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Background: Recording an accurate birth weight by primary health worker has been a problem in rural areas, leading to search for an alternative, inexpensive, age independent and noninvasive method to predict newborn birth weight and wellbeing. With this background I aimed to found out whether the neonatal-MUAC is associated with birth weight or not?Methods: This hospital based prospective observational study was conducted in SNCU and postnatal ward, Kamla Raja Hospital, G.R. Medical College, and Gwalior (M.P). A total of 1303 newborns were included in the study. The Mid upper arm circumference (MUAC) of newborns were taken and Birth weight recorded were filled in a proforma.Results: Total 1303 neonates were evaluated. The mean MUAC and birth weight in preterm was found to be 1854.80'387.3 and 7.47'0.9 as compared to full term newborn having mean birth weight(2818.95'328.1) and mean MUAC (9.58+0.7).The Pearson coefficient of correlation between neonatal MUAC (N-MUAC) and birth weight was found to be r= 0.987 and p<0.01. Birth weight can be predicted from regression equation: Birth weight (gms)=422.99 (N-MUAC) + (-1272.66). Cut-off value of neonatal mid upper arm circumference (N-MUAC) was found to be 8.85cm to predict low birth weight newborn.Conclusions: Birth weight of newborn can be predicted from neonatal mid upper arm circumference (N-MUAC) in areas where the conventional scale are not easily available for measuring the birth weight of newborn.
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Background: Objectives of present study was to assess receiving system of newborns, bed occupancies of referring facilities and receiving facility and assessment of rationality of referrals made by referring facilities to receiving facility leading to congestion at receiving facility. The study was conducted in Department of Pediatrics, Special Newborn Care Unit, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior, Madhya Pradesh.Methods: This study was a prospective observational study which was conducted for a period of one year. Referred newborns fulfilling inclusion criteria were enrolled in study, and their receiving characteristics, bed occupancies of referring facilities and receiving facility, number of rationale and irrational referrals at receiving facility were statistically analysed.Results: Total referred newborns enrolled in the study was 2000. As receiving SNCU, of institute caters not only its nearby places, but also to distant districts of Madhya Pradesh, Rajasthan and Uttar Pradesh. SNCU wise receiving was in order of SNCU Morar (20.60%), Morena (19.40%), Bhind (5.70%), Dholpur (5.35%), Shivpuri (4.40%), Chattarpur (3.10%), Datia (1.20%), Sheopur (0.40%) and Jhansi (0.30%). Referring SNCU wise bed occupancy was in order of SNCU Guna (189.16%), Shivpuri (154%), Morena (72.33%), Bhind (71.63%), Sheopur (69.32%), Morar (64.15%) and Datia (62.11%). Referring SNCU wise case fatality was in order of SNCU Jhansi (100%), Sheopur (100%), Chattarpur (56.45%), Bhind (38.59%), Shivpuri (35.22%), Morena (33.76%), Dholpur (27.10%), Datia (25%), Morar (22.08%).Conclusions: Discordant bed occupancy at referring SNCU and receiving SNCU and low rationality of referrals are reason for congestion at receiving SNCU. Optimum utilization of beds and cordant bed occupancy between referring and receiving SNCU may improve the working conditions in SNCU and newborn outcome. Referral system should be close loop systemwith the provision of Down Referral.
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Background: This study was aimed to assess newborn referral and factors contributing to outcome of referred newborns.Methods: This prospective observational study was conducted in a tertiary newborn referral facility for a period of one year. Referred newborns fulfilling inclusion criteria were enrolled in study, and assessed in terms of demographic profile, transport characteristics, physiological variables. Investigations, management of neonatal illness was done as per standard management protocols, they were followed up to their outcome.Results: Out of 2000 enrolled referred newborns, 30.10% were expired. Mean gestational age for survived newborns was 36.54'2.92 (SD) weeks, for expired newborns 35.24'3.99 (SD) weeks. Mean weight for survived newborns 2312.27 gms '555.71 (SD), for expired newborns 1936.71 gms '665.67 (SD). Out of total 60.05% newborns transported from periphery, had higher mortality i.e. 35% as compared to newborns transported from urban place i.e. 25%. Mean transport duration for survived newborns 61.94 minutes '55.18 (SD), for expired newborns 89.51 minutes '88.94 (SD). Prolonged CRT was observed' in 57.45% newborns, grunting'' 19.70%, Cyanosis 11%, gasping 7.6%, apnea 5%, respiratory distress 39.80%, hypothermia 74.95%, and 25.50% required resuscitation on admission. Unattended delivery, self-arranged mode of transport, prolonged CRT, respiratory distress, apnea , hypothermia on admission, weight on admission(<1500gms), hypoglycaemia and duration of transport more than 1 hour' found statistically significant independent variables associated with mortality of referred newborns.Conclusions: A significant number of neonatal deaths can be prevented, if referral system is structured and organized. Improper referral leads to poor physiological profile of referred newborns, which leads to their poor outcome. There are many independent variables which are affecting the outcome of referred newborns. These independent variables can be taken care in holistic way once the referral system is cultured and nurtured in existing health system.
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Background: Leprosy is a chronic granulomatous condition mainly affects cooler parts of the body; skin, upper respiratory tract, anterior segment of the eye, superficial portion of peripheral nerves and testes. Redley and Joplin have classified it into five types; Tuberculoid (TT), Borderline Tuberculoid (BT), Mid Borderline (BB), Lepromatous Borderlilne (BL) and Lepromatous (LL). FNAC is simple, rapid and cost effective method over the biopsy to diagnose, classify and monitor leprosy in a patient. The present study was undertaken to evaluate and compare FNAC smears findings with histopathological findings and to classify lesions on RJ scale. Methods: This prospective and descriptive study was done in department of pathology in Sri Venkateshwara institute of medical science, pondicherry, India between June 2007 to June 2010. The patients were examined by the investigator with dermatologist later on slit smear was done. FNAC perform and comparison with biopsy and clinical history was done using SPSS software version 16.0. Results: Total 82 cases were included with age from 8 years to 79 years with mean age 38.16. Male to female ratio was 1.0: 0.7. FNAC shows parity 71.42% for tuberculoid and 58.33% for lepromatous leprosy and histopathology shows parity 100% for tuberculoid and 75% for lepromatous leprosy that indicate FNAC is useful usually for polar or stable group than the unstable or borderline cases. Conclusion: FNAC is a quick and safe for early diagnosis and classify cases into paucibacilary and multibacillary. Exact RJ Scale categorization on FNAC should not be used in isolation but FNAC should be supplemented to the histopathological diagnosis.
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Tuberous sclerosis is a neurocutaneous syndrome characterized by a clinical spectrum varying from severe mental retardation and incapacitating seizures to normal intelligence and lack of seizures, often within the same family [1]. The younger the patients present with symptoms and signs of TSC [tuberous sclerosis complex], the greater are the likelihood of mental retardation [2]. Skin features are very characteristic of the disease and help in the early diagnosis of the disease. Shagreen patch is one of the major diagnostic features of the disease. It is a less common skin lesion consisting of an excess amount of fibrous tissue similar to that found in scar tissues [3]. It is a section of thickened, elevated pebbly skin like an orange peel. The name is derived from the French phrase "peau chagrinee". It is usually found on the lower back, buttock, thigh and the nape of the neck commonly. In this case report we report a characteristic skin lesion, the shagreen patch in a six-year-old child with TSC at an unusual site [the cheek] never reported before with the best of our knowledge