COVID-19 vaccine hesitancy in KwaZulu-Natal, South Africa: A survey of unvaccinated adults

Background: Concerns and misconceptions surrounding coronavirus disease 2019 (COVID-19) vaccines may account for vaccine hesitancy and low uptake. Aim: To determine prevalence of COVID-19 vaccine hesitancy, vaccine-related misconceptions, and predictors of vaccine hesitancy among South Africans. Setting: Community setting in five districts in KwaZulu- Natal province. Methods: Between August 20, 2021, and September 27, 2021, we conducted a cross-sectional survey, interviewing 300 unvaccinated adults amid the national vaccination campaign. Predictors of hesitancy were identified through multivariable logistic regression analysis. Results: Participants had a median age of 29 years (IQR: 23­39), 86.7% were Black African, 63.2% were male, 53.3% resided in rural communities, and 59.3% (95% CI: 53.8% ­ 64.9%) were classified as vaccine hesitant. The primary reason for not vaccinating was a lack of trust in the vaccine (62.1%). Factors associated with reduced vaccine hesitancy included age (participants aged 35­49 years: OR: 0.28, 95% CI: 0.18­0.64, p = 0.003; participants over 50 years: OR: 0.18, 95% CI: 0.07­0.47, p = 0.0004), previous COVID-19 infection (OR: 0.31, 95% CI: 0.11­0.87, p = 0.03), and receiving vaccine information from healthcare workers (OR: 0.32, 95% CI: 0.10­1.0, p = 0.05). Unemployed (OR: 2.14, 95% CI: 1.1­4.2, p = 0.03) and self-employed individuals (OR: 2.98, 95% CI: 1.27­7.02, p = 0.01) were more likely to be vaccine hesitant. Conclusion: COVID-19 vaccine hesitancy rates are high in KwaZulu-Natal. Uptake could be enhanced by healthcare workers leading information campaigns with messages targeting younger individuals, the unemployed, and the self-employed. Contribution: This survey provides evidence to improve COVID-19 vaccination uptake in South Africa.

Assessing clinical and molecular outcomes of prophylactic thermal pulsation therapy on ocular surface health following refractive surgery

Purpose: To study ocular surface signs, symptoms, and tear film composition following prophylactic thermal pulsation therapy (TPT) prior to refractive surgery, and to compare these outcomes with those who underwent TPT after refractive surgery. Methods: Patients with mild?to?moderate evaporative dry eye disease (DED) and/or meibomian gland dysfunction (MGD) undergoing refractive surgery were included. Group 1 patients received TPT (LipiFlow) prior to laser?assisted in situ keratomileusis (LASIK; n = 32, 64 eyes), and Group 2 patients received TPT three months after LASIK (n = 27, 52 eyes). Ocular Surface Disease Index (OSDI) score, Schirmer’s test (ST1, ST2), Tear Breakup Time (TBUT), meibography, and tear fluid were obtained preoperatively and at three months postoperatively in Groups 1 and 2. Additional postoperative evaluation was performed three months after TPT in Group 2. Tear soluble factor profile was measured by multiplex enzyme?linked immunosorbent assay (ELISA) using flow cytometry. Results: Postoperative OSDI score was significantly lower and TBUT was significantly higher when compared with matched preoperative values of Group 1 participants. On the other hand, the postoperative OSDI score was significantly higher and TBUT significantly lower when compared with matched preoperative values of Group 2 participants. TPT significantly reduced the postoperative elevation in OSDI and significantly reduced the postoperative reduction in TBUT in Group 2 participants. Tear Matrix metalloproteinase?9/ Tissue inhibitor matrix metalloproteinase 1 (MMP?9/TIMP1) ratio was significantly higher, postoperatively, when compared with matched preoperative levels in Group 2. However, MMP9/TIMP1 ratio remained unaltered in Group 1 participants. Conclusion: TPT prior to refractive surgery improved postsurgical ocular surface signs and symptoms and reduced tear inflammatory factors, thereby suggesting the plausibility of reduced post?refractive surgery DED in patients.

COVID-19 progression towards ARDS: a genome wide study reveals host factors underlying critical COVID-19

Coronavirus disease 2019 (COVID-19) is a viral infection produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus epidemic, which was declared a global pandemic in March 2020. The World Health Organization has recorded around 43.3 billion cases and 59.4 million casualties to date, posing a severe threat to global health. Severe COVID-19 indicates viral pneumonia caused by the SARS-CoV-2 infections, which can induce fatal consequences, including acute respiratory distress syndrome (ARDS). The purpose of this research is to better understand the COVID-19 and ARDS pathways, as well as to find targeted single nucleotide polymorphism. To accomplish this, we retrieved over 100 patients’ samples from the Sequence Read Archive, National Center for Biotechnology Information. These sequences were processed through the Galaxy server next generation sequencing pipeline for variant analysis and then visualized in the Integrative Genomics Viewer, and performed statistical analysis using t-tests and Bonferroni correction, where six major genes were identified as DNAH7, CLUAP1, PPA2, PAPSS1, TLR4, and IFITM3. Furthermore, a complete understanding of the genomes of COVID-19-related ARDS will aid in the early identification and treatment of target proteins. Finally, the discovery of novel therapeutics based on discovered proteins can assist to slow the progression of ARDS and lower fatality rates.

Inhaled iloprost as an add-on therapy for advanced pulmonary arterial hypertension: An Indian perspective

BACKGROUND Pulmonary arterial hypertension (PAH) is a progressive disease with high morbidity and mortality. Risk stratification and initiation of dual or triple combination therapy has a better clinical response, especially in high-risk patients. Unfortunately, prostacyclin analogues are not marketed in India; hence, the use of these medications is limited. We report the benefits and difficulties of using iloprost inhalation in patients with advanced PAH in India. METHODS In this prospective observational study, we included patients with group 1 PAH. Inhaled iloprost was initiated as an add-on therapy for patients who had clinical, echocardiographic or laboratory deterioration on dual oral medications. Patients with clinical instability were excluded. All patients underwent thorough clinical evaluation, detailed echocardiogram and laboratory investigations. Patients were started on inhaled iloprost 2.5 ?g six times daily and closely followed up. The dose was escalated if necessary. On follow-up, clinical echocardiographic and laboratory evaluation was done on all patients. RESULTS Fourteen patients (11 women) with a median age of 32 years (2–66 years) with group 1 PAH were started on inhaled iloprost as an add-on therapy. Improvement in clinical parameters, WHO functional class, echocardiographic-derived right ventricular function, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were observed in 10 of 14 patients. A median increase of 31% (4.2, 106%) in the distance travelled during 6-minute walk test, a median increase of 45% (–20, 120%) in right ventricular fractional area change, a median increase of 27% (–16.7, 60%) in tricuspid annular peak systolic excursion and a median decrease of 36.7% (–69.6, 17.2%) in NT-pro-BNP levels were observed after initiation of medication. Three patients had progression of symptoms and were then referred for lung/heart–lung transplant. One patient developed progression of symptoms after an excellent initial response and transitioned to subcutaneous treprostinil. Improvement in clinical, echocardiographic and laboratory features allowed us to successfully perform surgical Potts shunt in 2 patients. The medications were well tolerated with minimal and transient side-effects. There were no deaths. CONCLUSION Inhaled iloprost can be used with acceptable benefits and minimal side-effects in patients with PAH.

Survival outcomes with 12 weeks of adjuvant or neoadjuvant trastuzumab in breast cancer

Background: There is limited access to 1 year of adjuvant trastuzumab in resource-constrained settings. Most randomized studies have failed to prove non-inferiority of shorter durations of adjuvant trastuzumab compared to 1 year However, shorter durations are often used when 1 year is not financially viable. We report the outcomes with 12 weeks of trastuzumab administered as part of curative-intent treatment. Methods: This is a retrospective analysis of patients treated at Tata Memorial Centre, Mumbai, a tertiary care cancer center in India. Patients with human epidermal growth factor receptor (HER2)-positive early or locally advanced breast cancer who received 12 weeks of adjuvant or neoadjuvant trastuzumab with paclitaxel and four cycles of an anthracycline-based regimen in either sequence, through a patient assistance program between January 2011 and December 2012, were analyzed for disease-free survival (DFS), overall survival (OS), and toxicity. Results: A total of 102 patients were analyzed with a data cutoff in September 2019. The median follow-up was 72 months (range 6–90 months), the median age was 46 (24–65) years, 51 (50%) were postmenopausal, 37 (36%) were hormone receptor-positive, and 61 (60%) had stage-III disease. There were 37 DFS events and 26 had OS events. The 5-year DFS was 66% (95% Confidence Interval [CI] 56–75%) and the OS was 76% (95% CI 67–85%), respectively. Cardiac dysfunction developed in 11 (10.7%) patients. Conclusion: The use of neoadjuvant or adjuvant 12-week trastuzumab-paclitaxel in sequence with four anthracycline-based regimens resulted in acceptable long-term outcomes in a group of patients, most of whom had advanced-stage nonmetastatic breast cancer.

Access to HER2?targeted therapy at a tertiary care center in India: An evolution

Background:In a previous retrospective audit from our institution we reported that patients had limited access to HER2-targeted therapy due to financial constraints. Subsequently, the advent of biosimilar versions of trastuzumab and philanthropic support has potentially changed this situation. Herein, we reanalyzed and reported access to HER2-targeted therapy in a more recent cohort of patients. Methods: Medical records of new breast cancer patients registered in one calendar year were retrospectively reviewed, supplemented by online pharmacy data to extract information on receptor status, use of HER2-targeted therapy, and other relevant variables. Since not all HER2 immunohistochemistry (IHC) 2+ tumors underwent fluorescent in-situ hybridization (FISH) testing, we estimated the probable HER2 amplified from this group based on a FISH amplified fraction in those HER2 2+ tumors who did undergo FISH. Results: Between January 2016 and December 2016, 4717 new BC patients were registered at our institution, of whom 729 (20.04%) had HER2 IHC 3+ tumors while 641 (17.62%) had HER2 IHC 2+ tumors. The final number of HER2 overexpressing/amplified tumors was estimated to be 928 (729 HER2 IHC 3+, 105 known FISH amplified, and 94 estimated FISH amplified), of whom 831 received treatment at our institution. Overall 474 (57.03%, 95% confidence interval [CI] 53.6–60.4) of these 831 patients received trastuzumab for durations ranging from 12 weeks to 12 months in the (neo)adjuvant setting or other durations in metastatic setting compared to 8.61% (95% CI 6.2–11.6) usage of HER2-targeted therapy in the 2008 cohort. Conclusion: Access to HER2-targeted therapy has substantially increased among patients treated at a public hospital in the past decade, likely due to the advent of biosimilars, the use of shorter duration adjuvant regimens, and philanthropic support. However, further efforts are required to achieve universal access to this potentially life-saving treatment.

Comparative physiological and histological investigations on resistant and susceptible pomegranate genotypes infected with Xanthomonas axonopodis pv. Punicae

Xanthomonas axonopodis pv. punicae (Xap) is a bacterial pathogen wreaking havoc in pomegranate cultivation. It causes bacterial blight disease dwindling yield and making fruit unfit for consumption. Physiological and histological investigations during host-pathogen interaction are prerequisite to assess the onset of defense mechanism in plants. Therefore, we tried to compare the pomegranate resistant (IC 318734) and highly susceptible (Ruby) genotypes challenged with Xap. The bacterial suspension containing Xap cells of 0.3 OD600 (~106 to 107CFU mL?1) was used for challenge inoculation. Uniformly grown resistant and highly susceptible plants were selected, the surface of leaves was pricked and spray-inoculated with bacterial suspension using native strain IIHR1 (NCBI Gen Bank ID: KT 222897). Simultaneously, the control plants were also sprayed with only distilled water and observed. A total of three replications with five plants per replication were maintained and evaluated under completely randomized design. Physiological investigations were recorded using Portable photosynthesis system (LCpro+, ADC BioScientific limited, UK) for one cycle of disease progression viz., 0, 1, 5, 10, 15 and 20 days after bacterial spray inoculation (DAI). Significant changes in gas exchange parameters were witnessed on pathogen inoculation. Higher reduction in mean percent change of photosynthetic and transpiration rate, instantaneous water use efficiency, internal CO2 content, stomatal conductance and relative water content were noticed in highly susceptible genotype than resistant one. On contrary, an increased percent mean change of intrinsic water use efficiency, carboxylation capacity and lignin was documented in resistant genotype. Relative injury caused due to bacterial infection was found high in highly susceptible genotype than resistant one. Histological investigations in highly susceptible and resistant genotype were studied on 20th day of Xap inoculation using Scanning Electron Microscopy. Highly susceptible genotype exhibited maximum deformed cells, tissues and other visible abnormalities upon Xap inoculation. Thus, this study forms a basis for effective disease management and breeding programmes in pomegranate.

A Study of ICU Outcome and Long-Term Quality of Life in ICU Survivors in Central India

Background: Patient surviving in the ICU may have to undergo physical and mental sufferings after the discharge from the ICU. Health Related Quality of Life (HRQoL) of such patients post discharge has been addressed mostly in developed countries, however in developing countries the data is insufficient. Thus, in this study we have aimed to assessed the HRQoL of such patients. Objectives: To evaluate the HRQoL of critically ill survivors in Central India Methodology: It was a prospective, observational study conducted on the 82 patients of an ICU of central India. APACHE II and SOFA score were calculated after the admission of the patient and a Short Form Health Survey (SF -36) was conducted at 1 st , 3 rd and 6 th month by telephonic interview after the discharge of the patient. Result: APACHEII and SOFA score was found significantly associated with the mortality outcome of the patient (p<0.0001). HRQOL improved in survivor patients progressively after hospital discharge and was maximum at 6 months (p<0.0001). Conclusion: The APACHE II score and SOFA score were able to predict the mortality of the patients, and the HRQOL was improved significantly over a period of 6 months post discharge.

CORONAVIRUS DISEASE ASSOCIATED MUCORMYCOSIS FROM A TERTIARY CARE HOSPITAL

BACKGROUND: Coronavirus disease remains a health concern with recent rise of opportunistic infections especially mucormycosis in COVID-19 patients. Mucormycosis is well known to infect patients with diabetes mellitus, malignancy, chemotherapy, and other immunocompromised conditions. The treatment of COVID19 largely remains systemic steroids and other immunomodulators that add to the risk of invasive fungal infection. METHODOLOGY: We included patients who presented with diagnosed mucormycosis by culture in month May and June 2021 and who were previously treated for COVID-19 in last three months of presentation (recent COVID-19) or currently being treated for COVID19 (active COVID-19). Information regarding possible risk factors, like diabetes mellitus, steroid intake, hypertension, lung disease, ICU stay and requirement of oxygen support were collected .RESULTS Overall, 41 cases of mucormycosis in people with COVID-19 have been reported. Mucormycosis was predominantly seen in 30 males (73.17%). Pre-existing diabetes mellitus (DM) was present in 31 patients (75.6%) of cases. Corticosteroid intake for the treatment of COVID-19 was recorded in 28 patients (68.29%) of cases. Pre-existing lung disease was in 6 patient ( 14.63%), ICU stay due to COVID was in 7 patient (17.07%) , Pre-existing hypertension was in 12 patient (29.26 )and oxygen support at the time of COVID in 18 patient (43.9%) CONCLUSION: An unholy trinity of diabetes, rampant use of corticosteroid in a background of COVID-19 appears to increase mucormycosis. All efforts should be made to maintain optimal glucose and only judicious use of corticosteroids in patients with COVID-19.

Remineralization efficacy of nonfluoride versus herbal-based pediatric dentifrice in demineralized primary teeth

Background: Dental caries is one of the most prevalent posteruptive bacterial infections worldwide, characterized by a progressive demineralization process that affects the mineralized dental tissues. Although the decline of dental caries prevalence can be attributed to the widespread use of dentifrices that contain fluoride, yet there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Yet, there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Aim: The aim of this study was to evaluate and compare the remineralizing effect of nonfluoride-based and herbal-based pediatric dentifrice in demineralized primary teeth with an ideal in vitro method of pH cycling and evaluating the values under Polarized Light Microscope (Olympus BX43) using image analysis software (ProgRes, Speed XT core3). Materials and Methods: A total of 30 tooth samples were collected and placed in the demineralizing solution for 96 h to produce a demineralized lesion of approximately 100 ?m, and then cut longitudinally into 60 sections that were randomly assigned to two groups with 27 samples each, Group A – nonfluoride-based dentifrice (Mee Mee®), Group B – herbal-based dentifrice (Mamaearth™), after which they were subjected to pH cycling for 7 days along with dentifrice slurry preparation. The sections were evaluated under the polarizing light microscopy for remineralizing efficacy. The lesion depth was measured and tabulated to be sent for statistical analysis. Results: The mean demineralization value for nonfluoride and herbal-based dentifrice groups were 7.8730 ?m and 28.3174 ?m, respectively. Hence, it can be inferred that since lesion depth measured was lesser in nonfluoride than herbal-based dentifrice, remineralization has occurred in the nonfluoride-based dentifrice group. Conclusion: Nonfluoride-based dentifrice showed significant results in remineralizing the demineralized lesion, while herbal-based dentifrice showed poor efficiency in remineralizing the demineralized lesion.

Comparative Study of Bisphenol A Release from Various Orthodontic Adhesive and Myofunctional Appliances - An In-Vitro Study.

We wanted to compare & evaluate, regularly used orthodontic materials including adhesives & myofunctional appliances for release of Bisphenol A. MethodsBisphenol - A release was assessed from two materials - orthodontic adhesive resin and heat cure acrylic resin [twin block]. Based on materials used, a total of 40 samples was assigned into two groups; Group A and Group B, each containing 20 samples. For Group A [orthodontic adhesive resin], metal brackets were bonded to 20 bicuspid teeth using adhesive resin and cured with LED light. For group B, 20 twin block appliances made from heat cured acrylic resin were used. Then, samples from both the groups were immersed in artificial saliva and then subjecting to thermal treatment from hot (60 ˚C) to cold (4 ˚C) temperatures, followed by shaking for 5 minutes. The samples were again shaken at (37 ˚C) and 1.0-mL aliquots were removed at 24 hours and 7 days after insertion. Gas chromatography / mass spectroscopy was used for the evaluation of leaching of bisphenol A from artificial saliva. ResultsSignificant results were found after 24 hours of analysis in both groups where 70 % samples from group A had bisphenol A release, whereas 80 % samples from group B had bisphenol A release. However, a non-significant result was obtained after 7 days where 20 % samples from group A had bisphenol A release whereas 60% samples from group B had bisphenol A release. The Heat cure acrylic group showed higher Bisphenol - A than that of orthodontic adhesive resin group. It was seen that the levels were lower than the reference dose which were calculated for daily consumption but were statistically significant. CoclusionsBisphenol A is considered as an endocrine disruptor. Degradation of orthodontic materials results in leaching of Bisphenol-A into oral cavity which is a clinical concern.

To Evaluate the Shear Bond Strength of Bondable Molar Tubes by Two Enamel Conditioning Techniques

Shear Bond Strength (SBS) is considered to be the main factor in the evolution of bonding. The bracket bond strength should withstand the forces during the orthodontic tooth movement. The commonly used technique by Orthodontists is to attach the brackets to the enamel surface is the acid-etch bonding technique along with 37 % phosphoric acid as etchant. With time, a new technique emerged in orthodontics which is used before bonding for the primary preparation of teeth as well as for the purpose of increasing bond strength known as Sandblasting. This study was done to compare the shear bond strength of acid etching and air abrasion technique used in orthodontic practice. MethodsA total of 100 extracted human first molar teeth were selected and segregated into 4 groups of 25 teeth. Group I: bonding without enamel preparation, Group II: using acid etching with 37 % phosphoric acid, Group III - sandblasting with 50 μ aluminium oxide, Group IV - sandblasting with 100 μ aluminium oxide. These 100 samples were then subjected to the measurement of the shear bond strength with an Instron machine and was measured in Newtons. ResultsGroup 1 showed a mean shear bond strength of 7.21 ± 0.29; for group II it was 7.77 ± 0.53; for group III it was 8.3 ± 0.3 and for group IV it was 10.04 ± 0.45. Groups 2 and 3 and groups 2 and 4 showed statistically significant difference. Shear bond strengths of both the groups 3 and 4 showed highly statistically significant difference. Conclusions100 µ aluminium oxide group showed the highest Shear Bond Strength. On inter group comparison, sandblasting with aluminium oxide was found to have better shear bond strength compared to conventional acid etching techniques.

Drug utilization pattern in an intensive care unit of a teaching hospital in South India

Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated. About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively. Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay. Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics.Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated. About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively.Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay. Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics. Keywords: Antibiotics, Daily defined doses, Drug utilization, Intensive care unit

Midline Neck Swelling Mimicking Thyroglossal Cyst: Report Of An Uncommon Presentation Of Cysticercous Infestatation

Cysticercosis in humans is caused by an infestation by larvae of Taenia solium. The neck is a rare site of the infestation. Here, we present the case of cysticercosis situated in the neck of a 12-years-old child. The midline neck swelling present in the child since 2 years mimicked thyroglossal cyst, both clinically and radiologically. There were no other systemic complaints. Fine Needle Aspiration Cytology (FNAC) of the swelling was done for reaching the final diagnosis. Hence, in all inflammatory/cystic lesions, particularly in endemic areas, the possibility of cysticercosis should be taken into consideration irrespective of age, location, and the size of the lesion.

A Prospective Study on Prescription Analysis of Anaemic Condition with Pharmacist Intervention at Tertiary Care Hospital

As per the World Health Organization (WHO), anaemia is defined as a condition in which the number of red blood cells gets decreased which leads to decreased levels of haemoglobin (Hb). The study provides an overview of the prescription analysis of anemic condition with pharmacist intervention in tertiary care hospital. This study was conducted in the duration of 6 months (August 2017-January 2018) which includes patients of different conditions based on their range of haemoglobin categorized according to age, gender, and social habits. Our results imply that initially patients were found to be anemic at the time of admission but the anemic condition is not treated as they concentrated more on treating the pathological condition and according to prescription analysis we found that they became more anemic during the treatment process which may be due to their pathological condition such as Chronic kidney disease (CKD), Coronary artery disease (CAD), cancer, Chronic liver disease (CLD) or due to the usage of prescribed drugs like antibiotics, analgesics, NSAID’s. The observed disease conditions and the drugs may also show significance in the occurrence of anaemia and in most of the prescriptions appropriate treatment for anaemia was not provided during the hospital stay which includes our intervention regarding the study. As per the literature females were prone to be anemic, surprisingly in our hospital study we have found that males were found to be anemic in the age group of 25-64 years in mild anemic category (10-14 g/dl), whereas in the moderate (8-10 g/dl), severe (6.5-8 g/ dl) and life-threatening (>6.5 g/dl), female cases were more.

A community based cross sectional study to assess the prevalence and pattern of co- morbidities among known type 2 diabetic patients of urban slum of North Karnataka, India

Background: India is the second largest home for type 2 diabetes mellitus patients. The chronic nature of disease along with high prevalence of “co morbidities” make its management tricky. Hence this multiple health conditions lead to faster decline in quality of health, which poses a great concern on the health-care delivery system as well as on patients’ pocket. The objective of the study was to assess the prevalence of co-morbidities among known type 2 diabetic patients residing in urban slums of the field practice area of a Medical College in North Karnataka.Methods: It was a cross-sectional study done in urban slums among type 2 diabetics, sample size was calculated to be 155. Semi-structured questionnaire was used to collect information regarding socio-demographic data and history of co-morbidities; height, weight and blood-pressure were measured using standard criteria. HbA1C level was checked using single use HbA1C Now+ kit by BHR diagnostics.Results: Out of 158 type 2 diabetics in our study, 86.7% had presence of one or the other co-morbidity. 61.9% and 51.5% of male and female participants had HbA1c levels >7.0 respectively, this was statistically significant. HbA1c level and BMI were significantly associated with presence of co-morbidities in our study population.Conclusions: Results show high prevalence of co-morbidities among type 2 diabetics. Hypertension, obesity, depression and neuropathy are the commonest co-morbidities. So, prevention of such co-existing diseases improves the quality of life of the sufferers.

Assessment of seven year long results of kidney biopsy

Background: Kidney biopsy is a standard kidney biopsy tissue analysis to look at histopathological diagnosis of various kidney diseases. Previous studies have shown kidney biopsy findings mostly in pediatric population, and there is no much data on impact of various sized biopsy guns on biopsy outcome. This study includes all age group and describes impact of usage of various sized biopsy guns on biopsy outcome.Methods: A retrospective study was done on all patients who underwent kidney biopsy over 7 years.Results: Among total number of 386 patients, 55.2% were males. The commonest indication for biopsy was nephrotic syndrome. The commonest histopathological pattern was Lupus nephritis. Renal failure (RF) was found in 157 (40.7%) of which it improved in 78 (20.2%). Amongst RF patients, the commonest was IgA nephropathy. Change of needle size from 18G to 16G showed increased morbidity in the form of complications but also increased diagnostic yield. Biopsy related complications were noted in 0.8%-1.8%.Conclusions: The commonest indication for kidney biopsy was nephrotic syndrome. The commonest histopathological pattern was Lupus nephritis. Amongst RF patients, the commonest entity was IgA nephropathy. Change of needle size from thinner to thicker showed increased complications but also increased diagnostic yield too.

Early Neurodevelopmental Outcomes After Corrective Cardiac Surgery In Infants

Objective: To assess neurodevelopmental status in Indian infantsundergoing corrective surgery for congenital heart disease (CHD)and to analyze factors associated with neurodevelopmental delay.Design : Cross-sectional study.Setting: Tertiary-care pediatric cardiology facility.Participants: Consecutive infants undergoing corrective surgeryfor CHD (January 2013 –December 2014). Palliative procedures,and patients with known genetic syndromes were excluded.Main outcome measures: Neurodevelopmental evaluation 3months, and one year after surgery using DevelopmentalAssessment Scales for Indian Infants (DASII); scores werecategorized as delayed if ?70.Results: Of the 162 children enrolled, delayed PDI and MDIscores were observed in 33.5% and 19.6% of patients at 3months, respectively; this reduced to 14.5 % on 1-year follow-up.On multivariate analysis, delayed PDI outcome at one year waspredicted by early term birth and one-year postoperative headcircumference Z-score <–2. Delayed MDI was associated withhigher mean perfusion pressure on cardiopulmonary bypass.Cardiac diagnosis and peri-operative factors did not impactneurodevelopmental outcomes.Conclusions: Neurodevelopmental status is delayed in 14.5% ofinfants one year after corrective infant heart surgery

Non-pharmacological Interventions for Pediatric Cancer Patients: A Comparative Review and Emerging Needs in India

Context: Evidence-based research on psycho-oncology in last three decades lays emphasis upon the critical role of psychologicalservices for better illness adjustment, improved quality of life, reduced distress and cognitive problems among the rapidly increasingpediatric cancer population.Justification: This review aims to summarize the evidence-based psychological interventions in childhood cancer over the two decadesand addresses the wide gap that existed between intervention studies worldwide and India, thus highlighting the need for research andappropriate services.Evidence acquisition: We searched electronic databases such as MedLine, PubMed, PsycINFO, and Google Scholar. Key searchterms were pediatric cancer, psycho-oncology, children with cancer + psychological intervention, or multimodal treatment, psychotherapy,cognitive training, behavioral, social skills+ feasibility study, pilot, randomized controlled trial, case study, systematic reviews.Results: 28 full papers published between 1996 to 2016, including survivors and under-treatment children below 18 years, werereviewed. Various types of key interventions were psychosocial, physical, cognitive behavioral, cognitive, music art therapy and playtherapy. Generally, intervention settings were either hospital or home, and were designed to promote psychological well-being.Psychological interventions were more in customised formats in these studies. A generic intervention module was not available forreplication.Conclusion: Development of culture-specific generic intervention module and using the same in randomized control studies with largereffect size are needed in India for larger coverage of patients.

Breast cancer in a tertiary cancer center in India - An audit, with outcome analysis

Background: Surgery is the mainstay in the management of thyroid cancer. Surgical outcomes need to be tempered against the excellent prognosis of the disease. Aims: This study aims to study the surgical outcomes including the 30-day morbidity and 5-year survival of thyroid cancer patients. Settings and Design: Retrospective analysis of a prospectively maintained surgical database in a tertiary cancer center in India. Materials and Methods: We analyzed 221 surgically treated patients in the year 2012. Statistical Analysis: Used IBM SPSS 24.0 (Armonk, NY) with p < 0.05. Results: The median age was 40 years with predominantly papillary thyroid carcinoma (55%). Localized disease in 47% of cases, locoregional disease in 42.5% and distant metastasis in 10.2% of cases at presentation was noted. Treatment naïve patients were 71% and revision surgeries were done in 29% patients. Extended thyroidectomy constituted 11% of the surgeries. Temporary hypocalcemia was seen in 30.8% of patients, 5% requiring intravenous calcium supplementation. Vocal cord palsy as per nerve at risk and chyle leak were seen in 4.5% and 3.1%, respectively. Aggressive histology, extended thyroidectomy, and inadvertent parathyroidectomy were significant factors associated with complications. Five year estimated overall survival with median follow-up of 50 months was 98%, and event-free survival was 84.8%. Advanced age, distant metastasis at presentation and aggressive histology connoted poor outcomes. Conclusion: Thyroid cancer, irrespective of the extent of disease, has good prognosis. Aggressive histology, the extent of thyroid surgery, distant metastasis and age are important factors, which should be factored in the algorithm of thyroid cancer management.