Could mid-upper arm circumference be a valid proxy to the body mass index for elderly persons?

Introduction: In elderly persons, due to physiological, anatomical, and functional changes, body mass index (BMI) may not be suitable for the assessment of nutritional status. Mid-upper arm circumference (MUAC) can be a proxy indicator to identify underweight and overweight/obesity among elderly persons. This study aimed to estimate the correlation between MUAC and BMI, and the cutoffs for MUAC using receiver operating characteristic (ROC) analysis. Material and Methods: This survey was carried out in a resettlement colony of Delhi. The participants were residents of the area who were aged 60 years or older, and selected by a simple random sampling technique. The arm span, weight, and MUAC of the participants were measured. The correlation between MUAC and BMI for gender and age group was calculated. The ROC curve was also constructed. Results: A total of 946 eligible participants were enrolled. The correlation between MUAC and BMI was 0.67 (P < 0.001) and 0.76 (P < 0.001) among men and women, respectively. The MUAC cutoff for underweight was <25 cm with a sensitivity of 68.8% and specificity of 84.9%. The area under the curve (AUC) was 0.84 (0.80–0.88). The MUAC cutoff for overweight/obesity was ?27 cm with a sensitivity of 83.9% and specificity of 64.9%, and AUC was 0.78 (0.75–0.82). Conclusion: The MUAC of the participants increased as the BMI of the participants increased. MUAC cutoff was determined using the ROC curve for underweight and overweight/obesity among elderly persons.

Excess Screen Time and its Associated Factors among Young Men in a Rural Community of North India

Screen-based media usage among young people is blooming rapidly due to technological and digital revolution. We conducted community-based cross-sectional study to determine the prevalence of excess screen time and its association with sociodemographic and behavioral patterns in a rural block of Haryana, India. Asemi-structured interview schedule was administered by trained physicians to ascertain screen time in a typical day and various socioeconomic and behavioral factors among a random sample of 860 young men aged 18–24 years. The prevalence of excess screen time was 61.8% (95% confidence interval [CI] 58.4–65.1). It was significantly associated with education (adjusted odds ratio [AOR] 1.7, 95% CI 1.1–2.6) and occupation (AOR 2.2, 95% CI 1.2–3.9) of the father and their sleep duration of ?8 h (AOR 1.6, 95% CI 1.2–2.3). Limiting the screen time as per international standards and behavioral interventions are needed for this young population.

To Evaluate the Feasibility of Flip Technique in Dissection of Gall Bladder from the Liver Bed in Laparoscopic Cholecystectomy and Its Comparison with Standard Laparoscopic Cholecystectomy

Background: Laparascopic cholecystectomy is one of the commonly performed surgery and is the procedure of choice for gall bladder disease. Time to time advancements are being made in this procedure to ease this surgery and also decrease its complication rate. And with the same purpose, a special technique named as 揊lip Technique� has been introduced in which, in order to make the dissection of gall bladder easier near the fundus, the gall bladder is flipped over the liver surface after initial dissection of the gall bladder from the liver bed. The study to find out the feasibility of this flip technique of gall bladder removal in laparoscopic cholecystectomy was done in 100 patients admitted in department of general surgery, Govt Medical College and Rajindra Hospital, Patiala. Aim: This study aims to evaluate the feasibility of Flip technique for dissection of gall bladder from the liver bed in laparoscopic cholecystectomy with regard to operative time, intraoperative bleeding, bile duct injury, liver bed injury, injury to gall bladder wall, duration of hospital stay and mortality (if any).Methods:The present study was prospective, observational and comparative trial and was conducted on 100 patients of either sex diagnosed as case of GBD and planned for laparoscopic cholecystectomy, admitted in surgical ward of Rajindra Hospital, Patiala.Results:Latrogenic GB rupture occurred in 2% of patients in group A (cases) and 12% of patients in group B (control). The difference was statistically significant (p value 0.05). Site of rupture in group A is fundus of gall bladder in 2% of patients and none of gall bladder rupture is seen at body or Hartman抯 pouch. In group B gall bladder rupture was found at fundus in 6% of patients, at body in 4% patients and Hartman抯 pouch in 2% of patients.Conclusions:The use of Flip technique was more advantageous as compared to standard method of gall bladder dissection from liver bed in laparoscopic cholecystectomy with the mean duration of surgery being shorter in Flip technique.

An Audit on Gastrointestinal Perforation in a Tertiary Care Teaching Hospital Based in Northern Part of India: A Study of 100 Cases

Background: A prospective study was conducted on 100 patients of perforation peritonitis: To find out the incidence of gastro intestinal perforation in various age groups, sex, riral or urban, socio economic status, To find out the various causes and sites of gastra intestinal perforartions, To determine various types of procedures being done to treat gastro intestinal perforations.Methods:The study population consisted of 100 patients of perforation peritonitis admitted at surgical wards of Rajindra Hospital, Patiala. Patients underwent necessary investigations such as Blood counts, biochemical analysis and urine analysis. X-ray Abdomen and chest / USG Abdomen/Pelvis CT-Abdomen (as and when required). All diagnosed patients were subjected to surgery. In all cases, operative findings and postoperative course were followed up for three months. Final outcome was evaluated on the basis of clinical, operative and radiological findings. In pre-pyloric and duodenal perforation, GRAHAM扴 PATCH REPAIR carried out. In Ileal and Jejunal perforations, primary closure or exteriorization done depending upon the condition of the gut and duration of the symptoms. The patient outcome was assessed by duration of hospital stay, wound infection, wound dehiscence, leakage/entero-cutaneous fistula, intra-abdominal collection/abscess, ileostomy related complications and reoperation. Wound infection was graded as per SSI grading.Results:Most common age group for perforation was 21-40 years (50%) followed by 41-60 (33%) years in present study. Mean age of the patients is 37.91 + 13.15 years with male predominance (78%) in our study. 4% of the patients were of upper socio-economic status while 32% of the patients were of middle and 64% of the patients were of lower socio-economic status.Abdominal pain was seen in 100% of the patients while abdominal distension was present in 69% of the patients. Nausea/Vomiting was seen in 61% of the patients while Fever and Constipation was seen in 53% and 86% of the patients respectively. Diarrhoea was seen in 3% of the patients. Tenderness, guarding & rigidity, distension, obliteration of liver dullness and evidence of free fluid were present in 100% of the patients. Bowel sounds were not detected in all the patients. Most common perforations were Duodena(37%), Ileal (25%), Gastric (25%) followed by Appendicular (9%), Jejunal (4%) and Colonic perforation (2%). The most common etiology of gastrointestinal perforations was Peptic ulcer followed by Typhoid, Appendicitis, Tuberculosis, Trauma, Malignancy and non-specific infection.In Gastric perforations, Peptic ulcer was the most common cause of perforation followed by Trauma. In Ileal perforations, Typhoid was the most common cause of perforation followed by Tuberculosis and non-specific infection. In Appendicular perforations, most common cause was Appendicitis. In Jejunal perforations, most common cause was Trauma. In Colonic perforations, most common cause was Malignancy.Conclusions:The incidence of gastrointestinal perforations was common in 21-40 years age group followed by 41-60 years age group with male preponderance in our study. The most common site of perforations was Gastro-duodenal followed by Ileal perforations and the most common cause for these perforations was peptic ulcer followed by typhoid. The most common procedure done to treat gastrointestinal perforations was primary closure, resection and anastomosis, appendectomy and stoma formation. However, small sample size and short follow up period were the limitations of the present study.

Sustainable control of malaria employing Gambusia fishes as biological control in Jalore and Barmer districts of Western Rajasthan

Sardar Sarovar Irrigation Canal system was constructed by Narmada Valley Development Authority (NVDA) to cater to drinking water as well as for irrigation purposes in Jalore and Barmer districts of Western Rajasthan. To cater to the needs of water for the villagers in the command areas, ‘Diggies’ (surface water tanks) with ‘Sumpwells’ (water supply surface tanks) were installed. In a health impact assessment study of the irrigation canals from December 2010 to February 2016, the breeding of two major malaria vectors. An. culicifacies and An. stephensi were observed in diggies and sumpwells. As a biological control, Gambusia affanis fishes were employed for larval control in such stagnated water sites during the intervention phase viz. February 2012 in 251 diggies and 251 sumpwells. A significant reduction of breeding in diggies (99.54%) and sumpwells (97.81%) was observed. The positivity and larval density (dip index) were monitored in the control from up to February 2016 for their sustainability.

Early fixation versus delayed fixation in cervical spine trauma patient with absent cough reflex in view of intensive care unit stay and cost effectiveness

Background: This study was conducted in GMC Jammu to evaluate ICU stay and cost effectiveness in patients with cervical spine trauma undergoing early fixation (within 24-72 hours after trauma) versus late fixation (delayed fixation after applying traction and waiting for return of cough reflex).Methods: Retrospective and prospective study was done by collecting data from admission register and patient follow-up during 2016-2019. 50 patients were admitted as cervical spine trauma, out of which 38 were operated upon and ten managed conservatively. 15 patients were operated within 72 hours of admission with absent cough reflex and 23 were put on cervical traction and operated upon after return of cough reflex.Results: Average ICU stay for 15 patients (4 females 11 males) immediately operated ranged from 10 to 15 days along with prolonged mechanical ventilation. Average ICU stay for 23 patients (16 males and 7 females) operated after returning of cough reflex ranged from 3-4 days with considerably decreased requirement of mechanical ventilation.Conclusions: Delayed fixation of cervical spine after returning of cough reflex shortens post-operative ICU stay and is considerably more cost effective than early fixation.

Surveillance of Major Canine Pathogens in Feral Dogs and Big Cats at the Domestic-Wildlife Interface in Panna Tiger Reserve, India

The present study was conducted at Panna Tiger Reserve of Madhya Pradesh for sero-surveillance for canine parvovirus (CPV), canine distemper virus (CDV) and canine adenovirus (CAV) infections in feral dogs. Biological samples were also collected from the wild carnivore species which were immobilized or died during the study period. Serum samples were subjected for detection of IgG antibodies against CPV, CDV and CAV infections. Additionally biological samples of wild carnivores were subjected to molecular diagnosis of CPV and CDV genes. Seroprevalence for CPV, CDV and CAV infections was observed as 3.5%, 4.4% and 0.89%, respectively, whereas for mixed infections of CPV+CDV, CPV+CAV, CDV+CAV and CPV+CDV+CAV, it was observed as 48.2%, 1.7%, 4.4% and 36.6%, respectively. Sex wise, age wise and distance wise seroprevalence was non-significant in the present study. Seroprevalence for CPV, CDV and CAV infections in cats was observed as 50%, 100 % and 0%, whereas in wild carnivores, it was observed as 100%, 90% and 0% respectively. PCR based diagnosis in the wild carnivore also revealed CDV positive cases. Serological and genomic evidence of pathogens in dogs-cats of buffer villages and wild carnivores of Panna tiger reserve indicated that the viruses may pose a high risk of spillover to wild carnivores. Study also indicated that dog population is immuned to major infectious diseases but can be a threat to the compromised wild carnivore species including tigers

Psychosocial and quality of life assessment in cancer patients: a pilot study in Indian set up

Background: Routine screening for distress is internationally recommended as a standard of care among cancer patients. This study was conducted to assess the level of stress and determine the association between quality of life (QOL) with demographic, socio-economic status, treatment phase, cancer stage, etc.Methods: An observational study, performed in the department of Clinical Oncology, Nayati Multi Super Speciality Hospital, Mathura, India. Data of 62 histopathologically proven cancer patients between Nov 2016 and July 2018, were analyzed. This pilot study was conducted to assess the QOL and stress levels of cancer patients by using scales of WHOQOL-BREF, QSC-R23 and Hamilton scale. Results: Among 62 cancer patients, high distress along with poor QOL was seen maximum in males, 40-60 year age group and educated. In majority of domains, high distress was found in middle class, whereas poor QOL was found in Lower class in Environmental domain (p<0.01). We found higher distress in nuclear families (p<0.05). High distress was seen in cancer patients who were aware of illness and was found to statistically significant. Poor QOL in stage 4 was found to be statistically significant in Psychological domain of WHOQOL-BREF. High distress was found in patients undergoing treatment in all patients as compared to Pre-treatment phase and Post-treatment phase (p<0.05).Conclusion: To assess psychological stress in cancer patients using all three scales we could not obtain a conclusive result covering all dimensions of QOL. So, in our next study authors plan to develop one indigenous new scale.

Retrospective analysis of random and systematic errors in radiation therapy of head and neck cancer patients and its clinical predictive implications with VMAT treatment

Background: The accuracy of radiotherapy is based on the matching of 2D portal/CBCT image with a reference image. The aim of this study is to determine the random and systematic setup errors (in cm) in radiotherapy of head and neck cancer patients and to derive the setup margin and its clinical implications.Methods: Author retrospectively reviewed the records of 25 head and neck cancer (HNC) patients treated with radiotherapy between Dec 2017 and July 2018. After immobilization, setup accuracy was assessed by registration of XVI image with planning reference image using Elekta XVI image guidance system and the isocenter correction was applied. For each patient 10 CBCT image sets were taken. The translational errors in X, Y and Z directions were used to estimate systematic (Σ) and random (σ) errors and to derive the final setup margin by using van Herk’s formula (2.5Σ + 0.7σ).Results: The mean translational errors ranges from -0.23 cm to 0.32 cm in Lateral (X), -0.15 to 0.16 cm in Longitudinal (Y) and -0.11 to 0.17 cm in vertical (Z) directions. The Mean and SD for systematic errors 0.21±0.13, 0.11±0.18, 0.14±0.11 and random error (in cm) are -0.03±0.33, 0.00±0.21 and 0.05±0.30 in X, Y and Z axis respectively. The final total margin for CTV to PTV including setup margin in the X, Y and Z directions (in cm) were 0.56, 0.61, and 0.47 respectively.Conclusion: Thus, the precise immobilization techniques are very important to reduce the setup margins, and the number of CBCTs during head and neck radiotherapy treatment.

Lack of bundled care intervention training program will trip up rates of ventilator associated pneumonia: the contemporary trend

Background: Ventilator associated pneumonia (VAP) is the deadliest hospital acquired infection in many low resource settings of developing countries. For VAP prevention, the concept of bundle of care was defined. Evidence based resources showed it enabled great successes in VAP prevention. It has been observed in clinical practice due to insufficient compliance, there is a need to address related issues in order to define easier-to-apply procedures.Methods: It is a retrospective analytical secondary data based study. It was conducted in a tertiary care hospital of Bhopal city.Results: T value of Mann Whitney/U test was found to be statistically significant and is indicating need of “Bundle Care Intervention” training for the prevention of increase in ventilator associated pneumonia rates in any health care setting.Conclusions: Expanded bevy of options related to infect

Prescription pattern of medicines in a tertiary care hospital: a cross-sectional study

Background: Prescribing drugs for any disease is not complete until it is rationally done. Irrational prescriptions often lead to treatment failure, toxicity or drug interactions which may prove detrimental to the patient. Antibiotics are very much prescribed in day to day practice but their rational use prevents treatment failure, resistance.Methods: A cross sectional study was conducted in a tertiary care hospital to see the antibiotic prescribing pattern. Prescriptions were screened one time from different OPDs with prior permission from the doctor attending the respective OPD.Results: A total of 200 prescriptions were assessed out of which 121 had monotherapies prescribed, 79 had FDCs. Antibiotics were the most commonly prescribed drugs. Prescriptions having drug combinations were assessed and pantoprazole domperidone was the most commonly prescribed (32.91%).Conclusions: Drugs should be prescribed rationally for proper therapeutic benefit. It encourages the patient to properly use the medicine and properly comply to it.

Prevalence and determinants of depression among elderly persons in a rural community from northern India.

Background. Globally, more than 350 million people of all ages suffer from depression. Elderly persons are more vulnerable to depression. We conducted this study to estimate the prevalence of depression, and to study the association of depression with sociodemographic and clinical variables among elderly persons in a rural community. Methods. We conducted a community-based cross-sectional study among 395 randomly selected elderly persons aged 60 years and above in a rural area of Ballabgarh, Haryana, India. The participants were screened by using the Geriatric Depression Scale, and diagnosis was confirmed by the Mini International Neuropsychiatric Interview. Multivariate analysis was done for independent predictors of depression. Results. The prevalence of depression was 11.4% (95% CI 8.6%–14.9%). Living in a nuclear family (adjusted odds ratio [AOR] 8.98, 95% CI 3.40–23.71), lack of physical activity (AOR 4.95, 95% CI 2.00–12.27), whole-time involvement in household work (AOR 4.47, 95% CI 1.18–16.93), presence of two or more chronic diseases (AOR 4.45, 95% CI 1.60–12.35), having no role in family decision-making (AOR 2.77, 95% CI 1.19–6.42), sleep problems in past one year (AOR 2.97, 95% CI 1.32–6.69) and bilateral hearing impairment (AOR 4.00, 95% CI 1.80–8.88) were factors associated with depression in elderly persons. Conclusions. Depression is common among elderly persons in rural areas. Individuals providing healthcare to elderly persons need to be trained to identify depression and take appropriate action; elderly persons with chronic diseases and hearing impairment deserve special attention. Natl Med J India 2016;29:129–35

Epigenetic regulation of APC in the molecular pathogenesis of gallbladder cancer.

Background & objectives: Loss of function of adenomatous polyposis coli (APC) has been reported in cancer. The two promoters of APC, 1A and 1B also have roles in cancer. But, the epigenetic role of APC promoters is not yet clear in gallbladder cancer (GBC) and gallstone diseases (GSD). We undertook this study to determine the epigenetic role of APC in GBC and GSD. Methods: Methylation-specific (MS)-PCR was used to analyze the methylation of APC gene. The expression of APC gene was studied by semi-quantitative PCR, real-time PCR and immunohistochemistry (IHC) in GBC, GSD and adjacent normal tissues. Results: Of the two promoters, APC 1A promoter was found methylated in 96 per cent GBC (P=0.0155) and 80 per cent GSD (P=0.015). Exon 1 was downregulated in grade II (P=0.002) and grade III (P=0.0001) of GBC, while exon 2 was normally expressed. Scoring analysis of IHC revealed 0 or negativity in 34.48 per cent (P=0.057) and 1+ in 24.14 per cent (P=0.005) GBC cases suggesting loss of APC expression. Interpretation & conclusions: The present findings indicate epigenetic silencing of APC in advanced GBC. The methylation pattern, followed by expression analysis of APC may be suggested for diagnostic, prognostic and therapeutic purposes in GBC in future.

To Study Quality of Life in Hand Eczema Patients Using Skindex Score.

Background: Hand Dermatitis affects a significant portion of the population. The disease is severely distressing and has chronic course with negative impact on quality of life. Aim: To evaluate the clinical profile and quality of life in hand eczema patients. Materials and Methods: A total of hundred patients, clinically diagnosed as a case of Hand Eczema of different age and sex groups participated in this study. The patient’s quality of life was assessed by a self administered questionnaire using skindex-16. Results: It was seen that increased severity of the eczema might have become more tolerated with increasing age. Males had significantly more severe hand Eczema. The total skindex QoL mean score was 31.4. Of the three domains included in our study the symptoms domain was the most affected (mean percentage score 2.27), followed by emotional (mean 1.93) and functioning (mean 1.74). Responders reported being bothered most by itching, hurting due to skin condition, and hard to do work. After adjustment for potential confounders, poorer QoL was significantly associated with female gender (mean 31.45), unmarried group (mean 32.33), rural origin (mean 32.07), long duration between 1-5 years (51%). Individuals who elected to change jobs because of their skin condition reported worse QoL. Conclusion: We suggest that quality of life modification and emotional support should be included as a part of treatment for hand eczema. Educational programs are recommended for patients who are more vulnerable to having poorer QoL to prevent further impairment, as well as further studies of QoL in Indian patients for specific diseases using disease-specific instruments.

A Study of Prevalence of Metabolic Syndrome in Patients of Psoriasis of North India.

Aim: To assess the prevalence of Metabolic Syndrome in patients of psoriasis and its relation with disease severity. Materials and Methods: The study was cross sectional and hospital based. It was conducted on one hundred psoriasis patients of psoriasis between 18 to 70 years of age and of either sex. The severity of disease was assessed using PASI and BSA involved. Metabolic syndrome was diagnosed on the basis of South Asian Modified National Cholesterol Education Program’s Adult Treatment Panel III. Results: The overall prevalence of MS in our study was 42%, which is nearly three times as compared with the prevalence of MS in general population. Presence of MS did not have any association with the severity of psoriasis as assessed by PASI and BSA involvement. Overall disturbances in lipid profile (31% and 29% were having high TG level and low HDL level respectively) and abdominal obesity (30%) were the most important factors contributing to increased prevalence of MS. These were followed by increased BP(26%) and high FPG level (23%). Conclusion: Due to increased prevalence of MS in psoriasis, dermatologists should go for simple cardiovascular evaluations like BMI, blood pressure, fasting plasma glucose and lipid profile to prevent further morbidity.