Assessing burden and its determinants in caregivers of chronic kidney disease patients undergoing haemodialysis

Background: Caregivers face a lot of adversities while supporting their near ones undergoing haemodialysis, and their burden is often ignored by health professionals. The paucity of research in the Indian context has kept their needs out of sight. Aim: To explore the level of burden in the caregivers of patients with chronic kidney disease (CKD) undergoing haemodialysis and to assess whether patient related variable affects the burden. Methods: Fifty-one patients and their caregivers from two dialysis units in Sikkim, India, were assessed cross-sectionally. The Zarit Caregiver Burden Scale (ZCBS) was administered to measure the caregiver burden. The Patient Health Questionnaire-9 (PHQ-9) and the Charlson’s Comorbidity Index (CCI) assessed the patient’s depression and medical comorbidities, respectively. Descriptive analysis was done for the sociodemographic and clinical variables. Chi-square test was used to find the association between the categorical data. Kruskal-Wallis tested the association between categorical and quantitative variables. Results: Mean age of patient was 46.13 (±13.15) years and that of the caregiver was 44.78 (±12.14) years. 68.6% of caregivers had mild to severe levels of caregiver burden. Caregivers who were unemployed and educated till secondary school were more likely to report caregiver burden. Female gender, older caregivers, and caregivers attending patients with a longer history of haemodialysis reported a more severe burden. Conclusion: The level of burden in caregivers of CKD patients is significant and is affected by various factors, which, in turn, also affects patient’s wellbeing. Further research in this area is needed in our country for better management of patients and policymaking.

Neuropathic pain in cancer patients: A brief review.

Neuropathic pain (NP) is initiated or caused by a primary lesion or dysfunction in the nervous system. The NP in cancer patients is typically due to a combination of inflammatory, neuropathic, ischemic, infiltrative, and compression mechanisms that involve one or more anatomic sites. These patients will often have various types of co‑existing pain syndromes and co‑morbidities. Thus, any treatment plan needs to be individualized. After a thorough clinical assessment and evaluation, a combination therapy including anticonvulsants, antidepressants, N‑methyl‑D‑aspartate antagonists, opiates, topical agents, and interventional procedures should be considered in these patients.

Characterization and anti‑microbial susceptibility of bacterial isolates: Experience from a tertiary care cancer center in Delhi.

BACKGROUND: Hospitalization for fever in cancer patients is associated with considerable morbidity, mortality, and cost. AIM: The aim of this study was to study the bacterial spectrum and susceptibility patterns of pathogens in culture positive patients from the oncology unit of our hospital. METHODS: We retrospectively reviewed the medical records of patients admitted in our cancer center (medical, radiation, and surgical oncology) from January to December 2013. Blood and respiratory secretions from the indoor patients were evaluated. RESULTS: Of the total 693 samples, 76.4% were Gram‑negative and 23.6% were Gram‑positive. The most common bacterial isolates among Gram‑negative organisms in blood were Escherichia coli, Salmonella and among the Gram‑positive organism were Staphylococcus aureus and Enterococcus. Among the blood isolates extended spectrum of beta‑lactamase, multidrug‑resistant (carbapenem‑resistant) and pan resistant bugs were seen in 47%, 15%, and 5% of the blood isolates. Among the Gram‑positive organisms, 25% respiratory isolates were vancomycin‑resistant Enterococci. CONCLUSION: We observed a high incidence of Gram‑negative isolates with clinically significant resistance to first‑line antibiotics such as cephalosporin’s, piperacillin tazobactum, and fluoroquinolones.

Percentage Body Fat in Apparently Healthy School Children From Northern India.

Context: Increased prevalence of obesity in childhood and adolescence, defined by the use of body mass index (BMI), has drawn attention towards direct measurement of body fat Objective: To develop age-and sex-specific reference distribution of body fat in apparently healthy North-Indian children in the age group of 7-17 years and to assess agreement between obesity (defined by BMI) and excess body fat Design: Study subjects for this cross sectional study included1640 apparently healthy school children (825 boys; 815 girls) aged 7-17 years. Total body fat was measured by dual energy X-rays absorptiometry (DXA). The excess body fat by DXA was defined by two methods, prevalence matching and with the use of 85th and 95th centile cutoffs. Results: The mean ± SD, 3rd, 10th, 25th, 50th, 75th, 90th and 97th centile values of percentage body fat (PBF) are presented. PBF was highly correlated with BMI in both boys and girls (all boys: r=0.76, P<0.0001; all girls r=0.81, P<0.0001). There was no significant difference noted in PBF between boys and girls at the age of 7-8 years. From 9 years onwards, girls had significantly higher PBF than boys. Moderate degree of agreement was observed between BMI and PBF by DXA by both methods. Conclusions: Smoothened reference distribution of PBF for North-Indian children and adolescents in Delhi are provided. Indian children accumulate more body fat during peri-pubertal years in comparison with US children.

Comparative organoleptic quality of Indian major carps collected from pond and reservoir.

An attempt was made to distinguish the possible organoleptic differences between the pond reared and wild fish species of reservoirs and correlate these with the physicochemical characteristics of water bodies. The texture was found to firmer in wild varieties of fishes than pond reared fish, with best in Catla catla followed by Labeo rohita and Cirrhinus mrigala. All the cultured fishes had lighter colour than wild fish species which were darker in appearance. Comparatively, higher dissolved oxygen and transparency levels with low temperature and alkalinity levels were found in reservoirs. Hydrobiologically, the efficient ecosystem of reservoir was responsible for stronger texture and dark colouration in wild fish species. The fishes from reservoir exhibit tendency to lead active and agile life, comparatively the fishes from ponds are docile. Reservoirs have the potential of enhanced quality fish production.

Field evaluation of ZeroFly® - an insecticide incorporated plastic sheeting against malaria vectors & its impact on malaria transmission in tribal area of northern Orissa.

Background & objectives: Insecticide incorporated plastic sheeting is a new technology to control mosquitoes in emergency shelter places and also temporary habitations in different locations. Therefore, field studies were conducted to assess the efficacy of ZeroFly® plastic sheeting treated with deltamethrin on prevailing disease vectors Anopheles culicifacies and An. fluviatilis and its impact on malaria transmission in one of the highly endemic areas of Orissa. Methods: The study was conducted in Birkera block of Sundargarh district, Orissa state. The study area comprised 3 villages, which were randomized as ZeroFly plastic sheet, untreated plastic sheet and no sheet area. ZeroFly plastic sheets and untreated plastic sheets were fixed in study and control villages respectively covering all the rooms in each household. Longitudinal studies were conducted on the bioefficacy with the help of cone bioassays, monitoring of the mosquito density through hand catch, floor sheet and exit trap collections and fortnightly domiciliary active surveillance in all the study villages. Results: In ZeroFly plastic sheeting area, there was a significant reduction of 84.7 per cent in the entry rate of total mosquitoes in comparison to pre-intervention phase. There was 56.2 per cent immediate mortality in total mosquitoes in houses with ZeroFly sheeting. The overall feeding success rate of mosquitoes in the trial village was only 12.5 per cent in comparison to 49.7 and 51.1 per cent in villages with untreated plastic sheet and no sheet respectively. There was a significant reduction of 65.0 and 70.5 per cent in malaria incidence in ZeroFly plastic sheeting area as compared to untreated plastic sheet and no sheet area respectively. Interpretation & conclusions: Our study showed that introduction of ZeroFly plastic sheets in a community-based intervention programme is operationally feasible to contain malaria especially in the high transmission difficult areas.

Congenital stridor due to bilateral vocal cord palsy.

Congenital stridor is one of the rare presentations of respiratory distress at birth. The commonest cause of congenital stridor is laryngomalacia, which accounts for 60% of the causes. The other common causes are congenital subglottic stenosis and vocal cord palsy (VCP). VCP is usually unilateral and most often linked with birth trauma, and is temporary. Bilateral palsy can be associated with other congenital anomalies. The current report describes a case of congenital bilateral VCP, not related to birth trauma and severe enough to require tracheostomy.

Antioxidant property of Smilex china Linn.

Smilex china Linn. (Smilacaceae Syn Liliaceae) has special pharmacognostic feature as its root is multiseriate, with sclerenchymatic pericycle. The alcoholic extract of rhizome of S. china shows significant protection against FeSO4 induced lipid peroxidation in rat liver homogenate, but has no effect on the rate of oxidation of reduced glutathione. This fraction scavenges the superoxide and hydroxyl radicals, but the effect was more towards the removal of superoxide than that of hydroxyl radicals. Thus it could be concluded that rhizome of S. china has strong antioxidant property.

Seizures in the newborn.

Seizures in the newborn period constitute a medical emergency. Subtle seizures are mild paroxysmal alterations in motor or autonomic activity and are unique to the neonatal period. They are likely to be missed or confused with benign movements observed commonly in preterm children. Focal clonic seizures have a better prognosis as compared to myoclonic seizures for long-term neuro-developmental outcome. Seizures due to sub-arachnoid hemorrhage and late onset hypocalcemia carry a better prognosis as compared to seizures due to hypoglycemia, meningitis and cerebral malformations. Hypoglycemia and hypocalcemia are common causes and should be excluded in all neonates with seizures. Multiple etiologies can co-exist in neonatal seizures and a comprehensive approach for management of neonatal seizures has been described.

Antilipid peroxidative property of Nardostachys jatamanasi.

Antiperoxidative property of N. jatamanasi was tested by using iron induced lipid peroxidation in 5% rat liver homogenate. The degree of peroxidation was quantitated by thiobarbituric acid reactive substance (TBARS) content. The extract provided protection against lipid peroxidation. The hexane fraction was more potent than the alcoholic extract. Results suggested antilipid peroxidative property of the plant.

Bacopa monniera Linn. as an antioxidant: mechanism of action.

Bacopa monniera, Linn. (Brahmi: Scrophulariaceae) an Ayurvedic medicine is clinically used for memory enhancing, epilepsy, insomnia and as mild sedative. For the first time the effect of alcohol and hexane fraction of Brahmi has been studied on FeSO4 and cumene hydroperoxide induced lipid peroxidation. Alcohol fraction showed greater protection with both inducers. Results were compared with known antioxidants tris, EDTA and a natural-antioxidant vitamin E. The effect of Brahmi was also examined on hepatic glutathione content. The mechanism of action could be through metal chelation at the initiation level and also as chain breaker. The results suggested that Brahmi is a potent antioxidant. The response of Brahmi was dose dependent. Tris, an hydroxyl trapper did not show any protection in comparison to Brahmi where as EDTA and vitamin E did protect against FeSO4. In experimental conditions 100 micrograms Brahmi extract (alcoholic) was equivalent to 247 micrograms of EDTA (0.66 microM) and 58 micrograms of vitamin E. Interestingly Brahmi only slightly protected the autooxidation and FeSO4 induced oxidation of reduced glutathione on lower doses 100 micrograms/ml and below, but on higher concentrations it enhanced the rate of oxidation.

Asymptomatic spinal tuberculosis presenting as esophageal stricture.

Esophageal tuberculosis is rare and is usually due to secondary extension from contiguous structures. We report a patient who presented with dysphagia and was found to have esophageal stricture. Endoscopic biopsy was not suggestive of malignancy or tuberculosis. CT scan of the thorax revealed involvement of the fourth thoracic vertebra with paratracheal lymphadenopathy. The patient responded to anti-tubercular therapy.

Status of nitric oxide free radicals in diabetic neutrophils: effect of diabetic serum factor on the generation of these species in normal neutrophils and their relation to lysosomal degranulation.

Normal polymorphonuclear leukocytes (PMNL) in contrast to diabetic PMNL, generated significant amounts of .NO and NO2 when challenged with opsonised zymosan. Diabetic neutrophils, on the other hand, responded either weakly or insignificantly to the same stimulants. However, in resting state the levels of .NO and NO2 were higher in diabetic as compared to normal PMNL. Diabetic serum factor (DSF) provoked a significant generation of .NO and NO2 in normal PMNL, a phenomenon found parallel to the enhancement in cytosolic cathepsin D activity in normal cells on insult with DSF.

A case control study of cancer cervix patients attending Command Hospital, Pune.

A case control study was undertaken with the objective to determine the association of certain host factors like marital status, age at first marriage, duration of married life, parity, literary status and genital hygiene, in the subsequent development of cancer cervix. A total number of ninety-two cases and an equal number of control subjects, under matched case control design, were studied at Command Hospital, Pune over a period of nine months. Salient findings of this epidemiological study have been highlighted in this communication. Few of the risk factors viz early age at first marriage, longer duration of married life, increased and early parity, low educational status and poor genital hygiene were found to have played significant role in the subsequent development of carcinoma cervix.