OBJECTIVE:To study pH disorders in severe acute malnutrition. DESIGN: A prospective, cohort, observational study. SETTING: Severe malnutrition treatment unit in a tertiary level care hospital in central India. PARTICIPANTS: 202 children between 6 to 60 months of age. METHODOLOGY: Radial artery sample was taken at admission which was analyzed by automated blood gas analyzer; results were studied and correlated with nutritional status at discharge/outcome. STATISTICAL ANALYSIS: The data were analyzed using SPSS 20. Univariate and bivariate analysis of data was done using the Student t test and two-tailed Fisher exact or chi-square test. RESULTS: Out of 202 children studied 51.5% were males and 48.5% were females, 16.8% children had pH <7.35, 43.6% had pH between 7.35 to 7.45 and 39.6% had pH >7.45. The mean values of pH, HCO3 -, PCO2, PO2 and Cl -were 7.42, 17.1mmol/l, 25.22 mmHg, 93.71mmHg and 109.05mmol/l respectively. Most children (n = 173/202; 85.6%) were discharged, 11(5.4 %) expired and 18 patients left the treatment. In pH < 7.35 group, mortality rate was highest (P value < 0.00001). Rate of weight gain in all groups were comparable and duration of stay was 16½ days in normal pH group and was 19 days in pH < 7.35 and 17 ½ days in pH > 7.46 group. CONCLUSION: In this study, metabolic acidosis with hyperchloremia was associated with poor outcome. There is no significant change in the duration of hospital stay and rate of weight gain in any pH group. KEYWORDS: pH, severe acute malnutrition, metabolic acidosis INTRODUCTION:Severe acute malnutrition is a metabolic disorder, characterized by profound disturbance of water, electrolytes, minerals, protein, fat, carbohydrates and energy metabolism, along with disturbances in function and composition of almost all tissues of the body. Nutrition has long been known to strongly influence acid-base balance. Malnutrition is a state of catabolism and severe malnutrition is a state of severe catabolism. In a healthy body homeostasis is maintained mainly by kidney, lungs, minerals and body fluids, and it is altered in malnutrition.The present work is an attempt to study the prevalence of acid base disorder in severe acute malnutrition and its effect on outcome. Few studies have demonstrated the acid base disturbances in SAM children with associated diarrhea and pneumonia but their main focus was the underlying comorbidities rather than SAM. 1, 2, 3 The present study was conducted to evaluate prevalence of acid base disturbance in all SAM children irrespective of underlying etiology.
Neonatal suppurative parotitis(NSP) is an uncommon illness in the neonate. Here, to the best of our knowledge we describe first case of newborn who developed NSP due to acenatobacter species and was treated successfully with antibiotics.
Background: Intrauterine growth restriction (IUGR) is a major and silent cause of perinatal morbidity and mortality. Rate of IUGR in developing countries is 6 times higher than that of developed countries. 14 to 20 million infants are affected with IUGR in developing countries annually. The highest incidence is found in south central Asia (33%) and India (21%). Aim of study was to evaluate the role of early 3rd trimester ultrasound in diagnosis and role of color Doppler in prediction of adverse perinatal outcome in IUGR.Methods: A prospective case-control study was conducted on 720 women admitted in GMH Rewa for one year. 360 antenatal cases diagnosed as IUGR on ultrasound were taken as study group, same number of non IUGR cases were taken as control. Study cases were followed with Doppler. The umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI) and cerebro-placental ratio were calculated and the results were analysed.Results: Inferences drawn from the study were: rate of caesarean section was significantly higher (31%) in study group, perinatal outcome was poor in more number of cases (10.8%) in study group than the control group (3.4%), and the sensitivity and specificity of cerebroplacental ratio was more reliable indicator in comparison to that of UA PI and MCA PI in prediction of adverse perinatal outcome.Conclusions: Looking at the high burden of IUGR cases in our country and its adverse effects on perinatal outcome, if early third trimester ultrasound is made mandatory for all pregnant women, most of the IUGR cases can be detected and managed timely and perinatal outcome can be significantly improved.
To study the incidence of transient lactose intolerance in children below 24 months and to determine the need of discontinuation of breast feeding and necessity of lactose free formula. MATERIAL AND METHODS: Randomly selected 100 children below 24 months of age, who were admitted in department of pediatrics, S.S. Medical College and Associated G.M. Hospital Rewa, 70 of them were grouped as cases with diarrhea, abdominal distention, vomiting, perianal excoriation and 30 were age and sex matched control. After collection of stool, pH, reducing substances in stool was determined and osazone test was performed to identify the types of reducing substances. RESULT: Out of 70 cases with diarrhoea, 22 (31.4%) were found to have evidence of lactose intolerance. Besides loose motion, in lactose intolerance positive cases, most common presenting symptoms were abdominal distention, perianal excoriation and vomiting. Incidence of lactose intolerance was less in children who were on exclusive breast feeding till 6 months. In lactose intolerance positive as well as negative group duration of diarrhea after admission was same inspite of continuation of breast feeding. CONCLUSION:-Presence of abdominal distention, frothy character of stool, and perianal excoriation are suggestive of lactose intolerance. Lactose free formula and withdrawal of breast milk are not necessary in children with acute diarrhea and persistent diarrhea having transient lactose intolerance.
Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetric, still performed as lifesaving surgical procedure to control haemorrhage that is unresponsive to conservative treatment. The objective of this study was to review the incidence, indications, and predisposing factors and associated complications of EPH.Methods: The present study is a retrospective study included 37 women who underwent EPH over a period of 3 year. The records were collected from medical record department.Results: 37 patients underwent EPH during this period making an incidence of 1.1 per 1000 deliveries. Most common indication of EPH in present study was morbidly adherent placenta (MAP) seen in 19 cases (51.4%). 36 patients (97.4%) patient underwent cesarean section at the time of their index pregnancy and 25 out of 37 (67.6%) patient had undergone prior cesarean delivery. 20 (54%) patients underwent total abdominal hysterectomy (TAH) and 17 (46%) patients underwent subtotal hysterectomy (STH). Mean operative time, estimated blood loss, injury to urinary tract, febrile illness and duration of hospital stay was higher in TAH group as compared to STH group but difference was not statistically significant except for estimated blood loss. Maternal mortality was seen in 20% of cases and neonatal mortality was seen in 56.8% of cases.Conclusions: EPH although lifesaving but have devastating consequences. EPH should be performed with a multidisciplinary team approach. Measures should be taken to reduce caesarean section rate.
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