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WHO defines malnutrition as severe if the z-scores are less than − 3 Standard deviation (SD), moderate if between − 2 and − 3 SD and mild if between − 2 SD to – 1 SD. This study was aimed to assess nutritional aspects of Indian children suffering from EB and to evaluate the effect of severity of EB on the severity of malnutrition. In this study, pediatric EB patients were evaluated prospectively for baseline nutritional status using anthropometric parameters and WHO growth charts, and its correlation with disease severity using instrument for Scoring Clinical Outcomes for Research of Epidermolysis Bullosa-iscorEB. In second phase, an individualized diet chart was given to meet the energy, protein and micronutrients needs and its effects were observed after 6 months. The median age of participants was 3 years (IQR-9). Of 57 patients, malnutrition was seen in 40.35% patients (22.81%-moderate and 17.54%-severe), and significantly correlated with iscorEB (r = 0.45, p

A strict lifelong gluten-free diet (GFD) remains the only treatment of celiac disease (CD). Adherence to gluten-free diet is best reflected by mucosal healing. Noninvasive tools capable of predicting mucosal recovery in CD patients need to be identified.To compare the ability of various modalities used to assess compliance to GFD, for predicting persistent mucosal damage in children with CD.A prospective, single-center, observational study on children with CD on a GFD was conducted between January 2020 and April 2021. Children with CD on GFD were consecutively enrolled and various modalities used to assess adherence to GFD were compared.One hundred and fifty children (Mean age 12.2 ± 3.6 years, 58% Boys) on GFD (Mean duration 6 ± 3.1 years) were enrolled in the study. Persistent mucosal damage was seen in 88% of the enrolled. Fecal gluten immunogenic peptide (GIP) was positive in 87.8% (129/147). Antibodies to tissue transglutaminase (TGA-IgA) and/or deamidated gliadin peptide (DGP) were positive in 32% (48/150) whereas antibody to synthetic neoepitopes of TGA-IgA was positive in 24.8% (37/149). Non-compliance as assessed by local questionnaire, Biagi score, and dietitian detailed interview were 62.7%, 60%, and 75.3%, respectively. Serology had the highest specificity (83%) and fecal GIP had the highest sensitivity (89%). On logistic regression analysis, only non-compliance by Biagi score predicted poor mucosal recovery.Fecal GIP may be sensitive to detect only "one-point dietary transgression." None of the existing modalities used to assess compliance to GFD accurately predict persistent mucosal damage. A subset of patients may develop gluten tolerance.

The functional and morphological recovery following an episode of acute pancreatitis (AP) in children still remains ill understood as research exploring this is limited. We aimed to characterize the morphological and functional changes in pancreas following AP and ARP (acute recurrent pancreatitis) in children.Children with AP were followed prospectively and assessed at two time points at least 3 months apart, with the first assessment at least 3 months after the AP episode. Exocrine and endocrine functions were measured using fecal elastase and fasting blood sugar/HbA1c levels respectively. Morphological assessment was done using endoscopic ultrasound (EUS) and magnetic resonance imaging and cholangiopancreatography (MRI/MRCP).Seventy-three children (boys:59%; mean age:8.4 ± 3.2years) were studied and 21 of them (29%) progressed to ARP. Altered glucose homeostasis was seen in 19 (26%) at first and 16 (22%) at second assessment and it was significantly more in ARP group than the AP group at first (42.8%vs19.2%; p = 0.03) as well as second assessment (38.1%vs15.3%; p = 0.03). Twenty-one children (28.7%) at first and 24 (32.8%) at second assessment developed biochemical exocrine pancreatic insufficiency. EUS detected indeterminate and suggestive changes of chronic pancreatitis in 21% at first (n = 38) and 27.6% at second assessment (n = 58). On MRCP, main pancreatic duct and side branch dilatation were seen in 15 (20.5%) and 2 (2.7%) children respectively.More than one-quarter of children have evidence of altered glucose homeostasis and biochemical exocrine pancreatic insufficiency following an episode of AP. Similarly, morphological features of chronicity seen in some of the children suggest that a fraction of subjects may develop chronic pancreatitis on longer follow-up.

Giant isolate cavernous hemangiomas of the stomach are extremely rare. An eight year old boy with recurrent episodes of massive hematemesis and involvement of both the anterior and posterior walls of the stomach is presented. Awareness of the lesion, a combination of endoscopy and contrast enhanced CT scan are helpful in reaching a diagnosis. Surgical excision is curative.

A culture-appropriate and simple test battery consisting of 67 test items was developed and field tested in Haryana, India, in 1987-89. Trained field workers administered the tests to 3731 preschool children in 47 randomly selected villages of a district, irrespective of their physical/mental status. Centile age values were constructed for various developmental milestones included in the cultural-appropriate test battery. The locally relevant, simple, and low cost developmental tests and reference values will be used for early detection of developmental disabilities at primary care level.

Tissue diagnosis is essential for the management of patients with malignant biliary obstruction. We prospectively studied brush cytology in 30 patients with malignant biliary obstruction. Wire guided brush cytology was obtained from the stricturous segment during endoscopic retrograde cholangio-pancreatography. The study comprised of 30 patients (16 males, 14 females), with a mean age of 55 years (range 30-75 years). The obstruction was caused by carcinoma gallbladder in 16 cases, carcinoma head of the pancreas in 10 cases, and cholangiocarcinoma in 4 cases. Brush cytology was positive for malignancy in 8 cases (26.7%). Another 3 samples (10.3%), 1 from each group of tumors, were suspicious for malignancy. Cytology was positive in 25% of gallbladder cancers, 50% of pancreatic cancers, and 50% of cholangiocarcinomas. Brush cytology was positive in 6 of 18 (33.3%) proximal and 5 of 12 (41.7%) distal strictures. Brush cytology yielded a sensitivity of 36.7% in the diagnosis of malignant biliary strictures. However, a larger study is required to confirm these findings.