Mohan Kumaramangalam Medical College Hospital Research Articles

Posterior urethral valve in neonates - overview in a tertiary care center

Background: Posterior urethral valves are a unique obstructive pathology occurring in male children. Although known to present during various age groups when diagnosed in the neonatal period itself the outcome is better. Aims and Objectives: To study the incidence, clinical presentation, investigations, and management of neonates with posterior urethral valves and compare with literature. Materials and Methods: Retrospective study of neonates admitted to Government Mohan Kumaramangalam Medical College Hospital in South India for 1 year from August 2022 to July 2023. Results: Of a total of 16 cases studied the age of incidence of posterior urethral valve is 1–28 days with antenatally detected in nine cases. Fulguration was done in all 14 cases with vesicostomy in one case, bilateral ureterostomy in one case, and death in one case. Conclusion: Posterior urethral valve is a rare neonatal disease which is most often diagnosed antenatally. The investigations and modalities of management in our institution are inline with other studies in literature.

Clindamycin Resistance Detection among MRSA at a Tertiary Care Hospital: A Cross-sectional Study

Introduction: Antimicrobial resistance is on the rise, posing a global threat to the success of modern surgical procedures. A common and notorious superbug causing community and hospital-acquired infections is Methicillin-resistant Staphylococcus aureus (MRSA). Its potential for easy and rapid spread leads to increased mortality in hospitals. Clindamycin, a relatively inexpensive and effective drug, is empirically prescribed for the treatment of MRSA infections. Due to the risk of misidentifying clindamycin resistance as susceptibility, leading to treatment failure, its judicious use after D-test is advocated. Aim: To isolate Staphylococcus aureus (S.aureus) from various clinical specimens and to identify MRSA using cefoxitin disc (30 μg), further determining the incidence of inducible clindamycin resistance among MRSA by the disc diffusion method (D-test). Materials and Methods: The present cross-sectional study was conducted in the Department of Microbiology, Government Mohan Kumaramangalam Medical College Hospital (GMKMCH), Salem, Tamil Nadu, India, from June 2023 to August 2023. Study was conducted using 185 S.aureus isolates collected from samples received from patients of all genders treated at the present study hospital. Various clinical samples such as pus, sputum, blood, urine and fluids collected from patients treated at the study Institute Salem during the study period were included. A cefoxitin disc (30 μg) was used to detect MRSA among the 185 S.aureus isolates by disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines, which were further tested for clindamycin resistance using clindamycin (2 μg) with erythromycin (15 μg) discs by the D-test. The data of the study were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Further descriptive statistics and a chi-square test with a level of significance, p-value ≤0.005 (statistically significant), were used. Results: Among 185 S.aureus isolates, 130 (70.27%) were Methicillin-sensitive S.aureus (MSSA) and 55 (29.7%) were MRSA. Inducible clindamycin resistance was observed in 22 (40%) isolates, while 17 (30.9%) isolates showed constitutive resistance, 9 (16.36%) showed the MS phenotype, and the remaining 7 (12.72%) showed the susceptible phenotype. Among the clindamycin resistance patterns in MRSA, inducible clindamycin resistance was reported predominantly. Conclusion: The majority of S.aureus was isolated from pus samples, highlighting its importance as a pyogenic microorganism. The current study records a high rate of MRSA resistance among S.aureus isolates. The present study reports a higher rate of inducible clindamycin resistance among MRSA isolates when compared to other phenotypes of clindamycin resistance. Therefore, routine D-testing must be implemented to identify inducible resistance to clindamycin in MRSA to avoid treatment failure.

A novel approach of neoadjuvant and adjuvant therapy with surgery for large keloids of the ear

Background: Ear keloids form after ear piercing in genetically predisposed young adults, causing cosmetic disfigurement and negative psycho-social impact, and reducing quality of life. Total excision of ear keloids leads to loss of ear tissue distorting ear framework and reconstruction to restore esthetically pleasant ear causes scarring and more aggressive keloids. Rate of recurrence is higher than 80% when surgical excision alone is done. Aims and Objectives: The study was conducted to compare the efficacy of intralesional triamcinolone acetonide (TAC) or 5-fluorouracil (5 FU) as monotherapy, combined TAC+5 FU and multi-modal therapy (TAC+5 FU+surgical excision) for keloids of the ear. Materials and Methods: The prospective comparative study included 30 patients who presented to the out-patient clinic of plastic surgery department of Government Mohan Kumaramangalam Medical College Hospital, Salem for a duration of 2 years from January 2021 to December 2022. Patients were categorized into three groups based on size of ear keloids, Group I (10) – Injection TAC (A) or 5- FU (B), Group II (10): Injection TAC+5-FU, and Group III (10): Injection TAC+5- FU+Surgical excision (A – neoadjuvant+adjuvant; B – only adjuvant). Results: Of a total of 30 patients, Group IIIA showed significant reduction of keloid with least side effects, most pleasing cosmetically (Patient and observer scar assessment scale 1/10). No recurrence in follow up. Conclusion: Multi-modal therapy consisting of neoadjuvant TAC+5-FU, surgical excision, and adjuvant TAC+5 FU offers the best long-term results for large ear keloids.

FETOMATERNAL OUTCOME OF PATIENTS WITH FEVER DURING TERM PREGNANCY

Introduction: Fever in pregnancy is a common clinical problem globally. The risk to the mother and fetus is signicantly increased in pregnancy complicated by infection and fever. Fever is one of the most frequent reasons for emergency consultation during pregnancy and may be associated with signicant adverse outcomes, these being maternal (sepsis, organ damages) obstetrical (miscarriage, preterm birth, chorioamnionitis) or fetal (malformations, fetal demise). However, only one study including mainly second and third trimester pregnant women, evaluated causes of acute undifferentiated fever and 25 % of women had no identied cause. A hospit Methodology: al based analytical cross sectional study was analysed the maternofetal outcome of 50 cases of fever during term pregnancy and the outcome of 50 cases without fever in term pregnancy and it was studied between 2020-2021 at Govt. Mohan Kumaramangalam medical college, Salem. During the study cases were selected with pregnant women at term gestation with or without fever admitted in Labour ward and Antenatal ward of Govt. Mohan Kumaramangalam medical college hospital. The patients recruited for the study underwent Clinical history, General examination, Obstretic examination, CTG and USG Obstretics, fever ivestigations. In the group 1, Patients of 37weeks completed mothers with fever for more than one day and in the group 2 healthy AN mothers of 37weeks completed gestation were included. Fetal outcome will be studied by t Results: aking variableslow birth weight, intrauterine growth retardation, preterm delivery, neonatal sepsis and perinatal death.Maternal complications –post operative wound infection, post-partum haemorrhage, pneumonia, septicemia, jaundice, hypoglycemia and other complications of specic fever will be studied. Most common cause of fever in pregnancy was respiratory tract infections. Urinary tract infection was the second common cause. Pregnant women with fever 24% had Hypotension and 56% had Tachycardia. Pregnant women with fever had almost half the delivery with meconium stained signicantly. Among 50 delivered fever mothers, 24% cases were Previous LSCS cases, 44% cases went into spontaneous labour, only 32% cases induced. Out of 32% cases induced, 50% cases were delivered vaginally and 50% Cases underwent caeserean sections. So, Fever did not signicantly affect labour onset and the mode of delivery. Signicantly NICU admission was required among the fever cohorts Fever during pregnancy is a common occurrence that can lead to a wide range of issues Conclusion: for both the mother and the foetus and newborn. Because the most prevalent causes of fever are preventable, there has to be a greater emphasis on the importance of being aware of how to avoid such illnesses in order to avoid life-threatening foetomaternal consequences.

FEMALE PREDOMINANCE OF ANOSMIA IN COVID-19 INFECTION

Covid-19 is a pandemic that has changed the very structure of the world in the past year. Anosmia was not mentioned as a symptom during the first wave of the pandemic. Still, recent literature from both Western and Chinese started describing anosmia as an early symptom along with other flu-like symptoms. This paper discusses whether anosmia can be used as an early diagnostic symptom and if there is a female predominance of anosmia in Covid-19 patients. We used 290 Covid-19 positive patients from Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India. The results of our study demonstrated that there is a female predominance of anosmia in Covid-19 patients. Anosmia can be used as an initial diagnostic tool for the infection.

Effectiveness of Mannheims peritonitis index in predicting the mortality and morbidity in patients with hollow viscous perforation in GMKMCH, Salem

Background: Successful management of peritonitis is a challenge to surgeons inspite of various advancements in medicine and surgical techniques. The outcome depends on various factors and early intervention. This led to the development of disease severity grading systems that would help grouping the patients by individual risk factors and appropriately predict possible outcome.Methods: The prospective study was conducted in the Department of General Surgery, Government Mohan Kumaramangalam Medical College Hospital, Salem. The study population included 100 patients presenting with perforative peritonitis in the emergency department. Preoperative data like age, gender, preoperative symptom duration and operative data like appearance of exudate, extent of exudates, source of sepsis where noted. Tissue biopsies were followed up. Duration of hospital stay and other postoperative complications were also noted. Patients were followed up till their discharge. The study end point was at patient’s discharge or death.Results: Among the patients who had the maximum score >29, 11% of the patients belonged to age group beyond 50 years. Mortality was 7%. The specificity and sensitivity of morbidity prediction was 89% and 88.9% respectively. The specificity and sensitivity of mortality prediction was 91.40% and 100% respectively. Mortality was highest in patients with score >29.Conclusions: Mannheim peritonitis index is a simplified scoring system with variables that can be assessed preoperatively, intraoperatively and postoperatively, to assess mortality and morbidity and instil appropriate treatment protocols which will bring out a positive outcome in the patients and increase survival rate.

Incidence of congenital anomalies in newborn in tertiary care hospital

Background: Just about three decades ago (1976) congenital malformations comprised 8% of perinatal deaths, from available data and ranked fifth as a cause of perinatal mortality. But the trend is rapidly changing over the years. perinatal death was due to congenital malformation, is the second commonest cause. This changing trend over years warns us that with the control of nutritional and infectious diseases, congenital malformations will come to the forefront as it is in India. To find out the incidence of congenital anomalies in stillbirth. And the probable etiology of congenital anomalies.Methods: The study was conducted at Government Mohan Kumaramangalam Medical College Hospital, Salem in the year 2017 August- September 2018. Totally 5000 babies born of consecutive deliveries were taken for the study, over the period of one year. All mothers were interrogated within 48 Hours of delivery as per the proforma prepared, which contains the following particulars like, maternal and paternal age, consanguinity, detailed antenatal history with reference to exposure to teratogens, especially during 1st Trimester.Results: Of the five thousand consecutive deliveries 48 deliveries were multiple delivers and a number of stillbirths were 108. The incidence of congenital anomalies was 30.4 per 1000 live birth (152 cases). Major malformations were present in 20.8 per 1000 (104 cases) while minor malformations were 9.6 per 1000 (48 cases).Conclusions: Incidence of malformation were higher in preterm babies 6.31%. Incidence of malformations were higher in male babies, especially genitourinary system anomalies. Antenatal events in the 1st trimester like fever, drug intake could be implicated in the etiology of malformations especially neural tube defects in our study.

Etiological factors, clinical profile and outcome of meconium aspiration syndrome babies

Background: Meconium staining of amniotic fluid has for long been considered to be a bad predictor of the fetal outcome because of its direct correlation of fetal distress, and increased the likelihood of inhalation of meconium, resultant deleterious effects on the neonatal lung. To evaluate etiological factors and severity of MAS in the study group.Methods: This study was done in the Neonatal intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital Salem, Tamil Nadu, India in the year 2018. Complete maternal and neonatal details were recorded in to the proforma. Delivery details, resuscitation did were also recorded.Results: In present study, fetal distress was found to be the most common (42.5%) factor associated with MAS followed by PIH (21.6%) and PROM (17%). 22 (9.1%) cases were associated with Postdatism, 18 (7.5%) cases were associated with placental insufficiency. 88 babies had fetal distress (36.6%) prior to delivery. 138 babies had no fetal distress (57.5%).Conclusions: MAS is known to cause severe respiratory distress and Downe’s score ranging between 4-8, usually a few hours after the onset of respiratory distress. Nearly 73.3% of the cases with MAS had birth asphyxia, out of which 30% had severe birth asphyxia. This indicates that passage of meconium can occur in utero, often considered a feature of the stressed fetus. Undoubtedly aspiration had occurred before delivery in these babies.

Pediatric risk of mortality III score in predicting mortality in children with altered sensorium in pediatric intensive care unit

Background: The Pediatric Risk of Mortality (PRISM) Score has been devised to predict outcome and risk of mortality. The PRISM III score is one of the most recent scoring systems of pediatric mortality. This was developed involving 32 PICUs. Physiological data included the most abnormal values from the first 12 and second 12 hours of the PICU stay. To evaluate the mortality rate in children with altered sensorium by applying PRISM III (pediatric risk of mortality) score.Methods: This study was done in the paediatric intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India on 100 children of both sexes aged between 1 month and 13 years. The study was carried out for a period from December 2017 to July 2018. PRISM III scoring scale was applied for every child in his/her first 24 hours of PICU admission and their calculated score was recorded into the proforma. The clinical details at admission, laboratory data were recorded into the proforma.Results: Three major groups that contributed to the bulk of the admissions were acute CNS infection, seizure disorder and, bites and stings. They constituted to around 54% of our total admissions. As PRISM III Score increases there is a steady increase in the mortality rate. This table shows that the mortality rate is 0% for the 0-9 group and that it increases to 100% for 20-29 and 30 and above groups as the PRISM III score increase.Conclusions: PRISM III score provides an objective assessment of the severity of illness. PRISM III, when performed well, is good to predict mortality in an Indian PICU. Scoring systems with fewer laboratory parameters will be more useful in author’s context. Larger studies are needed to develop/validate a mortality prediction score for our country.

CADAVERIC STUDY OF MORPHOMETRIC ANALYSIS OF ANTERIOR CRUCIATE LIGAMENT AND ITS SIGNIFICANCE

Introduction: To determine the accurate morphometric data pertaining to the Anterior cruciate ligaments in relation to the south Indian population. Aims And Objectives: To analyse the following parameters of Anterior cruciate ligament of the knee joint. Length and Width of Anterior Cruciate Ligaments as well as the extent of their variations. Methods & Materials: The study was carried out in the Department of Anatomy of Govt. Mohan Kumaramangalam Medical College Hospital, Salem. Subjects having no obvious macroscopic deformities of their knee joints and ages ranging between 30 years to 60 years of both sexes were only chosen. 30 knee joints belonging to 15 cadavers matching the above criteria were dissected for the study. Result & Analysis: The mean length of the ACL of left side was recorded to be 28.06mm and the mean width of the ACL in its middle third was recorded to be 10.33mm in the Left side. The mean length of the ACL for the right side was found to be 28.53mm and mean width of the ACL in its middle third on the right side was found to be 10.23mm. Conclusion: This study will provide valuable information related to the length and width of the Anterior cruciate ligament in South Indian population for cruciate ligament reconstruction. Keywords: Morphometry, cruciate ligaments, knee joint

A study on the length of stay of neonates in neonatal intensive care unit in a referral hospital in India

Background: Estimate of length of stay is important while counseling the parents of preterm infants and also make them prepared psychologically.Methods: A retrospective study done in the Neonatal Intensive Care Unit (NICU) of Government Mohan Kumaramangalam medical college hospital, Salem, Tamil Nadu, India between December 2017 and November 2018. All the neonates admitted during the study period formed the study group.Results: There were 3902 neonates admitted in the NICU during the study period. The mean duration of stay of neonates in the NICU during the study period was 7 days. Out of 3902 neonates in the study group, 37 (0.94%) neonates stayed less than 24 hours, 2208 (56.58%) neonates stayed for 1 to 5 days, 929 (23.8%) neonates stayed for 6 to 10 days, 668 (17.11%) neonates stayed between 11 to 30 days, 41(1.05%) neonates stayed for 31 to 60 days and 7 (0.18%) neonates stayed for more than 61 days. About 45% of neonates in the birth weight category of 1001 to 1500g stayed for 11 to 30 days. A similar trend was also observed in the analysis of length of stay of 29 to 32 weeks preterm neonates.Conclusions: Every hospital should have their own data to predict the length of stay of neonates in NICU. Future directions should include strategies in reducing the length of stay in NICU thereby optimising resources for the parents and the country.

Definitive surgical treatment for diabetic forefoot ulcer

Background: Diabetic foot ulcers are common among 15% of the diabetic population, at one stage of life that may progress to minor or major amputation, because of not healing with all modalities of the treatment. Since recurrent rate is >90%. But the surgical treatment of the forefoot ulcer so-called surgery offloading will heal the ulcer within a short time and prevent minor of major amputation. The purpose of this study was to compare different outcome measures in the audit of the management of diabetic foot ulcers.Methods: Totally 20 diabetic patients were included in the study. The study was conducted in the department of plastic surgery, Government Mohan Kumaramangalam Medical College Hospital, from 2016-2018. Followed 20 patients with a surgical procedure called surgical offloading is by removing pressure element in head and neck of metatarsal bone involved.Results: Among the 20 patients wound healed, in about 12 patients within 4 to 5 week and its remaining 5 patients wound healed in 5 to 6 weeks are in other 2 patients it takes. More than 6 weeks to heal. We followed the patients for the past 1 year, out of 20 patients, 2 patients have developed an ulcer in another site, not the same site. In all other patients wound healed completely without any recurrence.Conclusions: In our study reducing the foot pressure by doing an excision of head and neck metatarsal surgically will completely remove the foot pressure over the ulcer site that helps to heal the ulcer without recurrence.

A study on clinical profile of neonatal seizures in newborn babies born in Government Mohan Kumara Mangalam Medical College Hospital, India

Background: Seizures represent the most distinctive signal of neurological disease in the newborn period. The convulsive phenomena are the most frequent of the overt manifestations of neonatal neurological disorders. This study was aimed at providing a clear picture regarding the epidemiology, etiology, onset, types and mortality of neonatal convulsions in our hospital. This study was carried to assess the incidence, types of Neonatal convulsions, etiology, time of onset and its relationship with the etiology and to determine the mortality associated with neonatal convulsions.Methods: This study was carried out in Government Mohan Kumaramangalam Medical College Hospital in June 2016 - May 2017.The Study Population is Newborn babies born in our hospital and admitted in Neonatal Intensive Care Unit. Babies born in other hospitals or at home with neonatal convulsions were excluded from the study. A detailed history was elicited for all recruited babies and was thoroughly examined. The baby’s clinical progression was closely monitored, and relevant investigations done. Data were entered in Microsoft Excel and analyzed in SPSS version 12.Results: There were 1385 neonatal cases admitted in the newborn ward in Govt. Mohan Kumaramangalam Medical College Hospital, Salem during the period of 12 months from June 2016 to May 2017. Of these, 104 neonates had convulsions. There were 4102 total live births in this period for 12 months from June 2010 to May 2011. Of these, 104 neonates had convulsions. So, the incidence of neonatal convulsions is 2.5%.Conclusions: Since birth asphyxia is the commonest cause of neonatal convulsions, improvement in antenatal, perinatal care with early identification of high-risk mothers will reduce the incidence of birth asphyxia and thereby reduce the incidence of neonatal convulsions. Subtle seizures are the commonest type of clinical seizures; therefore, careful observation of at risk newborns is necessary.

Validity of leukocyte esterase reagent (LER) strip in diagnosing infectious pleural effusion

Background: Pleural fluid sampling and analysis are essential to confirm an infection. In a resource-limited health care setting or if biochemistries of the aspirated fluid are not available on an emergency basis, urine reagent strips applied to pleural fluid may expedite diagnostic information. Present study was aimed to evaluate the effectiveness of leukocyte esterase reagent (LER) strip in diagnosing infectious pleural effusion and to correlate the reaction of LER strip with various stages of infectious effusions.Methods: A prospective longitudinal study was conducted in the medical ward of Government Mohan Kumaramangalam Medical College Hospital for a period of one year. Pleural effusion patients with associated immuno-compromised conditions like diabetes mellitus, patients on steroids, HIV reactive patients, chronic obstructive lung disease were included for the study. A totalof 84 patients were included for the study. Exploratory thoracocentesis was done with an 8 mm needle and pleural fluid was obtained and sent for cell count and biochemical testing. The pleural fluid was also tested using the leukocyte esterase reagent strip. The results were recorded as 0, 1+, 2+, 3+ based on the density of violet colour.Results: The leukocyte esterase reagent strip test showed totally negative results in all patients with transudative pleural effusion and also in patients with tuberculous pleural effusion, whereas among patients with infectious pleural effusion other than tuberculosis LER strip test showed negative to only 15% of the patients and for remaining it ranged from 1+ to 3+. The validity of leukocyte esterase strip test was tested in comparison with the gold standard culture test. The accuracy of LER strip test was found to be 88.6%, and the sensitivity and specificity was 90.2% and 66.2% respectively.Conclusions: Reagent strips may speed up the bedside diagnosis of infectious effusions. However, where access to standard biochemical pleural fluid analysis is not available this dipstick tests would add value to the management of the patients.

A study on new-born foot length measurement to identify high risk neonate

Background: In India, most of the neonatal mortality is due to low birth weight and prematurity. Since the majority of deliveries were conducted at the peripheral level, logistic constraints make it difficult for early and reliable identification of low birth weight babies who require extra care. There are so many studies have been conducted to find out an alternative anthropometric measurement for birth weight and Gestational age. One such innovation is the Foot length measurement. Various studies have been conducted on foot length reliability as a proxy measurement. The aim of the present study is to study the correlation between foot length and other variables like birth weight, gestational age, chest circumference and head circumference among small for gestational age, appropriate for gestational age and large for gestational age and to determine utility of using foot length as a screening tool to identify small babies (LBW/premature) in need of extra care.Methods: It is a cross-sectional descriptive study of 2000 neonate conducted in Government Mohan Kumaramangalam Medical College Hospital, Salem. Babies with lower limb anomaly were excluded from the study. The foot length, head & chest circumference, birth weight and gestational age of the study population were collected by using standard methods. The study group was categorized based on their sex, maturity and gestational age.Results: The study group included 53.7% of male and 46.3% female babies. There were 81.4% term and 18.6% preterm babies. In this study group, there were 85.1%, 14.3% and 0.6% of AGA, SGA and LGA babies respectively. The mean foot length for term babies observed in this study is 6.91 cm with the standard deviation of 0.44. The mean foot length for preterm babies is 5.94 cm with a standard deviation of 0.43. Statistically, by performing Scheffe’s multiple comparisons tests the foot length was found to be significantly different in AGA, SGA and LGA babies.Conclusions: Foot length is a simple and more reliable anthropometric measurement to assess the birth weight and gestational age in newborn babies. Foot length can emerge as an important anthropometric measurement in neonates and can be used to screen prematurity and SGA babies in need of care.

Study of prevalence, etiology, response to treatment and outcome of paediatric shock in a tertiary care hospital

Background: Shock accounts for 2% of children admitted to Paediatric casualty worldwide as per most western literature and in Nelson text book of Paediatrics. About 10 million children die of shock every year in the world. Highest mortality is observed in under 5 children in developing countries. Clinical manifestations are due to decreased perfusion to tissues, the compensatory mechanisms that are triggered by the decreased perfusion and the inadequate removal of metabolic wastes. This study was carried out to assess the prevalence of paediatric shock in children admitted to Paediatric ICU, to identify possible aetiology and the response to treatment and outcome in patients admitted with shock in Paediatrics Department of Government Mohan Kumaramangalam Medical College, Hospital, and Salem.Methods: All sick children admitted to Paediatric intensive care unit of Government Mohankumaramangalam Medical College Hospital, Salem with the suspicion of shock are assessed by using the rapid cardiopulmonary assessment and diagnosed suffering from shock. Possible etiology, type and severity of shock would be arrived at using a targeted history, clinical examination and relevant laboratory investigations.Results: All children who had unstable airway or bradypnea, were having decompensated shock and except one among them all expired despite prompt airway management. Respiratory distress noticed in 23 (40.4%) of children and all of them had either cardiogenic, septic shock or a combination of both. Capillary refill time was prolonged in 52 (91.2%) of children and the remainder 5 (8.8%) had flash refill and managed as warm septic shock. Decompensated shock as evidenced by low blood pressure was seen in 57.9% children. All of them had altered mental status. Urinary output was monitored in 38 children of which 31 (81.6%) had oliguria.Conclusions: Septic shock accounts for majority of decompensated shock and poor outcome to management. Infancy decompensated shock, septic shock and those requiring ventilator support were the factors influencing the outcome of management.

A study on clinical profile of paediatric HIV infection in the age group of 18 months to 12 years and its correlation with CD4 count

Background: The aim of the study was to assess the clinical profile of pediatric HIV infection in the age group of 18 month to 12 years and to correlate the clinical features with their CD4 count.Methods: This descriptive study was conducted over a period of 1 year from October 2007 to October 2008 at Govt. Mohan Kumaramangalam Medical College Hospital, Salem and included 100 children (aged between 18 months-12 years) diagnosed HIV by using rapid antigen tests or ELISA. Demographic data, clinical manifestations correlating with CD4 count and nutritional status of the children were recorded in predesigned proforma and analysed.Results: 100 children were included (males-65 and females-35) in the study. 22 children were asymptomatic and 78 were symptomatic. Clinical symptoms like skin lesions in 29, oral lesions in 10, lymphadenopathy in 46 children were observed. The respiratory (13%), central nervous (12%) and haemotological systems (16%) were most commonly involved organs systems. Children in stage III and IV disease were into Grade I-IV PEM classification (for weight) and majority of stage I-IV children were in Grade II according to Mclaren’s classification (for height).Conclusions: Majority of children with HIV infection presented with various clinical manifestations, malnutrition and immunosuppression. Hence, early identification of the disease and proper management in children helps in improving the immunological status and thereby life span of the child.

Clinical study and management of hollow viscus perforation of abdomen

Background: Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality. Surgery plays an important role in the management of perforation. Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality.Methods: 100 cases of hollow viscus perforation of the abdomen have been studied prospectively in detail during the period from May 2010 to July 2012. Cases were selected randomly from admissions in Government Mohankumaramangalam Medical College Hospital, Salem, Tamil Nadu, India. Clinical diagnosis of hollow viscus perforation confirmed by investigations or by laparotomy performed.Results: The results obtained in the present study were analysed: Among hollow viscus perforation duodenal ulcer perforation was common (52 out of 100 cases). Next being appendicular perforation. Age group of 20-40 years were affected mainly. Males are affected more than females. Signs and symptoms of acute abdomen like acute abdominal pain vomiting fever may present tachycardia, hypotension, abdominal tenderness guarding\rigidity with obliteration of liver dullness and absence of bowel sounds and absolute constipation were predominant signs.Conclusions: GI hollow viscus perforations cause significant morbidity and sometimes mortality. Hollow viscus perforation is the common cause of acute abdomen needing immediate effective surgical attention. A proper early diagnosis and adequate treatment can prevent complications. Surgical approach depends on the site, size, age of perforation and number of perforations.

Fighting the Battle With-Double Edged Weapons – A Prospective Study

Fighting the Battle With-Double Edged Weapons – A Prospective Study

A prospective study of functional & radiological outcome of management of intra-articular distal radius fracture by plating

Aim: To analyze prospectively the functional & radiological outcome of management of intra-articular distal radius fracture by plating Materials & Methods: About 30 adult patients with intra-articular distal radius fracture admitted to Government Mohan Kumaramangalam medical college hospital from May 2013 to February 2015 were included in this study. Post operatively patients were assessed using MAYO score.Follow up: All patients had regular follow up every 4 weeks until union occurred after which patients had follow up every 3 monthsResults: Low energy fractures in the elderly are linked to favourable functional outcomes, although there are several complicating factors. The morphological reduction of the distal radius articular surface and attaining good distal radio ulnar congruity with early mobilisation for early recovery are the important components of the treatment. According to the Mayo wrist score and other research, our study's 72% of VLCP patients had very good results.Conclusion: We conclude from our study Following the foregoing debate, it has been determined that the use of a volar plate and screw system for fracture fixation is a preferable way to keep fracture fragments from collapsing, even in severely comminuted, unstable, and osteoporotic bones. Patients who have an unstable, dorsally or vertically misplaced The radiographic result of the intraarticular radius fracture was excellent to good, when used with a volar locking plate with a fixed angle. However, further research is required to confirm our findings over time.