Failure of fresh frozen plasma infusion and vitamin K to correct elevated international normalised ratio

An 83-year-old, otherwise well, Caucasian gentleman was admitted with an incarcerated inguinal hernia. Routine preoperative tests revealed a raised international normalised ratio of 7.4, prothrombin time of 72.1 s and activated partial thromboplastin time of 73.1 s with normal liver and renal function tests. Despite fresh frozen plasma 15 ml/kg, and vitamin K, his repeat clotting remained deranged. The patient went on to have his hernia repair, and intraoperative bleeding remained normal despite the deranged clotting. The presence of endogenous clotting inhibitors can cause deranged coagulation studies but not impair bleeding. As in this case, the patient underwent surgery with no abnormal bleeding.

The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial

BACKGROUND

Up to half of neonatal deaths in high mortality settings are due to infections, many of which can originate through the freshly cut umbilical cord stump. We aimed to assess the effectiveness of two cord-cleansing regimens with the promotion of dry cord care in the prevention of neonatal mortality.

DESIGN

We did a community-based, parallel cluster-randomised trial in Sylhet, Bangladesh. We divided the study area into 133 clusters, which were randomly assigned to one of the two chlorhexidine cleansing regimens (single cleansing as soon as possible after birth; daily cleansing for 7 days after birth) or promotion of dry cord care. Randomisation was done by use of a computer-generated sequence, stratified by cluster-specific participation in a previous trial. All livebirths were eligible; those visited within 7 days by a local female village health worker trained to deliver the cord care intervention were enrolled. We did not mask study workers and participants to the study interventions. Our primary outcome was neonatal mortality (within 28 days of birth) per 1000 livebirths, which we analysed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT00434408.

RESULTS

Between June, 2007, and September, 2009, we enrolled 29 760 newborn babies (10 329, 9423, and 10 008 in the multiple-cleansing, single-cleansing, and dry cord care groups, respectively). Neonatal mortality was lower in the single-cleansing group (22·5 per 1000 livebirths) than it was in the dry cord care group (28·3 per 1000 livebirths; relative risk [RR] 0·80 [95% CI] 0·65-0·98). Neonatal mortality in the multiple-cleansing group (26·6 per 1000 livebirths) was not statistically significantly lower than it was in the dry cord care group (RR 0·94 [0·78-1·14]). Compared with the dry cord care group, we recorded a statistically significant reduction in the occurrence of severe cord infection (redness with pus) in the multiple-cleansing group (risk per 1000 livebirths=4·2 vs risk per 1000 livebirths=1·2; RR 0·35 [0·15-0·81]) but not in the single-cleansing group (risk per 1000 livebirths=3·3; RR 0·77 [0·40-1·48]).

INTERPRETATION

Chlorhexidine cleansing of a neonate's umbilical cord can save lives, but further studies are needed to establish the best frequency with which to deliver the intervention.

FUNDING

United States Agency for International Development and Save the Children's Saving Newborn Lives program, through a grant from the Bill & Melinda Gates Foundation.

Infant Feeding Practices in Kaski District, Pokhara

Background: Children in developing countries are prone to infectious diseases due to insufficient and inappropriate feeding practices. Socio-demographic and socio-economic factors directly and indirectly play a role in influencing infant feeding practices.  This study was conducted to assess the socio-demographic and economic factors associated with initiation of breastfeeding, complimentary feeding, and the various prelacteal feeds practiced in Kaski, Pokhara. Materials and Methods: In this prospective study, interviews were conducted to 500 mothers at Manipal Teaching Hospital who brought their child for treatment. The interviews were conducted in a questionnaire format relating to their demographic and financial statuses. Results: A total of 500 mothers were questioned, out of which 86.6% gave their child breastmilk as its first food. 47% initiated breastfeeding within half an hour of child’s birth. 86% gave Jaulo as the first complementary food to their children. About 26% of the mothers gave complementary feeding to their children before the recommended time of 6 months. Conclusion: Initiation of breastfeeding after life and complementary feeding practices overall has improved from previous studies. There is still need of making awareness campaigns and such in order to further improve this trend. Key words: Breastfeeding; Complimentary feeding; Malnourishment DOI: http://dx.doi.org/10.3126/jnps.v32i1.5339     J. Nepal Paediatr. Soc. Vol.32(1) 2012 23-27

Acoustic analysis of tracheo-oesophageal voice in male total laryngectomy patients

INTRODUCTION

The aim of this study was to test the null hypothesis that voice parameters of post-laryngectomy patients using tracheo-oesophageal (TO) prosthetic valves are similar to those of normal laryngeal subjects.

METHODS

Thirty total laryngectomy patients and thirty normal controls were subjected to acoustic analysis of single voice recordings using a sustained vowel. Acoustic parameters including fundamental frequency, jitter, shimmer, harmonics-to-noise ratio and maximum phonation time were analysed.

RESULTS

Poorer values were found as well as larger variability for all the voice parameters for the total laryngectomy patients using TO voice compared with those of normal subjects. There were statistically significant differences (p<0.05) for all studied parameters between the TO and normal speech.

CONCLUSIONS

Alaryngeal speech with TO voice prosthesis is not yet comparable to laryngeal speech.