Background: Congenital malformations represent a defect in the morphogenesis during fetal life. Since the introduction of primary health care and immunization programme, congenital malformations have emerged as one of the commonest cause of perinatal mortality. The objective was to study the incidence, systemic distribution, various maternal risk factors and immediate outcome of congenital malformations in hospital delivered neonates.Methods: This study was conducted at a tertiary care hospital for a period of 2 years. All the hospital delivered live neonates and stillbirth babies with congenital malformations are included in this study. Detailed history, examinations and investigations are carried out to identify etiological factors. Their outcome in form of morbidity and mortality are taken up to their hospital stay.Results: Out of 9600 babies with malformations 171(1.88%) having single malformation and 23(0.25%) having multiple malformations. Incidence of malformations was higher in stillbirths (24.25/1000 livebirths) against than in live births (19.96/1000 livebirths). The cardiovascular system was involved in 23.4% of babies, followed by musculoskeletal system (22.3%) then gastrointestinal (15.9%) and genitourinary system (15.4%). Multiple malformations were seen in 11.8% cases. Maternal risk factors associated with malformations were oligohydramnios in 4.12%, previous abortion in 2.5%, eclampsia in 2.5%, polyhydramnios in 1.54%, maternal diabetes in 1.54% and consanguinity in 1.03%. Maximum mortality occurred in babies with gastrointestinal system malformations (56.5%) followed by cardiovascular system malformations (21.7%). Majority of babies with malformations discharged (78.9%) only 11.8% of babies expired and 2.6% of babies left against medical advice (LAMA).Conclusions: Congenital malformations represent one of the causes of neonatal mortality. Stillborn babies have higher incidence of malformations. Antenatal ultrasonography and maternal risk factors has important role to identify malformations. Early detection and timely management required to decrease the mortality.
Background: Sickle cell disease is commonly seen in rural population of south part of Gujarat in India. It is one of the common causes of recurrent hospitalization, morbidity and mortality in pediatric population. This study was therefore undertaken to evaluate the clinical profile of sickle cell disease in a tertiary care hospital.Methods: This was the prospective observational study done from November 2015 to October 2016. All the hospitalized diagnosed case of sickle cell disease and trait in age group of 6 months to 14 years were taken in this study. Sickle cell disease with some genetic or metabolic disease and sickle-beta-thalassemia patients were not included in this study.Results: Total 61 patients were admitted over a one year of study period, out of which 47 were sickle cell disease and 14 sickle cell trait patients. Morbidity events were commonly observed in 5-12 years of age groups (68.85%). Seasonal variation also observed, 47.54% of total cases are seen in winter season. Pain (60.65%) was the most common presenting symptom. Severe pallor (39.34%) and splenomegaly (24.59%) was the most common sign in both groups. Vaso-occlusive crisis (59.01%) was the most common morbidity event observed, of which abdominal pain was the most common site of pain involvement. On laboratory analysis, there was statistically significant difference observed in disease and trait. In patients with sickle cell disease acute painful crisis (59.57%) was the common morbidity event observed while in sickle cell trait patients acute febrile illness (71.42%) observed.Conclusions: Vaso-occlusive crisis is the commonest manifestation in pediatric age group. Comprehensive medical care and management is required to decrease the morbidity and mortality.
Introduction: Enteric fever caused by Salmonella enterica continues to be a major public health problem worldwide. In the last decade, ceftriaxone and azithromycin have become the drugs of choice for treating enteric fever caused by Nalidixic acid resistant Salmonella (NARS) enterica. This has led to reports of drug resistance to both drugs. Since enteric fever is endemic in India, accurate drug susceptibility surveillance is crucial to ensure empiric management of enteric fever is appropriate. The aim of this study is to evaluate the minimum inhibitory concentration (MIC) of ceftriaxone and azithromycin for blood culture isolates of NARS isolated at our centre. Methodology: This is a retrospective study conducted in a tertiary care center in Mumbai for blood culture isolates of NARS from 2016 to 2018. Isolates were tested for antimicrobial susceptibility testing (AST) against ceftriaxone and azithromycin using a manual broth microdilution method (BMD). Results: Of 155 blood culture isolates of NARS: S. Typhi (n = 112) and S. Paratyphi A (n = 43) were included in the study. 81.9% (127 / 155) isolates were susceptible, 6.4% (10 / 155) isolates were intermediate while 11.6% (18 / 155) isolates were resistant to ceftriaxone. 100% susceptibility of NARS was observed to azithromycin. Conclusions: This study documents an alarming increase in resistance to ceftriaxone among NARS in Mumbai while azithromycin continues to be susceptible in vitro. It is essential to know MICs to understand epidemiological trends and choose appropriate treatment regimens for treating enteric fever.
Diagnosis of pulmonary tuberculosis is challenging till today. Smear microscopy is the easiest, commonest and widely employed tool for confirmatory diagnosis of pulmonary tuberculosis, but it has low sensitivity and specificity. Sputum culture can increase the diagnostic yield by 20-40%, but it takes long duration of 2-8 weeks to give result. The role of newly introduced cartridge based nucleic acid amplification test (CBNAAT) in the revised national TB control program (RNTCP) is highly promising with a higher yield of bacteriological diagnosis in sputum negative pulmonary tuberculosis patients with detection of rifampicin resistance rapidly. However, it also has some limitations which may result in false negative results. Case of a 50- year-old-male was reported who was initially managed for community-acquired pneumonia in view of negative sputum and CBNAAT but was later confirmed to have TB but by then he had developed cavities in lung and had transmitted the infection to his son.
Introduction : Glaucoma is the leading cause of irreversible visual loss in world and also in India. Because of the relatively asymptomatic initial phase of the disease, it is often detected by chance and is frequently associated with extensive and irreversible damage at the time of diagnosis. Objectives:To screen for Glaucoma among patients eligible as per inclusion criteria, to classify the glaucoma cases according to clinical presentation and to correlate the occurrence of glaucoma with different variables. Method: The present study was conducted at one of the tertiary care hospitals of Ahmedabad city during celebration of “World Glaucoma Week - 2021”. Total 1421 patients were offered opportunistic screening after oral informed consent during 6-12 March 2021, who attended the institute. After applying exclusion criteria, 945 were found eligible who underwent a comprehensive ophthalmic examination like visual acuity, intraocular pressure measurement, gonioscopy, optical disc and visual filed examinations were carried out as per standard protocols. Sociodemographic details, any relevant ophthalmic history pertaining to glaucoma and systemic illnesses were also assessed. The data were entered and analyzed in MS excel. Results: The incidence of newly diagnosed cases of glaucoma among opportunistic screened cohort was 36.71% (n=347). Of total newly diagnosed, the presentation as per clinical classification was as follows: Primary open angle glaucoma (POAG) - 202 (58.21%), Primary angle closure glaucoma (PACG) - 77 (22.19%), Primary angle closure suspect (PACS) – 41 (11.82%), Ocular hypertension (OHT) – 6 (1.73%), Normal tension glaucoma (NTG) – 10 (2.88%), Secondary glaucoma – 9 (7.09%) and Congenital glaucoma – 2 (0.58%). In yield, 25 (19.68%) were ≤40 years and 36 (28.35%) had positive family history of glaucoma. Conclusion: Presence of stand-alone Diabetes and Hypertension or presence of both accompanying – all three conditions were found to be statistically significant determinant for occurrence of particular variety of Glaucoma. There was highly significant statistical association between cup-disc ratio level at the time of presentation and clinical variety of glaucoma.
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