A cross sectional study of thrombocytopenia in malaria positive cases in a tertiary care hospital of Bareilly

Background: To find out correlation of thrombocytopenia with malaria. Malaria is a protozoal disease caused by infection with parasite of genus Plasmodium. Thrombocytopenia is a common and early sign of malarial infection and 60-80% thrombocytopenia is observed in malarial cases and present more frequently and severe in complicated P. falciparum malaria.Methods: A cross sectional study done in Central Pathological Lab of Department of Pathology, RMCH, Bareilly. Blood samples collected in ethylenediaminetetraacetic acid vial and blood smear was examined for malaria parasite within red blood cells. Malaria rapid test was done for detection of Plasmodium species and platelet count was done.Results: 780 cases of malaria was studied from September 2018 to December 2018, male predominance of 54.5%, maximum malarial positive cases 26.92% in the age group of 21-30 years, maximum 86.28% cases were of P. vivax, and thrombocytopenia was observed in 91.54% cases.Conclusions: Mostly developing countries with limited resources and trained health manpower are malaria-endemic region of world. Thrombocytopenia is associated with both P. vivax and P. falciparum infections. In our study significance association between malaria and thrombocytopenia has been observed. We suggest malaria should be a consideration in all patients with fever and thrombocytopenia.

Occurrence of high altitude cerebral edema (hace) and high altitude pulmonary edema (HAPO) simultaneously at 12000 ft: a rare phenomen

High altitude cerebral edema (HACE) and High altitude pulmonary edema (HAPO) are the most dreaded complications related to high altitude. Authors managed a case of HACE and HAPO simultaneously set at unusually low height (1200 ft) in a patient. The altitude was not too much to develop these comorbidities as studied earlier. Relationship with altitude was immaterial in our case. However, rapid ascent without proper acclimatisation, young and tender age, male sex and smoking were associated contributing factors. He was managed with standard protocol and descent to lower altitude.

Prevalence of shoulder disorders in tertiary care centre.

Background: Shoulder pain is the third most common musculoskeletal condition has a lifetime prevalence of up to 70% and this seems to be increasing in incidence. The diagnosis of these disorders is based primarily upon results of clinical tests. The prevalence of shoulder pain in India has not been reported. The aim of present study is to study and report the prevalence of various disorders causing shoulder pain in patients reporting to a tertiary care hospital in North India. Methods: This is a prospective hospital based cross-sectional study carried in a tertiary care hospital and 130 patients satisfying inclusion criteria over a period of two year were included. Results: Age of patients ranged between 23-69 years (51.36 ± 11.86 years). A predominance of females was observed (Male-Female ratio: 0.81:1). The commonest cause of pain was periarthritis shoulder (43.1%), subacromial (SA) impingement (13.8%), acute rotator cuff injury (13.1%), GH arthritis (10.0%) and AC Arthritis (8.5%). The major risk factors were diabetes mellitus, excessive overhead lifting and trauma. Conclusion: Periarthritis and subacromial pain syndrome are two most common diagnoses reporting to a tertiary care centre. Periarthritis is the commonest diagnosis in both genders. AC arthritis is more common in females (P <0.001) and rotator cuff injury is more in males (P <0.001). Periarthritis, GH arthritis and AC arthritis is much more common in fifth and sixth decades and rotator cuff injury is seen in young adults.

Correlation between WOMAC score and hyalrunoic acid levels in knee osteoarthritis.

Background: Osteoarthritis, a whole organ disease is diagnosed on clinical and radiological features, but plain radiographs show changes only in moderate to advanced stage of disease. Biochemical marker such as Hyaluronic Acid (HA) is used as a diagnostic tool in early stages. Hyaluronic acid level estimation has limited use in developing world due to cost and availability. Methods: A case-control study was done to correlate role of WOMAC score and serum Hyaluronic acid levels in knee osteoarthritis. All subjects were asked to fill the WOMAC questionnaire and were subjected to knee radiography. Blood samples of all subjects were tested for serum levels of Hyaluronic acid by Enzyme Linked Immuno-Sorbent Assay (ELISA). The assessment of severity was done by K-L grading of the radiographs. Results: The mean age in case group was 51.28 ± 7.93 years and in control group was 46.08 ± 4.81 years (P <0.001). A statistically significant difference in WOMAC score, HA levels and K-L grading of cases and controls was found (P <0.001). The results show a mild association of HA (r=0.421), moderate association of age (r=0.570), and strong association of K-L grade (r=0.910) with WOMAC scores and all these associations were highly significant (p<0.001). Multivariate analysis shows only WOMAC score >60 is independently associated with the outcome. Conclusion: WOMAC scores are significantly associated with knee osteoarthritis and can play a crucial role in identification, gradation and management of patients with knee osteoarthritis and can be used singly along with clinical features in situations where treatment cost and assessment of serum HA levels is of concern.

Validation of Ponseti method for clubfoot deformity correction.

Background: Idiopathic Congenital Talipes Equino-Varus (CTEV) is a complex deformity of foot that is difficult to treat. The goal of treatment is to gain a functional, pain free, plantigrade foot, with good mobility and without callosities. Currently, the most accepted and popular method is the Ponseti method which allows correction of all components of CTEV by manipulation and serial casting without any major surgical intervention. This prospective study was done in a tertiary care centre to statistically assess the efficacy of Ponseti method. Methods: We treated 150 children (210 feet) with idiopathic clubfoot deformity, using Ponseti technique. The severity of foot deformities were assessed by Pirani scoring system and were also recorded clinically, radiologically and podographically. The changes in the mean Catterall-Pirani scores at different follow ups were evaluated statistically. Results: The mean number of casts that were applied to obtain correction was 7.86 (range 5 to 11 casts). Percutaneous tendoachilles tenotomy was done in 70% of feet. All children were given foot abduction orthosis after the correction. The results were graded according to Ponseti and Smoley criteria. Good results were obtained in 83% of feet, acceptable results in 7% of feet and poor results in 10% of cases. Statistically significant correction was achieved in manipulation and casting stage which was maintained during bracing phase. The recurrences of the deformity were primarily due to poor compliance in the use of orthosis in post correction phase. Conclusion: The Ponseti method of correction is a safe and effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics is the main factor causing relapse of the deformity.

Spatiotemporal distribution of dengue vectors & identification of high risk zones in district Sonitpur, Assam, India.

Background & objectives: Dengue is an arboviral disease of public health importance in many parts of India and recently many cases have been reported from northeastern India. Aedes mosquitoes, which are the vectors of dengue, are widely prevalent in the region. A study was initiated in Sonitpur district of Assam to understand the spatiotemporal distribution and seasonal prevalence of dengue vectors and to identify the high risk zones. Methods: Ovitrap surveys were conducted in three randomly selected villages under each of the eight public health centres (PHC) in district Sonitpur of Assam, northeastern India during March 2011 - February 2012. Three risk zones (high, medium and low) were identified on the basis of per trap density of Aedes mosquitoes. Meteorological data were collected to study the temporal distribution of dengue vectors. Results: Aedes albopictus (99.3%) was the predominant dengue vector followed by Ae. aegypti (0.7%) recorded in the ovitraps. The highest vector density was observed during the post-monsoon (60.1 ± 18 per trap) while the lowest during the winter (7.6 ± 4.9 per trap) and the season-wise differences in the vector density were significant (p=0.005). Maximum temperature (correlation coefficient, r = 0.45) and minimum temperature (r = 0.408) showed the highest positive correlation with the vector density, whereas the number of rainy days showed high positive correlation (r = 0.185) than the total rainfall (r = 0.117). The high risk zone (Dekhiajuli, Behali, Bihaguri and Gohpur PHC) as indicated by the high larval densities of dengue vectors, 45.3 ± 18, 42.1 ± 22.3, 36.9 ± 29.1, 35.3 ± 22.6 per trap, respectively, was validated by dengue epidemiological data collected during 2012. Interpretation & conclusions: Yearlong monitoring of dengue vectors was done for the first time in this region. Monthly maximum temperature and the number of rainy days could be used for the prediction of larval density of Aedes mosquitoes. The identification high dengue risk zones would help in adopting targeted interventions for disease management in future.

Aceclofenac delivery by microencapsulation using LBL self-assembly for delayed release

Colonic targeting has gained increasing interest over the past years, not just for the transport of drugs for the treatment of local diseases associated with the colon but also for its potential for transporting peptides and proteins, particularly low molecular weight peptide drugs. Without protection, such peptide drugs are usually digested within the gastric and small intestinal sections. In the present work Layer-By-Layer [LBL] self-assembly was utilized to make Aceclofenac single bilayer microcapsules produced by sequential adsorption of positively charged chitosan and negatively charged Pectin on the external surface of negatively charged Aceclofenac microcrystals. Taguchi approach was applied to determine the best concurrence of composition factors that is concentration of chitosan, pectin, centrifugation speed and incubation time. The microcapsules were characterized for encapsulation efficiency, particle size, zeta potential, scanning electron microscopy and in-vitro release kinetics. Surface electric potential of Aceclofenac microcrystals was found to be negative with zeta potential -1.39 mV, in acetate buffer of pH 4. The primary and the secondary deposit layer of chitosan and pectin was found to have a positive and negative charge with zeta potential of +5.57 mV and -22.8 mV respectively. The sequential changing of surface zeta potential after each deposition is a satisfactory indication of the LBL self-assembly of the oppositely charged polyelectrolytes. The average size and encapsulation efficiency of the optimized single bilayer microcapsules [F5] was found to be 20microm and 63.83%, respectively. The ex-vivo percentage cumulative drug release of [F5] in Phosphate buffer pH 6.8 containing 2-4% w/v colonic fecal matter of male albino rat was found to be 98.40%. The optimized batch of microcapsules showed first order release kinetics [R[2]= 0.950] in presence of colonic fecal matter

Psychosocial effect and economic burden on parents of children with locomotor disability.

Objective. To assess the social and financial burden on parents of children with locomotor disability. Methods. A cross-sectional study was conducted in the Institute for Physically Handicapped (IPH), Delhi, where parents of 100 locomotor disabled children of age group 6 to 15 years were interviewed to estimate the socioeconomic burden of caregiving their children. Results. The study observed that the parents of the disabled children were severely burdened in terms of financial burden and mental health. Conclusions. There is an urgent need for support activities for such families at a national level in order to curb the huge economic and social burden of care-giving. Counselling should be an integral part of rehabilitat ion for such families.

Fine structure of olfactory epithelium in Schizothoraichthys progastus McClelland and Schizothorax richardsonii Gray (Cyprinidae: Teleostei) from Garhwal Himalaya (India).

The olfactory epithelium of two closely related species of snowtrout— Schizothoraichthys progastus McClelland and Schizothorax richardsonii Gray (Subfamily: Schizothoracinae. family-Cyprinidae, Teleostei), from a perennial glacier-fed river Mandakini of Garhwal hills was studied by employing transmission electron microscopic method The olfactory lamella comprises two epithelia—anterior and posterior, with a stroma sandwiched in between. Both are strartified. The anterior one is thicker than posterior. In Schizothoraichithys progastus, the sensory part of epithelium has two types of receptor cells—ciliated receptor cells and rod cells whilst in Schizothorax richardsonii, there arc three types of receptor cells—ciliated receptor cells, microvillous receptor cells and rod cells in addition to sustentacular cells, basal cells and mucous cells. While inhabiting similar hillstream habitat, the differential ecological niches, feeding habits etc., account for the presence of different receptor cell types in these species, It implies the possible diversification at cellular and physiological levels so as to minimize the competition by using varied olfactory cues.