bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of clinical features, comorbidities and laboratory profile with outcomes among dengue patients admitted in a tertiary care hospital, Delhi NCR
Authors: Tiwari Mohit , Tibrewal Abhishek , Pichika Varun S. , Singh Narinder P. , Choudhary Pankaj N. , Agarwal Rajat K.
Published: June 2021

Background: Dengue fever is an endemic disease across multiple countries. Dengue infection results in a wide spectrum of non-specific clinical manifestations with unpredictable clinical course and outcome. Objective of the study was to understand the association of different clinical features, comorbidities and laboratory profile with outcomes (ICU use, ventilation use and blood transfusion) among dengue patients admitted in a tertiary care hospital in Delhi, National Capital Region.Methods This cross-sectional study included 75 dengue patients with fever <1 week confirmed based on NS-1 antigen and/or IgM antibody positivity. Descriptive analysis was used.Results: Gender was not significantly associated with the outcomes. The duration of fever was significantly higher among those with ICU use (median: 6 versus 4 days; p=0.005), ventilator use (median: 5.5 versus 4.0 days; p=0.049] and blood transfusion (median: 6 versus 4 days; p=0.013). Dengue patients with co-morbidities (diabetes, hypertension, or chronic obstructive pulmonary disease) or co-infection had a significantly higher odds of the outcomes. The platelet level was significantly lower while liver enzymes were significantly higher among those with the outcomes.Conclusions: The clinical features, comorbidities and laboratory profile can help in identifying critical patients for ICU admission and timely intervention to improve outcome.
Histomorphological and clinicopathological correlates of reflux esophagitis
Authors: V. Vidhya , Joseph Leena Dennis , P. Ganesh , Jeswanth Jesse
Published: June 2021

Background: Inflammatory lesions of the esophagus are major concerns to patients who visit our Medical Out Patient Department (OPD) on a regular basis. Endoscopic examination, with histopathological confirmation is the diagnostic modality employed in many centers. Endoscopic appearance is characteristic, and so are histomorphological findings. In our study we have analyzed the clinical, endoscopic and histomorphological findings of various types of esophagitis. This will help us to arrive at a correct diagnosis to initiate appropriate therapy.Methods: We included 141 cases of esophagitis reported in Sri Ramachandra Institute of Higher Education and Research from January 2016 to December 2020 in our study, mostly the ones which came as biopsy samples in histopathology section. Slides were reviewed, various histological features, clinical and endoscopic findings were correlated. Microsoft excel was used for the calculation of results.Results: Reflux esophagitis was most commonly seen in male patients (64%), between 40-60 years (35%) of age with presenting complaints of heart burn and clinical diagnosis of reflux esophagitis. Classic histological feature for the diagnosis of reflux esophagitis was epithelial hyperplasia noted in 89% male and 86% female patients, followed by increased basal cell thickness noted in 66% male and 55% female patients.Conclusions: Accurate diagnosis of reflux esophagitis is mainly based on histomorphological features. Capillaries in epithelium and basal cell hyperplasia along with history and endoscopic appearance to be considered for the diagnosis of reflux esophagitis.
Evaluation of coronary artery risk factors in premenopausal women (<45 years): a single-center prospective study
Authors: Shinde Alok Suresh , Shukla Anand Narendra , Dixit Priyadarshini Mahadev
Published: June 2021

Background: The present study was designed to evaluate the association of conventional coronary risk factors in the angiographically proven cases of younger women (<45 years) with significant CAD along with clinical profile and coronary angiographic findings.Methods: This was a hospital-based prospective study conducted at a tertiary-care center in India. A total of 200 premenopausal women (age ≤45 years) who presented with chest pain likely to be of cardiac origin were enrolled. Each patient was subjected to routine clinical investigations, examination of complete lipid profile, follicular stimulating hormone (FSH), luteinizing hormone (LH), and prolactin; and underwent non-invasive cardiac examination and coronary angiography.Results: Mean age of patients was 39.1±4.98 years. A total of 64 (32%) patients had history of spontaneous abortions and 80 (40%) patients presented with ST-elevated myocardial infarction. Increased FSH, LH and prolactin levels was found in 70 (35%), 20 (10%), and 88 (44%) patients, respectively. Total 196 (98%) patients underwent coronary angiography which revealed presence of significant CAD in 122 (63%) cases and of which 80 patients underwent coronary angioplasty and 12 underwent coronary artery bypass grafting. Of all, 8 death were reported up to the mean follow-up of 11 months.Conclusions: The study stated that premenopausal females (<45 years) represent a special subgroup where non-conventional risk factors play an important role in occurrence of CAD. So, careful history taking with detailed menstrual and obstetric history should be considered in such group of patients.
A study to assess the feasibility of using hemolysis index to predict the corrected potassium in a hemolysed sample
Authors: Choudhury Biswadeep , Karim Nabiha Mayanaz , Chakraborty Manidip
Published: June 2021

Background: Potassium is one of the most commonly affected analytes in a hemolysed sample. Many formulae have been devised to predict the actual potassium in a hemolysed sample. This study was performed to compare the predicted potassium value in a hemolysed sample to that of potassium value in a non-hemolysed sample of the same patient.Methods: The hemolytic index (HI) derived equation from the paper by Dimeski et al was used to calculate potassium value in this study. A total of 99 paired samples were evaluated where the first sample in a pair was the hemolysed one and the other sample was a non-hemolysed one.Results: This study found that the potassium value in a sample and its respective HI have weak positive correlation. However, there was a statistically significant strong positive correlation between the estimated potassium of hemolysed sample to that of the potassium in the non-hemolysed sample.Conclusions: Hence, we conclude that it is feasible to use HI-derived equation to predict potassium in a hemolysed sample to avoid repetition of each sample.
Study of rifampicin resistance among newly diagnosed pulmonary tuberculosis patients with type 2 diabetes mellitus: a prospective observational study
Authors: Kumar Vipul , Yadav Jyoti , Parmar Aparna , Aggarwal Ritu , Gupta K. B.
Published: June 2021

Background: Rifampicin (RIF) resistance in new cases of pulmonary tuberculosis is a matter of concern. Diabetes Mellitus triples the risk of developing tuberculosis. Early detection of TB and its resistance status in diabetics can help in improving the care and treatment outcomes of both diseases.Methods: It was a prospective study conducted from February 2019 to March 2020 in PGIMS, Rohtak on 50 patients of DM with newly diagnosed Pulmonary TB. Rifampicin resistance was detected by CBNAAT on sputum, induced sputum and BAL samples. Results: Mean age of study subjects was 51.24±10.421 (in years) with M: F ratio of 3:1 and maximum patients in 50-59 age group. The average BMI in patients was 22.49±2.42 kg/m2. The most common presenting complaint was cough (92%) followed by fever (68%). Mean serum HBA1c was 9.66±2.24 and mean FBS and PPBS was 195.81±59.08 and 302.02±99.01 mg/dl respectively. Out of 36 cases who gave sputum, 29 (80.55%) were detected rifampicin sensitive and 7 (19.44%) were rifampicin resistant whereas out of 11 who were induced, 9 (81.8%) were rifampicin sensitive and 2(18.18%) were rifampicin resistant. Out of 3 cases detected by BAL CBNAAT, 2 (66.6%) were rifampicin sensitive and 1 (33.33%) was rifampicin resistant. Overall, 10(20%) patients were detected Rifampicin resistant by CBNAAT.Conclusions: We found that TB-DM patients had a higher proportion of drug resistance (20%), so DM should be considered as an independent risk factor for MDR-TB and effective measures are required for early diagnosis of MDR-TB.
Correlation of T3, T4 and TSH with lipid indices in obesity
Authors: Aruna V.
Published: June 2021

Background: Aim was to study the influence of Thyroid hormones on lipid indices in obese individuals. Thyroid dysfunction is a common occurence in South India. Increased accumulation of fats is a common feature of obesity and hypothyroidism.Methods: The study was undertaken at GGH, Guntur and 150 Obese individuals with BMI of >30 were recruited. They are classified into 3 groups based on thyroid profile - Euthyroid (N=77), hypothyroid (N=45)and hyperthyroid (N=28). Their fasting venous blood samples were analysed for thyroid profile, lipid profile, FBS and creatinine. Anthropometric data like height, weight and abdominal circumference was recorded. Lipid indices, atherogenic index of plasma (AIP), Castelli’s Risk Index (CRI) 1 and 2, small dense LDL (sdLDL), Atherogenic coefficient (AC) and BMI were calculated.Results: All the 3 groups showed female preponderance. In hypothyroid cases TSH, T3 and T4 showed significant correlation with lipid parameters (p value<0.0001) and with lipid ratios TSH and T4 significantly elevated (p value <0.00001). There was significant correlation of TSH with TC, TG and LDL between hypothyroid, hyperthyroid and euthyroid cases(p<0.0001). Spearman’s Rho correlation analysis showed negative correlation of Lipid ratios with T3, T4 and TSH in all 3 groups.(r≤1.0). Whereas multiple regression analysis of lipid ratios in all 3 groups with TSH as dependent variable demonstrated positive relation with sdLDL (p<0.01).Conclusions: Assessment of thyroid function is mandatory in all obese individuals to predict complications especially cardiovascular disease.
Efficacy of trifocal versus bifocal bone transport on large tibial bone defect: a systematic review and meta-analysis
Authors: Subawa I. Wayan , Astawa Putu , Razunip Priza , Putra Anak A. G. D. Maha , Putra Gede M. , Arnaya Agung K. , Putra Ryan , Marta Ketut K. A. , Putra Agus S. , Wiraputri Nariswari A.
Published: June 2021

One of the most common long-term complication of chronic osteomyelitis of tibia is segmental bone loss. One of the methods to manage the segmental bone loss in osteomyelitis is bone transport technique, which is able to reconstruct a defect of more than 6 cm. This paper aims to systematically review and analyze the outcome of bifocal and trifocal bone distraction technique on the tibial bony defect. A comprehensive literature search was performed using PubMed, Google Scholar, and Cochrane library. The inclusion criteria were any studies about comparison between bifocal bone transports with trifocal bone transport in management of large tibial bone defect. The outcomes assessed includes external fixation index, duration of regenerate consolidation, lengthening speed, bone transport distance, and operating time. Two studies reported shorter external fixation index in total of 57 fractures in the trifocal group and 61 fractures in the bifocal group. The meta-analysis showed significant difference in external fixation index between the two groups (Figure 1; RR=-44.37; 95% CI 73.73-15.01; p<0.0001) with significant heterogeneity (Chi square=11.38, p=0.0007); I2: 91%. Although only two studies were compared, both studies had almost similar subjects, and shown that trifocal bone transport technique had faster external fixator index compared to the bifocal bone transport group in the setting of severe bone loss in tibial fracture.
Hematoma vulvo-vaginal: exceptional etiology of obstetrical near miss
Authors: Dorland Ranjandriarison Tafitarilova , Rabarikoto Hary Fanambinantsoa , Raelison Jasper Grant , Randriambololona Domoina Malala Aurelia , Rajaonera Tovohery Andriambelo , Andrianampanalinarivo Hery
Published: June 2021

Postpartum hematoma, rare among several causes of postpartum hemorrhage, is exceptionally reported in the etiologies of obstetrical near miss. The authors reported a case of large vulvo-vaginal hematoma after home delivery in a 26 year old patient of Franco-Indian descent. The patient was admitted in a state of hemorrhagic shock combined with an impregnable blood pressure, a significant skin-muquauses pallor and conscience disorder. Its management required a good coordination between the anesthesia team and the obstetrical team as it was based on the hemostasis results after surgical evacuation of the hematoma for more than 1000 ml blood and corrections of blood crass disorders.
Large duplicated gallbladder: a rare congenital anomaly
Authors: Patil Bhimarao , Nagaraju Rashmi M.
Published: June 2021

Gall bladder duplication is a rare congenital anomaly, which may be asymptomatic or may present with disorders similar to that of a single gall bladder. The finding is important due to its association with biliary ductal and hepatic arterial anatomical variations, which may lead to inadvertent complications during laparoscopic surgery. We present a case of duplicated gallbladder with one of the gall bladder appearing large, elongated and coiled, without signs of cholelithiasis / cholecystitis. MRCP was helpful in tracing the two cystic ducts. This case emphasizes on importance of pre-operative anatomical delineation with MRCP in unsuspecting cases in order to minimize the incidence of post surgical complications.
Social marketing: a commercial marketing strategy for understanding and improving health
Authors: Kumar Mohan , Pathak Vineet Kumar , Tripathi Saparya
Published: June 2021

Disease prevention and health promotion is now looking forward to newer innovative platforms to bring social change. Social marketing is a process that applies marketing principles and techniques to create, communicate, and deliver value in order to influence target audience behaviours that benefit society (public health, safety, the environment and communities) as well as the target audience. There are many challenges of marketing approach in India like financial cost, non-availability of audience data, difficulty in measuring marketing efforts, negative demand benefit to third party etc. These challenges can be dealt with 8 benchmark of social marketing which includes exchange, self-interest, behaviour change, competition, audience segmentation, consumer orientation, formative research and marketing mix (4 ‘P’s). Currently in India, condoms are social marketed under NACP-IV which can be extended to OCPs, Injectable contraceptives, ORS, Mosquito nets etc. For success of social marketing incorporation of consumers as partners into the planning process is must along with training of health professionals to enable them to imbue public health organizations with a marketing mind-set. Grantees should be given sufficient time and resources to conduct formative research, develop evidence-based marketing strategies, pretest program interventions, and monitor program activities.
Prevalence and clinical correlates of neonatal thrombocytopaenia in a tertiary healthcare facility in a low-income country
Authors: Obiweluozor Chinazaekpere Oluebube , Ogoke Christian Chukwukere , Ikefuna Anthony Nnaemeka , Ezeofor Tochukwu Chukwukadibia
Published: June 2021

Background: Thrombocytopaenia is known to complicate many neonatal illnesses and contributes significantly to morbidity and mortality. Early diagnosis and treatment are necessary to avoid complications. There are a few studies on the prevalence of neonatal thrombocytopaenia in South Eastern Nigeria. This study aimed to determine the prevalence and clinical correlates of neonatal thrombocytopaenia in South Eastern Nigeria.Methods: The prospective study was carried out over a period of eight months (December 2015 to July 2016). One hundred and fifty nine neonates admitted consecutively into the Special Care Baby Unit of the Federal Medical Centre, Owerri were recruited and evaluated for thrombocytopaenia on admission and after forty-eight hours in the study. Blood platelet was analysed using Sysmex KX-21N automatic platelet analyser and manual counting. Thrombocytopenia was defined as blood platelet less than 100×109/L.Results: The subjects included 89 (56%) males and 70 (44%) females. The prevalence of neonatal thrombocytopaenia was 6.3% on admission and 8.3% after forty-eight hours. Bleeding from orifices (p=0.012), prolonged pregnancy (p=0.047) and petechiae (p=0.020) were clinical correlates significantly associated with thrombocytopaenia. No specific clinical diagnosis was significantly associated with thrombocytopaenia, though the odds of a newborn having thrombocytopaenia was higher in certain conditions indicating increased risk.Conclusions: The prevalence of thrombocytopaenia in this study suggests that platelet count should be done for neonates admitted into special care baby units in resource-poor settings. This should be more in neonates with bleeding from orifices, prolonged pregnancy and petechiae.
Study of iron deficiency anemia in infants of 3 to 6 months age group and its risk factors: a cross sectional study
Authors: Ganjigunta Varun , Ahirrao Varsha Suresh , R. Premalatha , B. Ravichander
Published: June 2021

Background: Iron deficiency anemia in 3-6 months-old infants is often neglected. Its presence in healthy infant of less than 6 months of age is largely debated. Neglecting IDA in this critical phase of growth can lead to serious consequences. The aim and objective of the study was to estimate the frequency of IDA in 3-6 months old infants, admitted in rural tertiary care hospital and to study its risk factors.Methods: The cross-sectional study was conducted in the pediatric department of rural tertiary care hospital. 100 infants in the age group 3-6 months were included in the study. Relevant maternal and infant factors were noted. CBC with blood indices, peripheral blood smear and reticulocyte count were studied. Anemia in them was defined as hemoglobin <9.5 g/dl. IDA was diagnosed based in history, examination, indices, and peripheral smear.Results: 22% of infants of 3-6 months had IDA. 40.9% of infants with IDA were low birth weight compared to 11.5% without IDA (p value<0.05). All pre-terms included in the study had IDA. 16% of term, normal birth weight, exclusively breast-fed infants had IDA. Underweight and stunting were seen in 31.8 % and 30.8% of IDA infants compared to 9% and 5.4% of infants without IDA.Conclusions: IDA was quite common in infants less than 6 months and also seen in healthy, term and exclusively breast-fed babies, so universal iron supplementation before 6 months need to be considered in National Iron plus Initiative in India. Preterm, LBW babies and babies with NICU stay are at higher risk of IDA.
Organism specific platelet response in neonatal sepsis in neonates weighing ≤1800 gm
Authors: Zanzrukiya Dipal M. , Thakkar Pareshkumar A. , Thakkar Abhishek K.
Published: June 2021

Background: Thrombocytopenia is an important but non-specific marker of severity of neonatal sepsis. Few studies have observed organism-specific response in platelet count, however this finding in not consistently seen in various studies. We carried out this study to look for organism-specific response of platelet count and indices in neonatal sepsis in our setup.Methods: A prospective analytical study was conducted during December, 2019 to November, 2020 at tertiary care centre of central Gujarat. Neonates weighing ≤1800 gm (n=100) were enrolled according to eligibility criteria. Sepsis screen including TLC, ANC, platelet count, platelet indices, micro ESR, CRP, and blood culture was done. Patients with culture-proven sepsis were divided according to organisms isolated from blood or CSF. Patients were followed up to the final outcome of their hospital stay. Appropriate analytical tests were used for the results.Results: Out of 100 patients, 69 had culture-proven sepsis, of which 40 (58%) were gram-negative, 21 (30%) were gram-positive and 8 (12%) had fungal sepsis. Of these 48/69 (70%) patients had thrombocytopenia. Of these patients with thrombocytopenia 60%, 30% and 10% in the first sample while 48%, 38% and 16% in the second sample had gram positive, gram negative and fungal sepsis respectively. Commonest organisms isolated were Enterococcus and MRCONS, and thrombocytopenia was not having specific correlation with any particular organism. There was no significant difference between mean and median platelet count of gram-positive, gram-negative, and fungal sepsis.Conclusions: Thrombocytopenia is significantly associated with neonatal sepsis. The effects of sepsis on platelet count are not organism-specific.
Umbilical cord blood TSH level: correlation with congenital hypothyroidism
Authors: J. Mahesh Reddy , G. Seshagiri , K. Padmaja , H. Archana C. , C. Ramya
Published: June 2021

Background: Congenital hypothyroidism is the most common preventable cause of mental retardation. Screening methods include measuring cord blood and venous blood TSH level. The objective of this study was to determine the impact if any of various risk factors affecting these levels.Methods: It was a cross sectional study done at our hospital and 263 cord blood samples were collected and TSH levels measured. The variables included in the study are parity of mother, GDM, mode of delivery, birth weight, gestational age, sex, weight appropriate for gestation, Apgar score.Results: In our study 35 among 263 cord blood samples were found to have CB TSH levels above the cut off value of 20 mIU/l and repeat venous sampling done on fifth day of life showed only one sample had high TSH with low free T4 levels and remaining 34 samples showed TSH levels which were significantly down from the earlier peak. The p value, ROC curve, test of significance and criterion cut off levels were made for each of the variables mentioned above. Among the variables studied, mode of delivery (<0.001), gestational age (p=0.001), low Apgar score (p=0.001) had p values which were statistically significant.Conclusions: Incidence of congenital hypothyroidism in our study is 0.0038%. There was no sexual predilection and the high cord blood TSH levels may be due to perinatal stress factors such as emergency LSCS, low Apgar score and prematurity which had significant positive correlation as evidenced with p values (≤0.001).
Prevalence of stress and anxiety among parents of COVID-19 positive children admitted in Kempegowda hospital, Bengaluru
Authors: Ramya H. S. , . Keerthidarshini , Asiya Afroza , L. Sanjay
Published: June 2021

Background: COVID-19 pandemic has led to rise in fear, anxiety, stress among population. Parents of COVID-19 positive children are most vulnerable of all, since they have to bear the economic burden and the fact that there is no definitive treatment which might end up with fear of uncertainty of bad outcome added to their stress. The aim of the study was to assess the level of stress and anxiety among parents of COVID-19 positive children admitted in Kempegowda hospital, Bangalore.Methods: Cross-sectional study was done in Kempegowda hospital. Total of 50 COVID-19 positive children were admitted in Kempegowda Hospital. 23 were boys and 27 were girls. Parents were explained about the DASS-21 questionnaire to assess stress and anxiety and relevant options were marked by the paediatrics post graduate posted in the COVID-19 ward. Association of mental health disorders such as stress and anxiety with symptoms, contact history, nutritional status and other demographic factors were analyzed using Chi square test.Results: Female to male ratio was 1.1:1. Among the 50 children, 80% had contact history with COVID-19 positive individuals. 24 (48%) were symptomatic, among which 7 individuals had fever, 7 individuals had cough, 3 individuals had cold, 2 children had respiratory distress and remaining had myalgia (2), loose stools (2) and pain abdomen (1). 82% parents had stress and 60% had anxiety.Conclusions: Severe stress and moderate anxiety levels was majorly seen in parents of symptomatic COVID-19 positive children during the hospital stay suggesting the need for counselling of parents and awareness of impact of COVID-19 infection in children.
Is parental satisfaction important in a public hospital NICU
Authors: Srivastava Roli , Taneja Sunil , Midha Tanu , Rao Yashwant Kumar , Bansal Alexandra , Goyal Pratishtha
Published: June 2021

Background: NICU in public hospitals in developing countries face immense challenges in the form of overcrowding, less manpower and lack of equipment. Patient care is the prime responsibility of the health care workers. Parental satisfaction although an important part of health care is not given its due importance. There are very few studies analysing parental satisfaction of NICU babies in the developing countries including India. The objective of this cross-sectional study was to 1. Assess satisfaction regarding medical treatment 2. To assess satisfaction regarding General environment. Take suggestions regarding improvement in services.Methods: A total of four hundred and fifty-nine parents were interviewed. They were parents of babies admitted in NICU, those coming for follow up in the well-baby clinic. Parents of babies who died or left against medical advice were interviewed at the time of leaving the hospital or telephonically later. Results were analysed statistically using the student chi square test.Results: 92.6% of the respondents were satisfied with the medical services and 96.6% were satisfied with the general environment. Reasons for lack of satisfaction were analysed. Nuclear families, urban background, adverse outcome of the baby were the Key factors. Parents gave pertinent suggestions like improvement in cleanliness, more beds, increase in medical staff, better availability of medicines and blood products.Conclusions: There is need to develop standardised protocols to analyse parental satisfaction. This will lead to better understanding of parental expectations and help to improve patient care.
Empyema thoracis in a Nigerian neonate: case report and brief literature review
Authors: Ezuruike Ezinwa O. , Chukwudi Ndubuisi K. , Nwokeforo Nathan U. , Obioma Mary-Anna Ekpe
Published: June 2021

Empyema thoracis (ET) is a significant cause of paediatric hospital admissions and mortality but an infrequent finding in the neonatal period. Our case was a three week old male who presented with respiratory distress and had empyema thoracis. He was managed successfully with antibiotics and chest tube thoracostomy drainage.
COVID-19 infected neonate presenting with cytokine storm and sepsis
Authors: Kariyappa Mallesh , Devadas Sahana , Dutt Aparna , Govindarajan Varun
Published: June 2021

COVID-19, a clinical syndrome caused by the coronavirus (SARS-CoV-2) became a pandemic following an outbreak of viral pneumonitis, first identified in Wuhan, China. The disease manifestations vary ranging from mild upper respiratory tract infection to severe pneumonitis, acute respiratory distress syndrome (ARDS) and even death. Although most of the neonatal cases are asymptomatic, rarely, they can present with cytokine storm mimicking with similar features of sepsis. This is a case report of SARS-CoV19 positive neonate presenting with sepsis and cytokine storm, 5-day old baby born to SARS-COVID 19 positive mother presented with fever and investigations showed elevated total counts with neutrophilic predominance, thrombocytopenia suggestive of sepsis and increased inflammatory markers suggestive of cytokine storm. Blood culture was sent and baby was started on intravenous antibiotics. In view of cytokine storm intravenous dexamethasone 0.5 mg/kg/day was given intravenously for 5 days. Neonate recovered from illness after 1 week as evidenced clinically and and by the fall in inflammatory markers before discharge. This report opens the possibility of having both sepsis and cytokine storm in a SARS-CoV19 positive neonate.
COVID-19 triggered systemic lupus erythematosus in a child: a case report
Authors: Maram Krishna Prasad , Paturi Venkata Rama Rao , Alla Lalitha Sudha , Bhagavatula Murali Krishna
Published: June 2021

The COVID-19 pandemic has continued to wreak havoc globally during the second wave. Even though it tends to be asymptomatic or cause only a trivial illness in children, it is reported to be associated with a delayed hyper-inflammatory response syndrome resulting in multi-organ dysfunction in children. It is possible that through unknown mechanisms, it could also result in triggering of other auto-immune disorders. We report a case of pediatric systemic lupus erythematosus (SLE) with lupus nephritis suspected to be triggered by SARS-CoV-2 virus which is not reported in the literature so far.
Compound heterozygote KCNQ1 mutation causing Jervell Lange Neilson syndrome: a case report of genotype-phenotype correlation
Authors: Agarwal Khushboo , Shankar Guruprasad H. , Sarangi Bhakti , Walimbe Ajay
Published: June 2021

Congenital sensorineural hearing loss (SNHL) is a common phenomenon with several genetic and non-genetic associations that require early diagnosis and work-up to prompt appropriate interventions. Of the genetic associations, Jervell and Lange-Nielsen syndrome (JLNS) remains a rare monogenic disease that is characterized by SNHL, prolongation of QT interval, syncopal attacks due to ventricular arrhythmias and sudden cardiac death from very early in life. We hereby report a 5 years old girl with SNHL and recurrent blackout episodes in early childhood with significant family history, admitted for cochlear implant who developed ventricular arrhythmias requiring multiple interventions with further investigations revealing a prolonged QT interval on electrocardiography (ECG) with metabolic abnormalities (hypomagnesemia and hypokalemia). Her clinical exome study showed a compound heterozygous KCNQ1 mutation, a more sporadic form of JLNS managed using oral beta-blocker. This experience illustrates the relevance of a detailed systemic evaluation with an elaborate cardiac assessment in children with SNHL, more so in the presence of frequent unexplained acute life-threatening episodes.
Compound haemangioma of lower lip: an interesting and rare case report
Authors: Chauhan Devika , Hota Subhransu Kumar , Kabra Hardik , Giri Ranjana , Senapati Urmila , Tudu Harish Chandra
Published: June 2021

Haemangiomas are common benign vascular tumours of infancy and childhood. Haemangiomas occur in 10-12% of children of 1 year of age and most of them are self-resolving within 9 years of age. Most common sites are head and neck (around 90%) and lip is one of the preferred sites. Sometimes persistence of haemangiomas may require surgical intervention. Capillary haemangiomas generally located superficially and cavernous haemangiomas located deep. Mixed capillary-cavernous haemangiomas or compound haemangiomas are one of the rarer types and location at lip rarest. Here we report a 14-years-old boy presented to paediatric surgery outdoor with swelling in lower lip for last 3 years. The excisional biopsy done with a clinical diagnosis of granuloma and sent for histopathological study. On microscopy of tissue sections given from lesion showed stratified squamous epithelium with sub epithelium revealing two distinct areas of capillary haemangioma component and cavernous haemangioma component within the lesion. So, final diagnosis of capillary-cavernous haemangioma (compound haemangioma) was made without any granuloma or malignant component. Patient followed up for six months and he was completely asymptomatic without any residual disease and recurrence.
An unusual presentation of encephalitis which mimicked generalised tetanus
Authors: Benny Anushree M. , Nagar Rajendra Prasad , Nagori Gautam Lal
Published: June 2021

Movement disorders are frequent mimickers of more severe neurological presentations, whenever it is diagnosed one should suspect a central nervous system infection as an underlying cause. A 11 year old girl presented in casuality with intermittent generalised muscle spasm, clear sensorium, trismus and risus sardonicus. Initially managed as a case of tetanus, rapid resolution of spasms made suspicion of encephalitis as underlying cause of dystonia which mimicked tetanus. Blood investigation and CSF analysis were normal. CECT brain showed hyper dense lesions bilateral temporal lobes suggestive of viral encephalitis. Child was managed with intravenous acyclovir and dexamethasone after which child improved considerably. Acute dystonia is a close mimicker of tetanus. Any patient presenting with new onset movement disorder should be investigated for central nervous system infection even though it has been reported as a rare cause for the same.
Assessment of knowledge and skills of cardiopulmonary resuscitation among health workers at Nakuru County Referral Hospital
Authors: Manono Betty K. , Mustisya Albanus , Chakaya Jackson
Published: June 2021

Background: Cardiopulmonary resuscitation is critical in the emergency healthcare settings. Effective cardiopulmonary resuscitation improves the patients’ outcomes hence reducing mortality related to cardiac arrest. The aim of the study was to assess the knowledge and skills of cardiopulmonary resuscitation among health workers at Nakuru County Referral Hospital.Methods: The study adopted an analytic cross-sectional design. A census sampling technique was used to recruit respondents in the study. Questionnaires and checklists were used to collect data.  Chi-square tests and multiple regression analysis were done to determine the significant association between demographic characteristics, knowledge and skills of cardiopulmonary resuscitation.Results: The study found that slightly above half 54.3% (n=88) of the respondents had low knowledge on cardiopulmonary resuscitation. Results revealed that age of respondent (p=0.038) and level of education (p=0.000) were significant. Cross tabulation showed that older respondents (>40 years) and those with a high level of education (degree and or masters) were more two and three times more likely to have a high knowledge of cardiopulmonary resuscitation. The study found out that majority 61.1% (n=99) of the respondents had poor CPR practice. Cross tabulation showed that respondents with high knowledge were four times (OR=4.303) more likely to have good practice.Conclusions: The study concluded that the performance of cardiopulmonary resuscitation is attributable to low CPR knowledge. The study recommends that more emphasis be placed on continuous professional development, and supervision be done after training to ensure that health workers follow the recommended guidelines.
Diagnostic accuracy of renal calculi on ultrasonography taking computed tomography as gold standard
Authors: Pathan Hina , Shazlee M. Kashif , Iqbal Junaid , Ali Ashraf A. , Hameed Kamran , Ahmed M. Saad
Published: June 2021

Background: Ultrasonography is a useful modality to diagnose stones and to confirm the occurrence of complications of other renal pathology, so it is important to understand these characteristic findings and other diseases that mimic them. In addition, other imaging modalities such as computed tomography (CT) can be recommended if the clinical or radiological diagnosis is ambiguous.Methods: A group of 325 patients with clinical suspicion of renal calculi were included in this study. Out of these 325 patients 179 (55.0%) were male and 146 (44.9%) were female. All these patients underwent ultrasonography (USG) examination. Final diagnosis was based on CT findings which was done subsequently.Results: The total number of patients comprising the study were 325 who underwent ultrasound examination. After USG and CT scan was done to confirm the diagnosis. Out of 325 patients, 201 patients were confirmed having renal calculi on USG analysis and remaining 103 patients were true negative.Conclusions: The study proves that USG is highly accurate in diagnosing and characterizing renal calculi. USG also guides in defining exact location as well as aids in deciding the medical or surgical approach to be used.
Occurrence of Demodex infestation in chronic blepharitis in a tertiary care hospital in North-East India
Authors: Hazarika Suranjana C. , Hazarika Himanto N. , Ghuge Ashwini
Published: June 2021

Background: Chronic blepharitis is frequently encountered by ophthalmologists. Demodex mites (Demodex folliculorum and Demodex brevis) can play a role in its pathogenesis, especially in treatment-resistant cases. Demodex infestation often remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash-sampling. Objective of the study was to find the association between Demodex infestation and chronic blepharitis.Methods: The study included 80 patients diagnosed with chronic blepharitis and 80 controls without blepharitis. Four eyelashes were epilated from each lower and upper lids of the right and left eye (a total of sixteen samples) of each participant. Eyelash samples were examined under a light microscope and Demodex species were identified and counted.Results: Demodex mites were detected in 45 cases (56.25%) and 14 controls (17.5%). Significant association was found between demodex infestation and blepharitis as odd’s ratio was found to be 6.0612 and p value <0.0001. D. folliculorum was detected in 42 cases, D. brevis in 2 cases while in one case, both were detected. The mean age for Demodex positive cases and controls were 49.78±13.25 and 64±7.86 years, respectively. Amongst the cases, Demodex was detected in 57.69% males (30 out of 52) and 53.55% females (15 out of 28).Conclusions: There is significant co-relation between Demodex infestation and chronic blepharitis. Demodex infestation should be part of the differential diagnosis of chronic blepharitis.
A cross sectional study to assess factors related to exclusive breast feeding practice among mothers of infants aged six months or less admitted in pediatric wards at tertiary care hospital
Authors: Singh Niti V. , Singh Vijaykumar , Chowdhury Soujannya K.
Published: June 2021

Background: Infant feeding practices have a major role in determining the nutritional status of a child. Despite several benefits of exclusive breastfeeding, the practice is not common in many developing nations, including India. So there is a need to assess factors associated with exclusive breast feeding by mothers.Methods: A cross sectional study using the quantitative method by the means of a well prepared questionnaire, carried out in the pediatric ward of a tertiary care hospital in Mumbai. Data was collected by face to face interview and filed in a pretested, semi-structured, questionnaire. Data entry was done in excel sheet and analysed with the help of epi-info and statistical package for the social sciences (SPSS) software and was presented in tabular and graphical form.Results: A total of 112 mothers with infants <6 months of age participated in the study with a response rate of 98%.Conclusions: Majority of mothers’ perception about exclusive breastfeeding was that they considered it insufficient for their infant’s health and nutrition, and hence also relied on other feeds.
Utility of augmented breast self-examination as an education and screening tool in Rural India for early detection of breast cancer
Authors: Suresh A. V. S. , Sharma Rakesh , Dattatreya P. S.
Published: June 2021

Background: Breast cancer contributes 19-34%, the percentages vary according to the region. There is an immense need for the structured breast cancer screening, which should start with education of breast self-examination (BSE). However due to poor literacy and education, we thought of augmenting the same (aBSC) with use of hand held device across various camps and compared with clinical breast examination (CBE) and conducting feasibility study.Methods: Data from screening camps between 2018-2020 using standardized AV tools (15 minutes duration) were analysed followed by a question answer section to elicit the understanding with 20:1 random check. For BSE and a aBSE we did verification for the understanding and adoption of techniques as per instruction manual. The participants were observed and supervised by trained personal during the process followed by CBE. The results BSE, aBSE and CBE were documented.Results: We trained 7214 women 2018-2020. Of the total trained persons, 93.8% of women understood accurately. aBSE was done for 1085. Comparison was done between the aBSC and CBE. aBSE could detect 92.6% of all the lumps identified by CBE, which is much better than 68% of BSE. There are 23.4% more suspicious lumps were unearthed after aBSE after conventional BSE. Of all the camps we detected 356 new lumps and malignancies were confirmed in 142 participants, which indicated high impact of such training programs in Rural India.Conclusions: BSE and aBSE are quite useful in clinical detection of lump and is easy to implement. With detection rate of 1.9%, which is quite high especially in the rural areas where medical facilities are poor, we feel that aBSE can be adopted in large scale and is well accepted among rural women and can improve on conventional breast self-examination and is comparable with clinical breast examination.
Knowledge and practices of universal safety precautions among interns and first year resident doctors in a tertiary care hospital
Authors: Wadekar Ashish A. , Singh Vijaykumar S. , Chowdhury Soujannya K. , Chape Maheshchandra M.
Published: June 2021

Background: Universal safety precautions also known as standard precautions are a set of evidence based clinical work practices published by Centers for Disease Control and Prevention (CDC) in 1996 and updated in 2007; the extension of blood and body-fluid precautions to all patients is referred to as universal precautions. Despite detail guidelines, the knowledge and understanding of universal safety precautions among health-care workers is found inadequate.Methods: This was a cross-sectional study carried out among interns and first year resident doctors in medical college attached to a tertiary care hospital. Around 200 doctors are enrolled in this study.Results: In our study, correct knowledge about hand hygiene found in interns was 84.1% and clinical residents 93.3% and this knowledge was practiced by 83.6%% interns and 84.1% clinical resident. The knowledge about the importance of wearing the gloves was 95.5% among interns and 95.4% among residents and facemask, eye wear was 78.5% among interns and 92% among residents, but in practice 78.5% interns and 71.5% residents were seen to use gloves and apron. Knowledge about needle stick injury was 95.5% among interns and 97.1% among resident doctors. The knowledge of interns was 81.25% for disposal of gloves and 70.5% for disposal of sharps whereas among resident doctors, it was 72.7% for gloves and 70.4% for sharps.Conclusions: In this study, we observed that overall knowledge regarding importance of hand washing, wearing gloves, risk of needle stick injury, disposal of biomedical waste were satisfactory. There was poor response regarding the steps of hand washing and recapping of needles.
Study of stress, anxiety, depression and coping strategies among nursing students in a tertiary care teaching hospital, South India
Authors: Das Biranchi Narayan , Mohandas Anu , Syed Saba
Published: June 2021

Background: Nursing students are at extremely high risk for experiencing stress, anxiety, and depression due to their varied circumstances. Indian studies has revealed, moderate stress among 77-82% of nursing students. The better the nursing students can manage their stress and anxiety and adopt healthy coping strategy, the more successful they can be in their clinical training and academic performance. Objective of the current study was to estimate the prevalence of depression, anxiety, and stress among the BSc nursing students and its association with socio-demographic and academic factors and to find the coping strategies adopted by them.Methods: A cross sectional study was conducted among 149BSc nursing students in a teaching hospital in Hyderabad. The data was collected by pre-validated questionnaire with 3 parts. Part I: socio-demographic and academic parameters, part II: psychological information (DASS-21) and part III: coping strategies (brief COPE). Data was analysed using SPSS version 24.The percentages of stress, anxiety and depression was found and categorised to mild, moderate, severe and extremely severe and associations analyzed with Chi-square test. The mean score and percentages were calculated for coping strategies.Results: The mean age of nursing students was 20±1.6 years. The proportion having depression, anxiety and stress were 67.7%, 85.3% and 46.9% respectively. The coping strategies ‘used a lot’ were spirituality (43.6%), Information support (30.9%) and active coping (28.2%). The study showed depression (p=0.05) and stress (p=0.002) to be higher among 2nd and 4th year students. Lack of leisure time (p=0.036) and difficulty in academics (p= 0.017) were identified as stressors.Conclusions: This study noted high levels of psychological disturbances among nursing students. There is urgent need to plan stress management programmes with peer instructors, mentorship, more leisure and outdoor learning activities.
A study to assess the knowledge regarding rabies prevention among general population of community residing at Pratap Nagar, Jodhpur, Rajasthan
Authors: Pandey Vandna , Kurien Nancy , Ghintala Sangeeta , Saini Sharda , Chauhan Shivani , Sharma Shweta , Sharma Sonali , Kachhawaha Suman , Gurjar Suman , Bhatiya Suman
Published: June 2021

Background: Rabies is a major public health issue. It is 10th biggest cause of death due to infectious disease worldwide and continues to be a burden for India with the country still registering around 18,000 to 20,000 cases of rabies every year. It is the only communicable disease of man that is always fatal. Domestic dogs are most common reservoir of virus, with 99% of human death caused by dog mediated rabies. Rabies is completely curable by early diagnosis and treatment regimen.Methods: Present study has been carried out among general population of community residing at Pratap Nagar, Jodhpur, and Rajasthan. Quantitative research approach was used to assess the knowledge regarding rabies prevention. Data was collected through self-structured interview schedule. Sixty samples were selected by non -probability convenient sampling technique.Results: In the study there were 60 subjects, in which male were 28 and female were 32. 7 subjects had excellent knowledge, 34 subjects had good knowledge, 17 subjects had average knowledge and 2 subjects had poor knowledge. No personal variable was found to be in association with level of knowledge at p<0.05 level of significance.Conclusions: The study indicates that awareness session on rabies prevention should be held regularly to improve the knowledge and create positive attitude and remove the misconception among general population.