Clinicopathological profile of hyperpigmented skin lesions- A prospective study

Introduction: Hyperpigmentation is one of the most common reac?on to inflammatory, benign and malignant lesions of the skin. These disorders comprise heterogeneous group of diseases of epidermal and dermal hyperpigmenta?on divided into various types according to e?ology and pathology. Correct diagnosis of these hyperpigmented lesions is linked to histopathologic examina?on of skin biopsies with clinical correla?on. Aim: To study the spectrum of hyperpigmented skin lesions with reference to age and sex distribu?on. Materials and Methods: This prospec?ve cohort study was conducted at Department of Pathology, at Alluri Sitaramaraju Academy of Medical Sciences, Eluru, Andhra Pradesh, India, which included 80 pa?ents who were clinically diagnosed with hyperpigmented skin lesions in all age groups from July 2014 to August 2016. Frequency and percentage sta?s?cs was used to present the results. Results: Out of 80 cases, 34 cases of inflammatory lesions, 23 cases of benign lesions and 23 cases of malignant lesions were reported. Among the post inflammatory lesions the majority were classical Lichen planus. Conclusion: Most common lesion was lichen planus and its variants with highest incidence in females and age group greater than 60 years. Histopathological diagnosis with clinical correla?on aids in effec?ve management of the pa?ents.

Oral health-related quality of life among elderly patients visiting special clinics in public hospitals in Delhi, India: A cross-sectional study

Background: Oral health is recognized as an integral component of general health, and poor oral health is reflected in general health and quality of life (QoL). India has seen a profound shift in the elderly population and is currently home to 103.9 million elders. General Oral Health Assessment Index (GOHAI) is a self-reported oral health assessment index used in elderly population and has been tested in multiple countries. Objective: The study aimed to assess the oral health-related QoL (OHRQoL) using GOHAI and various factors affecting it, among elderly patients visiting special Sunday geriatric clinics at Delhi public hospitals. Methods: A cross-sectional study was conducted among four purposively selected special geriatric public clinics in Delhi, India, and a convenience sample of 145 elderly patients was obtained. OHRQoL was measured using a prevalidated instrument (GOHAI) along with other variables (sociodemographic factors, self-perceived oral health, utilization of medical/dental services, dental problems in the past 12 months, and prosthetic status/need). Statistical analysis was done using Statistical Package for the Social Sciences software version 21, and descriptive results were obtained. Results: The sample consisted of 66 males (45.5%) and 79 females (55.5%), and around 58% (n = 84) of the participants were illiterate. Around 39% (n = 57) of the elderly had never visited a dentist and 48% (n = 69) were financially dependent (no income) on others. The mean GOHAI score for the population was 26.69 + 4.44 (median = 25, interquartile range = 23�). GOHAI score was compared for age, oral hygiene practices, dental problems in the past 12 months, self-reported oral health, and prosthetic need, and a statistically significant difference was observed. Conclusions: The current study assessed GOHAI score and highlighted important determinants of OHRQoL in elderly population visiting the special clinics in Delhi. Thus, OHRQoL should be considered as a surrogate measure to clinical oral examination.

Effects of home-based exercise training on functional outcomes and quality of life in patients with pulmonary hypertension: A randomized clinical trial

Objectives The objective of this study was to assess the effects of home-based exercise training (HBET) on function and quality of life (QoL) in patients with pulmonary hypertension (PH). Methods A prospective, nonblinded, randomized clinical trial was carried out on 84 medically stable patients with PH belonging to any functional class or etiology and of either sex. Patients were randomized to either standard care or HBET. Both groups also received education using the Pulmonary Hypertension Manual (PulHMan). Outcomes included functional capacity from 6-min walk distance (6MWD), QoL using the Medical Outcomes Survey Short Form – 36, functional class (FC), and right heart indices (right ventricular systolic pressure [RVSP] and tricuspid annular plane systolic excursion [TAPSE]) and were assessed at entry and after 12 weeks. Results HBET improved 6MWD by 48.5 m and 13 m in the experimental and control groups, respectively (p < 0.001). QoL showed statistical improvements after HBET between the groups for the physical and mental components and for the various subdomains (except body pain). Furthermore, FC improved by one grade with HBET (p < 0.001). Conclusion HBET program improved functional capacity, QoL, and FC in patients with PH.

Designing and validation of text messages for m-Health intervention for tobacco cessation and management

Objective: The objective of this study was to evaluate effectiveness of two psychological intervention techniques (reading – writing therapy vs. games – narrative therapy) using motivational intervention alone as a control among tobacco addicts. Materials and Method: This randomized control trial was conducted over a period of 6 months from April to September 2013 at a de-addiction center in Madhya Pradesh, India. Patients with moderate-to-high levels of dependence as determined by Fagerstrom Test for Nicotine Dependence (FTND) admitted for treatment in a de-addiction center were recruited. A cluster randomization technique was used for allocation of participants to three different groups. Group allocation was concealed from investigator and done by coordinator. Three interventions were group A – motivational intervention alone, group B – games and story therapy along with motivational intervention, and group C – reading and writing therapy along with motivational intervention. Interventions were applied for 1 month. Two postintervention follow-ups (one at the time of discharge and one after 1 month following discharge) were done to assess level of dependence using FTND besides undertaking urine cotinine analysis among three randomly selected participants in each group. Results: A total of 82 participants (28 in group A, 27 each in groups B and C) completed the study. Eighty-one (98.8%) participants had complete abstinence at the end of 1 month with no significant difference in the success rate between different categories (P = 0.357). At the end of 1 month following discharge from center, only 7 participants (8.5%) had complete abstinence and 51 participants (62.2%) had partial reduction and remaining 24 participants (29.3%) were considered failures with no difference between three groups (P = 0.768). Conclusion: Although overall abstinence was low (8.5%), all intervention techniques were equally effective in at least reducing level of dependence with no significant difference in their efficacy.

Hookah products and online retail marketing strategies in India: A content analysis

INTRODUCTION: Hookah smoking is becoming increasingly popular among the youth. Evidence shows that exposure to marketing of the unhealthy products through social media platforms may impact adolescent health behaviors. The aim of the study was to perform a content analysis of online portals selling hookah products. MATERIALS AND METHODS: A content analysis of online retail market was conducted on Google India using three keywords hookah, hookah products, and shisha. Retail websites popular in India that were selling hookah products were randomly selected and explored. A total of 15 themes were developed and used to describe various promotional strategies for hookah products. RESULTS: In all, 41 (19.2%) products claimed to be tobacco/nicotine-free and only 14 products (6.5%) displayed age/health-specific warnings. About 86% of products were available at discounted rates; glamorizing words for describing products in form of superior, premium, and legendary were found on 189 (88.3%) products. Phrases such as “ultimate way to celebrate,” “perfect excuse to chill with your friends,” and “now enjoy the world of smoking without any doubt of harm” are commonly used to promote hookah products. CONCLUSION: Easy availability of newer forms of smoking at online markets could play a role in promoting the use of hookah among the youth. Most products are being sold without any warnings and there is no means to control the selling of the products to minors. There is a need to raise the issue of hookah products in the same tune as done for other forms of tobacco.

Assessment Of Renal Dysfunction In Chronic Liver Diseases

Objectives:Renal impairment in Patients with chronic liver disease is a common phenomenon and is a functional impairment. It seems difficult for the assessment of renal function abnormalities by normal parameters. We aimed to determine the usefulness of creatinine clearance by timed urine collection and Cockcroft Gault formula and Serum creatinine as parameters in assessing renal function in this cohort of patients and also to find if etiology of chronic liver disease has a bearing on renal dysfunction. Material and methods:Renal parameters of 200 patients with chronic liver disease were studied to assess the reliability of the each parameter. Results: In the present study, Only 22% of alcoholics have clearance more than 60ml/min. 58% patients were found to have creatinine clearance more than 60ml/min by Cockcroft Gault formula while only 36% Patients have that by timed urine collection where the difference was found to be statistically significant (Pvalue<0.01). Cockcroft Gault formula overestimates probably due to disparity in weight due to fluid retention. Conclusion:ThemostreliableParameterin our clinicalsetup isCreatinine clearance by timed urine collection.Presence ofAscites,lowserumalbumin levels andAlcoholic etiologyhadmorepredispositiontorenalimpairment,however, a largerstudywithmorenumber ofpatients canthrowmore ligh

A review on oral mesenchymal stem cells and tissue engineering, prospects of stem cell-based regenerative dentistry

Regeneration of the damaged organs and tissues is an important physiological mechanism of the human body. Embryological research has shown that the pluripotent stem cells are responsible for the development and growth of an organism. The mesenchymal stem cells (MSCs) are present in various adult tissues including those of dental origin. Recently a lot of attention has been laid on the unique features of stem cells like replacing, repairing, maintenance and augmenting tissue function. Oral dental MSCs are able to not only regenerate dental pulp and other dental structures but also other parts of the body, especially those, which have almost, have lost their ability to regenerate.

Study of drug resistance in pulmonary tuberculosis cases in south coastal Karnataka

The present cross-sectional study was conducted for the first time from the Udupi district of coastal Karnataka to know the prevalence of drug resistance and comparative analysis of MDR and non-MDR cases of pulmonary tuberculosis. Details of 862 smear positive cases of pulmonary tuberculosis with age >/=15 years from 12 designated microscopy centres of the Udupi district were studied. Initially 2 sputum samples trailed by one follow-up sample were collected from each patient and processed for culture and drug sensitivity on the Lowenstein-Jensen medium. A total resistance of 33.4% was observed that includes the mono-resistance of 22.5%, multidrug resistance [MDR] of 6.3% and extensive drug resistance [XDR] of 0.3%. Significant odds ratio [OR] was observed in category 2 cases [OR 3.9] for the development of MDR tuberculosis. A significant statistical association was observed using Fisher's exact test while comparing mortality rate [19.3% vs. 1.8%], treatment failure [8.8% vs. 3.8%] and cure rate [68.4% vs. 85.4%] between MDR and non-MDR cases [p < 0.001]. Category 2 patients are important risk factors for the development of MDR in pulmonary tuberculosis. Due to high mortality and low cure rate in MDR cases it is imperative to know the drug sensitivity report before institution of anti-tubercular treatment

Lesson Learnt in Anal Melanoma: A Case Report.

A 54-year-old lady had presented with perineal pain. Clinically, she had pallor and inspection of the perineum showed black mapping of the skin. She was diagnosed to be a case of melanoma on transanal biopsy. There were no liver and pulmonary metastasis. She underwent abdomino-perineal resection and adjuvant chemoradiotherapy. However, she threw a convulsion after 6 months and later died of cerebral metastasis. Complete metastatic work-up is mandatory before undertaking cancer therapy in a case of malignant melanoma.

Acid-Base Imbalance and Dyselectrolytemia in Falciparum Malaria.

Malaria is re-emerging as the major infectious killer and it is the top priority tropical disease of the World Health Organization. Indian sub-continent harbours a global threat in the form of epicenter of multidrug resistant plasmodium falciparum. High prevalence of Complicated Falciparum Malaria in Costal Andhra Pradesh requiring ICU admission with high morbidity and mortality prompted this study. 60 cases of falciparum malaria in 3 sub groups, i.e, uncomplicated falciparum, severe falciparum with ARF, severe falciparum without ARF are taken. In Group-II, i.e, severe falciparum with ARF pts., mean serum potassium is 5.06 -hyperkalemia, mean PaO2 and PaCO2 are 80.33 and 32.75 respectively and mean bicarbonate value is 19.83, mean PH is 7.10, which reflects underlying metabolic acidosis and compensatory respiratory alkalosis, also mortality is 6 in Group-II out of total 9 deaths. Hence electrolytes and acid-base disturbance, especially hyperkalemia and acidosis are important cause of mortality in severe falciparum malaria. In acute renal failure setting, which is associated with both hyperkalemia and acidosis, prognosis is worsened. “Humanity has but three great enemies : fever, famine and war; of these by far the greatest, by far the most terrible, is fever(William Osler).

Jejunal Carcinoma – An Unusual Undiagnosed Cause of Anemia: A Case Report.

A 46-year-old male presented with features of anemia. On evaluation, there was iron deficiency. No source of bleeding could be located by upper and lower gastrointestinal endoscopy. Computed tomography (CT) scan and Mantoux test had evidence of tuberculosis. He deteriorated with antitubercular therapy. He improved only after laparotomy, a diagnostic laparoscopy and resection of the bleeding malignant lesion. It turned out to be jejunal cancer. Seven years after chemotherapy, he is surviving disease free. In undiagnosed iron-deficiency anemia, small bowel growth should be considered and diagnostic laparoscopy should be done to avoid confusion in diagnosis.

Prevalence of Falls and Risk Assessment for Falls Among Elderly in A Rural Area of Karnataka.

Background: Falls are extremely common among elderly population, accounting for substantial morbidity and mortality, and are often potentially preventable. Approximately 28-35% of people aged 65 yrs & above fall every year, increasing to 32-42% for those over 70 yrs (WHO). This study was designed for identification of risk factors among elderly, so that the future falls can be prevented. Objective: 1.To assess the prevalence of falls in elderly aged ≥60 yrs residing in a rural area in Bangalore 2.To assess the risk for falls and 3.To study the factors associated with the falls risk among these elderly. Materials and Methods: A cross sectional study was conducted in a village in Bangalore Urban District, Bangalore of Karnataka, among people aged ≥60 yrs during the period of July to August 2011. Demographic details, history of fall in the last one year were col-lected and falls risk was assessed. Data was analysed using SPSS16. Results: A total of 124 people aged ≥60 yrs participated in the study, 51(41%) were males and 73(59%) females. Prevalence of falls: 39(31.45%) people had history of at least one fall in the last one year averaging 1.25 falls per person per year. 32(82%) of them had one fall and 7(17.95%) experienced recurrent falls. Slip was the most common cause (51.3%) of the last fall. Risk for falls: 78(63%) elderly were having low risk, 12(9.6%) were in medium risk and 34(27.4%) were having high risk for falls. Risk was highest in 70–79 yrs age group and in females (P=0.003). On multivariate logistic regression analysis, people with hearing impairment (OR=10.09, CI=1.24-81.94), psychological im-pairment (OR=3.0, CI=1.19-7.55) and with history of falls in the last one year (OR=5.17, CI=1.98-13.49) had higher risk for falls and hypertensives (OR=0.25, CI=0.09-0.64) had lower risk. Conclusion: The study showed that there is a high prevalence of falls in elderly and more than 1/4th of the study population was at high risk. Psychological impairment, hearing impairment and history of previous falls significantly increased the risk of falling. Therefore, it is necessary to identify and address these problems and educate them on falls preven-tion.

Juvenile Dermatomyositis with Calcinosis Cutis.

A 6-year-old girl presented with irregular fever for last two months and difficulty in standing from sitting position for last 1½ months. She had pathognomonic heliotrope rashes on both eyelids, Gottron’s papules in proximal interphalangeal and metacarpophalangeal joints of both hands and papules on elbow, knee and ankle joints. She had elevated serum muscle enzyme levels and electromyogram was in favor of juvenile dermatomyositis (JDM). She is now under steroid treatment and showing signs of improvement.

Comparison of the effectiveness of 0.5% tea, 2% neem and 0.2% chlorhexidine mouthwashes on oral health: A randomized control trial.

Background: The aim of this study was to evaluate and compare the effectiveness of 0.5% tea, 2% neem, and 0.2% chlorhexidine mouthwashes on oral health. Materials and Methods: A randomized blinded controlled trial with 30 healthy human volunteers of age group 18-25 years was carried out. The subjects were randomly assigned to 3 groups i.e., group A - 0.2% chlorhexidine gluconate (bench mark control), Group B - 2% neem, and group C - 0.5% tea of 10 subjects per group. Plaque accumulation and gingival condition were recorded using plaque index and gingival index. Oral hygiene was assessed by simplified oral hygiene index (OHIS). Salivary pH was assessed by indikrom pH strips. Plaque, gingival, and simplified OHI scores as well as salivary pH were recorded at baseline, immediately after 1 st rinse, after 1 week, 2 nd week, and 3 rd week. The 3 rd week was skipped for group A. Results: Mean plaque and gingival scores were reduced over the 3 week trial period for experimental and control groups. Anti-plaque effectiveness was observed in all groups and the highest being in group C (P < 0.05). Neem and tea showed comparative effectiveness on gingiva better than chlorhexidine (P < 0.05). The salivary pH rise was sustained and significant in Group B and C compared to Group A. Oral hygiene improvement was better appreciated in Group B and Group C. Conclusion: The effectiveness of 0.5% tea was more compared to 2% neem and 0.2% chlorhexidine mouth rinse.

Right diaphragmatic hernia in an elderly man.

A 71-year-old male presented with progressive exertional breathlessness and cough for the last four years. His breathlessness aggravated after a heavy meal and on lying down. He was a smoker, but had no co-morbidities. He did not remember any major trauma or surgery. Examination of the respiratory system revealed mediastinal shift to the left, diminished breath sounds over the whole of the right hemithorax and gurgling sounds all over, mainly the infrascapular area. Examination of other organ systems revealed no abnormality.

In-hospital mortality of intermittent vs daily antitubercular regimen in patients with meningeal tuberculosis-a retrospective study.

Introduction: The Revised National Tuberculosis Control Programme (RNTCP), the State-run Tuberculosis Control Initiative of the Government of India, recommends intermittent thrice a week Directly Observed Treatment Short course (DOTS) both during intensive phase and continuation phase for a total of nine months for tubercular meningitis. However, most recent guidelines recommend daily regimen. Objective: Assessment of the in-hospital mortality in patients with meningeal tuberculosis. Material and Methods: We retrospectively analyzed the data of patients (n-98) admitted with a diagnosis of meningeal tuberculosis from January Ist 2006 to December 3lst 2009 in a tertiary care centre in South India. Thwaites index score of four or less was used for diagnosis of meningeal tuberculosis which is a weighted diagnostic index score for dichotomised clinical variables including age, blood white cell count, duration of illness, CSF total white cell count, and CSF neutrophil percentage. We compared in-hospital treatment outcome of patients on thrice weekly intermittent DOTS regimen with daily regimen patients. Results: The inhospital mortality was same (27%) in the two treatment regimens (p 0.944). However, there was less incidence of hepatic dysfunction in the intermittent DOTS regimen, even though it was not statistically significant (p 0.148). Conclusions: In the short term, both regimens have similar mortality outcomes and no statistically significant difference in hepatic dysfunction during the hospital stay.

Review of flora of anti-diabetic plants of Puducherry UT”.

Diabetes mellitus (DM) is the commonest endocrine disorder. The disease was well known to the ancient Indian medical experts. The modern pharmacopoeia contains many example of folk remedies which have led to the discovery of important therapies for a range of conditions. Traditional medicinal plants widely used and accounts for around 40 % of all health care delivered. In India indigenous medicines have been used in the treatment of DM since the time of Charaka and Sushruta (6th century BC). The main purpose of this research work is to document the anti-diabetic plants found in Puducherry. In this study the existing tradition of treating diabetes by 58 plants species, 52 genera comprise 36 families have been collected and summarized. The study reveals the persistence of folk medicine practices in Puducherry , especially in rural areas were people are still using indigenous traditional knowledge for health care, that are being influenced by cultural and socio-economical aspects, providing a cheaper and accessible alternative to the high cost pharmaceutical remedies. Present study does not prescribing any remedies for DM or any of the disease but the purpose is to document the use and draw the attention of pharmacologist, botanist, phytochemist and pharmocognosist for further scientific research in the field.

Questionnaire vs clinical surveys: The right choice?-A cross-sectional comparative study.

Purpose: To investigate the practical value of using questionnaires (self perceived assessment) as compared with clinical examinations (normative assessment) and to evaluate the role of socioeconomic status and implications of the results in understanding the public perception of oral health. Materials and Methods: This was a cross-sectional single-blind study. A purposive sample of 860 bank employees of Belgaum city, India, were asked to fill in a close-ended questionnaire inquiring about their socioeconomic status, dental, periodontal health levels and treatment needs. Clinical examinations, employing the WHO dentition status and Community Periodontal Index, were performed to determine normative status and needs. Perceived and normative assessments were compared for sensitivity, specificity, positive and negative predictive values. Results: The kappa values ranged from 0 (treatment needs) to 0.67 (for prosthesis). The degree of agreement with the following kappa values and sensitivity was seen in filled teeth (0.52, 60%), missing teeth (0.62, 83.8%), and prosthesis (0.67, 58.3%). However, the disagreement was seen with all other questions with average kappa value of 0.20. Conclusions: Self-assessment questionnaires were of low value in evaluating dental, periodontal health status and treatment needs in the study subjects. Findings reflect a low level of awareness that may influence care-seeking behavior and socioeconomic status has a clear role to play in dental health perception.

Genetics in public health: Rarely explored.

The availability and the integration of genetic information into our understanding of normal and abnormal growth and development are driving important changes in health care. These changes have fostered the hope that the availability of genetic information will promote a better understanding of disease etiology and permit early, even pre-symptomatic diagnosis and preventive intervention to avoid disease onset. Hence, our aim was to review and provide the insight into the role of genetics in public health and its scope as well as barriers. The use of genetics along with their goals and essential public health functions are discussed. From the era of eugenics to the present era, this area has seen many turns in which geneticists have put through their effort to tie together the strings of both molecular genetics and public health. Though still the dark clouds of eugenics, the predictive power of genes, genetic reductionism, non-modifiable risk factors, individuals or populations, resource allocation, commercial imperative, discrimination and understanding and education are hanging above. The technological and scientific advances that have fundamentally changed our perception of human diseases fuel the expectations for this proactive health.