bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of consumption patterns for essential medicines: a study of the Nyeri county referral hospital
Authors: Murigi Juliana W. , Ng'ethe Henry , Nderitu Douglas , Murigi Veronica
Published: June 2021

Background: Nyeri is one of the pilot Universal Health Coverage roll-out counties aimed at guaranteeing healthcare service access to all households in the region by 2022. The aim of the study was to provide management insights into ways of optimizing pharmaceutical management to ensure essential medicine are consumed by majority of population in need by 2022.Methods: A mixed-methods approach was used, combining quantitative and qualitative data collection techniques.Results: Amoxicillin had the highest (751,000) consumption over the study period. Other essential medicines with high consumption include paracetamol (432,000), metformin (280,264) and enalapril (111,800). The most cited reason for stock-outs was limited allocation of budget for medicines, a point that was mentioned by eight of the ten respondents.Conclusions: The study concludes that the stock-out frequency for essential medicines at the Nyeri County Referral Hospital is high. The frequent and persistent stock-out frequency for essential medicines is a problem considering the high consumption for essential medicines.
Diagnostic evaluation of tubal patency in a tertiary care hospital
Authors: Gandotra Nikita , Prashar Nivedita , Sharma Abhinav
Published: June 2021

Background: Infertility  has  always  been  one  of  the  most  elusive  symptom  complexes  that  perplex  the best gynecologists.  Amongst female factors, tubal factors are responsible for 25-30% of infertility. Hysterosalpingography and diagnostic laparoscopy with chromopertubation are widely used in the evaluation of tubal factors of infertility. Aim of the study was to compare hysterosalpingography and laparoscopy in the diagnosis of tubal patency in infertile patients.Methods: In this study 50 patients of infertility were evaluated prospectively in the Department of Obstetrics and Gynecology, Government Medical College, Jammu from April 2019 to March 2020. The findings of HSG and laparoscopy were compared.Results: Mean age at presentation for primary infertility was 28.6±4.20 years and for secondary infertility it was 32.1±3.84 years. Majority of patients of primary (77.6%) and secondary infertility (54.5%) had duration of infertility of 1-5 years in our study. The sensitivity of HSG was 90.91% and specificity was 77.78 % with positive predictive value of 83.33% and negative predictive value of 87.50%, when tubal pathology was defined as any form of tubal occlusion detected at laparoscopy, either one sided or two sided.Conclusions: HSG demonstrates high sensitivity in our study. So, it should be used as the initial investigation for identifying tubal patency. As the specificity is less, we suggest that laparoscopy is necessary to recognize those cases of tubal block which were unrecognized or wrongly recognized on HSG. In addition, the patients who were found to have tubal block on HSG, laparoscopy helps in finding the cause of infertility like existence of peritubal adhesions and endometriosis that can guide appropriate therapy.
A comparative evaluation of dexmedetomidine and fentanyl with ropivacaine (0.75%) for epidural anesthesia in lower limb orthopedic surgery
Authors: Parashar Preeti , Sharma Manoj Kumar , Sakhareliya Tushar , Raval Dipak L.
Published: June 2021

Background: The aim of the study was to compare sensory and motor block characteristics, sedation score, post-operative analgesia and hemodynamic changes following epidural ropivacaine 15 ml (0.75%) supplemented with either dexmedetomidine (1 µg/kg) or fentanyl (1 µg/kg) in lower limb orthopedic surgery.Methods: The study was conducted in 60 patients of either sex belonging to ASA status I , II or III, aged 20 to 60 years undergoing lower limb orthopedic surgeries. In this prospective, randomized controlled study patients were divided into two different groups. Group RD receiving dexmedetomidine 1 mcg/kg+15 ml ropivacaine (0.75%) and group RF receiving fentanyl 1 mcg/kg+15 ml ropivacaine (0.75%). Each group included 30 patients.Results: The onset of sensory analgesia at shin of tibia was significantly early with dexmedetomidine (251.7±131.9 secs) as compared to fentanyl (503±63 secs) and similarly the onset of motor block was significantly early in group RD (533±239.6 secs) as compared to group RF (712.66±90.25 secs). Time for complete motor blockade was also significantly faster with group RD (57.1±5.1 mins) as compared to (61.5±3.2 mins) in group RF. The mean time for two segment regression was 274.3±43.6 mins in group RD, while 243.2±19.2 mins in group RF which was statistically significant (p<0.05). The decrease in heart rate, systolic, diastolic blood pressure and mean arterial blood pressure was significantly more in group RD as compared to RF.Conclusions: Addition of dexmedetomidine to epidural ropivacaine produces rapid onset of sensory and motor blockade, prolonged duration of analgesia, with better hemodynamic stability as compared to fentanyl, hence being a useful alternative adjuvant.
Comparison of clinical profile of leptospirosis patients during post flood and non-post flood periods
Authors: . Bhagyanath , Jacob Jacob K. , Samuel Suma , Kurup Rakhi R. , Ravindran Reshnu
Published: June 2021

Background: Leptospirosis is a zoonotic infection with high mortality rates. The incidence of leptospirosis is more during floods. The aim of the study was to find the difference in clinical profile of leptospirosis during post flood and non-post flood periods.Methods: This was a cross sectional observational study comparing the clinical profile of leptospirosis patients admitted in Government Medical College Ernakulam, Kerala during the post flood period of 2018 with that of non-post flood period. The data with respect to clinical features and investigations were retrieved from the hospital records.Results: Out of the 42 patients studied 15 were from the post flood period and the rest 27 patients were from the non-post flood period. The mean age in the post flood group was 40 years and that in the non-post flood group 43 years. Myalgia, icterus and calf tenderness was significantly higher in the post flood group. The mean platelet count was significantly lower in the non-post flood period (p value=0.011). Mean serum urea and total bilirubin were significantly higher in the post flood group compared to non-post flood group (p value=0.001). Cardiac complications were seen only among the post flood group.Conclusions: The clinical profile and complications were different in leptospirosis patients during post flood and non-post flood periods. These findings help the treating physicians to formulate different approaches in treating patients during the post flood and non-post flood period.
Amygdalin laetrile-a nascent vitamin B17: a review
Authors: Bora Aparajeeta , Silvia C. R. Wilma Delphine , Mohanty Shrabani , Pinnelli Venkata Bharat Kumar
Published: June 2021

Amygdalin is also called Vitamin B17 and its semi synthetic product is laetrile. It is a natural glycoside nutrient which gained popularity due to wide availability and low cost in treating various diseases. Vitamin B17 is derived from natural food sources and can be used for cancer prevention in alternative medicine practices. This review illustrates the proposed anticancer activity and other effects of amygdalin on different body systems along with a variety of clinical trials on humans and animals with pharmacological, toxicological effects and provides a perspective for further investigation and research.
Correlation of peak expiratory flow rate and single breath count in normal adults
Authors: Bhandare Sushama A. , Rasal Sayali S. , Iyer Saraswati K.
Published: June 2021

Background: Spirometry mandates the requirement of equipments and skilled technicians which may be difficult to acquire in resource limited situations. Thus simple alternative tests like Peak Expiratory Flow Rate (PEFR) and Single Breath Count (SBC) can be used to assess the pulmonary functioning of an individual.Methods: Hundred healthy participants of both genders between the age group of 18-50 years were recruited for this study. They were asked to perform PEFR using the Mini Wright Peak Flow Meter and SBC using a metronome. Three reading were noted and the best of three readings were used for analysis.Results: The mean age and BMI of the participants were 31.54±10.42 years and 23.88±5.14 kg/m2 respectively. The Spearman’s correlation coefficient of PEFR and SBC was 0.7048 with p<0.001 indicating a strong positive correlation.Conclusions: SBC can be used as a simple, convenient and cost-effective alternative to PEFR to assess pulmonary function in adults.
Diagnostic accuracy of transabdominal ultrasound in respect to transvaginal ultrasound in diagnosing ectopic pregnancy in a tertiary care hospital of Kolkata taking histopathology as gold standard: a prospective study
Authors: Das Prasun , Saha Raj , Bhattacharyya Srijak , Basu Swadha Priya , Das Debopriya
Published: June 2021

Background: Ectopic pregnancy (EP) represents an important cause of acute pelvic pain in women of reproductive age. Initial evaluation consists of appropriate history and clinical examination followed by pelvic ultrasonography (US) and hormonal assays. Objective of the study was to measure diagnostic accuracy of TAS in respect to TVS in detecting ectopic pregnancy.Methods: This prospective cross sectional study was done for 1 year duration in Nilratan Sircar Medical College and Hospital, Kolkata. 50 patients with suspected ectopic pregnancy were transferred from Gynae emergency ward and trans-abdominal, transvaginal ultrasound were subsequently performed on each. The results were corroborated with histopathology reports..Results: Diagnostic parameters of TAS in respect to HPE:sensitivity 75.5, specificity-80,PPV-97.1, NPV-26.6 (all in percentages). Diagnostic parameters of TVS in respect to HPE:sensitivity 86.6, specificity-80, PPV-97.5, NPV-40 (all in percentages).Conclusions: Sonography by transvaginal route stood way ahead of trans abdominal scan in terms of all diagnostic parameters to correctly evaluate ectopic pregnancy.
Effectiveness of health communication programme on knowledge regarding prevention of congenital anomalies among parents: a pre-experimental study
Authors: Kumawat Harish K. , Kharadi Suresh , Narayan Dev , Gaur Rakhi , Paliwal Chetna
Published: June 2021

Background: Most commonly severe congenital anomalies (CA) are heart defects, neural tube defects, and Down syndrome where some CA can be prevented. The present study was aimed to improve the knowledge regarding the prevention of CA using a health communication programme (HCP) among parents in selected community area at Udaipur.Methods: Evaluative research approach and pre-experimental, one-group pre-test - post-test research designs were adopted for this study. Using a non-probability, convenient sampling technique, sixty parents were recruited from the selected community area at Udaipur city. Tools include demographic data and a self-structured knowledge questionnaire. Data were analyzed using descriptive and inferential values by IBM statistical package for social sciences (SPSS; version 23) software.Results: Data revealed that there is a lack of knowledge regarding the prevention of CA among parents and this knowledge can be increased by administering HCP on prevention of CA. The mean and standard deviation of post-test knowledge score 23.63±10.5 was higher than the mean and standard deviation of pre-test knowledge score 9.97±13.1.Conclusions: It is required to focus on HCP to improve the knowledge regarding the prevention of CA among parents in the community.
Characterisation of breast lesions: comparison of digital breast tomosynthesis and ultrasonography
Authors: Pandya Madhavi , Jain Abhilasha
Published: June 2021

Background: The main aim of the study was to characterize breast lesions using digital breast tomosynthesis and ultrasound and compare the detection and characterization of lesions between both the modalities.Methods: This was a cross-sectional, observational study that included 150 women who were screened with mammography followed by digital breast tomosynthesis and ultrasound for breast cancer. Patients approaching willingly for screening as per the inclusion criteria underwent mammography and digital breast tomosynthesis followed by ultrasonography. In lesion showing characteristics of malignancy biopsy correlation was done.Results: About half of the patients had type C tissue composition of the breast (50.67%). Most patients were of age between 35 to 44 years (46%). Malignant lesions were similarly detected by both the modalities. Almost all benign cases were also similarly diagnosed. Sensitivity and specificity of ultrasonography was 94.85% and 92%. Sensitivity and specificity for tomosynthesis was 91.86% and 88.24%. Combined testing showed 100% sensitivity, 97.8% specificity, 98.36% positive predictive value and 100% negative predictive value.Conclusions: Combining use of tomosynthesis and ultrasonography can make it possible to detect any small lesion, malignancy in its earliest stage (in situ) as well as few premalignant conditions like atypical ductal hyperplasia, as in few conditions there is possible sonography negative and mammogram positive calcifications are found.
Analysis of the factors affecting the application of critical thinking with the behavior of caring nurses in providing nursing care in RS Royal Prima Medan 2020
Authors: . Yusliana , Ginting Chrismis Novalinda , Chiuman Linda , Erawati Suci
Published: June 2021

Background: Caring behavior is the core in nursing that is indispensable in providing nursing care. One of the ways to improve caring behavior is through the development of critical thinking skills. This study was conducted to determine the effect of applying critical thinking with caring behavior of nurses in providing nursing care at the Royal Prima hospital in Medan.Methods: This study was a quantitative study using correlation research methods with a cross sectional approach to 35 nurses at the Royal Prima hospital in Medan using a simple random sampling technique.Results: The results showed that there was a significant influence between critical thinking and nurse caring behavior (p=0.020; 0.05), the characteristics of respondents who had an effect on nurse caring behavior were training (p=0.025; 0.05), critical thinking variable was a the most influential factor with nurses' caring behavior (OR=3.590).Conclusions: Based on the results of this study the importance of developing new knowledge and skills to improve critical thinking skills and caring behavior.
Clinicopathological study of bacterial lesions in a tertiary care hospital
Authors: Sulochana Sonti , Siddartha Jalavadi Rahul
Published: June 2021

Background: The incidence of bacterial lesions has been on the rise over the decades. In our study, we assessed and studied the spectrum of bacterial lesions retrospectively for one year and their clinicopathological correlation which was diagnosed on histopathological examination in a tertiary health care center.Methods: The present study (retrospective) has been done to analyse the incidence of bacterial infections obtained in the histopathology laboratory and study its clinical correlation and significance. Clinical details of the cases were accessed from biopsy requisition forms and included tissues from various sites in the body. Special stains were done which included acid fast bacilli (AFB), Fite Farraco (FF) stain and gram stain for the identification of bacteria.Results: A total of 318 cases including 288 H. pylori infections, granulomatous inflammation 18, Hansen disease 9 and 3 actinomycosis infections.Conclusions: The histopathological diagnosis of bacterial lesions are of utmost importance as it is more reliable than culture in circumstances of reduced tissue availability. Early reporting is extremely necessary to reduce complications related to bacterial lesions.
Spectrum of morbid anatomy of liver in autopsy cases
Authors: Kataria Sant P. , Singh Narender , Kumar Sanjay , . Mamta , Khanagwal Vijaypal
Published: June 2021

Background: Purpose of autopsy is to learn the truth about the person’s health during and how the person died. Thus, autopsy study provides valuable information about the disease. The main aim of the study was to know the spectrum of morbid anatomical changes in liver autopsy.Methods: A prospective study was carried out on 100 liver specimens of autopsy cases comprising of 37 cases of roadside accidents, 17 of poisoning, 13 of burns, 10 of chronic illness, 7 each of hanging and head injury, 4 of myocardial infarction and 5 of death due to miscellaneous causes. Representative microsections of liver were evaluated for histopathological parameters like congestion, ballooning degeneration, hepatocellular necrosis, sinusoidal dilation, fatty change, bile stasis, fibrosis, lobular inflammation and portal inflammation.Results: Out of total 100 cases, 77 were males and 23 females. Male to female ratio was 3.34:1. Hepatomegaly was seen in 15% of cases. Chronic venous congestion was the main histopathological diagnosis seen in 61% of the cases followed by chronic hepatitis in 12%, normal liver histology in 9%, hepatic steatosis and cirrhosis in 6%, granulomatous hepatitis in 2%, and sinusoidal congestion, portal triaditis and secondary neoplasm in 1% each.Conclusions: Chronic venous congestion, chronic hepatitis, cirrhosis and hepatic steatosis were the common liver diseases identified. Autopsy study is useful to monitor the cause of death and to plan medical strategy. Histopathological examination of the liver is specialized learning tool to study the various diseases of liver which is a great value in improving the diagnosis.
Gender inequality in hands-only cardiopulmonary resuscitation videos on YouTube
Authors: Gulve Reeya N. , Joshi Anuradha R.
Published: June 2021

Background: Bystander cardiopulmonary resuscitation (CPR) is performed at a significantly lower rate in women than in men. YouTube has a significant role in influencing the public’s perceptions about CPR due to its popularity. The aim of the study was to compare the availability, quality, and scientific accuracy of YouTube videos demonstrating hands-only CPR performed on men and woman recipient.Methods: Using a search term similar to hands-only CPR, YouTube was searched for videos in English. This study included the first 60 videos for each search term. All the videos meeting the inclusion criteria were viewed and classified according to gender of recipient of CPR. Views per day were calculated. Videos were scored for quality and scientific accuracy, using Global Quality Scale (GQS) score and comprehensiveness analysis respectively. Mean, standard deviation was calculated for all the variables. Independent t-tests were done to compare the mean values. A p value<0.05 was considered significant.Results: Only 12 (1.7%) videos demonstrated hands-only CPR performed on women as compared to 43 videos (6%) demonstrated in men. There was a statistically significant difference in GQS score, whereas, there was no statistically significant difference in viewer rate and comprehensiveness analysis score based upon the gender of recipient of CPR.Conclusions: The availability and quality of YouTube videos demonstrating hands-only CPR performed on men and women recipients differ significantly. There are limited numbers of videos available for demonstrations of CPR performed on women, and the majority of them are of poor quality and lack scientific accuracy.
Clinicopathological characteristics of colon cancers in a tertiary care centre
Authors: Yadlapalli C. Deepak , Lalith Reddy Kovvuri Hari , Sarma Yerraguntla S. , Nayak Samir Ranjan , Chowdary Gogineni Tarun , Gullipalli Muralidhar , Mushini Venkatesh
Published: June 2021

Background: Colon cancer is a leading cause of increase in cancer incidence and now becoming a major cause of cancer related mortality.Methods: We evaluated data of patients diagnosed with colon cancer and managed under Aarogyasri program between 2013 and 2019 at a tertiary care cancer hospital in Rajamahenderi, Andhra Pradesh, India. We collected data regarding demography, clinical presentation, subsite, histology, stage and treatment.Results: A total of 142 patients with colon cancer were managed. The mean age was 53.6 years with males accounting for 57%. Most common clinical presentation was abdominal pain followed by vomiting. Most common histology was well differentiated adenocarcinoma. Left sided colon tumors accounted for 47%. Most common stage at presentation was stage III.Conclusions: Our data of colon cancer was different from that described in the western countries. Young age presentation, higher mucinous and signet ring carcinomas and advanced stage presentation were reported in our study. Socioeconomic factors, inadequate health care access might account for some of these differences.
Cephalosporin graded challenges approach in community–acquired pneumonia patient with a history of penicillin allergy
Authors: Suryana Ketut
Published: June 2021

Community-Acquired Pneumonia (CAP) is an acute pulmonary parenchyma infection that acquired in the community. Diagnosis based on clinical manifestations, chest X-ray (CXR) and microbiological diagnosis test (lung aspirates culture). Recently there was advance in antimicrobial treatments of CAP and a microbiological diagnostic test is essential to ensure antimicrobial treatments. In the other hand microbiological diagnostic test does not achieve all of the pneumonic cases. Therefore, antimicrobial treatment should be empirically performed to avoid the delay in establishing appropriate treatment related with the mortality. By administering combination antimicrobial will achieve a better outcome than a mono-therapy. For patients with history of penicillin allergy, though the risk of cephalosporin allergic cross-reactivity is low, a greater awareness is still needed, so a graded challenge approach could be considered. Herein we present a case report of a female, 20-year-old, hospitalized due to CAP, and also had a history of penicillin allergy. She was treated by levofloxacin 750 mg IV q 24 hour and cephalosporin (ceftriaxone) 1 g IV q 12 hour with a Graded challenge approach. Although it does not a novelty, we hope it would remind the health care that a Graded challenge could be considered as an approach of administering cephalosporin in patient who has an experiece of penicillin allergy.
Multiple cavitating cannon ball metastasis with primary adenocarcinoma lung: a rare case report
Authors: Khan Nafees Ahmad , Firdaus Huma , . Salauddin , Shameem Mohammad
Published: June 2021

Multiple large round well circumscribed pulmonary nodules in lungs are known as cannon ball secondaries. There are malignant and non-malignant causes of cannon ball secondaries. In case of malignancy, they represent classical haematogenous dissemination to the lungs of a primary malignant tumor. Secondaries to lung from renal cell carcinoma and choriocarcinoma are necrotic. The less common primary tumors causing cannon ball secondaries to lung includes prostate carcinoma, synovial sarcoma, endometrial carcinoma and some gastrointestinal malignancies. Here we presented a very rare case, maybe first of its kind of multiple cavitating cannon ball secondaries where primary malignancy was in lung itself which was EGFR positive adenocarcinoma lung. This case was also rare as cavitation is largely a feature of squamous cell carcinoma lung both of primary and metastatic lung malignancy.
Posterior reversible encephalopathy and status epilepticus in Takayasu arteritis
Authors: Kumar Munish , Anand Vishal , Nadeem Rashid
Published: June 2021

Takayasu arteritis (TA) is a rare, systemic, chronic inflammatory condition causing granulomatous vasculitis of medium-sized and large arteries of unknown etiology. A possible relationship between Takayasu arteritis and tuberculosis has been suggested but not proven until now. Posterior Reversible Encephalopathy Syndrome (PRES) and seizure are rare complications. We report a case of Takayasu arteritis with lymph node tuberculosis presented with status epilepticus and Posterior reversible encephalopathy syndrome.
A rare presentation of perioperative myocardial infarction as a consequence of stent thrombosis in non-cardiac surgery
Authors: Kadakia Aditi P. , Koli Deepak C. , Mehta Hemant H.
Published: June 2021

Perioperative myocardial infarction (PMI) is a major cause of long term morbidity and mortality associated with non-cardiac surgery. In patients with recent coronary artery stent placement undergoing non-cardiac surgery perioperative management is always challenging. We reported an interesting case of a 67 year old man posted for head neck surgery with recent history of angioplasty with drug eluting stent developing perioperative MI and the challenges faced by an anaesthesiologist.
The role of lung ultrasonography in evaluation of COVID-19 pneumonia
Authors: Erenler Ali Kemal , Komut Seval , Baydin Ahmet
Published: June 2021

After a few months it emerged in Wuhan (China), Coronavirus Disease 2019 (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) was declared as a pandemic by the World Health Organization (WHO). Diagnosis of the disease is mainly based on real time polymerase chain reaction (PCR) test by nasopharyngeal swab. However, due to excess of numbers of false-negative PCR test results, chest computed tomography (CT) is commonly used as a supplementary modality. However, CT has some disadvantages. Firstly, a normal chest CT scan does not exclude the diagnosis of COVID-19 pneumonia. Additionally, the radiation exposure and a weak diagnostic value are other challenges. When the infection is limited to upper respiratory system or performed in the early stage, false-negative results may be obtained on CT scan.  Recently lung ultrasonography (LUS) has emerged as a easy-to-use, cost-effective and radiation-free tool in diagnosis, management and follow-up of COVID-19 pneumonia. In this narrative review, our aim is to clarify the utility of LUS in COVID-19 pneumonia with its advantages and disadvantages. We also aimed to guide clinicians to use LUS as a practical tool.
Cerebral malaria: a lethal complication of a common tropical infection
Authors: Parasher Anant , Chowdhary Rupak , Bez Jeplin
Published: June 2021

Cerebral malaria (CM) represents a deadly neurological complication associated with Plasmodium falciparum infection. It is defined as an unarousable coma or a deep level of unconsciousness in the presence of a P. falciparum parasitemia, the diagnosis confirmed after exclusion of other common causes of coma such as hypoglycemia, septicemia, metabolic derangements and bacterial and viral meningitis/encephalopathies. Mortality is high and some surviving patients sustain neuronal injury which manifests as long-term neuro-cognitive impairments. Microscopy of Giemsa-stained blood smears remains the gold standard for confirmation of malaria diagnosis. The purpose of this review was to summarize the updated knowledge on the disease, its presentation, complications and neurological sequelae and the presently available newer and experimental adjuvant therapies. For this review, a PubMed search was conducted for articles and case reports from 1968 to 2020 containing the keywords cerebral malaria, P. falciparum, neurological impairment, neurocognitive defects and artesunate combination therapy. The treatment includes specific antimalarial therapy, supportive therapy for multi-organ dysfunction and management of associated complications. Prompt and rapid stabilization of the patient, adequate fluid supplementation and correction of electrolyte imbalance remain the most vital supplementary interventions in these cases, along with early induction of primary parenteral antimalarial therapy in the form of artemisinin based combination therapy (ACT) or quinine. Neurological sequelae including seizures are frequently observed in many treated and recovered cases, with some patients having to endure long term neurocognitive defects.
Urinary tract infection in children presenting with diarrhea
Authors: Singraiah Avinash , Hegde Pavan
Published: June 2021

Background: Urinary tract infection (UTI) are the 3rd most common bacterial infection in infants and young children in developing countries after those of respiratory and gastrointestinal tract infection. Because of nonspecific signs and vague symptoms in very young children, they may remain unrecognized. Rapid evaluation and treatment of UTI is important to prevent renal parenchymal damage and renal scarring that can cause hypertension and progressive renal damage. Since gastroenteritis is rampant in developing countries demonstration of an association between UTI and diarrhea will be of clinical significance. The objective of this study was to estimate the prevalence of UTI in children presenting with diarrhea and to identify the clinical co-relates which may guide to identify children with UTI.Methods: This was a descriptive observational study done in 120 children meeting the inclusion and exclusion criteria, who were admitted in the paediatric ward in father Muller medical college hospital for a period of 1 and a half years. After obtaining an informed consent, a detailed clinical examination was performed on children meeting the inclusion criteria and the data was entered to the preformatted sheet. Urine samples were obtained from all the patients by clean catch mid-stream urine sample, following which urine culture was done for all the children.Results: In the present study, out of 120 children presenting with Diarrhea 17% had UTI. E. coli (15 cases) was the most common organism isolated in urine culture followed by Enterococcus. Out of 20 UTI cases, 15 were in the age group of 6 months to 1 year followed by 4 cases among 1-3-year age group.18 out of 20 UTI cases were females. Male:female ratio of UTI patients was 1:9.Conclusions:  UTI in young children can present with diarrhea and other nonspecific symptoms. Children presenting with diarrhea need to have a urine analysis and urine culture for the confirmation of UTI, so that long term complications like renal parenchymal damage and hypertension can be prevented.
Symptomatic neonatal SARS-CoV-2 infection in a tertiary care teaching hospital: an observational prospective study
Authors: Ambike Deepali A. , Haribhakta Sandhya V. , Soni Seema P. , Mundlod Suryakant , Sayyad Rijwana , Bijraniya Komal
Published: June 2021

Background: The likelihood of newborns acquiring severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) from infected mothers has raised concerns among families and clinicians worldwide. The disease seems to be mild in children and, to date; there are few reports in neonatal population. The aim of the study was to study the Prevalence of Neonatal SARS-CoV-2 infection in a tertiary care teaching hospital. The objective of the study was to study correlation of clinical features and laboratory parameters among SARS-CoV-2 positive neonates.Methods: Prospective observational study conducted in a dedicated COVID-19 tertiary care hospital and Postgraduate Institute in Pune, Maharashtra between May 2020 and August 2020 on a sample size of 55 COVID suspect neonates as they were admitted and diagnosed during the pandemic.Results: Out of 250 COVID positive mothers admitted, 55 COVID suspect neonates were admitted as their mothers were symptomatic. Among 55 suspect neonates, 11 turned out to be positive (20%). Out of 11 COVID positive neonates, tachypnea with requirement of non-invasive O2 in 2 (18%), feeding intolerance in 2 (18%), fever in 2 (18%) rash 1 (9%) was seen. out of the 11 COVID positive neonates admitted, 45% had elevated D-Dimer levels, 36% had elevated Leucocyte counts, 27% each had raised serum ferritin and fibrinogen levels and 18% had raised CRP Levels.Conclusions: We conclude that inspite of the first wave of COVID seen in neonates which was rare then, clinical and laboratory markers showed a good co-relation in our study in all neonates who were COVID positive but there was no radiological co-relation in any. However, all recovered with symptomatic treatment without any specific COVID treatment.
Vitamin D deficiency as a risk factor for COVID-19 infection in children
Authors: E. Adarsh , Jayanna Malavika , Reddy Neethu N.
Published: June 2021

Background: Vitamin D deficiency is a major public health problem in all age groups. Through its immunomodulatory, anti-inflammatory and antioxidant effects it is shown to have a protective effect in COVID affected children. The objective of the study was to evaluate vitamin D deficiency as a risk factor for developing COVID-19 infection in children and to study the relationship between vitamin D deficiency and the clinical findings in COVID-19 positive children.Methods: A retrospective study of all COVID positive children aged 1 month to 15 years admitted to COVID Paediatric ward of Rajarajeshwari Medical hospital from July 2020-November 2020. All COVID positive children confirmed with RTPCR of age group 1 month to 15 years will be included in the study the age at admission, clinical and laboratory data, and 25‐hydroxycholecalciferol (25‐OHD) levels will be recorded. Patients diagnosed with COVID 19 are divided into 2 groups those with deficient and insufficient vitamin D levels were determined as group 1 and patients with normal vitamin D levels as Group 2. Those with vitamin D Levels below 20ng/ml were determined as group 1 and those with >20 ng/ml as group 2. The various clinical outcomes and laboratory parameters were compared between the two groups.Results: Patients with COVID 19 had significantly lower vitamin D levels 22.39±6.27 (p≤0.0001). Patients in group A that is vitamin D deficient and insufficient group had higher levels of ferritin (p≤0.0001).No significant difference was found between other clinical and laboratory parameters between group 1 and group 2.Conclusions: This is one of the first to evaluate vitamin D levels and its relationship with clinical findings in paediatric patients with covid-19. Although vitamin D does not play a role in the pathogenesis of COVID-19 we do believe its putative role in preventing and treating the disease The results suggest that vitamin D levels may be associated with the occurrence and management of the COVID-19 disease by modulating the immunological mechanism to the virus in paediatric population.
Morbidity profile and outcome of neonates admitted in a secondary level SNCU in district Udhampur in Jammu and Kashmir
Authors: Kumar Deepak , Gupta Sonika
Published: June 2021

Background: Infant mortality is an important indicator of healthcare system of the country and neonatal mortality contributes a major proportion to infant mortality. So this study was undertaken to study the demographic and morbidity profile and outcome of neonatal care in our area.Methods: This study, a retrospective observational study was conducted in district hospital Udhampur which caters to a population of around 5.5 lakh. Case records of all SNCU (special newborn care unit) admissions between January 2018 to December 2018 were analysed in a pre-designed proforma which included identity, clinical and demographical variables, admitting complaints, diagnosis, treatment, hospital stay and outcome.Results: Of the total 364 neonates with an average birth weight of 2.67 kgs, 70.60% were of weight over 2.5 kgs. The most common diagnosis included sepsis (27.74%), neonatal hyperbilirubinemia (13.18%) and RDS (respiratory distress syndrome) (10.43%). Discharge rate was 60.71% with mortality of 3.26% and referral rate of 31.31%.Conclusions: Sepsis and RDS as the most common cause of morbidity in our setup indicate that improvement in community as well as hospital hygiene along with improved antenatal care and maternal health needs to be stressed upon to prevent them.
Study of procalcitonin in neonatal sepsis with blood culture in suspected sepsis in North India
Authors: Jaipal Munna Lal , Shrivastava Ajit Kumar , Choudhary Prema Ram
Published: June 2021

Background: Sepsis can occasionally be difficult to demonstrate, and its difference from non-infectious conditions in critically ill patients is often a challenge. Serum procalcitonin (PCT) assay is one of the biomarkers of sepsis. The aim of the study was to investigate the value of procalcitonin, in the early diagnosis of neonatal sepsis.Methods: A cross-sectional study was conducted at tertiary care hospital in New Delhi. It included all neonates with clinical signs of sepsis. The neonates were divided into two groups as sepsis, and healthy neonates. The PCT level was measured by using ELISA technique and compared between the two groups. Statistical analysis was performed using SPSS windows version 20.0 software.Results: In this study total number of patients included 350, out of which 175 were clinically suspected sepsis cases and 175 were healthy controls. 68 (39%) neonates were show positive blood culture and 107 (61%) neonates were representing negative blood culture report in study group. The mean serum value of PCT was significantly (p<0.001) higher in sepsis neonates. The serum PCT value was significantly increased in neonate’s sepsis with positive blood culture (p<0.001) and negative blood culture (p<0.001) as compared to healthy neonates.Conclusions: It is concluded from this study that the PCT assay was established to be a valuable biomarker of sepsis in this study. The assay might be performed and reported quickly and gave precious information before availability of culture results. This might assist in avoiding unnecessary antibiotic therapy.
A rare presentation of KBG syndrome
Authors: Mohan Dhanya Soodhana , Nagarajappa Vani Hebbal
Published: June 2021

KBG syndrome is a rare, genetic disorder characterizedby cognitive impairment, short stature, skeletal (mainly costovertebral) anomalies and a distinct craniofacial appearance. It is usually autosomal dominant in nature with a wide range of expressivity in its clinical features. We describe what appears to be the third case reported from India.The aim of this article is to review familiar clinical features and to highlight the endocrine management of KBG syndrome. We are hereby reporting a case of 17 year 10 months old adolescent who had neurocognitive impairment and a characteristic appearance, which led to the diagnosis of this genetic condition.
Jarcho-Levin syndrome term baby with recurrent apnea
Authors: Devadas Sahana , Govindarajan Varun , Hanumanna Anil Kumar , Gowda Chethana , Kariyappa Mallesh
Published: June 2021

Jarcho-Levin syndrome or spondylocostal dysostosis, is a rare axial skeleton anomaly due to mutation in genes involved in somitic segmentation during embryogenesis. We describe a term, newborn baby with antenatally detected midthoracic lordotic deformity with skeletal features of multiple rib anomalies and vertebral defects, but with normal limb lengths. Baby had recurrent apnea requiring non-invasive ventilation and was successfully weaned to room air within 2 days. This syndrome is underdiagnosed and we wish to highlight the simple process involved in making a clinico-radiological diagnosis.
Multi-system inflammatory syndrome presenting with refractory shock in an infant, temporally associated with SARS-CoV2 infection
Authors: Devadas Sahana , Ganesh Shruthi , Govindarajan Varun
Published: June 2021

Children with COVID-19 largely remain asymptomatic or mildly symptomatic with gastroenteritis or influenza like presentation. However, few of them go on to develop features of multi-system inflammatory syndrome secondary to dysregulated cytokine release, resulting even in death.  We report a 45 days old infant who presented to us with fluid unresponsive shock following protracted vomiting few hours prior to arrival. Eight days prior, child was admitted in COVID Isolation centre with mild illness, after testing positive on rapid Antigen Test and discharged 3 days later. Child when brought was severely acidotic and hence electively intubated. Shock did not improve even following multiple boluses and inotropic support on mechanical ventilation. Encephalopathy, myocardial dysfunction and acute kidney injury, with elevated inflammatory markers post COVID-19 suggested multi-system inflammation syndrome in him. The infant deteriorated rapidly and succumbed even before targeted therapy could be initiated. MIS-C presenting with refractory shock is increasingly being reported in pediatric age group and these children rapidly deteriorate without early recognition and treatment. Clinicians need a heightened suspicion for cytokine storm related complications and institute early immune-modulative therapy, especially during the present COVID-19 pandemic.
The knowledge and perception about COVID-19 among three tribal population of Khagrachari hill district, Bangladesh: a community based cross sectional study on ongoing outbreak
Authors: Morshed Mohammad M. , Tripura Soumik , Hossain Mohammad A. , Rahman Mohammad M. , Mahmud Asif , Somadder Pratul D.
Published: June 2021

Background: The ongoing pandemic COVID-19 is a new disease that provides a little bit of knowledge. Modern society is getting further information about this pandemic. But the people who are far away from development may not get proper learning and instruction to defect the new virus. Keep this reality in mind, and we aimed via this study to find out the precipitance and knowledge about COVID-19 of the tribal community from Khagrachari district, who are backward and less developed people of Bangladesh.Methods: Simple random sampling method is used for selecting responders. A willing responder was interviewed using a per-developed questioner and 348 responders (Chakma-131, Marma-106 and Tripura-111) across the Khagrachari district. All statistical analyses were done by SPSS version 20.Results: COVID-19 is a viral disease known by 87.0% Chakma, 85.0% Marma and 81.1% Tripura alongside 54.2%, 53.8%, and 60.4% Chakma, Marma Tripura; respectively think that COVID-19 is a deadly disease. Using face masks as a safety measurement about 87% of Chakma, 85% of Marma, and 81.1% of Tripura but using hand sanitizer or shop was slightly low compared to facemask use. Although they were eager to take a vaccine at a particular time, it seems they are not optimistic about the vaccine's efficacy.Conclusions: Overall, the tribal population has sufficient knowledge about COVID-19 and has a good tendency to maintain proper health hygiene to prevent COVID19 infection.
Calorie labelling on the menu: extent and disparities in use at sit down restaurants in the United States
Authors: Mbogori Teresia N. , Freeland Kylan B.
Published: June 2021

Background: Obesity remains a major health concern all over the world. The Food and Drug Administration in 2018 enacted a policy that required all food chain restaurants with more than 20 establishments to include calorie information on their menus. Very few studies have assessed the effects of this policy since its enactment.Methods: A secondary data analysis was conducted using the Health Information National Trends Survey (HINTS-5 Cycle 3), a nationally-representative survey administered by the National Cancer Institute (NCI). Data were collected using telephone interviews between January and May 2019. Regression models were used to determine the relationships between demographic and health related variables and the use of calorie information on the menu.Results: Forty six percent of the participants (n=5438) stated that they noticed calorie information on the menu. Among those who noticed the information, 65%, 37% and 44% reported that they ordered fewer calories, fewer items, or smaller sizes respectively, while 4%, 2%, and 2% reported that they ordered more calories, more items or larger sizes. Men were less likely to report seeing calorie information on the menu as compared to women (OR 0.70; CI: 0.56-0.89). Similarly, when compared to those between 18-45 years old, those 75 years and older were 33% less likely to report seeing this information (OR: 0.67 CI: 0.46-0.98). The odds of noticing calorie information on the menu increased with increase in education and income.Conclusions: Gender, age education, and income disparities exist in the use of calorie information among restaurant goers in the US. More targeted education is needed to ensure that the policy attains its intended goal.
Socio-cultural factors, adoption of continuum of care practices and occurrence of puerperal sepsis amongst mothers in Kericho County, Kenya
Authors: Kipkirui Beatrice Chelangat , Keraka Margaret , Nyagero Josephat
Published: June 2021

Background: This article examined socio-cultural factors and how they influence continuum of care practices and subsequently occurrence of puerperal sepsis amongst postnatal mothers. A cross-sectional research design and a mixed approach were adopted. Positivism paradigm guided the article. The study variables included socio-cultural factors, continuum of care practices and occurrence of puerperal sepsis. The study was conducted in Kericho County where participants were postnatal mothers and healthcare workers.Methods: A sample of 385 postnatal mothers and 6 health care workers was considered by the study. A structured questionnaire and focus group discussion guide were used in data collection. The tools were pretested with the view of assessing their validity and reliability. The collected data were analyzed with the aid of the Statistical Package for Social Sciences tool. Descriptive and inferential statistics were used in the analysis.Results: It was revealed that cultural factors such as religion, beliefs and services of midwives influenced adoption of continuum of care practices by postnatal mothers in Kericho County. Common puerperal sepsis that affect the aforesaid mothers included complications during PN period, pelvic pain, fever, foul-smelling discharge as well as involution of the uterus.  Conclusions: The article concludes that that socio-cultural practices are deeply entrenched in communities residing in Kericho County. It is recommended that cultural practices, norms and beliefs which dissuade mothers from seeking modern health services ought to be discouraged in order for the mothers to increase their adoption of continuum of care practices hence reducing occurrence of puerperal sepsis.
Epidemiological philosophy of pandemics
Authors: Raham Tareef Fadhil
Published: June 2021

Background: During  the COVID-19 pandemic, clinicians have struggled to understand why case fatality rates vary among countries. The role of clusters of infections in COVID-19 severity is well known before, furthermore the case overload was attributed to increased COVID-19 mortality in certain locations. The background theory in this study was the  already existing evidence that an increased viral load (density of infection) leads to more fatalities. The aim of this study was to find the correlation between high number of cases and high mortality (MR) in different countries and to find the correlation of MR with case fatality rate (CFR).Methods: We chose thirty-one countries with testing coverage levels of >400,0000 tests/M and populations greater than 1 million inhabitants. We used ANOVA regression analyses to test the associations.Results: There was a very highly significant correlation between MR and the total number of cases/million population inhabitants (M) (p=0.0000). The CRF changed with a change in the MR. A very high positive influence of the COVID-19 MR on the CFR (p= 0.0000).Conclusions: Increased number of cases per million inhabitants is associated with increased MR. Increased MR is associated with increased CFR. These findings explain variable mortality rates in relation to CFR and to the number of cases/M. This evidence gives us an idea of the behavior of epidemics in general. This  will help in the development of infection control policies.