Prevalence of mental retardation in urban and rural populations of the goiter zone in Northwest India.

BACKGROUND: The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. OBJECTIVE: The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. METHODS: This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. RESULTS: The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age group. The prevalence was higher among the males in all study populations [rural: 1.9%, urban (nonslum): 1.6%, and urban slum: 7.14%). The prevalence was similar among the urban (nonslum) (1.75%) and rural (1.11%) populations, whereas it was higher (4%) in the urban slum population. A prevalence of 2% was seen in families from the lower middle class and 1.8% among families from the lower class in the rural population, whereas a prevalence of 2% was seen among lower middle class families of urban (nonslum) areas. CONCLUSION: The prevalence of mental retardation was higher in our study than in other parts of the country. The study concludes with the hypothesis that the prevalence of mental retardation is differentially distributed geographically with socioeconomic factors being important predictors.

Awareness and Satisfaction About COVAXIN Vaccination Services at an Immunization Clinic in Nagpur: A Cross-Sectional Study.

Introduction Initially, coronavirus disease 2019 (COVID-19) vaccination was started in India for the elderly above 60 years of age. Adults with any comorbidity have been gradually included in the vaccination drive. It is empirical to gain insight into the satisfaction of these beneficiaries with the vaccination as it may act as an influencing factor for receiving the vaccine. Materials and methods This was a descriptive cross-sectional study carried out at the COVID-19 vaccination clinic of the Government Medical College and Hospital, Nagpur, among individuals above 60 years of age and those from 45 to 60 years of age with comorbidity. The survey tool was a predesigned structured questionnaire that had close-ended questions on various aspects of awareness about the COVID-19 vaccines and their satisfaction with the immunization center. Interviews were conducted by two interviewers on each day. Data were analyzed using open software Epi Info (CDC, Atlanta, Georgia). The chi-square test was applied as a test of significance. Results A total of 290 subjects participated in the study. The majority had correct knowledge about COVID-19 vaccination and appropriate COVID-19 behavior after vaccination. Fever and body ache were known to most of the subjects as adverse effects following immunization. Social media was the most common source of knowledge. The majority of the subjects were satisfied with the services provided at the vaccination center, but there was no difference as per age, gender, or residential status of the subjects. Conclusion Despite mixed rumors about the COVID-19 vaccine, the majority of the study subjects were well satisfied with the vaccination. They were apparently having fair awareness about the vaccine.

Epidemiology and genetic diversity of group A rotavirus in acute diarrhea patients in pre-vaccination era in Himachal Pradesh, India.

Acute gastroenteritis due to Group A rotaviruses remains the leading cause of mortality and morbidity in children in developing countries. India introduced its indigenous rotavirus vaccine Rotavac® in 2016 and Himachal Pradesh (HP) the first state to launch it. The present study aimed to evaluate rotavirus strain diversity associated with AGE prior to vaccine introduction in HP. A total of 331 fecal specimens collected from diarrheic children hospitalized at RPGMC Tanda, HP between July-2014 and June-2016 were screened for RVA by EIA. Rotavirus RNA was extracted by TRIZOL method and analyzed by RNA-PAGE. G/P typing was performed using semi-nested multiplex reverse transcriptase PCR. Rotavirus was detected in 45% (n = 149/331) of diarrheic children, with highest rate observed in the 6-11 months age group (47%). Vomiting was found more frequently associated with RV-infection. Among G-types, G12 was found most prevalent (33.1%) followed by G1 (28.4%), G9 (12.2%), G2 (9.5%), G3 (3.4%) and G10 (2.7%). G4 (0.7%) strains were rarely detected. Among P-types, P[6] was the most prevalent (40.5%) followed by P[8] (29.1%) and P[4] (14.2%). Of note, genotypes G3 and P[11] were detected for the first time in HP. Among G/P combinations, G12P[6] was most prevalent (30.4%) followed by G1P[8] (20.3%), G2P[4] (4.7%), G1P[6] (3.4%) and G3P[8] (2.7%). Interestingly, our study observed high percentage of unusual strains (14.2%) namely G9P[4], G2P[6], G2P[8], G12P[4] and G1P[11]. The regionally common strains G3P[6], G4P[6], G9P[6], G9P[8], G10P[6], G10P[8] and G12P[8] strains were very rarely detected. Of interest, RNA migration pattern of G1P[8] was DS-1 like and genomic heterogeneity was observed within G12P[4] strains with both long and short electropherotypes. Our study highlights rich genetic diversity with emergence of rare rotavirus strains circulating in HP and provides baseline data prior to Rotavac® introduction that will help to gauge the impact of the Rotavac® vaccine in HP.

Surveillance and genetic characterization of rotavirus strains circulating in four states of North Indian children.

Acute gastroenteritis due to Rotavirus (RV) infection is a major cause of morbidity and mortality in infants and young children worldwide. In India, around 0.1 million death reported annually due to RV illness. So, to assess the disease burden continuous surveillance of the circulating genotypes is needed. This study aimed to ascertain the genetic variance of 429 rotavirus positive specimens observed during the period October 2013-September 2014 at four study centers from North India. Out of 1057 patients enrolled, 1018 stool samples were collected at four centers in four different states of North India. Children aged <5 years who showed the symptoms of severe diarrhea and needed hospitalization were enrolled. The stool samples collected were screened by Enzyme Immuno Assay (EIA), and the RV positive samples were characterized by semi-nested PCR. During the study period October 2013 through September 2014, ~42% patients were found to be rotavirus positive of 1018 collected specimen. In Delhi, Rohtak and Meerut, we observed that Rotavirus is seasonal compared to Tanda (HP). The rate of rotavirus detection was significantly higher among children aged below 2 years, and a total of 21.5% of rotavirus infections comprised children aged <6 months. Genotype G1(48.0%) was predominant and frequently circulating strain whereas G12 (16.8%) and G9 (10.0%) was second and third prevalent strain in the four states of North India. High frequency of G1 genotypes was detected under the age group of 6-11 months which is followed by G12, similarly high rate severe disease was observed due to G1 genotypes followed by P[8], P[6] and G12. The most common types of strains were G1P[8] (27.73% of strains), G12P[6] (13.28%), G9P[4] (7.23%) and G1P[6] (6.75%). The rare strain reported were G1P[9]; P[11] strain was detected in combination with G1, G2, and G12. These data emphasized G12 is the second most predominant strain circulating among Northern Indian children highlights the needs for inclusion in the future polyvalent vaccine to break the burden of rotavirus infection.

Infantile Tremor Syndrome in Modern Times.

BACKGROUND: Infantile tremor syndrome (ITS) is a clinical syndrome of acute or gradual onset of mental and psychomotor changes, pigmentary disturbances of hair and skin, pallor, and tremors in malnourished children aged between 5 months and 3 years. It is a well-known entity, but the exact etiopathogenesis is still not known. SETTING AND DESIGN: Prospective observational study carried out in the Department of Pediatrics at Dr RPGMC Tanda, Kangra in Himachal Pradesh. MATERIALS AND METHODS: Demographic, clinical, and laboratory profile of 25 children with the diagnosis of preinfantile and ITS was collected who were admitted from May 2014 to June 2015. STATISTICAL ANALYSIS: Descriptive analysis was performed using SPSS 17 trial version. RESULTS: These children accounted for 0.5% of total pediatric admissions. Median, standard deviation age was 10, 3.1 months. Male to female ratio was 1.27:1. Cases were present throughout the year with two peaks observed in the months of May and November. This disease was found to be more common in higher birth order (68%). Complementary feeding, that too improper, was initiated in only 4 cases (16%). Ninety-six percent cases presented with comorbid illnesses. Respiratory tract infection was the most common association, followed by urinary tract infection. There was moderate anemia with dimorphic picture (40%). Thirteen (52%) had vitamin B12 levels below normal. Magnesium levels, though statistically insignificant (P = 0.8) were lower in patients with tremors. CONCLUSION: This is a disease of multi-micronutrient deficiency, which can be present either alone or in association. Educating women about proper nutrition during pregnancy and timely administration of complementary feeding is of utmost importance.

Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia and Neurotoxicity in Neonates from Hilly Terrain of India.

BACKGROUND AND AIM: Neonatal hyperbilirubinemia continues to be the most common cause of hospital admissions and readmissions in the neonatal population worldwide and this pattern continues despite attempts to identify neonates at risk of pathological hyperbilirubinemia. Therefore, this study aimed to study the risk factors for severe hyperbilirubinemia in neonates. MATERIALS AND METHODS: An observational prospective study was undertaken for 1 year in neonates with hyperbilirubinemia requiring double volume exchange transfusion in neonatology unit of a tertiary rural health care hospital. RESULTS: Risk factors included ABO incompatibility in 14 (28.5%), Rh incompatibility in 14 (28%). Other risk factors for hyperbilirubinemia were, jaundice in elder sibling, oxytocin use, birth asphyxia, hypothyroidism, ABO along with Rh incompatibility, Glucose-6 phosphate Dehydrogenase deficiency, cephalhematoma, and sepsis in neonates. Ten (20%) neonates were neurologically abnormal with signs of encephalopathy. Significant association of risk factors with neurotoxicity were also found. All neurologically abnormal neonates were small for date and none was appropriate for date (P = 0.05). There were no neurologically abnormal neonates with A+ and O- mothers (P = 0.04). CONCLUSION: The high rate of exchange transfusion warrants aggressive management of neonatal hyperbilirubinemia by health-care providers by adequate dissemination of information, strict following of hour-based normograms, performing total serum bilirubin assessment in all icteric neonates, and stratification into risk groups thereafter.

Malnutrition as a cause of mental retardation: A population-based study from Sub-Himalayan India.

BACKGROUND: Mental retardation is one of the most common disabilities of childhood. The research on childhood malnutrition and its relationship with cognitive functioning suggests that malnutrition alone does not cause mental retardation. OBJECTIVE: To identify the relation between malnutrition and cognition among children from a Sub-Himalayan state in North India. MATERIALS AND METHODS: A two-phase cross-sectional study was conducted in the rural, urban, and slum area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1-10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase, a door-to-door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for clinical examination to confirm mental retardation. Anthropometric assessment of all study children was done by measuring weight and height. The nutritional assessment was done by categorizing them according to Waterlow classification for malnutrition. RESULTS: Out of the total 5300 children, 1.7% were diagnosed as mentally retarded. No positive association was reported with different types of malnutrition and mental retardation. A weakly positive association existed between nutritional status and mental retardation (correlation coefficient-0.04). Children who were both wasted and stunted had the highest risk (odds ratio, 95% confidence interval - 5.57, 2.29-10.36) of mental retardation as compared to normal. CONCLUSION: Malnutrition may be one of the causes but certainly not the only cause of mental retardation. Other causes may be contributing more significantly toward it.

Formative assessment in postgraduate medical education - Perceptions of students and teachers.

CONTEXT: One of the most important factors of medical education that can revolutionize the learning process in postgraduate students (PGs) is assessment for learning by means of formative assessment (FA). FA is directed at steering and fostering learning of the students by providing feedback to the learner. However, though theoretically well suited to postgraduate training, evidence are emerging that engaging stakeholders in FA in daily clinical practice is quite complex. AIMS: To explore perceptions of PGs and teachers (Ts) about factors that determines active engagement in FA. SUBJECTS AND METHODS: It was a descriptive qualitative study involving focus group discussions (FGDs) with PGs and Ts from Departments of Pediatrics and Orthopedics. FGDs data were processed through points/remarks, data reduction, data display, coding followed by theme generation for content analysis. RESULTS: Four higher order themes emerged: Harsh reality of present summative assessment structure, individual perspectives on feedback, supportiveness of the learning environment, and the credibility of feedback and/or feedback giver. CONCLUSIONS: Engaging in FA with a genuine impact on learning is complex and quite a challenge to both students and Ts. Increased acceptability along with the effective implementation of FA structure, individual perspectives on feedback, a supportive learning environment and credibility of feedback are all important in this process. Every one of these should be taken into account when the utility of FA in postgraduate medical training is evaluated.

Socio demography of mental retardation: A community-based study from a goitre zone in rural sub-Himalayan India.

INTRODUCTION: Mental retardation is one of the most common disabilities of childhood which can be prevented by timely identification of the causative agent and an adequate management accordingly. District Kangra lies in the sub-Himalayan belt and forms a part of the 2400 km long goitre belt along the southern slopes of the Himalayas. OBJECTIVE: To study the prevalence of mental retardation among children (1-10) years of age. MATERIALS AND METHODS: A two-phase cross-sectional study was conducted in the rural area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1-10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase a door to door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for examination by the pediatrician to confirm mental retardation. RESULTS: A total of 2420 children were screened in the first phase of which 95 tested positive. About 52 of these children were found to be mentally retarded in the second phase giving a prevalence of 2.15%. The 69% of these children belonged to the lower middle class and 28.3% belonged to middle class families using the Uday Parekh scale for assessment of the socio-economic status. CONCLUSION: Prevalence of mental retardation is high in district Kangra of Himachal Pradesh in comparison to other states of India. This could be attributed to the good primary health care in Himachal Pradesh where institutional deliveries are about 70%. This may have led to better survival of children with congenital disorders and those that suffer perinatal trauma.

Cysticercosis of deltoid muscle.

Cysticercosis is a disease caused by tapeworm Taenia solium. It is commonly found in developing countries, but reports of its frequent occurrences even in developed countries due to immigrants from infected areas are widely reported. When cysticercosis affects the brain, the condition is commonly called neurocysticercosis however, sporadic cases of solitary intramuscular cysticercosis have been reported in the literature. We present a case of solitary cysticercosis in the right deltoid muscle in a 25-year-old woman who presented with a painful swelling on the right shoulder. The diagnosis was established by MRI and targetedultrasonography. Surgical removal of a cyst followed by 2 weeks of albendazole treatment resolved the symptoms.

Retroaortic left renal vein with cascade of complications in a neonate.

BACKGROUND: Retroaortic left renal vein, is a rare congenital anomaly. CASE CHARACTERISTICS: A 14-day-old male neonate with retrocrortic left renal vein with posterior nutcracker phenomenon resulting in renal congestion. OBSERVATION: He developed septicemia, renal abscess and thrombosis of abdominal aorta. OUTCOME: Improvement on antibiotics and heparin. MESSAGE: Retroaortic left renal vein can cause life threatening complications.

Heparin: induced thrombocytopenia: incidence and laboratory approach to diagnosis in Indians.

BACKGROUND AND OBJECTIVES: One of the most common complications of heparin administration is heparin-induced thrombocytopenia (HIT) which can also lead to catastrophic thrombotic events. The problem of identifying the cause of thrombocytopenia, as due to heparin, in patients with multiple co-morbid conditions is very essential for management. Thus, the laboratory investigations for diagnosis of HIT play a pivotal role. The objective of the study was to arrive at the incidence of HIT in ethnic Indian population and provide a decision after analysis of tests used to diagnose HIT. MATERIALS AND METHODS: 125 consecutive patients (Power of study being 80%) undergoing open heart surgery and receiving unfractionated heparin were taken as subjects. Blood samples were collected a day before the surgery and days 1, 3, 5 and 7 after surgery. The cases were categorized into probable and unlikely groups depending on the clinical presentation and degree fall of platelet count. Anti-heparin PF4-associated antibodies were detected using rapid-ID gel microtyping system and ELISA tests. HIT was also tested using functional assays: heparin-induced platelet aggregation test (PAT) and the rapid luminographic assay of heparin-induced ATP release. RESULTS: Of the 125 patients, 11 patients were clinically labeled as probable HIT and 29 patients were clinically labeled as unlikely HIT. There were seven confirmed cases of HIT cases that were positive for one functional and one immunological assay. Only one case of HITT was encountered. Accordingly, the incidence of HIT was found to be 5.6% and that of HITT to be 0.8%. ELISA tests were positive in 21 cases (17%) which demonstrated the presence of anti-HPF4 antibodies in non-HIT cases as well. It was found that the rapid gel test had sensitivity comparable to functional assay with better specificity than ELISA. INTERPRETATION AND CONCLUSIONS: Incidence of HIT in ethnic Indian population is 5.6%. Patients with a drop of >50% in platelet count should be perused as a likely candidate of HIT. These cases should be subjected to the ID-HPF4 antibody assay as this is a rapid test, can be done for individual cases, and has better specificity and similar sensitivity than ELSIA. Cases with clinically probable HIT and a positive ID-HPF4 assay can be taken as confirmed cases of HIT. However, cases clinically unlikely for HIT and a positive ID-HPF4 assay should be subjected to another test to establish the diagnosis of HIT.

A study of anemia among adolescent females in the urban area of nagpur.

OBJECTIVES: To estimate the prevalence of anemia among adolescent females and to study the socio-demographic factors associated with anemia. MATERIALS AND METHODS: A cross-sectional survey was conducted in an urban area under Urban Health Training Center, Department of Preventive and Social Medicine, Government Medical College and Hospital, Nagpur. A total of 296 adolescent females (10-19 years old) were included in this study. The study took place from October 2002 to March 2003 (6 months). Statistical analyses were done using percentage, standard error of proportion, Chi-square test, and Student's 't' test. RESULTS: The prevalence of anemia was found to be 35.1%. A significant association of anemia was found with socio-economic status and literacy status of parents. Mean height and weight of subjects with anemia was significantly less than subjects without anemia. CONCLUSIONS: A high prevalence of anemia among adolescent females was found, which was higher in the lower socio-economic strata and among those whose parents were less educated. It was seen that anemia affects the overall nutritional status of adolescent females.