Tear film dysfunction after clear corneal phacoemulsification in diabetics and non-diabetics

Purpose: A prospective cohort study was conducted in a tertiary eye care centre to study the incidence of tear film dysfunction and its recovery in diabetics and non-diabetics after clear corneal phacoemulsification. Methods: A total of 50 diabetics and 50 non-diabetics underwent clear corneal phacoemuslfication. Schirmer’s I test (SIT), tear film break-up time (TBUT), corneal staining, tear meniscus height (TMH), and ocular surface disease index (OSDI) assessment were done preoperatively, postoperatively at 7 days, 1 month, and 3 months in both groups to assess tear film function. Results: Both groups showed decreased SIT and TBUT values on postoperative Day 7, after which they gradually improved. SIT and TBUT values in diabetics were significantly lower than that in non-diabetics postoperatively (P < 0.001). SIT in non- diabetics reached baseline levels at postoperative 3 months. OSDI scores reached peak levels in both groups on postoperative Day 7, but were higher in diabetics than non-diabetics (P < 0.001). OSDI scores gradually improved over 3 months but remained over baseline levels in both groups. Corneal staining was positive in 22% diabetics and 8% non-diabetics at postoperative Day 7. However, none of the patients had corneal staining at 3 months. Tear meniscus height (TMH) did not reveal any significant difference between the two groups at any time interval. Conclusion: We concluded that tear film dysfunction after clear corneal incision occurs in both groups, but is more severe and recovers more slowly in diabetics than non-diabetics.

Estimation of surgically induced astigmatism after small-incision cataract surgery done by junior residents

Purpose: To estimate the postoperative astigmatism after small?incision cataract surgery (SICS) done by junior residents at the end of 1 and 3 months. Methods: This observational longitudinal study was conducted at the Department of Ophthalmology of a tertiary eye care hospital and research center. 50 patients enrolled in the study underwent manual small incision cataract surgery by junior residents. Preoperative detailed ocular examination was done, which included keratometric estimation using autokeratometer (GR?3300K). Incision length, distance of incision from the limbus, and type of suturing technique were noted. Postoperatively, keratometric readings were noted at 1 and 3 months. Astigmatism (surgically induced astigmatism [SIA]) was estimated using Hill’s SIA calculator version 2.0. All the analyses were performed using Statistical Package for the Social Sciences (SPSS) ver. 26.0 (IBM Corp., USA) software, and the statistical significance was tested at a 5% level. Results: Out of 50 patients, 54% had SIA between 1.5 and 2.5 D and 32% had SIA of more than 2.5 D. Only 14% had SIA less than 1.5 D at the end of 1 month. While 52% had SIA between 1.5 and 2.5 D, 22% had SIA between 1.5 and 2.5 D and 26% had SIA less than 1.5 D at the end of 3 months. Conclusion: The SIA in most of the SICS done by junior residents was above 1.5 D. It depended mainly on the incision length, its distance from the limbus, and the suturing technique.

Influence of weather parameters on Aphis craccivora and Bean common mosaic virus disease incidence in Vigna unguiculata L. Walp

Aim: Many crop modelling and climate simulation studies have reported variability in pest and pathogen distribution as well as their interaction with host. These prediction encourages to revisit the pest and pathogen epidemological and distribution studies in light of changing climate. In line with above assumption, the present field study was carried out to study the population dynamics of cowpea aphid (Aphis craccivora) and its influence on BCMV disease incidence. Methodology: In this field experiment, A. craccivora population and BCMV disease incidence data were collected in different standard meteorological weeks of 2013-2014 and 2014-2015. Impact of weather parameters on A. craccivora and BCMV disease incidence was statistically analyzed. Results: The significant change in A. craccivora population and BCMV disease incidence was documented during the study. The maximum aphid population was observed during rabi season and less was observed in kharif and summer season. Whereas, incidence of BCMV was recorded maximum in rabi season. Correlation analysis affirmed, minimum temperature (Tmin) and rainfall had negative impact on A. craccivora whereas weather parameters had non-significant impact on BCMV disease incidence. The regression models developed from the present study explained 41.4 % to 78.8 % and 18.5 % to 46.1% variability (R2) of aphid population and BCMV incidence, respectively. Interpretation: The weather parameters had more impact on A. craccivora population than BCMV disease incidence and merely presence of maximum number of A. craccivora was not a deciding factor for outbreak of virus disease incidence.

Item analysis as tool to validate multiple choice question bank in pharmacology

Background: Multiple choice questions (MCQs) are a common method for formative and summative assessment of medical students. Item analysis enables identifying good MCQs based on difficulty index (DIF I), discrimination index (DI), distracter efficiency (DE). The objective of this study was to assess the quality of MCQs currently in use in pharmacology by item analysis and develop a MCQ bank with quality items.Methods: This cross-sectional study was conducted in 148 second year MBBS students at NKP Salve institute of medical sciences from January 2018 to August 2018. Forty MCQs twenty each from the two term examination of pharmacology were taken for item analysis A correct response to an item was awarded one mark and each incorrect response was awarded zero. Each item was analyzed using Microsoft excel sheet for three parameters such as DIF I, DI, and DE.Results: In present study mean and standard deviation (SD) for Difficulty index (%) Discrimination index (%) and Distractor efficiency (%) were 64.54±19.63, 0.26±0.16 and 66.54±34.59 respectively. Out of 40 items large number of MCQs has acceptable level of DIF (70%) and good in discriminating higher and lower ability students DI (77.5%). Distractor efficiency related to presence of zero or 1 non-functional distrator (NFD) is 80%.Conclusions: The study showed that item analysis is a valid tool to identify quality items which regularly incorporated can help to develop a very useful, valid and a reliable question bank.

A study on self-perceived uselessness and its determinants among residents of old age homes in North Bengaluru

Background: The study on self-perceived uselessness may help health-care workers to provide opportunities for intervention for increased quality of health and greater survival rate in elderly. Objectives: To find the prevalence of self-perceived uselessness and its determinants among the elderly residents of old age homes of North Bengaluru. Methods: A cross-sectional descriptive study was undertaken on 129 elderly aged 60 years and above in the old age homes of North Bengaluru. Self-perceived uselessness, sociodemographic variables, morbidity status, functional status, financial status, and personal habits were assessed using a semi-structured questionnaire. Proportions, percentages, and Chi-square test were used for analysis. Results: Nearly half (45%) of the elderly had agreed that they had perceived themselves as useless as they age. Majority of those who perceived uselessness had one or >1 chronic morbidities and were functionally dependent (81.2%). Significant association was seen between self-perceived uselessness and functional dependency, gender, education, and having some form of activities during their leisure time. Conclusions: It can be concluded that self-perceived uselessness is quite prevalent in nearly one-half of the elderly in the old age homes in North Bengaluru having significant association with variables such as gender, education, leisure activities, and functional status.

Efficacy of low dose magnesium sulphate regime and Pritchard’s regime in controlling of eclamptic convulsion and prevention of recurrence

Background: Eclampsia is defined as the onset of convulsions or coma during pregnancy or in post-partum period in a patient who has signs and symptoms of pre-eclampsia. It is life threatening emergency that continues to be a major cause of serious maternal morbidity and mortality also along with high perinatal mortality and morbidity. The present study undertaken to determine the efficacy of low dose magnesium sulphate regime and Pritchard’s regime in controlling eclamptic convulsion and prevention of recurrence of convulsion.Methods: Out of total 60 patients enrolled in the study; 30 were given low dose magnesium sulphate regime and remaining 30 with Pritchard’s regime. Selection of patients was done with simple random sampling. Relevant history was obtained from the patient, if conscious, or from the relatives. Through clinical examination was done and blood samples were collected for investigations after securing IV line.Results: There was insignificant difference regarding type of eclampsia in both groups. Recurrence of convulsion in Pritchard’s regime group was 6.67% and in Low dose regime group found to be 10% but this was statistically insignificant. Total dose of magnesium sulphate required in Low dose regime group was less than that required for Pritchard’s regime.Conclusions: Low dose magnesium sulphate Regime proved equally effective as that of Pritchard’s regime in control of convulsion in spite of less amount of drug and comparatively low serum magnesium levels and hence there is hardly any fear of intoxicator.

Knowledge and perception about generic drugs in patients coming to OPD of tertiary care centre

Background: In an era of rapidly rising health care costs generic medicines provide a less expensive alternative to branded medicines. In addition to reducing the overall health care expenditure, it has been shown to improve adherence. Objective was to study knowledge and perception about generic drugs among patients coming to outpatient department of tertiary care centre.Methods: After ethical approval a cross sectional questionnaire based study was conducted. Patients (n=71) were interviewed according to questionnaire in vernacular language by investigator to fill questionnaire.Results: About 28% people think that price of generic drug is less than a branded drug while nearly 61% of people don’t know of it. Only 18.85% participants had taken generic medicine. Trusting efficacy of generic drugs only 30 participants were in favour it. Even they have not seen or heard publicity of generic drugs (61.97%). They (60.56%) opined that generic drugs never prescribe in our country.Conclusions: Limitation in knowledge and perception about generic medicines has been seen among participants.

Oral Sucrose for Pain in Neonates During Echocardiography: A Randomized Controlled Trial.

Objectives: To test the efficacy of oral sucrose in reducing pain/ stress during echocardiography as estimated by Premature Infant Pain Profile score. Design: Double-blind, parallel-group, randomized control trial. Setting: Tertiary-care neonatal care unit located in Western India. Participants: Neonates with established enteral feeding, not on any respiratory support and with gestational age between 32 and 42 weeks requiring echocardiography. Interventions: Neonates in intervention group received oral sucrose prior to echocardiography. Main outcome measures: Assessment was done using Premature Infant Pain Profile score. Results: There were 104 examinations; 52 in each group. Baseline characteristics like mean gestational age (37.6 vs. 37.1), birth weight (2.20 vs. 2.08), and feeding status (Breastfeeding- 59.6% vs. 44.2%, paladai feeding- 13.5% vs. 13.5%, and gavage feeding- 26.9% vs. 42.3%) were comparable. The mean (SD) premature infant pain profile score was significantly higher in control group [(7.4 (3.78) vs. 5.2 (1.92), P <0.001]. Conclusion: Oral sucrose significantly reduces pain, and is safe to administer to neonates.

Sociodemographic profile of Helicobacter pylori positive functional dyspepsia patients in central India.

Background: Dyspepsia is one of the common complaints in all sectors of the Indian population. It is diagnosed in the presence of symptoms thought to originate from gastroduodenal region and if there is no organic cause to explain dyspeptic symptoms on upper gastrointestinal endoscopy, the patient is labeled as functional dyspepsia (FD). Helicobacter pylori, a Gram-negative bacilli harboring in the acidic gastric environment has been said to be the causative agent, but this association has not been proved in Indian population. Hence, this study was conducted to find out the prevalence of H. pylori in FD. Methods: After the approval from Institutional Ethics Committee, patients presenting with symptoms of dyspepsia of both sex, within age group of 18-60 years and any dietary habit were enrolled in the study. After a detailed history and complete general and systemic examination, patients were subjected to gastroduodenoscopy. On endoscopy, if no lesion was observed, then the patient was labeled as FD. The severity of dyspepsia symptoms was assessed by seven-point global overall symptom (GOS) scale. Patients were then screened for H. pylori infection by both invasive (rapid urease, Gram staining, and culture) and non-invasive tests (C-14 urea breath test). Results: The prevalence of H. pylori in FD was found to be 63.38%. Among 90 H. pylori positive FD patients, 56% were male, 58.89% were below the age of 40 years, and 53.33% belonged to middle income group. The average GOS score for dyspepsia symptoms was 6.01±0.64. Epigastric pain and mild gastritis were the most common presenting symptom and endoscopic finding, respectively. Conclusion: Our results suggest that H. pylori is an important causative factor for dyspeptic symptoms in patients of FD. Hence, all the FD patients must be investigated for H. pylori and treated promptly.

Arterial Blood Pressure is Inversely Associated with Vascular Sympathetic Reactivity l(sometric Handgrip Exercise) in Gujarati Indian Adolescents.

Studies conducted earlier have found that vascular sympathetic reactivity to isometric handgrip exercise is either low or high in adolescents with higher blood pressure (Hypertensives) as compared to adolescents with relatively lower blood pressure (Normotensive). The current study was conducted to determine the correlation of vascular sympathetic reactivity to isometric handgrip exercise with blood pressure in Gujarati Indian adolescents so as to understand the pathogenesis and/consequences of Hypertension in this population. A cross-sectional study was conducted on 651 Gujarati Indian adolescents (285 girls, 366 boys) of age group 13-19 years. Blood pressure was measured by oscillometry and vascular sympathetic reactivity (Percentage rise in Diastolic Blood Pressure, %RDBP) was assessed using isometric handgrip test. Pearson’s correlation coefficient was determined to study the correlation between %RDBP and blood pressure. In both girls and boys, %RDBP showed significant negative correlation with resting SBP, DBP and MAP. The study thus indicates that an inverse association exist between arterial blood pressure and vascular sympathetic reactivity to isometric handgrip exercise in Gujarati Indian adolescents.

Newborn Care Practices and Health Seeking Behavior in Urban Slums and Villages of Anand, Gujarat.

Health status of neonates in urban slums has not been studied in smaller towns. A questionnaire was administered to 154 families of 10 urban slums of Anand (population - 197351) and 160 families from 6 villages of Anand district. The socioeconomic and education status of the slum dwellers versus rural participants were significantly lower (P<0.001). Antenatal care (79.9 vs 94.4%, P<0.001), hospital delivery (82.5 vs 93.8%, P=0.002), neonatal follow-up (27.9 vs 78.8%, P<0.001), health seeking (56.5 vs 91.3%, P<0.001), essential newborn care and exclusive breastfeeding (6.5 vs 85.6%, P<0.001) were also lower in urban slums, as compared to villages, Care seeking was low in urban slums, Hindus and illiterate mothers. Health care and socioeconomic status of neonates in slums of smaller cities is poorer than in surrounding villages.

Factors affecting 30-month survival in lung cancer patients.

Background & objectives: Age adjusted incidence rate of lung cancer in India ranges from 7.4 to 13.1 per 100,000 among males and 3.9 to 5.8 per 100,000 among females. The factors affecting survival in lung cancer patients in India are not fully understood. The current study was undertaken to evaluate the factors affecting survival in patients diagnosed with lung cancer attending a tertiary care cancer institute in Bangalore, Karnataka, India. Methods: Consecutive patients with primary lung cancer attending Bangalore Institute of Oncology, a tertiary care centre at Bangalore, between 2006 and 2009 were included. Demographic, clinical, radiological data were collected retrospectively from the medical records. Results: A total of 170 consecutive subjects (128 males, 42 females) diagnosed to have lung cancer; 151 non-small cell lung cancer (NSCLC) and 19 small cell lung cancer (SCLC) were included. A higher proportion of never-smokers (54.1%) were observed, mostly presenting below the age of 60 yr. Most subjects were in stage IV and III at the time of diagnosis. More than 50 per cent of patients presented with late stage lung cancer even though the duration of symptoms is less than 2 months. The 30-month overall survival rates for smokers and never-smokers were 32 and 49 per cent, respectively. No significant differences were observed in 30 month survival based on age at presentation, gender and type of lung cancer. Cox proportional hazards model identified never-smokers and duration of symptoms less than 1 month as factors adversely affecting survival. Interpretation & conclusions: Our results showed that lung cancer in Indians involved younger subjects and associated with poorer survival as compared to other ethnic population. Studies on large sample need to be done to evaluate risk factors in lung cancer patients.

Comparative analysis of antimicrobial activity of leaf extracts from fresh green tea, commercial green tea and black tea on pathogens.

Medicinal plants have been a major source of therapeutic agents for alleviation and cure diseases. In the present investigation comparative analysis of antimicrobial activity of green tea Camellia sinensis fresh leaves, commercial green tea leaves and dust tea against enteropathogens and specific fungi were carried out. The antimicrobial activity of the extracts of Camellia sinensis was analyzed by using well diffusion method paper disk diffusion method and minimum inhibitory concentration. Synergistic activity of green tea and commercial antibiotic chlorophenicol was analyzed. The allopathic antibacterial drugs are said to be costlier and have more side effects. Moreover multiple drug resistant strains are on the raise in this era and thus complicating treatment. On the other hand herbal preparations are comparatively cheaper and have lesser side effects. So, herbal preparations can supplement other systems of medicine for the treatment of diseases caused by bacteria and fungi.

A prospective observational study to assess quality of life and prescription pattern in osteoarthritis patients at tertiary health centre in Mumbai.

Background: Osteoarthritis (OA) is a major cause of disability and is focused in "Bone and Joint Decade" declared by WHO which substantially affect different dimensions of quality of life. The aim of present study was to find the disease pattern in OA patients, monitoring prescription pattern to assess prognosis of osteoarthritis by WOMAC index. Materials and Methods: An observational study on prospective data collected for the evaluation of Quality of Life (QOL) in OA was conducted at tertiary health care centre in Mumbai. Patients with a diagnosis of OA were enrolled. The patient's history and clinical examination was based on classification criteria of the American College of Rheumatology; drugs prescribed were noted on case record form. Same procedure was carried out for the first and second follow-ups at 6 th and 12 th weeks respectively. Results: The patients belong to primary OA (84%) as compared to secondary OA (16%). Females (70.56% and 10%) were affected more commonly than males (13.44% and 6%). Knee Joint was worst affected in 76%, followed by hip joint in 16% and shoulder, ankle, wrist, elbow joint each having 2% (n=1) involvement. NSAIDs continued to dominate prescriptions given to 84% of patients followed by antiarthritic drugs and calcium supplements in 54% cases. The WOMAC score was higher in most of patients. After medication hydroxy chloroquine sulfate has shown maximum reduction in average WOMAC sore followed by paracetamol, indomethacin and diclofenac sodium. Conclusion: Osteoarthritis has a significant impact on quality of life, only partly ameliorated by anti-arthritic drugs, as assessed by the WOMAC scale in this study population. Further, a study with larger sample size is needed to further support our findings.

Kikuchi's disease associated with systemic lupus erythematosus.

A 25-year-old multiparous female presented with fever, joint pains, facial rash and lymphadenopathy of three months' duration. Lymph node biopsy revealed a diagnosis of Kikuchi's disease. She fulfilled seven out of the 11 ARA criteria for SLE. The association of Kikuchi's disease and SLE is rare.

Heparin inhibits enhancing factor/phospholipase A2 activity and its binding to the cell surface.

Enhancing factor (EF), a mouse intestinal phospholipase A2 (PLA2), has been isolated and characterized. EF increases the binding of epidermal growth factor (EGF) to A431 cells almost two-fold by interacting with EGF. EF binds to a 100 kDa cell surface receptor and brings about an increase in the binding of EGF. In the present study we demonstrate that EF is a heparin binding protein and at the time of iodination of EF, the heparin binding site of EF has to be protected. Heparin inhibits the enhancing activity of EF as well as the binding of labelled EF to A431 cells. Inhibition of binding of EF to cells by heparin indicates that heparin binding region forms at least part of the receptor binding domain. These data suggest that the receptor for EF on the cell surface could be a heparin sulphate proteoglycan.

Management of neuroleptic malignant syndrome--a series of eight cases.

Neuroleptic Malignant Syndrome (NMS) is a rare and life threatening complication of treatment with Neuroleptic medication. Phenothiazine and butyrophenones are most frequently implicated in this syndrome even though there are case reports with other drugs. In this paper we describe the classical presentation of this syndrome in eight cases who had been on either a butyrophenone, a phenothiazine or a combination of these drugs. In addition some of our patients were also on either Lithium and/or Amitrytiline for control of depressive symptoms. Fever, muscule rigidity and elevated CPK are the important criteria for diagnosis and they were noted in all our patients. In addition four of our patients fulfilled five of the six minor criteria laid down by Levenson. Both Sinemet and Bromocriptine were found to be effective in the treatment of seven of the eight cases. However treatment with Dantroline sodium was associated with severe muscle wasting in one of our cases and the drug had to be discontinued. Two of our patients developed suspected myoglobinuria with dark coloured urine and progressive renal failure. One patient died after development of renal failure, pulmonary edema and hyperkalemia as a consequence of this disorders.