Utility of CECT in Evaluation of Intestinal Obstruction and its Outcome in Terms of Management

Intestinal obstruction is one of the leading causes of admission in general surgical emergency with variable outcomes. It is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Many previous studies have demonstrated computed tomography (CT) to be a valuable technique for imaging intestinal obstruction. Advantages of CT imaging are accurate demonstration of the site, level and cause of obstruction, presence or absence of adverse features such as ischemia, volvulus or closed loop obstruction. CT allows for smaller and site specific incisions with improved wound related outcomes. Methods: A prospective observational study on 50 patients admitted in General Surgery department of Rajindra hospital, Patiala with clinical features of intestinal obstruction to show the utility of CECT in diagnosing the presence, level, degree, and cause of intestinal obstruction, and the role of CT in detecting presence of complications. Results: The study demonstrated the sensitivity and sensitivity of CT scan in cases of intestinal obstruction as 92% and 100% respectively. The accuracy of CT scan in detecting the cause of intestinal obstruction was found to be 94% (with a significance level of P<0.001) with a positive predictive value 100% and negative predictive value 76.92%. Conclusion: CT scan is accurate at diagnosing the bowel obstruction with high sensitivity and high specificity; however it is not accurate in determining the cause of the obstruction. In clinical practice it is a useful tool to guide appropriately the line management whether conservative or surgical in such patients.

Electrolyte Changes in the Term Neonates Following Phototherapy in Neonatal Hyperbilirubinemia

Hyperbilirubinemia is one of the most prevalent problems in neonates. Jaundice is observed during first week of life in approximately 60% of term neonates and 80% of preterm neonates. Phototherapy is the most common therapeutic modality used in the treatment of uncomplicated neonatal hyperbilirubinemia. Objective: To study electrolyte (Ca, Na, K, Cl) changes in the term neonates following phototherapy in neonatal hyperbilirubinemia. Methods: This study was performed on 100 term neonates (65 males, 35 females) admitted to the Department of Pediatrics, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar, Punjab with unconjugated hyperbilirubinemia and were managed with phototherapy. These neonates were completely normal on physical examination. Electrolytes were checked at 0 hr (at the time of admission) and after 48 hours of phototherapy or at discontinuation of phototherapy (second sample) whichever was earlier. The first sample was considered as control. Results: After phototherapy, among electrolytes (Ca, Na, K ,Cl) there was significant fall in serum calcium (ionized) level. 16 neonates developed hypocalcemia after 48 hr or less of phototherapy and 11 neonates developed hypocalcemia after 48 hr or up to 96 hr of phototherapy. The difference between pre and post phototherapy serum calcium (ionized) levels was found to be statistically significant (p <0.005). Of the 27 term neonates who developed hypocalcemia, 7 (26%) developed jitteriness and none of them developed irritability, seizures and aponea. No statistically significant fall/rise in levels of Na, K, Cl were observed in term neonates after phototherapy. The incidence of potassium, sodium and chloride changes following phototherapy was found to be nonsignificant irrespective of gestational age, birth weight and duration of phototherapy. Conclusion: The study concluded that among electrolytes (Ca, Na, K, Cl), phototherapy induced hypocalcemia is a significant problem. Thus calcium supplementation should be considered.

To Study Nutritional Factors and Postnatal Growth as Predictors of Retinopathy of Prematurity in Neonates Weighing <1750g and/ or Gestation <34 Weeks

Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the developing retinal vessels of premature infants. ROP remains one of the leading causes of childhood blindness worldwide. India and other developing countries are facing the third epidemic of ROP. Various risk factors for development of ROP include low gestational age, low birth weight, hyaline membrane disease, sepsis, shock, prolonged oxygen therapy, poor nutrition and weight gain and blood transfusions. Objective: To study nutritional factors and postnatal growth as predictors of ROP in neonates weighing <1750g and/ gestation <34 weeks. Methods: It is a prospective observational study conducted over one year (May 2017 to April 2018) in NICU, Department of Pediatrics, Govt. Medical College Amritsar, in collaboration with Department of Ophthalmology. All antenatal, perinatal and neonatal factors along with nutritional factors and postnatal growth mointoring were recorded. Screening for ROP was done by indirect opthalmoscopy at 4 weeks of postnatal age and followed up till retinal vascularization was complete. Data was analysed using univariate and multivariate regression analysis to evaluate risk factors. Results: Out of 79 babies screened 44 were found to have ROP of which 4 required treatment. Important risk factors found significant on univariate analysis were low birth weight (p=0.023) gestational age (p=0.003), duration of i/v fluid therapy (p=0.004), day of start of feed (p=0.032), day of attainment of full feed (p=0.005), relative weight gain at 4 weeks (p=0.041) and 6 weeks of life (p=0.04). On mutivariate logistic analysis, relative weight gain (g/kg/day) at 4 weeks of life was found to be an independent risk factor. Conclusion: Relative weight gain (g/kg/day) at 4 weeks of life was found to be an independent risk factor for development of ROP. This result may be regarded as providing emphasis on the importance of weight gain at an earlier postnatal age.

Effect of wheat grass tablets on the frequency of blood transfusions in thalassemia major.

Forty patients of Thalassemia Major children were treated with wheat grass tablets (WGT). The mean hemoglobin in the pre WGT was 8.54 +/- 0.33 g% whereas in WGT period was 9.13 +/- 0.14 g% (p < 0.001). The mean blood transfused as packed cells in pre WGT period was 326.82 +/- 74.10ml/kg/year whereas during WGT period it was 256.39 +/- 45.47 ml/kg/ year. The percentage difference in the amount of packed cells transfused in pre WGT and WGT period was 18.02 +/- 22.96 (p < 0.001). The decrease in the blood transfusion requirements was by 25% or more in 20 (60.6%) cases. The mean interval between the consecutive blood transfusions in Pre WGT period was 18.78 ± 4.48 days whereas in WGT period was 24.16 ± 4.78 days (p < 0.001). Wheat grass has the potential to increase the Hb levels, increase the interval between blood transfusions and decrease the amount of total blood transfused in Thalassemia Major patients.

Pseudo tumoral laryngeal tuberculosis.

An 11-year-old female child presented with high grade intermittent fever and cough for a duration of 6-7 months and hoarseness of voice for 6 months. Skiagram of the chest showed evidence of miliary mottling. Direct laryngoscopic examination revealed inflammatory swelling over left vocal cord. The biopsy of the swelling showed chronic granulomatous lesion. Patient improved remarkably with anti-tubercular therapy.