Impact of BMW Segregation Training Program on Hospital Infection Control in a South Indian Hospital

This study aimed to investigate anaerobic co-digestion of palm oil mill effluent (POME) with cassava peels (CP) and cabbage waste (CW) for biomethane production. The anaerobic digestion (AD) in 10L capacity bioreactors loaded separately with three different ratios (3L/ 520g, 3L/ 600g and 3L/ 680g) of POME/CP, POME/CW and POME only (control) was operated under ambient temperature (25 - 36?C) and pH range of 6.5 - 8.5 for 45 days. Standard methods were adopted in the characterization of the bioreactor feeds and microbiological study. The biomethane content of the biogas was determined using Gas Chromatography (GC). The results showed the presence of Escherichia coli, Staphylococcus, Pseudomonas sp, Bacillus sp Salmonella sp among others. Fungal isolates identified include Saccharomyces, Aspergillus, Rhizopus, Penicillum, and Geotrichum species. The mean cumulative biogas yield recorded in bioreactors charged with POME/ CP 520g, POME/ CP 600g, POME/ CP 680g and POME/CW 520g, POME/CW 600g, POME/CW 680g were 7.08, 5.18, 9.06, 9.13, 9.28 and 8.33 dm3, respectively, whereas POME alone (control) was 4.64 dm3. The best performance in biogas yield was exhibited by POME/CW 600g (9.28dm3), and the highest percentage biomethane content (68.80%). Analysis of variance (ANOVA) revealed a significant difference (P ? 0.05) in biogas yield in all the treatments compared to control (POME alone) except in POME/CP 3L: 520g and POME/CP 3L: 600g. The results have shown that biogas production and biomethane content could be efficiently improved via co-digestion process, depending on the substrates used as feedstock.

Psychological risk factors associated with internet and smartphone addiction among students of an Indian dental institute

Background: The internet and smartphones have a strong potential for addiction. Excessive use of these technologies can have adverse effects on psychological well-being of the users. Objectives: The objective of the study is to find out the effects of internet addiction (IA) and smartphone addiction (SA) on psychological outcomes of dental students in an Indian institute. Methods: In this cross-sectional study, 320 dental students were assessed for their internet and smartphone habits using the Young's IA test (YIAT) and the SA scale (SAS), respectively. Psychological outcomes were evaluated using the insomnia severity index, the Depression, Anxiety and Stress Scale, and the Rosenberg Self-Esteem Scale. Results: The median YIAT score was 35 and interquartile range (IQR) of 24–49 with 23% subjects reporting potential IA. The median SAS score was 108 (IQR 91.25–128). Both IA and SA were significantly associated with participants' year of the study. Significant correlations were observed between IA and SA with psychological parameters. Conclusions: The association of IA and SA with psychological parameters shows how these habits can affect the users' mental well-being. Public especially young adults should be made aware about potential harmful effects of the internet and smartphones.

Primary Intratesticular Rhabdomyosarcoma-A Rare Case Report

Rhabdomyosarcoma is one of most frequent soft tissue sarcoma of skeletal muscle origin. It occurs predominantly in Head& Neck, Genitourinary tract and extremities. The majority of cases of rhabdomyosarcoma in the genitourinary tract occurs in the bladder and paratesticular organs Primary intratesticular Rhabdomyosarcoma is very rare, have aggressive growth pattern. A 15 years old male presented with painless right testicular swelling who underwent high inguinal orchidectomy and left testis appeared normal. Complete blood count , Serum alpha- fetoprotein (1ng/ml) and Beta Human chorionic gonadotropin(<2.39) are with in normal limits.X- ray{chest}reveals multiple variable sized nodules in bilateral lungs with right hilar lymphadenopathy.?Metastasis.HR-USG (scrotum) reveals ill-defined lobulated , heterogeneously hypoechoic, soft tissue mass with increased internal vascularity in the right scrotal region with multiple enlarged lymphnodes suggestive of neoplastic etiology. On histopathology diagnosis of rhabdomyosarcoma –Right testis was made., have aggressive growth pattern. The optimal management of paratesticular rhabdomyosarcoma remains unclear because of the rarity of the disease in adults.Radical orchidectomy with negative surgical margins followed by RPLND and chemotherapy is the recommended treatment. For the control of local recurrence and metastasis radiotherapy is recommended.The purpose of this article is to report a case of 15 years old male with primary intratesticular rhabdomyasarcoma which is very rare and our best knowledge few cases have been reported in the literature till now.

Blue Rubber Bleb Nevus Syndrome with Musculo-skeletal Involvement and Pulmonary Stenosis.

Background: Blue rubber bleb nevus syndrome is a rare clinical entity. Case characteristics: A 13-year-old Indian boy presented with characteristic cutaneous lesions, gastrointestinal malformations, skeletal involvement and pulmonary stenosis. Observation: Diagnosis was confirmed on skin biopsy, radiographic evaluation, colonoscopy and echocardiography. Echocardiography revealed pulmonary stenosis, an association hitherto undescribed. Message: Detailed evaluation in a patient of blue rubber bleb nerves syndrome is mandatory.

Study of Mumps in Children attending a Tertiary Care Centre.

Introduction: Mumps is a self-limiting viral infection of the salivary glands with systemic manifestations and complications. It primarily affects young children, with increased incidence in winter and spring. Mumps infection is endemic in developing countries because of poor vaccination coverage. This study is intended to highlight the increased number of mumps cases in children attending tertiary care center in Nepal and thus to emphasize the importance of mumps vaccination, so as to decrease the disease occurrence and disease burden by vaccinating all children. Materials and Methods: This was a prospective study done in Civil Service Hospital of Nepal over a period of 2 years from November 2009 to October 2011. All children less than 14years of age with symptoms of fever and parotid swelling were included in the study group. A detailed history pertaining to the disease was taken, that included; history of exposure and prior vaccination against mumps. Children were asked to follow up either after 5 days or in case of noticing any signs and symptoms of complication. Results: There were total 113 cases diagnosed clinically as mumps of which there were 71 males (62.83%) and 42 females (37.16%) with the peak incidence of disease in the month of March and September with 22 cases (19.46%) in each month. The increase incidence was seen in 4-6 years of age with 58 cases (51.32%). There were 70 patients (61.94%) that had history of exposure to mumps infection. All the patients in this study had either unilateral or bilateral parotitis. None of the children were vaccinated against mumps. And all the school going children had to be off school for a period of 3-5 days. Conclusion: There were large number of children with mumps and none of them were vaccinated. Child can be prevented from the infection by vaccination and thus avoiding possible sufferings and complications. Thus we recommend the use of mumps vaccination in Routine immunization programme.

Effect of tripod position on objective parameters of respiratory function in stable chronic obstructive pulmonary disease.

Objective. To examine changes in respiratory dynamics in patients with chronic obstructive pulmonary disease (COPD) sitting leaning forward with hands supported on the knees (tripod position), a posture frequently assumed by patients in respiratory distress. Methods. Spirometry, maximal inspiratory and expiratory pressures (MIP and MEP) generated at the mouth, and diaphragmatic excursion during tidal and vital capacity maneuver breathing measured by B-mode ultrasonography were studied in 13 patients with stable COPD in sitting, supine and tripod positions. Results. Mean±SD age of patients was 52.2±6.8 years. Median disease duration was three years. There was no statistically significant difference in spirometry for sitting, supine and tripod positions (FEV1: 1.11±0.4L, 1.14±0.5L and 1.11±0.4L; p=0.99), respectively, (FEV1/FVC: 49.2±11.0, 53.7±8.5 and 48.5±11.3, p=0.37), mouth pressures (MIP: 102.9±28.9, 90.6±29.1 and 99.2±32.9 cm H2O, p=0.61 and MEP: 100.8±29.9, 100.4±34.4 and 90.6±32.6 cmH2O, p=0.74) and diaphragmatic movements during tidal (16.1±5.9, 20.1±6.8 and 16.6±6.2 mm, p=0.22) and forced breathing (33.9±11.0, 43.1±19.6 and 37.4±17.1 mm, p=0.35). Conclusion. Commonly measured indices of respiratory function were not different in the tripod compared to sitting and supine positions.

A case-control study on insulin resistance, metabolic co-variates & prediction score in non-alcoholic fatty liver disease.

Background & objectives: Asian Indians have a high prevalence of insulin resistance and the metabolic syndrome. Currently, non-alcoholic fatty liver disease (NAFLD) is considered to be an integral part of the metabolic syndrome with insulin resistance as a central pathogenic factor. We studied anthropometric parameters, insulin resistance and metabolic co-variates in subjects with NAFLD as compared to those without NAFLD, and also developed a prediction score for NAFLD. Methods: Thirty nine subjects with NAFLD and 82 controls were selected for the study after ultrasonography of 121 consecutive apparently healthy subjects. Anthropometric profile [body mass index (BMI), waist circumference (WC) etc,], lipid profile, hepatic aminotransferases, fasting blood glucose (FBG), insulin were recorded and value of homeostasis model assessment of insulin resistance (HOMA-IR) was analysed. Step-wise logistic regression analysis and area under the receiver operator curve (aROC) were analysed to arrive at a prediction score. Results: Overall, prevalence of NAFLD was 32.2 per cent and prevalence of metabolic syndrome was seen in 41 per cent among cases and 19.5 per cent in controls (P<0.01). Subjects with NAFLD had significantly higher values of BMI, WC, hip circumference, FBG, fasting insulin, total cholesterol and serum triglycerides. Step-wise logistic regression analysis showed odds ratio (OR) and 95 per cent confidence interval (CI) for BMI [ 4.3 (1.6, 11.3)], FBG [5.5 (1.5, 19.8)] and fasting insulin [ 2.4 (1.0, 5.8)] as independent predictors of NAFLD. The prediction score for NAFLD was; 1 (fasting insulin) +1.6 (BMI) + 1.9 (FBG) (sensitivity of 84.6%, specificity of 51.2% and aROC 76%). Interpretation & conclusion: In this study, presence of NAFLD indicated close relationship with multiple features of metabolic syndrome. The prediction score developed could be used as a screening tool to predict NAFLD among Asian Indians in north India.

Distribution and cutoff points of fasting insulin in Asian Indian adolescents and their association with metabolic syndrome.

AIM: To evaluate the levels and appropriate cutoff points of fasting insulin, and their association with the metabolic syndrome (MS) in Asian Indian adolescents. METHODS: This cross-sectional, population based study included 948 (527 males & 421 females) adolescent subjects aged 14-19 years selected randomly from New Delhi, India. Cutoff points of fasting insulin were defined using Receiver Operating Characteristics curve analysis against overweight, abdominal obesity and high subscapular skinfold thickness. The MS was defined according to NCEP, ATP III and IDF criteria using age-, gender- and ethnicity-specific cutoff points. RESULTS: Fasting insulin levels peaked at 16 y and reduced subsequently in both genders. The derived cutoff points for fasting insulin (pmol/L) were: 14-15 y- 128.5 and 164.8; 16-17 y- 126.1 and 152.8; 18-19 y- 121.2 and 162.4 in males and females, respectively. Prevalence of fasting hyperinsulinemia (39.1%) and MS (NCEP 2.2%, IDF 1.5%) was highest in age group 16-17 years. CONCLUSION: The data from this first study describing the distribution and cutoff points of fasting insulin in Asian Indian adolescents may be helpful for detection of and application of primary prevention strategies for fasting hyperinsulinemia and the metabolic syndrome in this population.

Derivation of a prognostic equation to predict in-hospital mortality and requirement of invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease.

OBJECTIVE: Predicting in-hospital mortality and formulating a scoring system derived from predictors of mortality may aid prognostication. METHODS: One hundred and fifty-one consecutive patients admitted with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were followed to discharge or death in hospital stay. Secondary variables studied were duration of hospital stay, and need for and duration of mechanical ventilation (MV). RESULTS: Mean (SD) age of patients was 60.5 (11.4) years; 65.6% were mechanically ventilated, and 25.2% died in hospital. Independent predictors of mortality at admission were serum creatinine (odds ratio [OR] 2.1, 95% Confidence intervals [CI] 1.03 to 4.30; p = 0.04), and serum sodium (OR 0.94, 95% CI 0.90 to 0.99; p = 0.03). An equation derived [Score = 8+ (0.74 x creatinine) = (0.015 x sodium)] to predict mortality, had an area under receiver operating characteristic (ROC) curve of 73%, with a cut-off of 6.74 having sensitivity, specificity, positive and negative predictive values for predicting death of 71%, 64%, 40% and 87%, respectively. Glasgow coma scale (GCS), partial pressure of oxygen in arterial blood (PaO2) and partial pressure of carbon dioxide in arterial blood (PaCO2) at admission independently predicted need for invasive ventilation. An equation derived [Score = 2.36+(0.02 x PaO2)+(0.05 x PaCO2)-(0.47 x GCS)] to predict need for MV, had an area under ROC curve of 85%, with a cut-off of 0.54 having sensitivity, specificity, positive and negative predictive values for predicting need for MV of 82%, 81%, 89% and 70%, respectively. CONCLUSIONS: Serum creatinine and sodium at admission are independent predictors of mortality for patients admitted with AECOPD. The equation derived from these two variables is a simple and useful method for predicting outcome.

General pharmacology of Vitex leucoxylon Linn leaves.

Ethanol extract (ETE) and cold aqueous infusion (CAI) of Vitex leucoxylon leaf were evaluated in a battery of tests to define the activity profile of the plant. CAI depressed SMA, antagonised d-amphetamine stereotypy and oxotremorine tremors, shortened the duration of mice immobility in behavioural 'despair' test and lowered serum total cholesterol level. ETE showed significant inhibition of carrageenin paw oedema and granulation tissue formation in rats. Suppression of acetic acid writhing was observed with both ETE and CAI. LD50 value of ETE was > 3000 mg kg-1 (ip) and that of CAI 1050 (800-1200) mgkg-1.

Treatment and prevention of plasmodium falciparum malaria

Malaria remains the most prevalent and devastating public health problem in Africa despite considerable research and control efforts over the last two decades. Chloroquine in total dose of 25mg/Kg over three days is the first choice treatment of malaria in 4-aminoquinoline sensitive areas. Amodiaquine 25mg/Kg over three days is the second line treatment. Pyrimethamine/sulphonamide combinations are useful in areas where resistance to 4-aminoquinolines exist. Quinine 10mg/Kg every eight hours for seven days is the treatment of choice for severe and complicated malaria. In most parts of Africa; Proguanil 200mg daily together with chloroquine 5 mg/Kg per week is recommended for prophylaxis. However; in hard core multi-drug resistance areas; mefloquine 250mg once weekly together with chloroquine 300mg weekly is recommended. Because no anti-malarial drug can guarantee absolute protection against infection; basic preventive measures like the use of mosquito nets impregnated with permethrin; insecticides and mosquito repellents are advocated for those at high risk of severe malaria

Potassium homeostasis during & after cardiopulmonary bypass.

Potassium homeostasis was studied in 30 patients undergoing cardiac surgery by employing cardiopulmonary bypass (CPB) and moderate hypothermia, and using morphine, N2O, relaxant anaesthesia. There was a trend for hypokalemia, and for maintaining a K+ level of 4-4.5 mmol/l, K+ infusion was required during CPB (9.017 mmol/m2 BSA/h). K+ infusion required in the post-operative period was considerably less (1.532 mmol/m2 BSA/h). There was no significant difference in the K+ levels of patients receiving preoperative diuretic therapy, as compared to those not receiving such therapy. Potassium requirement was significantly higher in patients under-going CABG and valvular heart disease, as compared to congenital heart disease. The mean urinary loss of K+ during bypass was found to be 2.95 mmol/m2 BSA/h, which was only 32 per cent of that required to be infused (9.017 mmol/m2 BSA/h). The mean excretion of K+ in the post operative period was significantly higher (4.53 mmol/m2 BSA/h) than K+ required to be infused during this period (1.532 mmol/m2 BSA/h).

Myocardial dysfunction in diabetic rats: influence of beta-adrenoceptor blockade (propranolol).

The effects of a beta-blocker, propranolol, on the enzyme and isoenzyme activities in the heart muscle in vitro and concomitant histopathology of the component cells of the islets of Langerhans were studied in the Wistar rats after treatment with streptozotocin and isoproterenol. The biochemical data indicated that the isoproterenol induced myocardial infarction (MI) precipitates an acute diabetic response in the rat heart. The superimposition of MI in diabetes mellitus caused significant inhibition of phosphofructokinase and hexokinase in the heart muscle. The lactate dehydrogenase depicted shifting of H-type to M-type in diabetes with or without MI. The drugs, when administered in combination, brought distinctive histopathological changes in beta-cells of the pancreatic islets including degranulation, hyalinosis and a near-total destruction; however A and D cells remained more or less unaffected. The effect of propranolol in diabetes mellitus was uncertain but in MI with or without prior diabetes, the drug inversely altered the activities of all the cardiac enzymes, besides stimulating a mild recuperation of the cells of the endocrine parenchyma.

Carbohydrates, lipids and lipoproteins and islet changes in diabetes with superimposed myocardial infarction.

Short-term metabolic and concomitant morphologic effects of streptozotocin diabetes on isoproterenol-induced myocardial infarction was studied in Wistar rats, Of particular significance was the observation that myocardial infarction in concert with diabetes brought about a distinctive exacerbation of the severity and complexity of the histopathological lesions. Of all the biochemical parameters, serum glucose and free fatty acids registered maximum elevation and serum lactate and cardiac glycogen levels a maximum reduction. Among the lipoproteins, an inverse relationship was found between high density lipoproteins and low density and very low density lipoproteins; while high density lipoproteins, ratio of high density lipoprotein to low density lipoprotein and the percentage of high density lipoprotein were decreased, there was a significant increase in low density lipoprotein concentration and percentage values of low density and very low density lipoproteins. In diabetes, the Β cell of the endocrine pancreas depicted selective necrosis. Loss of insulin granules and wide-spread necrobiosis of cellular elements of the pancreatic islets were observed, respectively, in myocardial infarction and in diabetes plus myocardial infarction combinations. Pathological evidence of chemical-induced mild toxicity was present in the exocrine parenchyma. Mitotic features and the presence of centroacinar cells in the damaged Langerhans’ islets supposedly formed the basis of regeneration of the tissue in diabetes, with or without vascular complications.

Effects of some drugs on islet function in catfish.

Blood glucose variations and concomitant bioptical cytopathological changes in the pancreatic islets following treatment with certain drugs were studied in the catfish. Glucose loading produced a dose-related hyperglycemia, maximum within 3 hr, while alloxan caused a biphasic rise in glucose level without induction of permanent diabetes. Streptozotocin elicited a monophasic hyperglycemic state at a lower dose and biphasic response at higher doses. Glybenclamide produced hypoglycemia in normal and sham-operated fish; the depancreatized animals were unresponsive to this treatment. In all the cases, normoglycemic values were restituted within 4 days of the treatment. The beta-cells of the islets underwent varying histopathological changes with signs of regenerative activity. A depletion in heavy metal (zinc) in these cells was also evident after treatment with streptozotocin.