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Purpose: To study the epidemiological pattern, prevalence, types, and correlates of age?related cataracts in a tertiary care center in central India. Methods: This hospital?based single?center cross?sectional study was conducted on 2,621 patients diagnosed with cataracts for 3 years. Data pertaining to demography, socio?economic profile, cataract grading, cataract types, and associated risk factors were evaluated. Statistical analysis using unadjusted odds ratio (OR) and multivariate logistic regression was performed, with P-value <0.05 considered significant with the power of the study being 95%. Results: The commonest age group affected was 60–79 years, closely followed by the 40–59 years age group. The prevalence of nuclear sclerosis (NS), cortical (CC), and posterior subcapsular cataract (PSC) was found to be 65.2% (3,418), 24.6% (1,289), and 43.4% (2,276), respectively. Among mixed cataracts, (NS + PSC) had the highest prevalence of 39.8%. Smokers were found to have 1.17 times higher odds of developing NS than non?smokers. Diabetics had 1.12 times higher odds of developing NS cataracts and 1.04 times higher odds of developing CC. Patients with hypertension showed 1.27 times higher odds of developing NS and 1.32 times higher odds of developing CC. Conclusion: The prevalence of cataracts in the pre?senile age group (<60 years) was found to have increased significantly (35.7%). A higher prevalence of PSC (43.4%) was found in studied subjects, as compared to the data of previous studies. Smoking, diabetes, and hypertension were found to have a positive association with a higher prevalence of cataracts.
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Siddhars said about various diseases and the treatment methods with herbs, minerals and animal products. In Siddha literatures viral fevers can be compared to Vatha Kapha Suram and therefore decoction for this Suram is taken from classical Siddha text book and the ingredients are searched for pharmacological activity and toxicity study from 118 published journal papers from Pubmed, Scopus, Google Scholar, Research Gate and Science Direct. Collected data is entered in MS excel and analysed using RFC score. All together there are 51 pharmacological activities are published for these nine ingredients. In which Anti-inflammatory has RFC=1, other properties like antipyretic, anti-tussive, bronchodialator, anti-asthmatic, analgesic, neuro-regenerative, neuroprotective, anti-diarrhoeal, anti-emetic, neuroprotective, analgesic, sedative has more than 0.55 RFC score. More than this cardioprotective, renoprotective, hepatoprotective, and other protective properties are present in more than 50% of ingredients. In toxicity studies no toxic effects are seen in in vivo studies for the ingredients The Suvai, Thanmai, Pirivu, in Siddha aspect, of these ingredients can highly reduces Vatha and Kapha disorders. Therefore, the decoction shows significant pharmacological activity for the sign and symptoms of viral infections.
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Type 2 Diabetes Mellitus (T2DM) is a highly prevalent cardiometabolic disorder in India and is further projected to rise (10.4% by 2030). In newly diagnosed patients, maintaining HbA1c 6.5-7.0% and minimizing glycaemic exposure, particularly during the first year following diagnosis, may be crucial for preventing complications. Early treatment initiation with a synergistic combination of vildagliptin and metformin is one of the many possible combinations to manage type 2 diabetes mellitus. In view of emerging clinical evidence on early initiation of combination therapy than monotherapy with metformin, there is a need for expert consensus on the use of the current approved Fixed Dose Combination (FDC) of Metformin SR + Vildagliptin IR in newly diagnosed diabetic patients. Experts framed final consensus statements based on available scientiûc evidence, experience and collective clinical judgment from practical experience this FDC.
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Objectives: Amblyopia is the most common cause of preventable vision impairment in children. This study tried to evaluate the cost-effectiveness of photoscreeners in identifying refractive errors making children at risk of amblyopia. Materials and Methods: This was designed as a prospective, open?label, randomized controlled study to compare the cost?effectiveness of photoscreeners (2WIN Adaptica and Plusoptix) versus autorefractor and Mohindra retinoscopy to identify the at?risk amblyopia. This study was conducted from October 2018 to December 2018 in coordination with Nanna Kannu school screening project and children in the age group of 5–11 years were included in the study. The photoscreening was done by lay screeners. Asupervising ophthalmologist collated all data. Cost-effectiveness was calculated for the individual instruments and compared. The average time is taken for each instrument to record the refractive error was calculated and compared with the Mohindra retinoscopy. Results: Number of children included in this study was 2910. The mean age of the children was 7.82 + 0.65 years. The mean time taken for 2WIN Adaptica was 6 sec, Topcon –10 s, and Plusoptix –4 s. Plusoptix showed the minimal time for screening a child when compared to all other methods. The Plusoptix and 2WIN Adaptica were shown to be cost?effective when compared to Mohindra retinoscopy (P < 0.05). Conclusion: Photoscreening using Plusoptix and 2WIN Adaptica with lay screeners was < seven times the cost incurred and five times faster than the trained optometrists using either autorefractor or Mohindra retinoscopy and thus more cost?effective in screening a large number of young children with at-risk amblyopia at the community level.
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Congregate work settings are at increased risk for SARS?CoV?2 transmission and predispose to super spreader events. We investigated a COVID?19 outbreak among security guards to identify the risk factors and propose recommendations. We defined a COVID?19 case as a laboratory?confirmed reverse transcription polymerase chain reaction?positive case. We traced the contacts actively and described the cases by time, place, and person. We conducted a case–control study and collected data on potential exposures. We identified 20 (27%) COVID?19 cases among 75 security guards. Among the cases, 17 (85%) were male and 12 (60%) were symptomatic. We recruited all the 20 COVID?19?confirmed cases and 55 COVID?19?negative controls for the case–control study. SARS?CoV?2 infection was higher among those had high?risk exposure (60%, [12/20]) than who did not (16%, [9/55], adjusted odds ratio = 5.9, 95% confidence interval = 1.6?22.1). Having had high?risk exposure with COVID?19 cases led to COVID?19 outbreak among the security guards. We recommended avoiding the activities predisposed to high?risk exposure.
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Background: A screening program for cervical cancer was established in 2011 in Tamil Nadu. Since the inception of the program, coverage, and dropout of screening has not been analyzed. We conducted a study to describe the referral mechanism in the cervical cancer screening program implemented in Tamil Nadu, to estimate the level of adherence to the referral process by the beneficiaries, and to identify strengths and weaknesses related to the referral mechanism in the program. Methods: This descriptive study was conducted during 2015–2016 in the Tiruchirappalli administrative district of Tamil Nadu. All women aged 30 years and above, who were screened in public health facilities, were the participants. Using a structured form, we collected the data maintained in the registers at the district health administration. We estimated the screening coverage, follow-up evaluation, and dropout rates at different stages of the referral mechanism. We used SPSS and Epi Info software for analysis. Results: Coverage of cervical cancer screening was 4,838(41.6%). We estimated 4,838(41.6%) of screened positives were lost to follow-up for a colposcopy examination. Biopsy samples were obtained from 3425(84%) of those who required a biopsy. Cervical cancer was diagnosed in 159(4.6%) and precancerous lesions in 528(15.4%) women. Conclusion: More than half of the target population was screened in public health facilities. The dropout rate was less than half of those screened at the colposcopy evaluation level. Major pitfalls of the program were human resource issues at referral centers and poor maintenance of meaningful data
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Background: Clinical skills simulation (CSS) is an important tool in teaching and learning. The literature review showed a scarcity of research data regarding the use of CSS,in teaching, especially in dentistry. The use of CSS in dental teaching was found restricted to the use of low fidelity typhodonts fitted to phantom heads used in teaching cavity preparation and crown cutting. Aim: The aim of the study was to determine the efficacy of CSS using standardized patient in teaching behavior management and modification skills to dental undergraduate students. Settings and Design: This double-blinded, randomized controlled trial was undertaken among 3rd year dental undergraduate students, and the study was undertaken at the Department of Pediatric and Preventive Dentistry. Materials and Methods: Fifty, 3rd year BDS students were randomly allotted to simulation and nonsimulation groups. Baseline data regarding their knowledge in the behavior management of child patients were assessed. Simulation group was further divided into group of six students and underwent CSS with standardized patient. Pretest and posttest knowledge regarding behavior management was assessed in the simulation group using questionnaires approved by an expert committee. The results were analyzed to see if there is any improvement in their knowledge after CSS. Students in simulation and nonsimulation groups were assessed for their behavior management skills during patient management, by an independent observer, using a checklist. Statistical Analysis: Mean, standard deviation (SD), and unpaired student t-test were done to assess the baseline knowledge of students who participated in the study. Mean, SD, and paired t-test were used to compare the pretest and posttest score of students who underwent simulation. Mean, SD, and unpaired t-test were used to compare the behavior management skills of both groups of students. Results and Conclusions: The knowledge of students in both groups before the study was comparable with no statistically significant differences. There was a statistically significant improvement in the knowledge of students who underwent CSS regarding behavior management of child patients. The unpaired Student's t-test showed a significant difference in the behavior management skill of dental undergraduate students when treating a child patient. The students who underwent CSS fared better compared to students who were taught behavior management methods by traditional methods only. Clinical skill simulation using standardized patient is an effective adjunct to be used along with traditional method of teaching while teaching behavior management and modification skills to dental undergraduate students.
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Vaginal discharge in prepubertal children is mainly due to hypoestrogenic state of vaginal mucosa making it thin and alkaline leading to mucosal invasion by pathogen. In paediatric case persistent foul smelling, blood stained discharge not responding to medical therapy should arouse suspicion of foreign body. Authors report an interesting case of 2 years old child who presented with persistent vaginal discharge and was found to have a retained foreign body in the vaginaneonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted.
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Background: Prevalence of gestational diabetes mellitus shows wide variation across our country. From the recent studies, it is observed that incidence of gestational diabetes mellitus in antenatal women is increasing globally and India is not an exception from this. Gestational diabetes mellitus should be considered as a serious risk factor for both mother and baby as it affects two generations by having chance of developing diabetes and its related complications in future.Methods: A total of 585 pregnant women with 24 to 28 weeks of gestational age were recruited for the study. The study population was divided into four groups based on the age range; Group I include antenatal women with age <20 years, Group II includes antenatal women of age range 21-24 years, Group III includes antenatal women of age range 25-29 years, and Group IV includes antenatal women of age range ≥30 years.Results: In the present study GDM was diagnosed in 94 women among 585 antenatal women screened for GDM (16.06%). Majority of the studied population are in the age range of 20-29 years (441/585, 75.38%). The mean age of participants was 27.54±3.58 years (range 18-34 years). The prevalence of GDM was higher in the group of women aged ≥30 years (Group IV) followed by ≤20 years (Group I) (23.21% and 15.62% respectively) compared to the groups II and III (14.78% and 13.74% respectively). This observation was found to be statistically significant (p<0.001). Among 585 patients, delivery outcome was 100% successful, all delivered live babies, among them 64 patients delivered babies with macrosomia (11%).Conclusions: The study showed GDM prevalence of 16.06% from the neighboring rural villages attending our teaching hospital.
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Introduction: Distal radius is one of the common fracture sites of the human skeleton. Dorsally displaced distal radius fractures(DRFs) are the most common type of DRF.Materials and Methods: Two matched cohorts of 20 matched patients, one with a displaced dorsal rim fracture >2 mm (Group1), and the other without a dorsal rim fracture (Group 2) were analyzed in this study with volar variable angle locking compressionplate fixation for dorsally unstable DRFs.Results: No significant difference was found between the two groups in overall wrist function or wrist pain. The mean displacementof dorsal rims in Group 1 was 3.0 mm and the mean diameter of the retained articular portion of the dorsal articular wall was2.0 mm. No significant difference was found between the two groups in terms of any radiographic parameters or the arthriticgrading of radiocarpal joints.Conclusion: These results suggest that a displaced dorsal rim fracture does not adversely affect the outcomes after the volarvariable angle locking compression plate fixation of a dorsally displaced DRF, indicating that an additional dorsal approach isunnecessary for reducing a displaced dorsal rim fracture
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Background: Sickle cell disease prevalence is more in central part of India. This study tries to find extent of renal involvement, risk factors and screening tests in sickle cell disease.Methods: Study was Cross sectional observational study. Demographic and clinical findings were recorded. Renal function tests like serum creatinine, blood urea nitrogen, eGFR were studied. Presence of microalbuminuria was checkeed. Ultrasonography abdomen was done to see the texture and corticomedullary differentiation of kidney.Results: Total 143 patients were studied. Out of which, 117 homozygous (SS type), 26 heterozygous (AS type). Majority belonged to school going age group (i.e. 5 to 10 year age group) with male preponderance in homozygous state. Microalbuminuria was more common in crisis state (61.84% in SS pattern and 83.33% in AS pattern) as compared to steady state in both SS and AS pattern patients. Dipstic method detected more proteinuria than heat coagulation suggesting dipstick method superior to heat coagulation test. Low eGFR was common in patients with SS pattern as compared to patients with AS pattern and was significantly associated with microalbuminuria in both steady state and crisis state. Abnormal USG was seen 3.44% in patients with SS pattern. Renal involvement started below 5 years of age and then increases with age, homozygous childrens in crisis state are affected more.Conclusions: Renal involvement is common in sickle cell anemia i.e it is seen in 50% of the patients. Increasing age, male sex and homozygous state were risk factors. Simple test like dipstic method and heat coagulation test can be used as screening test to detect microalbumiburia, with dipstic method being superior. Presence of microalbuminuria can detect early renal involvement in sickle cell disease. This will help in early diagnosis and management of such patients which avoids further renal complications and thus prevents mortality and morbidity.
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Background: Hypertensive disorders of pregnancy is a spectrum of disorder which include chronic hypertension that antedates pregnancy and gestational hypertension or pre-eclampsia that is unique to human pregnancy. It is still a poorly understood condition. The clinical course is progressive and characterized by continuous deterioration that is arrested only by termination of pregnancy. Hence the disease must be detected in early stage and managed appropriately for improved maternal and fetal outcome.Methods: The study consists of 173 antenatal patients of gestational age 28 weeks and above. Study population was divided into two groups, Group 1 consists of 50 antenatal women of normotensive nature served as controls and group 2 consists of 123 antenatal women with confirmed hypertension. Venous blood samples were collected used for the estimation of lactate dehydrogenase enzyme.Results: Out of the total 173 patients 104 women delivered by C-section, 67 by normal vaginal delivery and 2 by assisted breech delivery. Among the women who delivered by caesarean 60 (57.69%) had serum LDH less than 600, 18 (17.30%) had serum LDH between 600 and 800 and 26 (25.00%) had LDH above 800. Among the women who delivered vaginally 61 (91.04%) had LDH less than 600, 1 (1.49%) had LDH between 600 and 800 and 5 (7.46%) had LDH above 800. Only 2 women delivered by assisted breech delivery one with LDH between 600 and 800 and another with S. LDH above 800.Conclusions: The study was done in search of a valuable marker for preeclampsia and Eclampsia which would reflect the severity of the disease and would predict the maternal and fetal outcome. Such markers can help in decision making and can influence the current management protocols in order to achieve a better maternal and perinatal outcome.
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In host–parasite co-evolution, parasites are assumed to have an advantage owing to their shorter generationtime. Evolution of pathogens within the lifetime of a host individual is implicated as a strong selective force inthe evolution of sex and aging in the host. However, this assumption or its testable predictions have not beenexamined empirically. We classified infectious bacteria and viruses into those that can have continued longterm existence on the host body (group 1) versus those that have only a short-term interaction during an activeinfection (group 2). We surveyed the literature for age-specific incidence data about infections from both thegroups. The age trends of the two groups show contrasting patterns. The incidence of infections by all group 1pathogens showed a 2.28- to 28-fold increase in older ages. In group 2, 6 out of the 9 pathogens showed asignificant declining trend in incidence with age. In both groups, there was greater mortality or morbidityamong the infected in the old-age classes. These patterns are better explained by pathogen evolution than byage-related decline in immunity
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Background: A normal Finger Flexion Cascade (FFC) is formed by the fingers of the hand when the hand in a relaxed position. Usually, the fingers of the hand assume a flexed position; gender may influence the normative values of the resting hand due to differences in the anatomical structure of hand and frequency of usage of joints of hand in their respective occupation and habitual activities of daily living. Hence the study aims to find the difference in the FFC between men and women in power grip and nonpower grip occupational activities. Methods: A cross-sectional study was conducted in a mixed population of five hundred active individuals aged between 25 and 40 years belonging to various occupations of industrial work and individuals working with software companies. Individuals who fulfilled the inclusion criteria participated in the study. After completing a questionnaire based on occupation, the subjects were grouped into power grip users and nonpower grip users. The range of motion of the joints of all the fingers, namely, metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of both dominant hand and nondominant hand was measured using universal finger goniometer, and the composite finger flexion was recorded using a geometric ruler. The results were analyzed, and Un-paired T-test was used to compare the FFC between the power grip and the nonpower grip group. Results: The FFC variations in both the hands of male and female subjects in power grip users (PGU) and nonpower grip users(NPGU) were recorded. In the dominant hand, it was found that the DIP joint of 5th digit in female subjects had a greater ROM values than male subjects, but greater ROM values in MCP joints of the hand in males were found. The comparison between the range of values of both groups revealed that the values in the PGU group were more than the NPGU group with a statistical significance of p<0.001. Conclusion: The finger flexion cascade was found to be more closed in female subjects than males in both the dominant and nondominant hands of in the power grip users than in the nonpower grip users.
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Background: Syndrome of inappropriate antidiuretic hormone is an important metabolic complication of perinatal asphyxia. This study aims to study the occurrence of syndrome of inappropriate antidiuretic hormone in different grades of perinatal asphyxia and to find out the correlation of syndrome of inappropriate antidiuretic hormone to gestational age and birth weight in birth asphyxiated babies.Methods: It was a hospital-based cohort study. 50 neonates with different grades of asphyxia were enrolled in the study and 50 controls were taken. Syndrome of inappropriate antidiuretic hormone was diagnosed based on calculated plasma osmolality, serum and urine sodium, urine specific gravity and analyzed with different grades of birth asphyxia and birthweight and gestation age.Results: The occurrence of SIADH in birth asphyxiated babies was 26% and none of the babies in control group developed SIADH. The occurrence was more in the severely asphyxiated babies (53.8%), followed by moderate (30.8%) and then mildly asphyxiated babies (15.4%). Hyponatremia was seen in 26% of birth asphyxiated babies and can be used as a marker of SIADH. In relation to gestation age and birth weight there was no statistically significant correlation between SIADH and different grades of asphyxia. Mortality was high among the neonates who developed SIADH.Conclusions: The occurrence of SIADH was 26% in asphyxiated neonates and high in severe asphyxia and gestation age and birth weight beard no significant co relation.
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Anacardium occidentale L. and Mangifera indica L. has been used worldwide both for pharmaceutical, food and cosmetic industries due to the presence of biological activities of some of its metabolites. The present study comprises the correlation of antioxidant activity and antimicrobial activity in ethyl acetate extract of young leaves and bark of A. occidentale and M. indica. The activity of 1, 1-diphenyl-2-picrylhydrazyl (DPPH) on radical scavenging effect of the extracts was carried out by spectrophotometrically. All the plant extracts showed DPPH radical scavenging activity and among the extracts, A. occidentale young leaves indicated higher antioxidant potential in comparison with those of the other extracts. The antibacterial activity of various extracts was also screened against some human pathogens of clinical importance; Pseudomonas aeruginosa; Salmonella typhi; Bacillus subtilis; Escherichia coli and Staphylococcus aureus.
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Haemophagocytic lymphohistiocytosis (HLH) is a clinicopathologic syndrome, characterised by hyperinflammation due to inherited or acquired defects in the immune function, leading to unchecked proliferation of histiocytes and lymphocytes resulting in multiorgan dysfunction. HLH can be primary (familial) occurring in young children caused by underlying genetic defects in natural killer cells/cytotoxic T cells or secondary HLH occurring in older children or adults following infections, rheumatological disorders or malignancies. HLH is a medical emergency, having varied clinical presentations and lacks a pathognomonic clinical or laboratory abnormality. Clinical presentations include unexplained fever, hepatomegaly, splenomegaly, skin rash, cytopenias, liver dysfunction, coagulation abnormality and neurological manifestations. It carries a poor prognosis. Early diagnosis based on HLH 2004 criteria and initiation of treatment is crucial in the management strategy, which is likely to improve the outcome of this life-threatening disease. The treatment strategies include immunosuppressive drugs, immunomodulatory therapy and autologous hematopoietic stem cell transplant in selected cases. Here with authors report a case of young adult, presenting with fever, thrombocytopenia, splenomegaly, and multi organ dysfunction, diagnosed as a case of secondary HLH based on the HLH 2004 guidelines.
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During the 20 century the proportion of senior citizens continued to rise, and this trend is expected to continue into the 21 century. Caregiver burden refers to a high level of stress that may be experienced by people who are caring for another person with some kind of illness. Caregivers are ‘hidden patients’ and their role is stressful.The role of the primary caregiver is stressful.The primary caregivers of senior citizen who experience care giving – related stress have a 63% higher mortality rate non caregivers of the same age.it is a paramount responsibility of the nurses to assess the degree of caregiver burden among primary care givers of senior citizen and to desire coping strategies, to reduce their level of care giver burden. Objectives:Assess the level of caregiverburden among primary caregivers of senior citizen and associate the demographic variables with level of caregiver burden. Materials and Methods: Non experimental research approach of descriptive design was adopted.This study was conducted at selected rural community in Bangalore.The primary caregivers (100) of senior citizen were recruited for this study by purposive sampling technique. Zarit’s Caregiver Burden five point likert Scale (ZCBS) was used to collect the data. Findings:The over all caregiver burden is moderate to severe among 92 % of the primarycaregivers.It shows that active coping skills and management strategies are inadequate among the primary caregiver’s of senior citizens. Conclusion: assessing the degree of caregiver burden among primary care givers of senior citizen and to desire coping strategies, to reduce their level of care giver burden is an essential part for the health care providers
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Background: Drugs used in the treatment of rheumatoid arthritis show significant toxicity and morbidity. The objective of the study was to evaluate the nature and incidence of adverse drug reaction in patients with rheumatoid arthritis on anti-rheumatic drugs and to assess the causality and severity of the documented adverse drug reactions.Methods: The prospective observational study was done for two months in rheumatology outpatient department. All patients were interviewed for basic details, treatment history and adverse drug reactions and were recorded. Causality assessment and severity assessment of the recorded adverse drug reactions were done.Results: About 283 patients attended the rheumatology out-patient department during the two months period out of which 57 patients had one or more adverse drug reaction. The incidence of adverse drug reaction observed in rheumatology out-patient department to anti rheumatic drug was 20.14%. A total of 145 adverse drug reactions were noted in 57 patients. The most common adverse drug reaction reported was epigastric pain (6.89%) followed by headache and dyslipidemia (6.25%). The most common system associated with adverse drug reaction was gastrointestinal system (29.66%) followed by central nervous system and cardiovascular system (15.86%). Reported adverse drug reactions were assessed for causality and maximum belonged to probable (66.9%). Severity assessment revealed that most of the adverse drug reactions were mild (74.48%) in nature.Conclusions: Active surveillance for adverse drug reactions to anti rheumatic drug in patients with rheumatoid arthritis will allow early detection of adverse drug reactions and timely intervention to provide maximum benefit to the patients.