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IntroductionSick preterm neonates are most vulnerable to developing skin injuries. Despite sound knowledge and application of evidence-based practices for preventing medical adhesive-related skin injury (MARSI), the incidence of MARSI was 30 events per 1000 adhesive application days in our unit.Aims and objectivesWe aimed to reduce the median MARSI rate from the existing 30 per 1000 MARSI days to <5 per 1000 MARSI over 5 months from June 2023 to October 2023.Material & methodsWith the point-of-care quality improvement (QI) approach, a prospective study was planned to reduce the incidence of MARSI among sick very preterm newborns (<32 weeks gestational age) and eventually improve overall skin condition during hospital stay. Sequential Plan—Do—Study—Act cycles were implemented based on the identified risk factors recognised during recurring team discussions.ResultsWe demonstrated a reduction in the MARSI rate from 30 events per 1000 adhesive applications (during baseline assessment) to zero events per 1000 adhesive applications at the end of the study period. It was temporally related to the assessment of skin risk stratification at admission using a validated tool, regular assessment of neonatal skin condition score based on the skin risk stratification, and reinforcement of MARSI prevention bundle by application of barrier spray. Awareness regarding ‘skin injury prevention’ bundles was continually generated among healthcare professionals. The MARSI rate remained <5 events per adhesive application in the sustenance phase over 6 months.ConclusionImplementing evidence-based skin care practices resulted in a significant reduction in iatrogenic cutaneous injury events in very preterm neonates.

Abstract Introduction: Ultrasonography (USG) can be used in neonates to manipulate and place the umbilical catheter in the correct position. Although chest radiograph (CXR) is the gold standard, a noninvasive method like USG without radiation exposure may be an alternative bedside armamentarium to the clinician. The purpose of the study was to evaluate whether USG-guided umbilical venous catheter (UVC) insertion is superior to the conventional method for the successful insertion of UVC. Method: The neonates born between 25 and 42 weeks of gestation requiring parenteral fluids and admission to neonatal intensive care unit (NICU) between September 2020 and November 2022 were randomized in two weight-based strata: ≤1,200 and >1,200 g. USG-guided UVC insertion was done in the intervention group and blind UVC insertion was done in the control group. Results: Out of 112 enrolled neonates, 58 were in the USG-guided group and 54 in the blind group. There was no significant difference in the failure rate between the intervention and control groups (20% versus 29% [RR: 0.69, 95% CI: 0.36–1.33]). The sensitivity and specificity of USG in locating tip position were 97 and 46.8%, respectively. The mean procedure time in USG and blind groups was 8.9 and 8.3 min, respectively (p value 0.56). Conclusion: USG does not reduce the failure rates during the insertion of umbilical catheters. However, being a safe, noninvasive procedure, it can be considered a rescue modality to CXR in NICUs equipped with portable USG for guiding UVC insertion.

INTRODUCTION: Mobile phone dependence has become an emerging public health problem. This cross-sectional study was conducted to find out the mobile phone involvement and dependence among undergraduate medical students in a Medical College of West Bengal, India. MATERIALS AND METHODS: A study was conducted at IQ City Medical College, Durgapur, District Burdwan, West Bengal, India, during July–August 2015 among 252 undergraduate medical students. Involvement and dependence were elicited by mobile phone involvement questionnaire (MPIQ) and mobile phone dependence questionnaire (MPDQ), respectively. Statistical Package for the Social Sciences (SPSS) software (version 19.0) was used for analysis. RESULTS: About 14.9% of students were being highly involved with their mobile phone. The mean score of MPIQ was greatest in domain 5, i.e. euphoria followed by domain 2, i.e. behavioral salience and then domain 4, i.e. conflict with other activities. About 19.4% of males and 11.1% of females had high dependence. Mean MPDQ score was higher among males, though it was not significant statistically. Sex, total recharge, and total hours spent on mobile phone could explain between 2.2% and 3.8% variance of the presence of dependence in binary logistic regression. Total recharge (adjusted odds ratio 1.144) and total hours spent on mobile (adjusted odds ratio 1.135) were positively associated with the presence of dependence. CONCLUSION: Many students were highly involved and dependent on mobile phone and they had already been experiencing some health-related problems. There is a need to identify students having high involvement and dependence so as to generate adequate awareness and plan educational or treatment interventions accordingly.

Tobacco use causes many diseases irrespective of age and sex. More the addiction, more is the occurrence of morbidity in terms of frequency and severity. This community-based study was conducted to find out any relationship between the morbidity associated with tobacco use and nicotine dependence. In an urban slum – Alamganj, district Burdwan, West Bengal, India, from January to October 2012 among 128 current adult tobacco users using Fagerström test for nicotine dependence (FTND) questionnaire. Tobacco users were maximally suffering from chronic obstructive pulmonary disease (COPD) (27.27%), gastritis (25.45%), and leukoplakia (25.45%). For individual diseases, the difference in FTND score was significantly high in cases of gastritis, hypertension, and COPDs. All types of morbidity were more common in the group of high nicotine dependence. FTND score can be suitably used to assess nicotine dependence of the tobacco users, who can be counseled accordingly to reduce the tobacco-related morbidity and mortality.

A full-term male baby was administered furosemide and enalapril for treatment of cardiac failure secondary to a ventricular septal defect. He also received piperacillin-tazobactam and amikacin for 7 days for suspected early-onset neonatal sepsis. He developed anuria and raised creatinine and was referred with acute kidney injury (AKI)—neonatal KDIGO (Kidney Disease Improving Global Outcomes) stage 3 on day 20. Urine output and renal parameters improved after discontinuing drugs and peritoneal dialysis. This case report highlights the importance of serial monitoring of kidney function tests while using nephrotoxic drugs and ensuring correct dosage and titration. In the early stages, AKI can be treated with conservative therapy but once established, renal replacement therapy might be required. It can also lead to chronic kidney disease.

Introduction: In developing countries, nonstress test (NST) is the most widely used method for antenatal fetal surveillance.Lately, cerebroplacental ratio (CPR) has emerged as a predictor for adverse perinatal outcomes, especially in hypertensive disorders in pregnancy (HDP). Against this background, the present study was conducted with the primary objective of quantifying the diagnostic accuracy of cerebroplacental ratio (CPR) versus nonstress test (NST) in predicting adverse perinatal outcomes in women with HDP.Methods: This was a prospective observational cohort study conducted in a tertiary care institute in eastern India. All consecutive women with hypertension in pregnancy at a gestational age of ≥32 weeks were recruited into the study. Both CPR and NST were performed at baseline and repeated weekly till delivery. The parameters obtained within one week of delivery were entered for analysis.Results: Sixty-two of the 65 women completed the study. There were 22 women (35.5%) in group A (both CPR and NST normal), 17 (27.4%) in group B (CPR abnormal, NST normal), 14 (22.6%) in group C (CPR normal and NST abnormal), and nine (14.5%) in group D (both CPR and NST abnormal). CPR had greater sensitivity (93.33% versus 46.67%), with higher positive predictive value (53.85% versus 30.43%), specificity (74.47% versus 65.91%), and negative predictive value (97.22% versus 79.49%) than NST for predicting neonatal intensive care unit admission. CPR also had higher sensitivity (84.62% versus 61.54%) and specificity (91.34% versus 69.39%) than NST in predicting neonatal complications. The negative predictive value (NPV) of CPR was 100% for predicting requirement of bag and mask ventilation and continuous positive airway pressure.Conclusion: CPR had greater diagnostic accuracy in terms of both higher sensitivity and greater specificity than NST in predicting adverse perinatal outcomes in women with hypertensive disorders of pregnancy.

In this case report, we present a female neonate referred to us, born to a primigravida mother at 39 weeks, who cried after birth, did not require any resuscitation, had a birth weight of 2.9 kg and developed abdominal distension and bilious vomiting on Day 1 of life. Ultrasound abdomen and X-ray imaging were suggestive of midgut volvulus with malrotation. The emergency explorative laparotomy revealed the small bowel to be gangrenous in extensive areas, and 10 cm of the small intestine was successfully preserved. The baby was admitted to the NICU and required three months of total parenteral nutrition. In between, the baby was managed successfully for sepsis, septic shock, diarrhea, and dehydration, Later, she was discharged, and is currently being followed up. At the first follow-up, the baby was noted to be gaining weight and has developed no complications to date.In this case report, we present a female neonate referred to us, born to a primigravida mother at 39 weeks, who cried after birth, did not require any resuscitation, had a birth weight of 2.9 kg and developed abdominal distension and bilious vomiting on Day 1 of life. Ultrasound abdomen and X-ray imaging were suggestive of midgut volvulus with malrotation. The emergency explorative laparotomy revealed the small bowel to be gangrenous in extensive areas, and 10 cm of the small intestine was successfully preserved. The baby was admitted to the NICU and required three months of total parenteral nutrition. In between, the baby was managed successfully for sepsis, septic shock, diarrhea, and dehydration, Later, she was discharged, and is currently being followed up. At the first follow-up, the baby was noted to be gaining weight and has developed no complications to date.

Transient abnormal myelopoiesis (TAM) is observed in a few neonates with Down syndrome. While a large proportion undergo complete remission without any treatment, some of them can develop myeloid leukemia of Down syndrome (ML-DS) in the future. Without proper treatment, mortality can be high. Here we have described an interesting and difficult-to-treat case of a neonatal with Down syndrome who presented with anemia, thrombocytopenia, and 75% blasts. We came across multiple challenges in treatment due to severe pneumonia.

Difficult intubation in neonates has innumerable aetiologies. It especially poses a formidable challenge to save a newborn baby immediately after birth where antenatal details are unavailable. A late preterm neonate was born limp and apnoeic. Several attempts to intubate the baby were unsuccessful. Possibility of subglottic obstruction was considered. The baby died of severe perinatal asphyxia. Autopsy showed a mass around the airway which turned out to be ectopic thymus on histopathology. Ectopic thymus can present as periglottic mass without externally visible cervical swelling and can cause difficult intubation which may lead to serious adverse outcome including death if not anticipated early and managed accordingly.

Tobacco use causes many diseases irrespective of age and sex. More the addiction, more is the occurrence of morbidity in terms of frequency and severity. This community-based study was conducted to find out any relationship between the morbidity associated with tobacco use and nicotine dependence. In an urban slum - Alamganj, district Burdwan, West Bengal, India, from January to October 2012 among 128 current adult tobacco users using Fagerström test for nicotine dependence (FTND) questionnaire. Tobacco users were maximally suffering from chronic obstructive pulmonary disease (COPD) (27.27%), gastritis (25.45%), and leukoplakia (25.45%). For individual diseases, the difference in FTND score was significantly high in cases of gastritis, hypertension, and COPDs. All types of morbidity were more common in the group of high nicotine dependence. FTND score can be suitably used to assess nicotine dependence of the tobacco users, who can be counseled accordingly to reduce the tobacco-related morbidity and mortality.