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Current Medical training in India is generally didactic and pedagogical, and often does not systematically prepare newly graduated doctors to be competent, confident and compassionate. After much deliberation, the Medical Council of India (MCI) has recently introduced a new outcome-driven curriculum for undergraduate medical student training with specific milestones and an emphasis on simulation-based learning and guided reflection. Simulation-based education and debriefing (guided reflection) has transformed medical training in many countries by accelerating learning curves, improving team skills and behavior, and enhancing provider confidence and competence. In this article, we provide a broad framework and roadmap suggesting how simulation-based education might be incorporated and contextualized by undergraduate medical institutions, especially for pediatric training, using local resources to achieve the goals of the new MCI competency-based and simulation-enhanced undergraduate curriculum.

To validate the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score for the evaluation of children presenting with acute scrotum.

This prospective study calculated TWIST score in patients of acute scrotum admitted to a pediatric surgery unit. The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1) and high-riding testis (1). All the patients were examined by a pediatric surgeon.

Among 96 children with acute scrotum, 68 (70.8%) patients had testicular torsion. In the testicular torsion group, the mean (SD) TWIST score was 5.7 (1.2) and in no torsion group, it was 1.46 (0.67). In the testicular torsion group, the number of patients with low, intermediate, and high risk was 0, 13, and 55, respectively and in without testicular torsion these were 21, 7, and 0, respectively.

TWIST score has high predictive value for testicular torsion, and can be used for clinical diagnosis of testicular torsion.

TWIST score has high predictive value for testicular torsion, and can be used for clinical diagnosis of testicular torsion.

To assess the usefulness and safety of flexible bronchoscopy in ventilated neonates with extubation failure.

This was a prospective observational study. Flexible bronchoscopy was done in eligible patients with failure of extubation form invasive ventilation. The main outcome measure was to find the presence of any anatomic or dynamic abnormalities of the airways of these patients and the organism profile of bronchoalveolar lavage (BAL) fluid.

Forty-eight babies (68.8% preterm) were enrolled in the study. #link# The most common finding on bronchoscopy was airway edema seen in 13 (27%) patients. BAL culture was positive in 29 (74%) patients. Overall treatment was modified in 35 (73%) patients based on bronchoscopy findings/BAL culture. Majority of infants (83.3%) tolerated the procedure very well.

Flexible bronchoscopy provides useful information in the management of newborn babies with extubation failure.

Flexible bronchoscopy provides useful information in the management of newborn babies with extubation failure.

To assess the effect of maternal occupational tobacco handling (bidi rolling) on cord serum leptin levels.

We enrolled 64 neonates born to women who were bidi-rollers, and 64 small for gestational age (SGA) neonates and 57 term appropriate for gestational age (AGA) neonates born to mothers with no tobacco exposure. Cord blood leptin levels between the groups were compared. Adjusted mean difference in leptin was calculated using regression model.

Cord leptin showed moderate correlation with birthweight (r=0.16; P=0.027) across the groups. Mean (SD) cord serum leptin levels (ng/mL) of study group was 19.79 (13.32), in comparison to 21.4 (13.4) of SGA (P=0.497), and 27.70 (13.96) of term AGA (P=0.002). Maternal occupational tobacco exposure contributed to significant decrease in cord leptin (adjusted mean difference (95%CI) -4.5 ng/mL (-8.82, -0.19); P=0.041).

Maternal occupational tobacco exposure causes signifi-cant reduction in fetal leptin levels.

Maternal occupational tobacco exposure causes signifi-cant reduction in fetal leptin levels.

This study was done to determine proportion of children carrying heavy school bags and to compare new guidelines issued by Government of India on school bag weight limit, based on class of the child with previous guidelines based on child's weight.

A cross-sectional study was done among students of schools from two cities of India - Pune and Hyderabad. GW441756 in vivo of school bag of 1321 children was measured and classified as 'heavy' or 'normal' based on existing as well as new guidelines. Agreement between two guidelines was also calculated.

In our study, 722 (77.2%) out of 935 students from class 1-10 were found to be carrying 'heavy' school bags. link2 Kappa coefficient for agreement between two guidelines was 0.55 (0.47,0.60) indicating moderately strong agreement.

Large proportion of school children are carrying school bags with weight beyond permissible limits. There is a need for all stake holders to take steps to reduce weight of school bags.

Large proportion of school children are carrying school bags with weight beyond permissible limits. There is a need for all stake holders to take steps to reduce weight of school bags.

To assess the progression of thyrotropinemia to overt hypothyroidism in overweight and obese children.

150 overweight and obese children aged 5-15 years were enrolled. Free T4 and thyroid stimulating hormone (TSH) were done at enrollment and for those with TSH >5 mIU/L, TSH levels were repeated after 1 year.

The mean (SD) body mass index (BMI) and TSH were 23.8 (3.19) kg/m2 and 2.70 (2.44) mIU/L, respectively. 17 children had thyrotropinemia (TSH between 10-15mIU/L); 10 (84.6%) of these children attained normal TSH levels at one year follow-up, and none progressed to overt hypothyroidism (TSH >15 mlU/L).

Levels of 5-15 mIU/L are common in asymptomatic overweight and obese children. Majority of these children revert back to normal TSH levels on follow-up.

Levels of 5-15 mIU/L are common in asymptomatic overweight and obese children. Majority of these children revert back to normal TSH levels on follow-up.

To identify WHO 2009 warning signs that can predict time taken for progression to severe dengue in a pediatric population.

Prospective analytical study over 1 year and 2 months.

Tertiary care center.

350 children aged 1 mo-12 y with serologically confirmed dengue without co-morbidities/co-infections; conse-cutive sampling.

At admission, clinical and laboratory details were noted. link3 Disease progression, time of onset of each warning sign, hematocrit, and platelet counts were recorded daily till discharge/ death. If progressing to severe dengue, its time of onset was noted. Time to event analysis with Log Rank test, Kaplan Meier plots and Cox Proportional Hazards Model was done.

Primary outcome was time interval from onset of first warning sign to onset of severe dengue (defined as per WHO 2009 guidelines). Predictors were WHO 2009 warning signs abdominal pain, lethargy, persistent vomiting, mucosal bleed, clinical fluid accumulation, hepatomegaly >2 cm, hematocrit ≥0.40 and platelet count <100xocrit ≥0.40, persistent vomiting and mucosal bleed. Study results have implications in policy making and practice guidelines to triage children attending a health care facility with or without warning signs.Sudden unexpected death in epilepsy (SUDEP) is a devastating complication in children with epilepsy. Children with generalized tonic-clonic convulsions, nocturnal seizures, and co-morbid developmental delay/intellectual disability are at higher risk of SUDEP. The pathogenic mechanisms are incompletely understood and involve cardiac, respiratory, autonomic and cerebral dysfunction. Prone positioning is also significantly associated with SUDEP and may be a target for SUDEP prevention. Good epilepsy control also attenuates the risk; hence, it is important to provide adequate antiepileptic drug therapy with stress on drug compliance as well as early surgical referral for seizure control, wherever necessary. It is recommended that parents of children with epilepsy be counseled about the risk factors for SUDEP and potential measures of SUDEP prevention. We herein provide a pediatric perspective of the problem and guidance about parental counselling for its prevention.

Despite growing evidence of deleterious health outcomes associated with sedentary behavior, prolonged static sitting in classrooms remains ubiquitous in primary schools. Sedentary behavior is associated with the development of cardio-metabolic conditions and poor back health. Preventative strategies to reduce sedentary behavior and its negative health effects may be required in a resource-constrained environment such as South Africa.

The primary objective of this study is to assess the feasibility of conducting a full trial to evaluate the effects of a multifaceted intervention comprising novel multifunctional classroom furniture and a video-based curriculum versus usual care on sedentary behavior among students aged 10-11 years in primary schools. The secondary objective is to assess the preliminary effects of the intervention on sedentary behavior and postural dynamism.

Eighty grade 5 or 6 students, aged 10 and 11 years, in mixed-gender schools within the Western Cape metropolitan urban area in Cape Tamism using the mean difference and 95% CI.

At the time of submission, two classrooms have been recruited into the study. Baseline physical activity and postural dynamism data have been collected from 10 participants from each class.

The results of this feasibility stepped-wedge cluster randomized controlled trial will be useful in informing the design of the main trial to assess whether this multifaceted intervention of multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum versus usual care has any effect on sedentary behavior in low-resource-setting primary schools.

Pan African Trials Registry PACTR201811799476016; https//tinyurl.com/y4upoys8.

RR1-10.2196/18522.

RR1-10.2196/18522.Bacterial contact-dependent growth inhibition (CDI) systems use a type Vb secretion mechanism to export large CdiA toxins across the outer membrane by dedicated outer membrane transporters called CdiB. Here, we report the first crystal structures of two CdiB transporters from Acinetobacter baumannii and Escherichia coli. CdiB transporters adopt a TpsB fold, containing a 16-stranded transmembrane β-barrel connected to two periplasmic domains. The lumen of the CdiB pore is occluded by an N-terminal α-helix and the conserved extracellular loop 6; these two elements adopt different conformations in the structures. We identified a conserved DxxG motif located on strand β1 that connects loop 6 through different networks of interactions. Structural modifications of DxxG induce rearrangement of extracellular loops and alter interactions with the N-terminal α-helix, preparing the system for α-helix ejection. Using structural biology, functional assays, and molecular dynamics simulations, we show how the barrel pore is primed for CdiA toxin secretion.