Preeti Singh

Gynecomastia commonly occurs in boys, especially during early stages of puberty, because of an imbalance favoring estrogen over androgens. Although pubertal gynecomastia is usually benign and resolves on its own, it is important to identify any pathological causes. Evaluation should focus on differentiating true gynecomastia from pseudogynecomastia and identifying red flags through careful history-taking, pubertal assessment, and systemic examination. In typical pubertal cases, investigations are rarely needed and should be guided by clinical signs. Treatment mainly involves reassurance, monitoring, addressing underlying conditions, and stopping any offending drugs. Medical therapy may be considered for selected symptomatic or persistent cases, while surgery is reserved for severe or refractory gynecomastia.

Objective To develop evidence-based guidelines for the prevention, identification, and management of growth failure in infants under 6 months (U6M), ensuring early detection and intervention to improve health outcomes. Justification Growth failure in the first 6 months of life significantly increases the risk of acute malnutrition and stunting in later childhood. Unlike older children, management in this age group prioritizes establishing exclusive breastfeeding and addressing feeding challenges. There are no standardized guidelines for identifying and managing growth failure in this vulnerable population. Process A national consultative committee of experts was convened to formulate these guidelines. The committee conducted extensive discussions, dividing key areas among six working groups. The process included four virtual and one in-person meeting between August and October 2024. A draft guideline was developed, reviewed, and approved by all committee members. Recommendations Early growth failure is a significant public health concern. Timely identification of at-risk infants through mother-infant dyad assessments during routine health visits is essential. Weight-for-age is the most reliable anthropometric indicator for recognizing at-risk infants U6M. The term “infant at risk of poor growth and development” is recommended to identify at-risk infants needing intensified support. Community-based interventions should support at-risk infants without medical complications, while those with complications need facility-based care with skilled lactation support. Severely wasted infants require close monitoring for hypothermia, hypoglycemia, and sepsis. Establishing exclusive breastfeeding should be prioritized in all cases, and when not feasible, F-100D (Catch-up D) should be used to ensure safe nutritional rehabilitation while minimizing renal solute load.

Objectives: Assessment of diabetes-specific knowledge among children with type 1 diabetes (T1D) and their caregivers using a validated diabetes knowledge test (DKT) and to determine the factors associated with DKT score. Methods: A cross-sectional study was conducted in a tertiary care hospital, New Delhi (India). Children 5–18 years with T1D and caregivers were evaluated using a validated DKT tool to assess knowledge in basic and advance domains. The factors associated with DKT scores were studied. Results: A total of 110 T1D children with mean (SD) age 12.2 (3.3) years and duration 5.3 (2.7) years were assessed. The mean (SD) composite DKT score (%) was 58.0 (11.1) while in basic and advance domains were 66.4 (9.5) and 50.4(1.5), respectively. Maternal education (≥graduate), socio-economic strata (≥upper middle), annual per capita income (>Rs 50,000/700 USD), urban setting and HbA_1c50 %. HbA_1c<8.5 % and urban setting were significant predictors of the DKT score on multivariate logistic regression analysis (p<0.001). Conclusions: DKT can identify individual challenges in specific (basic or advance) domains related to diabetes self-management skills. Higher maternal education significantly impacted achieving a high DKT score and improved glycemic control.

Objective To detail clinical profile and outcome in children infected with SARS-CoV-2. Methods This retrospective study was undertaken at a tertiary care pediatric teaching hospital in Northern India. The data on clinical characteristics and outcome of children (< 18 y) with COVID-19 illness from April 2020–October 2020 were reviewed and analyzed. Results A total of 2919 children with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness were tested for novel COVID-19 virus in the flu emergency (n = 1744), severe acute respiratory infection (SARI) ward (n = 825), and non-COVID area (n = 350) of the hospital. 8.73% (255/2919) children tested positive for SARS-CoV-2 infection. Of the 255 positive cases, 144 (56.47%) were managed on an outpatient basis and 100 (59 boys) required admission in COVID ward. The mortality rate of patients with SARS-CoV-2 was 11.4% (29/255). Majority of children admitted with COVID-19 had severe to critical illness due to the presence of malnutrition and underlying comorbidities. Conclusions Children of all age groups were susceptible to COVID-19 illness with a slight male preponderance. Amongst infected, two-third were asymptomatic or had mild symptoms that required outpatient management and home isolation. The adverse outcomes were more commonly seen in infants and children > 10 y of age with malnutrition and comorbid illness.