Kasai Portoenterostomy at a Slightly Delayed Age and Native Liver Survival in Children With Biliary Atresia: Single Center Experience

Objectives: We studied the modifiable prognostic factors that extend native liver survival at 2 years after Kasai portoenterostomy (KPE). Methods: We reviewed hospital records of patients with neonatal cholestasis, with focus on infants diagnosed with biliary atresia in a tertiary care hospital between January, 2014 and May, 2021. We determined the association of outcome with clinical and laboratory variables. Results: Infants who underwent KPE at a median (IQR) age of 76 (72-79) days had best outcomes, with minimal severe post-KPE complications and 2- year survival rate of 84.6%, compared to other infants (younger and older age at KPE). The median (IQR) weight at KPE in this group was 4.66 (4.2, 5.0) kg. Conclusions: In contrast to traditional recommendations, babies with median age at KPE of 76 days had superior native liver survival (84.6%) and reduced post-KPE complications, as compared to earlier KPE age. Nutritional status and weight of infant at KPE could be associated with this survival difference. This observation needs confirmation through multicentric prospective studies in different settings.

Drug utilization pattern in an intensive care unit of a teaching hospital in South India

Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated. About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively. Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay. Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics.Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated. About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively.Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay. Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics. Keywords: Antibiotics, Daily defined doses, Drug utilization, Intensive care unit

Adiposity and Cortisol Response to Stress in Indian Adolescents

Objective: We examined associations of different adipositymeasures with cortisol responses during the Trier Social StressTest for children (TSST-C).Design: Descriptive study.Setting: Holdsworth Memorial Hospital, Mysore, India.Participants: Adolescents aged 13.5y from a birth cohort wererecruited (N=269, 133 boys).Methods: The stressor (TSST-C) was 5-minutes each of publicspeaking and mental arithmetic tasks in front of two unfamiliar‘judges’. Salivary cortisol concentrations were measured atbaseline and at regular intervals after TSST-C. Weight, height,sub scapular and triceps skinfold thickness, and waist and hipcircumference were measured, and percentage body fat wasestimated (fat%; bioimpedance). Body mass index (BMI) andWaist-to-hip ratio (WHR) were calculated. All variables wereconverted into within-cohort SD scores before analysis. Stress-induced change in cortisol concentrations from baseline (cortisolresponse) was examined in relation to adiposity.Results: Stress increased cortisol concentrations significantlyfrom baseline (mean (SD): 5.5 (6.4) ng/mL; P<0.001). HigherWHR was associated with lower cortisol response at 20 and 30-minutes after stress (~0.13 SD decrease in cortisol response perSD higher WHR, P<0.05). Higher fat% was also associated withlower cortisol response only in girls 20-minutes post-stress (0.23SD lower response per SD higher fat%, P=0.004). Sum of skinfoldthickness and BMI were not associated with cortisol responses.Conclusions: Abdominal adiposity is associated with reducedhypothalamic-pituitary-adrenal axis reactivity to stress in thisadolescent population.

Primary hyperparathyroidism in North India: a description of 52 cases

Primary hyperparathyroidism [PHPT] has a variable clinical expression. Symptomatic PHPT is still the predominant form of the disease in many parts of the world, especially developing countries. Because the clinical profile of the disease has changed from that described in the past, we sought to improve our understanding of the disease in patients in north India. We summarized the clinical presentation, biochemical and radiological features, and operative findings from the case records from the last 13 years of 52 patients at a tertiary care centre in north India who had documented PHPT. The male: female ratio was 1: 3.3 with ages ranging from 6 to 60 years [mean +/- SD, 36.38 +/- 12.73]. Bone disease [46%], recurrent renal stones [21%] and body aches and pains [21%] were the most common modes of presentation. The lag time varied ranged from 1 month to 16 years. Common clinical manifestations included bone pain [67%], weakness/fatigue [56%], fracture of the long bones [48%], abdominal pain [39%], polyuria [37%] and psychiatric manifestations [23.1%]. Hypertension was observed in 42% and a palpable nodule in the neck in 19%. Biochemical features included hypercalcemia [86.5%], hypophosphatemia [65.4%] and hyperphosphatasia [67.3%]. Mean intact PTH [ +/- SD] was 809.0 +/- 696.3 ng/L with levels significantly lower in patients who had only kidney stone disease as compared with those with bone disease [P=0.017]. A single parathyroid adenoma was localized in 50 [98%] patients. Hungry bone disease was seen in 59% patients. PHPT in India continues to be a symptomatic disorder with skeletal and renal manifestations at a much younger age