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Purpose – The study aims to identify role of marketing mix with regard to Public and Private sector Banks of Udaipur after the emergence of COVID-19. A total of 200 respondents from the city of Udaipur Design/methodology/approach – provided the primary data. Structured questionnaires were used by the researcher. Initially, 230 participants were polled, but only 200 of them offered insightful responses, and the other 30 were unresponsive, incomplete responses that were removed for research purposes. The Findings – results revealed that there are differences among the respondents on building up of marketing mix in private and public sector banks in Udaipur city. The degree of change can be seen more in Private banks than in Public ones. Research limitations/implications – With a small sample size and a constrained sample area, data from the public and private sector banks were collected; a larger sample size and expanded sample area would have produced more accurate results. Practical implications – The study offers information aboutmarketing mix creation, emergence of COVID-19, its combination and effect on respondents, which on itself is a crucial subject. The write-up is based on the Originality/value – researcher's personal opinion and the findings from the data collection, which was done on a primary basis.
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Introduction Mullerian anomalies arise because of aberrant embryogenesis and a longitudinal vaginal septum (LVS) is a failure of resorption of the distal Mullerian canal. A 26-year-old Material and methods pregnant lady with full-term gestation presented to our rural hospital in labour. Her physical examination was normal except for a partial longitudinal vaginal septum that she had in the proximal vagina distinct from the cervix extending from the 12 O clock position of the anterior vaginal wall to 6 O clock of the posterior vaginal wall along with a bulge felt in the posterior fornix. An emergency lower segment caesarean section was performed for possible fetal distress and a right ovarian mass was encountered which was removed along with the resection of the partial longitudinal vaginal septum. Her postoperative period was uneventful and the histopathology report of the ovarian mass turned out as a mature cystic teratoma. A partial Conclusion longitudinal vaginal septum can be easily resected during labour if it hasn't been diagnosed before. This is one of the ?rst cases reported where a partial LVS along with an ovarian mass was reported and managed successfully by resection
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Aim: Irrational use of medicines is a global problem. In India, one contributing factor is the availability of a large number of fixed-dose combinations (FDCs). To improve rational use and to strengthen policies, it is important to assess the usage patterns and rationality of FDCs. Methods: This study was conducted as part of a 1-year prospective cross-sectional analysis of prescriptions in the outpatient clinics of broad specialities from 13 tertiary care hospitals across India. Five most commonly prescribed FDCs in each center were analyzed. In addition, all the prescribed FDCs were classified as per the Kokate Committee classification and it was noted whether any of the FDCs were irrational or banned as per the reference lists released by regulatory authorities. Results: A total of 4,838 prescriptions were analyzed. Of these, 2,093 (43.3%) prescriptions had at least one FDC. These 2,093 prescriptions had 366 different FDCs. Of the 366 FDCs, 241 were rational; 10 were irrational; 14 required further data generation; and the remaining 96 FDCs could not be categorized into any of the above. Vitamins and minerals/supplements, antibacterial for systemic use, and drugs for gastroesophageal reflux disease (GERD) and peptic ulcer were the most used FDCs. Conclusion: Based on the finding that some prescriptions contained irrational FDCs, it is recommended that a rigorous, regular, and uniform method of evaluation be implemented to approve/ban FDCs and that prescribers be periodically notified about the status of the bans.
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Personal hygiene refers to set of individual practices and conditions that help maintain health and prevent the spread of diseases. Maintaining personal hygiene is important for social health, physical health and psychosocial health. The present study aimed to assess the knowledge and reported practices of school going children regarding personal hygiene with a view to develop an information booklet. The study adopted cross sectional design to collect data from 410 school going children in rural villages of Haldwani block, Uttarakhand. The children were recruited via convenient sampling technique. It was found that majority (n=230, 56.09%) school going children had moderate knowledge of personal hygiene. The overall practices of children were found to be appropriate for 366 (89.51%) children. Regarding knowledge and hygienic practices, mother' s education plays vital role for school going children. Also, teachers with parents can play a pivotal role in providing health education regarding personal hygiene from early stage of childhood itself for longevity and to protect from illnesses.
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Introduction: Blood stream infection are very common in the pediatric age group and these are one of the common causes of morbidity and mortality in children. In developing countries ,the rate of blood stream infection in children is about 20-50%.The present study was undertaken to determine the etiological agents causing blood stream infection and their antibiotic susceptibility pattern in pediatric patients. Patients with bacteremia may have either a transient bacteremia or persistent bacteremia which can be self-limited without development of focal infection or sequelae or may progress to a more serious fatal infection or toxic effects. The present study in a hospital basedMethodology: single centred, Observational study, of 3 years. Blood sample were collected in BacTec bottle and standard microbiological protocol were applied for the isolation identification of bacteria strains. Antimicrobial susceptibility test was performed by the Kirby Bauer Disc Diffusion Method as per CLSI 2019 guidelines. Out of total 350 bloodResults: samples received for culture,87(23.14%)were culture positive, out of which 42/87(48.27%) were Gram positive organisms and 39/87(44.82%) were Gram-negative organisms and 6 /87(6.89%) were candida spp. The most common organism was Staphylococcus aureus(31.03%) the predominant organism followed by Klebsiella pneumoniae(21.83%) and Streptococcus pneumoniae (9.19%), Escherichia coli, Enterobacter cloacae each (5.74%). All Gram positive bacteria were susceptibile to vancomycin, teicoplanin and linezolid. 11/27(40.74% )of Staphylococcus aureus were Methicillin resistant Staphylococcus aureus (MRSA) strains. All Gram negative bacteria were susceptibility to amikacin, Colistin,Tigecycline. Staphylococcus aureus is the leading cause ofConclusion: childhood septicemia in this locale, has been decline in susceptibility of the pathogens to common antibiotics which ultimately stresses on the need for continuous screening and surveillance for antibiotic resistance in the pediatric ward and calls for increased efforts to ensure more rational use of these drugs.
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Neonatal severe hyperparathyroidism is a rare disorder arising from inherited defects in the calcium sensing receptor (CaSR) that presents early in life with severe hypercalcemia, failure to thrive, and developmental retardation. The authors describe an infant with neonatal severe hyperparathyroidism due to homozygous CaSR gene mutation presenting with recurrent episodes of severe hypercalcemia, growth retardation, and developmental delay. Medical management served as an efective bridge therapy to surgery. Total parathyroidectomy with right hemithyroidectomy was performed at 7 mo of age and resulted in successful cure and normalization of growth and developmental milestones. Timely medical and surgical management can help prevent mortality and morbidity in the form of neurodevelopmental sequelae. Life-long monitoring and treatment is mandatory for the resultant hypoparathyroidism.
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Background & objectives: The tribal population in India is considered as one of the vulnerable groups with respect to their achievements in health and other developmental issues. In this context, this mapping review attempted to understand the health profile of the Tharu tribal community residing in the northern State of Uttar Pradesh, India through literature mining. Tharu tribe is one of the indigenous groups living in the Terai plain on the Indo-Nepal border. In 1967, this tribe was documented as a Scheduled Tribe by the Government of India. The present review aimed to map the health-seeking behaviour of the Tharu population and review other factors pertaining to their health such as socioeconomic, developmental, employment, education, etc. Methods: Online data search was carried out on PubMed and Google Scholar using search terms ‘Tharu’ AND ‘India’. In addition, official reports avaibale in public domain and grey literature was also searched. Results: Twenty seven studies including reviews, articles, books/book chapters were evaluated along with 13 reports (including reports from government organizations and grey literature) were retrieved and analyzed. Of the 27 published reports, 16 were found relevant to Tharu tribe in India. A total of 29 (16 articles + 13 reports ) were included in this review. Interpretation & Conclusions: This mapping review highights the health seeking behaviour of the Tharu tribe in India that can help inform future interventions to improve the health status of the Tharu tribe as well as other aspects of their development.
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Background: The requirement for the mutation analysis for Kirsten rat sarcoma viral oncogene (KRAS) in colorectal cancer (CRC) is rapidly increasing as it is a predictive biomarker and also, its absence signifies response to anti?epidermal growth factor receptor (anti?EGFR) antibody treatment. The aim of our study was to investigate the pathological diagnosis and distribution of KRAS mutations in colorectal cancer with the use of next generation sequencing platform (Ion Torrent). Methods: A total of 56 CRC samples were tested to identify the genetic mutations, especially KRAS using the primers which included ~2800 COSMIC mutations of 50 oncogenes. Ion Torrent personal genome machine (semiconductor?based sequencing) was used for the sequencing and analysis. Along with KRAS, other 49 genes were also studied for COSMIC mutations. Results: KRAS mutation 25 (44.6%) had the highest frequency, followed by TP53 10 (17.9%) and PIK3CA mutation 4 (7.1%). Of all the KRAS mutations identified, mutations in codon 12 were most frequent followed by mutations in codon 13 and 61. The most frequent substitution was glycine to aspartate mutation in codon 12 (p.Gly12Asp) followed by glycine to valine (p.Gly12Val). Combinations of mutations were also studied. Our study revealed that seven cases (12.5%) had both KRAS and TP53 mutations (highest of all the combinations). Conclusion: The analysis of KRAS mutation frequency and its mutational subtype analysis in human CRCs by using semiconductor?based platform in routine clinical practices have been performed in Indian population. The findings were similar to earlier published reports from the Western literature.
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Russia and Ukraine war started on 24th Feb., 2022. After 2nd World war, it is the largest military con?ict in Europe. The war negatively affected the entire global market. The paper tries to ?nd out why Russia and Ukraine becomes enemy? The paper discuss about various reasons of dispute between Russia and Ukraine. The paper determines the various sanctions imposed by different countries on Russia and the steps taken by Russia to save its economy. The study discuss about positive and negative impact of war on Indian economy and what actually India can learn from Russia and Ukraine war. The data has been collected from secondary resources. The study concluded that it is necessary for a country to be self-reliant in defense matters. Each country needs to advance itself in technology. The defense services allegiance must not to the political party but to the constitution.
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Background : Gall Bladder Polyps are mucosal lesions that project from the Gall Bladder wall into the Gallbladder lumen. They form morphologically distinct lesion/s with internal characteristics different than that of neighboring structures as verified by microscopic examination. About 4-6% are picked up clinically, 2-12% in Cholecystectomy specimens and 4% on Ultrasound. Materias and Methods : A three calendar year retrospective single surgical unit study compromised of 1442 cholecystectomies performed for benign Gall Bladder Disease. The patient were subjected to Ultrasound of abdomen for diagnosis and routine clinic work up. The Gall Bladders Harboring Polyps were examined grossly for site ,number, and microscopy for histological details. Results : In a total number of 40 cases of Gall Bladder Polyp, females outnumbered males. This series spreads over age groups of 3rd decade - 9th decade, most of the patients were seen in 6th decade of life. Youngest patients were 27 years old and oldest one was 85 years old. Incidentally, none of the old patients had evidence of malignancy on histopathology in their Gall Badder Polyp, only 2% were necessitated for a pre-operative diagnosis of Gall Bladder Polyps alone. Rest required it for presence of Gallstones with or without Polyp. None of >10mm size showed any malignant change on histopathological examination. On the Contrary, among the polypoid lesions <10mm size, one polypid lesion (7mm) showed a malignant change (Carcinoma in situ) Conclusion : A predictive model for neoplastic potential of Gall Bladder Polyp may support clinical decision to achieve an ideal therapeutic outcome. Hence a need for reappraisal of management guidelines.
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Background & objectives: Obesity is a rising pandemic in childhood. There is scarcity of evidence on the efficacy of yoga in achieving weight loss in overweight/obese children. The objective of this study was to assess the efficacy of family-based comprehensive yoga intervention in the reduction of body mass index (BMI) in overweight/obese children, in comparison to standard dietary and lifestyle counselling and control group. Methods: This was an open-label randomized controlled study. Children aged 8-15 yr who were overweight or had obesity were randomized to one of the three arms for 18 wk; standard weight management (group 1), yoga with dietary modification (group 2) and control (no intervention; group 3). Reduction in BMI and improvement in physiological, biochemical and psychological parameters from baseline to 18 wk was compared between the three arms. Late follow up was also done at 6-12 months. Results: A total of 165 children with mean±standard deviation (SD) age of 11.6±1.8 yr and mean BMI 26.3±4.2 kg/m2 were enrolled. Outcome analysis at 18 wk was performed for 109 children. Improved diet quality and reduced intake were observed in both intervention arms. The median (IQR) reduction in BMI in standard and yoga arms was similar [?1.4 (?3.1, ?0.5) kg/m2 and ?1.2 (?2.3, ?0.6) kg/m2, respectively], while it increased by +0.3 (?0.3, 0.1) in the control arm. In the yoga arm, mean systolic BP reduced from 118 (10) to 114 (8) mmHg, (P=0.019). In the standard arm, significant improvement in psychological scores was noted. In group 3, the mean fasting glucose increased from 93±10 to 102±12 mg/dl (P<0.001). Interpretation & conclusions: The findings of the present study suggest that yoga in conjunction with dietary modification is equally effective as the standard weight management for BMI reduction in the paediatric age group.
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Introduction : This is a research innovation that aims to provide an additional therapeutic tool. It will open up a vast panorama of regenerative medicine by application of Adipose Derived Mesenchymal Stem Cells (ADMSCs). ADMSCs are selected since a large amount is available for lipoaspiration and a larger percentage (30%) of Mesenchymal Stem Cells (MSCs) obtainable there from. The applications in clinical practice extend across Mesoderm, Endoderm and Ectoderm layers1. Material and Methods : There are three products that can be derived from the lipoaspirate. They are (1) Stromal Vascular Fraction (SVF), (2) Islet Cell Aggregates (ICAs) Translated from ADMSCs, (3) and ADMSCs with ~95% purity. They are deployed to illustrate the safety and efficacy in clinical trials for (1) Mesoderm Translation as in Osteoarthritis Knee, (2) Endoderm translation to Insulin-producing Cells as applicable to diabetes, and (3) Ectodermal Translation as applicable on Non-healing Indolent Ulcers on the Skin. Results : All three products are found safe with no adverse side effects. Proof of concept studies along with initial clinical trials for Osteoarthritis, Diabetes Types I and II, and Non-healing ulcer of any aetiology is demonstrated with objective evidence. Discussion : The evidence based on the results of the clinical trials across all three Germinal Layers is cited along with literature support. Results are explained based on a plausible scientific hypothesis. Conclusion : The study enunciates that Autologous SVF and ADMSCs are in futuristic domain for conducting clinical trials across all the three Germinal Layers.
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Background: There is limited data from India regarding medical management of congenital hyperinsulinism (CHI). Objective: To study the molecular diagnosis, medical management and outcomes of children with CHI. Study design: Ambispective. Participants: Children with CHI admitted in from December, 2011 till March, 2020 at a tertiary care referral hospital. Outcomes: Clinical and genetic profile, treatment, and response Results: 42 children with a median age of 3 days (range 1 day to 6 years) were enrolled, of which 23 (54.7%) were diazoxideresponsive. Mutations were identified in 28 out of 41 (68.2%) patients. The commonest gene affected was ABCC8 in 22 patients. The pathogenic variant c.331G>A in ABCC8 gene was identified in 6 unrelated cases from one community. Good response to daily octreotide was seen in 13 of the 19 (68.4%) diazoxide-unresponsive patients. Monthly long-acting octreotide was initiated and daily octreotide could be stopped or tapered in 9 patients. Sirolimus was tried with variable response in 6 patients but was discontinued in 5 due to adverse effects. Four patients had focal CHI, of which one underwent partial pancreatic resection. The disease severity reduced with age and neurodevelopment was good in the patients with identifiable genetic defects who were optimally managed. Conclusions: Medical management of CHI is effective, if compliance can be ensured, with good quality of life and neurological outcomes.
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Background & objectives: COVID-19 pandemic has triggered social stigma towards individuals affected and their families. This study describes the process undertaken for the development and validation of scales to assess stigmatizing attitudes and experiences among COVID-19 and non-COVID-19 participants from the community. Methods: COVID-19 Stigma Scale and Community COVID-19 Stigma Scale constituting 13 and six items, respectively, were developed based on review of literature and news reports, expert committee evaluation and participants’ interviews through telephone for a multicentric study in India. For content validity, 61 (30 COVID-19-recovered and 31 non-COVID-19 participants from the community) were recruited. Test–retest reliability of the scales was assessed among 99 participants (41 COVID-19 recovered and 58 non-COVID-19). Participants were administered the scale at two-time points after a gap of 7-12 days. Cronbach’s alpha, overall percentage agreement and kappa statistics were used to assess internal consistency and test–retest reliability. Results: Items in the scales were relevant and comprehensible. Both the scales had Cronbach’s ? above 0.6 indicating moderate-to-good internal consistency. Test–retest reliability assessed using kappa statistics indicated that for the COVID-19 Stigma Scale, seven items had a moderate agreement (0.4-0.6). For the Community COVID-19 Stigma Scale, four items had a moderate agreement. Interpretation & conclusions: Validity and reliability of the two stigma scales indicated that the scales were comprehensible and had moderate internal consistency. These scales could be used to assess COVID-19 stigma and help in the development of appropriate stigma reduction interventions for COVID-19 infected, and mitigation of stigmatizing attitudes in the community.
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Background@#Supraglottic airway devices (SADs) are routinely used for securing the airway. In this study, the clinical performance of three SADs in adult patients under general anesthesia was compared. @*Methods@#American Society of Anesthesiologists physical status I-III subjects were randomly assigned to the i-gelTM (I), LMA SupremeTM (L), or Ambu AuraGainTM (A) group (30 per group). The primary objective of this study was to compare insertion times. Additionally, the ease of insertion, number of attempts, oropharyngeal leak pressure (OLP), airway maneuver requirement, difficulty with gastric tube placement, and complications were assessed. @*Results@#Demographic data did not differ between the groups. Group I (16.9 ± 4.9 s) had a significantly shorter time of insertion than Group L (19.6 ± 5.2 s) and Group A (22.1 ± 5.7 s) (P = 0.001). The OLP for Group A (29.8 ± 3.0 cmH2O) was higher than those for Group L (24.1 ± 6.3 cmH2O) and Group I (9.4 ± 6.1 cmH2O) (P < 0.001). The number of insertion attempts (P = 0.232), ease of insertion (P = 0.630), airway maneuver requirement (P = 0.585), difficulty with gastric tube placement (P = 0.364), and complications (P = 0.873) were not significantly different between the groups. @*Conclusions@#All three devices are convenient and effective for airway management in adults under general anesthesia. However, the shorter insertion time required for the i-gel may make it more suitable for resuscitation and emergencies, while aspiration risk may be reduced with the Ambu AuraGain, given its high OLP.
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Change from quadruped to erect posture has resulted in changes in the human pelvis. This has resulted in pelvis supporting the abdominal viscera. The bony pelvis is deficient on inferior aspect. Muscles covered by fascia on superior and inferior aspect. A good knowledge of pelvic floor is very basic and mandatory for any gynecologist as pelvic floor is crucial to support the pelvic organs and is required to maintain urinary and fecal continence.
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Introduction:Sepsis is defined as life threatening organ dysfunction caused by the dysregulated host response to infection with high mortality. Methods:We studied 2031 patients presenting to an emergency department with fever or suspected infection to find the correlation between q SOFA SCORE and procalcitonin level swith mortality.
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Glaucoma is the leading cause of irreversible blindness worldwide. Primary Open Angle Glaucoma (POAG) isusually asymptomatic till advanced stages of the disease. Intraocular pressure (IOP) is the primary risk factorfor development of POAG. But in spite of control of IOP, some cases progress which strengthens the viewthat there must be other independent risk factors in the pathogenesis of glaucoma. Serum lipids have beenfound to be associated with glaucoma in few studies. We conducted a study to assess the relation betweendyslipidemia and glaucoma on 100 cases of glaucoma and 100 age-matched controls. Detailed ophthalmicexamination was done in all subjects and fasting lipid profile was compared between cases and controls.Levels of total cholesterol, total triglycerides and LDL were significantly higher in cases than in controls witha p value < 0.0001. We conclude that dyslipidemia is an independent risk factor for POAG.
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Background: Acute appendicitis is one of the commonest surgical emergencies. Authors undertook this study to evaluate serum bilirubin levels in acute appendicitis and appendiceal perforation.Methods: A retrospective study evaluating the serum bilirubin levels in acute appendicitis and appendiceal perforation was carried out for 6 years at three tertiary care hospitals at India from 2014 to 2019. Patients having acute appendicitis and appendiceal perforation, confirmed on histopathology, with no other medical or surgical comorbidity were included in the study.Results: The total number of our study subjects was 927. 306 patients had appendiceal perforation, amongst these, 226 (74%) had hyperbilirubinemia. Out of the 621 patients having acute appendicitis only 186 (30%) had hyperbilirubinemia. The lowest and the highest serum bilirubin levels of this study group were 0.6 and 3.1 mg/dl, respectively, with an average of 1.6 mg/dl. In patients diagnosed to be having acute appendicitis, the lowest and highest serum bilirubin levels were 0.6 and 2.4 mg/dl, respectively, with an average of 1.3 mg/dl. As for the patients having appendiceal perforation the lowest and highest serum bilirubin levels were 0.8 and 3.1 mg/dl, respectively, with an average of 1.8 mg/dl.Conclusions: Hyperbilirubinemia is seen in acute appendicitis but predominantly in appendiceal perforation, so serum bilirubin estimation may help us in diagnosing appendiceal perforation pre-operatively if and when used in conjunction with other available diagnostic modalities.
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Background: To study the lipid profile of 3rd trimester pregnant women and their cord blood with and without intrauterine growth restriction Design: Observational study, Setting: Department of Obstetrics and Neonatology, in a teaching hospital in North India during February 2013 to August 2014.Methods: Third trimester pregnant women and their neonates. Enrolled 250 women were divided in intrauterine growth restricted and control groups. Outcome Measures: Venous blood Lipid levels of 3rd trimester mothers and their neonate at birth.Results: Women of IUGR group had significantly lowered total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL) and low density lipoproteins (LDL)210.2 (19.8), 221.6 (36.2),65.4(11.7)and 130.7 (20.8)compared to 251(55.3), 234.7(35.6), 70.8(19.9) and 181.3(16.8) mg/dl control group. The TC, TG and LDL levels in cord blood of IUGR group were 93.6(16.5), 50.4 (6.5) and 51.8(12.6) as compared 106.4(17.7), 30.7(4.4) and 55.9(12.1) mg/dl to control group (p value <0.05). HDL levels were significantly lower 15.8(4.6) in IUGR group as compared to 26.5(5.4) in control group. The LDL: HDL and TC: HDL ratio was significantly higher in IUGR group. Maternal weight, gestational age, urban residence, primi parity, birth weight and APGAR score were lower, while maternal age, parity, smoking, blood pressure, cesarean sections (%) and male sex (%) of baby was higher in IUGR group.Conclusions: Lipid profile of mothers of IUGR fetuses had significantly lowered cholesterol levels and their cord blood had shown atherogenic phenotype