Gopesh Mehrotra

300,000 IU or 600,000 IU of Oral Vitamin D3 for Treatment of Nutritional Rickets: A Randomized Controlled Trial

ObjectiveTo evaluate the non-inferiority of a lower therapeutic dose (300,000 IU) in comparison to standard dose (600,000) IU of Vitamin D for increasing serum 25(OH) D levels and achieving radiological recovery in nutritional rickets.DesignRandomized, open-labeled, controlled trial.SettingTertiary care hospital.Participants76 children (median age 12 mo) with clinical and radiologically confirmed rickets.InterventionOral vitamin D3 as 300,000 IU (Group 1; n=38) or 600,000 IU (Group 2; n=38) in a single day.Outcome variablesPrimary: Serum 25(OH)D, 12 weeks after administration of vitamin D3; Secondary: Radiological healing and serum parathormone at 12 weeks; and clinical and biochemical adverse effects.ResultsSerum 25(OH)D levels [geometric mean (95% CI)] increased significantly from baseline to 12 weeks after therapy in both the groups [Group 1: 7.58 (5.50–10.44) to 16.06 (12.71–20.29) ng/mL, P<0.001]; Group 2: 6.57 (4.66–9.25) to 17.60 (13.71–22.60, P<0.001]. The adjusted ratio of geometric mean serum 25(OH)D levels at 12 weeks between the groups (taking baseline value as co-variate) was 0.91 (95% CI: 0.65–1.29). Radiological healing occurred in all children by 12 weeks. Both groups demonstrated significant (P<0.05) and comparable fall in the serum parathormone and alkaline phosphatase levels at 12 weeks. Relative change [ratio of geometric mean (95% CI)] in serum PTH and alkaline phosphatase, 12 weeks after therapy, were 0.98 (0.7–1.47) and 0.92 (0.72–1.19), respectively. The serum 25(OH)D levels were deficient (<20 ng/mL) in 63% (38/60) children after 12 weeks of intervention [Group 1: 20/32 (62.5%); Group 2: 18/28 (64.3%)]. No major clinical adverse effects were noticed in any of the children. Hypercalcemia was documented in 2 children at 4 weeks (1 in each Group) and 3 children at 12 weeks (1 in Group 1 and 2 in Group 2). None of the participants had hypercalciuria or hypervitaminosis D.ConclusionA dose of 300,000 IU of vitamin D3 is comparable to 600,000 IU, administered orally, over a single day, for treating rickets in under-five children although there is an unacceptably high risk of hypercalcemia in both groups. None of the regime is effective in normalization of vitamin D status in majority of patients, 3 months after administering the therapeutic dose.

Studies on the time course of apparent diffusion coefficient and signal intensities on T2- and diffusion-weighted MR Imaging in acute cerebral ischemic stroke.

The time course of changes in apparent diffusion coefficient (ADC) and signal intensity on diffusion-weighted magnetic resonance imaging (DW MR) imaging in acute ischemic stroke is a very dynamic event. There is an initial reduction in ADCs with no change on T2-W imaging but signal intensity increase on T2-weighted takes place about 6–12 hours after onset of stroke. As necrosis begins to set in, there is a gradual reversal of ADC change, and around 3–10 days post-onset, ADC pseudonormalizes. Twenty-four patients of acute stroke underwent diffusion MR imaging in addition to conventional T1W, T2W, and Fluid Attenuated Inversion Recovery (FLAIR) sequence performed within 12 hours, at 30 days, and at 90 days. The mean signal intensity at b = 0 s/mm2 and at b = 1000 s/mm2 were significantly higher than control values for all time periods. The ratio of signal intensity at b = 0 (rSI b=0) significantly increased from 1.63 ± 0.20 in the acute stage to 2.19 ± 0.24 in the chronic stage (P < 0.001). The ratio of signal intensity on DWI (r SIDWI) decreased from 2.54 ± 0.46 to 1.54 ± 0.22. The mean ADC in the lesion was found to be 41% lower than the mean ADC in the contralateral hemisphere .Linear regression analysis between rADC and log hours showed that pseudonormalization occurred at 6.61 days (P < 0.001). We conclude that the above information could be useful in the management of very early stroke.

Massive pancreatico-pleural effusion: An often unrecognised entity

Massive haemorrhagic pleural effusion secondary to pancreatitis in a five year old girl is described. The diagnosis was established on the basis of an exudative pleural effusion with an amylase level above 4,000 IU/I. Management of effusion was by intercostal tube drainage and antibiotics.

Virtual cystoscopy (pneumo-cystoscopy)-Its utility in the prospective evaluation of bladder tumor

Aim: To evaluate the role of virtual cystoscopy (VC) comparing it with cystopanendoscopy (CPE) for detecting bladder tumor(s). Material and Methods: Ethical clearance was obtained from the Institutional ethics committee. After an informed consent 30 patients fulfilling the inclusion criteria were enrolled in the prospective non-randomized clinical study and were evaluated as per protocol with VC performed by a qualified radiologist who was blinded to the findings of CPE performed by a qualified urologist. The results so obtained were analyzed using appropriate statistical tools. Results: The mean age of the patients was 56 years. Sensitivity of VC in detecting bladder lesions was 92%. However, when axial images were also interpreted along with VC, the sensitivity increased to 96% for detecting bladder lesions. The specificity of VC with axial CT was 40% in respect of detecting bladder lesions. VC with axial CT was 85.7% sensitive in identifying multiple bladder tumors. There were no complications on account of performing VC. Minor problems were encountered with VC and CPE in 16.7% and 13.3% patients respectively. Conclusions: VC with axial CT is 96% sensitive in detecting bladder lesions and 85.7% sensitive in detecting the multiplicity of the tumors. VC may be a useful complementary diagnostic tool for the workup of select patients with suspected bladder lesions. However, larger randomized controlled studies are needed to better define the precise clinical and diagnostic role of VC in routine practice. Settings and Design: Prospective Clinical Comparative Non Randomized Clinical Study.