Septic Arthritis of Neonates: Descriptive Study of a Neonatal Intensive Care Unit Nosocomial Outbreak.

Purpose  This is a retrospective descriptive study of a nosocomial outbreak of septic arthritis in a neonatal intensive care unit with a Pseudomonas species as the predominant organism. There have been no previous reports of the same. The risk factors for this disease were analysed. The different diagnostic modalities that we used are described and the short-term outcomes are reported after antibiotic therapy and surgery. Methods  Fourteen patients and 16 joints were included in the study over a three-month period. The risk factors were analysed from the records and included prematurity, birth weight, sex and joint predilection. The causative organisms were also analysed from microbiological profiling. The outcomes after surgery and adjunctive antibiotic therapy were analysed in terms of clinical and laboratory parameters. Results  Pseudomonas aeruginosa was found to be the predominant organism in this series. The hip joint was predominantly involved and the majority of the patients were found to be premature. All the neonates affected were found to have low birth weight. Conclusion  Prematurity and low birth weight were found to have an association with risk for septic arthritis. In our setting of a nosocomial outbreak, a Pseudomonas species was more common than other organisms. A treatment regimen of arthrotomy surgery and adjunctive antibiotic therapy was found to be effective in all our patients.

Predictive Factors for the Complications of Dengue Fever in Children: A Retrospective Analysis.

Background and objective Dengue fever (DF) and its complications - dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) - are major public health problems in Southeast Asia. Predicting the development of DHF and DSS using hematological parameters and ultrasonic signs of vascular leakage will help in reducing morbidity and mortality associated with these diseases. Hence, this study aimed to test the association of platelets and packed cell volume (PCV) on day one (D1) of admission with gallbladder wall thickness (GWT) and ascites, which herald the onset of DHF and DSS. Methods The electronic health records of 52 pediatric patients admitted during a mini-outbreak were analyzed to assess platelets and PCV on D1, laboratory and ultrasonography findings, and outcomes. Correlations between D1 hematological parameters and GWT and ascites were tested. Results There was a positive correlation between GWT of more than 5 mm and ascites. However, there was no significant correlation of platelets and PCV on D1 with either GWT or ascites and consequently DHF or DSS. All the patients responded to fluid, blood, and supportive therapy. There were no mortalities. Conclusion Patients who develop GWT after DF are at an increased risk of developing ascites that deteriorate to DHF and DSS. D1 platelets and PCV are not reliable indicators for predicting the progression or worsening of the disease in the pediatric population.

Assessment of Virtual Peer Learning by Peer Feedback: A Pilot Project.

Introduction Virtual learning has become the preferred modality for health education during and after the coronavirus disease 2019 (COVID-19) pandemic. Peer learning is gaining a lot of significance lately and has been successfully tested in various settings. We combined virtual delivery of health education with peer-assisted learning and evaluated the effectiveness using peer-generated feedback and tested the effectiveness of the model for different cohorts. Methods We performed this study as part of a formal educational course on Health Professions Education. The educators were volunteers from different informal multi-disciplinary groups, working in varied healthcare settings, globally. This involved eight teaching sessions which were delivered virtually and the feedback was recorded as responses to six items (questions), which the learners graded on the Likert scale. The average for each item and the larger domains was then calculated and analyzed.  Results The feedback was provided by all the participants (53/53). In the feedback received item-wise, the best average rating was for legibility of the slides (4.8). The least rating was for adequate checking and assessment of prior knowledge (4.2). In terms of the broader domains, the best feedback was for the teaching material (4.6) and the lowest was for the planning of the sessions (4.4). Overall, the ratings for the domains and the items were above 3 on a scale of 1-5. Conclusions Virtual delivery of healthcare education, facilitated by peer-assisted learning, is an effective model for health education when delivered for a small group, as evidenced by the overall peer feedback. This model can be tested for larger cohorts in the future.

Penetrating Abdominal Trauma: Descriptive Analysis of a Case Series From an Indian Metropolitan City.

Introduction Penetrating abdominal trauma (PAT) is a major injury that patients present to the emergency department in developed and developing countries. There are many modes and causes of injury. The aim of this study is to analyse the patterns of presentation and parameters at assessment, including investigations, interventions and outcomes of penetrating abdominal trauma at a major trauma centre in an Indian metropolitan city. Methods This is an observational descriptive study done over 18 months at a major trauma centre in a metropolitan city in India. The study was registered with the institutional ethics committee and the patients were recruited after obtaining consent on admission. The relevant details were collected from the patient's electronic records after admission and analysed. Results Stab wounds in the 21-40-year-old subset were the commonest. The small intestine was the most commonly injured organ. The mortality rates and the duration of the hospital stay were similar to other case series of the same condition. Conclusion The analysis of our case series has highlighted the patterns and outcomes of penetrating abdominal trauma in an urban demographic of a developing economy. Individuals in the prime of their lives, unfortunately, are victims of this mode of injury. Better implementation of standard management protocols can improve outcomes.

Minor's Test: Objective Demonstration of Horner's Syndrome.

To highlight the Minor's test, which is useful in demonstrating anhidrosis of Horner's syndrome. A 39 year old female presented to us with a slow growing neck swelling which was provisionally diagnosed as a probable case of cervical sympathetic chain (CSC) Schwannoma. Intra operatively, the mass was found arising from the CSC which was sacrificed. Post operatively, Horner's syndrome was expected, but was difficult to demonstrate clinically. On performing the Minor's test, the presence of anhidrosis, and thus Horner's syndrome was confirmed. Minor's test is a simple objective test to demonstrate Horner's syndrome, especially because diagnosis from the eye signs can be difficult.