Retrospective Inspection and Dissemination Pattern of Common Metabolic Ailments among Hilly and Tarai Region Goats of Uttarakhand

Goats are considered as an important animal not in present scenario but also from ancient time. Due to increasing frugal interest of goat farming globally, profound animal husbandry practices are attaining importance under the target of obtaining quality products along with good animal health and welfare. During the transition phase of life, noticeable alterations in the endocrine and metabolic status of the dairy ruminants were registered. Among small ruminants i.e. goat’s hypocalcaemia, hypoglycemia/Pregnancy toxemia and hypomagnesaemia are the common metabolic disorders which normally precipitated during metabolic anxiety phase. The present study was conducted during the period of 1st January 2019 to 31st December 2019. During this period we had registered total 957 goats at Kalsi, Chakrata areas of district Dehradun, Chorgalia, Kotabagh, Kaladhungi areas of district Nainital and Shetlai, Pantnagar, Bazpur areas of district Uddham Singh Nagar beside this we had also included the concerned cases from Government Veterinary Hospital Outpatient departments (OPDs) of the above said areas in Uttarakhand. In the present study, we had performed a prevalence study over common occurring metabolic diseases of goats like hypocalcaemia, hypoglycemia/pregnancy toxemia and hypomagnesaemia. Besides this, we had also studied the dissemination pattern of common occurring metabolic diseases on the basis of their age groups and parity

Is problem-based learning a better teaching-learning tool for emergency obstetric care for undergraduate medical students?

Background: Clinical emergency management requires critical thinking, interpersonal skills in addition to content knowledge of the clinical issue. Problem-based learning (PBL) as a teaching-learning method for clinical emergency case scenarios has not been analyzed separately in the medical literature. Objectives: The objectives of the study were to compare learning outcomes and perception of medical graduates for lecture-based learning (LBL) and PBL for emergency obstetric care. Materials and Methods: In a randomized controlled study, 34 medical students participated in a LBL group (n = 16) or PBL group (n = 18). Lecture class of 1 h or PBL method was used for teaching “eclampsia.” Pre-test and post-test questionnaires were administered to both groups. Perception about PBL method was collected by closed-ended (Likert scale) and open-ended questionnaire. Results: Mean pre-test score of the PBL group was significantly lower than that of the LBL group (5.5, SD 2.2 vs. 7.2, SD 2.7; P = 0.048). Mean post-test score in the PBL group was higher than that of the LBL group (13.1, SD 1.6 vs. 12.1, SD 1.1; P = 0.064). Difference in mean of pre-test and post-test score was more in the PBL group (7.6 vs. 4.9). Students perceived PBL as a better method for teaching obstetric emergencies as it promotes collaboration with fellow students (17, 94.5%) and critical thinking (15, 83.3%). Majority (16, 88.8%) of students preferred a hybrid curriculum. Conclusion: While knowledge gain in PBL is at least at par with LBL, PBL is perceived as a better and more effective method for learning obstetric emergencies.

Prevalence estimation of microsatellite instability in colorectal cancers using tissue microarray based methods – A tertiary care center experience

Aim: Microsatellite instability (MSI) pathway is known to be implicated in carcinogenesis of 15% colorectal carcinomas (CRC), including 2%–3% of cases of Lynch syndrome, as per western literature. MSI status has important prognostic and therapeutic implications. The prevalence of MSI in Indian CRC patients is unknown. We aimed to determine the prevalence by studying 231 consecutive unselected cases of CRC. Methods: Tissue microarrays using duplicate cores per case for 141 cases, and whole tissue sections for 90 cases, were used. Immunohistochemistry with four mismatch repair (MMR) markers – MLH1, MSH2, MSH6, and PMS2 was performed. Molecular analysis for MSI status was performed in 18 randomly selected cases. Correlation with various clinical and histopathological features was done using univariate and multivariate analysis. Results: Loss of MMR immunohistochemical (IHC) was seen in 53/231 cases, i.e. 22.94% (95% confidence interval 17.52%–28.36%). MLH1-PMS2 dual loss comprised 13.9%, MSH2-MSH6 7.4%, and isolated PMS2 loss in 1.73% of cases. Univariate analysis showed significant association with age (<60 years), right-sided tumor location, histologic type, high grade, the presence of severe intratumoral lymphocytic (ITL) and peri-tumoral lymphocytic response, and N0 nodal stage. On multivariate analysis, independent variables were age < 60 years, right-sided location, and severe ITL. Molecular testing for MSI corroborated with the IHC results. Conclusion: The study results show a slightly higher prevalence of MSI-H phenotype, compared to Western literature, stressing the need for more widespread testing for better clinical management and identification of possible hereditary colon cancer syndrome.

Variations in Placental Attachment of Umbilical Cord.

Background: Our study aims to evaluate the variations in umbilical cord attachment to placenta by dissection method. Methods: Placentas for this study were obtained from the OBG Department and collected by the Department of Anatomy SRMS IMS. The placentas were washed, cleared, dissected and site of placental attachment to umbilical cord were observed. Variations in the type of insertion were noted. Result: Majority of the placentas showed central and eccentric attachments of the cord. Few abnormal placentas were observed with velamentous and marginal insertions of the umbilical cord. Conclusion: Abnormalities in the placental attachment of the umbilical cord can result in various complications of pregnancy and adversely affect the fetal outcome as well. Knowledge of the variations in attachment of the umbilical cord is very significant and of extensive use to obstetricians as well as anatomists. Frequently abnormal cord insertions may be associated with intrauterine growth retardation, preterm labour and congenital abnormalities.

Modulatory effects of Azadirachta indica leaf extract on cutaneous and hepatic biochemical status during promotion phase of DMBA/TPA-induced skin tumorigenesis in mice.

The modulation in biochemical status of skin and hepatic tissue at the time point of commencement of promotion stage of skin carcinogenesis in mice and its intervention with aqueous Azadirachta indica leaf extract (AAILE) were investigated. 7,12-Dimethylbenz(a)anthracene (DMBA, 500 nmol/100 ul of acetone) was applied topically for 2 weeks (twice weekly), followed by phorbol-12-myristate-13-acetate (TPA, 1.7 nmol/100 ul) twice weekly for 6 weeks on the depilated skin of mice and AAILE was administered orally at a dose level of 300 mg/kg body wt thrice a week for 10 weeks. DMBA/TPA treatment upregulated the phase I enzymes in skin and hepatic tissue, as revealed by the increased cytochrome P450 (CYP) and cytochrome b5 (cyt b5) levels and aryl hydrocarbon hydroxylase (AHH) activity when compared to the control group and differentially modulated the activities of phase II enzymes like glutathione-s-transferase (GST), DT-diaphorase (DTD) and uridine diphosphate glucuronosyltransferase (UDP-GT). AAILE treatment decreased the DMBA/TPA-induced increase in cutaneous CYP level and enhanced the DTD and UDP-GT activities when compared with DMBA/TPA group. In the hepatic tissue of AAILE + DMBA/TPA group, an increase in UDP-GT activity was observed when compared to DMBA/TPA group. DMBA/TPA treatment did not alter the skin lipid peroxidation (LPO) level when compared to control group, however, in the animals that received AAILE treatment along with DMBA/TPA, a significant increase in LPO was observed when compared to control group. This was associated with a decrease in cutaneous reduced glutathione (GSH) level of AAILE + DMBA/TPA group. Enhanced LPO level was observed in the hepatic tissue of DMBA/TPA and AAILE + DMBA/TPA groups when compared to control group. However, no alteration was observed in their hepatic GSH levels. The micronuclei score in hepatic tissue did not exhibit significant inter-group differences. The results of the present study suggest that apart from skin, liver may be affected during DMBA/TPA-induced skin tumorigenesis. AAILE treatment has the ability to modulate these changes potentially influencing the process of tumor formation. These findings seem to be important to carcinogenesis and its intervention with anti-cancer agents.

Characterization of nasopharyngeal isolates of type b Haemophilus influenzae from Delhi.

Background & objectives: Haemophilus influenzae is an important cause of mortality and morbidity among young children in developing countries. Increasing incidence of antibiotic resistance especially production of extended spectrum beta lactamase (ESBL) has made treatment and management of H. influenzae infection more difficult. Nasopharyngeal H. influenzae isolates are excellent surrogate for determination of antibiotic resistance prevalent among invasive H. influenzae isolates. In this study, we characterized nasopharyngeal H. influenzae isolates obtained from healthy school going children in Delhi. Methods: Nasopharyngeal H. influenzae isolates were collected from healthy school going children and subjected to serotyping, fimbrial typing and antibiogram profiling. ESBL production was recorded using phenotypic as well as molecular methods. Multi locus sequence typing (MLST) of 13 representative nasopharyngeal H. influenzae isolates was performed as per guidelines. Results: A significant proportion (26 of 80, 32.5%) of nasopharyngeal isolates of H. influenzae were identified as serotype b. Fimbrial gene (hifA) was detected in 23 (28.75%) isolates. Resistance against commonly prescribed antibiotics (Amp, Tet, Chloro, Septran, Cephalexin) were observed to be high among the nasopharyngeal commensal H. influenzae. Extended spectrum beta lactamase (ESBL) production was observed in a five (6.25%) isolates by both double disk diffusion and molecular typing. MLST identified several novel alleles as well as novel sequence types. Interpretation & conclusions: Our findings showed high resistance against common antibiotics and detection of ESBL in nasopharyngeal H. influenzae isolates collected from normal healthy school going children in Delhi. Detection of H. influenzae type b capsular gene and the presence of fimbrial gene (hif A) suggest virulence potential of these isolates. Discovery of novel alleles and presence of new sequence types (STs) among nasopharyngeal H. influenzae isolates may suggest wider genetic diversity.

Is there need for a transformational change to overcome the current problems with postgraduate medical education in India.

In spite of the existence of a dual system of postgraduation, one under the Medical Council of India (MCI) and the other on a parallel track under the National Board of Examinations, postgraduate medical education in India is beset with several problems. For example, the curriculum has not been revised comprehensively for several decades. The diploma course under the MCI has become unpopular and is largely a temporary refuge for those who do not get admission to degree courses. The level of skills of the outgoing graduate is falling and the increase in the number of seats is taking place in a haphazard manner, without reference to the needs. In spite of increase in seats, there is a shortage of specialists at the secondary and tertiary care levels, especially in medical colleges, to share teaching responsibilities. Further, the distribution of specialists is skewed, with some states having far more than others. To remedy these ills and fulfil the requirements of the country over the next two decades, a working group appointed by the erstwhile governors of the MCI was asked to suggest suitable modifications to the existing postgraduate system. After an extensive review of the lacunae in the present system, the needs at various levels and the pattern of postgraduate education in other countries, it was felt that a competency-based model of a 2-year postgraduate course across all specialties, the use of offsite facilities for training and a criterion-based evaluation system entailing continuous monitoring would go a long way to correct some of the deficiencies of the existing system. The details of the proposal and its merits are outlined for wider discussion and to serve as a feedback to the regulatory agencies engaged in the task of improving the medical education system in India. We feel that the adoption of the proposed system would go a long way in improving career options, increasing the availability of teachers and dissemination of specialists to the secondary and primary levels, and improving the quality of outgoing postgraduates.

Determinants of utilization of services under MMJSSA scheme in Jharkhand 'Client Perspective': A qualitative study in a low performing state of India.

Preventing maternal death associated with pregnancy and child birth is one of the greatest challenges for India. Approximately 55,000 women die in India due to pregnancy- and childbirth- related conditions each year. Increasing the coverage of maternal and newborn interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. With a view to accelerate the reduction in maternal and neonatal mortality through institutional deliveries, Government of India initiated a scheme in 2005 called Janani Suraksha Yojna (JSY) under its National Rural Health Mission (NRHM). In Jharkhand the scheme is called the Mukhya Mantri Janani Shishu Swasthya Abhiyan (MMJSSA). This paper focuses on community perspectives, for indentifying key areas that require improvement for proper implementation of the MMJSSA in Jharkhand. Qualitative research method was used to collect data through in-depth interviews (IDIs) and focus group discussions (FGDs) in six districts of Jharkhand- Gumla, West Singhbhum, Koderma, Deoghar, Garhwa, and Ranchi. Total 300 IDIs (24 IDIs each from mother given birth at home and institution respectively; two IDIs each with members of Village Health and Sanitation Committees (VHSC) / Rogi Kalyan Samitis (RKS) from each district) and 24 FGDs (four FGDs were conducted from pools of husbands, mothers-in-law and fathers-in-law in each district) were conducted. Although people indicated willingness for institutional deliveries (generally perceived to be safe deliveries), several barriers emerged as critical obstacles. These included poor infrastructure, lack of quality of care, difficulties while availing incentives, corruption in disbursement of incentives, behavior of the healthcare personnel and lack of information about MMJSSA. Poor (and expensive) transport facilities and difficult terrain made geographical access difficult. The level of utilization of maternal healthcare among women in Jharkhand is low. There was an overwhelming demand for energizing sub-centers (including for deliveries) in order to increase access to maternal and child health services. Having second ANMs will go a long way in achieving this end. The MMJSSA scheme will thus have to re-invent itself within the overall framework of the NRHM.

Multi locus sequence type comparison of invasive and commensal Haemophilus influenzae isolates from Delhi.

Haemophilus influenzae is a major public health concern in the developing world. The most virulent strain is H. influenzae Type b (Hib). Hib also constitutes a major portion of nasopharyngeal commensal flora in otherwise healthy individuals. Through dendogram based on composite gene sequences of seven multi locus sequence type genes, it was observed that invasive and commensal isolates made two completely separate clusters which are indicative of independent evolution of these two groups of H. influenzae in the Indian subcontinent.

Epidemiological transition of hepatitis A in India: issues for vaccination in developing countries.

With improvement in economic and living conditions of the communities, the age of acquiring hepatitis A virus (HAV) infection is shifting from early childhood to adolescence and young adulthood. Such epidemiological shift leads to an increased incidence of symptomatic HAV infection, including heightened risk of liver failure. Data from India indicate that the population is no longer homogeneous for its HAV exposure profile. Occasional outbreaks of HAV and higher proportions of symptomatic cases are reported amongst older children and adults from different regions of the country. However, the heterogeneous exposure to HAV defies widespread use of the vaccine. The challenge is to recognize the susceptible pockets and take pre-emptive steps. In regions with rapid improvement in living standards and environmental hygiene, there is a need for regular surveillance through structured protocols that are able to identify early signs of epidemiological shift. This review discusses relevant issues and concerns to influence decision making for HAV vaccination in such transition societies.

Social determinants and polio 'endgame': a qualitative study in high risk districts of India.

OBJECTIVES: To understand the perceptions and likely determinants that facilitate or act as barriers in implementing additional strategies for polio eradication: (a) accelerated delivery of mOPV1 (monovalent polio vaccine type 1); (b) use of IPV (inactivated polio vaccine); and (c) provision of incentives. DESIGN: QUALITATIVE. Rapid appraisal procedures (RAP) were adopted to derive the reality by synthesizing multiple sources of information; search for opinions, motivations, behaviors and attitudes of key stakeholders within their organizational and socio-cultural matrix. SETTING: Two districts of Uttar Pradesh - Moradabad and J P Nagar. SUBJECTS: Total 244 interactions were conducted; 33 interviews and 4 focussed group discussions (FGD) conducted with providers; 33 mothers (<5 years) and 10 leaders were interviewed; 8 FGD were conducted with mothers of under-fives. Informal interactions (156) were also conducted with village pradhans, religious leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. RESULTS: Providers expressed reservation regarding accelerated rounds of OPV; scientific rationale of accelerated rounds is not clear to parents and leaders. Although technical advantages of introducing IPV exist, issues of logistical difficulties and injection safety emerged strongly. Providers and communities indicated a clear 'no' to the cash incentives but argued for developmental issues. Resistance to the program has declined over time but still the program is perceived as the "government's need, not ours". CONCLUSION: The polio eradication program is critically poised, an opportunity to intensify efforts for reducing inequities in health services and improve access of all children to the PHC services. Ongoing dialogue with local communities and strong political commitment would be essential to translate the technological innovations into a sustainable program.

Alpha-1 antitrypsin deficiency among Indian children with liver disorders.

AIMS: To determine the frequency of alpha-1 antitrypsin (AAT) deficiency in children with chronic liver disease (CLD) and neonatal cholestasis syndrome (NCS). METHODS: All children with NCS (n=23) or CLD (n=35) attending the Pediatric Gastroenterology Clinic between November 2003 and July 2005 were screened for AAT deficiency using phenotyping through isoelectric focusing of plasma. RESULTS: Of the 58 children studied, 57 had normal PiMM phenotype. One child with CLD had the M1E type of normal variant. None of the patients had the abnormal phenotype PiZZ. CONCLUSION: AAT deficiency is infrequent among children with CLD and NCS in our region.

Pancreatic diseases in children in a north Indian referral hospital.

This was a cross-sectional study to determine the profile of pancreatic disorders in 54 children (age <15 years) presenting to a tertiary care center in India. Acute pancreatitis was the most common pancreatic disorder (28/54, 52%). Twenty-three children (43%) were diagnosed to have either chronic calcific (n = 15, 28%) or chronic non-calcific (n = 8, 15%) pancreatitis. Specific etiologic factors could be identified in 64.3% (18/28) of acute pancreatitis and 43.5% (10/23) of chronic pancreatitis patients. At least some of the 13 children with idiopathic chronic pancreatitis had features suggestive of tropical pancreatitis.

Streptococcus pyogenes meningitis.

Group A Streptococcus (GAS) is a rare cause of meningitis. Although it has a high mortality, the condition is easily treatable if diagnosed early since the bacteria retains its sensitivity to many antimicrobials. The authors report here two cases of GAS meningitis along with a review of world literature.

Effect of esmolol on oxidant status and antioxidant activity in acute myocardial infarction.

AIMS AND OBJECTIVES: The role of oxygen free radicals in reperfusion injury to the heart in myocardial infarction (MI) has been postulated. In this study, the clinical and antioxidant effects of esmolol, an ultra-short acting beta blocker in patients of acute MI was studied. MATERIAL AND METHODS: This was a randomized, double-blind, controlled, prospective study. Total 30 patients with acute MI were included. All patients were thrombolysed with streptokinase. Fifteen of these patients were randomly selected to receive esmolol while other 15 patients served as controls. The parameters compared at 0, 2 and 24 hours between the esmolol group and the controls were--malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPX). RESULTS: Patients with MI had 5.16 times higher MDA level at 0 hours (20.34 +/- 6.12 nmol/ml vs. 3.94 +/- 0.70 nmol/ml, p < 0.0001) than MDA level in normal healthy population. At 2 hours, patients with MI had 5.71 times higher MDA level compared to normal healthy population (22.51 +/- 5.51 nmol/ml vs. 3.94 +/- 0.70 nmol/ml, p < 0.0001). A statistically significant difference in MDA levels at 2 and 24 hours was observed in MI patients given esmolol (mean change 2.06 +/- 5.39 nmol/ml vs. -4.47 +/- 6.93 nmol/ml, p = 0.009). Esmolol infusion also caused significant difference in GPX level at 2 hours compared to controls (23.79 + 14.68 U/gm Hb vs 38.3 +/- 8.95 U/gm Hb, p = 0.003). CONCLUSION: Free radical levels are raised in patients with MI which may contribute to reperfusion injury. The antioxidant action of esmolol was clearly observed by significant difference in MDA level and GPX sparing effect. Large scale clinical trials may establish conclusively role of beta blockers as antioxidants as adjuvant to thrombolytic therapy in MI.

Acute liver failure.

Acute liver failure in children is associated with a high mortality. Most cases in our setup are due to water borne hepatotropic viruses HAV and HEV. The clinician must be aware of the earliest and the subtle signs of acute liver failure to identify cases early enough and institute supportive therapy. Focus of therapy has to be on prevention, early recognition and appropriate management of complications. Despite good intensive care, about 40-60% children with liver failure die. As and when liver transplantation becomes available in India, it would be an attractive option.

Nasopharyngeal carriage of Haemophilus influenzae.

OBJECTIVE: Nasopharyngeal colonization of Haemophilus influenzae (H. influenzae) in young children may be important in developing countries. METHOD: In this study, we screened school going children for carriage of H. influenzae. A total of 44 H. influenzae isolates out of a collection of 162 were characterized for biotypes, capsular serotypes and antibiotic resistance. RESULTS: A significant proportion of H. influenzae (25/44) isolates were serotype b. High antibiotic resistance was observed against commonly administered antibiotics like ampicillin (79%), chloramphenicol (20%), trimethoprim sulfamethoxazole (84%) and erythromycin (95%). Comparison of antibiotic resistance profile of nasopharyngeal isolates was observed to be correlated with those of H. influenzae from disease. CONCLUSION: Multidrug resistant nasopharyngeal H. influenzae in young healthy children may act as reservoir. Monitoring of antibiotic resistance among nasopharyngeal H. influenzae as a surrogate for invasive H. influenzae seems an attractive option.