed accessible terminal ileum. There were no major side effects reported in the study. The formulation was found to be palatable and acceptable by 100% of patients. Conclusion The study revealed the administration of the novel BP to be effective and safe in children undergoing elective colonoscopy for various indications.

This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Evidence-based recommendations and randomized controlled trials in the region are included. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by utilizing a modified Delphi process and applying the Likert scale in an electronic voting process. Bacillus clausii was recommended as an adjunct treatment with oral rehydration solution for acute viral diarrhea. B. clausii may also be considered for prevention of antibiotic-associated diarrhea, Clostridium difficile-induced diarrhea, and as adjunct treatment of Helicobacter pylori. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations currently apply to most Asia-Pacific countries. Ideally, these need to be validated with local randomized-controlled trials.

Data is limited or scarce in Indian children on food allergies and their incidence in India. We set to find out the incidence, prevalence, presenting symptoms and the common food allergens in our single center prototype study. To prove the non-existence of data we searched Scientific databases1,2. Literature review in PubMed/ Google scholar/med base using keywords “Food “ +“ allergy ”+”statistics “+ “children”+ “SAARC countries” didn’t reveal any results. Most of the papers related to food allergy were from the Western countries or they were anecdotal Indian data. The growing Indian population, increased usage of processed food, challenges posed by childhood obesity, reduced exposure to external triggers, rising cases of paediatric allergies makes it worthwhile to explore this rather grey area in India. Food allergies will have to be checked comprehensively and various parameters need to be critically analysed before lab- diagnosing food allergy. Increasing awareness in clinician’s diagnosis about food allergy and its existence has made us review different studies which have been done in the past few decades. It is an interesting fact to find that there has been no data published in India on this subject and we have attempted to look at an epidemiological cross sectional data of all children who presented with symptoms suggestive of Food allergy, Food protein induced Enterocolitis colitis syndrome or any other related symptoms there in our tertiary centre hospital at Chennai,Tamilndau,India.

Background: Nutrition plays a major part in the growth and well-being of a child and forms the basis of their existence. A global pandemic like COVID19 poses some serious questions and challenges in the minds of practicing pediatricians as what support to offer our children, theirparents and carers-alleviating their anxiety about their child’s diet and nutrition, that is critical at this time of crisis. Although the evidence for pediatric nutrition and COVID19 is not strong, this article aims to critically look into pediatric nutrition during COVID19 pandemic and bring the most recent evidence into limelight and making the right choices with pediatric nutrition. Methods: We performed a search on recent literature using the search terms “Covid19” + “Children” + “Nutrition” to analyze the current evidence supporting nutrition as a stimulant for covid19. A review article based on the above search results was written to highlight the importance of nutrition during this pandemic. Results: Strong recommendations remain unchanged for breast feeding, healthy complimentary feeding, use of supplemental formula where appropriate, Oral nutritional supplements, Zinc, n-3& n- 6 fatty acids, probiotics all have a certain role to play as a stimulant for Covid19 in children. Conclusion: Current evidence emphasizes the use of additional nutritional supplements especially in the “at risk” groups, low socio-economic status and children with chronic medical problems. Paediatric nutrition should never be overlooked and “one size does not fit all” as every child is different and their individual nutritional needs vary. This review points at the importance nutrition as a stimulant to covid19 in the pediatric population.

The immature gastrointestinal (GI) tract makes infants vulnerable to transient disorders including colic, gastro-oesophageal reflux (GER) and constipation. These conditions cause a significant distress to infants and caregivers, and are among the most common reasons for the paediatrician referral. In addition, these conditions are associated with a significant morbidity, hospitalisations and high healthcare costs, adding to the burden of the disease. Although they are additions to the ongoing physiological development or arise from maladaptive behavioural responses, the evidence remains limited. The vague aetiology and the self-limiting nature, has devoid these conditions of robust clinical attention, both in the research and clinical practice. Frequent early-life intestinal insults may translate as a risk factor in the development of chronic GI disorders and psychological problems later in life. Emerging evidence suggests that providing an optimal nutritional intervention closer to the breast milk can be a path breaking approach to manage these frequently encountered conditions and aid the growth and development of infants.

Background: Lactobacillus reuteri DSM 17938 is a well-studied probiotic which colonizes many mammals. In humans, L. reuteri is found in various body sites including the gastrointestinal tract, urinary tract, skin and breast milk. It fulfills all the prerequisites of being a good probiotic as described by the world gastroenterology organization.Methods: This was a retrospective observational study, where a nutritional supplement L. reuteri DSM 17938 was given to 197 children, aged 0-16 years, along with normal diet. The participants were having complains of diarrhea, stomach pain and frequent hospitalization. Various parameters were recorded such as sex, age, anthropometry-weight and height (every visit), diagnosis, reason for outpatient visits and various demography including but not limited to- birthplace, current location, year in school, reason for hospital admission (if any). Paired t test was used to find difference in weight and height between each visit.Results: A total of 118 subjects were included in the analysis. Five drops of nutritional supplement L. reuteri DSM 17938 was given. Supplementation of L. reuteri reduced the need for hospital admissions. 96% children did not require hospital admission. It improved the overall health of the children. There was a statistical significance in the height and weight between first and second visits (p

We compared fecal calprotectin and endoscopic findings of 53 children with possible inflammatory bowel disease and found an optimal cut-off of 68 µg/g in Receiver operative curve [AUC 0.88 (95% CI 0.79, 0.97)] to discriminate inflammatory bowel disease with other inflammatory gastrointestinal conditions.

Lactobacillus reuteri DSM 17938 has been one of the most extensively studied probiotic in children and adults with functional gastrointestinal disorders. In order to gather evidence on the efficacy of Lactobacillus reuteri DSM 17938 for treating and preventing some of these disorders. MEDLINE and the Cochrane Library were searched till February 2018 for relevant randomized controlled trials, retrospective studies, and meta-analyses with no language restrictions. The recent probiotic literature strongly suggests that Lactobacillus reuteri may be effective in the prevention and treatment of certain clinical conditions, such as infantile colic, infantile regurgitation, functional constipation, acute gastroenteritis, acute diarrhea, antibiotic-associated diarrhea, and necrotizing enterocolitis. No safety concerns with regard to the use of Lactobacillus reuteri in non-immunocompromised subjects were identified. A recent meta-analysis also supports the safety of using Lactobacillus reuteri even in preterm infants. This review presents the history of Lactobacillus reuteri DSM 17938 and the evidence base for its application in the health and disease.

A 4 year old girl was referred to the paediatric department with a six month history of abdominal distension, irritable mood, reduced appetite, and weight loss. She had recently had loose stools four to five times a day without any associated blood or mucus and “crampy” type abdominal pains after eating foods such as bread and oats. This led her mother to suspect a “food allergy,” and avoidance of these foods improved her symptoms. She had no other medical problems. Her birth and developmental histories were normal, and there was no family history of medical problems. On examination she had a distended abdomen, which was soft on palpation and tympanic to percussion. There was no organomegaly, ascites, or lymphadenopathy. She had no peripheral signs of gastrointestinal disease, and all other examinations were unremarkable. Her height and weight were plotted on the 25th centile, and there were no previous measurements with which to compare. Blood investigations showed haemoglobin at 78 g/L (reference range 120-160), total white blood cell count 9.7×109/L (4-11), neutrophils 4.6×109/L (2-7.5), and platelets 211×109/L (150-500). Her blood film was normal, and C reactive protein concentration was 5 mg/L (

The Liverpool neurological infectious diseases course is for anyone who has ever struggled with a patient who has meningitis, encephalitis, or another neurological infection and not known how best to manage him or her. The course is the only one of its kind in the United Kingdom, and there were 110 delegates from across the UK when I attended, plus people from Europe, Africa, and Asia. I took the course when I was a year 4 specialist registrar, but I wish I had known about it earlier. Patients with neurological infections are common, but their management is often very difficult. The presenting syndromes are elusive, which makes the diagnosis difficult, and determining the best treatment can be hard. Liverpool is the home of the School of Tropical Medicine, and it is also the base for several important institutions such as the Walton Centre for Neurology and Neurosurgery; Alder Hey …

Goals To assess the efficacy of probiotics in managing acute gastroenteritis in children, including reducing the need for inpatient care and antibiotics, repeat visits to emergency or private clinics, and incidence of adverse events. Background Acute gastroenteritis is characterized by diarrhea, vomiting, and occasionally, abdominal pain and fever. Treatments include oral rehydration solutions to prevent dehydration and nutritional damage and zinc supplementation to reduce the severity of diarrhea and reoccurrence. Probiotics are effective in reducing the intensity and duration of acute gastroenteritis; however, their efficacy in the Indian population needs further investigation. Study In this single-center open-label randomized study, the efficacy of 3 single-strain probiotics, Bacillus clausii, Saccharomyces boulardii, and Lactobacillus rhamnosus GG, as adjuvant therapy along with oral rehydration solution and zinc supplements in the management of acute gastroenteritis, were compared in 150 children aged 6 months to 16 years. Results B. clausii was the most effective single-strain probiotic in our study for the management of acute diarrhea in children across various parameters, including time to first formed stool, reduction in the duration of diarrhea, reduced hospital admissions, and earlier recovery. Conclusions All 3 probiotics demonstrated no adverse effects. Readmission and revisit rates after treatment with these probiotics were extremely low. B. clausii is strongly recommended as adjuvant therapy in children with acute gastroenteritis.