Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India

Introduction: Aging is a natural process that usually results in physiological, biological, emotional, and financial decline. As a result, a robust health system is required to meet their escalating health needs. Through this study, we got an opportunity to study the morbidity profile of the elderly and to assess their health-seeking behavior and its determinants in urban areas of Chandigarh. Material and Methods: The sample consisted of 360 participants. Multistage and proportionate sampling techniques were used to recruit study subjects. A structured interview was carried out to get information on the different parameters of health-seeking behavior of the elderly population. Results: The most pervasive determinant of health-seeking behavior was perceiving health issues related to age, no family support, and health-care expenditure. Conclusion: The elderly had a positive behavior toward seeking help with regard to health care. Multiple morbidities were evident among the elderly, and modern medication was the greatest choice. Improved perspective toward health, easy accessibility, and awareness regarding the disease may contribute to the willingness of seeking help for the health-care needs.

Evolution of Biomarkers for Frailty over the Last Decade : A Literature Review

Aging is a Complex Physiological Process which involves remodeling of cellular components and processes, decline of functional reserve, adaptation of the body to these changes and finally senescence. An important concept in ageing physiology is Frailty which is a physiological, age-related condition characterized by a decrease in functional reserve across multiple organ systems. The phenotype of physical frailty has five components, that is, slowness, weakness, low physical activity level, unintentional weight loss and exhaustion It is crucial to mention “Inflammaging”, a term that signifies the development of an age-related inflammation in the body wherein there is an increase in acute phase reactants and pro-inflammatory cytokines contributing independently to the pathogenesis of frailty. Inflammaging has been proposed to be associated with frailty and many studies suggest the existence of a relationship between age-related Frailty and inflammatory Biomarkers. The aim of this review is to study the evolution of our understanding of the role of inflammatory markers in development of Frailty in the older population.

Paraquat-induced lung fibrosis and multiorgan failure: A case report from North India

Paraquat is a herbicide which is widely used by agricultural communities worldwide. It is extremely toxic for humans and ingestion of as less as 30 mL of 20%–24% concentration is usually lethal. The lack of an effective antidote is a concern due to the fatal outcomes associated with ingestion of paraquat. Herein, we are presenting a case of fatal paraquat poisoning in a young male from a center in India. The clinical course was complicated by liver, renal, and lung injury. We also describe its mechanism of toxicity, clinical features, and newer strategies being tried for treatment.

Seasonal, Regional and Demographic Trends in Patients with Acute Undifferentiated Fever in Northern India

Introduction : Acute Undifferentiated Fever (AUF) has a myriad of etiologies most common of which are Vector Borne Diseases in a country like India. The etiology and diagnosis of AUF is driven by the regional disease burden, seasonality of infectious diseases, spectrum and severity of disease, availability of diagnostics and access to health care facilities. Methods : A twelve-month prospective study was conducted at our centre to determine the commonly occurring causes of AUF. Monthly incidence of each of the common etiologies was noted and a graph was plotted to understand the seasonal distribution of each disease. Other parameters including age, gender, occupation and regional distribution were also studied. Results : The mean age (±SD) of the population in the present study was 33.16 (±15.88) years. Our study established that Scrub Typhus, Dengue fever and malaria were the most common reasons for AUF. The maximum incidence of AUF was between the months of June to October, peaking in the month of August. Urban population, younger age and males were more affected by AUF. Haryana followed by Punjab and Chandigarh had the highest regional burden of disease. Conclusion : It is imperative that we understand the seasonal and regional trends of AUF so that we can plan the resource allocation. Identifying the population at risk and timely intervention at Community level may help to reduce disease transmission.

The Long and Short of Summative Assessment in Competency Based Medical Education: Time to Raise the Bar?

Background: The Competency-based medical education (CBME) has been introduced for MBBS programme in India from 2019. Reorganization of the assessment system is required to meet the challenges imposed by this new framework. Objectives: An evaluation of the university summative assessments held prior to the introduction of CBME-based curriculum was carried out to analyze the pattern, relevance and distribution of questions. Methods: Five sets of annual and supplementary summative examination papers from three universities, State (SU), Private (PU) and Medical (MU) were evaluated. The analysis included format i.e. Structured and Modified Essay questions, Short notes, other formats; marks distribution; terminology-based level of cognitive domain; subject-based relevance and topic-based distribution of questions. Results: A total of 352 questions were analyzed. The maximum number of questions were from the state university (140, 39.7%).The contribution of short notes in the theory papers was 65.8% (PU), 87.1% (SU) and 88.9% (MU).Only the PU had Modified-Essay Questions (10.5%) and Modified short notes(4.7%). Terminology addressing higher cognitive domains was low as the questions assessed mainly the knowledge level (80-96.8%), comprehension 3.1%-6.4%. Only the PU had problem solving questions comprising 11.7% of total questions. Majority of questions had moderate or high relevance and only 2.1%-8.2% were of low-relevance. Inter-university differences in the topics were observed for dermatology, psychiatry, and infections. Conclusions: The present evaluation of high-stakes assessment in three universities indicates minor differences in the format of questions. Questions were predominantly in the form of short notes, structured essays and modified essays were a rarity; few questions targeted higher cognitive levels although majority had high-moderate relevance.

Phosphorylation of DegU is essential for activation of amyE expression in Bacillus subtilis.

Alpha (α)-amylase (amyE) is one of the major exo-enzymes secreted by Bacillus subtilis during the post-exponential phase. The DegS-DegU two-component system regulates expression of majority of post-exponentially expressed genes in B. subtilis. It has been demonstrated that varying levels of the phosphorylated form of DegU (DegU-P) control different cellular processes. Exo-protease production is observed when effective concentration of DegU-P rises in the cell, whereas swarming motility is favoured at very low amounts of DegU-P. In this study we show that like other exo-proteases, expression of amyE is positively regulated by increase in DegU-P levels in the cell. We also demonstrate that residues at the DNA-binding helix-turn-helix (HTH) motif of DegU are necessary for the amyE expression. This observation is further reinforced by demonstrating the direct interaction of DegU on amyE promoter.

Unaccustomed exertion and opiate consumption leading to acute renal failure in a healthy male.

A 38 year old male presented with stupor and acute renal failure (ARF) following opium consumption and a protracted excursion on foot to a holy shrine situated at altitude of 4329 m above sea level. The finding of dark colored urine, myoglobinuria and a markedly elevated serum creatinine phosphokinase level supported the diagnosis of rhabdomyolysis. The patient had a rapid and complete recovery following fluid resuscitation and haemodialysis.

Nutrition therapy in critically ill elderly patients.

Nutrition therapy in critically ill patients is as important as curative pharmacotherapy or advanced cardiac life support. Nutrition support indeed improves the disease outcomes and must be given due importance in any therapeutic regimen. High incidence of co-existent malnutrition in elderly patients emphasizes the added value of nutrition therapy in this subgroup of patients. Enteral route of nutrition therapy is always preferred over parenteral route until and unless indicated otherwise, by virtue of being non-invasive and easy to administer. In addition it has local gut protective effects, lesser incidence of infectious morbidity and better cost-effectiveness. However, parenteral route may be the only viable option in certain clinical scenarios.

Outcome of pulmonary rehabilitation in patients after acute exacerbation of chronic obstructive pulmonary disease.

Background. Pulmonary rehabilitation (PR) is an evidence-based intervention in patients with chronic obstructive pulmonary disease (COPD) which improves the exercise capacity and quality of life (QoL). Methods. We studied 60 patients after an episode of acute exacerbation of COPD (AECOPD). They were randomised to receive conventional treatment without pulmonary rehabilitation (CTWPR) (n=30) or, standard treatment plus a 12-week post-exacerbation pulmonary rehabilitation (PEPR) programme in addition. Assessment of exercise capacity by six minute walk test (6MWT) and QoL measured by St George’s Respiratory Questionnaire (SGRQ) were carried out initially and at the end of three months. Results. The baseline characteristics of both the groups were found to be similar. There was a statistically significant increase in the six minute walk distance (6MWD) (increase by 37.9 meters, p< 0.001) and a significant decline in the total SGRQ score (by 3.8 units p< 0.001) in the PEPR group compared to CTWPR group. Conclusion. Early pulmonary rehabilitation in patients with an AECOPD has significant benefits on the QoL and exercise capacity.

Spo0A positively regulates epr expression by negating the repressive effect of co-repressors, SinR and ScoC, in Bacillus subtilis.

Bacillus subtilis under nutritional deprivation exhibits several physiological responses such as synthesis of degradative enzymes, motility, competence, sporulation, etc. At the onset of post-exponential phase the global response regulator, Spo0A, directly or indirectly activates the expression of genes involved in the above processes. These genes are repressed during the exponential phase by a group of proteins called transition state regulators, e.g. AbrB, ScoC and SinR. One such post-exponentially expressed gene is epr, which encodes a minor extracellular serine protease and is involved in the swarming motility of B. subtilis. Deletion studies of the upstream region of epr promoter revealed that epr is co-repressed by transition state regulators, SinR and ScoC. Our study shows that Spo0A positively regulates epr expression by nullifying the repressive effect of co-repressors, SinR and ScoC. We demonstrate via in vitro mobility shift assays that Spo0A binds to the upstream region of epr promoter and in turn occludes the binding site of one of the co-repressor, SinR. This explains the mechanism behind the positive regulatory effect of Spo0A on epr expression.

Cervical fibroid with amenorrhoea.

Fibroid are benign common tumour in reproductive age group arises from smooth muscles cells of uterus. Incidence is about 30-50%, vary from sizes very small to big, may be one or multiple1. Fibroid usually presents with menorrhagia/menstrual irregularities, but Cervical Fibroid with amenorrhoea is very rare entity. Usually 30-40 % hysterectomy are done for fibroids. Degenerative changes can occur, hyaline is common, while in 0.5% Malignant changes may occur. While operating a huge tumour the anatomy gets disturbed , so due care for the surrounding structure is to be taken otherwise we may land up in complications. In these Huge cervical fibroid Abdominal hysterectomy was proceeded up to uterine vessels, then transverse incision was kept over the anterior vaginal wall of cervix after pushing the bladder down, & fibroid was held with myoma screw & enucleated. Then routine Hysterectomy was completed. Bilateral ureteric tracing done. So meticulous examinations with a suspicion is needed for diagnosis & management of such case.

Clinicopathological study of hysterectomies.

A randomised study of 100 cases undergoing hysterectomy in the age group of 20-70 years was carried out and clinicopathological correlation was done. Maximum number of women who underwent hysterectomy were in the age group of 31-50 years. Abnormal menstrual flow was the most common complaint (66%). Clinically main indications for hysterectomy were fibroid (34%), dysfunctional uterine bleeding (DUB) (26%) and uterine prolapse (24%). Abdominal hysterectomy was the procedure of choice in conditions other than uterovaginal prolapse. Out of 34 cases, clinically diagnosed as fibroid uterus, leiomyoma was found on histopathology in 25 cases and adenomyosis in 3 cases. In 3 cases, both leiomyoma and adenomyosis were present. Out of 26 cases, clinically diagnosed as DUB, histopathological examination revealed leiomyoma in 6 cases, adenomyosis in 9 cases, endometrial polyp in 3 cases. Hence, after exclusion of organic pathology, DUB was confirmed in 8 cases.