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ABSTRACT Purpose: To assess Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum and correlate with ocular surface changes. Methods: This cross-sectional study evaluated patients with xeroderma pigmentosum. All patients underwent a comprehensive and standardized interview. The best-corrected visual acuity of each eye was determined. Detailed ophthalmic examination was conducted, including biomicroscopy examination of the ocular surface, Schirmer test type I, and meibography, and fundus examination was also performed when possible. Meibomian gland dysfunction was assessed by non-contact meibography using Oculus Keratograph® 5M (OCULUS Inc., Arlington, WA, USA). Saliva samples were collected using the Oragene DNA Self-collection kit (DNA Genotek Inc., Ottawa, Canada), and DNA was extracted as recommended by the manufacturer. Factors associated with abnormal meiboscores were assessed using generalized estimating equation models. Results: A total of 42 participants were enrolled, and 27 patients underwent meibography. The meiboscore was abnormal in the upper eyelid in 8 (29.6%) patients and in the lower eyelid in 17 (62.9%). The likelihood of having abnormal meiboscores in the lower eyelid was 16.3 times greater than that in the upper eyelid. In the final multivariate model, age (p=0.001), mutation profile (p=0.006), and presence of ocular surface malignant tumor (OSMT) (p=0.014) remained significant for abnormal meiboscores. For a 1-year increase in age, the likelihood of abnormal meiboscores increased by 12%. Eyes with OSMT were 58.8 times more likely to have abnormal meiboscores than eyes without ocular surface malignant tumor. Conclusion: In the final model, age, xeroderma pigmentosum profile, previous cancer, and clinical alterations on the eyelid correlated with a meiboscore of ≥2. Meibomian gland dysfunction was common in patients with xeroderma pigmentosum, mainly in the lower eyelid. The severity of Meibomian gland dysfunction increases with age and is associated with severe eyelid changes.
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Background: Universal developmental screening is recommended at 9, 18, 24 and 36 months. The Government of India Mother and Child Protection (MCP) card is an immunization record that is used to monitor child development, and identify children requiring further evaluation. Objectives: To determine the diagnostic accuracy of the MCP card for developmental screening, and perform its item analysis. Study design: Mixed-method study (prospective study of diagnostic accuracy and qualitative study). Participants: Mother-child dyads of children between 2-36 months of age were recruited from the outpatient department or wards of a tertiary level children’s hospital from November, 2019 to October, 2021. Children with confirmed neurodevelopmental disorders/disability, and mothers with less than 6th standard education were excluded. Intervention: Each mother was given a MCP card, and taught how to mark the items. This was followed by the researcher’s evaluation (index tool). The reference tool was a comprehensive clinical assessment (CCA) by the researcher and an expert. The CCA included clinical examination of hearing, vision, and neurodevelopment; and psychometric assessment of development and adaptive function. Each mother underwent an in-depth interview. Overall and group wise psychometric properties of diagnostic accuracy were computed. The interview transcripts were analyzed thematically. Outcomes: The proportion of children with ‘fail’ and ‘delay’ by the evaluation of the researcher with the MCP card and the expert by the CCA, respectively. Results: The study population included 213 children (40.4% females). Fifty-two (24.4%) children were identified as ‘Fail’ by the MCP card and 43 (20.2%) as ‘delay’ by the expert’s CCA. The overall sensitivity and specificity was 83.7% (95% CI 69.3-93.2) and 90.6% (95% CI 85.2-94.5), respectively. Acceptable diagnostic accuracy was found in the age-group 7-9 months, 13-18 months, and 25-36 months. Conclusions: The MCP card may be used for developmental screening at 9, 18, and 36 months.
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Justification: Global developmental delay (GDD) is a relatively common neurodevelopmental disorder; however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. Process: Seven subcommittees of subject experts comprising of writing and expert group from among members of Indian Academy of Pediatrics (IAP) and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of IAP. Guidelines: GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/ hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.
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Fistula-in-ano is most infectious disease among all the ano-rectal disorders since ancient times. Over the past few decades, various techniques are being evaluated in terms to prevent its recurrence and complications; it is still a challenging surgical disease. The sign and symptoms of fistula in ano resembles with Bhagandar described in Ayurvedic classics. Kshara sutra therapy (medicated thread) practiced in Ayurveda Since ancient time for the management of Naadi Vrana and Bhagandar. Kshara sutra therapy has revolutionized the treatment of fistula-in-ano, as it treat the main culprit of fistula that is cryptoglandular origin but the drawback of Kshara sutra therapy are as it takes more number of hospital visit, long anxiety period and discomfort. In present time LASER therapy is used in various medical surgery and also in proctology like in fistula as FILAC, DLPL etc. Diode LASER 980nm (Radial Fibre) burns unhealthy granulation tissues in 360° manner with less or minimal pain, LASER act as photo evaporation effect and leads to the shrinkage of the fistula tract. But if we do LASER in internal opening of fistula it provides a bare area for microbes and creates a chance to re-infects the crypts and anal glands, which further leads recurrent fistula formation. Therefore a novel technique for sphincter preserving surgery proposed as combined therapy of Kshara sutra ligation for main culprit that is cryptoglandular infection as SMAK (Sub Mucosal Application of Kshara Sutra) and LASER, shrink the remaining fistula tract instantly
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The brown planthopper (BPH) Nilaparvata lugens (Stål) (Homoptera: Delphacidae) is considered a threat to rice (Oryza sativa ssp.) crop in many parts of the world including India. Among the BPH-resistance (R) genes so far reported in rice, most of them are ineffective against BPH biotype 4 predominant in the Indian sub-continent. In this study, we show the introgression line RPBio4918-230S was identified as BPH resistant after five years of rigorous screening at seedling stage and two years at tillering and reproductive stages. The inheritance of resistance indicated that two recessive genes are involved at seedling and reproductive stages. The allelic relation with known genes using linked reported markers suggested that the genes present in RPBio4918-230S are different. We report here the genetics of the two newly introgressed BPH resistance genes from O. nivara in the background of Swarna which are effective at all the important growth stages. The genes have been tentatively named as bph39(t) and bph40(t). The honeydew area (feeding rate) and days to wilt parameters observed at 30 days after sowing in BC1F3 indicated that newly introgressed genes have both antibiosis and tolerance mechanisms for resistance. The BPH resistance genes identified in this study would facilitate the breeding of broad spectrum and durable resistance in rice against BPH biotype 4.
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BACKGROUND:Various new challenges have emerged since the introduction of laparoscopic surgery. Port site hernia is one of the serious complication. Various methods have been introduced to reduce it. The aim of this article is to introduce a procedure that is easy, safe and quick to perform and will help in decreasing port site complications after laparoscopic procedure.MATERIAL AND METHOD:We have described here a simple technique for the facial closure after laparoscopic surgery over 100 patients who underwent laparoscopic cholecystectomy repair at VMMC & Safdarjung Hospital, New Delhi.RESULT:This method was used in 100 patients with no intro-operative complication, no port site hernia reported in a follow up period of 1 year.CONCLUSION:This procedure of fascial closure is safe, quick, effective and easy to perform method of facial closure.
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Introduction: When people die and their bodies are found withno identifying documentation, it is very difficult for the police toestablish their identities. These bodies are labelled as‘unknown/unidentified dead bodies’ (UIDB). The body ispreserved in the mortuary for 72 hours, from the time it isreceived in the mortuary. If no one claims the body after 72hours the police are legally authorized to dispose of the body.The aim of study is to find incidence of unnatural deaths inrelation to the age, sex, pattern of injuries and other parameterof the unknown victims and to ascertain the root cause of alltypes of deaths.Materials and Methods: This prospective study wasconducted in the Department of Forensic Medicine andToxicology, Patna Medical College, Patna, Bihar, Indiabetween August 2012 to September 2014. All the medico legalautopsies of unknown/unidentified bodies during this periodwere included in the study. Information regarding unclaimedbodies with regard to age, sex, cause of death and manner ofdeath was sourced from the autopsy reports and the inquestpapers of the investigating officers.Results: Out of total of 5103 autopsies done 401(7.85%) wereunknown/unidentified dead persons. 342 cases (85.28%) wereof male. Incidence of unknown/unidentified death was mainly inmiddle age group (30-50yrs) (42.64%). 225 (56.10%) deathswere due to accident/injury. Major cause of death due toinjuries were polytrauma. Highest cases were seen in winterseason and lowest in Autumn. 279 cases were untreated and122 hospitalized or treated cases in total unknown cases.Conclusion: Most of the literature available were on theindividual body identification or identification of victims of massdisasters. Unknown bodies comprised 7.85% of the totalautopsy load of the department. The age group 21-40 yearswas responsible for 44.85% of total cases. Accident is animportant cause of morbidity and mortality in the study area.Males are the most affected population; the common agegroup affected is 21–40 years. However, more studies arerecommended to find the actual cause of accidents andprevalence of homelessness and its health-related effects onmorbidity and mortality, which will help in providing health carefacilities to the needy.
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Accidental penetrating injuries to the finger are common and their improper assessment can result in missed foreign bodies. These can result in a wide range of complications. Removal of retained foreign bodies is really challenging. We report the case of a male tailor who came to the department with a chief complaint of accidental injury with sewing machine needle and the broken piece of needle got stuck in his finger. This case report highlights the management of deeply embedded broken needle without the use of any expensive investigation. Even preoperative plain X-ray with a radio-opaque marker can localize the missed radio-opaque foreign body accurately. A comprehensive approach results in a successful removal of the foreign body and improved quality of life.
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Introduction: Communicative skills in medical education are inadequately met. Research has shown that poor communication can contribute to improper diagnosis and lack of understanding of patient's problems, investigations, and treatment options. Poor communication can lead to poor compliance to treatment and dissatisfaction among patients Objective: Assessment of the improvement in the communication skills after the training programme workshop Method: The interns posted in the department of community medicine were pre-tested using Kalamazoo Essential Elements Communication Checklist (Adapted) [KEECCA] who then underwent focused training by the trained faculty members. Two weeks following completion of training, all participants were subjected to a post-test and comparison between the pre-test and post-test scores was done using Wilcoxon Signed-Rank Test. The test was two sided and a p value less than 0.05 was considered as statistically significant. In order to know the effect of sensitization programme, feedback of the students and the faculty members as the assessors was taken after the completion of the posting Results: On the application of wilcoxon signed rank test, it was found that the difference between the pre and post test scores of assessment on kalamazoo scale after the training of interns on communication skills was found to be statistically significant as the t-value was 4.072 with the pvalue less than 0.001 that is also highly statistically significant Conclusions: The incorporation of communication skills in the medical curriculum will not only improve the doctor patient relationship but also help in arriving at the proper diagnosis through improved skills
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Objective: 1. To find out the prevalence of Vitamin A deficiency (VAD) on the basis of presence of bitot’s spot and conjunctival xerosis among rural school going adolescents of District Bareilly, Uttar Pradesh, India. 2. To identify the associated factors and to suggest the suitable measures to prevent VAD among them. Study Design: Cross sectional study. Place and Duration of Study: Field practices areas Department of Community Medicine RMC&H Bareilly, Uttar Pradesh India, between Jan 2012 to Dec 2012. Participants: 900 school going adolescents. Sampling: Multistage sampling method. A structured schedule was used to collect the information. Statistical Analysis: Data were analyzed with SPSS 17. Significant difference was determined using Chi- square test. Results: The overall prevalence of VAD was found to be 42.22%. It was higher in 15-19 years of age group adolescents (48.77%) as compare to 10-14 years (41.6%). The prevalence of VAD was slightly higher among boys (p value=0.666). Out of total 398 (42.22%) VAD adolescents 300 adolescents were from socioeconomic class V. Conclusion: Nutrition education regarding regular intake of foods rich in vitamin A rich is needed to prevent the deficiency.
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A parent benzothiazole nucleus was synthesized by para amino acetanilide, then it is subjected to treatment with various substituted aromatic aldehydes to get the corresponding Schiff’s bases followed by treatment with pthalic anhydride to form 2-(6- acetamidobenzo[d]thiazol-2-ylcarbamoyl)benzoic acid. The structures of synthesized compounds were confirmed by various spectroscopic methods such as IR, 1H NMR and mass spectroscopy. The products were evaluated for their anti-inflammatory and analgesic activities. Some of the compounds exhibited potent activities when compared with the standards.
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Background & objectives: Information about the genetic diversity of the extended-spectrum β-lactamases (ESBLs) and the clonal relationship of the organisms causing neonatal infections is limited, particularly from India where neonatal mortality is high. This study was undertaken to investigate the molecular epidemiology and risk factors associated with neonatal septicaemia caused by ESBL-producing Klebsiella pneumoniae and Escherichia coli. Methods: Bloodstream isolates (n=26) of K. pneumoniae (n=10) and E. coli (n=16) from the neonates admitted in a tertiary care hospital in New Delhi during January to May 2008 were characterized. Antimicrobial susceptibility tests were carried out and ESBL production was assessed phenotypically. PCR was carried out for ESBL and ampC genes. Genotyping was performed by pulsed-field gel electrophoresis (PFGE). Conjugation experiments were done to determine the mobility of ESBL genes. Risk factors associated with ESBL-producing K. pneumoniae and E. coli infections were analysed. Results: Resistance rates to most of the antibiotics tested were high, except for imipenem. Among the isolates tested, 60 per cent of K. pneumoniae and 75 per cent of E. coli were ESBL producers. PFGE of the isolates demonstrated a vast diversity of genotypes with no epidemic clones. Despite the clonal diversity, blaCTX-M-15 was detected in 100 per cent of ESBL-positive isolates. The other genes present in ESBL-positive isolates were blaTEM-1, blaSHV-1, blaSHV-28, blaSHV-11, and blaSHV-12. Class 1 integrons were detected in 7 of 18 ESBL-positive isolates. Moreover, the plasmid carrying blaCTX-M-15, in E. coli and K. pneumoniae were self transferable. Feeding through an enteral tube was identified as the only risk factor for sepsis by ESBL-producing organisms. Interpretation & conclusions: The study emphasises the presence of blaCTX-M-15 in clonally diverse isolates indicating probable horizontal transfer of this gene. The widespread dissemination of CTX-M-15 is of great concern as it further confines the limited therapeutic interventions available for neonates.
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Background: Children under-five are most vulnerable for malnutrition and infection. Morbidity pattern of this age group has several determinants like socio-economic status, basic education, occupation, socio-cultural practices, living environment etc. Objectives: To study the morbidity pattern in under-five children and to find out it’s association with various factors. Methods: This was a cross-sectional study conducted in paediatrics OPD of a tertiary care level hospital in rural area of Etawah District of Uttar Pradesh for three months. We included 379 children by random sampling design. Mothers of children were interviewed using a predesigned schedule. Chi-square test was used for statistical analysis. Results: Commonest morbidity was malnutrition (70.71%), followed by ARI (63.59%), anaemia (47.76%), diarrhea (20.58%), malaria (13.33%) and worm infestation (10.03%) while around 25 percent suffered from other illnesses. Most common symptom was fever (70.71%) and cough (62.8%). A statistically significant association was found in morbidity pattern of ARI, diarrhea, malaria, malnutrition and anaemia with various factors like education, socio-economic status, and occupation. Congenital anomalies were found in around 3 percent children. 3.69 percent children were admitted in wards from OPD. Conclusion: Common childhood illnesses were prevalent though children suffered from serious illnesses on very few occasions.
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Although sepsis is a major cause of morbidity and mortality among newborns in resource-poor countries, little data are available from rural areas on culture-proven sepsis. The aim of the present study was to provide information in this regard. The study reports results on the incidence and aetiology of neonatal sepsis cases admitted to a facility in a rural area in eastern India. Blood culture was done for all babies, with suspected clinical sepsis, who were admitted to the sick newborn care unit at Suri where the study was conducted during March 2009–August 2010. A standard form was used for collecting clinical and demographic data. In total, 216 neonatal blood culture samples were processed, of which 100 (46.3%) grew potential pathogens. Gram-negative infection was predominant (58/100 cases) mainly caused by enteric Gram-negative bacteria. Klebsiella pneumoniae was the most common Gram-negative isolate. The emergence of fungal infection was observed, with 40% of the infection caused by yeast. Gram-negative organisms exhibited 100% resistance to ampicillin, cefotaxime, and gentamicin. Amikacin and co-trimoxazole showed 95% (n=57) resistance, and ciprofloxacin showed 83.3% (n=50) resistance among the Gram-negative bacteria. Carbapenem showed emerging resistance (n=4; 6.6%). Results of analysis of risk factors showed an extremely significant association between gestation and sepsis and gender and sepsis. Gastrointestinal symptoms were highly specific for fungal infections. One-third of babies (n=29), who developed culture-positive sepsis, died. Blood culture is an investigation which is frequently unavailable in rural India. As a result, empirical antibiotic therapy is commonly used. The present study attempted to provide data for evidence-based antibiotic therapy given to sick newborns in such rural units. The results suggest that there is a high rate of antibiotic resistance in rural India. Urgent steps need to be taken to combat this resistance.
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A pilot study was undertaken to develop a feasible neonatal screening strategy for hemoglobinopathies. Isoelectric focusing using dried blood spots samples as a primary screening technique was standardized for the first time in India. The screened positives were confirmed by high performance liquid chromatography followed by parental screening, confirmation, and education.
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A cross sectional study was conducted during May-June 2010 among woman of reproductive age group (15-45 years) in the urban and the rural areas of Bareilly District to asses the level of awareness regarding RTIs/STDs. The two stage cluster sampling technique was adopted. A structured questionnaire was used to interview the study participants during the house to house surveys. Each woman of reproductive age of selected household was interviewed in private about her reproductive history, current knowledge, source of information and modes of transmission of RTIs/STDs. Statistical analysis was done with Epi Info computer software. Standard Normal Variate (SNV) Test for comparison of two groups’ proportion was done; z and p were calculated to know the significance of the proportions of two groups for comparison. Most of the women were aware of RTIs/STDs (80.32%) in urban areas whereas only 27.41% in rural areas were aware of these diseases. The television and radio was the main source of information in both rural (41.17% & 32.94%) and urban areas (TV-90.36%, Radio-48.19%).
Subject(s)
Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Drug Resistance, Multiple, Bacterial , Enterobacteriaceae/drug effects , Enterobacteriaceae/enzymology , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/microbiology , Humans , India , Microbial Sensitivity Tests , beta-Lactamases/metabolismABSTRACT
A Sick Newborn Care Unit (SNCU), established in a district hospital in India, substantially reduced the neonatal mortality rate in the district; it, however, suffered from a dearth of trained nurses. Local girls with 10-12 years of school education underwent structured and hands-on training for six months, followed by a six-month internship at the SNCU and were assigned to it as stipendiary 'Newborn Aides'. Based on the results of formal examinations, internal on-the-job assessment and interview of doctors, nurses, and parents and their technical skills and motivation were rated very high. Although the incremental cost of training is small, the cost of sustaining them, i.e. stipend and replacing attrition, needs to be addressed. Trained Newborn Aides may substantially alleviate human-resource constraint for SNCUs and Sick Newborn Stabilization units in smaller peripheral hospitals for care of sick newborns at an affordable cost.
Subject(s)
Adolescent , Adult , Community Health Workers/education , Delivery of Health Care/methods , Female , Hospitals , Humans , India , Infant Mortality , Infant, Newborn , Internship, Nonmedical , Male , Maternal-Child Health Centers , Perinatal Care/standards , PregnancySubject(s)
Child , Hamartoma/diagnosis , Humans , Male , Nevus/diagnosis , Sebaceous Gland Neoplasms/diagnosisABSTRACT
Low birth-weight is a leading health problem in developing countries. In a randomized controlled trial, the effect of antimicrobials in pregnant women on improving birth-weight and duration of gestation was evaluated. Two hundred twenty-four pregnant women in their second trimester were randomized to receive metronidazole (200 mg 3 times daily for 7 days) and cephalexin (500 mg twice daily for 5 days) orally by one group. The mean (+/-SD) birth-weights were 2,545 g (+/-374) and 2584 g (+/-358, p=0.51), the low birth-weight rates (<2.5 kg) were 40% and 36% (p = 0.28), and the prematurity rates were 8% and 11% (p = 0.6) in the treated group and the control group respectively. Due to small sample size, it is cautiously concluded that routine antimicrobials for genital and urinary tract infections of pregnant women do not improve birth-weight or duration of gestation. Rather an unexpected observation was the proportion requiring caesarian section or forceps, which was five-fold higher in the treated group (p = 0.001), and given no plausible explanations, this finding needs confirmation. Stunted mothers (<25th centile or 146.4 cm) had two-fold higher risk for low birth-weight (p = 0.04) and assisted delivery (p = 0.1). Low maternal body mass index (<25th centile or 18) had six-fold higher risk for stillbirth or abortion (p = 0.007), and high body mass index (>75th centile or 21.2) had three-fold higher risk for assisted delivery (p = 0.003).