ABSTRACT
Chylothorax is the most common form of pleural effusion encountered in neonates. It is defined as abnormal accumulation of lymphatic fluid in the pleural space. It may be either congenital or an acquired condition. It causes respiratory and nutritional problems and significant mortality rate. Neonatal chylothorax respond to octreotide treatment. Octreotide is a long-acting somatostatin analog that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax.'' Initial management may include restriction of enteral feedings. Authors report a case of newborn baby born to gravida 2 mother at 32'2 weeks of gestation with left sided pleural effusion subsequently confirmed to be a congenital chylothorax with patent ductus arteriosus. USG guided tap was done, and milky fluid was aspirated.
ABSTRACT
Background: Among the primitive tribe of Jharkhand, Birhor’s are the smallest group, and have been tagged as 'critically endangered' with population ~5000 (Census 2011). Traditional health care practices, traditional medicines, rituals and supernatural methods of treatment are integral part of tribal community. The main objective of the study was to integrate the cultural health practices focusing on reproductive health with modern medicine so that it impacts maternal and infant mortality.Methods: A three- and half-year study was done in one of the outreach clinical area of Tata Steel Rural development society in Chotabanki village, East Singhbhum, Jharkand, India, among the Birhor tribes. The study was based on primary quantitative data -Data collection was by interviewing the respondents using questionnaires. Numerous interactive sessions with community members were conducted to learn about their cultural practices related to maternal and infant health.Results: There was a definite change in behaviour in some of traditional health practices, related to maternal and child health. Acceptance of modern health services impacted the health indicators, resulting in increase in population growth by 7.6% with zero still birth, maternal and infant mortality.Conclusions: As medical professionals, extra effort should be taken to understand their cultures regarding health. By establishing a balance between their age-old cultural practices and modern medicine, we may get healthier and résistance free community & success in controlling morbidity and mortality.
ABSTRACT
Metastasis to the skin occurs rarely in gynaecologic cancer, especially in cervical carcinoma. Although carcinoma of cervix is the second to fourth most common malignancy in women, cutaneous involvement originating from cervical cancer is particularly unusual, even in terminal stage of the disease. We report a case of carcinoma cervix stage Ib treated with radical surgery. Patient was advised postoperative radiotherapy but did not receive due to some problem. Two and half months after surgery patient developed recurrence on the left side of abdominal scar. Patient received 6 cycles of chemotherapy. 3 months later patient came back due to complications of advanced disease and died in hospital. In conclusion incisional cutaneous metastasis is a rarity with carcinoma cervix and is considered as an ominous prognostic sign with short survival after diagnosis.
ABSTRACT
Pulmonary artery catheter (PAC) is generally inserted after induction of general anaesthesia (GA). However, in high-risk coronary artery disease patients (left main disease / ejection fraction (35%), it may be desirable to insert it before the induction of GA. Thirty patients with left main coronary artery disease and / or left ventricular ejection fraction < 35% undergoing coronary artery bypass grafting (CABG) surgery were prospectively randomized into 2 groups of 15 each. In group A, pulmonary artery catheter was inserted before induction and in group B, after induction of GA. Haemodynamic parameters like heart rate (HR), mean arterial pressure (MAP), cardiac index (CI) and other derived parameters were obtained serially up to 10 min after tracheal intubation in group A and the haemodynamic management was based on these parameters. In group B, the haemodynamic management was based on HR and MAP. The demographic data was similar in both the groups. The time required for insertion of PAC was also similar in the two groups (7.6 +/- 1.8 and 6.2 +/- 1.3 min, p > 0.05). The number of interventions in the form of infusions of volume, nitroglycerin or dopamine were significantly more in group A before tracheal intubation. The patients in group A maintained better haemodynamics at 10 min after tracheal intubation as compared with group B (CI 2.8 +/- 0.67 vs 2.1 +/- 0.49, p < 0.05; stroke volume 54 +/- 18 vs 51 +/- 0.65, p < 0.05; systemic vascular resistance 1431 +/- 409 vs 1724 +/- 430, p < 0.05; pulmonary vascular resistance 109 +/- 34 vs 181 +/- 110, p < 0.05). Insertion of PAC before induction of GA provides informative data and can be utilized to treat haemodynamic alterations in high-risk patients undergoing CABG.