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Steroid-resistant nephrotic syndrome (SRNS) is a rare condition that accounts for about 10% to 20% of all nephrotic syndromes in children. While calcineurin inhibitors induce remission in the majority, the data on long-term outcomes are limited. This retrospective study aimed to look at the clinical profile, biopsy findings, and long-term treatment outcomes in children with SRNS.The records of all children (1-18 years) with SRNS with biopsy findings of minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), or mesangioproliferative glomerulonephritis, who received treatment for a minimum period of 12 months and were in follow-up during the years 2007-2018 at a tertiary care teaching hospital were retrieved. The clinical, histopathological, and biochemical factors and treatment outcomes were recorded and analyzed.Ninety-one (72 boys) children with a median (interquartile range [IQR]) age of onset of nephrotic syndrome as 48 (24-87) months were included. MCD and FSGS were the most common histopathological types (57.1% and 36.3%, respectively) and 62 (68.1%) patients had late steroid resistance. Calcineurin inhibitors (CNIs) were used in 86.8% of the children, and response rates with cyclosporine and tacrolimus for complete remission (CR) were 80% and 73.7%, respectively, with median (IQR) time to response being 3 (2-4) months. The presence of MCD on histology and the use of CNIs were significantly associated with CR (SRNS children with MCD on biopsy, late resistance, and response to CNIs have better long-term outcomes. Most patients respond to CNIs within the first 6 months of use and need therapy for at least 24 to 36 months.

Primary hypothyroidism is observed in adult patients with chronic kidney disease (CKD) though described scantily in the pediatric population. The primary objective of this study was to detect the prevalence of hypothyroidism in children (1-18 years) with CKD as assessed by thyroid profile. This cross-sectional study was conducted in the department of pediatrics of a tertiary care teaching hospital between January 2016 and January 2017. Clinical examination and biochemical investigations were performed for children with CKD aged 1 -18 years. Sixty-five children (51 boys, 43 CKD Stages 1-3) with a mean [standard deviation (SD)] age of 7.9 (3.2) years were enrolled. Overall, 17 (26.2%) had thyroid dysfunction; nine (13.8%) had subclinical hypothyroidism, three (4.6%) overt hypothyroidism, and five (7.7%) had isolated low T3 levels. The prevalence of hypothyroidism increased from 20.9% in CKD Stages 1-3 to 40.9% in Stages 4-5 of CKD; P = 0.09. The mean (SD) height SD scores were lower in those with hypothyroidism than with normal thyroid function [-1.02 (1.69) and -1.89 (1.12), P = 0.003, respectively], lowest at -2.79 (0.65) in overt hypothyroidism. A significant proportion of children with CKD manifest with hypothyroidism who have more profound growth failure. It may be prudent to screen CKD patients for thyroid dysfunction.

Aim: To compare the efficacy of pre-incision intravenous single doses of cefazolin versus cefazolin plus azithromycin as an antibiotic prophylaxis in cesarean delivery (CD). Methods: This was a single-center, double blind, randomized controlled trial conducted in the PGIMER, Chandigarh. 200 women undergoing elective/emergency cesarean section were randomized. Group A received single dose of cefazolin plus placebo while Group B received single dose of cefazolin plus azithromycin. Primary outcome evaluated was occurrence of surgical site infections (SSI); secondary outcomes included incidence of febrile morbidity, UTI, endometritis, neonatal outcome, total cost of antibiotics, and duration of hospital stay in both the study arms. Descriptive statistics and χ2 tests were used for analysis of the data. Result: There was an overall significant reduction in the incidence of SSI (15% vs 3%; P = 0.03), endometritis (8% vs 2%; P = 0.048), and post-operative febrile morbidity (17% vs 3%; P = 0.001) with the addition of azithromycin to cefazolin. Duration of hospital stay was almost two days lesser for the cefazolin plus azithromycin group. Subgroup analysis of patients with SSI showed the age, duration of ruptured membranes, and type of anesthesia as important predictors of infection rate. Study observed statistically significant reduction in requirement of additional post operative antibiotics, phototherapy for neonates, hospital stay and cost of therapy in cefazolin plus azithromycin group (P < 0.05). Conclusion: Tertiary care hospitals in developing countries such as India can opt for the cefazolin plus azithromycin as antimicrobial prophylaxis during CD to maximize the efficacy as well as for decreasing the cost burden of postoperative infections.

Objective: To evaluate for subclinical atherosclerosis and its risk factors in Indian obese children. Materials and Methods: A cross-sectional, case–control study was conducted to recruit 80 children aged 6–17 years with constitutional obesity as cases and 23 age- and gender-matched controls with normal body mass index (BMI). Anthropometric and clinical evaluation was followed by biochemical analysis and body fat estimation by dual-energy X-ray absorptiometry in cases. Similar evaluation was performed for controls except laboratory parameters. Carotid intima-media thickness (CIMT) was measured with B-mode ultrasonography in both cases and controls to evaluate subclinical atherosclerosis. Results: The mean age of cases was 12.8 ± 3 years, with mean BMI of 29.2 ± 4.8 kg/m2. The mean CIMT was significantly higher in cases than controls (0.54 ± 0.13 vs. 0.42 ± 0.08; P < 0.001 across all ages). CIMT was significantly higher in participants who were hypertensive than nonhypertensive (0.6 ± 0.11 vs. 0.53 ± 0.11 mm; P = 0.04). CIMT showed a positive correlation with BMI (r = 0.23, P = 0.02), percentage body fat and fat mass index (r = 0.28 and 0.3 respectively; P < 0.001), but not with waist: hip ratio. CIMT showed significant positive correlation with blood glucose at 60 min (r = 0.22; P = 0.04), serum insulin at 60 min (r = 0.28; P = 0.01) while negative correlation with whole body insulin sensitivity (r = −0.27; P = 0.01). Conclusion: CIMT correlated significantly to blood pressure, insulin sensitivity, and body fat in Indian obese children.

Human amniotic membrane (HAM) is derived from the fetal membranes which consist of the inner amniotic membrane made of single layer of amnion cells fixed to collagen-rich mesenchyme attached to chorion. HAM has low immunogenicity, anti-inflammatory properties and their cells can be isolated without the sacrifice of human embryos. Amniotic membrane has biological properties which are important for the experimental and clinical applications in managing patients of various medical specialties. Abundant, natural and wonderful biomembrane not only protects the foetus but also has various clinical applications in the field of dermatology, ophthalmology, ENT surgery, orthopedics and dental surgery. As it is discarded post-partum it may be useful for regenerative medicine and cell therapy to treat damaged or diseased tissues.

Aims and Objectives: Osseointegrated implants are used in replacement of missing teeth. Survival rate of implant depends on many factors including oral hygiene, implant material used, bone quality, and personal oral habit such as smoking. The present retrospective research was conducted to assess the effect of smoking on survival of dental implant. Materials and Methods: The study participants were selected from all the patients who underwent for dental implant in implant center from 2005 to 2015. For each patient, various information regarding implant characteristics and smoking habits were recorded. The readings were statistically evaluated by SPSS statistical software by IBM version 21 and using Chi-square test at P ≤ 0.01. Results: In our study, the age range of patients was between 30 and 54 years. There were 2142 (57.2%) male and 1579 (42.4%) female participants, in that 72.2% were nonsmokers and 27.7% were smokers. Implant placed more in mandible (2312, 62%) than in maxillary region (1409, 37.8%). From 3721 patients, 3600 were successful and 121 failures. Success of implant was considerably more in nonsmokers than smokers. Implant failure rate was more in smokers with increased frequency and duration of cigarette smoking habit, but it was statistically not significant. In the present study, we have observed 0.049% mobility in smokers compared to 0.007% in nonsmokers. Conclusion: The present study showed that higher risk of implant failure was associated with long term and increased frequency of smoking due to bone resorption.

Objective: Primary – to determine the age of pubertal onset in Indian boys. Secondary – (a) to assess the impact of obesity on pubertal timing, (b) to assess the relationship between gonadotropins and puberty. Design: Cross-sectional. Setting: General community-seven schools across New Delhi. Participants: Random sample of 1306 school boys, aged 6–17 years. Materials and Methods: Anthropometric measurement for weight and height and pubertal staging was performed for all subjects. Body mass index (BMI) was calculated to define overweight/obesity. Serum luteinizing hormone (LH), follicle stimulating hormone, and serum testosterone were measured in every sixth subject. Main Outcome Measure: Age at pubertal onset-testicular volume ≥4 mL (gonadarche) and pubic hair Stage II. Results: Median age of attaining gonadarche and pubarche was 10.41 years (95% confidence interval [CI]: 10.2–10.6 years) and 13.60 (95% CI: 13.3–14.0 years), respectively. No significant difference in the age of attainment of gonadarche was observed in boys with normal or raised BMI, though pubarche occurred 8 months earlier in the latter group. Serum gonadotropins and testosterone increased with increasing stages of puberty but were unaffected by BMI. Serum LH level of 1.02 mIU/mL and testosterone level of >0.14 ng/mL showed the best prediction for pubertal onset. Conclusion: The study establishes a secular trend of the age of onset of puberty in Indian boys. Pubarche occurred earlier in overweight/obese boys. The cutoff levels of serum LH and testosterone for prediction of pubertal onset have been established.

Hepatic granulomas are reported in 2-15% of all liver biopsies that are attributable to various causes. Owing to the diverse prognostic and therapeutic implications, a detailed workup of all liver biopsies with granulomatous lesions is mandatory. The cause of the disease may remain obscure in up to 50% cases of idiopathic granulomatous hepatitis (IGH). This disease runs a chronic relapsing course. Hepatocellular dysfunction may be an early predominant manifestation unlike that in the available literature. Timely recognition and diagnosis of IGH is imperative as the disease responds well to immunosuppressants that can prevent permanent liver damage. We report a case of a young boy with IGH who was successfully treated with immunosuppressive therapy.

Childhood primary angiitis of the central nervous system (cPACNS) is a rare and a potentially fatal cause of childhood stroke. The disease poses a diagnostic dilemma for the clinicians due to overlapping and varied clinical manifestations such as headache, focal acute neurological deficits, cognitive impairment, or encephalopathy. We report a young boy who presented with low-grade fever and headache but rapidly progressed to develop acute encephalopathy and quadriparesis with multiple cranial nerve palsies, masquerading as acute disseminated encephalomyelitis. The neuroimaging was suggestive of vasculitis. He was diagnosed as cPACNS and recovered with immunosuppressive therapy.

Background: Recent studies have indicated that although malignant cells at the invasive tumor front, bare morphological resemblance to the cells at central portion of the tumor, their molecular character differs significantly. E-cadherin is a cell-cell adhesion molecule that connects epithelial cells. This study attempts to correlate the E-cadherin expression at the invasive tumor front with tumor differentiation along with its clinico-pathological parameters. Materials and Methods: Immunohistochemical staining with E-cadherin was carried out on archival cases of primary oral squamous cell carcinomas (n = 30). The E-cadherin expression at the invasive tumor front was analyzed and was linked to clinico-pathological parameters including patient prognosis. Results: The downregulation of E-cadherin expression at the invasive tumor edge when compared with patient's prognosis yielded a significant correlation (P = 0.041) but its correlation with the degree of differentiation determined was not significant (P = 0.27). Also, its association with tumor size and lymph node status was negative. Conclusions: Loss of E-cadherin expression at the invasive tumor front is an important event in the progression of oral squamous cell carcinomas. Tumors with a loss of expression of E-cadherin are those which had a poor prognosis

Anticancer chemotherapy is associated with a variety of nail changes. We present two children who developed different nail changes, while receiving almost similar antineoplastic drugs.