Comparison of calcium metabolism in different subgroups of nephrotic syndrome in children

Background: Children with nephrotic syndrome are at risk of altered calcium metabolism because of the disease per se as wellas steroid therapy even before fall in glomerular filtration rate (GFR). Objective: To compare the pattern of alteration in calciummetabolism in different subgroups (infrequent relapser [IFR], frequent relapser or steroid-dependent nephrotic syndrome [FR/SDNS], and patients in remission) of nephrotic syndrome in children. Methods: We conducted a cross-sectional study in theDepartment of Pediatrics, PGIMS, Rohtak. Children between 1 and 8 years of age were divided into three groups, viz., IFR (Group I),FR/SDNS (Group II), and patients in remission (Group III). Serum total calcium, ionized calcium, phosphate, parathormone (PTH),albumin levels, and urinary calcium and phosphate were measured, and X-rays of both lower limbs were done. Results: 10 patientsin each group were compared. Serum total calcium, ionic calcium, and urinary calcium levels were decreased in patient withnephrotic syndrome during active disease. No difference was noted in serum phosphate, urinary phosphate, and GFR in all thethree groups (p>0.05). Serum calcium and urinary calcium were significantly lower in Group II as compared to Group I (p<0.05),whereas serum PTH levels were significantly higher in Group II as compared to Group I (p<0.05). None of the patients withIFR and in remission had changes of osteopenia while 50% patients with FR/SDNS had features of osteopenia in their X-rays.Conclusion: Hypocalcemia is a common finding in children with nephritic syndrome. These children especially those with FR orSDNS should undergo careful monitoring of calcium, phosphorus, and PTH to prevent bone mineral disease

An auction-based market equilibrium algorithm for a production model

AbstractWe present an auction-based algorithm for computing market equilibrium prices in a production model, in which producers have a single linear production constraint, and consumers have linear utility functions. We provide algorithms for both the Fisher and Arrow–Debreu versions of the problem

Multimodal Behavior Program for ADHD Incorporating Yoga and Implemented by High School Volunteers: A Pilot Study

A low-cost resource approach to ADHD therapy would be a practical approach to treating children in developing countries. Research has shown that ADHD is prevalent in all areas of the world, and yet treatment for children in more impoverished countries is still lacking. The approach taken was to combine yoga and meditation combined with multimodal behavioral therapy program for children ageing 6 to 11. The program was kept low cost by using trained high school volunteers and integrating the program within the public school. After 6 weeks of the program, 90.5% of children showed improvement as measured by their performance impairment score, a measurement of academic performance. Parent and Teacher evaluations of behavior also found improvement as 25 of the 64 children (39.1%) improved into the normal range as measured by the Vanderbilt questionnaire. Moreover, children could successfully learn both yoga and meditation from high school students irrespective of their age, ADHD type, or initial performance impairment. The results demonstrate efficacy of a multimodal behavioral program incorporating yoga and meditation. The use of high school volunteers from schools in the area demonstrates an effective low-cost and universally applicable approach

To study the clinicoetiological profile of children admitted with bleeding diathesis

 Background: Bleeding complications in children may be caused by disorders of secondary hemostasis or fibrinolysis. A child who presents with bleeding warrants evaluation for a significant bleeding problem. Objectives: The aim is to study the clinicoetiological profile of children admitted with bleeding diathesis. Materials and Methods: Children up to the age of 14 years presenting in the Department of Pediatrics, Pandit B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, with hemorrhagic diathesis, that is, non-traumatic spontaneous bleeding, suspected to be either due to the defective primary hemostatic mechanism (platelet– blood vessel interaction) or defective secondary hemostatic mechanism, were enrolled for this study. Frequency distribution of various bleeding disorders in various age groups was studied. Results: A total of 92 children up to the age of 14 years were taken up for study, of which, maximum cases with bleeding presented with hematemesis (23.9%) followed by melena (22.8%). A total of 73 children (79.34%) presented with skin and joint bleeds. We were able to make diagnosis in 82 children (89.1%). Among 82 patients, 31 (37.8%) had bleeding secondary to infections, 11 (13.4%) had coagulation disorder, 9 (10.97%) had Henoch–Schonlein purpura (HSP) and immune thrombocytopenic purpura (ITP) each, 6 (7.3%) had hypoplastic bone marrow, 2 (2.4%) had chronic malaria, 4 (4.9%) had leukemia, 6 (7.3%) had liver diseases, and 6 (7.3%) had hemorrhagic disease of newborn (HDN). Almost half of the children with bleeding manifestations in each age group had thrombocytopenia. The most common causes of bleeding in <1 year were septicemia with thrombocytopenia and HDN; among 1-7 years were infections, ITP, and coagulation disorders; and in more than 7 years were HSP, ITP, liver disease, and hemolytic-uremic syndrome. Conclusion: Our study foundthat the gastrointestinal tract was the most common site of bleeding in children presenting with non-traumatic spontaneous bleed, and thrombocytopenia was present in 50% of the cases in each age group. We also found that infections were the most common cause of bleeding in younger children, whereas immunological causes and coagulation disorders predominate in older children. Hence, while evaluating any child with bleeding, age at presentation is also an important parameter to find the etiological diagnosis.&nbsp

A Randomized, Controlled Clinical Trial Comparing Efficacy, Safety and Cost Effectiveness of Lornoxicam with Diclofenac Sodium in Patients of Osteoarthritis Knee

Osteoarthritis is a chronic painful condition affecting larger joints; mostcommonly knee joint. Pharmacological control of pain is the mainstay of management of osteoarthritis. Many patientsfail to achieve satisfactory reduction in pain with one of the most commonly prescribed drugs, diclofenac sodium, even after maximum daily allowed doses. Lornoxicam is a newer molecule in the Indian market promising better pain relief incontext of low back pain and post knee replacement surgery pain as compared to standard therapies. As per profile of lornoxicam, if it is better than diclofenac sodium then it will be helpful in managing the patients of osteoarthritis more effectively. Till date no comparative clinical trial has been done to compare these two drugs for the management ofosteoarthritis knee. So, to evaluate the same we carried out this study to compare safety, efficacy and cost effectiveness of lornoxicam and diclofenac sodium in relieving pain in patients of osteoarthritis knee. This study is a randomized, open labeled, controlled clinical trial having 40 newly diagnosed patients with osteoarthritis knee. After random allocationinto two groups i.e. group D and group L (each having 20 patients); group D received diclofenac sodium 50 mg 12 hourly and group L received lornoxicam 4 mg 8 hourly for a period of 3 months. All patients were assessed with visual analogue scale and 100 meter walking test before starting of therapy, at 15 days and at 1, 2 and 3 months of therapy.Adverse drug reactions and cost of therapy was monitored during the study period. Mean decrease in visual analogue scale and time of 100 meter walking test was statistically significant in lornoxicam group as compared to diclofenac sodium. Gastric irritation was reported in one patient from group L and two patients from group D. Lornoxicam significantly relieves pain of osteoarthritis knee than diclofenac sodium without adversely affecting the tolerability to the patients

To study the clinical profile of children with pleural effusion at a Tertiary Care Center in North India: A prospective study

Introduction: Pleural effusion is the most common manifestation of pleural disorders and is mostly secondary to bacterial infections in children. Aims and Objectives: The primary objective was to study the clinical presentation of pleural effusion in hospitalized children. The secondary objective was to establish the etiology. Methods: A prospective observational study conducted from April 2014 to September 2015. Children >1 month and <14 years diagnosed to have pleural effusion on clinical and radiological examination were included in the study. Data regarding demographic profile, presenting complaints, immunization history, anthropometry, biochemical and radiological investigations, and the outcome of the patients were collected. Results: Seventy-five patients were included in this study. The mean age of the patients was 69.97±48.23 months. Regarding etiology of pleural effusion, it was parapneumonic in 35 (46.6%), empyema in 18 (24%), transudative in 12 (16%), tubercular in 9 (12%), and malignant (non-Hodgkin’s lymphoma) in 1 (1.3%) case. The presenting complaints were fever (82.6%), cough (78.7%), respiratory distress (69.3%), chest pain (36%), and abdominal pain (9.3%). There was no sex predominance. About 16% patients were severely malnourished. Severe anemia was present in 5 (6.7%) patients. None of them required decortication surgery, and none of the patients expired during hospitalization. Conclusion: Pleural effusion is a major health problem with parapneumonic effusion still beingthe most common etiology. Our study also confirmed that fever, cough, and respiratory distress were the most common presenting complaints and most of the children were malnourished. A high index of suspicion is required to avoid delays in diagnosis that may influence treatment and outcome

Characteristics of the phenotype of mixed cardiomyopathy in patients with implantable cardioverter-defibrillators

OnlinePublBackground or Purpose The prognosis of mixed cardiomyopathy (CMP) in patients with implanted cardioverter-defbrillators (ICDs) has not been investigated. We aim to study the demographic, clinical, device therapies and survival characteristics of mixed CMP in a cohort of patients implanted with a defbrillator. Methods The term mixed CMP was used to categorise patients with impaired left ventricular ejection fraction attributed to documented non-ischemic triggers with concomitant moderate coronary artery disease. This is a single center observational cohort of 526 patients with a mean follow-up of 8.7±3.5 years. Results There were 42.5% patients with ischemic cardiomyopathy (ICM), 26.9% with non-ischemic cardiomyopathy (NICM) and 30.6% with mixed CMP. Mixed CMP, compared to NICM, was associated with higher mean age (69.1 ± 9.6 years), atrial fibrillation (55.3%) and greater incidence of comorbidities. The proportion of patients with mixed CMP receiving device shocks was 23.6%, compared to 18.4% in NICM and 27% in ICM. The VT cycle length recorded in mixed CMP (281.6 ± 43.1 ms) was comparable with ICM (282.5 ± 44 ms; p = 0.9) and lesser than NICM (297.7±48.7 ms; p=0.1). All-cause mortality in mixed CMP (21.1%) was similar to ICM (20.1%; p=0.8) and higher than NICM (15.6%; p = 0.2). The Kaplan–Meier curves revealed hazards of 1.57 (95% CI: 0.91, 2.68) for mixed CMP compared to NICM. Conclusion In a cohort of patients with ICD, the group with mixed CMP represents a phenotype predominantly comprised of the elderly with a higher incidence of comorbidities. Mixed CMP resembles ICM in terms of number of device shocks and VT cycle length. Trends of long-term prognosis of patients with mixed CMP are worse than NICM and similar to ICM.Deep Chandh Raja, Indira Samarawickrema, Sarat Krishna Menon, Rikvin Singh, Abhinav Mehta, Lukah Q. Tuan, Ulhas Pandurangi, Sanjiv Jain, David J. Callans, Francis E. Marchlinski, Walter P. Abhayaratna, Prashanthan Sanders, Rajeev K. Patha

Predicting atrial fibrillation recurrence by combining population data and virtual cohorts of patient-specific left atrial models

Background: Current ablation therapy for atrial fibrillation is suboptimal, and long-term response is challenging to predict. Clinical trials identify bedside properties that provide only modest prediction of long-term response in populations, while patient-specific models in small cohorts primarily explain acute response to ablation. We aimed to predict long-term atrial fibrillation recurrence after ablation in large cohorts, by using machine learning to complement biophysical simulations by encoding more interindividual variability. Methods: Patient-specific models were constructed for 100 atrial fibrillation patients (43 paroxysmal, 41 persistent, and 16 long-standing persistent), undergoing first ablation. Patients were followed for 1 year using ambulatory ECG monitoring. Each patient-specific biophysical model combined differing fibrosis patterns, fiber orientation maps, electrical properties, and ablation patterns to capture uncertainty in atrial properties and to test the ability of the tissue to sustain fibrillation. These simulation stress tests of different model variants were postprocessed to calculate atrial fibrillation simulation metrics. Machine learning classifiers were trained to predict atrial fibrillation recurrence using features from the patient history, imaging, and atrial fibrillation simulation metrics. Results: We performed 1100 atrial fibrillation ablation simulations across 100 patient-specific models. Models based on simulation stress tests alone showed a maximum accuracy of 0.63 for predicting long-term fibrillation recurrence. Classifiers trained to history, imaging, and simulation stress tests (average 10-fold cross-validation area under the curve, 0.85±0.09; recall, 0.80±0.13; precision, 0.74±0.13) outperformed those trained to history and imaging (area under the curve, 0.66±0.17) or history alone (area under the curve, 0.61±0.14). Conclusion: A novel computational pipeline accurately predicted long-term atrial fibrillation recurrence in individual patients by combining outcome data with patient-specific acute simulation response. This technique could help to personalize selection for atrial fibrillation ablation

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701