Determinants Of Under-Nutrition Among Under Five Children in The Urban Slum of Ahmedabad, India

Introduction: In India, 6.8% of total population are under five children and 60 million are malnourished. Around 45% of deaths among children under five years are linked to under nutrition. The study aims to as-sess the nutritional status of under 5 children and associate it with various factors like age, gender, Immuniza-tion, birth weight, feeding practices, Anganwadi registration etc. Methodology: A community based cross-sectional study was conducted on 191 under five children in urban slum areas. Parents of under five children were interviewed with the help of a pre-designed questionnaire. Malnutrition was assessed using WHO recommended Z score category.Observations: Total 191 under 5 children were studied. Among them, 107 were male and 84 were female. Out of the assessed children two third were normal weight for age while one third were underweight. Nutri-tion status was significantly associated with age, birth weight, feeding practices and immunization status of children. Conclusions & Recommendations: One fourth of under-five children were under weight for age. Age, low birth weight, preterm delivery, faulty feeding practices and incomplete immunization were statistically signif-icantly associated with the underweight.

A Clinical Study Of Gastric Outlet Obstruction

Background:Diagnosis of Gastric outlet obstruction (GOO) is a challenge in 3rd world countries. Gastric outlet obstruction occurs because of impeding emptying of stomach mechanically, and it has varied causes. This study was taken up to know the etiological factors and management. Material And Methods:This was a descriptive prospective study done at Smt. NHL Municipal Medical College for a period of 2years from June 2019 to May 2021. A set of inclusion and exclusion criteria were defined and followed. Upper gastrointestinal endoscopy (OGD) was done in all cases w hile Barium meal study was done in a few cases to make the diagnosis. Relevant operative procedure was done, and patients were managed post operatively. Result:Cicatrised Duodenal ulcer (DU) was the commonest cause followed by Carcinoma Pyloric antrum (Ca PA). Majority of the patients were males (68%) with male to female ratio of 2.13:1. Vomiting was one of the major presenting symptoms in all the patients. Conclusion:Cicatrised DU was the commonest cause for GOO in present study. Present study highlights the increasing incidence of Ca PA. This could be due to better management of DU at an early stage.

Psychological Effect Of Chemosensory Deficits In COVID-19 Patients

Background:Mental health was broke greatly in this COVID-19 pandemic. Objective: This study aimed to detect the effect of chemosensory deficits from deadly pandemic COVID-19 on mental health. Material And Methods:A survey questionnaire was used to detect the level of psychological problems in this cross-sectional observational study in sample size of 200 COVID-19 positive patients.Result:The findings shows that there is increase in prevalence of psychological problems which affects mental health drastically like isolation, anxious, afraid of failure to recover back which hampering their quality of life.Conclusion:This study emphasizes on the importance and prevention of psychological problems as well as role of counselling & treatment.

A Record Based Study on Various Factors Affecting The Choice Of Intra-Uterine Contraceptive Device In Ahmedabad City

Background:Unplanned pregnancy may be the reason of many neonatal and maternal adverse effects. The objective is to study various factors affecting IUCD (temporary contraceptive method) preference. Material And Methods:A record based study of data of 483 couples selecting IUCD, during the one year period was collected with permission from tertiary care hospital. Result:The most common group preferring IUCD was 21-30 years (mean age-females-26 years and males-30 years).Majority having 2 children opted for IUCD while only 1 couple opted for IUCD without any child. Out of the total, 42% opted PPIUCD, 42% interval IUCD and 16% PAIUCD. Among lower age and up to primary educated groups, majority opted for PPIUCD. Among higher age and educated groups, majority opted for interval IUCD. PAIUCD proportion was higher in less educated females. Majority ofMuslims preferred PPIUCD while Hindus, interval IUCD. The association of type of IUCD with age, number of children and religion was found significant while with education, it was in-significant. Conclusion:The use and type of IUCD preferred depends on various factors such as age of male and female, number of children and religion of couples.

A Record Based Study On Various Factors Affecting The Choice Of Intra-Uterine Contraceptive Device In Ahmedabad City

Background:Unplanned pregnancy may be the reason of many neonatal and maternal adverse effects. The objective is to study various factors affecting IUCD (temporary contraceptive method) preference. Material And Methods:A record based study of data of 483 couples selecting IUCD, during the one year period was collected with permission from tertiary care hospital. Result:The most common group preferring IUCD was 21-30 years (mean age-females-26 years and males-30 years).Majority having 2 children opted for IUCD while only 1 couple opted for IUCD without any child. Out of the total, 42% opted PPIUCD, 42% interval IUCD and 16% PAIUCD. Among lower age and up to primary educated groups, majority opted for PPIUCD. Among higher age and educated groups, majority opted for interval IUCD. PAIUCD proportion was higher in less educated females. Majority ofMuslims preferred PPIUCD while Hindus, interval IUCD. The association of type of IUCD with age, number of children and religion was found significant while with education, it was in-significant. Conclusion:The use and type of IUCD preferred depends on various factors such as age of male and female, number of children and religion of couples

Development Of Mebeverine Hcl Prolonged Release Mini-Tablets By Thermoplastic Granulation Technique

Mebeverine HCl is a BCS class-I drug and thus it possesses high solubility in aqueous media across the biological pH range. The marketed reference product is a multi-unit particulate system (MUPS) containing prolonged release pellets filled in hard gelatin capsule. In conventional manufacturing process, a huge quantity of solvents (aqueous and/or organic) is used to manufacture such dosage form. Additionally, it demands more processing time and efforts. Therefore, a prolonged release capsules dosage form of Mebeverine HCl was formulated using thermoplastic (melt) granulation technique without usage of any solvent. Prolonged release minitablets sized 2 mm in diameter were developed as per quality by design principles. A 23 full-factorial design of experiment was applied to optimize levels of drug release controlling ingredients which includes a hydrophobic meltable binder (hydrogenated castor oil) cum matrixing agent, a hydrophilic meltable binder (polyethylene glycol) which may act as pore former also, and a release controlling polymer (ethyl cellulose). The optimized formulation was found stable. Dissolution profiles of the optimized formulation were found similar to the marketed reference product in different media across the physiological pH range. In conclusion, the explored solvent less process was capable to manufacture the MUPS dosage form of Mebeverine HCl prolonged-release capsules, which is stable and pharmaceutically equivalent with the reference product. The developed process is more beneficial to small and medium scale industry, as it does not require any special and costly equipment, significantly decreases manufacturing cost and increases productivity compared to conventional process, which is mentioned in literature.

A Clinical Study of Effect of Centchroman on Fibroadenoma

Background: Centchroman has been studied earlier and literature mentions it to be a novel non-steroidal, selective estrogenreceptor modulator, antiestrogen, and mild anti-inflammatory drug with a significant decrease in size of fibroadenoma. Ourstudy aims to check the reduction in the size of fibroadenoma in response to centchroman.Materials and Methods: A prospective observational study was carried out in patients of fibroadenoma attending surgeryoutpatient department and wards of Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa(Madhya Pradesh) from August 2015 to July 2016. Patients were included in the study after obtaining an informed consent.Patients were followed up for 12 weeks.Results: In our study, the maximum number of fibroadenomas was found in the left upper outer quadrant; of 102 patients,total lesions (fibroadenoma) were 130. Of 102 patients studied for the effect of centchroman on fibroadenoma, there was aresponse in 36 patients, which accounted for 35.29%. In 66 (64.8%) patients, there was no response after the treatment withcentchroman and they were subjected to excision and biopsy. The mean difference in volumes of fibroadenoma was statisticallyinsignificant. However, there was a reduction in size of mean volume of fibroadenoma which was 4.085 at the presentation andwhich was 3.24 at the end of the 12th week.Conclusion: Fibroadenoma was common in the age group of 21–30 years. The left breast was more involved in fibroadenomas.The most common site for fibroadenoma was the left upper outer quadrant. The effect of centchroman on decrease in volume offibroadenoma was seen in 35.29% of patients. Reduction in volume of fibroadenoma was statistically insignificant. More than 50%reduction in volume of fibroadenoma was seen only in 3 patients (2.94%). Surgical excision and biopsy were the preferred modalityof treatment for fibroadenomas in patients where the drug centchroman showed no response in regression in volume (64.8%).

Comparative study of continuous infusions of Ropivacaine v/s Ropivacaine + Fentanyl for post thoracotomy analgesia in 50 patients

Background: Epidural opioids have been widely used for post thoracotomy pain relief. One such drug is Fentanyl, a short acting lipophilic opioid analgesic, structurally related to Pethidine for its opioid activity. Adding Fentanyl, as an adjuvant to Ropivacaine, also reduces total consumption of Ropivacaine and incremental doses of rescue analgesics. Materials and methods: 50 patients of either sex aged 18-60 year belonging to ASA class II-III scheduled for elective thoracotomy were included in this study and divided into two groups: Group R receiving 0.1 ml/kg/hr of 0.2% Ropivacaine continuous epidural infusion for 24 hour and Group RF receiving 0.1 ml/kg/hr of 0.2% Ropivacaine + 4 µg/ml Fentanyl continuous epidural infusion for 24 hour. Results: There was no significant difference between two groups regarding to Age, sex, height, weight and ASA grade and preoperative vitals as well as VAS score at rest. There was highly significant difference between groups at 30 minute and 6 hour regarding to this variable with P <0.001. Patients in group RF were more comfortable during PEFR measurement than group R. Patel V,Chaudhary H, Patel HJ, Agrawal R. Comparative study of continuous infusions of Ropivacaine v/s Ropivacaine + Fentanyl for post thoracotomy analgesia in 50 patients. IAIM, 2016; 3(9): 66-73. Page 67 Conclusion: A continuous thoracic epidural infusion of 0.1 ml/kg/hr of 0.2% Ropivacaine + Fentanyl 4 µg/ml provided better pain relief than 0.2% Ropivacaine alone after thoracotomy; both at rest and during spirometry. The use of 0.2% Ropivacaine alone was associated with worse pain control during spirometry, larger consumption of IV Diclofenac Sodium and worse performance during spirometry. Addition of Fentanyl to Ropivacaine for continuous epidural analgesia in post thoracotomy patients provides better pain relief and improves spirometry performance.

Effect of transcutaneous electrical Nerve stimulation on pain in subjects with primary dysmenorrhea

Background: Low back pain and pelvic pain are most common symptoms of Primary dysmenorrhea. Most commonly used treatments are pharmacological drugs. TENS has been found to be effective for primary dysmenorrhea according to Parisa P. Transcutaneous Electrical Nerve Stimulation (TENS) can be given in pre-menstrual days or during menstrual cycle and in both phases TENS has been shown to be effective. So this study was done to see and compare the effect of TENS in primary dysmenorrhea in both phases. Aim: The present study aimed at assessing effect of Transcutaneous Electrical Nerve Stimulation on Pain in Subjects with Primary Dysmenorrhea. Materials and methods: A quasi-experimental study was conducted in community of Ahmadabad. Non athletic females between 18-25 years of age, diagnosed with primary dysmenorrhea with regular menstrual cycle and no other medical conditions were included in this study. 30 subjects included by convenience sampling were randomly divided in 2 groups. Both groups were given 20 minutes of TENS, to back over para spinal region (L5-S1) at 100 Hz frequency with 80 µs at comfortable intensity, once daily for 3 days. One of 2 groups was treated on three premenstrual days and other group was treated at same dose during initial three days of menstrual cycle. Outcome measure used was visual analogue scale. Level of significance was kept at 5%. Results: Wilcoxon test was used to compare mean preVAS, 5.36±1.652 and postVAS, 2.85±1.711, in group A (W/z= -3.413, p= 0.001). Wilcoxon test was used to compare mean preVAS 4.61±1.187 and postVAS 2.77±1.102, in group B (W/z= -3.408, p= 0.001). Mean difference between group A and B was 2.17± 0.87.Applying Mann-Whitney U Test (U= 63.500, p=0.042) showed significant difference between groups. Patel V, Sheth M, Vyas N. Effect of transcutaneous electrical Nerve stimulation on pain in subjects with primary dysmenorrhea. IAIM, 2016; 3(6): 1-5. Page 2 Conclusion: Use of TENS for 3 days before or during menstrual cycle is effective in reducing pain. However use of TENS in premenstrual phase is more effective for reducing pain.

Comparison of USG guided modified rectus sheath block with intraperitoneal instillation with Inj Bupivacaine for postoperative pain relief in diagnostic laparoscopy

Background: Laparoscopic surgery is associated with considerable postoperative pain, though it is less compared to open surgery. Post laparoscopic pain results from phrenic nerve irritation caused by residual gas, stretching of the intraabdominal cavity and peritoneal inflammation. The Modified Rectus Sheath Block (MRSB) is fairly easy and reliable procedure when performed using ultrasound guidance so it is compared with the intraperitoneal instillation method by using Inj. Bupivacaine for postoperative analgesia in diagnostic laparoscopy. Aim of the study was to assess and compare the effect of the USG guided modified rectus sheath block (MRSB) with the intraperitoneal instillation using Inj. Bupivacaine in diagnostic laparoscopy. Material and methods: It was prospective randomized study. The Patients were randomly allocated in two groups. Group A were given USG guided rectus sheath block and Group B was given Patel V, Mehta K, Patel K, Parmar H. Comparison of USG guided modified rectus sheath block with intraperitoneal instillation with Inj. Bupivacaine for postoperative pain relief in diagnostic laparoscopy. IAIM, 2016; 3(1): 85-89. Page 86 intraperitoneal 25 mg Bupivacaine. Patients with obesity, local anesthetic agent allergy and emergency surgeries were excluded. Pain was assessed 1, 6, 10 and 24 hours postoperatively by visual analogue pain score. Results: Postoperative pain was assessed by visual analogue pain score (VAS) at every hour for 24 hours postoperatively. The VAS was significantly lower in Group A at 6 and 10 hours postoperatively. After 6 hours the median pain score was 3 in group A while it was 7 in group B. After 8 hourrs the median pain score was 2 in group A compared with 5 in group B and after 10 hours the median score were 2 and 5 in group A, group B respectively (p<.001 and <0.004 respectively). No significant difference noted in pain score at 1 hour and 24 hour post laparoscopy among the two groups. Conclusion: USG guided modified rectus sheath block (MRSB) provides prolonged post operative analgesia than intraperitoneal instillation in diagnostic laparoscopy.

The effect of spousal violence on women's health: findings from the Stree Arogya Shodh in Goa, India.

BACKGROUND: Spousal violence has wide-ranging effects on the physical, reproductive, sexual and psychological health of women. There are few longitudinal studies that describe this association in developing countries. AIM: To test the hypothesis that spousal violence is an independent risk factor for a broad range of adverse health outcomes in women. SETTING AND DESIGN: A population-based cohort study of women living in the catchment area of a primary health center in north Goa. Two thousand four hundred and ninety-four of 3000 randomly selected women were recruited of whom 1750 married women were included for this paper. MATERIALS AND METHODS: Each participant was assessed at baseline with a structured interview for the assessment of exposure to spousal violence (verbal, physical, sexual) over two time periods (lifetime; recent in the past three months). The interview collected data on gynecological complaints and the Revised Clinical Interview Schedule was used for the diagnosis of depressive disorder. Laboratory tests for anemia and sexually transmitted infections (STI) were carried out. Longitudinal data was collected after six and 12 months on these outcomes. In addition, baseline measures for nutritional status and menstrual health were also obtained. STATISTICAL ANALYSIS: Univariate analyses were carried out on the cross-sectional and longitudinal data to assess the association between each type of spousal violence and each health outcome. Multivariate analyses adjusted for age, literacy, household per capita income. Logistic regression was used for all analyses in Stata (Version 10). RESULTS: Lifetime spousal violence was reported by 290 (16.6%, 95%CI=14.9-18.4) women; recent violence was reported by 230 (13.0%, 95%CI=11.6-14.8). The cross-sectional data showed an association between violence and a range of self-reported gynecological complaints, low Body Mass Index, depressive disorder and attempted suicide. The longitudinal analyses confirmed these associations only for STI and attempted suicide. CONCLUSION: Spousal violence is specifically associated as an independent risk factor for two adverse women's health outcomes, viz., STI and attempted suicide. Public health and clinical programs targeting these outcomes must specifically address spousal violence.

Adult cutaneous myofibroma.

A 63-year-old male presented with an asymptomatic, slow-growing swelling on the right lower limb for the past one and half years. The histopathology revealed a lobular neoplasm with a biphasic pattern of spindle shaped cells and hemangiopericytoma like areas at the periphery of the lobule. The diagnosis of adult cutaneous myofibroma was made. This case highlights the importance of histopathology in reaching a definitive diagnosis.

Neurosyphilis: a Clinico-Radiological Study

Purpose. Neurosyphilis is an uncommon disease. Although syphilis may promote the transmission of HIV the converse may not be true. The neuro-radiology of neurosyphilis is limited to two case series and several case reports. Our series of patients were reviewed to describe the clinical and radiological findings. Method. A retrospective chart review from 1994 to 2005 was done and demographic; clinical; laboratory and radiological findings were extracted. Patients HIV status was also recorded. Patients who satisfied the criteria for the diagnosis of neurosyphilis with the exclusion of alternate diagnoses were included. Results. Fifty-three patients were evaluated but only 41 charts were available for review. Thirty-nine of these had radiological data. The clinical spectrum included asymptomatic patients; strokes; dementia; cranial nerve palsies; spinal cord syndromes and polyradiculopathy. Imaging changes included normal findings; infarcts; meningeal based mass lesions; spinal intra-medullary hyper-intensities; cranial nerve enhancement and intra-medullary enhancing mass lesions. There was no difference in CSF cellular or chemistry findings between those with neurosyphilis who were HIV positive and those who were HIV negative. Amongst the patients where follow up was available most improved regardless of HIV status. Conclusion. Neurosyphilis has protean manifestations and can affect any central neurological system. The pathogenesis varies from inflammatory mass lesions to vascular occlusion and inflammatory damage. Syphilis should be an aetiological consideration in any neurological presentation where another cause is not obvious. The radiological features are not specific and would be seen with many inflammatory aetiologies affecting the CNS. The CSF picture is similar regardless of HIV status and patients should be managed similarly regardless of their HIV status

Irrational drug use in India: a prescription survey from Goa.

BACKGROUND: There is concern regarding the irrational production, prescription and use of drugs in India. This study aimed to describe the quality of prescriptions by medical practitioners, including both the layout of the prescription and the type and number of drugs prescribed. MATERIALS AND METHODS: A survey of all prescriptions dispensed at a busy pharmacy in the state of Goa, India, was carried out over a consecutive seven-day period. Each prescription was rated on the basis of a priori and pilot-tested variable list. The prescriptions by private practitioners were compared with those from practitioners in the public healthcare system. RESULTS: Nine hundred and ninety prescriptions were collected. The majority (83.9%) were from private practitioners. The quality of the layout of the prescriptions was unsatisfactory: information to identify the practitioner was incomplete in more than a third of the prescriptions and information to identify the patient was incomplete in more than half. Clarity of written instructions on how to take the medicines was unsatisfactory in the majority of prescriptions. Polypharmacy was the norm, with more than half (52.7%) the prescriptions containing at least 3 medicines. Forty per cent of prescriptions included a vitamin or tonic preparation and a quarter of the prescriptions included an antibiotic and an analgesic. Over 90% of prescriptions contained only branded medicines. Private practitioners prescribed significantly greater number of medicines and were more likely to prescribe vitamins and antibiotics, and branded medicines. DISCUSSION: This study confirms that the quality of prescriptions, both in terms of layout and the content of the drugs prescribed, is inadequate. There is a need to standardize the format of prescriptions in India so that all essential information is included. There is a need to strengthen an independent mechanism for continuing professional development of practitioners to ensure that patients are always given evidence-based, cost-effective treatments.

Gender, sexual abuse and risk behaviours in adolescents: a cross-sectional survey in schools in Goa.

BACKGROUND: There is little information on the prevalence and correlates of sexual abuse in adolescents in India. METHODS: A cross-sectional survey of all Class XI students in eight higher secondary schools in Goa (n = 811 ) was conducted in March 2000. A self-report questionnaire, developed and piloted in collaboration with the adolescents, elicited information on education, mental health, risk behaviours and the experience of violence and sexual abuse in the previous year. RESULTS: A third of adolescents had experienced some form of sexual abuse. Sexual abuse experiences were associated with the experience of other forms of physical and verbal violence. Coercive sex had been experienced by approximately 6% of adolescents. These adolescents had significantly poorer academic performance, poorer mental and physical health, greater substance abuse, poorer parental relationships and higher rates of consensual sexual behaviours. Gender differences in the types of abuse and the associations with abuse were found. However, there was no difference between boys and girls in the rates of experience of coercive sexual intercourse. Differences in risks were found for urban and rural school students; while rural boys were more likely to have experienced coercive sexual intercourse than urban boys (10.3% v. 2.5%), urban girls were more likely to have experienced any form of sexual abuse than rural girls (37.2% v. 25.4%). CONCLUSIONS: Abuse and violence in school-based adolescents is a common experience and is associated with poorer health and greater prevalence of risk behaviours. Interventions aimed at improving adolescent reproductive health must incorporate personal safety, prevention of abuse, communication skills and mental health issues.

Effect of current on dermal permeation of positively charged liposomes.

Transdermal permeation of positively charged liposomally entrapped diphenhydramine hydrochloride (DPH-HCL) has been investigated in presence of pulse D.C. anodic current. Positively charged liposomes were prepared by lipid film hydration technique with stearyl amine as a charge inducer. The prepared liposomes were then subjected to in vitro permeation studies using artificial membrane (cellophane membrane) and human cadaver skin under the influence of iontophoretic current. The effect of variable current density as well as time frequency of application of current onto the release pattern of the plain drug and charged liposomally entrapped drug were studied and the results were compared. The results indicate that application of pulse D.C. anodic current significantly influences the transfer of positively charged liposomally entrapped DPH-HCL across HCS.