Concerns of Primary Caregivers of Children with Complex Chronic Conditions in Kerala: A Qualitative Analysis.

Objectives: Exploring data on primary caregiver experiences of dealing with chronically ill children (CIC) strengthens the ability of paediatricians to improve the quality of care by detecting unmet needs in paediatric palliative care and understanding their original concerns instead of presumed needs. Hence, this study aims to identify and describe the primary concerns and challenges faced by caregivers of children with complex chronic conditions in a tertiary care hospital in Kerala. Materials and Methods: Primary caregivers of 25 children aged <13 years with non-malignant life-limiting illnesses, admitted to the paediatric department of a government medical college in Kerala between 1 July 2021 and 28 February 2022, underwent in-depth interviews to analyse their most worrisome issues. Thematic analysis was the method chosen for qualitative data analysis. Results: The main themes identified were medical issues, unmet needs, caregiver health issues, and social and financial issues. Among the medical issues, poor seizure control and infected bedsores, sleep deprivation in both patient as well as caregivers, and difficulty in maintaining the personal hygiene of patients were the major issues. Parents of almost all the CICs reported that they required diapers more than any other material or device. Maternal depression was the major caregiver health issue. The unavailability of antiepileptic drugs in peripheral health centres resulted in missing doses and undue expenses for travel to tertiary centres to obtain the same. Caregivers reported their dismay when they finally realised that they were given false hopes of a cure by different systems of medicine. Conclusion: The challenges faced by caregivers of children with complex chronic conditions are multifaceted. Their most problematic issues related to medical issues are the occurrence of breakthrough seizures and development of infected bedsores. The most important material hardship reported was diaper needs. Caregiver issues such as sleep deprivation and maternal depression must be identified and addressed while providing comprehensive palliative care.

Challenges in the diagnosis and management of atypical fungal keratitis during the COVID-19 pandemic: a case series.

Fungal keratitis is a time-sensitive ocular infection that often requires a high index of suspicion followed by intensive medical/surgical interventions to achieve a successful clinical outcome. COVID-19 pandemic-related restrictions, necessitated the modification of conventional protocols and guidelines associated with the treatment of keratomycosis. We report four cases of atypical fungal keratitis with poorly differentiated clinical characteristics. The challenges faced during their management were (1) the dilemma of clinically differentiating fungal (Scedosporium and Purpureocillium lilacinum) and bacterial keratitis; (2) treatment of Scedosporium and Trichosporon keratitis with natamycin monotherapy; (3) mixed infection of Candida albicans and Aureobasidium pullulans and continuing medications before rescraping the corneal ulcer against the recommended treatment guidelines; (4) phenotypic identification and differentiation among morphologically resembling fungi; and (5) decision making arising out of disparities between KOH and fungal culture results. Three patients responded well to conservative treatments. The fourth patient underwent therapeutic keratoplasty but was lost to follow-up due to travel-related pandemic restrictions. This case series seeks to broaden the clinician's knowledge of rare and emerging moulds as presumptive aetiologies of keratomycosis. It also intends to emphasize the significance of early microbiological investigations, (direct microscopy and culture), in resource-limited settings, for initiating empirical treatment for a better visual prognosis.

Sero-prevalence of Nipah antibodies among close contacts of the index case during 2019 Ernakulam outbreak.

Introduction: Nipah virus (NiV) infection is a fatal emerging zoonotic disease. Infection with NiV has a wide range of clinical spectrum which can range from asymptomatic cases to acute respiratory distress syndrome (ARDS). The index case of NiV infection of 2019 outbreak in Ernakulam district was a 23-year-old male who presented with features of encephalitis. This study was undertaken to address the subclinical or asymptomatic NiV infection amongst the close contacts of this index case by using NiV-specific Immunoglobulin IgM and IgG antibodies. The index case was first treated in a primary care center. He survived the infection and was discharged after a period of 108 days from the tertiary care facility where he was treated eventually. Methods: Serum samples from 49 close contacts of the index case were collected and tested for anti-NiVIgM and anti-NiVIgG antibodies. The contacts included health care workers including those from the primary care facility, family members, and his friends. Results: Most common type of exposure included physical contact (59.2%), followed by exposure to body fluids (22.4%). Conclusion: None of the 49 contacts tested positive for anti-NiV human IgM and anti-NiVIgG antibodies. There were no subclinical cases amongst the close contacts of Nipah index case during the 2019 Kerala outbreak.

Vitamin D status and associated factors among peri menopausal women in two selected districts of Kerala.

BACKGROUND: Vitamin D deficiency is highly prevalent among the Indian population and it is found to be associated with many diseases among perimenopausal women in various hospital-based studies. OBJECTIVES: This study aimed to find out the Vitamin D status among perimenopausal women and to assess the association of selected factors with Vitamin D status among them. METHODS: A cross-sectional study was conducted among 184 perimenopausal women in two districts of Kerala from July 2018 to February 2019. The data were collected and blood sample was taken for determining the 25(OH) D levels after obtaining informed written consent. Descriptive and inferential statistics were done using SPSS version 22. RESULTS: Among the 184 women, 2 (1.1%) had sufficient, 18 (9.8%) had insufficient, and 164 (89.1%) had deficient 25(OH) D levels. The mean 25(OH) D levels among the population were 15.01 ± 4.32 ng/ml (95% confidence interval 14.38-15.63), much lower than the required level of 30 ng/ml. Vitamin D level was significantly higher among women who had exposure to sunlight, were on Vitamin D supplementation, and those who had skin diseases. 25(OH) D levels were higher among residents of Ernakulam district, older age group, low socioeconomic status, mixed-diet consumers, those who attained menopause, and those had calcium supplementation. The level was low among those who regularly use sunscreen topical applications and had other comorbidities such as hypothyroidism. However, none of these factors were significantly associated with 25(OH) D levels. CONCLUSION: The study showed that Vitamin D deficiency is highly prevalent among the study population.

Anatomical Characterization of Nine Taxa of Genus Acmella Rich. (Toothache Plant) in India

Abstract The present study is aimed for anatomical characterization of nine taxa of Acmella to supplement data specifically for its current sectional classification and species circumscriptions. Anatomical characterization of this genus is little explored. This study focuses on internal structure of leaves, petioles, peduncles, stems, roots and cell inclusions to determine its taxonomic importance. In stem anatomy the number of hypodermal collenchymatous layers and the arrangement of parenchymatous cortex together place an important role in the identification of Acmella. Root anatomy was similar in all the examined taxa except in the arrangement of xylem vessels. In A. tetralobata xylem vessels arranged in pentarch fashion while rest of the species possess tetrarch arrangement. Several cellular inclusions such as calcium oxalate crystals and oil bodies were observed. The petioles were crescent shaped having bifacial surfaces with both surfaces pubescent. Peduncles possess ridges and furrows in its outline. The leaves are dorsi ventral and possess single layered epidermal cells covered with cuticle having anomocytic, anisocytic and diacytic types of stomata in both adaxial and abaxial surfaces. The present study provides a tool for the microscopic identification of the genus.

Quality of life and sociodemographic factors associated with poor quality of life in elderly women in Thiruvananthapuram, Kerala.

BACKGROUND: India is going through a phase of demographic transition leading to population aging and feminization of aging resulting in increased proportion of elderly women than men. Problems faced by the elderly women are more critical than men due to family and social conditions prevailing in India. OBJECTIVE: The study made an attempt to assess the quality of life (QOL) using the World Health Organization QOL (WHOQOL-BREF) scale and sociodemographic factors affecting QOL of elderly women residing in a community setting in South Kerala. METHODS: A community-based, cross-sectional study to assess the QOL of elderly women using WHOQOL-BREF questionnaire. Data were collected from 160 elderly women. RESULTS: 2.5% (95% confidence interval [CI]: 0.07-4.84) of the study participants were having "very good" QOL. 38.8% (95% CI: 31.2-46.4) had "good," 43.1% (95% CI: 35.4-50.8) had "poor," and 15.6% (95% CI: 9.98-21.22) had "very poor" QOL, respectively. QOL was least in the psychological domain followed by physical and health-related, social, and environmental domains. Logistic regression revealed age above 70 years (adjusted odds ratio [OR] - 11.3), nonpossession of property (adjusted OR - 8.99), neglecting attitude by family (adjusted OR - 6.9), and absence of visit by friends and relatives (adjusted OR - 9.9) as risk factors, whereas residing in the urban area as a protective factor (adjusted OR - 0.1) for poor QOL. CONCLUSION: It is possible to improve the QOL of elderly women by providing financial security, ensuring care, and by enhancing social relationships of elderly women.

Study of acute febrile illness: a 10-year descriptive study and a proposed algorithm from a tertiary care referral hospital in rural Kerala in Southern India.

Acute febrile illness (AFI), the initial diagnosis of whose cause is often presumptive, can sometimes be a challenge for the treating physician. To address this issue we carried out a hospital- based descriptive study. More than half (51.5%) of the patients were presumed to have viral fever. Most of the patients (60%) were in the productive phase of life (age range, 18-45 years). The outcome was worst among those aged over 65 years. A definite seasonal trend was observed with a peak in incidence with the arrival of the monsoon in Kerala. Public awareness regarding fevers in the pre-monsoon season should be heightened. Special care should be given to the elderly as they are often the most vulnerable. The use of the proposed locally based algorithm may avoid unnecessary investigations and treatment.

Elementary school enrolment and its determinants among children with cerebral palsy in Thiruvananthapuram district, Kerala, India.

CONTEXT: There is enough documented evidence to prove the benefits of early and appropriate initiation of education among children with cerebral palsy (CP). AIM: To find out the proportion of children with CP who are enrolled for some kind of formal education and to study the determinants of the same. SETTING AND DESIGN: This cross sectional study was done among children, attending the special clinics at government medical college, Thiruvananthapuram. MATERIALS AND METHODS: Children between 3 and 12 years of age diagnosed with CP were subjects for the study. STATISTICAL ANALYSIS USED: Enrollment for any form of formal education was the major outcome variable. The factors associated with initiation of formal education were tested using Chi-square test or Fischer's exact test. Independent association of each factor was evaluated through binary logistic Regression analysis. RESULTS AND CONCLUSIONS: The mean (SD) age of the children (n = 86) was 5.7 (2.3) years with forty-six (53.5%) of them being girls. Diplegia was the commonest limb abnormality found. Fifty-two (60.5%) children were undergoing some kind of schooling. Those children who were less dependent physically and those who had achieved better language development were regular school goers. After binary logistic regression the ability of a child to speak in sentences (P = 0.008) and ambulatory level of the child (P = 0.019) were factors which favored, whereas delay in attaining the adaptive developmental milestone of transferring objects from one hand to another (P = 0.014) was found to be detrimental for school enrollment.

Clinical Profile of Chikungunya Patients during the Epidemic of 2007 in Kerala, India.

BACKGROUND: The association of the present Chikungunya pandemic with a mutation in the Chik virus is already established in many parts of the world, including Kerala. Kerala was one of the worst-affected states of India in the Chikungunya epidemic of 2006-2007. It is important to discuss the clinical features of patients affected by Chikungunya fever in the context of this change in the epidemiology of the disease. AIM: This study tries to analyze the clinical picture of the Chikungunya patients in Kerala during the epidemic of 2007. SETTING AND DESIGN: A cross-sectional survey was carried out in five of the most affected districts in Kerala, India. MATERIALS AND METHODS: A two-stage cluster sampling technique was used to collect the information. Ten clusters each were selected from all the five districts, and the size of the clusters were 18 houses each. A structured interview schedule was used for data collection. Diagnosis based on clinical signs and symptoms was the major case-finding strategy. RESULTS AND CONCLUSION: Of the 3623 residents in the surveyed households, 1913 (52.8%) had Chikungunya clinically. Most of the affected were in the adult age group (73.4%). Swelling of the joints was seen in 69.9% of the patients, followed by headache (64.1%) and itching (50.3%). The knee joint was the most common joint affected (52%). The number of patients with persistence of any of the symptoms even after 1 month of illness was 1388 (72.6%). Taking bed rest till the relief of joint pain was found to be a protective factor for the persistence of the symptoms. Recurrence of symptoms with a period of disease-free interval was complained by 669 (35.0%) people. Older age (>40 years), a presentation of high-grade fever with shivering, involvement of the small joints of the hand, presence of rashes or joint swelling during the first week of fever and fever lasting for more than 1 week were the significant risk factors for recurrence of symptoms predicted by a binary logistic regression model. In conclusion, we found that there is substantial acute and chronic morbidity associated with the Chikungunya epidemic of 2007.

Determinants of childhood tuberculosis--a case control study among children registered under revised National Tuberculosis Control Programme in a district of South India.

AIM: To study the determinants of Tuberculosis (TB) in children between the age group of 0-14 years receiving treatment under Revised National TB Control Programme (RNTCP). METHODS: A case (registered under RNTCP) control study was undertaken with 41 cases and 82 controls. RESULTS: Factors found to have significance according to binary logistic regression were low-birth weight (LBW) [Odd's ratio = 3.56],Malnutrition [Odd's ratio = 3.96], Passive smoking [Odd's ratio=6.28] and exposure to fire-wood smoke [Odd's ratio = 6.91]. CONCLUSION: LBW, malnutrition, passive smoking and fire-wood smoke are the risk factors to be addressed to prevent pediatric TB.

Environmental factors of households in five districts of Kerala affected by the epidemic of chikungunya fever in 2007.

BACKGROUND: Two epidemics of chikungunya fever were reported from Kerala in 2006 and 2007. We aimed to investigate the environmental factors of households affected by chikungunya fever and to estimate the proportion of population that suffered from the disease during the epidemic in 2007. METHODS: A cross-sectional survey was conducted in the 5 heavily affected districts of Kerala during October-November 2007. The 2-stage sampling technique was used to collect data from 10 clusters, each having 18 houses from every district, by interviewing the subjects using a structured questionnaire. The sample size was 900. RESULTS: The proportion of the population affected by chikungunya fever was 57.1% (95% CI: 52.8%-61.4%). There was a significant association between location of houses and disease status. Houses located near a public conveyance facility (within 250 m) were relatively protected from the disease (OR 0.19 [0.06-0.60]). About 69% of the households perceived mosquito infestation as a problem and 46.6% used fumes to avoid mosquitoes. More than 42% of households were not using any anti-mosquito measures at the time of the survey. Stored drinking water was the most common potential breeding source in the houses (23.5%). Households which did not store water inside were protected from the disease (OR 0.22 [0.08-0.65]). CONCLUSION: The study indicated the persistence of favourable domestic and environmental factors after the epidemic, reflecting the necessity to strengthen anti-mosquito campaigns.