Influences of Total Life Style Changes in Leptin Level in Obese Type 2 Diabetes Mellitus

Background: To investigate the change of leptin levels after a total life style changes  (diet, exercise induced weight loss and behaviors modification) and the possible association between leptin and total life style changes (TLC) in obese subjects. Materials & Methods: A total number of forty obese subjects (twenty patients of DM type 2 and twenty age and sex matched healthy obese controls) divided into two different group (twenty in each) were studied. After recording a detailed history, a complete physical examination was carried out. Fasting serum leptin levels estimated and both group total life style changes intervention (diet control and exercise induced weight loss and behaviors modification) was given and after duration of eight-week TLC intervention, all subjects were reexamined and fasting serum leptin levels were re-estimated. Results: Obese diabetic group shows significant reduction in leptin levels 3.15 ± 10.87 in comparison with obese nondiabetic group 1.77 ± 9.21. Conclusion: Total lifestyle changes intervention (diet control and exercise induced weight loss and behaviors modification) significantly reduces leptin levels and significantly reduces the anthropometrics values and biochemical values in obese type 2 diabetes mellitus in comparison with obese nondiabetic group.

Strategies for attraction and retention of health workers in remote and difficult-to-access areas of Chhattisgarh, India: Do they work.

Background: To address the acute shortages of health workers in underserved, remote, and difficult-to-access areas, the Government of Chhattisgarh and the National Rural Health Mission (NRHM) launched the Chhattisgarh Rural Medical Corps (CRMC) in 2009. CRMC has enabled provisions such as financial incentives, residential accommodation, life insurance, and extra marks during admission at the postgraduate (PG) level to eligible doctors for the attraction and retention of health workers, i.e., doctors, staff nurses, auxiliary nurse midwives (ANMs), and rural medical assistants (RMAs) in underserved areas. Objectives: This study aims to understand the CRMC scheme in terms of implementation, challenges, gaps, and outcome in achieving the attraction and retention of health workers in the remote and difficult-to-access areas of Chhattisgarh. Materials and Methods: The study adopts a mix of both qualitative and quantitative research methods. The purposive sampling method was used for the selection of three districts having normal, difficult, and inaccessible areas. Data were collected through key informant (KI) interviews with beneficiaries and non-beneficiaries of CRMC or district and state government officials, and reviews of document were analyzed using a thematic analysis approach. Results: CRMC has made positive outcome as 1319 health workers, including doctors, have joined the service in 2010-11, reducing the vacancy of doctors from 90% to 45%. The scope of CRMC was primarily limited to payment of monthly financial incentives. The fund utilization rate of CRMC has increased (from 27% in 2009-10 to 98% in 2011-12), though there are delays in payment of incentives. The majority of staff lack awareness about CRMC during job applications. The payment of incentives based on facility performance has demotivated staff. Conclusions: Establishment of a performance management system, activating the CRMC cell to make it functional, and wide publicity of CRMC benefits are likely to improve attraction and retention of staff.

Contralateral stroke with rapid recovery in a patient of herpes zoster ophthalmicus

Herpes zoster ophthalmicus commonly presents with vesicular eruptions of skin along a dermatome and post herpetic neuralgia. Viral invasion into the intracranial vessel and resultant arteritis is rare complication, reported mainly in elderly, children and immunocompromised individuals. We report a young immunocompetent male who reported to us with acute right sided hemiparesis following an episode of left sided herpes zoster ophthalmicus three months prior to stroke. Patient had a near complete recovery of his weakness without any treatment with persistent mild dysarthria. Magnetic resonance imaging of brain showed subacute infarct in left middle cerebral artery territory. Magnetic resonance angiogram demonstrated marked narrowing of the proximal segment of left middle cerebral artery. This case highlights herpes zoster ophthalmicus as one of the causes of stroke in young with good prognosis.

Tuberculosis of the middle ear with post auricular abscess.

A case of tuberculous otitis media with post auricular abscess is being described in a 14 year old female patient in view of its rare occurrence. The diagnosis was made on demonstration of acid fast bacilli (AFB) in the ear discharge and characteristic cytological features of post auricular abscess aspirate.