Caregiving strain is associated with cardiac autonomic imbalance in primary oncology caregivers: A cross-sectional analytical study

Objectives: Oncology caregivers often endure a significant amount of psychosocial stress while going through the experience of caregiving for their dependents. Exposure to chronic stress disrupts the cardiac autonomic balance and increases the risk of cardiovascular events. There is a paucity of research on the association between caregiving strain and cardiac autonomic status of primary oncology caregivers. This study aimed to assess the cardiac autonomic balance and its association with the levels of perceived strain and quality of life (QOL) of primary oncology caregivers. Materials and Methods: Forty-six individuals (30 males and 16 females) who have been primary caregivers of patients under the treatment for cancer at the Regional Cancer Centre over the past 3 months–1 year were recruited in this cross-sectional study. Cardiac autonomic status was assessed by heart rate variability (HRV) technique. The level of strain perceived and QOL of the study participants were assessed using the Modified Caregiver Strain Index (MCSI) and Caregiver QOL-Cancer (CQOL-C) questionnaires, respectively. Comparison of study parameters based on MCSI scores (low strain vs. moderate-high strain) was done using the Independent Student’s t-test. Spearman rank correlation coefficient test was performed to assess the correlation between sympathovagal balance (Low frequency [LF]/high frequency [HF]) and other study parameters. Multiple linear regression analysis was performed to predict the LF/HF ratio with independent variables MCSI score and CQOL-C score. P < 0.05 was considered statistically significant. Results: Significantly high blood pressure, LF power, LF nu (LF normalised units) and LF/HF ratio were observed among caregivers with moderate-to-high caregiving strain as compared to those with low strain levels, while significantly low HF nu (HF normalised units) and CQOL-C scores were noted among the moderate-to-high caregiving strain subgroup as compared to the low caregiving strain subgroup. LF/HF ratio revealed a significant positive correlation with the level of caregiving strain (r = 0.563, P < 0.001) and a significant negative correlation with the QOL (r = ?0.489, P = 0.001) of caregivers. However, on regression analysis, the level of caregiving strain was found to be a significant predictor of autonomic dysfunction unlike the caregivers’ QOL. Conclusion: Increased caregiving strain is associated with cardiac autonomic imbalance in primary oncology caregivers.

​Clinical Profile and Outcome of Ludwig’s Angina in Tertiary Care Hospital in Tamil Nadu

Background: Ludwig’s angina is a lethal infectious cellulitis of the submandibular space, which always makes a difficult situationfor treating surgeons.Objectives: The objective of this study was to study about the presentation, management, and clinical outcome of Ludwig’sangina.Materials and Methods: A study made in the Department of ENT - Head and Neck Surgery, Tirunelveli Medical College,Tirunelveli, for a period of 1 year from July 2016 to July 2017, a total of 41 patients - 33 males and 8 females were includedin the study.Results: Majority of the patients were having a dental infection before the episode - 85%. Pseudomonas aeruginosa is the mostcommon among the isolated pathogens. Six patients presented with stridor and needed tracheostomy. With early incision anddrainage, proper antibiotics and supportive measures, 37 patients survived without any morbidities. Despite all of our greatestefforts, four patients expired. Although comorbidities such as diabetes and chronic kidney disease are seen in few, majoritywere not having any other systemic illness.Conclusion: Prompt diagnosis and surgical drainage with broad-spectrum antibiotics and if needed tracheostomy often givemuch better results in the treatment of Ludwig’s angina. An early intervention of dental infection in early stages may be helpfulin avoiding progression into Ludwig’s angina.

Community-based nutrition education for improving infant growth in rural Karnataka.

OBJECTIVE: To evaluate a nutrition education intervention designed to improve infant growth and feeding practices. DESIGN: An intervention study using monthly nutrition education delivered by locally trained counsellors targeted at caregivers of infants aged 5-11 months. Comparison of outcomes for 2 groups--one non-intervention group of infants enrolled in 1997 that did not receive the intervention in the first year of life, and an intervention group of infants enrolled 1998-1999 that received the nutrition education. SETTING: 11 randomly selected and 2 purposively selected villages of south Karnataka. SUBJECTS: 138 Infants (n = 69 intervention) aged 5-11 months. METHODS: Families were administered a monthly questionnaire on feeding and child care behavior, and study infants were weighed at this time, using the SECA solar scales, developed for UNICEF. Logistic regression was used to examine differences between intervention and non-intervention infants in infant feeding behavior outcomes. RESULTS: Statistically significant improvement was found in weight velocity for female infants in the intervention group. These infants were also more likely to exhibit at least four positive feeding behaviors--intervention infants had a higher mean daily feeding frequency (more likely to be fed solids at least four times a day (OR = 4.35, 95% CI = 1.96, 10.00), higher dietary diversity (more likely to receive a more diverse diet OR = 3.23, 95% CI = 1.28, 7.69), and were more likely to be fed foods suggested by the counsellors such as bananas (OR = 10.00, 95% = 2.78, 33.3) compared to non-intervention infants. CONCLUSION: Nutrition education and counselling was significantly associated with increased weight velocity among girls and improved feeding behavior among both boys and girls. These results provide further evidence that community-based nutrition programs that emphasise appropriate feeding and care behavior can be used to prevent and address early childhood malnutrition in poor households.

Jejunal disaccharidases in protein energy malnutrition and recovery.

The jejunal disaccharidases, sucrase, maltase and lactase, were determined in jejunal biopsies obtained from 43 malnourished children and 10 controls. In the study group, 63% were girls and 93% had severe malnutrition. Lactase activity was significantly reduced in third and fourth degree malnutrition (p < 0.05 and p < 0.005, respectively), but maltase activity was significantly reduced only in the fourth degree malnutrition (p < 0.01). After recovery, maltase and sucrase activities showed a marginally significant increase (p = 0.06), where lactase showed no significant increase (p > 0.05). We conclude that jejunal disaccharidase activity decreases significantly with increasing severity of malnutrition, lactase being the most severely affected and the last to recover.