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Background: Thyroid hormone metabolism disrupts after cardiopulmonary bypass both in adults and pediatric patients. This is known as Euthyroid sick syndrome, and it is more evident in pediatric patients who were undergoing complex cardiac surgeries compared to adults. This decrease in serum T3 levels increases the incidence of low cardiac output, requirement of inotropes, prolonged mechanical ventilation, and prolonged intensive care unit (ICU) stay. Aims and Objectives: The primary objective was to compare the mean Vasoactive?inotropic score (VIS) at 72 hours postoperatively between T3 and Placebo groups. Materials and Methods: One hundred patients were screened, and 88 patients were included in the study. Triidothyronine 1 mic/kg 10 doses 8th hourly was given orally postoperatively to cases and sugar sachets to controls. The blood samples for analysis of FT3, FT4, and TSH were taken every 24 hours postoperatively, and baseline values were taken after induction. Mean VIS scores, ejection Fraction (EF), Left ventricular outflow tract velocity time integral (LVOT VTi), hemodynamics and partial pressure of oxygen/ fraction of inspired oxygen(PaO2/ FiO2) were recorded daily. Results: The Mean VIS scores at 72 Hours postoperatively were significantly less in the T3 group (5.49 ± 6.2) compared to the Placebo group (13.6 ± 11.7).The PaO2/FiO2 ratios were comparatively more in the T3 group than the Placebo group.The serum levels of FT3 FT4 were significantly higher in the T3?supplemented group than the Placebo group.TheVIS scores were significantly lower from48 hours postoperatively in children < 6 months of age. Conclusion: In this study, we observed that supplementing T3 postoperatively decreases the ionotropic requirement from 72 hours postoperatively. This is more useful in children <6 months of age undergoing complex cardiac surgeries.
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Background: There is increasing evidence that neonatal seizures have an adverse effect on neurodevelopmental progression and it may predispose to cognitive, behavioral or epileptic complications later in life. The objective of this study was to compare the efficacy of phenobarbitone and levetiracetam for the treatment of neonatal seizures in term and late preterm neonates. The study was aimed to know the efficacy of phenobarbitone (PB) in comparison with levetiracetam (LEV) in controlling neonatal seizures.Methods: This was a randomized controlled trial where data of the babies with seizures weighing more than 2 kg who were admitted in NICU of Muzaffarnagar Medical College was collected and analysed for intervention to either phenobarbitone or levetiracetam.Results: Clinically apparent seizures were controlled in only 65.38% neonates assigned to receive levetiracetam as compared to 76.92% neonates assigned to receive phenobarbitone.Conclusions: LEV although lesser effective than PB with very fewer side effects is found to be a good alternative in controlling neonatal seizures.
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Background: Hepatitis B virus (HBV) infection is a global health problem. Over two billion people have been infected with hepatitis B virus globally, of whom over 350 million are chronic carriers. Vertical (mother to child) and horizontal early childhood transmission are the main routes of HBV transmission and are responsible for most chronic infections. The aim of this study was to study the role played by different modes of transmission of HBV and to study the burden of hepatitis B in pediatric age group.Methods: All children below 12 years of age, admitted for jaundice, of both sexes, during one year study period were included. 50 patients (control) who were not suffering from jaundice or known liver disease were also included.Results: Prevalence of HBsAg positivity among jaundiced children was 15.24%. There was increase in HBsAg positivity with increase in the age signifying role of horizontal mode of transmission in Hepatitis B virus infection.Conclusions: HBV infection is an important health problem in paediatric age group. Horizontal mode of transmission plays important role in the spread of HBV infection among children.
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Background: Remedial action that a person takes to treat his or her perceived illnesses, is called health-seeking behaviour. Understanding health seeking behaviour (HSB) in a community and the factors which influence their decision, are crucial for planning a “need based” comprehensive health care programmes for the people, especially for underprovided and rural population. The objective of present study was to determine HSB and its determinants in a defined rural population.Methods: A community based cross -sectional study was conducted in rural field practice area of A. J. Institute of Medical Sciences and Research Centre, Mangalore (Karnataka) from 1st October 2017 to 31st July 2018. A total of 866 heads of households were included in the study, using universal sampling method. A pre-tested, validated questionnaire was used to collect the data. p values of <0.05 were considered significant.Results: Among 866 participants, almost all (98.03%) heads of families were males, while majority of them (35.68 %) were farmers. Further, majority (48.15%) of the households preferred to visit government hospitals for their ailments, while among those visiting private practitioners, majority of them (55.54%) preferred Allopath system of medicine. Health insurance subscription rates were found to be low (18.93%). Main determinants of HSB were observed to be cost of treatment, convenience of approach, quality of services and life threatening emergencies.Conclusions:Present study brings out higher utilization of government health care facilities among the study subjects, while cost of treatment and life threatening emergencies were the main predictors of HSB.
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Antibiotics are an indispensable part of modern medicine. However, as with all drugs,antibiotics may have adverse effects and medication errors can occur in prescribing. Another untowardeffect of antibiotics is the selection of antibiotic-resistant bacteria. A clear relationship has been foundbetween the percentage of resistant strains and antimicrobial use. In addition, only around 60 % ofempirically started antibiotics are considered appropriate. Finding a balance between adequateantibiotic use for the individual patient, avoidance of selection of antibiotic resistance, and medicationerrors is the key role of antibiotic stewardship teams. ASTs have been shown to increase appropriateempirical antibiotic therapy and reduce medical errors and costs. In this study, a total of 124 cases werestudied, On the first day of survey, a total of 29 patients were prescribed with antimicrobials, out ofwhich 37.93% patients were prescribed with empiric antimicrobial therapy whereas on the second dayof survey, a total of 31 patients were prescribed with antimicrobials among which 67.74% patients weregiven empiric antimicrobial therapy. On the third day of survey, 29 patients were given antimicrobials,in which a percentage of 86.21% patients were on empirical antimicrobials. By the time of fourth day ofsurvey, the number of patients being prescribed with antimicrobials was 35, out of which 80.00%patients were given empirical therapy of antimicrobials. The empirical antimicrobial usage in adultintensive unit areas was high on an average (67.97%); whilst the use of definitive therapy was low andantimicrobials were prescribed majorly for prophylaxis (53.22%). Also, majority of the antimicrobialsbeing prescribed in the intensive care areas were in compliance with the local antimicrobial policy ofthe hospital (average compliance rate was 80.20%).
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Masses in nasal cavity form a heterogeneous group of lesions with a broad spectrum of histopathological features. The present study was histopathological assessment of lesions of nasal cavity. Methods: This present study was conducted on 113 specimens of nose obtained from ENT department. The sections were stained with haematoxylin and eosin, dried and mounted in DPX and then microscopy was done. Results: Maximum specimens were obtained from age group 21-30 years (45), followed by 31-40 years (28), 11-20 years (24), 41-50 years (13) and >50 years (3). The difference was significant (P< 0.05). Non neoplastic nasal lesions were 82 which comprised of polyps (66), mucormycosis (14), rhinophyma (2). Out of 16 neoplastic (benign) nasal lesions, inverted papilloma was seen in 8, hemangioma in 3, angiofibroma in 2, ossifying fibroma in 2. Out of 8 neoplastic (borderline) nasal lesions, 8 were hemangiopericytoma. Out of 7 neoplastic (malignant) nasal lesions, SCC was seen in 4 and BCC in 3. Conclusion: Common nasal lesions were seen in age group 21-30 years and maximum lesions were non- neoplastic nasal lesions and neoplastic (benign) nasal lesions.
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Background: India with 50% percent of its population in reproductive age group is the second most populous country in the world with an estimated population of 1.37 billion and if measures are not taken; it is likely to rise to 1.68 billion by the year 2050.The answer lies in promoting small family norms by modern contraceptive methods with the proposed goal of 75% coverage by 2030. In the backdrop of above present research was conceived to study, the knowledge, attitude and practices of contraception among urban women in Mangaluru, Karnataka. Methods: Present study is a cross sectional study. A total of 110 urban women were evaluated with the help of a pre-designed and pre-tested questionnaire for the knowledge, attitude and practices on various prevalent contraceptive methods. Results: Though all the participants were found to be aware of available contraceptives, only 57.3% of them had used one or the other method in their life time. The attitude of large majority (82.7%) of study subjects was found to be positive. The most commonly used contraceptive was condom 73.9%, followed by oral pills (39.2%) and Copper -T (23.9%). Desire for male child (30.1%), lack of awareness (15.1%) and fear of side effects (11.3%) were cited as the main barriers to the use of contraceptives. Conclusions: The study brings out the need for health educational strategies to create awareness in the community on family planning and contraceptive methods.
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Background: Malaria is a global health problem leading to huge morbidity and mortality. India accounts for 4% of global malaria cases and 52% of malaria deaths outside the African region. A disease that was relatively unknown in Mangaluru till 1990, has shown consistent rise till 2015 killing nearly 300 people. Though, declining trends are being observed since 2015, yet its incidence continues to be high. Present study was undertaken to study clinical as well as epidemiological factors associated with malaria transmission in Mangaluru.Methods: A record based retrospective study was conducted in A J Institute of Medical Sciences and Research Centre Mangaluru tertiary care hospital. The data was retrieved from the Medical Record Department of the hospital for three years i.e. 2015 to 2017 and analysed.Results: A total of 1779 confirmed cases of malaria were admitted during the study period. Out of these 1309 (73.58%) cases were due P. vivax, 73 (04.10%) cases due to P. falciparum 306 (17.20%) cases had mixed infections while species of remaining 91 (05.11%) cases remained unspecified. A peak in the number of inpatients was seen in June while mean duration of hospital stay was 5.17±3.31 days. A total of 252 (14.16%) patients had one or more severe manifestations of malaria as per WHO guidelines.Conclusions: The present study reveals that majority of admitted malaria cases were young adult males belonged to urban area. Majority of the cases were infected by Plasmodium vivax or had mixed infections.
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Neurofibromas (NFs) are benign tumors involving any nerve from the root level to the smallest branch. They may enlarge locally and cause a pressure effect on thoracic structures such as trachea, superior vena cava, and esophagus. Pulmonary and pleural involvement is very rarely seen. We have reported a case of a pleural effusion secondary to lymphatic obstruction due to remnant NF for which patient had undergone surgical resection in the past.
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Background: Breast cancer shows marked heterogeneity which is proven by the fact that tumors with similar morphologic and immuno histo-chemical features show distinct clinical behavior and different response to therapy. This led to microarray-based global gene expression profiling (GEP) and new avenues for classifying breast cancer into molecular subtypes. Among all molecular subtypes, the worst prognosis group has been identified as triple negative phenotype (TN). Further within this group, basal like breast cancer (BLBC) was identified using a 5 marker surrogate panel including ER-PR-HER2–negative and basal markers i.e. epidermal growth factor receptor (EGFR) or Cytokeratin 5/6 (CK5/6) positive. CK 5/6 is easily available and specific IHC surrogate basal markers and can be readily included in a five marker panel in prognostication of breast cancers. BME is not limited to triple negative subtypes but is also seen in other molecular subtypes. Methods: 61 cases of invasive breast carcinoma in which detailed clinical and histological prognostic factors could be determined were classified into molecular phenotype using IHC surrogate classification. Tumors expressing basal markers CK5/6 were classified as basal marker expressing (BME) tumors and were also compared with ER, PR, Her-2/neu expressing and also triple negative tumors. These tumors were compared with various prognostic and predictive markers of invasive breast carcinoma. Results: BME was seen in 50/106 cases. Also BME showed a significant association with tumor necrosis, lymph node metastasis and high histological grade. Conclusion: BME in breast carcinomas is an independent prognostic marker and its expression is not limited to triple negative cases. An expanded surrogate panel of ER, PR, Her-2 neu, and CK 5/6 provides more prognostic value than three panel marker.
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Background & objectives: A retrospective study on chikungunya outbreak in India in five States viz. Delhi, Madhya Pradesh, Orissa, Maharashtra and Kerala was conducted in 2007-2008 to know the distribution and determinants of chikungunya fever outbreak in India. Methods: On the basis of high and low incidence of chikungunya fever, two districts from each State and two wards from the selected district were taken for random selection of 1000 households from 10 districts and 5 States. Semi-structured questionnaires were administered to individuals, patients, qualified health professionals and to stakeholders for collecting information. Results: The educational background and occupation of the respondents showed variations across the study States. Only in high incidence ward of Maharashtra, water storage period for 3-6 days and emptying, drying of water containers on weekly basis was noted. The study through knowledge, attitude, belief, practice (KABP) obtained individual's perception of chikungunya fever, its prevention and control. Patients’ expenditure on treatment was mainly recorded less than Rs 500 across study States. Health facility survey obtained an overview of the capacity of local health facilities. Stakeholders’ perception regarding chikungunya fever was also noted. Interpretation & Conclusions: The study revealed differences in awareness of chikungunya, cause of the disease, vector responsible, mode of transmission, biting time and elimination of breeding of mosquitoes statistically significant among high and low incidence wards of all the States. Expenditure on treatment was independent of economically active status and loss of man-days across all the States. Education and occupation did not have any relation with emptying/drying of water containers in high incidence wards. Strengthening of surveillance, information, education and communication (IEC) activities along with case management facilities may be provided by the State health department for prevention of chikungunya outbreaks in future. Stakeholders should be more involved in outbreak management and future planning.
Subject(s)
Alphavirus Infections/epidemiology , Chikungunya virus/isolation & purification , Disease Outbreaks , Humans , Incidence , India/epidemiology , Retrospective Studies , Urban PopulationABSTRACT
Intrapericardial tumours can cause cardiac compromise either from pericardial effusion producing cardiac tamponade or from the mass obstructing the outflow from the heart or both. Respiratory embarrassment may also be present if the mass compresses the trachea or the main stem bronchus. A 1-month-old child presented in the emergency needing prompt measures to relieve compressive symptoms. Successful anaesthetic and surgical management led to uneventful recovery. Histopathology of the mass revealed a rarely occurring intrapericardial teratoma. After surgical removal, the child had clinical follow-up for more than a year. Intrapericardial teratoma is a rare entity that presents a diagnostic and therapeutic challenge. The authors describe the case of a 1-month-old male child with this condition who was successfully managed by resection of the mass.
Subject(s)
Anesthesia, General/methods , Heart Neoplasms/complications , Humans , Infant, Newborn , Male , Pericardial Effusion/etiology , Pericardium/surgery , Respiratory Distress Syndrome, Newborn/etiology , Teratoma/complications , Treatment OutcomeABSTRACT
Prevalence of covert bacteriuria in patients of nephrotic syndrome admitted for kidney biopsy was studied in 205 patients. Age ranged from 10 years to 65 years. 148 patients were male and 57 were female. Prevalence of covert bacteriuria was found in 38 patients (18.53%). In bacteriuric patients 30 were male, 8 were female. Escherichia coli was the commonest organism grown in bacteriuric patients (30 or 78.9%). Serum albumin was low and 24-hour urinary protein excretion was high in bacteriuric patients in comparison to abacteriuric patients. In bacteriuric patients membranous nephropathy was the commonest histopathological finding present in 15 patients (39.47%).