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Background: Hypertension is a major public health problem. Globally 1.28 billion adults aged 30-79 years have hypertension and among this 46% were undiagnosed. Kerala is one state undergoing epidemiological transition and having high prevalence of hypertension. So, we did this study to estimate the proportion of hypertension among non-medical employees of Medical College Thiruvananthapuram. Methods: A cross-sectional study was conducted among 202 non-medical employees of medical college Thiruvananthapuram. Data was collected using an investigator administered questionnaire. Anthropometric indices were measured and recorded. Blood pressure (BP) was recorded twice in a gap of 15 min for each participant in sitting position using mercury sphygmomanometer. Mean systolic BP (SBP) and diastolic BP (DBP) was calculated to confirm hypertension. Participants those who were already detected as hypertensive and on treatment were also noted. Data was analysed using SPSS software version 27. Results: Prevalence of hypertension in the study population was 61/202 (30.19%). Among the hypertensive 39 (63.9%) were already detected and on treatment and 22 (36.1%) were undiagnosed. Among already detected hypertensive 13 (33.3%) were found to be inadequately treated. Hypertension was found to be associated with waist circumference and BMI. Conclusions: The study population was found to have high prevalence of hypertension and having association with waist circumference and BMI. The rule of halves for depicting the trend of hypertension in study population can be used as a tool to deduce various interventions in the community.
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Background: Prescribing medicine is a core skill for dentists, impacting patient safety and requiring knowledge of medications, dosages, and risks. This study evaluates dental students' awareness of these critical aspects in Kerala, India. Methods: This study aimed to assess drug prescription awareness among dental students in Kerala, India, highlighting current knowledge, standard practices, and areas for improvement. Results: Dental pain emerged as the most commonly treated condition (57.7%), with Amoxicillin reigning as the antibiotic of choice (69.2%-76.3%). Textbooks reigned supreme as the primary source of prescription information (66.4%-58.3%), even as most participants (78.1%-72.4%) acknowledged the WHO prescribing guidelines. While interns demonstrably boasted greater confidence in their knowledge, nearly half of all participants grappled with a lack of confidence in drug dosage and frequency. Incorrect dosage stood out as the Achilles' heel of prescription practices (71.9%-77.6%). Strengths included awareness of the correct route of delivery (61.6%-74.4%) and adherence to WHO guidelines. Conclusions: Dental students in Kerala demonstrate fair drug prescription awareness but have gaps in knowledge regarding dosage, frequency, and duration. Textbooks are the primary information source, highlighting the need for more in-depth education and reliance on evidence-based resources. Targeted interventions focused on these areas could enhance prescribing practices and patient safety.
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Background: Klebsiella pneumoniae are Gram-negative opportunistic pathogen, belonging to the family Enterobacteriaceae that can cause severe nosocomial infections particularly in immuno-compromised individuals. They exhibit co-resistance to multiple antibiotics which emphasize the need for non-antibiotic therapies. The goal of the presented study was to investigate the antimicrobial ability of probiotic Lactobacilli on clinical isolates of K. pneumoniae. Methods: In this cross-sectional study, antimicrobial activities of probiotic L. acidophilus and L. rhamnosus on K. pneumoniae were evaluated by Agar overlay interference technique. Clear zone around Lactobacilli were taken as positive inhibition. Antibiotic susceptibility profiles of K. pneumoniae were determined by Kirby-Bauer disk diffusion method, analyzed using interpretive standards of CLSI M100-S33 and categorized into MDR, XDR and Non MDR groups. Statistical analysis was done using descriptive statistics such as mean and standard error and inferential statistics such as ANOVA single factor. Results: K. pneumoniae exhibited positive inhibition with both the probiotic strain. On comparing the zone of inhibition of L. acidophilus and L. rhamnosus (both treated-pH adjusted and untreated), L. acidophilus had greater zone of inhibition against K. pneumoniae but concluded that statistically the values are insignificant (p>0.05). Based on antibiotic susceptibility pattern of K. pneumoniae, 63% of isolates were XDR, 3% were MDR and 34% were Non MDR Conclusions: It can be concluded that L. acidophilus and L. rhamnosus had significant inhibitory effect against K. pneumoniae in vitro and should be further studied for their human health benefit.
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Background: Ischemic stroke is a top contributor to mortality amongst non-infectious diseases. Atherosclerosis is a major risk factor. This study aims to assess LDL levels and ejection fraction in ischemic stroke patients. Methods: This descriptive cross-sectional study was conducted in Government Thoothukudi Medical College from November, 2022 to April, 2023. 35 patients admitted in the neuromedicine ward and diagnosed as acute ischemic stroke were included in the study after informed consent and ethical clearance. Patients with acute neurological deficit and evidence of infarct on diffusion-weighted MRI were included. Patients with no evidence of infarct on DWI, those already on lipid lowering therapy, patients with a history of cerebrovascular disease or transient ischemic attacks were excluded. Blood for lipid profile taken after 8 hours of overnight fasting. Echocardiography done for all patients. Results: Of the 35 patients, 26 (74.28%) were men, mean age was 62.4. 57.14% ischemic stroke patients had their LDL levels elevated, 28.57% had decreased HDL, 28.57% had total cholesterol levels elevated, and in 14.28% triglycerides was elevated. This study also observed the cardiac status of the patients which showed 29% patients had decreased ejection fraction. Conclusions: This study concluded that most patients had elevated LDL levels which is an independent risk factor of ischemic cerebrovascular disease. LDL levels were also associated with decreased ejection fraction in a significant number of patients. Thereby it can be concluded that elevated LDL cholesterol levels can add to the cardiac risk, potentially contributing to stroke morbidity and mortality.
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Background: Stroke patients have high rate of mortality and morbidity and survivors suffer from physical, cognitive and emotional issues. Quality of life of stroke survivors depends on severity of disability. These disability or morbidities not only affect stroke survivors but also has impact on physical and psychological wellbeing of caregivers providing support for daily routine. Aim of this study is to analyse the dependency using Barthel Index in stroke patients and care giver strain (CSI) among caregivers. Methods: A cross sectional descriptive study in a tertiary care hospital in South India. Study duration of 5 months. 150 Patients admitted for stroke meeting the inclusion criteria were included for the study. Caregiver was interviewed after Informed consent and briefing of purpose of study. Berthel index and modified care giver strain index questionnaire was filled by interviewer with caregiver. Findings were described in simple descriptive manner. Statistical package for the social sciences (SPSS) version 24 was used for statistical analysis. Results: Of 150 patients male 64% female 36%. Care giver strain score of <7 (40%), 8-14 (42%), >14 (18%). Sleep deprivation 68%, physical strain 85%, family adjustment problems 32%, work adjustment problems 67%, financial strain 76%, emotional adjustment problems 33%, personal plans problems 44%, upsetting behavior problems 44%. Only 17% termed it as inconvenient, 24% completely overwhelmed, 29% confining. Barthel index of >80 able to live independently (13%), 61-80 minimally dependent (32%), 41-60 partially dependent (26%), 21-40 very dependent (13%), <20 total dependency (16%). Conclusions: In stroke care caregiver strain is high when patient is dependent for routine activities. This includes physical as well as psychological strain. There is need to develop strategic home based or community based programs to reduce caregiver stress and improve their quality of life.
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Kashmir Himalayas is known for its abundant supply of high quality wood suitable for cricket bat industry. The present study aimed to gather comprehensive data on the availability of raw material for the cricket bat industry in Anantnag and Pulwama districts of Kashmir during the specified time period (2017-2018). The main objective of this study was to evaluate the major problems faced by the industry and to assess quality parameters of cleft and the wood used for making these clefts. Shortage of quality raw material, absence of proper marketing channels and irregular electricity supply were the major factors responsible for production shortfall. The units used wood of Salix alba var. caerulea as main raw material while Populus deltoides wood was also used for low quality bats. For the study, latest available official records of Government of Jammu and Kashmir as well as questionnaire based sample survey data were used. The industry produced 15.10 crore clefts that consumed 17,28,532 ft 3 of wood. Sample survey revealed that in 2016, the selected 62 units procured 5,84,557 ft3 of wood with an average of 9,428.33 ft3 per unit.
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Background: Chronic obstructive pulmonary disease (COPD) is a chronic disease usually caused by significant exposure to noxious particles and are not fully reversible. COPD represents an important public health challenge that is both preventable and treatable. The aim of this study was to describe the clinico-epidemiological profile of COPD patients and to assess the disease severity using spirometry among respiratory symptomatic in a primary care centre. Methods: A cross sectional study was conducted among the COPD patients attending monthly pulmonology clinic in Urban Health centre, Ettumanoor, Kottayam from June to August 2019. The study comprised of 120 patients with symptoms suggestive of COPD attending the monthly respiratory clinic. Severity of airflow limitation assessed using spirometry results based on GOLD criteria. Clinical and epidemiological data were collected using a semi structured interview schedule. Results: The mean age of the participants were 64� and 51.7% were males. The median duration of COPD symptoms for the study participants was 10 (IQR 11) years and 62.5% were having productive cough with dyspnoea as the major symptom. All males except two were smokers and the mean packyears were 42�years. As per GOLD guidelines 44 (36.7%) had severe disease, 11 (9.2%) had mild, 39 (32.5%) had moderate and 26 (21.7%) had very severe disease. The average forced expiratory volume in one second (FEV1) in study subjects was 54.8�5. Conclusions: In view of the emerging public health risk, COPD need to be diagnosed and managed at the earliest to slow down the progression.
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The study investigated that the Socioeconomic status and use of an agroforestry system, 20 farmers from one district, four blocks, and four villages per block were randomly selected. The socioeconomic condition of the agroforestry system in the Azamgarh districts of Uttar Pradesh is based on preliminary study. According to the size of their holdings, the respondents were divided into Palhani, Bilariyaganj, Mehnagar, and Jahanaganj block farmers, and observations were made about their socioeconomic profiles. Farmers ranged in age from middle-aged to elderly; the majority had completed middle school, whereas large farmers were more likely to have completed high school; most of them were nuclear families with semi-cemented or cemented homes and had more than 10 years of expertise in agriculture and agroforestry. Their family sizes ranged from medium to big, or over 5 individuals. In the three categories of farmers, the risk orientation ranged from low to medium; the scientific orientation was of a medium degree. The large farmers were found to be more exposed to the media, and most farmers were found to attend group meetings. Smallholder farmers, especially in developing nations, contribute significantly to local, regional, and economies as a result of socioeconomic and environmental constraints. About 75% of the world's agricultural land is used by smallholders.
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PURPOSE@#Various surgical modalities are available to treat Neer types 2 and 5 unstable fractures of lateral end clavicle but none of them are standardized. Arthroscopic fixation of the displaced lateral end clavicle fractures provides good short-term results but mid- to long-term outcomes are not available. The purpose of this study was to show the mid- to long-term radiological and functional outcomes of these fractures treated arthroscopically by a TightRope device, and to show the complications associated with this procedure.@*METHODS@#A retrospective study was conducted over 2 years from January 2014 to December 2015 with a minimum 5-year follow-up. Active patients aged 18-50 years with acute (less than 3 weeks) displaced fracture of lateral end of the clavicle, with a minimum 5-year follow-up were included in the study. Patients with associated fractures of the proximal humerus, glenoid, scapula and acromioclavicular joint injuries were excluded from the study along with open fractures and neurovascular injuries. The outcomes were assessed by objective (complications and radiographic examination) and subjective criteria (quick disabilities of the arm, shoulder and hand score, the Constant-Murley score and the visual pain analogue scale). The data were analyzed by SPSS version 21.0.@*RESULTS@#Totally, 42 patients were operated during the study period and 37 were available with a minimum 5-year follow-up. Thirty were male and 7 were female with a mean age of 29.5 years and a mean follow-up of 6.1 years. The mean quick disabilities of the arm, shoulder and hand score was 68.2 ± 4.6 preoperatively and 1.27 ± 2.32 at final follow-up (p < 0.001); the mean visual pain analogue scale score was 6.85 ± 2.2 preoperatively and 0.86 ± 1.60 at final follow-up (p < 0.001). The average Constant-Murley score was 93.38 ± 3.25 at the end of the follow-up. There were 2 fixation failures, with established non-union and 3 patients developed radiographic acromioclavicular joint arthritis.@*CONCLUSIONS@#Arthroscopic TightRope fixation of displaced lateral end clavicular fractures provides good radiological and functional outcomes at mid- to long-term follow-up. With the low complication rates and high patient satisfaction, this technique can be considered as a primary option in the surgical treatment of these fractures.
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Humans , Male , Female , Adult , Follow-Up Studies , Clavicle/surgery , Retrospective Studies , Fractures, Bone/complications , Fracture Fixation, Internal/methods , Fractures, Open , Pain , Treatment OutcomeABSTRACT
Purpose: To compare and study the clinical outcome of tarsorrhaphy and amniotic membrane transplant in the healing of persistent corneal epithelial defects in terms of clinical improvement and symptomatic relief. Methods: This was an interventional, prospective study in which a total of 60 patients with persistent epithelial defects (PED's), randomly divided into two groups of 30 patients each who underwent tarsorrhaphy (Group A) or amniotic membrane transplantation (Group B) with a 4-week-follow-up period, were included. The main parameters studied were the size of an epithelial defect, total healing time, pain score, and complications. Results: The study included 60 eyes of 60 patients with PED. The healing time was 9.83 � 6.51 days in Group A (median = 9.50 days, IQR = 1�days) vs. 18.33 � 13.46 days (median = 19.50 days, IQR = 1� days) in Group B. A total of ten eyes (16.7%) did not heal at the end of 4 weeks. Conclusion: There was a significant reduction in the area of epithelial defect at the end of the 1 week and 2 week follow up postoperatively, in both the treatment forms. The mean healing time in patients of Group A was less as compared to that of the patients in Group B.
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The public health ramifications of marital violence are well documented and include injury, mental health concerns and physical health consequences for women and their offspring. Unfortunately, there remains social tolerance and even acceptance of these abuses against women, and health systems in India have done little to support victims despite their greater health risks. However, there are promising efforts and important advancements in India that could be built on for more effective prevention and support for women. Men and boys should be engaged in gender transformative interventions with male role models to alter men's attitudes of acceptability of and justification for marital violence and consequently their actual abusive behaviours. Given the strong demonstrated connection between men's risky and problem alcohol use and marital violence, alcohol interventions may also be beneficial. We must support women and girls vulnerable to marital violence, a group disproportionately affected by violence in their natal families as well, so they know that violence need not be part of their marriage relationship, and have skills on how to engage and communicate with or even leave their male partners to reduce their risk for violence. Formal services should be expanded for those in immediate danger and particularly for rural areas, where prevalence of marital violence is highest and supports are weakest. Finally, given the pervasiveness of attitudes accepting husbands' marital violence against women, and the fact that these have remained largely unchanged in India for a decade, large scale community and social change efforts are needed.
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Background & objectives: Survival of patients with multiple myeloma (MM) has improved in the past two decades following use of novel agents and autologous stem cell transplantation. To determine predictors of long-term outcome, data of MM patients who underwent autologous stem cell transplantation (ASCT) at a tertiary care centre in north India were retrospectively analyzed. Methods: Between 1995 and 2016, 349 MM patients underwent ASCT. Patients' median age was 52 yr, ranging from 29 to 68 yr, 68.2 per cent were males. Thirty three per cent patients had international staging system (ISS) Stage III and 68.5 per cent had received novel agents-based induction. High-dose melphalan (200 mg/m2) was used for conditioning; patients with renal insufficiency (estimated glomerular filtration rate <40 ml/min) received melphalan 140-150 mg/m2. Results: Post-transplant, 317 of 349 (90.8%) patients responded; complete [complete response (CR)] ?213 (61%)], very good partial response (VGPR) ?62 (17.8%) and PR in 42 (12%)]. Induction with novel agents, pre-transplant chemosensitive disease, transplant in first remission and serum albumin (?3.5 g/dl) were predictors of significant response. At a median follow up of 73 months, median overall survival (OS) was 90 months [95% confidence interval (CI) 70.8-109.2], and progression-free survival (PFS) was 41 months (95% CI 33.0-49.0). On multivariate analysis, achievement of CR post-transplant, transplant in first remission, ISS Stages I and II (vs. III), absence of extramedullary disease and serum albumin ?3.5 g/dl were predictors of prolonged OS. For PFS, achievement of post-transplant CR and transplant in first remission were predictors of superior outcome. Interpretation & conclusions: Treatment with novel agents, achievement of complete remission post-transplant, ISS Stages I and II, absence of extramedullary disease and transplant in first remission were predictors of long-term survival for patients with MM.
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Background: Internet has become a widely used tool in a developing country like India as in the developed world and has shown exponential growth particularly in the past 10 years or so. There has been a growing worry among the intellectuals about what level of use can be termed as “more than desirable” and when should it be termed to be “Addiction.” Objectives: The objectives of this study were to find the sociobehavioral correlates and prevalence of internet addiction (IA), study the relationship of IA with internet use profile, and evaluate the risk factors associated with it among university students of TMU, Moradabad. Materials and Methods: A longitudinal cross-sectional survey was executed with sample size of 587 students from medical, nursing, physiotherapy, and engineering courses in the University of TMU after securing permission from their respective college authorities. Semi-structured, pre-designed, and pre-tested survey instrument consisting of “The IATest (Young, 1998)” after instructing them briefly was administered. Results: Of the total of 552 study subjects who took part in the study, 182 (32.97%) were girls and 370 (67.03%) were boys. The mean age of the students was found to be 19.5 years. Majority (64.31%) subjects were only mild users or non-addicts. On application of Young’s original criteria, as much as 2.54% of students were found to be addicts. Conclusion: In the modern days, obsession for having “All-knowledge” at fingertips, hype for social media and has variety to entertainment to name the few, the use of internet is but must; apart from the indispensable uses of internet, the college students are highly susceptible to IA that may cause wasting of the precious study time as well as their time for relaxation and recreational activities, ultimately affecting the educational situation unfavorably. Hence, the Universities/Educational Institutes should wake up to the impending problem and extenuate the use of internet mainly for scholastic purposes.
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Purpose: The purpose of this study was to evaluate the serological profile of the eye donors and to study the influence of various factors on serological test results. Methods: A cross-sectional, observational study was conducted, and data of 509 donors were reviewed from the records of eye bank from December 2012 to June 2017. Various details of donors analyzed included the age, sex of the donor, cause of death, source of tissue, time since blood collection after death, macroscopic appearance of blood sample, and details of discarded tissues. Serological examination of blood was performed for human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus (HCV), venereal disease research laboratory (VDRL), and serology reports reactive or nonreactive were analyzed. Results: Among the 509 donors, 295 (58%) were male, and 420 (82.50%) belonged to age group ?60 years. Most donors (354, 69.5%) died due to cardiac arrest. Macroscopically, sera were normal in the majority of 488 (95.9%) cases. Among 509 donors, 475 (93.3%) were nonreactive, 12 (2.4%) donors were found to be reactive to hepatitis B surface antigen (HBsAg), and 1 (0.2%) was reactive to HCV, but no donor serology was reactive to HIV or VDRL. Twenty-one (4.12%) donors' sera were not fit for serological testing. Among all donors, 475 (93.32%) donors were accepted and 34 (6.67%) were rejected or discarded on the basis of serological testing. Cause of death and macroscopic aspect of sera influenced the serological results in a highly significant manner (P = 0.00). Acceptance or rejection of the donor was significantly influenced by the serological results of the donor (P = 0.00). Conclusion: The seroprevalence among eye donor for HBsAg and HCV was 12 (2.4%) and 1 (0.2%), respectively. Factors such as cause of death and macroscopic aspect of sera influence the serological results. Time since blood collection or sampling will not show any impact on viral serological results if postmortem sampling will be done in < 10 hours(h) after death which can improve the safety and utility of the donor cornea.
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Dens invaginatus is a developmental variation of a tooth resulting from an alteration in the normal growth pattern of the dental papilla. It is clinically characterized by a palatine furrow that can be limited to the coronal pulp or may extend to the radicular apex. The commonly affected tooth is maxillary lateral incisor. The occurrence of multiple dens invaginatus is extremely rare. Although a clinical examination may reveal a deep pit or fissure on the lingual surfaces of maxillary anterior teeth, the radiographic examination is the choice for diagnosis of dens invaginatus. Familiarity with the radiographic appearance of this anomaly is essential for the dental practitioner. The purpose of this paper is to present a clinical case of multiple dens invaginatus involving maxillary anterior teeth which was diagnosed during routine radiographic evaluation.
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Purpose: Primary infection with a varicella‑zoster virus (VZV) leads to chickenpox. Though the incidence of the disease has decreased in many developed countries due to the introduction of the varicella vaccine, outbreaks continue to occur in developing countries. Materials and Methods: The present study reports an outbreak of varicella in an urbanised village in the vicinity of Chandigarh City in North India in November 2013. The outbreak was confirmed by the detection of VZV IgM antibodies in serum samples of clinically suspected patients. Vesicular fluid samples were collected from 8 patients with active lesions and tested for VZV DNA by polymerase chain reaction. Blood samples were also collected from 17 healthy controls residing in the same locality and tested for the presence of VZV IgM and IgG antibodies. Results: A total of 18 cases occurred, and the majority of them (67%) were <15 years of age. Of 17 samples collected from patients with the clinically suspected disease, 13 (76.5%) showed the presence of VZV IgM antibodies. Of the healthy controls, 6 were VZV IgM positive and 4 of them developed symptomatic disease on follow‑up. VZV DNA was positive in 5/8 (62.5%) of the patients. In one patient, VZV DNA was detected in the absence of an IgM antibody response. Conclusion: The introduction of varicella vaccine in the universal immunisation programme of India may help to prevent these outbreaks; however, the cost‑benefit analysis needs to be carried out before making such policies.
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Introduction: Undergraduate medical education should be broad-based, holistic, integrated and should promote a framework for the development of higher order cognitive skills like communication, professionalism and teamwork to prepare the student for a life-long challenging medical career. Recent calls for a competency-based medical education require, in addition, competency in clinical and procedural skills prior to graduation. This study investigates how often opportunities exist for medical students to perform four common ward procedures prior to graduation. Method: A prospective cross-sectional study to assess the opportunities a medical student have in performing four common ward procedures, comprising intravenous cannulation, nasogastric tube insertion, urinary catheterisation and chest tube insertion, in a State General hospital in Malaysia was done. Results: A medical student has sufficient opportunity to perform only intravenous cannulation prior to graduation. He has a remote chance to insert a urinary catheter and is unlikely to have the opportunity to insert a nasogastric tube or insert a chest tube prior to graduation. Conclusion: Although competency in clinical skills and procedural skills prior to graduation are desirable, this is increasingly difficult to achieve due to shortage of clinical material, teachers to supervise, the large numbers of medical students and house officers, the short time spent on the main disciplines and the failure of many universities to invest heavily in skills laboratories staffed by full time clinicians. The calls to introduce competency-based medical education in undergraduate medical education, particularly in procedural competence, should take into account the challenges in delivery and the realities in the hospitals today. This is necessary to avoid demoralising students who are unable to achieve their quota of procedures through no fault of theirs.
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Assessing the needs and determining health priorities are essential to focus the attention in the right direction and use the scarce resources in the most efficient way that would positively affect the oral health status of the population, and help in maximizing the oral health results and enforcing equity. The present study was aimed at developing process dental nursing care standards based on literature review and eliciting participant's opinions regarding the importance of proposed standards. A methodological research design was used to determine the importance of proposed standards from point view of participants. The study was conducted in [34] governmental and nongovernmental dental clinics in Jenin district West Bank in Palestine. Subjects of the study included two groups consisted of [128] participants. Nursing group divided into two categories included [53] dental nurses, and [22] nurse managers, while dentistry group included [53]dentists. Data collection included Arabic questionnaire sheet aimed at determining the importance of tasks by eliciting participant's opinions. Results showed that majority of participants agreed upon importance of most proposed standards related to process dental nursing care, followed by development of these standards. As a conclusion, the developed standards are ready for application in study settings where they are urgently needed. It is recommended to apply developed standards in study settings and also in similar settings in other districts in Palestine. Training sessions about dental nursing care plan steps should be conducted for dental nurses to increase their knowledge