Acute Encephalitis Syndrome (AES) is a significant cause of mortality and morbidity in children in endemic regions. While viruses have been the primary etiological agents attributed to AES in India, other microbes and toxins have also been reported in recent years. This study aimed to determine the etiology, clinical features, and outcomes of AES in children. This prospective observational study was conducted in the pediatric department of Jorhat Medical College and Hospital of Assam over a period of one year. The study included 49 diagnosed cases of AES in children aged between one month to 12 years as per the WHO case definition. Clinical features, etiology, and outcomes (recovery without or with neurological sequelae or death) were recorded for each patient. The study found that fever (100%) and altered sensorium (100%) were the most common clinical presentations in AES cases. Seizure (63%), headache (34.7%), vomiting (26.5%), diarrhea (22.4%), and other symptoms such as excessive crying and irritability (22.4%) were also observed. Japanese Encephalitis (JE) was the most common cause of AES (28.6%), followed by Herpes Simplex Virus (4.1%), pyogenic meningitis (4.1%), and tubercular meningitis (2%). The majority of cases (61.2%) were of unknown etiology. Among the 49 cases, 27 (55.1%) recovered without neurological sequelae, 8 (16.8%) had neurological sequelae, and 14 (28.6%) died during hospital treatment. The most common neurological sequelae was motor deficit (37.5%), followed by behavioral disorders and aphasia (25% each). Cranial nerve palsy was observed in one case (25%). Of the eight AES cases with neurological sequelae, five were JE positive and three were caused by other agents. The study concludes that AES cases commonly present with fever, altered sensorium, seizure, headache, vomiting, and signs of meningeal irritation. JE remains a major cause of AES in children in this region of India. These findings highlight the need for global attention to combat the menace of this arboviral encephalitis and save the lives of children.
Background: Non-alcoholic fatty liver disease (NAFLD) is a common condition characterized by excess fat in the liver, which ranges from simple steatosis to steatohepatitis, cirrhosis, and hepatocellular carcinoma (HCC) in the absence of excessive alcohol intake. This study aimed to determine the prevalence of NAFLD among pre-diabetic and diabetic patients at a tertiary hospital.
Methods: This single-center, prospective, comparative, parallel-group, observational study included male and female patients between 30 and 70 years old who were either diabetic or pre-diabetic. A total of 600 patients with NAFLD were studied.
Results: Of the 200 diabetes cases studied, the prevalence of NAFLD was 52% (104 cases), while the prevalence of NAFLD among pre-diabetic cases was 45.5% (91 cases), and the prevalence of NAFLD among normal cases was 30.5% (61 cases). The prevalence of NAFLD was significant among females in all patient groups. Diabetic patients with NAFLD had a higher BMI and waist circumference than pre-diabetic and non-diabetic patients, and this difference was statistically significant. Diabetic patients with NAFLD also had higher Glycohemoglobin (%) and fasting glucose (mmol/L) than pre-diabetic and non-diabetic patients, and this difference was statistically significant. Liver function tests and other parameters such as total bilirubin, AST, ALT, GGT, LDL, HDL, total cholesterol, triglycerides, and platelet count were comparable in diabetic, pre-diabetic, and non-diabetic patients, and the difference was not statistically significant.
Conclusion: The prevalence of NAFLD among diabetic patients was 52%, while the prevalence of NAFLD among pre-diabetic cases was 45.5%. These findings highlight the importance of early screening and prevention strategies for patients with diabetes and pre-diabetes to reduce the burden of NAFLD.
Introduction: Vitamin A is an essential nutrient required for normal vision, epithelial maturation, and immunological responses. Vitamin A deficiency (VAD) is a major public health problem in many developing countries, including India, but only 5%-10% show clinical evidence. Studies have shown that subclinical vitamin A deficiency is associated with increased mortality and morbidity.
Materials and Methods: Children suspected of VAD, who were attending the Pediatric OPD at VIMS, Ballari, were studied. Those children with classical features of VAD were excluded. Conjunctival impression was taken using cellulose acetate filter paper, stained, and studied for epithelial changes, which were graded according to the Nelson grading system.
Results: Out of 250 children, 140 (56%) were male and 110 (44%) were female. All age groups were equally affected and had subclinical VAD with an average of 81.2%. The occurrence of subclinical VAD was significantly associated with severe grades of PEM, recurrent LRTI, diarrhea, UTI, measles, etc. Nelson’s grading for Conjunctival imprint cytology (CIC) was effective in detecting more than 80% of all cases of sub-clinical VAD.
Conclusion: Subclinical VAD without ocular manifestations was largely prevalent in a suspected group of children, more so in children of low socio-economic status. Conjunctival Impression cytology was able to detect the majority of these cases, initiate early management of these subclinical cases, and thus reduce the mortality and morbidity associated with VAD.
Background: Soft tissue tumors (STTs) and tumor-like lesions have fascinated clinicians and pathologists for years. Due to their wide variety and close histopathological similarities between certain tumors, they pose a diagnostic challenge. They most commonly present as masses and are rarely associated with pain. Fine-needle aspiration cytology (FNAC) has been documented as a reliable preoperative diagnostic tool to broadly differentiate them into benign and malignant categories. Histopathology is still considered the gold standard for STTs.
Aim of the Study:}The aim of this study is to classify and subcategorize soft tissue tumors and to correlate the findings of FNAC of soft tissue tumors with histopathology.
Methods: This prospective study was carried out on patients with palpable soft tissue masses attending the surgical OPD between January 2021 and June 2022. FNAC of soft tissue lesions was performed, and only cases with subsequent histopathological examination were included in the study. Cytopathological and histopathological diagnoses were correlated.
Results: Out of 90 soft tissue tumors, 83 (92.22%) were benign, 1 (1.11%) was intermediate, and 6 (6.6%) were malignant. The male to female ratio was 1.7:1. The most common site was the trunk (34.4%), followed by the lower extremity (30%). Of all benign lesions, lipoma was the most common (71.1%). There was a concordance of FNAC with histopathology in 88 out of 90 cases (97.8%).
Conclusion: Benign soft tissue tumors outnumber malignant tumors. FNAC is an effective method for the rapid diagnosis of STTs, and preoperatively, it helps differentiate between benign and malignant lesions in most cases. Although histopathology is the gold standard, FNAC has high specificity in diagnosing malignant tumors, thereby preventing unnecessary extensive or radical surgery for benign lesions.
Background: Abruptio placenta is a serious pregnancy complication that occurs when the placenta separates partially or completely from the uterus after the age of viability and before delivery, which can result in maternal and fetal morbidity and mortality.
Aim: This study aimed to determine the percentage, sociodemographic characteristics, risk factors, and feto-maternal outcomes of abruptio placenta in a tertiary care hospital, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli.
Materials and Methods: This retrospective study included all cases of abruptio placenta that occurred between June 1\({}^{st}\), 2020 and May 31${}^{st}$, 2022 in the obstetrics ward of Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli. Sociodemographic characteristics, risk factors, and fetal and maternal morbidity and mortality data were extracted from patient case notes for analysis.
Results: Of the 966 deliveries during the study period, 37 cases (3.83%) of abruptio placenta were identified. The incidence of abruptio placenta was higher in the age group of 20-29 years (64.8%) and in multiparous women (59.4%). Hypertensive disorders of pregnancy were the most common risk factors, observed in 54.05% of cases. Prematurity was the major perinatal morbidity and was found in 56.7% of cases, followed by birth asphyxia in 37.8%. NICU admission was required for 48.6% of babies, and 29.7% were stillborn. The caesarean section rate was 70.3%. Blood transfusion was required for 28 subjects (75.6%), postpartum hemorrhage occurred in 10 subjects (27.02%), and postpartum anemia was observed in 20 subjects (54.05%). There were two maternal deaths, resulting in a maternal mortality rate of 5.4%. The perinatal mortality rate was 51.3% due to a higher percentage of stillbirths.
Conclusion: Abruptio placenta is a serious pregnancy complication that can result in significant maternal and fetal morbidity and mortality. Hypertensive disorders of pregnancy were identified as the most important risk factor. Good antenatal care services and early referral to well-equipped institutions with qualified personnel, efficient blood banking systems, and good neonatal services are essential in reducing the adverse outcomes of abruptio placenta.
Background: Pregnancy is associated with numerous physiological and pathological changes. Thrombocytopenia, defined as a platelet count of less than 150,000/\(\mu\)L, is the second most common hematological finding in pregnancy after anemia. It may manifest during pregnancy and increase the risk of bleeding.
Materials & Methods: This prospective observational study was carried out in the Antenatal outpatient and inpatient Department of Gynecology and Obstetrics at Bharati Vidyapeeth Medical College and Hospital, Sangli. All pregnant women diagnosed with thrombocytopenia during the six-month study period were included. Patients were followed until delivery to record any complications such as preterm labor, abruption, preeclampsia, postpartum hemorrhage, or any other morbidities, and to determine maternal outcomes.
Results: Out of 246 pregnant patients, 30 were found to have thrombocytopenia with a platelet count of 150,000/mm\(^3\) or below, giving a prevalence of approximately 12%. The cases were recorded based on demographic characteristics, gestational age at the time of first onset of thrombocytopenia, severity of thrombocytopenia, and any intervention. Maternal outcomes were recorded.
Conclusion: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy and has good maternal outcomes. Managing pregnant women with platelet disorders requires a multidisciplinary approach and close collaboration between obstetricians and hematologists.
Introduction: Guillain-Barre Syndrome (GBS) is an acute and often severe polyradiculoneuropathy caused by autoantibody-mediated destruction of the myelin sheath, which presents with ascending paralysis and areflexia. The mortality rate of GBS is less than 5%. We conducted a study in our hospital to identify the epidemiological features, clinical profile, and electrophysiological features of GBS and to determine the various GBS variants present in the studied population. We also aimed to correlate the prognosis of GBS with age, critical time period, and requirements for ventilatory support.
Methods: We conducted a cross-sectional analytical study of 32 adult patients (age > 20 years) meeting the criteria for GBS after a detailed study and 3-month follow-up.
Results: GBS occurred in 71.87% males, mostly in those over 50 years of age. Antecedent events were present in 65.26% of patients, with respiratory tract infections being the most common (43.75%). The most common initial motor symptom was distal weakness (28.12%) with ascending progression. The most commonly involved cranial nerve was the facial nerve (49.99%). Twenty-two patients (68.65%) had a disability grade of 3 at peak. Ten patients developed respiratory weakness, with acute motor axonal neuropathy (AMAN), acute motor and sensory axonal neuropathy (AMSAN), and acute inflammatory demyelinating polyneuropathy (AIDP) cases being 4 (40%), 3 (30%), and 2 (20%), respectively. Postural hypotension was the most common autonomic dysfunction (12.5%). AIDP (71.87%) was the most common variant, and aspiration pneumonia (18.75%) was the most common complication in patients requiring mechanical ventilation (60% of ventilator-assisted patients developed aspiration pneumonia), while urinary tract infection (UTI) (3 cases, 9.37%) was the most common complication in non-ventilator-associated patients. Intravenous immunoglobulin (IVIG) was found to be beneficial, with a 72% recovery rate.
Conclusion: GBS is a disease that primarily affects adult males, with a rapid onset to peak, prolonged duration at peak, need for assisted ventilation, and axonal pattern being poor prognostic factors.
Objectives and methods: The present study is a cross-sectional study of 250 women with abnormal uterine bleeding in the reproductive age group undertaken in Srinivasan Medical college Hospital and Research centre over a period of 12 months. It was done to ascertain the possibility of a correlation between subclinical thyroid dysfunction and AUB.
Results and conclusion: The incidence of thyroid dysfunction in the reproductive age group is 1-2%. It is 10 times more common in women than in men. The incidence of thyroid dysfunction in a population with AUB is 20.4% according to our study and hence selective screening of this population would result in a higher yield. The study showed a significant correlation (p= 0.019, significant) between increasing age and thyroid dysfunction. TSH is a good screening test with a sensitivity of 72% and specificity of 100%. The positive and negative predictive values were 100% and 91% respectively.
Background: Central venous cannulation a vital intervention can be done using numerous approaches for cannulating the internal jugular vein such as anterior, posterior and approach. Of these, the anterior approach is being practised widely, since the identification of landmarks and palpation of carotid artery permits a beginner to learn the procedure easily. The major complications of this approach are carotid artery puncture and hematoma formation. Posterior approach needs identification of only the main bulk of the sternocleidomastoid muscle and external jugular vein, which could be identified even in obese patients easily by the trendelenberg position.
Aim: To evaluate and compare the success rates of anterior and posterior approach for internal jugular vein cannulation.
Material and methods: Hundred patients of American society of Anaesthesiologist (ASA) grade I and II, aged 20-60 years of age were divided into two groups. Group A patients were cannulated by anterior approach while Group-B patients cannulated by posterior approach. Number of attempts, time to identify vein, duration of cannulation, ease of threading and complications like carotid artery puncture, hematoma formation, pneumothorax, hemothorax, thrombophlebitis and catheter displacement were taken into consideration.
Result: The total number of attempts was statistically lower in group B as compared to group A (p value= 0.042). The mean time to identify vein and duration of cannulation was also found to be significantly lower in group B as compared to group A (p value= 0.0043,p value=0.001 respectively). The incidence of carotid artery puncture and hematoma formation was less in group-B as compared to group-A (p value=0.001).
Conclusion: Since Posterior approach for IJV cannulation required lesser number of attempts, less time to identify vein and also less duration of cannulation, It can be considered as a preferred choice for cannulation of internal jugular vein as compared to anterior approach.
Objective: To compare the efficacy of sublingual misoprostol tablet and intracervical dinoprostone gel for induction of labour in nulliparous postdated pregnancy and assess the maternal and fetal outcome after induction.
Methodology: It is a prospective randomized controlled study conducted over a period of 2 years (nov 2020 to nov 2022), in dept. of obstetrics and gynecology, mkcg mch. Out of 200 cases 100 cases were given sublingual misoprostol tablet (Group 1) and rest were given intracervical dinoprostone gel (Group 2). The efficacy of both the drugs were assessed by favorability of Bishop’s score at 24 hours, need of augmentation with oxytocin, drug administration to delivery interval, mode of delivery, APGAR score, NICU admission, maternal complication and number of failed induction, data was analyzed description statistics and chi square test.
Result: Mean Drug administration to delivery interval was shorter and significant (18. 53hours vs 20.42) hours, p-value 0.0018). Need for augmentation (48 vs 65, p-value 0.0125), failed induction rate (5 vs 11), post-delivery mean blood loss( 436.50mL vs 516 mL, p value- 0.0173) were significantly lower with misoprostol group. NICU admission was lower in dinoprostone group (7 vs 14).
Conclusion: Sublingual misoprostol tablet is efficacious in inducing labour, with shorter drug administration to induction interval, and higher vaginal delivery rate as compared to dinoprostone gel.
