A hospital-based descriptive study of Ayushman Bharat-Pradhan Mantri Jan-Arogya Yojana: an analysis of 4844 claims

Background: Current study was undertaken to analyze Ayushman Bharat claims settled during the initial two years of launch of the scheme in an empaneled, public hospital in northern India. Objective was descriptive analysis of 4844 settled claims in terms of demographic characteristics of beneficiaries, procedures and packages availed by them in an empaneled public hospital during the initial two years of the launch of the scheme. Methods: A cross-sectional records study of 4844 settled claims was conducted in a public, empanelled 1015 bedded tertiary care multi-specialty hospital of north India. Anonymized data was collected from the transaction management module of AB-PMJAY scheme and hospitalization record of patients retrieved from medical records department. Results: The study revealed that around 4844 claims were settled during the initial two years (December 2018 to December 2020). Highest number of claims (43.33%) were availed under general medicine category. Chemotherapy packages availed under medical oncology were 37.45% of all claims. Interventional cardiology packages were the costliest. Conclusions: The study provides an insight into the frequency of various claims, their costs, disease/procedural burden of beneficiary patients of AB-PMJAY. It will provide policy feedback and help in future planning and implementation of the scheme.

Critical analysis of fire incidents and self-assessment of fire safety program in a tertiary care hospital of India: an observational study

Background: Self-assessment of fire safety provides valuable insights for framing a robust fire safety program for hospitals by identifying gaps and taking corrective measures. The study was performed to (i) critically analyse fire incidents which occurred in the hospital and (ii) assess fire safety program of the hospital. Methods: A critical analysis of 3 fire incidents which occurred in hospital was performed. Further review of records regarding all fire incident reports was performed for last 4.5 years and analysed for cause, site, timing, triggering factor and firefighting. For the second objective, fire safety mechanisms in hospital were compared with national accreditation board of hospital checklist and national building code 2016 part 4 “fire and life safety” guideline. Results: It was found that a total of 44 incidents of fire occurred over a period of four and a half years from January 2019 to July 2023, of which 42 were minor, confined fires while two were major and non confined fires. Electrical cause was found in 48.84% of fire incidents, 37% occurred in external areas, 41% in the morning shift hours and in 51.16% incidents clean agent was used for extinguishing the fire. In 93.18% incidents, trained hospital security extinguished the fire. Average reporting time was 1.23 minutes and mean time taken to act and extinguish the fire completely was 10 minutes. Conclusions: Critical analysis of fire safety using records of fire incidents and comparison with guidelines helps hospitals in self assessment of their fire safety plans and guides in filling lacunae.

Toluene-induced erythrodermic lichen planus

Lichen planus is an inflammatory disease that affects the skin and mucous membrane. The exact etiology is unknown, but it is considered an immunologically mediated disease toward unrecognized antigen possibly located at the basal cell layer. Many clinical variants are recognized. Lichen planus-like lesions can be seen in chronic versus host disease, drugs, and chemicals. Here, we report a new case of a male patient who was exposed to toluene-containing compounds after which he developed an erythrodermic eczematous and lichenoid eruption, which is to the best of our knowledge, the third case of toluene-induced lichen planus reported worldwide and the first case in our country.

A case series on bullous pemphigoid like scabies: A diagnostic challenge

Scabies is an ectoparasitic infection caused by Sarcoptes scabiei var. hominis in humans. Accurate figures of the prevalence of scabies are difficult to obtain, it seems to affect around 100�0 million people worldwide. Scabies is usually transmitted by close intimate physical contacts, such as the sharing of a bed or prolonged hand-holding. Scabies mites survive for 24� h outside of human bodies. Itching is the most obvious manifestation of scabies, which is usually sparing the face in adult classic scabies. The onset occurs 3�weeks after acquiring the infection. Bullous pemphigoid-like scabies is one of the atypical and rare forms of scabies that may be overlooked and mismanaged, where only 44 cases worldwide with this mode of presentation were reported. Here, we reported a series of three cases of bullous pemphigoid-like scabies, which presented with nocturnal itching and vesiculobullous lesions that are to the best of our knowledge the first cases reported in our country.

Histopathological effects of the nematode Amidostomum acutum on the small intestines of two aquatic birds: Fulica atra and Gallinula chloropus

The small intestine of two rallid aquatic birds (Fulica atra Linnaeus, 1758 and Gallinula chloropus (Linnaeus, 1758) from Bahr Al-Najaf depression, southwest of Al-Najaf city, mid-Iraq), were infected with the nematode Amidostomum acutum Seurat, 1918 with a prevalence of 25% and 50%, respectively, and a mean intensity of 24.5 and 30, respectively. The infected birds showed several gross pathological and microscopic lesions in their small intestine due to the infection with this nematode. The gross lesions included hypertrophy in the anterior part of the duodenum and small rough nodules on the small intestine wall. Microscopic lesions included necrosis and shortening of villi with their fullness with inflammatory cells, degeneration of villi, and an increased number of acini at the base of the intestinal villi.

study of lichen planus and its association with hepatitis C infection

The association of lichen planus with chronic hepatitis C virus [HCV] has been widely reported in the literature. However, there are wide geographical variations in the reported prevalence of HCV infection in patients with lichen planus. This study was conducted to determine the association of lichen planus with HCV in Iraqi patients in Basra governorate [southern Iraq]. From January 2008 to October 2009, 97 cases of lichen planus, 47 women [48.5%] and 50 men [51.5%] were diagnosed on the basis of characteristic clinical features, and if necessary, typical histological findings on biopsy. The patients were screened for the presence of anti-HCV antibodies by third generation ELISA. The control group [2070 person] consisted of healthy blood donors who were screened for HCV in the Central Blood Bank of Basra. Anti-HCV antibodies were detected in 3 [3.1%] cases. This was significantly higher in blood donors [pvalue = 0.002]. A statistically significant association was demonstrated between lichen planus and hepatitis C virus infection. Liver function tests, plasma glucose and gender were not significantly different between HCV infected and non-infected patients. The prevalence of HCV among Iraqi patients with lichen planus [3.1%] was significantly higher than in the control group [0.14%]. It seems that there is an association between HCV and lichen planus among Iraqi patients in Basra city; however, liver function tests are not pivotal means in screening for HCV in lichen planus patients

Trail to induce psoriatic skin lesion in the skin of BALB/C mice by injection of Staphylococcus aureus exotoxin

An In Vivo attempt to induce psoriatic lesions in the skin of BALB/C mice by injection of bacterial superantigen. Staphylococcus aureus that was isolated from skin lesions of psoriatic patients was subjected to gel filtration chromatography for extraction and purification of their exoproteins. The skin of BALB/C mice was injected by 0.2 ml of the extracted purified exo toxin. The induced lesions were markedly similar to that of human psoriatic lesions, although the histopathological changes were not completely mirrored to that of human psoriatic skin lesions. There is an important role of Staph. aureus exotoxin [superantigen] in induction, triggering and maintenance of psoriatic lesions

Health Awareness among Geriatric People.

Demographic and epidemiological transitions reveal geriatric problems as burning public health issue. The present cross-sectional study was undertaken to explore the health awareness among geriatric people in Mirpur in Dhaka city from January to April 2008 on purposively selected persons aged 60 years and above. An interviewer administered semi-structured questionnaire was used for data collection. The mean age of the respondents was found to be 66.5 ±7.25 yrs (Range: 60-103 yrs). It was found that perfect knowledge about food, nutrition, health and disease is significantly high among male respondents. The study revealed that 13.3% and 12.8% respondents have perfect knowledge on balanced diet and fiber containing food for regular bowel movement respectively. A large number of respondents (40.6%) were found having no knowledge about osteoporosis preventing foods. It was also found that 38.0% and 22.6% respondents have no knowledge regarding the causes of gingivitis and helminthasis respectively. On the basis of significant findings, it was suggested that more emphasis should be given on health education and awareness among geriatric people in order to ensure physical, mental and socially sound health.

Risk factors for isolated periventricular leukomalacia in very low birth weight infants: a case-control study

Periventricular leukomalacia [PVL] is a major cause of neurological disabilities in preterm newborn infants. PVL can occur as isolated [iPVL] or associated with massive intraventricular-preivenfricular hemorrhage [grade 3 and grade 4 IVH]. This study aimed to determine the antenatal and neonatal risk factors associated with iPVL. We retrospectively studied the medical record of very low birth weight infants [birth weight of less than 1500 gm], delivered at King Abdulaziz Medical City-Riyadh [KAMC-CR] and admitted to the neonatal intensive care of KAMC-CR between Jan 2004 and Dec 2008. A total of 696 VLBW infants were born alive in the study period, 20 infants developed iPVL, with prevalence of 2.87%. Neonates that have grade 3 IVH, grade 4 IVH, or major congenital malformation were excluded. The 20 affected infant with iPVL [iPVL group] were compared with 98 VLBW infants without 1PVL [No iPVL group] from the same cohort. At multivariate logistic regression model, larger birth weight odd ratio [OR]: 0.22; 95% confidence interval [CI]:0.059-0.82; P value: 0.024, early neonatal hypotension that needs therapy by a second inotropes like dobutamine [OR: 6;95%, CI:1.23-29. 17; P value:0.031]. The delay in surgical closure of hemodynamic significant PDA [hsPDA] [OR :0.8, 95% Cl :0.7-0.9, P value:0.002], occurrence of neonatal sepsis [OR:1.38; 95%CI:1.03-1.84; p value:0.031], retinopathy of prematurity [ROP] [OR:2. 77, 95% CI:1.12-6.83; P value:0.026] were associated with an increased risk of iPVL. In conclusion, early hypotension, neonatal sepsis, hsPDA and the delay of its surgical closure are strong risk factors for iPVL

Scarring and none scarring facial Acne vulgaris and the frequency of associated skin diseases

Acne vulgaris [AV] is chronic inflammatory disease of pilosebaceous unit of young people. Patients with acne with or with out scarring might differ in regard to their immunological background from those free from acne. To evaluate the problem of facial AV especially patients with scarring and to determine the frequency of associated skin diseases and to be compared with acne free control. A cross sectional randomized controlled epidemiological study was conducted from Oct.2005-Oct 2006. Three hundred students from Basra University; 132 [44%] males and 168 [56%] females were enrolled, their ages ranged from 18-25 [20.9 +/- 1.8] years. They were divided into: Group A those free from acne [98 individuals], Growp B with non scarring facial AV [96 patients], and Group C with scarring facial AV [106 patients]. History and examination were done for their acne, scarring acne and associated skin diseases. Alien and Smith grading system for AV were used, and a new invented multiparametric scoring system for scarring acne was applied. AV was in 98[73.24%] males and 104 [61.9%] females. Scarring was 54 [50.95%] males and 52 [49.05%] females. Greasy skin was the most common type among Group B 67 [69.8%] versus 39 [39.8%] among Group A [P=0.000029] and was more common among Group C 84 [79.2%] [P=0.00000001]. Family history of AV was nearly similar in A and B Groups 55 [57.29%] and 56 [52.83%] respectively, while in Group A was 39 [39.79%]. Family history of scarring acne was in 35 [33.02%] of Group C, 16 [16.66%] of Group B, and 3 [3.1%] in Group A; [P=0.00000017]. The age of onset was similar in A and B Groups between 15-16 years. Majority of patients in Group B had non inflammatory type or mild inflammatory [papular] 65 [67.8%] patients, most of case were mild and moderate 86 [89.58%] patients, while high percent in Group C had inflammatory type 95 [89.62%], and more than half of them had severe and very severe types upon grading 56 [52.8%]. The aggravating factors were similar in A and B Groups with stress and hot weather being the leading aggravating factors. Squeezing and digging habit was in 53 [50%] in Group C versus 23 [23.95%] in Group B [P=0.00024]. In most cases of scarring acne, scarring was mild and moderate 85 [80.19%], and the most common type scars was the flat hyperpigmented [50 [47.17%] and 66 [62.26%] respectively].The most common effect of scarring acne on psyche was mild discomfort and mild dysmorphophobia 75 [70.75%]. Associated skin diseases were more common among Group A 31 [31. 63%] than among Group B 22 [22.91%] and least common among Group C 14 [13.20%] [P=0.0067] and they were mainly dermatitis and skin infections. AV might reflect the immunological status especially among patients with scarring. The frequency of skin diseases was much less among patients with scarring acne

Can deram be a cause of oral lichen planus?

To study the relationship between oral lichen planus [LP] and the habit of chewing deram. A clinically based controlled observational study including a total of 176 women who used to chew deram and 200 women who never used deram, who consulted the Dermatology Department of Basrah Teaching Hospital, and a private clinic, Barsah, Iraq during the period from February 2005 to July 2007. The study showed that the incidence of oral LP is greater among 176 deram chewers [23.3%] in comparison with 200 women who never use deram [1.5%], particularly among those with frequent [51.2%] and prolonged [65.8%] chewing of deram. Oral lesions, were mostly asymptomatic [80.5%] and predominantly of reticulate pattern [87.9%]. Avoidance of deram chewing induced marked or complete improvement of the oral lesions in 56.3% of cases even without treatment within a 3 month follow up period. Pathological examination showed features similar to classical LP. Deram chewing should be considered as a possible cause of oral LP, particularly among frequent and prolonged chewers

Psoriasis. Modes of presentations among children in southern Iraq

To elucidate on the presentation of psoriasis among children in southern Iraq. This is an outpatient based, cross sectional clinical study, that was carried out in the Dermatology Department of Basra Teaching Hospital, Basra, Iraq, from April 2004 to June 2007, where a total of 104 psoriatic children were enrolled in the study. They were 59 females and 45 males, with a mean age of 6.8 years. Among 104 psoriatic children, the study showed that scalp 20.2%, guttate 17.3%, and flexural psoriasis involving the napkin area 14.4% or one or more of the body flexures, were the common modes of presentation reported in most cases. Many other atypical forms were also reported, and many aggravating factors were recognized. Psoriasis should be considered in any child with chronic recurrent skin lesion with poor response to treatment, particularly if it is atypical

Effect of Ramadan fasting on clinical biochemical and immunological parameters in healthy fasting and type two diabetes mellitus patients

Ramadan fasting is one of the pillaris of islam. The fasting time is about 12-19 hours depending on the season in which Ramadan falls and the geographic position of the country. It is often a subject of discussion nether or not Ramadan fasting confer any harmful effect on the body. The aim of this study was to evaluate the effect of Ramadan fasting on some clinical, biochemical and Immunological aspects of the healthy and type two Diabetes mellitus patients. The study was performed on [30] healthy fasting and [30] patients with type two diabetes mellitus in the month of Ramadan [2005]. Blood samples were obtained on the second and fourth week's of Ramadan and were analyzed for fasting blood sugar, urea, uric acid, lipid profile, Immunoglobulins and complement component concentration, in addition, lymphocyte was separated to study the lymphocyte transformation assay in vitro compared with healthy non-fasting. There was slight elevation in the HDL-C, B. urea, S. Triglyceride, VLDL, S. uric acid and slight reduction in LDL-C at the end of fasting. There was slight reduction but the difference was non- significant [P>0.05] in the value of immunoglobulins [IgA, IgG, 1gM] and [C3, C4] also, there was no difference in the sensitization rate of lymphocyte transformation in both healthy and type two diabetic patients compared with healthy non-fasting control. Slight elevation of HDL-C and slight elevation of B. urea, S. uric acid, S. Triglyceride, VLDL and there is non significant changes in Immunoglobulins and complement concentration and sensitization rate of lymphocyte transformation. Thus, Ramadan is safe for type two diabetic patients with the proper education of diabetic management

Some variables affecting microencapsulation of d-alpha tocopherol succinate

d-alpha tocopherol succinate, [Vit.E] is one of the most important vitamin, that is incorporated in food and nourishment due to its high biological activity against free radical formation inside cells. This study was illustrated in the followings: Microcapsules of d alpha tocopherol were prepared from different core: wall ratios 1:1, 1:2 and 1:3 by solid dispersion method using ethyl cellulose [Ethoel] polymer. The powdered microcapsules with 1:1 core:wall ratio is formulated as tablets with good appearance and hardness. The drug release was found to be increased as a function of increasing, core: wall ratio, stirring speed and pH medium. The profile of cumulative different pH medium release of the drug gives rise an indication of prolonged release dosage form. [during 6hrs. of dissolution]

Immunomodulation of visceral leishmaniasis with pejianum harmala seeds extract in experimental animals

Visceral leishmaniasis is an endemic disease in Iraq with high incidence among children below two years. Some recent reports indicated a immunopotentiation role of peganum harmala seed extract against some intra cellular pathogen. To investigate the immunostimulation effect of peganum harmala seeds extract before infection with leishmania donovani in BALB/C mice through various parameter's. BALB/C mice were divided into experimental groups with each group consisting of six animals. The experimental groups injected introperitoneally with 5xl0[6] promastigotes. Experimental groups were injected intraperitoneally by peganum harmala seed extract at doses of [125, 250, 500] micro g/20 gm b. wt. On day 5, 10 and successive six days before infection with L. donovani. These animal were sacrificed after [8] weeks. Total parasite burden in spleen, liver percent of infected cells, leishmanial index in peritoneal macrophage, number of macrophage forming formazan. Decrease in number of total parasite burden in liver and spleen in all mice groups treated with P. harmala seed extracts also, decrease in percent of infected cells, increase in leishmanial index in peritoneal macrophage, increase in macrophage forming formazan. Peganum harmala seeds extract was found to have anti leishmanial had anti leishmanial activity through killing of leishmania donovani amastigotes by activated macrophages

High performance liquid chromatographic method for determination of doxycycline in human plasma and its application in pharmacokinetic studies

An accurate, sensitive and reproducible high performance liquid chromatographic [HPLC] method for the quantitation of doxycycline in plasma has been developed and validated. The drug and the internal standard were eluted from a micro-Bondapak C [18] column [3.9 mm x 150 mm, I.D., 5 micro m particle size] at room temperature with a mobile phase consisting of acetonitrile and water [28:72,% v/v]. The flow rate was 0.8 ml/min. A UV detector set at 346 nm was used to monitor the effluent. Each analysis required no longer than 6 min. Quantitation was achieved by measurement of the peak area ratio of the drug to the internal standard. The limit of detection was 10.0 ng/ml and the limit of quantification of doxycycline in plasma was 0.10 micro g/ml. The standard curve ranged from 0.1 to 2.5 micro g/ml. The intraday coefficient of variation [C.V.,%] ranged from 1.444 to 3.016%, and interday [C.V.,%] from 1.572 to 2.705% at four different concentrations. The relative recoveries ranged from 98.43 to 105.13% and the absolute recoveries ranged from 54.08 to 62.56% at four different concentrations. Stability studies showed that doxycycline is stable for at least 4 weeks in plasma after freezing at - 20 °C. The method was applied for the determination of the pharmacokinetic parameters of doxycycline after oral administration of 100 mg capsules of two commercially available formulations to 6 human volunteers

Power spectrum analysis and conventional electromyogram in duchenne muscular dystrophy

A comparative study of automatic electromyogram analysis [power spectral analysis] and manual measurements of the individual motor units potentials parameters in normal and Duchenne muscular dystrophy patients was performed to assess the diagnostic yield of both methods. The analysis of 20 motor unit potentials elicited at weak effort manually by visual assessment and by power spectrum analysis at 1400 Hz Haning window were performed with concentric needle electrode in the biceps brachii and tibialis anterior. The study includes 18 healthy controls and 32 Duchenne muscular dystrophy patients. The primary diagnosis of the patients was based on the clinical criteria, family history and serum creatin kinase activity estimation. Seventeen patients were biopsied for further histological and histochemical examination. The conventional electromyogram of the patient group characterized by condensed, low mean amplitude of the recruited pattern and an increase in the percentage of polyphasic potentials of short duration and low amplitude in comparison to the normal subjects. About 74% of the patients were identified as myopathic patients with this method. Power spectrum analysis showed significant increase [P<0.0005] in the mean power frequently and the relative power at 1400 Hz and a significant decrease [P<0.0005] in accumulated power. About 95% of the patients were identified as being myopathic patients by this method. Statistical correlation analysis revealed no relationship between the power spectrum analysis and motor unit potentials parameters. The electromyogram power spectra was shifted to the higher frequencies in the Duchenne muscular dystrophy patients as compared to the control. The diagnostic yield of the electromyogram power spectrum analysis was higher than the measurement of the motor unit potential parameters. The best parameter of the electromyogram power spectrum is the relative power at 1400 Hz than the other two parameters. The net result of this study is that the electromyogram power spectrum has diagnostic possibilities in the muscles, which showed normal, or few motor unit potential changes

survey of narcotic control in Saudi Arabia

The systems of monitoring, surveillance and adherence to the laws and regulations of controlled narcotic drugs in 47 hospitals, of 200 beds or more, in the Kingdom of Saudi Arabia were studied. Hospital pharmacists and nurses were asked to answer questionnaires, and their responses were tabulated and evaluated. The results revealed that the degree of control of narcotics in all hospitals was sufficient to comply with the laws and regulations of narcotic drugs in the Kingdom of Saudi Arabia. The need to improve the narcotic drug regulations is discussed with some recommendations to be implemented in the overall control of narcotics

Muscle contraction [tension] headache fact or fiction

Muscle contraction is presumed to play a major role in the causation of tension headache, but this claim had not been substantiated objectively. In this study 55 consecutive patients [46 females and 9 males were examined electromyographically during an attack of headache. Eleven patients only showed contraction of the frontalis, temporalis or the posterior cervical muscles, in the rest these muscles were silent. This finding suggest the mechanisms other than muscle contraction are responsible for this type of headache