Assessment of knowledge and practice of menstrual hygiene among adolescent girls of government school of Jabalpur and impact of health education on menstrual hygiene

Introduction: India is a developing country, it has made advancements in every field, but stillmenstruation is a topic of social taboo in many rural and suburban parts of the country, as peoplefeel shy and difficult to discuss it openly, even mothers, sisters and teachers are not able to providecorrect information regarding menstruation physiology and its hygiene. Objective: To educateadolescent girls and assess the impact of health education on them. Methods: About 400adolescent girls aged 11-19 years from 3 government schools of Jabalpur were interviewed using apretested and predesigned questionnaire in the local language. Health education regarding hygienicpractices during menstruation was given through audiovisual aids after filling out the questionnaire.Results: out of 400 girls,291(72%) girls already knew that menstruation is a physiological processwhich increased significantly to 307(76.8%). Knowledge was poor about the source and type ofbleed; only 99 (24.8%) knew that the original was the uterus. Only 59(14.8%)girls were usingsanitary napkins. In contrast, most of them were using old cloth265(66.3%)of which 86.3% werewashing it with soap and water, and 67.3% used to dry them inside their houses, which increasedsignificantly after imparting health education to 99%and decreased to 6% respectively. Conclusion:The result of this study indicates that there is a need for the establishment of a comprehensiveschool health education programme with solid familial input. Teachers should be trained to providehealth education about menstruation, its physiology and correct hygienic practices, as theadolescent girls will turn into mothers one day.

“Study of Estimation of Cerebrospinal Fluid C-Reactive Protein in Diagnosis of Acute Meningitis.”

Objectives:To assess the diagnostic role of CSF C-reactive protein quantitatively in acute meningitisand to evaluate the efficacy of CSF C-reactive protein in differentiating pyogenic meningitis fromnon-pyogenic meningitis.Material and Methods: It is a prospective observational study of total 102children with suspected meningitis allocated into three groups based on initial investigations; group-I Pyogenic meningitis, group-II Non-Pyogenic meningitis and group-III No meningitis (Controlgroup). Quantitative CSF C-reactive protein was detected by the latex agglutination method. Datawere analyzed to establish the diagnostic role of CSF-CRP and to evaluate the efficacy of CSF-CRP indifferentiating pyogenic meningitis from non-pyogenic meningitis.Results: A total of 102 clinicallysuspected meningitis patients were studied. Based on CSF findings, the study population (102cases) was categorized into 3 groups. Group I was pyogenic meningitis consist 53 cases (51.96%).Group II was Non-Pyogenic meningitis consists 27 cases (26.47%). Group III was normal CSFfindings consist 22 (21.56%). 98.1% cases of pyogenic meningitis had elevated CSF-CRP level >1.1μg/ml of CSF. In the case of Non-Pyogenic meningitis, 96.2% were found to have CSF- CRP in therange of 0.05-0.10 μg/ml. The mean value of CSF-CRP in groups I,II and III were 5.57±1.48,0.09±0.042 and 0.01±0.010 respectively. Conclusion: Detection of CSF-CRP provides a newdimension to establish the diagnosis of pyogenic meningitis. It is a rapid, reliable and sensitivediagnostic test. From this study it is concluded that CSF-CRP can be used to differentiate pyogenicfrom non-pyogenic meningitis. Early, accurate and appropriate therapy can ameliorate the morbidityand mortality rates in such cases.

Evaluation of Thyroid Hormone Levels in Full-Term Neonates Presented with Septic Shock

Introduction: The incidence of neonatal sepsis in India is 38 per 1000 live births. Many authorsfound an association between altered thyroid hormone levels and septic shock in neonates and itmay be of prognostic importance in septic shock treatment. This study has been conducted to findthe relationship between thyroid profile and septic shock in neonates and also to compare thethyroid profile in survivor and non-survivor groups of septic shock patients. Methods: Thisanalytical prospective cohort study was conducted in the NICU of a tertiary care teaching institutionin central India. Full-term neonates with late-onset sepsis were included in this study and estimationof thyroid hormones (TSH, T3, T4, fT3, and fT4) was performed. These neonates were divided intothose with and without septic shock patients and levels of thyroid hormones were correlatedbetween these patients to find significant relations. The Vasoactive-Inotropic Score (VIS) score wascalculated. Results: A total of 195 full-term neonates were included in the study. The mean value ofTSH, T3, T4, fT3, and fT4 among neonates with septic shock were 5.27 μg/ml, 80.01 ng/dl, 6.36μg/dl, 1.40 pg/ml, and 1.40 μg/dl, respectively while the values were 5.29 μg/ml, 94.4 ng/dl, 7.25μg/dl, 1.84 pg/ml, and 1.43 μg/dl, respectively in septic neonates without shock. This difference wasstatistically significant except for TSH (p>0.05). The mean value of TSH, T3, T4, fT3, and fT4 amongseptic shock survivors were 5.27 μg/ml, 80.01 ng/dl, 6.36 μg/dl, 1.40 pg/ml, and 1.40 μg/dl and inseptic shock non-survivors were 2.40 μg/ml, 37.33 ng/dl, 3.86 μg/dl, 0.99 pg/ml, and 0.84 μg/dl,respectively (p<0.0001). Only T3 was found to be significantly co-related with VIS in septic shock inall the groups (<0.001). Conclusion: Our study suggests that TSH, T3, T4, fT3, and fT4 levels aresignificantly low in patients suffering from the septic shock which may vary in the case of TSH. Also,there is a significant decrease in thyroid profile among septic shock non-survivors as compared tosurvivors.

Clinical, Microbiological and Radiological Characterises of Lower Respiratory tract Infection in Children with Established Congenital Heart Diseases.

Introduction: Acute Lower Respiratory Tract Infection (ALRTI) is the most common cause of deathin children under five. Various demographic, socio-economic and environmental factors have beenassociated with ALRTI, with conflicting results. Children with congenital heart diseases are morevulnerable to lower respiratory tract infections following the fact that they had an anatomical defectthat causes hemodynamic disturbance of lung circulation and mucosal oedema finally leads todecreased lung compliance and recurrent lower respiratory tract infections. Methods: Children agedbetween1 month and 18 years with clinically established congenital heart disease confirmed byechocardiography and presenting with signs and symptoms suggestive of lower respiratory tractinfection were enrolled in the study. A detailed history was taken and routine blood investigationswere done in all cases. Chest X-Ray was done to confirm the clinical diagnosis. Results: Mean ageof the study subjects was 2 years. VSD was seen in 64.9% of cases while 10.5% of cases had VSDand ASD. The most common presenting symptoms were: cough (98.2%), reduced feeding (97.4%),fever (89.5%), running nose (67.5%) and wheeze (49.1%). Leucocytosis and raised ESR were seenin 66.7% and 64.9% cases respectively. In Throat swab Commensals were seen in 36% of caseswhile gram-positive cocci were seen in 3.5% cases respectively. In blood culture Streptococcuspneumoniae being the commonest organism isolated. Bilateral and unilateral opacities on chest x-ray were seen in 16.7% and 12.3% cases respectively. Conclusion: Bronchopneumonia was thecommonest LRTI in children with the predominance of VSD.

The echocardiographic and radiological profile of Clinically diagnosed congenital heart disease in children

Introduction: Congenital heart disease (CHD) if diagnosed clinically early and confirmed by ChestX-ray and ECHO, can be appropriately managed. Objectives: To observe the clinical profile of CHDin clinically diagnosed CHD in children To correlate the clinical profile with radiological andechocardiographic findings in the study group. Methods: It’s a cross-sectional study. The durationwas 18 months. All children in the age group of 1 month to 18years of age with history & clinicalfindings suggestive of CHDs were taken, assessed, subjected to Chest X-ray & 2 DECHO & werecorrelate. Results: Total no. of cases admitted during the study period was 5423, 624 had CHDamong which 50 fulfilling the criteria were taken. Clinically CCHD was in 34%, ACHD in 66%. Clinicalcorrelation with X-ray was 83% and with ECHO was 87 %. Conclusion: ACHD is more common,Chest x-ray findings correlated closely. ECHO correlation with the clinical diagnosis was veryaccurate especially in isolated lesions and some cases were identified which had been missedclinically. Hence Clinical Diagnosis with X-ray and ECHO helps in increased identification & earlierintervention of CHDs.

Chronic Subdural Hygroma in Battered Baby.

The battered baby syndrome is a condition in which a child is seriously physically abused by thecaregiver or parents. The World Health Organization (WHO) estimates 40 million children aresubjected to abuse and neglect around the world. Most of the industrialized countries have theirreporting and surveillance system and data on child battery but in developing countries includingIndia, there is a lack of data regarding the extent of child battering that takes place within thehouseholds or institutions. India published a report on one of the largest surveys done on childabuse and found that two out of every three children were physically abused and 88.6% of themsuffered at the hands of their parents. Unfortunately, the methodology restricted the study to onlyolder children who could give a history of abuse. Therefore, the magnitude of the problem given onlyhighlights among children above the age of 5 years. [1]. we are reporting a case of an Infant withFebrile encephalopathy, detailed examination and investigation found out a case of chronic SubduralHygroma with classical neuroimaging features of Abusive trauma. We have done a multidisciplinaryapproach with a Neurosurgeon, a social worker who treated the child with burr hole surgery forsubdural hygroma & the child recovered with consciousness. This case is Special because a 5-monthMale infant was subjected to abuse due to a psychological problem in a Family Member, suspicionwas lacking as males are unlikely to undergo gender-biased in India and Early age of presentation.

To study the correlation between various levels of cord blood albumin & serum bilirubin at 48 hrs of age in term healthy newborns

Introduction: Neonatal Hyperbilirubinemia is the most common abnormal physical finding and themajor cause of neonatal morbidity during the early neonatal period. Early identification of infants atrisk might help in providing preventative therapy and follow-up. We aimed to assess whether arterialumbilical cord albumin level at birth predicts the development of neonatal hyperbilirubinemia in termnewborns at 48 hrs of life. Methods: This prospective observational cohort study was conducted ina tertiary care hospital over 1 year in 200 term healthy neonates. Cord blood albumin was estimatedat birth followed by serum bilirubin level on the 3rd postnatal day(48 hrs of age). Results: Total of200 neonates were divided into three groups based on cord blood albumin level of <2.8 g/dl(groupI), 2.8-3.4 g/dl(group II) and >3.4 g/dl(groupIII) with 32, 100 and 68 in three respective groups.19 newborns (59.4%) in group I,14 in group II, and 7 newborns (10.3%) in group III developedserum bilirubin levels above an intermediate high-risk zone in Bhutani nomogram at 48 hrs of age.newborn with low cord albumin (<2.8g/dl) were significantly associated with higher bilirubin levelsat 48 hrs of age. Conclusion: Neonates with cord blood albumin <2.8 gm/dl had a significantassociation of the development of hyperbilirubinemia at or above intermediate high-risk zoneaccording to Bhutani nomogram at 48 hrs of life.

Closure of a large upper muscular ventricular septal defect in a 2.3 kg baby using a duct occluder

Surgical closure of the ventricular septal defect is a time tested and well-accepted procedure to dateespecially in smaller babies with failure to thrive and severe pulmonary hypertension. Surgicalclosure is regarded as the gold standard treatment. However over the past 10 years percutaneoustrans-catheter device closure has emerged as a safer alternative especially in the case of muscularVSD. Transcatheter closure of ventricular septal defects (VSD) has not yet received generalacceptance. It is not well-established in the younger age group with a weight category of less than5kg. Occasionally, a hybrid procedure has been proposed. We believe that certain types of VSD canbe closed safely by the transcatheter approach even if weight is less than 5kg, especially if the trendof miniaturizing devices continues. This approach should be considered as a valid alternative to asurgical option. We are reporting such a VSD baby with a weight of 2.3 Kg at the age of 6 months,which was closed with a duct occluder

Knowledge, attitudes and practices regarding infant feeding among mothers of children with severe acute malnutrition in the rural areas of Northern India

Introduction: Malnutrition has been identified as one of the principal causes limiting India’s globaleconomic potential. The infant and young child-feeding practices determine the nutritional status,growth and ultimately the survival of infants and young children. The study aimed to assess theknowledge, attitude and practices of rural mothers with children diagnosed with severe acutemalnutrition (SAM) regarding infant feeding. Methodology: A hospital-based cross-sectionaldescriptive study on 116 mothers from the rural area of Northern India with children diagnosed withSAM. Assessment of knowledge, attitude and practice of mothers regarding infant feeding was donethrough face to face interviews using a structured questionnaire containing 32 questions. Results:The mean age of admitted children was 14.48 ± 4.71 months. The majority of mothers (81.9%)studied till only primary school or were illiterate. The appropriate knowledge about early initiation ofbreastfeeding and the ideal time to start complementary feeding was found in 42.4% and 45.6% ofmothers respectively which was suboptimal. The attitude towards ideal breastfeeding practices waspositive in most mothers. However in practice only 59.4% of mothers exclusively breastfed theirbabies till 6 months and 54.3% delayed initiation of complementary feed beyond 9 months of age.The frequency of complementary feeding was inadequate in the 6-8 months age group as stated by88.6% of mothers and minimum dietary diversity was not followed by 68.1% of mothers.Conclusion: The knowledge and positive attitude towards infant feeding are not applied in practiceby mothers. Efforts should be made to improve knowledge, attitude and practice with an emphasison complementary feeding indicators to reduce the burden of malnutrition in the rural population.67

Metachromatic Leukodystrophy (MLD): A Rare Genetic Disorder in child

Metachromatic leukodystrophy is a rare hereditary neurodegenerative disorder that causes fattysubstances to build up in cells, particularly in the brain, spinal cord and peripheral nerves. This iscaused by a deficiency of an enzyme that helps break down lipids called sulfatides. We present acase of a four-year-old boy born of non-consanguinous marriage with complaints of progressive lossof fully developed motor milestones as the inability to walk and sit (regression of achieved motormilestones). The patient was diagnosed with MLD based on whole xome sequencing and dischargedon symptomatic care and physiotherapy to improve the patient's quality of life.