Ranabir Pal

Prevalence of Bronchial Asthma in Indian Children

Background: The prevalence of childhood bronchial asthma and allergic disease has increased in developed countries. Studies have identified asthma among Indian children. Still, there is paucity of information on the overall prevalence of childhood asthma in India. Objective: To assess time trends and the overall prevalence rate of bronchial asthma among Indian children. Materials and Methods: Literature search for data sources was done through an extensive search in indexed literatures and website-based population survey reports. Fifteen epidemiological studies were identified on the development of asthma in Indian children from 300 potentially relevant articles. A broad criterion to define both allergic and non-allergic descriptions of asthma in Indian children was formed. Moreover, in the absence of universally accepted criteria by reporting of prevalence by researchers, weighted average data was considered during calculations of prevalence rates, irrespective of the criteria for diagnosis. Statistical analyses used were mean and median. Results: Wide differences in samples, primary outcome variables, lack of consistency in age category, rural–urban variation, criteria for positive diagnosis, and study instruments confounded the outcome variables. The mean prevalence was 7.24 ± SD 5.42. The median prevalence was 4.75% [with IQR = 2.65 − 12.35%]. Overall weighted mean prevalence was found to be 2.74. Childhood asthma among children 13 – 14 years of age was lower than the younger children (6 – 7 years of age). Urban and male predominance with wide inter-regional variation in prevalence was observed. Conclusions: Our findings indicate that the burden of bronchial asthma in Indian children is higher than was previously understood.

Extended spectrum beta-lactamase detection in gram-negative bacilli of nosocomial origin

Background: Resistance to third generation cephalosporins by acquisition and expression of extended spectrum beta lactamase (ESBL) enzymes among gram-negative bacilli is on a rise. The presence of ESBL producing organisms significantly affects the course and outcome of an infection and poses a challenge to infection management worldwide. Materials and Methods: In the period from June 2007 to 2008, we collected 1489 samples from patients suspected of nosocomial infection. The isolates were identified based on colony morphology and biochemical reaction. Gram negative bacilli resistant to third generation cephalosporins were tested for ESBL by double disc synergy test (DDST- a screening test)and then phenotypic confirmatory test. Antimicrobial susceptibility testing was done by modified Kirby Bauer disc diffusion method. Results: From the sample of 238 gram-negative bacilli, we isolated Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Citrobacter freundii, Proteus mirabilis, Morganella morganii and Enterobacter cloacae. Following both methods, 34% isolates were ESBL-positive. The ESBL producing isolates were significantly resistant (p < 0.01) to ampicillin, piperacillin, piperacillin/tazobactam, trimethoprim/sulfamethoxazole, tetracycline, ciprofloxacin and gentamicin as compared to non-ESBL producers. Multidrug resistance was significantly (p < 0.01) higher (69.14%) in ESBL positive isolates than non-ESBL isolates (21.66%). Conclusion: High prevalence of ESBL in our hospital cannot be ignored. ESBL producers can be detected by DDST and phenotypic confirmatory test with equal efficacy. The sensitivity of screening test improved with the use of more than one antibiotic and addition of one or two antibiotics would not increase cost and labor. We recommend DDST using multiple antibiotics in all microbiology units as a routine screening test.

Behavior disparities towards blood donation in Sikkim, India.

Background: The aim of the current research was to determine disparities in blood donation motives among the general mass of Sikkim. Aims: To identify the reasons for people donating and not donating blood voluntarily. Settings and Design: Population based cross-sectional study in Gangtok, East Sikkim. Materials and Methods: PARTICIPANTS: 300 adults by two-stage cluster sampling technique. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Correlates of attitudes towards blood donation. DATA COLLECTION PROCEDURE: The data collection tool used for the study was a pre-tested structured interview schedule by which the principal investigator collected the data using interview technique. Statistical Analysis Used: Percentages and ODDS ratio were used in this study. Results and Conclusions: Out of 300 respondents, overwhelming majority (78.7%) of the respondents in the present study felt that people donate blood to save a friend or a relative. On the contrary, minority respondents (46%) were ready to donate blood voluntarily. Only 12.7% of the respondents had ever donated blood while 87.3% had never donated. Among ever donors, gender wise men donors were found to be more; 89% were married, half were from the 30 to 39 years age group. As the per-capita income or level of education increased, so did the percent of blood donors.

Methicillin-resistant Staphylococcus aureus: prevalence and current susceptibility pattern in sikkim.

Background: Prevalence of methicillin-resistant Staphylococcus Aureus (MRSA) strains is reported to be increasing globally. Objectives: The study was conducted to find the magnitude and antibiotic susceptibility pattern of MRSA infection in a referral tertiary care teaching hospital of Sikkim, India. Materials and Methods: In this cross sectional study, 827 clinical specimens were collected from different departments of Central Referral Hospital. One hundred and ninety-six carrier screening nasal swabs were obtained from health care workers of the hospital. Subsequently, the antimicrobial susceptibility test was performed for the confirmed MRSA isolates as per Clinical and Laboratory Standards Institute (CLSI). Results: Methicillin resistance was seen in 152 isolates of S. aureus – 111 from clinical specimens and 41 from carrier screening samples. MRSA positivity among males was significantly higher than females. Extremely significant MRSA-positive cases were observed from ages less than 30 years, in-patient cases, particularly with a stay of more than 15 days and with a previous history of intake of broad spectrum antibiotics. Incidentally, there was no significant difference of MRSA positivity with a previous history of hospitalization. The extent of MRSA and drug resistance pattern was significantly different among various samples of S. aureus-positive isolates. The strains tested exhibited decreased susceptibility to vancomycin and imipenem. Most vulnerable of the carrier were the cleaners, that was a significant observation. Incidentally, there was no resistance in the carriers to both vancomycin and imipenem. Conclusion: MRSA is prevalent in our hospital and strains resistant to methicillin and vancomycin were quite high.

Bacteriological profile of septicemia and the risk factors in neonates and infants in Sikkim

Background: Bacterial infections remain an important cause of pediatric mortality and morbidity. It might be possible to reduce these factors by early diagnosis and proper management. Aim: The aim of the study was to analyze the bacteriological profiles with their antibiogram, and to register the risk factors for septicemia in neonates and infants. Setting and design: This observational cross-sectional study was conducted in a tertiary care teaching hospital at Gangtok, Sikkim, India, and included clinically suspected cases of septicemia in neonates and infants. Materials and Methods: Blood culture reports were studied in 363 cases of clinically suspected septicemia in neonates and infants, using the standard technique of Mackie and McCartney. The antibiotic sensitivity was performed by Kirby-Bauers disc diffusion method. Risk factors for sepsis in the children were registered. Results: Blood culture was positive in 22% of cases. Gram-negative septicemia was encountered in 61% of the culture-positive cases. Pseudomonas and Enterobacter species were the predominant pathogens amongst gram-negative organisms. Most gram-negative organisms were sensitive to Amikacin, Ciprofloxacin, and Co-trimoxazole. The most common gram-positive organism isolated was Staphylococcus aureus (97%). More than 70% of Staphylococci isolated were resistant to Penicillin, but were sensitive to Clindamycin (70%) and Vancomycin (40%). The most important risk factors of septicemia in our study population were preterm birth (31%), followed by respiratory distress (5%) and low birth weight (4%). Conclusion: As the cultures showed variable antibiogram with complicated patterns of resistance, culture and sensitivity test should be performed in all cases of septicemia.

Assessment of future physicians on biomedical waste management in a tertiary care hospital of West Bengal.

Background: One-fourths of the biomedical waste (BMW) is regarded as hazardous with the potential for significant health concern for both medical personnel and general community. So, awareness about various aspects of BMW management is required and it was assessed among junior doctors in a tertiary care hospital. Objectives: To assess the knowledge and awareness about various aspects of BMW management among junior doctors (future physicians) and thus help the authority to develop the strategy for improving the situation in future. Materials and methods: In this descriptive observational study, we interviewed 200 junior doctors of a tertiary care hospital of Kolkata using a pre-designed pre-tested self-administered, semi-structured, anonymous questionnaire. Results: Majority of the participants were in the age group of 22 to 24 years (62%), males (66.5%), hostelites (70.2%), belonged to nuclear family (80.1%), and had per capita monthly family income in the range of Rs 5 000 to 20 000 (61.4%). Almost all respondents (99.1%) heard about BMW, 94.4% heard about the BMW rule 1998, and 67.9% knew about the Bio Hazard symbol. Only 55.9% respondents could remember the ten category of BMW. Segregation at source (the golden rule of BMW) was known by 78.8% of the junior doctors, only 29.5% had the knowledge of various methods of final disposal of BMW. Though 98.8% of the study population was aware that improper management of BMW causes different health problems, only 76.4% knew about various types of color-coded bags for collection of BMW. All the junior doctors were trained in all these essential aspects of BMW in their undergraduate curriculum. Conclusion: Still, intensive training program and monitoring at regular time interval is needed for all staff, with special emphasis on junior doctors.

Serum malondialdehyde level: Surrogate stress marker in the Sikkimese diabetics

Background: The pbreakdown of phospholipids lead to accumulation of malondialdehyde (MDA) that is preferred as a surrogate marker of oxidative stress in diabetics. Objective: To compare serum MDA levels along with other biochemical parameters between type 2 diabetic patients with and without complications. Materials and Methods: This cross-sectional study was carried out in the Department of Biochemistry of a tertiary care teaching hospital in Sikkim on 60 type 2 diabetics and compared with 100 non-diabetic participants. The un-hemolyzed blood samples were used for estimation of biochemical parameters; MDA was estimated in serum by using trichloroacetic acid (TCA) and 1% thiobarbituric acid (TBA). Whole blood was used for estimation of glycated hemoglobin. The comparison of different parameters between cases and control was calculated by using Students t test. Results: In the study and control groups, no significant difference was noted with regard to independent variables. The fasting and postprandial serum glucose along with glycated hemoglobin from whole blood and the lipid profile differed significantly between the study and control groups. Overall, tmean serum MDA level in the study group was significantly higher thanin the controls. Male sex, addiction to tobacco (smoking and smokeless inclusive), longer duration of diabetes (≥5 years), and presence of complications (both microvascular and macrovascular) significantly increased the MDA level. Conclusion: To sum up, the serum MDA level was observed to be significantly high in diabetics with and without complication along with other parameters.

Spectrum of head and neck cancer in children

Aim: To assess the incidence of different head and neck cancers in pediatric age group in a referral hospital. Methods: In this prospective study, children below the age of 12 years underwent a thorough clinical, ENT examination and the diagnosis was conformed histologically in all the cases. Results: Fifty-three were diagnosed to be suffering from different head and neck neoplasms among 21,216 children (0.25%). Male-to-female sex distribution was 1.78:1. The lymphomas were the most common (43.39%) followed by the rhabdomyosarcoma (20.75%) and the nasopharyngeal carcinoma (15.09%). Of the lymphomas, the non-Hodgkins lymphoma was predominant (26.41%). Other lesions were thyroid carcinomas and mucoepidermoid carcinoma of parotid. Conclusions: Malignancy should always be considered in the differential diagnosis of masses in the head and neck region in children.

Clinicopathological correlates of pediatric head and neck cancer.

BACKGROUND The spectrum of head and neck tumors in children continues to be the cause of diverse, diagnostically challenging issues. AIMS To demonstrate and compare the unique clinicopathological features in our study population and their correlations with the final histopathological diagnosis. METHODS Fifty-three children with head and neck cancer were examined thoroughly at the Otorhinolaryngology department in a tertiary care teaching hospital followed by histopathological studies. RESULTS Lymphomas were the most common malignant lesions seen followed by rhabdomyosarcomas, nasopharyngeal carcinomas, and others like thyroid carcinomas and eosinophilic granulomas. In the neck, the commonest cause of primary malignant disease was lymphoma; however, the most frequent lesion was reactive lymphadenitis. In the sinonasal region, the commonest malignancy was rhabdomyosarcoma, which often had extension to the orbit and the face. Recurrent epistaxis was found universally in the malignant cases of this region. In the facial region, disfiguring swelling with proptosis was mainly caused by rhabdomyosarcoma. The only case of tonsillar malignancy was due to non-Hodgkin lymphoma. The duration of disease was less than 1 year. CONCLUSION The most common manifestation of the malignant lesions in the pediatric age group was with a history of an enlarging, painless neck swelling. Still, an insignificant lump in the neck or recurrent bleeding from nose may be the manifestation of an underlying cancer.

Ageing in Puducherry, South India: An overview of morbidity profile.

Background: The geriatric health problems are related to chronic disease as a result of increasing life expectancy. Objective: This study was undertaken to assess the health problems of the elderly in Puducherry. Materials and Methods: This cross-sectional study was carried out on 214 elderly persons from the age group of 60 years and above using a pre-designed and pre-tested questionnaire that addressed the disease magnitude in comparison with the socioeconomic variables. Results: Overall, 43% of the participants were diabetic, 47.7% hypertensive, 86% anemic and 68.2% visually impaired. All the morbidities were noted to be higher in the 70–79 years age group. Diabetes was significantly higher in participants from urban areas, with family history and increasing waist–hip ratio, but significantly lower in the below poverty line areas. Hypertension risk was significantly higher among females, among those leading sedentary life, those eating vegetarian food, those addicted to tobacco and with abdominal obesity. Anemia was significantly lower among urban vegetarians. Overweight and obese were noted in 31% of the participants, and were higher in females (87.5%). Rural residence, female sex, living in joint family, literacy, sedentary life style, decreasing per capita income and decreasing body mass index (BMI) were significantly associated with visual impairment. Conclusion: This study highlights the burden of health problems of elderly individuals in South India.