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This paper titled A Study of Consumption Behaviour of Plastic Card Holders of Ahmedabad City is aimed at knowing which types of plastic cards (credit card, debit/ATM card, charge card and smart card) are held by respondents and out of them which is the most used plastic card, the number of plastic cards used, most popular card issuing bank and most preferred brand of plastic card of respondents of Ahmedabad city. The findings are that majority of card holders have debit card and it is the most preferred card for purchasing goods and services by respondents. Respondents possess more than one cards. Only 32% card holders have only one card and nearly 68 % card holders have more than one card. Axis bank is the most popular card issuing bank (20.2%) amongst majority of respondents followed by SBI. The majority of respondents (34.6%) are using Classic brand plastic card. This revels that other brands like Classic Plus, Edge, Global, Gold, Neo, Platinum, Priority, Privilege,Titanium etc. are less popular.
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The business world is facing lots of challenges due to competitive global markets. Disruptive innovations in technology raised a question for many businesses regarding the longevity of advantages they are enjoying on their investments in current technology. Product differentiation is much tougher nowadays because of the competitors imitating the leaders in market matching the standards fairly. To solve this problem companies use brand and brand loyalty to enjoy long-term competitive advantage. The main objective of this paper is to review the existing academic literature on brand, brand loyalty and loyalty programs and its advantages to the businesses. The researchers have used secondary data sources to know how companies are using these tools for creating competitive advantages. This paper gives details regarding the benefits of having a strong brand and creating and developing brand loyalty for the organizations and its customers. The outcomes of this review paper show that brand and brand loyalty programs are an essential part of any given business
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Rationale: Candida auris is a potential emerging pathogen among Candida and causes serious health threats globally. Patient concerns: We reported a case of vulvovaginal candidiasis caused by Candida auris. A 26-year-old female presented with complaints of vaginal discharge, itching and low back pain. Diagnosis: High vaginal swab culture yielded Candida. The strain was confirmed as Candida auris by amplification and sequencing the internal transcribed spacer region. Antifungal susceptibility testing revealed that the isolate was resistant to fluconazole, amphotericin B and clotrimazole and susceptible to ketoconazole and nystatin. The isolate also exhibited biofilm forming ability. Interventions: Her symptoms did not subside with initial management with fluconazole and clotrimazole. Later, she was started on ketoconazole therapy. The patient responded well to ketoconazole. Outcome and lessons: To the best of our knowledge, this is the first report about the presence of a drug resistant biofilm forming Candida auris strain isolated from a vaginal swab sample from Chennai area. Biofilm forming ability might contribute to its drug resistance. Nucleic acid analysis helps in rapid and accurate identification of such rare species.
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Introduction: Neuropsychiatric Systemic LupusErythematosus (NPSLE) is a disease with central andperipheral nervous system manifestations. The diagnosis ofNPSLE is often a diagnostic challenge though the criteria forNPSLE is well-established.Objective: To study the prevalence and pattern ofneuropsychiatric manifestations in SLE.Materials and Methods: This hospital based observationalstudy was carried out from Nov 2017 to June 2018. A total of58 cases of SLE were assessed clinically and investigatedaccordingly. Special emphasis was given to look forNeurological involvement. MMSE, HAM A and HAM D scaleswere used for assessment of cognitive dysfunction, anxiety anddepression respectively. The disease activity was measured bythe SLEDAI.Results: In a total of 58 patients with SLE evaluated, 92%were female. The most common age group was 21 to 30 years.Mean age was 25.6 years. Nervous system involvement wasfound in 37 (63.79%) patients. Headache was the mostfrequent manifestation, present in 32 (55.17%) patientsfollowed by Cognitive dysfunction in 8 patients (13.79%).Seizure disorder was present in 6 (10.34%), acute confusionalstate in 2 (3.44%), depression in 4 (6.89%), anxiety in 2(3.44%) and psychosis in 2 (26.31%) patients. Asepticmeningitis and peripheral neuropathy was found in 2 (3.44%)and 1 (1.72%) patients respectively. Many of the patients hadmore than one neurological involvement. SLEDAI score washigh in SLE patients with neurological manifestations.Conclusion: The frequency of Neuropsychiatric involvementwas found in the majority of the patients with SLE andheadache was the most common manifestation. Patients withNPSLE showed high disease activity.
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Introduction: Hyponatremia, which is defined as a plasmasodium concentration less than (<) 135mmol/L, is a verycommon disorder and can occur in up to 22% of hospitalisedpatients. Its prevalence among non-hospitalised elderlypatients has been estimated to be between 7% to 11.4%,increasing to 11% to 22.5% among the hospitalised patients. Itis also the most common dyselectrolytemia seen in thegeriatric population which occurs due to impaired water andelectrolytes balance in response to diet, drugs andenvironmental changes.Aims and Objectives: The aims of the study were to describethe clinical features and different causes of hyponatremia inhospitalised elderly patients and to find out the types ofhyponatremia and to assess the short term outcomes duringhospital stay.Methods and Materials: The study was a hospital basedobservational study conducted in Medicine Department andGeriatric Regional Centre, Gauhati Medical College andHospital, Guwahati for a period of one year from August 2017to September 2018. Ethical clearance was obtained from theethical committee. A total of 106 patients with hyponatremiawere included in the study with aged greater than or equal to(≥) 60 years.Results and Observations: The mean age was 70.04 yearswith a standard deviation of 6.73 years. Male and Female ratiowas 1: 1.12. The mean serum sodium level was 124.8 mmol/Lwith a standard deviation of 5.8 mmol/L. Altered sensorium (48cases, 45.3%) was the most common presenting symptomfollowed by lethargy (21 cases ,19.8%). The most commonetiology was found to be SIADH (32 cases, 30.2%) followed byrenal failure (19 cases, 18%) and intake of drugs like diuretics(18 cases, 17%). Among SIADH majority of the cases werefound to have pneumonia (12 cases, 37.5%) followed by stroke(9 cases, 28.1%) and brain infections like meningitis andencephalitis (5 cases, 15.6%). In hyponatremia, majority of thecases was found to be in euvolemic status (55 cases, 51.9%).The overall mortality of hyponatremic patients was 8.5%. Shortterm outcomes in patients with comorbid condition like chronickidney disease was found to be significantly higher (pvalue=0.0396).Conclusion: Hyponatremia is a very common dyseletrolytemiaand clinical problem encountered in the elderly population andis associated with high morbidity and mortality particularlywhen associated with comorbidities.
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Background The present study aimed to assess the morbidity after cardiac surgery and identify the preoperative and intraoperative factors associated with postoperative morbidity. Methods A retrospective observational study was conducted including 362 adult patients aged 18–75 years who underwent open-heart surgery under cardiopulmonary bypass at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India, during the period from June 2016 to May 2017. Using a structured schedule, preoperative and intraoperative data were collected from the hospital's cardiac surgery database, whereas the postoperative data were collected from the intensive care unit (ICU) database and the hospital's clinical information system database. Results Of 362 patients, 254 (70.2%) had at least one major complication, and the most frequently occurring complication was low cardiac output state (29.8%). The ICU length of stay (LOS) was for > 2 days in 23.2% of patients, and the hospital LOS was for > 7 days in almost 60% of the patients. Multivariate logistic regression analyses revealed that gender, type of surgery, body weight, blood lactate level at ICU admission, and 12-h blood lactate level were significant predictors of complications; gender and 24-h blood lactate level were significantly associated with the prolonged ICU LOS, whereas type of surgery and 24-h blood lactate level were significantly associated with prolonged hospital LOS. Conclusion The appropriate patient management strategy can be tailored based on the personal attributes, surgery type, and blood lactate level for individual patients undergoing cardiac surgery to reduce the likelihood of postoperative complications, ICU LOS, and hospital LOS.
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Antitumour necrosis factor-alpha (TNF-α) therapy is used as a clinical intervention for rheumatoid arthritis (RA) but differences exist in response to the treatment which makes the candidature of the screening of TNF-α alteration(s) at genetic and expression levels an important agenda prior to treatment. This study aims to determine the associative role of TNF-α –308G/A polymorphism and differential expression of TNF-α in the pathogenesis of RA. A case–control study where a total of 126 RA patients were enrolled based on ACR-EULAR (2010) criteria, along with 160 community matched age and sex controls over a period of three years. The differential expression level of TNF-α mRNA and protein level was studied and TNF-α –308G/A polymorphism was screened by T-ARMS PCR assay. All statistical analysis was performed using SPSS software. mRNA expression level of TNF-α was upregulated in RA cases (avg. 15.85 ± 9.52 fold) compared to control. TNF-α protein level was found to be higher in RA cases (28.62±7.17 pg/mL) compared to control (23.14±6.91 pg/mL). TNF-α –308 variant GA genotype was higher in RA (46.03%) than in control (25%). The presence of TNF-α –308 variant A allele was associated with increased risk of RA susceptibility (odds ratio (OR) = 2.559 at 95% confidence interval (CI), P< 0.001) but not severity (OR = 1.617 at 95% CI, P = 0.571). The presence of –308 variant genotype was associated with a higher TNF-α mRNA and protein expression. The presence of TNF-α –308A allele is associated with increased risk of RA susceptibility and differential TNF-α expression, and has prognostic significance. Association of higher TNF-α pro-inflammatory cytokine levels with northeast Indian patients makes them suitable subjects for anti-TNF-α therapy.
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Introduction: Thyroid dysfunction is a disorder of the thyroid gland which manifests either as hyper - or hypothyroidism and is reflected in the levels of thyroid stimulating hormone (TSH). Type 2 Diabetes Mellitus is the commonest endocrine disorder and leading cause of morbidity worldwide. These two most common endocrine disorders encountered in clinical practice have been shown to mutually influence each other, and association between both the conditions has long been reported. The present study was conducted to find out the prevalence of thyroid disorders in patients of type 2 diabetes mellitus. Materials and methods: 100 cases of type 2 diabetes mellitus were examined for thyroid dysfunction. A detailed history was taken regarding presenting symptoms, duration of type 2 diabetes mellitus and clinical course of disease. A family history was taken with special reference to type 2 diabetes mellitus and other comorbidities. BMI was calculated to diagnose obesity. A thorough clinical examination was done. Ophthalmic examination was done to diagnose retinopathy and cataract. Detailed blood investigations were done including serum TSH, free T3 and free T4. Results: Males were more affected with diabetes than females and occurrence of thyroid dysfunction was found more common in females with Type 2 DM in our study. Hypothyroidism was most common type of thyroid dysfunction with affected age group was 51-60 years. DM and thyroid dysfunction were more common in overweight patients. Thyroid dysfunction in type 2 DM was seen more commonly with higher levels of HBA1C. Dyslipidemia was more in patients of diabetes with thyroid dysfunction. Patients taking insulin had more incidence of hypothyroidism than patients on OHA. Diabetes related microvascular complications increase the risk for thyroid dysfunction. Krunal Talsaniya, Chitralekha Vora, Bhavikkumar Prajapati. A study of thyroid dysfunction in known cases of diabetes mellitus type 2 and their clinical profile. IAIM, 2019; 6(1): 103-108. Page 104 Conclusion: Thyroid dysfunction prevalence is very high in patients with diabetes. Patients with diabetes having microvascular complications are more affected with thyroid diseases. Dyslipidemia is also common in DM with thyroid diseases. So thyroid function test must be done on regular basis in each and every patient of DM 2.
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Background: Cerebrovascular accident (CVA) remains a major cause of morbidity and mortality worldwide. There is growing evidence that high homocysteine level contribute to the pathogenesis of ischemic stroke. High hohmocysteine levels are associated with increased risk of cardiovascular and cerebrovascular disease, although there are few studies that show no increase in risk, and there is still debate as to the strength and validity of the association. This study has been undertaken to correlate the serum homocysteine level in patients of cerebrovascular accident. Materials and methods: This study comprised of 100 patients of cerebrovascular accident admitted with acute onset of neurological deficit which are radiologically diagnosed. The diagnosis of cerebrovascular accident was made on the basis of history and clinical examination. We did CBC with ESR, renal function test, liver function test, serum homocysteine level, RBS, Fasting lipid profile, vitamin B12, urine routine analysis, HIV, CT scan Brain/ MRI Brain, ECG, 2D ECHO, Carotid Doppler if required, ANA / RA factor and any specific investigation if indicated. Results: Highest no of patients were in 5th and 6th decades of life with highest mean serum homocysteine level. Males were more affected with CVA than females and the mean serum homocysteine level was also higher in males. Urban population has higher homocysteine level than rural. Most common presenting symptom of CVA in the present study was hemiplegia. Convulsion was more associated with hemorrhagic CVA rather than ischemic CVA. Hypertension is one of the major risk factors for CVA. The mean homocysteine was higher in vegetarian population. Out of 72 patients having raised S. homocysteine level, 38 patients had vitamin B12 deficiency. Chitralekha Vora, Krunal Talsaniya, Bhavikkumar Prajapati. Clinical profile of cerebrovascular accident patients with special reference to serum homocysteine level. IAIM, 2019; 6(1): 76-82. Page 77 Conclusion: Hyperhomocysteinemia is an independent risk factor for CVA. Urban lifestyle is associated with higher incidence of CVA and higher homocysteine level. Homocysteine estimation should be included as a routine laboratory test for persons with cerebrovascular risk factors. Plasma vitamin B12 concentration is inversely associated with s. homocysteine concentration. Treatment of hyperhomocysteinemia with vitamin B12 supplements will reduce homocysteine level and ultimately reduce risk of CVA.
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Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has considerable cardiovascular risk. Various cardiovascular diseases are common during exacerbations. Both diseases share several similarities such as older age of the patient, smoking as a common risk factor and symptoms of exertional dyspnea. Knowledge regarding the magnitude of underlying cardiovascular diseases during AECOPD is limited. Authors performed this study to assess the presence of different associated cardiovascular diseases (CVDs) in patients hospitalized for AECOPD and its effect on the outcome.Methods: It was a prospective observational study involving 436 patients of AECOPD divided to Group 1 (AECOPD with CVD- 137 (31.4%) patients) and Group 2 (AECOPD without CVD 299 (68.6%) patients). All the patients were subjected to full history taking, clinical examination, chest X-ray, spirometry, ECG and echocardiography.Results: COPD patients in exacerbation with CVD, were significantly more likely to have longer duration of hospital stay (p < 0.0001), high CRP level (p<0.001), more frequent mechanical ventilations (p < 0.001), two or more exacerbations per year (p <0.0001) and the mortality was (p<0.0001). Also, they have GOLD grade III/IV severe (43.5%) and very severe (19.5%) air flow limitation. The high percentage of them had (64.8%) pulmonary hypertension, (37.3%) systemic arterial hypertension, (31.5%) arrhythmia, (27.8%) ischemic heart diseases and (21.3%) heart failure.Conclusions: The prevalence of cardiovascular diseases (CVD) in patients hospitalized for COPD was high. Age, sex and CVD trends, as well as life style changes, should be considered when prevention and control strategies are formulated.
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The aim of the present study was to detect the extended-spectrum β-lactamase (ESBL) production among Pseudomonas aeruginosa isolates from various samples. A total of 125 Pseudomonas aeruginosa isolates from various samples in a tertiary care hospital from June 2014 to November 2014 were included in the study. The diagnosis was confirmed using standard bacteriological techniques and antibiotic susceptibility testing was done by Kirby Bauer disc-diffusion method. The isolates resistant to the third generation cephalosporins were tested for ESBL production using double-disc synergy test (DDST) using ceftazidime alone and combined ceftazidime-clavulanic acid discs. It was found that out of the 125 isolates tested, 17 (13.6%) were found to produce ESBL. Also, all the ESBL-producing P. aeruginosa were resistant to third generation cephalosporins and they were 100% susceptible to meropenem followed by 60% susceptibility to amikacin and 50% susceptibility to ofloxacin. This study emphasizes on the need for global control of antimicrobial resistance; and to create awareness among the clinicians and general population thereby reducing the mortality and morbidity associated with multi-drug resistant pathogens.
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Ebola viral disease is one of the major threats world wide. But the treatment option is merely supportive and symptomatic therapy. Vaccination and drug therapies are still under trial. This article throws light into the various emerging treatment options for the Ebola viral disease.
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Objective: To assess the effectiveness of facility-based care for children with severe acute malnutrition (SAM) in Nutrition Rehabilitation Centers (NRC). Design: Review of data. Setting: 12 NRCs in Uttar Pradesh, India. Participants: Children admitted to NRCs (Jan 1, 2010 - Dec 31, 2011). Intervention: Detection and treatment of SAM with locallyadapted protocols. Outcomes: Survival, default, discharge, and recovery rates. Results: 54.6% of the total 1,229 children admitted were boys, 81.6% were in the age group 6-23 months old, 86% belonged to scheduled tribes, scheduled castes, or other backward castes, and 42% had edema or medical complications. Of the 1,181 program exits, 14 (1.2%) children died, 657 (47.2%) children defaulted, and 610 (51.7%) children were discharged The average (SD) weight gain was 12.1 (7.3) g/kg body weight/day and the average (SD) length of stay was 13.2 (5.6) days. 206 (46.8%) children were discharged after recovery (weight gain ≥15%) while 324 (53.2%) were discharged, non-recovered (weight gain <15%) Conclusions: NRCs provide life-saving care for children with SAM; however, the protocols and therapeutic foods currently used need to be improved to ensure the full recovery of all children admitted.
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A 70-year-old woman came to ophthalmology outpatient department with complaints of repeated episodes of itching, redness and watering in both eyes of 3 months duration. She was treated with antibiotics elsewhere but had no improvement. Slit lamp examination showed lice and nits anchored to the eyelashes. Light microscopic examination of the matted eye lashes and crusts further helped in identification of the ectoparasites as Phthirus pubis (Pubic louse or Crab louse) with typical morphology.
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Paraoxonase 1 [PON1] is an esterase, exclusively synthesized by liver. The present study has two objectives: to determine the PON1 activity status in various disorders associated with hepatocellular damage and to correlate the changes of PON1 activity with the standard liver function and fasting lipid profile tests in these disorders. The study groups consisted of 95 patients with liver diseases including acute viral hepatitis [14], cirrhosis with portal hypertension [33], leptospirosis [14], sepsis and multi organ failure [15], left ventricular failure [9], and falciparum malaria [10]; and 53 healthy controls. Serum PON1 activity was measured manually using spectrophotometer. Liver function test parameters and fasting lipid profile were performed in clinical chemistry auto analyzer [HITACHI 912]. The serum PON1 activity in patients with acute viral hepatitis and sepsis decreased significantly [P<0.001] and moderately in falciparum malaria [P<0.05]. However, in patients with cirrhosis, leptospirosis and left ventricular patients, its activity did not change significantly. On applying Pearson correlation, serum PON1 activity correlated positively with high-density lipoprotein-cholesterol [HDL-C] in patients with sepsis [r=0.633, P<0.05], left ventricular failure patients [r=0.814, P<0.05] and negatively with acute viral hepatitis patients [r=-0.528, P<0.05]. PON1 activity has decreased significantly in acute viral hepatitis, sepsis with multi organ failure and falciparum malaria patients. Determination of PON1 activity may serve as a useful additional test in assessing these conditions
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Liver Diseases/enzymology , Hepatitis, Viral, Human/enzymology , Multiple Organ Failure/enzymology , Sepsis/enzymology , Malaria, Falciparum/enzymologyABSTRACT
Continuous birth control pills are the latest method of extended cycle oral contraception designed to eliminate women's monthly cycle dependant and disorders. In this case we present the clinical course of a forty year old lady who took oral contraceptive pills as extended regimen to get her period every three month instead of monthly for a period of two years, and describing the clinical symptoms, laboratory tests and imaging findings throughout the study
Subject(s)
Humans , Female , Contraceptives, Oral/adverse effects , Risk Assessment , Bone Diseases, Metabolic , Androstenes , AwarenessABSTRACT
Mast cells are known to be effector cells in various inflammatory reactions, but their role in appendicitis is unclear. The present study was undertaken to investigate the extent of mast cell involvement in appendicitis and evaluate their possible role. A total of 150 appendices including normal and inflamed appendices, were assessed for their histological changes and density of neutrophil, lymphocyte and eosinophil infiltration. The mast cells were counted in 1% toluidine blue-stained sections. It was found that eosinophil counts in all the layers were significantly low in normal appendices (P<0.01) and in chronic appendicitis (P<0.1) as compared to acute appendicitis. Mast cell counts were lowest in normal appendices, significantly higher in acute appendicitis (P<0.01) and highest in chronic appendicitis (P<0.001). Obstruction due to faecoliths or parasites were seen in only 20.1% and 2.1% of the inflamed appendices respectively. Hence a Type I hypersensitivity reaction with release of mediators by mast cells might be another triggering factor for the sequence of events leading to appendicitis.
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Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Appendicitis/etiology , Appendix/cytology , Child , Child, Preschool , Chronic Disease , Eosinophils/cytology , Female , Humans , Infant , Infant, Newborn , Male , Mast Cells/cytology , Middle AgedABSTRACT
Mast cells are known to be effector cells in various inflammatory reactions, but their role in gastritis is unclear. The present study was undertaken to investigate the extent of mast cell involvement in antral gastritis with and without Helicobacter pylori (H. pylori) infection and thus evaluate the possible role of mast cells in the pathogenesis of H. pylori-associated gastritis. Antral mucosal biopsies were taken from 212 subjects with symptoms suggestive of acid peptic disease. Sections were assessed for inflammation. Modified Giemsa stain was used to detect H. pylori infection and 1% toluidine blue to count mast cells. Mast cell counts were significantly higher in the antral mucosa even in H. pylori-negative gastritis (68.4 +/- 6.7/mm2), as compared to normal non-inflamed mucosa (45.7 +/- 5.8/mm2) (P < 0.05). However, with H. pylori infection, the mucosal mast cell count were markedly increased (123.8 +/- 4.7/mm2) as compared to normal mucosa (P < 0.01). and H. pylori-negative gastritis (P < 0.01) this increase was noticed uniformly in patients with H. pylori-positivity, irrespective of the presence or absence of a peptic ulcer. After cure of H. pylori infection, the mast cell density decreased significantly (44.9 +/- 4.6/mm2) to reach levels that were similar to those in normal mucosa. There was a positive correlation between the antral mucosal mast cell density and polymorphonuclear and mononuclear cell infiltration (rs = 0.61). H. pylori infection, and 0.73 respy. It was concluded that could be responsible for increasing the mast cell density in the gastric antrum. Probably by inducing castain mucosal cytokine.
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Adolescent , Adult , Aged , Cell Count , Female , Gastritis/pathology , Helicobacter Infections/pathology , Helicobacter pylori , Humans , Male , Mast Cells/pathology , Middle Aged , Pyloric AntrumABSTRACT
Endoscopic biopsies obtained from 275 patients (180 from the upper gastrointestinal tract and 95 from the lower gastrointestinal tract) were studied to compare the accuracy of biopsy imprint cytology and histology in the diagnosis of gastrointestinal lesions, and also to establish the degree of reliability of imprint cytology alone for an early diagnosis of malignancy. Biopsy histology results were found to be correct in 100% cases. Imprint cytology had an overall accuracy of 100%, 96.7%, 95.8% and 95.8% for the diagnosis of malignancies of the oesophagus, stomach, duodenum and colorectum respectively. False negative results were obtained with lymphomas. Regenerative cellular atypia was an important cause for false positive results. It was concluded that imprint cytology can serve as a useful and simple tool for an immediate diagnosis of malignancy. This should be subsequently correlated with histopathology which facilitates exact tumour typing and assessment of tumour invasion.