Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.

OBJECTIVE: To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India. STUDY DESIGN: Before-and-after intervention trial setting: limited resource teaching hospital; DESIGN: Before and after study. INTERVENTIONS: A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses. STATISTICAL METHODS: The categorical and continuous variables were compared with chi (2) and two-tailed tests, respectively. RESULTS: Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P=0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions. CONCLUSIONS: Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.     

An autopsy study of relationship between perinatal stomach capacity and birth weight.

BACKGROUND: Aspiration pneumonia is a common complication of overfeeding in neonates. Since overfeeding may be related to neonatal stomach capacity, it was considered worthwhile to obtain such data. AIMS: To measure the capacity of stomach obtained from fresh stillbirths and liveborn infants at autopsy and correlate the same with their birth weights. METHODS: Stomach capacity was measured at autopsy in 63 stillborn and 37 newborn infants with birth weights ranging from 500 g to 3500 g. RESULTS: Stomach capacity had a significant positive correlation with birth weight (r = 0.56, p < 0.001). A formula and a nomogram have been derived to estimate stomach capacity from birth weight. There was no significant difference in stomach capacity between liveborn and stillborn infants in any of the weight groups, except in the 1501-2000 g weight group (p < 0.001). CONCLUSIONS: Our results have provided normative data on stomach capacity across a wide birth weight range in the perinatal period.     

Menogaril in the treatment of relapsed multiple myeloma

Summary Fifteen patients with relapsed multiple myeloma (MM) were treated with menogaril 160 mg/m² intravenously (IV) every 28 days. No responses were seen: 8 patients had stable disease, 4 progressed after one course of therapy, and 3 patients were removed from study after 1 course for other reasons. Four of the 8 patients with stable disease had an improved performance status, and 3 had a decrease in analgesic use. The major toxicity was myelosuppression. The median progression-free interval was 3.0 months with a range of 0.7 to 22 months and median survival was 11.3 months with a range of 0.7 to 39+ months. Menogaril displays little activity in patients with previously treated MM.     

Preference changes of adult outpatients for giving saliva,urine and blood for clinical testing after actual sample collection

PurposePatients’ preferences of the type of sample collections for clinical testing are currently unknown. The aims of this study were: (1) to assess patients’ preferences of three types of samples for clinical testing (saliva, urine and blood) both before and after collection and (2) to assess whether prior experiences with collection of saliva impacted patients responses.MethodsAdult outpatients underwent collection of one sample each of saliva, urine and blood. Patients’ perceptions of comfort, convenience and easiness were assessed in pre-collection and post-collection questionnaires.ResultsPost-collection, patients’ endorsement of saliva as being the “most comfortable” and “most convenient” significantly declined (pre vs. post, 61.5% vs. 37.5% and 73.1% vs. 42.3%). However, saliva was still endorsed as the “most convenient” post-collection (compared to urine 33.7% and blood 24.0%).Although not statistically significant, the proportion of patients who changed their response in terms of what sample was “easiest to collect at home” was considerably higher in the group with vs. without prior experience giving saliva (54.6% vs. 32.6%, p = 0.19 Fisher's exact test).ConclusionsOverall, saliva remained as the most highly preferred sample to donate despite a decline in patients’ preferences of saliva donation after sample collection.The results of the study are promising for future widespread patient acceptance of saliva as a diagnostic fluid.