STUDY OF PAPILLOEDEMA & ITS CAUSATIVE FACTORS IN A TERTIARY CARE HOSPITAL

To study the etiology of papilloedema in north indian population. Our hospital based retrospective study enrolled 50 patients of papilloedema, who fullfilled our inclusion criteria. Demographic details, chief complains and detailed history was taken from all the patients. All the patients underwent blood pressure measurement by a mercury sphygmomanometer, Visual Acuity testing, Slitlamp Biomicroscopy, IOP measurement, Fundus examination. Fundus photographs were obtained using a fundus camera. Other investigations included B-scan, MRI, MRV, CT and required blood investigations were done wherever necessary. Although papilloedema occured in a vast variety of age group but maximum patients (32%) were from the age group of >18-31 years and males (64%) were more affected than females according to our study. 66% of the patients had good vision with papilloedema. In our study all the patients had bilateral papilloedema and 54% of patients were diagnosed with early papilloedema. Idiopathic Intracranial Hypertension was the main etiology for papilloedema. In this study we concluded IIH (a diagnosis of exclusion) as the most common underlying etiology for papilloedema

A qualitative comparative analysis of healthcare Supply–Demand side barriers under the publicly funded health insurance scheme in India

Background: India recently launched Ayushman Bharat – National Health Protection Mission – an upgraded version of Rashtriya Swasthya Bima Yojna (RSBY), which is projected as world's largest public insurance scheme by numbers. The new scheme can certainly draw learning from the former (RSBY) to ensure better reach and success. RSBY has been extensively analyzed for supply-side barriers but sparsely for demand and supply-side barriers simultaneously. Objectives: Through this study, authors intend to determine causality as well as configurations (pathways) of demand and supply barriers that make beneficiary vulnerable even under the scheme. The study explores the interaction of barriers that lead to patient dis/satisfaction, overcharging for a medical procedure and high disease severity among beneficiaries. Methods: The study uses RSBY insurance claim records from 2013 to 2015 backed up by posthospitalization survey of the state of Chhattisgarh, India. It employs a fuzzy set qualitative comparative analysis to determine causality and configuration (path-way) of parameters leading to the outcome. Results: Provision of medicine emerges as a necessary condition for patient satisfaction. Waiting time did not appear as a necessary parameter of satisfaction. Overcharging the cashless card in case of minor surgical procedures is observed irrespective of beneficiaries' education and occupation status. Urban male and rural female appear to bear high disease severity. Conclusions: Results have implication for policymakers and implementors to recognize the segment that remains vulnerable under the scheme and gain insights on the parameters of patient satisfaction.

Role of 2-D echocardiography in detecting cardiovascular abnormalities in chronic kidney disease patients: Case series of 50 chronic kidney disease patients

Background: Chronic kidney disease is a major public health problem worldwide with continuously increasing incidence and prevalence. Diabetes and hypertension are the leading causes of chronic kidney disease worldwide, whereas hypertension is a cause as well as effect of chronic kidney disease. Objectives: To evaluate and analyze the echocardiographic changes in the end stage renal disease patients on maintenance haemodialysis by the help of 2-D echocardiography. Materials and methods: End stage renal disease (ESRD) patients who were on maintenance haemodialysis for at least 3 months, in MG hospital were included in the study. We performed 2- Dechocardiography in 50 ESRD patients during inter-dialytic period. Patients with clinical evidence of coronary artery disease, previous history of hypertension, valvular heart disease, congenital heart disease and pericardial effusion were excluded from this study. Results: out of 50 chronic kidney disease patients, echocardiography revealed LVH in 29 (58%) patients, LVDD in 25(50%) patients, pericardial effusion in 10 (20%) patients, pulmonary hypertension in 23(46%) patients, dilated left atrium in 14(28%) patients, dilated left ventricle in 4 (8%) patients and regional wall motion abnormalities in 3 (6%) patients. Hypertension was present in Saxena N, Dhamija JP, Saxena S. Role of 2-D echocardiography in detecting cardiovascular abnormalities in chronic kidney disease patients: Case series of 50 chronic kidney disease patients. IAIM, 2017; 4(1): 122-126. Page 123 46 (92%) out of 50 CKD patients out of which LVH was in 29 patients. Severe Anaemia was present in 10 (20%) patients. Conclusion: LV diastolic dysfunction and left ventricular hypertrophy were the most common and significant echocardiographic findings among 50 CKD patients. There was statistically significant correlation between anaemia and the presence of left ventricular hypertrophy and positive correlation between presence of hypertension and left ventricular hypertrophy.

Evaluation of 2-D echo findings in chronic kidney disease: Case study of 35 end stage renal disease patients

Background: Chronic kidney disease (CKD) is a major public health problem worldwide with increase in incidence and prevalence. Diabetes and hypertension are the leading cause of CKD worldwide, whereas hypertension is a cause as well as effect of CKD. Objectives: To evaluate and analyze the echocardiographic changes in the end stage renal disease patients on maintenance hemodialysis. Materials and methods: End stage renal disease (ESRD) patients who were on maintenance Haemodialysis for at least 3 months, in MG hospital were included in the study. We performed 2D echocardiography in 35 ESRD patients during inter-dialytic period. Patients with clinical evidence of coronary artery disease, valvular heart disease, congenital heart disease and pericardial effusion were excluded from the study. Results: Out of 35 ESRD patients, echocardiography revealed LV dilatation and diastolic dysfunction in 18 patients (51.2%) , LV hypertrophy in 17 patients (48%), systolic dysfunction and pericardial effusion in 10 patients (28.57%) and 6 patients (17.14%) respectively. RWMA was present in 3 patients (8.5%) and no valvular calcification was seen in any patient. In a sub group of 21 patients with Hb <10g%, LVH was present in 15 patients (71.42%) vs 2 out of 14 patients (14.28%) in patients group with Hb >10 g%. Hypertensive patients were 27 of 35 ESRD patients, 13 out of 27 had Dhamija JP, Saxena N, Saxena S. Evaluation of 2-D echo findings in chronic kidney disease: Case study of 35 end stage renal disease patients. IAIM, 2016; 3(9): 61-65. Page 62 higher prevalence of LVH (51.85%). Systolic dysfunction and RWMA was absent in normotensive group. Conclusion: LV diastolic dysfunction and hypertrophy were most common echocardiographic findings. There was statistically significant correlation between anaemia and presence of LVH and positive correlation between presence of hypertension and LVH.

S-Beta Thalassemia leading to avascular necrosis of left hip joint in a young male – A rare case report

Sickle beta thalassemia is a disorder which represents the double heterozygous state for the Hb-S and the beta-thalassemia genes. The clinical and hematological manifestations of sickle beta thalassemia are highly variable due to existence of two types of genes, beta0 thalassemia gene and beta+ gene. Beta0 gene leads to complete absence of Hb-A levels, whereas beta+ gene leads to production of Hb-A levels 10-30%. This disorder is diagnosed by levels of HbS, HbA2 and HbF in Hemoglobin Electrophoresis. We are presenting one such young male patient with features of Sickle Beta+ thalassemia who presented with anemia, fatigue and joint pain with characteristic features of avascular necrosis of left hip joint in X-Ray and MRI. For the etiological diagnosis further investigation in the form of capillary haemoglobin electrophoresis and for final confirmation genetic analysis by PCR is done.

Primary Sjogrens Syndrome with Renal Tubular Acidosis with Central Pontine Myelinolysis – A rare case report

A middle aged female patient, a case of Primary Sjogren’s Syndrome with renal tubular acidosis as revealed by severe hypokalemia along with normal anion gap, metabolic acidosis and acidic urinary pH had brain stem lesion which presented as quadriplegia, dysphagia and dysarthria. Laboratory tests revealed that anti-nuclear antibodies (ANA) and anti Ro/SSA antibodies were positive. MRI showed hyper intense lesion in T2W images in middle pons, typical characteristic of central pontine myelenolysis. So, patient was diagnosed as Primary Sjogren’s Syndrome with renal tubular acidosis with central pontine myelinolysis. She recovered with correction of hypokalemia, intravenous methyl prednisolone and cyclophosphamide.

Unresolving pericarditis: Suspect filariasis in the tropics.

Filariasis, a mosquito-borne disease, is wide spread in India. While laboratory diagnosis has been conventionally done by demonstrating microfilaria in peripheral blood smears, occasionally they are reported in various body fluids including pericardial fluid. We report the case of 33-year-old man with severe dyspnoea and chest pain, referred from a private nursing home with a provisional diagnosis of unresolving pericarditis. Pericardial tap revealed massive pericardial effusion with actively motile microfilariae. No microfilariae (Mf) were seen in the peripheral blood. Haemorrhagic effusion resolved completely with DEC. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of pericardial effusion.

Rural poverty reduction through centrally sponsored schemes.

This paper discusses the evolving profile of poverty in India and reviews the national performance of selected anti-poverty programmes between 1997-1998 and 2005. For each programme, it outlines the budgetary allocation principle used for the States and districts and analyzes budgetary performance over the period. The main objective is to explore the extent to which the anti-poverty programmes are reaching their target groups effectively. Finally, it identifies the specific factors responsible for under-performance and provides a set of recommendations for policy makers and programme implementers which could help improve the outcomes of the schemes.

Molecular characterisation of Cryptosporidium: an emerging parasite.

PURPOSE: The aim of the present study was to determine the prevalence of Crytposporidium in local population and to understand its epidemiology by molecular methods. METHODS: Faecal samples from 681 children and 804 adults, admitted to tertiary care hospitals in twin cities of Hyderabad and Secunderabad with complaints of diarrhoea; and six calves with diarrhoea, were screened for Cryptosporidium oocysts by microscopy and enzyme linked immunosorbent assay (ELISA). Polymerase chain reaction restriction fragment length polymorphism (PCR RFLP) based identification of Cryptosporidium species in positive specimens was done to elucidate epidemiology of Cryptosporidium. RESULTS: Cryptosporidium was found in 52 (7.6%) children and 7(0.9%) adults and 1(16.6%) calf with diarrhoea. The prevalence of Cryptosporidium in children below five years of age was 8.2% and 14.3% in children in the age group of six months to one year. Of the 42 samples genotyped 29 (69%) were C. hominis and 8 (19%) were C. parvum and 5 (11.9%) were mixed infection with the two species. CONCLUSIONS: Children in the age group of six months to one year were found to be the most vulnerable. The occurrence of C. parvum, in nearly one third of cases in the present series indicates that the zoonotic transmission is of considerable significance in the epidemiology of Cryptosporidiosis in the study area.

Preparing for adulthood--patterns of physical growth, sexual maturity and menarche of adolescent girls in selected urban slums and rural areas.

Adolescent girls are the future mothers. Height less than 145 cm and weight less than 45 kg are considered to be high obstetric risk factor for adverse maternal and perinatal outcome including low birth weight. Teenage pregnancy is another problem in our country. This study aimed to study height and weight of girls of vulnerable urban slums and rural areas. It also studied the pattern of onset of menarche and attainment of sexual maturity in relation to age. The longitudinal, multicentric, descriptive observational study was carried out by the Indian Council of Medical Research during the period of 1986 to 1991 in selected rural (Chandigarh, Hyderabad, Jabalpur, Varanasi, Vellore) and two urban slum areas (Vellore and Delhi) in different regions of India. Girls of ages 10-12 years were followed up till 16 years for their height and weight. Weight increased from 22.3 to 39.4 kg in rural and 23.4 to 41.9 kg in urban areas from 10 to 16 years. Height increased from 126.2 cm to 150.2 cm in rural and 128.2 to 153.0 cm in urban areas. Large variations from centre to centre were observed in ages for appearance of sexual characteristic and the order in which these appeared. Pubic hair was the first sexual characteristic to appear in majority of the girls in all the centres. The mean age at stages II, III and IV of breast development in girls varied between 11.3 to 12.3 years, 12.3 to 13.2 years and 13.3 to 14.1 years respectively. The percentage of girls who had attained menarche by the age of 15 years, ranged from 30 to 100 per cent between centres. Those children in whom the sexual characteristics had appeared earlier than others had higher mean body weight and height as compared to others at the same age points. The data on physical growth parameters during adolescence revealed that girls from rural areas, were shorter and weighed less compared to those from urban slums. Adolescent girls are undernourished in urban slums and rural areas.

Maternal mortality in seven districts of Uttar Pradesh--an ICMR task force study.

Maternal mortality is a major health and development concern. The available information on maternal mortality in rural India is inadequate and scanty. This study presented maternal mortality data from the demographically and developmentally (including for health) poor performing state of Uttar Pradesh. A descriptive, cross-sectional survey was conducted utilizing a stratified cluster sampling design between 1989-90 in eight districts of Uttar Pradesh. Four good performing districts namely, Agra, Farrukhabad, Ghaziabad and Badaun from the western region and four poor performing districts from the eastern region namely, Gorakhpur, Basti, Varanasi and Pratapgarh were chosen. A door-to-door household interview survey was carried out in the selected villages covering a population of 11.67 lakhs in 889 villages. Maternal mortality rates during 1989 ranged between 533745 per 100,000 live births except in Ghaziabad district where the rate was as low as 101 per 100,000 live births. The rate in Eastern U.P. was higher (573 per 100,000 live births) as compared to that in Western U.P. (472 per 100,000 live births). A total of 286 maternal deaths were reported during the study period. The direct obstetric causes accounted for 55.7% of maternal deaths with haemorrhage (26.4%) being the most prevalent. Anaemia and jaundice (17.4%) were the most prevalent indirect causes of maternal deaths. Most of the maternal deaths could have been prevented if timely medical care was available.

Nonoxynol-9 vaginal pessary: a preliminary Indian experience.

BACKGROUND: Barrier methods of contraception do not have systemic effects and allow the user complete control over their use. For women, the ease of use of a contraceptive is often more important than its efficacy. Hence, barrier methods could be offered as a useful alternative method of contraception. Nonoxynol-9 (a spermicide) is a locally acting, non-hormonal method free from systemic side-efforts. It is a woman-controlled, reversible method which is to be used before intercourse. There are little data available on its efficacy, side-effects and acceptability among Indian women. METHODS: The vaginal pessary nonoxynol-9 was offered as a contraceptive option to 3200 women attending the Family Planning clinics at 31 Human Reproduction Research Centres (HRRCs) of the Indian Council of Medical Research. The other contraceptives offered included an intrauterine device, oral pills, condoms, Norplant, tubal sterilization and vasectomy using the cafeteria approach. Those who accepted nonoxynol-9 were followed up to assess the rates of continuation, failure and side-effects. RESULTS: The nonoxynol-9 pessary was accepted by 541 women who were followed up for 3470 woman-months of use. The reasons given for acceptance were that it was user-controlled and/or they did not wish to use other methods because of the side-effects or contraindications of these methods. The overall continuation rates were 41.2% and 33% at 9 and 12 months of use, respectively. Most women (31.3%) discontinued its use due to personal reasons such as husband dissatisfaction, desire for further pregnancy, irregular use of pessary and difficulty in insertion. Twenty-nine women became pregnant during the study period (15 due to method failure and 14 due to user failure) giving a use-effectiveness of 8.8% at 12 months. The method failure rate was 4.3% at 12 months of use. The failure rates were lower compared with the reported failure rates of barrier contraceptives (1%-30% at 1 year of use) and the side-effects were minimal. CONCLUSION: Nonoxynol-9 had low acceptability (16.9%) and overall continuation rates--41.2% and 33% at 9 and 12 months of use. It could be offered to women looking for a short term, user-controlled contraceptive.

Induced abortion and concurrent adoption of contraception in the rural areas of India (an ICMR task force study).

BACKGROUND: Despite a liberal Medical Termination of Pregnancy (MTP) act and awareness of family planning, maternal mortality attributable to induced abortion is high. AIMS: Assess attitude, behavior, practices and utilization of services by rural women for induced abortion and concurrent acceptance of contraception. SETTINGS AND DESIGN: Cross sectional survey of eligible married women in 13 states in India over one year. MATERIAL AND METHODS: A total of 1851 women who had an induced abortion during the previous 3 years were interviewed. STATISTICAL ANALYSIS USED: Includes proportions, rates and chi-square test. RESULTS: The main reason for seeking abortion was "don't need any more children" (42%), and in 12.4 per cent they specifically mentioned that they "don't need any more daughters". Around 46% of women accessed abortion services from private clinics as compared to government hospital (37.1%) and Primary Health Centre/Community Health Centre (14.0%). The decision to terminate the pregnancy and place of abortion was made by the husband in 42.8% and 52.5% respectively. Regret for abortion was expressed by 29.6% of the women. However, only 7.2% said they would not advice others for induced abortion. Nearly one half of the women undergoing abortion accepted a family planning method concurrently; of these Intra Uterine Device/oral contraceptives and a permanent method was adopted by 37.2% and 49.1% respectively. Acceptance of vasectomy by male partner was found to be low (1.3%). "Husband objected" (32.3%) was the main reason for not accepting post abortal contraception. Majority of the acceptors said they would recommend to others the same place where they had undergone abortion, thus indicating their satisfaction with the source and services received. CONCLUSIONS: Counselling for post-abortal contraceptive should be provided to the couple so that they can make an informed choice.

Reproductive health awareness of school-going, unmarried, rural adolescents.

OBJECTIVE: In 1996, India included Adolescent Health in Reproductive and Child Heatlh Programme. This Task-Force Study was planned to test the awareness level of adolescents regarding various reproductive health issues and to identify lacunae in knowledge, particularly in legal minimum age of marriage, number of children, male preference, contraceptive practices, about STIs /AIDS etc. METHODS: It was a multicentre study, done in rural co-education/higher secondary schools of 22 districts located in 14 states through Human Reproductive Research Centre (HRRC's) of the Indian Council of Medical Research (ICMR). A sample of 8453 school going adolescents (aged 10-19 years) was surveyed by means of open ended, self-administered questionnaires maintaining confidentiality. RESULTS: Mean age of adolescents was 14.3 +/- 3.4 years. Awareness of legal minimum age of marriage was present in more than half of adolescents. Attitude towards marriage beyond 21 years in boys and 18 years in girls was favorable. Mean number of children desired was 2.2 +/- 1.4. However, number of children desired by boys (2.2+/-1.6) was significantly more (p< 0.000) than those desired by girls (2.0+/-1.1). More boys (23.7%) than girls (9.4%) wanted three or more children with male preference. Only 19.8% of adolescents were aware of at least one method of contraception. Only two-fifth (39.5%) were aware of AIDS and less than one-fifth (18%) were aware of STDs and most of them thought it is same as AIDS. Awareness of at least one method of immunization was present in three-fifth (60.1%) of students. It was least for DPT (13.5%) and most (55%) were aware of polio only. Awareness of all Reproductive Health matters was more in boys than girls and more in late teens (15-19) than earlier teens (10-14). CONCLUSION: The study showed tremendous lacunae in awareness of all Reproductive Health (RH) matters. There is a need for evolving information, education, and communication strategies to focus on raising awareness on RH and gender related issues. A sociocultural research is needed to find the right kind of sexual health services for young girls and boys.

Contraceptive knowledge, practices and utilization of services in the rural areas of India (an ICMR task force study).

To obtain information from rural women regarding their contraceptive knowledge, practices and utilization of services, a cross-sectional survey of 117,465 eligible women was carried out in the sampled areas of 28 districts from January 1996 to February 1997. From among the current contraceptive users all of IUD, OC and acceptors of a permanent method in the last one-year (14,276) were interviewed in detailed. In addition a systematically selected sample of 17,082 non users were also interviewed. Overall contraceptive prevalence was 45.2% of which 34.2% had used a permanent method. Among the current users, the contraceptive had been availed mainly from either PHC (31.5%) or hospital (42.1%). Around half the women (53.1%) had received counseling and in 20.3% information regarding other methods. Pelvic examination was done in 39.1% Most of the women (>97%) expressed satisfaction with the method, provider and services. Almost all the women (98.8%) were using a contraceptive method with the knowledge of their husband and had his support for continuing the same. There was no concept of using any family planning method for either postponing the first conception after marriage or spacing between the two child births. A large majority of women (70.5%) used a family planning method for the first time only after completing their desired family size. Among the never users, 73.5% mentioned at least one modern method of family planning available in the national programme and 64.3% mentioned the service source where it would be available. Fewer women in most of the districts mentioned spacing methods as compared to female sterilization. The main reason given for not using any family planning method was "family not complete" (34.6%). There is need to promote spacing methods by policy makers and field workers and motivate couples to accept them.

Serous fluid leakage following modified Blalock-Taussig operation using PTFE grafts.

BACKGROUND: Serous fluid leakage is an unusual but often devastating complication following the placement of a modified Blalock-Taussig shunt using a polytetrafluoroethylene graft. METHOD AND RESULTS: Between September 1994 and September 1999, out of 268 patients undergoing a modified Blalock-Taussig shunt using polytetrafluoroethylene grafts, 10 developed massive pleural effusion or seroma due to a leak from the surface of the shunt. The age of the patients ranged from 9 days to 7 years. There were 7 males and 3 females. Nine patients presented with respiratory distress between 2 and 12 weeks of shunt surgery and one presented with sudden cardiac arrest. The shunt was patent in all the patients. Initial management was conservative. i.e. by pharmacological means and tube thoracostomy. Reoperation was undertaken in 9 patients when conservative treatment failed. All patients survived except one who had a cardiac arrest before any intervention could be carried out. CONCLUSIONS: Patients with serous effusion have significant morbidity and mortality and often require reoperation. The initial management remains conservative but, if unsuccessful, re-exploration can be undertaken as it proved to be uniformly successful in our experience.

Sandfly survey in Nainital and Almora districts of Uttaranchal with particular reference to Phlebotomus argentipes, vector of kala-azar.

Kala-azar continues to pose a major public health problem in Bihar, West Bengal and parts of eastern Uttar Pradesh in India causing great deal of morbidity and mortality. During 1998, several kala-azar cases from Sub-Himalayan region were treated in Delhi hospitals. And a suspected focus of kala-azar was subsequently reported from this area. Therefore a preliminary sandfly survey was carried out during October, 1999 in 18 randomly selected villages at different altitudes in Nainital & Almora districts of Kumaon region Uttaranchal. The surveys revealed relative preponderance of vector sandfly Ph. argentipes as 77%; mainly confined to cattlesheds and mixed dwellings in the villages at an altitude ranging from 350-960 metres main sea level. The other sandfly species encountered were: Ph. papatasi 6.9%, Ph. major 2.9% and 13.2% Sergentomyia spp. 17.4% Ph. argentipes reacted positive with human antisera and 82.6% with bovine but none reacted with goat, pig dog and bird antisera indicating that Ph. argentipes in the area is mainly zoophilic. Ph. argentipes was found to be highly susceptible to DDT; mortality ranging from 98-100%.

Treatment of fevers in Camatkāra Cintāmaņi.

Utility of the various formulae of Camatkāra Cintāmaņi can not be minimised due to limited and easily available ingredients. Because the efficacy of the formulae in curing the various diseases has proved them very useful. Treatment of fevers cover near about 93 verses in Camatkāra Cintāmaņi. Therefore an attempt has been made to check the potency and usefulness of the formulae in treatment of fevers.