JOURNAL COVER PAGE

CONTENT
MESSAGE FROM VP EAST ZONE – DR SANTANU DEB
MESSAGE FROM PRESIDENT – DR HIMESH BARMAN
MESSAGE FROM SECRETARY – DR ENBOKLANG
MESSAGE FROM EDITOR – DR ANAMIKA MALL
SECRETARY’S REPORT – DR JANEICA SWER
ARTICLE 1 - Rotary's Contribution to Maternal and Child Health – Dr Debashish Das
ARTICLE 2 - 3 Significant updated and new WHO guidelines for diagnosis and management
of drug sensitive tuberculosis in children - DR SANTANU DEB
ARTICLE 3 - Medical Missions to Rural Garo Hills - Drs Denyl & Dorothy Joshua
ARTICLE 4 - MATTERS OF THE HEART - Dr . Kamwamangika Rapthap
ARTICLE 5 - Patient Safety And Pediatrics – DR PRAMOD PAHARIA

ARTICLE 6 - Revolutionizing Pediatrics: The Transformative Role of Artificial Intelligence – DR

ANAMIKA MALL

INDIAN CHILD HEALTH STATISTICS

PHOTOS
MEMBERS LIST
CONTENT
MESSAGE FROM VICE PRESIDENT EAST ZONE CIAP – DR SANTANU DEB

Dear Editorial board of Cherry Blossoms and members of IAP

Meghalaya state branch,
Congratulations to all our members for once again bagging a heap of
awards from CIAP for sincere commemoration of the various days and
weeks. Special mention has to be made for Dr Janieca Swett, our
secretary who despite her very busy schedule diligently encouraged
everyone and filed the reports on time.
2023 has been a very important year for me personally and the
success would not have been possible without the encouragement, support and blessings
that each one of you gave me. I have no words to express my gratitude for the efforts that
many of you put in to reach out to IAP members all over the country to vote.
IAP Meghalaya branch is my home branch and I derive my strength from all of you. Now
that all of you have sent me to the national platform, I hope that I will be able to do justice
to the faith that you have reposed in me.
Thank you.

Dr Santanu Deb
National Vice President
East Zone 2024
MESSAGE FROM PRESIDENT MEGHALAYA STATE IAP – DR HIMESH BARMAN
MESSAGE FORM SECRETARY MEGHALAYA STATE IAP – DR ENBOKLANG
MESSAGE FROM EDITOR MEGHALAYA STATE IAP - DR ANAMIKA MALL
SECRETARY REPORT 2023 – DR JANIECA SWER
 Rotary's Contribution to Maternal and Child Health

INTRODUCTION

The importance of maternal and child health cannot be overstated, as it is critical to the
wellbeing and development of societies. Rotary International, a global service organization
of more than 100 years with a rich history of humanitarian initiatives, has been at the
forefront of addressing maternal and child health issues worldwide. Through various
initiatives and partnerships, Rotary has made significant contributions in this vital area,
making a positive impact on the lives of countless mothers and children around the world.
No wonder, Rotary has designated April as Maternal and Child Health month.

Preventable maternal and child mortality remains a significant challenge in many parts of
the world, particularly in low-income countries. According to the World Health Organization,
approximately 295,000 women died during and following pregnancy and childbirth in 2017,
and an estimated 5.4 million children under the age of five died, mostly from preventable
causes. Addressing these challenges requires a concerted effort from governments,
organizations, and individuals, and Rotary has been playing a crucial role in this regard.

ROTARY'S INITIATIVES

Polio eradication is Rotary’s top philanthropic priority. Since 1988, when Rotary began
working with partners in the Global Polio Eradication Initiative to immunize nearly 3 billion
children worldwide, the incidence of polio has decreased by 99.9% and till date Rotary has
contributed over 1.8 billion dollars worldwide for Polio Eradication through its generous
donors.

Furthermore, Rotary's commitment to eradicating polio has had a direct impact on maternal
and child health. Polio, a highly infectious disease, primarily affects children under the age
of five, leading to paralysis and, in some cases, death. By working in partnership with
organizations such as the World Health Organization and UNICEF,
Rotary has contributed significantly to the global efforts to eradicate polio through
vaccination campaigns and other interventions, thus protecting millions of children from the
debilitating effects of the disease.

Rotary International has launched several initiatives and programs aimed at improving
maternal and child health outcomes. The charitable arm, The Rotary Foundation, has
provided grants for projects that promote maternal and child health, such as prenatal care,
access to safe delivery, and immunizations. These grants have supported local healthcare
providers and community leaders in implementing sustainable solutions to address critical
health needs.

Nearer home, the Rotary Clubs of Shillong have substantially contributed to the Polio Plus
fund, and were instrumental in the establishment of Milk Bank and the Rotary Intensive
Care Unit at H Gordon Roberts Hospital, Jaiaw. One of the flagship projects of the Rotary
Clubs is the Gift of Life program where children with congenital cardiac defects are sent to
cardiac centers for surgical correction and till date more than 50 children’s have been
benefitted. A vocational training team comprising of senior Doctors from UK are likely to
visit Shillong in the month of April 2024 to impart training and skills to groups of doctors,
nurses, mid-wives to address the issues of maternal and childhood mortalities.

In addition to these initiatives, Rotary clubs around the world have been actively engaged in
community-based projects focused on maternal and child health. These projects encompass
a wide range of activities, including providing access to clean water and sanitation,
promoting nutrition education, and supporting maternal healthcare facilities. By
collaborating with local stakeholders and leveraging the expertise of healthcare
professionals, Rotary has been able to make a meaningful and sustainable impact on
maternal and child health in diverse communities.

PARTNERSHIPS AND COLLABORATIONS

Rotary's impact in maternal and child health is further amplified through strategic
partnerships and collaborations with organizations and government agencies. By joining
forces with leading healthcare institutions, non-governmental organizations, and public
health entities, Rotary has been able to leverage resources and expertise to implement
comprehensive maternal and child health programs.

For instance, Rotary's collaboration with the Centers for Disease Control and Prevention
(CDC) has facilitated the expansion of immunization programs, leading to increased vaccine
coverage for children and pregnant women in vulnerable communities. Similarly,
partnerships with organizations like the Bill & Melinda Gates Foundation have enabled
Rotary to mobilize resources for initiatives aimed at improving maternal and child health
outcomes, particularly in underserved regions.

IMPACT AND FUTURE DIRECTIONS

The impact of Rotary's contributions in maternal and child health is evident in the improved
healthcare infrastructure, increased access to essential services, and reduced mortality rates
in communities where its programs have been implemented. By prioritizing sustainable
solutions and community engagement, Rotary has fostered lasting changes that benefit
generations to come.

Looking ahead, Rotary remains committed to advancing maternal and child health globally.
With a focus on innovative approaches, advocacy, and capacity building, Rotary continues to
support efforts to address the root causes of maternal and child mortality, ultimately
striving to create a world where every mother and child has the opportunity to thrive and
lead healthy lives.

CONCLUSION
Rotary International's unwavering dedication to maternal and child health has yielded
tangible results and inspired hope for millions of families worldwide. Through its
multifaceted initiatives, strategic partnerships, and grassroots engagement, Rotary has
demonstrated that collective action can bring about positive change in the most pressing
health challenges. As the organization continues to champion the cause of maternal and
child health, its legacy of compassion and empowerment resonates across borders,
enriching the lives of mothers and children everywhere.

Dr. Debashish Das

Past District Governor (2019-20)
Medical Director, The Children’s Hospital shillong
 Three Significant updated and new WHO guidelines for diagnosis and management of
drug sensitive tuberculosis in children
(From the WHO 2022 consolidated guidelines)
Dr Santanu Deb MD FIAP
Senior Consultant
Nazareth Hospital, Shillong, Meghalaya

World Health Organization published the WHO consolidated guidelines on tuberculosis

Module 5: Management of tuberculosis in children and adolescents in 2022. The objectives
of the 2022 consolidated guidelines were: to provide policy-makers and implementing
partners with evidence-based recommendations on the cascade of care for children and
adolescents; to support the implementation of activities to prevent TB among children and
adolescents at risk; to improve TB case detection and treatment outcomes in children and
adolescents with TB using effective models of care; and to contribute to reductions in TB
related morbidity and mortality in children and adolescents in line with global targets
including those in the SDGs, the WHO End TB Strategy and the Political declaration of the
UN General Assembly High-Level Meeting on the fight against tuberculosis.
Recommendation 1: Xpert Ultra
Recommendation: In children with signs and symptoms of pulmonary TB, Xpert Ultra should
be used as the initial diagnostic test for TB and detection of rifampicin resistance on sputum,
nasopharyngeal aspirate, gastric aspirate or stool, rather than smear microscopy/culture
and phenotypic drug susceptibility testing (DST).
UPDATED: strong recommendation, moderate certainty of evidence for test accuracy in
stool and gastric aspirate; low certainty of evidence for test accuracy in sputum; very low
certainty of evidence for test accuracy in nasopharyngeal aspirate.
The Xpert MTB/RIF (Gene Xpert) assay revolutionised the diagnosis of tuberculosis along
with detection of Rifampicin resistance worldwide. But the test has some limitations in
sensitivity especially for children, smear negative and people living with HIV. Xpert Ultra test
(XpertMTB/RIF Ultra, also from Cepheid USA) may overcome these limitations. The Xpert
Ultra test has significantly lower limit of detection (16 bacilli per ml specimen as compared
to 131 per ml of Xpert MTB/RIF). Both use the same platform. Xpert Ultra assay is therefore
recommended by WHO in these guidelines as the test for initial diagnosis and rifampicin-
resistance detection in sputum (including induced and spontaneously expectorated
sputum), gastric aspirate, naso pharyngeal aspirate and stool specimens rather than smear
microscopy/culture and phenotypic DST in children aged below 15 years with signs and
symptoms of PTB.
A systematic search of literature was carried out in January 2021 where for the meta-
analysis, six studies (653 participants) provided data for gastric specimens and six studies
(1278 participants) for stool specimens found that for gastric aspirate, Xpert Ultra sensitivity
was 64% in children 0–9 years, against a microbiological reference standard and specificity
was 95%.
For stool, Xpert Ultra sensitivity was 53% in children 0–9 years, against the microbiological
reference standard and specificity was 98%. Sensitivity estimates against a composite
reference standard were lower for both specimen types. There were no studies that
evaluated the diagnostic accuracy of Xpert Ultra for detection of rifampicin resistance using
gastric aspirate or stool specimens. As with other microbiological tests, a positive test
accurately determines a case of TB disease, but a negative test does not exclude TB disease.
The meta-analysis on stool samples in children with SAM showed similar accuracy as in the
overall analysis (sensitivity 63.2%, specificity 98.5%). A meta-analysis on gastric aspirates
could not be performed due to insufficient data.
Xpert Ultra in stool sample: Stool sampling has the advantage of being non-invasive, with
the collection generally perceived as easy and feasible by HCWs and caregivers, irrespective
of the clinical condition of the child. The possible drawback is that children may not be able
to pass stool on command causing delay in sample collection. The Guideline development
group agreed that, despite the requirements of training and skills, using Xpert Ultra on
gastric aspirate is probably feasible to implement, especially at higher levels of the health
care system. The majority of the panel felt that Xpert Ultra on stool samples is feasible to
implement at all levels of the health care system.
Therefore, this opens up the usage of a sophisticated microbiological diagnostic techniques
at primary levels.
Xpert Ultra trace results: Trace results are common with the use of Xpert Ultra in all
paediatric specimen types, reflecting the paucibacillary nature of TB disease in children. For
children as well as people living with HIV who are being evaluated for PTB, and for persons
being evaluated for EPTB, the “M. tuberculosis complex (MTBC) detected trace” Ultra result
is considered as bacteriological confirmation of TB . This is an important implementation
consideration, in view of the risk of morbidity and mortality in these populations. Trace
results will have an indeterminate result for rifampicin resistance; therefore, alternative
specimens may need to be collected for Xpert Ultra processing in persons with a high
likelihood of drug resistance.
Recommendations on Xpert Ultra in children and adolescents with EP TB: Along with Xpert
MTB/RIF, Xpert Ultra may be used as initial diagnostic test for TB meningitis in CSF, in lymph
node aspirate and lymph node biopsy for TB lymphadenitis. In adults and children with signs
and symptoms of extra pulmonary TB, Xpert MTB/RIF or Xpert Ultra should be used for
rifampicin resistance detection rather than culture and phenotypic DST.
Recommendations on Xpert MTB/RIF and Xpert Ultra repeated testing in children and
adolescents with signs and symptoms of pulmonary TB: In children with signs and symptoms
of pulmonary TB in settings with pretest probability below 5% and an Xpert Ultra negative
result on the initial test, repeated testing with Xpert Ultra in sputum or nasopharyngeal
aspirate specimens may not be used. (Conditional recommendation, very low certainty of
evidence for test accuracy)
In children with signs and symptoms of pulmonary TB in settings with pretest probability 5%
or more and an Xpert Ultra negative result on the first initial test, repeated one Xpert Ultra
test (for a total of two tests) in sputum and nasopharyngeal aspirate specimens may be
used. (Conditional recommendation, very low certainty of evidence for test accuracy).
Issues with inclusion of Xpert MTB/RIF in NTEP: Of 19 studies that examined a total of 5855
samples, the pooled sensitivity and specificity of Xpert in TB diagnosis were 0.69 (95% CI:
0.57–0.78) and 0.99 (95% CI: 0.98–0.99), respectively. The pooled sensitivity and specificity
of Ultra in TB diagnosis were 0.84 (95% CI: 0.76–0.90) and 0.97 (95% CI: 0.96–0.98),
respectively.
Regardless of whether the comparisons were indirect or direct, Ultra was consistently found
to be more sensitive, but with slightly lower specificity than Xpert in diagnosing TB. The 2 %
reduction in specificity means that there will be more false positives with Ultra than with
Xpert. This may result in more adults and children being treated for TB when they don’t
require treatment. Indian Pediatric TB group has opposed the introduction of Ultra by NTEP
because of this reason. Therefore, Ultra has not yet been introduced by NTEP.
Recommendation 2: Treatment shortening in children and adolescents with non-severe TB
Recommendation: In children and adolescents between 3 months and 16 years of age with
non-severe TB (without suspicion or evidence of MDR/RR-TB), a 4-month treatment regimen
(2HRZ(E)/2HR) should be used. (Strong recommendation, moderate certainty of evidence).
Non-severe TB is defined as: Peripheral lymph node TB; intrathoracic lymph node TB
without airway obstruction; uncomplicated TB pleural effusion or paucibacillary, non-
cavitary disease, confined to one lobe of the lungs, and without a miliary pattern.
Children and adolescents who do not meet the criteria for non-severe TB should receive the
standard six-month treatment regimen (2HRZE/4HR), or recommended treatment regimens
for severe forms of extrapulmonary TB.
The use of ethambutol in the first two months of treatment is recommended in settings with
a high prevalence of HIV, or of isoniazid resistance.
The SHINE trial (Shorter Treatment for Minimal Tuberculosis in Children) was the first and
only large phase three trial to evaluate the duration of TB treatment in children with non-
severe drug-susceptible TB. The SHINE trial was a multi-centre, open-label, parallel-group,
non-inferiority, randomized, controlled, two-arm trial comparing 4-month (16 weeks) versus
the standard 6-month (24 weeks) treatment durations in children under 16 years of age
with symptomatic non-severe TB. Children and young adolescents aged below 16 years
were treated with rifampicin, isoniazid, pyrazinamide with or without ethambutol using
WHO recommended doses, appropriate for paediatric dosing.
The SHINE trial inclusion criteria were: children and young adolescents aged <16 years;
weight ≥3 kg;
no known drug resistance; symptomatic but non-severe TB; smear negative on gastric
aspirate or other respiratory sample (an Xpert MTB/RIF positive, rifampicin susceptible
result was allowed); clinician’s decision to treat with a standard first-line regimen; not
treated for TB in the previous two years; known HIV status (positive or negative).
Trial exclusion criteria were: respiratory sample acid fast bacilli smear positive (a smear-
positive peripheral lymph node sample was allowed); premature birth (<37 weeks) and aged
under 3 months; miliary TB, spinal TB, TBM, osteoarticular TB, abdominal TB, congenital TB;
pre-existing, non-tuberculous disease likely to prejudice the response to, or assessment of,
treatment (such as liver or kidney disease, peripheral neuropathy or cavitation); any known
contraindication to taking TB drugs; known contact with a drug-resistant adult source case
(including mono-resistant TB); known drug-resistance in the child; being severely ill;
pregnancy.
A total of 1204 children were enrolled in the trial between July 2016 and July 2018. The
median age of enrolled children was 3.5 years (range: 2 months – 15 years), 52% were male,
11% had HIV-infection, and 14% had bacteriologically confirmed TB. Retention in the trial by
72 weeks and adherence29 to allocated TB treatment were 95% and 94%, respectively.
Sixteen (2.8%) versus 18 (3.1%) children reached the primary efficacy outcome (treatment
failure) in the 16- versus 24-week arms respectively, with an unadjusted difference of -0.3%
(95% CI: -2.3, 1.6). Treatment success was reported in 97.1% of participants receiving the 16-
week regimen versus 96.9% in those receiving the 24-week regimen (relative risk (RR): 1.00,
95% CI: 0.98–1.02). Non-inferiority of the 16-week regimen was consistent across all
intention-to-treat, per-protocol and key secondary analyses.

Recommendation 3: Treatment regimens for TB meningitis in children and adolescents

Recommendation: In children and adolescents with bacteriologically confirmed or clinically
diagnosed TB meningitis (without suspicion or evidence of MDR/RR-TB), a 6-month intensive
regimen (6HRZEto) may be used as an alternative option to the 12-month regimen
(2HRZE/10HR) (Conditional recommendation, very low certainty of the evidence).
The regimen includes isoniazid, rifampicin, pyrazinamide and ethionamide. The
recommended doses are as follows -
Doses: Isoniazid: 20 mg per kg, maximum 400 mg daily; Rifampicin: 20 mg per kg, maximum
600 mg daily; Pyrazinamide: 40 mg per kg, maximum 2000 mg daily; Ethionamide: 20 mg per
kg, maximum 750 mg daily
The shorter intensive regimen is suitable for children and adolescents who have no evidence
of drug resistance and in children and adolescents who have a low likelihood of drug-
resistant TB, e.g. those without risk factors for any form of drug-resistant TB.
The recommendation from the Guidance for national tuberculosis programmes on the
management of tuberculosis in children (second edition, 2014) remains an option for the
treatment of children and adolescents with suspected or confirmed TB meningitis (TBM):
Children and adolescents with suspected or confirmed tuberculous meningitis should be
treated with a four drug regimen (HRZE) for 2 months, followed by a two-drug regimen (HR)
for 10 months, the total duration of treatment being 12 months (Strong recommendation,
low certainty of evidence).
Due to a lack of data, the shorter intensive treatment regimen recommendation should not
be used in children and adolescents living with HIV who are diagnosed with TB meningitis.

Summary of the new recommendations in the WHO consolidated guidelines on tuberculosis

Diagnostic approaches
1. In children with signs and symptoms of pulmonary TB, Xpert Ultra should be used as the
initial diagnostic test for TB and detection of rifampicin resistance on sputum,
nasopharyngeal aspirate, gastric aspirate or stool, rather than smear microscopy/culture and
phenotypic drug susceptibility testing (DST).
(UPDATED: strong recommendation, moderate certainty of evidence for test accuracy in
stool and gastric aspirate; low certainty of evidence for test accuracy in sputum; very low
certainty of evidence for test accuracy in nasopharyngeal aspirate)
2. In children with presumptive pulmonary TB attending health care facilities, integrated
treatment decision algorithms may be used to diagnose pulmonary TB.
(NEW: interim, conditional recommendation, very low certainty of evidence)

Treatment regimens
3. In children and adolescents between 3 months and 16 years of age with non-severe TB
(without suspicion or evidence of multidrug- or rifampicin-resistant TB (MDR/RR-TB), a 4-
month treatment regimen (2HRZ(E)/2HR) should be used.
(NEW: strong recommendation, moderate certainty of evidence)
4. In children with MDR/RR-TB aged below 6 years, an all-oral treatment regimen containing
Bedaquiline may be used.
(NEW: conditional recommendation, very low certainty of evidence)
5. In children with MDR/RR-TB aged below 3 years Delamanid may be used as part of longer
regimens. (NEW: conditional recommendation, very low certainty of evidence)
6. In children and adolescents with bacteriologically confirmed or clinically diagnosed TB
meningitis (without suspicion or evidence of MDR/RR-TB), a 6-month intensive regimen
(6HRZEto) may be used as an alternative option to the 12-month regimen (2HRZE/10HR).
(NEW: conditional recommendation, very low certainty of evidence)

Models of TB care
7. In high TB burden settings, decentralized TB services may be used in children and
adolescents with signs and symptoms of TB and/or in those exposed to TB.
(NEW: conditional recommendation, very low certainty of evidence)
8. Family-centred, integrated services in addition to standard TB services may be used in
children and adolescents with signs and symptoms of TB and/or those exposed to TB.
(NEW: conditional recommendation, very low certainty of evidence)

Conclusion: The updated WHO guidelines of 2022 have described several significant
recommendations and the evidence and methodology for arriving at these
recommendations. Before being adapted by our National TB Elimination Programme (NTEP),
the guidelines will in all likelihood be validated in Indian setting before being recommended
to be used in our country.

Further reading:
1. WHO consolidated guidelines on tuberculosis. Module 5: management of
tuberculosis in children and adolescents. Geneva: World Health Organization; 2022.
Licence: CC BY-NC-SA 3.0 IGO.
2. Updated Pediatric TB guidelines 2019: Managing Tuberculosis in Children Basic
Training Module, Developed by NTEP & Indian Academy
3. Paediatric TB management Guideline 2022, Developed by NTEP, Central TB division,
Ministry of Health & Family welfare, New Delhi
Medical Missions to Rural Garo Hills
Drs Denyl & Dorothy Joshua

In 2016 I first visited Garo Hills. I was fascinated with the beauty of this part of Meghalaya.

The Call

Amidst the beauty and the warmth and love of the local Garo’s, there was a deep need for
good medical care. Having completed our DCH from CMC,Vellore , Dorothy and I had
accepted the call to be posted in Mizoram. It had been two and half years since we came to
Mizoram that we received the service call to help the Medical work in rural Garo Hills. We
knew that it was a divine call when a Mizo parent having spend few years in Garo Hills said “
The Mizos love you but the Garo’s need you.”

When it all began

We started our journey in a small village called Jengjal in West Garo Hills. Using a small
abandoned rented building we were able to help the children in the surrounding villages.

Challenges :
We saw the challenges and the potentials at the grassroots. The major challenge was the
poor health seeking behaviour by the locals, lack of committed medical staff, poorly
equipped medical facilities all combined with poor connectivity to access to basic health
care.

The local villagers were accustomed to traditional methods of healing and would often seek
medical help only when things get complicated.

The biggest challenge was to change the mindset and build trust in the medical care.

Transforming into a Maternal and Child Centre

We were grateful to God for bringing in a committed medical team and a gynaecologist and
Paediatrician couple Dr.Paul and Dr.Suzie Francis to join the team. We saw us growing into a
maternal and child health centre.

We started a labour room and got an operation Theatre made. We were conducting
deliveries and operating..
We were able to help get a level 2 NICU as well.

The challenges were high but we could see that education and timely help could prevent
major complications.

Connecting with IAP, Meghalaya

Within a year after moving to Garo Hills we got in touch with IAP, Meghalaya Branch and
realised that we were not alone and had a family to look up to learn and be guided.

We especially were grateful to all our seniors and the members who took time to connect ,
support and also hear what we had to share. This was probably the most beautiful part of
our stay in Garo Hills.

Overtime we were able to engage in different activities of IAP and as well as attend CMEs
whenever we were able to make time. It also gave us the privilege to grow in our speciality
and also to stay connected.
Training and empowerment the cornerstone

We quickly understood that the need was far beyond what we could deal with. With
accessibility to health care a major challenge we felt it was paramount to be able to
empower the local Medical Officers at the PHCs.

Thanks to the DM&HO and the Health officials at State and local level who gave us the
opportunity to be part of training our Medical Officers who were working like foot soldiers
at the battlefield. It was heart warming to network with them and be a support in whatever
ways possible.
We were part of the training for Neonatal Resuscitation and SARS program which was very
comprehensive.

Conclusion

We saw the infant mortality rate gradually decline over the last 5 years and saw
transformation in the rural health care of Garo Hills. With Jengjal Subdivisional Hospital, we
are now part of a bigger network to bring about greater blessing to the community.

We take with us memories, experiences of a lifetime and friends who are our family.

Thank you IAP, Meghalaya, you made us feel special.

MATTERS OF THE HEART -
Dr . Kamwamangika Rapthap

It was just the end of a busy day shift . A telephone call came over the nursing counter. The
staff on duty said it was for me.
I picked up the call, apprehensive, hoping ut would not be another sick child. I was itching to
get home. It was my parents' wedding anniversary. Having missed a lot in the previous
years, my mother mentioned in the morning if I could make a "guest appearance " (Go
figure! )
So anyways, the call was for a child - for availability of beds. I replied in the positive.

Half an hour later, the child was wheeled into our ICU.
It was a young boy of 9 years of age.
He was very sick looking, with breathing difficulty. " What is your name? " I asked him. "
Everyone calls me Bahdeng" , he replied.
His mother came in along with him. Draped in a ' jainkyrshah' ,with a cloth bag slung over
her shoulders, she timidly handed me some papers. I opened the oil stained ' documents' .
There were a lot of illegible prescriptions ( or maybe they looked so because they were so
poorly maintained) , and an old ECHO report.
" Congenital heart disease", it read , amidst the ' kwai' stains. The rest of the page was torn
and missing.

Bahdeng required assisted ventilation. I explained all prognosis to the mother. She wept
bitterly, but quickly came back to her stoic self , and proceeded towards the pharmacy to
buy the medications our staff had written down.
I looked at Bahdeng . There was something very different in his eyes., his demeanor .Not
like a lot of the other children his age.
I could not point out what it was.
As i explained to him that he was a bit sick , and will need lots of interventions, I asked him if
he was okay. " Go for it", he replied, in small breaks of that short sentence. He was that
breathless!
" Is there anyone you want to talk to Bahdeng? Other than your mother?" , i asked.
" I will speak to my father in the morning over the phone ", he said.
" Shall I call him now?", i asked.
" No, it's okay. I don't want to disturb him.Let him rest. He has just travelled with us for 5
hours to reach this hospital. Now he has travelled back home. That's a total of 10 hours. And
he has to look after my 3 younger siblings at home. He need sleep . And my siblings need
him there . I will manage. Please take care of my mother outside.She is alone ".

I was very touched with what he said. Bahdeng , in his nine odd years of life has so much
maturity.
After starting all necessary medications, I handed over my duty to my colleague.
I left with a prayer for Bahdeng to get well.

The next day , I arrived on ICU. Bahdeng ' s bed was empty!
I learnt from my colleague that he has a cardiac arrest in the night. He did not make it
through the night.
I silently cried.
Not so much because I felt sorry for Bahdeng, but because in that short moment with him, I
felt a connection. He has taught me so much.
That he is able to put others before himself.
That he thought of his younger siblings, and put their needs first.
That he is able to think of his parents first.
That for a nine year old , he had lived beyond his years.
May we all as adults, learn from Bahdeng: learn to put others first . Learn to think of
others before our selfish needs.
I know Bahdeng is in a better place, a happy place.
May he rest knowing that he has touched a life , and many more who have come
to learn of him.
 Patient Safety And Pediatrics

Patient Safety is defined as the prevention of harm to patients. In 1999, Institute of

Medicine released its report “To Err is Human: Building a Safer Health System”. This report
raised concern of existing errors in the system and encouraged everyone to promote
policies and behaviours to reduce errors and implement a safe provision of healthcare
delivery. WHO confirmed the same and declared September 17th as Patient Safety Day.

Pediatrics errors and harms are regularly reported all over the world and there is a felt need
to improve reporting and minimizing the errors in healthcare system especially in Pediatrics.
Much has been learnt about medical errors and efforts have been made to disseminate the
knowledge on patient safety, but errors are still happening and affect a significant
proportion amongst hospitalized children. Data for errors in Pediatrics population in India is
scanty and available literature suggests that the prevalence of medication errors is
approximately 10.5% of which transcription errors are commonest. Communication errors
are another area of concern and occurs frequently. Children are greater risk of errors due to
development issues (physical or neurological), weight-based dosing systems, and
dependency on parents and other care providers. Other than medication error, harms can
affect Pediatrics population commonly like accidental extubation, pressure ulcers, patient
misidentification, tubing misconnections, drugs extravasation, falls, etc. Communication
errors are common and occurs in emergency room between pre-hospital care team and
emergency team, amongst emergency staff, and nursing staff and family members, during
transition of care, in between shifts. These can be minimised by use of appropriate hand-
offs tools for Pediatrics population. Another aspect of harm which usually goes unnoticed is
the use of unnecessary tests for diagnosis in hospitalised cases. Rational investigations for
defined disease condition are important and due to misuse of available testing facilities and
increasing fear of medical litigation, Paediatricians tend to overuse these tests resulting in
increasing cost to the family and increasing exposure to radiation and blood loss. Also, it
may lead to incidental diagnosis leading to unnecessary treatments.

Every healthcare provider needs to understand the culture of safety especially patient safety
to avoid any patient harm and medical errors. The hospital culture needs to be developed to
react to these harms on real time basis and with a principle of Just Culture. The principle
believes it is the system failure in case of any error rather than blaming an individual. High
reliability organizations beliefs in this principle and promotes safety culture by its
anticipation of preoccupation with failure (commitment to avoid failures by informed
culture with constant attentiveness), sensitivity to operations (by promoting team training,
communication, and awareness of the effect of the environment on patient care) and
reluctance to simplify (by adhering to a structured investigation), and commitment to
resilience (with debriefing and support to the individual involved) and deference to
expertise (any member can take the leadership role for a given event on the basis of
expertise and skills). A reporting culture, thus, becomes important and it helps providers to
collect, analyse, and disseminate data providing information on the existing status of the
organization. Organizations with ‘Just Culture’ maintains a non-punitive environment for all
errors reporting. This system allows to learn from their mistakes and create a culture of
safety across the medical system.

Various strategies can be used to reduce these errors in the organization. Joint Commission
International has defined International Patient Safety Goals which helps monitors the
various safety aspects in the organizations and covers most safety aspects of all patients
including Pediatrics patients. These goals are-

Goal 1- Identify Patients Correctly,

Goal 2- Improve Effective Communication,

Goal 3- Improve the Safety of High-Alert Medications,

Goal 4- Ensure Safe Surgery,

Goal 5- Reduce the Risk of Healthcare Associated Infections and

Goal 6- Reduce the Risk of Patient Harm Resulting from Falls.

Patient identification is done by name and unique hospital identification number and not by
bed numbers. Barcoding for laboratory samples, blood bags, medications help reduce
identification errors. Communication can be improved using effective handoff tools like
SBAR, ISBAR etc. labelling of medications, verification of high-risk medications, written
medication orders to patients/relatives are important ways to reduce medication records.
Infusion pumps can help administration of drugs in safer ways compared to giving manually
or by free-flowing drips. Use of Computerized Physician Order Entry or Electronic Health
Records help minimize errors due to transcription caused by bad handwriting. Use of
surgical safety checklist for surgeries help reduce surgery related errors. Handwashing
and/or hand hygiene practices help reduce hospital/healthcare associated infections. Fall
risks can be minimized by using effective fall risk assessment tools and using grab bars,
bedrails etc. Besides these, use of Pediatrics Early Warning Score or Modified Neonatal Early
Warning Score help detects deterioration in clinical status early and prevent need of
intubation and mechanical ventilation.

Medication reconciliation is an important aspect in patient management especially in high-

risk children and need to be informed to the treating team as well as the patient’s family.
Availability of standardized weighing machine to measure correct weight is important in
Pediatrics case management.

Leaders of healthcare organizations need to understand that to create a safer healthcare

setup for Pediatrics patients or any other patients requires their commitment. They need to
acknowledge that healthcare professionals work in a high-risk, complex environment,
mistakes can happen and collective participation of all can help reduce medical errors.
Continuous quality improvement is improvement to create a culture of safety in the
organization.

Pediatrics patient safety is a recognized area in healthcare and robust data is available to
help understand it at present. Effective leadership and continuous effort of patient safety
enthusiasts can help create a culture of safety in the organization by having a robust patient
safety program in the organization.

Compiled from various available resources by-

Dr Pramod Paharia, (MBBS, CPHQ, FISQua)
Senior Medical Officer Pediatrics & Quality Coordinator, Nazareth Hospital.
Principal Assessor NABH
[Qualified Quality Implementer (HSSC)
Trained in Healthcare Quality, Patient Safety, Healthcare Risk Management, Fire Safety & Disaster
Management, Quality Tools and Techniques, Antimicrobial Stewardship Program, Medical
Documentation
IAP BLS Instructor
Basic NRP Provider Course Instructor]
The Transformative Role of Artificial Intelligence in Healthcare: A Comprehensive Review

Abstract: Artificial Intelligence (AI) has emerged as a disruptive force in the healthcare
sector, promising significant improvements in patient care, diagnostics, treatment efficacy,
and operational efficiency. This article provides a comprehensive review of the current state
of AI applications in healthcare, highlighting key advancements, challenges, and future
prospects. Through a synthesis of recent literature and case studies, we explore the diverse
uses of AI, including medical imaging analysis, predictive analytics, drug discovery,
personalized medicine, and virtual health assistants. Additionally, we discuss ethical
considerations, regulatory frameworks, and the importance of interdisciplinary collaboration
in harnessing the full potential of AI to revolutionize healthcare delivery.

1. Introduction:
The integration of Artificial Intelligence (AI) into healthcare systems represents a paradigm
shift with profound implications for both patients and healthcare providers. AI technologies,
encompassing machine learning, natural language processing, and robotics, offer the
promise of more accurate diagnoses, personalized treatment plans, and streamlined
administrative processes. As the volume of healthcare data continues to grow exponentially,
AI-driven solutions have the potential to unlock actionable insights, improve clinical
outcomes, and enhance the overall quality of care.

2. Applications of AI in Healthcare:

Medical Imaging Analysis: AI algorithms have demonstrated remarkable proficiency in

interpreting medical images, such as X-rays, MRIs, and CT scans, aiding radiologists in early
disease detection and treatment planning. Deep learning techniques, in particular, have
shown superior performance in identifying anomalies and patterns indicative of various
medical conditions, including cancer, cardiovascular diseases, and neurological disorders.
Predictive Analytics: AI-powered predictive models leverage patient data to forecast disease
progression, identify individuals at high risk of developing certain conditions, and optimize
resource allocation within healthcare facilities. By analyzing electronic health records (EHRs),
genetic profiles, and environmental factors, these models enable proactive interventions
and personalized preventive care strategies.

Drug Discovery and Development: AI-driven approaches accelerate the drug discovery
process by facilitating the identification of novel drug targets, predicting molecular
interactions, and optimizing compound synthesis. Machine learning algorithms analyze vast
repositories of biological data to expedite the screening of potential therapeutics, thereby
shortening the time-to-market and reducing research costs.

Personalized Medicine: AI algorithms enable the customization of treatment plans based on

individual patient characteristics, including genetic predispositions, biomarker profiles, and
lifestyle factors. By integrating genomic sequencing data with clinical information, healthcare
providers can deliver tailored interventions that maximize efficacy while minimizing adverse
effects, ushering in a new era of precision medicine.
Virtual Health Assistants: AI-powered virtual assistants, chatbots, and telemedicine
platforms enhance patient engagement, facilitate remote consultations, and provide on-
demand access to medical advice and information. These intelligent systems offer
personalized recommendations, monitor patients' health status in real-time, and promote
self-management of chronic conditions, thereby improving healthcare accessibility and
patient satisfaction.

3. Challenges and Considerations:

Despite the transformative potential of AI in healthcare, several challenges must be
addressed to ensure ethical, equitable, and safe implementation:

Data Quality and Interoperability: The reliability and interoperability of healthcare data
pose significant challenges for AI applications, as inconsistencies, biases, and privacy
concerns may undermine the accuracy and generalizability of predictive models.

Regulatory Compliance: Regulatory frameworks governing the use of AI in healthcare vary

across jurisdictions and must adapt to accommodate rapidly evolving technologies while
safeguarding patient rights, data privacy, and safety standards.

Algorithmic Bias and Transparency: AI algorithms may perpetuate biases inherent in

training data, leading to disparities in diagnostic accuracy and treatment recommendations
across demographic groups. Ensuring transparency and accountability in algorithmic
decision-making processes is essential to mitigate these biases and promote algorithmic
fairness.

Clinical Adoption and Workforce Training: Healthcare professionals require adequate

training and support to effectively integrate AI technologies into clinical practice, interpret
algorithmic outputs, and maintain patient trust. Interdisciplinary collaboration between data
scientists, clinicians, and policymakers is essential to bridge the gap between AI research and
real-world healthcare settings.

1. Future Directions and Implications:

Looking ahead, the continued advancement of AI in healthcare holds immense promise for
transforming healthcare delivery, improving patient outcomes, and driving operational
efficiencies. Key areas for future research and innovation include:

Explainable AI: Developments in explainable AI techniques will enhance the interpretability

and trustworthiness of AI-driven diagnostic and decision-support systems, enabling clinicians
to understand and validate algorithmic predictions.

Federated Learning and Privacy-Preserving Techniques: Federated learning frameworks and

privacy-preserving techniques will enable collaborative model training across decentralized
healthcare data sources while preserving patient privacy and data security.

Augmented Intelligence: The convergence of human expertise with AI capabilities, known as

augmented intelligence, will empower healthcare professionals to make more informed
clinical decisions, enhance patient-provider communication, and optimize care delivery
workflows.

Health Equity and Access: Addressing disparities in healthcare access and outcomes
requires proactive measures to ensure that AI technologies benefit diverse patient
populations and mitigate biases in algorithmic decision-making.

Global Collaboration and Standards: International collaboration and the establishment of

interoperable standards are essential to facilitate data sharing, benchmarking AI algorithms,
and harmonizing regulatory practices across borders, thereby maximizing the societal impact
of AI in healthcare.

2. Conclusion:
In conclusion, the integration of Artificial Intelligence (AI) into healthcare has the
potential to revolutionize clinical practice, enhance patient outcomes, and catalyze
innovation across the healthcare ecosystem. By leveraging AI-driven solutions in
medical imaging analysis, predictive analytics, drug discovery, personalized medicine,
and virtual health assistants, healthcare providers can deliver more precise,
proactive, and patient-centered care. However, addressing the challenges of data
quality, regulatory compliance, algorithmic bias, and workforce training is crucial to
realizing the full potential of AI in healthcare while upholding ethical standards and
patient trust. Through interdisciplinary collaboration, ongoing research, and global
cooperation, we can harness the transformative power of AI to build a more
equitable, efficient, and resilient healthcare system for all.