Development of integrated care tool � BRIEF for screening the unmet psychosociomedical needs of older Indians

Background: With demographic shifts, there is an unprecedented increase in noncommunicable diseases, multimorbidity, and geriatric syndromes among older adults, especially in economically weaker sectors. However, there is no socioculturally appropriate tool to screen older adults for age-related health needs, multimorbidity, and geriatric syndromes at their doorstep. Objective: Our objective was to create a self-assessment tool, 搃ntegrated care tool� (ICT), and to assess its psychometric properties by applying it on older adults from multiple settings such as hospital, community, and old-age home (assisted living services). Methods: new questionnaire was developed using standardized procedure including item development, pilot testing, and psychometric validation. After obtaining the institutional ethics committee clearance, data were collected from consenting respondents attending the Outpatient Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, community settings through health camps, and long-term care center, between May 2016 and February 2017. Data were computerized and analyzed by principal component analysis as extraction method and orthogonal varimax as rotation method. Results: The final 30-item questionnaire was arranged into various domains as per rotated component matrix analysis. Overall internal consistency of the final questionnaire, as calculated by Cronbach's alpha, was 0.79, and the measure of sampling adequacy was 0.79. Conclusion: ICT-BRIEF is a simple, self-assessment/caregiver-assisted tool to screen the health needs of older adults. This tool can be validated for developing risk score and scaled up to generate a large database to create elderly centered care plans.

In vitro Cytotoxic Activity of Hydro Ethanolic Extract of Delonix regia (Bojer ex. Hook.) Flowers on Cancer Cell Lines.

Aims: To evaluate the In vitro cytotoxic effects of the hydro ethanolic extract (HEE) of the Delonix regia flowers against different cell lines. Methodology: The dried Delonix regia flowers are subjected to soxhlet extraction by using 70% ethanol. The dried extract was used to determine the qualitative preliminary phytochemical analysis, total phenolic and flavonoid content. The cytotoxic property of the extract was determined by using MTT assay against breast cancer (MCF-7), cervix (HeLa), brain and colon cancer cells. Tamoxifen is used as a standard for all the cell lines. Results: Qualitative phytochemical tests of extract HEE showed the presence of sugars, flavonoid, tannins, phenolic compounds, steroids and saponins. The percentage of phenolic and flavonoid content was determined as 31.42 mg/g, 29.22 mg/g respectively. The cytotoxic activity of the extract showed, IC50 concentrations (μg/ml) against MCF-7 (breast), carcinoma of cervix HeLa cells, carcinoma of the brain, and carcinoma of colon cells against tamoxifen are 141.6 ± 0.08, 223.7 ± 2.16, 173.9 ± 0.7, 168.33 ± 0.04 respectively. Conclusions: The experimental data clearly demonstrate the hydro ethanolic extract (HEE) showed cytotoxic properties against human cancer cells.

Recurrent nephrogenic adenoma of urinary bladder in a renal allograft recipient--a case report.

Nephrogenic adenoma is a rare benign tumour-like lesion within the urothelial mucosa of the urinary tract. It may be an incidental finding in bladder of a patient presenting with haematuria, dysuria and bladder growth after renal allograft transplant. Clinically it mimics bladder neoplasm. Definite diagnosis is established by histological examination of tumor. Though it attains an extensive spread in bladder mucosa and has a high tendency to recur, the clinical course is benign.

MRI findings in Kallmann syndrome.

Kallmann syndrome (KS) is a neuronal migration disorder characterised by hypogonadotrophic hypogonadism and anosmia or hyposmia. Five patients with clinical findings suggestive of KS were evaluated with MRI. All patients had abnormalities of olfactory system. Olfactory bulbs were absent in all patients. Olfactory sulci were absent in 3 patients and hypoplastic in 2 patients. Anterior pituitary was hypoplastic in two patients. The MRI findings in KS are characteristic and MRI is a useful adjunct to the diagnosis of KS.

Role of Foley's Catheter to Improve the Cervical Score Prior to Induction of Labour.

Present study was conducted on 40 patients to assess the role of Foley`s catheter in improving crvical score prior to induction of labour. Patients consisting of primigravidae and multiparae, rquiring induction of labour for various conditions-postmaturity, pre-eclampatic toxaemia, intrauterine growth retardation, pregnancy with bad obstetrical history were included in the study. Eoley`s patient was subjected to cervical scoring by Bishop`s score prior to and afrer the procedure. Foley`s self retaining catherer No. 20 was inserted extramniotically upto the level of internal os and was rmoved after 24 hours. Ir was found that Foley`s catherer improved the cervical score to 10.50 ± 2.17 with mean induction –delivery interval of 9.72 hours.

Diazepam induced delirium.

In Ophthalmic practice diazepam is often used a a premedicant. We report a case where administration of diazepam led to a state of acute delirium because of which surgery had to be postponed. The possible mechanisms for this reaction and the treatment is discussed. This side effect of diazepam should be kept in mind while dealing with delirium in the geriatric age group.

Immunologic tools to decipher efficacy of BCG immunotherapy in advanced breast cancer: a one year follow up study.

We report the clinical outcome of conventional therapy and BCG immunisation therapy for 40 patients with advanced breast carcinoma. The clinical outcome was better for the 20 patients receiving BCG immunisation therapy. All patients were assessed for cell mediated immunologic competence before starting treatment and after completion of treatment. Thereafter they were followed for one year. Those patients who showed good local response to BCG vaccination before starting therapy had better prognosis, and those for whom anergy to PPD and DNCB could be reversed by BCG immunotherapy showed clinical improvement. Another interesting finding was that IgA was the predominating immunoglobulin located in normal breast tissue and benign breast tumours while IgG was deposited in most of the malignant breast tumour. This indicated that malignant tumours of the breast jeopardise the secretory immune system of the mammary gland.