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Background: Care giving of children with leukemia involves considerable stress and anxiety on the part of family caregivers. Although caregivers’ burden is a crucial predictor of the health of both the child and the caregiver, it is often overlooked. Aim and Objectives: The present study aimed to assess the burden faced by caregivers of pediatric leukemia patients attending a tertiary care hospital in West Bengal, to elicit their sociodemographic characteristics and patients’ profile, and to find out relationship among these, if any. Materials and Methods: The study was descriptive observational type with cross-sectional design. It was conducted among caregivers of pediatric leukemia patients. Data were collected from 38 caregivers using predesigned, pretested, semi-structured schedule, and patients’ records. Burden was measured using Zarit Burden Interview, which is a 22 item 5-point Likert scale. Data were compiled and analyzed in Microsoft Excel and Statistical Software for the Social Sciences 20.0 for statistical analysis. Sociodemographic and clinical variables were expressed as number, percentages, mean, and standard deviations. To find out the association between different factors and caregiver burden, a logistic regression model was used. P < 0.05 was considered as statistically significant. Results: Majority of the caregivers were the mothers of the patients (68.42%), and most of the families of caregivers belonged to lower middle class according to modified BG Prasad Scale. Half of the caregivers (50%) experienced moderate–to-severe burden according to Zarit Burden Interview. Association was found between burden experienced and duration of disease and treatment. However, socioeconomic status was found to be the most significant determinant of burden as per multiple logistic regression by ENTER method. Conclusions: Majority of the caregivers were having moderate to severe and severe burden, which was significantly more among people coming from lower socioeconomic status. Prolonged disease duration and treatment were also found to be associated with increased burden of the caregivers.
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In recent years there is a rapid rise in coming out of sexual and gender minority adults to their family members and society. Unfortunately, studies on unmet health needs of transgenders with a special focus to mental health is under-researched in India. The current paper aimed to explore about the mental health of transgenders and a literature search was done using PubMed, Google Scholar, and Scopus databases for the following medical subject headings (MeSH) key terms “transgender”, “mental Health”, “social stigma”, “LGBT”, “gender dysphoria”, “genderqueer”, “intersex”, “MSM”, “hijra”, “gay”, “lesbian”, “bisexual”, and “homosexual”. Transgender individuals were found to show high rates of mental health concerns. The most common mental health problems that we have shown in this review article are depression, obsessive-compulsive disorders, generalized anxiety disorders, suicidal attempts and bipolar disorders. Transgender people are at more risk for mental health problems than their heterogenous counterparts. The intervention program to eliminate or reduce these problems needs to be planned carefully, considering all the determinants
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Background-There is a definitive risk to human health because of mobile phones. The awareness towards mobile phones emitted electromagnetic radiation is of paramount importance to prevent health risks and possible negative health disorders. Aim and objectives-The aim of the survey is to assess the awareness of mobile phone radiation and its harmful effects on the body and the mobile phone usage trend among Otorhinolaryngologists from India. Methodology-The present survey aimed to obtain baseline data on cell phone usage and radiation awareness among a relatively homogenous cohort of Otorhinolaryngologists from India. This is a cross-sectional online survey assessing awareness of Mobile Phone radiation through a custom-made questionnaire devised by the authors which consisted of four parts: 1. Demographic details, 2. Mobile phone usage trend, 3. Knowledge of mobile phone radiation 4. Awareness of health hazards produced by mobile phone radiation. Results- The total number (n) of otorhinolaryngologists to whom the questionnaire was sent was 6336 of which 259 of them responded which formed the sample size of our study. Thus, the response rate of the survey was 4%. A total of 259 Otorhinolaryngologists participated in the study. The mean age of the population involved in the survey is 41.7810.32 years. The male-female ratio of the survey is 161:98 respectively. There were 172 private and 87 government ENT practitioners in the survey. MS otorhinolaryngology was the most common qualification of the study with 223 doctors having the degree, 20 having DNB, and 7 of them having completed DLO. The mean years of medical practice after postgraduation of the Otorhinolaryngologists participating in the questionnaire are 13.537.38 years. The major contributors to the survey were private ENT consultants with a count of 110, followed by Senior Residents 58, Assistant Professor 39, Professor 29, Associate professor 10, and Additional professor 13. It was evident from the questionnaire that 242 of the respondents were right-handed and 204 of the study population used their right ear for talking over the phone, it was also cross-checked by giving a miss call to them in close vicinity. The mean years of exposure to mobile phone usage by Otorhinolaryngologists are 15.01 5.75. A maximum of 153 surgeons were using mobile phones for 11-20 yrs. The average hours of daily mobile phone usage were 373 minutes. A highest of 101 Otorhinolaryngologists using mobile phones for >4 Hrs. Surprisingly through the questionnaire we came to know that a total of 60 doctors among the 250 use the phone daily for an average of more than 10 Hrs, which is 24% of the study population surveyed. Questions 15-24 were purposed to bring the awareness knowledge of the respondents towards electromagnetic radiation of the cellular phones, and it can be arbitrarily said that a score of 5 or more means that the person is aware. The average of the correct responses to each of the 10 questions given by the ENT practitioners is 5.97±1.66. Similarly, questions 25 to 35 assess the awareness of health hazards produced by mobile phone radiation. The mean correct response of the Otorhinolaryngologists is 6.30±1.87.
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Objectives: Chryseobacterium indologenes has recently been identified as an inherently drug-resistant organism, responsible for a wide spectrum of infections, mainly device-associated infections in hospital settings. The presence of carbapenem resistance due to blaNDM-1 metallo-?-lactamase (MBL) gene further complicates the matter, leading to widespread dissemination of carbapenem resistance. This study aims to find out the presence of blaNDM-1 gene among C. indologenes strains causing bloodstream infections in a tertiary care hospital. Materials and methods: During 1 year of the study period, blood culture samples were collected from patients with features of bacteremia, and C. indologenes strains were isolated and identified as per protocol. Antibiotic sensitivity test was performed by using VITEK 2 Compact Automated AST machine (Biomerieux, France). Carbapenem-resistant strains were subjected to a combined disk diffusion test for detecting the presence of MBL enzyme. Strains positive for MBL production were subjected to a polymerase chain reaction (PCR) for detection of blaNDM-1 gene. Results: Out of 21 strains isolated during the study period, 12 strains (57.1%) were carbapenem-resistant. Among them, seven strains (58.3%) were MBL producers. After PCR, 3 strains (42.9%) were found to be harboring blaNDM-1 gene Discussion: As per our knowledge, this is the first report of blaNDM-1 gene harboring C. indologenes strain from Northeast India. This shows the emerging therapeutic dilemma due to the narrowing of treatment options against bloodstream infections due to C. indologenes strains. Strict antimicrobial stewardship has to be implemented to prevent the further compounding of the problem.
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Introduction: Researchers found that cryotherapy at the ankle joint heightened adjacent muscle activity and reflex amplitude, which facilitated greater force production at the ankle complex. Furthermore, cryotherapy appears to increase musculoarticular stiffness, which has been associated with heightened muscular performance at a joint. Aim and objective: the aim of the study is to examine the influence of dynamic stretching and IBA technique on the physical performance. Methodology: Total 20 healthy male basketball athletes encompassing two groups participated in the current study. The study consisted of two groups, Group A (ice bag application) and Group B (dynamic stretching). Cold compress was applied over the anterior thigh, posterior thigh, and calf. Subjects were assigned to Group A, and Group B, using Convenience sampling method. Each candidate performed the 5 minutes of jogging before taking intervention. All subjects performed three functional performance tests: Vertical Jump Test, Agility T-test & 20-meter sprint. Each participant attended an orientation session to become familiar with the testing procedures. Subjects were randomly assigned into two groups and exposed to a crossover study design. The experiment was performed on two separate occasions whereby one group received the dynamic stretching in the first session, while the other group uses the cryotherapy first. After 48 hours, (cooling session) on the next occasion, the groups were changed and the second group receives the cryotherapy, while the first group performs dynamic stretching. On both occasions, the dynamic stretching and cryotherapy interventions were the same. Between the sessions, the subjects will not allow to participate in any kind of vigorous physical activity. Results: The present study showed an increase in performance of recreational Basketball players by the combination of 5 minutes of warm up plus 6 min of dynamic stretching on the vertical jump height and 20-meter sprint
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Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor usually seen in children. It is frequently associated with Kasabach-Merritt phenomenon. Here we report two cases of KHE: the first case being an 11-month-old boy who came with massive swelling on the face and violaceous discoloration. The second case was a 7-year-old boy who presented with respiratory distress and bleeding manifestations. CT scan chest showed a large mass involving the anterior mediastinum. Histologic examination of resected masses from both these cases showed features of KHE involving subcutaneous tissue and thymus, respectively. Although cutaneous and subcutaneous location is common, thymic involvement is unusual. It is important to distinguish KHE from infantile haemangioma, tufted angioma, spindle-cell haemangioma, verrucous malformation and Kaposi sarcoma. Histologic features, supportive immunohistochemistry and the clinical profile together are helpful to differentiate KHE from other vascular lesions.
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Background: Most of the patients of Coronavirus Disease-19 (COVID-19) presented with mild symptoms and recovered, but a considerable number of cases deteriorated and succumbed to death. They often present with hemostatic abnormalities mimicking disseminated intravascular coagulation with increased risk of thrombosis rather than bleeding. Hence, early prediction of disease severity by some easily available hematological parameters might be helpful to reduce mortality in COVID-19 cases. Aim and Objectives: The aim of the study was to determine whether values of Prothrombin Time (PT), International Normalized Ratio (INR), Activated Partial Thromboplastin Time (APTT) and D-Dimer (DD) correlate with disease severity in COVID-19 and also to find out cutoff value of these parameters to predict disease severity. Materials and Methods: This observational cross-sectional study was done on total 400 hospitalized COVID-19 adult patients where patients were categorized into moderate and severe cases as per guideline of Government of India. Patients with pre-existing coagulation disorder or receiving anticoagulant drugs were excluded from the study. PT, INR, APTT, and DD values of these two groups were evaluated and compared statistically to determine their significance and the cut-off value to predict severity. Results: Among the measured blood parameters means of PT (P < 0.001), INR (P < 0.001) and DD (P < 0.001) found to be significantly higher in the severe group of patients compared to moderate ones and DD value ?1.365 mg/L indicates severe disease. APTT showed no statistically significant association with severity. Conclusion: PT and INR can be used as severity marker in COVID-19 patients; however, DD is the most reliable marker correlating with disease severity.
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Background: No drug, used as adjuvant to spinal bupivacaine, has yet been identified that specifically inhibits nociception without its associated side-effects. Dexmedetomidines a novel alpha-2 agonist which holds promise as an intra-thecal adjuvant. Aims: This observational study was conducted to evaluate the onset and duration of sensory and motor block as well as perioperative analgesia and adverse effects of dexmedetomidine given intrathecally with 0.5% hyperbaric bupivacaine for spinal anesthesia. Materials and Methods: A total of 60 patients belonging to age group 18-60 yrs, urban population, classified as American Society of Anesthesiologists status I and II scheduled for lower abdominal and lower limb procedures were prospectively studied. Patients were randomly allocated to receive intrathecally either 12.5 mg hyperbaric bupivacaine plus 5 μg (0.5 ml) dexmedetomidine (group D, n=30) or 12.5 mg hyperbaric bupivacaine plus 0.5 ml NS (group B, n=30). Sensory and motor blockade charactersistics- The onset time to reach peak sensory and motor level, the regression time for sensory and motor block, time for rescue analgesia, hemodynamic changes and side-effects were recorded. Data collection was done by observation and measurement of various parameters. Results: The onset times to reach T10 dermatome, peak sensory level and onset time to reach modified Bromage 3 motor block were similar in both groups. We found that adding dexmedetomidine intrathecally significantly prolonged sensory and motor block time. time for first analgesic request was also significantly prolonged in group BD. Statistically there were no significant differences in hemodynamic alterations and other adverse effects between the groups. Conclusion: clinical advantage of dexmedetomidine is that it facilitates the spread of the block and offers prolonged post‑operative analgesia. The groups were similar with respect to hemodynamic variables and there were no significant side-effects in either of the groups. However, prolonged duration of motor blockade with dexmedetomidine may be undesirable for short‑term surgical procedures or ambulatory surgeries.
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Introduction: Violent behaviours among teenagers have increased significantly over the years and the mean age of the crime has become younger. Aim and Objective: Our objective was to determine the effects of video games on male teenagers’ behaviors among population in the 24 secondary schools Muar, Johor, Malaysia. Methodology: This was a cross sectional study. Our sample size was 380 and the age of the respondents were between 13-16 years. Data was collected by using 4 sets of questionnaires, which are demographic information (4 items), Multi-Dimensional Emotional Empathy Scale (24 items), Buss-Perry Aggression Questionnaire (29 items) and Self Report Altruism scale (20 items). Results: Our results showed that 78.41% students were violent video gamers. Out of 380 students, 156 students (40.1%) engaged with videogames less than 2 hours per day, 151 teenagers (38.8%) used to play between 2 and 4 hours per day and only 82 teenagers (21.1%) used to play for more than 4 hours per day. About 70% of respondents score was lower than standard in both physical and verbal aggression. Level of altruism is one of the objectives in this research. Discussion: Our results documented that there is a relationship between the video games and the aggressive behaviour even the prosocial behaviour as well. Though the assessment of the aggression, the participant showed more on the anger and hostility attitude. Video games not only related to aggression but also it is related to the diminishing the sense of empathy among teenagers. Conclusion: We concluded in our study that most of the participants showed that they prefer violent video games, most of them are not empathetic and they don’t have altruism attitude.
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Background: Maintenance of hygiene is very important to lead a healthy, disease-free life. Lack of hygiene increases the chance of communicable and non-communicable diseases. Wastes generated by the hospitals increase the chance of nosocomial infections. Objective: The present study deals with the patient’s perception about hygiene and sanitation rendered by the hospitals. Materials and Methods: The present study was a questionnaire-based cross-sectional survey. The data were collected from the indoor patients admitted in the Department of Surgery, Obstetrics and Gynecology, and General Medicine during December 2016–January 2017 at a Medical College in Kolkata. Results: In the present study, a total of 150 patients were taken as study population, of which majority of them were female. The major age group of the study population was 32–39 years, 33 (22%). In the present study, 93.33% of patients responded that the food was hygienic, 90% of patients opined that all housekeeping staffs used their protective equipment while they were collecting the garbage in this hospital, and 78% of patients agreed that the dustbins were cleaned regularly. Conclusion: In order to improve patients’ compliance and reduce the sufferings, evaluation of to hospital hygiene is of utmost importance. Awareness programs should be implemented in hospitals and health-care centers about the importance and maintenance of hygiene. This would reduce the chances of hospital-borne infections not only for the patients but also for the hospital workers.
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There is a need of a relatively simple and inexpensive method for the determination of relative potency of various generic brands of antibiotics in comparison to original products. The current study describes an agar diffusion method which can be performed in any microbiology laboratory, is cheap (costs $2 per test) and its results can be available after overnight incubation. The results show that neither all generics are reliable nor are all generic antibiotics of poor quality.
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Background: Pseudomonas aeruginosa is one of the most common opportunistic pathogens that cause severe infections in humans. The burden of carbapenem resistance is particularly high and is on the rise. Very little information is available on the molecular mechanisms and its clonal types of carbapenem-resistant P. aeruginosa seen in Indian hospitals. This study was undertaken to monitor the ?-lactamase profile and to investigate the genetic relatedness of the carbapenemase-producing (CP) P. aeruginosa collected across different hospitals from India. Materials and Methods: A total of 507 non-duplicate, carbapenem-resistant P. aeruginosa isolated from various clinical specimens collected during 2014–2017 across seven Indian hospitals were included. Conventional multiplex polymerase chain reaction for the genes encoding beta-lactamases such as extended-spectrum beta-lactamase (ESBL) and carbapenemase were screened. A subset of isolates (n = 133) of CP P. aeruginosa were genotyped by multilocus sequence typing (MLST) scheme. Results: Of the total 507 isolates, 15%, 40% and 20% were positive for genes encoding ESBLs, carbapenemases and ESBLs + carbapenemases, respectively, whilst 25% were negative for the ?-lactamases screened. Amongst the ESBL genes, blaVEB is the most predominant, followed by blaPER and blaTEM, whilst blaVIM and blaNDM were the most predominant carbapenemases seen. However, regional differences were noted in the ?-lactamases profile across the study sites. Genotyping by MLST revealed 54 different sequence types (STs). The most common are ST357, ST235, ST233 and ST244. Six clonal complexes were found (CC357, CC235, CC244, CC1047, CC664 and CC308). About 24% of total STs are of novel types and these were found to emerge from the high-risk clones. Conclusion: This is the first large study from India to report the baseline data on the molecular resistance mechanisms and its association with genetic relatedness of CP P. aeruginosa circulating in Indian hospitals. blaVIM- and blaNDM-producing P. aeruginosa is the most prevalent carbapenemase seen in India. Majority of the isolates belongs to the high-risk international clones ST235, ST357 and ST664 which is a concern.
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WHO defined palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.” (1)
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Purpose: Data from developing countries about incidence, prognosis and healthcare cost of cytomegalovirus (CMV) reactivation amongst patients with allogeneic hematopoietic stem cell transplantation (AHSCT) remain scarce. The purpose of the study was to describe the epidemiology, outcome and cost implications of CMV reactivation and CMV disease amongst patients with AHSCT in cancer hospital in Eastern India. Materials and Methods: The study design was a retrospective audit of clinical records. Results: Ninety-nine per cent of patients and 94% of the donors were found to be CMV seropositive. CMV reactivation rate was 43.8% amongst patients with AHSCT (n = 130 patients). CMV reactivation occurred 118 days after AHSCT (median; range: 28–943 days). Patients with any grade of graft-versus-host disease (GVHD) had higher CMV reactivation rate than patients without GVHD. Patients with CMV reactivation had more frequent GVHD than patients without CMV reactivation. Use of steroids was associated with CMV reactivation. We found no differences in overall survival of patients with or without CMV reactivation. The cost of in-house CMV-polymerase chain reaction at our centre was USD $57 (Rs. 3650), cost for intravenous ganciclovir was USD $26 (Rs. 1665) per infusion and oral valganciclovir USD $8 (Rs. 512)/900 mg tablet. The median duration of anti-CMV therapy was 14 days (interquartile range: 14–28 days) and the average cost per patient per month directed towards CMV management ranged between USD $800 and USD $1,300 (Rs. 51,238–Rs. 83,264). Three patients (2.3%) in this series had CMV disease, all of whom died. Conclusion: In an increasingly globalised world, where medical tourism is common, data from developing countries regarding cost and outcome of CMV infections in AHSCT patients are of relevance.
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The prognosis of infected individuals with candidemia depends on rapid and precise diagnosis which enables optimising treatment. Three fungal DNA extraction protocols have been compared in this study for medically important Candida species. The quality and quantity of the DNA extracted by physical, chemical and automated protocols was compared using NanoDrop ND-2000 spectrophotometer. It was found that the yield and purity (260/230) ratio of extracted DNA was significantly high in the physical treatment‑based protocol as compared to chemical based or automated protocol. Extracted DNA‑based real time‑polymerase chain reaction showed an analytical sensitivity of 103 cfu/mL. The result of this study suggests physical treatment is the most successful extraction technique compared to other two protocols.
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BACKGROUND: Plasmablastic lymphoma (PBL), a rare non‑Hodgkin’s lymphoma (NHL) variant specifically associated with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), expresses well‑differentiated plasma cell markers like CD138, bright CD38, and MUM1; but not conventional B‑cell markers. It occurs at unusual sites like oral cavity and orbit, and has poor survival rates. AIMS: This study serves as a review of a clinical experience with six HIV patients with PBL and observes the spectrum of clinical presentations, histopathologies, and 1‑year outcomes in PBL patients. MATERIALS AND METHODS: This review of six PBL patients was conducted at a tertiary care hospital in eastern India using relevant radiological, histopathogical, and immunohistological studies. RESULTS: Incidence of PBL among HIV patients was 0.58% (6/1,028). Mean CD4 count at presentation was 125.5 ± 71.1 cells/μL. Sites of involvement included pleura, lung parenchyma, suprarenal gland, pelvic cavity, and retroorbital space (one each). Immunohistopathology of biopsied sample in each patient revealed PBL (positive plasma cell markers MUM‑1/ IRF4, CD38, and CD138/syndecan; and negative of B‑cell markers CD3, CD20, and CD30). Three (60%) were positive for Epstein Barr virus (EBV) immunoglobulin G (IgG). Five surviving patients received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen and attained partial remission (PR) after six cycles. Subsequently, three patients were started on EPOCH (etoposide, cyclophosphamide, doxorubicin, vincristine, prednisone) therapy; two attained near total regression after 6 months (four cycles). Overall, four patients remained alive with good quality of life at the end of 1 year of follow‑up. CONCLUSION: PBL in HIV occurs at unusual sites with varying aggressivity. This study is too small to comment on the long‑term outcomes of PBL in HIV; however, coadministration of antiretroviral therapy (ART) with standard chemotherapy may improve survival.
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Background & objectives: In India, human pulmonary paragonimiasis is an important public health problem in the northeastern (NE) region. In 2005 we reported a hyperendemic focus of paragonimiasis in a remote tribal village in the hills of Changlang district in Arunachal Pradesh. The community was made aware of the disease and all active cases were treated. This study was aimed to assess the decline in the prevelance of paragonimiasis in the same area after a re-survey done in 2011 after a gap of six years. Methods: Re-surveys were carried to determine the reduction in the prevalence of paragonimiasis. Community education was given to the villagers to raise their awareness about paragonimiasis. A total of 624 individuals including 301 children (age < 15 yr) were included in the study. Sputum and stool samples were examined for eggs of lung flukes. Serum samples were screened for IgG antibodies against lung fluke antigen by ELISA. Results: A significant (P<0.001) decline in the prevalence of paragonimiasis was found. There was decline in both ELISA positivity and egg positivity. Antibody positivity against excretory-secretary (ES) antigen in children (age < 15 yr) fell down from earlier 51.7 to 15.9 per cent and in individuals 16 - 30 yr of age the serological prevalence fell down from 22.4 to 8.2 per cent and in individuals aged > 31 yr, the decline in prevalence was from 15.3 to 3.7 per cent. Gender-wise analysis revealed that the decline in ELISA positivity was similar in both genders and fell down from 33.9 to 11.5 per cent in males and from 29.8 to 10.7 per cent in females. Similarly, there was a significant decline rate in egg positivity also. Interpretation & conclusions: The strategy of hotspot targeted active paragonimiasis case detection and treatment of infected cases together with community education appears to be feasible methods to achieve control of paragonimiasis in this region.
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Venous aneurysm is saccular or fusiform dilatation of vein, usually congenital origin. Among acquired variety post intravenous cannulation leading to venous aneurysm is extremely rare entity. Non invasive diagnostic procedure MRI and duplex scanning are very useful modality for anatomical localization of the aneurysm. Although an ascending venogram is an invasive test and should take a backseat for diagnosis of such aneurysm. Symptometic case needs surgical management. Anatomical delineation is an important pre requisite for planning surgery. Aneurysmorrhaphy preserves the affected venous segment because it does not produce luminal compromise.
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Purpose: For antibiotic susceptibility results, conventional culture and sensitivity methods takes 48 hours after a blood culture is fl agged positive by automated systems. Early initiation of targeted antibiotic therapy is essential for effective management of sepsis to reduce morbidity, mortality, cost of treatment and prevent antibiotic resistance. Objective of this study was to evaluate Direct Sensitivity Test (DST) as a potential tool to get reliable antibiotic susceptibility results 24 hours earlier. Materials and Methods: Blood cultures fl agged positive between May 2011 to December 2012 by BacT/ALERT were Gram stained. All uni-microbial gram-negative blood cultures were simultaneously cultured and processed for DST from broth using disk diffusion method using British Society of Antimicrobial Chemotherapy (BSAC) guidelines. DST results available next day were compared with conventional antibiotic susceptibility test (AST) performed by Vitek-2 on isolated colonies. Results of DST (test method) and AST (reference method) were compared for agreements or errors. Results: Of the 840 antibiotic gram-negative organism combinations tested, Categorical and essential agreements were 83.7% and 96.2% respectively. Minor, major and very major errors were 12.5%, 3.33% and 0.47%, respectively. Conclusions: DST using disk diffusion from positive blood culture broths helps to initiate early targeted antibiotic therapy. There is high concordance between DST and AST.