ABSTRACT
Objectives: To develop and assess Pediatric AppropriatenessEvaluation Protocol for India (PAEP-India) for inter-rater reliabilityand appropriateness of hospitalization.Design: Cross-sectional study.Setting: The available PAEP tools were reviewed and adaptedfor Indian context by ten experienced pediatricians followingsemi-Delphi process. Two PAEP-India tools; newborn (?28 days)and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness ofadmission and inter-rater reliability between assessors.Participants: Two sets of case records were used: (i) 274cases from five medical colleges in Delhi-NCR [?28 days (n=51);>28 days to 18 years (n=223)]; (ii) 622 infants who werehospitalized in 146 health facilities and were part of a cohort (n=30688) from two southern Indian states.Interventions: Each case-record was evaluated by twopediatricians in a blinded manner using the appropriate PAEP-India tools, and ‘admission criteria’ were categorized asappropriate, inappropriate or indeterminate.Main outcome measures: The proportion of appropriatehospitalizations and inter-rater reliability between assessors(using kappa statistic) were estimated for the cases.Results: 97.8% hospitalized cases from medical colleges werelabelled as appropriate by both reviewers with inter-rateragreement of 98.9% (k=0.66). In the southerm Indian set ofinfants, both reviewers labelled 80.5% admissions as appropriatewith inter-rater agreement of 96.1% (k= 0.89).Conclusions: PAEP-India (newborn and child) tools are simple,objective and applicable in diverse settings and highly reliable.These tools can potentially be used for deciding admissionappropriateness and hospital stay and may be evaluated later forusefulness for cost reimbursements for insurance proposes.
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Introduction: Clinicians and anatomists have been examining coronary artery variations for a long time. However, there is still no consensus on the normality or abnormality of coronary arteries. The present survey was therefore conducted to find out the variations in left coronary artery (LCA) and right coronary artery (RCA) branches, the existence and occurrence of the median artery in northern Indian population.Material and methods: The present study was planned and conducted during March 2012 to September 2014 at Department of Anatomy, Major S. D. Singh Medical College, Fatehgarh; a tertiary care teaching hospital. The hearts of 40 adult northern Indian cadavers fixed with 10% formaldehyde were used. To determine the dominant circulation, the artery that supplies the posterior inter ventricular sulcus was investigated. Dissections were performed under a dissection microscope and photographed. Results: LCA branched out of the aortic sinus in all the hearts and had an average diameter of 4.44 ± 1.79 mm. In 45% hearts, the LCA was separated into the anterior inter ventricular branch and the circumflex branch (bifurcation). In 42.5% hearts, in addition to the anterior inter ventricular branch and the circumflex branch; there was a median artery that coursed on the front wall of the left ventricle (trifurcation). In 10% hearts, branching occurred as in trifurcation but with two median arteries emerging from the LCA (quadrifurcation). Myocardial bridges were found on the LCA branches in 19 of the 24 hearts in which the median artery existence of the median artery and myocardial bridges. The median artery might be important as it may not result in any clinical symptom for many years in a large number of subjects. Knowledge of individual and racial variations in coronary arteries is essential for the diagnosis and treatment of coronary artery patients.
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Objective: To assess the efficacy of metronidazole and collagenase combination in the treatment of diabetic foot ulcers with regard to the reduction of slough formation, enhancement of granulation tissue and re-epithelization. Study design: Prospective, comparative study. Place and duration of study: Surgery department of a tertiary care teaching centre of rural Haryana, from January 2011 to February 2013. Methodology: The patients who were admitted for diabtic foot ulcers at Surgery Department of a tertiary care teaching centre during the study period were screened. 42 patients in the test group were treated with topical dressings of collagenase and metronidazole. The control group of 40 patients was treated with conventional topical dressings and bed side debridement. Ulcer's status was noted using visual score. Results: The number of patients with no necrotic tissue was significantly higher in test group at 3rd, 4th, 5th, 6th and 7th weeks than control group. Granulation tissue was significantly higher in test group at 3rd, 4th, 5th and 6th week. The test group patients had a faster wound bed preparation resulting in faster wound cover using secondary suturing, S.S.G., flap cover at the third week itself. Conclusion: Combination of collagenase and metronidazole topical application enhanced wound healing of diabetic foot ulcer as compared to conventional treatment modalities.
ABSTRACT
The nutritional need of various micronutrients is realised within the last decade with the advent of newer better diagnostic techniques. Lower intake of animal foods which are the prime source of zinc, lower quality of nutrients intake, higher faecal loss of Zn during diarrhoea and inhibition of absorption of Zn by phytates present in the vegetables are some of the causes resulting in zinc deficiency in children of developing countries. Its importance in the management of persistent diarrhoea is gaining momentum with satisfactory results are being reported worldwide particularly when associated with severe acute malnutrition. Further the potential role and consensus guidelines for routine use of Zn in the prevention of infective diseases like acute respiratory tract infections, malaria, tuberculosis and particularly in intrauterine growth retardation babies is to be proven in time to come. Better dietary habits, food fortification and increased awareness and health education can prevent the Zn deficiency to a large extent.