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Karande S, Das B, Acharya SS, Kumar A, Patel H, Sharma A, Gupta M, Ahmad I, Bhandare V, Sharma K, Kundu CN, Patil C. Computational and in vitro screening validates the repositioning potential of Coxibs as anti-fibrotic agents. J Biomol Struct Dyn 2024:1-13. [PMID: 38433403 DOI: 10.1080/07391102.2024.2318655] [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] [Received: 10/26/2023] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a life-threatening disease with a survival rate of <5 years. The TGF-β plays a significant role in the progression and severity of IPF. The TGF-β receptor type1 TGFBR1 antagonists inhibit the process of fibrosis and may have a role in the treatment of IPF. The main objective of the study was to identify promising drug candidates against IPF using In-silico and In-vitro evaluation methods. An in-silico screening was carried out of the marketed Coxibs to find their TGFBR1 inhibitory potential considering their structural resemblance with the JZO-a co-crystalized ligand of the crystal structure of the TGFBR1. The virtual screening yielded rofecoxib as a TGFBR1 ligand with a significant docking score. To further validate the outcome of molecular docking studies, MD simulation of 200 ns was carried out followed by the determination of conformational stability, binding free energy calculation using MMPBSA/MMGBSA, and Free Energy Landscape (FEL). The therapeutic efficacy of rofecoxib was compared with that of nintedanib (a therapeutic agent used in the treatment of IPF) at equimolar concentrations (5 µM). The model of TGF-β1 (1 ng/ml)-induced EMT of A549 was used to determine the effect of rofecoxib on the EMT markers like cellular morphology, cytokine expressions, fibrosis associated protein, E-cadherin, and α-smooth muscle actin. In vitro results indicated that rofecoxib significantly suppresses the TGF-β1-induced EMT of A549 cells and validates the possible preventive/protective role of rofecoxib in pulmonary fibrosis. In conclusion, rofecoxib may be considered for repositioning as an anti-fibrotic agent.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
| | - Biswajit Das
- KIIT School of Biotechnology, KIIT Deemed to be University, Bhubaneswar, India
| | | | - Anoop Kumar
- Department of Pharmacology, DPSRU, New Delhi, India
| | - Harun Patel
- Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Ajay Sharma
- Department of Pharmacognosy, DPSRU, New Delhi, India
| | - Madhu Gupta
- Department of Pharmaceutics, DPSRU, New Delhi, India
| | - Iqrar Ahmad
- Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | | | | | - Chanakya Nath Kundu
- KIIT School of Biotechnology, KIIT Deemed to be University, Bhubaneswar, India
| | - Chandragouda Patil
- Department of Pharmacology, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
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Karande S, Rajiv D. How appropriate are referral letters written by school principals to a learning disability clinic? A retrospective audit. J Postgrad Med 2024; 70:43-45. [PMID: 38174529 PMCID: PMC10947739 DOI: 10.4103/jpgm.jpgm_932_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
This retrospective study analyzed the quality of 1069 referral letters written by school principals to our learning disability clinic. Utilizing a self-devised checklist having four domains (with 26 items), the audit revealed that in only nine (34.6%) items, the necessary information was available in >90% of referral letters.
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Affiliation(s)
- S Karande
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - D Rajiv
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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Muranjan M, Karande S, Rajoria S. Impact of COVID-19 pandemic on healthcare delivery for lysosomal storage disorders at a tertiary care public hospital in Mumbai. J Postgrad Med 2024; 70:23-28. [PMID: 38197333 PMCID: PMC10947738 DOI: 10.4103/jpgm.jpgm_705_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/12/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Management of lysosomal storage disorders (LSDs) requires periodic visits for medical surveillance and hospitalizations. Management of LSDs may have been adversely impacted during the COVID-19 pandemic. Objective To identify the factors impacting health care for patients with LSDs during the COVID-19 pandemic. Methods An observational study was conducted in Mumbai comparing infusion practices and reasons for missed infusions for 15 months before March 2020 versus two phases during the pandemic (April 2020-March 2021 and April 2021-March 2022) in patients receiving intravenous enzyme replacement therapy (ERT) and on oral substrate reduction therapy (SRT). Results Fifteen patients with LSDs were enrolled. Before the pandemic, 6/13 (46%) were receiving ERT at the study site, 4/13 (31%) at a local hospital, and 3/13 (23%) at home; two were on SRT. The median distance traveled for receiving ERT was 37 km, and 4.4 infusions/patient were missed. From April 2020 to March 2021, two more patients opted for home ERT infusions. The median distance traveled for receiving ERT was 37 km, and 11.6 infusions/patient were missed. From April 2021 to March 2022, one more patient opted for home ERT infusions. The median distance traveled for receiving ERT was 7 km, and 5.6 infusions/patient were missed. The pandemic also affected SRT compliance adversely. For all patients, the cause of disrupted treatment was travel curbs (69%) and fear of getting COVID-19 infection (38%). Conclusions Treatment of LSDs was disrupted during the pandemic, with an increase in missed ERT infusions and SRT doses.
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Affiliation(s)
- M Muranjan
- Genetic Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - S Karande
- Genetic Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - S Rajoria
- Genetic Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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Karande S, Vaideeswar P, More T. How often are heart diseases correctly diagnosed antemortem in children with fatal illnesses? A retrospective review of medical and autopsy records. J Postgrad Med 2023; 69:224-226. [PMID: 37787265 PMCID: PMC10846810 DOI: 10.4103/jpgm.jpgm_608_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 10/04/2023] Open
Abstract
This retrospective study analyzed the concordance level between clinical and autopsy diagnosis of heart diseases over six years. Utilizing the Goldmann classification, the concordance rate was found to be 38.1%. Major discrepancies (Class I and II) were found in 39% cases and minor (Class III and IV) in 22.9% cases.
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Affiliation(s)
- S Karande
- Department of Pediatrics), Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - P Vaideeswar
- Department of Pathology (Cardiovascular & Thoracic Division), Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - T More
- Department of Pediatrics), Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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Divecha CA, Tullu MS, Karande S. Utilizing tables, figures, charts and graphs to enhance the readability of a research paper. J Postgrad Med 2023:380360. [PMID: 37395532 PMCID: PMC10394528 DOI: 10.4103/jpgm.jpgm_387_23] [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: 07/04/2023] Open
Affiliation(s)
- C A Divecha
- Department of Pediatrics, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman
| | - M S Tullu
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Chakraborty A, Muranjan M, Karande S, Kharkar V. Porphyrias: Uncommon disorders masquerading as common childhood diseases. J Postgrad Med 2023:374441. [PMID: 37082991 PMCID: PMC10394526 DOI: 10.4103/jpgm.jpgm_698_22] [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: 04/22/2023] Open
Abstract
Porphyrias are a rare group of inborn errors of metabolism due to defects in the heme biosynthetic pathway. The biochemical hallmark is the overproduction of porphyrin precursors and porphyrin species. Afflicted patients present with a myriad of symptoms causing a diagnostic odyssey. Symptoms often overlap with those of common diseases and may be overlooked unless there is heightened clinical suspicion. We are reporting clinical features and diagnostic challenges in four pediatric patients having variegate porphyria, congenital erythropoietic porphyria, acute intermittent porphyria, and erythropoietic protoporphyria (EPP), who presented with diverse multisystem manifestations. This case series illustrates a logical analysis of symptoms and judicious selection of investigations and the role of genotyping in successfully diagnosing porphyrias.
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Affiliation(s)
- A Chakraborty
- Genetic Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - M Muranjan
- Genetic Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - S Karande
- Genetic Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - V Kharkar
- Department of Dermatology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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Karande S, Gogtay NJ, Shaikh N, Sholapurwala R, More T, Meshram P. Self-perceived anxiety symptoms in school students with borderline intellectual functioning: A cross-sectional questionnaire-based study in Mumbai, Maharashtra, India. J Postgrad Med 2023; 69:89-96. [PMID: 36930546 DOI: 10.4103/jpgm.jpgm_956_22] [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: 03/18/2023] Open
Abstract
Background and Objectives Students with borderline intellectual functioning ("slow learners") underperform in all school subjects. The primary objective of this study was to evaluate the self-perceived anxiety symptoms of slow learners. Its secondary objective was to analyze impact of sociodemographic variables on their symptoms. Settings and Design Cross-sectional single-arm questionnaire-based study was conducted in the learning disability clinic of a public medical college in Mumbai. Subjects and Methods One hundred slow learners aged ≥8 to <18 years were recruited by non-probability sampling. Their anxiety symptoms scores were measured using the Screen for Child Anxiety Related Disorders-Child version (SCARED-C) instrument. Statistical Analysis Multivariate regression analysis was performed for determining the "independent" impact that variables had on the SCARED-C ("individual subscales" and "overall") scores. Results Symptoms of "separation anxiety" were present in 40%, followed by "social anxiety" in 32%, "generalized anxiety" in 31%, "panic" in 26%, "significant school avoidance" in 24%; and "overall anxiety" in 38% of slow learners. Multivariate analysis revealed that: (i) co-occurring attention-deficit/hyperactivity disorder was significantly associated with having panic symptoms (P = 0.040), and, (ii) studying in a Secondary School Certificate or Higher Secondary Certificate educational board-affiliated school was significantly associated with having symptoms of "generalized anxiety," "social anxiety," and "overall anxiety" (P = 0.009, P = 0.026, and P = 0.046, respectively). Conclusions Many slow learners in our city have symptoms of anxiety disorders and overall anxiety. There is an urgent need to screen them for anxiety disorders to facilitate their optimum rehabilitation.
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Affiliation(s)
- S Karande
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - N J Gogtay
- Department of Clinical Pharmacology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - N Shaikh
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - R Sholapurwala
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - T More
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - P Meshram
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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Karande S, Gogtay NJ, More T, Sholapurwala RF, Pandit S, Waghmare S. Economic burden of limited English proficiency: A prevalence-based cost of illness study of its direct, indirect, and intangible costs. J Postgrad Med 2023; 69:27-34. [PMID: 36367030 PMCID: PMC9997600 DOI: 10.4103/jpgm.jpgm_445_22] [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: 11/11/2022] Open
Abstract
Aims The primary objective of the present study was to evaluate the economic burden of limited English proficiency (LEP) by estimating its direct, indirect, and intangible costs. A secondary objective was to assess the impact of variables on the economic burden. Design and Setting A cross-sectional single-arm descriptive study conducted in a learning disability clinic in a public medical college in Mumbai. Subjects and Methods The study cases (aged ≥8 years and ≤18 years) were recruited by non-probability sampling. A structured questionnaire was used to interview the parent to collect data related to direct and indirect costs. Intangible cost data were collected by documenting the willingness-to-pay value using the contingent valuation technique. Statistical Analysis Used A multivariate regression model was used to assess the impact of predictor variables on the costs. Results The direct, indirect, and intangible costs due to LEP were Indian Rupees (INR) 826,736, 3,828,220, and 1,906,300, respectively. Indirect costs comprised 82.2% of the total costs. Expenditure on tuition and remedial education comprised 39.86% and 14.08% of the indirect and direct costs, respectively. The average annual learning disability clinic costs were INR 2,169,146. The average annual total costs per student were INR 42,102. Higher socioeconomic status was predictive of increased "indirect costs", "total costs", and "intangible costs." Conclusion LEP is a cost-intensive condition (indirect > intangible > direct costs). Non-medical costs are the costliest component of direct costs. Parental loss of earnings is the costliest component of indirect costs.
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Affiliation(s)
- S Karande
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - N J Gogtay
- Department of Clinical Pharmacology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - T More
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - R F Sholapurwala
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - S Pandit
- Department of Clinical Pharmacology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - S Waghmare
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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Divecha CA, Tullu MS, Karande S. The art of referencing: Well begun is half done! J Postgrad Med 2023; 69:1-6. [PMID: 36629224 PMCID: PMC9997612 DOI: 10.4103/jpgm.jpgm_908_22] [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: 01/12/2023] Open
Affiliation(s)
- C A Divecha
- College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman; and Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - M S Tullu
- Departments of Pediatrics; College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman; and Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Departments of Pediatrics; College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman; and Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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Bavdekar SB, Karande S. National Ethical Guidelines for biomedical and health research: Issues to ponder over. J Postgrad Med 2022; 68:125-128. [PMID: 35975346 DOI: 10.4103/jpgm.jpgm_474_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S B Bavdekar
- Department of Pediatrics, Surya Children's Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Karande S, Bhavani S, Gogtay NJ, Shiledar MP, Kelkar S, Oke AS. Do school students with specific learning disabilities have lower emotional intelligence abilities? A cross-sectional questionnaire-based study in Mumbai, Maharashtra, India. J Postgrad Med 2022; 68:24-30. [PMID: 35042316 PMCID: PMC8860125 DOI: 10.4103/jpgm.jpgm_834_21] [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: 11/06/2022] Open
Abstract
Background and Objectives: School students with specific learning disabilities (SpLDs) endure academic difficulties, anxiety, and social maladaptation. The primary objective of the present study was to evaluate the emotional intelligence (EI) abilities of these afflicted students. Its secondary objective was to analyze the impact of socio-demographic variables on their EI abilities. Settings and Design: Cross-sectional single-arm questionnaire-based study was conducted in the Learning Disability clinic in a public medical college in Mumbai. Subjects and Methods: SpLD students studying in class standards VII–IX were recruited by non-probability sampling. Their EI (overall, subscales, and settings) scores were measured using the Four EsScale of Emotional Intelligence-Adolescents (FESEI-A) questionnaire; and compared with Indian norm scores by utilizing the Mann - Whitney U test. To evaluate the unadjusted impact that each of the “variables” had on the FESEI-A scores, linear regression or the Mann-Whitney U test, or the Kruskal-Wallis test, was utilized as applicable. Results: SpLD students had similar “overall” EI abilities as their regular peers. Their EI scores in school setting were significantly lower (P = 0.001), but significantly higher in social setting (P = 0.005). At univariate level, presence of co-occurring attention-deficit/hyperactivity disorder was significantly associated with a lower “school setting” score (P = 0.040). Higher socioeconomic status was significantly associated with a higher “overall” score and “family setting” score (P = 0.023 and P = 0.041, respectively). Conclusions: There is an urgent need to evaluate the EI abilities of SpLD students to identify deficits so that optimum rehabilitation can be facilitated.
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Affiliation(s)
- S Karande
- Learning Disability Clinic, Department of Pediatrics, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - S Bhavani
- Learning Disability Clinic, Department of Pediatrics, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - N J Gogtay
- Department of Clinical Pharmacology, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - M P Shiledar
- Learning Disability Clinic, Department of Pediatrics, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - S Kelkar
- Eqip Kids, Equipoise Learning - The Emotional Intelligence Research and Training Organization, Thane, Maharashtra, India
| | - A S Oke
- Department of Psychology, Progressive Education Society's Modern College of Arts, Science and Commerce, Pune, Maharashtra, India
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Karande S, Gogtay NJ, More T, Pandit S, Praveenkumar. Parental-perceived health-related quality of life of school students with borderline intellectual functioning: A cross-sectional questionnaire-based study in Mumbai, Maharashtra, India. J Postgrad Med 2022; 68:213-220. [PMID: 35975344 PMCID: PMC9841546 DOI: 10.4103/jpgm.jpgm_310_22] [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: 01/19/2023] Open
Abstract
Background and Objectives Students with borderline intellectual functioning ("slow learners") underperform in all school subjects. The primary objective of this study was to evaluate the parental-perceived health-related quality of life (HRQoL) of these students. Its secondary objective was to analyze the impact of sociodemographic variables on their HRQoL. Settings and Design Cross-sectional single-arm questionnaire-based study was conducted in the learning disability clinic in a public medical college in Mumbai. Subjects and Methods One hundred parents of slow learners aged 8 to 16 years were recruited by non-probability sampling. Their HRQoL scores were measured using the English DISABKIDS chronic generic module parent (proxy) long-version ("DCGM-37-P") instrument. Statistical Analysis Multiple regression analysis was carried out for determining the "independent" impact that sociodemographic variables had on a poor facet and total score outcomes. Results Clinically significant deficits were detected in 4 facets, namely: small deficit in "social inclusion"; medium deficits in "independence", "emotion", and "social exclusion"; and large deficit in "total score". Multivariate analysis revealed that: (i) being an only child predicted a poor "emotion" and "social exclusion" facet score outcomes (P = 0.039 and P = 0.024, respectively); (ii) being a female predicted a poor "social inclusion" facet score outcome (P = 0.022); and, (iii) studying in a single-gender school predicted a poor "limitation" facet score outcome (P = 0.020). Conclusions Parents of slow learners perceive their psychosocial and total HRQoL to be significantly compromised. There is a need to evaluate the HRQoL of slow learners so that optimum rehabilitation can be facilitated.
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Affiliation(s)
- S Karande
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India,Address for correspondence: Dr. Karande S, E-mail:
| | - NJ Gogtay
- Department of Clinical Pharmacology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - T More
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - S Pandit
- Department of Clinical Pharmacology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Praveenkumar
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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Indrayan A, Vishwakarma G, Malhotra RK, Gupta P, Sachdev HPS, Karande S, Asthana S, Labani S. The development of QERM scoring system for comprehensive assessment of the Quality of Empirical Research in Medicine - Part 1. J Postgrad Med 2022; 68:221-230. [PMID: 36348606 PMCID: PMC9841535 DOI: 10.4103/jpgm.jpgm_460_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Whereas a large number of features are mentioned to connote the quality of medical research, no tool is available to comprehensively measure it objectively across different types of studies. Also, all the available tools are for reporting, and none includes quality of the inputs and the process of research. The present paper is aimed to initiate a discussion on the need to develop such a comprehensive scoring system (in the first place), to show that it is feasible, and to describe the process of developing a credible system. Method An expert group comprising researchers, reviewers, and editors of medical journals extensively reviewed the literature on the quality of medical research and held detailed discussions to parse quality at all stages of medical research into specific domains and items that can be assigned scores on the pattern of quality-of-life score. Results Besides identifying the domains of the quality of medical research, a comprehensive tool for scoring emerged that can be possibly used to objectively measure the quality of empirical research comprising surveys, trials, and observational studies. Thus, this can be used as a tool to assess Quality of Empirical Research in Medicine (QERM). The expert group confirmed its face and content validity. The tool can be used by the researchers for self-assessment and improvement before submission of a paper for publication, and the reviewers and editors can use this for assessing the submissions. Published papers can also be rated such as those included in a meta-analysis. Conclusion It is feasible to devise a comprehensive scoring system comprising domains and items for assessing the quality of medical research end-to-end from choosing a problem to publication. The proposed scoring system needs to be reviewed by the researchers and needs to be validated.
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Affiliation(s)
| | - A Indrayan
- Clinical Research, Max Healthcare, New Delhi, India,Address for correspondence: Dr. Indrayan A, E-mail:
| | - G Vishwakarma
- Biostatistics, Indian Spinal Injuries Centre, New Delhi, India
| | - RK Malhotra
- Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - P Gupta
- Pediatrics, University College of Medical Sciences, Delhi, India
| | - HPS Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Sciences and Research, New Delhi, India
| | - S Karande
- Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Asthana
- Epidemiology and Biostatistics, National Institute of Cancer Prevention and Research (Indian Council of Medical Research), Noida, Uttar Pradesh, India
| | - S Labani
- Epidemiology and Biostatistics, National Institute of Cancer Prevention and Research (Indian Council of Medical Research), Noida, Uttar Pradesh, India
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Agarwal A, Karande S. Blau syndrome: An under-reported condition in India? J Postgrad Med 2022; 68:63-67. [PMID: 35295039 PMCID: PMC9196289 DOI: 10.4103/jpgm.jpgm_1016_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Divecha CA, Tullu MS, Karande S. Published a research paper? What next?? J Postgrad Med 2021; 67:189-193. [PMID: 34806657 PMCID: PMC8706544 DOI: 10.4103/jpgm.jpgm_348_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- CA Divecha
- Assistant Professor of Pediatrics at College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman
| | - MS Tullu
- Assistant Professor of Pediatrics at College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman
| | - S Karande
- Assistant Professor of Pediatrics at College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman
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Karande S, Mahalawat S, Muranjan M. Spontaneous pneumothoraces complicating acute miliary tuberculosis in a child having recent coronavirus disease 2019. J Postgrad Med 2021; 67:177-179. [PMID: 34380803 PMCID: PMC8445116 DOI: 10.4103/jpgm.jpgm_338_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S Karande
- Department of Pediatrics, Seth G. S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - S Mahalawat
- Department of Pediatrics, Seth G. S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - M Muranjan
- Department of Pediatrics, Seth G. S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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Affiliation(s)
- S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - G A Marraro
- Healthcare Accountability Lab, University of Milan, Milano, MI, Italy
| | - C Spada
- Healthcare Accountability Lab, University of Milan, Milano, MI, Italy
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Karande S, Mahalawat S, Muranjan M. Spontaneous pneumothoraces complicating acute miliary tuberculosis in a child having recent coronavirus disease 2019. J Postgrad Med 2021. [DOI: 10.4103/0022-3859.190165] [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: 11/04/2022] Open
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Affiliation(s)
- S Tyagi
- Department of Forensic Medicine and Toxicology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Karande S, Mahalawat S, Muranjan M. Spontaneous pneumothoraces complicating acute miliary tuberculosis in a child having recent coronavirus disease 2019. J Postgrad Med 2021. [DOI: 10.4103/0022-3859.190167] [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: 11/04/2022] Open
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Affiliation(s)
- S Mhatre
- Department of Pediatrics, Genetic Clinic, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - M Muranjan
- Department of Pediatrics, Genetic Clinic, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Genetic Clinic, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Karande S, Kumar S, Vaideeswar P. How often is coarctation of aorta correctly diagnosed antemortem in children with fatal illnesses? A retrospective review of medical and autopsy records. J Postgrad Med 2020; 66:169-171. [PMID: 32675455 PMCID: PMC7542064 DOI: 10.4103/jpgm.jpgm_125_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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This retrospective study analyzed the level of concordance between clinical and autopsy diagnosis of coarctation of aorta over 10 years. Utilizing the Goldmann classification, the concordance rate was found to be 16%. Major discrepancies (Class I and II) were found in 56% cases and minor discrepancies (Class III and IV) in 28% cases.
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Affiliation(s)
- S Karande
- Department of Pediatrics, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai, Maharashtra, India
| | - S Kumar
- Department of Pediatrics, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai, Maharashtra, India
| | - P Vaideeswar
- Department of Pathology (Cardiovascular and Thoracic Division), Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai, Maharashtra, India
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Vaideeswar P, Karande S. Congenital absence of the left atrial appendage. J Postgrad Med 2020; 66:108-109. [PMID: 32134007 PMCID: PMC7239408 DOI: 10.4103/jpgm.jpgm_671_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- P Vaideeswar
- Department of Pathology (Cardiovascular and Thoracic Division), Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Karande S, Ramadoss D, Gogtay N. Economic burden of slow learners: A prevalence-based cost of illness study of its direct, indirect, and intangible costs. J Postgrad Med 2020; 65:219-226. [PMID: 31441438 PMCID: PMC6813681 DOI: 10.4103/jpgm.jpgm_105_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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims: The primary objective of this study was to evaluate the economic burden of slow learners (students with “borderline intellectual functioning”) by estimating its direct, indirect, and intangible costs. The secondary objective was to assess the impact of variables on the economic burden. Settings and Design: Cross-sectional, single-arm descriptive study. Setting: Learning disability clinic in a public medical college in Mumbai. Materials and Methods: The study cases (age ≥5 - 18 years) were recruited by nonprobability sampling. A structured questionnaire was used to interview the parent to collect data related to direct and indirect costs. Intangible costs data were collected by documenting the willingness-to-pay value using the contingent valuation technique. Statistical Analysis Used: A quantile regression model was used to assess the impact of predictor variables on the costs. Results: The direct, indirect, and intangible costs of slow learners were INR 6,065,915, 10,298,613, and 145,172,800, respectively. Indirect costs comprised 62.9% of the total costs. Expenditure on tuitions, medications, and remedial education comprised 57.38%, 16.18%, and 10.30% of the direct costs, respectively. The average annual total costs of slow learners were INR 3,544,880. The average annual learning disability clinic costs were INR 2,250,194. The average annual total costs per student were INR 57,951. Longer duration of poor school performance was predictive of higher direct and total costs. Conclusion: The economic burden of slow learners is enormous (intangible > indirect > direct costs). Tuitions are the most costly component of direct costs. Parental loss of earnings is the most costly component of indirect costs.
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Affiliation(s)
- S Karande
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - D Ramadoss
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - N Gogtay
- Department of Clinical Pharmacology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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Karande S, D'souza S, Gogtay N, Shiledar M, Sholapurwala R. Economic burden of specific learning disability: A prevalence-based cost of illness study of its direct, indirect, and intangible costs. J Postgrad Med 2020; 65:152-159. [PMID: 31169134 PMCID: PMC6659427 DOI: 10.4103/jpgm.jpgm_413_18] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims: The primary objective of the present study was to evaluate the economic burden of specific learning disability (SpLD) by estimating its direct, indirect, and intangible costs. A secondary objective was to assess the impact of variables on the economic burden. Settings and Design: Cross-sectional single-arm descriptive study. Setting: Learning disability clinic in a public medical college in Mumbai. Subjects and Methods: The study cases (aged ≥8 years) were recruited by non-probability sampling. A structured questionnaire was used to interview the parent/guardian to collect data related to direct and indirect costs. Intangible costs data were collected by documenting the willingness-to-pay value using the contingent valuation technique. Statistical Analysis Used: A quantile regression model was used to assess the impact of predictor variables on the costs. Results: The direct, indirect, and intangible costs due to SpLD were Indian Rupees (INR) 5,936,053, 29,261,220, and 42,295,000, respectively. Indirect costs comprised 83.1% of the total costs. Expenditure on tuitions and remedial education comprised 61.61% and 64.39% of the indirect and direct costs, respectively. The average annual learning disability clinic costs were INR 2,169,888. The average annual total costs per student were INR 90,773. Longer duration of poor school performance was predictive of higher direct, indirect, and total costs; and higher socioeconomic status was predictive of lower intangible costs. Conclusion: SpLD is a cost-intensive disability (intangible > indirect > direct costs). Tuitions, which are not the therapy for SpLD, are the most costly component of indirect costs. Remedial education is the most costly component of direct costs.
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Affiliation(s)
- S Karande
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India
| | - S D'souza
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India
| | - N Gogtay
- Department of Clinical Pharmacology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India
| | - M Shiledar
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India
| | - R Sholapurwala
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India
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Sanju S, Tullu MS, Karande S, Muranjan MN, Parekh P. Beta-thalassemia major complicated by intracranial hemorrhage and critical illness polyneuropathy. J Postgrad Med 2020; 65:171-176. [PMID: 31317877 PMCID: PMC6659433 DOI: 10.4103/jpgm.jpgm_127_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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Intracranial hemorrhage (ICH) is rarely seen in patients with thalassemia. A seven-year-old male, known case of beta-thalassemia major, on irregular packed cell transfusions (elsewhere) and non-compliant with chelation therapy, presented with congestive cardiac failure (Hb-3 gm/dl). He received three packed red cell transfusions over 7 days (cumulative volume 40 cc/kg). On the 9th day, he developed projectile vomiting and two episodes of generalized tonic-clonic convulsions with altered sensorium. He had exaggerated deep tendon reflexes and extensor plantars. CT-scan of brain revealed bilateral acute frontal hematoma with diffuse subarachnoid hemorrhage (frontal and parietal). Coagulation profile was normal. CT-angiography of brain showed diffuse focal areas of reduced caliber of anterior cerebral, middle cerebral, and basilar and internal carotid arteries (likely to be a spasmodic reaction to subarachnoid hemorrhage). He required mechanical ventilation for 4 days and conservative management for the hemorrhage. However, on the 18th day, he developed one episode of generalized tonic-clonic convulsion and his sensorium deteriorated further (without any new ICH) and required repeat mechanical ventilation for 12 days. On the 28th day, he was noticed to have quadriplegia (while on a ventilator). Nerve conduction study (42nd day) revealed severe motor axonal neuropathy (suggesting critical illness polyneuropathy). He improved with physiotherapy and could sit upright and speak sentences at discharge (59th day). The child recovered completely after 3 months. It is wise not to transfuse more than 20 cc/kg of packed red cell volume during each admission and not more than once in a week (exception being congestive cardiac failure) for thalassemia patients.
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Affiliation(s)
- S Sanju
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - M S Tullu
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - M N Muranjan
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - P Parekh
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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Karande S. Journal of Postgraduate Medicine 2016-2020: The editor's report. J Postgrad Med 2020; 66:61-62. [PMID: 32270776 PMCID: PMC7239405 DOI: 10.4103/jpgm.jpgm_165_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- S Karande
- Departments of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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28
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Affiliation(s)
- MS Tullu
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
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29
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Affiliation(s)
- M Muranjan
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
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Abstract
Aim Anxiety disorders usually remain undiagnosed in school students owing to the internalized nature of their symptoms. The present study was conducted with the primary objective of evaluating the prevalence of anxiety symptoms in school students in Mumbai. A secondary objective was to assess the impact of variables (age, gender, presence of sibling, and type of school curriculum or school) on anxiety symptoms. Materials and Methods Study cases (8-15 year olds) were recruited by nonprobability sampling from four English-medium schools. Anxiety was measured using Spence Children's Anxiety Scale (SCAS)-child self-report questionnaire. T-scores (total and subscales) were calculated and cut-off scores of> 60 were considered as significant. Results Symptoms of overall anxiety were present in 10.8% (53/493) of the students. Older students (12-15 year olds) had greater odds of having overall anxiety symptoms (crude OR = 4.36, 95% CI 2.27 to 8.39, P < 0.0001). Symptoms of all anxiety disorders were present in the 493 participants, with obsessions/compulsions and fears of physical injury being the most common (in 29.6% and 27.2%, respectively). Older students and boys had greater odds of having obsessions/compulsions (crude OR = 2.32, 95% CI 1.56 to 3.44, P < 0.0001; and crude OR = 1.54, 95% CI 1.04 to 2.27, P= 0.035, respectively]. Students with sibling (s) had greater odds of having fears of physical injury (crude OR = 0.48, 95% CI 0.30 to 0.78, P= 0.003). Conclusions There is an urgent need to screen school students in our city for anxiety disorders.
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Affiliation(s)
- S Karande
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - N J Gogtay
- Clinical Pharmacology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - N Bala
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - H Sant
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - A Thakkar
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - R Sholapurwala
- Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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Muranjan M, Karande S, Sankhe S, Eichler S. Childhood cerebral X-linked adrenoleukodystrophy with atypical neuroimaging abnormalities and a novel mutation. J Postgrad Med 2019; 64:59-63. [PMID: 29386416 PMCID: PMC5820819 DOI: 10.4103/jpgm.jpgm_349_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Childhood cerebral X-linked adrenoleukodystrophy (XALD) typically manifests with symptoms of adrenocortical insufficiency and a variety of neurocognitive and behavioral abnormalities. A major diagnostic clue is the characteristic neuroinflammatory parieto-occipital white matter lesions on magnetic resonance imaging. This study reports a 5-year 10-month old boy presenting with generalized skin hyperpigmentation since 3 years of age. Over the past 9 months, he had developed right-sided hemiparesis and speech and behavioral abnormalities, which had progressed over 5 months to bilateral hemiparesis. Retrospective analyses of serial brain magnetic resonance images revealed an unusual pattern of lesions involving the internal capsules, corticospinal tracts in the midbrain and brainstem, and cerebellar white matter. The clinical diagnosis of childhood cerebral adrenoleukodystrophy was confirmed by elevated basal levels of adrenocorticotropin hormone and plasma very long chain fatty acid levels. Additionally, sequencing of the ABCD1 gene revealed a novel mutation. The only specific palliative therapy that could be offered after diagnosis was dietary intervention. The patient died within 16 months of onset of neurological symptoms. Awareness that childhood cerebral XALD can present with atypical neuroimaging patterns early in its course may aid diagnosis at a stage when definitive treatment can be attempted and timely genetic counseling be offered to the family.
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Affiliation(s)
- M Muranjan
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - S Sankhe
- Department of Radiology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - S Eichler
- Centogene AG, Schillingallee 68, Rostock, Germany
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Bajaj S, Muranjan M, Karande S, Prabhat D. Rare disease heralded by pulmonary manifestations: Avoiding pitfalls of an "asthma" label. J Postgrad Med 2019; 63:122-127. [PMID: 28272068 PMCID: PMC5414422 DOI: 10.4103/0022-3859.201416] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary manifestations are seldom recognized as symptoms of storage disorders. The report describes the diagnostic journey in a 30-month-old male infant, born of a third-degree consanguineous marriage referred to our institute as severe persistent asthma. History revealed that the child had progressively worsening breathlessness and persistent dry cough not associated with fever but accompanied by weight loss. On physical examination, there was growth failure, respiratory distress, clubbing, hepatosplenomegaly, and occasional rhonchi. Blood gas revealed hypoxemia which improved with oxygen administration. Plain X-rays and high-resolution computed tomography of the chest showed perihilar alveolar infiltrates and patchy consolidation. The clinicoradiological features did not support a diagnosis of asthma but favored interstitial lung disease (ILD). Bronchoalveolar lavage was performed as a first-tier investigation. It showed periodic acid-Schiff-negative foamy macrophages. The clues of consanguinity, visceromegaly, ILD, and foamy macrophages in the bronchoalveolar fluid prompted consideration of lysosomal storage disorders as the likely etiology. Gaucher disease and Niemann-Pick disease A/B were ruled out by enzyme estimation. Niemann-Pick disease type C was suspected and confirmed by detecting a homozygous mutation in the NPC2 gene. This case serves to caution physicians against labeling breathlessness in every toddler as asthma. It emphasizes the importance of searching for tell-tale signs such as clubbing and extrapulmonary clues which point to a systemic disease such as lysosomal storage disorders as a primary etiology of chronic respiratory symptoms.
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Affiliation(s)
- S Bajaj
- Department of Pediatrics, Genetic Clinic, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - M Muranjan
- Department of Pediatrics, Genetic Clinic, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Genetic Clinic, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - D Prabhat
- Department of Pathology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Affiliation(s)
- H Kulkarni
- Department of Paediatric Respiratory Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield S10 2TH, UK
| | - S Kansra
- Department of Paediatric Respiratory Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield S10 2TH, UK
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Affiliation(s)
- S S Joshi
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Y C Shetty
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Grewal M, Gupta S, Muranjan M, Karande S. Managing pulmonary embolism secondary to suppurative deep vein thrombophlebitis due to community-acquired Staphylococcus aureus in a resource-poor setting. J Postgrad Med 2018; 64:164-169. [PMID: 29943741 PMCID: PMC6066628 DOI: 10.4103/jpgm.jpgm_548_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Deep vein thrombosis and pulmonary thromboembolism are rare and life threatening emergencies in children. We report an 11-year old female who presented with acute complaints of high grade fever, pain in the left thigh and inability to walk and breathlessness since 6 days. On physical examination, there was a diffuse tender swelling of the left thigh, tachypnea, tachycardia with hyperdynamic precordium and bilateral basal crepitations. Ultrasonography and venous doppler of lower limbs showed mild effusion of left hip joint and thrombus in the left common femoral vein and left external iliac vein suggesting a diagnosis of septic arthritis with thrombophlebitis. The tachypnea and tachycardia which was out of proportion to fever and crepitations on auscultation prompted suspicion of an embolic phenomenon. Radiograph of the chest revealed multiple wedge shaped opacities in the right middle zone and lower zone suggestive of pulmonary embolism and left lower zone consolidation. For corroboration, computed tomography pulmonary angiography and computed tomography of abdomen was performed which showed pulmonary thromboembolism and deep venous thrombosis extending up to infrarenal inferior vena cava. On further workup, magnetic resonance imaging of hips showed left femoral osteomyelitis and multiple intramuscular abscesses in the muscles around the hip joint. Blood culture grew methicillin resistant Staphylococcus aureus. Antibiotics were changed according to culture sensitivity and there was a dramatic response. After four weeks of anticoagulation and antibiotics the child became asymptomatic and thrombus resolved. Thus, it is crucial to consider methicillin resistant Staphylococcus aureus infection as an important infection when we encounter such a clinical scenario. This case report highlights an unusual and potentially life threatening presentation of a virulent strain of a common pathogen, which when diagnosed was completely amenable to treatment.
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Affiliation(s)
- M Grewal
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Gupta
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - M Muranjan
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Karande S, Deshmukh N, Rangarajan V, Agrawal A, Sholapurwala R. Brain SPECT scans in students with specific learning disability: Preliminary results. J Postgrad Med 2018; 65:33-37. [PMID: 29882521 PMCID: PMC6380134 DOI: 10.4103/jpgm.jpgm_61_18] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives: Brain single-photon emission computed tomography (SPECT) assesses brain function through measurement of regional cerebral blood flow. This study was conducted to assess whether students with newly diagnosed specific learning disability (SpLD) show any abnormalities in cerebral cortex perfusion. Settings and Design: Cross-sectional single-arm pilot study in two tertiary care hospitals. Subjects and Methods: Nine students with SpLD were enrolled. Brain SPECT scan was done twice in each student. For the first or “baseline“ scan, the student was first made to sit with eyes open in a quiet, dimly lit room for a period of 30–40 min and then injected intravenously with 20 mCi of 99mTc-ECD. An hour later, “baseline scan“ was conducted. After a minimum gap of 4 days, a second or “test scan“ was conducted, wherein the student performed an age-appropriate curriculum-based test for a period of 30–40 min to activate the areas in central nervous system related to learning before being injected with 20 mCi of 99mTc-ECD. Statistical Analysis Used: Cerebral cortex perfusion at rest and after activation in each student was compared qualitatively by visual analysis and quantitatively using NeuroGam™ software. Results: Visual analysis showed reduction in regional blood flow in temporoparietal areas in both “baseline“ and “test“ scans. However, when normalization was attempted and comparison done by Talairach analysis using NeuroGam software, no statistically significant change in regional perfusion in temporoparietal areas was appreciated. Conclusion: Brain SPECT scan may serve as a robust tool to identify changes in regional brain perfusion in students with SpLD.
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Affiliation(s)
- S Karande
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - N Deshmukh
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - A Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - R Sholapurwala
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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Affiliation(s)
- MS Tullu
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Aggarwal S, Karande S. Internet for child mental health: Boon or bane. J Postgrad Med 2018; 64:131-133. [PMID: 29943742 PMCID: PMC6066623 DOI: 10.4103/jpgm.jpgm_57_18] [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: 11/20/2022] Open
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Ramadoss D, Karande S, Muranjan M, Wagle P. Precursor B-cell acute lymphoblastic leukemia: An unusual cause of bilateral nephromegaly in an infant. J Postgrad Med 2017; 63:271-272. [PMID: 29022564 PMCID: PMC5664875 DOI: 10.4103/jpgm.jpgm_231_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- D Ramadoss
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - M Muranjan
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - P Wagle
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Affiliation(s)
- MS Tullu
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Affiliation(s)
- SB Bavdekar
- Department of Pediatrics, T. N. Medical College and B.Y.L. Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Affiliation(s)
- S Karande
- Department of Pediatrics, Learning Disability Clinic, Seth G. S. Medical College, KEM Hospital, Mumbai, Maharashtra, India
| | - A Agarwal
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- M S Tullu
- Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Rapose A, Karande S. Tuberculosis, human immunodeficiency virus, and the immune reconstitution inflammatory syndrome. J Postgrad Med 2017; 63:207-209. [PMID: 29022559 PMCID: PMC5664861 DOI: 10.4103/jpgm.jpgm_365_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Thakkar AN, Karande S, Bala N, Sant H, Gogtay NJ, Sholapurwala R. Is anxiety more common in school students with newly diagnosed specific learning disabilities? A cross-sectional questionnaire-based study in Mumbai, Maharashtra, India. J Postgrad Med 2016; 62:12-9. [PMID: 26482116 PMCID: PMC4944323 DOI: 10.4103/0022-3859.167663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Objectives: School students with specific learning disabilities (SpLDs) experience chronic academic underachievement and resultant stress. The present study aimed to determine if school students with newly diagnosed SpLD were more likely to have anxiety than their regular peers. Materials and Methods: The study cases (aged 8-15 years) were recruited from our institute's learning disability clinic. The matched controls were recruited from four schools in Mumbai, Maharashtra, India. Anxiety was measured using the Spence Children's Anxiety Scale (SCAS)-child self-report version questionnaire. Median SCAS scores and the proportion of students with an SCAS score in the “clinical anxiety” range were compared between the groups. Results: SCAS scores were significantly higher in 8-11-year-old learning-disabled male and female students (P < 0.0001 for both groups) and 12-15-year-old female students (P = 0.004), as compared with matched controls. A significantly higher number of learning-disabled students were found to have “clinical anxiety” [24.64% vs 4.35%, crude odds ratio (OR) = 7.19, 95% confidence interval (CI) 2.91-17.78, P = 0.0001], as compared with the controls regardless of gender, age group, presence of comorbid attention-deficit/hyperactivity disorder (ADHD), or associated medical conditions. A significantly higher proportion of 8-11-year-old learning-disabled students, especially males, were found to have “clinical anxiety” as compared with 12-15-year-old learning-disabled students (crude OR = 4.38, 95% CI 1.94-9.92, P = 0.0004). Gender, presence of comorbid ADHD or associated medical conditions, and type of school attended or curriculum did not impact the prevalence of “clinical anxiety” in learning-disabled students. Interpretation and Conclusions: Students with newly diagnosed SpLD have greater odds of being “clinically anxious” relative to their regular peers. We recommend screening for anxiety in children with SpLD immediately after diagnosis so that their optimum rehabilitation can be facilitated.
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Affiliation(s)
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, India
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Affiliation(s)
- S Karande
- Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Abstract
BACKGROUND Specific learning disability (SpLD) often remains undetected, resulting in the afflicted child experiencing chronic poor school performance. AIMS To measure and analyze the self-perceived health-related quality of life (HRQoL) of children with newly-diagnosed SpLD. SETTINGS AND DESIGN Cross-sectional questionnaire-based study in our clinic. MATERIALS AND METHODS From February to December 2008, 150 children consecutively diagnosed as having SpLD were enrolled and their HRQoL documented using the DISABKIDS chronic generic module self-report version instrument. STATISTICAL ANALYSIS Multiple regression analysis was carried out for determining the 'independent' impact that each of the clinical and socio-demographic variables had on a poor facet score outcome and on a poor total score outcome. RESULTS Clinically significant deficits were detected in all 6 facets, namely: 'large deficits (effect size ≥-0.8)' in "social exclusion", "emotion", "limitation", "treatment", and "independence"; and 'medium deficit (effect size -0.5 to <-0.8)' in "social inclusion"; and 'large deficit' in "total score". Multivariate analysis revealed that: (i) not belonging to the upper socio-economic strata of society was an independent predictor of a poor "independence" facet outcome (P=0.010, OR=1.99, 95% CI: 1.18 to 3.37); (ii) not having experienced class detainment was an independent predictor of a poor "emotion" facet outcome (P=0.008, OR=3.04, 95% CI: 1.34 to 6.85); (iii) first-born status was an independent predictor of a poor "limitation" facet outcome (P=0.022, OR=2.60, 95% CI: 1.15 to 5.90); and (iv) female gender was an independent predictor of a poor "social exclusion" facet outcome (P=0.024, OR=0.28, 95% CI: 0.09 to 0.85) and a poor "overall health" outcome (P=0.025, OR=0.32, 95% CI: 0.12 to 0.87). CONCLUSIONS Children with newly-diagnosed SpLD perceive their psychosocial, physical, and overall HRQoL to be significantly compromised.
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Affiliation(s)
- S Karande
- Department of Pediatrics, Division of Pediatric Neurology, Learning Disability Clinic, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
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Karande S, Kuril S. Impact of parenting practices on parent-child relationships in children with specific learning disability. J Postgrad Med 2011; 57:20-30. [DOI: 10.4103/0022-3859.75344] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
BACKGROUND Poor school performance in children causes significant stress to parents. AIMS To analyze the quality of life (QOL) of parents having a child with newly diagnosed specific learning disability (SpLD) and to evaluate the impact of clinical and socio-demographic characteristics on their QOL. DESIGN Cross-sectional questionnaire-based study. SETTING Learning disability clinic in tertiary care hospital. MATERIALS AND METHODS From June 2006 to February 2007, 150 parents (either mother or father) of children consecutively diagnosed as having SpLD were enrolled. Parent's QOL was measured by the WHOQOL-100 instrument which is a generic instrument containing 25 facets of QOL organized in six domains. STATISTICAL ANALYSIS USED Independent samples t-test, one-way analysis of variance, and multiple regression analysis were carried out for statistical significance. RESULTS Mean age of parents was 42.6 years (SD 5.5); mothers to fathers ratio 1.3:1; and 19 (12.7%) were currently ill. Only four WHOQOL-100 domains (psychological > social relationships > environment > spiritual) and five WHOQOL-100 facets (leisure > feel > energy > esteem > sex) contributed significantly to their "overall" QOL. Female gender, being currently ill, being in paid work, and having a male child were characteristics that independently predicted a poor domain/facet QOL score. CONCLUSIONS The present study has identified domains and facets that need to be addressed by counselors for improving overall QOL of these parents. Initiating these measures would also improve the home environment and help in the rehabilitation of children with SpLD.
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Affiliation(s)
- S Karande
- Learning Disability Clinic, Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai 400 022, India.
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