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Background: Ocular infections are a result of alteration in the normal microbial flora of eye. They are not only responsible for increase in morbidity varying from self-limiting trivial infection to sight threatening infection but also blindness.Methods: Patients with ocular infections were recruited at Regional Institute of Ophthalmology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh. Bacterial profile in ocular infections and susceptibility pattern to commonly used antibiotics were analyzed amongst these patients. The isolated organism was then identified by colony morphology, gram stain and biochemical test following which in vitro susceptibility test was performed by Kirby-Bauer disc diffusion method and interpreted clinically.Results: Staphylococcus aureus and coagulase negative Streptococcus were most common etiological agents of ocular infections in the present study. It was observed that bacterial isolates were highly (in 100% of cases) susceptible to vancomycin and chloramphenicol among gram positive organisms. Gram negative organisms showed higher susceptibility to moxifloxacin, tobramycin and gentamycin. Pseudomonas was seen to have sensitivity towards ceftazidime and cefazolin.Conclusions: The present study gives an insight into use of ocular antimicrobials in northern India. These findings illustrate the need for constant bacterial surveillance before starting empirical treatment.
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Background: Vernal keratoconjunctivitis (VKC) is a chronic allergic conjunctival disease. Immunomodulatory drugs like cyclosporine is being used for its treatment. Tacrolimus is another immunomodulator drug that can be used in VKC. This study was done to compare the efficacy of tacrolimus and cyclosporine in VKC.Methods: This prospective study was conducted on 60 patients of either sex by dividing them into two groups. The first group was treated with cyclosporine (0.05%) ophthalmic eye drop and second group with tacrolimus (0.03%) ophthalmic ointment. Total five objective signs (hyperaemia, oedema, papillae, corneal involvement and tantra’s dot) and five subjective symptoms (itching, tearing, foreign body sensation, discharge and photophobia) data was collected and tabulated for statistical analysis.Results: Authors found TSSS in both groups decrease significantly (p <0.05 or p <0.01 or p <0.001) at all post periods as compared to respective predecessor periods except 4 weeks to 6 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Similarly, for each period, on comparing the mean TSSS between the groups TSSS between the groups at all periods does not differed statistically though at final evaluation (mean change from baseline to 8 weeks), it improved 5.2% more in tacrolimus group (83.7%) than cyclosporine group (78.5%). Similarly, TOSS also decreased at all post periods except 4 weeks to 6 weeks, and 6 weeks to 8 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Improvement in scores was 11.6% more in tacrolimus (81.6%) than cyclosporine (70.0%). Cyclosporine eye drops are associated with burning sensation and redness of eyes while transient ocular irritation was only observed side effect with tacrolimus.Conclusions: The study found tacrolimus is clinically better drug for treatment of vernal keratoconjunctivitis than cyclosporine and is also cost effective.
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Background: Dry eye disease (DED) is the very common and underdiagnosed ocular condition affecting vision, quality of life, and the outcomes of cataract or refractive surgery. Dry eye disease (DED), either alone or in combination with other conditions, is a frequent cause of ocular irritation that leads the patients to seek ophthalmic care. Due to a wide variety of presenting symptoms, it is often unrecognized and this causes great frustration of the patient and treating physician. While these symptoms often improve with appropriate treatment, usually in majority of the cases the disease may not be curable. Aim of the study was to compare the efficacy of tacrolimus and cyclosporine in dry eye disease.Methods: This was a single centred, 3 months prospective study. Patients with unilateral or bilateral dry eye disease and an ocular surface disease index score >12, atleast one eye with schirmer score <5mm and TBUT <10 s were enrolled in the study. The enrolled patients were randomly divided into two groups, twenty-five patients in Group 1 and twenty three patients in Group 2 completed the follow up. Group 1(n =25) who received 0.03% tacrolimus eye ointment twice daily for consecutive 3 months and Group 2 (n= 23) received 0.05% cyclosporine eye drops twice daily for consecutive 3 months the primary efficacy outcome was Schirmer score after 3 months. The secondary outcomes were TBUT and adverse effects.Results: After 3 months, both the treatment groups showed significant improvement in mean Schirmer score (p<0.001) and mean TBUT (p <0.0001). However, on comparing both the groups, mean Schirmer score and mean TBUT, results were comparable. No patient discontinued treatment because of minor ocular adverse effects.Conclusions: Dry eye patients demonstrated improvement in Schirmer score and TBUT after 3 months of treatment with tacrolimus 0.03% ointment and cyclosporine 0.05% eye drops.
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Efavirenz is the first line non-nucleoside reverse transcriptase inhibitor suggested by World Health Organization for newly diagnosed patients started on antiretroviral therapy. Dermatologic manifestations are the usual side effects associated with this drug. Authors hereby, present a case report of efavirenz induced drug hypersensitivity reported at a tertiary care hospital at Allahabad, Uttar Pradesh. The patient developed rashes and vomiting within a week of start of TLE regimen. Re-challenge test revealed confirmation of the adverse drug reaction by efavirenz. Change of the regimen was done for the patient following hospitalization for the event. This case report explains that strict pharmacovigilance is essential in the initial days of start of antiretroviral therapy. Further trials to improve the safety profile of the patients on ART are the need of the hour.
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Objectives: The Government of India introduced guidelines on therapeutic supplementation of zinc in the management of childhood diarrhoea in the year 2007, but programmatic constraints delayed its introduction into public health programs. Micronutrient Initiative, with support from a donor, initiated a program in 2010 to demonstrate and scale-up the use of zinc through public sector channels, in the state of Bihar. Methods: The project was implemented in 15 demonstration districts with a population of 36 million. Over 40,000 community level health workers were oriented on use of zinc. Support was provided to strengthen procurement and supply chain mechanisms. A robust system of monitoring and evaluation was introduced to track performance. Meaningful engagement with the government ensued throughout the demonstration phase. Results: Use of Community-level volunteers (CLVs) is a pre-requisite to scaling-up access to care. More than one-million children were reported to be provided care. The CLVs need to be engaged through a relevant supportive supervision model. Supply chain mechanisms need to be strengthened to prevent stock-outs at service delivery points. Simple reporting tools need to be introduced for improved case- reporting. Conclusions: It is feasible and viable to introduce and scale-up therapeutic zinc supplementation as an adjuvant to ORS in the management of childhood diarrhea through public sector channels. The community-based approach of service delivery and proactive engagement with the government are key essentials in achieving the above objectives.
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Objectives: The Government of India introduced guidelines on therapeutic supplementation of zinc in the management of childhood diarrhoea in the year 2007, but programmatic constraints delayed its introduction into public health programs. Micronutrient Initiative, with support from a donor, initiated a program in 2010 to demonstrate and scale-up the use of zinc through public sector channels, in the state of Bihar. Methods: The project was implemented in 15 demonstration districts with a population of 36 million. Over 40,000 community level health workers were oriented on use of zinc. Support was provided to strengthen procurement and supply chain mechanisms. A robust system of monitoring and evaluation was introduced to track performance. Meaningful engagement with the government ensued throughout the demonstration phase. Results: Use of Community-level volunteers (CLVs) is a pre-requisite to scaling-up access to care. More than one-million children were reported to be provided care. The CLVs need to be engaged through a relevant supportive supervision model. Supply chain mechanisms need to be strengthened to prevent stock-outs at service delivery points. Simple reporting tools need to be introduced for improved case- reporting. Conclusions: It is feasible and viable to introduce and scale-up therapeutic zinc supplementation as an adjuvant to ORS in the management of childhood diarrhea through public sector channels. The community-based approach of service delivery and proactive engagement with the government are key essentials in achieving the above objectives.
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Indian Muslims, compared to their counterparts from other religions, lag behind on several yardsticks related to socioeconomic progress and the same is true with maternal health care utilization. Due to low age at marriage among Muslims, a majority of births is ascribed to young (15-24 years) mothers, which pose serious concerns on the maternal health care of Young Married Muslim women (YMMW). A thorough search of past literatures on Muslim women’s maternal health care reveals that the research on the determinants of maternal health care utilization among Muslim women is almost absent. Retrieving data from the National Family Health Survey -3 (2005-06) this study attempts to assess the level of utilization and factors effecting three key maternal health indicators [Full Antenatal Care (ANC), safe delivery and Postnatal Care (PNC)] among YMMW (15-24 years) in India. Bi-variate analysis and chi-square test was applied and variables which were found to be significant were further included in binary logistic regression. The findings of the study reveal abysmally low levels of utilization for all three indicators of maternal health care i.e. full ANC, safe delivery and PNC. Multivariate analysis reveals that no mass media exposure, lower autonomy, education, poor economic background, higher birth order and unintended pregnancy are some of the reasons behind low maternal health care utilization. The study suggests educating Muslim girls, promoting family planning use, involving media and collaboration between religious leader and health care system could be some important policy level interventions to address the unmet need of maternity services among YMMW. Existing government policies and programs should integrate YMMW who are poor and belong to backward states with poor demographic indicators.
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Adolescent , Young Adult , Women , Islam , Maternal Welfare , IndiaABSTRACT
No study has yet attempted to measure mean out-of-pocket expenditure on health care at household level, separately for government and private health facilities in India. Therefore, this study analyses the change in the out-of-pocket expenditure between 1995-96 and 2004 for fifteen major states of India, separately for rural/urban sector and inpatient/outpatient care. Using data from the 52nd and 60th rounds of the National Sample Survey, we present a disaggregated analysis of the trends and patterns of inflation adjusted household expenditure on health care. The analysis of average household expenditure on health care demonstrated that the mean outpatient care expenditure in government health sector decreased marginally at the aggregate level in both rural and urban sector, whereas it showed a significant increase in private facilities. A substantial rural-urban differential was also observed regarding households’ mean hospitalization expenditure in private hospitals while the same was not true for government hospitals. Almost all states observed a very high growth in households’ mean hospitalization expenditure in the private sector, while it was quite low in the government sector and even negative in rural areas of some states. The same pattern was observed in the growth pattern of households’ outpatient care expenditure. The analyses indicated a little improvement in the performance of government health sector in terms of out-of pocket expenditure. The improvement was more visible in developed and less developed states than in least developed states. Similarly, the improvement was more visible in rural areas than in urban areas.
Subject(s)
Health Expenditures , Delivery of Health Care , IndiaSubject(s)
Clinical Trials as Topic , Humans , India , Vaccines/administration & dosage , Vaccines/standardsABSTRACT
A new granular media developed by coating of iron and manganese on quartz sand surface proved to be effective for arsenic (III) removal from water. The media has shown alkali resistance. The kinetic and thermodynamic studies data were tested using pseudo-second- order, intraparticle diffusion and Elovich equation models. The rate constants, equilibrium sorption capacity and normalized standard deviations were calculated for all the three models. It was shown that all three models almost accurately predict the sorption capacity with respect to time for whole range of data points. However, sorption kinetic data were better correlated using Elovich equation model based on normalized standard deviation. The Langmuir and Freundlich isotherm equations could be used to describe the partitioning behavior of system at different pH and media size. The results of thermodynamic studies show that the As(III) adsorption on Mixed Oxide Coated Sand (MOCS) was endothermic in nature. Kinetic and isothermal studies data have also been used to obtain thermodynamic parameters of the process.