Self-instructional module on knowledge of staff nurses regarding systemic inflammatory response syndrome in pediatric surgery ward

Background: When any microorganisms like virus, fungi, bacteria or parasite enter into human body that may cause infection. Sepsis is a life-threatening illness caused by the body overreacting to an infection. Any inflammation that affect the whole body due to any trauma, burns, pancreatitis, and infection that are called systemic inflammatory response syndrome (SIRS). Sepsis is restrained for SIRS when any infection is suspected or proven in human being. We can identify SIRS when patient body temperature is >38°C and heart rate >90 beats per minute and patient is suffering from tachypnea with >20 breaths per minute. Objective: The objective of this study was to find out the effectiveness of self-instructional module regarding SIRS of staff nurses in pediatric surgery ward. Materials and Methods: In this study, researcher adopt quantitative research approach with one group pre-test and post-test research design was selected to assess the effectiveness of SIM regarding SIRS among staff nurses. Forty staff nurses were selected by non-probability convenience sampling technique. After pre-test, SIM was implemented among staff nurses and post-test of staff nurses was taken after 15 days of intervention. Ethical permission and written consent were taken from higher authority and staff nurses. Results: Before implementation of SIM, nurses had shown poor knowledge (10.6 ± 4.3) regarding SIRS, whereas after giving self-instructional module, the knowledge had significantly improved with the difference of 17.8 ± 3.6, indicating the effectiveness of self-instructional module. Conclusion: Most of the staff nurses in pediatric surgery ward had poor knowledge regarding SIRS. Self-instructional module was highly effective to increase knowledge among staff nurses. Therefore, the knowledge of staff nurse can be future improve by providing ongoing teaching programs.

Percutaneous Coronary Intervention in Chronic Total Occlusion – In Hospital Outcome.

Background- Although a total coronary occlusion is identified approximately in one third of the diagnostic cardiac catheterizations, still an attempted revascularization of total occlusion accounts for less than 8% of all percutaneous coronary interventions (PCI). Percutaneous Coronary Intervention (PCI) of chronic total occlusion (CTO) is one of the major challenges in interventional cardiology. It is now an well-accepted revascularization procedure. Methods: It was a prospective observational study conducted in National Institute of Cardiovascular Diseases, Dhaka, from July 2004 to June 2005. 50 consecutive patients with chronic total occlusion undergoing PCI were included in the study. Patients were observed during procedure and during the hospital stay. Result: The mean age of the patients was 46.7 ± 9.3 and 48.0% were in the age range of 45-54 years. 24 patients had post MI angina, 20 patients had chronic stable angina and 6 patients had unstable angina. Technical success was in 98% cases and procedural success was in 94% cases. One patient developed vessel perforation and was treated by prolonged balloon inflation. There was no death or STEMI and only 2 patients developed NSTEMI. Conclusion: In our study with the use of available facilities PCI in CTOs was possible with a high success rate. But dealing of more complicated lesion will require more improved technology and hardware. A study with larger number of patients and longer duration of follow up to determine the efficacy of the procedure in improving morbidity and mortality is needed.

Prevention of Stroke in Nonvalvular Atrial Fibrillation.

Cerebro-vascular Disease (CVD) is the third most common cause of death in developed world after cancer and IHD. Atrial fibrillation (AF) is responsible in 45% of cases cardioembolism leading to CVD. Atrial fibrillation is considered to be one of the growing cardiovascular epidemics in the 21st century. Warfarin is a proven drug for prevention of stroke in patients with atrial fibrillation. Newer anticoagulants are being tried, fibrillation. Newer anticoagulants are being tried, but not yet well established by clinical trials. Separation of left atrial appendage from circulation by surgery or device implantation is a promising one in this field.

Heart failure and acquired immune deficiency syndrome: report of 2 cases.

Acquired immune deficiency syndrome (AIDS) patients usually present with prolonged fever, chronic diarrhoea, weight loss and other opportunistic infections. Congestive heart failure is not a usual presentation of AIDS. Here two cases, one a female of 38 years and another a male of 22 years presented with fever and breathlessness. On examination they were found to have features of congestive heart failure. Echocardiography revealed dilated cardiomyopathy. Laboratory investigations suggested human immunodeficiency virus was reactive in both cases with immune deficiencies of different degrees. The first patient expired during hospital stay, but the second one is progressing well with antiretroviral therapy.

A study on intranatal care practices in a district of West Bengal.

A study was conducted at Birbhum district of West Bengal among mothers who delivered in last one year to generate area-specific community-based data on the proportion of home deliveries, assistance during conduction of delivery and the intranatal care practices followed in the district. A multistage 40 cluster sampling method was used to study 320 mothers in the district. 37.81% deliveries were conducted at home. About 25% deliveries were conducted by untrained birth attendants, unqualified practitioners or relatives and friends. In 85.13% of home deliveries, DDK was not used. 68.6% home deliveries were conducted on the floor without any clean covering sheet. Though a clean instrument was used to cut the cord in 86.78% of home deliveries, a clean cord tie was used in only 24.89% cases. In 36.36% home deliveries, something was applied on the cord stump. High proportion of deliveries assisted by untrained persons and high magnitude of faulty intranatal care practices observed in the study require urgent and appropriate intervention.

Routine primary immunization: status in two district of West Bengal.

The study was conducted at Birbhum and Purba Medinipur districts of West Bengal to assess the routine primary immunization coverage following 40 cluster sampling technique was used to study 320 children in each of the districts. BCG coverage was found to be 79.69% at Birbhum and 84.38% at Purba Medinipur. Only 62.81% children at Birbhum and 67.81% children at Purba Medinipur received all the three primary doses of DPT. Regarding OPV, coverage with three primary doses were only 65% and 66.88% at Birbhum and Purba Medinipur respectively. Measles vaccine coverage was very poor at both the districts, 55.94% at Birbhum and 62.5% at Purba Medinipur. Full primary immunization was observed 53.13% and 61.56% in Birbhum and Purba Medinipur respectively. High drop-out rate was identified as a major deficiency in both the districts. Of the children who received at least one routine vaccine, more than 1/3rd at Birbhum and more than 1/4 th at Purba Medinipur did not turn up later for completion of their primary vaccine doses. It is evident that routine immunization coverage was poor in both the districts and it seems there has been no improvement in situation for last few years. It will influence not only the child morbidity and mortality situation but also will jeopardize the paralytic polio eradication programme. Urgent intervention should be undertaken to address the large number of non-immunized children as well as high proportion of drop-outs.

Carcinoma of the gall bladder presenting as dermatomyositis.

Dermatomyositis (DM), manifested as paraneoplastic syndrome, is not a very common clinical entity but its association with various internal malignancies is well-documented in literature. We present such a case of DM associated with characteristic skin lesions and subacute onset of proximal muscle weakness, acquired from a very rare malignancy like adenocarcinoma of gall bladder.

The efficacy of low-dose oral corticosteroids in the treatment of vitiligo patient.

Autoimmunity is one of the most probable pathogenesis of vitiligo. Systemic corticosteroids may arrest the progression of vitiligo and lead to repigmentation by suppressing immunity. The clinical efficacy of low-dose oral corticosteroids was assessed to minimize the side-effects in actively spreading vitiligo patients. One hundred (100) patients with vitiligo were evaluated. The patients took daily doses of oral prednisolone (0.3 mg/kg body weight) initially as a single oral dose after breakfast for the first 2 months. The dosage was then reduced to half the initial dose during the 3rd month and was halved again for the 4th and final month. After 4 months of treatment, 76% showed repigmentation while the arrest of progression (both repigmentation and stationary) was noted in 90% of patients. Male sex, and patients under 15 years of age showed pronounced repigmentation with statistical significance. According to this study low-dose oral prednisolone is an effective method in preventing progression and inducing repigmentation of fast-spreading vitiligo without the associated serious side-effects.

Coverage of Maternal Care Services in the state of West Bengal.

Evaluation of the Coverage of Maternal Care Services was conducted during the year 1999 in the entire State of West Bengal, Urban poor localities of randomly selected three Municipal Corporation areas and 'high-risk' urban wards or villages of West Bengal that had reported AFP cases in 1998. It was observed that mothers who had three or more antenatal check-ups varied between 54% to 82% in different study areas. Tetanus Toxoid coverage varied between 83.5% to 93.4% being lowest in high-risk areas. Only a very small section of mothers (12.7% to 23.7%) consumed 100 or more Iron and Folic acid tablets during pregnancy. 'Danger Signs' of pregnancy were informed to only 21.1% to 38.2% of the pregnant mothers. Proportion of home deliveries varied between 16.7% (Calcutta) to as high as 72.7% (high-risk areas). Deliveries conducted by untrained personnel were 60.8% in high risk areas, 38.1% in State clusters and between 14.2% to 29.4% in the three urban areas. Vast majority of mothers (78.8% to 88.4%) received no post-natal check-up.

Declining trend in routine UIP coverage.

Routine UIP coverage status in the state of West Bengal and three selected Municipal Corporation areas (Calcutta, Howrah and Siliguri) were studied during 1997-98 and 1998-99. Also, UIP coverage status in the 'high risk' areas of the State (areas which reported Polio cases during 1998) was studied during 1998-99. UIP coverage in the state of West Bengal was only 54.3% in 1997-98, which further declined to 48.1% in 1998-99. In the three urban areas, UIP coverage ranged between 57.3%-70.9% in 1997-98, which further declined to 29.6%-47.1% in 1998-99. Antigenwise coverage revealed very poor performance with DPT3, OPV3, and Measles in 1997-98 and further decline in 1998-99. Dropout rate was also very high. In 1998-99 drop-out rate ranged between 30.1% to 54.2% in different studied areas. Some other studies suggested that PPI activities, which are very visible and targetted programme, may adversely affect routine UIP services. There is urgent need for further probing to identify the reasons for such poor state of affairs, keeping PPI angle in mind and to initiate remedial measure urgently.

Insecticidal susceptibility status of Anopheles stephensi (Liston) in selected areas of Calcutta (West Bengal).

Susceptibility tests were carried out with insecticides like Organochlorine Organophosphorus and Synthetic pyrethroids using the WHO test kits against Anopheles stephensi larvae and adults, collected from malaria endemic wards of Calcutta in December, 1995 and January, 1996 Anopheles stephensi adults were found resistant to DDT, Propoxure, Malathion but susceptible to Fenthion and Deltamethrin.

Cocos nucifera pollen inducing allergy: sensitivity test and immunological study.

Among the heterogeneous population (n = 975) in greater Calutta, sensitization to Cocos nucifera pollen accounts to be 2.65% and for atopic patients (n = 204) 47.06%. Out of 24 patients who had C. nucifera pollen sensitivity and suffered from asthma and allergic rhinitis, 16 showed sensitivity also to other allergens. All were skin test positive and 19 of them were phadezym RAST positive to C. nucifera pollen extract. Bronchial provocation test appeared to be positive in 7 out of 8 patients included in the test and no late response or non-specific reactions were observed. C. nucifera pollen extract on fractionation by ion-exchange chromatography following gel filtration yielded two major allergenic protein fractions, CnII (M(r) 158,000) and CnVII (M(r) 2900) as evidenced by skin prick test, ELISA-inhibition and immunoblot analysis. Hence, C. nucifera pollen should be considered to be a relevant allergen and thus included in the panel of allergens for routine clinical use.

Myositis ossificans progressiva.

Myositis ossificans progressiva is a rare, incurable disease causing progressive ossification of skeletal muscles leading to total immobility. We report one such case.

Chemical modification studies on Cocos nucifera pollen allergens.

Hydrogen bonding pattern of nucleotides and carbohydrates has been analysed using Cambridge database. An analysis on ribonucleotides shows the 3' ···5' hydrogen bond mediated aggregation to be the most common alignment. The 2' ···5' alignment, which occurs under special circumstances in nature, is found to be the second choice. An analysis on carbohydrates suggests that self assembly of these molecules is not conducive to the formation of polysaccharides of the type which are found in present day living organisms. Further, the role of water molecules in the polymerization of three important biomolecules, namely nucleotides, carbohydrates and amino acids, has been analysed. Implication of these results to prebiotic polymerization is discussed.