Clinical features of Vitamin D deficiency in children and their correlation with Vitamin D levels: A cross-sectional study in SRVS medical college, Shivpuri

Background: Vitamin D along with calcium plays an important role for the maintenance of musculoskeletal health during whole life, and it is essential to address their deficiency pediatric and adolescent population is vital. Ideally, all the children should be screened for Vitamin D deficiency because a large number of Vitamin D deficient are asymptomatic, but it is practically difficult to do Vitamin D levels in all the healthy children. Aims and Objectives: The aim of the study is screening children presenting with signs and symptoms suggestive of Vitamin D deficiency and tried to correlate the presenting clinical feature with the level of Vitamin D with the following objectives: (i) to study the level of Vitamin D (25 hydroxy Vitamin D) in apparently healthy children with clinical features indicating of Vitamin D deficiency and (ii) to correlate the specific clinical features with Vitamin D level. Materials and Methods: This study was approved by the institutional ethics committee, and informed consent was obtained by writing from the parents before starting of the study. Cross-sectional observation study conducted between November 2021 and November 2022 by convenient sampling method. Young children and adolescents of age group of 2–14 years attending OPD at SRVS Medical College Shivpuri was the study population. Results: The present study done in Shivpuri belt the prevalence deficiency of Vitamin D was found to be 52% in children. Prevalence of Vitamin D deficiency in Madhya Pradesh is high, pointing as the severe and critical public health issue. Conclusion: Vitamin D deficiency done by serum concentrations of 25 (OH) D if less values proper suggestive treatment is recommended.

A Study of Thyroid Profile and Lipid Profile in Patients with Chronic Kidney Disease with or without Hemodialysis in a Tertiary Care Hospital

Background: Chronic kidney disease (CKD), due to increasing frequency and prevalence, has become one of the leading public health issues. The Kidney Disease Outcome Quality Initiative (KDOQI) defines CKD as kidney injury or a reduction in the glomerular filtration rate (GFR) to <60 mL/minute/1.73 m2 for at least 3 months. This study aims to compare the effects of decreased renal function on thyroid profile and lipid profile in CKD patients. Materials and methods: This is a prospective cross-sectional observational study conducted among the patients attending Outpatient Department/Inpatient Department (OPD/IPD) at the School of Medical Sciences & Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India, in known cases of CKD, irrespective of the treatment/stage of CKD. All patients of >18 years of age with CKD were included in the study. Result: A total of 200 patients who met the inclusion criteria were included after obtaining detailed informed consent, of which 100 were cases and 100 were controls. The mean age of patients in the study was 47.74 years, with the mean age in patients with CKD 52 years, and the control was 43 years. The mean level of triglycerides (TGs) was significantly higher among the cases, and the high-density lipoprotein (HDL) was significantly lower among cases compared to controls (p < 0.05). Pearson’s correlation between thyroid-stimulating hormone (TSH) with creatinine showed a weak albeit significant positive association (r = 0.200; p < 0.05). Conclusion: Our study shows a higher incidence of alteration in thyroid profile and dyslipidemia among the patients with CKD compared to controls. There is a necessary need to screen routinely for hypothyroidism and dyslipidemia among patients with CKD. Importantly, thyroid hormone levels and their effects on the progression of CKD have not been studied exhaustively.

Healthcare Seeking Behaviour of Hospitalised COVID-19 Patients During Second Wave in Tertiary Care Hospital of Northern India

Background: The Coronavirus Disease (COVID-19) pandemic continues its deadly reign all over the world. Devising effective strategies for detecting and controlling the infection has become ever more critical. Effective prevention and control of the pandemic is entirely dependent on human behavior in terms of practicing preventive and curative measures. During the second wave of COVID-19, people’s perceptions of preventive and curative measures changed. Objective: To study healthcare-seeking behavior of hospitalized COVID-19 patients. Methods: Hospitalized patients due to COVID-19 in the month of March, April and May of 2021 were included in the study. Their attendants/close relatives were contacted telephonically to know about the admitted patients’ healthcare-seeking behavior. Verbal consent was taken from attendants before the commencement of the interview, followed by informing them about the purpose of the interview. Results: Amongst the subjects, there were more males than females (67.5 vs 32.4%), age ranged between 18 to 88 with a mean value of 56.61 ± 14.7 years. Self-medication was significantly associated with study subjects’ mortality (p=0.03). Conclusion: Elderly people were having higher mortality rate than their younger counterparts. People were hesitant to visit primary care physicians after having symptoms of COVID-19.

Technical expertise and behavior of the doctor- a major determinant of waiting time of OPD patients

Background: The study was conducted to understand various factors affecting waiting time spent by the patients in outpatient department (OPD) and to provide recommendations for reducing the waiting time in OPD of the selected hospital. Methods: It was a descriptive cross-sectional pretested questionnaire-based study involving all new 100 consenting patients at OPD recruited into the study using a systematic sampling technique after calculating the sampling interval. Results: The study indicates that 70% of patients were satisfied and only 30% were dissatisfied with the attention given by the OPD staff, cleanliness, attentiveness of doctor but shows great dissatisfaction regarding the waiting time spent by them in the outpatient department. Most of the subjects gave the reason for their satisfaction despite more time because of expertise of the doctor, behavior of the doctor, association of hospital with non-government organizations and insurance companies for free medicine and surgery. The dissatisfaction was not because of lack of administration but because of low level of awareness amongst patients attending the OPD about internet booking of appointment, COVID protocols, priorities given to recommendations given by other doctors/VIPs and walk in OPDs attended without prior appointment. Conclusions: A very important observation which evolved from the study was the version of patients that waiting time does not matter because they want to be treated from same doctor due to his/her expertise. Second important observation was that the addressing and greeting of patient by his/her name gave a great satisfaction and level of comfort to patients and affects the waiting time.

Determination of ABO Blood Group and Rhesus Factor from Teeth: A Double-Blinded Randomized Controlled Trial.

Background: Identification of a deceased subject can be established not only from the skeletal remains (including the congenital peculiarities in setting of teeth) but it can also be precisely established by blood grouping from the teeth with the help of the absorption-elution technique. Objectives: Our study was conducted to evaluate if dental pulp can be used as a reliable source for determination of ABO blood group and rhesus factor in an individual. Materials & Method: This double-blinded randomized controlled trial was conducted on a sample of 250 extracted teeth. An attempt to establish the blood group from pulp was made by absorption-elution method. The collected data were coded, and statistical analysis for comparison of ABO blood groups was done using Cronbach's alpha to check the reliability of the absorption-elusion method in the detection of blood group from dental pulp. Results: On comparison of capillary blood group (slide agglutination method) with pulp blood group (absorption elution technique) of the subjects, we found that positive results were obtained in 235 cases while 15 cases showed negative results. Hence, the sensitivity (ability to measure) of pulp in establishment of blood group was found to be 94%. Conclusion: On the basis of the results obtained from the present study, it could be concluded that pulp is a reliable source of blood group determination for ABO blood grouping where teeth happen to be the only remnants available for personal identification.

Oral Microbiome and Adverse Pregnancy Outcomes: An Update.

From last decade of the 20th century, numerous epidemiological studies and intervention trials have attempted to prove the relationships between maternal oral diseases and adverse pregnancy outcomes (APO). Several physiological, immunological and hormonal changes occurring during pregnancy ensures the woman’s body maintenance throughout the gestational period and the development of foetus. Studies have reported changes in the maternal microbiome in the gut, vagina, and oral cavity during pregnancy. Infections at the foetomaternal interface are known to upregulate the production of local proinflammatory cytokines, metalloproteinases and prostaglandins leading to membrane weakening, early rupture of membranes and uterine contractions. A clear understanding of the association between oral microorganisms and adverse birth outcomes conveys significant health implications. In this paper we reviewed the current literature regarding the link between oral microbiome and adverse pregnancy outcomes including preterm birth, chorioamnionitis, neonatal sepsis, stillbirth, and preeclampsia.

Comparison of Bone-Patellar Tendon-Bone Graft, Semitendinosus–Gracilis Graft and Semitendinosus–Gracilis with Preserved Tibial Insertion Graft in Anterior Cruciate Ligament Reconstruction in Sports Persons

@#Introduction: Bone-patellar tendon-bone (BPTB) and semitendinosus–gracilis (STG) are the commonest grafts used for ACL reconstruction. However even after having been debated for years, there is no consensus about the ideal graft. Moreover, the literature is deficient about STG graft with preserved tibial insertion (STGPI) which preserves the proprioception. Our aim is to compare the outcome of BPTB, free STG and STGPI grafts after ACL reconstruction in professional sports persons. We compared the outcome in terms of mechanical stability, functional outcome, return to sports activity and degenerative changes. Materials and Methods: Professional sports persons aged between 16-50 years operated for ACL tear using BPTB, free STG and STGPI grafts with minimum follow-up of two years were identified from hospital records. Patients with associated knee injuries were excluded. Patients, divided in three groups according to graft used, were compared in terms of mechanical stability (arthrometric examination KT-1000 score), functional outcome (Lysholm Score), return to sports activity (Tegner score and difference in thigh circumference) and degenerative changes (KL grading). Results: BPTB graft group was found to be better than free STG and STGPI graft groups in terms of KT-1000 score. There was no statistically significant difference among the groups in terms of Lysholm score, Tegner score, difference in thigh circumference and KL grading. Conclusion: BPTB graft is better than free STG and STGPI grafts in terms of knee stability. When compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts.

Plasma Vitamin C Status of Adolescent Girls in a Slum of Delhi.

A cross-sectional study was conducted among 775 adolescent girls (11-18 years) residing in a slum of Delhi to assess plasma vitamin C levels. The mean (SD) plasma levels of vitamin C were 0.76 (0.45) mg/dL. Overall, 6.3% and 27.6% girls had deficient (<0.2 mg/dL) and suboptimal levels (0.2-0.49 mg/dL) of plasma vitamin C, respectively.

A Cross Sectional Assessment of Knowledge, Attitude and Practices towards Hepatitis B among Undergraduate Medical Students of a Medical College in rural area.

Introduction: Hepatitis B virus (HBV) infection is one of the most common blood borne viral infection in the world. It is a major potentially life threatening, global health problem. About 6,00,000 people die every year due to the acute or chronic consequences of hepatitis B. Health care workers including medical students are at risk of acquiring the infection while at work. Objective: To assess the knowledge, attitude and practice of hepatitis B infection among Undergraduate (MBBS) medical students of Dr. Rajendra Prasad Government Medical College, Kangra at Tanda. Materials and Methods: Knowledge, attitude, and practises towards Hepatitis B was assessed by using a pre validated questionnaire in a cross sectional descriptive study. Mean scores for knowledge, attitudes and practices were calculated using the Epilnfo software version 7. Results: Four hundred fifty questionnaires were distributed among the students.387 responded, a response rate of 86%. Mean age of female students was 21.5 ± 1.59 yrs and mean age for male students was 21.9 ± 1.69 yr. Mean scores for Knowledge, Attitude, and Practises were 15.87 ± 1.57 (Maximum score 19) , 2.00 ± 0.63 (Maximum Score 3) and 4.6 ± 0.97 (Maximum Score 6) respectively. This study also demonstrates some important shortcomings in the knowledge, attitude, and practises of medical students. Conclusion: Results of the study suggest good Knowledge, Attitude and Practice of Hepatitis B among the students. Though, overall knowledge and attitude to HBV infection is good, there is a need to develop guidelines to ensure that medical students are not only fully vaccinated against HBV but adequate practice of standard precautions is also adhered to.

Use of social networking sites among medical undergraduates of a medical college in north-west India.

Introduction: Use of Internet for communication has become a very important part of young people's life. Social networking sites are virtual communities that allow users to create a profile and interact with friends. One area of interest in this field is regarding the activities of medical students on social networking sites and how these activities affect their academic performances. Objective: To assess the use of social networking sites and its impact on academic performance among medical undergraduates of a rural medical College. Methodology: It was a cross sectional study conducted over a period of three weeks in December 2013 among undergraduate students of Dr RPGMC Kangra at Tanda. A self-administered questionnaire was used to conduct the study. Data was entered in Microsoft excel sheet and analysed.Result: A total of 150 participants were enrolled of which only 141 agreed to participate. Among these 74 (52%) were males and 68 (48%) females. The mean age of the subjects was 20.2 ± 1.5 years. Majority 123 (87.2 %) used multiple networking sites, 45 % (60/123) had joined communities related to medicine. More than half 52.7 % (65/123) of subjects used these multiple sites to remain connected with their friends.81.7% (49/60) visited medical communities daily and 93.9% (46/49) among them said that these communities has helped increase their knowledge. Average time spent per session was 10-30 minutes among 26.8 % (33/ 123) participants.Conclusion: The results of the study showed that role of social networking sites among undergraduate students pursuing a professional course is important while communicating with friends and people of their own field. It helps them in broadening their knowledge and they feel it has helped them positively in their academic performance.

Wunderlich's syndrome with hepatic angiomyolipoma in tuberous sclerosis.

We present a patient of tuberous sclerosis complex with bilateral renal angiomyolipoma and hepatic angiomyolipoma with spontaneous retroperitoneal hemorrhage from right angiomyolipoma (Wunderlich's syndrome). Nephron preserving approach was tried but the right kidney could not be salvaged. Hepatic angiomyolipoma was managed conservatively. Wunderlich's syndrome has been found in around 10% of cases of renal angiomyolipomas. Hepatic Angiomyolipoma is a benign mesenchymal neoplasm of the liver which is rarely reported in literature.

Poly ADP ribosylation as a possible mechanism of microwave--biointeraction.

Electromagnetic fields (EMFs) affect the metabolism of the body including the nervous, endocrine, cardiovascular, hematological as well as the reproductive system. EMFs are environmental pollutants, thus posing a health hazard which can cause steric changes in the molecule located at the cell surface. Microwaves are known to cause chromosomal abberations and act as tumor promoters. The process involves a stream of signals from cell membrane to nucleus and other organelles. The present investigations aim to understand the mechanism of biological effects of microwaves (2.45 GHz). The effect was studied on poly ADP-ribosylation, which is a post translational modification of chromatin protein catalysed by the enzyme poly ADPR polymerase using NAD+ as the substrate. Poly ADP-ribosylation has been shown to be involved in several aspects of chromatin structure and function. Twenty-three days old rats weighing 42-48 gms were exposed at a microwave dose level of 1.0 mW/cm2. After exposure for sixty days the animals were sacrificed and an estimation of poly ADPR polymerase activity was undertaken in different organs of these animals. There was an increase of 20% in its activity in liver, 35% in testis, whereas brain showed a 53% decrease in diencephalon and 20% decrease in the cortex in the exposed animals as compared to their respective controls. There was no change in enzyme activity in spleen and kidney. This was accompanied by concomitant changes in NAD+ levels. The above results may be cited as important events in carcinogenesis and tumor promotion related to microwave exposure and the signal transduction mechanism involved. The goal is to shed light on complex ecogenetic interactions leading to cancer modulation of gene expression by epigenetic mechanism.

Serum cholesterol and its components (high, low & very low density lipoproteins) in children of patients of myocardial infarction.

Total serum cholesterol and its components high density lipoprotein, low density lipoprotein and very low density lipoprotein were estimated in serum of 409 children (212 males and 197 females) of 189 patients with myocardial infarction (MI). The patients were divided into 2 groups--1. having MI before the age of 40 years and 2. having it after 40 years. Three hundred and nine children were of parents belonging to group 1 and 100 children were of parents from group 2. Lipid patterns of these children were compared. Comparison was also carried out in subgroups made as per the age and sex of the parents. It was concluded that the disease is more likely to transfer from young patients to their children. Both paternal as well as maternal effects exist in young patients of MI but the paternal effect is dominant. In children of parents having myocardial infarct at a latter age, maternal effect is predominant. The lipid patterns of male and female case-children were also compared with the respective controls. More significant differences in the levels were observed in male case-children indicating that the disease is more likely to transfer in male case-children.

Phosphoinositide specific phospholipase C activity of goat spermatozoa in transit from the caput to the cauda epididymis.

Goat sperm lysate from cauda epididymis was incubated in the presence of [14C]phosphatidyl-choline, -ethanolamine, -inositol and diphosphatidyl-glycerol. The release of [14C]diacylglycerol from only phosphatidyl inositol confirmed the presence of phosphatidyl inositol specific phospholipase C. The enzyme activity was linear up to 1 hr of incubation at a sperm concentration of 1-10 x 10(9). It had pH optimum of 7.5 in a broad range of pH activity profile (pH 6-9). Maximum activity was observed at 8 mM calcium ion concentration. EDTA and EGTA (5 mM) did not inhibit the activity completely. A comparative study on spermatozoa and fluid from caput, corpus and cauda epididymis revealed 6.5-fold increase of activity in spermatozoa and a 4-fold decrease in case of fluid during the epididymal transit. However, the total protein content remained unchanged in fluid and decreased up to the extent of 2.4-fold in spermatozoa during this process. Thirty five percent of the caudal sperm activity was soluble and the rest was associated with head (44%), mid-piece (10%) and tail (10%).

Histomorphochemical effects of shortwave diathermy on healing of experimental muscular injury in dogs.

The biceps femoris muscle was surgically incised and sutured in 10 clinically healthy mongrel dogs, aged 1-2 yr and weighing 10-15 kg. The surgical wounds of 5 dogs were exposed to shortwave diathermy for 5 min daily for 7 days, starting a day after the creation of trauma. The remaining 5 dogs served as control. After 15 days of healing, the tissues from biceps femoris muscle were collected and subjected to histomorphological and histochemical examination. Mature collagen bundles were seen at healing site in diathermy treated animals while there were immature collagen fibres and more number of fibroblasts in control animals. Normal muscle fibres could be seen on either side of the healing tissue in treated animals whereas in control animals, atrophied and necrosed muscle fibres were encountered. The neutral and acid mucopolysaccharides, lipid droplets in the intermyofibrillar area and the activity of alkaline phosphatase, adenosine triphosphatase and lactate dehydrogenase at the healing site was better in treated as compared to controls.