Turbinate reduction during septoplasty; to do it or not? Clinical and radiological study

The objective was to determine whether during Septoplasty, turbinate reduction procedure should be done in every case of compensatory turbinate hypertrophy [CTH], or not. It is a prospective randomised study. 86 patients with septal deviation and compensatory turbinate hypertrophy were divided randomly into 2 equal groups; group A for whom septoplasty was done alone and group B for whom coblation-assisted turbinate reduction for CTH was done in addition. Both groups were compared as regard patient symptoms and CT measurements of the turbinate 9 months after surgery. 34.9% of group A complained of nasal obstruction in the side of CTH, compared to only 6.9% in group B. While turbinate reduction as measured by CT was significant in group A [p<0.05]; it was highly significant in group B [p<0.0001]. It was also found that there was a highly significant statistical difference between the postoperative results in the both groups in favour of group B [p<0.0001]. During septoplasty, turbinate reduction should be done in every case of CTH, as it improves patient symptoms and does not add to the complications

Transcutaneous bilirubinometry in the management of bilirubinemia in term neonates.

One hundred full term babies of both sexes were randomly selected for transcutaneous bilirubin index (TcBI) estimation at the forehead at 12-24 h intervals from the time of appearance of clinical jaundice till the serum bilirubin levels fell within safe limits. TcBI was correlated with serum bilirubin estimated by conventional diazo method. Forty babies required phototherapy, in 20 an area of 2.5 cm2 over the forehead was covered during phototherapy to make an unexposed 'window' for TcBI estimation. The other 20 newborns received phototherapy as such and TcBI was estimated on the forehead. There was a linear relationship between serum bilirubin level and TcBI estimated at the forehead (r = 0.9090; P < 0.001). Further a significant linear correlation between prephototherapy and post-phototherapy (covered and uncovered groups) TcBI and serum bilirubin levels also existed (r = 0.7979; P < 0.001). There was no significant difference between post-phototherapy TcBI estimated at the covered and uncovered areas of forehead. However, post-phototherapy values of TcBI were significantly lower than corresponding prephototherapy values at higher serum bilirubin levels (> 16 mg/dl).

Omphalitis neonatorum.

Clinicobacteriological profile of omphalitis neonatorum was analysed in this prospective study which comprised 4776 neonates (4410 hospital-born, 366 deliveries at home). The incidence of omphalitis in the hospital-born babies was 2.3%. About 21.3% babies delivered at home were admitted for neonatal sepsis, meningitis, birth asphyxia, etc. They were found to be concomitantly suffering from omphalitis. Improper severing of the umbilical cord, application of oily substances on the umbilical stump and unhygienic rearing practices during neonatal period were some of the important predisposing factors. The fall of the umbilical stump and the diagnosis of omphalitis neonatorum was made significantly earlier (p < 0.001) in the hospital-born babies and none of them developed sepsis. The institution of therapy for umbilical sepsis was considerably delayed in the babies delivered at home and the omphalitis was the probable cause of sepsis in 46.6% cases. The Gram-negative organisms were responsible for omphalitis in 57.1% cases. Klebsiella was the commonest Gram-negative organism. Its incidence was more among the babies delivered at home signifying a potentially infective environment in the community. Gram's stain was a reliable and easy method for grossly identifying the organism in the umbilical smear.

Antibiotic associated colitis.

It is a prospective study based on 100 consecutive cases of diarrhea following antibiotic therapy admitted to the pediatric services of J.N. Medical College, A.M.U., Aligarh between January to December 1987. They had C. penicillin (50), chloramphenicol (34), ampicillin (34), gentamicin (34), cephalosporin (4) and cotrimoxazole (4) for 3 days to 3 weeks prior to the onset of diarrhea. Apart from routine and special investigations, naked eye and microscopic examination of stool, its culture for pathogens including Cl. difficile were carried out in all cases. Presence of Cl. difficile cytotoxin was demonstrated by observing the cytopathic. Effect on veru cell culture, 18 grew Cl. difficile (14 cyto toxin positive). Frequency of fever, vomiting, abdominal distension, dehydration and duration of diarrhea was not different (p > 0.05) in the two groups. Purge rate and presence of mucus and blood in Cl. difficile positive patients was significantly higher (p < 0.05). Eight Cl. difficile positive (7 cytotoxin+ve) were subjected to endoscopy. Three of them showed P.M. colitis and 2 non specific colitis. Chloromycetin, gentamicin and penicillin were the main culprits responsible for AAC. None of the patients given ampicillin alone suffered from AAC. The mortality was 5%.

Comparison of temperatures at different sites in term and pre-term neonates.

Temperatures of 30 term and 20 preterm neonates were recorded by mercury-in-glass thermometer at 4 measurement sites; rectum (2 cm beyond anus), external auditory canal, axilla and between skin and mattress. Whereas, the mean rectal and aural temperatures in term infants were significantly higher than their preterm counterparts (p less than 0.01), axillary and skin mattress temperatures did not differ significantly in the two groups. The variation between stabilized temperature at four measurement sites was less marked in preterm as compared to term infants. The skin mattress temperature measurement is a simpler technique and it closely approximates the rectal temperature in preterm infants. Temperatures at all the measurement sites stabilized by 5 minutes both in term and preterm infants.

A comparative study of three types of ORS in the management of diarrheal dehydration.

Seventy five infants and children aged 6 months to 4 years admitted to Pediatrics services of J.N. Medical College, A.M.U., Aligarh with acute watery diarrhea with or without vomitings and associated with varying degree of dehydration were studied. They were randomly divided into three groups--(A, B, C) and were rehydrated with WHO standard ORS, super ORS and Rice water electrolytes solution. These children were subjected to investigations like hemogram, hematocrit, blood urea, blood glucose, plasma electrolytes, recorded on admission and repeated at 6 hours, 24 hours and at the time of discharge. The observation emerging out of this study include lower rate of purging, earlier control of vomitings, greater weight gain, earlier urination and consistently lower requirement of ORS and shorter time required for initial rehydration associated with early normally in laboratory parameters in dehydrated children receiving either super ORS or rice water electrolyte solution as compared to those on standard ORS. The difference in all these parameters was statistically significant.