A study of effect of aminoglycoside therapy on auditory brainstem evoked responses in preterm and term neonates

Background: Aminoglycosides are widely used drugs in neonates with associated ototoxic side effects, that can be diagnosed with auditory brainstem evoked responses, which is the recommended screening technique in neonatal intensive care unit infants.  This study was conducted to evaluate the effect of aminoglycoside therapy on auditory brainstem evoked responses in term and preterm neonates.Methods: A cross-sectional case control study. Two groups of 26 term and 22 preterm neonates who received aminoglycosides, with no other known risk factors for ototoxicity, were compared with suitable matched control group of 10 neonates in each. ABER was done after at least 5 days of aminoglycoside therapy and results were compared to suitable matched controls.Results: Mean latency of wave I in term neonates at 90 dB and 60 dB and mean interwave latencies of I-V waves in preterm neonates at 30 dB was higher in study group and statistically significant. No statistically significant difference in any of ABER parameters was observed in any group, at all other intensities.Conclusions: Wave I latency was prolonged in study group of term neonates at two intensities which indicates effect of aminoglycoside therapy on distal portion of acoustic nerve. But as there were no such findings at other intensities in term study group and in preterm study group and moreover no other ABER abnormalities were observed, it was concluded that the aminoglycoside therapy has low potential for ototoxicity. Authors support the ABER screening for early detection of hearing abnormalities, and recommend study on larger group of neonates and meta-analysis for final conclusion for evidence-based recommendations to use aminoglycosides in neonates, in view of audiometric and neurological abnormalities.

A study of sexual dimorphism of femoral head in Gujarat region.

Various diameters of head of femur have been in use for sex determination. These diameters vary region wise also. Therefore we undertook the study in Jamnagar region of Gujarat. Maximum diameter of the femoral head was measured in 184 dry, normal, adult, human femora (136 male & 48 female) obtained from M. P. Shah Medical College Jamnagar Gujarat. Mean Values obtained were, 43.75 and 40.33 for right male and female, and 43.88 and 40.64 for left male and female respectively. Higher value in male was statistically highly significant (P< 0.001) on both sides. The data was subjected to demarking point (D.P.) analysis. Maximum head diameter identified 11.90% of right male femora and 7.25% of left male femora; in female it identified 4% of left female femora while it was not useful (0.00%) for right female bone. Though the sex of the bone can be determined from head of the femur bone, in itself it is far from conclusive.

Profile of deaths due to electrocution: A retrospective study.

We carried out a retrospective analysis of deaths due to electrocution from the medico-legal deaths reported to our institution. Majority of the victims were males belonging to the age group of 11-50 years. Almost all deaths were accidental and most of them were concentrated in the period of monsoon implicating the important role of wetness in causing these deaths. In contrast to the studies done in the West, bathtubs, heaters or hair dryers were not involved in any of the deaths. The mortality rate due to electrocution was significantly higher at 4.4 per one lakhs (100000) population in the present study as against the figures of 0.94 and 0.14 from Bulgaria and Canada respectively. Most of the deaths were either instantaneous or immediate and most of the deaths were preventable by electrocution. It signifies that people living at home did not have elementary knowledge of risks of electrocution; therefore awareness about use of good quality electric appliances and cables is the need of the hour.

Study of occupational exposure to insecticides while spraying in cotton farms.

Organophosphorus compounds (OPC) are commonly used in farms and agricultural fields as insecticides. This study deals with manifestations of exposure among 40 workers engaged in the spraying of cotton crops with these insecticides over a period of two months. The compounds used were mostly monocrotophos, acephate, chlorpyriphos, methyl parathion and propanophos. All patients were illiterate males in the range of 15 years to 50 years of age. They showed typical manifestations of OPC poisoning. All of them responded to conventional treatment for OPC poisoning. There was one death. During the course of the survey it was found that none of the farmers were using protective gear as mandated by chapter VIII of Insecticides Rules, 1971 (Insecticides Act, 1968). A few of these workers were exposed to the insecticide for as much as nine hours per day for three days. In practice, in some deaths associated with OPC poisoning, history of inhalation is given. It is important to note that this could change the manner of death from suicidal to accidental. Due precaution must therefore be exercised in such cases before opining on the manner of death. It is imperative that extensive and persistent farmer education is done with regard to the implementation of various provisions under the Insecticides Rules, 1971, especially safety issues.

Mass illness due to datura poisoning: A case report.

This report concerns an incident of multiple non-fatal poisonings due to datura, which was mixed in sweetmeat disguised as "prasad". The accused wished to kill his mother-in-law, but the "prasad" was consumed by many others also, who suffered from the manifestations of datura poisoning. However they responded well to routine treatment, and there were no fatalities.

Evaluation of mechanical injuries in homicidal deaths: (A retrospective study of 5 years).

Jamnagar region, Gujarat state, enjoys a relatively low incidence of homicide in India. The following study examined 120 cases, (67.04%) of homicides where death was produced by inflicting various mechanical injuries on the body, reported during the years 2000 to 2004. Incidence of homicidal deaths due to mechanical injuries was 24 cases per year. It formed about 2.89% of all the total medico legal autopsies conducted during the period. Mechanical injuries were quite common in homicidal deaths involving as many as 92 male and 27 female victims. Majority of the victims were in the age group of 21 to 40 years with 77 cases, (64.17%). Blunt force was the most commonly employed method seen in 58 cases, (48.33%). It was followed by sharp force seen in 38 cases, (31.67%) and sharp and blunt combine forces seen in 23 cases, (19.17%). Incidence of fire arm injuries was quite rare in the present study. Head injury was quite common in homicide. Maximum external injuries were seen on the head and mostly they were produced by hard, blunt and heavy weapons. Stab injuries were commonly seen on the chest and abdomen. In the present study 35 cases, (29.17%) showed presence of defence wounds. Defence wounds were commonly seen in the male victims.

Brainstem evoked response audiometry (BAER) in neonates with hyperbilirubinemia.

OBJECTIVES: To evaluate Brainstem Evoked Response Audiometry (BAER) as an objective testing of hearing assessment in icteric babies and correlate the abnormalities with serum bilirubin levels. METHODS: BAER recordings were taken in 30 icteric ferm neonates at birth, at peak of serum bilirubin levels and on a follow-up visit at 2-4 months of age. RESULTS: Mean latency of waves and interwave intervals on the BAER records were prolonged in icteric babies compared to the control group suggesting early bilirubin encephalopathy. Abnormal records were obtained in 73.3% cases and the abnormality persisted in the follow-up tracings of 23.3% of the study group. CONCLUSION: BAER is a sample, reliable and effective technique for determining auditory functions in the neonates especially changes of early bilirubin toxicity.

Renal failure in asphyxiated neonates.

A prospective case controlled study was conducted in the NICU of a tertiary level referral teaching hospital to determine the incidence of renal failure in asphyxiated neonates and to correlate severity and type of renal failure with Apgar score and hypoxic ischemic encephalopathy (HIE) grading of the neonates. Ninety-eight neonates were enrolled 70 asphyxiated babies and 28 healthy controls. Renal functions were assessed using urinary output, urine microscopy, biochemical parameters and sonographic findings. Babies having renal failure were managed on a protocolised plan and followed up till 6 months of age to detect any residual impairment. Blood urea and serum creatinine were significantly higher in asphyxiated babies compared to the control group. Biochemical derangements correlated well with HIE staging and Apgar scores. There was no significant difference in urine output in the control and the study group as significant oliguria was seen in only 7 of the 70 asphyxiated babies and the output did not correlate with severity of asphyxia. Serum sodium level and fractional excretion of sodium showed significantly different values in the asphyxiated babies compared to control. Of the 70 asphyxiated babies 33 (47.1 %) had renal failure, which was of the non-oliguric type in 78 % cases and oliguric type in 22 % cases. Sonographic abnormalities were seen more often in oliguric babies and was associated with a bad prognosis. Renal parameters normalized in all neonates by 6 months of age. Mortality was higher in babies with oliguric renal failure. We conclude that renal failure is a significant problem in asphyxiated neonates with majority of babies having nonoliguric failure. Severity of renal function abnormality correlates well with degree of asphyxia. Oliguria, hyponatremia and abnormal sonographic scan are bad prognostic signs in renal failure secondary to birth asphyxia.

Profile of fatal poisoning in and around Jamnagar.

The paper presents the study of 132 cases of poisoning received in the Dept of forensic Medicine M.P. Shah Medical College, Jamnagar for post-mortem examination (PME) during the span of one year. Out of 826 PME done during the study period 132 (15.98 %) cases were that of poisoning. The cases were then analysed on various epidemiological parameters feeding the information in the proforma prepared for this purpose. We concluded that majority of victims were married, Hindu, males from rural area and low socio economic group. Majority of victims died within 1-6 hours of consumption of poison. Suicidal cases were for more commoner than accidental one. No case of homicidal poisoning was detected in present study. Chemical analysis of viscera was done in 115(87.12 %) cases (snake bite cases excluded). During the span of study we could get report of C.A. in 98 (85.21 %) cases. Insecticides still toped the list as killer no one, while snakebite was second most common fatal poisoning. This study differs from most of the contemporary studies in one important aspect that is we could get C. A. report in large no of cases. C.A. reports were positive in 90 per cent cases.

Sexing of sacrum by sacral index and kimura's base-wing index.

A study for sexing of sacra was carried on 64 sacra (32 male & 32 female sacra) by two methods.One method used was sacral index and the other method was Kimura's base-wing index. The measuring instrument used was sliding vernier caliper. The method of sacral index showed high success rate as compared with Kimura's base-wing index method.

Mass disasters: A preparedness plan book with particular emphasis on mortuary services.

This paper tries to prepare a “preparedness plan book” which can be used as a ready reckoner in case of disaster strikes. This is particularly meant for mortuary services but can also be used as a guide for other health care services as well. It covers the anticipation of the problem, role of mortuary services, requirements and their procurements in the hour of need. It also deals with some relevant ethical and legal issues.

Engelmann's disease with optic atrophy.

Engelman-Camurati disease is a rare Diaphyseal dysplasia, characterized by endosteal and periostal thickness of cortex of shaft of tubular bone sparing metaphysis and epiphysis. The bone of the hand, feet, ribs, scapulae and pubis are not affected.

Otitis media.

There is a high rate of use of antimicrobial drugs for otitis media in children. This article reviews the diagnostic considerations for acute otitis media. An extensive review of literature on this subject has been carried out in order to address the issues of indications, choice, appropriate doses of antimicrobial agents and the duration for which they should be used. It is important to distinguish acute otitis media from otitis media with effusion because antibiotics are seldom indicated for the latter condition. Oral amoxicillin remains first-line therapy for uncomplicated acute otitis media, a short course of antimicrobial therapy (five to seven days) may be appropriate in children two years of age or older with uncomplicated presentations. For clinical treatment failures after 3 days of amoxicillin, recommended antimicrobial agents include oral amoxicillin/clavulanate, cefuroxime axetil, cefprozil, cefpodoxime proxetil, and intramuscular (i.m.) ceftriaxone. Tympanocentesis for identification of pathogens and susceptibility to antimicrobial agents is recommended for selection of third-line agents.

Management of community acquired respiratory infections.

Respiratory tract infections (RTIs) are the most common diagnosis in children visiting outpatient departments in both developing and developed countries. The impact of these infections is enormous in terms of total morbidity and mortality. Management of these infections requires a meticulous evaluation and a comprehensive but rational use of supportive, symptomatic and specific therapy. Antibiotics are widely prescribed for the treatment of community acquired respiratory infections to compensate uncertainties of diagnosis and prognosis; unnecessary anti-microbial drug therapy is expensive and resistance by respiratory pathogens is increasing at an exponential rate at a time when new anti-viral as well as anti-bacterial agents are being introduced into the therapeutic armamentarium. Major dilemmas persist regarding symptomatic therapy and the indications of antimicrobial agents. A comprehensive but brief review along with latest protocols and advancements is the management of community acquired respiratory infections in children in cited.

Investigation of children with chronic diarrhoea.

OBJECTIVE: To study the lower G.I. endoscopic and histopathological findings in children with chronic diarrhoea. DESIGN: Prospective analysis. SETTING: Hospital based. SUBJECT: 83 children with age up to 14 years admitted in Umaid Hospital, Jodhpur including 33 subjects with chronic diarrhoea and 50 normal children in control group. METHODS: All 83 children including study (33) and control group (50) underwent lower G.I. Endoscopy using FUJINON-SIG-ET sigmoidoscope in older children and PENTAX FG-23H gastroscope in younger children after proper preparation. Rectal biopsies were taken in all the subjects except one and was sent for histopathological examination. RESULTS: Majority (90.8%) were in 0-5 year age group with median age of 3.8 years. We could finally reach to definitive diagnosis in 13% patients with chronic diarrhoea. Over all, colitis was the most common cause. CONCLUSION: Both, endoscopy and biopsy are needed to reach final diagnosis.

Primary gastrointestinal lymphoma--disease spectrum and management: a 15-year review from north India.

OBJECTIVE: To analyze retrospectively the disease spectrum and outcome of primary gastrointestinal lymphoma (PGIL) in a tertiary referral center in north India. MATERIAL: Seventy five patients presenting with PGIL between January 1971 and December 1985 were evaluated. RESULTS: The 49 males and 26 females were aged 3.5-69 years (mean 34) at presentation. Abdominal pain, weight loss and vomiting were cardinal symptoms at presentation; the stomach was the most common site of involvement. Histologically, a majority of patients were classified as having diffuse poorly-differentiated lymphocytic lymphoma (46.7%) and diffuse histiocytic type (30.7%). Twenty seven (36%) patients had stage I disease, 31 (40%) stage II, 11 (14.7%) stage III, and 6 (8%) stage IV. At laparotomy, primary resection and anastomosis was carried out in 66 patients, while only biopsies were taken in nine. Forty eight patients received adjuvant radiation with or without chemotherapy. The mean follow-up was 3.9 years (range 1-14). The 5-year actuarial survival was 34%, 25% and 16% for stages I, II, and higher-stage disease, respectively. The survival was significantly better (p < 0.01) for gastric location (44%) compared to other sites (24%). CONCLUSION: PGIL was more common in the 3rd and 4th decades of life, with the stomach being the predominant site of involvement. Survival was better among patients with stages I and II disease, and gastric location of lesion.

Results of treatment in endometrial carcinoma: ten years experience.

From 1980 to 1989, 145 patients of histologically proven adenocarcinoma of the endometrium were seen and treated at the Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, Majority of the patients (84/145) presented with FIGO stage I disease. Relationship of myometrial invasion to grade was highly significant (p < 0.001). One hundred and seven patients were treated by surgery in combination with pre-operative or post-operative radiotherapy. The importance of various prognostic factors was assessed and grade of the tumour had statistically highly significant effect on survival (p < 0.005). Postoperative radiotherapy is recommended in patients with poor prognostic factors.