Prediction of Outcome of the Children admitted in Pediatric Intensive Care Unit using Prism III Scoring System

INTRODUCTION: The field of Pediatrics has shown a lot of advancements and improvements in the recent past, which is definitely essential, as we pediatricians care for the young, tender, budding and yet to bloom part of the society. Pediatrics has been considered as one of the most sensitive fields of medicine and with the growing burden of illness among children, it has become a huge responsibility as a lot has to be shouldered by the Pediatric physician. This is aptly applicable especially for the Pediatric Intensivist who deals with children who are critically ill and at the verge of mortality many a times. To deal with children who are critically ill is a matter of high complexity. Hence they are catered in Pediatric Intensive Care Units designed especially for intensive monitoring of these children. These Pediatric Intensive Care Units have to be highly sophisticated with the latest technological advancements to treat these children, which costs a lot. OBJECTIVE: The aim of the study was to analyze the ability of PRISM III score in predicting the outcome of children admitted in PICU METHODS: A prospective descriptive study was done between August 2015 and July 2016 in the PICU of Institute of Child Health and Hospital for Children using PRISM III scoring to predict their outcome using their physiological parameters, blood gas analysis, biochemical and pathological lab parameters. RESULTS: A total of 100 children (64 boys and 36 girls) admitted in PICU comprised the study group. 47% were infant population. Respiratory system was the predominantly affected one (41%) followed by CNS (36%). About 42% of the study population was found to have wasting yet nutritional status did not contribute to the outcome. 89% of children had required mechanical ventilation and was considered to be an important risk factor, determining the outcome. Treatment with vasoactive agents contributed significantly in deciding the outcome. The chances for mortality increased with the addition of an inotrope. Need for renal replacement therapy & Cardio-pulmonary resuscitation contributed significantly to the outcome. MODS did not have a significant impact on outcome. For an increase of 5 in the PRISM score, a child’s odds of death increased by 13%. CONCLUSION: PRISM III score in our study showed adequate discriminatory capacity and calibration & can be considered a good tool for assessing the outcome of Paediatric patients admitted in the PICU. Variables considered to have a significant effect on the outcome were PRISM III score, Mechanical ventilation, Usage of vaso-active agents, renal replacement therapy and need for cardio-pulmonary resuscitation

A rare genetic mutation in a stone former

A 30-year-old woman with history of passage of stones since childhood presented with oliguria and pedal edema for 10 days. She had hypertension with a creatinine of 4.1 mg/dL. Evaluation showed presence of bilateral multiple renal calculi with features of chronicity of kidney disease. Metabolic work-up for nephrolithiasis turned out to be negative and eventually renal biopsy revealed features of chronic interstitial nephritis with greenish brown refractile crystals in the tubular lumen and interstitium. The possibility of dihydroxy adenine crystalline nephropathy was considered. Spectrophotometry of RBC lysates revealed decreased activity of Adenine phosphoribosyl-transferase enzyme. Gene amplification by PCR and sequential analysis identified a missense mutation in exon 3 region of APRT gene in the patient and her family members. This case report highlights the need to contemplate the diagnosis of DHA crystalline nephropathy in young patients with nephrolithiasis and the identification of a rare genetic mutation, which is being reported for the first time in India

Lupus nephritis in a patient with retroviral infection

A 38-year-old woman, diagnosed as Person Living with Human Immunodeficiency Virus (HIV) on Highly Active Antiretroviral Therapy (HAART) for three years, presented with features of fever, rashes, joint pain, dyspnea and pedal edema. On evaluation, a diagnosis of Systemic Lupus Erythematosus with Lupus Nephritis (LN) triggered by HIV infection was made based on clinical and serological evidence. She was continued on HAART, and immuno-suppressive therapy was co-administered resulting in the resolution of her symptoms. Lupus-like histopathological findings have been reported in patients with HIV-related kidney diseases. This case report is to highlight the co-existence of LN in a patient with HIV infection

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6 $\times$ 6 $\times$ 6 m$^3$ liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019–2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6x6x6m3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties