Risk of Childhood Obesity in Children With High Birth Weight in a Rural Cohort of Northern India

Objective: To compare the risk of early childhood obesity (BMI zscore of ?+2SD) among children of more than 7 years of age with a birth weight of more than 3500 g to a birth weight of 2500- 2999 g. Methods: Retrospective birth cohort study among children of 7 to 10 years of age in 22 villages of Himachal Pradesh with notexposed (birth weight: 2500 to 2999 g) and exposed (> 3500 g) group. Results: A total of 379 and 377 participants were enrolled in notexposed and exposed group, respectively. Adjusted relative risk (aRR) between exposed and high BMI (>+2SD) was 4.9 (95%CI: 1.3-17.5) adjusted for mean age, gender, mean years of schooling, consumption of butter, fruits, vegetables, and indoor playing. Conclusion: High birth weight (>3500 g) increases and normal birth weight decreases the risk of childhood obesity up to five times in rural India.

Knowledge of Accredited Social Health Activist (ASHA) Workers Regarding Maternal Health Services: A Comparative Study between Rural and Urban Areas of a Block of Haryana

Introduction: All people, everywhere, deserve the right care, right in their community. In any community, maternal mortality ratio strongly reflects the overall effectiveness of health systems. To increase utilization of existing health services, Accredited Social Health Activist (ASHA) is the key component of the National Rural Health Mission. o assess compare the level of knowledgeO : bjective T any of ASHA workers regarding maternal health services in between rural and urban areas of a block of Haryana. Method: The present cross-sectional, community-based study was conducted in block Barwala, district Hisar of Haryana. The assessment of knowledge of ASHA workers was done on the basis of scoring. Appropriate statistical tests like percentages and chi-square (?2) test were applied. RegardingResult :s maternal health services majority of ASHA workers had good knowledge, assessed by score gained by them and none of them was having poor knowledge about maternal health services. However in rural area score, gained was better than urban area & the observed difference was found to be statistically significant. Knowledge of identification & treatment of anaemia and identification of danger signs during pregnancy were inadequate among ASHA workers of both areas. Knowledge of ASHA workers wasConclusion: inadequate as far as anaemia and danger signs during pregnancy were concerned. Frequent and regular refresher training should be organized in their working area.

Effect of a Quality Improvement Package on Reducing Newborn Mortality from 26 to 14 in a Himalayan North Indian State

Background: In India, newborn mortality remains high due to a number of factors, including poor quality of care at health facilities. The experience of executing complete neonatal care quality improvement (QI) package at selected hospitals in Himachal Pradesh and reduction in newborn mortality rate (NMR) is described in this study. Objective: The short-term objective was the participants’ retention of knowledge and skills, and the achievement of uniform QI objectives following training and after a minimum of 6 months. Overall reduction in NMR was long-term objective. Methods: Newborn care QI package was implemented according to India Newborn Action Plan over a period of 48 months from 2013 to 2016, through infrastructure, trainings, and supportive supervision. Results: Total 13 health facilities were upgraded; 350 staff nurses and medical officers were trained. The mean posttraining knowledge score was 75% compared to 29% in the pretraining test, and 63% 1 year later. The competencies of health workers in the care of high?risk babies and 12 QI targets had improved, resulting in a 46% reduction in neonatal mortality in the state across all gestations and weights based on sample registration survey. Conclusion: Implementation of a bundle of evidence-based practices in low-resource setting for health system strengthening for intrapartum and neonatal care was linked to changed care behaviors among health-care providers, and reduction in NMR.

Microfilariae in bone marrow aspirate of a case of myelofibrosis: A cause or coincidence?

Filariasis is among the common parasitic infestations found in India, with Wuchereria bancrofti being the most common causative organism. Presentation ranges from clinically asymptomatic to profound elephantiasis. It is also detected incidentally in diagnostic samples such as body fluids, fine needle aspirates, peripheral blood smears, and other cytological smears. Its detection in bone marrow aspirates with an associated hematolymphoid neoplasm is rare, with only a few case reports. We report one such case of young male who presented with leukocytosis of 253 × 109/L with basophilia and massive splenomegaly. Bone marrow aspirate smears showed the presence of microfilariae along with other features of a myeloproliferative neoplasm (MPN). The present case is probably the first case of finding a microfilaria in a case of MPN

Analysis of Factors Associated with Success Journey of Newly Entered Medical Students in a Rural Medical College of Haryana

Introduction: Competition for admission to medical collegein India is intense as the number of applicants for nationaleligibility cum entrance test (NEET) always exceeds theavailable seats. The choice of a career in the medical fieldis a complex personal decision influenced by a multitude offactors. Current study was done with the objectives to studysocio-demographic profile of newly selected medical students,to assess reasons of choosing medical stream as a career andto determine the association of socio-demographic and otherfactors with number of attempts taken by the medical studentsfor selection.Material and methods: This was a cross–sectional studycarried out among 96 newly entered medical students ofMaharaja Agrasen Medical College, Agroha (Dist. Hisar),Haryana. Appropriate statistical tests like chi-square (χ2)test and Fisher’s exact test were applied and mean, mode,percentages were also measured.Result: Out of total 39 students (40.6%) belonged to familywhere one or more member was in medical profession.However 86 students (89.6%) choose the medical professionby their own choice. Most of students (72.9%) were attendingregular classes during 11th & 12th in their schools. Maximumnumber of students (46.9%) cleared the NEET in their 2ndattempt. Maximum selection was in students who spent 9-12hours for study for preparation. Out of total 60.4% studentsspent 5-7 hours for sleep during preparation period. Out oftotal 91.7% students were joined coaching for preparationpurpose. Majority of students (67.7%) migrated from theirnative place for study purpose.Conclusion: In our study maximum students have chosenmedical profession because of their personal interest. Inpresent study maximum newly entered medical students werethose who have attended schools regularly in 11th and 12thclasses. Adequate sleep hours for students play constructiverole in favorable outcome.

A Study on Association between Sleep Habits and Academic Performance among Medical Undergraduates in Maharaja Agrasen Medical College Agroha.

Introduction: Good quality and adequate amount of sleepis necessary for being healthy. Medical students are proneto more stress due to their academic demands. The sleepamong students is characterized by inadequate sleeping hours,delayed sleep onset, and mid day nap. Current research aimedto study sleep habits among medical students and to findrelationship between sleep habits and stress with academicperformance of students.Material and Methods: This cross–sectional study wascarried out among 139 medical students of third semester,seventh semester and interns enrolled at Maharaja AgrasenMedical College, Agroha (Dist. Hisar), Haryana. Primarytool in this study was a predesigned and semi-structuredquestionnaire. Epworth Sleepiness Scale (ESS) was used toassess daytime sleepiness. Collected data was analysed usingfrequencies, percentages and chi square test.Results: Out of 139 students, 38.8% were considered tohave excessive daytime sleepiness (EDS score >10). Femalestudents (43.1%) were found to have more abnormal EDS scoreas compare to male students(35.1%). Out of total, 70 studentssecured marks between 60-70 percent in which maximumnumber of students (61.42%) were stress free during examsand 54% had sleep duration of 7-10 hours. Good health wasfound to be strongly significant with academic performanceof the students. Duration of study hours was found to besignificant with academic performance of students. Delayedsleep onset was found to be more in female students (55%).Mid day nap was found in 76.25% of students.Conclusion: The negative effects of sleep difficulties havebeen well documented. EDS was more in female students.Also, good health had significant association with academicperformance so the knowledge of importance of good qualityand adequate amount of sleep and its impact on health shouldbe emphasized and translated into practice.

Clinical, Hormonal and Metabolic Profile of Different Phenotypes of Polycystic Ovarian Syndrome

Background: Polycystic ovarian syndrome (PCOS) is one ofthe most frequently encountered hormonal disorder withmetabolic abnormalities in females that can present at puberty,during reproductive age or even after menopause. Therefore,the aim of this study was to evaluate the occurrence of differentphenotypes among PCOS women and to compare thehormonal assay and metabolic profile of different phenotypesof PCOS.Materials & Methods: The present study was an observationalstudy conducted on 160 women of the age group of 16-35years and diagnosed with PCOS, in the department ofobstetrics and Gynecology at Mahatma Gandhi MedicalCollege and Hospital, Jaipur from January 2017 to July 2018.Diagnosis of PCOS was done by using the ESHRE/ASRMcriteria and subjects were divided into 4 phenotypes by usingthe all probable combination of Rotterdam criteria. Hirsutismwas assessed by using Modified Ferriman Gallwey score.Score <8 - Normal, 8-15- Mild and >15 indicate moderate tosevere hirsutism.Results: 160 PCOS women were distributed in 4 phenotypesand the most prevalent phenotype was phenotype D, 40.63%followed by 32.50% phenotype A and 14.38% phenotype C.Mean age of overall women was 24.94±4.86. In this studyoverall prevalence of metabolic syndrome was 37.5%. Almost50% women of phenotype A had metabolic syndrome followedby 35% of phenotype B, 34.78% of phenotype C and leastprevalence was in phenotype D 30.77%.Conclusion: We concluded that the most prevalent phenotypeis nonhyperandrogenic phenotype 40.63% and least commonphenotype is classic nonpolycystic ovaries phenotype(12.50%).

Improving the Breastfeeding Practices in Healthy Neonates During Hospital Stay Using Quality Improvement Methodology

Objective: To demonstrate the applications of the principles ofQuality Improvement (QI) in a tertiary-care centre with the aim toimprove the breastfeeding practices during hospital stay.Methods: An operational team was formulated to identify thereasons for low proportion of exclusive breast feeding (EBF) inhealthy neonates. Reason specific solutions were proposed,discussed, prioritized and tested using Plan-Do-Study-Act Cycle(PDSA Cycle). Strategies included clear departmental policy planand creation of Breastfeeding support package (BFSP). PDSAcycles were tested and implemented over 6 weeks period and itssustainability was measured monthly for five months duration.Results: After implementation of PDSA cycles, the proportion ofneonates receiving early breastfeeding within one hour of birthincreased from 55% to 95%, and the proportion of neonates onEBF during hospital stay increased from 72% to 98%.Conclusion: Quality Improvement principles are feasible andeffective to improve breastfeeding practices in the hospitalsetting.

Utility of thromboelastography versus routine coagulation tests for assessment of hypocoagulable state in patients undergoing cardiac bypass surgery

Introduction: Peri-operative monitoring of coagulation is important to diagnose potential cause of hemorrhage, to manage coagulopathy and guide treatment with blood products in patients undergoing cardiac surgery with cardiopulmonary bypass. This study was done to evaluate usefulness of Thromboelastography (TEG) and routine coagulation tests (RCT) in assessing hemostatic changes and predicting postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: Fifty adult patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled in this prospective study. Preoperative and post-operative samples were collected for routine coagulation tests and TEG. Regression analysis and test of significance using Pearson's correlation coefficient was performed to assess correlation between routine coagulation tests and corresponding TEG parameters .Regression analysis was done to study relation between blood loss at 24 hours and various coagulation parameters. Results: The Routine coagulation test i.e. PT, INR, APTT showed no significant correlation with corresponding TEG parameters in pre-operative samples. However platelet count significantly correlated (p = 0.004) with MA values in postoperative samples. A significant correlation (p = 0.001) was seen between fibrinogen levels and alpha angles as well as with MA in both baseline preoperative and postoperative samples. TEG parameters R time and MA in postoperative samples were the only parameters that predicted bleeders with fair accuracy. Conclusion: Though the techniques of RCT and TEG are different, a few RCT e.g. platelet count and fibrinogen correlated with corresponding TEG parameters i.e. MA and Alpha angle. TEG parameters (R time and MA in postoperative samples) were able to predict blood loss better than RCT.

Neurospora sp. SR8, a novel phosphate solubiliser from rhizosphere soil of Sorghum in Kachchh, Gujarat, India.

Phosphorus (P) is abundant in soils in both inorganic and organic forms; nevertheless, it is unavailable to plants due to its fixation. Phosphate solubilising microorganisms including fungi play a pivotal role in making P available for plants by the process of solubilisation and mineralisation. Among the fungi that solubilize phosphate, the genera Aspergillus and Penicillium are the most representative although strains of Trichoderma and Rhizoctonia solani have also been reported as P solubilizers. Here, we report Neurospora discreta strain SR8 (NCCS Pune accession No. MCC1096 and NCBI accession No. KJ676544) as a P solubiliser as the first report. The strain was isolated from rhizospheric soil of Sorghum bicolor (L.) Moench. grown in semi-arid climate of a unique ecological zone of Kachchh, western India. The organism was identified on the basis of morphological characterization and by sequencing of ITS region. The strain SR8 survived the stressed environment in terms of high salinity and low precipitation rate in this area and could be a potent P solubiliser in stressed environments.

Effect of glimepiride compared with glibenclamide on post prandial blood sugar in type II diabetes mellitus patients.

Background: Diabetes mellitus is a major public health problem with many complications. The Global Burden of Diabetes Study has projected that there will be a 122% increase in the number of people with diabetes mellitus worldwide in 2025 compared to 1995. Despite the availability of new agents for the treatment of type 2 diabetes mellitus oral sulfonylureas remain a cornerstone of therapy. Glibenclamide and glimepiride are widely used sulfonylurea antidiabetic drugs. Methods: A randomized, open, parallel group study was conducted by the Department of Pharmacology in association with Department of Medicine at Maharishi Markandeshwar Institute of Medical Sciences & Research (MMIMSR), Mullana, Ambala. Total 50 patients were divided into two groups I & II. In Group I (n=25) glibenclamide (5-15 mg/day) & in Group II (n=25) glimepiride (1-6mg/day) was administered for a period of 24 weeks and data analyzed by Student’s “t”- test. Results: There was a significant improvement in the post prandial blood sugar score (p<0.05) in both the study groups (I&II) after 24 weeks but post prandial blood level did not differ significantly (p>0.05) between the two groups. Conclusions: Both the drugs glibenclamide and glimepiride were effectively reduced post prandial blood sugar in both the groups. But these sulfonylurea drugs lowered post prandial blood sugar to a similar degree without significant difference between the two groups.

Implantation Rates after Two and Five Days of Embryo Culture: A Comparative Study.

The aim of our study was to compare the Implantation rates of embryos transferred after two and five days of culture. A Randomized, prospective study was conducted in Infertility clinic, Department of Obstetrics & Gynecology,Mahatma Gandhi Hospital, Jaipur on 300 patients aged 25-40 years undergoing in-vitro fertilization (IVF)/ intra-cytoplasmic sperm injection (ICSI) cycle from May 2010-April 2011. When three or more Grade-I embryos were observed on day 2 of culture, patients were divided randomly into two study groups, day 3 transfer group and blastocyst transfer group or day 5 transfer group having 150 patients each. IVF outcome in terms of Implantation rate was compared between the groups. The results were analyzed using proportions, standard deviation and chi-square test.Both the groups were similar for age, indication and number of embryos transferred. Embryo transfers on day 5 resulted in significantly higher ongoing pregnancy and implantation rates as compared with day 3 embryo transfers(44% and 35.17% versus 29.33% and 21.35%, respectively)(P< 0.001). No significant difference was found in terms of multiple gestations in both the groups. Embryo transfers on day 5 of culture give significantly higher chance of ongoing pregnancy and implantation rates per cycle and per transfer than day 3 transfers.

Implantation Rates after Two and Five Days of Embryo Culture: A Comparative Study.

The aim of our study was to compare the Implantation rates of embryos transferred after two and five days of culture. A Randomized, prospective study was conducted in Infertility clinic, Department of Obstetrics & Gynecology,Mahatma Gandhi Hospital, Jaipur on 300 patients aged 25-40 years undergoing in-vitro fertilization (IVF)/ intra-cytoplasmic sperm injection (ICSI) cycle from May 2010-April 2011. When three or more Grade-I embryos were observed on day 2 of culture, patients were divided randomly into two study groups, day 3 transfer group and blastocyst transfer group or day 5 transfer group having 150 patients each. IVF outcome in terms of Implantation rate was compared between the groups. The results were analyzed using proportions, standard deviation and chi-square test.Both the groups were similar for age, indication and number of embryos transferred. Embryo transfers on day 5 resulted in significantly higher ongoing pregnancy and implantation rates as compared with day 3 embryo transfers(44% and 35.17% versus 29.33% and 21.35%, respectively)(P< 0.001). No significant difference was found in terms of multiple gestations in both the groups. Embryo transfers on day 5 of culture give significantly higher chance of ongoing pregnancy and implantation rates per cycle and per transfer than day 3 transfers.

Microfilariae in bone marrow aspiration smears, correlation with marrow hypoplasia: a report of six cases.

Microfilariae have been reported in various cytological preparations, however there are very few case reports describing microfilariae in bone marrow aspirates. We report six such cases with the interesting finding of marrow hypoplasia in five of these cases.

Disseminated histoplasmosis in an immunocompetent individual--a case report.

We report a rare case of disseminated histoplasmosis in a immunocompetent young adult person involving bone marrow, liver, spleen and oral cavity. He presented with oral ulcers, weight loss and pancytopenia. His bone marrow aspiration examination revealed Histoplasma capsulatum.