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Context and Aims: To evaluate the efficacy and safety of biosimilar romiplostim in Indian patients with immune thrombocytopenic purpura (ITP). Settings and Design: Multicentre, retrospective observational study. Methods and Material: Patients with chronic ITP who received biosimilar romiplostim from July 2019 to March 2020 across 3 major hospitals in Guwahati, India, were included. The study outcomes were the platelet response (platelet count > 50 × 109/L), time to first response, number of dose-limiting events, and the median effective dose. Statistical Analysis Used: Descriptive. Results: Of 32 patients included in this analysis, majority (59.4%) were females. The mean (SD) age was 40.37 (15.79) years, and mean age at ITP diagnosis was 38.53 years. The median number of romiplostim doses were 27.5 (range: 10-42) over a period of 10 months; median romiplostim dose used was 4.2 ?g/kg (range: 2.8-5 ?g/kg). Platelet response was achieved as early as after one week in 9 (28.12%) patients, which continued to increase to 24 (75%) patients after the second, 30 (93.75%) patients after the third and all 32 (100%) patients after four weeks of romiplostim administration. The median platelet count was 161 × 109/L. Dose reduction was done in a total of 21 patients. Thrombocytosis (46.88%), elevated liver enzymes (15.63%) and myalgia (15.63%) were the most common adverse events. Conclusions: Biosimilar romiplostim was effective in achieving and maintaining platelet response without any new safety concerns in Indian adult patients with chronic ITP. The median effective dose of romiplostim required in our patients was lower as compared with the standard prescribed dose.
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A study was conducted in mid hill region of Rajouri district, J&K, India to analyze the impact lockdown amid covid-19 pandemic on weather parameters. Day and night temperature readings were recorded fortnightly from 1st March to 30th June 2020 from maximum and minimum thermometer, rainfall values from ordinary rain gauge, and soil temperature at different depth from soil thermometers and values were compared with data from 2017-2019 and normal. After analyzing the data statistically using “Descriptive statistics” in MS-Excel 2010, it was observed that within the period of lockdown, the change in day temperature was -6.66% from normal mean value, however night temperature was least affected as it changes 10.33% and rainfall pattern was 19.27% more from normal mean value. The average change in soil temperature in morning at 5 cm, 10 cm and 20 cm depth in lockdown was -4.65%, 3.74% and 2.65% as compared to year 2019 (1st March to 30th June) mean value and the change in soil temperature in evening at same depths was -5.14%, -11.30% and 0.3% from year 2019 (1st March to 30th June) depicting a slow change in values. With the significant sustainable pattern observed in day and soil temperature parameters and rainfall it can be concluded that lockdown might be an effective tool in reducing speed of climate change in future.
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Aim: A study was conducted in mid hill region of Jammu district, J&K to analyze the impact lockdown amid covid-19 pandemic on weather parameters so as to define it as a tool to mitigate the pace of climate change. Methodology: Day and night temperature readings were recorded fortnightly during 22nd March to 10th June 2020 from maximum and minimum thermometer, relative humidity from dry and wet bulb thermometers in stevenson screen, rainfall values from ordinary rain gauge, evaporation readings from pan evaporimeter and soil temperature at different depth from soil thermometers. Results: After analyzing the data statistically using “Descriptive statistics” in MS-Excel 2010, it was observed that after the implementation of lockdown and with the beginning of unlock down the change in day temperature was -8.07% from normal mean value, night temperature was -4.44% from normal mean value, rainfall pattern was 30.00% more from normal mean value, Relative Humidity (morning) pattern was 6.94% more from normal mean value, relative humidity (evening) pattern was 20.94% more from normal mean value, evaporation pattern was 7.66% more from normal mean value. The average change in soil temperature in morning at 5 cm, 10 cm and 20 cm depth was -3.46%, -3.84% and -7.23% as compared to year 2019 (22nd March to 10th June 2019) mean value and the change in soil temperature in evening at same depths was -7.69%, -6.31% and -4.14% from year 2019 (22nd March to 10th June 2019). Conclusion: With the variable significant pattern observed in almost all parameters, it can be concluded that lockdown might be an effective tool in mitigating pace of climate change in future.
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Background: The incidence of diabetes mellitus (DM) is increasing substantially worldwide. CAD silently progresses over years in the diabetics. Diabetic individual appears to be less able to perceive some of the symptoms and signs of ischemia or may have asymptomatic ‘classic silent ischemia’. Thus, screening for early detection of asymptomatic CAD in type 2 diabetes may be helpful to prevent these catastrophic cardiac events and consequent deaths. Objectives of the study was to assess utility of TMT in Type 2 diabetic mellitus subjects to detect silent myocardial infarction.Methods: Hospital based observational analytical case control study was conducted in Department of Medicine in Dr BRAM Hospital Raipur during August 2016 to September 2018. Cases were 45 subjects of Type 2 Diabetes mellitus with normal ECG and controls were 45 subjects of Type 2 Diabetes Mellitus with abnormal resting ECG. Data analyzed using SPSS 17 version.Results: Majority i.e. 40% were found to be in fifth decade of their life. 71 (78.9%) male subjects and 19 (21.1%) female subjects. TMT was found positive in 8(17.8%) subjects with positive ECG changes whereas in 12(26.7%) subjects with no ECG changes. No significant difference was noted between distribution of any parameters except for hypertension which was found to be significantly higher in TMT positive subjects compared to TMT negative subjects.Conclusions: No significant difference was observed regarding TMT findings between T2DM subjects with and without ECG changes. Type 2 diabetes mellitus subjects with dyslipidemia, and hypertension are at higher risk of Positive TMT.
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Background: According to WHO, pneumonia is the third important cause of death worldwide despite various advances in medical science. Incidence of Community acquired pneumonia is about 20% to 30% in developing countries compared to 3% to 4 % in developed countries. Incidence of CAP is much higher in the very young and the elderly individuals. Objectives of the study was to compare CURB 65, PSI (Pneumonia severity index) and SIPF (shock index and hypoxemia) scores with respect to outcome prediction in community acquired pneumonia (CAP).Methods: The present hospital based descriptive observational study was conducted in the Dept of medicine, Pt. J.N.M. Medical College and Dr B. R. A. M. Hospital, Raipur, during 2016-2018 involving a total of 98 patients of community acquired pneumonia.Results: Majority of them i.e. 22 (22.4%) subjects belonged to age group 41-50 years. 34 (34.7%) subjects were found to have CURB65 score 1. 28(28.6%) subjects PSI score was noted to be class I. 89 (90.8%) subjects were discharged while, there was death of 9 (9.2%) subjects. The difference in the mean score was statistically significant (p<0.001). PSI score was found to have diagnostic sensitivity of 94.4% and specificity of 100% while CURB 65 score having 83.1% sensitivity and 100 % specificity. SIPF score had least AUC 0.88.Conclusions: Maximum diagnostic ability was noted with PSI score followed by CURB 65 and SIPF score.
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Introduction: Type-2 diabetes mellitus is a common, chronic metabolic disorder with multiple complications if not well controlled. Depression is a very common psychiatric comorbidity in these patients. Multiple environmental and patient related factors are linked with this co-morbidity. It is important to address depression and related factors in these patients for a better outcome. This study aimed to assess depression and distribution of various socio-demographic and clinical details in patients of type-2 diabetes mellitus. Material and Methods: Using a purposive sampling technique, a total of 118 patients of type-2 diabetes mellitus who fulfilled the inclusion and exclusion criteria of this study were enrolled. They were administered Hamilton Depression Rating Scale to assess depression. Overall 66.1% of the patients had co-morbidity of depression. Results: Significantly more number of patients of type-2 diabetes mellitus with co-morbid depression were unmarried (41% vs 15%, χ2=9.029, df=2, p<.05), unemployed/unskilled workers (21.8% vs 5% / 73.1% vs 55%, χ2=24.893, df=2, p<.01), from lower socio-economic status (71.8% vs 52.5%, χ2=4.342, df=1, p<.05), joint family (33.3% vs 7.5%, χ2=9.519, df=1, p<.05) and rural background (82.1% vs 62.5%, χ2=5.453, df=1, p<.05), and had poor control of the level of HbA1c (55.1% vs 2.5%, χ2=41.022, df=2, p<.01) than those without co-morbid depression. There was a significant negative correlation of years in education with HAM-D total score (r=-.471, p<0.01). Conclusion: A co-morbidity of depression is very common in patients of type-2 diabetes mellitus and various sociodemographic and clinical factors are linked to this comorbidity. It is important to address these issues for the sake of overall better outcome in type-2 diabetes mellitus.
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Ventriculo-peritoneal (VP) shunt is the most commonly performed procedure for the management of hydrocephalus. Although shunts have improved the morbidity and mortality associated with disordered Cerebrospinal fluid (CSF) mechanics over the past 30 years, they still are associated with many potentially avoidable complications in clinical practice. However, extrusion of VP shunt catheter is an unusual complication of VP shunt Surgery. We are presenting this unusual complication in five patients. The lower end of the shunt was seen extruding from anal opening in one patient, umbilicus in one, urethra in one, inguinal hernia sac in one and oral cavity in one patient. All of these patients were managed by shunt removal, intra venous antibiotics followed by shunt replacement on the other side except the patient with inguinal hernia sac.
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Immense quantity of waste is generated in association with poultry meat egg and crop production. The potential risks due to disposal of these wastes are magnified as a result of dense refinement of poultry production and the decreasing amount of land available for waste disposal. The study aims at studying the microbiological biodiversity of poultry waste and paddy straw based co-composting system. The predominant microflora of the poultry manure were bacteria, fungi, enteric bacteria and spore forming bacteria whose population was high at the initiation of composting but decreased significantly as the compost approached maturity. The initial load of inherent enteric groups of bacteria in poultry waste, that also includes some pathogenic ones, is considerably reduced and some new vital groups contributed to compost quality as the microbiological biodiversity sets in the system and becomes stable. Major fraction of nitrogen of poultry waste was subjected to ammonia volatilization and a fraction of it conserved by co-composting it in conjunction with wastes having low nitrogen contents. In the treatment T1 and T5, where poultry manure and paddy straws alone were composted, 60 and 30 percent of organic carbon, respectively, was lost over a period of six months. Whereas in treatments T2,T3 and T4, poultry manure and paddy straw were co-composted in the ratio of 3:1, 2:2 and 1:3, respectively, 51.4,45.0 and 37.0 percent of carbon, respectively, was lost during decomposition. The C: N ratio in all the treatments decreased significantly to 18.3 for T1, 24.7 for T2, 27.0 for T3, 34.9 for T4 and 38.5 for T5 at the end of composting period.
Subject(s)
Animals , Manure/analysis , Ammonia/analysis , Biodiversity , Composting/analysis , Enterobacteriaceae/isolation & purification , Nitrogen/analysis , Garbage , Methods , Methods , VolatilizationABSTRACT
The present study was undertaken in seven major forest types of temperate zone (1500 m a.s.l. to 3100 m a.s.l.) of Garhwal Himalaya to understand the effect of slope aspects on carbon (C) density and make recommendations for forest management based on priorities for C conservation/sequestration. We assessed soil organic carbon (SOC) density, tree density, biomass and soil organic carbon (SOC) on four aspects, viz. north-east (NE), north-west (NW), south-east (SE) and south-west (SW), in forest stands dominated by Abies pindrow, Cedrus deodara, Pinus roxburghii, Cupressus torulosa, Quercus floribunda, Quercus semecarpifolia and Quercus leucotrichophora. TCD ranged between 77.3 CMg ha−1 on SE aspect (Quercus leucotrichophora forest) and 291.6 CMg ha−1 on NE aspect (moist Cedrus deodara forest). SOC varied between 40.3 CMg ha−1 on SW aspect (Himalayan Pinus roxburghii forest) and 177.5 CMg ha−1 on NE aspect (moist Cedrus deodara forest). Total C density (SOC+TCD) ranged between 118.1 CMg ha−1 on SW aspect (Himalayan Pinus roxburghii forest) and 469.1 CMg ha−1 on NE aspect (moist Cedrus deodara forest). SOC and TCD were significantly higher on northern aspects as compared with southern aspects. It is recommended that for C sequestration, the plantation silviculture be exercised on northern aspects, and for C conservation purposes, mature forest stands growing on northern aspects be given priority.
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Objective of the study: The present study was carried out to assess muscular fitness in healthy Indian school children between 9 to 12 years of age (older pediatric age-group) using Kraus-Weber Tests. The aim was to compare the results of this study with similar studies that have been carried out in India, Europe and America previously. Methods: Kraus-Weber Tests don’t require sophisticated equipment and are much easier to administer than traditional tools for analyzing muscular fitness like Electromyogram (EMG). Earlier studies have proven these tests to be excellent screening devices not only for physical but also psychosocial incompetence. They can actually be used as indicators of overall health in this older pediatric age-group. Results: The present study found more number of fitness and flexibility failures as compared to the last such study in India. In stark contradistinction to previous studies, girls have fared poorly than boys on the fitness front.Conclusion: These findings could be attributed to increased stress in school children especially in female students. A sharp dip has been observed in muscular fitness just prior to puberty (most probably due to hormonal causes).
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In an entomological study conducted during monsoon and post- monsoon season in the hilly state of Nagaland, a total number of 58 mosquito species under 11 genera were recorded. Out of these, 21 species viz., Aedes aegypti, Ae. nigrostriatus, Ae. annandalei, Ae. vittatus, Ae.caecus, Ae. vexans, Armigeres kuchingensis, Culex fuscocephala, Cx. pseudovishnui, Cx. murrelli, Cx. brevipalpis, Cx. epidesmus, Cx. minor, Cx. whitmorei, Coquilittidae crassipes, Malaya jacobsoni, Ml. genurostris, Toxorhynchites splendens, Uranotaenia campestris, Mansonia dives and Ma. annulifera were recorded for the first time from this state. Eleven mosquito species recorded earlier were not detected in the present study. Thus, with the addition these 11 species, the total mosquito fauna of the state goes up to 69. All the recognized vectors of malaria in the northeast and the vectors of Japanese encephalitis and dengue are recorded in the present study.
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Entomological surveys were conducted for three consecutive years in core and buffer zone of the Dibru-Saikhowa biosphere reserve in pre monsoon, monsoon and post-monsoon seasons. A total of 52 species of mosquitoes under eleven genera have been detected. The genus Anopheles (18 species) was the predominant followed by Culex, Aedes, Mansonia, Armigeres, Mimomyia, Ochlerostatus, Malaya, Toxorhynchites, Ficalbia and Aedeomyia. The buffer zone of the forest reserve where human habitations are there exhibited the presence of maximum number of species (49 species under 10 genera) in comparison to core zone (42 species under 10 genera). In buffer zone, maximum numbers of species (38) were recorded in monsoon season followed by post- monsoon (35 species) and Pre-monsoon season (34 species). Whereas in core zone, maximum number of species were collected in post monsoon season followed by pre monsoon season and monsoon season. In Core and buffer zone, the maximum species were recorded from the ground pool habitat and slow flowing stream respectively. Among the disease vectors, the potential Japanese encephalitis vectors incriminated in India were very much prevalent. This study provides the list of available mosquito species recorded for the first time in the Dibru-Saikhowa biosphere reserve.
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Present study was carried out to correlate academic performance of Indian school children with their intelligence quotient (as measured by Porteus Maze Tests). These tests have been tried and tested successfully in previous studies, don’t require sophisticated equipment and are easier to administer than traditional tests like Wechsler Tests. Contrary to popular belief, no statistically significant correlation was found in this study between intelligence and academic grades. Thus intelligence is not a prerequisite to succeed in examinations and therefore in life.
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Present study was carried out to correlate academic performance of Indian school children with their intelligence quotient (as measured by Porteus Maze Tests). These tests have been tried and tested successfully in previous studies, don’t require sophisticated equipment and are easier to administer than traditional tests like Wechsler Tests. Contrary to popular belief, no statistically significant correlation was found in this study between intelligence and academic grades. Thus intelligence is not a prerequisite to succeed in examinations and therefore in life.
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The effluent from a Lucknow- based distillery (Mohan Meakin Distillery) was analyzed for physico-chemical and biological parameters of pollution and concentration of potentially toxic heavy metals (Cd, Cr, Ni and Zn) and the effect of the distillery effluent, as such and on 50% dilution with tap water was studied on seed germination and seedling growth of maize (Zea mays L.) and rice (Oryza sativa L.). The effluent was wine red in colour and highly acidic (pH approximately 55) and possessed decaying alcoholic smell. The effluent contained high values of different pollution parameters, particularly total solids, 3450 mgl(-1) (soluble plus suspended solids), alkalinity 1500 mgl(-1), biological oxygen demand (BOD, 1649 mgl(-1)) and chemical oxygen demand (COD, 2036 mgl(-1)). It had very low values of dissolved oxygen (DO, 0.34 mgl(-1)). The heavy metals (Cd, Cr, Ni and Zn) content, particularly the nickel concentration (0.029 mg l(-1)) was high. Use of the distillery effluent, even on 1:1 dilution with tap water inhibited germination and early seedling growth of maize and rice. In both maize and rice, more so in the former germination % of seeds, length of radicle and plumule and the fresh and dry weight of the seedlings were significantly reduced. The emerging leaves of the seedlings also developed visible effects of toxicity some of which resembled the symptoms of nickel toxicity. Our observations suggest that the effluent, as discharged from the distillery carry a heavy load of pollutants. Its discharge into the river Gomti poses a potential threat to the aquatic life, perticularly during the summer months when the water flow in the river is drastically reduced. The distillery effluentis also harmful for irrigating crops grown along the drain carrying it.
Subject(s)
Germination/drug effects , Hydrogen-Ion Concentration , Industrial Waste , Metals, Heavy/analysis , Oryza/drug effects , Oxygen/chemistry , Seasons , Seeds/drug effects , Temperature , Time Factors , Water Pollutants, Chemical/analysis , Zea mays/drug effectsABSTRACT
Wilson's disease (WD) is a genetic neurodegenerative disorder; it exhibits wide heterogeneity in symptoms and usually presents with liver disease and/ or neuropsychiatric manifestations. The common neurological manifestations observed are dysarthria, gait disturbance, dystonia, rigidity, tremor, dysphagia and chorea. The frequent psychiatric manifestations reported are personality and mood changes, depression, phobias, cognitive impairment, psychosis, anxiety, compulsive and impulsive behavior. Isolated obsessive-compulsive disorder (OCD) is a rare presentation of WD. Reported herein is a case of a 17-year-old boy with isolated OCD. He presented to the psychiatrist with symptoms of contamination obsessions and washing compulsions, along with compulsion of repeated feet tapping and was treated with adequate doses of fluoxetine for 6 months but did not improve. Later on, he was diagnosed as a case of WD and showed improvement with chelating and behavior therapy. This implies the importance of the occurrence of isolated psychological symptoms in WD.
Subject(s)
Adolescent , Chelation Therapy , Hepatolenticular Degeneration/complications , Humans , Magnetic Resonance Imaging , Male , Obsessive-Compulsive Disorder/etiologyABSTRACT
There is a suspicion that mortality in gangrenous sigmoid volvulus has considerably declined over the recent years. This study was aimed to assess if this is a genuine trend, applicable to the patients, of this study too, and to identify factors responsible for the change, if any. Seventy-eight patients operated for gangrenous sigmoid volvulus, in the last four decades of the just gone century, were analysed. Nine clinical parameters were studied to identify factors responsible for mortality and to see if there was a change in clinical presentation in the later decades. Mortality in the 4 studied decades varied between 15.4% and 65%. Differences were significant (p<0.05) only between the decades of the seventies and eighties and between bunched pre 1980 (48%) and post 1980 (20%) decades. A sea change in survival scene occurred at the end of the decade of the seventies. The change was not accompanied by a concomitant improvement in clinical presentation (p>0.05). Two facts which could explain improved survivals in the post. 1980 period were, the increased recognition of gangrene extending beyond the area of constriction and improved survival after primary anastomoses (p<0.05). These indicated a more accurate assessment of viability and the distance between the cut bowel ends, a stricter selection of cases for primary anastomosis and using Hartmann operation in doubtful situations. Mortality in gangrenous sigmoid volvulus, without knotting in the Indian population has genuinely declined from over 50% in an earlier time to 20% in the later 20 years of the last century, the watershed in the changed scenario being the year 1980.
Subject(s)
Adult , Aged , Colon, Sigmoid/pathology , Colonic Diseases/mortality , Female , Gangrene/etiology , Humans , India/epidemiology , Intestinal Volvulus/mortality , Male , Middle Aged , Retrospective Studies , Sigmoid Diseases/mortality , Survival Rate , Time FactorsABSTRACT
Entomological studies conducted during monsoon and post-monsoon season in Manipur State revealed the presence of fifty-five species of mosquitoes under ten genera. Out of the seventeen Anopheles species recorded, Anopheles aconitus, An. dirus and An. nivipes were recorded for the first time from the state. The present study has confirmed the existence of An. dirus, the major malaria vector in the Northeast from a selected area of the state. Among Culicines, four species viz., Aedes nigrostriatus, Malaya genurostris, Aediomyia catasticta and Toxorhynchites splendens which were not reported earlier from this state have been recorded in the present study. With the addition of these seven species of mosquitoes to the earlier record of mosquitoes so far reported from Manipur, the mosquito fauna swells up to one hundred and eleven including the major vectors of malaria of the Northeast and the potential vectors of Japanese encephalitis and dengue virus transmission in India.