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Background: Under 5yrs mortality rates among male child is 30 and among female is 26 and overall infant mortality rate 24 per thousand respectively; these are the most vulnerable groups to different morbidity and mortality, and they ought to be fully dependent on parental knowledge and awareness to meet their health needs. Health seeking behavior (HSB) has become a tool for understanding the approach of people towards the health care systems in their respective socio-economic, cultural and demographic circumstances. A Community based Methods: descriptive study among “Tharu” ethnic women with children less than ?ve years of age in Triyuga Municipality, Nepal. Semi- structured questionnaire was used to collect socio-demographic information,, knowledge and current practice regarding health seeking behavior, including awareness and accessibility of health services. Among 406 respondents, 388 of Results: their children were reported ill within last 1 year, with fever accounting for 70%, followed by ARI (65%), diarrhea (6%) and others. Where 52.8% of respondents had appropriate HSB, taking their ill children to hospitals. More than 52% of respondents had hospitals as the ?rst preference for treatment for every morbidity. Except for access to health care facility, there was no signi?cant association of HSB was seen with parent's literacy,income, gender preference. With satisfactory Conclusion: awareness, literacy, and accessibility of health care centers, the HSB among tharu women, for the children morbidity seemed to be satisfactory in comparison to national scenario and other marginalized groups
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Background: The main purpose of providing antenatal care is to identify women at risk ofcomplications as a result of impaired uteroplacental circulation such as pre-eclampsia.Aim: To describe practical application of Doppler ultrasound in obstetrics with analysis of bloodflow velocity waveform in pre-eclampsia and to examine perinatal outcome in pregnancies withaltered Doppler indices.Material and Method: This is a prospective study of 40 pregnant women with pre-eclampsiaevaluated sono-graphically with color Doppler and to be followed subsequently for any adverseperinatal outcome.Result: Out of 40 cases 45% of cases were found in 25-29 years age group. 25 cases had abnormaluterine artery Doppler indices accounting for 62.5%, while 15 cases had a normal doppler indicesaccounting for 37.5%. Out of 40 cases, 24 cases had abnormal Middle cerebral artery accounting for60%. In our study 14 cases had abnormal umbilical artery Doppler indices accounting for 35%,while 26 cases had a normal Doppler index accounting for 65%. In this study total 6 cases (15%) ofperinatal mortality were seen.Conclusion: The knowledge of Doppler arteries waveform may help to improve pregnancyoutcome and any permit identification and assessment of pre-eclampsia at earliest gestational age ascompared to other ante partum test modalities.
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Objectives: The aim of the study was to assess the effect of life course factors on dental fear among adult dental patients attending out?reach clinics in a rural area of South India. The objectives were to measure dental fear and changes in socio?economic status during the life course among the study population and to know whether social mobility reduced/increased dental fear. Methods: Dental fear scale and life course data were collected from 403 respondents. The improvement status of individual life course criteria was categorised into “less/minimal”, “stable”, or “upwardly mobile”. Results: The odds of dental fear in the group showing less or minimal upward social mobility was two times that of the stable group [p = 0.022; 95% confidence interval (C.I): 1.104–3.598], whereas the odds of dental fear in the group showing more or good upward social mobility were 4.5 times that of the stable group [p = 0.001; 95% C.I: 1.928–10.515] when adjusted for covariates, that is, participant age, gender, and education and past history of dental avoidance. Conclusion: Social mobility was found to be a risk indicator for dental fear. Dental services may have been affected even with increased standards of living because of psychological factors such as dental fear.
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Pediatric glioblastoma (pGBM) is a rare entity accounting for only approximately 3% of all childhood brain tumors. Treatment guidelines for pGBM have been extrapolated from those in adult glioblastoma. Rarity of pGBM and underrepresentation of pediatric population in major studies precludes from defining the ideal treatment protocol for these patients. Maximum safe resection is performed in most of the cases followed by postoperative radiotherapy in children over 3 years of age. Benefit of temozolomide is unclear in these patients. Here, we present the clinicopathological details and outcome of six pGBM patients treated at our institute in 2018–2019.
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Pediatric glioblastoma (pGBM) is a rare entity accounting for only approximately 3% of all childhood brain tumors. Treatment guidelines for pGBM have been extrapolated from those in adult glioblastoma. Rarity of pGBM and underrepresentation of pediatric population in major studies precludes from defining the ideal treatment protocol for these patients. Maximum safe resection is performed in most of the cases followed by postoperative radiotherapy in children over 3 years of age. Benefit of temozolomide is unclear in these patients. Here, we present the clinicopathological details and outcome of six pGBM patients treated at our institute in 2018–2019.
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Pancreatic islet β-cell destruction in type I diabetes mellitus is prominent, and there may not be any better drug if onecan stimulate the regeneration/protection of islet. The objective of this study is to isolate the islet and evaluation ofthe protective potential of the isolated islet of a saponin. The extraction and isolation of saponin Momordica dioica(SMD) were done, and purification was achieved through the fractional method of thin liquid chromatography thatyielded a pure saponin and was characterized by high-performance liquid chromatography, liquid chromatographymass spectroscopy, Fourier transmission infrared, and nuclear magnetic resonance. The best optimized method for theisolation of rat pancreatic islets, islet viability, potential, insulin secretion, and intra-islet contents was performed, andalso, the insulin assay protective properties were assessed. The most optimum method was found to be the pancreasmincing and Collagenase Type XI digestion followed by cell straining (500μm), Ficoll gradient centrifugation and cellstraining (70μm). Glucose stimulated insulin secretion showed the islets secreted insulin in a dose dependent mannerwith respect to the different concentrations of glucose compared with their respective group indicating its functionality.MDA and NO results in STZ and high glucose conditions help in establishing the beta cell protective activity of SaponinMomordica dioica. All of these results are a promising signs of the diabetes patients.
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Background: The prevalence of gallstones among different populations is varied, which reflects the role of genetic and environmental factors, besides common factors like age, sex, parity, obesity and diet. Being a commonly treated surgical problem, we attempted to study the epidemiology, risk factors and predisposing factors related to gallbladder disease in our setup- the industrial township of Bharat Heavy Electricals Limited (BHEL), Bhopal, India.Methods: This was an observational study done over a period of 2 years. The patients were analyzed on the basis of age and sex distribution, dietary habits, body mass index, activity level, monthly income, family history, parity, associated illness if any, and abdominal ultrasound findings.Results: Of 104 patients, 44 were males and 60 females, with female to male ratio being 1.36:1. The commonest age group to be affected was 61 to 70 years (35 patients, 33.65%). Better socioeconomic status, lower activity level, higher parity, vegetarian diet and consumption of plant-origin fats were the factors present in most patients. No family history was present in 97.11% patients.Conclusions: As gallstones have multi-factorial etiology, it is difficult to disassociate their influence and to pin point towards the contribution of any one factor. But the results suggest that there is more than what meets the eye. Higher incidence in males and absence of family history point towards a cause not found in genes or at home, but something present in the workplace environment, where men form the major part of workforce.
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Introduction: Gastrinoma is a rare gastrin secretingneuroendocrine tumor. Clinical manifestations are nonspecificgastrointestinal (GI) symptoms or as Zollinger EllisonSyndrome(ZES) which often delays the diagnosis in majorityof patients. Hence a high clinical index of suspicion iswarranted in patients who present with nonspecific GIsymptoms to rule out gastrinoma.Case report: We report a case of 55 year old female whopresented with long standing dyspepsia and chronic diarrhoeaand was diagnosed with Sporadic Duodenal Gastrinomaon detailed evaluation. She was treated with surgicalresection and pathologically diagnosed as well differentiatedneuroendocrine tumor, Gastrinoma – grade I after IHCanalysis. Patient was relieved of her symptoms and becameeugastrinemic after surgery.Conclusion: Any patient with refractory dyspepsia associatedwith long standing non specific abdominal symptoms shouldbe evaluated for Gastrinoma and treated accordingly to avoidmisdiagnosis and complications in the long run.
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Background: Acute falciparum Malaria infected patients show wide ranges of metabolic derangement including changes in serum lipid profiles. The exact mechanisms of this derangement in serum lipid profiles are still poorly understood. Objective was to study the lipid profiles among acute plasmodium falciparum infected patients.Methods: It was a Prospective observational comparative study. A total of 100 patients were consecutively taken in the study. Fifty Non- malaria febrile cases and 50 healthy volunteers were taken as control group. Baseline lipid profiles were estimated in all cases at the time of admission and at the end of one week. Data were collected and analyzed.Results: There were 100 diagnosed cases of falciparum malaria and 50 non malarial febrile and 50 healthy volunteers taken as control group. Complications was present in 50 and 50 were uncomplicated. Serum total cholesterol, HDL and LDL levels were significantly low in falciparum malaria patients, and serum TG and VLDL levels were higher than control. There were no significant changes in mean serum lipids profiles in survived and deaths cases.Conclusions: The derangement in lipid profiles in falciparum malaria was characteristic and specific for the disease. Characteristic changes were lower HDL, LDL and total cholesterol levels and higher TG and VLDL levels in comparison to control groups. Changes are more pronounced in complicated falciparum Malaria and persisting till the end of the week. These findings may be of diagnostic and prognostic value.
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Background: Tissue harmonic imaging (THI) is a newer method that can diagnose and differentiate various types of pancreatic masses. The aim of this study was to evaluate the efficacy of tissue harmonic imaging for detection and differentiation of pancreatic masses and its comparison with conventional B-mode ultrasound, biphasic CECT abdomen and tissue diagnosis. Methods: 31 patients who presented with a suspicion of pancreatic mass clinically or radiologically were enrolled in this study. All patients underwent both conventional B-mode ultrasound abdomen and THI. Biphasic CECT abdomen was done for diagnostic reference. Pancreatic lesions were documented regarding site, size, internal architecture, and status of peri-pancreatic vessels. The USG diagnosis was compared with biphasic CECT and tissue diagnosis. Results: There was statistically significant difference between THI and conventional B-mode USG in visualization of image quality (p<0.001) and solid-cystic differentiation (SCD) (p=0.001). Taking tissue diagnosis as the standard, out of the 25 (80.6%) cases which were diagnosed as malignant on USG and biphasic CECT, 18(72%) cases were confirmed to be malignant on tissue diagnosis. There was no statistically significant difference between biphasic CECT and USG (conventional B-mode and THI) in the diagnosis of benign and malignant masses in pancreas (p=1). Conclusions: THI is superior to conventional B-mode USG in the Sonography of pancreatic masses because THI has better overall image quality, lesion conspicuity, visualization of lesion margin and fluid–solid differentiation. It should be routinely utilized as part of the diagnostic workup of patients with pancreatic masses.
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This report describes a patient with severe mitral stenosis who underwent mitral valve replacement. After completion of cardiopulmonary bypass, an unexpected finding of a right atrial mass was noticed on transesophageal echocardiography. The actual finding, possible differential diagnosis, and the management strategy are discussed.
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Background : Post-occlusive reactive hyperemia (RH) is impaired in Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea (OSA). The aim of the present study was to examine systemic vascular response and endothelial function in patients of Overlap Syndrome (OS) of COPD and OSA and also to investigate whether OS has any additional effect on endothelial dysfunction when compared to dysfunction caused by COPD alone. Methods : 31 COPD patients and 13 healthy controls participated in the study. Overnight Polysomnography was done to classify the patients into COPD only group (Apnea-Hypopnea Index <5) (n=15) and OS group (AHI >5) (n=16). Peripheral pulse waveform changes during reactive hyperemia were assessed using digital Photoplethysmography (PPG) technique in which pulse wave amplitude (PWA), Maximum slope of upstroke and Pulse Transit Time (PTT) were measured. C - reactive protein was assessed as marker of inflammation by ELISA. Results : Maximum percentage changes in PWA during RH were significantly lower in the both COPD group [20.34(12.02-34.07)] (p<0.001) and Overlap Syndrome group [10.96(6.21-21.49)] (p<0.0001) as compared to Controls [49.79(46.03-65.32)], whereas amplitude responses were not significantly different in the COPD and OS group (p>0.05). Maximum percentage change in slope of upstroke showed similar responses in the three groups. CRP levels (mg/l) were raised in COPD [11.60(1.75-15.00] (p<0.001) and OS group [12.52(5.28- 15.70))](p<0.0001) as compared to controls [0.59(0.58-0.91)]. Maximum percentage change in amplitude negatively correlated with serum CRP levels in COPD group (r=-0.557, p=0.03) and in OS group (r=-0.552, p= 0.02). FEV1% predicted positively correlated with maximum percentage change in amplitude in OS group
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Chryseobacterium indologenes organism is mostly confined to water and soil and has been isolated from patients in hospitals with severe underlying disease with indwelling devices and implants. Despite its low virulence, it has been found to be inherently resistant to many antibiotics. A rare case of meningitis was reported by C. indologenes in an 18-year-old patient treated for hydrocephalous with meningitis with an indwelling ventriculoperitoneal shunt, who was successfully managed with levofloxacin and gentamicin and discharged. This case report describes identification and isolation of C. indologenes on the basis of biochemical and microbiological analysis along with clinical signs and symptoms of meningitis with an indwelling ventriculoperitoneal shunt.
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Background & objectives: Chronic obstructive pulmonary disease (COPD) is characterized by slowly progressive airflow limitaion, chronic lung inflammation and associated systemic manifestations. The objective of this preliminary study was to investigate the levels of high sensitivity C reactive protein (hs CRP) and tumour necrosis factor-α (TNF-α) as markers of systemic inflammation and assessment of systemic vascular reactivity that may play an important role in development of cardiovascular disease in COPD patients. Methods: Systemic vascular reactivity was assessed non-invasively by measuring peripheral pulse waveform changes during reactive hyperemia (RH) in 16 COPD patients and 14 controls by photoplethysmography technique (PPG). Parameters measured were pulse wave amplitude (PWA), slope and pulse transit time (PTT). Tumour necrosis factor-α (TNF-α) and hs CRP were measured as markers of inflammation. Results: PWA during the 1st, 2nd and 3rd minutes post release of occlusion were significantly higher than the baseline means in controls, whereas in the patient group there was no significant change in the PWA during any of the observed time periods following release of occlusion, in comparison to the baseline means. Similar results were observed in slope values for patients and controls. Maximum percentage change in PWA during RH with reference to baseline was significantly lower in patients as compared to controls (26.78±20.19 vs 57.20±19.80%, P<0.001). Maximum percentage change in slope during RH with reference to baseline was significantly lower in patients as compared to controls (19.77±10.73 vs 39.25±13.49%, P<0.001). A vascular tone response as represented by PTT was also impaired in the 3rd minute of RH as compared to baseline mean values in COPD patients only. Interpretation & conclusions: Our findings showed raised hs CRP levels and impaired systemic vascular reactivity in COPD patients. Whether these may increase the risk of cardiovascular disease in COPD patients need to be confirmed in future studies with large sample size and appropriate study design.
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Context: We hypothesized that reduced oropharyngolaryngeal stimulation with video laryngoscopes would attenuate hemodynamic response to laryngoscopy and intubation. Aim: Comparison of hemodynamic response to laryngoscopy and intubation with video laryngoscopes and Macintosh (MC) laryngoscope. Setting and Design: Superspecialty tertiary care public hospital; prospective, randomized control study. Methods: Sixty adult patients undergoing elective coronary artery bypass grafting (CABG) were randomly allocated to three groups of 20 each: MC, McGrath (MG), and Truview (TV). Hemodynamic parameters were serially recorded before and after intubation. Laryngoscopic grade, laryngoscopy, and tracheal intubation time, ST segment changes, and intra‑/post‑operative complications were also recorded and compared between groups. Statistical Analysis: SPSS version 17 was used, and appropriate tests applied. P < 0.05 was considered significant. Results: Heart rate and diastolic arterial pressure increased at 0 and 1 min of intubation in all the three groups (P < 0.05) while mean arterial pressure increased at 0 min in the MG and TV groups and at 1 min in all three groups (P < 0.05). A significant increase in systolic arterial pressure was only observed in TV group at 1 min (P < 0.05). These hemodynamic parameters returned to baseline by 3 min of intubation in all the groups. The intergroup comparisons of all hemodynamic parameters were not significant at any time of observation. Highest intubation difficulty score was observed with MC (2.16 ± 1.86) as compared with MG (0.55 ± 0.88) and TV (0.42 ± 0.83) groups (P = 0.003 and P = 0.001, respectively). However, duration of laryngoscopy and intubation was significantly less in MC (36.68 ± 16.15 s) as compared with MG (75.25 ± 30.94 s) and TV (60.47 ± 27.45 s) groups (P = 0.000 and 0.003, respectively). Conclusions: Video laryngoscopes did not demonstrate any advantage in terms of hemodynamic response in patients with normal airway undergoing CABG.
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STUDY DESIGN: Prospective nonrandomized study. PURPOSE: To find a possible correlation between clinical outcome and extent of lumbar spondylolisthesis reduction. OVERVIEW OF LITERATURE: There is no consensus in the literature concerning whether a beneficial effect of reduction on outcome can be expected following reduction and surgical fusion for low grade lumbar spondylolisthesis. METHODS: Forty six patients with a mean age of 37.5 years (age, 17–48 years) with isthmic spondylolisthesis underwent interbody fusion with cages with posterior instrumentation (TLIF). Clinical outcome was measured using visual analogue score (VAS) and Oswestry disability index (ODI). Foraminal dimensions and disc heights were measured in standard digital radiographs. These were analyzed at baseline and 1 year after surgery and changes were compared. Radiographic fusion was judged with computed tomography scans at 1 year. RESULTS: Ninety percent of the patients had good or very good clinical results with fusion and instrumentation. Baseline and one-year postoperative mean VAS score was 6.33 (range, 5–8) and 0.76 (range, 0–3), respectively (p=0.004). Baseline and one-year postoperative, mean ODI score was 48 (range, 32–62) and 10 (range, 6–16), respectively (p<0.001). A mean spondylolisthesis slip of 32.1% was reduced to 6.7% at 1 year. Average anterior disc height, posterior disc height, vertical foraminal dimension), and foraminal) diameter improved from 9.8 to 11.7 mm (p=0.005), 4.5 to 5.8 mm (p=0.004), 11.3 to 12.6 mm (p=0.002), and 18.6 to 20.0 mm (p<0.001), respectively. The fusion rate was 75% with TLIF. There is no significant correlation between the improvements of ODI scores and the extent of slip reduction. CONCLUSIONS: Neural decompression and interbody fusion can significantly improve pain and disability but the clinical outcome does not correlate with radiological improvement in the neural foraminal dimension.
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Humans , Consensus , Decompression , Prospective Studies , Spinal Fusion , SpondylolisthesisABSTRACT
Background: Pulmonary artery (PA) catheter provides a variety of cardiac and hemodynamic parameters. In majority of the patients, the catheter tends to float in the right pulmonary artery (RPA) than the left pulmonary artery (LPA). We evaluated the location of PA catheter with the help of transesophageal echocardiography (TEE) to know the incidence of its localization. Three views were utilized for this purpose; midesophageal ascending aorta (AA) short‑axis view, modified mid esophageal aortic valve long‑axis view, and modified bicaval view. Methods: We enrolled 135 patients undergoing elective cardiac surgery where both the PA catheter and TEE were to be used; for this prospective observational study. PA catheter was visualized by TEE in the above mentioned views and the degree of clarity of visualization by three views was also noted. Position of the PA catheter was further confirmed by a postoperative chest radiograph. Results: One patient was excluded from the data analysis. PA catheter was visualized in RPA in 129 patients (96%) and in LPA in 4 patients (3%). In 1 patient, the catheter was visualized in main PA in the chest radiograph. The midesophageal AA short‑axis, modified aortic valve long‑axis, and modified bicaval view provided good visualization in 51.45%, 57.4%, and 62.3% patients respectively. Taken together, PA catheter visualization was good in 128 (95.5%) patients. Conclusion: We conclude that the PA catheter has a high probability of entering the RPA as compared to LPA (96% vs. 3%) and TEE provides good visualization of the catheter in RPA.
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Background: Most patients with noncommunicable diseases (NCDs) can be managed appropriately at the primary care level, using a simplified standard protocol supported by low-cost drugs. The primary care response to common NCDs is often unstructured and inadequate in low- and middle-income countries. This study assessed the feasibility of integration of NCD prevention and control within the primary health-care system of India. Methods: This study was done among 12 subcentres, 2 primary health centres (PHCs) and one subdistrict hospital in a block in north India. All 28 multipurpose health workers of these subcentres underwent 3-day training for delivering the package of NCD interventions as a part of their routine functioning. A time–motion study was conducted before and after this, to assess the workload on a sample of the workers with and without the NCD work. Screening for risk assessment was done at domiciliary level as well as at health-facility level (opportunistic screening), and the cost was estimated based on standard costing procedures. Individuals who screened positive were investigated with electrocardiography and fasting blood sugar. PHCs were strengthened with provision of essential medicines and technologies. Results: After training, 6% of the time of workers (n = 7) was spent in the NCDrelated activities, and introduction of NCD activities did not impact the coverage of other major national health programmes. Loss during referral of “at-risk” subjects (37.5% from home to subcentre and 33% from subcentre to PHC) resulted in screening efficiency being lowest at domiciliary level (1.3 cases of NCDs identified per 1000 screened). In comparison to domiciliary screening (`21 830.6; US$ 363.8 per case identified), opportunistic screening at subdistrict level (`794.6; US$ 13.2) was 27.5 times and opportunistic screening at PHC (`1457.5; US$ 24.3) was 15.0 times lower. There was significant utilization of NCD services provided at PHCs, including counselling. Conclusion: Opportunistic screening appears to be feasible and a cost-effective strategy for risk screening. It is possible to integrate NCD prevention and control into primary health care in India.