Patil Medical College Hospital Research Articles

Multi-System Inflammatory Syndrome in Neonates (MIS-N) - Clinical Profile and Outcomes - A Prospective Cohort Study

Aims: To analyze the clinical spectrum in Neonates with MIS-N based on the time of presentation and also to assess the use of immunomodulator therapy in MIS-N.
 Subjects and Methods: We studied 100 neonates delivered at BLDE (DU) Shri B M Patil Medical College Hospital admitted to Level III-A NICU from JULY 2020 to MAY 2021. 98 neonates had high titers of IG G antibodies and were negative for COVID Antigen. We categorized the cohorts into EARLY MIS-N (<72 hrs) and LATE MIS-N (>72 hrs).
 Results: 58 presented as EARLY MIS-N with Respiratory distress (RD) in 40 (70%), cardiac dysfunction 34 (60%), PPHN 12(20%), Fever 12(20%), seizures 12(20%), encephalopathy in 6(10%), sepsis-like features 6(10%), had elevated inflammatory markers like CRP (30%), D-Dimer (70%), Ferritin (30%), cardiac biomarkers like BNP (60%), LDH (30%) and ECHO showing LV dysfunction in 50%. LATE MIS-N presented mostly with fever 28(70%), sepsis-like features 24(60%), Respiratory Distress in 16(40%), cardiac dysfunction 12 (30%), hypoglycemia 4(10%), parotitis 4(10%), had significantly elevated inflammatory markers like CRP (70%), D-Dimer (50%), Ferritin (70%), cardiac biomarkers like BNP (40%), LDH (20%) and ECHO showing LV dysfunction in 20%, dilated coronaries in 20 %, PPHN in 10%. Oxygen and respiratory support requirements were higher in EARLY presenters and IVIG and steroid requirements were more in LATE presenters.
 Conclusion: We observed that maternal SARS-COV-2 antibodies transferred transplacentally and neonatal antibodies acquired after COVID-19 infection can cause MIS-N in neonates. Immunomodulator therapy is required in severe cases of MIS-N only.

Management of Open Tibial Diaphyseal Fractures by Limb Reconstruction System As Primary and Definitive Treatment: A Prospective Cohort Study.

Background One of the most frequent long bone fractures that most orthopaedic surgeons see is a tibial diaphyseal fracture. The tibia has more open fractures than any other major long bone because it is covered by skin for the majority of its length. The best course of therapy is still up for debate due to the high occurrence of comorbidities linked to these fractures. Materials and methods In this prospective study, 30patients who met the inclusion criteria were admitted to the Department of Orthopaedics of Shri B. M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India. The period of study was from January 2021to May 2022. The patients were followed up for a period of six months. Longer follow-up was required for some patients. Results In our study, there were 26 (86.7%)male and four (13.3%)female patients. The mode of injury was road traffic accidents in all cases. The functional outcomes obtained using the modified Anderson and Hutchinson's criteria were goodresults in22 (73.3%), moderateresults in five (16.7%), and poor results in three (10%)of the study population. Pin tract infections (six cases; 20%) and shortening (eight cases; 26.7%) were the most frequent complications Conclusion Because of the ease of use, good fracture stability, adjustable geometry, light weight, reasonable price, and patient friendliness, the limb reconstruction system (LRS) provides an excellent alternative treatment option for treating compound fractures of the tibia.

TO ESTIMATE THE INCIDENCE OF INTRAOPERATIVE NAUSEA AND VOMITING AND ITS ASSOCIATION WITH CAUSATIVE FACTORS IN LSCS UNDER SPINAL ANAESTHESIA

Introduction: Spinal anaesthesia is the injection of local anaesthetic into the subarachnoid space and is anaesthesia of choice for LSCS. Associated hypotension, uterotonic drugs, level of spinal anaesthesia, are the main cause of intraoperative nausea and vomiting which could lead to patient discomfort and protrusion of the abdominal viscera that disturbs the surgical procedure. [4] To study the incidence of intraoperative nausea and vomiting among the pati Objectives- ents undergoing LSCS under spinal anesthesia and its association with causative factors. Material and methods: The cross-sectional observational study was performed for the duration of 18 months at Dr. D. Y. Patil medical college hospital, and research Institute, Kolhapur from April 2021 to September 2022 after explaining the study and taking written consent from the participants. In this study, we use a 40% proportion to calculate the sample size and included 368 consecutive parturients, operated during the study period. The average age of t Result: he participant was 24.98±4.076 years ranging from 19 to 40 years. The signicant ndings of the study were the incidence of IONV was found to be 24.18%. Among the included subjects,25.8%(n=95) of the patients had a history of LSCS. Previous history of IONV was present in 19.6% (n=72) participants. IOH was noted in 41.6% (n=153) of patients whereas it was absent in 58.4%(n= 215) of subjects. The incidences of IONV were found to be present in 17.02%, 62.5%, and 44.64% of the patients who were administered with only oxytocin, oxytocin + carboprost, and oxytocin + methyl ergometrine as a Uterotonic respectively. In n=23 subjects, the level of anaesthesia was T5, among these subjects n=18 subjects had IONV.Out of 344 subjects with T6 anaesthesia level, n=70 subjects had IONV. A subject with a T7/8 level of anaesthesia had IONV. There was 24.18% Conclusionincidence of IONV among 368 subjects. IONV was signicantly associated with the previous history of IONV and predictive factors, IOH, type of UTs used, and level of anaesthesia

THE EFFECT OF SUCRALFATE DRESSING IN DIABETIC FOOT ULCER PATIENTS

Introduction-Diabetic foot ulcers are most commonly occurring complication in patients of diabetes mellitus who have poor glycaemic control. It's also the common cause for osteomyelitis of foot, amputation of lower extremities. About 60% of patients develop neuropathy eventually leads to formation of foot ulcers. Staphylococcus is common infective organism which cause ulcers over the foot. Objective-To study efcacy of topical Sucralfate in healing of diabetic ulcer, in terms of number of days needed for healing, rate of reduction in mean ulcer surface area. Also, to assess the bacterial load by culture & sensitivity of wound swabs before and after application of Sucralfate and conventional dressing. Methodology-The present prospective study was conducted at Dr. D.Y. Patil Medical College Hospital Research Institute, Kolhapur. Atotal of 30 patients from OPD & IPD with diabetic foot ulcers of Wagner grade- I&II having size less than 15x15cm were included in study. All patients were evaluated and investigated by a standard protocol for the management of the ulcer. The dressings were changed everyday morning in both groups for 6-weeks and appearance of the healthy granulation tissue is observed daily. The nal area is measured on 43rd day by planimetry using a transparent graph sheet and subjected to statistical analysis. Result-Sucralfate on daily application to wounds increases thickness of granulation tissue and promotes rapid epithelialization of second-degree burns. An ideal dressing that promotes chronic ulcer healing without any complications. Conclusions-The results of the study showed signicant effect in area of reduction, negative culture rate and weeks for recovery are seen in study group, suggesting that topical Sucralfate dressing can effectively increase the wound healing in diabetic foot ulcer compared to conventional dressing.

Association between Frontal QRS-T Angle and Major Adverse Cardiovascular Events among Patients with Acute Myocardial Infarction: A Cross-sectional Study

Introduction: Acute myocardial infarction has reached epidemic proportions in the Indian population. The premature onset of acute myocardial infarction has shifted the focus of research. An abnormal frontal QRS-T angle can be used as a marker of acute myocardial infarction and can also predict Major Adverse Cardiac Events (MACE) such as heart failure, complex ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation), early post-infarction angina, mechanical complications, and cardiac death resulting from acute myocardial infarction. Predicting the likelihood of serious adverse cardiovascular events and mortality in patients who have experienced an acute myocardial infarction aids in developing immediate and short-term treatment plans. Aim: To assess the association between the Frontal QRS-T angle and MACE among patients with Acute Myocardial Infarction (MI). Materials and Methods: A cross-sectional study was conducted on adult patients admitted with a diagnosis of acute MI at the Department of Medicine, BLDE (Deemed to be University) Shri B.M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India from January 2021 to June 2022. A total of 95 patients were enrolled in the study and classified into two groups: Group A (n=68) with a frontal QRS-T angle of <100 degrees, and Group B (n=27) with a frontal QRS-T angle of >100 degrees. The patients were monitored for the emergence of serious MACE such as heart failure, pulmonary oedema, cardiogenic shock, arrhythmias, and death while they were in the hospital. Statistical analysis was performed using the Chisquare test, Independent t-test, and Mann-Whitney U test as applicable. A p-value of <0.05 was considered statistically significant. Results: The most common age group in Group A was 60-70 years, while in Group B it was 50-60 years. A total of 95 patients with acute MI were enrolled and divided into two groups. Out of 95 patients, 68 patients with a frontal QRS-T angle <100 degrees were in Group A, and 27 patients with a frontal QRS-T angle >100 degrees were in Group B. There was a significant difference between the two groups with respect to MACE, including heart failure (Group A=8.8%, Group B=77.8%, p=0.00), pulmonary oedema (Group A=10.3%, Group B=77.8%, p=0.00), and cardiogenic shock (Group A=7.4%, Group B=40.7%, p=0.00). Conclusion: A frontal QRS-T angle of >100 degrees was a reliable factor for assessing in-hospital major adverse cardiac outcomes such as heart failure, pulmonary oedema, and cardiogenic shock. Hence, a frontal QRS-T angle of >100 degrees on a 12-lead ECG is a cost-effective, reliable, and noninvasive parameter of MACE in patients with acute MI.

Chemokine Receptor Gene (CCR5) Polymorphism in Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Acute coronary syndrome is a multifactorial disease with a complex pathogenesis, mainly resulting from the interplay of genetic and environmental risk factors. Chemokines and their receptors play crucial roles in the initiation and progression of atherosclerosis. Chemokine Receptor 5 (CCR5) is an important mediator of leukocyte recruitment and leukopedesis. Most studies conducted on the relationship between CCR5 gene polymorphism and coronary artery disease in different regions and populations worldwide show conflicting results. Aim: To investigate the genetic polymorphism of CCR5 genes associated with patients with acute coronary syndrome in the Vijayapura population. Materials and Methods: A cross-sectional study was conducted at BLDE (Deemed to be University) Shri B.M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India, involving patients admitted for acute coronary syndrome. A total of 100 patients were admitted with acute coronary syndrome. Nineteen patients with diabetes mellitus were excluded from the study based on the exclusion criteria. Clinical history, examination, electrocardiographic assessments, laboratory profiles, and blood samples were taken for the analysis of CCR5 gene polymorphism as part of the work-up. Patients were classified into two groups: one with the presence of CCR5 polymorphism as Group A (n=6), and the other without polymorphism as Group B (n=75). Parameters such as age, sex, occupation, lipid profile, renal function tests, and CCR5 polymorphism were studied between the groups. The data were statistically analysed. Categorical variables between the two groups were compared using the Chi-square test. Normally distributed continuous variables were compared using independent t-test, and non normally distributed variables were compared using the Mann-Whitney U test. Results: In the present study, the most common age group was 50-70 years with a male predominance of 60.7%. Most of the patients in the study group were farmers (34.7%), followed by housewives (32%) and businessmen (14.7%). The most common risk factors observed in both study groups were smoking and tobacco chewing. Gene sequencing revealed CCR5 gene polymorphism in six out of 81 patients who were labelled as Group A, indicating an incidence of 7.5% (p<0.001). Out of the six positive patients in Group A, three were males and three were females. One patient was 45 years old, while the remaining five were above 60 years old. Conclusion: The present study demonstrates a positive association between CCR5 polymorphism and acute coronary syndrome, indicating that the study population is genetically susceptible to the disease. By screening for high-risk individuals, better and more effective early interventions can be planned, thereby reducing the social burden, morbidity, and mortality associated with the disease.

Efficacy of Mid-Second-Trimester Serum b-HCG Levels as a Predictor of Hypertensive Disorders of Pregnancy: A Longitudinal Cohort Study

Introduction: Hypertensive Disorders of Pregnancy (HDP) affect up to 10% of pregnancies worldwide, despite improvements in maternal and neonatal care. HDP and its sequelae are a dreaded complication of pregnancy. If prediction becomes possible, prevention will follow naturally. Aim: To study the efficacy of mid-second trimester serum b-hCG levels in the prediction of HDP. Materials and Methods: This was a longitudinal cohort study conducted in the Department of Obstetrics and Gynaecology at Shri BM Patil Medical College Hospital and Research Centre , Vijayapura, Karnataka, India, between December 2020 and June 2022. All women with gestational age between 16-20 weeks were screened, and 163 pregnant women were enrolled in the study. Serum β-hCG levels were measured at enrollment, and values were followed-up until delivery. The development of HDP was evaluated using statistical analysis, including Chi-square, Independent t-test, Receiver Operating Curve/Area under the ROC Curve (ROC/AUC), sensitivity, and specificity. A p-value of <0.05 was considered significant. Results: Of the 163 pregnant women enrolled, 49 (30.1%) developed HDP, while 114 (69.9%) remained normotensive. The mean age of the study population was 24±4 years. The mean serum β-hCG level in the normotensive group was 55666 mIU/mL, while in the HDP group, it was 100124 mIU/mL, with a statistically significant p-value of 0.001. A cut-off value of 77817 mIU/mL showed 83.7% sensitivity and 92.1% specificity. Conclusion: This study suggests that serum b-hCG levels between 16-20 weeks can be used as a non-invasive predictor of HDP. It is a good predictor of HDP and could potentially improve prevention strategies.

ANALYSIS OF MULTIVARIATE GOITRES: RETROSPECTIVE STUDY IN A TERITIARY CARE CENTRE

Objectives : To evaluate demographic profile, risk factors, clinical presentation, pathological features of thyroid swellings diagnosed and managed at our tertiary care hospital. The purpose of the study was to compare the following parameters pre and post surgery. The following parameters were noted Type of Goitre, clinical symptoms, Biochemical status (thyroid profile), surgical complications, post-op status-comparison between FNAC and histopathological report. Materials and Methods : A total of 127 cases of thyroid swellings on examination from March 2018 to May 2020 in BLDE(DU) Shri BM Patil Medical College Hospital and Research Centre, Vijayapura were included. The medical records were retrieved, studied and analysed retrospectively with regards to type of goiters, clinical symptoms, Biochemical status (thyroid profile), at the time of presentation and surgical complications. Histopathological details were analyzed. Results : The most number of cases were noted in 41-60yrs age group, with female predominance, solitary nodules being most common. Hemithyroidectomy being the predominantly done surgery and nodular goitre was seen in the final histopathogical report in most of the cases. Conclusions : In our study we concluded that USG and FNAC findings of the thyroid goiters had higher sensitivity and specificity in detecting thyroid tumors but it has low sensitivity for follicular carcinoma as observed in our study, discrepancy between FNAC and HPR.

Surgical management of intertrochanteric fractures of femur with Proximal Fixation Nail Anti-Rotation-II

Background: Intertrochanteric Femur Fractures are usually complicated withassociated co-morbidities like osteoporosis, diabetes, hypertension, renal failure. In suchcircumstances, nonoperative treatment is mainly reserved for poor medical candidates and non-ambulantpatients with minimal discomfort after fracture. Objective: To study the management of intertrochanteric fractures with proximal femoral nail anti-rotation-II. Material and Methods: Present study was conducted on the patients admitted in at BTGH attached to MR medical college, Kalburgi &Shri B M Patil Medical College Hospital and Research Centre, Vijayapura,with diagnosis of intertrochanteric fractures from October 2017 to April 2019. A total of 21 cases were taken in our study. Results: Majority of the cases i.e., 12(60%) were in the age group of 61- 80 years, followed by 3 cases in the age group 41-60 years. The mean age was 69years. Majority of the patients were males 13 (65%) and 7 (35%) were females. We took less number of exposures time in case of comminuted fractures where reduction was not a problem. Blood loss was more in open reductions. The HARRIS HIP SCORE grading was done and 2 patients were graded excellent, 16 as good, 2 as fair and none as poor.

Efficacy of BAINS Circuit in Treating Critically Ill Hypoxemic COVID-19 Patients During the Second Wave of the Pandemic in India.

The COVID-19 pandemic has encouraged doctors to look for novel ways of treating patients with respiratory failure due to the limited availability of ventilators and highflow nasal cannula. The study aims to assess the efficacy of using the Bains circuit as an alternative to HFNC and NIV as life-saving tools in patients with respiratory failure during the second wave of the COVID-19 pandemic in India. This is a prospective interventional study carried out in the intensive care unit of Shri B.M Patil Medical College Hospital and Research Centre, Vijayapur, India, from May 2021 to June 2021. All patients (n=90) with respiratory failure not responding to therapy with an oxygen mask were included. Patients were placed on Bain circuits, one end connected to a non-invasive ventilation mask fitted to the face of the patients, and the other end connected to a central oxygen port. Patients' vital parameters were assessed on an hourly basis. The blood gas analyses were done before and after using Bains. The study showed diabetes (33.4%), hypertension (22.2%), and diabetes with hypertension (11.1%) as comorbid factors among the ICU admitted patients. The results from the arterial blood gas analyses showed a statistically significant increase in Sp02 (%) and a decrease in respiratory rate (cycles/min) in the patients after being kept on Bains (p<0.05). Further, it showed that 72% of ICU patients with 70-79% Sp02 had a recovery by using Bains. The overall outcome of ICU admitted COVID-19 patients on Bains showed that 38.9% of patients improved and were shifted to 02/NRBM masks. The study highlights a novel concept of using the Bains circuit as an effective alternative to HFNC and NIV for oxygenation in critically ill COVID-19 patients during scarcity of NIV and HFNC at the peak of the pandemic.

Role of cartridge-based nucleic acid amplification test in diagnosing extrapulmonary tuberculosis

Background: Tuberculosis (TB) is a major health concern globally. Extrapulmonary tuberculosis (EPTB) accounts for around 20% of the total (EPTB) cases which are difficult to diagnose due to the lack of availability of diagnostic tools. Although pulmonary TB is most common presentation, EPTB is also an important problem clinically. Cartridge-based nucleic acid amplification (CBNAAT) test has a well-documented role in diagnosing pulmonary tuberculosis. The potency of CBNAAT in the diagnosis of EPTB cases is still debated. Aim: To establish the importance and role of diagnosing EPTB by CBNAAT. Settings: Conducted in Dr. D Y Patil Medical College Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pimpri, Pune-411018. Design: Retrospective cross-sectional study of suspected EPTB patients in a tertiary care center area from April 2020 to September 2020. Materials and Methods: Data of suspected EPTB patients were retrieved. Potency of CBNAAT in diagnosing EPTB was assessed. Statistical Analysis: All the statistical analyses were carried out using the Statistical Package for the Social Sciences (SPSS) version 20. Results: Samples collected from 556 suspected EPTB patients were subjected to CBNAAT. The collected samples included pus, pleural fluid, cerebrospinal fluid, gastric aspirate, peritoneal fluid, tissue biopsy, pericardial fluid, ascitic fluid, synovial fluid, drain fluid, para-spinal fluid. In CBNAAT results, 67 cases were positive for TB bacilli, rifampicin resistance detected in 4 samples. Conclusion: Xpert®MTB/RIF assay is a rapid and effective method for early detection of EPTB and can be used in conjunction with routine culture methods for detection of the same.

A Comparative Study of the Effect of Propofol and Etomidate as an Induction Agent on Haemodynamic Changes during Induction and Endotracheal Intubation

Aims: Presently Propofol and Etomidate are popular as rapid acting inducing agents. Due to reflex sympathetic stimulation, direct laryngoscopy and endotracheal intubation typically cause a cardiovascular stress response characterized by hypertension and tachycardia. This study is conducted to compare the effects of these two drugs on hemodynamic responses during induction and endotracheal intubation, to compare time of induction to choose the better induction agent and to study adverse effects of the two drugs, if any.&#x0D; Study Design: Prospective double blind study&#x0D; Place and Duration of Study: Department of anaesthesiology Dr D.Y Patil medical college hospital and research centre Pimpri Pune Duration -Sept.2018 -sept 2021.&#x0D; Methodology: This is prospective randomized double-blind study. 60 ASA I and II patients randomly divided into two groups group P and group E of 30 each of either sex in age group of 18-65 years posted for elective surgery under general anesthesia. Group P: (n-30) received 2.5mg/kg Propofol and Group E:(n-30) received 0.3mg/kg Etomidate for induction. vital parameters such as HR, SBP, DBP, MAP, and SPO2 recorded at baseline (T0), before induction (T1), after induction (T2), during laryngoscopy (T3 ) ,after intubation at 1min, 2min, 3min, 5min and at 10 min. Time of induction was taken as period between time of start of study drug till loss of eyelash reflex&#x0D; Conclusion: Induction time between the two study groups was statistically insignificant. (p&gt;0.05) The fall in heart rate at post induction (T2), at 1 min, 2 min after intubation in Group P as compared to Group E was statistically significant, fall in SBP, DBP and MAP at post induction (T2), at 1 min, 2 min, 3 min and 5 min after intubation in Group P as compared to Group E was statistically significant. Pain on injection was more with propofol. However, myoclonus was more with etomidate.

English

BACKGROUND The drastically increasing rate of Caesarean section (CS) is a topic of constant worry and analysis throughout the world. In order to understand the degree to which Caesarean section may be preventable, it is important to know why Caesarean sections are performed. Due to nonexistence of any standard classification for indications of Caesarean section, indications for the same vary among institutions. We wanted to evaluate the rates and predictors of Caesarean section among institutional deliveries in a tertiary care hospital in an economically backward rural area. METHODS This was a cross-sectional prospective study. Pregnant women who underwent Caesarean section (CS) between June 2019 and December 2019 at BLDE (DU) Shri. B. M. Patil Medical College Hospital and Research Centre, Vijayapur, Karnataka, were recruited for the study. Demographic and obstetric data including indications of Caesarean section and pregnancy outcomes were collected and analysed. RESULTS The mean age of the study participants was 24.62 + / - 3.77 years. The study patients were multigravidas, majority delivered at term. The mean gestational age was 38.09 + / - 2.023. The common indications were previous CS (33.1 %), cephalopelvic disproportion (16.9 %), hypertensive disorders of pregnancy (6.7 %) and maternal request (3.4 %). Post-delivery, majority of the babies (78.92 %) were stable and were on mother’s side. CONCLUSIONS Previous caesarean section is the leading cause of Caesarean section in modern era. Hence reduction in primary caesarean section can reduce the rate of over all Caesarean section rate. Clinical, judgmental skills of the obstetrician, legal issues and the patient demands all contribute in the increasing trends of Caesarean section. Hence proper training, obstetric audit, and counselling of the patient party helps in changing the trends of increasing caesarean rate. KEY WORDS Caesarean Section, Indications for Caesarean Section, Maternal Morbidity

Outcome assesment of acute ischemic stroke by NIHSS score

In view of the long-term disabilities caused by stroke the need for an accurate early prediction of future functional abilities is paramount for setting therapeutic goals, starting early rehabilitation planning, implementing home adjustments and community support tailored to patients needs, and informing patients about their prospects and prognosis.in this study we have assessed significance of the national institute of health stroke scale (NIHSS) score on the day of admission in predicting the severity and outcome on 30 day ,in acute stroke patients. It is a observational prospective study, study conducted on 93 patients of stroke who were admitted in Shri B M Patil Medical College hospital who were diagnosed and admitted with acute stroke on the basis of the History, Clinical examination and proved on CT/MRI scan. Patients were selected on the basis of the inclusion and exclusion criteria. NIHSS score is noted on the day of admission and then after 30days of stroke and the patient is independent at home or requires assistance is also noted and statistically analyzed. This study was conducted between December 2017 to July 2019. In this study, after 1 month of stroke among 3 patients who had baseline NIHSS score 1-4, all 3(100%) are independent at home, among 73 patients who had baseline NIHSS score 5-15, 47(64.4%) are independent and 26(35.6%) required assistance, among 7 patients who had score 16-20, 1(14.3%) patient was independent at home, 6(85.7%) required assistance, and among 10 patients who had score more than 20, 7(70%) died, 3(30%) required assistance and none of them are home independent. With the p value &amp;#60;0.001 which is statistically significant.Baseline NIHSS score helps in predicting the outcome of the patient. Lesser the baseline score better will be the outcome.

Comparison of various phenotypic tests for detection of metallo-beta-lactamase in Pseudomonas aeruginosa isolates at a Tertiary care centre

Introduction: Pseudomonas aeruginosa is an opportunist pathogen, aerobic Gram negative bacilli belonging to family Pseudomonodaceae and genus Pseudomonas. Aim of the study is to compare of various phenotypic tests for detection of metallo-β-lactamase (MBL) in Pseudomonas aeruginosa. Objectives of the study: 1. Isolation and identification of P.aeruginosa from various clinical samples. 2. To determine the prevalence of metallo-β-lactamase in clinical isolates of Pseudomonas aeruginosa. 3. Comparison of different phenotypic tests for MBL detection. Materials and Methods: Pseudomonas aeruginosa isolates were isolated from various clinical samples for a period of one year from January 2016 to December 2016 at Shri B M Patil medical college hospital and research Centre. Samples which yielded P. aeruginosa were included in the study. Isolates resistant to imipenem were tested for MBL production using following three phenotypic tests 1. Double disk synergy test (DDST) (imipenem, EDTA 750μg/ml) 2. Combined disk test (CDT) (imipenem, imipenem + EDTA 750μg/ml) 3. MBL E test strip (Hi media) Results: A total of 92 P. aeruginosa were isolated. Of these, 22 were resistant to Imipenem and these were subjected to the phenotypic tests. MBL E test strip identified 13 (59%), CDT identified 10 (45.4%) and DDST identified 5 (22.7%) isolates as MBL producers. Majority of MBL producing isolates were isolated from pus sample. More isolates were obtained from in-patients compared to out-patients. Conclusion: Prevalence of MBL producing P. aeruginosa is 14%. MBL E test strip detected highest number of MBL producing isolates.

Obituary

FigureDr. Mallangouda Shivangouda Biradar was born on June 1, 1955, in a rural farmer family at Ukkali village of Vijayapura District. After pursuing his MBBS and MD in General Medicine from Government Medical College, Bellary, with Gold Medal, he joined District Hospital in Vijayapura and served in a government hospital for 5 years. In 1991, he joined BLDEA's Shri B M Patil Medical College Hospital and Research Centre and continued to serve in various capacities such as Vice Principal, HOD of Medicine, Principal, and Vice-Chancellor of BLDE Deemed to be university. His passion for teaching students won him many splendid hearts of students who are now spread across the world. He was aptly called walking Harrison as he was discussing molecular level to bedside signs with students during rounds. His style of teaching theory class was commendable, and many staff members were to attend his class along with students. He had a unique style to teach under- and postgraduate students with passion and always laid emphasis on clinical knowledge with differential diagnosis, which made students to understand the subject better. As a teacher, he always used to procure new editions of textbooks as and when released and used to share the knowledge among the students and simultaneously benefit the patients with newer drugs. He was a guide to postgraduate and PhD students. His passion to care his patients was so immense that he had generations of families as his patients. His contribution to academics has won many accolades at the national and international levels. He was organizing chairman for KAPICON 2015. His concept on Bench to Bedside lecture was a superhit at KAPICONs. He was good at time management and administrative skills. The very fact that the BLDE DU campus is secured, peaceful, and productive is because of he being visionary and believed in the teamwork that he managed. He has many National and International Orations, Publications, and Awards to his credit. He is blessed with two daughters. He was serving BLDE DU as vice-chancellor and representing various committees at State and National level till the tragedy hit on an ill-fated day, May 12, 2021, when he breathed last. The departure has created a large vacuum in the society as well as in the university. The students pray that may he be reborn as a medicine teacher. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Utilization of Foot Length as a Non-Invasive Anthropometric Measurement in Neonates Admitted to the NICU in a Tertiary Care Centre in North Karnataka, India

Background: The majority of the neonates in the Neonatal Intensive Care Unit (NICU) would be on respiratory support either invasive or non-invasive ventilation. Therefore, it is difficult to measure anthropometries, such as weight, length, and head circumference in these sick newborns. This study aimed to determine the correlation of foot length with occipitofrontal head circumference (OFC), crown-heel length (CHL), and weight of the newborn. Methods: A cross-sectional study was conducted at the level IIb NICU of Shri B M Patil Medical College Hospital and Research center, Vijayapur, India. The foot length, OFC, and CHL of the neonates with gestational ages of 28-42 weeks were measured between 12 hours and 7 days of life. Results: Out of 350 neonates enrolled, 61% and 39% of the newborns were preterm and term, respectively. The correlation between foot length and birth weight (r=0.90) and foot length and length (r=0.89) was pronounced in premature neonates. Moreover, a positive linear correlation was observed between foot length and weight in neonates of all gestational ages. To identify the low birth weight (LBW) neonates (<2500 gm), a foot length of less than 7.41 cm had sensitivity and specificity of 94% and 50%, respectively. Furthermore, foot length less than 6.62 cm had 100% sensitivity and 67% specificity to identify the very LBW newborns (<1500 gm). Conclusion: Birth weight and CHL of premature newborns can be estimated from the measurement of foot length that was performed easily and rapidly. Measurement of foot length is valuable in premature neonates who are too ill at birth or those who are on ventilators. Furthermore, foot length may be used in the identification of LBW and VLBW newborns who are admitted to the NICU.

Feasibility of minimal enteral nutrition in neonates with perinatal asphyxia during therapeutic hypothermia: A randomized controlled trial.

Background: Therapeutic Hypothermia (TH) is a standard of care for neonates with birth asphyxia with moderate to severe hypoxic-ischemic encephalopathy. Despite lack of evidence, it is common practice to withhold feeds during TH due to risk of NEC. As there are no prior Indian studies and in view of limited evidence, this study was aimed to assess the feasibility of minimal enteral nutrition in our cohort of asphyxiated neonates during TH. Methods: This study was conducted in the Level III a NICU of Shri BM Patil Medical College Hospital and Research Centre, Vijayapura. Design: Open-label, parallel grouped, randomized controlled trial. 100 asphyxiated neonates undergoing therapeutic hypothermia were enrolled. Eligible newborns were randomized to receive either minimal enteral feeding or no feeding (50 newborns in each group) during therapeutic hypothermia. Results: Both groups were comparable in maternal and neonatal characteristics. Among 100 cooled neonates, 50 cooled neonates were randomized to MEN group and 50 cooled neonates to Control group. No statistically significant differences were observed among complications associated with therapeutic hypothermia between MEN group and Control group. Indicators of Sepsis and NEC such as Leucopenia/Neutropenia/Thrombocytopenia were observed in both groups which was not statistically significant (p>0.05). MEN neonates had a reduced length of hospital stay (mean 9 ± 2 days vs. 14 ± 3 days, p<0.05), and time to reach full oral feeds (7 ± 2 days vs. 12 ± 3 days, p<0.05). Conclusion: Minimal enteral feeding for neonates with moderate or severe HIE receiving therapeutic hypothermia is safe and feasible and associated with decreased time to reach full enteral feeding and reduced NICU stay and is not associated with significant complications like NEC.

Late preterm births and associated neonatal outcomes in a tertiary care center-A prospective observational study.

Background: Prematurity is one of the leading causes of morbidity and mortality among newborns. The incidence of preterm deliveries especially the late preterm births have unfortunately gone up in the last decade. Late preterm births are associated with increased neonatal complications compared to term births. This study makes an effort to find out the relevant maternal and fetal factors associated with late preterm births. This study also assesses the maternal and neonatal outcomes associated with late preterm births. Methods: This prospective observational study was conducted at Maternal and Child Health Unit of Shri B M Patil Medical College Hospital Vijayapur, Karnataka over a period of 1 year. 200 late preterm births and 200 term births were enrolled in the study. During the study period, all neonates delivered in the hospital were divided into two groups as late preterm group and term group. Maternal and neonatal data was collected in predefined structured proforma. Results: The mother's mean age in the late preterm group was 24.34 ± 4.07 years, and among the term group was 25.24 ± 4.54 years, which was not statistically significant (P=0.857). The obstetric risk factors observed for late preterm births were inadequate antenatal care (39%), premature rupture of membranes (31%), hypertensive disease of pregnancy (24.5%), previous preterm delivery (21%), and maternal anemia (13%). When two or more factors were found, late preterm labor incidence was 32.6% in this study. 14.5% late preterm's needed resuscitation (P=0.003), 45% late preterm neonates had difficulty establishing feeding at birth (P<0.001), 34% late preterm’s had respiratory distress at birth (P<0.001), 12% had hypoxic-ischemic encephalopathy (Stage2/3) (0.003), 35% had early-onset sepsis (P<0.001), 28% had jaundice (P<0.001), 24% had hypoglycemia (P<0.001), 41% had hypothermia (P<0.001), 13.5% had HSPDA (P<0.006). The duration of hospital stay was significantly more in late preterm neonates (8.7 ± 1.6 days) as compared to term neonates (3.9 ± 1.1 days) with a pvalue of <0.05. Most important is the mortality, which was significantly more among late preterm neonates (18%) than term neonates (6%) with a p-value of 0.011. Conclusion: Maternal risk factors such as preterm premature rupture of membrane, inadequate antenatal care, hypertensive disorders of pregnancy, and maternal anemia were associated with late preterm births. Since late preterm birth is an independent risk factor for neonatal morbidity and mortality compared to term neonates, knowing maternal and perinatal risk factors is essential. Early identification and management of these risk factors reduces the neonatal morbidities and mortalities.

A case control study to compare the levels of homocysteine in normal and complicated pregnancies

Aim: Hyperhomocysteinemia during pregnancy is known to cause endothelial dysfunction as a result of increased oxidative stress or direct toxic effects. The purpose of this study is to find the correlation between Hyperhomocysteinemia and various placental dysfunctional related pregnancy complications. Materials and Methods: A prospective case control study of 100 women admitted in antenatal ward or Labour room of department of OBG was conducted at Shri B.M. Patil Medical College Hospital and research center Vijayapur. Study Group consisted of 70 pregnant women with different pregnancy complications like Pre eclampsia, Eclampsia, unexplained Abruption, FGR with oligohydramnios and unexplained oligohydramnios. Control Group was of 30 healthy pregnant women. Fasting Homocysteine level was checked in all participants. Results: Mean level of Homocysteine was significantly raised in all patients with pregnancy complications (study group-26.4 umol/l) compared to patients without complications (control group - 8.4 µmol/L) with a p value of