A Study of Knowledge and Attitude about Leprosy among the Physiotherapy Students and Practitioners: A Cross-Sectional Study

Physiotherapy adds quality to the life of people. It provides support to people with disability. Leprosy is such a debilitating condition in which people suffer concerning their functionality and emotional parameters even after bacteriological cure. Leprosy is having several types of social stigmas attached to it which could be the reason for the discrimination among this population. Boosting the knowledge and building up a strong and positive attitude among physiotherapy students and practitioners against leprosy will be of help in overcoming the various multiple taboos associated with this condition. This research work aims at evaluating the knowledge and attitude towards leprosy among physiotherapy students and professionals in India. This study involves 300 voluntary participants from the physiotherapy field (students and professionals) above the age of 18 years from any gender from India, with a good hold on the English language. The response of all the participants was descriptively analyzed. Among study participants the mean score for the knowledge was estimated to be 65.47±14.69. Out of 300 participants, only 72 participants have shown a high level of knowledge with a mean score value of 84.54±5.23, and 228 participants showed a low level with a mean score value of 59.44±11.14. The mean score for the attitude related questions was 54.7±26.21. 189 respondents presented a favorable response with a mean of 71.16±16.56 whereas 111 respondents presented an unfavorable attitude with a mean value of 26.67±11.86. The findings of this research work gave us an insight into the “low-level knowledge” and a relatively “favorable behavior” towards the patient affected by leprosy among the physiotherapy students and practitioners in India. However, still, there is a need to enhance the knowledge and improve attitude among the Physiotherapy students and professionals by educating them and including leprosy in sufficient details in physiotherapy curriculum. Properly designed research cum intervention studies are necessary to understand the gaps in knowledge and attitudinal problems and take remedial measures.

PHYSICAL AND FINANCIAL PERFORMANCE OF PUBLIC, PRIVATE AND FOREIGN BANKS IN INDIA

Banks are the fundamental components of the financial system and are also active players in the financial markets. Therefore an efficient banking system is needed in mobilizing the savings and channeling them to productive purposes for the development of any economy. This paper attempts to analyze and compare the physical and financial performance of three banking sectors: Public, Private and Foreign banks using physical and financial quantities of inputs and comparing the revenue maximization of banks during 2009-10 to 2018-19

Organoleptic Properties of Ready to Reconstitute Little Millet Smoothie with Fruit Juices

Millets being climate resilient crops with high nutritional value are far better than staple grains like wheat and rice. Being adaptable to wide range of agro ecological conditions, the nutricereals little millet can grow on low fertility dry lands meeting demands of exploding population and providing solution to agrarian and nutritional challenges the world is dealing with. Further, value addition could be a strategic intervention in popularization of underutilized small millets and transform the billions of people from nutrient insufficiency to nutrient adequacy. The present fast-paced era with increased nuclear families and changing eating habits due to rapid urbanisation and globalisation demands for development of ready to consume nutrient dense food. In addition, growing awareness regarding health benefits of millets demands for millet-based designer foods to meet diversified needs of consumers. In view of these aspects, a ready to reconstitute (RTR) little millet smoothie mix was developed and tested for its suitability to blend with fruit juices through sensory profiling. The nourishing little millet and fruit-based smoothies would be a healthy inclusion in one’s daily diet with a great market potential.

Antibiotic sensitivity trends of pseudomonas endophthalmitis in a tertiary eye care center in South India: A 12-year retrospective study

Purpose: To assess trends in antibiotic sensitivity of pseudomonas and compare multidrug resistance (MDR) between Pseudomonas endophthalmitis cases presenting in two consecutive 6-year time frames in a tertiary center in South India. Methods: This is a retrospective comparative series of all Pseudomonas endophthalmitis cases treated from June 2004 to May 2016. Microbiological culture results in all endophthalmitis patients were screened for pseudomonas. Positive cases in the initial 6 and final 6 years were compared for sensitivity to antibiotics and the proportion of MDR. MDR was defined as resistance to at least two different classes of antibiotics. Results: Pseudomonas accounted for 74 of 389 endophthalmitis cases (19%), 42 in initial 6 and 32 in final 6 years. Sensitivity to ciprofloxacin, ofloxacin, gatifloxacin, moxifloxacin, and ceftazidime was 85.7%, 82.9%, 76.5%, 76.9%, 88.1% up to 2010 which reduced to 75%, 59.4%, 68.8%, 56.3%, 56.3%, respectively, after 2010, being significant for ofloxacin (P = 0.0349) and ceftazidime (P = 0.0028). Susceptibility to amikacin, gentamicin, and tobramycin changed non-significantly from 83.3%, 43.9%, 47.6% to 71.9%, 61.3%, 61.3%, respectively. Twenty of 74 cases (27%) were MDR with 16.7% in first 6 years versus 40.6% in final 6 years. Postoperative MDR cases rose from 10.3% to 50% (P = 0.0048). Conclusion: This study shows rising resistance of Pseudomonas to fluoroquinolones, amikacin, and ceftazidime in endophthalmitis. MDR also showed an upward trend, particularly in postsurgical cases.

Azithromycin resistance mechanisms in typhoidal salmonellae in India: A 25 years analysis

Background & objectives: Azithromycin has been in use as an alternate treatment option for enteric fever even when the guidelines on the susceptibility testing were not available. There is lack of data on susceptibility and mechanisms of resistance of azithromycin in Salmonella Typhi and S. Paratyphi A. The aim of the present study was to determine the azithromycin susceptibility and resistance mechanisms in typhoidal salmonellae isolates archived in a tertiary care centre in north India for a period of 25 years. Methods: Azithromycin susceptibility was determined in 602 isolates of S. Typhi (469) and S. Paratyphi A (133) available as archived collection isolated during 1993 to 2016, by disc diffusion and E-test method.PCR was done for ereA, ermA, ermB, ermC, mefA, mphA and msrA genes from plasmid and genomic DNA and sequencing was done to detect mutations in acrR, rplD and rplV genes. Results: Azithromycin susceptibility was seen in 437/469 [93.2%; 95% confidence interval (CI), 90.5 to 95.1%] isolates of S. Typhi. Amongst 133 isolates of S. Paratyphi A studied, minimum inhibitory concentration (MIC) of ?16 mg/l was found in 102 (76.7%; 95% CI, 68.8 to 83.0). MIC value ranged between 1.5 and 32 mg/l with an increasing trend in MIC50and MIC90with time. Mutations were found in acrR in one and rplV in two isolates of S. Typhi. No acquired mechanism for macrolide resistance was found. Interpretation & conclusions: Azithromycin could be considered as a promising agent against typhoid fever on the basis of MIC distribution in India. However, due to emergence of resistance in some parts, there is a need for continuous surveillance of antimicrobial susceptibility and resistance mechanisms. There is also a need to determine the breakpoints for S. Paratyphi A.

Changing trends of culture-positive typhoid fever and antimicrobial susceptibility in a tertiary care North Indian Hospital over the last decade

Purpose: The present study was undertaken to analyse the trend in prevalence of culture-positive typhoid fever during the last decade and to determine antimicrobial susceptibility profile of Salmonella Typhi and Salmonella Paratyphi A isolated from patients of enteric fever presenting to our hospital. Methods: All the culture-positive enteric fever cases during 2005–2016 presenting to our Hospital were included in the study. Antimicrobial susceptibility was done against chloramphenicol, amoxicillin, co-trimoxazole, ciprofloxacin, ofloxacin, levofloxacin, pefloxacin, ceftriaxone and azithromycin as per corresponding CLSI guidelines for each year. We also analysed the proportion of culture positivity during 1993–2016 in light of the antibiotic consumption data from published literature. Results: A total of 1066 strains-S. Typhi (772) and S. Paratyphi A (294) were isolated from the blood cultures during the study. A maximum number of cases were found in July–September. Antimicrobial susceptibility for chloramphenicol, amoxicillin and co-trimoxazole was found to be 87.9%, 75.5%, 87.3% for S. Typhi and 94.2%, 90.1% and 94.2% for S. Paratyphi A, respectively. Ciprofloxacin, ofloxacin and levofloxacin susceptibility were 71.3%, 70.8% and 70.9% for S. Typhi and 58.1%, 57.4% and 57.1% for S. Paratyphi A, respectively. Azithromycin susceptibility was 98.9% in S. Typhi. Although susceptibility to ceftriaxone and cefixime was 100% in our isolates, there is a continuous increase in ceftriaxone minimum inhibitory concentration (MIC)50and MIC90values over the time. The proportion of blood culture-positive cases during 1993–2016 ranged from a minimum of 0.0006 in 2014 to a maximum of 0.0087 in 1999. Conclusion: We found that the most common etiological agent of enteric fever is S. Typhi causing the majority of cases from July to October in our region. MIC to ceftriaxone in typhoidal salmonellae is creeping towards resistance and more data are needed to understand the azithromycin susceptibility.

Spectrum of gynecological disorders in elderly women

Introduction: Postmenopausal phase is important that primary care clinicians be aware of common gynecologic concerns and the potential impact of these on the function and quality of life of older women. Aim: This study was done to know dimensions of various gynecological disorders in women above 60 years and to emphasize on increasing the different screening programmes for early detection and management of cancers and also to show the necessity of establishing geriatric units for women to give better quality of life to elderly women. Materials and methods: A Prospective study done for 1 year. Out of 7156 patients, 273 women who were above 60 years were included in study. Both in patient, out patients and patients who referred to cancer hospitals and other hospitals were studied. Results: Among 7156 women attending our OPD in one year, 273 (3.81%) were above 60 years, including surgical (7%) and natural (93%) menopause. Pelvic organ prolapsed (43.2%) was the most common gynecological disorder in the study. Total out of 82 patients of post menopausal bleeding 48 (59%) (17.5% out of 273) were benign and Malignancy among the study group was 34 (41%) (12.4%, Out of 273). The commonest cancer was cancer cervix in about 22% among postmenopausal bleeding. Ovarian cancer is 13%. Pelvic organ prolapse was most common gynecological disorder in elderly women after 60 years was pelvic organ prolapse seen in 43%. Out of 63 Urogenital infections 24 (38.09%) were with Urinary tract infections. Conclusions: The responsibility of the gynecologist as the primary physician for geriatric patients increases, to detect the cancer earlier and manage it to decrease morbidity and mortality. There should B Aruna Kumari, Aruna Ramaiah, A.Suman Chandra. Spectrum of gynecological disorders in elderly women. IAIM, 2016; 3(11): 112-117. Page 113 be increased screening programmes for cancer making this available for all the women at all stages and at all levels.

Histological diversity and clinical characteristics of Ewing sarcoma family of tumors in children: A series from a tertiary care center in South India.

BACKGROUND: The Ewing sarcoma family of tumors (ESFT) are aggressive malignant tumors with small round cell morphology affecting mainly children and adolescents. The aim of this study is to classify the histological diversity and clinical characteristics of ESFT in children from a Tertiary Care Center in South India. MATERIALS AND METHODS: This retrospective descriptive study includes 51 cases of ES in children aged below 15 years. Clinical details were collected from case files. Histomorphological features were reviewed and tumors were subtyped into classic, primitive neuroectodermal tumor (PNET) and atypical variants along with immunohistochemical markers, cytogenetics, and fluorescence in situ hybridization (FISH). RESULTS: Fifty‑three percent were female and 47% were male with mean age of 10 years. The most common site of involvement was skeletal involvement in 71%, followed by soft tissue involvement in 23%, and visceral involvement in 6%. Localized disease at presentation was seen in 44%, locally advanced disease in 28%, and metastatic disease in 28%. Recurrence was documented during follow‑up in 18% of the cases. Histomorphologically, classic type was the most common (72%) followed by PNET (20%) category and atypical variant (8%). All cases were immunoreactive for CD99. Cytogenetic study in 12 cases showed translocation t(11;22) (q24;12) in 80% and variant translocations such as t(3;16), t(3;11) with nonspecific numerical abnormalities in 20%. FISH was carried out for documentation of four cases with atypical histomorphology. CONCLUSION: ESFT had wide histological variation which required confirmation by ancillary studies.

A Complex Mandibular First Molar - An Endodontic Challenge Two Case Reports.

The aim of this article is to present two clinical cases of Mandibular first Molar with an additional distolingual root (Radix entomolaris-R E ) and in one case an additional canal in distal root known as D2,and a glance on the incidence of this anatomical feature and literature.

Hepatoblastoma: Experience from a single center.

Background: The cornerstones of successful treatment of hepatoblastoma (HB) include preoperative chemotherapy followed by complete anatomical resection of tumor, followed by chemotherapy. Advances in chemotherapy in the last 2 decades have been associated with a higher rate of tumor response and possibly a greater potential for resectability. Aims: We analyzed our single center experience with neoadjuvant chemotherapy (NACT) and surgery in HBs. Settings and Design: Our study included all children with HBs who received NACT and underwent surgical excision from January 1997 to July 2004. Materials and Methods: Patient characteristics, clinical features, clinical course, treatment modalities, and long-term outcome were analyzed. Results: There were 9 boys and 3 girls, aged 5-60 months (median age at tumor diagnosis was 24 months). All received NACT containing cisplatin and doxorubicin. Of the 12 children, 9 underwent hepatectomy and among them, 4 patients each had right and left hepatectomy and 1 patient underwent right extended hepatectomy. After surgery, all patients completed rest of the chemotherapy course (total 6 cycles). R0 resection was carried out in all the 9 cases with no life-threatening complications. Conclusions: Our experience of the 9 cases, although less in number, reaffirms the advantages of NACT followed by surgery. The prognosis for patients with resectable tumors is fairly good in combination with chemotherapy.

Methylenetetrahydrofolate reductase gene polymorphisms and risk of acute lymphoblastic leukemia in children.

Introduction: Methylenetetrahydrofolate reductase (MTHFR) is a critical enzyme in folate metabolism and is involved in DNA synthesis, DNA repair and DNA methylation. Genetic polymorphisms of this enzyme have been shown to impact several diseases, including cancer. Leukemias are malignancies arising from rapidly proliferating hematopoietic cells having great requirement of DNA synthesis. This case-control study was undertaken to analyze the association of the MTHFR gene polymorphisms 677 C"T and 1298 A"C and the risk of acute lymphoblastic leukemia in children. Materials and Methods: Eighty-six patients aged below 15 years with a confirmed diagnosis of acute lymphoblastic leukemia (ALL) and 99 matched controls were taken for this study. Analysis of the polymorphisms was done using the polymerase chain reaction -restriction fragment length polymorphism (PCR-RFLP) method. Results: Frequency of MTHFR 677 CC and CT were 85.9% and 14.1% in the controls, and 84.9% and 15.1% in the cases. The 'T' allele frequency was 7% and 7.5% in cases and controls respectively. The frequency of MTHFR 1298 AA, AC, and CC were 28.3%, 55.6% and 16.1% for controls and 23.3%, 59.3% and 17.4% for cases respectively. The 'C' allele frequency for 1298 A→C was 43.9% and 47% respectively for controls and cases. The odds ratio (OR) for C677T was 1.08 (95% CI 0.48- 2.45, p = 0.851) and OR for A1298C was 1.29(95% CI 0.65-2.29, p = 0.46) and OR for 1298 CC was 1.31 (95% CI 0.53-3.26, p =0.56). The OR for the combined heterozygous status (677 CT and 1298 AC) was 1.94 (95% CI 0.58 -6.52, p = 0.286). Conclusion: The prevalence of 'T' allele for 677 MTHFR polymorphism was low in the population studied. There was no association between MTHFR 677 C→T and 1298 A→C gene polymorphisms and risk of ALL, which may be due to the small sample size.

A comparative study on the physicochemical and bacterial analysis of drinking, borewell and sewage water in the three different places of Sivakasi.

The drinking, borewell and sewage water in the Sanmugasikamani Nadar (S.N) street, Naivatti Nadar (N.N) street and Thiruthangal area of Sivakasi has been studied. The various constituents monitored include the physicochemical characters like pH, total solids, total dissolved solids, total suspended solids; chemical parameters like total alkalinity acidity free CO2, dissolved oxygen, total hardness, calcium, magnesium, chloride, salinity and bacterial parameters like standard plate count (SPC), total coliform count (TCC), faecal coliform count (FCC), faecal streptococcal count (FSC). Most of the physicochemical characters of drinking and borewell water were within the ISI permissible level. However in water samples from all the sites, bacterial count exceeded the recommended permissible level of WHO. Introduction of sewage into the drinking and borewell water was the main reason for the bacterial contamination. The boiling of water is therefore advisable before consumption. The physicochemical and bacterial characters of the sewage water were unworthy. The sewage water recycling was necessary to minimize the water born diseases.

Loss of space and changes in the dental arch after premature loss of the lower primary molar: a longitudinal study.

The purpose of the study was to evaluate the space changes, dental arch width, arch length and arch perimeter, after the unilateral extraction of lower first primary molar in the mixed dentition period. A longitudinal study was conducted among forty children in the age group of 6-9 years, who reported for extraction of lower first primary molar in the department of Pedodontics, Govt. Dental College, Trivandrum. Study models were made from alginate impression taken before extraction and after extraction at the periodical intervals of two months, four months, six months and eight months. The mesiodistal width of lower first primary molar of the non-extracted side was taken as the control. The results of the study showed statistically significant space loss in the extraction side ( P value < 0.01) and no significant space loss in the control side (P value > 0.05). The rate of loss was greatest in the first four months. The arch width, arch length and arch perimeter had no significant change from initial to eight months follow up. The present study challenges the use of a space maintenance under the circumstances of premature loss of mandibular primary molar for preventing space loss.

Mixed exocrine-endocrine pancreatic carcinoma in childhood.

A 7-year-old boy with mixed exocrine-endocrine pancreatic cancer is presented. This may be the second reported case of such a tumor in childhood.

Value of AgNORS in fine needle aspiration cytology of breast lesions.

Silver staining Nucleolar organizer regions (AgNORs) were studied in fine needle aspirates of 48 benign and 36 malignant lesions and correlations with histological types, menstrual status, tumor size and lymph node involvement were looked for. A semiquantitative scoring system (AgNOR Score) reflecting total AgNOR area was applied to each of these parameters and compared with the standard counting method. The objectives were to examine the pattern of distribution and discriminating capacity of AgNORs in fine needle aspirates of different breast lesions and to evaluate the AgNOR scoring system as an alternative to the standard counting method. Mean AgNOR count was significantly higher in malignant (5.4; 95% CI 5.0-5.9) than benign (2.8; 95% CI 2.7-3.0) lesions. For AgNOR scores the corresponding values were: malignant 11. 2; 95% CI 10.2-12.2 and benign 5.3;95% CI 4.9-5.7. For malignant lesions, the counts and scores tend to be more in ductal carcinomas than lobular, more in premenopausal women, in tumors more than 5 cm in diameter and in cases with more than 3 lymph nodes involved. For all parameters the scoring system showed better discriminating capacity. The differences in AgNOR scores were statistically significant for tumor size and lymph node status. Multiple stepwise regression shown tumor size to be best correlated with AgNORs.

Extranodal sinus histiocytosis with massive lymphadenopathy--a case report.

Sinus histiocytosis with massive lymphadenopathy involving organs other than the lymph nodes is a rare event. A case of SIIML presenting with multiple skin and subcutaneous nodules and multiple osteolytic lesions is described. A search of the Indian literature revealed many cases of nodal SIIML, but none of the reported cases had prominent extranodal involvement.

Correlation between riboflavin carrier protein induction and its mRNA activity in estrogen stimulated chicken liver and oviduct.

Poly A enriched RNA from either liver or oviduct of estradiol-17β treated immature chicks supported [3H]-leucine incorporation into immunoprecipitable riboflavin carrier protein in a dose-dependent manner when translated in the rabbit reticulocyte lysate system. Primary translation product of riboflavin carrier protein had a molecular weight of 38,000 which on incubation with a stripped hepatic microsomal preparation was processed to a product with a size comparable to native riboflavin carrier protein. Poly A enriched RNA from both the liver and the oviduct of estrogen-treated birds stimulated [3H]-leucine incorporation into riboflavin carrier protein and this was 2-3 fold higher during secondary stimulation vis-avis primary stimulation with the steroid. Poly A enriched RNA from the liver of progesteronetreated birds during secondary stimulation did not support riboflavin carrier protein synthesis. In contrast, poly A enriched RNA from the oviduct of the birds treated with progesterone during secondary (but not primary) stimulation did exhibit riboflavin carrier protein-mRNA activity which was comparable to that stimulated by estradiol- 17β.