Hungry bone syndrome (HBS) is a well-recognised complication after curative parathyroidectomy in primary hyperparathyroidism (PHPT), contributing to morbidity and prolonged hospitalisation. Reported predictors remain inconsistent, and data from Indian cohorts are limited, particularly in settings where vitamin D deficiency and advanced skeletal disease may modify risk. This retrospective observational cohort study was conducted at a tertiary surgical centre between January 2023 and December 2025. Twenty-five consecutive patients with biochemically proven PHPT who underwent curative parathyroidectomy were included. Preoperative variables included serum calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase (ALP), and 25-OH vitamin D. For this study, HBS was defined as postoperative hypocalcaemia persisting for more than 72 h after surgery and requiring clinically significant calcium supplementation; transient asymptomatic biochemical hypocalcaemia was not classified as HBS. Receiver operating characteristic (ROC) curves were constructed, and a three-point bedside score was evaluated in an exploratory manner. HBS developed in 7 patients (28
Abstract Achieving equitable health care for all individuals is imperative for the establishment of a healthy society. A nation that mitigates the financial burden associated with health care while emphasizing preventive measures not only enhances public health outcomes but also contributes to the stability of its population. India follows a multi-payer universal healthcare framework. To assess the overall health of a country’s citizens, several key health indicators have been established. They play a critical role in understanding health conditions and guiding policy decisions aimed at improving health outcomes. In India, these indicators are shaped by a variety of geographical, cultural, and socio-economic factors. They are crucial for policy formulation by assisting policymakers in identifying health priorities and allocating resources effectively and monitoring progress by tracking advancements toward health objectives. Despite progress, India’s healthcare sector continues to face several challenges. A segment of the population lives under the poverty line, which restricts access to health care. There are inadequate health infrastructure facilities in rural and remote areas. The Indian healthcare sector has experienced significant growth over the years, driving economic growth, creating employment opportunities, and improving patient outcomes. The government is working toward health care for all. Primary health care enhances the performance of health systems by reducing overall healthcare expenditure while improving population health and access. Reforms in the healthcare system should be monitored with indicators that reflect the core characteristics of primary health care. However, the government will have to increase the budget for health care to achieve healthcare access for all citizens of India.
Introduction: Chest tube removal (CTR) is a painful procedure after cardiothoracic surgery. Non-pharmacological measures that are inexpensive and easy to administer may complement routine analgesia. This study evaluated the effectiveness of local ice-cold application on pain associated with CTR. Methods: A quantitative experimental pretest–posttest control-group study was conducted among 60 postoperative cardiothoracic patients in the cardiothoracic vascular surgery intensive care unit of a 600-bed tertiary/superspecialty cardiothoracic hospital in Western Maharashtra. Participants were randomly allocated by lottery to an ice-cold application group (n=30) or control group (n=30). Both groups received routine analgesia. In the intervention group, two ice packs (17 × 8 cm), wrapped in sterile gauze, were placed around the chest-tube insertion site for 15 min before removal. Pain was assessed before, immediately after, and 15 min after CTR using the Numeric Pain Rating Scale (NPRS) and Modified Comfort Scale. Between-group comparisons used the Mann–Whitney test; within-group comparisons used the Wilcoxon signed-rank test. Results: Immediately after CTR, mean NPRS was 4.77 ± 1.135 in the intervention group versus 7.10 ± 0.995 in controls (Z=5.81, p<0.0001). At 15 min, mean NPRS was 3.13 ± 0.973 versus 3.97 ± 1.217 (Z=2.58, p=0.01). Modified Comfort Scale scores immediately after CTR were 10.63 ± 1.650 versus 14.40 ± 1.610 (Z=5.92, p<0.0001); at 15 min the difference was not significant (8.17 ± 1.821 vs 8.43 ± 1.716; Z=0.73, p=0.47). Within the intervention group, pain decreased significantly from baseline to both post-CTR assessments (p<0.0001). No adverse incident was reported. Conclusion: A 15-min local ice-cold application before CTR was associated with lower immediate pain and lower NPRS at 15 min after removal. It may be considered as a simple adjunct to routine
Abstract Introduction: Vancomycin and Amikacin are drugs with renal excretion primarily and are used widely in critically ill children. Fall in urine output is one of the first events in case of kidney injury in PICU setting. It is not clear how early AKI (eAKI),defined as only fall in urine output by KDIGO 2012 AKI definition before rise in serum creatinine, impacts levels of these drugs.We conducted pilot study to determine drug levels of Vancomycin and Amikacin in critically children with eAKI and 48 hours after modification. Methods: Children on Vancomycin or Amikacin were monitored for hourly urine output . Serum creatinine and Amikacin or Vancomycin levels were measured at 24 hours and again at diagnosis of eAKI.Serum Vancomycin and Amikacin levels were estimated in-house as a research tool by high performance liquid chromatography (HPLC) done on Agilent Infinity II system. Results: Incidence of eAKI was 15.7% in children on Vancomycin and these children also had AKI by serum creatinine criterion. Among children on Amikacin, incidence of eAKI was 12.5% and none developed AKI by serum creatinine criterion. In children on Vancomycin, mean drug levels when eAKI was diagnosed was 22.8 ±4.36 mg/L and creatinine was 1.03 ±0.31 mg/dl, both significantly higher than baseline ( P < 0.0001).Post drug-dose modification trough level was 15.48 ±1.64 mg/L still significantly high ( P < 0.0001) but mean serum creatinine reduced to 0.66 ±0.10 mg/dl. Drug levels and creatinine at D7 were comparable.Mean Amikacin levels in children with eAKI were 59.9 ±13.79mg/L, significantly higher than baseline ( P < 0.0001). 48 h after dose reduction, trough Amikacin levels remained significantly elevated but there was no significant difference in serum creatinine from baseline levels in these children with eAKI.Amikacin level at day 7 also significantly higher despite dose modification. Conclusion: Children on Vancomycin with eAKI had simultaneous rise in serum creatinine. Drug levels remained 48h after drug dose modification and became comparable only at day 7. In children on Amikacin,with eAKI, serum creatinine showed no significant rise but drug levels in these children remained significantly high compared to baseline at 48h after dose modification as well at day 7.
