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Varmam- a discrete medical science and a great contribution of Siddhars to Tamil Nadu. It encompases Varma martial arts, Varma therapy, internal and external medicines. Varma therapy and medicines effectively treat neuro musculoskeletal conditions which is admirable. Shoulder pain is most common orthopaedic condition. It is the third common cause of musculoskeletal consultations in primary care. Approximately 1% of adult develops new shoulder pain annually. Common pathological conditions of shoulder like rotator cuff disorders and adhesive capsulitis etc exhibits similar clinical features like pain and stiffness of shoulder joint and restricted movements. Varma therapy rearranges and regulates the “Vaasi” and consequently helps to maintain the equilibrium of trihumours (Vatham, Pitham, Kapham). This review article explicates the Varma points for the treatment of shoulder pathological conditions, the exact anatomical location of Varma points and the appropriate method of its manipulation, certainly a key to further research articles.
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Objectives@# Prophylactic vaccines against high-risk human papillomaviruses (HR-HPVs) hold promise to prevent the development of higher grade cervical intraepithelial neoplasia (CIN 2+) and cervical cancer (CC) that develop due to HR-HPV genotypes that are included in HPV vaccines, but women will continue to develop CIN 2+ and CC due to HR-HPV genotypes that are not included in the quadrivalent HPV vaccine (qHPV) and 9-valent HPV vaccine (9VHPV). Thus, the current vaccines are likely to decrease but not entirely prevent the development of CIN 2+ or CC. The purpose of the study was to determine the prevalence and determinants of CIN 2+ that develop due to HR-HPVs not included in vaccines. @*Methods@# Study population consisted of 1476 women tested for 37 HPVs and known to be negative for qHPVs (6/11/16/18, group A, n = 811) or 9VHPVs (6/11/16/18/31/33/45/52/58, group B, n = 331), but positive for other HR-HPVs. Regression models were used to determine the association between plasma concentrations of micronutrients, socio-demographic, lifestyle factors and risk of CIN 2+ due to HR-HPVs that are not included in vaccines. @*Results@# The prevalence of infections with HPV 31, 33, 35 and 58 that contributed to CIN 2+ differed by race. In group A, African American (AA) women and current smokers were more likely to have CIN 2 (OR = 1.76, P = 0.032 and 1.79, P = 0.016, respectively) while in both groups of A and B, those with higher vitamin B12 were less likely to have similar lesions (OR = 0.62, P = 0.036 and 0.45, P = 0.035, respectively). @*Conclusions@# We identified vitamin B12 status and smoking as independent modifiable factors and ethnicity as a factor that needs attention to reduce the risk of developing CIN 2+ in the post vaccination era. Continuation of tailored screening programs combined with non-vaccine-based approaches are needed to manage the residual risk of developing HPVrelated CIN 2+ and CC in vaccinated women.
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Siddha system granting preventive, curative and rejuvenating healthcare. According to Siddha system three humours- Vatham, Pitham and Kapham- mediate the body’s physiological function. Derangements of trihumour lead to diseases. Vatha diseases are the most common diseases presenting in Siddha hospitals nowadays. In Siddha system the primary goal of the treatment is to restore the balance of trihumours. The first and foremost treatment for Vatha disease is Bhedhi (purgation). The quote ‘BhedhiyaalVathamthaalum’ indicates purgation therapy will reduce Vatham. For this study the purgative drug Agasthiyarkuzhambu is used. Aim and Objective: To make a validation of purgation therapy to alleviate Vathaim balance. To describe purgation therapy in alleviate Vathaim balance by giving Agasthiyarkuzhambu to outpatient and inpatient Department, Govt. Siddha Medical College, Palayamkottai. To observe the increased Vatha symptoms and Neikuri changes before and after treatment. Materials and methods: ANon randomized clinical trial was done with 40 patients, data were collected by interviewing with structured questionnaire about increased Vatha symptoms and samples of urine were collected to the analysis. The data will be analysed using SPSS. Results: Out of 40 patients, based on relief of Vatha symptoms 45% of cases reported good relief and 13% of cases reported better relief from their symptoms. In Neikuri before treatment 40% of cases had typical Vathaneikuri (fast, irregular, Aravu pol) and after treatment the Neikuri pattern changed to Pithavatham, Pitham and Kapham and only 10% of cases had Vathaneikuri. Neikuri and Vatha symptoms are better parameter for assessing alleviated Vatha imbalance in this study.
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Background: Open defecation is the leading cause for malnutrition and diarrhoeal deaths in low- and middle-income countries. The negative public health impacts of open defecation could be neutralized by toilet usage. However, the usage of improved sanitation facilities is unsatisfactory in rural India. Objectives: The study was carried out to find the psycho?social barriers among households for not having toilets and for not using the owned toilets and to develop and find out the effect of Behaviour Change Communication (BCC) strategy on toilet construction and usage. Methods: A community?based Embedded Experimental Mixed Methods study was undertaken in the four field practice villages of Urban Health Training Centre, Villupuram. For baseline and end?line surveys, 422 independent sample households who were not having or not using the toilets were selected by Simple Random Sampling. After IEC clearance, interviews and direct observation of the toilets were undertaken. Context?specific multi?faceted BCC strategy was employed through community participation. The data were analyzed in SPSS software. Chi?square test was used to determine the significance of difference and effect size was calculated to estimate the size of the difference between the baseline and end-line data. Results: Toilet ownership and utilization improved by 21.3% and 23.3% points, respectively. There was a significant reduction in households’ perceived psychosocial barriers in toilet adoption. Conclusion: Our intervention demonstrated considerable improvements in both toilet construction and usage surpassing the psycho-social barriers. Future sanitation promotion interventions should focus more on community participation and the key messages should be reinforced multiple times using different channels.
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Introduction: The Department of Community Medicine has been training medical interns for providing hospital-based palliative care (HBPC) and community-based palliative care (CBPC) services with an interprofessional team. This study was done to evaluate the training program on palliative care developed for medical interns. Material and Methods: It was a retro-pre type of program evaluation done among 172 interns between January 2016 and December 2017. One day program was conducted for the interns by faculty trained in palliative care, followed by placement in HBPC and CBPC program. At the end of training, self-perceived improvement in knowledge was collected on a five-point Likert scale. Certificates were issued on completion. Data were entered and analyzed using Epi Info (version 7.2.2.6) software. Wilcoxon signed-rank test was applied between pre- and post-scores. Manual content analysis was done for open-ended questions. Results: The mean age of the participants was 22.5 ± 0.8 years, with 76 (44.2%) males and 96 (55.8%) females. There was statistically significant improvement in perceived knowledge scores after attending the training. Areas of learning, values learned, and uses of learning in future career and suggestions for improving the training program were the categories obtained. Conclusion: The training program improved the self-perceived knowledge on palliative care among medical interns. The exposure to HBPC and CBPC program had a positive effect on their attitude and perceived skills for caring of chronically ill patients. Such programs can be initiated by other palliative care providing institutions for training medical interns.
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Background: The practice of caesarean section is increasing day by day. Delivery by caesarean section can cause more complications than normal vaginal delivery and one of the most common complications is primary or secondary postpartum hemorrhage. The aim of present study was to study the efficacy and safety of tranexamic acid in reducing blood loss during and after caesarean section.Methods: This study was conducted at Deccan College of Medical Sciences, Hyderabad. It was a prospective randomized double blind placebo controlled study. This study includes 60 pregnant women divided in to two groups. Just before the induction of anesthesia 1 gm of tranexamic acid in 20 ml of normal saline was given over 10 minutes in test group and 20 ml of normal saline was infused in control group.Results: The demographic characters of patients in two groups were comparable. There was no statistically significant difference in the heart rates, respiratory rates and blood pressures in the two groups. There was statistically significant difference in the quantity of the blood loss from during the operation and 2 hours postpartum (p=0.003). Total mean blood loss in control group was 718.80±233.1 ml and in study group was 554.28±207.8 ml. The drop in hemoglobin after caesarean section in study group was not significant where as in control group was significant. There was no significant difference in the prothrombin time and partial thromboplastin time in the groups, pre and post operatively. In this study the use of tranexamic acid reduced the dose of other uterotonics like syntocin in study group.Conclusions: Tranexamic acid significantly reduced the amount of blood loss during the caesarean section and also reduced the use of other uterotonics. Thus, tranexamic acid can be used safely and effectively in subjects undergoing caesarean section.
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@#Acute ischemic stroke (AIS) and acute ST-elevation myocardial infarction (STEMI) are leading causes of mortality worldwide. Concurrent AIS presentation with STEMI is rare and potentially fatal. Most importantly to date many centres in Malaysia are still not aware on how to treat this condition. We report a case of AIS, which was treated with intravenous tenecteplase (TNK) according to ischemic stroke dosage and lead to improvement of neurological deficit.
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Background: Mosquito control is the cornerstone in the prevention of dengue. There is a need for active community participation in the control of the disease. However, there have been various barriers in preventive activities. Understanding the barriers to the preventive activities would help in designing appropriate intervention/awareness program.Methods: A community based descriptive cross-sectional study was done in the villages of Kudikadu and Echangadu. House-to-house visit was done and persons above 15 years of age, present at the time of visit were included in the study. The data was captured using ‘Epicollect 5’, a mobile application for data collection based on the constructs of health belief model.Results: A total of 155 individuals were interviewed, whose mean age was 41.3 (±13.8). A majority of them were females (71.3%), had no formal education (27.5%) and belonged to socio-economic class 5. Majority of households 140 (87.5%) responded they have mosquito problem in the house and 103 (64.3%) of them perceived that there were barriers for carrying out dengue preventive activities. The barriers reported by the participants were lack of awareness (30%), poor government support (25%), financial issues (16.9%) and lack of motivation (7.5%). There was a significant association of socioeconomic class with lack of motivation and financial issues, with a high number of participants belonging to socioeconomic class IV and V reporting lack of motivation (p=0.028) and financial issue (p=0.025).Conclusions:Health providers have to find an appropriate and effective strategy to create awareness among people about the simple ways to prevent mosquito breeding.
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Background: Early diagnosis is the mainstay for reducing complications associated with diabetes. Though blood sugar testing was made freely available, there is gap in utilization of the same. Hence, the current study was conducted to assess the detection gap in diabetes compared to regional estimates. Also, to assess the extent of screening and factors associated with not getting screened.Methods: A community based cross-sectional analytical study was conducted in the selected rural areas of Puducherry. House to house enumeration survey was conducted in the purposively selected rural areas during September-2016 to February-2017. Information on diabetes status, status of screening in last one year was collected from individuals aged more than eighteen years. Data was entered in Epidata 3.1 and analyzed using Stata 12 software. Percentages with 95% CI were used to estimate the detection gap in diabetes on comparing with regional estimates given by IDF (8.6%). Generalized Linear Models were used to assess the individual level characteristics associated with not screening for diabetes.Results: Of the total 1844 enumerated individuals, 1423 (78.6%) were above 18 years of age. The detection gap for diabetics based on IDF was 39% and based on DLHS-4 was 69.8%. Of the eligible individuals for screening 81.9% (95% CI: 79.7%-83.9%) were not screened for diabetes in last one year.Conclusions: With high detection gap and low utilization of screening, there is need for developing innovative strategies like task shifting, ICT utilization for screening and targeted screening.
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Background: As Indian women has increased risk of developing GDM, screening for GDM is essential for early diagnosis and treatment and hence to reduce the adverse neonatal outcomes.Methods: The antenatal women are screened for GDM by administering 50g GCT and the screening test value of >130mg/dl measured at 1 hours were considered screening test positive and subjected to standard 2 hour 75gm OGTT and the neonatal outcome were observed in relation to neonatal birth weight, Apgar, and the occurrence of complications like hypoglycemia, hypocalcemia, hyperbilirubenemia.Results: The average neonatal birth weight in the study population was 3kg. The women with GDM who required diet alone had average neonatal birth weight of 2.9kgs and the GDM women who were on diet and insulin therapy had average neonatal birth weight of 3.4kg. There was increased incidence of hyperbilirubinemia 33.3% .There was only 1 preterm birth.Conclusions: There is association with neonatal Complications like hyperbilirubenemia and hypoglycemia with women who had screening positive for GDM.
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Background: In recent times, gestational diabetes is becoming more common Worldwide and complications are seen in fetal development, growth, labour and delivery due to maternal hyperglycemia. Gestational Diabetes Mellitus(GDM) is associated with adverse maternal and fetal outcomes. Among South Asian Population, Indian Women are at high risk of developing carbohydrate intolerance during pregnancy. Hence this study is undertaken to screen for gestational diabetes mellitus by two step method in Indian Women.Methods: This study was done in 153 nondiabetic pregnant women of gestational age 24-28 weeks, excluding diabetes mellitus diagnosed prior to pregnancy. Two step method was followed in the present study and GDM was diagnosed and the pregnancy outcomes were noted.Results: In our study the prevalence of GDM is 8.1% by two step method. Most of the women diagnosed with GDM were of age 26-30 yrs (41.66%). Among the women who were diagnosed as GDM, (58.33%) cases required Insulin along with diet control. In our study 33.33% had vaginal delivery, 8.33% had Emergency LSCS and 58.33% had Elective LSCS.Conclusion: Indian Women have high prevalence of GDM, hence universal screening is essential to diagnose GDM, which will improve the pregnancy outcome.
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Communication and interaction between teachers and students always plays a vital role in building a sound educational system where learning becomes an experience. Further enhancement of this learning and understanding of the subject can be supported and secured by a process of conceptual mapping. Conceptual mapping is a step-wise process which includes text filling, relational predicates (understanding) and finally constructing the map. It is a technical tool which is easily accessible and economical in its time use. The idea of using the concept map is still in the primitive level and more emphasis has to be made in this area to use it to its full potential in the academic field.
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INTRODUCTION:Unused and expired drugs in the households constitute a dominating cause of environmental contamination with drugs and other health hazards in addition to Industrial waste of the pharmaceutical companies. There are no proper disposal mechanisms being followed in India even we do not have a legislation to follow and to make health care providers accountable. METHODOLOGY:Around 650 households were surveyed to know about their current practicing methods of drug disposal and also their knowledge on impact of improper drug disposal on health and environment. RESULTS:Our study shown that nearly 85% of the participants discarded leftover medications by throwing them in the Garbage, while 7% burned in open place and few Respondents 1-2% followed returned to Pharmacy/health facility/friends etc. CONCLUSIONS :There is an urgent need for creating awareness among the people regarding proper drug disposal mechanisms
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Background: India’s current approach for intervention in non-communicable diseases (NCDs) is more in terms of early diagnosis and treatment. The focus should also be on the management of risk factors in the diseased individuals. The objectives of the study are to measure the risk factors of NCDs, lifestyle modification followed by them and to assess the challenges in reducing the risk factors of NCDs faced by the study population.Methods: The study was conducted between March and June 2017 in 2 government primary health centres (PHCs) in Puducherry. Based on systematic random sampling, 200 patients enrolled in NCD clinic with diabetes mellitus, hypertension, Stroke and myocardial infarction were selected for the study. After obtaining written informed consent, data was collected.Results: Out of 200 participants, majority of them were in the age group of 51-70 years (60%), females (71%) and living in nuclear family (83%). Among 200 participants, 23.5% of them had diabetes mellitus, 42% had hypertension and 24% had diabetes with hypertension. The risk factors that many of the participants had were excessive salt and sugar intake, overweight and obesity, less vegetable and fruits intake and alcohol consumption. Out of 200 participants, the major challenges in reducing the salt and sugar intake were lack of awareness and no family support.Conclusions: Most of the participants were oldest females who had diabetes or hypertension. The most common NCD they were suffering from were diabetes and hypertension. The major challenge in the management of NCDs is lack of awareness.
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Background: Anaemia during pregnancy is associated with serious maternal and fetal complications. Cord blood hemoglobin of the newborn is an important indicator of anaemia in newborn at birth. So, this study is done to assess the impact of maternal anaemia on cord blood hemoglobin levels of neonates.Methods: It is a cross sectional study done at government Kilpauk medical college and hospital in the department of paediatrics in year 2016.400 pregnant mothers attending the labour room in Kilpauk medical college were included and cord blood haemoglobin of their babies were collected. Mean cord blood haemoglobin of new-borns born to anaemic mothers (mild, moderate and severe) were compared with cord blood haemoglobin of new-borns born to non-anaemic mothers.Results: Out of 400 mothers,192 mothers were anemic, and 208 mothers were non anemic. The mean maternal hemoglobin among non-anemic mothers was 16.37'0.85 and among the anemic mothers it was 15.03'1.04. The mean cord hemoglobin of neonates born to anemic mothers among the three groups (mild moderate severe) were compared with mean cord hemoglobin of the non-anemic group. The difference between groups were statistically significant with P values <0.05,0.01 and 0.05 respectively.Conclusions: In present study maternal anaemia affects the cord blood haemoglobin of neonates. Present study infers that anaemic mothers deliver babies with lower haemoglobin compared to non-anaemic mothers. Authors have found a linear relationship between maternal haemoglobin and cord blood haemoglobin of the new-borns.
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Background: Non-communicable diseases are the leading causes of death globally, of which cardiovascular diseases are the most common. Cost-effective strategies, such as task shifting, are needed to mitigate the rising epidemic by controlling hypertension and diabetes in our country.Methods: This was a non-randomized interventional study undertaken in six (3 intervention and 3 control) villages of Lakkur primary health centre (PHC) area under Malur taluk, Kolar district, Karnataka, from November 2013 to April 2015. After obtaining written informed consent, baseline survey was done among 180 diabetics and hypertensives (adults>30 years). In the intervention villages, ASHAs who were trained did the intervention for 6 months. In non-intervention villages, standard usual care was given and repeat survey was done after 6 months to re-measure.Results: This study demonstrated that there was an increase of 44.8% in the proportion of hypertensives whose blood pressure was under control and increase of 26.5% in the proportion of diabetics whose blood sugar was under control in villages that received household visits by trained ASHAs (intervention villages). There was an increase in the medication adherence levels (29.6%) and reduction in tobacco usage (median difference of 4 times per day) among hypertensives and diabetics who are on medication in intervention villages.Conclusions: Findings from this study will provide policy makers and other stakeholders needed information to recommend scalable and cost-effective policy in respect to cardiovascular risk reduction, hypertension and diabetes control in resource-poor settings.
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Background: The objective of this study is to know the gender variation in number of admissions, severity of malnutrition at the time of admission, gaining of weight and adherence to follow up in children admitted to nutrition rehabilitation center and during follow up.Methods: This is a retrospective study involving the review of existing programme records. Children who were admitted to nutrition rehabilitation centre, district hospital, Chamarajanagar, Karnataka, India, between January 2017 to December 2017 with severe acute malnutrition were involved in the study. The programme included 2 weeks of in-patient care, and four follow-up visits to the NRC subsequently as follows; 1st visit at 7 days, 2nd at 14 days, 3rd at 1 month and 4th at 2 months after discharge.Results: Among 57 children who admitted to NRC females were 30 (52.6%) and males 27 47.4%). 25 among 57 children (43.9%) could sustain weight gain of >5grams/kg/day as per one of the discharge criteria. 13 (52%) were females and 12 (48%) were males. 32(56%) among 57 admitted children to NRC, could achieve <-1SD during entire programmed. 15(46.8%) were females and 17 (53.1%) were males.Conclusions: There was no gender variation in either number of admission or severity of malnutrition at the time of admission or weight gain during NRC programme.
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BACKGROUND: The different modalities used for intraoperative consultation of CNS lesions are squash smear cytology, frozen sections & fluid cytology. The intraoperative diagnosis of squash cytology enables the surgeon to take decision regarding treatment. Squash technique requires small sample size, needs minimal technical equipment, is less expensive and gives better morphological detail. The present study was taken to assess the diagnostic accuracy of intraoperative squash cytology of CNS lesions. MATERIALAND METHODS: It is a prospective study conducted for one and half year in the department of Pathology. All lesions of brain and spinal tract comprised the study group. The stain used for squash cytology was rapid haematoxylin and eosin. The squash diagnosis was compared with gold standard histopathology. RESULTS: Total 96 cases were studied. Male to female ratio was 1.13:1. The overall concordance rate was 89.13% (including both complete and partial agreement cases). Good correlation was noted in diffuse astrocytoma (100%) and least correlation was noted in anaplastic oligodendroglioma (28.5%). CONCLUSION: Squash cytology is a rapid and simple technique for intraoperative diagnosis with high overall accuracy.
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Introduction: Polypharmacy is defined as taking more than five drugs per day, every day. Polypharmacy in elderly is becoming more common because of increased number of chronic diseases with which an elderly person suffers given the longer life expectancy in modern times. The major concern about polypharmacy in elderly is prescription cascade. Drug interaction and adverse drug reactions are misinterpreted and misdiagnosed as another health problem. This will lead to one more prescription. Quality of life of an elderly person is compromised with polypharmacy though it prolongs life expectancy. Method: Questionnaire based cross sectional study conducted on both urban and ruralpopulation. Institutional ethics committee permission has been taken. Oral consent has been taken from the subjects and only their information has been used in this study.Subjects aged more than 60 years have been considered for the study. Bed ridden patients, hospitalized patients and elderly people with acute illness were excluded from the study. Results: Data was collected from 134 subjects. Number of subjects: urban participants were 64 and rural participants were 70. Male and female were included. Prevalence of polypharmacy observed in this study was 40% in urban participants and 23% in rural participants. It was observed that, among elderly participants on polypharmacy 75% faced adverse drug reactions and 60% were subjected to prescription cascade. Among the elderly participants taking less than 5 drugs per day, 50% faced adverse drug reactions and 12% were subjected to prescription cascade. Discussion: Adverse drug reactions and prescription cascade are main complications of polypharmacy in elderly people. Prescription review, counseling, life style modification and carefully supervised deprescription are some of the available solutions to solve the complications due to polypharmacy
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Myroides is a non-fermentative, Gram-negative rod-like bacteria. It is a rare opportunistic pathogen which has been reported to cause many serious infections. Management of infections caused by Myroides can be challenging due to its high resistance to most antibiotics. We report three cases of urinary tract infection (UTI) due to Myroides species in patients with diabetes mellitus Type II. Myroides spp. isolated were resistant to all the antibiotics tested: Amoxicillin-clavulanic acid, piperacillin-tazobactam, cefepime, ceftriaxone-cefoperazone sulbactam, amikacin, gentamicin, imipenem, meropenem, ciprofloxacin, colistin, tigecycline, and co-trimoxazole. Two strains were sensitive to minocycline (minimum inhibitory concentration <1 μg/mL). Two patients had Foley’s catheter in place and one patient had urinary retention at the time of diagnosis. The infection in two cases was nosocomial, whereas one case appeared to have a community-acquired infection with Myroides. Clinicians should consider the possibility of Myroides as a pathogen in UTI in diabetic patients, especially in nosocomial settings