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Background and Objective: Cardiovascular disease (CVD) is a significant cause of morbidity and mortality worldwide, with high-risk patients requiring effective management to reduce their risk of cardiovascular events. Bempedoic acid is a novel therapeutic agent recently approved as an add-on therapy to statins in patients with uncontrolled LDL-c. Bempedoic acid inhibits cholesterol synthesis in the liver, which ultimately reduces the risk of cardiovascular events. Therefore, the present study aims to assess the efficacy and safety of bempedoic acid in patients with uncontrolled LDL-c (Previously on moderate or high-intensity statins) with a high risk of CVD in real-world settings. Methods: This is a multicenter, retrospective, observational study on the data of high-risk-CVD patients collected from Bempedoic Acid on Efficacy and Safety in patients (BEST) Registry. The clinical data of 140 patients who were already on statin therapy and were receiving Bempedoic acid at a dose of 180 mg, along with measurements of the level of LDL-c, HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, serum creatinine was taken into consideration. The primary outcome includes a change in LDL-c level, and secondary outcomes involve a change in the level of HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, and serum creatinine at week 12 and 24. Adverse events were reported at both time points. Results: A total of 140 patients were included in the present study with a mean age of 51.8 ± 9.2 years and had primary confirmed diagnosis of dyslipidemia with uncontrolled LDL-c. The mean levels of LDL-c decreased from the mean baseline value of 142.67 ± 46.49 mg/dL, to 106.78 ±33.92 mg/d; a statistically significant reduction by 23.23% (p < 0.01) at week 12. Similarly, at week 24, the mean LDL-c value reduced to 90.39 ± 38.89 mg/dL. A 33.38 % decrease was observed (p < 0.01). Other parameters such as non-HDL, FPG, PPPG, AST and serum creatinine also showed statistically significant reduction at week 12 and week 24. Conclusion: The present study demonstrates that bempedoic acid is an effective add-on medication in lowering LDL-c levels in high-risk CVD patients with uncontrolled LDL-c.
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Background: The coronavirus disease 2019 has been spread almost all over the world in the last two years, including in India. Vaccines are a critical tool in the battle against COVID-19, and India has flagged the largest vaccination drive on 16 January 2021. Although public acceptance was varying, which can lead to non-acceptance. Aim & Objective: To estimate an acceptance of the COVID-19 vaccine and its associated factors. Settings and Design: An analytical cross-sectional study among health care workers in India Methods & Material: It was conducted using a validated, self-administrated online survey questionnaire, and data were analyzed using SPSS 23 version. The outcome variable was healthcare workers’ acceptance of a COVID-19 vaccine. Results: A total of 450 HCWs participated, including 205(45.6%) women and 245(54.4%) men. A total of 270 (60%) subjects will accept vaccines, while 33.3% were unwilling to accept and wait for vaccines. Male gender (OR=3.14), being married and experienced (OR=11.49), vaccine effectiveness (OR=6.4), vaccine safety (OR=3.4), and past history (OR=2.28) were significantly associated. On applying logistic regression for associated factors, gender (B= -1.145, S.E.= 0.200, Wald 32.748), being married (B= -1.482, S.E.= 0.216, Wald 46.937), for experienced (B= -0.865, S.E.= 0.200, effectiveness (B= -1.856, S.E.= 0.245, wald 57.431), Safety (B= -1.224, S.E.= 0.202, Wald 36.633) and past history (B= -0.357, S.E.= 0.248, Wald 2.071) found significant. Recommendation: Proper information is crucial and healthcare workers’ attitudes about vaccines are an important factor for acceptance and recommendation of the vaccine to the public for population-wide coverage.
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Prone positioning in percutaneous nephrolithotomy is more and more being replaced by supine positioning now a days for its various benefits. This is a prospective study which does Comparative study on percutaneous nephrolithotomy in supine versus prone position and their various outcomes were analysed. There were totally 100 patients included in the study with 50 patients each group (supine versus prone). 57 were male and 43 female patients. Age ranging from 18 to 70 years. Right side stones were 58 and left side was 42. Age, gender and side of stones were similar between two groups. Stone burden were 2.6cm and 2.9cm for supine and prone group respectively. But average operating time were 63.5 minutes ( 35 to 120 minutes) for supine group versus 80 minutes ( 45 to 160 minutes) for prone group. fluoroscopy time was 18.9 minutes for supine group versus 29.4 minutes for prone group. Clearance rate in our study were pretty good in both groups around 90% in both groups (90% vs 88%). five had complications in form of sepsis and bleeding requiring blood transfusion in both groups. Five in supine group and six in prone group required second procedures. Thus Supine percutaneous nephrolithotomy group had significant advantage in terms of less operative duration and less fluoroscopy time than prone percutaneous nephrolithotomy . The stone clearance and complication rates were similar in both the groups.
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Background: Tuberculosis (TB) patients suffer enormously due to huge cost on diagnosis and treatment. This study aims to assess the total expenditure and its predictors among patients of TB. Methodology: A longitudinal study was conducted among TB Patients registered in first quarter of 2018 at District Tuberculosis Center, Jammu. Data was collected by interviewing the patients and their attendants. Statistical significance of median expenditure between patients of pulmonary and extrapulmonary TB in rela-tion to various predictors was assessed using nonparametric tests followed by Multiple Linear Regression. Results: Total median cost, median direct and indirect cost incurred by a TB patient were recorded as USD 489.55, USD 246.55 and USD 229.5 respectively. Treatment costs were slightly higher in patients of pulmo-nary TB in comparison to extrapulmonary TB (p>0.05). On bivariate analysis, upper class, previously treated patients, Category 2 patients, with chronic illnesses, with guardians and who were employed expended signif-icantly higher amounts on their treatment, but on multivariate analysis, only formal employment, current earning and being reimbursed significantly predicted the total cost (p < .001, adjusted R square = 0.56). Conclusion: Huge direct costs incurred by patients is a matter of great concern, more so as the Indian gov-ernment has made all diagnostics and treatment free since the inception of the RNTCP.
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Purpose: The present study analyzed the existing literature related to COVID 19 and Mental Health by using the technique of bibliometric analysis which may serve as guide-map for future researchers and policy makers. Method: Bibliometric analysis is conducted in the present study by using various techniques like cita-tion analysis, co-citation analysis, co-occurrence of keywords, thematic mapping by using visualization of similarities (VOS) viewer open-source software and R-based bibliometrix. Results: The study highlighted the most significant journals, authors, co-cited authors, institutions, key-words co-occurrence, and most cited articles in the area of COVID-19 and Mental Health on the basis of bibliometric analysis of 149 studies taken from the database of Scopus for the past three years (2020–first quarter of 2022). Also, authors identified few relevant themes such as Economic Effects of COVID-19, COVID-19 and its Impact on Healthcare workers, COVID-19 and its Impact on Patients and General Population as important emerging key areas for further research. Conclusion: We have highlighted significant citations, co-citations and keywords co-occurrence to summarize the literature. The present bibliometric study convincingly confirms the effect of COVID 19 pandemic on mental health and provides enough evidence to advocate formulation of strategies to tackle mental health issues.
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Background: Picky eating is very common problem encountered by parents which does not require much intervention until other problems like micronutrients deficiency, stunting, wasting and malnutrition. Picky eating is mostly seen in preschool children and gradually withers away as age progresses but nevertheless parents need to take guard and observe the child and report any abnormality. The study was undertaken to understand the impact of picky eating on weight and height for age. Methods: The cross-sectional observational study was conducted among children attending outpatient department of tertiary health care centre in Hyderabad. A total of 200 children were included between the age 2 and 6 years. The anthropometric measurements were taken, tabulated and placed appropriately for weight for age, height for age and weight for height. Results: Among 200 Pre-school children Picky eating behaviour was observed in 54% children. The study showed among the picky eaters group the height and weight for age was lower when compared to non- picky eaters. When both picky and non- picky eaters, anthropometry were measured for association, Significance was observed for weight for age (p=0.001), height for age (p=0.001) and weight for height (p=0.01) depicting picky eating behaviour had an impact on growth of the child. Conclusion: Picky eating behaviour was observed in majority of preschool children. The height, weight and BMI is lowered compared to non-picky eaters. Interventions like parent counseling is needed and if needed medical intervention will be required.
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Aloe vera, a popular succulent perennial medicinal plant with a wide range of phytochemicals that have shown various pharmacological activities including anti-oxidant, antimicrobial, antidiabetic, wound healing promotion and so on. Acemannan, aloe-emodin, aloin, aloesin, and emodin are widely investigated active constituents that show various pharmacological activities. Thus, the purpose of this review is to highlight previous pharmacological studied conducted in vivo, in vitro and human assays over the past decades. As current pharmacological research is focused on anticancer and neurological action, it would be interesting and important to study the main compounds present in Aloe vera for therapeutic purposes.
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OBJECTIVES: This study compares the adverse effects (AEs) associated with trastuzumab in the treatment of human epidermal growth factor receptor 2-positive breast cancer (HER-2 + BC) when used alone or in combination with chemotherapy or with tyrosine kinase inhibitors, so as to aid in rational treatment choices. MATERIALS AND METHODS: An electronic search was conducted on PubMed using the Mesh terms ‘BC’, ‘HER-2 positive’, ‘metastasis BC, ‘trastuzumab’, and ‘safety’. Data from 32 studies regarding AEs were extracted and categorised as trastuzumab + chemotherapy (T+C), trastuzumab biosimilar (Tb), trastuzumab + tyrosine kinase inhibitors+ chemotherapy (T+TKi+C), and trastuzumab + tyrosine kinase inhibitors (T+TKi). The data are presented as the mean percentage of AEs. The statistical comparison was represented by a box and whisker plot of the interquartile range value of AEs. RESULTS: AEs related to the gastrointestinal tract, skin, nervous, blood, and lymph were reported to be the most common in T+C, T+TKi+C, and T+TKi. Nausea, vomiting, diarrhoea, constipation, neuropathy peripheral, alopecia, rash, anaemia, leucopenia, raised aspartate transaminase and alanine transaminase were the most common complaints. AEs such as myalgia, nasopharyngitis, hypertension, and ejection fraction decrease was reported to be the most common in Tb. CONCLUSION: This study concluded that biosimilar of trastuzumab is safest for the treatment of HER-2-positive BC. Cardiovascular disorder is often reported in the biosimilar group, but this group has fewer AEs reported as compared with chemotherapy, and tyrosine kinase inhibitors groups related to other systems such as digestive, nervous, and respiratory. The choice of combination is depending on the type of BC and the condition of the patients. The patients must monitor for cardiotoxicity when the biosimilar of trastuzumab is used.
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Background. Ambient aeroallergens and organic or inorganic air pollutants are known to cause asthma exacerbation and subsequent asthma-related hospital admissions. Methods. This study was carried out to study the impact of meteorological factors, air pollution, pollens over hospital visits for respiratory illness in north Delhi region from July 2014 to June 2015. Daily monitoring of pollen grains was done on the roof of the multistorey building (height up to 20m) of the Institute. Meteorological factors including temperature, relative humidity, and precipitations were recorded daily. Daily concentrations of nitric dioxide (NO2), particulate matter (PM2.5) and sulphur dioxide (SO2) were also recorded. Number of hospital visits of patients with respiratory illness were assessed in relation to air pollutants (NO2, SO2 and PM2.5) and climate change (temperature, relative humidity and rain). Results. During the study period, 113,462 pollen counts were recorded. Two highest peaks of mean pollen counts were observed in post-monsoon season (October-2014) and in the spring season (March 2015). The maximum and minimum pollen concentration was observed in the month of March 2015 (18818/m3) and August 2014 (4731/m3). Our results showed that pollen numbers significantly correlated with respiratory emergency department patient visits (P=0.037, r=0.604), and temperature and humidity (P=0.711, r=-120, and (P=0.670, r=-0.137), respectively. NO2 significantly correlated with SO2, respiratory emergency department patient visits and new respiratory OPD patients (P=0.017, r=0.670, P=0.031, r=0.622 and P=0.016, r=0.675, respectively). A statistically significant correlation between rainfall and SO2 was observed (P=0.004, r=-0.757) in the present study. Conclusion. Our study suggests that significant increase in pollen concentration and air pollutants in the ambient environment causes respiratory illness.
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Knee joint is an organ made up of joining of two long bones and supported by joint capsule, ligaments and menisci which is moved by muscles. It helps in locomotion. As many physicians thought osteoarthritis of knee is not a degenerative disease but failed attempt of the joint to repair the mechanically induced damage caused by abnormal intraarticular stress. Normalization of this stress is shown to result in structural and symptomatic improvement. Progression of osteoarthritis can be prevented by strengthening of bone and muscles and also by correcting the altered mechanical axis. Strength of bone and muscles is the strength of joint.
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Background: Adequate importance should be given to antimicrobial chemotherapy and the antibiotics resistance issues during undergraduate training. For successful and sustained intervention, knowledge, attitudes, and practices (KAP) of antimicrobials should be done. So accordingly, this study was planned. Aim and Objective: The aim of the study was to compare KAP of antibiotic use among the 2nd year medical and dental students before and after intervention. Materials and Methods: Questionnaire-based study was done in medical and dental undergraduate students. After taking consent, responses were collected before and after intervention. Each correct response was given a score of 1 and responses were graded as satisfactory and unsatisfactory. Data collected was statistically analyzed using Microsoft Excel 2010 and results were expressed in percentage. Paired t-test was used to analyze pre and post-interventional data. Results: Significant rise in mean knowledge, attitude, practice, and overall scores after intervention in medical and dental students were observed. Satisfactory responses were significantly reduced from 73% to 63% in medical students. Casual attitude towards self-use and irregular use of antimicrobial agents (AMA) was observed which may lead to antibiotic resistance. Significant improvement in overall satisfactory responses was also observed after intervention. Conclusion: Medical and dental students showed improved knowledge about AMA use and antimicrobial resistance (AMR) after pharmacology teaching. However, predominant low scores of attitude and perception indicate the need for further educational interventions such as small group exercises, prescription audits, frequent discussion on rational pharmacotherapy, skillful communication with the patient about prescription. To reduce AMR, students should be trained about AMA use and its adherence by patients as well.
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A study was conducted in mid hill region of Rajouri district, J&K, India to analyze the impact lockdown amid covid-19 pandemic on weather parameters. Day and night temperature readings were recorded fortnightly from 1st March to 30th June 2020 from maximum and minimum thermometer, rainfall values from ordinary rain gauge, and soil temperature at different depth from soil thermometers and values were compared with data from 2017-2019 and normal. After analyzing the data statistically using “Descriptive statistics” in MS-Excel 2010, it was observed that within the period of lockdown, the change in day temperature was -6.66% from normal mean value, however night temperature was least affected as it changes 10.33% and rainfall pattern was 19.27% more from normal mean value. The average change in soil temperature in morning at 5 cm, 10 cm and 20 cm depth in lockdown was -4.65%, 3.74% and 2.65% as compared to year 2019 (1st March to 30th June) mean value and the change in soil temperature in evening at same depths was -5.14%, -11.30% and 0.3% from year 2019 (1st March to 30th June) depicting a slow change in values. With the significant sustainable pattern observed in day and soil temperature parameters and rainfall it can be concluded that lockdown might be an effective tool in reducing speed of climate change in future.
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Aim: The present study was conducted with the aim to collect and evaluate the available genetic diversity of chilli (Capsicum annuum L.) in order to identify promising accessions for cultivation as well as use in crop improvement. Methodology: A total 78 accessions of chilli were collected from Western himalayan region, i.e., Kashmir valley of India. Collected germplasm was evaluated at one location for fifteen quantitative traits of horticultural importance. Results: With ample diversity in these traits, a high coefficient of variation was found. Principal Component Analysis (PCA) revealed that first five principal components possessed eigen value > 1, cumulatively contributed > 65.2 percent of total variability. All the genotypes were grouped into five clusters showing non parallelism between geographic and genetic diversity. Interpretation: The genotypes grouped in different clusters may be utilized for hybridization programme to produce more heterotic recombinants.
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Background: It is necessary to understand the way women think about their health. There is a 揷ulture of silence� among women regarding urinary incontinence (UI). Physiotherapy is proven effective mode of therapy in case of UI. Objectives: This study aimed to explore the attitude of the women toward UI, to understand the related sociocultural factors and health-seeking behavior, and to ascertain the challenges encountered in community-based physiotherapy interventions. Methods: A qualitative study was conducted among women who refused to participate in a physiotherapy intervention for UI in the rural community of Gujarat, India. Fourteen in-depth key informant interviews were conducted using an interview guide. The responses were noted and compiled into a composite interview script. Interviews were not recorded due to nonavailability of consent. Interviews were reviewed by investigators and content analysis was carried out. Key themes were identified after multiple iterations. Results: Most of the women were unaware of the UI and believed that it may be due to their gender or due to aging. Physiotherapy interventions were disregarded due to various reasons such as shy nature, lack of priority and privacy, dependency, self-neglect, and influence of social and cultural norms. Conclusion: Cultural and social systems were more important determinants of health seeking than health systems themselves particularly when sensitive issue such as UI in women of rural Western India was concerned.
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The Indian health infrastructure is struggling to handle the burgeoning number of people with diabetes. Managing the complications of diabetes in an organized manner through the government health programs is still a distant reality. Here, we describe a program aimed at addressing the problem of diabetic retinopathy in rural areas of Tumkur district in Karnataka. By amalgamating telescreening and our own novel distributive care model, we were able to screen 85% of the registered diabetics in the Government noncommunicable disease clinics and treat 95% of those needing laser therapy. We also describe the importance of using electronic medical records in public health programs which not only increase the efficiency in screening for disease but help in increasing uptake of treatment by tracking defaulters.
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In this case report, we demonstrate the use of optical coherence tomography angiography (OCTA) as a tool to evaluate intrinsic vasculature in a case of juxtapapillary melanoma which underwent ruthinium.106 plaque brachytherapy. In this case, OCTA could demonstrate a decrease in caliber and density of the intrinsic vasculature of the tumor post brachytherapy.
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Light chain myeloma (LCM) has a reported worldwide incidence of approximately 15%–20% among all multiple myeloma (MM) patients. Few western studies have shown strong correlation of LCM with anemia, higher International Staging System scores, proclivity to renal failure, elevated lactate dehydrogenase levels, raised serum-free light chain ratio, higher frequency of extramedullary plasmacytomas, and poorer overall survival, attributable probably to lack of differentiation and skeletal destruction. The primary aim of this retrospective observational study was to define the clinical and hematological characteristics as well as prognostic outcome of Indian LCM patients in comparison with the IgG and IgA subtypes. Patients were defined according to the International Myeloma Working Group diagnostic criteria 2016 and staged as per the International Staging System. Out of 104 patients of newly diagnosed MM in which results of serum immunofixation (IFE) were available, 65 were of IgG isotype (62.5%), 15 had IgA (14.4%), and 24 had light chain myelomas (LCMs) (23.1%). It was observed that LCM patients significantly correlated with hypercalcemia and higher serum-free light chain ratios, whereas IgA patients were strongly associated with anemia and lower serum albumin levels. However, no difference was found among the three subgroups in terms of serum lactate dehydrogenase levels, proclivity to renal failure, presence of lytic bone lesions, prognostic scoring, pretransplant chemosensitivity, and progession-free survival (1 year). Thus, it may be concluded that Indian LCM patients have significantly different clinico-hematological profile in comparison with other published studies worldwide. Also, their prognostic outcomes are not worse when compared with patients of other protein isotypes, probably due to standardized treatment regimens applied.
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Background & objectives: Breast cancer is the most common cancer of women. Inferior prognosis in some patients has been attributed to the higher proliferative capability of the tumour. Immunohistochemistry (IHC) for Ki-67, despite being a simple and cost-effective method, has not become a valid tool to evaluate this biomarker. This is ascribed to variation in pre-analytical and analytical techniques, variable expression, hotspot distribution and inter-and intra-observer inconsistency. This study was aimed at defining the analytical and clinical validity of real-time quantitative polymerase chain reaction (RT-qPCR) as an alternative to IHC evaluation. Methods: This study included a total of 109 patients with invasive breast cancers. Ki-67 IHC visual assessment was compared with the mRNA value determined by RT-qPCR. Concordance between both the methods was assessed. Receiver operating characteristic (ROC) curve analysis and Cohen's kappa value with intraclass correlation were performed. Results: The threshold value for Ki-67 by RT-qPCR obtained by ROC curve was 22.23 per cent, which was used to divide breast cancer cases into high proliferative and low proliferative groups. A significant correlation was observed between both the breast cancer groups formed using RT-qPCR threshold as well as median laboratory value of Ki-67 labelling index by IHC. Interpretation & conclusions: The study results showed a significant correlation between the two methods. While IHC is subject to technical and interpretative variability, RT-qPCR may offer a more objective alternative.
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Background: Every year about 5 million people die worldwide due to Injuries, Road traffic Injuries are a neglected public health problem. In the state of Tamil Nadu, India the total number of road accidents has been on a constant rise. Objective: This study aims to provide a description of the reported road traffic accidents in Tamil Nadu based on location, injury rates and fatality rates. Methods: Secondary data on Road traffic accidents was collected from state and national reports published on various authentic sources. Cluster analysis was carried. Result: Two-wheelers accounted for the highest share in total road accidents, Males were found to have higher risk than females. The districts with high injury rates were Villupuram, Ariyalur, Cuddalore, Thiruvarur, Kanchipuram and Nagapatinam. If the current circumstances continue, we predicted that, by the year 2023 the total number of accidents will be approximately 75985 in Tamilnadu. Conclusion: The Tamil Nadu Governments efforts to stop and reverse the increasing trend in the number of road traffic accidents, deaths, injuries through adoption of comprehensive measures covering Engineering, Education, Emergency care and Enforcement is seeing its results, but there is a need for more effective implementation across the state.