Barriers to healthcare and health seeking behaviors among elderly people living in rural regions of India: a study based on 9 villages in Eastern Uttar Pradesh

Background: The elderly population in India is experiencing exponential growth and facing various health and well-being challenges. This demographic shift is especially pronounced in rural areas, affecting social, financial, family, and transportation aspects, subsequently impacting health and well-being. This study aims to comprehensively understand these needs and priorities by exploring the multifaceted challenges faced by the elderly in India. Methods: An exploratory qualitative research study with a quantitative component was conducted in 9 villages in Uttar Pradesh’s Siddhartha Nagar District. Participants included individuals aged 60 years and above (n=29, M:F ratio of 13:16). Data were collected using Focus Group Discussions and Personal Interviews to assess the challenges faced by the geriatric population. The methodology involved multi-directional interactive sessions focusing on health, illness, and coping. Results: Participants averaged over 5.8 medical conditions. Those with better Socio-Economic Status (SES) reported multiple conditions but fewer troubles, while the majority, being very poor, did not consider health a primary concern. There were no complaints about the lack of public health facilities or transportation. The study highlights the complex interactions between healthcare, family, and financial difficulties that older people in rural India experience, underscoring the need for specialised treatments. The low level of knowledge about government programmes emphasises the need for improved outreach techniques to close existing accessibility gaps. Conclusions: The study recommends focused interventions and improved policies to meet the unique needs of India's rural elderly population. Policymakers and healthcare providers can enhance the well-being of this vulnerable demographic by understanding the complex nature of their issues.

Antibiotic resistance modulation of Clostridium perfringens type D using indigenous plants extracts

Aims@#The study was aimed to explore the antimicrobial potential of ethanolic leaf extracts of Eucalyptus globulus, Moringa oliefera, Syzygium cumini and Citrus limon against antibiotic-resistant Clostridium perfringens type D (n=5).@*Methodology and results@#Antibiotic resistance pattern of C. perfringens type D isolates against tetracycline, gentamicin, ceftriaxone, amoxicillin and streptomycin was evaluated by disc diffusion method. Well diffusion and micro broth dilution methods were used to determine the anti-bacterial activity, sub-inhibitory concentrations and antibiotic resistance modulating effects of the plant extracts. Ethanolic extract of E. globules was selected to evaluate its modulatory impact and subjected to GC-MS analysis to separate and identify the phytochemicals. The results showed that the isolates were resistant to gentamicin (0 ± 0.00 mm), streptomycin (0 ± 0.00 mm), tetracycline (13.2 ± 2.28 mm) and ceftriaxone (0 ± 0.00 mm) while sensitive to amoxicillin (23.8 ± 1.30 mm) and tetracycline (13.2 ± 2.28 mm). Eucalyptus globulus exhibited the maximum anti-bacterial activity with a zone of inhibition (ZOI) of 14.6 ± 0.54 mm and minimum inhibitory concentration (MIC) (1500 ± 947.85 µg/mL). Other plant extracts (M. oliefera, S. cumini and C. limon) also showed anti-bacterial activity but couldn’t modulate the resistance. The activity of ceftriaxone associated with E. globulus extract was improved with 20.2 ± 0.20 mm ZOI at 78.125 µg/mL sub-inhibitory concentration.@*Conclusion, significance and impact of study: @#The study results indicate the possible use of the ethanolic extract of E. globulus alone or in combination with common antibiotics for the treatment of C. perfringens infections in small ruminants.

Ameliorative effects of Lactobacillus against Aflatoxin B1 / Efeitos benéficos do Lactobacillus contra a Aflatoxin B1

Abstract Lactobacilli are probiotics with Aflatoxin (AF) detoxification ability, found in fermented products, GIT of animals and environment. Purpose of this study was to investigate the ability of broiler isolates of Lactobacillus against Aflatoxin B1 (AFB1). For this purpose, 5 isolates of Lactobacillus from broiler gut were incubated with 100 ppb AFB1 in aqueous environment and effect of different parameters (cell fractions, time, temperature, pH) on detoxification was determined by HPLC. The ameliorative effect of Lactobacillus salivarius (LS) against AFB1 was studied in broiler. The results revealed that LS (CR. 4) showed the best results (in vitro) as compared to other isolates (L. salivarius (CR. 3, CR, 4), L. agilis (CE. 2.1, CE. 3.1) and L. crispatus (CE. 28). Cell debris of CR. 4 showed significantly higher detoxification (P<0.05). Maximum amount of AFB1 was detoxified at 30°C (97%), pH 4.0 (99%) and 6 h (99.97%). In vivo study showed that AFB1 decreased weight gain (1,269 ± 0.04 gm/ bird), feed consumed (2,161 ± 0.08 gm/ bird), serum total protein (2.42 ± 0.34 gm/ dl), serum albumin (0.5 ± 0.2 2 gm/dl) and antibody titer (4.2 ± 0.83). Liver function enzymes were found (alanine transaminase (ALT): 32 ± 10.7 U/L) and aspartate transaminase (AST): 314.8 ± 27 U/L) elevated in AFB1 fed broilers. Treatment with 1% LS not only decreased the toxic effects of AFB1 (group D) but also improved the overall health of broilers due to its probiotic effects (p<0.05) as compared to control negative (group A). The detoxification ability of LS was better than commercial binder (CB) (0.2% Protmyc). It was concluded that detoxification of AFB1 by Lactobacillus was strain, temperature, pH and time dependent. LS has detoxification ability against AFB1 in vivo.

Resumo Os lactobacilos são probióticos com capacidade de desintoxicação da Aflatoxina (AF), encontrados em produtos fermentados, TGI de animais e meio ambiente. O objetivo deste estudo foi investigar a capacidade de isolados de frango de corte de Lactobacillus contra a Aflatoxina B1 (AFB1). Para tanto, 5 isolados de Lactobacillus de intestino de frango foram incubados com 100 ppb AFB1 em meio aquoso, e o efeito de diferentes parâmetros (frações celulares, tempo, temperatura, pH) na desintoxicação foi determinado por CLAE. O efeito melhorador de Lactobacillus salivarius (LS) contra AFB1 foi estudado em frangos de corte. Os resultados revelaram que LS (CR. 4) apresentou os melhores resultados (in vitro) em comparação com outros isolados [L. salivarius (CR. 3, CR. 4), L. agilis (CE. 2.1, CE. 3.1) e L. crispatus (CE. 28)]. Detritos celulares de CR. 4 mostraram desintoxicação significativamente maior (P < 0.05). A quantidade máxima de AFB1 foi desintoxicada a 30 °C (97%), pH 4.0 (99%) e 6 h (99,97%). O estudo in vivo mostrou que AFB1 diminuiu o ganho de peso (1,269 ± 0.04 g / ave), alimento consumido (2,161 ± 0.08 g / ave), proteína total sérica (2.42 ± 0.34 g / dl), albumina sérica (0.5 ± 0.22 gm / dl) e título de anticorpo (4.2 ± 0.83). As enzimas da função hepática foram encontradas (alanina transaminase (ALT): 32 ± 10.7 U / L) e aspartato transaminase (AST): 314.8 ± 27 U / L) elevadas em AFB1 alimentados com frangos. O tratamento com 1% LS não só diminuiu os efeitos tóxicos de AFB1 (grupo D), mas também melhorou a saúde geral dos frangos devido aos seus efeitos probióticos (p < 0.05) em comparação com o controle negativo (grupo A). A capacidade de desintoxicação do LS foi melhor do que o aglutinante comercial (CB) (0.2% Protmyc). Concluiu-se que a desintoxicação de AFB1 por Lactobacillus foi dependente da cepa, temperatura, pH e tempo. LS tem capacidade de desintoxicação contra AFB1 in vivo.

Foliar application of triacontanol ameliorates heat stress through regulation of the antioxidant defense system and improves yield of eggplant / Title in the second language of the article: Amelioration of heat stress in egg plant through application of tricontanol

Abstract Transplanting time and genotype contribute to improving crop yield and quality of eggplant (Solanum melongena L.). A field experiment was conducted to investigate the impact of foliar applied of triacontanol (TRIA) and eggplant genotypes 25919, Nirala, 28389 and Pak-10927,transplanted on 1 March,15 March, and 1 April on exposure to high air temperature conditions. The experiment was performed according to Randomized Complete Block Design and the data was analyzed by using Tuckey,s test . The TRIA was applied at 10µM at flowering stage; distilled water was used as the control. Rate of photosynthesis and transpiration, stomatal conductance, water use efficiency, and effects on antioxidative enzymes (superoxide dismutase, catalase and peroxidase) were evaluated. The 10µM TRIA increased photosynthesis rate and water use efficiency and yield was improved in all genotypes transplanted at the different dates. Foliar application of 10µM TRIA increased antioxidative enzyme activities (SOD, POD & CAT) and improved physiological as well as biochemical attributes of eggplant genotypes exposed to high heat conditions. Highest activity of dismutase enzyme 5.41mg/1g FW was recorded in Nirala genotype in second transplantation. Whereas, lowest was noted in PAK-10927 (2.30mg/g FW). Maximum fruit yield was found in accession 25919 (1.725kg per plant) at 1st transplantation with Triacontanol, whereas accession PAK-10927 gave the lowest yield (0.285 kg per plant) at control treatment on 3rd transplantation. Genotype, transplanting date and application of TRIA improved growth, yield and quality attributes under of heat stress in eggplant.

Resumo O tempo de transplante e o genótipo contribuem para melhorar a produtividade e a qualidade da cultura da berinjela (Solanum melongena L.). Um experimento de campo foi conduzido para investigar o impacto da aplicação foliar de triacontanol (TRIA) e genótipos de berinjela 25919, Nirala, 28389 e Pak-10927, transplantados em 1 de março, 15 de março e 1 de abril de exposição a condições de alta temperatura do ar. O experimento foi realizado de acordo com o Randomized Complete Block Design e os dados foram analisados pelo teste de Tuckey. O TRIA foi aplicado a 10 µM na fase de floração; água destilada foi utilizada como controle. Taxa de fotossíntese e transpiração, condutância estomática, eficiência do uso da água e efeitos sobre as enzimas antioxidantes (superóxido dismutase, catalase e peroxidase) foram avaliados. O TRIA 10 µM aumentou a taxa de fotossíntese e a eficiência do uso da água e o rendimento foi melhorado em todos os genótipos transplantados nas diferentes datas. A aplicação foliar de TRIA 10µM aumentou as atividades das enzimas antioxidantes (SOD, POD e CAT) e melhorou os atributos fisiológicos e bioquímicos de genótipos de berinjela expostos a condições de alto calor. A atividade mais elevada da enzima dismutase 5,41mg / 1g FW foi registrada no genótipo Nirala no segundo transplante. Considerando que o mais baixo foi observado em PAK-10927 (2,30 mg / g FW). A produtividade máxima de frutos foi encontrada no acesso 25919 (1,725 ​​kg por planta) no 1º transplante com Triacontanol, enquanto o acesso PAK-10927 deu a menor produção (0,285 kg por planta) no tratamento de controle no 3º transplante. Genótipo, data de transplante e aplicação de TRIA, melhoramento do crescimento, rendimento e atributos de qualidade sob estresse térmico em berinjela.

Sublethal toxicity of carbofuran in cattle egret (Bubulcus ibis coromandus): hematological, biochemical, and histopathological alterations / Toxicidade subletal do carbofurano na garça-vaqueira (Bubulcus ibis coromandus): alterações hematológicas, bioquímicas e histopatológicas

Abstract This study was aimed to investigate Carbofuran (CF)-induced pathological changes in cattle egret. Two hundred cattle egrets were reared and equally divided into four groups and given different CF concentrations (0.03 mg/L, 0.02 mg/L, 0.01 mg/L and 0 mg/L (control group)). Hematology, serum biochemistry, histopathology, and immunological markers were studied. Our results confirm that CF induces anemic conditions, leukocytosis, elevated liver enzymatic activity, and alterations in renal biomarkers. Moreover, specific microscopic lesions such as multifocal necrosis, pyknotic nuclei, hemorrhages, congestion, and inflammatory cell proliferation were observed in the liver, kidney, spleen, and thymus. These findings suggest that CF can induce harmful effects, so the application of this pesticide in the field must be strictly monitored to mitigate the possibility of exposure to non-target species.

Resumo Este estudo teve como objetivo investigar as alterações patológicas induzidas por carbofurano (CF) em garças-vaqueiras. Duzentas dessas garças foram criadas e divididas igualmente em quatro grupos e receberam diferentes concentrações de CF: 0,03 mg/L; 0,02 mg/L; 0,01 mg/L; e 0 mg/L (grupo controle). Foram realizadas análises de hematologia, bioquímica sérica, histopatologia e marcadores imunológicos. Nossos resultados confirmaram que CF induz condições anêmicas, leucocitose, atividade enzimática hepática elevada e alterações nos biomarcadores renais. Além disso, lesões microscópicas específicas, como necrose multifocal, núcleos picnóticos, hemorragias, congestão e proliferação de células inflamatórias, foram observadas no fígado, rim, baço e timo. Esses achados sugerem que o CF pode causar efeitos nocivos, portanto a aplicação desse agrotóxico no campo deve ser rigorosamente monitorada para mitigar a possibilidade de exposição a espécies não alvo.

Ameliorative effects of Lactobacillus against Aflatoxin B1

Abstract Lactobacilli are probiotics with Aflatoxin (AF) detoxification ability, found in fermented products, GIT of animals and environment. Purpose of this study was to investigate the ability of broiler isolates of Lactobacillus against Aflatoxin B1 (AFB1). For this purpose, 5 isolates of Lactobacillus from broiler gut were incubated with 100 ppb AFB1 in aqueous environment and effect of different parameters (cell fractions, time, temperature, pH) on detoxification was determined by HPLC. The ameliorative effect of Lactobacillus salivarius (LS) against AFB1 was studied in broiler. The results revealed that LS (CR. 4) showed the best results (in vitro) as compared to other isolates (L. salivarius (CR. 3, CR, 4), L. agilis (CE. 2.1, CE. 3.1) and L. crispatus (CE. 28). Cell debris of CR. 4 showed significantly higher detoxification (P 0.05). Maximum amount of AFB1 was detoxified at 30°C (97%), pH 4.0 (99%) and 6 h (99.97%). In vivo study showed that AFB1 decreased weight gain (1,269 ± 0.04 gm/ bird), feed consumed (2,161 ± 0.08 gm/ bird), serum total protein (2.42 ± 0.34 gm/ dl), serum albumin (0.5 ± 0.2 2 gm/dl) and antibody titer (4.2 ± 0.83). Liver function enzymes were found (alanine transaminase (ALT): 32 ± 10.7 U/L) and aspartate transaminase (AST): 314.8 ± 27 U/L) elevated in AFB1 fed broilers. Treatment with 1% LS not only decreased the toxic effects of AFB1 (group D) but also improved the overall health of broilers due to its probiotic effects (p 0.05) as compared to control negative (group A). The detoxification ability of LS was better than commercial binder (CB) (0.2% Protmyc). It was concluded that detoxification of AFB1 by Lactobacillus was strain, temperature, pH and time dependent. LS has detoxification ability against AFB1 in vivo.

Resumo Os lactobacilos são probióticos com capacidade de desintoxicação da Aflatoxina (AF), encontrados em produtos fermentados, TGI de animais e meio ambiente. O objetivo deste estudo foi investigar a capacidade de isolados de frango de corte de Lactobacillus contra a Aflatoxina B1 (AFB1). Para tanto, 5 isolados de Lactobacillus de intestino de frango foram incubados com 100 ppb AFB1 em meio aquoso, e o efeito de diferentes parâmetros (frações celulares, tempo, temperatura, pH) na desintoxicação foi determinado por CLAE. O efeito melhorador de Lactobacillus salivarius (LS) contra AFB1 foi estudado em frangos de corte. Os resultados revelaram que LS (CR. 4) apresentou os melhores resultados (in vitro) em comparação com outros isolados [L. salivarius (CR. 3, CR. 4), L. agilis (CE. 2.1, CE. 3.1) e L. crispatus (CE. 28)]. Detritos celulares de CR. 4 mostraram desintoxicação significativamente maior (P 0.05). A quantidade máxima de AFB1 foi desintoxicada a 30 °C (97%), pH 4.0 (99%) e 6 h (99,97%). O estudo in vivo mostrou que AFB1 diminuiu o ganho de peso (1,269 ± 0.04 g / ave), alimento consumido (2,161 ± 0.08 g / ave), proteína total sérica (2.42 ± 0.34 g / dl), albumina sérica (0.5 ± 0.22 gm / dl) e título de anticorpo (4.2 ± 0.83). As enzimas da função hepática foram encontradas (alanina transaminase (ALT): 32 ± 10.7 U / L) e aspartato transaminase (AST): 314.8 ± 27 U / L) elevadas em AFB1 alimentados com frangos. O tratamento com 1% LS não só diminuiu os efeitos tóxicos de AFB1 (grupo D), mas também melhorou a saúde geral dos frangos devido aos seus efeitos probióticos (p 0.05) em comparação com o controle negativo (grupo A). A capacidade de desintoxicação do LS foi melhor do que o aglutinante comercial (CB) (0.2% Protmyc). Concluiu-se que a desintoxicação de AFB1 por Lactobacillus foi dependente da cepa, temperatura, pH e tempo. LS tem capacidade de desintoxicação contra AFB1 in vivo.

Sublethal toxicity of carbofuran in cattle egret (Bubulcus ibis coromandus): hematological, biochemical, and histopathological alterations

Abstract This study was aimed to investigate Carbofuran (CF)-induced pathological changes in cattle egret. Two hundred cattle egrets were reared and equally divided into four groups and given different CF concentrations (0.03 mg/L, 0.02 mg/L, 0.01 mg/L and 0 mg/L (control group)). Hematology, serum biochemistry, histopathology, and immunological markers were studied. Our results confirm that CF induces anemic conditions, leukocytosis, elevated liver enzymatic activity, and alterations in renal biomarkers. Moreover, specific microscopic lesions such as multifocal necrosis, pyknotic nuclei, hemorrhages, congestion, and inflammatory cell proliferation were observed in the liver, kidney, spleen, and thymus. These findings suggest that CF can induce harmful effects, so the application of this pesticide in the field must be strictly monitored to mitigate the possibility of exposure to non-target species.

Resumo Este estudo teve como objetivo investigar as alterações patológicas induzidas por carbofurano (CF) em garças-vaqueiras. Duzentas dessas garças foram criadas e divididas igualmente em quatro grupos e receberam diferentes concentrações de CF: 0,03 mg/L; 0,02 mg/L; 0,01 mg/L; e 0 mg/L (grupo controle). Foram realizadas análises de hematologia, bioquímica sérica, histopatologia e marcadores imunológicos. Nossos resultados confirmaram que CF induz condições anêmicas, leucocitose, atividade enzimática hepática elevada e alterações nos biomarcadores renais. Além disso, lesões microscópicas específicas, como necrose multifocal, núcleos picnóticos, hemorragias, congestão e proliferação de células inflamatórias, foram observadas no fígado, rim, baço e timo. Esses achados sugerem que o CF pode causar efeitos nocivos, portanto a aplicação desse agrotóxico no campo deve ser rigorosamente monitorada para mitigar a possibilidade de exposição a espécies não alvo.

Foliar application of triacontanol ameliorates heat stress through regulation of the antioxidant defense system and improves yield of eggplant

Abstract Transplanting time and genotype contribute to improving crop yield and quality of eggplant (Solanum melongena L.). A field experiment was conducted to investigate the impact of foliar applied of triacontanol (TRIA) and eggplant genotypes 25919, Nirala, 28389 and Pak-10927,transplanted on 1 March,15 March, and 1 April on exposure to high air temperature conditions. The experiment was performed according to Randomized Complete Block Design and the data was analyzed by using Tuckey,s test . The TRIA was applied at 10µM at flowering stage; distilled water was used as the control. Rate of photosynthesis and transpiration, stomatal conductance, water use efficiency, and effects on antioxidative enzymes (superoxide dismutase, catalase and peroxidase) were evaluated. The 10µM TRIA increased photosynthesis rate and water use efficiency and yield was improved in all genotypes transplanted at the different dates. Foliar application of 10µM TRIA increased antioxidative enzyme activities (SOD, POD & CAT) and improved physiological as well as biochemical attributes of eggplant genotypes exposed to high heat conditions. Highest activity of dismutase enzyme 5.41mg/1g FW was recorded in Nirala genotype in second transplantation. Whereas, lowest was noted in PAK-10927 (2.30mg/g FW). Maximum fruit yield was found in accession 25919 (1.725kg per plant) at 1st transplantation with Triacontanol, whereas accession PAK-10927 gave the lowest yield (0.285 kg per plant) at control treatment on 3rd transplantation. Genotype, transplanting date and application of TRIA improved growth, yield and quality attributes under of heat stress in eggplant.

Resumo O tempo de transplante e o genótipo contribuem para melhorar a produtividade e a qualidade da cultura da berinjela (Solanum melongena L.). Um experimento de campo foi conduzido para investigar o impacto da aplicação foliar de triacontanol (TRIA) e genótipos de berinjela 25919, Nirala, 28389 e Pak-10927, transplantados em 1 de março, 15 de março e 1 de abril de exposição a condições de alta temperatura do ar. O experimento foi realizado de acordo com o Randomized Complete Block Design e os dados foram analisados pelo teste de Tuckey. O TRIA foi aplicado a 10 µM na fase de floração; água destilada foi utilizada como controle. Taxa de fotossíntese e transpiração, condutância estomática, eficiência do uso da água e efeitos sobre as enzimas antioxidantes (superóxido dismutase, catalase e peroxidase) foram avaliados. O TRIA 10 µM aumentou a taxa de fotossíntese e a eficiência do uso da água e o rendimento foi melhorado em todos os genótipos transplantados nas diferentes datas. A aplicação foliar de TRIA 10µM aumentou as atividades das enzimas antioxidantes (SOD, POD e CAT) e melhorou os atributos fisiológicos e bioquímicos de genótipos de berinjela expostos a condições de alto calor. A atividade mais elevada da enzima dismutase 5,41mg / 1g FW foi registrada no genótipo Nirala no segundo transplante. Considerando que o mais baixo foi observado em PAK-10927 (2,30 mg / g FW). A produtividade máxima de frutos foi encontrada no acesso 25919 (1,725 kg por planta) no 1º transplante com Triacontanol, enquanto o acesso PAK-10927 deu a menor produção (0,285 kg por planta) no tratamento de controle no 3º transplante. Genótipo, data de transplante e aplicação de TRIA, melhoramento do crescimento, rendimento e atributos de qualidade sob estresse térmico em berinjela.

Different approaches in the management of enterocutaneous fistula

Background: Enterocutaneous fistula (ECF) are abnormal communications between the skin and gastrointestinal tract. ECF are a difficult and costly surgical complication to manage. Methods: The aim of this study is to compare the outcomes and review the different approaches in the management of ECF. We conducted a retrospective study on 50 postoperative ECF patients after abdominal surgeries over a period of 10 months admitted through PMCH OPD and emergency. We included 30 men and 20 females between age 10-70 years. We excluded spontaneous fistula in Crohn’s disease, intestinal diverticulosis, or any inflammatory disease. Results: Out of 50 patients of ECF 42 (8%) were managed conservatively initially. Out of that 9 patients failed to respond to conservative management and required later secondary exploration. Eight patients (16%) needed initial primary surgical intervention after formation of faecal fistula and peritonitis. The overall incidence of ECF is 4% varied according to surgery type, -4% after colorectal surgeries, 7% after gastroduodenal surgeries, 0.5% after extra-digestive surgery. Conservative approach includes resuscitation, nutritional support, sepsis control, output control and skin protection whereas in Surgical management we included permanent closure of fistula, resection of fistula tract, anastomosis and excision of tract and direct drainage. Conclusions: Conservative treatment plays a pivotal role as an initial management in both low and high fistula output. There was no significant recurrence rate difference seen in conservative and surgical approach.

Barriers to access healthcare among the elderly population in rural regions of India

Aging care is critical. Hence, the best-known newly developed technologies must be provided to the older population. This paper explains the need for mapping of strategies that must address preventive and promotional care and sickness management, empowering geriatric services, and guaranteeing optimal rehabilitation for the elderly population of India. Databases considered to carry out the literature review was Scopus, PubMed and Web of Science. Scientific articles published in English were only considered. Apart from scientific articles, government report, and newspaper articles, were also reviewed. Data was managed in Mendeley software. Articles based on elderly residing in urban populations and other age groups were excluded from the study. There are multiple barriers between the elderly beneficiaries and the healthcare services which stop the utilization of healthcare services. It can be demographic, aging, geographic, economic, accessibility, psychological, housing, transportation, medical, and social. Financial security is the top reason for not availing of healthcare services, followed by the perception that the ailment is not serious enough. The second reason was the unavailability of accessible healthcare facilities. Therefore, elderly people residing in rural regions, are more prone to varying diseases and are vulnerable to health inequity among other age groups in India. Considering the projected demography, it will only get worse until there is an intervention and feasible infrastructure, healthcare facilities, and services are provided in collaboration with local stakeholders and program monitors.

A clinical study of ectopic pregnancy at a tertiary care hospital of North Delhi

Background: aim was to study the risk factors, clinical presentation and management of ectopic pregnancy in a tertiary care centre of North DelhiMethods: This was a prospective observational study conducted in the department of obstetrics and gynaecology Hindu Rao hospital and NDMC medical college, Delhi. A total of 65 cases of ectopic pregnancy were analyzed, over a period of 1 year that is from September 2020 to August 2021Results: The incidence of ectopic pregnancy was 12.8/1000 deliveries. Majority of cases were multigravidas and of gestation age between 6 to 10 weeks. The common risk factors were PID, contraception failure (IUCD), tubal ligation, infertility, ART procedures, tubal surgery, and previous ectopic and previous abortion. Ultrasound, urine pregnancy test, serum ?-hCG titre were done. Laparotomy was done in all cases. Surgery in form of salpingectomy, salpingo-oophorectomy, and uterine reconstruction was done. No maternal mortality occurred.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, ?-HCG and laparoscopy. It is an important cause of admission to Hindu Rao hospital as maternal near miss cases.

Acceptance analysis of PPIUCD in tertiary care centre of north Delhi region

Background: IUCD is a temporary method of contraception in use for many years in India. Our main objective is to find the acceptance of (postplacental intrauterine contraceptive device) PPIUCD in recent years in the North Delhi region.Methods: An interventional study was carried among the pregnant mothers visiting antenatal outdoor patient department Hindu Rao Hospital and NDMC Medical College during their 28 to 36 weeks of pregnancy over period of 12 months starting from March 2020 to February 2021.Results: The acceptance of PPIUCD was high in the present study where most of the women with higher parity (57%) accepted it and acceptance rate increased from 14% to 48% after counselling the patients and her family.Conclusions: Level of awareness for PPIUCD was poor among women of North Delhi region. PPIUCD can play a pivot role in country抯 family planning programme.

Efficacy of nasal irrigation of normal saline as compared to budesonide following functional endoscopic sinus surgery

Background: Nasal irrigation following Functional endoscopic sinus surgery (FESS) appears to be a nearly universal recommendation. FESS significantly improves the symptoms of the CRS (Chronic rhino sinusitis) and the postoperative endoscopy scores. The primarily objective of our study was to study the efficacy of nasal irrigation of normal saline as compared to budesonide following functional endoscopic sinus surgery. Methods: A total of 100 patients who underwent functional endoscopic sinus surgery were randomly divided into two groups on the basis of computerized generated random table with 50 patients in each group. In group 1 normal saline was used where as in group 2 budesonide solution was used for nasal douching. Post-operative evaluation was done using Lund Kennedy Endoscopic scoring (LKES) at the 7th and 30th postoperative day. Results: On 7th postoperative day, we found that none of our patient in the study groups had polypoidal change. There was decrease in scores of polyposis, discharge mucosal edema, scaring and crusting in both the groups. However, the reduction of discharge in the budesonide group was more significantly decreased than normal saline group (p value<0.05). We also noted that on 30th postoperative edema, scarring and crusting was significantly decreased in budesonide group as compared to normal saline group (p value <0.05). Conclusions: We concluded that the addition of budesonide in nasal irrigation resulted in improved scores of polyposis, discharge, mucosal edema, crusting and scarring and total score of LKES than normal saline alone.

Efficacy of nasal irrigation of normal saline as compared to budesonide following functional endoscopic sinus surgery

Background: Nasal irrigation following Functional endoscopic sinus surgery (FESS) appears to be a nearly universal recommendation. FESS significantly improves the symptoms of the CRS (Chronic rhino sinusitis) and the postoperative endoscopy scores. The primarily objective of our study was to study the efficacy of nasal irrigation of normal saline as compared to budesonide following functional endoscopic sinus surgery. Methods: A total of 100 patients who underwent functional endoscopic sinus surgery were randomly divided into two groups on the basis of computerized generated random table with 50 patients in each group. In group 1 normal saline was used where as in group 2 budesonide solution was used for nasal douching. Post-operative evaluation was done using Lund Kennedy Endoscopic scoring (LKES) at the 7th and 30th postoperative day. Results: On 7th postoperative day, we found that none of our patient in the study groups had polypoidal change. There was decrease in scores of polyposis, discharge mucosal edema, scaring and crusting in both the groups. However, the reduction of discharge in the budesonide group was more significantly decreased than normal saline group (p value<0.05). We also noted that on 30th postoperative edema, scarring and crusting was significantly decreased in budesonide group as compared to normal saline group (p value <0.05). Conclusions: We concluded that the addition of budesonide in nasal irrigation resulted in improved scores of polyposis, discharge, mucosal edema, crusting and scarring and total score of LKES than normal saline alone.

Acute Kidney Injury in Covid 19 Pneumonia Patients and its Impact on Clinical Outcomes

Introduction: COVID19 which started in China in December 2019 , spread all over the world and had a significant mortality many other organ systems other than the lungs were involved in the disease. The present study was undertaken to evaluate acute kidney injury in COVID 19 pneumonia patients and to study its impact on clinical outcomes. Material and methods: Methodology 150 patients of moderate and severe COVID 19 diagnosed b RT-PCR were included in the study. There were 98 males and 2 females in the study. Acute kidney injury was diagnosed b the KDIGO criteria. Results: The prevalence of acute kidney injury in the study population was 28%. Patients with AKI had significantly higher requirement of mechanical ventilation. Also the patients of COVID 19 pneumonia had higher mortality rates as compared with those who did not have acute kidney injury. Conclusions: The present study reveals that Acute kidney injury is common in COVID 19 pneumonia and impacts the clinical outcomes adversely.

Detection and Comparision of Cytopathological Changes in Smokers and Non-Smokers: A Comparative Study

Background: Oral cancer is one of the sixth most common cancers in the world. Oral exfoliative cytology is one of the popular screening tool for oral cancer. Use of tobacco in any form are documented as the most common cause as initiators for dysplastic changes in oral mucosa. The purpose of the study was to detect the cytological changes in buccal mucosa, tongue and palate among non-smokers & smokers. Material & Methods: Smears sample were collected according to site (buccal mucosa, tongue & palate) from 100 subjects among smokers & non-smokers. Smears were then stained using Papanicolaou staining technique. Results: Among the smokers and non-smokers the results were statistically significant. Conclusion: Recent advances in the clinical visualization and detection of the oral mucosa have made the viability of cytological procedures more specific and sensitive. Contact endoscopy and use of autofluorescence devices are the forerunners in this group. The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues21. Due to low feasibilities of such devices the benchmark of diagnosis will be microscopic tissue examination. Hence cytological smears will always be highly specific, sensitive, easy to use and reproducible procedures in routine screening of population for potentially and malignant conditions of the oral cavity.

Utility of bone marrow aspiration and trephine biopsy in various haematological malignancies

Background: The bone marrow examination is a useful and cost-effective diagnostic procedure in haematological practice for the diagnosis of haematological disorders. It may either confirm the clinically suspected disease or may provide the previously unsuspected diagnosis. The bone marrow examination can be done by bone marrow aspiration as well as by performing bone marrow biopsy. The aim of the study is to compare the diagnostic accuracy and rate of concordance between two modalities of bone marrow examination in diagnosis of haematological malignancies. Methods: The study was conducted at haematology section of the Department of Pathology, Government Medical College, Jammu spanned over a period of 2.5 years from June 2020 to December 2022. The clinical data along with physical examination, relevant haematological, biochemical and radiological investigations were also reviewed. After taking the informed consent bone marrow aspiration and bone marrow biopsy were done under aseptic precautions. Results: A total of 250 cases of haematological malignancies were studied over a 2.5 year period. The most common haematological malignancy was found to be leukemia 194 (77.6%) cases, followed by plasma cell dyscrasia with 30 (12%) cases, lymphomas and myeloproliferative disorders each with 11 (4.4%) cases and metastatic deposits 4 (1.6%) cases. In the present study, 64/250 (25.6%) patients underwent BMA and trephine biopsy simultaneously. A positive concordance was seen in 46 (71.8%) of the cases between the two methods and diagnostic discordance was observed in 10 (16.3%) of the cases. Conclusions: Bone marrow aspiration and biopsy both complement each other and should be evaluated simultaneously. This study emphasizes the need for greater vigilance in the early diagnosis and an interdisciplinary approach for the effective management of patients as well as inclusion of trephine biopsy as regular procedure for complete evaluation of patients with haematological malignancies.

Correlation of sinonasal polyposis with chronic suppurative otitis media

Background: Aim of the study was to assess correlation of sinonasal polyposis with CSOM. To see the role of lignocaine nebulisation and to compare its role with use of steroids and bronchodilators alone in post bronchoscopy patients. Methods: In the present study, 50 patients of sinonasalpolyposis were subjected to otoscopic, microscopic examination of tympanic membrane findings and tuning fork tests were performed. Pure tone audiometry (PTA) was also done in all patients. High resolution computed tomography (HRCT) of temporal bones and computed tomography (CT) of paranasal sinuses were used to assess otological and sinonasal pathology. Results: Out of 50 patients, males were 26 and females were 24. Age group 11-20 years had 8 males and 8 females, 21-30 years had 5 males and 7 females, 31-40 years had 11 males and 8 females and 41-50 years had 2 males and 1 female. Left side was involved in 6, right in 9 and both sides in 10 patients. Swab cultures revealed pure aerobic isolates in 16, mixed aerobic and anaerobic isolates in 10. Micro-organisms were staphylococcus aureus in 10, Pseudomonas aeruginosa in 6, Streptococcus spp. in 5, Peptostreptococcus in 3 and Bacteroides in 2 cases. The difference was significant (p<0.05). Out of 50 Sinonasal polyp patients, 26 (52%) had CSOM. Type identified was tubotympanic in 12 and atticoantral in 14. There was positive pearsoncorrelation of CSOM with sinonasal polyp (r value of 0.92, p value 0.021). Conclusions: In the present study there was positive correlation of sinonasal polyposis with CSOM. The prevalence rate was 26%. Micro-organisms were Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus spp., Peptostreptococcus and Bacteroides.

Importancia de la medición de la Viscosidad sanguínea: retos y limitaciones

La sangre es una mezcla de componentes que tiene su propia identidad. Una de las propiedades físicas que adquiere es su viscosidad, la cual es la resistencia que ofrece para desplazarse. A diferencia de sus componentes (como glucosa, hemoglobina, colesterol, etc.), la sangre no posee un nivel único de viscosidad, sino que esta es variable debido a diversos factores. Exponemos algunos principios físicos que nos permitirán entender mejor esta dinámica de la viscosidad sanguínea, y su posible aplicación en algunos fenómenos hemodinámicos, así como la complejidad de su medición en la práctica clínica habitual.

Blood is a mixture of components that has its own identity. One of the physical properties that it acquires is its viscosity, which is the resistance it offers to move. Unlike its components (such as glucose, hemoglobin, cholesterol, etc.), blood does not have a single level of viscosity, but it is variable due to various factors. We present some physical principles that will allow us to better understand these dynamics of blood viscosity, and its possible application in some hemodynamic phenomena, as well as the complexity of its measurement in routine clinical practice.

How common is burnout? Are there protective factors? A study from a tertiary cancer center

Background: Heathcare professionals (HCPs) in the field of oncology face challenging clinical situations, difficult conversations, and death. This can seriously affect their physical and psychological health. Methods: One hundred and eighty doctors and nurses participated in this descriptive study. The primary objective was to determine the proportion of burnout in HCPs in a tertiary care cancer hospital. The secondary objectives included assessment of psychological morbidity, correlation of burnout with demographic factors and years of experience, and resilience and its correlation with burnout. Data were collected using Maslach Burnout Inventory, General Health Questionnaire� (GHQ-28), and a Resilience scale (Dr. Vijaya Lakshmi and Dr. Shruti Narain). Descriptive statistics correlation and regression analysis were used to analyze the data. Results: One hundred and twenty-six (70%) respondents were young adults. Thirty-two (17.78%) respondents had a high Emotional Exhaustion (EE) score. A high Depersonalization score (DP) was seen in 24 (13.33%) and a low sense of Personal Accomplishment (PA) was perceived by 22 (12.22%). More nurses (55, 52.4%) had high resilience scores compared with doctors (21, 28%). Doctors (21, 28%) experienced more psychological morbidity than nurses (15, 14%). Among the domains of GHQ-28, high scores were observed in Somatic, Anxiety/Insomnia, and Social Dysfunction (mean 4.44 � 3.92, 4.61 � 3.85, and 4.54 � 3.16, respectively) and low scores in the severe depression domain (mean 2.48/�29). Conclusion: Fifteen to eighteen percent of HCPs scored high levels of EE, DP, and low PA. Burnout was more common in doctors who had worked in the cancer center for longer. However, the converse was true for nurses. HCPs with high resilience scores had less burnout. Age and resilience protect from burnout.