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A retrospective study of morphological and physiological pattern of severe anaemia in children of age group 6 months to 12 years in Tertiary Care Rural Hospital of Maharashtra.
Get PDFBackground: Anemia is a very common hematological disorder in pediatric age group. In India and other developing countries, incidence of nutritional anemia is as high as 60- 80% of the childhood population.
Anemia occurring during infancy affects the physical and neurological development of the child. It exposes the infant to the risk of infection which aggravates anemia so that there is a vicious cycle of anemia, infection, anemia. This can be prevented if anemia is detected early and treated properly. This study, was conducted to evaluate the factors causing anemia in children aged between 6 months to 12 years of age.
Material and methods: The retrospective study was conducted in Dr. Vitthalrao Vikhe Patil Pravara Rural Hospital, Loni over period of two years from September 2015 to September 2017. Patients between the age group of 6 months to 12 year admitted with anemia and hemoglobin <7g/dl were included in the study. Previously diagnosed hemolytic anemia was excluded from the study. The hemogram, PBS and Retic counts were compared and studied.
Results: Out of the 300 children enrolled in the study, 238 had Nutritional Anemia, and remaining had Hemolytic and anemia due to other causes. Both, the cases with Nutritional Anemia and Hemolytic Anemia have Microcytic Hypochromic picture, but are differentiated on the basis of Reticulocyte counts, as high retic counts are characteristic of Hemolytic Anemia.
Conclusion: Nutritional Anemia are more common and aggressive action at Anganwadi and schools for supplementation of Iron and Folic Acid along with Vitamin B12 can prevent it. Also severe complications, and hospital admissions can be reduced if proper Nutritional advise is given
A case study of neurological involvement in Wilson’s disease
Get PDFBackground: Wilson’s disease is a rare autosomal recessive disorder characterized by the accumulation of copper in the liver, brain, cornea and kidneys. This is a hospital-based study; there are no community- based prevalence and incidence studies of Wilson’s disease in India. Case Summary: A33 yr. male patient presented to medicine department with complaints of slurring of speech, difficulty in walking since 15 days and abdominal distension. Using the elevated levels of ceruloplasmin, urine copper and the presence of KF rings on both eyes Wilson’s disease with decompensated cirrhosis was confirmed. The patient started on zinc and antioxidants. Gradually he showed improvement in clinical signs. The patient was follow up regularly.
Conclusion: Wilson’s disease is an inherited metabolic disorder. Early diagnosis and appropriate management help to prevent the systemic complications. Siblings needed to be screened to prevent manifestations. It also points out the need to suspect Wilson’s disease in any young patient presented with the unexplained liver disease
Effect of misoprostol versus oxytocin in reducing postpartum hemorrhage after labor induction
Get PDFIntroduction: Postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that occurs after caesarean section (CS) or normal vaginal delivery (NVD). It may be defined as ≥500 mL hemorrhage after vaginal or ≥1000 mL hemorrhage after CS delivery. PPH is one of the most common obstetric maternal complications and is among the three most common etiologies of maternal death worldwide. Objective: To compare low dose sublingual misoprostol with the standard 10 IU of intramuscular oxytocin in active management of third stage of labor. Materials and Methods: The study was a randomized clinical trial carried out at the Department of Gynaecology & Obstetrics, 250 Bedded General Hospital, Noakhali, Bangladesh from July to December 2021. One hundred (100) patients were included. Women with term pregnancy were randomized to receive either 200 µg misoprostol sublingually or 10 IU oxytocin intramuscularly after vaginal delivery. Primary outcome measured was mean blood loss and incidence of primary postpartum hemorrhage (PPH). Secondary outcome measured included duration of third stage of labor, side effects of drugs and need for additional oxytocics to treat life‑threatening hemorrhage. Results: Total 100 women with term pregnancy in two groups of 50 each were studied. The mean blood loss with sublingual misoprostol and oxytocin groups was 320.58 ± 244.12 vs. 253.27 ± 171.74 ml; (P = 0.11). The mean duration of third stage of labor was similar and the difference was not statistically significant (6.65 ± 3.47 vs. 6.08 ± 3.07 minutes) (P = 0.38), as well as need for additional oxytocics (14.0% vs. 6.0% P = 0.18) misoprostol and oxytocin, respectively. There were no differences at the 5% level of significance between groups with regard to the incidence of PPH (20.0% vs. 14.0% respectively; P=0.43). Among the women who were recruited (safety population), the frequencies of the expected side effects did not differ significantly between the two groups. In misoprostol group, side effects were shivering, fever, nausea and abdominal pains, while the oxytocin group abdominal pains, headaches and shivering. Conclusion: Misoprostol administered in the third stage of labor after labor induction by Oxytocin showed a trend towards significantly reducing postpartum blood loss and incidence of postpartum hemorrhage. Sublingual misoprostol has similar efficacy to standard intramuscular oxytocin in preventing PPH following vaginal birth. Misoprostol at 200 µg with its thermostability may be an effective alternative to intramuscular oxytocin in active management of third stage of labor
The clinicpathological and radiological features of unilateral nasal mass in adults: A tertiary hospital experience
Get PDFIntroduction: Unilateral persistent nasal obstruction may indicate the presence of a sinonasal lesion, which could be inflammatory or neoplastic. It is a common practice to assume that unilateral nasal mass in adults is either inverted papilloma or a malignant lesion.
Aim of the study: Aim and objectives of the study were to analyze and study the diverse presentations of unilateral nasal mass and to identify the suggestive features of neoplastic pathology in adult population.
Methods: A retrospective analysis of 90 patients presented with unilateral sinonasal mass, reported to the Rhinology and Skull Base Clinic at the department of ENT in Shaheed Monsur Ali Medical College and Hospital, Uttara, Dhaka, Bangladesh. The cases reported from January 2019 till December 2019 were analyzed.
Result: A total of 34 patients reported to the rhinology clinic with unilateral sinonasal polyps consist of 21 (61.76%) males and 13 (38.24%) females with mean±SD age of 45.1±16.9, ranging from 19 to 78 years, of the 12 (35.29%) were smokers. The disease conditions were classified into different types (Figure 2) followed by benign tumors 18 (52.94%), 9 (26.47%) malignant cases, non-inflammatory 6 (17.65%), and mixed type 1 (2.94%). It is observed that there is a statistically significant relationship between gender (p=0.023) and the different types of diseases diagnosed.
Conclusion: Carcinoma, inflammatory polyposis, inverted papilloma, and allergic fungal sinusitis were the highest histological diagnosis. The clinical diagnosis and the suggestive features of radiological findings mostly resembled the histological findings. In contrary to the resemblance, the histological finding reveals the general diagnosis of nasal mass to the precise diagnosis, especially the fatal conditions like carcinoma. The high rate of malignancy and its suggestive radiological findings indicates that the specialists should consider the cases with caution to carry out histological analysis to rule out the probability of neoplasm
Lumbosacral transitional vertebra: Prevalence and association with low backache
Get PDFStudy Design-Retrospective observational analysis of radiological images.
Purpose- To determine the prevalence of lumbosacral transitional vertebra (LSTV) in patients symptomatic with low backache and study the association of type of LSTV with low backache.
Materials & Methods: Standard standing lumbosacral spine AP radiographs were obtained for 6000 patients aged between 18-60 years of age. The lumbosacral spine was assessed for the presence of lumbosacral transitional vertebra which was further classified into type I, II, III, IV based on Castellvi’s method. The association of low backache (LBA) with the subtypes of LSTV was also studied.
Results: The prevalence of lumbosacral transitional vertebra was found in 6.45 % (387 out of 6000), of which type II (pseudo articulation, unilateral or bilateral) was the commonest type found in 62.7 %, followed by type I (dysplastic transverse process) in 23.2 %, type III (true fusion) in 10.1 % and type IV (mixed, unilateral pseudo articulation and contralateral true fusion) in 3.8 %. The subtype IIA was found strongly associated with low backache.
Conclusions: In this cohort-based study, the prevalence of LSTV was studied and a positive association of LSTV was established to be considered as one of the differentials of low backache
Efficacy of Ibuprofen and Paracetamol in the management of hemodynamically significant patent ductus arteriosus in preterm babies.
Get PDFBackground: Preterm babies are at high risk for many complications and multiple morbidities. A patent ductus arteriosus (PDA) is one of the major problem which causes significant alteration in hemodynamics. There are various modalities of closing hemodynamically significant PDA such as surgical ligation and closure by various pharmacological agents like Indomethacin, Ibuprofen and Paracetamol. The present study was performed to explore the use of oral Indomethacin, Ibuprofen and Paracetamol in preterm babies in a rural based tertiary care center which has its own limitations.
Aims & Objectives: To compare the efficacy, side-effects and outcome of Ibuprofen and Paracetamol in the management of hemodynamically significant Patent Ductus Arteriosus in preterm babies.
Material and Methods: All neonates admitted at Pravara Rural Hospital during December 2020 to April 2022 with birth weight < 1800 grams were included in our study. All babies fulfilling the inclusion criteria were given either oral ibuprofen or paracetamol and result to each of these along with side effects was monitored for.
Results: PDA closure rate was maximal with oral paracetamol though the difference in closure rate of these drugs was statistically not significant. Preterm with gestational age lesser than 32 weeks showed better results with oral ibuprofen. Preterm with gestational age more than 32 weeks showed better closure rates with oral paracetamol.
Conclusion: This study demonstrates that Patent Ductus Arteriosus closure in preterm babies can be attempted with oral use of any of these drugs i.e Ibuprofen and Paracetamol. In our study, maximal success was obtained with use of oral paracetamol though the difference in closure rate of both drugs was statistically not significant
Clinico-investigative profile of hypernatremia in neonates of rural western Maharashtra.
Get PDFObjectives: To study the Clinico-investigative profile and outcome of hypernatremia in neonates.
Methodology: Observational descriptive, longitudinal study conducted at the tertiary rural hospital from August 2021 to August 2022. All the babies with hypernatremia admitted to NICU during the above period were included in the study excluding the preterm babies presenting to our hospital for NICU care.
Results: The sex ratio of 1.3:1 was seen in our study with the majority (69%) of babies born to primigravida mothers and 58.7% of the mothers subjected to LSCS. The majority of cases were admitted on the 3rd to 5th day (mean age being 4.2 days). Feeding frequency was less than seven times a day in 91.3% of babies, which could be due to inexperience and inadequacy. 88% of the neonates with hypernatremia had more than 10% weight loss due to dehydration. Fever, lethargy, and irritability were present in the majority of the patients. CNS signs and symptoms at the time of presentation included seizures, decerebrate posturing, and retrocollis.
Conclusion: The higher occurrence, as compared to other studies was due to a combination of factors such as summer months, inadequate feeding, early presentation or detection on 3rd or 4th day of birth
A Case series of Neonatal Inflammatory Syndrome (MIS-N) with rare clinical manifestations
Get PDFMultisystem inflammatory syndrome in neonates (MIS-N) is hypothesized to be caused either following transplacental transfer of SARS-CoV2 antibodies. MIS-N presents with a variety of clinical presentations and requires a high index of suspicion
Effect of glycaemic status in neonatal sepsis-A prospective observational study
Get PDFIntroduction: Neonatal hypoglycemia is a common and readily treatable risk factor for neurologic impairment in children. Although associations between prolonged symptomatic neonatal hypoglycemia and brain injury are well established, the effect of milder hypoglycemia on neurologic development is uncertain. Objective: To determine the glycemic status among patients with neonatal sepsis and to evaluate their association with the mortality. Methods: It was a prospective observational study conducted at Department of Pediatrics, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from July 2021 to June 2022. Total 52 patients clinically diagnosed as neonatal sepsis were studied, a detailed history and thorough physical examination was done in each patient on admission. History included age of newborn, sex, gestational age, h/o prolonged rupture of membrane (PROM), intrapartum fever or fever 3 days before delivery, per vaginal foul smelling discharge, prolonged labor and features of sepsis. Physical examination included respiratory rate, heart rate, temperature, chest indrawing, grunting, cyanosis, convulsion, breath sound, added sound, weight, jaundice, bleeding manifestation, status of fontanelles, umbilicus and capillary refill time. Blood glucose level and mortality of neonates having hypoglycemia and hyperglycemia were analyzed. Results: Out of 52 patients clinically diagnosed as neonatal sepsis were studied. The mean age was found 10.2±8.4 days with range from 1 to 28 days and more than half (51.6%) patients belonged to age ≤7 days. More than two third (68.7%) patients were male and 31.3% were female. 42(80.77%) patients were found CRP positive and 10(19.23%) were negative CRP. 34.62% patients were blood culture positive and 65.38% patients were culture negative. Majority (71.43%) of CRP positive patients were found normoglycemic, 11.90% were found hypoglycemic and only 16.67% were found hyperglycemic. Among 18 culture positive patients 11(61.11%) were normoglycaemic, 3(16.67%) were hypoglycemic and 4(22.22%) were hyperglycemic. 57.1% of hyperglycemic and 40% of hypoglycemic patients were died whereas only 13.3% of normoglycemic patients were died. Out of 10 expired patients, 2 patients Hypoglycemia, 4 patients Normoglycemia and 4 patients Hyperglycemia. Mortality was high in Hypoglycemia patient (40.0%) in comparison with normoglycaemic patient (13.33%) and the difference was not statistically significant (p>0.05) between two groups. Mortality was also high in hyperglycaemic patient (57.14%) in comparison with normoglycaemic patient (13.33%) and the difference was statistically significant (p<0.05) between two groups. Conclusion: Alteration of glycemic status occurred in septic newborn. Our study showed mortality is higher among the septic newborn with hyperglycemia. The incidence of hypoglycemia was high as compared to hyperglycemia. Neonatal hypoglycemia and hyperglycemia was a significant factor in the overall mortality in neonatal sepsis
Role of multi-detector computed tomography in characterization of ovarian masses with cyto-histopathological correlation
Get PDFBackground: Ovarian cancer continues to pose a major challenge to physicians and radiologists. Besides clinical examination, CA 125 levels, and ultrasonography, CT scan is also used as a diagnostic technique for ovarian carcinoma and is superior to US in assessment of the nature of ovarian masses. With the advent of MDCT, it has become possible to acquire several thin slices and image reconstruction in axial, coronal and sagittal planes contributing valuable information towards preoperative surgical and management planning. Objectives: To evaluate the diagnostic accuracy of MDCT to differentiate between benign and malignant ovarian masses and to compare the findings with cyto- histopathological results. Materials and methods: This study was conducted in the department of Radio diagnosis, Dr. Balasaheb Vikhe Patil rural medical college and Dr. Vitthalrao Vikhe Patil Pravara Rural hospital, Loni BK, 413736 during the period of April 2021 to June 2022.CT imaging findings of 50 patients with ovarian masses were compared with cyto-histopathological results. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of MDCT were calculated. Results: 50 cases were evaluated by Computed Tomography; total 60 lesions were found (10 bilateral / 50 unilateral). Benign ovarian lesions were present in 28 patients whereas malignant ovarian lesions were present in 22 patients based on Computed Tomography. Cyto/histopathological correlation revealed benign lesions in 30 patients and malignant lesions in 20 patients. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of Computed Tomography was found to be 90.0%, 86.6%, 89%, 85% and 90.0%. Conclusion: MDCT imaging offers a safe, accurate and noninvasive modality to differentiate between benign and malignant ovarian masses