Detection of micro-metastasis using cytokeratins (AE1/AE3) in haematoxylin & eosin-stained N0 lymph nodes of oral squamous cell carcinoma

Background & objectives: Oral squamous cell carcinoma (OSCC) is one of the most common malignancies affecting the head-and-neck region, regional lymph nodes being an important prognostication factor dictating the survival rate. Despite an array of modalities used, clinically, radiographically and routine histopathologically, the detection of micro-metastasis (2-3 mm tumour cell deposits) in the lymph nodes often escapes identification. The presence of few of these tumour epithelial cells in the lymph nodes drastically increases mortality and alters treatment plan. Hence, the identification of these cells is of major prognostic significance for a patient. Thus, the present study was aimed to evaluate and detect the efficacy of the immunohistochemical (IHC) marker [cytokeratin (CK) AE1/AE3] over routine Hematoxylin & eosin (H & E) staining in detecting micro-metastasis in the lymph nodes of OSCC cases. Methods: Hundred H & E-stained N0 lymph nodes of OSCC cases treated with radical neck dissection were subjected to IHC with marker AE1/AE3 antibody cocktail for detecting micro-metastasis. Results: The IHC marker CK cocktail (AE1/AE3) did not demonstrate any positive reactivity for the target antigen in all the 100 H & E stained lymph node sections evaluated in the present study. Interpretation & conclusions: This study was undertaken to check the efficacy of IHC (CK cocktail AE1/ AE3) in the detection of micro-metastasis in lymph nodes that are found to be negative in routine H&E stained sections. The findings of this study suggest that the IHC marker AE1/AE3 did not prove to be useful to detect micro-metastasis in this study population

Bilateral radiation retinopathy 17 years following radiotherapy for nasopharyngeal carcinoma: A diagnostic and therapeutic challenge during COVID-19 lockdown

A 40-year-old male presented with reduced vision in the right eye for one week. He had a history of nasopharyngeal carcinoma for which 34-Gy radiation was administered. The best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/20 in the left eye. Anterior segment examination suggested a bilateral early posterior subcapsular cataract. Fundoscopy revealed bilateral localized telangiectasia and macular edema in the right eye. Diagnosis of bilateral extremely delayed onset radiation retinopathy with right eye macular edema was made. Three doses of intravitreal bevacizumab injection were administered in the right eye. The patient was lost to follow-up due to COVID-19 and presented with recurrence.

A study to assess the knowledge on hypoglycemia among the diabetic patient in selected hospital, Siliguri

Background:The prevalence of diabetes mellitus, is a major health concern that affects people around the world, and is increasing yearly. When blood glucose levels go below normal, a condition known as hypoglycemia, an immediate consequence of diabetes mellitus, occurs. The International Diabetes Federation reported thatthere were 451 million diabetics globally in 2017 and by 2045, it is anticipated that there will be 693 million. The objective of this study was to assess the level of knowledge of diabetic patient regarding hypoglycaemia and to find out the association between the levels of knowledge of diabetic patient on hypoglycaemia with their selected demographic variable.Methods:A descriptive cross-sectional study, was carried out in the month of June 2022. A semi-structured questionnaire was used to interview 100 study participants who were diabetes patients who had been admitted to the medical ward and who had visited the endocrinology outpatient department.Results:52% of the samples had fair knowledge on hypoglycemia, while 23% of them had poor knowledge. Demographic variable such as age, income, treatment, frequency of taking medicine, experience of symptoms of hypoglycemia and dietary habit were statistically significant with the level of knowledge, p<0.05.Conclusions:The study's findings highlighted the fact that most diabetes mellitus patients had a fair understanding of hypoglycemia. The health care personnel should also take time and efforts to educate patients about the sign of hypoglycemia. So that hypoglycemic episodes and morbidity could be reduced or prevented at primordial level.

Different Therapeutic Angles of Commonly used Swarna Kalpa

Ayurveda being the science of life, primarily focuses on enhancing health of healthy individuals and removal of disease causing entities in a diseased person. Swarna (gold) has substantial therapeutic value, which has been indicated in different classics of Ayurveda. Swarna (gold) is desired by every human for many centuries. The desire is not only for its ornamental or commercial value but also because of its great medicinal value by which it increases strength and immunity. Swarna is converted into suitable dosage forms like Parpati, Pottali, Vati etc. Swarna kalpas are the unique blend of herbomineral formulations where Gold is used as one of the main ingredient. Swarna kalpas are widely used as therapeutic as well as life saving agents (in some emergencies). These formulations are helpful in treating many chronic disease conditions but it also acts miraculous when used for Rasayana purpose. In this review most commonly used Swarna kalpas such as Yogendra ras, Rasraj Ras, Vasant Kusumakar ras, Swarna malini vasant are discussed on the basis of different therapeutic angles

Mannose Binding Lectin Levels and its Association with Systemic Lupus Erythematosus Disease Severity: An Indian Report

Background: Inflammatory response in COVID-19 responsible for acute respiratory distress syndrome (ARDS) and multiorgan failure and play a major role in morbidity and mortality of patients. The present study was undertaken to assess serum level of cytokines and its association with other inflammatory markers and disease severity in COVID-19 and hence their prognostic significance. Methods: This was a retrospective observational study of 175 admitted COVID-19 patients. The patient’s clinical data, laboratory investigations, inflammatory markers and serum level of cytokines [interleukin-1? (IL-1?), interleukin-6 (IL-6), interleukin-10 (IL-10) and tumour necrosis factor ? (TNF?)] were extracted from their medical records. All patients were divided into three groups viz. group A had asymptomatic patients, group B had mild to moderate ill patients and group C had severe or critical ill patients. Above parameters were analysed and comparative evaluation with severity of disease was done. Results: In present study 55% patients were asymptomatic, 24% patients were mild to moderate illness and remaining 21% patients had severe or critical illness. Fever, cough, dyspnoea and co-morbidities including hypertension and diabetes were more common in group C. Absolute lymphocyte count (ALC), lymphocyte- monocyte ratio (LMR) showed decreasing trend whereas absolute neutrophil count (ANC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and eosinophil-lymphocyte (ELR) showed increasing trend with increase in disease severity. Serum IL-6 was found to be significantly higher in group C (64.98±111.18pg/mL) as compared to group B (15.51±20.66pg/mL) and group A (5.04±56.1pg/mL) (P<0.001). Receiver operating characteristic (ROC) curve for IL-6 to differentiate the patients with severe disease from asymptomatic and mild symptomatic disease showed a cut-off of 6.75pg/ml. Conclusion: Elevated IL-6 levels lead to adverse clinical events so IL-6 level might serve as a potential prognostic marker for severity of disease in COVID-19. Inhibition of IL-6 might be helpful to prevent serious adverse events in COVID-19 infection.

Ocular signs, visual and general developmental outcome in Indian children with radiologically proven periventricular leukomalacia

Purpose: Owing to the paucity of literature on Indian children with periventricular leukomalacia (PVL), this retrospective study aimed to describe the visual and associated developmental abnormalities in a series of affected children attending a tertiary level eye care facility. Methods: Children with radiologically confirmed PVL who attended the Pediatric Department of a tertiary eye hospital were included and underwent a detailed ocular and general developmental assessment. Results: Of the 75 children, the mean age was 2.3 years, the mean follow?up was 3.1 years, 68% were males and 43% were born preterm. Grade I PVL was identified in 13 children (17%), Grade 2 PVL in 39 (52%), and Grade 3 PVL in 23 (31%). Premies with ?2 kg (72.5%) and term babies with >2 kg (75%) had a greater association of PVL occurrence with a preponderance to severe PVL; 46% of the children were visually impaired which was significantly higher in the children with Grade 3 PVL (74%) than those with Grade 2 PVL (15%). Strabismus was common (80%) with a change in deviation over time. Seventy?one percent of the children had a refractive error, frequently myopic astigmatism. All the children except two had a delay in one or more general developmental milestones. Conclusion: PVL occurrence is observed both in the babies born at term and premies, resulting in significant ocular and systemic morbidities. We recommend a system in place for early identification and referral to initiate an early intervention program which goes a long way toward improving the quality of life in these children

Fibrous hamartoma of infancy with sarcomatous transformation: an unusual morphology

ABSTRACT Background Fibrous hamartoma of infancy (FHI) is a rare soft tissue lesion arising as a subcutaneous mass involving the axilla, trunk, and upper arm in infants and children <2yrs. Sarcomatous transformation in FHI is described in anecdotal cases in the literature. Case Report We describe one such example arising as a mass in the lower back in a 3-month-old infant. On histology, the tumor contained classic triphasic morphology; however, brisk mitotic activity noted at multiple foci was diagnostically challenging to categorize. The tumor was evaluated for ETV6-NTRK3 fusion to exclude other common differentials. Conclusion While FHI may be frequently encountered in infants, rare sarcomatous transformation are known to occur and merits special attention as it can be misdiagnosed. Also, a close follow-up is warranted as the lesion is known to recur locally.

Assessment of Scientific Production of the Health Sciences University on Oral Submucous Fibrosis Using Bibliometric Analysis

Oral submucous fibrosis is being recognized now as a chronic, insidious, premalignant condition affecting the mucosa of oral cavity, pharynx and the portion of upper oesophagus. Characteristically, it shows epithelial and sub-epithelial inflammation followed by fibro-elastic alterations in sub-mucosal region thereby leading to difficulty in opening mouth. Thus, stiffness of oral mucosa causes trismus and inability to eat. If untreated at earliest, it can progress to squamous cell carcinoma. Wardha is the smallest district in Maharashtra and a significant number of cases of oral submucous fibrosis and oral cancer are reported at the tertiary care hospital of the Health Sciences University. This study was conducted to shed light on the Scientific Productions of this Health Sciences University in Central India regarding cancers and oral submucous fibrosis over the period of last 15 years. METHODSThe Scopus and Web of Science databases were accessed, and the publications affiliated to the University were retrieved using the specified search query. The publications thus accessed were imported as BibText and RIS files and checked for duplicates in both databases. Duplicates were removed, and the final list of publications was prepared. Data related to finalised publications was imported to R-Studio application for producing the graphs and plots related to the number of scientific productions. RESULTSThe search generated a data of a total of 191 documents from 71 Sources (Journals, Books, etc.) for the period from 2007 – 2020. The number of authors included a list of 1356 authors. Authors of single-authored documents were 6; whereas, authors of multi-authored documents were 1350. Thus, there were 7.1 authors per document, 9.13 co-authors per document. The Collaboration Index was 7.3. Average citations per document was 37. CONCLUSIONSThe university has contributed significantly to the scientific literature on oral submucous fibrosis.

Subarachnoid haemorrhage mimicking unstable angina: a case report

Subarachnoid haemorrhage (SAH) is medical emergency caused by bleeding into the subarachnoid space. It is caused by rupture of an aneurysm or arteriovenous malformations (AVM). Symptoms of SAH are severe headache, nausea, vomiting, impaired consciousness and seizures. Neck stiffness and neck pain are relatively uncommon. Risk factors are high blood pressure, smoking, family history, alcoholism and even cocaine use. Diagnosis is mainly made by CT scan of head which should be done within six hours of the onset of symptoms and occasionally lumber puncture can also be done. An electrocardiogram (ECG) of all patients with subarachnoid should be done because patient with SAH can have myocardial ischemia due to increased level of circulating catecholamines or due to autonomic stimulation of the brain. ECG changes associated with SAH primarily reflect repolarisation abnormalities involving ST segment, T wave, U wave and QTc interval. Myocardial ischemia or infarction is often suspected in patients with SAH. Even troponin levels may be raised in these patients. However, suspicion of SAH is a contraindication for thrombolytic and anticoagulant therapy. This is a case of SAH which was initially treated for acute coronary syndrome (ACS) on the basis of symptoms and gradually changing ECG findings but on CT Head, patient was having SAH.

Marginalizing health: employing an equity and intersectionality frame / Marginalizando a saúde: empregando uma abordagem de equidade e interseccionalidade

ABSTRACT The understanding that the drivers of inequities are multiple and intersecting is critical for health policy formulation and implementation. An intersectionality analysis reveals these relationships and allows a nuanced grasp of how health inequities are framed and understood. Using global statistics and other examples, the paper argues the significance of an intersectionality analysis in unravelling the disproportionate impact of inequity and the implications for the health and lives of persons experiencing these multiple discriminations. Attention to this, challenges the assumption of homogeneity and helps to visibilize lived realities. A few examples of acts of resistance are cited by the authors that have attempted to amplify the voices and knowledge of those whose realities are otherwise invisibilized by prevailing inequities, policies and discourses. 'Marginalizing' health thus implies an intersectional understanding of inequity as well as challenging and changing prevailing socio-political structures.

RESUMO O entendimento de que os fatores motivadores das desigualdades são múltiplos e se cruzam é fundamental para a formulação e para a implementação de políticas de saúde. Uma análise de interseccionalidade revela essas relações e permite uma compreensão diferenciada de como as iniquidades em saúde são estruturadas e compreendidas. Usando estatísticas globais e outros exemplos, o artigo argumenta a importância de uma análise de interseccionalidade para desvendar o impacto desproporcional da desigualdade e as implicações para a saúde e a vida das pessoas que sofrem essas múltiplas discriminações. Essa abordagem desafia o pressuposto de homogeneidade e ajuda a visibilizar as realidades vividas. Alguns exemplos de atos de resistência são citados pelos autores que tentaram ampliar as vozes e o conhecimento daqueles cujas realidades são, de outro modo, invisibilizadas pelas iniquidades, políticas e discursos predominantes. A 'marginalização' da saúde implica, portanto, um entendimento interseccional da desigualdade, assim como em enfrentar e mudar as estruturas sociopolíticas predominantes.

Tourniquet application in snake bite: are we aware?

Background: To assess the use of tourniquets as mentioned in National Snake Bite Management Protocol among peripheral health care providers.Methods: This was a prospective cross-sectional study conducted in a tertiary care institute between June 2016 to June 2017. A total of 36 patients of snake bite referred from peripheral health facility were enrolled in the study and were evaluated for : date and time of bite, site of bite, weather snake was seen, type of envenomation, first aid given in Govt facility/alternative practitioner, tourniquet applied/not applied, anti snake venom given/not given as first aid and outcome.Results: The mean age of the study population was 39 years (17.38) range 18 years to 75 years. 18 patients were male and 18 were female. 30 (83.3%) patients had site of bite over the extremities’. The venom was hemotoxic in 12 (33.3%) patients and neurotoxic 21 (58.3%). 30 (83.3%) patients  received first aid in the Government health facility  manned by qualified in healthcare practitioner and 6 (16.7%) were treated by traditional healers. 29 (80.6%) patients had a tight tourniquet tied to the site of the bite when seen in emergency department of institute. None of the patients had their limbs splinted. 31 (86.1%) patients had received anti snake venom (ASV) at the peripheral health facility. The mortality rate was 5.6% with only 2 deaths.Conclusions: The majority of peripheral health care providers both qualified and unqualified use tourniquets in patients suffering with snake bite. The peripheral health care providers are not aware of importance of limb splinting and immobilisation. Though the rate of instilling ASV is good, the health care providers in the peripheral institutes should be made aware of recommendations of national snake bite management protocol with regard to use of tourniquets and limb splitting in snake bite patients.

'Marginalizing' health: employing an equity and intersectionality frame / 'Marginalizando' a saúde: empregando uma abordagem de equidade e interseccionalidade

ABSTRACT The understanding that the drivers of inequities are multiple and intersecting is critical for health policy formulation and implementation. An intersectionality analysis reveals these relationships and allows a nuanced grasp of how health inequities are framed and understood. Using global statistics and other examples, the paper argues the significance of an intersectionality analysis in unravelling the disproportionate impact of inequity and the implications for the health and lives of persons experiencing these multiple discriminations. Attention to this, challenges the assumption of homogeneity and helps to visibilize lived realities. A few examples of acts of resistance are cited by the authors that have attempted to amplify the voices and knowledge of those whose realities are otherwise invisibilized by prevailing inequities, policies and discourses. 'Marginalizing' health thus implies an intersectional understanding of inequity as well as challenging and changing prevailing socio-political structures.

RESUMO O entendimento de que os fatores motivadores das desigualdades são múltiplos e se cruzam é fundamental para a formulação e para a implementação de políticas de saúde. Uma análise de interseccionalidade revela essas relações e permite uma compreensão diferenciada de como as iniquidades em saúde são estruturadas e compreendidas. Usando estatísticas globais e outros exemplos, o artigo argumenta a importância de uma análise de interseccionalidade para desvendar o impacto desproporcional da desigualdade e as implicações para a saúde e a vida das pessoas que sofrem essas múltiplas discriminações. Essa abordagem desafia o pressuposto de homogeneidade e ajuda a visibilizar as realidades vividas. Alguns exemplos de atos de resistência são citados pelos autores que tentaram ampliar as vozes e o conhecimento daqueles cujas realidades são, de outro modo, invisibilizadas pelas iniquidades, políticas e discursos predominantes. A 'marginalização' da saúde implica, portanto, um entendimento interseccional da desigualdade, assim como em enfrentar e mudar as estruturas sociopolíticas predominantes.

Multisystemic Pediatric Langerhans cell histiocytosis: a comprehensive clinico-pathological and BRAF V600E mutation study at autopsy

Langerhans cell histiocytosis (LCH), a disorder of antigen-presenting cells, is the commonest disorder of the mononuclear phagocytic system. Diagnosis is always challenging due to heterogeneous clinical presentation. However, with the evolution and better understanding of its biology, many of these children are being diagnosed early and offered appropriate therapy. Despite these advances, in developing countries, an early diagnosis is still challenging due to resource constraints for specialized tests. As a result, many patients succumb to their disease. Autopsy data on LCH is notably lacking in the literature. We sought to analyze the clinical (including mutational) and morphologic features at autopsy in six proven cases of LCH. This study includes a detailed clinico-pathological and mutational analysis of 6 proven cases of LCH. Presence of BRAF V600E mutation was assessed by both Real Time PCR and Sanger sequencing. A varied spectrum of organ involvement was noted with some rare and novel morphological findings, like nodular bronchiolocentric infiltration of LCH cells, lymphovascular emboli of LCH cells, and paucity of eosinophils within the infiltrate; these features have not been described earlier. Surprisingly, all cases were negative for BRAF V600E mutation on both RQ-PCR and Sanger sequencing. The present study is perhaps the first autopsy series on LCH. This extensive autopsy analysis represents a correlation of pathological features with clinical symptoms which provides clues for a timely diagnosis and appropriate therapeutic intervention. Also, our findings hint at the low frequency of BRAF V600E mutation in our LCH patients.

Conceptual Measures of Oral Health Literacy and Oral Health Behaviour among Street Hawkers and Fruit Vendors in Wardha, Maharashtra.

Oral health is the most important but often neglected entity of life. Studies have revealed that literacy skills and knowledge are strong predictors of individual’s health status than age, income, employment status, education level, racial group or ethnic group. The objective of this study was to investigate how oral health literacy relates to oral health knowledge, attitude and practices among the street hawkers and fruit vendors.METHODSA cross-sectional study was conducted using a Marathi pretested, close ended, structured and validated questionnaire to assess oral health knowledge, attitude, practices and literacy among the street hawkers and fruit vendors. The data was collected, entered and analysed using SPSS Version 21.RESULTSThe study shows that only 24.4% of the participants knew that teeth were important for chewing, talking and appearance, 86.7% of the participants knew that consumption of sweets causes tooth decay, 80.4% knew that brushing teeth prevents dental caries and 91.6% knew that visiting a dentist prevents dental problems. Regarding oral hygiene practices, 16.4% used tooth paste with toothbrush, 44.4% brushed twice daily, 47.6% used tobacco more than once daily and 34.7% visited dentist when they experienced tooth ache. In case of oral health literacy, 35.6% answered correctly that bleeding gum is an inflamed gum, 32% knew that plaque is soft debris on teeth, 21.3% participants knew that fluoride strengthens the teeth and 95.1% were aware that eating/smoking tobacco causes oral cancer.CONCLUSIONSOur study shows that oral health literacy was limited. The awareness on oral health knowledge was good with positive attitude but practices were fair among the street hawkers and fruit vendors. Therefore, measures should be taken to improve OHL level and develop skills of self-management about oral hygiene behaviour which will promote the oral health practices.

A prospective observational study to describe magnetic resonance imaging findings in perinatal asphyxia in terms of severity, outcome and neurological sequel in term and preterm babies

Background: Perinatal asphyxia is a significant cause of neonatal mortality and morbidity. MRI is useful for assessing the severity and pattern of brain injuries. There is less data of MRI findings of perinatal asphyxia from India and the subcontinents. This prospective observational study was done to describe MRI brain findings in neonates with perinatal asphyxia with respect to various determinants.Methods:' Initial MRI brain was done when babies were stable after fulfilling inclusion criteria. Immediate outcome was assessed at the end of hospital stay. They were followed up for presence of any sequel up to 1 year. Repeat MRI brain was done in few selected babies. Data was collected and statistically analyzed.Results: Total 55 babies were included in the study (term 27, preterm 28). There were 9 babies in stage 1, 17 babies in stage II and 22 babies in stage III. MRI brain findings were normal in 8 and abnormal in 47 patients. There were Deep gray matter injury (DG) in 22, Para Sagittal subcortical white matter injury (PS) in 6, Germinal matrix haemorrage (GMH), intraventricular haemorrage (IVH) and Periventricular leucomalacia (PVL) in 12 and Mixed pattern of injury in 7 babies. Findings among 9 expired babies were: 4 (44.4%) DG, 2 (22.2%) GMH+IVH and 3 (33.3%) mixed. There was neurological sequel in 13 babies (48.1%).' Babies with normal MRI initially had no sequel.Conclusion: Brain injury due to perinatal asphyxia follows several patterns according to gestational age and severity. Early and accurate recognition of these patterns with the help of MRI brain helps in managing the baby and predicting the prognosis.

Multicystic encephalomalacia: An autopsy report of 4 cases

Multicystic encephalomalacia is varying sized cystic lesions in the brain encountered in developing fetuses or infants. These cysts start at the periventricular area and may extend onto the cortex. The cause of the formation of these cystic lesions is secondary to an ischemic or hypoxic insult, which leads to liquefactive necrosis and subsequent formation of gliotic cyst walls having an admixture of microglia. We discuss four autopsy cases that had multicystic encephalomalacia to highlight the scenarios in which these lesions are encountered.

Cost effectiveness analysis in the management of stroke in a tertiary care hospital

Background: Stroke has a high economic impact on the society especially in a developing country like India. In India health insurance doesn抰 cover all people leading to out of pocket expenditure. The objective of the present study was to study the cost of illness and outcome of stroke in a tertiary care hospital.Methods: Direct medical and nonmedical costs were obtained after 28 days of follow-up. The outcome of the stroke was measured by modified Rankin scale (mRS).Results: The mean age of the patients was 65.38�.98 years. Majority of the patients suffered from ischemic stroke and belonged to lower middle socioeconomic group. The mean cost of stroke was INR 39819. There was improvement in the mRS score after 28 days following treatment of acute stroke.Conclusions:Direct medical costs forms major component of cost of stroke. Early management and hospital discharge can reduce the economic burden of stroke.

Determinants of severe acute malnutrition in children between six months to five year of age enrolled in nutritional rehabilitation centre at a tertiary care level

Background: Indicators showing levels of nutritional status in children are often regarded as representative of the health and general well-being of a society at large. Malnutrition stands as a consequence of several key social and economic factors such as lack of education, inadequate health care services and ill-informed cultural behaviors.' In order to holistically address the issues surrounding malnutrition, a comprehensive understanding of the multi-dimensional complexities at play in society is crucial. Objective was to identify determinants of severe acute malnutrition among children with severe acute malnutrition under 5 years (between 6 months to 60 months) of age. Methods: A cross sectional study design involving 64 patients with severe acute malnutrition between 6 to 60 month of age was employed to identify the risk factors of severe acute malnutrition among children admitted in pediatric wards and nutritional rehabilitation centers, Civil hospital Ahmedabad, from April 2018 to march 2019. A detailed history of all the patients were taken and data collected using structured interviewer-administered questionnaire.Results: Thus, from the above study, it is clear' that age of the child <2 years, female gender, bigger family size, poverty, illiteracy in mother, poor feeding practices, improper complementary feed introduction, poor nutritional status of mother whose child were breastfed, acute or chronic illness in child and narrow birth spacing were the chief determinants of SAM in under five children.Conclusions: Socio demographic characters, nutrition and child caring practices, infection and other childhood illness as well as obstetric history of mother are important determinants of severe acute malnutrition in children under five years of age. As a result, collaborative efforts should be organized to improve promotion of better child caring practices through appropriate age specific child and maternal feeding practices, prevention and early treatment of acute childhood illnesses and promotion of family planning.

Correlation of TOPS scoring with immediate outcome among neonates transported to special newborn care unit: a prospective study

Background: Several sick neonates require transfer to tertiary level care neonatal unit for treatment. The facilities of neonatal transport in India are not optimal and the newborn thus transported can become hypothermic, hypoxic and/or hypoglycemic which can affect the neonatal outcome. These parameters can be maintained during transport by adopting simple measures. The aim and objective of this study is to study impact of acute physiological parameters during transfer of neonates on their immediate outcome by using TOPS score. TOPS score - Temperature, Oxygenation, Perfusion (Assessed by capillary refill time), Blood sugar.Methods: This prospective observational study was conducted at the special newborn care unit, Civil Hospital, Ahmedabad enrolling 460 transported neonates. TOPS scoring for each neonate was done at admission, and then the parameters of the TOPS score were correlated with the outcome at 48 h of admission.Results: A total of 460 transported newborns were assessed, 47.8% newborns were hypothermic, 33.9% had poor perfusion, 27.8% were hypoxemic, and 22% were hypoglycemic. On correlating with the outcome, Hypoxemia and hypo perfusion had the highest sensitivity (92.2% and 57.3%, respectively) while hypoglycemia had the highest specificity (88%), for an adverse outcome.Conclusions: TOPS score is a useful and easy to use the method to assess the physiological status and predict early mortality in transported neonates.

A Paradigm Shift from Mounted Intra-Oral Periapical Radiography to Hand-Held X-Ray Device: A Review

Handheld X-ray devices are now offered in dental practice. Handheld X-ray units challenge the concept of a restricted access to the “controlled area” as they are held by the operator. Although an integral lead shield is provided, the distance from the body is variable, dependent on how the device is held. Currently, there are voluntary guidelines provided by the NCRP for dental radiation protection. Hand-Held portable X-ray devices are increasingly used for intraoral radiography.