Anil C Mathew

Measuring malnutrition -The role of Z scores and the composite index of anthropometric failure (CIAF)

Background : The current WHO recommendation is to use the Z-Score or SD system to grade undernutrition which allows us to measure all the three indices and express the results in terms of Z scores or standard deviation units from the median of the international reference population. Objectives : To estimate the prevalence of undernutrition among under-five children in Coimbatore slums, using the Z-Score system of classification and the recently constructed Composite Index of Anthropometric Failure (CIAF). 2. To compare the Z-Score system with the Indian Academy of Pediatrics (IAP) classification of undernutrition. Methods : Nutritional assessment was done using anthropometry and clinical examination. Children were weighed and measured as per the WHO guidelines on Anthropometry. Epi-Info 2002 software package was used to calculate the Z scores and for statistical analysis. Results : Only 31.4% of the children studied were normal; 68.6% were in a state of Anthropometric Failure. As per the Z score system, 49.6% were underweight (21.7% severely); 48.4% were stunted (20.3% severely) and 20.2% were wasted (6.9% severely). Whereas, as per IAP criteria, 51.4% were undernourished and 3.2% were severely undernourished. Using Underweight (low weight-for-age) as the only criterion for identifying undernourished children (as done in the Integrated Child Development Services currently) may underestimate the true prevalence of undernutrition, by as much as 21.9%. Conclusions : More widespread use of the Z-Score system is recommended for identifying all the facets of undernutrition. Estimates of the true prevalence of undernutrition must incorporate a composite index of anthropometric failure.

Effect of topical corticosteroid application frequency on histamine-induced wheals

Background  Very few studies have been conducted to assess the effect of corticosteroid application frequency to attain maximum benefit with minimum side‐effects.

Prevalence and correlates of malnutrition among elderly in an urban area in Coimbatore.

Background: Different studies in India have shown that more than 50% of elderly population of India are suffering from malnutrition and more than 90% have less than recommended intake. Objectives: The aim of this study is to estimate the prevalence and correlates of malnutrition among elderly aged 60 years and above in an urban area in Coimbatore using Mini Nutritional Assessment (MNA). Methods: A cross-sectional study was conducted on 154 households and 190 elderly were interviewed. Nutritional status was assessed using the MNA questionnaire. Results: Mean (standard deviation) age of the total population (n = 190) was 71.09 (7.93) years and 30% was male. In this population, 37 (19.47%) was malnourished (MNA <17.0) and 47 (24.73%) were at risk for malnutrition (MNA 17.0-23.5). No significant association was observed between smoking, current alcohol consumption, higher medication use, higher comorbidity, and use of walk aid with malnutrition. Among the social factors studied, lower socioeconomic status compared to higher socioeconomic status (adjusted odds ratio [OR] =5.031, P < 0.001), single/widowed/divorced compared to married (adjusted OR = 3.323, P < 0.05), and no pension compared to those having pension (adjusted OR = 3.239, P < 0.05) were significantly associated with malnutrition. Conclusion: The prevalence of malnutrition observed in the aged people is unacceptably high. The increasing total number of lifestyle, somatic, functional, and social factors was associated with lower MNA scores. The findings of the present study clearly indicate that malnutrition is a multifactorial condition associated with sociodemographic, somatic, and functional status. Hence, we recommend that the treatment of malnutrition should be multifactorial, and the treatment team should be multidisciplinary. Further research is needed to develop appropriate guidelines for nutritional screening and interventional programs among geriatric population.

Activated charcoal and baking soda to reduce odor associated with extensive blistering disorders

BACKGROUND Skin disease leading to extensive blistering and loss of skin is associated with a characteristic smell. Odor can cause physiologic disturbances such as increase in heart rate and respiratory rate. It can also cause nausea and vomiting and is disturbing to bystanders. AIMS To test odor reducing capability of activated charcoal. METHODS In this blinded experimental study we used putrefied amniotic membrane to produce odor and studied the effectiveness of activated charcoal and soda-bi-carbonate to reduce odor. RESULTS Statistical analysis with Kruskal Walls Chi Square Test and Man Whitney U test showed significant reduction of odor using activated charcoal by itself or along with soda-bi-carbonate. CONCLUSION We recommend the usage of activated charcoal with/without soda bicarbonate as an inexpensive practical measure to reduce foul odor associated with extensive skin loss.

Study of histamine wheal suppression by dexamethasone with and without iontophoresis

BACKGROUND Iontophoresis increases the penetration of drugs into the skin by electric current. The ability of topical steroids to reduce the size of the histamine wheal was used to assess the efficacy of topical dexamethasone delivered with and without iontophoresis. AIM To determine the wheal suppressing ability of dexamethasone delivered with and without iontophoresis. METHODS A template with three squares of 3x3 cm was placed on both forearms of 20 volunteers and the edges marked. A gauze piece soaked in 2 ml of dexamethasone solution was placed on the flexor aspect of the left forearm and the electrode, an aluminum foil was placed on it and connected to the negative pole (since dexamethasone is negatively charged). An electric current was passed for 15 minutes. Similarly, on the right forearm, a dexamethasone soaked gauze piece was placed without iontophoresis. Histamine wheal suppression was assessed at the end of 30 min, 1 hr and 2 hrs, on both sides. Statistical analysis was done using an independent t-test. RESULTS There was a statistically significant difference in wheal suppression at 30 min (p=0.006) on the left hand where iontophoresis was used. CONCLUSION Our experiment showed that topical dexamethasone with iontophoresis has the maximum effect at the end of 30 minutes and is more effective than dexamethasone without iontophoresis.

The prevalence and correlates of low back pain in adults: A cross sectional study from Southern India

Low back pain is a major public health problem all over the world. It is generally assumed that overweight, height and low back pain are related. However, the scientific evidence to support this relationship is not fully conclusive. The aim of this study is to estimate the prevalence of low back pain and its association with height, fat distribution, reproductive history and socioeconomic influence. A representative sample of 401 men and 403 women aged 20 years and above were selected and studied. It is found that 28.4% and 52.9% respectively were having low back pain. Height and fat distribution were found to have no association with low back pain. Both men and women, whose household were in the lower socio economic status reported more back pain (Adjusted odds ratio (AOR) for men 1.61, 95% confidence interval (CI): 1.02, 2.55 and AOR for women 1.57, 95% CI: 1.02, 2.34). Men with lower educational qualification reported more back pain (AOR 1.89, 95% CI: 1.08, 3.31). In women, those who have undergone caesarean section (AOR 1.661, 95% CI: 1.02, 2.72) and sterilization (AOR 1.63, 95% CI: 1.09, 2.44) were found to be a positively associated with low back pain. The only socioeconomic link with back pain among women seemed to be manual occupation (AOR 3.33, 95% CI: 1.49, 7.4). The finding confirms the higher burden of back pain on the socially disadvantaged, but cannot yet be explained by known risk factors.

Irritancy potential of 17 detergents used commonly by the Indian household

BACKGROUND Detergents are used by almost every household in the developed and developing world. Soap and most detergents are anionic surfactants and attack the horny layer of the skin and increase its permeability with little or no inflammatory change and may result in hand eczema, which is very distressing and incapacitating. AIM To evaluate the irritant potential of common household detergents (laundry and dish wash) used by the Indian population using a 24-hour patch test and to convincingly educate the patients on the detergents less likely to cause irritation in the particular individual. METHODS Seventeen commonly used detergents found in Indian market were included in the study, of which, 12 were laundry detergents (powders--seven, bar soap--five) and five were dish wash detergents (powder--one, liquid--one, bar soap--three). The irritant potential of the 17 detergents were evaluated in 30 volunteers. Thirty microliters of each of the detergent bar solutions, distilled water (negative control), and 20% SDS (positive control) were applied to Finn chambers with a micropipette and occluded for 24 hours. Erythema, scaling, and edema were graded in comparison to the reaction at the negative control site (distilled water) for each volunteer separately. The scoring of erythema/dryness and wrinkling on a 0-4 point scale and edema on another 0-4 point scale was based on the Draize scale. The pH of each of the detergent solutions was determined using litmus papers (Indikrom papers from Qualigens fine chemicals). RESULTS The difference between detergents (F value) was significant for erythema/dryness and wrinkling (F = 3.374; p = 0.000), but not significant for edema (F = 1.297; p = 0.194). [Table 2] lists the means for erythema/dryness and wrinkling, and edema. The F value of the totals of the means for erythema/dryness and wrinkling and edema was significant (F = 2.495; p = 0.001). The pH of all the detergents was found to be alkaline except Pril utensil cleaner which tested acidic (pH 6). The positive control, 20% SDS also tested acidic (pH 6). CONCLUSION Similar to patch testing in allergic contact dermatitis, 24-hour patch testing with detergent solutions (8% w/v), will educate the patient on what detergent to avoid. This may bring down the total medication requirement and frequent hospital consultations for these patients.

Treatment of fissure soles with occlusion using micropore tapes

Fissure feet are a common condition; however, no effective therapy is available to date. This study was undertaken to study the effect of occlusion using 2″ micropore tapes in the management of fissure soles. The study was an open-paired, controlled study and included 26 volunteers with fissure feet. Fissures were graded separately over the right and left soles. All the volunteers were advised to wash their feet in tap water, air dry for 5 min before going to bed. To increase the tackiness of the tape, tincture benzoin was first applied and allowed to dry. The volunteers were educated to apply a 2″ micropore tape over the fissures at night on the right sole. The left sole was not taped and served as a control. The tape was removed the next morning and the fresh tape was again reapplied at night. The volunteers were advised to immerse the feet in water at room temperature and then remove the tape. Results were assessed after 15 days. Mc Nemars X2 test was performed to determine the statistical significance. P value < 0.05 was considered to be statistically significant. The right sole (study) and the left sole (control) constituted a pair. Out of the 26 matched pairs, in 16 pairs, the study site showed improvement and the control site did not show improvement. Seven pairs did not show improvement over both study and control sites. Three pairs showed improvement in both study and control sites. Mc Nemar X2 value was 14.06 ( P < 0.001). Occlusion therapy is effective in the treatment of fissure soles.

Consumption of Tea and its Relation to Risk of Type 2 Diabetes mellitus

Aim: The aim of the study was to examine the association of consumption of tea with the risk of type 2 diabetes mellitus. Methods: A case control study was conducted at PSG Hospitals between 1 st June 2017 and 1 st July 2017. All those who had newly diagnosed type 2 diabetes mellitus and attended Department of Endocrinology for followup visit were the cases and the relatives accompanying them without the history of diabetes mellitus were the controls. Tea consumption and other dietary factors were elicited. The mediating factors studied were age, sex, Body Mass Index (BMI), educational levels, smoking status, alcohol consumption, family history of diabetes mellitus, potassium intake, magnesium intake and use of statins. Results: After adjusting the potential confounders, tea consumption was inversely associated with risk of type 2 diabetes mellitus with odds ratio of 0.652 (95% CI = 0.43 – 0.98). The association was also observed with participants who consumed tea 3 or 4 cups per day compared to those who did not drink tea on a daily basis (odds ratio = 0.368, 95% CI = 0.14 – 0.96). However, the association was not observed among those who take 5 or more cups of tea per day (odds ratio = 0.328, 95% CI = 0.06 – 1.60).Conclusion: Our findings suggest that consumption of 3 to 4 cups of tea per day has a decreased risk of type 2 diabetes mellitus. The results from our study also suggest that adjusting for mediating factors did not alter the results and hence other unknown factors may explain inverse relation between tea consumption and type 2 diabetes mellitus. Further studies are warranted.

Fortification of salt with iodine and iron in India

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