1.Diagnostic approach to rickets: an Endocrine Society of Bengal (ESB) consensus statement
Ajitesh ROY ; Amarta Shankar CHOWDHURY ; Arindam RAY ; Arjun BAIDYA ; Bibek ROYCHOWDHURY ; Dasarathi SARKAR ; Debmalya SANYAL ; Indira MAISNAM ; Kaushik BISWAS ; Kaushik PANDIT ; Mainak BANERJEE ; Moutusi RAYCHAUDHURI ; Nilanjan SENGUPTA ; Partha Pratim CHAKRABORTY ; Pradip MUKHOPADHYAY ; Pradip RAYCHAUDHURI ; Pranab Kumar SAHANA ; Rajan PALUI ; Rana BHATTACHARJEE ; Sarmistha MUKHOPADHYAY ; Satinath MUKHOPADHYAY ; Sayantan RAY ; Soumik GOSWAMI ; Subhankar CHOWDHURY ; Subhodip PRAMANIK ; Subir Chandra SWAR ; Sujoy GHOSH ; Sunetra MONDAL ; Tapas Chandra DAS
Annals of Pediatric Endocrinology & Metabolism 2024;29(5):284-307
Rickets, one of the leading causes of bony deformities and short stature, can be calciopenic (inciting event is defective intestinal calcium absorption) or phosphopenic (inciting event is phosphaturia). Early diagnosis and timely treatment of rickets are crucial for correction of the limb deformities. Guidelines exist for nutritional rickets, but the diagnosis and management of the relatively uncommon forms of rickets are complex. This consensus aims to formulate a simplified diagnostic approach for rickets, especially in resource-limited settings. The consensus statement has been formulated by a 29-member committee from the Endocrine Society of Bengal. The process included forming a working group, conducting a literature review, identifying controversies, drafting, and discussion at a consensus meeting. Participants rated their agreement with the clinical practice points, and a 70% consensus was required. Input integration and further review led to the final consensus statements. Children with suspected rickets should initially be examined for distinctive skeletal deformities. The diagnosis of rickets should be confirmed with characteristic radiographic abnormalities. It is advisable to order tests for serum calcium, inorganic phosphorus (Pi), liver function, 25-hydroxyvitamin D (25OHD), parathyroid hormone, creatinine, and potassium in all patients with rickets. In cases of refractory rickets, it is also recommended that assessments be conducted for spot urine calcium, Pi, creatinine, and, blood gas analysis. In children with rickets and metabolic acidosis, tests for glycosuria, uricosuria, aminoaciduria, low molecular weight proteinuria, and albuminuria should be conducted. In children with resistant calciopenic rickets and sufficient serum 25OHD levels, serum 1,25(OH)2D concentration should be tested. 1,25(OH)2 D and fibroblast growth factor 23 estimation is useful for certain forms of phosphopenic rickets.
2.Role of serum high-sensitive C-reactive protein to predict severity of pre-eclampsia in a high-population resource-poor country: a prospective observational study
Jhuma BISWAS ; Mousumi DATTA ; Kaushik KAR ; Divyangana MITRA ; Lakavath JYOTHI ; Arghya MAITRA
Journal of Rural Medicine 2025;20(2):71-77
Objective: To determine the role of high-sensitive C-reactive protein (hsCRP) in predicting the severity of preeclampsia in a high-population, resource-poor country.Patients and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology of Calcutta National Medical College, India, from March 2021 to September 2022. A total of 180 participants were divided into three equal groups: patients with severe preeclampsia and non-severe preeclampsia and healthy pregnant women.Results: The levels of the biomarkers hsCRP and uric acid differed significantly between women with preeclampsia and healthy women, with cutoff levels of 3.72 mg/L and 5.15mg/dL, respectively, as determined using receiver operating characteristic (ROC) curve analysis. HsCRP was also able to differentiate severe preeclampsia from non-severe preeclampsia at a cutoff level ≥8.75 mg/L (high Youden index >0.6). However, uric acid levels failed to discriminate between pregnant women with severe and non-severe preeclampsia. Elevated hsCRP levels were strongly associated with low birth weight of newborns in pregnant women with preeclampsia and healthy control groups (P=0.001) and with disease severity (P<0.001), respectively.Conclusions: HsCRP can be used as an important diagnostic tool to exclude and evaluate the severity of preeclampsia.