Socio-demographic factors, overweight/obesity and nutrients associated with hypertension among rural adults (≥18 years): Findings from National Nutrition Monitoring Bureau survey

Background: Hypertension is the leading cause of death throughout the world. The study was conducted to assess the prevalence, determinants and knowledge & practices about hypertension among rural adults in India. Methods: A community-based cross-sectional study was carried out in 10 major states of India. Information on socio-economic & demographic particulars was collected and anthropometric measurements like height, weight, waist & hip circumference and blood pressure were measured. Foods and nutrient intakes were assessed by 24-h recall method. Analysis was done using SPSS window 22. Results: The prevalence of pre-hypertension was 45.3% (95% CI: 44.6e46.0) and hypertension was 22% (95% CI: 21.5e22.3) (age standardized prevalence; 20.2%) while, overweight/obesity was 22.6% (95% CI: 22.2e23.0) as per Asian cut offs (BMI_x0001_23). The prevalence of hypertension was higher in West Bengal (29.5%) and Kerala (28.9%) and low in Madhya Pradesh and Uttar Pradesh (16e19%). The odds of hypertension was 1.2 times higher among forward communities, businessmen, tobacco users and those consuming alcohol, 2e3 times higher among overweight (CI: 1.87e2.25) and obese (2.65e3.27). The odds of hypertension was 1.2 times higher among those consuming lower tertile of carbohydrates (CI ¼ 1.02e1.41) and zinc (CI ¼ 1.11e1.42). About 76% were aware of hypertension, 21% were old hypertensive & 19% were on treatment. Conclusions: Age standardized prevalence of hypertension was 20% among adults and was associated with age, occupation, overweight/obesity, tobacco and alcohol use, low intake of carbohydrates and zinc. Therefore, increasing awareness and consumption of healthy diet through behavior change communication will help to control hypertension among adults.

COVID-19-associated mucormycosis and treatments

In the current pandemic, COVID-19 patients with predisposing factors are at an increased risk of mucormycosis, an uncommon angioinvasive infection that is caused by fungi with Mucor genus which is mainly found in plants and soil. Mucormycosis development in COVID-19 patient is related to various factors, such as diabetes, immunocompromise and neutropenia. Excessive use of glucocorticoids for the treatment of critically ill COVID-19 patients also leads to opportunistic infections, such as pulmonary aspergillosis. COVID-19 patients with mucormycosis have a very high mortality rate. This review describes the pathogenesis and various treatment approaches for mucormycosis in COVID-19 patients, including medicinal plants, conventional therapies, adjunct and combination therapies.

Mosquito density in rural Kerala: a study on the trend of Aedes larval indices over monsoon in a rural area of Thrissur district, India

Background: Dengue is one of the most rapidly spreading mosquito-borne viral diseases in the world. Aedes aegypti mosquito is the main vector of dengue and Chikungunya. Entomological surveillance on Aedes mosquito has been standardized on different indices like House index, Container index, Breteau index. Larval indices are important predictors of outbreaks and are valuable in taking preventive measures. The objectives of the present study was to study the trend of larval indices over four months in selected wards of Kaiparambu Panchayat, Thrissur, Kerala, India and to identify the major breeding sources.Methods: A series of surveys were conducted from May to August of 2017 in Kaiparambu Panchayat under the field practice area of Amala Institute of Medical Sciences Thrissur. Houses were selected serially from 4, 5 and 6 wards with roughly 120 houses being covered each month.Results: A total of 489 houses were surveyed over 4 months. Overall, positive containers (with larvae) were present in 375 of 4055 potential containers showing a calculated House index (HI) is 44.4%, Container index (CI) is 11.5% and the Breteau Index is 76.7%. All three indices increased from May to June, peaked in July and dropped by August. Plastic containers were the most common source of breeding.Conclusions: The indices indicate risk even in the pre-monsoon season and there is a marked rise during monsoon. Hence, control measures need to be adopted during the pre-monsoon season so as to reduce the impact of the impending outbreak.

Management of Single Rooted Mandibular First Molar A Rare Entity –A CBCT Analysis

The case report here tries to describe the rare variation of root canal morphology in a mandibular first molar, which is rare in occurrence in literature. This case report presents a relatively rare case of mandibular first molar with single root and a single root canal in a 24-year-old female patient.. Cone-beam computed tomography (CBCT) was employed to confirm the extension of the unusual anatomy. Ambiguity in the canal morphology of the first molar is quite common. Knowledge of variations in internal anatomy of teeth is important for success in endodontic treatment. Root canal morphology is limitless in its variability and clinicians must be aware that anatomic variations constitute a formidable challenge to endodontic success. Hence, clinicians have to take utmost care when these cases with single canal and single root come in our practice.

External dose measurements in the Eloor industrial area in the Ernakulam district of Kerala, India

Background: natural background radiation of a particular region is one of the distinctive factors defining the status of environment. Eloor Island is an industrial area in Ernakulum District of the state of Kerala, India. The indoor and outdoor gamma level measurements have been carried out for the region for evaluating the annual effective dose to the population residing in this area

Materials and Methods: measurements of indoor gamma dose were done for a whole year using Thermo Luminescent Dosimeters [TLDs] and GM tube based survey meters in forty five selected locations. The activity concentration of [232]Th, [238]U and [40]K in the samples were analyzed using gamma spectrometry. The outdoor external gamma ray dose rates were evaluated from the activity concentration of [40]K, [238]U and [232]Th in the soil samples collected from the study area

Results: the average indoor gamma dose measured using TLDs were found to be 1219 microGy y[-1]. The measured activity in the soil samples had range from 92.5 Bq kg[-1] to 792.8 Bq kg[-1] for [232]Th, 9.2 Bq kg[-1] to 114.6 Bq kg[-1] for [238]U and 265.9 Bq kg[-1] to 851.9 Bq kg[-1] for [40]K. From the observed mean dose levels, the annual effective dose equivalent to population residing in the island has been estimated and is found to be 0.68 mSv y[-1] for indoors and 0.32 mSv y[-1] for outdoors

Conclusion: the annual effective dose equivalent to population estimated for indoor is found to be higher as compared to the global average the same for outdoor was found to be less when compared with the natural background gamma level reported by UNSCEAR for normal background areas

effect of obesity on pregnancy and its outcome in the population of Oman, Seeb Province

Objectives: The World Health Organization estimated that in 2011 worldwide 1.6 billion adults were overweight, and 400 million were obese. The obesity epidemic is a documented phenomenon and Oman is no exception. The aim of this study was to determine the effect of obesity on pregnancy and its prenatal and neonatal outcomes

Methods: A prospective cohort study was carried out among pregnant Omani women attending antenatal clinics in their first trimester in the Seeb province of Muscat, Oman

Results: A total of 700 pregnant women were enrolled in the study and were categorized according to their body mass index: 245 [35%] were normal weight, 217 [31%] were overweight, and 238 [34%] were obese. The relative risk [RR] of cesarean section among obese women compared to women of normal weight was 2.1 [95% confidence interval [CI] 1.2-3.2] and of overweight women was 1.4 [95% CI 0.9-2.3]. The risk of elective cesarean section increased to 7.5 [95% CI 1.7-32.8] in obese women and was statistically significant in the obese group. In this study, 100 women [15.7%] developed gestational diabetes [11.8% of normal weight women, 17.8% of overweight women, and 17.9% of obese women]. Miscarriages were more common among obese women 11.9% [n = 27] compared to the normal weight and overweight groups [6.7% and 9.4%, respectively]. There was a weak yet statistically significant correlation between birth weight and body mass index. The risk of macrosomia was significantly higher in obese women compared to normal weight women. To evaluate the sensitivity of the oral glucose challenge test [OGCT], the oral glucose tolerance test [OGTT] was measured in 203 participants [29%] who had a normal OGCT result. It was found that 14.5% of overweight women and 13.5% of normal weight women had an abnormal OGTT result even when their OGCT result was normal

Conclusions: Obesity is associated with an increased risk of cesarean section [especially elective cesarean], gestational hypertension, macrosomia, and miscarriage. It also increases the risk of gestational diabetes

Controlled Drug Delivery Approaches for Rheumatoid Arthritis.

A cure for rheumatoid arthritis is yet to be discovered. Although vast resources have been expended in the search for an immunological key to switch off the rheumatoid process, the most significant advances in the treatment of rheumatoid arthritis in recent times had come from gaining better understanding and skill in the safe use of existing disease modifying antirheumatic drugs (DMARDs). If prescribed appropriately and combined with adequate patient education and monitoring, Disease modifying anti-rheumatic drugs are safe and effective tools in the treatment of rheumatoid arthritis. The step down approach has been proposed for the treatment of patients with recent onset rheumatoid arthritis who have clinical features predictive of an adverse prognosis. More efficient ‘targeting’ of drugs at the site of desired action should help to minimize the adverse effects of therapy. Ultimately the most efficient way of relieving pain and stiffness will be to prevent or suppress the inflammatory disorders which give rise to the symptoms. Unfortunately this is a goal at present.

Retreatment Of A Maxillary Lateral Incisor With Two Canals Associated With Bony Dehiscence : An Endo- Perio Case Report.

A 25-year old female was referred with gingival recession and pus discharge associated with bony dehiscence in relation to previously root canal treated maxillary left lateral incisor. Radiographic examination revealed presence of a second canal which was left untreated in the previous treatment which could be the possible cause of treatment failure and development of bony dehiscence. During re-treatment, the second canal was located, cleaned and shaped and obturated and the bony defect was treated with free gingival graft. This case report demonstrates the need for greater attention in treating the root canal of maxillary lateral incisors due to its variations in root canal morphology and also the need for thorough evaluation of good quality pre-operative radiographs taken in different angulations to avoid such mishaps. This case is unusual because considerable research has reported that these teeth can only have a single canal.

Central hypothyroidism.

A 15-mth-old male child of consanguineous parents, presented with classical features of congenital hypothyroidism. Serum total thyroxine (T4), total triiodothyronine (T3) and TSH were low. There was no evidence of deficiency of other pituitary hormones. Magnetic resonance imaging of the pituitary was normal. TSHB gene sequencing revealed a homozygous missense mutation due to single base substitution G?A at codon 85 resulting in change from Glycine to Arginine. This mutation in TSHB gene has been reported earlier in three cases with similar phenotype from Japan.

Distribution of heavy metals in the core sediments of a tropical wetland system

Trace metal concentration was investigated in five sediment cores collected from the fresh water region of the Vembanad wetland system were studied. The average concentration of iron, manganese, nickel, copper, zinc, cadmium, lead, mercury and chromium were determined. The core samples were collected using gravity type corer, digested with a mixture of nitric acid and perchloric acid and analyzed by atomic absorption spectrophotometry. Heavy metals such as iron, copper, nickel and zinc reported enrichment towards the surface of the core sediment sample collected from the centre of the lake. Lead, cadmium and mercury showed uniform distribution through out the core. Quality of the sediments were evaluated based on sediment quality guidelines, pollution load index, sum of toxic units and with effect range low/effect range median and threshold effect level/probable effect level values of Environmental Protection Agency guidelines. The degree of contamination for each station was determined. The concentration of different heavy metals has been compared with the world average concentration of shale values. Results of the analysis showed that Vembanad lake is facing serious metal pollution with increased rate of deposition

Dissolution of pharmacobezoar using carbonated beverage.

Bezoars are concretion of undigested material found in the upper alimentary tract, particularly the stomach. Physiologic disturbances such as gastrointestinal dysmotility or anatomical derangements have been described as contributory in most cases of pharmacobezoars. Gastric phamacobezoars can be treated with endoscopic fragmentation or surgery. Gastric lavage with carbonated beverage has been successfully used to treat gastric phytobezoars. We report a 67-year-old man with pharmacobezoar successfully treated by infusion and intrabezoar injection of carbonated beverage. Subsequent endoscopy revealed an underlying adenocarcinoma in the stomach.

Small cell carcinoma occurring in a case of ulcerative colitis.

A 61-year-old man, with an 8-year history of ulcerative colitis, presented with bleeding per rectum for 4 weeks' duration. Colonoscopy revealed polypoidal neoplasm at the rectosigmoid junction. Histopathology depicted small cell carcinoma. On immunohistochemical staining, chromogranin A and synaptophysin were positive. The tumour was diagnosed as undifferentiated small cell carcinoma, which is unusual since generally it is the adenocarcinoma that occurs on a background of ulcerative colitis and there are only three previous reports of small cell carcinoma occurring in UC.

Symptomatic primary hyperparathyroidism: a retrospective analysis of fifty one cases from a single centre.

OBJECTIVE: Widely prevalent vitamin D deficiency and delayed diagnosis contributes to severe symptomatic primary hyperparathyroidism in India. We analysed fifty one consecutive patients of primary hyperparathyroidism managed at our centre. All of them were symptomatic. DESIGN: Retrospective analysis. MATERIAL AND METHODS: Fifty one consecutive cases of symptomatic primary hyperparathyroidism, presenting to our centre from January 1994 to May 2007 were retrospectively analyzed. Clinical presentation, biochemical, radiological and details of underlying parathyroid lesion were noted. RESULTS: A total of 51 cases of primary hyperparathyroidism were studied. Mean age was 39.5 +/- 11.5 yrs (Range 13 to 70 years, Female: Male 2:1). Mean duration of symptoms was 35.8 + 29.1 months. Bone pains and painful proximal myopathy were the commonest presentation (24/51), followed by pathological fractures in 12 cases. Distal Renal tubular acidosis was diagnosed in 4 cases, 3 of whom normalized after surgery. At initial evaluation, twenty one patients had elevated alkaline phosphatase with normal calcium levels indirectly suggesting associated vitamin D deficiency. Low serum levels of 25-hydroxy vitamin D were documented in five of them. Parathyroid carcinoma was diagnosed in 3 patients. Ectopic parathyroid adenoma was seen in 7 cases (3 mediastinal, 3 intrathyroidal, 1 near left carotid sheath). All the cases responded well to surgical excision. CONCLUSION: Lack of universal screening for hypercalcemia, normocalcemia contributed by associated vitamin D deficiency and lack of awareness about unusual presentations of primary hyperparathyroidism led to delayed diagnosis in our patients. Delayed diagnosis and associated vitamin D deficiency in our patients contributed to greater severity of symptomatic primary hyperparathyroidism.

Gall bladder carcinoid: a case report and review of literature.

Gall bladder carcinoid tumours are rare and usually lack specific symptoms. In most instances, they are incidentally detected after a cholecystectomy and rarely do they manifest with carcinoid syndrome. We report a case of gall bladder carcinoid in a patient who had undergone surgery for rectal carcinoid 10 years back. Occurrence of rectal carcinoid and gall bladder carcinoid in the same patient has not been reported before.

Endoscopic abnormalities in the oesophagus after variceal sclerotherapy--a long-term follow up study.

Endoscopic sclerotherapy is a well-established treatment modality for oesophageal varices. Various local, regional and systemic complications occur after sclerotherapy. Altered endoscopic appearances of the oesophagus have been observed on follow-up of patients after sclerotherapy. 171 consecutive patients with extra-hepatic portal venous obstruction on follow up after achieving variceal eradication by sclerotherapy during the period from January 2004 to June 2005 were enrolled in this study. The oesophagus was closely observed for mucosal abnormalities and the endoscopic findings were recorded. Out of 171 patients, 95 (55.5%) patients had no specific endoscopic changes in the oesophagus. The most common finding was mucosal neovascularization which was seen in 56 (32.7%) patients. Oval or oblong depressed areas were seen in 41 (23.9%) patients. Mucosal tags and polypoidal lesions were seen in 37 (21.6%) patients. 25 (15.6%) patients had stenosis of the lower oesophagus and 3 (1.7%) patients had mucosal bridges. On multivariate analysis, these abnormal endoscopic findings in the oesophagus correlated with the total volume of sclerosant injected when compared with those patients without similar findings on endoscopy (p value < 0.001). Endoscopic sclerotherapy leads to various abnormalities at the injection sites like neovascularization, oval or oblong depressed areas, mucosal tags, polypoidal lesions, stenosis and mucosal bridges. Endoscopic abnormalities correlated with the total volume of sclerosant used. The long-term significance of these changes is not known at present and further follow-up studies will be required.

Rapunzel syndrome: a case report and review of literature.

Bezoars consist of ingested foreign material or organic matter which forms a mass in the gastrointestinal tract, usually in stomach. Trichobezoars formed by swallowed hair present with malnutrition, weight loss, abdominal pain with signs of gastrointestinal obstruction. Gastric trichobezoar with a tail reaching the small intestine is called Rapunzel syndrome. Although endoscopic methods are available to remove bezoars, majority of trichobezoars with Rapunzel syndrome undergo surgical removal.

Prevalence of Hepatitis B and C in the normal population and high risk groups in north Kerala.

BACKGROUND: Our aim is to assess the prevalence of Hepatitis B and Hepatitis C infections among normal healthy persons and high risk groups in the northern part of Kerala state in South India as there is insufficient published literature related to this subject. METHODS: HBsAg and AntiHCV screening were done in normal persons and in high risk groups. Normal persons screened included voluntary blood donors, those attending mandatory medical check up for jobs in middle east Asia and pregnant women. High risk groups were health care workers, intravenous drug abusers, commercial sex workers and male homosexuals. RESULTS: HBsAg and anti HCV antibody test results in the various groups were as follows. Voluntary blood donors--HBsAg was positive in 0.71 % and anti HCV was positive in 0.33%; job seekers to middle east Asia had 0.89% and 0.12% prevalence of HBV and HCV respectively. Among the pregnant women, 0.21% were HBsAg positive. Among the high risk groups, none of the health care workers were HbsAg positive and 0.79% were antiHCV positive. Among the IV drug abusers 2.7% were HBsAg positive and 51.89% were positive for antiHCV. In commercial sex workers, 3.47 % were HBsAg positive and 2.6 % were antiHCV positive. In male homosexuals, 4.49% were HBsAg positive and 3.37% were antiHCV positive. CONCLUSIONS: The prevalence of Hepatitis B and C in the normal population of Calicut in the northern part of Kerela is 0.52% and 0.24%. Compared to other areas of India, the seroprevalence of Hepatitis B and C are low in the normal population of Calicut. Among the high-risk groups, IV drug users have a high prevalence of AntiHCV.