Technology and Medical Care in India: Growth of Telehealth Awareness during the COVID-19 Pandemic

Background: COVID-19 pandemic has highlighted the importance of telemedicine in health care delivery worldwide. However, the true success of telemedicine depends on patients’ acceptance, which in turn is decided by their interest in telemedicine. In this study, we aim to assess the population interest in telemedicine services across India during the COVID-19 pandemic. Methods: We measured national-level public interest in “telemedicine” using terms related to telemedicine in Google Trends during the years 2019 and 2020. The relationship between population search volume for telemedicine (composite score) and the number of COVID-19 cases during the early phase of COVID-19 was analyzed. The literacy rate and relative interest in telemedicine in the states were analyzed to assess the impact of education on telemedicine interest. Results: The interest in telemedicine in the year 2020 is higher compared to the year 2019 (U = 269.5, z = –7.043, p<0.001). The search trends for telemedicine increased consistently during the early phase of the COVID-19 pandemic. The greatest search volume was seen in Andhra Pradesh. There was a strong correlation (r = 0.65, p < 0.001) between the initial increase in the number of COVID-19 cases and population-level interest in telemedicine over time. The relative interest in telemedicine for the year 2019 showed a significant direct relationship with the literacy rate (r = 0.47, p = 0.04). However, the relative interest in telemedicine for the year 2020 showed no relationship with the state’s literacy rate signifying the spread of telemedicine across literacy barriers. Conclusion: Population interest in telemedicine was higher in the year 2020 compared to the previous year and remained high even after the easing of lockdown. The COVID-19 pandemic has played an important role in increasing the Indian public’s interest in telemedicine.

Clinical Study of Failures in Periodontal Therapy

The goal of periodontal therapy is to restore and maintain the health and function of the periodontium and natural dentition for a lifetime. This therapy has evolved over many years to include nonsurgical phase of therapy and subsequent surgical treatment followed by periodic maintenance therapy. The main objective is to study the failures in periodontal therapy. Methods: It is a hospital based study. It was conducted at Dental department of LTBRKM Gov. Medical College; Jagdalpur Chattissgarh.The study was carried out for a period of 6 months from June to Nov 2017. Total number of cases included in this study was 30. Permission from Institutional Ethics Committee was obtained. From each and every patient included in the study, initially informed individual consent was taken. Results: 6.7% cases were seen in 30 – 35 years of age group, 16.6% of cases were seen in 36 – 40 years of age group, 26.6% of cases were seen in 41 – 50 years of age group and 50% of cases were seen in 46 – 50 years of age group. Only 2 cases were failed in periodontal therapy due to age of the patient,3 cases were of poor maintenance, 5 cases are due to systemic diseases, 10 cases were due to smoking habit,1 case of poor healing potential,8 cases of local factors like plaque and only one case of psychological component. Conclusion: Careful attention to a few important points can improve the success rate of periodontal therapy. Periodontal health is achieved with a combination of treatment and regular periodontal maintenance care.

Evaluation of analgesic and anti-inflammatory activity of Levocetirizine in albino rats

Background: Levocetirizine, the R-enantiomer of Cetirizine has pharmacokinetically and pharmacodynamically favourable characteristics, with rapid onset of action, high bioavailability, high affinity for and occupancy of the H1-receptor, limited distribution, minimal hepatic metabolism together with minimal side effects. Non-steroidal anti-inflammatory drugs (NSAIDs) have been used for many years for analgesic, anti-inflammatory, and more recently in the case of aspirin, antithrombotic purposes. Because of the significant side effect profiles of steroidal and NSAID medications, there is a greater interest in newer compounds such as antihistaminic drugs. This article will consider the potential or otherwise of the reported analgesic and anti-inflammatory effects of levocetirizine to enhance its effectiveness in the treatment of allergic disease with pain.Methods: Albino Wistar rats of either sex weighing 150-250 grams were used. For both Analgesic activity and Anti-inflammatory activity, 4 groups consisting of 6 animals per group were used. Group I: Control: 1% Gum acacia. 2ml/kg, Group II: Standard drug: Diclofenac sodium 4.5mg/kg; Group III: Test Drug 1: Levocetirizine 1mg/kg; Group IV: Test Drugs 2: Levocetirizine 1mg/kg+Diclofenac sodium 4.5mg/kg. Drugs were administered orally. For analgesic activity, Tail clip method and Hot plate method was used. For acute anti-inflammatory activity Carrageenan induced rat paw oedema method was used.Results: Levocetirizine, is found to have significant analgesic activity in rats (1 mg/kg dose) alone and in combination with Diclofenac Sodium in Haffner’s Tail Clip method and Eddy’s Hot Plate Method. Levocetirizine also has got prominent anti-inflammatory activity in acute models evidenced by percentage inhibition of acute rat paw oedema.Conclusions: Levocetirizine possess analgesic and acute anti-inflammatory activity alone and in combination with Diclofenac sodium.

Study of drug utilization pattern and adverse drug reactions of psychotropic drugs in psychiatric inpatient department of tertiary care hospital

Background: Mental disorders are now widely recognized as a major contributor to the global burden of disease. The drug use in psychiatric illness is a complex process and because of this the optimal benefits of drug therapy in patient care is not achieved. This often leads to increased cost of medical care, drug resistance, adverse effects and patient mortality. Hence, this study is undertaken to study the drug utilization pattern and adverse drug reactions of psychotropic drugs in psychiatric inpatient department of a tertiary care hospital.Methods: A prospective, observational study was undertaken from 1st February 2015 to 31st July 2016. A total of 250 prescriptions were analysed. Defined daily dose of the drugs were calculated. ADR’s were recorded in the format of the National Pharmacovigilance Programme of India (PvPI).Results: In 250 prescriptions most, common drug prescribed was antipsychotics (48.5%). Total drug utilization in terms of DDD/100 bed days was 669. The total number of adverse drug reactions observed was 8%. Antipsychotics were the most common class of psychotropic drugs causing ADR’s.Conclusions: In conclusion, it has been found that the psychotropic drugs used in our psychiatry department was rational and was based on clinical knowledge, expertise and the guidelines available in the field of psychiatric practice.

Study of evaluation of anti-inflammatory activity of macrolide antibiotics in rats: an experimental study.

Background: Inflammation is a complex and dynamic condition in which many changes take place at the site of inflammation, as well as systemically. In general, inflammatory response acts to protect the host, but many times it goes unchecked with tissue destruction leading to a spectrum of inflammatory disorders. Antiinflammatory drugs have long been used to treat spectrum of inflammatory conditions. Anti-inflammatory agents, in use today, though have efficacy, cause a variety of side effects causing major problems during their clinical use. Amongst newer approaches to treat inflammation, macrolides, the anti-bacterial agents, seem to be beneficial in decreasing the inflammation. Still there is much speculation about the antiinflammatory activity of macrolide antibiotics. So, we planned this study to assess anti-inflammatory activity of macrolide antibiotics (erythromycin, roxithromycin, azithromycin, and clarithromycin) and to compare their anti-inflammatory activity with control and indomethacin (standard non-steroidal anti-inflammatory drugs). Methods: To assess anti-inflammatory activity of macrolides, we used acute (carrageenin-induced paw edema and turpentine oil-induced arthritis), as well as chronic model of inflammation (cotton pellet induced granuloma). Results: All the macrolides, i.e., erythromycin, roxithromycin, azithromycin and clarithromycin showed significant (p<0.05) anti-inflammatory activity in acute models of inflammation as compared to control group. However, macrolides showed insignificant activity as compared to indomethacin (acute and chronic models of inflammation) and as compared to control (chronic model of inflammation). Conclusions: This study shows macrolide antibiotics have anti-inflammatory activity in animal models of acute inflammation.

Evaluation of antidepressant activity of tramadol in mice: an experimental study.

Background: In spite of availability of effective antidepressant drugs, depression continues to be a major problem. Hence, great interest is being taken in development of innovative antidepressants. Tramadol (TRM) is a centrally acting opioid agonist, which is clinically effective in the treatment of moderate to severe pain. By virtue of its action of inhibiting norepinephrine and serotonin uptake, it can function as an antidepressant like venlafaxine. Hence, this study was planned to evaluate antidepressant activity of TRM in comparison and in combination with fluoxetine (FLX) in albino mice. Methods: TRM (20 and 40 mg) and FLX (20 mg) were administered i.p., alone and in combination once daily for acute (7 days) and chronic (14 days) period to Swiss albino mice of either sex. The immobility period of control and treated mice was recorded in forced swimming test (FST) and tail suspension test (TST). The open field test was also done for same period to test the locomotor activity in animal. The antidepressant effect of TRM was compared with FLX and normal saline treated group for acute and chronic study period. Results: TRM (20 and 40 mg) treated group produced significant antidepressant effect alone and in combination with FLX (20 and 40 mg) as indicated by reduction in immobility period compared with control group in FST and TST. TRM and FLX treated groups did not show significant activity in open field test when compared with control group. Conclusions: This study shows TRM has antidepressant activity in standard models of depression.

Timely use of anti-snake venom improves maternal and fetal outcome: a case report.

Snake bite is a common medical emergency and an occupational hazard in a rural population of India. Though it is uncommon in pregnancy, it is associated with poor maternal and fetal outcome. Early gestational age and delay in the treatment are the factors responsible for unfavorable prognosis. Here, we report a case of primigravida, aged 22 years, with 22 weeks of gestation presenting with a history of snake bite on the left frontal region of the face. While on anti-snake venom treatment, patient developed anaphylactic reaction. In spite of this, the maternal and the fetal outcome were good in this case.

A study on the clinico-epidemiological profile and the outcome of snake bite cases in the tertiary care hospital.

Background: Snake bite is a common medical emergency and an occupational hazard in India. It is also a major public health issue in rural India where farming is a major source of employment. Very few studies describe epidemiology of snake bite from India. Hence, this study was planned to collect information on various aspects of snake bite in a tertiary care hospital. Methods: A prospective observational study of 167 patients of snake bite and unknown bite carried out from September 1, 2012 to August 31, 2013. Results: Among a total 167 cases, majority were males (54.49%), aged between 20 and 40 years (38.92%). Most of the cases were laborers (61.67%) and farmers (17.36%). Peak incidence was observed during monsoon (64.67%). Bite mark was seen in 46.70% cases, upper extremity being common site (52.09%). Most cases were of vasculotoxic bite (65.26%) and few were of neurotoxic bite (19.76%). Major complications were respiratory failure (4.79%) and acute renal failure (1.8%). Average bite to needle time was 365 min. Bleeding & clotting time was raised in 44.03% & 35.19% cases, respectively. Average dose of anti-snake venom (ASV) required was 17.1 vials. Allergic reactions to ASV observed in 8.38% cases. Mean duration of hospital stay was 4.3 days. Recovery rate was 94.01% with three cases referred to higher center. Mortality rate was 2.39%. Conclusions: Our study highlights various aspect of snake bite cases and tries to fi nd out ways to improve quality of life of patients, decrease mortality and morbidity and decrease economic burden on society.

Effect of Lagenaria siceraria fruit extract (Bottle gourd) on hepatotoxicity induced by antitubercular drugs in albino rats.

Background: Anti TB drug induced hepatotoxicity has higher incidence in Indian population [11.5%] than western population [4.5%]. Antitubercular drug induced hepatotoxicity is mediated through oxidative and free radical damage to hepatocytes. Lagenaria siceraria [Bottle Gourd] is reported to have antioxidant and hepatoprotective activity. Hence in the present study we tested hepatoprotective and antioxidant activity of fruit extract of L. Siceraria in anti tubercular drug induced hepatotoxicity. Methods: We administered antitubercular drugs alone and in combination with fruit extract of Lagenaria siceraria (EELS 100mg/kg and EELS 200mg/kg) in healthy albino rats by oral route for 15 days. On 16th day blood collection for biochemical analysis is done by cardiac puncture. Biochemical markers used are serum transaminases (SGPT/SGOT), serum alkaline phosphatase [ALP], total bilirubin, total protein, superoxide dismutase [SOD] and malondialdehyde [MDA]. Liver is dissected for histopathological examinations. Results: Groups that received EELS [100 mg/kg & 200 mg/kg], in combination with anti tubercular drugs, showed significant reduction [p value <0.001] in biochemical parameters for hepatotoxicity [SGOT, SGPT, ALP, Total bilirubin, Total protein] in comparison with group that received anti tubercular drugs alone. Combined treatment of EELS [100 mg/kg & 200 mg/kg] & Anti tubercular drugs showed significant reduction in oxidative stress [SOD & MDA, p<0.001] as compared to anti tubercular drug alone. Histopathological examination of liver showed grade I & grade 0 changes in combination group while grade IV changes in group receiving anti tubercular drugs alone. Conclusion: Ethanolic extract of Lagenaria siceraria fruit possesses significant hepatoprotective and antioxidant activity in antitubercular drugs induced hepatotoxicity.

Socio demographic profile of oral cancer patients residing in Tamil Nadu - A hospital based study.

Introduction: In developing countries, a high proportion of patients with oral cancer are from lower socioeconomic classes. This high proportion is clearly associated with difficulties in accessing the health care system. Hence, the aim of this study is to assess the socio-demographic profile of oral cancer patients at Tamil Nadu, India. Objective: To determine the socio-demographic profile of study subjects. Materials and Methods: This study was a cross sectional study done at a cancer hospital in Chennai. The study population were subjects with oral cancer who reported for treatment. A pretested interviewer administered questionnaire was used to assess the socioeconomic status of oral cancer patients. Pareek's scale of classification was used for rural population and Kuppuswamy's classification was used in urban population to assess the socioeconomic status. Results: A total of 266 oral cancer patients aged 21-60 years and above comprised the study population. Most of the study subjects belonged to the lower socio economic classes. About 48.5% of rural subjects had agriculture as a source of occupation and 28.6% of urban subjects were unskilled labourers. In both rural and urban subjects, majority, 94.9% and 71.9% had family income below Rs 5000. The percentage of illiterates was high in both rural and urban class (i.e.) 55.8% and 21.9% respectively. The difference in the prevalence of oral cancer among different levels of literacy and occupation was found to be significant statistically. Conclusion: Identifying occupation, income and education specific disparities in tobacco use can provide a useful "signspot" indicating inequalities that need to be addressed by policy makers and broader community through allocation of resources.

Profile of EBV- Associated Infectious Mononucleosis.

During a 5 year period, 33 children (22 males) were diagnosed to have infectious mononucleosis (M:F::2:1; age 9 mo-15 y). The common clinical features observed were fever (100%), lymphadenopathy (84%) hepatosplenomegaly (81%), tonsillar enlargement (45%), neck swelling (30%), upper respiratory symptoms (21%), epitrochlear node enlargement (20%), vomiting and diarrhea (1%). Ten children had complications; upper airway obstruction and hemophagocytic lymphohistocytosis occurred in four each and septic shock in two. EBV associated infectious mononucleosis in hospitalized children was found to affect mainly preschool children and had a favorable prognosis.

Solitary Rectal Ulcer Syndrome: A Case Series.

A retrospective analysis of the clinical profile, endoscopic features and management of 22 children (age 18 months – 18 years) diagnosed as solitary rectal ulcer syndrome is presented. The majority (81.8%) were ≥8 years of age. Rectal bleeding was the presenting feature in all the children. Mucorrhea, constipation, tenesmus and rectal prolapse were observed in 77.3%, 63.6%, 59% and 13.6% children, respectively. Colonoscopy showed classical single rectal ulcer in 68.2% and multiple ulcers in 22.7%. Polypoidal and erosive lesions were documented in 4.5% each. The medical management comprised of bowel training and high fibre diet for all children. The other modalities included oral 5-amino salicylate (59%), sucralfate enema (4.5%) and rectal mesalamine in 9%. 64% children recovered and 13.6 % had recurrence of symptoms.

Correlation of renal length with somatic variables in indian children.

Mean kidney length in 230 Indian children without apparent renal disease were examined sonographically and correlated with, age, body weight, length / height, upper thigh (femur) length, head circumference and chest circumference. Mean kidney is length best correlated with height, followed by upper thigh (femur) length and chest circumference.

Chronic abdominal pain in children.

Chronic abdominal pain (CAP) continues to be a diagnostic and therapeutic challenge. It affects about 10% of school-going children and adolescents. Few Indian studies have reported an organic cause in 30%–40% of children with recurrent abdominal pain. In developing countries, parasitic infestations such as giardiasis and ascariasis are an important cause of recurrent abdominal pain but their frequency has decreased over time. There is a paucity of data from India on the aetiology, epidemiology and management strategies for CAP, and there is no consensus on the clinical approach to this problem. We present a practical approach to CAP in children. The first step is to elicit a detailed history and do a thorough physical examination so as to categorize CAP according to the site of pain (epigastric, periumbilical or left lower quadrant), the predominant symptom associated with pain (dyspepsia, isolated pain or altered bowel habits) and to differentiate the pain as organic or functional based on the characteristics of pain and presence or absence of alarm signs. The second step is to do appropriate investigations, restricted to simple tests when functional pain is suspected (Level I) and more investigations (Level Ia) if there are alarm signs and pain appears to be organic in nature. Invasive investigations such as gastrointestinal endoscopy (Level II) may be reserved for those with possible organic pain. Level III investigations need to be done in a small percentage of children and include EEG, workup for food allergy and porphyria. The third step is management of organic CAP according to the aetiology, while for functional CAP the pharmacological and, rarely, psychological intervention is more difficult but should be done discreetly and tailored to the needs of the child.

Primary intestinal lymphangiectasia.

Primary intestinal lymphangiectasia (PIL) is a rare disease of intestinal lymphatics presenting with hypoproteinemia, bilateral lower limb edema, ascites, and protein losing enteropathy . We report a series of 4 children from Chennai, India presenting with anasarca, recurrent diarrhea, hypoproteinemia and confirmatory features of PIL on endoscopy and histopathology.

Recurrent kawasaki disease.

We describe an infant who had recurrence of Kawasaki disease and responded to therapy with Intravenous Immune globulin (IVIG) and highlight the need for recognition of this vasculitis, which is being increasingly recognised in the Indian subcontinent.