Assessment of knowledge, attitude and practice (KAP) of parents/caregivers towards epilepsy in children - A cross- sectional observational study.

Objectives: The study aimed to assess the knowledge, attitude, and practice (KAP) of parents/caregivers toward epilepsy in paediatric patients at a tertiary care centre of North India. Methods: A cross sectional study was carried out among 418 parents or caregivers using convenience sampling technique with 16-item questionnaire in English language and also translated to local language that is Hindi. Children with epilepsy who visited the paediatric outpatient department within a year were included in the study (January 2021-22). A total of 450 children visited the clinic, 32 of whom were excluded for various reasons, and the final analysis was conducted among the 418 parents or caregivers who completed the questionnaire. Results: The male and female patients were 56.7% (n = 237) and 43.3% (n = 181) respectively. The age distribution of patients with less than 5 years, 6-10 years and more than 10 years were 35.6% (n = 149), 54.5% (n = 228), 9.8% (n = 41) respectively. Only one third of parents and caregivers did not consider epilepsy as psychiatric illness. Most of the parents and caregivers think that epilepsy affects school performance (77.2%) and hinders family life (71.0%). More than half of the parents or caregivers believes that the society discriminates against person with epilepsy and around 46.6% consider that alternative medicine can cure epilepsy. The parents or caregivers felt financial burden due to epilepsy was in 72.5% and approximately 78.5% perceived that their work is affected because of their child's epilepsy. Perception of epilepsy as a psychiatric illness was found to be significantly higher in parents with primary and secondary level education, when compared to parents who were graduates. The practice of the parents or caregivers towards administration of drugs to their child was good, however around 36.6% (n = 153) missed the dose of anti-seizure medications. Conclusion: The study highlights the substantial knowledge, attitude and practice gap amongst parents and caregivers for children with epilepsy which indirectly has huge impact on the management of epilepsy. Thus it becomes utmost important to educate the family as well as the community regarding epilepsy which will help in improving the therapeutic outcomes, overall quality of life and interpersonal and social relationships of these children.

Workload Assessment of Tractor Operations with Ergonomic Transducers and Machine Learning Techniques.

Dynamic muscular workload assessments of tractor operators are rarely studied or documented, which is critical to improving their performance efficiency and safety. A study was conducted to assess and model dynamic load on muscles, physiological variations, and discomfort of the tractor operators arriving from the repeated clutch and brake operations using wearable non-invasive ergonomic transducers and data-run techniques. Nineteen licensed tractor operators operated three different tractor types of varying power ranges at three operating speeds (4-5 km/h), and on two common operating surfaces (tarmacadam and farm roads). During these operations, ergonomic transducers were utilized to capture the load on foot muscles (gastrocnemius right [GR] and soleus right [SR] for brake operation and gastrocnemius left [GL], and soleus left [SL] for clutch operation) using electromyography (EMG). Forces exerted by the feet during brake and clutch operations were measured using a custom-developed foot transducer. During the process, heart rate (HR) and oxygen consumption rates (OCR) were also measured using HR monitor and K4b2 systems, and energy expenditure rate (EER) was determined using empirical equation. Post-tractor operation cycle, an overall discomfort rating (ODR) for that operation was manually recorded on a 10-point psychophysical scale. EMG-based maximum volumetric contraction (%MVC) measurements revealed higher strain on GR (%MVC = 43%), GL (%MVC = 38%), and SR (%MVC = 41%) muscles which in normal conditions should be below 30%. The clutch and brake actuation forces were recorded in the ranges of 90-312 N and 105-332 N, respectively and were significantly affected by the operating speed, tractor type, and operating surface (p < 0.05). EERs of the operators were measured in the moderate-heavy to heavy ranges (9-24 kJ/min) during the course of trials, suggesting the need to refine existing clutch and brake system designs. Average operator ODR responses indicated 7.8% operations in light, 48.5% in light-moderate, 25.2% in moderate, 10.7% in moderate-high, and 4.9% operations in high discomfort categories. When evaluated for the possibility of minimizing the number of transducers for physical workload assessment, EER showed moderate-high correlations with the EMG signals (rGR = 0.78, rGL = 0.75, rSR = 0.68, rSL = 0.66). Similarly, actuation forces had higher correlations with EMG signals for all the selected muscles (r = 0.70-0.87), suggesting the use of simpler transducers for effective operator workload assessment. As a means to minimize subjectivity in ODR responses, machine learning algorithms, including K-nearest neighbor (KNN), random forest classifier (RFC), and support vector machine (SVM), predicted the ODR using body mass index (BMI), HR, EER, and EMG at high accuracies of 87-97%, with RFC being the most accurate. Such high-throughput and data-run ergonomic evaluations can be instrumental in reconsidering workplace designs and better fits for end-users in terms of agricultural tractors and machinery systems.

Urine Specific Gravity Measurement for Fluid Balance in Neonates on Intravenous Fluids in a Neonatal Intensive Care Unit: An Open Label Randomized Controlled Trial.

Background: Urine specific gravity reflects hydration status and correlates well with urine osmolality. OBJECTIVE: To compare intravenous fluid therapy guided with and without inclusion of urine specific gravity to the standard parameters for maintaining postnatal weight loss within permissible limits in neonates admitted to the intensive care unit. METHODS: An open-label randomized controlled trial was conducted, including neonates requiring intravenous fluids for ≥72 hours, randomized into the study (urine specific gravity guided fluids) and control arms. The outcomes of the study were to determine proportion of neonates with weight loss within permissible limits, mean percentage weight loss and number of days to reach maximum weight loss. RESULTS: 80 preterm and term neonates (40 in each arm) were enrolled. A comparable proportion of neonates had weight loss within permissible limits in study arm and in control arms [39 (97.5%) vs 36 (90%); P=0.165]. The (mean (SD) percentage weight loss was significantly less in the study arm compared to control arm [All neonates: 7.2(2.6) vs 9.3(3.5); P=0.004); preterm neonates: 7.7 (2.8) vs 11 (3.9); P=0.008)]. Preterm neonates in the study arm attained nadir weight significantly earlier than in the controls (P=0.03) and attained complete enteral feeding earlier. Urine specific gravity showed a moderate negative correlation with the percentage weight loss. CONCLUSION: Using urine specific gravity to regulate intravenous fluids in neonates resulted in a significant reduction in postnatal weight loss, especially in preterm neonates.

Correction of hypernatremic dehydration in neonates with supervised breast-feeding: A cross-sectional observational study.

BACKGROUND: Hypernatremic dehydration is an uncommon but a serious cause of readmission in neonates especially in the ones on exclusive breast-feeding. The management of such neonates is challenging as serious complications can occur both because of hypernatremic dehydration and its rapid correction. The aim was to study the clinical profile of neonates with hypernatremic dehydration and determine the outcome of these neonates after appropriate management. METHODS: This is a prospective cross-sectional observational study of neonates readmitted with hypernatremic dehydration in a tertiary care hospital in a 12-month period from March 2017 to February 2018. The inclusion criterion was as follows: all neonates with serum sodium >145 mEq/l. The exclusion criteria were as follows: neonates with hypoglycemia, positive sepsis screen and any other congenital diseases. Neonates with serum sodium between 145 and 160 mEq/l were treated with supervised quantified oral feeds at 150 ml/kg/day, unless they had features of shock. Neonates who had serum sodium ≥160 mEq/l were given intravenous (IV) fluids initially. RESULTS: A total of 2412 deliveries took place during the study period. Hypernatremic dehydration was reported in 46 (1.9%) of them, which required admission. We found that all these neonates were exclusively breast-fed, with 81.3% neonates born to primigravidae. One neonate presented with seizures, and one, with metabolic acidosis. More than 50% neonates had acute kidney injury (AKI) on admission. No neonates in our study developed central nervous system (CNS) complications such as cerebral venous thrombosis, convulsions or intracranial haemorrhage, and complete recovery from AKI was documented in all neonates. CONCLUSION: Hypernatremic dehydration can be a serious problem even in term healthy neonates especially in exclusively breast-fed neonates born to primiparous women. Our study shows that quantified oral feeding is effective in successful management of hypernatremic dehydration and not associated with the dreaded CNS complications due to rapid correction.

Paget's disease diagnosed on bone scintigraphy: Case report and literature review.

Paget's disease of bone is a chronic bone remodeling disorder. Although most patients are asymptomatic, a variety of symptoms and complications may develop directly from bone involvement or secondarily due to compression by the expanded bone. It is usually diagnosed from radiological and biochemical abnormalities or in advanced cases it becomes clinically evident due to the expanded bone. We report a case of Paget's disease which was detected incidentally during evaluation of nephrolithiasis and polyarthritis but had normal radiographs and normal biochemical markers.

Design and implementation of ergonomic performance measurement system at a steel plant in India.

Management of Tata Steel, the largest steel making company of India in the private sector, felt the need to develop a framework to determine the levels of ergonomic performance at its different workplaces. The objectives of the study are manifold: to identify and characterize the ergonomic variables for a given worksystem with regard to work efficiency, operator safety, and working conditions, to design a comprehensive Ergonomic Performance Indicator (EPI) for quantitative determination of the ergonomic status and maturity of a given worksystem. The study team of IIT Kharagpur consists of three faculty members and the management of Tata Steel formed a team of eleven members for implementation of EPI model. In order to design and develop the EPI model with total participation and understanding of the concerned personnel of Tata Steel, a three-phase action plan for the project was prepared. The project consists of three phases: preparation and data collection, detailed structuring and validation of EPI model. Identification of ergonomic performance factors, development of interaction matrix, design of assessment tool, and testing and validation of assessment tool (EPI) in varied situations are the major steps in these phases. The case study discusses in detail the EPI model and its applications.

Ergonomic design of crane cabins: a case study from a steel plant in India.

The study, carried out at the Batch Annealing Furnace (BAF) shop of Cold Rolling Mill (CRM) at an integrated steel plant of India, concerns ergonomic evaluation and redesign of a manually-operated Electrical Overhead Travelling (EOT) crane cabin. The crane cabin is a complex worksystem consisting of the crane operator and twelve specific machine components embedded in a closed workspace. A crane operator has to perform various activities, such as loading and unloading of coils, setting and removal of convector plates, and routine maintenance work. Initially, an operator had to work in standing posture with bent back most of the time. Ergonomically poor design of the chair and the controls, awkward work postures, and insufficient vision angle resulting in musculoskeletal disorders (MSDs) are some of the critical problems observed.. The study, conceived as an industry-academia joint initiative, was undertaken by a design team, the members of which were drawn from both the company concerned and the institute. With the project executed successfully, a number of lessons, such as how to minimize the anthropometric mismatch, how to improve the layout of the components and controls within enclosed workspace, and how to improve work posture minimizing risk of MSDs have been learned.

Injury severity assessment for underground coalmine workers.

An injury severity model is proposed for assessment of injury incidents in industrial settings. A classification scheme for injury incidents considering interactions is also developed. The injury severity model considers injury potential in the form of unsafe conditions and analyzes its transfer to actual injury of varying severity. A case study was conducted in an underground coalmine of eastern India. An observed reduction in risk realization is explained through the model. Presence of interactions is found to be the most significant incident attribute of injury occurrences. The classification scheme and the results obtained from this study will help in improving accident/injury investigation reporting and devising preventive measures for reducing injury severity.

Potential density and basal area prediction equations for unthinned Eucalyptus hybrid plantations in the Gujarat state of India.

The aim of this paper is to present equation for estimating potential stand density and basal area projection model for unthinned pure even-aged plantations of Eucalyptus hybrid in Gujarat State of India. Relationships between quadratic mean diameter and stems ha(-1) were developed, which was used to establish the limiting density line. Eight different stand level models, belonging to the path invariant algebraic difference form of a non-linear growth function, were compared for projecting basal area. They can be used to predict future basal area as a function of stand variables like dominant height and stem number per hectare and are crucial for evaluating different silvicultural treatment options. The performance of the models was evaluated using different statistical criteria. The model proposed by Pienaar and Shiver performed best and hence is recommended for projecting the basal area in E. hybrid stands.

Stand density and basal area prediction of unthinned irrigated plantations of Eucalyptus camaldulensis in the hot desert of India.

Growth modelling is an essential prerequisite for evaluating the consequences of a particular management action on the future development of a forest ecosystem. Mathematical growth models are not available for many tree species in India. The objectives of this study were to estimate potential stand density and model the actual tree density and basal area development in pure even-aged stands of Eucalyptus camaldulensis. Relationships between quadratic mean diameter and stems ha(-1) were developed, and parameter values of this relationship were used to establish the limiting density line. Two different models were compared to describe the natural decrease of stem number. The model including site index as one of the variables performed slightly better than the model without site index. Seven different stand level models also were compared for predicting basal area in the stands. The models tested in this paper belong to the path invariant algebraic difference form of a nonlinear model. They can be used to predict future basal area as a function of stand variables like initial basal area, age or dominant height, and stems ha(-1) and are crucial for evaluating different silvicultural treatment options. The performance of the models for basal area was evaluated using different quantitative criteria. Among the seven models tested, the two models proposed by Pienaar and Shiver and Forss et al. had the best performance. The equations proposed to predict future basal area and stem number are related and, therefore, simultaneous regression technique has also been used to investigate the differences between parameter coefficients obtained by fitting the equations separately and jointly.

Levels of lipid peroxides and antioxidants in smokers and nonsmokers.

BACKGROUND AND OBJECTIVE: The aim of the study was to evaluate the relationship between cigarette smoking and periodontal damage in terms of the levels of free radicals and antioxidants. MATERIAL AND METHODS: Thirty-five healthy subjects in the age group 25-56 yr and with chronic moderate inflammatory periodontal disease (attachment loss of 3-4 mm) were selected. All subjects were matched with respect to the clinical parameters plaque index, gingival index and attachment loss. Of the 35 subjects, 25 were smokers (smoking a minimum of 15 cigarettes/day) and 10 were nonsmokers. Smokers were subdivided into three subgroups: group I (10 subjects smoking 15-20 cigarettes/day); group II (10 subjects smoking 21-30 cigarettes/day) and group III (five subjects smoking > 50 cigarettes/day). Gingival tissue (obtained during Modified Widman surgery) and blood samples were collected from each of the subjects and analyzed for the following parameters: lipid peroxide, superoxide dismutase, catalase, glutathione and total thiol. RESULTS: The level of lipid peroxide was lowest in nonsmokers (2.242 +/- 0.775 in tissue and 1.352 +/- 0.414 in blood) and highest in smokers smoking > 50 cigarettes/day (6.81 +/- 1.971 in tissue and 4.96 +/- 0.890 in blood), both in tissue and in blood. The increase was statistically significant in all groups, except in tissue of group I smokers. Catalase showed a similar trend, where the levels increased from 0.245 +/- 0.043 in controls to 0.610 +/- 0.076 in group III smokers for tissue, and from 0.231 +/- 0.040 in controls to 0.568 +/- 0.104 in group III smokers for blood. The increase was statistically significant for all groups. Total thiol levels were also higher in smokers than in controls (0.222 +/- 0.050 in controls vs. 0.480 +/- 0.072 in group III smokers in tissue; 0.297 +/- 0.078 in controls vs. 0.617 +/- 0.042 in group III smokers in blood). Except for group I in both tissue and blood, the increase was statistically significant. The superoxide dismutase (SOD) level was higher in nonsmokers (2.406 +/- 0.477 in tissue and 2.611 +/- 0.508 in blood) than in group III smokers (1.072 +/- 0.367 in tissue and 0.938 +/- 0.367 in blood), both in tissue and in blood, but this was significant only in the case of blood and for group III smokers in tissue. The glutathione level in tissue was consistently lower in smokers than in controls, showing a decrease from 121.208 +/- 37.367 in controls to 46.426 +/- 14.750 in group III smokers, but the decrease was not significant in group I smokers. In the case of blood, the glutathione level dropped from 262.074 +/- 68.751 in controls to 154.242 +/- 51.721 in group III smokers, but was statistically significant only for group III smokers. CONCLUSION: The study results show that smoking increases the level of free radicals in periodontal tissues, which in turn may be responsible for the destruction seen in periodontal diseases.

Recurrent nephrogenic adenoma of urinary bladder in a renal allograft recipient--a case report.

Nephrogenic adenoma is a rare benign tumour-like lesion within the urothelial mucosa of the urinary tract. It may be an incidental finding in bladder of a patient presenting with haematuria, dysuria and bladder growth after renal allograft transplant. Clinically it mimics bladder neoplasm. Definite diagnosis is established by histological examination of tumor. Though it attains an extensive spread in bladder mucosa and has a high tendency to recur, the clinical course is benign.

A study on sludge minimization during the treatment of pickling effluent.

In pickling industries, a lot of sludge is generated during the treatment of pickling effluent and there is severe problem of its disposal. Disposal of this sludge as per the Hazardous Waste (Management & Handling) Rules, 1989 is not easy. Its transportation and construction of lined disposal sites pose very severe problems. In the normal practice, the sludge is being disposed of at the sides of roads and railway tracks to fill low lying areas. This may cause serious health hazards. Considering these problems, a study has been undertaken to minimize the sludge generation during the treatment of pickling effluent by neutralizing it with lime, sodium hydroxide and combination of both. An attempt has been made to do an economic evaluation of the above process.

Growth and yield functions for irrigated plantations of Eucalyptus camaldulensis in the hot desert of India.

Eucalyptus camaldulensis forms a major portion of irrigated plantations in the hot desert of India and for effective management of these plantations, growth and yield functions are necessary. This paper describes the development of height, diameter and volume growth functions based on the analysis of the data collected from the permanent sample plots laid out in the study area. The Chapman-Richards equation could be used for the prediction of diameter growth while the Schumacher model could be considered for predicting volume growth. Some base-age variant and invariant site-index models, already reported in the literature, were compared in terms of relative accuracy and it was found that the Payandeh and Wang model performed the best among the four models tried.

Immune response to intragraft antigen in draining lymph nodes after corneal transplantation is mediated by interleukin-12.

To examine the molecular basis of immunity generated to intragraft antigens and determine whether it differs between acceptor and rejector hosts, we used a novel in vitro system to assay the T cell response to a specific antigen, ovalbumin (OVA), in the graft. OVA-containing corneas were orthotopically grafted into syngeneic or allogeneic hosts. Draining cervical lymph nodes (cLN) were assayed for OVA-specific T cell proliferation and cytokine production. In addition, cytokine production was assayed in cultures of antigen-presented cells (APC) isolated from cLN cultured with OVA-specific DO11.10 T cells and OVA. OVA-specific immunity was detected only in the draining cLN of mice following allogeneic, but not syngeneic, grafting, and this immunity was evident well before any demonstrable alloresponse in the graft. In addition, cLN cells from mice that accepted their corneal allografts produced significantly less interferon-gamma (IFN-gamma) when stimulated in culture than cells harvested from cLN of rejector hosts. Moreover, APC isolated from cLN of acceptor hosts produced significantly lower levels of IL-12. These data suggest that the induction of immunity to corneal antigens in the draining cLN occurs via an interleukin-12 (IL-12) and IFN-gamma-dependent mechanism. Targeting this process may serve as an effective immunomodulatory strategy in corneal transplantation.

14C-urea breath test for assessment of gastric Helicobacter pylori colonization and eradication.

BACKGROUND AND OBJECTIVE: Urea breath test (UBT) is a reliable noninvasive technique for detecting gastric Helicobacter pylori colonization. 14C isotope-based test requires simple equipment and is inexpensive. We studied the utility of 14C-UBT in diagnosis of gastric H. pylori infection. METHODS: Presence of H. pylori was studied using antral histology and culture in patients with rapid urease test (RUT)-positive peptic ulcer. 14C-UBT was performed using a 185-kBq dose. Radioactivity in 15-min breath samples was measured using a beta-scintillation counter and result expressed as % dose recovered/mmol CO2. H. pylori was considered positive when any two tests were positive. All tests were repeated one month after completion of H. pylori eradication therapy. RESULTS: Among 41 patients (duodenal ulcer 36, gastric ulcer 5), H. pylori was detected by histology in 23 (56%) and by culture in 27 (66%). Overall, H. pylori was detected in 28 (68%) patients. Follow-up assessment was possible in 28 patients: 26 cleared the infection (all three tests negative). Mean 14C recovery values at 15 minutes associated with H. pylori-positive status were significantly higher (12.3 [SD 6.8] x 10(-3); n=30; p<0.001) than those associated with H. pylori-negative status (2.1 [0.9] x 10(-3); n=26). Using receiver-operating-characteristic analysis of 15-minute 14C recovery values, a cut-off of 6.5x10(-3) gave the best separation of H. pylori-positive and -negative cases. 14C-UBT had 93% sensitivity, 96% specificity and 95% accuracy. CONCLUSION: 14C-UBT appears to be a reliable noninvasive test for diagnosis of H. pylori infection.

Delay in presentation of oral cancer: a multifactor analytical study.

BACKGROUND: Patients with oral cancer often present late to the doctor making treatment difficult, expensive and sometimes unsuccessful. Delay in presentation may be considered to be a health risk-taking behaviour. The present study analyses the psychosocial factors related to delay in presentation of oral cancer patients through the Triandis' model of health-seeking behaviour and also examines the relationship between delay and the stage of cancer. METHODS: Seventy-nine oral cancer patients were interviewed after evolving a valid and reliable questionnaire, and determining the sample size. Univariate and multivariate logistic regression analysis was applied between demographic variables, psychosocial factors, primary delay (defined as delay between the first symptom and the seeking of medical advice), secondary delay (interval between the first consultation and presentation at the medical college), tertiary delay (delay in definitive treatment even after being seen at a tertiary care centre) and stage of the disease. Multiple logistic regression was also carried out. RESULTS: Primary delay ranged from less than a week in 5 (6.3%) patients to more than 1 year in 8 (10%) patients. A linear relationship was found between primary and secondary delay (F-statistic p < 0.0152). A majority of patients (70.9%) had advanced oral cancer. The stage of cancer at presentation to the hospital was significantly related to primary (G-test 6.3; p < 0.0121) but not to secondary delay. Multivariate analysis revealed that five variables, 'ill fated to have cancer', 'cancer a curse', 'non-availability of transport', 'trivial ulcers in mouth are self-limiting' and 'prolonged treatment renders family stressful' were significant independent predictors of primary delay. CONCLUSION: The identified independent predictors of primary delay should be used to develop the main theme of an educational intervention programme for patients with oral cancer.