ABSTRACT
The second wave of SARS?CoV?2 infection came as a hypoxic emergency and situation became worse in rural India, where undiagnosed COVID-19 patients died without any diagnosis or intervention. The primary aim of this innovative model was the early diagnosis of suspected SARS?CoV?2 cases, providing empirical treatment and timely referral to appropriate COVID care facilities. Fever was measured with infrared thermometer and oxygen saturation level with pulse oximeter. A total of 8203 people were screened, of which 274 persons were febrile and 69 (25%) were hypoxic too. Sixty?four out of 69 (93%) patients turned COVID?19 positive on reverse transcription?polymerase chain reaction. At the end of 3 weeks, 48/64 (75%) patients were successfully discharged. This model can be easily implemented in resource?limited regions to identify and prioritize the patients not only in this pandemic but also in outbreak of other communicable diseases.
ABSTRACT
Background: Exclusive breastfeeding is considered a major public health intervention to promote both child and maternal health. Introduction and awareness of infant milk substitutes among mothers appear as a threat to this important practice.Methods: The study is an observational cross-sectional study using a questionnaire containing socio-demographic variables. The study was conducted among 300 mothers who reported to immunization clinic and paediatrics OPD of a BFHI accredited hospital in Delhi. Data collected in the study has been analysed using SPSS version 21.0 and MS-Excel. Student 't' test for quantitative variables and 'chi square test' for categorical variable have been used for statistical significance. p-value <0.05 was considered to be significant.Results: In this study 78.7% mothers intended to breastfeed. 71.3% knew that breastfeeding should be continued up to 2 years and 96.3% knew exclusive breastfeed should be given till 6months. Major source of knowledge were doctors and elders of society. However, 49.6% mothers started breastmilk substitutes before 6 months of age. Major causes that appeared as barriers against exclusive breastfeeding were insufficient quantity of milk (23.4%), child refusal (61%) and maternal health problems (15.6%).Conclusions: Despite good knowledge about breastfeeding among upper middle-class mothers, practice of exclusive breastfeeding remains suboptimal. There is a need for more reinforcement upon importance of breastfeeding, its benefits for both mother and baby so as to foster the practice.
ABSTRACT
Epithelioid leiomyoma is a rare variant of leiomyoma.The tumour includes three distinct entities,leiomyoblastoma, clear cell leiomyoma and plexiformleiomyoma. It is histologically characterised byepithelioid cells, clear cells or plexiform pattern invaried proportions. We report a case of a 49-year-oldfemale with complaints of palpable mass per abdomenand spotting per vagina. Radiology revealed a complexcystic mass with obscured right ovary. She underwenttotal abdominal hysterectomy with bilateral salpingooophorectomy. Pathological examination showed aposterior wall lesion with central 9 × 8 cm cyst withmultiple septations and surrounding rim of solid areas.Microscopic examination showed a clear cellepithelioid leiomyoma. No mitosis/tumour cell necrosiswas seen. The clinical course of epithelioid leiomyomais still unclear owing to absence of large studies. Smallsize, clear cell histology, mitosis of < 2/10 High PowerField (HPF) and hyalinization are features of a benigncourse, whereas cellular atypia, mitosis of > 5/10 HPFare definite indicators of a malignant outcome. Anepithelioid leiomyoma with, size >6 cm moderateatypia, necrosis and mitosis of 2-5/10 HPF are termedas smooth muscle tumours of uncertain malignantpotential and should be under close follow up.
ABSTRACT
Neuroblastoma is the most common extra–cranial solid tumour in children. Bone marrow examination is a part of diagnosis and staging workup of neuroblastoma. Chemotherapy forms mainstay of treatment and post–chemotherapy histological changes are an important indicator of prognosis. A 4–year–old male child came with complaints of fever and hepatomegaly. Investigations revealed a retroperitoneal neuroblastoma. Bone marrow was involved by neuroblasts (stage 4S). Platinum–based chemotherapy was started and post–induction phase bone marrow showed differentiation of neuroblasts to ganglion cells and schwannian stroma (tumour load <5%, minimal disease). The patient was lost to follow up thereafter. The patient returned after one year with the reappearance of neuroblasts (tumour load >20%, relapse) in the bone marrow. Use of immunohistochemical markers like chromogranin and S100 are helpful to map the tumour load and identify the tumour cells when they are sparse. Persistence / reappearance of neuroblasts post–chemotherapy or increasing tumour load indicate a relapse.
ABSTRACT
Intravascular large B-cell lymphoma (IVLBCL) is a rare variant of diffuse large B-cell lymphoma, characterized by its unique morphology. Modern-day diagnostic methods like flow cytometry have limitations in accurate diagnosis of the disease making morphology the mainstay for its diagnosis and adequate management. Here, we present a case of IVLBCL with emphasis on diagnostic aids and adjuncts. A 63-year-old female presented with fever of unknown origin, seizers, hepatosplenomegaly, and peripheral cytopenias. Bone marrow aspirate shows a small number of atypical lymphoid cells. Flow cytometry done on the aspirate yielded 7% abnormal lymphoid cells; however, further, subclassification of this non-Hodgkin lymphoma was not aided by it. Bone marrow biopsy revealed the intrasinusoidal localization of the tumor cells, which were positive for CD20, BCL2, and Mum1 and along with flow cytometric expression of CD5 and lambda restriction of tumor cells; a diagnosis of IVLBCL was made. IVLBCL is a rare entity with protean clinical presentation which frequently leads to a delay in diagnosis. Modern diagnostic modalities like flow cytometry help in picking up even a small number of tumor cells; however, it is limited by failure to subcategorize the entity making morphology and immunohistochemistry as the backbone of its diagnostic workup.
ABSTRACT
Background: Sepsis is one of the most common cause of neonatal deaths globally more so in low and middle-income countries. The key to management is high degree of clinical suspicion and prompt initiation of empirical antibiotic therapy pending investigations' results. Knowledge of one's own NICU flora and antimicrobial susceptibility pattern guides in choosing correct antibiotic therapy to pediatrician. If this data is standard and comparable across different sites, then it also helps in formulating regional and National treatment guidelines. Present study was therefore undertaken to study microbial flora of present NICU and analyze their antimicrobial susceptibility pattern and formulate antimicrobial policy.Methods: Data of blood culture isolates sent from suspected cases of neonatal sepsis received from January 2017 to July 2018 was analysed by 'WHONET'.Results: One hundred ninety-three non-repeat isolates were obtained from 992 blood culture samples. Coagulase negative Staphylococcus and K. pneumoniae were the most common isolates. Non albicans Candida were responsible for majority of fungal infection. There was an outbreak of C. pelliculosa for six months. Most of the bacteria were multidrug resistant (MDR). However, except one all other Candida isolates were sensitive to antifungal drugs.Conclusions: WHO guidelines suggest use of penicillin and gentamicin for neonatal sepsis. But in present study, they were not found useful, instead amikacin, netilmicin and piperacillin-tazobactam were found useful and changes were made in antibiotic policy. Authors therefore recommend regular monitoring of antimicrobial susceptibility pattern followed by necessary changes in antibiotic policy for reasonable empirical therapy.