Maternal and fetal outcome among gestational diabetes mellitus mothers treated at a tertiary care maternity hospital

Background: Incidence of gestational diabetes mellitus (GDM) in India is alarming. The present study was designed to determine the association between the maternal and fetal outcome with the blood sugar control status at the time of delivery. Methods: It was an analytical follow up study that included 180 antenatal women who met the criteria for GDM with singleton pregnancy irrespective of age, gestational period, parity were included into the study. Those with pre-existing diabetes mellitus, scarred uterus, multiple pregnancy, chronic medical disease and ante partum hemorrhage were excluded. Based on the blood sugar level at the time of delivery GDM mothers were classified into four groups excellent control, optimal control, poor control and no control group. The maternal and fetal outcomes were compared between groups. Results: Nearly 7500 antenatal women were screened and 198 eligible GDM women were selected. Of which 180 cases were successfully completed the follow up. Among the 180 cases of GDM, 74 (41.1%) were in excellent control group, 40 (22.2%) under optimal control, 41 (22.8%) belonged to poor control and 25 (13.8%) were not controlled at the time of delivery. There was statistically significant positive association between poor glycemic control and bad maternal and fetal outcome. Conclusions: Bad maternal and fetal outcomes were statistically higher among mothers with poor and no glycemic control. Strict glycemic control during antenatal period is mandate to avoid bad outcomes. Neonatal care center needs to be well equipped where GDM mothers seek care for delivery

Prevalence and determinants of metabolic syndrome among the rural adult population of Puducherry

Background: Burden of metabolic syndrome (MS) is rising. There were many previous studies conducted in India on MS, yet it is less studied in Puducherry which has embraced modern culture and lifestyle. Hence, we aimed to study the prevalence and predictors of MS. Materials and Methods: A cross-sectional study was undertaken on a representative sample of 489 adults of age 30 years and above over the period of 18 months. MS was defined according to the International Diabetes Federation (IDF) criteria. Data on sociodemography, lifestyle characteristics, and biochemical parameters were collected by a well-trained health professional using standard methods. Generalized linear models with Poisson distribution and log link function were used to calculate the adjusted prevalence ratio (PR). Results: The prevalence of MS was 39.7% (95% confidence interval [CI]: 35.3–44.1) among the study participants. The most commonly deranged component of MS was central obesity (63.6%). Increasing age, upper socioeconomic status, low fruit intake, physical inactivity, use of refined sunflower oil (PR: 1.40, 95% CI: 1.07–1.83) for cooking, and high perceived stress (PR: 1.77, 95% CI: 1.32–2.37) were found to be associated with MS. Conclusion: The prevalence of MS in Puducherry was high as per the IDF criteria. Usage of refined sunflower oil for cooking and perceived stress was independently associated with an increased risk of MS along with other routinely studied risk factors

Evaluation of palliative care training program for medical interns in a tertiary care teaching hospital, South India

Introduction: The Department of Community Medicine has been training medical interns for providing hospital-based palliative care (HBPC) and community-based palliative care (CBPC) services with an interprofessional team. This study was done to evaluate the training program on palliative care developed for medical interns. Material and Methods: It was a retro-pre type of program evaluation done among 172 interns between January 2016 and December 2017. One day program was conducted for the interns by faculty trained in palliative care, followed by placement in HBPC and CBPC program. At the end of training, self-perceived improvement in knowledge was collected on a five-point Likert scale. Certificates were issued on completion. Data were entered and analyzed using Epi Info (version 7.2.2.6) software. Wilcoxon signed-rank test was applied between pre- and post-scores. Manual content analysis was done for open-ended questions. Results: The mean age of the participants was 22.5 ± 0.8 years, with 76 (44.2%) males and 96 (55.8%) females. There was statistically significant improvement in perceived knowledge scores after attending the training. Areas of learning, values learned, and uses of learning in future career and suggestions for improving the training program were the categories obtained. Conclusion: The training program improved the self-perceived knowledge on palliative care among medical interns. The exposure to HBPC and CBPC program had a positive effect on their attitude and perceived skills for caring of chronically ill patients. Such programs can be initiated by other palliative care providing institutions for training medical interns

Outcomes and implementation challenges of using daily treatment regimens with an innovative adherence support tool among HIV-infected tuberculosis patients in Karnataka, India: a mixed-methods study

Background: In India, a new care package consisting of (i) daily regimen with fixed-dose combination drugs, collected once-a-month and self-administered by the patient, (ii) ‘one stop service’ at antiretroviral treatment (ART) centre for both HIV and tuberculosis (TB) treatment and (iii) technology-enabled adherence support (99DOTS, which required patients to give a missed phone call after consuming drugs) was piloted for treatment of TB among HIV-infected TB patients. Conventional care included intermittent regimen (drugs consumed thrice-weekly) delivered under direct observation of treatment supporter and the patients needing to visit TB and HIV care facilities, separately for treatment. Objective: To assess the effect of new care package on TB treatment outcomes among HIV-TB patients registered during January–December 2016, as compared to conventional care and explore the implementation challenges. Methods: A mixed-methods study was conducted in four districts of Karnataka, India where new care package was piloted in few ART centres while the rest provided conventional care. Quantitative component involved a secondary cohort analysis of routine programme data. Adjusted relative risk(aRR) was calculated using Poisson regression to measure association between new care package and unsuccessful treatment outcome. We conducted in-depth interviews with healthcare providers and patients to understand the challenges. Results: Unsuccessful TB treatment outcomes (death, loss to follow-up and failure) were higher in new care package (n = 871) compared to conventional care (n = 961) (30.5% vs 23.4%; P value<0.001) and aRR was 1.3(95% CI: 1.1–1.7). Key challenges included patients’ inability to give missed call, increased work load for ART staff, reduced patient–provider interaction, deficiencies in training and lack of role clarity among providers and reduced involvement of TB program staff. Conclusion: With new care package, TB treatment outcomes did not improve as expected and conversely declined compared to conventional care. TB and HIV programs need to address the operational challenges to improve the outcomes