Job satisfaction of the accredited social health activists in a community development block of Purba Bardhaman district, West Bengal

Background: Job satisfaction of accredited social health activist (ASHA), a voluntary health worker under national health mission, is not yet documented in many areas of the country. The present study assessed the job satisfaction of ASHA in Bhatar community development block of Purba Bardhaman district, West Bengal.Methods: A cross sectional study was undertaken during September–November 2017 among all the 191 ASHAs in Bhatar block. With prior consent, interviews were conducted using a questionnaire developed based on measures of job satisfaction (MJS) tool. The questionnaire contained total 28 items in six individual facets of satisfaction-personal component, workload, professional support, training, incentive and care providing. Responses for each item were recorded in 3-point Likert’s scale, total score ranging from 28–84. Overall satisfaction was categorised as dissatisfied (score=28), neutral (29-56) and satisfied (57-84) and similar categorisation was done for individual facets. Chi square test was applied to determine associated factors.Results: Overall 93.7% ASHAs were satisfied with their work, 6.3% were neither dissatisfied nor satisfied. Majority were satisfied regarding individual facets except incentive; 73.3% were rather dissatisfied. Overall satisfaction was significantly associated with the service duration of ASHA (p=0.001).Conclusions: Overall satisfaction level among ASHAs in the area though are quite high, some individual aspects like incentives needs to be looked into. Further studies will be helpful to delineate many unexplored reasons or aspects which might be necessary for developing strategies.

A study on periampullary diverticula 6 years ERCP experience from a referral centre

Introduction: Periampullary diverticula (PAD) are mucosal outpouchings commonly situated on the medial aspect of second part of duodenum; usually within 2-3 cm of the ampulla of vater. PAD are usually asymptomatic incidental findings during side viewing scopy. We aimed to analyze the influence of PAD in the management of patients who underwent ERCP during past 6 years in our centre. Materials and methods: Patients between the ages of 13 and 74 with the diagnosis of pancreaticobiliary diseases who underwent ERCP at Institute of medical gastroenterology, Madras Medical College from January 2012 to December 2017 were taken into account for retrospective analysis. We assessed and compared ERCP results in patients with and without PAD. Results: A total of 3412 patients underwent ERCP that of these 197(5.77%) patients had PAD. Among the 3412 cases , the incidences of PAD in patients age group less than 50 years was 2.6% and age group more than 50 years was 8.1%(P<0.001). Successful biliary cannulation was achieved in 79.18% (n=156) of patients with PAD and 93.1% of patients of patients without PAD (P<0.001). Of that in patients with PAD, for 28.93 %( n=57) cases underwent precut needle papillotomy. The papilla Rabindranath Eswaran, Premkumar Karunakaran, Allwin James, Venkateswaran Arcot Rajeswaran, Rajkumar Solomon. A study on periampullary diverticula – 6 years ERCP experience from a referral centre. IAIM, 2018; 5(6): 20-26. Page 21 was undetectable in 6 cases with PAD. Incidence of PAD was higher in choledocholithiasis group (9.2% vs 4.1%, p=0.003), but in incidence of CBD stricture had no difference. Complete clearance of CBD stones was achieved lesser in patients with PAD (72.4% vs 86.8% P=0.02). Conclusion: The frequency of PAD increases with age and occurs more in choledocholithiasis cases. Our experience showed decreased rate of cannulation success with PAD, increased difficulty in cannulation and decreased rate of successful stone retrieval.

A study of symptomatic choledochal cyst in South India

Introduction: Choledochal cyst is a type congenital anomaly in which there is dilatation of the intra or extrahepatic biliary tree. Choledochal cysts are classified into five types based on location or shape of the cysts. Materials and methods: A prospective analytical study was conducted from January 2015 to June 2017 at Madras Medical College, Chennai, India. All patients who underwent ERCP and had finding of choledochal cyst on cholangiogram were included in the study. Patients were assessed on their demographic data, clinical findings, presentation, and complications. Results: The incidence of symptomatic choledochal cyst was 2.5%. Type 1C was the most common type of choledochal cyst with obstructive jaundice due to large CBD stones as the most common presentation in this study. None had 30 day post-operative mortality. Conclusion: Type IC is the most common type among symptomatic choledochal cyst in south India. As it is a premalignant condition management includes endoscopic retrograde cholangiography followed by surgery with good clinical outcome.

Clinico-Epidemiological study of Alopecia Areata

Objective To evaluate the clinical and demographical pattern of alopecia areata [AA] and their association with other diseases

Methods A cross-sectional multicentric study of 410 patients with AA was carried out during the period of January 2013 to December 2014. A detail clinical and demographical pattern of the disease was taken in a prescribed proforma along with the association of other diseases, if present

Results A total of 410 patients with AA were included in the study with age ranging from 1 year to 74 years, out of which 206 were males and 204 females. The commonest age at onset was 21-30 years. Multilocular patches were the commonest presentation. Based on the pat

A study on the role of small intestinal bacterial overgrowth in patients with functional dyspepsia

Background: Functional dyspepsia (FD) accounts for majority of dyspepsia. Before labeling them as FD, a bunch of investigations to be done to rule out organic cause. Small intestinal bacterial overgrowth (SIBO) which is one of the cause for dyspepsia is not commonly sought and always neglected among physicians. So we aimed to study the frequency of SIBO in patients with dyspeptic symptoms and whether to include investigations to diagnose SIBO in the algorithm of approach to dyspepsia. Materials and methods: We consecutively enrolled 50 newly diagnosed functional dyspepsia patients based on Rome III criteria and 50 healthy controls in this study. They underwent glucose hydrogen breath test (GHBT) after overnight fasting. Results: In the cases with FD, 6 (12%) subjects were found to have positive GHBT and diagnosed as SIBO, whereas in the controls 2 (4%) had positive GHBT with no statistical significant difference among groups with a P value of 0.140. In the cases with FD, the most common subtype was post prandial distress syndrome (46%), followed by epigastric pain syndrome (36%) and mixed type Sabarinathan Ramanathan, Premkumar Karunakaran, Kani Shaikh Mohamed, Ratnakar Kini, Pugazhendhi Thangavel, Murali Ananthavadivelu, Mohammed Ali, Rabindranath Eswaran, Thinakar Mani, Chandrashekar Patil. A study on the role of small intestinal bacterial overgrowth in patients with functional dyspepsia. IAIM, 2017; 4(5): 88-97. Page 89 (18%). Patients with SIBO were treated with rifaximin 1200 mg/day in divided doses for 10 days. GHBT was repeated after 4 weeks and found to be normalized in all cases. Conclusion: SIBO should be considered before making a diagnosis of FD. GHBT is a simple noninvasive method to diagnose SIBO. One could avoid taking unnecessary drugs by timely diagnosis of SIBO in patients with dyspepsia.

Porokeratosis palmariset plantaris disseminata - a rare entity

Porokeratosis is a well-known keratinization disorder where cornoid lamella is characteristically seen. There are seven clinical variants of which porokeratosis palmaris et plantaris disseminata [PPPD] is a very rare entity. Our PPPD case was sporadic and diagnosed early at 35 years of age. The lesions started on trunk and disseminated to extremities, face, oral cavity, palms and soles. Involvement of oral mucosa made easier to differentiate our case from disseminated superficial porokeratosis. The response was good with isotretinoin therapy

Biomedical waste management: Study on the awareness and practice among healthcare workers in a tertiary teaching hospital.

Bio-medical waste has a higher potential of infection and injury to the healthcare worker, patient and the surrounding community. Awareness programmes on their proper handling and management to healthcare workers can prevent the spread of infectious diseases and epidemics. This study was conducted in a tertiary care hospital to assess the impact of training, audits and education/implementations from 2009 to 2012 on awareness and practice of biomedical waste segregation. Our study reveals focused training, strict supervision, daily surveillance, audits inspections, involvement of hospital administrators and regular appraisals are essential to optimise the segregation of biomedical waste.

Adherence to highly active antiretroviral therapy in a tertiary care hospital in West Bengal, India

<p><b>INTRODUCTION</b>The introduction of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) has led to the reduction of mortality and the improvement of the quality of life of people living with HIV/AIDS (PLWHA). The present study was conducted to determine the pattern of adherence to HAART among PLWHA, and to assess the factor(s) affecting nonadherence, if any.</p><p><b>METHODS</b>This study was a hospital-based analytical, cross-sectional epidemiological study conducted between July and October 2011. A total of 370 adult HIV-positive patients registered in the Antiretroviral Therapy Centre of Burdwan Medical College and Hospital, West Bengal, India, were included. Nonadherence was defined as missing at least a single dose of medicine within the last four days. Data was analysed using the Statistical Package for the Social Sciences version 19.0 (IBM Corp, Armonk, NY, USA).</p><p><b>RESULTS</b>A total of 87.6% of patients were found to be adherent to HAART. Principal causes of nonadherence were forgetting to take medicine (70.2%), being away from home (65.2%), and busyness with other things (64.7%). Multivariate logistic regression analysis revealed that nonadherence was significantly associated with a positive family history of HIV/AIDS (odds ratio [OR] 16; 95% confidence interval [CI] 2.2-114.3; p = 0.01), occurrence of side effects with HAART (OR 9.81; 95% CI 1.9-51.7; p = 0.01) and employment (OR 5.93; 95% CI 1.5-23.2; p = 0.01).</p><p><b>CONCLUSION</b>Although overall adherence was high, the factors that affect nonadherence can be addressed with proper counselling and motivation of patients and their family members. Adherence to HAART could delay the progression of this lethal disease and minimise the risk of developing drug resistance.</p>

Surveillance of multidrug resistant uropathogenic bacteria in hospitalized patients in Indian

<p><b>OBJECTIVE</b>To record surveillance, antibiotic resistance of uropathogens of hospitalized patients over a period of 18 months.</p><p><b>METHODS</b>Urine samples from wards and cabins were used for isolating urinary tract infection (UTI)-causing bacteria that were cultured on suitable selective media and identified by biochemical tests; and their antibiograms were ascertained by Kirby-Bauer's disc diffusion method, in each 6-month interval of the study period, using 18 antibiotics of five different classes.</p><p><b>RESULTS</b>From wards and cabins, 1 245 samples were collected, from which 996 strains of bacteria belonging to 11 species were isolated, during April 2011 to September 2012. Two Gram-positive, Staphylococcus aureus (S. aureus) and Enterococcus faecalis (E. faecalis), and nine Gram-negative bacteria, Acinetobacter baumannii, Citrobacter sp., Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, Klebsiella oxytoca, Proteus mirabilis, Proteus vulgaris and Pseudomonas aeruginosa were isolated. Both S. aureus and E. faecalis were vancomycin resistant, and resistant-strains of all pathogens increased in each 6-month period of study. Particularly, all Gram-negatives were resistant to nitrofurantoin and co-trimoxazole, the most preferred antibiotics of empiric therapy for UTI.</p><p><b>CONCLUSIONS</b>Antibiograms of 11 UTI-causing bacteria recorded in this study indicated moderately higher numbers of strains resistant to each antibiotic studied, generating the fear of precipitating fervent episodes in public health particularly with bacteria, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae and S. aureus. Moreover, vancomycin resistance in strains of S. aureus and E. faecalis is a matter of concern.</p>

Eicosapentaenoic and docosahexaenoic acids enriched polyunsaturated fatty acids from the coastal marine fish of Bay of Bengal and their therapeutic value.

Eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) enriched polyunsaturated fatty acids (PUFA) significantly present in marine fish oil emerge as preventive agents for combating many health problems specially in chronic or metabolic disorders. The fish in the coastal area of Bay of Bengal has remained unexplored with respect to EPA/DHA enriched PUFA content in its oils, although it may be a potential source in harnessing the health benefit. In this study, seven varieties of the coastal fish were analysed for the content of EPA/DHA. The one locally known as lotte, (Harpadon nehereus) though has low content of total lipids, was found to have high EPA/DHA in its oil. The phospholipids rich fraction was extracted from the total fish oil. The EPA/DHA enriched PUFA was isolated to investigate the potential use for health benefits. EPA/DHA is found to act as protective agent against mercury poisoning studied in cell culture as well as in animal mode. It is found to be highly preventive in diabetes. The lotte is available in the coastal area of Bay of Bengal adjoining West Bengal, India in large scale and it is the first report showing EPA/DHA enriched PUFA in these fish oil that can be availed to harness in important health benefits.

Limited Access to Iodized Salt among the Poor and Disadvantaged in North 24 Parganas District of West Bengal, India.

Iodine deficiency is endemic in West Bengal as evident from earlier studies. This community-based, crosssectional descriptive study was conducted in North 24 Parganas district during August-November 2005 to assess the consumption of adequately-iodized salt and to ascertain the various factors that influence access to iodized salt. In total, 506 households selected using the multi-stage cluster-sampling technique and all 79 retail shops from where the study households buy salt were surveyed. The iodine content of salt was tested by spot iodine-testing kits. Seventy-three percent of the households consumed salt with adequate iodine content (≥15 ppm). Consumption of adequately-iodized salt was lower among rural residents [prevalence ratio (PR): 0.8, 95% confidence interval (CI) 0.7-0.9], Muslims (PR: 0.8, 95% CI 0.7-0.9), and households with monthly per-capita income of ≤US$ 10 (PR: 0.7, 95% CI 0.6-0.8). Those who heard and were aware of the risk of iodine-deficiency disorders and of the benefit of iodized salt were more likely to use appropriate salt (PR: 1.2, 95% CI 1.1-1.3). Those who were aware of the ban on non-iodized salt were more likely to consume adequately-iodized salt (PR: 1.1, 95% CI 1.01-1.3). The iodine content was higher in salt sold in sealed packets (PR: 2.9, 95% CI 1.8-4.8) and stored on shelves (PR: 1.6, 95% CI 1.3-2.0). Seventy-two percent of the salt samples from the retail shops had the iodine content of ≥15 ppm. The findings indicate that elimination of iodine deficiency will require targeting the vulnerable and poor population.

Characterization of arylsulphatase A in a 70 kDa protein isolated from goat spermatozoa having Na+, K+-ATPase inhibitory activity.

A protein having inhibitory effect on Na+, K+-ATPase as well as showing arylsulphatase A activity (ASA) was isolated from the cytosolic fraction of goat spermatozoa and characterized biochemically. The molecular mass of the protein was found to be 70 kDa (P70) on 10% SDS-PAGE after 35% ammonium sulphate precipitation, followed by hydroxyapatite column chromatographic separation. The isoelectric point (pI) of the protein was found to be 4.9. The sequencing results of first ten N-terminal amino acid residues of protein showed 100%, 90%, and 80% homology with N-terminal 18-27 amino acid residues of mice, pig and human testicular ASA, respectively. The optimum pH, temperature and incubation time for maximum ASA activity of the protein was 5.5, 37°C and 30 min respectively. The ASA activity of protein and AS from a commercial source was studied with respect to the sensitivity to different metal ions, vanadate, carbonyl compounds and ascorbate. Inhibition of AS activity of P70 by silver nitrate suggested that it was related to ASA. Comparable effects of different polyunsaturated fatty acids (eicosapentaenoic and docosahexaenoic acids) and purified anti P70-antibody on P70 and AS from commercial source were observed. The findings suggested that protein was novel in nature, having both regulatory and catalytic functions and showed similarities with the ASA reported from different sources.

study on validity of copper sulphate specific gravity method as a screening procedure to detect anaemia

Whether the Copper sulphate specific gravity method is a valid screening test to detect anaemia at the field level and if it is affected adversely by any common prevalent nutritional and physiological or obstetric factors of the women. To find out the validity of Copper sulphate specific gravity method to detect anaemia at 11 gm% and 12 gm% haemoglobin level among women. Cross-sectional, Observational, Epidemiological, Community-based study. Urban Health Clinic at Ghoshbagan slum of Kolkata, the field practice area of Dept. of Community Medicine, R G K M C and H. Women of 10 - 45 years of the area, selected by systematic random sampling. The study recruited 373 women from the slum area. For haemoglobin level of 12gm%, the sensitivity was 91.19%, specificity was 82.14%, Predictive value for positive test was 92.25% and that for negative test was 80.0%. Respective results for Haemoglobin level of 11gm% were 81.53%, 96.30%, 94.12% and 87.76%. Similar high values of validity were obtained for different physiological and nutritional status of the women. The results implied that copper sulphate specific gravity method is a valid screening procedure for detection of anaemia irrespective of differing physiological and nutritional statuses of women

CT guided fine needle aspiration cytology of thoracic mass lesions: a prospective study of immediate cytological evaluation.

To evaluate the role of CT guided FNAC as diagnostic and supportive investigation for thoracic lesions, 190 patients were studied during two years period from March 2003 to February 2005 in our institution. A total number of 163 (85.8%) lung lesions, 22 (11.6%) mediastinal lesions and 05 (2.6%) pleural lesions were obtained; only neoplastic lesions were categorized as per WHO classification. The diagnostic sensitivity for malignancy was 97.71% and specificity 100%. Though our priority was cytological assessment, the cytological diagnosis was corroborated with clinico-radiological parameters and transbronchial biopsies whenever applicable.