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Objective?The word “telemedicine” literally translates to “healing at a distance.” In the current scenario of the coronavirus disease 2019 (COVID-19) pandemic and shut outpatient department, the patients are facing difficulty in consultation. This article evaluated the use of telemedicine in the management of pediatric surgical patients. Materials and Methods?In this observational cohort study, from April 2020 to August 2020, all patients who took advice on phone/WhatsApp were assessed for addressing their complaints. The data was collected and analyzed. Result?A total of 307 patients were provided consultation via telecommunication. The male to female ratio was 2.3:1. Fifty-six (18.2%) patients called on an emergency basis, while the remaining 251 (81.8%) patients called for nonemergency or routine problems. Of these, attendants of 25 (8.14%) patients were not able to state the situation adequately. They were called to the department. Of these, 11 (3.5% of total) patients were admitted. One-hundred and eighty-three (59.6%) patients were in the department's follow-up, while the remaining 124 (40.4%) were new patients. The attendants of 296 (96.4%) patients were satisfied by using this modality of consultation. Conclusion?In the current scenario, telecommunication may help us to avoid unnecessary travel to the hospital. It may be helpful to deal with minor clinical complaints and evaluating for an emergency.
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Purpose:The purpose of this study was to review the effect of the pre?operative use of clopidogrel and aspirin on peri?operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off?pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on?pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post?operatively, this was statistically significant. Re?exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre?operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.
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Introduction:Veno-arterial extracorporeal membrane oxygenation (ECMO) is well-recognized treatment modality for patients with refractory cardiogenic shock. Uncomplicated cannulation is a prerequisite and basis for achieving a successful outcome in ECMO. Vascular access is obtained either by surgical cut-down. Common vascular access complications are bleeding and limb ischemia. Objective: To evaluate cannulation technique, the incidence of vascular complications, and their impact on the outcome. Methods: A retrospective data analysis conducted on 95 patients receiving ECMO from 2013 to 2020 was done. The patients were divided into two groups: no vascular access complications (non-VAC group) and vascular access complications (VAC group). The groups were compared related to the hospital and ICU stays and blood transfusion. Results: The patients in both groups were demographically and clinically comparable. The Non-VAC group had 75 patients, whereas the VAC group had a total of 20 patients. The main complication observed in the VAC group was bleeding from the cannulation site which required more blood transfusion than the non-VAC group (6.8 ± 1.02 vs 4.2 ± 1.26). Limb ischemia was another complication seen in the VAC group (4.2%, n = 4). Two patients had delayed bleeding after decannulation. The overall average length of stay in the hospital was statistically similar in both the groups (22 days in the VAC group vs 18 days in the non-VAC group), but the average ICU stay was more in the VAC group compared to the non-VAC group (18 days vs 12.06 days). Conclusion: Bleeding and limb ischemia are the important vascular access site complications, which increase blood transfusion requirements, ICU stay, and overall hospital stay.
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Purpose:The aim of this study is to analyze anticoagulation?related complications in patients following mechanical valve replacement and factors influencing the outcome. Materials and Methods: A total of 250 patients were analyzed during OPD follow?up for anticoagulation?related complications and various factors influencing outcome. Patients received prosthetic valve at mitral and/or aortic or both. Results: Out of 250 patients, 48% were male and 52% were female. The mean age was 41.9 ± 14.4. A total of 139 had mitral valve replacement (MVR), 70 had aortic valve replacement (AVR), 40 had double valve replacement (DVR), and 1 patient had triple valve replacement. Valves implanted were mechanical bileaflet valve. The mean international normalization ratio (INR) in the study was 2.4 ± 0.56. A total of 49 events occurred during follow?up, of which 4.5% per patient years were anticoagulation?related hemorrhagic events and 4.8% per patient years were thromboembolic events. Among thromboembolic events, valve thrombosis occurred in 10 patients and cerebrovascular accidents occurred in 11 patients. Mean INR for thromboembolic events was 1.46 ± 0.25 and anticoagulation?related hemorrhagic events was 4.4 ± 1.03. Mortality rate was 1.6% in AVR, 4% in MVR, and 0.4% in DVR? groups; about 34% of patients needed dose modification of Acenocoumarol and reason for derangement of INR was associated with infectious process and poor compliance; 85% of cases showed good compliance for daily anticoagulation therapy. Conclusion: Anticoagulation for mechanical valve replacement can be managed with INR range of 2.0 to 2.5 in MVR and 1.5 to 2.0 in AVR with acceptable hemorrhagic and thromboembolic events. We must educate and counsel the patients during follow?up for better compliance to optimal anticoagulation.
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Background: Neonatal' sepsis' is' a' clinical syndrome' characterized by signs and symptoms' of' infection' with' or' without' accompanying' bacteremia' in' the' first' month' of' life. Neonatal' sepsis' may' be' classified' into' two' groups : early onset' sepsis and' late onset' sepsis . Early onset neonatal sepsis' is' generally' associated' with' the' acquisition' of' microorganisms' from' the' mother' and' usually' presents' with' respiratory' distress' and' pneumonia.Methods: The study included one hundred' term' neonates with early onset neonatal sepsis. A septic screen including total leukocyte count, absolute neutrophil count, blood smear evaluation, blood cultures and C-reactive protein (CRP) were performed in all neonates with suspected sepsis to corroborate early onset sepsis diagnosis. Epidemiological parameters including gender of the neonate, mode of delivery, rural/urban residence were recorded in addition to clinical profile.Results: Respiratory distress was the most common presentation in the form of tachypnea, seen in 63 (63.0%) neonates. In present study, Staphylococcus aureus was the most common organism isolated followed by Staphylococcus epidermidis, Staphylococcus hominis, Acinetobacter baumannii and Klebsiella pneumonae.Conclusions: Early onset neonatal sepsis' was seen more in males. Among the gram-positive Staphylococcus aureus and among gram negative Acinetobacter baumannii and Klebsiella pneumonae were most common organisms to be isolated.
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Background: Routine childhood immunization is a proven tool for eradicating and controlling infectious diseases. Despite its key role in maintaining global public health, many individuals either refuse or delay immunization because of pain from the needle puncture. Several methods have been employed to reduce injection pain during immunization in children.Methods: Study comprised of 210 healthy infants coming for immunizations. They were divided into three groups A, B and C having equal number of infants. Group A was given oral sucrose solution, group B was given topical anaesthetic prior to immunization; whereas group C acted as controls. Response to pain was recorded among the three groups and findings were analyzed.Results: Infants enrolled in group A, i.e. those who were given 24% oral sucrose solution before immunization showed significant reduction in pain (measured by modified behaviour pain scale) as compared to control group at 15 seconds and 60 seconds of injection administration. Infants enrolled in group B, i.e. those who were sprayed topical local anaesthetics (10% lignocaine spray) before immunization showed significant reduction in pain as compared to control group at 15 seconds and 60 seconds of injection administration.Conclusions: Administration of oral sucrose solution and application of topical local anaesthetics are effective measures to reduce injection pain during immunization. Administration of oral sucrose solution before immunization showed greater reduction in pain as compared to application of topical local anaesthetics in present study.
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Introduction: The social and economic problems cuased byepilepsy are offen under appricaiated. The message shouldreach the broadest population of effected individuals, many ofwhom are in low socio economic groups and are at higher riskfor development of epilepsy. Study aimed to asess the impactof socio economic status and cultural factors on the prevalenceof Epilepsy in school going Children (6-16 years) in Kashmir.Material and methods: This was a population based studyconducted in school children. The selection of school wasdone by using PPS Method (Proportionate to PopulationSize) used in cluster surveys. The Pretexed Questionnairewas administered to 60 randomly selected children from eachselected school, the positive responders were examined by theneurologist and psychologistResults: The crude Prevelance of epilepsy in school goingchildren was 3.8/1000 for males which was higher thanfemales 2.77. The Govt schools had higher prevalence3.81/1000 as compared to private schools 2.79/1000 reflectinghigher prevalence in economically weaker section. Childrenfrom lower middle class had highest prevalence 3.56/1000.Conclusion: The prevelance of Epilepsy seems to increasewith socio economic deprivation though the association maybe compounded by other factors. The over all prevelance wascomparable to other studies. However there is significantimprovement about the awareness of epilepsy in Kashmirvalley over the past decades.
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Background: Vitamin D is a fat-soluble steroid hormone. Vitamin D also has immunomodulatory effects on immune function. Early onset sepsis (EOS) is characterized by signs and symptoms of infection with or without accompanying bacteremia in the first three days of life. The objective of the study was to determine the possible association between neonatal vitamin D levels and EOS in term neonates.Methods: 100 term neonates with clinical and laboratory findings of EOS (study group) and 100 healthy infants with no signs of clinical/laboratory infection (control group) were enrolled. Sera was drawn during first 3 postnatal days of life in both groups for measurement of 25-hydroxyvitamin D (25-OHD) levels.Results: Neonatal 25-OHD levels (17.4ng/dL) in the study group were significantly lower than those of the control group (26.8 ng/dL) (p=0.001). In present study negative correlation was found between vitamin D level and CRP.Conclusions: Lower neonatal 25-OHD levels are associated with EOS. Adequate vitamin D supplementation during pregnancy may be helpful to prevent EOS in term neonates.
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Background: Diagnosis of pulmonary tuberculosis (TB) is difficult and often requires a lung biopsy. The goal of this retrospective study was to determine the histopathological parameters useful for diagnosis of pulmonary TB in different types of bronchoscopic biopsies (transbronchial lung biopsy [TBLB], transbronchial needle aspiration [TBNA], and bronchial biopsy [BB]). Materials and Methods: The records of patients diagnosed to have pulmonary TB, over a period of 1‑year were evaluated. Patients with positive acid‑fast bacilli (AFB) culture and with three bronchoscopic biopsies including TBLB, TBNA, and BB were included in the study. Selected (14) histological parameters were evaluated retrospectively in a total of 27 biopsies from 9 patients with TB after hematoxylin‑eosin and Ziehl‑Neelsen staining. Results: Diagnostic yield in TBLBs and TBNA was similar for granulomas detection (66.6% each). Granulomas in TBNA were larger, caseating and confluent as compared to small interstitial granulomas seen in TBLB. AFB was demonstrated in only one patient in TBNA. Lymphocytic cell cuffing was seen around most TBLB granulomas. One patient also showed microfilaria in blood vessel in TBLB. BBs in all patients showed the presence of goblet cell metaplasia and increased peribronchial plasma cell infiltrate with or without eosinophils may be indicative of chronic injury. The yield of granulomas was low in BBs seen in only 2 patients (22.2%). Conclusion: Diagnostic yield of TBNA and TBLB for granulomas was similar; however, caseation was seen more frequently in TBNA than on TBLB. Of other histological parameters, bronchial metaplastic changes and peribronchial plasma cells infiltrate were constant findings in all tubercular biopsies indicative of chronic injury.
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The present work carries an analytical method development of prednisolone and 5- amino salicylic acid in tablet dosage form. The method is based upon Q – absorption ratio method for the simultaneous determination of the prednisolone and 5-amino salicylic acid. Both the drugs are widely used for bacterial cure and are recommended for the patients with mild to moderate inflammation of the digestive tract. Ulcerative colitis and crohn’s disease are the target disorders which are treated by both drug candidates. Absorption ratio method is used for the ratio of the absorption at two selected wavelength one of which is the iso-absorptive point and other being the λmax of one of the two components. Prednisolone and 5-ASA shows their iso-absorptive point at 283 nm in ethanol and 0.1N HCl respectively. The second wavelength used is 302 nm which is the λmax of 5-ASA in 0.1N HCl. The linearity was obtained in the concentration range of 1-10 μg/ml for prednisolone and 5-ASA. This method was applied to all pharmaceutical dosage form because there is no excipients interference between them. The results have been validated by recovery studies.
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Dietary habits have been associated with variations in the risk of colon disorders, either its increase or decrease. Colon-specific approaches showed their potential to target and treat colon cancers and inflammatory diseases, but they vary in success rates for local recurrence, disease-free survival, and overall survival. Also, chemotherapies and radiotherapies have been applied as the surgical adjuvant treatments. The significant role of exogenously administered Lactobacilli in reducing toxin-producing bacteria in the gut and increases the longevity of the host, led to the coining of the term ‘probiotics’. The evidence on the effects of inulin and oligofructose on colonization, translocation of pathogens and the prevention of intestinal diseases make them suitable candidates to treat colon disorders. Among potentially protective foods, growing attention has been dedicated to functional foods comprising probiotics, such as Lactobacilli or Bifidobacteria, and prebiotics such as fructooligosaccharides or fructans, as their consumption may treat inflammatory bowel diseases, like ulcerative colitis, crohn’s disease as well as experimentally induced colon cancer in mammals. The readily apparent synergy of concomitantly using beneficial microorganisms and nutritive materials that support their growth led to the term “synbiotics” to describe foods or supplements that combine both probiotics and prebiotics. Various potential mechanisms are addressed in the present paper. This article discusses the real value of dietary components, which offers practical information to help patients as well as health professionals. Furthermore, article has focused on the possible value of probiotics, prebiotics and synbiotics in treatment and maintenance therapy of colonic ailments.
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Various minerals have been reported which are directly linked to our health and cancer development in body. The immune system (immunoglobulin’s, cell mediated immunity, phagocytosis complement, lysosomes, interferon, metabolic function, hormones, metabolic and respiratory alkalosis) is the natural mechanism which defends against cancer. Minerals like zinc, selenium, magnesium, vanadium, and germanium augment this natural mechanism. In this review various aspects of these mineral are discussed and their relation with cancer.
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Colon specific drug delivery has achieved utmost importance because the colon is an area that is vulnerable to a number of diseases including ulcerative colitis, crohn’s disease, irritable bowel syndrome and carcinomas. And, preservation of formulation in upper GIT to colon is still important step. Treatment of these diseases with a colon-specific drug delivery system provides an interesting alternative over systemic drug administration because of lower dosing and fewer systemic side effects. Different challenges are associated with this delivery system like long transit time, enzymatic interference, intersubject variation of microflora etc. A variety of under clinical and commercially available approaches were designed for remediation of colonic ailments. Different dosage forms like tablets, capsules, pellets, multiparticulates, microspheres, liposome, nanoparticulates etc. were used for colon targeting. The present review article mainly focused on different approaches, mainly on formulation, carrier system and/or coating system, bioactive stability, patient compliance and evaluation of colon specific drug delivery system.
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The present study was planned to evaluate the safety and efficacy of vinyl bags in prevention of hypothermia during resuscitation at birth in very low birth weight neonates. Sixty neonates of gestational age ≤32 weeks and birth weight ≤ 1500gm were randomised to either study group, or control group. Study group neonates were put in vinyl bags up to neck and the head was covered with a cap after drying immediately following delivery and resuscitated under radiant warmer. Control group neonates were resuscitated by conventional drying under radiant warmer. Mean axillary and rectal temperature recorded immediately after admission to NICU were significantly higher in the study group compared to control group. Temperature recorded after 1 hour of admission to NICU were however comparable between the two groups. As temperature maintenance in these VLBW neonates is of tremendous importance, it would make sense to recommend the use of vinyl bags during their resuscitation.
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Fiberoptic bronchoscopy is minimally invasive procedure which can be performed on outpatient basis.The study is a reterospective review of the data at a tertiary center and compares the diganostic yield of the patients (n=720), who underwent FB at our pulmonary unit with the data from international centers. The diagnostic yield of the FB was high(70%) with good selection of the patients and growth was the most common finding followed by infections.FB was normal in 218(30%) patients. Flexible fiberoptic bronchoscopy is a useful diagnostic tool with a low rate of complications. The diagnostic yield in our institution is alsmost similar to that reported in other series.
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Biological activities of the salannin type of limonoids isolated from Azadirachta indica A. Juss were assessed using the gram pod borer Helicoverpa armigera (Hubner) and the tobacco armyworm Spodoptera litura (Fabricius) (Lepidoptera: Noctuidae). Inhibition of larval growth was concomitant with reduced feeding by neonate and third instar larvae. All three compounds exhibited strong antifeedant activity in a choice leaf disc bioassay with 2.0, 2.3 and 2.8 microg/cm(2) of 3-O-acetyl salannol, salannol and salannin, respectively deterring feeding by 50% in S. litura larvae. In nutritional assays, all three compounds reduced growth and consumption when fed to larvae without any effect on efficiency of conversion of ingested food (ECI), suggesting antifeedant activity alone. No toxicity was observed nor was there any significant affect on nutritional indices following topical application, further suggesting specific action as feeding deterrents. When relative growth rates were plotted against relative consumption rates, growth efficiency of the H. armigera fed diet containing 3-O-acetyl salannol, salannol or salannin did not differ from that of starved control larvae (used as calibration curve), further confirming the specific antifeedant action of salannin type of limonoids. Where the three compounds were co-administered, no enhancement in activity was observed. Non-azadirachtin limonoids having structural similarities and explicitly similar modes of action, like feeding deterrence in the present case, have no potentiating effect in any combination.