Atharva Scientific Publications (E-Jounals)
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To study the morbidity and mortality pattern of outborn neonates admitted in neonatal intensive care unit of Indore
Get PDFIntroduction: About 50% of infant deaths occur within the 1st month (neonatal period) of life; of these, more than half die during the first 24–48 h after birth. Despite various advances in the newborn care, the neonatal mortality and morbidity remain high, especially, in the developing countries. Objective: The objective of this study is to analyze the factors and the patterns associated with the morbidity and mortality of the newborns. Materials and Methods: This retro pective study was conducted from August 2014 to September 2016. Medical records of 500 outborn neonates admitted in the neonatal intensive care unit of a medical college of CentralIndia were reviewed. The morbidity and mortality pattern of neonate was studied and correlated with birth weight, gestational age, sex, chief complaint, and the underlying cause. Results: There was male preponderance in the study group (60.2%) and male-tofemale ratio was 1.5:1 (p<0.05); preterm babies accounted for 48.6% and term babies 51.40% of neonatal death. The outcome of hospitalized newborn showed that 62% of the newborns were discharged, 28.4% newborn expired, and 9% newborn left against medical advice. Respiratory distress syndrome (RDS) (46.4%) was the leading cause of death, followed by neonatal sepsis (21.9%) and prematurity (15.49%) Conclusion: The major causes of neonatal death were found to be RDS, neonatal sepsis, prematurity, low birth weight, and birth asphyxia. Hence, it is the need of the hour to improve the health of the mother, to give birth to healthy babies. 
Percutaneous cystolithotripsy in children and its outcome: A single center experience
Get PDFBackground: Pediatric bladder stone disease is very common in certain regions of India. Traditionally, pediatric surgeons have been managing this by open surgeries. Aim: The aim of the study was to manage vesical calculus in children by percutaneous cystolithotripsy (PCCL). Materials and Methods: All the children up to 18 years of age suffering from vesical calculus were operated by PCCL. Cystoscopy performed first to assess the stone burden. 18 Fr angiocath needle was used to puncture the bladder under vision and 0.035 guide wire was passed. Tract was dilated using single-step screw dilator; a 20 French Amplatz sheath was passed over the screw dilator and nephroscope was introduced. Lithotripsy was done using pneumatic lithotripter. Per urethral Foley catheter was placed and suprapubic puncture site was suture closed. Results: A total of 74 patients were operated in the past 3 years with an age range was 1–18 years with female preponderance. Complete clearance was achieved in all patients while the average duration of surgery was 30 min with range of 15–50 min. All the patients were operated under regional anesthesia and were discharged the next day. Among the study population, three patients had superficial wound infections at the puncture site which was managed conservatively. Conclusion: PCCL is a good option for managing vesical calculus in children. It has minimal morbidity and very small scar as compared to open cystolithotomy. Even in recurrent stones, it can be effectively performed, and in fact, it is easy to learn and reproducible
Dietary diversity and anthropometric status of 6–36 months old children of Mumbai city
Get PDFBackground: Dietary diversity (DD) is an indicator of food security, accessibility, availability, and also a significant predictor of growth. Poor feeding practices are responsible for low DD which affects the nutritional status of child. Objective: The objective of the study was to assess the association of DD with nutritional status of urban slum children. Methodology: Data were collected using structured interview schedule on 823 children from 16 slums of western suburbs of Mumbai city. DD score was calculated using food frequency questionnaire as per Food and Agriculture Organization. Weight and height measurements of all children were taken using standard techniques, and nutritional status was assessed using Z scores in terms of wasting, stunting, and underweight as per the World Health Organization norms. Results: About 5.4% children were severely wasted, 10.2% children were severely underweight, and 24.7% children were severely stunted. About 22.1% children had low DD scores, 41.3% had scores indicating medium diversity, and 36.6% children had high scores for DD. Children who were severely undernourished, i.e. those whose Z scores were ≤3 tended to have lower DD scores than their better-nourished counterparts for all three nutritional status indicators - weight for height, weight for age, and height for age. Conclusion: DD plays an important role in improving the nutritional status of child. Therefore, there is need to educate mothers in terms of DD to improve nutritional status of children
Clinical profile of anemia among 6–60-month children living in South Karnataka – A cross sectional study
Get PDFIntroduction: Anemia is a worldwide public health problem and has a variable impact on the physical development of child. This study aims to assess the epidemiological characteristics and clinical profile of anemia among 6–60 month children living in South Karnataka. Methods: This was a cross-sectional, community-based study conducted in Bengaluru, from 2012 to 2014. Participants were weighed and measured, and their blood was taken. Demographic, morbidity, and feeding data were obtained from mothers. All the collected data were tabulated and stastically analyzed. Results: Prevalence of anemia in children is 77.8%. Seventy-five children (90%) with anemia belonged to lower socioeconomic status. The chief presenting symptoms in the present study were easy fatigability (34%), loss of appetite (36%), pallor (26), and irritability (24%). The chief clinical signs in anemic children were pallor of mucosa (76%), pallor of skin, palms, and soles (64%), tachycardia (23%), cheilitis (13%), and hemic murmur (9%). Conclusions: Most of the children suffering from anemia were from lower socioeconomic status. Diarrhea was the chief associated symptom in more than half of the cases studied. Hence, the proper periodic deworming measure is advised. Furthermore, timely giving of weaning food, reducing infection by proper immunization, and good personal hygiene will help to prevent anemia
Effect of valproic acid monotherapy on thyroid function on short-term follow-up in children with newly diagnosed epilepsy
Get PDFBackground: The effect of valproic acid (VPA) monotherapy on thyroid function test is controversial. Objective: The aim of this study is to assess the effect of VPA monotherapy on thyroid function on short-term follow-up in children with newly diagnosed epilepsy. Methods: In this prospective cas
Are we still misdiagnosing clubfoot? A study of non-clubfoot cases labeled or referred as clubfoot from primary care centers in Uttarakhand
Get PDFBackground: Clubfoot is a congenital disorder identifiable with the clinical assessment itself, provided the knowledge of key features is sound. Several disorders affecting the foot and lower limb that present with crooked or bent anatomy may be confused with it. Knowledge of common disorders that mimic clubfoot in a particular region is thus important to adequately distinguish, manage or refer the case to specialist opinion. Objectives: The current study attempts to provide an overview and documentation of the conditions referred and labeled as clubfoot from primary care facilities, the knowledge of which is important so that appropriate treatment is given to each. The findings will reflect lacunae in the knowledge and perception of primary healthcare workers regarding the deformity. Materials and Methods: A retrospective assessment of all cases referred to our dedicated clubfoot clinic with a diagnosis of clubfoot by peripheral health-care facility was done from September 2016 to October 2017. Relevant demographic details including that of parents, type of deformity, nature, laterality, and treatment received were noted for each case. Conditions requiring non-operative treatment and those requiring further evaluation were noted separately with a detailed description. Results: Out of total 97 cases labeled as clubfoot, 32 (33.68%) cases with 64 feet were part of the study after excluding true clubfoot cases. The common condition noted was calcaneovalgus, postural clubfoot, equinus deformity secondary to cerebral palsy, metatarsus adductus, in-toeing, and posteromedial bowing of tibia. Conclusion: The knowledge of common foot disorders in primary care settings should be strengthened by refresher practical training so that these disorders are diagnosed and managed there an appropriate referral is made thus leading to decrease the burden on higher centers
A study of serum-ionized calcium in neonates with unconjugated hyperbilirubinemia on phototherapy
Get PDFObjectives: The objective is to study the occurrence of phototherapy-induced hypocalcemia in neonates with unconjugated hyperbilirubinemia and to compare the occurrence between pre-term and full-term neonates. Materials and Methods: The study was conducted in the Neonatology Unit of Department of Pediatrics, at a tertiary care teaching hospital for 12 months. A total of 230 full-term and pre-term neonates with jaundice were recruited. Of 230 neonates, 150 were given phototherapy (cases), while 80 did not receive phototherapy and were used as control. Serum-ionized calcium levels were measured at initiation, after 24 h and after 48 h, or at the end of phototherapy in the case duration of phototherapy was <48 h. Serum-ionized calcium was repeated at 24 h after the completion of phototherapy. In the control group, ionized calcium levels were measured at the time of development of jaundice and 24 h after the initial measurement. Results: Of 150 cases who received phototherapy, 105 were term and 45 were preterm. 69 babies (46%) developed hypocalcemia after 24 h of phototherapy. Of these, 28 (40.5%) were preterm and 41 were term (59.5%). 4 patients developed symptoms, which included jitteriness and seizures. 62.2% of the total pre-term and 39% of term neonates developed hypocalcemia after phototherapy. Conclusion: This study suggests that neonates exposed to phototherapy are at the risk of developing hypocalcemia. There is a significant decline in the ionized calcium levels after exposure to phototherapy, and this level can even fall to hypocalcemic levels. As the duration of phototherapy increases, the serum levels of calcium may decline further. The risk of developing hypocalcemia is higher in pre-term neonates
Breastfeeding promotion network of India and beyond: A commentary on the breastfeeding
Get PDFBreast milk promotion network of India and the infant milk substitute Act (IMS Act) 1992 have prevented the slide down in the rates that existed at the time of their inception but there has only been a modest 5.8% increase in the exclusive breastfeeding rate at 6 months from 199
Study of azithromycin sensitivity in enteric fever in pediatric population
Get PDFBackground: Enteric fever is a major human infectious disease in Southeast Asia. It is exacerbated by a high level of resistance some isolates display to the drugs routinely used in treatment. Azithromycin may be a treatment option for such isolates. Objective: The objective of this study was to analyze the azithromycin susceptibility in culture positive enteric fever and to evaluate the relationship between ciprofloxacin and azithromycin sensitivity and resistance patterns. Methods: This retrospective study was conducted at a tertiary care hospital, Bengaluru, India, between June 2012 and June 2016. Case records of 363 children in the age group of 0–18 years diagnosed with proven enteric fever were reviewed. Susceptibility to antimicrobial drugs was tested by the disc diffusion according to Kirby-Bauer method. They were interpreted based on Clinical and Laboratory Standards Institute guidelines 2016. Results: There were 280 Salmonella enterica serovar typhi (77.13%) and 83 serovar paratyphi A strains (22.86%) among the 363 enteric fever children. The susceptibility to azithromycin and third-generation cephalosporins has been 100% among these isolates. Azithromycin minimum inhibitory concentrations (MICs) were 0.064–12 μg/ml among the 363 isolates, and there is no increase in resistance in the past 4 years. Only 5 (18.5%) of the isolates which were resistant to ciprofloxacin had MIC >4 to azithromycin, but none were resistant to azithromycin. Conclusion: Salmonella typhi continues to remain susceptible to azithromycin and third-generation cephalosporins. There is no increasing trend in resistance to azithromycin over the years in the area of study. Azithromycin can be used in the isolates resistant to ciprofloxacin as there is no correlation between their resistances, thus making it a safe alternative for oral therapy of enteric fever in children
Breastfeeding-related problems in primigravida mothers at the time of hospital discharge from a tertiary care hospital
Get PDFBackground: Breastfeeding-related problems are common in primigravida mothers. There is a lacuna in the knowledge about these problems in Indian population. Objective: The present study is undertaken to study the prevalence of breastfeeding-related problems in the first-time mothers in a tertiary care hospital at the time of discharge. Methods: Consecutive primigravida mothers, who delivered term babies, were interviewed at the time of hospital discharge about breastfeeding-related problems based on a validated questionnaire. The pre-determined predictors were educational status of mother, mode of delivery, and prior knowledge about breastfeeding. Results: Between March 2015 and June 2015, 171 mothers were interviewed. The following were demographic profile of mothers: Average age: 24 years, education above matriculation: 55%, and vaginal delivery: 70%. The common problems were pain while feeding (n=50, 29%), improper latching (n=20, 12%), and feeling of inadequate milk (n=29, 17%). Cesarean section was associated with lower confidence levels for breastfeeding (odds ratio [OR] 2.68 [1.04-6.91], p=0.041), delayed onset of first breastfeed (OR 33.4 [12.67-88], p=0.0001), and feeling of inadequacy of breast milk quantity (OR 3.76 [1.64-8.58], p=0.001). Illiterate mothers were at higher risk of having these problems. Prior knowledge about breastfeeding was associated with fewerproblems. Conclusion: The study presents the existing problems related to breastfeeding at the time of discharge from a tertiary care hospital