ABSTRACT
Background: Clinical sign of osteoporosis includes fragility fractures or a T-score that is <2.5 SD below the mean as determined by a dual-energy X-ray absorptiometry (DXA) scan of bone mineral density (BMD). People with T-scores of –2.5 have the highest risk of fracture. People with T-scores of –2.5 have the highest risk of fracture. However, maximum fractures are seen in patients with a T-score between –1 and –2.5 because of more people in this category. As there is very little knowledge of osteoporosis in perimenopausal and postmenopausal women in male region, this study will help us to know the current status of osteoporosis in these females. Aims and Objectives: The objective of the present study was to determine the prevalence of osteoporosis in 296 premenopausal, perimenopausal and postmenopausal women of more than 40 years of age attending midlife health clinic at a tertiary care center in Patiala, Punjab and to observe its correlation with age, menopausal status, body mass index, and dietary intake. Materials and Methods: A detailed medical, surgical, obstetrical, gynecological, and drug history were recorded in a pro forma designed for the study after taking the informed consent. Information about history of fracture on a trivial fall, family history suggestive of osteoporosis, socioeconomic status, educational status, and occupation was documented. Women having history of endocrinal disorders (hypo/hyperthyroidism, hypo/hypergonadism, and hypo/hypercalcemia), receiving therapeutic agents (thiazide diuretics, glucocorticoids, and osteoporosis treatment), having restricted mobility issues and with implants (at lumbar spine, hip, and lower limbs) were excluded from the study. Quantitative ultrasound (QUS) measurement of calcaneum was performed that T-score was generated based on the speed of sound and was used to classify the bone health status of the subjects. Results: Out of 296 women, 227 women had a low bone mass density, that is, <–1 SD. We divided all the participants into three groups as shown in Table 1. Group I (n = 69 [23.2%]) having normal BMD, that is, T score >–1 SD; Group II (n = 204 [69.2%]) included women with BMD between –1 and –2.5 SD (Osteopenia); and Group III (n = 23 [7.6%]) included women with BMD <–2.5 SD (Osteoporosis). Most women in perimenopausal (75%) and postmenopausal (64.6%) group were osteopenic (Group I). Out of all women with osteopenia (Group II, n = 204), 113 (52.1%) were postmenopausal and 82 (40.3%) were perimenopausal. All women with osteoporosis were postmenopausal. The difference between BMD categories and menopausal status was statistically significant (P = 0.014). In these women, the BMD was found to decrease with increase in the average number of years since menopause (YSM) (P = 0.06). Conclusion: Menopause is an important event in a woman’s life cycle which affects bone health with the prevalence of osteoporosis and osteopenia increasing with increasing YSM. QUS technology emerges as cost-effective screening tool for the early detection of osteoporosis for a large population in developing country like India.
ABSTRACT
The biomedical waste, if not properly managed, can harm the surrounding environment, cause various infections and injuries to the healthcare workers, patients, their attendants. Methods: This cross-sectional study was conducted to assess the knowledge, attitude and practices among different cadres of health care providers in a tertiary care institute. Expecting that 50% of the study population had precise knowledge about the rules and legislation of biomedical waste management, with an allowable error of 10%, at 95% confidence interval, and accounting for the finite population correction for 1700 participants, a minimum sample size of 426 was taken. Data analysis was done by using Microsoft excel and SPSS. Results: Out of 426 subjects, 138 (32.4%) were nurses, 35 (8.2%) were lab technicians and 253 (59.4%) were housekeeping staff. Knowledge, attitude and practices regarding biomedical waste management and handling were significantly (p<0.05) higher among the nurses as compared to other health care providers. Conclusions: Knowledge, attitude and practices regarding the collection, segregation, rules, and disposal of biomedical waste management was more among nursing staff compared to other health care workers. Hence, emphasis on adequate training is required among other health care workers for the safe handling and disposal of biomedical waste management.
ABSTRACT
Introduction Undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery. The percentage of undernutrition, stunting and wasting in children under 5 years of the age in India are 35.7, 38.4 and 21.0 respectively. The etiology of malnutrition is complex and multi-factorial usually a consequence of inadequate dietary intake and various diseases. Methodology: A community based case-control study was conducted among children aged 6 to 59 months, registered at the Anganwadi centers in an urban locality of Surat city, Gujrat. Study population was divided into cases and controls using WHO classification based on anthropometric measurements. Result: The prevalence of undernutrition and severe acute malnutrition among the under-five children were 26.2 and 8.7% respectively. Significant association was found between nutritional status of the children and type of the family( OR 3.84, 95% CI =1.87-7.86, p = 0.000), low birth weight (OR 4.85, 95% CI =2.29 � 10.26, p = 0.000), poor appetite (OR = 2.89, 95% CI = 1.38-6.01, p = 0.004), bottle feeding (OR = 5.41, 95% CI = 1.91-15.29, p= 0.001) and children with habits of eating wafers/candies (OR = 21.99, 95% CI = 9.02-53.60, p = 0.000). Conclusion: Severe acute malnutrition continues to be an important health concern among under five children in the urban area and is affected by many risk factors which can be mitigated through structured and timely interventions using IEC materials.
ABSTRACT
Introduction: The standard of care for treatment of cancer cervix is concurrent chemoradiation followed by brachytherapy in the majority of cases. Conventional radiotherapy with chemotherapy causes haematological toxicities which may be related to radiation to pelvic bone marrow. The present study aims to study the haematological toxicities and correlate with the mean dose to the bone marrow. Material and Methods: Retrospective data of cancer patients treated in the institute in the year 2019 was retrieved. Haematological toxicities were analyzed in terms of CTCAE criteria. Mean dose to bone marrow was calculated after the delineation in the CT scan. The correlation between haematological toxicity and mean bone marrow was done using a paired t-test for statistical significance. Results: The data of 20 patients were retrieved. Anaemia Grade, I and Grade II-IV was seen in 65% and 35% respectively. Leukopenia Grade I and Grade II-IV were seen in 85% and 15% respectively and Lymphopenia Grade I and Grade II-Iv were seen in 55% and 45% respectively. The mean dose to bone marrow did not show any statistical significance with the severity of haematological toxicity. There was no Grade II-IV toxicity of neutropenia and thrombocytopenia. Conclusion: Conventional radiotherapy can safely be practice for patients with cancer cervix with acceptable haematological toxicities.
ABSTRACT
Introduction: Radiotherapy in head and neck cancers is treated for several weeks and daily setup and reproducibility is a challenge. This daily variability causes setup errors which accounts planning target volume margins. Reduced PTV margins have to be taken to decrease the dose to the parotid glands, without compromising on loco regional control rates. The present study is done to identify setup errors and see the feasibility to decrease the PTV margins by creating dummy radiotherapy plans in order to decrease dose to parotid glands. Material and Methods: 420 portal images were evaluated for setup errors in three dimensions (Antero Posterior, Left to Right and Superior to Inferior) which were performed in ten patients of oropharyngeal squamous cell carcinoma. All patients were treated in supine position using immobilization cast. After target volume delineation a PTV margin of 7mm was given. Dosimetric parameters of PTV and organs at risk were assessed. PTV margins were calculated according to three methods proposed by Stroom, Van Herk and ICRU 62. Dummy radiotherapy plans were generated using new PTV margins and compared with 7mm PTV margins. The data was analyzed using 3-way ANNOVA test for statistical significance. Results: The optimum PTV margins were 4mm in LR and SI direction and 7mm in AP direction. The PTV parameters (V95, D95, Dmax, Dmean, HI and CI) had no significant difference among different radiotherapy plans with different PTV margins. There was a significant decrease in the dose to right parotid (39.12 Gy to 32.88Gy; p-0.04), left parotid (37.90 to 31.21Gy; p-0.03) and parotid combined (38.65 to 31.45 Gy; p-0.01) when 7mm PTV margins were reduced to 4mm PTV margins. The results of dummy radiotherapy plans using asymmetric PTV margins (LR-4mm, SI-4mm and AP-7mm) and symmetrical PTV margins (4mm in all directions) are compared with PTV margins (7mm in all directions), in terms of PTV and OAR dosimetric parameters. Conclusion: The decreased PTV margins of 4mm decreases the dose to the parotid significantly. The implementation of radiotherapy plans needs to be supplemented by daily IGRT.
ABSTRACT
Background & objectives: The growing incidence and the wide diversity of carbapenemase-producing bacterial strains is a major concern as only a few antimicrobial agents are active on carbapenem-resistant bacteria. This study was designed to study molecular epidemiology of carbapenem-resistant Gram-negative bacterial (GNB) isolates from the community and hospital settings. Methods: In this study, non-duplicate GNB were isolated from clinical specimens, and phenotypic test such as modified Hodge test, metallo ?-lactamase E-strip test, etc. were performed on carbapenem-resistant bacteria. Multiplex PCR was performed to identify the presence of blaIMP, blaVIM, blaKPC, blaOXA48, blaOXA23, blaSPM, blaGIM, blaSIM and blaNDM. Minimum inhibitory concentration (MIC) of colistin, fosfomycin, minocycline, chloramphenicol and tigecycline was also determined. Results: Of the 3414 GNB studied, carbapenem resistance was 9.20 per cent and maximum resistance (11.2%) was present at tertiary care centre, followed by secondary care (4%) and primary centre (2.1%). Among the carbapenem-resistant bacteria, overall, the most common isolate was Pseudomonas aeruginosa (24%). On multiplex PCR 90.3 per cent carbapenem-resistant isolates were positive for carbapenemase gene. The blaNDM(63%) was the most prevalent gene followed by blaVIM(18.4%). MIC results showed that 88 per cent carbapenem-resistant Enterobacteriaceae were sensitive to fosfomycin, whereas 78 per cent of P. aeruginosa and 85 per cent Acinetobacter spp. were sensitive to colistin. Interpretation & conclusions: Carbapenem resistance in GNB isolates from the community and hospital settings was found to be on the rise and should be closely monitored. In the absence of new antibiotics in pipeline and limited therapeutic options, prudent use of antibiotics and strict infection control practices should be followed in hospital to limit the emergence and spread of multidrug-resistant bacteria.
ABSTRACT
Introduction: Over past few decade morbidities and mortalities associated with NCDs (Non-Communicable Diseases) leads to a significant loss of productive life years both in developed and developing countries. Therefore, the present study was done to determine the prevalence of common risk factors for major NCDs in a rural population of Barabanki district in eastern Uttar Pradesh. Materials and Methods: The present cross-sectional study was conducted in Satrikh block of Barabanki district. Multistage sampling was used for enrolment of the study subjects. A totalof 1824 participants aged ≥25 years were enrolled in the study. WHO STEPs- wise tool was used to collect information on behavioural risk factors like tobacco use, diet, alcohol useand associated anthropometric indices were measured. Results: Prevalence of tobacco smoking, smokeless tobacco products use, alcohol consumption, less than five servings of fruits/vegetables, more than five grams of salt intake and overweight/obesity was found to be 26.2%, 27.08%, 24.1%, 91.61%, 10.9% and 34.86% respectively. Individuals with age more than 35 years, male subjects, illiterates and those who belonged to scheduled castes/tribes were significantly (p<0.05) more predisposed to both smoked tobacco as well as smokeless tobacco use and alcohol consumption.Consumption of alcohol was significantly (p<0.05) higher among employed groups who belonged to upper and upper middle class while tobacco consumption was more prevalent in lower socioeconomic group. Consumption of salt more than 5 grams per day was significantly higher among individuals in elder age group (35-65 days), among females, those who were literate, those who belonged to other backward castes and among government employees. Conclusion: The study revealed high prevalence of non-communicable disease risk factors among adults. This indicates towards need of prompt community based preventive measures and control strategies to lower the forthcoming consequences of NCDs.
ABSTRACT
El priapismo es una emergencia urológica que debe ser diagnosticada y tratada apropiadamente. Específicamente en casos conocidos de leucemia el pene turgente doloroso debe hacer surgir la sospecha de priapismo de primera movida y el Doppler peneano debe ser la mera línea de modalidad de imágenes. Esta información debe ser transmitida al paciente y al departamento clínico emergentológico
Priapism is an urological emergency and must be diagnosed and treated appropriately. Specifically in known cases of leukemia painful turgid penis should raise suspicion of priapism in first hand and penile Doppler should be the first line of imaging modality. This information should be forwarded to patient and emergency department clinician
Subject(s)
Humans , Male , Penis/pathology , Priapism/diagnosis , Priapism/therapy , Blood Gas Analysis , Leukemia, Myeloid/complications , Leukapheresis/methods , Ultrasonography, Doppler, Duplex , Drug TherapyABSTRACT
Background: Knowledge of the normal and variant anatomy and anomalies of coronary circulation is an increasingly vital component in the management of congenital and acquired heart disease. Anatomical variations in relation to coronary artery and its branches will help cardiac surgeons for refining imaging techniques and coronary artery bypass grafting. The current study is aimed at understanding the normal patterns of coronary arteries with reference to its predominance, branching pattern, variations and anomalies. Methods: Heart specimen for this study were obtained from Department of Anatomy, SIMS Hapur and GFIMSR Ballabhgarh. The cadaveric human hearts were dissected to observe the coronary arteries and its branches. Results: The diameter of right and left coronary orifices were measured. The distance of the orifices from the supravalvular ridge was also measured. The length and the diameter of the coronary arteries and its branches were measured and statistical significance was determined. Conclusion: The present study revealed that, ostium diameter of left coronary artery is larger than the right coronary artery. The outer diameter of the left coronary artery is larger than the right coronary artery. The mean lumen circumference of left coronary artery, anterior interventricular artery, right coronary artery and circumflex artery is more in males as compared to female. This knowledge is important for interpretation of the coronary angiography and surgical myocardial revascularization and paramount to cardiac surgeons for proper diagnosis and treatment of cardiac ailments and radiologists to refine image interpretation.