A Prospective Observational Study To Evaluate TOPS Score As An Outcome Predictor In Extramural Referred Neonates Admitted At A Tertiary Care Center

Background:The neonatal period is the most vulnerable time for a child's survival. As survival perspective of extramural neonates significantly relies on the state of neonate at admission, various survival scores like CRIB, SNAP, MINT, TRIPS, TOPS etc. are designed to prognosticate the outcome of neonate at admission. This study was de signed to delineate correlation of TOPS score with outcome of referred neonates.Aims And Objectives:To recognise correlation of TOPS score with outcomes of extramural neonates. Material And Methods:It was prospective observational study conducted from September 2019 to February 2020 at nicu of tertiary care hospital. Clinico-demographic characteristics and TOPS score were documented in a pre-designed proforma. Hypothermia, Hypoxia, prolonged CRT and Hypoglycemia were defined as<36.5C, <90%, ?3 secs and <40mg/dl respectively. Each parameter was assigned a score of ‘1’ if abnormal and ‘0’ if normal. Neonates were treated as per standard protocol and their outcome was recorded as survive d or expired. Result:Out of 239 neonates 140 (58.6%) were males and 99 (41.5%) were females. The area under the ROC curve (AUROC) for TOPS Total predicting Outcome: Expired vs Outcome: Survived was 0.932. At a cut-off of TOPS Total ?2, it predicts Outcome: Expired with a sensitivity of 83% and a specificity of*The relative risk (95% CI) for Outcome: Expired when TOPS Total is ?2 was 25.68.Hypothermia (Chi-squared test, ?2 = 38.462, p = <0.001), hypoxia (Fisher's exact test, ?2 = 122.636, p = <0.001), poorperfusion (shock) (Fisher's exact test, ?2 = 103.563, p = <0.001) are found to be significantly associated with poor outcome. Conclusion:TOPS score is an easy, reliable and applicable tool for outcome prediction of transported neonates.

A Descriptive Observational Study of Effect of Covid-19 Pandemic on Routine Immunization in Children at Tertiary Health Care Centre

Background:Immunization has crucial role in protecting a child from vaccine preventable infections. But during last year 2020, Due to ?COVID-19?pandemic, Routine& supplementary immunization and the surveillance of vaccine-preventable diseases have beenimpacted in many countries. This may lead to the resurgence of vaccine-preventable diseases. So, wehave opted this study to see impact of Covid 19 on routine immunization at vaccination centre of a tertiary care hospital. Aims: To assess effect of covid 19 pandemic on routine immunization. Material And Methods:This study was retrospective observational study, conducted at vaccination centre of tertiary care hospital of Ahmedabad. Data was retrieved from January 2019 to December 2020 from register of vaccination centre and entered in excel sheet and analysed individual month and vaccine wise. Result:Number of immunised children was lower in 2020 as compared to 2019. The result was significant at p<0.05 by Mann Whity test. Inj Td of 10 year was most affected and OPV0 & BCG was least affected. Maximum reduction in percentage was seen in May month and least in February. Conclusion:Health system should design strategies for catch-up vaccination to prevent surge of vaccine preventable disease.

Evaluation of anti-histidine-rich protein 2 monoclonal antibodies, developed by using poly (N-isopropylacrylamide) as an adjuvant for malarial diagnostic application

@#Objective: To evaluate the sensitivity and the stability of the monoclonal antibodies (Aa3c10, b10c1), against truncated Histidine-rich protein 2 (PfHRP2), developed using smart polymer, poly N-isopropylacrylamide, as adjuvant for malarial diagnostic applications in comparison with the available commercial antibodies. Methods: Two hybridoma clones (Aa3c10, b10c1) were used for the production of ascites in BALB/c mice. Purification of monoclonal antibodies from the ascites was carried out using affinity columns. The thermal stability study of monoclonal antibodies was done by storing it at 37°C and 45°C for thirty days. The stored antibodies were analyzed using SDS-PAGE and flow-through device where the antigenantibody interaction was visualized by Protein A colloidal gold solution. Sensitivity was determined by endpoint dilution ELISA and the dissociation constant by competitive ELISA. Sensitive pair optimization was done by sandwich ELISA using biotinylated antibodies. Prototype preparation for lateral flow assay had a colloidal gold-based detection system. Results: Thermal stability experiments showed that both mAbs (Aa3c10; b10c1) are stable up to thirty days at 45°C while the commercially available mAbs were stable up to fifteen days only. Compared to commercial antibodies, the mAb Aa3c10, showed the highest sensitivity in end-point titre. In sensitive pair optimization, it was observed that the mAb, b10c1, as a detector and the mAb, Aa3c10, as a capture antibody showed the highest absorbance to detect 50pg/ml PfHRP2 antigen. The prototype formulation of lateral flow assay using the mAbs (Aa3c10; b10c1) showed good reactivity with WHO panel and no false-positive results were observed with twenty clinically negative samples and five P. vivax positive samples. Conclusions: The novel monoclonal antibodies (Aa3c10, b10c1) against truncated PfHRP2, could be a strong potential candidates that can be included in making RDTs with better sensitivity and stability.

Evaluation of Serum Adenosine Deaminase and Retinol in patients with Laryngeal Cancer.

Laryngeal cancers account for 4% of all head and neck cancers in India. The disease process has better prognosis if it is diagnosed early. In view of this the objective of the study was to assess the reliability of serum enzyme marker adenosine deaminase and non-enzymatic antioxidant retinol in laryngeal cancer patients as supportive parameters for diagnostic purpose. Materials and methods:-25 clinically and histopathologically confirmed patients of laryngeal cancer in age group of 45-65 years were included in the study and 25 healthy subjects with in the same age group served as controls. Results:-The level of serum ADA was significantly elevated in laryngeal cancer patients in comparison to controls whereas retinol levels were significantly decreased. Conclusion: - Lipid per-oxidation as a result of cancer leads to membrane damage and an increase in cytoplasmic ADA. It is also associated with a decrease in levels of non-enzymatic antioxidant retinol. These biochemical parameters may be used as supportive parameters for diagnostic purpose and may add further for prognostic information. Further studies are required on a larger sample size to explore strategies by which normal levels of anti-oxidant can be maintained by a retinol rich diet which may play a role in reducing the morbidity and mortality due to cancer.

Wilson's disease presenting as status epilepticus.

A patient of Wilson's disease having neurological as well as psychiatric manifestations who presented with status epilepticus is being reported. The diagnosis was confirmed by biochemical investigations and 'face of giant panda' sign was present on MRI brain.

Quality control of culture media in a microbiology laboratory.

The nature of reporting of a microbiology laboratory depends upon the quality of the culture media used. Quality of media directly affects the observations and inferences drawn from the cultural characteristics of microorganisms. Checking of different parameters of media such as growth supporting characteristics, physical characteristics, gel strength and batch contamination can help to assess their quality. There are different methods to check all these parameters systematically. The meticulous performance of quality control of culture media can assure precision in reporting.

Anticlastogenic activity of plumbago indica using mouse bone marrow: Micronucleus test.

Certain human cancers can be prevented by identification of mutagenic agents in the environment and protecting humans from exposure to such agents. The purpose of this study is to evaluate the anticlastogenic activity of Plumbago indica in mouse bone marrow cells. The known clastogen used was mitomycin C at 1.5mg/kg body weight. The Plumbago indica extract is treated with mitomycin C at three different dose levels viz., 0.5, 1 & 2mg/kg at varying time periods. The pretreatment was carried out at 3, 6, & 12 hours, and the animals were sacrificed after 24 hours of the last administered injection. The percent inhibition of micronucleated polychromatic erythrocytes (MNPCEs) was found to be more than 50% at all time points of pretreatment. Plumbago indica was found to be effective at 12 hours before treatment of mitomycin C (−80%). The inhibition of micronuclei in MNPCEs induced by mitomycin C was not effective at simultaneous and post treatment of Plumbago indica.

Complementary medicine seminar for medical undergraduates at the University of the West Indies, Mona

Use of complementary medicine by the general public is increasing. It is therefore apt that doctors in training learn more about it. For several years, medical students doing their Year III Community Health clerkship have had one afternoon devoted to the subject. In advance, they are given reading materials and are asked to prepare short presentations relating to definitions, types of therapies available, principles underlying some of these therapies, extent of usage of complementary medicine, expenditure on it, appropriate research methods to evaluate effectiveness, and opinions of the public and the profession regarding its use. A demonstration of one kind of complementary medicine by a practising therapist forms part of the activities.

Prevalence, identification and distribution of various species of enterococci isolated from clinical specimens with special reference to urinary tract infection in catheterized patients.

Various clinical specimens were processed to find the prevalence rate of enterococci and to identify the species of clinical isolates of enterococci. Screening of various clinical specimens revealed that enterococci were prevalent in 22.19% of the total specimens, with Foley's catheters and burn wounds to be the major site of isolation. High rate of colonization was noted as opposed to infection. Conventional test scheme proposed by Facklam and Collins were successfully used to speciate enterococcal strains. Seven species of enterococci were identified in the study from a set of 202 cultures, with E.faecalis (49.50%) and E. faecium (35.64%) predominating. E. avium (9.40%), E.hirae (2.47%), E.raffinosus (1.98%) and one isolate each of E.gallinarum and E. casseliflavus were the other members of Enterococcus species identified. Urinary tract infection (UTI) by enterococci due to catherisation was found in 8.92% of the patients and is probably the result of high rate of colonization of Foley's catheters and use of broad-spectrum antibiotics.

Alternative medicine: old ideas with new interests?

The use of complementary or alternative medicine has greatly increased in developed countries during the last few years. In such countries, laws have been passed and regulations made to protect both the public and the practitioners. There are a growing number of research units in universities, journals, and associations of practitioners of complementary medicine. In Jamaica, too, there is increasing recognition, if not acceptance, of the popular interest in complementary medicine. In preparation for the next century we will need to address some of the legal, educational and scientific issues raised.

Dental plaque: an unlikely reservoir of Helicobacter pylori.

BACKGROUND AND AIM: Dental plaque has been suggested as a reservoir for Helicobacter pylori, though data in this regard are conflicting. We evaluated the prevalence of H. pylori DNA in dental plaque using polymerase chain reaction (PCR). METHODS: Antral H. pylori status of 156 patients with acid-peptic disease (APD) was studied by rapid urease test (RUT), histology and culture. Dental plaque obtained from these 156 patients and 92 healthy volunteers was evaluated for the presence of H. pylori using RUT, culture and PCR. RESULTS: H. pylori was present in 133 antral biopsy samples by RUT and/or histology. The dental plaque of 37 patients with APD and 21 healthy volunteers tested positive by RUT. H. pylori was not isolated by culture from any of the dental plaques. PCR gave a significant amplification product in 11 of 248 (4.4%) dental plaque samples, 7 from patients with APD and 4 from normal healthy volunteers. CONCLUSION: The frequency of H. pylori in the dental plaque is low, and this is unlikely to be a prominent site of infection with H. pylori.

Risk assessment of tobacco, alcohol and diet in cancers of base tongue and oral tongue--a case control study.

This is a retrospective case-control study of male tongue cancer patients seen at Tata memorial Hospital, Bombay, during the years 1980-84. The purpose of the study was to identify the association of tobacco, alcohol, diet and literacy status with respect to cancers of two sub sites of tongue namely anterior portion of the tongue (AT) (ICD 1411-1414) and base of the tongue (BT) (ICD 1410). There were 142 male AT patients and 495 BT patients interviewed during the period. 635 interviewed male patients who were free of any disease were considered as control. Bidi smoking was found to be a significant risk factor for BT patients and tobacco chewing for AT patients respectively. Alcohol drinkers showed about 45% to 79% excess risk for both sites of tongue cancer. Illiteracy and non vegetarian diet proved to be a significant factor for AT patients only. The study brings out that the location of cancer has got a direct bearing with the type of tobacco use and other related habits and this inturn may provide meaningful interpretation of variations observed in the incidence of tongue cancer around the world.

Profile of women undergoing reversal of sterilisation.

Two hundred twenty women who were subjected to reversal of female sterilisation over 7 years were analysed. It was found that death of the male child was the strongest reason for seeking a reversal. This was coupled with the parity of these subjects being two or less in 70% instances at the time of primary sterilisation surgery. Nearly 85.9% reversal were sought in the higher age groups clubbed together. This has an adverse bearing on success of reversal surgery as the fertility potential of a woman declines physiologically as age advances.

A clinicopathologic profile of adrenocortical tumors.

OBJECTIVE: To study the clinical, biochemical, hormonal, radiological and histopathological profile of adrenocortical tumors in children; to assess the clinicopathological correlations and note the future outcome. DESIGN: Retrospective and prospective study. SETTING: Hospital based; Endocrine Service of our institution and other institution based services. SUBJECTS: 14 children (Females = 11, Males = 3) with adrenocortical tumor, aged 8 months to 13 years (mean age 5.1 +/- 3.42 years), seen over a period of 9 years. RESULTS: Females predominated (F:M = 3.7:1). Majority (64%) had a mixed picture with cushingoid features and virilization, whereas 36% presented only for virilization. Elevated serum cortisol levels with loss of diurnal variation was noted only in those with mixed clinical presentation. Adrenal androgen elevation was noted in majority of cases as virilization was common to all. CT confirmed the diagnosis of tumor, 7 on either side. Thirteen cases were operated. Histopathologic diagnosis was carcinoma in 7 and adenoma in 6 cases. Three of the seven with carcinoma died within 3 months to 2 years but two of these with small tumours (weight 60-65 g and diameter < 6 cm) were well at 2 and 5 years, while as one of the six with a large adenoma had recurrence and metastasis after three years. CONCLUSION: Female preponderance was marked (4 times), 43% of tumors had occurred by 3 years of age and 64% by 6 years. Neither the hormonal parameters nor the histopathology correlated well with the biological behavior and outcome. Prolonged and vigilant follow up is essential.

Pain relief in chronic pancreatitis with epidural buprenorphine injection.

BACKGROUND: The management of intractable pain in chronic pancreatitis is difficult. A novel method for its relief is described. METHODS: Twelve patients were given a mixture of buprenorphine (0.3 mg) and blood (10-15 mL) into the epidural space. RESULTS: All patients had pain relief lasting up to six months. CONCLUSION: Epidural buprenorphine injection is a simple, safe and effective method for pain relief in chronic pancreatitis.

Epidemiological observations on cancer of the oesophagus--a review of Indian studies.

This is an epidemiological review on cancer of the oesophagus. In this attempt, all aspects of epidemiological factors based on national and international studies on oesophageal cancer have been brought out. The problem of this cancer in Indian context has been documented. The association of tobacco and alcohol habits with oesophageal cancer has been confirmed from the studies conducted in India. There is an urgent need to educate the common people about the harmful effect of these two habits and governments and voluntary organisation should take effective steps for its prevention.

Cancer control in the Asia Pacific region--the next lap.

Cancer control in any part of the world has to be a multi-directional effort addressed in a holistic manner. The general impression that cancer control means only collation of epidemiological data and efforts at primary prevention needs to be redefined because preventive and educative oncology, though an important component of cancer control, can achieve long-term goals only after 20 years or more. Along with such long-term objectives, methodology needs to be developed which takes care of immediate and recent needs in early diagnosis, effective treatment, and appropriate basic research for the ultimate control and cure of cancer. A holistic approach to the cancer control effort will, therefore, need the combined skills of many different specialists.

Undifferentiated embryonal sarcoma of the liver in childhood.

Primary undifferentiated embryonal of the liver in children is a rare neoplasm with dismal prognosis. Surgery is the treatment of choice. Adjuvant chemotherapy may prove useful in improving the prognosis of these tumours. We report two cases of Primary undifferentiated embryonal sarcoma of the liver.