Dr Sumit Kar

Scopus Publications

Adverse Events Following COVID-19 Vaccination among the Beneficiaries of Sikkim Manipal University: A Cross Sectional Study
Jayden Lhamu Bhutia, Binu Upreti, Eden Jamyang Bhutia, Sumit Kar, and Forhad Akhtar Zaman
Indian Association of Preventive and Social Medicine
Background: Covid-19, an infection caused by SARS- CoV2 has claimed millions of lives since late 2019 with no curative measures. In India, 4 vaccines have been approved for use i.e. Serum Institute’s Covishield, Bharat Biotech’s Covaxin, GRIEM’s Sputnik V and Moderna’s Covid-19 vaccine. Aims: This study aims to find the adverse events following Covishield vaccination among the beneficiaries of Sikkim Manipal University, Sikkim. Material &Methods: A cross sectional study was conducted among the beneficiaries of Sikkim Manipal University to find out the adverse events following the first dose of vaccination. The data was collected using a self-administered questionnaire when the beneficiaries came for their second dose of vaccination. Microsoft Excel and SPSS version 27 was used for statistical analysis. Results: Out of 716 study participants majority i.e. 79.5% of the study participants developed adverse events following their first dose with maximum (73.8%) complaining of pain at the site of infection followed by fever (65.2%). Conclusions: Vaccines may prevent diseases, but it also brings about adverse effects, be it minor or major. Hence, many studies are required to study their full-fledged side effects and the means to overcome them.

Global review of the age distribution of rotavirus disease in children aged <5 years before the introduction of rotavirus vaccination
Mateusz Hasso-Agopsowicz, Chandresh Nanji Ladva, Benjamin Lopman, Colin Sanderson, Adam L Cohen, Jacqueline E Tate, Ximena Riveros, Ana Maria Henao-Restrepo, Andrew Clark, M Alkorta,et al.
Oxford University Press (OUP)
Abstract We sought datasets with granular age distributions of rotavirus-positive disease presentations among children <5 years of age, before the introduction of rotavirus vaccines. We identified 117 datasets and fit parametric age distributions to each country dataset and mortality stratum. We calculated the median age and the cumulative proportion of rotavirus gastroenteritis events expected to occur at ages between birth and 5.0 years. The median age of rotavirus-positive hospital admissions was 38 weeks (interquartile range [IQR], 25–58 weeks) in countries with very high child mortality and 65 weeks (IQR, 40–107 weeks) in countries with very low or low child mortality. In countries with very high child mortality, 69% of rotavirus-positive admissions in children <5 years of age were in the first year of life, with 3% by 10 weeks, 8% by 15 weeks, and 27% by 26 weeks. This information is critical for assessing the potential benefits of alternative rotavirus vaccination schedules in different countries and for monitoring program impact.

Knowledge and personal beliefs about human papilloma virus infection among Sikkimese female nursing professionals in India
Hafizur Rahman and Annet Thatal
OMICS Publishing Group

Fast foods and physical inactivity are risk factors for obesity and hypertension among adolescent school children in east district of Sikkim, India
Sumit Kar and Bidita Khandelwal
Medknow
Background: Obesity and hypertension among school children have a huge impact on public health. Hence, we estimated the prevalence and sociodemographic correlates of childhood obesity and elevated blood pressure (BP) among adolescent schoolchildren (11-19 years) in urban areas of Gangtok, Sikkim, India. Materials and Methods: A population based cross-sectional study was conducted on 979 school children, during November 1, 2009 - April 30, 2010 in Gangtok, East Sikkim India. Anthropometric measurements and BP were recorded among the study population. Obesity and hypertension prevalent among adolescent school children and their correlates were analyzed. Results and Conclusion: Prevalence of obesity, overweight, and hypertension was 2.04%, 14.5% and 5.62%, respectively. The average fast food intake, screen time and limited outdoor activities were significantly associated with obesity. Increase in abdominal height positively correlated with increase in body mass index and body fat; however waist — hip ratio was not a reliable index. The burden of overweight/obesity as well as hypertension with all its associated risk was found to high among our study population, which necessitates framing of policies and actions at national level to address the risk associated with these noncommunicable diseases.

Knowledge, attitudes and practice toward cervical cancer screening among Sikkimese nursing staff in India
Hafizur Rahman and Sumit Kar
Georg Thieme Verlag KG
Objectives: To assess baseline knowledge of cancer cervix, screening and practice of Pap smear screening among Sikkimese staff nurses in India. Materials and Methods: Between April 2012 and February 2013, a predesigned, pretested, self -administered multiple responses questionnaire survey was conducted among staff nurses′ working in various hospitals of Sikkim. Questionnaire contained information about their demographics, knowledge of cervical cancer, its risk factors, screening methods, attitudes toward cervical cancer screening and practice of Pap smear amongst themselves. Results: Overall, 90.4% nurses responded that they were aware of cancer cervix. Three quarter of the staff nurses were not aware of commonest site being cancer cervix in women. Of the 320 participants, who had heard of cancer cervix, 253 (79.1%) were aware of cancer cervix screening. Pap smear screening should start at 21 years or 3 years after sexual debut was known to only one-third of the nursing staff. Age was found to be a significant predictor of awareness of Pap smear screening among nursing staff. Awareness was significantly more prevalent among older staff (P < 0.007). Married nursing staffs were significantly more likely to be aware of screening methods, and nursing staff of Christian and Buddhist religion were 1.25 times and 2.03 times more likely to aware of screening methods than Hindu religion respectively. Only 16.6% nurses, who were aware of a Pap smear (11.9% of the total sample), had ever undergone a Pap smear test. Most common reason offered for not undergoing Pap smear test were, they felt they were not at risk (41%), uncomfortable pelvic examination (25%) and fear of a bad result (16.6%). Conclusion: Knowledge of cancer cervix, screening and practice of Pap smear was low among Sikkimese nursing staff in India. There is an urgent need for re-orientation course for working nurses and integration of cervical cancer prevention issues in the nurses′ existing curriculum in India and other developing countries.

Comparative Evaluation of 50 Microgram Oral Misoprostol and 25 Microgram Intravaginal Misoprostol for Induction of Labour at Term: A Randomized Trial
Hafizur Rahman, Anup Pradhan, Latha Kharka, Prachi Renjhen, Sumit Kar, and Sudip Dutta
Elsevier BV
OBJECTIVES To assess and compare the efficacy and safety of 50 µg oral misoprostol and 25 µg intravaginal misoprostol for induction of labour at term. METHODS This non-blinded, randomized clinical trial included 228 pregnant women at term with obstetric or medical indications for induction of labour. Women either took 50 µg misoprostol orally (two 25 µg tablets) or had one 25 µg tablet of misoprostol inserted in the posterior vaginal fornix. In each group, misoprostol administration was repeated every four hours in the same dose until regular uterine contractions were established or to a maximum of five doses. Time to delivery and outcome data for each group were compared. RESULTS Of the 228 women, eight (3.5%) were excluded from the analysis as they withdrew their consent after randomization. Mean induction-to-delivery interval was similar in both groups (21.22 hours in the oral group vs. 20.15 hours in the vaginal group; P = 0.58). There was no significant difference between the groups with respect to the number of women who delivered within 24 hours or who required oxytocin augmentation of labour, the mode of delivery, and neonatal outcomes (P > 0.05). Uterine hyperstimulation occurred in two women who received misoprostol vaginally, but not in any of the women in the oral misoprostol group. CONCLUSION Oral misoprostol in a dose of 50 µg every four hours, to a maximum of five doses, has the potential to induce labour as safely and effectively as 25 µg misoprostol administered vaginally every four hours.

Moraxella catarrhalis: An emerging pathogen in bronchopulmonary infections
ForhadA Zaman, Sumit Kar, SiddeshB Sirwar, AmruthaS Indupalli, and Ranabir Pal
Medknow
Background: Moraxella catarrhalis ( M. catarrhalis ) is a common pathogen in the human upper respiratory tract. This microbe is also implicated in chronic lower respiratory tract infections as well as conjunctivitis, sinusitis, meningitis, otitis media, osteomyelitis, endocarditis, etc. Objectives: This study was carried out to know various facets of M. catarrhalis infection among adults with bronchopulmonary infections and the related antibiotic susceptibility pattern. Materials and Methods: A hospital-based study was carried out among adult participants with history of respiratory tract infection admitted to a tertiary care teaching hospital in Karnataka during the period of May 2007 to April 2010. A total of 912 early morning sputum samples were collected, processed with standard procedures, and analyzed. Results: Out of all the sputum samples, M. catarrhalis was the third most important pathogen (16.01%). Most of these M. catarrhalis isolates were sourced from participants with bronchopneumonia (31.51%), followed by chronic bronchitis (25.34%), bronchiectasis (25.34%), and bronchial asthma (17.81%). M. catarrhalis infection was predominantly noted among males (78.08%) and in older age group (22.60%), i.e., 61-70 years. All strains of M. catarrhalis were sensitive to tetracycline, co-trimoxazole, chloramphenicol, and gentamicin; 75.34% were resistant to penicillin, ampicillin, and amoxycillin. Surprisingly, all strains were resistant to erythromycin; 37 (25.34%) were beta-lactamase positive. Conclusions: M. catarrhalis is one of the emerging pathogens in bronchopulmonary infections, and the beta-lactamase-producing strains imply its ability for antibiotic resistance.

Knowledge of, attitudes toward, and barriers to the practice of emergency contraception among women in Sikkim, India
Hafizur Rahman, Ezzat Khalda, Sumit Kar, Latha Kharka, and Golay Paden Bhutia
Wiley
To assess knowledge, attitudes, and barriers associated with the practice of emergency contraception (EC) among women from the state of Sikkim, India.

Profiling acute respiratory tract infections in children from Assam, India
Sumit Kar, Ranabir Pal, Farzana Islam, Ratna Sarma, and Arup Debroy
Medknow
Background: Acute respiratory infections (ARI) are leading global cause of under-five mortality and morbidity. Objective: To elicit the prevalence and risk factors associated with ARI among under-five children. Materials and Methods: A community-based cross-sectional study was undertaken in 21 registered urban slums of Guwahati in Assam to determine the prevalence and risk factors associated with ARI among 370 under-five children from 184 households and 370 families. Results: The prevalence of ARI was found to be 26.22%; infants and female children were more affected. Majority of the ARI cases were from nuclear families (84.54%), living in kutcha houses (90.72%) with inadequate ventilation (84.54%), overcrowded living condition (81.44%), with kitchen attached to the living room (65.98%) and using biomass fuel for cooking (89.69%). ARI was significantly associated with ventilation, location of kitchen in household; presence of overcrowding, nutritional status, and primary immunization status also had impacts on ARI. Conclusion: The present study had identified a high prevalence of the disease among under-fives. It also pointed out various socio-demographic, nutritional, and environmental modifiable risk factors which can be tackled by effective education of the community.

Admission cardiotocography: Its role in predicting foetal outcome in high-risk obstetric patients
Hafizur Rahman
OMICS Publishing Group
BACKGROUND Routine and continuous electronic monitoring of foetal heart rate (FHR) in labour has become an established obstetric practice in high-risk pregnancies in industrialised countries. However, the same may not be possible in non-industrialised countries where antenatal care is inadequate with a large number of high-risk pregnancies being delivered in crowded settings and inadequate health care provider to patient ratios. AIMS The objective of this study was to evaluate the predictive value of the admission cardiotocogram (CTG) in detecting foetal hypoxia at the time of admission in labour and to correlate the results of the admission CTG with the perinatal outcome in high-risk obstetric cases. METHOD This was a prospective observational study conducted in the labour and maternity ward of a hospital in Gangtok, India, during the period 2008 to 2010. The study included high-risk pregnant women, admitted via the emergency or outpatient department with a period of gestation ≥36 weeks, in first stage of labour with foetus in the cephalic presentation. All women were subjected to an admission CTG, which included a 20 minute recording of FHR and uterine contractions. RESULTS One hundred and sixty patients were recruited. The majority of women were primigravida in the 21-30 years age group. About 42% patients were postdated pregnancy followed by pregnancy-induced hypertension (PIH) (15.6%) and premature rupture of membranes (PROM) (11.3%) as the major risk factors. The admission CTG were 'reactive' in 77%, 'equivocal' in 14.4% and 'ominous' in 8.7% women. Incidence of foetal distress, moderate-thick meconium stained liquor and neonatal intensive care unit (NICU) admission was significantly more frequent among patients with ominous test results compared with equivocal or reactive test results on admission. Incidence of vaginal delivery was more common when the test was reactive. CONCLUSION The admission CTG appears to be a simple non-invasive test that can serve as a screening tool in 'triaging' foetuses of high-risk obstetric patients in non-industrialised countries with a heavy workload and limited resources.

Assessment of impact of small group teaching among students in community medicine
Ranabir Pal, Sumit Kar, ForhadAkhtar Zaman, DilipKumar Jha, and Shrayan Pal
Medknow
Background: We conducted a study to assess the impact of small group teaching (SGT) among students by feedback analysis to identify intricacy so that learning can be facilitated. Materials and Methods: This cross-sectional study was undertaken among 182 MBBS students studying at a teaching hospital at Gangtok. Students were provided with a questionnaire following an assignment on a scheduled topic. Students were asked to provide feedback on the modes of teaching-learning practiced in community medicine with the parameters of evaluation including assessment of presentation by faculty member in reference to relevance, sequencing, depth, interaction, etc., to the overall rating of presentations in different teaching–learning methods. Results: The faculty members were on the positive evaluation by the students in the SGT, which was preferred over lectures as the teaching–learning methods. Among SGTs “tutorials” were graded better than “practical”, “seminar” and “field posting” on the basis of longer duration at a stretch. Among the parameters for evaluation, relevance, depth, and interaction in regard to scheduled topic of presentations, the rating was significantly higher in SGT than different other teaching–learning methods. Largely the students noted that the time devoted and number of hours/sessions allotted for each topic was adequate. Conclusion: All forms of SGT were on the positive appraisal by the students on their learning experience and were considered as a comprehensive tool for in-depth teacher–student interaction.

Clinico-pathological correlates of incidentally revealed thyroid swelling in Bihar, India
Ranabir Pal, Sumit Kar, Mausumi Basu, Shrayan Pal, ForhadAkhtar Zaman, and Arup Sengupta
Medknow
Background: Global prevalence of thyroid cancer has been on the rise in recent decades. Objectives: To study the clinical presentations to reach an agreement for diagnosis and optimal management of incidentally revealed thyroid swellings for early diagnosis. Materials and Methods: A prospective study was carried out on 178 cases of incidentally detected thyroid swelling attending a tertiary care teaching institute of Kishanganj Bihar. All the cases were subjected to a thorough clinical examination followed by evidence-based interventions. Fine needle aspiration cytology was done in all the cases preoperatively as out-patients basis and histopathologically confirmed postoperatively. Results: The highest incidence of thyroid swelling (75.84%) was found in the age group of 20-40 years; a female preponderance was noted in the ratio 4:1. The duration of swelling ranged from six months to three years. Difficulty in swallowing and breathing was complained by 23 (12.9%) and 18 (10.1%) of the patients respectively. Typically the swellings were located in the right lobe. Commonly the subjects in our study were in euthyroid state (90%) and were with firm swellings (66.7%). Follicular and anaplastic carcinoma was important postoperative cytological findings. Majority of surgical intervention was hemithyroidectomy (55.06%). Conclusion: Incidentally revealed thyroid swelling was quite high in eastern India for which we need a consensus line of intervention.

Spectrum of visual impairment among urban female school students of Surat
Ranabir Pal, VikasK Desai, Mausumi Basu, Palash Das, Sumit Kar, and Abhay Kavishwar
Medknow
Aim: Eye morbidities with or without symptoms delineate a significant morbidity among adolescent schoolgirls in India. The study was undertaken to assess the extent of visual impairment and ocular morbidity to identify influencing factors and the impact on scholastic performance. Materials and Methods: A population-based cross-sectional study was undertaken among 3002 urban girl students of Surat in Gujarat, India. Overall prevalence of refractive error was found to be 15.22%; myopia affected 91.47%, hyperopia 4.60%, and astigmatism 0.04%. The prevalence of myopia and astigmatism was more in higher age groups, while hyperopia was more in lower age groups; even students with good vision reported ophthalmic symptoms. Of all spectacle users, in 29.73% cases the eyesight was not found to be with the best possible corrections. Refractive error was observed to be higher among the general caste (50.98%) and among Muslims (54.05%). Still, among those with problems of eyesight, 75.93% students had good academic performance. Associated ocular morbidity was noted in 20.35% participants along with the refractive error. Conclusion: This study highlighted the load of eye morbidities of adolescent Indian urban girls.

Ageing in Puducherry, South India: An overview of morbidity profile
Ranabir Pal, TV Yamuna, AngelineNeetha Radjou, DharamvirRanjan Bharati, R Rekha, and Sumit Kar
Medknow
Background: The geriatric health problems are related to chronic disease as a result of increasing life expectancy. Objective: This study was undertaken to assess the health problems of the elderly in Puducherry. Materials and Methods: This cross-sectional study was carried out on 214 elderly persons from the age group of 60 years and above using a pre-designed and pre-tested questionnaire that addressed the disease magnitude in comparison with the socioeconomic variables. Results: Overall, 43% of the participants were diabetic, 47.7% hypertensive, 86% anemic and 68.2% visually impaired. All the morbidities were noted to be higher in the 70–79 years age group. Diabetes was significantly higher in participants from urban areas, with family history and increasing waist–hip ratio, but significantly lower in the below poverty line areas. Hypertension risk was significantly higher among females, among those leading sedentary life, those eating vegetarian food, those addicted to tobacco and with abdominal obesity. Anemia was significantly lower among urban vegetarians. Overweight and obese were noted in 31% of the participants, and were higher in females (87.5%). Rural residence, female sex, living in joint family, literacy, sedentary life style, decreasing per capita income and decreasing body mass index (BMI) were significantly associated with visual impairment. Conclusion: This study highlights the burden of health problems of elderly individuals in South India.

Prevalence and determinants of diabetes mellitus in Puducherry, South India
Ranabir Pal, R Rekha, Mausumi Basu, DharamvirRanjan Bharati, Sumit Kar, and TV Yamuna
Medknow
Background: Diabetes mellitus is an emerging global health problem. It is a chronic, noncommunicable, and expensive public health disease. Aims and Objectives: To determine the prevalence and the risk factors of type 2 diabetes mellitus among the adult population of Puducherry, South India. Materials and Methods: This was a population-based cross-sectional study carried out during 1st May 2007–30th November 2007 in the rural and urban field practice area of Mahatma Gandhi Medical College and Research Institute, Puducherry. Simple random sampling technique was used for the selection of 1370 adult 20 years of age and above. Main outcome measures were the assessment of the prevalence of prevalence and correlates of diabetes among the adult population. Predesigned and pretested questionnaire was used to elicit the information on family and individual sociodemographic variables. Height, weight, waist, and hip circumference, blood pressure was measured and venous blood was also collected to measure fasting blood glucose, blood cholesterol. Results: Overall, 8.47% study subjects were diagnosed as diabetic. The univariate analysis and multivariate logistic regression analysis showed that the important correlates of diabetes mellitus were age, blood cholesterol, and family history of diabetes. The findings were found to be statistically significant. Conclusions: In our study we observed that adults having increased age, hypercholesterolemia, and family history of diabetes mellitus are more likely to develop diabetes mellitus.

The quest for an Indian blood law as of blood transfusion services regulatory framework
Ranabir Pal, ForhadAkhtar Zaman, Sumit Kar, and Shrayan Pal
Medknow
Background: Blood transfusion services are a vital part of the national health delivery system. The responsibility for ensuring a continuous supply of blood rests with health administrators, who need to galvanize entire communities towards regular and non-remunerated blood donation. Objective: The present study aimed to examine the prevailing global regulations and practices related to blood transfusion and press the case for a dedicated blood law in India. Materials and Methods: We attempted a comprehensive, annotated assembly of published studies on blood transfusion services in India. Data Abstraction and Synthesis: Laws related to blood transfusion services exist in India as a part of the Drugs and Cosmetics Law. In the developed world, most blood donors are unpaid volunteers who give blood for a community supply. In order to augment safe blood transfusion services in India, we have to develop operational legal guidelines on recruitment and retention of voluntary blood donors to direct related organizations for this imperative activity. Conclusion: Several factors, such as political will and a professional and ethical approach can help in formulating a common vision, building trust, by providing optimum information towards a social movement for the rational blood transfusion services. We have to come together for a dedicated blood law in order to improve the quality of blood transfusion services in India.

Spectrum of Guillain-Barré syndrome in tertiary care hospital at Kolkata
Ranabir Pal, ForhadAkhtar Zaman, Sumit Kar, Jyoti Singh, Mohan Mondal, Soma Mukherjee, UjjalKr Sarkar, Lalita Menon, and Debabrata Sarbapalli
Medknow
Objective: In childhood Guillain–Barré syndrome (GBS), the clinical profiles using intravenous immunoglobulin (IVIg) in addition to supportive care were studied. Materials and Methods: This was a retrospective analysis of 139 children with severe GBS admitted to our respiratory care unit managed with the IVIg as an adjunct intervention to conventional supportive and respiratory care. Results: In our case series of 139 cases, motor weakness was the most common presenting feature. Antecedent illness was found in 66.7% of cases in the preceding two weeks, which included nonspecific illness, acute respiratory infection, diarrhea, and chickenpox. At onset, sensory symptoms (pain and paresthesia) were noted in 59% of the cases and limb weakness in 77%. On admission, a majority (61.54%) were in Hughes neurological disability grading stage V; all had limb weakness at the peak deficit, autonomic disturbance was seen in 35.8%, and bulbar palsy in 52%. Duration of illness was less than three weeks in 67% of cases. The mean duration of ventilation was 21.5 days (range, 5-60 days). Conclusions: Male preponderance and motor weakness was the most common presenting illness and a majority achieved full recovery in our series. Although IVIg may be useful in the treatment of GBS, the key issue is excellent intensive care unit management.

Sociodemographic variables of contraceptive practice in Sikkim
Ranabir Pal, YD Chankapa, Sumit Kar, Dechenla Tsering, and Mausumi Basu
Medknow
Objectives: The objective was to assess sociodemographic characteristics of men who use contraceptive and to compare them with men whose wives use contraceptive. Materials and Methods: Study design: A population-based cross-sectional study was performed. Study setting: It was performed in rural setting of the Sang PHC and Pakyong PHC service areas in Sikkim, India. Study participants: A total of 596 currently married men enrolled in the eligible couple registers. Interventions: No interventions occurred. Measurements: Sociodemographic correlates of contraceptive use were analyzed: occupation, religion, ethnicity, literacy, age, loss of children, and distance from health facility. Results: The use of contraceptive was high among the cultivators - men (44.45%), spouse (36.01%) followed by persons in Government service, respectively, 31.49% and 31.55%. Hindu men (55.42%), women (69.25%), and other backward communities (OBC) men (47.53%) and their wives (52.31%) were the majority users. A significantly higher number of users of contraceptive were literate men (72.33%) and their wives (86.17%) (χ2=0.021, P> 0.05). Highest use was found in men and women (44.47%) in the 35 years and above (43.83) age group. But this difference was not significant. With the increase in the number of losses of children the contraceptive use declined among men and their spouses. Contraceptive users were higher at distances 1 hour and above from the health center compared to others. Conclusions: The finding of the research indicated that sociodemographic correlates determine the magnitude of the contraceptive use among couples in a rural community. A research agenda should define factors at both macro and micro levels that interact to adversely impinge on reproductive health outcomes.

Understanding the clinico-microbiological spectrum of common ear, nose and throat infections in Sikkim, India
Ranabir Pal, Sumit Kar, and TseringC Dechen
Medknow
Sir, The aim of our investigations was to evaluate the current microbiological pattern of ear, nose and throat (ENT) infections and the antibiotic sensitivity pattern at a tertiary care teaching hospital in Sikkim from May 2007 to April 2009. Two hundred and ninety-five samples (64 nasal, 189 throat, and 42 aural) were collected from clinically diagnosed cases of acute tonsillitis, acute pharyngitis, acute rhinitis, acute and chronic sinusitis, otitis externa, acute and chronic suppurative otitis media. The samples were cultured on sheep blood (5%), chocolate, and Mac Conkey agar plates, incubated at 37 ̊C aerobically (Mac Conkey) and in 5% carbon dioxide (blood and chocolate agar) and examined at 24 and 48 h.[1] Aural swabs from cases of otitis externa were cultured on Sabouraud’s dextrose agar. Group A β-hemolytic streptococci (GABS) were identified by determining bacitracin sensitivity. Throat swabs were also cultured on chocolate agar for recovery of Haemophilus species. The antibiotic susceptibility test was performed on Muller Hinton agar by the modified Kirby Bauer disc diffusion method following the criteria of Clinical and Laboratory Standards Institute.[2] Overall, less than half (47.46%) were culture positive isolates; positivity was more among adults (72.86%). The pediatric group had higher ear involvement (61.90%), whereas in the adults infection was more in throat (81.48%). Culture positivity was more in ear (92.86%), followed by nose (51.56%) and throat (35.45%). Staphylococcus aureus was the most common isolate from ear (65%), nose (96.97%), and throat (53.73%); associated organisms were chiefly Streptococcus pyogenes, Klebsiella, and Haemophilus influenza. Pseudomonas aeruginosa was isolated in ear and nasal infections. S. aureus from nose were most sensitive to cefuroxime (84.37%) followed by clindamycin (71.87%) and cloxacillin (62.50%); S. aureus from throat were mostly sensitive to cloxacillin (77.77%) followed by clindamycin (61.11%) and cefuroxime (55.55%); from aural swabs a majority of S. aureus were sensitive to clindamycin (69.32%) followed by cefuroxime (61.53%) and penicillin (57.69%). A majority of S. pyogenes isolated from throat were sensitive to penicillin (84.61%) followed by clindamycin (76.92%) and cefuroxime (65.38%). Among the gramnegative isolates P. aeruginosa isolated from ear, nose, and throat were entirely sensitive to cotrimoxazole, gentamicin, cefotaxime, and cefuroxime. Proteus mirabilis and Klebsiella pneumoniae isolates from ear were all sensitive to gentamicin, cefotaxime, ciprofloxacin, and cefuroxime. Of total six cases of otitis externa, Aspergillus niger was isolated from two cases and Candida albicans from one case. Rohtak study noted that GABS and was cultured from 15% to 36% of children with sore throat and was the causal agent in 10% of adult pharyngitis. Polymicrobial nature of chronic suppurative otitis media (CSOM) was noted in both pediatric (70.8%) and adult (71.4%) cases. In CSOM, S. aureus in children and in adult P. aeruginosa was the most common aerobic isolate; sensitivity to cefuroxime was 72.2%. Among anaerobes higher sensitivity was seen to metronidazole (98.6%), clindamycin (95.7%), and chloramphenicol (98.6%).[3] Aarhus University Hospital study reported that the bacterial flora in ENT infections was dominated by S. pneumoniae, all 100% susceptible to penicillin.[4] In the Nepal study, the most common isolates were S. aureus (69.2%). The overall sensitivity was to amoxicillin (53.84%), cloxacillin (53.84%), ciprofloxacin (46.15%), gentamicin (46.15%), and cephalosporin (46.15%) and resistance to erythromycin, tetracycline, cotrimoxazole and norfloxacin.[5] To sum up, there was a diverse pattern of antibiotic sensitivity to first line drugs to commonly isolated organisms that indicate these as the growing public health concern in this part of India.

Obesity in Kolkata children: Magnitude in relationship to hypertension
Ranabir Pal, Sumit Kar, ForhadAkhtar Zaman, Shrayan Pal, Partha Chakraborty, and Subrata Dey
Medknow
Background: Limited data is available from India regarding the distribution and profile of childhood obesity and hypertension. Materials and Methods: A population based cross-sectional study was conducted in the urban schools of Kolkata. Using stratified random sampling method, 979 participants were selected. Body mass index (BMI) status and blood pressure (BP) were estimated using standard protocol and their various correlates regarding sociodemographic characteristics were looked into. Results: Majority (38.92%) of the study population were in the preadolescent group followed by adolescent group (33.40%). Male constituted 52.09%, overweight was more prevalent among preadolescent age group (22.57%). Overall 27 cases of prehypertension were found of which 19 (70.37%, n=27) were in the adolescent age group. There was no significant association between ages with increased BMI status. We detected total 15 cases (1.53%) of hypertension in our study population and three-fourths of them were from adolescent age group. However, significant association was seen between high BP with increasing age. Average fast food intakes and screen time was higher in obese as compared to their normal peers. Upper and upper-middle social status contributed to higher number of obese/overweight and hypertensive children and was the significant risk factor. Conclusion: Childhood obesity and hypertension were found to be common in the city of Kolkata which suggest the need for greater public awareness programs on these morbidities.

Evaluation of Ondansetron-induced QT interval prolongation in the prophylaxis of postoperative emesis
Ranabir Pal, Aniruddha Sarkar, Sudakshina Mukherjee, Koel Mitra, Suddhadeb Roy, Debabrata Sarbapalli, KanakKanti Kundu, ForhadAkhtar Zaman, Sumit Kar, and SampaDutta Gupta
Medknow
Background: To avert nausea and vomiting the 5-Hydroxytryptamine3 (5-HT3) antagonists have become the first line of treatment ifassociated with cardiovascular effects andappear to cause QT prolongation. Objective: Evaluate the effect of 1 mg, 4 mg, and 8 mg bolus doses of intravenous Ondansetron, relative to placebo, in prevention of postoperative nausea and vomiting (PONV) and to find out the changes of QT interval corrected for heart rate (QTc). Materials and Methods: This prospective randomized, placebo-controlled, double-blind study was carried out among 136 adult participants of both sexes in a tertiary care postgraduate teaching institute at Kolkata. mg, 4 mg or 8 mg inj. Ondansetron was diluted to 10 ml with normal saline, was infused 30 min before extubation in relation with a control group. Time to first rescue antiemetic medication and in QTc interval at different time intervals, in each group was noted in different in the various surgical operation theaters (OTs). Results: Requirement of the first rescue antiemetic in the postoperative period between 60 to 120 min in the mg, 4 mg or 8 mg Ondansetron groups was in 28%, 24% and 7% participants respectively; between 120 to 240 min in 63%, 72% and 57% respectively; and within 360 min in 9%, 4% and 36% respectively. Significant and maximal QTc prolongation was observed in the participants with mg or 8 mg Ondansetron 3 and 5 min of drug administration. Conclusions: One mg Ondansetron in healthy adult participants can effectively prevent PONV causing no or insignificant prolongation of QTc interval.

Fine needle aspiration cytology as the primary diagnostic tool in thyroid enlargement
Ranabir Pal, Sumit Kar, ForhadAkhtar Zaman, Subhabrata Sengupta, Shrayan Pal, and Arup Sengupta
Medknow
Background: In the preoperative decision-making of the thyroid swellings, fine needle aspiration cytology (FNAC) is becoming an ever more vital tool. Objectives: To compare the advantage of preoperative FNAC of thyroid swellings with postoperative histopathology to reach a consensus protocol as a simple procedure for diagnosis and optimal management of thyroid swellings. Materials and Methods: A prospective study of preoperative FNAC was carried out on 178 incidental thyroid swellings attending a tertiary care centre in Kishanganj, Bihar. Evidence-based surgical interventions were done, irrespective of FNAC findings and diagnosis was confirmed by histopathological examination (HPE) postoperatively in all the cases. Results: In the FNAC, preponderance of the cases (75.84%) was colloid goitre followed by granulomatous thyroiditis; follicular carcinoma was noted in 7.30 percent and anaplastic carcinoma in 3.37 percent of cases. Histopathological examination showed colloid goitre predominantly (76.97%), followed by follicular carcinoma (8.99%). The overall prevalence of malignancy was 11.24 percent diagnosed by HPE and 9.55 percent by FNAC. In our FNAC series sensitivity of was 90 percent while specificity was 100 percent; accuracy was 98.88 percent. Predictive value of a positive test and negative tests was 100 percent and 98.75 percent respectively. Conclusion: The study highlights that FNAC should be treated as a first-line diagnostic test for thyroid swellings to guide the management though this is not a substitute for HPE as a need to improve primary healthcare in India.

Bacteriological profile of septicemia and the risk factors in neonates and infants in Sikkim
Ranabir Pal, Sumit Kar, DechenC Tsering, and L Chanchal
Medknow
Background: Bacterial infections remain an important cause of pediatric mortality and morbidity. It might be possible to reduce these factors by early diagnosis and proper management. Aim: The aim of the study was to analyze the bacteriological profiles with their antibiogram, and to register the risk factors for septicemia in neonates and infants. Setting and design: This observational cross-sectional study was conducted in a tertiary care teaching hospital at Gangtok, Sikkim, India, and included clinically suspected cases of septicemia in neonates and infants. Materials and Methods: Blood culture reports were studied in 363 cases of clinically suspected septicemia in neonates and infants, using the standard technique of Mackie and McCartney. The antibiotic sensitivity was performed by Kirby-Bauer's disc diffusion method. Risk factors for sepsis in the children were registered. Results: Blood culture was positive in 22% of cases. Gram-negative septicemia was encountered in 61% of the culture-positive cases. Pseudomonas and Enterobacter species were the predominant pathogens amongst gram-negative organisms. Most gram-negative organisms were sensitive to Amikacin, Ciprofloxacin, and Co-trimoxazole. The most common gram-positive organism isolated was Staphylococcus aureus (97%). More than 70% of Staphylococci isolated were resistant to Penicillin, but were sensitive to Clindamycin (70%) and Vancomycin (40%). The most important risk factors of septicemia in our study population were preterm birth (31%), followed by respiratory distress (5%) and low birth weight (4%). Conclusion: As the cultures showed variable antibiogram with complicated patterns of resistance, culture and sensitivity test should be performed in all cases of septicemia.

Evaluating ranitidine, pantoprazole and placebo on gastric pH in elective surgery
Ranabir Pal, Ujjal Sarkar, Sumit Kar, KanakKanti Kundu, ForhadAkhtar Zaman, Tapas Bhattacharyya, and Debabrata Sarbapalli
Medknow
Background and Aim: Concern about the grim nature of postoperative acid aspiration syndrome grew among the anesthesiologist over the years warranting the need for pre-emptive intervention. The aim of the study is to compare the effects of preoperative oral ranitidine versus pantoprazole given in regulating gastric pH in elective surgery. Methods: This prospective, parallel group, controlled, randomized, single-blind study was conducted at a tertiary care postgraduate teaching institute at Kolkata, involving 120 participants of either sex, aged 18-60 years of American Society of Anesthesiologists physical status I and II, who were scheduled for elective surgery under general anesthesia lasting for more than 2 h. The participants were divided into three groups. In group A (n=40) participants received placebo tablet, in group B (n=40) participants received ranitidine tablet while in group C (n=40), participants received pantoprazole tablet and their gastric pH estimated serially. Results: The participants in the three groups were comparable in terms of age, sex, body weight, duration of surgery and type of surgery distribution. In regard to changes in gastric pH trends, there was no statistically significant difference between serial pH values in group A (Friedman test; P>0.05) and group C participants. (P>0.05). However, the mean preoperative gastric pH values (7.140±.7652) were significantly lower than mean pH values (7.253±.7514) after 2 h postoperatively in group B participants (P<0.05). Conclusion: From the observations and analyses of the present study, it can be inferred that ranitidine is more effective than pantoprazole to raise the gastric pH for prevention of aspiration pneumonitis.

Methicillin-resistant Staphylococcus Aureus: Prevalence and current susceptibility pattern in Sikkim
Ranabir Pal, Sumit Kar, and DechenC Tsering
Medknow
Background: Prevalence of methicillin-resistant Staphylococcus Aureus (MRSA) strains is reported to be increasing globally. Objectives: The study was conducted to find the magnitude and antibiotic susceptibility pattern of MRSA infection in a referral tertiary care teaching hospital of Sikkim, India. Materials and Methods: In this cross sectional study, 827 clinical specimens were collected from different departments of Central Referral Hospital. One hundred and ninety-six carrier screening nasal swabs were obtained from health care workers of the hospital. Subsequently, the antimicrobial susceptibility test was performed for the confirmed MRSA isolates as per Clinical and Laboratory Standards Institute (CLSI). Results: Methicillin resistance was seen in 152 isolates of S. aureus – 111 from clinical specimens and 41 from carrier screening samples. MRSA positivity among males was significantly higher than females. Extremely significant MRSA-positive cases were observed from ages less than 30 years, in-patient cases, particularly with a stay of more than 15 days and with a previous history of intake of broad spectrum antibiotics. Incidentally, there was no significant difference of MRSA positivity with a previous history of hospitalization. The extent of MRSA and drug resistance pattern was significantly different among various samples of S. aureus-positive isolates. The strains tested exhibited decreased susceptibility to vancomycin and imipenem. Most vulnerable of the carrier were the cleaners, that was a significant observation. Incidentally, there was no resistance in the carriers to both vancomycin and imipenem. Conclusion: MRSA is prevalent in our hospital and strains resistant to methicillin and vancomycin were quite high.