bluuebunny/crossref_metadata_2025 huggingface dataset:
Elective induction of labour at 39 weeks versus expectant management up to 41 weeks in a tertiary care centre
Authors: Kabadi Yogindra M. , Kumar Sanjana
Published: January 2020

Background: The timing of delivery and effective management of labour at term makes a huge difference in the obstetric and perinatal outcome. There have always been controversies between choosing the elective induction of labour at 39 weeks versus expectant management up to 41/42 weeks which can result in placental ageing, reduced liquor, non-assuring fetal heart tracings, meconium stained amniotic fluid and fetal macrosomia.  our objective was to perform a comparative effectiveness analysis of elective induction of labor at 39 weeks gestational age among nulliparous women with uncomplicated singleton pregnancies as compared to expectant management up to 41 weeks.Methods: 120 primigravidae with singleton pregnancies with fetus in cephalic presentation were recruited into the study and divided into 2 groups of 60 each A: Patients were induced electively using dinoprostone gel (maximum 3 doses 8 hours apart) B: They were managed expectantly up to 41 weeks allowing for spontaneous onset of labour, induction or cesarean section was done for obstetric indications between 39 and 41 weeks and pregnancy was  terminated by induction for those who continued up to 41 weeks. Their obstetric and perinatal outcome were noted.Results: The cesarean section rates were higher in the expectantly managed group (21%) when compared to the electively induced group (16%). The same was with instrumental delivery rates (15% versus 10%). The perinatal outcome was poorer for the expectantly managed group with 20% NICU admissions and 5% perinatal deaths compared to the electively induced group which had 12% NICU admissions and 3.3% perinatal deaths. The expectantly managed group also resulted in respiratory distress in a larger number of fetuses and resulted in problems due to reduced liquor.Conclusions: Elective induction at 39 weeks gestational age was found to be a better option compared to expectant management up to 41 weeks in terms of obstetric and perinatal outcomes.
Mayer-Rokitansky-Kuster-Hauser syndrome and ovarian benign teratoma: a case report
Authors: Adjoby Cassou R. , Koffi Soh V. , Effoh Denis , Lagaud Eleonore Gbary , Alla Christian H. , Loba Okoin P. J. , Abauleth Yao R.
Published: January 2020

Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is an unknown congenital etiology disorder characterized by agenesia or hypoplasia of the Müller ductal system, including the upper vagina, uterus and fallopian tubes. The occurrence of an associated ovarian tumor is rare, with fewer than 20 cases reported to date according to the literature. We report the case of a 14-year-old girl, virgin, who had not yet seen her menarche, complaining of an abdomino-pelvic mass associated with pain. The ultrasound performed revealed a large left ovarian tumor and an absence of uterus. The indication of a laparotomy confirmed the ovarian mass and a complete absence of uterus associated with vaginal hypoplasia. The contralateral ovary was present, and of normal appearance. The pathological examination was in favor of a mature benign multi-tissular teratoma. This is the first case described in our service. The mode of transmission of this entity appears to be autosomal dominant with low penetrance and variable expressivity, suggesting that the incidence of this syndrome is likely underestimated. With the development of techniques of medical assistance to procreation, maternity remains possible, particularly through gestational surrogacy.
Dihydroartemisinin-piperaquine for the routine treatment of uncomplicated malaria in Northern Ghana
Authors: Oduro Abraham R. , Chatio Samuel , Ayamba Emmanuel , Anyorigiya Thomas , Binka Fred , Amenga-Etego Lucas
Published: January 2020

Background: Dihydroartemisinin-piperaquine is a first line treatment for uncomplicated malaria in Ghana. A facility-based study was undertaken to examine the effectiveness of the treatment in the routine health care system.

Methods: The study was undertaken at the Navrongo demographic surveillance area. Patients presenting with acute febrile illness were enrolled after informed consented and confirmation by microscopy. Patients were randomized into supervised group who received treatment under direct observation and unsupervised group which had only the first treatment given under supervision. Treatment was according to bodyweight and 42 days follow-up was undertaken.

Results: A total of 194 patients were enrolled; 54.1% were females and 51% had supervised treatment. The median age and weight were 6.7 years and 20.0 kg respectively. Mean baseline temperature, haemoglobin concentration and parasite density were, 37.6 oC, 11.1 g/dl and 11,098 parasites per microliter of blood respectively. Study completion rate was 93.3%, day 42 polymerase chain reaction-unadjusted adequate clinical and parasitological responses rate (ACPR) was 93.4% by evaluable and 87.1 % by intention-to-treat (ITT). The day 42 ACPR by evaluable was 92.3% in the supervised arm compared to 94.4% in the unsupervised arm. The day 42 ACPR by ITT was 85.7% in the supervised and 88.5% in the unsupervised arms. The fever resolution and haemoglobin concentration changes for the two arms were similar.

Conclusions: The results show that dihydroartemisinin-piperaquine is effective and good first-line antimalarial in the routine health delivery system.
Oncology patient preferences in reporting on symptoms
Authors: Peechatka Alyssa L. , Gerzon Millie , Ly Jenny J. , Dallabrida Susan M.
Published: January 2020

Background: Collecting patient reported outcomes (PROs) in oncology clinical trials is becoming increasingly important. However, there is limited consensus on the most appropriate frequency of PRO administration in oncology trials.  The aim of this preliminary study is to examine the perspective of participants with a cancer diagnosis on the importance of completing PROs and to identify at what frequency participants prefer to report on their cancer-related symptoms.

Methods: 166 participants with a self-reported cancer diagnosis completed a multiple-choice online survey regarding perceptions of symptom importance and reporting preferences.

Results: When asked about the benefit of reporting oncology-related symptoms daily, 44% of participants indicated there would be “very much” a benefit, 29% indicated there would be “quite a bit” of benefit, and 17% indicated there would be “somewhat” of a benefit. When asked about how frequently they would prefer to report symptoms, 41% of participants preferred “as they occur,” 36% preferred “once a day,” 18% preferred “once a week,” 4% preferred “twice a day,” and 1% preferred “every 4 hours”.

Conclusions: PROs in oncology clinical research are most often collected at weekly, monthly, or longer intervals; however, meaningful fluctuations in cancer-related symptoms can occur more frequently. While concerns regarding patient burden are often raised to support infrequent reporting, these data suggest that participants would like to report symptoms with greater frequency, as episodic and daily reporting options were most popular. Based on these data, more frequent PRO data capture is not only feasible but perceived as important by individuals with cancer.
Randomized response surface pathway design with skewed starting point and stochastic dose window
Authors: Holand Trond , Evensen Øystein , Dewi Sagita , Larsen Stig
Published: January 2020

Background: The aim was to introduce response surface pathway (RSP)-design with skewed starting value and stochastic dose-window to estimate optimal efficacy dose (OED) of BP-C2 after IL-1β stimulation in Atlantic salmon.

Methods: 54 healthy smolt of Atlantic salmon between 50 and 100 g before habituated to salt water were included. The study was conducted as a one-dimensional, randomized between-patient three-level RSP designed trial with one interventional- and one response variable and odd outcomes. The interventional variable was intraperitoneal injected BPC2 with skewed starting dose of 0.10 mg/100 g related to the initial dose-window <0.02-0.5 mg/100 g. The response variable was the Ct-value of mRNA IL-1β expression 24 hours after injection.

Results: Skewed starting value of 0.10 mg/100 g was chosen in the first design-level with a dose-window of <0.0-0.20]. The three smolt obtained a reduction in Ct-value above 15%, and the dose-window adjusted with the lower boundary equals the previous dose. The five smolt at second design-level received 0.16 mg/100g with a dose-window [0.10-0.22]. Four smolt obtained above 15% and one of 0.5% reduction in cycle threshold (Ct)-value. Six smolt in the third design-level received 0.21 mg/100 g and one 0.16 mg/100 g. The mean Ct-value was reduced from 30.0 in the unstimulated situation to 25.0, 24.8 and 26.4 after BP-C2 stimulation of 0.10, 0.16 and 0.21 mg/100 g, respectively. The OED of BP-C2 related to IL-1β was estimated to 0.14 mg/100 g.

Conclusions: Skewed starting value in the initial dose-window made the K-adjustment factor and dose-window stochastic. The RSP-procedure works in accordance to the expectation and estimated OED of BP-C2 sufficiently.
 
Comparative evaluation of post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients undergoing laparoscopic cholecystectomy
Authors: Katoch Madan Lal , Kour Loveleen
Published: January 2020

Background: Laparoscopic cholecystectomy is commonly performed as a day care procedure for treating symptomatic gallstones. Suitability of patient discharge from the inpatient facility depends upon adequacy of postoperative pain control. Among the various modalities for pain relief, intraperitoneal local anaesthetic has become an important approach. In this study we aimed at comparing the post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients after laparoscopic cholecystectomy. The objective of this study was to determine which adjuvant drug was superior to the other in terms of prolonging the analgesic effects of levobupivacaine in post-operative period of laparoscopic cholecystectomy.

Methods: A total of 90 patients undergoing laparoscopic cholecystectomy were selected. They were divided into three groups: Group L- received 50 ml of 0.25% levobupivacaine; Group LT- received 0.25% of levobupivacaine and tramadol 2 ml (50 ml total); group LF- received 0.25% levobupivacaine plus fentanyl 2 ml (50 ml total). Postoperative pain was assessed using visual analogue scale.

Results: The combination of levobupivacaine fentanyl and levobupivacaine tramadol was superior to plain levobupivacaine for reducing postoperative pain. No significant difference was found between Group LT and LF with respect to first analgesic and total analgesic requirement. However significant difference was found between LF and L; and between LT and L.

Conclusions: Levobupivacaine should be used along with adjuncts either tramadol or fentanyl.

 
Evaluation of neo adjuvant chemotherapy response in patients with locally advanced breast cancer
Authors: Krishna Nallamothu Murali , Mani C. Mandava Radha , C. Veera Abhinav , Jaya Chandra T.
Published: January 2020

Background: Carcinoma of the breast from the very beginning has been a feared disease. Advanced disease is treated by neoadjuvant chemotherapy (NACT). With this, a study was conducted to evaluate the pathologic response to NACT in locally advanced breast cancer.

Methods: Study was conducted in GSL Medical College, approved by institutional ethics committee, females aged >18 years with locally advanced breast cancer were included in the study. Female <18 years and breast cancer male were not considered. The dimensions are marked and size of the lump compared before and after NACT. Chi-square test was used to find out the significance of study parameters; p<0.05 was considered statistically significant.

Results: Total 110 patients were included in the study, mean age was 50.63±10.76 years and 53% were in pre menopausal women. When pathological response was considered, 12.7% had complete response, 66.4% had partial response and 20.9% had no response to NACT; statistically there was significant difference between pre and post treatment tumor sizes (p<0.05).

Conclusions: Most of the individuals belonged to premenopausal group. Tumour size showed significant decrease after NACT. The overall response rate (complete and partial) after NACT was significant in our study group.
A quasi-experimental study on exploring the use of mobile phone technology for optimizing, tracking and responding to children's developmental progress in Korogocho, Nairobi, Kenya: study protocol
Authors: Kitsao Wekulo Patricia , Nampijja Margaret , Okullo Domnick O. , Okelo Kenneth O. , Njeri Milka , Onyango Silas , Kimani Murage Elizabeth
Published: January 2020

Background: The massive use of technology can be leveraged to facilitate access to growth and development programs for children. Existing programs supporting such initiatives for children younger than three years are inadequate and not accessible to most families. In most cases, primary caregivers are unable to identify delayed milestones in their children’s growth and development due to inadequate information. They therefore often report the cases when they have become very severe and difficult to reverse. In order to promote early identification of possible developmental delays, African Population and Health Research Center together with Val Partners will develop, implement and evaluate the use of mobile phone technology to help caregivers track their children's developmental outcomes.

Methods: The study will employ a quasi-experimental design and will use a mixed-methods approach combining quantitative and qualitative methodologies. In one arm, 110 caregivers will be trained on the use of a mobile phone application to assess child growth and development. The other arm, with 110 caregivers, will receive standard care provided by community health volunteers. Child developmental outcomes will be assessed in both arms. Feasibility of the intervention will be assessed qualitatively. Performance data will be compared across the two arms using mixed linear models to assess the effect of the intervention on child development.

Conclusions: The findings are expected to provide evidence on whether the intervention is feasible and has an effect on child developmental outcomes. The results will inform the scalability and sustainability of the project.

Trial Registration: The trial has been registered with the Pan African Clinical Trial Registry (www.pactr.org) database (ID number: PACTR201905787868050).
Demographic variation of electrolyte imbalance in a tertiary care pediatric intensive care unit
Authors: Routray Mrutyunjay , V. Kishore S. , Champatiray Jyotiranjan , Satpathy Saroj Kumar
Published: January 2020

Background: Electrolyte imbalances are common in critically ill paediatric patients. When present, they can significantly affect the outcome. Critical care provision through Paediatric Intensive Care Units (PICU) is aimed at maintaining ‘homeostasis’ in the body which is vital for the organ’s support and optimal function. This involves fluids and electrolytes balance.Methods: This prospective observational study was conducted in the PICU, SCB MC and Hospital, Cuttack during November 2015 to October 2017. includes Children admitted to PICU (Based on consensus guidelines for PICUs in India, Indian Society of Critical Care Medicine (Pediatric Section) and Indian Academy of Pediatrics (Intensive Care Chapter).Results: Percentage of male children was 65.9%, with male to female ratio 1.9:1, showing male dominance. Most electrolyte imbalances were seen in age group of 1 to 5 years (67.06%). Abnormal serum electrolyte was seen in 37.91% in our study. SIADH was observed in 43.5% of euvolemic hyponatremic patients. SIADH was observed in 27.8% of hyponatremic patients. Respiratory disorder was the most common attributing factor for SIADH followed by CNS disorder.Conclusions: The present study showed high incidence of electrolyte abnormalities in patients admitted to pediatric intensive care unit. Though at times symptoms of electrolyte disorder is indistinguishable from symptoms of primary pathology, so a close monitoring and correction of electrolyte abnormalities is necessary for better outcome. SIADH is recognizable and common cause of electrolyte imbalance in PICU. Thus, this study recommends early routine monitoring of serum electrolytes in all patients admitted to PICU.
Study of parenting styles, family functioning and its relation to coping strategies in children of specific learning disorder
Authors: Rupesh Enagandula , Singh Shipra , Subramanyam Alka A. , Kamath Ravindra M.
Published: January 2020

Background: Families of children with disabilities otherwise experience higher stress; and relation between parenting styles and coping of children is well known. Parental factors and family functioning may play a role in shaping the child, especially having issues like SLD. The objective is to study was coping strategies of children with SLD, parenting styles of their parents, their family functioning and relation of these with each other.Methods: It is a cross-sectional study undertaken after Institutional Ethics Committee approval, parent’s consent and child’s assent. Participants were 100 consecutive children, diagnosed with SLD, 9-13 years of age. Tools used were: Semi-structured proforma, Parenting Practices Questionnaire, Family Assessment Device and Children’s Coping Strategies Checklist Revision 1.Results: Authoritarian parenting style was significantly was associated with less use of ‘active’ and ‘support seeking’; and increased use of ‘distraction’ and ‘avoidance’ strategies. High scores on Authoritative style was associated with ‘active’ and ‘support seeking’ strategies. Avoidance coping strategy was associated with poor (high scores) and active coping strategies with higher (low scores) on problem solving, communication, and general family functioning.Conclusions: Parenting practices and family functioning can be pivotal in determining child’s attitude and coping. Assessment of this can be routinely included in child evaluation.
An evaluation of safety and efficacy of nadifloxacin 1% ointment versus mupirocin 1% ointment in Indian children with skin and soft tissue infection
Authors: Janbandhu Swapnil , Chaudhary Sushil , Chaudhary Sunil , Puppalwar Gaurav , Jain Rishi
Published: January 2020

Background: Although nadifloxacin has been shown to be effective in the treatment of skin & soft tissue infections (SSTI), there is a paucity of data comparing its efficacy and safety with other antibacterials, especially in Indian paediatric population. Therefore, objective of this study was to compare the safety and efficacy of nadifloxacin with mupirocin in children with SSTI.Methods: This was a single-centre, open label, randomized, parallel group, comparative study in 60 children of <12 years of age with SSTI. Test group (n=30) received nadifloxacin 1% ointment and reference group (n=30) received mupirocin 1% ointment, to be applied twice daily. Patients were followed up at day 4, 8 and 15. Efficacy of the study drugs was evaluated by clinical and bacteriological cure rate. Safety was assessed by reporting of adverse events.Results: Baseline characteristics of enrolled patients were comparable between treatment groups and all 60 patients completed the study. At Day 15, 100.0% cases among nadifloxacin group and 96.7% cases among mupirocin group achieved clinical cure (p=0.313). The most common bacteria found in culture were Gram positive cocci in both the groups (86.7% in nadifloxacin and 58.8% in mupirocin group). None of the cases in any of the groups showed bacteriological presence at day 15. No adverse event was reported in any of the treatment groups during the study duration.Conclusions: Nadifloxacin was found to be equally efficacious and safe to mupirocin in the treatment of SSTI in Indian pediatric population.
Optimal feeding practices in Tamilnadu, breast feeding and complementary feeding: the reality
Authors: R. Rathisharmila , P. Uvaraj , N. Saraswathi , V. Ilamaran
Published: January 2020

Background: Optimal feeding of infants under two years of age has the greatest potential impact on child survival of all preventive interventions. This study was done to evaluate feeding practices of infants in first two years of life.Methods: In this cross sectional study, 161 mothers with infants 6 mo to 24 mo of age, attending the well-baby clinic of this hospital were selected for study from April 2014 to March 2015 and interviewed using a structured questionnaire.Results: The prevalence of exclusive breastfeeding for 6 mo was 44% with a median duration of 4.9±1.8 mo. The proportion of infants who received continued breast feeding at 1 year of age (12-15 mo) was 67%. The median duration of any breast feeding was 13.6 mo by survival analysis. Early introduction of cow’s milk and bottle feeding were associated with nonexclusive breast feeding under 6 mo and early termination of breast feeding.Conclusions: While rate of exclusive breast feeding was comparable to the state average (48%), there was a higher rate of introduction of cow’s milk and bottle feeding which contributed to early termination of breastfeeding before one year of age. This study emphasis the fact that bottle feeding and inappropriate complementary feeding should be tackled to improve IYCF indicators in Tamilnadu.
Clinical profile and outcome of congenital cyanotic heart disease in neonatal period: a retrospective study
Authors: Pradhan Janaki B. , Kamalarathnam C. N.
Published: January 2020

Background: Congenital Cyanotic Heart Disease (CCHD) is under reported during neonatal period and mortality rate is high in India. Aims and objectives of the study determine clinical presentation, maternal and neonatal risk factors and outcome of CCHD during neonatal period.Methods: A retrospective study conducted over 15-month period during March 2017 to June 2018 in a tertiary out born NICU. Neonates with echocardiographically confirmed case of structurally abnormal heart disease were analyzed.Results: Among 106 CCHD neonates, 60% neonates were asymptomatic, 22% had persistent cyanosis and 19% had tachypneic at birth. Cyanosis (35%) and tachypnea (30%) were common initial presentation in postnatal period. 22% neonates were readmitted with initial clinical symptom after discharge from birthing centre. CCHD were more common in male and term neonate, 34% were small for age, median age at admission and discharge were 5days (2-12) and 5 days (2.7-9.2) days respectively. Nineteen percent neonates had fetal distress and 6% neonates required aggressive resuscitation at birth. First trimester abortion (16%), maternal diabetes (10%) and hypothyroidism (7%) were common maternal risk factor. Nearly 20% neonates were diagnosed at referring hospital and 4.7% were transported with PGE1 during transport. TGA (17%) was most common lesion noted followed by pulmonary atresia (10%). Fourteen percent neonates died during the neonatal period. Disease specific death rate was highest for Single ventricle (42%) followed by TGA with IVS (37.5%) and aortic arch anomaly (28.5%) in this study.Conclusions: Early diagnosis and management may improve the survival in CCHD neonates.
Clinico-aetiological profile and outcome patterns of neonatal seizures at a tertiary care centre
Authors: Agrawal Vijay , Bagri Dhan Raj , Sharma J. N. , Singh Roop
Published: January 2020

Background: Neonatal seizures are a major risk factor for neonatal mortality and subsequent neurological disability. The incidence of seizure varies from 1.5-3.7/1000 live birth; while in NICU it can be up to 5/1000 live birth.Methods: This Descriptive type of observational study aimed to study clinical profile, aetiology in neonatal seizures and short term outcome was done in all Neonatal units attached to paediatric Department of SMS Medical College, Jaipur.Results: In the 100 cases Majority of neonates had onset of seizure <3 days (<72 hours) 53% and remaining 47% neonates had onset of seizure >3 days (>72 hours). Most common type of neonatal seizure was subtle(75%), other types were tonic seizure (17.3%), clonic seizure (5.1%) and least common type was myoclonic (2.5%). Most common cause of neonates seizure noted was birth asphyxia (73%) second common cause is pyomeningitis and third common cause is hypoglycaemia. Most common cause of neonatal seizure both in full term (71.17%) and preterm (25%) is birth asphyxia. Second most common cause of neonatal seizure in full term is pyomeningitis (8.70%) and in preterm is pyomeningitis and hypoglycaemia (25%). Most common cause of neonatal seizure both in onset of seizure <3 days (<72 hours) 53% and in onset of seizure >3 days (>72 hours).Conclusions: Out of total 100 cases, neonates with normal birth weight 92% and low birth weight 8%. Majority of neonates had onset of seizure <3 days (<72 hours) 53% and remaining 47% neonates had onset of seizure >3 days (>72 hours). Majority of neonates with seizure delivered by vaginal route (86%) and remaining 14% neonates were delivered by LSCS.
Impact of effective counselling on management of moderate acute malnutrition in a community
Authors: Arya Vikas , Gaur Ajay , Agarwal Neetu S. , Chouhan Harsha
Published: January 2020

Background: Moderate Acute Malnutrition (MAM) is defined as Weight for Height between -2SD to -3SD, and/or Mid Upper Arm Circumference (MUAC) 11.5 cm to 12.5 cm. Effect of not treating MAM has a significant impact on Severe Acute Malnutrition (SAM) burden. Management of MAM is possible through supplementary feeding or Community centre counselling.Methods: Present study was a prospective case control study done in 2013-14 in 200 children in adjacent communities. Community in which intervention (dietary counselling) was planned, it was labelled as case group. For dietary counselling ‘structured group counselling’ method was selected in which at a time parents of six MAM children were involved. Counselling was done by a trained counsellor using all techniques proposed by IYCF. Counselling sessions were scheduled at 0, 1, 3 and 6 months.Results: 60% children of case group moved to improved or well- nourished nutritional status (p-value 0.00001). Amongst improved group, weight for height improvement is statistically significant (p-value 0.001), average weight attained is 2-3 kg in 6 months with average weight gain of 1.5-3 grams/kg/day. MUAC improvement was also found to be statistically significant (p-value 0.003), there was 47% improvement in case group with average MUAC gain is 0.6 cm to 1 cm in 6 months (0.13 cm/month). Also, there is early rise in weight for height then MUAC. Average duration to achieve target weight for height is 4.3 months in case group as compare to 5.3 months in control group.Conclusions: Structured and integrated group counselling using all counselling skills by a trained counsellor should be an integral part of managing MAM in community. Weight for height should be primary indicator in early phase of response as compare to MUAC in measuring impact of counselling.
The predictive accuracy of hypoxic scoring for prediction of adverse outcome in neonates born with asphyxia
Authors: Saqib Muhammad , Jamil Safeer A. , Arif Usman , Anwar Zubda , Waheed Sarosh , Bashir Munibah , Javed Maham
Published: January 2020

Background: Birth asphyxia is a major contributor to neonatal mortality. Fetal hypoxia followed by asphyxia is common cause of brain injury in term infants. Hypoxia score has shown to be accurate enough to predict adverse outcome in asphyxiated neonates. But controversies exist regarding predictive accuracy of hypoxia score. So we conducted this study. Objective to assess the predictive accuracy of hypoxic scoring for prediction of adverse outcome in neonates born with asphyxia.Methods: 170 neonates were screed for hypoxia score. Neonates were labelled as positive or negative. Then all neonates were followed-up for 7 days. If neonate died within 7days, then case was confirmed as positive or negative. Data was analysed by using SPSS 20. 2x2 table was developed to calculate sensitivity, specificity, PPV, NPV and predictive accuracy of hypoxia score.Results: The mean Apgar score at birth was 5.01±0.83. The sensitivity of hypoxia score was 87.8%, specificity was 90.9%, PPV was 90%, NPV was 88.9% while predictive accuracy was 89.4% taking actual adverse outcome as gold standard.Conclusions: The predictive accuracy of hypoxia score was high for prediction of adverse outcome in asphyxiated neonates.
A study on breastfeeding initiation in low birth weight and very low birth weight babies and their developmental outcome with special reference to kangaroo mother care
Authors: Sura Bramhini , Belavadi Gangadhar B.
Published: January 2020

Background: Kangaroo Mother Care (KMC) was developed for caring of low birth weight (LBW) babies in developing countries. Study was done with the objective to evaluate the factors affecting initiation of breast feeding and effect of Kangaroo Mother Care (KMC) on morbidity problems and developmental outcome in Low Birth Weight (LBW) and Very Low Birth Weight (VLBW) babies.Methods: Prospective follow-up cohort study was carried out at Neonatal Intensive Care Unit (NICU) at Narayana medical college hospital Nellore from January 2018 to December 2019 and details of neonates were recorded on prestuctured proforma. Kangaroo mother care was given to one group. ASQ 3 questionnaire was used to assess the developmental outcome of the infants.Results: In this study, 100 babies were divided into two groups, case group consists of 50 babies where KMC is given and another control group consists 50 babies where KMC is not given. Mean gestational age for case and control group babies were 34.5 and 33.7 weeks respectively. Mean Birth weight in cases (1700 gr) and control (1580) grams respectively. Number of Male babies were more in cases (51%) and Group B (53%). Main factors affecting the initiation of breastfeeding in babies are LSCS (62% and 48%), RDS (50% and 40%), Apnea (24% and 25%) and seizures (20% and 14%) respectively in case and controls. Rates of exclusive breastfeeding is significantly increased in cases (90%) when compared to control (72%). Morbidity in cases is comparatively lesser than controls. At 6 months of corrected gestational age, mean weight in cases (5.2 kg) is significantly more than mean weight in control (4.7 kg). Significant development is noticed in communication (p=0.036), gross motor (0.04), and fine motor (0.05) compare to controls. Percentage of babies who acquired better personal social skills are more in cases (80%).Conclusions: The main factors affecting the initiation of breastfeeding in LBW and VLBW babies are LSCS, RDS, not secreted milk and seizures. KMC helps to achieve smooth and early transition to direct breastfeeding, increases the exclusively breastfeeding rate, better growth and developmental outcome and reduces the morbidities in LBW neonates.
Early hospital discharge and readmission jaundice in term babies
Authors: Saleem Saleena , Nair Rekha S. , Nair P. Madhava Chandran
Published: January 2020

Background: Hyperbilirubinemia is a common and often benign disease in the neonatal period. It is the most common cause of readmission in early neonatal period. Prolonged hyperbilirubinemia can result in chronic bilirubin encephalopathy. Increasing the hospital stay of otherwise healthy neonates is not an acceptable solution for medical, social and economic constraints. So, identifying the risk factors for readmission assumes importance. Aim of our study is to identify the risk factors for readmission jaundice in our hospital.Methods: In this study, authors used a questionnaire to find out the risk factors for readmission in those babies who were readmitted with jaundice within 3 weeks of life to our hospital. During the study period, routine treatment practices were followed and there was no deviation from the standard of care for the purpose of research.Results: Of the 2297 deliveries during this study period, 93 babies (4%) were readmitted with jaundice.Among the 93 babies, prevalence of blood group incompatibility was one of the common causes of neonatal jaundice. 46.2% of the babies had an early discharge. Total Serum bilirubin levels were measured by a hospital-based bilirubin assay. Babies with serum bilirubin level above photozones as per American Academy of Pediatrics practice guidelines 2004 were identified and subjected to photo therapy. All the babies in this study responded to photo therapy. No other interventions were needed.Conclusions: Though an early discharge is the most cost-effective strategy in this era of high medical expenditure, we can identify certain high-risk babies, prone for readmission. Blood group incompatibility, infants of primiparous mothers and GDM mothers are more prone to readmission jaundice. Identifying these high-risk babies and educating the mothers is a more cost-effective strategy than prolonging the hospital stay for all babies.
Nutritional status and age of menarche in adolescent girls in urban and rural area schools
Authors: D. Ramamani , Rajendiran Ramyaa , Kannan Iyanar
Published: January 2020

Background: There are various factors that influences the age of menarche which includes genetic, nutritional status, socioeconomic status and environmental conditions. Further it has also proved that the malnutrition has delayed the age of menarche. Thus, the present study focuses on the study of relation between the nutritional status and age of menarche among the adolescent girls in a rural and urban area in Tamil Nadu, India.Methods: It is a community based cross-sectional study done in the adolescent girls of age between 11 to 15 years studying in school in the city of Chennai, India and surrounding rural areas. A total of 602 post-menarcheal adolescent girls were included in the study. The participants who were post-menarcheal were asked to recall the year and month of menarche and was noted. To assess the nutritional status, the parameters weight, height and waist circumference were determined.Results: The association between the age of menarche and BMI was studied. The study showed that there was an association with a Pearson coefficient (r) value of - 0.252 which is statistically significant (p˂0.001). The association between the age of menarche and waist to height ratio was studied. The study showed that there was an association with a Pearson coefficient (r) value of - 0.261 which is statistically significant (p˂0.001).Conclusions: This study has confirmed that the nutritional status has association with the age of menarche and is the contribution to the reduction in the mean of age of menarche in this geographical area.
Study on demographic factors of discharge against medical advice in pediatric population
Authors: U. Vidya B. , K. Anil Shetty
Published: January 2020

Background: Discharge against medical advice (DAMA) is of serious concern among the pediatrics population. Parent(s)/guardians understanding about the disease and various other factors play role in their decision of DAMA. The aim of this study is to know the prevalence of DAMA in a tertiary care center and to observe the gender stratification in DAMA.Methods: A retrospective survey of medical records of children discharge against medical advice during the period January 2017 to January 2019. Demographic data, length of hospital stay, clinical diagnosis and procedure refused was collected.Results: Total 12977 were discharged during the study period of which, 387 children were DAMA, prevalence of DAMA was 2.9%, male to female ratio among DAMA patients is 1.2:1. The mean length of stay was 4.8 days. Among the DAMA patients’ newborns were predominant (61.6 %), p value = 0.0001, highly significant. No significant difference with respect to age and gender (p value = 0.535). Out of 370 DAMA patients, 211 patients who required further investigations and procedure was refused by parents/guardians (p value = 0.0001) highly significant. Phototherapy refusal was most common among newborn (59.7%), followed by neuroimaging and lumbar puncture in children (10.9%).Conclusions: DAMA was observed more among the newborns compared to infants, toddlers and children. Among newborns, phototherapy refusal was most common. In infants and children neuroimaging and lumbar puncture was the most commonly refused procedure. There was no gender bias.
Etiology of short stature in children attending pediatric endocrinology clinic of a tertiary care hospital in Bangladesh
Authors: Karim Muhammad Rezaul , Shamaly Kohinoor Jahan , Tithi Baraka Badrudduja , Akter Romana , Jahan Ismat , Begum Suraiya
Published: January 2020

Background: Short stature is a common problem to practicing pediatricians. It results from various etiologies, which are categorized as normal variants and pathological causes. Normal variant short stature consists of Familial Short Stature (FSS) and Constitutional Growth Delay (CGD), while pathological causes are subdivided into endocrine diseases, clinically defined syndromes, chronic diseases, metabolic diseases and others. There are not so much data available in Bangladesh in this respect. So, present study was conducted to know the common causes of short stature.Methods: This cross-sectional study was done in pediatric endocrinology clinic of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2017 to August 2018. One hundred children with short stature meeting inclusion criteria were recruited after taking an informed consent. The detailed history, physical examination including anthropometric measurements and relevant investigations were done. Data were recorded on a predesigned questionnaire for final analysis.Results: The common causes of short stature identified were familial short stature (FSS) 51% cases, Constitutional Growth Delay (CGD) 14% cases and hypothyroidism 12% cases. Other less common causes of short stature were Growth Hormone Deficiency (GHD) 8% cases, malnutrition 6% cases and genetic syndrome 5% cases.Conclusions: FSS and CGD were the leading cause of short stature in children. Endocrinological causes were the most common cause of short stature after normal variant while nonendocrine causes were the least.
Study of liver enzyme variation in children with dengue fever
Authors: Joseph Clara Rilna , Nandini Nitish Kumar P. , Shenoy K. Varadaraj
Published: January 2020

Background: Dengue fever continues to be one of the major public health problems in large parts of the world, with an estimated 50 million dengue infections occurring annually. Liver enzyme variation is commonly seen in patients with dengue fever. This study was undertaken to assess the pattern of liver enzyme variation in children with dengue fever and to correlate it with the severity of this disease.Methods: Observational, descriptive hospital-based study involving 100 children who were serologically positive for dengue fever. The cases were classified as Mild, Moderate and Severe Dengue based on National Guidelines of clinical management of Dengue fever, 2015 and severity was assessed in each category. The study assessed the variability of liver enzymes in these children.Results: Aspartate Aminotransferase (AST) was elevated in 56 cases whereas Alanine Aminotransferase (ALT) was elevated in 44 cases. The elevation in liver enzymes in mild cases was 52%, moderate cases was 75% and severe cases was 100%. In cases presenting on day 1 of fever, enzymes were elevated in 0%, on day 2 in 20%, on day 3 in 38%, on day 4 in 51%, on day 5 in 90% and on day 6 in 88%.Conclusions: Liver Enzyme (AST and ALT) elevation in Dengue is a common feature. AST elevation was more common than ALT. Highest elevation in liver enzymes were observed on 5th and 6th day of fever. Liver enzyme elevation was more commonly seen in moderate and severe cases.
Role of peak expiratory flow rate and chest radiography in children above 5 years of age with acute asthma
Authors: Shankarnarayana Sankeerthana , Devdas Jaidev M. , John Sujonitha , Khan Habeeb Ullah , Hegde Pavan
Published: January 2020

Background: Asthma is a heterogeneous disease characterized by cough, wheeze and shortness of breath that vary in intensity and time with variable expiratory airflow limitation, associated with chronic airway inflammation. Aim of the study was to assess the usefulness of Peak Expiratory Flow Rate [PEFR] and oxygen saturation in determining severity of acute asthma, to measure objective change in PEFR and oxygen saturation following bronchodilator therapy and the role of chest X-rays in acute asthma.Methods: A prospective study of 50 children above 5 years with acute asthma who presented to the emergency department in a tertiary care hospital were included. PEFR and oxygen saturation before and after bronchodilator therapy was measured. Indication for chest X-rays, its clinical correlation and change in standard treatment of acute asthma based on X-ray reports was noted.Results: The mean PEFR and PEFR % of expected was lower in severe asthma when compared to moderate asthma and was statistically significant (p<0.001). The % of expected PEFR before salbutamol therapy was 48.78±14.36, which improved significantly to 67.13±14.22 after treatment (p<0.001). Oxygen saturation before and after salbutamol therapy was 94.96 ± 4.11 and 96.96±2.87 respectively with the change being significant (p value <0.001). Chest X-rays were performed in 12 (24%) children as per standard guidelines, of which 1(9%) was abnormal showing right basal consolidation. Chest X-ray correlated with clinical findings in 1 child and the findings on chest X-ray altered the ongoing treatment by addition of antibiotic.Conclusions: PEFR and oxygen saturation is useful in the emergency department to objectively assess the severity of acute asthma and the response to initial bronchodilator therapy. Chest X-rays are not routinely indicated in the standard treatment of acute asthma.
Clinico-laboratory profile and outcome of dengue fever among children attending a tertiary care hospital of rural Telangana, India
Authors: Shekar V. , Kumar K. Praveen , Soren C. , Reddy K. Venkataramana , Dharani N.
Published: January 2020

Background: Dengue is a self-limiting, vector-borne disease transmitted by Aedes mosquito, causing a major public health threat globally. The objective of this study is to assess the clinical profile and outcome of the dengue infection in children less than 14 years of age September 2018 to August 2019 at the Pediatric Department of S.V.S. Medical College, the tertiary care hospital in Mahabubnagar, Telanagana.Methods: Prospective study of 82 hospitalized children of <14 years with the diagnosis of dengue illness. Children with diagnosis of dengue were classified further in to two groups as per WHO guidelines, Non-severe dengue fever (probable dengue, dengue with warning signs) and ‘Severe Dengue’ (Dengue Haemorrhagic Fever and/or Dengue Shock Syndrome (DHF/DSS). A separate questionnaire form used for documenting clinical history, laboratory parameters. Haematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done. Children were managed as per WHO protocol. The outcomes of the cases were mentioned as discharge, left against medical advice and death.Results: A total of 82 children with dengue were divided in to 55(67%) non severe dengue and 27(33%) severe dengue with males 56(68.2%) and females 26(31.7%). The most common age of presentation was between 6-10 years 34(41.5%). Fever 73(89%) was the most common presenting symptoms. Pleural effusion and hepatomegaly were the commonest clinical findings 28(34.1%) each, which were more among the severe dengue patients. Gall bladder edema 29(35.3%) was the most common ultra-sonogram finding. Significant elevation of transaminases (SGOP, SGPT) was seen in 39(47.5%). Severe thrombocytopenia was observed in 22(26.8%) children. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a global problem. Presenting features include high grade fever, vomiting, abdominal pain, skin rash. Early recognition of symptoms and proper management can reduce the mortality.
A study on vitamin D levels in preterm and term neonates and their mothers
Authors: Thomas Deepa J. , Khan Habeeb U. , Paul Saritha , D. Jaidev M. , Hegde Pavan
Published: January 2020

Background: Vitamin D is a fat-soluble vitamin which has immunomodulatory and anti-inflammatory effects. Vitamin D deficiency is a worldwide problem and yet is one of the most under diagnosed and under treated nutritional deficiency. Despite India being in the tropical zone with plentiful sunlight, there is a wide prevalence of vitamin D deficiency.Methods: Cross sectional descriptive study done in a tertiary care hospital involving 30 mother baby dyads equally divided into term and preterm babies. Maternal vitamin D levels (before delivery) and cord blood vitamin D levels (after delivery) were estimated.Results: All the mothers had low vitamin D levels, 93% having deficiency and 7% having insufficiency. The maternal vitamin D levels correlated with cord blood vitamin D levels. There was significant correlation between maternal vitamin D levels and cord blood vitamin D levels with maternal age and parity. There was no correlation between maternal vitamin D levels with gestational age, sociodemographic profile or neonatal anthropometry.Conclusions: Vitamin D deficiency is widely prevalent even in well-nourished mothers. Vitamin D supplementation may be helpful in antenatal mothers. Larger studies are needed to study the prevalence of vitamin D deficiency in mothers and babies and look for effectiveness of supplementation.
Study on peak expiratory flow rate and its influencing factors in healthy school children in Kancheepuram district of Tamil Nadu, India
Authors: D. Ramamani , Kannan Iyanar
Published: January 2020

Background: The Peak Expiratory Flow Rate (PEFR) is useful to screen and monitor the severity of asthma in children. Many studies have documented that age, height and weight are some of the main factors that affect the PEFR. Thus, the present study was done to find the PEFR values among the school children and to find the factors that influences the PEFR values in our geographical area.Methods: It was a cross sectional study conducted in school children belong the rural area of Kancheepuram district, Tamil Nadu, India. A total of 378 students of both the gender at the age group of 5-10 years were selected for the study. The PEFR was measured by making the participant seated comfortably. One peak flow meter was used for 25 children and mouthpiece was changed for each student.Results: The PEFR value among and male and female participants was analyzed statistically (Table 2). The mean value of male and female study population was 169.53±37.38 and 146.24±33.01 respectively. The difference in the mean values were statistically significant (p=0.001) and found to be high in male participants. The Pearson correlation r between PEFR with height is 0.463, thus showing a positive correlation with the p˂0.001 which is statistically significant. The Pearson correlation r between PEFR and chest circumference is 0.335 thus indicating a positive correlation between PEFR and chest circumference.Conclusions: From the present study, the normal values of PEFR has been deduced for the healthy school children in our geographical area. Further, it was found that the height and chest circumference are influencing factors for PEFR. Further regression equation has been derived that can help us to find the approximate PEFR values with the help of height and chest circumference of the children.