Tertiary Care Centre In Haryana Research Articles

Study of Sociodemographic Profile of victims in Road Traffic Accidents: An Autopsy-Based Study at a Tertiary Care Centre in Haryana

Road traffic accidents are considered one of the important general health concerns, as they result in numerousinjuries and deaths worldwide. India is a developing nation which experiences very high rate of such accidents.This study was planned to study the sociodemographic profile of victims of fatal RTAs involving different typesof vehicles, so as to widen the database for developing the preventive measures that could reduce morbidityand mortality in such cases. A retrospective study was conducted on one hundred cases of road traffic accidentsbrought for medicolegal autopsy to mortuary of Pt. B.D Sharma PGIMS Rohtak over a period of one year. Theirage, gender, region and other socioeconomic factors were studied.

Respectful Maternal Care Initiative: Experiences at a Tertiary Care Center in Haryana

Abstract Objective: Respectful Maternity Care (RMC) is a part of the prescribed standard of health care norms globally today. The RMC has been defined under seven broad domains, which are useful in identifying and quantifying maternal disrespect and abuse and dealing with solutions. Evidence on the nature and frequency of maternal disrespect and abuse is essential for effective policy and advocacy. The present study is directed to assess the current status of RMC. Materials and Methods: It was a hospital-based cross-sectional study carried out in a tertiary care center over a period of 3 months. A total of 220 women who delivered at our institute during the data collection period and met inclusion criteria were enrolled for the study. Data were collected using a predesigned and pretested questionnaire based on seven major categories per the respectful maternity care (RMC) charter and included sociodemographic details of respondents. Results: Of all, nearly half of them experienced at least one or theother form of disrespect during their labor, childbirth, or postnatal period at the hospital. The lowest mean scoring was seen in domains of confidential care (3.32), dignified care (3.07), and abuse related to cost of detention (3.38). Conclusion: Although mothers are noticing and reporting positive changes in maternity care practices, respectful maternity care still has miles to go. Effective and sustainable measures need to be implemented within the context of the Indian health system to stop the disrespect and abuse surrounding childbirth!

An observational cross-sectional study of the serum sodium levels and their association with severity in chronic liver disease patients in a tertiary care center in Haryana

Background: Chronic liver diseases (CLDs) cause significant morbidity and mortality worldwide. Reduced serum sodium concentration is a common finding in patients with cirrhosis, being the most common electrolyte disorder in this setting. Aims and Objectives: The objectives of the study were as follows: (1) To find the association of altered serum sodium levels with the disease severity (as per Child-Pugh Score [CPS] and Model for End-Stage Liver Disease [MELD]) and (2) to assess for the type of dysnatremias commonly found in CLD and its association with complications of CLD. Materials and Methods: It is an observational cross-sectional study. It was done for 18 months (June 2019 till May 2020) in the Department of General Medicine of Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana. Results: Among all patients with CLD, 30.8% had serum sodium levels ≤130 mEq/L), 32.5% had 131–135 mEq/L, and 36.7% had ≥136 mEq/L. Thus, hyponatremia was observed in 63.3% of the patients. Mean MELD score and mean CPS were significantly higher in patients with reduced serum sodium levels. In addition, Child-Pugh Class C was significantly more common in patients with serums sodium levels ≤130 mEq/L as compared to other patients. Hepatic encephalopathy, hepatorenal syndrome, and coagulopathy were found to occur significantly more common in patients with serums sodium levels ≤130 mEq/L. Conclusion: Hyponatremia is very common among patients with CLD. Low serum sodium level was associated with more severe liver disease, more complications, and higher mortality.

Comparison of prices of commonly used drugs in AMRIT pharmacy, Jan Aushadhi Centre and Private chemist shop: An analytical study from a tertiary care centre in Haryana

Background: The price of medicine in India has always been a point of discussion in public domain. The price range of the same drug is very large with more than 100% difference between various brands available in different settings. Aims and Objectives: To assess the price of different drugs at Jan Aushasdhi (JA), AMRIT and Private Chemist and to compare the prices of these three outlets so that the issues. Material and Methods: This institution-based cross-sectional study was carried out from May 2019 to June 2019. A pretested proforma was prepared to compare the prices of 284 different medicines in Jan Aushadhi, AMRIT and private chemist shops. The collected data were entered in an Excel spreadsheet and presented in Proportions, percentages, and mean. Results: The price of 284 medicines were compared from JA (Median(IQR)- 15.18(18.75) INR) and Private chemist shop (Median(IQR)-88(111.5) INR) while 249 medicine from AMRIT (Median(IQR)-61.05(78.33) INR). Although the majority of the AMRIT drugs are cheaper than the chemist shop except for 31% of Antipsychotic drugs, 26.6% of antihypertensives, 25% of respiratory drugs, 25% of steroids, 21.9% of antibiotics. Conclusion: We concluded that JA is providing drugs cheaper than AMRIT and Private chemist . The prices of medicines offered at AMRIT are lower than market pricing but they are costlier when compared to JA prices.

Prevalence and Risk Factors of Dry Eye Disease at a Tertiary Care Centre in Haryana, India: A Cross-sectional Study

Introduction: Dry Eye Disease (DED) is a multifactorial disease which causes ocular discomfort and visual disturbances. It is one of the major causes of patients’ visit to the clinic. The prevalence of DED has increased in recent times due to increased time spent on computers and mobile phones, ageing population and highly stressful social environment. Various studies done in past on DED prevalence have given the variable results. Aim: To determine the prevalence of DED and analyse the associated risk factors in a tertiary care centre in Sonepat, Haryana, India. Materials and Methods: Present study was a cross-sectional observational study done in outpatient Department of Ophthalmology at Bhagat Phool Singh Government Medical College for Women, Sonepat, Haryana, India, from April 2021 to December 2021. Total 820 patients, aged >18 years were administered Ocular Surface Disease Index (OSDI) questionnaire. Patients with OSDI score >12 and positive one or both of the dry eye objective tests of Schirmer’s and Tear film Break Up Time (TBUT) below cut-off value were labeled as DED and were evaluated for association with various risk factors. Data were statistically analysed by Chi-square test, Wilcoxon-Mann-Whitney U test and Fisher’s exact test. Results: The mean age of patients were 39.65±15.52 years ranging between 18-79 years. DED was found to be more prevalent in females 120 (56.1%) compared to males 94 (43.9%). The prevalence of DED was 26.1% (214/820). Maximum prevalence was found in the age group 18-40 years (43.9%). Out of the 214 DED patients, 113 (52.8%) had mild, 95 (44.4%) had moderate and 6 (2.8%) had severe dry eye. The risk factors significantly associated (p<0.05) with DED were: more than 3.71 hours of Visual Display Terminal (VDT) use, occupational VDT users, homemakers, previous ocular surgery, uncorrected refractive error, diabetes mellitus, hypertension, Chronic Obstructive Pulmonary Disease (COPD), alcohol intake and mask use. Conclusion: DED is a significant cause of ocular morbidity, affecting more than quarter (26.1%) of the study population. Awareness and identification of risk factors for dry eye which are occupational VDT users, previous ocular surgery, uncorrected refractive error, diabetes mellitus, hypertension, COPD, alcohol intake and mask use is important for effective prevention and management of DED.

Anthropometric and Micronutrient Assessment in Pediatric Patients with Cleft Lip and Palate in a Tertiary Care Hospital of Haryana, India

Introduction: Cleft lip (CL) and/or cleft palate (CP) are the most common visible craniofacial anomalies throughout the world. CL and CP occur due to a failure of the skeletal components of the mid-face to fuse. The affected individual may have an isolated defect or a combination of both. These children can be undernourished due to feeding difficulties after birth. The growth problems of children with clefts have largely been attributed to inadequate nutrition. The aim of the study is to assess the anthropometric status and micronutrient deficiencies in children with cleft lip and palate. Methods: This is a cross-sectional study of 18 months duration conducted at SGT medical college, Gurugram, a tertiary care center in Haryana, India between June 2020 to December 2021 involving the assessment of patients with cleft lip and palate between the age of 3 months to 5 years of either gender who visited pediatric unit for complete evaluation before surgery. A total of 100 patients were enrolled in the study and the following information was recorded: age, gender, hemoglobin, serum vitamin D3 level, serum ferritin, and serum vitamin B12 level. Results: A total of 100 patients were included in the study, of which, 53 (53%) were males and 47 (47%) were females. Anthropometrically, in our study, 83% of patients had moderate to severe wasting, according to WHO classification. Anemia was prevalent in 71.1% of cases in the current study. Vitamin D3 deficiency was seen in 88% of the study population, while 37% of cases had Vitamin B12 deficiency. The correlation between anthropometric assessment and nutritional deficiency suggested that children of cleft lip and palate with severe wasting had significant iron deficiency anemia as well as vitamin B12 deficiency. However, vitamin D deficiency was not statistically significant in severe wasting group. Conclusion: A large number of children with cleft lip and/or palate are not exclusively breastfed due to anatomical deficits. They need supplemental Iron and vitamin D to meet the demands. Macro and micronutrient deficiencies along with recurrent infections, lead to moderate to severe wasting and stunting in these children causing severe malnutrition with complications and failure to thrive.

Pregnancy Wastage Due to Fetal Congenital Malformations

OBJECTIVES: To study the pattern of various congenital anomalies in rural Haryana.STUDY DESIGN: This was a retrospective study conducted over 1 and ½ years (from January 2015 to June 2016) in a tertiary care center in Haryana, India.RESULTS: Out of 11,178 births, 227 babies had gross congenital malformations 2.03%. In literature, the most common birth defect reported in western countries is cardiovascular anomalies while in India and eastern countries, it’s the neural tube defect. In our study also, neural tube defects were the most common congenital anomalies accounting for 64.31% of total anomalies. They were more common in unbooked patients (70%) and the rural population. So, the main cause appears to be a lack of awareness and illiteracy.CONCLUSION: There is a need for increased awareness and folic acid supplementation routinely in the periconceptional period to decrease the incidence of congenital anomalies.

A prospective study of a new prediction model of vaginal birth after cesarean section at a tertiary care centre

Objective:To create a new and simple model for predicting the likelihood of vaginal birth after cesarean (VBAC) section using variables available at the time of admission.Materials and Methods:A prospective observational study was performed at a tertiary care centre in Haryana over a period of 12 months (January 2018 - December 2018) in pregnant women attending the labour room with one previous cesarean section fulfilling the criteria for undergoing trial of labour after cesarean (TOLAC). The sample size was 150. A VBAC score was calculated for each patient using a new prediction model that included variables available at the time of admission such as maternal age, gestational age, Bishop’s score, body mass index, indication for primary cesarean section, and clinically estimated fetal weight. The results of the VBAC scores were correlated with outcomes i.e. successful VBAC or failed VBAC. The chi-square test and Student’s t-test was used for comparison among the groups. Descriptive and regression analysis was performed for the study variables.Results:Out of 150 TOLAC cases, 78% had successful VBAC and the remainder (22%) had failed VBAC. The observed probability of having a successful VBAC for a VBAC score of 0-3 was 34%, 4-6 was 68%, 7-9 was 90%, and ≥10 was 97%. The prediction model performed well with an area under the curve of 0.77 (95% CI: 0.68 to 0.85) of the receiver operating characteristics receiver operating characteristic curve.Conclusion:The present study shows that the proposed VBAC prediction model is a good tool to predict the outcome of TOLAC and can be used to counsel women regarding the mode of delivery in the current and subsequent pregnancies. Further studies of this model and other such models with different permutations and combinations of variables are required.

SAT-LB85 Use of Weekly Levothyroxine Regimen for Rapid Normalization of Thyroid Hormone Levels: A Case Report

Background: Hypothyroidism affects around 4.6% of the U.S. population1. Non-adherence with thyroid hormone replacement is one of the biggest challenges in treating hypothyroidism1. The half-life of T4 and T3 in hypothyroidism is about 7.5 and 1.4 days respectively2. A large dose once-weekly administration of levothyroxine (Lt4) is possible3, 4. Recent publications suggest that once-weekly Lt4 does not increase the risk of cardiovascular events and is well tolerated by most of patients4. Once weekly Lt4 produces similar results as daily Lt4 as evidenced by thyroid function tests3,4, and potentially improves patient compliance and satisfaction with the treatment4. Clinical Course: A 29-year-old female with a history of Hashimoto’s hypothyroidism, polycystic ovarian syndrome, depression, presented with irregular menses. Her symptoms included depression, fatigue, increased appetite. Her TSH was grossly elevated at 217 uIU/mL (0.27-4.20 uIU/mL). However upon re-visit, after increasing Lt4 to 100 mcg daily her TSH increased to 280 uIU/mL. She admitted to non-adherence with her daily Lt4 prescription. Physical exam was notable for sinus bradycardia and slow mentation, otherwise unremarkable. Blood count, basic metabolic panel and hemoglobin A1C were within normal limits. Liver function tests showed mild transaminitis, ALT 46 U/L (10-45 U/L). Lt4 was started at 875 mcg per week. At five weeks, her TSH was 6.31 uIU/mL and at seven weeks, the patient was euthyroid with a TSH of 2.53 uIU/mL. Her periods have since normalized. Conclusion: The current discourse on weekly dosing mainly focuses on its use for non-adherent patients. This case provides a clear time course also demonstrating rapid normalization of TSH using weekly dosing. Weekly Lt4 dosing as first-line therapy in noncompliant depressed patients with severe hypothyroidism should be considered. 1.Hepp, Z., Wyne, K., Manthena, S., Wang, S. and Gossain, V. (2018). Adherence to thyroid hormone replacement therapy: a retrospective, claims database analysis. Current Medical Research and Opinion, 34(9), pp.1673-1678.2.Colucci, P., Yue, C., Ducharme, M. and Benvenga, S. (2010). A Review of the Pharmacokinetics of Levothyroxine for the Treatment of Hypothyroidism. European Endocrinology, 9(1), p.40.3.Jayakumari, C., Nair, A., Puthiyaveettil Khadar, J., Das, D., Prasad, N., Jessy, S., Gopi, A. and Guruprasad, P. (2019). Efficacy and Safety of Once-Weekly Thyroxine for Thyroxine-Resistant Hypothyroidism. Journal of the Endocrine Society, 3(12), pp.2184-2193.4.Rajput, R. and Pathak, V. (2017). The Effect of Daily versus Weekly Levothyroxine Replacement on Thyroid Function Test in Hypothyroid Patients at a Tertiary Care Centre in Haryana. European Thyroid Journal, 6(5), pp.250-254.

Accidental poisoning with cassia occidentalis: A rare cause of fatal acute encephalopathy in children

In pediatric population, accidental poisonings are not an uncommon cause for presentation as acute encephalopathy syndrome (AES). Certain plants found in India such as Ricinus Communis (Dhatura) and Cannabis are known to produce a clinical picture of AES. Hereby, we share our experience of accidental poisoning with Cassia occidentalis in three young children who presented with acute encephalopathy to the emergency department of a tertiary care center in Haryana, North India.

Oral health status, self-perceived dental needs, and barriers to utilization of dental services among people with psychiatric disorders reporting to a tertiary care center in Haryana

Patients with psychiatric disorders can be vulnerable to oral diseases due to the adverse effects of medications and disease per se. The aim of this study is to assess oral health status, self-perceived dental needs, and barriers to utilization of dental services along with evaluation of intervention urgency among psychiatric patients. In this cross-sectional study, 165 individuals were examined at the psychiatric outpatient department of a tertiary care center. Clinical examination [dentition status and community periodontal index (CPI) modified] was done according to the World Health Organization Basic Oral Health Surveys, 2013. Other information was collected by direct interview and all the data were recorded on a prestructured, validated pro forma. Data were analyzed using SPSS Software. The statistical significance was determined by analysis of variance (ANOVA) and level of significance was set at P < 0.05. Although decayed, missing, and filled teeth (DMFT) and CPI-modified scores increased with increase in duration of illness, the difference was not statistically significant. Evaluation of self-reported attributes revealed that the majority of the individuals had reported dental pain (34.6%) as their dental problem, 39.6% visit dentist only when there is a dental problem, and 41.7% did not felt any need to visit dentist. The ANOVA of DMFT in relation to duration of illness (P > 0.062) and CPI-modified scores (P > 0.078) were not statistically significant. Although when intervention urgency was evaluated, 70.3% needed prompt treatment depending on their oral health assessment. The findings of this study suggest that oral health concerns of this marginalized section of the population are unrecognized and should be given prominence by psychiatrists.

Tobacco use among health care workers of tertiary care center of Faridabad, Haryana, India

BackgroundAssociated health risks and increasing mortality with tobacco consumption has been increasing. If people involved in health care of the community practice the same it may further increase the magnitude of problem. ObjectivesTo assess the prevalence and reasons of tobacco consumption among health care workers (housekeeping staff and nursing orderlies) of a tertiary care center in Haryana, India. MethodsIt was a fully mixed concurrent dominant status design with dominant quantitative part where cross sectional design was used. The qualitative component used phenomenology. All the housekeeping staff and nursing orderlies working (306 total) at a tertiary care center, Faridabad were recruited in the study. In depth interview was conducted on twenty workers (12 housekeeping staff and 8 nursing). ResultsOverall prevalence of tobacco consumption was 43.4%. Among tobacco users, smokeless tobacco was used by more than half of housekeeping staff (53.2%). Nursing orderly preferred smoked form i.e. cigarette (41%). Participants discussed social and cultural conditions in Haryana under which smoking hookah are practiced and maintained. Smoking as a means of socializing and relaxation were consistently discussed as the main reasons for continued use in everyday lives. Working condition was a compelling factor for housekeeping staff leading to its continuous use to carry on the current job. ConclusionTobacco consumption among health workers is higher as compared to general population. Appreciating their diverse representations their attitudes towards health and anti-tobacco measures; would increase acceptance of policies and probability that can lead to positive outcomes.

The Effect of Daily versus Weekly Levothyroxine Replacement on Thyroid Function Test in Hypothyroid Patients at a Tertiary Care Centre in Haryana

Objective: We compare the effect of daily versus weekly levothyroxine (LT4) replacement on thyroid function test (TFT) in hypothyroid patients at a tertiary care centre in Haryana. Materials and Methods: This was a randomised crossover study in which 100 hypothyroid patients on a stable LT4 dose were divided into 2 groups of 50 each. In group I, patients were given daily therapy for 6 weeks and then shifted to weekly therapy for the next 6 weeks. In group II, patients were given LT4 once a week for 6 weeks and then switched to daily therapy for the next 6 weeks. TFT, quality of life (QOL), and hyperthyroidism symptom scale (HSS) score of patients were compared in each group at 0, 6, and 12 weeks. Results: TFT remained within the normal range, but TSH increased (group I, daily 2.8 ± 1.4 mIU/L, weekly 3.9 ± 1.1 mIU/L, p = 0.001; group II, weekly 4.6 ± 1.1 mIU/L, daily 2.7 ± 1.2 mIU/L, p = <0.001) and T3/T4 decreased with weekly therapy as compared to daily therapy. No significant difference in HSS score was found between daily and weekly administration of LT4. With weekly therapy, QOL showed improvement in bodily pain, vitality, mental health, and social functioning. Conclusion: Once-weekly LT4 administration is a reasonable alternative for patients, especially for those who have issues with compliance.

Prevalence of glucose intolerance in rheumatoid arthritis patients at a tertiary care centre in Haryana

AimsRecent studies have shown increasing prevalence of dysglycemia in rheumatoid arthritis (RA) patients. The present study was planned to study the prevalence of pre-diabetes and diabetes in RA patients from a tertiary care centre in Haryana, India. Methods150 diagnosed cases of rheumatoid arthritis which were on follow up in Rheumatology clinic from last one year and equal number of age, sex matched controls were recruited for the study. FPG, 2h plasma glucose level after 75g oral glucose tolerance test and HbA1c were estimated in all the subjects. In RA patients c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF) and Anti-cyclic citrullinated (Anti CCP) antibodies were also measured and disease activity was assessed by using (DAS28 joint counts) and CDAI. ResultsPatients with RA had statistically significant higher waist circumference, hip circumference and BMI as compared to control group. Prevalence of glucose intolerance in RA patients and control group was 14.67% and 6.67% respectively which was statistically significant (p=0.025). The prevalence of pre-diabetes was in RA group was not significant statistically. There was higher disease activity in glucose intolerant (GI) RA cases as compared to normal glucose tolerant (NGT) RA cases. The most commonly used drug combination among RA patients was MTX+HCQ+SAAZ (49 patients, 32.67%). Maximum glucose intolerance was observed in patients who were on Non-HCQ drug combinations. ConclusionsThere is elevated prevalence of glucose intolerance among RA patients that is related to high disease activity, visceral adiposity and drugs usage.

Opportunistic screening for random blood glucose level among adults attending a rural tertiary care centre in Haryana during world health day observation activity

Background: Diabetes mellitus is one of the most common non-commu­nicable diseases worldwide and major global risks for morbidity and mortality. The total burden of deaths from high blood glucose in 2012 has been estimated to 3.7 million which includes 1.5 million diabetes deaths, 2.2 million deaths from cardiovascular diseases, chronic kidney disease, and tuberculosis. Various studies reported that population-based screening of blood glucose level will result in low yield but higher cost. However, opportunity screening at earlier stage had good prognosis. Hence opportunistic screening for raised random blood glucose level was planned.Methods: During observation of World Health Day 2016 activity based on theme, “Beat diabetes: Scale up prevention, strengthen care, and enhance surveillance” this present cross-sectional study was conducted. Attendants of the patients having age &gt;30 years; visiting this institute on that day enrolled as study participants. Information gathered regarding their socio-demographic parameters and doing regular physical activity. A brief clinical examination regarding anthropometric measurements and random blood glucose was done using standard procedures by trained personnel.Results: Out of 215 opportunistic screened participants, 14 (6.51%) participants were known diabetic and having random blood glucose level &lt;200 mg%. However among rests 201 study participants whose diabetic status was unknown, 8 (4%) participants had random blood glucose level &gt;200 mg%. BMI status of 48 (22%) and 103 (48%) study participants were recorded as pre-obese and obese respectively.Conclusions: It was concluded that after every 7 cases of known diabetes mellitus there were 4 unknown cases identified as raised random blood glucose level. Hence in tertiary care settings, individuals more than 30 years should get priority for opportunistic screening of random blood glucose estimation. Health-care providers should be sensitized on practicing opportunistic screening in outpatient department.

Prevalence of Thyroid Peroxidase Antibody and Pregnancy Outcome in Euthyroid Autoimmune Positive Pregnant Women from a Tertiary Care Center in Haryana.

Objective:To study the prevalence of thyroid peroxidase autoantibody in euthyroid pregnant women and to evaluate the association between thyroid peroxidase autoantibody and pregnancy outcomes.Materials and Methods:One thousand thirty consecutive pregnant women attending the antenatal clinic over a period of 1 year and were carrying a healthy singleton uncomplicated intrauterine pregnancy and consuming iodized salt were recruited for the study. Outcomes of the pregnancy was compared between TPO antibody positive euthyroid women (group 1) and TPO antibody negative euthyroid women (group 2).Results:Out of 1030 women, 164 (18.9%) were detected TPO antibody positive with euthyroid status. The mean FT4 and TSH level were significantly different in those who were TPO Ab positive as compared TPO Ab negative euthyroid pregnant women. No correlation was observed between the maternal age, gestational age and gravidity with anti TPO antibody levels. Eighteen (12%) women in Group 1and 5 (3.3%) women in Group 2 had miscarriages and the difference was found to be statistically significant (P value of 0.004). Twenty-one (14%) women in Group 1 and 5 (3.3%) women in Group 2 had preterm deliveries, which was also found to be statistically significantly (p value of 0.001). Other pregnancy related complications like Intrauterine death, IUGR, preeclampsia and PIH though are present in comparatively higher number in TPO Ab positive euthyroid pregnant women as compared to TPO Ab negative euthyroid pregnant women but this difference was not found to be statistically significant.Conclusions:To conclude with the present study shows that a good number of pregnant women with euthyroid status have TPO Ab positivity and this is associated with some adverse pregnancy outcomes like miscarriage and preterm birth of the baby.

Study of Liver Function Test in Perinatal Asphyxia at a Tertiary Care Center in Haryana

Background: Perinatal asphyxia is an insult to the fetus or newborn due to lack of oxygen (hypoxia) and /or a lack of perfusion (ischemia) to various organs. The diagnosis of perinatal asphyxia is mostly established retrospectively. But it is difficult to diagnose perinatal asphyxia retrospectively in the absence of perinatal records. As because of hypoxaemia, different organ systems of the body are affected in perinatal asphyxia, this study was done to assess the hepatic function in the cases of perinatal asphyxia which could prove useful in diagnosing perinatal asphyxia. Methods: The study included 25 asphyxiated neonates as cases and 25 healthy neonates as control group. Venous blood was analyzed between 2nd and 5th day of life to estimate serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP), serum total bilirubin (STB), direct bilirubin (DSB) and prothrombin time (PT). Unpaired student’s ‘t’ test was used for data analysis and P value of <0.05 were considered significant. Results: Serum ALT and AST were found significantly higher in asphyxiated babies compared to reference groups (p<0.001). The mean ALT and AST of asphyxiated babies were 100.17±35.50 and 84.13±44.49 U/L, respectively and those of normal babies were 30.25±9.49 U/L and 41.97±11.49 U/L respectively. Conclusions: Estimation of liver enzymes can prove helpful in diagnosing perinatal asphyxia in absence of birth details especially in developing country like India.

Characteristics of patients of ante-partum hemorrhage at a tertiary care centre

Introduction: Antepartumhaemorrhage (APH) defined as bleeding from or into the genital tract after 24 weeks of gestation but before the birth of baby. The causes of APH are placenta previa, abruption placentae, local causes and vasa previa. Aims and Objectives: To study the demographic profile and maternal and perinatal outcome in antepartum haemorrhage. Material and Methods: It is a retrospective study done at a tertiary care centre in Haryana over a period of seven months. Case files of 140 patients of antepartum haemorrhage were studied for various parameters and analyzed. Results: Total deliveries were 6227 during the study period, out of which abruption placentae cases were 51.43% and placenta previa were 48.57%. Three maternal death were reported due to abruption placentae and one was due to placenta previa. Perinatal mortality was 68.96% due to abruptio placentae and 16.96% was due to placenta praevia. Conclusion: In antepartum haemorrhage, both mother and foetus are at risk. Proper antenatal care, early diagnosis, early referral and timely management can improve the maternal and perinatal outcome. Keywords: Booked, Unbooked, Antepartum haemorrhage, Placenta previa, Abruption placentae

Evaluation of POSSUM and P-POSSUM as a tool for prediction of surgical outcomes in the Indian population.

Increased scrutiny and the need to institute a truly patient centered approach to surgical care has motivated the growing interest in measuring the quality of surgical care through comparative surgical audit. This study aimed to assess the validity of the POSSUM (Physiological and Operative Severity Score for enumeration of Mortality and Morbidity) and P-POSSUM (Portsmouth-POSSUM) score in predicting the risk of morbidity and mortality respectively in general surgical patients presenting with conditions of various operative severities at a tertiary care centre in Haryana, a northern state of India. A prospective study was performed in 100 general surgical patients including an equal number of patients in each of the four groups of operative severity i.e. minor, moderate, major, major plus. The risks of mortality and morbidity were calculated by using the POSSUM equation for morbidity and the P-POSSUM equation for mortality in each patient. The predicted risks were compared with the observed risks of mortality and morbidity and statistically analysed. The difference in p value of predicted risk of morbidity by POSSUM equation and observed morbidity; calculated by chi square test was 0.756 which was not statistically significant. The difference in p value of predicted mortality by P-POSSUM equation and observed mortality; calculated by chi square test was 0.472 which was also not statistically significant. POSSUM and P-POSSUM appear to be good and valid indices for use in the risk prediction of morbidity and mortality in the north Indian population.