Maternal anaemia and its severity: an independent risk factor for preterm delivery and adverse neonatal outcome

Background: This study was done to evaluate the effect of maternal anaemia and its severity on gestational age and neonatal outcome.Methods: This was a retrospective study, conducted in Vardhman Mahavir medical college and Safdarjang hospital, New Delhi between April 2012 to March 2013. Cases were divided in three groups i.e. non anaemic, mild to moderately anaemic and severely anaemic (according to WHO classification). A total of 1050 woman (350 in each group) were recruited for study. The following outcome measures were used: preterm delivery (<37 weeks), birth weight, APGAR score, admission of baby in neonatal intensive care unit and early neonatal death. Data was analyzed by Chi-square test. A P value of or less than 0.05 was considered as significant.Results: The risk of preterm delivery, low birth weight, poor APGAR score and admission of baby in neonatal intensive care unit was more in anaemic group and it increased with severity of anaemia which was statistically significant. The increase in risk of early neonatal death was not significant in mild/moderate anaemic group (P value 0.326) while it was statistically significant in severely anaemic group (P value 0.004).Conclusions: Anaemia in pregnancy has a recognizable association with prematurity, low birth weight and poor neonatal outcome.

Skill up; gradation of anganwadi workers pertaining to growth chart plotting and interpretation in rural areas of Varanasi district, India

Background: The task of using the growth chart by Anganwadi Workers (AWWs) for growth monitoring requires technical skill. It was hypothesized that skill up-gradation can make a difference in the performance of AWWs in regard with growth monitoring. The aim of the study was to evaluate the effect of intervention in improving skill of AWWs regarding growth chart plotting and interpretation.Methods: It was a field based interventional study, which was conducted in rural areas of Varanasi district, India. A total of 66 AWWs each from Chiraigaon (intervention) and Cholapur (control) community development blocks of Varanasi district was selected for the study. Each AWW was provided 3 weight readings of different ages for plotting and 4 filled growth charts for interpretation. Chi square test has been applied to assess the significant difference.Results: Only around 10% of AWWs could correctly plot all 3 growth charts and similar proportion of AWWs could also correctly interpret all 4 filled growth charts. The planned intervention could significantly improve their skill of growth chart plotting and interpretation and during end line survey 41% and 77% of AWWs could correctly plot all 3 growth charts and interpret all the four growth charts, respectively.Conclusions: The developed hypothesis is proved, and intervention was found effective in significantly improving the skills of AWWs in regard with growth monitoring

Health-care-associated infection in a pediatric intensive care unit

Introduction: Health-care-associated infection (HAI) is a major cause of concern in pediatric intensive care units (PICUs) all over&nbsp;the world and represents an important cause of mortality and financial burden for health-care systems. Objective: The objective&nbsp;of this study was to describe the epidemiologic profile of children with HAI. Methods: This was a prospective surveillance study&nbsp;conducted in a pediatric intensive care unit of a tertiary care hospital, India. Children, admitted to PICU between December 1, 2015,&nbsp;and November 30, 2016, were monitored for the development of bloodstream infection (BSI), ventilator-associated pneumonia, andurinary tract infection. Results: A total of 430 patients were admitted during the study period. Of 250 eligible patients, 15 children(6%) developed 19 episodes of HAI with patient prevalence of six infections per 100 patients. Only Gram-negative bacteria were&nbsp;identified, Klebsiella pneumoniae was the most common organism (68.42%). Bloodstream was the most common site of HAI&nbsp;(n=11, 58%) followed by respiratory tract (n=6, 32%) and urinary tract (n=2, 10%). In a univariate analysis, survivors of cardiac&nbsp;arrest or trauma, malnourished children had an increased risk of acquiring HAI. The presence of lymphopenia (≤1000/mm3),&nbsp;hypercarbia (Pco2 &gt;65 mmHg), sodium imbalance (&lt;130 meq/L or &gt;150 meq/L), organ dysfunctions, and length of stay before&nbsp;acquiring infection was all associated with an increased risk of developing HAI (p&lt;0.05). Conclusions: BSI is the most common&nbsp;HAI and only Gram-negative organisms were identified in our unit

Mechanism of Wound-Healing Activity of Hippophae rhamnoides L. Leaf Extract in Experimental Burns

The present investigation was undertaken to evaluate the healing efficacy of lyophilized aqueous leaf extract of Sea buckthorn (Hippophae rhamnoides L., family Elaeagnaceae) (SBT) and to explore its possible mechanism of action on experimental burn wounds in rats. The SBT extract, at various concentrations, was applied topically, twice daily for 7 days. Treatment with silver sulfadiazine (SSD) ointment was used as reference control. The most effective concentration of the extract was found to be 5.0% (w/w) for burn wound healing and this was further used for detailed study. The SBT-treated group showed faster reduction in wound area in comparison with control and SSD-treated groups. The topical application of SBT increased collagen synthesis and stabilization at the wound site, as evidenced by increase in hydroxyproline, hexosamine levels and up-regulated expression of collagen type-III. The histological examinations and matrix metalloproteinases (MMP-2 and -9) expression also confirmed the healing efficacy of SBT leaf extract. Furthermore, there was significant increase in levels of endogenous enzymatic and non-enzymatic antioxidants and decrease in lipid peroxide levels in SBT-treated burn wound granulation tissue. The SBT also promoted angiogenesis as evidenced by an in vitro chick chorioallantoic membrane model and in vivo up-regulated vascular endothelial growth factor (VEGF) expression. The SBT leaf extract had no cytotoxic effect on BHK-21 cell line. In conclusion, SBT aqueous leaf extract possesses significant healing potential in burn wounds and has a positive influence on the different phases of wound repair

Effect of triple drug antiretroviral therapy on CD4+ count in pregnant women with HIV and prevention of parent to child transmission

Background: India has moved from single drug Antiretroviral Therapy (ART) in 2002 to triple drug ART in 2013 to prevent parent to child transmission of HIV. The aim of the study was to know the effects of triple drug ART on maternal CD4+ count and prevention of HIV transmission to baby along with its adherence, side effects and pregnancy outcome.Methods: A prospective study wsas done in Safdarjung Hospital, New Delhi on 40 HIV positive pregnant women who received single dose combination of triple drug ART. CD4+ count, LFT and KFT were done before beginning of ART and repeated after 6 months of ART. The infants received nevirapine prophylaxis and HIV status was determined by DBS PCR at 6 weeks.Results: The median CD4+ count was 317 and 397 pre and post ART for 6 months respectively (p value<0.001. Low birth weight (LBW) was seen in 43.59% which was statistically significant but confounded as 76.4% of these babies were preterm. 23.08% of babies had an APGAR of < 7 at 1 minute, out of which 77.7% were preterm. Nine out of 39 infants (one had abortion) needed NICU admission. Only one baby (2.56%) was HIV positive who died at 4 months of age due to pneumonia. There was no defaulter and no statistically significant changes in LFT and KFT after 6 months of ART.Conclusions: Triple drug ART offers greater convenience improves fetomaternal outcome and minimize the risk of HIV transmission from mother to child

Association of polymorphisms in pulmonary surfactant protein A1 and A2 genes with high-altitude pulmonary edema

Study objectives: A potential pathogenetic cofactor for the development of high-altitude pulmonary edema (HAPE) is an increase in capillary permeability, which could occur as a result of an inflammatory reaction and/or free-radical-mediated injury to the lung. Pulmonary surfactant protein A (SP-A), the most abundant surfactant protein, has potent antioxidant properties and protects unsaturated phospholipids and growing cells from oxidative injury. Single-nucleotide polymorphisms (SNPs) in SP-A1 and SP-A2, genes encoding SP-A, have been associated with susceptibility to respiratory distress syndrome, COPD, and pulmonary infections. In view of the protective role of SP-A against inflammatory reactions and oxidative damage, the two underlying mechanisms in development of HAPE, we examined the association of constitutional susceptibility to HAPE with polymorphisms in SP-A1 and SP-A2. Design: A cross-sectional case-control study. Setting: Blood samples were collected at an altitude (&#8805; 3,500 m). Participants: Twelve low-altitude native (LAN) subjects with a history of HAPE, 15 healthy LAN sojourners without a history of HAPE (LAN control subjects), and 19 healthy high-altitude natives (HANs) without a history of HAPE (HAN control subjects). Measurements: The SNPs in four exons and intermediate introns of the SP-A1 and SP-A2 were screened by polymerase chain reaction and sequencing. Biochemical parameters related to oxidative stress (malondialdehyde and reduced glutathione in RBC) and membrane permeability (circulating levels of lactate dehydrogenase) were measured in plasma. Results: Allele frequencies of three loci in SP-A1 and one in SP-A2 were significantly different between LAN HAPE patients (SP-A1 C1101T: C allele, 36.4% and T allele, 63.6%; SP-A1 T3192C: T allele, 61.1% and C allele, 38.9%; SP-A1 T3234C: T allele, 61.1% and C allele, 38.9%; and SP-A2 A3265C: A allele, 21.4% and C allele, 78.6%) and LAN control subjects (SP-A1 C1101T: C allele, 8.3% and T allele, 91.7%; SP-A1 T3192C: T allele, 15% and C allele, 85%; SP-A1 T3234C: T allele, 15% and C allele, 85%; and SP-A2 A3265C: A allele, 37.5% and C allele, 62.5%) [C1101T odds ratio [OR], 6.3 with 95% confidence interval (CI), 2.8 to 14.3; T3192C OR, 8.9 with 95% CI, 4.5 to 17.6; T3234C OR, 8.9 with 95% CI, 4.5 to 17.6; and A3265C OR, 2.2 with 95% CI, 1.2 to 4.1 (p &#8804; 0.01)]. Heterozygous individuals, with respect to SP-A1 C1101T and SP-A2 A3265C, showed less severity in oxidative damage in comparison with homozygous subjects (SP-A1 T1101 and SP-A2 C3265). Conclusion: The polymorphisms in SP-A1 (C1101T, T3192C, and T3234C) and SP-A2 (A3265C) might be one of the genetic factors contributing to susceptibility to HAPE

Predictors of candidemia in pediatric patients (0–12 years) admitted in a tertiary care hospital of Northern India

Background: Bloodstream infections due to Candida species are becoming a major cause of morbidity and mortality in hospitalized patients. The emergence of non-albicans Candida (NACs) species with lesser susceptibility to antifungals has added to the woes of clinicians. Objectives: The objectives of the study were to determine the clinical and laboratory predictors and microbiological profile of candidemia in pediatric patients. Materials and Methods: This is a hospital-based, prospective, and cross-sectional study conducted in the pediatric department of a tertiary care hospital. A total of 250 children aged 0–12 years with risk factors for fungal sepsis were enrolled. Demographic details, clinical, and laboratory parameters were noted and samples were sent for culture. Cultures yielding growth of Candida were included in the study, and antifungal susceptibility performed. Associations were assessed using Chi-square test first and then through logistic regression models. Results: Among the 250 patients with risk factors for fungal sepsis, 47 patients (18.8%) with culture proven candidemia were identified. Predictors of candidemia among neonates were prematurity (&lt;30 weeks), prolonged ventilation (&gt;72 h), and thrombocytopenia. Among pediatric patients, prolonged steroid intake, Candida isolation from sites other than blood and persistent neutropenia, were significantly associated with the candidemia. NAC species were the predominant isolates (78.7%). Conclusion: Candidemia should be suspected in premature neonates requiring prolonged ventilation with unexplained thrombocytopenia. Among pediatric patients, prolonged steroid intake, Candida isolation from sites other than blood and persistent neutropenia are predictors of candidemia

Demographic and clinical profile of brought in dead cases to pediatric emergency department of a tertiary care hospital

Background: The incidence of brought in dead (BID) is high in tertiary hospitals, but there is a lack of proper audit and relevant data of these cases. Objective: The current study aimed to assess the demographic characteristics and clinical profile of BID patients presenting in emergency department (ED) of a tertiary hospital. Materials and Methods: This was a retrospective observational study. All children between 0 and 12 years who were BID at the pediatric ED in a tertiary hospital between February 2018 and December 2018 were included. Data were collected on demography, history of illness, treatment seeking history, and details about transport to the hospital. Microsoft Excel was used for analysis. Results: A total of 64 BID cases were included in the study, of which 39% cases belonged to the neonatal age group. Most of the referrals were from government hospitals. Of total neonatal deaths, 44% were preterm babies; 52% of neonates had a previous history of hospitalization. Among previously hospitalized cases, 56% were discharged and 22% took their child against medical advices. Conclusion: It is crucial that the government reinforces the measures to avoid the existence of clandestine health centers. Improving referralcounter-referral system will permit the limitation of fatal medical errors. This study expects to bring the focus on BID so that future studies explore the possible strategies to contain this problem