c l i n i c a l e p i d e m i o l o g y a n d g l o b a l h e a l t h 4 (2 0 1 6) 8 9-9 4

Introduction: In India, in spite of improvement in perinatal-neonatal care, perinatal asphyxia accounts for 23% of the neonatal deaths. Objective: The objective of the study was to study the clinical profile and short-term outcome of perinatally asphyxiated term neonates. Materials and Methods: This prospective study conducted at a tertiary care teaching hospital in Southern Kerala from June 2011 to June 2015. 120 term asphyxiated neonates fulfilling the inclusion criteria admitted in the NICU were followed up till death or survival. Results: 49.2% babies were inborn and 50.8% babies were outborn. Of the total, 53 (44.2%) were delivered vaginally, 54 (45%) by cesarean section, and 13 (10.8%) by instrumental delivery. Antenatal complications were seen in 58 (48.3%) and intrapartum complications in 93 (77.5%). Hypoxic ischemic encephalopathy (HIE) was diagnosed in 78.3%, with HIE 1 in 19.3%, HIE 2 in 27.5%, and HIE 3 in 31.6%. The mortality was 31 (25.8%) and it was more in out born babies compared to inborn. Factors associated with development of severe HIE (HIE 3) were male gender (p=0.0057), need for endotracheal intubation (p=0.0114), instrumental delivery and pH <7.2 (p=0.0013). Factors associated with mortality were instrumental delivery (p=0.0032), place of birth (p=0.0012), pH ? 7 (p=0.0006), HIE 3 (p<0.0001), and 5 min Apgar ?3 (p=0.0372). Conclusion: HIE was seen in 78.3% perinatally asphyxiated babies with HIE 3 contributing to 31.6%. The mortality rate in HIE 3 was 81.6% which was significantly associated with place of birth, instrumental delivery, pH <7, and 5 min Apgar ?3.

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Objective: The aim of this study is to find the characteristics of nutritional rickets and the proportion of cases diagnosed prospectively. Methods: Details of 54 cases of nutritional rickets in the age group of 1 month-12 years diagnosed during 2013-2015 in a tertiary care teaching hospital in Kerala were collected. The criteria taken for diagnosis were clinical features, biochemical parameters such as calcium, phosphorous, alkaline phosphatase (ALP), radiological features, and response to vitamin D treatment. Vitamin D level and serum parathyroid hormone levels were collected whenever it is available. The data were then analyzed statistically. Results: Among the 54 cases analyzed, 61.11% were male. A maximum number of cases were identified in the age group of 1-2 years (44.44%). Nearly 88.89% of patients were born term. About 83.3% of patients were intermediate or dark skinned. The most common clinical feature identified was bowlegs. Radiological features were identified in 70.4% of cases. The most common biochemical abnormality noted was elevated serum ALP (83.33%). Hypocalcemic seizures were a predominant manifestation in <6 months’ age group. Rickets was detected prospectively in 26 patients (48.15%) during evaluation for other illnesses. The mean ALP level was found to be significantly lower in patients with clinical or radiological features of rickets compared to those without clinical or radiological evidence. Conclusions: Rickets is very common in the age group of 1-2 years and among exclusively breastfed term babies. The significant number of cases of nutritional rickets was detected prospectively during evaluation for other illnesses. ALP level may be routinely checked in the vulnerable high-risk age group for identification of early rickets as it is significantly elevated even before clinical and radiological changes appear.

Objectives: To study the clinical profile and electrocardiographic (ECG) changes in rodenticide poisoning in children. Methods: Patients admitted with a history of ingestion of rat poison between October 2014 and October 2016 were included in the study. Clinical history was taken in detail, and stomach wash samples were sent for toxicological analysis. Continuous ECG monitoring was done in all cases. Investigations to assess organ functions and coagulation profile were done at admission and repeated as indicated. Results: There were 17 cases of rodenticide poisoning. Zinc phosphide was the rodenticide identified in 50% of cases, bromodiolone in 30%, and yellow phosphorous in 20% cases. Only 23% presented within 1 h of ingestion and only 12% received stomach wash from referring hospital. Out of the 17 cases, 12 cases (70%) were symptomatic, of which 42% hadminor symptoms such as vomiting and abdominal pain and 58% had major symptoms including dysrhythmias, shock, coagulation abnormality, hepatic failure, and seizures. ECG changes were observed in 7 cases (42%), and coagulopathy was seen in 2 (12%) cases of which one had hepatic failure. The mean time of onset of ECG changes was 19.7 h (range 9-36 h). The overall mortality rate was 17.6%. Cardiac arrhythmia was the most common cause of death (66%). Conclusion: Zinc phosphide has been detected as the most common chemical being used as domestic rodenticide. Transient rate abnormalities, metabolic acidosis, fever, and leukocytosis are early markers of toxicity and they should be looked for in all cases. General public, medical, and aramedicalpersonnel should be made aware of the toxic nature of rodenticides.