Effectiveness Of Cognitive Behaviour Therapy in managing Rumination And Insomnia among adolescent girls

Background: The present study attempts to study the effectiveness of cognitive behaviour therapy in managing rumination and insomnia among adolescent girls from the Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore. Methodology: 200 students from undergraduates were screened for their level of Rumination and Insomnia using Ruminative Response Scale and Insomnia Inventory. Out of 200, 120 students with high and average level of Rumination and Insomnia were selected using random sampling technique. Cognitive Behaviour Therapy was given to manage Rumination and reduce Insomnia for the adolescent girls. Results: The age range is 17 to 18 years. Pearson correlation, mean and standard deviation and ‘t’ test was computed to analyse the data. The results indicate that there was a positive correlation between rumination and insomnia and significant difference in managing rumination and insomnia among the adolescent girls proving the effectiveness of Cognitive Behaviour Therapy. Conclusion: Cognitive Behaviour Therapy is an effective therapy for the management of insomnia and rumination in adolescent girls and further studies in this area are needed.

Analyzing Out of Pocket Health Expenses: An Assessment based on Cross Section Study in Assam

Background: Increasing out of pocket health expenses is one of the major debates among the policy makers during the recent years. Out of pocket (OOP) health expenses above the catastrophic level leads to impoverishment of the rural poor. Aims & Objectives: To analyzes the impact of inpatient care in escalating OOP expenses and identifies the factors associated with catastrophic health expenditure in Assam, India. Material & Methods: The study is based on the household survey conducted during 2014 - 15 in Nagaon and Nalbari districts of Assam. The factors associated with catastrophic health expenditure are estimated using binary logistic regression model. Results: The households are afflicted with a larger burden of healthcare expenditure mainly in case of inpatient care. Due to severe shortage of medical personnel and equipment, residents are compelled to visit private health facilities. Huge costs are borne by the households due to outsourcing of services from government to private sector. Conclusions: Provision of protection from financial risk for health hazards and improvement of quality of health care in government hospitals is imperative to improve the existing situation.

High Prevalence of Metabolic Syndrome among Outpatients in a Tertiary Care Centre, Tamil Nadu, India.

Background: Metabolic Syndrome (MetS), aconstellation of specific cardiometabolic risk factorsincreases the risk of diabetes and cardiovasculardiseases. These risk factors can be largely reversedthrough lifestyle changes. To develop individualizedlifestyle therapeutic interventions among patientsattending non-communicable disease specialtydepartments, there is a need for identification of peoplewith high risk of developing MetS. Aim and Objectives:To determine the prevalence of MetS, it's associateddemographic and clinical characteristics amongpatients attending specialty Outpatient Department(OPD) in a tertiary care centre. Material and Methods:In this hospital-based cross-sectional study, randomlyselected adults (aged 20 years or more) attending thediabetology or cardiology OPD were included. Usingpretested interview tool, demographic details, height,weight and waist circumference were measured as perstandard guidelines. Blood pressure, fasting bloodsugar and fasting lipid profile were assessed. MetS wasclassified based on the modified Adult Treatment Panel(ATP-III) and International Diabetes Federation (IDF)criteria. Results: A total of 668 patients were includedand the mean age was 50.1 ± 9.7 years. Of the total,72.6% and 64.5% of patients had MetS. Patients aged60 years or more had 1.8 times [Adjusted PR 95% CI:1.05-3.16] higher prevalence of MetS compared to 20-30 years. Patients who were doing at least 30 minutes ofregular moderate physical activity had 17% lessoccurrence of MetS [Adj PR: 0.71-0.96] compared tothose who did less than 15 minutes of physical activity.Gender, literacy, type of diet and amount of visible fatintake were not significantly associated with MetS.Conclusion: MetS is highly prevalent among patientsattending diabetology and cardiology OPD. Acrossseveral subgroups, around two-thirds had MetS and lowhigh-density lipoprotein was the major contributingfactor for MetS.

A Questionnaire Based Observational Study On Polypharmacy In Elderly People Living In Urban And Rural Areas

Introduction: Polypharmacy is defined as taking more than five drugs per day, every day. Polypharmacy in elderly is becoming more common because of increased number of chronic diseases with which an elderly person suffers given the longer life expectancy in modern times. The major concern about polypharmacy in elderly is prescription cascade. Drug interaction and adverse drug reactions are misinterpreted and misdiagnosed as another health problem. This will lead to one more prescription. Quality of life of an elderly person is compromised with polypharmacy though it prolongs life expectancy. Method: Questionnaire based cross sectional study conducted on both urban and ruralpopulation. Institutional ethics committee permission has been taken. Oral consent has been taken from the subjects and only their information has been used in this study.Subjects aged more than 60 years have been considered for the study. Bed ridden patients, hospitalized patients and elderly people with acute illness were excluded from the study. Results: Data was collected from 134 subjects. Number of subjects: urban participants were 64 and rural participants were 70. Male and female were included. Prevalence of polypharmacy observed in this study was 40% in urban participants and 23% in rural participants. It was observed that, among elderly participants on polypharmacy 75% faced adverse drug reactions and 60% were subjected to prescription cascade. Among the elderly participants taking less than 5 drugs per day, 50% faced adverse drug reactions and 12% were subjected to prescription cascade. Discussion: Adverse drug reactions and prescription cascade are main complications of polypharmacy in elderly people. Prescription review, counseling, life style modification and carefully supervised deprescription are some of the available solutions to solve the complications due to polypharmacy

Fracture Resistance of Teeth with Different Cavity Designs for Proximal Lesions with Different Restorative Materials

Background: Many diseases and conditions weaken the strength of tooth making it to fracture. Many cavity designsand materials are used to restore the tooth to bring about the normal function. The present study was done to determine which one of the three class II cavity design offer the best fracture resistance to the teeth when used with different restorative materials. Methods: 165 molars (150 intact and 15 carious) were collected and preserved in hydrogen peroxide. These teeth were divided into five groups and restored with silver amalgam, compomer (Dyract AP) and metal modified ionomer cement (Miracle mix). The restored teeth were subjected to a compressive load using Universal Testing Machine by flat and metallic die. Results: Conventional designs with amalgam restoration seemed to withstand more load when it was imparted through a flat surface (741 kg ±158 SD) compared to the box or slot designs. However, when the load was imparted through a metallic die, the slot design with compomer restoration gave the maximum value (SD) of 472 (±88) kg. When analyzed statistically on the difference in the fracture resistance among the different restoration materials and the different cavity designs, statistically significant values were found between certain combinations. Conclusion: The study concluded that in the case of silver amalgam material, the test conducted by flat surface gives the best strength for the conventional design which is 3% and 23% better than that of box type and slot type respectively. However, when tested with a metallic die, slot type takes 8.3% more load than the conventional type. Among the various restoration materials tested for, amalgam provides more strength followed by compomer and miracle mix.

Effect of Surface Hardeners on a Physical Property of Type IV Gypsum Products

Background: Gypsum products are being used for construction of dental prosthesis. Most of the researches done sofar on gypsum materials are on its use as fixed and removable prosthodontics. And although many studies have looked at a multitude of means for altering its properties, relatively less has been explored on examining the abrasion resistance of the gypsum product itself. Objectives: The current study was done to determine the abrasion resistance of three commercially available type IV gypsum products on application of three die-hardeners when abraded with 20gm and 50gm load stylus. Methods:An experimental in vitro study was done in the Dept. of Prosthodontics, UP Dental College & Research Center and the Dept. of Pharmacy, BBD National Institute of Technology & Management, Lucknow. A standardized machined die was fabricated so that the die consisted of 27 vertical ridges of 1mm depth. Three type IV gypsum products viz., Kalrock, Elite Rock and Denstone Plus and three die-hardeners viz., Hartebad die-hardener, Handae die-hardener and Maarc die-hardener were included in the study. 40 samples were prepared from each of the die-stones by pouring into impressions made by using the putty-wash technique. Resultantly, 120 samples were prepared which were let to mature. These 120 samples were divided into 24 groups, each group consisting of 5 samples. They were grouped as uncoated, coated with Hartebad die-hardener, coated with Handae die-hardener and coated with Maarc die-hardener. They were sub-grouped further for abrading under 20gm and 50gm loads by using an abrasion-testing machine. After 10 oscillations, the loss of mass was measured using analytical electronic machine. The different findings were compared by using appropriate statistical analytic tests. Results: The abrasion resistance of type IV gypsum products increased with the application of surface-hardeners irrespective of the load and Elite Rock showed better abrasive resistance while Denstone Plus showed lesser abrasion resistance among all the type IV gypsum products tested. Conclusion: Elite Rock when coated with Hartebad die-hardener showed maximum abrasion resistance irrespective of the load applied.

Tamsulosin vs Naftopidil in Medical Expulsive Therapy for Ureteral Stones — A Randomized Controlled Study.

The aim of the present study was to compare the efficacy of naftopidil and tamsulosin in the management of ureteral stones. A total of 92 patients with symptomatic, single < 10 mm ureteral stone, were enrolled in a prospective study and randomized into two groups. Group 1, received 0.4 mg tamsulosin daily, whereas Group 2, received 50 mg naftopidil daily. Patients were followed –up for up to 6 weeks. The primary end point was stone expulsion rate and secondary end points were stone expulsion time , the rate of interventions such as uretero-renoscopy, ureteric stenting and extracorporeal shock wave lithotripsy and side effects. There were no significant differences between the groups with respect to age, sex, stone size and location. Stone expulsion rate were 76% and 56% in the tamsulosin and naftopidil group respectively. No significant difference in the stone expulsion time and the rate of interventions between the two groups. The finding suggest that tamsulosin is superior to naftopidil for stone expulsion therapy.

Clinical Characteristics and Outcome of Obstetric Patients Who Required Mechanical Ventilation in a Tertiary Care Hospital in North Kerala.

Objectives: To describe the clinical characteristics of obstetric patients requiring mechanical ventilation in a tertiary referral hospital and their maternal and perinatal outcome in order to identify their risk factors and clinical outcome and determine adverse prognostic factors in these patients. Study design: A prospective study was conducted in the Dept. of Obstetrics and Gynecology, Government Medical College, Kozhikode on all pregnant women up to 6 weeks postpartum from January 1, 2011 to December 31, 2013 and who subsequently required mechanical ventilation. Data was recorded in a predesigned proforma and was analyzed and frequency, and percentages were calculated. Results: In the 3-year period, 75 obstetric patients required mechanical ventilation. Majority were between 20-35 years (88%) and were primipara (53.3%). Eighty percent were admitted in the antepartum period and most were in the gestational age of 30-36 weeks (41.3%). Hypertensive disorder is an important antepartum complication (29.3%). Postpartum hemorrhage was the important cause (45.3%) of ICU admission. About 49.3% required mechanical ventilation for <24 hours and multiorgan failure was the important complication encountered (13.3%). Conclusions: Providing optimal prenatal care and improving the management of hemorrhagic complications and hypertensive disease can improve the morbidity and mortality of critically ill obstetric patients requiring mechanical ventilation.

Aflatoxin Contamination in Agricultural Commodities.

Aflatoxin is a naturally occurring Mycotoxin produced by Aspergillus flavus and Aspergillus parasiticus. Aspergillus flavus is common and widespread in nature and is most often found when certain grains are grown under stressful conditions such as draught. The mold occurs in soil, decaying vegetation, hay and grains undergoing microbiological deterioration and invades all types of organic substrates whenever and wherever the conditions are favourable for its growth. Favourable conditions include high moisture content and high temperature.The aflatoxin group is comprised of aflatoxin B1,B2,G1 and G2. In addition , aflatoxin M1 (AFM1), a hydroxylated metabolite of AFB1, is excreted in the milk of dairy cows consuming an AFB1-contaminated ration. Aflatoxin B1 a prototype of the aflatoxins, is widely recognized as the most potent hepato carcinogenic compound and along with other certain members of the group, possess additional toxic properties including mutagenicity, tetrogenicity, acute cellular toxicity and it suppresses the immune system. Aflatoxin contamination of food and feed has gained global significance as a result of its deleterious effects on human as well as animal health. The marketability of food products is adversely affected by aflatoxin contamination.

Isolation and Quantification of Aflatoxin from Aspergillus flavus Infected Stored Peanuts.

Isolates of Aspergillus infected Peanuts were separately grown on modified Czapek’s medium at 280 C and the metabolites were tested for aflatoxin by HPLC. Naturally infected peanuts collected from trader’s godown were tested for aflatoxins. Aflatoxins are considered to be one of the most dangerous contaminants in food and feeds. Aflatoxins are a special group of naturally occurring metabolites produced by the fungi aflatoxins B1, B2, G1 and G2 which contaminate a variety of agricultural food and feed products .Naturally infected peanuts from Aspergillus flavus stored at trader’s godown, after several months’ storage, were found to be contaminated with aflatoxin B1.

Antimicrobial activity and Characterization of Marine bacteria.

Marine bacteria were isolated from seawater was collected from different coastal areas of the Tamilnadu Sea. The antimicrobial activities of these bacteria were investigated. Ethyl acetate extracts of marine bacterial fermentation were screened for antimicrobial activities using the method of agar diffusion. The results showed that 25 strains of the isolates have antimicrobial activity. The proportion of active bacteria associated with isolated from seawater. The active marine bacteria were assigned to the genera Alteromonas, Pseudomonas, Bacillus and Marinobacter. The TLC autobiographic overlay assay implied that the antimicrobial metabolites produced by four strains with wide antimicrobial spectrum were different. These marine bacteria were expected to be potential resources of natural antibiotic products. It can be concluded that isolation of Marine bacterial samples can offer a numbers of microbial strains for sources of new biomolecules from Marine sources.

Needle Stick Injuries among Junior Doctors.

Objective: To determine the prevalence of needle stick injuries (NSIs) among junior doctors of RIMS and to assess the measures undertaken by the respondents after the NSI. Methods: A cross sectional study was conducted in RIMS, Imphal, Manipur among internees, house officers and post graduate trainees from Sept to Oct 2011. Self-administered questionnaire was used to collect data. Descriptive statistics like mean, percentage and standard deviation were used. Analysis was done using Chi square test. And P-value of <0.05 was taken as significant. Results: Out of 382 eligible respondents, 289 participated in the study. Males were 70.2% (n=203). Prevalence of NSI among junior doctors within the last one year was 39.4% (N=114). Of the three designations, NSI was highest among the house officers. Most NSI took place while blood withdrawal (33.3%), suturing (27.3%), giving injections (16.6%) and recapping (14.9%). Majority of those doctors injured, 56.1% attributed NSI during rush hour. Around fifty-four percent of them were not wearing gloves during the NSI. Nearly forty-five percent of the doctors washed their injured part with water and soap and also applied antiseptic as immediate measures after NSI. Only 10 (8.8%) took Post Exposure Prophylaxis (PEP). Conclusion: Needle stick injuries among junior doctors are common and often not reported and majority of them did not take post exposure prophylaxis. These findings warranted the need for ongoing attention to strategies to reduce such injuries in a systematic way and to improve reporting system so that appropriate medical care can be delivered.

Diversity and utilization of tree species in Meitei homegardens of Barak Valley, Assam.

An inventory of tree diversity in traditional homegardens of Meitei community was conducted in a Bontarapur village in Cachar district of Barak Valley, Assam. Meitei homegarden locally called Ingkhol exhibits a wide diversity in size, shape, location and composition. Seventy one tree species were enumerated from 50 homegardens belonging to 60 genus and 35 families. Among the families encountered, Rutaceae was the dominant family (4 genus and 7 species) followed by Meliaceae (5 genus and 5 species), Arecaceae (4 genus and 4 species) and Moraceae (3 genus and 5 species). Total 7946 tree individuals were recorded, with the density of 831 No ha-1 of and total basal area of 9.54 m2 ha-1. Areca catechu was the dominant species with the maximum number of individuals. Other dominant trees include Mangifera indica, Artocarpus heterophyllus, Citrus grandis, Parkia timoriana, Syzygium cumini and Psidium guajava. Being a cash crop, the intensification of betel nut has been preferred in many homegardens. Homegardens form an important component of land use of Meitei community which fulfills the socio-cultural and economic needs of the family and helps in conserving plant diversity through utilization.

Dipterous haematophagous insects occurring in Dehradun district and its adjoining areas in Uttarakhand, India

Haematophagous dipterans belonging to 10 genera - Aedes (12), Anopheles (14), Armigeres (01), Culex (09), Toxorhynchites (01), Uranotaenia (01), Sergentomyia (02), Phlebotomus (01), Atylotus (01) and Tabanus (03) were encountered from 12 localities under 6 blocks of Dehradun district (Uttarakhand) during January 2011 to December 2012. The Culicines (50.69%) were more dominant than the Anophelines (38.9%), Toxorhynchites (1.72%), horse flies (6.63%) and sandflies (2.01%). The following species viz., Toxorhynchites splendens and Phlebotomus argentipes have been recorded for the first time while Aedes pseudotaeniatus as reappeared species from the study area. Species diversity is represented through Species richness (S), Shannon index (H) and Shannon Eveness (E) among Aedes, Anopheles, Culex, Sandfly and Horsefly. The species richness (S) and evenness (E) were found as 12, 0.65; 14, 0.84; 09, 0.74; 3, 0.61 and 4, 0.78 respectively by Aedes, Anopheles, Culex, Sandfly and Horsefly. Highest Shannon index was shared by Anopheles (2.214) followed by Culex (1.639), Aedes (1.631), Horsefly (1.085) and Sandfly (0.672) in succeeding order.

Medicinal Plants of Ultapani Forest Range Under Holtugaon Division, Manas Biosphere Reserve (Assam).

Ultapani is one of a “hotspot” area situated in Holtugaon forest division under Manas Biosphere Reserve, Assam. Ultapani forest range is located in between 26068.18// N to26081.18// N and 90024.44// E to 90041.90// E. Vegetation of the forest is unique in the world as most of its plants are evergreen and semi-evergreen. It consists of lots of floristically diverse plants, of which some of them are rare, endangered and threatened. Moreover, the forest of Ultapani forest range under Holtugaon division is rich for its valuable plant resources. Among these some plants have medicinal values, some are edible fruits, while, some of them are oil and timber yielding plants with great economic prospects. But the valuable asset of this forest is now threatened due to over exploitation of forest resources by forest mafias and encroachment for agricultural and human settlements by economically poor people in the forest lands living there in. Therefore, authors thought that the medicinal plants of the study area need to be surveyed, conserved and protected in their natural habitat. Considering this view point in mind, a survey has been carried out on certain naturally occurring medicinal plants of the study area. The present paper throws light on the description and uses of certain species of medicinally important plants along with their botanical and local names.

Persistence of Stunting After Highly Active Antiretroviral Therapy in HIV-Infected Children in South India.

After one year of antiretroviral treatment in 49 HIV-infected children compared to 53 children without, weight for age improved significantly and was highly correlated with baseline immune status and CD4% increase but height for age did not change. Stunting is a common feature of pediatric HIV, both on and off HAART.

Rapid progression of HIV infection in infancy.

Transmission of HIV from mother to child can occur in utero, during labor or after delivery via breast feeding. Data on the fate of babies born with HIV in India are scarce. We present details of 25 infants with perinatally acquired HIV infection (virologically confirmed) to highlight the observed high rate of morbidity and mortality within the first 18 months of life. Our findings of rapid disease progression among perinatally infected HIV positive children underline the importance of early diagnosis and treatment.

Reappraisal on anopheline mosquitoes of Garhwal region, Uttarakhand, India.

BACKGROUND & OBJECTIVES: The study examines occurrence of anopheline mosquitoes in seven districts--Dehradun, Pauri, New Tehri, Hardwar, Rudraprayag, Chamoli and Uttarkashi of Garhwal region in Uttarakhand state, India. METHODS: The methodological approach comprised sampling and processing of adult/immature mosquitoes, data compilation, meteorological information and parasitological survey. RESULTS: A total of 87 localities covering 24 tehsils/blocks were surveyed during January 2000 to December 2005 for mosquito sampling. The study encountered 18 species of anophelines including three malaria vectors namely Anopheles culicifacies, An. fluviatilis and An. stephensi collected from Kalsi, Dehradun City, Sahaspur, Hardwar town, Roorkee, New Tehri town and Kotdwar localities. An. pallidus has been recorded for the first time from the Garhwal region. All the collected species have been presented with particular reference to their both adult and immature distribution, brief account of bionomics and some ecological notes. INTERPRETATION & CONCLUSION: Out of 18 collected anopheline species, 15 were non-vectors and they were found to create nuisance to the inhabitants. As far as the species distribution was concerned the diversity was more at elevation between 150 and 1000 m above the mean sea level, while the immature of some species were not recovered from those localities where their adults were collected. Certain species of Anopheles were climate determined and their distribution was localized while some others were cosmopolitan.

Recurrent herpes zoster in early childhood.

Herpes Zoster is produced by reactivation of latent Varicella Zoster Virus from the dorsal root ganglion of sensory nerves. It is common in older individuals and rarely described in the pediatric age group. We report a case of recurrent herpes zoster in a 3-year-old HIV positive child involving T4 dermatome on the first occasion and subsequently involving T10 dermatome. The child responded well to oral acyclovir.

Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections.

PURPOSE: To assess the knowledge, attitudes and practices among the different health care workers (HCWs) on nosocomial infections. METHODS: A total of 150 HCWs, doctors (n=50), nurses (n=50) and ward aides (n=50) were included. A questionnaire was administered to the HCWs to assess their knowledge, attitudes and practices on nosocomial infections. A scoring system was devised to grade those (KAP score). They were further subjected to a series of similar questionnaires at intervals of 6, 12 and 24 months after an education module. Subjects in each category of staff (n=10) were observed for compliance to hand washing practices in the ward in the post-education period. Statistical analysis was done using statistical software. RESULTS: The study showed an increase in the number of subjects in each category scoring good and excellent in the post-education questionnaire; however this declined with the progress of time. It was observed that the compliance level to hand washing practices differed among the different HCWs. Total compliance was 63.3% and ward aides were most compliant 76.7% (adjusted Wald 95% CI= 58.80-88.48). CONCLUSIONS: Education has a positive impact on retention of knowledge, attitudes and practices in all the categories of staff. There is a need to develop a system of continuous education for all the categories of staff. In order to reduce the incidence of nosocomial infections, compliance with interventions are mandatory.