Anemia among 6 - 59 months children in a rural area of Bareilly district: a cross sectional study

Background: Anemia is a global health problem affecting mostly in developing countries. Iron deficiency anemia is a significant health problem and especially in developing countries. It’s the most neglected micronutrient deficiency disorder among under-five children. The objective of the study was to assess the prevalence and determinants of anemia among under-five children and to suggest suitable remediable measures to prevent and control of anemia.Method: This is a cross-sectional study. Household survey carried out in twelve villages in a rural practice area Dhaura, Bareilly. A total of 396 children were contacted for obtaining blood samples by taking 33 children from each village. Blood samples were taken from all children between the 6th month to 59 months of age using simple random sampling. After the collection, data will be analyzed using the SPSS software version 20.Result: A total of 47.5% of the children were found to have anemia. Among them 25.5% had mild, 63.3% had moderate and 11.2% had severe anemia. The majority of them were male 269 (67.9%). The mean age of participating children was 17.351±7.785 months. 48.2% of anemic children were low birth weight.Conclusion: High prevalence could be due to deficiency in iron nutrition among under-five children associated with poor food availability, due to lack of nutritional education and other sociodemographic conditions, child’s age and worse household conditions also contributed to the prevalence of anemia.

A study of contaminated sharp injury and associated morbidity among health care workers

Background: Needles are one of the biomedical waste materials generated during the treatment or procedure in the hospital. Improper handling, capping or disposal technique causes a major health hazard among the health care workers (HCWs). Needle stick injuries (NSIs) can occur accidentally at any time when people use, disassemble, or dispose needle. The aim of the present study were to find out the burden of chronic morbid condition due to NSIs to HCWs, to find out various risk factors responsible for causing chronic disease to HCWs and to suggest the prevention and control of needle stick injury among the HCWs.Methods: A cross-sectional study, conducted among HCWs. Sample size was estimated by using standard formula and 312 HCWs were taken in study. Equal number of respondent was taken from each group. The information has been collected and data entry has been done using specific software SPSS version 20.0.Results: Most of the HCWs were infected with hepatitis B (24.0%) followed by hepatitis C virus (8.7%) and HIV (1.9%) after the percutaneous injuries with needle of infectious patients during any intervention procedures of the patients.Conclusions: Occupational exposures to percutaneous injuries are substantial source of infections with blood borne pathogens among health-care workers because of the poor practice as well as not opting personal protective equipment’s during intervention process regarding preventive and control measures. These infections are highly preventable and should be eliminated.

Impact of socio-demographic variables and morbid conditions on general health component of perceived health using SF-36 form

Background: Perceived health (PH) is a subjective assessment of the health and it is a strong, independent and reliable predictor of morbidity, mortality. It includes so many aspects that are difficult to capture clinically such as incipient disease, physiological, psychological reserves. We assessed the impact of diabetes mellitus (DM), hypertension (HTN), co-morbidity and other associated factors on the general health (GH) dimension of the PH of the patients attending the outpatient department (OPD), Inpatient department (IPD), rural health training centre (RHTC) and urban health training centre (UHTC) of Shri Ram Murti Smarak Institute of Medical Sciences (SRMS, IMS), Bareilly.Methods: PH status of the patients was assessed by the GH dimension of the physical component summary of PH using the 36-Items short form health survey (SF-36).Results: The impact of morbidity deteriorate the GH score but hypertensive patients scored poor results as compared to those with DM and comorbid patients (p>0.05). Age was inversely related with GH scores but male gender, higher education (p<0.05) and good occupation were all associated with higher GH score. There was not much influence of geographical area on the GH scores but urban score slightly better and the association was insignificant (p>0.05).Conclusions: Male young patients from urban area, educated and good job performed better score for GH and association was significant for education and occupation. The presence of morbidity and co-morbid condition deteriorate the GH of the patients. The impact of various socio-demographic factors on the PH status was also evident in the study.

Study of knowledge, attitude and practice of needle stick injury among nurses in a tertiary care hospital

Background: Needle stick injuries (NSIs) are a hazard for people who work with hypodermic syringes and other needle equipment. These injuries can occur at any time when people use, disassemble, or dispose of needles. Needle Stick and Sharps Injuries (NSSIs) are one of the major risk factors for blood-borne infections. The aim and objectives of the study were to assess the knowledge, attitude, practice and prevalence of NSIs among nurses in a private tertiary care hospital of district Bareilly; to recommended the preventive measure to control the injuries.Methods: A survey has been conducted in August 2013 to February 2014 among the nurses. This is a cross-sectional study. A purposive sampling was done aimed at covering at least 50 trained nurses and 50 nursing students working in a private tertiary care hospital Bareilly.Results: The prevalence of needle stick injuries per year equals 69.0%. Self inflicted were most common among nurses working in the wards. Instruments contaminated with infectious material accounted for the injuries in the study group of nurses.Conclusions: NSSIs are highly prevalent among nurses, and prevention is the most effective way to protect nurses from infectious diseases. The most common cause of injuries from needles was an improper handling of syringes and needles after injections.

Primary Postpartum Haemorrhage – Morbidity And Mortality

Background:To study the incidence of primary postpartum haemorrhage, morbidity and mortality. Methods: Study was carried out in department of obstetrics and gynaecology, Swaroop Rani Nehru and associated Hospital, M..L.N. Medical College Allahabad. All pregnant women who underwent vaginal delivery and those who were admitted within 24 hours of delivery were included in the study .Group allocation was done randomly in three groups. Analysis of study data was done by chi square test. Result:The incidence of primary postpartum haemorrhage was 4%.Maximum incidence was noted in group A (5.8%) and minimum in group C (4.2%) .The morbidity which were related to primary postpartum haemorrhage were anaemia (68%),infection (42%),blood transfusion related complications (26%),DIC(4%), and hysterectomy (3%). 0.3% of patients died of severe postpartum haemorrhage .Management options included intensive therapy ,B-Lynch sutures and hysterectomy. Conclusion: ?

Seroprevalence of Toxoplasmosis in Pregnant Females Attending a Tertiary Care Hospital in Uttar Pradesh, India and its Effect on Perinatal Morbidity and Mortality.

Objective: To document the seroprevalence of toxoplasma in pregnant females attending a tertiary care hospital and to study its effect on perinatal morbidity and mortality. Design: Prospective follow-up study. Setting: Queen Mary’s Hospital, a tertiary level hospital affiliated to King George Medical University (earlier known as KGMC), Lucknow, Uttar Pradesh, India. Sample: All pregnant women coming to this hospital for antenatal care in the Obstetrics and Gynaecology Dept. Methods: Pregnant females were selected through systematic random sampling. A pre-tested semi-structured questionnaire was administered. Blood sample was drawn to detect IgM and IgG antibodies against toxoplasma. Delivery outcomes were recorded with reference to abortions, still births, delivery of congenitally malformed baby and gestational age at delivery. Main outcome measures: Perinatal outcomes among those positive for toxoplasma antibodies. Results: Out of 260 subjects screened, 23 (8.8%) were IgM positive and 40 were IgG positive (15.4%). IgM sero-positivity was observed more in females aged >30 years, those ≥3 gravida, belonging to low socio-economic status, Muslims, those predominantly non-vegetarian and those exposed to raw meat. Still births (17.4% vs. 3.8%; p=0.006), congenital abnormalities (8.7% vs. 0.5%; p=0.002) and abortions (17.4% vs. 2.7%; p=0.001) were more common in those positive for IgM antibodies compared to sero-negatives. Conclusions: Toxoplasma infection plays a role in adverse foetal outcome. Socio‑epidemiological aspects constitute an important contributing factor for the spread of the disease. All pregnant women should be educated and counselled for Routine serological testing for toxoplasma-specific antibodies.

The efficacy of polyherbal formulation of Moringa oleifera, Viola odorata, Allium sativum against microbes- synergistic effect.

The purpose of our present study is to test antimicrobial and antifungal activity of polyherbal formulations. The testing of the antimicrobial activity on polyhernal formulation was done against gram positive (Staphylococcus aureus, Bacillus subtilis) and gram negative (Salmonella typhi, Escherichia coli,) bacteria. The testing of antifungal activity was done against Aspergillus niger and Candida albicans with different combinations of polyherbal formulation. The microorganism to be tested was grown in relevant nutritional media. The solvent used for the extraction of Moringa oleifera, Viola odorata, Allium sativum was methanol. These methanolic extracts of chosen plants were further used in specific proportions for the preparation of polyherbal formulation (PF-1, PF-2, and PF-3). The resultant compositions were further used to check the efficacy against selected experimental microorganisms. PF-3 showed the significant high zone of inhibition against all the experimental microorganisms as compared to the other two combinations PF-1 and PF-2. Thus, the result has revealed that the antimicrobial activity is due to the synergistic effect of secondary metabolites present in these selected plants.

Synthesis, DNA cleavage and antimicrobial activity of 4-thiazolidinones-benzothiazole conjugates.

Antimicrobial screening of several novel 4-thiazolidinones with benzothiazole moiety has been performed. These compounds were evaluated for antimicrobial activity against a panel of bacterial and fungal strains. The strains were treated with these benzothiazole derivatives at varying concentrations, and MIC’s were calculated. Structures of these compounds have been determined by spectroscopic studies viz., FT-IR, 1H NMR, 13C NMR and elemental analysis. Significant antimicrobial activity was observed for some members of the series, and compounds viz. 3-(4-(benzo[d]thiazol-2-yl) phenyl)-2-(4-methoxyphenyl)thiazolidin-4-one and 3-(4-(benzo[d]thiazol-2-yl)phenyl)-2-(4-hydroxy phenyl)thiazolidin-4-one were found to be the most active against E.coli and C.albicans with MIC values in the range of 15.6–125 μg/ml. Preliminary study of the structure–activity relationship revealed that electron donating groups associated with thiazolidine bearing benzothiazole rings had a great effect on the antimicrobial activity of these compounds and contributes positively for the action. DNA cleavage experiments gave valuable hints with supporting evidence for describing the mechanism of action and hence showed a good correlation between their calculated MIC’s and its lethality.

A study on rural & urban differences in tobacco use and its socio-demographic determinants in district Dehradun.

Background: Today, tobacco use causes 1 in 10 deaths among adults worldwide – more than five million people a year. By 2030, unless urgent action is taken, tobacco’s annual death toll will rise to more than eight million. Material & method: A community based cross sectional study was undertaken in district Dehradun. Multistage stratified random sampling was done for selection of study area. A sample of 632 was taken for study purpose. Kish method was used for selection of respondents in selected household. Statistical analysis: Chi-square test, Mantel Haenszel Odds Ratio and Multi Variate Logistic Regression Analysis was done to develop results. Significant level was assumed at p<0.05. Results: The overall prevalence of ever use of tobacco was 24.4%. It was more (32.9%) in rural area as compare to urban area (15.8%). Tobacco use was directly proportional to age, more prevalent in Muslims and was indirectly proportional to education & socioeconomic status. Conclusion: Legislation pertaining to tobacco and alcohol sale and use does exist. However its strict enforcement is required in order to reduce the menace.

Molecular epidemiology of Vibrio cholerae causing outbreaks & sporadic cholera in northern India.

Background & objectives: Several outbreaks of cholera have been reported in Chandigarh region during a span of seven years from 2002-2008. The genetic characteristics of Vibrio cholerae isolates obtained during these outbreaks have not been adequately studied. The aim of this study was to do molecular typing of V. cholerae isolated from the sporadic and outbreak cases by pulsed-field gel electrophoresis (PFGE), Rep-PCR and ribotyping. Methods: Fifty representative isolates of V. cholerae from outbreak as well as sporadic cases were subjected to molecular typing by PFGE, 173 isolates (163 clinical and 10 environmental) were typed by rep-PCR and ribotyping. Ribotyping was done by determination of rRNA restriction pattern of BglI restriction digestion and hybridization with 7.2 kb rRNA probe of pKK3535 plasmid using DIG DNA labelling and detection kit. Universal VC1 primer was used for rep-PCR. Results: PFGE generated 15 pulsotypes, of which four matched the published pulsotypes and there were 11 new pulsotypes. PFGE was the most discriminatory method that could differentiate between isolates belonging to single ribotype. Pulsotype P1 corresponding to known pulsotype H1 was the major pulsotype till 2003. Pulsotype P3 corresponding to known pulsotype L emerged in 2004. The 2007 outbreaks in Punjab and Haryana were caused by P5 though P1 and P3 were isolated from the sporadic cases from the same region. The 2008 outbreak was caused by pulsotypes P6 and P7. Ribotype IV was the most predominant followed by RIII. This ribotype was not isolated after 2003 and ribotype IV became the most predominant 2004 onwards. Of the two unknown ribotypes (UNI and UN2), UNI was more common (27 isolates). Rep-PCR was the least discriminatory and divided all clinical isolates into four major profiles. The dendrogram analysis of PFGE revealed similarity of some clinical isolates with environmental isolates indicating the genetic relatedness. Interpretation & conclusion: Our findings showed that Rep-PCR was least discriminatory method. Ribotyping was a reliable and reproducible method. Ribotype IV was predominant ribotype followed by RIII. A total of 15 pulsotypes were generated and 11 of these were not reported earlier. Genetic relatedness was shown by clinical and environmental isolates which needs to be confirmed in future studies.

High occurrence of blaCMY-1 AmpC lactamase producing Escherichia coli in cases of complicated urinary tract infection (UTI) from a tertiary health care centre in north India.

AmpC beta lactamase producing Gram-negative bacteria have emerged worldwide. It is important to distinguish plasmid mediated AmpC β lactamases from chromosomally mediated enzymes for surveillance, epidemiology and hospital infection control as plasmid mediated genes can spread to other organisms. Occurrence of blaCMY-1 AmpC β-lactamase, a plasmid mediated cephamycinase was studied in 100 consecutive isolates of Escherichia coli from cases of complicated urinary tract infection (UTI). Screening for AmpC production was done by modified Hodge test, three dimensional test and AmpC disk test. All isolates showing a positive result by 2 out of 3 tests were then tested for blaCMY-1 gene by PCR. Fifty nine isolates were positive for AmpC β lactamase production, 56.6 per cent were positive by PCR. Eight out of 13 isolates which were negative by EDTA disk method were positive by PCR, whereas none of the isolates negative by 3D and modified Hodge test was positive by PCR. Among admitted patients urinary catheterisation was the major risk factor followed by obstructive uropathy, three patients developed urosepsis. High occurrence of blaCMY-1 AmpC β-lactamase warrants health care workers to endorse good hospital practices.

Pediatric solid malignant neoplasms: A comparative analysis.

Background: Pediatric solid malignant neoplasms (PSMNs) are a significant cause of death among children. Our aim was to evaluate the pattern and frequency of PSMNs at our hospital in the United States and compare the results to data from other regions of the world. Materials and Methods: This is a retrospective review of 127 PSMNs in the Pathology database at Stony Brook University Medical Center (SBUMC) from 2000 to 2008. We compared our cases to a cohort of 101 cases from an academic hospital in India (1975-1982) (Christian Medical College and Hospital) and to reports from other parts of the world. Results: We report a male to female ratio of 1.16 : 1 and a mean age of 4.8 years for cases at SBUMC. Lymphomas and central nervous system (CNS) neoplasms were more common in the 5-12-year-old group while other major diagnostic groups were more common in the 0-4-year-old group. The top five most frequent tumor categories included CNS, sympathetic nervous system (SNS), soft tissue, lymphoid and renal tumors. Lymphomas were more common than soft tissue and SNS tumors in the United States' registries but all three occurred with equal frequency in our study. Tumors of the soft tissue and SNS were more frequent at SBUMC compared to registries around the world. At the academic hospital in India, the male to female ratio was 4 : 1 and the five most frequent tumor categories included lymphoid, SNS, CNS, renal and bone tumors. Lymphoid tumors made up a greater percentage and CNS tumors made up a lesser percentage of tumors at the hospital in India compared with SBUMC. The differences between CNS tumors, lymphomas and retinoblastomas between the two hospitals were statistically significant (P value <0.05 by Fisher's Exact test). Conclusions: Geographic differences in the incidence and histologic types of PSMNs exist. Despite advancements in diagnosis and treatment, PSMNs continue to be tragically lethal.

Effects of obesity on balance and gait alterations in young adults.

The effects of obesity on the balance and gait parameters like step width and foot angle (degree of toe out) in young adults were studied. 60 subjects of both the genders were taken. 30 were taken as a control group (non-obese, BMI < 25) and 30 were taken as experimental group (obese, BMI 30 >). Functional Reach Test (FRT) was used for Balance Testing and the Footprint method was used for Gait parameters measurements. The value of functional reach test in females was 11.90±0.12 inches in control group and 7.01±1.80 inches in experimental group (t=5.31, P<0.001) and in males, it was 16.45±0.72 inches in control and 11.66±0.53 inches in experimental group (t=6.47, P<0.001). The degree of toe out in females was 6.66±0.08 degrees for control and 8.13±0.21 degrees for experimental group (t=4.08, P<0.01) and in males, it was 6.59±0.04 for control and 9.79±0.51 for experimental group (t=6.53, P<0.001). The step width was found to be 4.41±0.15 inches (control group) and 6.27±0.35 inches (experimental) in males (t=4.53, P<0.01) and it was 3.95±0.03 inches (control) and 3.42±1.05 inches (experimental) in females (t=0.77, P>0.05). We concluded that obesity has a negative impact on balance of an individual. The degree of toe out was more in obese group as compared to normal BMI group in both genders. The Step Width measurement was more in males of obese group than that in males of normal BMI group but it showed statistically insignificant when compared in females of both groups.

Pediatric urinary tract infections in a tertiary care center from north India.

Background & objectives: Paediatric urinary tract infections (UTI) are associated with high morbidity and long term complications like renal scarring, hypertension, and chronic renal failure. A cause of occult febrile illness, they often remain undiagnosed. We studied the clinical and microbiologic profile and antibiotic resistance profile of such infections in paediatric UTI patients at our center. Methods: Clean catch mid-stream urine samples for culture were received from 1974 children aged < 12 yr over a period of 6 months. Quantitative wet mount microscopy and semiquantitative culture on cysteine lactose electrolyte deficient medium were done to diagnose UTI. Isolates were identified by standard biochemical tests and antimicrobial sensitivity was determined. Clinical details including risk factors and underlying illness were noted. Results: Significant bacteriuria was found in 558 children (28.3%). Male gender (25.6%), age < 1 yr (77.5%), vesicoureteric reflux disease (VUR) (19.9%) and posterior urethral valve (PUV) (27.6%) were common risk factors in children suffering from UTI. Pyuria was detected in 53.6 per cent of infections. Common uropathogens isolated were Escherichia coli (47.1%), Klebsiella spp. (15.6%), Enterococcus fecalis (8.7%), members of tribe Proteae (5.9%), Pseudomonas aeruginosa (5.9%) and Candida spp. (5.5%). Against lactose fermenting Enterobacteriaceae, in-vitro resistance was least against amikacin (32.5%), nitrofurantoin (26.7%) and imipenem (3.7%). Among enterococci, vancomycin resistant enterococci constituted 12 per cent of the strains. 93.4 per cent of the UTI detected was nosocomial. Interpretation & conclusion: Paediatric UTI was common in children with male gender, age < 1 yr, and in children suffering from VUR and PUV. Spectrum of pathogens causing paediatric UTI in our center had a preponderance of nosocomial multi-drug resistant pathogens.