Acute Respiratory Distress and Its Risk Factors among Neonates Admitted in a Tertiary Care Center of Western Nepal

Background: Neonatal period is defined as a period from birth to under 4 weeks (<28 days) of age. It is a highly vulnerable time for an infant, who is completing many of the physiologic adjustments required for extra uterine existence. The term Respiratory distress (RD) is used to indicate signs & symptoms of abnormal respiratory pattern. Methods: All neonates admitted in neonatal intensive care unit of Nepalgunj Medical College, Kohalpur with respiratory distress were included. Same number of age and sex matched controls without RD were selected. Results: The NICU based hospital incidence of RD was 9.1% with male: female ratio 1.4:1 The Most Common etiology was neonatal sepsis (51.6%), followed by hyaline membrane disease (17.8%), TTN (12.7%), meconium aspiration syndrome (6%), birth asphyxia (5.08%), tracheoesophageal fistula (2%) and pneumothorax (2%). Newborns with poor APGAR score requiring resuscitation were more likely to develop RD (p=0.025). Newborns with birth weight <2.5 kg and >4 kg were 2 times likely to develop RD as compared to control group (p<0.012). There was 7 times higher risk of developing MAS when a baby was born through thick MSL as compared to control group (P<0.022). Inadequate ANC visit significantly increased RD in newborns (p<0.001). Babies born to mother with PROM for more than 18 hours were 5.5 times likely to develop RD (p<0.001) whereas those born to mother who had any source of infection were about 6 times at risk of developing respiratory distress than control group (p=0.007). Conclusion: Certain measures that could be taken to reduce the number of RD are: 1. discouraging early marriage and teenage pregnancy. 2. Increasing awareness regarding temporary and permanent contraceptive measures. 3. Promoting education of girls. 4. Increasing coverage of ANC visit in rural areas and 5. formulating integrated plan and policies from the Government level.

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Evaluation of Hypothermia in Sick Neonates as Predictor of Fatality at a Tertiary Care Center of Eastern Nepal

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v14i2.21527 ◽

2018 ◽

Vol 14 (2) ◽

pp. 8-11

Author(s):

Piush Kanodia ◽

R Bhandari ◽

N Bhatta ◽

S Yadav

Keyword(s):

Respiratory Distress ◽

Neonatal Sepsis ◽

Prospective Observational Study ◽

Mild Hypothermia ◽

Care Center ◽

Tertiary Care ◽

Birth Asphyxia ◽

Moderate Hypothermia ◽

Time Of Admission ◽

Frequent Problem

Introduction: Hypothermia is a common and frequent problem in newborns. It has larger impact in outcome related to management of sick infants.Objective: To correlate the severity of hypothermia in sick extramural neonates with fatality and physiological derangements.Materials and Methods: This prospective observational study was carried out at Neonatology unit of Pediatric department of B. P. Koirala Institute of Health Sciences (BPKIHS) Dharan. Total 200 extramural hypothermic neonates were transferred to BPKIHS from June 2015 to June 2016. Neonates weighing more than 1000 g, with abdominal skin temperature less than 36.5°C at admission were included in the study.. Clinical features and associated features were recorded at the time of admission. Oxygen saturation was recorded by a pulse oximeter.Results: Fatality was observed to be 39.3% in mildly hypothermic babies, 51.6% in moderately hypothermic babies and 80% in severely hypothermic babies. However, the presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g were associated with more than 50% fatality even in mildly hypothermic babies. When moderate hypothermia was associated with hypoxia or shock, the fatality was 83.3% and 90.9%, respectively. Similarly, mild hypothermia with hypoglycemia was associated with 71.4% fatality.Conclusion: The presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g should be considered adverse factors in hypothermic neonates. Their presence should classify hypothermia in the next higher category of severity in WHO classification. JNGMC Vol. 14 No. 2 December 2016, page: 8-11

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IMMEDIATE OUTCOME OF PRETERM BABIES BORN IN A TERTIARY RURAL CARE CENTER

10.36106/gjra/2309767 ◽

2021 ◽

pp. 22-27

Author(s):

Rohan Yadav ◽

P. Sunil Kumar ◽

Mahendrappa K.B. ◽

G.M. Kumar ◽

Channabasavanna N

Keyword(s):

Preterm Birth ◽

Observational Study ◽

Early Recognition ◽

Care Center ◽

Tertiary Care ◽

Ventilatory Support ◽

Birth Asphyxia ◽

Preterm Births ◽

Female Ratio ◽

Preterm Babies

Introduction. In neonatology preterm birth is one of the major issues as it leads to perinatal mortality and serious neonatal morbidity. Complications related to preterm birth are the leading cause of under ve 2 children death responsible for approximately 1 million death worldwide in 2015. Though Preterm births is a worldwide problem, >60% of preterm happen in South Asian countries and Africa. Since few studies have been done in rural setup this observational study of immediate outcome of preterm babies born in a rural tertiary care center has been taken up. Material and methods. This prospective observational study was done in Adichunchanagiri Institute of Medical sciences, st st Mandya from 1 August 2019 – 31 July 2020. Study sample comprised of 100 preterm babies who were born in the study period. Data was collected on a preformed Performa, it was complied and entered in a MS excel sheet. Results. Majority of preterm births in this study were in 32-36weeks which accounted for 86% of the babies. In this study male to female ratio was 0.81:1. More babies were AGA (71%) then SGA (29%). Common fetal morbidities were RDS (28%), NNH (28%), Birth asphyxia (17%), sepsis (13%). CPAP was required in 19 babies and majority of them had RDS. Ventilatory support was required in 7 babies. Mean duration of total stay was 10.64±7.65 days. In our study preterm mortality was 3% which was caused by RDS. Conclusion. Early recognition of preterm morbidities and prompt treatment can reduce preterm mortality.

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ASSESSMENT OF BURDEN OF ASPHYXIATED BABIES ACCORDING TOMETHOD OF RESUSCITATION AT TERTIARY CARE HOSPITAL

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i10.627 ◽

2019 ◽

Vol 3 (10) ◽

Author(s):

Dr. Satya Narayan Bijarnia ◽

Dr. Deveshwar Dev ◽

Dr. R K Gupta

Keyword(s):

Clinical Symptoms ◽

Perinatal Asphyxia ◽

Tertiary Care ◽

Birth Asphyxia ◽

Control Group ◽

Care Hospital ◽

Term Infants ◽

Female Ratio ◽

New Born ◽

Male Female Ratio

Background: Perinatal asphyxia is characterized among the fetus or new born due to deficiency of perfusion to the various organs of the fetus or new born. Birth asphyxia is the single most important perinatal cause of brain damage in term infants. When asphyxia is followed by an abnormal neonatal behavior a syndrome has been described known as hypoxic ischemic encephalopathy. Material & Methods: The new born with congenital malformation of CNS were excluded from the study. Each selected newborn was subjected to Apgar scoring at birth and assessment of gestational age. The Apgar scoring was done at one and five minutes after births and infants were categorized into mild, moderate and severe birth asphyxia according to Apgar score at 1 minute of age after birth Results: In the present study, on the basis of clinical symptoms we found that asphyxiated group males comprised 62% cases and females 38% cases male female ratio was 1.63:1.0 it is statistically in significant. as compared to control group where male female ratio was 2.59:1. In Mild and moderate asphyxia male preponderance was seen while in severe asphyxia the difference was not marked There was no statistically significant sex difference in birth asphyxia. Conclusion: We concluded from the present study that in resuscitation of mild and moderately asphyxiated babies Bag and Mask was used more frequently (40% and 82.5% respectively) and endotracheal tube with Ambubag was used more (75%) frequently for severely asphyxiated babes. Key words: asphyxia, resuscitation, Ambubag.

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Esophageal Cancer in North West India: A Tertiary Care Center Experience of 5 Year

Asian Pacific Journal of Cancer Care ◽

10.31557/apjcc.2021.6.3.285-288 ◽

2021 ◽

Vol 6 (3) ◽

pp. 285-288

Author(s):

Falak Khan ◽

Rohitashwa Dana ◽

Pawan Kumar

Keyword(s):

Esophageal Cancer ◽

Rural Areas ◽

Care Center ◽

Performance Status ◽

Tertiary Care ◽

Current Status ◽

High Risk Population ◽

Female Ratio ◽

North West ◽

Tobacco Chewing

Background: Incidence of Esophageal cancer (EC) is increasing now a days and it has became a sixth leading cause of cancer related death in world. EC is associated with multiple risk factors. Despite various advances in the treatment of EC, it remains one of the least responsive tumors to cancer therapy, thereby overall prognosis remains poor. The current status of EC in North West India in relation to the demographics, diagnosis, staging, multimodality treatment, and the future perspectives are discussed. Methods and Materials: This is a retrospective analysis of medical records of the EC patients registered in the Department of Radiation Oncology SMS Medical and Attached Hospitals Jaipur from January 2015 to December 2019. Results: Out of 10,464 patients with various malignancies registered in SMS hospital for radiotherapy via Co-60 technique in the previous 5 years from 2015-2019; 449 were having EC. 40.25% patients were in 6th decade and male to female ratio was 1.49:1. EC was most common in farmers (51.79%) and 76.16% patients were the resident of rural areas addicted with smoking (41.4%) and tobacco chewing (24.7%) habit. Dysphagia was the presenting feature in almost all the patients. Most common type and site of involvement were squamous type (75.72%) and middle third (45.43%) part of the esophagus respectively. 39.19% patients presented in stage III and 24.70% patients in stage IVA. The patients were planned with treatment according to their age, performance status, extent of disease and other co-morbidities. Conclusions: At our centre most of the patients landed up in advanced stage poverty, illiteracy, ignorance, late diagnosis. Majority of the EC patient were addicted with smoking and tobacco chewing habit, hence screening of high risk population and lifestyle modifications limiting the use of tobacco, may help in the early detection and can decrease the mortality related to EC. Careful selection of patients for radical treatment is very important for providing relatively longer disease free interval.

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Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality

OTO Open ◽

10.1177/2473974x20975020 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2473974X2097502

Author(s):

Joseph Chang ◽

Sen Ninan ◽

Katherine Liu ◽

Alfred Marc Iloreta ◽

Diana Kirke ◽

...

Keyword(s):

Virtual Reality ◽

Local Anesthesia ◽

Controlled Trial ◽

Care Center ◽

Tertiary Care ◽

Depression Scale ◽

Control Group ◽

Procedure Time ◽

Pain Scores ◽

Distress Scale

Objectives Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures. Study Design Randomized controlled trial. Setting Tertiary care center. Methods Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected. Results Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively ( P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively ( P = .770). Average pain scores were 3.53 and 2.64, respectively ( P = .434). Conclusion This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia. Level of Evidence 1

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TO STUDY THE PREVALENCE AND CLINICAL PROFILE OF CHRONIC ATRIAL FIBRILLATION IN HOSPITALIZED PATIENTS

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703758 ◽

2014 ◽

Vol 04 (02) ◽

pp. 017-020

Author(s):

Dharma Rao V. ◽

Rajaneesh Reddy M. ◽

Srikanth K. ◽

Raj Kumar Prakash B. ◽

Satya Prasad A. ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Care Center ◽

Tertiary Care ◽

Chronic Atrial Fibrillation ◽

Hospitalized Patients ◽

Clinical Profile ◽

Female Dominance ◽

Elderly Age ◽

Female Ratio

Abstract: Objective: To determine the prevalence of chronic atrial fibrillation (AF) in a tertiary care center and to identify the clinical profile of chronic AF in hospitalized patients. Methods: All patients admitted to Mamata General Hospital in medicine/cardiology wards with chronic AF (persistent and permanent) during the period January 2012 to December 2012 were included into the study. The principal exclusion criteria were new onset AF and acute AF. Results: During the study period, 49 patients were admitted with chronic AF with an average of 45.44 years. A slight female dominance was seen with male: female ratio of 1:1.2. Half of the patients (51%) were below the age 50 years. The elderly age group comprised of only 16.3% of cases. The commonest presenting complaint was dyspnea followed by palpitation. Rheumatic valvular heart disease was seen more commonly in people below the age of 50 years whereas hypertension and ischemic heart disease after 50 years. Heart failure was the commonest condition associated with the chronic AF and was the cause of hospitalization in almost fifty percent of cases Conclusion: Chronic AF is still a cause of concern in India in people below the age of 50 years due to high prevalence of rheumatic fever inspite of advances in the medical field.

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GASTRIC CANCER: A 5 YEAR RETROSPECTIVE ANALYSIS OF CLINICAL, PATHOLOGICAL AND TREATMENT ASPECTS FROM A TERTIARY CARE CENTER IN SOUTH INDIA.

10.36106/gjra/0711411 ◽

2021 ◽

pp. 129-132

Author(s):

B. Ramkumar ◽

J. Kannan ◽

Ingersal. N ◽

Srigopal mohanty ◽

Amit saklani ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

South India ◽

Care Center ◽

Tertiary Care ◽

Tumor Location ◽

Advanced Stage ◽

Tertiary Care Center ◽

Nodal Disease ◽

Female Ratio

Context: Gastric cancer(GC) is fth most common cancer worldwide. Mostly presents with advanced stage and poor overall survival. Methods: Retrospective study on clinical, pathological, pattern of distant metastasis(DM) , treatment aspect of GC treated between January 2014 to December 2018 in a tertiary care center in south India. Statistical analysis : Chi square test and multivariate analysis (MVA) were used for analysis. P <0.05 was considered signicant. Results: Median age at diagnosis is 57 years. Higher male : female ratio. Most common presentation was abdominal pain followed vomiting. Malignant Gastric outlet obstruction(MGOO) was present in 22.7%. Histologically , all patients had adenocarcinoma with predominantly moderate differentiation (51.1%). Liver (19.1%)was most common site of metastasis . Curative surgery was done in 35.5% of patients. D2 lymph node dissection was performed in 12.4% of patient. Patients were given perioperative /preoperative/ adjuvant / palliative chemotherapy. MVA revealed history of tobacco use, body of stomach tumor location, nodal disease were risk factors for DM. Conclusion : The present analysis revealed use of tobacco, alcohol intake were main risk factors for GC. Most of the patients present in advanced stage , so prevention by avoiding risk factors and early detection by signs , symptoms and endoscopy are necessary. Use of tobacco,site of tumor location, nodal disease were factors associated with DM. Aggressive management with both surgery and chemotherapy is warranted for locally advanced disease.

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A prospective case control study of the effects of oligohydramnios on fetomaternal outcome in mothers with term pregnancy in a rural medical college

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184534 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4706

Author(s):

Dipak Mandi ◽

Sayantan Sen ◽

Vasundhara Goswami

Keyword(s):

Demographic Data ◽

Tertiary Care ◽

Birth Asphyxia ◽

Case Control ◽

Control Group ◽

Case Group ◽

Perinatal Complications ◽

Medical College ◽

Increased Risk ◽

Nicu Admission

Background: The aim of the current study was to assess the fetomaternal effects of oligohydramnios on term pregnancies in a rural tertiary care setup.Methods: A perspective case control hospital-based trial was conducted at Burdwan Medical College and Hospital for a period of one year. Pregnancies at term (37-42 weeks) were included in the study. 103 patients with sonographically diagnosed oligohydramnios were included in the case group. The control group comprised of 103 mothers at term with normal liquor volume. Demographic data and fetomaternal outcome parameters were assessed and compared.Results: There was increased incidence of fetal and perinatal complications including low birth weight, birth asphyxia and NICU admission. There were more perinatal deaths in the case group compared to the control group. Induction of labour, operative delivery, meconium stained liquor and incidence of preeclampsia were also increased in mothers with low AFI.Conclusions: Oligohydramnios is associated with an increased risk of labour and perinatal complications. Adequate antenatal surveillance and intranatal monitoring coupled with correction of underly-ing factors is the mainstay of management.

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A profile on the spectrum of neonatal mortality and morbidity pattern of extramural neonates in the Specialised Neonatal Care Unit (SNCU) in a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180529 ◽

2018 ◽

Vol 5 (2) ◽

pp. 427 ◽

Cited By ~ 1

Author(s):

Anuradha D. ◽

Rajesh Kumar S. ◽

Aravind M. A. ◽

Jayakumar M. ◽

J. Ganesh J.

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Respiratory Distress ◽

Neonatal Mortality ◽

Low Birthweight ◽

Tertiary Care ◽

Birth Asphyxia ◽

Newborn Care ◽

Care Hospital ◽

Neonatal Deaths

Background: Every year, nearly four million newborn babies die in the first month of life. India carries the single largest share (around 25-30%) of neonatal deaths in the world. Neonatal deaths constitute two thirds of infant deaths in India. 45% of the deaths occur within the first two days of life. It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively at the appropriate time. It was further estimated that health facility-based interventions can reduce neonatal mortality by 23-50% in different settings. Facility-based newborn care, thus, has a significant potential for improving the survival of newborns in India. This research has been planned with an aim to study the profile of pattern of admissions in a SNCU and their outcomes following admission and management in the unit.Methods: All babies referred for neonatal problems (less than 28 days) and admitted in NICU will be included. Both term and preterm babies will be considered. The criteria for admission includes various causes like low birth weight, preterm, birth asphyxia, respiratory distress, hyperbilirubinemia, congenital anomalies, risk factors (maternal, neonatal, prenatal), infections and outcome will be analysed.Results: Among the 2927 admissions term babies and boys outnumbered. The common causes for admission were birth asphyxia, respiratory distress, low birthweight and preterm. Most babies had an uncomplicated stay. The mortality in the extramural neonates was due to neonatal sepsis, extreme preterm and congenital malformations.Conclusions: Intensive and interventional management, along with good neonatal monitoring and care can reduce the mortality and improve the survival of low birth weight babies and other treatable problems. Thus, a combined effort of management by pediatricians, nursing care, neonatal intensive care unit can improve the survival rates of neonates.

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Clinical and laboratory profiles of genital ulcers (sexually transmitted diseases) in a tertiary care center in northeastern India

Our Dermatology Online ◽

10.7241/ourd.20212.4 ◽

2021 ◽

Vol 12 (2) ◽

pp. 120-129

Author(s):

Romita Bachaspatimayum ◽

Zamzachin Guite ◽

Thangjam Bijayanti Devi

Keyword(s):

Care Center ◽

Tertiary Care ◽

Herpes Genitalis ◽

Tertiary Care Center ◽

Cross Sectional ◽

Female Ratio ◽

Ulcer Disease ◽

Sexually Transmitted ◽

Northeastern India ◽

Genital Ulcers

Background: Genital ulcers are defined as breaches in the continuity of the genital mucosa and/or skin. Sexually transmitted infections (STIs) that cause genital ulcer disease (GUD) are syphilis, chancroid, donovanosis, lymphogranuloma venereum (LGV), and herpes genitalis. This study aimed to investigate the clinical and laboratory profiles of STI-related genital ulcers. Materials and Methods: A cross-sectional two-year study was conducted on patients attending the Outpatient Department of Dermatology, Venereology and Leprosy in a tertiary care center in northeastern India. Selected were 95 patients who presented themselves with STI-related genital ulcers. Detailed history taking and examination were conducted with basic tests to assist the diagnosis. Results: The male-to-female ratio was 3.32:1, and the most common site was the glans and prepuce in males (28.77%) and the labia majora and minora in females (36.36%). 96.84% of patients had superficial ulcers. The KOH mount was positive in 26 patients. The Tzanck smear was positive in 31 patients. RPR was positive in four. HIV was positive in eleven. Herpes genitalis (96.84%) was the most common GUD. Mixed STIs were attested in 41.05% of patients. Conclusion: GUD can take various forms of presentation. The available laboratory tests should be utilized. The possibility of mixed infections should always be kept in mind.

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