Pediatric acute kidney injury: A syndrome under paradigm shift.

The recent standardization and validation of definitions of pediatric acute kidney injury (pAKI) has ignited new dimensions of pAKI epidemiology and its risk factors. pAKI causes increased morbidity and mortality in critically ill-children. Among the hospitalized patients incidence of pAKI ranges from 1% to 31%, while mortality ranges from 28% to 82%, presenting a broad range due to lack of uniformly acceptable pAKI definition. In addition, cumulative data regarding the progression of pAKI to chronic kidney disease in children is rising. Despite these alarming figures, treatment modalities have failed to deliver significantly. In this review, we will summarize the latest developments of pAKI and highlight important aspects of pAKI management.

Presynaptic membrane receptor in human brain.

Myasthenia gravis (MG) is an autoimmune disease that results from antibody mediated damage of Acetylcholine receptor (AChR) at the neuromuscular junction. The autoimmune character of MG and pathogenic role of AChR antibodies have been established by several workers i.e., the demonstration of anti-AChR antibodies in about 90 % of MG patients. It has been demonstrated that patients with MG also have antibodies against a second protein named presynaptic membrane receptor (PsmR), which is identified by utilizing ß-Bgtx, a ligand which binds to PsmR. Using ß-Bgtx Sepharose 4B affinity matrix, the PsmR was purified from different regions of human cadaver brain by affinity chromatography. Purified receptor was characterized both by biochemical and immunological procedures. PsmR purified from different regions of the brain shows a specific activity of 0.37 ± 0.01, 0.39 ± 0.02 and 0.43 ± 0.005 nM/ µg of protein in Parietal lobe, Occipital lobe and Frontal lobe respectively. The affinity purified PsmR from the brain of 87 and 68 kd (parietal lobe, occipital lobe and frontal lobe) shows immunoreactivity with myasthenic sera. These findings suggest that PsmR from brain is another antigen against which autoantibodies are developed in Myasthenia gravis patients. Upon treatment with various enzymes we concluded that PsmR from brain is a glycoprotein in which the immunoreactivity resides in the carbohydrate as well as the peptide epitopes. In conclusion the PsmR is another antigen against which autoantibodies are formed in different regions of brain. These can be used as a diagnostic tool for detecting antibodies in the sera or cerebrospinal fluid of MG patients.

Pediatric hypertension: an updated review.

Globally hypertension in adults is among the leading preventable cause of premature death, where a graded association from the childhood hypertension is well recognised. With the concurrent rise in obesity and pediatric hypertension (HTN) during the past decade in developed countries, a parallel trend is emerging in developing countries that has a potential for exponential rise in cardiovascular, cerebrovascular and renal tragedies. A cumulative incidence of pediatric HTN in China and India is 50-70 and 23% respectively, is quite disturbing. New guidelines for the detection, evaluation and management of hypertension in children and adolescents published in 2017, where a jump in prevalence of pediatric HTN is observed, rings a call to address this under-attended burning problem; for which a review in pediatric hypertension and its management is warranted.

A study of prevalence and pattern of congenital heart disease at Sopore, Kashmir, North India

Background: Early detection of congenital heart disease is of paramount importance to improve the quality of life of children and prevent morbidity and mortality. Congenital heart disease (CHD) is one of the major causes of mortality and morbidity in the pediatric population of both the developing and developed countries. Present aim was to study the prevalence, age and sex wise distribution, and clinical spectrum of congenital heart disease (CHD) at Sopore, Kashmir, North India.Methods: Around 39829 children in the age group 0 months to 18 years were screened for Defects at birth, Diseases in children, Deficiency conditions and Developmental Delays including Disabilities over the period of 18 months under RBSK. Clinical examination, echocardiography and color Doppler were used as diagnostic tools.Results: A prevalence of 5.3 per 1000 population was observed. VSD (ventricular septal defect) was the commonest lesion (30.1%), followed by PDA (patent ductus arteriosus) in 21.6 % and ASD (atrial septal defect) in 20.2%. Tetralogy of Fallot was the commonest cyanotic heart disease (8.0%). Maximum numbers of children with heart disease were diagnosed in the age group 6 weeks to 6 years.Conclusions: For better estimation of prevalence of congenital heart diseases, more elaborate community-based studies are needed. Such community based studies can be easily done by collecting and analyzing data collected from screening programs like RBSK. Such community based screening programs helps in detecting silent cardiac ailments, their prevalence and pattern, and early therapeutic intervention. A few prevalence studies have been carried out piecemeal in different locations of India; and more such studies can be easily done by collecting and analyzing data collected under RBSK screening program.

Role of Serum Prolactin Levels in Diagnosis of Epileptic and Pseudoepileptic Events in Children, A Tertiary Care Experience

Introduction: Transient elevation of serum prolactin levels occurs in immediate postictal period in true epileptic events only. Current study was aimed to investigate the role of postictal serum prolactin levels in differentiation of true seizures from pseudo epileptic events. Material and methods: A total of 110 patients of either sex between ages of 6 months to 12 years out of 676 cases admitted for seizure evaluation were enrolled in our study and divided into four groups. Group 1 included 30 children having frank seizures, group 2 included 30 children with typical febrile seizures, group 3 included 25 children with seizure mimics and group 4 included 25 children without seizures.The serum prolactin levels were quantitatively determined by using CoatA-Count Prolactin Immuno-radiometric assay (IRMA). All data was analyzed by standard statistical methods. Results: There were 64(58.2%) males and 46(41.8%) females with mean age of 60.8 and 61.3 months. The serum prolactin level was highest in group I with mean level of 25.5ng/ml ±10 SD(p value =0.00).The serum prolactin levels were raised in 30.3% (20/66) of patients in group I,II,and III when serum sample was obtained within 20 minutes and in none 0/19 (0.00%) when sample was taken after 20 minutes (p value =0.006).All patients with generalized tonic clonic seizures with abnormal EEG had abnormal prolactin levels while as only 83.3% with complex partial seizures and 20% with simple partial seizures had raised prolactin levels (p value =0.002). Conclusion: There was a significant rise in serum prolactin level in children with epileptic seizures as compared to febrile seizures and seizure like events.

The practice of exclusive breastfeeding: its socio-demographic determinants in Kashmir, North India

Background: Breastfeeding is a well-established and recommended intervention for the improvement of child nutrition. Formula feeding is a major public health problem. Objective of the current study was to know the significance of demography, socioeconomic, parental education and employment and mode of delivery on exclusive breast-feeding Kashmir, North India.Methods: A prospective hospital-based study, carried out in the Department of Pediatrics, G.B Pant Hospital Srinagar Kashmir India over the period from 2014 July to June 2015. A teaching, research and tertiary care hospital at Srinagar Kashmir North India. All the mothers who were having infants in the age group 0 to 6 months were included in study. Procedure of this variables recorded were modes of feeding, demographics, socioeconomic status, literacy level, mode of delivery, place of delivery etc.Results: A total of 600 mothers were included in study. Less than 35% of mothers were exclusively breast feeding their infants. Exclusive breast feeding was significantly high in babies born by normal vaginal delivery, more than 3 antenatal visits, mother knowing advantages of breast feeding and higher parental education.Conclusions: Exclusive breast feeding is very low (less than 35%) in this part of world and formula feeding is a major public health problem.

Clinicobacteriological profile, antibiotic sensitivity patterns and mortality of neonatal sepsis in a tertiary care hospital in Kashmir, Jammu and Kashmir, India

Background: Neonatal sepsis refers to generalized bacterial blood stream infection in first 28 days of life documented by positive blood cultures. It is one of leading causes of neonatal mortality. Objectives was to study clinicobacteriological, antibiotic sensitivity patterns and mortality of neonatal sepsis.Methods: This prospective study was conducted in the Department of Pediatrics of Government Medical College Srinagar in collaboration with Department of Microbiology of same medical college after ethical clearance from ethical committee of Government Medical College Srinagar. One hundred (100) neonates out of 731 neonates admitted between octomber2007 and September 2008 with signs and symptoms of neonatal sepsis were included in our study by random sampling method. After history, examination and laboratory investigation blood culture results were analyzed by standard statistical methods.Results: The blood culture was positive in 40% of neonates. Fifty one (51) neonates were males while as 49 were females. Sixty three (63) neonates had late onset of sepsis while as 37 had early onset sepsis. The positive' blood culture was more common in males, late onset sepsis, babies born in rural areas, home born, vaginal births, preterm and other' low birth weight neonates .The gram negative isolates were most common followed by positive ones .The best sensitivity of gram negative isolates was to ciprofloxacin followed by amikacin and cephalosporins while as gram positive isolates were sensitive to imipenum followed by vancomycin. Pseudomonas was most responsive to pipercillin +tazobactum combination. The neonatal mortality was 35% being higher in early onset sepsis and low birth weights.Conclusions: This study depicts a high rate of neonatal sepsis, mainly caused by gram negative organisms followed by gram positive organisms with rising drug resistance that could bear far reaching implications to the times to come, mandating the implementation of sepsis preventive measures and administration of specific antibiotics.