International Journal of Medical Research & Review (IJMRR)
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Correlation between maternal mid upper arm circumference and neonatal anthropometry
Get PDFIntroduction: An infant’s birth weight has been identified as the best marker of optimal fetal growth and development. Maternal anthropometry (weight, height and Mid-Upper Arm Circumference) have been identified to influence an infant’s birth weight and length. If MUAC can be established as a surrogate marker for neonatal anthropometric parameters it will help to plan the timely intervention for improvement of health of pregnant female.
Aim: To study the correlation between maternal mid upper arm circumference and neonatal anthropometry.
Material and Methods: A cross sectional study conducted in Dr. B R Ambedkar Memorial Hospital & Pt. JNM Medical college Raipur, Chhattisgarh since January 2015 to September 2016. Sample size was 232. Materials like weighing machine, measuring tape, Infantometer, were used. Data was expressed as percentage and correlation was established using Spearman\u27s chi square test (p<0.05). Data was analyzed using SSPS (version 16.0).
Result: Significant correlation exists between maternal MUAC and birth Weight and length of neonates. Low birth weight is higher in female neonates. Birth length is higher in male neonates. MUAC of mother is a good predictor of risk of low birth weight as compared with other classic anthropometric measurements.
Conclusion: Maternal MUAC is a significant predictor of neonatal anthropometry and can be used instead of pre- pregnancy weight to assess maternal nutritional status especially in resource poor setting
Study of efficacy and safety of bipolar coagulation in total laparoscopic hysterectomy
Get PDFAim: To study the efficacy and safety of bipolar coagulation in total laparoscopic hysterectomy.
Methods: A single surgeon, single center, retrospective study of one year was conducted in Akola Endoscopy center from 1 May 2010 to 30th April,2011. 200 patients who underwent total laparoscopic hysterectomy for benign conditions were enrolled. Data about the surgical time, estimated blood loss, related complications and length of hospital stay were evaluated.
Results: The patients who underwent TLH with bipolar coagulation in the present study, it was found that the mean operating time was 52.83+-12.28 min, mean blood loss was 40.50+-28.02 ml, post-operatively febrile morbidity was found to be in 1.5% of patients and secondary hemorrhage in 2.5% with average hospital stay around 9-10 hours. No patient required blood transfusion or re-laparotomy. There were no intra-operative or anesthetic complications and no case of hernia or mortality.
Conclusion: bipolar coagulation for hemostasis used in laparoscopic hysterectomy is safe and effective
Comparison of survival outcome in early versus late surfactant therapy in preterm neonates with respiratory distress syndrome at a tertiary care centre: A randomized control trial (Open)
Get PDFIntroduction: Prematurity and RDS largely contribute to early neonatal morbidity and mortality. With adequate antenatal steroid and early CPAP, early surfactant therapy improve survival outcome.
Material and Methods: Prospective interventional study included newborns with 24-28 weeks prematurity or 28-34 weeks(GA) with clinical RDS and birth weight(BW)>650gms. All subjects were preferably provided early surfactant therapy (within 2hours after birth). Surfactant (Curosurf) was delivered by INSURE technique (Intubate- Surfactant administration- Extubate) and only those who required further respiratory support were ventilated. Records on birth weight, gestational age, timing of therapy (early/late), duration of ventilation, sepsis, complications, and survival/death outcome were collected and data was analysed using SSPS version 17.
Results: Out of 100 neonates (49 male, 51 female), 46 received early surfactant therapy and 54 obtained it late; significantly more indoor patients could be treated early (p<0.0001). Although high mortality was observed with both early (65.2%) and late therapy (85.2%), there was significantly higher survival with early therapy (p=0.018). Though no statistical differences of outcome were observed with different GA and BW in study groups; irrespective of timing of therapy, higher mortality occurred in lower BW/GA subgroups with least survival among extremely preterms<27wks(p=0.000057) and ELBW<1000gm(p=0.013). No difference was seen for need of re-intubation/ventilation, but duration of ventilation was more on late group (p=0.043). Culture positive sepsis was found in 68% with higher association with late therapy (p=0.033). Hypotension was frequent complication with late intervention (p=0.029), whereas there was no difference for pulmonary hemorrhage or apnea.
Conclusion: Early surfactant administration improved survival with minimal complications in RDS except for extremely premature/LBW babies
A comparative study of Olopatadine and Ketorolac eye drop with Ketorolac eye drop alone in seasonal allergic conjunctivitis
Get PDFBackground: Seasonal allergic conjunctivitis is the most common allergic disorder seen in eyes. The aim of study was to compare the clinical efficacy of combination of 0.4% ketorolac and 0.1% olopatadine with 0.4% ketorolac alone in seasonal allergic conjunctivitis.
Material and Method: The study was prospective, double blind parallel group comparative. Two hundred cases enrolled in the study. All the subjects were randomly divided in two groups, 100 in each. Group 1 patients received 0.4% ketorolac eye drop in both eyes 2 times a day and group 2 patients received combination of 0.1% olopatadine and 0.4% ketorolac in both eyes 2 times a day. Observations were collected at baseline and on day 3,7,15 and analyzed statistically regarding improvement in sign and symptoms.
Result: In group 1, 50- 60% patients had no sign and symptoms on day 15 whereas in group 2 more than 95% patients showed improvement in clinical picture. p value was significant (p<0.0001) at day 15 in all sign and symptoms and on day 3 in itching and on day 7 in watering. Overall group 2 patients had better and earlier response regarding symptoms of itching at day 3.
Conclusion: The combination of 0.1% olopatadine and 0.4% ketorolac was more effective than 0.4% ketorolac alone in seasonal allergic conjunctivitis patients
Clinical profile of mortality predictors in Leptospirosis:a prospective study in a tertiary care center
Get PDFAims and Objectives: To look for mortality predictors of Leptospirosis, with specific importance given to oli-guric renal failure and hypotension as possible predictors.
Materials and Methods: A Prospective Cohort study conducted over two years which enrolled patients with clinically and serologically confirmed Leptospirosis. Of these, 30 patients were included who had hypotension and 30 patients who had oliguric renal failure, as per statistical requirements. Epidemiological, clinical, and laboratory data was collected at admission and the patients were followed up to look for outcome (discharge/death).
Results: A total of 83 patients were included in this study. Of these 8 patients died (Mortality of 9.6%). Data analysis with Chi Square Test showed that oliguric renal failure was significantly associated with mortality in Leptospirosis (p<0.05). Other factors were also found which were associated with mortality including elevated bilirubin and AST levels, anemia, Type 2 Diabetes Mellitus, Alcohol Dependence Syndrome, and Chronic Liver Disease. However, hypotension was found to not be significantly associated with mortality.
Conclusion: In patients with Leptospirosis, significant mortality pre-dictors included oliguric renal failure, elevated bilirubin and AST levels, anemia, Type 2 Diabetes Mellitus, Alcohol Dependence Syndrome, and Chronic Liver Disease
Digoxin Toxicity presented with Right Bundle Branch Block: A Case report of Drug- Drug Interaction
Get PDFDigoxin, one of the digitalis glycosides has specific effects on the myocardium. The effects of Digoxin in heart failure are mediated by its positive inotropic and neurohormonal deactivating effects, whereas the effects of the drug in atrial arrhythmias are related to its vagomimetic actions. It is the most common drug used in treatment of congestive heart failure and tachy-arrhythmias. It is used in treatment of arrhythmias but when arrhythmias occur in a patient on maintenance dose of Digoxin, its toxicity should be suspected. Here we report a case of Digoxin toxicity with the therapeutic dose confirmed by elevated Serum Digoxin levels. This occurrence could be due to Digoxin itself or this adverse effect could be predisposed by a suspected drug –dug interaction (SDDI) with the concomitant drugs this patient was prescribed
A clinical study of prevalence of ocular manifestations in malnourished children attending Anganwadi centers in urban slum areas
Get PDFAim: A clinical study of prevalence of ocular manifestations in malnourished children attending anganwadi centers in urban slum areas.
Material & Method: A cross sectional study was carried out in Anganwadi centers of urban slum area, with children of age group 0 – 6 years. All children underwent detailed systemic and ocular examination and were graded for malnutrition according to IAP classification. The results were analysed statistically.
Results: In our study the prevalence of ocular manifestations is 9.6% (50). Prevalence of malnutrition is 18.53% (96). Out of 96 malnourished, 56 children (58.33%) belong to grade I malnutrition, out of which 16 children (32%) had ocular manifestation, which is total ocular manifestation in all the grades of malnutrition. So, ocular manifestation in malnourished children is 32%. Overall ocular involvement was seen in 50 children out of 518 children examined, with overall prevalence of 9.65%. Thereis significant difference of ocular involvement between malnourished and wellnourished (p value – 0.017).
Conclusion: Overall prevalence of malnourished children wasfound to be very less at anganwadi centers in our study. This may be probably due to the timely vaccination of children and the nutritional supplements being provided to them at Anganwadi centers through various national programmes
Role of antituberculous therapy in Eales disease
Get PDFAim: To establish the role of Anti Tuberculous therapy (ATT) in Eales disease.
Methods: This is a prospective study in which 15 patients with Eales disease of the age group 18- 40 years were included. This study was conducted from January 2014 to June 2016. In our study, all patients were previously treated with a full course of steroids and four patients were treated with Pan retinal photocoagulation for neovascularisation in addition to the steroid therapy but had recurrences of inflammation. All the above patients were treated with Category 1 Anti Tuberculous therapy and oral prednisolone in tapering doses. The patients were reviewed at 1 and 6 months while on ATT and for every 2 months for one year after completion of ATT. The presence or absence of active inflammation was assessed and the outcome was analyzed.
Results: In our study, 11 patients had complete resolution of inflammation with ATT and showed no recurrence of inflammation during the follow up period of one year. Two patients developed neovascularisation and Pan retinal photocoagulation was given and was considered as non response to treatment. One patient developed vitreous hemorrhage. One patient had persistent inflammation and showed no resolution of inflammation while on ATT.
Conclusion: With the above study we conclude that anti tuberculous therapy should be considered in patients with Eales disease with recurrent inflammation for preventing further recurrences and reducing ocular morbidity due to complications
Comparison and correlation of ophthalmic and systemic manifestations with respect to CD4 counts in HIV infected adults
Get PDFPurpose: To compare and correlate ophthalmic and systemic manifestations with respect to CD4 counts in HIV infected adults.
Materials and Methods: In a prospective clinical study, 182 HIV positive patients were evaluated for their ophthalmic findings. All patients underwent complete ophthalmic examination including detailed history, best corrected visual acuity, slit lamp examination, indirect ophthalmoloscopy and +90D lens biomicroscopy. Fundus photographs were taken in patients with ocular manifestations. Routine blood tests including total and differential count, Hb levels, erythrocyte sedimentation rate, erythrocyte and platelet counts were done. Serologic tests (ELISA for IgM antibody) for toxoplasma, cytomegalovirus was done in clinically suspicious cases. VDRL, and chest x-ray was performed in cases suspected to have syphilis and tuberculosis respectively.
Results: 182 patients were examined, 65.9% male and 34.1% being female patients. Most common systemic manifestation was pulmonary TB (39.1%) (p <0.001), second common being oral candidiasis (16.5%) (p <0.001) followed by abdominal TB (15.5%). Also, 37.9% patients had ocular lesions out of which 15.4% had HIV retinopathy, second common was CMV retinitis(9.3%) followed by HIV optic neuropathy(3.8%). 34.1% had CD4<100, 44% between 01-100 and 22% had CD4 >200. . Twenty five % of patients with pulmonary TB had HIV retinopathy and 12% with pulmonary TB had CMV retinitis. Among the 30 oral candidiasis patients 8(26.6%) developed HIV retinopathy, where as 10% developed CMV retinitis. Fifty seven % of patients with HIV retinopathy had CD4<100, 28.6% with CD4 between 101-200 and 14.3% with CD4 >200. Similarly 47.1% with CMV retinitis had CD4 <100, 52.9% had CD4 101-200. None with CD4 >200 developed CMV retinitis.
Conclusions: Study shows an increased prevalence of systemic diseases along with ocular diseases with decreased CD4 counts, particularly <100. Pulmonary TB is seen more frequently with CD4<200 and is also seen to be associated increasingly with ocular manifestations and more so when CD4 <100
Blood stream infections with Candida species: a prospective study in a tertiary care center
Get PDFAims and Objectives: To study the profile of blood stream infections with Candida species, their current epidemiological trend at our setting, clinical management, resistance trends and outcome in terms of mortality.
Methods: This is a prospective observational study conducted among all adult in-patients, at AIMS, Kochi from August 1st 2014 to February 28th 2016, both in wards and ICUs, who have positive isolates of Candida species in bloodstream infection among the positive blood culture samples. Incidence rate of Candidemia was calculated and distribution of Candidemia with respect to characteristics like age, gender, comorbid illness, mechanical ventilation, prior antibiotic therapy, prolonged ICU stay.
Results: Out of 1600 blood stream infection isolates, Candidemia was fourth most common blood stream isolate infection in our study with an incidence rate of 7.5%. Candida tropicalis was the predominant species in our study (30.8%). Mortality rate due to Candidemia was (61%). Urethral catheterization, Central venous access, neutropenia at presentation, prior antibiotic therapy, renal failure, Dialysis patients, prolonged ICU stay were some of the risk factors found to be statistically significant in assessing the mortality of patients in our study with a p value of <0.001.
Conclusion: All patients with Candidemia should be treated with an antifungal agent at the earliest without any delay, as delay causes increase in mortality. All vascular catheters should be removed to help clear Candida from blood more quickly. Improved survival was found with the use of an Echinocandin and the removal of central venous catheters