Drug adherence to anti-tubercular treatment during COVID-19 lockdown in Haldwani block of Nainital district

Background: India saw one of the stringent lockdowns during the COVID-19 pandemic. In the wake of this period, the normal functioning of medical services was affected. People were reluctant to seek medical attention and notification of Tuberculosis dipped. The aim of the study was to estimate the proportion of non-adherence to anti-tubercular treatment and to identify the factors affecting the non-adherence to treatment. Methods: A retrospective community-based study was conducted among 284 tuberculosis patients. They were interviewed using a pre-designed questionnaire consisting of WHO dimensions of non-adherence and lockdown related questions. Results: The proportion of non-adherence to treatment was found to be 5.3%. Factors like chronic diseases, depression, without knowledge on how the disease is transmitted and that medication can be discontinued once the symptoms subsided, alcohol consumption, and trouble accessing medicine were found to be the determining factors in non-adherence to the treatment. Conclusions: Non-adherence to anti-tuberculosis treatment in our study was low but the various dimensions of adherence along with lockdown related factors had significant impact on it. To further minimize non-adherence during emergency like the lockdown due to COVID-19 pandemic, corrective measures must be explored and implemented.

Study on low birth weight and its associated factors among newborns delivered in a tertiary care hospital of Banda district, Uttar Pradesh

Background: Low birth weight is associated with higher morbidity and mortality including impaired growth and development, malnutrition etc. Worldwide, one- fifth of newborns delivered are low birth weight. Aims & objectives: To estimate frequency of low birth weight & its associated factors among newborns delivered in a tertiary care hospital. Materials & Methods: A cross sectional analysis of 290 newborns delivered in tertiary care hospital, Banda, Uttar Pradesh during period of 15th February 2021 to 31st December 2021 was done for estimating low birth weight frequency & its associated factors including child characteristics, mother characteristics & father characteristics using data from medical record section of hospital. Frequency, percentages, mean, standard deviation, chi square test & independent t- test was used. P value <0.05 was considered significant. Results: 91 out of 290 newborns delivered were low birth weight (27.9%, 95% CI- 23.1%- 33.4%). The following factors were shown to have a significant association with low birth weight: education of mother (p=0.04), education of father (p=0.03), occupation of father (p=0.02), and duration of pregnancy (p<0.001). Conclusion: This study demonstrated that education of mother, education of father, occupation of father, and duration of pregnancy had significant association with low birth weight frequency that suggests that improving literacy status can help in decreasing burden of low birth weight apart from other factors.

Leptin as a predictor of delirium in geriatric inpatients: An observational study

Background: Delirium is a complex, reversible neuropsychiatric disorder that frequently occurs in the geriatric age group in acute care settings with multifactorial etiology and numerous knowledge gaps in the pathogenesis. Objective: This study aimed to establish an association between leptin levels and delirium in patients aged 60 years and above admitted under the geriatric medicine department of a tertiary care hospital. Materials and Methods: A prospective observational study was conducted in consecutively admitted patients to the geriatric ward. Patients were assessed for delirium within 24 h of admission and daily thereafter until they were discharged from the hospital or died using the Confusion Assessment Method (CAM) or CAM?intensive care unit with subsequent division into delirium and nondelirium groups. Serum leptin levels were measured using enzyme?linked immunosorbent assay. Results: Two hundred patients were recruited in the study. The mean age of participants was found to be 73.1 ± 8.8 years. Prevalence rates of delirium at the time of admission and incidence rates during hospital stay were found to be 20% and 5%, respectively. The occurrence of delirium was also found to be significantly associated with mortality (32.5% vs. 8.7%, P = 0.001). Serum leptin levels were found to be significantly lower in patients with delirium (2.58 ± 1.01 ng/mL vs. 10.72 ± 1.46 ng/mL, P = 0.03). Multivariable regression analysis revealed delirium to significantly correlate positively with age (Odds Ratio [OR]: 1.63 (1.07–2.47), P = 0.021) and negatively with leptin levels (OR: 0.94 (0.90–0.99), P = 0.018). Conclusion: Delirium is a frequently occurring condition in hospitalized older adults with high mortality rates. Leptin might serve as a potential predictor of delirium owing to its probable role in the pathophysiological processes of delirium.

Is the Rule of Halves in Hypertension Valid Uniformly across India? A Cross-sectional Analysis of National Family Health Survey-4 Data

Background: Hypertension is widely prevalent across India. The rule of halves is commonly used to describe the attrition and gaps in the care cascade of hypertension management across detection, availing treatment, and having controlled blood pressure (BP) on treatment. Objectives: Using nationally representative data, we aimed to assess the rule of halves in hypertension management in different states of India and across sociodemographic, health system, and personal factors. Methods: A descriptive analysis of secondary data from the National Family Health Survey?4 was conducted. We included 770,662 individuals(112,122 men and 658,540 nonpregnant women) of 15–49 years of age. The proportion of individuals not aware of hypertension status among those with high BP, known hypertensives not availing of treatment, and uncontrolled BP among those on treatment were expressed as percentage with a 95% confidence interval (CI). Results: Of those with high BP, 48.5% (95% CI: 47.8%–49.3%) were not aware of their hypertensive status. Among known hypertensives, 72% (95% CI: 71.2%–72.8%) had not availed treatment for hypertension. Among those on treatment, 39.8% (95% CI: 38.7%–40.9%) had uncontrolled hypertension. Conclusion: The rule of halves of India shows that the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke has made relatively good progress with the detection of hypertension and achieving BP control among those on treatment. However, with three?fourth of known hypertensives not availing treatment, more dividends from the detection of hypertension efforts could be realized. The program needs to especially focus on ensuring the treatment for those detected with hypertension.

Is Menstruation a Valid Reason to Postpone Cardiac Surgery?

Background:Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss. Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation. Settings and Design: A prospective,matched case?control study which included sixty women of reproductive age group undergoing OHS. Patients and Methods: The surgical blood loss was compared between women who weremenstruating (group?M;n = 25) and their matched controls, i.e., women who were not menstruating (group?NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup?P) and perioperative period (subgroup?PO) was compared to determine the effect of OHS onmenstrual blood loss. Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr?M = 245.6 ± 120.1 ml vs gr?NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr?P = 36.8 ± 4.8 ml vs gr?PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr?P = 4.2 ± 0.6 days vs gr?PO = 4.4 ± 0.6 days, P value = 0.10). Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.

Coverage evaluation of Mass Drug Administration (MDA) for lymphatic filariasis in a district of Bundelkhand Region of Uttar Pradesh

Introduction: Lymphatic filariasis results in severe disability that leading to severe social and economic burden at each level from individual to family, and community. This study was carried out to assess the coverage and compliance of MDA. Methods: From 300 households (1837 individuals) in both rural & urban area were covered in coverage evaluation survey by systematic selection of subunits using probability proportionate to size (PPS). Each household was visited by WHO designated team and data were collected using predesigned questionnaire. Data was compiled on MS-excel spreadsheet, frequency and percentage were calculated. Results: The overall effective coverage for all drugs was low (19.1%). The coverage was low, compliance was higher in urban as compared to rural area. Females had better coverage and compliance than males. The primary reasons for drug not offered was nobody came to offer drug, drug not swallowed was not sick, drug swallowed was useful information from drug administrator (DA). Only one female reported adverse effect. Conclusion: Increase in coverage along with decrease in coverage-compliance gap is needed to achieve filariasis elimination that warrants intense IEC activities using different platforms, development of better drug delivery strategies and strengthening monitoring system.

Land use and land cover modification and its impact on biodiversity and the ecosystem services in District Kurram, Pakistan / Uso del suelo y modificación de la cobertura terrestre y su impacto en la biodiversidad y los servicios de los ecosistemas en el distrito de Kurram, Pakistán

Modifications of land use and vegetation cover are proceeding faster than ever before in human history, with a considerable reduction in forest cover in biodiversity hotspots. We investigated the land use and vegetation cover changes, their impact on biodiversity in the Kurram District, Pakistan, for 27 years (1989 to 2015). Temporal satellite imagery was processed using a supervised maximum likelihood classification algorithm in ARCGIS 10.1 to elucidate information regarding land use/land cover changes,with conducted structured interviews to obtain the inhabitants' perspectives on their dependence on ecosystems in Kurram, and how their environment is changing. We found that the land under forest cover and rangeland showed a remarkable decrease over the study period. This decline in rangeland and forest cover was a result of the increased of farmland, barren land. The study area is part of a biodiversity, with important medicinal, rare and unique plant species.

Las modificaciones del uso de la tierra y la cobertura vegetal están avanzando más rápido que nunca en la historia de la humanidad, con una reducción considerable de la cobertura forestal en los puntos críticos de biodiversidad. Investigamos el uso de la tierra y los cambios en la cobertura vegetal, su impacto en la biodiversidad en el distrito de Kurram, Pakistán, durante 27 años (1989 a 2015). Las imágenes satelitales temporales se procesaron utilizando un algoritmo de clasificación de máxima verosimilitud supervisada en ARCGIS 10.1 para dilucidar información sobre los cambios en el uso del suelo/cobertura del suelo, con entrevistas estructuradas realizadas para obtener las perspectivas de los habitantes sobre su dependencia de los ecosistemas en Kurram y cómo está cambiando su entorno. Descubrimos que la tierra cubierta por bosques y pastizales mostró una disminución notable durante el período de estudio. Esta disminución en los pastizales y la cubierta forestal fue el resultado del aumento de las tierras de cultivo, tierras estériles. El área de estudio es parte de una biodiversidad, con importantes especies de plantas medicinales, raras y únicas.

Lung Function and Health Status in Patients of Chronic Obstructive Pulmonary Disease on Treatment with Tiotropium

Introduction: Chronic obstructive pulmonary disease (COPD) is a group of chronic and slowly progressive respiratory disordercharacterized by reduced maximum expiratory flow during forced exhalation. Tiotropium, a long-acting antimuscarinic agent,has well-known documented effect on improving lung function and quality of life (QOL). There are many studies globally ontiotropium and its effect on lung function, but limited studies available in our Indian set up. Hence, we planned this study.Materials and Methods: Patients were recruited from chest clinic and outpatient department from the Department of Medicineof University College of Medical Sciences and GTB Hospital. It was a prospective observational cohort study conducted fromNovember 2017 to April 2019. Tiotropium was given as meter dose inhaler in dose of 18 µg per dose, in schedule as prescribedby the Global Initiative for Chronic Obstructive Lung Disease-2017 guidelines. Patients were followed up for 3 months withperiodic assessment of lung functions, Saint George’s Respiratory Questionnaire (SGRQ) score, and symptoms assessment.Results: A total of 65 patients were recruited for study which included 57 (87.7%) males and 8 (12.3%) females. Among thepulmonary function tests measured, there is a significant change in mean forced expiratory volume (FEV1) at the end of followup period compared to FEV1 at baseline. There is a significant change in mean forced vital capacity at the end of follow-upstudy compared to start of the study. There was no significant change in mean SGRQ score after 1 month of start of drug,but significant statistical change observed at end of the 3rd month of the study compared to the 1st month that implies SGRQscore decreased and patients health status and QOL improved. There is a significant change in mean SGRQ score at the endof follow-up study compared to baseline. In our study, 16 patients (24.6%) complained of dry mouth, 7 (10.7%) complained ofpharyngitis or throat irritation, and 3 (4.6%) patients complained of constipation.Conclusion: There was a statistically significant change in lung functions and improvement in QOL scores as assessed bySGRQ at the end of the study compared to baseline by use of inhaled tiotropium in COPD patients

Knowledge and Practice of Breastfeeding among Mothers in Arma’a District Shabwah Governorate - Yemen

@#Breastfeeding is almost universal, but there are many barriers for proper breast feeding practices. Inadequate knowledge, or inappropriate practice, of breastfeeding may lead to undesirable consequences. The aim of this study was to assess breastfeeding knowledge, and practice among mothers in Arma’a district Shabwah governorate and identify factors that may affect breastfeeding practice in the study population. A cross-sectional study using pre-tested validated structured questionnaire conducted among mothers who were attending Arma’a hospital and four health care units around Arma'a district. Sample size was 130 mothers who had at least one child aged two years or younger. Breastfeeding knowledge and practice of participants were assessed based on their experience with the last child.This study found that there are only 24 mothers (18.6%) have good knowledge while 106 mothers (81.4%) have low knowledge. 63 mothers (48.5%) had good breastfeeding practice while 67 mothers (51.5%) have poor breastfeeding practice. 54.0% mothers that have good knowledge have good practice while 52.8% mothers of poor knowledge have poor practice. Mothers’s knowledge was significantly associated with their education level and their practice was significantly associated with the number of pregnancies (p-value=0.04 and =0.027 respectively). There was no significant association with other demographic data, and between knowledge and practice. No exclusive breastfeeding reported in this study.This study shows that undesirable cultural practices such as giving pre-lacteal, avoiding exclusive breastfeeding are still prevalent among the mothers. The maternal knowledge towards breastfeeding was very low and there was big gap between actual and desired practices.

The 3-Question Approach: A Simplified Framework for Selecting Study Designs

Conventional algorithms for selecting study designs are difficult to use for a novice researcher, especially the postgraduate students. Aninherent limitation of using the existing algorithms is the requirement of a priori knowledge of the characteristics of various study designs.We propose a simple and novel 3-question approach to select study designs. The questions are asked in a stepwise manner with answersin ‘yes’ or ‘no’. The responses to each of these questions lead the researcher towards choosing the appropriate study design. We believethat this 3-question approach would be useful for unexperienced researchers in selecting study designs, besides serving as a tool toteach-learn selection of study designs

TQM Practices and their Effect on Non-financial Performance: An Empirical Study of Pakistani Hospitals

Introduction: There has been a vigorous change in the healthcare sector with increased patient expectations, technological advancements, and growing competition in the healthcare market. Therefore hospitals have to shift from traditional management approach to more diverse aspects like TQM practices and effective quality management system to augment the performance level. Relationship between TQM practices and performance is multipronged and widely discussed in the literature. Aim: Main purpose of this study was to evaluate the impact of TQM practices on nonfinancial performance elements of performance in different quality management system settings. Methods: This study used an empirical approach to identify and explain the TQM practices and non-financial performance relationship. A cross-sectional survey was conducted in 5 hospitals from different regions with either Joint Commissioned International (JCI) or ISO 9001 based quality management system. Data were collected from 150 hospital managers between October 2018 and February 2019. Descriptive and inferential statistical analysis was conducted using IBM SPSS 20 version. Results: Finding of the study support that TQM practices have a statistically significant and positive relationship with non-financial performance (p<0.05). Result of multiple linear regression analysis shows that TQM practices are a strong predictor of non-financial performance (Beta=0.793, t=15.837, R2=0.629, and p=0.000) and explain 63% variation in the model. TQM practices demonstrate higher overall and individual mean values for JCI accredited hospitals. T-test shows that there is a significant difference (p<0.05) in TQM practices between JCI and ISO-based quality management system. Conclusion: It can be inferred from this study that TQM practices have a leading role in the improvement of the non-financial performance of hospitals. Hospital managers at a different level can achieve improved results with effective implementation of identified TQM practices. TQM practices significantly contribute towards individual dimensions as well as an overall improvement in non-financial performance.

Effect of bupivacaine on postoperative pain after laparoscopic cholecystectomy

Objective: To determine whether intraoperative local injection of 0.5% bupivacaine around port sites would decrease early postoperative pain after laparoscopic cholecystectomy, and the use of intravenous opioid analgesics postoperatively

Study Design: Randomised controlled trial.

Place and Duration of Study: Department of Surgery, Khyber Teaching Hospital, Peshawar, from July 2016 to June 2017

Methodology: Patients who underwent laparoscopic cholecystectomy were divided into two groups. Group A had instillation of 20 ml of 0.5% Inj. bupivacaine at the end of procedure into port sites and group B had no bupivacaine injection at trocar sites. Both groups had postoperative intravenous ketorolac 30 mg three times daily and intravenous opioid analgesics on demand. Pain was assessed 2 hours after recovery from general anesthesia, and at 6, 12 and 24 hours through visual analog scale 0-10

Results: One hundred and twenty patients completed this study with 60 patients in each group. A significant difference in mean postoperative pain scores was observed at 2 and 6 hours after surgery between the groups. Pain scores at 2 and 6 hours after surgery were 3.97 +/- 1.327 and 3.02 +/- 1.08 in group A, while it was 4.65 +/- 1.448 and 4.72 +/-1.277 in group B with p-values of 0.008 and 0.005, respectively. There was no significant difference in mean postoperative pain scores at 12 and 24 hours between the groups, with pain scores of 3.72 +/- 0.78 and 3.75 +/- 0.95 [p=0.488 and 0.744, respectively]. However, there was a significant difference in opioid analgesics use in first 24 hours with less analgesics use in bupivacaine injected group

Conclusion: Injecting 0.5% bupivacaine at trocar sites during laparoscopic cholecystectomy offers significant reduction in early postoperative pain

Biowaiver studies of newly optimized meloxicam tablets

In this research work biowaiver studies of newly developed and optimized Meloxicam 7.5mg and 15mg water dispersible formulations were carried out at different dissolution media i.e. 0.1N HCl, phosphate buffer pH 4.5, pH 6.8, and pH 7.5 at 50 rpm. For this purpose reference [MA[9] and MB[9] and tests MA[2], MA[4], MA[6], MA[7] and MA[8] [15 mg] and MB[2], MB[4], MB[6], MB[7]and MB8 [7.5 mg] formulations were compared. In vitro patterns were analyzed by using model-independent and model-dependent methods. Results indicated that all formulation at pH 0.1N HCl and phosphate buffer pH 4.5 followed Weibull model, while at pH 6.8 and pH 7.5 all formulations followed Hixson-Crowell model. Similarly results of model independent methods demonstrated that all the reference formulations were found to be similar with the tests formulations. Results indicated that Biowaiver could be granted to all the optimized water dispersible meloxicam formulations of both batches, so waiver for bioequivalence study can be allowed

Use of oral Vitamin-D glass ampoule and tablet: experience of patients and physicians

Objective: To ascertain patients and physician views regarding hazard and compliance of oral liquid Vitamin D glass ampoule and tablets

Methods: This cross sectional survey was conducted from November 1st 2016 to 15th December 2016. Patients who were prescribed Vitamin D glass ampoule from oral route in last three months were included along with physicians who routinely prescribe vitamin D after taking informed consent. The participants were asked about injuries related to the use of glass ampoule, ease of using this from, after taste preference of tablet or injectable form as well as demography. Data was analysed with SPSS version 24.0

Results: Total 182 patients were included in the study with mean +/- SD age of 39.4 +/- 12.4 years. Majority of patients, 80.2% [142] said they prefer oral tablet in preference to injectable ampule in oral form if given choice while prescribing Vitamin D. Moreover 66.7% [64] doctors prefer to prescribe tablet form of Vitamin D instead of injection as oral form for vitamin D deficiency among their patients. One third of patients, 33% [n=59] sustained injury while breaking the ampule which included minor self-controlled bleeding by glass particles in 50% [n=35]. Less than half of doctors 46.9% [n=45] said they taught their patients about usage of injectable Vitamin D ampules

Conclusion: Majority of patients prefer Vitamin D tablet instead of Oral liquid in glass ampoule if they got the choice among two. The results of this study provide important implications for our doctors about patients concern of hazard, after taste and compliance with orally administered Vitamin D glass ampoules

Birth preparedness and complication readiness: a cross sectional survey from expectant mothers visiting a rural health center

Objective: To assess level of awareness of expectant mothers about their birth preparedness and complication readiness [BPACR]

Study Design: Descriptive cross sectional study

Place and Duration of Study: It was a descriptive cross sectional study conducted at a Rural Health Center, Mandra over period of six months, from Sep 2016 to Feb 2017

Material and Methods: Three hundred and twenty pregnant women of rural area of residence in their third trimester [29-40 wks] were approached using non probability convenient sampling. They were interviewed by using a structured questionnaire after taking informed consent. SPSS version 20 was used for data entry and analysis. A p-value <0.05 was considered statistically significant

Results: The mean age of the participants was 29.02 +/- 6.403 years. All the 320 participants were from rural area of residence. The knowledge of elements of BPACR was highest [7 out of 8] in only 26 [8.1%] women followed by 6 elements in 47 [14.7%], 5 elements in 78 [24.4%], 4 elements in 83 [25.9%]. There was significant number of females who had poor knowledge of only 3 elements 69 [21.6%]. Overall 45% of pregnant women knew 5 or more elements were well prepared while 55% were less prepared regarding birth and related complications. Participants' education and husbands' monthly income was found to be significantly associated with birth preparedness and complication readiness knowledge [p-value<0.05]

Conclusion: The majority of expectant mothers were well prepared for the birth and were also aware of the danger signs of pregnancy. Antenatal visits were taken by majority of the participants. However arrangements for transportation, financial support and blood donor identification were not satisfactory

Health Problem Pattern Among Geriatrics In Aligarh- A Cross Sectional Study.

Background & Objectives: Old age is associated with decline in physical, physiological & cognitive function affecting the quality of life of the elderly population. The robust increase in proportion of elderly has resulted in demographic burden in a developing country like India. To cope up with this burden appropriate & timely intervention is required based on the situational analysis of the health problems faced by the aged population. Objective is to determine the pattern of health problems among geriatric population and to find out the rural- urban difference in health problems, if any. Methodology: The cross- sectional study was done among 450 individuals aged 60 years & above residing at field practice area of Urban Health Training Centre & Rural Health Training Centre, JN Medical College, AMU, Aligarh. The data was obtained through pretested & predesigned questionnaire by selecting individuals using systematic random sampling with PPS. Data was entered & analyzed by SPSS 20. Tests of proportion & Chi square test were applied. P value <0.05 was considered significant. Results: The present study revealed that the most prevalent problem was cataract (79.6%), followed by depression (36.2%), refractive error (31.3%), locomotor problems (23.6%) and hearing loss (16%). No significant rural- urban difference was found among the prevalence of health problems. Conclusion: The study concluded that the magnitude of health problems faced by elderly ranges from low (hearing loss) to high (cataract) that warrants strengthening of the available health care services to tackle the burden of health problems.

Allgrove syndrome: adrenal insufficiency with hypertensive encephalopathy

Allgrove syndrome or triple-A syndrome is a rare familial multisystem autosomal recessive disorder. It is characterised by triad of alacrima, achalasia and adrenal insufficiency due to adrenocorticotropin hormone [ACTH] resistance. If it is associated with autonomic dysfunction, it is termed as 4-A syndrome. This syndrome is caused by a mutation in the Achalasia - Addisonism - Alacrima [AAAS] gene on chromosome 12q13 encoding the nuclear pore protein ALADIN. A 5-year boy presented with history of fits and altered sensorium for one day. He also had increased pigmentation of body and persistent vomiting since six months of age. Laboratory investigations and imaging revealed alacrimia, achalasia and adrenal insufficiency due to ACTH resistance. He had episodes of hypertensive crises, for which he was thoroughly investigated and it was found to be due to autonomic instability. Based on clinical findings and investigations he was diagnosed as case of Allgrove syndrome or 4-A syndrome with autonomic dysfunction

Most association between lifelong daily activities and knee and hip osteoarthritis in a group of people attending Rizgary teaching hospital in Erbil city

Background and objective: Wear and tear of joint cartilage is regarded as one of the main causes of osteoarthritis hence recurrent minor traumas due to some of lifelong daily activities can correlate with the development of osteoarthritis especially in weight bearing large joints. This study was designed to evaluate the association between 10 specified lifelong daily activities with knee and hip osteoarthritis

Methods: A cross-sectional study was carried out in the outpatient clinic of Rizgary Teaching Hospital over a period of six months starting from November 2009. The study sample constituted 101 subjects with knee and/or hip osteoarthritis and 100 subjects of normal joints. Subjects fulfilling the inclusion criteria underwent clinical evaluation and radiology of their knee and hip joints. Differences between comparable subdivisions of the studied subjects in relation to the duration of each of the 10 specified lifelong daily activities was tested by the Chi-square test concerning the association of each daily activity with knee and hip osteoarthritis

Results: Five of the 10 specified lifelong daily activities showed association with knee osteoarthritis, and these were; squatting, sitting on the floor, knee bending and crossed leg sitting postures, cycling, and less time sitting on chair or sofa. The same applied for osteoarthritis of hip except for cycling

Conclusion: Lifestyle has an important role in the pathogenesis of knee and hip osteoarthritis

effect of tumor necrosis factor alpha inhibitor on wound healing of oral mucosa in induced diabetic rats

Background and objective: Impaired wound healing is a major complication of diabetes mellitus. This study was carried out to determine the healing process of oral mucosa in diabetic rats and the role of systemic tumor necrosis factor alpha inhibitor [infliximab]

Methods: Thirty eight male rats were divided into two groups, the normoglycemic group [11 rats], and diabetic group [27 rats] that were rendered diabetic by alloxan injection. Two months later, wound was created in the lateral side of the tongue for both groups. The diabetic group was then subdivided into two subgroups, 14 rats received 5mg/kg infliximab subcutaneous injection at the day of wound creation while the other 13 rats received saline injection. After 7 days, biopsies of the tongue were collected and subjected to histological and histochemical procedure

Results: Histological examinations showed delayed healing in the diabetic group with persistence of epithelial discontinuity, large amount of granulation tissue and destruction of the underlying muscle fibers. In the subgroup injected with infliximab, reepitheliazation of the wound was demonstrated with well arranged underlying collagen fibers. Using PAS stain, diabetic group revealed a dramatically high amount of PAS positive precipitants in the lamina properia, especially in the wall of the blood vessels, while with infliximab injection, the PAS+ve precipitants were more prominent than normoglycemic group but less than diabetic group without infliximab

Conclusion: These findings suggest that infliximab accelerated mucosal wound healing in the diabetic rats with the formation of well organized connective tissue