Pancreatic, hepatobiliary, and gastrointestinal manifestations of children with cystic fibrosis: A 10-year experience from a tertiary care center in southern India.

OBJECTIVES: To describe the demography and spectrum of pancreatic, hepatobiliary, and gastrointestinal (GI) manifestations in children with cystic fibrosis (CF) from the Indian subcontinent. METHODS: In this retrospective study, relevant information from the database of all children with CF below 18 years of age was collected and analyzed. RESULTS: Among the total 109 children, 58 (53%) were from the southern states of India. The most common manifestation was pancreatic insufficiency (PI) in 85 (83%) children. Those with PI presented at an earlier age (1.8 vs. 6.9 years). Cirrhosis with portal hypertension was documented in only one patient and meconium ileus in three (2.8%). There was significant malnutrition in the PI cohort with a mean weight-for-age Z-score of - 3.17 ± 1.79 at diagnosis. Twenty-one (19%) patients had died during the follow-up and 18 (90%) of them had PI. There was no difference in the prevalence of selected pulmonary manifestations in the PI and pancreatic sufficient (PS) groups. Among children with PI, 78 were screened for ΔF508 mutation, 16 (21%) were homozygous, and 17 (22%) were heterozygous. In the PS group, only 2 (14%) were heterozygous for ΔF508 mutation. The median duration of follow-up of the patients was 1.8 (1.5) years. CONCLUSION: PI is the most common GI manifestation of children with CF and is associated with severe malnutrition and poor outcome. Timely identification and management of the comorbidities involving the digestive system are essential for better growth and quality of life in these children.

Vitamin-D deficiency and its association with breast feeding among children at 1 year of age in an urban community in South India.

CONTEXT: High prevalence of Vitamin D deficiency is reported among healthy infants, children and adolescents. Maternal Vitamin-D deficiency, poor vitamin-D content of breast milk even in Vitamin-D replete mothers, exclusive breastfeeding without Vitamin-D supplementation and inadequate sunlight exposure are important risk factors for Vitamin D deficiency in infants. AIM: To determine the prevalence of hypovitaminosis-D and its relation with breast feeding and childhood illness among healthy infants at 1 year of age. SETTINGS AND DESIGN: A prospective cohort study was conducted among the infants in an urban community in south India. METHODS AND MATERIAL: A total of 495 children were followed up at 1 year of age. Clinical history, anthropometric measurements, and serum blood samples for vitamin-D were obtained. The effects of breastfeeding duration and infections on Vitamin-D status were assessed by univariate and multivariate analysis. RESULTS: The prevalence of Vitamin D deficiency was 22% in these infants. Univariate analysis showed risk of hypovitaminosis-D in children breast fed for more than 6 months (p 0.02); however, multivariate analysis did not prove an association. Other risk factors analysed were not significantly associated with Hypovitaminosis D. CONCLUSION: The prevalence of hypovitaminosis-D in this study was low compared to previous studies from India. This study emphasizes the issue of hypovitaminosis-D in otherwise normal children. Routine Vitamin-D supplementation for antenatal women and infants may be needed to overcome this public health problem.