Prevalence of Vitamin D3 deficiency among pediatric patients with idiopathic nephrotic syndrome in remission - A cross-sectional observational study from Vadodara, Gujarat

Background: Vitamin D deficiency occurs in nephrotic syndrome (NS) through various mechanisms, resulting in loss of both, Vitamin D binding protein and 25-(OH) D, in the urine leading to the risk of bone disorders. Objectives: The objectives of the study were to detect the prevalence of Vitamin D deficiency in children with idiopathic NS during remission. Methods: This study was conducted from April to November 2016 at the pediatric nephrology clinic at a tertiary care hospital in Vadodara. A total of 34 children were enrolled with idiopathic NS in remission, of which 14 had first attack of NS and ten of Frequently Relapsing Nephrotic Syndrome (FRNS) and Infrequently Relapsing Nephrotic Syndrome each. Vitamin D levels were measured using serum levels of 25-(OH) D by chemiluminescence method. Results: Vitamin D deficiency was observed in 28 of 34 (82%) children; of which, 16 (47%) had severe deficiency and 12 (35.2%) had mild to moderate deficiency. Children with the first attack of NS had a median Vitamin D level of 8.17 ng/ml (interquartile range [IQR] 2.9–28), IFRNS had a median of 6.8 ng/ml (IQR 2.9–33), and FRNS had the lowest median of 5.3 ng/ml (IQR 2.9–16). Although there were differences among all the 3 groups, differences were not statistically significant (Kruskal–Wallis 4.89, p=0.08) which showed decreased levels of Vitamin D. Conclusion: High prevalence of Vitamin D deficiency was observed in all 3 groups of idiopathic NS; the lowest being in FRNS. There was no significant association with lower levels of Vitamin D and relapses in NS. More research is needed to assess Vitamin D deficiency and to ensure the effect of Vitamin D supplementation for children with NS

Linear and whorled nevoid hypermelanosis: A rare familial case report

Linear and whorled nevoid hypermelanosis (LWNH), also known as ‘zebra-like pigmentation’ is characterized by linear and swirlingstreaks of hyperpigmentation along the Blaschko’slines without preceding inflammation and atrophy. It is mainly located on trunkand limbs. The hyperpigmentation may be present at birth or may develop by early childhood. Very rarely, familial cases have beendescribed. Here, we are reporting one such rare case of familial LWNH in a 19-year-old female

Person-person transmission of Brucella melitensis - A rare case report

Brucellosis, also known as “undulant fever” and “Mediterranean fever,” is a zoonosis. It is almost invariably transmitted by direct or indirect contact with infected animal tissues or ingestion of their products. It is endemic in many parts of the world and can affect people of all ages and both the sexes. Person-to-person transmission of brucellosis is usually rare. Here, we report the case of human-to-human transmission of brucellosis melitensis presented as a breast abscess

Breast hamartoma: An underrecognized entity

Hamartoma is a rare benign tumor of the breast. Pathologically, hamartomas are also labeled as lipofibroadenoma, fibroadenolipoma, or adenolipoma. This is due to a benign proliferation of the fibrous, glandular, and fatty component of the breast tissue surrounded by connective tissue capsule. Here, we report the case of a 60-year-old female patient who presented with a lump in the left breast for 4 months. Fine-needle aspiration cytology suggested the entity to be a benign cystic lesion. Lumpectomy was done and the cut surface showed cystic and solid areas. Histopathological examination revealed several irregular tissue fragments showing mammary glandular tissue with a prominent lobular arrangement, fibrous stroma, and fibroadipose tissue with the presence of papillary metaplasia at few places and confirmed it to be the hamartoma of the left breast

Acute colonic pseudo-obstruction (ogilvie’s syndrome) or colonic perforation: A rare complication following cesarean section

Ogilvie’s syndrome or pseudo-obstruction of the colon shows up as a clinical picture of acute obstruction of the large bowel without an associated pathological lesion as usually occurs in older patients. Here, we report a case series of three cases of Ogilvie’s syndrome following caesarean section. The caesarean section seems to be the most common operative procedure associated with this syndrome. The diagnosis was made by plain X-ray of the patient’s abdomen, which revealed dilated gut loops or air under the diaphragm in case of perforation. The pathological cause seems to be the disturbance of the autonomic innervation of the colon. The colon should be decompressed rapidly using colonoscopy. Surgery should be reserved for cases that have complications or that have been refractory to conservative treatment. Of our three cases, one was treated successfully by colonoscopic decompression and IV neostigmine, whereas, rest two patients presented late with colonic perforation. So they were immediately taken for exploratory laparotomy

Short-term safety and beneficial effects of hydroxyurea therapy in children with sickle cell disease

Introduction: Worldwide, sickle cell disease (SCD) is the most common hemoglobinopathy among which SS pattern is more common. Although hydroxyurea (HU) is approved by the Food and Drug Administration for the treatment of recurrent moderate-to-severe painful crises in pediatric sickle cell anemia, there is a fear of toxicities. Objectives: The objectives of the study were to evaluate the short-term safety and beneficial effects of low-dose HU therapy in SCD (SS pattern) children. Materials and Methods: This prospective cohort study enrolled 40 cases of severe SCD and started HU in a fixed dose of 10 mg/kg/day. During follow-up, cases were evaluated for compliance of HU, its toxic effects and adverse events from their histories, clinical examinations, and laboratory parameters. Furthermore, beneficial effects of HU therapy were evaluated by assessing blood transfusion rate, frequency of painful events, strokes, acute chest syndrome, avascular necrosis of femur, and estimation of hemoglobin F (HbF) level after 2 years of therapy. HU was discontinued temporarily if any toxicity or minor adverse drug events occurred during therapy and was restarted at the same dose after normalization of deranged laboratory parameters. Results: The clinical adverse drug events seen were nausea (8.33%), diarrhea (2.78%), and hematuria (2.78%). The most common hematological toxicity was anemia and thrombocytopenia. Renal and hepatic toxicities were transient in nature. The mean acute painful events and blood transfusion rate reduced significantly on HU therapy. It increased Hb and HbF level significantly in SCD children. Conclusion: HU is a safe drug without significant toxicity or adverse events in a dose of 10 mg/kg/day for short duration and it is beneficial in SCD (SS pattern) children in reducing acute painful events and decrease blood transfusion rate