Anxiety among people living with HIV/AIDS on antiretroviral treatment attending tertiary care hospitals in Lucknow, Uttar Pradesh, India

Background: One of the major health challenges faced by India is the rapid growth of HIV/AIDS and its impact upon human life. Co-morbidities like anxiety are often overlooked while providing ART services to HIV/AIDS patients. Therefore the present study was conducted to assess the anxiety and associated factors among PLHA (People Living with HIV/AIDS) on antiretroviral treatment attending tertiary care hospitals in Lucknow.Methods: Hospital‑based cross-sectional study was conducted from November 2013 to March 2014 among 170 patients on treatment attending antiretroviral therapy (ART) centre of two tertiary care hospitals of Lucknow. Systematic random sampling was used to recruit patients. The anxiety level of all included patients was scored as per Hamilton anxiety rating scale. Results: The mean HAM-A score of 179 patients was 10.74±6.04. Majority (92.1%) of the patients had HAM-A score less than 17 indicating mild severity, 5.0% of the patient had mild to moderate severity while only 2.7% had moderate to severe level of anxiety symptoms. None of the patient had very severe level of anxiety. Significant association was found between level of anxiety symptoms with educational status (0.03), perception of side-effects during last one month (0.03) and duration of treatment (0.04).Conclusions: People living with HIV/AIDS need to be periodically educated and informed about various issues associated with the disease severity and antiretroviral treatment along with its side-effects so that they could better cope with disease and its treatment outcomes over time and be able to seek early treatment accordingly.

Feeding practices in infants: ritual factors dominating mother’s education - a cross sectional study

Background: The objective was to know the impact of mother education on feeding practices of infants.Methods: Observational analytic cross sectional study. We used Semi-structured, pre-tested questionnaire to interview 355 mothers of infants, aged one and half to 12 months, who came in OPD of Department of Paediatrics UPRIMS and R, Saifai for immunization or some problem.Results: Total 267 (75.2 %) out of 355 women had initiated breast feeding within 24 hours of birth. 172 (48.5%) mothers exclusively breast fed their infants. Total 166 (46.8%) practiced Prelacteal feed. Out of 166 subjects, 121 (34.1%) practiced for 7 days and 41 (12.7%) beyond the 7 days. There were highly significant relationship found between education level of mothers with type of breast feeding, in the form of exclusive or non- exclusive breast feeding and Prelacteal feeding practices ( p 0.05), but an important pattern of initiation of breast feeding was seen at the different level of mothers education.Conclusion: Ritual and customary factors have much impact then mother’s education on breast feeding practices of infants. Apart from education, breast feeding awareness programme should be increased including both literate and illiterate mothers.

A study of habit of fast food eating among school going adolescents and parental advice and its relation with their nutritional status

Background:A study of habit of fast food eating among school going adolescents and parental advice and its relation with their nutritional status.Methods: Design: an epidemiological analytic observational study. Subjects: 600 adolescents’ 15-19 years of age, studying in 11 and 12 classes and included both boys and girls. A single observer interviewed each student and gathered the information regarding their eating habits. It was recorded on a pre-tested open and closed ended Performa. Nutritional status was assessed by BMI. The adolescents for the purpose of analysis were broadly grouped in two groups. Group I (those having normal BMI ranging 18.5 to 25) and group II (Malnourished i.e. those having BMI 25). Group II adolescents were further divided into group IIa (Underweight, BMI25).Results:Adolescents who took both fast food and soft drinks 73.1% were malnourished (group II) as compared to those who did not take both the things 13.7% in group II. Difference was found to be statistically significant (p value 25) subsequently. Incidence of malnutrition was significantly less in 12.4% adolescents’ interfered by their parents as compared to 69.6% of those where parents was not interfering. Difference was found to be statistically significant (P value <0.01).Conclusion: A habit of fast food eating and taking soft drink provokes malnutrition. Interference in eating by parents is beneficial among adolescents.

Probiotics in acute diarrhea: A randomized control trial

Background: Probiotics have been used for long in the treatment of acute diarrhea although their efficacy has always&nbsp;remains the subject of discussion. Objective: To determine the effect of probiotics in acute diarrhea among the children in&nbsp;rural population. Method: Double-blinded randomized control trial. We included children of age group 6 months - 5 years&nbsp;suffering from acute diarrhea of &lt;48 h and fulfilling the inclusion criteria. All children were given oral rehydration salts&nbsp;(ORS) ad-lib till the resolution of diarrhea and zinc 20 mg/day for 14 days while intervention arm (n=101) were given&nbsp;probiotic sachet twice a day for 7 days containing Streptococcus faecalis 30 million, Clostridium butyricum 2 million,&nbsp;Bacillus mesentericus 1 million, Lactobacillus sporogenes 50 million, control group were given identical placebo apart from&nbsp;ORS and zinc. Duration of diarrhea in both the groups was measured as primary outcome while secondary outcome was&nbsp;to know the days of maximum recovery from diarrhea in both groups. Results: Totally, 207 patients were randomized to&nbsp;control and study group, out of which, 195 completed the study. Out of total 195 patients, 94 (48.2%) patients were treatedwith standard treatment of diarrhea without probiotics while 101 (51.8%) patients were given probiotics apart from standard&nbsp;treatment of diarrhea. The mean duration of diarrhea was found to be reduced in the study group (4.6 days [2.84-4.776 days])&nbsp;as compared to control group (5.31 days [5.108-5.512 days]), p&lt;0.001. Conclusion: Probiotics significantly reduced the&nbsp;duration of acute diarrhea in children

Sizes of induration and nutritional status in children with positive Mantoux test

Background: The immune status of children is always affected by nutrition. Sometime severe malnutrition is associated with falsenegative Mantoux test. There is a need to study to observe the effect of nutritional status on the size of indurations in Mantoux positivechildren. Study Design: Observational analytical cross-sectional study. Methods: The study population consisted of 310 patients,belonging to both sexes and age of 1-14 years, attending the outpatient department of UP Rural Institute of Medical Sciences andResearch, Saifai, Etawah. Only Mantoux positive cases were included in the study. Their sizes of indurations of skin reaction weremeasured and recorded in mm. The nutritional status was calculated as the weight for age and height for age standard (Z-score), usingthe NCHS charts of for males and females. Results: Out of 800 children screened for tuberculosis, 310 children had positive Mantouxtest and were recruited in the study. Mean induration (20 mm) was similar in all the groups. However, the size of indurations rangedfrom 10-40 mm, 11-33 mm, and 12-24 among normal weight, underweight, and overweight Z-score groups. Mean induration was same(20 mm) in two Z-score height for age groups (normal height, stunting), while it was 20.6 mm in the over-height group. Although, therange of Mantoux positivity ranges from 10-35 mm, 11-40 mm, and 18-22 mm among normal height, stunting, and over height Z-scoregroups. Conclusion: Although, nutritional status can affect the positivity of Mantoux test; in Mantoux positive children, the size ofindurations does not depend on their nutritional status

Prevalence and genotypes of Mycobacterium avium subspecies paratuberculosis in large ruminants of Eastern Uttar Pradesh, North India

Uttar Pradesh is the fourth largest, most populous and leading milk and meat producing state in India. Despite the huge livestock population, information on the status of paratuberculosis homogeneity and heterogeneity of Mycobacterium avium subspecies paratuberculosis (MAP) isolates of eastern Uttar Pradesh is non-existent. Present study was aimed to estimate the presence of MAP in large ruminants (Cattle and Buffaloes) of eastern Uttar Pradesh. A total 108 fecal samples were collected from farmer’s herds of large ruminants (cattle and buffaloes) from different geographical regions (Chandauli, Mughalsarai, Gazipur, and Naugarh) of eastern Uttar Pradesh and screened for the presence of MAP infection using microscopic examination, direct IS900 PCR and culture on Herrold egg yolk (HEY) medium. The isolates recovered on HEY medium were subjected to molecular identification and genotyping using IS900 PCR and IS1311 PCR-REA method, respectively. Of the 108 fecal samples, 25 (23.14%) and 11 (10.18%) samples were positive for the presence of acid-fast bacilli and growth on HEY medium, respectively. Species-wise, 17.5, 7.5% and 26.5, 11.7% fecal samples from cattle and buffaloes were found positive for the presence of acid-fast bacilli and growth on HEY medium, respectively. Isolates recovered on HEY medium with mycobactin J were positive for IS900 sequence and genotyped as Bison Type using IS1311 PCR-REA method. Present study is the first report on the presence of MAP infection and ‘Bison Type’ genotype of MAP in eastern Uttar Pradesh. These findings will be useful for the intervention of effective control measures in order to reduce the prevalence of MAP infection in domestic livestock species and prevent its spread to the human population in the regions

Out-Of-Pocket Expenditure on Institutional Delivery in Rural Lucknow

 \ud Introduction: Promotion of reproductive health through institutional delivery has been adopted by government as a strategy for reducing maternal mortality rate but still about half of the deliveries have been conducted at home. Cost barrier is one of the major cause for preferring home delivery instead of institutional delivery. Not only the direct costs responsible for low institutional delivery but also indirect costs too accountable for less number of institutional births in the country. Aims & Objectives: To estimate the out of pocket expenditure incurred by households during delivery and its determinants. Materials and methods: A community based cross sectional study was conducted during which a total 272 households having women who had recently delivered in government institutions were interviewed. Result: The mean out of pocket expenditure was found to be Rs. 1406.04 ± 103.27 including spending’s on drugs, travel, pathological tests and unofficial payments. Low socioeconomic class, residence outside the catchment area of delivery point, tertiary and secondary health care facilities as place of delivery and low literacy status of head of the family below high school  were found to be significantly associated with out of pocket expenditure bivariate analysis (p<0.05). On multivariate analysis low socioeconomic (OR 22.40; 95% CI 9.44-53.15; p = 0.01)   and residence (OR 13.07; 95% CI (1.58-116.55); p = 0.03)  outside the catchment area of delivery point were found to be independent predictors of catastrophic out of pocket expenditure during delivery. Conclusions: Although government has been running lot of schemes for availing free of cost health services but still one has to pay from their pocket as medical expenses. In order to bear these expenses, they have to borrow money, sell their assets and securities due to which households suffer a lot. In the present study, unofficial payment was found prevalent in public institutions and these informal payments make the health service unaffordable for households

INFANTILE TREMOR SYNDROME IN CHILDREN AND MATERNAL VITAMIN B12 DEFICIENCY: A TIME FOR PRIMARY PROPHYLAXIS

Objective: The aim of the study was to determine the percentage of Vitamin B12 deficiency in mothers of children suffering from infantile tremor syndrome (ITS). Other objectives were to determine the percentage of Vitamin B12 deficiency in children and to look for percentage of children having neurological changes in contrast enhanced computed tomography (CT) scan of brain. Methods: Data of children between 1 and 60 months admitted between April 2019 and December 2019 with ITS in a tertiary care hospital were collected. Serum Vitamin B12 levels of both mother and child were determined. Vitamin B12 deficiency and insufficiency were defined as levels &lt;200 pg/ mL and 200–350 pg/mL, respectively. The primary outcome was percentage of mother with Vitamin B12 deficiency and the secondary outcomes were percentage of children with Vitamin B12 deficiency and percentage of children with cerebral atrophy on contrast-enhanced CT of brain. Results: Forty-five children were enrolled in our study. Vitamin B12 deficiency was found in 29 (64.4%) children and 22 (55%) of their mothers. Cerebral atrophy in CT scan was found in 29 (70%) out of 41 children. Conclusion: The most of the mothers of children with ITS are also Vitamin B12 deficient. ITS occurs in infants and toddler with underlying Vitamin B12 deficiency and causes early cerebral atrophy in children, which is crucial period of brain growth. Hence, screening and supplementing anemic pregnant women with vitamin B12 can be one of the primary prevention in India