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

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

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed agespecific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitorin