Incidence of Neonatal Seizures and it's ClinicoEtiological Profile in A Tertiary Care Hospital in Western India

Introduction: Neonatal seizure is defined as paroxysmal electrical discharge from the brain. The immature brain seems more prone to seizures. The incidence was found to increase with decreasing gestation and birth weight- preterm neonates (20.8 vs. 8.4 per 1000 live-births) while very low birth weight neonates had more than 4-fold higher incidence (36.1 per 1000 live-births). Objective: The study was conducted to estimate the incidence, etiological factor, time of onset, clinical types, and biochemical abnormalities among the different types of neonatal seizures. Methods: This is a hospital based prospective observational study conducted in NICU, Department of Pediatrics, SMIMER during the period of January 2020 to March 2021. Results: Total patients with neonatal seizures were 90 in our study. Incidence of neonatal seizures in our study was 1.1%. Incidence was higher in pre-term neonates (4.8%) and more in males (56.67%). Incidence of neonatal seizures was higher in LBW babies (4.3%) and more common in SGA babies (51.11%). Incidence among vaginal delivered babies was 0.9%, LSCS was 1.7% and forceps was 1.1%. Birth asphyxia (41.1%) was the most common cause of all neonatal seizures followed by hypoglycemia (17.8%), neonatal meningitis/septicemia (14.5%), hypocalcemia (12.2%), ICH (7.8%). Subtle seizures (44.4%) were the most common type of seizure followed by tonic (38.9%), focal clonic (11.1%), multifocal clonic (5.6%). 33.3% of neonatal seizures occurred in < 24hrs & 40% in 24-72 hrs. The most common biochemical abnormality was hypoglycemia (17.8%) followed by hypocalcemia (12.2%). Conclusion: Incidence of neonatal seizures was 11.1/1000 live births (1.1%) & more common in preterm, LBW & LSCS deliveries. Birth asphyxia was the most common cause and subtle seizures were the most common type of seizure. Subtle seizures were more common in 24-72 hours of life. Most common biochemical abnormality was hypoglycemia followed by hypocalcemia

Doppler predictors of perinatal outcome in intra-uterine growth retarded foetuses

Background: The study aims at early detection of intrauterine growth retarded fetuses which are at high risk of perinatal complications. It can help obstetricians take appropriate preventive steps and prevent serious perinatal complications.Methods: The study undertaken over 100 pregnant women with pregnancy induced hypertension between 28-36 weeks subjected to umbilical artery and uterine artery doppler. The outcome data including gestational age at birth, birth height, APGAR score, admission to NICU, need for positive pressure ventilation and neonatal mortality.Results: The study shows that 58% mothers with IUGR foetuses were primigravida; gestational age at delivery is 34.2 weeks and 82% of IUGR foetuses were delivered by C-section. Average birth weight of foetus with abnormal doppler was significantly lower and there was high incidence of NICU admission. The study also shows that oligohydroamnios was common with abnormal doppler group.Conclusions: Umbilical artery doppler velocity in addition to uterine artery velocity doppler should be considered as a primary tool for foetal surveillance in pregnancy induced hypertension patients and for planning management of IUGR foetuses.

Red Blood Cell Count: Brief History and New Method.

Introduction: Red blood cells (RBCs) were observed under microscope by Jan Swammerdam in 1658. The RBC count was done in 1852 by Professor Karl Vierordt from Germany for the first time almost after 192 years. After this, the other scientists have also done RBC count with different methods. Hayem used a new diluting fluid (Hayem‖s diluting fluid) for RBC count which is used even today. The present methods have many errors mainly due to sampling, diluting, and pipetting. Materials and methods: In this study, the modified method of RBC counting has been shown. The RBC counting was done using hemoglobinometer pipette and modified diluting fluid - Hayem‖s fluid mixed with Leishman‖s stain (HFLS) RBC diluting fluid - in the ratio of 97.5 mL of Hayem‖s RBC diluting fluid and 2.5 mL of Leishman‖s stain to make 100 mL. Amber colored glass bottle top dispenser was used to dispense 2 and 4 mL of diluting fluid into the glass test tubes .With aseptic precautions, 10 and 20 μL of blood samples were collected by using the hemoglobinometer pipette (marked with black marker pen to get accurate measurement for 10 μL) from finger prick with sterile needle. The blood samples were added to the glass test tubes containing HFLS RBC diluting fluid and mixing was done with a glass stirrer. With the help of glass capillary tube, Neubauer chambers were charged and observed under microscope. Results: Red blood cells were seen better. The RBCs retained their shape and size even after 96 hours when the blood samples mixed with HFLS RBC diluting fluid were kept at room temperature. Conclusion: Red blood cells were seen better with this method and diluting and charging errors were minimized.

Better Visualization of Red Blood Cells by Adding Leishman’s Stain to Hayem’s Fluid.

The visualization of red blood cells (RBCs) was compared by the modified method and the conventional method. The RBCs were seen better with the modified method.

A Study Of The Prevalence Of Cryptosporidium Parvum In Stool Samples Of Patients Of Tertiary Care Hospital, Ahmedabad.

Abstracts: Background: Intestinal parasitic infections remain a serious public health problem globally.Although there could be many other causes of diarrhoea, the enteric protozoa Cryptosporidium parvumhave been recognized as important causes of both out-break-related and sporadic diarrhoea in humans. Both immunocompetent and immunocompromised individuals could be the victims but immunocompromised peoples are likely to be most seriously affected. This study was done to determine the prevalence of Cryptosporidium parvumin Stool samples. Methodology: A 100 Stool samples of patients visiting General Hospital, Sola, Ahmedabad from December 2013 to March 2014 were followed for Stool microscopy for demonstration of cyst of Cryptosporidium parvum.Modified ZN stain done from direct smear from stool sample but their concentration is increased by formal ether concentration technique. Results: Out of total 100 stool samples were examined in which 85 were positive for bacteriological infections and 15 for parasitic infection. Prevalence of Cryptosporidium parvum infection in our study is 5 %. Among 100 patients only 3 were positive for Cryptosporidium infection in 96 immunocompetent patients and 2 were positive for Cryptosporidium infection in 4 immunocompromised patients. So higher rate of prevalence of Cryptosporidium parvum infection seen in immunocompromised patients. Conclusion: Cryptosporidium infection is transmitted by feco-oral route & water borne, so proper sanitation and disinfection of water reduce the prevalence of infection. Cryptosporidium parvum diarrhoea is self-limiting illness and cured by fluid therapy. Drug therapy is only for severe infection. In immunocompromised patients like HIV antiretroviral therapy and fluid therapy is necessary for Cryptosporidium infection.

A Prospective Comparative Study of Semi-Quantitative Slide Widal test& Quantitative Tube Widal test.

Objective: The diagnosis of enteric fever currently depends upon the isolation of Salmonella from a patient, most commonly by blood culture. This facility is not available in many areas where the disease is endemic. The Widal agglutination test which demonstrates the presence of somatic (O) and flagellar (H) agglutinins to Salmonella in the patient's serum using O and H antigen suspension is one of the most utilized diagnostic tests for typhoid fever in developing countries. In the recent past, a rapid slide test was developed which is now the most commonly used technique in local laboratories because of its convenience. The semi-quantitative slide test provides an approximation to the tube test titre. The present study was an attempt to compare the results of semi-quantitative slide agglutination with the quantitative tube method to ascertain any significant difference between two methods. Material and Methods: 300 precollected blood samples of OPD patients were collected over a period of 4 months and subjected to semi-quantitative rapid slide and quantitative tube Widal tests using commercially available Salmonella antigen test kits. Results: From the 300 samples studied, 17(5.7%) serum samples were positive by slide test method while 25(8.7%) seropositive by Tube test method. Present study shows, slight difference in the results obtained by the two methods of Widal test. Conclusion: The Tube Widal test is more sensitive and specific than slide Widal test, especially for rule out prozone phenomena, but slide Widal agglutination test is found to good alternative screening test because less time consuming, easy to perform, cost effective and can be applied in resource poor nations. There is an urgent need for the rational design and evaluation of effective and appropriate diagnostics for typhoid fever.

Association of OSTA index with bone mineral density (BMD) and its comparison with calcaneal quantitative ultrasound for the prediction of low BMD in peri-menopausal Indian women.

Background: Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fractures with advancing age in postmenopausal women. BMD measurements with dual energy X-ray absorptiometry (DEXA) are costly and not widely available The Osteoporosis Self-Assessment Tool for Asians (OSTA) index is a simple tool based on age and body weight to predict low BMD and identify women at risk of osteoporosis. The objective was to study the association of OSTA index with BMD (T-score) and to validate OSTA index in comparison with calcaneal Quantitative Ultrasound (QUS) for the prediction of low BMD in peri-menopausal Indian women. Methods: This was a prospective, cross-sectional, descriptive study carried out in department of physiology of a tertiary care teaching hospital (Navi Mumbai). Seventy two peri-menopausal women between 40 to 55 years with no previous diagnosis of osteoporosis were included. Participants’ socio-demographic detail, anthropometric measurements, OSTA index and QUS-based BMD was recorded. Pearson’s correlation test was used. Sensitivity, specificity, positive and negative predictive value was calculated. Results: OSTA index did not correlate with BMD in the entire samples. On subgroup analysis, OSTA index significantly correlated in a positive direction with BMD (T-score) in women in the age group of 50-55 years. OSTA index had a sensitivity of 70 %, and specificity of 84.62 % at T-score cutoff value of < -1. Conclusions: OSTA index is a simple risk assessment tool that can be used to identify women with low BMD in the age group of 50-55 years.

Maternal and fetal outcome in oligohydramnios- Study of 100 cases.

Background: Decrease in amniotic fluid volume or Oligohydramnios has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality one side and decreased caesarean deliveries on the other side. Aims & Objective: (1) To study affects Oligohydramnios on fetal outcome in form of (a) Fetal distress (b) Growth retardation (c) NICU admission (2) To study APGAR scores of newborn babies in relation to Oligohydramnios (3) To study incidence of congenital malformation (4) To study early neonatal morbidity and mortality (5) To study maternal morbidity in form of operative delivery and induced labour. Material and Methods: Present study was done over a period from May 2009 to November 2011. 100 patients in third trimester of pregnancy with Oligohydramnios selected randomly after satisfying inclusion and exclusion criteria. A detailed history and examination were done. All required investigation done. Oligohydramnios confirmed by measuring AFI. Results: Mean maternal age-23.66 years. Incidence of oligohydramnios was more in primipara (52%) in our study. And operative morbidity was also more in primipara. Most common cause of Oligohydramnios is idiopathic (52%). Second commonest cause is PIH (25%). Operative morbidity is highest in PIH (60%). Operative morbidity was significantly higher in NST (non-stress test) non-reactive (3.12 ± 75=78.12%) group than NST reactive (26.47%) group. Most common reason to perform caesarean was fetal distress which was either due to cord compression or IUGR. 7% patients were found with fetoplacental insufficiency on Doppler study. Oligohydramnios was related to higher rate of growth retardation and NICU (neonatal intensive care unit) admission. Conclusion: Oligohydramnios is frequent occurrence and demands intensive fetal surveillance and proper antepartum and intrapartum care. Due to intrapartum complication and high rate of perinatal morbidity and mortality, rates of caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so that unnecessary maternal morbidity prevented and other side timely intervention can reduce perinatal morbidity and mortality.

Candida prevalence and its antifungal susceptibility in various clinical specimens in tertiary care center.

Background: The purpose of this study was to isolate the Candida spp. & examine their susceptibility to antifungal drugs from various clinical specimens. One hundred fifty isolates of Candida spp. were included in this study. Clinical history revealed that all patients were on systemic broad spectrum antibacterial drugs. Materials and Methods: Candida spp. was differentiated by germ tube test, culture characteristics on special media for fungus, sugar fermentation, sugar assimilation and growth on corn meal agar. Antifungal drug susceptibility testing against Fluconazole, Ketoconazole, Itraconazole, Voriconazole, Nystatin and Amphotericin B were done on basis of CLSI guidelines on Methylene blue containing Mueller Hinton Agar by disk diffusion method. Result: We found 52% and 48%, C.albicans & Non albicans candida spp., respectively. There were no resistance to Nystatin and Amphotericin B. C.albicans was more susceptible than Non albicans candida. Nystatin & Amphotericin B were susceptible to all isolated Candida spp. In present scenario, Fluconazole is most commonly used empirical antifungal drug, which is more effective to C.albicans than Non albicans Candida. Conclusion: Due to emergence of resistance in Azole group of antifungal among Non albicans candida, it should be mandatory to use antifungal drugs as per the susceptibility testing.

A study of superficial mycoses in tertiary care hospital.

Background & Objectives: Fungal infections are extremely common in the tropical regions and some of them are serious .Fungi produce diverse human infections ranging from superficial skin infections to systemic disease .The study of superficial mycosis is important due to the frequent occurrence in dermatology clinics. The present study was undertaken with a view to find out the clinical pattern of dermatophytic and non – dermatophytic fungi (superficial mycosis) and most common fungal pathogens in tertiary care hospital affiliated with medical college in Western India from August 2007 to July 2008. Methods: A clinical and mycological study of superficial mycosis was conducted on 215 cases (138 males and 77 females). Direct microscopy by KOH (potassium hydroxide) mount and culture was undertaken to isolate the fungal pathogen in each case. Results: Commonest age group involved was adults of 19-59 years age. Tinea corporis was the most common clinical presentation and Trichopyton rubrum was the most common fungal pathogen isolated. Dermatophytosis was the commonest superficial fungal infection and found in 147/215 cases (68.4%). Non dermatophytic fungus like pityriasis versicolor and yeast like candida species were isolated in 48/215(22.3%) cases and 20/215 (9.3%) cases respectively. The KOH positivity rate was 72.4% and total culture positivity rate was 62.8%.Interpretation & conclusion: Along with dermatophytes, nondermatophytic fungi are also emerging as important causes of superficial mycosis. Direct microscopy and culture both are important tools for diagnosis of the fungal infections.

Development and validation of dissolution method for carvedilol compression-coated tablets

The present study describes the development and validation of a dissolution method for carvedilol compression-coated tablets. Dissolution test was performed using a TDT-06T dissolution apparatus. Based on the physiological conditions of the body, 0.1N hydrochloric acid was used as dissolution medium and release was monitored for 2 hours to verify the immediate release pattern of the drug in acidic pH, followed by pH 6.8 in citric-phosphate buffer for 22 hours, to simulate a sustained release pattern in the intestine. Influences of rotation speed and surfactant concentration in medium were evaluated. Samples were analysed by validated UV visible spectrophotometric method at 286 nm. 1 percent sodium lauryl sulphate (SLS) was found to be optimum for improving carvedilol solubility in pH 6.8 citric-phosphate buffer. Analysis of variance showed no significant difference between the results obtained at 50 and 100 rpm. The discriminating dissolution method was successfully developed for carvedilol compression-coated tablets. The conditions that allowed dissolution determination were USP type I apparatus at 100 rpm, containing 1000 ml of 0.1N HCl for 2 hours, followed by pH 6.8 citric-phosphate buffer with 1 percent SLS for 22 hours at 37.0 ± 0.5 ºC. Samples were analysed by UV spectrophotometric method and validated as per ICH guidelines.

O presente estudo descreve o desenvolvimento e a validação de método de dissolução para comprimidos revestidos de carvedilol. O teste de dissolução foi efetuado utilizando-se o aparelho para dissolução TDT-06T. Com base nas condições fisiológicas do organismo, utilizou-se ácido clorídrico 0,1 N como meio de dissolução e a liberação foi monitorada por 2 horas para se verificar o padrão de liberação imediata do fármaco em condições de pH baixo, seguidas por pH 6,8 em tampão cítrico-fosfato por 22 horas, para simular o padrão de liberação controlada no intestino. Avaliou-se a influência da velocidade de rotação e a concentração de tensoativo no meio. As amostras foram analisadas por método espectrofotométrico UV-visível validado, em 286 nm. O laurilsulfato sódico a 1 por cento (SLS) mostrou-se ótimo para aumentar a solubilidade do carvedilol em pH 6,8 em tampão cítrico-fosfato. A análise da variância não mostrou diferença significativa entre os resultados obtidos a 50 e a 100 rpm. O método da dissolução discriminante foi desenvolvido com sucesso para os comprimidos revestidos de carvedilol. As condições que permitiram a determinação da dissolução foram: aparelho USP tipo I a 100 rpm, contendo 1000 mL de HCL 0,1 N por 2 horas, seguido de pH 6,8 com tampão cítrico-fosfato, com 1 por cento de SLS por 22 horas a 37,0 ± 0,5 ºC. Amostras foram analisadas por método espectrofotométrico e validadas pelas normas ICH.