Serum Micronutrients and Antioxidant Levels in Children With Transfusion-Dependent Thalassemia.

OBJECTIVES: To estimate serum zinc, copper, magnesium and antioxidant levels in children with transfusion-dependent thalassemia (TDT). METHODS: Cross-sectional study, enrolling children with TDT aged 3-14 years and age-matched healthy children without thalassemia. Serum zinc, copper, magnesium and total antioxidant capacity were estimated by direct colorimetric method and ELISA, respectively. RESULTS: 72 children (24 females; mean (SD) age 8.5 (3.2) years) were enrolled. Mean (SD) values of micronutrients in the study group and control group children were: serum zinc [89.4 (26.9) vs 93.5 (41.6) mg/dL; P=0.496], copper [118.3 (36.6) vs 123.3 (29.8) mg/L; P=0.133], magnesium [1.9 (0.3) vs 2.0 (0.2) mg/dL; P=0.015]. Total oxidant capacity level was not different in both the groups [median (range) 124.8 (16.0-501.7) vs 146.8 (14.0-641.7) mg/mL; P=0.605]. 24 (33%) children with TDT had low serum zinc levels (<65 mg/dL), and 31 (43%) had high serum copper levels (≥121 mg/L). CONCLUSIONS: Children with TDT were found to have significantly lower magnesium levels compared to healthy children.

Dyslipidemia and atherogenic indexes in children with transfusion-dependent thalassemia.

OBJECTIVE: This study endeavored to assess the lipid profile and atherogenic lipid indexes in children with transfusion-dependent thalassemia (TDT) and to compare them with matched healthy children. METHOD: The study group consisted of a total of 72 TDT patients aged 3 to14 years, while the control group had 83 age- and sex-matched healthy children. The fasting lipid profile and lipid indexes were estimated and the atherogenic index of plasma (AIP), Castelli's risk indexes I and II, atherogenic coefficient were calculated and compared between the two groups. RESULT: Compared to the control group, the mean LDL, HDL and cholesterol levels were significantly lower among the case group (p-value < 0.001). The mean VLDL and triglycerides were significantly higher in the case group (p-value < 0.001). Lipid indexes, including the atherogenic index of plasma (AIP), Castelli's risk indexes I and II and atherogenic coefficients were significantly higher in TDT children. CONCLUSION: Dyslipidemia and increased risk of atherosclerosis were found in TDT children, as they had elevated atherogenic lipid indexes. Our study underlines the importance of the routine use of these indexes in TDT children. Future studies should focus on lipid indexes in this high-lipid group of children so that preventive strategies can be planned accordingly.

Nutritional enrichment of fruit peel wastes using lipid accumulating Aurantiochytrium strain as feed for aquaculture in the North-East Region of India.

Utilization of fruit peel wastes to grow thraustochytrids for nutritional enrichment of wastes will lower environmental and economic costs associated with feedstock specific for aquaculture industries. In this study, high-carbohydrate content agricultural wastes, such as orange, pineapple, banana, and mausambi fruit peels were enriched with essential fatty acids producing thraustochytrids Aurantiochytrium sp. ATCC276. Characterizations of fruit peels revealed the presence of high carbohydrate content (9-16%) and reducing sugars essential for the growth of thraustochytrids. Optimization for lipid production of Aurantiochytrium sp. ATCC276 was carried out using response surface methodology (RSM) in combination with different concentrations of fruit peels in solid-state fermentation (SSF) conditions. Fruit peels composed of SSF experiments were designed using a central composite design. Aurantiochytrium sp. ATCC276 cells efficiently utilized the sugar components of fruit peels for their growth and lipid accumulation. Different SSF composites made of fruit peels were significantly enriched with fatty acids of Aurantiochytrium sp. ATCC276 cells. Culturing Aurantiochytrium sp. ATCC276 cells with these waste materials demonstrated distinct responses towards lipid accumulation at different compositions. The optimized SSF composite consists of 9.91 g 100 mL-1 orange, 5 g 100 mL-1 mausambi, 4.12 g 100 mL-1 pineapple, and 8.01 g 100 mL-1 banana peels and was enriched with 8.37% of Aurantiochytrium sp. ATCC276-derived lipids. This study expands the benefits and bioprocessing potential of essential fatty acids producing Aurantiochytrium sp. ATCC276 along with fruit peel wastes which a frontier in circular bioeconomy and valorizing waste for usage.

Fentanyl Versus Dexmedetomidine for the Prevention of Emergence Agitation in Children After Sevoflurane Anaesthesia: A Comparative Clinical Study.

Introduction Sevoflurane is widely used in pediatric anesthesia due to its rapid onset and offset of action, smooth induction, and less hepatotoxicity. However, it is associated with emergence agitation, which can be frightening and harm the patient or the caregiver. While a definite preventive measure of emergence agitation is in search, the use of some drugs is associated with a lesser incidence of emergence related to sevoflurane.  Aims and objective This study aimed to compare the efficacy of fentanyl with dexmedetomidine in preventing emergence agitation in children undergoing surgery with sevoflurane anesthesia. Also, we assessed the perioperative hemodynamic and postoperative recovery characteristics and side effects, if any, between children receiving the two groups of drugs. Material and method We conducted a prospective, double-blinded, randomized controlled trial after getting approval from the institutional ethical committee. A total of 120 patients were recruited into the study and divided into two groups, F and D, of 60 patients each. Patients in group F received an infusion of injection fentanyl at 1 mcg/kg and patients in group D received infusions of injection dexmedetomidine at 0.15 mcg/kg, respectively, after induction of general anaesthesia. Additionally, all patients received a caudal epidural block with 0.125% isobaric levobupivacaine. After the conclusion of surgery, we transferred the patients to the post-anaesthesia care unit for further observation and assessment. Result The Pediatric Anesthesia Emergence Delirium (PAED) score for emergence agitation was significantly greater in the fentanyl group compared to the dexmedetomidine group at 0 minutes (7.08 ± 1.03 vs. 6.43 ± 1.33, p = 0.003) and 15 minutes (5.51 ± 1.7 vs. 4.01 ± 1.08, p = 0.0001) postoperative period. The mean time to eye-opening was significantly earlier amongst children receiving fentanyl than those receiving dexmedetomidine (9.3 ± 1.1 min vs. 10.12 ±1.05 min, p = 0.0001). The modified Aldrete Score for adequacy of recovery was statistically insignificant initially, but as the duration progressed to 15 minutes, the children in the fentanyl group had significantly higher scores than those in the dexmedetomidine group (8.05 ± 0.67 vs. 7.76 ± 0.62, p = 0.01). Conclusion Prophylactic administration of dexmedetomidine (0.15 mcg/kg) or fentanyl (1 mcg/kg) administered is effective in preventing emergence agitation. Although we found emergence agitation was higher amongst children receiving fentanyl than those receiving dexmedetomidine during the early recovery period, this difference became insignificant as the postoperative period increased to 30 minutes.

Efficacy and Safety of Low Dose Insulin Infusion against Standard Dose Insulin Infusion in Children with Diabetic Ketoacidosis- An Open Labelled Randomized Controlled Trial.

Objective: To compare the efficacy and safety of low dose insulin infusion (0.05 U/kg/h) against the standard dose insulin infusion (0.1 U/kg/h) in children with diabetic ketoacidosis. Method: Children (age <12 years, n = 30) presenting with diabetic ketoacidosis were enrolled and randomised to receive insulin infusion either as 0.05 U/kg/h (low dose) or 0.1 U/kg/h (standard dose) as an open labelled randomised controlled trial. The rest of the management was identical in both groups. The time taken for resolution of acidosis (pH ≥7.3 and HCO3 ≥15) was the primary outcome variable. The secondary outcome variables included the time taken until a decline in blood glucose to 250 mg/dl, the proportion of children developing hypoglycemia and hypokalemia, and any treatment failure. Results: The two groups were similar with respect to mean age, weight and gender distribution. New-onset diabetes was diagnosed on 24/30. The mean ± SD time for resolution of acidosis was similar between the groups; 27.0 ± 6.1 hours in the low dose group vs 23.4 ± 7.3 hours in standard dose group, P = 0.16. The mean time for the decline in blood glucose to 250 mg/dl was 13.0 ± 5.9 hours in low dose vs 11.6 ± 6.0 hours in standard dose group, P = 0.52. A lesser proportion of participants developed hypoglycemia and hypokalemia in the low dose group, though not statistically significant. There was no incidence of treatment failure in either group. Conclusion: Low dose insulin infusion is equally effective and safe as standard dose insulin infusion in children with diabetic ketoacidosis.

Addition of Clonidine or Dexmedetomidine With Bupivacaine to Prolong Caudal Analgesia in Children Undergoing Infraumbilical Surgery.

Introduction Clonidine, a selective α2 adrenergic receptor agonist, combined with caudally administered bupivacaine, is frequently used in children to prolong the duration of postoperative analgesia following infraumbilical surgery. On the other hand, dexmedetomidine is highly selective and has a greater affinity toward α2 adrenergic receptors, especially toward its α2a subtype, accountable for more analgesic and hypnotic effects than clonidine. Aims and objectives We designed a prospective, double-blinded, randomized controlled trial to compare the analgesic efficacy and adverse effects of clonidine and dexmedetomidine when combined with bupivacaine for caudal analgesia in children undergoing infraumbilical surgeries. Materials and methods A total of 60 children aged one to eight years were randomly assigned into two different groups in a double-blinded manner. Following induction of general anesthesia, every patient received a single dose of caudal bupivacaine 0.25% (0.75 ml/kg) mixed with either clonidine (1 µ/kg) in normal saline or dexmedetomidine (1 µ/kg) in normal saline. We noted the hemodynamic variables and postoperative sedation scores. Duration and quality of postoperative analgesia and the number of rescue analgesic drug doses required were recorded during the first 24 hours postoperatively. We also observed the patients for any adverse effects to the study drugs. Result Adding dexmedetomidine to caudally administered bupivacaine significantly increased the duration of analgesia (15 ± 0.78 hours) and decreased the need for rescue drug doses than the addition of clonidine to bupivacaine (9.63 ± 1.95 hours) in children undergoing infraumbilical surgeries. Incidences of hemodynamic changes or other side effects were comparable between patients of two groups. Conclusion The addition of dexmedetomidine to caudally administered bupivacaine in children undergoing infraumbilical surgeries may provide a longer duration of analgesia than the addition of clonidine, with less requirement of rescue analgesic doses and without any significant differences in the hemodynamic parameters or other side effects.

Severe Multi-inflammatory Syndrome in Children Temporally Related to COVID 19-Clinical Course, Laboratory Profile and Outcomes from a North Indian PICU.

Objective: We describe the trajectory of clinical course, laboratory markers and outcomes in children with severe multi-inflammatory syndrome temporally related to COVID-19 (MIS-C) admitted to our pediatric intensive care unit (PICU). Methods: This was a prospective case series of children admitted to PICU between May 1, 2020 and January 31, 2021, fulfilling the case definition of MIS-C published by World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC). We analyzed demographic, clinical, laboratory data and echocardiographic findings. We also plotted the variation in trends between survivors and nonsurvivors. Results: Of the 34 critically ill children referred to PICU with diagnosis of MIS-C only 17 fulfilled the WHO/CDC classification of MIS-C, rest were MISC mimickers albeit other tropical infections. Median age at admission was 4 years (range 1y 6 mo-8 years). Fever, rash and conjunctival redness were most prominent symptoms. Myocardial involvement was seen in 70.5% while 76.4% developed shock; Invasive mechanical ventilation was required in 64.7% cases. Inflammatory markers showed a downward trend such as-median C- reactive protein (mg/L) had a serial reduction in levels-from (median/IQR) 210 (132.60, 246.90) at admission to 52.3 (42, 120) on Day 3. Median Ferritin (ng/ml) (n = 12) was 690 (203, 1324), serum LDH (IU/L) (n = 12) was 505 (229.5, 1032) and Mean D-dimer (ng/ml) (n = 7) was 5093.85 (1991.65), suggestive of hyperinflammatory syndrome. Twelve patients received intravenous immune globulin, with adjunctive steroid therapy used in two third of the cases. Six children died, 4 of them were under-5 years of age. Tocilizumab was prescribed in two children with high vasotrope inotrope score (VIS), cardiogenic shock and oxygenation index more than 15, both survived. Conclusions: Severe MIS-C has a heterogenous presentation, local or regional outbreaks of prevalent infectious diseases often lead to confusion and overdiagnosis. Higher proportion of mortality was seen in Under -5 children with MISC. Shock-like presentation, presence of myocardial dysfunction or nonsurvivor status is associated with higher trend of inflammatory markers and more profound multi-organ dysfunction. If disease progresses rapidly despite first line therapy (IvIg and steroids), use of Tocilizumab should be considered-as a rescue therapy under resource limitations in the absence of extracorporeal support.

Peripheral Lymphadenopathy in Children: Cytomorphological Spectrum and Interesting Diagnoses.

OBJECTIVE: Peripheral lymphadenopathy is a common complaint in the pediatric outpatient department. Fine needle aspiration cytology is the first investigation of choice with a high sensitivity for diagnosis but cytology may be challenging in some cases. The study was planned to study the cytomorphological spectrum and discuss a few interesting cases. MATERIAL AND METHOD: 1890 paediatric subjects' up to 12 years of age with significant peripheral lymph node enlargement and an adequate cytology specimen were included in the study. Inadequate aspirates were excluded. RESULTS: The majority of children presented within 4-8 years of age with a male to female ratio of 1.7:1. The anterior cervical group was most commonly affected, followed by the posterior cervical, axillary and inguinal. Reactive lymphadenitis constituted the majority of the diagnoses, followed by Tuberculosis, acute suppurative, BCG-induced lymphadenitis, Kimura disease, Rosai-Dorfmann disease and Kikuchi-Fujimoto disease. Lymphomas and metastatic malignancies were less common, and mainly consisted of Hodgkin lymphoma, non-Hodgkin lymphoma, anaplastic large cell lymphoma, and Langerhans cell histiocytosis. Cytomorphological features of a few challenging and interesting cases have been discussed. CONCLUSION: Non neoplastic causes of lymphadenopathy predominate in the pediatric age group. A definitive diagnosis rests upon a complete clinical, radiological, microbiological, and cyto-histopathological correlation with the use of ancillary techniques wherever necessary.

Clinicoepidemiological Observations of Enteric Fever in Infants: Experiences From a Tertiary Care Pediatric Hospital in North India.

BACKGROUND: There is a lack of evident data to explain the true scenario of age-specific enteric fever in India. The current study aimed to evaluate the burden and disease pattern of enteric fever among infants in a tertiary care pediatric hospital. METHODS: A prospective laboratory-based surveillance was conducted from April 2018 to January 2020 at a children's hospital in North India, under the Surveillance for Enteric Fever in India study. The study included children <1 year of age in whom Salmonella serovar Typhi/Salmonella serovar Paratyphi grew in cultures from blood or sterile body fluid. The key outcome measures included disease spectrum and clinical presentation. RESULTS: Of the 10 737 blood cultures from infants, 26 were positive for S. Typhi or S. Paratyphi. The majority of cases occurred in infants aged 6-12 months, with the youngest being 1 month old. Fever with abdominal pain and diarrhea were the common symptoms, with 46% of infants requiring inpatient care. All of the isolates were susceptible to ceftriaxone. Third-generation cephalosporins were used as the first-line therapy for hospitalized infants. The average duration of fever was 8.6 days. The overall case-fatality rate among infants with enteric fever was 7.4%. CONCLUSIONS: Enteric fever is a major contributor to disease and death among children. Robust surveillance studies are required to understand the true disease burden.

Bimetallic Co/Zn zeolitic imidazolate framework ZIF-67 supported Cu nanoparticles: An excellent catalyst for reduction of synthetic dyes and nitroarenes.

In this study, a sub-class of microporous crystalline metal organic frameworks (MOFs) with zeolite-like configurations, i.e., zeolitic imidazolate frameworks of single node ZIF-67 and binary nodes ZIF-Co/Zn are used as the supports to develop Cu nanoparticles based nanocatalysts. Their catalytic activities are comparatively evaluated where Cu(x)@ZIF-Co/Zn exhibits better performances than Cu(x)@ZIF-67 in the reduction of synthetic dyes and nitroarenes. For instance, the Cu(0.25)@ZIF-Co/Zn catalyst shows an excellent reaction rate of 2.088 × 10-2 s-1 and an outstanding activity of 104.4 s-1gcat-1 for the reduction of methyl orange. The same catalyst also performs an exceptional catalytic activity in the hydrogenation of p-nitrophenol to p-aminophenol with the activity of 216.5 s-1gcat-1. A synergistic role of unique electronic properties rising from the direct contact of Cu NPs with the bimetallic nodes ZIF-Co/Zn, higher surface area of support, appropriate Cu loading and maintainable microporous frameworks with higher thermal and hydrolytic stability collectively enhances the catalytic activity of Cu(x)@ZIF-Co/Zn. Moreover, this catalyst shows excellent stability and recyclability, which can retain high conversion after reuse for 10 cycles.

Clinical profile of poisoning due to various poisons in children of age 0-12 years.

BACKGROUND: Majority of childhood poisonings are unintentional. The incidence of poisoning in children has been shown to be reduced by a significant amount. But to develop effective prevention strategies, the state health care planners need better information on the number and types of poisonings, circumstances in which they occur, and how serious the problem is. OBJECTIVE: To study the clinical profile of poisoning in children. METHODS: A hospital-based cross-sectional study was carried out among children aged 0-12 years with the history of poisoning. Detailed history, clinical examination, and details of poisoning was obtained. Data was analyzed using proportions. RESULTS: Majority (77.8%) belonged to the age group of 1-5 years and were males (65.4%). Household chemicals were ingested in 83 cases out of 153, (54.25%) and in 147 cases (96.1%), poisonous substance was easily accessible to victim. In 144 out of 153 cases (94.1%), poisonous substance was accidentally ingested by the child itself, 131 out of 153 cases (85.6%) occurred at home, while 18 (11.8%) cases occurred in home surroundings. Of the 153 cases, 2 patients (1.3%) presented with the history of diarrhoea, 12 patients (7.8%) in altered sensorium, 6 patients (3.9%) had fever, 16 patients (10.5%) presented with cough, 37 patients (24.2%) presented with excessive secretions from mouth. 31 patients (20.3%) presented with vomiting without blood staining and 12 patients (7.8%) had blood stained vomiting as their chief complaint. Mucosal injury was noted in 41 cases (26.8%). CONCLUSION: Poisoning was common in males. Household chemical was most commonly ingested. Majority children had domestic poisoning and self-unintentional.

Insight into the Superior Lithium Storage Properties of Ultrafine CoO Nanoparticles Confined in a 3 D Bimodal Ordered Mesoporous Carbon CMK-9 Anode.

Ultrafine CoO particles immobilized into the mesopores of three-dimensional cubic bimodal ordered mesoporous carbon CMK-9 is successfully prepared by using a combination of nanocasting and wet-impregnation methods. It is found that the cubic bimodal interconnected mesoporous framework of CMK-9 plays a crucial role in achieving the excellent electrochemical performances by assisting the rapid mass and charge transfer. Among the prepared nanocomposites, CoO(10)@CMK-9 delivers a discharge capacity of 830 mAh g-1 after 200 cycles at a current density of 100 mA g-1 in lithium-ion batteries. At a higher current density of 1000 mA g-1 , the anode presents an outstanding discharge capacity of 636 mAh g-1 after 200 cycles. In sodium-ion batteries, the anode provides a discharge capacity of 296 mAh g-1 after 250 cycles at a current density of 100 mA g-1 . The remarkable performances of CoO(10)@CMK-9 demonstrate the promising potentials of the nanocomposite as the anode for rechargeable batteries.

Ultrafine bimetallic Ag-doped Ni nanoparticles embedded in cage-type mesoporous silica SBA-16 as superior catalysts for conversion of toxic nitroaromatic compounds.

Highly active Ag-doped Ni nanoparticles are successfully fabricated within carboxylic acid (-COOH) functionalized mesoporous silica SBA-16 by a facile wet incipient technique for catalytic conversion of toxic nitroaromatics. The -COOH groups on SBA-16 play a crucial role by enhancing the electrostatic interactions with Ag(I)/Ni(II) cations, that control the crystal growth during the thermal reduction. Systematic characterizations of SBA-16C and Agx%Ni@SBA-16C are performed by different techniques including solid state 13C and 29Si nuclear magnetic resonance (NMR) spectroscopy, Fourier transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD), N2 sorption, X-ray photoelectron spectroscopy (XPS), high resolution transmission electron microscopy (HRTEM) and superconducting quantum interference device (SQUID). The highly dispersed ultrafine Ag-doped Ni NPs (∼3 nm) are well-confined within SBA-16C and exhibit magnetic properties that are extremely beneficial for recycling. The bimetallic Ag2.4%Ni@SBA-16C shows exceptionally high catalytic activity during catalytic conversion of toxic nitroaromatics to environmentally friendly amino-aromatics. The enhanced catalytic activity could be ascribed to the combined effects of unique electronic properties, synergistic effects of Ag-doped Ni, ultra-small size, metal loading, and favorable textural properties. These magnetically separable nanocatalysts show excellent durability.

Ellagic acid prolongs the lifespan of Drosophila melanogaster.

Wild-type Canton-S flies of Drosophila melanogaster were treated with ellagic acid at 100 µM and 200 µM concentrations. Longevity assay showed male flies fed with 200 µM ellagic acid displayed longer mean lifespan and maximum lifespan than control flies. Female flies fed with 200 µM ellagic acid laid less number of eggs than control. The eclosion time was less in female flies fed with 200 µM ellagic acid. Ellagic acid fed female flies performed better than male flies and control flies for heat shock tolerance and starvation stress. Male flies treated with 100 µM ellagic acid recovered faster from cold shock compared with control flies. Male and female flies treated with ellagic acid displayed increased survival following exposure to 5% hydrogen peroxide. Gene expression studies displayed upregulated expressions of CAT, dFOXO, ATG1, and SOD2 in ellagic acid-treated male flies, and upregulated expressions of dFOXO, CAT, and SOD2 in ellagic acid-treated female flies. Results from these studies show the pro-longevity effect of ellagic acid on Drosophila melanogaster.

Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome / Incidência e fatores de risco para infecções graves em crianças hospitalizadas com síndrome nefróticas

ABSTRACT Introduction: Children with nephrotic syndrome are at increased risk of infections because of disease status itself and use of various immunosuppressive agents. In majority, infections trigger relapses requiring hospitalization with increased risk of morbidity and mortality. This study aimed to determine the incidence, spectrum, and risk factors for major infections in hospitalized children with nephrotic syndrome. Methods: All consecutive hospitalized children between 1-12 years of age with nephrotic syndrome were enrolled in the study. Children with acute nephritis, secondary nephrotic syndrome as well as those admitted for diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion were excluded. Results: A total of 148 children with 162 admissions were enrolled. Incidence of major infections in hospitalized children with nephrotic syndrome was 43.8%. Peritonitis was the commonest infection (24%), followed by pneumonia (18%), urinary tract infection (15%), and cellulitis (14%), contributing with two thirds of major infections. Streptococcus pneumoniae (n = 9) was the predominant organism isolated in children with peritonitis and pneumonia. On logistic regression analysis, serum albumin < 1.5gm/dL was the only independent risk factor for all infections (OR 2.6; 95% CI, 1.2-6; p = 0.01), especially for peritonitis (OR 29; 95% CI, 3-270; p = 0.003). There were four deaths (2.5%) in our study, all due to sepsis and multiorgan failure. Conclusions: Infection remains an important cause of morbidity and mortality in children with nephrotic syndrome. As Pneumococcus was the most prevalent cause of infection in those children, attention should be paid to the pneumococcal immunization in children with nephrotic syndrome.

RESUMO Introdução: Crianças com síndrome nefrótica apresentam maior risco de infecções devido ao próprio status da doença e ao uso de vários agentes imunossupressores. Em grande parte, as infecções desencadeiam recidivas que exigem hospitalização, com risco aumentado de morbidade e mortalidade. Este estudo teve como objetivo determinar a incidência, o espectro e os fatores de risco para infecções graves em crianças hospitalizadas com síndrome nefrótica. Métodos: Todas as crianças hospitalizadas consecutivamente entre 1 e 12 anos de idade com síndrome nefrótica foram incluídas no estudo. Crianças com nefrite aguda, síndrome nefrótica secundária, bem como aquelas admitidas para biópsia renal diagnóstica e infusão intravenosa de ciclofosfamida ou rituximabe foram excluídas. Resultados: Foram cadastradas 148 crianças com 162 internações. A incidência de infecções graves em crianças hospitalizadas com síndrome nefrótica foi de 43,8%. A peritonite foi a infecção mais comum (24%), seguida por pneumonia (18%), infecção do trato urinário (15%) e celulite (14%), contribuindo com dois terços das principais infecções. Streptococcus pneumoniae (n = 9) foi o organismo predominantemente isolado em crianças com peritonite e pneumonia. Na análise de regressão logística, a albumina sérica < 1,5gm / dL foi o único fator de risco independente para todas as infecções (OR 2,6; 95% CI, 1,2-6; p = 0,01), especialmente para peritonite (OR 29; IC95% 3 -270, p = 0,003). Houve quatro mortes (2,5%) em nosso estudo, todas devido a sepse e falência de múltiplos órgãos. Conclusões: A infecção continua sendo uma importante causa de morbimortalidade em crianças com síndrome nefrótica. Como o Pneumococo foi a causa mais prevalente de infecção nessas crianças, deve-se atentar para a imunização pneumocócica em crianças com síndrome nefrótica.

Cardiovascular and respiratory physiology in children.

Children are at increased risk of perioperative respiratory and cardiovascular complications because of their unique respiratory and cardiovascular physiology compared to adults. Anaesthesia can exaggerate respiratory deterioration in young children because of their inability to control respiration and inherent susceptibility to rapid desaturation, airway obstruction, early respiratory fatigue and lung atelectasis. Premature infants (less than 60 weeks of postconceptional age) can be exposed to the danger of prolonged apnoea and consequent worsening of respiratory function. The transitional phase of circulation is vulnerable to revert to persistent foetal circulation in neonates. Myocardium and autonomic control of the heart is immature and different in neonates and infants compared to older children and adults and are predisposed to inadvertent life-threatening haemodynamic changes during the perioperative period. In this review article, we discuss respiratory and cardiovascular physiology in neonates, infants and younger children and their differences with older children and adults. We mainly focus on transitional physiology of both respiratory and cardiovascular system in newborns and infants and the deleterious changes that may occur during anaesthesia or perioperatively.

Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome.

INTRODUCTION: Children with nephrotic syndrome are at increased risk of infections because of disease status itself and use of various immunosuppressive agents. In majority, infections trigger relapses requiring hospitalization with increased risk of morbidity and mortality. This study aimed to determine the incidence, spectrum, and risk factors for major infections in hospitalized children with nephrotic syndrome. METHODS: All consecutive hospitalized children between 1-12 years of age with nephrotic syndrome were enrolled in the study. Children with acute nephritis, secondary nephrotic syndrome as well as those admitted for diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion were excluded. RESULTS: A total of 148 children with 162 admissions were enrolled. Incidence of major infections in hospitalized children with nephrotic syndrome was 43.8%. Peritonitis was the commonest infection (24%), followed by pneumonia (18%), urinary tract infection (15%), and cellulitis (14%), contributing with two thirds of major infections. Streptococcus pneumoniae (n = 9) was the predominant organism isolated in children with peritonitis and pneumonia. On logistic regression analysis, serum albumin < 1.5gm/dL was the only independent risk factor for all infections (OR 2.6; 95% CI, 1.2-6; p = 0.01), especially for peritonitis (OR 29; 95% CI, 3-270; p = 0.003). There were four deaths (2.5%) in our study, all due to sepsis and multiorgan failure. CONCLUSIONS: Infection remains an important cause of morbidity and mortality in children with nephrotic syndrome. As Pneumococcus was the most prevalent cause of infection in those children, attention should be paid to the pneumococcal immunization in children with nephrotic syndrome.

Prediction of Severe Acute Kidney Injury using Renal Angina Index in a Pediatric Intensive Care Unit.

OBJECTIVE: To determine the proportion of children in a pediatric intensive care unit with a positive Day 0 Renal angina index who develop severe acute kidney injury (AKI) on Day 3; and to compare the predictive ability of the index with that of individual markers of renal injury, for the development of severe acute kidney injury. DESIGN: Observational study. SETTING: Pediatric intensive care unit of a tertiary-care hospital. PARTICIPANTS: Consecutive children, 1 month to 12 years, admitted in Level 3 pediatric intensive care unit for a minimum of 8 hours, having weight and intake-output records, were eligible. Children known to have chronic kidney disease or already in stage 2/3 acute kidney injury/dialysis were excluded. PROCEDURE: Day 0 Renal angina index was calculated from the product of Risk Group score (Pediatric intensive care admission/Ventilation and inotropy) and Renal Injury score (fluid overload over previous 8 hours or the % fall in estimated creatinine clearance from baseline). Renal angina index ³8 was considered positive. MAIN OUTCOME MEASURE: The proportion of children with positive Day 0 Renal angina index who develop severe AKI (Kidney Disease Improving Global Outcomes (KDIGO) ≥ Stage 2) on Day 3. RESULTS: Of 162 enrolled children (median (IQR) age 10.5 (3,39) months), 86 (53%) had positive Renal angina index. On Day 3, a higher proportion of children with positive index developed severe AKI, compared to negative group (RR 95.5; 95% CI 21.7,420.5; P<0.001). Day 0 positive Renal angina index had a sensitivity, specificity, positive predictive value and negative predictive value of 96.9%, 75.5%, 72% and 97.4% respectively, for predicting severe AKI on Day 3. The Receiver Operating Characteristic curve of Day 0 renal angina scores showed AUC of 0.90 (95% CI 0.85, 0.95), better than the AUC obtained from either Day 0 serum creatinine or Day 0 percent fall in estimated creatinine clearance from baseline. CONCLUSIONS: Day 0 Renal angina index positivity is a promising tool to identify critically ill children with impending severe AKI.