Who needs prenatal counselling with a pediatric surgeon? Experience from a large tertiary care university hospital

Objectives To describe our experience with prenatal counselling for surgical anomalies in a large volume center. The secondary aim is to suggest a list of prenatal abnormalities warranting counselling by a pediatric surgeon. Methods We reviewed all prenatal counselling consultations performed by the pediatric surgery team between January 1st, 2015 and December 31st, 2016. Results A total of 169 patients or couples had a prenatal consultation with a pediatric surgeon. Prenatal work-up included a fetal MRI in 26% of cases, mainly for digestive and thoracic pathologies (56.1% of cases). Consultation with the pediatric surgeon led mainly to recommendations concerning the place of delivery. Induction for reasons related to the fetal anomaly occurred in 22.2% of cases. Most children were surgically treated within the first year of life (63.5%). Correlation between predicted prognosis and actual status at four years of life was 96.9%. Correlation between prenatal and postnatal diagnosis was 87.4%. Conclusions Prenatal counselling by a pediatric surgeon allows couples to obtain clear information on the pathology of their unborn child, giving them greater autonomy in their decision to continue the pregnancy.

TO STUDY THE USE OF GUIDELINES IN STATINS PRESCRIPTION AT TERTIARY CARE CENTRE OF NORTH INDIA

Background: To study the use of guidelines in statins prescription at tertiary care centre of North India Methods: Study was conducted on Patients with indications for statins presenting to cardiology OPD,Medicine OPD and Endocrinology OPD and started on statins at PGIMER, Chandigarh, within a period of 9 months. Results: In our study, 81.9% of total study population were receiving statins according to guideline and 18.1% were receiving statins not according to guideline. In the primary prevention group,91(83.5%) patients were receiving statins according to guideline and 18(16.5%) were receiving not according to guideline. In the secondary prevention group, 108(80.6%) patients were receiving statins according to guideline and 26(19.4%) patients were receiving statins not according to guideline. Concluded: In our study, more than two third of patients in our study were receiving prescriptions according to guideline Keywords: Statin, Guideline, Use

Comparison of Tubeless Mini Percutaneous Nephrolithotomy with Conventional Technique in a Tertiary Care Center

Introduction: Mini Percutaneous Nephrolithotomy (mPCNL) is a safe and efficient method for management of nephrolithiasis. Post procedure nephrostomy tube drainage is considered as the standard practice. In recent years, tubeless mPCNL with the use of double J (DJ) stent alone has replaced the placement of the nephrostomy tube. Aims: This study intends to evaluate the safety and efficacy of tubeless Mini Percutaneous Nephrolithotomy. Methods: A total of 80 patients with Nephrolithiasis, admitted to Urology Unit of Nepalgunj Medical College, between September 2018 and September 2019 were enrolled in the study and divided into two groups: Tubeless group where tube was omitted and Standard Group where it was placed. The two groups were compared with respect to hemoglobin drop and blood transfusion requirement, hospital stay and analgesic requirement in the post-operative period. Results: Mean age of the patients was 34.30 ± 13.19 years. Mean stone size was 19.03 mm. The mean change in hemoglobin after standard mPCNL was 1.68 gm/dl and that in the tubeless group was 1.11 (p=0.018). The tubeless group had a significantly (p=0.001) shorter hospital stay (3.05 ± 1.23 days) compared to standard group (3.85 ± 0.86). The postoperative pain as assessed by visual analogue scale, was more in the standard group necessitating additional analgesia. It was significantly higher in the standard group at 12, 24, 48 hours, as compared to the tubeless group. Conclusion: Placement of nephrostomy tube can be omitted as a routine practice as Tubeless mini PCNL has an added advantage of significantly reduced postoperative pain, less analgesic requirement, shorter hospital stay, less postoperative blood loss.

PATTERNS OF PRESCRIPTION OF STATINS IN A TERTIARY CARE CENTRE OF NORTH INDIA

Background: To study the pattern of prescription of statins in a tertiary care centre. Methods: Study was conducted on Patients with indications for statins presenting to cardiology OPD, Medicine OPD and Endocrinology OPD and started on statins at PGIMER, Chandigarh, within a period of 9 months. Results: Atorvastatin was found to be more commonly prescribed (n=179), which is about73.7%compared to Rosuvastatin (n=64) which is about 26.3%. In our study, 75 (68.8%)patients of primary prevention group and 104(77.6%) patients of secondary prevention group were receiving Atorvastatin and 34 (31.2%) patients of primary prevention group and 30(22.4%)patients of secondary prevention were receiving Rosuvastatin on their prescription. Concluded: In our study, there were prescriptions with only Atorvastatin and Rosuvastatin. No prescription with other statins was found. Atorvastatin was being more commonly prescribed to rosuvastatin. Keywords: Statin, Atorvastatin, Rosuvastatin

INDICATIONS OF PRESCRIPTION OF STATINS IN TERTIARY CARE CENTRE OF NORTH INDIA

Background: To determine the indications for which statins are being prescribed Methods: Study was conducted on Patients with indications for statins presenting to cardiology OPD,Medicine OPD and Endocrinology OPD and started on statins at PGIMER, Chandigarh, within a period of 9 months. Results: In our study, out of 243 prescriptions, 55.1%(n=134) were prescribed statins for secondary prevention and 44.9%(n=109) had statins prescribed for primary prevention. Overall coronary artery disease (37.03%) was the leading indication followed by Diabetes mellitus without ASCVD(70.64%).Other indications of secondary preventionincluded newly diagnosed statin naïve patients diagnosed with stable coronary artery disease ,unstable coronary artery disease /acute coronary artery disease , ischemic cardiovascular accidentsand peripheral arterial disease .64.22 percent patients in primary prevention group were diabetics in our study . Concluded: We concluded that secondary prevention was found to the more common indication of statin prescription than primary prevention (ratio 1.22:1). Keywords: Statin, CAD, Prevention

Quality of life among caregivers of thalassaemic children, attending at Thalassaemia control unit of a rural tertiary care hospital, in a sub-Himalayan district of West Bengal

Thalassaemia is a disease of abnormal development of red blood cells which manifests as anaemia. This chronic disease may cause mental, social, financial burdens on the families, care givers and also on health care system.To assess the quality of life (QOL) of the caregivers of thalassaemic children and to identify the predictors of quality of their physical and mental health.Institution based descriptive cross-sectional study conducted in the Thalassaemia Control Unit (TCU) of North Bengal Medical College (NBMC) from December 2018 to April 2019. Total 136 caregivers of children (≤12 years) with thalassaemia were included by complete enumeration method. Physical and mental health of the caregivers were reported in Short Form-36 (SF-36) Health Survey. Collected data were entered into MS-Excel, analysed with the help of SPSS (Version 22).Mean age of caregivers was 34.3 (SD ± 1.4 years). Most of caregivers were female (89%) and had educational qualification up to Primary school (45.6%). Majority (70.6%) of the caregivers were the mothers of the children. Most of the study participants (60.3%) had favourable Physical health Component Summary (PCS) but 64.7% of the caregivers had unfavourable Mental health component Summary (MCS). Educational status was found to be the predictor for PCS but age and relationship with the child were the predictors for MCS.Counselling, psychotherapy, social support for family members or caregivers of the thalassaemic children and community involvement with their full participation should be emphasized to reduce stigma related to thalassaemia.