New onset diabetes after transplantation (NODAT) in renal transplant recipients: a study from tertiary care center in Kashmir, India

Background: New onset diabetes after transplantation (NODAT) is a common entity in the post-transplant period after several types of organ transplants like kidney, liver heart and lungs. NODAT is a common complication after solid organ transplantation and has been reported to have an adverse impact on patient and allograft outcomes. Risk stratification and intervention to minimize risk should be an integral part of management of transplant recipients.Methods: A total of 100 patients who underwent renal transplantation were observed for the development of NODAT in the post transplantation period. Patients were evaluated in the pre- transplant and post-transplant period. Risk factors which were associated with the development of NODAT were analyzed.Results: Out of 100 patients, 79 were males and 21 were females. The mean age of the patients undergoing renal transplantation was 40 years. The youngest patient was 18 years old and the eldest was 64 years old. Majority of the patients were in the age group of 31 to 50 years (60 patients, 60%). The incidence of NODAT in present study was 17%. The major risk factors for the development of NODAT were identified as male sex, positive family history of diabetes, history of alcohol intake before renal transplantation, hypertriglyceridemia, post renal transplantation hypomagnesemia, proteinuria, and use of drugs like tacrolimus and prednisolone.Conclusions: NODAT has been identified as a risk factor for graft rejection, long-term graft failure, and decreased patient survival. Once NODAT has been diagnosed, specific anti-hyperglycemic therapy is essential to reach a tight glycemic control, which contributes to significantly reduced post-transplantation morbidity. Due to the importance of NODAT, diabetes education and its impact on the outcome of post-transplantation morbidity and mortality becomes crucial point of research among organ transplantation populations. Diabetes education in a group setting can be adopted for organ transplantation recipients with NODAT

Role of blood culture in critically sick paediatric patients and its clinical impact: a tertiary care hospital based study

Background: Blood cultures form a critical part of evaluation of patients with suspected sepsis. The present study was undertaken to study the risk factors, duration of incubation for obtaining positive cultures, and the clinical impact of the culture report. Methods: A total of 224 samples from 110 critically sick pediatric patients presenting with suspected bacteraemia were processed aerobically.Results: Cultures were positive in 25.45% of the Patients. Most of the positive cultures were obtained after 24 hours of incubation of the broth and no isolates were obtained beyond day 4 of incubation. Therapy was modified in 52.73% of the patients after receipt of culture report. Conclusions: Incubation beyond four days (unless with specific indication like enteric fever) may be unnecessary for issuing a negative culture report. Repeated isolation of doubtful pathogens confirms true bacteraemia. Early culture report increases therapeutic compliance

Non-localizing Fever as Urinary Tract Infection in Children

Introduction: Urinary tract infection (UTI) is one of the commonly diagnosed bacterial infections of childhood. However, fever without a localizing point often remains the diagnostic dilemma and not diagnosing UTI could have devastating result for an otherwise easily manageable entity.Materials and Methods: All febrile children aged 2 months to 10 years without an apparent cause of fever were enrolled and evaluated for possible UTI.Results: A total of 304 children were recruited; 140 were males and 164 females. Of 304 who had fever without any apparent signs, 40 had UTI. The prevalence of UTI was 13.2% in the study group.Conclusions: Urinary tract infection presenting as fever without any focus was present in 13.2% of hospitalized patients favouring urine examination to rule out UTI in all febrile children without definite source of fever.Keywords: Child; E Coli; Fever; Urinary tract infections

Medical thoracoscopy in evaluation of undiagnosed pleural effusion

Background: Medical thoracoscopy or pleuroscopy, in recent past has received lot of interest for diagnostic as well as therapeutic purposes. In the evaluation of undiagnosed pleural effusion, it has become a key diagnostic modality as it is a cost effective and safe procedure. The aim of present study was to assess the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion.Methods: This prospective study was conducted at government chest diseases hospital Srinagar between December 2016 to June 2018. One hundred and twenty-five (125) patients who fulfilled inclusion criteria were included in this study. Thoracoscopy was done using rigid thoracoscope under local anesthesia.  Thoracoscopic and histopathological data of enrolled patients was collected prospectively and analysed.Results: Patients enrolled in the study were in the age range of 17 to 82 years and consisted of 80 males and 45 females. Most common thoracoscopic finding was multiple variable sized nodules (53.6%) followed by sago grain infiltration (15.2%). Malignancy was the most common histopathological diagnosis (60.8%) with metastatic adenocarcinoma being the most common histopathological diagnosis (50%). The overall diagnostic yield of thoracoscopy was 90.4%.Conclusions: Medical thoracoscopy is a safe procedure with excellent diagnostic yield for evaluation of undiagnosed pleural effusion with minimal complication rates

Chronic Kidney Disease in Children: A Review

Chronic kidney disease (CKD) in children is a life-consuming ailment with a variable but progressive course. CKD, in particular, the end stage kidney disease (ESKD) affects multiple body systems complexed with secondary complications that significantly and adversely affect the growth, development and quality of life. Although uncommon in children, CKD poses unique challenges to the health care delivery system to manage the primary renal disorders and extrarenal manifestations of CKD along with a heavy socioeconomic burden. Despite the availability of better management tools, there is a rise in incidence and prevalence of pediatric CKD for which wide range short- and long-term planning is inevitable that will lure the medicos to acquire the advanced nephrological training and skills, besides providing quality infrastructure and sustained socio-economic support. Our review is aimed to provide recent advances regarding the evaluation and management of pediatric CKD and its complications