Objective:This study was conducted to validate the use of Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system in pediatric population in predicting the risk of mortality and to compare the predicted death rate (using APACHE II) with the actual death rate of the patients.Design:Hospital-based prospective study.Setting:Tertiary care Pediatric Intensive Care Unit (PICU) in Western Rajasthan, India.Methods:A total of 100 critically ill children between 1 and 18 years of age admitted to PICU and fulfilling the inclusion criteria were enrolled. APACHE II score was calculated in each patient on the day of admission. The predicted mortality was calculated on the basis of this score.Results:The mean APACHE II score was 21.35 ± 5.76. Mean APACHE II score among the survivors was 16.60 ± 6.12, and mean APACHE II score among the nonsurvivors was 26.11 ± 5.41, and the difference was statistically significant (P = 0.00). The area under the receiver operating characteristic curve for APACHE II score was found to be 0.889 (P = 0.008) indicating good discrimination.Conclusion:APACHE II scoring system has a good discrimination and calibration when applied to a pediatric population.

A 28-year-old primigravida with spontaneous conception and no complicating medical illness presented to the authors for an early morphology scan. Her scan was unremarkable with normal nuchal translucency for crown rump length, no stigmata for chromosomal abnormalities and no major detectable structural abnormality. A repeated search for ductus venosus revealed non visualization of the ductus with intrahepatic drainage of the umbilical vein. The karyotype was normal. Fetal echocardiogram, anomaly and serial growth scans were also within normal limits. She developed mild hydramnios in the late third trimester and delivered a normal healthy female child at 37 weeks. Postnatal echocardiogram showed a very small muscular ventricular septal defect. Mild pulmonary stenosis has been diagnosed at the age of 6 months. Ductus venosus is the key regulator of oxygenated blood in fetal life. Absent ductus venosus is associated with multiple structural, chromosomal, cardiac abnormalities partial or complete absence of portal venous system, hydrops and fetal death. In the absence of ductus venosus the umbilical vein may drain normally into the liver (intrahepatic shunt) or may drain in an aberrant location into the systemic circulation (e.g., iliac vein, inferior vena cava, right heart and coronary sinus) creating an extrahepatic shunt. In all the cases of absent ductus venosus, the prognosis depends on the presence or absence of associated abnormalities. In cases of extrahepatic aberrant drainage of the umbilical vein, the prognosis depends upon the presence or absence of portal venous system, abnormal shunt site and shunt diameter. In general, intrahepatic variant has a much better prognosis in the absence of other abnormalities.

Background: Vitamin B12 deficiency is common in children but under diagnosed disorder. Helicobacter pylori infection plays an important role in the development of atrophic gastritis and related malabsorption. There may be a relationship between H.Pylori infection and vitamin B12 deficiency. Aims and Objective: To find out prevalence of Helicobacter pylori infection by endoscopic and histopathological findings, in children aged 2-18 years, with vitamin B12 deficiency. Materials and Methods: Seventy-eight patients with deficient serum vitamin B12 levels were evaluated. Upper GI Endoscopy was performed in all cases and gastric biopsies were obtained for histopathological examination and evidence of H. pylori infection. Results: Tissue biopsy revealed chronic atrophic gastritis in 09 patients and chronic antral gastritis in 52 patients. H. pylori infection by histology was positive in 45(57.70%) patients. We found significant correlation between atrophic gastritis and H. pylori infection, as well as between H. pylori infection and B12 deficiency. Conclusion: H.pylori has an effect on gastric mucosa, which affects the absorption of vitamin B12. Thus individuals with B12 deficiency should be subjected for diagnostic evaluation of H.pylori infection so that appropriate therapy can be initiated.

Objectives: To assess the occurrence of serum vitamin D, zinc, iron and copper deficiency in children with newly diagnosed coeliac disease (CD) as compared to healthy controls at a tertiary care centre in Western Rajasthan, India Method: A case control study was conducted in the Gastroenterology Clinic, Department of Paediatrics, Dr S. N. Medical College, Jodhpur, India for a period of one year. Sixty consecutive newly diagnosed CD patients between 2-18 years of age, confirmed via serology and duodenal biopsy, who fulfilled the study criteria, were enrolled as cases in the study. Representative samples of 30 age-and-sex matched healthy subjects were taken as controls. Serum levels of vitamin D, zinc, iron and copper were assessed at diagnosis in cases and controls.Results: Mean age of the cases in the study was 6.19 ± 3.42 years. Serum vitamin D, zinc, iron and copper deficiency were seen in 55%, 40%, 58.3% and 11.7% cases respectively. The median (IQR) of serum vitamin D (p=0.002), zinc (p<0.001) and iron (p=0.003) were significantly lower in cases as compared to controls. A statistically significant correlation was seen between serum tissue transglutaminase (TTG) and mean serum vitamin D levels of cases in the study group (p<0.05) and between vitamin D levels and short stature (p <0.001).Conclusions: Vitamin D, zinc and iron deficiencies were more frequently observed in children with newly diagnosed CD as compared to healthy controls.

Background: Iron deficiency anemia (IDA) can result from both physiological and pathological events, the etiology of underlying IDA should be determined. Helicobacter pylori infection in children has mostly been associated with recurrent abdominal pain, gastric dyspepsia, or duodenal-ulcer. Other extra-digestive tract conditions such as iron deficiency or IDA have been recently related to the H. pylori infection. Aims and Objectives: To find out the prevalence of H. pylori infection in children aged 2–18 years with IDA in a tertiary care hospital. Materials and Methods: Across-sectional observational study was carried out in the Department of Paediatrics, Dr. S.N. Medical College, Jodhpur for a period of 1 year. A total of 52 children aged between 2 and 18 years with anemia (as per the WHO criteria of anemia) were evaluated for complete blood count, peripheral blood film and serum ferritin, serum iron, total iron-binding capacity (TIBC), Upper gastrointestinal endoscopy and two biopsy specimen evaluated for H. pylori and histopathological changes. Normally distributed data means were compared using student’s t-test unpaired and paired. Proportions were compared using Chi-square or Fisher’s exact test. Results: The prevalence of H. pylori in our study population was 32.69%. In children with H. pylori infection mean S.iron was 25.78±10.24 μg/dl, mean S.TIBC 544.66±91.68 μg/dl, and mean S.ferritin was 6.07±3.00 μg/dl. There was statistically significant difference in serum iron, S.TIBC and S.ferritin between children having H. pylori infection and without H. pylori infection(P<0.001). Conclusion: There is an association of IDA and H. pylori infection. Therefore prevention and eradication of H. pylori infection might be helpful to prevent IDA, especially in those patients who are not responding to usual treatment.