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Objective: The present study evaluates the immunoexpression of p16 and Ki-67 in cervical squamous intraepithelial lesion (SIL) and carcinomas and correlates their expression with clinicopathological features and HPV-DNA status. Material and Methods: A total 36 included cases of SIL and squamous cell carcinoma (SCC) were subjected to p16 and Ki-67 immunostaining. p16 staining was evaluated depending on grading, distribution, localization pattern, intensity and IHC score. Ki-67 expression was graded based on percentage of positive cells. Results: Incidence of HSIL and SCC cases was found to be significantly increased with parity > 5. p16 grade III diffuse nucleocytoplasmic immunostaining was observed in 62.5% LSIL, 80% HSIL and 87% SCC cases. Significant association of p16 staining intensity, IHC score and Ki-67 indices was noted with increasing grades of SILs and carcinomas. Conclusion: Our experience indicates that a combination of p16 and Ki-67 immunostaining may be useful to determine the severity of dysplastic change.
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Background: Breast cancer is the most common cancer among women and its early detection is critical to improve survival. Breast self-examination is a cheap, basic and non-intellectual method to detect breast cancer. Aims and objectives: 1To determine the knowledge, attitude and practices regarding breast self-examination2. To explain the various factors which affect the practice of BSE Material and Methods: The present study was carried out among 300 women residing in rural and urban areas of district Ambala using a self-designed pretested semi-structured questionnaire. Results: In this study 127 (42.3%) of the participants had heard of BSE and 107 (35.7%) of the participants knew how to perform BSE. Overall, 47.7%, 30.3%, and 22% of the study participants had poor (<50%), medium (50–75%), and good knowledge (>75) on BSE, respectively. Educational qualification, knowing the three positions to perform BSE, knowing how often should BSE be done, taught how to do BSE, BSE is a useful tool to detect breast cancer were seen to be significantly associated with practice of BSE. Conclusion: This study elucidates that the knowledge as well as practice of BSE was significantly low in the population. This study provides insights into the various factors which affect the practice of BSE
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Different blood components are associated with various types of adverse transfusion reactions and are linked to several factors including the number, rate and volume of transfusions. The given study was conducted to study the relationship between various transfusion reactions and its causative factors. This study was a prospective study carried out over eighteen months on all patients who received a blood transfusion and blood components including various adverse reactions and events related to transfusion. These were correlated with tests for compatibility including general blood picture ,tests for haemolysis ,hematuria and haemoglobinuria, Coombs Test (Direct and Indirect), culture along with relevant clinical details of the patient. Out of a total of 31451 units of blood issued, 47 adverse transfusion reactions were noted with a maximum number in the age group of > 18 years (87.3%) with M: F being 1.6: 1 .0.24% of adverse transfusion reactions were by Packed red blood cell transfusion and mostly were immediate transfusion with a mean volume of 100 ml and mean time of 20 minutes. Febrile Non Hemolytic Transfusion Reaction (FNHTR) was the most common Adverse Transfusion Reaction (ATR)(0.128%) with 2 cases positive for Direct Coombs Test. A thorough serological and immunological examination and the addition of methods like buffy coat reduction and leucocyte filtration help in reducing the incidences of hemolytic transfusion reactions and transmitted infections and establishing a hemovigilance system help in the attainment of the goal of safe transfusion
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This study aims to assess the continuity of medical care, the impact on disease condition and to highlight the major challenges faced by people affected by leprosy during the pandemic. Telephonic questionnaire-based survey was conducted among previously registered patients of leprosy at referral hospitals in India. Leprosy affected people aged >18 years, either on treatment or who had completed treatment with access to phone and willingness to participate were included. The questions were asked pertaining to demographic details, baseline disease characteristics and various problems faced during lockdown relating to livelihood, finances, treatment, and mental status. A total of 196 patients consented to participate in the study. Mean age of study participants was 37.31 (13.86) years, male participants (n=123, 62.7%) were more than females (n=73, 37.2%). Overall, 101 patients (51.5%) experienced exacerbation, 21 patients (10.7%) reported improvement and 74 patients (37.8%) reported no change in disease status during the pandemic. Most common difficulty faced was the procurement of medicines (115 patients, 58.6%) followed by difficulty in diagnostic testing (61 patients, 31.1%). Course of treatment was interrupted in 16 patients. Most of the patients (n=147, 75%), agreed that teleconsultation services would aid in management of their disease. The majority of patients (88.2%) were able to continue some form of treatment. Two patients (1%) tested positive for COVID-19. Nearly all patients (n=189, 96.4%) were informed regarding the risks and preventive measures related to COVID-19. Fifty percent of the patients reported deterioration in mental health due to the pandemic. The present study highlights the gaps in healthcare delivery and social inequalities along with their impact on the health, livelihood and mental status of people affected by leprosy during the current COVID-19 pandemic.
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Introduction: In this paper, we introduce geographical information systems (GIS) as a tool to study trends in disease spread in time and space. Based on data gathered by the integrated disease surveillance programme (IDSP), we can see where outbreaks of Chickenpox have occurred. Objective: The aim of this study is to assess the trends in chickenpox diseases in India between January 2015 and April 2021 using GIS maps. Methods: For the collection of secondary data relating to chickenpox, a free app called collect 5 was used for collecting data weekly from the IDSP website and then storing them in an online server. In this project, variables that needed to be processed with QGIS were combined with table attributes of many shapefiles of India and presented as maps. Results: Between Jan 2015 and May 2021, 1269 chickenpox outbreaks (27,257 cases) have been recorded. Thirty-one deaths have been confirmed, with most occurring in Bihar and Uttar Pradesh. Nineteen states did not report any deaths. According to the seasonally adjusted trend, the number of cases was highest during the months of January and March. Conclusion: In summary, geographic information systems have become an invaluable tool for mapping the hotspots of acute epidemics and planning public health interventions to prevent the spread of these diseases.
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Xylometazoline, a sympathomimetic available as over the counter drug, acts as a nasal decongestant and has been reported as an independent risk factor for hemorrhagic and ischemic stroke. The chronic use of xylometazoline leads to either increased release of more potent vasoconstrictor norepinephrine in the presynaptic region, or acts directly on central adrenoreceptors which leads to dysfunction resulting in chronic progressive vasculopathy that manifests as an ischemic stroke. Sympathomimetics also activate 12-lipoxygenase pathways which induce proliferation and migration of vascular smooth muscle cells. 12-lipoxgenase also plays a significant role in regulating the degree and stability of platelet activation, as its activation significantly strengthens platelet activation and uncontrolled platelet activation, which may lead to myocardial infraction and stroke. The present case reports a rare case of young adult suffering from isolated left medial cerebellar peduncle infarct related to the chronic use of xylometazoline. Acute cerebellar stroke is rare, especially in young adults and represent only 3% of total ischemic and hemorrhagic strokes. Clinical symptoms, patient age at the onset of stroke, and lesion size had no significant effect on the clinical outcome. Symptoms are frequently underestimated and misdiagnosed which further lead to serious complications and poor functional outcomes.
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Eosinophilic gastroenteritis disorder is an uncommon inflammatory disorder of the gastrointestinal tract, affecting predominantly, stomach and small intestine. Subserosal inflammation is a major source of minor?to?moderate ascites. We present the case of an 8?year?old girl child who was brought to the hospital with complaints of chronic abdomen pain and mild ascites. There was a remarkable finding of eosinophils in ascitic fluid. Other differential diagnosis was excluded. Treatment abdomen with deflazacort gave significant resolution of symptoms over the time.
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Low crop yields due to constant monocropping systems and deteriorating soil health in a smallholder farmers’ field of Indo-Gangetic plains of India have led to a quest for sustainable production practices with greater resource use efficiencies. The aim of the study was to elucidate the short term effects of conservation agricultural systems on productivity, soil health and carbon sequestration rate of soils in three different diversified cropping systems. The treatments consisted of two different tillage systems (conventional and reduced tillage), two mulch levels (no and straw mulch) and two levels of fertility (100 and 75% RDF) were compared in three rice-based cropping systems (rice-wheat; rice-vegetable pea-greengram; and rice-potato-maize sequences) for two years on an experimental field (clay loam) located at Norman E Borlaug Crop Research Center, Pantnagar, India. The resource conservation technologies (RCT) i.e. reduced tillage, mulch, and 100% RDF had recorded 2.5 and 3.0% higher system productivity and relative production efficiency in rice-vegetablepea-greengram and rice-potato-maize sequences, respectively in two consecutive years. Conservation tillage had sequestered three times higher carbon than conventional tillage while mulching acted four times higher than non-mulched condition in agricultural soils. Even though cropping system not significant significantly influenced on carbon sequestration, rice-vegetablepea-greengram sequence had recorded higher carbon sequestration rate and higher soil organic carbon stock noted in surface plough sole layer than any other cropping systems. Therefore, our results suggested that Indo-Gangetic farmers should consider adopting resource conservation practices together in indogangetic area because of benefits to soil health, carbon sequestration and system productivity.
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Background: Hypertension is an important health problem globally. One of the main causes of uncontrolled hypertension is the failure on the part of the patient for not taking the prescribed drugs. Objectives: This study was conducted to study the level of adherence to antihypertensive medication and to determine multiple factors which affect it. Materials and Methods: This community-based cross-sectional study was conducted in the field practice area of the department of community medicine. The study subjects were 700 patients aged 18 years and above diagnosed with hypertension for at least 1 year who had been prescribed antihypertensive treatment. Results: In this study, it was found that of the 700 participants, 57.3% were adherent to antihypertensive drugs. Factors significantly associated with adherence to hypertensive medication included being literate, socioeconomic Classes 1 and 2, taking only one hypertensive medication, monthly cost of drugs <500, being aware of hypertensive complications and complications of not taking drugs regularly, perception of current health status, and knowledge about worsening of health condition on stopping the treatment. Conclusions: Many factors such as literacy, socioeconomic factors, and awareness of consequences impact the adherence to treatment and hence the treatment outcomes. Community support and financial help can improve the same. It is imperative that all hypertensive patients receive repeated counseling to continue therapy. Financial support is an important issue which needs to be addressed.
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Background: Anemia is a continuously rising threat to not only present but also future generations as well and Indians are under high risk, especially adolescent girls. The anemic adolescent girls grow into adult women with compromised growth, both physical and mental. These women have low pre-pregnancy weight and are more likely to die during childbirth and deliver low birth weight babies. Objectives: The objectives of this study were to find the prevalence of anemia in urban and rural adolescent school-going girls 10–16 years of age, among adolescent girls of district Ambala, Haryana. Materials and Methods: A community-based cross-sectional study was conducted in government and private schools of district Ambala. This study was conducted among 300 adolescent girls, 10–16 years of age studying in government and private schools of Ambala. The blood samples were taken from the students and hemoglobin was measured. Data were collected by interviewing the study subjects using a self-designed, pre-tested semi-structured questionnaire. Results: Overall prevalence of anemia was found to be 69.7%. Conclusion: The prevalence of anemia was very high among adolescent girls. This indicates a need to educate them about anemia and its risk factors. Regular screening of school students to rule out anemia is the need of the hour.
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Background: Immunization is safe, powerful and proven tool for elimination and controlling various highly infectious diseases and in spite of every possible effort put by the Government still there is a big gap between reported and evaluated coverage. Aims & Objectives: To find out the immunization coverage and its determinants among children in the age group 12 – 23 months in urban and rural area of district Ambala. Material and Methods: It was a cross sectional study carried out by WHO recommended 30 by 7 cluster survey technique. Results: It was observed that overall 83.1% children were fully immunized, 14% were partially immunized and 2.9% were unimmunized. In present study Educational status of mothers, Occupation of mothers, Religion, Sex, Monthly Family Income and Caste were found to be significantly associated with immunization coverage. “Fear of side effects” of vaccination was found to be the main reason for failure to fully immunize the child. Conclusion: To conclude, immunization coverage was found to be reasonably but still there is a lot of scope for improvement.
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Background: Nutritional anaemia is the most common nutritional problem worldwide. Underweight and anaemia are associated and together constitute a serious problem in developing countries like India. Aim & Objectives: To estimate the prevalence of anaemia among medical students and determine its association with their body mass index (BMI). Material & Methods: Hemoglobin estimation was done in 140 MBBS students and anaemia status was determined by WHO criteria for anaemia. BMI was calculated and interpreted using cutoffs for Asian Indian population. Statistical analysis was done by Chi-square distribution and Binary logistic regression. Results: Overall prevalence of anaemia in students was 55.7% and 78.6% females compared to only 32.9% males were anaemic (p<0.001). Gender was associated with both the severity of anaemia (p=0.028) and BMI (p=0.036). Prevalence of anaemia was significantly (p=0.007) higher in underweight students (88.9%) compared to normal (54.2%) and overweight/obese (46%) students. However, no association was found between BMI and severity of anaemia (p=0.985). Conclusion: Anaemia is significantly associated with nutritional status. Prevalence of anaemia is higher in underweight students compared to normal and overweight/obese students and management of both undernutrition and anaemia is critical for optimal results.
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Posotoprative nausea and vomiting remains a persistent and distressing problem inspite of many advances on perioperative care and anti-emetic drugs. A newer antiemetic drug Granisetron has not been studied in patients undergoing gynaecological surgery under spinal anaesthesia
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Background: Hemodynamic variations are commonly encountered following subarchnoid block and can attribute to significant mortality and morbidity. To counteract the hypotension, fluid adminstration before spinal anaesthesia is recommended (preloading). Crystalloids and colloids are recommended as preloading fluids but both have their own merits and demerits. Objective: This comparative study was done to compare the effectiveness of ringer lactate versus 6% hydroxyl ethyl starch for preventing spinal anesthesia induced hypotension. Material and Methods: In this prospective study, we compare the effectiveness of ringer lactate versus 6% hydroxy ethyl starch at 10ml/kg over a period of 20 minutes before spinal anaesthesia in preventing hypotension. After administration of spinal anaestheisa mean arterial pressure were recorded at 1, 5, 10, 15, 30, 45, 60, 90 minutes and 3 hours after spinal anaesthesia. Number of patient, recieving injection Mephentermine sulphate for persistent hypotension was also recorded. Results: We found that hydroxy ethyl starch is more effective than ringer lactate solution as a preloading fluid in prevention of hypotension following spinal anaesthesia. Conclusion: Hydroxy ethyl starch is superior to ringer lactate in preventing hypotension in patients undergoing elective lower abdominal surgeries under spinal anaesthesia but the incidence of hypotension is not completely eliminated.
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Background: It is usually difficult to diagnose brucellosis clinically in the absence of specific clinical features. Hence serological testing forms the mainstay of diagnosing the disease. Seroepidemiological determinants of brucellosis in rural western Maharashtra have not been closely investigated. Aim: The present study was therefore conducted to determine the incidence and to analyze seroepidemiological determinants of Brucellosis in cases of pyrexia of unknown origin (POU) in rural western Maharashtra. Material and methods: The present hospital based cross sectional survey was carried out in Rural Medical College, Loni on 500 cases of PUO. SPSS version 20.0 was used for analysis. The serum samples were subjected to serological tests like Rose Bengal Plate Test (RBPT) and Standard Tube Agglutination Test (STAT). The inoculated agar plates were watched daily for the presence of growth Brucella on culture. Results: Males (51.6%) outnumbered females (48.4%) in the study sample. Out of 500 cases 10 samples showed the presence of Brucella agglutinins. The male female ratio in the seropositive cases was 2.33:1. Headache and joint pain was observed in 5 and 3 cases respectively. 50% samples yielded the growth of Brucella on culture. All the culture positive samples had titer of 640 IU or more. Conclusion: Agglutination test if properly performed can be used as a very dependable laboratory procedure for rapid diagnosis of Brucellosis.
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Background: A medication error is an episode associated with use of medication that should be preventable through effective control system. Investigating the incidence, type, and nature of medication errors are very crucial to prevent them. Aim: The study aimed to analyze and ascertain profile and pattern of medication errors among admitted patients in a tertiary care teaching hospital. Material and methods: The present prospective study was carried out by the Department of Pharmacology in collaboration with the Department of Internal Medicine and Office of Medical Superintendent, MSDS Medical College, Fatehgarh, among the patients admitted to the General medicine ward during October 2013-February 2014. Hospital/medical records, Case sheet of the study subjects, a 46 item self administered questionnaire and Medication error reporting and documentation form served as study tools. Results: Overall incidence of medication errors was found to be 28.3%. 31.4% were ‘Errors in medication ordering and transcription’, 24.4% were ‘Errors in medication dispensing’, whereas 44.2% were observed as ‘Nursing errors in medication administration’. Most frequent nursing errors in medication administration was found to be ‘Medication not given’ i.e. Omission error. 67.4% were due to nurses, 22.1% were due to pharmacists and remaining 10.5% were due to physicians. Most of the nurses attributed cause of this error to ‘Repeated distraction’ and ‘High activity duty hours’ 41.4% and 39.6% respectively. Conclusion: A robust surveillance system to detect such medication errors is need of an hour. Competencies of pharmacology department hibernating in a tertiary care teaching institution could be utilized in the early detection and prevention of medication errors and thus can improve the delivery of care quality to the patients.
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Background: Acne vulgaris is one of the most common skin disorders in puberty. The widespread and indiscriminate use of antibiotics in the treatment of acne has resulted in the spread of resistant bacterial strains and treatment failure. Aim: The study aimed to analyze the microbiological spectrum in acne vulgaris and to evaluate its susceptibility to the antibiotics widely used for acne. Material and methods: The present cross sectional study was carried out by the Department of Microbiology and Dermatology, MSDS Medical College, Fatehgarh among the patients seeking care for acne vulgaris with pustular and nodulocystic skin lesions in the Dermatology OPD of a rural medical school from western Uttar Pradesh. Patients with pregnancy or endocrinal problems like hirsutism, menstrual dysfunction or adrenal dysfunction and those taking drugs or contraceptives were excluded. The samples were cultured individually on blood agar and Muller-Hinton media. The cultures were then incubated under both aerobic and anaerobic conditions for 2-7 days . Bacteria were identified and their resistance to common antibiotics was evaluated according to the standard procedures. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Aerobically, Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acne and Micrococcus spp were detected in 44%, 47%, 1% and 46% of samples respectively whereas anaerobically these were 39%, 21%, 34% and 1% respectively. Propionibacterium acne Staphylococcus epidermidis and Staphylococcus aureus were more sensitive to rifampin (almost 90%) compared to other drugs. Neomycin was found to be least sensitive. Conclusion: The study highlighted the need to discourage antibiotics' abuse. Rifampin is a suitable antibiotic for acne patients, but to achieve a better result, combination of rifampin with other antibiotics should be tried. It is also suggested that studies with bigger sample size on evaluation acne vulgaris treated by rifampin should be undertaken.
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Multifocal skeletal involvement in primary non-Hodgkin’s Lymphoma (NHL) is very rare as compared to the focal one. These findings of multifocal nature are more common in children than in adults. We present 52 years old male patient who presented with slow growing multiple tender swellings on the left side of mandible and on the medial end of right first rib. We present the clinico-radiological aspects of the disease which lead to suspicion of the NHL and later proved to be primary non- Hodgkin’s Lymphoma on fine needle aspiration cytology.