Excellent discharge planning should be initiated early on during the road to recovery and should involve all aspects such as caregiver understanding of the diagnosis and why it happened, training (if required for meeting specific needs of the child such as nasogastric tube feeds or the use of home medical equipment), who will be the medical provider post discharge and establishing that connection if possible, and clearly explaining to the caregiver the critical need for close follow up and monitoring after discharge.
Risk factors of preterm and low birth weight babies:
• Feeding difficulties since the coordinated “suck and swallow” process only starts at 34 weeks gestation. Preterm babies need help to feed and are more likely to aspirate.
• Premature babies are at higher risk of dying from sepsis once they get an infection.
• Babies born below 32 weeks of gestation, are at higher risk of developing respiratory distress syndrome (RDS), although this risk can be reduced by antenatal corticosteroids given to the mother at risk of preterm labour.
• Jaundice is more common in premature babies since the immature liver cannot easily metabolise bilirubin and the preterm baby’s brain is at a higher risk since their blood-brain barrier is less developed to protect the brain.
• Brain injury in preterm babies is most commonly intraventricular haemorrhage, occurring in the first few days after birth, in about 1 in 5 babies under 2 kg and is often linked to severity of RDS and hypotension.
• Necrotizing enterocolitis is a rare condition affecting the intestinal wall of very premature babies. Formula feeding increases the risk tenfold compared to babies who are fed exclusive breastmilk.
• Retinopathy of prematurity due to abnormal proliferation of blood vessels around the retina of the eye, which is more severe if the baby is given very high levels of oxygen for long durations.
• Anaemia of prematurity, which often becomes apparent at a few weeks of age due to the delay in producing red blood cells as the bone morrow is immature.
Approximately 5% to 10% of all cancers are hereditary. The hereditary cancer panels are detected by NGS (Next Generation Sequencing). Hereditary cancer panels are used in cancer syndromes, colorectal, pancreatic, renal, breast, and ovarian cancer. Somatic mutation cancer panels are by NGS. This will differentiate somatic and germ line mutations, determine the prognosis of patients, screen for therapeutic markers, and determine the sensitivity or resistance to targeted therapy drugs.
The most common peak incidence of this tumor as per available literature was in late sixth and early seventh decades of life with male preponderance. In our case, the age of occurrence was in a much younger male of 42 years age, showing a relatively early onset as compared to the reported peak ages in the literature. It has been noted that the most frequent site is the stomach (52%), followed by the small intestine (25%), large bowel (11%) and oesophagus (5%).
It has been estimated that up to 95% of EPN cases have an underlying uncontrolled diabetes mellitus. Further more, hyperglycemia in association with impaired blood supply to the kidneys from vasculopathy, both of which are prevalent in diabetic patients, facilitates the process of anaerobic metabolism.
Current evidence suggests that females are more susceptible to EPN because they are also more susceptible to urinary tract infections. E. coli is noted to be a very common pathogen in EPN. Klebsiella however is not so common.
The clinical approach to treating patients with EPN has changed over the years. Currently, due to advances in medical imaging, interventional radiology, newer more effective antibiotic therapy, and readily available intensive care integrated with dialytic support, patients with EPN have much better outcomes. Managing EPN more conservatively has thus become the standard of care. In patients with extensive/fulminant disease with hemodynamic compromise, it has been determined that together with fluid resuscitation and antibiotics, immediate nephrectomy should not be delayed for the successful management of EPN.
A 14-day-old male neonate born preterm at 34 weeks gestation by lower segment caesarean section (LSCS) presented with bilious vomiting of one day duration. He was admitted for observation and developed persistent vomiting and abdominal distension within 24 hours. He refused feeds, became tachypneic, hypothermic, and showed signs of shock. He was on formula feeds and had passed pellet-like stools. He had right lower quadrant swelling, and abdominal wall erythema noted on inspection and, tenderness and a tender lump on palpation.
Lab investigations revealed a white blood cell count of 18,000 per cubic mm with 80% neutrophils and normal platelet counts. Serum bilirubin was 10.4 mg/dl and electrolytes were normal. The c-reactive protein (CRP) was more than 120 mg/L. Plain x-ray showed haziness in the right lower quadrant with distended small bowel loops with few fluid levels (Figure 1). Faecal pellets were also seen in the colon. The abdominal ultrasound showed dilated small bowel loops with free echogenic peritoneal fluid suggesting perforative peritonitis.
The Evolution of Medical Education and Practice in Goa can be looked upon as :
1. Pre-Portuguese Era
2. Era of Scientific Medicine
3. Medical Education Post-Liberation from Portuguese
Breastfeeding is the right of every newborn child. It has many benefits for the newborn, the infant, as well as the mother. The results of breastfeeding can affect a society and its economy. Understanding the reflexes behind breastfeeding and the skills required by the mother is essential for every physician that looks after a child. Breastmilk has many stages which are responsive to the physiology and stage of the neonate. Breastfeeding is also beneficial to the mother which a physician can help explain. If the physician can encourage and stress to the mother how vital it is to breastfeed, then it can be followed by the mother in a proper manner.
Treasuring our natural resources with appropriate and warranted action against any form of pollution is not only necessary but vital to our interests to preserve our land, health, and well being. Eco imbalance has adversely affected climatic conditions all over the world and has resulted in damage to flora and fauna. The animal and plant kingdom including the aquatic (marine) atmosphere has also been adversely affected due to the pollutants in the atmosphere, soil, and water. At the turn of the century, the situation is further aggravated with destruction of bio-diversity resulting in damage to the natural processes that maintain an eco-balance. The various types of pollution such as air, water, soil, and noise are discussed here with their causes and consequences.
End of life care is a person-centred approach of care of an individual, at his or her end of life, guided by a personalized perception of “good death” that encompasses all aspects involved in the comprehensive care of that individual. It involves several key features such as (i) applicability to any person, place and illness (ii) relief of physical, psychological, social, spiritual and existential symptoms (iii) dying at the preferred place of choice and receiving appropriate care by a trained health care provider (iv) having universal access to standard palliative care at the end of life and every individual having a right to a good, peaceful, and digniﬁed death.
There certainly is something more beyond just the treatment of cancer, simply because “there is a limit for cure, but there is no limit for care!”
When it is time to tell patients that nothing more can be done for the cancer, it is with deep satisfaction that one can tell them that there is still something more that can be done. Tears of despair change to those of joy and hope! They are oﬀered a place to go to where they can be relieved of their pain and suﬀering. It is here that palliative care is given with much love, and above all, at no cost to the patient. This is the Shanti Avedna Sadan.
A five-day-old male neonate with 3.2 kg weight was referred for non-bilious vomiting and refusal of feeds. He was delivered by caesarean section and no congenital anomaly had been detected antenatally or at birth.
On examination, he was lethargic, pale, tachypneic, and dehydrated, with mild icterus. There was no cyanosis. He had passed normal meconium at birth. Further physical examination revealed epigastric fullness with tenderness. His investigations showed hemoglobin of 6 grams per decilitre (gm/dL), white blood cell count of 16,000 per cubic millimetre, low serum sodium and potassium, with C-reactive protein (CRP) level of 12 milligrams per decilitre (mg/dL).
The chest X ray showed a left sided diaphragmatic hernia.
Drug induced alteration in heart rate and rhythm are often encountered in clinical practice. Torsades de pointes (TdP), a polymorphic ventricular tachycardia with a prolonged QT interval, though often of very little consequence and self-limiting, can at times can be life threatening. The authors wish to highlight the various responsible drugs causing TdP with their common indications and likely causative mechanism(s). This would serve as a good guide to clinicians.
A 48-year-old female patient presented with a chief complaint of swelling of the left side of the upper jaw for the past 15 days. The patient had a history of occasional yellowish discharge from the gums, but no complaint of pain. On oral examination, a smooth surfaced dome-shaped swelling was noted on the palate in relation to the left maxillary canine. The swelling was soft in consistency and non-tender to palpation. The overlying mucosa appeared stretched.
We present a case of a pregnant patient with epilepsy requiring lower segment caesarean section (LSCS). A 25-year-old female, G3P0+2 at 36+1 weeks with seizure disorder and hypothyroidism who presented with severe intrauterine growth retardation (IUGR) with doppler changes. The modality of anaesthesia planned for her was epidural with general anaesthesia. We used multimodal anaesthetic techniques which not only reduced the dose requirement of every drug but also provided adequate anaesthesia, analgesia, amnesia and muscle relaxation. The postoperative analgesia part was also well managed.
Interventional pain constitutes an important arm in the management of chronic pain and in the palliative care of patients, to improve their quality of life and thereby reduce the need for opioids. This article describes the various interventional pain management strategies that were performed in a patient with Complex Regional Pain Syndrome, who was not responding to the medical line of management.