Knowledge attitude and practice of paediatricians regarding tuberculosis case management in five major districts of Punjab state, India

Background: The operational research was done to assess the Knowledge, Attitude and Practice regarding TB case management of Pediatricians. Place were five major cities of Punjab state, India. i.e. Ludhiana, Jalandhar, Amritsar, Patiala and Bathinda.Methods: Study design was observational cross-sectional study. Period was one year. The data collection was done from Paediatricians from 5 cities inhabiting approximately half of the urban population of Punjab, using a pre-tested, structured questionnaire and knowledge of TB and its management was assessed.Results: Total of 139 pediatricians participated in the study, 69% were male. Majority pediatricians had adequate knowledge of TB disease and case suspicion. Adequate knowledge of TB diagnosis was seen in 87% doctors. Only 20% doctors had adequate knowledge about treatment of TB cases. Overall 64% of Pediatricians referred TB cases to DOTS centre for treatment.Conclusions: Improving the treatment knowledge of paediatricians can go a long way in improving management of TB cases.

Etiological Spectrum and Clinical Profile of Patients Admitted with Pancytopenia

Aims:The etiological spectrum and clinical profile of admitted patients presenting with pancytopeniawere studied. Study Design:This was a prospective study conducted on 200 patients presenting to the Department of Medicine, Department of Oncology and the Allied Specialities of Medicine, Dayanand Medical College and Hospital, Ludhiana and were found to have pancytopenia during hospital stay.Results:Mean age of the patients was 45.69 ± 17.05 years with maximum number of patients (23%) in the age group of 51-60 yearsand 119 patients were males and 81 patients were females.Most common physical finding was pallor (95%), followed by splenomegaly (22%) and hepatomegaly (17%). Total of107 patients were vegetarians (53.5%) and 93 patients (46.5%) were non-vegetarians. Mean hemoglobin was 7.16 ± 2.04 g/dl, mean total leucocyte count was 2.51 ± 1.02 x 103/cu.mm, mean platelet count was 54885.37 x 103/ul ± 40320.96 and mean the absolute neutrophil count was 1.59 x 103 /cu.mm ± 0.84. Ten patients of pancytopenia were because of tropical fever which included 4 cases of dengue, 3 cases of malaria, 2 cases of enteric fever and 1case of mixed infection (malaria + scrub typhus).Viral markers were positive in 14 out of the 63 patients tested. Out of these 14 patients, 4 were HBsAg reactive, 7 were HCV +ve and 3 were HIV +ve. Most common red blood cell picture on peripheral blood film was normocytic normochromic (34.5%), followed by mixed morphology (33.5%). Macrocytic and microcytic morphology was seen in 19.5% and 12.5% of the patients respectively. Hypercellular marrow was seen in 82 patients (42.9%), normocellular marrow was seen in 58 patients (30.3%) and hypocellular marrow was seen in 51 patients (26.7%). The most common cause of pancytopenia in this study was megaloblastic anemia in 59 patients (29.5%), the 2nd common cause was leukemias in 28 patients (14%) and the 3rdcause was aplastic anemia in 22 patients (11%). Drug induced pancytopeniawas seen in 21 patients (10.5%) and hypersplenism in 9 cases (4.5%).Conclusion:This study has helped us in knowing the various etiologies of pancytopeniain this hospital. Megaloblastic anemia was the most common etiology in this study followed by leukemiasand aplastic anemia. The study helped us in understanding of the age and gender distribution, the hematological parameters, the peripheral blood film in pancytopenia and the bone marrow picture in these patients.

Thyroid function studies in children of nephrotic syndrome

Background: Nephrotic syndrome is a condition which is characterized by proteinuria, hypoproteinemia, hypercholesterolemia and significant edema. In children with nephrotic syndrome, it is probable to determine a hypothyroid state because of significant loss of thyroxine (T4), triiodothyronine (T3) in presence of proteinuria. The objectives of this study were to evaluate the level of serum free T3, free T4, and TSH in children with nephrotic syndrome and its correlation with healthy controls.Methods: A comparative study was carried out on total of 60 children (divided into two equal groups of 30 cases and 30 controls) in the age group of 1-18 years of either sex admitted to Department of Paediatrics. Maharishi Markandeshwar institute of Medical Sciences and Research. Mullana, Ambala, Haryana over a from January 2017 to September 2018. Serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) were done in all 60 children and compared.Results: Among cases 18 (60%) were males and 12 (40%) were females. 63.4% of the cases were in the age group 1-10 years and 36.6% were in age group 11-18 years. Studied patients showed lowered FT3 and FT4 and raised TSH in comparison with normal values.Conclusions: Hypothyroidism should be actively sought for in children with nephrotic syndrome as it is a treatable complication.

Dermatoglyphic Pattern On Fingertips Of Thalassemia Patients: A Case Control Study In North Indian Population

Background: Dermatoglyphics is the scientific study of fingerprints. Fingerprint is a multifactorial trait. Largenumber of genes play their role along with environmental influence. Chromosomal aberration affect these genesand produce variation in dermatoglyphic pattern in various chromosomal syndromes.Materials and methods: The present study was conducted in the Department of Anatomy, Government MedicalCollege and Rajindra Hospital,Patiala and is based on digital dermatoglyphics of 100 Thalassemic patientsfrom Thalassemia Ward of Rajindra Hospital, Patiala hailing from Northern region of India. The control groupcomprises of 50 individuals of similar origin. Fingertip dermatoglyphic patterns of both hands of Thalassemiapatients and control group were recorded by INK method.The fingertip pattern type was recorded by using Henry’sclassification method. The data so obtained was compiled and analysed statistically.Results: It was found that whorls were most frequent pattern on digit IV in patients and controls, with statisticalsignificance in both hands, right hand (p value .042) and left hand (p value .010). Ulnar loops had preponderanceover other patterns on digit V in both the groups but the difference was statistically significant in left hand (pvalue .033).Conclusion: From our study it can be concluded that dermatoglyphics can prove to be an extremely useful tool forthe preliminary investigations into conditions with a suspected genetic base and dermatoglyphic abnormalitiesshould prove of considerable value in preliminary mass screening.

Study of Liver Function Test in Perinatal Asphyxia at a Tertiary Care Center in Haryana

Background: Perinatal asphyxia is an insult to the fetus or newborn due to lack of oxygen (hypoxia) and /or a lack of perfusion (ischemia) to various organs. The diagnosis of perinatal asphyxia is mostly established retrospectively. But it is difficult to diagnose perinatal asphyxia retrospectively in the absence of perinatal records. As because of hypoxaemia, different organ systems of the body are affected in perinatal asphyxia, this study was done to assess the hepatic function in the cases of perinatal asphyxia which could prove useful in diagnosing perinatal asphyxia. Methods: The study included 25 asphyxiated neonates as cases and 25 healthy neonates as control group. Venous blood was analyzed between 2nd and 5th day of life to estimate serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP), serum total bilirubin (STB), direct bilirubin (DSB) and prothrombin time (PT). Unpaired student’s ‘t’ test was used for data analysis and P value of <0.05 were considered significant. Results: Serum ALT and AST were found significantly higher in asphyxiated babies compared to reference  groups (p<0.001). The mean ALT and AST of asphyxiated babies were 100.17±35.50 and 84.13±44.49 U/L, respectively and those of normal babies were 30.25±9.49 U/L and 41.97±11.49 U/L respectively. Conclusions: Estimation of liver enzymes can prove helpful in diagnosing perinatal asphyxia in absence of birth details especially in developing country like India.

Differentials in colostrum feeding among lactating women of block RS Pura of J and K: a lesson for nursing practice

Breast feeding is universally and traditionally practicised in India. Experts advocate breast feeding as the best method of feeding young infants. To assess the role of various factors in determining colostrum feeding in block R. S. Pura of district Jammu. A stratified two-stage design with villages as the primary sampling unit and lactating mothers as secondary sampling unit. Villages were divided into different clusters on the basis of population and sampling units were selected by a simple random technique. Breastfeeding is almost universal in R. S. Pura. Differentials in discarding the first milk were not found to be important among various socioeconomic groups and the phenomenon appeared more general than specific.

Co-infection of hepatitis A and E with Salmonella infection; a case report

Ours is a developing country so infectious diseases contribute maximum to the morbidity and mortality. Among these, water borne diseases like diarrhea, typhoid, infectious hepatitis etc. are on rise. Sometimes more than one type of infection coexists which makes the diagnosis and management a challenging task. We report a case of Coinfection of Salmonella typhi with Hepatitis A and E. A 5 year old male child came to us with complaints of fever and jaundice for last 9 days. Blood culture of patient was positive for Salmonella typhi. Viral markers turned out to be positive for Hepatitis A and E. To the best of our knowledge coinfection of Hepatitis A and E with Salmonella has rarely been reported earlier. In view of the restricted finances in our country vaccines against typhoid and Hepatitis A can not be incorporated in the national immunization schedule at present but these vaccines can be offered on an individual basis

Multivariate analysis of childhood microbial keratitis in South India

<p><b>INTRODUCTION</b>Corneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and treat, as they are unwilling and sometimes unable to cooperate during active management. This study analyses the prevalence, microbiology, demography, therapeutic and visual outcome of infectious microbial keratitis in the paediatric age group seen at a tertiary eye care hospital in south India.</p><p><b>MATERIALS AND METHODS</b>A retrospective review of all cases presenting with keratitis to the ocular microbiology and cornea service at Aravind Eye Hospital, Coimbatore, from February 1997 to January 2004, was done to screen the patients for microbial keratitis. Their records were further analysed for clinical and microbiological details. Cases with culture-proven non-viral keratitis in children <or=15 years were included in the study. Full ophthalmic examination was performed for all cases.</p><p><b>RESULTS</b>Of the 310 patients who attended the cornea clinic, 97 (31.2%) patients were confirmed to be positive for microbial keratitis. 54.6% of cases were male. The most common predisposing cause of ulceration was trauma (69%) with organic matter. Pure bacterial cultures were obtained from 64 (65.9%) eyes, whereas pure fungal cultures were obtained from 37 (38.1%) eyes. Four (4.1%) eyes showed mixed growth.</p><p><b>CONCLUSION</b>The most commonly isolated organism was Pseudomonas aeruginosa. The most common predisposing cause of infectious microbial keratitis was corneal trauma. Early stage of diagnosis and formulation of an uncompromising management protocol can prevent profound visual morbidity.</p>