Critical Analysis of PIM2 Score Applicability in a Tertiary Care PICU in Western India

Objective. Children have limited physiological reserve that deteriorates rapidly. Present study profiled patients admitted to PICU and determined PIM2 score applicability in Indian setting. Patients and Methods. Prospective observational study. Results. In 742 consecutive admissions, male : female ratio was 1.5 : 1, 35.6% patients were ventilated, observed mortality was 7%, and 26.4% were <1 year. The profile included septicemia and septic shock (29.6%), anemia (27.1%), pneumonia (19.6%), and meningitis and encephalitis (17.2%). For the first year, sensitivity of PIM2 was 65.8% and specificity was 71% for cutoff value at 1.9 by ROC curve analysis. The area under the curve was 0.724 (95% CI: 0.69, 0.76). This cutoff was validated for second year data yielding similar sensitivity (70.6%) and specificity (65%). Logistic regression analysis (LRA) over entire data revealed various variables independently associated with mortality along with PIM2 score. Another logistic model with same input variables except PIM2 yielded the same significant variables with Nagelkerke R square of 0.388 and correct classification of 78.5 revealing contribution of PIM2 in predicting mortality is meager. Conclusion. Infectious diseases were the commonest cause of PICU admission and mortality. PIM2 scoring did not explain the outcome adequately, suggesting need for recalibration. Following PALS/GEM guidelines was associated with better outcome

Association of quality of life of carers with quality of life and functional independence of stroke survivors

Background: Stroke has a great impact not only on patients′ but also on their caregivers′ lives. Carers may experience high levels of burden that can result in deterioration of their health status, social life, and well-being. Association between quality of life (QOL) of carers and that of stroke survivors in Indian setting is not much researched. Aims and Settings: To find out QOL and mental health of caregivers of individuals with stroke visiting Physiotherapy Department of Tertiary Care Center in Western India. Design and Methodology: A cross-sectional survey to find QOL and mental health of caregiver of stroke survivors, self-administered screening instrument WHO-QOL BREF, functional independence measurement (FIM) scale, and BRIEF COPE were used for data collection on adult populations. Statistical Analysis Used: The statistical analysis was performed by descriptive analysis and correlation. Result: Fifty-four stroke patients and their caregivers (all adults) were included in the study. Average FIM score was 83.75 (18.46) while median was 90 (25). FIM score of patients did not much affect QOL of caregivers. Discussion: Analysis of QOL data showed that QOL of caregivers was good in all domains, but patient′s QOL was good only in social relations. There was no correlation found in QOL of carers and stroke survivors. Nine percent of change in caregivers social relationship scores can be attributed to patients′ sphincter scores. Conclusion: QOL of carers and stroke survivors may be independent. Stroke patients in the study required a moderate assistance for their functional independence which does not seem to affect the caregivers QOL significantly

Quality of life and coping strategies of caregivers of children with physical and mental disabilities

Background: Developmental disability is a term that refers to permanent cognitive and or physical impairment. Arrested development of physical or mental capacities can lead to number of problems for the sufferer as well as the carers. Methodology: This study was conducted to assess the quality of life (QOL) and coping mechanisms used by the carers of physically challenged children. In this cross-sectional study, all the 116 children from a school for children with special needs in Anand, Gujarat and their carers were included. World Health Organization-QOL (WHO-QOL) and BREF COPE were administered to measure QOL and coping strategies, respectively. Results: On WHO-QOL, the social relationship domain was observed to be the best while environment domain had the lowest score. The main coping style used by the caregivers was Active emotional coping. Conclusions: Significant differences were found in QOL of the caregivers of physically challenged children based on the type of disability of the child. Rehabilitation programs can be planned to provide psychological support to the caregivers to ease the burden if any through collaborative efforts

Prevalence of Postmenopausal Symptoms, Its Effect on Quality of Life and Coping in Rural Couple

Aim: Menopause is a physiological process, with potential to lead to various pathological/psychological complications, leading to change in quality of life (QOL). Although literature suggests the effect of menopause on various aspects of life, there is scarcity of studies from rural setup in this regard. Thus, it is essential to assess extent of menopause-related changes, its awareness, and coping mechanisms in rural couple. This study aimed to find the prevalence of postmenopausal symptoms, its severity, and effect on QOL of rural women and the couples' coping mechanisms. Materials and Methodology: A cross-sectional survey was conducted by approaching 250 families from two villages of Gujarat, India. Inclusion criteria were any woman having attained menopause naturally within last 10 years and having her husband available for data collection. Hundred such couples consenting for participation were included in the study. Data on demographic variables, menopause-specific QOL, personal health of women, and coping of the couple were collected. Results: The prevalence of menopausal symptoms was found to be 47%. Mean (standard deviation) age at menopause was 44.9 (4.9) years. The prevalence of at least one symptom related to vasomotor was 21.3%, physical 91.5%, psychosocial 44.7%, and sexual was 0%. “QOL and Bother” analysis revealed that all those with menopausal symptoms also had their QOL affected from mild-to-moderate extent. The husbands of women with menopausal symptoms were aware of their condition; however, neither of them exhibited use of the active coping mechanism. The avoidant emotional coping strategy appeared to be followed by most. Conclusion: Couples were found to be aware of menopause; however, the symptoms arising as consequence of it seem to be accepted as natural age-related changes. This could possibly account for not taking any active coping strategy despite reporting of mild-to-moderate botheration by women and awareness in both. Rigorous health education and awareness about menopausal changes might be beneficial

Microtensile dentin bond strength of fifth with five seventh-generation dentin bonding agents after thermocycling: An in vitro study

Objectives: The objective of this in vitro study was to compare the microtensile dentin bond strength (μTBS) of five seventh-generation dentin bonding agents (DBA) with fifth-generation DBA before and after thermocycling. Materials and Methods: Ten extracted teeth were assigned to fifth generation control group (optibond solo) and each of the five experimental groups namely, Group I (G-Bond) ,Group II (S 3 Clearfil), Group III (One Coat 7.0), Group IV (Xeno V), and Group V (Optibond all in one). The crown portions of the teeth were horizontally sectioned below the central groove to expose the dentin. The adhesive resins from all groups were bonded to the teeth with their respective composites. Specimens of sizes 1 × 1 × 6 mm 3 were obtained. Fifty specimens that bonded to dentin from each group were selected. Twenty-five of the specimens were tested for debonding without thermocycling and the remaining were subjected to thermocycling followed by μTBS testing. The data were analyzed with one-way ANOVA and Dunnett′s-test for comparison with the reference group(Vth Generation). Results: There was no significant difference (P > 0.05) between the fifth- and seventh-generation adhesives before and after thermocycling. The results of our study showed significantly higher value (P < 0.05) of μTBS of seventh-generation Group II (Clearfil S 3 ) compared to the fifth-generation before and after thermocycling. Conclusion: The study demonstrated that the Clearfil S 3 bond had the highest μTBS values. In addition, of the five tested seventh-generation adhesive resins were comparable to the fifth-generation DBA

PRESCRIBING PATTERNS OF CEPHALOSPORIN IN CHILDREN FOLLOWING IMPLEMENTATION OF ANTIBIOTIC STEWARDSHIP PROGRAM IN A TERTIARY CARE HOSPITAL AT WESTERN INDIA

Objective: The objective of the study was to study the prescribing patterns of cephalosporins in children following the implementation of Antibiotic Stewardship Program (ASP) in a tertiary care hospital at western India. Methods: This was an observational study of records using data of pre- and post-implementation of ASP. Data were collected from case files of children admitted to pediatric wards in the years 2012 and 2014, respectively. Data were analyzed to find the prescribing pattern of cephalosporin and its appropriateness in relation to ASP program guidelines. Results: Three hundred case files were collected and analyzed (n=150 each from the year 2012 and 2014). The mean age of patients in both years was 6.21 years±5.63 (the year 2012) and 5.88 years±5.88 in (the year 2014). Majority of children, that is, 47.3% were suffering from infectious diseases in the year 2012 while in the year 2014, 38.7% suffered from infectious diseases. Post-implementation of ASP, there was an improvement in the appropriateness of cephalosporin prescribing in terms of prophylactic and empirical treatments. Switch over of parenteral cephalosporins to oral was observed in 54.0% patients in 2012, while in 2014, it was seen in 51.3% of patients. There was a 4.6% rise in prescriptions containing 1st generation cephalosporins. Overall there was a significant impact of ASP in terms of appropriate cephalosporin prescribing (p=0.039). Conclusion: Implementation of ASP and its adherence by pediatricians can improve antibiotic prescribing in children

Critical Analysis of PIM2 Score Applicability in a Tertiary Care PICU in Western India

Objective. Children have limited physiological reserve that deteriorates rapidly. Present study profiled patients admitted to PICU and determined PIM2 score applicability in Indian setting. Patients and Methods. Prospective observational study. Results. In 742 consecutive admissions, male : female ratio was 1.5 : 1, 35.6% patients were ventilated, observed mortality was 7%, and 26.4% were <1 year. The profile included septicemia and septic shock (29.6%), anemia (27.1%), pneumonia (19.6%), and meningitis and encephalitis (17.2%). For the first year, sensitivity of PIM2 was 65.8% and specificity was 71% for cutoff value at 1.9 by ROC curve analysis. The area under the curve was 0.724 (95% CI: 0.69, 0.76). This cutoff was validated for second year data yielding similar sensitivity (70.6%) and specificity (65%). Logistic regression analysis (LRA) over entire data revealed various variables independently associated with mortality along with PIM2 score. Another logistic model with same input variables except PIM2 yielded the same significant variables with Nagelkerke R square of 0.388 and correct classification of 78.5 revealing contribution of PIM2 in predicting mortality is meager. Conclusion. Infectious diseases were the commonest cause of PICU admission and mortality. PIM2 scoring did not explain the outcome adequately, suggesting need for recalibration. Following PALS/GEM guidelines was associated with better outcome

Factors associated with internet addiction among school-going adolescents in Vadodara

Introduction: The internet is an important modern means of obtaining information and communicating with others which has converted the world into a global village. At the same time, increasing internet use among adolescents is also likely to pose a major public health concern that is internet addiction (IA). The aim was to assess the prevalence of IA among school-going adolescents and factors associated with IA. Methods: A cross-sectional study was designed to survey adolescents studying in 8th to 11th standard of five schools of Vadodara. Information regarding sociodemography and various patterns of internet use were obtained using survey forms. IA test (IAT) was used to screen for IA. Descriptive analysis, univariate analysis, and logistic regression were done to analyze the data. Results: Seven hundred and twenty-four participants that completed IAT were analyzed. Internet use prevalence was 98.9%. Prevalence of IA was 8.7%. Male gender, owning a personal device, hours of internet use/day, use of smartphones, permanent login status, use of internet for chatting, making online friends, shopping, watching movies, online gaming, searching information online and instant messaging were found to be associated significantly with IA in univariate analysis. Internet use for online friendships was found to be a significant predictor of IA (odds ratio [OR] =2.4), and internet use for searching information was found to be protective (OR = 0.20) against IA on logistic regression. Conclusions: IA is prevalent in the adolescent population and requires awareness and intervention. Characteristics of internet usage found to be associated with IA needs to be considered while developing strategies for interventions

Development, implementation, and evaluation of structured Performa in the initial assessment of sick children at the emergency department: A third level Kirkpatrick’s evaluation model

Background & Objective: At emergency department (ED) at different point of time different teams are involved in management of patients as per their posting/duty roster. So, a robust system should be in place to avoid major mishaps. The current study was an attempt to improve pediatric care at our Emergency Department through third-level Kirkpatrick’s evaluation model after training of pediatric resident doctors to use newly developed structured proforma while doing initial assessment of sick children at ED. Materials & Methods: This Quasi-experimental study included all departmental pediatric resident doctors and as per sample size calculation, 36 (pre-intervention) and 36 (post-intervention) computer-generated random selection records were reviewed from the total of serially arranged admissions of pediatric patients. The intervention was the implementation of a Structured proforma, and training of all departmental residents. All raters scored the records of patients on 47 & 51 items of documentation pre-and post-intervention periods respectively on a scale 0-2, 0 meaning ‘no mention’, 1-incomplete/improper mention and 2-complete/proper mention. Mean, standard deviation (SD) of scores were calculated item-wise, raters-wise and overall. Bland Altman analysis was done to find agreement in scoring among raters both in pre-and post-intervention. Results: The mean (SD) and percentage of mean score were 32.93 (4.50) and 35.03% before intervention whereas 89.64 (4.35) and 87.88% post-intervention. This indicated 53.5% improvement post-intervention. Bland Altman analysis found good agreement post-intervention. Conclusion: The introduction of Educational tool along with the training of pediatric resident doctors to implement it, has improved documentation process significantly

Xanthelasma palpebrarum with arcus cornea: A clinical and biochemical study

Background: Xanthelasma palpebrarum (XP) is characterized by sharply demarcated yellowish flat plaques on upper and lower eyelids. It is commonly seen in women with a peak incidence at 30–50 years. It is also considered as the cutaneous marker of underlying atherosclerosis along with the disturbed lipid metabolism. XP and corneal arcus are associated with increased levels of serum cholesterol and low-density lipoprotein (LDL) cholesterol. Aims and Objectives: To study the clinical pattern of XP, its relationship with lipid profile and association with arcus cornea. Materials and Methods: This study was conducted at Department of Dermatology and Opthalmology, between August 2013 and January 2015. Patients with clinical diagnosis of XP who visited skin outpatient department and willing to undergo lipid profile test and eye examination were included in the study. Data regarding demographics, clinical findings, family history, and past history were noted along with the lipid profile details. Data of age-matched healthy controls were taken for comparison. The clinical profile of the participants was presented using frequency and proportions. Gender wise analysis comparing the lipid profile in cases with XP and without XP was done using independent sample t-test. Results: Total 49 patients of XP, 81.6% were females. Maximum, 35% patients were among 50–60 years of age and 69.4% were homemakers by occupation. The average lipid values were-cholesterol 210.57 mg%, triglyceride 123.06 mg%. LDL 142.79 mg% and VLDL 30.95 mg% among patients of XP. Arcus cornea was found in 20% cases of XP. Conclusions: Patients of XP requires proper investigation at the onset and regular follow-up thereafter for any altered lipid profile and early diagnosis of coronary artery disease