Pediatric Pneumonia: A Review of Clinical Practice Essentials – A Clinical Study in a Tertiary Hospital

Background: Lower respiratory tract infections are common cause of morbidity in infants and preschool children. Among them,infectious pneumonia is foremost in causing serious illness and creates problems in its diagnosis. Determination of exact etiology ofpneumonia is uncertain due to difficulty in obtaining suitable and adequate samples and shortage of accurate diagnostic methods.Aim of the Study: The aim of the study was to review the clinical diagnosis, investigations, diagnosis, and management ofpneumonia in children in the light of the WHO guidelines.Materials and Methods: A total of 79 children with pneumonia attending a tertiary teaching hospital were included in thestudy. Children aged between 2 and 59 months were included in the study. Children satisfying WHO criteria for the diagnosisof pneumonia were included from the study. Children with documented evidence of comorbidities were excluded from thestudy. Demographic data, nutrition history including breastfeeding practices, immunization history, and treatment history, wereelicited. Children were divided as Group A: Children with weight for age <3rd percentile, and Group B: Children with weight forage ≥3rd percentile. Investigations included radiological, hematological investigations such as complete blood picture, sputumexamination, and nasopharyngeal aspirates analysis for organism and blood cultures were done. All the children were treatedfollowing the WHO guidelines. The hospital stay was grouped as <1 week group and more than 1 week group.Observations and Results: Among 79 children there were 43 (54.43%) male children and 36 (45.56%) female children. Theyoungest child was 2 months old and the eldest child was aged 57 months old with a mean age of 28.4 ± 1.3 months. Childrenbelonging to Group A were 40 (50.63%) and belonging to Group B were 39 (49.36%). Among 79 children, 46/79 (58.22%) werediagnosed as “Pneumonia” and the remaining 33/79 (41.77%) children as severe pneumonia. 62/79 (78.48%) children below36 months (3 years) were found to have either pneumonia or severe pneumonia. 17/79 (21.51%) children belonged to theage group above 36 months were found to have either pneumonia or severe pneumonia in this study. 39/62 (62.90%) childrenwho had pneumonia were below 36 months and 23/62 (37.09%) children who had severe pneumonia were below 36 months.Conclusions: Pneumonia is a clinically curable disease when identified and initiated on recommended treatment protocols.Lack of exclusive breastfeeding till 6 months of age, failure of complete immunization coverage, child malnutrition, infancy, andtoddler age are the risk factors for both types of the pneumonia but more so with severe pneumonia. There was no statisticalsignificance correlating the X-ray findings and severity of pneumonia was observed.

Health-care quality from patients’ perspective: A cross-sectional study at anti-rabies clinic of a tertiary care center, Bengaluru

Background: Rabies is a highly fatal viral disease, yet preventable through timely administration of post-exposure prophylaxis (PEP). Anti-rabies clinic (ARC) plays an important role in providing PEP. Evaluation is a systematic way to improve current activities and by careful selection of alternative ways for better planning of future. Objective: The study was done with the intention to identify the gaps in the patients’ care in terms of patient satisfaction at ARC of a tertiary care center, Bengaluru. Materials and Methods: A cross-sectional study was conducted among 260 animal bite victims who visited outpatient department of ARC. The study tool comprised three sections; socio-demographic profile, details of animal bite, and patient satisfaction scale (PS-18) which was scored using 5-point Likert scale. T-test, analysis of variance and Pearson’s correlation was used to assess the relationship between quality dimensions and PS-18 scores. Results: The mean age of the study participants was 37.33 (17.71) years and majority were males. The overall mean score of PS-18 was 4.15 (0.42). The highest and lowest mean scores of PS-18 among the components were given to communication, 4.36 (0.61) and accessibility, 3.56 (0.75), respectively. There was significant association between religion, frequency of visit, category of bite, and cost incurred with mean scores of PS-18. Out of 260, about 62.7% of them gave good scoring for PS-18. Conclusions: The study findings showed that more than half of the patients visiting the outpatient department shared a positive experience. Although the mean scores for overall PS-18 scale belonged to the grade of good scoring; due interest to be taken to improve accessibility and convenience which was the least scored among the components of PS-18.

Understanding the structural changes following photodynamic and transpupillary thermotherapy for choroidal hemangioma using optical coherence tomography and optical coherence tomography angiography

Purpose: To study optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) features of circumscribed choroidal hemangioma (CCH) following treatment with photodynamic therapy (PDT) and transpupillary thermotherapy (TTT). Methods: A retrospective chart review of consecutive patients treated for CCH over 2 years (May 2016�April 2018). The investigations, in addition to comprehensive eye examination, included color fundus photography, B-scan ultrasonography, OCT, and OCT-A. Results: The study included 16 eyes of 16 patients (9 males and 7 females). The mean age at presentation was 43.5 � 9 years (range 33�62 years). Macula (n = 6) and superior arcade (n = 5) were the common tumor locations. Twelve eyes received multiple treatment sessions: TTT (seven eyes; mean 2.4 sessions) and PDT (five eyes; mean 2 sessions). Four eyes were observed because vision was not threatened. Pretreatment OCT features were Bruch's membrane atrophy (15 eyes), retinal pigment epithelial atrophy (13 eyes), outer retinal abnormalities (12 eyes), and macular subretinal fluid (12 eyes). Pretreatment OCT-A features were complete loss of choriocapillaris (16 eyes), irregularly arranged fine arborizing vessels (11 eyes), and more than 50% signal void hyporeflective areas (12 eyes). Posttreatment OCT-A showed persistence of choriocapillaris loss, flat scar with fibrosis and thinning of choroid in all eyes treated with TTT, and persistence of deeper choroidal vessels and no loss of choriocapillaris in eyes treated with PDT. Conclusion: OCT and OCT-A help understand the structural outcome following PDT and TTT in circumscribed choroidal hemangioma.

Samrat Ashoka's Inscriptions And Ayurveda: A Review

Samrat Ashoka was the grandson of Chandragupta and he founded the Mauryan dynasty empire about 324 B.C. Ashoka built a large number of inscriptions on rocks and pillars to propagate Buddhist message of loving kindness. He was the follower of Buddhist thought after Kalinga war. He had dug wells and planted trees and medicinal plants along the roads for human beings as well as animals. The fundamental principles of Ayurveda have been based on Indian philosophical sciences such as Aastika and Nastika Darshan. Ancient Indian history has been written mainly based on texts/literatures but there was some role of coins sand inscriptions also. The total number of incretions inscribed on rocks, pillars, caves by Samrat Ashoka has reached 42 but in this article only two (Girnar’s second and Dhauli’s first Shilalekh) which is related to Ayurveda has been reviewed.

Analytical study of mortality in Intensive Care Unit

Background: Intensive care Unit is the one place where we come across various medical critical cases and high number of deaths is also recorded here. In spite of so many deaths occurring at this unit, cause of death is poorly reported. We studied the different causes for deaths in ICU which includes single and multiple factors for cause of death.Methods: A retrospective study performed between January 2017 to January 2018 at Rajiv Gandhi Institute of Medical sciences, Kadapa, Ongole, A.P. This study includes 260 deaths among patients admitted in ICU of our institute during this duration. We gathered data at various levels like clinical evaluation and investigations.Results: A total of 260 deaths were recorded during this study. Among these 215 (82.69%) are female and 45 (17.30%) are male. At the time of death 174 (66.92%) patients has single systemic cause 86 (33.06%) had more than one systemic cause. Cardiovascular death 50 (19.23%) is the most common cause of death among all in which CAD 28 (10.76%) are major portion and congestive cardiac failure 20 (7.6%) are the remaining portion of the cardiac deaths. Chronic kidney disease 37 (14.2%) is the next highest deaths recorded and cerebro vascular 35 (13.46%) deaths follows the next in line.Conclusions: Majority of ICU patients were present with at least one organ failure at the time of death. What we have concluded in this study is that there are more number of deaths with single systemic cause than multiple systemic causes

Clinical analysis of cardiac failure in post-myocardial infarction patients

Background: Cardiac failure is one of the common complications of Acute Myocardial Infarction. As CAD is the leading cause of death and post MI Cardiac failure also causing increase in rate of Mortality. It directs us to assess the complications of MI and to evaluate the precautionary & preventive steps of cardiac failure.Methods: The present study comprises of 50 cardiac failure patients with history of MI in the past and who presented with myocardial infarction with cardiac failure were included in this study. We excluded the patients who presented with Cardiac failure without Prior history of MI. This hospital based cross sectional study was conducted at Rajiv Gandhi Institute of Medical Sciences (RIMS), Ongole, Prakasam District, Andhra Pradesh. The study was carried out for a period of 1 year with informed consent.Results: In present study majority number of patients (33) show hypokinesia and 10 are found to have dyskinesia and only 4 are akinesia. In this study More than 50% patients are with history of anterior wall involvement. 36(72%) patients have elevated JVP, 34(68%) have cardiomegaly, 38 patients presented with PND. 29(58%) patients are DM and 35(70%) are HTN and only 6(12%) patients are neither DM, nor HTN.Conclusions: Cardiac failure is a common complication after MI. Most common presentations are breathlessness, chest pain, PND, JVP etc. Anterior wall MI on ECG either isolated or associated with other walls is the leading cause of post MI cardiac failure.

Conventional DCR vs DCR implant method in chronic dacryocystitis

Background: Chronic dacryocystitis is the commonest cause of lacrimal passage obstruction indicates inflammation of lacrimal sac. Dacryocystorhinostomy (DCR) is the preliminary choice of surgical procedure in which lacrimal sac is connected with nasal mucosal flap by bypassing nasolacrimal duct. Objectives: This comparative study described and evaluated the effectiveness of conventional D.C.R method and D.C.R implant method in chronic dacryocystitis cases. Materials and methods: The present comparative study consisted of 200 patients with complaint of watering, pus discharge and diagnosed as chronic dacryocystitis. Out of which 160 cases were followed up for a period of 3-6 months. Study cases were operated by using “Pawar implant”. Results: Bleeding occurred during operation was much more in conventional D.C.R. (53.3%) method than D.C.R. implant method (7.7%). Complete patency of nasolacrimal duct was observed in 125 cases i.e. 76 cases in D.C.R. implant method, 35 cases in Conventional D.C.R. method and 14 cases in D.C.R implant after D.C.T done. Partial patency of naso lacrimal duct was observed in 22 cases and failure of patency was seen in 11 cases. Conclusion: D.C.R implant (Pawar Implant) method is secure, minimal time consuming, needs little incision, little bony ostium and less painful surgical modality for chronic dacryocystitis than conventional D.C.R method.

Evaluation of thyroid hormone dysfunction in type – 2 diabetes patients on metformin therapy A cross sectional study

Diabetes and thyroid diseases are two familiar endocrinopathies seen in the general population. Abnormal thyroid hormone levels can also be found in individuals with diabetes. Metformin may lower thyroid stimulating hormone levels both in hypothyroid as well as euthyroid individuals. To this purpose,we studied analys is of serum TSH levels in patients with type-2 DM who were receiving metformin and compared them with serum TSH levels of those individuals with T2DM that were not on metformin. Study participants were selected from the people residing in neighbouring vill ages in and adjoining Kadapa district of Andhra Pradesh. Study duration was 6 months between June-November 2008. Sample size was 80 subjects with T2DM on Metformin and 80 subjects with T2DM receiving non Metformin based therapy were included in the study.Data were entered in Microsoft Excel 2007 and data was expressed as mean and standard deviation (Mean±SD). Serum TSH values, metformin dose and metformin duration were not normally distributed. Comparison of difference in means between the two groups for normally distributed continuous variables namely age HbA1c, R.V. Rama Narayana Reddy, T.A.R.Raja,.Senthil,Priyadharshini. Evaluation of thyroid hormone dysfunction in type -2 diabetes patients on metformin therapy –A cross sectional study. IAIM,2016; 3(1):24-28.Page 25 serum T3 and T4 was done by unpaired student’s t test. P <0.05 was treated as significant.Metformin utilize was not associated with changes in serum thyroid stimulating hormone levels in euthyroid type-2 DM patients. The presence of acomparative group of type 2 diabetes individuals not receiving Metformin add to the analytical value of the study design.

Demystifying the Mystified - An Ambiguous Presentation of Cemento-ossifying Fibroma in Maxilla.

Cemento-ossifying fibroma is a slow growing benign tumor of mesenchymal origin. It is typically found in craniofacial bones, frequently involving the mandible and it tends to occur in third and fourth decade of life with predilection for women. Occurrence of this lesion in maxilla is a rare entity. We report one such case of cemento-ossifying fibroma of size 5x4 cm on upper left maxilla in 38 year old female patient which is an unusual presentation.

Influence of Biofertilizers, Vermicompost and Chemical Fertilizrs on Growth, Nodulation, Nutrient Uptake, Seed Yield and Economics of Black Gram.

The experiment was conducted during rabi season in medium black soil at College Farm, College of Agriculture, Rajendranagar, ANGRAU, Hyderabad, Andhra Pradesh to study the influence of biofertilizers, vermicompost and chemical fertilizers on growth, nodulation, nutrient uptake, seed yield and economics of Black gram. From the data, it was observed that 50%RDF + Vermicompost + Rhizobium + Pseudomonas significantly increased the plant height, root length, leaf area index and leaf chlorophyll content at 25 and 50 DAS over the other treatments including control. The same treatment recorded highest seed yield (707 kg ha-1) and haulm yield (7067 kg ha-1) as compared to the control. Nutrient uptake recorded significantly highest in the treatment supplied with biofertilizers along with Vermicompost and 50%RDF. Treatment supplied with 50%RDF + Vermicompost + Rhizobium + Pseudomonas recorded highest net return (17784 Rs ha-1) but highest B: C ratio (2.11) was recorded in the treatment supplied with 50%RDF + Rhizobium + Pseudomonas.

Platelet Distribution Width (PDW) in Thrombocytopenia.

Background: Platelet volume parameters are significant especially in diagnosis of causes of thrombocytopenia. The platelet parameters are widely available as part of full blood count with no extra cost. Thrombocytopenia is of varying etiology based on which it is broadly divided into three major categories (1) as increased destruction, (2) decreased production and (3) splenic sequestration/abnormal pooling. The present study was undertaken to understand relation between cause of thrombocytopenia and Platelet Distribution Width as well as other platelet parameters. Materials and Methods: 500 cases of Thrombocytopenia (TCP) and 300 control cases having normal platelet count were selected. TCP was defined as platelet count <1.5lakh/ìl. Analysis was done by Sysmex KX 21 cell counter and every case was reassessed by Peripheral Smear (P.S.) examination and if necessary also by manual method. Only those cases that had sufficient clinico-hematological work -up and the causes of low platelet count had been reliably established were included in the study. Results: The study was conducted on 500 cases they were broadly categorized into three groups Group A with accelerated platelet Destruction Group B with Impaired production and Group C with abnormal pooling. Out of 500 cases 272 (54%) were male and 228(46%) were female. A slight male preponderance was seen in overall picture as well as in almost all age groups. The overall male to female ratio being 1.19 : 1. Mean platelet volume [MPV] was statistically significant with ‘p’ values

Comparative study of Socio-economic status of mothers who delivered term low birth weight babies with mothers who delivered normal birth weight babies in a tertiary care rural hospital.

Objectives: To compare the demographic profile of mothers who delivered term low birth weight babies with that of mothers who delivered normal birth weight babies and study the association between the demographic variables of mother and the delivery of low birth WEight babies. Material and methods: Study conducted at Department of Pediatrics and Department of Obstetrics of Narayana medical college hospital, Nellore, India. Participants were 120 postnatal mothers who 60 mothers who delivered term low birth weight babies and 60 mothers who delivered normal birth weight babies were include in the study. Five demographic variables: age of the mothers at the time of conception, educational status of the mothers, monthly family income, occupation of the mothers and presence or absence of consanguinity were recorded. Using chi-square test these variables are compared between two groups of mothers and association of these demographic variables with the delivery of low birth weight babie is studied. Results: Significant association was found between the family income and low birth weight (p-value 0.002.) and between consanguineous marriage and low birth weight (P-value 0.000). Significant association was not found between the age of the mothers and low birth weight (P-value 0.000). Significant association was not found between the age of the mothers and low birth Weight (P value 0.924), between occupation of the mother and low birth weight value (p value 0.15) and between educational status of the mother and low birth weight babies (p value 0.062). Conclusion: Low family income and consanguineous marriage have significant association with delivery of low birth weight babies.

Epithelioid Haemangioma – A Diagnostic Dilemma.

Epithelioid haemangioma (EH), synonymously termed as angiolymphoid hyperplasia with eosinophilia, is a rare lesion whose etiopathogenesis is unclear. Clinically it manifests as solitary or multiple nodules in the skin and subcutaneous tissues of the head and neck region. It can also arise in the deep tissues such as muscle, bone and lymphnode. Intra oral involvement is less common and very few cases have been reported in the literature. Common intra oral sites include lip followed by buccal mucosa and tongue. Epithelioid Haemangioma affecting alveolar mucosa is very rare. We report one such case of epithelioid hemangioma of size 4x4 cm on lower right alveolar mucosa in 38 year old female patient.

Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series.

Warts are generally managed using cryosurgery, keratolytic ointments, curettage and electrodessication. Warts, vis‑a‑vis Charmakila, in Ayurvedic classical texts are classified into different types depending on the dominance of dosha. Ayurveda prescribes oral medications, topical use of Kshara (alkaline ash of herbs), Agni (thermal cautery) and Shastrakarma (surgery) for removal of Charmakila. Use of topical Kshara in the form of powder, aqueous solution i.e. Ksharodaka and Ksharasutra (thread smeared with Kshara) for warts has been reported. However, these methods necessitate multiple sittings and takea longer duration for removal of the warts. Herewith, we report a case series of different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK), i.e. aqueous solution of Apamarga (Achyranthes aspera) Kshara. We observed that all these warts took a minimum of 2–6 days to shed off, leaving minor scars. There were no adverse reactions reported in any of these cases.

Review of spectrum and sensitivity of bacterial bloodstream isolates in children with malignancy: A retrospective analysis from a single center.

BACKGROUND: Febrile neutropenia is a life‑threatening emergency in pediatric cancer patients. Its management is based on established guidelines that emphasize on prompt action. Consideration of local microbiologic spectrum and its susceptibility is pivotal in devising a rational protocol. AIMS: To study the spectrum of bacterial isolates and its antibiotic sensitivity profile in bloodstream infections (BSIs) of pediatric cancer patients. SETTINGS AND DESIGN: Retrospective study. MATERIALS AND METHODS: This study was conducted at a tertiary cancer center for pediatric cancer patients. Blood culture samples sent during the evaluation of patients with clinical diagnosis of febrile neutropenia during the year of 2013 were analyzed. The microbiological and antibiotic sensitivity patterns were studied. RESULTS: A total of 27 isolates represented BSIs out of 412 blood cultures sent (6.5%). These were predominantly Gram‑negative (92%) with Klebsiella contributing to the majority of them. Extended spectrum beta‑lactamase production was seen in 59% of all isolates. Multidrug resistance phenotype was seen in 48%, extreme drug resistance in 32% and pan drug resistance in 16% of Gram‑negative isolates. Klebsiella predominated in all of these isolates. Mortality resulted in 15% isolates, majorly contributed by Klebsiella. Colistin was the most sensitive antibiotic (75% sensitivity) and in significant number of cases the only salvage option. CONCLUSION: Gram‑negative bacteria are the most common etiologic agents. The emergence of drug resistant strains of Klebsiella and the poor sensitivity of most of these strains to common first choice empiric agents is alarming. Low prevalence of Gram‑positive organisms questions the routine use of empiric vancomycin.

Giant Cell Fibroma - An Unusual Case Presentation With Review And Treatment Using Diode Laser.

Fibroepithelial hyperplasias of the oral cavity are a variety of lesions that exhibit different clinical and Histologic presentations and types causing diagnostic confusion despite their relatively trivial nature. While stressing upon the importance of histological examination in such cases, A case of large giant cell fibroma presenting over the maxillary gingiva in a 33 years male patient is presented. The lesion is excised using diaod laser and no recurrence is noted over a period of 12 months. The importance of histological examination in such cases is stressed upon.

Survey of Turcicum Leaf Blight of Maize in Major Maize Growing Areas of Andhra Pradesh.

Northern corn leaf blight or turcicum leaf blight caused by Exserohilum turcicum (Pass.) Leonard and Suggs is one of the important diseases affecting photosynthesis with severe reduction in grain yield to an extent of 28 to 91%. Disease symptoms first appear on the leaves at any stage of plant growth, but usually at or after anthesis. The studies on survey reveals that high intensity of the disease was noted in the district where mean maximum temperature was below 320C and relative humidity was above 85 percent during the cropping season (June-October). The maximum PDI of 51 percent was recorded in Khammam district where the maximum temperature of 31.820C and the relative humidity of 87.5 percent was recorded whereas minimum (33 percent) PDI was recorded in Guntur district and it was due to high maximum temperature of 35.220C and low relative humidity of 76 percent.

In-vitro and in-vivo anti-inflammatory activity of Andrographis serpyllifolia (Rottl. Ex Vahl.) Wt.

The study was aimed to evaluate the analgesic and anti-inflammatory activity (by both in-vitro and in-vivo) of both chloroform and methanol root extracts of Andrographis serpyllifolia (Rottl. Ex Vahl.) Wt. Methods used for the studies were In-vitro 5-Lipoxygenase inhibition assay and In-vivo measurement of rat paw edema and ear edema in rats, acetic acid induced writhing response and hot plate method in albino mice. Chloroform and methanolic extracts of A. serpyllifolia root have shown moderate potency in inhibiting 5-LOX and shown significant anti-inflammatory activity. Despite the IC50 values are little higher, anti-inflammatory efficacy of these extracts possibly due to other mechanisms apart of 5-LOX inhibition. However, In-vivo anti-inflammatory studies revealed that A. serpyllifolia methanolic extract has shown higher degree of efficacy when compared to the chloroform extract. In terms of analgesic activity in writhing test, methanolic extract has shown more efficacy than chloroform extract. Hence, it is important to isolate the active principles for further testing the anti-inflammatory efficacy.