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Abstract Introduction: Acyanotic congenital heart disease (ACHD) patients with pulmonary hypertension (PH) are prone to postoperative complications, and characterization of the risk profile continues to fail in identifying inflammatory predilection. Our objective is to investigate the role of platelet-leukocyte indices (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII] [neutrophil × platelet/lymphocyte]) in predicting poor outcomes following cardiac surgery in ACHD cohort with preoperative PH. Methods: This single-center, retrospective risk-predictive study included ACHD patients undergoing surgical correction at our tertiary cardiac center between January 2015 and December 2019. Standard institutional perioperative management protocol was followed, and poor postoperative outcome was defined as ≥ 1 of: low cardiac output syndrome, new-onset renal failure, prolonged mechanical ventilation (MV > 24 hours), stroke, sepsis, and/or death. Results: One hundred eighty patients out of 1,040 (17.3%) presented poor outcome. On univariate analysis, preoperative factors including right ventricular systolic pressure (RVSP) (PH-severity marker), congestive heart failure, albumin, NLR, PLR, SII, and aortic cross-clamping (ACC) and cardiopulmonary bypass (CPB) times predicted poor outcome. However, on multivariate analysis, RVSP, NLR, SII, and ACC and CPB times emerged as independent predictors. An NLR, SII prognostic cutoff of 3.33 and 860.6×103/mm3 was derived (sensitivity: 77.8%, 78.9%; specificity: 91.7%, 82.2%; area under the curve: 0.871, 0.833). NLR and SII values significantly correlated with postoperative MV duration, mean vasoactive-inotropic scores, and length of intensive care unit and hospital stay (P<0.001). Conclusion: Novel parsimonious, reproducible plateletleukocyte indices present the potential of stratifying the risk in congenital cardiac surgical patients with pre-existing PH.
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The diagnosis of congenital pseudarthrosis of the tibia (CPT) in pediatric age group is difficult (1), particularly if the patient had repeated trauma and was mismanaged.[2,3] The etiology of congenital pseudarthrosis is unknown. Mostly patient presents with neurofibromatosis.[4] Most of cases have defect on anterolateral angulation. Most effective treatment option for CPT is surgery. Surgical methods like Ilizarov technique, intramedullary fixation, and grafting [5] with combination of two or three types surgeries. However, Ilizarov ring fixation is the most effective treatment option. Every surgery should include correction of deformity, bone remodeling, limb lengthening, and complete removal of the lesion. Many patients developed deformity and degenerative arthritis of knee and ankle joints. Unfortunately, operation can’t differ according to the nature of disease history and pathology.[1] As such cases should undergo Ilizarov ring fixation. Most common complication was refracture. Therefore, an effective, safe and practical treatment method that minimizes the residual challenges after healing and accomplishes the multiple goals of treatment is needed.
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Fractures of the femur are the most incapacitating fractures. For children aged 6-16 years, there is no clear consensus as to the preferred treatment. The conventional treatment of traction and casting is no longer preferred. We report our experience in titanium elastic nailing for treatment of paediatric femoral diaphyseal fractures. We wanted to study the functional outcome following the use of flexible titanium nails for femoral shaft fractures in children and evaluate the duration of union in the above-mentioned fractures. We also wanted to study the complications of fracture shaft femoral after intramedullary nailing.METHODSThirty patients in the age group of 6-16 years with displaced diaphyseal femoral fractures were stabilized with titanium elastic nails. Patients were followed up clinically and radiologically for a minimum period of 6 months to 1 year. The final results were evaluated using Flynn’s criteria. Technical difficulties and complications associated with the procedure were also analysed.RESULTSOverall results were excellent in 28 cases and satisfactory in 02 cases. No patient had poor result. The average hospital stay was 6.47 days. All the fractures healed in 70 days (10 weeks) of times with an average time of union of 60 days (7.5 weeks). The most common complication encountered was soft tissue irritation at the nail entry site seen in 2 cases. Clinically, shortening was noticed in 3 cases, while no patient had lengthening. Malalignment was seen in only 6 cases. There was no iatrogenic bone injury, delayed injury and non-union, bending or breaking of implant, refracture and avascular necrosis of femoral head. There was no evidence of physeal injury on follow up.CONCLUSIONSTitanium elastic nails are a relatively easy to use, minimally invasive, physeal-protective implant system with high rate of good and excellent outcomes in children aged 6-16 years. Technical pitfalls can be eliminated by adhering to the basic principles.
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Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Fractures around the elbow are a great challenge to orthopaedic surgeons. Clinical diagnosis may be difficult due to noncooperative patient and massive swelling around the elbow. Displaced type of supracondylar fractures poses problem not only in reduction but also in maintenance of reduced fracture and rapid inclusion of nerves and vessels.Methods: The present study was conducted on 30 cases of displaced supracondylar fracture humerus in children, aged 2-14 years, who were treated by CRPP with either lateral entry of k-wires or a lateral wire and a vertical wire through olecranon (transolecranon).Results: Both the Groups achieved 90% satisfactory results, but 10% unsatisfactory results recorded in Group A only rather than in Group B.Conclusions: Although the transolecranon wire has the disadvantage of limiting the flexion and extension of the elbow, this does not influence the final-outcome much as the elbow is fixed in a POP splint for minimum 3 weeks-in all patients in both groups.
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ABSTRACT Strain RT1 was isolated from root nodules of Lens culinaris (a lentil) and characterized as Rhizobium etli (a Gram-negative soil-borne bacterium) by 16S rDNA sequencing and phylogenetic analysis. The signaling molecules produced by R. etli (RT1) were detected and identified by high-performance liquid chromatography coupled with mass spectrometry. The most abundant and biologically active N-acyl homoserine lactone molecules (3-oxo-C8-HSL and 3-OH-C14-HSL) were detected in the ethyl acetate extract of RT1. The biological role of 3-oxo-C8-HSL was evaluated in RT1. Bacterial motility and biofilm formation were affected or modified on increasing concentrations of 3-oxo-C8-HSL. Results confirmed the existence of cell communication in RT1 mediated by 3-oxo-C8-HSL, and positive correlations were found among quorum sensing, motility and biofilm formation in RT1.
Subject(s)
4-Butyrolactone/analogs & derivatives , Biofilms , Quorum Sensing , Rhizobium etli/physiology , 4-Butyrolactone/chemistry , 4-Butyrolactone/metabolism , Lens Plant/microbiology , Plant Roots/microbiology , Rhizobium etli/chemistry , Rhizobium etli/genetics , Rhizobium etli/isolation & purificationABSTRACT
Early diagnosis and prompt initiation of treatment are essential for an effective tuberculosis (TB) control program. This study was done to assess the extent of various delays among TB patients diagnosed at medical colleges of Puducherry. A cross-sectional study involving retrospective medical record review and prospective patient interviews was conducted in and around the union territory of Puducherry during the period 2009-10. Various delays and adjusted odds ratios (ORs) were calculated. Level of significance was determined at 95% confidence interval (CI) (P value <0.05) and all tests were two-sided. Among 216 new sputum smear-positive TB patients, 11.1% and 10.6% were smokers and alcohol users, respectively. The median patient delay, health system delay, and total delay was 37 days, 28 days, and 65 days respectively. Being a resident of Puducherry (OR = 0.39, 95% CI = 0.18-0.87) and family size of ≤5 (OR = 0.45, 95% CI = 0.21-0.97) were found as the determinants of patient delays and total delays, respectively.
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Background: Maternal mortality is an important indicator of women’s health and social well-being. According to the WHO report, each year, an estimated 190 women for every 100,000 live births die due to maternal causes. In India, unsafe abortion and related complications accounts for 9% of all maternal deaths. Abortion was made legal in India by the Medical Termination of Pregnancy (MTP) act, which was enacted by Indian Parliament in the year 1971. But the number of unsafe abortions has not declined. Methods: A present study was conducted by the Department of Obstetrics and Gynaecology of Pondicherry Institute of Medical Sciences, in Puducherry, India. All undergraduate students of VIIth semester MBBS participated in the study. A pre-designed semi-structured questionnaire was used to collect information regarding the awareness and perceptions on abortion care and Medical Termination of Pregnancy Act in India. Data were entered in Microsoft Excel 2007. Averages were calculated and chi square test was applied to find the significant difference. Results: Among a total of 75 participants, 41(54.7%) were female and 34 (45.3%) were male students. Majority of the students (97.3%) were aware of the fact that unsafe abortions are a serious health problem in India and all of the students (100.0%), were aware of the MTP Act of India. But only 36.0% students were aware of the fact, that consent from husband was not required to undergo abortion. To reduce the number of unsafe abortions in India majority of the medical students (45.3%) were of the opinion that easy access to MTP services in the community is an effective measure. Conclusions: Legalization of abortions through the MTP Act in India resulted in a considerable decrease in maternal mortality through the decline in abortions but it has failed to ensure effective implementation and access to medically safe abortion services. Training in basic contraceptive counseling and abortion care should be incorporated in basic medical education in India.
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Background: Malnutrition and poor health among school children is the common cause of low school enrolment, high absenteeism, early dropout and poor classroom performance. This study was conducted to assess the various morbidities and nutritional status among school children. Methods: This descriptive study was conducted during year 2013 in a higher secondary school located in a coastal area of Puducherry. A total of 714 students were interviewed and examined. A pre-designed and pre-tested questionnaire was used to interview and examine all the participated students. Body weight and height were measured using standardized procedures. WHO criteria for classification of nutritional status was used. Visual acuity and colour vision was assessed using Snellen’s chart and Ishihara’s pseudo isochromatic chart respectively. Mean scores and proportions were calculated and chi-square test was applied. P value of <0.05 was considered as statistically significant. Results: Among 714 student, 369 (51.4%) were males and 345 (48.6%) were females. The mean age of children was 10.2 ± 3.1 years. Among all age groups and both sexes, the observed BMI was lower as compared to the reference values. The prevalence of underweight among children of 5-9 years was (30.7%) and (1.1%) were severely underweight. The prevalence of stunting was 10.4%, including 0.1% of severely stunted children. A total of 30.7% children were thin (low BMI for age). Pallor (39.5%), myopia (34.9%) and dental caries (14.7%) were the common morbidities observed among children. The pallor was observed more commonly among girls and this difference was statistically significant (p value <0.05). Conclusion: Under-nutrition is a prevalent condition among school children. Apart from various nutritional programmes, health education to parents, community and school teachers are quite important to address this problem.
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Background: Early diagnosis of the disease and prompt initiation of treatment are essential for an effective tuberculosis (TB) control program. The delay in the diagnosis and treatment may worsen the disease, increases the risk of death and enhances tuberculosis transmission in the community. This study was done to assess the extent of various delays and their determinants among TB patients. Methods: A cross-sectional study including retrospective medical record review and patient interviews was conducted during the year 2010 in and around union territory of Puducherry in India. A structured questionnaire used in the WHO multi-country study to estimate the diagnostic and treatment delay in TB was used to interview the patients. Average estimates and proportions were calculated for continuous and categorical variables respectively. Unadjusted odds ratios (OR) were calculated. Level of significance was determined at 95% confidence level (P value <0.05) and all tests applied were two-sided. Results: A total of 138 new sputum smear positive TB patients were included in the study. The mean age of participants was 41.8 years ± 17.3 years (range 15-87 years). Majority (67.4%) of the patients were male and married (68.8%). Majority (86%) of the patients were literate. The median patient delay, health system delay and total delay was 36 days, 28.5 days and 81 days respectively. The place of residence (OR = 0.39, 95% CI = 0.18-0.87) and family size (OR = 0.45, 95% CI = 0.21-0.97) were found as the determinants of various delays for TB patients. Conclusion: Patient and health care system delay for TB patients is long. There is need to improve the referral mechanism to ensure an early initiation of treatment for TB patients diagnosed a tertiary care hospitals.
Subject(s)
Humans , Male , Female , Blepharospasm/therapy , Hemifacial Spasm/therapy , Treatment OutcomeABSTRACT
To determine the frequency of thyroid dysfunction in patients with chronic hepatitis-C. Case-series study. Department of Medicine, outpatient department of Internal Medicine at Aga Khan University Hospital Karachi. From April 25[th] till October 25[th] 2008
Subject(s)
Humans , Male , Female , Hepatitis C, Chronic/physiopathology , Thyroid Gland , Hypothyroidism , Hyperthyroidism , Hepatitis C , HepacivirusABSTRACT
To determine the frequency of clinical and subclinical hypothyroidism in patients with chronic hepatitis-C. Case-series study. Department of Medicine, outpatient department of Internal Medicine at Aga Khan University Hospital Karachi. From April 25th till October 25th 2008. A total of 73 patients were enrolled in the study. Data was entered and then analyzed using Statistical Packages for Social Sciences [SPSS] Version 14. Results are given for quantitative variables such as age are presented as means +/- Standard deviation and percentages are presented for hypo and hyperthyroidism. Stratification on age, gender, ALT levels and gender is undertaken to control for effect modification. Out of total of 73 patients 8 patients [11% of total patients] were found to be suffering from hypothyroidism. Out of these 8 patients 2 patients were males [6.9% of total male patients] and 6 patients were females [13.6% of total female patients]. Known duration of chronic hepatitis C infection in most of the patients suffering from hypothyroidism was 6-12 months [6 patients], however rest of 2 patients had known duration of chronic hepatitis C greater than 13 months. Looking at the ages of the patients in the study group with hypothyroidism showed that half [4 out of 8] patients were in the age group 35-43 years, however 2 patients were younger to the former group and were in the 25-34 age group, and remaining 2 patients were over the age of 44 years