Correlation of renal length with anthropometric and demographic data in healthy children: A prospective cross sectional study.

Background: Renal size is an important parameter in the assessment of a child with renal disease. Renal size can be estimated by measuring renal length, renal volume, and cortical volume or thickness. Renal length depends on different factors, which include size, body mass index and gender. Ultrasonography is useful, non-invasive and easily available method for reliably performing the measurement of kidney length. This study was conducted to find out correlation between renal length and age and anthropometric variables in healthy children. This prospective cross sectional study was carried out with the following objectives: (a) To determine the anthropometric variable that correlated best with renal length in healthy children. (b) To develop a nomogram for renal length in healthy children. Methods: Five hundred healthy children were included in this study. Sonographic assessment of renal length was performed using real time mechanical sector scanner with 5 MHz and 8 MHz frequency. The renal length was correlated with somatic parameters like age, weight, height, body surface area and body mass index. Regression equations were derived for each pair of dependent and independent variables. Results: We performed the measurement of renal length in 500 healthy children. In our series, renal measuring parameters showed a good correlation with studied body parameters, height having the best correlation. Data from left and right kidneys are shown separately since there was small but statistically significant difference between them. Based on our study, using the height of the child, renal length may be calculated by using following equation: Left renal length (cm) = 0.052 × height (cm) + 1.042, Right renal length (cm) = 0.052 × height (cm) + 0.867. Conclusions: This study provides values of renal length (mean ± 2SD) in normal Indian children and its correlation with body parameters. Renal length may be easily calculated by derived linear regression equation. Nomograms of renal length with respect to age and height have been formulated. Renal Length was found to correlate best with height of the child.

Differential expression of insulin receptor substrate-1(IRS-1) in visceral and subcutaneous adipose depots of morbidly obese subjects undergoing bariatric surgery in a tertiary care center in north India; SNP analysis and correlation with metabolic profile.

BACKGROUND: /aim: Abdominal obesity and associated metabolic consequences are a burgeoning problem in Asian Indians and studying their genetic predisposition is important. This study is aimed at assessing variations in Insulin receptor substrate-1 (IRS-1), its expression at regional fat-depots (visceral and subcutaneous) in morbidly obese patients, and correlation with genotype-phenotype traits. METHODS: Gene expression of IRS-1 in paired adipose tissue from 35 morbidly obese subjects (BMI) > 40 kg/m2) with co-morbidities and 15 controls (BMI<25 kg/m2), undergoing bariatric/elective abdominal surgery, respectively was determined by quantitative real time PCR. Genotyping of IRS-1Gly972Arg (n = 436) (rs 1801278) was performed by PCR-RFLP. Metabolic parameters were assessed. Full length sequencing of IRS-1 was performed to identify known/novel variations. RESULTS: A marked reduction in IRS-1 expression was observed in visceral as compared to subcutaneous adipose tissue of morbidly obese subjects (p = 0.02). Homozygous variant of IRS-1 Gly972Arg was absent and there was no association with obesity or insulin resistance. A salient finding of this study was identification of two new variants in IRS-1 gene, representing G > A (codon 1102) encoding Glu > Lys and a deletion of (A) at codon 658 in morbidly obese subjects with insulin resistance. CONCLUSIONS: Observation of a substantially lower expression of IRS-1 for first time in visceral adipose tissue of morbidly obese subjects is suggestive of predictive role of IRS-1 expression in insulin responsiveness of visceral adipose tissue. New variants in IRS-1, a non-synonymous mutation and a deletion should be evaluated further for their role in development of obesity and/orT2DM.

Study of pain response in neonates during venipuncture with a view to analyse utility of topical anaesthetic agent for alleviating pain.

BACKGROUND: Neonates being nonverbal are unable to express their pain leading to underestimation of their pain and hence insufficient pain relief. Neonatal pain is assessed by pain scales based on the behavioural and physiological changes that occur in response to painful stimuli. This cross sectional study was conducted at a tertiary care centre using Premature Infant Pain Profile (PIPP) score with 4% lidocaine as local anaesthetic agent to produce surface anaesthesia of skin prior to intravenous cannulation. METHODS: Sample size was collected by simple randomisation method. Our study groups included 50 term and 50 preterm neonates with POG of 28-40 weeks requiring IV cannulation. Heart rate (HR), SpO2, facial expressions and behavioural state were noted before venipuncture and after venipuncture using PIPP scale. Same cohort of patients was assessed for pain response after applying 4% lidocaine cream during future venipuncture with help of PIPP score. RESULTS: The PIPP score in preterm group before and after anesthesia was 11.28 ± 3.72 and 9.58 ± 3.39. PIPP score in term group before and after anesthesia was 11.54 ± 2.84 and 9.04 ± 2.97. There was reduction in mean PIPP score after using topical anesthetic agent in both study groups and the results were statistically significant. CONCLUSION: This study found that topical anesthetic agents were effective in reducing pain during venipuncture. Based on the facts of the study, it is recommended that pain scoring should be a part of routine monitoring in neonatal intensive care units and appropriate measures should be used to reduce pain.

Biofabrication and characterization of flavonoid-loaded Ag, Au, Au-Ag bimetallic nanoparticles using seed extract of the plant Madhuca longifolia for the enhancement in wound healing bio-efficacy.

The present communication warrants the presence of significant wound healing bio-efficacy of aq. alc. extract of the seed (49.78%) of the plant Madhuca longifolia. A family of seven flavonoid fractions have been ascertained in the seed aq. alc. extract of the target plant using LCMS-8030 analysis. In vivo wound healing parameters (wound area, wound closure, epithelization period, skin breaking strength and hydroxyproline content) have been examined in Swiss albino mice models. Statistically significant (p < 0.001) enhancement in the wound healing bio-efficacy has been effectively induced using flavonoid-loaded gold: (Mlf@AuNps), silver: (Mlf@AgNps), and Au-Ag bimetallic: (Mlf@Au-AgNps) nanoparticles. Among the biofabricated nano-biomaterials, Mlf@AgNps exhibited an exceptional enhancement in the wound healing bio-efficacy (80.33%) attaining almost to the level of reference drug Placentrex (84.02%). All the fabricated nano-biomaterials were thoroughly characterized using UV-Vis, XRD, FE-SEM, TEM, EDX, and DLS. The promising enhancement in the wound healing potential of the nano-biomaterial (Mlf@AgNps) has been explained based on the cumulative effects of biological and nanotech parameters. The bio-fabricated (Mlf@AgNps) nano-biomaterials using the plant M. longifolia have lustrous prospects for the development of complimentary herbal nanomedicine for scaling-up the wound healing bio-efficacy.

Iron deficiency anemia in children with cyanotic congenital heart disease and effect on cyanotic spells.

BACKGROUND: Iron deficiency anemia (IDA) in cyanotic congenital heart disease (CCHD) and its association with cyanotic spells has been documented in literature. However, Indian data especially in the pediatric age group is scarce. This study was conducted to find out the prevalence of IDA in this population. METHODS: An observational study was conducted in a tertiary care hospital. Children with CCHD in the age group of birth-12 years were included in the study. Hematological parameters of these patients were determined and compared. An assessment of the incidence of cyanotic spells in the iron-deficient and iron non-deficient children was also done. Data analysis was done using Fischer's exact test. RESULTS: The prevalence of IDA was 47.06% in the study population. The study also showed that hemoglobin and hematocrit levels were paradoxically higher in the iron-deficient group as compared to the non-deficient, though the iron studies revealed the iron deficiency. The incidence of cyanotic spells was higher in the iron-deficient group. The mean corpuscular volume (MCV), red cell distribution width (RDW), serum ferritin, serum iron, total iron binding capacity (TIBC), and transferrin saturation (TS) values were the parameters, which were found to be statistically significant to differentiate the study groups. CONCLUSION: The prevalence of IDA in children with CCHD was found to be high. Iron-deficient group had an increased frequency of cyanotic spells as compared to the non-deficient group, which was statistically significant.

Improving medical stores management through automation and effective communication.

BACKGROUND: Medical stores management in hospitals is a tedious and time consuming chore with limited resources tasked for the purpose and poor penetration of Information Technology. The process of automation is slow paced due to various inherent factors and is being challenged by the increasing inventory loads and escalating budgets for procurement of drugs. METHODS: We carried out an indepth case study at the Medical Stores of a tertiary care health care facility. An iterative six step Quality Improvement (QI) process was implemented based on the Plan-Do-Study-Act (PDSA) cycle. The QI process was modified as per requirement to fit the medical stores management model. The results were evaluated after six months. RESULTS: After the implementation of QI process, 55 drugs of the medical store inventory which had expired since 2009 onwards were replaced with fresh stock by the suppliers as a result of effective communication through upgraded database management. Various pending audit objections were dropped due to the streamlined documentation and processes. Inventory management improved drastically due to automation, with disposal orders being initiated four months prior to the expiry of drugs and correct demands being generated two months prior to depletion of stocks. The monthly expense summary of drugs was now being done within ten days of the closing month. CONCLUSION: Improving communication systems within the hospital with vendor database management and reaching out to clinicians is important. Automation of inventory management requires to be simple and user-friendly, utilizing existing hardware. Physical stores monitoring is indispensable, especially due to the scattered nature of stores. Staff training and standardized documentation protocols are the other keystones for optimal medical store management.

Effects of maternal epidural analgesia on the neonate--a prospective cohort study.

BACKGROUND: Epidural analgesia is one of the most popular modes of analgesia for child birth. There are controversies regarding adverse effects and safety of epidural analgesia. This study was conducted to study the immediate effects of the maternal epidural analgesia on the neonate during early neonatal phase. METHODS: A prospective cohort study of 100 neonates born to mothers administered epidural analgesia were compared with 100 neonates born to mothers not administered epidural analgesia in terms of passage of urine, initiation of breast feeding, birth asphyxia and incidence of instrumentation. RESULTS: There was significant difference among the two groups in the passage of urine (P value 0.002) and incidence of instrumentation (P value 0.010) but there was no significant difference in regards to initiation of breast feeding and birth asphyxia. CONCLUSIONS: Epidural analgesia does not have any effect on the newborns in regards to breast feeding and birth asphyxia but did have effects like delayed passage of urine and increased incidence of instrumentation.

Vitamin D insufficiency is associated with abdominal obesity in urban Asian Indians without diabetes in North India.

OBJECTIVE: We evaluated the associations of serum 25-hydroxyvitamin D [25(OH) D] levels with clinical, biochemical, and anthropometric profiles and total abdominal adipose tissue (TAAT), subcutaneous abdominal adipose tissue (SCAT), and intraabdominal adipose tissue (IAAT) depots in Asian Indians without diabetes residing in north India. SUBJECTS AND METHODS: In this cross-sectional study (n=137; 74 males and 63 females; 18-60 years of age), anthropometric (body mass index, waist and hip circumferences, and skinfold thickness at four sites) and biochemical (fasting plasma glucose, lipid profile, and fasting insulin levels) assessments were done. Measurement of percentage body fat was done by dual energy x-ray absorptiometry, and areas of TAAT, SCAT and IAAT were measured at the L2-L3 intervertebral level by single-slice magnetic resonance imaging. Levels of 25(OH) D were measured by radioimmunoassay. Correlation analysis was used to assess relationships among clinical, biochemical, and anthropometric profiles, areas of TAAT, SCAT, and IAAT, and 25(OH) D levels. RESULTS: The mean concentration of 25(OH) D was 40.5 ± 8.6 ng/mL. Overall, 6.6% had vitamin D deficiency (<10 ng/mL), 87.6% had insufficiency (<30 ng/mL), and 5.8% had a sufficient level (>30 ng/mL). Levels of 25(OH) D did not correlate with demographic, biochemical, and anthropometric profiles or with abdominal fat depots (TAAT, SCAT, and IAAT). In the correlation regression model, 25(OH) D was associated with TAAT in obese subjects. CONCLUSIONS: In obese urban Asian Indians without diabetes, higher values of total abdominal fat at the L2-L3 intervertebral level were associated with low 25(OH) D levels.

Assessment of 11-ß hydroxysteroid dehydrogenase (11-ßHSD1) 4478T>G and tumor necrosis factor-α (TNF-α)-308G>A polymorphisms with obesity and insulin resistance in Asian Indians in North India.

11-ß hydroxysteroid dehydrogenase (11-ßHSD1), tumor necrosis factor-α (TNF-α) and their role in obesity, regional adiposity and insulin resistance has been sparsely evaluated. We determined the polymorphic status of 11-ßHSD1 4478T>G and TNF-α-308G>A in Asian Indians in north India. In this cross-sectional study (n = 498; 258 males, 240 females), association of genotypes (PCR­RFLP) of 11-ßHSD1 and TNF-α were analyzed with obesity [BMI ≥ 25 kg/m(2), percentage body fat (%BF by DEXA); subcutaneous and intra-abdominal fat area (L(2-3) level by single slice MRI) in a sub sample] and insulin resistance. 46 percent subjects had generalized obesity, 55 % abdominal obesity and 23.8 % were insulin resistant. Frequencies (%) of [T/T] and [T/G] genotypes of 11-ßHSD1 were 89.57 and 10.43 respectively. Homozygosity for 11-ßHSD1 4478G/G was absent with no association with parameters of obesity and insulin resistance. Frequencies (%) of TNF-α [G] and [A] alleles were 88 and 12 respectively. Higher frequency of variant -308[A/A] was observed in females versus males (p = 0.01). Females with at least one single A allele of TNF-α-308G>A had significantly high %BF and total skinfold, whereas higher values of waist hip ratio, total cholesterol, triglycerides and VLDL were observed in males. Subjects with even a single A allele in TNF-α genotype showed higher subscapular skinfold predisposing them to truncal subcutaneous adiposity (p = 0.02). Our findings of association of TNF-α-308G>A variant in females with obesity indices suggests a gender-specific role of this polymorphism in obesity. High truncal subcutaneous adiposity is associated with A allele of TNF-α-308G>A in this population.

Gaucher's disease: rare presentation of a rare disease.

Gaucher's disease is a rare lysosymal storage disorder characterized by deposition of glucocerebroside in cells of the macrophage monocyte system. Gaucher's disease has 3 types-non-neuronopathic (type I), acute neuronopathic (type II), and chronic neuronopathic (type III). It generally presents with delayed milestones, seizures, bony deformities, or massive organomegaly. The acute neuronoapthic variety is the rarer type that predominantly presents with neurological features. The authors present a case of the acute neuronopathic variety of Gaucher's disease where the child presented with only abnormal head position.

Can we prevent pediatric HIV? An experience at a tertiary care hospital.

BACKGROUND: Parent-to-child transmission (PTCT) is the commonest mode of acquiring HIV in more than 90% children. The risk during pregnancy varies from 20 to 45% and with specific interventions in mother and baby; it can be reduced to less than 2%. This study was conducted to assess the efficacy of comprehensive PPTCT programme. METHOD: This descriptive study was conducted at a tertiary care hospital, from Jan 2008 till Jul 2010. 32 HIV-positive pregnant mothers were enrolled in the study. They were evaluated, given triple drug antiretroviral therapy and followed up. Babies were given single dose nevirapine and zidovudine till 6 weeks of age. DNA-PCR was done for confirming the HIV status of baby. RESULTS: The yearly period prevalence of pregnant mothers found HIV positive at antenatal clinic showed a downward trend, from 0.39% in 2008 to 0.18% in 2010. Mean CD4 count of mothers at diagnosis was 459.41 [SD - 238.37]. Twenty eight mothers (93.3%) received antiretroviral therapy. 15 (50%) babies were delivered by cesarean section and 26 infants were given replacement feeding. All the babies were singletons, 29 (96.7%) born at term with an average birth weight of 2.60 kg (SD = 0.5) and male to female ratio of 0.87:1. Twenty nine (96.7%) infants were declared HIV-negative and parent-to-child transmission rate at our center was 3.3%. CONCLUSION: A comprehensive PPTCT programme with administration of antiretroviral therapy to the mother and infant, safe delivery practices, avoidance of breastfeeding, and close follow up, the incidence of PTCT can be reduced to negligible rates as seen in our study.

A study to determine the prevalence of pulmonary arterial hypertension in children with Down syndrome and congenital heart disease.

BACKGROUND: Down syndrome (DS) is a common chromosomal abnormality associated with congenital heart disease (CHD). These cardiac abnormalities are known to be associated with pulmonary arterial hypertension (PAH). METHODS: The aim of this study was to assess the prevalence of PAH in DS children with CHD and to compare it with PAH prevalence in non-syndromic children with CHD. It was a cross-sectional study including all children presenting to Cardiology Department at a tertiary care center between Jan 2007 and Dec 2010. RESULTS: Thirty-five DS children with CHD were compared with 38 non-syndromic children with CHD. Atrioventricular septal defect (AVSD, 13/35) was the commonest CHD among DS children while isolated VSD (26/38) accounted for maximum cases in non-syndromic CHD. PAH was more prevalent among DS children with CHD (18/42) than among the control group (7/38, p = 0.038). In addition, 14/19 patients with AVSD in the entire cohort developed PAH. CONCLUSION: DS children with CHD have a higher predisposition to develop PAH, and the likelihood is highest with underlying AVSD.

Ala/Ala genotype of Pro12Ala polymorphism in the peroxisome proliferator-activated receptor-γ2 gene is associated with obesity and insulin resistance in Asian Indians.

AIM: We determined the association of the Pro12Ala polymorphism of the peroxisome proliferator activated receptor (PPAR)-γ2 gene with obesity, insulin resistance (IR), and lipids in Asian Indians without diabetes in north India. SUBJECTS AND METHODS: In this cross-sectional study (n = 495; 279 males and 216 females, 18-60 years of age), anthropometric (body mass index, waist and hip circumferences, and skinfold thickness) and biochemical (fasting glucose, lipid profile, fasting insulin, leptin, and adiponectin) parameters were assessed. Polymerase chain reaction-restriction fragment length polymorphism analysis was used for identification of individual genotypes. RESULTS: Frequencies of the Pro and Ala alleles were 0.89 and 0.11, respectively. The genotype frequencies (%) of Pro/Pro, Pro/Ala, and Ala/Ala were 82.6, 14.7, and 2.7, respectively, without any gender differences. The frequency of the Ala/Ala genotype was higher in obese than in nonobese subjects (4.9% vs. 1.5%, P = 0.06). The Ala/Ala genotype was associated with higher values of hip circumference, subscapular skinfold thickness, and sum of four skinfold thickness than the Pro/Pro and Pro/Ala genotypes (P<0.05). Using a multivariate logistic regression model after adjusting for age, sex, and insulin, subjects with the Ala/Ala genotype showed a high risk of obesity (odds ratio [OR], 3.2, 95% confidence interval [CI] 1.2-12.9) and IR (OR, 3.6, 95% CI: 1.04-12.4). CONCLUSION: The Ala/Ala genotype of the PPAR-γ2 gene is associated with obesity and IR in Asian Indians without diabetes living in north India.

Perinatal outcomes among children born by assisted reproductive techniques-a hospital-based case control study.

BACKGROUND: Widespread use of assisted reproductive techniques (ART) has raised major concern about the outcome of resulting pregnancies, as well as about the health of the newborn children. The ART conceived pregnancies have an increased risk for prematurity and low birth weight (LBW). The risk of congenital malformations among children conceived via ART is contemplated to be high. The present case control study was conducted with an aim of analysing perinatal outcomes of children born by ART in the Indian context. METHODS: The case control study was conducted in the Army Hospital (Research and Referral), New Delhi. It included 82 cases and 164 controls. The data was collected on maternal and newborn characteristics among cases and controls. Perinatal outcomes were compared between ART conceived and spontaneously pregnant women in terms of birth weight, preterm, multiple pregnancies, and neonatal complications. RESULTS: Significant difference was observed in terms of the preterm delivery, birth weight, neonatal complications between the cases and the controls. The adjusted odds ratio (OR) was 21.6 (95% confidence interval [CI] 4.3, 112.9) for preterm delivery; 6.0 (95% CI 1.1, 43.8) for multiple pregnancy and 3.2 (95% CI 1.5, 7.0) for caesarean section. The risk of LBW and neonatal complications was heavily confounded by preterm delivery and multiple pregnancies, the adjusted OR being 0.9 and 1.0, respectively. CONCLUSION: Increased risk of preterm delivery, multiple pregnancies and caesarean section was associated with ART. The LBW was confounded by preterm delivery and multiple pregnancies.

Genotype of the LMNA 1908C>T variant is associated with generalized obesity in Asian Indians in North India.

OBJECTIVE: To determine the frequency distribution of LMNA 1908C>T SNP and its association with generalized obesity, abdominal obesity and coexistent metabolic disorders in nondiabetic Asian Indians living in a metropolitan city of north India. DESIGN: A cross-sectional population-based study of LMNA 1908C>T polymorphism with obesity and insulin resistance as outcome. PATIENTS: Five hundred and fifty-one Asian Indians, with 240 obese and 289 nonobese subjects. MEASUREMENTS: Allelic and genotypic frequency of LMNA 1908C>T were determined by PCR-RFLP. Association of LMNA alleles and genotypes was analysed with various measures of obesity [BMI ≥ 25 kg/m(2) , percentage body fat (by DEXA); subcutaneous and intra-abdominal fat at L2-3 level by single slice MRI in a subsample and surrogate marker of insulin resistance (fasting serum insulin levels >10 µU/ml in men and >11 µU/ml in women). RESULTS: Forty-six per cent of the subjects had generalized obesity while 54% had abdominal obesity. Frequency of C and T alleles was 0·71 and 0·29, respectively. Higher frequency of variant allele (T) was observed in obese than nonobese individuals (P = 0·001). On multivariate analysis adjusting for age, gender and serum insulin levels, subjects with LMNA1908T/T genotype were at 5·6 times higher risk [OR (95% CI): 5·6 (2·5-12·2), P = 0·001], while individuals with genotypes with at least one T allele, i.e. 1908C/T and T/T genotypes, were at 2·7 times higher odds to develop generalized obesity [OR (95% CI): 2·7 (1·8-4·1), P = 0·001]. CONCLUSION: LMNA 1908T/T and C/T genotypes emerged as independent genetic risk factors for generalized obesity in Asian north Indians.

Persistent pulmonary hypertension of the newborn: a review.

Persistent pulmonary hypertension of the newborn (PPHN) is a serious medical emergency in the neonatal period which occurs because of failure of transition of the foetal circulation into the normal circulation. The condition is characterised by persistently elevated pulmonary vascular pressures and despite numerous modalities of treatment available, the condition carries with it a high rate of mortality and morbidity. Early awareness of predisposing conditions and early diagnosis leads to better outcomes in PPHN.