Road traffic accidents attending casualty in a tertiary care hospital : a 03 year study from South Western India

Background: Road Traffic Accident (RTA) is any vehicular accident occurring on the roadway i.e. originating on, terminating on, or involving a vehicle partially on the roadway. Road traffic accidents are a human tragedy which has an immeasurable impact on the families affected. The WHO estimates that over 1.2 million people pass away every year on the world’s roads, and between 20 and 50 million fall victims to non-fatal injuries.  The incidence of RTA remains poorly measured in India.Methods: The present study is conducted at casualty department of a tertiary care hospital in South Western India among victims of road traffic accident. This cross sectional study was conducted to elucidate the role of various factors involved in road traffic accidents and to study demographic profile and injury pattern among RTA victims. All the reported RTA cases from 1st January 2016 to 31st December 2018 were included in the study.Results: A total of 875 cases of RTA were studied. There were 83.77%(n=733) male and 16.23%(n=142) female accident victims. Most of the patients were aged between 21 and 30 years. Monsoons witnessed 46.63%(n=408) cases. Most cases occurred between 6 and 12pm (54.4%, n=476). Commonest injury was a simple injury (72.91%, n=638), dangerous injuries (27.09% percent, n=237) and dead was (7.43%, n=65). The highest number of accidents took place in the month of June (19.09%, n=167) and on Sundays (22.17%). Among the motorized vehicles, two-wheeler drivers were more (76.91%, n=673) involved in accidents. In this study 17.60% (n=154) were under influence of alcohol while driving.Conclusions: This study shows there are multiple factors associated with road traffic accidents. Most of the factors responsible for RTA and its fatal consequences are preventable. India, as a signatory to the Brasilia declaration, intends to reduce road accidents and traffic fatalities by 50% by 2022. A comprehensive multipronged approach can mitigate most of them.

Undernutrition in children & critical windows of opportunity in Indian context

It is intriguing to note that majority of the wasting among the under 5 yr in India is present at birth. The National Family Health Survey 4 (NFHS-4) data analysis shows 31.9 per cent wasting at birth, which is decreasing to 17.7 per cent in the under five children; clearly suggesting that any reduction in wasting should come from improvement in foetal growth. In addition, children with both severe wasting and severe stunting, in whom the risk of mortality increases many folds, are <1 per cent in almost all the States; and these are the children in whom special care is required under the community-based management of severe acute malnutrition. This article presents an overview of nutrition status in children, their antecedents, and the critical phases; especially, nutrition status before pregnancy that plays a crucial role in all the nutrition status indicators of children. More attention on the critical phases is crucial to maximize the benefits from national programmes.

Relationship of Vitamin D Status with Muscle Mass and Muscle Strength in Young Indian Adults – Evidence from Andhra Pradesh Children and Parents Study Cohort.

Objectives: Positive relationship of vitamin D status with muscle mass and strength has been observed in studies from the developed countries but evidence from the developing countries is sparse. This study assessed the relationship of vitamin D status with muscle mass and muscle strength in rural young adults from Hyderabad, India. Methods: The study participants (n=956; age 18-20 years; 42% women) were a part of Andhra Pradesh Children and Parents Study cohort which was established to assess the long term impact of early nutrition supplementation provided through a government programme. Their serum 25- hydroxyvitamin D was assessed using HPLC, appendicular skeletal muscle mass (ASM) was assessed using dual energy X-ray absorptiometry and grip strength was assessed using grip dynamometer. Results: The participants were lean with average body mass index of 19.5 kg/m2. Prevalence of vitamin D deficiency (serum 25(OH) vitamin D3 < 20 ng/ml) was 33.6% in men and 51.4% in women. Vitamin D deficiency was associated with lower ASM (β (95% CI): - 0.38 (-0.72 to -0.05) kg; p = 0.02) with a trend of lower muscle strength in unadjusted analyses. After adjustment for relevant confounders, the relationship of vitamin D deficiency with lower ASM (β (95% CI): -0.21 (- 0.37 to - 0.05) kg; p =0.01) persisted but not with lower grip strength. Conclusions: Prevalence of vitamin D deficiency was high in these rural young adults. Vitamin D deficiency was associated with lower muscle mass but not with lower muscle strength in this cohort. Alleviation of vitamin D deficiency may improve muscle mass.

A Community-based Randomized Double Blind Controlled Trial of Lactobacillus paracasei and Bifidobacterium lactis on Reducing Risk for Diarrhea and Fever in Preschool Children in an Urban Slum in India.

Aims: The aim of the study was to determine the effect of probiotics on diarrhea and fever in preschool children in a community setting in a developing country. Study Design: Double blind randomized controlled trial. Place and Duration of Study: The study was performed in Addagutta; a slum of Hyderabad (India), from July 2010 to April 2011. Methodology: Healthy preschool children (2-5 years, n=379) in an Urban Slum in India. Three randomly allocated groups of children received either of the two probiotics (Lactobacillus paracasei Lpc-37 and Bifidobacterium lactis HN019) or the placebo for a period of 9 months and were assessed for weight gain, linear growth and incidence of diarrhea and fever. Results: Neither of the tested probiotics; L. paracasei Lpc-37 or B. lactis HN019 had any influence on weight gain or linear growth. There was no significant difference between the groups in incidence of diarrhea and fever when assessing the whole study period. However, during the wet season, in the months of August and September, incidence of diarrhea was significantly higher in placebo group (16.9%) compared to L. paracasei Lpc- 37 (11.7 %) and B. lactis HN019 groups (8.4 %). Similarly, the incidence of fever was significantly higher in the month of August in the placebo group (11.5%) compared to the L. paracasei Lpc-37 group (7%) and B. lactis HN019 group (7.3%). Probiotic supplementation had no effect on fecal calprotectin, but fecal IgA and serum interleukin 8 were decreased significantly in the B. lactis HN019 group compared to placebo. Consumption of L. paracasei Lpc-37 lead to increased levels of fecal L. paracasei. Conclusion: During the rainy season, when incidence of fever and diarrhea was highest, the administered probiotics reduced the incidence of these symptoms. Over the whole study period, the probiotics did, however, not influence incidence of diarrhea or fever.

A Comparative Study Of Tracheobronchial Pattern Using Luminal Plastination.

Background: The tracheobronchial pattern of human lungs is well known. An attempt was made to compare the pattern with that of sheep lung using luminal plastination of sheep lung. Several similarities were observed between the two patterns, due to which, the sheep lung serves as an ideal experimental model to study the effect of treatment in several human airway diseases. Objective: The first objective was to compare the two tracheobronchial patterns. Moreover the study also provided an opportunity to the authors to attempt a luminal plastination. The final objective is to highlight the various advantages of advances in luminal plastination in current medical education and research. Materials and methods: Silicon sealant was injected into the tracheobroncheal tree of sheep after thoroughly cleaning the lungs with saline. After the sealant solidified the surrounding lung tissue was destroyed by boiling. Thus a luminal cast was prepared. Result: The result was a splendid luminal cast of the sheep lung showing its tracheobronchial pattern. Conclusion: It was observed that the tracheobronchial division pattern showed significant similarities and a single variation. Therefore the sheep lung is an ideal experimental model and luminal plastination can be applied to comparative anatomical study to identify more such models.

Accidental ingestion of a barbed wire broach and its endoscopic retrieval: Prevention better than cure.

Ingestion of instruments is a potential complication that can occur during dental procedures. We report a case of accidental ingestion of an endodontic barbed wire broach during root canal treatment and its subsequent retrieval by endoscopic methods. Although prevention is the best approach, proper management of such an event is also crucial. The objective of this report is to draw attention to the potentially serious complications that can occur if preventive techniques are not practised, and to discuss the accepted guidelines for management of such an event.

Pattern of Growth Faltering and Recovery in Under-5 Children in India Using WHO Growth Standards - A Study on First and Third National Family Health Survey.

Objective: To examine the pattern of growth faltering in preschool children, using World Health Organization (WHO) growth standards 2006 from the available datasets of first and third National Family Health Survey (NFHS 1 and 3). Design: Data-analysis of two large-scale cross-sectional surveys done at a gap of 15 years. Setting: General community. Subjects: Preschool children included in NFHS 1 (n = 37,768) and NFHS 3 (n = 41,306). Main outcome measures: Weight for age Z-scores (WAZ), height for age Z scores (HAZ) and weight for height Z scores (WHZ) based on WHO growth standards for the first four years of life. Results: Mean WAZ score at ‘0’ month during first and third surveys were -1.15 (n=268) and -0.76 (n=184), respectively. Of the total growth faltering in weight for age Z (WAZ) score by the end of third year, 55% and 44% of the growth faltering was already present at birth for the first and third survey, respectively. There was no change in weight for height Z (WHZ) score for the first three years during both the surveys. Conclusions: A good part of the total growth faltering in India has already taken place at birth. Much of the growth faltering in early life can be attributed to faltering in HAZ scores or stunting. Understanding the causal role of stunting and its prevention as well as improving birth weight appears to be the key for better efficacy of public health programs in preventing under-5 malnutrition in India.

Hospital Based Nutrition Rehabilitation of Severely Undernourished Children Using Energy Dense Local Foods.

Objective: To examine the catch up growth in severely wasted children using energy dense local foods at a hospital based nutrition rehabilitation unit. Design: Retrospective cohort. Setting: In-patient ward at a tertiary care government pediatric hospital in Hyderabad. Patients: Children with severe malnutrition (n=309) admitted to nutrition ward from January 2001 to December 2005. Intervention: A diet based on energy dense local foods along with multivitamin-multimineral supplements. Main outcome measures: Catch up growth (g/kg/day) during each week of hospital stay. Results: Mean age of the children was 25 months (range 2-60). Their baseline weight for height (WHZ) Z score was –4.1. Mean weight gain was moderate (5g/kg/day) and baseline WHZ score had a significant negative relationship to the weight gain. The prevalence of morbidities was high and the commonest morbidity was fever. Weight gain was higher by almost 40% in the absence of morbidities in any week. Conclusions: The diet based on local energy dense foods was found to be suitable for the nutrition rehabilitation of severely malnourished children though the rate of weight gain was moderate.

Respiratory syncitial virus in children with acute respiratory infections.

Objective. To study the nutritional status of children with Respiratory Syncitial virus infection. Methods. One hundred and twenty six children with acute respiratory infection, between the age of 4-24 months, were investigated for RSV infection with bronchiolitis, pneumonia and upper respiratory tract infection. Nasopharyngeal aspirates were collected and cytokine responses were determined by ELISA. Upper respiratory tract infections were detected in 16.66%, bronchiolitis in 30.15% and Pneumonia in 53.17% children. Results. Of the 126 patients, 46.66% children were positive for RSV while 58.33% were negative for RSV. Children with bronchiolitis were more commonly positive for RSV compared to URTI and pneumonia. RSV was almost equally distributed among boys (42.5%) and girls (48.7%). More children were RSV positive when the mean age lesser (8.4 mo) was compared to RSV negative (9.93 mo). Well nourished children and children with normal birth weight had more RSV positives, though not statistically significant. In a sub sample analysis of cytokines done (n=25), Interleukin-2 and Interleukin-8 levels were higher in the RSV positive children and these levels declined after 5 days of illness. Conclusions. RSV is more commonly associated with bronchiolitis in younger infants with normal birth weight or more weight for age (WFA). Proinflammatory cytokine IL-8 was secreted at high concentrations in the nasopharyngeal aspirate in all the children.

Homocystinuria due to cystathionine beta synthase deficiency.

A two year-old male child presented with cutis marmorata congenita universalis, brittle hair, mild mental retardation, and finger spasms. Biochemical findings include increased levels of homocysteine in the blood-106.62 micromol/L (normal levels: 5.90-16 micromol/L). Biochemical tests such as the silver nitroprusside and nitroprusside tests were positive suggesting homocystinuria. The patient was treated with oral pyridoxine therapy for three months. The child responded well to this therapy and the muscle spasms as well as skin manifestations such as cutis marmorata subsided. The treatment is being continued; the case is reported here because of its rarity. Homocysteinuria arising due to cystathionine beta-synthase (CBS) deficiency is an autosomal recessive disorder of methionine metabolism that produces increased levels of urinary homocysteine and methionine It manifests itself in vascular, central nervous system, cutaneous, and connective tissue disturbances and phenotypically resembles Marfan's syndrome. Skin manifestations include malar flush, thin hair, and cutis reticulata / marmorata.

Validation of hemoglobin estimation using Hemocue.

OBJECTIVE: This piece of work is an attempt to compare Hemocue and Cyanmethemoglobin methods for hemoglobin estimation. METHODS: In 100 apparently healthy children of 1-6 years of age, Hb was estimated using Hemocue and cyanmethemoglobin methods from finger prick blood sample. The results obtained by the two methods were compared using appropriate statistical methods. RESULTS: Mean +/- SD values for hemoglobin (g/dl) were 9.33 +/- 2.719 by Hemocue and 8.14 +/- 2.448 by cyanmethemoglobin method. When assessed by Hemocue method the proportion of children with anemia was 66% while it was 88% with cyanmethemoglobin method. The sensitivity of Hemocue method was 0.75 and specificity 1.0 considering cyanmethemoglobin method as gold standard. The corresponding values by cyanmethemoglobin method for a given Hemocue value fell within the Mean difference +/- 2 SD with correlation coefficient being r = 0.922. Despite the good association, the two methods agreed, the magnitude of difference being -1.19 g/dl (CI: -1.40 to -0.98) thus suggesting an overestimate of hemocue values ranging from 10 to 15%. A correction factor was arrived for converting Hb values obtained by Hemocue method to arrive at the expected value by the reference method, this factor being 0.389 + 0.831 Hb (Hemocue). CONCLUSION: As there are limitations expressed for both the methods in accurately estimating Hb, it is difficult to decide whether one is an overestimate or the other an underestimate. By virtue of the principle involved in estimating Hb, cyanmethemoglobin method may be taken as an indirect indicator of iron status. However, it is not clear whether such a principle is involved in estimating Hb by Hemocue. Therefore, these two methods need to be further validated against a sensitive and specific indicator for iron status like circulating transferrin receptor to decide which of the methods can be used to accurately determine the prevalence of iron deficiency anemia in the community.

Meckel's diverticulum in children.

Twenty one surgically documented cases of Meckel's diverticulum in children treated at Kasturba Hospital, Manipal since 1981 are reviewed. Of them, 14 presented with intestinal obstruction, 2 with pain abdomen, 2 with Littre's hernia and 2 were found incidentally. Only one patient presented with gastrointestinal bleeding. The clinical profile of these patients is analyzed.

Intra-abdominal lymphatic cysts in children.

Ten children with intra abdominal lymphatic cysts operated in the last 8 years are reported. They formed 0.50% of all pediatric surgical admissions and 33.3% of all intra-abdominal cystic lesions. The mean age was 5 1/2 years and the male-female ratio was 1:1. Half the cysts were in the mesentery and 30% in the omentum. The other 2 cysts were located at unusual sites. Two children having mesenteric cysts presented as abdominal emergencies. Three of them were wrongly diagnosed and treated for tuberculous ascites before laparotomy. Four mesenteric cysts were excised along with the adjoining intestinal segment, and one was drained by tube marsupialisation. All 3 omental cysts and the two cysts at unusual sites were excised in toto. There was no mortality or morbidity.