Vitamin D Deficiency and Parathyroid Response in Critically-ill Children: Association with Illness Severity and Clinical Outcomes.

Objective: To determine the prevalence of vitamin D deficiency in critically ill children, and to study its association with parathyroid response, severity of illness and clinical outcomes. Design: Prospective observational study. Setting: Medical Pediatric Intensive Care Unit of a tertiary care centre of Northern India. Participants: 154 children in-patients: August 2011-January 2013. Main outcome measures: Vitamin D deficient children were (serum 25-hydroxy vitamin D <20 µg/mL) divided into "parathyroid-responder" [serum parathyroid hormone >65 pg/mL with 25(OH)D<20 µg/mL and/or calcium corrected for albumin <8.5 mg/dL] and "non parathyroid-responder.’’ Illness severity was assessed by Pediatric Index of Mortality-2 (PIM-2) score at admission. Biochemical parameters, illness severity scores and clinical outcomes were compared between parathyroid-responders and non-parathyroid-responders. Results: Vitamin D deficiency and hypocalcemia were observed in 125 (83.1%) and 91 (59%) children, respectively at admission. There were no differences in illness severity score at admission, mortality rate and length of stay between vitamin D-deficient children and 19.8% of non-vitamin D-deficient children. Among Vitamin D-deficient children, parathyroid-responders had higher PIM-2 score at admission compared to non-parathyroid-responder [12.8 (7.4,20.6) vs. 6.5 (2.5,12.2), P=0.01]. However, there were no differences in other clinical outcomes between two groups. Conclusion: Critically ill children have high prevalence of vitamin D deficiency. Parathyroid gland response secondary to hypocalcemia or vitamin D defiency is impaired in critical illness.

Role of HRCT temporal bone in pre operative evaluation of choesteatoma.

Background: Cholesteatoma is potentially dangerous condition as it can extend and erode into adjacent structures and can cause various serious complications. HRCT temporal bone very clearly depicts the anatomy of various small important structures in middle and inner ear cavity. Hence it is an excellent modality and investigation of choice in diagnosing and defining the extent of cholesteatoma. It has become essential investigation in preoperative planning for surgeon. Present study shows good correlation of various preoperative HRCT findings with intraoperative findings. Aims & Objective: To study the role of HRCT temporal bone in pre-operative evaluation of cholesteatoma. Material and Methods: Total 35 cases with clinically suspected cholesteatoma were selected for this study. All the patients were from Sir Sayajirao General Hospital, Vadodara and were scanned at the CT scan, Radiology Department of the hospital. The important intra-operative surgical findings were correlated with pre-operative HRCT findings. The results were analyzed, studied and compared with similar studies of the past. Results: Present study shows good correlation between the preoperative findings of cholesteatoma by HRCT temporal bone and intraoperative surgical findings. Conclusion: In present study HRCT enabled the pre-operative delineation of the cholesteatoma and the recognition of its manifestations and complications. HRCT is confirmed to be valuable in the diagnosis and in guiding the surgical management of cholesteatoma.