Atharva Scientific Publications (E-Jounals)
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Incidence and characterization of early- and late-onset skin diseases in neonates – A hospital-based cross-sectional study
No full textBackground: Neonatal skin diseases occur in almost every newborn baby. Many are transient, involute rapidly and require no management. Objective: The objective of the study was to study the incidence and characterization of early and late onset of various skin diseases in the neonates. Methods: A cross-sectional observational study was carried out among 200 neonates in a tertiary care hospital in Central India. Skin lesions which appeared on or before 48 h before birth were categorized as early onset and skin lesion appearing after 48 h were considered as late onset and the characteristics of lesions were highlighted. Results: The most common skin lesions identified within 48 h of birth were Epstein pearl’s (77.0%), followed by Mongolian spot (45.5%), desquamation of skin (35%), sebaceous gland hypertrophy (31.5%), and milia (28.4%), respectively. Less incidence of salmon patch, erythema toxicum neonatorum, impetigo, miliaria rubra, accessory auricles, pigmented nevi, port-wine stain, and lamellar ichthyosis also was recorded. Impetigo (11.2%) and candidiasis (11.2%) were commonly seen after 48 h of birth followed by dermatitis 6.4% and a few cases of birthmarks. Conclusion: Along with increasing awareness of neonatal diseases, our study results also aid in better identification and diagnosis of these diseases
Clinicodemographic profile of diabetic ketoacidosis and its management in hospitalized children – A prospective study
No full textBackground: Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with Type 1 diabetes (T1DM). In developing countries, mortality is between 6 and 24%. Recent studies have documented that DKA in association with cerebral edema (CE) accounted for a mortality of 1–24% with a high rate of permanent neurologic morbidity. Objective: The objective of the study was to study the demographic profile, clinical presentation at the time of admission, management, and complications of patients diagnosed as T1DM with DKA. Materials and Methods: A prospective observational study was conducted among children admitted in PICU MGM hospital, Warangal, Telangana between December 2016 and November 2018. Children up to the age of 18 years diagnosed as T1DM who presented with DKA were included in the study. Sociodemographic profile, dietary intake, and treatment history of children were collected using a pre-designed pro forma. Clinical features and management were noted. Results: A total of 51 children were included in the study. Among them, 32 (62.74%) cases were newly diagnosed and 19 (37.2%) were previously diagnosed. A majority of the children belonged to lower socioeconomic status with 40% of the children suffering from severe grade of malnutrition. Classical symptoms of polyuria, polydipsia, and polyphagia were observed in 32 patients (62.74%). Vomiting was observed in 59% of cases, tachypnea in 82.35%, and abdominal pain in 29.41% of cases. About 54.90% of cases presented with severe and 33.3% with moderate DKA. Administration of regular insulin was the main modality of management in all cases. The major complication observed was hypoglycemia followed by cerebral edema. Conclusion: Cerebral edema with septic shock is a life-threatening complication of patients suffering with DKA. Active management with regular insulin can avert major complications and can lead to better outcomes
Diphtheria in adult - A case report
No full textDiphtheria caused by Corynebacterium diphtheriae is a toxin-mediated upper respiratory tract infection. It spreads by airborne respiratory droplets and commonly affects children. The implementation of a Universal Immunization Program has resulted in a decline in the incidence. In spite of the ongoing immunization program, there is an intermittent re-emergence of diphtheria in developing countries like India. The resurgence of diphtheria in the recent past, with a shift in the age from children to adults, poses a major concern. Hereby, we report a case of isolation of toxigenic C. diphtheriae from an adult patient who suffered from diphtheritic tonsillitis
Predictive value of cord blood bilirubin in neonatal hyperbilirubinemia: A prospective study
No full textBackground: As there is a tendency for early discharge from a hospital, some babies may develop significant neonatal jaundice at home, which may go unrecognized and cause subclinical damage to the growing brain. If such babies could be identified early, their discharge can be postponed for timely and better management. Objectives: The objectives of the study were to evaluate the umbilical cord bilirubin (UCB) levels as a predictor for hyperbilirubinemia in full-term and near-term newborns up to the 3rd day of life. Materials and Methods: A prospective cohort study was carried out in a tertiary care hospital in South India. Data were collected from the enrolled cases by a pre-designed proforma. Statistical analysis was carried out with the help of statistical measures, such as percentages and proportions and the sensitivity, specificity, and negative and positive predictive values (NPV and PPV). Results: A total of 301 newborns were enrolled. A cutoff UCB 2 mg/dl had 94% sensitivity, 93% specificity, 61% PPV, and 99% NPV. A total of 61% of neonates who had UCB levels ≥2 mg/dL required phototherapy by the 3rd day of life. However, 99% of neonates who had UCB <2 mg/dL did not require phototherapy, and these infants with low risk of hyperbilirubinemia could be discharged early from the hospital. Conclusion: The cutoff value of 2 mg/dL of UCB with 94% sensitivity and 93% specificity canbe used as a predictor for developing subsequent hyperbilirubinemia
An unusual presentation of daily headache: A case report
No full textHeadache is a fairly common universal symptom caused by multiple etiologies. More than 90% of headaches are primary headaches which are tension-type headaches and migraines. The rest are secondary headaches that have an underlying local or systemic cause. Most often, there could be underlying psychopathology, where the headache would be the presenting symptom. Life stresses, depression, anxiety, and relationship issues are often seen in headache patients. We report a case that was referred to psychiatry from the medicine outpatient department for tension-type headache but had an underlying organic etiology, though it was detected only after thoroughly evaluating the patient with liaison with neurology and ear, nose, and throat doctors
Cavernous hemangioma within a schwannoma: A case report of a rare amalgamation of two entities
No full textSchwannoma occurring in peripheral nerves is a common tumor. Cavernous hemangiomas are also common vascular malformations. Although both of these lesions occur quite frequently, an amalgamation of both lesions is rare. Here, we present one such case. An adult male presented with a chief complaint of swelling over the left arm for 20 years. On histopathology, a diagnosis of schwannoma with cavernous hemangioma was made. A total of 36 cases have been reported in the literature, which showed cavernous hemangioma associated with neoplastic lesions of the nervous system; 24 cases were of Schwann cell origin. Furthermore,only 26 cases have been found in conjoint association. Overall, the association of cavernous hemangioma with neoplastic lesions of the nervous system is rare
Overlaid temporomandibular joint disorders and otology symptoms – A diagnostic approach and management considerations for otolaryngologists and dentists
No full textThere is an overlap of symptoms related to temporomandibular joint disorders (TMD) and otological diseases. It becomes empirical to differentiate the two conditions since the prevalence of otalgia, tinnitus, headache, etc., in TMD patients may be as high as 50%. This review paper discusses the overlapping symptoms, diagnostic work up and treatment strategies for TMD, aiding both the oral physician and otolaryngologist to be able to treat the patient in a holistic manner
The risk associated with iron deficiency anemia for simple febrile seizures in children: A case–control study
Full text linkBackground: Studies have postulated iron deficiency state to be a risk factor for febrile convulsions as it changes the threshold of neurons excitation which may lower the threshold for seizures in children. However, many other studies have reported a protective role for febrile convulsions by increasing the neuronal threshold. Objective: The objective of the study was to evaluate the association of iron deficiency anemia (IDA) as a risk factor for the occurrence of simple febrile seizures (FS) in children. Material and Methods: A case-control study was conducted in a tertiary teaching hospital from September 2015 to February 2017. A total of 240 cases with fever and simple FS were enrolled according to the inclusion and exclusion criteria. Another 100 cases of children without seizure but with short duration of fever were enrolled as controls. Blood samples were then taken for assessing the hematological indices of these patients. The results were statistically analyzed. Results: Incidence of IDA was found to be more in children with simple FS than controls but was not statistically significant (p=0.35). Furthermore, no association was found with other hematological indices with FS occurrence. Conclusion: We could not find any association of IDA as a risk factor for a simple FS
Intranasal midazolam for the treatment of seizures in children in rural India
Full text linkBackground: About 5% of healthy children experience at least one convulsive episode in their lifetime with onset during childhood in more than half the cases. The current evidence suggests that prolonged seizures are best stopped with early treatment. Objective: The objective of the study was to assess the role of intranasal administration of midazolam for seizure cessation at home by caregiver in semi-urban and rural settings. Materials and Methods: A total of 50 children in the age group of 6 months–14 years were included in the study, who previously had a history of convulsions and were on regular follow-up. The study was conducted over a period of 6 months. The parents were instructed to give intranasal midazolam (INM) if seizure activity lasted for more than 3 minutes and the need of giving it 2nd time if the seizure was not aborted and to bring the child to nearest pediatrics emergency set up for the further management. Results: The subjects were divided into three groups according to age: Group A consisted of children between 6 months and 4 years, Group B of 4 and 9 years, and Group C had 9 and 14 years old children. Average duration of aborting seizures before INM use was 16.22 min and after its use was 4.66 min. Seizures were aborted in 45 children within 10 min. Conclusion: INM is safe and efficacious in aborting seizures at home in semi-urban and rural settings
A quality improvement initiative in reducing nasal trauma during the application of nasal bubble continuous positive airway pressure in a tertiary care neonatal unit
No full textBackground: Trauma following nasal bubble continuous positive airway pressure (bCPAP) is more commonly observed in areas where there are inadequate nursing staffs. It may progress to be a source of sepsis, prolonged hospitalization, and permanent facial disfigurement. Aim: This study aims to conduct a quality improvement (QI) initiative to decrease the proportion of neonates developing nasal trauma following bCPAP from baseline of 79% to 30% over a period of 16 weeks in Level III neonatal intensive care unit of a tertiary hospital of South India. Materials and Methods: The study was conducted as a single-center QI initiative from October 2018 to February 2019. A QI team was formulated, problem/outcome indicator decided and problem analysis was done using fishbone analysis and Pareto principle. Change ideas were discussed and plan, do, study, and act (PDSA) cycles were formulated. It took four PDSA cycles to reach the aim. The first cycle aimed to train nurses, second to reinforce the same in treating doctors, third was to start using Duoderm (gel plaster) over nasal septum, and the fourth was to intermittently shift the baby to high-flow nasal cannula and introduction of written policy to maintain the changes introduced. Results: Incidence of nasal trauma reduced from baseline of 79% to 26% over a period of 16 weeks. Incidence of Grade III trauma reduced from 35% to 0%. Conclusion: A simple method of training the junior residents and nursing staff and use of barrier gel plaster and maintaining policy on the application of nasal CPAP (NCPAP) can go a long way in reducing NCPAP trauma substantially and hence helping reduce hospital stay, morbidity, and probably also sepsis-related mortality