An Update of Bronchiolitis - A Review
Published on: 22nd December, 2023
Bronchiolitis is one of the most common respiratory infections in children under 2 years of age predominantly caused by Respiratory syncytial virus and other viruses like influenza, Para influenza, and Adenovirus. Rhinovirus, etc. Most children have mild symptoms however bronchiolitis has also been well linked to severe morbidities and mortalities. Even though bronchiolitis has been well recognized for many years, there are still very few therapeutic strategies available beyond supportive management. There are many controversies about therapeutic management in bronchiolitis published in standard guidelines and research in this area. Management can be divided into pharmacological and supportive therapy. Evidence suggests that the current management of bronchiolitis is purely supportive consisting of oxygen supplementation, frequent suctioning, and maintaining good hydration and nutrition. Regarding pharmacological therapy, neither bronchodilators nor corticosteroids have significant efficacy in the treatment of bronchiolitis. However, some studies suggest that adrenaline and nebulizer 3% saline showed some benefit only in terms of outcome. The current recommendation also supports the use of Palivizumab as prophylaxis in certain groups of infants and young children.
Maltodextrin Use in Persistent Neonatal Hypoglycemia; Audit Report of a Single Center Experience
Published on: 27th December, 2023
Background: Neonatal hypoglycemia is known to cause significant neuronal damage and poor neurodevelopmental outcomes. Consensus guidelines are lacking for the management of persistent neonatal hypoglycemia and hyperinsulinism which often requires high concentrations of dextrose and medications. Although used in the pediatric population with persistent hypoglycemia, only a few case reports are published regarding the use of Maltodextrin supplementation in persistent neonatal hypoglycemia due to transient hyperinsulinism. Objective: To audit the use of Maltodextrins in the management of persistent neonatal hypoglycemia due to transient hyperinsulinism in neonates. Audit design: A retrospective chart review (CERNER electronic data) of all cases with persistent neonatal hypoglycemia who received Maltodextrin supplementation for a period of 3½ years between July 2018 and December 2021. Results: A total of 18 neonates received Maltodextrin supplementation for neonatal hypoglycemia during the audit period. 16/18 (89%) neonates who received Maltodextrin supplementation were weaned off from intravenous dextrose within 1 week without major side effects or severe rebound hypoglycemia. Two out of 18 babies who received Maltodextrin needed Diazoxide supplementation for persistent hypoglycemia. Conclusion: The results of our audit are promising, yet further research and randomized controlled studies are needed to systematically evaluate the findings of this audit regarding Maltodextrin supplementation for the management of neonatal hypoglycemia with transient hyperinsulinism.
Antioxidants and Pregnancy Complications: Exploring Therapeutic Strategies for Better Outcomes
Published on: 25th January, 2024
Pregnancy complications present significant challenges, impacting maternal health and fetal development. Oxidative stress, a key contributor to various pregnancy-related disorders such as preeclampsia, gestational diabetes mellitus (GDM), and preterm birth, has spurred interest in exploring antioxidant interventions. Antioxidants, known for their ability to counteract oxidative damage, have emerged as potential therapeutic agents to mitigate these complications. This paper synthesizes current knowledge on the role of antioxidants in pregnancy, elucidating their mechanisms of action, sources, and impact on oxidative stress-related complications. It examines diverse antioxidant compounds, including vitamins C and E, selenium, and natural phytochemicals, highlighting their potential to modulate oxidative stress pathways and promote maternal-fetal well-being. Furthermore, this paper critically analyzes clinical studies, meta-analyses, and preclinical research exploring the efficacy and safety of antioxidant supplementation during pregnancy. It discusses the complexities surrounding optimal dosages, timing, and formulations of antioxidants, aiming to delineate strategies for their integration into prenatal care. In conclusion, this review provides insights into the promising role of antioxidants as therapeutic strategies to alleviate pregnancy complications associated with oxidative stress. It highlights avenues for future research, advocating for a deeper understanding of antioxidant mechanisms and their optimal utilization in prenatal care to enhance maternal and fetal health outcomes.
COVID-19 Pneumonia in Pregnancy: A Retrospective Study on Maternal and Neonatal Outcomes
Published on: 8th April, 2024
Objective: To identify risk factors among pregnant with COVID-19 for adverse outcomes related to disease severity, maternal mortality, and morbidity.Materials and methods: In this retrospective study, 45 pregnant patients with COVID-19 pneumonia were confirmed by RT-PCR. The inclusion criteria were pregnant patients diagnosed with COVID-19 confirmed by RT-PCR and hospitalized in the gynecology-obstetrics and intensive care unit. Exclusion criteria were non-pregnant patients and pneumonia cases with unconfirmed COVID-19 causes. The study used SPSS software to analyze the data. Results: Our study recorded 45 cases of SARS-CoV-2 infection in pregnant women over 2.5 years. The age group most affected was 20-35 years, with 75% of cases. 57% of patients had no known comorbidities. 88.8% of patients were symptomatic at diagnosis. Almost 30% of patients required admission to the ICU, with 60% requiring oxygen supplementation. The study recorded 36 live births (80%), of which 26 cases (72.2%) required no further care and had a favorable outcome.Conclusion: Pregnant women with medical conditions are at higher risk of severe COVID-19, which can cause respiratory distress syndrome and impact delivery and neonatal outcomes. Preventive measures are important.
Severe Alcoholic Hepatitis-optimizing Medical Management: Whether we need a Liver Transplant
Published on: 9th July, 2024
Severe alcoholic hepatitis is an ethical and clinical conundrum, wherein a liver transplant is often recommended. The adequacy of medical treatment versus the risk of recidivism after transplant is often debated. Complete recovery in 26 of 27 patients with severe alcoholic hepatitis was observed, and hence the data was retrospectively analysed.Methods: 27 patients, with severe alcoholic hepatitis, with Maddrey's discriminant function between 59.7 to 165.2 (mean 107.53), from June 2017 to May 2022, were followed up for between 11 months to 6 years. INR ranged from 1.99 to 3.7 (mean 2.709), and bilirubin was between 7.6 to 37.01, (mean 20.859). 8 patients had pre-existing liver cirrhosis. All patients received probiotics, nutritional support, physical rehabilitation, saturated fat (clarified butter/ desi ghee) supplementation, and anti-oxidant support. At 90 days, total bilirubin improved to between 1.0 to 6.8 (mean 2.625). ALT (Alanine Transaminase/ SGPT) ranged from 65 to 550 (mean ALT – 197); and AST (Aspartate Transaminase / SGOT) ranged from 58 to 810 (mean AST – 271.51). Both the AST and ALT were near normal after 90 days. One patient died due to bacterial pneumonia and sepsis; the remaining 26 patients made a complete recovery. All patients including those with diagnosed liver cirrhosis, had complete resolution of their ascites, and near-normal liver function. At the last outpatient visit, none had ascites, edema, or encephalopathy, and had normal albumin levels and INR values. Conclusion: Probiotics, nutrition, a saturated fat diet, and exercise; all have shown benefits in patients with severe alcoholic hepatitis when tested individually. Concomitant use of all the above has not been reported in the treatment of alcoholic hepatitis. The role of nutrition alone versus the contribution of nutritional deficiencies and the role of gut-derived endotoxemia need to be studied in detail. How to identify patients who need a transplant, if it is needed at all, remains a challenge.
Nanoencapsulated Extracts from Leaves of Bauhinia forficata Link: In vitro Antioxidant, Toxicogenetic, and Hypoglycemic Activity Effects in Streptozotocin-induced Diabetic Mice
Published on: 5th September, 2024
In this study, we evaluated the assessed the hypoglycemiant, toxicogenetic and genotoxic effects of nanoencapsulate extracts of Bauhinia forficata Link. Phytochemical evaluations of extracts were carried out, as well as the evaluation using HPLC-MS and of antioxidant capacity in vitro. DM2 was induced in mice with streptozotocin and extracts were given orally for 28 days. That dried extract from infusion (ESIN) had a higher rate of bioactive compounds compared to the dried extract from decoction (ESDC), and higher antioxidant capacity. Glucose levels decreased from 77.26% to 57.79% and 45.15% after supplementation with ESIN (200 and 600 mg/kg/day) and ESDC (600 mg/kg/day), respectively, when compared to the diabetic group treated with metformin (600 mg/kg/day) (21.53%), with an improvement in the glycemic response e recovery of pancreatic β cells. Thus, our study has shown that these extracts exhibit hypoglycemiant activity, with a beneficial effect superior to metformin, as a result they could be considered as potential therapeutic agents for application in pharmaceutical formulations in the treatment of DM2.
Comparative Analysis of Demographic and Clinical Profiles of Conventional Retinopathy of Prematurity with Aggressive Posterior Retinopathy of Prematurity
Published on: 10th September, 2024
Aim: To compare the demographic and clinical profile of conventional retinopathy of prematurity (ROP) with aggressive posterior retinopathy of prematurity.Material and methods: A prospective, unmasked, and observational study involving 150 ROP patients was conducted over a period of one year. The risk factors including maternal and neonatal risk factors were recorded. The data was entered into the Excel sheet and analyzed to compare the risk factors between the conventional ROP and APROP.Results: A total of 17 (11.3%) babies were found to have AP-ROP and 133 (88.7%) babies were found to have conventional ROP. There was no significant difference in average gestational age between infants diagnosed with AP-ROP (29.6 ± 2.9 weeks) and those with Conventional ROP (30.1 ± 2.2 weeks) (p = 0.428). However, infants with AP-ROP had a significantly lower average birth weight (1022.7 ± 123.5 g) compared to infants with Conventional ROP (1208.2 ± 261.0 g) (p = 0.004). Multivariate logistic regression analysis revealed that birth weight, surfactant use, number of days of oxygen supplementation, and metabolic acidosis were independently associated with the development of AP-ROP.Conclusion: The development of APROP is multifactorial and complex. Although we have identified factors such as birth weight, surfactant use, number of days of oxygen supplementation, and metabolic acidosis in the causation of APROP, further long-term multicentric studies are required for validation.
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