Atharva Scientific Publications (E-Jounals)
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Avascular necrosis of the hip: A unique presentation of pseudohypoparathyroidism
Full text linkPseudohypoparathyroidism is a rare, heterogeneous disorder characterized by parathyroid hormone resistance. Its association with avascular necrosis of the hip has been reported infrequently in the past. We report the case of a 27-year-old lady with pseudohypoparathyroidism Type 1 whose initial presentation was with avascular necrosis of bilateral hip. Apart from the common clinical features of pseudohypoparathyroidism, clinicians should also be aware of the rarer resentations such as avascular necrosis. A good clinical history and physical examination are warranted for early diagnosis in order to prevent serious morbidity in thesepatients
Pierre Robin sequence in association with tracheoesophageal fistula and esophageal atresia
Full text linkThe first symptom of esophageal atresia and tracheoesophageal fistula is the inability to eat and respiratory distress after feeding. The coexistence of Pierre Robin Sequence (PRS) with esophageal atresia and tracheoesophageal fistula is a rare clinical condition. In infants with PRS, evaluation of respiratory and nutritional problems is important. The coexistence of esophageal atresia and tracheoesophageal fistula leads to increased nutritional and respiratory problems. Problems that may occur in the airways may occur late. In this case report, we aimed to present a case of neonatal infant with rare esophageal atresia, tracheoesophageal fistula, and PRS
Optimizing use of empirical antibiotics in late preterm neonates at risk of early-onset sepsis
Full text linkBackground: In sick neonates, we are posed to treat suspected or proven infection. However, the vast majority of newborn babies who are given antibiotics do not have any infection. Objective: The objective of this study was to optimize the use of empirical antibiotic therapy in late preterms who are asymptomatic with maternal risk and symptomatic neonates without maternal risk for early-onset sepsis (EOS) and to estimate the rate of risk increase in onset of symptoms in neonates exposed to maternal risk factor for EOS. Methods: In this descriptive study, late preterm neonates (34+0–36+6 weeks) who are asymptomatic at birth with and without maternal risk factor for EOS at birth were subjected to clinical assessment of sensorium, temperature, oxygenation status, perfusion, and skin color, starting after 1 h of initial stabilization till discharge from hospital. Sepsis screen (C-reactive protein and absolute neutrophil count) was obtained at 24 h and 48 h of age from these asymptomatic late preterms. Results: A total of 135 late preterm neonates (34+0–36+6 weeks) recruited during the study period were included for analysis. The presence of maternal risk factor for EOS has shown no statistical significance in relation to the presence of symptoms at birth odds ratio 0.66, 95% confident interval (0.24–1.8) p=0.42. Conclusion: In our study, as maternal risk factor for sepsis has shown no statistical significance in relation to the presence of symptoms at birth, antibiotic use can be restricted to only those babies who have clinical worsening over 24–48 h of observation and/or along with supportive evidence of positive sepsis screen and/or blood culture, irrespective of the presence or absence of maternal risk for EOS
Death clustering in India: Levels, trends, and differentials, 1992–2016
Full text linkBackground: India and many of its bigger states could not achieve the national goal related with child health based on 4th UN Millennium Development Goal. There is a need to look for different approaches which deal with infant mortality. Literature emphasizes clustering of infant deaths in families has implications on infant mortality. Objective: The present study attempts to examine the levels, trends, and differentials of clustering of infant deaths in families in India using National Family Health Survey (NFHS) dataset and how they changed over the years. Materials and Methods: Study used bivariate analysis and multilevel random effects logit model based intraclass correlation coefficient and median odds ratio to examine the clustering of deaths in families, in India. Results: There has been a consistent decline in both infant mortality rate (IMR) and clustering of infant deaths in families in India between 1992 and 2016. However, the pace of decline was faster after 2005. States such as Uttar Pradesh, Madhya Pradesh, and Bihar are the major contributors in clustering of infant deaths in families. In Kerala, clustering of infant deaths has been disappeared in families while among relatively more developed states such as Maharashtra and Tamil Nadu have experienced a reduction in clustering of infant deaths in families by an amount of <1%. Conclusion: Between NFHS-3 and NFHS-4 there has been an increase in clustering of infant deaths among mothers with age at first birth >30 years and for mothers who have received higher education. IMR can be reduced to a greater extent if government policies and health resources are directed toward the families experiencing the clustering of infant deaths
Clinical profile of acute kidney injury in neonatal sepsis and perinatal asphyxia using nRIFLE and modified KDIGO criteria
Full text linkBackground: Newborn babies with sepsis and perinatal asphyxia form a high-risk group for developing neonatal acute kidney injury (nAKI). The diagnosis and staging of nAKI is challenging and has several limitations. Objective: The objectives of this study were to estimate the hospital-based incidence of nAKI in septic and asphyxiated neonates, describe their clinical profile and outcome, and compare the two classifications – neonatal risk, injury, failure, loss, and end-stage renal disease (nRIFLE) and neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria for their agreement. Materials and Methods: Consecutive neonates who fulfilled the diagnosis of sepsis or perinatal asphyxia were included in this prospective cohort study. Urine output was monitored 6 hourly by diaper weight and serum creatinine every 48 h or earlier if required. The clinical profile and outcome of neonates who developed AKI were studied, and AKI was staged using both nRIFLE and KDIGO criteria. Chi-square test was used to test the association of risk factors with AKI, Pearson’s Chi-square and Kappa statistics were used to compare the two staging criteria. Results: Of 90 neonates enrolled, the incidence of AKI in sepsis was 145/1000 neonates and perinatal asphyxia was 464/1000 neonates. AKI was maximally observed in the early preterm neonates (45.4%) and very low birth weight neonates (36.36%). Oliguria was present in a majority of the neonates with nAKI but varied according to the classification system used. nAKI was significantly associated with high mortality (54.2%) (p<0.01) which increased with decreasing gestation and birth weight and increasing severity of nAKI. On comparing KDIGO and nRIFLE criteria, there was a poor agreement between the two. Conclusion: AKI is a common occurrence in septic and asphyxiated neonates and portends poor outcomes. Although studies have evaluated nRIFLE and KDIGO individually, larger studies comparing the two criteria are required to improve early diagnosis and accurate staging of neonatal AKI
Phenotypic detection of Metallo Beta Lactamase Producing Pseudomonas aeruginosa among Clinical Isolates from the intensive care unit of a tertiary care centre
Full text linkBackground: Pseudomonas aeruginosa is an opportunistic pathogenic bacterium responsible for both, acute and chronic infection, causing serious infections in patients who are mechanically ventilated individuals, who are immunocompromised, and patients with malignancies or HIV infection. Objectives: The phenotypic screening of metallo beta-lactamases (MBL) in strains of Pseudomonas aeruginosa resistant to imipenem. Material and Methods: The study was carried out in the department of Microbiology, in a medical hospital, Bareilly, over a period 18 months from January 2013 to June 2014. A total of 103 Pseudomonas aeruginosa isolated from sputum, broncho alveolar lavage (BAL), urine, pus and blood from critically ill patients admitted in the intensive care unit of a tertiary care centre. Strain of P. aeruginosa resistant to imipenem, were tested for metallo beta-lactamase production by phenotypic methods. Result: Out of 103 Pseudomonas aeruginosa, 48 strains were found imipenem resistant, of which 43(89.6%) were MBL positive by imipenem -EDTA combined disc test and the rest 35(72.9%) were by modified Hodge test. Conclusion: Imipenem – EDTA combined disc test found to be the best phenotypic method for detection of MBL. The appearance of the MBL and their spread among bacterial pathogens is a matter of concern with regard to the future of antimicrobial therapy. Both the methods are simple and one of these phenotypic methods can be easily incorporated in routine lab procedures to detect MBL
The Neutral Zone: Concept and Technique
Full text linkWhen all of the remaining natural teeth are removed; there exists within the oral cavity a void that may be called the potential denture space. The denture space is bounded by the tongue, medially or internally, and by the muscles and tissues of the lips and cheeks laterally or externally. Within the denture space, there is an area that has been termed the neutral zone. The neutral zone is that area in the mouth where during function, the forces of the tongue pressing outward are neutralized by the forces of the cheeks and lips pressing inward.Since these forces are developed through muscles contraction during the various functions of chewing, swallowing and speaking, they vary in magnitude and direction in differentindividuals and in different periods of life. The way these forces are directed against the dentures will either help to stabilize them or will tend to dislodge them. In summary, the neutral zone philosophy is based on the concept that for each individual patient, there exists within the denture space a specific area where the function of the musculature will not unseat the denture and at the same time, where the forces generated by the tongue are neutralized by the forces generated by the lips and cheeks. Furthermore, denture stability is as much or more influenced by tooth position and flange contour as by any other factors. 
Prevalence of children at risk of behavioral problems among preschoolchildren between the ages of 3 and 6 years
Full text linkBackground: Behavioral problems often go unnoticed in children; however, it is important to identify and treat the problem in childhood to prevent the long-term disability. Objective: The objective of the study was to find the prevalence of children “at risk” of behavioral problems in preschoolchildren and to identify the social, environmental, and family factors associated with the risk of behavioral problems in preschoolchildren. Materials and Methods: A cross-sectional observational study was conducted in 370 children from 3 to 6 years of age studying in preschools of Bhopal, using Preschool Pediatric Symptom Checklist. Bivariant analysis was performed using Chi-square test on STATA 11.2. Results: Overall prevalence of children at risk of behavioral problems was found to be 46.7% in the studied population. Children belonging to low-income families were at a higher risk of developing behavioral problems (p<0.001). Working mothers and time spent by fathers had a positive impact on a child’s behavior (p=0.008). Other factors that were studied but did not have significant association were gender, age, time spent by mother with child, presence of a sibling, and family size. Conclusion: The main factors contributing to increase in risk in children for developing behavioral problems were found to be less time spent by father with child and lower family income. However, working status of mothers did not increase the risk of developing behavioral problems
Pediatric injuries: The etiology and associated factors as seen at a Mission Hospital in Aba, Southeast Nigeria
Full text linkBackground: Pediatric injuries constitute a significant health burden, particularly in developing countries, including Nigeria. Comprehensive and case-specific management including a good database is largely unavailable in these countries. Aim: This study aims to determine the causes and associated factors of pediatric injury (PI) in Aba, Southeast Nigeria. Materials and Methods: This was a retrospective study conducted for a period of 3 years (January 1, 2015–December 31, 2017) in a Mission Hospital in Aba. Data were obtained from the case notes of children aged 16 years and below, who were seen for injuries at the accident and emergency department (AED). Information extracted from the case files included the sex, age, nature of injury, venue of injury, body areas involved, and outcome of treatment. Results: PI constituted 13% of all trauma cases seen in the AED during the study period. There were 54 males and 39 females, giving a male:female ratio of 1.4:1. The leading mechanisms of injury were road traffic accident (RTA), 36 (38.7%) and domestic accidents, 27 (29%), while gunshot wounds 3 (3.3%) constitute the least. RTA occurred most frequently in the age groups of 6–15 years, 24 (25.8%). Again, 91.7% of RTA occurred in the urban area and involved mostly pedestrians crossing the road (55.6%). Children aged 0–5 years, 34 (36.6%) were the most frequently involved in PI. Leading mechanisms of injury in this age group were domestic accidents, falls, and burns. There was a statistically significant association between age and mechanism of injury (p=0.000). Mortality rate was 2%. Conclusion: Pediatric injuries constituted 13% of all trauma cases in this study. Children aged 0–5 years were the most frequently involved in PI. RTA and domestic accidents were the leading causes of PI. Very young children at home and older children crossing the road were vulnerable to pediatric injuries
Rare isolation of Leclercia adecarboxylata in a child with pneumonia: Case report and review of literature
Full text linkLeclercia adecarboxylata is a Gram-negative flagellated bacilli named after Leclerc, who first described it in 1962. Isolation of thisorganism from body fluids is rare. Although it has been reported in immunocompromised individuals and nosocomial infections,pneumonia due to this organism is still rare. We report a case of 13 months old, previously healthy immunocompetent child, withcommunity-acquired pneumonia due to L. adecarboxylata