Compromised Vitamin B12 Status of Indian Infants and Toddlers.

BACKGROUND: Vitamin B12 deficiency is prevalent worldwide especially in vegetarian communities. Its deficiency in early childhood may result in serious neurological and cognitive deficits. It is important to know the prevalence among our infants and toddlers so that nutritional policy changes could be suggested in this regard. OBJECTIVE: To evaluate the vitamin B12 status of apparently healthy Indian children between 6 and 23 months of age. METHODS: Apparently healthy Indian children (n = 210), of age 6 to 23 months, attending pediatric outpatient department were recruited and samples obtained to evaluate their hemogram and levels of vitamin B12, folate, and ferritin. Data were analyzed to obtain the mean levels and the proportion of participants deficient in vitamin B12. The dietary habits of the children were also analyzed and correlated with their vitamin B12 status. RESULTS: Vitamin B12 deficiency was observed in 37.6% of the participants. CONCLUSIONS: There is a high prevalence of vitamin B12 deficiency in our infants and toddlers, and there is need to initiate supplement to prevent any possible neurological consequences. Early initiation of animal milk had a positive effect on the vitamin B12 status of the child, though it was not significant.

An unusual case of metastatic male breast cancer to the nasopharynx-review of literature.

Metastatic breast carcinoma has been described to the various areas in the head and neck region. However, these metastases are rarely found in nasopharynx. Herein we are presenting the first case of male breast carcinoma with the longest survival secondary to distant metastases in right maxillary sinus and extending to the nasopharynx with extensive skeletal & lung metastases. Here we present a case of 65-year-old male with past medical history of right breast carcinoma, presented clinically with symptoms of recurrent sinusitis. Physical examination revealed a mass in the nasopharynx, which subsequently proved to be hormonal receptor positive high-grade adenocarcinoma secondary to metastasis of primary breast cancer on biopsy. The patient received three cycles of palliative chemotherapy based on Doxorubicin with Paclitaxel weekly. In spite of that, he developed pulmonary, liver and bone metastases. Later, treatment regimen was changed to Gemcitabine, Paclitaxel and injectable Zolendronate with calcium and vitamin D supplementation. Still he didn't show any improvement and later, he developed febrile neutropenia. Then, he refused further chemotherapy and died after 12 months of receiving the best hospice care. Breast cancer is one of the most common cancers in terms of incidence and mortality; breast cancer deserves extensive studies and research in different aspects. Breast cancer metastasizing to nasopharynx would be the last diagnosis that comes to mind for a male patient presenting with clinical features suggestive of recurrent sinusitis infection. As recurrent sinusitis is a very common ailment affecting human kind and is mostly due to benign causes. Metastasis, although rare, should be included in the differential diagnosis of nasopharyngeal lesion since it may clinically mimic a benign neoplasm or primary carcinoma. Based on our clinical experience and review of literature, although it is a very rare possibility in a patient with sinusitis, still we advise not to overlook any symptoms suggestive of the etiology of recurrent sinusitis.

Demystifying the complex patellar form via ratios and indices.

Indices and ratios are effective tools for defining balanced dimensions as they compensate for extremes in sizes and do not rely on absolute measurements for establishing normal values. The present study was designed to characterize patellar morphology in the form of useful 'patellar ratios' and 'patellar indices'. The study was conducted on 200 adult North Indian male patellae (100 each of right and left sides respectively). The patellar dimensions were found to be smaller for the North Indians as compared with other populations. The predominant phenotype for North Indians emerged to be a Wiberg type II (60%) patella. The North Indian patellae were classified as medium height (50-55)/medium width (51-56) patellae. The present study is the pioneer study where these indices have been determined and quantified for a population. The paucity of literature on morphology of patella gives credibility and relevance to the present pioneer work on patellar shape, ratios and indices.

Educational barriers of nurses caring for sick and at-risk infants in India.

AIM: To gain ideas and information from healthcare providers to optimize the education and clinical practices of nurses caring for sick or at-risk newborns in India. BACKGROUND: Improving infant survival has been identified as a Millennium Development Goals; however, India still faces many challenges with 3.1 million neonatal deaths and 2.6 million stillbirths annually. Skilled nursing care has been associated with decreased morbidity and mortality in newborns. However, core competencies in newborn care education and training are lacking for nurses. METHODS: Qualitative data were collected from 12 focus groups with 101 newborn care providers from three areas of India as well as from a 2-day stakeholders' meeting. Data analysis was undertaken using descriptive and thematic content analysis. RESULTS: Perceived challenges included limited manpower and high nurse turnover, lack of access to evidence-based orientation to newborn care and problems with access to appropriate learner-based, neonatal training. Relevant, ongoing education opportunities, led by nursing leaders were identified to be important solutions. CONCLUSION: Findings provide insight into the current healthcare system in India with specific reference to the nursing care of at-risk newborns. There is a lack of existing resources to provide standardized and specific orientation curricula for nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Policy makers in health and education need to: support and enact learner-based orientation and continuing educational opportunities as well as ongoing competency-based education programmes; encourage nurse leader involvement and support; and provide sustainable system-related supports. Nurses and other health providers need to work together to influence government policy.

Effects of ageing on otoacoustic emission.

To study the effects of ageing on otoacoustic emission (OAE) in individuals with normal pure tone audiogram (PTA). Tertiary/Medical College Hospital. Descriptive/Prospective study. We screened healthy individuals: (1) 50 persons in the age group of 20-25 years. (2) Fifty persons in the age group of 45-50 years. (3) Fifty persons in the age group of 55-60 years. (1) The individuals in the age group of 20-25 years showed absent/decreased distortion product OAE (DPOAE) in two cases (2/50) with normal PTA. (2) The individuals in the age group of 45-50 years showed absent/decreased DPOAE in eleven cases (11/50) with normal PTA. (3) The individuals in the age group of 55-60 years showed absent/decreased DPOAE in 47 cases (47/50) with normal PTA. Just like any other organ in the body which exhibits the process of ageing, the cochlea too undergoes similar changes to the ageing process. The DPOAE is the first sign to disappear in presbyacusis. The many factors which hasten the onset of presbyacusis-like nutrition, lifestyle, environment and occupational hazards, infection and illness, drug intake, hereditary etc.; can be modified for prolonging a healthy natural hearing.