Effects of total parenteral nutrition on postnatal growth in very low birth weight and extremely low birth weight newborns

Background: Prematurity is the most important cause of mortality in Under-5 children responsible for one million deaths/ year. Premature babies are not able to store enough nutrients for their optimal survival; it is essential to provide them total parenteral nutrition. Intravenous lipid infusion in neonates is linked with high risk of sepsis and thrombocytopenia. PN with amino acids and glucose can be imparted to achieve nutritional goal. This trial was intended to assess the effects of various components of amino acid PN on postnatal growth in VLBW and ELBW newborns.Methods: A prospective observational study was conducted from January 2018 - May 2019 in NICU of TMMC and RC which included preterm newborns with birth weight of less than 1500gms who received aminoven infusion. Anthropometric measurements, incidence of hypo/hypercalcaemia, hypo/hyperglycaemia, direct hyperbilirubinemia, incidence of sepsis were evaluated.Results: Out of 22 patients, 12 neonates received high dose aminoven therapy whereas 10 neonates received low dose aminoven therapy. It was seen that rapid rate of increment of amino acids had adequate weight on discharge, 72.72% have adequate growth among the rapid group compared to 36.36% among slower group. No significant changes in calcium metabolism or glucose metabolism were seen in both the groups.Conclusions: In resource limited settings, parenteral nutrition with intravenous amino acids have a better effect on the weight of preterm newborns at discharge when high doses of amino acids infusion started early with rapid increment in the dose

Study of occurrence of childhood hypertension in school going children attending pediatrics OPD in Moradabad city

Background: In developed countries, childhood hypertension is a proven indicator of adult hypertension and organ damage and is estimated to be great concern. This study was conducted to assess the occurrence of childhood hypertension in school going children attending pediatrics OPD.Methods: An observational study was performed at TMMC and RC among 500 school going children attending pediatrics OPD in TMMC and RC over a period of 1 year. Socio-demographic variables including age, gender, family history of hypertension, parental smoking habits were recorded in a proforma. Dietary habits including consumption of junk food, fruits and daily calorie intake was evaluated utilizing number of times diet intake questionnaire and 24 hour recall method. Height was measured by stadiometer with candidate posing in bare feet. Weight assessment was done with bare footed and candidate clad in light clothing with weighing instrument of electronic type rounded to nearest unit.Results: Elevated blood pressure and hypertension was reported among 9.4% and 6.8% of the subjects respectively. High blood pressure was significantly associated with presence of family history, stress and lack daily physical activity. Chances of elevated blood pressure and hypertension increase along with the increase in subject height, weight and BMI.Conclusions: Performing the BP measurements in routine consultations becomes essential for diagnosis and early intervention

Study of correlation of gestational age estimation by new ballard score with inter mammary distance in new born

Background: It is important to recognise preterm babies as they have a different set of problems than term babies.Methods: Study was done over a period of 2 years.254 new-borns ranging in gestational age from 27 to 42 weeks were studied in MYH Hospital, Indore.Results: Intermammary distance and gestational age showed a positive correlation with a correlation coefficient of 0.9. SGA and AGA babies had correlation coefficient of 0.95 and 0.89 respectively.Conclusions: Intermammary distance of 69.60mm can be used to differentiate preterm and term babies. This simple measurement can be easily used by peripheral health workers at remote places to differentiate between term and preterm babies

Study of clinical spectrum of hyperbilirubinemia with frequency of glucose six phosphate dehydrogenase deficiency in neonates

Background: Jaundice is defined as visible reflexion of serum hyperbilirubinemia on mucous membranes and skin as yellowish discoloration. The frequency of icterus among neonates is about 1 in 2500-5000 live births. When there is disparity between the production of bilirubin, conversion from unconjugated to conjugated bilirubin and excretion of bilirubin results in jaundice. Unconjugated bilirubin is usually harmless but it can also cross blood-brain barrier causing neurotoxicity or kernicterus.Methods: A hospital based prospective observational study which is carried out in the department of paediatrics of Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh from December 2019 to November 2020 on 74 neonates who required admission for hyperbilirubinemia.Results: The most common jaundice occurred in neonates were idiopathic or breastfeeding jaundice as the neonates were breast fed (47.29%). The second most common cause was ABO incompatibility leading to jaundice in 27 (36.48%) neonates. Incidence of neonatal Sepsis, G6PD deficiency, hypothyroidism and cephalhematoma was 22.9%, 4.1%, 2.70% and 4.1% respectively. Polycythemia contributed to 1.35% and the frequency of hyperbilirubinemia in infants of diabetic mother’s or GDM was 10.8%. Rh incompatibility was seen in 13.5%.Conclusions: G6PD deficiency is a significant cause for NNHB and the cases with pathological jaundice if left untreated may lead to severe neurological deficits and lifelong disabilities, hearing impairment, mental retardation, seizures and movement disorders. Hence we recommend G6PD screening in every newborn with significant hyperbilirubinemia to reduce morbidity and mortality

The study of association of fetal and maternal factors in the occurrence of hyperbilirubinemia in early neonatal period

Background: Hyperbilirubinemia in neonates is considered to be one of the common phenomena which generally occurs during the first week of life and usually leads to NICU admission in both term and preterm new-born babies. It is also regarded as one of the most common causes which leads to neonatal morbidity and mortality.Methods: A total of 100 neonates along with their mothers were enrolled in the study from time period between 2018 to March 2019. Newborns were assessed daily for the jaundice and serum bilirubin levels were done. Various fetal-maternal factors included in proforma were. analysed to find out the association of feto-maternal factors in the occurrence of significant neonatal hyperbilirubinemia. Two groups, group A =15.7 mg/dl were taken. For data analysis chi square test is applied and p-value is calculated.Results: Statistically significant association between total serum bilirubin with neonatal factors like birth weight (p<0.014), maturity (p<0.011), period of gestation (p<0.003), and heart rate abnormality (p<0.005) and maternal factors like age in years (p<0.05), oral contraceptive pills use (p<0.005),  and anti-epileptics use (p<0.034) were found to be linked to neonatal hyperbilirubinemia.Conclusions: Neonatal jaundice should be considered as the main policy in all health care settings of the country. Therefore, identification of factors affecting the incidence of jaundice can be effective in preventing susceptible predisposing factors in new-borns and high-risk mothers

Association of Epicardial Fat with Metabolic Syndrome in Indian Population

Introduction: Visceral obesity and dyslipidemia are the two most commonly occurring components of the metabolic syndrome. Epicardial fat is a true visceral adipose tissue deposited around the heart and has characteristics of a high insulin-resistant tissue. Material and methods: The study included 66 subjects (33 cases and 33 controls). Epicardial fat thickness was measured by echocardiography on the free wall of the right ventricle from both parasternal long- and short-axis views and anthropometric and biochemical parameters were recorded. Results: Range of epicardial fat thickness varied between 0.8 to 7.3 mm. The normal cutoff value is considered to be between 1 to 4 mm. The mean epicardial fat thickness was found to be 4.3 ± 1.83 mm (mean ± standard deviation) in females and 3.5 ± 1.18 mm in males amongst the cases, and 2.4 ± 1.33 mm in females and 2.2 ± 1.02 mm in males in the control group. Epicardial fat thickness was higher in the patients with metabolic syndrome as compared to controls. There was a statistical significant correlation between epicardial adipose tissue and body mass index (BMI), fasting plasma glucose, triglycerides and homeostasis model for assessment of insulin resistance (HOMA IR). Conclusion: Our data showed that epicardial adipose tissue measured by echocardiography is related to the main anthropometric and clinical parameters of metabolic syndrome which was the objective of our study. Epicardial adipose tissue measurement could be an important tool to increase the knowledge of metabolic syndrome on epidemiological basis

Delayed Diagnosis of Hemophilia B Presenting with Hematemesis

A 36-year-old nonalcoholic gentleman presented with history of moderate-amount hematemesis. He received multiple blood transfusions. upper gastrointestinal endoscopy was done which showed no evidence of varices, but a tiny bleeding ulcer was seen in lower end of esophagus; sclerosing agent was injected at the base of ulcer. All the blood investigations were normal. A diagnosis of Dieulafoy’s lesion was made. After two months, he developed hemarthrosis after sustaining injury in right knee. Again investigations were done and coagulation profile revealed raised activated partial thromboplastin time and normal prothrombin time. Factor VIII and IX assay were sent in view of raised aPTT. Factor VIII and IX was 120% and 4% of normal respectively. Von Willebrand factor levels were within normal limits. Revised diagnosis of moderate hemophilia B was made

Systemic Variety of Anaplastic Large - Cell Lymphoma

We present a case report of a patient with very aggressive course of anaplastic large-cell lymphoma. The patient had nonspecific complaints of easy fatigability and progressive breathlessness and had generalized lymphadenopathy. Initial investigations revealed pancytopenia. Bone marrow examination revealed presence of atypical cells. Liver biopsy showed portal tracts infiltrated by atypical lymphoid cells. Fine-needle aspiration of the lymph node finally confirmed anaplastic large-cell lymphoma. Patient succumbed to the illness

Effect of phototherapy on serum calcium levels in neonates receiving phototherapy for neonatal jaundice

Background: To study the occurrence of hypocalcaemia in neonates with physiological unconjugated hyperbilirubinemia after 48 hours of phototherapy or at the end of phototherapy, in case duration of phototherapy was less than 48 hours.Methods: This prospective study was conducted on 100 term neonates (61 males and 39 females) admitted to Neonatal intensive care unit of Teerthankar Mahaveer Medical College, Moradabad with unconjugated hyperbilirubinemia and requiring phototherapy. Total Serum bilirubin levels and serum calcium levels were checked before and after phototherapy. Neonates were assessed for clinical features of hypocalcemia i.e. jitteriness, irritability/excitability, lethargy and convulsions.Results: After phototherapy, there was hypocalcemia in 35.0% neonates. The difference between pre and post phototherapy serum calcium levels were found to be statistically significant (p <0.001). 2.86% of neonates developed jitteriness among those who had hypocalcemia. Hypocalcemia was more in subjects who received phototherapy for longer duration.Conclusions: Hypocalcaemia is a common complication of phototherapy. Therefore, calcium supplementation should be done in all neonates undergoing phototherapy

A clinical trial of treatment of uncomplicated typhoid fever: efficacy of ceftriaxone-azithromycin combination

Background: Typhoid fever is a systemic infection caused by Gram-negative bacterium Salmonella enterica serovar typhi (S. typhi). It is a major health problem in India. It carries significant morbidity and mortality. Antimicrobial therapy is critical for the management of typhoid fever. Emergence of multidrug-resistant (MDR) and nalidixic acid-resistant (NAR) strains of S. typhi has complicated therapy by limiting treatment options. Hence, this study was conducted to evaluate the efficacy and safety profile of ceftriaxone and azithromycin combination therapy in uncomplicated typhoid fever.Methods: Adults patients of blood culture proven uncomplicated typhoid fever admitted in the medicine ward of Teerthanker Mahaveer Medical College and Research Centre were treated with ceftriaxone intravenously (2 g daily for 14 days) and azithromycin orally (500 mg daily for 7 days). Patients were clinically and bacteriologically evaluated during the study period and follow-up.Results: 96% cure rate was observed. No relapse was recorded.Conclusion: Ceftriaxone-azithromycin combination may be considered as an empirical therapy for treatment of uncomplicated typhoid fever in view of the emergence of MDR and NAR strains of S. typhi