Suman Saurabh

Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India.

Background: The burden of diabetes and its foot complications is increasing in India. Prevention of these complications through foot care education should be explored. The objective of our study was to assess the risk factors of poor diabetic foot care and to find the effectiveness of health education in improving foot care practice among diabetes patients. Materials and Methods: A structured pre-tested questionnaire was administered to the outpatients of a rural health center with type 2 diabetes. Awareness regarding diabetes, care of diabetes and foot care practice ware assessed and scored. Individual and group health education focusing on foot care was performed. Foot care practice was reassessed after 2 weeks of education. Results: Only 54% were aware that diabetes could lead to reduced foot sensation and foot ulcers. Nearly 53% and 41% of the patients had good diabetes awareness and good diabetes care respectively. Only 22% of the patients had their feet examined by a health worker or doctor. The patients with poor, satisfactory and good practice scores were 44.7%, 35.9% and 19.4% respectively. Low education status, old age and low awareness regarding diabetes were the risk factors for poor practice of foot care. Average score for practice of foot care improved from 5.90 ± 1.82 to 8.0 ± 1.30 after 2 weeks of health education. Practice related to toe space examination, foot inspection and foot wear inspection improved maximally. Conclusion: Foot care education for diabetics in a primary care setting improves their foot care practice and is likely to be effective in reducing the burden of diabetic foot ulcer.

Female literacy rate is a better predictor of birth rate and infant mortality rate in India

Background: Educated women are known to take informed reproductive and healthcare decisions. These result in population stabilization and better infant care reflected by lower birth rates and infant mortality rates (IMRs), respectively. Materials and Methods: Our objective was to study the relationship of male and female literacy rates with crude birth rates (CBRs) and IMRs of the states and union territories (UTs) of India. The data were analyzed using linear regression. CBR and IMR were taken as the dependent variables; while the overall literacy rates, male, and female literacy rates were the independent variables. Results: CBRs were inversely related to literacy rates (slope parameter = −0.402, P < 0.001). On multiple linear regression with male and female literacy rates, a significant inverse relationship emerged between female literacy rate and CBR (slope = −0.363, P < 0.001), while male literacy rate was not significantly related to CBR (P = 0.674). IMR of the states were also inversely related to their literacy rates (slope = −1.254, P < 0.001). Multiple linear regression revealed a significant inverse relationship between IMR and female literacy (slope = −0.816, P = 0.031), whereas male literacy rate was not significantly related (P = 0.630). Conclusion: Female literacy is relatively highly important for both population stabilization and better infant health.

Screening for skin diseases among primary school children in a rural area of Puducherry

How to cite this article: Saurabh S, Sahu SK, Sadishkumar A, Kakkanattu JC, Prapath I, Ralte IL, et al. Screening for skin diseases among primary school children in a rural area of Puducherry. Indian J Dermatol Venereol Leprol 2013;79:268. Received: September, 2012. Accepted: November, 2012. Source of Support: Nil. Conflict of Interest: Nil. Screening for skin diseases among primary school children in a rural area of Puducherry

Is red blood cell a mediator of remote ischaemic preconditioning

Remote ischaemic preconditioning is emerging as a promising clinical technique which can afford immediate protection against coronary ischaemia. The mechanisms which mediate the signal transduction from remote organ to the heart are still unclear. The role of ATP sensitive potassium channels in ischaemic preconditioning has been established. It is known that the red blood cell (RBC) acts as a mediator of local autoregulation in adjusting oxygen supply to demand by sensing hypoxia and releasing ATP locally to achieve vasodilatation in the adjacent vascular beds. Our hypothesis links these two known mechanisms. Remote ischaemic preconditioning and local RBC autoregulation might share a common mechanism using the ATP sensitive potassium channels. Therefore, we hypothesize that the signal transduction by RBC might be partly responsible for this protection against ischaemia.

Use of insecticide-treated bednets in an urban coastal area of Puducherry, India: A cross-sectional study

Use of Insecticide-Treated Bednets (ITNs) has been shown to reduce the incidence of mosquito-borne diseases. However, the impact of ITNs depends on its community acceptance. We studied the ITN usage and factors influencing it, following the distribution of one ITN to each family in an urban area of Puducherry. Around 93.6% of the 157 respondents surveyed were aware of mosquito-borne diseases. Coils and vaporizers were used in 91.1% of the families. Around two-fifths (41.3%) of the 116 families who received the ITNs used it regularly with another 5.1% using it irregularly. Majority of the users (85%) reported reduced mosquito bites and pleasant sleep after use. Small size of ITNs was the most common reason for non-use (46.3%). Families not using normal bed nets at the time of distribution of ITNs were unlikely to use ITNs at present (odds ratio = 5.22, P < 0.001). Therefore, ITN size should be increased and distribution in urban settings should accompany behavior change communication.

Global reduction in measles mortality

1draws highly relevant conclusions for measles control. Simons and colleagues rightly take the S/N (proportion of susceptibles in the total population) as directly aff ecting transmission. However, if, as we assume, they have used fi rstorder kinetics for disease transmission and arrived at a form similar to that of annual proportion of deaths in a fi xed population, the power of “e” must be a constant multiplied by time “t”, which equals 1 year here. Yet S/N can never be expected to remain constant, especially for a highly infectious disease such as measles. 2

Public–private mix in tuberculosis

www.thelancet.com/infection Vol 12 December 2012 907 factors of hospital admission for all-cause severe anaemia. Because vitamins A and B12 are essential for erythropoiesis and have immunemodulating eff ects, we anticipate increased effi cacy can be achieved when monthly IPTpd is combined with micronutrient supplementation and short-term antimicrobial prophylaxis. This more integrated approach to the management of children with severe anaemia in hospital and after discharge needs to be explored.

Corticosteroids for prevention of tuberculosis mortality

www.thelancet.com/infection Vol 13 November 2013 915 patients with pulmonary tuberculosis recover uneventfully without major complications with multidrug treatment. The most important fi nding is that not one patient died in four of the fi ve trials that assessed the eff ects of steroids in pulmonary tuberculosis in the era of multidrug treatment. The only trial that did report deaths included only patients with HIV who received high doses of glucocorticoids. Predictors of mortality in patients with HIV and tuberculosis diff er from those in patients with tuberculosis without HIV. Moreover, the biological mechanisms of benefi cial eff ect of corticosteroids in tuberculous meningitis and pericarditis are poorly understood. The possibility of increased risks of emergence of drug resistance in the era of multidrugresistant tuberculosis, coexistent HIV infection, and immunosuppression leading to disease progression with coadministration of steroids to patients with pulmonary tuberculosis need to be carefully considered before doing further research.

Diagnosis and treatment of pulmonary tuberculosis in patients with HIV

We appreciate the attempt of Timothy Holtz and colleagues to address a highly relevant public health topic. However, we have some comments and queries about their article. The investigators stated that the study was both observational and interventional and use the terms interchangeably, but consistent use of either term would be preferable. Although the methods of the study are very clear with operational defi nitions and standard protocols used throughout, more information about the extent of implementation of the WHO algorithm in KwaZulu-Natal would have been helpful. Training of healthcare staff before implementation of management according to the WHO algorithm and no loss to follow-up in either cohort are notable aspects of the study. Enrolling only patients who are seriously ill will lead to a lower estimate of successful treatment than would otherwise be the case and will in turn reduce the extent to which the fi ndings can be generalised. The justifi cation for enrolling only seriously ill patients is not provided in the article. The period of enrolment is clearly stated, but the duration of study is not. The investigators discuss long-term and seasonal trends without stating which periods they have compared. The basis on which primary endpoints (ie, rates of continued stay in hospital at 7 days after admission and survival at 8 weeks after admission) were decided is not clear. For example, the researchers could have recorded average duration of hospital stay and average duration of survival as in some other studies of populations with the same disorders. Although the investigators state that the present shift in standard practice towards taking routine sputum cultures and giving early treatment might lead to a substantial increase in laboratory and pharmaceutical costs in resourcelimited settings compared with use of the WHO algorithm, their own results show that a higher number of sputum and blood cultures were ordered for the algorithm cohort than for the standard practice cohort. Therefore, a cost-wise assessment comparing implementation of the algorithm with present standard practice is needed before any policy decision is made. The fi ndings of Holtz and colleagues have important implications for tuberculosis control in patients with HIV in settings in which resources are scare; however, they also underline a need for research into the cost eff ectiveness of recommended practices.