Tertiary Care Teaching Institute Research Articles

Adverse events following immunization with pentavalent vaccine in a tertiary care hospital

Background: Immunizations currently save 3 million lives per year throughout the world and is one of the most cost-effective health interventions. The Global Alliance for Vaccines and Immunizations (GAVI) and WHO recommended the use of pentavalent to replace the DPT vaccine in developing countries. Vaccines related most side effects are mild and non-serious. Surveillance of adverse events following immunization will enable us to monitor the safety of immunization programs and thereby contribute to validating the immunization program. The main aim of this study is to analyze all suspected adverse events in children reported for pentavalent vaccination.Methods:A prospective, observational epidemiological study was conducted in the department of Paediatrics OPD at tertiary care teaching institute during October 2016 to December 2016. The study was conducted amongst 190 children attending the department of Paediatrics OPD for the second or third dose of pentavalent vaccine.Results: The study shows the following adverse effects after pentavalent injection 127 (66.8%) children had pain at the site of injection, 103(54.2%) mild fever, Swelling at injection site 84(44.2%) and 55(28.9%) children held their leg back due to pain. In majority 85 (44.7%) of children antipyretic and in 65 (34.2%) children analgesic was given was given to relieve the symptoms. The parents were very positive for completing their children’s immunization schedule even though they have faced few symptoms.Conclusions:It can be concluded that all the adverse events reported were mild and could be managed easily without any complications.

Impact of human milk banking on neonatal mortality, necrotizing enterocolitis, and exclusive breastfeeding – experience from a tertiary care teaching hospital, south India

Objective: The objective of this study is to study the impact of a Human Milk Bank (HMB) on neonatal mortality, incidence of necrotizing enterocolitis (NEC) and rate of exclusive breastfeeding.Methods: This pre–post intervention study was conducted in a tertiary care teaching institute in south India. Data regarding neonatal mortality, incidence of NEC, and exclusive breastfeeding rates were collected for a period of 6 months before and after establishing a modern HMB and compared.Results: The number of deliveries, live births, and incidence of preterm and VLBW neonates during pre- and post-HMB periods were comparable. Neonatal mortality was 11.32/1000 live births pre-HMB compared with 10.77/1000 live births post HMB. The incidence of NEC was 1.26% of live births pre-HMB compared with 1.07% post-HMB. Exclusive breastfeeding rate pre-HMB was 34% compared with 74% post HMB (p < .001).Conclusion: There is a decreasing trend in neonatal mortality and incidence of NEC after establishing a HMB. Human milk banking significantly improved exclusive breastfeeding rate in the population studied.

Medication-related clinical decision support alert overrides in inpatients.

To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers' reasons for overriding them and the appropriateness of those reasons. We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons. Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden, though the rate of overrides varied by alert type (P < .0001). About 60% of overrides were appropriate, and that proportion also varied by alert type (P < .0001). Few overrides of renal- (2.2%) or age-based (26.4%) medication substitutions were appropriate, while most duplicate drug (98%), patient allergy (96.5%), and formulary substitution (82.5%) alerts were appropriate. Despite warnings of potential significant harm, certain categories of alert overrides were inappropriate >75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to reduce alert fatigue. Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate. Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert fatigue so that important alerts are not inappropriately overridden.

Laparoscopic choledochoduodenostomy as a reliable rescue procedure for complicated bile duct stones

Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction is generally accepted as first line management for common bile duct (CBD) stones. CBD exploration, either by open or laparoscopic approach nowadays, is usually reserved for ERCP failures, complicated stone locations, along with altered anatomical situations. The aim of this study was to highlight the increasing role of laparoscopic choledochoduodenostomy which is not only a reliable but also as a rescue procedure for those failed ERCP cases due to complicated bile duct stones. It is a retrospective review of the database, from a tertiary care teaching institution from India, from Jan 2012 up to December 2016. Out of total 30 patients who underwent laparoscopic choledochoduodenostomy, 28 had failed ERC stone clearance while two patients were directly offered drainage in view of unfavorable anatomy. The major reasons for failed ERC stone clearance were as follows-multiple large calculi (42.8%), recurrent stones (21.4%), and associated stricture (21.4%). Mean operating time was 130 (± 27) minutes with mean blood loss of 60 (± 19) ml. Stone extraction was successful, primarily by milking in 13 (43.33%) patients, rest required augmentation by Dormia basket/balloon. Two patients (6.66%) developed controlled bile leak which resolved with conservative treatment. The median length of hospital stay was 5days (IQR 3-9). Mean duration of follow-up was 17 (± 3.2)months. Laparoscopic common bile duct exploration with choledochoduodenostomy has been shown to be a safe, reliable, and efficient method for treating complex CBDS, especially after failed ERCP procedures.

Encountering Chronic Sore Throat: How Challenging is it for the Otolaryngologists?

Objective To explore and diagnose the underlying causes of chronic, recalcitrant sore throat. Methodology In this descriptive, cross-sectional study spanning 3years (January 2014-December 2016), 1580 patients with chronic sore throat (>12weeks duration, despite conventional medication) were evaluated for the possible cause(s) in a tertiary care teaching institute of eastern India, through proper history, appropriate investigations, and a self-designed algorithm. Results The common causes for chronic sore throat were chronic tonsillopharyngitis, gastroesophageal reflux disorder, submandibular sialadenitis, and laryngopharyngeal reflux disorder, respectively. Allergy, psychiatric illnesses, oral submucous fibrosis, systemic comorbidities (diabetes mellitus, hypothyroidism, uremia, arthritides), stylalgia, Koch's pneumonitis, recurrent aphthous ulcers, and dietary deficiencies formed the other major causes. There was a minimal female preponderance, the female: male ratio being 1.25. About 39% patients were chronic smokers, and 31% addicted to alcohol. Forty-three (2.72%) patients were reactive to HIV 1/2. Conclusion The study provided with a detailed account of the heterogeneous etiology of chronic sore throat, and an overall structured idea on how to approach to its work-up and diagnosis. Proper history taking and appropriate structured investigations are the keys. Chronic tonsillopharyngitis, gastroesophageal reflux disorder, submandibular sialadenitis, and laryngopharyngeal reflux disorder were the chief causes of chronic sore throat.

Cancer penis evaluation of role of prophylactic inguinal lymph nodes dissection

Background: Incidence of penile cancer is considerably variable across the globe; this disease is uncommon in the western world. But it is not uncommon to see the disease in Indian subcontinent. Also, it is not uncommon to see Penile growths with palpable unilateral or bilateral lymph nodes. In this retrospective observational study, we would like to present our data of 31 cases of Penile cancer with variable presentations, in terms of palpable groin lymph nodes. FNAC from palpable lymph nodes may not be diagnostic of metastasis. It is said that battle of cancer penis is either won or lost depends on how you deal with groin. It is a clear understanding that in presence of positive groin nodes Lymphadenectomy is the choice of treatment but it is unclear, how to deal with negative groin? In this study we present experience, in terms of deal with the groin lymph nodes aggressively, even when they not palpable for a better outcome after balancing the morbidity of the procedure. Aim was to evaluate the role of early prophylactic inguinal node dissection in patients with squamous cell cancer of Penis.Methods: This retrospective observational study was carried out at tertiary care teaching institute from 2003 till 2012. The clinical, investigational, operative, pathology details and follow-up data were collected from patient records.Results: Study showed data of 47 patients treated during the period from 2003 to 2012 and included 31 patients in this study, 21 patients (67.74%) presented with palpable inguinal nodes at the time of primary presentation. FNAC from these lymph nodes could prove metastasis, only in 16 patients (76.19 %). 5 patients (23.80) on FNAC had no metastasis. Remaining 10 patients were without lymph node enlargement at the time of primary presentation. Patients presented without palpable lymph nodes were offered modified inguinal block dissection. Histology showing 8 nodes positive for metastatic disease. And were FNAC was negative 4 (80 %) out of 5 patients with negative nodes shown positive for metastasis.Conclusions: This retrospective observational study concludes with fact that palpable lymph nodes in the groin, is no doubt an indication for Inguinal node dissection but even when nodes are negative on FNAC or not palpable then prophylactic lymph nodes dissection should be undertaken. Delay in inguinal lymphadenectomy in non-palpable nodes you may lose the battle on cancer penis, as many reports say that, delayed lymphadenectomy has a strong impact on the survival. The only drawback with prophylactic lymph node dissection is the associated morbidity. But with modified procedures this can be very well minimized.

Comparison of single-injection ultrasound-guided approach versus multilevel landmark-based approach for thoracic paravertebral blockade for breast tumor resection: a retrospective analysis at a tertiary care teaching institution.

BackgroundThe role of thoracic paravertebral blockade (TPVB) in decreasing opioid requirements in breast cancer surgery is well documented, and there is mounting evidence that this may improve survival and reduce the rate of malignancy recurrence following cancer-related mastectomy. We compared the two techniques currently in use at our institution, the anatomic landmark-guided (ALG) multilevel versus an ultrasound-guided (USG) single injection, to determine an optimal technique.MethodsWe retrospectively reviewed records of patients who received TPVB from January 2013 to December 2014. Perioperative opioid use, post anesthesia care unit (PACU) pain scores and length of stay, block performance, and complications were compared between the two groups.ResultsWe found no statistical difference between the two approaches in the studied outcomes. We did find that the number of times attending physicians in the ALG group took over the blocks from residents was significantly greater than that of the USG group (p=0.006) and more local anesthetic was used in the USG group (p=0.04).ConclusionThis study compared the ALG approach with the USG approach for patients undergoing mastectomy for breast cancer. Based on our observations, an attending physician is more likely to take over an ALG injection, and more local anesthetic is administered during USG single injection.

Deferral Patterns of Voluntary Blood Donation in a Tertiary Care Teaching Institute

Deferral Patterns of Voluntary Blood Donation in a Tertiary Care Teaching Institute

Role of 256 slice CT scan in pre and postoperative evaluation of congenital cardio-vascular anomalies: our experience at a tertiary care teaching hospital

Background: Ultrafast CT (UCT) scan plays an important role in the evaluation of congenital cardiovascular anomalies (CCVA). A major advantage of higher slice multi-detector CT (MDCT), is improved temporal as well as spatial resolution, that helps accurately to delineate complex cardiac and extra-cardiac anomalies with relative ease. Hence this study was aimed to highlight the utility of UCT in the evaluation of congenital cardiovascular anomalies in a large series of patients.Methods: All consecutive patients with suspected CCVA were evaluated by cardiac CT angiography (CCTA) on 256 slice CT scan in a multispecialty tertiary care teaching institute from June 2013 to December2015.Results: A total of 160 cases of CCVA were evaluated by CCTA. 50 patients had multiple anomalies. A total of 216 anomalies were diagnosed. Tetralogy of fallot (TOF) dominated the list of CCVAs (60, 28%) than the other abnormalities. Of them, 25 patients underwent Blalock Taussig (BT) shunt surgeries, 20 patients underwent total repair operation like Rastelli’s operation or augmentation of pulmonary arteries (PAs) while 15 patients were lost to follow up. Most of the patients diagnosed with CCVAs were managed successfully based on the imaging diagnosis of the cardiovascular anomaly.Conclusions: Ultrafast CT scans have immense role in the evaluation of various types of congenital cardiovascular anomalies. It is particularly helpful in the evaluation of extra-cardiac systemic and pulmonary arterial and venous system, postoperative complications, to see the status of shunts, stents and conduits.

Estimation of partitioning of airflow in septal surgery: A prospective study with reference to the NOSE scale.

Improper patient selection for septal surgery often has been found to result in therapeutic failure, and there needs to be an objective assessment of nasal obstruction before the surgery and for postoperative follow-up that can be applied in the routine otolaryngology practice. The purpose of this study is to assess the usefulness of a cost-effective device for objective measurement of the nasal airway partitioning in selecting patients for septal surgery and for postoperative outcome evaluation. A hospital-based, prospective, observational study was carried out in a tertiary-care teaching institution involving 74 patients waiting for septal surgery. Each patient was exposed to subjective assessment of nasal obstruction by the Nasal Obstruction Symptom Evaluation (NOSE) scale and objective measurement by Nasal Partitioning Ratio (NPR) using a new device, Nasal Airway Partition Meter (NAPM), once before and twice after surgery. Overall, average NOSE score and NPR values were 66.42 ± 9.42 and 0.57 ± 0.18, respectively, at preoperative assessment (correlation coefficient 0.441). Sixty of the 74 patients had high values for both NPR and NOSE scores (Group 1), but in the remaining 14, NPR values were found to be lower despite high NOSE scores (Group 2). Postsurgery, the NOSE score and NPR values were significantly reduced in Group 1. In contrast, participants in Group 2 showed no alteration in the values of both the parameters after the same operative maneuver. However, 2 patients in Group 1 had NOSE score and NPR values unaltered, while 1 patient in Group 2 had a reduced NOSE score after surgery. Therefore, the validity of the new equipment was calculated to be 96.7% sensitive and 92.9% specific to identify patients who needed to undergo septal surgery for their nasal obstruction. It can be deduced from the present study that NAPM can be a cost-effective device for clinicians to objectively measure nasal airway obstruction and screen patients for septal surgery.

Knowledge Attitude and Practice towards Infection Control Measures amongst Medical Students in a Medical Teaching Tertiary Care Hospital

Introduction: Health care associated infections (HAIs) are likely to be the most common complication of hospital care. World Health Organization (WHO) estimates these infections to occur among 7% - 12% of the hospitalized patients globally, with more than 1.4 million people suffering from infectious complications acquired in the hospital at any time. Keeping this in mind, the present study was conducted to delineate the level of knowledge, attitudes, and practices (KAP) for the use of proper disinfection procedures among the final year undergraduate medical students in a tertiary care hospital and teaching institute. Methodology: Present study was conducted at Government Medical College, Surat, a tertiary care hospital and teaching institute. The participants who gave consent were provided with a pre-tested questionnaire that included several questions on knowledge attitude and practices on hospital acquired infections and its control practices. Analysis of the answers was done based on KAP score. Result: 80 students who consented were included in the study. 75% of the study population had correct knowledge about the most common health care associated infections (HAIs), being infection of venous access, urinary tract infection, respiratory infections and surgical site infections, based on their current knowledge on hospital acquired infections. Majority of study participants agreed with the fact that the inappropriate application of disinfection procedures increases the risk for a health care worker of either acquiring or transmitting a HAI from/to a patient. >90% participants had a good attitude towards risk of getting or transmitting any infectious disease by a Health care worker (HCW) while working and the utility of the application of disinfection procedures during work would reduce the rates of HAI. Practices of the students towards disinfection during performance of certain medical procedures ranged from 10% to 88% of the times showing poor practices of the medical students in following disinfection practices. Conclusion: In the present study the knowledge of medical students for the most common cause of hospital acquired infection was satisfactory. The overall attitude of the students was satisfactory as the mean score was 8. The practices of the students for the application of disinfection during performance of certain medical procedures were also satisfactory, although time to time training and tutorials of these students can help in increasing their knowledge, attitude and practices.

Candidemia profile and antifungal drugs susceptibility pattern in neonatal intensive care unit patients in a tertiary care teaching institute in Maharashtra

Background: Invasive candidiasis is one of the most commonly encountered problems in neonatal intensive care unit (NICU) leading to substantial morbidity and mortality. Recent studies show an increase in antifungal resistance of candida species. Therefore, species identification with antifungal susceptibility pattern of Candida isolates is very important and helps in the selection of appropriate antifungal agents to prevent the emergence of drug resistance and successful treatment. Methods: Seven thirty four blood culture samples from 244 patients of NICU were tested. Yeast isolates from these blood cultures were identified by conventional methods. Anti-fungal susceptibility testing was done according to CLSI M44A guidelines for Fluconazole, Voriconazole, ketoconazole, Amphotericin-B and Itraconazole. Result: From 118 isolates c. albicans were 37.28 % and remaining 62.72% were non-albicans candida species including c.glabrata (28.81%), c.parapsilosis (14.4%), c.tropicalis (12.71%) and other (6.77%). From all isolates of candida species, Fluconazole, Amphotericin B and ketoconazole were sensitive in 61.0%, 86.4% and 99.1% patients respectively. Voriconazole and Itraconazole were 100% sensitive. Conclusion: Although previously Candida albicans accounted for majority cases of candidiasis, recently NAC species have been increasingly reported in neonatal intensive care units. Amphotericin B should be reserved for life threatening conditions and extended spectrum azole drugs like Voriconazole, Itraconazole and ketoconazole can be good alternatives for treating these infections. DOI: 10.21276/APALM.2017.1000

The Vitamin D Status in 6-14 Year Old Children Attending Tertiary Care Teaching Hospital in South India

Introduction: Vitamin D insufficiency among healthy children and adolescents is reported to be highly prevalent in the different parts of world. Objective: To assess the Vitamin D status in children in the age group of 6-14 years attending a tertiary care teaching institute of South India and to analyze the factors which can contribute to Vitamin D deficiency in these children. Methods: Cross-sectional study. 6 – 14 year old children attending the outpatient department were included in the study. Children with co – morbid conditions that affect Vitamin D metabolism and those children on chronic drug treatment and on Vitamin D supplementation were excluded from the study. Results: Average age of study population was 8.93± 2.02. In the study 48 (52.2%) children among a total of 92 had a normal Vitamin D status while the rest 44 children (47.9%) had insufficient Vitamin D status (25 hydroxy vitamin D < 30 ng/ml). Among these children 21 (22.8%) had sub-optimal vitamin D levels, 19 (20.7%) were deficient, 3 (3.3%) had severe and 1 (1.1%) had very severe deficiency of Vitamin D. The average Vitamin D level among the study population was 31±14.13 ng/ml. There was significant statistical association between Vitamin D deficiency and stunting (p=0.003). No statistically significant association was found between outdoor activity, clothing and skin colour with Vitamin D deficiency in this study. Conclusions: Vitamin D insufficiency was documented in 47.9% of 6 – 14 year old children and there is a significant association between stunting and Vitamin D deficiency.

Study of carotid intimal medial thickness in essential hypertension with or without left ventricular hypertrophy.

Introduction:Hypertension and atherosclerosis though separate entities, are interrelated as hypertension plays an important role in the pathogenesis of atherosclerosis. This study was undertaken to study the association of carotid intimal medial thickness with left ventricular hypertrophy (LVH) in hypertensive patients.Materials and Methods:Hundred hypertensives (JNC-7, Stage 1 and 2) between 30 and 55 years were enrolled in this prospective observational study conducted at a tertiary care teaching institute of Punjab, India. Electrocardiogram, Carotid Doppler, and Echocardiography were carried out in addition to routine biochemical investigations.Results:Increased carotid intimal medial thickness (CIMT) had statistically significant association with age, duration of hypertension, high systolic and diastolic blood pressure (BP), left ventricular hypertrophy and left ventricular mass index but was not associated with body mass index, low-density lipoproteins, and total cholesterol.Conclusions:LVH and arterial wall changes occur concurrently, and therefore, management of hypertension should not be limited just to control of BP but should also include therapy for carotid plaques and increased CIMT.

Perioperative management of obstetrical surgeries in women having coexisting cardiovascular disease: our experience

Background and aim: Coexisting cardiovascular disease in pregnancy is associated with high maternal morbidity and mortality. These patients pose a great challenge to both anesthesiologist and obstetrician. Present study was aimed at reviewing the perioperative management and outcome of obstetrical surgeries in women who had coexisting cardiovascular disease in a tertiary care teaching institute. Materials and Methods: Departmental database of all pregnant patients with coexisting cardiovascular diseases who underwent obstetrical surgeries during January 2011 to August 2016 were reviewed. Patients functional status, obstetrical history, stage of labor, type of anaesthesia, monitoring, hemodynamics, post operative care and baby outcome were noted. Data are expressed in absolute number and percentage scale and INSTAT software was used for measuring central tendencies and dispersion. Results: A total of 22 women (mean + Standard deviation: SD age 26.18 + 4.78 years) were found eligible and included for analysis. 21(95.45%) patients underwent cesarean section and one medical termination of pregnancy. 68.18% cases were done under subarachnoid block. Most of the patient needed post operative high dependant unit care, one patient developed mild pulmonary edema and no maternal and fetal deaths were noted. All the babies were born with APGAR > 7 at 1 min. No patient was managed using pulmonary artery catheter or continuous cardiac output monitoring. Conclusion: Pregnant patients with coexisting cardiovascular disease need multidisciplinary approach, timely delivery and intensive therapy in perioperative period. They can be safely delivered under subarachnoid blocks. Pulmonary artery catheterization is probably not an essential for hemodynamics management of such patients in perioperative management.

Analysis of the results of surgical management of traumatic paraplegia

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Aim of this study was to evaluate the results of surgical management of traumatic paraplegia, complete or incomplete as classified by Frankel scoring.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was conducted in patients attending outdoor and emergency department of orthopaedics of a tertiary care teaching institute in Katihar Medical College, Katihar (Bihar) with traumatic paraplegia involving the dorsolumbar spine. The duration of the study was July 2014 to July 2016. The important objectives are the time for recovery of various functions like sensory, motor and bowel and bladder function, comparison between early and late decompression, results of posterolateral fusion and time taken for solid bony fusion after operation. Cases selected for these studies were those treated surgically between July 2014 to July 2016. Total 46 cases were selected within a minimum of 6 month post-operative follow up of which 4 cases lost in follow up. Data collected from patients records including age, sex, time from injury to hospitalization, initial neurological status as per Frankel score, MRI findings, surgery performed, postoperative course and neurological status at the time of discharge and latest follow up. Patients lost to follow up were not studied for outcome analysis.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; When decompression done within 1&lt;sup&gt;st&lt;/sup&gt; week in incomplete paraplegia 80% of the patients showed return of grade 3 power. In complete paraplegia cases, 11% of the patients had return to power upto grade 3 when decompression done within 1 week where no cases return of grade 3 power when decompression done after2nd and 3&lt;sup&gt;rd&lt;/sup&gt; week&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; After recovery from spinal shock, the earlier the surgical decompression done, the better the neurological and bowel/bladder function recovery both in complete and incomplete paraplegic cases. Reduction is better and easy and less time consuming in early decompression than in late. Motor recovery can continue for over 6 month after decompression&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Study of biochemical and nutritional indicators in severe acute malnutrition: A prospective observational study

Background: Malnutrition in children is widely prevalent in developing countries including India. More than 33% of the deaths in 0-5 years are associated with malnutrition. Children with severe acute malnutrition (SAM) are in danger of death from hypoglycemia, hypothermia, fluid overload, electrolyte mismanagement, and undetected infections. Hence, biochemical and nutritional indicators in these children are important for management. Objectives: To study the biochemical and nutritional indicators in children with SAM. Methods: This hospital based prospective study was conducted on children aged 6-59 months admitted at Nutrition Rehabilitation Center attached to a tertiary care teaching institution. 100 consecutive SAM children admitted during 2013-2015 were studied. Children were tested for biochemical and nutritional status like complete blood picture with peripheral smear, liver function tests, renal function tests, serum electrolytes, calcium, phosphorus, and alkaline phosphatase. Results: A total of 100 cases were included, of these 57 were male and female were 43. Mean age of presentation was 18.45±2.37 months. A lack of exclusive breastfeeding was seen in 67% of these children and in 78% children complimentary feeds were initiated either early or later than 6 months. Hypoglycemia was seen in 15% cases, hypokalemia in 22%, and hypocalcemia in 35% of cases. Hyponatremia was seen in 14% and hypernatremia in 19% of the children. The most common type of anemia was microcytic hypochromic type (55%). Conclusion: The observations in this study confirm a significant association between SAM and faulty feeding and early introduction of complementary feeds. It was observed that these children have significant alterations in nutritional indicators at admission.

Comparative evaluation of different modalities of treatment in benign prostatic hyperplasia at tertiary care teaching institute

Background:Benign prostatic hyperplasia (BPH) is the most common disease occurring in men as the age advances. There are various treatment modalities available, amongst which trans-urethral resection of prostate (TURP) is widely used but role of open Freyer's prostatectomy and medical management can't be ignored at the same time. This study was done to compare different modalities of treatment, to evaluate the individual modality in view of its efficacy, complications and patient satisfaction, to compare the different modalities in their efficacy for management of BPH and their complication profile, to suggest the best form of therapy that can be offered to patients.Methods: A retrospective comparative study was conducted including 90 patients having benign prostatic hyperplasia (BPH) were enrolled for the study and randomly divided into three groups of 30 patients each. Group I consists of patients undergoing for Freyer's prostatectomy, Group II consists of patients undergoing TURP and in Group III patients were managed conservatively with medical management. Results:Temporary Incontinence of urine was the most common complication occurred found in 6 cases (20%) in Freyer’s prostatectomy group I and in 3 cases (10%) in TURP group II; per-urethral catheter was removed between 2-5 days in all 30 cases (100%) of TURP, but in Freyer’s prostatectomy it was kept up to average 10 days (8-18); All 30 cases (100%) of in Group II where TURP done were discharged within 6 days of surgery whereas in Group I where Freyer's prostatectomy done, most of the cases 21 (70%) were discharged between 11-15 days post-operatively. In Group III, patients were managed by medical management patients, 11 cases (36.67%) presented with acute urinary retention (AUR) and 19 (63.33%) patients presented with lower urinary tract symptoms (LUTS) without retention.Conclusions:TURP is having definite advantage over Freyer's prostatectomy, because Length of hospitalization, postoperative complications are less frequent. Transurethral resection is the method of choice in the treatment of benign prostatic hyperplasia especially in patients with mild to moderate prostatic enlargement and in the elderly patients with co-existing medical disease. Endoscopic instruments, training and more experience is required for TURP. Medical management can delay immediate surgery but later on surgical management is usually required.

Optimizing the outcome of transnasal endoscopic sphenopalatine artery ligation in managing refractory posterior epistaxis: A case–control analysis

ObjectiveTo optimize the outcome of transnasal endoscopic sphenopalatine artery ligation (TESPAL) by determining the key surgical steps and applying them accordingly. MethodsThis is a case–control study carried out in a tertiary care teaching institution on subjects who underwent TESPAL during the period of October 2010 to September 2015. Their surgical and clinical records were reviewed, and success (no re-bleed) and failure (return with re-bleed) were considered the main outcome measures of TESPAL. Accordingly, depending on whether the subjects returned with re-bleed or not, they were classified as “failure” and “success” groups. After appropriate matching in terms of age, gender and a given set of exclusion criteria that could influence per-operative decision-making or contribute to post-operative epistaxis, the groups were considered as cases (subjects undergoing TESPAL and returned with re-bleed; part of the “failure” group following matching) and controls (subjects undergoing TESPAL and did not return with re-bleed; part of the “success” group following matching). Per-operative/surgical factors executed or followed in varied combinations in each group that influenced the outcome of TESPAL were then identified from the surgical notes and were subsequently analyzed statistically. ResultsIn 89% of cases, the sphenopalatine artery (SPA) pedicle was either clipped or cauterized, whereas in 90% of the controls, it was both clipped and cauterized. The posterior nasal artery (PNA), when found, was cauterized in 25% of the cases, compared to 85% in the controls. Also, the septal artery region was cauterized in only 33% of cases. Both cauterization/clipping of the SPA along with cauterization of PNA was done in 69% of the controls, whereas in 59% the septal artery region was also cauterized. However, there were no cases when all these steps were combined. The results were statistically significant. ConclusionWhen only the per-operative/surgical factors were considered, the outcome of TESPAL was most favorable when the procedure could be done combining both clipping and cauterization of the SPA, along with cauterization of the PNA and the septal artery region.

Long-term Prednisolone in Post-stroke Complex Regional Pain Syndrome

Background: There is no study on the long-term use of prednisolone in post-stroke complex regional pain syndrome-1 (CRPS1). Objective: To evaluate the efficacy and safety of long-term low dose prednisolone in post-stroke CRPS-I. Study Design: Open-labeled randomized controlled trial. Setting: Tertiary care teaching institute. Methods: Seventy-seven out of 396 (19.4%) patients with stroke had CRPS-1 and 58 met the inclusion criteria. Their clinical details and CRPS, Visual Analogue Scale (VAS), modified Rankin Scale (mRS), and Barthel Index (BI) scores were noted. The patients were prescribed 40 mg prednisolone for 2 weeks followed by tapering in the next 2 weeks. Patients who responded were randomly assigned prednisolone 10 mg daily (group I) or no prednisolone (group II). They were followed up for the first and second month of randomization and their CRPS, VAS, mRS, and BI scores were noted. The primary outcome was improvement in CRPS score and secondary outcomes were VAS, mRS, BI scores, and severe adverse events (SAE). Results: Fifty-six of fifty-eight (96.5%) patients responded to the initial high dose prednisolone and 26 each were assigned group I and group II treatment. Group I patients had further improvement in CRPS score. Fifty percent of patients in group II had deterioration at one month and needed reinstitution of prednisolone; following which 77% of them improved in the next month. The improvement in CRPS score paralleled the VAS score but not mRS and BI scores in the first and second months in group I compared to group II. There was no SAE necessitating withdrawal of prednisolone. Limitation: The design of the study is not double blind. Conclusion: In post-stroke CRPS-I, continuation of low dose prednisolone for 2 months is safe and effective. Key words: Shoulder hand syndrome, CRPS, corticosteroid, prednisolone, stroke, Visual Analogue Scale