A study of timed get up and go scores as falls risk assessment in elderly in a tertiary care centre

Background: Early detection of falls risk in the community dwelling elderly helps to take preventive measures to avoid falls and hence decrease morbidity associated with falls. Falls are a serious threat to independent living and self-confidence of the elderly. Using simple tools to determine risk of falls helps in early detection and prevention of falls. Aims and objectives of the study was to establish TUG data among patients attending the geriatric clinic at MGM hospital, Kamothe and to determine risk of falls in these patients with respect to their systemic involvement.Methods: A prospective observational study of 100 geriatric age group patients were studied for their TUG scores and classified based on systems involved. TUG was performed using standard protocol and scores were stratified based on gender, age and diagnosis. Participants were required to perform TUG and were instructed to rise from an armless chair walk 3 meters and turn around at the chalk mark, walk back, and sit. They were instructed to walk at a normal pace without walking aids and shoes. Time was recorded when participants’ buttocks were lifted off the chair to stand and stopped when the buttocks touched the seat when returning to sitting position.Results: The results showed that the average TUG score of this cohort of 100 patients attending our geriatric outpatient clinic was 13 sec. 60 Males and 40 females were analyzed of which  38 patients had less than 12 s  as TUG score and 62 patients  had more than or equal to 12 sec  as TUG score. Maximum number of patients undergoing the TUG test had musculoskeletal complaints. Yet patients with respiratory conditions had the highest mean TUG score of 14 sec and patients with abdominal and CNS conditions had lowest mean TUG scores.Conclusions: This study of TUG score of cohort of 100 patients showed that average TUG score was 13 sec which was higher than  12 second mark which indicates that these patients who did not have any previous fall had a  risk of future falls and hence a requirement of  an in depth  mobility assessment and early intervention.

Sero-prevalence of Rubella Antibodies in Pregnant Women with Bad Obstetric History Attending A Rural Tertiary Care Hospital in West Bengal, India

Background: Rubella infection in pregnant mothers is of great concern as it acts as a teratogen causing abortions, still births, intra-uterine foetal deaths and multiple birth defects. In India, rubella causes significant bad obstetric pregnancy outcome including congenital deformities due to lack of proper surveillance and immunization coverage with rubella vaccination. Aim: To determine Sero-prevalence of rubella IgM and IgG antibodies in Bad Obstetric History (BOH) pregnant women in Tertiary Rural Medical College in Eastern India. Materials and Methods: Cross sectional study was conducted from 1st January 2017 to 31st March 2017 on sera of 100 antenatal mothers with bad obstetric history aged between 20-40 years of age group with pregnancy of ≥18 wks. Rubella IgM and IgG antibodies were assessed by ELISA. Statistical Analysis: Percentage, proportions and ᵡ2 test were applied. Results: Eleven per cent (11%) sero-prevalence for IgM antibodies and 54% for IgG antibodies was observed with maximum sero-positivity among 20-25 years mothers. Repeated abortions were the commonest pregnancy outcome. Conclusion: All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and foetal outcome and strong recommendation for universal coverage of MMR in early age group of children.

Sero-prevalence of Rubella Antibodies in Pregnant Women with Bad Obstetric History Attending A Rural Tertiary Care Hospital in West Bengal, India

Background: Rubella infection in pregnant mothers is of great concern as it acts as a teratogen causing abortions, still births, intra-uterine foetal deaths and multiple birth defects. In India, rubella causes significant bad obstetric pregnancy outcome including congenital deformities due to lack of proper surveillance and immunization coverage with rubella vaccination. Aim: To determine Sero-prevalence of rubella IgM and IgG antibodies in Bad Obstetric History (BOH) pregnant women in Tertiary Rural Medical College in Eastern India. Materials and Methods: Cross sectional study was conducted from 1st January 2017 to 31st March 2017 on sera of 100 antenatal mothers with bad obstetric history aged between 20-40 years of age group with pregnancy of ≥18 wks. Rubella IgM and IgG antibodies were assessed by ELISA. Statistical Analysis: Percentage, proportions and ᵡ2 test were applied. Results: Eleven per cent (11%) sero-prevalence for IgM antibodies and 54% for IgG antibodies was observed with maximum sero-positivity among 20-25 years mothers. Repeated abortions were the commonest pregnancy outcome. Conclusion: All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and foetal outcome and strong recommendation for universal coverage of MMR in early age group of children.

Estimation of patient perception on hygiene standards in a tertiary care hospital, West Bengal: A questionnaire-based study

Background: Maintenance of hygiene is very important to lead a healthy, disease-free life. Lack of hygiene increases the chance of communicable and non-communicable diseases. Wastes generated by the hospitals increase the chance of nosocomial infections. Objective: The present study deals with the patient’s perception about hygiene and sanitation rendered by the hospitals. Materials and Methods: The present study was a questionnaire-based cross-sectional survey. The data were collected from the indoor patients admitted in the Department of Surgery, Obstetrics and Gynecology, and General Medicine during December 2016–January 2017 at a Medical College in Kolkata. Results: In the present study, a total of 150 patients were taken as study population, of which majority of them were female. The major age group of the study population was 32–39 years, 33 (22%). In the present study, 93.33% of patients responded that the food was hygienic, 90% of patients opined that all housekeeping staffs used their protective equipment while they were collecting the garbage in this hospital, and 78% of patients agreed that the dustbins were cleaned regularly. Conclusion: In order to improve patients’ compliance and reduce the sufferings, evaluation of to hospital hygiene is of utmost importance. Awareness programs should be implemented in hospitals and health-care centers about the importance and maintenance of hygiene. This would reduce the chances of hospital-borne infections not only for the patients but also for the hospital workers.

A clinical study of COPD in elderly with special reference to HRCT chest and PFT

Background: Chronic Obstructive Pulmonary Disease (COPD) is defined as a preventable and treatable lung disease with some significant extra-pulmonary effects. Pulmonary component is characterized by airflow limitation that is not fully reversible, usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles and gases. Elderly patients are more prone to COPD due to the reduction in the immune power along with the muscle weakness of the chest wall and bone weakness. Aim and objectives: To study the COPD in elderly with reference to HRCT chest and PFT, to study the pattern of pulmonary involvement in COPD in elderly. Materials and methods: It was Prospective observational study. Study population was elderly patients (age ≥60 years) detected having COPD (both in-patient and out-patient) attending MGM Hospital for treatment. Detailed history was taken from patient, particularly history of symptoms like fever, cough, shortness of breath, weight loss, night sweat etc. Thorough physical examination of all the systems with special emphasis on respiratory system was done. Results: Total 50 patients were enrolled in the study. Majority of the patients (44%) were in the age group of 60-70 years followed by 32% in the age groups of 70-80 years and 24% patients in the age group of >80 years. The mean age of the patients was 72.76±7.58 years. There was male preponderance (72%) in the study. Majority of the male patients were smokers (61%). Dyspnoea (76%), cough (68%), sputum production (64%) were the common symptoms. Centriacinar emphysema (34%) was mostly observed. FEV1/FVC ratio ranged from 38-89% (mean 62.9+/- 18.52%) preinhalation, ranged from 45% to 90% (mean 69.26±15.08) post-inhalation. Conclusion: HRCT showed regional assessment of compartment involved and has greater sensitivity than chest radiography in early diagnosis of emphysema.

Nutritional Status of Rural Govt. Primary School Children in Khammam District, Andhra Pradesh, India.

Background: Rural school children are more vulnerable victims of undernutrition and its consequences. On that ground, rural govt. primary school children were examined on the basis of height, weight and few background variables to find real picture of nutritional status. Objective: To assess nutritional status of govt. rural primary school children in Khammam district, Andhra Pradesh, India. Materials and Methods: A cross sectional study adopting a multistage random sampling technique was conducted among 600 govt. primary school children of rural communities of Khammam district, Andhra Pradesh. Anthropometric measurement like weight for age and height for age was recorded to assess nutritional status. Data were collected by interview and physical examination and were analyzed with SPSS10.0 Results: Among 600 children, 36.0% were in Grade I malnutrition, 37.7% in Grade II malnutrition, 6.3% in Grade III and 19.0% of children were stunted and 4.0% were severely stunted. Girls (20.1%) were more stunted than boys (17.9%). Conclusions: The study concluded that despite adoption of several measures to curb the malnutrition, still high prevalence of undernutrition was observed in govt. rural primary school children in India and to be addressed properly immediately.

In vitro susceptibility pattern of Tigecycline against MRSA, ESBL producing Escherichia coli, Klebsiella species and Acinetobacter isolates in a rural tertiary care hospital.

Background: Tigecycline is the first commercially available glycycline, derivatives of the tetracycline antibiotics, having enhanced activity against various pathogens. In vitro activity has been demonstrated against multi drug resistant Gram positive and Gram negative pathogens like MRSA, ESBL producing Esch.coli and Klebsiella spp. and Acinetobacter Objective: To determine Tigecycline in vitro susceptibility pattern in MRSA, ESBL producing Esch.coli and Klebsiella spp. and Acinetobacter spp. Material and Methods: Investigations were carried out from August 2012-January 2014 to detect MRSA,ESBL producing Escherichia coli and Klebsiella spp. as well as Acinetobacter spp. by using a standard protocols and Tigecycline in-vitro susceptibility testing was done by Kirby Bauer Disc diffusion method and it’s MIC value against resistant isolates was evaluated.Statistical analysis was done by Fishers extract method. Result: Out of 107 Staphylococcus aureus isolates 52(48.59%) were MRSA, none of them showed resistance to Tigecycline. Out of 82 Esch.coli isolates 14 (i.e 17.07%) were ESBL producers, none of them showed resistance to Tigecycline.Out of 67 Klebsiella isolates 21 (i.e 31.34%) were ESBL producers out of which only 1 (i.e 4.76%) was resistant to Tigecycline.Out of 19 Acinetobacter spp.isolated 3 (i.e 15.78%) were resistant to Tigecycline. The MIC range for ESBL producing Eschcoli, Klebsiella spp., MRSA and acinetobacter spp were 0.14-0.45 μg/ml,0.25-2.4 μg/ml,0.12-0.26 μg/ml, 1-3.2 μg/ml respectively. Conclusion: The results of the study confirm the excellent in vitro activity of Tigecycline against Gram positive and Gram negative multidrug resistant pathogens.

A Case of Mirror Image Dextrocardia with Ostium Secundum Atrial Septal Defect.

Dextrocardia when associated with situs inversus usually has no structural defects. A case of dextrocardia with situs inversus and atrial septal defect (ASD) in a 14-year-old boy born of consanguineous marriage is reported because of its rarity.

A randomised multicentre study to compare the safety and efficacy of albendazole and metronidazole in the treatment of giardiasis in children.

A randomised control multicentre study to compare the safety and efficacy of albendazole and metronidazole in the treatment of giardiasis in children is reported. One hundred and fifty children of either sex (age range: 2-10 years) were randomised to receive either a single dose of 400 mg of albendazole suspension, or 22.5 mg/kg/day of metronidazole in 3 divided doses for 5 consecutive days. At the end of therapy, majority of children in both treatment groups were symptom free. Two days after completion of therapy, 97% of children in both treatment groups were giardia free in the stools. Side effects were noted in 3 children in the albendazole group, and in 20 children in the metronidazole group. We conclude that albendazole suspension is as effective as metronidazole in the treatment of giardial infection in children. It is safe and has fewer side effects as compared to metronidazole.

Study of foetal antigen in haematological malignancy.

Forty patients with different varieties of leukaemia and lymphoma were studied before and after therapy. Red cells and lymphocytes from each patient were tested for foetal antigen by lectin-agglutination test. The antigen was detectable on red cells in all untreated cases, the highest titre being found in chronic myeloid leukaemia. The titre showed significant reduction after treatment in all cases. We conclude that foetal antigen on red cells is a useful diagnostic aid in haematological malignancy and is a good indicator of the outcome of therapy.

Study of ascitic fluid in relation to systemic and portal venous blood in hepatic cirrhosis.

Twenty uncomplicated cases of cirrhosis of liver, proved by liver biopsy, and free from other systemic diseases were studied. Glucose (pre- and postprandial) and electrolytes (Na+, K+, Cl-) values were compared to those of systemic and portal venous blood. Chloride level in ascitic fluid was found to be significantly high in cirrhosis, as compared to portal and systemic venous blood. Sodium and glucose levels were similar in ascitic fluid and portal venous blood except in two cases complicated with tuberculous peritonitis, where pre- and postprandial glucose levels were considerably low. In 55% cases, there was impaired glucose tolerance, as measured by pre- and postprandial glucose levels in systemic venous blood.

Immunoclinical correlation in diabetes mellitus. A preliminary report on the lectin-agglutination test.

Twenty cases with insulin dependent diabetes mellitus (IDDM) were studied and compared with a control group with non insulin dependent diabetes mellitus (NIDDM) and another group of nondiabetic healthy persons. Lymphocytes of each group were tested for agglutination with three sets of lectins: concavalin A (ConA), soyabean agglutinin (SBA) and peanut agglutinin (PNA). SBA test, being highly positive in IDDM and persistently negative in NIDDM, is the most significant of the three tests for differentiating between the two types of diabetes mellitus.

Study of serum myoglobin and serum electrolytes in acute uncomplicated myocardial infarction.

Forty patients with uncomplicated acute myocardial infarction were studied within 6-18 hours after the infarction. Serum myoglobin was elevated in all the cases and was markedly high in cases studied 18 hours after the acute infarction, though the level did not show any relation with the severity of the attack. Myoglobin level showed no correlation with SGOT level, which did not rise appreciably within 6 hours. Serum sodium and potassium levels did not show any change, even in the most severe cases. Serum myoglobin estimation is thus a good diagnostic test in the early hours of acute myocardial infarction.

Studies on outbreak of viral hepatitis at Calcutta with special reference to serological investigations.

Sixty cases of acute viral hepatitis were studied from clinical, biochemical and in particular serological point of view. Majority of the patients had significant pre-icteric and icteric phase with moderate elevations of bilirubin, SGOT and SGPT and marginal elevations of serum alkaline phosphatase. Cholestatic features were observed only in 6.7% of cases. All subjects improved and there was no death in this series. Serological marker studies revealed hepatitis A in 8 (13.3%) cases and hepatitis B in 3 (5.0%) cases. Rest 49 cases were possibly due to non-A, non-B hepatitis. As there was no evidence of parenteral transmission, it was concluded that this epidemic was water borne from contaminated municipal water supply.

Abdominal aortic aneurysm with Leriche syndrome.

An interesting and unusual case of abdominal aortic aneurysm with Leriche syndrome that presented with multiple vasculopathies and peptic ulcer is being reported.