Child Survival Status in India.

The National Health Mission (NHM, previously called National Rural Health Mission) was launched by Government of India in 2005 to make architectural correction of the Health system. One of the primary Goals of the Mission was to reduce Under five Mortality rate (U5MR) vis a vis Global commitment made under Millennium development Goals especially Goal numbering 4. Although, India still contributes to about one fifth of U5MR and Maternal Mortality rate but unfortunately it contributes to one third of Global Neonatal Mortality Rate. In sheer numbers alone, these rates are alarming. However, India has achieved a faster pace of reduction in U5MR by 46.5% in comparison to 41% for the entire world. In this article, data from Sample Registration System of the Registrar General of India which is available for most of the States/UTs has been analyzed for child health indicators in the country. In the next NHM phase, focused efforts need to be made with state specific Goals so as that the desired targets could be achieved.

Sensorineural hearing loss in patients with unilateral safe chronic suppurative otitis media.

Background: Chronic Suppurative Otitis Media (CSOM) is the major cause of hearing impairment, mainly conductive type of hearing loss. The occurrence of sensorineural hearing loss (SNHL) in CSOM is controversial and the controversy is more for safe mucosal type. This study aims to assess the association between SNHL and safe mucosal CSOM and its relation to patient’s age, sex, duration of disease, active or inactive disease and speech frequencies. Methods: 100 patients with unilateral mucosal type of CSOM with normal contralateral ear were included in the study. The infected ear was taken as study ear and normal ear as control ear in all patients. All patients underwent hearing assessment by pure tone audiometry for both ears. In case of active disease, ear discharge was first cleared and then audiometric assessment done. Results were statistically compared in all patients for both study and control ears using parameters of patient’s age, sex, duration of disease, speech frequency and active or inactive disease. Results: There was significant higher number of study ears with CSOM having average bone conduction threshold of all frequencies above 25 decibels which implies SNHL (21%) compared to control contralateral ears without infection (5%). There was higher incidence of SNHL at higher speech frequencies. The incidence also increased with age of patient and duration of disease. The incidence was higher in active stage than inactive or quiescent stage. There was no difference among males and females. Conclusion: Safe mucosal CSOM can cause significant SNHL and risk increases with increasing age, duration of disease, higher speech frequencies and presence of active disease.

Newer oral anticoagulants in perioperative settings

Newer oral anticoagulant agents [NOACs] have several potential merits over previously used vitamin K antagonists [VKAs] during the perioperative period, including a wider therapeutic index, higher efficacy, quicker onset and offset of action, high oral bioavailability, less need for monitoring, reduced variability in dose response and drug/dietary interactions and less adverse effects. These oral anticoagulants have discrete targets within the coagulation pathway. The patients on these drugs often present to anesthesiologists for routine or emergency surgery, hence the awareness of the pharmacological profile of these newer drugs is imperative to attain its optimal response. This update describes some of the new generation oral anticoagulants and focuses on its merits and demerits in the existing perioperative settings

Comparison of intraperitoneal and periportal bupivacaine and ropivacaine for postoperative pain relief in laparoscopic cholecystectomy: a randomized prospective study

Patients experience considerable pain during the first 24 hours after laparoscopic surgeries in spite of great progress in pain relief methods. Intraperitoneal local anesthetics in different doses have been used effectively to reduce this pain.The present study was conducted to compare whether moderate dose [75 mg] intraperitoneal and peri-portal bupivacaine or ropivacaine can produce effective pain relief after laparoscopic cholecystectomy. Eighty ASA I and II female patients undergoing laparoscopic cholecystectomy under general anesthesia were included in the study and were assigned to either of the two groups in a double blind randomized manner, Group B and Group R. At the end of the surgery, patients in Group B received 20 ml of 0.25% bupivacaine intraperitoneally and 10 ml was infiltrated in periportal area. Patients in Group R received 20 ml of inj. ropivacaine 0.25% intraperitoneally and 10 ml was infiltrated in periportal areas. Visual analogue score for pain and vital signs were recorded for 24 hours in the postoperative period. Injection of tramadol was administered as rescue analgesic. Total analgesic consumption in 24 hours and side effects were recorded. Statistically significant difference [p<0.05] was found in pain intensity [visceral and parietal pain] within groups during the first 4-6 hrs in the postoperative period. The total number of rescue analgesic doses were similar in both groups and statistically insignificant. Variables of post operative recovery were similar in both groups. Moderate dose intraperitoneal analgesia with local anesthetic [ropivacaine and bupivacaine] is simple to use and effective method with minimal side effects

Bilateral congenital lacrimal fistula in down syndrome

Congenital lacrimal fistulae are rare in Down syndrome and bilateral presentation is very unusual. It can be associated with nasolacrimal duct obstruction. We report a 3-year-old female with Down syndrome who presented with watering and discharge from both eyes and bilateral fistulous openings present inferonasal to the medial canthus. Upon examination, the lacrimal sac regurgitation test was positive on both sides. Our case report documents a distinctive case of bilateral congenital lacrimal fistulae in association with Down syndrome. It was managed successfully by primary fistulectomy and nasolacrimal duct probing

Prehospital trauma care services in developing countries

Trauma is a leading cause of death and disability especially amongst young people. Prehospital trauma care service remains a dynamic field of medicine for care of trauma patients. The goal of prehospital emergency care system should be to match the needs of the patients to the available resources so that optimal, prompt and cost-effective care can be offered. For bridging the wide gap between the actual and expected level of care, the urgent need must be appreciated by the community, administration, medical professionals and very positive steps should be taken to meet the future challenges. The authors included a "snapshot" of current articles applicable to prehospital trauma care in developing countries. The current review aims to explore the concept of "golden hour" and objectives, controversies and existing status of prehospital trauma care service using the recent evidence based literature in developing countries

Dual infection with hepatitis A and E virus presenting with aseptic meningitis: a case report

We report the case of a young male who presented with features of aseptic meningitis and elevated serum liver enzymes, but no symptoms or signs suggestive of an acute hepatitis. Subsequently, he was diagnosed with dual infection with hepatitis A and E viruses, and recovered completely with symptomatic therapy. Isolated aseptic meningitis, unaccompanied by hepatitic features is an unusual presentation of a hepatotrophic viral infection, and is yet to be reported with hepatitis A and E virus co-infection.

double blind, randomized, controlled study of the effect of addition of butorphanol to 0.25% bupivacaine for bilateral ilioinguinal nerve blocks in post-caesarean patients

Ilioinguinal nerve block [IIB] is highly effective in controlling postoperative pain following inguinal herniorrhaphy, orchidopexy and caesarean sections. Butorphanol has been claimed to increase the duration and quality of analgesia in various nerve blocks. This prospective, randomized, double blind study was designed to compare the effect of butorphanol when added to bupivacaine [0.25%] with plainbupivacaine [0.25%] in bilateral IIBs in post-caesarean patients. This prospective, double blind, randomized, controlled study was conducted at University College of Medical Sciences / GTB Hospital, Delhi, which is a tertiary care healthcare centre, from March 2006 to December 2008. Sixty ASA 1 or 2 patients, scheduled for elective caesarean section via Pfannensteil incision under general anaesthesia, were selected for the study. The patients who had a known allergy to any of the drugs used; or had placenta previa, eclampsia or severe preeclampsia were excluded from the study. The patients were randomly divided into two groups of 30 each; Group A, to receive bilateral IIB with 0.25% bupivacaine [to a volume of 10 ml on each side], and Group B to receive bilateral IIB with 0.25% bupivacaine plus 1 mg butorphanol. The randomization was clone using computer generated random number tables. All the patients completed the study. After administering appropriate antacid prophylaxis, routine general anaesthetic technique was used with rapid sequence intubation. At delivery of baby, all patients received oxytocin infusion followed by inj. morphine [0.1 mg/kg] intravenously. Just after the last stitch, bilateral IIB was performed using the prefilled syringes with the block solution. Neuromuscular blockade was reversed and inj. diclofenac sodium [1.5 mg/kg i.m.] was selected as a rescue analgesic. Numeric pain scale [marked 0-10] and simple descriptive pain scoring were used for assessment of pain intensity at 1 st, 2nd, 3rd and 4th hours postoperatively and then after 24 hours. The time to first rescue analgesic was noted and the study was terminated with that. The adverse effects, if any, were also noted. More than 86% of Group B and 70% of Group A complained of no pain in immediate 4 hours of postoperative period. In Group B, six patients felt no pain even after 4 hours of postoperative period. In Group A, all patients developed pain after 2 hours. Maximum analgesic effect was observed in Group B [18 hours]. Bilateral IIB with 0.25% bupivacaine and 2 mg of butorphanol is more effective and safe post-operative analgesic technique in patients undergoing caesarean section

Incidence of hepatocellular carcinoma among Indian patients with cirrhosis of liver: an experience from a tertiary care center in northern India.

BACKGROUND/AIM: Despite bearing the main burden of HCC, prospective studies from developing countries are lacking. This prospective observational study was designed to estimate the incidence of HCC among Indian patients with hepatic cirrhosis. METHODS: Between April 2001 and November 2004, we enrolled 301 patients with liver cirrhosis. Patients found to be free of HCC using baseline abdominal ultrasound, triple-phase computed tomography (TPCT) and serum alpha-fetoprotein (AFP) levels were followed up prospectively for detection of HCC using ultrasound and AFP every 6 months, and TPCT annually. RESULTS: Among the 194 patients (mean age [SD] 45.1 [+/-13.1] years; male:female 6.1:1.0) followed up, 154 had Child's A and 40 had Child's B disease. The causes of cirrhosis were: hepatitis B-71 (36.6%), hepatitis C-54 (27.8%), dual infection with hepatitis B and C-12 (6.2%) and others including autoimmune, alcoholic and cryptogenic cirrhosis 57 (29.4%). During a cumulative follow up period of 563.4 person-years, 9 cases of HCC were detected, with an incidence rate of 1.60 per 100 person-years. CONCLUSION: In our study, the incidence of HCC among patients with liver cirrhosis was intermediate, being lower than that in Japan but higher than that reported from Europe.