Showing papers by "North Bengal Medical College published in 2008"

A randomised comparative study on sublingual versus vaginal administration of misoprostol for termination of pregnancy between 13 to 20 weeks

Abstract: Background: Misoprostol is the drug of choice for medical abortion worldwide but consensus is yet to be reached regarding its preferred route of administration. Aims: To compare the outcome of sublingual with vaginal administrations of misoprostol for induction of second trimester abortion. Methods: A randomised comparative trial where 300 women at 13–20 weeks gestation, requiring medical abortion, were randomly assigned to sublingual or vaginal route for misoprostol administration with a dose schedule of 400 µg three-hourly, up to a maximum five doses over 24 h. The same doses were repeated for another 24 h in non-responders. Primary outcome measure was complete abortion rate at 24 and 48 h, and the secondary outcome measures were induction–abortion interval, failure rate, side-effects and patients’ preference to the route. Results: No statistically significant differences in the complete abortion rates were observed at 24 h (64.03% vs 61.59%, P = 0.767) and at 48 h (79.14% vs 82.01%, P = 0.651) when sublingual and vaginal groups were compared. Mean induction–abortion intervals in sublingual and vaginal groups were 14.1 and 14.5 h, respectively (P = 0.066). Other outcome measures were also more or less similar in both groups. Differences in the incidence of side-effects were also statistically insignificant when both groups were compared. Sublingual administration of the drug was preferred by most of the women as compared to vaginal administration (P < 0.0001). Conclusion: Both sublingual and vaginal administrations of misoprostol are equally effective in inducing medical abortion during second trimester but sublingual route was preferred by the patients.

Gender inequality in nutritional status among under five children in a village in Hooghly district West Bengal.

Abstract: A community based, cross-sectional study was conducted in the Mollasimla village of Hooghly district of West Bengal, to examine the differences in nutritional status of under-five males and females and to determine the different bio-social factors associated with such differences. It was found that 55.9%, 51.4% and 42.3% of the girls were underweight, stunted and wasted respectively compared to 46.6%, 40.5% and 35.3% of the boys and a significantly higher proportion of malnutrition was found to be present among female children of higher birth order and those belonging to families with lower per capita income compared to the males.

Antibiotic misuse in children by the primary care physicians--an Indian experience.

Abstract: To determine the misuse of antibiotics in the Pediatric outpatients department (OPD) of a busy teaching hospital and to ascertain the probable reasons behind it. Over a 6 months period, new cases primarily treated with antibiotics by Medical Officers (first contact physicians in Peadiatric Medicine and Surgery OPD) were recruited in the study after obtaining written consent from the parents. Various errors of antibiotic usage were noted. All Medical Officers were asked to fill up a preformed questionnaire and the parents/guardians were interviewed on their ideas about antibiotics. Data were analyzed by the statistical software SPSS 10. Antibiotics were prescribed in 2427 (84.9%) new patients. Misuse of antibiotics was documented in 36.8% patients (no indication in 35.3%, improper selection in 17.9% and incorrect dosage in 7.7%). All medical officers were aware that they overuse antibiotics. The various reasons sited were demand of the parents, reluctance to counsel due to patient overload, free supply of medicines from OPD and sympathetic grounds as follow up visits were uncertain. Majority of the parents/attendants belonged to poor socioeconomic status and did not have any idea regarding antibiotics. All parents wanted quick relief without hospitalization and only 2.3% were willing to revisit the OPD for the same illness. Both medical officers and parents felt that base line investigations were unnecessary. Antibiotic misuse is quite common in this part of the world. Irrational use was mostly seen in over-prescribing and improper selection of antibiotic. Poor socio-economic status and overcrowding of patients in OPD were the main responsible factors.Antibiotics, child, physicians. Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.53-58

Needle sticks injury among nurses involved in patient care: a study in two medical college hospitals of West Bengal.

Abstract: A hospital-based retrospective study on a sample of 228 nurses involved in patient care, in two medical college hospitals of West Bengal, showed that 61.4% of them sustained at least one Needle Stick Injury (NSI) in last 12 months. The risk of such injuries per 1000 nurses per year was found to be 3,280. Out of the most recent injuries among 140 nurses, 92.9% remained unreported to appropriate authorities; in 52.9% events hand gloves were worn by the nurses; only 5% of those nurses received hepatitis B vaccine, 2.1% hepatitis B immunoglobulin and none of them received post exposure prophylaxis for HIV.

Analysis of the Role of Human Leukocyte Antigen Class-I Genes to Understand the Etiopathology of Schizophrenia

Abstract: Background: Schizophrenia is the paradigmatic illness of psychiatry. The involvement of immunological and immunopathological mechanisms in the etiopathogenesis of schizophrenia has been a matter of research, with recently increasing effort. Aims: In this study, we investigated the incidence of human leukocyte antigen (HLA) Class I antigens to understand the role of HLA genes in schizophrenia. Materials and Methods: India born schizophrenic patients in and around Siliguri who attended outpatient department (OPD) of Department of Psychiatry, North Bengal Medical College and Hospital were considered for the present study. After the longitudinal follow up, 50 patients were enrolled for the study. The same number of age, sex and ethnically matched healthy subjects were considered as control. Low resolution polymerase chain reaction-sequence specific primer method was applied for typing the HLA antigens. Statistics: The phenotype frequencies were calculated by direct count. χ2 test was done to compare the frequency of each antigen among the patients and control group and it was followed by Fisher's exact test. Relative risk was estimated by using Haldane's method. Results: The result showed that some of the HLA antigens are associated with the schizophrenia and significant increase were observed for HLA A*03 antigen along with the significant decrease for HLA A*25, A*31 and HLA B*51. Conclusions: The study provides the evidence for the possible existence of susceptibility locus for schizophrenia within the HLA region. This preliminary observation may help to understand the etiological basis of this disorder and the study may further strengthen the HLA antigens as the marker for schizophrenia.

Miller Fisher syndrome--an uncommon clinical presentation.

Abstract: Miller Fisher syndrome is an uncommon disease and it is a variant of Guillain-Barre syndrome Miller Fisher syndrome also has rarer variants Combined features of classic Guillain-Barre syndrome and Miller Fisher syndrome are uncommon Here we are reporting a case of Miller Fisher variant with Guillain-Barre syndrome overlap in which ataxia, are flexia, oculomotor disturbance and limb weakness occurred within few days

Clinico-pathologic profile of Hodgkin's lymphoma in a rural medical college.

Abstract: Purpose of study A prospective study was done at North Bengal Medical College and Hospital (NBMCH), Darjeeling, West Bengal, which caters predominantly to the rural and hilly population. All patients diagnosed as Hodgkin’s lymphoma (HL) were analyzed for clinical presentation, histological classified and staging.

Fetal ascites owing to congenital cytomegalovirus : response to ganciclovir

Abstract: A term newborn with severe congenital cytomegalovirus (CMV) infection is described. Fetal ascites was detected at 28 weeks gestation, and at birth there was tense ascites. There was intra-uterine growth retardation, microcephaly, chorioretinitis, jaundice, purpura and pneumonitis. Computed tomographic scan of the brain showed ventriculomegaly with periventricular calcifications. Serology was positive for cytomegalovirus-specific immunoglobulin M, and cytomegalovirus DNA was detected in the ascitic fluid and urine by nested polymerase chain reaction. He received 6 weeks of treatment with ganciclovir. Ascites resolved spontaneously and liver function tests became normal. Although there was a good clinical response to ganciclovir therapy without any side-effects, on follow-up the infant had global developmental delay and bilateral sensorineural deafness.

Working environment and morbidities of child laborers in an urban slum of kolkata.

Abstract: Sir, According to the World Health Report (1995), 15% of children aged 10–14 years old were working in Asia and India has the largest percentage of child laborers in the world.(1) Child labor contributes to about 20% of India's GNP(1) and mostly operates in the unorganized, informal, and unregulated sectors of the economy and is not being adequately reported. The most powerful force driving children into labor is exploitation of poverty. They begin to work at a very young age. These child laborers are engaged in various types of working situations in unorganized urban sectors. Poor and unsafe working conditions adversely affect these children and they may suffer from poor physical, mental, and social development. They have to work in an unkind, uncomfortable, and often physically hazardous environment for long hours. This study was carried out to assess the working conditions and environment of child laborers and to determine their morbidity pattern. A cross-sectional, observational study was conducted for a period of 3 months from October to December 2003 in the service area of the Urban Health Centre (UHC), Chetla, Kolkata under the All India Institute of Hygiene and Public Health, Kolkata. Of the four sectors catered by this UHC, Sector I and III were selected randomly for the study. Children working in two lanes of each sector, chosen randomly, were considered for the study. The study units were selected based on the definition given by the Operation Research Group, Baroda i.e., children between 5–14 years old, full-time workers, and on remunerative work.(2) The children working in commercial establishments were considered for the study. Based on this, the sample size came to be 45. Data was collected using a pretested and predesigned schedule. The children were interviewed in their working places. The adult workers were interviewed to judge the validity of information. Observation was done to assess the working place environment such as, the type of construction, ventilation, lighting, availability of drinking water, latrine facility, etc. The current morbidity pattern was recorded based on 2 weeks recall. The study revealed that a majority (86.6%) of the child laborers were male and most of the children (84.4%) were between the ages of 11 and 14 years old. The average age of the child laborers was 11.9 years old. Among the working children, 73.3% were Hindus and the rest were Muslims. A majority (84.4%) of the children were from nuclear families. For 6.7% of the children, both the parents were dead and in the case of 17.7% of the children, the father was either dead or had left the family. A total of 48.9% of the children had not been to school, 46.7% of the children received primary education, and only 4.4% of the children had gone to middle school. A total of 5 out of 45 children were still trying to pursue their education. Among the study population, 42.3% worked in a garage, 35.5% were rag pickers, 13.3% worked in hotels and food stalls, and 8.9% were shop helpers. None of the children were engaged in so-called hazardous occupations as described by the Indian Child Labor (Prohibition and Regulation) Act, 1986. Children working in garages, hotels, and shops were all males and the females were rag pickers. The Indian Child Labor (Prohibition and Regulation) Act, 1986 had recommended that the child workers would work for a maximum of 6 hours a day with 1 hour rest after 3 hours of work and they would get a weekly holiday. The present study showed [Table 1] that most of the child laborers (71.2%) worked for more than 6 hours a day and about one third of them did not get any rest in between their work. All the child laborers included in the study get one weekly holiday except the hotel boys who are allowed leave after one or two months of continuous work or when they are sick. Table 1 Distribution of child laborers according to working hours and remuneration It was found that 26.6% of the child laborers were paid less than Rs 300 per month. Among the laborers working, 21 (46.7%) received food, mainly hotel and some garage workers and 6 (13.3%) received tips. Financial support in medical care was available to 20 (44.4%) of the workers. The majority of the working children had to spend almost all of their income to support their family. A total of 32 (71%) of the working children were satisfied with their working conditions, 17.8% felt tired during work, and 11.1% considered the remuneration to be very low. As laid down in the Child Labour Act, it is the responsibility of the appropriate government agencies to make rules to provide safe and healthy environmental conditions for child laborers such as disposal of wastes and effluents, ventilation, temperature, lighting, cleanliness, drinking water, latrine, urinals, fencing of machinery, etc. Among the study population, 35.5% of the children worked totally exposed to the sun and rain and 31% had to work partly under open air. Almost all the working places were adequately ventilated and illuminated. A total of 44.4% had no latrine facilities at their work places although arrangements for drinking water were present in most (84%) of the places. Being fragile physically, children are more susceptible than adults to various work-related injuries and illnesses. Also, because they are not yet matured mentally, they are less aware, even completely unaware, of the potential risks involved in their specific occupations or at the work place itself. About 40% of the children said that they had no health problems in last 2 weeks but 31% complained of respiratory infections, 24% had skin infections, and 13.3% had toothaches and caries tooth. A total of 42.2% had pallor and 11.1% had signs of vitamin B deficiency. Physical injury while working had been sustained by 6 (13.3%) children. Morbidities were more in children who worked in the sun and rain (87.5%) than those who were not exposed (44.08%) and the difference is statistically significant. It is now evident that child labor cannot be totally eradicated by legislation alone. Implementation of such laws and detection of violations, especially regarding working hours, rest period, holidays and to supervise the working environment are necessary. We should try to provide these children with education, supplementary nutrition, health care, and vocational training to improve their living conditions.

Dandy-Walker syndrome.

Abstract: Epidemiology Incidence is approximately 1 in 25-35,000 live births. [3] It occurs slightly more frequently in females than in males. Marked variation has been shown in the genetics and aetiology. Most cases of DWS are sporadic, although familial occurence has been reported and several individuals with de novo interstitial deletions of 3q have been identified. [4] DWS may result from chromosomal anomalies or environmental factors. [5] Recognised chromosomal abnormalities associated with DWS include trisomies (trisomy 18, 13, 21 or 9) and triploidy. Recognised single gene defects associated with DWS include Walker-Warburg syndrome or Meckel's syndrome and in these cases the recurrence risk for siblings may be high. [6] Associated environmental factors include first-trimester exposure to rubella, cytomegalovirus, toxoplasmosis or warfarin. Maternal diabetes during pregnancy is also associated with increased risk. However, brain malformations associated with DWS often occur as an isolated condition and in these cases the cause is usually unknown. When the evidence suggests that there is no association with a Mendelian or chromosomal disorder then the recurrence risk is relatively low at between 1% and 5%. [7]