Exposure to Household Air Pollution During Pregnancy and Birthweight

This case-control, hospital-based study aimed to study the role ofhousehold air pollution in adverse birth outcomes like low birthweight. 200 newborn babies weighing <2500 g were included inthe study along with 200 matched controls. After adjusting forconfounders, it was found that exposure to second hand smoke(adjusted OR 1.72, 95% CI 0.85, 3.50, P=0.13) or indoor airpollution due to cooking fuel (adjusted OR 1.63, 95% CI 0.71,3.72, P=0.25) were not significantly associated with birth weight.

Contraceptive practices and awareness about emergency contraception among women attending a tertiary care hospital of Delhi, India

Background: Emergency contraceptive pills (ECs) are a safe female-controlled method of post-coital contraception; however, the knowledge about them is low among general population.Methods: This cross-sectional study was done among the adult females, aged 18 years and above, who visited the various out-patient departments (OPD) of a tertiary care hospital in July 2017. A total of 640 adult females, who visited the OPDs of medicine, surgery, orthopedics and gynecology were included in this study. Data were entered and analyzed using SPSS ver 16. Chi-square test was used to test association. A p-value of less than 0.05 was considered as significant association.Results: Of the 640 participants, mostly were Hindu, aged between 20-29 years, married and had more than one child. Only, 52% females were aware of the term ‘contraception’ and 17.7% about ‘emergency contraception’. The only method of ECs they were aware of was i-pill. Commonest source of their knowledge was friends, relatives and spouse. Only 70 women knew that it can be used after unprotected intercourse and 25 knew that it can be used after failure of barrier method. Just 41.2% women used any kind of contraceptive and 5.3% women have ever used an EC. Around 28% women reported not using contraception due to lack of knowledge.Conclusions: Despite of their availability since many years, awareness about emergency contraception is low. More efforts are required to generate awareness about regular use of effective contraception and emergency contraception if required.

A Study On Awareness Regarding Prescribed Drugs Of Patients Attending Outpatient Departments In A Tertiary Care Hospital Of Delhi

Background: The treatment outcomes of patients attending Outpatient Departments (OPD) in hospitals are largely dependent upon the awareness of patients about the prescribed drugs. This awareness about treating drugs further affects their compliance which is guided by the communication between the doctor and patient. Objectives: To know the proportion of prescription slips that was complete. To study the level of awareness of patients attending OPDs regarding prescribed drugs. Methods: It is a cross sectional study involving 200 patients attending OPDs in a tertiary care hospital. Adult patients leaving the outpatient departments (OPDs), who could understand local language, were selected randomly and their prescription slips were screened for completeness. Further, their awareness was assessed with the help of a semi–structured and pre–tested questionnaire. Results: It was observed that of the two hundred prescription slips, one seventy three (86.5%) did not have complete instructions listed in them. However, one eighty seven patients (93.5%) had knowledge about their disease, one ninety one (95.5%) knew how to take the medicine (dose and timing), one eighty eight (94%) knew about the common side effects and one eighty five (92.5%) knew when they have to visit the doctor next. One ninety six (98%) said they knew that they should keep the medicines out of reach of children and the same number of respondents said they check expiry date before consuming the medicines Conclusions: The study reveals that the patients are being communicated the relevant information, but documentation is insufficient and should be improved.

Rickettsial Diseases in Central India: Proposed Clinical Scoring System for Early Detection of Spotted Fever.

Objectives: To report a series of cases of rickettsial infections from central India and to develop a clinical scoring system for its early detection. Design: Retrospective review of children hospitalized during one year period with fever without a source, and presence of one or more of the clinical features suggestive of rickettsial infection. Diagnosis of rickettsial disease was made by classical clinical features and detection of IgM antibody by ELISA. A clinical scoring system was developed to diagnose spotted fever group by using classical clinical and laboratory findings. Results: 161 patients were admitted and met the inclusion criteria, 75 (45.6%) were diagnosed with rickettsial diseases. 52 (69.3%) had spotted fever group and 23 (30.7%) scrub typhus. The mortality rate with rickettsial diseases was 9%. By using proposed clinical scoring system, a score of 14 has sensitivity and specificity of 96.15% and 98.84%, respectively in making a diagnosis of spotted fever group. Conclusion: Rickettsial diseases are common in the central part of India and should be included in the differential diagnosis of patients with fever of undetermined source. The proposed scoring system can be used for early detection, treatment and prevention of mortality and morbidity from spotted fever group.

Vitamin D and Child Health in the 21st Century.

Context: Vitamin D has emerged as a topic of great interest among researchers. Recent evidence indicates that today the world is facing vitamin D deficiency pandemic. Sensitizing pediatricians to widespread vitamin D deficiency in children and benefits accrued from it’s correction would go a long way as far as clinical practice and public health is concerned. Evidence Acquisition: We performed a literature search using PubMed/medline, EMBASE and ScienceDirect databases indexed under the Medical Subject Heading (MeSH) terms; “Vitamin D OR Vitamin D deficiency” combined with the terms “children” OR “pediatric” OR “child health”. The literature search was limited to articles in last 35 years and written in the English language. All articles having direct relevance to to the present review were searched. Reference lists of all articles were also reviewed. Emphasis was placed on pediatric literature, although sentinel adult studies relevant to this article have been included. Latest editions of standard texts were also searched. Results: Vitamin D deficiency is highly prevalent throughout the world including India. Though some evidence suggests a role of hypovitaminosis D in pathophysiology of many clinical situations other than rickets and osteomalacia like autoimmune diseases, cardiovascular diseases, infections, cancers, fetal health, and exercise performance, some authorities feel there is a lack of unequivocal evidence in favour of nonskeletal health benefits of vitamin D. Conclusions: Widespread subclinical and pre-rachitic vitamin D deficiency in children should be diagnosed by serum 25(OH)D levels and these levels should be maintained above 20 ng/mL to obtain optimal health benefits. There is a need for large randomized clinical trials to investigate the nonskeletal benefits of vitamin D deficiency.

Relapse of herpes simplex encephalitis presenting as choreoathetosis.

We report a case of herpes simplex virus (HSV) encephalitis (HSE) in an 11-year-old boy who recovered with acyclovir therapy but developed relapse after 2 weeks. Choreoathetosis was the presenting feature of relapse. Response to antiinflammatory treatment was excellent. To the best of our knowledge, this is the first case of HSE relapse presenting with choreoathetosis reported from India. We describe the patient and review the literature on HSE and HSE relapse.

Rickettsial Infections: Indian Perspective.

Context: Underdiagnosed and misdiagnosed rickettsial infections are important public health problems. They also lead to extensive investigations in children with fever of undetermined origin contributing to financial burden on families. The present review addresses the epidemiology, clinical features, diagnosis and management issues of these infections, primarily for a practicing clinician. Evidence acquisition: We did a PubMed, Medline and Cochrane library search for literature available in last 40 years. Results : Rickettsial infections are re-emerging and are prevalent throughout the world. In India, they are reported from Maharashtra, Tamil nadu, Karnataka, Kerala, Jammu and Kashmir, Uttaranchal, Himachal Pradesh, Rajasthan, Assam and West Bengal. In view of low index of suspicion, nonspecific signs and symptoms, and absence of widely available sensitive and specific diagnosic test, these infections are notoriously difficult to diagnose. Failure of timely diagnosis leads to significant morbidity and mortality. With timely diagnosis, treatment is easy, affordable and often successful with dramatic response to antimicrobials. As antimicrobials effective for rickettsial disease are usually not included in empirical therapy of nonspecific febrile illnesses, treatment of rickettsial disease is not provided unless they are suspected. Knowledge of geographical distribution, evidence of exposure to vector, clinical features like fever, rash, eschar, headache and myalgia alongwith high index of suspicion are crucial factors for early diagnosis.