Outcome of Surgical Condition of Neonates who Underwent Surgery: A Prospective Study from a Tertiary Care Center

Background: The neonatal period is a highly vulnerable time for an infant, who is completing many of the physiologic adjustments required for extra- uterine survival. If the neonate has a coexisting pathology which needs surgery, this challenge is magnified. Neonatal surgical conditions are unique in their type because some require early diagnosis, prompt surgery and postoperative care to improve the survival and outcome. Objective: The aim of this study was to know the clinical profile of congenital surgical conditions and to estimate the burden and outcome in special new born care unit. Method: The study population include 138 surgical neonate admitted in special new born care unit, department of paediatrics, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior (M.P.) from April 2017 to April 2018 including six month follow up period. Results: Total admission in special new born care unit were 5378 out of which 138 (2.5%) neonates of surgical condition were admitted in the study period. Incidence of neonatal surgical condition was found to be 8.48%. Surgery was performed in 57 (41.30%) neonates. The Commonest neonatal surgical condition was constituted by gastrointestinal system (39.13%). Among gastrointestinal system anomalies, tracheoesophageal fistula were 28.6% of total gastrointestinal system cases. The most common surgical condition encountered was meningomyelocele, 23.36% of total cases. The survival of neonatal surgical condition in hospital was 52.89% and after six month follow up was 26.08%. The overall mortality with neonatal surgical condition in this study was 73.91%. Maternal age, antenatal care, history of congenital malformation, socioeconomic status, mode of delivery, prematurity, type of admission, single or multiple surgical condition, inotropic and ventilation support, post operative complication were significantly associated with final outcome of neonatal surgical condition. Conclusion: High mortality was found in neonates suffering from surgical conditions. Commonest anomaly includes conditions of gastrointestinal tract. Maternal age more than 35 year, poor antenatal care, prematurity, vaginal delivery, extra mural neonate, multiple surgical condition, inotropic and ventilation support and post operative complications were associated with increased mortality.

Comparative evaluation of adherence to antiretroviral therapy

Background: While treating patients with HIV infection it is important to achieve more than 95% compliance to ART (Antiretroviral Therapy) in order to suppress viral replication.Methods: This was a retrospective, observational, record based study of HIV positive patients undergoing treatment with ZLN (zidovudine 300 mg, lamivudine 150 mg, nevirapine 200 mg) and TLE ( tenofovir 300 mg, lamivudine 150 mg, efavirenz 600 mg) regimens. The treatment charts of the patients fulfilling inclusion and exclusion criteria were reviewed.Results: Analysis of adherence showed that there were 12 patients out of 150 on ZLN regimen and 31 patients out of 150 on TLE regimen were nonadherent to the respective treatments.Conclusions: In this observational study patients on ZLN regimen were showing greater compliance than TLE regimen.

Ventilator associated pneumonia: incidence and risk factors in a tertiary care hospital

Background: The objective of this study is to find the occurrence and contributing risk factor of ventilator associated pneumonia (VAP) in 2 months-5 years age group.Methods: This was a prospective, observational, hospital-based study carried out in a tertiary care setting hospital. All patients between 2 months-5 years age admitted in the ICU who had undergone MV were included in the study. Inclusion criteria includes patients who developed pneumonia after the 48 hours of mechanical ventilation and those patients were excluded who developed pneumonia within 48 hours of mechanical ventilation and having respiratory system findings /involvement prior to the MV. After recruiting patients baseline clinical characteristics (age, sex, diagnosis, duration of MV) were taken, monitored and diagnosed VAP using CDC guidelines until they were discharged or deceased. The parameters such as fever, oxygenation, leucocytosis, other risk factors. chest X-ray and ETA>105CFU/ML or microscopy (grain stain>l bacteria/>10 polymorphonuclear cells) were collected every 48 hours.Results: This study was done in 133 patients while 42 patients (31.58%) developed VAP during their ICU stay. Early onset VAP occurred in 34 (80.9%) while late onset VAP was observed in the remaining 8 (19.1%) patients. In ETA culture CFU>105 Klebsiella (38%) was the predominant isolate followed by Pseudomonas (23%), Acinetobacter (17%), Staphylococcus (13%) and Citrobacter (10%) are offending organism responsible for VAP in MV patient in present study. On analysis (univariate) reintubation, altered sensorium at intubation and use of antacid are found significantly associated risk factors with the development of VAP.' Multivariate analysis revealed that reintubation was an important risk factor for the development of the VAP.Conclusions: The various risk factors can be minimized for better outcome of patients undergoing mechanical ventilation. Risk factors such as reintubation, altered sensorium at intubation and use of antacid are associated with VAP and also the physician treating must have knowledge and awareness about prevention of these risk factor to improve the outcome of patients.

Four percent formalin application for the management of radiation proctitis in carcinoma cervix patients: An effective, safe, and economical practice

Context: Radiotherapy is a very effective treatment modality for pelvic malignancies such as carcinoma of the cervix. However, it is quite common for chronic radiation proctitis (CRP) to manifest after radical radiotherapy. CRP is a source of significant morbidity, and there is a lack of effective treatment modalities. There also exists a general lack of guidelines on management of CRP. Aims: To assess the benefit from 4% formalin application for the treatment of Grade >2 CRP among patients previously treated with radical radiotherapy for cervical carcinoma. Settings and Design: This retrospective descriptive study involved 29 eligible patients who were treated from November 2010 - November 2015 for CRP with 4% formalin application. Materials and Methods: Of the 1864 patients of carcinoma cervix treated during the said patients, 29 patients fulfilled the eligibility criteria. Eligible patients were invited telephonically for follow-up and were assessed for response and complications of the procedure. Results: The treatment of hemorrhagic radiation proctitis with local formalin instillation is effective, well tolerated and safe procedure. The procedure is inexpensive, technically simple and can be done on an outpatient basis. 62% patients had complete freedom from rectal bleed, while 34.5% patients had partial benefit. Only one patient required diversion colostomy for persistent bleeding.

Pattern of Antimicrobial Resistance of Escherichia coli Isolates from Urinary Tract Infection Patients: A Three Year Retrospective Study.

Objectives: To study the changing pattern of antimicrobial resistance of Escherichia coli isolates from patients of urinary tract infections over last three years Materials and Methods: A retrospective, record based study carried out based on the records of Culture and sensitivity (C/S) reports of indoor patients, during past three years (2012 - 2014). The type of organisms most common in urine sample was noted and the drugs still effective for the particular organism were noted. Results: E. coli was the most frequent isolate throughout the three years (67.66 % of the total isolates). Analysis of the results year wise indicated that the lowest percentage of resistance was manifested against imipenem between 11.86 % (2012) and 11.36 % (2014). Resistance for nitrofurantoin decreased over the three consecutive years from 36.1 % (2012) to 18.15 % (2014). Over the successive years, resistance to ceftriaxone tends to increase from 53.39 % (2012) to 73.33 % (2014). E coli showed absolute resistance (100 %) to cotrimoxazole and tetracycline. On an average over the three years E. coli showed high amount of resistance to fluoroquinolones (75 %) and aminoglycosides (67 %).While Multi drug resistant (MDR) E. coli range between 63 % (2012) to 65 % (2014). Conclusion: The antimicrobial resistance patterns are constantly evolving and vary from region to region it has become a necessity to do constant antimicrobial sensitivity surveillance. This will help clinicians to provide safe and effective empirical therapies.

International Classification of Headache Disorders, 3rd Edition: What the Pediatrician Needs to Know.

Objective: To compare ultrasonography with chest radiograph to detect the level of endotracheal tube tip in intubated neonates. Design: Observational. Setting: Neonatal care unit of a teaching hospital. Participants: 53 neonates selected by convenience sampling. Intervention: Ultrasonography of chest was done with probe of 5 to 8 MHz using high parasternal view. The distance of the endotracheal tube tip to the arch of aorta on ultrasonography was compared with level of endotracheal tube tip in radiograph. Primary Outcome: Distance of endotracheal tube tip from the upper border of the arch of aorta on ultrasonography. Results: Endotracheal tube tip was visualised on ultrasonography within 0.5 - 1.0 cm distance from upper border of arch of aorta in 48 out of 53 neonates. This corresponded with the normal position of endotracheal tip in radiograph at T2 to T3. In 5 neonates, endotracheal tube tip was not visualized on ultrasonography and in all these newborns it was at higher level in radiograph. Conclusions: Distance of endotracheal tip to arch of aorta as measured on ultrasonography is helpful in early identification of the level of endotracheal tube tip.

An Analysis and Comparison of Commonly Available Prescribing Information Resources in North Indian Set Up.

To determine the prescribing information resources and the types of information about new drugs that Indian doctors perceived as important before prescribing and how they keep their information upto date . Also to determine if hospital doctors and General practitioners differed in their use of the sources. Two hundred general practitioners (GPs) and 200 hospital doctors were asked to rate information sources in terms of their importance for prescribing ‘old’ and ‘new’ drugs, and then to name the source from which information about the last new drug prescribed was actually derived. The study was carried out by information collection, by filling a questionnaire. Among 200 GPs, the Monthly Index of Medical Specialties (MIMS), pharmaceutical representatives and medical journal articles were most frequently rated as important for information on both old and new drugs . Among 200 hospital doctors, Refreshers courses by Govt.(Trainings),Monthly Index of Medical Specialties (MIMS) , and Hospital clinical meetings were of greatest importance. Information on the last new drug prescribed was derived from a broad range of sources. GPs and hospital doctors differ in their utilization of the prescribing information resources .This study generates the information that can be sought to help in shaping the development of health policy and the implementation of the Primary Health Care Strategy.

Clinical effectiveness and safety of brimonidine (0.2%) versus Dorzolamide (2.0%) in primary open angle.

A Comparison of efficacy & tolerability of brimonidine (0.2%) versus dorzolamide (2.0%) in primary open angle glaucoma or ocular hypertension. In this open, randomized, cross over comparative study, 30 subjects of primary open angle glaucoma with IOP > 22 mmHg were taken. The patients fulfilling the inclusion criteria and after verifying the exclusion criteria were included in the study after a written informed consent. These subjects were randomized to receive brimonidine (0.2%) TDS or dorzolamide (2.0%) TDS for 4 weeks. After a wash out period of 4 weeks the subjects were crossed over to other therapy .The IOP was measured at 8.00 am before dosing and at 10.00 am i.e. 2 hours after dosing at each baseline and at the end of each treatment period. Monotherapy with brimonidine (0.2%) TDS and dorzolamide (2.0%) TDS given for 4 weeks had caused overall reduction in IOP of 5.833+2.102mmHg (23.48%) and 5.433+ 2.582mmHg (22.42%) respectively at peak levels. The difference is statistically insignificant (p>0.05). Overall monotherapy with brimonidine and dorzolamide appear to produce equivalent IOP lowering efficacy and have well tolerated adverse effect profile, although a trend was observed at 10.00 a.m. of greater brimonidine efficacy compared with dorzolamide.