Comparison of outcomes of acute kidney injury in elderly and non-elderly hospitalized patients in a tertiary care hospital in India: a prospective observational study

Background: The prevalence of acute kidney injury (AKI) progressively increases with age. A higher rate of dialysis dependency and mortality is observed in elderly with AKI. Here we have studied the comparison of clinical features, outcomes of AKI between elderly (age � years) and non-elderly AKI patients and their risk factors for mortality. Methods: This prospective observational study enrolled 100 patients with AKI, with elderly and non-elderly in a 1:1 ratio for comparison, from September 2021 to January 2023 at AIIMS Rishikesh in India. Detailed history, clinical examination, relevant laboratory and radiological investigations were done to evaluate for the cause of AKI. Etiological causes, complications of AKI, and in-hospital outcomes were observed. They were given standard treatment and dialysis as per standard indications. We analysed the mortality risk of these groups using the Cox proportional hazards model. Results: The in-hospital mortality rates among these two groups were non-significant (p=0.29). A significantly higher number of patients with non-elderly AKI were HD-dependent at discharge (p=0.027). Elderly patients had significantly lesser complications like uremic encephalopathy and fluid overload compared to non-elderly. There was a significant association between mortality and female gender, intensive care unit (ICU) admissions, hospital-acquired AKI, pre-renal/renal causes, chronic obstructive pulmonary disease (COPD) as comorbidity, multiple organ dysfunction syndrome (MODS), mechanical ventilation requirement, vasopressor support requirement, need for hemodialysis and prolonged ICU stay. Conclusions: Elderly patients with AKI do not experience worse mortality outcomes than non-elderly patients with AKI. Therefore, elderly patients should not be denied timely treatment, solely based on their age.

Self-care activities and quality of life among people with type II diabetes in rural east India: a cross-sectional study

Background: Unattended diabetes led to severe diabetic complications. Self-care activities are specific activities of self-management that lead to well-regulated glycaemic levels and eventually to better quality of life. This study is aimed to assess the level of self-care activities and quality of life among individuals with type 2 diabetes mellitus (T2DM) in selected villages of East India. Methods: The summary of diabetes self-care activities (SDSCA) scale was used to evaluate self-care activities, while the world health organization quality of life-Bref (WHOQOL-Bref) scale was employed to measure quality of life. A total of 150 participants clinically diagnosed with diabetes for more than 6 months were included in the analysis. Results: The results indicated that the mean score for overall quality of life was 61.66±15.35, with 17.3% of participants reporting poor overall quality of life. The majority of participants (66.6%) did not engage in any form of exercise in the last week, and a significant number (86%) had not checked their blood sugar levels in the previous week. Regarding foot care, 46.6% regularly washed their feet, while 80% did not check their shoes regularly. Medication adherence was relatively high, with 73.3% of participants reporting adherence to prescribed medication. Conclusions: These findings highlight the need for interventions to improve self-care activities and enhance the overall quality of life among individuals with T2DM in the selected villages of East India. Strategies targeting dietary habits, physical activity, blood sugar monitoring, foot care, and medication adherence should be implemented to promote better management of T2DM.

Nurses: a guide towards assistive devices and technologies for the visually impaired individuals

Assistive devices for people with visual disability is growing rapidly over the past few years around the world. These devices enhance the functioning and performance of daily living skills, thereby improves the independent living and quality of life of these individuals. These innovations range from low to high cost and it includes devices which assist the visually impaired individual in mobility, reading, writing, daily living, and communication technologies. Children primarily need these devices for education whereas adults use these devices for doing daily routine tasks. It is expected that the need and demand of these devices and technologies will increase over time due to the exceptional growth in the proportion of population with visual impairment, specifically in low middle-income countries like India. Therefore, the first and forefront strategy is to introduce assistive devices to the visually impaired individuals and create awareness, sensitize eye care professionals, potential beneficiaries, caregivers, and their families. The present paper will highlight some of the assistive devices and technologies which will increase the independence in doing activities of daily living as well as increase the quality of life of individuals suffering from visual impairment.

An unusual case of cavitary lung lesion in catheter related blood stream infection

Cavitary lung lesions are commonly caused by Staphylococcus aureus, Klebsiella pneumoniae. Pseudomonas rarely causes such lesion. Here we report a case of cavitary pneumonia due to pseudomonas aeruginosa in the setting of catheter related blood stream infection in a 25-year-old male with crescentic IgA nephropathy who was on immunosuppressive medication.

Comparative Study Of Dry Needling V/S Transcutaneous Electrical Nerve Stimulation In The Treatment Of Hamstring Strain In Football Players

Background:Myofascial pain syndrome is defined as sensory, motor and autonomic symptoms that are caused trigger points (MTrP). It is defined as a hyperirritable spot in skeletal muscle, which is associated with hypersensitive palpable nodule in a taut band. Objectives: Present study was undertaken to add on to available treatment methods for myofascial Trigger points and to find out the effectiveness of dry needling and Transcutaneous Electrical Nerve Stimulation (TENS) therapy for treating myofascial trigger point. Material And Methods:In this study, 32 participants were recruited based on inclusion and exclusion criteria. Dry Needling and TENS therapy was administered to them for a period of 2 weeks, 6 sessions in 2 weeks. Pre and post assessme nt were taken using following outcome measures-Pain Pressure Threshold, Numerical Pain Rating Scale (NPRS), Functional Assessment Scale for Acute Hamstring Injuries (FASH)Result:There was significant decrease in Pain due to hamstring injury on NPRS, agility score and increase in Pain Pressure threshold in patients which is suggestive of decrease in pain and improve functional independency. The outcome of Pressure Algometer, Agility score and NPRS were statistically analyzed. It was found to be effective with significant P value<0.000. Conclusion:Statistically both Dry Needling and TENS are competent enough to alleviate pain but clinically TENS having better response in pain depletion and in increase in functional independency compared to Dry Needling.

Radiation therapy outcomes in muscle invasive urinary bladder cancer: A single institution experience.

INTRODUCTION: To audit the survival outcomes and loco‑regional control in muscle invasive urinary bladder cancer patients treated with external beam radiation therapy (RT). MATERIALS AND METHODS: From November 2008 through December 2011, 50 consecutively diagnosed muscle invasive urinary bladder carcinoma (T2‑4a N0‑2, M0) patients were included in this retrospective study. All these patients received external beam RT to a median dose of 60 Gy (range 30‑66 Gy), and were not suitable for radical surgery due to patients’ preference or medical comorbidities. A stepwise procedure using proportional hazard regression was used to identify prognostic factors with respect to survival. RESULTS: Completion trans‑urethral resection of bladder tumor was done in 38 (76%) patients of the cohort and 47 (94%) had transitional cell carcinoma on histopathology. Clinical stage T2 was diagnosed in 40 (80%) patients. The median follow‑up for the entire cohort was 14 ± 8.9 months (range 1‑36 months). In conclusion, 24 patients (48%) were free of disease, 5 patients (10%) had residual disease, and 13 patients (26%) had died of disease. Two‑year and 3 year overall survival of intact bladder for the entire cohort was 58% and 43.6%, respectively. Cox regression modeling strongly suggested clinical stage (P = 0.01) and RT dose (P = 0.001) as being predictors for overall survival. CONCLUSION: RT shows reliable outcomes and excellent compliance in this advanced disease. Prescribing a higher RT dose could potentially correlate to better intact bladder control rates while maintaining good quality of life in selected patients.

Assessment of specialization preference among undergraduate medical students and its influencing factors

Background: Understanding the future career interests of medical graduates is important, as they are the future workforce of the healthcare profession. Aim: The aim of this study was to determine the career choices and the factors that influence undergraduate medical students to choose a particular medical specialty. Materials and methods: A cross sectional observational study was conducted among ‘300’ undergraduate medical students of Sardar Patel Medical College, Bikaner, Rajasthan between January to March 2014. A self-administered questionnaire was used to collect data and the association between different variables was tested using Chi-square test. Results: Out of total ‘300’ respondents, 84% (n=252) considered post-graduation very important for future career and majority of them (99%) wanted to pursue the same in clinical subject. The most preferred specialty expressed by male students was Medicine, followed by Surgery and Orthopedic, while the female students were more interested in Radiology, Paediatrics and Obstetrics and Gynecology. Little interest was shown in other specialities. Personal interest was found to be the most common factor that influenced the choice of specialization. Conclusion: A variety of factors appeared to inspire medical graduates to opt for a particular specialty. All the substantial factors that influence the medical graduates’ decision should be equally justified and addressed, so that the quantitative and qualitative inequality of specialists can be nullified.

Breast reconstruction in low resource settings: Autologous latissimus dorsi flap provides a viable option.

BACKGROUND: Breast reconstruction (BR) plays a significant role in the woman’s physical, emotional and psychological recovery from breast cancer. However, the current most accepted methods of reconstruction are expensive, may require microsurgical skills and can be offered to a very small number of patients seeking treatment in tertiary care centers. For the large majority of women seeking treatment in public hospitals, solution lies in finding a method of reconstruction, which is autologous, produces a reasonable match to the contralateral breast in size, shape and symmetry and produces minimal donor site morbidity. It should also be a technique, which is cost effective and can withstand the effects of radiotherapy (RT). The autologous latissimus dorsi (LD) flap is one such versatile technique, which can serve as an ideal reconstructive option for the majority of patients. MATERIALS AND METHODS: During a period of 6 years, 19 patients underwent immediate BR using this flap in the Department of General Surgery. Patients who were young (mean age 37.4 years), had small to medium sized breasts, with operable breast cancer (Stage II and IIIa) were selected for the procedure. RESULTS: Satisfactory cosmetic results as rated by patients as well as surgeons were achieved in the majority. Donor site morbidities were seroma formation (78%) and donor site wound breakdown (21%). Post‑operative RT was well‑tolerated by the reconstructed breast. CONCLUSION: Autologous LD flap reconstruction is a safe and economical option for BR in low resource settings and is suitable for women with small and medium sized breasts.

Changes in Preterm Human Milk Composition with Particular Reference to Introduction of Mixed Feeding.

Objective: To study the changes in composition of preterm milk till 6 months of age. Methods: Milk samples from 33, 19, 7 and 12 lactating mothers (delivered <34 weeks) were analyzed on days 7, 28, 90 and 180, respectively. Results: Triglyceride and sodium concentrations increased significantly with time and protein concentration decreased significantly over 180 days. Sodium (P=0.02) and triglyceride concentrations (P=0.06) were higher in milk samples of mothers who had introduced mixed feeding by 6 months post natal age (n=6) compared to exclusively breast-feeding mothers (n=6); but lactose and protein content was not significantly different. Conclusions: Milk of preterm mothers has higher amount of triglycerides and sodium during introduction of mixed feeding.

A Bacteriological Study of Vibrio cholerae Isolated from Rural Tertiary Care Hospital of Loni, Western Maharashtra.

Aim: Cholera is endemic in many parts of India and a major public health problem. The present study was carried out with the aims to understand biotype, serotype, phage type and drug resistance of Vibrio cholerae isolates obtained at a rural tertiary care hospital in Loni. Study Design: Descriptive retrospective study was carried out to study V. cholerae isolates from 544 faecal specimens of patients with acute gastroenteritis. Place and Duration of Study: The study was conducted during 2009-2012 at Rural Medical College of Pravara Institute of Medical Sciences, Loni, District Ahmednagar, Maharashtra, India. Methods: A total of 28 isolates of V. cholerae were included in the study. V. cholerae was identified by standard microbiological procedures. Biotyping, serotyping and phage typing was done. Antibiotic sensitivity testing was performed by Kirby- Bauer disc diffusion method. Results: V. cholerae strains were isolated from 28 faecal specimens. All the isolates were identified as V. cholerae O1 biotype El Tor serotype Ogawa and phage 27 was the predominant type. Male: Female ratio was 1:1.5 and high incidence was seen in 0-10 age group (35.71%). Maximal occurrence in monsoon season was recorded. All the isolates were resistant to co-trimoxazole, nalidixic acid and ampicillin. However maximum sensitivity was observed to norfloxacin (71.42%) followed by gentamycin (67.85%) and chloramphenicol (28.57%). Conclusion: A continuous surveillance for V. cholerae is required with respect to changing epidemiology and emergence of antibiotic resistance strains. The source and spread of infection should be investigated to decide the proper management strategies. Additionally, quality of water and status of sanitation should be monitored.

Seropositivity of HIV and HBV Co-infection.

The rise of HIV as well as HBV infections in rural population is alarming. Different studies suggest, approximately one third of HIV infected individuals also harbour Hepatitis B virus simultaneously. Co-infection of HIV and HBV leads to complex immuno-pathological disease heralding poor prognosis. The present study was undertaken to ascertain sero-positivity of HIV and Hepatitis B virus co-infection in and around the rural area of Loni. The rate of sero-positivity for HIV infection was 2.61%; however, that of Hepatitis B was 1.26 %. The incidence of Hepatitis B in HIV infected individuals was found to be 2.5 %.

A rare case of an appendiceal mass masquerading as a pelvic tumour and causing bilateral hydronephrosis

Diagnosing acute appendicitis in children can be difficult due to atypical presenting symptoms. While there are reported cases of acute appendicitis or appendiceal masses causing unilateral hydronephrosis, bilateral hydronephrosis as a complication of appendiceal mass is very rare. We report a case of a child who presented with cardinal symptomatology associated with the urogenital tract. Ultrasound (US) investigation showed a pelvic mass causing bilateral hydronephrosis. An initial diagnosis of a pelvic teratoma was made based on the US and computed tomography (CT) scan findings. The final diagnosis of an appendiceal mass causing bilateral hydronephrosis was established intraoperatively.

Avaliação da condição de saúde bucal como um indicador de progressão da doença em crianças HIV positivas / Evaluation of oral health status as an indicator of disease progression in HIV positive children

Objetivo: Avaliar a condicao de saude bucal (condicao gengival, carie dentaria, lesoes na mucosa oral) em um grupo de criancas HIV positivas em relacao a contagem de CD4. Metodo: Um total de 234 criancas HIV positivas com idades entre 2 e 15 anos foram examinadas. A carie dentaria foi avaliada segundo os criterios da OMS. Os tecidos gengivais foram analisados sendo empregado o indice de sangramento gengival. Para a presenca de biofilme dental empregou-se o indice de Sillness e Loe. As criancas encontravam-se sob terapia anti viral e a contagem de CD4 de cada um dos pacientes foi obtida por meio dos prontuarios hospitalares. Resultados: Os escores maximos ceo-d/ceo-s foram observados nas criancas cuja contagem de CD4 estava entre 200 - 500. Entretanto, as medias mais altas do cpo-d/cpo-s foram vistas nas criancas com contagem de CD4 menor de 200. As medias de placa, sangramento gengival foram mais elevados nos individuos com contagem de CD4 menor que 200, sem diferenca estatisticamente significante. Candidiase pseudomembranosa foi a lesao oral mais observada. A lingua foi o local mais comum de ocorrencia de lesoes bucais em todos os grupos. Conclusao: A condicao de saude bucal em criancas HIV positivas deteriora-se com o declinio da contagem de celulas CD4.

Objective: To evaluate the oral health status i.e., gingival condition, dental caries, oral mucosal lesions progression in a group of HIV positive children in relation to CD4 count. Method: A total of 234 HIV positive children in the age group of 2-15 years were included in the present study. Dental caries status was evaluated as per the criteria devised by WHO. Gingival condition index was used to assess and criteria given by Muhlemann was used for Papillary Bleeding scores. Plaque was assessed using the Sillness and Loe Index. The children were under active anti retroviral therapy the CD4 count of each patient was available from the hospital records. Results: Maximum dmft /defs, score was observed in individuals with CD4 count 200 - 500. Whereas highest mean DMFT/DMFS score was seen in children with CD4 count less than 200. The mean plaque, gingival and papillary bleeding score were highest in individuals with CD4 count less than 200 but the difference was statistically insignificant. Pseudomembranous candidiasis was the most observed oral lesion. Tongue was the most common site of occurrence of oral lesions in all groups. Conclusion: The study confirms that the oral health status in HIV positive children deteriorates with the decline in CD4 count.

Effect of Emblica officinalis (Gaertn) on lens regeneration in the frog, Rana cyanophlyctis (Schneider).

Emblica officinalis (Amla) accelerated cell proliferation and dedifferentiation of pigmented epithelial cells of dorsal iris and consequently induced lens regeneration in R. cyanophlyctis. Further it enhanced the percentage of lens regeneration not only in young tadpoles but also is adult frogs. Lens regeneration ability declined with the age of animals in both control as well as treated groups.

Correlation between baseline CD4 + T-Lymphocyte count and plasma viral load in AIDS patients and their early clinical and immunological response to HAART: a preliminary study.

The aim of this study was to determine the clinical, immunological and virological status of newly diagnosed AIDS cases and to monitor their clinical and immunological response to HAART after a minimum period of three months. Forty three drug naive AIDS patients were enrolled. The most common presenting complaints were weight loss (74.4%), cough (72.1%) and diarrhoea (67.4%). Mean baseline CD4 cell count was 112 +/- 60 cells/microL and mean baseline plasma viral load of 31 patients studied was 192,686 copies/mL. Baseline plasma viral load was higher among patients with lower baseline CD4 cell count. During follow-up, 80.8% patients showed clinical improvement, while a CD4 cell count increased by > or =50 cells/microL in 84.6% cases. Mean CD4 cell count increased from 126 +/- 16.6 cells/microL at baseline to 278 +/- 196.7 cells/microL.

Comparative evaluation of shear bond strength of different bracket base designs in dry and wet environments.

One hundred and thirty five extracted premolars were selected and bonded with three types of brackets with different bracket base designs viz. Gemini (foil mesh), Miniature twin (Laser etched) and Mini Dynalocks (Integral base). These brackets were bonded with Transbond XT adhesive using two types of primers viz. Conventional Transbond XT in dry conditions and M.I.P in dry and wet environments. The specimens were tested for SBS using Instron machine at C.I.P.E.T. (Amritsar), Punjab. Results were statistically analyzed. RESULTS AND DISCUSSION: The Miniature twin brackets revealed higher SBS values as compared to Gemini and Mini Dynalock in dry and wet conditions. All the groups showed higher SBS values in dry conditions as compared to wet conditions respectively. The Gemini and Mini Dynalock brackets showed very little difference of SBS values. CONCLUSION: Miniature twin brackets with laser etched bracket base in dry and wet environments have revealed the highest SBS values. All the groups have revealed clinically acceptable SBS value of above 8 MPa in moist conditions.

Simultaneous detection of Neisseria gonorrhoeae and Chlamydia trachomatis by PCR in genitourinary specimens from men and women attending an STD clinic.

Neisseria gonorrhoeae and Chlamydia trachomatis are the two most common bacterial sexually transmitted infections that manifest primarily as urethritis in males and endocervicitis in females, though the infection may be asymptomatic especially in women. Since complications may occur in untreated symptomatic and asymptomatic infected individuals, early diagnosis and treatment of infected individuals is required to prevent severe sequelae and spread of these diseases. Recently molecular amplification assays like Polymerase Chain Reaction (PCR) and Ligase Chain Reaction (LCR) have been found to be highly sensitive and specific methods for detection of N. gonorrhoeae and C. trachonmatis not only in urethral and cervical specimens but also in urine. The objective of this study was to screen male and female Sexually Transmitted Disease (STD) clinic attenders, with and without symptoms suggestive of urethritis and cervicitis for presence of N. gonorrhoeae and C. trachomatis using a multiplex PCR based assay, to compare its performance with culture for N. gonorrhoeae and Direct Fluorescent Antibody (DFA) staining for C. trachomatis and also to compare the efficacy of PCR test performed on urine and genital swab specimens collected from this high risk group. Genital specimens and urine was collected from STD clinic attenders. N. gonorrhoeae and C. trachomatis was detected in genital specimens by culture and DFA respectively. Multiplex PCR was used to detect N. gonorrhoeae and C. trachomatis infection in both genital and urine specimens. Among men with urethritis, N. gonorrhoeae was detected in 70% by culture and 77% by PCR, while C. trachomatis as detected in 7.5% by DFA and 17.5% by PCR. Among females with endocervicitis, N. gonorrhoeae was detected in 7.7% by culture and 30.7% by PCR, while C. trachomatis was detected in 7.7% by DFA and in 15.4% by PCR. None of the asymptomatic males were positive for N. gonorrhoeae and C. trachomatis by conventional methods, while 43.9% were positive for N. gonorrhoeae and 7.5% for C. trachomatis by PCR. Fifty per cent of asymptomatic women were positive for C. trachomatis by PCR alone. We encountered PCR positive but culture/DFA negative results and also PCR negative but culture/DFA positive results. In view of this a single PCR test cannot be used for diagnosis and treatment of N. gonorrhoeae and C. trachomatis infection unless confirmed by a second test.

Role of anaerobes in acute pelvic inflammatory disease.

Pouch of Douglas aspirates were collected from 50 women with history and examination suggestive of acute pelvic inflammatory disease (PID) and 20 healthy women admitted for tubal ligation served as control. A total of 57 microorganisms were isolated from 37 patients out of 50 in study group. Of 37 positive cultures 21(56.7%) were monomicrobial and 16(43.2%) were polymicrobial. Most common symptom in study group was lower abdominal pain (90%), vaginal discharge (70%) and irregular bleeding (40%) and 30% patients had history of intrauterine contraceptive device (IUCD) implantation. The predominant aerobic isolates were Escherichia coli, Coagulase Negative Staphylococcus (CONS), Staphylococcus aureus, Klebsiella pneumoniae while common anaerobes were Bacteroides fragilis, Prevotella melaninogenica, Fusobacterium nucleatum and Peptostreptococcus spp. Our study shows that cefotaxime, cefuroxime and gentamicin may be used for gram negative aerobic bacilli; cloxacillin, cephaloridine and erythromycin for aerobic gram positive cocci and amikacin and ceftazidime for Pseudomonas aeruginosa. Thus for optimum therapy of acute PID it is beneficial to keep in mind major conceptual changes and therapeutic realities that have influenced current understanding of acute PID and have affected the choice of therapy.

Antibiotic susceptibility of bacterial isolates in gingivitis and periodontitis.

The present study was conducted to isolate aerobic as well as anaerobic microbes from patients of gingivitis and adult periodontitis and to study the susceptibility patterns of these isolates to different antibiotics. In our study all the samples belonging to the control as well as the study groups yielded microbes. Aerobes and facultative anaerobes were isolated from 100 percent and 96 percent cases of normal gingiva and orodental infections respectively. Anaerobes were isolated from 80 percent of the normal gingival samples and 97 percent of the cases of orodental infections. Metronidazole was found to be the best for the anaerobes while the aerobes and facultative anaerobes showed good susceptibility to cefazolin and cefotaxime.