Assessment of quality-of-life in cancer patients at tertiary care hospital in North India

Introduction: Cancer is a disease that emerges as a result of abnormal cell proliferation and their propensity to spread from one bodily region to another. There are over a hundred different types of cancer that impact individuals all over the world. It is difficult to identify in the early stages, but there are certain warning signals that the cells will turn malignant. Quality of life (QOL) is described by the World Health Organisation as "individuals' perception of life, values, objectives, standards, and interests within the cultural framework of the social environment in which they live and in relation to their goals, expectations, standards, and concerns." QOL assessment in health system is a multidimensional construct that can be measured by evaluating objective levels of health status filtered by the subjective perceptions and expectations of the individual. Aim and Objective: To assess socio-demographic factors and quality of life among cancer patients in tertiary care hospital. Materials and Methods: A hospital-based prospective observational study was conducted at Guru Gobind Singh Medical College and Hospital Faridkot district, Punjab (India). The study was conducted for a period of six months after getting approval from Institutional Ethical Committee (IEC). Generic instrument, SF-36 was used to assess the QOL. The study was analyzed on SPSS version 26.0 software. Descriptive and analytical analysis was used to describe the results. Results: Linear regression was conducted to see the relationship of physical functioning score with age and weight of the patients. The descriptive statistics shows the mean and standard deviation of the variable. The mean of physical functioning score was found to be (M = 27.82, SD = 15.635). The physical functioning score and age, weight of the patients in linear regression shows that the age and weight explain 17.5% Conclusion: Treatment revealed that severe and moderate activities restricted nearly half of the assessed patients, with body pain interfering with employment and routine activities. According to the findings of the current study, QOL deteriorates as the disease progresses. Cancer unquestionably has a detrimental influence on patients' quality of life, which is connected to the illness process itself, the therapy administered, and the length of the disease. (AU)

Ocular conjunctival microbiome profiling in dry eye disease: A case control pilot study

Purpose: Keratoconjunctivitis sicca (KCS) or dry eye disease (DED) is a multifactorial disease that results in discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. A pilot study was undertaken to determine if there were any major substantial differences in the ocular microbiome in DED patients versus healthy controls. Methods: The bacterial communities residing in the conjunctiva of patients with DED (n = 4) and healthy controls (n = 4) were assessed by 16S ribosomal RNA (rRNA) gene sequencing of the V4–V5 region. Results: The phyla Proteobacteria, Actinobacteria, Bacteroidetes, and Firmicutes were most dominant and accounted for 97% and 94.5% of all bacterial sequences in patients and controls, respectively. At the genus level, 27 bacterial genera were found with more than two?fold difference between patients and controls. Four of these – Acinetobacter, Corynebacterium, Lactobacillus, and Pseudomonas spp. – dominated the ocular microbiome of all subjects, but were proportionately lower in DED (16.5%) compared to controls (37.7%). Several bacterial genera were found to be unique in DED (34) and controls (24). Conclusion: This pilot study is an attempt to profile the ocular microbiome in patients with DED that demonstrated a higher concentration of microbial DNA compared to controls, with Firmicutes phyla dominating the bacterial population in patients with DED.

Dried blood spots: a robust tool for malaria surveillance in countries targeting elimination

With the advancements in analytical and molecular techniques, Dried Blood Spots (DBS) are re-emerging as attractive and cost-effective alternatives for global health surveillance. The use of DBS has been well-characterized in the neonatal screening of metabolic diseases, therapeutic screening as well as in epidemiological studies for biomonitoring. Malaria is one such infectious disease where DBS use can expedite molecular surveillance for assessing drug resistance and for refining drug usage policies. In India, malaria cases have reduced significantly over the past decade but to achieve malaria elimination by 2030, country-wide DBS-based screening should be conducted to identify the presence of molecular markers of artemisinin resistance and to study parasite reservoirs in asymptomatic populations. DBS has wide applications in genomics, proteomics, and metabolomic studies concerning both host and pathogen factors. Hence, it is a comprehensive tool for malaria surveillance that can capture both host and parasite information. In this review, we elucidate the current and prospective role of DBS in malaria surveillance and its applications in studies ranging from genetic epidemiology, parasite and vector surveillance, drug development and polymorphisms to ultimately how they can pave the roadmap for countries aiming malaria elimination

The case report of a non-resident Indian with Plasmodium ovale curtisi from Kerala, India

India’s target of malaria elimination by 2030 may not be achieved solely by detecting Plasmodium falciparum and P. vivax, the two common Plasmodium species causing infections in humans. Sporadic reports have been documented on other Plasmodium species in the country, associated mostly with travel history. A febrile patient of Indian origin (Non-resident Indian (NRI)) was diagnosed with an infection of Plasmodium ovale curtisi malaria on his arrival from Sudan. A case report from Kerala was published in December 2020 and this is second report. Due to the inaccessibility of molecular techniques for routine diagnosis, this neglected non-falciparum malaria goes undetected. For an accurate diagnosis, suspected malaria cases should be tested using PCR and other advanced methods.

An investigation of the efficacy of di fferent statistical mod els in malaria forecasting in the semi-arid regions of Gujarat, India

Background & objectives: Robust forecasting of malaria cases is desirable as we are approaching towards malaria elimination in India. Methods enabling robust forecasting and timely case detection in unstable transmission areas are the need of the hour. Methods: Forecasting efficacy of the eight most prominent statistical models that are based on three statistical methods: Generalized linear model (Model A and Model B), Smoothing method (Model C), and SARIMA (Model D to model H) were compared using last twelve years (2008–19) monthly malaria data of two districts (Kheda and Anand) of Gujarat state of India. Results: The SARIMA Model F was found the most appropriate when forecasted for 2017 and 2018 using modelbuilding data sets 1 and 2, respectively, for both the districts: Kheda and Anand. Model H followed by model C were the two models found appropriate in terms of point estimates for 2019. Still, we regretted these two because confidence intervals from these models are wider that they do not have any forecasting utility. Model F is the third one in terms of point prediction but gives a relatively better confidence interval. Therefore, model F was considered the most appropriate for the year 2019 for both districts. Interpretation & conclusion: Model F was found relatively more appropriate than others and can be used to forecast malaria cases in both districts.

Linkages between blood groups and malaria susceptibility

Blood typing has revolutionized the field of medical science since its discovery about a century ago. Besides its established role in life-saving blood transfusions, researchers have always been curious about the relationship between blood groups and human ailments. The effect of blood groups on disease outcomes, susceptibility, and mortality has been widely explored. According to a particular school of thought, the endemicity of diseases shapes the distribution of blood group frequency in human populations and exert selection pressure favoring one blood type over another. Here we discuss the scope and association of different blood groups in the context of malaria.

Validation of micro-chip based PCR assays for diagnosis of both Plasmodium falciparum and Plasmodium vivax

Background & objectives: Microscopy is considered as the gold standard for malaria diagnosis, however sub-microscopic infections can only be detected by Polymerase chain reaction, which demands high cost and elaborate laboratory setup. The Micro-chip PCR based Truenat Malaria Pv-Pf and Pf assay is a portable solution for detection of sub-microscopic/asymptomatic cases of malaria in the field, three lots of which were evaluated for P. falciparum and P. vivax malaria. Methods: Three lots of Truenat® Malaria Pv-Pf and Pf assay (kits) were assessed using blood samples of P. vivax and P. falciparum as well as malaria negative blood samples. DNA was extracted from the blood samples using the Trueprep Auto v2 Universal Cartridge based sample prep device and real time qPCR was performed using Truelab DUO micro PCR Analyzer with three lots of Truenat® Malaria Pv-Pf and Pf Assays. Mean, Standard deviation and one-way analysis of variance (ANOVA) was used to assess the significance of inter-lot variability in Cycle threshold values. Results: The Truenat® Malaria Pv-Pf and Pf assays identified the malaria parasites with 100% accuracy. Based on the test for variance (ANOVA) the inter-lot variability in cycle threshold values were not significant, indicating a high degree of precision. Interpretation & conclusion: Based on high accuracy and precision between different lots, the Truenat® Malaria Pv-Pf and Pf assays were found to be suitable for the diagnosis of sub-microscopic infections in field conditions to provide support in elimination of malaria.

Laboratory evaluation of the efficacy of boric acid containing toxic sugar baits against Anopheles culicifacies, An. stephensi and Aedes aegypti mosquitoes

Background & objectives: Attractive toxic sugar baits (ATSB) is a novel tool which employs mosquito sugar feeding behaviour to kill them. The potential of ATSB against mosquito vectors has been demonstrated in limited scope around the world including Israel, some of the African countries and USA. But their efficacy against mosquito vectors of India is yet to be ascertained. Therefore, current study was planned to evaluate the efficacy of TSB (without attractant) against two important malaria vectors Anopheles culicifacies and An. stephensi along with major dengue vector Aedes aegypti. Methods: TSB solution was prepared by dissolving different concentrations of boric acid in glucose and tested against each of the mosquito species. Another experiment was done by spraying this boric acid sugar solution on to Calendula officinalis plant. It served as a sole source of mosquito feed and mortality of mosquitoes was counted after 24 hours. Results: The TSB resulted in 100% mortality of Ae. aegypti and An. stephensi at 4% concentration of boric acid while in An. culicifacies 100% mortality was achieved at 3% concentration TSB solution. TSB solution with 2% boric acid, resulted in 99.1% mortality in An. culicifacies while ~95 % mortality of An. stephensi and Ae. aegypti. When TSB solution with 2% boric acid was sprayed on plant, ~89-94% mortality was observed in both An. stephensi and An. culicifacies. Interpretation & conclusion: Based on the results, boric acid based toxic sugar bait solution could be a promising tool for vector control. Further studies are needed to find out its toxicity of TSB against non-target organisms and residual efficacy in field trials in different ecotypes.

A study to validate thoracic trauma severity score in chest trauma patients

Background: Aim of this study was to validate thoracic trauma severity score (TTSS) in assessing the requirement of mechanical ventilation, mortality, and predicting prognosis in chest injury patients.Methods: This study was conducted in department of general surgery, Dr. S. N. Medical College, Jodhpur, Rajasthan, from December 2018 to September 2019. This was a single centred, prospective, observational study, conducted in 110 patients, aged >18 years, of isolated chest injury, excluding polytrauma patients. Data was summarized in the form of proportions, histograms and tables to show relationships of parameters with results. Data was presented as mean±SD and proportions as appropriate. Chi square test, z test or t tests were used wherever necessary for association analysis between categorical variables. Diagnostic test characteristics for mortality and complications was calculated from the ROC curves. A two sided of p values of less than 0.05 was considered statistically significant.Results: Most common mode of chest injury was blunt trauma and most common age group affected was 42-54 years. Maximum mortality was seen in TTSS between 16-20, shows higher the TTSS more the mortality. Ventilator requirement was more in high TTSS. Patients with higher TTSS had longer hospital stay as compared to patients with lower TTSS.Conclusions: On application of TTSS on admission, TTSS had direct correlation with need for oxygenation, ventilator need, duration of hospital stay, mortality or outcome in chest trauma patients. Thus we recommend TTSS as a good useful score for evaluation of prognosis, outcome and mortality in chest trauma patients.

Evaluation of 2 mm locking plates for treating mandibular fractures

Background: The progressive development in the trauma management has now paved way to the use of miniplates for the treatment of mandibular fractures. We present a case series of twenty-five patients treated with miniplates for the mandibular fractures.Methods: The study was done on twenty-five patients diagnosed clinically and radiographically with mandibular fractures and attending the outpatient department of Oral and Maxillofacial surgery of a tertiary care hospital in Jaipur city. The selected cases were treated by open reduction and internal fixation under general anesthesia. 2.0-mm titanium locking mini plates were used as a method of internal fixation. The patients were evaluated for the location, type and number of fractures, time required for adaptation and fixation of single four hole 2.0-mm locking plate, complications during surgery, pre and post-surgical occlusal relationship, adequacy of reduction on postoperative radiograph and any post-surgical complications requiring a secondary surgical intervention.Results: Majority were in the age group of 21-30 years (72%) with a mean age of 26.6 years. Among these, there were 23(92%) male and 2(8%) female patient. Maximum (28%) patients were of symphysis and angle fracture followed by symphysis and condylar (25%), while only 2% cases were of Para symphysis and condylar. The mean time taken for single plate adaptation and fixation was 11.34 minutes for symphysis fracture, 14.12 minutes for parasymphysis fracture, and 11.56 minutes for body fracture and 18.90 minutes for angle fractures.Conclusions: The locking miniplates in mandibular fractures is efficacious enough to appreciate early recovery of normal jaw function, uneventful healing and good union at the fracture site with minimal weight loss due to early reinstatement of masticatory function.

Sex-wise changes in haematological and biochemical parameters before and after exchange transfusion in neonatal hyperbilirubinemia

Background: Exchange transfusion (ET) is required in hyperbilirubinemic hospitalized neonates.Methods: The study center at SMS and associated hospitals. The blood bank is licensed and fully equipped. Fall in serum bilirubin minimum of 40 cases was required as the sample size of the present study.Results: The Sex ratio in the neonates undergoing Exchange transfusion was 65% (26) Males and 35% (14) females. The mean values of Hb (g/dl), Hematocrit and Direct bilirubin (mg/dl) of male and female before and after exchange transfusion, were non-significant.Conclusion: Exchange transfusion was required more commonly in male neonates.  The mean values of change in Hb (g/dl), Hematocrit and Direct bilirubin (mg/dl) of males and females before and after exchange transfusion, were non-significant. The mean values of change in Indirect bilirubin (mg/dl) in both males and females before and after exchange transfusion was highly significant.  The mean values of change in Total bilirubin (mg/dl) in males and in females were significant.

Performance and Carcass Traits of Broiler Chickens Reared on LEDs vis-a-vis CFL as a Growth Promotor

The present study was conducted to compare the performance of broiler reared under two different light sources and three different light colours. For this purpose, 120, two-week-old IBL-80 (Indian Broiler Ludhiana-80) broiler chicks were randomly distributed in four different treatment groups viz. TLEDB-G (first 2 wks, blue LED then switched to green LED for the next 2 wks), TLEDG-B (first 2 wks, green LED then switch to blue LED for the next 2 wks), TLEDW (White LED) and TCFL (CFL light; Control) with 3 replications and 10 birds in each experimental unit was applied. The effects of different lights on performance (BW, BWG and FCR), carcass traits and its economic impact on broiler chickens were investigated in the present study. The results show that performance and carcass traits of broiler birds of blue-green and green blue LED light group was at par to that of CFL group whereas benefit cost ratio of birds of TLEDB-G (1.13) was found highest among different treatment groups. Therefore, use of a combination of monochromatic Blue-Green or Green-Blue LED light could be a better alternative source of light than CFL light in terms of birds’ performance, economics and energy saving

A Randomized Clinical Trial Of Rasapushpadi Malahara On Vicharchika W.s.r. To Eczema

Skin disorders are most common occurring diseases in places where humidity prevails throughout the year. Vicharchika and Eczema both having resemblance in set of their clinical signs. Rasapushpadi Malhara (RPM) is Rasa preparation described in Rasa tarangini which is indicated in some skin disorders like Phirang, Vrna, Vicharchaika etc. In present study two samples of Rasa Pushpa (RP) has been prepared by two methods i.e. Kupipakva method and Damru yantra method. Both the samples were further used to prepare two samples of Rasapushpadi Malhara using Siktha taila as base and ratio of Siktha & Til taila was taken in ratio of 1: 5 according to the season. The randomized control clinical trial was carried out in between two groups. Both groups showed significant results on different clinical parameters like Kandu, Daha, Srava, Rukshta, Pidika, Vaivaranyata, Pidika, Raji, but group B showed highly significant result in EASI Score, which indicates severity of eczema. Level of significance in Group B for EASI Score is, P<0.00001. Rasapushpadi Malahara is very potent in treatment of Vicharchika as it contains mineral and herbal drugs like Parada, Kasisa, Saindhava, Sphatika, Wax, Tila taila, all having good antibacterial and antifungal properties. So this formulation showed significant results only by external application.

Cell cycle inhibitory activity of Piper longum against A549 cell line and its protective effect against metal-induced toxicity in rats.

Anticancer potential of Piper longum fruit against human cancer cell lines (DU-145 prostate, A549 lung, THP-1 leukemia, IGR-OVI-1 ovary and MCF-7 breast) as well as its in vitro and in vivo biochemical efficacy in AlCl3-induced hepatotoxicity were evaluated in the rats. Dried samples were extracted with several solvents using soxhlet apparatus. Flavonoid content in chloroform, benzene, ethyl alcohol and aqueous extracts of fruit was 19, 14, 12 and 11 μg quercetin equivalent/mg of sample, respectively. Hexane extracts exhibited 90-92% cytotoxicity against most of the test cell lines (A549, THP-1, IGR-OVI-1 and MCF-7), while benzene extract displayed 84-87% cytotoxicity against MCF-7, IGR-OV-1 and THP-1 cell lines. Among extracts, hexane, benzene and acetone extracts demonstrated considerable cytotoxicity (91-95%) against A549 (lung cancer) cell line in Sulforhodamine B dye (SRB) assay. Cell cycle analysis revealed that hexane, benzene and acetone extracts produced 41, 63 and 43% sub-G1 DNA fraction, demonstrating cell cycle inhibitory potential of these extracts against A549 cell line. Chloroform, ethyl alcohol and aqueous extracts displayed 71, 64 and 65% membrane protective activity, respectively in lipid peroxidation inhibition assay. P. longum fruit extracts also ameliorated AlCl3-induced hepatotoxicity, as indicated by alterations observed in serum enzymes ALP, SGOT and SGPT activity, as well as creatinine and bilirubin contents. In conclusion, study established the cytotoxic and hepatoprotective activity in P. longum extracts.

Modifiable Factors for Prevention of Childhood Mortality.

Objective: To know the disease-related causes of child mortality and identify socially modifiable factors affecting child mortality among hospitalized children aged >1 month-18 years in a referral hospital of North India. Methods: Causes of death (ICD-10 based) were extracted retrospectively from hospital files (n=487) from 17 March 2003 to 30 June 2012. Modifiable factors were prospectively studied in 107 consecutive deaths from 6 October 2011 to 30 June 2012. Results: Pneumonia, CNS infections and diarrhea were the most common disease-related causes of child mortality. Conclusions: Amongst modifiable factors, administrative issues were most common followed by family-related reasons and medical-personnel related problems.

Do patients with tuberculosis referred from a tertiary care referral centre reach their peripheral health institution.

Background. Tuberculosis (TB) is a major public health problem in India. The Revised National Tuberculosis Control Programme (RNTCP), started in 1997, involved medical colleges in the control of TB on a high priority. We assessed whether patients with TB referred from a tertiary care hospital in Delhi reached the desired peripheral health institution and had their treatment initiated. Methods. This descriptive, retrospective study was done at a tertiary care hospital and included all patients with a diagnosis of TB (pulmonary or extrapulmonary) who were seen at the referral centre during the year 2011. Data were collected from various records of the referral centre and analysed for availability of feedback of the referred patients. Information regarding their registration and initiation of treatment was also collected. Postcards were used for the first time to trace referrals in patients with TB. Results. The majority (94%) of patients with TB seen in the referral centre at a tertiary care facility were referred to a peripheral health institution nearest to their place of residence. Feedback on referral was received from these institutions for 79.4% of patients from the National Capital Region (NCR) of Delhi and for 47.4% of patients from outside the NCR of Delhi. Conclusion. We found that a majority of patients with TB were referred and the registration and initiation of treatment could be traced in >75% of patients.

Ringer’s Lactate vs Normal Saline for Children with Acute Diarrhea and Severe Dehydration: A Double Blind Randomized Controlled Trial.

Objective: WHO recommends Ringer’s lactate (RL) and Normal Saline (NS) for rapid intravenous rehydration in childhood diarrhea and severe dehydration. We compared these two fluids for improvement in pH over baseline during rapid intravenous rehydration in children with acute diarrhea. Design: Double-blind randomized controlled trial Setting: Pediatric emergency facilities at a tertiary-care referral hospital. Intervention: Children with acute diarrhea and severe dehydration received either RL (RL-group) or NS (NS-group), 100 mL/kg over three or six hours. Children were reassessed after three or six hours. Rapid rehydration was repeated if severe dehydration persisted. Blood gas was done at baseline and repeated after signs of severe dehydration disappeared. Outcome Measures: Primary outcome was change in pH from baseline. Secondary outcomes included changes in serum R E S E A R C H P A P E R INDIAN PEDIATRICS 963 VOLUME 49__DECEMBER 16, 2012 electrolytes, bicarbonate levels, and base-deficit from baseline; mortality, duration of hospital stay, and fluids requirement. Results: Twenty two children, 11 each were randomized to the two study groups. At primary end point (disappearance of signs of severe dehydration), the improvement in pH from baseline was not significant in RL-group [from 7.17 (0.11) to 7.28 (0.09)] as compared to NS-group [7.09 (0.11) to 7.21 (0.09)], P=0.17 (after adjusting for baseline serum Na/ Cl). Among this limited sample size, children in RL group required less fluids [median 310 vs 530 mL/kg, P=0.01] and had shorter median hospital stay [38 vs 51 hours, P=0.03]. Conclusions: There was no difference in improvement in pH over baseline between RL and NS among children with acute diarrhea and severe dehydration.

Cardiac tamponade following post myocardial ventricular wall rupture: A case report.

Cardiac tamponade is a clinical syndrome caused by an increase in intrapericardial pressure due to the accumulation of blood, pus, other fluid, or gas in the pericardial space. Cardiac tamponade typically leads to a crisis by decreasing venous return, which impairs diastolic ventricular filling. Ventricular wall rupture is an uncommon complication after a myocardial infarction that is associated with a high mortality rate from pericardial tamponade, especially in the elderly. Cardiac ruptures following acute myocardial infarction include rupture of the left ventricle free-wall, ventricular septal defects, and papillary muscle rupture. Cardiac tamponade is a life-threatening clinical syndrome that requires timely diagnosis. A high index of suspicion of this clinical entity as cause of death during autopsy in suspected cardiac cases is imperative. In recent years, several different therapeutic approaches have been described including percutaneous seals and surgical mechanical closure of ventricular free wall rupture. We present a case of a 41 year-old man who suffered myocardial infarction, had findings of ventricular wall rupture complicated by pericardial tamponade. A brief overview of the clinical presentation, diagnosis, and management of this challenging and potentially fatal complication is presented.

Traumatic asphyxial deaths due to an uncontrolled crowd at railway station: Two case reports.

Deaths in stampede accidents are not new in India. Majority of causalities occurred as a result of traumatic asphyxia in such cases. Traumatic asphyxia is a rare syndrome first described over 150 years ago by Olivier. It is caused by sudden compressive chest trauma and is associated with craniocervical cyanosis, facial edema and petechiae, sub-conjunctival hemorrhage, and neurological symptoms. Although minor incidents of jostling are common at railway stations, but deaths occurring consequent to stampede by an uncontrollable crowd is not very common. A stampede occurred at New Delhi railway station which results in death of two persons and injuring many. The autopsy findings along with circumstantial evidence, results in arriving of conclusion that these deaths occurs as a consequence of traumatic asphyxia. Various clinical features of this condition are described in the literature, a brief review of which is given in this article. In the conclusion few preventive measures are also suggested so that in future such tragedies can be averted.