A study of neonatal hyperbilirubinemia from a tertiary care hospital in Northern India

Objective: The objective of this study was to analyze the incidence of pathological jaundice, average time of presentation, mean duration of phototherapy, and need for exchange transfusion with appropriate medical management. Methods: Thus, retrospective study was conducted at neonatal intensive care unit of a tertiary care hospital from August 2017 to August 2018. All live births who were diagnosed with neonatal hyperbilirubinemia and requiring treatment were included in the study. Exclusion criteria included any baby with conjugated serum bilirubin >20% of total serum bilirubin or >2 mg/dl or neonate with any congenital malformation. Results: Nearly 5% of total babies delivered developed neonatal jaundice requiring treatment. The most common causes isolated were ABO incompatibility followed by Rh incompatibility. Almost 46% of babies were not found to have any cause. The most likely etiology concluded in this group was breastfeeding jaundice. Conclusion: Breastfeeding jaundice should be considered as one of the common causes of pathological jaundice making lactational counseling during antenatal and postnatal period an essential component of management and prevention of pathological jaundice. Early detection and timely intervention with lesser invasive treatment modalities such as intravenous immunoglobulin G, hydration, and phototherapy should be attempted aggressively to avoid need for high-risk procedures like exchange transfusion

Perceived Barriers to Adherence to Standard Precautions among Healthcare Personnel Working in a Teaching Hospital of Palpa District, Nepal

Introduction: The present study aimed to find out the perceived barriers to adherence to standard precautions among healthcare personnel working in a teaching hospital of Palpa district. Methods: A descriptive cross-sectional study was conducted among 191 healthcare personnel in April 2019. Barriers to standard precautions adherence were evaluated using ‘Factors Influencing Adherence to Standard Precautions Scale’. Mann Whitney U test and Kruskal Wallis H test were applied to examine the association of selected demographic variables: age, educational background, duration of employment, working areas and having attended trainings related to standard precautions with the perceived barriers to standard precautions adherence. Results: The mean age of participants was 24.87±6.05 years. Most (85.3%) of participants were nurses.  19.9% and 52.4% of participants always performed hand hygiene before and after using personal protective equipment respectively. The subscale scores in leadership and culture of the institute were 14.86±4.21 (possible range 0-24) and 14.59±2.60 (possible range 0-20) respectively. Subscale scores in judgement and contextual cues were 17.49±3.46 (possible range 0-20) and 18.02±5 (possible range 0-24) respectively. Score in justification was 7.52±5.12 (possible range 0-28). Age, educational background and duration of employment had a statistically significant association with subscale scores on justification and perceived culture of the institution. Conclusion: The present study revealed that only 19.9% of the participants would perform hand hygiene before using gloves and 52.4% of participants would do it afterwards. Personal judgement, dependence on contextual cues and inadequate leadership skills were found to be the major barriers to adherence to standard precautions

Comparative study between Blair’s procedure of ankle fusion and arthroscopic ankle arthrodesis

Background: Our objective was to perform a comparative study in terms of functional outcome of Blair’s procedure of ankle fusion versus arthroscopic methods of ankle fusion.Methods: 25 patients that underwent arthroscopic ankle arthrodesis versus Blair’s procedure of ankle fusion were taken for study at government medical college, Srinagar (VCSGGIMS and R) from the duration 2015-2021. Clinical assessment was done foot and ankle disability index and visual analog scale score for pain. Radiological assessment was done by serial X-rays. Regular follow-ups were taken till one year.Results: Both modalities proved to be equally effective in terms of patient’s functional outcome. Our analysis showed that Blair’s procedure ankle fusion was associated with a lower fusion rate (OR 0.26, 95% CI 0.13-0.52, p=0.0002), longer tourniquet time (MD 16.49, 95% CI 9.46-23.41, p<0.00001), and longer length of stay (MD 1.60,95% CI 1.10-2.10, p<0.00001) compared to arthroscopic ankle fusion; however, there was no significant difference between two groups in terms of infection rate (OR 2.41, 95% CI 0.76-7.64, p=0.14), overall complication rate (OR: 1.54, 95% CI 0.80-2.96, p=0.20), and operation time (MD 4.09, 95% CI 2.4910.66, p=0.22).Conclusions: We found no significant difference between two groups in terms of infection rate, overall complication rate, and operation time. Further high quality randomized controlled trials that are adequately powered are required

Perception of Educational Environment among Nursing Students of Different Colleges: A Cross- Sectional Study

Introduction: Learners are key figures for whom the provision and perception of positive, progressive and encouraging interactive educational environment at any educational institution is very crucial. The study aimed to find the perception of nursing students of two different medical colleges regarding their educational environment. Methods: A cross-sectional descriptive study was conducted among 190 students through the use of internationally validated, non-culturally specific questionnaire. The responses were made on five points Likert scale scored from 0 to 4. The overall score was interpreted as very poor, plenty of problems, more positive than negative and excellent based on obtained score of 0-50, 51-100, 101-150 and 151-200 respectively. Descriptive statistics and one way analysis of variance test was used to analyze the collected data. Results: There were 98 (51.6%) participants from College of Medical Sciences and 92 (48.4%) from Lumbini Medical College and Teaching Hospital. The overall score of perception of educational environment were 142.13±14.90 (74.64%) and 144.34±15.59 (76.14%) in the two centers respectively which means more positive than negative perceptions. Only nature of accommodation was found statistically significant with students’ perception of teachers (p = 0.014). Conclusion: Majority opined a more positive than negative perception towards educational environment. Good communication skills of teachers, knowledgeable teachers, teaching to develop their competence level were some positive perceptions. Whereas, teachers being authoritarian, focus on short term and factual learning, lack of support system were the areas which could be improved

Awareness and Pattern of Tobacco Use among the Medical Students of Government Medical College

Introduction: Nearly 6 million people die due to tobacco every year and this figure will increase to 8 million tobacco-attributed deaths per year by 2030 with 80% of them occurring in developing countries. Objective: To study the awareness and pattern of tobacco use among the undergraduate medical students of Government Medical College, Haldwani. Material and Methods: A Cross-sectional study was conducted among 303 medical students using a predesigned and pretested, semi-structured self-administered anonymous questionnaire. Data was analyzed by using SPSS v 16. Results: Among 303 participants, 44(14.5%) were smokers.  Majority of the students (97.73%) were more than 20 years of age at the time of initiation of tobacco use. Cigarette smoking was most common form (79.55%) of abuse. Male students were using tobacco significantly higher than that of females (?2=36.68). The effect of parental tobacco use on tobacco consumption habits of the users were significantly higher than non-tobacco users (?2=180.75). The tobacco consumption was significantly increased among the senior students as compared to that among the juniors (?2=15.29). Awareness about harmful effects of tobacco abuse was very high (90.76%) and mainly they got knowledge from media. 84.16% students support ban on tobacco use in public places. Conclusion: We can conclude that though the awareness among medical students regarding harmful effects of tobacco use was very high but they got this knowledge mainly from the electronic media, so it is necessary to introduce teaching on tobacco dependence and cessation early in the courses of the medical colleges

Evaluation of different paddy straw management technologies for their economic viability in rice-wheat system

The study examines the economics of different paddy straw management methods in rice-wheat systems in Gurdaspur, Punjab during the Rabi seasons (2019-20 and 2020-21). The experiment was carried out with 2 wheat varieties, HD 3086 (V1) and PBW 550 (V2), using varied treatment combinations of crop residue management approaches, tillage and seed drilling methods. Based on the pooled data, the PAU (Punjab Agricultural University) cutter cum spreader + incorporation with Mould Board plough + Use of Seed drill (M4) treatment produced the highest plant height (95.87 cm). Treatment PAU cutter cum spreader + PAU happy seeder with press wheel (M2) (437.71) had the highest density of tillers per square meter, significantly outperforming other treatments. A significant interaction was observed between paddy residue management methods and varieties in terms of the number of tillers. Maximum spike length (12.81 cm) was obtained with Stubble Shaver + Burning + Zero Tillage Drill (M1), whereas maximum number of spikelets per spike (18.33) was noted in method (M2). The treatment method (M2) turned out to be the most efficient in terms of yield (44.02 q/ha) and benefit cost ratio (1.72)

Wada serca typu criss-cross heart połączona z zespołem Taussig-Binga — dwie rzadkie anomalie u jednego pacjenta

Criss-cross heart is an extremely rare anomaly, characterized by an abnormal rotation of the ventricular mass along its major axis that is the apical part twists about t heir long axes while the base of the heart and the atrio-ventricular (AV) valves remains fi xed. Due to the complex structural changes and rarity of the anomaly, the rotation of ventricular axis is often misdiagnosed. Though associated with multitudes of ventriculo-arterial discordances; we report an extremely rare case of criss-cross heart presented in late infancy associated with Taussig-Bing anomaly which has never been reported earlier in the literature to the best of our knowledge.Wada serca typu criss-cross heart jest bardzo rzadką anomalią polegającą na nieprawidłowej rotacji komór wokół długiej osi serca, przy czym przemieszczeniu ulega koniuszek serca, a podstawa serca i zastawki przedsionkowo-komorowe pozostają na miejscu. Ze względu na złożone zmiany strukturalne oraz rzadkie występowanie tej wady rotacja osi serca często nie zostaje właściwie rozpoznana. Anomalia ta wiąże się z wieloma zaburzeniami przedsionkowo-komorowymi. W niniejszej pracy przedstawiono niezwykle rzadki przypadek wady serca typu criss-cross heart ujawnionej w późnym okresie niemowlęcym, połączonej z zespołem Taussig-Binga. Według najlepszej wiedzy autorów taki przypadek nigdy wcześniej nie był opisywany

Ostry zespół wieńcowy u 16-letniego chłopca — opis przypadku

Spontaneous coronary artery dissection is a rare but important cause of acute coronary syndromes in young patients.16-year-old boy presented as acute anterior wall myocardial infarction for which he was thrombolysed. Coronary angiogramshowed spiral luminal filling defects, with extensive contrast staining of proximal left anterior descending arteryand its branches. The patient refused angioplasty, which was advised, and was managed conservatively. Three weekslater he presented with acute coronary syndrome with unstable angina. Repeated angiogram showed complete healingof dissection. The hospital course of the patient was uncomplicated. This shows, that sometimes higher grade dissectionbeside intervention, can respond to conservative management as well.Samoistne rozwarstwienie tętnicy wieńcowej jest rzadką, lecz ważną, przyczyną ostrych zespołów wieńcowych u młodych pacjentów. W niniejszej pracy przedstawiono przypadek 16-letniego chłopca, u którego wystąpił ostry zawał ściany przedniej. Zastosowano leczenie trombolityczne. W koronarografii stwierdzono ubytki wypełnienia w kształcie spiralnym z silnym zakontrastowaniem proksymalnego odcinka gałęzi międzykomorowej przedniej i jej gałęzi. Zalecono wykonanie angioplastyki wieńcowej, jednak chory nie wyraził zgody na zabieg i w związku z tym zastosowano leczenie zachowawcze. Po 3 tygodniach u pacjenta wystąpił ostry zespół wieńcowy w postaci niestabilnej dławicy piersiowej. W wykonanym powtórnie angiogramie stwierdzono całkowite wygojenie rozwarstwienia. Hospitalizacja chorego przebiegała bez powikłań. Opisany przypadek pokazuje, że w niektórych rozwarstwieniach znacznego stopnia można uzyskać dobrą odpowiedź na leczenie zachowawcze bez zabiegów interwencyjnych

Dynamic Communication in Emergency Response: A Data-Driven Evaluation with the Emergency Communication Test

This research provides a data-driven assessment of dynamic communication in emergency response, highlighting important findings supported by actual data. In comparison to police officers in law enforcement situations, EMTs responded to medical crises 25% quicker, according to the response time research. When it came to communication accuracy, firemen performed at a 96% accuracy rate during fire situations, compared to a 91% accuracy rate in law enforcement circumstances. When compared to law enforcement situations, there was a 3% improvement in the completeness of information shared in fire incidents. Additionally, compared to accident situations, police officers' communication efficacy in law enforcement occurrences was 2.3% greater. These results highlight how crucial customized communication plans, data-driven insights, and technology and training integration are to maximizing dynamic communication in emergency response systems

Successful transcatheter closure of very large ruptured sinus of Valsalva aneurysm

Sinus of Valsalva aneurysm, usually a congenital anomaly, almost always ruptures into the right side of the heart causing a left-to-right shunt with profound hemodynamic consequences. With the availability of devices and hardware, transcatheter closure is gradually replacing surgical one. Till now, most of closures have been performed by Amplatzer duct occluder. To the best of our knowledge, the present case is first to be reported with this rare defect undergoing successful transcatheter closure of largest ruptured sinus of Valsalva aneurysm arising from right coronary sinus by using 20/18 mm Cocoon Duct Occluder (Vascular Innovations, Nonthaburi, Thailand)