Abhay Gaidhane

Assessing self-care component of activities and participation domain of the international classification of functioning, disability and health (ICF) among people living with HIV/AIDS.

Abstract Disability experience of persons with HIV illness has shifted from issues related to physical well-being to those concerning performance of daily life activities. This study aimed to find out the nature of self-care among people living with HIV/AIDS (PLWHA) in rural tertiary care center. The objectives were to determine reported self-care by performance qualifier of PLWHA and to find out reported self-care by capacity qualifier of PLHIV. A cross sectional study was conducted among the 194 PLHIV in rural tertiary care hospital. The Self-Care (d5) component of Activities and Participation domain (d) of the International Classification of Functioning, Disability and Health (ICF) was used. Among the 194 PLHIV patients studied, 82% were male. The average age was 36.87 years (SD±9.01) with a median of 35 years, varying from 15 to 65 years. Over 65% of the study group experienced one or more impairments. As HIV disease has become a more lifelong, unpredictable, but medically manageable condition, there is a need for more collaboration with other disability groups in order to identify commonalities in their experiences and to share collective concerns.

Ghrelin: Ghrelin as a Regulatory Peptide in Growth Hormone Secretion

BACKGROUND Ghrelin is a type of growth hormone (GH) secretagogue that stimulates the release of GH. It is a first hormone linking gastrointestinal-pituitary axis. OBJECTIVE This review highlights the interaction of ghrelin with GHRH and somatostatin to regulate the secretion of GH and intends to explore the possible physiological role of the ghrelin-pituitary-GH axis linkage system. OBSERVATION Ghrelin is highly conserved among species and is classified into octanoylated (C8:0), decanoylated (C10:0), decenoylated (C10:1) and nonacylated,ghrelin. Acylated ghrelin is the major active form of human ghrelin. The primary production site of ghrelin is the stomach, and it interacts with stomach ghrelin as well as hypothalamic GHRH and somatostatin in the regulation of pituitary GH secretion. Ghrelin stimulate GH release through the GHS receptor to increase intracellular Ca2+ ([Ca2+] levels via IP3 signal transduction pathway. Ghrelin is a specific endogenous ligand for the GHS receptor and provides a definitive proof of the occurance of a GHS-GHS receptor signalling system in the regulation of GH secretion. CONCLUSION Studies suggests that ghrelin is a powerful pharmacological agent that exerts a potent, time-dependent stimulation of pulsatile secretion of GH.

Substance abuse among street children in Mumbai

Abstract Adolescent street boys are a highly mobile population and difficult to reach. They are recognized to be vulnerable to substance, physical and sexual abuse. Our objective was to conduct a study among adolescent street boys of Mumbai City to assess substance, physical and sexual abuse and the factors associated with them. Most of the studies on adolescent street boys were conducted either in observation homes or via surveys, but we have adopted a unique approach in which a cross-sectional study was conducted in a 3-day ‘Diwali Festival Mela’, an annual celebration when these adolescent street boys come from almost all areas of Mumbai City in large numbers. During this period they are relaxed and provide confidential information in privacy; the response rate was 83.5%. Of 163 street boys, 132 (80.98%) were substance abusers; 52 (31.9%) had been sexually abused and 87 (53.3%) had been physically abused. The most common reasons for substance abuse or the perceived functions of substance use mentioned by participants were peer pressure (62.1%), experimentation (36.3%) or to boost self-confidence (28.7%). Almost three-quarters (70 %) of all substance users wanted to quit and about 40% had tried to quit. A multiple logistic regression statistical method was used in which increasing age, family pathology, substance abuse among peers and those who were living ‘only on-street’ were at a greater risk of substance abuse (P < 0.05), while concerning sexual abuse the above factors were not statistically significant (P > 0.05). Those adolescent street boys with family pathology were at more risk of physical abuse, with a statistical significance of P < 0.05. This study will help in the intervention and evaluation of programmes intended for a most elusive population at extreme risk for various abuses and its adverse consequences.

Risk factors of type-2 diabetes mellitus in rural Wardha: A community based study

CONTEXT: The rise in diabetes mellitus (DM) portends a disaster of major proportion worldwide. AIM: To study the determinants of type-2 DM in people who are ≥45 years of age by selective screening methodology in rural area of Wardha district. SETTINGS AND DESIGN: A cross-sectional study in a rural area of Wardha district. METHODOLOGY: A cross-sectional population-based study was conducted among those who are at risk of developing DM, as per the WHO guidelines on Laboratory Diagnosis and monitoring of Diabetes Mellitus 2002. Blood glucose estimation was done using a blood glucose meter. STATISTICAL ANALYSIS USED: Multiple Logistic Regression. RESULTS: Eight point four nine percent of the 306 persons above the age of 45 years were diabetic. This study also revealed that the proportion of people diagnosed with DM increases with increasing age groups. Mean fasting and post meal blood glucose level (in mg%) among the study participants (nondiabetics) were 83.6 ± 1.6 and 129.9 ± 1.9 and mean fasting and post meal blood glucose level among diabetics were 138.8 ± 2.1 and 220.7 ± 1.9, respectively. The difference between the post meal blood glucose level among the diabetics and nondiabetics was statistically significant. The proportion of diabetics was more among those who had family history of diabetes (8.6%), BMI more than 25 (24.1%) and those with sedentary lifestyle (10.4%). CONCLUSIONS: Implementation of preventive measures to reduce the burden of diabetes is needed. Identification of the environmental factors adversely related to glucose intolerance helps evolve preventive strategies.

Effect of Ghrelin on Mortality and Cardiovascular Outcomes in Experimental Rat and Mice Models of Heart Failure: A Systematic Review and Meta-Analysis

Background Heart failure (HF) continues to be a challenging condition in terms of prevention and management of the disease. Studies have demonstrated various cardio-protective effects of Ghrelin. The aim of the study is to determine the effect of Ghrelin on mortality and cardiac function in experimental rats/mice models of HF. Methods Data sources: PUBMED, Scopus. We searched the Digital Dissertations and conference proceedings on Web of Science. Search methods: We systematically searched for all controlled trials (upto November 2014) which assessed the effects of Ghrelin (irrespective of dose, form, frequency, duration and route of administration) on mortality and cardiac function in rats/ mice models of HF. Ghrelin administration irrespective of dose, form, frequency, duration and route of administration. Data collection and analysis: Two authors independently assessed each abstract for eligibility and extracted data on characteristics of the experimental model used, intervention and outcome measures. We assessed the methodological quality by SYRCLE’s risk of bias tool for all studies and the quality of evidence by GRADEpro. We performed meta-analysis using RevMan 5.3. Results A total of 325 animals (rats and mice) were analyzed across seven studies. The meta-analysis revealed that the mortality in Ghrelin group was 31.1% and in control group was 40% (RR 0.83, 95% CI 0.46 to 1.47) i.e Ghrelin group had 68 fewer deaths per 1000 (from 216 fewer to 188 more) as compared to the control group. The meta-analysis reveals that the heart rate in rats/mice on Ghrelin was higher (MD 13.11, 95% CI 1.14 to 25.08, P=0.66) while the mean arterial blood pressure (MD -1.38, 95% CI -5.16 to 2.41, P=0.48) and left ventricular end diastolic pressure (MD -2.45, 95% CI -4.46 to -0.43, P=0.02) were lower as compared to the those on placebo. There were insignificant changes in cardiac output (SMD 0.28, 95% CI -0.24 to 0.80, P=0.29) and left ventricular end systolic pressure (MD 1.48, 95% CI -3.86 to 6.82, P=0.59). Conclusions The existing data provides evidence to suggest that Ghrelin may lower the risk of mortality and improve cardiovascular outcomes. However; the quality of evidence as assessed by GRADEpro is low to very low. Clinical judgments to administer Ghrelin to patients with HF must be made on better designed animal studies.

Ghrelin O Acyl Transferase (GOAT) as a Novel Metabolic Regulatory Enzyme

BACKGROUND Obesity and Type 2 Diabetes Mellitus (T2DM) presents a growing threat to the global health. Evidences highlight an important role of ghrelin as a key regulator of glucose metabolism. The physiological functions of ghrelin are mediated by enzyme ghrelin-O-acyltransferase (GOAT) which is capable of generating the active form of this metabolic hormone. However, its exact mechanism of action and influence on energy balance and glucose metabolism is yet to be explored. OBJECTIVES To review the physiological role of GOAT in the regulation of energy balance and glucose metabolism and explore the potential therapeutic avenues of modulators of GOAT to counter the progression of obesity and T2DM. METHODS Publications were sought through electronic searches. The bibliographies of all papers, book, chapters and editorials were scanned and hand searches were also conducted for journals, and conference proceedings. CONCLUSION GOAT peptide modulates the insulin secretion as well as insulin sensitivity. Modulators of GOAT signaling like inhibitors of GOAT increases insulin secretion, enhance peripheral insulin sensitivity and thus counters obesity and T2DM. Modulators of GOAT can be a probable therapy for modifying food intake and for countering obesity and T2DM.

Prevalence and pattern of tobacco use among tribal adolescents: Are tobacco prevention messages reaching the tribal people in India?

Objectives: The objective of the study was to find the prevalence and pattern of tobacco use, exposure to tobacco prevention activity among adolescent from tribal area. Materials and Methods: A cross-sectional study was conducted in six tribal villages. Data was collected by interview from 240 adolescent by home visits. Results: Prevalence of tobacco use (all forms), smokeless tobacco use and smoking in tribal adolescents were 54.45%, 53.41%, and 23.14%, respectively. Prevalence of tobacco use in boys (66.25%; 95% Confidence Interval (CI) = 60.29-72.21) was more than girls (26%; 95% CI = 25.84-37.57). Prevalence of tobacco use was more in late adolescent period and earning adolescents. The average age of starting smokeless tobacco use and smoking was 13.75 years (SD 2.26) and 14.22 years (SD 2.54), respectively. Boys start smoking relatively earlier than girls (P = 0.04). Education shows significant protective effect on tobacco use. Bidi was commonly used for smoking, while pan masala and gutka were the preferred smokeless tobacco. Almost all smokers were also using smokeless tobacco. Around 69% adolescents from the tribal area have heard of the tobacco prevention message, but only three could interpret it correctly. Radio and television were the commonest modes of information. Conclusion: Considering the high prevalence of tobacco use among tribal adolescents, anti-tobacco activities need to scale up for tribal people, with more emphasis on behavior change through group or personal approach. School programs may have some limitation in tribal area due to high school dropout, and low enrolment. Prevention activities need more focus on smokeless tobacco use and bidi smoking.

Prevalence and determinant of early childhood caries among the children attending the Anganwadis of Wardha district, India.

BACKGROUND Dental caries is one of the most common chronic diseases of early childhood. Dental problems in early childhood have been shown to be predictive of future dental problems, growth and development by interfering with comfort, nutrition, concentration, and school participation. AIM To find out the prevalence of Early childhood caries (ECC) among the children attending the Anganwadis of Wardha district, to determine the feeding habits and their relationship to early childhood caries. MATERIALS AND METHODS Community-based cross-sectional study among the selected Anganwadis children of 2-5 years of Wardha district. RESULT A total 330 subjects, 105 children were found to be having ECC, 47 (30.92%) males and 58 (32.58%) females. Total 215 children belonged to 43-60 months age group. Out of these, 72 (33.48%) children were having ECC. A significant association was found between the history of bottle-feeding and ECC (P = 0.0218). Prevalence of ECC was more among those who were bottle-fed than those who were not bottle-fed. CONCLUSION Future health promotion and education programs in Anganwadis should include oral health issues and the risk factors for ECC, and its consequences should be addressed. Public-funded oral health program should be started and targeted at children from lower socioeconomic status. Effective strategies should be developed to promote use of brush and paste for cleaning teeth and discouraging inappropriate bottle-feeding, discouraging on demand consumption of chocolates and sugars.

Predictors for antenatal services and pregnancy outcome in a rural area: a prospective study in Wardha district India.

BACKGROUND Antenatal care is essential to reduce morbidity and mortality among newborn babies and pregnant women. AIMS To study the pattern of utilization of antenatal services and to find out the potential predictors, their distributions and their association with antenatal care utilization and pregnancy outcomes. SETTINGS AND DESIGN A prospective longitudinal study was conducted in Deoli, a rural teaching area of a medical college of Wardha district, Maharashtra state. MATERIALS AND METHODS Medical social workers contacted all the registered 305 pregnant women in 1 month. A total of 274 women were included in the study. The response rate was 89.83%. STATISTICAL ANALYSIS USED Percentages, rate ratio. RESULTS Mean age at marriage was 19.8+/-3.6 years, and the average age at first pregnancy was 21.6+/- 4.5 years. Of the 274 pregnant women, 156 (56.9%) were pregnant for the first time (gravida 1), and the remaining 118 (43.1%) pregnant women, gravida 2 and above, had an average of 2.1 living sons and 1.9 living daughters. Only 92 (33.6%) women had undergone the minimum recommended antenatal checkup during their current pregnancy, and 188 (68.6%) women had institutional deliveries. A large proportion of women in Deoli do not receive proper health care during pregnancy and childbirth. CONCLUSION In Deoli, antenatal services, in spite of being essential to the care of pregnant women, are being poorly delivered.

Building Interdisciplinary Leadership Skills among Health Practitioners in the Twenty-First Century: An Innovative Training Model

Transformational learning is the focus of twenty-first century global educational reforms. In India, there is a need to amalgamate the skills and knowledge of medical, nursing, and public health practitioners and to develop robust leadership competencies among them. This initiative proposed to identify interdisciplinary leadership competencies among Indian health practitioners and to develop a training program for interdisciplinary leadership skills through an Innovation Collaborative. Medical, nursing, and public health institutions partnered in this endeavor. An exhaustive literature search was undertaken to identify leadership competencies in these three professions. Published evidence was utilized in searching for the need for interdisciplinary training of health practitioners, including current scenarios in interprofessional health education and the key competencies required. The interdisciplinary leadership competencies identified were self-awareness, vision, self-regulation, motivation, decisiveness, integrity, interpersonal communication skills, strategic planning, team building, innovation, and being an effective change agent. Subsequently, a training program was developed, and three training sessions were piloted with 66 participants. Each cohort comprised a mix of participants from different disciplines. The pilot training guided the development of a training model for building interdisciplinary leadership skills and organizing interdisciplinary leadership workshops. The need for interdisciplinary leadership competencies is recognized. The long-term objective of the training model is integration into the regular medical, nursing, and public health curricula, with the aim of developing interdisciplinary leadership skills among them. Although challenging, formal incorporation of leadership skills into health professional education is possible within the interdisciplinary classroom setting using principles of transformative learning.