A Cost-Effective Novel Method of Preparing Plastinated Specimens of Brain

The human bodies and organs have traditionally been preserved using formalin solution, although it irritates the eyes, nose and throat. Plastination is an unique and expensive method for preserving biological samples that can be used in teaching and research. Therefore, the goal of the current study was to prepare a costeffective solution using thermocol to plastinate the brain specimens as a supplement for teaching and research. Two human brains were used in this pilot research project. According to standard procedures, the brains were first fixed in 10% formaldehyde, sectioned horizontally, sagittally and coronally dehydrated in acetone, and then immersed in the plastination solution at room temperature and pressure. Then the specimens were airdried at room temperature. A team of 62 Anatomists and Pathologists assessed the quality of the specimens using a self-developed grading scale. The grading was provided based on the specimens’ clarity, stability, aesthetic look, colour and smell. Statistical analyses was performed using SPSS software, Kruskal Wallis test showed that the lowest mean score was 4.04 provided for colour and highest mean score was 5 provided for the smell with a statistically significant p<0.001. Thus our plastinated specimens were of good quality, durable and handlefriendly. Our study demonstrated that the cost-effective plastination solution (CEPS) procedure is an inexpensive and efficient way to create plastinated specimens that are appropriate for teaching neuroanatomy.

Glycemic Control and its Determinants among People with Type 2 Diabetes Mellitus in Ernakulam District, Kerala

Background: Diabetes is a public health problem of colossal proportions. The National Family Health Survey 5 (2019–2020) has found high blood sugar levels among 13.5% of women and 15.6% of men in India. The high morbidity and mortality in diabetes mellitus are due to uncontrolled hyperglycemia resulting in micro- and macrovascular changes affecting multiple organs in the body. The objectives of this study were to estimate glycemic control and its determinants among type 2 diabetics in the Ernakulam district. Methods: A community-based cross?sectional study was conducted among 364 type 2 diabetics who had the disease for at least 5 years duration in the Ernakulam district of Kerala. Probability proportional to size cluster sampling technique was adopted. A semi-structured questionnaire was used to collect sociodemographic and behavioral profiles. Participants’ HbA1c levels were assessed to determine glycemic control. Results: The proportion of people with good glycemic control was 21.4%. Determinants such as female gender adjusted odds ratio (aOR = 2.36, P = 0.005), body mass index >23 kg/m² (aOR = 2.71, P = 0.002), combined drug treatment with Oral Hypoglycaemic agents (OHA) and insulin (aOR = 3.76, P = 0.004), and poor compliance with medications (aOR = 1.93, P = 0.030) were found to be significantly associated with poor glycemic control. Conclusions: Poor compliance with medications and unhealthy lifestyle choices has resulted in a high proportion of diabetics with poor glycemic control in the district. Women are particularly more vulnerable to uncontrolled hyperglycemia than males. Type 2 diabetes mellitus people should be encouraged to maintain strict glycemic control, which is an important measure for secondary prevention of complications.

Burden of dengue in Kerala using disability-adjusted life years from 2006 to 2016

Background: State-specific disability-adjusted life years (DALYs) are seldom calculated. Understanding the health and disease trends in groups of states is useful for finding the heterogeneity of disease epidemiology in the country. Objective: The objective of the study was to assess dengue burden in Kerala state, using DALY. Methods: DALY was computed using the DALY package of R. Incidence was derived using reported and estimated dengue cases for 2006–2016. Mortality was calculated using reported deaths. We computed DALYs using the mortality estimates for the South-East Asia region (SEAR) also. Sensitivity and scenario analyses were done. Results: The highest estimated relative DALY for dengue is 7.22 (95% confidence interval [CI]: 6.66–7.72) per lakh population. The DALY obtained using the mortality rates of SEAR ranged from 19.89 (95% CI: 8.44–29.45) per lakh population to 28.56 (95% CI: 17.04–38.05). We observed a cyclical pattern of increase in DALY every 2–3 years. The DALY in lower age groups is lesser. DALY in females was higher than males. Conclusions: The dengue-related DALY for the state of Kerala is lower than that of the global burden of disease due to lower mortality rates. Mortality reduction becomes the key to reducing burden, especially in areas of low incidence. The study also forms the benchmark for evaluating and implementing cost-effective measures for dengue control in the state.

Compliance and its determinants to pharmacologic management of hypertension

Background: Compliance to medications and lifestyle modifications is important in the management of hypertension. Aims and Objectives: The purpose of this study was to measure the compliance and its determinants to pharmacological management of hypertension. Material & Methods: A population based cross sectional survey was conducted among 221 known hypertensives in medical college health unit area of urban Trivandrum. Results: Mean age of the study subjects was 64.6 yrs (SD 10.6). The overall compliance with antihypertensives was 62.4%. Male gender, joint/extended family type, family support, co-morbidities, once daily regimen, awareness about the BP control status and adequacy of BP control were the predictors of good compliance. The barriers to compliance were alcohol abuse, out of pocket expenditure and more number of pills/day. Conclusion: Drug compliance among the study population was low compared to previous studies. Low drug compliance and poor blood pressure control among the hypertensives in the area warrants immediate actions to prevent the development of complications. The burden of morbidity and mortality due to hypertension and related complications on the family and health system will be immense if the situation is left unattended.

Mortality risk among tobacco users in a rural population of southern India: Evidence from a cohort study.

Background. Tobacco has long been identified as one of the most hazardous risk factors detrimental to health. To plan and implement anti-tobacco activities in any community, it is necessary to understand the risk it poses in that setting. We assessed the risk of mortality associated with tobacco use in a rural community of Kerala. Methods. This cohort study (PROLIFE) was done in Varkkala, a rural development block of Thiruvananthapuram district of Kerala. Adults aged 20 years and above were included. Age-adjusted mortality rates were computed for both users and non-users of tobacco. The risk of mortality was plotted using Kaplan–Meier curves. Cox regression was used to compute the age-adjusted hazard ratio of mortality among tobacco users. Results. More than one-fourth of the study population used tobacco. The age-adjusted mortality rates were higher among tobacco users. The major causes of death among both users and non-users of tobacco were similar. The incidence proportion of death among all causes of death was higher for tobacco users. The hazard of mortality was significantly more among tobacco users, with the age-adjusted hazard ratio being 1.225 (1.140–1.315). Conclusion. The mortality risk due to tobacco use is high irrespective of the cause of death.

Environmental factors of households in five districts of Kerala affected by the epidemic of chikungunya fever in 2007.

Background. Two epidemics of chikungunya fever were reported from Kerala in 2006 and 2007. We aimed to investigate the environmental factors of households affected by chikungunya fever and to estimate the proportion of population that suffered from the disease during the epidemic in 2007. Methods. A cross-sectional survey was conducted in the 5 heavily affected districts of Kerala during October–November 2007. The 2-stage sampling technique was used to collect data from 10 clusters, each having 18 houses from every district, by interviewing the subjects using a structured questionnaire. The sample size was 900. Results. The proportion of the population affected by chikungunya fever was 57.1% (95% CI: 52.8%–61.4%). There was a significant association between location of houses and disease status. Houses located near a public conveyance facility (within 250 m) were relatively protected from the disease (OR 0.19 [0.06–0.60]). About 69% of the households perceived mosquito infestation as a problem and 46.6% used fumes to avoid mosquitoes. More than 42% of households were not using any anti-mosquito measures at the time of the survey. Stored drinking water was the most common potential breeding source in the houses (23.5%). Households which did not store water inside were protected from the disease (OR 0.22 [0.08–0.65]). Conclusion. The study indicated the persistence of favourable domestic and environmental factors after the epidemic, reflecting the necessity to strengthen anti-mosquito campaigns.

Eosinophilic meningitis due to Angiostrongylus cantonensis.

Angiostrongylus cantonensis is a nematode parasite that inhabits the pulmonary arteries and heart of rodents. It is one of the causative agents of fatal eosinophilic meningoencephalitis in man. We present five cases of eosinophilic meningitis presumably due to infection with Angiostrongylus cantonensis . All the five patients gave history of ingestion of monitor lizard within ten days of onset of symptoms.

Splenic abscess in a boy with isolated levocardia.

Levocardia with situs inversus is a rare condition. We present the case of a fourteen-year-old boy with congenital cyanotic heart disease, isolated levocardia and splenic abscess. It is the first report of both these conditions occurring in the same person.

Neonatal mechanical ventilation.

OBJECTIVE: This study was undertaken to analyze indications, complications, outcome and the factors influencing neonatal mechanical ventilation. METHODS: Prospective observational study conducted on 102 consecutive newborns, who required mechanical ventilation in a medical college tertiary neonatal care setting. RESULTS: The commonest indication was birth asphyxia (37.3%), followed by hyaline membrane disease (HMD) (31.4%), meconium aspiration syndrome (MAS) (21.2%), septicemia (14.7%) and apnea of prematurity (5.9%). The overall survival rate in our study was 51%. Babies weighing less than 1.5 kg and less than 32 weeks of gestation had survival rates of 30% and 25% respectively. The best outcome among various indications was observed in babies with MAS (63.6%) followed by pneumonia (62.5%) and HMD (53.1%). Babies with birth asphyxia and septicemia had a low survival rate of only 42% and 40% respectively. The overall complication rate in the study was 58.8%. Common complications encountered were septicemia (42%), tube block (36%) and air leak (15%). CONCLUSION: About half (51%) of newborns requiring mechanical ventilations for various indications survived and more than half (58.8%) developed complications. The study also reconfirms that survival rate increases with birth weight and gestational age irrespective of indication.

Intestinal helminthic infestations among tribal populations of Kottoor and Achankovil areas in Kerala (India).

The present study was undertaken among 258 subjects belonging to 152 houses of two tribal communities (Kani and Malampandaram) settled in Kottoor and Achankovil areas, respectively of Thiruvananthapuram and Kollam districts in Kerala, South India. The survey covered people of all age groups and both the sexes from the study population. Out of the total 258 stool samples examined, 60 showed ova of one or more intestinal helminthes, showing the overall prevalence of 23.3% with a confidence interval of 18.5-28.45. Among the tribal populations of two areas studied, Achankovil area showed an increased overall prevalence rate (26.15%) as compared to Kottoor area (22.27%). The difference in prevalence rates of the two areas is found to be statistically significant (p-value 0.01). Hookworm infestation was found to be predominant (58.82%) in Achankovil and the remaining (41.1%) was due to only roundworm. Whereas in Kottoor area, roundworm infestation predominated (74.41%) followed by hookworm (18.6%) and other types (6.97%). Analysis of haemoglobin (Hb) level of the 190 study population showed that 66.32% were anaemic (<11 gm/dl) from both the areas. The proportions of subjects either moderately anaemic (7 gm/dl-11 gm/dl) or severely anaemic (<7 gm/dl) were almost same in the two study groups, showing a similar pattern in both the areas with no statistically significant difference. Haemoglobin level in relation to helminthic infestation revealed that in the worm infested group, 81.1% (43/53) was anaemic, as compared to only 60% (83/137) of non-worm infested group, showing significant difference (p value=0.01). Hb level in relation to helminthic infestation also seemed to differ in both the areas. Among the environmental factors studied in relation to helminthic infestation, the practice of hand wash alone was found out to be statistically significant, showing that habit of proper hand wash considerably reduces the risk of helminthic infestation.

Type 2 diabetes in southern Kerala: variation in prevalence among geographic divisions within a region.

BACKGROUND: Numerous surveys carried out in India report the high prevalence of type 2 diabetes. Such studies have not included the population of Kerala. We estimated the prevalence of type 2 diabetes mellitus in Neyyattinkara taluk, Thiruvananthapuram district, Kerala state. METHODS: All panchayat wards in the taluk were grouped into urban, highland, midland or coastal, and one ward from each stratum was randomly selected for the study. All households were listed and adults, 20 years or older, screened for high (> 110 mg/dl) random blood sugar (RBS) by a glucometer test. Those with high RBS were reassessed by a fasting oral glucose tolerance test (OGTT), consisting of initial examination of venous blood for fasting plasma glucose (FPG) values, administration of 75 g of glucose dissolved in distilled water, and examination of venous blood for postprandial plasma glucose (PPPG) exactly 2 hours after the administration of glucose. Diabetes was diagnosed according to the World Health Organization criteria as either FPG > 139 mg/dl, or PPPG > 199 mg/dl, or both. Impaired glucose tolerance (IGT) was diagnosed if PPPG was 140-199 mg/dl. RESULTS: Out of 4988 eligible subjects, 3899 were available for the study, a response rate of 78.2%. Response was highest in the highland area (86.2%), and lowest in the coastal area (73.6%). The overall crude prevalence rate of type 2 diabetes was 5.9%. It was highest in the urban (12.4%), followed by midland (8.1%), highland (5.8%), and coastal (2.5%) regions. Ageing was associated with greater prevalence of type 2 diabetes in all regions and both sexes. Women showed a higher prevalence in the highland and coastal areas and men in the urban and midland areas. When compared to a population with standard age structure suggested by the World Health Organization for international comparisons, prevalence in the age group 30-64 years was found to be 16.9% in the urban, 10.1% in the midland, 6.8% in the highland and 3.6% in the coastal regions, respectively. Overall age-adjusted prevalence of type 2 diabetes in 30-64-year-olds in Neyyattinkara was 9.2% among men, 7.4% among women, and 8.2% for all persons. There was not much difference in prevalence if the American Diabetes Association criteria for diagnosis were used. The prevalence of impaired glucose tolerance was fairly low in this population. Out of 229 diabetics in the sample, 175 (76.5%) were already diagnosed and under treatment, while our survey identified 54 new diabetics (23.5%). CONCLUSION: Though prevalence of type 2 diabetes is high in this population, the detection rate is also high. However, impaired fasting glucose and impaired glucose tolerance are low. The reasons for this need to be elucidated.

Mattancherry urban agglomeration, a diminishing focus of lymphatic filariasis in Kerala.

Parasitological survey conducted recently in Mattancherry, Kerala showed a low prevalence of microfilariae (mf), with a mf rate of 1.81%, compared to that of 1956 when the mf rate was 14.7%. No brugian infection was encountered in the present investigation, though both bancroftian and brugian infections were reported earlier. Culex quinquefasciatus, the vector of bancroftian filariasis was the most predominant (93.3%) mosquito species, and its infection and infectivity rates were 0.76% and 0.54% respectively. Mansonioides spp., the vectors of brugian filariasis constituted only 0.2% of the total mosquitoes and with no infection. The overall reduction in the prevalence of mf cases and vector infection rates over the years is attributed to the continued activities of the National Filaria Control Programme. The disappearance of brugian filariasis could mainly be due to the drastic reduction in the Mansonioides breeding habitats, as a result of rapid urbanization coupled with improved socio economic conditions.