Effect of short-term Psychiatric Intervention in Cancer Patients

A total of 50 patients undergoing cancer treatment at Malignant Disease Treatment Centre were included in the present study aimed at evaluating the psychological status of cancer patients. All patients filled a specially designed proforma and the following psychological questionnaires : General Health Questionnaire, Carroll Rating Scale for Depression, State-Trait Anxiety Inventory, PGI General Well-being Scale and Quality of Life Scale. Analysis of the results showed that 22 (44%) of the cancer patients had psychiatric disorders and this number had reduced to 12 (24%) after therapy. The difference was statistically significant. Psychiatric treatment also resulted in a statistically significant reduction in level of depression as measured by Carroll Rating Scale for depression. Short term psychiatric treatment was found to be very useful in treating psychiatric morbidity and depression in cancer patients.Key Words: Cancer, Depression, Psychiatric morbidity     

Use of pulse oximeter for determining distal perfusion in neonates &; infants with suspected vascular compromise

Conclusion The use of a pulse oximeter, which is readily available in the ICU, can be of immense benefit to determine the status of distal limb perfusion in neonates and children who are suspected of having a vascular compromise, and the pulsations cannot be appreciated due to the presence of limb edema. Limb warmth and capillary filling are the primary indicators of vascularity but may be misleading in some patients. The presence of poor quality tracings or absent tracings is a definite indicator of significant ischemia. The use of a pulse oximeter, for determination of oxygen saturation, was declared by Severinghaus and Astrup to be “arguably the most significant technologic advance ever made in monitoring the well being of patients during anaesthesia, recovery and critical care. Perhaps the use of the pulse oximeter for determination of distal perfusion can further augment the statement. Editor Note The authors are to be congratulated for their observations which are clinically relevant. However we urge them to continue their study and obtain meaningful data, with proper statistical analysis. For the time being these observations may be considered preliminary.     

Giant dentigerous cyst

Dentigerous cyst - a cyst of dental origin, though common in lower jaw is relatively uncommon in upper jaw. Here a 14 years, F, presented with huge swelling of unilateral maxilla and clinicoradiologically diagnosed as dentigerous cyst is being reported along with brief review of literature.     

Congenital right coronary artery aneurysm with fistula to right ventricle associated with isolated pulmonary valvular stenosis

Congenital aneurysmal dilatation of coronary artery with coronary cameral fistula is rare in childhood. We report an even rarer association of congenital right coronary artery aneurysm and right coronary artery to right ventricle fistula with bicuspid pulmonary valve stenosis and an intact ventricular septum in a 3-year-old child.     

Management of Rh-isoimmunised Pregnancies : Our Experience

Background

The aim of this study was to assess the role of middle cerebral artery peak systolic velocity (MCA-PSV), as measured by doppler ultrasound, in detecting foetal anaemia in Rh- isoimmunised pregnancies. Intra-uterine foetal blood transfusion was performed in such anaemic foetuses to tide over the crisis of foetal immaturity till considered fit for extra-uterine survival.

Methods

Rh-isoimmunised pregnancies reporting to a tertiary institute from 2003 to 2005, were screened by doppler ultrasound to estimate MCA-PSV to detect foetal anaemia. If the foetus developed MCA-PSV of more than 1.5 multiple of median (MoM) for the gestational age, foetal blood sampling through cordocentesis was performed to confirm foetal anaemia, followed by intrauterine foetal blood transfusion to all anaemic foetuses at the same sitting. Neonatal outcome was evaluated by recording gestational age at the time of delivery, duration of gestational time gained and need for blood transfusion in the neonatal period.

Results

A total of thirteen isoimmunised pregnancies were evaluated. Three pregnancies did not require in-utero foetal blood transfusion. Twenty-one intrauterine foetal blood transfusions were performed in the remaining ten patients. Five received blood transfusion in the neonatal period. Intra uterine foetal death occurred in one grossly hydropic foetus and favourable neonatal outcome was recorded in the rest.

Conclusion

The clinical outcome of these pregnancies justifies the use of doppler studies of MCA-PSV in detecting foetal anaemia and intra uterine foetal blood transfusion is the only hope of prolonging pregnancy and salvaging such foetuses.Key Words: Rh-isoimmunisation, Middle cerebral artery peak systolic velocity, Foetal anaemia, Foetal blood transfusion     

Risk factors for development of dehydration in young children with acute watery diarrhoea: a case-control study

In a case-control study to understand the risk factors for development of life-threatening dehydration, a total of 379 children comprising 243 cases (moderate or severe dehydration) and 136 controls (non or mild dehydration) up to 2 years of age suffering from acute watery diarrhoea were studied. By univariate analysis, the presence of vibrios in stool, withdrawal of breast feeding during diarrhoea, not giving fluids, including oral rehydration solution (ORS), during diarrhoea, frequent purging (> 8/ day), vomiting (> 2/day) and undernutrition were identified as risk factors. However, by multivariate analysis after controlling for confounders, withdrawal of breast feeding during diarrhoea (odds ratio (OR) = 6.8, p < 0.00001) and not giving ORS during diarrhoea (OR = 2.1, p < 0.006) were identified as significant risk factors. The confounding variables which also contributed significantly to increasing the risk were age (≤ 12 months; OR = 2.7, p = 0.001), frequent purging (> 8/day; OR = 4.1, p < 0.00001), vomiting (> 2/day; OR = 2.4, p = 0.001) and severe undernutrition (%median <60 weight-for-age of Indian Academy of Paediatrics classification; OR = 3.1, p = 0.001). We feel that these findings will be useful for Global and National Diarrhoeal Diseases Control Programmes for formulating intervention strategies for preventing death due to diarrhoeal dehydration.