Study of breast feeding knowledge among mothers in perinatal period admitted in a tertiary care centre in Dehradun, Uttarakhand, India

Background: Exclusive breast feeding reduces infant and neonatal mortality. NFHS-3 (2005-06) and NFHS-4 (2015-16) (India), showed only marginal improvement from 46% to 55%, regarding exclusive Breast feeding, among children during first 6 months of life. If mother’s knowledge is good, she will be confident to take decision on Breast feeding. This study was conducted to assess, the knowledge, regarding breast feeding, among mothers in perinatal period admitted in a tertiary care centre in Dehradun, Uttarakhand, India.Methods: This was descriptive, cross-sectional study carried out among 300 perinatal mothers. The data was collected using self-administered questionnaires.Results: 95% of mothers knew that the breast milk is best for the baby. 75% of mothers were aware that the breast milk should be the neonates first feed, though only 55% knew about initial breast milk (colostrum). 77% of the mothers said the time for first feed should be within an hour. 27% said baby should be fed as and when hungry. 56% of the mothers stated that the baby should be allowed to feed as long as the baby sucks at the breast. 63.7% mothers were aware about the duration of EBF.Conclusions: Knowledge regarding exclusive breast feeding is inadequate among mothers in Uttarakhand. The government must incorporate breast feeding topic in schools to improve the knowledge on breast feeding, so that mothers can take decision independently.

Traditional beliefs and practices in newborn care among mothers in a tertiary care centre in Dehradun, Uttarakhand, India

Background: Neonatal care practices are different in different communities. Before any intervention planned to reduce mortality and mortality in community, understanding of local belief and practices is necessary. Some of the harmful practices need to be abandoned and good or harmless practices need to be appreciated. This study was conducted to understand the cultural beliefs and practices in newborn care among residents of Uttarakhand.Methods: This was descriptive, cross-sectional study carried out among 300 postnatal mothers admitted to the hospital. The data was collected using self-administered questionnaires. Statistical analyses of the data was done using SSPS version 22.0.Results: 4% of the mothers believed colostrum to be unsuitable for the newborn. 71% mothers were practicing daily baby massage. 71.3% believed that hot and cold foods can harm their baby’s health. 57.3% practiced application of Kajal on baby’s face. 74.7% of mothers would keep Knife under pillow and 16.7% match box under baby’s cloth. 5.3% mother believed in practice of branding. 81% of mothers accept to practice of pouring oil in baby’s ear. 22.3% mothers believed in isolating mother baby together for 30-40 days.Conclusions: Certain practices are still prevalent like Branding, discarding colostrum, Kajal application, pouring oil in baby’s ear and very restricted dietary regime of mothers. These practices need to be stopped by educating mothers and relatives in postnatal wards.

Binding pattern of 125Iodine thyroxine and tri-iodothyronine in skin and liver tissues of spotted munia, Lonchura punctulata: Co-relation to seasonal cycles of breeding and molting.

Prevalent notion about thyroid hormones is that thyroxine (T4) is a mere precursor and physiological effects of thyroid hormones are elicited by tri-iodothyronine (T3) after mono-deiodination of T4. Earlier studies on feather regeneration and molt done on spotted munia L. punctulata suggest that T4 (mono-deiodination suppressed by iopanoic acid and thyroidectomized birds) is more effective than T3 in inducing feather regeneration. The binding pattern of 125I labeled T4 and T3 has been investigated in the nuclei prepared from skin and liver tissues (samples obtained during different months) of spotted munia using scatchard plot analysis. The results show that binding capacity (Bmax – pmole/80 µgm DNA) of 125I-T3 to nuclei of skin was significantly higher in November as compared to April and June, whereas the binding affinity (Kd-10-9M-1) was significantly lower in November as compared to April and June. During November, Bmax for binding of T3 and T4 did not vary in liver and skin nuclei but Kd varied significantly. Binding capacity of 125I- T3 to skin and liver did not vary but binding affinity of 125I- T4 to skin was approximately 7 times higher than that of liver. The results suggest that T4 does show a variation in binding pattern that co-relates to the molting pattern of spotted munia. These variations might play important role in different physiological phenomenon in this tropical bird. The experiments do point towards the possibility of independent role of T4 as a hormone, however, further experiments need to be done to ascertain the role of T4 in this model and work out the exact molecular mechanism of action.

Blood group phenotype frequencies in blood donors from a tertiary care hospital in north India

BACKGROUND: Knowledge about the frequency of red blood cell-antigen phenotypes in a population can be helpful in the creation of a donor data bank for the preparation of indigenous cell panels and for providing antigen-negative compatible blood to patients with multiple alloantibodies. METHODS: ABO and RhD blood grouping was performed on 9,280 continuous voluntary and replacement donors. For other rare blood groups, 508 ACD blood samples were obtained from the donors at the Blood Bank of the Department of Transfusion Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Blood group antigens were determined by tube method using anti-sera (Bio-Rad, USA), and the phenotype frequencies were expressed as percentages. RESULTS: Group B (37.39%) was the most common, followed by group O (31.85%). R1R1 and rr were the most common phenotypes amongst Rh positive and Rh negative groups, respectively. A rare phenotype R2Rz was found in one donor. For Kidd and Duffy blood group systems, Jk (a+b+) and Fy (a+b+) were the most common phenotypes (46.06% and 48.03%, respectively). The most common phenotypes for MNSs, Lu, and Kell blood groups were M+N+, S-s+, Lu (a-b+), and K-k+, respectively. A very rare case of Fy (a-b-) and Jk (a-b-) was found in a single donor. CONCLUSION: This study is the first small step to create a rare donor data bank and to prepare indigenous cell panels to provide compatible blood to all multi-transfused alloimmunized patients.

Blood group phenotype frequencies in blood donors from a tertiary care hospital in north India

BACKGROUND: Knowledge about the frequency of red blood cell-antigen phenotypes in a population can be helpful in the creation of a donor data bank for the preparation of indigenous cell panels and for providing antigen-negative compatible blood to patients with multiple alloantibodies. METHODS: ABO and RhD blood grouping was performed on 9,280 continuous voluntary and replacement donors. For other rare blood groups, 508 ACD blood samples were obtained from the donors at the Blood Bank of the Department of Transfusion Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Blood group antigens were determined by tube method using anti-sera (Bio-Rad, USA), and the phenotype frequencies were expressed as percentages. RESULTS: Group B (37.39%) was the most common, followed by group O (31.85%). R1R1 and rr were the most common phenotypes amongst Rh positive and Rh negative groups, respectively. A rare phenotype R2Rz was found in one donor. For Kidd and Duffy blood group systems, Jk (a+b+) and Fy (a+b+) were the most common phenotypes (46.06% and 48.03%, respectively). The most common phenotypes for MNSs, Lu, and Kell blood groups were M+N+, S-s+, Lu (a-b+), and K-k+, respectively. A very rare case of Fy (a-b-) and Jk (a-b-) was found in a single donor. CONCLUSION: This study is the first small step to create a rare donor data bank and to prepare indigenous cell panels to provide compatible blood to all multi-transfused alloimmunized patients.

Huge uterine-cervical diverticulum mimicking as a cyst.

Here we report an incidental huge uterine-cervical diverticulum from a total abdominal hysterectomy specimen in a perimenopausal woman who presented with acute abdominal pain. The diverticulum was mimicking with various cysts present in the lateral side of the female genital tract. Histopathological examination confirmed this to be a cervical diverticulum with communication to uterine cavity through two different openings. They can attain huge size if left ignored for long duration and present a diagnostic challenge to clinicians, radiologists, as well as pathologists because of its extreme rarity. Therefore, diverticula should also be included as a differential diagnosis. Its histopathological confirmation also highlights that diverticula can present as an acute abdomen, requiring early diagnosis with appropriate timely intervention. Immunohistochemistry CD 10 has also been used to differentiate it from a mesonephric cyst.

Individual donor nucleic acid testing for blood safety against HIV-1 and hepatitis B and C viruses in a tertiary care hospital.

Background. In July 2010, we started universal individual donor nucleic acid testing (ID-NAT) at our blood bank. This test simultaneously detects human immunodeficiency virus-1 (HIV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) in samples of donor blood. We continued to do the enzymelinked immunosorbent assay (ELISA) test for these agents, as per the guidelines of the Drug Controller General of India. We assessed the impact of ID-NAT in preventing transfusionassociated transmission of viruses. Methods. We used fourth generation ELISA to screen blood samples of all voluntary and replacement blood donors. ID-NAT was done by transcription-mediated amplification (TMA). Results. Of the 18 356 donors, ID-NAT could not be performed on 2 samples which were inadequate. Of the 18 354 donors tested by both ID-NAT and fourth generation ELISA, 7 were found to be NAT-positive but ELISA-negative (NAT yield) for HBV and HCV. The prevalence of NAT yield cases among routine donors was 1 in 2622 donations tested (0.038%). Since we supply blood as components (packed red cells, fresh frozen plasma and platelet concentrate), these 7 units of blood would have yielded 21 components and hence 21 patients could have been infected with HBV and HCV viruses. Conclusion. In the vast majority of blood units tested, the results of ELISA and ID-NAT for HIV-1, HBV and HCV were concordant. ID-NAT did detect the presence of viruses missed by ELISA in some blood units. It widespread use in blood banks would ensure safer blood transfusion.

Reliability of Fine Needle Aspiration Cytology (FNAC) in Very Small Breast Lumps.

FNAC diagnosis and subsequent histopathology of 166 breast lumps of different sizes, depth and mobility were studied prospectively over a 10-year period (1990-2000) and grouped into two groups. Group-I of lumps <2cm and Group-II of lumps >2cm (control 80 cases). They were again subclassified as deep or not deep and mobile or fixed. Statistically significant positive correlation was found in all categories for less accurate diagnosis of lumps of <2 cm as compared to those of >2 cm. Therefore, because of low diagnostic accuracy in Group- I, it is recommended that for lumps <2cm even if the FNAC diagnosis is “non-malignant” a lumpectomy histopathological examination be done.

Irrigation with domestic wastewater: Responses on growth and yield of ladyfinger Abelmoschus esculentus and on soil nutrients.

Domestic wastewater is generated continuously and in large quantities. It can serve as an alternative water nutrient source for irrigation. In the present study Abelmoschus esculentus L. (Ladyfinger) was irrigated using untreated wastewater (T1), treated wastewater (T2) and rainwater (T3) in pot experiments. The effect was seen on nutrient fortication, growth and yield of the plant and the nutrient status of the soil. Additionally the build up of Cr, Cu and Zn from the irrigation water were anlayzed in different parts of the plant biomass and in the soil. The sapling survival rate was found to be 87% in T1 followed by T2 and T3. Root shoot ratio under different treatments was found in the order T3 (0.46) >T2 (0.35) >T1 (0.31). The chlorophyll a, b and carotene content in the leaves (mg g-1) was found to be 6.3, 0.5, 0.9 under T1, 4.8, 0.4, 0.8 under T2 and 3.2, 0.3, 0.5 under T3 respectively and all the three varied in the order T1>T2>T3. The same trend was found in case of total dry matter (g) T1 (6.3) >T2 (3.7) >T3 (2.3) at p<0.05. There was a considerable increase in nutrients in the soil under T1 and T2 as compared to T3 after final harvest. The organic matter (%), NO3 -N and PO4 3- (mg kg-1) content post harvest soil was found to be 3.4, 71, 90 under T1 and 2.9, 52, 63 under T2 respectively. Also, there was an increase in cations Na, K, Ca and Mg in the soil irrigated with T1 and T2 after the final harvest. Thus irrigation with wastewater generally increased soil fertility. Only a small percentage of the heavy metal was bioaccumulated by the plant parts from the irrigation water. There was hardly any metal accumulation in fruits. Bulk of the metal ions remained in the soil.

A rare presentation of invasive rhino-orbital mucormycosis in an immunocompetent young girl: a case report.

A 18 year young, healthy, immunocompetent girl presented with proptosis of left eye, referred to eye OPD, suspected clinico-radiologically as malignancy. This presentation with suspicion of malignancy resulted into extensive surgical debridement with removal of left eye, which was diagnosed as mucormycosis on histopathological examination. Her eye could have been saved if the mucormycosis was highly suspected initially, because of the good general health and immunocompetency led to misdirected thought.

Presence of Hb S in Uttaranchal.

Haemoglobin-S has been reported in several studies on remote populations from various parts of India eg Maharashtra, Madhya Pradesh, Andhra Pradesh, Orissa, West Bengal, Rajasthan and Malaysian Indians. Uttaranchal also has got scattered areas with people living in remote-pockets due to its geophysical nature. There has been no previous report from this state about prevalence of Hb-S. In the present study on 38 individual eight were found to have Hb-S positivity by sickling test. In one of these electrophoretic confirmation was positive with demonstration of associated Beta thalassaemia. The group was a family of muslims in village Baghori near Haldwani. Due to technical, geographical and social restrictions further study could not be done. However, this study does establish the presence of Hb-S-Beta thalassaemia in Uttaranchal State for the first time. Follow up study in the affected area and elsewhere in the state might discover more of Hb-S positivity, other haemoglobinopathies and thalassaemias.

TORCH infection in women with bad obstetric history--a pilot study in Kumaon region.

TORCH infections in the mother are transmissible to fetus in the womb or during the birth process and cause a cluster of symptomatic birth defects. In mother they are inapparent or asymptomatic and hence difficult to diagnose clinically. Over a nine months period 20 pregnant women with bad obstetric history were-studied. Seropositivity of Toxoplasma, rubella, CMV, and HSV infections (TORCH) were demonstrated by the presence of IgM and IgG antibodies by ELISA method. It was found that, IgM antibodies were positive in 4 cases (20%) for Toxoplasma, 4 cases (28.6%) for rubella and 4 cases (26.7%) for CMV and HSV each. IgG antibodies were positive in 11cases (55%) for Toxoplasma, 10 cases (66.6%) for rubella, 14 cases (93%) for CMV and 11 (73%) for HSV. Therefore all antenatal cases with BOH should be routinely screened for TORCH as early diagnosis and appropriate intervention will help in proper management and fetal outcome.

Nephrogenic diabetes insipidus presenting with developmental delay and intracranial calcification.

A one-year-boy presented with constipation, fever, failure to thrive and developmental delay from the neonatal period. Investigations revealed persistent hypernatremia and deranged renal functions. Diagnostic work-up was suggestive of nephrogenic diabetes insipidus (NDI). Computerized tomography of head revealed calcification in the frontal, thalamic and basal ganglia region. The rare association of NDI and intracranial calcification is discussed.

Human brucellosis: review of an under-diagnosed animal transmitted disease.

Human brucellosis is an important animal transmitted disease of man. Although, the cases have been recorded all over the world, the prevalence is higher in developing countries. Lack of sufficient knowledge about the disease among the physicians, its under-diagnosis or misdiagnosis and absence of effective prevention and management strategies are attributed to the widespread of the disease. Increase in the occurrence of animal brucellosis has also resulted indirectly in an increase in the prevalence of human infection. Absence of characteristic clinical symptoms, chronic nature of the infection and difficulty in isolation of the causal agent from the patients make the diagnosis of the disease more difficult. The serological tests employed for diagnosing human brucellosis vary in terms of their sensitivity and specificity. Therefore, a combination of serological tests is desirable. Currently no vaccine is available against human brucellosis, which could check the spread of the disease effectively. It is suggested that clinicians investigate the cases of pyrexia of unknown origin (PUO) for brucellosis. It is desirable that specimens from cases of tuberculosis, typhoid, rheumatoid arthritis, urogenital infections, kala-azar, cirrhosis, bacterial endocarditis, leukemia and filariasis should also be screened for brucellosis in man. The cases of meningitis of unestablished etiology as the cases of human brucellosis are often misdiagnosed as cases of typhoid or tuberculosis.

Seroprevalence of brucellosis in man.

A total of 352 human serum samples were screened for brucellosis. A combination of serological tests including Rose Bengal plate test (RBPT), standard tube agglutination test (STAT) and dot-enzyme linked immunosorbent assay (dot-ELISA) were employed for the purpose. The study revealed a prevalence rate of 4.97 per cent in samples that included specimens from persons occupationally exposed to animals. The number of seropositives through all tests used was higher among males (5.95 per cent) than females (3.15 per cent). A markedly higher prevalence of 17.39 per cent was recorded among field veterinarians. A low prevalence (2-6 per cent) was observed in humans with unknown history of animal contact. Dot-ELISA yielded 4.97 per cent positives compared to 1.38 and 0.82 per cent through RBPT and STAT respectively.

Enterotoxigenicity as an attribute of virulence in Yersinia enterocolitica.

Seven strains of Y. enterocolitica were screened for their enterotoxic activity. Three strains belonging to serogroups 0:3 and 0:9 elicited enterotoxic response in rabbit ligated gut segments and in infant mice. The enterotoxin resisted heat at 65 degrees and 100 degrees C for 20 min. The toxin was eluted in the second beak material during Sephadex G-75 gel filtration. On the basis of polyacrylamide disc gel electrophoresis the toxic component had a molecular weight of about 12,400.