Factors associated with Exclusive Breast Feeding(EBF) and Complementary Feeding in an Indian Urban Community: A Cross Sectional Study

Context: Inappropriate feeding practices are very much prevalent in India in areas where there is a high cultural influence on dietary habits, which starts right from the birth and remains throughout the life.Aims: To study the infant and young feeding practices and factors affecting the exclusive breast feeding in children aged 6-23m.Methods and Material:A community based cross sectional study was conducted during the period Jan2008-Dec 2008 in Mehrauli(New Delhi).Feeding practices in the community was assessed using a semistructured questionnaire from the mother/guardian of 309 children in the age group of 6-23m.Results: Breast feeding was initiated within an hour of the birth in only 10.7%(33) of children. Around half(153) of the children were fed with prelacteals and colostrum was discarded in two-thirds (208) of the total. Exclusive breast feeding was dismally low with only 6.8%(21) mothers having practiced it. EBF was found more in institutional delivered and normal birth weight babies in comparison to domiciliary delivered and low birth weight babies respectively(p<0.05). Only 31.7%(98) children were given complementary feeding at the appropriate age, and feeding in terms of calories was inadequate in three-fourth(232) of the total subjects. Knowledge assessed about IYCF(Infant and Young child Feeding) was seemingly pooramongst the mothers in the community.Conclusions: Feeding practices are considerably errant in the community due to the widely prevalent myths and rituals. There is a need of consistent re-enforcement of IEC regarding IYCF by the health workers and AWWs to dispel the misconception from the community to improve the health status of the children

Knowledge assessment about risk prevention of rabies amongst doctors in AIIMS, Jodhpur

Background:Rabies still continues to be a public health problem in India and to protect our citizens from this menace; medical professionals have to be well equipped to tackle it more efficiently. The paper aims to assess the knowledge of residents and faculty in newly established AIIMS regarding risk prevention of rabies.Methods:A cross sectional study using a structured questionnaire on rabies was done at AIIMS Jodhpur amongst the doctors and the data was compiled in Microsoft excel 2010 were further analysed using SPSS version 21.  Results:Out of the total sixty respondents, faculty constituted 38.3%, and junior residents and senior residents 28.3% and 33.3% respectively. Nearly 72% responded correctly regarding post exposure prophylaxis (PEP) i.e. 5 dose regimen of intramuscular administration of Anti Rabies Vaccine (ARV) and 56.7% doctors were unaware about the current recommendation of intradermal (ID) route. Rabies immunoglobulin (RIG) or Anti-Rabies Serum (ARS) against Rabies infection used in Class III bites was known to only 45% of the total doctors.Conclusion:The study reveals that there is a scope of improvement in important areas related to the knowledge of doctors in AIIMS regarding animal bites which needs to be upgraded time to time through continuing medical education in order to follow the standard protocol and guidelines at the apex institute.

Correlates of microalbuminuria in hypertensive patients of a tertiary care teaching hospital of Central India

Background: Although the prevalence of hypertension is high in India, the relationship between micro-albuminuria and target organ damage in hypertension is not well studied. Hence this study aims to study the prevalence of micro-albuminuria in patients of hypertension and its correlation with other cardiovascular risk factors.Methods: This cross-sectional study was done in 112 essential hypertension non-diabetic patients presented at a tertiary care hospital of Madhya Pradesh, India who fulfilled inclusion criteria and exclusion criteria during a calendar year. The diagnosis of essential hypertension was made by the study physician after complete medical history, physical examination and routine biochemical analysis of blood and urine. The data was analysed using SPSS version 20 and Mann Whitney U and Chi-square test was used for quantitative and qualitative data respectively.Results: The total number of patients having micro-albuminuria was 26 and the prevalence came out to be 23.21%. The mean age of micro-albuminuric patients was less compared to non-microalbuminuric patients (p<0.05). The systolic, diastolic blood pressure and cholesterol levels were found to be higher but was statistically insignificant whereas body mass index (BMI) and duration of disease was statistically  higher (p<0.05) amongst the cases having micro-albumin in their urine.Conclusions: The prevalence of micro-albuminuria increases with the increase in duration, stages /severity of hypertension. Micro-albuminuria may be considered as a marker of adverse cardiovascular risk profile such as LVH and hyperlipidemia. High BMI, smoking and advanced stages of retinopathy are also the risk factors of micro-albuminuria.

Pharmacotherapy in idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis or cryptogenic fibrosing alveolitis is a form of chronic, progressive interstitial lung disease causing scarring of lung tissue and usually affect adults. Treatment is usually aimed at controlling inflammation and thus slowing the process of fibrosis. With only few patients responding to treatment and the disease being ultimately fatal with poor progression, the underlying lesion was considered to be fibrotic rather than inflammatory. Fibrotic foci, deposition of collagen, and lack of inflammatory cells are a predominant finding. Pirfenidone and N-acetyl cysteine are the only effective pharmacotherapy available till date. Interim results of PANTHER Trial clearly indicate more risk with triple therapy. However, in Indian patients, trial of steroid therapy may be tried when there is doubt of chronic hypersensitivity pneumonitis. BIBF 1120 has also shown positive results in Phase II clinical trial and shows a positive response in deteriorating lung function. Supplemental oxygen, education of patient, pulmonary rehabilitation, and Streptococcus pneumoniae and influenza vaccine are the most important supportive care. Pulmonary rehabilitation should be used as a treatment in the majority of patients

Core attributes of stewardship; foundation of sound health system

Stewardship is not a new concept for public policy, but has not been used to its optimum by the health policy- makers. Although it is being practiced in most successful models of health system, but the onus to this function is still due till date. Lately, few experts in World Health Organization (WHO) have realized its importance and have been raising the issue at different platforms to pursue the most important function of the health system i.e. stewardship. The core attributes of stewardship need to be understood in totality for better understanding of the concept. The se core attributes, required for hassle free functioning of a health system, include responsible manager, political will, normative dimension, balanced interventionist and proponents of good governance

Core Attributes of Stewardship; Foundation of Sound Health System

Stewardship is not a new concept for public policy, but has not been used to its optimum by the health policy-makers. Although it is being practiced in most successful models of health system, but the onus to this function is still due till date. Lately, few experts in World Health Organization (WHO) have realized its importance and have been raising the issue at different platforms to pursue the most important function of the health system i.e. stewardship. These core attributes of stewardship need to be understood in totality for better understanding of the concept. The core attributes required for hassle free functioning of a health system include responsible manager, political will, normative dimension, balanced interventionist and proponents of good governance

Tartrazine InducedFixedDrugEruption

A 29 year old oncology resident presented to a dermatologist with the complaints of burning pain and hyperpigmentation of lips of acute onset. He was a non smoker without any significant history of known drug allergy or symptoms suggestive of intestinal polyposis or any endocrinological disorders. He was not exposed to any local irritants in the form of chewing tobacco, its related products and other chemicals. Detailed history revealed that he had suffered from 3 episodes of diarrhea one day back, took a tablet containing combination of the drugs norfloxacinandtinidazole with tartrazine as a coloring agent. He felt burning sensation in upper and lower lips seven hours after the drug intake which increased in severity at night.On examination, hyperpigmentation and desquamation was noted which involved median portion of upperlip and right lateral portion of lower lip, not involving mucocutaneous junction or skin adjacent to lips(fig.1).Finally based on history, clinical examination and known allergic properties of the coloring agents used for coating the drugs, a diagnosis of Fixed Drug Eruption induced by Tartrazine was made.He was treated by moisturizers and steroid (momentasone) ointment. Further patient developedpostinflammatory hyperpigmentation(fig.2) at the site of eruption which was treated by local application of hydroquinone and momentasone ointment