bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and risk factors for pre-hypertension and hypertension amongst school going adolescents in a rural area: an observational study
Authors: Fadnis Vidya P. , Poyekar Subhash P. , Ambike Deepali A. , Lazar Shraddha
Published: May 2020

Background: Hypertension seen in childhood can progress into adulthood thereby increasing morbidity and mortality due to cardiovascular diseases in adulthood. Younger the age of onset of hypertension, the greater is the reduction of life expectancy if left untreated. With increase in incidence of elevated blood pressure and hypertension in children; it is important to measure and record blood pressure along with weight and height at least once a year as recommended by National Institute of Health (NIH) task force of USA. Aims and objectives was to determine the prevalence of pre-hypertension and hypertension and to identify the associated risk factors for them in school going adolescents.Methods: An observational/cross-sectional study conducted among adolescents studying between Std 5th to Std 9th. A total 507 students belonging to the age group of 10-17 years were examined. Anthropometric measurements were taken to calculate Body Mass Index (BMI) and Blood pressure was measured by using mercury sphygmomanometer. Gender, age and height were considered for determining hypertension.Results: Amongst the 507 children, prevalence of pre-hypertension was 15.4% and that of hypertension was 10.85%. The study also revealed statistically significant higher prevalence of hypertension in males than in females. Family history of hypertension and dietary habits, obesity were positively correlated with higher prevalence of hypertension. A higher prevalence of pre-hypertension and hypertension was seen in the present study group compared to the similar studies in the state.Conclusions: The prevalence of pre-hypertension and hypertension among adolescent school children was 15.38% and 10.8% respectively. Possible risk factors for this current trend may be the increasing sedentary life style, faulty eating habits, and increased fat/salt contents of diet. The results suggest the need for more public awareness and prevention programs for childhood obesity and hypertension.
Serum procalcitonin in pediatric bacterial meningitis versus pediatric non bacterial meningitis: open label prospective study
Authors: Patel Vinaykumar K. , Gosai Mehul M. , Gohil Jayendra R. , Patel Rupal V.
Published: May 2020

Background: Several studies have shown potential value of serum Procalcitonin level (SPCT) for diagnosing and differentiating bacterial meningitis (BME) from other, but the results were inconsistent.Methods: Children from birth to 12 years, with clinical suspicion of meningitis were enrolled. Clinical and laboratory information was collected and cases were classified according to pre decided case definition (based on clinical and laboratory) as bacterial or non-bacterial meningitis (NBME).Results: Out of 4393 admission (2016-17) 60 patients were selected for final study (on basis of case definition) which were equally distributed in both group (BME and NBME) in terms of age and sex (p 0.97). 29/41 (70%) patients of pyogenic meningitis had high level of SPCT which was significant, whereas only 2/19 (10.5%) patients of NBME had high level of SPCT. Although SPCT seems to be the good marker in differentiating between BME and NBME, SPCT level specificity (89%) in the diagnosis of BME was not higher than CSF protein level (94%) and CSF glucose level (94%).Conclusions: Measurement of plasma SPCT levels are of value in differentiating BME & NBME in children. However, SPCT should not be used as single sole diagnostic marker of BME if CSF protein and glucose are available. CSF WBC Count alone should not to be used in diagnosis of BME as specificity is low. This study needs to be validated with a larger sample size and microbiological confirmation of bacterial disease.
Comparison of clinical and lab profile between steroid sensitive and steroid resistant nephrotic syndrome at onset of disease and evaluating predictors for developing steroid resistance in nephrotic syndrome
Authors: Palaniyandi Anitha , Palaniyandi Subramani
Published: May 2020

Background: Nephrotic syndrome is a notable chronic disease in children. The objective of this study was to compare the clinical and lab profile between steroid sensitive nephrotic syndrome and steroid resistant nephrotic syndrome at the onset of disease. Certain parameters were tested if they could be significate predictors of developing steroid resistance at the onset of first episode of nephrotic syndrome.Methods: Retrospective observation study done children 1-12 years diagnosed with nephrotic syndrome in Sri Ramachandra Medical College and Hospital, Department of Paediatrics, Chennai. Sample size 150. Period of study Jan 2013- Dec 2015. Variables considered were age at onset, sex, parental consanguinity with essential lab parameters done at the onset of nephrotic syndrome proteinuria, pyuria, microscopic hematuria, urine protein creatinine ratio, serum creatinine, serum triglycerides and serum albumin. Children less than 1 year of age, cases with secondary causes of nephrotic syndrome and steroid dependant nephrotic syndrome, children with incomplete records were not included in this study. 150 cases who fulfilled the study criteria were included in this study.Results: 75 cases of steroid sensitive nephrotic syndrome (SSNS) were compared with an equal number of steroid resistant nephrotic syndrome (SRNS). 85 children had onset of disease before 3 years of age and majority had 3+ proteinuria and males predominated in both the groups. The overall consanguinity rates were higher among SRNS group. Triglyceride level >300 mg/dl predominated in SRNS group along with a higher severity of hypoalbuminemia when compared to SSNS group. None of the parameters tested were significant predictors of developing SRNS subsequently.Conclusions: Comparing steroid sensitive with steroid resistance nephrotic syndrome, no lab parameter could identify the risk of a child developing steroid resistance subsequently. This could be a field of interest in future studies that could predict the development of steroid resistance at the onset of first episode of nephrotic syndrome itself.
Thymus size and its changes during treatment of children with severe acute malnutrition
Authors: Selvaraj Stalin , Venkatasamy Seenivasan , Sinnathambi Sathyaseelan
Published: May 2020

Background: The study was conducted to radiologically demonstrate increase in thymus size with clinical recovery following nutritional rehabilitation in children with severe acute Malnutrition and to correlate the improvement with anthropometric and biochemical parameters.Methods: Prospective observational study was conducted in 60 children in the age group of 6months to 24 months with severe acute malnutrition. Children with severe systemic illnesses were excluded from study. After obtaining informed consent from parents, history focusing on demography, perinatal events, nutrition including breast feeding and immunization status were recorded. Anthropometric parameters were measured. All relevant blood investigations and ultra-sonogram of the chest for thymus size were done. All children were followed up during the course of hospital stay till discharge and were also followed up after 2 months. Relevant blood investigations and ultrasonogram of chest for thymus size were also done during follow up.Results: The difference in means of thymic area by imaging at admission and at discharge (p and lt;0.0001) and at admission and after 8 weeks (p and lt;0.0001) were statistically significant. The increase in weight, length, weight for length, mid upper arm circumference, hemoglobin, total protein, serum albumin, serum globulin from admission to discharge and from discharge to 8 weeks after admission was statistically significant.Conclusions: Thymus size can be used as a marker of immunological dysfunction in severe acute malnutrition and as a marker of severity of the illness. The thymus size was found to be increasing in size during nutritionally rehabilitation and recovery from the illness. Correlations between anthropometric parameters and thymic size are not robust in under-nourished state and during nutritional rehabilitation.
Pattern and prevalence of metabolic syndrome in obese adolescents aged 10-18 years: a community based study
Authors: Jothilakshmi K. , Vinoth Vadivel , Kannappan Suvetha
Published: May 2020

Background: The prevalence and magnitude of childhood obesity is increasing in pediatric age group. Incidence of metabolic syndrome is high among obese children and adolescents leading to increased risk of cardiovascular morbidity in long term. For this reason, recognition of metabolic syndrome in obese children is of great importance.Methods: This study was a cross-sectional study carried out among children aged 10-18 years from both urban and rural schools in Coimbatore. Children were screened, sample for metabolic studies collected after consent and analyzed.Results: Total 1582 children in the age group of 10-18 years were screened. 300 children were recruited. Among the studied group, 19.3% were overweight, 30.7% were obese. Metabolic syndrome was present in 55.1% of obese and overweight children. Hyperinsulinemia was present in 30% of obese children.Conclusions: This study done in adolescent school children showed a strong association between obesity and early onset of metabolic syndrome. Early intervention with lifestyle modifications is strongly recommended to prevent long term cardiovascular morbidity.
Incidence, bacteriological profile and risk factor analysis of neonatal sepsis in a peri urban set up of North India
Authors: Upadhyay Shalini , Chakravarti Anita , Bharara Tanisha , Agarwal Priti
Published: May 2020

Background: The high incidence and antimicrobial resistance among the pathogens causing neonatal sepsis is alarming. In addition to substantial immediate mortality, survivors of infections in the neonatal period are at increased risk of long-term disability. The present study was conducted to know the bacteriological profile and risk factors associated with culture proven neonatal sepsis in a peri urban population.Methods: This study was conducted over a period of 4 year (2015-2019). On clinical suspicion, blood culture specimens were sent to microbiology laboratory. The organisms isolated from blood cultures were identified and tested for antimicrobial susceptibility. As part of infection control practices, environmental samples from the neonatal intensive care units were tested.Results: Of 907 blood cultures of neonates received in the microbiology laboratory, 20.7% were culture positive. Majority of the episodes occurred at or before 72 hours of life (81.4%). 54.3% were Gram positive cocci including Coagulase negative Staphylococci, Staphylococcus aureus and Enterococcus spp. The common Gram-negative pathogens included Escherichia coli, Klebsiella spp. and Pseudomonas spp. Common risk factors involved were preterm birth, low birth weight, premature rupture of membrane, prolonged labour and iatrogenic causes.Conclusions: The early signs of sepsis are often subtle and nonspecific. Therefore, a high index of suspicion is needed for early diagnosis. Rapid, reliable detection and appropriate case management can save lives of many new-borns.
A study to identify knowledge, attitude and practices prevalent amongst the caregivers of children below five years presenting with acute diarrhoea in a tertiary care centre
Authors: Gohiya Poorva , Shrivastava Varsha , Mandavi Swetleena , Dwivedi Rashmi
Published: May 2020

Background: Diarrhoeal infections are the second leading cause of death worldwide in under-five children covering 9% of the total deaths. The objective of the study was to assess and compare mothers’ knowledge, attitude and practice regarding prevention and management of diarrhoea in children.Methods: A cross-sectional hospital-based observational study was conducted in a tertiary centre amongst all 356 children between age group 2 months to 60 months admitted with acute watery diarrhea. A pre-tested questionnaire and face-to-face interviews with the mothers was used as a data collection tool.Results: Most of the mothers 282 (79.2%) were 20-30-year-old, 51.4% were illiterate, 57.3% were unemployed and 27.2% were daily wage labourers. 44.6% people came from rural background and 78.9% belonged to lower socio-economic strata. 30.3% were exclusively breastfed and 69.7% were on top feeds. Animal milk was taken by 62.1%, 46.6% had dilution and 50.6% used bottles for feeding. 70.5% of mothers washed their hands at the time of feeding of their child, 93.8% mother covered food in their houses while only 26.7% of mothers gave freshly cooked food. Mother’s outlook on various aspects of diarrhea was sought. Very few mothers considered poor sanitation (2.5%) andcontaminated water (12.6%) as a source of diarrhea. Only 8.7% mothers knew about the role of ORS in diarrhea and maximum (53.4%) considered that diarrhea could not be avoided by any measure.Conclusions: Mother’s knowledge regarding causes, management and prevention of diarrhea needs to be upgraded to allow better utilisation of health resources by the families.
A study to determine association of the interval between seizure and delivery with the APGAR scores and perinatal asphyxia of the neonates of eclamptic mothers of a rural tertiary care hospital in Eastern India
Authors: Bandyopadhyay Santanu , Burman Medhatithi , Datta Asok Kumar
Published: May 2020

Background: Eclamptic seizure not only affects maternal health but may predispose low APGAR scores and development of perinatal asphyxia and thereby influence perinatal mortality too. This study was carried out to evaluate the correlation of the interval between the onset of seizure and delivery with the APGAR scores (at 1 minute and 5 minutes) and perinatal asphyxia of the neonates of the eclamptic mothers.Methods: A prospective, cross-sectional, observational, epidemiological study was conducted from April, 2012 to March, 2013 at a tertiary-care Government teaching hospital catering rural population of Eastern India. The participants comprised of 100 consecutive admitted eclamptic mothers and neonates born to them.Results: Majority of mothers were unbooked, primigravidae (86%), aged below 20 years (66 %). Significant inverse correlation was observed between seizure to delivery interval and Apgar scores (1 min and 5 minutes), while seizure to delivery interval >12 hours was found to be a significant risk factor for perinatal asphyxia (OR =16.824, 95% CI = 5.107-55.424, p <0.001).Conclusions: Measures to minimise the interval between the onset of seizures and delivery will decrease the incidence of perinatal asphyxia and perinatal mortality of neonates of eclamptic mothers in rural areas.
Urinary uric acid or urinary creatinine ratio as a non-invasive marker for perinatal asphyxia
Authors: . Siddharth , Rai Preeti Lata , Prasad P. L.
Published: May 2020

Background: Perinatal asphyxia is amongst the common problem of neonates and there exists a significant contribution to the neonatal morbidity and mortality. It is observed as a common and a vital cause of the preventable cerebral injury. The prediction of the perinatal asphyxial outcome is very important but dreadful. There is a limited role for APGAR score to predict the immediate outcome, like HIE and the long-term neurological sequelae observational error may happen in APGAR. But the biochemical parameters can truly be relied upon. This study was done to assess urinary uric acid/urinary creatinine ratio (UA/Cr) as a non-invasive marker for perinatal asphyxia and co-relate its absolute value to the degree of the perinatal asphyxia.Methods: In this prospective case control study conducted in the Pediatrics Department of Shri Ram Murti Smarak Institute of Medical Sciences between Nov 2017 to May 2019, 42 asphyxiated and 42 non-asphyxiated newborns were included. Detailed history and assessment were for all the enrolled newborns. Spot urine samples were sent for the uric acid and creatinine estimation. Results were documented, and statistical analysis was performed.Results: Urinary uric acid to creatinine ratio used as additional non-invasive, early and easy biochemical marker of the birth asphyxia that biochemically supports severity grading and clinical diagnosis of the asphyxia by APGAR score.Conclusions: The ratio of the urinary uric acid and creatinine enables rapid and early recognition of asphyxial injury and also the evaluation of its severity and potential for short-term morbidity or death.
Magnitude, risk factors and outcome of low birth weight babies admitted to neonatal intensive care unit of a tertiary care centre in Puducherry, India
Authors: K. Maheswari , Sharma Neha
Published: May 2020

Background: This study was undertaken to know the magnitude, risk factors and outcome of LBW babies admitted in NICU in a tertiary centre.Methods: This is a hospital based, retrospective study, of LBW babies admitted to NICU of Sri Venkateshwara Medical College hospital and research centre, Puducherry, from Jan 2019 - Dec 2019.Results: About 340 babies were admitted to NICU and 56 were LBW babies, 5 were excluded and 51 LBW babies analysed. Magnitude of LBW babies, 51 (15%). Socio demographic pattern showed, IUGR (62.7%). Term IUGR (52%) and preterm IUGR (9.8%). Preterm babies (37.2%). Preterms <28 weeks of gestation (7.8%), 28-34 weeks (9.8%) and 34 to < 37 weeks (19.6%). LBW babies <1kg (7.8%), 1-1.5kg (1.9%) and 1.5 to 2.49 kg (90.1%). Male (52.9%), female babies (47%). LBW babies from rural area (62.7%), urban area (37.2%). Among the maternal risk factors, maternal anemia was common (31.3%). Elderly primi (13.7%), PROM and twin pregnancy in (9.8%) each, bad obstetric history (7.8%). PIH, APH, GDM and oligohydramnios in (3.9%) each. Rh negative pregnancy, grand multipara, teenage pregnancy, ART with hypothyroidism and unbooked pregnancy seen in (1.9%) each. Fetal distress (19.6%). Morbidity was (92.1%). Most common was jaundice (31.9%), sepsis (21.2%). Feeding difficulties (19.1%), TTNB (17%), apnea of prematurity (14.8%). Hypoglycemia and HIE in (12.7%) each. Hypothermia and HMD in (10.6%) each. Seizures in (8.5%) MAS and NEC (4.2%) each, congenital anomalies and hypocalcemia in (2.1%) and mortality in (7.8%). Extreme prematurity, ELBW with sepsis and RDS being common cause of mortality.Conclusions: Iron tablets intake, nutritional care, regular antenatal checkup, spacing pregnancy, avoidance of teenage and elderly pregnancy is important. Improving the infrastructure, manpower in NICU to manage preterm babies, when surfactant and ventilation is given.
Acute Illness Observation Scale in community acquired pneumonia in children aged 2 months to 59 months
Authors: K. Anoop , P. Sangeetha
Published: May 2020

Background: Pediatric respiratory disease remains an important cause of morbidity in both the developing and the developed world. Aim of the study is to validate Acute Illness Observation Scale (AIOS) in predicting illness severity and clinical outcome of community acquired pneumonia.Methods: This was a descriptive study done in a cohort of 248 children at the Department of Paediatrics, at a tertiary care hospital in Chennai. Children between 2 months - 59 months coming to outpatient department with suspected pneumonia, if satisfying the inclusion criteria were enrolled into the study. AIOS scoring is done on each subject on day 1, day 2, day 5 by two persons simultaneously in a reasonably quite state. Respiratory parameters, vital signs and pulseoximeter reading of each patient as in data collection form are documented.Results: Children scoring abnormally on AIOS (>10) had significantly higher frequency of severe tachypnea (p=0.001), marked chest retraction (p=0.001), grunting, cyanosis (p=0.01), lethargy, inability to drink and so on except incidence of convulsion and wheeze which didn’t have any statistical significance. Severe hypoxemia associated with cyanosis (SpO2<85) was observed in 14 children of which 92.9% (13) scored a high value on AIOS (AIOS>15). Complications were absent in those who scored <10, while maximum complications were seen in those who scored >15.Conclusions: AIOS can be used as a tool to decide on therapeutic modalities and prognosticating a child with pneumonia admitted to the hospital by a physician.
Recommendation of an ideal mixed fluid preparation to be used as partial parenteral nutrition in surgical Neonatal Intensive Care Unit
Authors: Ghosh Arindam , Basak Anirudhdha , Pramanik Dibyarup Datta , Mishra Prafulla Kumar
Published: May 2020

Background: This study was conducted to assess the role of Partial Parenteral Nutrition (PPN) and a specially prepared “mixed fluid formula” used as PPN in sick surgical neonates.Methods: This single institution based Randomised Control Trial was performed in Surgical NICU of a tertiary care Centre. Surgical neonates who required bowel rest for >3 days like Esophageal Atresia (22), Duodenal Atresia (38), Jejuno-Ileal Atresia (50), Necrotising Enterocolitis (29) and others (11), were chosen. As a CONTROL population half (75) neonates were allowed maintenance fluid only (Isolyte P) and rest (75) were given a combination of maintenance fluid (Isolyte P) and PPN (specially prepared mixed fluid). This mixed fluid each 100 ml was prepared with 65ml Isolyte P, 15 ml 25% Dextrose, 10 ml Normal Saline, 7 ml Astymin 3, 2 ml Multivitamin and 1 ml Injection KCl. Fluid was continued till enteral feeding was established.Results: Neonates according to their body weight were divided in three groups <1 kg (50), 1-2.5 kg (71) and >2.5 kg (29) and their post-operative outcome was assessed as Clinical Positive/Negative and Laboratory Positive/Negative. Results were separately assessed in 3 body weight groups under “Control” and “Study” which showed both Clinical and Biochemical improvement in “Study group”.Conclusions: The composition of mixed fluid, its nutritional value, calorie supplementation, compatible osmolarity for peripheral venous administration and most importantly its easy and cost-effective preparation were assessed thoroughly and we recommend this “mixed fluid” preparation as a very useful PPN for sick surgical neonates.
A study on risk factors associated with neonatal hyperbilirubinemia among newborns at tertiary care level in Kerala, India
Authors: S. Chandramohan Reddy , Varghese Sam
Published: May 2020

Background: Neonatal hyperbilirubinemia is defined as serum bilirubin levels >7 mg/dl around 85% of all term newborns and most of the premature babies develop clinical jaundice and various associated risk factors are involved in NNH and treatment for this condition depends on gestational age, serum bilirubin levels at different time interval during early life of these newborns and treating them with phototherapy or exchange transfusion. Objective of the study was to establish the relation with the NNH and risk factors among newborns and treatment with the phototherapy if required.Methods: The present prospective study was conducted at Karuna Medical College, Chittur Palakkad from January 2019 to December 2019. A total of 40 samples which are born during the study period were included in the study. All types of gestations (preterm, full term, post term), both genders (male and female), new-borns with risk factors, serum bilirubin (TSB) >7 mg/dl at 48 hrs of life were included in the studyResults: In our study, female samples consists of 55% and male samples were 45% during the study period minimum gestational age was 35 weeks and maximum was 40 weeks. 5% sample with a serum bilirubin level of 9 mg/dl,  with risk factor as a Rh(-ve) incompatibility was treated with phototherapy up to 96 hrs of life.Conclusions: Study conveys various risk factors responsible for NNH and treatment with phototherapy given to the affected new-borns. With good clinical history, risk factors involved in new-borns, antenatal counseling is needed to all pregnant women’s it is necessary to check the serum bilirubin levels and treated with phototherapy to avoid further NNH related complications in the new-borns.
Complications and renal biopsy profile in childhood steroid resistant nephrotic syndrome
Authors: Palaniyandi Subramani , Palaniyandi Anitha
Published: May 2020

Background: Nephrotic syndrome is a notable chronic disease in children. The objective of this study was to study the complications and renal biopsy profile in childhood steroid resistant nephrotic syndrome.Methods: Retrospective observation study done in Sri Ramachandra Medical College and Hospital, Department of Paediatrics, Chennai. Inclusion criteria was children aged 1-12 years diagnosed with steroid resistant nephrotic syndrome defined as absence of remission despite therapy with daily prednisolone at a dose of 2mg/kg/day for 4 weeks. Remission defined as urine albumin nil/trace in 3 consecutive early morning samples. Children less than 1 year of age, children with renal transplant and incomplete records were excluded. Period of study January 2013- December 2015. Informed consent was obtained and 75 cases who fulfilled the study criteria were included in this study. Variables assessed were incidence of hypertension (both at onset of disease and later during the course of disease), incidence of urinary tract infection and its microbiology, associated co-morbidities, complications of nephrotic syndrome and renal biopsy profile.Results: Incidence of hypertension at onset of disease was 13.3% and later during the course of the disease was 48%. Most common infection was UTI (28%) and the most common organism isolated in urine culture was E-coli. Incidence of other co-morbidities like asthma, atopy was 17.3%. No case had evidence of end stage renal disease. 60% of cases had undergone renal biopsy and minimal change disease was the most common biopsy finding.Conclusions: Hypertension and UTI remain important complications in nephrotic syndrome and hence all such children should be continued to be monitored for these complications. Minimal change disease (MCD) was the most common renal biopsy finding.
Audit of transfusion practices in pediatrics in a tertiary care hospital
Authors: Iyengar Vaishnavi , Parekh Anjali , Natu Sanjay
Published: May 2020

Background: Audit of transfusion practices in pediatric patients was performed to study indications, clinical profile and whether transfusions were in accordance to guidelines.Methods: Retrospective analysis of all episodes of transfusions from a tertiary care centre was done. The study period was from January 2018 to December 2018.Patients in the age group of 4 months to 12 years were enrolled in the study. The data was reviewed according to the British Committee for Standards in Haematology guidelines for transfusion.Results: During the study period of 12 months,168 units of hemocomponents were transfused to children, 66.07% (111/168) of the total products transfused were packed red cell units, followed by 36 units (21.42%) of fresh frozen plasma and 21 units (12.5%) platelets. Overall usage of blood components was found to be appropriate in 58.33% (98/111). Red blood cells were the most appropriately transfused (64.86 %) (72 units out of 111) blood product as compared to 42.85% of platelets (9/21) and 47.22% of FFP (17/36).Conclusions: Most frequently transfused blood components are red blood cells in pediatrics. Inappropriate transfusion of blood components is hinders the utility of this valuable resource, Thus it becomes necessary to conduct regular audit of blood component transfusion for optimum utilization.
Esophageal varices presenting as lower GI bleed in an infant: a rare presentation
Authors: Choudaha Anmol , Banzal Rajeev Kumar , Mehrotra Gunjan Kela , Sodha Nandini
Published: May 2020

GI Bleeding is a common problem encountered in the emergency department and in the primary care settings. Lower GI Bleeding is relatively rare as compared to upper GI bleeding. Common causes of lower GI Bleeding are Polyp (32.5%), chronic nonspecific colitis (20.7%), lymphoid nodular hyperplasia (20%), Proctitis (18.2%), Solitary rectal ulcer (10%), Inflammatory bowel disease (6.5%).Among the various causes of lower GI Bleeding, esophageal varices is a rare cause. One such case presented to us with lower GI bleeding, on further evaluation was found to having esophageal varices due to portal hypertension. Child improved after conservative and definitive management.
Persistent vomiting, an alarm sign in children
Authors: G. Ramya , A. Arul Kumaran , Gupta Tanay
Published: May 2020

Brain tumors, the second common cancer following hematological malignancies account for up to 21% of all malignancies below 14 years of age. Medulloblastoma is a common form of Primitive neuro ectodermal tumor and likely arise from either the external granular layer (e.g., desmoplastic variant) or the subependymal matrix cells of the fourth ventricle (e.g., classic variant), or both. The clinical course of the disease is aggressive in children than in adults. The tumor can invade the CSF through the ventricles or even cause metastases to bones and lymph node. With the emergence of advanced technologies and treatment facilities, the morbidity and mortality of the disease is greatly improved with a five-year survival of up to 75%. However, the presence of disease in children <3 years or evidence of dissemination on diagnosis carries poor prognosis. Here we are discussing a case of 5-year-old girl who presented to OPD with vomiting for 1 month.
Chorea as the first presenting sign of rheumatic fever in a 12-year-old female child
Authors: Kasundra Mitul N.
Published: May 2020

Rheumatic chorea (RC*) is a movement disorder seen in young children and adolescents with a recent history of incompletely treated group A beta-hemolytic streptococcal (GABHS) pharyngitis. Although, it rarely presents as the first manifestation of the rheumatic fever, physicians should be aware of the disease, so that early diagnosis and prompt treatment may lead to elimination of the pathogen and prevent further disease progression. We present a case of a 12-year-old female child who presented with only RC as the first clinical sign.
A study on poor prognostic factors associated with ventilator associated pneumonia at a tertiary care hospital
Authors: R. Raveendra K. , Hegde Suraj S.
Published: May 2020

Background: Ventilator associated pneumonia (VAP) is a hospital acquired infection (HAI) seen among critically ill patients, on mechanical ventilation, due to various causes in intensive care units (ICUs). It is associated with increased morbidity and mortality which increases the cost of health care. The aim of this study was to determine the poor prognostic factors associated with VAP.Methods: In this cross-sectional prospective study,40 patients who developed features of ventilator associated pneumonia on a platform of mechanical ventilator for >48 hrs in ICU were included in the study. VAP was then diagnosed based on clinical pulmonary infection scoring system (CPIS) with a score of >=6. All patients were evaluated and correlated with different parameters for the treatment and outcome.Results: Most of the patients had late onset VAP (60.7%) with average number of days being around 8 days. Pseudomonas, Acinetobacter, Enterobacteriacea, Staphylococcus aureus were commonly isolated organisms. Polymicrobial infections were not detected. Antibiotics like colistin, tigecycline and beta-lactamases are the most commonly effective antibiotics. Of the 40 VAP patients,20 patients survived and  20 died with protocol line of treatment. Following poor prognostic factors were identified-Early onset VAP (42.5%), elderly patients (>65 years) (90%), Type 2 DM (80%), hypertension (70%), prior antibiotic therapy (65%), prolonged supine position (68%) and re-intubation (75%).Conclusions: Ventilator associated pneumonia is associated with a significant increase in length of stay in ICU, time of mechanical ventilation and different complications and certain risk factors further worsens the prognosis.
Study of lipid profile parameters abnormalities in patients with sickle cell disease from single centre study in central India
Authors: Gupta Manoj , Sharma Pinki , Vishwakarma Sumit Kumar , Bhalke Lokesh , Chandra Umesh Kumar
Published: May 2020

Background: Metabolism of lipids and lipoproteins is being altered in patients with sickle cell disease (SCD). It has been postulated that the hypocholesterolemia in SCD might be due to increased cholesterol utilization and decreased circulation. Hemolytic stress can be associated with a significant reduction in plasma lipid concentration.Methods: This prospective observational study was conducted from February 2016 to October 2017 at MGM Medical College and MY Hospital Indore, MP, which included 50 SCD patients and 50 healthy, age, and sex matched controls.Results: Total Cholesterol (TC) was less than 200mg/dl in 48 SCD patients with mean TC levels was 115.3mg/dl and it more than 200mg/dl in 2 SCD patients only with mean TC was 211mg/dl. This was statistically significant low as compare to controls (p value=0.001060). HDL was less than 60mg/dl in 47 SCD patients with mean HDL was 33.74mg/dl and more than 60mg/dl in 3 SCD patients with mean HDL was 105.6mg/dl and it was statistically significantly low in SCD patients(p value=0.001787). Tryglyceride (TG) was more than 150mg/dl in 27 SCD patients and it was less than 150mg/dl in 23 SCD patients. TG was statistically significantly high in SCD patients (p value=0.011303). LDL was less than 60mg/dl, 60-130mg/dl, and more than 130mg/dl in 25, 21, and 4 SCD patients respectively. This increase in LDL in SCD patients was statistically significant (p value 0.018977).Conclusions: It was evident from this study that dyslipidemia characterized by low HDL and TC was present among the SCD patients who participate this study. Further study in large number of SCD patients and controls may help to confirm or exclude the above correlation of SCD with derangement in lipid profile.
Role of reciprocal changes in predicting short term prognosis of patients of acute STEMI
Authors: Khanna Mridul , Mahajan Devinder Singh
Published: May 2020

Background: Recent studies indicate that STEMI with reciprocal changes is associated with more myocardial area at risk, larger infarct size and less ejection fraction as compared to STEMI without reciprocal changes. We undertook this study for correlating clinical outcome and complications in patients with and without reciprocal changes in ECG in acute STEMI.Methods: Eighty patients were divided into two groups of forty each. One having reciprocal changes in ECG and one without reciprocal changes. The KILLIP class of each patient at time of admission was noted. Patients were monitored for development of any complication, Left ventricular ejection fraction (LVEF) and mortality. BNP levels, Trop I levels, Hba1c levels were obtained at time of admission. Echocardiography was done on the second day of the admission.Results: The patients with reciprocal changes were found to be having a higher KILLIP class on admission. The LVEF of patients with reciprocal changes and who subsequently went on to develop complications was lower than those without reciprocal changes. The number of patients having unsuccessful thrombolysis was significantly higher in the group with reciprocal changes.Conclusions: There was significant association of reciprocal changes in ECG with higher Hba1c, higher KILLIP class and higher incidence of unsuccessful thrombolysis. Moreover, the sensitivity of other markers of poor clinical outcomes, such as BNP and LVEF increases in patients having reciprocal changes in their ECG. The monitoring in such patients should thus be more intensive.
Case-control study to evaluate the role of smoking, alcohol abuse, intravenous drug abuse, tobacco use and biomass fuel exposure as risk factor in pulmonary tuberculosis
Authors: Mathew Libin , Pandhi Naveen , Kajal N. C. , . Guneet
Published: May 2020

Background: An association between smoking and tuberculosis disease has been shown in various studies, it is less clear to what extent smoking increases the risk of Mycobacterium tuberculosis infection. Therefore the aim of this study is to evaluate the role of smoking, alcohol abuse, intravenous drug abuse, tobacco use and biomass fuel exposure as a risk factor for the development of pulmonary tuberculosis.Methods: This is a case control study and total 200 subjects will be included with 100 sputum smear positive pulmonary tuberculosis cases and 100 age and sex matched healthy subjects as controls. Data collected from both cases and controls using a proforma by enquiring smoking habits, alcohol abuse, intravenous drug abuse, biomass fuel exposure and documenting chest X-ray features.Results: The study showed significant association between tuberculosis and smoking as a risk factor with beedi smoking, early age of starting smoking, increased duration and quantity of smoking increases risk for tuberculosis. There was significant association between intravenous drug abuse, biomass fuel exposure and risk of tuberculosis. There was no significant association in the study between alcohol abuse, tobacco chewing and tuberculosis, but heavy drinking and tuberculosis showed significant association. The study also showed significant association of cavitary lesion with smoking.Conclusions: There is significant association between smoking, intravenous drug abuse, biomass fuel exposure and tuberculosis, since these risk factors impairs host immune defences that allows the development of active tuberculosis.
Serum albumin level as prognostic indicator of acute ischemic stroke in tertiary care hospital admitted patients
Authors: Dash Prafulla Kumar , Behera Smrutiranjan , Sahoo Nirmal Chandra , Rattan Roma , Tripathy Saroj Kumar
Published: May 2020

Background: Serum Albumin level is an important multifunctional protein in the blood for maintaining the normal permeability across vessel wall by osmotic gradient, in inhibiting platelet aggregation and in reducing blood viscosity.  Serum albumin level as a novel parameter for predicting outcome and assessment of severity of coronary artery disease is established. Keeping in mind the scarcity of studies regarding albumin level in ischemic Cerebrovascular Accident (CVA), present study was undertaken to correlate serum albumin level with clinical outcome in acute ischemic stroke (AIS) patients.Methods: One hundred patients of diagnosed AIS were included in the study. Thorough clinical examination and risk factor profile assessment was done. Severity of stroke was assessed using National Institute of Health Stroke Scale (NIHSS) Score and then followed up to 1 week and 3 months post-admission with serum albumin level and assessment was done using modified Rankin Scale (mRS) score. Institutional ethics committee cleared the study.Results: In 100 patients with AIS, 58% were male and 42% were female. Mean age was 65±8.160. Motor weakness (85%) was the commonest presenting symptom. Around 75% of patients revealed infarction in middle cerebral artery (MCA) territory. Hypertension (HTN) (74%) was the most frequently associated comorbid condition. Patients with low serum albumin level at admission time were directly proportional to severity of stroke at presentation and poor clinical outcome. 1 week and 3 months follow up mean albumin level (g/dl) was 3.8±0.25 and 3.7±0.23 in patients with poor functional outcome respectively. Significant co-relation between mean serum albumin level and clinical outcome was observed.Conclusions: Serum albumin level is inversely correlated with severity of stroke at presentation and functional outcome in patients on follow up.
Study of carotid intima media thickness as surrogate marker of endothelial dysfunction in early chronic kidney disease patients
Authors: Jamra Yogendra , Jhavar Dharmendra , Gowda Dharshan , Vishwakarma Sumit Kumar , Chandra Umesh Kumar
Published: May 2020

Background: Micro-albuminuria has been extensively regarded as a marker of generalized vascular endothelial impairment. Endothelial dysfunction is an early marker for atherosclerosis and can be detected before structural changes to the vessel wall.Methods: This case control study was carried out in the Department of Medicine, MGM Medical College and MY Hospital, Indore, India, from December 2017 to February 2019, with sample size of 100 including 50 cases and 50 controls.Results: In our study, mean CIMT of cases and controls was 0.83±0.10mm and 0.63±0.14mm in right respectively. Mean CIMT of cases and controls was 0.83±0.10 and 0.64±0.07mm in left side respectively. These results are suggestive that mean CIMT are significantly higher (p values <0.05 in each) in cases than controls. 90% of cases were in stage II of CKD and their mean CIMT was 0.83±0.09mm and 10% of cases were in stage I of CKD and their mean CIMT was 0.80±0.09mm and there were no significant difference in mean CIMT between CKD stage I and CKD stage II in cases. There were significant positive correlation between Mean CIMT and Age of cases (Pearson correlation=0.382, p-value 0.006).Conclusions: Increased CIMT was found in all the cases as compare to controls so, increased CIMT can be used as an early marker of atherosclerosis in early CKD patients. Further study in large number of subjects may help to confirm or exclude the findings.
Retrospective analysis of disability evaluation and work fitness reports issued in occupational therapy training school and centre, Mumbai, Maharashtra, India
Authors: Pai Anuradha V. , Paithankar Anushka B. , Bankhele Jyotsna R. , Dixit Harshal M.
Published: May 2020

Background: Patients from medicine, neurology and neurosurgery are referred to occupational therapy for disability calculation and if applicable work fitness. The patients who were referred from other units are not analysed here. Objectives of this study were to find the total number of patients referred for disability evaluation and certification from neuro-medicine and neuro-surgery units. To find the number of patients referred according to the different diagnosis. To find the patient distribution according to the percentage of disability. To find number of patients who were given work fitness (unfit, fit, light duty).Methods: A total 84 patients were given disability certificate in 2018 whereas 79 patients in 2019. In 2018, out of 84 patients, 1 received disability <40%, 64 got disability between 40-70% and 19 got disability >70%. In 2019, out of 79 patients, 2 got disability <40%, 58 got disability between 40-70% and 19 got disability >70%. In 2018, out of 84 patients, 33 patients were referred for work fitness in which 27 got unfit, 1 patient was given fit and 5 got light duty after work simulation. In 2019, out of 79 patients, 21 were referred for work fitness in which 18 were given unfit, 1 patient was given fit and 2 got light duty after work simulation.Results: A total 144 participants included in the study, 75 (52%) were females and rest were males 48%. Out of these 111 (77%) were aware about dog bite causes disease and among these 52 (46.8%) were aware that dog bite causes rabies. Among the participants, 138 (95.8%) were aware about the vaccine availability and 125 (90.5%) knew vaccine is available in Government Hospital. In the study 88% of dog bite victims received treatment.Conclusions: The patients were analysed based on age, gender, type of diseases, percentage of disability, type of work and work fitness (fit, unfit, light duty).
Pattern of stress and anxiety behaviour among people with type 2 diabetes in a tertiary care hospital of Delhi, India: an observational study
Authors: Ranjan Prakash , Das Jayanta K.
Published: May 2020

Background: The prevalence of stress and anxiety in diabetes is considerably higher than normal population and found to have a negative impact on diabetes. The aim of this study was to examine the relationships among perceived diabetes-related stress and anxiety behaviors in adults living with type 2 diabetes (T2DM).Methods: In this descriptive and cross sectional study, systematic random sampling technique was used to select the sample of type 2 diabetic patients. Scheduled interview of 412 type 2 diabetic patient was conducted at outpatient department of a tertiary care hospital in New Delhi.Results: Out of 412 diabetic patients, 58.7 percent feel diabetes-related stress and anxiety behaviors when they think about living with diabetes. Age of patients, educational status, occupation and average monthly family income of diabetic patients are statistically associated with perceived diabetes-related stress and anxiety behaviors of type 2 diabetes mellitus patients. Lifestyle behaviour like diet pattern (vegetarian or nonvegetarian diet) and moderate intensity activities like walking are also statistically associated with perceived diabetes-related stress and anxiety behaviors of type 2 diabetes mellitus patients.Conclusions: This study found a high prevalence of diabetes-related stress and anxiety behavior in patients with Type 2 DM. Therefore, the care of individuals with type 2 Diabetes Mellitus (DM) should include the screening and possible management of stress and anxiety in order to achieve and sustain treatment goals.
Pharmacognostical and pharmaceutical analysis of Punarnava guggulu an ayurvedic polyherbal formulation
Authors: Kakadiya Chaitali , Goyal Mandip , Harisha C. R. , Shukla V. J.
Published: May 2020

Background: Punarnava Guggulu is a polyherbal formulation mentioned in Bhaishajya Ratnavali containing various Ayurvedic medicinal drugs and specially indicated for the treatment of Amavata and Vatarakta. For assurance of quality of herbal compounds pharmacognostical and pharmaceutical analysis should be done.   Methods: Punarnava Guggulu was subjected to microscopic evaluation for Pharmacognostical study, physiochemical analysis like hardness, weight variation, loss on drying, ash value, acid insoluble extract, pH value, water soluble extract, alcohol soluble extract, high performance thin layer chromatography (HPTLC).Results: Pharmacognostical study showed the presence of certain identifying characters of all of the ingredients of Punarnava Guggulu that is Punarnava, Erandamula, Shunthi, Guggulu, Eranda Tail, Trivruta, Danti, Guduchi, Haritaki, Bibhitaki, Amalaki, Maricha, Pippali, Chitraka, Bhallataka and Vidanga. In pharmaceutical study, preliminary physiochemical analysis showed that hardness of the Vati was 4.05 Kg/cm2, ash value 12.84% w/w, acid insoluble ash value 1.56% w/w, loss on drying 1.6% w/w, water soluble extract 35.93% w/w, alcohol soluble extract 22.14% w/w and HPTLC showed 13 spots in 254nm and 8 spots in 366nm.Conclusions: Present work was carried out to standardize the polyherbal formulation Punarnava Guggulu in terms of its identity, quality and purity. Pharmacognostical and physico-chemical observations revealed the specific characters of all active constituents in the preparation were present in it.