Family Support to Women During Pregnancy and Its Impact on Maternal and Fetal Outcomes.

BACKGROUND: Family support is one of the determinants of lifestyle habits and relevant health behavior for pregnancy outcomes. In India, the joint family system is still practiced. Due to education, urbanization, and industrialization, the family institution continues to play a central role in people's lives. Pregnancy is a crucial period in women's lives. Good care during pregnancy is important for the health of the mother and the newborn baby. During this period, hormonal changes are complex and involve multiple hormones working together to support the developing fetus and prepare the mother's body for labor, delivery, and breastfeeding. To avoid maternal and fetal complications, she needs support from her family throughout pregnancy and the postnatal period. AIM AND OBJECTIVES: This study aims to evaluate the influence of the level and quality of family support during pregnancy on maternal and fetal outcomes and to identify any association between the sociodemographic variables and the impact of the level and quality of family support during the first trimester. MATERIAL AND METHODS: This study used a quantitative approach with a survey research design. Data were collected from four Primary Health Centers at Karad, Maharashtra, India, i.e., Rethare, Vadgaon, Kale, and Supane. A consecutive sampling technique was used to select the 344 subjects from the Rethare, Vadgaon, Kale, and Supane areas of Karad Taluka. Data were collected before the completion of the first three months of pregnancy, then during the second trimester and after delivery. Upon evaluation, the tool was validated by experts representing a range of specialties, including community health nursing, mental health nursing, obstetric gynecology, and pediatric care. A pilot study was conducted on 30 samples. The data collected were analyzed by using descriptive and inferential statistics. RESULT: The findings of the study show a significant association between the psychosocial support received in the first trimester and the total gestational weeks completed at the time of delivery (p < 0.05). The study suggests the need for psychosocial support during the first trimester for better maternal and fetal outcomes. CONCLUSION: Psychosocial family support is needed by pregnant women during the first trimester to achieve maternal and fetal outcomes.

Evaluation and comparison of intratumoural and intrastromal infiltrating lymphocytes with clinicopathological features in breast carcinoma patients who have received neoadjuvant chemotherapy - A cross-sectional study.

Background: The microenvironment of breast cancer plays a significant role in determining the prognosis of the disease. With the shifting paradigm on the predictive factors post-Neoadjuvant Chemotherapy (NAC), it was sought out that Tumour infiltrating lymphocytes (TILs) are of valuable use for the same. Yet, the delineation of the two types - Intrastromal and Intratumoural has seldom been facilitated. This study, therefore, aimed to evaluate, analyse and compare the two - to gauge the importance of the treatment outcome and clinicopathological features. Materials and methods: 180 breast cancer patients were included in this study who underwent NAC, and their post-surgically resected tumour specimens were sectioned and stained using routine Haematoxylin and Eosin techniques. The evaluation of TILs in the stroma and tumour was done based on the standardised guidelines. Results: Out of the 180 patients, 55 (i.e. 30.56%) displayed pathological complete resolution (pCR). Furthermore, Intratumoural TILs had a slight association with the pCR (p = 0.0335) whereas Intrastromal TILs had a significantly large association with pCR (p < 0.0001) dependent on the lymphocytic response. Backward regression revealed that - the age at operation, pCR, lymph node involvement and menopause highly contributed to predicting 68.2% of the total cases correctly with a sensitivity of 93.0% and specificity of 24.6% for Intratumoral TILs. Age at operation, pCR, lymph node involvement and tumour emboli highly contributed to predicting 71.5% of the total cases correctly with sensitivity of 71.6% and specificity of 71.4% for Intrastromal TILs. Conclusion: TILs and the prediction of NAC and pCR should be made standardised and reproducible so that they can be universally available to all patients with breast cancer. Through this study, further avenues of research have opened up for their relations with clinicopathological features mainly age at operation and menopausal status.

Effectiveness of self-instructional module on awareness on screening regarding breast cancer with Intelligent Breast Examination among primary schoolteachers in Karad.

AIM: As Breast cancer is most common in developed and developing world. Despite of seriousness & importance of breast cancer the awareness is low. This Study highlights the primary screening of breast cancer with the device Intelligent Breast Examination. OBJECTIVES: The objectives of this study are to assess the knowledge regarding awareness on screening of breast cancer with Intelligent Breast Examination (IBE), to develop a self-instructional module (SIM) on awareness on screening regarding breast cancer with IBE, and to assess its effectiveness on awareness about screening breast cancer with IBE. MATERIALS AND METHODS: Evaluative research approach was used. The study used preexperimental research design. The samples (60 primary schoolteachers) were selected by the use of two sampling techniques, i.e., random sampling (for schools) and purposive sampling (study participants). Data were collected in two phases (pre and post) using structured questionnaire followed by the administration of SIM. RESULTS: The results revealed a significant increase in mean knowledge scores (mean pre 11.16 standard deviation [SD] = 2.631 to mean post 21.2 SD = 1.842) regarding awareness on screening of breast cancer with IBE. The calculated paired t value (23.902) is greater than the table value ( t = 1.67) at 0.05 level of significance. CONCLUSION: The study concluded that the SIM prepared proved to be effective in increasing the awareness regarding screening with IBE in breast cancer.

Development of Risk Scoring Scale Tool for Prediction of Preterm Birth.

BACKGROUND: Prediction of preterm births in the early stage during pregnancy may reduce prevalence of preterm births by appropriate interventions. AIMS/OBJECTIVE: The aim of the study is to develop an antenatal risk scoring system/scale for prediction of preterm births. SUBJECTS AND METHODS: From a cohort of 1876 and subset of 380 pregnant women attending Krishna Hospital Karad, Maharashtra, routine antenatal and in-depth information on diet, occupation, and the rest were collected and analyzed using SPSS version 16. A scoring system was developed by multivariate analysis based on the relative risk (RR) and tested on separate set of 251 mothers. STATISTICAL ANALYSIS USED: Bivariate analysis by Chi-square test, backward multivariate regression model, receiver operating characteristic curve (ROC) curve analysis, and calculation of RR for identified risk factors. Sensitivity and specificity of newly developed risk scoring scale. RESULTS: Out of six risk factors from whole cohort (n = 1876) and three risk factors from subsample (n = 380) identified by bivariate analysis. Further four and three risk factors were retained after multivariate analysis from whole and part of cohort, respectively, and risk scores of "7" and "9" were assigned based on RR cutoff levels of three and five were identified separately for whole and part data by ROC curve analyses together making it "8" with 75.5% sensitivity and 85.5% specificity when tested on 251 independent patients. Based on the prevalence of preterm births, low-, moderate-, and high-risk grading was done by identifying as second cutoff value. CONCLUSIONS: Identification of low-, moderate-, and high-risk of preterm births was possible at <8, 8, and 9 and equal to ≥10 with high sensitivity at lower cutoff and high specificity at upper cutoff.

Antenatal Risk Scoring Scale for Predication of Low Birth Weight and Its Validity.

BACKGROUND: Prediction of low birth weight (LBW) early during pregnancy may prevent LBW by appropriate interventions. AIMS/OBJECTIVE: The aim of the study is to develop an antenatal risk scoring scale for prediction of LBW. SUBJECT AND METHODS: Routine and in-depth information on diet, occupation, and rest was collected from November 1, 2013, to November 13, 2015. A cohort of 1876 and subset of 380 pregnant women attending Krishna Hospital Karad, Maharashtra, India. STATISTICAL ANALYSIS: Multivariate analysis and relative risks (RRs) were found out by SPSS version 16 and tested on a separate set of 251 mothers. RESULTS: The frequency of meals of <4, hard work <6 h of sleep and illiteracy, antenatal morbidity, <10 kg weight gain, <40 kg maternal weight, and anemia during the first trimester were the risk factors identified from subset and cohort, respectively. Based on their RRs, a new scoring system with a total score of 24 and cutoff "12" was identified by using receiver operating characteristics (ROC) curve analysis with 98.6% sensitivity and 41.1% specificity as tested on 251-independent individuals. The second cutoff of "15" score was identified based on the prevalence of LBW in babies of these 251 mothers. CONCLUSIONS: The identification of low-, moderate-, and high-risk of LBW was possible at <12, between 12 and 15, and >15 scores, respectively, with good sensitivity and specificity.

Determining the antibacterial substantivity of Triphala mouthwash and comparing it with 0.2% chlorhexidine gluconate after a single oral rinse: A crossover clinical trial.

CONTEXT: Triphala has been extensively used in dentistry as a mouthwash because of its antiplaque and antigingivitis properties. AIM: The present study is designed to determine the duration of its antibacterial substantivity after a single oral rinse and to compare it with the substantivity of 0.2% chlorhexidine gluconate (CHX). MATERIALS AND METHODS: In this clinical crossover trial, unstimulated saliva from 30 individuals was collected 2 h after routine oral hygiene procedures but not rinsing (pre-sample) with randomly selected mouthwash, (10% Triphala mouthwash, 0.2% CHX, and normal saline) and 5 min after rinsing (postsample). A washout period of 1 week was kept between two rinses. The sampling was repeated after every 2 h for 12 h (post 1, post 2, post 3, post 4, post 5, and post 6) and was checked for microbial count. STATISTICAL ANALYSIS USED: Friedman test, Kruskal-Wallis test, and post hoc analysis were used to assess the effect of different mouthrinses on colony forming units at different times. RESULTS: Ten percent Triphala showed statistically significant results when the antibacterial effect at post, post 1 and post 2 were compared to pre-assessment count (P < 0.05). After which the effect was at par with normal saline (P > 0.05). The results for CHX were statistically significant at all times when compared to pre-assessment count (P < 0.05) and it showed the maximum substantivity of 7 h. CONCLUSION: After a single rinse with no eating and drinking restrictions over the day, 10% Triphala mouthwash had an antibacterial effect for 3-4 h. It can be used three times daily for its maximum antibacterial effect.

Action-oriented colour-coded foot length calliper for primary healthcare workers as a proxy for birth weight & gestational period.

BACKGROUND & OBJECTIVES: Foot length of the newborn has a good correlation with the birth weight and is recommended to be used as a proxy measure. There can be variations in the measurement of foot length. A study was, therefore, carried out to develop a foot length calliper for accurate foot length measurement and to find cut-off values for birth weight and gestational age groups to be used by primary healthcare workers. METHODS: This study was undertaken on 645 apparently healthy newborn infants with known gestational age. Nude birth weight was taken within 24 h of birth on a standard electronic weighing machine. A foot length calliper was developed. Correlation between foot length and birth weight as well as gestational age was calculated. Correctness of cut-off values was tested using another set of 133 observations on the apparently healthy newborns. Action-oriented colour coding was done to make it easy for primary healthcare workers to use it. RESULTS: There was a significant correlation of foot length with birth weight (r=0.75) and gestational age (r=0.63). Cut-off values for birth weight groups were 6.1, 6.8 and 7.3 cm and for gestational age of 6.1, 6.8 and 7.0 cm. Correctness of these cut-off values ranged between 77.1 and 95.7 per cent for birth weight and 60-93.3 per cent for gestational age. Considering 2.5 kg as cut-off between normal birth weight and low birth weight (LBW), cut-off values of 6.1, 6.8 and 7.3 were chosen. Action-oriented colour coding was done by superimposing the colours on the scale of the calliper, green indicating home care, yellow indicating supervised home care, orange indicating care at newborn care units at primary health centres and red indicating Neonatal Intensive Care Unit care for infants. INTERPRETATION & CONCLUSIONS: A simple device was developed so that the primary health care workers and trained Accredited Social Health Activist workers can identify the risk of LBW in the absence of accurate weighing facilities and decide on the type of care needed by the newborn and take action accordingly.

Correlation of Cotinine Levels with Use of Smokeless Tobacco (Mishri) among Pregnant Women and Anthropometry of Newborn.

INTRODUCTION: 'Smokeless tobacco' is the term used for the tobacco that is consumed in un-burnt form and it can be used orally or nasally. Cotinine, a nicotine metabolite, is used to quantify exposure to tobacco, which readily gains access to foetal circulation. Cotinine is invariably found in coelomic, amniotic and foetal serum when maternal serum cotinine levels exceed 25ng/ml. AIM: To estimate cotinine levels among pregnant women using and not using smokeless tobacco (mishri) and to correlate cotinine level with anthropometry of newborns. MATERIALS AND METHODS: A hospital based cohort study was conducted at Krishna Hospital, Karad, District Satara, Maharashtra, India. Pregnant women who were using smokeless tobacco (mishri) during pregnancy were analyzed for cotinine levels in blood by using ELISA kit tech and correlated with anthropometry of newborn babies and compared with non users of tobacco. RESULTS: About 480 gm reduction in Birth weight and 6.5 cm reduction in birth length of babies born to mishri users compared to non users of tobacco and also cotinine levels among users were found significantly negatively correlating with anthropometric measurement of newborn babies. CONCLUSION: A pro-active effort is essential to educate the women about adverse effects of tobacco in general and on the intrauterine growth of the baby in particular.

Seroprevalence, risk factors and genotype distribution for Hepatitis C infection: A study from rural hospital in Maharashtra.

BACKGROUND AND OBJECTIVES: Hepatitis C is global health problem affecting a significant portion of the world's population. Available data in Western Maharashtra on seroprevalence, risk factors and genotype distribution are very limited. OBJECTIVES: The present study was carried out to estimate the seroprevalence, factors influencing transmission and distribution of genotype of hepatitis C virus (HCV) in a hospital-based population. MATERIALS AND METHODS: This was a cross-sectional, hospital-based study. A total of 25193 serum samples were tested for HCV and HBV infection. All samples from HCV antibody-positive patients were subjected for HCV RNA detection and genotype. Chi-square, unpaired t-test, logistic regression analysis was used for statistical analysis. RESULTS: The seroprevalence for anti-HCV-Ab was 0.46%. Backward multivariate logistic regression analysis revealed increasing age; alcoholic, blood transfusion and dialysis were significant risk factors. Of 116 patients with HCV, 8 (6.89%) patients had HCV-HBV co-infection. The most common genotype (61.90%) was 3 followed by Genotype 1 (38.09%). CONCLUSIONS: In the present study, significant risk factors were a history of blood transfusion, habit of alcohol, dialysis. The prevention of HCV infection can be achieved by screening of blood and blood products and creating awareness about risk factors. Since the efficacy of current and new therapies differ by genotype, genotype study is essential.

Serological, Clinical, and Epidemiological Profile of Human Brucellosis in Rural India.

BACKGROUND: Brucellosis is an important but neglected zoonotic disease in India. Due to frequent animal contact, high prevalence of this disease, though expected in rural population, has not been much studied. AIM: The study was carried out to determine serological, clinical, and epidemiological profile including associated risk factors for human brucellosis in rural India. MATERIALS AND METHODS: In this cross-sectional study, serum samples from 1,733 individuals residing in rural areas were screened for the presence of anti-brucellar antibodies by Rose Bengal Plate test (RBPT), Serum Agglutination test (SAT), and 2-Mercaptoethanol test (2-ME). Clinical symptoms, epidemiological data including risk factors and knowledge about brucellosis were evaluated by personal interview using a structured questionnaire. RESULTS: Of the 1,733 individuals, 998 had direct contact with animals, whereas 735 had no direct contact. The overall positivity rates by RBPT, SAT, and 2-ME test were 10.50% (182), 7.32% (127), and 5.88% (102), respectively. Clinical symptoms resembling brucellosis were seen in 151 (8.71%) subjects. Animal contact especially during milking, parturition/abortion was the major risk factor, followed by raw milk ingestion. None of the participant knew about brucellosis. CONCLUSION: Regular surveillance of the disease with awareness programs emphasizing prevention and control are needed.

Klebsiella Pneumoniae in Septicemic Neonates with Special Reference to Extended Spectrum ß-lactamase, AmpC, Metallo ß-lactamase Production and Multiple Drug Resistance in Tertiary Care Hospital.

BACKGROUND: ß-lactamases viz., extended spectrum ß-lactamase (ESBL), AmpC, and metallo ß-lactamase (MBL) production in Klebsiella pneumoniae has led to a serious concern about septicemic neonates in Neonatal Intensive Care Units due to high resistance against commonly used antimicrobials. PURPOSE: To study the prevalence of ESBL, AmpC, and MBL production in K. pneumoniae isolates in neonatal septicemia, to check antimicrobial susceptibility to various drugs including tigecycline; and to assess burden of multiple drug resistance (MDR). MATERIALS AND METHODS: Total 24 clinical isolates of K. pneumoniae isolated from 318 blood samples of suspected cases of neonatal septicemia were studied. Isolates were screened for ESBL, AmpC, and MBL production by Clinical and Laboratory Standards Institute (CLSI) disk method, AmpC cefoxitin screen, and imipenem, meropenem, ceftazidime disk screen respectively; and confirmation was done by CLSI phenotypic disk confirmatory test, AmpC sterile disk method, and imipenem ethylenediamine tetracetic acid double disk synergy test respectively. Antimicrobial susceptibility was determined by Kirby-Bauer's disk diffusion method. Efficacy of tigecycline was evaluated using United States Food and Drug Administration guidelines. RESULTS: Of the 24 K. pneumoniae isolates, co-production of AmpC + MBL was found in more number of isolates (67%) (P < 0.0001) compared to single enzyme production (ESBL and MBL 8% both, AmpC 12.5%). Rate of resistance for penicillins and cephalosporins was highest. Susceptibility was more for imipenem, co-trimoxazole, and meropenem. Nonsusceptibility to tigecycline was low (21%). A total of 23 (96%) isolates were MDR. CONCLUSIONS: Routine detection of ESBL, AmpC, and MBL is required in laboratories. Carbapenems should be kept as a last resort drugs. Trend of tigecycline susceptibility has been noted in the study. Continued monitoring of susceptibility pattern is necessary to detect true burden of resistance for proper management.

Socio-demographic profile of pregnant women using mishri.

BACKGROUND: "Mishri" is one among the various smokeless tobacco products used in the central and southern part of India. The use of newer tobacco products is increasing not only among men, but also among children, teenagers, and women of the reproductive age-group. OBJECTIVES: To study socio-demographic profile of mishri users among pregnant women admitted for delivery into Krishna Hospital, Karad - Satara, Maharashtra. MATERIALS AND METHODS: All the consecutive pregnant women admitted for delivery in Krishna Hospital, Karad over a period of 6 months were enrolled and a detailed history of use of tobacco was obtained from them. A representative sample of mishri used by them for each application was collected and weighed on an electronic weighing machine. The socio-demographic information was collected among all mishri users and age-, parity-matched controls of non-mishri users during pregnancy. RESULTS: A total of 258, i.e., (12%) of the women delivering in Krishna Hospital were using mishri. The mean duration of mishri use was 2 years with a standard deviation (SD) of 1.09 years, frequency of daily application being 1.4 times with an SD of 0.55, dwell time in mouth being 10 min with an SD of 2.9 min, and the quantity of each application being 236 mg with an SD of 66.2 mg. 29% of the teenagers and 68% of the primiparas were found to be using mishri, and a majority of them were housewives, having minimum education and belonging to the middle and lower socio-economic class. It was also found that the family members played a role in influencing the habit of mishri use. INTERPRETATION AND CONCLUSION: A small but significant number of women who deliver in the hospital used mishri during pregnancy and were in need of de-addiction counseling.

Evaluation of reference intervals of serum lipid profile from healthy population in Western Maharashtra.

Fasting samples of 914 subjects from healthy population were analyzed for total cholesterol, triglyceride and three major fractions of lipoproteins i.e. high-density lipoprotein cholesterol, low lipoprotein cholesterol and very low-density lipoprotein cholesterol. The values obtained were (in mg/dl) 165.7±30.2,88.36±31.2, 44.86±10.68, 101.66±29.8 and 18.11±7.35 respectively. When these subjects were grouped according to the age and sex, no appropriate differences were observed between most of the groups. Triglycerides were found to be low and HDL cholesterol was high in female when compared with male of similar age. Beyond age 40 years cholesterol level and low density lipoprotein cholesterol was found to be gradually increased in case of women. Minor difference was observed with dietary pattern. Present study suggests that clinical evaluation of patient should be made on the basis of these reference values for Western Maharashtra population.