Typhidot IgM as a reliable and rapid diagnostic test for typhoid fever among children in a tertiary care hospital

Background: Typhoid fever still continues to be a major public health problem in Nepal. A clinical spectrum of typhoid varies widely. It causes significant complication as well as mortality. A simple, reliable, affordable and rapid diagnostic test has been a long felt need of the clinicians to prescribe specific medication, adopt prevention of the emergence of antibiotics resistance and overall reduce the disease burden in the community.Methods: The prospective descriptive study was performed in 125 children between 2 years to 15 years of age admitted to the Pediatrics Department from September 2017 to September 2018. Blood culture, Typhidot rapid IgM were performed. MEDCALC software was used to calculate 95% confidence interval for sensitivity, specificity, predictive value positive, predictive value negative and accuracy. Kappa test was used to determine the agreement between Typhidot IgM and blood culture methods.Results: The study consisted of 125 children with acute febrile illness for more than 3 days with clinical symptomatology, consistent with typhoid fever. The reliability of Typhidot IgM in relation with blood culture and the study lighten that sensitivity 92.3% (95% CI: 63.9, 99.8), specificity 49.1% (95% CI: 39.5, 58.7), PPV 17.4% (95% CI: 14.2, 21.1), NPV 98.2% (95% CI: 89.2, 99.7) and accuracy 53.6% (95% CI: 44.5, 62.6). The two methods i.e. Typhoid IgM and blood culture shows significant agreement with p value 0.004.Conclusions: The present study demonstrates that Typhidot IgM has all the attributes of an ideal screening test.

Serum levels of bone sialoprotein, osteopontin, and β2-microglobulin in stage I of multiple myeloma

Context: The fluctuations of proteins in multiple myeloma (MM) are well-known markers for checking the status of the patients. Aims: The objective of this study was to examine three proteins that have an important role in disease progression. Subjects and Methods: The study was performed with two groups: 30 MM stage I patients' (14 females/16 males; aged 60.83 ± 12.38 years) as case group and 40 healthy individuals (18 females/22 males; aged 57.65 ± 6.43 years) as control group. Both groups have been matched in gender and age. Bone sialoprotein (BSP), osteopontin (OPN), and β2-microglobulin (β2M) were measured with an enzyme-linked immunosorbent assay. Results: Serum BSP levels of MM-I patients was significantly higher than that of healthy controls (29.24 ± 5.57 vs. 20.89 ± 3.67, P = 0.001). OPN levels of MM-I patients were significantly lower than that of healthy individuals (12.03 ± 3.45 vs. 19.35 ± 4.67, P = 0.001). β2M levels of patients and controls were similar (1.49 ± 0.67 vs. 1.29 ± 0.55, P = 0.193). Conclusions: The results suggested that myeloma cells may affect the production of BSP and OPN, which possibly contributes to osteoclastic bone resorption in MM-I patients. Their levels may be a useful biomarker for assessing bone destruction in MM-I patients and distinguishing MM-I from healthy individuals

A Tertiary Care Hospital based Study on the Prevalence of Pulmonary Hypertention in Patients with Glomerular Filtration Rate less than 30 Ml /Min Per 1.73 Meter Square on Dialysis.

Introduction: Pulmonary artery hypertension (PAH) whichcan be primary or secondary, has been found to be associatedwith chronic kidney disease, especially end stage renal disease.Finding prevalence of pulmonary hypertension in early stagesof chronic kidney disease is important because it createsvery high burden of cardio vascular morbidity and mortality.In this study we have assessed various factors associatedwith prevalence of pulmonary hypertension in patients withglomerular filtration rate less than 30ml/min per 1.73 metersquare on dialysis.Material and methods: This is a one year, hospital based,prospective observational study of patients aged more than 18years with GFR less than 30 ml/min per 1.73-meter square ondialysis, who were found to have pulmonary hypertension onechocardiography. The prevalence of pulmonary hypertensionin this group of patients and the risk factors in CKD associatedwith it are calculated followed by a descriptive analysis andinterpretation of the data.Results: The various factors we analyzed and p value forassociation of pulmonary hypertension in CKD for thepercentage of male and female in our study group is 0.241, fordistribution of the pulmonary hypertension among differentage groups is 0.503, for the significance of diabetic mellitus is0.595,for systemic hypertension is 0.206, for arterial venousfistula is 0.780,for superimposed infections 0.166, for volumeoverload is 0.560, for anemia is 0.780, for left ventriculardiastolic dysfunction is 0.662, for creatinine clearance is0.717,for duration of dialysis is 0.000. With above results,only association with significant p-value (0.000) in our studypopulation with pulmonary hypertensions longer duration.Conclusion: Prevalence of pulmonary hypertension in ourstudy is 22%. The risk factors like age,sex, diabetes, systemichypertension, AVF, superimposed infection, volume overload,anaemia, LVDD has no influence on pulmonary hypertensionin our study, only strong association that we have in our studypopulation with pulmonary hypertension with CKD is longerduration of dialysis.

Obstetric Complication Profile in Relation to the Utilization of Maternal Health Services of the Females of Rural and Urban Areas of Aligarh

Introduction: Millions of women are still suffering from pregnancy related complications even after the implementation of a number of health programs relating to mother and child. The utilization of these services is not up to the mark, so a study was done to evaluate the utilization of Maternal and Child health services in relation to the mother who had complications related to them or their children during the last pregnancy. Material and Methods: A community based cross sectional study was performed in the field practice areas of the department of community medicine, the study period was one year and the data was analyzed by SPSS13. Results: It was found that 32% Recently Delivered Women suffered from complications in their last delivery. The most common being Still Birth. Utilization rates for all maternal health services except full ANC package were found to be significantly better in women having had experienced a complication in an earlier pregnancy. Conclusions and Recommendations: Even though we are having so many health programs in place still a majority of women are suffering from pregnancy related complications. The utilization of Maternal health services was high for these women as compared to the ones who had no complications in their last pregnancy. But need of the hour is to further increase the rate of utilization to achieve our MDG goals.

Protective Lip Guard for Prevention of Lip Injury during Third Molar and other Intraoral Surgeries

Aim: Soft tissue injury, especially lip burns, is very common complications seen during the third molar and other intraoral surgical procedures. To overcome this complication, we have devised a custom-made protective lip guard which is beneficial for the patient as well as surgeon. Conclusion: It is simple device, very easy to fabricate, does not require any special armamentarium or material to fabricate, not time consuming, and eco-friendly. It is comfortable and readily accepted by the patient.

Unification of Software Technology with Oral and Maxillofacial Surgery

Almost entire human creativity today, from the standpoint of its efficiency and expediency, is conditioned with the existence of technology. Progresses in computer-based technologies including virtual reality (VR) simulators, augmented reality (AR), virtual plastic surgery software, and computer-aided design/computer-aided manufacturing systems have resulted in new modalities for instruction and practice of oral and maxillofacial surgery. VR dental simulators enable repeated, objective and assessable practice in various controlled situations. Superimposition of three-dimensional (3D) virtual images on actual images in AR allows surgeons to simultaneously visualize the surgical site and superimpose informative 3D images of invisible regions on it to serve as a guide. Bone segment navigation is the modern surgical approach in orthognathic and temporomandibular joint surgeries, reconstruction of orbit and midface, and image-guided implantology.The efficiency offered by new technology to conventional model surgery can return hours to a surgeon’s day through a more streamlined workup and smoother intraoperative experience with confidence in the surgical accuracy.The purpose of this paper is to give technological touch to traditional dentistry practiced today, making oral surgeons aware of tremendous advantages including accuracy, result anticipation, reduced complications, and patient satisfaction.

Etiology, Clinical Features, and Complications of Urethral Stricture.

Introduction: Most urethral strictures are either idiopathic or iatrogenic secondary to urethral instrumentation or failed surgery for hypospadias and complications of prostatectomy. Sometimes, it also presents as a surgical emergency. Aim: The aim of the present study was to study the etiological, clinical features, and complications of urethral stricture. Materials and Methods: A total of 50 cases of urethral stricture were studied over a period of 2-year in Katihar Medical College, with emphasis on various aspects of urethral stricture. Results: Maximum 24% of the cases were in the age group of 31-40 years followed by age group 41-50 years (20%). All the patients in this study were males. The disease was mostly prevalent among people of lower socio-economic status. Acute and chronic retention of urine were the most common complication comprising of 50% of the total cases. A maximum number of cases were traumatic in nature. Conclusion: Urethral stricture is a disease of varying symptoms and lots of complications affecting the psyche of the patient. The treating surgeon must be competent in the use of various techniques to deal with conditions of the urethra presented at the time of surgery.

Prevalence of Iodine Deficiency Disorders - A School Based study in Aligarh

Introduction: Iodine deficiency is one of the most neglected and wide spread of all nutritional deficiencies, constituting a real brake on human development. Deficiency of iodine may result in development of goitre and other Iodine Deficiency Disorders (IDD). Objective: To assess the status of iodine deficiency disorders (IDD) in school children. Methods: This study was conducted among school children of 1st to 5th standard (6–12 yrs.) from 1st January 2009 to 31st December 2013. A total of 950 students of seven schools were included in the study using proportionate to population size (PPS) method. Each child was examined clinically. Statistical analysis was done using SPSS version 20. Result. Age distribution of the study population shows that majority of the students (30.5%) belonged to 11-12 years, and most of the students (56.2%) were males. Only 17 (1.8%) students had goitre. Goitre prevalence was slightly higher (1.9%) in the 6-8 years age group and in females (1.9%). Manifestations of iodine deficiency other than goitre, were retarded growth (0.6%), squint (0.3%), deafness (0.2%), lethargy (0.5%), and mental retardation (0.1%).  Conclusion. In the present study, Aligarh may be classified as non-endemic for iodine deficiency as the goitre prevalence in school children was only 1.8%, below the 5.0%, required for endemicity. Sustained IEC (Information, Education and Communication) activities should be carried out to sensitize the people regarding IDD.

Benign Breast Lesions in a Teaching Hospital in Rural Bihar.

Background: Breast diseases has captured attention of surgeons throughout the ages with its uncertain cause. Study of a pattern of benign breast diseases (BBDs) is a challenge due to variants in occurrence and presentation in different age groups and different geographical areas. The breast is a complex structure and any unnatural change affects the body and psyche of the person. Aim: The aim of this study was to observe age distribution, clinical signs, symptoms and pathology of benign breast lump and correlate them with pathological findings. Materials and Methods: A total of 124 cases of benign breast lump were included in this study. These cases were selected among patients visiting the outdoor clinic of Department of General Surgery in Katihar Medical College, Katihar, Bihar, India. The selected cases belonged to different etiology, age group and sex. Results: Maximum cases of benign breast tumors were observed in age group of 21-30 years (third decade). Fibroadenoma was the most common presentation. The majority of patients reported within 1 year of onset of disease. The painless lump was the most common mode of presentation. The right breast was involved in a more number of cases with maximum lesions noted in the upper outer quadrant. Conclusion: BBDs are common in female patients. Clinical, sonological, mammographical, and pathological studies need to be conducted in a systemic way to find answers of complexities posed by the confusing pattern of BBDs.

Exploring Demographic Factors Influencing Acceptance of Family Planning Methods in Aligarh

Introduction: Population of India has jumped to 1,290,974,613 (1.29 billion) on Dec 07, 2015. There are certain demographic factors, which affect the acceptance of family planning methods. Therefore this study was conducted to determine the extent of felt need of family planning methods and to assess the demographic factors influencing the contraceptive acceptance. Materials and Methods: This cross-sectional study was conducted in J.N. Medical College, AMU, Aligarh, for a period of two and half year. Only the mothers in the post partum period were interviewed. Those mothers who had already accepted family planning methods were not included in the study. 1383 mothers were interviewed. Data were tabulated and analysed using SPSS version 20. Chi-square test (χ2) was applied to know the statistical significance. Results: Significant number of mothers (39.6%) had planned to adopt family planning methods. Majority of the mothers (71.4%) were in the age group of 21-30 years. In this age group, 39.7% mothers wanted to adopt family methods. As the age of the mothers increased, the acceptance rate also increased. Majority of mothers (52.9%) admitted in the hospital were Hindus. Among Muslims, 40.3 per cent mothers had felt need of family planning methods. Mostly the mothers were illiterate (50.8%). 30.8 per cent of these illiterate mothers wanted to accept family planning methods. Similar felt need (36.4%) was observed in mothers with education up to primary level (V standard). As the birth order increased, felt need also increased. Conclusion: It may be concluded that significant number of mothers had planned to adopt family planning methods. Though the campaign to promote family planning methods in our country is being carried out, the message should be given more vigorously through information, education and communication (IEC) activities and involvement of non-governmental organisations (NGO). Concerted efforts are needed to find out the reasons for unmet need and its solution

Investigations of polyethylene glycol mediated ternary molecular inclusion complexes of silymarin with beta cyclodextrins.

Objective To evaluate the effect of Polyethylene glycol and β-cyclodextrin on the solubility and dissolution of silymarin, a poorly water soluble herbal drug. Methodology Effects of beta cyclodextrins and Polyethylene glycol on solubility of silymarin were evaluated by phase solubility studies both separately as well as in combination. Solid inclusion complexes of silymarin –β-cyclodextrin in 1:1 molar ratio were prepared with and without polyethylene glycol by kneading method then evaluated for solubility dissolution and physical nature by XRD, FT-IR and NMR spectroscopy studies. Results The aqueous solubility of silymarin was linearly increased as a function of the concentration of β-cyclodextrin alone and in the presence of polyethylene glycol. Beta cyclodextrin formed molecular inclusion complexes with silymarin in1:1 molar ratio as revealed by phase solubility diagram. The ternary complexes of silymarin, β-cyclodextrin and polyethylene glycol demonstrated better dissolution than those of silymarin and its binary complexes with β-cyclodextrin alone. Silymarin - β-cyclodextrin complex caused 1.3 fold increase in the dissolution rate of silymarin, which was further increased up to 1.7 fold in presence of small amount of polyethylene glycol. Conclusion The presence of polyethylene glycol markedly enhances the molecular complexation and solubilizing efficiencies of β-cyclodextrin on silymarin.

Accelerating Progress to Universal Salt Iodization in India Achievements, Challenges, and Future Actions.

Objectives: India was one of the first countries to introduce salt iodization. This presentation reviews the national efforts towards universal salt iodization (USI) in India, documents achievements and progress, and highlights key challenges in programme implementation. Methods: The Salt Department of the Government of India and its development partners have made concerted efforts to improve availability, access and use of adequately iodized salt. Results: National and state level advocacy meetings were carried out to ensure high political commitment and prioritization of the USI programme. The National Coalition for Sustained Iodine Intake was launched to improve the overall programme management and coordination. The technical capacity of salt producers was enhanced and salt wholesalers and retailers were mapped, sensitized and equipped with tools and skills to procure only adequately iodized salt. A state-of-the-art management information system was launched to improve the efficiency in monitoring the flow of iodized salt. In addition, awareness and communication activities were scaled up to generate demand for iodized salt. As a result, the national household coverage of adequately iodized salt increased from 51% in 2005 to 71% in 2009. However, data indicate a clear urban-rural and rich-poor differential, leaving some of the most disadvantaged populations vulnerable to iodine deficiency. Conclusions: An evidence-based, well-defined strategy will be necessary to reach the last 30% of households, which are are likely to be least accessible and most socio-economically vulnerable. Both national and state level policies should mainstream the use of adequately iodized salt in feeding programmes for the benefit of all.

Antibacterial activity of silver nanoparticles dispersion against MSSA and MRSA isolated from wounds in a tertiary care hospital of north India.

Staphylococcus aureus, the main cause of nosocomial infection worldwide result in significant increases in mortality, morbidity, and cost related to prolong treatments. Silver compound has been in use since time immemorial for the treatment of burns, wounds and several other bacterial infections. In the present work, we explore the antibacterial activity of silver nanoparticles (Ag-NPs) dispersion (5-10 nm) against reference strain and clinical isolates of Methicillin-sensitive S. aureus (MSSA), and Methicillin-Resistant S. aureus (MRSA).The typical minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against standard reference strain as well as, MSSA and MRSA were observed in the range of 12-48 μg/ml and 12-96 μg/ml, respectively. The MBC/MIC ratios against all strains were found in the range of ≤1 to ≤4, which shows that Ag-NPs inhibit bacterial growth in a bactericidal rather than a bacteriostatic manner. Our finding suggests that Ag-NPs are effective broad-spectrum antibacterial agents regardless of their drug-resistance mechanisms.