Background: Neonatal hyperbilirubinemia (NH) is the most prevalent aberrant physical finding in the first week of life, affecting about 60% of term and 80% of preterm neonates. Hyperbilirubinemia is more common in preterm infants due to a... more
Background: Neonatal hyperbilirubinemia (NH) is the most prevalent aberrant physical finding in the first week of life, affecting about 60% of term and 80% of preterm neonates. Hyperbilirubinemia is more common in preterm infants due to a variety of causes, although it can also occur in healthy term infants. The liver produces albumin, which aids in the transport of unconjugated bilirubin. Hyperbilirubinemia can be predicted early, allowing newborns and mothers to be discharged sooner and stay in the hospital for less time. Objective were to study cord albumin levels, to study the proportion of newborn requiring intervention for neonatal jaundice (phototherapy or exchange transfusion) based on different levels of cord blood albumin (CBA) level at birth and thereby defining the critical cord blood albumins values with respect to significant neonatal jaundice.Method: The 200 cases who filled the inclusion and exclusion criteria were included into the study for predictive value of CBA ...
Research Interests:
Background: MIS-C as a disease has varied symptoms and signs that affect multiple organs and systems in the body. The present study aimed to describe the clinical presentation among children admitted as a case of multisystem inflammatory... more
Background: MIS-C as a disease has varied symptoms and signs that affect multiple organs and systems in the body. The present study aimed to describe the clinical presentation among children admitted as a case of multisystem inflammatory syndrome in children in Indira Gandhi Medical College, Shimla.Methods: We conducted a cross sectional study of children with MIS-C from January to July 2021, in the pediatric ward of Indira Gandhi Medical College Shimla in Himachal Pradesh. All children admitted with a diagnosis of MISC were included in the study. Data regarding clinical presentation was extracted and analyzed using Epi Info V7 software.Results: In the present study, a total of 31 children diagnosed and admitted as a case of multisystem inflammatory syndrome in children (MIS-C) were included. Mean age of these children was 7.12±4.78 years. Among the total 16 (51.6%) were males while 15 (48.4%) were females. All 31 patients had presented with fever and 13 (41.9%) patients had fever w...
Research Interests:
Background: Low birth weight (LBW) is a serious public health problem and a leading cause of death in the first month of life. The present study aimed to study the trends of low birth weight in Shimla district of Himachal Pradesh,... more
Background: Low birth weight (LBW) is a serious public health problem and a leading cause of death in the first month of life. The present study aimed to study the trends of low birth weight in Shimla district of Himachal Pradesh, India.Methods: Retrospective review of records of Kamla Nehru Hospital, Shimla covering the period January 2016 to December 2020 was done. The total number of low-birth-weight babies each year were retrieved.Results: A total of 34769 live births took place in Kamla Nehru Hospital, Shimla from 2016 to 2020. Among the total live births, 8479 (24.39%) were having low birth weight (<2500 gm) while 26290 (75.61%) were having normal birth weight (>2500 gm). Out of total 8479 LBW Babies, 7148 (84.3%) were LBW (<2500 gm),1167 (13.76%) were very low birth weight (1000-1500 gm) and 164 (1.93%) were of extremely low birth weight There was continuous decrease in low birth weight from 35.14% in 2016 to 17.51% in 2019. After that it start increasing slightly to...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
VACTERL (Vertebral, anal, cardiac, tracheoesophageal, renal and limb) is an acronym for cluster of congenital malformations including Vertebral or Vascular anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula/Esophageal... more
VACTERL (Vertebral, anal, cardiac, tracheoesophageal, renal and limb) is an acronym for cluster of congenital malformations including Vertebral or Vascular anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula/Esophageal atresia, Renal and Limb defects. It is a rare association with sporadic and non-random occurrence where multiple organs are affected due to developmental defect during blastogenesis. Exact cause is unknown but multiple environmental and genetic factors have been implicated. For diagnosis, three components of VACTERL association are needed however patient may have other congenital malformations also. Here we report a newborn with VACTERL association born to a healthy mother by cesarean section for polyhydramnios with unstable lie.
Research Interests:
Research Interests:
Research Interests:
Background: The aim of palliative care is most certainly the improvement of quality of life of patients suffering from various haematological diseases like leukaemia, haemophilia, thalassemia owing to the importance of palliative care in... more
Background: The aim of palliative care is most certainly the improvement of quality of life of patients suffering from various haematological diseases like leukaemia, haemophilia, thalassemia owing to the importance of palliative care in ensuring quality end-of-life care, provision of palliative care has been identified as an international human right. The objective of this study was to asses palliative care in chronic haematological conditions using Paediatrics palliative screening scale (PaPaS).Methods: 71 cases who fulfilled inclusion and exclusion criteria were included in the study for assessment of palliative care. Then, the data was analysed using the Statistical Package for Social Sciences (SPSS) software (version 13) and descriptive and interferential statistics were used.Results: In leukaemia patients the mean PaPaS score was reported to be 23.58 (SD: 7.43). Nineteen participants (61.29%) had a PaPaS score of >25 and 12 participants (38.71%) had PaPaS score of less tha...
Research Interests:
Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant genetic disease manifesting as mucocutaneous pigmentation and multiple polyps in gastrointestinal tract. We report this case of PJS as it is a rare entity with our patient having a... more
Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant genetic disease manifesting as mucocutaneous pigmentation and multiple polyps in gastrointestinal tract. We report this case of PJS as it is a rare entity with our patient having a unique presentation of severe anaemia only without any gastrointestinal complaints. Please download the full paper by clicking on the PDF file below...
Research Interests:
Background: Lumbar puncture (LP) is one of the most commonly encountered painful procedure in paediatric medicine. Research has shown that neonates too experience pain from noxious stimuli that can be more intense than what is experienced... more
Background: Lumbar puncture (LP) is one of the most commonly encountered painful procedure in paediatric medicine. Research has shown that neonates too experience pain from noxious stimuli that can be more intense than what is experienced by an adult, and so have the right to receive safe, efficient and effective pain management. Objective was to determine efficacy of topical eutectic mixture of local anesthetics (EMLA) in alleviating pain associated with lumbar puncture among newborns admitted to sick newborn care unit (SNCU).Methods: The study was a one-year tertiary care teaching hospital-based randomised comparative double blinded trial among 42 neonates aged 32 weeks or more admitted to SNCU and required a diagnostic lumbar puncture, randomly assigned to one of two groups. Half hour before the procedure, 1 g of topical EMLA cream was applied to LP site in intervention group versus placebo in other group. At different stages, the heart rate, transcutaneous oxygen saturation leve...
Research Interests:
Background: Frequency of nutritional rickets, its clinicobiochemical profile and its relationship to the lower respiratory tract infections in indoor patients from 2 to 60 months of age.Methods: Children aged 2 to 60 months admitted for... more
Background: Frequency of nutritional rickets, its clinicobiochemical profile and its relationship to the lower respiratory tract infections in indoor patients from 2 to 60 months of age.Methods: Children aged 2 to 60 months admitted for the first time were included in the study and divided into two groups i.e. with and without clinical signs of rickets. Disease profile was studied in both groups. Incidence of lower respiratory tract infection was compared between two groups. Children with clinicoradiological signs of rickets were also investigated for biochemical abnormalities.Results: During the one year study period a total of 393 children were admitted, 65 were found to have rickets constituted as study group and 328 were without rickets were included the controls. Rickets incidence was 16.5% of which majority (74.6%) were males and most rachitic children (64.6%) were below six months of age. Acute lower respiratory tract infection (64.6%) was commonest in study group and acute ...
Research Interests:
Research Interests:
Background: The incidence of low birth weight i.e. <2500gm babies in India is 30-40% as compared to 7.5% in the developed world. The objective of this study was to find correlation between neonatal anthropometric indices and maternal... more
Background: The incidence of low birth weight i.e. <2500gm babies in India is 30-40% as compared to 7.5% in the developed world. The objective of this study was to find correlation between neonatal anthropometric indices and maternal nutritional status.Methods:Out of one thousand twelve live births during the study period 529 newborns which were fulfilling the required criteria were enrolled in the study. All the enrolled newborns were assessed for weight, length, OFC, MAC, MAC/OFC and Ponderal index. Maternal nutritional status was assessed by maternal weight, maternal height and BMI. Maternal data also comprised of demographic and social factors viz. maternal age, socioeconomic status, dietary habits, maternal education, occupation, parity, residence, altitude and antenatal care. The correlation between neonatal anthropometric indices and maternal nutritional status was studied using appropriate statistical methods.Results: The study population had mean maternal weight 50.0593±...
Research Interests:
Background: Satluj Valley of Himachal Pradesh is a newly identified focus of Cutaneous Leishmaniasis (CL) and here disease is still in emerging phase. Although children are most commonly affected victims by CL but till date no such study... more
Background: Satluj Valley of Himachal Pradesh is a newly identified focus of Cutaneous Leishmaniasis (CL) and here disease is still in emerging phase. Although children are most commonly affected victims by CL but till date no such study has been done on childhood CL in this region.Methods: All newly diagnosed cases of CL were registered and detailed clinico-epidemiological parameters of children between 0-18 years were recorded. Imprint smears for LD bodies and biopsies for histopathology were done in atypical cases to confirm clinical diagnosis.Results: Over a period of one year 337 cases of CL were registered, out of them 115 children (0-18 years) were enrolled for this study. School going (6-18 years) population was predominantly affected age group. Males outnumbered the females with a ratio of 1.88. Face was most commonly affected site and most (65.21%) cases presented with single lesion. Nodules (40.87%), plaques (24.35%) and papules (7.39%) were commonly observed morphologies...
Research Interests:
Research Interests:
Research Interests:
Objectives: To measure D-dimer levels in neonatal sepsis and compare D-dimer as a marker of sepsis with the gold standard that is, blood culture and other established marker of sepsis like C-reactive protein, micro-erythrocyte... more
Objectives: To measure D-dimer levels in neonatal sepsis and compare D-dimer as a marker of sepsis with the gold standard that is, blood culture and other established marker of sepsis like C-reactive protein, micro-erythrocyte sedimentation rate and total leucocyte count (TLC) in predicting sepsis. Study Design: Prospective observational hospital based study. Setting: Tertiary care hospital. Subjects: From November 2010 to October 2011, 936 neonates were admitted to the neonatal unit of Indira Gandhi Medical College, Shimla, Himachal Pradesh. Out of these, 355 neonates were admitted with suspected sepsis. Out of these, only 101 term neonates were without asphyxia and blood culture positive and were enrolled as cases, and 96 term neonates without the asphyxia admitted for neonatal jaundice without sepsis were enrolled as controls. Methods: All neonates, cases and control were investigated as per the protocol at admission and simultaneously the D-dimer levels were measured. D-dimer levels were evaluated in predicting neonatal sepsis and were compared with other established markers of sepsis in predicting sepsis. Results: In the study group, age ranged from 0 to 22 days with an average of 5.58 days. In the control group, age ranged from 0 to 23 days with an average of 5.62 days. Sex distribution was almost equal in both groups. The mean value of D-dimer in the cases and control group were 1.832 mg% and 1.365 mg% respectively. The study group had significantly higher values of D-dimer (P - 0.04). Sensitivity and negative predictive value of D-dimer in predicting sepsis were 90.0% and 84.4% respectively, the highest amongst all the markers studied in sepsis. Positive predictive value and specificity of TLC in sepsis was highest in all the marker studied. Negative predictive value of various markers was comparable in sepsis. Conclusion: D-dimer is a sensitive predictor of sepsis in neonates with a high sensitivity and negative predictive value. Hence, it should be included in the septic screening of newborns.
Research Interests:
Most intrasellar ICA aneurysms may be treated with surgical or endovascular procedures. In the four patients reported in literature, one patient successfully underwent endovascular management,[3] while in one other patient, an attempt to... more
Most intrasellar ICA aneurysms may be treated with surgical or endovascular procedures. In the four patients reported in literature, one patient successfully underwent endovascular management,[3] while in one other patient, an attempt to clip the aneurysm was unsuccessful.[2] Our patient presented with irregular menses with compression of pituitary stalk by the aneurysm and surgical resection of the large aneurysm relieved the mass effect bringing about improvement in the patient’s condition. There was no difficulty encountered while dissecting the neck and dome of the aneurysm from bilateral optic nerves and the pituitary stalk.[2] In addition, temporary clipping of the proximal anterior cerebral artery, partially excising the aneurysmal sac, and removing the intraluminal thrombus helped in applying the clip to the neck of large thrombosed intrasellar aneurysm.