Evaluation of 18FDG PET-CT-positive mediastinal-hilar lymph nodes in extrathoracic malignancies by EBUS-TBNA; correlation of SUVmax, and short-axis diameter with the final diagnosis

Introduction: Intrathoracic lymph node metastasis from extrathoracic neoplasms are rare. Primary malignancies that metastasize to mediastinal-hilar lymph nodes are head and neck , carcinoma breast ,and genitourinary. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)/endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the preferred modality for mediastinal lymph node sampling. Methods: Fifty seven patients with extrathoracic malignancies with maximum standardized uptake value (SUVmax) of mediastinal-hilar lymph nodes greater than or equal to 2.5 were taken up for EBUS-TBNA. The histo-cytopathological results obtained from EBUS-TBNA were compared with SUVmax value and short-axis diameter of a lymph node as noted on EBUS. Results: Out of 74 sampled nodes, 49 (66.2%) were benign and 25 (33.8%) were malignant. The SUVmax range of benign nodes was 2.8� as compared to 3� of malignant nodes. The size range of malignant and benign nodes were 8� mm and 8� mm, respectively. The mean size of abnormal nodes (metastatic + granulomatous) was 17.5 (8� mm) and the mean SUVmax was 9.1 (3.4�), and it was a statistically significant difference when compared to reactive (normal) nodes. At SUVmax cut-off 7.5, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 78.5%, 81.2%, 84.6%, and 74.2%, respectively for detecting abnormal nodes. At 13 mm size cut-off, sensitivity, specificity, PPV, NPV were 75.5%, 65%, 75%, and 72%, respectively, for detecting abnormal nodes. Conclusion: The majority of mediastinal-hilar nodes with increased metabolic activity are benign in nature. Size and SUVmax are poor predictors of metastasis in tuberculosis endemic region. There should be a restrictive attitude toward invasive diagnostic testing for mediastinal-hilar nodes in extrathoracic malignancies.

A Comparative Study of Sublingual and Vaginal Low Dose Misoprostol for Induction of Labor

Introduction: Labour induction is a clinical intervention thathas the potential to confer major benefits to the mother andnew-born. Study aimed to compare the safety and efficacyof sublingual versus vaginal misoprostol and to evaluatematernal and foetal outcomes after sublingual and vaginalroutes of administration.Material and methods: We conducted a study on inductionof labor with misoprostol on antenatal patients with medicalor obstetric indication who presented in the Department ofObstetrics and Gynaecology, RMCH.Result: There was no significant difference in the demographiccharacteristics between the two groups. The main indicationfor induction in both groups was pregnancy induced HT.Incidence of caesarean section was not significantly differentin the two groups. There was no significant difference inmaternal complications between the two groups.Conclusion: Sublingual misoprostol is as effective and safe asvaginal misoprostol for induction of labor at term.

Effect of nasal suction on reliving feeding difficulty in children affected with bronchiolitis

Background: Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. Although bronchiolitis is a prevalent illness in India, very few studies are performed in India regarding management of bronchiolitis. Supportive care is the mainstay of treatment concentrating on fluid replacement and gentle suctioning of nasal secretions, oxygen therapy, and respiratory support if necessary. Infants affected with bronchiolitis also have feeding difficulty which will lead to dehydration and also increase the severity of disease.Methods: A prospective randomized control study was performed in the department of Pediatrics SSMC Rewa. Nasal suction was performed in 75 patients classified under the case group. Feeding difficulty was assessed before and after the suction for 24 hours.Results: We noted that after the first episode of nasal suction which is at 0th hour feeding difficulty was persisted in most of the patients. The p-value was 0.1148 which is not significant. But from 4th hour till the 16th hour the difficulty in feeding decreased after the nasal suction, and by Chi-square test this improvement was statistically. From 20th hour difficulty in feeding still improved after nasal suction but this change was not statistically significant.Conclusions: Nasal suction is an effective supportive treatment in the patients with bronchiolitis and by its use it improves the feeding in the infants suffering from bronchiolitis.

​Spot Urine Uric Acid Level As Early Marker Of Kidney Injury In Birth-Asphyxiated Newborns

Introduction: Perinatal asphyxia is a condition defined as hypoxemia, hypercapnia, and acidosis in neonate. Cellular hypoxialeads to increased excretion of uric acid. This study was conducted to assess the feasibility of urine uric acid level for theidentification of kidney injury in asphyxiated newborns in first 48 h of life.Aims and objectives: The aims and objectives of this study were to evaluate the utility of urinary uric acid levels within 48 hof birth as non-invasive and early biochemical means of identifying kidney injury in birth asphyxiated neonates.Material and methods: Study design - this was a prospective observational cohort study. Settings - this study was conductedat neonatal intensive care unit in tertiary level hospital in Central India. Duration - the study duration was from July 2017 to June2018. Due to financial constraints, 100 neonates were enrolled and urine sample collected within 48 h of life was evaluated forurine uric acid level. On day 3rd of life, serum creatinine was done. Statistical analysis was performed by Mann–Whitney U-test.Results: The mean rank of urine uric acid (32.76 vs. 20.29) was significantly higher in term newborns as per asphyxia (P = 0.005). Themean rank of urine uric acid (24.13 vs. 15.46) was significantly higher in term asphyxiated as per urine output (P = 0.031). However,the mean rank of urine uric acid (23.29 vs. 16.00) was not significant in term asphyxiated newborns as per serum creatinine (P = 0.08).Conclusions: Urine uric acid = 16.10 µmole/24 h has a sensitivity (61.4%) and specificity (72.2%) for detecting asphyxia innewborns. Similarly, urine uric acid = 22.3 µmole/24 h has a sensitivity (66.7%) and specificity (91.4%) for detecting kidneyinjury in asphyxiated newborns.

Cervical cancer awareness and HPV vaccine acceptability among females in Delhi: A cross-sectional study

AIMS: The aim of this study is to assess the awareness about cervical cancer and the acceptability of cytological screening and vaccine against human papilloma virus (HPV) among women in Delhi, the national capital of India. MATERIALS AND METHODS: A cross-sectional survey of women was conducted in Delhi to assess the awareness of cervical cancer and acceptability of Papanicolaou (Pap) test and HPV vaccine. The sample size of the population was 450, and a pre-tested questionnaire was administered to them. RESULTS: Majority of the participants (85.11%) were aware of cervical cancer and were willing to undergo diagnosis by Pap test (84.6%). As far as vaccination was concerned, 63.14% found the HPV vaccine acceptable for their daughters. However, very few participants were willing to vaccinate themselves against HPV. CONCLUSION: The high awareness among females in Delhi about cervical cancer and acceptability of screening programs, if done free of cost, shows a positive trend. The only inhibition about HPV vaccine was primarily due to concerns about postvaccination complications. However, inclusion of HPV vaccine in Government-sponsored immunization program would go a long way in increasing the acceptability of the vaccine.

Neurodevelopmental Status of Children aged 6-30 months with Severe Acute Malnutrition

Objective: This cross sectional study was done to assess the developmental status inchildren (6-30 mo old) with severe acute malutrition (SAM). Methods: Study subjects wereenrolled from children in SAM therapeutic unit, and controls were selected from well-babyclinic of the institute. Neurodevelopment of both groups was assessed using theDevelopmental assessment scale of Indian infants (DASII). Developmental quotient (DQ) ?70was considered delayed.Results: Mean (SE) motor DQ 59.04 (0.74) and mental DQ 62.1(0.57) was lower in SAM as compared to controls (both P<0.0001). Clusters of early agewere normal but clusters with items of later infancy were delayed. Conclusions: Childrenwith SAM show significant delay in development, and motor DQ is affected more thanmental DQ.

Retinopathy as a Prognostic Marker in Cerebral Malaria.

Objectives: To study the association between fundal changes (malarial retinopathy) and mortality in children with cerebral malaria. Methods: 50 consecutive children (mean age 8.4 y, 23 males) with cerebral malaria (acute febrile encephalopathy and either peripheral smear or Rapid diagnostic test positive for malaria) were evaluated by a single ophthalmologist for any changes of retinopathy. Children were managed as per standard guidelines for treatment of cerebral malaria. Results: P. vivax infection was seen in one child, P. falciparum infection in 42 children, and a mixed infection in 7. Retinopathy was present in 48% of the children. 13 children died during hospital stay. The mean interval from admission to fundus examination was 11.6 (4.64) h. Presence of ‘any retinopathy’ (P=0.02), and either of papilledema (P=0.02), hemorrhages (P=0.005) or vessel changes (P=0.01), were associated with a significantly higher risk of death. Conclusions: Malarial retinopathy is significantly associated with mortality in children with cerebral malaria. It may be used for both prognostication, and triaging for optimum utilization of intensive care facilities in these children.

Placental and Neonatal Outcome in Maternal Malaria.

Objective: Primary: To determine the incidence of congenital malaria in a cohort of pregnant women in a hyper-endemic area of central India. Secondary: (1) To find out the placental weight and placental malaria positivity, and to assess fetal and neonatal outcome in terms of survival, mean hemoglobin and mean birth weight. Design: Prospective observational study. Setting: Maternity and neonatal ward of a tertiary level hospital attached to a medical college located in Rewa, Madhya Pradesh, India. Participants: Near term and term pregnant women admitted in the maternity ward with a singleton pregnancy, whose neonates were available for examination till at least 6 hours after birth. Methods: Thick and thin blood smear were examined for malarial parasites from mothers prior to delivery. Based on the results of peripheral smear they were divided into ‘exposed group’ (peripheral smear positive for malaria parasite) and unexposed group’ (smear negative for malaria parasite). These groups were then followed prospectively till delivery and subsequently till the mother and the neonates were discharged from the hospital. Outcome variables: Primary: Presence of asexual parasite in neonate. Secondary: Placental weight, presence of asexual malarial parasite in placenta, still births, early neonatal deaths, mean birth weight and mean hemoglobin. Results: Seventy-two (35.5%) of 203 blood smears of near term and term pregnant women were found positive for malaria parasite (60 P. vivax and 12 P. falciparum); rest 131 comprised the unexposed group. Six (2.95%) neonates had parasitemia (4 P. vivax and 2 P. falciparum). Of the 203 smears made from placental blood, 24 (11.8%) were positive for malaria parasite. The mean (SD) birth weight [2300 (472) g vs 2430 (322) g; P=0.98], proportion of preterm babies (6.9% vs 8.4%, P=0.71), incidence of still birth (4.2% vs 3.0%, P=1.0) and early neonatal death (2.8% vs 3.0%, P=1.0) were not significantly different between the exposed and unexposed group. Conclusions: The incidence of congenital malaria is low despite high maternal smear positivity for malaria.

Effectiveness of Anti Scorpion Venom for Red Scorpion Envenomation.

Objective: To study the efficacy of anti-scorpion venom plus prazocin. Methods: Comparison of clinical features, outcome and duration of stay between children receiving anti-scorpion venom plus prazocin or prazocin alone for management of red scorpion envenomation. Results: Requirement for dopamine and requirement and duration of dobutamine therapy were significantly less in patients received anti-venom plus prazocin than those had prazocin only. Faster recovery was seen in cases who received antiscorpion venom plus prazocin than prazocin only group. Conclusion: Anti-scorpion venom plus prazosin was safe and more effective than prazocin alone for scorpion envenomation.

Co-morbidities in Hospitalized Children with Severe Acute Malnutrition.

Objective: To study the co morbidities in hospitalized children with severe acute malnourishment. Methods: 104 severe acute malnourished children were included. Results: 54% had diarrhea and 27.8% had acute respiratory tract infections. Tuberculosis was diagnosed in 22% of cases (60.8% cases in children 6-12 mo old). Malaria and Measles were diagnosed in 3.8% each, and HIV infection was seen in 2.9% cases. Signs of vitamin B and vitamin A deficiency were seen in 14.4% and 5.8% cases, respectively. Malaria and HIV were not found to be major co morbid conditions. Conclusions: Timely identification and treatment of various co-morbidities is likely to break undernutrition-disease cycle, and to decrease mortality and improve outcome.

Latency Intervals of Moro Response: A Valuable Neuro-screening Tool.

Moro response in healthy term newborns were studied to determine latency interval, time taken for optimal response (embracing movement of arms), and total duration of reflex response. Latency interval for onset of response was 0.41-0.49. Time taken for optimal response was 0.910-1.041s. Total duration of Moro response was 2.34 -2.59 s. Values were similar for males and females. Optimal response in babies born by cesarean section were significantly delayed than vaginal babies.

Significance of Family Survey of Index Case for Detection of Tuberculosis.

Tuberculosis is highly prevalent amongst children in India. Contact survey has not received much attention in the Revised National Tuberculosis Control Program guidelines. This study was conducted to look for tuberculosis in asymptomatic family members of pediatric tuberculosis patients at a government hospital attached to a medical college in Central India. 168 siblings and 162 parents of 86 index cases of tuberculosis were studied. 64 tuberculosis infected siblings and 7 sputum positive parents were identified.

Clinicoepidemiological profile and predictors of severe illness in young infants (< 60 days) reporting to a hospital in North India.

OBJECTIVES: To describe the clinical and epidemiological profile of young infants reporting to a hospital and assess previously proposed simple clinical signs for their value in enabling health workers to detect young infants with severe illness warranting hospital admission. METHODS: Observational study of infants less than 2 months of age presenting consecutively to a large public hospital in South Delhi who were evaluated by a health worker (nurse), on a standardized list of signs and symptoms, and the ability of these were evaluated against the need for hospital admission which was assessed by an independent pediatrician. RESULTS: Of the 1624 young infants triaged, 878 were enrolled into the study. Of these 100 (11%) were below 7 days of age, for whom the common reasons for seeking care were jaundice (52%), not feeding well (6%) and fever (5%). The remaining 778 (89%) were 7-59 days of age with respiratory symptoms as the main presenting complaints (29.1%). The primary clinical diagnoses in infants with serious illness needing admission to hospital in the age group <7 days (n = 66) were hyperbilirubinemia (56%) and sepsis (21%). In those between 7-27 days of age (n = 60), primary diagnoses were sepsis (27%), pneumonia (13%), diarrhea, dysentery or dehydration (10%), while in the age group 28-59 days of age (n = 47) pneumonia (40%), sepsis (19%) and diarrhea or dehydration (13%) were the common primary diagnoses. Signs that had at least a prevalence of 5% and were strong predictors for all the age categories studied were history of difficult feeding (OR 6.8 for 0-6 days, 15.1 for 2-27 days and 6.2 for 28-59 days age groups), not feeding well on observation (OR 13.7, 27.6 and 20.9 respectively for the 3 age groups), temperature > 37.5C (OR 21.8, 14.6 and 30.0 respectively for the 3 age groups) and respiratory rate > 60 per minute (OR 6.8, 15.1 and 21.0 respectively for the 3 age groups). Additional strong predictors with > 5% prevalence were history of convulsions (OR 7.9, only in 0-6 day age group), lethargy (OR 26.1, only in 7-27 day age group), and history of diarrhea (OR 3.0 for 2-27 days and 2.2 for 28-59 days age groups). CONCLUSIONS: Simple clinical signs are useful in hands of health worker for identifying neonates with serious illness warranting hospital admission. These will be of use in the further development of clinical algorithms for the national integrated management of childhood illnesses.