scholarly journals BERA in Newborns with Hyperbilirubinemia

Author(s):  
Edwin Dias

BACKGROUND: Neonatal hyperbilirubinemia is a common problem seen in the newborn period, is usually mild and transient without long-lasting sequelae. Bilirubin induced neurologic damage may occur and auditory pathway is the most sensitive past to bilirubin toxicity. Auditory brainstem response (BERA) provides an electro physiologic means of assessing ascending auditory pathway and to localise the lesion. AIMS: To assess the effect of bilirubin toxicity on brainstem auditory pathway among neonates with hyperbilirubinemia using BERA and compare with control of normal newborns. MATERIAL AND METHODS: BERA was recorded in twenty five term newborns admitted to Tertiary care hospital, with hyperbilirubinemia at level exceeding exchange transfusion (mean bilirubin level 25.4+/- 4.66 mg/dl). They were compared with 25 term normal newborns without any risk factor for hearing impairment. The results were analysed by Gaussian test (Z), student unpaired ‘t’ test, chi square test and Mann-Whitney U test. RESULTS: At least one of waves I, III and V was absent in 8% of newborn with hyperbilirubinemia. There was statistically significant prolongation of mean latencies of waves III and V and mean I-V interwave latency in hyperbilirubinemia newborn compared to normal neonates . Auditory threshold was elevated in 6 out of 25 jaundiced newborn. Significant positive correlation between BERA abnormalities and bilirubin levels was found with respect to presence of waves I, III and V and auditory threshold. No significant positive correlation was found between bilirubin levels and BERA latencies. CONCLUSION: BERA abnormalities were noted in form of absence of waves I, III, V,prolongation of latency and interwave latencies and increased auditory threshold in newborns with hyperbilirubinemia as compared to normal neonates. BERA abnormality was also found to be transient and was normal in most of these patients during follow up.

2021 ◽  
Vol 2 (3) ◽  
pp. 137-141
Author(s):  
Aeshvarya Dhawan ◽  

AIM: To analyse the association between dyslipidemia and severity of meibomian gland dysfunction (MGD) in a tertiary care hospital of Uttarakhand region. METHODS: This prospective observational study was conducted over a period of one year including 50 consecutive patients of MGD. Patients underwent detailed history (including Ocular Surface Disease Index Questionnaire) and examination (including meibum quality, expressibility and numerical staining). MGD was graded according to the guidelines submitted by the International Workshop on Meibomian Gland Dysfunction and Management in 2011. Fasting lipid profile of all the patients was done. Various parameters of lipid profile including total cholesterol (TC), triglycerides (TG), low density lipoproteins (LDL), high density lipoproteins (HDL) and very low density lipoproteins (VLDL) were correlated with MGD severity. Chi-square test was done for statistical analysis (P<0.05). RESULTS: Stage 2 MGD was the most common disease entity (60%, n=30). A significant positive correlation was noted between increasing age and severity of MGD (P=0.004). High TC (>200 mg/dL), TG (>150 mg/dL), LDL (>130 mg/dL) and VLDL (>22 mg/dL) levels had a significant positive correlation with the severity of MGD (P=0.001, 0.019, 0.001, 0.016 respectively). CONCLUSION: Monitoring the fasting lipid levels may aid in establishing the severity of MGD and further studies may be conducted to establish the role of treatment of dyslipidemia in MGD.


Author(s):  
Shubham Bhaskar ◽  
Heena Anjum Tarafdar ◽  
Manish Kumar ◽  
SK Astik

Aim: The aim of this study to determine the relation between HbA1C, Lipid profile and CRP in individuals with type 2 diabetes mellitus. Material and methods: This prospective observational study was carried out in the Department of Medicine in Nalanda Medical College and Hospital at Patna, Bihar India for 1 year. The patients above 30 years with fasting venous blood glucose value equal or more than 100 mg/dl and postprandial glucose >140 mg/dl were include in this study. FBS and PPBS, CRP (immunoturbidimetric method), and HbA1C (ion exchange chromatography using HPLC) lipid profile samples were drawn at entry and at subsequent follow-up with a minimum gap of 3-6 months. Results: There was no significant difference between gender, age and BMI (p>0.05). FBS and HbA1C were directly correlated. PPBS showed a direct correlation with both HbA1C and CRP in this study. There was a significant positive correlation between CRP and total cholesterol (p<0.05). There was no significant correlation between CRP and LDL cholesterol (p>0.05). There was a negative correlation between HDL cholesterol and CRP. There was significant positive correlation between CRP and triglyceride levels (p<0.05). There was significant correlation between CRP and HbA1C (p<0.05). Conclusion: We concluded that the CRP is an additional marker of better glycaemic control and also correlates with the dyslipidaemia profile seen in type 2 diabetes mellitus. Keywords: C-reactive protein, Glycemic control, Hemoglobin A1C, Type 2 diabetes mellitus.


Author(s):  
Mohanram Venkatesan ◽  
Arulraj Russelian ◽  
Palpandi Velimuthu

Background: For determining hyperbilirubinemia in a neonate, clinical evaluation, serum bilirubin estimation and trans cutaneous bilirubin estimation are the modalities available. Transcutaneous bilirubinometry (TcB) is routinely used to monitor jaundice in term and near-term infants. Literature shows a positive correlation observed between TcB and total serum bilirubin (TSB). The present study was conducted determine the correlation of TcB with TSB in neonates with hyperbilirubinemia admitted at a tertiary care hospital, ChennaiMethods: A cross sectional study was conducted at a tertiary care hospital, Chennai where 350 neonates who have clinical jaundice and require estimation of serum bilirubin who are admitted to the tertiary care centre, Chennai during December 2020-March 2021 were included in the study. The ROCHE INTEGRA-e 411+ autoanalyzer was used to estimate TSB (mg/dl) using a modified diazo method. The Jaundice Meter JM-103 to measure TcB, (Manufactured by Draeger medical systems, Germany). Pearson corelation coefficient was used to find the correlation between the two variables. P<0.05 was considered to be statistically significant.Results: Out of 350 neonates admitted to the tertiary care centre, term deliveries were 57.1% and pre term were 42.9%. 83.1% were in the age group of 3-7 days. The mean weight of the study population was 2.16±0.60 kg. In term babies, Pearson corelation between TSB and TcB shows a statistically significant positive correlation, r=0.90 with p≤0.0001. Among pre term babies, Pearson corelation between TSB and TcB shows a statistically significant positive correlation, r=0.96 with p≤0.0001.Conclusions: This study's findings support the use of a TcB metre as a screening tool for clinically significant hyperbilirubinemia.


Author(s):  
Mohammed Sarfaraz ◽  
A. S. Archana ◽  
Bhavana Kalwa ◽  
Monish Abraham Mathew ◽  
Shilpa Anna Kuriakose ◽  
...  

Background: Anemia is a major public health problem in India affecting people in all age groups with major consequences for human health as well as economic development. Hence the study aims to assess prescribing pattern of physicians in anemia and to create awareness among in-patients in a tertiary care teaching hospital.Methods: A prospective and observational study was carried out in 180 in-patients admitted to General Medicine department in a tertiary care teaching hospital diagnosed with anemia for 6 months. Data was collected from case sheets of patients and assessed for prescribing pattern and direct interview was conducted with patients using standardized KAP questionnaire on anemia.Results: Among 180 in-patients, 126 patients (70%) were females and 54 patients (30%) were males. As part of the therapy, folic acid with vitamin combinations (37 prescriptions) followed by elemental iron with folic acid combinations (32 prescriptions) were most prescribed drugs. KAP questions were scored appropriately and compared with hemoglobin levels. Knowledge level of patients was not significantly correlated (i.e., p=0.254) with their haemoglobin levels. There was a highly significant positive correlation (i.e., p=0.006) between attitude scores of patients and haemoglobin levels. A significant positive correlation (i.e., p=0.001) was found between practice scores of patients and hemoglobin levels.Conclusions: This study clearly showed that prescribing pattern of drugs in anemia patients’ needs to be continuously evaluated. To address the issue of anemia, the patient’s awareness should be enhanced.


Author(s):  
Mritunjay Kumar Mishra ◽  
DVSS Ramavataram ◽  
Tejas Shah

Introduction: Heart attack in medical terminology is generally called as Acute Myocardial Infarction (AMI). When blood flow is abruptly cut-off to the heart muscle, it damages the myocardial tissue. This could be the consequence of blocked coronary arteries. The plaque formed due to the deposition of cholesterol and other fatty material over a period of time is the leading cause of this blockage. Aim: To assess the level of Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) in cardiac and non-cardiac chest pain and their association to Body Mass Index (BMI). Materials and Methods: The present study was an observational case-control type of study which included 100 subjects of age group 30-65 years from March 2019 to April 2020. Out of them 50 were non-cardiac chest pain individuals which were control and 50 Cardiac chest pain arrived within 6-8 hours of chest pain who suspected to be Myocardial Infarction (MI) from Emergency Department, Dhiraj General Hospital, Gujarat, India. BMI was calculated by height and weight. PT and aPTT analysis was carried out using STAGO-S.A.S. coagulation analyser. Results: There were increased levels of PT and aPTT (statistically significant) in AMI cases compared to corresponding age and sex matched controls (p<0.0001). Pearson correlation analysis in AMI patients, a slightly positive correlation between BMI and aPTT was observed (r=0.19, p<0.001) and also between PT and aPTT (r=0.66, p<0.001). Conclusion: There was a slightly positive correlation found between BMI and aPTT which indicated that the weight and height of the patients do not affect the plasma PT and aPTT levels on anticoagulant therapy.


Author(s):  
Jihana Shajahan

Introduction: Concomitant use of several drugs for a patient is often necessary for achieving therapeutic response. Understanding the profile of Drug-Drug Interactions (DDI) will help health care providers to optimise therapy for better patient outcomes, reinforcing the concept of rational drug use. Aim: To analyse the frequency, mechanisms and severity of DDIs in a tertiary care hospital at Kerala. Materials and Methods: A retrospective cross-sectional study among 350 inpatients of a tertiary care hospital in Kerala from August 2020 to September 2020. Prescriptions containing ≥3 drugs were collected from inpatient medical records. A drug interaction check was performed using the Lexicomp drug interaction checker software. Results: DDIs were present in 74.6% of prescriptions and the average number of interactions was found to be 2.78. Most number for interactions was in the age group 61-80. Average number of DDI was significantly high among patients >60 years. Percentage of prescriptions with DDI and average number of DDI was found to be increasing with increase in number of drugs. Average number of interactions were maximum (5.01) in the group >10. Drug groups most commonly involved in interactions were antiplatelets, oral hypoglycaemic agents, bronchodilators, antibiotics, diuretics, insulin, statins, beta blockers, Proton Pump Inhibitors (PPI) and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). The most common interventions for minimising the impact of DDIs were changing the timing of drug administration, monitoring for symptoms/signs/lab values/drug levels or both. There was a significant positive correlation between duration of hospital stay and number of DDI. Conclusion: This study threw light upon the pattern and profile of DDIs among inpatients of a tertiary care hospital in Kerala. Elderly people (>60 years) were most prone for DDIs. Percentage of prescriptions with DDI and average number of DDIs was found to be increasing with increase in number of drugs. There was a positive correlation between duration of hospital stay and number of DDI.


2020 ◽  
Vol 18 (2) ◽  
pp. 57-61
Author(s):  
B.L. Shrestha ◽  
S. Karmacharya ◽  
A. Dhakal ◽  
A.K. KC ◽  
K.S. Shrestha ◽  
...  

Background Hearing loss among neonates is one of the important health issue in pediatric population which may remain unnoticed until the child reaches a certain age. The importance of universal early screening, diagnosis and intervention in reducing the negative impact of congenital hearing loss has been described all over the world. Objective To observe the outcome of hearing screening by Automated Auditory Brainstem Response (AABR) in newborns delivered in Dhulikhel Hospital and neonates admitted in an intensive care unit (NICU) of Dhulikhel Hospital. Method A prospective study was done in neonates who were born at Dhulikhel Hospital, Kathmandu University Hospital from February 15th, 2017 to October 30th, 2019. AABR was used for their hearing assessment within 24 hours of birth and again at about 6 weeks of age in those neonates who failed the initial test. All the neonates admitted in NICU were studied regarding the risk factors based on Joint committee on Infant Hearing. Those who failed the test for the second time were referred for detailed audiological diagnostic work up. Result The screening rate was 92.6% of the total deliveries. A total of 5517 neonates comprising of 2800 males and 2717 females were screened from total deliveries of 5956 neonates in the study period. Among them, NICU (sick) babies were 422 (7.7%) and well babies were 5095 (92.3%). Out of them, 1675 failed the test in the first screening and 374 failed in the second screening. So, the total number of referred babies in second screening was 6.7% (374) out of 5517 screened. Amongst them, well babies were 6.59% (336), out of 5095 screened and sick babies were 9% (38) out of 422 screened. Low birth weight and prematurity were found to be the commonest risk factor present among them, followed by the use of ototoxic medications, hyperbilirubinemia and prolonged use of mechanical ventilation. Conclusion Automated Auditory Brainstem Response (AABR) is a very useful tool for hearing screening which should preferably be done in all the neonates where possible. It should be done within one month of life and those with confirmed hearing loss should receive early appropriate intervention for better hearing in future.


2017 ◽  
Vol 126 (7) ◽  
pp. 555-560
Author(s):  
Jason E. Cohn ◽  
Andrew Touati ◽  
Mark Lentner ◽  
Mark Weitzel ◽  
Casey Fisher ◽  
...  

Objectives: The purpose of this study is to identify laryngeal symptoms and injuries in self-extubated patients. Methods: A retrospective chart review was conducted to identify symptoms and clinical findings associated with self-extubation. A novel scoring system was developed and used to quantify these findings. Symptom score included all symptoms that patients reported after self-extubation. Clinical score consisted of laryngeal findings visualized on nasopharyngeal laryngoscopy. Finally, a total self-extubation score was calculated as the sum of the symptom and clinical scores. Additionally, duration of intubation and endotracheal tube size were correlated with these scores. Results: Sixty (n = 60) patients who self-extubated in our institution’s intensive care unit were identified. Average calculated symptom, clinical, and total self-extubation scores were 0.92, 1.43, and 2.35, respectively. The most common symptom observed was hoarseness (62%), while the most common clinical finding was posterior laryngeal edema (58%). A significant positive correlation was found between duration of intubation and both symptom score and total self-extubation score (r = 0.314, P = .008 and r = 0.223, P = .05, respectively). Symptom score predicted clinical score with a significant positive correlation present (r = 0.278, P = .02). Conclusions: This study demonstrates that the majority of self-extubated patients have laryngeal symptoms and clinical findings. A comprehensive, multidisciplinary evaluation is warranted for self-extubations.


2021 ◽  
Vol 48 (4) ◽  
pp. 417-426
Author(s):  
Madhubari Vathulya ◽  
Mohit Dhingra ◽  
Hawaibam Nongdamba ◽  
Debarati Chattopadhyay ◽  
Akshay Kapoor ◽  
...  

Background Soft tissue coverage plays a vital role in replacing the vascularity of the underlying bone in Gustilo type IIIB fractures. The aim of this article was to evaluate the feasibility of local pedicled flaps in type IIIB fractures at a tertiary care center.Methods We included all cases of open Gustilo-Anderson type IIIB fractures of the tibia treated with local flap coverage from January 2017 to February 2019. We carried out a retrospective analysis to investigate the relationships of complications, hospital stay, and cost-effectiveness with the choice of flap, infective foci, site and size of the defect, and type of fixation.Results Out of 138 Gustilo type IIIB fractures analyzed in our study, 27 cases had complications, of which 19 (13.76%) involved flap necrosis, four (2.89%) were infections, three (2.17%) involved partial necrosis, and one (0.72%) was related to bone spur development. Flap complications showed a statistically significant association with the perforator flap category (propeller flaps in particular) (P=0.001). Flap necrosis showed a significant positive correlation with cases treated within 3 weeks after trauma (P=0.046). A significant positive correlation was also found between defect size and the duration of hospital stay (P=0.03).Conclusions Although local flaps are harvested from the same leg that underwent trauma, their success rate is at least as high as microvascular flaps as reported from other centers. Amidst the local flaps, complications were predominantly associated with perforator flaps.


Author(s):  
Kapil Bhatia ◽  
Pratibha Misra ◽  
Amandeep Singh ◽  
Bhasker Mukherjee ◽  
Vivek N Ambade

Introduction: Patients of Diabetes mellitus type 2 are known to have high levels of BUN and Serum creatinine levels as compared to non-diabetics. There is an association between the raised BUN, serum creatinine levels and poor glycemic controls, subsequently leading to complications like nephropathy in Diabetic patients. Aim and objectives: The aim of this study is to assess the BUN, Serum creatinine levels in relation to fasting plasma glucose (FPG) and 2-hour post plasma glucose (2h-PG) status in diabetic patients as compared to non-diabetics. Materials and methods: 215 cases of Diabetes Mellitus were recruited along with the 100 age and sex matched controls who were healthy and non-diabetic and their blood samples were analyzed for BUN and FPG and 2-h-PG after 75-gram oral glucose in National Accreditation Board for testing and calibration Laboratories (NABL) certified laboratory. Results: In our study we have found that there is a significant association of FPG, 2h-PG, BUN and serum creatinine in diabetic cases as compared to non-diabetic controls. There also exists a significant positive correlation between mean BUN (12.3 ± 5.9mg/dL) and mean FPG (159.72 ± 71.60 mg/dL) and mean 2h-PG (222.76 ± 100.86 mg/dL) levels. Conclusion: BUN and serum creatinine are the markers in diabetes patients to assess the diabetic nephropathy. Serum BUN may be preferred over serum creatinine in assessing early renal impairment due to positive correlation with fasting and post prandial glycemic levels. Keywords: BUN, Nephropathy, FPG, 2h-PG, Diabetic complications.


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