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Background: India has the highest burden of tuberculosis in the world. It is experiencing an increasing burden of noncommunicable diseases, thereby facing a dual disease burden. Recent evidence shows an association between TB and noncommunicable diseases like diabetes, CVD and chronic respiratory infections. Aims and Objectives: To assess the feasibility of screening for NCDs and risk factors for NCDs among patients with TB in DOTS centers of a medical college in Delhi and ascertain challenges for the same among providers and patients. Methodology: It was a mixed-methods study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data). Results: Among the 139 patients screened, ten new cases of hypertension and six new patients were diagnosed with DM. Outof- pocket expenditure for tests was a concern of the patients. Health care providers found the screening tool easy to use but were apprehensive about increased workload Conclusion: The study provide useful visions for incorporating NCDs into routine TB care through DOTS centers under RNTCP/NTEP.
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Trauma is the main cause of subluxation or dislocation of the lens followed by ocular surgery and spontaneous dislocation due to hypermature cataract. Other causes are Marfan’s, Homocystinuria, Ehler Danlos syndrome and pseudoexfoliation. We report a case of dislocated lens by a trivial trauma with a wooden stick which was left unattended unless patient noticed decreased vision in that eye.
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Background: Term small for gestational age (SGA) babies are at risk for developing iron deficiency anemia. The association between maternal and infant iron stores is not clear. Objective: To assess proportion of term SGA neonates developing iron deficiency anemia by 10 weeks of age, and measure correlation between iron profile and hepcidin of babies at birth and at 10 weeks of age with maternal iron profile. Design: Prospective cohort study conducted from November, 2018 to April, 2020. Participants: 120 term SGA babies and their mothers. Intervention: Hemogram, iron profile and serum hepcidin (every fourth case) estimated in mother, cord blood and baby at 10 weeks. Babies developing anemia at 6 weeks detected by hemogram and ferritin were started on iron supplementation and excluded from the study. Outcome: Proportion of babies developing iron deficiency anemia at 10 weeks of age. Results: 35 (29.2%) of 120 term SGA babies developed anemia (hemoglobin <9 g/dL) at 6 weeks. Proportion of infants who developed iron deficiency anemia (hemoglobin <9 g/dL and serum ferritin <40 µ/dL) at 6 and 10 weeks of age was 14.2% and 23.3%, respectively. No significant correlation was found bet-ween hemoglobin, iron and hepcidin of the baby in cord blood and at 10 weeks of age with that of mothers. Serum hepcidin in babies at birth (137.5 ng/mL) were higher than maternal values (128 ng/mL). Conclusion: A significant proportion of term SGA infants developed anemia during early infancy, irrespective of maternal iron status.
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Background : Seasonal variations in the incidence of Intracerebral Haemorrhage (ICH) have been extensively evaluated in the studies conducted in various parts of the world. The prevalence per 100,000 person-years of spontaneous cerebral haemorrhage is regularly highest in the winter and lowest in the summer. However, these seasonal variations of ICH in India have not been comprehensively described in any published literature. Methodology : In this retrospective cross-sectional study, data of 15000 patients were collected from various State Government-owned Hospitals of India of the months April, May and June. The present study examined the association between temperature variations and spontaneous ICH incidence during recent severe Cyclonic Storms ‘Yaas’, and ‘Tauktae’ in India with the brain’s Computed Tomography (CT) scans. A CT brain persists in being the investigation of choice in the initial diagnosis of ICH, as it is readily available, accessible and fast. Results : During these Cyclones, there was a significant temperature drop associated with an increased incidence of ICH in the specified time. Conclusion : Sudden temperature drop during a Cyclone can cause spontaneous Hypertension, which causes rupture of arteries in the brain and results in Stroke. The Government, Physicians and the general public need to be made aware of such associations
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Demand refers to amount of instalments of agriculture loan demanded by banks for the year. Collection is a part of demand which is paid by the borrower and balance is the difference between demand and collection
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Vivax malaria is in general described and considered as benign as it less likely causes severe illness, compared to malaria caused by Plasmodium falciparum (P.falciparum)species. Of late, there have been increasing evidences of Plasmodium Vivax (P.vivax) too causing severe disease and leading to poor outcomes.. We report a case of severe P vivax malaria in a 12 year old child complicated by Acute respiratory distress syndrome(ARDS)
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Background: Fatigue represents a common complaint of patients with diabetes as it can be reported in up to 60% of patients, prominent in patients with type 2 diabetes. It is a major health problem, affects approximately 6% of the world's adult population, and is increasing in epidemic proportions. Evidence suggests that MSRT a yoga-based relaxation techniques significantly reduces anxiety, stress, fatigue and psychological distress. The aim of the study wasObjective: to study the effect of MSRT on fatigue levels among type-2 diabetes patients. Materials and Methods: In this interventional study with a pre-post design on 100 type-2 diabetes patients, were taught MSRT. Assessment were carried out on the 1 and 30 day of the program, using FSS, VAFS. Results: Significant reduction in fatigue levels in both FSS and VAFS respectively (p<0.00). Conclusion: This study provides evidence that MSRT practice is an effective, economical and noninvasive method to combat fatigue in diabetes patients.
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Super refractory status epilepticus (SRSE) is a rare but serious neurological emergency. This case report aims to highlight the challenges faced during the diagnosis and management of SRSE in a 36-year-old preeclamptic patient taken for cesarean delivery under spinal anesthesia. The patient developed a seizure episode minutes after administration of intrathecal bupivacaine, necessitating administration of general anesthesia. Postoperatively, SRSE developed which did not respond to multiple anti-epileptics and thiopentone sodium infusion. Although the clinical picture and magnetic resonance imaging findings supported the diagnosis of posterior reversible encephalopathy syndrome, the role of intrathecal bupivacaine in causing SRSE could not be ruled out due to the temporal association of events. The patient had a prolonged and complicated hospital stay and despite a multimodal approach to the treatment, suffered neurological sequelae.
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Eichhornia crassipes (EC) is a well-known invasive weed in different aquatic ecosystems. Its effective and complete eradication remains a challenge. The plant is a heavy metal (HM) hyperaccumulator in water bodies; however, studies regarding its biomass utilisation post-phytoremediation remain limited. The abundant growth rate and biochemical composition make EC a promising lignocellulosic feedstock for biofuel production; hence could be a deterministic approach for solving the twin problems of water pollution and higher energy demand, which are the global pressing issues in today’s scenario. The present study aimed at evaluating the phytoremediation potential of EC followed by proximate and biochemical analysis to investigate its suitability for biofuel production. After two weeks, the EC removed above 90% of Lead (Pb) and 60% of Cadmium (Cd) at all experimental doses. Lower doses of HMs, especially Pb, showed stimulatory effects on E. crassipes leaf biomass (ECLB). The recovered ECLB from Pb contaminated water (1 mg L?1) was further analysed for moisture (89.23±0.86%), dry matter (10.77±0.60%), ash (11.91±1.20%), organic carbon (51.56±1.08%), cellulose (21.89±0.64%), hemicellulose (26.50±1.13%), lignin (5.62±0.83%), total carbohydrate (32.00±1.58%), and protein (20.83±0.52%) content. SEM imaging of harvested ECLB confirmed compact and rigid structure. The recorded peaks in FTIR-spectra (1015.21, 1153.71, 1246.01, 1339.63, 1419.71, 1540.71, 1646.80, 1736.73, 2933.03, and 3263.72 cm?1) indicate the presence of lignocellulosic biomass. XRD peak at 21.55? confirmed the crystalline fraction of cellulose in ECLB. The results of theoretical yields of H2 and CH4 co-generation (HMG) (210.85 mLH2/g DW and 150.28 mL CH4/g DW) and Bioethanol (0.278 g/g DW) derived from cellulose and hemicellulose content of ECLB were comparable to those in reported studies. Overall, this work demonstrates an integrated methodology of phytoremediation followed by biofuel production from the recovered phytobiomass.
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Background@#Inferior alveolar nerve block (IANB) is known to have a lower success rate for anesthesia in patients with irreversible pulpitis. This calls for supplementary techniques to effectively anesthetize such patients.This systematic review aimed to evaluate the published literature for determining the success rate of anesthesia induction using post-IANB intraligamentary (IL) injection in the mandibular teeth of patients with symptomatic irreversible pulpitis. The review question was, “What is the success rate of IL injection in the mandibular teeth of patients with irreversible pulpitis as a supplementary technique for endodontic treatment?” @*Methods@#A thorough search of electronic databases and manual searches were performed. The protocol of the review was framed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and was registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with a proper criterion for inclusion and exclusion of studies. The included studies were analyzed using the Cochrane Collaboration ‘‘Risk of Bias’’ tool. A meta-analysis that included a comparison of primary nerve block and supplemental IL injection was performed. The success rate was evaluated using the combined risk ratio (RR) with a random risk model. A funnel plot was created to measure publication bias. @*Results@#After all analyses, four studies were included. In the forest plot representation, RRs were 3.56 (95% CI: 2.86, 4.44), which were in favor of the supplemental IL injections. Statistical heterogeneity was found to be 0%. These values suggest that supplemental IL injections provide better success rates for anesthesia. @*Conclusion@#According to the pooled qualitative and quantitative analyses, supplemental IL injections increased anesthetic efficacy.
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This review aims to identify the influence of the vehicle and its concentration used to carry calcium hydroxide (Ca(OH)2 ) medicament on postoperative pain.The protocol for this review was registered in the open science framework (Registration DOI-10.17605/OSF.IO/ 4Y8A9) and followed the guidelines provided by the Joanna Briggs Institute. Reporting was based on the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR). Literature screening and searches were performed on PubMed/Medline, Scopus, and EBSCO hosts. Furthermore, additional records were manually analyzed using various sources. The selected studies were published in English and included the use of any vehicle adjunct to Ca(OH)2 to evaluate postoperative pain using qualitative and quantitative pain assessment tools. Descriptive analysis was conducted to review the study design, vehicle elements, and their effects.A preliminary search yielded 7584 studies, of which 10 were included. According to the data collected, the most commonly used Ca(OH)2 vehicles were chlorhexidine (CHX), normal saline, and camphorated paramonochlorophenol/glycerine (CPMC/glycerine), which had a significant effect on postoperative pain. Among the included studies, six evaluated the effect of CHX as a vehicle. It was observed that a higher concentration of the vehicle (2%) showed a favorable response in reducing postoperative pain.A majority of studies have validated a positive consequence of using a vehicle on postoperative pain. Although higher vehicle concentrations were found to alter postoperative pain levels, the data were insufficient to draw a firm conclusion. Our scoping review indicates that further clinical studies should focus on using different vehicles at various concentrations and application times to check for feasible and safe exposure in addition to providing pain relief.
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Background and Aim: To study effect of FMT in patients with moderate or severe IBS. Methods: Patients with IBS for more than one year were offered three sessions of colonoscopicFMT in addition to standard of care. Severity of disease, psychological distress and QOL were assessed by IBS-SSS, HAM-D, HAM-A and WHO-QOL scores. Results: Ten patients with IBS (IBS-D 5, IBS-C 4 and IBS-M 1) were studied. Median IBS-SSS reduced from 313.5 (SD ± 66.8) at baseline to 163 (SD ± 84.5) at 1 week (p = 0.0005), 216 (SD ± 79.3) at 2 weeks (p = 0.003), 201(SD ± 86.6) at 4 weeks (p = 0.005) and 262 (SD ± 69.4) at 8 weeks. Median IBS-SSS at 12 weeks and 24 weeks was not significantly different from baseline. Reduction of IBS-SSS severity was seen in 8 (80%) patients at one week, 6(60%) at 2 and 4 weeks, 3(30%) at 8 weeks and 1(10%) at 12 and 24 weeks. weeks. Of four patients with depression, there was improvement in two patients at 2 and 4 weeks and one at 8 weeks. Quality of life improved in four patients at 2, 4 and 8 weeks, two patients at 12 weeks and one at 24 weeks. Three patients reported marked improvement of symptoms at 12 months along with change in stool odor to donor type. Conclusion: FMT results in short-term improvement in global symptoms of IBS, psychological distress and QOL. Repeat sessions of FMT did not accrue additional benefit.
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BACKGROUND@#The Hokkaido Study on Environment and Children's Health is an ongoing study consisting of two birth cohorts of different population sizes: the Sapporo cohort and the Hokkaido cohort. Our primary objectives are to (1) examine the effects that low-level environmental chemical exposures have on birth outcomes, including birth defects and growth retardation; (2) follow the development of allergies, infectious diseases, and neurobehavioral developmental disorders, as well as perform a longitudinal observation of child development; (3) identify high-risk groups based on genetic susceptibility to environmental chemicals; and (4) identify the additive effects of various chemicals, including tobacco.@*METHODS@#The purpose of this report is to provide an update on the progress of the Hokkaido Study, summarize recent results, and suggest future directions. In particular, this report provides the latest details from questionnaire surveys, face-to-face examinations, and a collection of biological specimens from children and measurements of their chemical exposures.@*RESULTS@#The latest findings indicate different risk factors of parental characteristics on birth outcomes and the mediating effect between socioeconomic status and children that are small for the gestational age. Maternal serum folate was not associated with birth defects. Prenatal chemical exposure and smoking were associated with birth size and growth, as well as cord blood biomarkers, such as adiponectin, leptin, thyroid, and reproductive hormones. We also found significant associations between the chemical levels and neuro development, asthma, and allergies.@*CONCLUSIONS@#Chemical exposure to children can occur both before and after birth. Longer follow-up for children is crucial in birth cohort studies to reinforce the Developmental Origins of Health and Disease hypothesis. In contrast, considering shifts in the exposure levels due to regulation is also essential, which may also change the association to health outcomes. This study found that individual susceptibility to adverse health effects depends on the genotype. Epigenome modification of DNA methylation was also discovered, indicating the necessity of examining molecular biology perspectives. International collaborations can add a new dimension to the current knowledge and provide novel discoveries in the future.
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Child , Child, Preschool , Female , Humans , Infant , Male , Pregnancy , Biomarkers/blood , Child Health , Cohort Studies , Environmental Exposure/adverse effects , Environmental Health , Environmental Pollutants/adverse effects , Fetal Blood/chemistry , Follow-Up Studies , Growth/drug effects , Hypersensitivity/etiology , Japan/epidemiology , Neurodevelopmental Disorders/etiology , Prenatal Exposure Delayed Effects/etiology , Prevalence , Smoking/adverse effectsABSTRACT
Background: To study the Feto-maternal outcome in cases with previous surgical intervention for first trimester abortion on subsequent pregnancy and to compare with cases without history of previous abortion.Methods: A cross sectional observational study was conducted over a period of two years. Study included 80 consenting females at 28 weeks POG. Females with history of prior surgical abortion just before the present pregnancy were included as cases (n=40) and rest as controls (n=40). Detailed obstetric history was taken, subjects were then followed till delivery and feto-maternal outcomes such as period of gestation, mode of delivery birth weight, Apgar score, increased NICU stay at the time of delivery were recorded and analyzed.Results: We observed that the women with history of induced surgical abortion were at increased risk of Pre term birth (52.5%, p value0.006), Cesarean section (40%, p value 0.012), Low birth weight (47.5%, p value <0.001), increased NICU stay (32.5%, p value 0.027) compared to primi-gravida controls.Conclusions: We concluded that women with previous history of induced surgical abortions were at increased risk of preterm birth, very preterm birth and low birth weight babies, NICU stay in the subsequent pregnancies. The risk of caesarean was found to be increased in women with previous induced abortions exposing the women to the morbidity associated with the C-section. Hence patient with prior history of surgical first trimester abortion needs more vigilant monitoring during antenatal period in subsequent pregnancy.
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Background: Present study was undertaken to do a comparative evaluation of artificial rupture of membrane (ARM) and spontaneous rupture of membrane (SRM) on the course of labour and feto-maternal outcome.Methods: It was prospective interventional randomized comparative study including 120 primigravidae (60 in ARM and SRM group each) with cervical dilatation ≥3 cm and intact membranes. Amniotomy was performed in ARM group after enrolment while no intervention in SRM group. Outcomes noted were duration of labor, mode of delivery, APGAR score, NICU stay.Results: Significant reduction seen in duration of labour in ARM group (p=0.0001). Mean duration of labor was 5.24 hours in ARM group while 6.94 hours in SRM group. No significant difference noted in mode of delivery (p=0.082). No significant adverse feto-maternal outcomes were seen with amniotomy. APGAR score and NICU admission had no significant difference among the two groups.Conclusions: ARM can be opted as an intervention with shorter duration of labour without adversely affecting the feto-maternal outcomes. It is safe, reliable and cost effective modality when employed in primigravida and may be considered as a low-cost accessible intervention to reduce prolonged labour and its associated complications.
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Cleft lip and palate is a common condition affecting thousands of children in India and overseas. With an incidence of 1 in 800 live births, these cleft lip and cleft palate patients face numerous aesthetic as well as functional challenges. The condition goes untreated in many scenarios, or patients do not receive adequate treatment due to various reasons like lack of awareness, lack of specialist dentists etc. leading to permanent facial deformity with significant deterioration of quality of life. There have been many changes in the management of alveolar cleft in the past 100 years. Documentation of the first cleft lip repairs dates back to 400 BC, and was performed by Hippocrates, while the first cleft velum repair was done for the first time by a French dentist, Monnier, in 1764. The treatment protocol for the same has been upgraded with time, with better understanding of the anatomy and pathophysiology of the condition, and for better results to the patients. Alveolar bone grafting (ABG) is now becoming an integral part of managing cleft patients. There still isn’t a fixed and widely accepted protocol for ABG in the management of cleft patients, but there are various opinions of researchers around the world regarding the indications of bone grafting, the type of grafting (primary or secondary) to be employed, timing of grafting, the source of bone graft and use of various bone graft substitutes in the procedure. An increasing value of multidisciplinary approach, including maxillofacial surgeons and orthodontists, towards managing such patients, is helping improve the outcome of such patients, and hence easing the overall treatment duration for the patient and relatives. Hence, through this article, we aim to shed some light over the evolvement and current place of alveolar bone grafting in treating cleft lip and palate patients. The anatomy of involved parts, types and indications of ABG, clinical evidences on the timing of the surgery, future evaluation, results and complications, and orthodontic treatment have been mentioned in this article.
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Small bowel obstruction can be due to benign or malignant pathologies. Gastro intestinal lipomas are one of the benign subepithelial tumours causing obstruction. These are usually detected incidentally if asymptomatic. Adult intussusception due to intestinal lipoma is a very rare cause. We are presenting a case of male hypertensive patient with features of multiple subacute obstruction due to multiple submucosal lipomas in ileum. Exploratory laparotomy with intra-operative enteroscopy was performed and resection-anastomosis of affected segment was done.
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Non compaction cardiomyopathy (NCM) is a rare, primary genetically derived cardiomyopathy with a variable clinical presentation ranging from absence of symptoms to congestive heart failure, systemic thromboembolism, arrythmias and sudden cardiac death. Being an uncommon condition, the perioperative concerns in a patient with NCM have not been studied much. With increasing awareness and improved diagnostic tools including high resolution echocardiography and cardiac MRI, there has been an increase in the reporting of cases which stresses on the need for a complete understanding of this form of cardiomyopathy and its perioperative anaesthetic management. Authors report the case of a 24 years old female, with NCM who underwent prophylactic Implantable cardioverter defibrillator (ICD) insertion 5 years ago and was now posted for ICD removal and replacement in view of inappropriate ICD functioning.
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Background: Amniotic fluid plays a vital role during foetal life. The main purpose of this study was to evaluate the foetomaternal outcome in relation to amniotic fluid index in pregnant females beyond 36 weeks of gestation.Methods: This prospective type of study was conducted for one-year duration from May 2018 to May 2019 in 350 pregnant females beyond 36 weeks of gestation with clinically significant abnormal liquor volume. Clinical diagnosis was later on confirmed with ultrasonography and patients were categorized in three categories as patients with Amniotic fluid index (AFI) 5 to 24, AFI <5 and AFI > or = 25. Complete labour record was made and fetomaternal outcome was assessed.Results: In this study, incidence of oligohydramnios was found to be more than polyhydramnios at term. No significant differences were found in relation to age, parity, religion, residence and booking status in all the study groups. Mostly patients 119 (52%) delivered by caesarean section in oligohydramnios group whereas vaginal delivery was commonly seen in patients with normal AFI (80%) and polyhydramnios (55%). Growth restriction 59 (26%) and malpresentation 18 (8%) were commonly seen with oligohydramnios. In the polyhydramnios group, 14 (35%) babies had malformations whereas only 6 (3%) babies had malformations in patients with oligohydramnios. Significant differences were found in the foetal outcome between the patients with oligohydramnios and polyhydramnios in comparison to patients with normal AFI.Conclusions: In pregnant females with abnormal liquor volume increases the chances of maternal morbidity and perinatal morbidity and mortality.