bluuebunny/crossref_metadata_2025 huggingface dataset:
An observational cross-sectional study to assess knowledge, attitude and practice of resident doctors and nursing professionals regarding pharmacovigilance in a tertiary care teaching hospital in Central India
Authors: Vishwe Akash , Chandel Satish , Jhaj Ratinder , Chenchulla Santenna , Rai Niket
Published: April 2017

Background: Adequate knowledge, positive attitude and motivated practice of pharmacovigilance are the building pillars of ADR reporting. This study was conducted to evaluate the knowledge and attitude towards pharmacovigilance and adverse drug reaction reporting among the resident doctors and nursing staff in AIIMS Bhopal, Madhya Pradesh, India.Methods: This cross-sectional questionnaire based study was carried out in a tertiary care centre. The survey was carried out using a pre-validated questionnaire that included 20 questions to evaluate the participant’s knowledge, attitude and practice.Results: Answers to knowledge based questions were given correctly by around 82.6% (95% CI 0.7576 to 0.8794) of resident doctors and 74% (95% CI 0.6033 to 0.8424) nursing professionals. The difference of basic knowledge about pharmacovigilance between resident doctors and nursing professionals was insignificant (p-value is 0.7967). The most common reason for underreporting was unawareness, which was opted by 69% (95% CI 0.6153-0.7617) of resident doctors, while among the 58% (95% CI 0.4422-0.7064) nursing staff, the major factor was non-feasible ADR monitoring system in hospital. The suggestion of conducting training and awareness programme to promote ADR reporting given by resident doctors and nursing staff were 85% (95% CI 0.7872-0.0957) and 80% (95 % CI 0.6677-0.8895) respectively.Conclusions: The participants were well aware of pharmacovigilance and adverse drug reaction reporting. They had expressed the positive attitude towards pharmacovigilance and ADR reporting. But the routine practice of reporting ADRs is lacking. Hence there is need for increasing awareness and building positive attitude and practices among the health care professionals.
Cardiovascular safety of oral antidiabetic therapy in type 2 diabetes mellitus- review article
Authors: Singh P. S. , Yadav Sudhir K. , Sharma Himanshu , Kumar Manoj
Published: April 2017

Cardiovascular disease is the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus (DM). There is twofold increased risk of cardiovascular (CV) mortality among diabetic patients as compared with nondiabetic patients. The glycemic efficacy of anti-diabetic drugs does not necessarily provide cardiovascular safety. Since 2008, US Food and Drug Administration has recommended that new drugs for type 2 DM should undergo clinical trials to demonstrate cardiovascular safety in addition to glycemic benefit. In 2012, European medicine agencies issued a similar recommendation. In this review, we have tried to examine the cardiovascular safety of oral antidiabetic agents in major published trials. Metformin remains the initial drug of choice in type2 DM till date. The sulfonylureas, one of oldest oral anti-diabetic drugs, have adverse cardiovascular events and are gradually being out classed by other second line drugs. The glitazones have been found to have adverse outcome in heart failure. The incretin based drugs have been found to have cardiovascular safety in various trials in recent past and their performances have been reassuring. There is lack of enough cardiovascular outcome data for meglitinides and glucosidase inhibitors. Various current trials have found sodium glucose cotransporter-2 inhibitors to have a potential for cardiovascular benefit. Careful selection of drug therapy with special attention for cardiovascular risk is important in selection and optimization of diabetic therapy.
A review of the blood transfusion practices in neuroanesthesia in the perioperative period in a tertiary care hospital
Authors: Ali Zulfiqar , Hassan Nelofar , Mehdi Saqib , Shah Mubashir A. , Bijli Akram Hussain , Khan Talib
Published: April 2017

Background: Blood transfusion involves the administration of blood and blood components. Neurosurgical procedures are associated with significant blood loss with the need for blood transfusion in the preoperative, intraoperative and postoperative period to maintain optimal hemodynamic and cerebral oxygenation. Various neurosurgical procedures as traumatic brain injury, complex spinal surgeries, and endovascular neurosurgical procedures may need blood transfusions to maintain the optimal physiology.Methods: This study was performed prospectively at a tertiary care hospital in northern India with about a work load of 800 to 1000 elective neurosurgical surgical procedures being done per year. This data was collected prospectively over a period of one year from the patients being operated for elective neurosurgical procedures and later on shifted to the neurosurgical intensive care unit and the neurosurgical wards. The patients operated for emergency procedures for traumatic brain surgery were not included in the study.Results: A total of 455 elective neurosurgical procedures were done during the study period. Out of these 455 patients there were 95 patients who were in the paediatric age group with age less than 12 years. Out of 360 adult patients 85 patients were in need of blood transfusion which constituted 23.6 percent of the operated patients.   Out of these 85 patients 45 patients needed two transfusions in the form of whole blood or packed cells, 40 patients needed a single transfusion.42 units of fresh frozen plasma were transfused to 17 patients with 15 patients receiving platelet transfusions.Conclusions: In conclusion, neurosurgical population is associated with significant blood loss and a requirement of blood transfusion. About 47 percent of paediatric population needed blood transfusion in our study with around 24 percent of adult population. The transfusion requirement was mainly seen in patients with craniostenosis, meningiomas, cerebello pontine tumours and meningiomas.
Comparison of glycated hempglobin with HPLC and capillary electrophoresis
Authors: Warade Jayesh
Published: April 2017

Background: Hemoglobin A1c, also called A1c or glycated hemoglobin, is hemoglobin with glucose attached. The A1c test evaluates the average amount of glucose in the blood over the last 2 to 3 months. The higher the level of glucose in the blood, the more glycated hemoglobin is formed. Once the glucose binds to the hemoglobin, it remains there for the life of the red blood cell – normally about 120 days. The predominant form of glycated hemoglobin is referred to as A1c. Testing of HbA1c levels via capillary electrophoresis is a relatively new but well-validated method that separates A1c and other Hb fractions via charge difference at high voltage using electro-osmotic flow. This method can be useful in patients who possess such variant hemoglobins because it has a longer runtime, leading to better resolution.Methods: We have processed random samples coming to our laboratory for HbA1C analysis on both the analyzers Biorad D 10 (HPLC method) and Sebia Flex piercing (Capillary Electrophoresis).Results: The value of t is 0.056748 for paired 't' test. The value of p is 0.954819. The result is not significant at p≤0.05. There is no significant difference between the results obtained from both the equipment.Conclusions: From this study, it is concluded that the results obtained after testing samples in Sebia Flex Piercing II and Biorad D10 are comparable and there is no significant difference in the results obtained. The advantage of of using Sebia is detection of underlying hemoglobinopathies is easier and can serve as passive surveillance in population that will provide additional information for multidisciplinary approach of treatment. Whereas Biorad D10 has benefit of shorter testing time and is cost effective.
Comparative study of duration of analgesia with epidural bupivacaine and bupivacaine with tramadol in lower limb surgeries
Authors: Saxena Dipti , Sanwatsarkar Sadhana , Dixit Atul , Arya Bipin
Published: April 2017

Background: The administration of local anaesthetic and opioid mixture via epidural route is excellent for post-operative pain during lower limb surgeries. This combination provides better quality of analgesia, lower side effects and high level of patient satisfaction. Therefore, this study was taken up to evaluate the efficacy safety, tolerance and side effects for the combination of tramadol and bupivacaine in the management of post-operative pain.Methods: This was a prospective study where a total of 40 patients; 20 each in group I and II were selected. Patients who were admitted for lower limb surgeries   in age range of 18-50yrs and belonged to ASA grade I &II.  Group A was given epidural bupivacaine 0.5% and group B was given epidural bupivacaine 0.5% with tramadol 50mg. The parameters studied were onset of action, quality of anesthesia, degree of motor blockade, duration of analgesia, hemodynamic alterations, intraoperative and postoperative complications. Pain was evaluated with verbal score. Results were evaluated statistically.Results: The mean duration of analgesia was significantly longer in patients with tramadol. The quality of analgesia and pain scores were better in patients who were administered tramadol.  The number of drug doses required was significantly reduced by addition of tramadol.Conclusions: Tramadol is a safe and effective adjuvant to epidural bupivacaine for prolongation of total duration of analgesia in lower limb surgeries.
Outpatient-based misoprostol to prevent prolonged pregnancy
Authors: Jindal Nikita , Vaid Neelam Bala
Published: April 2017

Background: Prolonged pregnancy is defined as the one that persist at or beyond 42 weeks of gestation. Incidence of prolonged pregnancy is around 10%. Aim of the study was to evaluate the efficacy and safety of single dose vaginal misoprostol (25 µg) in preventing prolonged pregnancy when given on outpatient basis at 40 completed weeks of gestation. Objective was to compare number of women entering spontaneous labor between 40 to 41 weeks of gestation, time from enrolment in study till delivery, need for cesarean section and neonatal outcome in early neonatal age in study vs control group.Methods: Total no. of 130 subjects of uncomplicated singleton pregnancy with vertex presentation with bishop score ≤5 were recruited for the study. Patients were randomly allocated into two equal study and control groups. Women allocated to study group received intra-vaginal 25µg misoprostol and control group did not receive any intervention.Results: 92.3% (60/65) of women in the study group had onset of spontaneous labor in one week in comparison to only 72.3% (47/65) in the control group. Mean duration from enrolment to delivery was 1.33±2.03 days in study group and 4.98±2.74 days in control group, which is nearly four times less in women in study group. Women in study group did not have any side effects from single dose of misoprostol given. Mean birth weight, meconium stained liquor rate, NICU admission rate and neonatal morbidity were found to be comparable in both the groups. No neonatal or perinatal mortality was observed in either group.Conclusions: The present study supports the use of 25µg single dose vaginal misoprostol at 40 weeks of gestation to prevent prolonged pregnancy.
Study of histomorphological pattern of ovarian neoplastic and non-neoplastic lesions
Authors: Fatima Rasheed , M. Sandhya , S. Sowmya T.
Published: April 2017

Background: The ovary is a striking exception to the Virchow’s dictum that organs that are frequently the site of primary cancer are rarely involved in secondary malignancy, and vice versa. Both primary and secondary carcinomas of the ovary are relatively frequent and show an astounding variety of pathologic patterns. The objectives were to study the histomorphological diversity of various neoplasms and non neoplastic lesions of ovary. To provide a specific diagnosis based upon the histomorphological study which is of paramount clinical significance in further management of the patient.Methods: The present study is based on histomorphological evaluation of 100 cases of ovarian neoplastic and non neoplastic lesions received at the department of Pathology, tertiary care hospital from June 2008 to Aug 2010.Results: A wide variation of age was noted. Among neoplastic lesions, majority of the cases were seen in age group of 20-39 years i.e., 50.6%. Non neoplastic lesion occurred in all age group, but majority of the incidences were seen in the age group of 20 to 40 years of age, accounting for 60% of total occurrence. the commonest ovarian tumor was serous cyst adenoma constituting 54.1% (46 cases) of all ovarian neoplasm. Mucinous cyst adenoma was the second most common tumor. There were 72 cases (85%) of benign, 2 cases (2%) of borderline and 11 cases (13%) of malignant tumors in the present study.Conclusions: The diversity of neoplasms makes it mandatory to classify the tumors accurately by histopathological features following universally accepted classification.
Histopathological spectrum of ovarian tumours from a referral hospital in Kashmir valley, Jammu and Kashmir, India
Authors: Sheikh Sheema , Bashir Humaira , Farooq Summyia , Beigh Arshi , Manzoor Farzana , Reshi Ruby
Published: April 2017

Background: Ovary is a complex structure and its neoplasms show a wide spectrum of histological types and clinical behaviour. The present study was done with the aim of studying the histopathological pattern of the ovarian tumours in women of various age groups.Methods: This was prospective study conducted over a period of 2 years from Jan 2015 to Dec 2016 and included 193 cases of ovarian neoplasms.Results: Of 193 cases 155 (80.3%) were benign, 8 (4.1%) were borderline and 30 (15.5%) were malignant tumours. Surface epithelial tumours constituted majority of the tumours (64.7%). Mature cystic teratoma (30.6%%) was the most common benign tumour followed by serous cyst adenoma (26.9%). Serous cyst adenocarcinoma (7.8%) was the most common malignant tumour of the ovary. While tumours were seen over a wide range of 6-75 years, >80% of benign tumours were seen in patients of <40 years and 60% of malignant tumours were seen in patients of >40 years of age.Conclusions: The findings of present study are comparable to the published data from the subcontinent.
Prevalence of hypertension and its association with anthropometric parameters in adult population of Raipur city, Chhattisgarh, India
Authors: Panda Prem S. , Jain Kamlesh K. , Soni Gopal P. , Gupta Shubhra A. , Dixit Srishti , Kumar Jitendra
Published: April 2017

Background: Obesity is now an important emerging public health problem in India. It is one of the major risk factor for hypertension. Overweight persons have two to six fold increase in the risk of developing hypertension. This study was carried out with objective to find out prevalence of Hypertension and assess its association with four obesity-related indices- body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR).Methods: A cross-sectional community-based study was done among 640 study subjects of age group 25-59 years during July 2015 to June 2016. Multi stage random sampling method was used. Data collection was done using WHO STEPS instrument V 3.1. Privacy and confidentiality of data was maintained. Data was entered in the Microsoft excel, collected data was checked for its completeness and correctness before data analysis with the help of PSPP software.Results: Prevalence of hypertension among study subjects was found to be 22.19% (142 out of 640).With respect to body mass index, waist circumference, waist hip ratio and waist height ratio, 4.38%, 64.35%, 85.33%, 76.2% were found to be obese respectively. Hypertension was strongly associated with BMI (p<0.001), waist circumference (p<0.001), waist hip ratio (p<0.05), waist height ratio (p<0.05). Out of the four anthropometric variables waist hip ratio (WHR) was most strongly associated with hypertension (β=420.236, p=0.007).Conclusions: The study shows a rising burden of hypertension among study population. As WHR is the best indicator for measuring obesity, so measurement of WHR should be made compulsory in healthy life style clinics along with other parameters.
Childhood obesity and socio-economic class
Authors: Goyal Rajni , Goyal Puneet , Garg Rajveer
Published: April 2017

Background: Childhood obesity has reached epidemic levels in developed countries. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. There are supporting evidence that excessive sugar intake by soft drink, increased portion size and steady decline in physical activity have been playing major role in the rising rates of obesity all around the world. The aim of this study was to compare the obesity status of children (5-18 years) from the upper and middle socio-economic class.Methods: 400 children (200 boys and 200 girls) in the age group of 5-18 years from upper and middle socio-economic status (According to the modified version of Kuppuswamy’s socio-economic status scale) were selected as subjects for this study. Weight and height were measured in minimum acceptable standard clothing without shoes and socks and BMI was calculated. Because there are changes in body weight and height with age, BMI levels among children and teens need to be expressed relative to other children of the same age and sex. Number of children in each BMI-for-age-percentile-range were calculated. By using chi–square test an association of overweight/obesity with socio-economic class was studied in children.Results: The prevalence of overweight/obesity was more in upper socio-economic class boys in comparison with middle socio-economic class boys, more girls from upper socio-economic class were overweight/obese in comparison with middle socio-economic class girls and more girls were obese in comparison to boys from upper socio-economic class.Conclusions: The primary prevention could be the key plan for controlling the current epidemic of obesity and these strategies seem to be more effective in children than in adults.
Effect of dexamethasone as an adjuvant with bupivacaine in ultrasound guided single shot supraclavicular brachial plexus block in upper extremity surgeries- a prospective randomized study
Authors: Parveen Shaheena , Jan Masrat , Taj Arshi , Bhat Arif A.
Published: April 2017

Background: Supraclavicular brachial plexus block is a good alternative to general anesthesia in surgeries of elbow, forearm, wrist and hand. The aim of this study was to assess the effect of dexamethasone as an adjuvant with bupivacaine in supraclavicular brachial plexus block in upper limb surgeries.Methods: This study was carried out on 60 adult patients of both sexes planned for upper limb surgery during the period from May 2015 to Jan 2016 after approval by the institutional Ethical Committee. Inclusion criteria were American Society of Anesthesiologists physical Status I-II and age between 18 and 50 years. Patients were randomly allocated to two groups of 30 patients each [group I (bupivacaine alone) and group II (bupivacaine + dexamethasone)]. Group I received 30ml of 0.5% bupivacaine with 2ml normal saline while group II received 30ml of 0.5% bupivacaine with 2ml (8mg) dexamethasone for supraclavicular brachial plexus block. Statistical analysis was performed with SPSS for Windows (SPSS Inc., Chicago, IL, USA), version 16.0. For analysis of demographic data and comparison of groups, χ2, unpaired Student's t-test and Mann-Whitney U-test were performed. Power of significance p-value of <0.05 was considered to be statistically significant. We evaluated onset, quality and duration of sensory and motor block along with side effects if any.Results: The mean onset of sensory and motor block in Group I and II was statistically insignificant. The duration of motor and sensory block was significantly prolonged in Group II than in Group I. There were no statistically and clinically significant differences in respiratory and hemodynamic parameters.Conclusions: We conclude that dexamethasone as an adjuvant in supraclavicular brachial plexus block prolongs the duration of motor and sensory block with insignificant side effects.
Medical thoracoscopy- an experience
Authors: Shah Naveed Nazir , Mehfooz Nazia , Farooq Syed Suraya , Dar Khurshid A. , Shumayl . , Tariq .
Published: April 2017

Background: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases especially undiagnosed exudative pleural effusion. It is cost effective and safe. The diagnostic yield in undiagnosed pleural effusion is excellent.Methods: This prospective observational study was done in Government Chest Disease hospital of Government Medical College, Srinagar during the period between December 2015 to Dec 2016.Thirty undiagnosed pleural effusion patients after thoracocentesis and who fulfilled inclusion and exclusion criteria’s were included in the study. Medical thoracoscopy using rigid thoracoscope was started for the first time in our hospital and was done in these enrolled patients. Clinical, Thoracoscopic findings and histopathological data of the patients were collected prospectively and analysed.Results: Maximum patients were in the age group of 41-50 years. Most common Thoracoscopic finding was multiple nodules (40%) followed by sago grain infiltration (33.4%). Malignancy was the most common HPE finding of pleural biopsy (46.6%) followed by TB (33.3%). All nodules (13) turned out to be malignant while all sago grain appearance pleura (10) turned out of to be TB. The overall diagnostic yield is 80% as a whole and 96% among patients who had thoracoscopic pleural findings.Conclusions: Medical Thoracoscopy is a safe and easy outpatient procedure and an excellent diagnostic tool for undiagnosed exudative pleural effusion. The diagnostic yield is quite high and complications of procedure are negligible.
Clinical study of ventilator-associated pneumonia in tertiary care hospital, Kolhapur, Maharashtra, India
Authors: Deshmukh Babasaheb , Kadam Suhas , M. Thirumugam , K. Rajesh
Published: April 2017

Background: Ventilator‑associated pneumonia (VAP) is the most common nosocomial infection acquired by patients admitted in the intensive care unit (ICU). However, there is very less information or clinical data available on the occurrence of VAP in Kolhapur, Maharashtra.Methods: study aims to determine the Incidence of VAP in ICU, to study the association between causative microorganism and sensitivity, and to study the association between prognosis and incidence of VAP. Settings and Design: Tertiary level, medical‑surgical ICU; prospective, observational study.Results: Patients coming to Medicine Department of the hospital subjected to mechanical ventilation for more than 48 hours in critical Care Facility during the period of two years May 2014 to April 2016.Conclusions: In the incidence of VAP was found to be 78% among ICU patients. Majority (36%) patients had diabetes mellitus, 30% had hypertension before the admission. It is observed that chances of developing VAP were more in patients with co-morbid conditions. The microbiological results of Endotracheal Aspirate showed that, majority 36% had pseudomonas, 26% had Acinetobacter, 22% had no growth, 14% staphylococci (Staphylococcus is a gram-positive, round-shaped bacterium that is a member of the Firmicutes, and is frequently found in the nose, respiratory tract, and on the skin), 2% proteus mirabilis as compared to similar studies. Out of all, Pseudomonas is the most commonly isolated organism. This could be attributed to decreased immunity and a compromised general condition due to associated illness. Also, prolonged hospital stay is also of significance.
To study the thyroid profile in menstrual disorder at tertiary care hospital in northern western Rajasthan, India
Authors: Jinger Surendra Kumar , Verma Anita , Dayma Indu , Talreja Tamanna
Published: April 2017

Background: Abnormal uterine bleeding is a common but complicated clinical presentation. It is one of the most frequently encountered conditions in gynaecology and is defined as abnormal bleeding from the uterus.Methods: Present prospective study was conducted on 100 patients who presented with abnormal uterine bleeding at Sardar Patel Medical College, Bikaner, Rajasthan, India.Results: Among 100 women, 39 had hypothyroidism, 8 patients had hyperthyroidism rest 53 were euthyroid. Out of 39 hypothyroid patients, 23 had menorrhagia, 3 had oligomenorrhea and out of 8 patients with hyperthyroidism patients, 6 had oligomenorrhea, 2 had hypomenorrhoea.Conclusions: The menstrual irregularities are significantly more frequent in patients with thyroid dysfunction and menorrhagia was the commonest menstrual abnormality. The study concludes that biochemical evaluation of thyroid function should be made mandatory in all cases of AUB.
A study of clinical and ophthalmologic profile of patients undergoing cataract surgery
Authors: Shori Chhaya , Shori Rakesh , Laxmiprasad Gannaram , Alli Ashalatha
Published: April 2017

Background: Intraocular lens implantation is the only surgical approach available mostly in developing countries. Thus cataract constitutes as the leading cause of blindness in developing countries as many patients with cataract do not have access to hospitals and surgery. Objective was to study the clinical and ophthalmologic profile of patients undergoing cataract surgery.Methods: A hospital based cross sectional study was carried out among 100 cataract patients assigned to undergo conventional extra capsular cataract excision surgery for a period of two years in a tertiary care referral hospital. One day before the surgery these patients were admitted to the indoor wards of department of ophthalmology. From each patient, detailed history was obtained. Visual acuity was checked with Snellen’s visual acuity chart and pinhole improvement was noted.Results: Maximum prevalence was seen in the age group of 51-60 years i.e. 37% followed by 61-70 years of 30%. Thus cataract is seen more commonly in the age group of above 50 years. Prevalence of cataract was more in females (59%) as compared to 41% in males. Cortical cataract constituted 86% of total cases and remaining 14% were constituted by nuclear type of cataract. Majority of the patients i.e. 59% had visual acuity of less than 1/60 followed by 33% of having 5/60 to 1/60. 58% of the patients had against the rule type of astigmatism. 34% of the patients had with the rule type of astigmatism. Only 8% had NOA type of astigmatism.Conclusions: Increasing age and female gender were the most important risk factors in the present study. Cortical type of cataract was more common than nuclear type of cataract. Maximum had low vision.
Assessment of incidence of occurrence of fractures of posteriors malleolus region: a retrospective analysis
Authors: Jindal Rajneesh
Published: April 2017

Background: Fracture of ankle joint involving posterior malleolus easily causes traumatic arthritis and prognosis of this fracture is poor. There are a number of controversies regarding the indications for fixation of fragments of posterior malleolus. Some studies report that if the articular surface at the distal end of the tibia accounts for more than twenty five percent, then fixation of posterior malleolus fragments should be done. In this retrospective study we evaluated the treatment effect of ankle joint fractures involving the posterior malleolus and analyzed the impact of different posterior malleolus fragment sizes on the treatment effect.Methods: A total of 52 subjects, including 23 males and 29 females, were selected for the present study. Patients with a definitive diagnosis of ankle joint fracture with involvement of the posterior malleolus and undergoing open reduction internal fixation surgery for the same were included in the present study. Mean age of the patients was 41.3 years.Results: Significant results were observed with respect to posterior malleolus fragment size and arthritis score of two groups. Non- significant results were observed with respect to difference in the American Orthopedic Foot and Ankle Society (AOFAS) score, Visual analogue scale (VAS) rating under various conditions and patient satisfaction rating.Conclusions: Treatment effect on all 52 cases of ankle joint fractures involving posterior malleolus fractures were satisfactorily.
Dysembryoplastic neuropithelial tumor: a rare case report
Authors: Thanvi Shailesh , Jangid Hemant , Joshi Yogi Raj
Published: April 2017

Dysembryoplastic neuropithelial tumor (DNET) is a rare recently described, benign glioneural tumor frequently associated with intractable seizures in children and young adults which is important to recognise clinically and radiologically as it is surgically curable without need for adjuvant chemoradiotherapy. We hereby present a case report of a 10year old male child who presented with intractable seizures and right parietal space occupying lesion which was diagnosed DNET radiologically, treated by microsurgical excision and confirmed histopathologically as DNET, thus emphasising multidisciplinary role in management of this rare entity.
Evidence behind use of levosalbutamol over salbutamol to prevent cardiac side effects
Authors: Lahiri Subhrajit
Published: April 2017

Salbutamol and levosalbutamol are the two most frequently used medications for asthma in pediatrics. Levosalbutamol is more expensive than salbutamol and is usually considered safer option for patients with existing cardiac condition and, to reduce tachycardia in otherwise healthy patients. In this article, we reviewed the literature which included randomized controlled trials, retrospective studies and case reports and compared the cardiac side effects of these two medications with primary emphasis on tachycardia
Profile of newborns discharged from the intensive neonatal care unit submitted to the kangaroo ward
Authors: Souza Karla Camila Lima de , Carvalho ANNY Caroline Ferreira de , Evangelista Natália Maria Chagas , Nascimento Magnely Moura do , Braide Andrea Stopiglia Guedes , Silveira Maria Goretti Alves de Oliveira da , Viana Márcia Cardinalle Corrêa , Araújo Maria Valdeleda Uchoa Moraes
Published: April 2017

Background: Describe the profile of newborns discharged from the neonatal intensive care unit (NICU) sent to a kangaroo ward and their neonatal variables.Methods: Retrospective and documentary study with a quantitative approach, performed at the General Hospital César Cals, whose sample consisted of 30 charts. The following variables were analyzed: weight, gestational age, Apgar score, gender, race, adequacy of the pregnancy and assistance provided in the NICU and kangaroo ward. The variables were analyzed using Microsoft Excel® 2010 program to obtain percentages.Results: There was a prevalence of extremely premature infants with high underweight and small size for the gestational age, male gender and browns, with Apgar score at 1st and 5th minutes more than 7, born by cesarean section, who used mechanical ventilation and surfactant, with prevalence of respiratory distress syndrome, with admission weight in Kangaroo ward less than 1.250g, making use of exclusive breast milk, who were attended by physiotherapy and with weight less than 1.600g at discharge, of the variables studied.Conclusions: Kangaroo care is an excellent cost-effective model for the newborn coming from the neonatal intensive care unit.
Paediatric empyema: video-assisted thoracoscopic surgery (vats) and its outcome study
Authors: G. Manasa , B. Swetha , T. Yashoda H. , S. Pramod
Published: April 2017

Background: Empyema thoracis defined as purulent pleural effusion is a common condition in children with significant morbidity and mortality. The aim of therapy for empyema is to ensure rapid recovery with a normal long term pulmonary outcome. VATS (Video-assisted thoracoscopic surgery) is gaining acceptance as a primary modality of treatment in cases of early empyema. VATS is associated with decreased morbidity and reduced hospital stay of the patient. Methods: This is a retrospective observational study conducted in the department of pediatrics KIMS Hospital, Bengaluru from November 2014 to November 2016. In this study, review of the medical records of all the children aged 2 months to 18 years, who underwent VATS for empyema was done. The children included in the study were diagnosed with empyema thoracis based on chest X- ray, USG chest and CT chest and have undergone VATS by pediatric surgical team. Results: The median age of presentation was 4.1 yrs. 18 children were malnourished of which 3 had severe malnutrition. Male to female ratio was 1:1. Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics. Follow-up data showed that symptoms resolved in 24 children, 2 children had complications, one child had a pneumothorax and another had a broncho-pleural fistula. Results: Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics.Conclusions: These results suggest that primary operative therapy in the form of VATS is an effective treatment option for children with empyema. VATS is associated with a lower in-hospital mortality rate, re-intervention rate, length of stay and duration of tube thoracostomy.
Use of the pediatric symptom checklist to screen for behaviour problems in children
Authors: Muppidathi Subbiah , Boj Jenitha , Kunjithapatham Muthukumar
Published: April 2017

Background: Behavioral and emotional problems comprising internalizing, externalizing and mixed disorders consist of psychiatric disorders in childhood and adolescents. This study aimed to measure the prevalence of emotional and behavioral disorders and to evaluate the usefulness of the pediatric symptom checklist (PSC) in identifying behavioral problems in children between ages of 4 and 12 attending OPD.Methods: Parents of 450 children between the ages of 4 and 12 attending pediatric OPD were randomly selected for the study after their valid informed consent, regarding awareness of psychosocial problems in their child with the help of 17-item pediatric symptom checklist (PSC)Results: Overall, 81(18%) children had at least 1 positive PSC-17 subscale or a positive PSC-17 total score. 27 (6%) children scored positive on the internalizing subscale, 36 (8%) scored positive on the externalizing subscale, and 36 (8%) scored positive on the attention subscale. Boys had higher PSC scores than girls for both school-aged (21% vs 16%) and preschool-aged children (15%vs 9%). Children from low socio economic status (20%), living with single parent (53%), nuclear family (21%), alcoholic father (28%) and single child (33%) are the risk factors associated with increased behavioral problems. Internalizing problems were seen more commonly in older children (10 - 12years), whereas attention and externalizing problems were more commonly seen in younger children (4 - 8 years).Conclusions: This study showed the extent of childhood emotional and behavioral problems. Use of the PSC offers an approach to the recognition of psychosocial dysfunction that is sufficiently consistent across groups and locales to become part of comprehensive pediatric care in virtually all out-patient settings. Further research is needed to identify effective strategies for using primary care for recognizing, diagnosing, and treating mental health disorders in children and adolescents.
Six minutes walk test outcome measures in children
Authors: Singh Vandana , Verma Yogendra Singh
Published: April 2017

Background: There are limited numbers of studies on 6 MWT in school going children in India. Objectives were to know gender wise outcome measurements for 6 MWT and its correlation with various anthropometric parameters, to make comparison of results between children of various socio-economic groups. Methods: After a randomized selection of schools a total of 500 children belonging to different socioeconomic status and studying in Government and Private Schools aged between 7-12 years were enrolled in the study. At the start, anthropometric measurements and baseline parameters like HR, BP, SPO2, PEFR, level of dyspnea were recorded and then children were made to walk for 6 minutes. After the walk changes in these parameters were taken as outcome measures.Results: The Mean distance walked in 6 minute was 609 ± 166 m. Boys covered more distance than girls. Heart rate increased from a baseline of 82.73 ± 1.63 to a maximum of 104.32 ± 3.11; heart rate recovery occurred (>90%) at 5 min in both the genders. SBP (systolic blood pressure) increased from baseline 109 ± 2.38 to maximum of 121.86 ± 1.75 at the end of the test, with no significant increase in DBP. The 6 minute walk distance correlated well with higher level of dyspnea. No significant change in oxygen saturation was observed during the test.Conclusions: The study provides data on normal values of 6MWT in healthy children, which may help to evaluate functional capacity and thus predict the morbidity risk in future and to know the effects of therapeutic interventions in the diseased children.
Cross sectional study on nutritional status and prevalence of anemia in rural adolescents
Authors: A. Dharmalingam , Mena Raju , S. Raghupathy N. , M. Sowmiya
Published: April 2017

Background: This study is targeted to find out the nutritional status of adolescents in rural population. Studies were done in urban areas of India on nutritional status and anemia prevalence these studies do not reveal the actual prevalence of anemia and malnutrition among adolescents in the rural areas. The purpose of this study is therefore to determine the nutritional status and prevalence of anemia in rural adolescents.Methods: Five hundred and eight rural adolescent school going and non-school going living in villages around A.V.M.C. and H., Pondicherry of age 10 to 19 years of both sexes were chosen by systemic random sampling. Migration populations were excluded from the study.Results: Among 24 Villages, of which 20 Camps were conducted and 508 Adolescents were included. The non-school going constituted 8.27% among male and 27.39% among female. Among the school going males were 42.2% and female were 30.5%. Among male, in the school going group, 33.96% in early, 36.14% of middle and 43.94% of late adolescents were under nourished, whereas in non-school going male, 50% in early, 58.33% of middle and 20% of late adolescents were under nourished. In case of female adolescent, in the school going group, 49.18% in early, 20.59% of middle and 18.42% of late adolescents were under nourished whereas in non-school going female, 14.29% in early, 36.84% of middle and 45.95% of late adolescents were under nourished. Stunting is more common among boys from 10 years of age to 14 years of age than girls. After 14 years of age stunting is more common in girls than boys. The average stunting was 46.18% in male and to 48.1% in females.Conclusions: Under nutrition was found to be a significant problem in both sexes of rural adolescents. Late adolescents were more undernourished in both sexes. Under nutrition was more common in boys than in girls. Anemia was more common in female than in male in both school going and non-school going. Anemia was more common in non-school going than in school going in both sexes. Severe anemia was more common in female of non-school going group.
Effect of antenatal corticosteroid on early neonatal outcome in preterm neonates: a prospective observational study
Authors: H. Joy Christ , K. Praveen B.
Published: April 2017

Background: Respiratory distress syndrome (RDS) is the most common complication observed in preterm neonates. It has been observed in many studies done till date that neonates born to mothers who have received antenatal corticosteroids (ACS) have shown significantly lesser incidence in developing RDS as compared to neonates born to mothers who have not received ACS. The aim of the present study is to observe and compare the outcome of the neonates born to the mothers who have received and not received ACS between 24 weeks + 0 days to 36 weeks + 6 days of gestation.Methods: This was a hospital based prospective observational study, consisting of 201 neonates born to the mothers who have received and not received ACS between 24 weeks + 0 days and 36 weeks + 6 days of gestation. The outcome of neonates was observed and the data was analyzed by using frequency percentage and pearson’s chi square test.Results: Two hundred and one neonates were included in our study. It was concluded that the need of surfactant (P=0.004), CPAP (P=0.001) was significantly less and the rate of survival (P=0.000) was better in babies born to mothers who have received ACS in comparison to neonates born to mothers who have not received ACS. Conclusions: It was observed that in neonates there was significantly lesser incidence of respiratory distress syndrome, use of surfactant, CPAP, ventilation and number of deaths. But there was no significant statistical difference in incidence of necrotizing enterocolitis, sepsis, and PDA as compared to neonates born to mothers who have not received ACS. Hence it will require further study and analysis in a larger population.
A hospital based prospective study to determine incidence of retinopathy of prematurity among premature and low birth weight babies admitted to NICU in Rajarajeshwari Medical College and Hospital
Authors: Raj Darshan K. , E. Adarsh , R. Prema , Jayaprakash . , M. Dhanyatha , Naseer Sherin
Published: April 2017

Background: ROP is a disorder of the developing retinal blood vessels in the premature infant retina. Objective of present study is to determine the number of babies affected with ROP among the premature and low birth weight babies admitted to neonatal intensive care unit or attending neonatal follow up clinic at RRMCH Hospital during a period of one year.Methods: This is a prospective observational study conducted in Rajarajeswari Medical College and Hospital Bangalore for 12 months. All eligible babies were screened at Neonatal Intensive Care Unit where temperature is well controlled and the place to handle any emergencies. The pupils were dilated using 2.5% phenylephrine and 0.5% tropicamide eye drops instilled three times into each eye at intervals of 15 minutes about one hour before the scheduled examination.Results: 100 babies were screened and followed up. The incidence of ROP is 40%. Gestational age (<37weeks) and low birth weight (2500g) are important risk factors for ROP. Our study concluded that ROP is an important complication of prematurity.Conclusions: The present study highlights the magnitude of the problem due to ROP in a tertiary care centre. Meticulous fundus examination with indirect ophthalmoscopy in all preterm babies with gestational age <37weeks and birth weight ≤2500gms is essential non invasive method for early detection of ROP and its progression.
Thrombocytosis as an additional predictor of serious bacterial infection in febrile young infants
Authors: Eapen Merin , R. Sreelatha P. , C. Jayakumar
Published: April 2017

Background: To estimate the incidence of Reactive Thrombocytosis among febrile young infants and to assess the utility of platelet count as a potential predictor of Serious bacterial infection (SBI).Methods: This study was conducted as a prospective study between January 2014 to September 2015 at the tertiary care pediatric unit, Alappuzha, India. The participants were all infants 30 to 89 days of age, admitted with rectal temperature >38°C. The results of the sepsis evaluation on admission were recorded. SBI included cases of occult bacteremia, urinary tract infection, bacterial meningitis, pneumonia, bacterial gastroenteritis and infections of the soft tissues and bones.Results: Of the 120 infants studied, 24 (28%) had SBI. Platelet count was significantly higher in infants with SBI compared to those without {Platelet count ≥ 4.5lakhs /mm3 in SBI (70.3%) vs. Non SBI (30.2%). Mean platelet count 4.82±1.4 in SBI vs. 3.9±1.2 in non SBI which was statistically significant (p<0.05). Thrombocytosis had moderate ability in predicting SBI (Area under curve area under the curve: 0.720). The combination of platelet count ≥450,000/mm3, WBC ≥15,000/mm3, C-reactive protein ≥1 mg/dl, pyuria ≥5 White blood cells (WBC) per High power field (HPF) and erythrocyte sedimentation rate (ESR) >30mm/hr resulted in identification of all infants with SBI.Conclusions: Thrombocytosis in combination with leukocytosis, elevated C-reactive protein, ESR, and pyuria, may help in early recognition of febrile young infants at risk for SBI.
Simple and feasible blood markers-as predictors of perinatal asphyxia
Authors: Koreti Sunita , Gupta Akriti
Published: April 2017

Background: The objective of this research work was to study the hematological parameters as predictors of perinatal asphyxia and to assess their correlation with severity. Setting: Postnatal Wards, Kamla Raja Hospital and SNCU, Department of Pediatrics, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior. Design: A prospective case control study. Participants :100 cases and 100 controls enrolled based on the selection criteria, on day 1 of life.Methods: New born on day 1, who fits the selection criteria was enrolled. Birth details, relevant perinatal history, findings on physical examination and systemic signs were recorded on a predesigned proforma. Staging was done and new born classified as HIE stage I, II or III. Cord blood samples were collected and results analysed. Results: This study included 100 cases and 100 controls. Presence of maternal illness and birth history were found to have significance (p value <0.001) when compared between cases and controls. Number of nucleated RBCs/100 WBCs were found to be 6±1.93 in HIE-I; 9.5±4.8 in HIE-II and 16.45±6.6 in HIE-III as compared to 5.9±3.6 among the controls. The results are found to be significant (p value <0.001). Mean value of hemoglobin found among the controls was 16±2.5. This was 17.4±2.18 in HIE-I; 17.45±1.8 in HIE-II and 15.5±3.07 in HIE-III. The results are significant on comparison between cases and controls and among cases (p value <0.015, <0.001 respectively). Mean value of hematocrit among the controls was 49.24±7.98. This was 52.5±6.57 in HIE-I;52.56±5.46 in HIE-II and 47.6±5.8 in HIE-III. The difference was significant (p value <0.001) when comparison was done among the cases. Value of total leucocyte count (TLC) among the controls was 14.14±4.15; 14.06±6.8 in HIE-I;15.8±5.6 in HIE-II; 21.14±7.90 in HIE-III. The results were significant (p value <0.001) when comparing cases with controls and cases among themselves. There was no correlation seen with platelet count. Polychromatophilia was found significant (p value <0.001) when compared between cases and controls and among cases themselves.Conclusions:Hematological parameters are altered in perinatal asphyxia and can be used to predict the severity and outcome.