A prospective study to evaluate influence of maternal, obstetric and fetal risk factors on the outcome of asphyxiated neonates born intramurally and extramurally

Background: The present study was planned to determine the influence of maternal, obstetric and fetal risk factors on the outcome of intramurally (born at a tertiary care centre) and extramurally (born at a peripheral centre, home or a private facility) born asphyxiated neonates.Methods: It was an observational clinical research with a prospective design and was conducted in Neonatal Intensive Care Unit (NICU), Paediatric Neurology Clinic attached to Department of Paediatrics and Department of Obstetrics and Gynecology, Dr S N Medical College Jodhpur, Rajasthan. A total of 160 asphyxiated neonates (80 intramural and 80 extramural) were included in the study. A detailed antenatal and perinatal history with obstetrical interventions were recorded. The progress or deterioration in the clinical status of child was noted in hours. Outcome was evaluated in terms of survival, severest Hypoxic Ischaemic Encephalopathy (HIE) stage, time taken to reach non encephalopathic state, requirement of vasopressors and anticonvulsants, ventilator support, hemodynamic stability, time period to attain full enteral feeding, neurological examination at time of discharge and time taken for discharge.Results: Significant difference was observed in the antenatal and perinatal profile, perinatal management and resuscitation, postnatal management, morbidity, mortality and neurodevelopment outcome of extramurally delivered neonates in a peripheral health centre or at home as compared to intramurally delivered neonates in a tertiary institute.Conclusions: It is of paramount importance to have an early referral of asphyxiated neonates to a well equipped NICU using an appropriate well equipped transport unit/ chain so as to improve their outcome

A clinical study of foreign bodies in air passages

Background: Foreign body in the airways is a serious event and fatal if not managed properly in time. Accident resulting from the inhalation of the foreign body continues to take formidable toll of lives every year.Objecti ve: This study was undertaken to find out the incidence of foreign bodies in air passages in this part of the country and types of foreign bodies, to establish the role of radiological investigations, and to find out the effective measures which are valuable in decreasing the post endoscopic complications and morbidity. Methods: This retrospective study was conducted in all suspected cases of foreign body in the air passages attending as well as referred to the Department of Otolaryngology of a Medical College of Rajasthan from January 2014 to December 2015. In each case, a procedure like direct laryngoscopy or bronchoscopy was done depending on the site of the foreign body. Results: Out of 100 cases, 58 were males and 42 were females. 88% of the patients were children below the age of 12 years. The most common foreign body extracted was betel nut in 47% of the cases. Commonest sign observed was decreased air entry in the lung (83%). Commonest radiological finding was obstructive collapse (37%). 48% of the total foreign bodies were present in right bronchus while 32% were lodged in the left bronchus and 3% at the carina. Conclusion: A diagnostic bronchoscopy should always be done in refractory cases of chronic respiratory infection, allergy or pneumonia. A negative radiological examination does not exclude a foreign body

Acute and Subacute Toxicity Study of Abhraka Bhasma- Incinerated Mica Ash

Among the various Ras dravyas (mineral drugs), Abhraka Bhasma (incinerated mica ash) is widely used in therapeutics. Many herbal and other organic materials have been quoted in reference for various procedures in preparing Abhraka bhasma. It is wonderful that different pharmacological action has been attributed to different Dravyas used in the pharmaceutical processing of Abhraka Bhasma. However, to establish the safety of such metallic and mineral formulation it is the need of the hour to generate scientific data for such drugs. In the present study two samples of Abhraka Bhasma were prepared using two different methods. The safety profile of Abhraka Bhasma samples (AB-1 & AB-2) were evaluated by conducting acute and subacute toxicity study as per OECD Guidelines. Both acute and sub-acute toxicity study demonstrated safety of AB-1 and AB-2 when administered at therapeutic dose, TED X5 dose and TED X10 dose. Even though the sample AB-1 was prepared using a smaller number of Puta, it was sufficient for preparing good quality of Bhasma and was non-toxi

Behavioral Problems and Intelligence Quotient Changes in Pediatric Epilepsy: A Case–Control Study

Background: Epilepsy is the most common chronic neurological disease and has neurological impairment as an important comorbidity. Objective: To find behavioral problems and intelligence quotient (IQ) changes associated with epilepsy and to know the association of variables such as frequency, type of seizures, and duration of disease with cognitive impairment. Materials and Methods: A descriptive cross sectional study, consisting of 50 cases (patients of epilepsy) and 50 controls (other patients of same socioeconomic status) was conducted at S.P. Medical College, Bikaner. The patients were subjected to detailed clinical history, thorough examination, Pediatric Symptom Checklist, and Bhatia's Battery of Performance intelligence Test. Data analysis was carried out with the help of SPSS 22 software. Results: The prevalence of behavioral problems in generalized and partial seizure group was high (42% and 53.8%) as compared to control group (9%). Low IQ was present more in the patients (44%) of generalized and partial seizure group as compared with the control group, and results were statistically significant. Furthermore, behavioral problems were more in patients who were having more number of seizures (≥3 per year) with significant P values (χ2 = 5.067, P = 0.024). Conclusion: We conclusively found that behavioral problems and cognitive factors, apart from control of seizures, must be kept in mind to determine how well a child with epilepsy progresses toward independence

Prediction of cardiovascular disease risk using framingham and data on adverse effect of antiretroviral drugs risk equation in relation to lipodystrophy in HIV patients on highly active antiretroviral therapy

Background: In the era of high active antiretroviral therapy (HAART), with increasing survival of HIV patients, cardiovascular risk has emerged as a leading health issue. Aims: This study aims to predict the 10-year cardiovascular disease risk in HIV patients using the Framingham risk score and its modification for HIV-infected patients on HAART, that is, the data on adverse effect of antiretroviral drugs (DAD) prediction equation. Setting and Design: This is a case control study. Materials and Methods: The present study included 320 subjects (220 HIV infected cases and 100 age, sex and body mass index matched HIV noninfected healthy controls) and was conducted in a tertiary care centre in western Rajasthan. All the patients were subjected to a detailed clinical history, complete physical examination and evaluation of laboratory parameters. We calculated Framingham risk score and DAD prediction equation for these patients and compared these scores between patients on HAART with lipodystrophy, those without lipodystrophy, HAART naive and healthy controls. Statistical Analysis: Unpaired t-test was used and statistical analysis was performed using SPSS version 20. Results: In our study, 46.67% patients on HAART developed lipodystrophy, of which 17.72% had moderate-to-high risk of cardiovascular risk according to Framingham risk score, which is significantly higher than in patients without lipodystrophy and controls (3.3% and 6%, respectively). Similar high risk was also seen with DAD score. The various risk factors also showed a positive correlation with duration of HAART. Conclusion: Our study emphasizes the need for early recognition of cardiovascular risk in HIV-infected patients on HAART, especially in those with lipodystrophy and advocates effective use of risk calculators in these patients

Clinico-radiologic Profile of Pediatric Traumatic Brain Injury in Western Rajasthan

Objective: The aim of this study was to evaluate clinico-radiological profile and outcome of pediatric traumatic brain injury (TBI). Design: Prospective observational study Setting: Intensive Care Unit, ward and OPD of Pediatrics, Dr. S. N. Medical College, Jodhpur (tertiary care hospital). Participants: A total of 188 children (1 month–18 years) were enrolled and 108 admitted. Intervention: TBI classified as mild, moderate, or severe TBI. Neuroimaging was done and managed as per protocol. Demographic profile, mode of transport, and injury were recorded. Outcome: Measured as hospital stay duration, focal deficits, mortality, and effect of early physiotherapy. Results: Males slightly outnumbered females mean age was 5.41 ± 4.20 years. Fall from height was the main cause of TBI (61.11%) followed by road traffic accident (RTA) (27.78%). Majority (56.56%) reached hospital within 6 h of injury, out of which 27% of patients were unconscious. Mild, moderate, and severe grade of TBI was seen in 50%, 27.78%, and 22.22% of cases, respectively. About 12.96% of cases required ventilator support. The average duration of hospital stay was 11.81 ± 12.9 days and was lesser when physiotherapy and rehabilitation were started early. In all children with temporal bone fracture, magnetic resonance imaging (MRI) brain revealed a temporal lobe hematoma and contusion in spite of initial computed tomography (CT) head normal. Children who have cerebrospinal fluid (CSF) rhinorrhea/otorrhea had a high chance of fracture of base of skull and contusion of the basal part of the brain. Conclusion: In India, fall from height is common setting for pediatric TBI besides RTA. Early initiation of physiotherapy results in good outcome. MRI detects basal brain contusions in children presenting with CSF rhinorrhea/otorrhea even if initial CT brain is normal