Clinical characteristics and associated factors of cerebral palsy in pediatric population: a tertiary care centre clinicoepidemiological study

Background: Although, a highly prevalent disease, the etiology of cerebral palsy is still poorly understood thereby eluding a definitive prevention strategy. Our study aimed to evaluate the etiological, clinical and prognostic factors associated with cerebral palsy in children of western Rajasthan. Methods: All cases of non-progressive neurological disorder in the age group of 6 months to 14 years were enrolled in the present study. Detailed assessment, CNS examination and related neuroimaging were performed. Statistical analysis was done by standard statistical methods. Results: Maximum number of patients in current study were in the age group of 1-3 years. In our study according to sex, 40 (66.67%) were males and 20 (33.33) were females. Most of the patient in the present study were spastic quadriplegic type (40%) followed by spastic diplegia in 20% cases. As per gross motor function classification system (GMFCS) grading, maximum number of cases were 16 (26.67%) from grade 4. The most common sequelae in cerebral palsy were speech delay in 49 (81.66%) patients. Cortical atrophy was the most commonly (71.73%) seen abnormality on neuroimaging with CT-scan. Conclusions: Cerebral palsy is a non-progressive CNS disorder which has a major physical as well as psychological effects on the children as well as their families. The present study highlights the importance of understanding epidemiological and etiological aspects of the disease in Indian scenario

Cesarean scar pregnancy: scope for hysteroscopy

Scar ectopic pregnancy also known as cesarean scar pregnancy is a rare form of an extrauterine pregnancy. The blastocyst is implanted at the site of the previous cesarean scar. Most patients remain asymptomatic and are detected on routine ultrasonography imaging. The diagnosis and management of this condition is hence challenging and difficult. A timely ultrasonography in the early weeks of gestation is the key to preventing catastrophic events like uterine perforation and excessive hemorrhage. There is a wide armamentarium of treatment modalities to choose from, however each case must be individualised. Medical management has its own limitations and often patients are required to have a long-term follow-up. We present a case of a cesarean scar pregnancy managed conservatively with systemic methotrexate but subsequently requiring surgical intervention done successfully via hysteroscopy. A repeat ultrasonography done a fortnight later revealed no retained products of conception

Impact of COVID-19 pandemic on the utilization of ART Centre Services of a teaching hospital

Background- COVID-19 pandemic has had a huge impact on the collateral health system. It made access to essential health services difficult. Such an essential service is a service provided to HIV patients. This study was planned to assess the effect of the current COVID-19 pandemic on Anti-Retroviral therapy (ART) center services. Methods -Pre-recorded epidemiological data from an ART center of a teaching hospital was used to answer the research question. Data was collected for retrieving 4 parameters i.e. number of registrations, number of HIV-positive patients kept on ART, number of deaths, and loss to follow up of the COVID-19 year and non-COVID-19 year then comparison was made between both. Data analysis was done with the help of SPSS. Independent t-test, one-way ANOVA test, and multiple comparison Tuckey’s test were applied. Results- Statistically significant difference was noted in the total number of registrations, the number of patients kept on ART, death, and loss to follow-up in non- COVID-19 & COVID-19 years.  After appling above mentioned statistical test the p-value came out to be <0.05. Conclusion-COVID-19 pandemic has adversely affected the auxiliary non-COVID-19 health services and health programs. The current study gives evidence that ART functioning is negatively affected by the COVID-19 pandemic

Prescribing pattern of drugs in sick newborn care unit in a tertiary care hospital, Haldwani, Uttarakhand, India

Background: Sick Newborn Care Unit (SNCU) is meant to reduce the case fatality among sick newborns. Although it has been shown that patterns of drug utilization in SNCU are changing dynamically, current data on drug utilization patterns in SNCU is limited. This study was done to find out drug utilization pattern in newborn admitted at SNCU.Methods: This prospective observational drug utilization study was carried out in SNCU of Government Medical College and Hospital, Haldwani (Uttrakhand). The pattern of drug use in 206 sick newborn admitted at SNCU was assessed.Results: 75.25% sick newborns were in early neonatal period and 63.11% sick newborns were male. 33.98% sick newborn were preterm and mean±SD of weight of sick newborn was 2.16±0.6kg. Neonatal sepsis was commonest reason for admission followed by birth asphyxia . Three or more drugs (average 2.35drug/ Range 3-9 drug) were given to 52.91% new born and two drugs were given to 40.78% new born. Commonest route of drug administration was intravenous (97.08%), followed by intramuscular (72.82%), followed by orally (13.59%) and 11.65% new born received drug by inhalation. Most frequently used drugs in SNCU were antibiotics (Ampicillin, Gentamicin, Amikacin, Cefotaxime). Only two adverse drug reactions (mild rash by ampicillin and fever) were reported during study period. Out of 206 sick newborn, 18.93% died. Most common causes for death were respiratory distress syndrome (41.03%) followed by sepsis (23.08%) and hypoxic ischemic encephalopathy (17.95%).Conclusions: Antibiotics were of major concern in SNCU. The uncertainty regarding the choice of antibiotic can be minimized by periodic survey of etiological agent and their antibiotic susceptibility pattern

Role of bundled intervention in reducing surgical site infection rate in gynecologic surgeries

Background: Surgical site infection (SSI) is most common nosocomial infection (15%) among surgical patient’s and contributes significantly to morbidity and mortality. CDC (2015) provides “bundled intervention for prevention of SSI. The present study was planned to evaluate the feasibility and usefulness of these bundled intervention in reducing SSI in our setup. Objectives of this study to study the effect of bundled interventions on SSI in gynaecologic surgery.Methods: A total 50 cases  undergoing gynecological surgery in elective OT included in pilot group and bundled intervention followed  these pilot group cases compared with 50 control group operated in same OT in which bundled intervention not followed outcome measures recorded were Incidence of SSI, type of SSI, need for antibiotic usage, need for secondary suturing, duration of hospital stay.Results: Out of 50 subjects in pilot group, five developed signs and symptoms of SSI giving an SSI rate of 10%. Out of those five, two had superficial SSI and three had deep SSI, none of the patient had organ space SSI.SSI rate in 50 cases operated in the same operating room during the same time period without use of bundled interventions (control group) was 12%.Conclusions: Bundled approach is easy and feasible in all setups. It adds only three extra minutes to the total duration of the surgery with risk reduction of SSI

Injectable Opioid use: An insight into the problem

Background: The present study characterizes the socio-demographic variables of injection drug users (IDUs) attending Oral substitution therapy (OST) center. Aims & Objectives: To provide a comprehensive knowledge and better insight regarding the socio-demographic profile and pattern IDUs. Material & Methods: A total of 158 IDUs aged 18 to 60 years who attended the OST centre during one-year period at a government medical college are included in the study. Results: All the IDUs are male with median age of 33.13 years. More than half of the participants are homeless and earn their livelihood by rag picking and rickshaw driving. 35.4% of participants are married. Their mean monthly income is Rs 2823.4 ± 1811.8 and they spend a major amount of it on drug use. Conclusion: All the participants are using Pharmaceutical Opioid injections (POI), mostly as cocktail with benzodiazepines and antihistamines. Sharing of needle and paraphernalia is present in most of the participants especially among the illiterate and low income group IDUs

Carotid Intima Media Thickness as a Marker of Atherosclerosis in Ankylosing Spondylitis

Aim. Increased cardiovascular morbidity and mortality have been observed in ankylosing spondylitis because of accelerated atherosclerosis. We measured carotid intima media thickness (CIMT) as a surrogate marker of atherosclerosis in this study. Methods. In this study 37 cases of AS and the same number of matched individuals were recruited. CIMT measurements were done using B-mode ultrasound. Disease activity was assessed using Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrological index (BASMI) scores and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. Results. Mean age of the study groups was 29.43 ± 9.00 years. Average disease duration was 65.62 ± 54.92 months. Twenty-eight (75.68%) of cases were HLA B-27 positive. A significantly increased CIMT was observed in cases as compared to control group (0.62 ± 0.12 versus 0.54 ± 0.04; P<0.001). CIMT in the cases group positively correlated with age (r=0.357; P<0.05), duration of disease (r=0.549; P<0.01), and BASMI (r=0.337; P<0.05) and negatively correlated with ESR (r=−0.295; P<0.05). Conclusions. Patients of AS had a higher CIMT than those of the control group. CIMT correlated with disease chronicity

Nanostructured anatase-titanium dioxide based platform for application to microfluidics cholesterol biosensor

We report results of studies relating to the fabrication of a microfluidics cholesterol sensor based on nanocrystalline anatase-titanium dioxide (ant-TiO 2) film deposited onto indium tin oxide (ITO) glass. The results of response studies (optimized under the flow rate of 30 μl/min) conducted on cholesterol oxidase (ChOx) immobilized onto crystalline ant-TiO 2 nanoparticles (∼27 nm)/ITO microfluidics electrode reveal linearity as 1.3 to 10.3 mM and improved sensitivity of 94.65 μA/mM/cm 2. The observed low value of K m (0.14 mM) indicates high affinity of ChOx to cholesterol. No significant changes in current response of this microfluidics sensor are measured in the presence of different interferent

Clinical Profile of Dengue Infection in Patients with Hematological Diseases

Managing hematological disorders in a tropical country presents several unique diagnostic and management problems. Apart from the disease process, we need to be aware of infections that can exacerbate or mimic serious hematological problems. We present here a series of five patients with pre-existing hematological diseases who were infected by dengue virus. These cases highlight the need to keep a strong suspicion of common endemic diseases in tropical countries before considering extensive workup for the basic hematological disease. There was no mortality and all patients recovered without any significant impact on their pre-existing hematological condition inspite of their low baseline blood counts. There was no excessive bleeding, prolonged stay in the hospital or relapse of underlying hematological disease in these patients and the only major concern was the increased anxiety among both the patient and treating physician regarding the relapse/progression of pre-existing hematological disease