Epidemiological study to assess the status of measles vaccination in under five children and factors associated, in a peri-urban area, Asudgaon village, in Raigad district, Maharashtra, India

Background: Measles continues to be a major cause of childhood morbidity and mortality in India. Measles is considered one of the leading vaccine-preventable causes of child mortality worldwide. Major reasons for low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization. Materials and Methods: A cross-sectional, descriptive, epidemiological study that aimed to examine the coverage of measles vaccination among under-five children of Asudgaon village. All under-five children residing in every 5th household of the village were included(n = 445). After obtaining consent from the mother, data was collected from her using a pre-designed and pre-tested questionnaire. The data was entered and analyzed in SPSS 23. Results: There was a total of 100 children eligible for the study. Overall, 41% of children were fully immunized against measles, 37% were partially immunized, 5% were immunized to date and 17% were not immunized. The most reasons for partial or non-immunization for measles were inadequate knowledge about immunization (19%), unawareness of days of vaccination(n = 14%), the child being ill at the time of vaccination, husband or mother-in-law against vaccination, fear of effects, and others. The Chi-square test indicates a significant association between mothers’ education and measles vaccination. Conclusion: Immunization status needs to be improved through education, increasing awareness, and counseling of parents regarding immunization and associated misconceptions as observed in the study.

Postoperative morbidity following Whipple’s procedure for periampullary carcinoma: a retrospective study spanning 5 years

Background: The morbidity rates for Whipple’s procedure has remained high even as mortality rates were coming down. This study was intended to assess postoperative morbidity rates in  a tertiary care centre and to compare it with other centres.Methods: Data was collected from various registers and medical records for this retrospective cohort study. All Whipple’s procedures for 5 years were included in the study. Statistical analysis was done using R statistical software and the results were tabulated.Results: There were 48 patients and half of them developed morbidity. Surgical site infection was the most common complication (18.8%) followed by pulmonary complications (12.5%) and bile leak (6.25%). Half of the patients having pulmonary complications died while nobody with surgical site infection or bile leak died.Conclusions: In this study the morbidity rates were comparable to other centres. Hypoalbuminemia is a significant predictor of morbidity. Surgical site infection was the most common morbidity. Pulmonary complications were the most common cause for death. Morbidity rate is comparable to other centres and Whipple’s procedure is a safe surgery in the tertiary centre where the study was conducted.

Postoperative Mortality Rate Following Whipple’s Procedure for Periampullary Carcinoma: A 5 Year Cohort Study

The mortality rates for Whipple’s procedure has come down during the last few years. This study was intended to assess perioperative mortality rates in a tertiary care centre and to compare it with other centres. Methods: Data was collected from various registers and medical records for this retrospective cohort study. All Whipple’s procedures for 5 years were included in the study. Statistical analysis was done using R statistical software and the results were tabulated. Results: There were 48 patients and 8 of them died. A median serum bilirubin level of 16.9 mg% was found statistically significant with respect to mortality. Similarly placed was median serum albumin levels of 2.71 gm% and poor differentiation of tumour. Conclusion: In this study the mortality rates were comparable to other centres. Hypoalbuminaemia is a significant predictor of mortality. Tumour size of more than 3 cm is associated with high mortality. High serum bilirubin levels is an independent predictor of mortality. Several studies also show similar predictors of death in Whipple’s procedure. Pulmonary complications were the most common cause for death. Mortality rate is comparable to other centres and Whipple’s procedure is a safe surgery in the tertiary centre where it was studied.

Maternal periodontal disease as a significant risk factor for low birth weight in pregnant women attending a secondary care hospital in South India: A Case-control study.

Context: Periodontal disease (PD) is a common infection in the community; however, its relationship with low birth weight (LBW) has not been well‑established. Aims: The aim was to determine the association between maternal PD and LBW. Settings and Design: A case–control (1:1) study. Materials and Methods: The study population comprised of women who delivered at the hospital during the study period (September 2011 to February 2012).Women between 18 and 35 years of age, who delivered singleton, live infants during study period with at least 18 teeth were enrolled. Those with pregnancy induced hypertension, gestational diabetes, blood‑borne viral infections, periodontal treatment within the past 6 months and valvular heart disease were excluded. Control population was parity matched to the cases. Statistical Analysis Used: Chi‑square test, t‑test and univariant and multivariant logistic regression were used to analyze various study findings, and level of significance was set at 5% (P < 0.05). Results: PD was independently associated with LBW (odds ratio: 4.94, 95% confidence interval: 1.03–23.65, P=0.045). Additionally, conventional risk factors such as maternal height (P=0.029), secondary schooling (<8 years of schooling) (P = 0.001), socio‑economic status (P = 0.046), type of family (joint) (P = 0.008), number of ante‑natal visits (P = 0.028) and gestational age at birth (<37 weeks) (P = 0.045) showed significant association with LBW. Conclusions: There seems to be an association between PD and LBW independent of conventional risk factors. Women who had PD were 5 times more likely to deliver LBW infants.

Sexual dysfunction among men in secondary care in southern India: Nature, prevalence, clinical features and explanatory models.

Background. Sexual dysfunction, common in general medical practice, is under-recognized and inadequately managed resulting in significant morbidity and reduction in quality of life. We examined the nature, prevalence, clinical features and explanatory models of illness among men with sexual dysfunction in a general healthcare setting. Methods. We recruited 270 consecutive men attending a general health clinic. Participants were evaluated using a structured interview. The International Index of Erectile Function-5, the Chinese Index of Premature Ejaculation-5, Short Explanatory Model Interview and the Revised Clinical Interview Schedule were used to assess sexual dysfunction, explanatory models and psychiatric morbidity. Results. Premature ejaculation and erectile dysfunction were reported by 43.0% and 47.8% of men, respectively. The most common perceived causes were loss of semen due to masturbation and nocturnal emission. Popular treatments were herbal remedies and resources used were traditional healers. The factors associated with erectile dysfunction were diabetes mellitus, financial stress, past history of psychiatric treatment and common mental disorders such as depression and anxiety; those associated with premature ejaculation were common mental disorders, older age and financial debt. Sexual dysfunctions and concerns were under-diagnosed by physicians when compared to the research interview. Conclusion. There is a need to recognize sexual problems and effectively manage them in general medical settings. The need for sex education in schools and through the mass media, to remove sexual misconceptions, cannot be under-emphasized.

Domestic violence as a risk factor for infant and child mortality: A community-based case–control study from southern India.

Background. Violence against women may have an impact on infant and child mortality. We aimed to determine whether domestic violence is a risk factor for infant and child death. Methods. Eighty infant and child deaths (under 5 years of age) were identified from a central register of a comprehensive community health programme in rural southern India; controls were matched for age, gender and street of residence. Results. Domestic violence during the lifetime (OR 2.63, 95% CI 1.39–4.99), which was severe (OR 4.00, 95% CI 2.02–7.94) and during pregnancy (OR 5.69, 95% CI 2.03–15. 93) and father’s smoking status (OR 3.81, 95% CI 1.92–7.55) were significantly related to infant and child death while immunization being completed for age (OR 0.04, 95% CI 0.01–0.19) and having at least one boy child in the family (OR 0.29, 95% CI 0.14–0.59) were protective. These variables remained statistically significantly associated with outcome after adjusting for other determinants using conditional logistic regression. Conclusion. There is evidence for an association between domestic violence in mothers, and infant and child death.

Polyherbal Formulation (Hairzone Solution) in the Management of Diffuse Hair Loss: Post Marketing Safety and Efficacy Study.

Hair loss is a common and distressing problem, affecting men and women of all the ages and ranging from a small bare patch to a more diffuse and obvious pattern. The purpose of this study is to evaluate the safety and efficacy of Hairzone solution in diffuse hair loss. Twenty-eight cases were included in the study according to the subject selection criteria. All the patients were advised to gently massage the solution into the scalp part by part, covering the whole area of the scalp and to rinse it in the morning. The response to therapy was evaluated at monthly intervals for a period of six months. The changes in various parameters from baseline values and the values at each visit for six months were evaluated statistically using Graph Pad Prism Version 4.03 for windows, Graph Pad Software, San Diego, California, United States. The criteria for evaluation were signs and symptoms such as reduction in hairfall by 1-minute combing test, reduction in associated symptoms like itching and overall impression. The study clearly demonstrated the beneficial effects of Hairzone solution in diffuse hair loss as evident by reduced hair fall by 1-minute combing test, in addition to decrease in itching. Hair loss was reduced in 21 of 28 patients. Further safety of the product was also substantiated by clinical parameters. Therefore, it can be concluded that Hairzone solution is safe and effective in the management of diffuse hair loss.

Symptoms related to the reproductive tract and mental health among women in rural southern India.

BACKGROUND: Symptoms related to the reproductive tract and symptoms of psychological distress are commonly seen in women living in South Asia. This study aimed to determine the association, if any, between symptoms related to the reproductive tract and mental health among women in rural southern India. METHODS: The study was conducted in a community setting of a comprehensive community health programme in a development block in rural southern India. It was a cross-sectional survey with a nested case-control study. The main outcome measure was the probability of mental distress as assessed by the Tamil version of the General Health Questionnaire-12 (GHQ). RESULTS: Of the 622 subjects recruited, 150 (24.4%) complained of at least one symptom related to the reproductive tract. The commonest symptom was vaginal discharge (17.5%). Significantly higher scores on the GHQ were associated with the presence of many current and past symptoms related to the reproductive tract, and receiving treatment for the same, even after adjusting for age, education, current marital status and type of house, using multiple regression analysis. GHQ scores were positively correlated with a higher number of current and past symptoms. Significantly higher scores were also associated with greater knowledge about prevention of sexually transmitted diseases and reproductive tract infections. Being currently married and educated were significant protective factors. A nested case-control study was done with the presence of a current common mental disorder as the outcome. Symptoms and other factors dated prior to this outcome were considered potential risk factors. Logistic regression models were developed. The presence of a symptom related to the reproductive tract for more than one month (OR 3.6; 95% CI 1.8, 7.2) and a history of similar symptoms over the past year (OR 2.2; 95% CI 1.3, 3.7) were risk factors for the development of common mental disorders. Higher education (OR 0.5; 95% CI 0.3, 0.7) and being currently married (OR 0.2; 95% CI 0.1, 0.6) were protective factors. CONCLUSION: The cross-sectional data suggest an association between symptoms pertaining to the reproductive tract and psychological distress. The results of the nested case-control study suggest that symptoms related to the reproductive tract are risk factors for common mental disorders, while education and being currently married are protective factors.

Explanatory models and common mental disorders among patients with unexplained somatic symptoms attending a primary care facility in Tamil Nadu.

BACKGROUND: Patients with unexplained somatic symptoms are commonly seen in primary care. We assessed the explanatory models and common mental disorders in patients with unexplained somatic symptoms attending a primary care facility in a rural area of south India. METHODS: One hundred consecutive patients diagnosed to have unexplained somatic symptoms attending a primary care facility were examined. The Tamil version of the Revised Clinical Interview Schedule was used to assess common mental disorders and the Tamil version of the Short Explanatory Model Interview was used to assess their explanatory models. RESULTS: Ninety-eight patients thought that their problem was serious. Sixty-nine, 41 and 40 claimed that it affected their work, family and social lives, respectively. Forty-two of the patients believed in black magic. Forty-four patients satisfied the ICD-10 PC criteria for common mental disorders. Depression was the commonest diagnosis (63.6%). Patients with psychiatric diagnoses admitted to emotional problems (chi2 = 46.9; p < 0.001), and felt that their problems affected their family (chi2 = 38.5; p < 0.001), social life (chi2 = 28.6; p < 0.001) and work (chi2 = 34.4; p < 0.001). More patients who satisfied criteria for psychiatric diagnosis felt that their problems were moderate or very serious (chi2 = 21.5; p < 0.001) and they feared they might become disabled or die (chi2 = 12.2; p < 0.001). Psychiatric syndromes were significantly associated with belief in black magic (chi2 = 7.01; p < 0.01). These associations remained statstically significant after adjusting for age, gender, literacy and socioeconomic indices using logistic regression. CONCLUSION: The majority of patients held strong beliefs regarding the physical nature of their complaints, believed In the serious nature of the problem and feared disability or death. There is a need to elicit specific explanatory models regarding the nature of illness in patients who present with somatic symptoms without organic causes. Understanding the patient's perspectives is a prerequisite for providing the necessary treatment and to dispel fears.

Antitumour and radioprotective action of Podophyllum hexandrum.

A significant antitumour effect of P. hexandrum, a herb thriving at Himalayas (2500-4000 m), was observed in strain 'A' mice carrying solid tumours developed by transplanting Ehrlich ascites tumour (EAT). Subtoxic well tolerated sequential doses of aqueous extract of P. hexandrum (a daily dose of 34.5 mg/kg b.w. for 15 days) enhanced tumour doubling time (TDT) from 1.94 +/- 0.26 days to 19.1 +/- 2.5 days. However, no synergism was revealed between radiation and P. hexandrum, though both independently manifested antitumour effects. In normal mice, pre-irradiation administration of extract of P. hexandrum protected mice in a dose dependent manner (optimal dose being 34.5 mg/kg body.wt. rendering 72% survival for 30 days) against whole body lethal irradiation of 10 Gy. Radioprotective properties of P. hexandrum were found to be comparable to synthetic radioprotectors like diltiazem etc.

Radioprotective effects of diltiazem on cytogenetic damage and survival in gamma ray exposed mice.

Diltiazem, a calcium ion channel blocker, already in use in cardiovascular therapeutics, has been observed to protect against bone marrow damage (cytogenetic damage, cell death) and mortality in whole body irradiated mice. The micronuclei fraction in bone marrow cells of whole body irradiated (60Co gamma rays, 2.0 Gy) mice was reduced from 2.24 +/- 0.23% to about 0.74 +/- 0.33% by preirradiation administration (-20 min) of 110 mg/kg body wt. diltiazem (ip). Endogenous colony forming unit counts in spleen of mice administered 110 mg/kg body wt. (-20 min) of diltiazem before 10 Gy whole body irradiation were 6 times more than untreated irradiated controls. Pretreatment with diltiazem accelerated the recovery of radiation induced weight loss also. Diltiazem (110 mg/kg body wt, -20 min) enhanced 30 day survival to about 95% and 85% after lethal whole body absorbed dose of 9 and 10 Gy respectively and also mitigated radiation induced life- span shortening. Post-irradiation (10 Gy) administration of diltiazem (+20 to 30 min) enhanced survival from about 2 to 15% only but was highly significant (P < 0.001). Possible modes of radioprotective action of diltiazem have been discussed.

On the contribution of height to predict lung volumes, capacities and diffusion in healthy school children of 10-17 years.

Lung volumes, capacities, diffusion and alveolar volumes with physical characteristics (age, height and weight) were recorded for 186 healthy school children (96 boys and 90 girls) of 10-17 years age group. The objective was to study the relative importance of physical characteristics as regressor variables in regression models to estimate lung functions. We observed that height is best correlated with all the lung functions. Inclusion of all physical characteristics in the models have little gain compared to the ones having just height as regressor variable. We also find that exponential models were not only statistically valid but fared better compared to the linear ones. We conclude that lung functions covary with height and other physical characteristics but do not depend upon them. The rate of increase in the functions depend upon initial lung functions. Further, we propose models and provide ready reckoners to give estimates of lung functions with 95 per cent confidence limits based on heights from 125 to 170 cm for the age group of 10 to 17 years.

Serum and tissue sodium/potassium changes in estrogen treated female albino rats.

Five control and ten estrogen treated albino rats were studied for changes in sodium and potassium in serum, heart, muscle, uterus and brain. The serum levels of sodium depleted significantly in the estrogen treated rats. Of the tissues studied, only uterus and brain had significantly sodium retention effect. The potassium levels on the other hand decreased significantly, both in serum and tissues following treatment with estrogen.

Continuous illumination and oogenesis in albino rabbits.

Photo periodism is probably a phenomenon of natural selection. The critical period of ovulation can be adjusted to the environmental condition such as exposure to continuous illumination (LL) at constant temperature. Many investigators have also observed that blindness in girls causes early menarche while opposite results are obtained in rats. The present study was based upon the changes in circadian rhythm of ovaries of albino rabbits, by exposing the animals to continuous illumination through an electric bulb of 100 watt kept at one metre distance, at 37 degrees C, vaginal smear showed constant estrus. It was observed that degenerative changes started appearing in the histology of ovaries from first week of experiment. Degenerative changes were gradual and led to complete metaplasia or atrophy of ovary.