Mandyam Dhati Ravi

Background: Acute, acute recurrent and chronic pancreatitis cause significant health problems in the paediatric population. In view of the small number of patients, it is difficult to evaluate outcomes, genetic causes, treatments, prognostic indicators, severity, and epidemiologic factors in childhood in a prospective way. Objectives: To determine the characteristics of patients with pancreatitis (acute, chronic and recurrent) presenting to us. Method: This was a retrospective descriptive study of consecutive paediatric patients admitted between January 2017 and December 2020 (4 years) in our paediatric department with a diagnosis of pancreatitis. Patient characteristics, laboratory and imaging results, identified aetiology of pancreatitis, and recurrence rates were recorded and evaluated.Results: There were 34 visits, of which 28 were for acute pancreatitis (including 3 with acute on chronic pancreatitis), and 6 for an episode of recurrent pancreatitis. The median age for all visits was 9 years (range 2-16). Of the acute cases, 14 had uncertain or undetermined aetiologies, 3 had systemic diseases, 2 were associated with medications, most common being valproic acid, 3 were cholelithiasis-related, 5 were due to other infections and one was due to trauma; one child with 3 recurrent episodes was suspected to have a genetic basis and 1 child was diagnosed to have Rapunzel syndrome (trichobezoar). There were five patients with chronic pancreatitis, of which 3 had acute on chronic pancreatitis.Conclusions: Abdominal pain, nausea, vomiting, fever and jaundice were the common clinical presentations of acute pancreatitis in children. The common aetiological factors identified were infections (18%), systemic illness (11%), drug induced (7%) and obstructive/ cholelithiasis (7%); in 46% the aetiology was unknown.

Nutrient inadequacies among picky-eaters have adverse effects on growth and development. Oral nutritional supplements (ONS) along with dietary counseling (DC), rather than DC alone as reported in our earlier publication, promoted growth among picky-eating Indian children aged from >24 m to ≤48 m with weight-for-height percentiles lying between the 5th and 25th (based on WHO Growth Standards) over 90 days. This paper presents the contribution of ONS to nutrient adequacy, dietary diversity, and food consumption patterns in children (N = 321). Weight, height, and dietary intakes, using 24-h food recalls, were measured at baseline (Day 1) and at Days 7, 30, 60, and 90. Nutrient adequacy, dietary diversity score (DDS), and food intake adequacy were calculated in both the supplementation groups (ONS1 + DC and ONS2 + DC; n = 107 in each group) and the control group (DC-only; n = 107). Supplements increased nutrient adequacy in both of the ONS + DC groups relative to control (p < 0.05). The proportions of children with adequate nutrient intakes increased significantly at Day 90 in the supplemented groups as compared to in the control group (p < 0.05), especially for total fat, calcium, vitamin A, vitamin C, and thiamin. Although no significant differences were observed in DDS in any of the groups, the percentage of children consuming ≥4 food groups in a day had increased in all the groups. Consumption of fruit and vegetables and cereals had increased significantly from baseline to Day 90. ONS along with dietary counseling was found to have improved nutritional adequacy without interfering with the normal food consumption patterns of picky-eating children at nutritional risk.

The problem of poor nutrition with impaired growth persists in young children worldwide, including in India, where wasting occurs in 20% of urban children (24 to ≤48 months old, at malnutrition risk (weight-for-height percentile 3rd to 15th), and described as a picky eater by their parent. Enrollees were randomized to one of the three groups (N = 107 per group): ONS1 + DC; ONS2 + DC; and DC only. From day 1 to day 90, study findings showed significant increases in weight-for-height percentile for ONS1 + DC and for ONS2 + DC interventions, as compared to DC only (p = 0.0086 for both). There was no significant difference between the two ONS groups. Anthropometric measurements (weight and body mass index) also increased significantly over time for the two ONS groups (versus DC only, p < 0.05), while ONS1 + DC significantly improved mid-upper-arm circumference (p < 0.05 versus DC only), as well. ONS groups showed a trend toward greater height gain when compared to DC only group, but the differences were not significant within the study interval. For young Indian children with nutritional risk and picky eating behaviors, our findings showed that a 90-day nutritional intervention with either ONS1 or ONS2, along with DC, promoted catch-up growth more effectively than did DC alone.

Maintaining the quality and safety of immunization is as important as the efficacy of vaccines in vaccine-preventable diseases (VPD) programs. The aim of this study was to determine the problems associated with different stages of vaccine use and to assess the outcome of an educational intervention on safety and quality use of vaccines among health care providers. A pilot prospective interventional study was conducted over a period of 2 years at 271 sites in Mysuru, India. The study population was health care professionals (HCPs) involved in immunization and a sample of parents (one per site). A validated questionnaire was used as a study tool. An educational intervention on best immunization practice was conducted for the enrolled HCPs and the impact of the educational intervention was assessed using the study tool after 3 weeks. The total number of the study population was 594 (323 HCPs and 271 parents). Of these, 41.49% were working at community health care facility and 33.13% were enrolled from primary care centers. There were statistically significant improvements in post interventional assessment of all stages of the immunization process including storage (p −0.001), transportation (p −0.001), administration (p 0.001), monitoring and reporting of adverse events following immunization (AEFIs) (p −0.001), knowledge of AEFIs (p 0.001), and HCP-parent communication (p 0.001). AEFI reporting improved by 30% in the post education phase. Continuous education and motivation can result in positive behavioral changes on best immunization practices amongst HCPs involved in immunization, which may help to improve and maintain the safety and quality use of vaccines in immunization centers irrespective of the type of facility.