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Purpose: To establish the normative data of the head and face measurements needed to design an appropriate spectacle frame for the Indian population. Methods: Indian subjects between 20 and 40 years were included in the study. Thirteen parameters were measured using the direct and indirect methods using ImageJ software. Photographs of subjects were captured in the primary gaze position, with the head turned toward the subject’s right and left by 90° from the primary gaze. Results: The mean ± standard deviation of age was 27.6 ± 5.7; 55.38% were males. An independent t?test showed a significant difference in nose width (P = 0.001), inter?pupillary distance (P = 0.032), and body mass index (P = .012) between males and females. Inner inter?canthi distance (P = .265), outer inter?canthi distance (P = .509), and frontal angles (P = .536) showed no significant difference. There is a significant difference in face width compared with the other studies. The mean head width of males (154.168 ± 9.121) was wider than that of females (145.431 ± 8.923). This suggests a smaller distance between the temples of a spectacle frame for females. Conclusion: Considering the above factors, there is a need for a customized spectacle frame design providing better optics, improved cosmesis, and comfort to the wearer
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Purpose: Optic neuritis, defined as inflammation of the optic nerve, is the most common optic neuropathy affecting adults. Various studies in Southeast Asia have shown that the clinical profile of optic neuritis might differ in these regions from that reported in the western literature. Through this study, we evaluate the clinical profile of pediatric optic neuritis (PON) in the Indian population. Methods: This was a hospital?based prospective observational study. Patients with optic neuritis younger than 16 years who attended the neuro?ophthalmology clinic from May 2016 to April 2017 were included in the study. Results: This study included 54 eyes of 38 patients. The mean age of presentation was 10.6 years. Unilateral disease (58%) was found to be more common, and a slight female preponderance (58%) was noted. The most common feature was visual loss (96.3%). Pupillary light reflex abnormality was seen in most patients. Fundus examination revealed disk edema (77.7%) to be the most common feature. Neuroimaging was performed in 34 patients, and multiple sclerosis was diagnosed in four patients. At 3 months follow?up after treatment, 89% of eyes had best correct visual acuity of 6/9 or better (P < 0.001). Conclusion: In our study, we found the clinical profile of PON to be similar to that seen in western studies as well as those done previously in the Indian population, although with a few differences
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Ewing抯 sarcomas are rare, aggressive tumors with a tendency toward recurrence following resection, and early metastasis. Although patients of younger or older age account for almost 30% of instances, peak incidences occur between the ages of 10 and 20. We, hereby, report the case of a 10-year-old girl who presented with a 3-month history of pain in her right hip that was unable to be relieved by non-steroidal anti-inflammatory medicine and physical therapy. On examination, bone mar
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Background: There are no data on electrocardiographic (ECG) findings from general population of Indian subcontinent. We analyzed ECG abnormalities of in adults as part of a community survey of prevalence of coronary artery disease and risk factors from South India. Methods and results: In this cross-sectional study of men and women between the ages 20 to 79 years, ECGs recorded digitally were analyzed using the Minnesota code. Electrocardiograms were analyzed for abnormalities in 4630 participants (women 59.6%). The overall prevalence of ECG abnormalities (39.9%) was higher in men (47.24% vs. 34.9% p <0.0001). QRS axis deviation, first degree AV block, fascicular blocks, incomplete right bundle branch block, sinus bradycardia and ST elevation in the anterior chest leads were markedly higher in men. Sinus tachycardia and low voltage QRS occurred more often in women. The overall prevalence of atrial fibrillation was 0.32% which was markedly lower than the western data. Brugada and early repolarisation patterns occurred in 1.06% and 1.56% respectively, equal in both age groups, but markedly higher in men. Brugada pattern occurred more often than in the west, but much less than the Far East population. Early repolarisation pattern was similar to rest of Asian population, but significantly less than the Caucasian population Conclusion: In this community-based study, prevalence of major electrocardiographic abnormalities was high. Overall, men had significantly higher ECG abnormalities
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Background: Age estimation through dental maturity indicators is relatively more accurate, reliable, and valid for living as well as dead individuals. It acts as an important tool in diagnosis and treatment planning in clinical as well as in forensic dentistry. There are various methods to estimate the dental age. Out of which, Demirjian's method has been widely used in various populations. However, there is a dearth of literature on Indian population comparing Demirjian's method to Cameriere's method. Aim: The purpose of this study was to evaluate the accuracy of Demirjian's and Cameriere's age estimation methods to chronological age in growing children using orthopantomograph (OPG). Setting and Design: The sample consisted of digital OPGs of 280 children in Navi Mumbai aged 5–16 years. Materials and Methods: Digital OPGs were used to assess the dental maturity of seven mandibular left teeth using Demirjian and Cameriere's method and were compared to the chronological age. Statistical Analysis Used: Data were analyzed using Student's t tests. Result: Irrespective of gender, dental age estimated by Cameriere's method (mean 10.23 ± 2.79 years), underestimated the chronological age (mean 11.74 ± 2.86 years) for overall population which showed statistically significant difference. Demirjian's method overestimated (mean 12.24 ± 3.06 years) the chronological age for the overall population but was statistically insignificant. Conclusion: Demirjian's method is more closely in correlation with the chronological age of growing children as compared to the Cameriere method when applied to children of age 5–16 years in Navi Mumbai.
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@#Introduction: To evaluate the trends of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) in the first three weeks after uncomplicated total hip (THR) and total knee (TKR) arthroplasty/replacement in the Indian population and to compare it with available literature. Material and methods: A total of 90 patients were enrolled for this prospective study, of which 30 were unilateral THR, 30 were unilateral TKR (U/L TKR) and 30 were simultaneous bilateral TKR (B/L TKR). Serum CRP and ESR were measured on the day before surgery and postoperatively on day 1st, 2nd, 3rd, 7th, 12th, and at the end of 3rd week. Results: CRP showed a peak at day 2nd with normalisation to pre-operative value by the end of 3rd week. While ESR showed a peak on day 3rd and continued to remain elevated even at end of 3rd week post-operatively. Both mean CRP and ESR values were higher in THR patients followed by in B/L TKR and then in U/L TKR patients. Conclusion: CRP persists to be the best acute phase reactant in the early post-operative phase with a relatively typical pattern as compared to ESR. CRP values peak at postoperative day 2nd and then show a gradual decline. However, its normalisation to pre-operative baseline values may vary among different groups of population.
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Background: Self-medication is a widely practiced trend in the general Indian population. Among the medical students, self- medication is popular because of awareness about the disease and their treatment. Analgesics are one of the most common drugs used for self-medication. Very few studies are available in Jharkhand regarding this subject. So, the present study aims to delve into the pattern of self-medication practices of analgesics among the 1st and 3rd semester medical students of RIMS, Ranchi, Jharkhand.Methods: A questionnaire based cross sectional study was done in RIMS, Ranchi, Jharkhand, India in March-April 2019 among the undergraduate medical students. The results were expressed as percentage and frequency.Results: Out of total 150 and 142 students in the 1st and 3rd semester respectively, 140 and 130 students practiced self- medication. Advice from seniors was the biggest source of information in both the groups followed by internet and books. Paracetamol was the most common drug (75%; 60%) and headache was the most common indication (55%; 68%). Quick relief of symptoms was the most common reason for self-medication in both the groups (44%; 48%).Conclusions: In both the groups, the students continued the drug even after experiencing side effects (77%; 60%). Most students were of the view that such practice is not acceptable at all times (75%; 72%).
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Background: Fetal heart rate is an indicator of fetal viability. During third trimester and labour the normal range of fetal heart rate is between 110-160 bpm as recommended by the international guidelines. Unlike this, the first trimester embryonic heart rate does not lie in the same range. During the first trimester the normal embryonic heart rate varies between each week of gestation, as determined by a few western studies. Indian studies on the same are not available. Objective of this study was to determine the trend of the fetal heart rate in first trimester of pregnancy in South Indian women.Methods: Transvaginal scan was done in 51 pregnant women with singleton pregnancy attending the antenatal clinic in a medical college hospital. Crown rump length and fetal heart rate were measured and plotted on a graph. Also, the fetal heart rate at different gestational age of our study was compared with the fetal heart rates at the same gestational age from the studies in the western population.Results: The range of fetal heart rate at different weeks of gestation was comparable to the heart rate variations as seen in the western population. The maximum heart rates at 9 weeks of gestation in our study was higher than the heart rate in the western population.Conclusions: Possibility of variation in the fetal heart rates in the first trimester in different populations cannot be ruled out until confirmed by studies with large sample size.
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Background: Dental anxiety is a significant and challenging problem in patients seeking dental treatment. During any dental procedure patients often experience severe pre-operative and intra-operative anxiety which makes the procedure more difficult. Anxiety during endodontic therapy often leads to increased pain perceptions and instability of the physiological parameter throughout treatment. Aim: The purpose of this study was to evaluate the influence of music as a nonpharmacologic aid on anxiety, pain perception and physiological parameters (heart rate, systolic blood pressure, and diastolic blood pressure) at three different time period - before, during, and after endodontic treatment. Methods: A total of 100 patients were recruited in the present study. Before starting the endodontic treatment, the interviewer administered the Modified Corah Dental Anxiety Scale (MCDAS) to assess the baseline level of anxiety and Visual Analog Scale (VAS) for pain assessment. Patients were randomly divided into 2 groups: the first one listened to the music during endodontic treatment and the second one did not. Before, during, and after the endodontic procedure, the physiological parameters (i.e. heart rate, systolic and diastolic blood pressure) were recorded. All the data were collected and statistically analyzed. Results: Direct contrasts between patients listening or not listening to music showed that all the measured physiological parameters improved considering the overall period (during and after the root canal therapy) in the group of patients listening to music (P < .05). Conclusion: Within the limitation of the study, music administered to subjects with different levels of anxiety during endodontic treatment significantly decreased pain levels and improved physiological parameters during the endodontic procedures. Clinical Significance: Music and medicine always work together and the soothing effects of sounds and musical frequencies make this union an extraordinary tool of synergistic care. Music therapy can be considered as a valid nonpharmacologic aid to manage anxiety during endodontic treatment.
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Trillions of microbes living in the gastrointestinal tract (GIT) of the human body finely tune homeostatic equilibrium in theGIT ecosystem and encode key functionalities that play crucial role in host metabolic functions, synthesis of macro- andmicronutrients, xenobiotics metabolisms, development of innate and adaptive immune systems, tissue and organ developments and resistance against invasion of enteric pathogens. The microbial diversity and richness of GIT ecosystem variesgreatly between individuals and over time. Extent of taxonomic and functional variations in GIT ecosystem is linked withdietary habit, pharmaceuticals usages, age, sex, body mass index, ethnicity, geography, altitude and civilization. Understanding a holistic picture of GIT microbiome of healthy people living across geography and identifying population specific‘keystone’ taxa is of immense importance for identifying microbial species that may provide protection against chronic andmetabolic diseases. Knowledge on geographic or ethnicity specific microbial signatures may also help us to understand thevaried efficacy of different drugs and vaccines in different population. India is the home of more than 1.36 billion peoplebelonging to 2000 human communities residing in well distinct geography. In the present review, we discuss the microbialsignatures in health and diseases of the rural and urban Indians living in sea level and high altitude areas.
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Background: Magnesium sulphate is anticonvulsant of choice for eclampsia. Single dose magnesium sulphate therapy was tried for the management of Eclampsia and Imminent Eclampsia considering the low body mass index of Indian population.Methods: A prospective interventional study comprising of total 80 patients having either eclampsia or imminent eclampsia, to whom the Pritchard or a single dose MgSO4 was given alternatively in a tertiary hospital from October 2014 to October 2017. Serum magnesium levels, maternal and perinatal outcome and recurrence of convulsions were evaluated using Student- t test and chi square test.Results: Mean Serum Magnesium levels in eclampsia and imminent eclampsia group at 0 min, 30 min, 4 hours in Pritchard regimen were 1.96mg/dl, 5.85mg/dl, 4.68mg/dl while in single dose regimen it was 1.78mg/dl, 462mg/dl, 3.63mg/dl respectively. Those who received Pritchard regimen showed higher level of Serum magnesium levels at 30 minutes and 4 hours than those receiving single dose. By applying T-test it was found that there is a significant difference in serum magnesium levels range in both group but no statistical difference in the control of convulsions in both groups.Conclusions: With increased and almost widespread use of magnesium sulfate in obstetrics there has been concerns regarding its safety. In the study, although P-values are not significant because of small sample size, there is considerable difference in serum magnesium levels 30 min and 4 hours, recurrence of convulsions and maternal morbidity between Pritchard regimen and single dose regimen. The goal which was achieved with Pritchard regimen previously, now can be achieved with single dose regimen in Indian women. Single dose magnesium sulphate is safe and effective in controlling convulsions with improved maternal and perinatal outcome.
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Background: In individuals with type 2 diabetes mellitus (T2DM) the presence of Cardiac autonomic neuropathy (CAN) increases the risk of severe hypoglycaemia, cardiac arrhythmias, silent myocardial ischemia and stroke. It is also associated with increased perioperative morbidity and mortality, even with minor surgeries in these patients. The present study was conducted to assess the prevalence of CAN in T2DM patients and to investigate any possible association between CAN and micro vascular complications.Methods: 102 T2DM patients between the age of 30 years and 70 years, who attended outpatient department of Institute of Diabetology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai, Tamil Nadu were included. All the selected patients underwent laboratory investigations, biothesiometry, fundus examination, and CAN assessment by CANS analyser.Results: A slight female preponderance was noted in the study, though it was statistically insignificant. Out of 102 patients, prevalence of CAN dysfunction was found in 82 (80.39%) of T2DM patients. No significant association of CAN was noted with duration of diabetes (p=0.772), HbA1c (p=0.827) and nephropathy (p=0.524). However, peripheral neuropathy (p=0.006) and retinopathy (p=0.03) were found to be significantly associated with CAN in T2DM patients.Conclusions: Prevalence of CAN in asymptomatic South Indian T2DM population was found to be 80.39%, with equal sex distribution and was most common in the 51- 60 years age group. Diabetic neuropathy and retinopathy were the most significant microvascular complications predictive of the incidence of CAN in T2DM patients.
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Introduction Asian Indians have a propensity for premature, severe, and diffuse coronary artery disease (CAD). Several single-nucleotide polymorphisms (SNPs) in the ‘core CAD’ region of the chromosomal region 9p21.3 are known to be strongly associated with CAD. Objectives We aimed to study SNPs in the 9p21.3 region associated with CAD and premature CAD and identify their association with demographic and clinical characteristics in an Asian Indian population. Methods SNP genotyping was performed for 30 SNPs of the 9p21.3 region using MassARRAY® technology. Along with demographic and SNP data analysis, we also performed multivariate logistic regression analysis and multifactor dimensionality reduction analysis to study SNP–SNP and SNP–demographic/clinical variable interactions. Results Our results suggest that females are at a higher risk of premature CAD. We found that SNPs rs1333045 (CC), rs16905599 (AA), rs2383206 (GG), rs2383208 (AG), and rs4977574 (GG) were significantly associated with premature CAD. When adjusted for covariates/confounders, we found that rs2383206 showed the strongest risk association with CAD followed by rs16905599 and rs2383208. Further, SNPs rs1333049 (CC) and rs4977574 (GG) were found to be exclusively associated with premature CAD cases, suggesting their potential as genetic markers for premature CAD in the local population. Upon gender-based stratification, it was found that rs10757272 (TT and TC) is significantly associated with eightfold to ninefold CAD risk specifically among females. SNP rs7865618 (GG) is significantly associated with more than 2.5-fold CAD risk specifically among males. Conclusion Our study suggests that SNPs at the 9p21 risk locus may be used to generate a reliable genetic risk score along with markers at other loci.
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Background: Nutrient foramen is an opening in the bone shaft which allows passage to the blood vessels of themedullary cavity of a bone for its nourishment and growth. Knowledge about precise location and direction ofthe nutrient artery of long bones is important during any surgical or orthopaedic procedures of limbs, such asbone grafts and microsurgical vascular bone transplantations. This study was carried to record the number,situation and position of nutrient foramina in humerus of adults in south Indian population.Materials and methods: The study was conducted on 85(Right-38, Left-47) humerii collected from AnatomyDepartment of Coimbatore Medical College, Coimbatore. Length of each humerus bone was measured with thehelp of osteometric board. With the help of hand lens bones were observed for the number, direction andlocation of nutrient foramen with respect to the surface and borders.Results: In the present study majority of humerus bones have single nutrient foramen(64.7%) and mainly locatedon the anteromedial surface(51.7%) followed by medial border (36.5%) especially in the middle one third (87.1%)of the humerus.Conclusion: This study may give precise knowledge about location and number of nutrient foramina which isimportant for orthopaedic surgeons during surgical procedures such as fracture repair, bone grafts andmicrosurgeries.
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Purpose: To study the frequency and intraoperative difficulties associated with pseudoexfoliation (PXF) syndrome at a tertiary eye care center in a rural central India. Methods: This study included patients scheduled for cataract surgery who were diagnosed with PXF syndrome. All patients underwent a complete ophthalmologic evaluation, including slit-lamp examination, tonometry, gonioscopy, and ophthalmoscopy before the surgery. Cataract surgeries were performed by a single surgeon who reported the intraoperative difficulties. Results: In total, 1022 phakic eyes of 1823 patients were evaluated, 226 of whom (22.1%) were diagnosed with PXF syndrome. Most eyes (n = 81, 35.8%) with PXF syndrome were ?81 years old. Eighty-six eyes (38.1%) had bilateral involvement, whereas 70 (30.9%) had right or left eye involvement. Further, PXF material was distributed on the iris, pupil, and lens in 70 eyes (30.9%) and on the pupillary margin in 36 eyes (15.9%). The mean pupillary dilation was 5.1 (�4) mm in patients with PXF syndrome compared with 7.2 (�6) mm in those without it (P = 0.03). Grade VI cataract was observed in 93 eyes (41.2%) and hypermature cataract was the most commonly observed cataract stage. Twenty-one eyes (9.3%) had increased intraocular pressure. Intraoperative difficulties were encountered in 62 eyes (27.4%) with poor pupillary dilation being the most common problem (32 eyes, 14.2%), followed by zonular dehiscence (18 eyes, 8%). Conclusion: This hospital-based study showed that PXF syndrome is common in Indian rural population and that the intraoperative complication rate in these patients is high.
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The recently published Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial evaluated the hypothesis that rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary prevention. In India, stable cardiovascular disease occurs in a much younger age group relative to the rest of the world. Our critical analysis of COMPASS trial showed that the younger age group appeared to derive greater benefit from the rivaroxaban + aspirin combination (relative to aspirin alone) as seen with number needed to treat metrics as compared to the older age group.
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Purpose: The aim of this study was to establish the prevalence and association of age-related macular degeneration (AMD) and obesity which was not studied extensively in Indian population over 60 years of age. Methods: This was a cross-sectional, population-based study. A total of 4791 patients with gradable fundus photography were included. All patients underwent detailed ophthalmic examination and AMD was graded with retinal photographs. Grading of AMD was done according to the International ARM Epidemiological Study Group and staged based on grading in worse eye. The association of AMD severity and obesity (based on body mass index, waist–hip ratio, waist circumference, isolated abdominal obesity, isolated generalized obesity, and combined obesity) was assessed. The main outcome variable was an association between the presence and severity of AMD with different grades of obesity. Results: No direct significant association was noted between the presence and severity of AMD and any obesity indices. Subgroup analyses based on lifestyle patterns and common systemic pathologies in AMD population were done. Late AMD was significantly associated with tobacco consumption in population with combined obesity (P = 0.033 and odds ratio = 2.998). Conclusion: No direct association was noted between the presence or severity of AMD and obesity in South Indian population. However, indirect associations between the severity of AMD and combined obesity were found.
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Background “Coronary slow flow’’ (CSF) is delayed vessel opacification in the absence of epicardial stenosis. Studies in different ethnic groups have found variable risk factors associated with CSF. Aim of present study was to analyze the risk factors and angiographic profile of CSF in North Indian population, not studied till date. Methods 40 patients with CSF and 40 controls were studied. CSF was determined quantitatively by thrombolysis in myocardial infarction (TIMI) frame count method. Various clinical risk factors (age, sex, body mass Index (BMI), diabetes, hypertension, dyslipidemia, smoking), hematological and biochemical parameters (hematocrit, platelet count, uric acid, homocysteine, fibrinogen, high sensitivity C reactive protein (hsCRP), glycosylated hemoglobin (HbA1c) were assessed. Results Of the 40 patients with CSF, 37 (92.5%) were males. While 20 patients (50%) presented with chronic stable angina, rest 20 (50%) presented with acute coronary syndrome. [15 (37.5%) with unstable angina and 5 (12.5%) with non ST elevation myocardial infarction (NSTEMI)]. Patients with CSF had significantly higher BMI (27.27 ± 2.82 vs. 24.12 ± 2.35, p < 0.001), fibrinogen levels (398.48 ± 120.96 vs. 331.55 ± 162.6, p = 0.04) and smoking (24(60.0%) vs 14(35.0%), p = 0.02). On multivariable regression analysis, only BMI was found to have an independent association with CSF (odds ratio 1.613, 95% confidence interval 1.265–2.057, p < 0.001). Conclusion This is the first study to analyze clinical presentation, angiographic profile and risk factors associated with CSF in North Indian population. In this study, we found only BMI to have an independent association with CSF.
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Primary cilia play a key role in sensory perception and various signaling pathways. Any defect in them leads to group of disorders called ciliopathies, and Bardet–Biedl syndrome (BBS, OMIM 209900) is one among them. The disorder is clinically and genetically heterogeneous, with various primary and secondary clinical manifestations, and shows autosomal recessive inheritance and highly prevalent in inbred/consanguineous populations. The disease mapped to at least twenty different genes (BBS1-BBS20), follow oligogenic inheritance pattern. BBS proteins localizes to the centerosome and regulates the biogenesis and functions of the cilia. In BBS, the functioning of various systemic organs (with ciliated cells) gets deranged and results in systemic manifestations. Certain components of the disease (such as obesity, diabetes, and renal problems) when noticed earlier offer a disease management benefit to the patients. However, the awareness of the disease is comparatively low and most often noticed only after severe vision loss in patients, which is usually in the first decade of the patient’s age. In the current review, we have provided the recent updates retrieved from various types of scientific literature through journals, on the genetics, its molecular relevance, and the clinical outcome in BBS. The review in nutshell would provide the basic awareness of the disease that will have an impact in disease management and counseling benefits to the patients and their families.
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Incidence of sickle cell trait in India is high in peninsular south, south-eastern, central and south-western India, while in north and north-eastern India, it is absent. Unicentric origin of SCD in the tribals of nilgiri hills in southern India has been proposed. The present study on the frequency of HbS trait and -globin gene haplotypes was conducted in the tribal-rich states of Chhattisgarh and Jharkhand to get an insight into the uneven distribution of HbS in India. Jharkhand borders with the HbS-high Odisha and Chhattisgarh, and HbS-low UP, Bihar and Bengal. Cellulose acetate gel electrophoresis was performed on the collected blood samples, to detect sickle haemoglobin (HbS) followed by DNA analysis. HbS associated -gene haplotype was constructed for the samples positive for HbS and all the tribals by PCR-RFLP. Out of 805 (Chhattisgarh – 261, Jharkhand – 544; >36% tribals) samples analysed HbS frequency was 13% in Chhattisgarh and 3.3% in Jharkhand. Within Jharkhand, frequencies varied considerably from 10% in Tatanagar to nil in Sahibganj. The Arab-India (AI) haplotype of -globin cluster occurred in low frequency, confined mainly to Chhattisgarh. The most abundant haplotype in all the populations was the East Asian, + − − − − − +, rare in HbS, mainly in Sahibganj in east Jharkhand, which lacked AI. Our results indicate that besides the heterozygote advantage againstmalaria, the uneven regional distribution of HbS trait is because of restricted movement of two different populations, Dravidian from the south and Tibeto-Burman from the east into the Indianmainland which failed tomeet, we conjecture, due to severe climatic conditions (deserts and heat) prevailing through parts of central India. Apparently, Jharkhand became a zone of contact between them in recent times.