An Inter District Analysis of Public Healthcare Infrastructure Disparities in Assam.

Background: Sufficient and quality healthcare services are basic requirement for overall development of a nation. Public healthcare infrastructure is one of the major determinants of health outcomes in a country, and public healthcare services have a considerable impact on people's health status. The rural population primarily relies on public healthcare services. Assam is not an exception in this regard, where the insufficiency of public healthcare services is still an issue. 86 % of the population of Assam lives in rural areas. Objectives: The present work attempts to study the inter-district variation regarding public health infrastructure in 33 districts of Assam. Methods: The Inter district variation is estimated with a composite index of public health infrastructure. Principal Component Analysis (PCA) is adopted to construct a composite index using nine health infrastructure indicators. Results: The study has observed variations in health infrastructure among the various districts of Assam, reflecting the shortage of health infrastructure-physical and human in rural and remote areas of the state. The study finds inter-district variations in the state.

Role of PPI and importance of anti-reflux agents in the treatment of NERD

Background: Esomeprazole, an S-isomer of omeprazole, is a much more potent acid inhibitor than most other currently available PPIs and gives excellent results. Therefore, it is a first-line drug for acid-related diseases like NonErosive Reflux Disease (NERD). Yet, patients demand faster onset and response. Aim : To establish the role of esomeprazole and the importance of anti-reflux agents like a combination of two antacids (calcium carbonate and sodium bicarbonate) and alginate in treating NERD. Conclusion: Esomeprazole therapy shows potential efficacy in the continuous maintenance treatment of the NERD. However, it is suggested that to improve the efficiency of esomeprazole for the treatment of NERD; we can supplement the drug with antacids (sodium bicarbonate and calcium carbonate) and alginates.

Influence of Weather Parameters on Foliar Diseases of Sesame (Sesamum indicum L.) in Coastal Ecosystem of West Bengal, India

Sesame is one of the most important oilseed crops in India due to mainly its high quality seed oil and antioxidant properties. Occurrence of foliar diseases, like Alternaria leaf spot and Cercospora leaf spot has become a major constraint in recent years for successful and profitable cultivation of sesame. Field experiments were conducted with sesame var. savitri in a factorial randomized block design with three different dates of sowing with 15 days interval and two different plant protection situations (Protected i.e., treated with disease control protocols and unprotected i.e., control), replicated four times, during two consecutive summer seasons of 2018 and 2019 at Agricultural Experimental Farm, Institute of Agricultural Science, University of Calcutta, Baruipur, South 24 Parganas. The diseases incidence was estimated and correlated with the weather parameters. The average of weather parameters viz., maximum temperature, minimum temperature, relative humidity (morning), relative humidity (evening) and rainfall prior to seven days of disease appearance were considered for study the correlation between the weather factors and the disease. In 2018, disease incidences of the plants shown at third date of sowing (26th April, 2018) in both the protected and unprotected plots had significant (P=.05) but negative correlation with maximum temperature. For plants sown at first date of sowing (27th March, 2018) in 2018 had disease incidences significantly (P=.05) and positively correlated with minimum temperature. However, in 2019, except for the relation between disease incidences in the unprotected plots and maximum temperature, all other disease-temperature correlations were non-significant. Disease incidences were positively and significantly correlated with relative humidity (both morning and evening) in all dates of sowing irrespective of experimental years, except with morning relative humidity at first date of sowing in first year. Total rainfall was positively and significantly correlated with disease incidences at all dates of sowing in 2018; however, such relation was non-significant in 2019.

Plasma total homocysteine is not associated with peripheral neuropathy in a groups Bangladeshi type 2 diabetic subjects.

Aims: The present study was undertaken to explore the relationship of plasma homocysteine in the pathogenesis of neuropathy in diabetic patients. Subjects and Methods: Forty two type 2 diabetic patients [22 with neuropathy (DN group) and 20 without neuropathy (DNN group)], age range between 35-70 years had relatively controlled glycemia and duration of diabetes 7-15 years, were studied. Motor and sensory nerve conduction velocities and action potential amplitudes of peripheral nerves were determined by following standard protocol. HbA1c was estimated by modified HPLC (BIO-RAD Variant, USA). Serum C-peptide was measured by enzyme linked immunosorbentassay (ELISA), plasma total homocysteine by Fluorescent Polarization Immunoassay (FPIA). Results: Age, BMI and blood pressure of the study subjects were. Duration of diabetes between DN and DNN groups was comparable. DN group had significantly higher fasting glucose levels (9.8±3.8, mmol/l) compared to the DNN group (6.9±1.8, p=0.004). This trend was also reflected in the HbA1c level: 8.7± 2.1 vs 7.2±1.6 in DN group and DNN group respectively (p=0.009). The two diabetic groups had relatively higher absolute C-peptide level compared to the controls (p=ns). DN and DNN groups had significantly higher plasma homocysteine level compared to the Controls. But between the two diabetic groups no significant difference was observed. Ulnar and peroneal motor nerve conduction velocities and compound muscle action potentials in the diabetic neuropathy group significantly lower compared to diabetic counterpart and the controls. Ulnar and sural sensory nerve conduction velocities and action potentials were significantly lower in the diabetic neuropathy group compared to the diabetic counterpart and the controls. Plasma homocysteine did not show any correlation with nerve conduction velocities and action potential amplitudes. Conclusions: The data concluded that (i) Diabetic neuropathy may not be related to hyperhomocysteinemia in type 2 diabetic patients of Bangladeshi origin; (ii) Hyperglycemia, even at milder level, is related to neuronal dysfunction in these subjects; and (ii) Hyperinsulinemia don't seem to be prerequisite for neuropathy in these subjects.

Recurrent lymphocytic hypophysitis in a woman 27 years after subtotal adrenalectomy for hypercortisolism possibly of autoimmune origin.

Lymphocytic hypophysitis commonly occurs in females in peripartum period but several unusual presentations have been reported. Here we report a rare case of recurrent lymphocytic hypophysitis in a woman who had subtotal adrenalectomy for hypercortisolism 27 years back. Polyglandular autoimmune endocrinopathy with an uncommon combination of Cushing's syndrome and recurrent hypophysitis is a strong possibility in this case. Treatment with steroids has been found to have beneficial effect.

Hepatorenal syndrome.

Hepatorenal syndrome is a life-threatening complication occurring commonly in cirrhosis liver and rarely in acute liver failure. It can be precipitated by shock, infection, surgery, large volume paracentesis or nephrotoxic drugs. Type I hepatorenal syndrome which usually develops over acute liver failure is rapidly progressive and has poor outcome. Type II hepatorenal syndrome is usually associated with refractory ascites and is slowly progressive with relatively good prognosis. Peripheral vasodilation with intrarenal vasoconstriction is the main pathophysiologic change. Diagnostic criteria, ascertained by international ascites club, is helpful to reach at a proper diagnosis. Management includes pharmacologic therapy to induce splanchnic vasoconstriction which improve renal circulation. Dopamine, vasopressin analogs (ornipressin and terlipressin), midodrine, noradrenaline have been used mainly as a bridge to the liver transplant or in anticipation of improvement in hepatic function. The molecular adsorbent recycling system (MARS) have been recently used in patients with hepatorenal syndrome. Transjugular intrahepatic portosystemic shunt is also another modality which has been used as a bridge to liver transplant in such patients.

Study of portal hypertension in children with special reference to sclerotherapy.

Portal Hypertension (PH) is the commonest cause of upper gastrointestinal bleeding in children. Most Indian studies have highlighted extrahepatic portal venous obstruction (EHPVO) as the major cause of PH in children. As there is paucity of data from the eastern part of the country we decided to study the major causes of PH in children in this region and to ascertain the efficacy of sclerotherapy for its management. Fifty children aged 14 months to 10 years with PH were studied from April 1990 to April 1995. Thorough examination and relevant investigations showed non-cirrhotic portal fibrosis (NCPF) in 24 (48%), EHPVO in 18 (36%) and cirrhosis of liver in 8 (16%) children. Forty six children had hematemesis and melaena of whom endoscopic sclerotherapy (EST) was done in 45 cases. One child having type 2 gastric varices was referred for surgery. Following eradication of varices the patients were followed-up at 3 monthly intervals. Number of sittings of sclerotherapy required for obliteration of varices was 5.9 +/- 1.6. A variceal state was achieved in 35 (78%) cases and varices were reduced to Grade I in 6 cases (13%). Two cases underwent surgery for EST failure. One patient of cirrhosis died within two weeks of bleeding episode due to hepatic encephalpathy. Rebleeding (13%) and recurrences (13%) were noted during the follow-up period. Retrosternal discomfort (22%), dysphagia (22%), stricture (13%), oesophageal ulceration (13%) and fever (11%) were the complications noted but these could be managed conservatively. The present study highlights that NCPF is an important cause of PH in eastern India. EST is useful in controlling variceal bleeding in children irrespective of their aetiology.

Evaluation of antimuscarinic activity in human volunteers: a teaching aid in clinical pharmacology.

The antimuscarinic activity of oxyphenonium bromide, diphenhydramine hydrochloride and astemizole were evaluated in six volunteers. The parameters used were salivary secretion, heart rate and pupillary size. The results indicated that the changes in heart rate and pupillary size and measurements were not convenient parameters for class room demonstration. However, salivary secretion and dryness of mouth were found to be reliable parameters for measurement. It was concluded that simple procedures like evaluation of antimuscarinic activity could be introduced as teaching aids in clinical pharmacology for undergraduate students.

Incidence of helminthic infections and comparative study of pyrantel pamoate with levamisole and mebendazole in hospital patients at Barisal, Bangladesh.

A study was carried out to find out the incidence of helminthic infections in hospitalized patients at Sher-e-Bangla Medical College, Barisal and to determine the comparative efficacy of pyrantel pamoate, levamisole, and mebendazole. It was observed that 76.2 per cent of total hospitalized patients were infected with intestinal helminths. Polyparasitism (52.6 per cent) was more frequent than single infection (21.8 per cent). Amongst these, 47.5 per cent was suffering from Asearis lumbricoides (AL), 42.5 per cent from Hookworm (H.W) and 65.8 per cent from trichuris trichura (TT). Out of 255 cases examined separately, 40 per cent was suffering from Enterobious vermicularis (EV) infection. The comparative study showed that mebendazole produced egg negative stool in 90.9 per cent of AL, 95.6 per cent of HW and 86.8 per cent of TT after eight days of treatment. On the other hand, pyrantel pamoate cured AL in 93.3 per cent, HW in 78.5 per cent and TT in 34.2 per cent eases. Levamisole cured 75 per cent AL, 4.1 per cent H.W. and 22.2 per cent TT within the same period.