ACCESS TO SAFE DRINKING WATER REMAINS NEED OF HOUR IN PREVENTING BACTERIAL AND PARASITIC DIARRHEA AMONGST UNDER 5 CHILDREN

In India, diarrhea prevalence among under 5 years children remains high and is associated with a wide range of bacteria, parasites, and viruses, transmitted through contaminated food and water. The present study aimed at the detection of enteric pathogens in children with diarrhea and its relationship to the source of drinking water. Fecal samples were collected from 157 children from July 2021 to July 2022. Among 157 children, parasitic and bacterial pathogens were detected in 4.5% (7/157). Parasites were detected in 2% (Giardia 67%, H nana in 33%) and bacteria in 2.5% (Ecoli O157 in 75% and salmonella in 25%) cases. Specific sources of drinking water more often associated with diarrhea were hand pumps (43%), house tap water (28.6%), bore well (14.2%), and well (14.2%) cases. Thus, demonstrating the persistence of significant pathogens and re-emphasizing that diarrheal illnesses are preventable through safe drinking water practices.

Innovations In Use Of E-Platform In The Development Of Tourism Sector In India With Respect To Odisha

There are a number of challenges that the travel and tourism sector in India face during post COVID-19 session. Innovations in e- platform are the adoption of infrastructure and information technology in the field of tourism by transforming the e-processes. Thereby it is an alarming time for marketing to attempt to match the hike in expectations of tourists and travelers to achieve effectiveness and efficiency in promotion of the tourism sector. e- Platform is playing an important revolutionized role both in consumer choice and service delivery processes. Due to the impact of Marketing 5.O, customers are becoming much more sophisticated and concerning because they have experienced high levels of service and standards of living as an user with high frequency of e mode in all aspect of marketing activities in recent days. It has been growing considerably due to the availability and penetration of more choices in e platforms in all aspects of marketing activities involved in tourism sector. The aim of this paper is to establish the fact happen in tourism sector due to variables in choices and opinion of tourists and travelers due post COVID session. A structured questionnaire is used to collect responses on e mail and WhatsApp. The survey is designed for 100 respondents and analysis is done by considering research objectives based on innovations and use of e platform in the development of tourism sector

A Prospective Study to Evaluate the Possible Role of Cholecalciferol Supplementation on Autoimmunity in Hashimoto’s Thyroiditis

Introduction : Several studies have reported a low Vitamin D status in Autoimmune Thyroid Diseases (AITD), indicating association between Vitamin D deficiency (<20 ng/ml) and thyroid autoimmunity. If supplementation of Vitamin D decreases anti-TPO antibody titres, in future it may become a part of AITDs' treatment, especially in those with Vitamin D insufficiency (21-29 ng/ml) or deficiency. Objectives : Our study aims to assess any potential therapeutic role of Vitamin D in the management of HT. Study Design : It is a randomised, double blind, single centre, placebo-controlled study. Results : Significant negative correlation between Serum anti TPO Antibody and Vitamin D level; statistically significant reduction of anti TPO Antibody titre in intervention group compared to placebo group. Conclusions : Vitamin D can be a therapeutic option in Hashimoto's Thyroiditis.

Pharmaceutical amorphous solid dispersion: A review of manufacturing strategies

Amorphous solid dispersions (ASDs) are popular for enhancing the solubility and bioavailability of poorly water-soluble drugs. Various approaches have been employed to produce ASDs and novel techniques are emerging. This review provides an updated overview of manufacturing techniques for preparing ASDs. As physical stability is a critical quality attribute for ASD, the impact of formulation, equipment, and process variables, together with the downstream processing on physical stability of ASDs have been discussed. Selection strategies are proposed to identify suitable manufacturing methods, which may aid in the development of ASDs with satisfactory physical stability.

Large anterior abdominal wall fibrosarcoma in a known case of recurrent dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans is a rare soft tissue sarcoma of low to intermediate malignant potential. Incidence is estimated to be 0.8 to 4.5 cases per million persons per year. The tumor is highly aggressive locally and is known to recur. Punch biopsy or excisional biopsy (in case of small tumors) are diagnostic. Computer tomography (CT) and magnetic resonance imaging (MRI) are useful in determining the size and extent of the tumor’s treatment is primarily surgical, with a wide local excision with at 2 cm margin. However, local recurrence after apparently adequate surgical excision is common. Mohs micrographic surgery has been recommended as it enables maximum preservation of tissue. When surgery is insufficient, imatinib mesylate is shown as a safe and effective treatment in dermatofibrosarcoma protuberans (DFSP), especially in cases of locally advanced or metastatic disease. Here, we report a case of a giant fibrosarcoma on the anterior abdominal wall, measuring 27×18×9 cm, which occurred in a recurrent dermatofibrosarcoma protuberans. Diagnosis was done by histopathological examination (HPE) of the previously excised tumor and CT was done. The tumor was excised with a 3 cm margin and extensive reconstruction of the anterior abdominal wall defect was done using synthetic mesh, myocutaneous flaps and split skin grafting. Keeping in view the recurrent nature of our case, large tumor size, DFSP-fibrosarcomatous (FS) transformation and close negative margins in the HPE of the postoperative specimen, the patient was planned for adjuvant radiotherapy.

A study of prevalence of migraine in stroke patients and its association with ischemic versus hemorrhagic stroke: a cross sectional study

Background: Migraine is characterized by recurrent attacks of disabling headache and autonomic nervous system dysfunction. Up to one third of patients also have neurological aura symptoms. It has been suggested that migraine can be a risk factor for stroke. Migraine affects three times the number of women than men. The incidence of stroke in men is two times that of women. It is shown in several studies that women aged 35 to 45 years old are at increased risk of ischemic stroke who had migraine with or without aura.Methods: The present cross sectional study was conducted in 350 consecutive patients of stroke who were attended OPD and admitted in wards of the Department of Medicine, M.G.M. Medical College and MY Hospital, Indore, MP, India, during period from December 2017 to December 2018.Results: The highest percentage of respondents i.e. 68% belonged to male group followed by 32% of respondents who were females. The highest percentage of respondents i.e. 66.6% had ischemic stroke while, 33.4% had hemorrhagic stroke. The highest percentage of respondents i.e. 90.9% had no Migraine while, 9.1% had Migraine. The highest percentage of respondents i.e. 31.2% had weekly reoccurrence, followed by forth nightly (25%) and lowest was 3.1% of daily recurrence. The association of type of stroke with sex group of patient’s history of headache which found to be significant (p ?0.05). The association of type of stroke with sex group of patient’s history of various cerebro-vascular risk factors which found to be significant (p<0.05). Patients having hemorrhagic and ischemic stroke also had HTN in 47% and 12.4% patients respectively.Conclusions: In this study it is concluded that migraine can be established as a risk factor for ischemic stroke. Early diagnosis and treatment with available medication can be helpful in prevention or decreasing risk for developing stroke.

Management of Flabby Ridge using Modified Window Technique and Liquid Supported Denture: A Case Report

Introduction: Rehabilitation of patients with flabby ridgesposes a great amount of difficulty for a prosthodontist. Asthe flabby tissues easily gets distorted while impressionmaking, the dentures fabricated on such foundations are oftencompromised in its retention and stability.Case report: Liquid supported denture fabricated usingmodified window impression technique in this case usesmucostatic impression technique where flabby tissue is locatedand the denture base is covered with a preshaped, closed fittingflexible PVC sheet which help in continued adaptation of thedenture to the mucosa in the resting and functional states.Conclusion: Liquid supported denture fabricated usingmodified window impression technique can stand a betteroption in case of flabby ridges while considering conventionalprosthodontics. This concept can further improve the patient’scomfort and acceptance because of uniform distribution ofmasticatory forces.

NSAIDs Preferred Over Opioid as Post-Operative Analgesic: A Prospective, Observational Prescribing Pattern Study in a Tertiary Care Hospital of Eastern India

Pain is an unpleasant sensation as a consequence of injury, disease along with emotional disorder occurring in varying degrees of severity. Poor control of pain is complete unethical, clinically unsound and economically disastrous. Effective pain control in postoperative period is one of the essential components of post-operative care for those patients who have undergone surgery. Inadequate and inappropriate pain control results in significant increase in post-operative morbidity or mortality. Methods: An prospective, observational analytical study by collection of data without intervention was done. Ethical committee’s approval was duly taken. Data were collected in the post- operative ward of department of general surgery from the bed side tickets of the patients. Results: In our current study we observed out of 515 postoperative patients 49.5% (255) were male and 50.5 % (260) were female, on the other hand more Hindu(85.4%) than Muslim(14.6%). On the day of surgery Monotherapy was prescribed for 440(67%) patients and 33% received both combination analgesic therapies. A total of 33% patients who received dual analgesic therapy immediate post-operative period most commonly used combination was Tramadol+Diclofenac (130/170), followed by Tramadol+ Paracetamol (40/170). In the following post-operative days increase in use of Diclofenac+Paracetamol was noted. No Triple drug therapy observed in this study. Conclusion: The results of current study shows that diclofenac was the most commonly prescribed analgesic. It is due to high efficacy of diclofenac in post operative pain control with better safty profile; i.e. lesser side effects compared to other analgesic.

Study of Antibiotic Utilization Pattern and Cost of Antibiotic Therapy in Patients Undergoing Cholecystectomy in a Tertiary Care Hospital of Eastern India

Cholecystectomy, one of the most common operative procedures done in our institution. In a developing country like India, choice of antibiotics should be rational to reduce the burden of cost. There are no standard treatment guidelines to follow regarding antibiotic usage causing indiscriminate use of this antibiotic. Methods: An observational, prospective analytical study by collection of data without intervention was done. Ethical committee’s approval was duly taken. Data were collected in the department of general surgery from the bed side tickets of the patients after taking a short history and informed consent from the patient. Cost of the therapy was calculated from CIMS (Current Index of Medical Specialities) and institutional pharmacy. Results: More commonly single antibiotic (190/320) prescribe followed by two antibiotic (80/320) and three antibiotic (50/320). Piperacillin + Tazobactum most commonly prescribe antibiotic as a single agent and overall. Ceftriaxone / Tazobactum + Metronidazole preferred combination when two antibiotic use at a time. Mean hospital stay 3.78 days. Average duration for prescribing of antibiotic 3.25 days. Mean cost for antibiotic in 984 INR, with a range 115-2700 INR. The average duration of stay in open Cholecystectomy was 7 days whereas the mean duration of stay in cases of laparoscopic Cholecystectomy was reduced to 3.07 days. Average antibiotic prescribing duration was 4.75 days significantly higher than Lap. Cholecystectomy (1.4 days). Conclusion: As there is no standard treatment protocol and antibiotic policy to follow antibiotics are used as pick and choose method due to lack of standard treatment protocol.

Antimicrobial prescribing patterns in surgical inpatient of tertiary care hospital in Eastern India

Background: Antimicrobials form the cornerstone of prescriptions for treating infection. Surgical management cannot be possible without the use of antibiotics. Severity of infection, suspected spectrum of organisms and their sensitivity, co-morbidities of the patient, route of antibiotic administration are the important parameter to consider before selecting antibiotic.Methods: Cross-sectional, hospital based, descriptive study was conducted in the ward of Surgery Department of IQ City Medical college, Durgapur over a period of 1 year. The relevant information was entered into the pretested preformats (containing name, age, sex, diagnosis, ongoing treatment as recorded from patients’ prescription slips or CRFs) and analyzed. Necessary permission was granted by the Institutional Ethical Committee and written informed consent was obtained from the patients prior to collecting their prescription slips/CRF.Results: Commonest cause of hospitalization was cholelithiasis (318 (32.7%)). Antimicrobials were the most commonly prescribed drugs (1626 (31.6%)). Single antibiotic prescribing frequency are similar to two antibiotic prescribing (both 44%). Piperacillin+Tazobactum combination most commonly prescribe antibiotic.Conclusions: Beta lactam antibiotic specifically Piperacillin (ATC class: J01D) were the most commonly prescribed antibiotic agents both before and after surgical procedures.

Prevalence of gestational diabetes mellitus and its relationship with various risk factors in a tertiary care hospital in West Bengal with special reference to tribal population, India

Background: Gestational diabetes mellitus (GDM) is the most common medical complication and metabolic disorder of pregnancy. The aim and objective of this study was to determine the prevalence of GDM and its relationship with various risk factors with special reference to tribal population.Methods: The study was done in 200 patients between 24 and 28 weeks of gestation, attending antenatal outdoor in a tertiary care hospital of West Bengal.  These patients were given 75gm oral glucose irrespective of the last meal and their plasma glucose was estimated at 2hours. Patients with plasma glucose values ≥140 mg/dl were labelled as GDM. Patients who were diabetic before pregnancy or whose pre pregnancy body mass index was not known or was in labour or had chronic disease, were not included in the study.Results: Prevalence of GDM was 11% in whole population while it was 14.63% and 10.06% in tribal and non-tribal population respectively.  Prevalence of GDM and its correlation with most of risk factors in previous pregnancies was found to be significant in both non-tribal and tribal population. Family history of diabetes mellitus was the most prevalent risk factor in both non-tribal (9.4%) and tribal population (14.63%). There was no single most common risk factor among GDM patients found as there were multiple risk factors present with same frequency in both tribal and non-tribal population.Conclusions: The prevalence of GDM is 14.63% in the tribal population and 10.06% in non-tribal population which is not statically significant (P<0.407). The relation between the prevalence of GDM and risk factors was found to be significant for most of the risk factors.

Diabetes mellitus as a risk factor for ischemic stroke: a case control study

Background: In developed countries, stroke is the third most common cause of mortality, following cancer and coronary heart disease. The increase risk is often seen in individuals with diabetes and is associated with poorer clinical outcomes (including higher mortality). That’s why assessment of risk factors for stroke are important.Methods: This age and sex matched hospital based case control study assessed the risk factors of ischemic stroke in tertiary care hospital for a period of one year. Sample size was calculated for matched case control (1:1 ratio) by n-master software and came out to be 189 pairs. All patients under WHO case definition were enrolled as cases for study purpose, controls were selected from the same hospital with disease other than stroke. Analysis was conducted through calculation of odd ratio (OR) and confidence internal (CI) by using SPSS 22.0 program. Odds ratio (OR) of risk factor was calculated using bivariate analysis.Results: Results revealed that male: female ratio among the case and control was 2.1:1, mean age of case and control were 58.86±13.03 and 58.21±12.67. Out of 189 Case, 59 (31.2%) were suffering from diabetes, while only 39 (20.6%) controls were having diabetes mellitus. P value was 0.02, which is significant.Conclusions: In the present hospital based case control study, it was found that diabetes mellitus was a significant risk factor among the ischemic stroke patients.

Current Status of Stem Cell Treatment for Type I Diabetes Mellitus

BACKGROUND: Diabetes mellitus is a major health concern in current scenario which has been found to affect people of almost all ages. The disease has huge impact on global health; therefore, alternate methods apart from insulin injection are being explored to cure diabetes. Therefore, this review mainly focuses on the current status and therapeutic potential of stem cells mainly mesenchymal stem cells (MSCs) for Type 1 diabetes mellitus in preclinical animal models as well as humans. METHODS: Current treatment for Type 1 diabetes mellitus mainly includes use of insulin which has its own limitations and also the underlying mechanism of diseases is still not explored. Therefore, alternate methods to cure diabetes are being explored. Stem cells are being investigated as an alternative therapy for treatment of various diseases including diabetes. Few preclinical studies have also been conducted using undifferentiated MSCs as well as in vitro MSCs differentiated into β islet cells. RESULTS: These stem cell transplant studies have highlighted the benefits of MSCs, which have shown promising results. Few human trials using stem cells have also affirmed the potential of these cells in alleviating the symptoms. CONCLUSION: Stem cell transplantation may prove to be a safe and effective treatment for patients with Type 1 diabetes mellitus.

Traumatic perforation of the tympanic membrane: Etiologies and risk factors for healing and intervention

OBJECTIVE: To study various etiologies of traumatic tympanic membrane perforation; evaluate the factors involved in healing of traumatic tympanic membrane perforation; and identify patients with perforations unlikely to benefit from conservative management.METHODS:Design: Prospective observational studySetting: Tertiary Government Medical College and HospitalParticipants: 64 consecutive cases of traumatic tympanic membrane perforation seen over one year were followed for 3 months. Perforations were assessed in terms of size, etiology, condition of edge and other associated factors or combinations of factors with regards to spontaneous healing using descriptive statistics and chi-square tests.RESULTS: Of the 64 cases, 51 perforations healed while 13 did not. There were significant associations between tympanic membrane condition after 3 months and explosive mode of injury (?2 = 23.30; p=.00001) as well as with size of perforation ((?2 = 25.75; p=.00001). The risk of persistence of a tympanic membrane perforation was 34.57 times more among patients with a perforation size >50% compared to those with perforation size ?50% [OR-34.57 (6.28, 190.14); p= .00001]. Combined, explosive etiology and perforation size >50% were significantly associated with non-healing ((?2 = 37.60; p = .00001). There were no significant associations with the condition of the edge of the perforation and upper respiratory tract infection.CONCLUSIONS: An explosive etiology and tympanic membrane perforation size >50% may be significant risk factors predicting non-healing of the perforation. Risk stratification of patients having one or both of these risk factors with early intervention for those with both, and close monitoring for those with any one of these may lessen unnecessary morbidity. Bigger multicenter future studies are necessary to confirm these initial findings.

Traumatic perforation of the tympanic membrane: Etiologies and risk factors for healing and intervention

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To study various etiologies of traumatic tympanic membrane perforation; evaluate the factors involved in healing of traumatic tympanic membrane perforation; and identify patients with perforations unlikely to benefit from conservative management.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Prospective observational study<br /><strong>Setting:</strong> Tertiary Government Medical College and Hospital<br /><strong>Participants:</strong> 64 consecutive cases of traumatic tympanic membrane perforation seen over one year were followed for 3 months. Perforations were assessed in terms of size, etiology, condition of edge and other associated factors or combinations of factors with regards to spontaneous healing using descriptive statistics and chi-square tests.<br /><strong>RESULTS:</strong> Of the 64 cases, 51 perforations healed while 13 did not. There were significant associations between tympanic membrane condition after 3 months and explosive mode of injury (?2 = 23.30; p=.00001) as well as with size of perforation ((?2 = 25.75; p=.00001). The risk of persistence of a tympanic membrane perforation was 34.57 times more among patients with a perforation size >50% compared to those with perforation size ?50% [OR-34.57 (6.28, 190.14); p= .00001]. Combined, explosive etiology and perforation size >50% were significantly associated with non-healing ((?2 = 37.60; p = .00001). There were no significant associations with the condition of the edge of the perforation and upper respiratory tract infection.<br /><strong>CONCLUSIONS:</strong> An explosive etiology and tympanic membrane perforation size >50% may be significant risk factors predicting non-healing of the perforation. Risk stratification of patients having one or both of these risk factors with early intervention for those with both, and close monitoring for those with any one of these may lessen unnecessary morbidity. Bigger multicenter future studies are necessary to confirm these initial findings.</p>

Bilateral congenital lacrimal fistulas in an adult as part of ectrodactyly-ectodermal dysplasia-clefting syndrome: A rare anomaly.

Ectrodactyly‑ectodermal dysplasia and clefting syndrome or “Lobster claw” deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD) obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR) which is a good alternative to lacrimal probing or open DCR in such a case.

Lateral rhinotomy for a large, infected haller cell causing proptosis

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To report a case of a large sinus Haller cell that presented with chronic rhinosinusitis and proptosis and its surgical management.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 34-year-old lady with proptosis and secondary sinusitis due to a giant infected Haller cell was successfully treated by lateral rhinotomy approach and clearance of all diseased mucosa therein into the nasal cavity.<br /><strong>CONCLUSION:</strong> Approach to diseased sinonasal structures via lateral rhinotomy is an alternative to endoscopic sinus surgery in the presence of an unusually large Haller cell.</p>

Basal cell adenoma of palate, a rare occurrence with review of literature

Basal cell adenoma is an uncommon benign epithelial neoplasm of salivary gland which derives its name from the basaloid appearance of tumor cells and accounting for 1-2% of all salivary gland epithelial tumors. This tumor usually arises in the major salivary glands, with the parotid being the most frequent site of occurrence, followed by the upper lip; while it is very rare in the minor salivary glands. Microscopically, it is composed of isomorphic cells similar to basal cells with nuclear palisading. We report a case of BCA presenting as an asymptomatic swelling over the right side of palate of 55-year-old female patient. A follow-up of 1 year revealed no recurrence. This report emphasizes the rare site of occurrence of this tumor and briefly reviews the literature

Efficacy of nonsurgical periodontal therapy on glycaemic control in type II diabetic patients: a randomized controlled clinical trial

PURPOSE: Diabetes and periodontal disease are two common diseases with high prevalence rates. Recent evidence has shown a bidirectional relationship between diabetes and periodontitis. The aim of this study was to investigate the effects of nonsurgical periodontal therapy on glycemic control in type 2 diabetes mellitus patients. METHODS: Sixty subjects aged 35-45 years with blood sugar controlled by oral hypoglycaemic agents were randomly divided equally among 3 groups: group A (scaling, mouthwash, and brushing), group B (mouthwash and brushing), and group C (brushing only). Glycated haemoglobin (HbA1c), fasting blood sugar (FBS), probing pocket depth (PPD), gingival index (GI), plaque index (PI), and the relevant drug history were recorded at baseline and after 3 months of intervention. Comparison of the mean difference among the variables was performed by parametric and nonparametric tests, which were further evaluated using multiple regression analysis. RESULTS: The mean differences between the PPD, FBS, HbA1c, GI, and PI in groups A and B were found to be statistically significant (P<0.001). Multiple regression analysis in group A showed that out of all the independent variables, GI and frequency of drug administration independently (b=0.3761 and b=0.598) showed a significantly greater impact on HbA1c (R2=0.832, P<0.05). CONCLUSIONS: Nonsurgical periodontal therapy can effectively decrease HbA1c levels in type 2 diabetes mellitus patients on medication.