Evolving A Children's Manifesto.

The health and welfare of children and adolescents-the nation's future-must always be a priority. One would, therefore, expect this to be reflected in the manifestos of political parties. This article suggests that pediatricians and the Indian Academy of Pediatrics (IAP) should play a more proactive role in influencing political parties to commit to an inclusive manifesto that addresses key issues related to child health and welfare, by also liaisoning and collaborating with other stakeholders, such as parents, educators, and child rights organizations.

Over Investigation: An Ethical Debate.

Over investigations contribute to escalating health costs driven by multiple factors including physician decisions, patient requests, information overload, technological advances, marketing, hospital management policies, insurance requirements and defensive practices. The reconciliation between knowledge and clinical wisdom while dealing with uncertainties in medicine is the primary way forward through this ethical maze. A case scenario illustrates what pediatricians need to reflect upon while facing decisions on rational investigations to maximize beneficence while being aware of economics of healthcare delivery.

Fascinating interaction between host and pathogen.

Clinical manifestations of disease depend upon host's immune response that is induced by pathogen and modified by the host's innate and adaptive immunity. Immunocompetent children of similar age and nutrition evoke different responses to the same pathogen varying from benign to potentially fatal condition. This results in diverse clinical presentations of a disease, that is different from the standard expected pattern and thus, poses a diagnostic challenge.

Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in healthy infants and toddlers given with routine vaccines in India.

Background: The childhood burden of disease attributable to Streptococcus pneumoniae is particularly high in India. The immunogenicity and safety of 13-valent pneumococcal conjugate vaccine (PCV13) were compared with 7-valent pneumococcal conjugate vaccine (PCV7) in a randomized, active-controlled, double-blind trial conducted at 12 sites in India.

Methods: Healthy infants received PCV13 or PCV7 at 6, 10, and 14 weeks of age (infant series) and at 12 months of age (toddler dose), along with routine pediatric vaccinations.

How to optimize current (available) diagnostic tests.

Isolation of mycobacterium tuberculosis is the gold standard in the diagnosis of childhood tuberculosis. However, it has inherent limitations due to paucibacillary nature of the disease in children and technical difficulties encountered in collection of appropriate sample. Thus, diagnosis is dependent on circumstantial evidence at best supported by conventional tests such as tuberculin test and chest radiograph.

Conjugate vaccines for enteric fever: proceedings of a meeting organized in New Delhi, India in 2009.

Enteric fever is responsible for significant morbidity in South Asia and high prevalence of severe disease is seen in children under two years of age. Effective typhoid vaccines are available, but they cannot be used for children under two years of age and also have some limitations in older age groups. Participants supported development of a Salmonella Typhi conjugate vaccine able to induce effective, long-lasting immunity in young children.

Changes in the management of tuberculosis.

There has been significant change in management of tuberculosis ever since pre-chemotherapeutic era to the present day RNTCP protocol based on specific disease categories. This has been based on knowledge of rational use of anti-TB drugs. DOTS has added new dimensions to TB control program.

Reversal of severe hepato-pulmonary syndrome in congenital hepatic fibrosis after living-related liver transplantation.

We report a 5-year-old girl with congenital hepatic fibrosis who presented with clubbing and cyanosis. Partial pressure of oxygen was 40 mmHg with oxy-gen saturation of 70% on room air, which improved to 128 mmHg and 92% on inhalation of 100% oxygen. Macroaggregated albumin scan showed 58% shunting to the brain, suggestive of severe hepatopulmonary syndrome.

Tuberculosis -- persistent threat to human health.

With the increasing incidence of tuberculosis worldwide, childhood cases now constitute 40% of the total. TB control thus has global importance. Unfortunately, control of disease is not in sight.

Tuberculosis - persistent threat to human health.

With the increasing incidence of tuberculosis worldwide, childhood cases now constitute 40% of the total. TB control thus has global importance. Unfortunately, control of disease is not in sight.

Natural history of asthma in children.

Asthma is a syndrome of reversible bronchial obstruction in hyperresponsive airways mediated by allergy or other trigger factors. Allergic disease represents true asthma while transient wheezing may be caused by factors such as viral infection, aspiration, prematurity and neonatal lung damage and is likely to outgrow within few years. Personal or family history of atopy, increased serum IgE and positive skin tests may suggest allergic asthma, which persists throughout life irrespective of presence or absence of symptoms.

Cough and asthma.

Cough is a common symptom in office practice. Though troublesome, it serves to maintain normal function of respiratory tract. Chronic or recurrent cough may be caused by variety of diseases, asthma being the most common amongst them.

Emerging issues in pediatric pulmonology in India.

With the advent of ventilatory care for newborn in India, the practicing pediatrician is likely to see the "intensive care nursery survivors" who are likely to manifest an abnormal pulmonary outcome during infancy. These include: sudden death, bronchopulmonary dysplasia (with chronic lung disease and even core pulmonale), reactive airway disease, an increased propensity for respiratory infections and anatomical complications as subglottic stenosis, tracheobronchomalacia or palatal grooves. These not only have effects on respiratory compromise but also impact on feeding, growth and development.