Depression and diabetes: A tendency or demon of darkness among diabetics? A cross-sectional study among type 2 diabetes mellitus patients attending an “integrated diabetes and gestational diabetes clinic” of Eastern India

Background: Depression is a common comorbid condition found in chronic medical illnesses in general and diabetes mellitus (DM) in particular. Worldwide, more than 365 million people are estimated to have Type 2 DM (T2DM), and almost 300 million people have major depression. Depression can be viewed as a Modifiable independent risk factor for the development of T2DM and for progression of complications from either type 1 or T2DM. Objectives: The aim of the study was to find out the distribution and determinants of depression among T2DM patients attending an integrated diabetes and gestational diabetes clinic (IDGDC) of a tertiary care hospital of West Bengal, East India. Materials and Methods: This cross-sectional, observational study was conducted among T2DM patients who attended IDGDC during May 2017–June 2017. Public Health Questionnaire-9 was used to assess depression and its severity. A total of 196 study subjects participated in the study. Results: The prevalence of depression was found to be 54.6%. About 28.1% of the study subjects had mild depression, 17.9%, 6.1%, and 2.6% subjects had moderate, moderately severe, and severe depression, respectively. Women gender, increasing age, rural residence, low literacy, longer duration of diabetes, and overweight/obesity were significantly associated with high frequency of depression. Addiction was significantly higher among depressed T2DM patients. Mean hemoglobin A1c level was significantly lower among non-depressed T2DM patients. Conclusion: More than half of the T2DM patients are suffering from depression of varying severity. There should be a dedicated counselor in diabetes clinics for routine screening of depression among all T2DM patients to identify the high-risk patients requiring urgent psychiatrist consultation.

Development delay in children with severe acute malnutrition and its association with Vitamin B12 deficiency

Background: About half of the under five children are malnourished in India and so is morbidity associated with it. Malnutrition is also associated with multiple vitamin deficiency one of which is vitamin B12. Vitamin B12 is essential for DNA, RNA and protein synthesis; and for myelination of brain during the early childhood period. Deficiency of vitamin B12 can lead to megaloblastic anemia and neurological problems. So, authors aimed to look prevalence of vitamin B12 deficiency and; its hematological and neurological effects in severe acute malnourished children.Methods: it was an observational case control study, in which severe acute malnourished (SAM) children aged 0- 59 months who were admitted in Nutritional Rehabilitation Centre (NRC) were enrolled. Vitamin B12 levels were estimated and levels <200 pg/ml, 200-350 pg/ml, and >350 pg/ml were considered deficient, insufficiency and sufficient. Complete blood count was done for hematological effects and; developmental assessment was done to look for neurological effects.Results: Vitamin B12 was deficient, insufficient, normal in 15(16.3%), 25 (27.5%) and 52 (56.5%) children respectively. Vitamin B12 deficiency was significantly associated with hyperpigmentation and glossitis. Infant and young child feeding practices were not associated vitamin B12 deficiency. Macrocytic anemia was found in 23.4% SAM children and macrocytosis was not significantly associated with vitamin B12 deficiency.' Developmental delay was found in 55.3 % children and was not significantly associated with severe acute malnutrition.'Conclusions: There is high prevalence of Vitamin B12 deficiency and insufficiency in children with severe acute malnourished children. Macrocytic anemia and developmental delay are not significantly associated with vitamin B12 deficiency.

Phytochemical Investigation and In-vitro Antifungal Activity of Essential Oil from the Roots of Selinum vaginatum C. B. Clarke

Aim: The study was to evaluate the phytogenic chemical compounds and Antifungal Activity of essential oil from roots of Selinum vaginatum C.B. Clarke, growing in the Himalayan region of Jammu & Kashmir. Methodology: The essential oil was analyzed by Gas Chromatography & Gas Chromatography-Mass Spectrometry in relation with their Kavot indices and mass spectra. Results: The oil was found completely dominated by oxygenated sesquiterpenoids (71.9%) which includes 14-hydroxy-δ-cadinene (37.5%), khusinol (20.7%), viridiflorol (8.0%), acorenone -B (4.2%) and 14-oxy-α-muurolene (1.1%) whereas δ-cadinene (8.9%), α-copaene (6.8%), germacrene-A (2.5%), and β-caryophyllene (1.3%) were the major compounds among sesquiterpenoids. Monoterpenoids constituted as the minor portion (3.8%) of essential oil. The oil was found almost free from oxygenated monoterpenoids (0.2%). The roots of S. vaginatum are used in folk lore medicines in Jammu & Kashmir. The oil from the roots showed marked antifungal activity. The oil had shown 100% mycelia growth inhibition against A. tenuis, C. graminicola, R. solani and S. sclerotiorum at a concentration of 500 µg/ml, 2000 µg/mL, 2000 µg/mL and 300 µg/mL respectively. However F. oxysporum was found less susceptible to the root oil of S. vaginatum. The IC50 values showed a range from 57.4 µg/mL–74.7 µg/mL as compared to standard fungicides with IC50 values 32.8 µg/mL–98.6 µg/mL. The spore germination inhibition test revealed the root oil as a potent inhibitor with IC50 values as 201.4 µg/mL, 414.7 µg/mL and 784.7 µg/mL for A. tenuis, C. graminicola and F. oxysporum. Conclusion: Our study showed that14-hydroxy-δ-cadinene (37.5%), khusinol (20.7%), & viridiflorol (8.0%) are the major components in this oil and possessed potent antifungal activity against test fungal strain, respectively.

“Near-Miss obstetric events” and its clinico-social correlates in a secondary referral unit of Burdwan District in West Bengal

Near-miss obstetric events (NMEs) refers to the situations where women experience severe, life-threatening obstetric complications during pregnancy, delivery, or postpregnancy (up to 42 days) which they survive either by chance or because they receive good care at a facility. A cross-sectional study was conducted from May to June 2016 at the subdivisional hospital of West Bengal. The WHO near-miss criteria were followed for case identification. Data were collected by interview and record review. No maternal deaths were reported during data collection period; however, the frequency of NMEs was quite high (38%). Maternal near-miss ratio was 379.51/1000 live births, and maternal mortality index was 0%. Higher age group, below poverty line status, term pregnancy, and higher gravid and higher parity significantly favored the occurrence of NMEs, while ANC registration and Iron and Folic Acid consumption were significantly protective against it. Early identification of risk factors for NMEs and prompt initiation of treatment plays a critical role in the management of NMEs.

Imaging in acute abdomen.

OBJECTIVE: The present study aims at establishing the exact role and limitation of ultrasound in pediatric acute abdomen. METHODS: Fifty children less than 14 years of age presenting with acute abdomen were evaluated by US and other imaging modalities. The mean age of presentation was 3 1/2 years. Maximum number of cases were seen in less than two years of age. There were 17 cases of intussusception with US sensitivity and specificity of 88.2% and 100% respectively and positive and negative predictive values of 100% and 94.5% respectively. There were 13 cases of appendicitis. US was diagnostic in 11 with sensitivity and specificity of 91.6% and 97%; the positive and negative predictive values were 91.6% and 97% respectively. RESULTS: There were two cases each of congenital bands, adhesive intestinal obstruction, malrotation of bowel with volvulus, incarcerated inguinal hernia, hypertrophic pyloric stenosis, duplication cyst and pseudopancreatic cyst, one case each of trichobezoar, Meckel's diverticulum, ureteric calculus and worms as a cause of intestinal obstruction. The sensitivity of US for diagnosing specific cause of acute abdomen was found to be 77.5%. The main limitation of US was in the diagnosis of acute intestinal obstruction such as congenital bands and adhesions. CONCLUSION: US should now be considered as imaging modality of choice in pediatric acute abdomen. However, at times, plain radiography, conventional contrast studies and CT may be vital to reach the true diagnosis.

Prevalence and severity of dental caries and treatment needs among population in the Eastern states of India.

The present epidemiological investigation was conducted on a total sample of 2067 individuals in the age groups of 5-6, 15-16 and 30-35 years belonging to urban (U) and rural (R) areas of three states of eastern region of India viz. West Bengal (U & Rn = 361 & 359), Orissa (U & Rn = 351 & 351) and Sikkim (U & Rn = 323 & 321). Dental caries recording was done according to WHO index 1983. The point prevalence of dental caries, deft/DMFT and defs among all the three age groups in the urban and rural areas of three states revealed common pattern i.e. (i) Dental caries was higher in 5-6 year old children (U & R - W.B. = 52.4% & 48.3%, Orissa = 56.0% & 48.7% and Sikkim = 61.8% and 22.0% exception) as compared to 15-16 years (U & R.- WB. = 21.0% & 15.2%, Orissa = 18.3% & 19.8%, and Sikkim = 30.1% & 17.9%) and 30-35 year old individuals (U & R WB = 19.4% & 18.1% Orissa = 24.3% & 20.1% and Sikkim 29.9% & 24.5%) in West Bengal, Orissa and Sikkim respectively, (ii) dental caries was higher in urban as compared to rural areas. The decayed (d/D) component contributed maximum to total deft/DMFT and defs/DMFS score, followed by e/M (missing due to caries) and f/F component (filling) which was negligible or absent. Teeth requiring various type of treatment found that one or two surface fillings were maximum followed by others. Fluoride content of drinking water was negligible (0.004 - 0.011 ppm).

Silver amalgam versus resin modified GIC class-II restorations in primary molars: twelve month clinical evaluation.

The purpose of this study was to compare the clinical efficacy of resin modified GIC with amalgam as a restorative material, in Class-II cavities of primary molars. Restorations were evaluated at four, eight, and twelve months for their marginal integrity, anatomic form and development of recurrent caries. When each parameter was considered separately, there was no difference in the success rate between the two groups, except development of recurrent caries significantly less (p<0.05) in RMGIC group(4.7%) compared to amalgam group (12.5%) at twelve month follow up. However, the cumulative success rate at 12 month was found to be significantly higher (p<0.05) in RMGIC (Fuji II LC) group(83.1%) compared to amalgam(72%).

Effects of variation in the timing of palatal repair on sagittal craniofacial morphology in complete cleft lip and palate children.

The complete cleft lip and palate children, ranging from 6-14 years of age were studied to evaluate the effect of variation in the timing of palatal repair on craniofacial morphology and compared to the noncleft children. It was observed that all the groups early (8 to < or = 24 months), medium (> 24 to < or = 36 months) and late repair (> 36 to < or = 78 months) had significantly larger cranial base, retruded maxillomandibular relations, skeletodental and incisal relationships compared to the noncleft children. However, intercomparison among the cleft groups showed insignificant difference amongst them suggesting that the timing of palatal repairs does not effect the anterioposterior (sagittal) relationship.

Effects of variation of the timing of palatal repair on nasality of speech in complete cleft lip and palate children.

Nasality is related to factors like velopharyngeal closure and acoustic factors pertaining to cavities. The present investigation is a retrospective study aimed at evaluating the effects of variation in the timing of palatal repair on nasality during speech development in complete cleft lip and palate cases. It has been observed that the delay in palatal repair is associated with increase in nasality. Also, from the operated complete cleft lip and palate cases, it has been observed that the early and medium repair groups had almost similar effects on nasality of speech. (if they were operated before 36 months of age).

Effects of variation in timing of palatal repair on articulation skills in complete cleft lip and palate cases--a retrospective study.

The effects of variation in the timing of palatal repair on articulation skills in complete cleft lip and palate was evaluated from fifty subjects. The present study confirmed that development of articulation was similar in the groups operated upon before 24 months and between 24 to 36 months. The insignificant difference suggests that articulation was good irrespective of the early or medium timing of palatal repair.

Remineralizing efficacy of a mineral enriched mouth rinse and fluoridated dentifrice on artificial carious lesions: an in vivo scanning electron microscopic study.

This comparative investigation was carried out to evaluate the remineralization potential on early artificial carious lesions under Scanning Electron Microscope (SEM) of a Mineral enriched mouthrinse and a fluoridated dentifrice using an in-vivo intra-oral removable appliance model. This findings revealed that the remineralization was found to have occurred in almost all the samples (in children) using non-fluoridated, fluoridated dentifrices as well as those using mineral enriched mouthrinse. However the qualitative analysis of the remineralization revealed that in case of non-fluoridated dentifrice group, the prismatic holes showed deposition of granular, variable sized particles with uneven distribution, while in fluoridated dentifrice group, deposits were found to have partially but more densely filled up the prism cores. In case of mineral enriched mouthrinse group these deposits were found to be in the form of amorphous globular precipitate.

Calcium hydroxide as a root canal filling material in primary teeth--a pilot study.

A pilot study was carried out in five mandibular primary molars using calcium hydroxide (Ca(OH)2) Paste as root canal filling material to find out an alternative to the routinely used zinc oxide eugenol (ZnOE), which is non-resorbable and causes deflection of succedaneous teeth. The six month clinical and radiographic follow-up carried out at 2 months interval, revealed that the treated teeth with Ca(OH)2 as root canal filling material were successful, showing no pain and tenderness to percussion. A tendency for decrease in size of radiolucency was seen. Two teeth showed complete healing of the periradicular radiolucency. Depletion of Ca(OH)2 paste was seen from the root canals even prior to physiological resorption of roots in 2 out of 5 treated teeth.

Bioavailability of fluoride in humans from commonly consumed diets in India.

There is a paucity of data on the amount of fluoride absorbed in humans from whole cooked food; especially a combination of different foods taken at regular meal times. The present study was thus aimed at estimating the amount of fluoride present and absorbed in humans from four regional representative meals viz. North Indian Vegetarian, North Indian Non-vegetarian, South Indian and East Indian. Twenty five healthy human volunteers aged 22-35 years participated in the study and each diet was tested on five volunteers. Each test diet was weighed into six equal parts, one part was kept for estimation of fluoride content and remaining five were given one each to the five test subjects in each of the four test diet groups. Eight hour plasma fluoride profiles were then studied after ingestion of weighed quantity of test diets and means calculated. The bioavailability of fluoride from these diets was evaluated in relation to that of sodium fluoride in solution form. The amount of fluoride estimated in different test diets varied between 1.53 - 10.0 mg. The bioavailability was found to be 1.6 per cent for north Indian vegetarian diet, 7.5 per cent for east Indian diet, 14.4 per cent for north Indian nonvegetarian diet and 31.7 per cent for south Indian diet, however, the amount of F(mg) absorbed in plasma from these diets was found to be low i.e. 0.06 mg, 0.75 mg, 0.72 mg and 0.48 mg respectively.

Prevalence of malocclusion and abnormal oral habits in North Indian rural children.

This epidemiological investigation was conducted on a sample of 3164 rural children aged 6-15 years in Raipur Rani and Naraingarh blocks in the district of Ambala in Haryana. 29. 2 percent of rural children were found to have malocclusion whereas 70.8 per cent had normal occlusion. Class I malocclusion was found to be maximum in 14.4 per cent of children, while malocclusion with class II molar relationship was observed in 13.5 per cent of children. Malocclusion with Class III molar relationship was seen in 1.3 per cent of the population studied. Three per cent of rural children were found to have abnormal oral habits, predominantly tongue thrusting and thumb sucking. The frequency distribution of abnormal oral habits in children with malocclusion was found to be 10.3 per cent.

Sagittal craniofacial morphology in repaired unilateral and bilateral complete cleft lip and palate cases.

Fifty repaired complete cleft lip and palate cases (38 UCLP and 12 BCLP) in the age of 6 to 14 years were evaluated for sagittal craniofacial morphology using lateral cephalograms. A total of twenty three measurements (19 angular and 4 linear) were used in the analysis to represent a comprehensive pattern of dento craniofacial morphology. The results of comparison between UCLP and BCLP revealed differences for only the skeletodental and interincisor sagittal relationship (greater retroclination in BCLP group).

Evaluation of the change in the knowledge of community regarding infant dental care subsequent to intervention strategies through existing health manpower in rural areas of Haryana (India).

The knowledge about infant dental care (as a part of primary preventive programme) was delivered by the existing health team of CHC viz. medical doctors, multipurpose workers, health workers, Anganwadi workers (ICDS scheme), after due training from the dental experts, in the rural community of Raipur Rani (Haryana). The knowledge of community regarding infant dental care subsequent to intervention strategies when evaluated and compared to baseline values three years after intervention revealed that 72 percent of the community had the correct knowledge of prolonged breast/bottle feeding causing nursing bottle caries. 94 per cent had correct knowledge about harmful effects of thumb/finger sucking on teeth and jaw bones and 77 percent about harmful effects of mouth breathing. 98 percent of expecting mothers knew when to clean the gum pads and 62 percent how to clean the gum pads in an infant. 100 percent of the expecting mothers had the correct knowledge that pacifiers should not be used in small children.

Clinico-haematological profile in acute and chronic Plasmodium falciparum malaria in children.

The clinicohaematological findings of acute state (Group A, 30 patients) and chronic state (Group B, 34 patients) of falciparum malaria in paediatric patients are compared. The children with chronic falciparum malaria were apyrexic and presented with features of moderate to severe anaemia with hepato-splenomegaly. Greater severity of anaemia and haemolysis, higher incidence and severity of neutropenia, atypical lymphocytosis, monocytosis and thrombocytopenia were observed in patients with chronic falciparum malaria as compared to patients with acute falciparum malaria despite lesser degree of parasitaemia in the former as compared to the latter. While mechanical destruction of parasitised RBC's, ineffective and dysplastic erythropoiesis either due to unmasking of border line dierty folic acid deficiency or otherwise, transient hypoplasia of bone marrow, impaired utilization of iron and immune destruction of RBCs with hypersplenism may be the mechanisms for anaemia, transient hypoplasia of bone marrow and hypersplenism may be the factors responsible for thrombocytopenia and neutropenia.