Diabetes self care activities among adults 20 years and above residing in a resettlement colony in East Delhi

Background: Self-care activities are the cornerstone of diabetes care that ensures patients participation to achieve optimal glycemic control and to prevent complications. Objective: The aim of this study is to find the level of self-care activities among diabetics aged ?20 years residing in a resettlement colony in East Delhi and its association with sociodemographic factors, disease, and treatment profile. Methods: Using cross-sectional survey, 168 known diabetic patients were selected from Nand Nagri, a resettlement colony in East Delhi. Data were collected using Hindi translation of revised version-Summary of Diabetic Self Care Activities along with a pretested semi-open-ended questionnaire. Self-care was assessed on six parameters as follows: (a) general diet, (b) specific diet, (c) exercise, (d) blood sugar testing, (e) foot-care, and (f) smoking. The study period was from November 2014 to April 2016. Results: Nearly 35.1% of respondents belonged to 60� years age group. About 52.4% of respondents were female. Fifty-two diabetics (31%) reported having practised diet control on all 7 days in the past 1 week. Nearly 39.3% of patients did not perform any physical activity. The blood test was not practised by 92.3% of respondents. Foot-care was practised by only 19% of patients. There was a significant association between general diet among diabetics with family support (P = 0.020), place of diagnosis (P = 0.033), and treatment funds (P = 0.017). The exercise score among diabetics who were below the poverty line was higher than those above poverty line (P = 0.029). Younger age (P = 0.005) and treatment with insulin (P = 0.008) were positively associated with blood glucose testing. The foot-care practice was better in patients aware of complications and foot-care practices (P < 0.001). Conclusion: Self-care activities among diabetic patients were very poor. Self-management educational programs at hospitals along with information, education, and communication activities at the community level and one-to-one counseling are recommended.

Family caregivers’ burden: A hospital based study in 2010 among cancer patients from Delhi.

BACKGROUND: A large number of patients with chronic diseases like, cancer are cared for in homes by the family members in India. The vital role that these family members play as “caregivers” is well recognized, however, the burden on them is poorly understood. AIMS: To assess burden and to determine the predictors of burden on family caregivers of cancer patients. SETTING AND DESIGN: A cross‑sectional, hospital based study conducted in National Capital Territory of Delhi. MATERIALS AND METHODS: 200 family caregivers of cancer patients were selected by systematic random sampling and interviewed using standard, validated Hindi version of Zarit Burden Interview. STATISTICAL ANALYSIS: Univariate analysis and multivariable logistic regression were carried out using Statistical Package for the Social Sciences software (version 17.0). RESULTS: The study population consisted of 90 (45%) males and 110 (55%) female caregivers aged 18‑65 years. 113 (56.5%) caregivers reported no or minimal burden while 75 (37.5%) caregivers reported mild to moderate burden. Using logistic regression marital status, education and type of family of caregivers, occupation of cancer patients and type of treatment facility were found to be the predictors of burden on caregivers. CONCLUSION: In view of the substantial burden on family caregivers coupled with lack of adequate number of cancer hospitals, there is a public‑health imperative to recognize this important group. All levels of health‑staff in cancer hospitals in developing countries should be sensitized to the various burdens faced by family caregivers.

Prevalence of stress among resident doctors working in Medical Colleges of Delhi.

The present cross-sectional study was conducted from November 2007 to December 2008 in four medical colleges and associated hospitals of Delhi. Study subjects comprised 930 resident doctors. The overall prevalence of stress was found to be 32.8% in resident doctors from all colleges. Out of 930 resident doctors, 165 (17.7%) had mild stress, 113 (12.2%) had moderate stress, and 27 (2.9%) were severely stressed. Important reasons of stress as perceived by the study subjects included long duty hours, departmental academic activities, financial constraints, family and emotional problems in the decreasing order of preference. Important factors significantly associated with stress-included existence of children, year of residency, type of department, and presence or absence of job satisfaction, having close friends, spending time with family/friends, and place of graduation. In the multivariate model, year of residency, giving time to family and or friends, having close friends during residency, job satisfaction, and state of graduation came out as predictors of stress.

Obesity amongst affluent adolescent girls.

OBJECTIVE: To assess the prevalence and type of obesity in affluent schoolgirls aged 16 and 17 yr. METHODS: A cross-sectional study was conducted in 2002, in 4 randomly selected public schools of Delhi. All girls from randomly chosen classes were included. Weight, height and waist and hip circumferences were measured for all 414 schoolgirls and their socio-demographic profile was recorded. Body mass index [BMI] and waist hip ratio [WHR] were calculated for all the girls. BMI > 30 (i.e.--95th percentile) denotes obesity and BMI > 25 (i.e.--85th percentile) denotes overweight as according to International Obesity Task Force (IOTF) criteria. WC > 80 cm or WHR > 0.85 denote central obesity. RESULTS: Prevalence of obesity and overweight amongst the study subjects was 5.3% and 15.2% respectively (IOTF). Out of the 22 obese girls central obesity was present in 21 girls (95.4%) [WC > 80 cm] and 12 girls (54.5%) [WHR > 0.85]. CONCLUSION: There is significant prevalence of obesity in affluent schoolgirls in Delhi and more than half of them have central obesity.

Chair side simple caries activity test: Ora test.

Oratest, a caries activity test was performed on 48 school going children of Mangalore city to estimate efficacy of the test. High statistical significance was found when the means of control and test group were compared [gamma = 0.913]. The Oratest is found to be a simple chair side, less time consuming and inexpensive caries activity test.

Disseminated histoplasmosis with reactive haemophagocytosis presenting as PUO in an immunocompetent host.

Disseminated histoplasmosis (DH) with reactive haemophagocytosis has been described in literature mainly in immunocompromised hosts. Only sporadic case reports exist in immunocompetent hosts. Here, we present a rare case of DH with reactive haemophagocytosis in an immunocompetent host presenting as PUO.

Prevalence of dental caries among 5-13-year-old children of Mangalore city.

A study of prevalence of dental caries was undertaken in 5-13-year-old children from Mangalore city. A total of 524 children were examined. The sample consisted of 193, 160, and 171 children in the 5-7, 8-10 and 11-13 years of age group, respectively. Dental caries was examined visually and observations were recorded. Silness and L phie plaque index, L phie and Silness gingival index were used to record the periodontal status. The prevalence of dental caries was highest in 5-7-year-age group compared to 8-10 years and 11-13 years age groups. The increasing prevalence of dental caries needs dental health programmes, which target the specific segments of the population.

Chemotherapy-induced palmer planter erythrodysesthesia.

We report a case of palmar plantar erythrodysesthesia (PPE) in a case of acute lymphoblastic leukemia treated with VALP regime. The treating physician must be aware of this uncommon complication of chemotherapeutic agents to avoid unnecessary investigations.

Is education a determinant of knowledge about malaria among Indian tribal population?

Malaria is a major public health problem in tribal villages of India, where 8% of the country's population lives. Literacy level among tribal population is very low. This study aims to examine the relation between education status and knowledge about malaria among Indian tribal communities. 125 randomly selected tribal respondents from one tribal village each of 17 states were administered a close ended questionnaire by trained interviewers to assess their knowledge about various aspects of malaria. Effect of educational status on the level of knowledge was analyzed using chi square test. Stratified analysis was performed using Mantel Haenszel chi square test to eliminate gender bias. 2125 respondents', randomly selected from 17 tribal villages in as many states, findings were analyzed. Fifty seven percent male and 72% female respondents were illiterate. Only 2% respondents had college level education. Educated females were more knowledgeable than their male counterparts. Mantel Haenszel chi square analysis showed that educated respondents were more knowledgeable than the illiterates, after adjusting for sex of respondents. However, there was gross lack of knowledge regarding diagnosis and treatment of malaria and use of insecticides irrespective of gender and educational status. Improvement in literacy status of tribal population will help in increasing awareness about malaria. Opportunities for disseminating information about various aspects of malaria should be utilized during treatment of malaria cases by health workers.

Pyogenic Brain Abscess and its Management

Forty-five cases of Brain abscess diagnosed were treated by elective aspiration through a burr hole and intra-cavitatory application of antibiotic. Repeated aspiration was needed in 30 cases and in only 05 cases surgical excision of abscess along with capsule was done. Mortality in our series was around 11 %. Cases with otogenic/sinusitis as causative factors did better than those cases. which were due to haematogenolls spread. Corticosteriods were not used in the managernent protocol. Five cases needed care in ICU with ventillatory support, 03 of which died.

Knowledge amongst adult population regarding vectors of malaria in 21 states of India.

Malaria is the world's most important tropical disease which kills more people than any other disease except tuberculosis. It is a public health problem in more than 90 countries, inhabited by a total of some 2400 million people, 40% of the world's population. More than 90% of all malaria cases are in sub Saharan Africa, with two thirds of the remainder concentrated in six countries viz. India, Brazil, Sri Lanka, Afghanistan, Vietnam and Columbia in decreasing order of prevalence. Even now the problem of malaria in India is grossly underestimated. A rough estimate of morbidity due to malaria made on the basis of consumption of antimalarials comes to 35.5 million episodes in addition to malaria cases treated by the National Anti Malaria Programme (NAMP). In addition to large scale morbidity and mortality, it affects agricultural and industrial produce causing great socioeconomic losses.

Status of physical exercise and its association with obesity and hypertension in two urban assembly constituencies of East Delhi.

In a community based study using systematic random sampling in two urban Assembly constituencies in East Delhi, 420 subjects above the age of 30 years were interviewed to find out their status regarding physical exercise. People doing regular exercise were found to be only 44.8%. The commonest reason associated for not doing/irregular physical exercise was nonavailability of time (63.3%), followed by no need felt by the respondents to exercise (23.3%). The prevalence of obesity in the group doing regular exercise was much lower than the group that was not doing regular exercise and the results were statistically significant. Though a similar association was found with hypertension also, the results were not statistically significant.

Long-term nutritional effects of ICDS.

Nutritional status of 1243 children (636 boys and 607 girls) in the age group of 7-13 years was assessed in relation to utilisation of Integrated Child Development Services (ICDS) during their childhood. All the houses in every 10th Anganwadi selected by systematic random sampling were surveyed in the ICDS project, Nand Nagri in East Delhi. Information regarding utilisation of ICDS facilities, sociodemographic details, general awareness etc. was collected by interview technique and anthropometric and clinical examination of every child was done and Anganwadi attendance score was calculated for each child. It was found that most of the children were non-beneficiaries (59.1%). On univariate analysis Anganwadi attendance score, age, sex of the child and education status of the father showed statistically significant association (p < 0.005) with malnutrition. On Multiple logistic regression analysis higher age (OR 1.4155 for grade 1 malnutrition and 1.6913 for grade 4 malnutrition) and being female (OR 1.5214 for Grade 4 malnutrition) remained significant risk factors for development of malnutrition for all grades. Anganwadi attendance score did not show any statistically significant association for decreasing the risk of getting malnourished for any grades of malnutrition in 7-13 years age group. There is special need to take special care for girls as well as to continue the special nutrition care even at an higher age. More in depth studies are needed so as to formulate effective nutritional policies for children.

Psychosocial dysfunction in tuberculosis patients.

Tuberculosis continues to be a major health problem in India. It carries social stigma and results in adverse psychological sequelae. In the present study, 50 patients suffering from tuberculosis were examined. There was higher degree of neuroticism and the patients with tuberculosis showed marked to severe psychosocial dysfunctioning in personal, familial, vocational, social and cognitive areas.

Perceptions of teachers regarding sex education in National Capital Territory of Delhi.

A cross sectional study was conducted to find out the knowledge and attitudes of school teachers regarding sex education. Information was collected from 476 senior secondary school teachers belonging both to the government and public schools, selected randomly in National Capital Territory of Delhi using pre-tested close ended questionnaires. A majority of school teachers (73%) were in favour of imparting sex education to school children. Regarding contents of sex education, 90% agreed to the inclusion of reproductive anatomy, physiology including menstruation and birth control measures like condoms and oral pills. However, a majority of school teachers did not want sex education to include topics like abortion, premarital sex and masturbation etc. Fourteen years of age was considered to be the most appropriate for imparting sex education by 28.6% of school teachers. School teachers and doctors were considered by 69.4% and 63.6% of the respondents respectively to be the most appropriate persons for providing sex education.

Spontaneous rupture of hepatic hydatid cyst causing inferior vena cava thrombosis.

We report a patient with an infected hepatic hydatid cyst, which spontaneously ruptured into the inferior vena cava, with resultant thrombosis of the inferior vena cava, and left renal, right common iliac and right external iliac veins.

Tuberculous mediastinitis: a rare presentation.

Granulomatous mediastinitis is a rare condition, and tuberculosis and fungal infections are the most important causes of this potentially lethal condition. Tuberculous mediastinitis usually presents with fever, cough, dyspnoea and rarely, florid features of obstruction to intra-thoracic structures are seen. A case of tuberculous mediastinitis presenting as a suprasternal lump, a rare presentation, is described here.

Process evaluation of pulse polio immunisation in Delhi.

The aim of the study was to assess the functional aspects and the staffing at Pulse Polio immunisations posts. Interns and medical students conducted the survey in eighty seven pulse polio immunisation posts scattered all over National Capital Territory of Delhi on 18th January 1997. A pre-tested structured format containing information pertaining to dose utilisation and staffing was filled. Number of children given pulse polio was on an average 459.2 per immunisation post (474.7 rural, 516.35 slums and 435.0 urban). Average number of neonates (below one month) per immunisation post given polio drops was 5.1 (1.1%). The break-up for rural area, slums and urban area was 3.0 (0.63%), 6.7 (1.30%) and 4.9 (1.13%) respectively. By 12 pm, 67.8% and by 2 pm 88.7% of the doses had been administered. Staffing at most of the immunisation posts was adequate for all categories of staff except doctors (0.48 per booth).