Intra-articular Steroid alone vs Hydrodilatation with intraarticular Steroid in Frozen Shoulder - A Randomised Control Trial

@#Introduction: Various non-operative treatment modalities have been advocated for a frozen shoulder. In the present study we compared the efficacy of single intra-articular steroid injection vs hydrodilatation with intra-articular steroids for frozen shoulder (FS) in the frozen phase. Materials and methods: This was a prospective, randomised control trial (RCT) done at a tertiary care centre. A total of 108 participants were randomised into two groupsone group received intra-articular steroid with hydrodilatation (HDS) and other group received intraarticular steroid injection only (S). Shoulder Pain and Disability Index (SPADI) scores were taken, and statistical analysis was done to measure the outcome at two weeks, six weeks and three-month intervals after the injection. Result: There was significant improvement in symptoms at each interval for both the groups (p=0.0). There was no statistically significant difference in the SPADI score between the two groups at two weeks post injection, however at six weeks (p=0.04) and 3 months (p=0.001) significant difference in the SPADI score was demonstrated with better scores in group S. The mean duration of analgesia required in group HDS was 5.17 days (S.D.=1.73) and for group S was 4.28 days (S.D.=1.01), with a statistical significance (p=0.002). Conclusion: Better clinical results were obtained at six weeks and three months with the group receiving corticosteroid only and also had a lesser requirement of analgesia post-intervention. Thus, intra-articular steroid injection only seems to be a more desirable method of management during the frozen phase of FS than that of hydrodilatation with intra-articular steroid injection.

Change in Disease Dynamics and Health Care Utilisation in Children during COVID 19 in a Tertiary Care Hospital of Eastern India

This retrospective, observational study was conducted by collecting data from medical records during COVID 19 pandemic from March 2020 till August 2020. This was compared with the data of 2019 during similar months. The impact of COVID 19 on use of preventive and curative paediatric health care service units like outpatient department, casualty, intensive care and immunization clinic were assessed. Data from 2019 to 2020 were compared using standard parametric and nonparametric tests. There was a significant decline in routine OPD (68%) attendance during the COVID 19 period as compared to pre-COVID period. Paediatric ward admissions and PICU admissions were decreased by 55% and 42% respectively. We also observed a significant 43% decline in the number of children attending immunization clinic in the year 2020. The fear of COVID 19 pandemic and the measures taken to control the pandemic has affected the health seeking behaviour of patients. This evaluation of trends in healthcare use may help in planning the delivery of healthcare service delivery in future.

Mental health, bullying, and violent injuries among adolescents – A cross-sectional study

Background: Adolescents (10–19 years) constitute about one-fifth (21.4%) of India’s population. It has been identified as one of the vulnerable periods of life when the various health problems may occur. The prevalence of mental health problems among adolescents in India varies from 8.7% to 31.2% as shown in different studies. Objectives: The objectives of this study were to estimate the prevalence of mental health issues, violence, bullying, and unintentional injuries among adolescents. Materials and Methods: The present study is an observational descriptive study. After obtaining ethical clearance from the institutional ethics committee, 100 students from rural and 100 from urban areas of both sexes were randomly selected. A questionnaire based on global school-based student health survey was prepared. Responses obtained from self-administered questionnaire were entered into Microsoft Excel. Data were analyzed in Microsoft Excel using simple proportions and Chi-square test to find statistical significance if any. Results: About 11% felt lonely most of times, 13.5% had difficulty in sleeping at most of nights, and 2.5% even considered of attempting suicide. Girls (15%) reported being bullied more as compared to boys who reported it to be 9%. Furthermore, reports were more for urban area (15%) than for rural one (9%). Conclusion: Adolescents are being bullied or get involved in a physical fight (17%). Mental health issues are also widely prevalent among them. About 28% felt lonely, 30.5% could not sleep at night, and 2.5% even considered attempting suicide.

Unilateral palatal palsy with viral hepatitis.

Isolated unilateral palatal (velopalatopharyngeal) palsy is a clinical rarity. This usually presents in a child as acute onset rhinolalia, unilateral absent palatal reflex and pharyngeal asymmetry with a benign self-resolving course. Etiology remains controversial. We report association of this entity in a male child with viral hepatitis A.

An outbreak of dengue fever in Veerannapet village, Cherial Mandal, of Warangal district, Andhra Pradesh.

An epidemiological and entomological investigation was carried out in Veerannapet village, Cherial Mandal of Warangal district, Andhra Pradesh. The study showed that all age groups and both the sexes were affected with the disease. Fever and bodyache was the first presenting feature, which was self-limiting and lasted for 4-5 days. Of the 19 Serum Samples tested, 17 showed high titre to Dengue antigen with 10 showing diagnostic titre. Five samples were positive for IgM antibodies to dengue virus. Larval surveys indicates high Breteau index (30.40%), House index (23.20%) and Container index (9.17%). The clinico-epidemiological and entomological investigation indicates present episode of fever outbreak is due to dengue fever. Strengthening and intensification of surveillance along with educating the community is recommended for prevention of outbreak.

Breeding habitats and larval indices of Aedes aegypti (L) in residential areas of Rajahmundry town, Andhra Pradesh.

Entomological studies on relative prevalence and distribution of adults and immatures of Aedes aegypti were conducted in Rajahmundry town of Andhra Pradesh from December 1998 to November 1999. Adults and immature stages of Aedes aegypti were found in all the 22 localities viz; posh area (8), mixed area (8) and slum area (6) of the town. Larval indices were found to be higher in slum areas as compared to mixed or posh areas of the town. However, the larval habitats were observed to be similar in all localities. The larval indices were highest during monsoon and post-monsoon months. The breeding preference ratio (BPR) was highest for cement tubs followed by discarded tyres and barrels. The high larval indices of Aedes aegypti in these areas warrant intensification of vector surveillance activities along with source reduction and health education.

Primary multi-drug resistant tuberculous gumma.

A 28-year old lady presented with three discrete gummatous lesions on the anterior abdominal wall, one at the site of a previous laparoscopic scar. Skin biopsy showed epitheloid cell granulomas and a pus culture and sensitivity (for AFB) performed, showed growth of M. tuberculosis. The culture-isolate was resistant to all the essential anti-TB drugs. The patient was put on second line anti-TB chemotherapy and the gummas resolved.

Alginate immobilization of Spirulina platensis for wastewater treatment.

Immobilization of cyanobacterium Spirulina platensis in sodium alginate (1.5 %) gave the best quality of bead and 15-16 beads were formed per mL of aqueous solution of alginate. The immobilized cells were used in a batch process for treatment of diluted sewage. After 8 days, 95 % of BOD5, 77 % of COD, 90 % of ammonia, and 94 % of TSS were removed.

Community studies on prevalence of HBsAg in two urban populations of southern India.

OBJECTIVE: To find out prevalence of HBsAg in general population, especially in under-five children. SETTING: Bangalore and Rajahmundry towns in southern India. METHODS: Localities were chosen as the sampling units in each town. About 10-20 households were randomly selected from each locality. Only the youngest but apparently healthy person present in the household was interviewed for age, sex and history of jaundice any time in life. Mothers were interviewed to collect data for children below 15 years of age. Blood samples were collected from these persons on filter paper strips (18-mm diameter disc, Whatman filter paper No. 3) by finger prick method. The samples were tested for HBsAg by Micro ELISA (Ortho-Clinical Diagnostics). RESULTS: Overall, 3.3% (95% CI, 2.0-4.5) of 737 persons in Rajahmundry and 4.2% (95% CI, 2.8-5.5) of 816 persons in Bangalore were found carriers of HBsAg. Age-specific or sex specific carrier rates were similar in Rajahmundry as well as in Bangalore. Most of the carriers (96%) denied having jaundice ever in life. CONCLUSIONS: The results from this community based study are in agreement with the historical data from hospital based studies that about 3-5% of persons may be carriers of HBsAg and that the pool of chronic carriers of hepatitis B virus in India is built up in childhood and is then maintained in older children and adults. The results highlight the need of completing hepatitis B immunization during the infancy.

Study of impact of nutrition & health day strategy on the coverage rates of supplementary nutrition and health interventions among the ICDS beneficiaries in a rural block of Madhya Pradesh.

To study the trends of beneficiary coverage (pregnant and lactating women and children less than two years of age) for utilization of supplementary nutrition and health services in a rural block before and after the launch of a strategy to converge Health & Integrated Child Development Services (ICDS) on a single day christened "Nutrition and Health Day" (NHD). It is a before and after intervention design in rural ICDS block Amarwada in district Chhindwada. As a part of intervention, NHD were organised on which convergent services of Health & ICDS were made available to the beneficiaries. On the weekly NHDs, uncooked supplementary nutrition for the week was distributed to pregnant and lactating mothers and children under two. The Health worker visited the Anganwadi Centre (AWC) and immunized children and pregnant women, distributed IFA, Vitamin A and provided health and nutrition education. The study assessed the impact of these interventions on the coverage rates of the services. Study was conducted between May 97 and March 98. The routine monitoring reports of the ICDS and Health System of the state government were used as study tools. The study sample comprised of AWC beneficiaries in the project area. The total population of the block was 89,476. Participation in the supplementary nutrition program (SNP) increased two to three folds in all categories of the target population. Immunization and Vitamin A coverage levels for children also showed an increase of about 3 and 5-8 times from baseline status respectively in a year's time. Among pregnant women, Tetanus Toxoid (TT) and Iron and Folic Acid (IFA) utilization rates have also shown two and five fold increase respectively.