International Journal of Medical Research and Review

Acute Febrile Illnesses – Clinico-epidemiological Pattern in a Remote Geographical Location of North-eastern India

Monya Michi — 2023-08-18

Background: Acute undifferentiated febrile illness (AUFI / AFI) is a common cause for patients seeking hospital care in tropical country like India. Non-specificity of symptoms and lack of appropriate diagnostics pose challenge especially in resource limited settings. Investigation into etiology and trends of AUFI provide valuable public health data to target clinical workup and guide optimal treatment.

Method: A record based descriptive study was conducted on all AFI cases presenting to a Government tertiary care centre in a tribal hilly sate of Northeast India in the year 2021.

Result: Under five children were the most affected and respiratory infections were the most common cause of fever. Enteric fever and scrub typhus were the most common cause of undifferentiated fever. However, it was a remarkable finding that no case of malaria or dengue was reported from this region. Fevers remained undetermined in 28% of cases. Undetermined fevers and scrub typhus had higher occurrence during winters while no seasonality was observed with enteric fever. Majority of the patients recovered and discharged. Case fatality rate was 0.35%.

Conclusion: The local epidemiology of AUFI can help guide presumptive diagnosis and deliver optimal patient management in these settings. Typhoid and scrub typhus to be considered as differentials for AUFI in this region.

The Effect Of Umbilical Cord Milking In Reducing ROP Of Preterm Babies.

Md. Abdul Mannan — 2023-09-11

Background: Recent advances in neonatal care in the last decade have improved the survival rates for premature infants. Consequently, the incidence of ROP has increased in parallel. ROP is under constant epidemiological study around the world. Prematurity, low birth weight, respiratory distress syndrome, mechanical ventilation, prolonged oxygen treatment and blood transfusion increase the risk of ROP. Umbilical cord milking reduces the incidence of ROP in preterm infants by reducing the need for blood transfusions in preterm infants. Objective: To observe effect of ROP with umbilical cord milking. Methodology: This prospective observational study was carried out on neonates, in the Department of Neonatology, BSMMU after approval from IRB. Neonates admitted into neonatal intensive care unit of BSMMU satisfying the inclusion and exclusion criteria was enrolled for the study. A written informed consent was taken from parents and assurance about confidentiality was given. Neonates born before 37 weeks of gestation was assigned to either umbilical cord milking or non-milking group at a 1: 1 ratio according to a computer generated randomized sequence. After delivery of a baby umbilical cord milking was performed by holding the infant at the level of the placenta. First eye evaluation for ROP was done at 20 days of age for gestational age less than 30weeks & weight below 1200gm & at 30 days of age for gestational age more than 30 weeks & above weight 1200gm. Follow-up was continued until retinal vascularization was completed. The follow-up schedules were organized depending on the retinal findings. The retinal finding was evaluated according to the International Classification of Retinopathy of Prematurity. The patients were grouped as no ROP, mild ROP (stages I-II ROP without plus disease, showed regression), and severe ROP (zone 1 or zone 2, stage III, aggressive ROP without stages, stage II with plus disease who required treatment). Data were recorded in a preformed questionnaire and data were analyzed by statistical package for social sciences (SPSS) version 20. Results: 114 newborns were enrolled in this study. Then among 114 preterm neonates 57 were randomized to umbilical cord milking group and 57 were randomized to no milking group. Baseline characteristics were almost similar between the two groups. There were significant increase is hematocrit level 57.3 ±3.5 V 47.4 ± 4.5 (P value less than 0.001), reduction in need of blood transfusion 3.5% V 42.1% (P value less than 0.001) & reduction in ROP 3.5% V 19.3% (P 0.007). Conclusion: This study concluded that umbilical cord milking after delivery improves hematocrit level, reduces need of blood transfusion & reduces the incidence of ROP in preterm infant.

Sonal Appliance an innovative space maintainer in management of early loss of first permanent molar: A Rare Case Report

Sonal Gupta — 2023-09-12

Introduction: In preventative and interventional dentistry, keeping deciduous teeth until their natural exfoliation is critical. An early tooth or group of teeth loss might have a variety of effects. The first molar is the largest tooth in the mouth, it carries the most occlusal stress, and it affects the vertical distance between the mandible and the maxilla. Adolescent patients who have lost a permanent first molar (PFM) require early space maintenance. Case report: In this case report a successful use of modified distal shoe appliance was made in a patient whose 1^st permanent molar was lost before the eruption of 2^nd permanent molar. In circumstances when the permanent first molar is lost before the emergence of the permanent mandibular second molar, a unique device is described in this publication. The distal extension of a normal distal shoe appliance was extended distally along with a fixed bilateral appliance, a modified band and loop, and other components in this design. Conclusion: For individuals with bilateral molar loss, a modified distal shoe appliance is a promising option.