GMC Srinagar Research Articles

A Study on Evaluation of Drug Package Inserts in Kashmir, India

Background: Drugs constitute a major part of the therapeutic modality for most of the patients. Accurate and authentic drug information is important for its safe and effective marketing. Drug package insert (PI) is the primary source of such information. They serve very important role in minimizing the medication errors. PIs need to be updated regularly, but despite regulations, studies have shown that Indian PIs provide inadequate information. Aims and Objectives: To check the completeness of information provided in package inserts of allopathic drugs. Material and Methods: This observational study was carried out for a period of 3months in the department of pharmacology, GMC Srinagar. 139 PIs were collected from local pharmacies and drug store of tertiary care hospital of Government Medical College, Srinagar.17 duplicate package inserts were excluded. The remaining PIs (122) were evaluated according to section 6.2, 6.3 of schedule D (II), Drugs and Cosmetics Act (1940) and Rules (1945).Data was entered in Microsoft Excel Sheet and then analyzed. Results: Among 122 PIs evaluated maximum package inserts were of antibiotics (15%) and anti-diabetics (15%) followed by CNS drugs (14%). Considering the dosage forms 60% inserts wereoral preparations followed by intravenous injections 17%. Regarding the various components of Section 6.2 of Schedule D (II), Drug and Cosmetic Act, posology and method of administration was present in 100% inserts, special precautions and warnings were present in 97%, side effects in 96%, contraindication in 94%. With regards the components of Section 6.3, excipients were mentioned in 78% inserts, incompatibility in 49% inserts, shelf life in the product package for sale was present in 28%, shelf life after dilution in 30%. Conclusion: Our study concluded that only a few inserts contained all the headings of Section 6.2 and 6.3 of Drug and Cosmetic Act (1945). Completeness of information has improved a lot as compared to past, still a lot needs to be done so that patients can derive maximum benefit from them. This demands strict scrutiny of inserts by regulatory authorities.

Buzz Session as an Active Learning Method in Medical Undergraduate Physiology Teaching-An Institutional-Based Study.

In the current era of medical teaching, multiple active teaching-learning strategies are being explored due to drawbacks of conventional didactic learning methodology which are applicable to a typical classroom setting. Our attempt was to introduce short interactive buzz sessions in the midst of a lecture and assess the perception of students and faculty towards the use of these buzz sessions as an active learning method in physiology. To introduce buzz sessions as a teaching-learning tool in undergraduate medical teaching and to assess the student and faculty perception of this teaching method. This prospective, non-randomized, interventional study was carried out in the Department of Physiology, GMC Srinagar. The participants were 180 students of MBBS 1st Phase and 08 faculty members of the Physiology Department. Both the students and faculty were sensitized about the buzz sessions. Ten lectures of 1 h each were chosen from the Endocrine System, and taught by incorporating the buzz session in the lecture. The study was approved by the Institutional Ethical Committee. Both the students and the faculty favoured incorporating buzz sessions during the lectures as this teaching method makes the class interesting and interactive and helps to enhance communication, reasoning skills, and collaborative learning among the students. The study concludes that learning physiology using buzz sessions is liked and preferred by both students and faculty, and hence the need for buzz sessions in current medical teaching.

Evaluating the Olfactory Fossa Depth and KEROS Classification in Kashmiri Population

Background: KEROS classification is a means of classifying the depth of the olfactory fossa The olfactory fossa is shallow depression in the anterior cranial fossa whose floor is formed by medial lamella of cribriform plate located within ethmoid bone, lateral boundary by lateral lamella which is a thin plate like bone and is susceptible to injury during functional endoscopic sinus surgery, especially when fossa is deep/asymmetric. Functional endoscopic sinus surgery (FESS) although considered the gold standard technique to treat various nasal and paranasal sinus disorders but detailed anatomical study of the paranasal sinuses, olfactory fossa and adjacent anatomical structures during surgery is the necessity to avoid the complications like cerebrospinal fluid leak, periorbital and orbital hematoma, and blindness. Computed tomography(CT) is a frequently used imaging method in the evaluation of the paranasal sinuses, nasal cavity and nasopharynx. Objective: The purpose of the study was to evaluate the depth of olfactory fossa and ethmoid bone using computed tomography in kashmiri population and distributing Kashmir people on the basis of KEROS classification. Methods: In this observational study, PNS CT scan images of 396 patients including 234 males and 162 females between the age group of 17 and 75 years were examined in the Department of Radiodiagnosis, GMC Srinagar. Results: The average depth of the total 792 olfactory fossa (OF) examined was 5.05 mm with a standard deviation (SD) calculated of ±1.51. Statistically, no significant difference was found between males and females in mean OF depth (p>0.05). According to KEROS classification in kashmiri population, 192(24.2%) had type I, 518 sides (65.50%) had type II and 82 sides (10.30%) had type III among 792 olfactory fossa.

The epidemiology of neonatal respiratory distress in a tertiary care neonatal Centre Kashmir India

Background: Respiratory distress is most common cause of neonatal admission to NICU and has different etiologies with similar clinical presentation. Early diagnosis of specific cause for respiratory distress is very important as different etiologies have different specific treatment and require altogether different ventilatory strategies. Objectives were to study the demographic and etiological profile of neonatal respiratory distress. Method: Hospital based prospective observational study conducted in department of pediatrics, associated hospital of GMC Srinagar. Results: Respiratory distress was more common in males 56.30%, frequency of prematurity was 68% and most common mode of delivery lower section caesarian section (LSCS) 69.10%. Different maternal risk factors associated with adverse outcome premature rupture of membranes (PROM) (37.7%), meconium-stained amniotic fluid (MSAF) (34.60%), maternal hypertension (31.50%), gestational diabetes mellitus (GDM) (26.9%). Common causes for respiratory distress in neonate were transient tachypnea of newborn (TTN) (22.0%), respiratory distress syndrome (RDS) (20%), meconium aspiration syndrome (MAS) (16.90%), sepsis (14%) and perinatal asphyxia (12%). Conclusions: Early diagnosis of specific cause for respiratory distress is very important as different etiologies have different specific treatment and require altogether different ventilatory strategies. The TTN was the most common cause of distress in term newborns, followed by perinatal asphyxia, meconium aspiration, neonatal sepsis, and congenital heart diseases (CHD). Therefore, timely diagnosis and management of these conditions is very imperative to discharge an intact neonate from the NICU.

Study of Clinicopathological Pattern and Outcome of Adnexal Masses in Females from Puberty to Perimenopause at LD Hospital

Background: An adnexal mass, which refers to a mass located in the ovary, fallopian tube, or surrounding connective tissues, is a common problem in gynecology. A significant number of females present with adnexal masses, and the clinicopathological pattern and outcome of these masses are not well characterized. Therefore, a study was undertaken to evaluate the clinicopathological features and outcomes of adnexal masses in females from puberty to perimenopause. Methods: This study was a prospective observational study that was conducted over a period of one and a half years in the postgraduate department of Obstetrics and Gynaecology at Lalla Ded Hospital, GMC Srinagar. Ethical clearance was obtained from the Institution Ethics Committee (IEC) prior to conducting the study. Results: For patients aged 12-20, the chief complaints were pain abdomen (66.7%) and menorrhagia (33.3%). For patients aged 21-30, the chief complaints were pain abdomen (70.3%), dysmenorrhea (11.1%), secondary infertility (7.4%), and incidental finding during LSCS (11.1%). For patients aged 31-40, the chief complaints were pain abdomen (96%) and incidental finding during LSCS (4%). For patients aged 41-50, the chief complaints were distension and menorrhagia (both 50%). The chief complaints associated with these masses include Pain abdomen, Dysmenorrhea, Secondary infertility, Menorrhagia, Distension, Polymenorrhea, and Incidendal finding. The percentage of patients associated with each type of adnexal mass varies from 1% to 100%, depending on the type and chief complaint. Conclusion: The study found that adnexal masses were more prevalent in married women aged 21 to 40 years, with abdominal pain being the primary presenting symptom. Most of the masses were less than 100cc, and the majority of neoplastic lesions were surface epithelial tumors. The study also showed that non-neoplastic lesions were more common than neoplastic lesions, with only one malignant tumor found among the neoplastic lesions. Keywords: Adnexal mass, ovarian cancer, clinical presentation, histopathology

A Clinical Study of Maternal and Neonatal Outcomes in Pregnant Women with Obesity (BMI >30) at a Tertiary Care Hospital

Background: The increasing prevalence of obesity among women of childbearing age is a significant concern as it poses additional risks for both the mother and baby. This study aims to investigate the maternal and neonatal outcomes in pregnant women with obesity (BMI > 30) at a tertiary hospital to improve management strategies for this patient population. Methods: This study was a prospective observational study conducted at LD Hospital, Department of Obstetrics and Gynaecology, GMC Srinagar. The study included pregnant women with gestational age more than 28 weeks, BMI more than 30, delivering at the study hospital, and willing to participate. Detailed history and examination were performed, and data were documented. The women were followed up to delivery and postpartum until discharge, and their outcomes were studied. Data were collected using Microsoft Excel, and statistical analysis was performed using descriptive statistics. Results: Of the 130 patients, the majority were between 20-25 years of age, primi gravida, and had a BMI between 30-34.9 kg/m2. Gestational age ranged from 32-34 weeks to over 37 weeks. The most common event was preterm labor, affecting 19.2% of patients, followed by PPH, affecting 6.9% of patients. The least common event was eclampsia, affecting only 1.5% of patients. the majority of neonates had a weight in the range of 2.5-2.9 Kg, accounting for 65.4% of neonates. Only a small proportion of neonates had a birth weight less than 2.5 Kg (5.4%). The Apgar score, which measures the health of a newborn immediately after the birth, was less than 7 for 5.4% of neonates, while 94.6% of neonates had an Apgar score greater than or equal to 7. Conclusion: The study results emphasize the need for appropriate management strategies for obese pregnant women to reduce adverse outcomes. Early identification, close monitoring, and tailored interventions are crucial to reduce the risks associated with maternal obesity. Keywords: obese pregnant women, BMI >30kg/m2, gestational hypertension, preeclampsia, gestational diabetes mellitus

Prevalence of pulmonary arterial hypertension in children with down syndrome attending new 500 bedded paediatric hospital, Government Medical College, Srinagar

Background: Children with down syndrome are at increasing risk of developing pulmonary hypertension (PH) due to multiple factors. The high frequency of PH in this population has probable genetic, congenital, and environmental contributions. Methods: This prospective observation study was conducted in the Post Graduate Department of Pediatrics, New Pediatric Hospital GMC Srinagar, on all Indoor/Outdoor patients with karyotype documented cases of Down syndrome over a period of 2 years between December 2020 to December2022. After detailed history and examination routine baseline investigations both screening and diagnostic echocardiography was done. CT was done in selected patients. In some patients, whose history and examination was suggestive of obstructive sleep apnoea (OSA), polysomnography and OSA questionnaire was used to make the diagnosis. Results: This study included 306 children with karyotype documented Down syndrome. Out of them 72 were identified with PAH (Echocardiography documented) and the prevalence was 23.5%. Out of these 72 patients, 41 (57%) were males and 31 (43%) were females with male: female ratio of 1.3:1 and maximum number of patients were present in age group 1-6months. Out of them 60 (83%) patients had underlying echocardiographic documented CHD, 10 (14%) patients had OSA (Obstructive Sleep Apnea) and 2 (3%) had GERD (Gastrointestinal Reflux Disease). Conclusions: The PH is common in children with downs syndrome, is typically transient related to CHD or PPHN but can recur in setting of respiratory disease such as obstructive sleep apnea, intermittent hypoxia and recurrent pneumonia.

Laparoscopic reversal of Hartmann’s procedure: a hospital-based prospective observational study

Background: Hartmann’s procedure involves surgical resection of the rectosigmoid colon with the closure of the anorectal stump and the formation of an end colostomy. After recovery from the initial surgery, colostomy reversal and restoration of bowel continuity are indicated in selected patients. The second stage procedure is associated with a considerable morbidity rate of 10% to 50% and a modest but genuine fatality rate. Laparoscopic reversal of Hartmann’s procedure is a safe and practical alternative to the open reversal method. Methods: This prospective observational study was conducted in the department of general surgery, GMC Srinagar over a period of 2 years after obtaining ethical clearance from the institutional ethical committee. Results: Our study included 40 patients between the age group of 32 to 67 years, with the highest incidence between 41 to 50 years. 32 males and 8 females with a ratio of 4:1. Mean operative time was 184.6±47.06 minutes. The conversion rate to open was 10%. The mean duration of hospital stay was 6.25±2.21 days. The mean time of return to normal work was 13.4 days. Postoperatively, two patients developed ileus which was managed in the immediate postoperative period and two suffered from adhesion obstruction, managed by diagnostic laparoscopy with adhesiolysis. It remained uneventful in the rest of the patients. Conclusions: Laparoscopic reversal of Hartmann’s procedure is safe, effective, and achieves faster positive results with significantly better short-term outcomes despite a proportion of patients being converted to open surgery.

Epidemiology and clinical course of bronchiolitis in hospitalized children in tertiary care hospital in Kashmir

Background: Bronchiolitis is the commonest lower respiratory tract infection in children < 2 years of age and is responsible for the majority of their pediatrician visits and hospital admission during the winter season. The aim of this study was to describe the epidemiological data, seasonal trends, clinical characteristics, and outcomes of children admitted with bronchiolitis in pediatric hospital GMC Srinagar. Methods: This was a retrospective observational study in children less than 2 years of age admitted in department of pediatrics in GMC Srinagar. Data were collected through review of the medical records of patients with a diagnosis of bronchiolitis on discharge and analyzed through SPSS 20. Results: A total of 228 infants were enrolled in the study. The majority were males (60.08%). The median age on admission was 5.5 months, exclusive breastfeeding was the mode of feeding in majority and 8.77% were ex-preterm. Respiratory syncytial virus (RSV) was identified in majority (103) and admission peak was from October to March. Most of the patients presented on day 3 of the illness. Most patients 45.17% were having feeding difficulties and chest auscultation was normal in about 22% of the children. Oxygen supplementation was administered to 85.52% of the children. The 32 children (14.03%) required admission to PICU. Mechanical ventilation was required in 6 children (18.75%). No death occurred in infants while in the hospital. Conclusions: RSV has been found to be the main responsible virus. Management of bronchiolitis is usually symptomatic as recommended by most of the guidelines.

Short Term Outcomes of Stapled Hemorrhoidectomy Our Experience at GMC Srinagar

Short Term Outcomes of Stapled Hemorrhoidectomy Our Experience at GMC Srinagar

Effectiveness of structured teaching programme on knowledge regarding importance of mental health among B. Sc nursing students at Government College of Nursing Dewan-bagh Srinagar, Kashmir

The study aims to assess the effectiveness of structured teaching programme on knowledge regarding importance of mental health among B.Sc Nursing Students of first year at Govt. College of Nursing Dewan-bagh, GMC Srinagar, Kashmir. The methodology of the presents study was a pre experimental one pretest post test research design. Sample size of the study was 30 selected with purposive sampling technique. Self-structured knowledge questionnaire on importance of mental health was used for data collection. Data collection was done in the month of October 2022. Results: The study findings reveal with regard to the group the pre - test value is 11.6000 (SD±3.42) and the post-test value is 20.8667 (SD ±2.50). The difference between knowledge scores of pre-test and post-test was found statistically significant at P value 0.001. Hence structured teaching programme on knowledge regarding importance of mental health among B.Sc Nursing students of first year was effective and has increased the level of knowledge among them. There was a statistically significant association between pre-test levels of knowledge of samples with socio demographic variables (age, gender, domicile and source of information). Conclusion: The study concluded that the structured teaching programme was effective in enhancing the knowledge regarding importance of mental health among B.Sc Nursing students of first year students studying at Govt. College of Nursing Dewan-bagh, GMC Srinagar, Kashmir.

Fetomaternal Outcomes of Postdated Pregnancy: A Prospective Observational Study

Background: With increasing gestational age, the risk to the mother and the foetus increases. Our research aims to examine maternal and foetal outcomes in pregnancies that go over the scheduled delivery date in order to establish safe induction times and the most suitable delivery method. Method: This was a 6-month prospective observational study conducted in the Department of obstetrics and gynaecology, LD Hospital GMC Srinagar from July 2017 to December 2017. The patient provided written, fully informed consent. The non-random sampling strategy resulted in the inclusion of 100 patients in total. Results: We observed that with an average gestational age of (40.8±2.76) weeks, majority of our patients (77.8%) had gestational age of 40-41 weeks. Majority of our patients (65.6%) had NVD mode of delivery. Meconium stain liquor with fetal distress was indication for cesarean section for 29% of patients, followed by failure of induction as the cesarean indication for 25.8% patients. Respiratory distress syndrome was evident in 8.9%, meconium aspiration syndrome was found in 6.7% patients, 3.3% and there were two neonatal deaths. Conclusion: Fetal discomfort, meconium aspiration syndrome, and foetal hypoxia were all connected with postdated pregnancy among other perinatal issues. Postpartum haemorrhage (PPH), perineal tears, cervical tears, and shoulder dystocia were among the consequences of childbirth that were more likely to occur. Obstetricians find managing postdated pregnancies challenging, but with good advice and monitoring, they can reduce maternal anxiety and unfavourable outcomes. Keywords: Last menstrual period, Maternal complication, Postdated, Pregnancy outcome

Closure of Fasciotomy Wound Using Dynamic Dermal Approximation Technique

Purpose: Compartment syndrome is a surgical emergency that is managed by a fasciotomy. However, it is associated with complications, including long hospital stay, wound infection and osteomyelitis need for further surgery for delayed wound closure or skin grafting, scarring, delayed bone healing, pain and nerve injury, permanent muscle weakness, chronic venous insufficiency, cosmetic problems, and an overall increased cost of care. A need for an early closure technique that will decrease all the above complications is described in this study. Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between from January 2020 to December 2022.This hospital-based study was done on compartment syndrome patients where fasciotomy was done and the wound closed by dynamic dermal suture approximation technique and results reviewed and outcome assessed. Results: The technique was applied to a total of 12 patients with compartment syndrome. Ten of twelve patients in study were compartment syndrome of upper limb since severe lower limb trauma patients were excluded in view of need for other procedures. The wounds were divided into three classes as post burn, post trauma and post contrast extravasation. Wound closure was achieved in 75 percent of total cases and all of six post contrast extravasation compartment syndrome patients. Conclusion: Following a fasciotomy, wound closure is a topic that is often controversial. The preference for one technique over another is influenced by the availability of resources, institutional familiarity, and clinical scenarios. Dynamic dermal approximation sutures can be applied with minimal risk to most uncomplicated fasciotomies. The benefits are minimal complication, the best cosmetic outcome, and low cost. However, patients with a high risk of complications may need other methods. Keywords: Compartment Syndrome, Fasciotomy, Wound Closure Techniques, Negative-Pressure Wound closure

Study of Fingerprint Pattern in Relation to Gender and Blood Grouping amongst the Medical Students of GMC Srinagar

A study was conducted on MBBS students in GMC Srinagar. A total of 100 students was included in the study ofboth genders. A proper informed consent was taken from participants. For collection of fingerprint, a tabulatedproforma was be used. Black printers ink was used for creating an imprint by rolling the finger on ink and thenon paper (rolling method) A cello tape was used to seal the print and a magnifying lens was used for aiding inobservation. Imprints from all ten fingers were collected. Information about blood groups was collected fromstudent identity card. In a few cases where the information was not known, blood grouping and Rh typing wasconfirmed by slide agglutination method using antiserum A, antiserum B and anti serum D. The aim of the studywas to find out the correlation between gender, fingerprint and blood grouping in students of GMC. Results: Wenoted that majority of the subjects belonged to blood group O (37.2%), followed by B+ve(24.5%) and A+ve(23.5.Maximum subjects (97%) were Rh positive. The rest were Rh negative. Females had highest percentage of loops(44%) followed by whorls (41%). Males had the highest percentage of whorls (55.5%) closely followed by loops(39.4%).Blood group O-ve is correlated to fingerprint whorl followed by AB+ve with whorls and B+ve with loops.A+ve is correlated to whorls and O+ve with whorls and B-ve with whorls. Blood group A showed highest whorls(45.4%) followed by loops (41.25%) and arches (10.42%). Also males had predominantly whorls (44.2%) followedby loops (39.4%) and females had predominantly loops(44.29%) followed by whorls (41.7%). the purpose of thisstudy is to correlate the relationship between various patterns of fingerprints, gender and “ABO” blood groupsand “Rh” blood types in students of GMC Srinagar. Conclusion: blood group, fingerprint and gender can only beassessed independently to secure identity if an individual.

A STUDY ON THE PREVALENCE OF ANAEMIA AMONG PREGNANT WOMEN IN A TERTIARY CARE HOSPITAL IN KASHMIR VALLEY.

Introduction: Anaemia during pregnancy is a major health problem in South Asian countries and developing countries.World Health Organization (WHO) has dened anaemia in pregnancy as the haemoglobin less than 11g/dl. Predisposing factors of anaemia in pregnancy are young age, grandmultiparity, low socioeconomic status, illiteracy, ignorance and short interpregnancy interval. This study was done to know the prevalence and type of anaemia among pregnant women in Kashmir valley and study the factors that lead to the women being anaemic prior to pregnancy and gradually worsening of anaemia with each trimester. Materials And Method: A retrospective observational time based study was conducted from to mid October 2021 to mid January 2022 at Lalla Ded hospital , GMC Srinagar, Kashmir. Relevant patient data,ie. gestational age, parity, interpregnancy interval, same day haemoglobin estimation was collected from opd record register and analysed. The prevalence of anaemia was Results: 82.46%. moderate anaemia was most common (52.13%). The prevalence of anaemia was high among all the trimesters; 71.43% in rst trimester,86.5% in second trimester,80.5% in third trimester. Although the prevalence of anaemia was high in both primigravidae (76.72%) and multigravidae(85.51%), the prevalence of anaemia among primigravidae was less than multigravidae. Mild anaemia was more prevalent in primigravidas (24.66%) than multigravidas (19.56%) whereas moderate and severe anaemia was more in multigravidas. With interpregnancy interval of < 1yr, there was high incidence of moderate anaemia (85.71%). Whereas it was 31.25% when interpregnancy interval was between 1-<2yr. Conclusion: Most women enter pregnancy in an anaemic state, which is worsened as pregnancy progresses. Iron supplementation helps in decreasing the severity of anaemia, however the current measures are inadequate as high percentage of women in the third trimester suffer from anaemia(80.5%).Multiparity and interpregnancy interval < 1 yr was found to be important risk factors for anaemia.

Management of calcaneal fractures using the minimally invasive, the ilizarov ring fixation technique

Introduction: The calcaneal fractures usually result from high energy trauma such as fall from height, road traffic and industrial accidents. Calcaneal fractures constitute about 2% of all skeltal fractures. These fractures are usually displaced and intraarticular in about 60 to 75% of cases and the treatment varies accordingly, however there is still controversy regarding the treatment of calcaneal fractures.Materials and Methods: The current study retrospectively analyzed 30 cases of calcaneal fractures using the minimally invasive, the ilizarov ring fixation technique at the Postgraduate Department of Orthopaedics, Government hospital for Bone and Joint Surgery Barzulla, an associated hospital of GMC Srinagar from date June 2020 to June 2021.Results: There were 12 (40%) excellent, 9(30%) good, 5(16.66 %) fair and 4(13.33%) poor. We achieved good alignment in all cases except 4 (13.33%) feet and had varus deformity at the last follow‑up. Superficial pin tract infection occurred in 5 (16.66%) fractures which was controlled with local antibiotics and frequent pin care. The range of movement of the subtalar joint was >25° in 23 (76.66%) patients. In 7 (23.33%), the range of movement of the subtalar joint was

POS-003 ACUTE KIDNEY INJURY IN CHILDREN WITH COVID-19 RELATED MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C)

Although children with coronavirus disease 19 (COVID-19) generally experience a mild disease, a subset of them develop multisystem inflammatory syndrome (MIS-C) which can lead to multiorgan failure. There is relative rarity of literature regarding acute kidney injury (AKI) in MIS-C. We aim to characterize the clinical features, laboratory findings, and therapies for AKI in MIS-C in our setup. This was a 1 ½ year prospective study with patients from GMC Srinagar, its associated hospitals and Shifa Medical Centre, Srinagar. Children <21 years old who had AKI and met the criteria for MIS-C based on CDC guidelines were included in the study. A total of seven cases were included in the study ranging from 4 to 20 years (mean 11.4±5) with 4 females and 3 males. Persistent fever was present in all patients. Six children had vomiting/diarrhea along with rashes and/or swelling of hands. Myocardial involvement was seen in four, respiratory in two and musculoskeletal in one patient. Oropharyngeal swab for SARS-Cov2 RNA was negative in all the patients. Anticovid antibodies were positive in five patients and two had a history of contact with COVID-19 patients. AKI Stage 1 was present in 3, stage 2 and 3 in 2 patients each. Neutrophilia with lymphopenia was seen in all the patients and thrombocytopenia in 4 patients. Laboratory findings for inflammatory markers showed marked elevation of C-reactive protein (mean 87.6±72.1mg/l), ferritin (mean 810±224ng/ml), procalcitonin (mean 4.9±2.1ng/ml), ESR (mean 64.6±21.9mm/hr), fibrinogen (690±142.1mg/dl), LDH (mean 578.2±370.1U/L) and D-Dimer (mean 7.8±9.4 µgFFU/ml). The patients were treated with a combination of steroids, IVIg and inotropic support wherever needed. All of the patients recovered with a median duration hospital stay of 7 (IQR 5) days. Children with covid 19 infection should be carefully followed for MIS-C. Although children with MIS-C develop AKI, most of them have full clinical recovery. The long term prognosis of this syndrome is currently unknown until their follow up data becomes available in future.

Preoperative planning of primary total hip arthroplasty using conventional radiographs

Objective: The aim of this study was to present an analog method for preoperative planning of primary total hip arthroplasty procedures based on component measurements by overlaying the transparency of the prosthesis on preoperative radiographs and checking the accuracy, both for predicting the size of the acetabular and femoral components to be used and to restore offset and correct dysmetria if any. Methodology: From May 2019 to June 2022, 18 primary total hip arthroplasties were performed and were analyzed in 18 patients at the Post graduate Department of Orthopaedics GMC Srinagar. Measurements on femoral and acetabular components obtained by planning were compared to those used in surgery. Displacements measured through preoperative planning was compared with planning measured on postoperative radiographs. Dysmetria was assessed before and after surgery. Results: accuracy of 68.5% (p

Is This A Fact? Hypertensive Disorder in 1st Pregnancy Recurs in 2nd Pregnancy

Background: Hypertensive disorder of pregnancy (HDP) entails a risk of recurrence in a subsequent pregnancy. Several risk factors have been associated with recurrence of hypertensive disorder in pregnancy. There is also evidence that the different clinical forms of HDP may be related to each other. Therefore, in HDP studies, it may be preferable to include all clinical forms of the hypertensive disorder not only in the 1st pregnancy, but also in later pregnancies. Aim: To study recurrence of Hypertensive Disorder of Pregnancy in 2nd Pregnancy with regard to the type and time of onset of hypertensive disorder in 1st pregnancy. Methodology: The study was conducted at department of obstetrics &amp; gynecology Lalla Ded Hospital GMC Srinagar. 250 patients with history and maternity records of hypertensive disorder of pregnancy (HDP) in first pregnancy were followed on OPD basis till final outcome of second pregnancy to observe the recurrence of hypertensive disorder in second pregnancy with regard to type of hypertensive disorder and time of onset of hypertensive disorder in first pregnancy. Paired t-test &amp; Chi-square test was used. Recurrence rate of HDP was reported as percentage along with its 95% confidence interval. Two sided p-values were reported and a p-value of &lt;0.05 was considered statistically significant. Results: Out of 250 patients, 142 (56.8%) had gestational hypertension in 1st pregnancy with recurrence of different types of HDP of 101(71.12%) in present pregnancy. 43(17.2%) patients having preeclampsia/eclampsia in 1st pregnancy had recurrence of 25(58.13%) in present pregnancy. 55(22%) patients having Chronic hypertension in 1st pregnancy had recurrence of 49(89.09%) in present pregnancy.7(2.8%) patients diagnosed as having superimposed preeclampsia in 1st pregnancy had recurrence of 6(85.7%). Out of 3(1.2%) patients diagnosed as having HELLP syndrome in 1st pregnancy, the recurrence was 3(100%). Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (&lt;34 weeks) of gestation and was associated independently with higher age of pregnant women (&gt; 30 years), women belonging to urban areas and family history of HDP. Conclusion: Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (&lt;34 weeks) of gestation and was associated independently with higher age of pregnant women (&gt; 30 years), women belonging to urban areas, women with family history of HDP and also associated with higher cases of preterm and caesarean section deliveries.

MICROBIOLOGICAL PROFILE OF BRONCHOALVEOLAR LAVAGE IN PATIENTS WITH NOSOCOMIAL PNEUMONIA IN NEONATAL INTENSIVE CARE UNIT

Introduction: Intensive Care Units (ICU) are a major threat to nosocomial pneumonias with children being the most common victims of pneumonia. It is defined as manifestation of infection after 48 hours of hospital admission which can be also attributed to any procedures done to the patient. Aim: To find out the bacteriological profile in pulmonary involvement in the ICU setup and to determine the sensitivity patterns of these bacteria to the antibiotics by doing Bronchoalveolar Lavage (BAL). Materials and methods: Present study was a retrospective study conducted on children aged upto 1 month, who were admitted and ventilated for more than 48 hours and developed ventilator associated pneumonia (VAP) as per CDC criteria with the data collected between a one year period from June 2020 to June 2021 and was conducted at a pediatric tertiary care centre of GMC Srinagar, India. The study included 34 BAL samples received in the laboratory from these patients. Results and discussion: The most common bacteria found out from the 34 BAL specimens was Acinetobacter baumanii which accounted to 16 samples (47%) of the entire sample size. It was followed by Klebsiella pneumonia from 8 samples accounting to 23%. Pseudomonas aeruginosa was the third commonest with 6 samples accounting to 18%. Escherschia coli was isolated in 4 of the samples. Colistin was the only antibiotic which was seen uniformly sensitive (100%) among all the organisms isolated which was followed by tigecycline which was sensitive in 78% of isolated organism.