Background and Aim: One of the most frequent complaints that bring a child to the hospital is noisy breathing which causes a lot of anxiety to the parents. Pediatricians are the first responders to this complaint, and managing such patients can challenge the skills of even of the most astute clinicians. We conducted this study intending to provide a simple algorithm with endoscopy as a primary tool to diagnose patients presenting with stridor of more than one-month duration Methods: Thirty-five patients were consecutively enrolled and given a number (1-35) in the same order. After due consent and proper preparation, endoscopic video evaluation was performed by the experts under sedation who were not part of the study. Results: All thirty-five patients were investigated and managed according to the standard protocol. The most common chief complaint was noisy breathing of more than one-month duration (n=24). We also found a correlation between the time of commencement of stridor and the likely etiology behind the stridor. The most common associate diagnosis was pneumonia with stridor. (n=6). (n=33) (94.28%) patients had abnormal findings at endoscopy out of which (n=17)(48.57%) patients required surgical management, whereas (n=18)(51.42%) patients were managed conservatively. Conclusion: we conclude that endoscopic evaluation should be performed in all patients presenting with chronic stridor to assess the airway and guide further investigations and management. We offer a simple diagnostic algorithm for approaching a child with chronic stridor that will save valuable time dealing with such patients.

Objective: To conduct an umbrella review collating the existing evidence to determine whether there is an association between exposure of paracetamol in utero or in infancy, and the development of childhood asthma. Methods: In this review, systematic reviews with or without meta-analysis that reported the association between paracetamol and asthma in children were included. To identify relevant reviews, a search was performed in the electronic databases PubMed, the Cochrane Central Register of Controlled Trials Library, and Ovid. Results: The search strategy in various databases identified 1913 conceivably significant studies for inclusion. After removal of 493 duplicates ,1420 studies were screened for titles and abstracts against a standard eligibility criterion. Full text screening yielded four systematic reviews to be included in this review. Prenatal paracetamol exposure is associated with an increased risk of Asthma in the offspring. Of the four systematic reviews, 2 have an unclear risk of bias, one has a high risk and one has a low risk of bias. Association does not imply causation and we recommend further research to answer this very important question. In the absence of any other alternative, paracetamol will have to continue to be the safest and the most widely prescribed analgesic and antipyretic in pregnancy. Conclusions: We recommend further research to answer this very important question. In the absence of any other alternative, paracetamol will have to continue to be the safest and the most widely prescribed analgesic and antipyretic in pregnancy.

Background: Aspergillus fumigatus and other fungal species are common pathogens isolated in CF patients and they lead to a variety of diseases like ABPA and invasive aspergillosis. Aims and Objectives: To study the prevalence of Aspergillus colonization, sensitization and ABPA in our cohort of CF patients. Also, to study the various risk factors for Aspergillus colonization and ABPA in these patients. Methodology: This was a observational study in which 30 patients of cystic fibrosis between 0 to 18 years were enrolled visiting a tertiary care hospital in north India during January 2019 till December 2020. Data was collected on pre-structured proforma on cough swab and sputum c/s for bacteria and fungus, skin prick test for Aspergillus fumigatus, total IgE, Aspergillus specific IgE, Aspergillus specific IgG, galactomannan and CXR. Prevalence of Aspergillus colonization, sensitization and ABPA was calculated, Odds ratio for all the postulated risk factors for Aspergillus colonization and ABPA were calculated and further Chi square test was applied to check association of ABPA with pulmonary exacerbation. Results: Patients enrolled were between the age group of 4 months till 18 years of age with the median age being 4.75 years (IQR: 2.25 -11.75). 16.67% (n=5), 36.67% (n=11) of the patients enrolled in our study were colonized and sensitized with Aspergillus fumigatus respectively. While, 23.34% (n=7) of the patients had ABPA. We found positive association of Aspergillus colonization with multiple risk factors under study, in the following order of decreasing odds ratio, inhaled antibiotics (OR: 4.75) followed by use of azithromycin (OR: 3.5), inhaled corticosteroids (OR: 2.6), and atopy (OR: 1.3). Conclusion: Aspergillus fumigatus is a common colonizer in patients of cystic fibrosis (16.67%), and can lead to an inflammatory response and ABPA (23.34%). Use of azithromycin, inhaled antibiotics, inhaled corticosteroids and atopy increases the chances of Aspergillus colonization.

Introduction: Tuberculosis is still a leading cause of morbidity and mortality in the world, especially the low and middle income countries. While a lot is being done on the programmatic level, the burden of the disease is still underestimated owing to problems in diagnostics and infrastructure. Objective: The objective of this study was to estimate the prevalence of Latent Tuberculosis infections in the pediatric household contacts of patients of pulmonary tuberculosis in India. Methods: We searched electronic databases PubMed, EMBASE and Ovid for relevant articles. Search of grey literature and unpublished data was also done.The protocol of the study was registered in the PROSPERO. The quality of included studies was assessed using the Hoy et, al. checklist. The data extraction from relevant studies and subsequent data synthesis and analysis was done. The calculation of the pooled prevalence of LTBI, and the construction of galbraith plot for heterogeneity was done using STATA software. Result: The searches yielded 600 studies out of which 19 were included in the review. The pooled prevalence of LTBI among household contacts was 39.27[26.05-52.49]. On subgroup analysis, the prevalence of LTBI from studies with only pediatric contacts included was 26.73[17.70-35.76].There was significant heterogeneity amongst the various studies with overall I2=99.7%. A Galbraith Plot was constructed which also shows significant heterogeneity among the different studies. All studies had a low risk of bias with a score of 3 or less, except one, which had a moderate risk of bias with a total score of 4.

There is no confirmatory diagnostic test for pulmonary hydatid cyst other than surgical excision and histopathologic confirmation. Imaging is at best suggestive and serology does not have a satisfactory sensitivity. We present a series of children wherein flexible fibreoptic bronchoscopy under conscious-sedation, revealed hydatid membranes in airways. Broncho-alveolar lavage analysis confirmed hydatid in half of them. We propose flexible fibreoptic bronchoscopy with broncho-alveolar lavage as a confirmatory diagnostic test for pulmonary hydatid in children. To the best of our knowledge, this is a completely novel approach to the condition with potential to alter the diagnostic paradigm.

A 12-year-old girl presented with chronic suppurative lung disease secondary to an old forgotten, foreign body (plastic whistle) in the right lower lobe bronchus, confirmed by Contrast enhanced computer tomography (CECT) chest. Rigid bronchoscopic removal was attempted twice but the foreign body could not be removed. Under general anesthesia, a flexible bronchoscope was inserted through the rigid bronchoscope and the foreign body was grasped and removed using rat-toothed forceps inserted through the suction channel of the flexible scope. Although there are a few reports of sequential use of flexible and rigid bronchoscopies, this report highlights the feasibility and utility of flexible through rigid bronchoscopy technique for foreign body removal in the distal airways.

Antiglomerular basement membrane disease is a small vessel vasculitis which affects the lungs and kidneys, causing diffuse alveolar haemorrhage and rapidly progressive glomerulonephritis respectively. It is extremely uncommon in children. Diagnosis requires the presence of specific anti-GBM autoantibodies. Presentation with renal involvement is much more common than pulmonary involvement. However, a small proportion of cases might have isolated pulmonary involvement. Minimal changes on renal biopsy could still be present in these patients. Treatment of antiglomerular basement membrane disease includes plasmapheresis and immunosuppression. We present a case where a 7 year old boy presented with a long history suggestive of pulmonary haemorrhage but no renal manifestations and was diagnosed on the basis of anti-GBM autoantibodies and renal biopsy. He responded well to immunosuppressive therapy alone.