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Childhood allergies pose huge economic burden and adverse effects on quality of life. Serum IgE has been considered a surrogate allergymarker for decades. Availability of several over-the-counter allergy tests add to confusion of partially trained caregivers. The presentreview focuses on current status of allergy testing in Indian scenario. Various in-vitro and in-vivo diagnostic modalities are available forallergy detection. Skin prick tests are useful for aero-allergies whereas oral challenge tests are best for identifying suspected foodallergies. An allergy test should be individualized based on clinical features, diagnostic efficacy, and cost-benefit analysis.
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Objective: To describe the utility of flexible fiberoptic bronchoscopy for the diagnosis andmanagement in the neonatal ICU. Methods: A retrospective, medical chart review wasconducted in neonates who underwent flexible fiberoptic bronchoscopy over a period of 7years. Besides demographic data and diagnostic findings, the results of medical and/orsurgical interventions done by treating neonatologist were recorded. Results: 88bronchoscopies were performed in 83 neonates, of which 37 were done throughendotracheal tube. Indications included persistent need for mechanical ventilation (32),persistent atelectasis (21), and stridor (27). Most common airway anomalies diagnosedincluded tracheobronchomalacia (20), laryngomalacia (18), subglottic stenosis (7), choanalatresia (4), laryngeal cleft (4), and tracheoesophageal fistula (4). Surgical interventions wereundertaken in 17 cases (9 tracheostomies and 2 cases of slide tracheoplasty). Conclusion:Flexible fiberoptic bronchoscopy can be beneficial for the diagnosis and management ofneonates with persistent or undiagnosed respiratory problems.
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Background: In preterm neonates, enteral feeding is advancedslowly, considering the risk of necrotizing enterocolitis. Prolongedintravenous alimentation in these neonates, however, mayincrease the risk of sepsis-related morbidity and mortality,particularly in low resource settings.Objectives: Objective of this was study to evaluate impact ofaggressive enteral feeding on mortality and morbidities amongpreterm neonates.Design: Randomized controlled trial.Participants: Neonates with birthweight 750-1250 g.Interventions: 131preterm neonates with birth weight 750-1250g, admitted to neonatal intensive care unit between April 2012 andJune 2014, were randomized to aggressive feeding orconservative feeding regimen.Outcomes: The primary outcome of the study was all-causemortality during hospital stay. The secondary outcomes includedproportion of sepsis (blood culture proven), necrotizingenterocolitis, feed intolerance, survival without major morbidity atdischarge, time to reach full enteral feed (180 mL/kg/d), durationof hospitalization, and average daily weight gain (g/kg).Results: All-cause mortality was 33.3% in aggressive regimenand 43.1% in conservative regimen, [RR (95%) CI 0.77 (0.49,1.20)]. Neonates with aggressive feeding regimen reached fullenteral feed earlier; median (IQR) 7 (6, 8) days compared toconservative regimen, 10 (9, 14) days; P <0.001. There was nodifference in culture positive sepsis rate, survival without majormorbidities, feed intolerance, necrotizing enterocolitis, duration ofhospitalization and average daily weight gain.Conclusions: In neonates with birth weight 750-1250 g, earlyaggressive feeding regimen is feasible but not associated withsignificant reduction in all-cause mortality, culture positive sepsisor survival without major morbidities during hospital stay.Neonates with aggressive regimen have fewer days on IV fluidsand reach full feed earlier
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Abstract Agricultural Machinery as an off-road vehicle is the backbone of the World agricultural industry. Its main function is to operate as a prime mover and support the power requirements to function the various type of draft implements. In this regards, the hydraulic system is an important part and is controlled by the propagated oil which is cleaned by impurities and debris using a filter system. Once it blocks, the bypass opens to avoid any pressure burst of the system, and the particles find their way into the hydraulic system and get lodged in the gears, pumps, valves, and drive train to hinder the performance of the Agricultural Machinery. This research presents an onboard Multiple Signal Classification Algorithm (MUSIC) and pseudo-spectrum analysis as a computational tool used by cellphones to analyze the particle pollution level of the hydraulic filter. This analysis is carried out on the soundtracks recorded from different cell phones in different incremental stages of fluid contamination to the particles until it being choked, based on the standard of ISO4406.
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Acoustics , Preventive Maintenance/methods , Hydraulics , Algorithms , Diagnostic ErrorsABSTRACT
Objective: To study the association between red cell distribution width (RDW) and mortalityin critically-ill children admitted in a Pediatric intensive care unit (PICU). Methods: 101participants were recruited consecutively over 3 months. Data collected includeddemographics, vital parameters, laboratory values, severity and organ failure scores, RDWfor the first 5 days of admission, duration of PICU stay and survival outcome. Results: 11patients died during study period. High RDW at admission (RDW D1) correlated significantlywith mortality (P=0.007). The odds of death increased by 15 to 23 times with rise in RDW D1from 18% to >21%. The optimal RDW D1 cut-off value for mortality was 18.6%, which yieldedsensitivity 90.9%, specificity 70.8%, positive predictive value 27.8%, negative predictivevalue 98.4%, and area under curve (AUC) 0.83 (95%CI 0.737, 0.925). 29 out of 60 (48.3%)patients with RDW D4 >18% had PICU stay of ?7 days. Conclusion: High (?18.6%) RDW atadmission and its persistent high levels are associated with high mortality and prolonged stayin PICU, respectively
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Background: Laparoscopic surgeries are commonly done in patients suffering from cholelithiasis. However, laparoscopic surgeries are associated with pneumoperitoneum, increased intra-abdominal pressure and insufflation of carbon dioxide leading to altered haemodynamic stability. We conducted a prospective randomised study to evaluate the effects of Clonidine and fentanyl in premedication for intraoperative haemodynamic stability in patients undergoing laparoscopic cholecystectomy. Methods: 70 patients of either sex posted for elective laparoscopic cholecystectomy were included for our study. All patients were randomised using computer generated program and divided into two groups; Group F (35 patients): received Inj. Fentanyl (2 μg/kg IV) 5 minutes prior to induction of anaesthesia, whereas Group C (35 patients) received Inj. Clonidine (1 μg/kg IV) at the similar time before induction of anaesthesia. Haemodynamic parameters (heart rate, mean arterial pressure) of all patients were assessed prior to premedication, before induction, following laryngoscopy and intubation and after pneumoperitoneum. Results: The baseline mean heart rate and mean arterial pressure between Group C was found to be statistically insignificant on comparing with Group F. However, the mean heart rate after intubation, after creation of pneumoperitoneum and after extubation was observed to be statically significant between Group F and Group C (p=0.001). Similar statistical significance was observed between fentanyl group and Clonidine group after premedication and after intubation. Conclusion: Both Clonidine and fentanyl as a premedication had effectively attenuated intraoperative haemodynamic responses but the role of Clonidine was observed to be more appreciable.
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Context: Continuous Positive Airway Pressure (CPAP) is a cost-effective and minimal invasive respiratory support for the newborn. Objective: To review the evidence related to various aspects of CPAP usage and its applicability for developing countries. Evidence Acquisition: We conducted a literature search on PubMed, CENTRAL, and Cochrane Database of Systematic Reviews using the terms ‘CPAP’ OR ‘continuous positive airway pressure’ OR, non-invasive ventilation’ AND ‘newborn’ OR ‘neonate’ OR ‘infant’. We also searched the reference lists from the above articles and of review articles. Extracted manuscripts and reviews were analyzed and results related to various aspects of CPAP usage were summarized in narrative form. Results: Early use of CPAP with early rescue surfactant (InSurE) is the ideal approach for management of respiratory distress syndrome in preterm and extremely preterm infants. Delivery room CPAP is feasible and reduces the need for surfactant and mechanical ventilation by nearly 50%. Prophylactic surfactant for extreme preterms should be discouraged. Heated humidified high flow nasal cannula is best utilized for post-extubation respiratory support. The search for ideal interface still continues and binasal prongs or nasal masks are the good contenders. Evidence on the ideal CPAP delivery is still inconclusive. Conclusions: CPAP, if used early and judiciously, is an effective intervention and need immediate scaling-up in resource-limited settings. Future research should focus on the ideal interface and the CPAP delivery methods.
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Planning organisation and delivery of educational program(s), culminating in purposeful learning require strong basis of principles of adult learning along with a sound knowledge and requisite skills in both psychology as well as technology of medical education. Assessing effectiveness of a CME program is as important as the organization of learning activities and delivery of academic program as these may provide further directions for enhancing the efficacy of the CME delivery system. Objective: (i) The purpose of this study was to investigate the effectiveness of well planned and conducted CME program in terms of enhancing knowledge and competence of the participants. (ii) To explore if the gain in knowledge and competence, if any, can be attributed to the interactive design of the educational process. Methods: The study was conducted during NAMS-AIIMS Regional Symposium on Sleep Medicine at AIIMS, Jodhpur as part of NAMSCON 2013. After explaining the objectives of the study to the participants and assurance of confidentiality, a validated and pre-tested questionnaire consisting of 30 multiple choice, single response questions, was administered to 103 participants. Following intervention consisting of didactic lectures by experts in different aspects of sleep medicine, interactive sessions and problem triggered sessions consisting of clinical data, participants were readministered post test questions which were, however, different from pre-test but had similar difficulty level. Result: The response rate of participants was 89%. Pre-intervention scores were 11.76 ± 4.4, with only 26 % of participants achieving an arbitrary pass score of 50 %. Comparison of paired score of participants who attempted both pre and post tests (n=59) showed improvement from 12.1 ±4.6 to 18.3 ± 3.8 which was significant (p <0.05). 84.7 % of participants secured above pre decided 50% score. The mean increase in the score was 6.2 with 95% CIs 4.8; 7.5 (P <0.001). Higher gain in knowledge and competencies is attributed to intense interactive involvement of participants during the problem triggered sessions, feedback provided during interaction and system of reward and incentive introduced at time of sessions. The study concludes that well designed educational intervention based on the principles of adult learning brings positive gain in the knowledge and enhances competence of the participants.
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The present study that is Medical Practice and Professional Liabilities in Bijapur Region of Karnataka was carried out in the northern part of Karnataka, details of the cases are collected from the district consumer forum Bijapur between January 1, 1995 and December 31, 2009 (15 years). In each case, complaint of the complainant and response to a complaint by the opponent is studied and analyzed. Date of filing and date of judgment is noted in each case. If needed complainant and opponent were consulted personally for details about the case. The most common cause for litigation was found to be misguided allegation; this can be prevented by proper communication to the patient at first consultation. Hence, it is important to spend more time at first consultation. It is the utmost importance that professional liability claims should be avoided. The lawsuits not only have heavy emotional toll on doctors and patients but on the society as a whole.
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India has made impressive gains in its child survival indices during the past half a century with infant mortality rates declining from 159.3 in 1960 to 44 in 2011 and neonatal mortality rate declining from 47 (1990) to 32 (2010). Neonatal health is now an integral part of the country’s flagship program – National Rural Health Mission. Facility based newborn care is not only available in large public and private sectors hospitals, but also in about 300 of India’s district hospitals. Complementing these efforts is home based newborn care being delivered by community health volunteers. The last two decades has also witnessed an increase in newborn research and its incorporation into medical and paramedical education as a major course component. Neonatology now is an independent superspecialty in India. The National Neonatology Forum has had a major role in spearheading reforms in neonatal care in India.
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D-amino acid oxidase (DAAO) is biotechnologically relevant enzyme that is used in various food and pharmaceutical industries. DAAO from the yeast Trigonopsis variabilis is an important agent for use in commercial applications because of its high activity with cephalosporin C and is reasonable resistant to the oxidants O2 and H2O2 byproducts of reaction. In this study, response surface methodology (RSM) in shake flask culture was used to enhance the production of DAAO from T. variabilis by optimization of fermentation media composition. The effects of six factors (DL-alanine, glucose, pH, ZnSO4, (NH4)2SO4 and temperature) were evaluated on DAAO production. Results of Placket-Burman design showed that DL-alanine, pH, glucose and ZnSO4 were significant factors for DAAO production (P<0.05). The optimum values of media components as predicted by the central composite design were inducer (DL-alanine) concentration 3 g/L, pH 7.7, glucose 17 g/L and ZnSO4 34 mg/L. At these optimum values of media composition, maximum production of DAAO was 153 U/g yeast dry weight. Two-fold increase in DAAO production was achieved after optimization of the physical parameters by RSM.
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Biostatistics/methods , D-Amino-Acid Oxidase/analysis , Models, Statistical , Research Design/methods , Yeasts/analysisABSTRACT
Objective: To apply cumulative sum (CUSUM) to monitor a drug trial of nebulized hypertonic-saline in bronchiolitis. To test if monitoring with CUSUM control lines is practical and useful as a prompt to stop the drug trial early, if the study drug performs significantly worse than the comparator drug. Design: Prospective, open label, controlled trial using standard therapy (epinephrine) and study drug (hypertonic-saline) sequentially in two groups of patients. Setting: Hospital offering tertiary-level pediatric care. Patients: Children, 2 months to 2 years, with first episode of bronchiolitis, excluding those with cardiac disease, immunodeficiency and critical illness at presentation. Interventions: Nebulized epinephrine in first half of the bronchiolitis season (n = 35) and hypertonic saline subsequently (n = 29). Continuous monitoring of response to hypertonic-saline using CUSUM control-charts developed with epinephrineresponse data. Main outcome measures: Clinical score, tachycardia and total duration of hospital stay. Results: In the epinephrine group, the maximum CUSUM was +2.25 (SD 1.34) and minimum CUSUM was -2.26 (SD 1.34). CUSUM score with hypertonic-saline group stayed above the zero line throughout the study. There was no statistical difference in the post-treatment clinical score at 24 hours between the treatment groups {Mean (SD) 3.516 (2.816): 3.552 (2.686); 95% CI: -1.416 to + 1.356}, heart rate {Mean (SD) 136 (44): 137(12); 95% CI: -17.849 to +15.849) or duration of hospital stay (Mean (SD) 96.029 (111.41): 82.914 (65.940); 95% CI: -33.888 to +60.128}. Conclusions: The software we developed allows for drawing of control lines to monitor study drug performance. Hypertonicsaline performed as well or better than nebulized epinephrine in bronchiolitis.
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Background & objectives: Stabilized live attenuated oral polio vaccine (OPV) is used to immunize children up to the age of five years to prevent poliomyelitis. It is strongly advised that the cold-chain should be maintained until the vaccine is administered. It is assumed, that vaccine vial monitors (VVMs) are reliable at all temperatures. VVMs are tested at 37°C and it is assumed that the labels reach discard point before vaccine potency drops to >0.6 log10. This study was undertaken to see if VVMs were reliable when exposed to high temperatures as can occur in field conditions in India. Methods: Vaccine vials with VVMs were incubated (10 vials for each temperature) in an incubator at different temperatures at 37, 41, 45 and 49.5°C. Time-lapse photographs of the VVMs on vials were taken hourly to look for their discard-point. Results: At 37 and 41°C the VVMs worked well. At 45°C, vaccine potency is known to drop to the discard level within 14 h whereas the VVM discard point was reached at 16 h. At 49.5°C the VVMs reached discard point at 9 h when these should have reached it at 3 h. Conclusion: Absolute reliance cannot be placed on VVM in situation where environmental temperatures are high. Caution is needed when using ‘outside the cold chain’ (OCC) protocols.
Subject(s)
Poliomyelitis , Poliovirus Vaccine, Oral , Refrigeration/methods , Specimen Handling/methodsABSTRACT
Pneumothorax is a common complication in pulmonary tuberculosis that is usually seen with underlying cavitary lesion. However, it is uncommonly seen in patients with miliary tuberculosis. This communication describes bilateral spontaneous pneumothorax in an 18 years’ old female patient having miliary tuberculosis.
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Background: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) have the potential to produce delayed ejaculation in men, delayed orgasm or anorgasmia in women and decreased libido that is independent of the gender. The occurrence of medication-associated sexual dysfunction increases the likelihood of medication non-compliance (or non-adherence) in patients, which may contribute to untreated depression and/or disease relapse. Materials & Methods: 60 patients with diagnosis of Depressive episode (in remission at the time of study), divided into 2 groups of 30 patients taking Duloxetine and the remaining 30 patients taking Escitalopram, were recruited on consecutive basis from the patients attending Psychiatry OPD of Lady Hardinge Medical College (LHMC). Each subject was rated on Arizona Sexual Experience Scale (ASEX) and the results obtained were statistically analyzed. Results: In the present study the average ASEX score obtained in the Escitalopram group (12.63) was found to be more than that in Duloxetine group (12.36), though this difference was not found to be statistically significant. Conclusions: These results illustrate that antidepressant-induced sexual dysfunction is reported frequently by patients taking SSRIs or SNRIs. Our study did not find any significant difference between escitalopram and duloxetine with respect to their sexual dysfunction profile but in view of the limitations of our study there is need for further research in this domain of psychopharmacology.