Parenting styles of parents with one to five-year children attending Government Taluk Hospital, Anekal, Karnataka

Background: Parenting is the process of raising and teaching a child from birth to adulthood. There are four types of parenting styles, of which the most common is authoritative parenting. Parenting styles and the quality of a parent-child relationship are considered to have an impact on the psychosocial development of the child. Objectives: The objectives of the study were (1) to assess the parenting styles of parents with 1–5-year-old children attending Government Taluk Hospital, Anekal, Karnataka. (2) To assess the association between sociodemographic factors and parenting styles of parents. Materials and Methods: This cross-sectional study was conducted among 200 mothers of 1–5-year-old children accessing health care at Government Taluk Hospital, Anekal. Modified parenting styles and dimensions questionnaire was administered to mothers. Results: Mean age of the 200 mothers was 26.2 ± 2.4 years and fathers reportedly were 32.1 ± 3.1 years. Most fathers had high school education and were laborers. Majority of mothers had primary education and were homemakers. There was a significant difference in the mean parenting score of fathers (86.2 ± 14.1) and that of mothers (92.1 ± 11.9), where higher scores indicate better parenting styles. Authoritative parenting style was significantly associated with occupation and education of the fathers. Uninvolved parenting was significantly associated with education of the fathers; occupation and younger age (<26 years) of the mothers. Conclusion: A limitation of this study was that the mothers responded for themselves as well as on behalf of their husbands. Mothers felt that their husband’s parenting style was inadequate. The study identified a need for education of the parents regarding parenting styles.

Drug Utilization Pattern For Skin Diseases In Dermatology Opd At Tertiary Care Hospital Of Western Maharashtra

Background: Periodic auditing of prescriptions in terms of drug utilization study is an important tool to enhance the efficacy of the treatment, to decrease the risk of the adverse effects, to give cost-effective treatment and to provide useful feedback to the clinician. Prevalence of dermatological diseases is very high throughout the world, and in day to day practice, a quarter of the cases are related with dermatological manifestations. In studies conducted in the Out Pa-tient Department (OPD) of dermatology in North Palestine and Western Nepal, irrationalities in the prescriptions have been reported. Aim: To study the drug utilization pattern for skin diseases in dermatology OPD at tertiary care hospi-tal of Western Maharashtra. Methodology: The retrospective analysis of dermatology OPD records of 6 months (1stMarch 2018-31stAugust 2018) was carried out during the study period (1stSeptember 2018 to 30thNovember 2018). The proforma for collecting data was designed. Demographic details, diagnosis and treatment given for each patient were recorded. The data collected was condensed, and the master chart was prepared for data analysis. Result: During the study period, a total of 3869 patient’s case records were studied and analysed. A maximum number of patients (26.5%) found in the age group 31-40 years, followed by 23.5% of patients in the age group 21-30 years. Fungal in-fection was found in 39.6 % of patients followed by acne in 14.2% patients and eczema in 9.1% of patients. Drugs most commonly prescribed were antihistaminics (45.02%) followed by antifungal (39.6%) and steroids (27.8%). Levocetirizine (74.07%) and hydroxyzine (16.5%) were the most commonly prescribed antihistaminics. Itraconazole (58.17%) and Griseofulvin (24.67%) were the most commonly used oral antifungal drugs. Miconazole (73.73%) was the most commonly used topical antifungal drug, followed by ketoconazole (12.45%). Among steroids, prednisone (52%) and betamethasone (38.05%) were the most commonly used steroids by oral route while clobetasol (68.09%) and mometasone (19.5%) were the most commonly used steroids by topical route. Our study revealed that the per-centage of drugs prescribed from the WHO essential drug list was only 23.87%. Drugs which prescribed by the gener-ic names were less than <1%. Conclusion:Treatment protocols used in the management of skin disorders were near to the standard guidelines.

A Validated Stability Indicating Rp-Hplc Method Development For Anti Cancer Drug Enzalutamide In Bulk And Pharmaceuticals

A reproducible stability-indicating Reverse Phase-HPLC technique for the quantification of enzalutamide in in pharmaceuticals was developed and validated. Chromatography was achieved on Inertsil-ODS-C18 (250mm×4.6 mm) 5µmanalytical column with acetonitrile: methanol: water in 40:30:30% v/v proportion as mobile phase and flow rate of 1 ml/min. Enzalutamide was detected at 237 nm UV-wavelength maximum. In the present work mobile phase used as a diluent. Developed technique was validated over 20-150 µg/ml linear concentration range for enzalutamide. This method established with linearity coefficient value of 0.99 and the percentage recovery was found to be 99.3%. This method was proven with LOD and LOQ values of 0.53 µg/mL and 1.61µg/ml respectively. The drug was degraded in acid and alkaline conditions and the percentage degradation values were 3.10 % and 4.54 % respectively. There was no degradation of drug when exposed to neutral, UV, thermal, sun-light and oxidative conditions.Drug was undergoing degradation when exposed to acid and alkaline conditions. The developed technique was useful in the routine quantitation of enzalutamide.

Attenuation of Neuronal Damage by Gymnemic acid in Experimentally Induced Cerebral Ischemia in Rats.

Gymnemic acid is obtained from the natural resource and has got antioxidant property, was investigated for the possible neuroprotective effect in experimentally induced cerebral ischemic rats. Carotid arteries clamped with the help of aneurysm clips to produce cerebral ischemia, the clips were removed from the arteries to allow the reflow of the blood through carotid arteries. It was observed that lipid peroxidation was increased significantly after bilateral common carotid artery occlusion. Brain endogenous antioxidant GSH and total protein levels were low. Administration of gymnemic acid in a dose of 250 mg/kg and 500 mg/kg b.w orally showed promising neuroprotective effect by reducing cerebral infarct size as well as improved all antioxidant levels showing activity against oxidative stress.

A Study of Cardiac Autonomic Neuropathy and Its Correlation with QTc Dispersion in Type-2 Diabetes Mellitus.

Aims: To evaluate the presence of cardiac autonomic neuropathy in Type-2 Diabetes and to correlate autonomic dysfunction with QTc dispersion. Study Design: This was a hospital based cross-sectional study carried out in the department of Medicine JSS Hospital Mysore, India between March 2012 and March 2013. Methodology: We included 50 Diabetes patients (Cases) and 50 Non Diabetes healthy adults (Controls) of both genders. Five standard cardiovascular response tests were carried out (Valsalva ratio, expiration-inspiration ratio, immediate heart rate response to standing, fall of systolic blood pressure on standing and sustained hand grip test) to determine the severity of cardiac autonomic neuropathy. QTc dispersion was determined by subtracting heart rate-corrected minimum QTc interval (QTc min) from maximum QT interval (QTc max) from standard electrocardiogram. Results: 17 patients (34%) had evidence of cardiac autonomic neuropathy. Of this 8 (16%) had borderline and 9(18%) had abnormal CAN. In the control group only 1(2%) had CAN. (P value of 0.000) Mean QTc in cases was 41.60+/-18.11) and in controls was 20.80(+/-4.88) QTc dispersion was 32.7(+/-13.0) in those without CAN and 48.75(+/-9.71) in borderline CAN and 67.77(+/-9.71_in abnormal CAN group. (P =0.000). Conclusion: Prolonged QTc a feature of autonomic dysfunction due to diabetes. QTc dispersion correlates significantly with presence of cardiac autonomic neuropathy and may be a simple and useful measure for detection of cardiac autonomic neuropathy.

Validation of the existing modified screening criteria for detection of all cases of retinopathy of prematurity in preterm babies - 11 year study from a governorate referral hospital in Oman

Purpose: To study appropriateness of our modified screening criteria for detection of all cases of Retinopathy of Prematurity [ROP] among preterm babies

Method: Retrospective observational cohort study among preterm neonates who underwent ROP screening as per set protocol for 11 years at Nizwa Hospital, Al Dhakilya Governorate, Oman. We screened all babies with gestational age 32 weeks of GA or BW > 1500 g with unstable clinical course believed to be at high risk by the attending neonatologist also were screened

Results: During the study period 528 babies were screened for ROP of which 76 babies were excluded due to death, associated congenital ocular malformation and loss for follow-up either due to transfer to other institution or defaulting. Thus 452 babies were included in the final analysis. Incidence of ROP was 46.4% of which 27.9% had mild ROP, 11.3% had severe ROP which regressed and 7.3% had severe ROP who were treated. The incidence of ROP among infants with GA < 26 wks, 26-28 wks, 29-30 wks, 31-32 wks and above 32 weeks was 100.0%, 80.0%, 59.3%, 34.4% and 19.4% respectively. 56 babies of this cohort belonged to Extended [modified] criteria group. Among these 12 babies had ROP out of which 9 had mild ROP and 3 had severe ROP. Among cases with severe ROP, two cases regressed spontaneously and one case needed treatment. Multivariate analysis using stepwise regression model showed statistically significant association of GA and BW to development of ROP. We would have missed few babies with ROP if we had followed other criteria

Conclusion: Our modified screening criteria seem to be appropriate as no infant with severe ROP was missed during the study period. Incidence of severe ROP among babies in the extended criteria group [5.4%] is low but significant compared to lower gestational age. We plan to formulate a scoring system following all risk factor analysis to enable us to optimize the number of infants screened. Detection of all babies with ROP is important as they need long-term follow-up for the timely detection and management of associated ocular comorbidities

Investigation of antioxidant and anti-inflammatory activity of leaves of Dalbergia paniculata (Roxb)

OBJECTIVE@#To investigate the antioxidant and anti-inflammatory activity of orally administered methanolic leaf extract of Dalbergia paniculata (D. paniculata) in Carrageenan induced inflammation in rats.@*METHODS@#In vitro antioxidant activity was evaluated for superoxide radical, Hydroxyl radical and DPPH radical scavenging activity. Three doses 200 mg/kg, 400 mg/kg and 800 mg/kg of D. paniculata were tested for anti-inflammatory activity in Carrageenan induced rat paw edema model and paw thickness was measured every one hour up to 6 h.@*RESULTS@#The methanolic leaf extract of D. paniculata produced dose dependent inhibition of Superoxide radical, Hydroxyl radical and DPPH radicals. In Carrageenan induced inflammation model, all three doses produced significant percentage inhibition of rat paw edema and 800 mg/kg dose produced maximum percent inhibition of rat paw edema (47.83%) at 3h compared to control group.@*CONCLUSIONS@#In the present study we found that methanolic leaf extract of D. paniculata showed good in vitro antioxidant activity and in vivo anti-inflammatory activity in rats.

Multiple courses of antenatal steroids.

The benefits and risks of multiple courses of antenatal steroids (ANS) are still unresolved issues. This was a prospective cohort study in a level III neonatal unit. Preterm babies < or = 35 wk gestation were included. Malformations, chronic maternal steroid intake, exchange transfusions prior to cortisol sampling and incomplete ANS courses were exclusion criteria. Subjects were classified into: No course (Group 0), 1 course (group 1), 2 courses (Group 2), > 2 courses (Group 3) of antenatal dexamethasone. The key outcome was adrenal function assessed by basal and post-ACTH cortisol on day 3. Other outcomes were neonatal morbidity, mortality, growth parameters at birth, long term growth and neuro-development. Of 210 eligible babies, 124 were enrolled. 38, 51, 10 and 25 babies belonged to groups 0, 1, 2 and 3 respectively. Basal and post-ACTH serum cortisol did not show any significant difference between groups (p=0.5 and p=0.9 respectively). Incidence of severe HMD requiring ventilation was significantly lower (p=0.02) in multiple course group (combined groups 2 and 3) compared to single course group. There were no differences in other neonatal morbidity, birth OFC and weight between single and multiple ANS groups. Follow up data at a mean age of 22 mth was available in 59 subjects (69%) belonging to groups 1-3. No differences were noted in the proportion of patients with abnormal neurological examination (p=0.1), abnormal PDI (p=0.9), abnormal MDI (p=0.9) and physical growth between multiple and single course groups. Multiple courses of antenatal dexamethasone resulted in a significant decrease in severe forms of RDS and they did not cause adrenal suppression, decreased growth or impaired neuro-development.

Cost of neonatal intensive care in a tertiary care center.

BACKGROUND: The number of neonatal intensive care units (NICUs) in India has increased substantially over the last decade; yet many more are required. There is limited information on the actual costs of setting up and running an NICU in India. OBJECTIVE: Systematic and comprehensive calculation and analysis of the costs of neonatal intensive care in a tertiary care teaching hospital. METHODS: The costs were compiled by studying the detailed records of various hospital departments and prospectively documenting the costs of drugs, consumables and investigations for a representative group of 30 babies. RESULTS: The total cost of establishing a 16 bed level III tertiary care NICU was Rs 3.78 crore (Rs. 37.8 million, USdollar 860,000) (2003). Equipment cost formed two-thirds of the establishment cost. The running cost of NICU care per patient per day was Rs 5450 (USdollar 125). NICU and ancillary personnel salary comprised the largest proportion of the running costs. The average total cost of care for a baby less than 1000 grams was Rs. 168000 (USdollar 3800), Rs. 88300 (USdollar 2000) for babies 1000 g to 1250 g. and Rs. 41700 (USdollar 950) for those between 1250 to 1500 g. The family had to bear only 25 percent; rest was subsidized. CONCLUSIONS: Equipment and personnel salary form the biggest proportion of establishment and running costs. The costs of treatment for a baby in NICU should be seen in context with costs of other types of health care and the number of useful life years gained.

Identification of male factor infertility using a novel semen quality score and reactive oxygen species levels

OBJETIVO: Determinar se pacientes portadores do fator de infertilidade masculina podem ser precisamente identificados através do cálculo de um novo escore de qualidade de sêmen e pela medida de espécies reativas de oxigênio durante uma avaliação rotineira de infertilidade. MÉTODOS: Amostras de sêmen de 133 pacientes e de 91 doadores saudáveis foram avaliadas através de análise manual e computadorizada de sêmen. Um modelo de análise do componente principal foi empregado para calcular o escore de qualidade de sêmen, utilizando logaritmos base 10, multiplicados por ponderações variáveis de 9 parâmetros espermáticos. Os níveis de espécies reativas de oxigênio foram medidos através de testes de quimiluminescência. RESULTADOS: O escore de qualidade de sêmen apresentou sensibilidade de 80.45% e precisão de 77% para um "cutoff" de 93.1 na identificação do fator de infertilidade masculina. A área sob a curva "receiver operating characteristic" para o escore de qualidade de sêmen foi de 84.28% (95% intervalo de confiança: 65.22%-100%). Os níveis de espécies reativas de oxigênio [log10 (espécies reativas de oxigênio +1)] foram siginificativamente mais elevados nos pacientes portadores de fator de infertilidade masculina. A medica de espécies reativas de oxigênio apresentou sensibilidade de 83.47% e especificidade de 60.52% com uma precisão (definida como pacientes portadores do fator de infertilidade masculina com diagnóstico positivo e doadores corretamente excluídos) de 75% para um "cutoff" de 1.25 na identificação de pacientes portadores do fator de infertilidade masculina. A área sob a curva "receiver operating characteristic" para níveis de espécies reativas de oxigênio foi de 78.92% (95% intervalo de confiança: 72.60%-85.23%). Os escores de qualidade de sêmen correlacionaram negativamente com os níveis de espécies reativas de oxigênio tanto nos doadores e nos pacientes portadores do fator de infertilidade masculina. CONCLUSÕES: O escore de qualidade de sêmen e os níveis espécies reativas de oxigênio nas amostras de sêmen parecem associar-se fortemente com o fator de infertilidade masculina. Na medida em que os dois parâmetros mostraram-se mais sensíveis que parâmetros espermáticos individuais na identificação do fator de infertilidade masculina, deveriam ser incluídos na avaliação rotineira de infertilidade.

Prevalence of isolated minor congenital anomalies in a regional hospital in Oman

To study the prevalence of isolated minor congenital anomalies in a regional hospital in Oman. We determined the prevalence of isolated minor congenital anomalies in 21988 births during a 10-year period from January 1993 through December 2002 by using data from the hospital-based congenital anomaly register at Nizwa Hospital, Oman. The total prevalence of congenital anomalies was 37 per 1000 births and that of minor anomalies 12.4 per 1000 births. Hypospadias, talipes deformity and polydactyly were the most common minor anomalies. A nurse or the house resident detected most of the minor anomalies soon after birth during routine neonatal examination. The study demonstrates the important contribution of minor congenital anomalies to the total prevalence of congenital anomalies. An accurate estimation of the prevalence rates of isolated minor anomalies should be possible as they are easily identifiable with minimal expertise. Case classification of congenital anomalies is important so that case groups are homogeneous and more comparable

Changing trends in the management of respiratory distress syndrome (RDS).

The management of respiratory distress syndrome (RDS) has advanced because of improvements in mechanical ventilators, promotion of antenatal steroids, availability of surfactant and overall advancements in neonatal intensive care. Intermittent mandatory ventilation still forms the mainstay of assisted ventilation. Newer modes of ventilation have not delivered the results as promised. Because of the continued high incidence of bronchopulmonary dysplasia, there is a renewed interest in non-invasive modes of ventilation like CPAP and nasal IPPV. The present trend is to follow gentle ventilatory strategies accepting higher arterial carbon dioxide and lower oxygen. The role of antenatal steroids has been established beyond doubt but still they fall short of universal acceptance. Surfactant replacement therapy is the standard of care for RDS but beyond the reach of majority in India. Postnatal steroids are out of vogue because of probable links with cerebral palsy and abnormal neurological outcomes.

Unusual manifestations of VACTERL association.

We report a case of VACTERL association along with unusual manifestations of pseudo-exostrophy of bladder, hemifacial microsomia and an urachal cyst communicating with the bladder.