Poonam Joshi

Skeletal muscle strength in young Asian Indian females after vitamin D and calcium supplementation: a double-blind randomized controlled clinical trial.

CONTEXT Randomized control trials (RCT) of the effect of vitamin D/calcium supplementation on skeletal muscle strength have not shown promising effect in the elderly. OBJECTIVE Our objective was to assess the effect of vitamin D and/or calcium on muscle strength in young adults with vitamin D deficiency. DESIGN AND SETTING We conducted a RCT using a factorial design at a tertiary-care center from September 2010 to April 2011. SUBJECTS A total of 173 healthy females with mean age, body mass index, and 25-hydroxyvitamin D [25(OH)D] of 21.7 ± 4.4 yr, 20.8 ± 2.96 kg/m(2), and 9.3 ± 3.37 ng/ml, respectively, were block randomized to 1) double placebo, 2) calcium/placebo, 3) cholecalciferol/placebo, and 4) cholecalciferol/calcium for 6 months. Cholecalciferol was given at 60,000 IU/wk for 8 wk followed by 60,000 IU/fortnight. Elemental calcium was given in doses of 500 mg twice per day for 6 months. METHODS Assessment included hand grip (primary outcome) and pinch grip strength, distance walked in 6 min, dyspnea score, quality of life by Short Form (36) Health Survey (SP-36), serum 25(OH)D, 1,25-dihydroxyvitamin D, and intact PTH. RESULTS The serum 25(OH)D increased significantly to 29.9 ± 8.35 and 27.0 ± 9.54 ng/ml in two groups on cholecalciferol. The mean hand grip strength (19.4 ± 3.92, 21.1 ± 3.31, 20.6 ± 3.92, and 20.1 ± 4.00 kg) and its increase from baseline (0.3 ± 2.25, 0.3 ± 2.64, -0.3 ± 2.41, and 0.6 ± 2.30 kg) were comparable in four groups at 6 months. Quality of life, urinary calcium/creatinine ratio, and adverse effects were also comparable in groups. CONCLUSION Oral cholecalciferol/calcium supplementation in the dose/schedule used is effective and safe in increasing and maintaining serum 25(OH)D. However, this does not lead to improved skeletal muscle strength in young females.

Comparing the Effectiveness of Webinars and Participatory Learning on Essential Newborn Care (ENBC) in the Class Room in Terms of Acquisition of Knowledge and Skills of Student Nurses: A Randomized Controlled Trial

A randomized controlled trial was conducted in tertiary level center to compare the effectiveness of Webinars (WL) vs. Participatory learning (PL) on Essential Newborn Care (ENBC) in terms of acquisition of knowledge and skills of pre-service 6th semester student nurses. They were randomized to receive teaching on four topics of ENBC by two facilitators. Gain in knowledge and skill scores in ENBC were measured using validated assessment methods. Baseline characteristics including age, education, marks and hours of internet surfing were comparable between two groups (WL: n = 28, PL: n = 30). Pre-training mean knowledge scores in WL and PL group (mean ± SD) (30.96 ± 5.62 vs. 31.43 ± 4.74 p = 0.42), and skill scores (19.14 ± 3.37 vs. 19.20 ± 3.71 respectively, p = 0.77) were comparable. Training methods resulted in equal gain in knowledge in both groups. Satisfaction scores among the participants were also comparable. Thus, using webinars on ENBC as new technology in class room teaching may be an effective, alternative method to using participatory learning.

Improving Duration of Kangaroo Mother Care in a Tertiary-care Neonatal Unit : A Quality Improvement Initiative

ObjectivesTo increase the duration of Kangaroo mother care (KMC) in preterm infants from an average of 3 hours/day to at least 6 hours/day over 7 weeks through a Quality improvement (QI) approach in a tertiary-care neonatal unit.MethodsPreterm mother-infant dyads who were admitted in the Neonatal intensive care unit and KMC ward were enrolled in this study. A QI team comprising of nurses, nurse educators, resident physicians and nursing-in-charge of unit was formed. The potential barriers for prolonged KMC were evaluated using fish bone analysis. A variety of measures (allowing family members including male members during night for doing KMC, making KMC an integral part of treatment order, introducing the concept of weekly KMC champions, etc.) were introduced and subsequently tested by multiple Plan-do-study-act (PDSA) cycles. Data on duration of KMC per day was measured by bedside nurses on daily basis.Results20 eligible mother-infant dyads were studied during implementation period (50 d). The mean (SD) weight and gestation of infants were 1199 (356) g and 31.1 ( 2.3) wks, respectively. We achieved our goal by step-wise implementation of changes through construction of 3 PDSA cycles. The duration of KMC increased to 6 hours-a-day over a period of 7 weeks. Evaluation at 6 and 12 months in the post-implementation phase suggested sustenance of improved KMC duration up to 9 h/day in the unit.ConclusionsOngoing quality improvement measures increased the duration of KMC from a baseline of 3 h to 6 h in eligible preterm infants, and the results were sustained at 6–12 month.

Admission Vitamin D status does not predict outcome of critically ill patients on mechanical ventilation: An observational pilot study

Background and Aims: Effect of serum 25-hydroxy vitamin D (25[OH] D) levels on the recovery of critically ill mechanically ventilated patients is unclear. Hence, this study assessed 25(OH)D levels of critically ill patients on mechanical ventilation at the time of admission to the Intensive Care Unit (ICU) and its relationship with clinical outcome. Methods: In this prospective observational pilot study, forty adult patients receiving mechanical ventilation in the ICU were included. Serum 25(OH)D was assessed within 24 h of admission. Primary outcome was 30-day mortality and secondary outcomes were days on mechanical ventilation, ICU-length of stay (ICU-LOS), days to reach spontaneous breathing trial (SBT), requirement of advanced care modality and complications. Results: Seventy-five percent patients had low serum 25(OH)D (65% deficient and 10% insufficient). Between patients with low and normal vitamin D , there was no significant difference in 30-day mortality (10% vs. 16.7%; P = 0.81), days on mechanical ventilation (16.2 ± 8.9 vs. 19.9 ± 8.4; P = 0.23), ICU-length of stay (18.7 ± 8.5 vs. 23.3 ± 11.4; P = 0.28), days to reach SBT (11.5 (0–20) vs. 21 (8–30); P = 0.78), complications developed during ICU stay (P = 0.60) and need for advanced care modalities (P = 0.72). Conclusion: Low Vitamin D level at admission did not affect 30-day mortality of critically ill patients on mechanical ventilation.

Video teaching program on management of colostomy: Evaluation of its impact on caregivers

Context: Care of a child having colostomy has not been institutionalized for a long time for economic and administrative reasons. After stoma formation, stoma care has to be provided to the child by caregivers at home. Hence, caregivers need to be provided with ongoing education and support, commencing from preoperative teaching to discharge from the hospital and home care. Aims: The aims of this study were to develop video-based learning resource material and to evaluate its effectiveness in terms of knowledge and skill attainment by caregivers. Settings and Design: The study design was time series, one group pretest and post test. This was conducted among 30 caregivers attending pediatric surgery outpatients and indoor departments of a tertiary level care center. Materials and Methods: A video teaching program (VTP) related to pediatric colostomy was developed and used to teach the caregivers about colostomy care. Pretested and validated knowledge questionnaire, observational checklist, and stoma assessment scale (SAS) were used to assess the knowledge and skills of caregivers before and after the administration of VTP immediately (post test 1) after and 2 weeks (post test 2) after the intervention. Statistical Analysis Used: Repeated measures analysis of variance (ANOVA), Bonferroni correction, Mann-Whitney U test, and Kruskal-Wallis test were used. Results: There were significant increases in knowledge (from 10.9 ± 2.5 to 16.4 ± 1.67 and 15.9 ± 4.02, P = 0.001, maximum score 20) and skill scores as assessed by the observation checklist (from 5.6 ± 2.0 to 9.8 ± 1.6 and 8.6 ± 2.1, P = 0.001, maximum score 12) immediately after and 2 weeks after the VTP. However, a decline in skills was observed at 2 weeks when compared with immediate scores, as measured by the observation checklist. There was no significant increase in the skill scores of caregivers as measured by SAS at 2 weeks compared to the immediate scores. Conclusion: The VTP was effective in bringing about an increase in the knowledge and skill of caregivers of children having colostomy. Therefore, video can be utilized for the counselling of caregivers of children with colostomy.

Parents Influence on Quality of Life of Children with Epilepsy: An Evaluative Survey

An evaluative survey was conducted to investigate the influence of parents in the HRQOL of children with epilepsy. Sixty children with epilepsy from pediatric neurology clinic (OPD) and 60 normal children and their parents were enrolled for the study. The HRQOL of epilepsy children as assessed by the children themselves and their parents was compared with normal children and their parents using a standardized Peds QL 4.0 tool. Both, children with epilepsy and their parents, despite having chronic illness like epilepsy, rated better quality of life than the comparison group. Parents had made significant influence in the quality of life of children with epilepsy.

Dual presentation of tuberculosis: Otitis media with retropharyngeal abscess - The first case report

Tubercular otitis media is a rare disease and its association with retropharyngeal abscess is rarer. We have not come across any such case in the English literature of the dual presentation of tuberculosis to the best of our knowledge so far. Early diagnosis and prompt management are the key to reduce the disease burden and also to avoid life-threatening complications.

Unilateral sensorineural hearing loss: A retrospective study

Background: This retrospective study was carried out to know the characteristics of patients suffering from unilateral sensorineural hearing loss (USNHL) (type and degree). Aims and Objectives: (1) To know the incidence of pure USNHL (other ear being normal) in patients complaining of HL. (2) To establish the type and degree of USNHL in patients. Materials and Methods: This study was conducted over a period of more than 1 year to find out the pattern of pure USNHL (other ear being normal) in the patients attending ear, nose, and throat outpatient department (OPD) with a complaint of HL. Pure tone audiometry data of 1800 cases between August 2014 and December 2015 with HL were analyzed for this study. Demographic characteristics were compared with types and degrees of unilateral sensorineural hearing impairment. Results: A total of 1800 OPD patients who had a complaint of HL and had undergone pure tone audigram (PTA) in a period of more than 1 year in the Department of Otorhinolaryngology and Head and Neck Surgery were studied. SNHL type was the highest with 802 cases (44.55%). Out of 802 cases of SNHL, 257 (32.05%) were USNHL - out of which, only 155 patients (60.31%) had pure USNHL with other ear being normal; this constituted the study group, i.e., 155 patients (8.6%) out of 1800. Age of patients ranged from 9 years to 76 years (mean age - 41.5 years). Male:female ratio was 1.31:1. Both ears were almost equally involved. The highest numbers of USNHL patients were seen in the age group of 31-40 years (23.87%). Most cases presented with mild (34.2%), followed by profound (31.6%) USNHL. Conclusion: Our study concluded that SNHL type is the most common type (44.55%) of hearing impairment among patients complaining of HL. The incidence of pure USNHL (i.e. other ear being normal) was 60.31% (155/257) cases of USNHL, 19.32% (155/802) cases of SNHL, and 8.6% (155/1800) cases of PTA performed on patients complaining of HL. Limited work has been published on incidence, characteristics, and causes of pure USNHL. Further studies and researches are required in the field of USNHL to know the incidence, functional and psychological impact, and treatment options.

An Exploratory Survey to Identify the Determinants of Health Care Services Utilization by under Five Children in a Selected Village of Jhajjar, Haryana

This mixed method community based study identifies households, primary caregivers, under-five children, demographic factors and health care services characteristics and the pattern of health care services utilization for childhood illness. A cross-sectional household survey was conducted in a selected village of Jhajjar district of Haryana from June 2011 to June 2012, in which 1265 households were contacted. Total 340 primary care givers of children suffering from illness currently or during last 2 weeks were interviewed using a semi-structured interview schedule. Some primary care givers were randomly selected for in depth interviews. One way ANOVA and the Chi-square test were used to determine the association with selected variables (p<0.05, CI 95%). Qualitative data was transcribed analyzed for content and grouped into thematic categories. Majority of primary care givers were mothers 269 (79.1%), in the age group of 25- 35 years (149, 43.8%) with mean age 28.2±9.9 years (15–70). Majority of sick children 328(96.4%) were between 2 months to 5 years, male (206, 60.6%). Majority of sick children suffered from cold and cough (218, 64.1%) During the current illness majority of PCGS 205(60.3%) had been to the private health care facility to seek the treatment. Significant relationship was found between the private health care facility utilization and the selected variables. Majority primary care givers despite low socio- economic status sought health care services from private sector. It was preferred mainly due to their availability and accessibility even in the evening and night time, faith, quick relief within reasonable amount and good individual attention by them without any loss of daily wages.

A Comparative Study to Find out the Health Related Quality of Life of Children with End Stage Renal Disease on Various Renal Replacement therapies: Self and Parental Perception

A descriptive cross-sectional survey was undertaken on a sample of 55 children with ESRD on maintenance dialysis (MD) and kidney transplantation (KTP) attending indoor and outdoor units of pediatrics department between June 2012- June 2013. The objectives of the study were to assess the quality of life of children with end stage renal disease on MD and following KTP & to compare the health related quality of life (HRQOL) assessed by child self report and parents proxy report. Data was collected using Peds QL 3.0 ESRD module, Hindi version. Health related quality of life of children was assessed by child self report and parent proxy report. The data was analyzed using descriptive and inferential statistics. Children with ESRD in KTP group had better health related quality of life rated by both children and parents in comparison to MD group. There were no differences between the HRQOL scores of the children and their parents.