Comparison of novel clinic-based approach (amblyopia school) Vs. home-based occlusion for amblyopia therapy – A retrospective study

Purpose: To compare visual outcomes of standard occlusion therapy at home versus clinic in amblyopic children. Methods: A retrospective study of case records of children aged <15 years with diagnosis of strabismic or anisometropic amblyopia or both was conducted at a tertiary eye hospital located in rural North India between Jan 2017–Jan 2020. Those with at least 1 follow?up visit were included. Children with ocular co?morbidities were excluded. Treatment in clinic by admission or at home was based on the parents’ discretion. Children in clinic group underwent part time occlusion & near work exercises for minimum 1 month, in classroom format which we called amblyopia school. Those in home group underwent part time occlusion as per PEDIG recommendations. Primary outcome measure was improvement in number of Snellen’s lines at the end of 1 month & at final follow?up. Results: We included 219 children with mean age of 8.8±3.23 years, out of which clinic group had 122 (56%) children. At one?month, visual improvement in clinic group (2.1±1.1 lines) was significantly greater than home group (mean=1.1±0.8 lines) (P < 0.001). Both groups continued to improve vision on follow?up, however the vision in the clinic group (2.9±1.2 lines improvement at mean follow?up of 4.1±1.6 months), continued to be better than home group (2.3±1.1 lines improvement at mean follow?up 5.1±0.9 months) (P = 0.05). Conclusion: Clinic based amblyopia therapy in the form of an amblyopia school can help expedite visual rehabilitation. Thus, it may be a better option for rural settings where patients in general tend to be poorly compliant.

Correction of pre-existing astigmatism by on-axis incision size modulation in manual small-incision cataract surgery

Purpose: To study the effect of wound size modulation on pre?existing astigmatism by on?axis placement of incision in manual small?incision cataract surgery (MSICS). Methods: In this prospective interventional study conducted at a tertiary care centre, 40 eyes of 40 consecutive senile cataract patients with 1.00�00 D corneal astigmatism were enrolled for the study. MSICS by modified Blumenthal抯 technique was performed through 6.0, 6.5, and 7.0 mm on?axis incision in 1.0�49 D (group A), 1.50�99 D (group B), and 2.00�00 D (group C) astigmatism, respectively. Surgically induced astigmatism (SIA) was calculated by vector analysis and double angle plots (DAP) at 12 weeks postoperatively. Results: There were 22 males and 18 females with mean age of 58.12 � 1.18 years. The mean SIA at 12 weeks was 0.85 � 0.28 D in group A (17 eyes), 1.32 � 0.65 D in group B (10 eyes), and 1.91 � 0.69 D in group C (13 eyes). The overall median uncorrected visual acuity was 0.18 (IQR = 0 to 0.2). The mean astigmatism decreased from 1.95 � 0.74 D to 1.04 + 0.57 D (P = 0.00) in superior incision and from 1.70 + 0.50 D to 0.92 � 0.45 D (P = 0.00) in temporal incision group with central shift of centroid in all cases. Conclusion: The customization of on?axis external incision size can be used to manage pre?existing corneal astigmatism of less than 3.00 D using both temporal and superior incisions effectively

Growth Faltering Among Discharged Babies from Inpatient Newborn Care Facilities: Learnings from Two Districts of Himachal Pradesh

Objective: To determine the burden of early growth faltering and understand the care practices for small and sick babies discharged from newborn units in the district. Study design: Observational and follow-up study. Participants: 512 babies discharged from two Special Newborn Care Units (SNCUs) and four Newborn Stabilization Units (NBSUs) in two districts of Himachal Pradesh. Methods: Anthropometric assessments, interview of mothers and Accredited Social Health Activists (ASHAs) conducted between August, 2018 and March, 2019. Change in weight-forage z-score (?WAZ) of <-0.67SD between birth and assessment was used to define growth faltering. Outcomes: Proportion of growth faltering (or catch-down growth) in small and sick babies discharged from SNCUs and NBSUs, and infant care practices. Results: Growth faltering was observed in a significant proportion of both term (30%) and preterm (52.6%) babies between 1 to 4 months of age. Among babies with growth faltering (n=180), 73.9% received a home visit by ASHA, and only 36.7% received a follow-up visit at a facility. There were 71.3% mothers counselled at discharge (mostly informed about breast feeding). Most (96.7%) mothers did not perceive inadequate weight gain in their babies post-discharge. During home visits, ASHAs weighed 61.6% of the infants with growth faltering. Amongst infants who had growth faltering, only 49.6% of mothers had been provided information about their infant’s growth and 57.1% mothers had received breastfeeding counselling. Conclusion: Small and sick newborn infants (both term and preterm babies) discharged from special care newborn units are at increased risk of early growth faltering. Follow-up care provided to these infants is inadequate. There is a need to strengthen both facility-based and home-based follow up of small and sick newborn infants discharged from newborn care facilities.

Retinal Hamartomas in a case of Tuberous Sclerosis

A 21-year-old male patient suffering from epilepsy came for fundoscopic evaluation. Right eye showed a ?at, smooth surfaced well circumscribed, non-calci?ed translucent lesion of 1 disc dioptre size, inferior to the optic disc, obscuring underlying vessels & an opaque, calci?ed, yellow white lesion having irregular surface & margins with mulberry appearance, elevated, supero-nasal to the disc, obscuring the underlying vessels. Adenoma sebaceum, periungual ?bromas, Ash leaf macules were seen on general physical examination suggestive of tuberous sclerosis. MRI brain revealed subependymal nodules & subcortical tubers. OCT showed an optically hyper re?ective mass with retinal disorganization and moth-eaten spaces. 2D echo showed mild Left Ventricular Hypertrophy, diastolic dysfunction, trivial mitral and tricuspid regurgitation. Ultrasonography of abdomen & pelvis showed fatty liver and renal angiomyolipoma. It was interesting to note cardiac & hepatic involvement in addition to the standard tuberous sclerosis complex (TSC) major & minor diagnostic criteria

An epidemiological study on diabetes and its determinants among urban slum women of Rajkot city, Gujarat

Background: India has the maximum number of diabetic patients in the world and this had given the country the dubious distinction of being the “diabetic capital” of the world. It is evident that the urban poor living in slums and slum like areas adopt a more urbanized lifestyle which places them at a higher risk for non-communicable diseases and have poor access to healthcare, partly related to their poor purchasing ability. Women slum dwellers are particularly vulnerable to negative health outcomes. The study was conducted with objectives to assess prevalence, determine factors and know treatment and control status.Methods: This is a cross sectional study conducted among 405 slum women of age 35 years or more in Rajkot city. Interview, anthropometric measurements and selective clinical examinations i.e., blood sugar estimation were done for all participants.Results: In present study, total 64 (15.80%) women were diagnosed with diabetes. A statistically significant association was found between body mass index, remaining busy in household work, walking, practicing healthy habits, parental history, sibling history and diabetes. Out of 64 women who were diagnosed with diabetes, about half i.e., 36 (56.25%) were aware of their diabetic status. Out of those aware, 29 (80.66%) were on treatment. Among those on treatment, about half i.e., 16 (55.17%) had their blood sugar under control.Conclusions: Studied population high prevalence and inadequate control of diabetes.

Nanotechnology in reproductive medicine: Opportunities for clinical translation / 대한생식의학회지

In recent years, nanotechnology has revolutionized global healthcare and has been predicted to exert a remarkable effect on clinical medicine. In this context, the clinical use of nanomaterials for cancer diagnosis, fertility preservation, and the management of infertility and other pathologies linked to pubertal development, menopause, sexually transmitted infections, and HIV (human immunodeficiency virus) has substantial promise to fill the existing lacunae in reproductive healthcare. Of late, a number of clinical trials involving the use of nanoparticles for the early detection of reproductive tract infections and cancers, targeted drug delivery, and cellular therapeutics have been conducted. However, most of these trials of nanoengineering are still at a nascent stage, and better synergy between pharmaceutics, chemistry, and cutting-edge molecular sciences is needed for effective translation of these interventions from bench to bedside. To bridge the gap between translational outcome and product development, strategic partnerships with the insight and ability to anticipate challenges, as well as an in-depth understanding of the molecular pathways involved, are highly essential. Such amalgamations would overcome the regulatory gauntlet and technical hurdles, thereby facilitating the effective clinical translation of these nano-based tools and technologies. The present review comprehensively focuses on emerging applications of nanotechnology, which holds enormous promise for improved therapeutics and early diagnosis of various human reproductive tract diseases and conditions.

Nanotechnology in reproductive medicine: Opportunities for clinical translation / 대한생식의학회지

In recent years, nanotechnology has revolutionized global healthcare and has been predicted to exert a remarkable effect on clinical medicine. In this context, the clinical use of nanomaterials for cancer diagnosis, fertility preservation, and the management of infertility and other pathologies linked to pubertal development, menopause, sexually transmitted infections, and HIV (human immunodeficiency virus) has substantial promise to fill the existing lacunae in reproductive healthcare. Of late, a number of clinical trials involving the use of nanoparticles for the early detection of reproductive tract infections and cancers, targeted drug delivery, and cellular therapeutics have been conducted. However, most of these trials of nanoengineering are still at a nascent stage, and better synergy between pharmaceutics, chemistry, and cutting-edge molecular sciences is needed for effective translation of these interventions from bench to bedside. To bridge the gap between translational outcome and product development, strategic partnerships with the insight and ability to anticipate challenges, as well as an in-depth understanding of the molecular pathways involved, are highly essential. Such amalgamations would overcome the regulatory gauntlet and technical hurdles, thereby facilitating the effective clinical translation of these nano-based tools and technologies. The present review comprehensively focuses on emerging applications of nanotechnology, which holds enormous promise for improved therapeutics and early diagnosis of various human reproductive tract diseases and conditions.

Uterine Scar Condition and Complications Associated with Repeat Caesarean Section: A study in a Tertiary Care Hospital

Introduction: Lower segment cesarean section is thecommonest surgical procedure in obstetrics. Repeating acesarean section in subsequent pregnancies is the usualmethod of termination which involves many complications.Our objective was to study these complications and difficultiesobserved in a repeat cesarean section.Material and methods: It was a prospective observationalstudy of 241 cases of repeat cesarean section from October2017 to September 2018 in department of obstetrics andgynecology of Hi-Tech medical college and hospital,Bhubaneswar, odisha.Results: In this study, total 1610 patients are taken. Amongthese most common indication for cesarean section is CPDi.e56 (23%).Most common incidence of intraoperativecomplication of previous cesarean section is adhesion i.e.124(51.61%).Conclusion: Maternal morbidity is a cause of concern in repeatcesarean section because of the intraoperative complicationsencountered during surgery and thereafter. Reduction inprimary caesarean rate can reduce the complications. Patientswith previous cesarean section are categorized as high riskand counselled for VBAC in suitable cases.

Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

Clinical correlation of vitamin D in depression

Background: Literature has substantially advanced our understanding of the action of vitamin D in depression, much is still unknown concerning how vitamin D relates to dimensions of depression. Hence, authors aimed to examine the relationship of vitamin D in patients of depression, its correlation with the severity of depression and different symptom domains of depression.Methods: This Hospital based case control study included 75 patients with depression and 50 controls who were age and gender matched. Beck’s Depression Inventory II was used to assess the severity and symptom domains of depression. Vitamin D levels was assessed using Enhanced Chemiluminescence Technique.Results: Vitamin D deficiency was found significantly (<0.001*) among cases than controls. Significant (0.003*) inverse correlation was observed between severity of depression and vitamin D level.In cognitive symptoms, pessimism, punishment feeling, self-criticism, suicidal thoughts and worthlessness were found significantly higher among vitamin D deficient patients. However, in somatic-affective symptoms, crying, indecisiveness, loss of energy, irritability, concentration difficulty and being tired were the significant by prominent symptoms in vitamin D deficient patients.Conclusions: Vitamin D (<50 nmol/L) was found to be significantly associated with depressive symptoms with cognitive and somatic-affective symptoms being affected by vitamin D deficiency.

Anaemia during Pregnancy and its Association with Adverse Maternal and Foetal Outcomes

Nutritional iron deficiency is the main cause of anemia throughout the world. It is especially common in women of reproductive age and particularly during pregnancy. Anemia during pregnancy is associated with adverse perinatal outcomes in the form of preterm birth, stillbirth, small for gestational age babies and increased perinatal mortality. There is persistently high prevalence of anemia in Indian mothers despite a national program in place. Objective: To assess the prevalence of anaemia, its different types and their association with maternal and perinatal outcomes. Methods: This study was conducted on 100 pregnant patients with severe anemia. The study population was divided into 3 groups based on basis of peripheral smear picture i.e. microcytic, macrocytic and dimorphic anemia. These pregnant mothers were followed up until their time of delivery and associations between anaemia types and maternal as well neonatal adverse outcomes were explored. All the data collected was analyzed using statistical computer software (STATA Version 13.0). Result: Microcytic hypochromic anemia was most commonly present (45 patients, 45%). Intrauterine growth restriction was seen in 20% of total study population and out of these, majority were born to mother with macrocytic anemia (32.5%). The same trend was also seen for gestational hypertension with 8.9%. 32.5% and 6.7% patients having gestational hypertension in microcytic, macrocytic and dimorphic anemia groups respectively (p=0.009). A total of 23 patients had low birth weight babies; 65.2% patients with low birth weight babies had macrocytic anemia and this difference was statistically significant (p=0.024). Overall 15% of babies were small for gestational age, out of which 66.7% babies were in macrocytic anemia group. Low Apgar score at one minute after birth was seen in four babies born to mothers having macrocytic anemia and this was a statistically significant relationship (p=0.044). Conclusion: Anemia is increasingly becoming prevalent and is associated with poor maternal and perinatal outcomes. Public health interventions should be made by way of appropriate food fortifications to reduce prevalence of anemia Early diagnosis should be made by appropriate investigations and proper therapy should be started as soon as possible according to type of anemia, in order to prevent adverse maternal and foetal outcomes.

Comparative Study between PGE1 Misoprostol and PGE2 Dinoprostone in Preinduction Cervical Ripening

Prostaglandin E2(cerviprime gel), an inducing agent is instilled intracervically or placed high in the posterior fornix of the vagina and may need to be re-in- stilled after 6 h if required. Another alternative is misoprostol (15-deoxy-16- hydroxy-16-methyl prostoglandin E1) which is used in various dosages. Methods: This was a prospective observational study of nulliparous women undergoing labor induction for one year, 100 womens, in a tertiary care center. Participants were then randomly assigned to pre-induction cervical ripening with a dinoprostone vaginal insert (0.5mg) (group I), and with misoprostol (50 microg) intravaginally(group II). Result: From our study observation, maximum patients delivered normal vaginal delivery. Of the vaginal deliveries six (18%) of PGE2 group and five patients(10%) of PGE1 having meconium stained liquor after ARM or spontaneous rupture of membrane, fetal heart was reassuring i.e, no fetal distress was there. The caesarean section rate in both groups nine (18%) and (10%) was statistically insignificant. Mean change in bishop score was also not significant in both groups. Need for oxytocine after 8hrs of induction between both group was significant, 84% in dinoprostone group and 56% in misoprostol group. Gastrointestinal side effects, uterine tacchysystole, uterine hyperstimulation was more common in misoprostol group than dinoprostone group, that is statistically significant. Induction to delivery time was shorter in misoprostol group that is statistically significant. No adverse neonatal outcomes that can directly be related with both drugs. Both agents are equally efficacious in causing cervical repining and almost equal changes in mean bishops. Conclusion: Misoprostol is an excellent labour-inducing agent and can be used liberally for labour induction, unlike PGE2 gel, is comparatively cheaper and is stable at room temperature; thus, it could be an ideal inducing agent in poor resource settings. Local application of misoprostol tablet in posterior vagina is easier method than dinoprostone insertion. Intravaginal insertion of misoprostol tablet is superior to dinoprostone gel in inducing labour and shorter interval between induction and delivery.

Contraceptive knowledge, practices among women in Garhwal region

Background: Family planning is defined by World Health Organization (WHO) as, “a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of family groups and thus contribute effectively to the social development of a country”. The extensive acceptance of family planning, in a society, is an integral component of modern development and is essential for the incorporation of women into social and economic life. Therefore the present study as well focused on the women knowledge and participation in family planning. Objectives: This study projected to evaluate the knowledge of the women about various family planning methods and its sources of information.Methods: In this cross-sectional study, 200 married women between 15-60 years of age group selected by multistage random sampling. The women were asked to complete the 20 questions including demographic data. Self structured questionnaire was used to evaluate their knowledge about Family planning methods. Subsequently, the data analyzed by using SPSS version 1.2.Results: In this present study knowledge of family planning methods were higher. Female sterilization and use of condom is the most widely known and practiced method of all contraceptive methods followed by oral Pills and IUDs. Health functionaries were found to the more informative as compared to media and others sources of information regarding family planning methods.Conclusions: From the results found in this study it can be accomplish that women’s awareness regarding family planning was higher and found satisfactory.

Correlation between 6-minute walk distance and spirometry parameters in stable chronic obstructive pulmonary disease patients

Background: Six minute walk test (6MWT) is a sub-maximal exercise test, used as a clinical indicator of the functional capacity, in patients with cardiopulmonary diseases. It is simple, objective and reproducible test. The present study was designed to assess correlation of six minute walk test with spirometry parameters, in patients with chronic obstructive pulmonary disease.Methods: In this cross sectional study, fifty patients diagnosed with chronic obstructive pulmonary disease (GOLD criteria) coming to tertiary center were recruited according to inclusion and exclusion criteria. All patients underwent spirometric measurement. Spirometric indices including FEV1, FVC, FEV1/FVC and MVV were tested using computerized spirometer. 6MWT was performed following American Thoracic Society (ATS) guidelines. Percent (%) predicted 6MWD was calculated. Correlation between spirometry and 6MWT was assessed.Results: It was found that correlation between 6MWT and spirometry is statistically significant. There is significant strong positive correlation between percent predicted 6MWD and FEV1 (r=0.850 and p= <0.001), whereas there is significant moderate correlation between percent predicted 6MWD and FVC (r=0.554 and p= <0.001), FEV1/FVC (r=0.509 and p= <0.001) and MVV (r=0.615 and p= <0.001).Conclusions: In chronic obstructive pulmonary disease, percent predicted 6mwd significantly correlated with the spirometry parameters (FEV1, FVC, FEV1/FVC, and MVV). 6MWD decreases as there is decline in the pulmonary function. 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.

Urodynamic Assessment of Bladder Behaviour in Traumatic Spinal Cord Injury (SCI) Patients in Response to Rehabilitation: Findings from a Government Tertiary Care Hospital in Bihar, India

The objective of the study was to document the bladder behaviour in response to rehabilitation intervention in patients with traumatic spinal cord injury (SCI) using urodynamic study (UDS). Additionally, it also aimed to compare the nature of the bladder in a rehabilitated and non- rehabilitated neurogenic bladder of traumatic SCI. Study design: The study adopted a prospective follow-up design. Setting: Department of Physical and Rehabilitation Medicine, Jawahar Lal Nehru Medical College and Hospital (JLNMCH), Bhagalpur, Bihar, India. Methods: One hundred and thirty traumatic SCI patients mean age 31.3±7.8 years, 113 males and 17 females, admitted for rehabilitation were done UDS to see the bladder behaviour in response to rehabilitation intervention and compare the nature of bladder of the rehabilitated and that of the non-rehabilitated neurogenic bladder. Result: There were significant changes in the max. cystometric capacity (p=0.019) after rehab intervention in upper motor neuron (UMN) neurogenic bladders. The compliance, Pdet. at first desire to void and Pdet. at max. cystometric capacity were also found to have significant correlations (p=0.010, 0.010 and 0.013 respectively) in those with UMN neurogenic bladders. However, the volume at the first desire to void did not show significant changes after rehabilitation intervention (p=0.54). Significant decrease in amplitude and frequency was found in involuntary contractions (detrusor hyper-reflexia). In lower motor neuron (LMN) neurogenic bladder significant changes after rehabilitation intervention was found only in the max. cystometric capacity (p=0.015). Conclusion: Based on these findings we conclude that the change in the nature of the rehabilitated neurogenic bladder is different with the type of bladder.

Women’s knowledge and practice regarding primary health care services in Garhwal region of Uttarakhand

Background: Primary health care (PHC) relies heavily on the contributions of women, particularly in the area of health education, it raises their self-esteem and empowers them to serve their communities in a number of ways: by improving women's health and the health of their families and by training women both as care givers and as health educators. Primary health care is the first level of contact of the individuals, the family and the community with the national health system bringing health care as close as possible to where the people live and work: It should be based on practical, scientifically sound and socially acceptable methods and technology. It should be made universally accessible to the individuals and the family in the community through their full participation. This study projected to evaluate the knowledge and practice of women regarding health care services and their source of information.Methods: Stratified multistage random sampling of the target population was done. In the first stage villages were selected by simple random sampling technique. In the second stage population for the study purpose was selected from the selected village again by simple random sampling technique.Results: In this present study knowledge regarding health care services were higher and found satisfactory, health functionaries were found to be more informative as compared to media and others sources of information.Conclusions: From the results found in this study it can be said that women’s knowledge regarding health care services was found satisfactory.

Efficacy of Platelet Rich Plasma in Comparison to Steroid for the Management of Chronic Plantar Fasciitis

Background: Planter fasciitis is an injury of unknown origin in more than 80% cases. It affects quality of life as well as daily activity of the patients. Various surgical procedures, autologous blood and steroid injection also have been applied without constant success. Platelets rich plasma have been found effective in various orthopedically disorders like osteoarthritis, tennis elbow etc. That is why the present study was designed to compare the efficacy of platelets rich plasma injections and steroidal injections for the treatment of planter fasciitis. Methods: The present interventional study was conducted fromJuly 2016 to June 2018. Study population was divided into groups. Group I included patients (n=40) of a single ultra sound guided platelets rich plasma injection whereas, group II contained patients (n=40) with a single ultra sound guided depomedrol 40 mg injection. Scores of VAS and AOFAS were recorded at the initial level and follow ups after the injections. Follow up examinations were done at 6 weeks, 6 months and 12 months. Results: There was a significant improvement in mean VAS scores of platelet rich plasma group patients (1.8) compare to corticosteroid injection group patients (3.4) after one year of the treatment. However, results showed that steroids failed to show long term decrease in VAS score (p<0.05). Mean AOFAS was significantly increased (64.4) in the steroid group at 6wks as in comparison of platelet rich plasma group (52.2). Conclusion: Findings of the present study showed that improvement in steroid group was faster but benefits were lost in longer run. In contrast, platelets rich plasma was more effective in sustaining the long term beneficial effects.

Depression and anxiety in patients with epilepsy

Background: Anxiety and depression are commonly found in epileptic patients. However, the etiology behind the mechanism remains multifactorial, mostly because of variability in study settings. In order to fill the knowledge gap, we investigated the prevalence of anxiety and depression among epileptic patients and their correlation with certain demographic variables.Methods: In a Cross Sectional Out Patient Based Study, a total of 147 patients with epilepsy were recruited and evaluated for inclusion and exclusion criterion. Participants who met the inclusion criterion were assessed using standardized scales HARS and HADS rating scale for anxiety and depressive symptoms respectively.Results: 100 participants were included with mean age of 33.63 years for men and 30.16 years for females. 27% showed mild to severe anxiety and 21% had mild to moderate depression. Prevalence of both anxiety and depression was found more among females, singles, participants from urban background and having partial epilepsy. Significantly (p-0.020*) higher anxiety was seen in patients with partial epilepsy than those with generalized epilepsy.Conclusions: Individuals with partial epilepsy are more prone to get affected from comorbid disorder like anxiety and depression, especially females, singles and those from urban domicile.

Primary Postpartum Haemorrhage – Morbidity And Mortality

Background:To study the incidence of primary postpartum haemorrhage, morbidity and mortality. Methods: Study was carried out in department of obstetrics and gynaecology, Swaroop Rani Nehru and associated Hospital, M..L.N. Medical College Allahabad. All pregnant women who underwent vaginal delivery and those who were admitted within 24 hours of delivery were included in the study .Group allocation was done randomly in three groups. Analysis of study data was done by chi square test. Result:The incidence of primary postpartum haemorrhage was 4%.Maximum incidence was noted in group A (5.8%) and minimum in group C (4.2%) .The morbidity which were related to primary postpartum haemorrhage were anaemia (68%),infection (42%),blood transfusion related complications (26%),DIC(4%), and hysterectomy (3%). 0.3% of patients died of severe postpartum haemorrhage .Management options included intensive therapy ,B-Lynch sutures and hysterectomy. Conclusion: ?

Prevalence of Upper Limb Neuropathy in Rehabilitated Spinal Cord Injured Patients in North India

Background: Upper extremities are principally adapted for grasping or seizing activities. In individuals with spinal cord injury, they are additionally used for transfers, wheelchair propulsion, and daily living activities, putting additional strain on the joints. For this reason, it is essential to distinguish the effects of these increased demands in terms of prevalence of peripheral neuropathies in rehabilitated spinal cord injured population from developing countries. Methods: Spinal cord Injury patient with a neurological level below T2, who were independent in activities of daily living was monitored during the yearly follow up. Electrodiagnostic study of median, ulnar, radial nerve was graded in a scale of 0-2 with 0 being normal, 1 being neuropathy of one hand and 2 being an association of both the hands and the final conclusion was based on this study. Results: There were 45 wheelchair users, 5 walker users, 30 elbow crutch users, 10 subjects using sticks and one subject with a unilateral transtibial amputation using an axillary crutches. Thirty eight patients were using tricycle for independent mobility. Among 55 patients using wheel chair CTS was observed in 70% patients. In the same group 24% had ulnar neuropathy and 16% had radial neuropathy.Conclusion: Findings of our study suggest that upper limb compressive neuropathy was highly prevalent among the spinal cord injury patients. Further, current study recorded carpal tunnel syndrome was the most common neuropathy incorporated with paraplegia patients especially using wheel chair and crutches. We strongly advocate for the importance of the modification of in the vocational instruments like light weight or electrical wheelchair etc along with improvement in accessories like grip style, gloves etc to avoid the constant pressure and repetitive trauma to upper limb of paraplegia patients with spinal cord injury