Abdominal tuberculosis has been reported in 0.3-4% of all cases of childhood tuberculosis. It has been reported mainly from developing countries and is rarer in children as compared to adults. The commonest age group affected is 9-14 years. Abdominal pain, fever and weight loss are the most frequent symptoms on presentation and diagnosis is often delayed by 4-6 months. There is a variability in the distribution of the disease within the abdomen reported from different centres and multiple abdominal sites are frequently involved. Overall, the spectrum of disease in children is different from adults, peritoneal and lymph nodal involvement being more common than gastrointestinal disease. Chest x-ray shows pulmonary involvement in up to 25% even in the absence of symptoms and 1/3rd have history of contact with an infected adult. Abdominal imaging is an important preliminary investigation and helps in guiding further evaluation. It's important to try and establish bacteriological and/or histopathological confirmation by obtaining appropriate samples (ascitic fluid, endoscopic biopsies, imaging-guided aspiration from lymph nodes, omentum etc. depending on involved site), however it's possible in only 23-47% cases and one may often have to resort to a therapeutic trial. Standard anti-tuberculous drugs are generally effective and are given for 9-12 months. A proper follow.up is important and the improvement should be assessed both subjective improvement and by objective parameters (such as endoscopic healing and resolution of imaging features). Surgery is reserved for patients who have developed a perforation or obstruction not responding to medical management.

For diagnosing Acute Kidney Injury (AKI) newer biomolecules such as serum cystatin C and urinary neutrophil gelatinase-associated lipocalin (NGAL) are more accurate in estimating GFR. Renal resistive index [RRI] is early marker of AKI in cirrhotics. There is limited data on these markers in pediatric liver disease. This study was planned to study the diagnostic value of the serum cystatin C, urinary NGAL and RRI in AKI amongst pediatric CLD with PHTN. Prospective observational study in which all patients of CLD with PHTN with or without AKI were enrolled and followed up for 6 months for development/resolution of AKI as per Kidney Diseases. Improving Global Outcomes (KDIGO definition. AKI score was calculated using newer markers. Of the 100 children enrolled, 41 (16.5%) had AKI. Mean age at AKI was 8 ± 5.4 years and PELD/MELD of 30 ± 12. Among AKI group median (IQR) values of serum urea (mg/dl), serum creatinine value (mg/dl), serum cystatin C (mg/L), urinary NGAL (ng/ml) and RRI was significantly higher than in non AKI group. ROC analysis showed best cut off of 0.97 mg/L of serum cystatin C, 101 ng/ml of urinary NGAL and 0.8 for RRI had maximum sensitivity, specificity and diagnostic accuracy. On logistic regression analysis including all three markers only serum cystatin C and urinary NGAL was found to be significant and AKI score formula was calculated as [AKI score: -7.34 +6.3 (Cystatin in mg/L) + 0.006 (Urinary NGAL in ng/ml)]. ROC analysis of the calculated AKI score showed that the cutoff of -0.5 has sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic accuracy of 82.9%, 83.1%, 3.57, 0.17 and 83% respectively with AUROC of 0.855. On applying AKI-score on those who did not fulfill the definition of AKI at baseline as per KDIGO, we identified 10 additional cases of AKI, and 7 of whom either died or had liver transplant. Conclusion: Calculated AKI score is better tool to identify early AKI as compare to serum cystatin C, urinary NGAL, RRI and KDIGO definition.

Wheat is a rich source of Selenium (Se). Dietary compliant celiac disease (CD) patientsin disease remission may be prone to Se deficiency and its biological effects. Aim of the study were: 1) Assess the absolute and functional deficiency of Se in gluten free diet (GFD) compliant CD children.2) Assess the sequential effect of oral Se supplementation and dietary modifications in those deficient. Asymptomatic CD children (<18 years) on compliant GFD. 3 years in serological (anti-tissue transglutaminaseantibody. 3 times upper limit normal) and mucosal (Marsh grade<2) remission were included. Elemental Se (100 μgday) for 3mo followed by Se-rich (>100 μgday) modified GFD for next 3mo was given. Dietary selenium content (3 day recall), plasma Se levels, selenoprotein- P1 (SEPP1) andglutathione peroxidase-3 (GPX-3) were estimated at baseline. Se deficiency was defined as plasma Se levels <60 μgL. Response in growth parameters, absolute and functional Selevels were reassessed at 3 and 6mo. Results: Of 77 screened, 51CD [duration of compliant GFD 6 (3-13) y; age at study enrolment 14 (4.7.18) y] children were eligible for the study. Thyroid hypofunction and impaired glucose tolerance were seen in 21 (41%) & 4 (7.8%) children on baseline endocrine screen. All 51 patients were Se-deficient [plasma Se 34.5 (19.3-53) μgL]. Baseline dietary Se content [26.7 (12-99) vs. 40.7 (6.5-94) μgd, p = 0.009], plasma Se[33.5 (19.3-45.9) vs. 34.7 (23.8-53) μgL, p = 0.4], SEPP1 [3.1 (2.2-5) vs. 3 (1.9-4.4) μgmL, p = 0.7], GPX3[7.5 (3.3-60.3) vs. 9.5 (0.6-60.6) μgmL, p = 0.3] were present in pure vegans (53%) andovo/non-vegans (47%). Ten patients with irregular follow-up were excluded. Significant increase from baseline to 3mo was noted in SEPP-1 [3.0 (2.1-5) vs. 3.9 (2.4-8.3) μgmL, p = 0.02] but not in GPX-3 levels [7.5 (3.4-60.6) vs. 6.3 (3.2-40.7) μgmL; p = 0.3]. Conclusion from the study: GFD-compliant CD have absolute and functional Se deficiency. Short term therapy improves the Se status and growth parameters.

Standard assessment of chelation adequacy in Wilson's Disease (WD) by liver function tests (LFT), non-ceruloplasmin copper (NCC) and 24- hour urine copper (UCu) have fallacies. Exchangeable copper (ExCu) is a newer concept in the diagnosis and management of neurological WD. The aim of the study is to explore the role of ExCu as a prognostic tool for assessment of therapy in liver disease. Hepatic WD patients on. 1 y chelation therapy were prospectively enrolled. Newly diagnosed chelation-naive WD children were controls. ExCu in ultrafiltrates was analysed by atomic mass spectrophotometry. Relative exchangeable copper (REC) was defined as percentage ratio of ExCu and total serum copper. Sub-group analysis of ExCu on degree of chelation [well-chelated (UCu 200-500 μgday); poorly chelated (UCu <200 or > 500 μgday)] and liver disease [stable (normal liver synthetic function and transaminases < 2 times upper limit of normal) and unstable (poor synthetic functions and elevated transaminases] The authors found that 96 children (n = 61 on chelation, n = 35 controls) aged 12.5 ± 4.4y were assessed. Chelated WD vs. controls had lower ExCu (0.9 ± 0.6 vs 3 ± 7 μmol/L, p = 0.03) and higher REC (43 ± 27.4% vs 30.4 ± 14.3%, p = 0.01). AUROC of ExCu in chelated vs. controls was 0.8 (cut-off 0.97 μmol/L, sensitivity 80%, specificity of 68%, p<0.01) and stable vs. unstable liver disease was 0.73 (cut-off 0.87 μmol/L, sensitivity 77%, specificity of 65% p = 0.01). ExCu had positive correlation with NCC (r = 0.92, p < 0.001), UCu (r = 0.52, p < 0.001) and Pediatric end-stage liver disease (PELD) scores (r = 0.47, p = 0.01). Multivariate analysis of the entire cohort showed Child Turcotte Pugh scores (p = 0.002) and duration of treatment (> 1-year vs < 1-year) (p = 0.002) significantly influences ExCu values. Median follow-up duration was 10 (0-24) months. 14/96 (15%) either died or were referred for liver transplantation. Survival on Kaplan Meier curves were significantly higher (p = 0.01) if baseline ExCu was ⩽ 0.87. The conclusion from the study was Exchangeable copper is an effective monitoring tool to assess chelation. New chelators reduce ExCu levels to <0.97 μmol/L after 1 year of chelation and thereafter achieve liver stability if values are <0.87 μmol/L.