The Effect of Steamed Tempeh on Hemoglobin Levels and Body Weight in Pregnant Women at the Kalar - Kalar Health Center, Aru Islands District

Background: Nutrition of pregnant women is very influential on fetal growth, one of which is iron deficiency anemia. Iron deficiency increases in pregnant women with increasing age in pregnancy. Significantly low intake of nutrients will make pregnant women experience Chronic Energy Deficiency. The nutritional content of tempeh can be used to meet the nutritional needs of pregnant women. Objective: The aim of this study was to analyze the effect of giving steamed tempeh to the increase in hemoglobin and Body Weight levels in pregnant women at the Kalar-kalar Health Center, Aru Islands Regency. Method: This type of research is a quasi-experimental with a pre-posttest control group design. The intervention was given to the respondents as many as 24 people with 12 people in the control group and 12 people in the treatment group. Sampling purposive sampling. Subjects were taken from two villages in the working area of ​​the Kalar-Kalar Public Health Center which have relatively the same geography and socioeconomic status and only pregnant women with Hb <11 G/dL were selected. The form of treatment was giving 100 G of steamed tempeh 2 times a week for 30 days while the control group was given biscuits for pregnant women 2 times per week 100 G. Data analysis used univariate and bivariate analysis with paired T test and Mann Whitney. Results: Mann Whitney test results of the effect of steamed tempeh on weight gain in the treatment group obtained a p-value of 0.050 (p=0.05). Differences in hemoglobin levels in anemic pregnant women with a p-value of 0.018 (<0.05) with a mean difference of 0.42 G/dL in the pre-posttest treatment group and the control group with a p-value of 0.217 (<0.05) with a mean difference of 0.21 G/d dL. Conclusion: There is an effect of giving steamed tempeh to increase hemoglobin and body weight in pregnant women. Keywords: Anemia, Pregnant women, Hemoglobin, Body Weight, Tempeh.

A Study on Pharmacist Mediated Intervention in Identifying and Reporting of Adverse Drug Reactions at a Tertiary Care Hospital

Background: Adverse drug reactions are major problem in health care system due to its consequences - morbidity, mortality and health care cost. Recent epidemiologic research reveals that the total incidence rate of ADRs was 6.7%, with an overall fatality rate of 0.32%. Method: A prospective observational study was carried out for 6 months in a tertiary care hospital. Patients admitted to the department of medicine, Pediatrics, orthopedics & surgery were selected randomly and followed from date of admission to date of discharge by enrolling into the study by considering the study criteria. Results: During the research about 27 ADRs were recognized & reported. Among them 14 (51.86%) patients were male and 13(48.14%) were female patients. The system or organ most commonly involved was Blood disorders were 8 (29.62%). Type A were 16(57.25%) reactions followed by Type B were 8 (29.62%); Type C were 3 (11.11%). Study depicts drug class usually implicated with ADRs was Antibiotics and antineoplastic drugs were 6 (22.22%) followed by Anti-Tubercular were 3 (11.11%); NSAIDS and Antidiabetic drugs were 2 (7.4%); The least implicated (3.7%) drug class are Anti-Pyretic, Diuretics and Antiretroviral. Causality was assessed for all the reported reactions are found to be PROBABLE according to WHO-UMC Scale. Conclusion: The study report shows that incidence of ADRs is steadily increasing. Under reporting of ADR is a major problem in India. Clinical Pharmacist plays a vital role in surveillance and prevention of ADRs. Keywords: Adverse Drug Reactions, Pharmacovigilance, Causality.

Pattern of Congenital Overt and Occult Pediatric Surgical Anomalies in a Tertiary Care Centre Over 5 Years

ongenital anomalies are important cause of infant and childhood deaths, chronic illness and disability. The proportion of deaths and disability due to congenital anomalies has increased, as deaths due to other diseases have decreased over the years due to better health care. Hence it is essential to have basic epidemiological information of these anomalies. This is a hospital based, cross-sectional, record based study, conducted in the Department of Pediatric Surgery, Govt. Medical College Thiruvananthapuram, Kerala. Sample size included 300 children below the age of 12years admitted in the department of pediatric surgery with various major congenital anomalies, over a period of 5 years. More than half of these children were admitted after infancy for treatment, male children were more compared to females. Majority of these children were from low socioeconomic group. Only in 5.6% cases there was a history of consanguineous marriage. In 7.33% there was family history of congenital anomalies. In 32% cases the anomalies were detected in the antenatal period. Most of the anomalies were isolated anomalies. Genitourinary system was the most common system to be involved followed by, gastrointestinal tract. 91.67% children underwent surgical treatment, and only 10.67% children had major complications in postoperative period. This study shows that congenital anomalies are a major cause of hospital admissions in children of all ages. Pattern of anomalies seen in various centers are different. Knowledge of the pattern of congenital anomalies may be useful in planning health services. Keywords: Congenital, Anomalies, Pediatric surgery.

Elicitation of Hidden Expectations of Customers in Healthcare Service

In healthcare service, the customer feedback is often incomplete unless the unexpressed expectations are captured at the right time. These latent feelings and opinions are the ‘hidden expectations’ which are the quality indicators of the service offered. This short communication paper describes a couple of techniques for elicitation of hidden expectations of customers in the context of healthcare services. As an illustration, the paper depicts the application of these techniques for identification and prioritization of hidden expectations at a diagnostic center. Any organization in healthcare service sector could employ these techniques quickly and conveniently to improve quality of service thereby enhancing customer satisfaction. Keywords: Elicitation, Customer satisfaction, Hidden expectation, MoSCoW, Healthcare.

A Clinical Study on the Incidence and Visual Outcome after Surgical Management of Lens-Induced Glaucoma

Aims and Objectives: To determine 1) the incidence of lens-induced glaucoma. 2) the more prevalent type of LIG. and 3) Visual outcome following surgical management of LIG. Material and Methods: 50 patients of lens-induced glaucoma, who presented in OPD of Regional Institute of Ophthalmology, were included in the study. All patients were admitted and managed in indoor wards. Informed and written consents were taken. A detailed history and a thorough ocular examination was done. Surgical correction was done by SICS or Phacoemulsification or triple procedures operations. Results: A standardized proforma was used to compile data and it was analyzed statistically using Chi-square test and Probability value. The incidence of LIG was found to be 0.174 among all OPD attendees. Phacomorphic glaucoma (58%) was found to be the highest followed by phacolytic glaucoma (32%). No significant association with respect to sex and age of the cases was found. The presenting symptoms varied in severity and were directly proportional to the degree of rise of IOP. 38% of cases in our study achieved best corrected visual acuity of 6/9 and 28% achieved 6/12 acuity at the end of 6 weeks. Visual outcome was found to be better for cases with early detection and treatment. Conclusion: The mainstay to prevent and treat LIG is early diagnosis and treatment of cataract. Delayed treatment of LIG may result in poor visual outcome. Keywords: LIG, IOP, Phacomorphic glaucoma, Phacolytic glaucoma, SICS, Phacoemulsification.

Impact of COVID-19 on Surgical Residency Training: Indian Perspective - A Review

Introduction: The COVID-19 pandemic has severely affected the health delivery system. The residency training program has had a major setback, with a maximum impact on Surgical residency training. This study attempts to explore the extent of impact of COVID-19 on Surgical Residency training and the corrective measures to be taken from the trainee’s perspective. Methods: A Questionnaire was made and response was sought from the surgical trainees. The aspects of surgical training assessed were; the impact on hands on surgical training, bed-side clinical teaching, efficacy of the alternative virtual academic program and the OSCE based assessment. Suggestions were also sought with regards to the remedial measures needed to be taken. The responses were compiled and conclusion was drawn. Statistical analysis was made using SPSS software programme. Results: A total of 68 residents participated in the survey. Of these, 17 (25.37%) were first year residents (6 from Govt and 11 from private institute), 26 (38.23%) second year (9 from Govt and 17 from private institute), and 25 (36.76%) third year residents (10 from Govt and 15 from private institute). The responses were analysed. All respondents reported decrease in clinical workload ranging from 50 to 90 %. The reported loss of surgical experience too ranged from 50-90% depending on the seniority of the residents. Operative autonomy too was experienced by only 13.23% of respondents. Reported decrease in the Bed side clinical training ranged from 50 to 95% All the respondents reported increase and benefits of online academic sessions with overall score >5 on a scale of 1-10. All the respondents (100%) approved of the OSCE pattern of exams held by the NBE board. Conclusions: The COVID-19 pandemic has adversely impacted surgical training. There is a need to assess the future training program advancement, with the need to include remedial measures, and adopting an individualized approach. The OSCE pattern of examination conducted has been accepted by all and recommended to be integrated as a part of the practical exams in future too. The virtual learning and telemedicine embraced in the time of pandemic, has had a great impact in enhancing surgical education Keywords: COVID 19-infection, Impact on Residency training Program

A Cross-Sectional Study of Clinical and Immunological Profile of SLE Patients from a Tertiary Care Center in the Sub Himalayan Region of Northern India

Introduction: Systemic Lupus Erythematosus (SLE) is a disease of thousand faces whose manifestations vary with the interplay of genetic, ethnic, and host factors along with environmental exposures and geographical conditions. Since the first case of SLE reported in India in 1955, many case series have been published from various centers depicting Clinical and Immunological features in the Indian population. This study was undertaken to study the clinical and immunological profile in a tertiary care center in the sub-Himalayan region of northern India. Materials and Methods: This study is a cross-sectional retrospective study conducted at a tertiary care center in the hilly northern state of Himachal Pradesh over a period of 1 year; from 1st June 2017 to 31st May 2018. The records of all patients admitted in the study period with the department of medicine and diagnosed with SLICC 2012 classification criteria were studied to abstract the Clinical and Immunological profile of patients. Results: A total of sixty-nine patients were included in the study. 96% of the subjects were female patients, and 84 % of the patients were in the reproductive age group of 20 – 40 years. Mucocutaneous manifestations were most commonly seen in nearly 89 % of patients followed by musculoskeletal involvement in about 71 %. Hematological involvement was more frequent than reported in the literature. Lupus Nephritis was diagnosed in about 30 % of the patients. Fatigue and synovitis were the most common features, followed by oral ulcers and Acute cutaneous lupus. ANA and ds DNA positivity was 98.5 and 72.4 % respectively. Six cases of MCTD were d=found in the study group. Conclusion: In hospitalized SLE patients admitted in a tertiary care center of the northern hilly state, females of reproductive age group constituted the majority of patients. Mucocutaneous, Musculoskeletal, hematological, and renal involvement was most prevalent. Keywords: SLE, cross-sectional study, Mucocutaneous involvement, Renal Biopsy, Hilly area.

Plasma Zinc Levels, Lipid Profile Parameters and CVD Risk Markers in Relation to Glycemic Status in T2 DM Patients

Background: Diabetes is global endemic rapidly increasing in both developed and developing countries and is a common secondary cause of hyperlipidaemia in T2DM patients. Diabetic- dyslipidemic patients exhibit atherogenic lipid profile, which greatly increases their CVD risk. Zinc, essential trace element, has significant function in energy metabolism and has been shown to serve a regulatory role in insulin signalling pathway and in supporting structural integrity of endothelial cells. A study designed to assess the plasma zinc status in t2 dm patients and to correlate zinc levels with lipid parameters, CVD markers as well as with glycemic status. Methods: The t2dm patients in the age group 30-60 years were randomly selected and were sub-grouped age wise, glycemic status-wise and diabetic duration-wise. Fasting Glucose, lipid parameters and zinc were estimated and atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC), and Cardiac Risk Ratio (CRR) were calculated. Results: The results shows levels of glucose, lipid parameters, AIP, AC and CRR are significantly elevated whereas the levels of HDLC and zinc are significantly lowered in t2dm patients and the rises as well as the fall in HDLC and zinc are proportional to glycemic status. Conclusion: It can be concluded from the present study that zinc levels are lower in t2dm patients and is reciprocally related to glycemic status as well as to the diabetic duration. Further the rise in CVD markers is directly proportional to the glycemic status but inversely related to CVD markers. Keywords: t2dm, CVD markers, glycemic status, zinc.

Correlation of Urine Dipstick Test with Spot Urine Protein-Creatinine Ratio in Women with Preeclampsia: A Cross Sectional Study

Background: Preeclampsia is one of the leading causes for the maternal and perinatal morbidity and mortality. Increase level of proteinuria is worsening condition for the pregnant women with hypertension. Objective: Our study aimed to compare urine dipstick method with P/C ratio to know the proteinuria level in hypertensive pregnant women. Material and Methods: This Cross-sectional study was conducted on 100 antenatal women with preeclampsia in Department of obstetrics and gynecology, CAIMS Karimnagar. Antenatal cases with pre-eclampsia of more than 20 weeks gestation were included in the study and Urinary Tract Infection, Diabetic, renal function disorder were excluded from study. After getting patients consent detailed history were taken, general physical and systemic including obstetric examination was done Association between the variable analyzed by using chi-square or fisher exact test and quantitative variable compare using ANOVA and Pearson correlation coefficient. P-value<0.05 considered as significant Result: Among 100 patients admitted, there are 50 cases having mean age was 25±3.266 Years, systolic blood pressure was 156.5±21.94mmhg. Association between P/C ratio and urine dipstick was statistically significant and also correlation between urine dipstick and P/C ratio was moderately correlated (r= 0.564) and highly significant (p-value <0.05) Conclusion: Our study conclude that Urine dipstick method and P/C ratio has strong correlation between them with high accuracy, at 2+or greater level it can used to estimate significant proteinuria or spot urine P/C ratio for screening pregnant women with suspected preeclampsia. Also, this method is convenient and cost effective for patient. Keywords: Preeclampsia, Proteinuria, Urine Dipstick, Antenatal.

Effectiveness of Video Assisted Teaching on Knowledge Regarding Breast Self Examination among Women in Selected Rural Area at Villupuram District

Aim: The study aims to create awareness among women regarding incidence, risk factors, clinical symptoms, prevention and management of Breast Cancer through Breast self examination. Objectives: i) To assess the pre and post test level of knowledge regarding Breast self examination among women. ii) to assess the effectiveness of video assisted teaching on knowledge regarding Breast self examination among women. iii) to find the association between post test level of knowledge regarding breast self examination among women with their demographic variables. Methods Material: A quantitative research approach - experimental - pre- experimental-one group- pre -test post-test research design was adopted. 30 samples were selected for the study by using non probable-purposive sampling technique. Results: the study findings shows that in pre test level of knowledge among 30 samples 25(83.4%) had inadequate knowledge and 5(16.6%) had moderate adequate knowledge. In post test level of knowledge among 30 sample 8(26.6%) had moderate adequate knowledge and 22(73%) had adequate knowledge. Conclusion: the study concluded that, video assisted teaching programme regarding breast self examination was effective on improving the knowledge level among women in selected settings of rural area. Keywords: Breast Cancer, Breast self examination, Video assisted teaching.