Incidence and management of acid peptic disorders in sickle cell disease patients in Western Odisha

Background: Sickle cell disease (SCD) is a chronic hemolytic disorder characterized by the presence of crescent-shaped red blood cells. Abdominal pain is the common presenting symptom in adults with SCD. Among the patients who are not in crisis, it is estimated that one third of patients with homozygous SCD with chronic recurrent epigastric pain has endoscopic evidence of peptic ulcer disease. Aims and Objectives: This study was undertaken with an aim to analyze the incidence and management of acid peptic disorders among SCD patients in Western Odisha. Materials and Methods: A prospective study was done considering 88 homozygous SCD patients. All the patients underwent upper gastrointestinal endoscopy (UGIE) with gastric antral biopsy and rapid urease test (RUT). Cases with Helicobacter pylori were administered a 14 days course of three drug regimen of anti H. pylori drugs and followed-up to 6 weeks of beginning the treatment with repeat UGIE and RUT. Results: Out of 88 cases, 19 cases had duodenal ulcer (21.6%) which was significantly high than patients with gastric ulcer (13.6%). Other findings were gastroesophageal reflux disease and gastritis. About 93.5% of patients became RUT negative after taking anti H. pylori medication. Conclusion: SCD patients with acid peptic disorder constitute a sizeable proportion of patients attending surgical outpatient department and indoor department of surgery. Conservative treatment with life style modification can effectively improve the symptoms of acid peptic disease.

Profile of distress callers and service utilisation of tele-counselling among the population of Assam, India: an exploratory study during COVID-19

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected people globally by causing psychological, social, and economic chaos. The Assam Police, India started telephone helplines to address the psychological issues. Aims: To evaluate the sociodemographic profile of the distress callers, their psychosocial concerns, the interventions provided by the service provider, and whether the service users were satisfied with the intervention(s) or not. Method: It was a cross-sectional study done during the period of lockdown (7-24 April 2020). All the callers who called the helpline were screened for anxiety, depression, suicidal thoughts (when required), and the psychosocial issues which they were facing were explored. They were provided the psychological intervention(s) at the appropriate time, and they were asked to rate their experience at the end. Results: A total of 239 callers used the tele-counselling services. The majority of callers were male (79.1%). Most of the callers were between 19-35 years of age group (66.5%), married (52.5%), and graduates (31%). Two-thirds of the callers called to seek guidance for their own issues and one-third for their relatives or friends. Callers had anxiety (46%), depressive disorder (8.3%), and depressive symptoms not qualifying for depressive disorder (14%), and suicidal thoughts (5.44%). The commonest intervention provided to the callers was supportive (77.8%), followed by psychoeducation (30.5%), cognitive behaviour therapy (24.7%), relaxation (23.6%) and behaviour therapy (13.4%). Most of the callers utilised more than one type of therapy. Overall, most of the callers were satisfied and appreciated the tele-counselling services. Conclusion: The findings could help in formulating psychological interventions to improve the mental health of vulnerable groups in the post-COVID-19 period to reduce psychiatric morbidity and mortality.

Factors associated with inter-district variation of maternal mortality in Assam

Background: Maternal mortality is an important indicator of the health and socioeconomic status of a nation. Assam has the highest maternal mortality ratio (MMR) in the country. Although maternal death is a biomedical event, the contributory factors are many. Objectives: The objectives of the study were to assess the role of demographic, socioeconomic, nutritional, health service availability, and utilization indicators in inter-district variation of maternal mortality in Assam. Materials and Methods: We conducted an analysis of maternal mortality using district-level secondary data of 27 districts of Assam. The dependent variable was the MMR, while independent variables were demographic, socioeconomic, nutritional, health service availability, and utilization indicators. Pearson correlation and linear regression analysis were done to assess the relationship between MMR and 14 indicators at the district level using SPSS version 20. Results: MMR decreased linearly with increase in proportion of rural population and accounted for 20% variability (P = 0.018). Proportion of households with access to safe drinking water had a significant negative linear association with MMR and accounted for 27% of variability (P = 0.005). MMR increased linearly with increase in proportion of pregnant women with anemia at the district level (P = 0.019). Community health centers (CHCs) per million populations were found to have a negative linear association with MMR and accounted for 15% of variability in MMR at the district level. Conclusions: Proportion of rural population, households with access to safe drinking water, pregnant women with anemia, and CHCs per million populations were associated with inter-district variation of maternal mortality in Assam.

An unusual case of orbitocranial wooden foreign body with amazing outcome: A case report

Penetrating orbitocranial injuries can present with foreign body/bodies (FBs) lodged in eye, orbit, and/or brain. But limited literatures are available about FBs lodged partly in orbit and partly intracranially. Here, we present a rare case of orbitocranial wooden FB impacted in right palpebral aperture extending intracranially following accidental fall from height. Unexpectedly, the patient himself removed the FB in fully conscious and oriented state while waiting for neurosurgical intervention, later completely recovered under observation and antibiotic prophylaxis. Therefore, it is important to have high suspicion of intracranial extension in impacted orbital FBs and a team approach for managing such cases.

The effect of a newly established urban diarrhea treatment facility in Bangladesh: Changing patient characteristics and etiologies

Background: Mirpur treatment centre (MTC), Dhaka of the International Centre for Diarrhoeal Disease Research, Bangladesh, was established as a consequence of an outbreak of diarrheal disease during the summer month of April 2007 in Mirpur area. Objective: The present study aimed to evaluate the impact of this new facility on patient load, common etiology, and other characteristics of patient population who sought treatment at Dhaka Hospital. Methods: As part of the Diarrheal Disease Surveillance System (DDSS), 10% patients (every 10th) seeking care irrespective of age, sex, sociodemographic background, and severity of disease were enrolled at MTC as opposed to 2% (every 50th) at Dhaka Hospital following identical methodology from 2010 to 2013. Moreover, enrolled DDSS patients from 2005 to 2009 at Dhaka Hospital were also included in analysis to further examine the impact of MTC on Dhaka Hospital. Results: Patient load from Mirpur area attending the Dhaka Hospital reduced from 13% during epidemic in 2010 to 6% in 2013 (53% reduction), whereas attendance in MTC increased substantially by 33%. This changing trend was also observed among children <5 years old. A significant reduction of patients presenting with moderately severe disease from Mirpur area at Dhaka Hospital was observed (69% reduction); however, attendance at MTC increased by 26% during same period. Conclusion: The number of patients from Mirpur area in Dhaka Hospital reduced but increased at MTC explaining the need for establishment of a set up for early treatment and control of diarrheal disease when consistent increase in annual number of cases or at the time of upsurge of cases is observed.

Ecology of Two Riverine Wetlands of Goalpara District, Assam in Relation to Plankton Productivity.

Ecological investigation of two riverine wetlands of Goalpara district, Assam, India was carried out in relation to planktonic productivity from 2006 to 2008. The physico chemical parameters were found fluctuating with the growth of both phytoplankton and zooplankton. Both the beel was dominated by Chlorophyceae throughout the year amongst which Ulothrix and Spirogyra were found as dominating species. Among the Copepods, Cyclops was over all dominating species and amongst the Cladoceran groups; Daphnia, Bosmina and Moina were found in the wetlands throughout the studied period. Phytoplankton community of Urpod beel constituted 58.82% to 65.52%, while zooplankton community constituted 34.48% to 41.18% of the total plankton hauled throughout the studied period. Chlorophyceae fluctuates between the range of 47% to 58%, Bacillariophyceae 20% to 27% and Myxophyceae fluctuates between the ranges of 20% to 30%. Mean value of GPP in Hasila beel was estimated between the range of 2.88 gC/ m2/day and 4.66 gC/ m2/day, while in Urpod beel it was between 2.75g Cm-2day-1 and 4.27g Cm-2day-1.

Length-weight relationship and condition factor of Aorichthys aor (Hamilton-Buchanan) in Lower Reaches of River Brahmaputra.

The studies were conducted during 2008–2010 to evaluate length-weight relationship and condition factor of Aorichthys aor in lower reaches of River Brahmaputra. 750 nos of fishes having weight of 20g to 1250 g and total length of 10 cm to 55 cm were recorded. The Cube law or Length–weight relationship was calculated as W = 0.00352 L3.246. The coefficient of correlation (r) between observed length & weight and calculated length & weight was 0.96 and 0.93 respectively, which indicated highly significant relationship between length and weight. The exponent (b) value obtained indicating the positive allometric growth pattern. The relative condition factor (Kn) value was found higher in fishes of above 650 g weight groups.

Ichthyofaunal diversity of lower reaches of the Brahmaputra River, Assam.

An investigation was carried out from February 2009 to January 2010 in the core fish landing centres of Goalpara district, Assam to evaluate the present status of ichthyofaunal diversity of the lower reaches of Brahmaputra River. A total of 97 species including exotic species belonging to 56 genera of 26 families were recorded from all the fish landing centres. Among these, according to IUCN status, 5 species are endangered, 21 species vulnerable, 29 species lower risk-near threatened, 7 species lower risk-less concern and other 29 species are not evaluated. The families recorded were Notopteridae, Clupeidae, Engraulidae, Cyprinidae, Psilorhynchidae, Balitoridae, Cobitidae, Bagridae, Siluridae, Schilbeidae, Sisoridae, Clariidae, Heteropneustidae, Chacidae, Mugilidae, Beloniidae, Synbranchidae, Mastacembelidae, Chandidae, Nandidae, Cichlidae, Gobiidae, Anabantidae, Belontidae, Channidae and Tetradontidae. Seasonal variations of the fishes were also noticed remarkably. The taxonomic composition of the fish fauna suggests, Cyprinidae were the most dominant family with 39 representative species (42.8%) followed by Bagridae having 7 species (7.7%). The study reveals that lower reaches of River Brahmaputra is very rich in ichthyofaunal diversity. However, strategies such as controlled harvest, checks on growth of exotic species, controlling water pollution etc. are suggested for conservation of the native and endemic fish species of the region.

Eradicating Polio: It's Feasibility in Near Future.

Continuous wild poliovirus transmission despite 12 years of intensive surveillance has raised serious questions about the feasibility of polio eradication programme with current strategy in near future. At present most of the cases are confined to four endemic countries, which are causing sporadic outbreaks in non-endemic areas. India has experienced a significant increase in number of cases reported in 2006 compared to previous year. Outbreaks originated in western UP which was due to the accumulation of susceptibles between the last outbreak in 2002 and early 2006. Substantial improvement has been observed in strategies of polio eradication but still there are gaps in the programme implementation which needs immediate attention so that goal of polio eradication can be achieved at the earliest opportunity. Even though there are many issues but there are also many factors, which favour polio eradication. These factors include new tool in form of m OPV, natural immunity due to recent outbreak, limiting international spread of polio, new researches to guide programme in right direction, political commitments from endemic countries, etc. 2008 presents the best opportunity ever to interrupt wild polio virus transmission which will lead to global eradication of Polio. Since global eradication is within sight, it is scientifically possible to eradicate the disease in near future.

Preponderance of GC-rich sites in silver-stained nucleolus organizing regions of Rita rita (Hamilton) and Mystus gulio (Hamilton) (Bagridae, Pisces), as revealed by chromomycin A3-staining technique and scanning electron microscopic studies

The karyotypes of two species of catfish, Rita rita (Hamilton) (2n = 54; 14m + 34sm + 6st; NF = 102) and Mystus gulio (Hamilton) (2n = 58; 30m + 12sm + 2st + 14t, NF = 100) were studied through Giemsa-, silver- and chromomycin A(3)-staining techniques. The silver-stained karyotypes in both sexes of R. rita and M. gulio revealed that the nucleolus organizing regions were located terminally at the shorter arms (Tp) of one pair of submetacentric chromosomes, placed at positions Nos. 2 and 1, respectively, which was confirmed by scanning electron microscopy. Staining with a GC-specific fluorochrome, chromomycin A(3), produced bright fluorescence in the Ag-positive nucleolus organizer regions, suggesting thereby that nucleolus organizing regions actually included GC-rich sites of active r-RNA genes in metaphase chromosomes of these two bagrids. Further such studies are needed due to the extreme paucity of data on fish.

Treatment of primary localised cutaneous amyloidosis with cyclophosphamide.

The study was undertaken to evaluate the efficacy of cyclophosphamide in primary localised cutaneous amyloidosis. Thirty-six patients of primary localised cutaneous amyloidosis were treated with cyclophosphamide 50 mg. tablets orally daily for a period of six months. Most of the patients following the therapy showed marked improvement in respect of itching, pigmentation and sizes of the popular lesions. Side effects of cyclophosphamide were very low.

A study of drug eruptions by provocative tests.

Sixty cases of drug eruptions were observed during the period of one year. The incidence of drug eruption was 0.47% amongst all Dermatology O.P.D. attendances. Male to female ratio was 7:3. The highest number of cases were seen in the age group of 21-30 years. Fixed drug eruptions were the most frequent (58.3%), followed by urticaria and angioedema (20%). The drug sulphonamides (including co-trimoxazole) accounted for the highest number of eruptions (35%). The other drugs which were responsible for the eruptions, in order of frequency, were oxyphenbutazone, ampicillin, analgin, penicillin, tetracycline, ibuprofen, paracetamol, phenylbutazone, acetaminophen and phenobarbitone. The causative drug (s) were confirmed by provocation tests in 42 (70%) cases.

First care givers of mentally ill patients: a multicenter study.

Pathways to psychiatric care were evaluated among three hundred and eighty four first-contact psychiatric patients from five socio-culturally different regions of India by a modified version of World Health Organization encounter form for 'pathways in psychiatric care'. Concerning first caregivers, out of 384 respondents 34.1% had chosen the psychiatrists, 29.4% the general practitioners and 26% had chosen faith healers and exorcists. Choice for the first caregiver was not influenced by gender differences, literacy status and family type. Mostly the subjects hailing from rural areas and those presenting with somatic symptoms chose psychiatrist as their first caregivers.

Profile of glaucoma in a major eye hospital in north India.

PURPOSE: To study the clinical profile and distribution of various subtypes of glaucoma in a referral practice in North India. METHOD: A retrospective analysis was done of 2425 patients who attended the glaucoma clinic in a tertiary eye-care centre for five years from January 1995 to December 1999. A detailed history was obtained and a thorough examination was performed, including gonioscopy, disc assessment, applanation tonometry and automated perimetry. Diurnal variation of IOP and provocative tests for glaucoma were done where applicable. RESULT: Primary angle closure glaucoma (PACG) was the most common glaucoma subtype. The primary open angle glaucoma (POAG) to the PACG ratio was 37:63. Chronic angle closure glaucoma (CACG) was the most common PACG subtype. The majority of CACG cases were relatively asymptomatic. Male dominance was seen for POAG, juvenile open angle glaucoma (JOAG), CACG, normal tension glaucoma (NTG) and secondary glaucomas. Female dominance was seen for ocular hypertension (OHT), acute or intermittent ACG and developmental glaucomas. The mean age in years at presentation was POAG:60.54 years (males 61.54 years, females 59.01 years) and PACG: 55.13 years (males 57.25 years, females 53.60). The three common secondary glaucomas were: glaucoma secondary to adherent leucoma, aphakic and pseudophakic glaucomas and traumatic glaucomas. Advanced glaucoma was detected in 42 to 53% of patients and bilateral blindness in 8 to 14% of patients in various subtypes. CONCLUSION: Compared to Caucasians, glaucoma patients in North India seem to present nearly a decade earlier and the disease is more advanced at presentation. While PACG is the most commonly encountered glaucoma, NTG and exfoliative glaucoma are relatively rare.