MUCOCUTANEOUS MANIFESTATIONS FOLLOWING CHEMOTHERAPY IN PEDIATRIC MALIGNANCIES

ABSTRACTObjective: Chemotherapy causes destruction of neoplastic cells and rapidly proliferative normal cells leading to significant mucocutaneous changes.The aim of the present study was to determine the postchemotherapeutic mucocutaneous manifestations in pediatric malignancies.Methods: In this cross-sectional study, 63 children with malignancy undergoing chemotherapy over 2½ years were examined carefully and followedup for 6 months. A comprehensive clinical history was taken. Detailed systemic and dermatological examination was carried out in the subjects at thetime of enrollment. Dermatological examination was performed subsequently at 3-6 months and whenever child presented with any symptoms to theoutpatient department. The chemotherapy-induced alopecia (CIA) and pigmentary changes of skin and nails were graded using OSLEN CIA, NationalCancer Institute pigment changes and nail changes' grading scales.Results: Males (41 [65%]) outnumbered females (1.8:1). Acute lymphoblastic and myelogenous leukemia were noticed in 38 (60.3%) and 8 (12.6%)patients, respectively. Alopecia (43 [68.3%]) was common with predominant grade 3 (22 [34.92%]). Hair regrowth was noticed in 53 (83.7%)patients within 6 months. Cutaneous linear pigmentary lines, ichthyosis, acral pigmentation, skin peeling, and mucositis were observed in 13 (21%),10 (16%), 10 (16%), 7 (11%), and 9 (14.28%) patients, respectively. Among total 56 cutaneous infectious manifestations, viral infections include 4cases of Herpes Zoster, single case of extensive molluscum contagiosum and Varicella. Tinea faciei was recurrent and poorly responsive to treatment.The common nail changes noted were Muehrcke's lines and melanonychia (26 [41.26%]).Conclusion: Alopecia in 43 (68.3%) patients though distressing was reversible in 53 (83.7%) patients. Infections were extensive, recurrent, andrequired aggressive treatment.Keywords: Chemotherapy, Pediatric malignancies, Cancer

MODIFIABLE RISK FACTORS FOR MYOCARDIAL INFARCTION AMONG HYPERTENSIVE PATIENTS VISITING OUTPATIENT CLINICS OF TERTIARY CARE HOSPITALS IN COASTAL SOUTH INDIA

Objectives: To assess the proportion of modifiable risk factors for myocardial infarction (MI) among hypertensive patients and to categorize theminto different risk categories so as to determine the probability of developing MI in near future.Methods: A hospital-based cross-sectional study done in two tertiary care hospitals attached to a medical college in south India. 600 hypertensivepatients were interviewed by the treating physician using convenient sampling technique after taking the written informed consent from them. Theinterview was conducted using the non-laboratory INTERHEART Modifiable Risk Score (non-laboratory IHMRS scores).Results: The majority of the study participants (n=404, 67.3%) never smoked in their life time, 21.6% were former smokers (n=130), and 11.1% ofthe study participants were currently smoking (n=66). More than half of the study participants (n=328, 54.7%) were currently diabetic. Most of themhad abdominal obesity (n=469, 78.2%). Around 35.3% (n=212) of the subjects had felt sad or depressed for 2 weeks or more in a row in the last year.Fruits and vegetables were not consumed one or more times daily by 35.5% (n=213) and 11.1% (n=67) of the subjects respectively. A 19 patients(3.2%) were in the lowest risk category, 132 (22%) were at moderate risk, and 449 (74.8%) fell into the highest risk category for development of MI.Conclusion: The present study categorized the hypertensive patients into different risk categories; wherein majority of them fell into the high-riskcategory. Thus, this non-laboratory IHMRS can be used as a risk predictor for the development of MI.Keywords: Risk factors, Hypertensive, Non-laboratory INTERHEART Modifiable Risk Score, Myocardial infarction

CORRELATION BETWEEN INSULIN RESISTANCE AND SEVERITY OF CORONARY ARTERY DISEASE IN NON-DIABETES

Objective: There is an increased risk of CAD in both diabetes and non-diabetes. Insulin resistance has been associated with development of CAD in this both populations. However, there are not many studies on correlation between insulin resistance and severity of CAD in non-diabetes. The present study aimed to establish a correlation between insulin resistance and severity of CAD in non-diabetic individuals.Methods: A cross-sectional study of 79 consecutive Non-diabetic patients undergoing coronary angiogram for evaluation of clinically suspected coronary artery disease at a tertiary care hospital in Mangalore, Karnataka were recruited. Clinical history, anthropometric and biochemical parameters were analyzed. Insulin resistance was determined by Homeostasis model assessment (HOMA-IR). The severity of CAD was assessed by modified Gensini score. Pearson correlation was done to find out the relation between HOMA-IR and Gensini core.Results: The correlation between log of HOMA-IR and severity of coronary artery disease as assessed by Gensini score (r = -0.053 and p= 0.64) was not significant in non-diabetic patients. The correlations between severity of coronary artery disease and other known risk factors of coronary artery disease were also was not significant.Conclusion: HOMA-IR is negatively associated with severity of CAD in non-diabetes

Effectiveness of Integrated Emotional-Self Enhancement (IESE) program among staff nurses: protocol for a quasi-experimental study [version 3; peer review: 2 approved]

Background: Staff nurses face frequent emotional situations in their work environment. The constant contact with suffering patients, and the busy work environment, pose tremendous stress on nurses' physical and emotional health. The Emotional Intelligence skills of empathy, self-awareness, motivation, self-control, and keeping relationships, can help handle difficult emotions and allow nurses to work in an organized, calm, and professional way. This study aims to implement and assess the effectiveness of a training program developed by the investigator, tailored to the mental and emotional needs of staff nurses who are working in an organisation. The study also aims to observe any significant change, correlation, and association in the staff nurses’ level of emotional intelligence, intrinsic motivation, self-compassion, emotional labour, and nurse-in-charges’ and patients’ perception of nursing care after the program. Methods: A quasi-experimental (one-group) study design will be used in this study. The study will involve 80 staff nurses working in a selected hospital in India. The staff nurses will be selected from the hospital's general wards using convenience sampling. The investigator will deliver a training program, divided into four sessions of two hours each. Data will be collected from the participants at baseline and 3-months pre-intervention; and post-test data will be collected immediately after the intervention, at 3-month, and 6-month follow-up, to observe any significant change in the study variables before and after the intervention. Results: The current study primarily focuses on the vital aspect of developing emotional needs, for promoting a better work-life balance. Research findings from the study will significantly contribute to the evidence-based Emotional Intelligence programs for staff nurses, and if proven effective, could be delivered extensively in hospitals. Trial registration: The study is registered in June 2019 under the Central Trial Registry of India (CTRI/2019/08/020592)

Lymphatic Filariasis and Mass Drug Administration

BackgroundA third of world’s filariasis cases occur in India. As a result Mass Drug Administration (MDA) was commenced in 1997 with the aim of eliminating this disease by 2015. However the coverage of MDA was not satisfactory. The underlying reasons for the poor coverage need to be identified. This study was conducted to assess the awareness of health personnel of lymphatic filariasis and the MDA programme.Method  This cross-sectional study was conducted in Kundapura taluk of Karnataka state in India during the 6th round of the MDA which was held between December 11 to 13, 2009. 78 health personnel who were posted for drug distribution were selected by convenience sampling. After obtaining informed consent health personnel were interviewed individually using a semi-structured questionnaire. Performance of health personnel was assessed according to points scored for their responses.ResultsThe mean age of all participants were 22.7± 8.9 years, 74(94.1%) were females and 58(74.4%) were nursing students. Only 17 (21.8%) participants had prior experience before taking part in this round of MDA. Only 4 (5.1%) participants achieved good scores while 45 (57.7%) got average scores. Performance scores were significantly better among paramedical workers (

KNOWLEDGE AND PRACTICE REGARDING FOOT CARE AMONG TYPE 2 DIABETES MELLITUS PATIENTS AT A TERTIARY CARE HOSPITAL IN COASTAL SOUTH INDIA

Objective: The present study was designed to assess the knowledge and practice among diabetic patients in a tertiary care hospital regarding diabeticfoot care.Methods: A cross-sectional study was conducted in government district hospital of Mangalore in the month of January 2014. A pre-designed semistructuredquestionnairewasused tocollectthe informationpertainingtotheknowledgeand practicesofthediabetic patients regardingfootcare.Thecollecteddata wereanalyzedusing Statistical PackagesforSocial Sciences version11.5.The resultsobtained wereexpressedin proportions.Results: A total of 133 subjects were assessed regarding their knowledge and practice regarding diabetic foot care. Around three-fourth (75.2%) ofparticipants had adequate knowledge. More than half (55.5%) of the subjects had adequate practice. No significant association was found betweenstudy variables such as gender, socioeconomic status, and education status with awareness regarding diabetic foot care in the present study (p>0.05).Gender, socioeconomic, and educational statuses were found to be significantly associated with diabetic foot care practices.Conclusion: The gap between knowledge and practice regarding self-care among diabetic patients can be bridged by providing continuous healtheducation by the health workers. Foot care should be promoted at all available opportunities whenever the patient comes in contact with the health system.Keywords: Mangalore, Foot care, Diabetes

Gender preferences among antenatal women: a cross-sectional study from coastal South India

Background: A balanced sex ratio is essential for a stable society. Objective: The main objective of the present research was to study the perceptions of women attending the antenatal care (ANC) facility regarding their gender preferences and family composition. Method: In this cross-sectional study 132 antenatal women were interviewed in their preferred language using a predesigned semi-structured questionnaire. The collected information was analyzed using SPSS version 11.5. Results: The mean age of the study participants was 27.2 \ub1 4.1 years. The majority of the antenatal women (60.6%, n=80) did not have any gender preferences. Among those who had a gender preference (39.4%, n=52), male and female preference was reported by 55.7% (n=29) and 44.3% (n=23) of the participants respectively. The overall son preference index was observed to be 1.3. No consistent relationship could be established between the socio-demographic factors and the preference for gender. The mean preferred family size in our study was 1.85\ub10.531 and more than half of the participants had a balanced gender preference. The majority of the participants were aware that the adverse sex ratio can lead to fall in the number of brides and that it would bring about a social imbalance. Conclusion: As a developed society we need to ensure that both the genders get equal respect and are free from any sort of preferences and prejudices. To achieve this, more and more people need to be made aware of the consequences of gender imbalance and adverse sex ratio in a society

Effectiveness of multi-component modular intervention on screen-based and non-screen-based sedentary time among adolescents in an urban area of Mangalore: a school-based cluster randomised controlled trial-protocol [version 2; peer review: 2 approved]

Background Behavioural risk factors may often present during adolescence and account for 70% of premature deaths during adulthood. Excessive sedentary behaviour and screen time have become significant concerns, especially among adolescents, due to their potential negative impact on physical and mental health. Adolescents with a high screen-based sedentary time are more likely to be physically inactive, have unhealthy body structure and poor academic performance. The objective of our study is to assess the effect of multi-component modular educational intervention on screen-based sedentary time (SST) and non-screen-based Sedentary time (NSST) among adolescents. Methods Ethical approval for the study has been obtained from the institutional Ethics Committee of Kasturba Medical College in Mangalore, India. This cluster randomized control trial will be carried out in schools located in the urban area of Mangalore. Using simple randomization, the eligible schools will be randomized into intervention and control arms, each consisting of 10 clusters. A multi-component modular educational intervention will be administered to participants in the intervention group at baseline, second and fourth month. The control group will receive the standard curriculum. Both the groups will be assessed at baseline and at second month, fourth month and sixth month of follow up for SST, NSST and level of physical activity. Anthropometric measurements like height, weight, waist circumference and hip circumference will be taken at baseline and sixth month of follow up. Results A comprehensive school-based modular educational intervention can have cumulative advantages by reducing screen- and non-screen-based sedentary time, and encouraging physical activity. Similar modular teaching can be incorporated into the curriculum, which will promote healthy life-style among the adolescents

Letter to the Editor

Background Disaster, whether man made or natural, may occur at any place or time. This study was conducted to assess the preparedness of hospitals in handling emergencies as per District Disaster Management Plan (DDMP) at Mangalore, a coastal city on the Western coast of Karnataka. Method A cross sectional study was conducted in 12 hospitals of Mangalore city, located at the Southwestern coast of India in April 2009, using a semi-structured proforma. All surveyed hospitals were included in the DDMP. The respondents were hospital administrators. Results Though all the hospitals surveyed were aware about the existence of DDMP in the district of Dakshina Kannada, 6 (50%) were unaware that their hospitals were included in the same plan. Out of 12 hospitals, 4 (33.3%) said that they had got a letter from DDMP, spelling out their responsibilities. Only 6 (50%) hospitals had a contingency plan for emergency. Mock drill was conducted only by 6 (50%) hospitals. Six (50%) hospitals had blood bank, 5 (41.6%) had trauma center and 8 (66.6%) had burns ward available for emergency. Half of them had more than 2 ambulances and 10(83.3%) had sufficient stock of medicines. Extra beds for emergency were available in 11(91.7%) hospitals with maximum number of 42 beds in one hospital. Conclusion; Most hospitals in Mangalore were not well prepared to manage emergencies in disasters. Facilities like burns ward, blood bank and ambulance services need to be enhanced