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BACKGROUND: Pediatric infective endocarditis (IE) has been associated with high morbidity and mortality, mostly related to thromboembolic complications (TEC). The objective of our study was to describe the experience in children with IE and to review the changes over a thirty-year period, regarding origin of IE, incidence of vegetations, TEC and their respective morbidity and mortality rates. METHODS: A retrospective chart review of children aged 0-18years with IE defined by the Duke Criteria and admitted to The Hospital for Sick Children, was conducted. Data were divided into three periods (P); P1 (1979-1988); P2 (1989-1998); and P3 (1999-2008). RESULTS: The study included 113 patients, median age 7yrs.; females: 46 (41%), congenital heart defects 95 (84%), comparable in all periods. Overall, cardiac vegetations were found in 68/113 patients (60%); large vegetations (≥1cm) in 32 patients (28%). Fourty-five (45/133 [40%]) TEC were documented, 22 patients (20%) developed cerebrovascular events (CVE) and 23 patients (20%) had non-CVE. Patients diagnosed during P3 were older, had more vegetations (p<0.05), and a higher incidence of community acquired-IE (p<0.05). Overall, mortality was 15%, comparable in all periods. Significant risk factors for mortality were vegetations (HR 6.44; 95% CI: 2.07-20.01, p=0.002) and heart failure (HR 28.39; 95% CI: 10.49-76.85, p<0.001). CONCLUSIONS: Over the study period, we report a growing incidence of community acquired pediatric IE in older children accompanied by an increasing rate of TEC. Heart failure and vegetations were associated with an increased mortality. These preliminary data need to be confirmed by prospective data.

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BACKGROUND: Medical education is perceived as being stressful, and a high level of stress may have a negative effect on cognitive functioning and learning of students in a medical school. OBJECTIVES: To (a) assess the perceived stress among medical undergraduate students, (b) identify the sources of stress, and (c) find an association of perceived stress with sociodemographic characteristics and various stressors. MATERIALS AND METHODS: A cross-sectional study was conducted among medical undergraduate students in a private medical college in Tamil Nadu. A total of 750 medical students from 1st year to final year were invited to participate in the study. Self-administered questionnaire was used to collect data regarding sociodemographic profile, perceived stress using perceived stress scale-14 and academic, psychosocial and environmental stressors. Descriptive statistics was used to describe the sociodemographic characteristics, sources of stress and perceived stress. Logistic regression analyses were carried out to assess determinants of stress. RESULTS: The overall response rate was 93.33% (700 out of 750 students). The mean perceived stress score was 25.64 ± 5.44. Higher age-group, year of studying bachelor of medicine and bachelor of surgery, vastness of academic curriculum, fear of poor performance in examination, lack of recreation, loneliness, family problem, and accommodation away from home were important determinants of perceived stress. CONCLUSIONS: The perceived stress was higher among higher age group and final year medical students. Academic, psychosocial, and environmental stressors are associated with perceived stress. Reframing the academic curriculum and examination patterns, incorporating recreational and sports activities, and establishment of counseling cells in the institution is needed.

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BACKGROUND: In most developing countries, open defecation is the 'way of life'. This practice is considered as the most serious health and environmental hazard. Prime Minister of India launched the "Swachh Bharat Mission" to accelerate the efforts for achieving universal sanitation coverage and to put focus on sanitation. OBJECTIVE: To find the knowledge, attitude and practices of sanitary latrines usage in rural area, Tamil Nadu. MATERIALS AND METHODS: This was a cross sectional study conducted among rural population in Kuthambakkam village, Tamil Nadu. There were a total of 1175 households in Kuthambakkam village. These households were serially numbered and of these a sample of 275 households were selected for the study using simple random sampling technique by lottery method. A structured questionnaire was used to collect information regarding the background characteristics, their knowledge, attitude and practices towards sanitary latrines usage. Descriptive statistics were calculated for background variables, the prevalence of sanitary latrines usage and open air defecation. Association between factors responsible for open air defecation was found by using chi square test. RESULTS: The prevalence of usage of household sanitary latrine and community latrines was 62.5% and 4.3% respectively. The prevalence of open air defecation among the study participants was 33.1%.Significant association was found between low standard of living and open air defecation practice. CONCLUSIONS: To solve the problem of underutilization of sanitary latrines, planning and conducting Information Education Communication activities is very essential. Effective political and administrative support is needed to scale up the sanitation program.

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To identify the role of dietary habits (type of diet, skipping meals, snacking in-between meals and frequency of visits to fast food restaurants) in caries occurrence and severity. To explore the correlation between frequency of intake of selected foods and dental caries. A cross-sectional study was carried out on adolescent children (n = 916) of age 13-19, following a two-stage random sampling technique. Data were collected using a pretested questionnaire. Questionnaire included demographic details, dietary habits of children and food frequency table that listed selected food items. The dependent variable-dental caries was measured using the decayed, missing, filled teeth (DMFT) index. The prevalence of dental caries in this study population was 36.7% (95% confidence interval: 33.58-39.82). The mean DMFT was 1.01 (±1.74). No statistically significant difference found between caries occurrence and type of diet (P = 0.07), skipping meals (P = 0.86), frequency of eating in fast food stalls (0.86) and snacking in between meals (0.08). Mean DMFT values were higher among nonvegetarians and among children who had the habit of snacking in between meals. Frequency of intake of selected food items showed that mean frequency intake of carbonated drinks and confectionery was higher among children who presented with caries when compared to caries-free children (P = 0.000). Significant correlation found between mean DMFT and mean frequency intake of carbonated drinks and confectionery. Odds ratios were calculated for the same for frequency ≥4 times/day for confectionery and ≥4/week for carbonated drinks and results discussed. Frequent intake of carbonated drinks and confectionery is harmful to oral health that eventually reflects on general health. Educating the adolescent children on healthy dietary habits should be put in the forefront.

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OBJECTIVE: To explore the influence of pocket money on Dental Caries and Body Mass Index. MATERIALS AND METHODS: A cross-sectional study was conducted wherein urban adolescent schoolchildren of age 13-18(n=916) were selected by two stage random sampling technique. Dental caries was measured using the DMFT Index. The children's nutritional status was assessed by means of anthropometric measurements. Body Mass Index using weight and height of children was evaluated using the reference standard of the WHO 2007. RESULTS: RESULTS showed that 50% of children receive pocket money from parents. The average amount received was Rs. 360/month. There was a significant correlation between age and amount of money received (r=0.160, p=.001). The average amount received by male children was significantly higher (Rs. 400) when compared to female children (Rs. 303). It was observed that income of the family (>30,000 Rs./month) and socioeconomic status (Upper class) was significantly dependent on the amount of money received by children (p<0.05). There was no significant difference in the occurrence of caries among children receiving pocket money or not. When BMI categories and pocket money were considered, statistically significant difference was seen among overweight and obese and normal weight children (p<.05). Higher proportion (40.1%) of overweight and obese adolescent children frequented the fast food restaurants every week when compared to the underweight (31.7%) and normal weight children (29.9%). CONCLUSION: Adolescent children receiving pocket money from parents could influence their eating habits in turn affect general health. Parents and teachers should motivate children on healthy spending of their pocket money.

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