Psychological health problems and associated factors among perimenopausal women in rural Prayagraj

Background: The perimenopause is an ill-defined time period that surrounds the final years of a woman’s reproductive life. It begins with the first onset of menstrual irregularity and ends after one year of amenorrhea has occurred. Various psychological illnesses also mark this period. Methods: A cross-sectional study was conducted among 320 perimenopausal women aged between 40 to 55 years in rural Prayagraj. The study participants were interviewed and examined for psychological illnesses. A structured and predesigned questionnaire was used for the same. In this study, the scales used were PHQ-9, ISI, and GAD-7 for assessing depression, insomnia and anxiety respectively. Results: Study found average age of perimenopausal women to be 46.55±2.64 years. Among the psychological problems depression, insomnia and anxiety was analysed using scales- PHQ-9, ISI and GAD-7 respectively. It was found that 84.69% perimenopausal women had depression, 82.50% women had anxiety and only 35.31% women had insomnia. Of all women with depression majority had mild depression (70.94%). Regarding anxiety status majority had mild anxiety (68.13%). whereas 30.94% of women were found to have sub threshold insomnia. Conclusions: Present study shows association between psychological symptoms and employment status. Depression was found to be associated with type of family and age of woman. Insomnia was found to be associated with marital status and age of woman. Anxiety was found to be associated with type of family. Most common psychological morbidity among perimenopausal women was found to be depression.

Urban Flood Relief Management in COVID-19 Pandemic

Introduction: Urban floods were addressed as a separate disaster after the historical 2005 Mumbai floods. Urban flood peaks are 2-8 times and volume 6 times when compared with rural floods. We are now handling multiple disasters simultaneously due to the Covid-19 Pandemic. The river plains of north India are prone to floods in the monsoon season and geographical location of Prayagraj doubles the damage because it faces wrath from two sides. Very few researches have been conducted on urban floods and evidence needs to be generated from the field. Methodology: This qualitative research was planned with an objective to identify the difficulties faced in operating an urban flood relief camp during superimposed burden of COVID-19 Pandemic and to suggest remedial measures from the public health aspect. We conducted in-depth interviews of nodal officers, health staff and beneficiaries of the identified camps. Informed consent was taken from participant after explaining them about the research. Results: The findings from the interviews were categorized into 3phases of flood relief i.e. before the floods, during floods and lastly post flood. The most crucial work before floods is to spread awareness about do’s and don’ts in detail. Next was identification of the local people actually affected by flood. The space and facilities at few centers was low for the population load. Urban flood management needs a major overhauling of public health infrastructure to handle such disasters in future. Conclusion: The officials were working hard to make the homeless feel as if they are on a picnic. The database of beneficiaries should be strengthened and should also include students and labourers, anyone who is a flood victim and not only local flood victims.

ROLE OF NELUMBO NUCIFERA (LOTUS) STEM AS IMMUNITY BOOSTER AND ANTI-INFLAMMATORY FOOD

In China and India, Nelumbo nucifera, a perennial aquatic plant, has been used as a medicinal herb. The various sections of plants, such as leaves, seeds, flowers and rhizomes, have been reported to have beneficial effects in the treatment of pharyngopathy, pectoralgia, spermatorrhoea, leucoderma, smallpox, dysentery, cough, haematemesis, epistaxis, haemoptysis, haematuria, metrorrhagia, hyperlipidaemia, fever, cholera, hepatopathy and hyperdipsia in the traditional medicine system. Different pharmacological activities such as anti-ischaemic activity, antioxidant activity, hepato- protective activity, anti-inflammatory activity, anti-fertility activity, anti- arrhythmic activity, anti-fibrosis activity, antiviral activity, anti-proliferative activity, anti-diarrhoeal activity, psychopharmacological activity, antipyretic activity, immune-modulatory activity, hypoglycaemic activity, aldose reductase inhibitory activity, antibacterial, aphrodisiac activity, anti-platelet activity, cardiovascular activity, anti-obesity activity, lipolytic activity, hypo-cholesterolaemic activity, hepato-protective activity, anticancer activitydiuretic activity, antioxidant activity have been clinically evaluated for N.nucifera. Different pharmacological activities such as anti-ischaemic activity, antioxidant activity, hepato-protective activity, anti-inflammatory activity, anti-fertility activity, anti-arrhythmic activity, anti- fibrosis activity, antiviral activity, anti-proliferative activity, anti-diarrhoeal activity, psychopharmacological activity, diuretic activity, antioxidant activity have been clinically evaluated for N.nucifera. A wide number of phytoprinciples from the plant have been isolated. The present review seeks to consolidate the traditional, ethno-botanical, phytochemical and pharmacological data available on N.nucifera stem and to explore its role as an immunity booster and anti-inflammatory food.

Causes of congenital corneal opacities and their management in a tertiary care center / Causas de opacidades corneanas congênitas e seu controle em um centro de cuidados terciários

ABSTRACT Purpose: To evaluate causes and management of congenital corneal opacities (CCO) diagnosed in a tertiary care eye center and to compare the data with a previous study at the same institution. Methods: Computerized medical records in all patients with congenital corneal opacities diagnosed in the Cornea Service at Wills Eye Hospital (Philadelphia, PA) between January 1, 2007, and December 31, 2015, were retrospectively reviewed. Children aged 12 years and younger at the first visit were included in the study. Patients' demographics, ocular diagnosis, laterality, associated ocular abnormalities, other ocular surgery performed prior or subsequent to the first visit, and their treatment were extracted from the medical records. Results: A total of 77 eyes in 56 patients were examined. The mean age at presentation was 32.8 ± 44.2 months, with the mean follow-up period of 26.7 ± 30.1 months. The most frequent diagnosis was Peters anomaly (53.2%), followed by limbal dermoid (13.0%), aniridia with glaucoma and microphthalmos (6.5%), sclerocornea and congenital glaucoma (5.2%), idiopathic (3.9%), Axenfeld-Rieger anomaly and Hurler syndrome (2.6%), and microcornea (1.3%). Primary keratoplasty was performed in 26 eyes, with the outcome rate in the clear cornea of 76.0% during the follow-up. Conclusion: Peters anomaly is the most common cause of congenital corneal opacities encountered at our institution. Penetrating keratoplasty is the most frequent choice of corneal surgery to treat congenital corneal opacities. Additional interventions during penetrating keratoplasty were moderately positively correlated with graft failure. This study also shows the rates of some etiologies of that changed over the recent decades in our tertiary care Cornea Service. Although Peters anomaly remains the most common presenting reason for congenital corneal opacities, its rate appears to be increasing over the recent decade. Congenital corneal opacities due to birth trauma, which is one of the preventable causes, were observed in a previous study in our clinic; however, no new cases were noted in this study.

RESUMO Objetivo: Avaliar as causas e o controle das opa cidades corneanas congênitas diagnosticadas em um centro oftal mológico de atendimento terciário e comparar os dados com um estudo anterior realizado na mesma instituição. Métodos: Prontuários médicos informatizados de todos os pacientes com opacidade corneana congênita diagnosticada no Serviço de Córnea no Wills Eye Hospital (Filadélfia, PA) entre 1º de ja neiro de 2007 e 31 de dezembro de 2015 foram revisados retrospectivamente. Crianças com 12 anos ou menos na primeira consulta foram incluídas no estudo. A demografia dos pacientes, o diagnóstico ocular, a lateralidade, as anormalidades oculares associadas, outras cirurgias oculares realizadas antes ou após a primeira consulta e o tratamento foram extraídos dos prontuários médicos. Resultados: Um total de 77 olhos de 56 pacientes foi examinado. A idade média de apresentação foi de 32,8 ± 44,2 meses, com um tempo médio de acompanhamento de 26,7 ± 30,1 meses. O diagnóstico mais frequente foi anomalia de Peters (53,2%), seguido por dermóide límbico (13,0%), aniridia com glaucoma e microftalmia (6,5%), esclerocórnea e glaucoma congênito (5,2%), idiopático (3,9%), síndrome de Axenfeld-Rieger e síndrome de Hurler (2,6%) e microcórnea (1,3%). Ceratoplastia primária foi realizada em 26 olhos, com desfecho de córnea clara de 76,0% durante o acompanhamento. Conclusão: A anomalia de Peters é a causa mais comum de opacidade corneana congênita encontrada em nossa instituição. A ceratoplastia penetrante é a escolha mais frequente de cirurgia corneana para o tratamento de opacidades corneanas congênitas. Intervenções adicionais durante a ceratoplastia penetrante foram moderadamente correlacionadas positivamente com a falha do enxerto. Este estudo também mostra as taxas de algumas etiologias do que mudou ao longo faz últimas décadas em nosso serviço de córnea de atendimento terciário. Embora a anomalia de Peters continue a ser a causa mais comum das opacidades congênitas da córnea, sua taxa parece estar aumentando na última década. Opacidades congênitas da córnea devido a trauma no nascimento, que é uma das causas evitáveis, foram observadas em um estudo anterior em nossa clínica; no entanto, nenhum caso novo foi observado neste estudo.

Socio-demographic profile of multi-drug resistant tuberculosis patients and its association with severity of adverse drug reactions in DOTS plus centre at tertiary hospital in Himachal Pradesh, India

Background: Multi-drug resistant tuberculosis has become major public health problem and obstacle to effective control of tuberculosis. Objectives was to study the socio-demographic profile of multi- drug resistant tuberculosis patients and its association with severity of ADR (adverse drug reactions) in DOTS plus centre at tertiary hospital in Himachal Pradesh.Methods: It was a prospective observational study carried out from November 2012 to October 2013 on multi-drug resistant tuberculosis (MDR-TB) patients after approved from Institutional Ethics Committee.Results: Out of 104 patients the mean age of patients was 39.9 ±14.26 years. Majority of the patients were in the economically productive age groups. Multi-drug resistant tuberculosis was more in male (76%) than female (24%) and 96% of patients were belonged to rural area. The educational status of the MDR-TB shows 24% patients were illiterate. 63.46% MDR-TB patients were underweight (BMI<18.5%) according to WHO guidelines for obesity. Severity of ADR assessed by Hart wig and Siegel’s scale showed 21% patients experienced mild ADRs, 49% patients had moderate and 17% patients had severe ADRs. Severity of ADR is seen more in male, economically productive age group, subjects on vegetarian diet, patients who were underweight (BMI<18.5%) and with lower educational status.Conclusions: MDR-TB is a rapidly increasing health problem with major socio-economic and individual consequences. Multi-drug resistant tuberculosis mainly affects middle age that is in the economically productive age group which hampers the social and economic development of individual, society and nation.

Comparison of the safety and efficacy of caroverine and betahistine in patients of subjective tinnitus.

Background: Owing to lack of any established treatment and handicap assessment methods, subjective tinnitus can be a debilitating disorder. This study was carried out to compare the safety and efficacy of caroverine and betahistine in patients of subjective tinnitus. Methods: A total of 60 patients of subjective tinnitus were randomized into two groups and followed-up for 12 weeks using tinnitus handicap inventory (THI) questionnaire. One group received 8 mg betahistine tablet TDS for a month whereas the other group was given supervised intravenous (IV) infusion of 160 mg of caroverine dihydrochloride. Data for the safety were also recorded. Results: Both the drugs showed significant improvement in severity of symptoms at 1 week, 4 weeks and 12 weeks individually as assessed by the THI scores. The response to caroverine was significant up to 4 weeks, but it was not significant at 12 weeks; whereas the response to betahistine was significant up to 12 weeks. A total of 28 adverse drug reactions (ADRs) were reported (53.6% with caroverine, 46.4% with betahistine). 24 ADRs were mild and 4 were moderate in intensity. There was no serious adverse event. Conclusions: Both the drugs are safe and efficacious in reducing the handicap of subjective tinnitus. A single IV infusion of caroverine may suffice for 4-6 weeks, so it may be repeated after 6 weeks to maintain the relief.

Exaggerated mantoux reaction in a case of LTBI.

Summary: A 42-year-old female presented with a history of receiving PPD on right forearm intradermally before two days. Patient started having itching and irritation within a few hours and pain, oedema and vesicles formation by next day at the injection site. On examination, the whole right forearm was oedematous with induration of size 50mm x 50mm around the site of injection. Tubercular infection was suspected and the patient was subjected to further investigation but nothing, including physical examination, hemogram, fundus examination, chest X-ray, USG abdomen and CT thorax, was found suggestive of tuberculosis, leading to a diagnosis of LTBI.

Are current guidelines for categorization of visual impairment in India appropriate.

Context: Visual disability in India is categorized based on severity. Sometimes the disabled person does not fit unambiguously into any of the categories. Aims: To identify and quantify disability that does not fit in the current classification, and propose a new classification that includes all levels of vision. Settings and Design: Retrospective chart review of visual disability awarded in a teaching hospital. Materials and Methods: The last hundred records of patients who had been classified as visually disabled were screened for vision in both eyes and percentage disability awarded. Data were handled in accordance with the Helsinki Declaration. Results: Twenty-one patients had been classified as having 30% disability, seven each had 40% and 75%, and 65 had 100% disability. Eleven of them did not fall into any of the current categories, forcing the disability board to use its own judgment. There was a tendency to over-grade the disability (seven of 11; 63.6%). The classification proposed by us is based on the national program for control of blindness' definition of normal vision (20/20 to 20/60), low vision (<20/60 to 20/200), economic blindness (<20/200 to 20/400) and social blindness (<20/400). It ranges from the mildest disability (normal vision in one eye, low vision in the other) up to the most severe grade (social blindness in both eyes). Conclusions: The current classification of visual disabilities does not include all combinations of vision; some disabled patients cannot be categorized. The classification proposed by us is comprehensive, progresses logically, and follows the definitions of the national program.

Paradoxical reaction in tubercular meningitis resulting in involvement of optic radiation.

A 25-year-old woman was diagnosed to have tubercular meningitis (TBM) with a right parietal infarct. She responded well to four-drug anti-tubercular treatment (ATT), systemic steroids and pyridoxine. Steroids were tapered off in one and a half months; she was put on two-drug ATT after two months. Six months after initial diagnosis she presented with sudden, bilateral visual loss. Vision was 3/200 with afferent pupillary defect and un-recordable field in the right eye; vision was 20/60 in the left eye, pupillary reaction was sluggish and the field showed a temporal hemianopia. On reintroduction of systemic corticosteroids vision improved (20/120 in right eye and 20/30 in left eye) within three days; the field defects improved sequentially to a left homonymous hemianopia, then a left homonymous inferior quadrantonopia. A diagnosis of TBM, on treatment, with bilateral optic neuritis, and right optic radiation involvement was made. Since the patient had been off ethambutol for four months, the optic neuritis and optic radiation lesion were attributed to a paradoxical reaction to tubercular allergen, corroborated by prompt recovery in response to corticosteroids. This is the first report of optic radiation involvement in a paradoxical reaction in neuro-tuberculosis in a young adult.

Environmental conditions, anthropometric parameters and arterial blood pressure.

The influence of environmental conditions and anthropometric parameters on arterial blood pressure level was studied in 280 healthy Kashmiri subjects, aged 18-50 years (140 males, 140 females) Men in the age group of 18-20 years had higher blood pressure than women and their systolic blood pressure showed significant correlation with height, weight and skinfold thickness. Females (18-20 years) showed association of diastolic blood pressure with weight, skinfold thickness. Females (18-20) years) showed association of diastolic blood pressure with weight, skinfold thickness and mid-arm circumference. After the age of 20 years females had higher blood pressure than males. Height and weight decreased with age in both the sexes. Skinfold thickness and midarm circumference increased with age in females. A comparison between the present study and those reported from Haryana and Delhi revealed a higher diastolic pressure in Kashmiris.

Incidence of P.T.C. taste sensitivity and threshold in Kashmiri population.

Taste sensitivity and threshold of Phenylthiourea (PTC) was determined in 800 individuals of Kashmir who form a distinct ethnic group. Correlation, if any, with age, sex, blood group, pH of Saliva, or smoking habits was investigated. The taste sensitivity of P.T.C. increased with advancing age. The percentage of non-tasters was more in blood group 'B' & 'O'. However, no correlation was observed as far as sex, pH of saliva and smoking habits were concerned.