bluuebunny/crossref_metadata_2025 huggingface dataset:
The comparison of mesh and sutured repair for adult umbilical hernia: a prospective study
Authors: Agarwal Shwetank
Published: August 2018

Background: Umbilical hernia is the commonest of all the abdominal hernias. The current study was planned to evaluate the outcome of Mayo's tension free mesh repair to sutured repair in umbilical hernias.Methods: The prospective study was piloted on 110 patients who underwent umbilical hernia repair over a period of 1-year period in the department of General Surgery. The patients were divided into two groups – Group A comprises 68 patients and group 2 consists of 42 patients in which suturing, and mesh repair was done respectively. The patients were then grouped in Suture group or Mesh group as per the procedure done and 1 year follow up was done. The complications and the duration of hospital stay in both groups was recorded.Results: The mean age of the subjects was 52.8±12.1 years.  The ratio of male to female was 7:4. Seven patients (10.3%) developed recurrence following sutured repair compared to none following mesh repair (P<0.05). Five patients (5.3%) developed wound infection following suture repair compared to none in the mesh group (P<0.05). Two patients had hematoma while 1 had seroma in suture group, both haematomas occurred in patients who underwent the Mayo repair.Conclusions: According to present results mesh repair is the preferred technique of manoeuvre in umbilical hernias. Mesh repair for umbilical hernias is in effect and concomitant with negligible morbidity.
Liver abscess, management strategies, and outcome
Authors: Jayakar Sudhir R. , Nichkaode Prabhat B.
Published: August 2018

Background: Liver abscess, a disease troubling mankind from ancient times, has earliest documentation in the Sanskrit document. Where right upper abdominal pain, have potentially lethal consequences, if prompt diagnosis and treatment are not accomplished. However, two major types are known, amoebic and pyogenic, in medical literature. Pyogenic liver abscess constitutes major bulk of hepatic abscess in western countries. The diagnosis is confirmed by ultrasonography, reddish brown (anchovy-paste like material) aspirate from abscess. The diagnosis, treatment and prognosis, of liver abscess have evolved remarkably over past few years. Imaging has improved diagnostic competence and has altered therapeutic strategy. The study aims at early clinical and  diagnosis on imaging of liver abscess, to set up some guide lines in view of conservative or either  intervention.Methods: The present study was hospital based longitudinal study, carried out in tertiary care teaching hospital from November 2013 to November 2015.  A total of 55 patients were enrolled in the study. All patients with suspicion of having liver abscess were confirmed on Imaging and included as present study population. Authors studied mainly presentation, role of conservative treatment, Aspiration, pigtail catheter, Outcome, and post procedural complications.Results: All patients presented with Pain right or left upper abdominal pain in abdomen, any chest complaints , majority of present study group patients had fever with or without rigors, deranged liver function. Imaging is the most diagnostic method, and also helped in therapy and follow up.Conclusions: Males are affected more than females, Imaging is the best modality for diagnosis, therapy and follow up. Aspiration or pigtail drainage is the standard method of drainage. Pigtail drainage is the better method of treatment than aspiration.
Peritoneal closure or non-closure in open appendectomy: a reality or a myth
Authors: Wilkinson T. R. V. , Chauhan Mahendra K. , Trivedi Isha
Published: August 2018

Background: The objective of this study is to analyze the difference of outcome and complications in peritoneal closure versus non-closure in open appendicectomy.Methods: This was the prospective comparative study. 126 patients with the diagnosis of acute appendicitis undergoing open appendicectomy divided in two groups non-randomly. Group A: Open appendicectomy with closure of peritoneum (n=59) and Group B: Open appendicectomy with non-closure of peritoneum (n=67). Intra operative time and post-operative period for pain and complications like wound infections, hernia and duration of hospital stay were analyzed. Patients were shown ‘visual analogue scale’ on a daily basis and those who reported unbearable pain given additional analgesia.Results: Operative time, number of doses of analgesic required, wound infections and duration of hospital stay in both groups were compared. Difference in operative time between both the groups was found to be statistically significant (p< 0.0001).Conclusions: Non-closure of peritoneum in open appendicectomy is associated with lesser operative time, and shorter duration of hospital stay. Hence, it can be safely recommended.
A study of laparoscopic cholecystectomy in rural setup
Authors: Barase Avishkar K.
Published: August 2018

Background: Cholelithiasis is one of the major healthcare problems faced by the adult population all over the world. The disease prevalence is ever increasing because of the changing lifestyles and dietary habits. With emergence of laparoscopic cholecystectomy, it has become standard treatment modality for all kind of patients of gall stone disease. But still in India laparoscopic procedures are not routinely carried out in rural setup. So, we have decided to carry out this prospective study of laparoscopic cholecystectomy in rural setup mainly emphasizing on the cost benefit aspect and its impact on economical aspect of the rural government hospital as well as the patient’s financial burden.Methods: In this prospective randomized study, 60 patients of symptomatic cholelithiasis were grouped into open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) groups randomly (30 each). The preoperative, intra operative and postoperative findings were noted and compared with each other and also with previous studies. The results are compared using paired t test and chi square test.Results: Laparoscopic cholecystectomy was better than open cholecystectomy in terms of less analgesic requirement, postoperative hospital stay, surgical site infection with better cosmetic outcome. The results were comparable regarding intra operative complications. Only duration of surgery was comparatively more in laparoscopic group. Thus, overall laparoscopic cholecystectomy was cost effective alternative as compared to open cholecystectomy.Conclusions: Laparoscopic cholecystectomy is better alternative to open cholecystectomy in term of less intra and postoperative complications as well as decreased financial burden on public health sector and patient point of view.
Randomized comparison of stapled haemorrhoidopexy and open haemorrhoidectomy
Authors: Rulaniya Suresh Kumar , Chandra Soumitra
Published: August 2018

Background: Surgical management of haemorrhoids is reserved for stage III and IV haemorrhoids. Both Milligan-Morgan technique (CH-Conventional Haemorrhoidectomy) and stapled haemorrhoidopexy technique are used as surgical therapy. Our prospective, comparative study of conventional haemorrhoidectomy versus stapled haemorrhoidectomy was designed in present institution.Methods: This prospective randomised comparative study was carried out in present Surgery Dept from July 2016 to December 2017 with total 60 sample size. All data were analysed according to applicable statistical methods. The results were compared to previous studies so as to arrive at a conclusion.Results: The mean duration of surgery with stapled method was 30.76±3.13 minutes and with conventional method was 49.36±4.08 minutes which was significantly high in conventional method. VAS scores for pain at 12 hours, 24 hours, 72 hours and 7 days for stapled group were 2.63±0.76, 1.66±0.88, 0.90±0.71 and 0.50±0.43 while that for the conventional group were 5.63±0.72, 4.56±1.22, 3.26±1.25 and 2.00±0.69. At all points of time the VAS was significantly lower in stapled group. The mean duration of hospital stay of the patients with stapled method was 3.10±0.75 days and with conventional method was 6.06±0.94 days, which was significantly high in conventional method. The mean time to return to normal activities of the patients with stapled method was 8.16±1.93 days and with conventional method was 12.60±1.67 days, which also significantly high in conventional method.Conclusions: Present study inferred that stapled haemorrhoidopexy is faster, minimally invasive for treatment of haemorrhoids as compared to Conventional haemorrhoidectomy. It is associated less pain and provides a more satisfactory alternative to Conventional surgery because of reduced hospitalisation and earlier return of patient to daily activities, with no significant differences in short term follow up.
Diathermy versus scalpel incisions in elective abdominal surgery: a comparative study
Authors: Nandukar Vikranth S. , K. Mohan Kumar , M. Prakash , S. Suma
Published: August 2018

Background: Scalpel incisions produce little damage to surrounding tissues. There has been a widespread use of diathermy for hemostasis but fear of production of large scars and improper tissue healing has restricted their usage in making skin incisions. Use of diathermy in skin incisions reduces bleeding and makes the incision quicker, but there are no differences in wound burst strength. Objective of the study was to compare the use of diathermy and scalpel incisions in elective abdominal surgery’s to see the variations in incisional time, blood loss during incision, postoperative pain and wound complicationsMethods: This was a prospective randomized study, which included patients above 18 years who underwent elective abdominal surgery. The patients were randomly included into Group A or Group B. In Group A incision was made with a scalpel and in group B with diathermy. Data was analyzed for incisional time, blood loss during incision, postoperative pain and wound complications.Results: There was a significant increase in mean time taken for incision in Group A when compared to Group B. Mean incision blood loss was found to be significantly higher in group A compared to group B patients. Postoperative pain was significantly higher in group A (p value <0.05) on postoperative day 1. Among wound complications, no statistically significant differences were seen between the two groups.Conclusions: Electrocautery incisions were safe, less time consuming, reduced blood loss and had less postoperative pain. We conclude that diathermy could be accepted as an alternative method for surgical skin incisions.
Comparative study of open mesh repair and Desarda’s no-mesh repair for inguinal hernia, in GMKMCH, Salem, India
Authors: . Prakash , Mohan Padmalakshmi Bharathi
Published: August 2018

Background: Mesh repair has gained popularity among the surgical repair of hernias but has limitations. This study is being carried out to compare the effectiveness of Desarda’s no mesh repair, with Lichtenstein’s tension free repair.Methods: This prospective study was carried out in GMKMCH, Salem, over a period of 2 years. A total of 60 cases with inguinal hernia were included in the study. 30 patients were randomly subjected to Desarda’s technique and 30 patients underwent Lichtenstein’s repair. After surgery, patients were followed up and noted for complications like groin pain, surgical site infections, duration of hospital stay, duration to return to normal activity.Results: Operative time was 45 minutes in Desarda’s group and 50 minutes in the Lichtenstein group which was highly significant (p<0.01). On 2-year follow-up there were no recurrences in both groups. There were no surgical site infections in the Desarda’s group, compared to whereas Lichtenstein’s repair where had 4 (10%) recurrences. The occurrence of complications like loss of sensation over the groin, scrotal edema, abdominal wall stiffness was not seen in Desarda’s group, whereas its occurrence was highly significant (p<.01) in Lichtenstein’s group.Conclusions: Desarda’s no mesh technique is easy to learn and simple when compared to other no mesh repair techniques and requires no mesh. It can be used in a contaminated surgical field, in young individuals and in cases of financial constraints. Hence, Desarda’s no mesh repair is favourably comparable with Lichtenstein’s mesh repair.
Legal and ethical dilemma in treating trauma patients
Authors: D. Srinivasan , P. N. Sreeramulu , Dave Prakash , Sathanantham Dinesh Kumar
Published: August 2018

Background: The severity of the injury may be such that ongoing care of the individual patient is futile, and this can lead to disagreement with the family or friends of the patient with regard to further treatment. Patient capacity or ability to participate in the informed consent process may be compromised and the patient is therefore managed by the clinical team on the basis of the best interest’s principle, with clinicians relying on proxy consent or substituted judgment. These sections of the hospital have their own ethical and medico-legal issues for the trauma patient and the treating clinician. The aims and objectives were to estimate the time of triage/ specialist care given in the Emergency Medical department (EMD) in Trauma case; to compare the result with Australasian triage scale and Manchester triage scale system and to study about the demography and audit the necessary findings from trauma patients in casualty.Methods: This is a Prospective observational study done at R. L. Jalappa Hospital a constituent of Sri Devaraj Urs Medical College and Research, Kolar, Karnataka a rural based tertiary teaching hospital.Results: A total of n=108 patients were evaluated in this study, severity of the injury was moderate been the highest with 52 (48%), severe been 33 (30.6%), mild been 20 (18.5%). Majority of the injury was in the age group 21-40, mostly been the major working population and bread winners involved in the Road traffic accidents. Mean time of specialist (surgeon) attending to the case was 70 minutes i.e. the interval between CMO and consultant attending to the trauma case in EMD.Conclusions: Management of Trauma patients involves very meticulous work which can be achieved only with proper team-work and planning protocol and the more important aspects towards the management involves the documentation and proper communication with patient attendants and responsible persons. On concluding, the triage system followed in our setup with specialist care been provided is equal in its efficacy in comparison to the Manchester triage scale and is almost in par with the Australasian triage scale.
Laparoscopic versus open pyeloplasty: an experience at a tertiary care centre
Authors: M. Sunil Krishna , T. A. Moideen Nafseer , Rajendra Benakatti
Published: August 2018

Background: Ureteropelvic junction obstruction can lead to symptoms such as hydronephrosis and progressive renal damage. Authors explain present primary experiences about laparoscopic pyeloplasty and open pyeloplasty in the treatment of UPJO.Methods: A bidirectional non-randomized study from March 2012 to April 2015 was conducted at a tertiary care centre in southern India. A Total 37 cases, 18 patients in laparoscopic pyeloplasty group and 19 patients in open pyeloplasty group were included.Results: A total of 37 patients were included in the study. 18 patients underwent laparoscopic Anderson-Hyne's pyeloplasty, 19 patients underwent open Anderson-Hyne's pyeloplasty patients. Outcomes were measured in terms of pain, surgery duration, postoperative pain, complications which were significant.Conclusions: Laparoscopic pyeloplasty was found to be better in terms of postoperative pain, hospital stay and complications.
A case with missed pancreatic injury with massive pancreatic ascites and severe traumatic pancreatic necrosis: a case report and literature review
Authors: Sedik Alaa , Ibrahim Mohamed , Zarrouq Abdulla , Elhoushy Sal Wa
Published: August 2018

Despite the major advances in the field of trauma management. High grade Blunt pancreatic injury remains a disease with both high mortality and morbidity specially in cases of delayed diagnosis. Herein we will present a case report of 31 years old Saudi male who was involved in motor vehicle accident with a delayed diagnosis of pancreatic injury associated with other multiple injuries. He was diagnosed late on 12th day of admission during laparotomy where a missed high-grade pancreatic fracture at the neck of pancreas, massive pancreatic ascites and extensive pancreatic necrosis was found. Open abdominal closure technique with mesh mediated fascial closure and Vacuum assisted closure was used to improve both respiratory function and abdominal disease through repeated debridement with peritoneal lavage and sequential approximation of fascia. He responded well gradually and offered definitive closure of fascia and feeding jejunostomy. Unfortunately, he had a sudden stroke followed by rapid deterioration then expired 48 hours later.
Osseous metaplasia of ovarian cyst: a rare case report
Authors: Singh Anil Kumar , Gogoi Priyanka , Diwaker Preeti , Adhlakha Bhuvan , Gayatree Aishwary
Published: August 2018

Osseous metaplasia has been described at many sites, however previous reports of osseous metaplasia in ovarian lesions are rare. This is most commonly associated with dermoid cyst, osseous metaplasia in stroma rich in serous or mucinous neoplasm and ossification of endometriotic cyst (chocolate cyst). Here The authors report a case of incidental finding of osseous metaplasia in the endometriotic cyst (chocolate cyst) of resected ovary in 42-year-old female who had gone for total abdominal hysterectomy with bilateral salpingo-oophorectomy for provisional diagnosis of AUB.
Retro-rectal mass: a clinical dilemma; report of three cases with brief review of literature
Authors: Kant Kamal , Singh Kapisoor , Rathod Yashpal Singh , Purohit Richa
Published: August 2018

Retro rectal or presacral tumors are uncommon lesions. It can be difficult to diagnose as presenting signs and symptoms are usually nonspecific. Retro rectal lesions can be congenital or acquired, benign or malignant.  Children can also have retro rectal masses like anterior meningocele, teratomas or cystic teratomas.  FNAC or biopsy usually is not required as imaging can provide a reasonably good diagnosis.  Cross-sectional imaging is essential in evaluating these lesions to determine the optimal surgical approach and the extent of resection. Surgery is the mainstay of treatment as it establishes the diagnosis and prevents the adverse consequences associated with malignant degeneration and secondary bacterial infection. The outcomes for patients with benign presacral tumors are favourable.
A rare case of spontaneous gastric perforation in an adolescent
Authors: R. Vasuki , P. S. Arun , Moothedath Rajesh Menon
Published: August 2018

Incidence of Peptic ulcer perforation in children and adolescents are very rare. Perforated gastric ulcer is extremely rare with only handful of cases reported worldwide in the same age group. Pneumoperitoneum and peritonitis due to gastric perforation is a very rare presentation in children and adolescents and it can often be overlooked with disastrous consequences. Even though in young patients, peptic ulcerations can happen in association with H. pylori infection, secondary to medications like non-steroidal anti-inflammatory agents, corticosteroids, rarely due to Zollinger Ellison syndrome, related to stress, post burns or head trauma it is seldom common. Among perforations gastric perforation is very rare. Here we discuss a case of 15-year-old school student who presented with acute abdominal pain and features of peritonitis which we initially thought probably due to perforated appendix but turned out to be a gastric perforation. Plain radiograph of the abdomen showed pneumoperitoneum. When an emergency midline laparotomy was performed, we found a perforation in gastric antrum anteriorly with peritonitis which was treated by thorough decontamination and Graham's live omental patch closure. H. Pylori tests were negative. At a time when acute presentation of peptic ulcerations or perforation as its complication is decreasing in incidence worldwide, this case has come as an eye opener. Thus, perforated gastric/duodenal ulcer in pediatric and young adult patient should not be overlooked in a young patient presenting with acute abdomen. Many times, there is no clear etiology and then it is spontaneous perforation. Emergency surgical management is the preferred mode of treatment.
An interesting case of subdiagphragmatic cold abscess: a case report
Authors: C. Tharun Ganapathy , S. Jeyakumar , Mathew Koshy , Sekhar Sidhu
Published: August 2018

Subdiaphragmatic abscess is rather common itself but a tubercular subdiaphragmatic abscess in the absence of coexisting tuberculous abdomen presenting as thoracic complication is extremely rare. A cold abscess is an abscess that commonly accompanies tuberculosis. It develops so slowly that there is little inflammation and it becomes painful only when there is pressure on the surrounding area. Here we report a case of isolated subdiagphragmatic tuberculous cold abscess in a 38-year-old female whose imaging of the abdomen revealed a hyperechogenic area involving segment 7 of liver adherent to rib cage and diaphragm, S/O ruptured liver abscess, subdiagphragmatic abscess. The pus drained from the abscess cavity at diagnostic laparoscopy proved Multidrug Resistant Tuberculosis. This case has been reported for the rarity of isolated subdiaphragmatic tuberculous abscess and the importance of microscopic or culture diagnosis in a suspected case of tuberculous abscess.
Management of rectal foreign body with endoscopic snare: a case report
Authors: Kishore A. Sai , Jeyasekharan S. Sabu , C. Nithila , Reddy N. Pradeep
Published: August 2018

Foreign bodies in the rectum, although not much common present a challenging task to the surgeons for retrieval.  Depending on the type and position they can cause anorectal trauma and perforative peritonitis. Diagnosis is usually by history, per rectal examination and radiography. Here authors present a 27-year-old male who came with history of insertion of candle into rectum to prevent bleeding from haemorrhoids. Perforative peritonitis was ruled out and manually tried to remove it and all attempts failed. He was posted for colonoscopy and it revealed 23cm long candle in the rectum with bleeding anal tag. The tip of candle extended into sigmoid colon. Polypectomy snare applied around the candle and foreign body was gently removed. Check colonoscopy revealed no significant injury. He was referred to psychiatry department and he was discharged the next day.
Rare presentation of TB oesophagus: a case report
Authors: Reddy Nagella Pradeep Kumar , Jeyasekharan S. Sabu , C. Nithila , Kishore A. Sai
Published: August 2018

This is a rare case report of Tb oesophagus presenting as upper GI bleeding. Patient was subjected to upper gastrointestinal endoscopy, which revealed an ulcerative growth in the mid oesophagus. Biopsy revealed oesophageal tuberculosis. Patient was managed conservatively with Anti-Tuberculosis Treatment (ATT). Follow up endoscopy after six months revealed resolution of the ulcer and patient was symptomatically better. In spite of the rare nature of the disease, it can be managed effectively with ATT to avoid complications (fistula, stricture, and oesophageal perforation), which might warrant surgery.
Perforation of old gastrojejunal anastomotic site presenting as acute abdomen: a case report
Authors: C. Tharun Ganapathy , S. Jeyakumar , P. Manimaran , Sekhar Sidhu
Published: August 2018

Complications at the gastrojejunal anastomosis site after a bypass procedure is challenging in terms of diagnosis, therapy and prevention. Complications most frequently encountered are marginal ulcer, bleeding and stenosis, while perforation secondary to ulceration at anastomosis site is very rare and seldom reported. Direct exposure of gastric acid is the important cause of ulcer formation which may get further complicated by the use of NSAID's, alcohol intake and smoking. We report a case of 47-year-old male who developed perforation at the gastrojejunal anastomotic site of old gastrojejunostomy for peptic ulcer disease.
Importance of vaccines in children with Down syndrome
Authors: Alrahili Mohanned , Binyamen Ali , Al Otaibi Fares , Alnour Abeer Abu , Alsaadi Majd , Aloufi Shahad , Al Sadiq Fatima , Alzahrani Wejdan , Aljabri Moath , Alqarni Ahmed
Published: August 2018

Down syndrome is the most common chromosomal disorder affecting infants. It is characterized by various morphological features and systemic manifestations. Immune system is one of the main systems affected by trisomy 21, and it dysfunction is the major etiology for the recurrent infections encountered among patients with Down syndrome. Knowledge about immune system defects had made a considerable progress in prevention of infections among those patients, and subsequently decreased the morbidity and mortality among those patients. Many vaccines were recommended to be administered to Down syndrome patients as a means of prophylaxis against potential infections. Therefore, the life expectancy of Down syndrome witnessed a dramatic improvement during the past few decades. The aim of this review article is to discuss the immune system defects in patients with Down syndrome, the types of infections they are prone to, and the vaccines necessary for prophylaxis against these infections.
Knowledge toward epilepsy among Ardabil Medical University students: North-West of Iran
Authors: Abbasi Vahid , Atalou Abolfazl , Amani Firouz , Fezollahzadeh Hadi
Published: August 2018

Background: Medical university students is a better group of society that should be had correct and good knowledge about healthcare issues such as epilepsy. Epilepsy is a common neurologic disease that caused to many problems in patient’s life. This study aimed to evaluate the knowledge of medical students toward epilepsy in Ardabil province.Methods: A cross-sectional descriptive survey was conducted in Ardabil province (Northwest of Iran) in 2017. Over a one-month period, 130 students selected randomly from all medical, paramedical, nursing and health students and completed the self-administered questionnaire which provided for this study. Collected data analyzed by statistical methods in SPSS version 19.Results: Of all students, 83.1% were girls and rests of them were boy. Of all students 20% had good and 56.2% had moderate knowledge about epilepsy. Many of students in all fields had moderate knowledge and there wasn’t significant relation between field, semester and knowledge rate. Most of boys with 54.5% had week and most of girls with 58.3% had moderate knowledge and there was significant relation between sex and knowledge rate.Conclusions: Results showed that most of students in this study had moderate knowledge about epilepsy. Students had poor knowledge about important point about diseases such as treatment, diagnosis. Providing necessary training programs for knowing this disease in future for students is essential.
Red cell distribution width as a prognostic marker in mechanically ventilated children admitted in pediatric critical care unit of tertiary care centre, India
Authors: Gadappa Swati M. , Behera Manas Kumar
Published: August 2018

Background: Paediatric population is a vulnerable group necessitating standard care for medically and surgically ill children. Red cell distribution width (RDW) is a simple and low-cost measure that denotes the variability in red blood cell size. Any process that releases reticulocytes in the circulation will result in an increase in RDW. RDW may also be useful as a biomarker of disease severity and clinical outcomes in critically ill patients. Methods: Retrospective cohort study of all patients between 1month-12yrs of age, mechanically ventilated in Paediatric intensive care unit. Those patients with RDW on admission and complete data for PIM3 (Paediatric Index of Mortality 3) were included. Analyses included correlation, logistic regression analysis, and receiver operating characteristic (ROC) curves.Results: Retrospective analysis of data on 93 consecutive critically ill children admitted in PICU was done between Jan 2015- June 2016. We noted statistically significant correlation between mortality and anemia (10.24 g/dL, SD 2.26; 8.78 g/dL, SD 2.60.p = 0.009), LOS on MV (p = 0.008), RDW (p = 0.002), shock (p = 0.004) and ventilator associated Pneumonia (p = 0.024).  Mortality increased as length of stay on mechanical ventilation increased (4.13 days, SD 2.125 versus 6.94 days, SD 7.603 p = 0.008). The cut-off of 18.10 was chosen as Mean RDW. Based on AUROC, RDW is independently associated with high risk of mortality.Conclusions: RDW measured within 24 hours of PICU admission was independently associated with length of stay on mechanical ventilation and mortality in a general PICU population. We recommend the need for multicentric, prospective longitudinal studies to determine the optimum utility of RDW to enhance decision making in PICU.
Serum sodium level in dengue infected children: a retrospective study
Authors: Raj Reshma , Alva Rashmi
Published: August 2018

Background: Dengue fever is one of the most common arbo virus mediated outbreaks, being reported from different parts of the world. Now as the outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. Aim of this study is to document the serum Sodium level in dengue infected children in a tertiary care centre.Methods: A total 128 cases of NS1 antigen, IgM positive or ELISA positive dengue patients were included in this observational study and analyzed.Results: The serum Sodium level in dengue varies according to the different groups. In group A (dengue with no warning signs) the serum Sodium level was normal, whereas in case of group B (dengue with warning signs), there was significant hyponatremia. In group C, severe dengue the serum Sodium was normalConclusions: Mild hyponatremia is a common electrolyte disturbance in patients with dengue with warning signs. Hence, the lower the serum Sodium levels the higher is the incidence of complications associated with dengue fever.
Immediate clinical outcome of newborns with meconium stained amniotic fluid
Authors: V. Raju , M. Dhivya Narayani , K. Vindyarani W.
Published: August 2018

Background: The detection of meconium-stained amniotic fluid during labour often causes anxiety in the delivery room because of its association with increased perinatal mortality and morbidity. The aim of the study is to determine whether meconium staining of amniotic fluid had an influence on the neonatal outcome and the factors responsible for meconium-stained amniotic fluid.Methods: This case-control study was done between March 2015 to October 2017 in the Department of Paediatrics, Sri Muthukumaran Medical College, and RI. 217 newborns who had meconium staining of the amniotic fluid were taken into the study. For each case, two controls were taken. Mode of delivery of baby noted with the grading of meconium either thin or thick meconium. Type of resuscitation done for these babies was noted. Those newborns who were admitted in the newborn unit were followed up till discharge and type of management of these babies were monitored. The outcome of seizures, air leak, MAS etc., were looked for. For each MSAF baby, two newborns without MSAF were recruited and looked for maternal and fetal risk factors.Results: Incidence of MSAF is 16.9%. Among 217 cases of MSAF, thin meconium constituted 141 cases (64.97%) and thick meconium 76 cases (35.02%). The incidence of thin meconium is more when compared to thick meconium. Of the 217 cases of meconium-stained liquor, 170 (78.7%) cases are vigorous babies and 47 (21.6%) are non-vigorous. Out of 47 babies who were non-vigorous, most of them (70.2%) had thick meconium stained liquor. Most of them, 172 cases (79.2%) required only routine resuscitation, whereas BMV with tracheal toileting required in 18 cases (78.3%) of thick MSAF when compared to 5 cases (21.7%) of thin MSAF.Conclusions: MSAF is associated with morbidity and mortality when associated with factors like maternal PIH, anemia, oligohydramnios, IUGR babies and CTG showing FHR variability. The majority of which are thick meconium suggesting that consistency of meconium had a direct bearing on the neonatal outcome.
A study on laboratory features of scrub typhus
Authors: Ramanathan R. , Yazhini E.
Published: August 2018

Background: Rickettsial infections are the most common re-emerging infections in the recent times especially Scrub typhus. If untreated, fatality rate is as high as 30-35%. Scrub typhus can cause changes in hematological and biochemical parameters. The need for this study is to correlate the laboratory investigations in patients with scrub typhus, so that early diagnosis and appropriate treatment can be done.Methods: This prospective observational study was carried out in children admitted in the pediatric ward/ pediatric ICU of RMMCH who were diagnosed to have Scrub typhus by positive ELISA test. Their basic laboratory investigations are categorized and correlated.Results: Normal Leukocyte count was seen in 48% (n=24) of the cases, leucocytopenia 30% (n=15), leucocytosis 22% (n=11). Platelets <1.5 lakhs were seen in 72% (n=36) and none of the cases had platelets less than 80000. Hb< 9gm/dl was seen in 44% (n=22). Hyponatremia in 24% (n=12). CRP was positive in 28% (n=14). Hypoalbuminemia was seen in 22% (n=11). Renal function test was normal in all the cases.Conclusions: This study discusses the various biochemical and hematological changes in patients with Scrub typhus. Pancytopenia is rare in patients with Scrub typhus. Abnormalities in renal and liver function tests may indicate the progression to complications. Normal WBC count with hyponatremia and hypoalbuminemia with related symptoms and signs can be used to diagnose the disease at earlier stages.
Study of quantitative bacterial cultures of non-bronchoscopic samples in ventilator associated pneumonia
Authors: Azarudeen Mohamed , Sharma B. S. , Jain Pankaj Kumar , Goyal Alok Kumar , Malhotra Bharti
Published: August 2018

Background: Diagnosis of VAP based on non bronchoscopic samples-ETA, NB-BAL culture. The aim is to study quantitative culture of the non-bronchoscopic sampling techniques such as Blind Broncho-alveolar lavage (NB-BAL) and endotracheal aspirates (ETA)in Ventilator Associated Pneumonia. It is a hospital based, observational study conducted in SPMCHI, Jaipur from September 2015 to September 2016.Methods: Seventy patients who were under mechanical ventilation for more than 48 hours and clinically suspected for VAP were included in the study and divided into early and late onset VAP. The NB-BAL and ETA were obtained from these patients and quantitative cultures were performed.Results: Out of the 70 samples analysed, 60 patients were found positive in BAL and 61 positive in ETA. The agreement between NB-BAL and ETA is 86.8%. GNBs remain the main burden of both early and late onset VAP. Most common organisms isolated were Enterobacter and Acinetobacter in early onset and Pseudomonas and Acinetobacter in late onset VAP. All the GNB isolates were sensitive to Polymyxin and Colistin and were resistant to majority of routinely used antibiotics.Conclusions: The quantitative culture of   non-bronchoscopic samples is a useful alternative to bronchoscopy, in the diagnosis of VAP in resource deprived centers. MDR gram negative bacilli are the main causative agents of VAP.
Clinical profile and outcome of children presenting with poisoning or intoxication: a hospital-based study
Authors: Qazi Mahvish , Saqib Najmus
Published: August 2018

Background: Poisoning is a common preventable cause of morbidity and mortality in children. Most of the poisoning in children less than 5 years of age is accidental. Not much of Indian data is available particularly from this part of the country. So, authors conducted a retrospective hospital record-based study to know clinical profile and outcome of children presenting with poisoning in our set up. The objective was to study clinical profile, outcome of childhood poisoning and intoxication in Jammu District (Jammu and Kashmir) IndiaMethods: This was a retrospective hospital record-based study done in patients who were admitted in pediatric wards and pediatric intensive care unit (PICU) of SMGS Hospital Jammu with history of ingestion of poison or intoxication or envenomation from January 2017 to December 2017. The data collected was analyzed with SPSS 12.0 software. Demographic and etiological factors were retrospectively recorded and analyzed.Results: There were 227 children enrolled in study with an incidence of 0.99%. Male: female ratio was 1.2:1. Most of the children were asymptomatic and majority of them arrived to the hospital in less than 2 h. The majority of our patients 115 (50.66%) were in the 13-18 years age group. Organophosphorus poisoning was the commonest poisoning seen in 51 (57.30%) patients followed by snake bite 29 (55.77%), insect bite 17 (32.69%), Phenol 14 (77.78%), kerosene 11 (12.36%) and rat poison 10 (11.23%). Alcohol problem occurred in 9 (24.32%) cases. The most frequent cause of suicide attempt were school problems, followed by conflict in the family. Route of poisoning was ingestion in 173 (76.21%) cases followed by bites 53 (23.35%) and inhalation in 1 (0.44%) case. Vomiting 105 (46.25%) was the predominant clinical feature. Aspiration pneumonia 17 (43.59%) followed by respiratory failure 7 (17.95%) were the most common complications. During treatment 67 (27.91%) received gastric lavage and 28 (12.33%) received antidotes. Overall survival was 210 (92.51%), among remaining cases 2 (0.88%) cases died in hospital and 15 (6.61%) cases left against medical adviceConclusions: Parental health education will decrease the occurrence of childhood poisoning. Along with the parents and teachers, media also should take active steps to educate the rural population about the preventive measures from bite, stings and handling of poisonous agents.
Prospective study of clinical profile, causes, risk factors and treatment of hyperbilirubinemia in preterm and term babies
Authors: Garg Komal , Kondle Vamshi Krishna
Published: August 2018

Background: Neonatal jaundice is often physiologic and benign, but dangerous, at levels producing neurological injury, adding on to mortality and morbidity in developing nations. Hence the present study is undertaken to document the proportion, clinical profile, causes, risk factors and treatment of hyperbilirubinemia in preterm and term babies.Methods: This study conducted over 100 hyperbilirubinemia babies who admitted in Rich Pediatric Hospital, Pogathota, Nellore during the period of October 2014 to September 2015.Hyperbilirubinemia is more common among preterm babies born to mothers of 19-22 years and term babies born to mothers of 21-26 years age group.Results: The most common etiological factors identified among all the gestational categories were sepsis (23.0%) followed by ABO incompatibility (20.0%) and Rh incompatibility (6.0%). Among preterm babies (35-37 wks.) the most common were ABO incompatibility (15.0%), Sepsis (10.0%) and polycythemia (10.0%), while among term babies, the most common factors were ABO incompatibility (23.9%), Sepsis (16.4%) Rh incompatibility (7.5%) and Cephalhaematoma (7.5%). In a large proportion of cases, etioliogy remined idiopathic (44.0%).Conclusions: Requirement of exchange transfusion was more among term babies compared to preterm babies. Rh incompatibility was the only etiology.
A study of early neonatal mortality in a tertiary hospital of Maharashtra, India
Authors: Mehkarkar Nitin , Sonawane Vijay Baburao
Published: August 2018

Background: India has a high Neonatal Mortality Rate (NMR) of 31 per 1000 live births and rural being 34 whereas urban being 17 (2011). Two thirds of the newborn deaths usually occur in the first week of life. Newborn survival has become an important issue to improve the overall health care goals. This study is carried out to identify primary causes of early neonatal deaths and to ascertain the factors affecting early neonatal mortality.Methods: This is a prospective study of all the early neonatal deaths in tertiary hospital of Maharashtra over two years. Details of each early neonatal death were filled in the standard perinatal death proforma.Results: Out of the 2073 total births, there were 75 early neonatal deaths (END) which is nearly 36.18 per 1000 live births. The important causes of END were severe birth asphyxia, respiratory distress syndrome and septicemia. About 50% of deaths were observed in mothers with age < 20 years, 25% deaths observed in mothers of age group 20-29 years, and similar percentage is with age >30 years. Most of the early neonatal deaths were due to Birth asphyxia and RDS was the second most important cause of early neonatal deaths. 70% of ENDs were among LBW babies. Prevention of premature delivery, proper management of very low birth weight babies and early detection and appropriate management of perinatal hypoxia have become important interventional strategies in reducing early neonatal deaths.Conclusions: Early Neonatal Mortality (ENM) at Tertiary Hospital is fairly high. In present study, early neonatal death rate of 36.18 per 1000 live births is observed which significantly higher than reported in literature.
Rectal stimulation to relieve constipation in infants: is it safe?
Authors: Mandal Kalyanbrata , Roy Abhishek
Published: August 2018

Background: Physiological constipation is the most common cause of stool retention in neonates and infants. Functional constipation is the commonest type of constipation in children of Indian subcontinent with 3% worldwide prevalence. It is quite bothering to the parents when child has not passed stool for the last 3-4 days. Rectal stimulation by betel nut leaf stalk is a widely practiced home remedy in rural India over centuries to treat this physiological constipation in infants.Methods: An OPD based prospective observational study was conducted in a tertiary care hospital of Eastern India. The cases chosen were 100 infants who underwent rectal stimulation for relieving constipation and another 100 infants who haven’t were the controls. Both cases and controls were followed up clinically as well by digital rectal examination and radiologically where indicated for next 6 months for any adverse outcome arising from rectal stimulation.Results: Outcome on follow up was almost similar in cases and controls. Immediate evacuation of stool following rectal stimulation was seen in 90% cases. Majority of the subjects had an uneventful follow up. Functional constipation diagnosed by ROME III criteria was 30% in cases and 35% in controls. Habit formation and minor local ulcers in perianal region were also noted in few cases. Two cases and one control were diagnosed as Hirschsprung disease on follow up. All caregivers of cases experienced psychological relief following the practice.Conclusions: Rectal stimulation is an absolutely harmless practice with insignificant outcomes.
Clinico-hematological manifestations of malaria in children in Western Uttar Pradesh, India
Authors: Hassan Najia , Chalotra Sonam , Aneja Satinder
Published: August 2018

Background: Globally, malaria is one of the important causes of mortality in pediatric age group.  We describe here the clinico-hematological manifestations of malaria in children in Western Uttar Pradesh.Methods: A Retrospective study was done over 8 months in pediatric ward and pediatric intensive care unit of a tertiary care centre in Greater Noida. Children below 18 years admitted with acute febrile illness with peripheral smear and / or rapid malaria antigen test positive were included in the study.  Detailed clinical, biochemical and hematological characteristics of children hospitalized with severe malaria were recorded and patients were managed according to National Vector Born Disease Control Programme Guidelines for malaria treatment.Results: Out of 115 children admitted with malaria, majority of cases were due to P. vivax (88.7%) compared to P. falciparum (5%) and Mixed infection (6%). Malaria was more common in males and in 1 to 5 years age group. Out of 115 patients, severe malaria was present in 27 (23.4%) patients, all infected with P. vivax. Among them, bleeding was present in 13.04 %, shock in 9.56%, acidosis in 9.56%, jaundice in 5.21%, seizures in 3.47%, severe anemia in 5.21%, renal impairment in 3.47%, impaired sensorium in 1.73% and pulmonary edema was present in 0.86% patients respectively.  Case fatality Rate was 1.73%, all due to severe vivax malaria.Conclusions: The study highlights that P. vivax is a common  cause of malaria in Western UP and can result in a severe disease with potential mortality.
Awareness and practices of parents about immunization of children in the age group 2-5 years
Authors: Upadhye Jayant V. , Marathe Sanjay M. , Mandlik Milind R. , Upadhye Aditi J. , Upadhye Jayshree J.
Published: August 2018

Background: Immunization is a highly cost-effective way of reducing morbidity and mortality in children in developing countries Objectives of this study were to determine awareness of parents and immunization status of children in the age group of 2 to 5 years and study the social factors influencing immunization status of a child.Methods: A total 200 children aged 2-5 years who are attending Pediatric OPD, immunization clinic from May 2017 to April 2018 were enrolled in the present study.Results: In the present study, 170 children (85%) received full immunization given by Government of India free of cost while 30 children (15%) got partial immunization. 90 children (45%) received full immunization while 110 children (55%) got partial immunization NOT given by Government of India free of cost. Parents of 80 children (40%) were unaware of vaccination schedule, parents of 70 children (35%) did not give full vaccination due to high cost, parents of 30 children (15%) had wrong beliefs while parents of 20 children (10%) couldn’t understand the importance of vaccination due to less education.Conclusions: The goal of 85% coverage is an uphill task. Adverse effects following immunization, busy parents, lack of knowledge seems to be a major contributing factor for the non-success of this national program. Parent’s occupation and education are statistically significant contributing factors for the poor immunization coverage among these children.
A study on health care seeking pattern of under five children in the rural field practice area of a medical college in Mandya District, Karnataka, India
Authors: L. Lakshmi , Penta Bharathi Tulasi , K. Ragavendra S.
Published: August 2018

Background: Children below five year constitute 14 % of total population in our country. They are vulnerable group deserving special health care. children are considered to be susceptible to host of disease and infection and the most important causes of under-five mortality are Acute Respiratory Infection (ARI), Preterm birth Complications, Diarrheal diseases, Intrapartum related complication, Malaria, Neonatal Sepsis, Meningitis and Tetanus. The objective of the present study was to study the health care seeking pattern of under five children in rural areas of Mandya District.Methods: A cross sectional study was conducted at Adichunchanagiri Institute of Medical Sciences, Bellur Cross from January 2017 to June 2017. All the children under the age of five years in the Rural Field Practise area of the AIMS, were included in the study.Results: Out of the 324 male children in present study only 90 (27.7%) of them had suffered from any kind of illness in the past three months of duration and 59 (29.4%) out of 201 Female children had fallen ill. Fever, Diarrhoea, Pnemonia were the most common illness seen among the children. The association between the gender and illness was found to be statistically not significant.Conclusions: Large number of parents availed government service due to fact that large number of families belonged to lower socioeconomic class. IEC activities should be enhanced so as to change the behavior of 100% mothers to seek the timely reference from a qualified Doctor for the illness and proper adherence to the treatment.