Etiologies of neonatal cholestasis at a tertiary hospital in Bangladesh

Background Neonatal cholestasis is an important etiology of chronic liver disease in young children. It has a varied etiology. There is considerable delay in presentation and diagnosis of neonatal cholestasis in Bangladesh. Lack of awareness and knowledge among the pediatricians regarding etiological diagnosis and outcome of neonatal cholestasis is the reasons for poor outcome in major portion of cases in Bangladesh. Objective To evaluate the etiological spectrum of neonatal cholestasis. Methods This retrospective study was conducted at the Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. We reviewed medical records of children who were diagnosed with neonatal cholestasis. Complete diagnostic profiles of every cases with age of presentation, male-female ratio and final diagnosis were analyzed. Results A total of 114 children with neonatal cholestasis were evaluated. Subjects’ male-female ratio was 1.92: 1.0, and mean age at hospitalization was 92.7 (SD 39.5) days. Biliary atresia was the most common etiology (47.4%), followed by idiopathic neonatal hepatitis/INH (21.9%). Other identified etiologies were, toxoplasmosis, others (syphilis, varicella-zoster, parvovirus b19), rubella, cytomegalovirus (CMV), and herpes/TORCH infection (8.61%), progressive familial intrahepatic cholestasis/PFIC (4.4%), galactosemia (4.4%), choledochal cyst (3.5%), sepsis (1.8%), urinary tract infection/UTI (1.8%), hypothyroidism (1.8%), lipid storage disease/Niemann-Pick disease (0.9%), non-syndromic paucity of interlobular bile ducts (2.67%), and Caroli’s disease (0.9%). Conclusion In Bangladesh, neonatal cholestasis cases are most often due to obstructive causes, particularly biliary atresia. Idiopathic (INH), infectious (primarily TORCH), metabolic, and endocrine causes followed in terms of frequency.

Download Full-text

Profile of Secondary Glaucoma at a Tertiary Hospital in East Java

Folia Medica Indonesiana ◽

10.20473/fmi.v56i1.24609 ◽

2021 ◽

Vol 56 (1) ◽

pp. 56

Author(s):

Evelyn Komaratih ◽

Yuyun Rindiastuti ◽

Yulia Primitasari

Keyword(s):

Intraocular Pressure ◽

Observational Study ◽

Surgical Complication ◽

Anterior Segment ◽

Tertiary Hospital ◽

Secondary Glaucoma ◽

Female Ratio ◽

Poor Vision ◽

Detailed History ◽

Male Female Ratio

Glaucoma is the leading cause of irreversible blindness. The aim of this study was to review the profile of secondary glaucoma cases visiting a tertiary hospital in East Java. This is retrospective observational study, completed case records of new patients with secondary glaucoma who presented to glaucoma clinic from January 2014 to April 2016 were included. Out of the 363 case records screened, 66 cases were found to eligible for inclusion. The evaluation included a detailed history and examination performed including vision, anterior segment examination, intraocular pressure (IOP), gonioscopy, and fundus evaluation. Diagnosis of secondary glaucoma was made on the basis of presence of a secondary cause for presence of raised IOP. 66 cases were eligible for inclusion in the study, most of the cases was occurred in the range age 21-50 years. The male female ratio was 1.3:1. Frequent causes of secondary glaucoma were lens factor 30.8%, steroid induced 29.5%, uveitic 20.5%, neovascular15.4%, and surgical complication 3.8%. Most patients with secondary glaucoma have poor vision < 0.1 with high IOP at presentation. Assessment and early detection of underlying cause is the key guide to treatment strategy.

Download Full-text

The Prevalence of Autistic Disorder among Children with a Learning Disability

The British Journal of Psychiatry ◽

10.1192/bjp.165.3.395 ◽

1994 ◽

Vol 165 (3) ◽

pp. 395-399 ◽

Cited By ~ 44

Author(s):

Shoumitro Deb ◽

K. B. G. Prasad

Keyword(s):

Learning Disability ◽

Autistic Disorder ◽

Rural Areas ◽

Learning Disabled ◽

Final Diagnosis ◽

School Age Children ◽

Special Schools ◽

Female Ratio ◽

North East ◽

Male Female Ratio

BackgroundIt has been suggested recently that the prevalence of autistic disorder may be rising. No prevalence study specifically among learning disabled children exists and so this study was prompted.Method. 767 children with a learning disability who attended 16 different special schools in the Grampian region of north-east Scotland were studied for a diagnosis of autistic disorder according to the DSM–III–R criteria. The study was conducted in three stages. In the first screening stage, a questionnaire was completed for each child by their teachers. In the second stage, teachers completed another questionnaire based on DSM–III–R criteria for autistic disorder. A final diagnosis was made on the basis of examination and information gathered from the questionnaires.ResultsQuestionnaires were completed for 634 (82.7%) children. 14.3% of children with a learning disability fulfilled the diagnostic criteria for autistic disorder. There was a male: female ratio of 3:1. This gave a 9 per 10 000 minimum prevalence of autistic disorder among all school-age children in the Grampian region. There was a higher prevalence of autistic disorder in the cities compared with rural areas. The prevalence did not change with age but increased with decreasing IQ.

Download Full-text

Clinical study of herpes zoster in 109 patients in central referral hospital, Gangtok

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20194680 ◽

2019 ◽

Vol 5 (4) ◽

pp. 849

Author(s):

Rukma L. Sharma ◽

Rekha Sharma

Keyword(s):

Herpes Zoster ◽

Dorsal Root ◽

Skin Lesions ◽

Age Group ◽

Female Ratio ◽

Varicella Zoster ◽

Single Nerve ◽

Male Female Ratio ◽

The Common

Background: Herpes zoster results from the reactivation of varicella-zoster virus lying dormant in the dorsal root ganglia following an earlier primary infection (chickenpox), usually in childhood. The reactivation occurs due to multifactorial causes leading to decreased immunity.Methods: This study was conducted on 109 cases of herpes zoster. Patient’s particulars were noted. A detailed history was recorded; morphology, the site and side of skin lesions were recorded. Any other associated diseases were noted.Results: Out of 109 patients 66 were male and 43 were female. The total of 53 (48.6%) patients were under the age of 40 years and 56 (51.4%) patients above 40 years. Bhutias were affected in highest number (18.4%) followed by Sharma community (15.6%). The ophthalmic division of trigeminal nerve was the most commonly affected single nerve with 13.8% followed by T10 and T7 dermatome at 9.17% and 7.3% respectively. Thoracic nerves the most commonly involved thoracic nerves with 44 cases. Single dermatomal eruptions were found in 55 patients. The dissemination of herpes zoster was although very rare but was present in three patients. Type 2 diabetes mellitus was the common associated systemic illness with 10.09% of patients.Conclusions: From this study it was revealed that both young adults and older age group people were affected almost equally. The male: female ratio was 1.5:1 with Bhutia community being mostly affected. Thoracic dermatome was the most common dermatome involved and in half the patients some form of associated disease noted.

Download Full-text

Rose Angina Questionnaire: Validation in emergency department to detect myocardial infarction in a tertiary hospital of eastern Nepal

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919836573 ◽

2019 ◽

Vol 27 (5) ◽

pp. 257-261

Author(s):

Masum Poudel ◽

Rabin Bhandari ◽

Gyanendra Malla ◽

Dharanidhar Baral ◽

Samyog Uprety ◽

...

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Descriptive Analysis ◽

Final Diagnosis ◽

True Positive Rate ◽

Tertiary Hospital ◽

True Positive ◽

True Negative ◽

Cross Sectional ◽

Female Ratio

Background: Rose Angina Questionnaire (RAQ) is a useful screening questionnaire for ischemic heart disease validated in different settings; however, its diagnostic ability to predict myocardial infarction (MI) in the emergency is less clear. Objectives: To find out the usefulness of RAQ to predict MI in patients presenting to the emergency. Methods: A cross-sectional study was conducted at the BP Koirala Institute of Health Sciences (BPKIHS), a teaching hospital in eastern Nepal from 1 January to 30 March 2017, after ethical clearance from the Institutional Review Committee. Informed consent was obtained from the patients for their anonymised information to be published in this study The samples were collected from 100 patients with chest pain aged 40 to 70 years presenting to the emergency. RAQ was applied and its performance to detect MI was compared with emergency and cardiologist diagnosis of MI. Sensitivity, specificity, positive predictive value and negative value were calculated along with descriptive analysis. Results: A total of 100 patients were analysed with the mean age of 63.78 years (SD 11.60) and male to female ratio of 1.94. RAQ detected 58 cases (63.8%) with emergency department (ED) diagnosis of MI (true positive) and identified 3 (33.3%) cases with non-MI (true negative). The true positive rate for RAQ to detect MI after cardiologist consultation was 71.6%. RAQ had a sensitivity of 84.91% (95% confidence interval (CI) 72.41% –93.25%) to detect positive troponin, 63.74% (52.99–73.56) to detect positive electrocardiogram (ECG) and 71.60% (95% CI 60.5% to 81.07%) to detect final diagnosis of MI. Conclusion: RAQ is a good screening tool to detect MI in the emergency that can be used in isolation or in combination with other diagnostic modalities to detect it early.

Download Full-text

A study of clinicopathologic spectrum of vesicobullous disorders

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20173203 ◽

2017 ◽

Vol 3 (3) ◽

pp. 355

Author(s):

Heena Mittal ◽

Sukhjot Kaur ◽

Bhavna Garg ◽

Neena Sood ◽

Sunil Kumar Gupta ◽

...

Keyword(s):

Pemphigus Vulgaris ◽

Clinical History ◽

Final Diagnosis ◽

Stevens Johnson Syndrome ◽

Direct Immunofluorescence ◽

Diagnostic Dilemma ◽

Dermoepidermal Junction ◽

Female Ratio ◽

Male Female Ratio ◽

Detailed Clinical History

Background: Blistering diseases are alarming skin conditions. Autoimmune blistering diseases are a group of bullous disorders characterized by pathogenic antibodies directed at the target antigens in the epidermis or dermoepidermal junction.The objectives were to study the spectrum of histopathological changes by light microscopy, to evaluate the pattern of direct immunofluorescence (DIF) and to correlate clinical, histopathological features and DIF findings of vesiculobullous lesions of the skin or/and mucosa.Methods: The present study was carried out on 110 skin and/or mucosal biopsies with vesicobullous disorders from July 2013 to June 2016. Detailed clinical history, morphology of lesions, site of involvement and other findings were recorded as per proforma. These cases were analysed clinically, histopathologically and on immunofluorescence.Results: Majority of the patients presented in the age group of 41-50 years (30.9%). The male: female ratio was 1:1.15. Pemphigus vulgaris was the most common vesiculobullous disorder constituting 48.2%, followed by Bullous Pemphigoid constituting 27.3%. Dermatitis herpetiformis constituted 8.3%; Pemphigus foliaceous 3.6%, varicella and Stevens Johnson Syndrome both were observed in 2.7% each. DIF was performed in 81 cases out of which only 72 cases (92.6%) showed positivity. Conclusions: DIF is a sensitive tool for distinguishing immune mediated bullous diseases from other vesiculobullous disorders especially in cases which pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on correlation of clinical, histopathological and immunoflourescence findings.

Download Full-text

Evaluation of haematological findings in cases of pancytopenia

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205027 ◽

2020 ◽

Vol 8 (12) ◽

pp. 4311

Author(s):

Roshny Jacob ◽

Deepthi M. L. Raj

Keyword(s):

Bone Marrow ◽

Disease Process ◽

Final Diagnosis ◽

Underlying Disease ◽

Diagnostic Challenge ◽

Female Ratio ◽

Male Female Ratio ◽

Bone Marrow Study ◽

Proper Diagnosis ◽

One Year

Background: Pancytopenia is a clinical condition which poses diagnostic challenge to the haematologist. The aetiology of pancytopenia is varied and depends on many factors. A bone marrow study is highly indicated in cases of pancytopenia and it provides information regarding the underlying disease process. This study was done to learn the causes of pancytopenia and to document how each case was evaluated and followed up.Methods: The present study is a descriptive retrospective one year study on bone marrow samples received in the laboratory. Bone marrow samples included aspirate smears, imprint and trephine and their findings were correlated to arrive at a final diagnosis.Results: Out of the total 28 patients with pancytopenia, 35.71% were from the age group between 61 and 80 years. A male female ratio of 1.5:1 was observed. Most common presenting complaint documented was easy fatiguability. Anisocytosis with macrocytes and ovalocytes were the most common peripheral smear finding. In current study, a cellular marrow was described in 24 (85.71%) cases and hypocellularity in two (7.14%) cases. Final diagnosis was evident in 16 cases, in which the most common cause was acute leukaemia (14.28% each) followed by lymphoma infiltration and myelodysplastic syndromes in 3 cases (10.71%).Conclusions: Bone marrow study helps to arrive at a diagnosis of pancytopenia. But proper technique for sampling, good clinical workup and history taking and clinico haematological correlation is mandatory for the proper diagnosis of a pancytopenia case.

Download Full-text

Clinical study to assess the risk factors for recurrence of febrile seizures in tertiary hospital at Cuddalore district

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20200486 ◽

2020 ◽

Vol 7 (3) ◽

pp. 561

Author(s):

Chidambaranathan S. ◽

Madhubalan T. ◽

Harivasudevan S.

Keyword(s):

Age Of Onset ◽

Strong Association ◽

Febrile Seizures ◽

Tertiary Hospital ◽

P Value ◽

Female Ratio ◽

Medical College ◽

Male Female Ratio ◽

History Of ◽

The Difference

Background: Febrile seizures are the most common and benign convulsive disorder in childhood and a frequent cause of emergency hospital admission Febrile Seizures (FS) are age-dependent and are rare before the age of 9 months and after 5 years of age, the peak age of onset is 14-18months. To assess the clinical profile in children with febrile seizures and compare these values with febrile children without seizures.Methods: The study included children admitted with bronchiolitis in between during the period of August 2018 to March 2019 at Department of Pediatrics, Raja Muthiah Medical College and Hospital. It is a case-control study. The study group includes 50 cases (febrile seizures) and 50 controls (fever without seizures) aged 6months to 5 years (6-60 months) attending the pediatric out-patient department.Results: 54% of the cases were male (27) and 46% of the cases were female (23). Male: female ratio was 1.17:1. Mean temperature in cases and controls were 101.61±1.31 °F and 101.17±0.86 °F respectively. The difference between the two groups was not statistically significant (p-value >0.05). duration of seizure was <5 minutes in 80% of cases (40/50) and >5mins in 20% of the cases (10/50).Conclusions: Simple febrile seizures may slightly increase the risk of developing epilepsy, but have no adverse effects on behaviour, scholastic performance, or neurocognition. The risk of developing epilepsy is increased further in children with a history of complex febrile seizures. A strong association exists between febrile status epilepticus or febrile seizures characterized by focal symptoms and later development of temporal lobe epilepsy.

Download Full-text

Maternal and neonatal characteristics of babies admitted with congenital CNS anomalies in a tertiary hospital in North Central Nigeria

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20182804 ◽

2018 ◽

Vol 6 (7) ◽

pp. 2205

Author(s):

Udochukwu Michael Diala ◽

Bose Ozoiza Toma ◽

Danaan Shilong ◽

David Danjuma Shwe ◽

Gyang Markus Bot ◽

...

Keyword(s):

Folic Acid ◽

Care Delivery ◽

First Trimester ◽

Tertiary Hospital ◽

University Teaching ◽

Female Ratio ◽

North Central ◽

Male Female Ratio ◽

Hospital Births ◽

Cns Anomalies

Background: CNS anomalies are an important group of largely preventable congenital anomalies. Knowledge of maternal and neonatal sociodemographic characteristics could identify a pattern of population at risk in order to target preventive interventions.Methods: This was a 3-year retrospective review of health records of all neonates admitted with CNS anomalies in Jos University Teaching Hospital (JUTH), Jos, central-Nigeria.Results: Out of a total of 27 neonates with congenital CNS anomalies reviewed, 25 had neural tube defects, 1 hydrocephalos and 1 anencephaly. The peak age group of mothers were 20-29years (44.4%) and 30-39 years (44.4%). Twenty-two (81.5%) mothers had antenatal care (ANC). No mother booked in the 1st month and only 7 (25.9%) booked in the first trimester. Twenty-four (88.9%) mothers took folic acid during pregnancy. No mother had peri-conceptional folic acid use. There were 11(40.7%) home births with 14(87.5%) of the 16 hospital births taking place in lower tier health facilities. Twenty-six (96.3%) mothers had vaginal delivery. An obstetric ultrasound scan was reported by one (3.7%) mother and did not detect the anomaly. Five (18.5%) of the mothers had HIV infection. Twenty-six were term with a male: female ratio of 1.1:1. The median age at presentation was 2 (interquartile range 1, 8) days.Conclusions: Neonates with congenital CNS anomalies in JUTH frequently had mothers aged <35 years who did not receive preventive care before and during delivery. We therefore recommend interventions to improve the efficiency of health care delivery to cater for this gap.

Download Full-text

Profile of Secondary Glaucoma at a Tertiary Hospital in East Java

Folia Medica Indonesiana ◽

10.20473/fmi.v56i1.18452 ◽

2020 ◽

Vol 56 (1) ◽

pp. 56

Author(s):

Evelyn Komaratih ◽

Yuyun Rindiastuti ◽

Yulia Primitasari

Keyword(s):

Intraocular Pressure ◽

Observational Study ◽

Surgical Complication ◽

Anterior Segment ◽

Tertiary Hospital ◽

Secondary Glaucoma ◽

Female Ratio ◽

Poor Vision ◽

Detailed History ◽

Male Female Ratio

Glaucoma is the leading cause of irreversible blindness. The aim of this study was to review the profile of secondary glaucoma cases visiting a tertiary hospital in East Java. This is retrospective observational study, completed case records of new patients with secondary glaucoma who presented to glaucoma clinic from January 2014 to April 2016 were included. Out of the 363 case records screened, 66 cases were found to eligible for inclusion. The evaluation included a detailed history and examination performed including vision, anterior segment examination, intraocular pressure (IOP), gonioscopy, and fundus evaluation. Diagnosis of secondary glaucoma was made on the basis of presence of a secondary cause for presence of raised IOP. 66 cases were eligible for inclusion in the study, most of the cases was occurred in the range age 21-50 years. The male female ratio was 1.3:1. Frequent causes of secondary glaucoma were lens factor 30.8%, steroid induced 29.5%, uveitic 20.5%, neovascular15.4%, and surgical complication 3.8%. Most patients with secondary glaucoma have poor vision < 0.1 with high IOP at presentation. Assessment and early detection of underlying cause is the key guide to treatment strategy.

Download Full-text