Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Risk factors for prevalence of retinopathy of prematurity in a tertiary care centre of North India

Background: The goal of the current study was to shed light on the risk factors responsible for the prevalance of ROP in infants born before 34 weeks of gestation or in infants born with birth weights under 2000 g admitted in NICU at a tertiary care hospital. Methods: This study was a hospital based prospective observational study conducted on 160 neonates after ethical clearance within a period of four months. The study population comprised of neonates less than 34 week of gestational age and with birth weight less than 2000 gm and gestational age between 34-36 weeks. All statistical analysis was done using appropriate statistical software like SPSS (Statistical Sciences Package for Social).  Categorical / Nominal variables were indicated as number and percentage and were surveyed using Chi square test or Fischer exact test. Continuous variables were expressed as mean and standard deviation. Results: Among the 160 neonates screened, 30 neonates were found to have Retinopathy of prematurity, giving a rate of 18.8% for ROP. Among the 30 neonates with ROP, 10 (33.3%) delivered at gestational age <32 weeks, 12 (40%) had respiratory distress syndrome, 19 (63.3%) had sepsis, 23 (76.7%) required oxygen therapy, 5 (16.7%) received mechanical ventilation, 18 (60%) received blood transfusion, 17 (56.7%) had hypoglycemia. Other risk factors have been discussed in detail in the article. Conclusion: Prematurity, low birth weight, inadvertent use of oxygen therapy blood transfusion, sepsis and hypoglycemia were found to be significant risk factor for ROP

Viscoelastic-augmented trabeculectomy: A newer concept

Purpose: Comparison of conventional trabeculectomy (CT) and viscoelastic-augmented trabeculectomy (VAT) in primary open-angle glaucoma. Methods: A total of 65 primary open-angle glaucoma cases were taken for each of the two groups, i.e., CT and VAT. Viscoelastic-augmented trabeculectomy constituted lamellar scleral flap, deep scleral flap, penetrating trabeculectomy, peripheral iridectomy, filling of the anterior chamber with viscoelastic (sodium hyaluronate) and balanced salt solution, movement of visco in bleb, and tight flap closure. Success criteria included intraocular pressure (IOP) <14 mmHg with no devastating complications. P < 0.05 was considered statistically significant. Results: Mean IOP was significantly lower after VAT compared to CT at 6 weeks, 12 weeks, and 6 months postoperatively. Target IOP was achieved in 60% cases in VAT group compared to 36.92% in CT group. Conclusion: VAT is effective in reducing IOP to the target level for advanced glaucoma with lower postoperative complications

Unilateral ocular surface squamous neoplasia in a case of laryngeal carcinoma: A case report

We discuss a unique case, where a patient is suffering from both laryngeal carcinoma and ocular surface neoplasia with a strong family history of multiple malignancies of various organs. The patient is a 65-year-old male suffering from unilateral left-sided ocular surface neoplasia involving the inferotemporal quadrant of limbus and sclera. The lesion was excised surgically with double freeze-thaw cryotherapy and was started on topical mitomycin-c (0.02%) for 3 1-week cycles over 6 weeks.</jats:p

A CROSS-SECTIONAL STUDY TO ASSESS THE PATTERN OF SELF-MEDICATION USED FOR DIARRHEA AMONG MEDICAL STUDENTS IN TERTIARY CARE TEACHING HOSPITAL OF CENTRAL INDIA

Objective: The objective of the study is to assess the drug usage pattern, personal hygiene, and sanitation practices among day scholars and hosteller medical students. Methods: A questionnaire-based cross-sectional study was conducted at MGM Medical College and M.Y. Hospital, Indore. Undergraduate and postgraduate medical students who experienced episodes of diarrhea in the past 6 months were included in the study. Diarrhea occurring due to organic causes was excluded. Data were collected using a Google or physical form and were analyzed using descriptive statistics. Results: 254 students who suffered from diarrhea in the past 6 months participated in the study, out of which 56% were hostellers. Commonly used drugs were ofloxacin, metronidazole, etc. 50.2% of them took self-medication; the majority of them were hostellers. Students were found to eat outside at least once a week. Personal hygiene and sanitation were more compromised among hostellers than day scholars. Conclusion: Personal hygiene and sanitation practices should be improved among medical students, especially hostel students. These students, despite being from medical backgrounds, still take irrational medication. Therefore, there is a need for increased awareness regarding drug usage, and self-medication should be discouraged

PHARMACOVIGILANCE IN PRACTICE: ASSESSING ADVERSE DRUG REACTIONS IN TERTIARY CARE HOSPITAL CENTRAL INDIA

Objective: Our study aimed to evaluate the frequency, severity, and causality of ADRs reported at the ADR Monitoring Centre, Department of Pharmacology, MGM Medical College, Indore, to improve drug safety practices. Methods: A retrospective study at the ADR Monitoring Centre in Indore analyzed suspected ADR Reporting Forms from the past six months. The analysis focused on ADR frequency, severity, and causality, categorized using the World Health Organization (WHO) causality assessment scale. Results: Over six months, 502 ADR forms were reported at Maharaja Yashwant Rao Hospital, Indore, with males (25-55 years) accounting for 50% of the cases. The psychiatry department reported the most ADRs (57.5%), followed by pediatrics (12.1%) and gynecology (9.7%). Commonly implicated drug classes were antipsychotics, antibiotics, and anticonvulsants. Valproate (14%), ceftriaxone (8%), and olanzapine (6%) were frequently involved drugs. About 52.6% of ADRs were certain, and 25% were probable in causality analysis. Conclusion: Monitoring and reporting ADRs are crucial in healthcare. Raising awareness about ADR reporting among doctors and patients can promote safer drug use, reduce associated ADR-related morbidity, ease the treatment burden on patients, and enhance their quality of life