Effect of Clinician-directed Technical Specifications on Entrance Skin Doses in Neonates

Objectives: To compare the entrance skin doses (ESD) before and after implementation of a radiation safety policy in neonates (RSN), which focused on clinician-directed technical specifications on the digital X-ray machine. Methods: Prospective observations included two sets of X-rays: Before (BRSN) and after (ARSN) implementation of RSN (documented indication for Xray/expected posttest findings, settings of 40 kVp, 0.5 mAs, film-focus distance 100 cm, gonadal-shield, optimal collimation, and post-shoot image-enhancement). Results: 33 and 32 X-rays were analyzed in respective groups. Mean (SD) of calculated and machine-quantified ESD (µGy/m2) was higher in BRSN group as compared to ARSN group (P <0.001). All ARSN X-rays were interpretable for expected post-test findings. Conclusion: Clinicians’ cognizance of ability to make consequential bedside technical specifications, can reduce ESD without affecting interpretability. These single observations could have a larger impact in sick neonates, where multiple X-rays are done.

CHANGE AND OCCUPATION MOBILITY AMONG VADDARS OF DHARWAD DISTRICT OF KARNATAKA

In every society, changes occur, either in a slow process or a fast process which involves both positive and negative elements. Change is a broad and complex concept. As we have noticed, it is an alteration that takes place in concepts, practices and situations. It also indicates an alteration between points in time. Similarly, we can notice many changes in the Vaddar community. These changes may benet or damage the community or society. With the passage of time, changes also take place. It indicates nothing is permanent and as days go by everything changes. These changes may come to our notice or may not come to our notice. In the social eld also, changes take place either at a slow pace or fast. For instance, we know women are hard workers but with the advancement of science and technology, especially urban women started using grinding machines, washing machines etc., to reduce their workload. So changes in every walk of a woman's life have taken place in accordance with their modern lifestyle. Individuals and materials change gradually but such changes are easy in a social world. Change depends upon the speed of time, direction and materials which come under the transition

Cardiorespiratory Adverse Events after First Vaccination in Preterm Neonates With Gestational Age ?30 Weeks

Objectives: To document the adverse cardiorespiratory events following first routine immunization in preterm neonates. Methods: We retrieved records of neonates with gestational age ?30 weeks, and included those who developed cardiorespiratory events after first vaccines before discharge. Our Unit’s protocol is to administer Bacillus Calmette-Guerin (BCG), hepatitis B vaccine to those discharged at <8 weeks postnatal age. Hexavalent, BCG, pneumococcal vaccine and rotavirus vaccines are given at 8 weeks of age, if hospital stay is predicted to be longer. Unit compliance to vaccination administration at appropriate ages were also measured. Results: Data of 161 neonates ?30 weeks (17.4% <27 week) who completed care in the unit was studied. Cardio-respiratory adverse events were reported in 21(13.7%). None of these required initiation of invasive ventilation. High flow nasal cannula therapy and caffeine restart were required for these events in 14 (9.3%) and 6 (3.9%) neonates, respectively. Lower gestational age, bronchopulmonary dysplasia and sepsis were significant risk factors on univariate analysis. On multivariate analysis, continued need for respiratory support at 4 weeks of age (P=aOR 14.5 (95% CI 5-59.1) was the only independent risk factor for post-vaccination cardiorespiratory adverse events. Of 38 who were not vaccinated at recommended ages by unit policy, 25 were missed opportunities, the rest were deemed unstable for vaccinations at that age by the clinical team. Conclusion: Adverse cardiorespiratory events were uncommon after first vaccinations in very preterm neonates. Administering vaccines in this group before discharge would allow monitoring for these events, especially for those who require long-term respiratory support.

Association of sunlight exposure with visual impairment in an Indian fishing community

Purpose: Indian fishermen belong to a marginalized population and are continuously exposed to extreme occupational hazards and sunlight. A high prevalence of visual impairment (VI) is reported in the coastal fishing community. We aimed to investigate the association between VI and sunlight exposure measurement (SEM). Methods: In this cross?sectional observational study, 270 eyes of 135 participants were enrolled from a coastal fishing village. Participants underwent a comprehensive ophthalmic examination, which included best?corrected visual acuity (BCVA), and anterior and posterior segment examination. Ocular Surface Disease Index (OSDI) and SEM questionnaire were administered to estimate the level of dry eye and ultraviolet?B (UV?B) exposure, respectively. VI was defined as presenting visual acuity worse than 6/12 (logarithm of the minimum angle of resolution [logMAR] > 0.3). Results: The mean age and spherical equivalent were 50.56 ± 11.72 years (range: 18–80 years) and 0.36 ± 1.68 diopters (D) (range: ?7.0 to +3.0 D), respectively. Age, SEM, OSDI, fishing as an occupation, and cataract were significantly associated with higher odds of VI in univariate analysis. Refraction, gender, education level, smoking status, amblyopia, systematic, and other ocular diseases were not significantly associated with VI. In the multivariate analysis, age, SEM, and presence of cataract remained significantly associated with a higher risk for VI. The area under the receiver operating characteristic curve values for age and SEM scores demonstrate a fair index of discrimination for the detection of VI. Conclusion: SEM level is directly associated with a higher risk of VI among fishermen. The fishing community might benefit from regular eye examinations and awareness about the harmful effects of sunlight exposure and preventive measures.

THE PRACTICE OF UNTOUCHABILITY: A SOCIOLOGICAL STUDY

We get a lot of valuable information regarding untouchability from the works of Dr B.R. Ambedkar, M.K. Gandhi, G.S. Ghurye, A. Ayyappan, B Kuppuswamy, J.H. Hutton, H.N. Brailsford, D.R. Desai and others. `Basically, the people considered within the scheduled castes category are untouchables in India. For the rst time, the Government of India prepared a list of people under the head 'Scheduled Castes, amounting to a population of 5.35 crores. Now their number has increased tremendously in all the states of India. In this paper, the researcher has tried to prove that, even today untouchability occurs among the Madiga community in a few villages in the Haveri district.

Factors influencing medication adherence and quality of life in outpatients attending Department of Psychiatry in a tertiary health care centre

Background: Nearly one third of people who suffer major psychiatric disorders end up with a long- term disability and dependency. They are most likely to be non-adherent to medication due to various reasons including lack of knowledge or insight about their illness and treatment which in turn leads to exacerbation of their illness, reduce treatment effectiveness, or make them less responsive to subsequent treatment, multiple hospitalizations and poor quality of life. Materials and methods: A cross sectional study was carried out in outpatients attending the Psychiatry OPD using the consecutive sampling technique. Subjects meeting the ICD-10 Diagnostic criteria for psychiatric disorders, age 18 year and above, subjects willing to participate in the study were included. A structured proforma, the Drug attitude inventory and the WHO-QOL-BREF questionnaires were used for assessment. Results: Mean age of subjects = 38.07 + 11.07 years. Mean medication cost = Rs. 917.82 + 397.89. 87 subjects participated in the study and of them 48% were adherent to medication and 52% were non-adherent. 56% of males and 43% females were adherent to medication. There was significant association between the occupation and the type of family of the subjects and medication adherence (p<0.05). Majority of patients with medication non-adherence were seen in schizophrenia, delusional disorder, bipolar disorder, generalized anxiety disorder, obsessive-compulsive disorder and substance related disorder. Majority (44.5%) of them reported fear of side effects, followed by stopping the medication when feeling better (35.5%) as the reasons for non-adherence followed by cost, embarrassment, etc. There was significant association between the psychological and social quality of life and medication adherence (p<0.05). Conclusions: This study implicates the importance of psycho education about the diagnosis, prognosis, need for medication and the expected adverse effects which should be clearly explained to the patient. The therapeutic alliance is the most effective component in helping the patient maintain medication adherence and subsequently better quality of life.

Education Among Madiga Community In The Haveri District Of Karnataka

Madiga community is one of the largest communities in Karnataka state and politically this community is neglected as well as educationally backward. In the field study region, most of the respondents have lower status because these community people are being treated as untouchables. Though this community is included in the scheduled caste, they have failed to utilise the benefits of the government. The first generation of this community is going to school but because of poverty, many dropouts are noticed among the respondents' children. This paper is to shed some light on education and other changes among the respondents

Effect of Dasapaka Bala Taila Yonipooranam in Atrophic Vaginitis - A Case Report

Atrophic vaginitis is a common condition that occurs in post menopause due to the deficiency of estrogen. The condition Atrophic vaginitis is defined as atrophy of the vaginal epithelium due to decreased estrogen levels. This common menopausal condition which is often underreported and under diagnosed is caused by estrogen related changes to the vaginal epithelium and can adversely affect quality of life. Atrophic vaginitis is a common condition in postmenopausal women experience due to estrogen deficiency that causes involution of the vaginal tissue, leading to vaginal dryness, burning sensation in vagina and dyspareunia, the atrophy of the vulvovaginal structures occurs due to estrogen deficiency. Among them Sushka yoniroga can be most suitably correlated with Atrophic vaginitis. The management principle of Atrophic vaginitis includes Vathika yoniroga chikitsa, along with Sthanika chikitsa. Treatment mainly aims at Vatapittasamana, Brimhana, Balya and natural supplementation of estrogen containing drugs. Sthanika chikitsa like Yonipooranam, Pichu dharanam, etc can be done in Atrophic vaginitis. Sthanika chikitsa which is of prime importance in the management of Streeroga facilitates absorption of drugs through the vagina as the walls and adjacent tissues are highly vascular, where the medicines are administered intra vaginally. In the present case, Yonipoorana as Sthanika chikitsa as tried. A 54 year old lady was presented with complaints of burning sensation in vagina and pain during sexual intercourse. The vaginal examination was painful and the walls are found inflamed, she was diagnosed with Atrophic vaginitis. She was sent to cytological screening. The reports revealed high grade parabasal cells and low grade superficial cells. The maturation index was found 60/25/5 vaginal pH was 5.3. Pap smear was done which was negative for intraepithelial lesion or malignancy. Dasapaka Bala tailam was administered intravaginally for 7 days in 3 consecutive months. During follow up she was relieved from the symptoms like burning sensation in vagina and pain during sexual intercourse. From this case report, it shows that Yonipoorana with Dasapaka Bala tailam is effective for the management of Atrophic vaginitis.

AN EVALUATION OF CLINICAL OUTCOMES AFTER ABDOMINAL MESH RECTOPEXY & DELORME'S PROCEDURE FOR RECTAL PROLAPSE AT TERTIARY HEALTH CARE CENTER.

Background: Rectal prolapse is protrusion of rectum through anal canal, and proccidentia ~ complete prolapse is the term used when full thickness rectal wall prolapse . 30 patients presenting with Materials and methods: mass per rectum were evaluated & diagnosed clinically as having rectal prolapse were included in the study. The recurrence rate for the abdominal mesh Results: rectopexy is considered to be lower than Perineal Delorme's procedure. There was no recurrence in the rectopexy group. There was 1 recurrence (10%) in Delorme's group. .Better outcomes achieved when treatment individualized to Conclusion: each patient. Abdominal rectopexy for patients who can tolerate laparotomy & significant constipation. .Delorme's considered in young patients with short prolapse but with acceptable recurrence rate.

Cyclophosphamide Pulse Therapy in the Treatment of Systemic Sclerosis Associated Interstitial Lung Disease: An Observational Study

Introduction: Scleroderma is a multisystem autoimmune connective tissue disease with approximately 90% of patients having lung involvement. It is the leading cause of morbidity and mortality in scleroderma. There is no effective treatment once there is lung involvement in the form of fibrosis. Study setting: Conducted in a tertiary care center between January 2017 and December 2019. Aim: To evaluate the efficacy of intravenous cyclophosphamide in patients with scleroderma-associated interstitial lung disease (ILD). Study population: Symptomatic patient with scleroderma with high-resolution computed tomography (HRCT)-proven non-specific interstitial pneumonia (NSIP)-pattern ILD. Methodology: Patients received 12 cycles of cyclophosphamide at a dose of 10 mg/kg every 4 weeks. Patients were followed up for 1 year after treatment completion. A six-minute walk test (6MWT) and spirometry were done at baseline and then every 6 months up to 2 years. Diffusing capacity of lung for carbon monoxide (DLCO) was done at baseline and then yearly for up to 2 years. Results: A total of 38 patients completed the study. The majority of patients had diffuse cutaneous type of systemic sclerosis. Throughout the study period, there was a gradual worsening of dyspnea as measured by the Modified Medical Research Council (mMRC) scale. Mean forced vital capacity (FVC) improved with 1 year of treatment, but later steadily decreased during follow-up. Similarly, DLCO also improved during 1-year treatment, but the improvement was not sustained during follow-up. There was a statistically significant improvement in 6MWD at the end of 6 months. This was followed by a gradual fall in 6MWD during follow-up. The only adverse event noted was persistent leukopenia in one patient. Conclusion: Intravenous pulse cyclophosphamide therapy in patients with scleroderma-associated ILD is associated with stabilization of pulmonary function during the treatment period, but not maintained during follow-up.

AN OVERVIEW OF HISTORY OF PRIMARY EDUCATION IN INDIA

Education is the passport to the future and tomorrow belongs to those who prepare for it today. Primary education, also called an elementary education, is the ?rst stage traditionally found in formal education, beginning at about age 5 to 7 and ending at about age 11 to 13. The primary stage is very crucial stage in the life of the child. The primary school lays the foundation for children to learn moral values. India has achieved signi?cant progress in recent decades regarding access to schooling and enrolment rates in primary education. The paper makes an attempt on the history of the primary education in India

Menstrual Hygiene Management and Socio-demographic Factors among Rural Female Adolescents in Two Backward Districts of Karnataka: A Community Based Cross-Sectional Study.

Introduction: Hygienic menstrual is a major problem, particularly for rural female adolescents. Most of the time, appropriate information regarding menstrual issues is lacking due various socio-cultural and communication issues. Objective: The aim of the study is to examine the menstrual hygiene practises among adolescent females in two underdeveloped districts of Karnataka, and to trace the relationship between the practise and changing socio-demographic variables. Methods: A cross-sectional community based study with 384 adolescent females from the Two backward districts of Karnataka using stratified random sampling technique. Findings: According to the study, 66% respondents use the modern pads, while shyness, cost, and other factors prevent 33% of respondents from using pads. Approximately, 20% of respondents identified hygiene as their top reason for using disposable pads, while 31% cited cleanliness. Most of the respondents (50%) dispose sanitary pads in the toilet, whereas 21% dump it with other trash. The use of sanitary pads is strongly correlated with mothers' education, income and family structure. Conclusion: The study concludes that there is a critical need for widespread education on menstrual hygiene management in rural, parts. There must be arrangements for rural women to have easy access to the affordable pads.

Incidence of Metabolic Bone Disease After Implementation of Bone Protective Nutritional Strategies: A Prospective Cohort Study

Background: Metabolic bone disease (MBD) is a morbidity of multifactorial etiology with a high incidence in very preterm infants. We planned to study the incidence of MBD after implementation of bone health focussed nutritional strategy (BNS) in those <30 weeks gestation at birth. Methods: This prospective cohort study including preterm newborns (<30 weeks) who received nutrition that incorporated (a) Early initiation of intravenous potassium phosphate; (b) Early enteral supplementation with multicomponent human milk fortifier at enteral feed tolerance of 40 mL/kg/day feeds itself; and (c) Weekly phosphorus measurements with optimization of enteral intakes. Incidence of MBD at 4 weeks of postnatal age and beyond were analyzed. Other relevant safety and clinical outcomes were measured. Results: Of the 67 included neonates receiving BNS, 20.9% were classified as MBD. There was a low rate of hyperphosphatemia (4.5%) and hyperkalemia (2.9%). Full enteral feeds were achieved by median (IQR) of 6 (5,7) postnatal days. Conclusion: In preterm newborns (24-30 weeks) MBD incidence was 20.9% after BNS was implemented. Intravenous potassium salt of phosphorus and early use of HMF were safe and feasible.

Vayasthapana Gana Ksheerapaka in Perimenopausal Symptoms - A Case Report

Perimenopause is the transition period from reproductive to non-reproductive phase. It usually begins with menstrual cycle irregularity and extends to one year after permanent cessation of menstruation. There is manifestation of varied physical, psychological and somatic symptoms. Menopause may be correlated to Rajakshaya. It usually occurs as part of the ageing process and is the period of transition from Pitta predominant middle age to vata predominant old age. Treatment in modern medicine includes hormone replacement therapy and use of anti-depressants etc. Acharyas mention Jara among Swabhavabala pravritta Vyadhi, and its management is to be done with drugs having Rasayana property. Here we present a 48-year-old lady who presented with complaints of hot flushes, severe sweating especially during night hours, reduced sleep, irritability, multiple joint pain, loss of interest in most daily activities and stress incontinence. Vayasthapana gana was administered as Ksheerapaka. Vayasthapana gana include ten drugs which are Rasayana, Medhya, Tridosha samana and possess anti-oxidant, free radical scavenging and anti-stress activity. Ksheera is Vata pitta samana, Rasayana, and Jeevaneeya. Vayasthapana gana ksheerapaka is given in the dose of 48ml twice daily one hour before food for thirty days. After treatment intensity of these symptoms were reduced. Follow up was done thirty days after stopping the medication, here also intensity of these symptoms remained less when compared to before treatment. Here we reviewed the probable role of Vayasthapana gana ksheerapaka in alleviating perimenopausal symptoms.

Computational studies on new Leishmanial drug targets against Quercetin

Leishmaniasis, a parasitic disease caused by Leishmania parasite which resides in the infected sand flies. Control of Leishmaniasis remains a source of grave concern worldwide. Studies on Leishmaniasis triggered because of its outbreak in tropical and subtropical regions of Asia, East Africa and South America. There is an urgent need for new therapeutic interventions such as vaccine and new drug targets as it develops resistance towards the available drugs. Quercetin, a derivative of polyphenolic flavonoid exhibits various biological activities by interacting with proteins and nucleic acids. In this study, computational analysis was performed to identify the potential drug target of Quercetin in Leishmania species by molecular docking. The newly predicted targets were subjected for subcellular localization prediction and determined the protein-protein interaction networks that would aid in the development of anti-Leishmanial drugs. This study helps in the identification of targets and development of anti-Leishmanial drugs.

Ayurvedic Management of Primary Dysmenorrhea with Abhayatrivrudadi Kashayam- Case Report

Dysmenorrhea, one of the most prevalent gynaecological problems in young women, particularly among teenagers, characterized by painful menstruation severe enough to prevent a person from doing day-to-day activities. It is the main factor behind young women's missed job and school days of teenagers. Primary dysmenorrhea is widely prevalent in more than 70% of teenagers and 30 -50% of menstruating women. Among Yonirogas, Udavarta yonivyapat is a condition characterized by painful menstruation and the relief of discomfort following blood discharge, which is typical of primary dysmenorrhea. In modern medical science, various forms of treatments are available for the relief of Primary dysmenorrhea which includes antispasmodic, analgesics, prostaglandin synthesis inhibitors, hormonal therapy etc. Reluctance of young girls and ladies to adopt the hormone therapies bring them to Ayurvedic treatment or any other alternative treatment of their choice. Ayurvedic management aims at vatanulomana through Snehana, Swedana, Vasti along with Samana oushadha which can alleviate Vata. Abhayatrivrudadi kashaya mentioned in the context of Udavarta chikitsa from Chikitsa manjari consists of Abhaya, Trivrut, Kulatha, Pippali and Eranda taila. Properties of this yoga include Vatanulomana, Sulaghna and Udavartahara. An 18 year old girl complained with severe pain during menstruation, low back ache, nausea and vomiting came to the OPD of Prasutitantra & Streeroga, Government Ayurveda College, Tripunithura is taken for this study. It is evident from the case study that Abhayatrivrudadi kashaya is effective in the management of primary dysmenorrhea.

Outcome of COVID-19 in Children With Tuberculosis: Single-Center Experience

Objective: To evaluate the outcome of Coronavirus disease 2019 (COVID-19) infection in children and adolescents with tuberculosis. Methods: We analyzed hospital records for the period May, 2020 to September, 2021 for children who were severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) positive or SARS-CoV-2 antibody positive. They were divided into two groups viz., those with tuberculosis (tuberculosis group) and those without tuberculosis (non-TB group). Demographic information, symptoms, and outcomes of COVID-19 were compared between the two groups. Results: Median (IQR) age of participants was 11 (8,14) and 4.5 (2,9) year for the tuberculosis and non-TB groups, respectively. 93.5% and 36.1% of children were asymptomatic in the tuberculosis and non-TB group, respectively. No variable in the study was significantly associated with COVID-19 positivity in children with tuberculosis. No difference was found in the outcomes of COVID-19 infection in children having tuberculosis. Conclusions: No differences were noted in the outcomes of COVID19 infection in children having tuberculosis.

Efficacy and safety of subliminal transscleral cyclophotocoagulation in uncontrolled glaucoma

Purpose: To determine the efficacy of subliminal cyclophotocoagulation in reducing intraocular pressure (IOP) and to assess the safety profile of the procedure. Methods: We reviewed the charts of all patients who underwent subliminal cyclophotocoagulation between August 2019 and August 2020. The IOP, number of antiglaucoma medications, and visual acuity were compared at baseline and at 6 months. The post-laser complications were noted. Paired t-test, Wilcoxon rank-sum test, and McNemar test were used for analysis. Results: This study included 40 eyes of 40 patients. The most frequent diagnosis was neovascular glaucoma (55%), followed by primary open-angle glaucoma (17.5%). The mean IOP reduced from 32 to 21 mmHg (mean IOP reduction: 32%, 95% confidence interval [CI]: 27%–37%, P < 0.001). Mean number of antiglaucoma medications declined from 3.2 to 1.9 (P < 0.001). Use of oral acetazolamide decreased from 62% to 5% (P < 0.001). The success rate of the procedure at 6 months was 55%. One patient had unexplained visual acuity decline after the procedure. Conclusion: Subliminal sub-cyclophotocoagulation is effective in treating refractory glaucoma in the Indian population. It decreases the medication burden. However, subliminal lasers can also cause vision-threatening complications such as hypotony, uveitis, and optic nerve hypoperfusion. So, clinicians should be cautious when using sub-cyclophotocoagulation in patients with good vision.

A Prospective and Retrospective Study of Bone Marrow in Patients with Pancytopenia– A Study of 150 Cases

BACKGROUND : The bone marrow is widely distributed organ and is the principle site for blood cells forma?on. The broad spectrum of disorders affects the marrow primarily or secondarily with presenta?on of peripheral pancytopenia. Hence, bone marrow examina?on is extremely helpful in evalua?on of pancytopenia. This study emphasizes the different causes of pancytopenia and bone marrow morphology in cases of pancytopenia. MATERIALS & METHODS: The present study is a retrospec?ve and prospec?ve study done in the department of Pathology, for a period of two years. All the relevant history, clinical details, radiological details, and biochemistry parameters were considered. RESULTS: Out of 150 cases,96 were males and 54 were females. Majority of the pa?ents were in the age group of 41-60 years (54%) amongst whom Megaloblas?c anaemia was the most important cause of pancytopenia. CONCLUSION: Bone marrow aspira?on is rela?vely a very safe invasive procedure and primarily permits cytological assessment since the underlying pathology determines the management and prognosis of the pa?ents.