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The objective of this study was to evaluate the feasibility, safety, and diagnostic accuracy of percutaneous cholecystocholangiography (PCC) in cases of conjugated hyperbilirubinemia in which biliary atresia (BA) could not be diagnosed or ruled out based on clinical, radiological, and histopathological findings. This was a retrospective, chart review of all cholestatic infants who underwent PCC within the last 5 y. PCC was performed via the transhepatic route using 23-g needle. The patency of both the proximal and distal biliary trees was assessed. PCC was technically feasible in 12/13 (92.3%) of infants without any procedure-related complications. PCC demonstrated proximal and distal biliary patencyin 7/12 (58.3%) infants, thereby avoiding unnecessary laparotomy in them. PCC failed to demonstrate biliary patency in 5 infants; of which, 4 were confirmed as cases of BA on laparotomy. PCC can correctly differentiate BA from non-BA cases of conjugated hyperbilirubinemia preoperatively, reducing the negative laparotomy rates.

There is limited literature on Gilbert's syndrome (GS) in children with persistent unconjugated hyperbilirubinemia from Indian subcontinent. All patients (18 y of age) with genetically confirmed GS were included, and their profile was analysed. A total of 170 subjects were confirmed as having GS as per genetic analysis (133 with homozygous and 37 with heterozygous status). Majority were diagnosed in the adolescent age group (mean age 13.6 y). The median serum total bilirubin (TB) levels were around 3.3 mg/dl with maximum levels reaching upto 18 mg/dl. Around 15% subjects had an associated condition including hematological or hepatobiliary disease amongst others. GS is an important but under-recognised cause of unexplained unconjugated hyperbilirubinemia in Indian pediatric subjects. It may co-exist with other hematological and hepatobiliary disorders, and complicate the clinical/laboratory picture. Extent of hyperbilirubinemia may fluctuate to levels much higher than what is usually described in current world literature.

Limited literature is available in pediatric population regarding drug-induced liver injury (DILI) making it a diagnostic challenge. This study was thus planned to determine the clinical spectrum and the outcome of DILI in children. All patients with DILI under 18 y of age were retrospectively reviewed and details regarding clinical presentation, Roussel Uclaf Causality Assessment Method (RUCAM) scale, drugs implicated, biochemical abnormalities and outcome were noted. DILI constituted 3.7% of all children with liver disease. Cases were divided into the hepatocellular (18, 50%), cholestatic (10, 27.8%), and mixed pattern (8, 22.2%). Complementary and alternative medicines (CAM) and antitubercular (ATT) drugs accounted for three-fourth cases of total DILI (39% and 33% cases respectively). Overall, 4 (11%) patients died and 5 (14%) patients progressed to chronic DILI. Presence of ascites, non-hepatocellular injury pattern and high serum total IgG levels were significantly associated with unfavourable outcome (death or chronicity).

Non hepatic origin of refractory ascites is not a rarity. Hemolytic anemias are known to cause inspissated bile and biliary obstruction. Distal biliary obstruction can lead to biliary perforation. The authors report a case of hereditary spherocytosis leading to inspissated bile causing bile duct perforation and biliary ascites. A high index of suspicion for biliary ascites should be kept in a child with refractory ascites in the setting of progressive ascites with decreasing bilirubin. Ascitic fluid bilirubin analysis will clinch the diagnosis. Surgical repair is the optimal management.

To see the efficacy and safety of 250 mg of Saccharomyces boulardii twice daily for 5 d in acute childhood diarrhea.Children aged between 3 mo and 59 mo with acute onset diarrhea (of less than 48 h) admitted in DTTU (diarrhea treatment and training unit) were included and those with clinical evidence of severe malnutrition, systemic infection, encephalopathy and/or convulsion, electrolyte imbalance, invasive diarrhea or previous use of any probiotics were excluded from the study. Those included randomly were given either a placebo or Saccharomyces boullardi (SB) in identical packets mixed with puffed rice powder.Mean post intervention duration of diarrhea was significantly (95% CI = -28.13 to -5.43) shorter in SB group (52.08 ± 24.57 h) as compared to placebo group (64.04 ± 30.43 h). The time of appearance of first semi formed stool in SB group (39.48 ± 23.09 h) was significantly (95% CI -25.4 to -3.87) shorter than the placebo group (54.13 ± 28.21 h). No statistically significant difference was found in rest of the parameters.There is initial evidence available that SB may have a therapeutic role in the management of acute childhood diarrhea.

Objective : A double-blind randomized controlled-trial was done to evaluate the efficacy of tyndalizedLactobacillus acidophilus in acute diarrhea.Methods : All children from 6 months to 12 years with acute diarrhea were included.Lactobacillus acidophilus/placebo was given to the children for 3 days with ORS and feeds. Intake-output was recorded 4 hourly. Of the 98 children, 48 receivedlactobacillus and 50 the placebo.Results : ORS consumed, frequency of stools, duration of diarrhea, time for rehydration, hospital stay, weight gain and IVF needed were comparable in the two study groups. There were 4 treatment failures in thelactobacillus group and none in the placebo group (OR 0.92,95%CI 0.84–0.99). In the rotaviral diarrhea and in those who had diarrhea of less then 60 hours the difference did not reach statistical significance.Conclusion : There is no significant benefit of tyndalizedLactobacillus acidophilus in acute diarrhea.

Objective: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in children upto 14 years of age.Methods: Equal number (115 each) of apparently healthy children of both sexes of different age groups i.e. < 1, 1–4, 5–9 and 10–14 years, attending pediatric outpatient services and Well Baby Clinic of the hospital were tested for HBsAg using ELISA test. Positive results were confirmed by a second ELISA.Results: Overall 4.35% (95%CI, 2.44 –6.25) of the 460 children tested were HBsAg positive. The prevalence rate was the highest (6.09%) in the 1–4 year age category. In the < 1, 5–9 and 10–14 year age groups it was 4.35%, 4.35% and 2.61% respectively. The overall male to female ratio was 2.1:1, with no significant difference in seropositivity rates (P = 0.816).The difference in the prevalence rates between the rural (4.84%) and urban populations (3.77%) was also statistically insignificant (P = 0.577).Conclusion: Average HBsAg positivity in the pediatric population in this region is 4.35% (95%CI, 2.44 –6.25). The prevalence progressively increases and peaks in the 1–4 years age group. It is least in 10–14 years age group.

Objective : To determine diarrhea management in rural practitioners.Methods : This study was conducted among the RMP’s of 4 blocks of Aligarh. Pre-coded questionnaire was completed and educational programme followed. 91 % were prescribing ORS in various combinations, but only 9.8% were advising ORS and feeding as standard management of diarrhea. Only 12.8% could name a WHO ORS brand and 50% were giving wrong instructions for preparation. 95% were advising inadequate amounts of ORS. Only 43.5% were advising feeding during diarrhea but 86.6% were advising to continue breastfeeding. On an average every 3rd to 4th patient was administered IVF’s. 52% felt that drugs should be prescribed.Results : 90% and 55.3% of RMPs could identify diarrhea and key signs of dehydration.Conclusion : There is a need for hands on training for the practitioners and education of the masses regarding proper management of diarrhea.

After recovery from persistent diarrhea, some children have recurrent episodes of diarrhea and associated problems. We undertook this study to identify the risk factors responsible for this relapse. All patients reporting at 1 month follow up since discharge, with > 7 diarrheal days, or inadequate weight gain compared to the weight at discharge, constituted the failure group. All others constituted the non-failure group. Various risk factors were studied in 21 cases (failure group), and 42 controls (non-failure group). Univariate analysis revealed a significant association of hospital stay < 5 days (OR 10.6; 95% CI 3.13-36), working mothers (OR 8.5; 95% CI 2.5-27), poor socioeconomic status (OR 4.5; 95% CI 1.4-14) and presence of younger sibling (OR 3.69, 95% CI 1.1-12.6) with failed outcome. On logistic regression analysis, only hospital stay < 5 days (OR 11.7; 95% CI 1.02-134.68) and female children (OR 17.65; 95% CI 1.26-246) remained significant. We therefore conclude, that a short hospital stay, limited optimal contact and limited health education adversely affects the outcome. Pediatricians should be more cautious while managing female children.