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Vaishnav S, Pandya D, Shrivastava R, Patel N, Phatak AG, Patel A. Early treatment will prevent feto-maternal complications in thyroid disorders during pregnancy: A prospective study. J Family Med Prim Care 2023; 12:3393-3398. [PMID: 38361867 PMCID: PMC10866218 DOI: 10.4103/jfmpc.jfmpc_1185_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 02/17/2024] Open
Abstract
Context Associations between adverse maternal complications and fetal outcomes are known entity in thyroid disorders during pregnancy. Thus, prompt identification of thyroid disorders and timely initiation of treatment is essential. Universal screening and early treatment of pregnant women for thyroid disorder should be considered especially in a resource-limited country like India with a high prevalence of undiagnosed thyroid disorders and adverse feto-maternal outcomes. Aims Early treatment will prevent feto-maternal complications in thyroid disorders in pregnant females visiting outpatient department in tertiary care hospital in rural settings. Settings and Design This study was conducted in a tertiary care rural-based medical college with participation from departments of Obstetrics and Gynaecology, Medicine, and ENT. Methods and Material Expectant mothers in first trimester who had urine pregnancy test positive in outpatient clinic were included after a written informed consent. Detailed history and examination was done. TSH was done if abnormal-FT3 and FT4 were done. All thyroid disorders were treated according to American Thyroid Association (ATA) 2017 guideline. All pregnancies were followed up for maternal complications and fetal outcomes. Statistical Analysis Used Data from the performa were entered in Office Excel and analysis was performed using STATA (14.2). Descriptive statistics (mean [standard deviation], Frequency [%], etc.) were used to depict profile of study participants, prevalence of thyroid dysfunction, and outcome measures. Chi-square test was employed to assess the association between thyroid dysfunction and various maternal and fetal outcomes. A P value less than. 05 was considered statistically significant. Results Of 350 pregnant females, 83 (23.5%) pregnant females had thyroid disorder. Of which, 33 (9.4%) had subclinical hypothyroidism, 37 (10.5%) had overt hypothyroidism, 11 (3.1%) had subclinical hyperthyroidism, and two (0.5%) had hyperthyroidism. The prevalence of hypothyroidism in pregnancy increases with increasing age (P value. 001) and not associated with parity, abortion, and consumption of iodized salt. Total patients with feto-maternal outcome follow-up were 241. Pre-eclampsia (P value. 004) was a significant complication in hypothyroid mothers. There was no significant difference in the rate of cesarean section and preterm delivery in hypothyroid and euthyroid mothers. Neonatal outcomes showed more trends of abortion, fetal demise, and IUFD in the hypothyroid group, although not statistically significant. (P value. 07). Conclusions Due to the high prevalence of thyroid disorders during pregnancy, universal screening of thyroid disorders should be done in early pregnancy instead of high-risk screening. Early detection and early treatment in the first 10 weeks of pregnancy help to prevent maternal and fetal complications of thyroid disorders in pregnancy. Pre-eclampsia is to be monitored in treated pregnant females with hypothyroidism.
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Affiliation(s)
- Smruti Vaishnav
- Obstetrics and Gynaecology Department, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Dharak Pandya
- Consultant Physician, Yogeshwar Hospital, Chhotaudepur, Gujarat, India
| | - Rama Shrivastava
- Obstetrics and Gynaecology Department, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Nimeshkumar Patel
- ENT Department, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Ajay G. Phatak
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Alpaben Patel
- Medicine Department, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India
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Nimbalkar SM, Thakkar FA, Thacker JP, Phatak AG, Shinde MK. Comparison of Sucrose vs. Swaddling in Pain Management during Birth Dose of Hepatitis B Vaccine: A Randomized Control Trial. Indian J Pediatr 2023:10.1007/s12098-023-04900-6. [PMID: 37991714 DOI: 10.1007/s12098-023-04900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/05/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To evaluate the efficacy of pain management of 1 ml of 24% sucrose given orally compared to routine care given one minute before vaccination for reduction of pain. METHODS This double-blind randomized controlled trial included term neonates visiting Pediatric OPD for immunization. Neonates were randomly assigned into two groups (Group A- Sucrose, Group B- Swaddling). Commercially available sucrose solution (StayHappi solution 24%) was given in a dose of 1 ml to the neonates. Video recording of the neonate's facial expression was done during the procedure. Duration of cry, latency of onset of cry as well Modified Neonatal Facial Coding Score (MFCS) were the outcome variables. RESULTS The mean (SD) of birth weight and gestational age was 2729 (321.6) g and 38.24 (0.84) d, respectively. Analysis showed significant difference in total MFCS across the groups (P <0.001). Total MFCS was significantly lower in sucrose group [4.88 (1.07) vs. 7.17 (0.95)]. The duration of cry (in seconds) was also found to be significantly lower in sucrose group. CONCLUSIONS Administration of 1 ml 24% sucrose one minute prior to immunization is efficacious in pain management during injectable immunization.
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Affiliation(s)
- Somashekhar M Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India.
| | - Fenil A Thakkar
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Jigar P Thacker
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Ajay G Phatak
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Mayur K Shinde
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
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Patel DV, Barot RB, Cecil R, Phatak AG, Shinde MK, Patel AJ, Nimbalkar SM. Temperature Monitoring in Children: An Agreement Study. Journal of Neonatology 2023; 37:134-141. [DOI: 10.1177/09732179231164527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Background: Noncontact infrared thermometer (NCIT) measures temperature rapidly and noninvasively. It is commonly used at forehead, but other potential sites such as axilla and abdomen are yet to be explored. We assessed agreement of temperature recordings of axillary temperature by glass mercury thermometer (the “gold standard”) with axillary temperature by the digital thermometer as well as with NCIT at forehead, axilla, mid abdomen, and at right hypochondriac areas. Methods: Neonates and children below 5 years admitted in neonatal and pediatrics wards were enrolled in the study through convenience sampling. For each participant, temperature was measured using NCIT at forehead, mid abdomen, right hypochondrium, and right axilla as well as using digital thermometer at right axilla and using glass mercury thermometer at right axilla. The agreement between methods was presented as mean difference (95% limits of agreement) using Bland-Altman analysis. Results: Total 400 temperature readings were taken for each method from 132 participants. There was a good agreement between mercury axillary with digital axillary in both the groups, that is, neonates and children (>1 month to 5 years) (Mean difference [95% limits of agreement] = –0.046 [–0.26 to 0.169]°C and –0.028 [–0.183 to 0.128]°C, respectively). While for all the methods using NCIT, there was a poor agreement with mercury axillary temperature in both the groups. Conclusion: Agreement between axillary temperatures using digital and glass mercury thermometers was good, while agreements between the axillary temperature using glass mercury thermometer with NCIT readings at different sites were poor in neonates and children below 5 years.
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Affiliation(s)
- Dipen V. Patel
- Department of Neonatology, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Rushi B. Barot
- Department of Pediatrics, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Rashmin Cecil
- Department of Pediatrics, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Ajay G. Phatak
- Central Research Services, Shree Krishna Hospital, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Mayur K. Shinde
- Central Research Services, Shree Krishna Hospital, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Arya J. Patel
- Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Somashekhar M. Nimbalkar
- Department of Neonatology, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
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Chaudhari AJ, Nimbalkar SM, Patel DV, Phatak AG. Effect of Kangaroo Mother Care on Cerebral Hemodynamics in Preterm Neonates Assessed by Transcranial Doppler Sonography in Middle Cerebral Artery. Indian Pediatr 2023; 60. [PMID: 36333897 PMCID: PMC9885412 DOI: 10.1007/s13312-023-2690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective To study the effect of KMC in premature newborns on cerebral hemodynamics in the middle cerebral artery (MCA) using transcranial doppler sonography. Methods In this descriptive study, 40 clinically stable preterm neonates admitted to the neonatal intensive care unit of our institute and undergoing Kangaroo mother care (KMC) were enrolled. Physiological and cerebral blood flow parameters of MCA were obtained by using transcranial doppler sonography at baseline, at 60 minutes of KMC, and after 60 minutes of stopping KMC. Results Of the 40 enrolled neonates (24 males), the mean (SD) birth weight, gestation age, and postnatal age were 1698.25 (495.44) g, 33.00 (1.67) wk, and 6.80 (4.51) days, respectively. The mean (SD) cerebral blood flow velocities increased (peak systolic velocity (PSV), P=0.03; end diastolic velocity, P<0.001; mean velocity, P<0.001) and doppler indices decreased (resistive index, P=0.001; pulsatility index, P<0.001) significantly; whereas, heart rate (P<0.001) decreased but SpO2 (P=0.001) and mean blood pressure (P=0.003) increased significantly at 60 minutes of KMC as compared to baseline. Sixty minutes after stopping KMC, all parameters (except PSV) were higher than baseline, indicating post KMC effect. Conclusion KMC improves cerebral hemodynamics in clinically stable preterm neonates.
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Affiliation(s)
- Anal J. Chaudhari
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat India
| | - Somashekhar M. Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat India
- Central Research Services, Charutar Arogya Mandal, Bhaikaka University, Karamsad, Gujarat India
| | - Dipen V. Patel
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat India
| | - Ajay G. Phatak
- Central Research Services, Charutar Arogya Mandal, Bhaikaka University, Karamsad, Gujarat India
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Patel DV, Soni SN, Shukla VV, Phatak AG, Shinde MK, Nimbalkar AS, Nimbalkar SM. Efficacy of Skin-to-Skin Care versus Swaddling for Pain Control Associated with Vitamin K Administration in Full-Term Neonates: A Randomized Controlled Trial. J Trop Pediatr 2022; 68:6614519. [PMID: 35737952 DOI: 10.1093/tropej/fmac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of the study was to assess the efficacy of immediate skin-to-skin care (SSC) versus swaddling in pain response to intramuscular injection of vitamin K at 30 min of birth in neonates. METHODS Healthy full-term newborns were enrolled immediately after normal vaginal delivery and randomized in two groups, SSC and swaddling. Neonatal Infant Pain Scale (NIPS) was measured before, immediately after and at 2 min after the injection. RESULTS Total 100 newborns were enrolled in the study (50 in each group). The mean (SD) birth weight of newborns in the SSC and swaddling group was 2668 (256) and 2730 (348) g, respectively. NIPS was comparable between the SSC and swaddling at before [1.78 (0.58) vs. 1.96 (0.83), p = 0.21], and immediately after the injection [4.82 (0.72) vs. 5.08 (0.75), p = 0.08]. NIPS at 2 min after the injection was significantly low in the SSC group compared to the swaddling group [1.38 (0.70) vs. 2.88 (1.00), p < 0.001]. At 2 min after injection, the NIPS score was significantly lower than baseline in the SSC group (p = 0.002), while it was significantly higher in the swaddling group (p < 0.001). A significantly higher proportion of newborns had a NIPS score of more than three at 2 min after injection in the swaddling group as compared to the SSC group (22% vs. 2%, p < 0.001). CONCLUSION Immediate SSC was more efficacious as compared to swaddling as a pain control intervention while giving vitamin K injection. CLINICAL TRIAL REGISTRATION The trial is registered with the Clinical Trial Registry of India with Registration number: CTRI/2020/01/022984.
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Affiliation(s)
- Dipen V Patel
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, India
| | - Sarthak N Soni
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, India
| | - Vivek V Shukla
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, India.,Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ajay G Phatak
- Central Research Services, Pramukhswami Medical College, Charutar Arogya Mandal, Bhaikaka University, Karamsad, India
| | - Mayur K Shinde
- Central Research Services, Pramukhswami Medical College, Charutar Arogya Mandal, Bhaikaka University, Karamsad, India
| | - Archana S Nimbalkar
- Department of Physiology, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Somashekhar M Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, India
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Ansari M, Patel NM, Mahida AN, Phatak AG, Prabhakaran A, Varma JR. Correlates of internet gaming among violent and nonviolent gamers and comparison of their psychological well-being with nongamers in a university student population. Indian J Psychiatry 2022; 64:98-101. [PMID: 35400738 PMCID: PMC8992759 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1208_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND India's population has seen increasing access to the Internet and gaming mainly in adolescents and young adults. AIM The aim of the study was to assess the prevalence and correlates of Internet gaming and its effects on the psychological well-being of gamers versus nongamers. MATERIALS AND METHODS Cross-sectional survey was done to enroll a convenient sample of nongamers, violent gamers, and nonviolent gamers. Measures included Psychological general well-being scale-short (PGWB-S), Internet Gaming Disorder-Short Form-9 (IGDS9-SF), name, frequency, and duration of game use. RESULTS The study enrolled 119 nongamers, 62 violent gamers, and 58 non-violent gamers. The prevalence of IGD was 0.8%. PGWB-S scores of gamers were comparable to nongamers. On multiple linear regression, lower PGWB-S score and higher frequency of use were found significantly associated with higher IGDSF-S9 scores. Violent gaming was found significantly associated with male gender (P ≤ 0.001), frequency (P = 0.012), and duration of game use (P ≤ 0.001). CONCLUSIONS The study provides empirical evidence for the "gaming as a consequence of self-medication" hypothesis.
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Affiliation(s)
- Maliha Ansari
- Department of Psychiatry, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Nisheet M Patel
- Department of Psychiatry, Smt. B K Shah Medical Institute and Research Center, Sumandeep Vidhyapeeth Piparia, Vadodara, Gujarat, India
| | - Ankur N Mahida
- Department of Psychiatry, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Ajay G Phatak
- Department of Central Research Services, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Anusha Prabhakaran
- Department of Psychiatry, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Jagdish R Varma
- Department of Psychiatry, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
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Gohel MK, Phatak AG, Kharod UN, Pandya BA, Prajapati BL, Shah UM. Effect of Long-term Regular Yoga on Physical Health of Yoga Practitioners. Indian J Community Med 2021; 46:508-510. [PMID: 34759498 PMCID: PMC8575208 DOI: 10.4103/ijcm.ijcm_554_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/27/2021] [Indexed: 11/04/2022] Open
Abstract
Background Yoga is a physical, mental, and spiritual discipline. The effect of yoga on mental health has been studied extensively in India but less in the context of physical health. Objective The objective was to explore the effect of long-term regular yoga on physical health of yoga practitioners. Materials and Methods It was an interventional study. Inclusion criteria were students who enrolled for 1-year diploma course at the yoga center. Exclusion criteria were nonregular yoga practitioners during the course. Physical health parameters considered for assessment before and after the yoga course were pulmonary function tests, maximum oxygen consumption (VO2 max) using Bruce treadmill test, flexibility, body composition analysis, and hemoglobin level. Paired sample t-test and Chi-square test were used for statistical analysis. Results The aerobic capacity improved significantly in terms of mean (standard deviation [SD]) forced vital capacity (P < 0.001), forced expiration volume at the end of the first second (P < 0.001) as well as peak expiratory flow rate (P = 0.04). The mean (SD) flexibility score improved significantly (P < 0.001). Similarly, the endurance improved significantly in terms of mean (SD) Vo2 max (< 0.001) and treadmill time (P < 0.001). There was no significant change in body composition and hemoglobin level. Conclusions Regular yoga practitioners demonstrated the improvement in pulmonary functions, cardiorespiratory fitness, endurance, and flexibility.
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Affiliation(s)
- Manisha Kalpesh Gohel
- Department of Community Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Ajay G Phatak
- Department of Central Research Services, Bhaikaka University, Karamsad, Gujarat, India
| | - Utpala N Kharod
- Department of Aneshthesia, Bhaikaka University, Karamsad, Gujarat, India
| | | | | | - Utkarsh M Shah
- Department of Community Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
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Patel DV, Upadhyay V, Phatak AG, Thakker B, Nimbalkar SM. Comparison of Fenton Versus Intergrowth-21 Growth Charts for Preterm Neonates. Journal of Neonatology 2021; 35:131-137. [DOI: 10.1177/09732179211041960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Background:Fenton charts from developed world are commonly used for growth assessment of preterm newborns. Recently prescribed Intergrowth-21 (IG-21) charts look more promising as they include mixed population from economically diverse nations.Objective:We compared IG-21 with Fenton charts for birth size classification and extrauterine growth in preterm infants.Study design:A prospective collection of growth parameters.Participants:Preterm newborns (<37 weeks).Intervention:Weight (W), length (L), and head circumference (HC) were collected at weekly interval during the stay as well as follow-up.Outcomes:Growth of preterm newborns at birth and last follow-up was assessed using Fenton and IG-21 charts. Agreement between Fenton and IG-21 for percentiles and z-scores of growth parameters was assessed using Bland-Altman plot.Results:A total of 301 preterm newborns were enrolled in the study. Mean (standard deviation [SD]) gestational age at birth was 34.08 (1.84) weeks, while at last follow-up (N = 296) it was 37.62 (1.85) weeks. The mean (SD) of birth W, L, and HC were 1889.24 (418.9) g, 44.69 (3.03) cm, and 30.6 (1.84) cm, respectively, while for last follow-up, they were 2114.76 (397.7) g, 47.64 (2.97) cm, and 32.65 (1.7) cm, respectively. The agreement of z-score/percentile between the 2 growth charts was not good for all the anthropometric parameters. Overall, Fenton reported more intrauterine (42.9% vs 36.9%) and extrauterine (92.9% vs 73%) growth restriction as compared to IG-21.Conclusion:The agreement between the 2 charts was poor. More proportions of the preterm population were growth restricted using Fenton charts.
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Affiliation(s)
- Dipen Vasudev Patel
- Department of Neonatology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Vaishali Upadhyay
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Ajay G. Phatak
- Central Research Services, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Biraj Thakker
- Department of Neonatology, Akanksha Hospital and Research Institute, Anand, Gujarat, India
| | - Somashekhar M. Nimbalkar
- Department of Neonatology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
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Parikh PA, Shah BV, Trivedi B, Patel VB, Desai S, Nimbalkar SM, Phatak AG. A Comparison of the Pulmonary Valve, Main Pulmonary Artery, and Branch Pulmonary Artery Measurements by Echocardiography and Computed Tomography Scan. Cureus 2021; 13:e16075. [PMID: 34345556 PMCID: PMC8324428 DOI: 10.7759/cureus.16075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Congenital heart diseases (CHD) are one of the most commonly occurring congenital anomalies. Echocardiography is usually the initial investigation for suspected CHD. However, it is operator-dependent and limited by available chest windows. Multidetector computed tomography (MDCT) scan provides superior temporal and spatial resolution producing excellent cross-sectional anatomical images. MDCT is specifically helpful for pulmonary artery anomalies if not clearly visible on an echocardiogram. Objective and methods: The study aims to compare measurements of branch pulmonary arteries, pulmonary valve, and main pulmonary artery obtained from trans-thoracic echocardiography measurements and MDCT. Forty-nine patients younger than 17 years of age underwent MDCT, and an echocardiogram was included in the study. The measurements of the pulmonary valve, main pulmonary artery, and branch pulmonary arteries were measured on MDCT and echocardiogram. Results: Bland-Altman analysis revealed the mean difference (95% confidence limits) in measurements of diameter between echocardiogram and MDCT for the right pulmonary artery, left pulmonary artery, pulmonary valve, and main pulmonary artery, which were -0.5 (-3.1, 2.2) mm, -0.6 (-3.3, 2.1) mm, 0.7 (-2.5, 3.9) mm, and 1.2 (-6.9, 4.5) mm, respectively. Conclusion: The analysis revealed acceptable agreement in measurements of the pulmonary valve, main pulmonary artery, and branch pulmonary arteries obtained from MDCT and echocardiogram. The difference was marginally more for the main pulmonary artery compared to the pulmonary valve and branch pulmonary arteries.
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Affiliation(s)
- Priyanka A Parikh
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, IND
| | - Binoy V Shah
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, IND
| | - Bhadra Trivedi
- Pediatric Cardiology, Shree Krishna Hospital, Karamsad, IND
| | - Viral B Patel
- Radiodiagnosis, Pramukhswami Medical College, Karamsad, IND.,Radiodiagnosis, Shree Krishna Hospital, Karamsad, IND.,Radiodiagnosis, Bhaikaka University, Karamsad, IND
| | - Shreya Desai
- Radiodiagnosis, Pramukhswami Medical College, Karamsad, IND.,Radiodiagnosis, Shree Krishna Hospital, Karamsad, IND.,Radiodiagnosis, Bhaikaka University, Karamsad, IND
| | - Somashekhar M Nimbalkar
- Central Research Services, Bhaikaka University, Karamsad, IND.,Department of Pediatrics, Pramukhswami Medical College, Karamsad, IND
| | - Ajay G Phatak
- Central Research Services, Bhaikaka University, Karamsad, IND
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10
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Kumar A, Sinha A, Varma JR, Prabhakaran AM, Phatak AG, Nimbalkar SM. Burnout and its correlates among nursing staff of intensive care units at a tertiary care center. J Family Med Prim Care 2021; 10:443-448. [PMID: 34017768 PMCID: PMC8132798 DOI: 10.4103/jfmpc.jfmpc_1651_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Burnout syndrome has been widely reported in nursing staff. It is more pronounced in intensive care setting (up to 80%). This survey was designed to assess the prevalence of burnout and its correlates among critical care nurses. Methods: Anonymous questionnaire was distributed to all ICU nursing staff of a tertiary care teaching hospital. Questionnaire had 25 questions covering – demography, job characteristics, Visual Analogue Scale for stress, co-worker support, work–life balance, question for measuring burnout, job satisfaction, turnover intention, organizational commitment, for depression screening and psychosomatic symptoms. The burnout scale score was used to dichotomize into low burnout (<3) or high burnout (> = 3) group. These two groups were compared using Chi-square test, Fischer's exact test for categorical variables and independent t-test for continuous variables. Significant variables were entered in multivariate logistic regression analysis. Results: Out of 150 ICU nurses, 125 (83.3%) gave completely filled questionnaires which were evaluated. 47 (37.6%) participants reported experiencing high burnout. Binary logistic regression model revealed that lack of specialized ICU training (OR = 4.28, 95% CI: 1.62 to 11.34, P = 0.003), performing extra duty in last month (OR = 5.28, 95% CI: 1.90 to 14.67, P = 0.001), High physical symptoms in last 12 months (OR = 4.73, 95% CI: 1.56 to 14.36, P = 0.006) and mid-level experience (1–5 years) were significantly associated with burnout. Conclusions: Burnout is significantly prevalent (37.6%) among intensive care nurses. Specialized training and limiting work hours can help in mitigating this problem. High frequency of physical symptoms could be early indicators of burnout.
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Affiliation(s)
- Amit Kumar
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Archana Sinha
- Department of Critical Care, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Jagdish R Varma
- Department of Psychiatry, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Anusha M Prabhakaran
- Department of Psychiatry, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Ajay G Phatak
- Department of Central Research Services, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Somshekhar M Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
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Patel IS, Dongara AR, Mungala BM, Chapla A, Phatak AG, Nimbalkar SM. Knowledge and attitude about cervical cancer and human papillomavirus vaccine among medical and paramedical students of a university. J Family Med Prim Care 2021; 10:462-467. [PMID: 34017771 PMCID: PMC8132775 DOI: 10.4103/jfmpc.jfmpc_625_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/10/2020] [Accepted: 10/24/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Every year, globally 570,000 women are diagnosed with cervical cancer, out of which around 311,000 die. India contributes to about 132,000 new cases and 74,000 deaths yearly. One of the major risk factors for cervical cancer is infection with some types of human papillomavirus (HPV). This is both preventable (by vaccination) and detectable early (routine screening programs). OBJECTIVE The objective of this study is to assess the knowledge and attitude in medical and paramedical students about cervical cancer and HPV vaccination. MATERIAL AND METHODS A cross-sectional survey was conducted, using predesigned and validated questionnaire. It was segregated into three parts: Q1-demographic details, Q2a-questions assessing knowledge, Q2b-questions assessing attitude. Our target population was female students (18-25 years) studying in medical, nursing, and physiotherapy colleges. Descriptive statistics of data was analyzed using SPSS 16.0. RESULTS We had 73% response rate. Most participants belonged to upper middle and upper socioeconomic class, were pursuing MBBS, resided in villages, had educated parents, and had good health-care-seeking behavior. School education, television, and printed advertisements appeared to be underutilized. Around 50% of the participant had received chickenpox and typhoid vaccine, but only 8% had received HPV vaccine. The mean knowledge score was 5.19 ± 2.24, with 0.00 minimum and 11.0 maximum, out of a maximum possible score of 17. Only, place of residence appeared to effect the knowledge score. CONCLUSION The study shows the dismal knowledge levels about HPV amongst students. Participants were interested in seeking knowledge; consider HPV vaccination provided they were provided with sufficient knowledge.
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Affiliation(s)
- Ishani S. Patel
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | | | - Bhavdeep M. Mungala
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Apurva Chapla
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Ajay G. Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India
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12
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Ganguly A, Bhadesia PJ, Phatak AG, Nimbalkar AS, Nimbalkar SM. Pain profile of premature infants during routine procedures in neonatal intensive care: An observational study. J Family Med Prim Care 2020; 9:1517-1521. [PMID: 32509642 PMCID: PMC7266194 DOI: 10.4103/jfmpc.jfmpc_1033_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Premature neonates receive a large number of painful procedures during their stay in the neonatal intensive care unit (NICU). However, there are many other processes that happen in the NICU, which may not be considered painful but can cause discomfort and/or stress to the neonate. Method: Pain profile during routine procedures in NICU was assessed using the premature infant pain profile (PIPP) score. Neonates of gestational age >26 weeks, less than 7 days old and admitted for less than 7 days in the NICU were included. Results: A total of 662 procedures were observed in 132 (78 M, 54 F) neonates. The mean (SD) age of the neonates was 2.4 (1.8) days and the mean (SD) birth weight was 2.3 (0.6) kg. 63 (54.5%) were of low birth weight (LBW), 85 (64.39%) were full term. High PIPP score was noted in blood sampling, heel prick, suction, and weight measurement. Significant differences were observed in the PIPP score during blood sampling and suction across gender. Some ordinary and non-stressful procedures also scored very high on the PIPP scale. Conclusions: The validity of PIPP needs to be reexamined. Our understanding of pain during routine procedures may need to be revisited.
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Affiliation(s)
- Arindrajit Ganguly
- Department of Paediatrics, Pramukhswami Medical College, Karamsad-Anand, Gujarat, India
| | - Pranav J Bhadesia
- Department of Paediatrics, Pramukhswami Medical College, Karamsad-Anand, Gujarat, India
| | - Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad-Anand, Gujarat, India
| | - Archana S Nimbalkar
- Department of Physiology, Pramukhswami Medical College, Karamsad-Anand, Gujarat, India
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13
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Parikh PA, Shah BV, Phatak AG, Vadnerkar AC, Uttekar S, Thacker N, Nimbalkar SM. COVID-19 Pandemic: Knowledge and Perceptions of the Public and Healthcare Professionals. Cureus 2020; 12:e8144. [PMID: 32550063 PMCID: PMC7294885 DOI: 10.7759/cureus.8144] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and objective The recent pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major concern for the people and governments across the world due to its impact on individuals as well as on public health. The infectiousness and the quick spread across the world make it an important event in everyone’s life, often evoking fear. Our study aims at assessing the overall knowledge and perceptions, and identifying the trusted sources of information for both the general public and healthcare personnel. Materials and methods This is a questionnaire-based survey taken by a total of 1,246 respondents, out of which 744 belonged to the healthcare personnel and 502 were laypersons/general public. There were two different questionnaires for both groups. The questions were framed using information from the World Health Organization (WHO), UpToDate, Indian Council of Medical Research (ICMR), Center for Disease Control (CDC), National Institute of Health (NIH), and New England Journal of Medicine (NEJM) website resources. The questions assessed awareness, attitude, and possible practices towards ensuring safety for themselves as well as breaking the chain of transmission. A convenient sampling method was used for data collection. Descriptive statistics [mean(SD), frequency(%)] were used to portray the characteristics of the participants as well as their awareness, sources of information, attitudes, and practices related to SARS-CoV-2. Results The majority (94.3%) of the respondents were Indians. About 80% of the healthcare professionals and 82% of the general public were worried about being infected. Various websites such as ICMR, WHO, CDC, etc., were a major source of information for the healthcare professional while the general public relied on television. Almost 98% of healthcare professionals and 97% of the general public, respectively, identified ‘Difficulty in breathing” as the main symptom. More than 90% of the respondents in both groups knew and practiced different precautionary measures. A minority of the respondents (28.9% of healthcare professionals and 26.5% of the general public) knew that there was no known cure yet. Almost all respondents from both the groups agreed on seeking medical help if breathing difficulty is involved and self-quarantine if required. Conclusion Most healthcare professionals and the general public that we surveyed were well informed about SARS-CoV-2 and have been taking adequate measures in preventing the spread of the same. There is a high trust of the public in the government. There are common trusted sources of information and these need to be optimally utilized to spread accurate information.
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Affiliation(s)
- Priyanka A Parikh
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, IND
| | - Binoy V Shah
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, IND
| | - Ajay G Phatak
- Central Research Services, Bhaikaka University, Karamsad, IND
| | | | - Shraddha Uttekar
- Department of Public Health, International Pediatric Association, Gandhidham, IND
| | - Naveen Thacker
- Department of Pediatrics, Deep Children Hospital, Gandhidham, IND
| | - Somashekhar M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, IND.,Central Research Services, Bhaikaka University, Karamsad, IND
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Gupta AV, Phatak AG, Patel MU, Das N, Vaghela NP, Prakash H, Raithatha SJ. Effectiveness of a community health worker (CHW) training in monitoring and care of patients with chronic obstructive pulmonary disease (COPD) in rural Gujarat, India. J Family Med Prim Care 2020; 9:1910-1914. [PMID: 32670939 PMCID: PMC7346932 DOI: 10.4103/jfmpc.jfmpc_1193_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 12/26/2019] [Accepted: 01/02/2020] [Indexed: 11/11/2022] Open
Abstract
Context: Chronic obstructive pulmonary disease (COPD) is the second leading contributor to the disease burden of India. The current COPD burden cannot be managed effectively just through a physician-based approach. In a primary care setting, community health workers (CHWs) can play an effective role in making COPD care accessible and effective. Aim: Findings of an assessment of a training program for CHWs on COPD have been reported here. Methods: 90 CHWs working as a part of a noncommunicable disease prevention and care program in a rural primary care setting were exposed to a series of five training sessions. The sessions were designed and administered jointly by a team of public health experts and physiotherapists in the year 2017–18. Topics covered were basic clinical aspects of COPD, monitoring a patient with COPD, and basic aspects of pulmonary rehabilitation. The assessment comprised 12 MCQs and short questions, 7 video exercises, 2 case vignettes, and 5 skill assessments through objectively structured clinical examination (OSCE). Statistical Analysis: Mean percentage scores were calculated for each domain of assessment to make it comparable. Results: 70 CHWs with a mean age of 42.2 years completed all the training and underwent the assessment. Mean percentage score (SD) for knowledge was 62% (16.3). In OSCE assessment, scores were best in sputum clearance technique demonstration (92.1%) and the least in dyspnea relieving positions (59.2%). The CHWs had difficulties in identifying signs of respiratory distress (score - 55.1%). No statistically significant association was observed between performance scores and their sociodemographic profile. Conclusion: The results were encouraging and the program may be pilot tested in a government setting particularly using the health and wellness centers (HWC) platform.
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Affiliation(s)
- Ashish V Gupta
- K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India
| | - Ajay G Phatak
- Central Research Services, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Meha U Patel
- K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India
| | - Neha Das
- Community Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Nirav P Vaghela
- K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India
| | - Harihara Prakash
- K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India
| | - Shyamsudar J Raithatha
- Community Medicine and Extension Programmes Department, H M Patel Centre for Medical Care and Education, Karamsad, Anand, Gujarat, India
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15
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Abstract
BACKGROUND Hospitalization of a new-born child is stressful for parents. This study was done to determine the level and sources of stress in mothers of infants admitted in Neonatal Intensive Care Unit (NICU) and variance in stress by infant and maternal characteristics. MATERIALS AND METHODS Parental Stressor Scale for NICU was used as the primary outcome measure. Maternal socio-demography, maternal and infant characteristics such as gravidity, number of prenatal visits, perceived support from family members, perceived level of discomfort that the baby underwent, pregnancy and delivery complications, gestational age, sex, birth weight, length of NICU stay and ventilator support, and neonatal morbidity were also collected from maternal and infant hospital records. RESULTS Amongst these rural and poorly educated mothers, the appearance of the baby, sights and sounds of NICU environment were major sources of stress. Higher maternal stress was found to be associated with poor family support during pregnancy, mothers' perception of the baby's discomfort, lower birth weight of the baby, baby on ventilator, post-partum depression, and moderate to severe anxiety symptoms. Mothers who had higher levels of education and those with pregnancy complications were more stressed. CONCLUSIONS Before designing remediation programs for parents, local demography and the predominant NICU stressors need to be kept in mind. Possibility of screening at-risk mothers by questioning them about perception of baby's discomfort needs to be evaluated further.
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Affiliation(s)
- Jagdish R Varma
- Department of Psychiatry, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Somashekhar M Nimbalkar
- Department of Paediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India.,Central Research Services, HM Patel Center for Medical Care and Education, Karamsad, Gujarat, India
| | - Dipen Patel
- Department of Paediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Ajay G Phatak
- Central Research Services, HM Patel Center for Medical Care and Education, Karamsad, Gujarat, India
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16
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Morgaonkar VA, Patel DS, Patel DV, Phatak AG, Nimbalkar SM. A time-motion analysis of the mothers staying in the neonatal care unit. J Family Med Prim Care 2019; 8:1129-1133. [PMID: 31041262 PMCID: PMC6482785 DOI: 10.4103/jfmpc.jfmpc_348_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Context: In addition to various barriers studied for kangaroo mother care (KMC), time opportunities for better implementation of KMC need to be studied. Aim: Time–motion analysis of the mother's daily activities was carried out to identify scope to improve KMC. Settings and Design: This is a 24-h recall-based questionnaire study. Mothers were interviewed whose newborns were admitted at a tertiary and secondary care neonatal care unit of western India over a period of 9 months from November 2015 to July 2016. Materials and Methods: Mothers were approached when the preterm neonate and mother dyad was eligible for KMC, that is, when mothers were physically healthy and newborns were physiologically stable. A total of 60 mothers were enrolled in the study. Mothers’ daily activities were noted, and time spent in each activity was charted for 3 consecutive days. Missed time opportunities which could be used to increase daily KMC hours were studied. Statistical Analysis Used: To compare quantitative variables, two-sample unpaired t-test and one-way analysis of variance were used. Results: The average time of activities which consumed most was 8.24 h for sleep/rest, 3.46 h for meals/snacks, 4.89 h for breastfeeding, and a daily average of only 1.4 h was used for KMC. A quite a significant proportion, that is, 3.89 h, was spent for meeting relatives which could be used for KMC as well without affecting social meetings. Conclusion: Time–motion analysis was helpful to find out weak links in KMC implementation. Providing family-centered environment in terms of implementing KMC during meeting hours with family may augment KMC hours.
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Affiliation(s)
- Vallaree A Morgaonkar
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Anand, Gujarat, India
| | - Dharti S Patel
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Anand, Gujarat, India
| | - Dipen V Patel
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Anand, Gujarat, India
| | - Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal, Anand, Gujarat, India
| | - Somashekhar M Nimbalkar
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Anand, Gujarat, India.,Central Research Services, Charutar Arogya Mandal, Anand, Gujarat, India
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17
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Nimbalkar SM, Khanna AK, Patel DV, Nimbalkar AS, Phatak AG. Efficacy of Polyethylene Skin Wrapping in Preventing Hypothermia in Preterm Neonates (<34 Weeks): A Parallel Group Non-blinded Randomized Control Trial. J Trop Pediatr 2019; 65:122-129. [PMID: 29800322 DOI: 10.1093/tropej/fmy025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this study was to determine the efficacy of polyethylene skin wrapping on thermoregulation in preterm neonates. METHODS Total 151 neonates were enrolled in this randomized control trial. In the control group, neonates were transferred to the radiant warmer and covered with warm cloth after initial care. In the study group, neonates were transferred to the radiant warmer and placed in a food-grade polyethylene bag for 1 h. Axillary temperature of all neonates was recorded for first 24 h at frequent time intervals. RESULTS Mean temperature reached to normal range earlier and remained significantly higher in the study group for most time intervals, and this difference persisted even at 24 h. Significantly less number of preterm newborns suffered from hypothermia in the study group as compared with the control group [50 (67.6%) vs. 67 (87%), p = 0.004]. CONCLUSIONS Polyethylene wraps achieved rapid, sustained thermal control and were effective in preventing hypothermia in preterm newborns.
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Affiliation(s)
- Somashekhar M Nimbalkar
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Gujarat, India.,Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India
| | - Ankush K Khanna
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Dipen V Patel
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Archana S Nimbalkar
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Gujarat, India.,Department of Physiology, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India
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Mistry AA, Amin AA, Nimbalkar SM, Bhadesia P, Patel DR, Phatak AG. Knowledge of umbilical cord blood banking among obstetricians and mothers in Anand and Kheda District, India. J Family Med Prim Care 2019; 7:1032-1036. [PMID: 30598952 PMCID: PMC6259528 DOI: 10.4103/jfmpc.jfmpc_147_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: To assess the knowledge of obstetricians and expectant mothers towards UCB banking and their awareness regarding pros and cons of the process. Methods: Questionnaires from a previously published study were modified contextually and translated into vernacular language (Gujarati). The questionnaires were distributed among 200 obstetricians, of which 100 responded and 100 mothers were in Anand and Kheda districts of India. Informed consent was taken for both. Results: Mean (SD) age of obstetricians was 47.5 years (11.14) with mean (SD) work experience of 19.72 years (9.94). Almost all were aware of collection procedure for UCB and felt that UCB banking is useful. Thirty obstetricians thought that stored blood can be used in conditions of Autism, Duchenne Muscular Dystrophy and all genetic conditions. Sixty-three were aware of the procedure technique. Majority felt that the process was feasible and would do it for their own child. All the 100 mothers approached consented for the study with average age (SD) of 26.88 (4.17). Many were not aware of such a procedure and were not certain about the usefulness of the procedure. Seventy-six did not know the conditions in which the stored blood can be used. Only 4 mothers/family members had opted for UCB banking, whereas 27 expressed their willingness to recommend UCB to another mother. Five Muslim women wanted UCB but could not pursue it due to religious norms. Conclusion: The level of understanding among obstetricians was not commensurate with the amount of faith with which they promoted UCB banking.
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Affiliation(s)
- Ayushi A Mistry
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Amee A Amin
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Somashekhar M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India.,Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India
| | - Pranav Bhadesia
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Darshak R Patel
- Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India
| | - Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India
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19
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Mori KS, Patel AN, Amin AA, Phatak AG. Effectiveness of Indian Diabetes Risk Score as a Screening Tool for Non-alcoholic Fatty Liver Disease: A Study from Anand, Gujarat, India. J Clin Diagn Res 2019. [DOI: 10.7860/jcdr/2019/41650.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Aim of Study: We assessed the prevalence and severity of premenstrual syndrome (PMS) in adolescents and identified probable associations of PMS and premenstrual dysphoric disorder (PMDD) with age, locality, food habits, obesity, stress, genetic influence, menorrhagia and dysmenorrhoea. Methods: Cross-sectional study in schools of Anand District in State of Gujarat, India. We conducted the study in 1702 girls in the age group of 8–23 years who had achieved menarche. Main Outcome Measures: Prevalence of PMS and PMDD using the self-administered Premenstrual Symptoms Screening Tool for Adolescents (PSST-A). Results: The prevalence of moderate to severe PMS was 19.3% and PMDD was 4.6%. Almost all (94.8%) girls had at least one PMS symptom with 65.7% having moderate to severe symptoms. We found dysmenorrhoea in 71.2% girls and menorrhagia in 15.2%. Physical symptoms were reported by 53.5%, disruption of daily activities by 41.7%, while 25.1% had to miss school/college. Majority (81.3%) felt that PMS was a normal part of menstruation and 53.0% reported moderate to severe stress. Multivariate logistic regression model revealed older age, dysmenorrhoea, menorrhagia, high levels of stress and PMS in mother to be significantly associated with PMS. In addition to these, lower age at menarche and junk food significantly contributed to PMDD. Conclusion: Prevalence of moderate to severe PMS and PMDD in this population falls within the range reported elsewhere. PMS/PMDD affects the lives of many, significantly reducing their efficiency and worsening the quality of life.
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Affiliation(s)
- Shruti V Kamat
- Department of Paediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Archana Nimbalkar
- Department of Physiology, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Ajay G Phatak
- Department of Physiology, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Somashekhar M Nimbalkar
- Department of Paediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India.,Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India
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Shah RR, Fahey NM, Soni AV, Phatak AG, Nimbalkar SM. Screen time usage among preschoolers aged 2-6 in rural Western India: A cross-sectional study. J Family Med Prim Care 2019; 8:1999-2002. [PMID: 31334169 PMCID: PMC6618175 DOI: 10.4103/jfmpc.jfmpc_206_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims: We have evaluated screen time usage among preschool-aged (≤6 years) children in rural Western India. In addition, we have evaluated various lifestyle factors and their impact on the screen time of these children. Materials and Methods: English-medium schools in the locality were chosen based on convenience. A self-report survey requesting family information and screen usage information was distributed to the parents. Daily screen time was categorized as a three-category variable. Ordered logistic regression with multivariable regression was performed to examine the association of risk factors with screen time. Results: Average screen time among the 379 (208 males, 171 female) children amounted to 2.7 hours (SD: 1.7), with average daily television screen time of 1.6 hours (SD: 1.1). Most children (87.2%) started screen use by the age of 3. Only 65 (17.2%) participants met AAP recommendation. Households with three devices and smartphone usage by mothers increased the odds of screen time by 60% and two-folds, respectively. Compared to weekdays, children had increased screen time exposure (3.5 vs 2.7 hours, P < 0.001), outdoor activity time (2.3 vs 1.6, P < 0.001), and reading hours (1.2 vs 1.1, P = 0.03) on weekends. No association was observed between screen time and mother's occupation. Conclusions: More than 80% of children exceeded the advised screen time with television and smartphone being the major contributors. This issue has to be dealt with at both individual and societal levels. Increased awareness about the high prevalence of inappropriate use of screen time use within the Indian context is needed to inspire attention and interventions for this emerging public health problem in India.
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Affiliation(s)
- Rutvi R Shah
- Department of Paediatrics, Pramukhswami Medical College, Karamsad Anand, Gujarat, India
| | - Nisha M Fahey
- Department of Paediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Apurv V Soni
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester Massachusetts, USA
| | - Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad Anand, Gujarat, India
| | - Somashekhar M Nimbalkar
- Department of Paediatrics, Pramukhswami Medical College, Karamsad Anand, Gujarat, India.,Central Research Services, Charutar Arogya Mandal, Karamsad Anand, Gujarat, India
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Phatak AG, Nimbalkar SM. Association vs Agreement: The Mystery Continues…. Indian Pediatr 2018; 55:439-440. [PMID: 29845968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India.
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Bhadarka HK, Patel NH, Patel NH, Patel M, Patel KB, Sodagar NR, Phatak AG, Patel JS. Impact of embryo co-culture with cumulus cells on pregnancy & implantation rate in patients undergoing in vitro fertilization using donor oocyte. Indian J Med Res 2018; 146:341-345. [PMID: 29355140 PMCID: PMC5793468 DOI: 10.4103/ijmr.ijmr_1702_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background & objectives: Cumulus cell co-culture of embryo had been found to be beneficial for achieving better pregnancy and implantation rate (IR). The present study was aimed to evaluate efficiency of cumulus co-culture technique over simple culture of embryo in terms of pregnancy rate (PR) and IR in patients undergoing treatment for infertility using donor oocytes fertilized by intracytoplasmic sperm injection. Methods: This was a quasi-experimental study between control and study groups. The primary endpoint was achievement of pregnancy. Control group included 508 women who underwent embryo development without cumulus cell co-culture and study group included 394 women who underwent embryo development with cumulus cell co-culture using donor's cumulus cells. Results: The present study demonstrated a significant increase in the IR (37.2 vs 24.2%, P<0.001) and in PR (45.7 vs 37.8%, P<0.05) in study group than in control group. The PR and IR were found to be higher in study group, among all groups of women, grouped on the basis of different indications for use of donor oocytes. Interpretation & conclusions: Cumulus cell co-culture technique was found to be more effective than simple culture technique for embryo development in women undergoing treatment for infertility using donor oocytes fertilized by intracytoplasmic sperm injection.
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Affiliation(s)
- Harsha K Bhadarka
- Department of Biochemistry, P.D. Patel Institute of Applied Sciences, Charotar University of Science & Technology, Changa; Department of IVF, Akanksha Hospital & Research Institute, A Unit of Sat Kaival Hospital Pvt. Ltd., Anand, India
| | - Nayana H Patel
- Department of IVF, Akanksha Hospital & Research Institute, A Unit of Sat Kaival Hospital Pvt. Ltd., Anand, India
| | - Niket H Patel
- Department of IVF, Akanksha Hospital & Research Institute, A Unit of Sat Kaival Hospital Pvt. Ltd., Anand, India
| | - Molina Patel
- Department of IVF, Akanksha Hospital & Research Institute, A Unit of Sat Kaival Hospital Pvt. Ltd., Anand, India
| | - Kruti B Patel
- Department of IVF, Akanksha Hospital & Research Institute, A Unit of Sat Kaival Hospital Pvt. Ltd., Anand, India
| | - Nilofar R Sodagar
- Department of IVF, Akanksha Hospital & Research Institute, A Unit of Sat Kaival Hospital Pvt. Ltd., Anand, India
| | - Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad, India
| | - Jagdish S Patel
- Department of Biochemistry, P.D. Patel Institute of Applied Sciences, Charotar University of Science & Technology, Changa, India
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Shah K, Varma JR, Patel MV, Tandon KR, Phatak AG, Nimbalkar SM. Financial Burden, Depression and Coping Strategies among Parents of Children Admitted to Paediatric Intensive Care Unit (PICU). J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/32011.12324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Soni A, Fahey N, Jaffe A, Raithatha S, Raithatha N, Prabhakaran A, Moore Simas TA, Byatt N, Vankar J, Chin M, Phatak AG, Srivastava S, McManus DD, O'Keefe E, Patel H, Patel N, Patel D, Tracey M, Khubchandani JA, Newman H, Earon A, Rosenfield H, Handorf A, Novak B, Bostrom J, Deb A, Desai S, Patel D, Nimbalkar A, Talati K, Rosal M, McQuilkin P, Pandya H, Santry HP, Thanvi S, Kharod U, Fischer M, Allison J, Nimbalkar SM. RAHI-SATHI Indo-U.S. Collaboration: The Evolution of a Trainee-Led Twinning Model in Global Health Into a Multidisciplinary Collaborative Program. Glob Health Sci Pract 2017; 5:152-163. [PMID: 28351882 PMCID: PMC5482068 DOI: 10.9745/ghsp-d-16-00190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/25/2017] [Indexed: 01/01/2023]
Abstract
RAHI–SATHI presents an innovative twinning model of global health academic partnership, resulting in a number of successful research activities, that features trainees or students as the driving force, complemented by strategic institutional support from both sides of the partnership. Others can promote similar student-led initiatives by: (1) accepting an expanded role for trainees in global health programs, (2) creating structured research and program opportunities for trainees, (3) developing a network of faculty and trainees interested in global health, (4) sharing extramural global health funding opportunities with faculty and trainees, and (5) offering seed funding. Background: In recent years there has been a surge in the number of global health programs operated by academic institutions. However, most of the existing programs describe partnerships that are primarily faculty-driven and supported by extramural funding. Program Description: Research and Advocacy for Health in India (RAHI, or “pathfinder” in Hindi) and Support and Action Towards Health-Equity in India (SATHI, or “partnership” in Hindi) are 2 interconnected, collaborative efforts between the University of Massachusetts Medical School (UMMS) and Charutar Arogya Mandal (CAM), a medical college and a tertiary care center in rural western India. The RAHI–SATHI program is the culmination of a series of student/trainee-led research and capacity strengthening initiatives that received institutional support in the form of faculty mentorship and seed funding. RAHI–SATHI's trainee-led twinning approach overcomes traditional barriers faced by global health programs. Trainees help mitigate geographical barriers by acting as a bridge between members from different institutions, garner cultural insight through their ability to immerse themselves in a community, and overcome expertise limitations through pre-planned structured mentorship from faculty of both institutions. Trainees play a central role in cultivating trust among the team members and, in the process, they acquire personal leadership skills that may benefit them in their future careers. Conclusion: This paradigm of trainee-led twinning partnership promotes sustainability in an uncertain funding climate and provides a roadmap for conducting foundational work that is essential for the development of a broad, university-wide global health program.
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Affiliation(s)
- Apurv Soni
- University of Massachusetts Medical School, Worcester, MA, USA.
| | - Nisha Fahey
- University of Massachusetts Medical School, Worcester, MA, USA.,Des Moines University, Des Moines, IA, USA
| | - Abraham Jaffe
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Michael Chin
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - David D McManus
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Niket Patel
- Pramukhswami Medical College, Karamsad, India
| | | | - Michaela Tracey
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Haley Newman
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Allison Earon
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Anna Handorf
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Brittany Novak
- University of Massachusetts Medical School, Worcester, MA, USA
| | - John Bostrom
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Anindita Deb
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Dipen Patel
- Pramukhswami Medical College, Karamsad, India
| | | | | | - Milagros Rosal
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Heena P Santry
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Melissa Fischer
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeroan Allison
- University of Massachusetts Medical School, Worcester, MA, USA
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Abstract
Unprecedented technological growth in the last quarter of twentieth century has resulted in improved health care and opened new domains of health care research. This technological leap also facilitated the paradigm shift from hospital care to home care through development of 'point of care' devices. As early diagnoses and timely referral is a key to health management, these devices play an important role in improving health. Validation of the new technology in different settings is necessary before adopting it to practice. For a binary result like pregnancy test, it is trivial to use statistical tools like sensitivity, specificity etc. For a continuous variable like blood glucose level the analysis is not straightforward. Many of us misinterpret 'association' as 'agreement'. This misinterpretation is reflected in studies which have compared two different technologies. The findings of well conducted studies do not contribute to the evidence base just because of wrong analysis strategy. We delineate on finer nuances of analysis and interpretation of method comparison studies.
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Affiliation(s)
- Ajay G Phatak
- Manager, Central Research Services, Charutar Arogya Mandal , Karamsad , Anand, Gujarat, India
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Dongara AR, Nimbalkar SM, Phatak AG, Patel DV, Nimbalkar AS. An Educational Intervention to Improve Nurses’ Understanding of Pain in Children in Western India. Pain Manag Nurs 2017; 18:24-32. [PMID: 27964909 DOI: 10.1016/j.pmn.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/16/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022]
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Soni A, Amin A, Patel DV, Fahey N, Shah N, Phatak AG, Allison J, Nimbalkar SM. The presence of physician champions improved Kangaroo Mother Care in rural western India. Acta Paediatr 2016; 105:e390-5. [PMID: 27111097 PMCID: PMC4982817 DOI: 10.1111/apa.13445] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/04/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
AIM This study determined the effect of physician champions on the two main components of Kangaroo Mother Care (KMC): skin-to-skin care and breastfeeding. METHODS KMC practices among a retrospective cohort of 648 infants admitted to a rural Indian neonatal intensive care unit (NICU) between January 5, 2011 and October 7, 2014 were studied. KMC champions were identified based on their performance evaluation. We examined the effect of withdrawing physician champions on overall use, time to initiation and intensity of skin-to-skin care and breastfeeding, using separate models. RESULTS In comparison with when KMC champions were present, their absence was associated with a 45% decrease in the odds of receiving skin-to-skin care, with a 95% confidence interval (CI) of 64% to 17%, a 38% decrease in the rate of initiation skin-to-skin care (95% CI 53-82%) and an average of 1.47 less hours of skin-to-skin care (95% CI -2.07 to -0.86). Breastfeeding practices were similar across the different champion environments. CONCLUSION Withdrawing physician champions from the NICU setting was associated with a decline in skin-to-skin care, but not breastfeeding. Training health care workers and community stakeholders to become champions could help to scale up and maintain KMC practices.
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Affiliation(s)
- Apurv Soni
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Amee Amin
- Pramukhswami Medical College, Gujarat, India
| | | | | | - Nikhil Shah
- Pramukhswami Medical College, Gujarat, India
| | | | - Jeroan Allison
- University of Massachusetts Medical School, Worcester, Massachusetts
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Gohel MK, Prajapati JB, Mudgal SV, Pandya HV, Singh US, Trivedi SS, Phatak AG, Patel RM. Effect of Probiotic Dietary Intervention on Calcium and Haematological Parameters in Geriatrics. J Clin Diagn Res 2016; 10:LC05-9. [PMID: 27190835 DOI: 10.7860/jcdr/2016/18877.7627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/05/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit on the host. Sufficient calcium intake has been reported to support bone growth and prevent bone loss during the ageing process. AIM To determine the effect of Lactobacillus helveticus MTCC 5463 probiotic dietary intervention on serum calcium & haematological parameters in geriatric population. MATERIALS AND METHODS Healthy volunteers with age ranging from 64-74 years were recruited from the nearby residential areas in and around Anand, Gujarat. Study duration was from 2012 to 2015. Of the 112 subjects initially enrolled in the trial, 36 withdrew before the intervention because of not matching with criterias. Of the 76 participants, 5 subjects (4%) under test group and 12 subjects (11%) under placebo left the study. We had 59 subjects who successfully completed a double blind cross over trial. Probiotic fermented milk products (in form of "Lassi") was prepared by supplementing toned milk with honey and fermenting with probiotic Lactobacillus helveticus MTCC 5463 and Streptococcus thermophilus MTCC 5460. The final product had at least 10(8) CFU/ml of viable Lactobacillus helveticus MTCC 5463 at the time of feeding. During feeding period, 200 ml of fermented product containing the test strain to one group and a similar product but without the test strain as placebo were fed regularly at the time of breakfast in morning for 4 weeks. Subjects of each group were given a washout period of 4 weeks before they were crossed over and included to the other group. The study was approved by institutional ethics committee. RESULTS The socio-demographic and clinical profiles were similar at baseline. The mean (SD) calcium level improved significantly in test {9.36 (0.45) vs 8.45 (0.61), p<0.001}. No significant effect was observed with respect to haemoglobin & haematological parameters. CONCLUSION The well-documented probiotic Lactobacillus helveticus MTCC 5463 confirmed increase in serum calcium level but no effect on haematological parameters when administered to geriatrics.
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Affiliation(s)
- Manisha Kalpesh Gohel
- Associate Professor, Department of Community Medicine, Pramukhswami Medical College , Karamsad, India
| | - Jashbhai B Prajapati
- Professor and Head, Department of Dairy Microbiology, SMC College of Dairy Science Anand Agricultural University , Anand, India
| | - Sreeja V Mudgal
- Assistant Professor, Department of Dairy Microbiology, Anand Agricultural University , Anand, India
| | - Himanshu V Pandya
- Professor, Department of Medicine, Pramukhswami Medical College , Karamsad, India
| | - Uday Shankar Singh
- Professor and Head, Department of Community Medicine, Pramukhswami Medical College , Karamsad, India
| | - Sunil S Trivedi
- Professor, Department of Microbiology & Principal, Smt.L.P. Patel Institute of Med. Lab.Technology Pramukhswami Medical College & Shree Krishna Hospital , Karamsad, India
| | - Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal , Karamsad, India
| | - Rupal M Patel
- Associate Professor, Department of Microbiology, Pramukhswami Medical College , Karamsad, India
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Kothari SY, Dongara AR, Nimbalkar SM, Phatak AG, Nimbalkar AS. Missed Opportunities for Sedation and Pain Management at a Level III Neonatal Intensive Care Unit, India. Front Pediatr 2016; 4:7. [PMID: 26942166 PMCID: PMC4763094 DOI: 10.3389/fped.2016.00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/01/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neonates in the neonatal intensive care unit (NICU) undergo a multitude of painful and stressful procedures during the first days of life. Stress from this pain can lead to neurodevelopmental problems that manifest in later childhood and should be prevented. OBJECTIVE To determine the number of painful procedures performed per day for each neonate, to verify documentation of painful procedures performed, and to, subsequently, note missed opportunities for providing pain relief to neonates. METHODS We conducted a cross-sectional study at a level III NICU located in a rural part of western India. A total of 69 neonates admitted for more than 24 h were included. Twenty-nine neonates were directly observed for a total of 24 h each, and another 40 neonatal records were retrospectively reviewed for the neonate's first 7 days of admission. All stressful and painful procedures performed on the neonate were recorded. Also recorded were any pharmaceutical pain relief agents or central nervous system depressants administered to the neonate before or at the time of the procedures. Average nurse-patient ratio was also calculated. Data were analyzed using descriptive statistics. RESULTS A documentation deficit of 2.2% was observed. The average nurse-patient ratio was 1.53:1. A total of 13711 procedures were recorded, yielding 44.1 (38.1 stressful, 3.8 mildly painful, and 2.2 moderately painful) procedures per patient day. Common stressful procedures were position changing (2501) and temperature recording (2208). Common mildly and moderately painful procedures were heel prick (757) and endotracheal suctioning (526), respectively. Use of pharmacological agents coincided with 33.48% of the procedures. The choice of drug and time of administration were inappropriate, indicating that the pharmacological agents were intended not for pain relief but rather for a coexisting pathology or as sedation from ventilation with no analgesia. CONCLUSION Stressful procedures are common in the NICU; mildly and moderately painful procedures fairly common. Almost two-thirds of the times, no pharmaceutical pain relief methods were used, and when administered, the pharmaceutical agents were seldom intended for pain relief; this implies poor pain management practices and emphasizes the imperative need for educating NICU nurses, residents, fellows, and attendings.
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Affiliation(s)
- Shikha Y Kothari
- Department of Pediatrics, Pramukhswami Medical College , Karamsad-Anand , India
| | - Ashish R Dongara
- Department of Pediatrics, Pramukhswami Medical College , Karamsad-Anand , India
| | - Somashekhar M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad-Anand, India; Central Research Services, Charutar Arogya Mandal, Karamsad-Anand, India
| | - Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal , Karamsad-Anand , India
| | - Archana S Nimbalkar
- Department of Physiology, Pramukhswami Medical College , Karamsad-Anand , India
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Dongara AR, Shah SN, Nimbalkar SM, Phatak AG, Nimbalkar AS. Knowledge of and Attitudes Regarding Postoperative Pain among the Pediatric Cardiac Nursing Staff: An Indian Experience. Pain Manag Nurs 2014; 16:314-20. [PMID: 25439124 DOI: 10.1016/j.pmn.2014.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/08/2014] [Accepted: 08/08/2014] [Indexed: 11/20/2022]
Abstract
Pain following cardiac intervention in children is a common, but complex phenomenon. Identifying and reporting pain is the responsibility of the nursing staff, who are the primary caregivers and spend the most time with the patients. Inadequately managed pain in children may lead to multiple short- and long-term adverse effects. The aim of this cross-sectional study was to assess the knowledge and attitudes regarding postoperative pain in children among the nursing staff at B.M. Patel Cardiac Center, Karamsad, Anand, Gujarat, India. The study included 42 of the 45 nurses employed in the cardiac center. The nurses participating in the study were responsible for the care of the pediatric patients. A modified Knowledge and Attitudes Survey Regarding Pain and a sociodemographic questionnaire were administered after obtaining written informed consent. The study was approved by the institutional Human Research Ethics Committee. Mean (SD) experience in years of the nursing staff was 2.32 (1.69) years (range 1 month to 5 years). Of the nurses, 67% were posted in the cardiac surgical intensive care unit (ICU). The mean (SD) score for true/false questions was 11.48 (2.95; range 7,19). The average correct response rate of the true/false questions was 45.9%. Knowledge about pain was only affected by the ward in which the nurse was posted. In first (asymptomatic) and second (symptomatic) case scenarios, 78.6% and 59.5% underestimated pain, respectively. Knowledge and attitudes regarding pain and its management is poor among nurses. Targeted training sessions and repeated reinforcement sessions are essential for holistic patient care.
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Affiliation(s)
- Ashish R Dongara
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, Anand, India
| | - Shail N Shah
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, Anand, India
| | - Somashekhar M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, Anand, India; Central Research Services, H.M. Patel Academic Center, Charutar Arogya Mandal, Karamsad, Gujarat, Anand, India.
| | - Ajay G Phatak
- Central Research Services, H.M. Patel Academic Center, Charutar Arogya Mandal, Karamsad, Gujarat, Anand, India
| | - Archana S Nimbalkar
- Department of Physiology, Pramukhswami Medical College, Gujarat, Anand, India
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Nimbalkar AS, Dongara AR, Phatak AG, Nimbalkar SM. Knowledge and attitudes regarding neonatal pain among nursing staff of pediatric department: an Indian experience. Pain Manag Nurs 2012; 15:69-75. [PMID: 24602426 DOI: 10.1016/j.pmn.2012.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 06/08/2012] [Accepted: 06/11/2012] [Indexed: 11/19/2022]
Abstract
Neonates receiving care in intensive care units are highly likely to experience pain due to investigations and/or treatments carried out by the health care providers. Neonates are a vulnerable population because they are unable to vocalize their pain. Unaddressed and mismanaged pain can not only affect the child's comfort, but also may alter the development and cognitive abilities of the child in a later part of his/her life. Therefore it is entirely the caregiver's responsibility to accurately assess and manage neonatal pain. We assessed and compared the knowledge and attitudes regarding neonatal pain among the nurses posted in the various units of a pediatric department [pediatric ward, pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU)]. An appropriately modified Knowledge and Attitudes Survey Regarding Pain questionnaire was consensually validated, pretested, and then administered to the nursing staff of the pediatric department at a department at a hospital in Gujarat. Data were entered in Epi-Info and analyzed with the use of SPSS 14.0. The questionnaire was administered to 41 nurses working in the Department of Pediatrics, and the response rate was 97.5%. Mean age of the nurses in the study sample was 25.75 years (SD 5.513). The mean total score of the participants was 8.75 out of 17 (SD 2.549), which was unsatisfactory. The mean correct answer rate was 49.67% among the staff of NICU and 48.67% among the pediatric ward and PICU staff. The attitudes among the nurses were assessed. It was concluded that the nurses lack knowledge and that their attitudes also were hindering pain management. One of the barriers identified by the nurses was that physicians do not prescribe analgesics for managing neonatal pain. So not only the nursing staff, but all of the caregivers involved in neonatal care may be lacking in knowledge and hold perceptions and attitudes that hamper neonatal pain management.
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Affiliation(s)
- Archana S Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Ashish R Dongara
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Ajay G Phatak
- Central Research Services, H. M. Patel Academic Center, Karamsad, Gujarat, India
| | - Somashekhar M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India; Central Research Services, H. M. Patel Academic Center, Karamsad, Gujarat, India.
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Abstract
BACKGROUND/AIMS To establish the efficacy of two-port appendectomy as an alternative to standard laparoscopic and open appendectomy in the management of acute appendicitis. MATERIALS AND METHODS Of the 151 patients included in the study, 47 patients were in the open group, 61 in two-port and 43 patients were included in the three-port group. Only patients with uncomplicated acute appendicitis were included in the study. Patients with complicated appendicitis like perforated appendix, appendicular lump and appendicular abscess were excluded from the study. Patients converted to open procedure after initial diagnosis and patients with other pathology in addition to appendicitis were also excluded. Patients with recurrent appendicitis and chronic appendicitis were excluded. The total number of excluded cases was 50. Data were compared with cases of open and three-port appendectomy. RESULTS The mean operative time was 43.94, 35.74, and 59.65 min (SD: 18.91, 11.06, 19.29) for open, two-port, and three-port appendectomy groups respectively. Mean length of stay in days was 3.02, 1.93, and 2.26 (SD: 1.27, 1.04, 1.09) for open, two-port, and three-port appendectomy groups respectively. Surgical site infection was significantly lower (P = 0.03) in laparoscopy group as compared to that in open appendectomy group. Seven patients (4.63%) developed surgical site infection, 5 (10.63%) in the open and 2 (1.92%) in the laparoscopy group. Surgical site infection was 1.63% and 2.32% in two-port and three-port appendectomy groups respectively. CONCLUSIONS For uncomplicated appendicitis, the two-port appendectomy technique significantly reduces operative time as well as length of hospital stay. It also reduces surgical site infection as compared to open appendectomy group.
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Affiliation(s)
- Vipul D. Yagnik
- Department of Surgery, Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad - 388325, Gujarat, India,Address for correspondence: Dr. Vipul D. Yagnik, 77, Siddhraj Nagar, Station Road, Patan-384265, Gujarat, India. E-mail:
| | - Jignesh B. Rathod
- Department of Surgery, Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad - 388325, Gujarat, India
| | - Ajay G. Phatak
- Department of Surgery, Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad - 388325, Gujarat, India
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Phatak AG. Oral submucous fibrosis. Natl Med J India 1993; 6:249-50. [PMID: 7950926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Phatak AG, Muley PR. Message from AIDS case. J Assoc Physicians India 1989; 37:193-4. [PMID: 2619821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
In seven out of seven patients suffering from oral submucous fibrosis (OSMF), we detected circulating molecules that are immunologically similar to fibrinogen (MISFI), as suggested by the hemagglutination inhibition studies using the FDP Kit (Wellcome) and by paracoagulation tests such as serial dilution protamine tests. The ethanol gelation test was positive in three of the seven patients. Cryofibrinogen developed in six of the seven patients within three to six days of incubation of plasma samples at 4 degrees C. Plasma kept at 37 degrees C did not develop any fibrous or amorphous precipitate. In OSMF, fibrinogen, fibrinogen intermediates, and fibrin degradation products deserve further scrutiny, as this may help define the etiology of OSMF which is, so far, obscure.
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Abstract
Lymphocytes (leukocytes mainly containing mononuclear cells) are separated by six different methods and these lymphocytes are used for non-immune rosette formation. It is found that the percentage of non-immune rosettes varies according to the method of separation of lymphocytes. Buffy coat on Dextran-70 and Gravity Sedimentation method give the best rosette yields as compared with lymphocytes separated by centrifugation of heparinized blood (unsupported centrifugation) P less than 0.001) or on Hypaque-Ficoll or Diaginol-Ficoll gradients (supported centrifugation) P less than 0.05). Furthermore, the buffy coat separated on Dextran-70, layered on Ficoll-gradients (supported centrifugation) yields lower values of rosettes (P less than 0.05). It is possible that in certain methods which yield lower values of rosettes there is loss of selected subpopulations of lymphocytes. This loss of subpopulation appears to be due to the centrifugation of the blood and the loss is appreciably more on 'unsupported' than 'supported' centrifugation.
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Hegiste MD, Phatak AG. Electrophoresis on agarose gel slide: an improved technique including transfer of bands to paper. INDIAN J PATHOL MICR 1977; 20:183-6. [PMID: 614244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Pujari BD, Phatak AG, Jayaramaiah M, Deodhare SG. Dermoid cyst of the spleen. Int Surg 1976; 61:603-4. [PMID: 1010706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Phatak AG, Hegiste MD. Simultaneous electrophoretic separations of serum lipoproteins and proteins on agarose. Indian J Med Sci 1975; 29:167-9. [PMID: 1218944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Phatak AG, Gujar AG. Di'Guglielmo's disease and acute myeloblastic leukaemia in cousin brothers: relevance to the inter-related parents. J Assoc Physicians India 1974; 22:923-5. [PMID: 4532997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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