bluuebunny/crossref_metadata_2025 huggingface dataset:
Inappropriate complementary feeding practice increases risk of stunting in children aged 12-24 months
Authors: Hijra Hijra , Fatimah-Muis Siti , Kartasurya Martha Irene
Published: January 2017

Background
In 2013, the prevalence of stunting in Central Sulawesi province was 41%, which was higher than the national prevalence of 37.2%. Complementary feeding practice, infectious disease, history of exclusive breastfeeding, birth weight and birth length were assumed to contribute to the prevalence of stunting. The objective of the present study was to identify the risk factors for stunting among children aged 12 to 24 months.

Methods
This study was conducted using a case control design. Subjects were children aged 12-24 months, consisting of 58 cases and 58 controls. Data were obtained with a body length infantometer. Data on complementary feeding practices, history of exclusive breastfeeding, and history of infectious diseases were obtained using questionnaires. Nutrient intakes were measured by semi quantitative food frequency questionnaires. Data on birth weight and birth length were obtained from the buku KIA (maternal and child health record). Data were analyzed by chi-square and logistic regression tests.

Results
There was no difference in sex, BMI, and parental education between cases and controls (p>0.05). After controlling for history of exclusive breastfeeding and birth weight, the risk factors for stunting were inappropriate complementary feeding practice in terms of quantity and quality (OR=8.26; 95% CI: 2.69-25.44), history of diarrhea (OR=4.73; 95% CI: 1.08-20.69), birth length (OR=5.11; 95% CI: 1.69-15.46) and respiratory tract infection (OR=5.30; 95% CI: 1.03-27.23). Inappropriate complementary feeding practice was the most dominant factor for stunting.

Conclusion
Inappropriate complementary feeding practice increased the risk of stunting in 12-24 months old children by 8.26. This study confirms the need to scale up interventions during the first 2 years of life, including appropriate infant feeding practices.
Dyselectrolytemia in hyperglycaemic crisis patients with uncontrolled non-insulin dependent diabetes mellitus
Authors: Rana Anup K , Ray Subhashree
Published: January 2017

Background: Diabetes is a group of disorders characterized by high blood glucose levels. Disturbances in serum electrolytes sodium (Na+), potassium (K+) and chloride (Cl‑) is found in diabetes. The objective of the study was to investigate the disturbances in concentrations of serum electrolytes in hyperglycaemic crisis, uncontrolled non – insulin dependent diabetes mellitus patients: early detection and treatment of such abnormalities, leading to better quality of life of patients.Methods: Data was collected prospectively over a period of 1 year and analyzed retrospectively. Of the 131 subjects included in the study, two groups were formed; 60 hyperglycaemic diabetes mellitus patients and 71 healthy volunteer as controls. Biochemical analysis for Na+, K+, Cl- was performed by ISE method using Easy – lyte automatic electrolyte analyzer. The random glucose levels were estimated by direct Hexokinase enzymatic method using Cobas Interga 400. Unpaired t-test was done to find out the difference between the two paired groups and Pearson's correlation was calculated to know the correlations between electrolytes and random glucose levels.Results: In uncontrolled diabetes mellitus, increase in serum Na+ and Cl- levels were observed to be highly significant (p<0.001, respectively) while that of K+ showed significant (p<0.05) alterationsConclusions: The study demonstrated significant association of Na+, K+ and Cl- with hyperglycaemia in patients with hyperglycaemic crisis in uncontrolled type 2 diabetes mellitus. So, electrolytes should be measured during the treatment of type 2 diabetes mellitus.
Clinical profile and factors determining outcome of intramural very low birth weight babies in a tertiary care centre: a retrospective study
Authors: K. Devi Meenakshi , A. T. Arasar Seeralar , Padmanaban Srinivasan
Published: January 2017

Background: Very low birth weight (VLBW) babies are at increased risk of a number of complications both immediate and late. Worldwide it has been observed that these babies contribute to a significant extent to neonatal mortality and morbidity. Aim of the study was to study the risk factors contributing to mortality in VLBW babies and to evaluate the morbidity pattern in these infants.Methods: A retrospective analysis of data retrieved from the case records of VLBW babies admitted in the NICU of Kilpauk Medical College between January 2015 to December 2015. Out of the 2360 intramural babies admitted during the study period, 99 babies were less than 1500 gms. The risk factors for these babies were analyzed for their association with the outcome. Data were statistically analyzed.Results: In present study, we found that sex of the baby, gestational age, obstetric score, birth asphyxia, pulmonary haemorrhage, ROP and presence of shock were found to be associated with increased mortality. By logistic regression analysis it was observed that birth weight of the baby (p value 0.002), duration of stay (p value 0.0006), presence of shock (p<0.0001), were the risk factors significantly associated with poor outcome.Conclusions: Among the maternal and neonatal factors analyzed in the study using logistic regression analysis, birth weight, duration of hospital stay and presence of shock were significantly related to poor outcome. Of these presence of shock was the single most important factor that predicted increased mortality.
Phenotypic detection of inducible clindamycin resistance among Staphylococcus aureus isolates
Authors: Nikam Archana P. , Bhise Pramod R. , Deshmukh Mukta M.
Published: January 2017

Background: Staphylococcus aureus is a leading cause of nosocomial and community acquired infection in every region of world. Clindamycin is a frequent therapeutic option in the treatment of skin and soft tissue infection caused by Staphylococcus aureus. However resistance to this drug is again a problem which may be inducible or constitutive. The present study was carried out to determine the prevalence of inducible clindamycin resistance among Staphylococcus aureus and to find out the relationship between methicillin resistant Staphylococcus aureus and inducible clindamycin resistance.Methods: A total of 177 Staphylococcus aureus isolated from different clinical samples were subjected to routine antibiotic sensitivity testing by Kirby Bauer disc diffusion method. All were tested for Methicillin resistance by using cefoxitin 30 µg disc. Inducible clindamycin resistance was detected by ‘D’ test as per CLSI guidelines.Results: Out of the 177 Staphylococcus aureus isolates, 77 (43.50%) were MRSA and 100 (56.50%) were MSSA. 101 (57.06%) isolates were erythromycin resistant. These erythromycin resistant isolates when subjected to ‘D’ test, 27 isolates showed MS phenotype, 26 showed inducible MLSB phenotype and 48 showed constitutive MLSB phenotype. Out of 77 MRSA isolates 23 (29.87%) showed Inducible MLSB phenotype and 33 (42.85%) showed Constitutive MLSB phenotype, while in 100 methicillin sensitive Staphylococcal isolates 03 (3%) showed Inducible MLSB phenotype and 15 (15%) showed Constitutive MLSB phenotype. The percentage of inducible and constitutive resistance was higher amongst MRSA isolates as compared to MSSA isolates.Conclusions: Study showed that ‘D’ test should be used routinely to detect inducible clindamycin resistance.
A study of bone mineral density among people living with HIV in India and its correlation with CD4 count
Authors: Sawlani Kamal K. , Singh Sushrut , Chaudhary Shyam C. , Reddy D. Himanshu , Usman Kauser , Atam Virendera
Published: January 2017

Background: Data on the prevalence of osteoporosis in HIV patients in Asian population is scarce this study was done to find out the prevalence of osteoporosis in HIV infected patients and its correlation with CD4 counts.Methods: This cross- sectional study was conducted in NACO- ART center of tertiary care hospital. Total 115 HIV patients were included in this study which were divided into ART naive (n= 69) and patients taking ART (n= 46). We analysed BMD by DEXA in 115 HIV positive patients and 78 HIV negative age and sex matched controls. Correlation of BMD with a CD4 count and ART regimen was studied.Results: BMD was found to be low in HIV positive patients. T score in HIV positive patients was significantly lower (p<0.05) as compared to the HIV negative control group. The prevalence of osteopenia and osteoporosis in HIV positive patients was 50.4% and 29.6% respectively, as compared to 23.1% and 2.6% in HIV negative controls. BMD showed relation with CD4 count. We did not find any statistical difference between any ART regimen and BMD.Conclusions: The prevalence of osteopenia and osteoporosis in HIV infected cases was higher as compared to HIV negative controls and higher in ART group as compared to ART naïve group. Low BMD levels show correlation with low CD4 count. We recommend that HIV positive patients especially with advanced stage of disease, low CD4 count should be screened for low BMD by DEXA scan for osteoporosis and managed accordingly
Functional and radiological outcome in distal radius fractures treated with locking compression plate
Authors: Chavhan Ashish N. , Dudhekar Ulhas J. , Badole Chandrashekhar M. , Wandile Kiran N.
Published: January 2017

Background: Fractures of distal end of radius are one of the most common skeletal injuries encountered in orthopaedics. There are various modalities for treatment like close reduction and cast application, external fixators, ORIF with plate etc. CR and cast application or K-wire fixation, external fixation is associated with immobilisation, wrist stiffness, loss of reduction postoperatively. So we performed volar plating for distal end radius fractures and calculated its results.Methods: We performed ORIF with plating (Volar approach) in 35 patients (22 male and 13 female) of distal end radius fractures depending on inclusion and exclusion criteria. Fractures were classified according to AO classification. All patients were operated under tourniquet. Results were analysed using Mayo score.Results: Out of 35 patients, 14 had type A, 16 had type B and 5 had type C fractures (AO classification). Average operative time was 45 minutes and blood loss of 50 ml. Average time to clinico-radiological union was 7 weeks. Average follow up time was 8 months. Average time to wrist mobilisation was 8 days. According to Mayo score, 16 patients had excellent results, 15 had well and 4 had satisfactory results.Conclusions: Volar plating for fracture distal end radius reduces chances of wrist joint stiffness and loss of reduction and good results can be obtained. So in our opinion, volar plating for treatment of fracture distal end radius is good method with excellent outcomes.
Does fentanyl prolong the analgesia of local anaesthetics in brachial plexus block? A randomized controlled study
Authors: Kaniyil Suvarna , Radhakrishnan Priya
Published: January 2017

Background: Several adjuvants have been added to enhance the effects of local anaesthetic agents in peripheral nerve blocks. In this randomized controlled study we aimed to assess the effects of addition of fentanyl to local anaesthetics in brachial plexus block with respect to onset time and total duration of analgesia.Methods: In this prospective randomized double- blind study, 40 adult patients of 18-65 years age group were randomly divided into two groups of 20 each. In group L supracavicular brachial plexus block was performed with 30 ml of local anaesthetic solution (10 ml 1.5% lignocaine with adrenaline +20 ml 0.25% bupivacaine) +1ml saline whereas in group LF received the same 30 ml local anaesthetics with 50µg fentanyl in 1ml added to it. The characteristics of block with respect to onset time of sensory and motor blockade, total duration of analgesia and any side effects were evaluated.Results: Both groups were comparable with respect to demographic parameters and duration of surgery. The onset time of complete sensory and motor block was significantly prolonged in group LF (17.2±2.5min and 20.3±2.9min) compared to group L (13.7±3.6min and 17.45±3.7min). The total duration of analgesia was also significantly prolonged (P <0.001) in group LF (374.5±51min) compared to group L (239.25±40.27min). There were no significant side effects noted in any patients in both groups.Conclusions: Addition of fentanyl to local anesthetics in brachial plexus block significantly prolonged the duration of analgesia without any significant side effects though it had delayed the onset of block.
Can Tc-99m labeled erythrocyte scintigraphy be an alternative non-invasive method to endometriosis diagnosis?
Authors: Demirel Fatih , Koca Gokhan , Demirel Koray , Aydogmus Huseyin , Akbulut Aylin , Sadic Murat , Atilgan Hasan Ikbal , Korkmaz Meliha , Gokmen Bulent
Published: January 2017

Background: Endometriosis is defined as the implantation of endometrial gland and stroma ectopically outside the uterus. Clinically, it is a hormone dependent benign disease accompanied by pelvic pain and infertility. The aim of this study was to demonstrate the activated implants with 99m-Tc labeled erythrocyte scintigraphy (99mTc-RBCs) in patients with recurrent endometriosis and compare the results with pelvic MRI results.Methods: Patients who were diagnosed histopathologically as endometriosis either with operation and / or therapeutic laparascopy or laparotomy and, were included to present study. Thirty patients, who were diagnosed as recurrence by clinical, and laboratory terms and 10 healthy volunteer (control group) patients were included in the study. Between the second and fifth days of menstruation when the endometriotic lesions were highly activated, radionuclide imaging was performed by 99mTc-RBCs and compared with pelvic MRI findings.Results: In 27 patients out of 30 patients (90%) pathological accumulation of radioactivity foci with 99mTc-RBCs were present. The focal pathological accumulation was significant in 26 patients and moderate in 1 patient. In 22 patients (81.5%) the increased radioactivity accumulation in radionuclide images was concordant with MRI images. Regarding the MRI as reference, the sensitivity of 99mTc-RBCs was determined as 96%, specificity 29%, positive predicitive value 81% and negative predictive value was 66%.Conclusions: Imaging of endometriosis regions with 99m-Tc-RBCs can be an alternative diagnostic procedure for the patients with recurrent endometriosis.
Severe androgenetic alopecia as a maker of metabolic syndrome in male patients of androgenetic alopecia: a hospital based case control study
Authors: Tilwani Mohd. R. , Dogra Naina K. , Dogra Devraj , Rather Suhail Raheem , Rather Parvaiz A.
Published: January 2017

Background: Several previous studies have investigated the association between androgenetic alopecia (AGA) and metabolic syndrome (MS), with inconsistent results. Objectives of the study were to study the prevalence of metabolic syndrome in male patients of androgenetic alopecia and compare with control population and study the relationship of metabolic syndrome with different grades of AGA.Methods: This prospective hospital based case control study included 100 new clinically diagnosed males of androgenetic alopecia, and age and sex matched control group. Assessment for presence of various components of metabolic syndrome was done following a uniform protocol in cases and controls. AGA was classified as per Hamilton –Narwood classification, grade I to III was classified as mild –moderate and grade IV and higher as severe AGA.Results: Of the 100 male AGA patients (age range 21-50, mean 34.49), 36 had grade II AGA, 24 had grade III AGA, 20 had grade IV AGA, 15 had grade V AGA and 5 had grade VI AGA. Among AGA patients, 60 of patients had mild-moderate AGA and 40 patients had severe AGA. Metabolic syndrome was statistically significantly more common in patients with AGA compared to controls. Among patients of AGA, metabolic syndrome was statistically significantly present in severe AGA compared to mild-moderate AGA. Among the evaluated parameters, like blood pressure, fasting blood sugar, dyslipedemia, abdominal obesity, all were significantly more common in AGA patients compared to controls except abdominal obesity.Conclusions: In the present study, metabolic syndrome was found to be 4.6 times more common in patients of androgenetic alopecia as compared to controls, being statistically significant, and more common in those with severe grades. This suggests that androgenetic alopecia patients especially with severe grades are at risk of metabolic syndrome and other cardiovascular diseases.
A hospital based study of scenerio of glaucoma patients in upper Assam, India
Authors: Gogoi T. , Bhattacharjee Supantha
Published: January 2017

Background: Glaucoma can be defined as a chronic multifactorial optic neuropathy with a characteristic accelerated degeneration of retinal ganglion cells presenting as classical optic nerve head features and correlating visual field changes, which may or may not be associated with angle abnormality in the presence or absence of any cause for the disease.Methods: This was a prospective hospital based study of patients >40years with a suspicion of glaucoma attending the Outpatient Department of Ophthalmology, Assam Medical College, Dibrugarh, Assam, india. Patients were subjected to a comprehensive eye examination to diagnose and classify glaucoma.Results: In this study out of 1000 patients, 22 were diagnosed to have glaucoma (2.2%), most common age group >61years (50%), male patients were 73%, PACG accounted for 11 patients (50%). POAG in 7 cases (32%), LIG in 14%, Neovuscular in 1 cases (5%).Conclusions: Glaucoma prevalence, age and sex distribution was found to be similar to studies conducted in other parts of India. Most common type of glaucoma was PACG followed by POAG.
Efficiency of nalbuphine as an adjuvant to bupivancaine in lower limb orthopaedic surgery-a prospective study
Authors: Gupta Kanhya Lal , Gupta Amit , Neeraj .
Published: January 2017

Background: Spinal Anaesthesia is a well-known technique of performing lower limb orthopaedic surgeries. It has a shorter duration of action and early arising postoperative pain due to which various adjuvant needs to be added and their roles are being evaluated in various studies. Intrathecal opioids act synergistically with local anaesthetics and thus intensifying the sensory block without having any effect on sympathetic blockage. The main aim of present study is to investigate and evaluate the effectiveness of intrathecal nalbuphine (preservative free) as an adjuvant and also the efficacy of nalbuphine for postoperative analgesia and its complications if there are any.Methods: A total of 60 patients were included in this study belonging to ASA I and ASA II score with normal coagulation profile. Patients were randomly divided into 2 groups of 30 patients each. Group I receiving 3 ml of hyperbaric bupivacaine 0.5%+1.0mgm of nalbuphine (preservative free) injection made in 0.5 ml normal saline intrathecally. Group II received 3 ml of hyperbaric bupivacaine 0.5%+0.5 ml injection Normal saline intrathecally. The following criteria were noted. The onset of sensory blockade and complete motor blockade highest level of sensory blockade, duration of sensory blockade, duration of motor and duration of effective analgesia were recorded. Any hemodynamic alterations were also noted.Results: The mean time for the onset of sensory blockage was 56 sec in Group I and 59 sec in Group II (control). The difference were statistically insignificant (p>0.05). The mean onset of motor blockage was 106 sec in Group I and 208 sec in Group II (control). The difference was statically insignificant. The peak onset time in Group I and Group II was 372 sec and 220 sec respectively (p>0.05). Two segment regression times for sensory blockage was prolonged in Group I (118.20±8.56 min) compared to Group II (104.56±15.20 mins).Conclusions: The duration of postoperative analgesia was 6-8 hours in Group I compared to 3-4 hours in Group II (p value= 0.0001, statistically significant).
A study on ocular injuries following road traffic accidents
Authors: Puzari B. S. , Das R. K. , Pegu Indira
Published: January 2017

Background: Ocular injuries in road traffic accidents (RTA) constitute a major but preventable cause of visual morbidity worldwide and so it is of public health importance. Aim of the study was to assess the visual outcome in patients attending tertiary care hospital with ocular injuries following RTA and compare various associated risk factors.Methods: A prospective study was done with 60 cases of ocular injuries following road traffic accidents in Assam Medical College and Hospital to find out the visual outcome and compare various risk factors .Detailed history and clinical evaluation was done with follow up at 1st and 3rd week.Results: Maximum cases were seen in the age group of 30-40 years, more in males (76.66%); with 78.33% in two wheelers. Out of the 60 cases, 38.33% occurred at night, 21.66% was under the influence of alcohol. 15.27% of patients presented with diminished vision, out of which 15% cases reported with severe ocular morbidity like vitreous haemorrhage, lens dislocation, sclera-corneal tear etc.Conclusions: Younger age group was mostly affected with male preponderance, alcohol and two wheelers being quite important risk factors. Early treatment of ocular injuries and use of protective wear result in better visual outcomes.
Pulmonary function changes in asymptomatic smokers - a community survey in Udupi, Karnataka, India
Authors: Elumalai Senthil Kumar , Maiya Arun G. , Chakravarthy Kalyan B.
Published: January 2017

Background: Smoking has been labeled the most important preventable cause of a respiratory disease and its effects in a smoker are well established. A better understanding on the pulmonary function impairments in an asymptomatic smoker is the need of the hour. Objective: To study the pulmonary function changes in asymptomatic smokers and non- smokers and to establish the dose -effect relationship amongst asymptomatic smokers.Methods: A cross sectional survey was conducted in Udupi district of Karnataka, India. 140 men aged between 20 to 45 years with a BMI ranging from 18.5 to 29.9 Kg2 /m was enrolled in to the study. 70 subjects were asymptomatic smokers and the other 70 were non-smokers. Outcomes measured were standard spirometric measures for pulmonary function and symptoms like breathlessness, cough and sputum using a Breathlessness Cough Sputum scale.Results: The mean age (mean ± SD) of non-smokers and asymptomatic smokers enrolled was 34.7±5 and 33.8±5 years respectively. The mean smoking dose amongst the asymptomatic smokers was 15.74±5.5 pack years. FEV1 amongst the asymptomatic smokers showed a negative correlation with smoking dose (p<0.05) and there was a significant difference in FEV1, FVC, PEFR, MVV and FEF 25- 75 % (p<0.001) amongst the asymptomatic smokers and non-smokers.Conclusions: Asymptomatic smokers showed low values of pulmonary function parameters compared to those in non-smokers.
A study on the bacteriological profile of urinary tract infection in adults and their antibiotic sensitivity pattern in a tertiary care hospital in central Kerala, India
Authors: A. T. Jubina Bency , R. Priyanka , Jose Ponnu
Published: January 2017

Background: Urinary tract infection is one of the most common bacterial infections in humans and a major cause of morbidity. The etiology of UTI and the antibiotic sensitivity pattern varies with the widespread availability of antimicrobial agents; UTI has become difficult to treat because of appearance of pathogens with increasing resistance to antimicrobial agents.Methods: A descriptive study done during January-June 2013. All positive urine culture and sensitivity reports of males and females aged 20-70years were included. A total of 373 positive urine culture cases were taken from the culture and sensitivity register from Microbiology department and details were entered using a questionnaire.Results: Out of 373 adults, males were 137 (36.7%) and females were 236 (63.3%). E. coli (74.3 %) was the most common organism, followed by Klebsiella (15.8%), Enterococcus, Pseudomonas and Staphylococcus. The incidence of UTI was more in patients in the age group of 60-70years. E. coli and Klebsiella were sensitive to Amikacin (97.1%), Nitrofurantoin (90.7%), Gentamycin and Imipenem. Both organisms were resistant to Ampicillin (>90%).Conclusions: In this study, females were mostly affected and the most common organisms were E.Coli and Klebsiella. These organisms were most sensitive to Amikacin, Nitrofurantoin and resistant predominantly to Ampicillin. The sensitivity and resistance pattern of uropathogens to common antimicrobial agents must be taken into account when selecting treatment plans for UTI.
A rare case report of primary renal squamous cell carcinoma
Authors: Chavarkar Sneha P. , Agrawal Amit K. , Shrivastava Alok C. , Shrikhande Anuradha V.
Published: January 2017

Primary renal squamous cell carcinoma is a very rare entity. Only few cases are reported in the world literature. Most of the patients present at a late stage resulting in poor prognosis. We report a 44 year old female who presented with a history of lump in right flank accompanied with a dull intermittent pain for 2 months duration which intensified in the last 15 days. Antecedent risk factors like renal calculi, analgesic use were absent. Computed Tomography (CT) examination revealed a mass arising from the superior pole of kidney with extension to the posterior segment of liver. Histopathology following nephrectomy showed histological features of well differentiated squamous cell carcinoma.
Modern wound care application in diabetic wound management
Authors: Rohmayanti . , Handayani Estrin
Published: January 2017

Diabetes mellitus is a group of metabolic disease which facilitates diabetic wound foot. To prevent long diabetic wound complication and worse condition it is needed wound care for diabetic patient. Modern bandage has been used for recent wound care technique. The principles of modern wound care product are maintaining and watching over the humid environment of the wound to facilitate the wound healing process, maintaining liquid tissue deprivation and cell decease. This research was aimed to find out how modern wound bandage is applied to the diabetic patient and to find out the influence in healing wound phase. This research is qualitative research using phenomenology approach, 4 wound diabetic patients who were hospitalized for 2 weeks using modern wound care method in Magelang regency were participated. The participants were elected using purposive sampling method. Observation and interview were used to obtain data, data was analyzed using explanation building method. The results of this research have 4 topics which are wound examination, type of modern bandage, the way of wound care, and the influence toward the wound. Bates-Jensen Wound was used for the wound examination, the type of bandage used were hydrogel and wound ointment, TIME management approach was used in wound care, and the wound care influences the decreasing of wound size, wound proliferation and granulation. Modern bandage application of diabetic wound influences the decreasing of wound size, wound proliferation and granulation. Paramedic is suggested to use modern wound care method in diabetic wound management.
Subarachnoid haemorrhage mimicking as myocardial infarction
Authors: Kindra Amanjeet S. , Pandit Abhimanyu , Bhaskar Suryanarayanan
Published: January 2017

Electrocardiographic (ECG) changes due to subarachnoid haemorrhage (SAH) are seen frequently and mimic acute myocardial infarction. For appropriate therapeutic management it is very important to distinguish acute coronary syndrome from neurogenic myocardial injury, which is a reversible condition. A 35 year old male presented to us with history of acute chest pain, ECG suggestive of anterolateral myocardial infarction for which he underwent anticoagulant therapy. It was subsequently diagnosed to be a case of SAH due to ruptured anterior communicating artery aneurysm.
Pseudomonas septicaemia: in a case of pancytopenia
Authors: Nagori Yusuf , Chandakb Darshan , Dube Sunil , B. Vatsal
Published: January 2017

Pseudomonal infection is a rare condition with multiple systemic complications. A new condition of interest is ecthyma gangrenosum in a patient with pseudomonas septicaemia with pancytopenia and megaloblastic anaemia. So here we present you the case of Ecthyma gangrenosum in a 20-year-old female with pseudomonas septicaemia due to pancytopenia. A high degree of clinical suspicion is required, but a tissue sample is ultimately necessary for definitive diagnosis.
Benign cystic teratoma of fallopian tube with shadow cell differentiation – a rare diagnostic entity with review of literature
Authors: Konar Karabi , Singh Shivani , Chakrabarti Nirmalya
Published: January 2017

A 26 year old gravida 2 para 1 presented to obstetrics department at full term with an unremarkable USG. LSCS was performed for CPD. A fimbrial cyst was discovered intra operatively and excised and sent to us for histopathological examination which showed derivatives of all 3 germ cell layers with presence of shadow cells surrounded by basaloid cells and giant cell reaction. Objective was to report a case of mature cystic teratoma of Fallopian tube with shadow cell differentiation.
Seronegative celiac disease: a case report
Authors: Surana Amita , Chaudhari Vaishali , Patel Shefali
Published: January 2017

In this article we report a case of 17 years old male with short stature, severe anaemia and delayed puberty. After extensive workup and in-spite of being seronegative for celiac antibodies, he was diagnosed as an atypical case of celiac disease based on duodenal biopsy report suggestive of CD. The patient is put on gluten free diet along with other nutritional supplements. Long term consequences like short stature, infertility can be prevented by higher clinical suspicion and early diagnosis. Intestinal biopsy should be performed if there is strong clinical suspicion. The relevant literature has been reviewed and discussed in brief.
Prevalence of co-morbidities among adult patients presented for open heart surgery and the implication on convalescence period
Authors: Adwan Hayel Al , Fadel Ashraf , Naser Yanal F. Al , Qaysi Abdallah Al , Qsous Rami , Al-issa R. N. Ahmad Omar
Published: January 2017

Background: Improvements in perioperative medical care, anesthetic management, surgical and myocardial protection techniques made cardiac surgery feasible in the high risk surgical patients. The aim of the study was to determine the prevalence of comorbidities in adult patients undergoing open heart surgery and to evaluate their implications on recovery profile.Methods: This randomized retrospective observational study of 100 adult patients presented for heart surgery for different pathologies took place at Queen Alia heart Institute in the period of time between February 2013 and June 2014. Patients' data was collected in forms, tabulated and retrospectively analyzed. Patients' demographics, co-morbidities and type of surgery were recorded. Risk stratification models (ASA-American Society of Anesthesiology and EUROSCORE 2- European system for cardiac operative risk evaluation) were used. Time of extubation, ICU discharge and hospital discharge was recorded with each patient.Results: Age of patients ranged from 18 to 77 years (mean±SD: 58±12). 83% of patients were male and 17% were female. 80 patients were presented for CABG and 20 patients for heart valve(s) surgery. BMI (body mass index, mean±SD) was 28.9±4.6 kg/m². The prevalence of smoking was 56% (6 times higher among males (64%), in comparison to females (12%). Hypertension was prevalent in 72% of patients; diabetes was present in 53%, respiratory disease in 30%, previous myocardial infarction in 23%, 37% of patients had left ventricular impairment, renal impairment in 6%, renal failure in 2% and previous stroke in 2%. EUROSCORE values ranged between 0.5 to 5.3 % (mean 1.4%). ASA grades ranged from 2 to 4 (85% of patients were grade 3). 5% of surgeries were emergent. Average operative time was 248±47 minutes (mean±SD). 30% of patients needed inotropic support and 6% needed intra-aortic balloon. Mean time in the intensive care was 43.2±28.8 hours (mean±SD).Conclusions: There is a high prevalence of co-morbidities in patients presented for cardiac surgery. Most common associated diseases were hypertension, obesity, smoking, previous myocardial infarction and diabetes; which are all well known risk factors of ischemic heart disease. Preoperative risk scoring is of paramount importance.
Role of helical CT and MRI in the evaluation of spinal dysraphism
Authors: Kumaran S. Kanagarameswara , Chirtrarasan P.
Published: January 2017

Background: Spinal dysraphism is a complex congenital anomaly involving the spine and spinal cord. Some lesions seldom require imaging. The aim was to study the usefulness of helical CT and MRI in the evaluation of various presentation of spinal dysraphism, to identify, characterize the lesions and its association with other anomalies which helps in giving an accurate diagnosis based on specific imaging findings.Methods: Seventy patients including 33 males and 37 females’ age ranging from 1year to 30 years clinically suspicious for spinal dysraphism were evaluated using helical CT and MRI in the Department of Radiodiagnosis, Government Kilpauk Medical College and Hospital, Chennai, India.Results: Statistical data analyzed based on imaging findings.56 patients were of open spinal dysraphism type and 14 patients were of occult spinal dysraphism. Different imaging features in spinal dysraphism were evaluated to give composite diagnosis for management.Conclusions: Helical CT and MRI are adjuvant in evaluating cases of spinal dysraphism. MRI is excellent in characterizing the soft tissue spinal anomalies of spinal dysraphism helical CT is an excellent imaging modality for characterization of vertebral bony anomalies.
The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease
Authors: Bikramjit Pal , Raveender Nagaraju , Sudipta Pal
Published: January 2017

Background: The study is to determine the relation between the high HbA1c and ESR as prognostic factors with the severity of the diabetic foot ulcer disease, particularly, in predicting the final outcome in the form of higher incidence of lower extremity amputation (LEA) and/or prolonged hospital stay. The study explored the importance of increased level of serum HbA1c and erythrocyte sedimentation rate (ESR) in determining the final outcome of the disease. It revealed that the severity of diabetic foot ulcer disease is more in patients who had concomitant high levels of baseline HbA1c and ESR on admission.Methods: This observational study was done in 89 patients who were admitted in the surgical wards of the two teaching hospitals in India. The cohort consisted of patients from the age of 26 to 83 years of age who presented with clinically infected foot ulcers. Routine blood tests were done which include HbA1C on the day of admission and fasting ESR (1st hour) on the next day morning. The standard X-ray plates were routinely taken on the first day for determination of the involvement of underlying bones and soft tissues. The outcome of the diabetic foot ulcer was assessed from the severity of the disease according to Meggit-Wagner classification, the incidence of lower extremity amputation and the duration of hospital stay.Results: The high levels of baseline HbA1C (more than 7.0%) in blood on the first day of admission was found in all of the 89 patients who were included in this study but the criteria for consideration of high risk was more than 9% which was found in 41 patients. The criteria for consideration of high ESR in this study was set to be 50 mm/h. High ESR of more than 50 mm was found in 63 patients. We had subdivided 31 patients into a High Risk Group whose baseline levels of HbA1C > 9% and ESR > 50 mm/h. The incidence of amputation was 79.31% and 44.44% with HbA1c of more than 9.0% and ESR of more than 50 mm respectively and was considerably increased (83.87%) when both HbA1c and ESR were more than the critical value as set in the study. Similarly, the incidence of prolonged hospital stay of more than 14 days was 58.54% in patients with HbA1C level of greater than 9 %, 51.85% in patients with baseline ESR > 50 mm/h and 93.55% in presence of high levels of both HbA1C (>9%) and ESR (>50 mm/h)..Conclusions: The study observed that the patients who presented with baseline high levels of HbA1C, ESR or both on admission had unfavourable prognosis with increased incidence of lower extremity amputation and prolonged hospital stay than the other patients in the cohort.
Clinical profile, bacterial profile and outcomes in an intensive care unit of a tertiary care hospital in south India: one year study
Authors: Sarvepalli Ajay Kumar , Dharana Prakash Kalakappa
Published: January 2017

Background: Infections still remain as one of the major cause of mortality in low and lower- middle-income countries as reported by Global Burden of Diseases study. Intensive care units (ICU) are a major source of infections in tertiary care hospitals. Widespread multi-drug resistant gram positive and gram negative bacterial isolates are also associated with infections in ICU. A hospital based epidemiological study was to determine the risk factors; bacterial isolates, antibiotic sensitivity and outcomes in ICU patients.Methods: This prospective study was done at Narayana Medical College and Hospital for 12 months from 1st February 2015 to 31st January 2016. All the risk factors were noted. Patient’s outcome noted as death, recovery and transfer to palliative care. Data entry and analysis performed in Microsoft excel, p valve < 0.001 was considered significant.Results: Three hundred and thirty patients were included in the study (age: 56.16±15 years, 57.6% males). 159 (48.2%) were direct admissions, 103 (31.2%) were transfers from other hospitals. Major cause of admission was neural (29.1%) followed by cardiovascular (21.8%). HTN (52.4%) was major co-morbidity followed by type-2 DM (47.3%). 51.9% culture positivity (n = 539) was observed with sputum 83.6% and blood 24.2%. Gram-negative pathogens were predominant which includes Acinetobacter baumanii (13.8%), Escherichia coli (20%), Klebsiella pneumoniae (14.3%), Pseudomonas aeruginosa (9%), Enterobacter aerogenes (5.1%). Candida Sp and MRSA, VRE were isolated. In the study 255(77.3%) recovered, 38(11.5%) progressed to death and 37(11.2%) transferred to palliative care. Higher mortality was noticed with Acinetobacter baumani (81.6%).Conclusions: High prevalence of gram-negative bacterial infections and multi-drug resistant isolates was noted in Indian ICUs.
Need for teleconsultation among the emergency medicine and critical care personnel during pre-hospital transport in a tertiary care unit
Authors: Kadhir V. Karunai , Hemalatha T. , Chandrasekaran V. P.
Published: January 2017

Background: Time being the most crucial factors in emergency medicine, teleconsultation enables patient assessment by specialists, immediate reception of appropriate treatment guidelines until the patient's arrival at hospital.Methods: Our study evaluated the need for teleconsultation among the emergency physicians (EP) and emergency technicians (ET) in a tertiary care hospital. Cross-sectional study conducted in Department of Emergency Medicine, a tertiary care setting. Pretested semi-structured questionnaire was given to EP and ET. Various parameters like the need for teleconsultation, the minimum time required for EMS (emergency medical services) to arrive at the scene and to the hospital, effectiveness of teleconsultation in prehospital care were evaluated.Results: SPSS version 18.0 was used. 24 EP and 36 ET participated in the study. The minimum time required for the EMS to arrive at the scene and then to hospital was calculated indirectly to be > 30 min. There was a significant difference among the EP an ET in interpreting common emergency condition p = 0.029 and criticality assessment p=0.035.The training of EMS staffs was adequate. Both EP and ET were able to adhere recent guidelines during prehospital transport. All the study participants (100%) felt the need for teleconsultation which would improve the patient management during the prehospital period.Conclusions: Teleconsultation has the potential to improve patient safety and quality of treatment in a prehospital setting and should be further evaluated.
Knowledge, attitude and practices of women towards vaginal discharge
Authors: Varghese Shiny , Kour Gagandeep , Chacko Joffi , Rathi Juhi , Dhar Tapasya
Published: January 2017

Background: Vaginal discharge (VD) is one of the common problems affecting the reproductive life of women which has high prevalence in South-East Asia. The aim was to analyse the knowledge, attitude and perception of women towards vaginal discharge (VD).Methods: A prospective study was conducted on 150 women, above 18 years of age, irrespective of marital status, who presented with VD and its associated symptoms in the Out Patient Department, Obstetrics and Gynaecology, Christian Medical College and Hospital, Ludhiana, India. The study involved a period from April 2015 to June 2016. A pre-structured questionnaire was used to record various parameters related to VD.Results: Results of the present study revealed a relationship between the symptoms of VD and various socio-cultural based beliefs. Opinions regarding various aetiological factors and perception of preventive measures were recorded.Conclusions: A direct relationship between knowledge attitude and perception about symptoms of VD and educational status of the patients was observed. The study emphasised the need to take effective measures to educate women about reproductive health at community level.
Study of sociodemographic profile of juvenile boys admitted in an observation home
Authors: Bhoge Nitin D. , Panse Smita N. , Pawar Alka V. , Raparti Girish T. , Ramanand Sunita J. , Ramanand Jaiprakash B.
Published: January 2017

Background: World Health Report estimated that 20% of children and adolescent suffer from a disabling mental illness worldwide. Incidences of vagrancy, delinquency and crime have been growing among steadily increasing juvenile population in the last few years. Various studies have revealed the presence of difficult family environment, lower socio-economic status, and low parental education associated with the psychiatric morbidity in children. Given the growth of juvenile delinquent population, epidemiologic data of this high risk group is becoming increasingly important. Therefore this study was undertaken to study the sociodemographic profile of male juvenile admitted in an observation home.Methods: This cross sectional study was conducted in an Observation Home for Boys. The study sample consists of 50 boys aged between 6-16 years. Out of 50, 20 juveniles under conflict of law and 30 under care and protection were included.Results: All the juveniles in this study were belonging to the lower socioeconomic status. Delinquency was significantly more common in older age group (12-16 years) than younger age group (6-11 years). The maternal education and school dropout rate had significant correlation with delinquency in our study, found to be more common in juveniles under conflict of law than those under care and protection.Conclusions: Establishment of multidisciplinary mental health services at each juvenile center of India, for complete rehabilitation of the juveniles admitted there, under social justice system is immediately required.
Spectrum of opportunistic infections with correlation to CD4 counts in newly diagnosed HIV seropositive cases
Authors: Sarvepalli Ajay Kumar , Dharana Prakash Kalakappa
Published: January 2017

Background: A rise in HIV/AIDS is observed in resource poor countries like India despite successful implementation of control programmes. Most of these deaths recorded in cases of AIDS are because of opportunistic infections [OI] and other malignancies. The reason may be attributed to the effective destruction or decrease in CD4 cells which play a pivotal role in immune system. OI cause substantial morbidity and hospitalization, economical loss to the society and shorten the survival time of HIV patient. The objective of this study was to evaluate the different type of infections and identify the frequent pathogens affecting the HIV patients who are attending a tertiary care hospital in India. The clinical profile of these patients was studied and proportion of CD4 counts with respect to their type of infection and pathogen is also evaluated.Methods: A prospective cross sectional study was conducted for one year period. Clinical samples were collected from all the newly diagnosed cases of HIV and performed various staining techniques and cultured on appropriate culture media.  All the isolates were identified as per standard guidelines. Serological evaluation for IgM antibodies for toxoplasma was done by ELISA. CD4 counts were estimated by FACS.Results: Tuberculosis was the commonest (67%) OI in HIV cases, followed by candidiasis (61.5%), respiratory tract infections (50%), gastro intestinal tract infections (44%) and meningitis (38%) in our study. The mean CD4 cell counts in the study was 267.11cells/µl. The commonest fungal pathogen was C.albicans and Cryptosporidium parvum the parasitic pathogen. The mean CD4 cell counts were lesser in parasitic infections when compared to bacterial and fungal infections. Six cases of P.jiroveci pneumonia were identified in our study. Mortality was recorded among the HIV cases with CD4 cell counts <50 cells/ µl.Conclusions: Early diagnosis and prompt treatment of OIs contributes to increased life expectancy among infected patients, delaying the progression to AIDS. This study helps the clinicians in proper guidance to come up with right diagnosis and early response to manage the patients in resource poor countries like India.
Profile of gestational dyspnoea with focus on peripartum cardiomyopathy
Authors: M. Tergestina Meenu , R. Legha
Published: January 2017

Background: Peripartum cardiomyopathy (PPCM) is even today an incompletely understood and rare disease affecting pregnant women. There have been few studies from south India, especially Kerala on PPCM.Methods: Women who were referred from Department of Obstetrics and Gynecology from May 2010 to April 2016 for evaluation of dyspnoea during pregnancy or within 5 months of delivery were included in the study. They were screened and women with history suggestive of heart failure during peripartum period were evaluated in detail and followed up.Results: 8760 pregnant and peripartum women presented with dyspnoea out of which 20 patients were diagnosed with PPCM. The incidence of PPCM was 1 per 2190 pregnancies. The mean left ventricular end-diastolic dimension was 58±9 mm, the mean end-systolic dimension 45±6 mm and mean left ventricular ejection fraction (LV EF) 31.45±3.73%  at diagnosis. Major adverse events (MAE) occurred in 4 patients. Low baseline ejection fraction (LV EF < 30%) significantly correlated with greater incidence of adverse events.Conclusions: The majority of pregnancy related dyspnoea is benign. Echocardiography can reliably diagnose potentially life threatening conditions and should be performed early. Echocardiography aids in both diagnosis and prognostication in PPCM. Low ejection fraction at baseline (LVEF < 30%) significantly correlates with greater incidence of major adverse events in patients with PPCM.