ABSTRACT
Introduction: TB is the most common opportunistic infection in HIV positive people. HIV-TB co-infection is a fatal combination with higher death rates in developing countries. In cured TB cases in HIV positive people, chances of recurrent also high. ART prevents the progression of HIV, reduces the chances of another opportunistic infection that could make management of care more complicated, and reduces the chances of TB recurring. Objectives: To document the profile of HIV positive TB patients availing both Anti-Retroviral (ART) and Anti Koch's Treatment (AKT) at a tertiary care hospital. Method: A retrospective descriptive study was conducted using available records of 198 HIV positive TB patients enrolled at an ART Centre of South Gujarat from November 2016 to November 2017. Age at enrollment at ART Centre, sex, native place, ART status, CD4 count were recorded along with detection, category, previous history and treatment of TB. Test of significance (t test) was applied to analyze the difference between CD4 count before and after treatment with AKT. Results: Mean age of male (n=123) and female (n=75) patients at the time of HIV detection was mean 37.62 (SD±11.61) years and mean 34.05 (SD±8.85) years respectively. Majority (86.87 %) were migrants from states other than Gujarat, of which 31.31% were from Maharashtra. Among them, 66% patients were on CAT-I AKT and 10.6% had previous history of TB. Among 56.1% patients who had extra-pulmonary TB, common were abdominal TB (47.75%), lymphadenopathy (18.02%) and pleural effusion (16.22%). While 32% of patients had completed their AKT regimen, 68% were on AKT. Among those were missed out (8.6%) and lost to follow up (3.5%) from ART, almost half (41.67%) had been initiated under CAT-II AKT. Mean CD4 count for 84 patients who completed their AKT was increase, this was statistically significant (p=0.001). Conclusion: Majority of patients were migrants and extra pulmonary TB was more common in this study group. Mean CD4 count increased significantly after completion of AKT. Prompt treatment and preventing loss to follow up are key to successful treatment completion and cure.
ABSTRACT
Over 8 lakh deaths occur every year due to diseases associated with tobacco use in India. The cancer registry data reveals that 48% of cancers in males and 20% in females are tobacco related and are totally avoidable. The present study evaluated socio demographic profile of diamond cutting and polishing workers of Surat city. Additively, the prevalence of various forms of tobacco use and factors related with it in diamond cutting and polishing workers was also studied. The present study was a cross sectional study of 295 diamond cutting and polishing workers selected randomly from different diamond units and interviewed with pre designed and pre tested semi st ructured questionnaire. Data on socio demographic characteristics, various forms of tobacco use and its related factors was collected and analysed with MS Excel and Epi info7. It was seen that the mean age of diamond workers was 29.51±9.02. About 71.2 % workers had history of tobacco use in different forms, from them, 68.1 % were currently consuming tobacco and 3.1 % had already quit their habit. Mean age of starting tobacco was 21.44±6.35 among current users. Mawa-masala (79.6%), khainee (22.39%) and Gutkha (4.48%) were preferred forms of smokeless tobacco among current-users. Smoking form of tobacco was used by 11.4 % of current user, out of which 9.4 % were bidi smokers and 2 % were cigarette smokers. Most common reason for tobacco initiation was peer pressure (74.13%), followed by psychological stress (47.76%). It was concluded that the prevalence of tobacco use among diamond workers is very high compared to that in general population. Preventive strategies are warranted to reduce the future burden of tobacco-related morbidity among these workers.
ABSTRACT
Background: Inguinal hernia block is cost effective, but fear of intra-operative pain may hinder its widespread use. It is unknown whether hyaluronidase along with local anesthetic agent provides good analgesia for hernia block. The aim was to evaluate the effectiveness of hyaluronidase along with local anesthetic agents for inguinal hernia block in patients undergoing inguinal hernioplasty. Methods: 50 patients ASA grade I and II, age above 18 years, undergoing inguinal hernioplasty were randomized into two groups. Group A received inguinal hernia block with local anesthetic agents without hyaluronidase and Group B received inguinal hernia block with hyaluronidase and local anesthetic agents. Both groups received premedication 10 minutes before induction in the form of inj. Fentanyl, Midazolam, Ranitidine and Ondansetron Results: In Group B, out of 25 patients only 4 patients required intraoperative analgesia while in group A 16 patients required intraoperative analgesia. Post operative pain was assessed for 24 hours using the pain rating scale. The mean duration of analgesia was significantly longer in group B (16.16±6.8780 hrs) compared to group A (7.32±2.5285 hrs); pain score was compared between the two groups. Group B had lower pain scores than group A which was statistically significant (P<0.05). Conclusion: It concludes that hyaluronidase with local anesthetic agent for inguinal hernia block provides excellent intraoperative analgesia and also prolongs the post operative analgesia.
ABSTRACT
Background: Drug utilization studies are powerful exploratory tools to ascertain the role of drugs in society. They create a sound sociomedical and health economic basis for healthcare decision making. The study was aimed to find out the changing pattern of prescribing the antidiabetic agents in patients suffering from diabetes mellitus type 1 and 2. Methods: It was a cross sectional study done on 200 patients suffering from type 1 and 2diabetes. Indoor patients and diabetes mellitus due to secondary cause were excluded. Each patient was followed up over a period of 1 year and the analysis of the prescriptions was done during that period. At end of study only 129 patients could be included for analysis. Results: In this study the maximal change in medicine was with pioglitazone which was discontinued as a 1st change in 6.2% of patients followed by metformin [5.4%], insulin [4.6%], and glipizide [3.8%]. The drug most commonly added as a first change was glipizide [11.6%] followed by metformin [10.0%] and pioglitazone [7.7%]. In order of 2nd change the most common drug discontinued was insulin [4.6%] followed by pioglitazone [3.8%] whereas drug commonly added as second change was insulin [2.3%] followed by glipizide [1.5%] and pioglitazone [1.5%]. In our cross sectional study average onset of 1st change was found to be at 4.38±2.75 months for discontinuation of drug and 3.75±2.42 months in adding the drugs. Conclusions: Due to lack of certain records, it is envisaged that the change of medicine both discontinuation as well as addition was done because of blood glucose control, cost factor [in case of pioglitazone] as well as patient’s compliance.
ABSTRACT
Healthy environment for children initiating an alliance for action (WHO) has reported that over 40% of the global burden of disease attributed to environmental risk factors fall on children below 5 years of age, who account for about 10% of the world's population. That is why to look into the new area of concern, this cross sectional study was carried out to explore the influence of domestic environment over the illness of under five children.