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Background & objectives: Scrub typhus or chigger borne typhus, caused by Orientia tsutsugamushi is an emerging vector-borne disease as large numbers of cases have been reported in various tropical countries. It is transmitted to humans through bites of infected chiggers (larval mites). The knowledge about the vector, its distribution, density and habitat are important so as to understand the epidemiology of scrub typhus in a given area. To control rickettsial infections, regular rodent-vector surveillance should be planned in areas where the disease transmission is occurring and it will also help to strengthen the existing entomological data related to the vector of scrub typhus in northern India. Methods: In the present study, rodent-vector surveillance was planned for one whole year, covering both mite active and non-active seasons (October 2019–December 2020) in selected areas of Chandigarh and Punjab in north India. Rodent tissues and mites were also examined for the presence of O. tsutsugamushi by nested PCR for 56 kDa gene and real-time PCR for 47 kDa outer membrane protein gene. 18S gene PCR was performed for molecular identification of mites. Results: In the surveillance, three types of ectoparasite, viz. mites, fleas and ticks were obtained in rodents. All mites found were of Laelapidae family. None of the pooled rodent tissue samples as well as mite samples were found positive for O. tsutsugamushi by nested PCR for rickettsial DNA. Interpretation & conclusion: In the present study, we did not get any evidence of carriage of O. tsutsugamushi in either mites or rodents collected and sampled in selected regions in Chandigarh and Punjab. We need to strengthen the entomological surveillance over a broader region and increase the frequency of trapping rodents to increase clarity on vector-reservoir dynamics in this geographical region.
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Twin to twin transfusion syndrome is a rare but serious complication of monochorionic twin pregnancy. It is characterized by the development of abnormal placental vascular communication from one foetus (donor) to the other foetus (recipient). If left untreated it led to high rates of perinatal morbidity and mortality due to its poorly understood etiology and difficulty in diagnosing and treatment. Authors report a case of twin to twin transfusion syndrome in 24 years old primigravida with gestational age of 18 weeks 5 days diagnosed on ultrasound.
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Background: Following Myocardial Infarction some proteins and enzymes, CPK-MB/ Troponin-I, T, are released into the blood from the necrotic heart muscle. Serum Uric Acid (SUA) may be a risk factor and negative prognostic marker for cardiovascular diseases. Aim of the study was to study serum uric acid levels in patients of acute Myocardial infarction with congestive heart failure, its relation with stages of congestive heart failure as per Killip classification and the role of serum uric acid levels as a marker of mortality.Methods: The case control study was conducted on 120 patients divided into two groups. Group A included 60 patients of acute Myocardial infarction. Group A was further divided into two categories. One includes 30 patients of with congestive heart failure and another includes 30 patients without congestive heart failure. Group B consists of 60 control patients. Serum uric acid levels were measured in Group A on 1st, 3rd and 7th day of hospital admission and in Group B on 1st day.Results: The study showed females have higher degree of hyperuricemia than males. SUA was significantly higher in patients of acute myocardial infarction than control group patients. SUA were also higher in patients with history of IHD, in patients with BNP >100 and it correlates with Killip class and mortality rates. Patients of acute myocardial infarction with diabetes mellitus had higher degree of hyperuricemia than nondiabetic and control group. No significant difference in SUA levels were observed with regard to age, alcohol intake, lipid profile, ejection fraction and hypertension.Conclusions: In acute myocardial infarction, patients with hyperuricemia had higher mortality and may be considered as poor prognostic biomarker.
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Background: Access to safe water and sanitation practices is an important issue of health and development at local, regional and national levels. The government has come up with various facilities regarding the water supply and sanitation but there are various factors which curtail their utilization. The present study deals with the extent of utilization and factors impeding the utilization of such services at the village level.Methods: The present impeding cross-sectional study was carried out in village Nagkalan, Amritsar, where the eldest adult member present in the house at the time of the visit was interviewed. Every house of the village was visited during the period of January 2017 to December 2017, and a total of 1123 families were included in the final analysis. Thereafter, data was compiled and analyzed.Results: Out of total 1123 families, only 31.4% were using government water supply (tap water); while 42.7% had no government connection at all and used submersible as their sole source of water supply. 20.2% did not have a toilet at their house and therefore practiced open defecation; out of which majority families belonged to lower socio-economic status (statistically significant). Out of total 896 families having a toilet at their house, there were only 30 families (3.4%) who responded that some of the family members practice open defecation. Also, only 6.1% of the respondents were aware about the functions of Village Health Sanitation and Nutrition Committee (VHSNC).Conclusions: More number of families (42.7%) were dependent on submersible pump as sole source of water supply. 20.2% lacked separate toilet facility, mostly belonging to lower socio- economic status. Only 6.1% were aware regarding the VHSNC. All the families disposed of their household waste on the roads.
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Background: Thalassemia is a chronic debilitating disease that affects nearly 200 million people worldwide. A caregiver who has good knowledge regarding the disease can not only provide a better quality of care to his/her ward but also may spread knowledge in the society in which he/she lives which helps immensely in raising community awareness related to the disease.Methods: 50 caregivers (either mother or father) of chronically transfused thalassemic children were questioned regarding their knowledge, attitude and practice towards this disease, using a self-constructed questionnaire.Results: It was found that despite adequate knowledge regarding every aspect of this disease, there is a lack of attitude of practice towards prevention of this disease in their subsequent child or in their near and dear ones.Conclusions: There is a need to promote an attitude of practice in prevention of the birth of thalassemic children as mere knowledge regarding the disease is not enough in the present scenario where the disease burden is increasing as is the financial and emotional burden on the families. Role of Government sponsorship, a social worker and a child psychologist in the Thalassemia day care unit cannot be minimized.
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Background: Low level of education of the slum dwellers along-with poor socio- economic status and pathetic environmental conditions lead to their poor health indicators. Since the National Urban Health Mission (NUHM) was launched in 2013, the health services are still in their initial stages. Assessment of the availability as well as the utilization of health care services of the urban slums is the need of the hour.Methods: The cross-sectional study was conducted in randomly selected slum in Amritsar city. All the houses were enumerated and visited by the interviewer herself. The eldest adult member of the family was selected as key respondent and written, informed consent was obtained. Predesigned questionnaire was used to collect the data which was then compiled and analyzed using statistical tests.Results: Out of the total respondents, one third respondents had knowledge about the government health center nearby (statistically significant) while out of these, only one third utilized the services at the center (statistically non-significant). Almost half of the respondents had knowledge about the medical camps and out of these, two-thirds utilized the services at medical camps.Conclusions: Overall utilization of services is poor. More respondents were aware of the medical camps than the static government health facility and utilization of medical camps was also more. So the static health services under NUHM need to be further strengthened.
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Background: Slums are not new phenomenon. They are characterized by insanitary condition, crime, drug abuse etc. The male youth living in the slums, are prone to various health impacting conditions including substance use like alcohol consumption, smoking, tobacco chewing, drugs etc.Methods: Cross-sectional study was conducted in the four selected urban slums of Amritsar city. From each slum 250 male youth aged 15-24 years were included in the study, so total 1000 respondents were interviewed and required information was filled in pre-designed semi-structured proforma. Data was compiled, analysed and valid conclusions were drawn.Results: The overall prevalence of substance use among the respondents was 25.9% and as the age increases the prevalence of substance use also increases. Among substance users, tobacco (86.8%) was the most common substance consumed both in smoking form (52.1%) and smokeless form (34.7%), followed by the alcohol (72.2%) and then drugs (12%). Majority (62.1%) of respondents had initiated the substance use between 15-19 years of age. Factors like illiteracy, migration, joint family, married status and increased mental stress were significantly associated with substance use, however no association was found with socio economic status of the respondents.Conclusions: Government should take robust steps to improve the awareness and education status of the youth living in the slums. As the younger ages are most vulnerable ones, health education, IEC and BCC activities regarding the harmful effects of substance use along with life skills should be incorporated into the school curriculum.
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Background: Diabetes has become global issue due to premature illness and death due to its complications. Awareness about good health seeking practices are essential for prevention, early detection and management of diabetic complications. Objective of the study was to evaluate the health seeking practices among diabetics (>10 years of duration) in the field practice areas of Government Medical College, Amritsar.Methods: A community based cross-sectional study was conducted in rural and urban areas of district, Amritsar. A total of 200 diabetic patients who had diabetes equal to or more than 10 years of duration were interviewed using pretested and predesigned questionnaire. Data such collected was analysed at p<0.05.Results: Out of total 200 diabetic respondents, 50% (100) were from urban and 50% (100) were from the rural area. In both urban and rural areas, majority were literate i.e. 80% (161) and employed i.e. 51% (103). The mean age of diabetic respondents was 58.05 years with a male to female ratio of 1.1:1. The majority 82% (165) were diagnosed in the private sector and 99% (198) were on allopathic treatment. Oral hypoglycaemic agents were used by 77% (153) patients to manage their disease. 23% (45) were using both oral hypoglycaemic agents and insulin. About 48% (96) were monitoring their RBS regularly, 76% (151) were on regular treatment for diabetes and 55 (27%) were doing physical activity.Conclusions: Poor health seeking practices and less awareness about non pharmacological measures are main factors for development of complications among diabetics.
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Background: Health care expenses induced impoverishment in the poverty stricken strata of rural India is a major issue. The government of India has come up with various services in public health facilities, but there are various factors which curtail the utilization of available services and people have to visit some private health facility. The present study deals with the extent of utilization of services of government health facility and the factors impeding the utilization.Methods: The present cross sectional study was conducted in village Nagkalan, district Amritsar, where the eldest adult members present in the house at the time of the visit, and are interviewed using a semi-structured and predesigned questionnaire. A total of 1123 families were included in the final analysis. Data was compiled, analysed and valid conclusions drawn.Results: Almost all the respondents were aware about the existence of subsidiary health centre in the village. However, out of those who were aware, 40.8% never visited the centre. Utilization was more in the lower socio economic status. Immunization services followed by treatment for common ailments constituted the top two reasons for visiting the centre. Out of those visiting the centre, 80.7% were not satisfied with the current timings of the centre; only 20.2% were attended by the doctor and 33.3% reported that the prescribed medicines were never available at the centre.Conclusions: Regular supply of prescribed medicines, availability of the doctor and appropriate timings are critical for utilization of health care services at the government health facility.
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Background: Slums are most vulnerable and deprived areas within a city. The unhygienic and polluted environment, overcrowding, poor housing and absence of educational exposure affect youth in slums. Consequently, their health is affected adversely.Methods: This cross-sectional study was conducted in four slums, one each from four different directions (north, south, east and west) of Amritsar city. A total of 1000 respondents, 250 from each slum were interviewed by using pre-tested semi-structured questionnaire. Data was compiled and statistically analysed.Results: Out of total study population, 41.2% of the families had migrated from other states, Overcrowding was present in majority (92%) of the families, 20% of the respondents didn’t have latrine facility at their home, 44.4% respondents throw their garbage waste in the open space nearby their dwellings and 45% of population was not satisfied with the cleanliness of their slum, 54.6% of the respondents reported to have some kind of health problem during last three months. Educational status, socio-economic status and overcrowding were significant factors affecting their health.Conclusions: Important factor in causation of disease were found to be poor socio-economic status, lack of education and overcrowding. There is a strong need to intensify the IEC/BCC activities to raise the awareness about the health-related issues.
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Surgical Site Infections (SSIs) are the second most commonly reported nosocomial infections after Urinary tract infection following a delivery by caesarean section. They add significantly to the morbidity, mortality and socioeconomic consequences in both patients as well as health care systems. Aim: To study the microbial etiology and antibiogram of post caesarean SSIs. Methods: This prospective study was conducted on pregnant women undergoing elective/emergency caesarean section irrespective of the indication during a study period from Jan 2017 to June 2018. 250 pregnant women undergoing LSCS developing signs and symptoms suggestive of SSI till the 30th post-operative day were included as cases. Under all aseptic precautions, two pus swabs were collected from every post caesarean women enrolled in the study. The first swab was used for gram staining while the other was inoculated on 5% blood agar and Macconkey agar. The isolates were identified by their colony characters and their standard biochemical tests. Antimicrobial susceptibility pattern was performed on Mueller Hinton agar plates by Kirby Bauer disc diffusion methods and interpreted as per latest CLSI guidelines. Results: Among 250 cases suspected of having SSIs, 93 aerobic isolates were obtained. Staphylococcus aureus (41.9%) was the most common organism isolated followed by Acinetobacter baumanii (15.1%), Escherichia coli(11.8%) Klebsiella pneumoniae(9.7%). 15/39(38.4%) of Staphylococcus aureus were observed to be Methicillin resistant. 15/45 (33.3%) of Gram negative isolates were Extended Spectrum Beta- Lactamase producers. Conclusion: Since MRSA is the leading cause of post caesarean SSI and the incidence of multidrug resistant pathogens as a cause of post-operative wound infections is rising with the increased prevalence of ESBL, therefore rational and judicious use of antimicrobials, active surveillance and reporting of SSI, enforcement of aseptic measures, implementation of infection control strategies and their periodic review is the need of an hour to reduce the rate of post caesarean SSIs.
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Background: Painful diabetic neuropathy is a common complication of long standing diabetes mellitus. Amitriptyline is commonly used to treat painful diabetic neuropathy. Pregabalin has been shown to be effective in the treatment of painful diabetic neuropathy with lesser adverse effects. Sustained release (SR) of pregabalin has the advantage of once daily dosing and a better patient compliance. Hence, this study was planned to compare the efficacy and safety of pregabalin-SR with amitriptyline in painful diabetic neuropathy.Methods: It is a prospective, open labelled, randomized controlled study. A total of 80 patients diagnosed with painful diabetic neuropathy based on Diabetic neuropathy symptom score and Michigan neuropathy screening instrument, were randomized into two groups to receive amitriptyline and pregabalin SR. Amitriptyline was started at 25mg OD and pregabalin SR 75mg OD for 6 weeks with optional dose titration. Patients were assessed for pain relief by using visual analogue scale and an overall improvement in their general condition by patient’s global impression of change scale. Adverse drug reactions were recorded on each follow up.Results: All patients had significant improvement in pain relief in both the treatment groups. The median VAS (visual analogue scale) score was slightly higher in pregabalin SR group (25 vs 22) however it was not statistically significant. Intergroup comparison did not show any significant differences between the treatment groups. Good and moderate pain relief were noted in 37(92.5%) and 3(7.5%) patients on amitriptyline and 36 (90%) and 4 (10%) patients on pregabalin SR respectively. The common adverse effects reported in amitriptyline group were drowsiness (27.5%) and dry mouth (17.5%) and in pregabalin-SR group were drowsiness (15%) and dizziness (5%). No serious adverse event was reported in either of the groups.Conclusions: In patients with painful diabetic neuropathy both amitriptyline and pregabalin-SR are equally effective in alleviating pain and improving the patient’s general condition, but pregabalin-SR has the advantage of fewer adverse effects and convenient dosage timing.
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Background: There are limitations of currently recommended stepwise treatment for Type 2 diabetes, especially failure with monotherapies to achieve the strict glycemic control. This has prompted the intensification of therapy with such combinations which have additive efficacy and complimentary mechanisms of action. Vildagliptin is one such agent with the above potential which does not increase the risk of hypoglycemia and does not promote weight gain. Methods: It was a prospective, open-label, randomized, and parallel group study involving 90 patients, divided into three Groups A, B, and C. Group A given vildagliptin/metformin (50/500 mg), Group B vildagliptin/pioglitazone (50/15 mg)and Group C metformin/pioglitazone (500/15 mg) combinations twice daily for 12 weeks. Fasting blood glucose (FBG) was estimated biweekly while hemoglobin A1c (HbA1c), lipid profile, insulin, and C-peptide levels at 0 and 12th week. Statistical analysis was done using ANOVA and Student’s t-test. Results: At the end, mean percentage of age fall in HbA1c and FBG from baseline was maximum in Group B, which was found out to be more efficacious than Group A and C (p<0.001) on glycemic parameters. Mean percentage of age decrease in triglyceride from baseline was maximum in Group C, which was found out to be more efficacious than Group A and B (p<0.001) on lipid parameters. The adverse effects were low in all the groups. However, the incidence of peripheral edema and weight gain was more with the use of Group C while nausea, vomiting, and nasopharyngitis was more with the use of Group A. Conclusion: Vildagliptin/pioglitazone combination is of choice in patients with uncontrolled hyperglycemia but normal lipid profile while metformin/pioglitazone combination in diabetic patients with dyslipidemia.
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Background: The objective was to study quality-of-life in patients of acne vulgaris before and after treatment by benzoyl peroxide 2.5% gel and clindamycin 1% gel or benzoyl peroxide 2.5% gel and nadifloxacin 1% cream or tretinoin 0.025% and clindamycin 1% gel. Methods: This was a prospective, open, randomized, parallel comparative study of 60 patients of acne vulgaris attending the Department of Dermatology and Venereal Diseases, Government Medical College, Rajindra Hospital, Patiala. Three groups were made 20 in each group, one group received benzoyl peroxide 2.5% gel and clindamycin 1% gel, the second group received benzoyl peroxide 2.5% gel, and nadifloxacin 1% cream and the third group received tretinoin 0.025% and clindamycin 1% gel. Cardiff acne disability index questionnaire was filled before starting and after the treatment. Results: In these three groups, it was found that the group on benzoyl peroxide 2.5% gel and clindamycin 1% gel, mean score, before starting treatment was 8.35±3.48 and after treatment was 2.95±2.09 (p<0.001), group on benzoyl peroxide 2.5% gel and nadifloxacin 1% cream, mean score, before starting treatment was 7.60±3.75 and after treatment was 5.80±2.98 (p<0.001) and group on tretinoin 0.025% and clindamycin 1% gel mean score is 8.00±3.06 and after treatment was 5.40±2.93 (p<0.001). Conclusion: Quality-of-life improves more in patients taking benzoyl peroxide 2.5% gel and clindamycin 1% gel, and then, tretinoin 0.025% and clindamycin 1% gel and then benzoyl peroxide 2.5% gel and nadifloxacin 1% cream.