Does full enteral feed from day one of life influence weight gain in hemodynamically stable VLBW babies weighing between 1000-1500 grams as against standard feeding? an open label randomized controlled trial

Background: Preterm neonates post-natal growth should be similar to the intrauterine growth of the fetus of the same gestational age. This study aims to' evaluate the effects of full enteral feed (60 ml/kg/day of human milk on day one, 20ml/kg/day during feeding advancement) started from day one of life (intervention) in enhancing'' the regain of birth weight compared to that of standard feed (both human milk feeds and intravenous fluid) in a group.Methods: Babies were started on enteral feeds with human milk at the rate of 60ml/kg/day from day one and progressed by increments of 20 ml/kg/day up to maximum enteral feed of 180 ml/kg/day. The primary outcomes like Number of days taken to regain the birth weight, Duration of hospital stay, Incidence of Necrotising Enterocolitis (NEC), Incidence of sepsis, need for intravenous fluid therapy was assessed and statically analysed.Results: Full enteral feeding group infants had lesser days of intravenous fluids. Full enteral feeding group regained birth weight at a mean age of 17.37'4.9 days and in the standard feeding group, birth weight was regained at a mean age of 19.8'4.3. Full enteral feeding group regained birth weight at a mean age of 13.12'2.17 days and in standard feeding group at a mean age of 15.38'3.57and this was statistically significant (p - 0.009). Full enteral feeding group babies had lesser number of days of intravenous fluids compared to babies in standard feeding group. It was statistically significant (p - 0.003).Conclusions: Full enteral feeding practices from day one of life with human milk is feasible, cost effective and safe in hemodynamically stable VLBW infants and results in earlier regain of birth weight

Mortality profile of extreme to very preterm infants in an extramural tertiary care neonatal unit of a teaching hospital in Southern India: a retrospective study

Background: Neonatal deaths account for 47% of all deaths in children younger than 5 years globally. More than a third of deaths are due to preterm related complications. Understanding the factors contributing to preterm deaths and pattern of mortality is needed to implement interventions that are essential in improving neonatal survival.Methods: This was a retrospective study done in neonatal intensive care unit, Institute of Child Health (ICH) and Hospital for Children, Chennai, a tertiary care regional center. All preterm (<32 weeks) deaths registered in the neonatal medical records from 1st of January 2018 to 31st of December 2018 were analysed. Primary causes of deaths were analysed by two consultants. When there were more than one cause contributing to responsible for death the most significant problem was taken as the cause of death.Results: Overall neonatal mortality was 312 (14.2%) of 2189 neonates. Out of 148 admissions in the study population mortality was 74.2% (26 of 35) for extreme preterm (<28 weeks) infants and 42.7% (48 of 113) for very preterm (28 to 32 weeks) infants. Predominant causes of death were sepsis 44.5% (33), prematurity-related complications 37.8% (28) followed by congenital anomalies 12.1% (9) and miscellaneous causes 2.7% (2). Respiratory Distress Syndrome (RDS) and Intra Ventricular Haemorrhage (IVH) attributed to 75% (21/ 28) of deaths among prematurity-related complications.Conclusions: This study identified sepsis; prematurity related complications were the predominant causes of mortality in the extreme to very preterm population. Understanding the specific causes of preterm mortality would help to implement interventions to promote their survival.

Optical coherence tomography: A guide to interpretation of common macular diseases

Optical coherence tomography is a quick, non invasive and reproducible imaging tool for macular lesions and has become an essential part of retina practice. This review address the common protocols for imaging the macula, basics of image interpretation, features of common macular disorders with clues to differentiate mimickers and an introduction to choroidal imaging . It includes case examples and also a practical algorithm for interpretation.

Agreement between Framingham Risk Score and United Kingdom Prospective Diabetes Study Risk Engine in Identifying High Coronary Heart Disease Risk in North Indian Population

BACKGROUND: The aim of the study is to evaluate the concurrence between Framingham Risk score (FRS) and United Kingdom Prospective Diabetes Study (UKPDS) risk engine in identifying coronary heart disease (CHD) risk in newly detected diabetes mellitus patients and to explore the characteristics associated with the discrepancy between them. METHODS: A cross-sectional study involving 489 subjects newly diagnosed with type 2 diabetes mellitus was conducted. Agreement between FRS and UKPDS in classifying patients as high risk was calculated using kappa statistic. Subjects with discrepant scores between two algorithms were identified and associated variables were determined. RESULTS: The FRS identified 20.9% subjects (range, 17.5 to 24.7) as high-risk while UKPDS identified 21.75% (range, 18.3 to 25.5) as high-risk. Discrepancy was observed in 17.9% (range, 14.7 to 21.7) subjects. About 9.4% had high risk by UKPDS but not FRS, and 8.6% had high risk by FRS but not UKPDS. The best agreement was observed at high-risk threshold of 20% for both (kappa=0.463). Analysis showed that subjects having high risk on FRS but not UKPDS were elderly females having raised systolic and diastolic blood pressure. Patients with high risk on UKPDS but not FRS were males and have high glycosylated hemoglobin. CONCLUSION: The FRS and UKPDS (threshold 20%) identified different populations as being at high risk, though the agreement between them was fairly good. The concurrence of a number of factors (e.g., male sex, low high density lipoprotein cholesterol, and smoking) in both algorithms should be regarded as increasing the CHD risk. However, longitudinal follow-up is required to form firm conclusions.

Concept and canons of fasting in ayurveda

Ayurveda, manoeuvres mankind to head a healthy life in order to pursue four?fold bliss. With a view to combat physical and mental annoyances, classics have explicated two?fold therapeutic modalities; langhana/depletion and brihmana/nourishing. Upavasa /fasting is one among ten depletion therapies explained. It is envisioned at all three levels of Ayurvedic therapiesrational/objectively planned, psychological, and spiritual. Fasting is reckoned to be refraining from all forms of food intake for a given period, under supervision of a qualified physician. Acharya Charaka advocates fasting in diseases of milder intensity, in those due to aama [metabolic toxin], after purificatory procedures. Fasting person should avoid beautifying oneself, day sleep, sexual acts, and feasting prior and ulterior to fasting. Fasting is contraindicated in very young, elderly, emaciated, pregnant lady, and shortly after strenuous exercise. The principle avers that fasting kindles metabolic/digestive fire which, in absence of food, brings about paachana of vitiated doshas, thereby riposting health. Sound fasting ensues proper elimination of excretory wastes, clear belch, sweat, and taste for food. Benefits of fasting include lucidity of sense organs, lightness of body and mind, control of diseases, and enthusiasm. Yoga Shastra describes fasting with respect to three levels of food: physical, impressions, and associations and a means to unite three bodies: astral, physical, and causal. Ayurveda thus advocates fasting depending upon the dosha, agni, vaya, kala, and bala of the individual, as a preventive as well as therapeutic modality