Department Of Tertiary Care Center Research Articles

Clinical spectrum study of female patients with benign breast diseases in surgery department of tertiary care centre

Background: Benign breast disorders are classified as congenital disorders, injury related inflammatory conditions infective conditions, aberration of normal differentiation and involution, duct ecstasies and congenital breast conditions such as inverted nipple etc. Aberration of normal differentiation and involution of breast consist of cystic nodularity, mastalgia, cysts and fibroadenoma. Methods: Aim of the study is to study the co-relation of clinical, pathological and radiological parameters in benign breast diseases and study detail the different modes of presentations of benign breast disease respect to age, marital status, religion, clinical features, menstruation, presentation of lump, diagnostic modalities used. Results: The 200 patients diagnosed with benign breast disease. Most of the cases belong to the age group of 20-29 years, fibroadenoma is the most common benign disorder in that age group followed by fibroadenosis. The presentation is breast lump without pain in most of the time. Conclusions: Benign breast disease occupy majority of the total breast diseases. Majority of the benign breast diseases occur in the reproductive age group with fibroadenoma as the most common lesion. Lump is the most common presentation of all of the benign breast diseases.

Assessing pattern of the Pediatric Multisystem Inflammatory Syndrome (PMIS) in children during the COVID-19 pandemic: experience from the emergency department of tertiary care center of a low-middle-income country

BackgroundPediatric Multisystem Inflammatory Syndrome (PMIS) is a hyperinflammatory condition affecting multiple organs in children, often resembling incomplete Kawasaki Disease during later phases of COVID-19 infection. Data on PMIS in low-middle-income countries, particularly in emergency department settings, is limited.ObjectivesThis prospective observational study at Aga Khan University Hospital, Karachi, aimed to determine the frequency, clinical presentation patterns, and laboratory parameters of children with PMIS visiting the emergency department during the COVID-19 pandemic. Secondary objectives included assessing factors associated with in-hospital mortality.MethodsFrom March 2020 to September 2021, patients meeting World Health Organization PMIS criteria were enrolled. COVID-19 testing included PCR and antibody testing. Data was collected through a questionnaire and analyzed statistically.ResultsAmong 56 PMIS patients (85.7% male, mean age 7.67 ± 4.8 years), respiratory symptoms (70%), neurological symptoms (57%), and gastrointestinal symptoms (54%) were common presentations. Signs included delayed capillary refill time (93%), low-volume pulses (89%), and hypotension (68%). COVID-19 antibodies were positive in the majority (78.6%) while PCR was positive in 18%. Risk factors for mortality included prolonged emergency department stay, and high Ferritin and Lactate Dehydrogenase levels.ConclusionPMIS affects children of all ages. Respiratory and gastrointestinal symptoms are the most frequent presentations. Elevated inflammatory markers, including LDH, Ferritin, D-dimer, and Pro-BNP, correlate with higher mortality risk.

Novel approach of plate assisted buttressing in Hoffa fracture

PurposeHoffa fracture is a femoral condyle fracture in the coronal plane. The lateral condyle is more commonly involved. The diagnosis is often difficult to detect with routine radiographs. Conservative management in this type of fracture resulted in nonunion, malunion, and other complications, such as stiff knee. Therefore, surgical management is mandatory in displaced fractures. Previous studies suggest only application of cancellous screw fixation, but these are not enough to counter vertical shear stress. Therefore, this study will evaluate the clinical outcomes of open reduction and internal fixation of Letenneur type I Hoffa fracture using cancellous screws with posterior buttressing plate. MethodThis was a prospective cohort study conducted from March 2017 to July 2022 in orthopaedics department of tertiary care center after approval of institutional ethical committee. The study included 36 patients with Letenneur type I fractures treated by open reduction and internal fixation using posterior buttress plate and cancellous screws. Radiographs and clinical outcomes, range of movement (ROM), bone union, and knee society score (KSS) of patients were assessed at the end of 4 and 12 months in the follow-ups. All statistical analysis was done using Epi info version 7.2.1.0. ResultsIn the 36 patients with Letenneur type I fracture, the majority belong to younger age group between 25 and 54 years with 22 males and 14 females. The modes of injury were road traffic accidents in 25 patients and fall from height in 11 patients. The right knee was involved in 21 cases and left was involved in 15 cases. Lateral condyle involvement was seen in 27 cases and medial condyle in 9 cases. All 36 patients with Letenneur type I Hoffa fracture were evaluated 4 months after surgical intervention. The notable improvements were observed in terms of ROM 120.4° ± 5.0° and KSS 85.0 ± 4.2. At the 12-month follow-up, considerably better outcomes were maintained regarding ROM 128.1° ± 5.2° and KSS 89.3 ± 4.8 with p < 0.05 which was statistically significant. At the final follow-up, all patients had routine fracture healing with a union time of (3.2 ± 3.4) months. ConclusionsFixation of Letenneur type I Hoffa fracture with cancellous screws and posterior buttress plate is effective, reliable and capable of providing adequate stability. Buttress plate assisted fixation is a valuable enhancement of the conventional technique of lag screw fixation of Hoffa fractures.

The prevalence of risk factors for non-communicable diseases among patients attending outpatient department of tertiary care centre, Bengaluru: A cross-sectional study

Introduction: Worldwide, 74% of all deaths, or 41 million/year, are caused by non-communicable diseases (NCDs). In India, 65% of fatalities are caused by NCDs. NCDs are caused by risk factors connected to lifestyle, such as bad eating habits, inactivity and problematic alcohol and cigarette use. In light of this, the present study was conducted to determine the prevalence of NCD risk factors among patients utilising a Bengaluru tertiary care facility. Materials and Methods: Patients at a tertiary care centre in Bengaluru made up the 480 participants in this cross-sectional study. After receiving consent, a semi-structured questionnaire was used to collect the data. SPSS software version 25 was used to evaluate the data once it had been entered into Microsoft Excel. As a test of significance, the Chi-square test was applied. Results: Participants in the study had an average age of 43.6 ± 14.6 years. The prevalence of a sedentary lifestyle was 90.6%, followed by physical inactivity at 68.3%, and obesity at 11.5%. Risk factors such as physical inactivity, waist-hip ratio and obesity were significantly associated with the age group. Conclusion: By implementing lifestyle changes and undertaking community-based health education programs, it should be possible to counteract the rise in the prevalence of risk factors for non-communicable illnesses.

Comparison of Short Term In-Hospital Outcomes in patients presenting with ST-Elevation Myocardial Infarction Versus Non-ST-Elevation Myocardial Infarction

Objective: To compare the short term in-hospital outcomes in patients presenting with acute ST-Elevation Myocardial Infarction (STEMI) and Non-ST-Elevation Myocardial Infarction (NSTEMI). Study Design: Comparative Cross-sectional study. Place and Duration of Study: Adult cardiology department of tertiary care center, Rawalpindi Pakistan, from Aug 2022 to Feb 2023. Methodology: A sample of 323 patients of acute STEMI and NSTEMI were enrolled. Patients fulfilling the inclusion criteria were enrolled through non-probability consecutive sampling. Patients were divided into two groups. The data of short term in hospital outcomes was recorded. Data was entered and analyzed using SPSS version-26:00. Chi-square and t-test were used to find association and mean difference of study variables between study groups. Results: Out of total 317 patients, males were 262(82.6%) and females were 55(17.4%)) with an average age of 63.34±8.96 years in the study. 139(43.8%) patients had Diabetes Mellitus, 146(46.1%) were hypertensive and 73(23.0%) were smokers. 198(62.5%) patients had STEMI and 119(37.5%) had NSTEMI. Mortality within hospital was found in 10(3.2%) patients. There were significant findings with age (p&lt;0.001), gender (p&lt;0.001), diabetes (p=0.01), pulmonary edema (p=0.01) and severe Left Ventricular Dysfunction (LVD) (p&lt;0.001). Higher in-hospital mortality rate was noted in NSTEMI group, i.e. 5(4.2%) compared to STEMI 5(2.5%), but the findings were statistically insignificant (p=0.40). Conclusion: There was no meaningful distinction between the two groups' immediate outcomes. Although patients with NSTEMI had relatively higher complication rates and in-hospital mortality, and patients with STEMI had better short-term outcomes, suggesting that patients with NSTEMI may also require immediate medical attention.

A Study to Detect Risk Factors of Chronic Subdural Hematoma Recurrence

Introduction: Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. The risk factors for recurrence of chronic subdural hematoma (CSDH) after surgical evacuation has not been completely understood until now, but several risk factors for recurrence have been reported. Meanwhile, the definitive risk factors have not been defined until now. The aim of this study was to study the potential risk factors, including preoperative, operative and post-operative ones for CSDH recurrence. Materials and Methods: The study population comprised of all &gt; 18 year age group patients who were operated for chronic subdural hematoma in Neurosurgery Department of tertiary care center. It was prospective cohort study. Patients who met inclusion criteria, postoperative outcomes were assessed at discharge, then at one month and three months afterwards in the neurosurgery OPD. Both the treatment options i.e. BHC Burr hole craniotomy and minicraniotomy as required as per CT scan or MRI findings. Results: 7 patients (10.7%) had recurrence, of CSDH. All the reoccurrences occurred in burr hole operated patients. There was no recurrence in mini craniotomy operated group. Conclusions: Many risk factors for recurrence of CSDH have been found, including old age, cerebral atrophy, large hematoma, bilateral hematomas, hematoma density, inflammation markers, alcohol ingestion, bleeding tendency, and some technical aspects of surgery such as irrigation with small amount of fluid, not excising thick membrane preventing brain expansion.

Prevalence of smoking among psychiatric patients in outpatient department of tertiary care centre: A descriptive cross-sectional study

Background: Even though psychiatric illness is a risk factor of smoking tobacco; only few studies have been conducted to estimate the prevalence of smoking among that patient group in Nepal. Our study aims to determine the prevalence of smoking among psychiatric patients in the outpatient department of tertiary care centre. Material and Method: A descriptive cross-sectional study was conducted in the psychiatric outpatient department of a tertiary care centre from 27th March to 27th May, 2022 following ethical approval from the Institutional Review Committee (Reference number: 577/078-079). A convenience sampling technique was used to include 398 patients, who were assessed for tobacco use behaviour using a semi-structured questionnaire and nicotine dependence using the Fagerstrom Test for Nicotine Dependence instrument. Data was collected using the “KoBo toolbox” Android mobile application and analysed using Microsoft Excel, Statistical Package for Social Sciences version 25.0, and R Studio. Point estimates and 95% confidence intervals were calculated. Results: The prevalence of current smokers was 104 (26.13%) (21.88-30.74 at 95%CI). The prevalence of past smokers was 48 (12.06%) (9.03-15.67 at 95% CI). Nicotine dependence was present in 75(72.12%) of the 104 current smokers and 40 (83.33%) among 48 past smokers. Conclusion: Our study found a lower prevalence of smoking among participants compared to other similar studies conducted at the national level.

Effect of Dietary Diversity on the Nutritional Status in Pregnant Women and in Turn its Effect on Birth Weight of the Baby

Background: Nutrient intake is important to the well-being of pregnant women and the fetus. Most of the previous studies points nutrition status based on energy and protein intake. However there are few studies indicate the use of dietary diversity as a marker of assessing the nutrition status. Healthy diets include the most diverse foods, and balance in eating food provides maternal and fetal health and reduces the prevalence of Low birthweight. Objectives: The objectives of the present study are to find out the association between Dietary diversity score with the nutrition status of the Pregnant Women (Gestational weight gain and nutritional anaemia.) And to find out the effects of gestational weight gain and nutritional anemia on the birth weight of the baby. Methods: An Institutional ethical clearance was obtained and the present Hospital based study was carried out in the OBG department of tertiary care centre of North Karnataka between December 2019 to February 2020. Sample size was estimated to be 120. Results: In the present study, a total of 120 women participated in the study. The Mean age of the study participants was 25.2±3.4, and the study found mean DDS was 7.04±1.58, with the scores ranging from 3 to 12. Association between the Dietary diversity score (DDS) and birthweight of the baby was found to be statistically significant (p=0.03) There is a statistically significant difference in DDS mean score between anaemic and normal pregnant women (p=0.007). There was a statistically significant positive correlation between Gestational weight gain and birth weight of the baby (p=0.03). There were positive correlation between the DDS and the Birthweight and Gestational weight gain, though it was statistically non-significant. Conclusion: Nutrition education for pregnant women should include the facts about the different food groups, it advantages will help to include diverse food items in their diet. Keywords: Dietary diversity score, Gestational weight gain, Birth weight

A STUDY ON MATERNAL AND PERINATAL OUTCOME IN ECLAMPSIA

Introduction: Eclampsia is still amongst the six major determinants of maternal mortality. It is characterized by sudden onset of generalized tonic-clonic convulsion or coma in pregnancy or postpartum, unrelated to other cerebral conditions,in patients with signs and symptoms of preeclampsia. Eclampsia results in increased maternal morbidity and perinatal morbidity. Materials And Methods: This is a prospective hospital based observational study in which all women with eclampsia admitted in OBG department of tertiary care center over one year period from January 2021 to December 2021. Aims And Objectives: To study the incidence of eclampsia, maternal and fetal outcome in eclampsia, complications of eclampsia. Results: Mean age of study group was 23.9±3.55 SD.Majority of the cases were primigravida- 74 (61.66%). Majority of cases were unbooked- 112 (93.3%). Mean gestational age in study group was 35.11 ± 3.24weeks.Majority of cases were antepartum eclampsia- 110 (91.66%)Caesarean delivery was needed in 74 (61.66%) and 46 (38.33%) delivered vaginally.The perinatal mortality is 29.03%. The maternal mortality is 4.16%. Conclusion: Eclampsia occurred in young unbookedprimigravidas in the antenatal period and its incidence is 1.32%. Women require care in HDU-ICU and need careful evaluation to decide the mode of delivery in the best interest of mother and the, to be born preterm baby.We still have a long way to go to improve the outcome of such mothers and infants by better high-risk assessment at peripheral hospitals, critical care ambulances for transfer of these women from periphery and improvement of critical care at our institution by training of our faculty and residents in critical care obstetrics.

De Quervain's Disease among Patients Visiting the Orthopaedic Outpatient Department of Tertiary Care Center: A Descriptive Cross- sectional Study.

de Quervain's disease is one of the common causes of wrist pain. It can cause serious disability and absence from work due to impaired functioning of the wrist and hand. The aim of this study is to find out the prevalence of de Quervain's disease among patients visiting the orthopaedic outpatient department of a tertiary care centre. This was a descriptive cross-sectional study conducted among patients visiting the orthopaedic outpatient department of a tertiary care centre after receiving ethical approval (IRC KAHS Reference: 078/079/56). This study was conducted from 1 January 2021 to 30 December 2021 from hospital medical records. A convenience sampling method was used. Patients with de Quervain's disease from 16 to 60 years were included in this study. Clinically diagnosis of de Quervain's disease was based on the tenderness of the radial styloid process, tenderness over the first extensor compartment on resisted thumb abduction or extension and positive Finkelstein test. Point estimate and 95% Confidence Interval were calculated. Out of 9600 orthopaedic outpatients, de Quervain's disease was seen in 128 (1.33%) (2.68-4.52, 95% Confidence Interval). The prevalence of de Quervain's disease was similar when compared to other studies conducted in similar settings. de Quervain's disease; surgery; tenosynovitis.

Hemoperitoneum among Pediatric Abdominal Trauma Patients Visiting in Emergency Department of a Tertiary Care Centre: A Descriptive Cross-sectional study

Pediatric abdominal trauma presents a major challenge for first-line responders in the Emergency Department for assessment and management. The Focused assessment sonography for trauma is a readily available, easy-to-use, and affordable tool for detecting hemoperitoneum during the initial assessment of trauma in the Emergency Department for adult traumatic patients. The aim of this study was to find the prevalence of hemoperitoneum among pediatric abdominal trauma patients visiting the Emergency Department of tertiary care centre through Focused assessment with sonography for trauma examination technique. This was a descriptive cross-sectional study conducted in the Emergency Department of a tertiary care hospital from 7 April 2019 to 7 April 2020. Among 413 pediatric trauma patients, 93 children (1 to 17 years) admitted to the Emergency Department who underwent focused assessment with sonography for trauma examination were included in the study. Ethical approval was obtained from the Institutional Review Committee (Approval number: 111/19). Convenience sampling was used. Point estimate and 90% Confidence Interval were calculated. Among 93 children receiving focused assessment with sonography for trauma imaging in the Emergency Department with a history of blunt abdominal trauma, the prevalence of hemoperitoneum was 18 (19.34%) (12.61-26.09, 90% Confidence Interval). The prevalence of hemoperitoneum was similar to other studies conducted in a similar setting. blunt injuries; emergency medicine; focused assessment with sonography for trauma.

Kimura Disease: A Diagnostic Perplexity

Introduction: Kimura disease (KD) is a rare condition of unknown etiology and pathogenesis. This is more common in young males of Asian descent. The most common clinical presentation is presence of unilateral subcutaneous mass in the head and neck region, especially in post-auricular area. We present a case of KD in 26- year- old Asian man who presented with subcutaneous mass behind both auricles. Case report: A 26- year- old man presented to ORL-HNS outpatient department of tertiary care centre with chief complaint of mass behind both ear for 5 months. Incisional biopsy was performed under local anesthesia. Histopathological examination report confirmed the case as KD. Patient was managed with intralesional triamcinolone injection. Conclusion: Kimura disease, though rare, should be considered in differential diagnosis of head and neck subcutaneous masses. A high-index of suspicion and tissue biopsy confirmation is essential to diagnose this condition.

Clinico-etiological profile of children with seizures at a tertiary care centre in rural area in North India with special emphasis on “treatment gap”: a retrospective observational study

Background: Childhood seizures are common neurological disorder. There is paucity of studies on etiology of seizures with revised standard definitions and of studies highlighting the treatment gap, required to plan health care services in rural areas of developing countries with limited resources. Objectives were to study the clinical and etiological profile of children with seizures and treatment gap in outpatient department of tertiary care centre in rural area in Northern India.Methods: It was a retrospective observational study in which relevant data on clinical, etiological profile and treatment details collected from OPD records was analyzed,Results: Study population of 249 children with mean age 9.2 (4.6) years and 52% females was analyzed. Generalized seizure was most frequent seizure type (71.50%). Neurocysticercosis was most common etiology (45.8%). Neuroimaging was abnormal in 79% cases. There was treatment gap of 66% with 43% children not started on any antiepileptic drug. The 58% children were taken to local tantriks believing that seizure is due to evil spirit. Amongst children who were given antiepileptic drugs (AEDs) (n=142), 86.6% were on monotherapy of which carbamazepine was most frequently prescribed drug (41%).Conclusions: The results of study would help to streamline the limited resources available for treatment and prevention of childhood seizures in the rural community and conduct socio culturally acceptable health campaigns to educate people about seizure and bridge the treatment gap.

A COMPARATIVE STUDY OF CLINICAL FEATURES AND TREATMENT OUTCOMES IN PREGNANT AND NON PREGNANT FEMALE HAVING BRONCHIAL ASTHMA

Background: Asthma is the most common potentially serious medical condition complicating 4-8% of the pregnancies. The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations. Objectives: To compare difference in clinical features between pregnant and non-pregnant females having bronchial asthma. To study the treatment given in pregnant and nonpregnant females having bronchial asthma. To compare the treatment outcome between pregnant and non-pregnant females having bronchial asthma. Material and Methods: This Prospective cohort study included 35 pregnant and 35 non-pregnant females(total 70) diagnosed with bronchial asthma attending the OPD and indoor facility of Respiratory Medicine Department in tertiary care center ,over the period of 15 months. Results: Out of 70 females most common symptoms is dyspnea followed by Cough, Rhinitis, Fever and Chest tightness in non-pregnant and pregnant females and there was signicant statistical difference found between two groups(p=0.02). After giving treatment in 1st follow up symptoms were well controlled in 20 (57.14%)pregnant and 29(82.86%) non pregnant female and there was statistical difference between the two groups (p=0.018).After 2nd follow up, symptoms were well controlled in 20(57.15%)pregnant and 31(88.57%) non pregnant there was statistical difference in control of symptoms between the two groups(p=0.010). Conclusion: Management of asthma in pregnancy does not signicantly differ from management in non-pregnant. Inhaled Corticosteroids remain the cornerstone of treatment in both pregnant as well as non-pregnant females.

Efficacy of cling film dressing on palmoplantar psoriatic lesions among patients with psoriasis: A randomized controlled trial

Introduction: Caring for patients with skin disorders is “more than skin deep”. Psoriasis is a systematic immune-mediated disease that generally does not affect survival, but certainly has major negative effects on patients. The previous research has reported that artificial restoration of a permeable barrier by occlusion results in regression of lesions in psoriasis.The aim of this research is to assess the efficacy of cling film dressing versus conventional treatment on palmoplantar psoriatic lesions among patients with psoriasis. Methods: The research design used in the study was a true experimental time series design. Block randomization was used to assign the study participants into either study or control group in a Psoriatic Out-Patient Department of tertiary care center at Southern part of India. As usual, the intervention group participants received the application of topical corticosteroid Eczivate MF with cling film wrap while the control group participants followed the conventional treatment (topical corticosteroid Eczivate MF without occlusive dressing). The modified psoriasis severity index (MPSI) score was used to measure the outcomes. Results: There was a high statistical significance difference on the severity of psoriatic disease level between the control and study groups (p ˂ 0.05). Conclusion: Steroidal cream application with occlusive dressing yielded better results than non-occlusive open treatment.

A study of quality of life of head and neck cancer patients attending ear, nose, throat out-patient department of tertiary care centre in upper Assam region

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Head and neck cancer makes up 3-4% of cancers, however, in developing nations like India, it constitutes 30-40% of cancer cases, primarily attributed to use of tobacco, alcohol.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A hospital-based, descriptive, cross-sectional study was done in a tertiary care centre upon 54 patients during a period of 1 year. Patients were subjected to a questionnaire on quality of life, using University of Washington quality of life questionnaire (UW-QOL).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 54 patients, 43 were males, 11 were females. Maximum cases were observed in the 6th decade of life. When asked to state the most important aspect of lifestyle for the patient in the past week, the highest percentage answered pain followed by appearance and chewing, swallowing and speech.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Around two-fifths of patients experienced moderate pain needing regular non-narcotic medications and approximately one/fourths stated they felt significantly disfigured. Around 45% patients stated they can chew soft solids, while 30% stated that they can swallow certain soft solids, 28% stated that they can swallow only liquids and 15% were unable to swallow (choking). Around one-third of patients complained of difficulty in speech and around a third of all patients were depressed. Around 45% patients were dissatisfied with their sex lives. Around half of the patients complained of reduced salivation, attributed to radiation-induced xerostomia. One-third of the patients experienced shoulder stiffness and/or pain due to possible injury to spinal accessory nerve.&lt;/p&gt;

Factors influence on ultrasound scan imaging quality and point of care in the clinical context

Objectives: Patient preparation before abdominal ultrasound plays a major role to ensure improved visualization of internal organs and pathologies by minimizing artifacts. The aim of this study was to assess the effectiveness on abdominal ultrasound scan imaging quality by patient preparation and evaluate its associated factors. Method and Materials: This was a descriptive cross-sectional study on consenting medical patients who had undergone elective abdominal ultrasound scan examinations at the radiology department of tertiary care center, in Sri Lanka for a three months period. Blinded examiners examined the patient preparation and optimization of the scan image findings in related to the abdominal ultrasound scan. The univariate, bivariate analysis and the chi-squared test were used to check the relationship between two categorical variables as this study dataset comprises more than 50 observations, where 5% was used as the significance level. Results: The total 320 randomized patients were included in the primary analyses. The majority of this study participant (29.7%) age was above 60 years while considering gender prevalence both male and female had relatively an equal contribution 52.2% and 47.8% respectively. The greater number of study participants represented urban living places (53.1%) while there was 46.9% from rural places. The occupational category accounted for skilled workers 16.9%, menial jobs 27.8% and a larger proportion was jobless (55.3%). Conclusion: There are lack of research study on patient preparation and optimization of abdominal ultrasound imaging quality. However, our study contends that patient’s preparation improves the abdominal ultrasound scan imaging quality to some extent.

Study of Serum Electrolytes and Calcium Changes in Children with Severe Pneumonia and it’s Outcome

Background: Electrolyte imbalance is one of the serious complications in hospitalized children with severe pneumonia. Monitoring of changes in electrolytes is very essential to prevent the complications leading to increased morbidity and mortality. Aims and objectives: To study serum electrolytes and calcium disturbances in patients with severe pneumonia. To identify relation of serum electrolytes with outcome of severe pneumonia. Material and Methods: After taking approval of ethics committee of our institute, we studied a total of hundred cases over a span of 24 months- August 2018 to December 2020. Study is carried out among cases of severe pneumonia and community acquired pneumonia (CAP) in age group of 2 months to 5 years admitted in pediatrics department of tertiary care centre in Maharashtra. Laboratory investigations of serum sodium, potassium, chloride and calcium levels were noted at admission and 24 hours after hospitalization. Results: This is observational cross study carried out in 100 children of severe pneumonia admitted in paediatric intensive care unit at Dr. Vasantrao Pawar Medical College, Nashik to observe and study electrolyte changes in them. Most children were in age group of 2 months to 12 months (i.e., 72%) followed by 28% in age group of 13 months to 60 months. At admission most common abnormality was hypocalcemia 49% followed by hyponatremia 27%, hyperchloremia 7%, hyperkalemia 6%, hypernatremia 6%, hypokalemia 4%, hypochloremia 1%. After 24 hours of stabilization hyponatremia was most common 40%, followed by hapocalcemia 43%, hypokalemia 9%, hypernatremia 8%, hyperkalemia 4%, hyperchloremia 4%. Conclusion: Mortality was significantly higher in cases with chloride level abnormality than with normal chloride level. Cases with disturbances in electrolytes showed higher mortality than those without electrolyte disturbances. Hyponatremia and hypokalaemia were associated with adverse outcomes in pneumonia cases. Electrolyte disturbances are commonly seen in pneumonia cases, so we should monitor them properly while treating them to avoid complications. Hyponatremia in pneumonia occurs due to Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH). Hyponatremia at admission significantly affect outcome in terms of prolonged duration of hospitalization and two fold increase in mortality.

LINEAR MORPHEA- A RARE CASE SERIES

INTRODUCTION: Linear morphea is rare localized form of scleroderma. The lesions are characterized by localized hard/smooth ivory-coloured immobile areas of skin. The appearance is hidebound skin, known as andrew's disease of skin. These linear lesions often develop along the line of blaschko. METHOD: A cross-sectional,hospital-based clinical study of patients with linear morphea attending the Outpatient Department of tertiary care centre was done over a span of 3 months. Detailed history was taken along with clinical examination. After counselling and after recording their consent, skin biopsy done along with routine investigations and results were evaluated. RESULTS: We have come across six cases in 3 months. Age group ranged from 10-20 years with 2 male and 4 female patients. Average age of onset was 14.5 years. Two cases had lesions involving limbs, two had lesions on forehead and one patient had extensive lesions involving entire right half of body including face. Serum ANA titre was positive in one case,which also showed changes in CT scan and bone scan. EEG changes were seen in two out of three cases of facial lesions. Skin biopsy in all cases were consistent with morphea. CONCLUSION: Though linear morphea is a local disorder without systemic association generally,patients with Serum ANA positivity and EEG changes in facial lesions need to be observed for permanent CNS damage if not counteracted with immunosuppressives. As it has higher morbidity and predilection in younger population,cosmetic and functional disability caused by it affects the quality of life.

Histopathological study of lower gastrointestinal tract lesions

Background: The benign lesions of the lower gastrointestinal tract are responsible for a largenumber of morbidities. The microscopic examination of and determination of histological types ofmalignant lesions help to decide treatment options and to predict prognosis. The histopathologicalstudy is the Gold standard for the diagnosis of intestinal lesions. Aims and Objectives: To studythe prevalence of various lower gastrointestinal tract lesions site-wise, age-wise and gender-wiseand to compare the obtained results with other studies. Materials and methodology: Aretrospective study of 600 various lower gastrointestinal tract lesions sent for histopathologicalexamination at Pathology department of tertiary care centre, VS General Hospital, Ahmedabad iscarried out. Results: Among all the 600 cases, non-neoplastic lesions 572 (95.34%) are far morecommon than neoplastic lesions 28 (4.66%). Conclusion: Non-neoplastic lesions are common in thesmall intestine, while the large intestine harbors most malignant lesions.