King George Hospital Research Articles

A STUDY ON FUNCTIONAL OUTCOME AFTER HIGH FIBULAR OSTEOTOMY IN MEDIAL COMPARTMENT OSTEOARTHRITIS KNEE.

Background: Primary Osteoarthritis of the knee is more prevalent than that of the other joints. Treatment for knee osteoarthritis can be broken down into nonsurgical and surgical management. Initial treatment begins with nonsurgical modalities and moves to surgical treatment once the nonsurgical methods are no longer effective. Various treatment modalities available include intraarticular injections, physiotherapy, visco supplementation, arthroscopic debridement, high tibial osteotomy, and knee replacement with uni compartmental arthroplasty. All of it has its complications. Hence, there is a necessity for a modest technique, easily reproducible, provides decent functional outcomes and associated with a smaller recovery period, and develops the quality of life for the affected patients. In this scenario, this study is designed to know the functional outcomes, when an osteotomy of the bula at proximal 3rd is performed in medial compartment osteoarthritis knee. The present study was conducted at the depart Methods: ment of orthopaedics Andhra medical college/ king George hospital Visakhapatnam between 2019 and 2021.Thirtypatients who fullled inclusion criteria were taken up for study n=30. Statistical Analysis: Statistical analysis was performed using SPSS version 19.0 statistical software for the window. Continuous variables were expressed as mean, ±SD, and dichotomous variables were expressed as percentages. A two-tailed t-test was applied to analyze the postoperative weightbearing ratio of knee joint space (medial/lateral compartment) data. In addition, the nonparametric test (Wilcoxson's signed-rank test) was applied to analyze the OKS, AKSS, and VAS scores. The chi-square test will analyze the Comparison of qualitative variable, and Comparison of the quantitative variable will be analyzed by independent samples unpaired T-test. A P-value less than 0.05 was considered to be signicant. Data will be entered in Microsoft Excel, and data analysis was performed using windows MEDCALC software on a personal computer. Results: Sample size of the present study was 30 (n=30). Average age of the patients was 56 years. with males accounting to 56.66% and female's 43.33 percent. There were 17 males and 13 females among the 30 patients. The majority of the patients have grade 2 medial compartment osteo arthritis. Preoperatively, the mean medial/lateral joint space ratio was 0.26+/-0.12, which increased in the postoperative phase, reaching 0.67+/- 0.29 after six months. Proximal bular osteotomy effectively reduces the pain of m Conclusion: edial compartment osteoarthritis. It also improves the mean vas pain score earliest postoperatively. We observed modest improvement in both oxford knee scores and American knee society score.

OUTCOME ANALYSIS OF DISTAL RADIUS FRACTURES TREATED WITH K-WIRES VS CASTING

Background Distal radius fracture has long been treated by closed reduction and casting . Although casting sufces in a proportion of cases, it may fail to maintaining the reduction is usually a problem. Hence, in a majority of cases, with cast satisfactory reduction can lost resulting in a poor anatomical and in some cases functional outcome. Percutaneous K-Wire xation1-3 is a simple way of providing additional stability to immobilization in casting an unstable fracture of distal radius in which acceptable anatomical reduction is obtainable. The technique is simple, minimally invasive and inexpensive. It is much less intrusive than other methods such as external xation. Though it has its own set of complications e.g. pin tract infection, supercial radial neuropathy etc. It still forms an effective tool in the surgical armamentarium for treatment of distal radius fractures. The present study was conducted at the de Methods partment of orthopaedics Andhra medical college/ king George hospital Visakhapatnam between 2020 and 2021.Sixty patients who fullled inclusion criteria were taken up for study n=60. They were randomly divided into two groups with 30 members each belonging to casting and k-wire xation groups. In Results both treatment methods radial length, ulnar variance, radial angulation are restored to near normal but correction of dorsal tilt is not complete. This is because the fact that volar ligaments are stronger on distraction before relatively 'Z' oriented dorsal ligaments. So, on distraction volar cortex is brought out to length before dorsal cortex preventing full correction of dorsal tilt.Cast immobilization alone could not maintain reduction in unstable fractures resulting in poor anatomical outcome.53% patients of cast immobilization had moderate to severe deformity, compared with only 11.76% patients of K wire and casting group having moderate deformity. At the end of 12 weeks, functional outcomes in the studied both types were almost similar with no signicant difference in DASH scores. At the end of the study, we concluded that Conclusion both the techniques of managements K wire xation and casting and closed reduction and casting gives near equal results in terms of functional outcome. Better anatomical reduction and maintenance of reduction can be expected with K wire xation and casting group.

REVIEW OF MATERNAL MORTALITY AT A TERTIARY CARE HOSPITAL - A ONE YEAR STUDY

Background:Mothers are the nurturing pillar of the family. When a woman dies, the consequences have the potential to affect not only the woman herself, but her family, society and the nation as well.In 2015 globally 303,000 women died of various causes related to maternity. Aim:To determine the Maternal Mortality ratio at the tertiary care hospital for a period of one year and to identify the causes and factors leading to Maternal mortality. Material and Methods:This was a retrospective observational study carried out in the department of Obstetrics and Gynaecology at Andhra MedicalCollege and King George Hospital, Visakhapatnam, which is atertiary care centre of North Andhra.The hospital runs one ICU and Obstetric HDU, one blood bank and emergency operation theatre round the clock to provide emergencyobstetric services and critical care to their patients.The female deaths which met the WHO Criteria for Maternal Death were included in this study.The details of all the maternal deaths from January 2021 toDecember 2021 were collected from the individual case sheets and facility-based maternal death review forms. Results:During the study period January 2021 to December 2021, therewere 18,892 live births and 86 maternal deaths. The MMR in thestudy period was 455.2/100,000 live births.The maximum number of maternal deaths was seen in the age group 20-25 years, 61 cases (70.93%).The number of maternal deaths were maximum in the low socioeconomic status group with 71 cases (82.55%). Type I delay was seen in 49 cases (56.97 %). Direct causes of maternal death in the study was due to abortion in 3 cases (3.4%), hypertension in 37 cases (43.02%), obstetric hemorrhage in 22 cases (25.58%), infection/sepsis in 21 cases (24.41%) and embolism in 3 cases (3.4%) The most common indirect cause of maternal death was anemia seen in 51 cases (59.3%) Conclusion:Hypertension, hemorrhage and sepsis continue to be the leading causes of direct maternal deaths and anemia indirect cause of maternal death. Majority of deaths are preventable and with proper strategies and focusing on the 3 delays, maternal deaths can be reduced.

A STUDY ON CLINICAL PRESENTATIONS AND LABORATORY PROFILE OF ACUTE GLOMERULONEPHRITIS IN CHILDREN ADMITTED IN A TERTIARY CARE HOSPITAL

Introduction: Acute glomerulonephritis is the most common reversible cause of kidney disease in children. Although most common presentations are oedema, hypertension, haematuria and oliguria, glomerulonephritis may manifest with atypical features. Aims and objectives: The aim of the study was to evaluate the frequency of various clinical manifestations of glomerulonephritis and to identify various abnormalities in laboratory prole in children with glomerulonephritis. Materials and methods: 30 children admitted in paediatric department, King George Hospital, Visakhapatnam with clinical features of glomerulonephritis were enrolled into the study . Data on clinical features, laboratory parameters and outcome was recorded. Results: Males were more commonly affected. Majority were in the age group of 9-12 years. Most common presentation was facial pufness. Atypical presentations were observed in 40% cases. Anaemia was observed in 50% cases. Hypertension was seen in 56% of cases. PSGN was commonest cause of AGN. Hypocomplementemia was seen in 80% cases. Conclusion: Even though most children with acute glomerulonephritis present with common clinical features, early identication of atypical presentations of acute glomerulonephritis should be emphasised as their prompt recognition can lead to reduction in mortality.

SURFACTANT THERAPY IN MECONIUM ASPIRATION SYNDROME AND ITS OUTCOME IN TERTIARY CARE HOSPITAL

Aims: To study the role of surfactant therapy in meconium aspiration syndrome and its outcome in tertiary care hospital. Objectives: To evaluate the efcacy of surfactant in the treatment of term and near term infants with meconium aspiration syndrome and their outcome in terms of duration and outcome of ventilation, duration of oxygen requirement,complications associated with meconium aspiration syndrome. Material and methods: 64 neonates admitted in NICU, King George Hospital, Visakhapatnam with symptoms of MAS were enrolled in the study, of them 32 were given surfactant and were taken as cases,32 were not given surfactant and enrolled as controls. Data on APGAR, need for resuscitation, baby weight, gestational age and laboratory prole were recorded. Those babies with downe's score >7 were given high dose(4ml/kg) of surfactant and were followed up. Results: There was a rapid fall in oxygenation index in 24hrs after administration of surfactant and improvement in PaO2/PAO2. In surfactant group mean duration of ventilation, oxygen supplementation after extubation and length of hospital stay were all signicantly low as compared to control groups. Conclusion: Surfactant administration improved PaO2/PAO2 signicantly in comparison to the control group with in 24 hours after delivery, indicating that surfactant aids in improving gaseous exchange at the alveolar capillary barrier in lungs.

FUNCTIONAL EVALUATION OF PROXIMAL HUMERUS FRACTURES TREATED BY PHILOS PLATING

Introduction Proximal humeral fractures are now recognized as an increasingly common fracture, accounting for 4%–5% of all fractures and 45% of all humeral fractures [1,2]. It is the third most common fracture, in people above 65 years of age, after fractures of the hip and distal radius [3]. These fractures have a bimodal distribution occurring either in young people after high energy trauma or in those older than 50 years with low- velocity injuries like simple fall [3]. 85% of these fractures are minimally displaced and are effectively treated with immobilization followed by early motion. The remaining 15% of these are either displaced or unstable. These fare poorly with non-operative treatment and are better treated with surgical intervention. Surgical treatment is necessary especially in young patients and active elderly people in order to prevent minimal dislocations of tuberosity or articular surface from compromising the long-term articular function. This study was planned to evaluate the outcome of proximal humerus fractures managed with PHILOS plate after approval by the Institutional Ethical Board. Aims And Objectives To evaluate the efcacy of PHILOS plate in the treatment of proximal humeral fractures and assess its functional outcome. To assess any complications that could arise postoperatively Early rehabilitation of the patient Methods And Materials Study Design: Hospital Based Prospective study. Study Period: October 2019 to September 2022. Study Setup: Study is conducted in Department of Orthopaedics, Andhra Medical College, Visakhapatnam. Study Population: Patients attending emergency/orthopaedic OP and admitted in department of orthopaedics in King George Hospital, Visakhapatnam with proximal humerus fractures and are classied according to Neer's Classication Sample Size: 30 patients admitted in the Department of Orthopaedics, King George Hospital, Visakhapatnam with proximal humerus fractures in the above said period. Results We have included 30 proximal humeral fractures in our study. Males dominated and left side is more common than right. Domestic falls are common than road trafc accidents. 2-part fractures are more common than 3- and 4-part fractures. All of them are treated with PHILOS stable angled plate. Complications like stiffness, screw penetration and supercial infection occurred in our study which are dealt appropriately. Signicantly, we could prevent varus malunion which is notable in our study. Rehabilitation started early with pendulum exercises and could achieve good range of useful movements for most of the cases. Average range of radiological union is 13.5 weeks. Conclusion PHILOS plate, stable, angled construct is used in all our cases and the results evaluation done with Constant Murley score which ranged 54 to 87. Our average score is 67.43 which is in concurrence with few of the studies. The rehabilitation after operation started early with pendulum exercises as soon as the patients compliance within the limits of pain. The range of movements in our study, abduction maximum range obtained is 120 to 150 degrees and forward exion 90 to 120 degrees and rotations average score is 7. Though we have few complications like stiffness of shoulder (5), AVN (1), intraarticular screw penetration (1), supercial infection (1) and subacromial impingement (1), we have dealt with all these complications appropriately. Signicantly, varus malunion did not occur in our study

TITANIUM ELASTIC NAILING SYSTEM IN MID-SHAFT CLAVICLE FRACTURE- A PROSPECTIVE STUDY.

Introduction: Young and active persons are liable for clavicle fractures, most common among Racing individuals ,sports persons and in athletes due to high velocity injury. Clavicle fractures are about 2.5% of all fractures and it is the most common .Satisfactory results with high union rates and less complications have been reported from various techniques for operating Clavicle fractures .The clavicle is a long bone with broad medial and at lateral end and is treated best with Intramedullary elastic devices. So, titanium elastic nailing system is the recommended procedure for all displaced midshaft clavicle fractures to reduce the rate of malunion , non-union, delayed union , symptomatic malunion, and Other complications. Aim Of The Study: To analyze the functional outcome of displaced middle third clavicle Fractures treated by titanium elastic nailing system that will keep the Anatomical shape and length of the clavicle. The study was provisionally approved by the institutionalMaterials And Methods: ethics committee, Andhra medical College, visakhapatnam. This prospective study of displaced midshaft Clavicle fractures treated by titanium elastic nail system was done at the Department of Orthopedics, King George Hospital, Andhra Medical college, Visakhapatnam, from September 2019 to September 2021. Over a period of 2 years with in my academic years from may 2019 to may 2022. Titanium elastic nailingConclusion: system for displaced midshaft clavicle fracture is a safe minimally invasive technique with good functional and radiological outcomes and has better cosmetic appearance . Clavicular fractures which are displaced at middle third are best treated with titanium elastic nailing system with less operative time of 30-45 minutes compared with clavicular plating which takes more than 60-90 minutes. This procedure has better functional outcome than conservative treatment . A good reliable sophisticated minimally invasive technique for midshaft clavicular fractures are xed by Closed nailing or minimal open reduction at fracture site.

A study of growth pattern and serum ferritin levels in transfusion-dependent thalassemic children on oral iron chelating agents (deferasirox) in King George Hospital, Visakhapatnam

Background: In India majority of thalassemia children are under transfused and receive insufficient chelation therapy. Only few researches on growth parameters from this region are available making it difficult to comprehend the loopholes of the disease and its treatment.Methods: It was a descriptive, prospective study of 50 cases of transfusion-dependent thalassemia children on oral iron chelator deferasirox observed during one year (November 2019-December 2021) at King George hospital, Visakhapatnam.Results: Most commonly affected were more than 6 years of age. 98% of the children had mean pre-transfusion hemoglobin of less than 8 g/dl with the temporal association of growth retardation. Weight (64%) was more affected than height (36%). Only 46% showed effective iron chelation after using deferasirox.Conclusions: 98% had low pre-transfusion hemoglobin and deferasirox alone was not an effective oral iron chelator resulting in growth retardation in the majority of children. Thalassemia that requires blood transfusions Children are at a high risk of developing morbidities such as growth retardation as a result of insufficient therapy. Many of them were the result of consanguineous marriage, suggesting the disease's genetic basis. 98 percent of children had low pretransfusion hemoglobin of 7 gm%, with a mean of 6.5 gm%, showing that blood transfusions were insufficient. There were no side effects associated with the use of deferasirox and it alone proved ineffective in lowering serum iron excess, highlighting the need to combine it with novel modalities to improve its effectiveness. Growth retardation is a common ailment and low hemoglobin levels increased with age, showing hypoxia as a cause.

Effectiveness of counseling in patients of breast and cervical cancer receiving chemotherapy and radiotherapy-prospective observational study

Cancer is one of the main problems in the India and world also. From the world health organization report (2022), 10 million deaths in the year of 2022 of the entire world. This reflects one in six deaths. Side effects are very common in the cancer treatment process i.e. chemotherapy, radiotherapy and chemo radiation therapy. Proper knowledge is required in these aspects. Sometimes these side effects lead to life threatening due to lack of knowledge on side effects management while patients are in the home. These patients also need counseling, consultation and about side effects management of their treatment. This counselling leads to not only the patient’s quality of life but also improve the patients’ psychological conditions during their treatment process. In our prospective observational study, the main objectives are checking the effectiveness of before counselling and after counselling with respect to patient’s side effect management and psychological effectiveness. Finally evaluate the outcome with the counselling in both breast and cervical cancer patients. We provide counseling for cancer patients in King George Hospital, Visakhapatnam, India. In our study we used EORTC QLQ – C30 (version 3) scale for comparison of with or without counseling in the areas of side effect management, effectiveness of psychological and nutritional in breast and cervical cancer patients. Finally in our study we noticed that mostly rural area and some urban people were lack of knowledge on side effect management of cancer treatment. By providing better counseling to these patients especially in rural area people for their treatment and create awareness of cancer in group counseling for care givers then automatically better side effect management was possible in cancer patients. Pharmacist counseling is one of the important services that has been associated with improved outcome.

Radiological and functional outcome of distal radius fractures treated with cast vs. plate-a prospective study

Fractures at the distal end of radius are one of the most frequent fractures1 encountered in the emergency department related to Orthopaedics. They have been treated since ages with closed manipulation and reduction, but maintaining reduction is a very difficult task, especially within a week after injury, after subsidence of swelling. Hence, in a majority of cases, casing gives a satisfactory reduction but can be lost, resulting in a poor anatomical and, in some cases, poor functional outcome. Displacement following conservative management with closed manipulation and casting, is an indicator of instability, and revision to correct the displacement by manipulation will not give a satisfactory alignment and thereafter resulting in poor functional outcome. Fractures at the distal end of the Radius, with displacement are considered unstable when alignment cannot be maintained after closed reduction in a plaster cast. For minimizing the loss of reduction in unstable distal radius fractures, various methods have been devised of which, Open reduction and internal fixation with plating provide better anatomical reduction and aids in early mobilization.Aims and Objectives: To study the functional and radiological outcome in distal end of the Radius fractures managed with cast vs. plate. Materials and Methods Study Design: Hospital-Based Prospective study Study period: November 2019 to October 2021 Study setup: Study will be conducted in Department of Orthopaedics, Andhra Medical College, Visakhapatnam. Sample size: Number of patients, who sustained distal end of the radius fractures attending King George Hospital from November 2019 to October 2021 will be chosen. Results: Both the treatment methods showed significant outcome at the time of post-intervention. While comparing the radiological parameters at 6thweek and 6thmonth, casting group have more significant changes in radiological parameters than the plating group which indicates that plating helps in maintaining reduction better than casting. Mean DASH scores were compared in two groups at the end of six weeks and six months. At end of six weeks p-value was 0.33 (˃0.05) and at end of six months p-value was 0.0048 (

A STUDY OF PROGNOSTIC SCORES TO PREDICT THE OUTCOME IN CEREBRAL VENOUS THROMBOSIS

Background:Cerebral Venous Thrombosis (CVT) is a multifactorial condition with wide clinical presentation. They have favourable prognosis but 15% die or become dependent. Hence, there is need for user friendly risk scoring system which helps in clinical decision making and predicting prognosis. Methods:The present study was a prospective observational study of CVT patients from April, 2018 to February, 2019 at Department of Neurology, King George Hospital, Andhra Medical College, Visakhapatnam, and followed up for three months. Patients with confirmed diagnosis of CVT based on history and radiological findings were studied. All the patients were assessed for CVT Grading Scale, CVST Scoring and CVT Risk Score. Results:Sixty-six CVT patients were enrolled with mean age of 32.4years. CVT Risk score can predict poor outcome if cut off score is above 3 with sensitivity of 92 % and specificity of 20 %. Prediction of prognosis and brain lesions by CVT risk score analysed by Fischer exact test is highly significant (p= 0.00). CVT Risk Score and CVT Grade Scale had high sensitivity in predicting prognosis at one and three months. CVT grading scale with mild scores had good outcome and those with severe grading had poor outcome. Conclusion:Prognostic Scores in Indian population was a novel study in CVT patients. Despite low specificity, it can be used to avoid unnecessary or dangerous intervention in low-risk patients and identifies high-risk patients with poor prognosis, who require intensive interventions, such as local IV thrombolysis and decompressive surgery.

COMPARISON OF SEVERITY AND CLINICAL OUTCOMES OF PATIENTS WITH COVID-19 FROM MULTIETHNIC BACKGROUNDS IN A TERTIARY CARE CENTER

TYPE: Abstract TOPIC: Chest Infections PURPOSE: To evaluate association between severity of COVID-19 infection in hospitalised patients belonging to different ethnic backgrounds. METHODS: Retrospective analysis of 728 COVID-19 affected patients admitted to King George Hospital and Queens Hospital between April 2020 and March 2021. Ethnic groups included were White (British), Asian, Black, White (Other) and others. Admission chest X-ray was classified as mild (score less than 6), moderate (between 7 and 12) and severe (more than 13) using a semiquantitative severity score. Rates of admission to intensive care unit, modes of respiratory support required and mortality were also compared between the groups. RESULTS: Of the 728 patients admitted, White (British) constituted 51% of total patients. X-ray data was unavailable for 9% (n=51). Severe X-ray scores was found in 12% of White (British) and 15% of patients from other ethnic background (p=0.24), whereas moderate scores were seen in 33% and 39% respectively (p=0.07). ITU admission was required in 11% of white (British) compared to 20% from other ethnicities (p=0.001). Continuous positive airway pressure (CPAP) was required for 21% vs 26% (p=0.12) and mechanical ventilation for 5% vs 10% (p=0.013) of White (British) and other ethnicities respectively. Proportion of death was more in White (British) as compared to other ethnicities (12% vs 5%; p=0.001). CONCLUSIONS: There was no significant difference in chest X-ray severity amongst COVID-19 patients from different ethnic backgrounds. Requirement of mechanical ventilation and ITU admissions were significantly more among non-whites, whereas mortality was more in White (British). CLINICAL IMPLICATIONS: Ethnicity did not have a substantial prognostic factor in Covid-19 survival. DISCLOSURE: Nothing to declare. KEYWORD: Continuous positive airway pressure -CPAP, MV- mechanical ventilation, ITU- intensive therapy unit

Post-Covid Cerebral Mucormycosis, Varied Presentations and Surgical Strategies of a Newer Epidemic: An Institutional Experience.

During the challenging second wave of the COVID-19 pandemic, we encountered a most dreadful fungal infection in the form of COVID-associated mucormycosis (CAM), with a varied pattern of presentation from previous experience. Patients presented with simple fungal sinusitis or more complicated brain abscesses, and newer manifestations such as skull osteomyelitis. We report our findings and innovative treatment strategies used to manage this morbid condition. To study the various presentations and surgical strategies in treating post-COVID rhino-orbito-cerebral mucormycosis (ROCM). Observational cross-sectional study. From May to October 2021, 270 patients with CAM were admitted to Andhra Medical College Department of Neurosurgery, King George Hospital, Visakhapatnam, India. A cohort of 61 cases with intracranial involvement was studied in detail. The varied presentations and different or innovative treatment modalities were analyzed. The death rate was 30/270 in the whole cohort, and three deaths (4.9%) occurred in 61 cases with cranial involvement. Thirty-three (54.1%) of the 61 cases were treated surgically: 17 patients required bone excision (for focal osteomyelitis) and 16 cases required abscess drainage/excision. Post-COVID mucormycosis (especially with intracranial involvement) is a highly challenging entity. A multidisciplinary approach with early and aggressive anti-fungal medication combined with timely surgical interventions offers some hope of overcoming this complex infection in CAM patients. We identified some novel techniques during regular follow-up that have proven helpful in combatting this devastating condition.

STUDY OF CORRELATION OF FOETAL BRAIN WEIGHT TO FOETAL TOTAL BODY WEIGHT TO ASSESS THE DEVELOPMENT OF BRAIN

Background: Owing to the present-day usage of advanced development of ultrasonographic technique with high resolution scanning, one is able to identify, analyse and report the congenital abnormalities of rd developing foetuses in their intrauterine life with great specicity. As the development of neural tube begins very early as 3 week of intrauterine period, a clinician is able to detect neural tube defects at a very early stage. The normal growth of the brain during the intrauterine period can be estimated by assessing the ratio of foetal brain weight to the total body weight of the foetus by measuring the various parameters of the foetuses. The weight of the foetal brain varies in various conditions like congenital heart defects, intrauterine growth retardation, microcephaly, neural tube defects associated with folic acid deciency and due to various teratogenic factors. So, studying the ratio of foetal brain to total body weight is useful tool to diagnose various conditions. Methodology: A total of about 100 foetuses of different gestational ages were collected from the Gynaecology and Obstetrics department in King George Hospital and Victoria General Hospital, Visakhapatnam. It was ensured that the foetuses are properly embalmed as soon as they are procured and foetal height, weight and other important parameters required for the study were taken. Results: The ratios were calculated for gestational ages from 13 to 40 weeks. The ratio for brain declined very slowly throughout the period examined. An observation of practical importance of the brain weight/bodyweight ratios was virtually constant after 30 weeks of gestation. Conclusion: In this study foetal body weight is compared with the brain weight to correlate the subsequent brain development according to the weight of the foetus. By this study we can understand the foetal brain growth and compare results attained with the readings of foetal brain vol / weights got by non-invasive techniques like ultrasound, MRI scanning and identify the affected brain development in various conditions like congenital heart defects, intrauterine growth retardation, syndromes with associated microcephaly, zika virus infections and genetic anomalies etc

English

BACKGROUND Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia1 in mechanically ventilatedchildren that develops after 48 hrs of initiation. It is one of the leading causes of morbidity and mortality among hospital-acquired infections.2,3 VAP complicates 8-28 % of the children receiving mechanical ventilation. The incidence of VAP is estimated to be 3 to 10 % of the ventilated PICU children in developed countries. Studies from India have shown a contrastingly high range of VAP rates of 6 % to 46 %. The mortality rate with VAP considerably increased, varying from 24 to 50 % and can reach as high as 76 % when high-risk pathogens cause lung infection.4 Several risk factors predispose to VAP development during mechanical ventilation, as shown in different studies. Most of the risk factors are preventable, which can reduce the incidence of VAP when appropriately managed. As there is an increased use of mechanical ventilation in developing countries like India because of delays in reaching the hospital, the condition of the child is critical. The poor living conditions of the children who come to the tertiary care centres from remote rural areas often present with poor general conditions. We wanted to know about the risk factors, organisms causing VAP, their antibiotic sensitivity, and for optimal VAP management to reduce health care costs, guide antibiotic therapy, and reduce the morbidity and mortality associated with the VAP. METHODS A prospective observational study was done at PICU, King George Hospital, Visakhapatnam from December 2018 to July 2020 for a period of 20 months on children aged > 1 month to 12 years, who were kept more for than 48 hours in PICU. The sample size was 126. RESULTS All PICU children between theage group of > 1 month and < 12 years who received mechanical ventilation (MV) for > 48 hours were consecutively enrolled in the study. A total of 126 children were enrolled during the study period. CONCLUSIONS VAP is an important nosocomial infection in PICU with an incidence of 26 % and was associatedwith a high mortality rate of 38.5 %. Gram-negative bacilli (acinetobacter and klebsiella) were the important causative agents that were nearly resistant to commonly used antibiotics. KEY WORDS ARDS, BAL, CPIS, ETA, VAP, MDR, MASA. HF, PAWP.

English

BACKGROUND Respiratory distress syndrome (RDS) is a common condition in preterm and late preterm neonates with age less than or equal to 34 weeks or weight < 1.5 kgs need some intervention like intubation, and administration of surfactant. Early administration of surfactant can give better outcome. We wanted to assess the outcome of babies administered with surfactant. METHODS New-born babies with respiratory distress admitted to NICU, Department of Paediatric, King George Hospital, Andhra Medical College, Visakhapatnam, Andhra Pradesh, were enrolled in this case control study. A total of 100 neonates of both sexes who were admitted with respiratory distress syndrome of < 35 weeks and < 1.5 kg were included in the study. RESULTS Out of 100 neonates, most of the neonates 34 (66.6 %) in the surfactant group and 37 (75.0 %) neonates in the control group were between 30wks to 32wks of GA respectively. 12 (25.0 %) in the surfactant group and 10(19.4 %) in the control group were between 27wks. to 29 wks. of GA respectively. Very less 4 (11.76 %) in the surfactant group and 3 (8.10 %) in the control group were between 32 wks. of GA to 35 weeks respectively. CONCLUSIONS The study concludes that among spontaneously breathing premature infants treated with INSURE, decreases the need for subsequent MV by 22 %. The higher birth weight, the use of antenatal steroids, the lower RDS score at the time of procedure and the early use of surfactant are the good predictors in the INSURE success group. KEY WORDS RDS, Preterm, Intubation, Surfactant (INSURE), GA (Gestational age), MV (Mechanical ventilation), Pulmonary Haemorrhage, CPAP.

Various surgical modalities for cerebral mucormycosis - our institutional experience, King George Hospital, Andhra Medical College, Visakhapatnam, India

Various surgical modalities for cerebral mucormycosis - our institutional experience, King George Hospital, Andhra Medical College, Visakhapatnam, India

Epidemiology of mucormycosis in post-COVID-19 patients treated in a tertiary care hospital, Visakhapatnam, Andhra Pradesh.

Mucormycosis is associated with high mortality (45-90%) in average-income countries including India. Prevention of mucormycosis associated with coronavirus disease 2019 (COVID-19) or in patients recovering from COVID-19 needs a further understanding on epidemiology and underlying risk factors. A hospital-based observational cross-sectional study was performed in a dermatology ward and neurosurgery ward, King George Hospital, Visakhapatnam (dedicated wards for mucormycosis), during May-June 2021 (60 days). After obtaining permission from Institutional Ethics Committee, the convenience sampling method was used and 115 cases admitted for mucormycosis who are post-COVID-19 patients were included in the study. Complete case history including the demographic data and signs and symptoms including the course of hospitalisation for COVID-19 was collected through a semi-structured questionnaire, and detailed clinical examination was conducted in relation with mucormycosis. Data collected were entered in MS excel 2010, and the analysis was performed using SPSS Version 21 for testing the level of significance with P < 0.05. The majority of the patients belong to the 51-60 years (31.3%) age group, and 76.5% of them were females. Diabetes mellitus (76.5%) was the most common co-morbidity. Inhalational oxygen was given to 68 (59.1%) of patients. Pain in the eyes and nose was the most common complaint in patients with mucormycosis. Oxygen therapy during hospital admission and the presence of co-morbidities were significantly associated with findings of broad aseptate fungal hyphae on KOH mount. Prevention of COVID-19-associated mucormycosis needs to focus on aiming for appropriate oxygen therapy and better glycaemic control in COVID-19 patients and monitoring the use of systemic corticosteroids in treating severe cases.

IMAGING OF RHINO-ORBITO-CEREBRAL MUCORMYCOSIS A PROSPECTIVE OBSERVATIONAL STUDY IN THE SETTING OF COVID 19 PANDEMIC IN A TERTIARYCARE CENTRE IN AP, INDIA

Background: Rhino-orbito-cerebral mucormycosis (ROCM) is a potentially fatal fungal infection that commonly affects diabetic and other immunocompromised patients. Necrotizing and angioinvasive features of this class of pathogenic fungi facilitate spread from sinuses into orbit and brain with devastating consequences. Early diagnosis and timely intervention is key to successful treatment Objective: To interpret the Imaging ndings of all patients presented with ROCM at various stages on CT and MRI . Materials and methods: This prospective observational descriptive study was conducted in the Department of Radiodiagnosis, Andhra Medical College, King George Hospital, Visakhapatnam, India from April 2021 to August 2021 for 5 months. Reviewed 100 patients of adult age group with strong clinical complaints suggestive of ROCM predominantly by MRI and also by CT Results: We presented 100 cases of ROCM to emphasize effectiveness of magnetic resonance imaging (MRI) in diagnosis of this potentially fatal form of mucormycosis.. CT and MR imaging of 100 patients showed predominantly pan-sinus involvement (67%). Extension to the orbit and face (66%) preceded involvement of the deep skull base (62%) and brain (40%). Bone erosion was seen less often (40%), with rest (60%) of the patients showing extra sinus extension across grossly intact appearing bones on imaging. Conclusion: CT and MRI show a spectrum of ndings in rhinocerebral mucormycosis. Imaging plays a major role in assessing the extent of involvement and complications. DWI may add specicity to the diagnosis by showing restricted diffusion in the path of fungal invasion. Thus Magnetic resonance imaging is highly useful imaging modality for the diagnosis of ROCM and for staging of the disease.

Epidemiological Profile of Snakebite Cases in King George Hospital, Lucknow

Epidemiological Profile of Snakebite Cases in King George Hospital, Lucknow