Adherence and Cost Effectivity of Home-Based Prophylaxis Over Institutionalized Prophylaxis in Patients with Hemophilia

Purpose: Home-based prophylaxis in hemophilia facilitates the treatment of patients with hemophilia (PwH) at home resulting in an improved quality of life, experiencing less pain and greater flexibility in daily activities. This literature studies the cost effectivity and adherence to prophylaxis treatment after the implementation of home-based prophylaxis therapy in PwH registered under the Hemophilia Treatment Centre (HTC) of Assam Medical College and Hospital. Materials and Methods:?PwH and their parents were advised for self/home infusion after being trained by a medical professional for 6 months. Data were collected on the skip in prophylaxis treatment by PwH and their traveling cost to access the prophylaxis treatment before and after the implementation of home infusion, through questionnaire and telephonic interview. Results:?The mean number of days of skip in prophylaxis was significantly reduced from 25 (±11) to 4 (±2) days after implementation of home infusion. The mean transportation cost was also found to be significantly decreased from Rs. 3297 (±2251) to 440 (±279). Before home/self-infusion, 77% of the registered PwH were found to skip prophylaxis doses more than 12 times a year but after home infusion, no PwH were found to skip more than 12 doses a year. Conclusion:?Home therapy facilitates the PwH to strictly adhere to the prophylaxis regime significantly reducing the skipping of doses to be administered to the PwH. The risks of regular traveling and the burden of transportation expenditure to avail the prophylaxis treatment was also found to be reduced significantly.

A Study of Association between Preoperative Fine Needle Aspiration Cytology and Post-Operative Histopathological Examination of Solitary Thyroid Nodule among Patients Attending North Bengal Medical College and Hospital, Siliguri.

FNAC (Fine Needle Aspiration Cytology) is an essential tool in the preoperative diagnosis and preoperative planning for surgery of solitary thyroid nodules. It is a cost effective procedure that provides specific diagnosis rapidly with minimal complication. The purpose of the study was to evaluate the accuracy of Fine Needle Aspiration Cytology as a diagnostic tool in detecting malignancy in case of solitary thyroid nodule by correlating the preoperative fine needle aspiration cytology (USG Guided) findings with post-operative histopathology findings of the excised specimen in a sub Himalayan tertiary medical college & hospital.METHODSIt was a cross sectional hospital based study conducted on 30 patients in the period from April 2015 to March 2016 after acceptance from West Bengal University of Health Sciences and approval from ethical committee. All admitted patients having solitary thyroid nodule (confirmed clinically & ultrasonographically), biochemically euthyroid and giving consent for surgery were included in this study. Patients who are medically unfit for surgery, biochemically hypo- or hyper-thyroid and not giving consent for surgery were excluded from the study.RESULTSThe sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNAC for diagnosis of neoplastic solitary thyroid nodule were 75%, 94.44%, 86.67%, 90% and 85%. Commonest malignancy detected was papillary carcinoma in 9 patients.CONCLUSIONSIt is evident from our study that USG guided FNAC should be regarded as the investigation of choice and first line investigation in evaluation of cases with solitary thyroid nodule due to its simplicity, high diagnostic accuracy, easy to perform procedure and absence of significant complications.

Effect Of 4 Week Expiratory Muscle Strengthening On Exercise Induced Breathlessness In Normal Adults-a Pilot Study

Background:During exercise, the expiratory phase plays an equally important role in improving endurance as it helps in reducing the exercise-induced breathlessness. Therefore this study aims at specifically strengthening the expiratory muscles to study the effect of expiratory muscle strengthening on exercise-induced breathlessness. Aims and objectives: To evaluate the effect of 4 weeks of expiratory muscle strengthening on exercise-induced breathlessness in normal individuals. Methodology:Study was carried out on a total of 13 subjects ranging in the age group of 20-35yrs, where pre-intervention the Maximum Expiratory Pressure (MEP) and 1.5mile walk distance was calculated after which the subjects underwent a 4 week intervention protocol using Expiratory Muscle Strength Trainer 150 ( EMST-150) where the subjects performed 25 training breaths in one session where there were a total of 5 sessions in a day, 5days/week for a total of 4 weeks. Post the intervention the MEP and 1.5mile walk values were recalculated and compared to check for the difference. Result:Data was analyzed in terms of the mean difference. Statistically significant change was seen in the MEP and 1.5 mile walk test values post-intervention, i.e at the end of 4 weeks, where the values obtained were, MEP : pre –77.537 ±13.67 and post ­­–88.063 ±18.39 with a p-value of 0.0019 , 1.5 mile walk(vo2max.) : pre –35.810 ±14.56 and post –39.810 ±11.8 with a p-value of 0.0038 and RPE: pre –3.80 ±0.5 and post –1.7 ±0.5 with a p-value of 0.0057, thereby proving a statically significant improvement in the outcome measures. Conclusion: The study concludes that Expiratory muscle strengthening improves the maximum expiratory strength thereby reducing the exercise-induced breathlessness leading to an improvement in the endurance level.

Immediate Effect Of Incentive Spirometry On Arterial Blood Gases Analysis After Coronary Bypass Graft Surgery Patients

Background:The patients who have done CABG are prone to pulmonary complications. Various physiotherapy man-agement is present for prevention of lung complication. Literature shows lots of technique as treatment of choice, incentive spirometry is one of them. AIM: To asses immediate effect of incentive spirometry on arterial blood gas analysis in patient recently underwent coronary artery bypass surgery. Method:There was 30 patients. Blood was drawn from arterial line for pre-treatment ABG. Incentive spirometry was given 10 reps and 3 sets. Patient was prop up 30-40 degree. Romsons tri colour volume spirometry is used. Mouthpiece was placed in patient’s mouth and made a good seal over the mouthpiece with lips. Exhaled through nose normally then breathe in slowly through mouth. Ball in the incentive spirometer will go up. The patient to hold or rise the ball as high as possible and hold it for 3 or 5 seconds the slowly exhale. This was done for 10 to 15 times. Blood was drawn from arterial line for post treatment ABG. Result: There was statistically extremely significant change in value of PaO2 (112.54 ±39.46 vs133.01 ±42.13) p value <0.0001, PaCO2 (38.75 ±4.2 vs 36.9 ±3.7) p value 0.0003 and SaO2 (96.8 ±1.84 vs 98.93 ±1.11) p val-ue <0.0001 Conclusion:This study shows that there is immediate effect of Incentive Spirometry on ABG analysis in CABG surgery patient by significant improvement of PaO2 and SaO2 and decrease in PaCO2

Chironomid midges as allergens: evidence from two species from West Bengal, Kolkata, India.

Background & objectives: Arthropods of different taxonomic identity including chironomid midges are known to induce allergic response in humans. The present study was done to access two common chironomid species Chironomus circumdatus and Polypedilum nubifer for their sensitizing potential as an allergen in atopic patients and controls. Methods: Following preparation of allergenic extracts of the two chironomid species separately, 198 atopic patients attending an allergy clinic and 50 age matched controls were tested along with a routine panel of allergens to assess sensitization. Results: The skin prick test (SPT) results revealed that 189 of the 198 patients (95.4%) demonstrated sensitization to both the chironomid species. Higher levels of total IgE was observed in atopic subjects than in the control group. Interpretation & conclusions: The results suggest that the chironomid midges Chironomus circumdatus and Polypedilum nubifer can elicit sensitization in humans. A potential risk for allergic reactions by susceptible individuals exists due to these chironomid species, owing to their abundance and chances of contact with human beings. Further studies may be initiated to characterize the nature of the allergens and to assess their clinical relevance.

In vitro antimicrobial activity and characterization of mangrove isolates of streptomycetes effective against bacteria and fungi of nosocomial origin

The study aimed at determining the in vitro antimicrobial activity of alkaliphilic and halotolerant actinomycetes isolated from a mangrove ecosystem and identification of a potent strain. Twenty five isolates of actinomycetes were isolated from the sediment samples of Valapattanam mangrove swamp in Kerala, India. Antimicrobial activity of four selected actinomycete isolates was determined against bacterial and fungal pathogens of nosocomial origin by agar well diffusion method. Molecular characterization of the potent isolate was performed by 16S rDNA sequencing. Isolate no I-1 significantly inhibited Staphylococcus aureus ATCC 25923 (12 mm), S. aureus (15±0.05 mm), S. citreus (20±0.5 mm), Bacillus cereus (17±0.2 mm) and Serratia marcescens (12 mm). It also demonstrated effective antifungal action against Penicillium sp. (12±0.2 mm), Candida albicans (20±0.5 mm), C. parapsilosis (12 mm) and Cryptococcus neoformans (12 mm). Morphological study revealed that all the isolated actinomycetes belonged to the genus Streptomyces. Based on 16S rDNA sequence data, the selected isolate I-1 was shown to be closely related to Streptomyces xiamenensis. The results revealed that the mangrove ecosystem of Valapattanam harboured a rich consortium of many potent actinomycetes, which could synthesize novel bioactive compounds of pharmacological significance.

Enhancement of protease production by Pseudomonas aeruginosa isolated from dairy effluent sludge and determination of its fibrinolytic potential

Objective: The present study aimed at isolating proteolytic bacteria from dairy effluent sludge, designing the process parameters for the enhanced production of protease and determination of its fibrinolytic potential. Methods: The dairy sludge was processed according to the microbiological criteria for the isolation of proteolytic bacteria. All the isolates were screened for their protease production ability and the isolate showing highest proteolysis was selected for further studies. Effects of various media components and process parameters like carbon and nitrogen supplementation, temperature, pH and incubation period were investigated. Partial purification of the protease was done using ammonium sulphate fractionation, following which its molecular weight and fibrinolytic activity were determined. Results: Based on the biochemical studies, the selected isolate was identified as Pseudomonas aeruginosa. The highest protease yield was obtained with maltose and yeast extract as supplements. The optimum pH, temperature and incubation period for protease production by the isolate was found to be 7.0, 37℃ and 48 h respectively. The partially purified enzyme preparation showed a single protein band in sodium dodecyl sulphate polyacrylamide gel electrophoresis, revealing the apparent molecular weight of the enzyme to be 35 kDa. The efficient removal of the blood stain emphasized its fibrinolytic potential. Conclusions: From the present study it is envisaged that cultural parameters significantly affect the protease production. Based upon the fibrinolytic activity, this protease may find broad applications in detergent and pharmaceutical industries.

Mycoremediation of Congo red dye by filamentous fungi

Azo, anthroquinone and triphenylmethane dyes are the major classes of synthetic colourants, which are difficult to degrade and have received considerable attention. Congo red, a diazo dye, is considered as a xenobiotic compound, and is recalcitrant to biodegradative processes. Nevertheless, during the last few years it has been demonstrated that several fungi, under certain environmental conditions, are able to transfer azo dyes to non toxic products using laccases. The aim of this work was to study the factors influencing mycoremediation of Congo red. Several basidiomycetes and deuteromycetes species were tested for the decolourisation of Congo red (0.05 g/l) in a semi synthetic broth at static and shaking conditions. Poor decolourisation was observed when the dye acted as the sole source of nitrogen, whereas semi synthetic broth supplemented with fertilizer resulted in better decolourisation. Decolourisation of Congo red was checked in the presence of salts of heavy metals such as mercuric chloride, lead acetate and zinc sulphate. Decolourisation parameters such as temperature, pH, and rpm were optimized and the decolourisation obtained at optimized conditions varied between 29.25- 97.28 percent at static condition and 82.1- 100 percent at shaking condition. Sodium dodecyl sulphate polyacrylamide gel electrophoretic analysis revealed bands with molecular weights ranging between 66.5 to 71 kDa, a characteristic of the fungal laccases. High efficiency decolourisation of Congo red makes these fungal forms a promising choice in biological treatment of waste water containing Congo red.

A Study on Significance of Serum Effusion Albumin Gradient in The Differential Diagnosis of Pleural Effusion.

To evaluate serum pleural effusion albumin gradient (SEAG) as method of differentiating pleural transudates from exudates.Cases admitted in AMCH with diagnosed pleural effusion were divided into 2 groups based on etiology. Group I (transudates): Comprising 14 patients of congestive heart failure (n=6) and nephrotic syndrome (n=3), Cirrhosis (n=4), pericardial effusion (n=1). Group II (exudates): comprising 26 cases of tuberculous (n=15), malignant (n=8) and parapneumonic effusion (n=2), rheumatoid arthritis (n=1). In all patients estimation of pleural fluid to plasma protein ratio, pleural fluid to serum LDH ratio & pleural fluid LDH level, plasma-pleural effusion gradient were evaluated. All these parameters were compared in differentiating pleural transudates from exudates. A total of 40 patients having pleural effusion were divided into 2 groups. Group I (Transudates),Group II (Exudates). Pleural fluid to serum protein of .5 misclassified 20%, pleural fluid LDH OF 200 U/L misclassified 17.5%, pleural fluid LDH to serum LDH misclassified 12.5%, & serum effusion albumin gradient misclassified 5% while differentiating transudates from exudates. Serum pleural effusion albumin gradient (SEAG) is a very useful parameter to differentiate between exudates and transudates esp. in cases misclassified by Light’s criteria.