Shrayan 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.

Obesity in Kolkata children: Magnitude in relationship to hypertension.

Background: Limited data is available from India regarding the distribution and profile of childhood obesity and hypertension. Materials and Methods: A population based cross-sectional study was conducted in the urban schools of Kolkata. Using stratified random sampling method, 979 participants were selected. Body mass index (BMI) status and blood pressure (BP) were estimated using standard protocol and their various correlates regarding sociodemographic characteristics were looked into. Results: Majority (38.92%) of the study population were in the preadolescent group followed by adolescent group (33.40%). Male constituted 52.09%, overweight was more prevalent among preadolescent age group (22.57%). Overall 27 cases of prehypertension were found of which 19 (70.37%, n=27) were in the adolescent age group. There was no significant association between ages with increased BMI status. We detected total 15 cases (1.53%) of hypertension in our study population and three-fourths of them were from adolescent age group. However, significant association was seen between high BP with increasing age. Average fast food intakes and screen time was higher in obese as compared to their normal peers. Upper and upper-middle social status contributed to higher number of obese/overweight and hypertensive children and was the significant risk factor. Conclusion: Childhood obesity and hypertension were found to be common in the city of Kolkata which suggest the need for greater public awareness programs on these morbidities.

Fine needle aspiration cytology as the primary diagnostic tool in thyroid enlargement

Background: In the preoperative decision-making of the thyroid swellings, fine needle aspiration cytology (FNAC) is becoming an ever more vital tool. Objectives: To compare the advantage of preoperative FNAC of thyroid swellings with postoperative histopathology to reach a consensus protocol as a simple procedure for diagnosis and optimal management of thyroid swellings. Materials and Methods: A prospective study of preoperative FNAC was carried out on 178 incidental thyroid swellings attending a tertiary care centre in Kishanganj, Bihar. Evidence-based surgical interventions were done, irrespective of FNAC findings and diagnosis was confirmed by histopathological examination (HPE) postoperatively in all the cases. Results: In the FNAC, preponderance of the cases (75.84%) was colloid goitre followed by granulomatous thyroiditis; follicular carcinoma was noted in 7.30 percent and anaplastic carcinoma in 3.37 percent of cases. Histopathological examination showed colloid goitre predominantly (76.97%), followed by follicular carcinoma (8.99%). The overall prevalence of malignancy was 11.24 percent diagnosed by HPE and 9.55 percent by FNAC. In our FNAC series sensitivity of was 90 percent while specificity was 100 percent; accuracy was 98.88 percent. Predictive value of a positive test and negative tests was 100 percent and 98.75 percent respectively. Conclusion: The study highlights that FNAC should be treated as a first-line diagnostic test for thyroid swellings to guide the management though this is not a substitute for HPE as a need to improve primary healthcare in India.

Assessment of impact of small group teaching among students in community medicine

Background: We conducted a study to assess the impact of small group teaching (SGT) among students by feedback analysis to identify intricacy so that learning can be facilitated. Materials and Methods: This cross-sectional study was undertaken among 182 MBBS students studying at a teaching hospital at Gangtok. Students were provided with a questionnaire following an assignment on a scheduled topic. Students were asked to provide feedback on the modes of teaching-learning practiced in community medicine with the parameters of evaluation including assessment of presentation by faculty member in reference to relevance, sequencing, depth, interaction, etc., to the overall rating of presentations in different teaching–learning methods. Results: The faculty members were on the positive evaluation by the students in the SGT, which was preferred over lectures as the teaching–learning methods. Among SGTs “tutorials” were graded better than “practical”, “seminar” and “field posting” on the basis of longer duration at a stretch. Among the parameters for evaluation, relevance, depth, and interaction in regard to scheduled topic of presentations, the rating was significantly higher in SGT than different other teaching–learning methods. Largely the students noted that the time devoted and number of hours/sessions allotted for each topic was adequate. Conclusion: All forms of SGT were on the positive appraisal by the students on their learning experience and were considered as a comprehensive tool for in-depth teacher–student interaction.

Correlates of voluntary blood donation among people in a hill capital in India

In an attempt to understand the problems and to improve voluntary blood donation at Gangtok, East Sikkim, this study was designed to assess the possible reasons for donating and not donating blood. Study Design: Population based cross-sectional study; Study Period: 01.01.2004 to 30.03.2004. (Three months activity); Setting: Gangtok, East Sikkim; Interventions: None; Study Population: 300 adults; Sampling Technique: Two-stage cluster sampling technique; Main Outcome Measures: socioeconomic and demographic variables of voluntary blood donation. Data Collection Procedure: Three hundred adults were selected from the adult population of Gangtok, East Sikkim. Then by interview technique the principal investigator Dr. Namgay Shenga collected the data using the pretested, close-ended structured schedule. In 300 adults, the study showed a significant association between attitude towards voluntary blood donation and education. There was a significant association between knowledge about blood donation and attitude towards voluntary blood donation, along with moral obligation, charity and duty parameters. Variables that were not significantly associated with voluntary blood donation were age, sex, religion, marital status, community status, occupation and per-capita monthly income. Several possible reasons have been put forward for not donating blood voluntarily, varying from problems of time, procedure and physical health. The finding of the study indicated that education gives birth to an ocean of difference between the positive attitudes of the general mass towards voluntary blood donation, in true life practice. The results suggested that reinforced steps should be taken to educate the population about voluntary blood donation. Key words: Attitude, variables, voluntary blood donation

Awareness on psychosomatic health among adolescent girls of three schools in north Kolkata

Introduction: Psychosomatic health of adolescent girls at crossroads of childhood and mature adulthood, may lead to various health problems in future. Objective: To determine the improvement in the knowledge and attitude on health among adolescent girl students of Kolkata after the health education intervention. Materials and Methods: This ‘Health Education Intervention Study’ was conducted in October and November 2006, in three senior secondary schools of North Kolkata. The Simple Random Sampling Technique was applied to select three schools from the spot map of North Kolkata for this study, and 282 girl students in the adolescent age group of 13 to 19 years were selected from the completed updated list of students from the enrollment registers in these schools. Results: The mean age of the participants was 15.7 years (±1.8 years). This health education intervention showed a significant improvement in their knowledge on adolescent health, in the aspects of sex differences in pubertal spurts, probable causes of health problems during adolescence, physical changes in adolescent boys and girls, and psychological problems of adolescence. A significant improvement in positive attitude was observed, with regard to their opinion on substance abuse in the adolescent period and importance of sex education for adolescents. Conclusion: This study revealed some unknown parts of psychosomatic health among adolescent girls, in this part of India.

Medical Education: The Hot Seat

Medical science has eventually metamorphosed from ′Knowledge based′ to ′Skill based′ applied social science. So, the age-old traditional courses and curriculums in Indian medical education need a overhauling with radical modifications. With a paradigm shift, we have to take into account not only the help of scientific feedback from the teachers and students but also from all the stakeholders of health care delivery system.

Clinico-pathological correlates of incidentally revealed thyroid swelling in Bihar, India.

Background: Global prevalence of thyroid cancer has been on the rise in recent decades. Objectives: To study the clinical presentations to reach an agreement for diagnosis and optimal management of incidentally revealed thyroid swellings for early diagnosis. Materials and Methods: A prospective study was carried out on 178 cases of incidentally detected thyroid swelling attending a tertiary care teaching institute of Kishanganj Bihar. All the cases were subjected to a thorough clinical examination followed by evidence-based interventions. Fine needle aspiration cytology was done in all the cases preoperatively as out-patients basis and histopathologically confirmed postoperatively. Results: The highest incidence of thyroid swelling (75.84%) was found in the age group of 20-40 years; a female preponderance was noted in the ratio 4:1. The duration of swelling ranged from six months to three years. Difficulty in swallowing and breathing was complained by 23 (12.9%) and 18 (10.1%) of the patients respectively. Typically the swellings were located in the right lobe. Commonly the subjects in our study were in euthyroid state (90%) and were with firm swellings (66.7%). Follicular and anaplastic carcinoma was important postoperative cytological findings. Majority of surgical intervention was hemithyroidectomy (55.06%). Conclusion: Incidentally revealed thyroid swelling was quite high in eastern India for which we need a consensus line of intervention.

The quest for an Indian blood law as of blood transfusion services regulatory framework

Background: Blood transfusion services are a vital part of the national health delivery system. The responsibility for ensuring a continuous supply of blood rests with health administrators, who need to galvanize entire communities towards regular and non-remunerated blood donation. Objective: The present study aimed to examine the prevailing global regulations and practices related to blood transfusion and press the case for a dedicated blood law in India. Materials and Methods: We attempted a comprehensive, annotated assembly of published studies on blood transfusion services in India. Data Abstraction and Synthesis: Laws related to blood transfusion services exist in India as a part of the Drugs and Cosmetics Law. In the developed world, most blood donors are unpaid volunteers who give blood for a community supply. In order to augment safe blood transfusion services in India, we have to develop operational legal guidelines on recruitment and retention of voluntary blood donors to direct related organizations for this imperative activity. Conclusion: Several factors, such as political will and a professional and ethical approach can help in formulating a common vision, building trust, by providing optimum information towards a social movement for the rational blood transfusion services. We have to come together for a dedicated blood law in order to improve the quality of blood transfusion services in India.

HB E/β°Thalassemia can present with normal phenotype.

Sir, Hb E is the second most common hemoglobin variant in the world with a high frequency in SE Asia reaching a frequency from 15% to 50% in Thailand, Burma, Srilanka, and Vietnam as the most common hemoglobin variant. Hemoglobin E/β°Thalassemia, however, resembles homozygous β°Thalassemia both clinically and hematologically. Heterozygous HbE diseases are asymptomatic with mild hypochromia that is prevalent in Bengal, Assam, and in East India. Homozygous suffer from mild hemolytic anemia and have modest splenomegally with target cell 25-50%. HbE diseases entity often goes unnoticed as most of the cases have no noticeable clinical findings as reviewed extensively by Wasi in Thailand.[1–5] A 6 years old girl presented with progressively increasing generalized weakness, difficulty in walking with breathlessness, withdrawn at home, poor appetite since her third birthday. Family history or other histories revealed no significant related events of regular intake of blood. The girl was moderately pale, mild icteric with mesomorphic features with an apparently normal look for her age and sex with mild hepatosplenomegally. No dysmorphic feature (mega hepatosplenomegally or bronzy discoloration of skin or typical facial changes) suggestive of chronic or congenital hematological diseases was present to bring the child under multiple differential diagnoses. Pulse oxymetry showed 91% oxygen saturation. Hemoglobin level was 4 g% with few reticulocytes, numerous hypochromic nucleated red cells, and microcytes with almost no normal appearing red cells on smear, occasional spherocytes present, more than 50% red cells being the target cells. MCV was 50-66 fL and serum bilirubin 1.84 mg%, unconjugated 1.4, conjugated 0.4. The hemoglobin agar gel electrophoresis at pH 8.6 showed Hb E in the same position as Hb C and Hb A2. At pH 6.3, Hb E ran with Hb A; HbA 0.2 g (5.8%), HbF 1.8 g (44.1%), HbE 2.0 g (50.1%). The caregivers were counseled with the ‘live with a disease’ philosophy and the diagnosis as well as prognosis of this disease was carefully explained in the line of management of β°Thalassemia. It is very important to generate awareness among our fraternity regarding subtle presentation and importance of early detection of E/β°Thalassemia and that timely intervention can help in better prognosis. Professionals related to community pediatrics, clinical epidemiology, and community genetics, functioning in unison, has a dominant role to play in preventing the fatal outcome of this genetic disorder.