Medico Research Chronicles

Prevalence and Pattern of Anemia and Micronutrient Deficiencies in Children with Severe Acute Malnutrition at a Tertiary Care Center: A Cross-sectional Study

Dr Chinmaya G S — 2025-01-04

Background: Severe acute malnutrition (SAM) remains a major health concern in developing countries like India, significantly contributing to pediatric morbidity and mortality. Children with SAM are particularly vulnerable to infections and anemia due to impaired immune response and nutritional deficiencies. This study aimed to assess the prevalence and severity of anemia in children under 60 months diagnosed with SAM.

Method: A cross-sectional study was conducted over 11 months at Pravara Institute of Medical Sciences DU, Loni involving 48 children with SAM. Detailed demographic profiles and medical histories were collected using a predesigned proforma. Anthropometric measurements and laboratory investigations, including hemoglobin, serum iron, ferritin, folate, and vitamin B12 levels, were performed. Anemia was classified based on hemoglobin levels into mild, moderate, and severe categories.

Results: Results revealed that 37 (77.1%) children were anemic, with 9 (24.3%) having mild anemia, 25 (67.6%) moderate anemia, and 3 (8.1%) severe anemia. Low serum iron levels were identified in 21 (43.8%) children, with a higher prevalence in females. Abnormal ferritin levels were observed in 24 (50%), folate deficiency in 15 (31.3%), and vitamin B12 deficiency in 29 (60.4%) children.

Conclusion: Addressing anemia in children with SAM requires early interventions, starting with maternal nutrition during pregnancy and promoting exclusive breastfeeding for the first six months. Continued breastfeeding, appropriate complementary feeding, and caregiver education during routine child health visits are essential. Preventing, detecting, and managing anemia in children with SAM can significantly reduce associated morbidity and mortality.

Study on various anthropometric parameters in Beta-thalassemia Major Patients in tertiary rural hospital, Loni

Dr. Pachchalla Hari Chandana — 2025-01-27

BMI, mid-upper arm circumference (MUAC), and waist-to-hip ratio were recorded. These parameters were analyzed in relation to clinical variables such as serum ferritin levels, transfusion history, and pre-transfusion hemoglobin levels. Data analysis was performed using IBM SPSS statistics version 28.0.

Results: The study revealed significant growth retardation with 51.4% of patients showing height-for-age z-scores below -2 SD (mean -2.1 ± 1.3). The mean age of the study population was 8.4 ± 2.1 years, with an average transfusion dependency of 6.6 ± 2.3 years. Weight-for-age and BMI z-scores were also compromised (-1.8 ± 1.1 and -1.2 ± 0.9 respectively). Strong negative correlations were observed between serum ferritin levels and growth parameters (r = -0.45 for height-for-age z-score, p < 0.01). Duration of transfusion therapy showed moderate negative correlation with height-for-age z-scores (r = -0.42, p = 0.012) and weight-for-age z-scores (r = -0.38, p = 0.024).

Conclusion: This study highlights significant anthropometric deficits in young BTM patients from rural settings, with growth retardation evident even in early childhood. The findings suggest that optimization of chelation therapy and nutritional support, along with strengthening rural healthcare infrastructure, are crucial for improving growth outcomes in these patients. Regular monitoring of growth parameters and early intervention strategies are essential for managing growth abnormalities in young thalassemic patients.

Clinical spectrum and outcome in neonates with PPHN in rural tertiary care hospital

Dr Tanmayata Naithani — 2025-01-30

Background: Persistent pulmonary hypertension of the newborn (PPHN) remains a significant challenge in neonatal care, particularly in rural settings where access to advanced therapeutic options is limited. This study aimed to evaluate the clinical spectrum and outcomes of PPHN in a rural tertiary care hospital.

Methods: This prospective observational study was conducted at Dr. Vitthalrao Vikhe Patil Pravara Rural Hospital, Loni, from August 2023 to August 2024. Eighty neonates diagnosed with PPHN were included. Demographic characteristics, clinical presentations, management strategies, and outcomes were analyzed. The severity of PPHN was classified as mild, moderate, or severe based on standardized criteria.

Results: The study population comprised 65% males and 35% females, with 56.3% term and 43.8% preterm neonates. Birth weight distribution showed 66.1% >2500g, 31.3% between 1500-2500g, and 1.3% between 1000-1500g. Growth assessment revealed 73.8% appropriate for gestational age (AGA), 23.8% small for gestational age (SGA), and 2.5% large for gestational age (LGA). Meconium aspiration syndrome emerged as the predominant etiology, followed by birth asphyxia. Moderate PPHN was observed in 48% of cases. High-flow nasal cannula oxygen was required in 70% of neonates, while 43.8% needed escalation to high-frequency oscillatory ventilation. Pharmacological management included sildenafil (75%), milrinone (50%), and dobutamine (32%). The overall survival rate was 78.9%, with mortality predominantly occurring in severe cases requiring mechanical ventilation due to secondary complications.

Conclusion: Early recognition and systematic management of PPHN can achieve favorable outcomes even in resource-limited settings. The study highlights the effectiveness of a staged approach to respiratory support and the importance of standardized treatment protocols. The findings emphasize the need for improved preventive strategies, particularly for meconium aspiration syndrome and birth asphyxia. While resource limitations pose challenges, they need not preclude effective care delivery for neonates with PPHN.

Surgical Management of Non-malignant Cases by Tracheostomy in a Tertiary Care Hospital

Dr. Mohammad Nuruzzaman — 2025-02-05

Background: Tracheostomy is a commonly performed surgical procedure that involves creating an opening through the neck into the trachea to establish an airway. It can be performed for both malignant and non-malignant conditions. In non-malignant cases, tracheostomy is typically indicated in scenarios where long-term airway management is necessary, and it is often performed in tertiary care hospitals, where specialized expertise is available. Objectives: The aim of the study was to evaluate the surgical management of non-malignant cases by tracheostomy in a tertiary care hospital. Methods: This cross-sectional study was carried out in the Department of ENT, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during June 2022 to May 2023. A total of 100 patients participated in the study. Statistical analyses of the results were obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: In this study, according to the age distribution, 10% of the patients were aged 15 to 24 years. Furthermore, 38% were between the ages of 35 and 44, with 12% between the ages of 55 and 64. And the majority 57% of the patients were male, while 43% were female. According to the socioeconomic position of the study population, 27% come from low class, 42% from middle class, and 31% from high class families. Conclusion: The surgical management of non-malignant cases requiring tracheostomy in tertiary care hospitals is highly specialized and ensures optimal outcomes through a multidisciplinary approach.

Presumptive Tuberculosis In Children Below 12 Years At Tertiary Care Rural Hospital

Dr. Sakthi. D — 2025-02-08

Background: Tuberculosis remains a significant public health challenge, particularly affecting children in India with an estimated 2.2 lakh cases annually. The clinical presentation of tuberculosis in pediatric populations differs markedly from adults, presenting unique diagnostic challenges. This study aimed to investigate presumptive tuberculosis in children below 12 years at a tertiary care rural hospital following the NTEP 2020 protocol.

Objectives:

To diagnose tuberculosis according to NTEP 2020 protocol
To study the clinical profile and nutritional status of these patients
To identify confirmed cases of tuberculosis from presumptive cases

Materials & Methods: We conducted an observational, descriptive cross-sectional study of 120 patients over two years (June 2022 - May 2024) at a tertiary care rural hospital. Children presenting with persistent fever or cough exceeding two weeks, significant weight loss, or contact history with pulmonary TB patients were enrolled. A standardized study proforma captured detailed clinical information. Comprehensive evaluation included anthropometric measurements, laboratory investigations, tuberculin testing, radiological assessment, and microbiological studies following NTEP 2020 guidelines.

Results: Among 120 children with presumptive tuberculosis, 75 (62.5%) were confirmed cases. The majority (86.66%) of confirmed cases occurred in children under five years. Males showed higher prevalence (65.33%) compared to females. Persistent cough was the predominant symptom (82.66%), followed by fever (57.33%). Severe acute malnutrition was present in 46.77% of confirmed cases aged 6 months to 5 years. Hilar lymphadenopathy was the most common radiological finding (76%). Mantoux test positivity was observed in 33.33% of confirmed cases. Pulmonary tuberculosis constituted 94.66% of confirmed cases, while 5.33% presented with extrapulmonary manifestations.

Conclusion: Implementation of the NTEP 2020 protocol demonstrates effectiveness in early tuberculosis detection among children. The strong association between malnutrition and tuberculosis emphasizes the need for systematic TB screening in malnourished children. The study supports a comprehensive diagnostic approach combining clinical, radiological, and microbiological criteria, particularly focusing on children under five years who represent the most vulnerable group.

Clinical Profile and Outcome of Infant of Diabetic Mother in Tertiary Care (NICU) in Rural Maharastra.

Dr. Amata Praneeth — 2025-02-11

Background: Infants of diabetic mothers (IDMs) face unique challenges that require specialized care. The management of these high-risk neonates in rural tertiary care settings presents additional complexities due to resource limitations. This study aimed to evaluate the clinical profile and outcomes of IDMs in a rural tertiary care Neonatal Intensive Care Unit (NICU) in Maharashtra.

Methods: This observational analytical study included 50 infants born to mothers with preexisting or gestational diabetes mellitus admitted to our rural tertiary care NICU. We analyzed maternal characteristics, neonatal complications, and short-term outcomes. The study evaluated various parameters including gestational age, birth weight, metabolic complications, respiratory morbidities, and immediate outcome.

Results: Among the study population, 54% were male infants, with 30% being preterm. Birth weight distribution showed 16% small for gestational age, 62% appropriate for gestational age, and 22% large for gestational age infants. Major complications included hypoglycemia (36%), respiratory problems (38% combined, including 14% requiring surfactant), and hyperbilirubinemia (30%). Congenital anomalies were observed in 12% of cases. The survival rate was 94%, with a median NICU stay of 7 days. Poor maternal glycemic control significantly correlated with adverse neonatal outcomes (adjusted OR 2.8, 95% CI 1.4-5.6, p=0.003).

Conclusion: Despite resource limitations, rural tertiary care centers can achieve favorable outcomes in managing IDMs through systematic protocols and vigilant monitoring. The study highlights the importance of maternal glycemic control and early intervention in preventing complications. The findings provide valuable insights for developing standardized protocols tailored to rural healthcare settings, though larger multicenter studies are needed to validate these results.

To study the relationship between the presence and location of intracardiac echogenic foci (ICEF) and their potential association with congenital heart defects (CHDs)

Smita Shaline — 2025-02-03

Background: Intracardiac echogenic foci (IEF) are common findings during second-trimester fetal ultrasound examinations, yet their relationship with congenital heart defects (CHDs) remains incompletely understood. This study investigated the association between the anatomical location of IEF and the presence of CHDs to enhance current risk assessment strategies. Methods: In this prospective observational study, we examined 100 pregnant women between 18-24 weeks of gestation who presented with fetal IEF during routine anatomical scanning. Detailed fetal echocardiography was performed in all cases, documenting the precise location of echogenic foci within the cardiac chambers. All cases underwent postnatal cardiac evaluation to confirm prenatal findings. The relationship between IEF location and CHDs was analyzed using multivariate logistic regression. Results: Among the study population, IEF were predominantly located in the left ventricle (48%), followed by the right ventricle (28%), both ventricles (16%), and other cardiac chambers (8%). Congenital heart defects were identified in 15 cases (15%), with a significantly higher prevalence in fetuses with bilateral IEF (adjusted OR: 3.8; 95% CI: 1.6-9.2; p = 0.002) and right ventricular IEF (adjusted OR: 2.4; 95% CI: 1.1-5.3; p = 0.038). Ventricular septal defects were the most common anomaly (40% of CHD cases), followed by atrial septal defects (20%). Conclusion: The anatomical location of IEF demonstrates significant association with the risk of congenital heart defects, with bilateral and right ventricular IEF carrying higher risks compared to isolated left ventricular IEF. These findings suggest the need for location-specific risk stratification in prenatal counseling and follow-up protocols.

Etiology and Clinical feature of neonatal pneumothorax in inborn and outborn NICU settings in rural tertiary care hospital.

Dr. Tanmayata Naithani — 2025-02-04

Background: Neonatal pneumothorax (NP) is a critical condition characterized by air accumulation in the pleural space, leading to lung collapse and respiratory distress. Its incidence varies, with risk factors including prematurity, mechanical ventilation, meconium aspiration syndrome (MAS), congenital pneumonia, and birth asphyxia. Objective: This study aimed to analyze the etiology and clinical presentation of neonatal pneumothorax in inborn and outborn neonates admitted to NICUs of a rural tertiary care hospital. Methods: A descriptive, longitudinal observational study was conducted over two years (December 2020–December 2022) at Dr. Balasaheb Vikhe Patil Rural Medical College, Loni. A total of 60 neonates diagnosed with pneumothorax were included. Clinical history, diagnostic methods (transillumination and chest X-ray), and management strategies were documented. Statistical analysis was performed to assess associations between etiology and outcomes. Results: Out of 60 neonates, 63.3% were inborn, and 36.7% were outborn. The most common etiologies included congenital pneumonia (51.7%), MAS (38.3%), birth asphyxia (25%), and post-surfactant administration in RDS cases (58.3%). Right-sided pneumothorax was more frequent (48.3%), followed by left-sided (28.3%) and bilateral (23.3%). Spontaneous pneumothorax occurred in 26.7% of cases. Mortality was 56.6%, with higher rates among inborn cases (60.5%) than outborn (50%). Conclusion: Neonatal pneumothorax remains a significant challenge in NICU settings, with congenital pneumonia and MAS being the primary causes. Early recognition, prompt intervention, and improved resuscitation techniques, particularly in outborn cases, may reduce mortality. Further research incorporating advanced ventilation strategies like high-frequency oscillatory ventilation (HFOV) is recommended.

Frequency and Patterns of Eye Diseases in Outpatient Department in a Sub-Urban Clinic

Ferdousi Tabassum — 2025-02-10

Background: Eye diseases are a major cause of visual impairment and blindness worldwide. In Bangladesh, conditions such as refractive errors, cataracts, and dry eye syndrome contribute significantly to vision-related morbidity. Understanding the frequency and patterns of eye diseases in outpatient settings is crucial for early diagnosis, effective treatment, and the prevention of avoidable blindness.

Objective: This study aimed to assess the prevalence and patterns of eye diseases among patients attending the outpatient department of Bashundhara Ad-din Medical College Hospital, Dhaka from January 2024 to December 2024.

Methods: A cross-sectional study was conducted among 98 patients aged 2 years and older who presented with eye-related complaints. Data were collected using structured questionnaires, clinical examinations, and medical records. Statistical analysis was performed using SPSS-26, and results were presented in text, tables, and charts.

Results: Refractive errors (61.2%) were the most prevalent eye condition among patients, followed by dry eye syndrome (24.5%) and cataracts (16.3%). The most commonly reported symptoms included blurred vision (71.4%), eye pain (49%), and watering/tearing (44.9%). In terms of management, medications (71.4%) were the primary treatment approach, followed by spectacle prescriptions (59.2%) and surgical interventions (20.4%). Notably, no cases of diabetic retinopathy, uveitis, corneal ulcer infections, or trauma-related injuries were observed in the study population.

Conclusion: The study highlights the high prevalence of refractive errors, dry eye syndrome, and cataracts among OPD patients. These findings emphasize the need for regular vision screening programs, early detection strategies, and improved access to corrective eyewear and treatment options. Strengthening public health initiatives and referral systems can help reduce the burden of preventable blindness and improve eye care services in sub-urban healthcare facilities.

Comparing Outcomes of Lifestyle Modifications Versus Pharmacological Interventions on Metabolic Syndrome in Obese Individuals: A Cohort Analysis

Angela B — 2025-02-06

Background: Metabolic syndrome in obese individuals presents a significant global health challenge, with ongoing debate regarding the optimal treatment approach. This study aimed to compare the effectiveness of lifestyle modifications versus pharmacological interventions in managing metabolic syndrome among obese individuals over a 24-month period.

Methods: This prospective cohort study enrolled 490 obese adults (BMI ≥30 kg/m²) with metabolic syndrome across three tertiary care centers. Participants were allocated to either lifestyle modification (n=245) or pharmacological intervention (n=245) groups. The lifestyle modification group received structured dietary counseling, supervised exercise programs, and behavioral support, while the pharmacological group received standardized medication regimens including metformin, antihypertensives, and statins. Primary outcomes included changes in body weight, waist circumference, blood pressure, and metabolic parameters. Secondary outcomes encompassed treatment adherence, quality of life, cost-effectiveness, and adverse events.

Results: At 24 months, the lifestyle modification group demonstrated superior outcomes in weight reduction (-8.4 ± 4.2 kg vs. -6.1 ± 3.8 kg, p=0.008) and waist circumference reduction (-7.8 ± 3.9 cm vs. -5.4 ± 3.6 cm, p=0.006). The pharmacological intervention group showed greater improvements in blood pressure (systolic: -14.8 ± 8.9 vs. -12.3 ± 8.4 mmHg, p=0.042) and glycemic control (HbA1c: -0.7 ± 0.4% vs. -0.5 ± 0.3%, p=0.018). Treatment adherence was higher in the pharmacological group (83.2% vs. 68.9% at 24 months, p=0.002). The lifestyle modification group demonstrated better cost-effectiveness (ICER: $2,834 vs. $4,256 per QALY gained) but higher dropout rates. Adverse events were more frequent in the pharmacological group (32.4% vs. 18.7%, p<0.001) but were predominantly mild to moderate in severity.

Conclusions: Both interventions demonstrated distinct advantages in managing different aspects of metabolic syndrome. Lifestyle modifications showed superior outcomes in anthropometric measures and cost-effectiveness, while pharmacological interventions achieved better results in blood pressure control, glycemic parameters, and treatment adherence. These findings suggest that personalized treatment approaches, potentially combining elements of both strategies, may be optimal for managing metabolic syndrome in obese individuals.

Efficacy and Safety of Platelet-Rich Plasma Therapy for Erectile Dysfunction: An Observational Study

Dr. Mohammed Arif Chowdhury — 2025-02-13

Background: Erectile dysfunction (ED) is a prevalent ailment that significantly impacts one's quality of life. An effective regenerative treatment for the underlying pathophysiological mechanisms of ED is platelet-rich plasma (PRP) therapy. Assessing PRP therapy's effectiveness, safety, and patient-reported results in mild to moderate ED was the goal of this study.

Objective: to evaluate how PRP treatment for mild to moderate ED affects patient satisfaction, safety profile, and erectile function.

Methods: This 12-month prospective observational study was carried out at Ashiyan Medical College Hospital. The study included 60 male patients with mild to moderate ED. One month apart, two intrapenile injections of PRP therapy were given. The International Index of Erectile Function (IIEF) scores were used to assess erectile function at baseline, one, three, and six months. Additionally, adverse events and patient satisfaction were evaluated.

Results: PRP treatment significantly improved erectile function; at 6 months, the mean IIEF score increased by +5.1 points over baseline (p < 0.001). 60% of participants said they were satisfied with the therapy, and 70% said they had seen improvement. According to subgroup analysis, patients with lower BMIs and no hypertension had better results. With only minor side effects like mild pain (16.7%) and hematoma (5%), PRP therapy was well tolerated and did not result in any significant complications.

Conclusion: PRP therapy offers notable and long-lasting enhancements in erectile function with a high level of patient satisfaction, making it a safe and effective option for mild to moderate ED. PRP appears to be a promising restorative treatment based on these findings. It will take more randomized controlled trials to confirm these findings and investigate long-term advantages.