Indian Journal of Neonatal Medicine & Research

Preface to the First Issue

Dr Hemant Jain

The “Great Imitator’’-Congenital Syphillis

Aremu Ademola Adegoke

Background: Most antenatal centers have stopped routine screening for syphilis; it is assumed that the advent of penicillin had eradicated the disease. Cases of congenital syphilis seen in neonates and diagnosed by radiological features before serological confirmation were reviewed. Results: Twenty neonates presented for peripheral limbs radiographs within the studied period. Ten of them had positive radiographic features with serological confirmation. None of the mothers had VDRL screening in pregnancy. Periarticular swelling (of the knee) was the commonest presentation and Metaphysitis (ostechondritis) characterized by “saw tooth” distal metaphysis and periostitis were the commonest features. Conclusion: High index of suspicion and awareness of congenital syphilis are required to avoid misdiagnosis by clinicians and radiologists. Routine prenatal screening should be instituted by all antenatal care providers to prevent congenital syphilis since some cases are not symptomatic until late stage.

A Clinical Study of Respiratory Distress In Newborn and its Outcome

Santosh S, Kushal kumar K, Adarsha Eay

Introduction: Respiratory distress in neonates is one of the important clinical manifestations of a variety of disorders of the respiratory system and non respiratory disorders. It has been estimated that 40-50% of all the perinatal deaths occur following respiratory distress. Aims and Objectives: 1. To estimate the proportion of respiratory distress in the newborn period. 2. To know the etiological factors of respiratory distress. 3. To study the morbidity and mortality of respiratory distress in nicu. Materials and Methods: All newborn babies admitted to kims hospital nicu during a period of 1 year from april 2002 to march 2003 who developed respiratory distress were studied. These admissions comprised of neonates delivered in our hospital (in-borns) as well as those neonates who were refered to our nicu from other hospitals and delivery centers (out-borns). Results: The present study is descriptive in nature where clinical spectrum of respiratory distress in neonates and its outcome were studied. 553 Neonates were admitted in NICU during the study period, among them 76(13.7%) Developed respiratory distress. In the overall study 92.2% Survived with 6 deaths. 4 Deaths were due to preterm with RDS, 1 due to preterm with BA with RDS and 1 due to BA with RDS and sepsis. Most of the deaths were due to RDS (83%). Conclusion: Transient tachypnoea was the main cause of respiratory distress followed by RDS. In most of the cases X-ray findings correlated with the clinical picture. ABG was found normal in most of the cases. RDS was the main cause for ventilation.

Pathogenesis of Metabolic Acidosis in Preterm Infants

Christopher Geoffrey Alexander Aikenay

Objective: To determine how the balance between mineral base, and carbonic and organic acids is altered to cause metabolic acidosis in preterm infants. Study Design: Mineral balance and arterial blood measurements of 3 groups of preterm infants given 5 different total parenteral nutrition (TPN) regimens were analyzed. Mineral base was measured as the difference between mineral cations and anions. Organic acid was measured as the difference between mineral base, bicarbonate and protein anion. Results: The degree of metabolic acidosis measured as base excess, was determined by deviation in both mineral base and organic acid from normal. Sodium minus chloride balance determined change in arterial blood mineral base. TPN containing more chloride than sodium caused mineral acidosis with low mineral base, whereas TPN containing more sodium than chloride caused mineral alkalosis with high mineral base. Lactic, organic and carbonic acidosis all increased mineral base. Arterial blood organic acid was determined by: 1. Glomerular filtration rate: Low rates after delivery caused high organic acid that fell as GFR improved. 2. TPN non metabolized organic acid content: Gluconate and sulphate caused organic acidosis by accumulating in blood and mineral acidosis by urine excretion resulting in mineral base loss. 3. Rate of protein catabolism: Increased protein catabolism from TPN providing only 25 kcal/g amino acids or from dexamethasone caused organic acidosis. Conclusion: Metabolic acidosis was caused by high organic acid, resulting from low glomerular filtration rates in the first 1-2 weeks, exacerbated by TPN containing gluconate or sulphate or only 25 kcal/g amino acids. Renal bicarbonate wasting could not account for metabolic acidosis.

Variations of Fissures and Lobes In Human Lungs-A Multicentric Cadaveric Study from West Bengal, India

Rationale: Being a vital organ of respiration, the human lungs are divided by fissures into lobes, which facilitate movements of lobes in relation to one another. This knowledge of fissures & lobes is of academic interest to all medical professionals. Not only that, considering the fact that malignant lung neoplasms are on the rise all over the world and also in India, this case series would also be particularly useful to cardiothoracic surgeons during surgical resection of individual lung segments. Objective: Keeping in mind the above clinical importance, a cadaveric study focussed on anatomical variations of fissures & lobes was done in 82 human cadaveric lungs, over a period of one year. Result: Among the right lung specimens examined, one lung showed absence of oblique fissure & 22 right lungs had no horizontal fissure. None of the right lung specimens showed any accessory fissure. Among the left lung specimens studied, incomplete oblique fissure was seen in 29 lungs & absence of oblique fissure in two lung specimens. Conclusion: Hence, awareness of anatomical variations of lungs with respect to its lobes & fissures is of great significance.

Mayer Rokistanky Kuster Hauser Syndrome-The Psychological and Socio-cultural Implications In Nigerians

Background: Most cases of reported Mayer-Rokinstanky-Kuster-Hauser Syndrome(MRKH) were from developed countries. The relevance of procreation in less developed nations, prevalent illiteracy and poverty made it necessary to examine MRKH in our context. Material and Methods: Socio-demographic information was collected after informed consent from patients with the aid of questionnaires. The findings on clinical and radiological examinations were analysed and reviewed. Results: Most of the patients presented rather late in our environment with the mean age of presentation being 31 years. Most of the patients were poorly educated with meagre income. Renal anomaly was the commonest anomaly and ectopic kidney was the commonest of all renal anomalies. The commonest skeletal anomaly was spinal bifida occulta. There was a very high incidence of divorce/separation and depression amongst the patients after diagnosis despite counselling and follow-up. Conclusion: MRKH diagnosis has a devastating psychological and socio-cultural effects on the patients. There is a need to further educate the populace, improve the economy and make health services including assisted reproductive facilities accessible and affordable.

The Effect of Fenugreek (Trigonella Foecum Graecum) Intake on the Oxidative Stress in Hypercholesterolaemic Subjects

Renuka Devi, Jaya, Nandhini, Madhanika Madhavan, Saikumar

Introduction: The consumption of fenugreek (Trigonella Foecum Graecum) has been seen to have antidiabetic and hypolipedaemic effects. Hypercholesterolemia is a substrate for lipid per oxidation. An increased lipid per oxidation leads to oxidative stress. When the lipid levels are lowered, we can expect a reduction in the lipid per oxidation, which reduces the oxidative stress. Oxidative stress is a well established factor in the pathogenesis of ageing to deadly disease like carcinoma. Objective: The purpose of this research was to study the effect of fenugreek intake on the oxidant and the antioxidant status in hyperlipedaemic subjects. Method: Twenty subjects with an elevated lipid profile were included in this study. A detailed history was taken and clinical examinations were done for all the patients. They were grouped into two. The first group was treated with placebo for 30 days. The second group was treated with Trigonella Foecum powder (fenugreek) for 30 days. Fasting blood samples were taken from both the groups before and after the 30th day of the intake of placebo and fenugreek. The blood levels of MDA (oxidant) and Caeruloplasmin (antioxidant were estimated. Their levels before and after the intake of placebo and fenugreek were compared statistically. Results: The levels of MDA and Caeruloplasmin were found to be reduced significantly following the fenugreek consumption as compared to their pre treatment levels.No significant difference was found in the controls who consumed placebo. Conclusion: This study proved that a regular intake of fenugreek could reduce the oxidative stress by reducing the lipid per oxidation.

Expression of Low Molecular Mass Proteins in Stone Quarry Workers

Lucky R. Thakkar, Shubhangi K. Pingle, Rajani G. Tumane, Pravin N. Soni

Background: In India, there are many unauthorized stone quarries in which millions of workers exposed to crystalline silica dust. Silica dust is the most significant causative agent for the irreversible but preventable disease like silicosis. It is an unavoidable occupational disease among mining population. Silicosis, silicotuberculosis, chronic bronchitis, Chronic Obstructive Pulmonary Disease (COPD) and lung cancer are reported in long term occupational exposure to silica dust. Early health care is the key to silicosis prevention, but until now no effective indicators of early health care is developed. Objectives: The present study was performed on stone quarry workers for the evaluation of protein fractions by SDS-PAGE electrophoresis. Materials and Methods: For this study, Stone quarry (n=30) workers were selected from the Panchgaon- kuhifata located in central India as experimental subjects with an exposure of 0-35 years. For comparison, control subjects (n=20) belonging to the same socio-economic status and age group were selected. Blood samples were collected. Separated serum samples were used for SDS-PAGE. Results: The molecular mass of differentially expressed protein was determined by log graph method which was found to be 10 kDa. Remarkably 90% expression of 10 kDa protein were observed in control subjects but no such expression were determined in serum of stone quarry workers. Conclusions: The loss of expression of targeted (10 kDa) protein in stone quarry workers may be used as a potential peripheral marker for early silica toxicity.

Isolation Speciation and Determination of High Level Aminoglycoside Resistance of Enterococci Among Hospitalised Patients in Davangere

K. Suresh, B. Saipriya, G. Viswanathay

Background: Enterococcus, considered a normal commensal of intestinal tract is one of the fast emerging pathogen causing serious and life threatening hospital borne infections. This is attributed to acquisition of multi-drug resistance. Aims and Objectives: The present study was undertaken to isolate and characterize Enterococci from clinical specimens and determine the anti-microbial susceptibility pattern of these isolates. Methods: A total of 58 Enterococcal isolates from various clinical samples were speciated as per the scheme of Facklam and Collins. Anti-bacterial susceptibility pattern was determined by Kirby Bauer disc diffusion method with recommended drugs including high level aminoglycoside resistance. MIC for Vancomycin and Gentamicin was determined by E – test method. Results: Of the total 58 Enterococcal isolates, 52 were E. faecalis and 6 E. faecium. Antibiotic susceptibility tests showed high level resistance to penicillin, Ampicillin, Gentamicin and Streptomycin. All strains were sensitive to Vancomycin, Linezolid, Teicoplanin, E. faecium was more resistant than E. faecalis to the tested antibiotics. MIC for vancomycin was in range 1-4μg/ml. Conclusions: We conclude that Enterococcal strains with high rate of resistance to penicillin and aminoglycosides are prevalent in our nosocomial setting. Therefore, there is an urgent need for more rational and restricted use of antimicrobials in order to minimize the selection and spread of such strains.

A Anatomical Study on Relationship Between Posterior Cerebral Artery and Posterior Communicating Artery

Roopashree R.

Background and Objectives: A anastomotic ring called Circle of Willis, which is formed by the internal carotid and vertebrobasilar systems is one of the greatest anastomosis of human body. It slows down the blood before it reaches the brain and helps in collateral circulation. Anatomic study reveals the variation in the pattern and calibre of vessels which make up the circulus arteriosus. The variations in calibre occurring in the posterior communicating artery and posterior cerebral artery are not uncommon. Methodoloy: A total of 45 brain specimens were collected, cleaned and dissected. A careful examination of the specimens was done to check for variations arterial components of the Circulus Arteriosus. The calibre of the pre communicating (P1) segment of posterior cerebral artery and the posterior communicating artery (PCoA) were carefully recorded. Results: The posterior part of the Circle of Willis was more anomalous and the posterior communicating artery was the most anomalous segment. The fetal configuration of PCoA was found in 20% of the cases. An inverse relationship was found in the components of the posterior part of the circle, between PCoA and P1 segment on the ipsilateral side. Anomalies in the formation of Circulus Arteriosus may predispose to stroke. The neurosurgical importance of this study lies during the exploration of the region for different purposes. Knowledge of the vascular variations will increase the success of the procedure.

4641_ Oxidative Stress and Total Antioxidant Capacity in Renal Failure and Renal Calculi Patients-A Cross Sectional Study

Shivprasad S, Smita Sonoli, Anuradha B Patil

Background: Oxidative stress has been the centre of focus in most of the research, and in the field of medicine it takes a special place especially in diseases associated with kidneys. Stimulation of renal tissue by factors like infection, proteinuria, food allergens, drugs, high glucose levels, and increased blood pressure reactive oxygen species are released resulting in tissue injury and progression of disease. Aims: To determine the level of oxidative stress and the antioxidant defense in patients with CRF, ARF and renal calculi. Methods & Materials: Patients between age group of 30 to 50 years were selected as participants of the study. 50 cases each of acute renal failure, chronic renal failure and renal calculi were taken along with 50 control samples. The blood was collected after obtaining written informed consent. 5 ml of blood was collected under aseptic precautions and all the parameters were evaluated by standard biochemical methods. Oxidative stress was measured in terms of MDA, a reliable indicator of lipid peroxidation product. Statistical Analysis: Student “t” test (unpaired) – was used to calculate the statistical significance between cases and controls and also by Analysis of variance (ANOVA). Results & Conclusion: Malondialdehyde representing the oxidative stress in patients of Chronic Renal Failure, Acute Renal Failure and renal calculi was high indicating the stress among those patients. Total antioxidant capacity was low among ARF and CRF in comparison with controls. Reactive oxygen species (ROS) formation is part of the nonspecific defense system of an organism. ROS may also affect almost all cells of the host organism, in particular at sites where there is active inflammation.

Oxidative Stress and Total Antioxidant Capacity in Renal Failure and Renal Calculi Patients-A Cross Sectional Study

Shivprasad S, Smita Sonoli, Anuradha B Patil

Prenatal Diagnosis of Congenital Anomalies-Preliminary Report From A New Specialized Ultrasound Unit

The version that appears in Online First is the definitive article, edited to the JCDR's normal standards and will be available only as a PDF file. It will be semi formatted, devoid of page numbers, and HTML version.

A Clinical Study of Respiratory Distress In Newborn and its Outcome

Santosh S, Kushal kumar K, Adarsha Eay

Introduction: Respiratory distress in neonates is one of the important clinical manifestations of a variety of disorders of the respiratory system and non respiratory disorders. It has been estimated that 40-50% of all the perinatal deaths occur following respiratory distress. Aims and objectives: 1. To estimate the proportion of respiratory distress in the newborn period. 2. To know the etiological factors of respiratory distress. 3. To study the morbidity and mortality of respiratory distress in nicu. Materials and Methods: All newborn babies admitted to kims hospital nicu during a period of 1 year from april 2002 to march 2003 who developed respiratory distress were studied. These admissions comprised of neonates delivered in our hospital (in-borns) as well as those neonates who were refered to our nicu from other hospitals and delivery centers (out-borns). Results: The present study is descriptive in nature where clinical spectrum of respiratory distress in neonates and its outcome were studied. 553 Neonates were admitted in nicu during the study period , among them 76(13.7%) Developed respiratory distress .In the overall study 92.2% Survived with 6 deaths. 4 Deaths were due to preterm with rds, 1 due to preterm with ba with rds and 1 due to ba with rds and sepsis. Most of the deaths were due to rds (83%). Conclusion: Transient tachypnoea was the main cause of respiratory distress followed by rds. In most of the cases x ray findings correlated with the clinical picture. ABG was found normal in most of the cases. RDS was the main cause for ventilation.

Congenital Epulis: Case Report and Literature Review

Rema Nagpal, Pradeep Suryawanshi, Nandini Malshe, Alok Godse, Vijay Kalra

Congenital epulis of the neonate (CE) or congenital gingival granular cell tumor (CGCT) is a rare, benign, mostly single tumor. This arises from gingival mucosa, most commonly from maxillary alveolar ridge, with predominance in females. The histogenesis of the lesion remains unclear. The present report describes a case of congenital epulis in the maxillary alveolar ridge. This lesion was causing feeding difficulties and was excised under general anaesthesia.

Septicemia Due to Multidrug Resistant Elizabethkingia Meningoseptica: An Emerging Nosocomial Pathogen In India

B. Appalaraju, M. Dheepa, Marina Thomas , J. Krishnaveniy

Elizabethkingia Meningoseptica is a gram-negative bacillus that is known to cause meningitis in premature neonates, and a variety of infections in immunocompromised adults. We are presenting the case of a 37 year old patient with an ileal perforation, in whom an ileostomy was done. He was on a ventilator for eleven days in the ICU and he developed septicaemia due to this organism. It is important that clinicians consider Elizabethkingia Meningoseptica also as a rare cause of septicaemia. The patient was successfully treated with levofloxacin, with a good clinical outcome.

Blue Rubber Bleb Nevus Syndrome - A Rare Cause of Anemia in Children

Ashok V. Badaka li, B.C. Yelamali, Meenakshi. A. Badakali

A 10 year old boy presented with generalized weakness and progressive pallor requiring multiple blood transfusions. The skin demonstrated multiple raised, bluish-black lesions over extremities, trunk and oral cavity. He also suffered from several episodes of maelena & upper GI bleeding, chronic anemia and growth retardation. The endoscopic examination of GIT revealed multiple bluish black, sessile, venous malformation of various sizes. A diagnosis of Blue rubber bleb nevus syndrome was made which is a rare disease characterized by distinctive cutaneous and gastrointestinal venous malformation causing massive or occult gastrointestinal hemorrhage and iron deficiency anemia.

An Anomolousincidence of a Cervical Rib-A Radiographic Case Report

Vinodhini P., Sendil Kumar, Mamatha H., Antony Sylvan D’souza

The 7th cervical vertebra or vertebra prominence is visible and palpable for its long spinous process at the lower end of the nuchal furrow. The costal lamella is thin and partially deficient or may separate as a cervical rib. During the routine radiologic interpretation of a chest X-ray, in the of Department of Radiology, Kasturba Medical College, Manipal, India, we observed a case of right cervical rib, in a 30 years old woman. The patient came to the OPD with the complaints of swelling along the arms, pain, feeling of pins and needles in her affected right arm. The cervical rib is a supernumerary rib arising from a cervical vertebra, an elongation of the transverse process of the seventh cervical vertebra. However, cervical ribs are accessory or additional ribs that are permanent dysmorphological structures, forms an important cause for neurovascular compression and consequent muscular and cutaneous symptoms at the thoracic inlet and beyond into the upper extremity. Accessory ribs are permanent structures in contrast to ossification sites that disappear postnatally, probably becoming part of the lateral transverse vertebral processes.

Lipoma of the Tongue – A Rare Site for a Common Tumour

S. Manikandan, Md. Nazish Alam

Although lipomas are among the most common mesenchymal neoplasms, only 1 to 4% affect the oral cavity. Lipoma of the tongue represents about 0.3% of all the benign lesions of the oral cavity. These soft tissue tumours of adipose tissue origin are not interesting as such, but the sites of their presence may attract our attention. Lipoma of the tongue is a rare site for a common tumour. Herein, we present a rare case and the management of the site.

Appendicular Diverticulosis with Diverticulitis and Perforation

Sulochana Sonti, Madhavan Manoharan, P.B. Sudhars

Diverticulum of the appendix is rarely encountered. Mostly, it is a pseudo or a false diverticulum. It may suffer either inflammatory complications with or without associated appendicitis or it may rarely be an incidental finding in an inflamed appendix. Diverticulosis of the appendix cannot be differentiated from acute appendicitis preoperatively and it is usually revealed during a pathological examination Here, we are reporting a case of a pseudodiverticulum which was clinically diagnosed as acute appendicitis, with a brief review of the literature.

Anterior Wall Urethral Leiomyoma of the Distal Urethra – A Case Report

Mary Mathew, Bhavna Nayal, Sumeet Kaur Dil, Joseph Thomas

Urethral leiomyomas are uncommon smooth muscle lesions usually affecting the proximal segment and the anterior wall of the urethra. These lesions are cured by simple excision. We present a 35-year-old lady with urethral leiomyoma of the distal portion of the urethra arising from the anterior wall and presenting as mass per urethra. The patient was treated by surgical excision and there was no recurrence on follow up.

Simple Renal Ectopia with Chronic Kidney Disease

Sudhanshu Ku Das, Monalisa Subudhi, Ajit Ku

An ectopic kidney is described as an abnormal localization of a kidney due to a developmental anomaly and it occurs as a result of a halt in the migration of the kidneys to their normal locations during the embryonic period. The asymptomatic, non-complicated cases are managed conservatively, but nephrectomy may be necessary if there are otherwise untreatable complications such as stones, infection, failure or trauma.

An Imaging Review Article on Pleura Pulmonary Calcification and its Impact

Sushil. G. Kachewar, Devidas. S. Kulkarni

The lungs as well as the pleura are common sites of calcification. Important causes of calcification of lung parenchymal are prior infections (like viral pneumonia, miliary Koch`s), primary lung tumours and calcifying metastases to lung from carcinoma of breast, testes, thyroid and osteosarcoma. Lung parenchymal calcifications may also be seen in occupational lung diseases like coal workers pneumoconiosis. Common causes of pleural calcification are tuberculosis, asbestosis, empyema and old hemothorax. Primary pleural malignancy like mesothelioma and pleural metastases from carcinoma of breast, testes, thyroid and osteosarcoma can also calcify. While tiny calcifications are seen only on high resolution computed tomography [HRCT], larger calcifications are visible on routine chest radiographs as well. Ultrasound of the thorax does not demonstrate them satisfactorily. As the calcifications involving the Lung and the Pleura can have grave significance especially in the setting of neoplastic conditions, it is important to know how they appear on some common imaging modalities.

An Imaging Review on Urinary Tract Calcifications

Sushil. G. Kachewar, Devidas. S. Kulkarni

The urinary tract is one of the most important excretory systems in the human body. It consists of the kidneys, ureters, bladder and the urethra. The existence of calcium and other minerals in the excretory contents makes it prone to calcifications in the conditions of stasis of these contents, in a conducive biochemical environment. The calcifications in the renal parenchyma - Nephrocalcinosis can be seen in a number of metabolic diseases which present with renal impairment or failure. The calcifications in the lumen of the dilated renal calices, pelvis, ureters, and the bladder or even in the urethra can be seen as stones which impair or obstruct the normal flow of urine. Urinary tract calcifications are seen not only in benign conditions, as has been described above, but also in malignant conditions like Wilm`s tumour in children or renal cell carcinoma in adults. Inflammatory conditions like Xanthogranulamatous Pyelonephritis can also have renal caliceal or pelvic calculi. The mode of presentation of the patients with urinary tract calcifications is different in different entities. A correct and a timely diagnosis is therefore a must for treating this malady. It is the single largest contributor of the cases of acute abdomen globally. This imaging review focuses on the calcifications in the urinary tract and the roles of various imaging modalities in their diagnosis, treatment and follow up.

Dual Pathology

Prathvi Shetty, Leo Francis Tauro