Rst Week Research Articles

STUDY OF LABORATORY PARAMETERS IN NEONATAL JAUNDICE

Introduction: Neonatal hyperbilirubinemia with a total serum bilirubin level above 5mg/dL is one of the most vexing situations in neonates thereby becoming a concern for pediatricians. It is observed during the rst week of life in full-term infants and preterm infants. It results from a predisposition to the production of bilirubin in newborns infants and reects the immature excretory pathway of bilirubin by the liver. Preterm infants have higher rates of bilirubin production. This retrospective study considered 150 cases of term and pre-term neonates w Materials And Methods: ith jaundice within one week of diagnosis of neonatal jaundice (NNJ). The blood group of the mother and baby, Serum bilirubin, Complete blood count with peripheral smear examination, Reticulocyte count, Direct coomb's test, and C-reactive protein of the baby were done. The mean age of the neonates was 2 days. 76 (50.66 %) were male while 74 Results: (49.33) were females. Percentage of Preterm babies was 30%. Neonates having low birth weight were 31 %. Physiological jaundice constitutes to 58 % of cases followed by ABO incompatibility Septicaemia, Rh incompatibility. Highest level of serum bilirubin was found in septicemia and Rh incompatibility. Direct Coomb's test and Indirect Coomb's test were found to be positive in all cases in Rh incompatibility while they were positive in 27 % of cases of ABO incompatibility. In cases of septicemia CRP was found to be positive in 100% of cases. Most of the cases were due to physiological jaundice. To rule out hemolys Conclusion: is, causes of hyperbilirubinemia should be enquired widely to avoid complications

EARLY POSTOPERATIVE ULTRASONOGRAPHY ROLE FOR AV FISTULA FAILURE PREDICTION IN HEMODIALYSIS PATIENTS.

Doppler ultrasonography is the main modality for imaging of hemodialysis AV stula as it is safe and non-invasive. This study is to measure the Arterio-venous (AV) stula blood ow during early postoperative period (0–7days) and assess its role in AV stula failure prediction. Doppler ultrasonography was used to estimate the blood ow in the AV stula of 50 patients at (0–7days) after the stula was made. The blood ow in stula during early postoperative period for stula failure was evaluated, and long term failure was predicted. Method Blood ow rates measured in arteriovenous stula created in upper extremity were measured in rst week and sixth week post-operative. Results After follow up evaluation out of 50 patients, 40 stulas considered to be matured; 10 considered failed. 30% failure were males and 70% were female. In early post operative period, cut off was set at 182 ml/min and the sensitivity of blood ow for prediction of stula failure is 98%, specicity 90 %, PPV 95% and NPV 90%. Conclusion Measurements of the AV stula blood ow in proximal artery and draining vein with its diameter of lumen were noted in the early postoperative period has a role predicting AV stula failure. There is risk of failure if the blood ow less than 182 ml/min (day 0–7).

A STUDY ON CLINICO-EPIDEMIOLOGICAL PROFILE AND CORRELATION BETWEEN CRANIAL ULTRASONOGRAPHY FINDINGS AND SEVERITY OF HYPOXIC ISCHAEMIC ENCEPHALOPATHY IN TERM NEONATES WITH PERINATAL ASPHYXIA ADMITTED AT SNCU IN A RURAL MEDICAL COLLEGE AND HOSPITAL IN WEST BENGAL, INDIA

Introduction: Perinatal asphyxia (PNA) is dened as failure to initiate and sustain breathing after birth. PNA leading to Hypoxic ischemic encephalopathy (HIE) is a dreaded neurological condition of the newborn. HIE is one of the important causes of neonatal morbidityBackground: and mortality in the rst week of life. Neuroimaging plays an essential role in the assessment of brain injury in HIE patients. 1.To studyObjectives: the clinico-epidemiological prole of term neonates with PNA 2.To study the serial cranial USG ndings in asphyxiated term neonates in rst week of life. 3. To assess the correlation between concurrent use of serial cranial ultrasonography ndings in term neonates with PNA and with regards to the severity of HIE. This hospital based cross-sectional study was conducted at SNCU of Bankura Smmilani MedicalMaterials And Methods: College and Hospital, Bankura. 100 cases of term neonates with HIE admitted at SNCU from 1st December 2021 to 31st January 2022 were taken as study population. All the relevant history was taken based on clinico-epidemiological parameters and detailed clinical- examination was done. Serial cranial USG was perfomed in rst week of life. In our study among 100 neonates, 62 (62%) cases belonged to HIE-I, 29 (29%) casesResult: with HIE-II, and 9(9%) cases with HIE-III. 42(42%) cases showed normal Cranial USG nding, 24(24%) cases showed cerebral oedema, 14 (14%) cases showed Gr-I IVH, 10(10%) cases showed Gr-II IVH, 6(6%) cases showed Gr-III IVH and 4(4%) cases showed Gr-IV IVH. Among HIE-I neonates, 42(67.7%) cases had normal cranial USG ndings and 20(32.2%) cases showed cerebral oedema. In HIE-II neonates, 4(13.7%) cases showed cerebral oedema, 14(48.2%) cases showed Gr-I IVH, 10(34.4%) cases showed Gr-II IVH and 1(3.44%) case showed Gr-III IVH. In neonates with HIE-III, 5 (55.5%) cases showed Gr-III IVH and 4 (44.4%) cases showed Gr-IV IVH. Correlation of cranial USG shows worsening trend with increasing severity of HIE as per Sarnat and Sarnat staging. Chi-square test revealed strong positive correlation. (p= 0.0001, rs=0.9) Conclusion: This study concluded that the serial cranial USG ndings in PNA neonates when done in rst week of life, revealed a strong positive correlation with the severity of HIE. Cranial USG is cost effective, easily available and is ideal for the initial assessment of neonates with HIE.

ELECTROPHYSIOLOGIC PATTERN OF FACIAL MUSCLE INVOLVEMENT IN BELL'S PALSY

Introduction: Idiopathic Bell's Palsy is the commonest cause of Facial nerve palsy accounting for 45% to 71% of all causes of Facial Palsy. Electrophysiological evaluation comprises of Nerve conduction studies(NCS), Blink response and Electromyography(EMG) Methods: This was a prospective cross-sectional study done among 50 consecutive patients with Bell's Palsy who were evaluated and diagnosed within 1 week after onset of symptoms. Patients with facial palsy with a normal MRI and normal hematological and biochemical parameters were labelled as Bell's Palsy and were subjected to an NCS. Latency and CMAP recordings were obtained from Orbicularis Oculi, Nasalis and Orbicularis Oris. Results: Fifty patients were included in this study (27 male and 23 female). Most patients belonged to the age group of 41 - 60 years. One-Half(25) of the included patients had palsy of the Facial nerve on the right side and the others on the Left side. Forty-one(82%) of included patients had electrophysiological involvement of the orbicularis oculi as dened by a decrease in CMAP of more than 50% compared to the normal side. Similarly, 41(82%) patients had electrophysiological abnormality of the Nasalis muscle and 26(52%) patients had decreased CMAP of the Orbicularis Oris Muscle. The most frequent electrophysiologic pattern observed in this study in the rst week was involvement of all 3 muscles studied i.e., Orbicularis Oculi, Nasalis and Orbicularis Oris. Conclusion: In the rst week of illness, electrophysiological abnormality was most frequently seen in Orbicularis Oculi and Nasalis muscles. Follow-up electrophysiological studies are required to know the pattern of progression

TAMSULOSIN VS TOLTERODINE IN THE MANAGEMENT OF URETERIC STENT RELATED SYMPTOMS FOLLOWING URETERORENOSCOPY

Background: Indwelling ureteric stents produce varying degrees of complication and discomforts ranging from frequency and urgency to haematuria or infection and signicantly impacts quality of life. Aim: assess the effectiveness of Tamsulosin and tolterodine in improving the lower urinary tract symptoms of patients with indwelling double –J- ureteric stents following ureterorenoscopy Methods: The study was conducted in randomized, double-blind manner in department of general surgery , NMCH ,Patna from 1st January 2014 to 10th June 2015. In total, 40 patients with double J stent were randomly divided into two groups (group A, n: 20, group B, n: 20 ). Each patient randomly received one pack of drug in different colours of the content to take Tamsulosin 0.4 mg before sleep, Tolterodine 4 mg once a day : group A received Tolterodine , group 2 Tamsulosin a for 1 month in a double-blind manner. Ureteral stent-related morbidity indices which analysed included urinary symptom, pain, general health, quality of work and sex scores were measured by Ureteral Symptom Score Questionnaire for rst and fourth weeks after drug consumption and the rst week after double J stent removal. Results: No signicant change in various domains of USSQ like urinary symptoms , body pain, general health , work performance , sexual matters. Conclusions: Both drugs minimise the symptoms however a larger well-designed study needs to be conducted to conrm the ndings.

EFFECT OF DRY NEEDLING IN PATIENT WITH TIBIAL STRESS SYNDROME (SHIN PAIN) IN ATHLETES UNIVERSITY PLAYER

40 Patient With tibial stress syndrome (shin splints) in Athletes ages of 18-45 year with tibial stress syndrome (shin splints), were analysis using subjective questioning based on a ten point Likert pain scale that was used to assess pain level. The Likert pain scale ranged start from none (1) to Distressing (5) to Unbearable (10). The athletes were divided into 2 treatment groups: conventional Sports physiotherapy (N=20), Dry needling (N=20). The treating practitioners were certied and patient is athletic trainee at DAVV University. The study took place over a 6 week period, with each participant lling out an initial questionnaire (Intake) prior to the rst week of treatment and After 6 week treatment).Participants answered questions concerning intensity and duration of pain during and between activities, in addition to dosages taken of anti-inammatory medications (NSAID). All Subjects of groups taken a minimum of 2 treatments sessions per week. The 2 treatment groups compared to each other: conventional Sports physiotherapy (A), Dry needling along with conventional sports physiotherapy (B). All athletes reported an increase in effectiveness of treatment after 6 week. Regardless of the treatment group they were in. The perception of pain, pain relief, and effectiveness was signicantly improved for athletes in the both Group. Athletes in the B Groups received the most pain relief, were least blocked by pain during sporting and nonsporting activities, and felt overall that the treatments were more effective than A Group.

DYNAMICS OF BONE MINERAL COMPOSITION OF RABBIT LOWER JAW AFTER BONE-DESTRUCTIVE TRAUMA

The properties of bone tissue, in particular its strength and hardness, depend on the mineral component of the bone. The aim of our work was to study the content of four mineral macronutrients – calcium, phosphorus, magnesium and sodium in the bone tissue of the rabbit lower jaw and to analyze the posttraumatic dynamics. Research was done on 20 adult 6-7-month-old rabbits, having 2.5-3.0 kg weight, which were segregated into experimental (15 animals) and control (5 animals) groups. Animals of the experimental group under combined anesthesia were subjected to bilateral bone-destructive trauma with a dental drill, that disrupted the integrity of the bone tissue of the alveolar part of the lower jaw. 1, 2, and 3 weeks after the injury the animals were taken out of the experiment, and were subjected to lower jaw disarticulation. To determine the mineral composition of the bone tissue, we used the method of atomic absorption spectral analysis. The content of four mineral elements (Ca, P, Mg, Na) was determined. It was found that calcium content more than doubled by the end of the fi rst week after injury, slightly decreased by the end of the second week, and slightly increased again during the third week. Bone phosphorus content increases by the end of the fi rst week after injury, and decreases during the next two weeks. The amount of sodium decreases slightly at the end of the fi rst week after injury, but increases during the next two weeks and exceeds the norm at the end of the third week. The amount of magnesium in the bone tissue decreases during the two weeks after injury, and increases by the end of the third week, almost returning to normal levels. The results of the study allowed us to conclude that within three weeks after surgical bone-destructive trauma, the studied macronutrients in bone tissue have a pronounced dynamic, diff erent and specifi c for each element.

PATHOMORPHOLOGICAL CHANGES IN THE RETINAL LAYERS AT THE END OF THE SEVENTH DAY OF EXPERIMENTAL OPIOID EXPOSURE

The aim of the work was to clarify the fundamental issues regarding the dynamics of early changes in the retinal layers under experimental exposure of opioids. Research was done on 15 adult 4-months-old mature male mongrel rats, having 100.0-160.0 g weight. Opioid eff ects were modelled by daily intramuscular injections of nalbuphine 1 time per day in one period of time (10-11 am) for 7 days. The initial dose of nalbuphine was 0.212 mg ̸kg. Histological slides were prepared according to generally accepted methods using the dyes, as hematoxylin, eosin and azan according to the Heidenhain method.All animals were kept in the vivarium and the work was carried out according to the European Convention for t he Protection of Vertebrate Animals used for experimental and other scientifi c purposes [Strasbourg, 1985]. During the experimental opioid administration after one week of research the changes in the structure of the retinal layers were established. In the early stages of low-dose opioid analgesia administration, the fi rst pathomorphological changes were de tected during the fi rst week, in the form of initial manifestations of vacuole dystrophy of the pigmental epithelium, signs of microcystic degeneration of the outer retinal and neurofi brous layers with the vacuole dystrophy of retinal ganglion cells appearance.

TO STUDY EFFECT OF PHOTOTHERAPY ON SERUM SODIUM, POTASSIUM AND CHLORIDE LEVELS IN NEONATAL JAUNDICE

INTRODUCTION The most common morbidity in the rst week of life is the jaundice which occurs in 80% of term and 60% of preterm neonates and is the most often causes readmission after the baby is discharged from the hospital. The treatment of neonatal hyperbilirubinemia is phototherapy. Like any other treatment modality, phototherapy also has side effects of which very few studies were done on electrolyte disturbances. Hence present study was designed to determine the serum sodium, potassium and chloride changes in neonates receiving phototherapy for neonatal jaundice. AIMS AND OBJECTIVES To study the effect of phototherapy on serum sodium, Potassium and Chloride levels in neonates with neonatal hyperbilirubinemia. MATERIALS AND METHODS This Hospital Based Longitudinal Observational Study was done in the Department of Paediatrics at MMIMSR, Mullana over a period of one and a half year. Serum bilirubin, sodium, Potassium and Chloride levels were measured before initiation of phototherapy and on termination of phototherapy. RESULTS The study included 100 neonates with hyperbilirubinemia treated with phototherapy with male: female ratio of 58%:42%.The mean gestational age was 37.681.63 weeks and birth weight was 2.790.38kgs. The age of onset of phototherapy and duration of phototherapy were 3.802.50 days and 28.627.02 hours respectively. Before phototherapy, the total serum bilirubin, sodium, potassium and chloride levels were 13.87±1.41,140.72±3.45,4.55±0.44 and 106.08±3.1 respectively which decreased to 9.50±1.60,137.45±3.09,4.20±0.46 and 104.52±3.91 with statistically signicant change in bilirubin(p<0.0001),sodium(p<0.0001), potassium(p<0.0001) and Chloride(p=0.0038).

ACCURACY OF TRANSCUTANEOUS BILIRUBIN MEASUREMENTS DURING PHOTOTHERAPY IN JAUNDICED PRETERM NEONATES

Aim: It is very difcult to nd veins and also seems unethical to withdraw blood daily in a preterm baby for the monitoring of jaundice during the course of phototherapy. So it becomes essential that we nd out a method which is non-invasive and at the same time accurate to assess jaundice. Jaundice is the most common morbidity in the rst week of life, reported in 60% of term, 80% of preterm (1, 2) & also being the commonest cause of readmission. Materials and Method: Study was planned to assess the accuracy of transcutaneous bilirubin in comparison to total serum bilirubin in premature jaundiced neonates of gestational age (28-32 weeks v/s 32-37 weeks) during phototherapy. Result: Study has demonstrated reliability of TCB measurements in preterm infants during phototherapy. Gestational age, comorbidities and risk factors for jaundice did not inuence the correlation. Summary: This study reveals that Transcutaneous Bilirubin Estimation by bilirubin meter can be used as a non-invasive method for monitoring of jaundice treatment during phototherapy in preterm neonates.

HYPERGLYCEMIAAS AN INDEPENDENT RISK FACTOR FOR RETINOPATHY OF PREMATURITY (ROP): A COHORT STUDY

OBJECTIVE: Retinopathy of prematurity (ROP) is a severe morbidity that can lead to blindness in premature babies. Neonatal hyperglycemia has been related to the growth of ROP in a variety of studies. However, there aren't many observational trials to show whether hyperglycemia is linked to ROP in the absence of other comorbidities. The aim of this research was to see if hyperglycemia in premature babies is linked to ROP in a different way. STUDY DESIGN: Premature infants (<1500 g or⩽ 32 weeks gestational age) were enrolled in a prospective longitudinal cohort study. All demographic, clinical and laboratory data were collected. Bedside whole-blood glucose concentration was measured every 8 hours daily for rst 7 , days of live. For any glucose reading <50 or>150 mg dl 1 serum sample was sent to the laboratory for conrmation. Hyperglycemia was dened as any blood glucose level⩾ 150 mg dl − 1. ROP patients were compared with non-ROP patients in a bivariate analysis. Variables signicantly associated with ROP were studied in a logistic regression model. RESULT:Atotal of 100 patients were enrolled with gestational age <32weeks and birth weight <1500g. Forty-eight patients (48%) were identied with hyperglycemia. On eye examination, 30 cases (30%) had ROP (19 with stage 1, 10 with stage 2 and 1 with stage 3). There were more cases of ROPin the hyperglycemia group compared with the euglycemia group (45.83% vs 15.38%, P = 0.007). Patients who developed ROP had signicantly higher maximum and average glucose concentrations when compared with non-ROP patients. Multiple factors have been associated with ROP on bivariate analysis, including gestational age, exposure to oxygen, respiratory support and poor weight gain. However, in a logistic regression model including all signicant variables, average blood glucose in the rst week of life was the factor independently associated with ROPwith an odds ratio of: 1.77 (95% condence interval: 1.08 to 2.86), P= 0.024 CONCLUSION: In a prospective cohort study of premature infants, elevated average blood glucose concentrations in the rst week of life is an independent risk factor associated with the development of ROP.

Hemocytopoiesis and microelements metabolism’s indices in calves under the infl uence of national vitamin-amino-acid complex

In Ukrainian veterinary medicine the study of the eff ectiveness of new complex drugs remains relevant. The eff ect of the vitamin-mineral complex "Alphabet for Animals" on the state of hemocytopoiesis and the microelements metabolism in calves of 1.5‒2.5 months of age were studied. The composition of this drug includes the biologically active substances: vitamins A, D3, E, B1, B3, B5, B6, B12, K3 and essential amino-acids: DL-methionine, L-lysine and arginine. It is used in farm animals and poultry for the normalization of hemocytopoiesis, the prevention and treatment of vitamins and trace elements metabolism’s disorders. In the fi rst week of drug administration, the number of erythrocytes in the experimental animals group has increased signifi cantly (p<0.05) and after its second feeding, the positive eff ect on erythrocytopoiesis in calves has became even greater (p<0.001), compared to the calves in control group. The level of hemoglobin in calves of experimental group also increased signifi cantly from the beginning of the drug to the end of the experiment, whereas in calves of the control group there was a tendency to decrease its level throughout the all experiment. The color index and erythrocyte saturation by hemoglobin (MCH) at the fi rst and second blood samples were signifi cantly decreased (p<0.05) in control calves group, whereas in animals of experimental group there was no signifi cant diff erence between these parameters (p<0.1). The average volume of red blood cells did not diff er between control and test calves during the experiment (p<0.1). Under the drugs infl uence the Ferum blood content in calves of experimental group increased by 24.2 %. In the control calves group, this tendency was not so noticeable (the increase of Ferum serum level at the end of experiment was only +7.8 % (p<0.1), compared to the initial indices). The Zinc metabolism, on the contrary, has not undergone signifi cant changes. The Cuprum serum level in experimental calves group remained always signifi cantly higher than in control animals group. “Alphabet for Animals” has a positive eff ect on hemocytopoiesis in calves due to its complex composition (fat-soluble and water-soluble vitamins, aminoacids) and improves the metabolism of microelements, including Ferum and Cuprum. The infl uence on these processes the vitamins of B group, which are a part of this drug, we consider especially valuable in the conditions of the unformed rumen digestion in young cattle. Key words: vitamin-amino acid complex, erythrocytopoiesis, hypochromia, microcytosis, hemoglobin, color index, hematocrit.

Postoperative Atrial Fibrillation and its association with the Atrial Substrate and the electrophysiological properties of the Atrial Myocardium

Postoperative atrial fi brillation (AF) has a high prevalence, affecting up to 45% of coronary artery bypass graft surgery patients within the fi rst week of the operation [1-4]. Interestingly, asymptomatic AF was reported more likely to occur after the fi rst 4 days following the cardiac surgery.

Impact of Calorie Intakes on the Risk of Bronchopulmonary Dysplasia in Extremely Preterm Infants

Aim: To examine whether caloric intake during the fi rst week of age infl uences the risk of Bronchopulmonary Dysplasia (BPD) in extremely preterm infants.

Comparison of Different Doses of Escitalopram in the Prophylaxis of Dementia in Patients with Depression and Moderate Cognitive Dysfunction in Chronic Cerebral Ischemia

Objective – to compare different doses of escitalopram (Cipralex) in the prophylaxis of dementia in patients with depression and moderate cognitive dysfunction on the background of chronic cerebral ischemia. Materials and methods. Two groups of patients, aged 65–78 years, with chronic cerebral ischemia and mild-moderate depression and moderate cognitive dysfunction were studied and treated with different doses of escitalopram: 30 patients received escitalopram at a dose of 5 mg/day throughout the treatment period; 42 patients received escitalopram at a dose of 5 mg/day for the fi rst week and then 10 mg/day. Treatment duration was six months and the observation period was eight months. Results and conclusions. Escitalopram was shown to be effective not only in the treatment of depression-associated cognitive dysfunction in patients with chronic cerebral ischemia but also in decreasing the risk of dementia in the long term. The effectiveness of the prophylaxis of dementia was found to depend on the escitalopram dose used.

Nutritional support for critically ill children: A Cochrane review summary

Background: The need for nutritional support for critically ill children is a contentious issue that has not been well investigated (Joffe et al., 2016 ). When children are critically ill, the suggestion that their metabolic rate increases is questioned; there is evidence during the fi rst week of illness that metabolism is more likely at, or even below, the child ’ s predicted basal metabolic rate (Framson et al., 2007 ). The provision of nutritional support during illness is considered a priority by both parents and health professionals. However, there may be reasons to warrant reducing caloric intake during a critical illness. Animal studies have demonstrated improved survival from critical illness is associated with reduced caloric intake. (Alexander et al., 1989 ) In adult studies, high caloric intake is associated with delay in weaning from ventilators( Singer et al., 2011 ), and underfeeding during critical illness associated with improved mortality and reducing length of hospital stay. (Boitano, 2006 )

Characteristics of Infectious Diseases in Hospitalized Patients During the Early Phase After the 2011 Great East Japan Earthquake: Pneumonia as a Significant Reason for Hospital Care

Natural catastrophes increase infectious disease morbidity rates. On March 11, 2011, a 9.0-magnitude earthquake and associated Pacific coast tsunami struck East Japan. The aim of this study was to investigate the characteristics of patients with infectious diseases who needed hospitalization after this disaster. We searched the medical records of 1,577 patients admitted to Tohoku University Hospital in the Sendai area within 1 month (March 11, 2011-April 11, 2011) after the disaster. We examined (1) changes in the rates of hospitalizations for infectious diseases over time and (2) the variety of infectious diseases. The number of hospitalized patients with infectious diseases increased after the fi rst week to double that during the same period in 2010. Pneumonia comprised 43% of cases, and 12% consisted of skin and subcutaneous tissue infection, including tetanus. Pneumonia was prevalent in elderly patients (median age, 78 years) with low levels of serum albumin and comorbid conditions, including brain and nervous system disorders. Sputum cultures contained Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae , known pathogens of community-acquired pneumonia in Japan. In addition, 20.5% of patients had positive results for urinary pneumococcal antigen. Among hospitalized patients, infectious diseases were significantly increased after the disaster compared with the same period in 2010, with pneumonia being prominent. The analyses suggest that taking appropriate measures for infectious diseases, including pneumonia, may be useful for disaster preparedness and medical response in the future.

Effect of Routine Lactobacillus reuteri DSM 17938 use on Rates of Late-onset infection in Extremely-low-birth-weight Infants

Background: Preterm infants are at high risk for late-onset infections due to gram-negative or fungal organisms. Evidence supports that a common source for these organisms may be the gastrointestinal tract. One theoretical way to change the infection rate is to alter the bacterial flora inhabiting the newborn gastrointestinal tract using probiotics. This study examines the impact of routine use of a probiotic, Lactobacillus reuteri DSM 17938 (BioGaia®), on the rate of late-onset gram-negative and fungal infection in neonates with birth weight ≤ 1000 grams. Methods: This is a retrospective cohort study comparing the rates of gram-negative bacterial and fungal infections in neonates with birth weight ≤ 1000 grams. The groups are separated into those neonates born from January 2004 to June 30, 2009, before introduction of L. reuteri, and neonates born July 2009 through July 2012 who received routine L. reuteri prophylaxis. Neonates were excluded if they died or were transferred within the fi rst week of life. The remainder were included in the study and recorded as either having late onset infection related to gram negative organisms or fungi, or not having late onset infection. Since no major changes occurred in our NICU practice in recent years, and the introduction of L. reuteri as routine prophylaxis was abrupt, we attributed the post-probiotic changes to the introduction of this new therapy. Rates of infection were compared using Chi square analysis with Fisher exact t-test. Results: Medical records for 354 neonates were reviewed, 232 before- and 122 after-introduction of L. reuteri prophylaxis. Despite a marked reduction in necrotizing enterocolitis and mortality, the incidence of late-onset infection varied from year-to-year, but was not signifi cantly altered by the introduction of routine L. reuteri. No adverse events related to use of L. reuteri were noted. Conclusions: Prophylactic initiation of L. reuteri as a probiotic does not decrease late-onset infection.

Comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients: a task still not concluded!

In a recent issue of Critical Care, we read with interest the article by Wlodzimirow and colleagues [1], who prospectively studied the Risk Injury Failure Loss Endstage renal disease (RIFLE) [2] classifi cation with serum creatinine (SCr) and urine output (UO) (RIFLE SCr+UO ) and without UO criteria (RIFLE SCr ) for acute kidney injury (AKI) in 260 critically ill patients. RIFLE SCr signifi cantly underestimated the presence of AKI on admission and during the fi rst week in the intensive care unit and signifi cantly delayed AKI diagnosis. Th ose are important fi ndings that corroborate the utility of simultaneously using both criteria as proposed by the Acute Dialysis Quality Initiative workgroup [2]. Th e authors also found that RIFLE SCr was associated with higher mortality than RIFLE SCr+UO . Th is observation should be interpreted with extreme caution, as this association has not been tested by multivariate analysis. Data regarding the impact on mortality of RIFLE defi ned by SCr and UO or by SCr are not conclusive. For example, in a systematic review, the relative risk for death among studies that used RIFLE SCr+UO was lower than in those using RIFLE SCr [3]. Previously, however, we did not fi nd any diff erence in terms of mortality for RIFLE SCr+UO (Risk, odds ratio (OR) 2.69; Injury, OR 2.01; Failure, OR 3.59; AKI of any category, 2.78; area under the receiver operator characteristic (AUROC), 0.733) or for RIFLE SCr (Risk, OR 2.63; Injury, OR 2.12; Failure, OR 3.2; AKI of any category, 2.68; AUROC, 0.729) [4]. Th erefore, prospective studies with a large number of patients are still needed to better determine the impact on mortality of RIFLE defi ned by SCr+UO criteria or by SCr criteria.

Delayed graft function in living donor kidney transplantation

Dear Editor,This paper [1] made interesting reading but con-tains several contradictions which need to be discussed.The glaring issue is the confusion about the de ni-tion of delayed graft function (DGF). In materials and methods, the authors de ne DGF as the need for dialysis (HD) in the rst week after transplan-tation, which would then be expected to be the cri-terion for diagnosis of DGF throughout the study. However, in the background section, the same def-inition is termed “the older de nition”, and that it was subjective and not standardized. Importantly, the de nition of DGF used in the results section to calculate its incidence is also different, because it included recipients who did not require HD. Eleven of their 68 recipients (16%) were labeled DGF, but of whom, only 3 (4%) required dialysis? The remaining 8 recipients labeled DGF did not re-quire dialysis and should correctly be labeled slow graft function (SGF), although the day 5 serum cre-atinine is not available [2]. The authors did quote this paper on SGF but failed to recognize its rele-vance of SGF to their own study [2]. The DGF g-ure of 16% quoted by the authors is perhaps the incidence of the combined DGF and SGF, which is comparable to the incidence of poor early graft function in the other series [3–5]. The confusion about the de nition is also present in discussion, and the vital question the authors failed to address was exactly how they de ned DGF? This inconsist-ency in de ning DGF puts a question mark over the ndings of the entire study.