Correlates of Thymus Size and Changes during Treatment of Children with Severe Acute Malnutrition (SAM)

AIMS & OBJECTIVES: 1. To radiologically demonstrate increase in thymus size with clinical recovery following nutritional rehabilitation in children with severe acute malnutrition. 2. To correlate the improvement in the clinical status of such children with severe acute malnutrition using objective markers such as MUAC, weight,weight for height, etc 3. To correlate improvement in the clinical status of such children with biochemical parameters. METHODOLOGY: Study Design - Prospective observational study. Study Setting - General medical wards in Institute of child health, Egmore, Chennai. Study Period - May 2017 to July 2018. Study Population: Inclusion Criteria: All children aged 6 months - 24 months presenting with severe acute malnutrition admitted in the hospital. Exclusion Criteria: Children with Severe respiratory distress requiring intubation and inotropic support at admission, Hemoglobin < 4gm%, infections like HIV, Tuberculosis. • Sample size: 59 (Sample size is calculated using nMaster software version 2.0.) • After obtaining informed consent from parents, demographic data like age, sex and locality of the family was collected. History regarding the complaints for which the child was admitted to the hospital was noted. History regarding the neonatal period like birth weight of the child and hospitalization for any illness was noted. History regarding breast feeding practices whether exclusively breast fed or not, given any other type of milk (animal or commercial) apart from breast milk was also enquired. History regarding developmental milestones was asked and noted. Immunization status of the child whether completely or partially immunized was also asked. • Detailed clinical examination including anthropometry like weight, height/length, mid upper arm circumference, head circumference measured as per prerequisites was done. Cardiovascular system, respiratory system, abdominal system and neurological examination was done. Presence of edema or wasting was noted. All relevant blood investigations done were noted down. Ultrasonogram of the chest for thymus size was done and noted. • All children were followed up during the course of hospital stay till discharge and was also followed up after 2 months. Relevant blood investigations and ultrasonogram of chest for thymus size was also done during follow up and noted down. RESULTS: • Mean age of presentation was 14.21 months. • The sex ratio male: female is 1.06:1. • Around two third of children were from rural area. • 48% of the children were not completely immunized. • The increase in weight, length, weight/length, mid upper arm circumference, hemoglobin, total protein, serum albumin, serum globulin from admission to discharge and from discharge to 8 weeks after admission was statistically significant in paired t test. • Change in thymus size is positively correlated with change in ionised calcium. • Change in thymus size is negatively correlated with head circumference. CONCLUSION: Thymus size in severe acute malnutrition was initially small and in some sick cases it is invisible and the thymus size was found to be increasing in size with statistical significance on follow up scan after 8 weeks of admission as the child is nutritionally rehabilitated and recover from the illness indicating that thymus size can be used as a marker of immunological dysfunction in severe acute malnutrition and as a marker of severity of the illness. Change in thymus area was statistically significant and positively correlating with the anthropometric indicators such as weight, weight/length and with ionised calcium levels, indicating the importance of calcium supplementation in severe acute malnutrition. Change in thymus area is negatively correlating with head circumference

The predictive role of serum magnesium in prognosis of critically ill medical patients

Introduction: Magnesium deficiency is a common disorder, but easily ignored as compared to other electrolyte abnormalities. Other studies are showing varied prevalence and increased association with morbidity and mortality. Aims & Objectives: The aim of our study is to find out the prevalence of hypomagnesemia among the critically ill medical patients and to correlate the serum magnesium levels with the mortality and morbidity outcome considering the length of ICU stay, duration of ventilatory support, APACHE 2 score, SOFA score, primary medical conditions in critically ill patients in medical ICU. Methodology: This prospective observational study was conducted in Medical intensive care unit of a tertiary care hospital. After the approval from Institutional ethical committee patients admitted to the medical intensive care unit with age more than 12 years and admitted for more than 2 days were included in the study after obtaining written informed consent. Laboratory tests and radiological investigations were done. APACHE 2(acute physiology and chronic health evaluation) score, SOFA score, total ICU stay, hospital stay, need of mechanical ventilation, duration of ventilatory assistance and associated medical conditions like diabetes, sepsis and electrolyte abnormalities were followed up to assess the relation with mortality and morbidity. Results: Among total of 170 critically ill medical patients were included in the study, prevalence of hypomagnesemia was 56.8 %. The morbidity was higher in hypomagnesaemic patients (48.5% vs 23.4%), longer ICU stay (6.96 ± 3.85 vs 5.12 ± 1.31) and need of mechanical ventilation was also more (68.9% vs 40.4 % p value < 0.003). Sepsis and maximum SOFA score indicate being the predominant underlying factor for hypomagnesemia. Even though association was there between mortality and hypomagnesemia, mortality has not correlated significantly [beta -0.041, t -0.473, 95 % CI -0.219 and 0.138]. Conclusion: Hypomagnesemia is more prevalent among the critically ill medical patients. Hypomagnesemia was also associated with increased mortality, longer ICU stay, higher APACHE 2 score, SOFA score, frequent ventilatory support and significant electrolyte abnormalities also

Towards the clinical implementation of pharmacogenetics in bipolar disorder.

BackgroundBipolar disorder (BD) is a psychiatric illness defined by pathological alterations between the mood states of mania and depression, causing disability, imposing healthcare costs and elevating the risk of suicide. Although effective treatments for BD exist, variability in outcomes leads to a large number of treatment failures, typically followed by a trial and error process of medication switches that can take years. Pharmacogenetic testing (PGT), by tailoring drug choice to an individual, may personalize and expedite treatment so as to identify more rapidly medications well suited to individual BD patients.DiscussionA number of associations have been made in BD between medication response phenotypes and specific genetic markers. However, to date clinical adoption of PGT has been limited, often citing questions that must be answered before it can be widely utilized. These include: What are the requirements of supporting evidence? How large is a clinically relevant effect? What degree of specificity and sensitivity are required? Does a given marker influence decision making and have clinical utility? In many cases, the answers to these questions remain unknown, and ultimately, the question of whether PGT is valid and useful must be determined empirically. Towards this aim, we have reviewed the literature and selected drug-genotype associations with the strongest evidence for utility in BD.SummaryBased upon these findings, we propose a preliminary panel for use in PGT, and a method by which the results of a PGT panel can be integrated for clinical interpretation. Finally, we argue that based on the sufficiency of accumulated evidence, PGT implementation studies are now warranted. We propose and discuss the design for a randomized clinical trial to test the use of PGT in the treatment of BD

Convergent functional genomic studies of omega-3 fatty acids in stress reactivity, bipolar disorder and alcoholism

Omega-3 fatty acids have been proposed as an adjuvant treatment option in psychiatric disorders. Given their other health benefits and their relative lack of toxicity, teratogenicity and side effects, they may be particularly useful in children and in females of child-bearing age, especially during pregnancy and postpartum. A comprehensive mechanistic understanding of their effects is needed. Here we report translational studies demonstrating the phenotypic normalization and gene expression effects of dietary omega-3 fatty acids, specifically docosahexaenoic acid (DHA), in a stress-reactive knockout mouse model of bipolar disorder and co-morbid alcoholism, using a bioinformatic convergent functional genomics approach integrating animal model and human data to prioritize disease-relevant genes. Additionally, to validate at a behavioral level the novel observed effects on decreasing alcohol consumption, we also tested the effects of DHA in an independent animal model, alcohol-preferring (P) rats, a well-established animal model of alcoholism. Our studies uncover sex differences, brain region-specific effects and blood biomarkers that may underpin the effects of DHA. Of note, DHA modulates some of the same genes targeted by current psychotropic medications, as well as increases myelin-related gene expression. Myelin-related gene expression decrease is a common, if nonspecific, denominator of neuropsychiatric disorders. In conclusion, our work supports the potential utility of omega-3 fatty acids, specifically DHA, for a spectrum of psychiatric disorders such as stress disorders, bipolar disorder, alcoholism and beyond

Thermodynamic and transport properties of ionized solutes in molten state continuously miscible in organic solvents: A class of systems with interesting features

121-127There exists a class of systems, in which a salt in its molten state exhibits continuous miscibility in a solvent. This situation is different from preparing a solution of salt in its solid state in a solvent, which restricts the solubility of the salt and forms a biphasic system. In the case of continuously miscible systems, a single phase is observed, as the salt is in its molten phase, dissolved in a liquid. Organic salts, in general, have low melting points and thus, can offer easier experimental conditions compared to the inorganic salts. The properties of such systems display some interesting features, such as anomalous viscosity behaviour, ion-pairing and predominant role of short-range interaction forces in determining the behaviour of these systems. Thermodynamic, surface, volumetric and transport behaviour of such systems are described with a view to exposing their peculiar characteristics. An application of Scaled Particle Theory for estimating the surface tension and compressibility of these systems is explored with a reasonable degree of success. It is hoped that the analysis of such systems as described herein, will throw light on the connectivity likely to be present between molten and ordinary liquid phases

Health advice given by general practitioners for travellers from Australia

Objectives: \ud To investigate the prevalence of travel health advice and written documentation reported to be given by general practitioners to travellers from Australia.\ud \ud Design and setting: \ud A postal questionnaire was sent to general practitioners (GPs).\ud \ud Participants: \ud 433 GPs were randomly selected from the register of the Medical Directory of Australia from the areas of western Sydney and Townville.\ud \ud Results: \ud Two hundred and thirteen questionnaires (49.2%) were returned. Approximately two-thirds of the sample was male (133/207,64.3%) and one-third female (74/207,35.7%). The mean age of the GPs was 46.7 (SD±12.1) years. The GPs reportedly saw an average of 3.9 (SD±11.8) travellers per week. Most GPs (160/202,79.2%) reported that they spent between 5–25 min for pre-travel consultations. GPs generally reported giving advice to travellers on travel vaccines, malaria prophylaxis, personal protective measures against insect bites, geographic diseases, clothing, and sexually transmitted infections. The majority of GPs did not routinely give information on travel insurance, unsafe sex, barotrauma, in-flight exercise, jet lag or first aid knowledge. Most GPs reported not routinely giving written documentation in the form of written travel health advice, a doctor's letter or a travellers' vaccination record.\ud \ud Conclusions: \ud GPs report seeking core information needed for formulating travel health advice. GPs also provided travellers with health advice on most of the areas, which need to be covered in the pre-travel consultation. More GPs may wish to consider advising travellers about the importance of travel insurance and managing common maladies of travellers, such as motion sickness, barotrauma, and jet lag. With limited time in general practice to advise travellers, more GPs should consider providing written advice and documentation for travel, including a travellers' vaccination record