Mid upper arm circumference cutoffs for identifying underweight and severe underweight among infants less than six months: A Hospital Based Cross-Sectional study

Background: Prevalence of undernutrition among infants <6 months are very high in India. WAZ is the most sensitive predictor of mortality among infants <6 months as compared to other anthropometric parameters. However, taking weight and calculating z-score in the community setting have many challenges. Taking mid upper arm circumference (MUAC) is more feasible in a field setting. Methodology: A cross-sectional study was conducted with 419 infants <6 months in a tertiary care hospital in India to identify appropriate MUAC cutoffs for identifying underweight (WAZ<-2) and severe underweight (WAZ<-3) among infants <6 months by calculating sensitivities, specificities and Youden indices. Cohen kappa coefficients were calculated to assess agreements between MUAC and WAZ cutoffs. Results: The MUAC cut-offs for underweight and severe underweight were calculated as 11cm (Youden Index: 0.503; sensitivity: 83.4%; specificity: 66.9%) and 10.9cm (Youden Index: 0.504; sensitivity: 76.3%; specificity: 74.1%), respectively. Kappa coefficients to diagnose underweight with MUAC<=11cm was highest at 0.48. Conclusions: The MUAC cut-off of 11cm could reliably be used to screen infants <6 months with underweight and severe underweight for providing appropriate care in the Indian settings.

Optimal cyclosporine therapy--an Indian experience.

Thirty consecutive adult patients who underwent renal transplantation were prospectively studied. The immunosuppression consisted of cyclosporine, azathioprine and prednisolone. Oral Cyclosporine CyA was initiated at a dose of 7 mg/kg/Day and reduced by 1 mg/kg/month. Blood level of CyA was monitored by monoclonal RIA (Cyclo-Trac-NS) method on 3rd, 10th, 30th, 60th, 90th and 180th days. The dose was titrated according to the blood level and the renal function. In spite of progressive reduction in the dose of CyA, the blood level did not show any significant change, probably because of increased absorption or decreased metabolism. Though the percentage change in CyA dose was significant, the CyA level and serum creatinine remained relatively stable during the follow up period. Our patients required relatively lesser dose to achieve optimum blood level. Though the blood level of CyA ranged between 387 and 2120 ng/dL. There was no evidence of rejection or irreversible nephrotoxicity.