NEONATAL OUTCOME IN MECONIUM STAINED DELIVERIES — A PROSPECTIVE STUDY

This prospective study analyzes the neonatal outcome in deliveries complicated by meconium stained amniotic fluid. In a study of 1000 live born deliveries, meconium staining of amniotic fluid was seen in 50 (5%) deliveries. Out of these, 20 newborns (40%) developed classical signs of meconium aspiration syndrome and were managed according to a predetermined protocol. Multiparity, term deliveries, use of sedatives in mother, intrauterine growth retardation and prolonged labour were some of the risk factors for development of meconium aspiration syndrome in newborns. This study highlights the need for review of management protocol in newborns after meconium staining of the amniotic fluid, including the use of prophylactic antibiotics.KEY WORDS: Amniotic fluid, Delivery, Meconium aspiration, Respiratory distress syndrome     

Evaluating community health worker performance in India

In 1977 the Government of India launched a health care experimentin which volunteers were used to provide a basic health careservice. Community health workers have also been used in manysmall, non-governmental programmes. Although much has been saidabout the selection and training of such workers, there havebeen very few attempts to evaluate their actual work performance.This paper makes the plea for more, regular evaluations of theiractivities by those involved in the programmes: communities,supervisors and health workers themselves. Such evaluationsare useful even if they are only done on a small scale. Whatis described here is a small study of the performance of part-timecommunity health workers (PTCHWs) in a programmme initiatedin 1977 by the Community Health Department of the ChristianMedical College in Vellore, South India. It concludes that thePTCHWs with the highest performance scores have, on the whole,less education, more experience, less population to cover andmore intense supervision.     

AIRWAY OBSTRUCTION IN CHILDREN

Seventeen children presenting with airway obstruction have been studied to highlight the similar clinical features of different etiological conditions, their diagnostic limitations, and the importance of early bronchoscopy. There were 8 patients with foreign body in lower airway, out of which 6 were vegetable foreign bodies. Few rarer conditions like membranous laryngotracheobronchitis, subglottic hemangioma and acyanotic congenital heart disease producing airway obstruction have been highlighted. There were 2 deaths in the study unrelated to endoscopic procedure.KEY WORDS: Airway obstruction, Bronchoscopy     

Suicidal Zinc Phosphide Poisoning Unmasking Brugada Syndrome and Triggering Near Fatal Ventricular Arrhythmia

Brugada syndrome (BrS) is an inherited channelopathy associated with increased incidence of ventricular arrhythmias and has many acquired triggers. Zinc phosphide (ZnP) is a rodenticide and is commonly implicated in suicidal poison ingestion. ZnP poisoning can cause myocardial toxicity and death. We report a case of ZnP poisoning that triggered a type I Brugada pattern and ventricular fibrillation in a 67‐year‐old male. He had no other features of toxicity and recovered later. As metal phosphide is the commonest toxin involved in suicidal poisoning in India and BrS being endemic here, this case highlights an important clinical problem.     

Atrial Fibrillation and Anticoagulation in Patients with Permanent Pacemakers: Implications for Stroke Prevention

Several large prospective randomized trials have demonstrated that anticoagulation with warfarin reduces the risk of thromboembolic stroke in high risk patients with chronic AF by approximately 70%. Large numbers of patients with permanent pacemakers have AF, and anticoagulation rates in this population have not been described. In a prospective analysis of 110 consecutive patients attending the pacemaker clinic of a large university hospital, we assessed the number of patients with AF and the proportion of these patients who were receiving anticoagulation to prevent thromboembolic stroke. Where necessary, temporary pacemaker reprogramming to low ventricular rates was utilized to facilitate the diagnosis of AF. Fifty-three of the 110 patients (48%) were diagnosed with AF, all of whom (100%) had accepted high risk factors for thromboembolic stroke. Only eight of the 53 (15%) had been anticoagulated with warfarin. Thirty-six of the 53 patients (68%) diagnosed with AF had no prior documented diagnosis of chronic AF, and the majority had no symptoms suggesting AF. A single lead II ECG was insufficient in 67 of the 110 patients (61%) to diagnose the underlying atrial rhythm; the remainder required 12-lead ECGs or temporary pacemaker reprogramming to low ventricular rates to diagnose the underlying atrial rhythm. AF is common in patients with permanent pacemakers. It is commonly asymptomatic, and anticoagulation is markedly underutilized in reducing stroke risk in these patients. Attention to the possibility of AF in paced patients should allow prompt diagnosis and allow both the initiation of anticoagulation in order to reduce thromboembolic stroke risk and consideration for cardioversion of AF to sinus rhythm.