Admissions to a sick new born care unit in a secondary care hospital: Profile and outcomes

Background: To reduce neonatal mortality in North Bihar, evidence is required about the impact of sick newborn care units (SNCUs) in secondary level hospitals on mortality at the end of the neonatal period. Objectives: The objective of the study is to assess the profile of neonates admitted to an SNCU and the outcome at the completion of neonatal period. Methods: A cohort of neonates admitted from March to June 2014 to an SNCU was assessed through family interviews and hospital records. Demographic details (age, sex, and socioeconomic status) and clinical details (antenatal care, birthplace, weight, diagnosis, and family history) were documented. Follow-up was done at discharge or death or referral and the completion of neonatal period. The primary outcome was survival at the completion of neonatal period. Secondary outcomes were case fatality rate at discharge and weight gain. Results: Of 210 neonates assessed, 87.6% (95% confidence interval [CI] 82.4–91.4) survived till the end of the neonatal period. The case fatality rate at the time of discharge was 0.9% (95% CI 0.3–3.4). Majority of the diagnoses were infections, hyperbilirubinemia, and infant of diabetic mother. Mean weight gain at the end of neonatal period (n = 157) was 706 g (P = 0.00). Sex ratio at admission was 567 girls to 1000 boys (95% CI 428/1000–751/1000). No neonate from lower socioeconomic families was admitted. Conclusions: SNCUs in remote areas can bring down neonatal mortality in North Bihar. Unequal access of SNCUs services to girls and lower socioeconomic groups highlighted the existing barriers which require attention.

Maternal periodontal disease as a significant risk factor for low birth weight in pregnant women attending a secondary care hospital in South India: A Case-control study.

Context: Periodontal disease (PD) is a common infection in the community; however, its relationship with low birth weight (LBW) has not been well‑established. Aims: The aim was to determine the association between maternal PD and LBW. Settings and Design: A case–control (1:1) study. Materials and Methods: The study population comprised of women who delivered at the hospital during the study period (September 2011 to February 2012).Women between 18 and 35 years of age, who delivered singleton, live infants during study period with at least 18 teeth were enrolled. Those with pregnancy induced hypertension, gestational diabetes, blood‑borne viral infections, periodontal treatment within the past 6 months and valvular heart disease were excluded. Control population was parity matched to the cases. Statistical Analysis Used: Chi‑square test, t‑test and univariant and multivariant logistic regression were used to analyze various study findings, and level of significance was set at 5% (P < 0.05). Results: PD was independently associated with LBW (odds ratio: 4.94, 95% confidence interval: 1.03–23.65, P=0.045). Additionally, conventional risk factors such as maternal height (P=0.029), secondary schooling (<8 years of schooling) (P = 0.001), socio‑economic status (P = 0.046), type of family (joint) (P = 0.008), number of ante‑natal visits (P = 0.028) and gestational age at birth (<37 weeks) (P = 0.045) showed significant association with LBW. Conclusions: There seems to be an association between PD and LBW independent of conventional risk factors. Women who had PD were 5 times more likely to deliver LBW infants.

Intestinal Permeability in Normally Nourished and Malnourished Children with and without Diarrhea.

We evaluated the association between diarrhea, malnutrition and intestinal function using the lactulose-mannitol test. Our study showed that a third of all children have abnormal intestinal permeability, there was an expected increase of permeability in children with acute diarrhea and alteration in intestinal permeability was greater in children with concurrent malnutrition and diarrhea

T-Cell Assay as a Diagnostic Tool for Tuberculosis.

This study aimed to estimate the specificity and sensitivity of a whole blood IFN-g assay (ELISPOT) test for diagnosis in childhood tuberculosis. 96 patients, less than 18 years of age, diagnosed and commenced on anti-tubercular therapy were enrolled and tested. 47 age and sex matched controls were also tested. 23 tests were deemed invalid and analysis done on the remainder. The sensitivity was 53.3% in confirmed cases and less in other groups. The specificity was high at 97.9%. This test can be an useful aid in the diagnosis of tuberculosis.

Safety and reactogenicity of a low dose diphtheria tetanus acellular pertussis vaccine (Boostrix) in pre-school Indian children.

OBJECTIVE: To evaluate the safety and reactogenicity of a reduced-antigen-content combined Diphtheria Tetanus Acellular Pertussis (dTpa) vaccine in Indian preschool children. METHODS: GlaxoSmithKline Biologicals combination dTpa vaccine was administered as a single booster dose to 347 children aged 46 years in seven centers across India. All children were subsequently followed up for two weeks for safety and reactogenicity assessment. RESULTS: A total of 345 subjects completed the study and two subjects were lost to follow-up. One serious adverse event (head injury) unrelated to vaccination was reported. Otherwise, all subjects were in good health throughout the study period. Three subjects (0.9%) reported transient general symptoms (such as irritability and drowsiness), which prevented normal activity. Pain at injection site, swelling and redness was reported in 31.1%, 18.2% and 8.9% subjects respectively. Five subjects (1.4%) reported severe pain preventing normal movement. This resolved within 48 hours in all cases. There were no other severe local reactions including large injection site reactions. CONCLUSION: The reduced antigen content combined dTpa vaccine is safe and well tolerated in Indian pre-school children.

Intussusception in southern Indian children: lack of association with diarrheal disease and oral polio vaccine immunization.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in young children and has been reported as a complication of a recently withdrawn tetravalent reassortant rotavirus vaccine. METHODS: We studied the history, clinical presentation, management and outcome of intussusception presenting to a tertiary care hospital in southern India over a 10-year period, in order to assess potential association with diarrheal disease and immunization. RESULTS: Data from 137 index cases and 280 control subjects indicated that the risk of diarrheal disease or oral polio vaccine administration in the month prior to presentation was similar in the index cases and controls. Mean time to presentation to hospital after developing symptoms was 1.8 days, and 77.3% of patients required surgery, with 47.4% undergoing intestinal resection. Mortality was 0.006%. CONCLUSIONS: No association could be demonstrated between gastroenteritis or oral poliovirus vaccine immunization and intussusception in southern Indian children. These children presented later and required operative intervention more frequently than has been reported in other studies, but had a good outcome with low mortality.

Role of destructive operations in modern day obstetrics.

One hundred and forty-one cases of obstructed labour was referred to RG Kar Medical College and Hospital in the last one year. Out of 12,034 total hospital deliveries, incidence of obstructed labour was 1.17% whereas 36 cases (0.29%) accounted for intra-uterine foetal death (IUD). Of the IUD with obstructed labour, 69.4% were delivered by destructive operation and 30.6% by lower segment caesarean section (LSCS). Craniotomy was performed in 44.4% cases and evisceration in 25% of cases. About 68% of the patients were in the young age group belonging to 20-30 years and 36% of cases were primigravida. It ws found that cephalopelvic disproportion was the commonest cause of obstruction for which craniotomy was performed. Traumatic rupture uterus was encountered in one case. There was no maternal death following destructive operation.

Mechanism of action of an eukaryotic initiation factor-2 (eIF-2) associated 67 kDa glycoprotein (p67) and an eIF-2 kinase (dsI).

Mechanism of regulation of eIF-2 alpha-subunit phosphorylation by dsI and p67 was studied. The results are as follows: (1) At low dsI concentration, p67 protected equimolar concentration of eIF-2. (2) At high dsI concentration, dsI efficiently phosphorylated eIF-2 alpha-subunit even when equimolar concentrations of both p67 and eIF-2 were present. Significantly increased p67 concentration was necessary to protect eIF-2 alpha-subunit at high dsI concentration. (3) dsI was also phosphorylated as it phosphorylated eIF-2 alpha-subunit. p67 inhibited both eIF-2 alpha-subunit and dsI phosphorylation similarly. (4) Although the [32P]-labelled dsI formed during the reaction could be effectively chased upon subsequent addition of excess unlabelled eIF-2 and ATP, the [32P] labelled eIF-2 formed under identical conditions, retained most of the radioactivity. (5) dsI coimmunoprecipitated with three subunit eIF-2 and p67 inhibited this coimmunoprecipitation reaction. It has been proposed: Three subunit eIF-2 and free p67 are in equilibrium with eIF-2 bound to p67 and, eIF-2.p67 complex is resistant to dsI phosphorylation. Activated dsI is already phosphorylated. At high concentration, dsI(P) can bind to free three subunit eIF-2 and form eIF-2.dsI(P) complex. dsI(P) in this complex then transfers its phosphoryl residue to eIF-2 and forms eIF-2 alpha(P) in an irreversible reaction. In a subsequent reaction, unphosphorylated dsI is autophosphorylated using [gamma 32P]-ATP and the cycle continues. Inhibition of eIF-2 alpha-subunit phosphorylation by p67 blocks this phosphorylation cycle and consequent dsI phosphorylation.

Iodide transport in isolated cells of mouse submaxillary gland.

A method has been developed to isolate cells from the submaxillary gland of mouse by treatment with pronase. Three fractions of cells have been isolated having almost equal iodide concentrating activity. The isolated cells show time dependent uphill transport of iodide. The transport is substrate-saturable, having a Km value of 0·3 μΜ for iodide. The transport is sensitive to antithyroid drugs, metabolic inhibitors and to some extent to ouabain. Pseudohalide such as thiocyanate competes with the transport of iodide. Thyroid hormones or thyroid stimulating hormone have no significant effect on the iodide transport in these cells.

Effect of mersalyl at cholinoceptive sites.

The effects of an organic mercurial compounds, mersalyl, were tested at the muscarinic and nicotinic sites (the smooth muscles, frog heart and frog rectus muscle) in vitro. Mersalyl had an antimuscarinic effect in the smooth muscle tissues and in the myocardium. On the frog rectus muscle, mersalyl had some potentiating effect on acetylcholine response.