Recovery From Otitis Media and Associated Factors Among 1- to 6-Year-Old Children in South India: A Longitudinal Study

Background and Objectives@#This study was aimed at assessing recovery from otitis media (OM) and variables associated with it among 1- to 6-year-old children. @*Subjects and Methods@#We assessed 87 children with OM otologically and audiologically. Medicines were prescribed, and medication compliance was ensured. The children were followed up after 3 months to judge the status of OM as resolved or recurrent. Data were statistically analyzed to derive the risk of recurrence of OM with effusion (OME) and acute OM by degree of hearing loss, type of tympanogram, age group, and sex. @*Results@#The overall recurrence rate was 26%. The risk of recurrence was higher for OME (odds ratio [OR]=4.33; 95% confidence interval [CI]: 1.90 to 9.83); at AC auditory brainstem peak V responses up to 40 dBnHL (OR=5.20; 95% CI: 2.05 to 13), 50 dBnHL (OR=3.47; 95% CI: 0.5 to 23), and 60 dBnHL (OR=16.09; 95% CI: 4.36 to 1.2); in B (OR= 3.16; 95% CI: 1.36 to 7.33) and C tympanograms (OR=2.83; 95% CI: 0.70 to 11.41); and in the age group of 5-6 years (OR=8, 95% CI: 2.23 to 28). The risk of recurrence of OM did not differ between male and female patients. @*Conclusions@#The rate of recurrence was comparable to or lower than that reported in the pediatric population of other countries. The findings suggest that children with OME, severe pathology, or age of 5-6 years require more attention and frequent monitoring to minimize the risk of recurrence.

COMPARISION OF DIAGNOSTIC ACCURACY OF NON – FASTING DIPSI AND HBAIC WITH FASTING WHO CRITERIA FOR DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS

Background Gestational Diabetes Mellitus [GDM] is de?ned as Carbohydrate intolerance with recognition or onset during pregnancy and resolves postpartum. Prevalence of GDM in India varies from 3.8 - 21% with different demography and diagnostic methods used. As early diagnosis and control of maternal hyperglycaemia plays a vital role in prevention of adverse outcomes, universal screening is almost mandatory due to high prevalence, we need a simple economical, feasible test with higher sensitivity to diagnose GDM. To compare diagnostic accuracy of two non- Aim fasting tests DIPSI & HBAIC and fasting WHO criteria for diagnosis of GDM. To compare DIPSI with WHO criteria as Objectives standard. To compare HBA1C with WHO criteria as standard This study was done on 100 ANC cases to compare Results: diagnostic accuracy of DIPSI & HBAIC with fasting World Health Organization Glucose Tolerance Test. Mean age of participants was 27.18±4.60 years. 39% patients were in age group of 21 to 25 years and 34% patients were in age group of 26 to 30 years. Majority (45%) of the patients were in gestational age of 26 to 30 weeks. In this study, gestational diabetes mellitus was diagnosed in 47 (47%) patients according to WHO GTT, in 48 (48%) patients according to DIPSI and in 34 (34%) patients according to Glycated Haemoglobin. Mean gestational age of patients during diagnosis of gestational diabetes mellitus was 29.21±2.84 weeks by DIPSI, 28.83±2.82 weeks by WHO GTT and 29.29±3.15 weeks by Glycated Haemoglobin. Mean blood sugar parameters of gestational diabetes mellitus women were 174.96±16.58 mg/dl by DIPSI, 173.21±17.58 mg/dl by WHO GTT and 9.41±1.91 gm% by Glycated Haemoglobin. The sensitivity of DIPSI with regard to WHO GTT was 89.36%, speci?city 88.68%, positive predictive value 87.50%, negative predictive value 90.38%, diagnostic accuracy 89.00% and chi square value of 60.78. These values convey that DIPSI is as good as gold standard WHO GTT criteria. The sensitivity of Glycated Haemoglobin with regard to WHO GTT was 51.06%, speci?city 81.13%, positive predictive value 70.59%, negative predictive value 65.15%, diagnostic accuracy 67.00% and chi square value of 11.51. These values convey that Glycated Haemoglobin is not as good as gold standard WHO GTT. Based on ?ndings from this study it can be concluded that DIPSI is Conclusions: equally as good as World Health Organization Glucose Tolerance Test criteria in diagnosing gestational diabetes mellitus in antenatal women of south India. Since DIPSI does not require fasting it is more feasible than World Health Organization criteria. Glycated haemoglobin estimation is another test to detect diabetes mellitus which does not require fasting however its results are not close to gold standard WHO criteria unlike DIPSI

Perception about pap smear screening test among females attending a tertiary care center

Background: Knowledge regarding the screening test (Pap smear) among women has been proven to be a significant predictor of first-time screening and in turn helps in early diagnosis and treatment of the disease. Hence this study was conducted to assess the knowledge and practice of pap smear screening test for cervical cancer among the women attending the outpatient department of obstetrics and gynecology.Methods: The cross-sectional study was conducted by the department of obstetrics and gynecology, at Sri Muthukumaran Medical College Hospital and Research Institute, among the women attending the outpatient department, during the month of August 2019. A total of 180 participants were included in the study. Data was entered in Microsoft excel and data analysis was done using statistical package for social sciences (SPSS) version 17.Results: Knowledge about carcinoma cervix and pap smear were present among 86.7% and 74.4% of participants, respectively. About the practice of pap smear, only 24.4% of the study participant have undergone the screening test and only two participants had taken the HPV vaccine.Conclusions: Most of the women had poor attitude and practice related to screening and vaccination for cervical cancer. But their attitude is favorable for screening. Hence promotion of free regular health check-up and vaccination for cervical cancer among general population might increase the awareness and decrease the disease burden.

A study on perception about antenatal care among primigravida attending a tertiary care hospital

Background: Maternal mortality rate and Infant mortality rate remains high in India when compared to several other countries. Understanding and being aware about the basic care provided during pregnancy is an important factor to make the pregnant woman to utilize the antenatal care. Hence this study was planned to assess the existing knowledge of primi gravid mothers attending the tertiary health care center about the various antenatal care services provided.Methods: This cross-sectional study was conducted among the primi gravid females attending the outpatient department of Obstetrics and Gynecology in Sri Muthukumaran Medical College Hospital and Research Institute, Chennai during months of June 2018 to May 2019. A total of 280 primi gravid mothers were included in the study. Data was collected through one to one interview and analyzed using statistical package for social sciences (SPSS) version 17.Results: In this study 82.9%, 70.4%, 80.7% of the mothers were aware about consumption of IFA tablets, TT injection and adequate ANC visits, respectively. PNDT act was known to 76.1% of the participants. Only 12.5% of the primi mothers were aware about Janani Suraksha Yojna (JSY) scheme and 91.8% of the mothers were aware about Dr. Muthulakshmi Maternity Benefit scheme.Conclusions: Knowledge about ANC services was found to be fair among the primi mothers but not sufficient, which shows the need for the healthcare professionals to educate young woman even from adolescent age itself.

Sonographic assessment of fetal head deflexion using occiput: spine angle measured during first stage of labour and its role in predicting the mode of delivery among nulliparous women

Background: The attitude of the fetal head during labour significantly influences the progress and outcome of delivery and is mainly diagnosed by vaginal examination during labour. The aim of the study was to quantify the extent of deflexion of the fetal head by measuring the fetal occiput spine angle (OSA) through transabdominal ultrasonography in the first stage of labour and to determine whether the fetal OSA can predict the mode of delivery.Methods: We conducted a prospective observational study on 145 nulliparous uncomplicated singleton pregnant women without occiput-posterior position of the fetus during active labour. The OSA was measured as the angle between the two tangential lines to the occipital bone and the vertebral body of the first cervical spine, during active labour and monitored until delivery. Intra- and interobserver reproducibility of the OSA measurement and the correlation between the OSA and mode of delivery were also evaluated.Results: For the study population, the mean value of the OSA measured in the active phase of the first stage was 124.2±11.5⁰. The OSA measurement showed excellent intraobserver agreement (r = 0.82; 95% confidence interval [95% CI] 0.70-0.80) and fair-to-good interobserver agreement (r = 0.62; 95% CI 0.51-0.71).  The mean OSA was significantly less for the group of patients who required conversion to cesarean section due to labour arrest (n=32) as compared to those who had vaginal delivery (n=113) (116.25±9.2⁰ versus 126.53±11.1⁰, P<0.01). An OSA of ≥121° was associated with vaginal delivery in 80.5% (91/113) of women, whereas 87.5% (28/32) of the women who delivered by cesarean section had an OSA <121⁰.Conclusions: Measurement of the OSA, by sonography is feasible, reproducible and an objective tool to assess the degree of fetal head deflexion during labour and to predict the mode of delivery.

Complicated Inguinoscrotal Hernia Management by Endoscopic Totally Extraperitoneal Mesh Repair

Introduction: The purpose of this study is to assess the safety and effectiveness of endoscopic totally extraperitoneal (TEP) mesh repair in the management of complicated inguinal hernia. Materials and Methods: This is 18-month retrospective observational study done in our department of minimal access surgery between January 2017 and June 2018. Patients demographic data, operative and post-operative course, and outpatient follow-up were studied. Results: A total of thirty patients with complicated inguinoscrotal hernia underwent TEP repair were studied, for a period of 18 months, with a follow-up period of 6 months. Out of the thirty operated cases, 28 were elective surgery and 2 were emergency. Demographic characteristics are shown in Table 1. All male patients , the mean age was 49.7 years. Chief complaint was irreducible swelling and pain in groin region. Diabetes mellitus was the major comorbidity. Conclusion: In an expert hand with few additional maneuvers complicated inguinal hernia can be successfully managed by TEP approach.

Evaluation of Arogyasri Seva Scheme in a Government Maternity Hospital, Govt Victoria Hospital, Visakhapatnam

A prospective observational study was conducted in Government Victoria Hospital, Visakhapatnam from 2013 to 2018 to evaluate Arogyasri scheme. Arogyasri scheme provides end to end cashless services for identified diseases in Andhra Pradesh. During this period, 891 gynecological surgeries were conducted under this scheme. Out of them, 44 were not approved for claim. A total of 10,880,238 rupees were claimed.

Clinical Characteristics and Associated Congenital Lesions with Tracheomalacia in Infants

Objective: To describe clinical presentation, bronchoscopy findings and associatedanomalies in cases of congenital tracheomalacia in infants (age <1y). Methods: Hospitalrecord review of 88 infants (mean age 8 mo, 57 males) diagnosed as having tracheomalaciaby flexible bronchoscopy between 2012 and 2015. Results: The predominant features werewheeze (57.9%), stridor (42.1%), cough (38.6%), pneumonia (29.5%) and collapse (12.5%).On bronchoscopy, malacia was observed in lower half of trachea in 51 (57.9%) infants.Synchronized airway lesions observed were laryngomalacia (30.7%) and bronchomalacia(3.4%). 15 (17%) infants had associated congenital heart disease and 21 (23.8%) requiredcare in intensive care unit. Conclusion: Wheeze,stridor and cough are the main symptomsin tracheomalacia. Laryngomalacia and congenital heart diseases are the most commonother anomalies associated in these infants.

Patients' Response to Waiting Time in an Out-Patient Pharmacy at a Tertiary Care Hospital.

This study was carried on to know the average time taken from when the customer arrives in out-patient pharmacy till the collection of medicine and to know the time spent at various counters in the out-patient pharmacy. It was an observational study done on customers attending hospital pharmacy for a period of two months. Seventy out-patients were randomly selected from the population of patients who attended pharmacy. Similarly dispensing operations were observed. Workflow analysis method and stop watch techniques were used to measure patient waiting time. The various places where the customer has to wait from billing till the procurement of medicine was noted and also the total time taken. A total of 35 patients / patient attender’s were observed both in the morning and in the evening. Majority of the time was consumed in billing after placing the prescription on the dispensing table .It was seen that in the morning session the waiting time for the various components of processing was less compared to the afternoon, except for the processing of the transaction time by the cashier is more in the morning (38.34±34.66) sec compared to (28.42±25.67) sec. Majority of the time was consumed in billing after placing the prescription on the dispensing table.

Efficacy of a herbal extract gel in the treatment of gingivitis: A clinical study.

Background: Chronic gingivitis is the most prevalent in all dentate animals. Regular methods for controlling it have been found to be ineffective, which have paved the way for the use of herbal products as an adjunctive to mechanical therapy as they are free to untoward effects and hence can be used for a long period of time. Objective: The antigingivitis effect of a gel containing pomegranate extract was evaluated using a 21-day trial in patients with chronic gingivitis. Materials and Methods: Forty patients participated in this randomized clinical study, carried out in four phases of 7 days each over 21 days. The patients were randomly assigned to four groups: First group was treated with mechanical debridement and an experimental gel and the second group with mechanical debridement and a control gel; the third group wasn’t subjected to mechanical debridement and only experimental gel was used. The fourth group was treated with control gel only. All the groups were subjected to various clinical and microbiological parameters to evaluate the antiplaque and antigingivitis effect of the pomegranate extract. Results: The group which used the pomegranate gel along with mechanical debridement showed signifi cant improvement in all the clinical and microbiological parameters included in the study when compared with the other three groups. Conclusion: Hence it can be concluded that the pomegranate gel when used as an adjunct with mechanical debridement was effi cient in treating gingivitis.

Kawasaki Disease Mimicking Retropharyngeal Abscess

Kawasaki disease is an acute, self-limiting febrile mucocutaneous vasculitis of infants and young children. Retropharyngeal lymphadenopathy is a rare presentation of Kawasaki disease. We present a case of Kawasaki disease mimicking a retropharyngeal abscess, with upper airway obstruction resulting in delayed diagnosis.

Utilisation of integrated counselling & testing centre (ICTC): a comparative study between a tertiary care teaching hospital and a government district hospital in Karnataka.

A study was undertaken during November 2005 to October 2006 to assess about utilization aspects of ICTC at a tertiary care teaching hospital and a government district hospital in Karnataka. The average monthly numbers of persons visiting ICTC per month at the tertiary care teaching hospital (509) were higher than that of Government district hospital (222). However, the average monthly number of direct walk-in persons and follow up, attending the centre at district hospital were higher than that of teaching hospital. Thus optimal use of information, education and communication (IEC) techniques needs to be strengthened to improve the utilization of ICTC services at the tertiary care teaching hospital.

Reduced exercise capacity in non-cystic fibrosis bronchiectasis.

OBJECTIVE: Bronchiectasis not due to cystic fibrosis is usually a consequence of severe bacterial or tuberculous infection of the lungs, which is commonly seen in children in developing countries. Our aim was to study its functional sequelae and affect on work capacity in children. METHODS: Seventeen children (7-17 years of age) with clinical and radiological evidence of bronchiectasis of one or both lungs were studied at the Cardiopulmonary Unit of the Tuberculosis Research Centre. Pulmonary function tests including spirometry and lung volume measurements were performed. Incremental exercise stress test was done on a treadmill, and ventilatory and cardiac parameters were monitored. Control values were taken from a previous study. RESULTS: Children with bronchiectasis had lower forced vital capacity (FVC) (1.1 + 0.4 L versus 1.5 + 0.4 L, p = 0.003) and FEV1 (0.95 +/- 0.2 L versus 1.4 +/- 0.3 L, p < 0.002) compared to age- and sex-matched healthy controls. The patient group had significantly higher residual lung volumes (0.7 +/- 0.3 L versus 0.4 + 0.1 L, p < 0.02). At maximal exercise, they had lower aerobic capacity (28 +/- 6 ml/min/kg versus 38 +/- 5 ml/min/kg, p < 0.0001) and maximal ventilation (24 +/- 8 L/min versus 39 +/- 10 L/min, p < 0.001). At maximal exercise, while none of the controls desaturated, oxygen saturation fell below 88% in eight of 17 patients. CONCLUSION: The findings show that children and adolescents with non-cystic fibrosis bronchiectasis have abnormal pulmonary function and reduced exercise capacity. This is likely to interfere with their life as well as future work capacity. Efforts should be made to minimize lung damage in childhood by ensuring early diagnosis and instituting appropriate treatment of respiratory infections.

Role of surface swab, core swab and fine needle aspiration in isolating the core bacteria in inflammed tonsils.

The microbial flora of 75 patients with chronic tonsillitis were sudied to identify the commonest organism causing chronic tonsillitis and to compare surface swab, fine needle aspiration (FNA) and core swab in isolating the pathogens. Staphylococcus aureus was the predominant isolate from surface core swab FNA and surface swab. In our study the correlation between surface swab with core swab was 47.9% and between surface swab with FNA 57.3%. The correlation between FNA with core swab of 69.3% showed that FNA for culture was superior to surface swab in predicting the core culture. Hence FNA of the tonsil has more advantage over the routinely performed surface swab in representing the core pathogen. Thus the rationale of treating chronic tonsillitis medically should be based on the knowledge of the common core pathogen.

T-lymphocyte subpopulations in tuberculosis.

BACKGROUND: Tuberculosis is associated with both qualitative and quantitative defects in the cell mediated immune response. The changes that occur in the lymphocyte profile in blood in children with tuberculosis are not well understood. DESIGN: Prospective study. SETTING: Referral hospitals. METHODS: Lymphocyte subpopulations were determined by flow cytometry in 17 healthy tuberculin positive children, in 22 children with newly diagnosed pulmonary tuberculosis and in 8 of these children after antituberculosis therapy. RESULTS: Absolute numbers and percentages of CD3+ and CD4+ T cells were reduced in children with tuberculosis, compared to controls. CD4+ counts increased significantly following antituberculosis treatment, compared to baseline values. In contrast, the proportion of T cells expressing the gdT cell receptor was similar in tuberculosis patients and controls. CONCLUSION: Children with tuberculosis have a systemic decrease in the proportion and number of CD3+ and CD4+ T cells which reverses during therapy.

Bronchoalveolar lavage in pediatrics.

Bronchoalveolar lavage is a relatively new technique that is used to study the local cellular, biochemical and immunological changes occurring in the lower respiratory tract. The procedure involves instilling a fixed volume of saline into a lung segment after the flexible fibreoptic bronchoscope is wedged into a distal bronchus. The saline is aspirated back and can be used for microbiological and other studies. Recently, attempts have been made to standardise the procedure in children and obtain data on BAL cellular profile in healthy children. The main indications for BAL are diagnostic, particularly to diagnose unusual infections in immunocompromised children. It is also helpful in the diagnosis of a number on non infectious conditions, based on the cellular profile and other constituents. With the availability of new techniques like flow cytometry, analysis of lymphocyte and other cell subsets has become possible leading to a better understanding of the immunopathogenesis of various respiratory diseases.

Flexible fiberoptic bronchoscopy.

The value of flexible fiberoptic bronchoscopy in children are increasing day by day, but still underutilized even in many advanced institutions. 630 Fiberoptic bronchoscopy procedures under local anaesthesia were performed for various clinical conditions for diagnosis and therapy. Nasal route is preferred than oral route. Therapeutic indications are more in children than adults. Nearly one third of children with collapse, consolidation have shown radiological clearance after repeated bronchoscopy.

Childhood asthma--advances in pathogenesis.

Increase in morbidity and mortality of asthmatics in the world is a cause of concern. Many researchers have described various aspects of etiopathogenesis which has thrown light on the better understanding of asthma. Our experience with nearly 3 lakhs of asthmatic children, over a period of twenty-five years and our studies in Asthma clinic of ICH & HC, Madras generated new ideas to propose a hypothesis on etiopathogenesis of asthma. "Asthma is a disease caused by a specific infective agent in a genetically predisposed individual resulting in altered cellular response initially leading to hyperactive bronchial tree which on exposure to various aggravating factors manifest clinically as recurrent cough, dyspnoea and wheeze". Category of wheezers who manifest asthma is also discussed.