Geriatric syndromes: A therapeutic challenge

Aging is a natural phenomenon that is irrevocable. The older adult population is increasing rapidly in India, projected to increase from 6% to nearly 20% in 2050. Clinical conditions found among the elderly that do not fit into discrete disease categories and result from accumulated impairments in multiple systems are called geriatric syndromes. The authors have done a literature search of research papers from indexed and nonindexed journals e databases, Google Scholar, PubMed, and Scopus, Science Direct, Research Gate, and Cochrane. The search terms included were geriatric population, geriatric syndrome, geriatric care, elderly health problem, and comprehensive approach. The management of geriatric syndromes is a challenge to modern geriatric clinical practice. The comprehensive assessment of older adults using standardized tools must be carried out in any healthcare facility to ensure that their needs are met through care and treatment. Evidence-based standards of practice need to be implemented to provide nursing care for dealing with the therapeutic challenges of various geriatric syndromes.

Ballooned Out Tracheal Cuff of DLT Causing Acute Obstruction: Is there a Way to Test Its Integrity?

Introduction: Sudden intraoperative desaturation may be dueto numerous reasons such as- ETT kinking, dislodgement,obstruction by tight gauze, obstruction off ETT lumen byforeign body, blood, bronchospasm, tension pneumothoraxand hemothorax, pulmonary embolism and finally equipmentmalfunction.Case Report: We hereby present a case of 28 year old femalethat was diagnosed with hydatid cystic.Conclusion: Regular cuff pressure measurement and vigilantpatient monitoring goes a long way to prevent catastrophe.

Nurse’s knowledge regarding importance of human milk and milk banking

Background: Breast milk is the complete nutrition for the babies during first 6 months of life. It is very important to feed the baby with breast milk during that crucial period of growth. Unavailability of breast milk can put the baby in life threatening conditions. In order to resolve the problem and to improve the mortality rate of neonates, nurses should have up to date information regarding the breast milk and its storage. Aim of this study was to assess the knowledge of nurses regarding importance of human milk and milk banking.Methods: Quantitative, descriptive research approach was used to assess the knowledge of 150 purposively selected nurses working in obstetric, gynae and pediatric wards in selected hospitals of Punjab by using socio-demographic sheet and self-structured questionnaire. Both descriptive and inferential statistical methods were used for the analysis of data.Results: Study findings revealed that majority of nurses 66% have adequate knowledge regarding importance of human milk and milk banking. Knowledge of nurses regarding importance of human milk and milk banking is significantly associated with working department.Conclusions: Study concluded that knowledge of nurses regarding importance of human milk and milk banking is satisfactory. But for the further improvement in knowledge of nurse’s in-service programs should be provided to them after regular intervals of time. So that they perform their work efficiently.

Anaesthetic Management of an Infant with Myocarditis for Non-Cardiac Surgery

We report a case of two months old infant diagnosed with acute myocarditis, with a ventricular septal defect (VSD) of 0.9 mm size, admitted to our hospital with gangrene of left foot. A below knee amputation was planned under general anaesthesia with caudal block. Digoxin and diuretics were continued. Induction was done with fentanyl and sevoflurane and supraglottic device was used to secure the airway. Caudal block with bupivacaine was administered.The recovery was satisfactory and postoperative stay was uneventful.

Condom catheter: a simple and efficacious alternative of hysterectomy in postpartum haemorrhage

Background: The aim of this study was to evaluate the effectiveness of the condom catheter in treating postpartum hemorrhage refractory to medical treatment.Methods: This prospective study included 21 women with postpartum hemorrhage treated with a condom catheter as a conservative therapeutic option.Results: The condom catheter was successful in controlling hemorrhage in 90.4% of the women. It was effective in all women with vaginal delivery (11 of 12) and highly effective in women with uterine atony who did not respond to medical uterotonic treatment (6 of 7 women).Conclusions: Its ease of use and high effectiveness make the condom catheter a useful approach for the conservative management of acute postpartum hemorrhage. This device reduces bleeding, shortens the hospital stay and avoids the need for surgical management.

Comparison of maternal and perinatal outcome in pregnancy with altered thyroid profile and euthyroid patients: a prospective, observational and case control study in a tertiary care centre

Background: Thyroid disease is one of the commonest endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of complications. The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction on maternal and perinatal outcome.Methods: This prospective, observational hospital-based case-control study carried on women coming for antenatal check-up in a Tertiary Care Hospital in INDORE from May 2018-December 2018. 50 known booked antenatal (case) patient with established thyroid disorder, more than 32 week of gestation, and 50-matched euthyroid patients (control) were taken.Results: Women suffering from overt and subclinical hypothyroidism and hyperthyroidism are nulliparous in 72% cases as compared to 32% in euthyroid patient. Increased maternal age was associated with higher incidence of thyroid dysfunction. Normal vaginal delivery by spontaneous labour seen in 56% of euthyroid, while it is reduced with thyroid dysfunction. 38% of altered thyroid profile patient undergo induction of labour and 24% cases undergo caesarean section as compared to control (17%). Adverse fetal outcome like intrauterine growth retardation, preterm birth and ICU admission seen increased with thyroid dysfunction  as compared to euthyroid patients.Conclusions: Thyroid dysfunction in pregnancy, although has a low incidence, but is associated with adverse maternal and fetal implications. Thus, thyroid screening should be done in antenatal period to improve fetomaternal outcome.

Evaluation of antibacterial activity of macrocyclic metal complexes derived from dihydrazone and diketone.

Synthesis of macrocyclic metal complexes of Cr(III) and Fe(III) by the condensation of benzil dihydrazone with 1H-indole-2, 3-dione.The metal complexes were characterized by elemental analysis, molar conductance, magnetic susceptibility, thermal analysis, ESR, infrared, 1H NMR and UV-visible spectroscopy. On the bases of these studies, a five-coordinate square pyramidal geometry is proposed for all the metal complexes. In vitro antibacterial activity of macrocyclic metal complexes exhibited good results.

A Rapid and Sensitive One Step-SYBR Green Based Semi Quantitative Real Time RT-PCR for the Detection of peste des petits ruminants Virus in the Clinical Samples / 中国病毒学·英文版

A sensitive and rapid single step real time (rt) RT-PCR was standardized using one-step Brilliant SYBR Green kit(R) for detection and semi-quantitation of peste des petitis ruminants virus (PPRV) using the virus RNA and matrix (M) protein gene-specific primers and compared with established conventional RT-PCR and TaqMan RT-PCR.The assay amplifies a 124 bp fragment of the PPRV M gene with Tm of 78.28 to 78.50.The assay was linear within a range of 50 ng to 0.5 fg total virus RNA with a detection limit (sensitivity) of 0.5 fg.Based on the serial dilution of the live-attenuated PPR vaccine virus,the detection limit was ～0.0001 cell culture infectious dose 50％ units (TCID50).Additionally,swab materials spiked with known titre of vaccine virus were equally well detected in the assay.The standardized rt RT-PCR was easily employed for the detection of PPRV nucleic acid directly in the field and experimental clinical samples.The assay detected the PPRV nucleic acid as early as 3 day post infection (dpi) and up to 20 dpi in swab materials from the experimental samples.The assay was rapid and more sensitive than TaqMan and conventional RT-PCR in the detection of PPRV nucleic acid from the PPR suspected clinical samples of sheep and goats.Therefore,the established,simplified SYBR green rt RT-PCR is an alternative test to the already existing various diagnostic assays and could be useful for rapid clinical diagnosis with advantage in reducing risk of contamination.

Role of Acute Illness Observation Scale (AIOS) in managing severe childhood pneumonia.

OBJECTIVE: In the perspective of integrated management of childhood illness (IMCI) strategy and recent evidence favoring use of oral antibiotics in severe pneumonia, a generic illness severity index--Acute Illness Observation Scale (AIOS)--was prospectively validated in children with severe pneumonia in a civil hospital in remote hilly region. METHODS: AIOS was used in quantifying overall severity of illness for eighty-nine consecutive children (age, 2-59 months) hospitalized with community-acquired severe pneumonia. A detailed clinimetric evaluation of scale was carried out and logistic regression analyses predicted the following outcomes: 1) mode of initial antimicrobial therapy (oral vs. parenteral); and 2) need for intravenous fluids at admission. RESULTS: Majority of children (80.9%) with severe pneumonia scored abnormally (AIOS score> 10) at initial evaluation. Children with abnormal AIOS scores (>10) had significantly greater severity of respiratory distress and higher incidence of radiological pneumonia. Outcome measures i.e. time to defervescence and length of hospital stay were also positively and significantly correlated with the scores. The six-item scale had good internal consistency (Cronbach's alpha 0.81); and its factor analysis yielded a single latent factor explaining 54% of variance in illness severity at admission. Furthermore, logistic regression analyses revealed an independent predictive ability of AIOS in aiding clinician to decide the mode of initial antimicrobial therapy (oral or parenteral), as well as need for intravenous fluids. CONCLUSION: Authors study indicates the clinimetric validity of AIOS in managing, Severe childhood pneumonia and suggests its role in further enriching IMCI strategy.

Severe pneumonia in a remote hilly area: integrated management of childhood illness.

OBJECTIVE: This study aims to profile children with severe pneumonia in the perspective of Integrated Management of Childhood Illness (IMCI) strategy in a resource-constrained environment. METHODS: 115 consecutive children, aged 2 months to 10 yr, hospitalized with severe pneumonia were prospectively evaluated between May 1997 and June 1998 at a civil hospital in the northern hilly state of India. RESULTS: All children had tachypnea and lower chest wall indrawing. Grunting was observed in 39.7%, inability to drink in 16.5%, and cyanosis in 1.7% cases. Radiological investigation was carried out only in 90 children that included abnormal chest radiographs (CXRs) in 76.6% cases. Feeding malpractices, vaccination inconsistencies, exposure hazards to smoking, micronutrient as well as macronutrient deficiencies, treatment from unqualified practitioners, inconsequential involvement of health care workers, predominant burden on mothers in the care of sick children, failure to recognize signs and symptoms of pneumonia by parents at home, lack of oxygen facilities, problems of accessibility and less faith on primary health care services were widely prevalent bottlenecks for effective implementation of 3 components of IMCI. CONCLUSION: Our study offers practical insights that can be useful in customizing IMCI to needs of children with pneumonia in a resource-constrained environment.

Potential antifilarial activity of fruit extracts of Ficus racemosa Linn. against Setaria cervi in vitro.

Effect of alcoholic and aqueous extracts of the fruits of F. racemosa Linn., on the spontaneous movements of both the whole worm and nerve muscle preparation of Setaria cervi and on the survival of microfilariae in vitro was studied. Alcoholic as well as aqueous extracts caused inhibition of spontaneous motility of whole worm and nerve muscle preparation of Setaria cervi characterized by increase in amplitude and tone of contractions. Initial stimulatory effect was not observed with aqueous extract on whole worm preparation, while effect of alcoholic extract on whole worm and nerve muscle preparation was characterized by an increase in amplitude and tone of contractions followed by paralysis. The concentrations required to inhibit the movement of the whole worm and nerve muscle preparation for alcoholic extract of fruits of F. racemosa were 250 and 50 microg/ml, respectively, whereas aqueous extract caused inhibition of the whole worm and nerve muscle preparation at 350 and 150 microg/ml, respectively, suggesting a cuticular barrier. Both alcoholic and aqueous extracts caused death of microfilariae in vitro. LC50 and LC90 were 21 and 35 ng/ml, respectively for alcoholic, which were 27 and 42 ng/ml for aqueous extracts.