Severe acute respiratory syndrome for COVID-19 by RT-PCR test during its intensifying phase, Gujarat, India

Background: The COVID-19 disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) originated from Wuhan, China, a pandemic. By knowing different demographic and clinical data, one can have a better idea about the progress and fate of disease, which will help others to plan accordingly to manage patients in terms of decreasing morbidity and mortality caused by it. Aims and Objectives: The study was done to describe the RT-PCR diagnostic profiles of SARS-CoV-2 patients in Gujarat from three districts (Arvalli, Sabarkantha, and Gandhinagar) and their correlation with respect to age, sex, travel history, symptoms, and underlying conditions. Materials and Methods: This was a retrospective cohort study of patients with COVID-19, who were screened for SARS-CoV-2 from April 16 to May 25, 2020, from three districts of Gujarat (Arvalli, Sabarkantha, and Gandhinagar). Positive cases were confirmed by qRT-PCR and analyzed for epidemiological, demographic, and clinical characterization among different groups. Results: Of 4000 suspects screened, a total of 199 patients were confirmed with SARS-CoV-2 infection. Among them, middle-aged group (5.4%) and young adult patients (4.3%) were infected with SARS-CoV-2. The median age was 33 years, including 143 males and 56 females. The positivity rate from breathlessness was 8 (28.5%), nasal discharge 2 (25%), and nausea/vomiting 2 (25%) followed by fever 28 (20%) among total cases in respective categories. Among asymptomatic 3536 patients, 146 patients were confirmed for SARS-CoV. Among 256 patients with comorbidities, 14 patients were confirmed for SARS-CoV. Conclusion: Clinical investigation in initial SARS-CoV-2 patients in the western Indian region revealed that young adult male was more susceptible than female. Symptoms such as fever, cough, and sore throat reports are useful for screening the SARS-CoV-2.

A partnership model for capacity-building of primary care physicians in evidence-based management of diabetic retinopathy in India

In India, more than 72 million people have diabetes. Diabetic retinopathy (DR), a vision-threatening complication of people with diabetes, is an important cause of avoidable blindness. The delay in the detection of DR is due to lack of awareness and shortage of ophthalmologists trained in the management of DR. With this background, in 2015, we initiated a capacity-building program “Certificate Course in Evidence Based Management of Diabetic Retinopathy (CCDR)” with an objective to build the skills and core competencies of the physicians across India in the management of diabetes and DR. The program has completed four cycles and 578 physicians have been trained. The course elicited an excellent response, which reflects the much-felt need for skill improvement in DR diagnosis and management for physicians in India. This model demonstrates an innovative modality to address DR-related avoidable blindness in a resource-restraint country like India.

A Review: Mechanistic Insights Into The Effect Of Thyroid Disorders On Estrogen Level And Bone Mineral Density

Thyroid hormone serves as an indispensable component for the optimum functioning of various biological systems. They curb body’s metabolism, regulates the estrogen level, regulates bone turnover, essential for skeletal development and mineralization. Within the scope of knowledge, it is intimately familiar that thyroid disorders have widespread systemic manifestations, among which in hypothyroidism, even though elevated TSH (thyroid-stimulating hormone) may reduce estrogen level which in turn stimulates osteoclasts and thus cause osteoporosis, while hyperthyroidism accelerates bone turnover. Hypothyroidism does not directly interfere with the skeletal integrity, but treatment with levothyroxine for the suppression of TSH to bring the hypothyroid patient to euthyroid state for a long haul; lead to simultaneous reduction in bone mass and in (bone mineral density) BMD. After the initial relevation of the correlation between thyroid disorders and osteoporosis in numerous studies have emphasized that both hypo and hyperthyroidism either directly or indirectly affects the bone mineral density or leads to the progression of osteoporosis. Therefore the present study is aimed and so designed to review all the possible associations between them and the impact of thyroid disorders on estrogen level and bone mineral density. The main findings of this review indicate that both excesses as well as deficiency of thyroid hormone can be potentially deleterious for bone tissue.

An analysis of prescription patterns in cases of uncomplicated hypertension in a tertiary care hospital.

Background & objectives- Prescribing pattern in hypertension patients were found to be different from the recommended guidelines in the past. The objectives of the present study were to analyze prescribing trends in uncomplicated hypertension and to compare with those of current international guidelines with the objective to note any deviation. Methods- A prescription based analysis in 1400 hundred uncomplicated hypertensives in the age group 30 to 60 years was carried out. Results- Monotherapy was prescribed to 893 cases (M 407; F 486) and combination therapy to 507 cases (M 342; F 165). Overall, Calcium Channel Blockers (CCBs) were the most common agents used 787 (56.21%) cases, 350 monotherapy and 437 as combination therapy. Angiotensin Converting Enzyme Inhibitors (ACE I) 452 (32.28%) and Angiotensin II Receptor Blockers (ARBs) 231 (16.5%) cases were the next preferred groups. In double drug combination CCB+ Beta Blockers (BB) and for triple drug combination CCB+ARB+ Diuretics (D) were more preferred. A significant effect of age (p<0.01) on prescription of CCBs was noted. Prescription of ARBs and D were significantly (p<0.05 and <0.01 respectively) influenced by gender. Gender had no significant effect on the prescribing trend of antihypertensive agents in combination therapy, while a significant effect (p<0.05) of age and combined drug classes CCB+ACE I and CCB+BB+D was noted. The overall prescription rate for diuretics was 40.24% and that for monotherapy was meagre 5.15% (M 1.23%±; F 3.92%). Diuretics were always prescribed in triple drug combinations. Interpretation & Conclusions- CCBs were the most commonly prescribed agents. A deviation existed between antihypertensives prescribed and current international guidelines thus calling upon greater awareness.

Analytical study of water safety parameters in ground water samples of Uttarakhand in India.

The main problem of the locality is the drinking water. Certain health problems are associated with people living in hills that are because of the presence of excess of heavy metals and other impurities. The present study was conducted to analyze the various parameters of ground water in uttarakhand, India and to check its fitness for drinking. It will also clarify the health hazards imposed on the population of this state. The present study was conducted in five regions of Uttarakhand, India (Haridwar, Vikasnagar, Mussoorie, Dehradun & Dakpathar). Ten samples of ground water were collected from each of the five regions during the pre-mansoon (Jan-Feb ) and post-mansoon (Sept-Oct )seasons.The pH was estimated by pH meter, acidity,alkalinity, sulphates,chorides,Total hardness(Ca & Mg) were determined by titration methods. The total suspended solid was calculated by the formula. The heavy metals like Mn, Al, Ba, Cd, Cr, Co, Cu, Fe and Pb were determined in the ground water samples by ICP mass spectroscopy. The concentrations of heavy metals, pH, alkalinity, sulphate, chloride, TDS & Total Hardness (TH) were compared with the standards by BIS for Drinking water (IS 10500:1991). The results shows that water pH of all the five regions showed no remarkable variation from the BIS recommended value of pH (6.5-8.5). The alkalinity was above the BIS desirable level of 200mg/l in all the samples, but was less than the maximum permissible limit. The Drinking water of all the regions contains higher amounts of TDS than the desirable limits. maximum TDS was detected in Haridwar & dehradun state. The ground water of mussoorie region shows total hardness to be above the BIS desirable level of 300mg/l. The chloride content was above the BIS desirable level of 250mg/l in dehradun only. The sulphate content was highest in haridwar (197.5mg/l) and dehradun (170mg/l) but it was below the desirable limit of 200mg/l. The Cd,Cr,&Pb content of all the five regions of Uttarakhand showed higher the BIS permissible limits of 0.01, 0.05 and 0.05 mg/l respectively. The content of Mn,Ba,Cu, Co&Fe are within the permissible limit of BIS standards for drinking water.

Study of antibiotic sensitivity pattern in urinary tract infection at a tertiary hospital.

This study was conducted in a tertiary hospital at Bareilly, Uttar Pradesh between Aug 2009 and July 2010 to check the changing pattern of antibiotic sensitivity among uropathogens causing urinary tract infections (UTI). A total of 170 urine culture sensitivity reports were analyzed. The predominant growth of single bacteria was seen in 143 (84.12%) samples. The most common organisms isolated were Escherichia coli, klebsiella, pseudomonas, and Staphylococcus aureus. (These represented 64.33%, 92; 20.3%, 29; 9.1%, 13 and 6.30%, 9 of isolates respectively). More than 80% of the isolates were sensitive to amikacin and nitrofurantoin, while more than 70% were sensitive to norfloxacin, ciprofloxacin and levofloxacin. Very high rate of resistance was seen against cotrimoxazole (81.82%), amoxicillin (77.42%) and amoxi-clav (64.34%). E. coli showed high sensitivity to Amikacin 98.91% (91), Nitrofurantoin 93.48% (86). 75% of E. coli isolates were sensitive to minocycline, showing a good utility of this drug for the treatment of outdoor patients with urinary tract infections.

Growth inhibition of struvite crystals by the aqueous root extract of Rotula aquatica.

Formation of urinary stone is a serious and debilitating problem throughout the world. In the present study, the inhibitory effect of aqueous extract of root of Rotula aquatica was investigated against struvite crystals (one of the components of urinary stone) grown in vitro using single diffusion gel growth technique. For setting the gel, sodium metasilicate solution (specific gravity 1.05) and 0.5 M aqueous solution of ammonium dihydrogen phosphate were mixed, so that the pH of the mixture could be set at 7.0. Equal amounts of supernatant solution of magnesium acetate (1.0 M) prepared with 0.0%, 0.5% and 1% concentrations of the extract were gently poured on the set gels. It was observed that the number, dimension, total mass, total volume, growth rate and depth of growth of struvite crystals decreased with the increasing extract concentrations in the supernatant solutions. The enhancement of dissolution rate and fragmentation of struvite crystals suggested potential application of the extract for inhibition of struvite type urinary stone.

Prevalence of intestinal parasites among school going children in Bareilly District.

This study was conducted to find out the burden of intestinal parasitic infection among school going children in Bareilly District Uttar Pradesh India. A total of 320 stool samples were collected and screened from 4 schools. The stool sample was examined by direct wet mount examination. The prevalence of intestinal parasite was 22.81%. Ascaris lumbricoides (9.68%), Giardia lamblia (6.25%), Entamoeba histolytica (2.50%) were the commonest parasite isolated. Lack of pure drinking water and lack of proper sanitary disposal, and improper health education is supposed to be the root cause of these parasitic infections. This also advocates the regular and periodic health check up & deworming schedule for the students attending the school.

Determinants of nutritional status of school children - A cross sectional study in the western region of Nepal.

Under-nutrition continues to be a primary cause of ill health and mortality among children in developing countries. Besides poverty, there are other factors that directly or indirectly affect the nutritional status of children. In the present study, an attempt was made to find the prevalence of under-nutrition among school children in 4 – 14 year age group and the role of socio-demographic characteristics of mother on child nutrition. Methods: Descriptive, cross-sectional study was conducted in schools of Kaski district of Western Nepal from January 2007 to June 2007. A total of 786 students were randomly selected from six schools in the study area and nutritional status of the children was assessed by anthropometric measurements. Results: Among 786 students, 26% of the students were found to be undernourished and 13% stunted, 12% wasted and only 1% both stunted and wasted. The present study shows highly significant association (p<0.005) of maternal factors like literacy, occupation, diet knowledge and monthly per-capita income respectively with child nutrition. Conclusion: Maternal education status, socio-economic status, occupation and dietary knowledge are important determinants of nutritional status of school children.

Risk factors for low birth weight (LBW) babies and its medico-legal significance.

Birth weight is the most important factor that affects infant and child mortality. This one year study was conducted in a cohort of pregnant women to study the proportion of low birth weight babies and to find out the socio-economic and maternal risk factors affecting the birth weight of newborns and its medico-legal significance. Information regarding socio-economic status, obstetric history and present pregnancy was collected. These women were followed up till their delivery and birth weight was recorded with 24 hours of delivery. Birth weight was available for 256 births. The overall prevalence of low birth weight was 34.37%. Overall mean birth weight was found to be 2.64±0.444 with 95% confidence interval of 2.59-2.69. Primigravida mothers showed the highest prevalence of low birth weight (30.86%, p< 0.001). The main factors which were significantly associated with LBW were maternal education, stature, age at delivery; short inter pregnancy interval, inadequate antenatal care, and per capita income of family.

Comparative study between tramadol and dexamethasone as an admixture to bupivacaine in supraclavicular brachial plexus block.

This is a prospective, randomized, double blind study to evaluate the postoperative analgesia following supraclavicular brachial plexus block with Tramadol or Dexamethasone as an admixture to bupivacaine in upper extremity surgery. Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block with Bupivacaine were randomly divided in to two groups; one group received Tramadol (2 mg/kg) and the other group received Dexamethasone (8 mg) as an admixture to Bupivacaine. The duration of postoperative analgesia was recorded in both groups using pain VAS score which was determined by maximum VAS score of 8-10 and when patient demands for additional analgesics. The mean duration of postoperative analgesia in the Dexamethasone group was 1028.00 minutes while in the tramadol group it was 453.17 minutes We concluded that Dexamethasone with local anaesthetic prolongs postoperative analgesia significantly than Tramadol (P<0.05) when used as admixture to local anaesthetic in brachial plexus block in upper extremity surgery.

Cytotoxic drug: towards safer chemotherapy practices.

Health care is nearly 10 years behind other industries in its efforts to reduce the errors. Medication error may be nobody's baby, but when it happens, it could well turn out to be everyone's worry and the reasons given for medication error range from silly to the downright serious. The anticancer drugs are known to be mutagenic, teratogenic and carcinogenic, so extra precaution should be taken while storing, diluting, administering the drugs and disposing the waste. The objectives of this article are to define the standards for using cancer chemotherapy in hospitals; to tackle any spillage of drug and how to dispose of the waste of anticancer drugs. This could be beneficial to any hospital where chemotherapy is given without any defined standard operating procedure. The information furnished in this article is collected from the mentioned references and also from websites- The American Cancer Society: Cancer Facts and Figures 2002, www.cancer.org and www.cancersourceRN.com.

Saphenous--peritoneal shunt in refractory ascites: a neglected technique.

Management of intractable ascites has always been a challenge. Peritoneovenous shunt (PVS) plays a major role in the surgery of intractable ascites in patients with liver cirrhosis. Positive pressure gradient between the ascitic fluid and venous pressure leading to one-way drainage of ascitic fluid into venous circulation is the mainstay. Over decades, various modifications of shunting technique have been done. Here we report our experience with this procedure which is safe, easy and effective. Here the long saphenous vein is used as a drainage system. One-way ascites flow is ensured by a natural valve in the saphenous orifice.

Effect of aqueous extract of neem (Azadirachta indica) leaves on offensive and diffensive gastric mucosal factors in rats.

Standardized aqueous extract of Neem (Azadirachta indica) leaves (AIE) has been reported to show both ulcer protective and ulcer healing effects in normal as well as in diabetic rats. To study the mechanism of its ulcer protective/healing actions, effects of AIE (500 mg/ kg) was studied on various parameters of offensive acid-pepsin secretion in 4 hr pylorus ligation, pentagastrin (PENTA, 5 microg/kg/hr)-stimulated acid secretion and gastric mucosal proton pump activity and defensive mucin secretion including life span of gastric mucosal cells in rats. AIE was found to inhibit acid-pepsin secretion in 4 hr pylorus ligated rats. Continuous infusion of PENTA significantly increased the acid secretion after 30 to 180 min or in the total 3 hr acid secretion in rat stomach perfusate while, AIE pretreatment significantly decreased them. AIE inhibited the rat gastric mucosal proton pump activity and the effect was comparable with that of omeprazole (OMZ). Further, AIE did not show any effect on mucin secretion though it enhanced life span of mucosal cells as evidenced by a decrease in cell shedding in the gastric juice. Thus, our present data suggest that the ulcer protective activity of AIE may be due to its anti-secretary and proton pump inhibitory activity rather than on defensive mucin secretion. Further, acute as well as sub acute toxicity studies have indicated no mortality with 2.5 g/kg dose of AIE in mice and no significant alterations in body or tissues weight, food and water intake, haematological profile and various liver and kidney function tests in rats when treated for 28 days with 1 g/kg dose of AIE.

Effect of plantain banana on gastric ulceration in NIDDM rats: role of gastric mucosal glycoproteins, cell proliferation, antioxidants and free radicals.

Methanolic extract of Musa sapientum var. Paradisiaca (MSE, 100 mg/kg) was studied for its antiulcer and mucosal defensive factors in normal and non-insulin dependent diabetes mellitus (NIDDM) rats. NIDDM was induced by administering streptozotocin (STZ, 70 mg/kg, ip) to 5 days old rat pups. The animals showing blood glucose level >140mg/dL after 12 weeks of STZ administration were considered as NIDDM positive. Effects of MSE were compared with known ulcer protective drug, sucralfate (SFT, 500 mg/kg) and anti-diabetic drug glibenclamide (GLC, 0.6 mg/kg) when administered orally, once daily for 6 days against gastric ulcers (GU) induced by cold-restraint stress (CRS) and ethanol and subsequent changes in gastric mucosal glycoproteins, cell proliferation, free radicals (lipid peroxidation and nitric oxide) and anti-oxidants enzymes (super oxide dismutase and catalase) and glutathione (GSH) levels. MSE showed better ulcer protective effect in NIDDM rats compared with SFT and GLC in CRS-induced GU. NIDDM caused a significant decrease in gastric mucosal glycoprotein level without having any effect on cell proliferation. However, all the test drugs reversed the decrease in glycoprotein level in NIDDM rats, but cell proliferation was enhanced in case of MSE alone. Both CRS or NIDDM as such enhanced gastric mucosal LPO, NO and SOD, but decreased CAT levels while CRS plus NIDDM rats caused further increase in LPO and NO level without causing any further changes in SOD and CAT level. MSE pretreatment showed reversal in the levels of all the above parameters better than GLC. Ethanol caused a decrease in glutathione level which was further reduced in NIDDM-ethanol rats. MSE reversed the above changes significantly in both normal as well as in NIDDM rats, while GLC reversed it only in NIDDM rats. However, SFT was ineffective in reversing the changes induced by CRS or ethanol or when given in NIDDM-CRS or NIDDM-ethanol rats. The results indicated that the ulcer protective effect of MSE could be due to its predominant effect on mucosal glycoprotein, cell proliferation, free radicals and antioxidant systems.

Upper GI endoscopy in children- in an adult suite.

Although Upper GI endoscopy is commonly performed in adults, paediatric endoscopy is not available in many of our referral centres. The efficacy and safety of upper GI endoscopy in paediatric age group performed in adult suite of Kathmandu Medical College is reviewed. PATIENTS AND METHOD: A retrospective study of endoscopies performed on children aged up to 15 years in an adult endoscopy suite of Kathmandu medical college over last one year is presented. All cases were the referred cases from paediatric unit for various problems. RESULTS: Endoscopy in paediatric group comprises only 6% of total upper GI endoscopies performed during the same year. Sex ratio was almost equal. Most cases (87%) were performed under local anaesthetic and well tolerated by the patients. Recurrent abdominal pain (RAP) was the commonest indication and among them one third of cases had significant positive finding. CONCLUSION: Upper GI endoscopy is a useful diagnostic tool in children. Where specialized paediatric endoscopy units are not feasible i.e. developing countries, endoscopic services to children can be safely provided in adult endoscopy suite with or without sedation. Upper GI endoscopy is well tolerated by children even without sedation.

Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma.

INTRODUCTION: Clinically detectable thyroid carcinoma constitutes less than 1% of human cancers. Ninety percent of all thyroid malignancies are differentiated papillary and follicular carcinoma. Surgery plays a key role in differentiated thyroid carcinoma as it carries excellent prognosis, lower recurrence rate and low mortality rate but controversy persists for extent of surgery and optimal surgical management of lymph node metastasis. PATIENT AND METHOD: A retrospective analysis was done for the cases that underwent total thyroidectomy with lymph node dissection for differentiated carcinoma of thyroid in Kathmandu Medical College during two year periods (Oct 2001 to Oct 2003). RESULT: In our experience with 18 cases of Differentiated Thyroid Carcinoma (DTC) treated with total thyroidectomies and lymph node dissection, papillary carcinoma was predominant with 83% incidence. Disease was prevalent in 50 to 60 year age group. Except two cases of transient hypocalcaemia and few wound related complications, there have been no other complications. CONCLUSION: Total thyroidectomy with lymph node dissection is safe and effective, so, the treatment of choice in cases of differentiated thyroid carcinoma.