Study of Socio-Demographic Factors among Injured Persons in a District of Western Uttar Pradesh – A Cross Sectional Study.

Background: Injuries are becoming major public health problem worldwide and since India is also passing through a major socio-demographic, epidemiological and technological transition; injuries are coming up as an emerging health problem. Objectives: To fi nd out prevalence of “Injuries” and role of socio demographic factors related with injuries. Material & Methods: It is a type of observational study in rural & urban area of Agra district. Th e area to be surveyed was selected by multistage stratifi ed random sampling technique. A recall period of three months for minor injuries & one year for major injuries or deaths due to injury was used. A total of 4 villages covering 2439 population and in urban area 2 mohalla & 2 slums covering 2410 population were surveyed. Data collected was entered on Fox. Pro (vs. 2.6) and analyzed by SPSS (vs. 10). Results: A total of 93 persons in rural and 142 persons in urban had major while 147 peoples in rural and 200 peoples in urban had minor injuries during the recall period. It was found that as the age increases the number of minor injuries increased from 0-35 yrs while decreased after that and maximum major & minor injuries were found in 16-35 yr age group. Regarding socio-economic class maximum injuries both major & minor were found in class IV (lower middle). Conclusions: Considering the high morbidities due to injuries focusing health education eff orts based on local epidemiology and behavioral practices is needed.

Evaluation of the effectiveness of diagnostic & management decision by teleophthalmology using indigenous equipment in comparison with in-clinic assessment of patients.

Background & objectives: There is a concern on the quality and the usefulness of teleophthalmology images, particularly those using indigenous equipment, in making a diagnosis and treatment decisions in ophthalmology. The present study was done to compare the level of agreement and sensitivity and specificity of diagnosis and management decisions of various eye diseases by teleophthalmology using indigenous equipment, compared to the in-clinic assessment. Methods: Patients having different eye diseases were evaluated by two ophthalmologists – one ophthalmologist examined the patient in clinic setting while the other ophthalmologist made the diagnosis and management decision based on images sent by teleophthalmology. The images were taken by the ophthalmic technician using digital imaging system and fundus camera. The clinical findings and management decisions by the two ophthalmologists were masked to each others. Results: In diagnosis of anterior segment eye diseases such as cataract and corneal diseases there was good to very good agreement (kappa values of 0.68 and 0.91 for cataract and corneal diseases respectively) between in-clinic assessment and assessment by teleophthalmology. There was moderate agreement (kappa values of 0.52 and 0.48 for glaucoma and retinal diseases respectively) between in-clinic assessment and assessment by teleophthalmology for the diagnosis of glaucoma and retinal diseases. For the management decisions of patients, there was moderate level of agreement in all groups of eye diseases. Interpretation & conclusions: Teleophthalmology, using indigenous equipment was found to be effective in diagnosis and management decision of anterior segment eye diseases such as cataract and cornea, and with some modification and continuous training to the technicians could become an effective tool for screening and referral of glaucoma and retinal diseases.

Effect of Disease Related Variables on Treatment Outcome Under DOTS.

The study was undertaken to assess the effect of various disease related variables on treatment outcome of patients treated under Directly Observed Treatment Shortcourse (DOTS) chemotherapy. The objective of the study is to identify the factors which affect treatment outcome and are responsible for default. This Cross sectional study was carried out at three TUs (Tuberculosis Unit) of Agra city, Uttar Pradesh, India. Two DMCs (designated microscopy centers) were selected randomly from each TU. All the patients from the DOTS centers under these DMCs registered during January to December 2007 were included in the study until the sample size of 900 patients was complete. Treatment cards of these patients were obtained from their respective DMCs after their outcome had been recorded. Chi-square test was used for statistical analysis. 71.6% patients had favorable outcome while 15.1% defaulted. Defaulter were more among category-II (26.4%), pulmonary cases (18.2%) and retreatment cases (28.4% among treatment after default, 18.8% among failure and 42.9% among relapse cases), while 19.4% & 18.3% of patients among sputum positive & negative patients defaulted. Deaths were also more among pulmonary (8.0%), category II (12.3%) & treatment after default cases (11%). Favorable outcome was observed among 80.4% of new patients, 72.8% of category I patients and 85.7% of category III patients. 83.5% of patients with extra pulmonary disease had favorable outcome, while only 67.4% of pulmonary TB patients had favorable outcome. Present study concludes that default to treatment is more among category II patients, retreatment cases and patients with pulmonary disease.

Effect of Disease Related Variables on Treatment Outcome Under DOTS.

The study was undertaken to assess the effect of various disease related variables on treatment outcome of patients treated under Directly Observed Treatment Shortcourse (DOTS) chemotherapy. The objective of the study is to identify the factors which affect treatment outcome and are responsible for default. This Cross sectional study was carried out at three TUs (Tuberculosis Unit) of Agra city, Uttar Pradesh, India. Two DMCs (designated microscopy centers) were selected randomly from each TU. All the patients from the DOTS centers under these DMCs registered during January to December 2007 were included in the study until the sample size of 900 patients was complete. Treatment cards of these patients were obtained from their respective DMCs after their outcome had been recorded. Chi-square test was used for statistical analysis. 71.6% patients had favorable outcome while 15.1% defaulted. Defaulter were more among category-II (26.4%), pulmonary cases (18.2%) and retreatment cases (28.4% among treatment after default, 18.8% among failure and 42.9% among relapse cases), while 19.4% & 18.3% of patients among sputum positive & negative patients defaulted. Deaths were also more among pulmonary (8.0%), category II (12.3%) & treatment after default cases (11%). Favorable outcome was observed among 80.4% of new patients, 72.8% of category I patients and 85.7% of category III patients. 83.5% of patients with extra pulmonary disease had favorable outcome, while only 67.4% of pulmonary TB patients had favorable outcome. Present study concludes that default to treatment is more among category II patients, retreatment cases and patients with pulmonary disease.

Efficacy of hydrocortisone acetate/hyaluronidase vs triamcinolone acetonide/hyaluronidase in the treatment of oral submucous fibrosis.

Background & objective: Oral submucous fibrosis is a common premalignant condition caused by chewing arecanut and other irritants in various forms. Its medical treatment is not yet fully standardized, although the optimal doses of its medical treatment is in the form of hydrocortisone acetate combined with hyaluronidase. The problem with the prevailing treatment was injections at weekly interval. In this study we compared the efficacy of hydrocortisone acetate and hyaluronidase at weekly interval versus triamcinolone acetonide and hyaluronidase at 15 days interval. Methods: Patients of OSMF (100) were randomly divided into two groups A and B. Group A patients received combination of hydrocortisone acetate (1.5 ml)/hyaluronidase (1500 IU) at weekly interval submucosally in pterygomandibular raphe, half dose on each side for 22 wk. Group B patients received combination of triamcinolone acetonide (10 mg/ml)/ hyaluronidase (1500 IU) at 15 days interval for 22 wk. Treatment outcome was evaluated on the basis of improvement in symptom score, sign score and histopathological improvement. Student’s ‘t’ test was applied for comparing the results. Results: No statistically significant difference in symptom score, sign score and histopathological improvement was seen between the two groups. Interpretation & conclusion: Treatment regimen of group B was more convenient to the patients because less number of visits required and cheap. No side effects were seen. A follow up study is required to see long term effects.

Rapid assessment of immunization practices in Agra district.

A cross sectional study was conducted utilizing rapid assessment procedures, covering 516 children of 12-23 months in 80 clusters of both urban and rural areas of district Agra. The results revealed that 41.5% had immunization cards; only 37.2% children were fully immunized and 37.6% children were unimmunized. 43.6% had received measles vaccine. The most common reason for non immunization was obstacles (46%), followed by lack of motivation (22.6%), lack of information (19.4%). 13.8% had received vitamin-A oil along with measles vaccine while only 5.3% had received vitamin A upto three years.

Prepatent detection of Fasciola gigantica infection in bovine calves using metacercarial antigen.

Metacercarial antigen of Fasciola gigantica was evaluated for early immunodiagnosis of experimental bovine fasciolosis using ELISA and Western blot. In ELISA, the experimental F. gigantica infection was detected as early as 2 weeks post-infection (WPI). The gradual increasing trend of antibody level was observed from 2 to 7 WPI, followed by a plateau, which was maintained up to 14 WPI. In Western blot, sera from experimentally infected calves recognized one distinct polypeptide of 21 kDa in fractionated metacercarial antigen as early as 10th day post infection. From 2 WPI, more polypeptide bands were reacting. Recognition of these protein bands persisted till the end of the experiment (14 WPI). Cattle sera collected from the field showed 34.5% seroprevalence of fasciolosis by ELISA using MAg. Comparative immunoblot studies of metacercarial antigen with anti-Gigantocotyle explanatum and anti-Paramphistomum epiclitum sera revealed that 21 and 25 kDa polypeptides of metacercarial antigen did not cross-react with any of these sera and appear to be unique to F. gigantica and having the desirable qualities of early and specific immunodiagnosis.

Single strand confirmation polymorphism (SSCP) detection in exon I of the alfa-lactalbumin gene of Indian Jamunapari milk goats (Capra hircus)

The genetic diversity of Jamunapari goats (Capra hircus) was investigated using an optimized non-radioactive polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) method to detect alfa-lactalbumin polymorphism in a sample of 50 goats. Our data show that PCR-SSCP is an appropriate tool for evaluating genetic variability in Jamunapari goats. Polymorphism was detected in the sample, indicating that Jamunapari goats have high genetic variability at loci, exon I of the a-lactalbumin gene. This result opens interesting prospects for future selection programs and conservation strategies. These a-lactalbumin variants can be sequenced and screened in the population to develop single nucleotide polymorphism (SNP) markers for association studies and marker assisted selection.

Pre and post-treatment histopathological changes in atrophic rhinitis.

Atrophic rhinitis is a chronic debilitating nasal mucosal disease of unknown etiology. It is characterized by progressive nasal mucosal atrophy, crusting, fetor and enlargement of the nasal space with paradoxical congestion. The disease induces bilateral nasal obstruction and a persistent foul odour of which the patient and by-standers are painfully aware. Primary atrophic rhinitis has decreased markedly in incidence in the last century. However the prevalence still remains high in developing countries like India. Histopathological features allow this entity to be distinguished from chronic non-specific hypertrophic rhinitis, which may have a cell-mediated immune basis underlying its pathogenesis. Histopathological examination of primary atrophic rhinitis was performed on biopsy material from 30 patients. Mucosal atrophy, squamous metaplasia, and chronic inflammatory cell infiltrate were found to characterize this disease.

Comparative diagnostic potentiality of ELISA and dot-ELISA in prepatent diagnosis of experimental Fasciola gigantica infection in cattle.

A glycoprotein (27 kDa) was isolated from crude somatic antigen of Fasciola gigantica by two steps affinity chromatography and was used in early detection of experimental fasciolosis in cattle by indirect ELISA and in dot-ELISA formats. Although, anti-27 kDa antibodies could be detected after 3 weeks post infection (WPI) by dot - ELISA which was one week later than indirect ELISA. The test, dot-ELISA, was more convenient in field application. By the test (dot-ELISA) the infection could be equally detected in animals infected with 100, 200 and 300 metacercariae of F. gigantica with high sensitivity. Further, the antigen (27 kDa) was not found to react with goat sera infected with Paramphistomum epiclitum, which are giving strong reaction to homologous immature and mature fluke antigens of P. epiclitum.

Radiological and antroscopic study of maxillary antrum in multibacillary leprosy patients.

Sixty consecutive patients having multibacillary leprosy were examined for symptoms of nasal involvement and sinusitis. A complete ENT examination was carried out of all these patients and they were subjected to radiological examination of paranasal sinuses. Radiological abnormalities of maxillary antrum were found in 15 of 20 cases of lepromatous leprosy, 6 of 26 cases of borderline lepromatous and in 14 cases of mid-borderline leprosy. Localized or generalized mucosal thickening was the most common finding, followed by opacity of maxillary antrum. Radiological abnormalities were confirmed by antroscopy, which is the most appropriate technique for making an accurate diagnosis of maxillary antral diseases. Initially, antral involvement may begin with a localized area of mucol erythema, progressing to a typical granuloma formation and ulceration. The antero-inferior part of the antrum was found to be the most commonly affected region.

Pleomorphic lipoma of the tonsillar fossa--a case report.

Pleomorphic lipoma is a benign adipocytic tumor, commonly located in the shoulder and posterior neck region. The presence of bizarre, hyperchromatic stromal cells along with multinucleated giant cells often poses difficulty in diagnosis, especially when it arises at an unusual site like tonsillar fossa.

Cytohistological study of urinary bladder neoplasms.

Eighty patients presenting with painless hematuria and 24 patients of transitional cell carcinoma bladder coming for follow up were included in this study to assess the role of exfoliative (voided urine) and lavage (saline lavage) cytology in initial diagnosis and follow up of the patient with carcinoma bladder. Freshly voided urine samples and saline lavage bladder washing samples were collected. A thorough cystoscopic examination was done and biopsy was taken from any apparent growth. Cytological smears were stained with hematoxylene and eosin and PAP's stain, histology sections were stained with hematoxylene and eosin. A statistically significant correlation (p < 0.001) was observed between the increasing grade of malignancy and cytopositivity. A good association was observed between histology and two methods of cytology (p < 0.01). The sensitivity, specificity and overall diagnostic accuracy of lavage cytology was more as compared to exfoliative cytology (71.05%, 56.0%, 78.85% Vs 47.37%, 41.18% and 61.54%). Cystopositivity was more with single large sessile tumour as compared to multiple small pedunculated tumours. Cytohistological discrepancy was observed in patients of transitional cell carcinoma with recurrence. It is concluded that cytology may act as a good adjuvant to histology in picking up early flat lesions and/or follow up of patients with transitional cell carcinoma.

Gall stones and carcinoma gall bladder.

One hundred and fifty surgically resected gall bladder specimens were included in the study to evaluate the relationship between the prevalence of gall stones and histochemical alteration in sequential changes of metaplasia, dysplasia and neoplasia in gall bladder epithelium. Multiple sections were processed and stained with haematoxylin and eosin, Periodic acid Schiff's stain, Alcian blue (pH 2.5)/Periodic acid, Orcein/Alcian blue (pH 2.5) and Alcian Blue/Periodic acid/Potassium borohydride saponifications stains. Details of gall stones present were also noted. Prevalence of gall stones in gall bladders with metaplastic, dysplastic and neoplastic mucosal changes was significantly higher (P < 0.001) than those gall bladders which had no epithelial changes. Increase in sialomucin with a corresponding decrease in sulphomucin was observed from metaplasia to malignancy. Neutral mucin increased in metaplastic cells but was significantly reduced in neoplastic cells. Loss of O-acylation in sialmucin was also present in neoplastic cells. The histochemical changes suggest that chronic injury due to cholelithiasis induces appearance of neutral mucin positive metaplastic cells, which may further dedifferentiate to sialomucin containing dysplastic or neoplastic cells if the stimulation persists.

Immunization of rabbits against Hyalomma anatolicum anatolicum using homogenates from unfed immature ticks.

Antigens were prepared from unfed larvae and nymphs of H. a. anatolicum as homogenised antigens (HLAg and HNAg, respectively). Five rabbits each were inoculated, s.c. with 8.56 mg HLAg and 9.34 mg HNAg in 3 divided doses. Following immunisation rabbits developed significant level of protective immunity to infestation with adults of this species. Significant reduction in engorged percentage and weights of engorged females and egg masses were observed in females fed on immunized rabbits, compared to that of female ticks fed on control rabbits. The engorgement period was also increased significantly. However, conversion efficiency indices remained unaffected. Larval antigen immunized rabbits showed significant antibody level from 28-126 days while with HNAg elevated antibody levels were recorded up to 112 days. Further, the rabbits immunized with HLAg had elevated level of antibodies against HLAg, HNAg, and adult antigen in ELISA. But HNAg immunized rabbits had lower levels of antibodies against HLAg and HAAg as compared to values recorded against HNAg. Anti-HLAg and anti-HNAg sera recognised common antigenic bands of 97.4, 85, 66, 47.3, 42 and 31 kDa in homogenates of larvae, nymphs and adults.

A, B & H isoantigens in cervical lesions.

Expression of A, B and H isoantigens in cervical mucosa was demonstrated by specific red cell adherence test in 92 cervical lesions (40 chronic cervicitis, 12 dysplasia and 40 carcinoma cervix). Eighty percent cases of chronic cervicitis showed a moderate reaction. On the contrary, in carcinoma cervix, 75% cases were found to be SRCA negative. In dysplasia, the intensity of red blood cell adherence was found to be directly related to the degree of cellular differentiation. Study of A, B and H isoantigens might help in deciding the prognosis of dysplasia and/or early detection of malignancy.