STUDY ON THE ROLE OF VENTILATION-PERFUSION SCAN IN DETECTION OF SILENT PULMONARY EMBOLISM IN NEPHROTIC SYNDROME CHILDREN

2021 ◽  
pp. 81-83
Author(s):  
Srabani Sen ◽  
Suprit Basu ◽  
Malay Kumar Sinha
Keyword(s):  
Pulmonary Embolism ◽  
Nephrotic Syndrome ◽  
Pulmonary Thromboembolism ◽  
Tertiary Care ◽  
Pediatric Nephrology ◽  
Tertiary Care Centre ◽  
Group Iii ◽  
Group I ◽  
Duration Of Illness ◽  
Perfusion Scan

INTRODUCTION: Clinically silent pulmonary thromboembolism is commoner than symptomatic one in children with nephrotic syndrome. The present study was done to look for the occurrence of asymptomatic pulmonary thromboembolism in children with nephrotic syndrome using V IQ scan, which is noninvasive, cost effective. MATERIALS AND METHODS: This prospective study conducted at a tertiary care centre over a period of one year on one hundred children with nephrotic syndrome between the ages of 5 and 15 years with a median age of 8 years attending the Pediatric Nephrology Clinic were taken up for the study. Patients showing defect in Tc99m-MAA perfusion scintigraphy underwent ventilation scan within 24-48 hours. Scan ndings were interpreted by two nuclear medicine physicians independently who were unaware of illness of the patients. The results were interpreted according to Modied Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) criteria. The overall incidence of abnormal V/Q RESULTS: scan in our study was 14%. Individually the incidence was 13.9% in group I, 22.22% in group II and 3.6% in group III, which indicates that patients with steroid resistant and steroid sensitive nephrotic syndrome in relapse were prone to develop thromboembolic complications more than those who were in remission. Combined scintigraphic evidence of pulmonary thromboembolism was 18.05% in Groups I and II compared to 3.6% in controls (Group III). Patients with abnormal ventilation-perfusion scan showed s CONCLUSION: ignicantly larger (p<0.05) duration of illness (mean 69.7±55.3 months) and signicantly greater degree (p<0.001) of proteinuria as compared to patients with normal ventilation-perfusion scan who had mean duration of illness of 45.5±38.0 months.

scholarly journals A Crossover Comparative Study to Assess Efficacy of 5% vs. 20% Albumin in the Treatment of Anasarca in Children with Idiopathic Nephrotic Syndrome

2020 ◽  
Vol 40 (3) ◽  
pp. 157-163
Author(s):  
Ajoy Kumar Garg ◽  
Suprita Kalra ◽  
Ashutosh Kumar ◽  
Madhuri Kanitkar
Keyword(s):  
Nephrotic Syndrome ◽  
Urine Output ◽  
Tertiary Care ◽  
Randomised Trial ◽  
Tertiary Care Centre ◽  
Group I ◽  
Duration Of Illness ◽  
Percentage Weight ◽  
Group A ◽  
Group B

Introduction: Co-administration of albumin and furosemide has shown better response than furosemide alone in managing anasarca among children with nephrotic syndrome. There are different concentrations of albumin available. The aim of this study was to compare diuretic response to co-administration of either 5% or 20% albumin with furosemide in these children. Methods: It was a crossover randomised trial conducted on children with nephrotic syndrome with moderate to severe oedema at a tertiary care centre. They were  randomised to two groups; Group A (n = 14) received 5% albumin along with furosemide in midway followed by 20% albumin after washout period of 48 hrs and group B (n = 10) received albumin vice versa. Baseline and post therapy vitals, fluid intake, urine output and biochemistry were noted. Primary outcomes were increase in urine output and reduction in weight following co-administration of albumin with furosemide. For analysis of primary outcomes, two interventional arms were formed; group I (5% Albumin co-administered with furosemide) and group II (20% albumin co-administered with furosemide). Results: Total children were 24 in each arm i.e. group I and II. Eighteen (75%) were males. Mean (range) age at enrolment and duration of illness were 55.3 (15 - 144) and 18.6 (1 - 120) months respectively. Mean difference (SD) in urine output were 1.52 (1.11) and 1.66 (0.95) ml/kg/hr (p = 0.12) and mean percentage weight loss were 2.25% (2.12) and 3.68% (3.84) in group I and II respectively (p = 0.64). On further comparing, urine output was significantly better when 5% albumin was co-administered with furosemide during first period than in second period. Conclusions: Co-administration of either 5% or 20% albumin with furosemide is equally safe and effective in increasing urine output in children with anasarca.

“ROLE OF PARTOGRAM IN MANAGEMENT OF LABOUR IN PRIMIGRAVIDA PATIENT AT TERTIARY CARE CENTRE”

2021 ◽  
pp. 49-53
Author(s):  
Surabhi Gupta ◽  
Preeti Sharma
Keyword(s):  
Tertiary Care ◽  
World Health ◽  
Normal Vaginal Delivery ◽  
Tertiary Care Centre ◽  
Obstructed Labor ◽  
Group Iii ◽  
Group I ◽  
Management Protocol ◽  
Prolonged Labor ◽  
Group Ii

Introduction: Although labor is a natural physiological process characterized by progressive increase in frequency, intensity and duration of uterine contractions, resulting in effacement and dilatation of cervix, with descent of the fetus through the birth canal, this physiologic process many a time may lead to prolonged labor. The partograph developed by World Health Organization is the best-known partograph in the lowresource setting. Partograph when used with dened management protocol is an inexpensive tool which can effectively monitor labor and be helpful in reducing incidences of both maternal and fetal morbidity and mortality by reducing the number of operative interventions, prolonged labor, obstructed labor and caesarean section. Then WHO in 1994 endorsed the partogram and later modied in 2000 and removed latent phase and dened active phase at 4 centimetres instead of previously used 3 centimetres. WHO advocated its use as a necessary tool in management of labor and recommended its universal use during labor. Objective: To analyse the patterns of labor amongst spontaneous parturient using a WHO modied partogram and to compare outcome of labor and neonatal outcomes in relation to partogram ndings. Methods: This prospective study was carried over a period of 18 months on 100 parturients. Modied WHO Partogram was used to assess the progress of the labor. Parturients were divided on basis of partogram ndings. Group-I (n=64), where parturients partogram remained to the left of alert line, Group-II (n=20), where parturients partogram remained between the alert and action lines and Group-III (n=16), where parturients partogram crossed the action line. In these three groups, the maternal and fetal outcomes were assessed. Results: Normal vaginal delivery was done in 95.3% of Group-I, 80% of Group-II and 43.75% of Group-III parturients. Instrumental delivery was done in 1.56% of Group-I, 10% of Group-II and 18.75% of Group-III parturients. LSCS was done in 3.1% of Group-I, 10% of Group-II and 37.5% of Group-III parturients. Instrumental / LSCS deliveries were higher in Group-II and Group-III parturients. Alarge proportion of newborns of Group-II and Group-III parturients had Apgar Score <7. Conclusion: The Modied WHO partogram is very helpful in the prediction of maternal and fetal outcome. It is highly recommended for use in resource decient medical facilities, where early decision for delivery or referral can be taken on the basis of partogram ndings..

COMPARATIVE EVALUATION OF TREATMENT OF ACUTE PULMONARY EMBOLISM (ACCORDING TO DATA CLINICAL HOSPITAL OF ALMATY #7)

Vestnik ◽  
2021 ◽  
pp. 57-61
Author(s):  
С.М. Анартаев ◽  
О. Тайманулы ◽  
Д.М. Кайралиев ◽  
К.А. Ергешов ◽  
Е.Б. Ибадуллаев ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Anticoagulant Therapy ◽  
Comparative Evaluation ◽  
Acute Pulmonary Embolism ◽  
Therapy Group ◽  
Heparin Group ◽  
Group Iii ◽  
Group I ◽  
Complex Therapy ◽  
Acute Pe

В статье представлены результаты сравнительного анализа 50 больных тромбоэмболии легочной артерии (ТЭЛА), которые по способу лечения были разделены на 3 группы: I группа - с антикоагулянтной терапией (гепарин). II группа - с селективной катетерной тромболитической (альтеплаза) и антикоагулянтной терапией. III группа - с катетерной аспирационной тромбоэкстракцией; Установлено, что на фоне комплексной терапии, включающую тромболитическую и антикоагулянтную терапии наблюдалась лучшая выживаемость пациентов с острой ТЭЛА. The article presents results of a comparative analysis of 50 patients with pulmonary embolism (PE), which were divided into 3 groups according to the method of treatment: Group I - with anticoagulant therapy (heparin); Group II - with catheter thrombolytic (alteplase) and anticoagulant therapy. Group III - with catheter embolectomy (aspiration thromboextraction); It was found against the background of complex therapy, including thrombolytic and anticoagulant therapy, there was a better survival rate for patients with acute PE.

scholarly journals Prevalence of anaemia among children under five years in tertiary care hospital of Nepal.

2015 ◽  
Vol 13 (1) ◽  
pp. 33-36 ◽  
Author(s):  
Sundari Joshi ◽  
Megha Pradhan Pradhan ◽  
Ujjwal Joshi
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Severe Anaemia ◽  
Care Hospital ◽  
Cross Sectional ◽  
Children Under Five ◽  
Group Iii ◽  
Under Five ◽  
Group I ◽  
Group Ii

Introduction: Anaemia is a pathologic deficiency in oxygen-carrying haemoglobin in red blood cells which may be the result of genetic diseases, infections and deficiency of several nutrients. Nepal is one of the developing countries where anaemia is one of the most serious public health problems. So, a study was planned to evaluate the prevalence of anaemia among children under five years in tertiary care hospital of Nepal. Methods: A cross-sectional study was carried out from August 2011 to January 2012 using a structured questionnaire interview and observation. The children were divided into three groups: group I (0-1 years), group II (>1-3 years), group III (>3-5 years). Anaemia was assessed using  haemoglobin measurement in gram in decilitre on Sysmex KX -21 (automated haematology analyzer). The severity of anaemia were grouped as follows: severe anaemia, < 7.0 g/dL; moderate anaemia, 7.0 to 8.9 g/dL; and mild anaemia, 9.0 to 10.9 g/dL as per WHO classification. Stool test was also carried out to assess worm infestation. Data were analysed using SPSS 11.5. Results: There were 208 children among which 52.9 % were male while 47.10 % were female.  The overall prevalence of anaemia was found to be 49.5% of which 43.3% had mild, 15.8% had moderate and 0.5% had severe anaemia. Out of 20 children in group I, 70 % were anaemic. Among the 94 each in group II and group III, children suffering from anaemia were 51% and 43% respectively. The stool investigations showed that 5.3 % children suffered from worm infestations.   Conclusions: prevalence of anaemia was seen in 49.5% of children below five years age group and the diet and worm infestations didn’t affect it.doi:  http://dx.doi.org/10.3126/mjsbh.v13i1.12998

scholarly journals P1826ASSESSMENT OF GROWTH PARAMETERS OF CHILDREN IN LONG TERM FOLLOW UP WITH DIFFERENT RELAPSING COURSE OF NEPHROTIC SYNDROME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sonia Sharma
Keyword(s):  
Nephrotic Syndrome ◽  
Growth Parameters ◽  
Tertiary Care ◽  
Age At Onset ◽  
Standard Deviation Score ◽  
Pediatric Nephrology ◽  
Group 2 ◽  
Nephrotic Children

Abstract Background and Aims Childhood Nephrotic syndrome has its peak onset in the age group 2-4 years, and that is also a period of significant height growth. Corticosteroids and chronic diseases are known to have long term effects on growth parameters of these children. Hence we assessed and compared the growth of children with Infrequent relapsing (IFRNS) and remission (R) as group 1, Frequent -relapsing (FR), and steroid - dependent (SD) as group 2 and steroid -resistant (SR) as group 3. Method This retrospective single center study collected data from medical records of children presented in a pediatric nephrology clinic in a tertiary care center in New Delhi. Nephrotic children, aged 1-18 years with regular follow up in the period of 2014 to 2019 were included. Basic demographic details including age at onset and age at last follow up in clinic, sex, anthropometry details at last follow up were recorded. We traced initial height at nephrotic syndrome onset to assess growth velocity but were unavailable at the moment so excluded from analysis. Also, children completed less than 1 year follow up, and compliance issues were excluded. Z scores (standard deviation score) for weight, height and BMI were calculated. Initial comparison of three groups as FR/SDNS, IFRNS/R and SRNS was done. But in the second comparison, we combined FR/SD and SR children in one group as Difficult nephrotic syndrome (DNS) group. Anova Kruskal-Wallis test was used to find significance in three groups in table 1. Subsequent analysis was done by the non-parametric statistic method Mann-Whitney Test to assess significance in subgroups of boys and girls. Results: 27 IFR/R nephrotic children, 36 FR/SD, and 15 SRNS were compared as in Table1. D-NS and IFRNS-R for boys and girls ratio (11; 16) & (18; 32) followed for a median period of 18 (max 46; 12), 24.6 (57.6; 12), and 32 (50;12) months respectively. Conclusion Linear growth (height) is the most affected parameters in children in SRNS and FR/SD nephrotic syndrome. Effect is more significant in girls then in boys as they showed improvement in . No difference in weight and BMI is seen on applied statistics in two groups.

scholarly journals Pulmonary embolism in patients with chronic hypoxemia

2010 ◽  
Vol 63 (7-8) ◽  
pp. 492-496 ◽  
Author(s):  
Lidija Ristic ◽  
Milan Rancic ◽  
Tatjana Pejcic
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Predictive Value ◽  
Diagnostic Study ◽  
Diagnostic Strategy ◽  
Radiological Findings ◽  
Group I ◽  
Perfusion Scan ◽  
Group Ii ◽  
Chronic Hypoxemia

Introduction. The aim of this prospective, originally designed, clinical - diagnostic study including 200 chronic hypoxemic patients was to assess the possibility of implementation of noninvasive diagnostic strategy and to investigate the incidence of pulmonary embolism and parameters of diagnostic accuracy of radiological findings according to Shintz criteria, echocardiography, lung perfusion scanning according to PIOPED criteria. Material and methods. The study included 200 chronic hypoxemic patients divided into 2 groups, the group I consisting of 42 women and 58 men and the group II consisting of 48 women and 52 men. Results and conclusion. Out of 200 hypoxemic patients, 49 patients (24.5%) were found to have pulmonary embolism. In the group I of 100 patients (42 women and 58 men) with chronic hypoxemia and secondary erythrocytosis the diagnosis of pulmonary embolism was confirmed in 39%, that being statistically significantly different (p<0.001) from 100 patients (48 women and 52 men) in the group II with chronic hypoxemia without secondary erythrocytosis, where pulmonary embolism was found in 10% of the patients. The predictive value was positive for direct radiological signs in 92.3% of patients in the group I for PTE, for indirect ones in 74.35%, and in the group II it was positive for direct radiological signs in 60% and for indirect ones in 90%. The predictive value of perfusion scan was positive in 59% of the group I and in only 22% of the group II. The predictive value for high pressure in the pulmonary artery was positive in 93.7% of the group I and in 66.6% of the group II. The following were found to be a variable predictor: hypoxemia, enlargement of the pulmonary artery, peripheral oligemia and elevation of diaphragm. Logistic regression according to backward - conditional method showed that the chronic hypoxemic patients with secondary erythrocytosis, who had radiological sign of peripheral oligemia - Westermark sign, had 2.286 times higher probability of having pulmonary embolism than similar patients without this sign.

scholarly journals Ambulatory vital signs in the workup of pulmonary embolism using a standardized 3-minute walk test

CJEM ◽  
2015 ◽  
Vol 17 (3) ◽  
pp. 270-278
Author(s):  
Qamar Amin ◽  
Jeffrey J. Perry ◽  
Ian G. Stiell ◽  
Subhra Mohapatra ◽  
Abdulaziz Alsadoon ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pulmonary Embolism ◽  
Oxygen Saturation ◽  
Tertiary Care ◽  
Heart Rate Change ◽  
Rate Change ◽  
Walk Test ◽  
Tertiary Care Centre ◽  
Absolute Decrease ◽  
Minute Walk

AbstractObjectiveDiagnosing pulmonary embolism can be difficult given its highly variable clinical presentation. Our objective was to determine whether a decrease in oxygen saturation or an increase in heart rate while ambulating could be used as an objective tool in the diagnosis of pulmonary embolism.MethodsThis was a two-site tertiary-care-centre prospective cohort study that enrolled adult emergency department or thrombosis clinic patients with suspected or newly confirmed pulmonary embolism. Patients were asked to participate in a standardized 3-minute walk test, which assessed ambulatory heart rate and ambulatory oxygen saturation. The primary outcome was pulmonary embolism.ResultsWe enrolled 114 patients, including 30 with pulmonary embolism (26.3%). A ≥2% absolute decrease in ambulatory oxygen saturation and an ambulatory change in heart rate >10 beats per minute (BPM) were significantly associated with pulmonary embolism. An ambulatory heart rate change of >10 BPM had a sensitivity of 96.6% (95% confidence interval [CI] 83.3 to 99.4) and a specificity of 31.0% (95% CI 22.1 to 45.0) for pulmonary embolism. A ≥2% absolute decrease ambulatory oxygen saturation had a sensitivity of 80.2% (95% CI 62.7 to 90.5) and a specificity of 39.3% (95% CI 29.5 to 50.0) for pulmonary embolism. The combination of both variables yielded a sensitivity of 100.0% (95% CI 87.0 to 100.0) and a specificity of 11.0% (95% CI 6.6 to 21.0).ConclusionIn summary, our study found that an ambulatory heart rate change of >10 BPM or a ≥2% absolute decrease in ambulatory oxygen saturation from baseline during a standardized 3-minute walk test are highly correlated with pulmonary embolism. Although the findings appear promising, neither of these variables can currently be recommended as a screening tool for pulmonary embolism until larger prospective studies examine their performance either alone or with pre-existing rules.

scholarly journals A STUDY ON CHANGES IN PLATELET COUNT AND PLATELET INDICES IN PATIENTS WITH PREECLMPSIAAND ECLAMPSIA: A CASE CONTROL STUDY

2020 ◽  
pp. 7-9
Author(s):  
Pulakesh Sinha ◽  
Sourav Barik ◽  
Apurba Bikash Pramanik ◽  
Victor Roy ◽  
Debarshi Jana
Keyword(s):  
Platelet Count ◽  
Tertiary Care ◽  
Total Sample ◽  
Screening Tests ◽  
Control Group ◽  
Medical Sciences ◽  
Multisystem Disorder ◽  
Platelet Indices ◽  
Group Iii ◽  
Group I

Preeclampsia is a hypertensive pregnancy specific multisystem disorder. It requires prompt intervention that may include observation in tertiary care setting and termination of pregnancy either by inducing labour or by caesarian section. To study the variation of platelet counts, platelet indices in preeclampsia and eclampsia Department of Pathology and Gynaecology & Obstetrics Ramakrishna Mission Seva Pratisthan, Vivekananda Institute of Medical Sciences from January 2017 to June 2018. Group I: Women affected with convulsion and having signs of preeclampsia during pregnancy or within seven days after delivery after ruling out epilepsy or any other convulsive disorder were treated as eclamptic women. Group II: Women having BP> 140/90 mmhg and significant proteinuria (>300mg/24hrs) and or edema are treated as preeclampsia. Group III: Normotensive women having pregnancy >20weeks were considered as control group. Total sample size was 66 pregnant women. 22 patients are taken from each group. The platelet indices e.g. MPV, PDW and also PLCR are in consistent relationship with PIH. The higher their values, the greater severity of PIH, from preeclampsia to eclampsia. The estimation of platelet count and indices offer early, simple, rapid assessments of the disease for its severity and the risk of complications. Therefore these tests may be considered as screening tests to be routinely performed in antenatal workup of women with PIH.

scholarly journals Survival among patients admitted in PICU (Pediatric Intensive Care Unit) of tertiary childcare hospital.

2021 ◽  
Vol 28 (12) ◽  
pp. 1773-1777
Author(s):  
Fatima Jabeen ◽  
Asim Khurshid ◽  
Maria Saleem
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Care Hospital ◽  
Group Iii ◽  
Group I ◽  
Male Patients ◽  
Study Participants

Objective: To determine the frequency of survival among patients admitted in Paediatric Intensive Care Unit (PICU) of tertiary care hospital according to disease severity score PRISM III. Study Design: Descriptive study. Setting: PICU of The Children’s Hospital and Institute of Child Health, Multan. Period: October 2019 to April 2020. Material & Methods: A total of 205 admitted children in PICU were recruited. PRISM III forms were filled and PRISM III score was calculated for all study participants. Results: Of these 205 study cases, 124 (60.5 %) were male patients while 81 (39.5 %) were female patients. Mean age of our study cases was 3.64 ± 1.96 years. Mean duration of PICU stay was 4.52 ± 3.59 days and 139 (67.8%) patients had PICU stay for upto 5 days. Mean PRISM III score was 11.25 ± 4.69 and 69 (33.7%) had group I score, 118 (57.6%) had group II score, 14 (6.8%) had group III score and 4 (2%) had group IV score. Of these 205 study cases, mortality was noted in 31 (15.1%). Conclusion: High Frequency of mortality among children admitted to pediatric intensive care unit (PICU) was observed and mortality was found to be increasing with increasing PRISM III score.

scholarly journals Clinical profile of patients with steroid sensitive nephrotic syndrome at tertiary care centre in Gujarat, India

2018 ◽  
Vol 5 (4) ◽  
pp. 1172 ◽  
Author(s):  
Nimisha K. Pandya ◽  
Kedar G. Mehta
Keyword(s):  
Nephrotic Syndrome ◽  
Chronic Renal Disease ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Response To Treatment ◽  
Renal Diseases ◽  
Sex Distribution ◽  
Tertiary Care Centre ◽  
Steroid Dependence ◽  
Special Clinic

Background: Nephrotic syndrome is a significant cause of chronic renal disease in children. The objective of the study was to analyze demographic profile, response to steroids and associated complications, in children with Nephrotic syndrome.Methods: A retrospective study of all patients referred to Renal diseases clinic at GMERS Medical College Gotri Vadodara was done. Period of study was from year 2014 to June 2017. Variables assessed were sex distribution, age at presentation for first attack, occurrence of complications, steroid responsiveness and use of steroid sparing agents. Study was done from special clinic cards used for documentation of visits of patients in Nephrotic disease special clinic.Results: 59 patients were studied. Mean age at presentation of was 4.08 years. Sex distribution ratio was 1.18:1. 88% of cases were infrequent relapsers. Steroid dependence was observed in 8.4% of cases. Complications were noted in 38% children. UTI was the commonest complication 13.5%. Associated renal conditions were present in 5% of children.Conclusions: In the present study clinical profile of children with Nephrotic syndrome was concordant with typical nephrotic syndrome in children. Pattern of nephrotic syndrome and response to treatment did not differ significantly from other studies.

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