Household Characteristics, Cost of Illness and Coping Mechanism of Families of Hospitalized Acute Encephalitis Syndrome Children: A Mix Method Study

Background: AES is responsible for causing high social and economic burden to the affected families. The study was conducted to know the household characteristics, cost of illness and coping strategy adopted by the family members of AES children admitted to a tertiary care facility in Assam, India. Methods: It was a sequential exploratory mixed method study, with a cross-sectional survey among AES chil-dren and their guardians, followed by In Depth interview. Results: Out of 51 cases 55% were male. The median age was 11 years. 53% of the families belonged to lower socioeconomic class. 96% of families reported to reside in rural areas. Commonly reported household assets were mobile phone 94%, bicycle 86%, television 31% and motorcycle 29%. Three major themes were emerged to contribute towards economic burden. The first major theme is “Direct cost” due to patient trans-portation cost (mean Rs 1161.00) and hospital costs: mostly due to medicinal cost (mean Rs1955.00), investi-gational cost (mean Rs 2920.00) and food cost (mean Rs 8375.00). The second theme “Indirect cost” is due to work days loss: 100% care providers had missed work days during hospital stay of their children and 84% had missed work days during post hospital care. The third theme is “Inherent cost spotted through coping mechanisms” which mostly 94% included borrowing money from the market and 31.4% selling household assets. Conclusion: Cost of illness is a huge burden to the AES afflicted families which demands reforms in health care financing and reimbursement in current context.

Physico-chemical And Microscopic Study Of Arjuna (terminalia Arjuna) Bark

In present study plant of Arjuna has been taken for physical and chemical analysis in terms of microtome of bark, powder study, loss on drying, ash values, extractive values, bulk density, Acid insoluble ash, Water-soluble Ash, Water-soluble extractive value, Alcohol-soluble extractive, pH range, TLC, Tapped density, Compressibility index, Hauser ratio, Angle of repose, Ultra violet fluorescence analysis of drug, etc. Physical and chemical analysis an important place in standardization of Ayurvedic drugs in order to make its global acceptability. The plant of Arjuna botanically named as Terminalia arjuna linn.; family Combretaceae, has traditionally been used to treat many diseases especially heart disease for centuries, that’s why it is called as “Guardian of the heartâ€. Transverse sections of Arjuna bark shows the calcium oxalate crystal, starch grains and lignified cells respectively shows that Xylem Vessels, Sclerenchymatous Fibers, Cork Cells, Tracheids, Sclereids, LOD value of the sample of Arjuna is 5.63%. According to result the Arjuna has three Rf vaule0.70, 0.42, 0.28 table1.4. Angle of repose of powder sample shows the flow of powder. The extractive value of Arjuna have different solvent like water, ethanol, isopropanol, acetone, chloroform, benzene, toluene, petroleum ether, hexsene are respectively 50.80, 41.07,30.37, 8.95, 0.96, 0.67, 0.52, 0.51, 0.46.

Evaluation of fracture resistance of mandibular incisors before and after endodontic treatment and metal ceramic crown placement

Background: Mandibular incisors are the smallest among the permanent dentition, with thin enamel and dentin. Intact teeth do not fracture easily while mastication. Objectives: To evaluate the fracture resistance of mandibular incisors after endodontic treatment and metal ceramic crown placement. Materials and methods: Eighty recently extracted intact mandibular incisors were divided into four groups of twenty each based on root canal treatment and crowns, intact natural tooth without RCT and crown preparation was used as control group. Each tooth was mounted separately in acrylic block and subjected to loading in universal load testing machine until fracture, results were analyzed by one-way ANOVA and Turkey’s multiple post hoc procedures. N Sandeep, G. Ramaswamy Reddy, Kancham Kalyan Kumar Reddy, K Subash Chander, Vasanthi Bondugula, Ram B. Basany. Evaluation of fracture resistance of mandibular incisors before and after endodontic treatment and metal ceramic crown placement. IAIM, 2017; 4(11): 18-26. Page 19 Results: The results showed that Fracture resistance of teeth restored with metal ceramic crowns was very high when compared to the teeth without crowns (p<0.05).There was no statistically significant difference between intact and endodontically treated teeth (p>0.05). Conclusion: The study concluded that endodontic treatment and tooth preparation followed by metal ceramic restoration increased the fracture resistance of mandibular incisors.

Design and in vitro evaluation of effervescent gastric floating drug delivery systems of propanolol HCl / Diseño y evaluación in vitro de sistemas de administración de tabletas flotantes gástricas everfescentes de HCl propanolol

The purpose of this research was to develop and evaluate effervescent gastric floating tablets of propranolol HCl. The oral delivery of antihypertensive propranolol HCl was facilitated by preparing an effervescent floating dosage form which could increase its absorption in the stomach by increasing the drug’s gastric residence time. In the present work, effervescent floating tablets were prepared with a hydrophilic carrier such as polyethylene oxide (PEO WSR N 60K and PEO WSR 303) as a release retarding agent and sodium bicarbonate as a gas generating agent. The prepared tablets were evaluated for all their physicochemical properties, in vitro buoyancy, drug release and rate order kinetics. From the results, P9 was selected as an optimized formulation based on their 12 h drug release, minimal floating lag time and maximum total floating time. The optimized formulation followed first order rate kinetics with erosion mechanism. The optimized formulation was characterized with FTIR studies and no interaction between the drug and the polymers were observed.

El propósito de la presente investigación fue desarrollar y evaluar tabletas flotantes, efervescentes de HCL propranolol. La administración oral del antihipertensivo HCL propranolol se facilitó mediante la preparación de una forma de dosificación flotante y efervescente que permitiría su absorción en el estómago, mediante el aumento del tiempo de residencia gástrico de la droga. En el presente trabajo, las tabletas flotantes efervescentes fueron preparadas con un portador hidrofílico, tal como el óxido de polietileno (PEO WSR N 60K and PEO WSR 303), como agente retardador y bicarbonato de sodio como un agente generador de gas. Se evaluaron todas las propiedades fisicoquímicas de las tabletas preparadas, su flotación in vitro y su tasa de orden cinético. Se seleccionó el P9 a partir de los resultados obtenidos, como una fórmula óptima, basados en la liberación de la droga a las 12 h, tiempo mínimo de retraso para flotación y máximo tiempo total de flotación. La formulación optimizada siguió una tasa cinética de primer orden con mecanismo de erosión. Esta fórmula óptima se caracterizó mediante estudios FITR y no se observó ninguna interacción entre la droga y los polímeros utilizados.

The evidence-based management of bilateral ethmoid osteomas: diagnosis, endoscopic resection and review of the literature / Tratamiento basado en la evidencia para el osteoma etmoidal bilateral: diagnóstico, resección endoscópica y revisión de la literatura

A 56-year old woman presented with headaches and nasal congestion secondary to bilateral ethmoid osteomas and she made a full recovery following endoscopic resection. Paranasal osteomas are common, benign, encapsulated tumours that are often asymptomatic, but may present similarly to rhinosinusitis and occasionally cause complications depending on their anatomical location. Bilateral ethmoidal osteomas, however, are a rare occurrence and have not been previously reported in the English literature as far as the authors are aware. Ethmoidal and fronto-ethmoidal osteomas, like other paranasal osteomas, are easily diagnosed using computed tomography and are increasingly amenable to endoscopic resection. An evidence-based management plan is presented.

Una mujer de 56 años se presentó con los dolores de cabeza y congestión nasal secundaria a un osteoma etmoidal bilateral, tras su recuperación total a partir de una resección endoscópica. Los osteomas paranasales son tumores comunes, benignos, y encapsulados, a menudo asintomáticos, pero que pueden presentarse de modo similar a la rinosinusitis, y ocasionalmente causar complicaciones, en dependencia de su localización anatómica. Los osteomas etmoidales bilaterales, sin embargo, son una ocurrencia rara y hasta donde sabemos, no ha sido reportado con anterioridad en la literatura en inglés. Los osteomas etmoidales y fronto-etmoidales - al igual que otros osteomas paranasales - se diagnostican fácilmente usando CT, y son cada vez más tratables mediante resección endoscópica. Se presenta un plan de tratamiento basado en la evidencia.

Postprandial lipid abnormalities in type 2 diabetes mellitus.

AIM AND OBJECTIVES: To study the postprandial lipid abnormalities in patients with type 2 diabetes mellitus. MATERIAL AND METHODS: Postprandial lipids were studied in 20 male type 2 diabetic subjects (age 49.75 +/- 4.82 years) and 20 age and sex matched healthy controls (age 49.55 +/- 4.82 years) after an oral fat challenge which consisted of a meal providing 729 keal/m2 body surface area with 68 gm fat. RESULTS: Average duration of diabetes among diabetic was 2.32 +/- 3.03 years. The body mass index (cases 25.84 +/- 4.52; controls 25.74 +/- 5.0; p > 0.05) and waist-hip ratio (cases 1.06 +/- 0.13; controls 1.14 +/- 0.2; p > 0.05) were similar in both groups. While fasting serum lipids were not significantly different between the two groups, a number of serum lipid abnormalities were noted in type 2 diabetic subjects in the postprandial state. These included a higher triglyceride-area under curve (AUC) (cases 1298.08 +/- 485.2 vs. controls 922.15 +/- 390.47 mg/dl/8h; p=0.01), a higher triglyceride-area under incremental curve (AUIC) (cases 549.68 +/- 382.24; control 294.75 +/- 172.6 mg/dl/8h; p=0.01), a higher peak triglyceride level (cases 425.2 +/- 204.47 mg%, controls 283.9 +/- 11.6.94 mg%, p=0.01), a lower HDL-AUC (cases 130.35 +/- 33.55 vs. controls 168.48 +/- 56.01 mg/dl/8h, p=0.013) and a lower HDL nadir (Cases 28.05 +/- 10.94 mg%, controls 37.13 +/- 13.52 mg%, p < 0.02). Triglyceride AUC correlated significantly with fasting serum triglyceride (r=0.62) and BMI (r=0.7), but not with waist hip ratio or fasting serum insulin levels. Postprandial lipaemia did not correlate with age, duration of diabetes, fasting blood glucose or glycosylated hemoglobin. CONCLUSION: In conclusion, make type 2 diabetics demonstrate significant postprandial lipid abnormalities, particularly of triglycerides, which appear to be independent of glycaemic control.

Cognitive dysfunction in NIDDM: P3 event related evoked potential study.

P3 component of the endogenous cerebral evoked response is a sophisticated, objective and quantitative approach to assess higher functions of the brain. This test was employed using auditory 'odd ball' paradigm to assess cognitive functions in thirty non insulin dependent diabetic patients (NIDDM) aged 43.6 +/- 9 yrs with poor blood glucose control. (HbAlc. 9.9 +/- 1.0%). The peak latencies of N2, P3 components of event related evoked potentials obtained in these patients were compared with 30 age and sex matched non diabetic healthy controls. Latencies of these potentials were: N2 = 248.0 +/- 36.3, P3 = 391.6 +/- 49.9 msec in NIDDM as compared to 220.6 +/- 26.4, 326.2 +/- 26.8 msec in controls and were highly significant (P < 0.001). The duration of disease, blood glucose level or the physical parameters of height, weight and blood pressure did not show any correlation with N2 or P3 latencies or amplitude. These findings provide an electrophysiological evidence of delayed cognition in poorly controlled NIDDM cases.

Leukemoid reaction in amoebic liver abscess.

A case of amoebic liver abscess with leukemoid reaction is described. This patient also had jaundice as the presenting feature. Therapy with metronidazole resulted in improved general condition and both blood picture and liver function tests also became normal.

Fat and oil inhibit phosphine release from aluminium phosphide--its clinical implication.

Poisoning by suicidal or accidental ingestion of aluminium phosphide (AlP) is a frequent medical emergency seen all over the world. AlP, a grain fumigant and rodenticide, on exposure to moisture, liberates highly toxic gas, phosphine. The rapidly inhibits mitochondrial respiration and has cytotoxic action. No specific antidote is known against it till date and prognosis depends much on dose and time lag between AlP ingestion and the stomach wash in the hospital (critical period). Physicochemical properties of AlP and nonmiscibility of fat and water promoted us to study the effect of different fats and oils as possible antidotes to inhibit phosphine liberation. In vitro experiments revealed that vegetable oils and liquid paraffin were much more effective than butter and ghee in inhibiting release of phosphine from AlP. These findings may have significant clinical implication.

Aetiological profile of overt hypothyroidism in Indian population.

We analysed the aetiology of hypothyroidism in 144 patients. In these hospital referral data, thyroid surgery and decompensated iodine deficiency were the major known causes of hypothyroidism (19.5% and 15.3% respectively), while in the majority of patients (45.14%) the aetiology was obscure. The idiopathic group had patients who were significantly younger (p less than 0.01), showed a gland size between 2 and 3 SD ranges in significantly higher preponderance (p less than 0.05), and presented with generally higher prevalence rates of signs and symptoms; however, only menstrual disturbances (p less than 0.01), loss/reduced appetite (p less than 0.01) and dry/thickened hair (p less than 0.25) reached statistical significance. Since hypothyroidism has definite and substantial morbidity, these results are of importance to public health and medical personnel for a Bayesian approach to the aetiological diagnosis of hypothyroidism and for ordering specific confirmatory laboratory investigations.

High prevalence & heterogenicity of thalassaemias in Orissa.

High incidence of alpha thalassaemias (estimated from detection of Hb Bart's from cord blood), Hb constant spring (CS) and high A2 beta thalassaemia trait (estimated from normal adult subjects) were detected in 12.6, 15 and 8 per cent people of coastal Orissa (with less than 5% tribal population) respectively. Quantitation of Hb Bart's suggest that the alpha thalassaemia could be any of the genotypes such as, -alpha/alpha alpha, -alpha/-alpha, --/alpha alpha and alpha alpha/alpha alpha cs. Both heterozygotes and homozygotes for Hb CS were identified.