Recommendation of an ideal mixed fluid preparation to be used as partial parenteral nutrition in surgical Neonatal Intensive Care Unit

Background: This study was conducted to assess the role of Partial Parenteral Nutrition (PPN) and a specially prepared 'mixed fluid formula' used as PPN in sick surgical neonates.Methods: This single institution based Randomised Control Trial was performed in Surgical NICU of a tertiary care Centre. Surgical neonates who required bowel rest for >3 days like Esophageal Atresia (22), Duodenal Atresia (38), Jejuno-Ileal Atresia (50), Necrotising Enterocolitis (29) and others (11), were chosen. As a CONTROL population half (75) neonates were allowed maintenance fluid only (Isolyte P) and rest (75) were given a combination of maintenance fluid (Isolyte P) and PPN (specially prepared mixed fluid). This mixed fluid each 100 ml was prepared with 65ml Isolyte P, 15 ml 25% Dextrose, 10 ml Normal Saline, 7 ml Astymin 3, 2 ml Multivitamin and 1 ml Injection KCl. Fluid was continued till enteral feeding was established.Results: Neonates according to their body weight were divided in three groups <1 kg (50), 1-2.5 kg (71) and >2.5 kg (29) and their post-operative outcome was assessed as Clinical Positive/Negative and Laboratory Positive/Negative. Results were separately assessed in 3 body weight groups under 'Control' and 'Study' which showed both Clinical and Biochemical improvement in 'Study group'.Conclusions: The composition of mixed fluid, its nutritional value, calorie supplementation, compatible osmolarity for peripheral venous administration and most importantly its easy and cost-effective preparation were assessed thoroughly and we recommend this 'mixed fluid' preparation as a very useful PPN for sick surgical neonates.

Ileal duplication cyst: a rare cause of intestinal obstruction in infants

Ileal duplication cyst (IDC) is a rare congenital anomaly where there is an abnormal portion of intestine attached to or intrinsic with the normal bowel. A 6-month-old male child presented with obstipation and bilious vomiting at emergency. X-ray abdomen showed multiple air fluid level suggestive of intestinal obstruction. Laparotomy was performed. Diagnosis of IDC was made and resection with primary anastomosis was done. Post-operative period was uneventful, and patient did well during 3 month follow-up checkup. IDC is a rare cause of intestinal obstruction which can present with different clinical symptoms posing a diagnostic dilemma. Diagnostic laparotomy is a suitable approach for both diagnosis and treatment to avoid delays in treatment where imaging method is unavailable for exact diagnosis.

A rare form of domestic accident: blast abdominal injury with evisceration of abdominal viscus

Evisceration of abdominal viscus following 'Flowerpot firecracker' (tubri) blast injury to the abdomen is a rare but dangerous form of domestic accident. Lack of knowledge and non-compliance of safety measures is the major reason for firecracker eventualities. A 10-year male child presented three hours post-injury with a wound over the upper abdomen. On examination there was evisceration of part of stomach along with colon through supraumbilical abdominal wound. Resuscitation and repair following exploratory laparotomy performed. Patient recovered well postoperatively. Public awareness and safety measures need to be taken to prevent the fatal outcomes of firecracker misuse.

Serum Prolidase Activity in Metabolic Syndrome

Metabolic syndrome (Mets) is defined as the existence of central obesity, insulin resistance, glucose intolerance, hypertension and dyslipidemia. Prolidase, a member of Matrix metalloproteinases (MMPs), plays an important role in collagen metabolism and extracellular matrix remodelling. Altered Matrix Metalloproteinase (MMPs) is the important factor in the pathogenesis of MetS. Methods: In this study 50 cases with metabolic syndrome diagnosed based on the Adult Treatment panel III ( ATP III ) criteria of the National Cholesterol & Education program (NCEP) and 50 age, sex matched healthy individuals were taken as control. Serum prolidase was estimated by ELISA, fasting plasma glucose, lipid profile, urea & creatinine were estimated by standard methods. Results: The prolidase levels was significantly higher in metabolic syndrome group (41.49±6.59) compared to control group (28.86±3.39) with a p value < 0.05. Statistical analysis were done by SPSS20 software. Conclusion: The serum prolidase values showed positive correlation with waist circumference, SBP, DBP, TG, LDL-C & negative correlation with HDL-C.

Evaluation of Serum Prostate Specific Antigen in Benign and Malignant Enlargements of Prostate

Prostatic enlargement is a common cause of bladder outlet obstruction among men in India. The enlargement usually leads to lower urinary tract symptoms, irrespective of whether it is benign or malignant. Methods: Forty six patients attending surgical outpatient department of Hi-Tech Medical College, Rourkela with symptoms of bladder outflow obstruction and prostate enlargement were studied. Results: The maximum numbers of patient recruited in the study were in the age range of 56–65 years and 66–75 years, having 14 (30.4%) and 11 (23.9%) cases, respectively. Out of 31 cases which were categorized as malignant on the basis of the serum PSA levels, 27 were confirmed by histopathology & 4 cases which were diagnosed as malignant by serum PSA levels were confirmed as benign by histopathology. Categorization of the Prostatic lesions on the basis of the Sr P.S.A. levels, which were confirmed by CytoHPE the accuracy for BPH was 50% and 67.4 % for malignant lesions. Conclusion: Patients with symptomatic prostate enlargement, serum PSA should be seen as a continuum with increasing risk of prostate malignancy.

Estimation Of Vitamin B12 Levels In Patients With Type 2 Diabetes Mellitus On Metformin: A Hospital Based Study

Background: Metformin is considered as the first-line antidiabetic agent in the treatment of type 2 diabetes mellitus (T2DM) due to its effect on glucose and lipid metabolism. The mechanism of action of Metformin in improving hyperglycemia involves in improving the signaling of insulin together with suppressing hepatic gluconeogenesis. Methods: 45 patients with type-2 diabetic patients on metformin therapy with an age ranged from 30 to 65 years along with 45 healthy controls were recruited from the General Medicine Department of HMCH, Rourkela according to inclusion and exclusion criteria. RESULTS: The mean age and BMI of both the cases and controls were 48.62 ± 7.94 and 43.52 ± 5.24; 28.04 ± 4.34 and 26.54 ± 3.32 respectively. Mean serum vitamin B12 levels in the case group was 217.45±86.32 and in control was 370.08±91.6and the difference was statistically significant. Conclusion: Metformin which is first line oral hypoglycemic agent as recommended by ADA is significantly associated with decrease in vitamin B12. There is moderate correlation between the markers of B12 status and levels of fasting blood sugar as well as HbA1C. There is a significant correlation between insulin and C-peptide with the markers of vitamin B12 status.

Comparative Study of the Serum Bilirubin and Various Other Liver Related Enzymes in Different Types of Jaundice

Background: This study was designed to compare the study of serum bilirubin and various other Liver related enzymes in different types of Jaundice in patients attending the Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha. Methods: The study includes total 50 subjects, out of which 20 were controls and 30 were Jaundice cases. Thirty jaundice cases were divided into 10(Pre-Hepatic), 10(Hepatic) & 10(Post-Hepatic) jaundice patients according to inclusion-exclusion criteria. Results: The results of our study show that the levels of Total Bilirubin, Direct Bilirubin & Indirect bilirubin were significantly raised in the Jaundice patients than that of control. This study was found that the other liver enzyme i.e. SGOT, SGPT & ALP were found to be increased than the control. Conclusion: In conclusion, the high serum bilirubin level is a marker of Jaundice. Increased direct bilirubin and alkaline phosphatase (ALP) specifically points towards obstructive Jaundice, Increased indirect bilirubin level points towards pre-hepatic (Hemolytic) jaundice whereas increased bilirubin (Direct & Indirect) along with SGOT & SGPT levels points towards hepatic jaundice.

Metastatic ganglioneuroma: A misnomer.

Neuroblastoma, ganglioneuroblastoma and ganglioneuroma atumors arising from the neural crest cells. Ganglioneuroma is considered as the most mature amongst the three and usually has no metastatic potential. Spontaneous maturation of neuroblastoma into ganglioneuroma is, however, quite well-known. Here, we present a case of an 8-year-old girl child with evidence of metastasis of ganglioneuroma into a lymph node.