Enteral paracetamol or Intravenous Indomethacin for Closure of Patent Ductus Arteriosus in Preterm Neonates: A Randomized Controlled Trial.

Objective: To compare the efficacy of enteral paracetamol and intravenous indomethacin for closure of patent ductus arteriosus (PDA) in preterm neonates. Design: Randomized controlled trial. Setting: Level III neonatal intensive care unit. Participants: 77 preterm neonates with birth weight ≤1500 g and PDA size ≥1.5 mm, with left to right ductal flow with left atrium to aortic root ratio >1.5:1; diagnosed by 2D-Echo within first 48 hours of life. Intervention: Paracetamol drops through the infant feeding tube (15mg/kg/dose 6 hourly for 7 days) or intravenous indomethacin (0.2 mg/kg/dose once daily for 3 days). Outcome measures: Primary: PDA closure rate assessed by echocardiography. Secondary: need for surgical closure of PDA, renal impairment, gastrointestinal bleed, necrotising enterocolitis, hepatotoxicity, pulmonary hemorrhage, sepsis, hypothermia, retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia and mortality. Results: PDA closure rate was 100% (36/36) in enteral paracetamol group as compared to 94.6% (35/37) in intravenous indomethacin group (P=0.13). The secondary outcomes were also similar between the two groups. There was no occurrence of hepatotoxicity. Conclusions: Enteral paracetamol is safe but not superior to intravenous indomethacin in the treatment of PDA in preterm neonates.

Eye of horus – Erratum revealed a prescription survey.

Background: The aim of this study was to survey the quality and the content of prescription of practitioners and also assess the legibility of alphabet, and short form of the drug. Methods: A survey of all prescription received by the patients that were written by general practitioners, consulting physicians and dentists in and around Virajpet and Madikeri (south Coorg) was included.The prescriptions were photocopied and returned back to the patients. The prescription was scored and analyzed by a qualified medical investigator. Results: A total of 171 prescription samples were collected. In most prescriptions, one or more aspects of patient’s personal details were missing. Concerned doctor’s details also lacked in most cases. 40.3% of the prescriptions were obtained wherein short form of the drug was used for prescribing drug. Legibility of alphabet was also evaluated and the most confusing letter noted in our study was letter “C”; followed by A, T, S, O, G, and D in this study the letter Rx was written in 7% of the prescription and in 19% prescription it was replaced by word “Adv” and 74% of prescription without symbol of Rx. Conclusions: The present data shows most prescriptions in the study was inadequate and important details were lacking, legibility of prescription was poor in rating.

Glycerin Suppository for Promoting Feeding Tolerance in Preterm Very Low Birthweight Neonates: A Randomized Controlled Trial.

Objective: To compare the efficacy of glycerin suppository versus no suppository in preterm very-low-birthweight neonates for improving feeding tolerance. Design: Randomized controlled trial. Setting: Level III neonatal unit from Mumbai, India. Participants: 50 very-low-birthweight (birth weight between 1000 to 1500 grams) preterm (gestational age between 28 to 32 weeks) neonates randomized to glycerine suppository (n=25) or no intervention (n=26). Intervention: Glycerin suppository (1g) once a day from day-2 to day-14 of life or no suppository, along with intermittent oral feeds and standardized care. Primary outcome: Time required to achieve full enteral feeds (180 mL/kg/d). Results: Baseline characteristics of neonates like gestational age, birthweight, gender and age at the time of introduction of feeds were comparable in both groups. The mean (SD) duration to reach full enteral feed was 11.90 (3.1) days in glycerin suppository group and was not significantly different (P=0.58) from control group, [11.33 (3.57) days]. Glycerin suppository group regained birth weight 2 days earlier than control group but this difference was not significant (P=0.16). There was no significant difference in duration of hospital stay or occurrence of necrotizing enterocolitis amongst the two study groups. Conclusion: Once daily application of glycerin suppository does not accelerate the achievement of full feeds in preterm very-lowbirthweight neonates.

Hepatic angiosarcoma arising in an adult mesenchymal hamartoma.

Embryonal (undifferentiated) sarcomas arising in mesenchymal hamartoma are on record but cases of hepatic angiosarcoma (AS) arising in mesenchymal hamartoma (MH) of the liver are extremely rare. We report one such case in a 20-year-old male patient. He presented with a lump in the right hypochondriac region and pain of two years duration with rapid increase in size since two months. Ultrasonography (USG) revealed a well circumscribed mass on the undersurface of the right lobe of liver suggestive of hemangioma. The patient underwent resection of the mass. Histopathology revealed AS with areas of MH.

Left shoulder region metastasis from hepatocellular carcinoma as an initial presentation--a case report.

Hepatocellular carcinoma metastasis as a soft tissue mass is rare; we came across a 65 years old female who presented with a left shoulder region mass. There was no previous history of any liver disease and liver function tests were normal. Histologically, it turned out to be a metastasis from hepatocellular carcinoma.

Anaerobic infection in chronic maxillary sinusitis.

1) Ten per cent of cases of chronic maxillary sinusitis in a series of 50 cases treated in the ENT department of Dayanand Medical College, Ludhiana, were caused by anaerobic infection. 2) The causative anaerobic micro-organisms encountered were Peptostreptococcus and Clostridium species. 3) Treatment should, therefore, include metronidazole, especially in those cases refractory to conventional antibiotic therapy.