One year randomized controlled trial to compare the effectiveness of honey dressing versus povidone iodine dressing for diabetic foot ulcer at Dr. Prabhakar Kore Hospital and MRC, Belagavi

Background: The objective of the study is to find out the effect of honey dressing versus povidone iodine dressing for reduction of wound size in diabetic foot ulcer.Methods: This randomized controlled trial was done in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital, Belagavi from January 2017 to December 2017. 64 patients were randomized into 32 group each undergoing unprocessed honey dressing and other group undergoing povidone iodine dressing.Results: The mean wound size in honey dressing was 23.16 cm2 and 23.03 cm2 in povidone dressings  at baseline, 23.16 cm2 and 22.94 cm2 at 1st day follow up, 23.16 cm2 and 22.94 cm2 at 3rd day follow up, 19.38 cm2 and  20.28 cm2 at 5th day follow up, 16.13 cm2 and 17.06 cm2 at 7th day follow up, 12.44 cm2 and  16.13 cm2 at 10th day follow up and the end of 15th day, it was 10.69 cm2 and 15.06 cm2 respectively in honey dressing group and povidone dressing group. The difference in the wound size in honey dressing group and povidone dressing group at 1st day, 3rd day, 5th day, 7th day, 10th day follow up period were statistically not significant (p>0.05). The difference in the wound size in honey dressing group at 15th day follow up period were statistically significant (p<0.05).Conclusions: This study shows more favorable results with honey dressing for reduction of wound size in diabetic foot ulcers.

MII RetCam assisted smartphone based fundus imaging for retinopathy of prematurity

Purpose: The gold standard for evaluating Retinopathy of prematurity (ROP), a potentially blinding disease in preterm babies, is by indirect ophthalmoscopy which is quite subjective. Digital imaging with RetCam, an advanced wide field imaging system is more precise but it is not easily available or affordable. Smartphones are being explored as an alternate cost effective and accessible imaging tool. This is possible because of the good illumination and the built-in high resolution cameras available in modern smartphones. The aim of this study is to illustrate the utility of MII RetCam assisted smartphone based fundus imaging (MSFI) in the documentation and monitoring of ROP. Methods: Single-centre, retrospective observational study of all the preterm babies subjected to MSFI as part of ROP screening from September 2017 to November 2018. iPhone 4S and + 20 Diopter lens attached to the MII RetCam device was used for fundus imaging at baseline and during follow up. The statistical analysis used for the same is the SPSS statistical software. Results: Good quality images of central and peripheral retina could be captured in 33 out of 42 babies (78.57%) with ROP. Serial imaging done in 24 babies with ROP helped in precise monitoring of the disease and planning management. Incidentally detected non-ROP findings were also documented. Unique design of the device enabled imaging by a single examiner. Image database created was useful for academic and counselling purposes. Smaller field images which can cause difficulty in distinguishing the zones is a limitation. Conclusion: MSFI is a potential alternate imaging tool enabling objective documentation and monitoring of ROP in low resource settings.

Prevalence and determinants of nocturnal enuresis in school going children in Southern Maharashtra, India

Background: Nocturnal enuresis or bedwetting is a common health problem in children in the age group of 5 to 15 years. In India the prevalence of nocturnal enuresis ranges from approximately 7% to 12.6%. The prevalence from other parts of the world ranges from 6% to 42%. This study was planned to find the prevalence and determinants of nocturnal enuresis in school going children.Methods: This cross-sectional study was conducted in four primary and secondary schools in Solapur. A predefined questionnaire, prepared in English and translated to local languages, Marathi and Kannada, was handed over to all the children attending the selected schools. Children were asked to hand over the questionnaire to their parents and return with the filled questionnaire. The questionnaire was prepared to obtain the information related to the socio-demographic factors of the family and child, frequency of enuresis and information related the risk factors. Nocturnal enuresis was defined if the frequency of enuresis was more than twice per week.Results: The overall prevalence of nocturnal enuresis was 11.4 %. The maximum prevalence was found in the age group of 8 -9 years (22.96 %). The prevalence of nocturnal enuresis in boys (14.34 %) was significantly more than the prevalence in girls (8.31 %). The study showed that nocturnal enuresis was significantly associated with stress, poor school performance, sleep pattern (hard to awaken), family history, burning micturition etc. But it was not associated with maternal or paternal education, birth order, type of family.Conclusions: The prevalence of nocturnal enuresis is 11.40 % in school going children and it is associated with age, sex, stress, family history, burning micturition, hyperactive child, poor school performance, sleep pattern (hard to awake) avoidance of going to micturate before sleep etc.

Nutritional anaemia: clinical and haematological presentation in children

Background: There are three main causes of anemia, decreased production of RBCs, and excessive destruction of RBCs or Excessive blood loss. In India, the main reason of anaemia is the decreased production due to nutritional deficiency. The main nutrients required in the process of haemoglobin production are iron, folic acid and cyanocobalamine. The objective of the present study was to find the clinical presentations and hematological changes in children with nutritional anaemia.Methods: This Cross-sectional study was conducted from January 2018 to October 2018 in the department of Paediatrics of Ashwini Rural Medical College Hospital and Research Centre, Solapur. Children visiting the paediatric OPD due to any illness and having clinical suspicion of anemia were initially screened for inclusion in the study. Detailed laboratory investigation such as CBC, peripheral blood for Leishman's stain and reticulocyte count were performed. Serum Ferritin, vitamin B12, folic acid levels were also done to ascertain the cause of anemia. World Health Organization recommended criteria were used to diagnose and grade the anemia.Results: A total of 405 anemic children were included in the study. Out of that 213 were boys and 192 were girls. A total of 226 children presented with mild anemia. The most common clinical presentation was respiratory tract infection, found in 62.22 % of children followed by fever in 53.09 % of children. Maximum numbers of patients were suffering from iron deficiency anemia, followed by folic acid deficiency. Deficiency of both of these nutrients was also common. Vit B12 deficiency was found in only 5 children.Conclusions: The study concluded that iron deficiency anemia was the commonest nutritional anemia in children in the age group of 5 to 15 years. Second most common deficiency was of folic acid. Majority of the anemic patients presented with respiratory tract infection and fever.

A study on the clinical profile of ulcers and membranous lesions of oral cavity and oropharynx.

Background: An ulcer is a discontinuity of an epithelial surface. Many a times, patients with oral ulcers are treated sympathetically without even coming to a definitive conclusion of their problem. Oral ulcers are common diseases for which patient seeks medical advice. Till date the clinical profile to diagnose the oral ulcers, membranous lesions of oral cavity and oropharynx is not well established. Hence, the study has been taken up to investigate the aetiopathology of ulcers of oral cavity and oropharynx. Methods: 60 cases of ulcers of oral cavity and oropharynx were included in the study. The aetiopathology of ulcers of oral cavity and oropharynx were investigated on the basis of age, sex, duration, etiological factors, symptom Index, socioeconomic status and anatomical distribution. Values are expressed as percentages. Results: The highest incidence was found to be in low socioeconomic group, where there is lack of education, improper food habits, cultivation of bad habits in early childhood and negligence of the disease are the predisposing factors in most of the malignancies. The highest incidence was found in low socioeconomic status. The lesions studied in this study were 50% of non-specific ulcers (Short term (<3 wks) 20-67% and Long term (>3 wks) 10-33%), 15% of Aphthous ulcers, 8.3% of Traumatic Ulcers, 6.5% of Malignant ulcers, 6.5% of Dental ulcers, 3.2% of HIV infection & AIDS, 3.2% of ulcer due to T.B. and 6.5% of ulcers. The majority of the cases were between the age 21-30 yrs constituting 35% followed by 11-12 years constituting 26.6%.d 62% of the short term ulcers, Female 38%. Conclusions: Low socioeconomic status, lack of education, bad oral hygiene, bad habits cultivated in early childhood is predisposing factors. Hence early diagnosis and prompt treatment is advised in all cases of ulcers.

Aetiopathology of ulcers of oral cavity and oropharynx: a cross sectional study.

Background: Oral ulcers are common diseases for which patient seeks medical advice. Till date the clinical profile to diagnose the oral ulcers, management and risk of malignancy is not well established. Hence, the study has been taken up to investigate the aetiopathology of ulcers of oral cavity and oropharynx. Methods: 60 cases of ulcers of oral cavity and oropharynx were included in the study. The aetiopathology of ulcers of oral cavity and oropharynx were investigated on the basis of age, sex, duration, etiological factors, symptom Index, socioeconomic status and anatomical distribution. Values are expressed as percentages. Results: The highest incidence was found in low socioeconomic status. The lesions studied in this study were 50% of Non Specific ulcers [Short term (<3 wks) 20-67% and Long term (>3 wks) 10-33%], 15% of Aphthous ulcers, 8.3% of Traumatic Ulcers, 6.5% of Malignant ulcers, 6.5% of Dental ulcers, 3.2% of HIV infection & AIDS, 3.2% of ulcer due to T.B and 6.5% of ulcers. The majority of the cases were between the age 21-30 years constituting 35% followed by 11-12 years constituting 26.6%.d 62% of the short term ulcers, Female 38%. Conclusions: Low socioeconomic status, lack of education, bad oral hygiene, bad habits cultivated in early childhood is predisposing factors. Hence early diagnosis and prompt treatment is advised in all cases of ulcers.

Influence of mating histories and age on female remating behaviour in a few closely related species of Drosophila nasuta subgroup.

Female remating with more than one male leads to coexistence of sperm from different males in the same female, thus creating a selection pressure on sperm. To understand the extent of divergence in the reproductive behaviour among closely related species, in the present study, the influence of first mating histories like mating latency, duration of copulation and age of flies have been analysed on female remating behaviour in closely related Drosophila nasuta subgroup species with varying levels of reproductive isolation. The time taken for the once mated females to remate varied from 7 days in D. s. sulfurigaster to 19 days in D. s. neonasuta after first mating. The female remating frequency varied from a minimum of 29% in D. s. neonasuta to a maximum of 95% in D. s. sulfurigaster. The younger flies, which had remating latency of three times less than aged flies, show 100% remating frequency. In addition, it was observed that the duration of copulation in the first mating influences the remating behaviour among the nasuta subgroup members. The results revealed that D. nasuta subgroup members despite being closely related differ in their reproductive behaviour.

Chandipura virus encephalitis outbreak among children in Nagpur division, Maharashtra, 2007.

Background & objectives: An outbreak of acute encephalitis syndrome (AES) among children from Nagpur division, Maharashtra was investigated to confirm the aetiology and to describe clinico-epidemiological features. Methods: AES cases among children <15 yr, from Nagpur division, hospitalized between June-September 2007, were investigated. Serum and cerebrospinal fluid (CSF) were tested for IgM antibodies against Chandipura virus (CHPV) and Japanese encephalitis virus (JEV) and for CHPV RNA by RT-PCR. Partial N gene sequences were used for phylogenetic analysis. Virus isolations were attempted in rhabdomyosarcoma (RD) cell line. Sandflies were collected, pooled and tested for CHPV RNA by RT-PCR. Results: A total of 78 AES cases were recorded in children <15 yr of age. Case fatality ratio was 43.6 per cent. Male to female ratio was 1:1.2. Chandipura (CHP) was confirmed in 39 cases. CHPV RNA was detected in both CSF and serum specimens of 2 cases and in serum of 22 cases. Phylogenetic analysis showed 99.98 – 100 per cent nucleotide identity in the sequences studied. Anti-CHPV IgM antibodies were detected in CSF of 2 cases and in serum of 8 cases. Seroconversion to anti-CHPV IgM antibodies was observed in 5 cases. Clinical manifestations of CHP cases (n=38) were fever (100%), convulsion (76.3%), altered sensorium (34.2%), headache (23.7%), vomiting (44.7%) and diarrhoea (23.7%). CHPV RNA was detected in one of two pools of sandflies from affected locality. Interpretation & conclusions: Chandipura virus was confirmed as the aetiological agent of this acute encephalitis outbreak with high case-fatality among children.

Prevalence of anemia in pregnancy.

Mild degree of anaemia seen (49.18%), the type anaemia is Microcytic hypochromic anaemia (63.24%), which is mainly due to iron deficiency anaemia of nutritional anaemia. Multi gravida is seen (68.03%), minimum gravida 1 and maximum gravida 5. severe anaemia seen in multi gravida that is gravida 4 & 5. The knowledge about anaemia in pregnancy & its complications in the patients is very low (6.48%). And 94.59% of pregnant women in 3rd trimester attended the antenatal care 1st time. 48.64% of cases lie between the age group 18–24 years and shows early pregnancy. By all these conclusions, still more research are to be undertake in Raichur district, to prevent the complication of anaemia in the pregnant women's to have the healthy society.

Analysis of lung functions in flour mills and ricemills workers.

Aims: To study of the lung function tests in asymptomatic flour and rice mill workers and this study would be helpful in preventing longstanding harmful effects of such exposures and it is also useful for preventing environmental risks. Study Design: Cross – sectional study Material and Methods: The subject 207 asymptomatic healthy male is instructed to take maximal inspiration (to TLC) and he was connected to medspiror through the mouthpiece, after that nose clip is applied and the subject was asked to exhale forcefully into the medspiror as fast as possible. Statistical analysis: Statistical tests used like Student's ‘t’ test for two groups and ANOVA for multiple group comparisons. Results: Majority of lung function test parameters showed reduced levels in flour mill workers when compared to rice mill workers. However the difference was not statistically significant. Conclusion: It is concluded that flour dust and rice husk dust causes deterioration of pulmonary functions in subjects working at mills (flour and rice). The findings of this study recognized the role of grain dust (flour and rice) for a longer duration in decline of pulmonary function test among flour mills and rice mills workers.

The Chennai glaucoma study: Prevalence and risk factors for glaucoma in cataract operated eyes in urban Chennai.

We report the prevalence and risk factors for glaucoma among aphakes and pseudophakes in 3850 subjects who participated in a population-based study in urban south India. The subjects underwent an ophthalmic examination including applanation tonometry, gonioscopy, optic disc evaluation and frequency doubling perimetry. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Thirty eight, 15 aphakes and 23 pseudophakes (0.99% of 3850 subjects) of the 406 persons who had undergone cataract surgery were diagnosed with glaucoma. Aphakes/pseudophakes were at higher risk of glaucoma as compared to the phakic population (Odds Ratio: 2.71, 95% CI: 1. 94, 3.38, p=0.001). On multivariate analysis, older age and higher intra ocular pressure were risk factors for glaucoma. Blindness attributable to glaucoma was detected in 20% of aphakic and 4.3% of pseudophakic eyes. Glaucoma was a significant cause of morbidity in those who had undergone cataract surgery in this urban population.

Outcomes of cataract surgery in a rural and urban south Indian population.

Purpose: To assess the visual outcome after cataract surgery in a south Indian population. Materials and Methods: Population-based cross-sectional study of subjects aged 40 years or more. Three thousand nine hundred and twenty-four rural subjects from 27 contiguous villages and 3850 urban subjects from five randomly selected divisions were studied. All subjects underwent a comprehensive ophthalmic examination that included visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, and dilated retinal examination. Statistical Analysis: Chi square test, t test and multivariate analysis were used. Results: Five hundred and twenty-eight (216 males, 312 females, 781 eyes) rural subjects (13.5%, 95% confidence interval (CI) 12.4% to 14.6%) and 406 (197 males, 209 females, 604 eyes) urban subjects (10.5%, 95% CI 9.6-11.5%) had undergone cataract surgery. Outcome of cataract surgery was defined based on visual acuity. Using best-corrected visual acuity for classification, the single most important cause for visual impairment was cystoid macular edema in the aphakic group and posterior capsule opacification in the pseudophakic group. Aphakia (visual acuity of <20/60 to ≤20/400 - odds ratio (OR) 1.8; 95% CI 1.3 to 2.6%, visual acuity of <20/400 - OR 6.2; 95% 4.0 to 9.8%), rural residence (visual acuity of <20/60 to ≤20/400 - OR 3.2; 95% CI 2.2 to 4.5% and visual acuity of <20/400 - OR OR 3.5; 95% CI 2.3 to 5.5%) were associated with visual impairment. The urban cataract-operated population had significantly more pseudophakics (P < 0.001), men (P = 0.02) and literates (P < 0.001). In the rural group the prevalence of cataract surgery (13.5% vs. 10.5%, P < 0.001) and number of people that had undergone cataract surgery within three years prior to examination (P < 0.001) were significantly greater. In 30% of rural and 16% of urban subjects uncorrected refraction was the cause of visual impairment. Conclusions: Surgery-related complications were major causes for visual acuity of <20/60.

Prevalence of bacterial pathogens causing ocular infections in South India.

Background / Aims: The eye may be infected from external sources or through intra-ocular invasion of micro-organisms carried by the blood stream. This study was undertaken to isolate and identify the specific bacterial pathogens causing ocular infections and to determine their in-vitro antibacterial susceptibilities to commonly used antibacterial agents. Materials and Methods: A retrospective analysis of all patients with clinically diagnosed bacterial ocular infections such as blepharitis, conjunctivitis, internal and external hordeolum, suppurative scleritis, canaliculitis, keratitis, dacryocystitis, preseptal cellulitis, endophthalmitis and panophthalmitis presenting between January 2005 and December 2005 was performed. Extra-ocular and intra-ocular specimens were collected and were subjected to direct microscopy and culture. Results: A total of 756 patients with bacterial ocular infections were analyzed, of which 462(61%) eyes had adnexal bacterial infection, 217(28.7%) had corneal infection, 6 (0.8%) had scleral involvement and the remaining 71(9.39%) eyes had infection of the intra-ocular tissues. The predominant bacterial species isolated was S. aureus (195 of 776; 25%) followed by S. pneumoniae (169 of 776; 21.78%) and coagulase negative staphylococci (142 of 776; 18.3%). The largest number of gram-positive isolates were susceptible to cefazolin (545 of 624; 87.34%), chloramphenicol (522 of 624; 83.65%) and gatifloxacin (511 of 624; 81.89%) and gram-negative isolates were to amikacin (127 of 136; 93.38%), gatifloxacin (125 of 136; 91.91%) and ofloxacin (119 of 136; 87.5%), while aerobic actinomycetes were to amikacin (100%), gatifloxacin (14 of 16; 87.5%), chloramphenicol (14 of 16; 87.5%) and ofloxacin (13 of 16; 81.25%). Conclusions: S. aureus frequently causes infections of eyelids and conjunctiva, S. pneumoniae of lacrimal apparatus and cornea and coagulase negative staphylococci causes intra-ocular infections. Of all routinely used antibacterials tested, flouroquinolones, especially gatifloxacin and ofloxacin represented a good choice for treating bacterial ocular infections.