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@#Introduction: The objective of the current study was to test our hypothesis that older patients sustaining high energy trauma need to be evaluated for their comorbidities similar to geriatric patients sustaining low energy trauma. Materials and methods: This study was a retrospectiveprospective analysis of 173 patients of more than 50 years of age enrolled between November 2017 and December 2018. Herewith, we have compared retrospectively collected laboratory investigations of 124 fragility fracture patients with prospectively collected laboratory investigations of 49 patients with high energy trauma. The laboratory investigations, including the liver function tests, renal function tests, indices of calcium metabolism, serum electrolytes, complete blood counts, and bone mineral density (BMD) scores. Results: Both groups were similar to each other as far as baseline demographic characteristics were concerned. The proportion of female patients and patients with nonosteoporotic range BMD (T-score >-2.5) was significantly higher in the high-energy fracture group (P value <0.05). Hypoalbuminemia (<3.4gm/dl) 17.3%, abnormalities sodium (<135mmol/L or >148mmol/L) 23.2%, Anaemia (<10g/dl) 12.7%, Hypercalcemia (>10.4mg/dl) 16.3%, Vitamin D deficiency (<20ng/ml) 17.3% are the common laboratory abnormality found in study population. No statistically significant difference was found among the two groups in terms of laboratory investigation abnormalities. Conclusion: The laboratory investigation abnormality in an older patient with a clinical fracture is independent of the mechanism of injury. The results of the current study emphasise the need for a comprehensive laboratory workup in older patients with either high- energy fractures or fragility fractures.
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Background: High body iron stores have been linked to insulin resistance, metabolic syndrome, and gestational diabetes. Complications of diabetes mellitus are influenced not only by its duration but also by average level of blood glucose, the latter can be monitored by glycated hemoglobin. Aim and Objective: The aim of this study was to study the relationship of serum ferritin and glycated hemoglobin in type 2 diabetes mellitus. Materials and Methods: The case–control study was undertaken on 100 subjects, both males and females; age 35–70 years; categorized into two groups: Group 1 (Cases = 50 patients of type 2 diabetes mellitus [T2DM]) and Group 2 (Controls = 50 healthy, non-diabetic individuals). Results: Fasting blood glucose, serum ferritin, and glycated hemoglobin values were 178.96 ± 37.16 mg/dL, 261.29 ± 76.98 ng/dL, and 9.37 ± 1.44%, respectively, in T2DM cases, while the corresponding values were 95.06 ± 12.68, 90.75 ± 67.53, and 4.81 ± 0.88 in healthy controls. Conclusion: Increased levels of serum ferritin were seen in T2DM and significant correlation between blood sugar and serum ferritin was found.
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Background: Chronic liver disease (CLD) is defined as a process of slow and continuous destruction and regeneration of the hepatic parenchyma giving rise to fibrosis and cirrhosis. When it has markedly progressed, it may present with clinical bleeding due to reduction in levels of procoagulant factors, barring some like factor VIII and von Willebrand factor, which are elevated. It is essential to observe that reduced levels of the procoagulants are accompanied by decrease in levels of anticoagulants such as antithrombin and protein C. Under normal conditions, the coagulation machinery is balanced, but the phenomenon of the simultaneous reduction of procoagulants as well as anticoagulants in patients with CLD has been an unsolved puzzle since long. Objective: This study was undertaken to study the relevance and significance of first-line coagulation tests (prothrombin time [PT] and activated partial thromboplastin time [aPTT]) in relation to bleeding manifestations in patients with CLD, to classify the cases of CLD enrolled on the basis of etiology, to study the platelet count, PT, and aPTT values of the cases, and to calculate the Child–Pugh (CP) and model for end-stage liver disease (MELD) scores for all the patients and stratify them accordingly. Materials and Methods: It was a prospective observational study including 40 patients known to be diagnosed with CLD. CP score and MELD were calculated for all. Values of coagulation parameters were compared in patients with and without cirrhosis, in patients belonging to different CP classes, those with low and high MELD scores, and patients with or without upper gastrointestinal (UGI) bleed. Results: Means of PT and aPTT were compared in patients with and without cirrhosis where it was found that there was no statistically significant prolongation of PT or aPTT in patients with cirrhosis compared to those without. We also studied the values of PT and aPTT through increasing grades of CP score and found statistically significant difference between values of PT between those belonging to Class A versus Class C. It was observed that the difference of the mean of PT of the two groups (with MELD <15 and above 15) is statistically significant, whereas it is not true in case of aPTT. Conclusions: The study showed no significant alterations overall in patients with CLD except those in advanced CP classes and those with high MELD scores. They were not significant in patients presenting with UGI bleed, a common manifestation in cirrhotic patients, although those constituted a very small part of the study group. These indices alone are insufficient to include as part of their prognostic and clinical work up to predict bleeding.
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Aim: The present study was undertaken to examine the relation between genetic divergence of some tropical inbred lines of maize and extent of heterosis manifestation in their single cross hybrids. Methodology: Fifteen inbred lines and three inbred testers along with 45 single cross hybrids were evaluated by adopting randomized complete block design during two seasons. The observations recorded on eight metric traits of the entries in each of three replications were utilized during statistical analysis across the seasons. Relative importance of classification variables was determined by principal component analysis and the phenogram was generated using average taxonomic distance. Molecular profiling of inbred lines was carried out by employing 28 SSR primer pairs covering all the chromosomes. Principal coordinate analysis was performed and similarity indices based dendrogram was constructed. Relationship between parental genetic divergence and heterosis was statistically tested. Results: Significant differences due to parents, hybrids and parent vs. hybrids were observed for all metric characters. Principal component analysis based diagram and average taxonomic distance based phenogram separated the inbred lines into five clusters. Amplification profiles based principal coordinate analysis and hierarchical cluster analysis differentiated the inbred lines into four major clusters. Statistically non-significant correlation of genomic data based genetic similarity or phenotypic data based genetic dissimilarity of inbreds was revealed with grain yield and heterosis of hybrid combinations. Significantly positive correlation was found between heterosis over mid parent or better parent and grain yield of hybrids. Interpretation: Parental genetic divergence was not linearly or additively related to heterosis manifestation in hybrid. Moderate genetic divergence together with high per se performance of inbreds seemed to be a better criterion than consideration of merely extreme genetic diversity as the basis for the choice of parental inbreds during heterotic single cross hybrid development in maize
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Aim: The study was conducted to determine the impact of landuse on soil physical properties and erodibility. Methodology: Representative soil samples were collected from surface and sub-surface soil depths. Soil physical properties and erodibility indices viz suspension percentage, dispersion ratio, clay/moisture equivalent ratio, erosion ratio, percolation ratio, clay ratio, erosion index and modified clay ratio were determined using standard procedures. Interrelationship among soil properties and erodibility indices were evaluated using Pearson correlation analysis (at 95% and 99% significance level). Results: Among landuse systems, the clay was highest in forest while least in soils under barren landuse. Lowest bulk density and highest value of maximum water holding capacity was found in forest soils. According to susceptibility to erosion, the landuse systems were found in the following order barren lands > cultivated systems (agriculture and horticulture) > forest lands. The ‘r’ values showed positive and highly significant correlations between sand content and bulk density with suspension percentage (SP), clay ratio (CR), modified clay ratio (MCR), dispersion ratio (DR), percolation ratio (PR), erosion ratio (ER), erosion index (EI) while negative and significant correlations of these erodibility indices were found with clay and porosity. Among the erodibility indices SP, DR, PR, ER and EI were positively and significantly correlated with each other. Interpretation: Physical quality of soil was higher in forest compared to other landuse systems. Erodibility of different landuse systems could be arranged in order barren lands > cultivated systems (agriculture and horticulture) > forests. The study was useful for suggesting remedial measures and landuse planning for future
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Ophthalmology is a field that is now seeing the integration of robotics in its surgical procedures and interventions. Assistance facilitated by robots offers substantial improvements in terms of movement control, tremor cancellation, enhanced visualization, and distance sensing. Robotic technology has only recently been integrated into ophthalmology; hence, the progression is only in its initial stages. Robotic technologies such as da Vinci Surgical System are integrated into the field of ophthalmology and are assisting surgeons in complex eye surgeries. Ophthalmic surgeries require high accuracy and precision to execute tissue manipulation, and some complex ocular surgery may take few hours to complete the procedures that may predispose high-volume ophthalmic surgeons to work-related musculoskeletal disorders. A complete paradigm shift has been achieved in this particular field through the integration of advanced robotic technology, resulting in easier and more efficient procedures. Where robotic technology assists the surgeons and improves the overall quality of care, it also projects several challenges including limited availability, training, and the high cost of the robotic system. Although considerable studies and trials have been conducted for various robotic systems, only a few of them have made it to the commercial stage and ophthalmology, on its own, has a long way to go in robotics technology.
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Background: Carbapenems have the broadest activity spectra of any β-lactam antibiotic and are often the most appropriate agents for use in the treatment of infections caused by multi resistant gram negative bacteria. The recent worldwide emergence and dissemination of carbapenemase-producing Gram negative rods that are resistant to carbapenems is a significant concern with respect to patient care and infection control strategies. Hence this study was undertaken to study the magnitude of carbapenem resistance among routine clinical isolates of family Enterobacteriaceae so as to guide the clinicians in selection of appropriate antimicrobial chemotherapies and infection control measures.Methods: The present study was conducted in the Department of Microbiology over a period 18 months from January 2017 to July 2018. All the clinical isolates of Enterobacteriaceae were screened for carbapenem resistance as per CLSI guidelines. Such strains were then subjected to phenotypic confirmation of carbapenemase production by the Modified Hodge test. All isolates that gave a positive screening test were further evaluated for metallo-β-lactamase production. The technique used was the Combined Disk Test using a combination of Imipenem and Imipenem-EDTA.Results: Out of the 400 total clinical isolates of Enterobacteriaceae isolated in the laboratory,57 were found to be Meropenem resistant (14.25%) and were labelled 'Carbapenem resistant Enterobacteriaceae" or CRE. Modified Hodge test (MHT) performed on the 57 carbapenem resistant isolates showed 41 (71.93%) isolates to be carbapenemase enzyme producers. Combined disc test (CDT) conducted on the 57 isolates of CRE detected Metallo-β-lactamase (MBL) enzyme production in 39 isolates (68.42%).Conclusions: Since there is a high prevalence of carbapenemase resistance in our setting hence we need to be cautious with the indiscriminate use of broad spectrum antimicrobials, more so, the carbapenems.
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Aim: The present study was conducted with an objective to assess the suitability of colemanite (Ca2 B6.O11.5H2O) as a slow release source of boron to potato crop. Methodology: Soil was incubated with boron (1.25 and 2.50 mg kg-1 soil) using borax and colemanite for six weeks. Soil moisture was maintained at 80% field capacity. Soil samples were analyzed weekly for hot-water extractable boron content. Direct and residual effects of borax and colemanite on potato plant growth and boron uptake were studied in pot experiments. Leaf boron concentration was measured by an ICP-OES. Results: In laboratory incubation, although the rate of release of hot water extractable boron from colemanite was slower than borax, it was enough to meet the requirement of potato crop. Application of both the sources of boron increased its content significantly in soil as well as in potato leaves. This study revealed that boron uptake from colemanite was comparable to borax in meeting the boron requirement of potato. Interpretation: Soil incubation and pot experiment studies showed that colemanite is a suitable slow release source of boron fertilizer for potatoes
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@#The Livestock Sector of India plays an important role in livelihood security and socioeconomic development of rural households. Leptospirosis is an important zoonotic disease responsible for septicaemia, interstitial nephritis, jaundice, abortion, reproductive problem in most of the animal species. Reproductive disturbances in bovine population is most often restricted to investigation of brucellosis, however apart from brucellosis, there are many undiagnosed diseases like leptospirosis that takes a toll in the reproductive anomalies of cattle and buffalo. Hence, the present study was elucidated to screen the seroprevalence of Leptospira in cattle and buffalo in various hamlets of North India using a user friendly screening test i.e. LipL32 latex agglutination test. The overall seropositivity was found to be 26.01% (230/884) in case of bovine in this study and the LipL32 LAT showed a profound sensitivity and specificity with level of 94.97% and 99.53% respectively.
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Several techniques are used to make a capsulorhexis in white mature cataract cases as needle cystotome, Utrata capsulorhexis forceps, microincision capsulorhexis forceps, femtosecond Laser, etc. Zepto precision nano-pulse capsulotomy device (Mynosys Cellular Devices; Fremont, CA, USA) is Food and Drug Administration approved, a disposable capsulotomy device that uses low-energy pulses to create a precise central capsulorhexis, independent of pupil size, corneal clarity, or lens density. In this article, the authors report their experience of performing anterior circular curvilinear capsulorhexis with Zepto precision nano-pulse capsulotomy device in challenging cataract cases done at our center. The Zepto handpiece device was inserted through 2.8 mm clear corneal incision. Results of our study in 3 cataract cases (intumescent cataract, morgagnian cataract, and cataract with small pupil) revealed that the precision pulse capsulotomy technology mechanically and simultaneously cleaves all 360� of the apposed capsule of without cauterizing it, creating CCC of 5.2 mm size.
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Background & objectives: Dohra is a areca nut preparation used with or without tobacco in a few of the areas of Uttar Pradesh (UP), India. There is evidence that it causes potentially malignant disorders and oral cancer. This study was undertaken to provide information on dohra by searching through literature and also through a survey in three areas of Uttar Pradesh (UP), India. Methods: The information on dohra was collected through literature search, study tour to different areas of UP, where group discussions with dohra vendors and with community members of different age group were done to obtain information. Results: Dohra was prepared by the users for their personal use or prepared by small-scale industry for sale. It was available mostly in betel shops or any other store/kiosks and was also available in special dohra shops. Dohra was available in both dry and wet form. Its common constituents were areca nut, catechu (Acacia catechu), edible lime, peppermint (Mentha piperita), cardamom (Elettaria cardamomum) and some flavoring agents. Dohra was consumed as such or with tobacco. Interpretation & conclusions: Different varieties of Dohra were available such as sukha dohra, sukha mulethi dohra and geela dohra. Different processing methods for producing dohra existed. As dohra increases the risk of cancer, it needs to be banned or it should be sold in packets with the details of its constituents and also statutory warning about its adverse health effects.
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Background & objectives: Hepatitis B and hepatitis C virus (HBV and HCV) cause acute and chronic hepatitis, and infections with HBV and HCV are common in HIV-infected patients. The present study was conducted to determine the co-infection of hepatitis B and C virus in stored serum samples of HIV-positive/negative individuals attending an Integrated Counselling and Testing Centre (ICTC) in north India and their association with certain risk factors. Methods: This study included a total of 840 serum samples, of which 440 were from HIV seropositive individuals and 400 were from control individuals seeking voluntary check-up of HIV status at ICTC. Serum samples were used for the detection of HBV and HCV infection. Results: HBV infection (11%) was found to be less in contrast to HCV (13%) amongst the HIV seropositive. In controls, HBV and HCV infection was two and three per cent, respectively. Co-infection of HBV and HCV was found in 15 of 109, and in controls, it was 2 of 15. Age group between 21 and 40 was significantly associated with HBV and HCV infection. Heterosexual contact was the leading mode of acquiring HBV and HCV infection. Interpretation & conclusions: HBV and HCV co-infection was found to be significantly higher in HIV-positive individuals in comparison to normal population. Hepatitis virus infection leads to rapid progression of liver cirrhosis in HIV-infected patients. Routine check-up of HIV seropositive patients for hepatitis virus may be required to monitor clinical outcome.
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Background: Fractures of the distal end radius represent the most common upper extremity fracture in elderly. The treatment problem includes not only achieving union in right anatomical position but also good functional results as far as joint mobility is concerned. Many types of external fixation devices are described to achieve reduction and fixation of the fragments without loss of position and acceptable functional results. The ligamentotaxis is the basic principle used by external fixation. The aim of the study was to assess the functional outcome in fractures of the lower end radius in elderly patients treated by static external fixator (Modified JESS). Materials and Methods: A total of 52 wrists in 51 patients (24 males and 27 females), aged more than 50 years with intra-articular distal end radius fracture were treated with Modified Joshi’s External Stabilization System from 2003 to 2016. The patients were followed up at 2 weeks, 3 weeks, between 6 and 8 weeks, 6 months, 1 year and at 2 years after the surgery. The assessment of pain, range of motion, grip strength and activity were assessed at 6th month, one year and two years follow- up and scored according to Green and O’Brien scoring system. Results: Result was excellent in 42 (80.76%), good in 6 (11.54%) and poor in 4 (7.69%) at 2 years post operatively. Conclusion: Ligamentotaxis using external fixator has been the traditional mode of treating unstable distal radius fractures and is still used by many as the preferred technique due to its acceptable results, easy application and cost-effective.
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Purpose: This study aims to study the prevalence of DED and analyze risk factors in North Indian population. Methods: This was a cross-section hospital-based, observational study. Cases enrolled over 2 years (systematic random sampling) were administered ocular surface disease index questionnaire to evaluate the prevalence and risk factors of DED. Schirmer's test and tear break-up time were performed only in the subset of patients giving consent. Categorical data were assessed with Chi-square/Fisher's Exact test, and odds ratio was analyzed using bivariate and multivariate logistic regression. P < 0.05 was statistically significant. Results: A total of 15,625 patients were screened. The prevalence of DED was 32% (5000/15625); 9.9% (496/5000) had mild DED; 61.2% (3060/5000) had moderate DED; and 28.9% (1444/5000) had severe DED. Age group of 21� years, male sex, urban region, and desk job were associated with increased risk of DED. Hours of visual display terminal (VDT) usage significantly correlated with DED (P < 0.001), and 89.98% of patients with 4 h or more of VDT use had severe dry eye. Cigarette smoking and contact lens usage had increased odds of developing severe DED (P < 0.001). Objective tests were undertaken in 552 patients; of these, 81.3% (449/552) had severe DED. Conclusions: The prevalence of DED in North India is 32%, with the age group of 21� years affected most commonly. VDT use, smoking, and contact lens use were associated with increased odds of developing DED.
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Background: The use of drugs and occurrence of its ADRs go hand in hand. Spontaneous reporting of ADRs is an effective method and needs to be encouraged. Objective: The study was planned to know the perception of interns towards pharmacovigilance and to make them aware of the importance of ADR reporting. Materials and Methods: A cross sectional observational questionnaire based study conducted on 100 interns to gather information about the knowledge of Pharmacovigilance, attitude towards reporting and factors in practice which could act as a deterrent to the reporting of ADRs. Results: Out of the 100 interns, 90 responded. 50 % participants knew the purpose of PV. 67% agreed that it should be mandatory. 59% and 67% said that medical students and nurses have a role to play in PV. Half of the interns had seen an ADR, only 42% knew how and where to report. Very few (9%) were aware of what happens to the information submitted by them. Conclusion: There is a huge gap between knowledge of ADR reporting and pharmacovigilance and the practical reporting of ADRs. Our health care providers need to be well equipped to detect, manage, report ADRs. For this, educational intervention, regular training programmes are the need of the hour to create awareness and take care of the factors responsible for under reporting. Pharmacovigilance programme needs to be strengthened by increasing the rate of ADR reporting by active participation of health care providers.