Diversity and management of plant species in an Eri silkworm agroforestry system by Mishing tribe of Assam, India

Aim: The present study was conducted to investigate the status and diversity of plant species used for rearing of Eri silkworm and their traditional management in the homegardens of Mishing tribe.Methodology: A total of 45 homegardens from three villages were surveyed randomly which were primarily associated with rearing of Eri silkworm. Vegetation was studied using quadrat method. The data on traditional knowledge associated with the management of plants species for rearing of Eri silkworm were collected using semi structured questionnaires. Results: The average size of studied homegardens was 0.35 ha. A total of 243 plant species were recorded from the studied homegardens of which six species were used as food plants for rearing of Eri silkworm and 10 species were used in construction of mountage. Trees related to Eri culture contributed to 37.47% of the total importance value index (IVI) in the studied homegardens. Heteropanax fragrans (Roxb.) Seem and Ricinus communis L. were the primary food plants of Eri silkworm and were found to be dominant in the homegardens. Activities such as land preparation, sowing, pruning, weeding and watering are carried out for the management of Eri silkworm food plant species and were found to vary for different species. Interpretation: There is an urgent need to document the indigenous knowledge and traditional practices associated with the management of host and food plants used in the rearing of Eri silkworm in the present day context as it is a part of their cultural heritage and should be reoriented through integration of modern farming technique.

Anthropometric Status between Tribal and Non Tribal School Children.

A descriptive cross sectional study named "Anthropometric status between tribal and non tribal school children" was conducted on Guimara primary school, Matiranga, Kharagrachari and Thana primary school, Sitakund, Chittagong to assess the difference in nutritional status between tribal and non tribal school children aged 6 to 10 years in terms of selected indicators. The indicators were height for age Z score, weight for height Z score, and weight for age Z score. Data were collected by interview from mother of the child through semi-structured questionnaire and measuring height and weight of 128 children. Among them 63 were selected from tribal community and 65 from non tribal area. The study revealed that 9.2% non tribal and 7.9% tribal children were severely stunted, 12.3% non tribal and 1.6% tribal were moderately wasted and 9.2% non tribal and 1.6% tribal children were moderately underweight. In relation to sex among tribal children 12.9% tribal boys and 3.1% tribal girls were severely stunted, only 3.2% tribal boys were both moderately wasted and underweight. In case of non tribal children 17.9% boys and 2.7% girls were severely stunted, 17.9% boys and 8.1% girls were moderately wasted and 17.9% boys and 2.7% girls were moderately underweight. According to the age group of 6 to 7 years it was found that, only 4.2% non tribal children were severely stunted and 29.2% were moderately stunted where as 12% tribal children were moderately stunted. In both case of moderately wasting and underweight non tribal were 8.5% more than tribal children and among 8 to 10 years age group it was 12.2% and 7.3% more respectively and in case of severely stunted tribal children were 1% more than non tribal. Improper dietary practice was also found among the two group of study population. Information and health education should be provided to the parents of the children by community participation regarding proper use of sanitary latrine, provision of safe drinking water and proper dietary practice.

Synchronous primary cancers of the head and neck region and upper aero digestive tract: Defining high-risk patients

Background: Patients with cancers in the head and region are at increased risk of developing synchronous primary cancers. Aim: To see the epidemiology of synchronous cancers of the head and region and identification of high-risk factors for the development of synchronous primary in the head and neck cancers. Materials and Methods: Data of head and neck cancer patients from January 2010 to December 2011 were obtained from the hospital cancer registry for retrospective analysis of patients with synchronous cancers. All synchronous malignancies were analyzed for distribution of sites, association with smoking history, stage of index head, and neck tumor and the average age of patients at presentation with synchronous cancers. The Chi-square test for association of upper aero digestive tract (UADT) and smoking and statistical formula of median for calculating the average age have been employed for analysis. Results: Incidence of synchronous primaries has been found to be 1.33%, majority were seen at the oropharynx (39.2%) and 60.7% synchronous occurred at the esophagus, 0.81% of all head and neck cancers developed synchronous primary at the esophagus. Approximately, 65% of all synchronous primaries were in Stage III and Stage IV disease and 88.2% esophageal synchronous had Stage II disease. Association of UADT synchronous cancers with smoking is highly significant, relative risk = 1.95 95% confidence interval for relative risk 1.05-3.64 P = 0.00010981 (P < 0.05) and the average age is 62.4 years in males and 57.8 years in females. Conclusion: Patients who are at the high-risk for the development of synchronous primary tumors in the cancers of the head and neck region are patients with oropharyngeal carcinoma, smoking population, patients over the age of 62 years in males, and 57 years in females and in patients with higher staged index tumor.

Diabetes in rural Pondicherry, India: a population-based study of the incidence and risk factors.

Background: For India, the ‘diabetes capital’ of the world, it is essential to know the incidence of type 2 diabetes mellitus (T2DM) and its key determinants. As two thirds of Indians live in rural areas, a study was undertaken to assess the incidence and risk factors of T2DM in rural Pondicherry, India. Methods: In a population-based cohort study initiated in 2007, a sample of 1223 adults > 25 years of age from two villages of Pondicherry were selected using cluster random sampling. Data on risk factor exposure were collected using a structured questionnaire, anthropometric tests and fasting blood glucose assessment. During house visits, 1223 of 1403 invited subjects participated. Of these, 71 (5.8%) were found to have diabetes. In 2010–2011, 85% of the non-diabetics (979/1152) were followed up using the same protocol. We calculated the risk of T2DM per annum standardized by age and sex. Population estimates of the risk factors associated with T2DM were analysed using the Generalized Estimating Equation model and the Population Attributable Risk (PAR) for T2DM calculated. Results: During 2937 person-years (PY) of follow-up, 63 new cases of T2DM occurred, giving an incidence rate of 21.5/1000 PY. Almost one third (31.7%) of cases occurred in people aged below 40 years. The incidence was double among males (28.7/1000 PY; 95% confidence interval (CI): 21.0–38.7) compared with females (14.6/1000 PY; 95% CI: 9.4–21.7). Applying these rates to rural populations, it is estimated that each year 8.7 million people develop T2DM in rural India. Nearly half of the T2DM incidence was attributed to overweight/obesity and alcohol usage. Conclusion: T2DM incidence was 2% per year in adults in rural Pondicherry, India, with the rate increasing twice as fast in men. Increasing age, obesity, alcohol use and a family history of T2DM independently predicted the development of diabetes. As half of T2DM incidence was attributed to overweight/obesity and alcohol use, health promotion interventions focusing on maintaining an optimal weight and decreasing alcohol consumption may be effective in reducing the rise in T2DM cases.

Brevundimonas vesicularis bacteremia in a neonate: a rare case report.

There are very few cases of Brevundimonas vesicularis reported worldwide. We present a case of bacteremia in a neonate who had aspirated meconium . A blood culture showed growth of a non hemolytic yellow colored colony at 37°C. It was identified as Brevundimonas vesicularis by Vitek 2 automated system (BioMeriuex). There are only a couple of reported cases of bacteremia caused by Brevundimonas vesicularis . To our best of knowledge this is the third case report of Brevundimonas vesicularis bacteremia from India.

White paper on academic emergency medicine in India: INDO-US Joint Working Group (JWG).

Emergency Medicine (EM) is a new discipline for India. As Medical Council of India (MCI) makes progress in recognizing the need to develop EM residency training programs in India it is important that there exist an established training model for future faculty, residents and medical students. This INDO-US white paper makes a serious attempt to recognize the opportunities and challenges in developing academic emergency medicine in India. The contents of this white paper address the overall scenario and are not targeted towards a person, physician, body, hospital or any other associated entity. This paper emphasizes the importance of MCI recognized training in Emergency Medicine for physicians in India.

Challenges in diabetes care in India: sheer numbers, lack of awareness and inadequate control.

With an estimated 40 million people suffering from the condition, the largest in any country in the world, diabetes has become a major health care problem in India. Recent epidemiological studies from India point to the great burden due to diabetes and its micro and macrovascular complications. This is primarily because the status of diabetes control in India is far from ideal. Based on the available data, the mean glycated hemoglobin levels are around 9% which is at least 2% higher than the goal currently suggested by international bodies. The IMPROVE study has helped identify the barriers to good control of diabetes both among patients as well as physicians in today's practice. However the recent ACCORD study points to the dangers of overaggressive treatment, especially in high risk in elderly patients. A balanced approach to improve awareness about diabetes and its control both among patients and the medical fraternity is urgent need of the hour in India. The associated risks of tight control in high risk groups should also be kept in mind.

Validation of the University of Washington quality of life questionnaires for head and neck cancer patients in India.

Quality of life (QOL) is a multidimensional construct capturing the subjective wellbeing of patients in physical, emotional, functional and social domains. Available work on post treatment QOL have only been made in western literature and less in Indian literature. AIMS: To translate the UW-QOL into both Hindi and Marathi and psychometrically validate the translation in HandN cancer patients in Indian population. SETTINGS AND DESIGN: A prospective study was done at the Tata Memorial Hospital for patients who were treated for H and N cancers. MATERIALS AND METHODS: 147 patients were enrolled from January to April 2005. The study was carried out in two phases. Patients were given translated versions of the UW-QOL and EORTC QOL questionnaires pre-operatively, 15 days post-operatively and then three months post-operatively. RESULTS: Both the Hindi and Marathi translations had strong internal consistency (Cronbach's alpha=0.7971 and 0.7839). UW-QOL composite scores correlated well with the global questions on overall QOL in both the Hindi (r=0.69) and Marathi (r=0.66) translations and also with T-stage. QOL scores were worse three months post-operatively than pre-operatively and for patients undergoing surgery that violated the mucosa. A strong correlations was observed (r>0.50) between all similar domains on the UW-QOL and EORTC HandN35 except the saliva item on the Marathi translation, where r< 0.50, but P-values were significant. CONCLUSIONS: The Marathi and Hindi versions of the UW-QOL appear to be valid and reliable instruments for assessing the QOL in Indian population and will be a vital tool for achieving greater insight into the short- and the long term QOL.

Chikungunya.

Chikungunya fever is a viral disease transmitted to humans by the bite of infected Aedes aegypti mosquito. Like malaria and dengue, this infection has almost become endemic in India, especially central and south India. Symptoms of sudden onset of fever, chills, headache, nausea, vomiting, joint pain with or without swelling, low back pain, and rash are very similar to those of dengue but, unlike dengue, there is no hemorrhagic or shock syndrome form. Chikungunya is a self-limiting illness with no specific treatment. Travellers visiting endemic areas should be careful and take precautions to see that they are not bitten by mosquitoes.

Gestational diabetes mellitus--guidelines.

The Diabetes In Pregnancy Study group India (DIPSI) is reporting practice guidelines for GDM in the Indian environment. Due to high prevalence, screening is essential for all Indian pregnant women. DIPSI recommends that as a pregnant woman walks into the antenatal clinic in the fasting state, she has to be given a 75g oral glucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one step procedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible. Screening is recommended between 24 and 28 weeks of gestation and the diagnostic criteria of ADA are applicable. A team approach is ideal for managing women with GDM. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator, dietitian, midwife and pediatrician. Intensive monitoring, diet and insulin is the corner stone of GDM management. Oral agents or analogues though used are still controversial. Until there is evidence to absolutely prove that ignoring maternal hyperglycemia when the fetal growth patterns appear normal on the ultrasonogram, it is prudent to achieve and maintain normoglycemia in every pregnancy complicated by gestational diabetes. The maternal health and fetal outcome depends upon the care by the committed team of diabetologists, obstetricians and neonatologists. A short term intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in the offspring, as the preventive medicine starts before birth.

Neuroparalysis and ventilatory support in severe tetanus.

In severe form of tetanus, even with maximum dose of muscle relaxants, spasms and apnoeic spells may persist and that may be life-threatening. The aim of this study was to assess the effect of neuroparalysing the patients and then providing ventilatory support in bringing about their recovery. Forty-nine adult patients of severe tetanus (Ablett's grade IIIA--6 patients and Ablett's grade IIIB--43 patients) were studied during the period from April, 1993 to February, 1996. Mean period of onset ie, period from trismus to first spasm, in these patients was 24 hours. Patients were neuroparalysed with a bolus dose of 2-4 mg of pancuronium followed by a continuous infusion of 1-2 mg/hour and simultaneously supported with mechanical ventilation until spasms subsided. Fourteen patients (28.6%) survived and rest died. Mean duration of ventilatory support on survived patients was 14.4 days. The commonest complication encountered during ventilatory support was respiratory tract infection observed in 36 patients (73.5%). Commonest cause of death was autonomic imbalance encountered in 15 patients (30.6%). Treatment of choice in severe tetanus should be neuroparalytic ventilatory support. With use of new generation ventilators and better intensive care facility, death in severe tetanus is likely to be very less.

Quality of life of head and neck cancer patient: validation of the European organization for research and treatment of cancer QLQ-C30 and European organization for research and treatment of cancer QLQ-H&N 35 in Indian patients.

AIMS: To present the first cross-culture validation of the European organization for research and treatment of cancer (EORTC) quality of life questionnaires, the EORTC-QLQ-C30, and the QLQ-H&N 35 in India. SETTINGS AND DESIGN: These questionnaires were translated into two vernacular languages and pilot test was done on 15 patients. Two hundred head and neck cancer patients completed the QLQ-C30 and the QLQ-H&N 35 at two time points during their treatment. Psychometric evaluation of the structure, reliability, and validity of the questionnaire was undertaken. RESULTS: The data supports the reliability of the scales. Validity was tested by item-scale, scale--scale correlation and by performing known group comparisons. The results demonstrated that the items correlated with their respective scale and no significant correlation was found between scales. The questionnaire was responsive to change over a period of time. SUMMARY: This data suggests that the EORTC QLO-C30 and the QLQ-H&N 35 are reliable and valid questionnaires when applied to a sample of head and neck cancer patients in India.

Feasibility of acute thrombolytic therapy for stroke.

BACKGROUND: Thrombolysis is an expensive medical intervention for ischemic stroke and hence there is a need to study the feasibility of thrombolysis in rural India. Aims: To asses the feasibility and limitations of providing thrombolytic therapy to acute ischemic stroke patients in a rural Indian set-up. MATERIAL AND METHODS: The first 64 consecutive patients registered under the Acute Stroke Registry in a university referral hospital with a rural catchment area were studied as per a detailed protocol and questionnaire. RESULTS: Of the 64 patients 44 were ischemic strokes, and 20 were hemorrhagic. Thirteen (29.55%) patients with ischemic stroke reached a center with CT scan facility within 3 hours, of whom only 7 (15.91%) were eligible to receive thrombolytic therapy as per the existing clinical and radiological criteria, but none received the therapy. Of the remaining 31 (70.45%) who arrived late, 11 (25%) had no clinical and radiological contraindications for thrombolysis, except the time factor. All the patients belonged to a low socioeconomic status and a rural background. CONCLUSION: Though a large proportion of ischemic stroke patients were eligible to receive thrombolytic therapy, the majority could not reach a center with adequate facilities within the recommended time window. More alarmingly, even for those patients who reached within the time window, no significant attempt was made to initiate thrombolysis. These data call not only for attention to improve existing patient transport facilities, but also for improving the awareness of efficacy and therapeutic window of thrombolysis in stroke, among the public as well as primary care doctors.

Comparative evaluation of grading of breast carcinomas in fine needle aspirates by two methods.

BACKGROUND & OBJECTIVES: Fine needle aspiration (FNA) material is increasingly being used to determine various prognostic parameters in patients with carcinoma breast. It was recommended that cytological grading should be part of all FNA reports of breast carcinoma so that preoperative prognostication could be done on it. However, the most reliable method for cytological grading that closely reflects the most widely used histological grading system is yet to be determined. This study was undertaken to compare results of two cytological grading methods to see which corresponded better to the histological grade. METHODS: In a double-blind study, cytological grading of 52 patients with breast carcinoma was carried out using two different grading systems (Robinson's and Mouriquand's methods) and the grades compared with the histological grading to find out which reflected histological grades more closely. RESULTS: By Robinson's method 28.8, 46.2 and 25 per cent aspirates were graded as I, II and III respectively. Using Mouriquand's grading 9.6, 69.2 and 21.2 per cent aspirates were graded correspondingly. Comparison of the two methods showed a concordance in 40 (76.9%) cases. Both cytological grading systems showed a concordance of 71.2 per cent with the histological grading. Robinson's cytological grading showed a diagnostic accuracy of 80.76 per cent with 77.77 per cent specificity while Mouriquand's method had an accuracy of 84.60 per cent with 33.33 per cent specificity. INTERPRETATION & CONCLUSION: Though the Robinson's and Mouriquand's grading systems were found to have similar concordance with histological grading, Robinson's method was considered better because of its simplicity, and specificity.

Comparison of latex agglutination and co-agglutination for the diagnosis and prognosis of cryptococcal meningitis.

PURPOSE: To compare a commercially available Latex agglutination test and an in house co-agglutination test for the detection of cryptococcal antigen in cases of chronic meningitis. METHODS: One hundred and fifty cerebrospinal fluid (CSF) samples from 150 cases of chronic meningitis were tested for the presence of Cryptococcus neoformans by modified India ink, culture and antigen detection by latex agglutination test (LAT) and co-agglutination (Co-A) test. RESULTS: Thirty-nine cases were positive by one or more tests employed. Antigen detection in CSF by LAT and Co-A was found to be most sensitive (94.9%) while culture was the least (25.6%). Of the two antigen detection methods, Co-A was found to be more sensitive than the LAT, the difference being statistically significant. Initial CSF antigen titres did not have any prognostic significance. CONCLUSIONS: Co-A for antigen detection is an inexpensive and useful adjunct to direct microscopy and culture for the diagnosis of cryptococcal meningitis, though its usefulness in prognosis needs to be evaluated further.