Body Mass Index and Hypertension in Adolescents.

The ongoing rise in the prevalence of Pre-hypertension & hypertension in adolescent is considered to be accompanied with the childhood overweight and obesity. Body Mass Index is one of the indicators which positively correlate with the hypertension (HTN) in adolescents. The study was conducted to establish prevalence of HTN in adolescents with Body Mass Index (BMI). The study was conducted in 450 adolescents children from the age 10 to 19 yrs. range. Blood Pressure and Anthropometric data were collected and analysed. Result: Our Result shows that 9.8% Patient were at risk of overweight and 1.6% were overweight with striking feature that 14.6% early adolescents were overweight. 10.8% of adolescent female and 11.7% males were having BMI more than Normal. Prevalence of Pre-hypertension and hypertension were 7% and 5.60% respectively. Pre-hypertension and hypertension were more prevalent (19.6% & 27.4%) in adolescents having BMI ≥ 85 percentile for the age and sex then adolescents having BMI below 85th percentile. (5.5%, 2.8%) Conclusion: By our study we can conclude that the prevalence of Pre HTN and HTN is directly related to Body Mass Index (BMI). Overweight and obesity may give rise to pre HTN and HTN and should be considered as an alarming feature, and in turn we can prevent prevalence of Essential HTN in adults. Intervention at this age by change in the life style at the earliest can be of greater help. Reduction in the intake of High calorie Diet like Junk Food and initiation of exercise, Meditation and Yoga to the Borderline adolescent will definitely decrease the incidence of HTN. Further study is required to establish direct relation of BMI and HTN so as to prepare useful charts and tables.

Platelet count – a diagnostic aid in fever.

Introduction: Vivax Malarial infection. Dengue Viral fever is also emerging as a Febrile conditions to have reduced platelet count. The absence of the normal platelet count on peripheral smear in case of fever is a clue to the presence of Malaria and Dengue fever. Material & Method: Present study we have tried to study the pattern of thrombocytopenia in these febrile conditions and their diagnostic and prognostic implications. The study was conducted at GMERs Medical College, Gandhinagar. This study group consisted of 146 Patients of Fever treated at Pediatric Department, Malaria diagnosed by thick & thin smear examination. The platelet count was done by Abascus Junior B- Blood Cell counter. Dengue Fever was diagnosed by NS1 Antigen Test. The Mean Platelet counts in P. Falciparum are 69852 cells/mm3, P.Vivax 1,15,580 and Dengue Fever 53,100. Statistically the difference between P. Falciparum & Vivax is significant for differentiating Malarial type. Result: Platelet count <20,0000 cells/mm3 was observed in both the types of Malaria and not seen with Dengue Fever. Profound thrombocytopenia still remains the distinguishing, feature of P. Falciparum Malaria. Platelet count more than 1,00,000 cells/mm3 favours the diagnosis of P.Vivax & Moderate reduction in Platelet Count (between 20,000 to 1,00,00) is clue to P. Falciparum and Dengue Fever. In this segment other diagnostic criteria like pFHrp Antigen and N.S.Antigen should be applied to differentiate these two grave conditions. Thrombocytopenia (Platelet count <150000 cells/mm3) can be considered as a predictor of Malaria and in combination with Anemia (Hb<10gm/dl) is a next best parameter. Unlike Malaria, in Dengue fever thrombocytopenia is usually associated with normal Hemoglobin.

Accreditation-a public reporting of healthcare quality data.

Internet facility provides the easy and accurate access of the hospital performance on key matrics and because of this information the consumer has become more knowledgeable. Further, more to empower the consumer to make informed decision public reporting of healthcare data is Essential & that initiates the concept of ‘Report Card’ model for Hospital. Accreditation of hospital is public recognition awarded by National Healthcare Accreditation Body on the achievement of standard level of performance. National Accreditation Board for hospital and healthcare providers (NABH), set up to establish and operate Accreditation programme for Healthcare organization. Concept of Accreditation can be utilized successfully as a ‘Report Card’ is reviewed in this article.

Ultrasonic measurement splenic size of normal & comparison with various medical disorders involving spleen in paediatric Indian population.

Intorduction:The present study was conducted in the departments of Anatomy, Radiology and Paediatrics at a General Public Charitable Hospital, Mumbai. Method: The study group consisted of 160 children of both sexes, who were referred to the Radiology department for ultrasonography. Out of these 160 chidren, 80 underwent sonography for abdominal and/or pelvic problems unrelated to the spleen and 80 children were suffering from medical disorders related to spleen i.e. 55 patients of thalassemia major, 13 patients of malaria, 9 patients of typhoid and 3 patients of portal hypertension. The splenic length was measured by using a commercially available real time ultrasound system with a TOSHIBA ECOCEE USG SYSTEM particularly by using the convex probe. Result: In the present study in abnormal spleen group, there is a strong correlation between weight and splenic size, and between age and splenic size, there is a partial correlation between height and the splenic size. In all the children with clinically obvious splenomegaly, the splenic length exceeded at least 2 cm than the normal splenic length at that particular age.Conclusion : This study shall stand as a good reference to Radiologists, Paediatricians, Haematologists and Physicians in an undiagnosed and complicated cases and will also helpful to determine the mode of treatment in thalassemia major with splenomegaly.

Electronic medical record - essential for healthcare system.

In recent years, medical record-keeping has evolved into a science which is increasingly using computers and digital technology to fulfill the needs of clinicians, researchers, administrators, legal regulatory agencies and insurance companies. Medical records are important because ‘people forget and record remembers. The Medical Record Department, which is entrusted with storage, analysis and retrieval of records, plays a key role in management, planning, medical audits, policy decisions and research in any institution. Further, the information provided by this department to the health authorities of the city, state and country forms the basis on which several health-related decisions are taken at those levels. Medicolegally these records are to be preserved for, fix time periods depending on type of cases, so proper storage and damages to the conventional paper based records is emerging as a big issue to institutions. A hospital should follow well established procedures meticulously; update them regularly including the use of Information Technology for having sound Electronic Medical record Department. The transformation of conventional medical records to electronic medical records, certain Technical features and standard are to be observed strictly. In turn, this will provide more reliability, Transparency and accuracy in Medical Records. This will generate great amount of confidence in our patients, Insurance Companies, TPAs and Accreditation bodies. Electronic Medical record will be first step towards “Paperless Hospital”.

Thrombocytopenia in p. vivax malaria.

Backgroud: Plasmodium Falciparum and P. Vivax are endemic infections in India and commonly associated with Hematological Abnormalities. Severe thrombocytopenia is frequently noticed with P. Falciparum Malaria, but its occurrence is less reported and studied with P. Vivax Malaria. In present study we have tried to evaluate severity & prognostic implications of thrombocytopenia in cases of P Vivax Malaria. The study was conducted in Department of Pediatrics, GMERS Medical College, Gandhinagar.Method: The study group consisted of 92 Pediatric Patients diagnosed on thick & thin blood smear examination having thrombocytopenia. The platelet counts were done by Abacus Junior B Blood Cell Counter. Result: Platelet Count <150000 Cell/mm3 (thrombocytopenia) was observed in 73.92% patients of P. Vivax Malaria. The mean platelet count 1,16,520 is significantly low and the range being 18000 cell/mm3 to 5,10,000 cells/mm3. Anaemia with mean Hemolobin level 8.8 gm/dl. was reported in the patients with P. Vivax Malaria with thrombocytopenia. Discusssion: In our view, this statistically low platelet count in P.Vivax Malaria is having significance & should be kept as differential diagnosis in Acute Febrile conditions. Unnecessary Platelet transfusions can be prevented as noticed in the study. Platelet transfusion was not required in the patients having severe thrombocytopenia (platelet count <20000 cells/mm3)as bleeding tendencies and systemic complications were not observed as compared to Falciparum Malaria. Platelet count and clinical recovery were immediate on 2nd day after initiation of treatment and complete recovery within 7 day without any complications and mortality suggest a good prognosis. Conclusion: Anaemia with severe thrombocytopenia in P. Vivax Malaria required further study to differentiate other febrile conditions with low platelet count and unaltered hemoglobin levels.