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Background: Skin diseases occur in all age groups in developed and developing countries. Various types of skin diseases are found worldwide and depend on factors like environment, surrounding ecology, dietary habits, socioeconomic status, mental health, and literacy. Health-related quality of life (HRQOL) improves after treatment or cure of the diseases. Objectives: To estimate the pattern of skin disease. To find out the quality of life and association of skin disease with sociodemographic factors among patients. Methods: This observational cross-sectional study was done in skin OPD at the tertiary care center, Banda district of Uttar Pradesh, India from May 2022 to July 2022. All patients who attended to skin OPD during study period were included in the study after taking informed verbal consent. Results: Skin diseases had further divided in subcategories which were infectious conditions, pigmentary disorders, inflammatory dermatoses, miscellaneous skin conditions, benign tumor and other lesions with their percentage 44.8, 10.5, 28.6, 7.1, 2.9 and 6.2%, respectively in this study Classes of DQLI where major portion of patients (49.52%) were in ‘Small effect on patient’s life’ category. The relation of age, religion, education and member of household with history of skin disease were found to be highly statistically significant. Conclusion: Infectious skin diseases were found more common in study area. Male populations were more commonly affected. Skin diseases were more common in age group of 18–60 years. Study participants showed no predominant effect on quality of life. But small effect class had major effect on participant’s quality of life.
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Background: Low birth weight is associated with higher morbidity and mortality including impaired growth and development, malnutrition etc. Worldwide, one- fifth of newborns delivered are low birth weight. Aims & objectives: To estimate frequency of low birth weight & its associated factors among newborns delivered in a tertiary care hospital. Materials & Methods: A cross sectional analysis of 290 newborns delivered in tertiary care hospital, Banda, Uttar Pradesh during period of 15th February 2021 to 31st December 2021 was done for estimating low birth weight frequency & its associated factors including child characteristics, mother characteristics & father characteristics using data from medical record section of hospital. Frequency, percentages, mean, standard deviation, chi square test & independent t- test was used. P value <0.05 was considered significant. Results: 91 out of 290 newborns delivered were low birth weight (27.9%, 95% CI- 23.1%- 33.4%). The following factors were shown to have a significant association with low birth weight: education of mother (p=0.04), education of father (p=0.03), occupation of father (p=0.02), and duration of pregnancy (p<0.001). Conclusion: This study demonstrated that education of mother, education of father, occupation of father, and duration of pregnancy had significant association with low birth weight frequency that suggests that improving literacy status can help in decreasing burden of low birth weight apart from other factors.
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Background: The five-year survival rate of oral cancer remains 50% or less despite the treatment advances. An effective screen- ing test is necessary for early detection of oral cancer. Aim: To assess the efficacy and diagnostic accuracy of centrifuged liquid-based cytology in comparison to conventional exfolia- tive cytology in normal oral mucosa and oral squamous cell carcinoma. Materials & Methods: The study population comprised of 40 individuals, equally divided into two groups: healthy individuals and previous histopathologically proven oral squamous cell carcinoma cases. Exfoliative cytology was done and the samples were processed by conventional cytology as well as by centrifuged liquid-based cytology and stained with Papanicolaou stain. Seven cytological parameters were analysed to assess the quality of slides prepared. A cytological diagnosis of the case group was also made and was compared with histopathological diagnosis to evaluate the diagnostic accuracy. Results: The present study revealed statistically significant superior results in all the cytological parameters evaluated by centri- fuged liquid-based cytology compared to conventional exfoliative cytology (P ?0.05). There was an ‘almost perfect agreement’ found between centrifuged liquid-based cytology diagnosis and histopathology (k=0.89) while only a ‘substantial agreement’ was found between conventional exfoliative cytology with histopathology (k=0.79). Conclusion: The present study summarizes that centrifuged liquid based cytology is more effective than conventional oral exfoliative cytology in screening oral cancer. Further studies with larger sample size in different oral lesions are necessary to validate the use of this cytology technique.
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Background: Hyperhomocystenemia and genetic variants are factors for causing young age stroke glob-ally. This study aims to identify homocysteine related-MTHFR gene polymorphism that associated with recurrent cardiovascular outcomes. Methodology: A randomized controlled trial conducted upon 90 hyperhomocysteinemic ischemic stroke patients were taken from the neurology wards of a tertiary care hospital were randomly selected into vitamin B therapy group and control groups (n=45 in each group). Baseline subject details were col-lected venous blood sample for MTHFR genetic testing via PCR-RFLP technique along with blood homo-cysteine levels, vitamin B12, folic acid levels. Results: The results showed that the frequency of CT genotype polymorphism was 15.5% vs 13.3% for the MTHFR C677T gene without any significant difference between vitamin group and control group re-spectively (p-value >0.05). The reduction in mean homocysteine up to -6.77±4.50 versus -2.08±0.71 μmol/L in the vitamin group as compared to control group respectively, p value 0.001. Conclusion: Considerable amount of MTHFR gene polymorphism found among hyperhomocysteinemic ischemic stroke of sub-Himalayan region. Nutritional deficiencies including vitamin B 12 & folic acid, and some hidden reasons found, which could lead to the primary cause of hyperhomocysteinemia. Vitamin B therapy is an effective for reducing homocysteine.
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Objectives: Chronic obstructive pulmonary disease (COPD) being a disease with systemic consequences necessitate the use of multidimensional indices for a comprehensive assessment of the disease's impact including the future risk of exacerbations and mortality. To study the role of dyspnea, obstruction, smoking, and exacerbation (DOSE) index as a predictor of future disease severity and its correlation with chronic obstructive pulmonary disease test (CAT) score. Measurements and results: A total of 60 inpatients with COPD exacerbations were followed up for 6 months to record the number of exacerbations of COPD. The DOSE index and CAT score were calculated after stabilization within 48 hours of admission, at 1 week, and again at 6 months. The mean difference between DOSE index score at admission and at 1 week was 1.382 � 0.561 and at admission and at 6 months was 2.15 � 0.988, both being statistically significant (p < 0.001). A high DOSE index score (?4) was associated with a greater risk of 2 or more exacerbations [odds ratio (OR), 12 (3.09�.60) and risk estimate, 3.75 (1.53�17)]. For the prediction of exacerbations, the area under the curve (AUC) was larger for the DOSE index (0.854) than the global initiative for chronic obstructive lung disease (GOLD) stage (0.789), p < 0.001 for both. Furthermore, DOSE index correlated significantly with the CAT score, an established health status measure, at all stages of disease severity; at the onset of exacerbation (r = 0.719, p < 0.001), after stabilization at 1 week (r = 0.736, p < 0.001) and at 6 months (r = 0.884, p < 0.001). Conclusion: The DOSE index is a simple, practical multidimensional grading tool for assessing current symptoms, health status, and future risk in COPD and acts as a guide to disease management as its component items can be modified by interventions. Its correlation with CAT, a well-known score is a novel observation, which further corroborates the validity of the DOSE index.
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Background: High incidence of breast cancer among the endogamous Mizo-Mongoloid tribe stresses the need to explore the disease pertaining to the family history as well as other risk factors. This study in-vestigates the association of risk factors and inherited diseases with breast cancer.Methodology: The study includes 426 unrelated breast cancer cases and 810 healthy controls of female Mizo ethnicity. Association between reproductive history, lifestyle/ dietary habits, tobacco and alcohol exposures, family history in relation to cancer and inheritable diseases was assessed by univariate lo-gistic regression using Chi-square tests and multivariate analyses using Cox regression. Results: Age at diagnosis was highest between 41 to 50 years. Consumption of fermented pork fat, smoked food and Smoke-less tobacco, lower intake of vegetables/ water, having a first/ or second de-gree relative with cancers and inheritable diseases were found to be the major risk factors. Certain known factors were also acting as confounding factors. Conclusions: The present study reveals that Mizo women with first- and second-degree relatives of breast cancer, various other cancers and inheritable diseases have increased risk of breast cancer. This study also highlights the importance of analysing genetic factors which can aid in early detection of in-herited risk factors.
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Introduction: Lymphatic filariasis results in severe disability that leading to severe social and economic burden at each level from individual to family, and community. This study was carried out to assess the coverage and compliance of MDA. Methods: From 300 households (1837 individuals) in both rural & urban area were covered in coverage evaluation survey by systematic selection of subunits using probability proportionate to size (PPS). Each household was visited by WHO designated team and data were collected using predesigned questionnaire. Data was compiled on MS-excel spreadsheet, frequency and percentage were calculated. Results: The overall effective coverage for all drugs was low (19.1%). The coverage was low, compliance was higher in urban as compared to rural area. Females had better coverage and compliance than males. The primary reasons for drug not offered was nobody came to offer drug, drug not swallowed was not sick, drug swallowed was useful information from drug administrator (DA). Only one female reported adverse effect. Conclusion: Increase in coverage along with decrease in coverage-compliance gap is needed to achieve filariasis elimination that warrants intense IEC activities using different platforms, development of better drug delivery strategies and strengthening monitoring system.
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The World Health Organization (WHO) in its Alma Ata Declaration, 1978, focuses on the development, promotion and recognition of the traditional medical systems. India has taken steps in this direction by recognising Unani medicine with other traditional medical systems practised in India. Presently, Government is promoting integration of the recognised traditional medical systems with conventional medicine at the national level, as an interdisciplinary approach to providing better patient-centred care. Bioethics is a field of enquiry that examines ethical issues and dilemmas emerging from medical care and research involving humans. Although the term ‘bioethics’ was first mentioned in 1927 and later established as a distinct discipline in 1970s, the ethical principles in various contexts had been described centuries ago in the classical texts pertaining to traditional medical systems. Since ethics as a code of conduct was followed by ancient Unani physicians to safeguard the interests of humanity when providing healthcare, it was felt that a review of classical Unani manuscripts should be attempted to give an insight into codes of conduct described by various Unani physicians. In this paper, a 10th century book, “Kamilussanah” authored by Ali ibn Abbas al-Majoosi, also known as Majoosi (930-994 CE), is reviewed through the prism of ethics.
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Background: As there were no vaccines available for any strains of coronaviruses, it was inevitable to develop safe and effective vaccines for the prevention of infection. There were limited data on the safety of the vaccine in the real-world environment, so the present study is undertaken to assess the safety of the vaccine. Aim and Objectives: The objective of the study is to evaluate the safety profile of ChAdOx1-nCoV-19 Coronavirus Vaccine (Covishield) among health care professionals. Materials and Methods: This is 6 months follow-up observation of vaccinated individuals, 545 health care workers have taken Covishield Vaccine for a duration of 1 month in a tertiary care hospital in two doses with 28 days apart. Demographic data such as age, gender, and comorbidities were noted. They were given a World Health Organization-based Adverse Event Following Immunization form to fill if they have any of the symptoms. Their phone numbers were collected to check for any adverse reactions every week after the first dose till the next dose and every month for another 6 months. Results: Adverse reactions were reported by 147 out of 297 vaccinated individuals after the first dose, 40 members out of 248 individuals after the second dose 24 h after vaccination. Pain at the site of infection and body ache/myalgia was seen in 27% of individuals. Reactions were mild in most of the individuals which resolved in a day without medication. Conclusions: Although the frequency of adverse reactions was observed in more individuals, they were mostly mild and self-limiting. This may show that vaccine has an acceptable safety profile in our observation among health care professionals.
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We present a 60 years old patient who presented to us with history of domestic fall and sustained injury to the right hip and was diagnosed with trochanteric fracture right side. As closed reduction was not acceptable and bone spike was not available in the set, we designed our own technique of using a bone lever introduced from the same incision from where reaming/nail insertion was done. To the best of our knowledge this technique has never been described before in english literature.Since our first case we have tried it in 6 other patients and without any issues
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Bilateral olecranon fractures are a rare occurrence. Direct trauma usually results in comminuted fractures and indirect trauma in transverse fractures. We describe a case of bilateral olecranon fracture with a radial head comminuted fracture with coronoid fracture without the involvement of collaterals. Olecranon fractures are usually a result of direct trauma (fall from height/motor vehicle accidents) or indirect trauma. A 22year old male patient presented to the emergency department with complaints of pain and swelling around both elbows following a motor vehicle accident. The patient also sustained trauma to the head and had a history of transient loss of consciousness. CT brain at the time of presentation was normal and the patient was conscious. The Olecranon Fracture was fixed with a pre-contoured olecranon locking compression plate (Synthes, USA). In our case, the collaterals were intact and as the radial head was comminuted, we excised the radial head. The radial head being secondary stabilizer of the elbow in injuries to the medial collateral ligament complex. The excision of the radial head would not cause any instability. Bilateral olecranon fractures need to be fixed anatomically, the comminuted radial head was excised and the anterior capsule was repaired
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Objective: The objective of the present study is the evaluation of the effect of the sublethal (40% and 60% of 48h LC50) binary combination (1:5 ratios) of molluscicides deltamethrin+MGK-264 on the endogenous levels of protein, amino acid and nucleic acid in different tissues of snail Lymnaea acuminata. Methods: The snails were treated with 1:5 mixtures of sub-lethal concentration of (40% and 60% of 48h LC50) deltamethrin+MGK-264 on the protein, amino acid and nucleic acid levels in gonadal, nervous and foot tissue of L. acuminata. In order to study the effect of withdrawal from treatment, the snails were first exposed to the above concentrations for 96h, after which they were transferred to freshwater. Water was changed every 24h for the next seven days, after which different biochemical parameters were estimated. Results: There was a significant change in the levels of protein (sublethal concentration of 60% of 48h LC50 after 96h) gonadal, nervous and foot tissues are 48.1, 12.1 and 14.5%, respectively, amino acid are 273, 234 and 252%, respectively, DNA are 25.1, 38.9 and 42.1%, respectively and RNA are 12.2, 30.7 and 30.5%, respectively. These changes were time and concentration-dependent. In the withdrawal experiment, the snails were treated for 96h to transfer in freshwater for 7 d, which caused significant recovery in all the biochemical parameters. Conclusion: The present study concluded that the high molluscicidal activity of deltamethrin+MGK-264 simultaneous decrease in the levels of proteins, DNA, RNA and increase in the level of amino acids.
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Background: Ethmoid Skull Base (ESB) is anarticulation of ethmoid roof with Lateral Lamella ofCribriform plate (LLCP). An increased LLCP heightwas observed to increase the vulnerability of ESB tosurgical injuries. Aim and Objectives: The present studywas undertaken to analyze the configuration of thelateral lamella of cribriform plate, the ethmoid roof withrespect to Keros type of olfactory fossa. Material andMethods: Aretrospective Computed Tomographic (CT)study was done with 60 Coronal Paranasal Sinuses(PNS) scans and LLCP height was determined bysubtracting Medial Ethmoid Roof Point (MERP) fromCP heights and classified according to Keros. Thedifference between Medial Ethmoid Roof Point(MERP) and Lateral Ethmoid Roof Point (LERP)heights in both anterior and posterior planes indicatesthe direction of ethmoid roof slope. Results: Theaverage height of the LLCP was between 1.53 to 8.55mm with a mean (SD) of 3.77 mm 1.66 and majoritybelonged to Keros type I. Overall mean differencebetween LERP and MERP was 5.43 0.74 mm inanterior and 4.43 0.63 mm in posterior planes. In boththe planes irrespective of the sides the height of theLERPwas higher in relation to medial side. Conclusion:Keros type I was the most common type and the slope ofanterior ethmoid roof is steeper compared to posterior.This preoperative knowledge about the configuration ofLLCPas well as the ethmoid roof contour is vital duringendonasal ethmoidal surgeries.
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Introduction: Surgical correction is the fundamental strategyfor severe rheumatic mitral regurgitation as (MR) as medicalmanagement for MR can not prevent the hemodynamicconsequences of severe MR in the asymptomatic andminimally symptomatic subjects. The purpose of this study isto assess the impact of duration of progressive rheumatic MRon LVEF, PH, LV and right ventricular dysfunction and decideabout the selection of optimal timing for surgical interventionin our patient population.Material and methods: This study involves the data of 30patients of MVR divided over 2 groups, from 1st January 2015to 31st December, 2018 and follow up of the survivors. Therewere (a) 12 cases of isolated severe MR described as MR and(b) 18 cases of severe MR associated with mild MS describedas MS +MR. Changes in echocardiographic parameters inboth the groups after MVR, LVEF, LVESD, LV end diastolicdiameter (LVEDD), PASP and NYHA functional class wereassessed, analyzed and compared at 30 and 180 days.Results: In the postoperative period after 30 days,improvement of NYHA status were observed to be higher in13 survivors with MS +MR from III to I while it was 6 in MRgroup. This improvement noted more in younger group below40 years. NYHA changes from III to II was observed in 4 ineach in both groups more in older group above 40 years. At180 days, 1 each from NYHA II improved to I in youngergroup. Out of the 2 post operative mortality, there was 1 in MRgroup who had post operative RV dysfunction and died afterdischarge on 29th day and 1 in MS+MR group and who diedof respiratory failure after 7 days though the cardiac indicesimproved and both were in older group.Conclusion: MVR can reversely remodel hearts and restoreLV function with relatively preserved LV.
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Objective: The objective of the present study is to explore the vipaka of an extra-pharmacopoeia drug Bridelia stipularis (L.) Blume belongs to the Euphorbiaceae family. Methods: 12 Wistar strain albino rats were selected and divided into 2 groups; Group A-Control, Group B-Test group. Each rat was kept in separate metabolic cages provided with a constant amount of water and food per day. Assessment of vipaka was done based on the consumption of food, consumption of water, the quantity of faecal matter, urine output, and quantity of water content of expelled faecal matter per day. Assessment of Vipaka was done on the basis of consumption of food; consumption of water; the quantity of faecal matter, urine output and quantity water content of expelled faecal matter per day. Assessment of Vipaka was done on the basis of consumption of food; consumption of water; the quantity of faecal matter, urine output and quantity water content of expelled faecal matter per day. Results: Absolute values of Group B or test group exhibited significant increase in water consumption (p<0.01), wet faecal matter (p<0.05), dry faecal matter (p<0.001), and food conversion ratio (p<0.05), and non-significant increase in food consumption, urine output, faecal water, and body weight. Conclusion: Based on the preliminary analysis it may be concluded that the drug Bridelia stipularis (L.) Blume possess Madhura vipaka (Sweet metabolic transformation).
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Introduction: Renal injuries account for up to 1–5% of alltrauma related injuries. Over the years there has been a shifttowards non-operative treatment for blunt renal trauma. Theaim of our study was to assess outcomes of patients managedconservatively (non-operatively) for high grade blunt renalinjury at our centre.Material and methods: The study was conducted in aretrospective manner using hospital records of last 5 years. Allpatients with blunt renal injuries were included. These patientswere categorized based on AAST(1989) injury gradingand further subdivided into operative and non-operativemanagement groups. These management strategies wereanalyzed in terms of ‘failure of non- operative management’,complications and need for adjunctive procedures. Descriptiveanalysis was done using Microsoft Excel(2010, ver14)software.Results: Forty three patients were included in the study witha mean age of 44.6 years. Out of the total, 28 had grade I– III injuries, 11 had grade IV and 4 had grade V injuries.All the grade I-III patients were managed conservatively andrequired no adjunctive procedures. One (9%) of grade IV and2(50%) of grade V injuries underwent immediate exploration.Out of 10 cases of grade IV injuries which underwent nonoperative management, 3(30%) required delayed explorationand none of the grade V injuries required delayed exploration.Complications included urinary tract infection (UTI) (6 cases),persistent hematuria (3 cases), hypertension(2 cases), urinoma(2 cases) and ileus(2 cases) .All complications were Claviengrade 1-2 with no mortalities overall.Conclusion: If the patient is hemodynamically stable,even grade IV and V blunt renal injuries can be managedconservatively, as is seen in our study where failure of nonoperative management occured in only 30% of grade IV andnone of the Grade V injuries.
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The authors report a rare case of bilateral elbow dislocation with associated radial head fractures in a 33 year male who presented to our hospital following a road traffic accident. The elbow dislocations were reduced in the emergency room, the left radial head fracture was treated conservatively in an above elbow slab for four weeks and the right radial head and neck fracture was treated operatively with Herbert screw fixation for the radial head fracture andbuttress plating for the radial neck fracture. At six months follow-up, the patient was pain free and had functional range of flexion and extension of both elbows with pronation and supination of the right elbow up to 50°and 40° and that of the left elbow up to 60° and 45° respectively.
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Background: Fasciotomy is a standard treatment for acute compartment syndrome. Historically, fasciotomy incisions were usually left open till oedema settles down. In literature, there is a wide range of wound closure techniques published, but none of them is deemed to be the best. In this study, focus is laid on whether delayed primary closure (DPC) by shoelace technique, is as effective as conventional secondary suturing, in closure of fasciotomy wounds, done for spreading cellulitis.Methods: All those patients who met below mentioned inclusion criteria and underwent fasciotomy, were allocated into 2 groups (A and B) where Group A consists of 30 patients undergoing conventional secondary suturing, whereas Group B consists of 30 patients undergoing DPC by shoelace technique for closure of fasciotomy wounds. Parameters such as duration of hospital stay, time taken for complete wound closure, local wound complications, hospital expenses, anaesthesia related complications between the two groups were compared.Results: Patients who underwent DPC for fasciotomy wound closure achieved wound closure ~7 days earlier with 5 days lesser hospital stay than that of those who underwent conventional secondary suturing. Average health care cost of Group B was significantly lower compared to Group A, but there was no statistically significant difference in incidence of wound infections between the two groups.Conclusions: DPC by shoelace technique, takes less time for wound closure and hence the need for nursing care and hospital stay is significantly reduced in comparison to the conventional secondary suturing method.
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Objective: The objectives of the present study were to determine the prevalence of Potentially Inappropriate Medications and Adverse Drug Reactions in older adults and to collect doctors’ responses regarding the PIM list or any other criteria to treat older adults in India. Methods: This was an observational study conducted in different tertiary care hospitals of two districts, Erode and Salem after obtaining approval of the Institutional Ethics Committee. A sample of 250 older adults (60 y and above) and 97 doctors were included during the study period of 6 mo from February 2019 to July 2019. Inappropriate medications were identified by using 2019 updated Beer’s criteria. The causality of the adverse events was assessed by Naranjo Adverse Drug Reaction Probability Scale. Results: Out of the 250 prescriptions, only 86(34.4%) of the prescriptions were appropriate and 164(65.6%) were inappropriate. The most commonly inappropriate prescribed medications were diuretics, ranitidine, and tramadol. A total of 74 ADRs was observed in 74 patients. Of these, 57(22.8%) ADRs were due to inappropriate medications listed in Beers criteria. There was a significant association between the occurrence of ADRs and the use of PIMs listed in 2019 updated Beer’s criteria [χ2 = 6.08, P = 0.013 (df = 1)]. Conclusion: The study shows that there is a high prevalence of inappropriate medications and adverse drug reactions in hospitalized older adults. Beer’s criteria can be used as a guideline by the physicians while prescribing the drugs to the geriatric population.
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To synthesize a series of ornidazole thiosemicarbazone analogues on the basis of literature reviews of 2-Methyl-5-nitroimidazoles and thiosemicarbazones and to evaluate all the analogues in vitro for their activity against Aspergillus niger and fumigatus. Thiosemicarbazone analogues were synthesized from oxidising ornidazole with potassium dichromate and refluxing the oxidised product with substituted thiosemicarbazide using ethanol as solvent in the acidic medium overnight. All the synthesized analogues of ornidazole showed good antifungal action against fumigatus and niger except compound C-4. Unsubstituted amine analogue C-2 has shown highest percentage inhibition (96.6%, 500 μg/ml) against fumigatus while aromatic amine with or without electronegative atom analogues C-3 and C-5 has shown highest activity against Aspergillus niger which is two times than standard drug ornidazole (100%, 1000 μg/ml).