Congenital hyperinsulinism treated by surgical resection of the hyperplastic lesion which had been preoperatively diagnosed by 18F-DOPA PET examination in Japan: a nationwide survey

Purpose

Congenital hyperinsulinism is a rare disease, and the newly developed 18 fluoro-_L-dihydroxyphenylalanine-positron emission tomography (18F-DOPA PET) examination can detect hyperplastic lesions. Our purpose was to report the results of a nationwide survey on surgical treatment of congenital hyperinsulinism in Japan.

Methods

A questionnaire was sent to the 159 accredited and affiliated training institutes certified as pediatric surgical institutes by the Japanese Association of Pediatric Surgeons, asking if they had encountered patients who underwent surgical treatment for congenital hyperinsulinism after 18F-DOPA PET examination from 2000 to 2017. Six institutes answered that they had treated such cases, and the total number of cases was 14.

Results

18F-DOPA PET examination detected the focal lesion in 12 of the 14 cases. 18F-DOPA PET examination could accurately determine the site of the hyperplastic lesion in the pancreas in 11 (91.7%) of the 12 cases. All cases underwent surgical resection of the hyperplastic lesion at under 2 years of age.

Conclusion

Surgical resection of a focal hyperplastic lesion in the pancreas was a safe and effective treatment if the hyperplastic lesion was a focal lesion. However, it is necessary to check the exact distribution of the lesion by intraoperative pathologic examination of frozen sections.

     

Early interim FDG PET/CT prediction of treatment response and prognosis in pediatric Hodgkin disease—added value of low-dose CT

Background

Interim 18F-FDG PET helps predict outcome and tailor treatment in adults with Hodgkin disease (HD).

Objective

The purpose of this study was to assess predictive values of interim 18F-FDG PET/CT in children with HD and to define the potential added value to interim PET of low-dose CT.

Materials and methods

Children were prospectively enrolled August 2002–April 2007. PET/low-dose CT was performed at staging, after 2 cycles, at the end of treatment and during follow-up (mean 45 months). Treatment was unchanged regardless of interim results. PET and low-dose CT were read independently.

Results

Of 34 enrolled children (ages 3–17 years), 27 achieved complete response, 4 had progressive disease and 3 had relapse. Interim PET alone had positive and negative predictive values of 67% and 89%, respectively. Interim low-dose CT alone had positive and negative predictive values of 35% and 100%, respectively. Interim PET/CT had positive and negative predictive values of 75% and 96%, respectively.

Conclusions

Early interim PET/CT was a good predictor of outcome. Integrated PET and low-dose CT improved the predictive value in children with HD.     

Early differential diagnosis methods of biliary atresia: a meta-analysis

Purpose

To evaluate the accuracy of early differential diagnosis methods of biliary atresia in patients with infantile cholestasis.

Methods

We searched PubMed, EMBASE and the Web of Science databases for articles evaluated the early differential diagnosis methods of biliary atresia. The methodological quality of each study was assessed with version 2 of the Quality Assessment of Diagnostic Accuracy Studies tool. Two reviewers extracted data independently. Pooled sensitivity, specificity, positive likelihood ratio (LR?+), negative likelihood ratio (LR??), diagnostic odds ratio (DOR) with 95% CIs were calculated to assess each diagnosis method.

Results

A total of 38 articles were included. Summary sensitivity and specificity were 77% (95% CI 74–80%) and 93% (95% CI 91–94%), respectively, for B-US in 23 studies; 96% (95% CI 92–98%) and 58% (95% CI 51–65%), respectively, for MRCP in five studies; 87% (95% CI 82–91%) and 78% (95% CI 74–82%), respectively, for acholic stool in seven studies; 84% (95% CI 78–89%) and 97% (95% CI 97–98%), respectively, for serum liver function test in seven studies; 96% (95% CI 94–97%) and 73% (95% CI 70–76%), respectively, for hepatobiliary scintigraphy in 18 studies; 98% (95% CI 96–99%) and 93% (95% CI 89–95%), respectively, for percutaneous liver biopsy in 11 studies.

Conclusion

The accuracy rate of percutaneous liver biopsy is better than all of the noninvasive methods. Take into consideration the advantages and disadvantages of the six methods, combination of multidisciplinary noninvasive diagnosis methods is the first choice for differential diagnosis of BA from other causes of neonatal cholestasis.

     

18F-FDG PET/CT evaluation of children and young adults with suspected spinal fusion hardware infection

Background

Evaluation of the child with spinal fusion hardware and concern for infection is challenging because of hardware artifact with standard imaging (CT and MRI) and difficult physical examination. Studies using ¹⁸F-FDG PET/CT combine the benefit of functional imaging with anatomical localization.

Objective

To discuss a case series of children and young adults with spinal fusion hardware and clinical concern for hardware infection. These people underwent FDG PET/CT imaging to determine the site of infection.

Materials and methods

We performed a retrospective review of whole-body FDG PET/CT scans at a tertiary children’s hospital from December 2009 to January 2012 in children and young adults with spinal hardware and suspected hardware infection. The PET/CT scan findings were correlated with pertinent clinical information including laboratory values of inflammatory markers, postoperative notes and pathology results to evaluate the diagnostic accuracy of FDG PET/CT. An exempt status for this retrospective review was approved by the Institution Review Board.

Results

Twenty-five FDG PET/CT scans were performed in 20 patients. Spinal fusion hardware infection was confirmed surgically and pathologically in six patients. The most common FDG PET/CT finding in patients with hardware infection was increased FDG uptake in the soft tissue and bone immediately adjacent to the posterior spinal fusion rods at multiple contiguous vertebral levels. Noninfectious hardware complications were diagnosed in ten patients and proved surgically in four. Alternative sources of infection were diagnosed by FDG PET/CT in seven patients (five with pneumonia, one with pyonephrosis and one with superficial wound infections).

Conclusion

FDG PET/CT is helpful in evaluation of children and young adults with concern for spinal hardware infection. Noninfectious hardware complications and alternative sources of infection, including pneumonia and pyonephrosis, can be diagnosed. FDG PET/CT should be the first-line cross-sectional imaging study in patients with suspected spinal hardware infection. Because pneumonia was diagnosed as often as spinal hardware infection, initial chest radiography should also be performed.     

Characteristic imaging features of desmoplastic small round cell tumour

Background

Desmoplastic small round cell tumour (DSRCT) is a rare malignant neoplasm. Its radiological features have rarely been described.

Objective

To assess the CT parameters characteristic of DSRCT. We also report our experience with combined FDG PET/CT in staging and follow–up for DSRCT.

Materials and methods

The pretreatment diagnostic CT’s of 65 patients with DSRCT were evaluated. Pertinent imaging findings were catalogued, with histopathology or serial follow-up studies as reference standard. Combined FDG PET/CT examinations of 11 of these patients who underwent pretreatment imaging were also reviewed.

Results

Sixty-two patients presented with primary intra-abdominal disease; three had primary extra-abdominal tumours at presentation. The most common imaging finding of patients with intra-abdominal DSRCT was multiple peritoneal soft tissue masses, with a dominant mass in the retrovesical or rectouterine location in more than half of the cases. Forty percent had metastatic disease to the liver, lungs, spleen or bones at diagnosis. FDG PET/CT accurately detected 97.4% of all DSRCT lesions.

Conclusion

DSRCT typically presents as a large abdominopelvic mass with widespread peritoneal involvement predominantly in young males. Familiarity with its radiological features can help guide diagnosis and treatment. Functional imaging with PET/CT offers advantage over anatomical imaging for accurate disease staging.     

Central adiposity and the risk of hypertension in Asian Indian girls

Background

Elevated blood pressure during childhood is an established predictor of elevated blood pressure in adulthood. This study was undertaken to evaluate the relationship of general and central adiposity measures with hypertension and to find out the best adiposity measure in predicting hypertension.

Methods

A cross-sectional study was carried out in 197 girls aged 5 to 16 years. Anthropometric measurements included stature, weight, waist circumference (WC) and hip circumference. Body mass index (BMI, kg/m²), waist hip ratio (WHR) and conicity index (CI) were calculated subsequently. Systolic blood pressure (SBP) and diastolic bold pressure (DBP) were taken and hypertension was defined as age and stature adjusted SBP and/or DBP ≥95^th percentile. Linear and logistic regression analysis was made to determine the relationship of adiposity measure with blood pressure and hypertension and to find out the best adiposity measure in predicting hypertension.

Results

Both WC [odds ratio (OR)=2.20, 95% confidence interval, 1.32–3.69] and CI (OR=1.85, 95% confidence interval, 1.14–3.0) were significantly associated with hypertension. However, there was no significant association in BMI and WHR with hypertension.

Conclusion

WC is the best adiposity measure in predicting hypertension in girls.     

Lactobacillus rhamnosus GG supplementation for preventing respiratory infections in children: A Meta-analysis of Randomized, Placebo-controlled Trials

Objective

To systematically review the effectiveness of administering Lactobacillus rhamnosus GG (LGG) for preventing respiratory infections in children.

Design

Systematic Review and Meta-analysis.

Data sources

Electronic databases and trial registries.

Results

Four RCTs involving 1805 participants met the inclusion criteria. Compared with placebo, LGG administration was associated with a reduced incidence of acute otitis media (four RCTs, n=1805, RR 0.76, 95% CI 0.64–0.91, fixed effects model, NNT 17, 95% CI 11–46), a reduced risk of upper respiratory infections (one RCT, n=281, RR 0.62, 95% CI 0.50–0.78, NNT 4, 95% CI 3–8) and antibiotic treatments (four RCTs, n=1805, RR 0.80, 95% CI 0.71–0.91, fixed effects model). There was no significant difference between the LGG and the control groups in the risk of overall respiratory infections and the incidence of lower respiratory infections. However, subgroup analysis of two studies on children older than 1 year showed significant reduction in the risk of overall respiratory infections (two RCTs, n=794, RR 0.73, 95% CI 0.57–0.92, random effects model, NNT 8, 95% CI 5–14). Adverse effects were similar in both groups. No serious adverse events were reported.

Conclusion

The administration of Lactobacillus rhamnosus GG compared with placebo has the potential to reduce the incidence of acute otitis media, the upper respiratory infections and antibiotic use in children.     

Effectiveness of screening for craniosynostosis with ultrasound: a retrospective review

Background

Minimizing the ionizing radiation dose to children is fundamental to pediatric radiology. The most widely accepted imaging examination for evaluating craniosynostosis is computed tomography (CT) of the head, an examination that involves ionizing radiation.

Objective

To determine if sonography of the cranial sutures is an adequate screening examination for the diagnosis of craniosynostosis in patients with abnormal skull shape.

Materials and methods

A retrospective review of all cranial suture ultrasound (US) examinations performed during the course of a 3-year period (July 2012 – September 2015) was undertaken. Results were compared with clinical follow-up and/or head CT to evaluate the accuracy of this modality as a screening tool to determine the presence or absence of craniosynostosis. Fifty-two sonographic exams were adequate for inclusion.

Results

Forty-five of the examinations did not reveal synostosis. In each of these instances, follow-up physical exam findings and/or CT imaging confirmed that no abnormal premature suture closure was present. US findings demonstrated synostosis in seven cases. CT exam or operative reports of these cases confirmed all seven findings of premature suture closure. Statistical analysis demonstrated a sensitivity of 100% (95% confidence interval [CI]: 56.1–100.0%), a specificity of 100% (95% CI: 90.2–100.0%), and a negative predictive value of 100% (95% CI: 90.2–100.0%).

Conclusion

Cranial US is a reliable screening tool to rule out craniosynostosis in patients with abnormal head shape.

     

Maintaining reduced noise levels in a resource-constrained neonatal intensive care unit by operant conditioning

Objective

To evaluate the efficacy of operant conditioning in sustaining reduced noise levels in the neonatal intensive care unit (NICU)

Design

Quasi-experimental study on quality of care.

Setting

Level III NICU of a teaching hospital in south India.

Participants

26 staff employed in the NICU. (7 Doctors, 13 Nursing staff and 6 Nursing assistants).

Intervention

Operant conditioning of staff activity for 6 months. This method involves positive and negative reinforcement to condition the staff to modify noise generating activities.

Main outcome measures

Comparing noise levels in decibel: A weighted [dB (A)] before conditioning with levels at 18 and 24 months after conditioning. Decibel: A weighted accounts for noise that is audible to human ears.

Results

Operant conditioning for 6 months sustains the reduced noise levels to within 62 dB (A) in ventilator room (95% CI: 60.4–62.2) and isolation room (95% CI: 55.8–61.5). In the pre-term room, noise can be maintained within 52 dB (A) (95 % CI: 50.8–52.6). This effect is statistically significant in all the rooms at 18 months (P = 0.001). At 24 months post conditioning there is a significant rebound of noise levels by 8.6, 6.7 and 9.9 dB (A) in the ventilator, isolation and pre-term room, respectively (P=0.001).

Conclusion

Operant conditioning for 6 months was effective in sustaining reduced noise levels. At 18 months post conditioning, the noise levels were maintained within 62 dB (A), 60 dB (A) and 52 dB (A) in the ventilator, isolation and pre-term room, respectively. Conditioning needs to be repeated at 12 months in the ventilator room and at 18 months in the other rooms.     

MRI for clinically suspected pediatric appendicitis: an implemented program

Background

Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized.

Objective

To describe our institution’s development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis.

Materials and methods

A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17?years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results.

Results

Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1–99.9%), specificity 97.0% (CI: 93.2–99.0%), positive predictive value 88.9% (CI: 76.0–96.3%), and negative predictive value 99.4% (CI: 96.6–99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/? 52.5?min, median 65?min; first-to-last sequence time stamp mean 14.2 +/? 8.8?min, median 12?min; last sequence to report mean 57.4 +/? 35.2?min, median 46?min. Mean age was 11.2 +/? 3.6?years old. Girls represented 57% of patients.

Conclusion

MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation.     

Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

Objective

Unenhanced MRI has emerged as a useful tool for diagnosing pediatric acute appendicitis. The use of contrast-enhanced MRI for diagnosing pediatric appendicitis has not been documented. The purpose of this study is to examine the diagnostic performance of contrast-enhanced MRI for acute appendicitis and alternative entities in the pediatric population presenting with acute abdominal pain.

Materials and methods

A retrospective review was conducted of 364 consecutive pediatric patients undergoing contrast-enhanced MRI for the evaluation of possible appendicitis at a single institution between November 2012 and September 2013.

Results

There were 132 cases of pathologically confirmed appendicitis out of 364 pediatric patients (36.3%) included in the study. Overall sensitivity and specificity were 96.2% (95% CI [91.4–98.4%]) and 95.7% (95% CI [92.3–97.6%]), respectively. Positive predictive value and negative predictive value were 92.7% (95% CI [86.6–96.3%]) and 97.8% (95% CI [94.7–99.1%]), respectively. The appendix was visualized in 243 cases (66.8%). Imaging confirmed alternative diagnoses in 75 patients, including most commonly colitis, enteritis or terminal ileitis (n?=?25, 6.9%), adnexal cysts (n?=?25, 6.9%) and mesenteric adenitis (n?=?7, 1.9%).

Conclusion

Contrast-enhanced MRI is capable of accurately diagnosing acute appendicitis while detecting many alternative entities of abdominal pain, and it allows good visualization of the appendix. Further evaluation is needed to determine whether contrast-enhanced MRI provides an advantage over non-enhanced MRI for imaging evaluation of acute abdominal pain in the pediatric population.     

Prevalence of overweight and obesity among school children and adolescents in Chennai

Objectives

To determine the prevalence of overweight and obesity among children and adolescents in Chennai, India, using national and international age- and sex- specific body mass index (BMI) cut-off points.

Methods

The Obesity Reduction and Awareness and Screening of Non communicable diseases through Group Education in Children and Adolescents (ORANGE) project is a cross-sectional study carried out on 18,955 children (age 6–11 years) and adolescents (age 12–17 years) across 51 schools (31 private and 20 government) of Chennai. Overweight and obesity was classified by the International Obesity Task Force (IOTF 2000) and Khadilkar’s criteria (2012), and Hypertension by the IDF criteria (in children ≥10 years and adolescents).

Results

The prevalence of overweight/obesity was significantly higher in private compared to government schools both by the IOTF criteria [private schools: 21.4%, government schools: 3.6%, (OR: 7.4, 95% CI:6.3–8.6; P<0.001) and by Khadilkar criteria (private school: 26.4%, government schools: 4.6% OR: 6.9, 95% CI:6.2–7.8; P<0.001). Overweight/obesity was higher among girls (IOTF: 18%, Khadilkar: 21.3%) compared to boys (IOTF: 16.2%, Khadilkar: 20.7%) and higher among adolescents (IOTF: 18.1%, Khadilkar: 21.2%) compared to children (IOTF: 15.5%, Khadilkar: 20.7%). Prevalence of hypertension was 20.4% among obese/overweight and 5.2% among non-obese (OR 4.7, 95%CI: 4.2–5.3, P<0.001).

Conclusion

The prevalence of overweight and obesity is high among private schools in Chennai, and hypertension is also common.     

Radiation dose reduction through combining positron emission tomography/computed tomography (PET/CT) and diagnostic CT in children and young adults with lymphoma

Background

Both [F-18]2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (¹⁸F–FDG PET/CT) and diagnostic CT are at times required for lymphoma staging. This means some body segments are exposed twice to X-rays for generation of CT data (diagnostic CT + localization CT).

Objective

To describe a combined PET/diagnostic CT approach that modulates CT tube current along the z-axis, providing diagnostic CT of some body segments and localization CT of the remaining body segments, thereby reducing patient radiation dose.

Materials and methods

We retrospectively compared total patient radiation dose between combined PET/diagnostic CT and separately acquired PET/CT and diagnostic CT exams. When available, we calculated effective doses for both approaches in the same patient; otherwise, we used data from patients of similar size. To confirm image quality, we compared image noise (Hounsfield unit [HU] standard deviation) as measured in the liver on both combined and separately acquired diagnostic CT images. We used t-tests for dose comparisons and two one-sided tests for image-quality equivalence testing.

Results

Mean total effective dose for the CT component of the combined and separately acquired diagnostic CT exams were 6.20±2.69 and 8.17±2.61 mSv, respectively (P<0.0001). Average dose savings with the combined approach was 24.8±17.8% (2.60±2.51 mSv [range: 0.32–4.72 mSv]) of total CT effective dose. Image noise was not statistically significantly different between approaches (12.2±1.8 HU vs. 11.7±1.5 HU for the combined and separately acquired diagnostic CT images, respectively).

Conclusion

A combined PET/diagnostic CT approach as described offers dose savings at similar image quality for children and young adults with lymphoma who have indications for both PET and diagnostic CT examinations.

     

Predictors of mortality in neonates with meconium aspiration syndrome

Objective

To identify risk factors for mortality in neonates with meconium aspiration syndrome.

Methods

All neonates (2004–2010) with meconium aspiration syndrome, irrespective of gestation were included. Risk factors were compared between those who died and survived.

Results

Out of 172 included neonates, 44 (26%) died. Mean (SD) gestation and birth weight were 37.9 (2.3) weeks and 2545 (646g), respectively. Myocardial dysfunction [aOR 28.4; 95% CI (8.0–101); P<0.001] and higher initial oxygen requirement [aOR 1.04; 95% CI (1.02–1.07); P<0.001] increased odds of dying while a higher birth weight [aOR 0.998; 95% CI (0.997–1.00); P=0.005] reduced the odds of dying.

Conclusions

Meconium aspiration syndrome is associated with significant mortality. Myocardial dysfunction, birth weight, and initial oxygen requirement are independent predictors of mortality.     

Epidemiology and Outcome of Sepsis in a Tertiary Care PICU of Pakistan

Objective

To determine the epidemiology and outcome of sepsis in children admitted in pediatric intensive care unit (PICU) of a tertiary care hospital.

Methods

Retrospective review of children 1?mo to 14?y old, admitted to the PICU with severe sepsis or septic shock from January 2007 through December 2008 was done. Demographic, clinical and laboratory features of subjects were reviewed. The primary outcome was mortality at the time of discharge from PICU. The independent predictors of mortality were modeled using multiple logistic regression.

Results

In 2?years, 17.3% (133/767) children admitted to the PICU had sepsis. Median age was 18?mo (IQR 6–93?mo), with male: female ratio of 1.6:1. Mean PRISM III score was 9 (±7.8). One third had culture proven infection, majority (20%) having bloodstream infection. The frequency of multi-organ dysfunction syndrome (MODS) was 81% (108/133). The case specific mortality rate of sepsis was 24% (32/133). Multi-organ dysfunction (Adjusted OR 18.0, 95% CI 2.2–144), prism score of >10 (Adjusted OR 1.5, 95% CI 0.6–4.0) and the need for?>?2 inotropes (Adjusted OR 3.5, 95% CI 1.3–9.2) were independently associated with mortality due to sepsis.

Conclusions

The presence of septic shock and MODS is associated with high mortality in the PICU of developing countries.     

FDG uptake in cervical lymph nodes in children without head and neck cancer

Background

Reactive cervical lymphadenopathy is common in children and may demonstrate increased ¹⁸F–fluoro-deoxyglucose (¹⁸F–FDG) uptake on positron emission tomography/computed tomography (PET/CT).

Objective

We sought to evaluate the frequency and significance of ¹⁸F–FDG uptake by neck lymph nodes in children with no history of head and neck cancer.

Materials and methods

The charts of 244 patients (114 female, mean age: 10.4 years) with a variety of tumors such as lymphoma and post-transplant lymphoproliferative diseases (PTLD), but no head and neck cancers, who had undergone ¹⁸F–FDG PET/CT were reviewed retrospectively. Using the maximum standardized uptake value (SUVmax), increased ¹⁸F–FDG uptake by neck lymph nodes was recorded and compared with the final diagnosis based on follow-up studies or biopsy results.

Results

Neck lymph node uptake was identified in 70/244 (28.6%) of the patients. In 38 patients, the lymph nodes were benign. In eight patients, the lymph nodes were malignant (seven PTLD and one lymphoma). In 24 patients, we were not able to confirm the final diagnosis. Seven out of the eight malignant lymph nodes were positive for PTLD. The mean SUVmax was significantly higher in malignant lesions (4.2) compared with benign lesions (2.1) (P = 0.00049).

Conclusion

¹⁸F–FDG uptake in neck lymph nodes is common in children and is frequently due to reactive lymph nodes, especially when the SUVmax is <3.2. The frequency of malignant cervical lymph nodes is higher in PTLD patients compared with other groups.

     

Comparison of radiation dose estimates, image noise, and scan duration in pediatric body imaging for volumetric and helical modes on 320-detector CT and helical mode on 64-detector CT

Background

Advanced multidetector CT systems facilitate volumetric image acquisition, which offers theoretic dose savings over helical acquisition with shorter scan times.

Objective

Compare effective dose (ED), scan duration and image noise using 320- and 64-detector CT scanners in various acquisition modes for clinical chest, abdomen and pelvis protocols.

Materials and methods

ED and scan durations were determined for 64-detector helical, 160-detector helical and volume modes under chest, abdomen and pelvis protocols on 320-detector CT with adaptive collimation and 64-detector helical mode on 64-detector CT without adaptive collimation in a phantom representing a 5-year-old child. Noise was measured as standard deviation of Hounsfield units.

Results

Compared to 64-detector helical CT, all acquisition modes on 320-detector CT resulted in lower ED and scan durations. Dose savings were greater for chest (27–46%) than abdomen/pelvis (18–28%) and chest/abdomen/pelvis imaging (8–14%). Noise was similar across scanning modes, although some protocols on 320-detector CT produced slightly higher noise.

Conclusion

Dose savings can be achieved for chest, abdomen/pelvis and chest/abdomen/pelvis examinations on 320-detector CT compared to helical acquisition on 64-detector CT, with shorter scan durations. Although noise differences between some modes reached statistical significance, this is of doubtful diagnostic significance and will be studied further in a clinical setting.     

Effect of enalapril on glomerular filtration rate and proteinuria in children with chronic kidney disease: A randomized controlled trial

Objective

To evaluate the efficacy of enalapril treatment on decline in glomerular filtration rate and reduction in proteinuria in children with chronic kidney disease (CKD).

Design

Open-label, randomized controlled trial.

Setting

Pediatric nephrology clinic at a tertiary-care referral hospital.

Intervention

Children with GFR between 15–60 mL/min/1.73 m² were randomized to receive either enalapril at 0.4 mg/kg /day or no enalapril for 1 year.

Outcome measures

Change in GFR using 99mTc-DTPA and urine protein to creatinine ratio. Secondary outcomes included occurrence of composite outcome (30% decline in GFR or end stage renal disease) and systolic and diastolic blood pressure SDS during the study period.

Results

41 children were randomized into two groups; 20 received enalapril while 21 did not receive enalapril. During 1 year, GFR decline was not different in the two groups (regression coefficient (r) 0.40, 95% CI -4.29 to 5.09, P=0.86). The mean proteinuria reduction was 65% in the enalapril group, significantly higher than control group. The difference was significant even after adjustment for blood pressure was 198.5 (CI 97.5, 299.3; P<0.001). 3 (17.6%) patients in enalapril and 7 (36.8%) in nonenalapril group attained the composite outcome.

Conclusions

Enalapril is effective in reducing proteinuria in children with CKD and might be renoprotective in proteinuric CKD.     

Residential environmental tobacco smoke exposure during pregnancy and low birth weight of neonates: Case control study in a public hospital in Lucknow, India

Objective

To determine whether residential environmental tobacco smoke (ETS) exposure during pregnancy is associated with low birth weight (LBW) neonates and establish a dose response relationship.

Design

Case control study.

Setting

Tertiary care hospital.

Methodology

Mothers giving birth to LBW neonate (<2.5 kg) were cases and those whose neonates weighed ≥2.5 kg at birth were controls. Excluded were women smokers and tobacco chewers, high parity (>3), multiple pregnancy and still births. Included were 100 cases and 200 controls, aged 20 to 30 years. Information was collected on ETS exposure and other risk factors of LBW within 24 hours of delivery. Clinical information like maternal haemoglobin levels, birth weight and gestational age of the neonate was extracted from hospital records.

Results

On univariate analysis, preterm pregnancy, low socioeconomic status, previous LBW neonate, no utilization of antenatal care (ANC), severe anemia and ETS exposure were statistically significantly associated with LBW neonate and controlling for these in logistic regression analysis, adjusted Odds ratio for ETS exposure association with LBW neonate was 3.16 (95% CI=1.88–5.28). A dose response relationship was also found which was statistically significant (10–20 cigarettes smoked/day: OR = 4.06, 95% CI=1.78–9.26 and >20 cigarettes smoked/day, OR = 17.62, 95% CI= 3.76–82.43).

Conclusion

Exposure to ETS during pregnancy is associated with LBW of neonates. Hence, there is an urgent need to increase awareness about health hazards of ETS during pregnancy and bring about behavioural changes accordingly as a one of the strategies to reduce LBW deliveries in India.