Determinants of delay in initiation of post exposure prophylaxis for rabies prevention among animal bite cases attending a rural tertiary care hospital of Haryana

Introduction : Rabies is a fatal but vaccine-preventable viral disease. Animal bite victims who report in primary and secondary level health care lack some measures which can help in protecting and preventing deaths due to rabies. The most important factor for prevention of death due to rabies is the timely administration of post-exposure prophylaxis (PEP) among animal bite victims. Therefore, in addition to an understanding of the epidemiological distribution of animal bites, it is necessary to explore the factors leading to delay in PEP initiation. Objective: To determine the determinants of delay in initiation of post exposure prophylaxis for rabies prevention among animal bite cases attending anti-rabies clinic of a ruraltertiary care hospital in Sonepat, Haryana. Method: This cross-sectional study was conducted at an Immunization-cum-antirabies clinic of Bhagat Phool Singh Government Medical Collegefor Women, Khanpur Kalan, Sonepat, Haryana. A pre tested, structured questionnaire was used to collect information among 410 participants after taking consent. The Institutional Ethics Committee of institute approved the study. The groups were compared with Chi-square test for categorical data. Results: Delay was present among 27.3% of participants. Significant factors of delay were no local wound treatment, any treatment taken prior to anti-rabies vaccine administration, rabies clinic closed on holidays, unawareness about PEP, non-availability of accompaniment, transportation issues and money problem for transportation. Knowledge also played significant role as delay was significantly more among the participants not having knowledge regarding source of infection, mode of transmission and incubation period of rabies. Conclusions: Delay ininitiation of PEP was common and were significantly associated with lack of knowledge and unawareness, closure of rabies clinic on Sundays/holidays, non-availability of accompaniment and money problem during transportation

Clinical and demographic profile of patients treated with electro convulsive therapy from a tertiary care psychiatry hospital in North India

Background: Electro-convulsive therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. This study was undertaken with the aim of exploring the clinical and demographic profile of patients treated with ECT from a tertiary care psychiatry hospital in north India.Methods: It was a retrospective descriptive study of patients who were treated with ECT after admission in the inpatient psychiatry unit of Institute of mental health and neurosciences Kashmir during a period of one year (March 2017 to February 2018).Results: A total of 70 patients received ECT during the course of one year. About 72.85% of the patients belonged to 20-39 years age group. Female patients constituted more than half of the subjects (55.71%). Review of diagnostic profile showed that majority of patients receiving ECT were suffering from Schizophrenia (35.71%), followed by bipolar affective disorder (28.57%), depressive disorder (28.57%), schizoaffective disorder (4.28%) and substance induced mood/psychotic disorders (2.85%). A significant majority of subjects (57.13%) received about 7-9 ECT sessions. No any major complications were noted during ECT treatment.Conclusions: This study suggests that ECT, use as a treatment modality is common in adults between 20 to 39 years of age and females with Schizophrenia being the most common indications.

Alcohol and drug intake pattern among truckers of Haryana, India

Background: Newborn period is culturally and traditionally sensitive in every society. Different communities have different traditional practices when it comes to taking care of newborn. Head-shaving in newborn period is one such unique traditional practice existent among rural population of West Bengal. This study was conducted to explore the traditional practice of head-shaving and to highlight its related morbidities among newborns following head-shaving.Methods: This was a descriptive, cross-sectional study conducted at triage of special newborn care unit of Malda Medical College and Hospital among 650 mothers who presented to us with their sick newborns following head-shaving. After obtaining informed consent, mothers were interviewed. The data were collected using pre-designed questionnaires. Statistical analyses of the data were done using SPSS version 21.Results: In the present study, majority (52.62%) of the mothers were within the age group of 18-21 years and 94.15% belonged to Muslim community. Neonatal head-shaving was usually done on 4th day of life (48.15%) and on 10th day of life (28.77%). Baby bath following head-shaving was given in 49.54% newborns using pond water and 77.70 % mothers used crude mustard oil for massaging following baby bath. Following head-shaving, 37.69% of newborns presented with poor feeding, 33.23% with abdominal distension and 61.23% presented with respiratory distress.Conclusions: Findings of present study highlights the harmful aspects of traditional practice of head-shaving among newborns in rural Bengal. This practice can be avoided by proper health education and counselling of the mothers and her associates involved in newborn care.

A Comparative Study of AIMS 65 Score with other Scoring Systems to Predict Outcomes in Patients with Upper GI Bleed in Chronic Liver Disease

Introduction: The AIMS 65 score is a new bedside scoreproposed for the assessment of liver function which issimple and more independent. Different scores have beenrecommended to predict outcomes in the setting of uppergastrointestinal bleeding (UGIB), limited comparative studieshave been published between simplified versions of olderscores and recent scores. In this present study, we aimed toretrospectively compare the performance of AIMS 65 scorewith Child-Pugh score, MELD score and ALBI score forpredicting the outcome in patients with upper GI bleed inchronic liver disease.Material and Methods: Data of patients with chronic Liverdisease secondary to ethanol were retrospectively reviewed.Child Pugh score, MELD score, ALBI score and AIMS 65score were calculated for the patients and results . ROC curvesderived from comparison with outcome and were analysed.Results: In our study conducted on 112 patients, the agedistribution was between 20-85 years with mean age ofpatients being 46.47 ± 10.9 years, sex ratio Male: Female:105:7 with mortality rate of 33.92%. The Area under curves ofROC of AIMS65, Child Pugh score, MELD score, ALBI scorewas 0.779, 0.864, 0.763 and 0.777 respectively.Conclusion: AIMS 65 is a simple and non-endoscopic scorefor the prediction of in hospital mortality. No statisticaldifference was observed between AIMS-65 and other scoressuch as Child Pugh score, ALBI and MELD score.

Prevalence and risk factors associated with prehypertension and hypertension among attendants of patients at a rural tertiary care institute of Haryana

Background: Hypertension (HTN) is the leading risk factor for death and disability globally and disproportionately impacts low-and middle-income countries. HTN is present in 25% of urban and 10% of rural subjects in India. Our objective was to estimate the prevalence of pre-HTN and HTN among the attendants of patients at a rural tertiary care institute of Haryana.Methods: This was a hospital-based cross-sectional study. A total of 309 attendants of patients were enrolled for this study. Diagnosis of pre-HTN and HTN was done on the basis of seventh joined national committee guidelines. Data were collected on a semi-structured proforma and were analysed by using R software.Results: The prevalence of pre-HTN and HTN was 18.4% and 21.4% respectively. Both the pre-HTN and HTN were significantly higher in males (p=0.002) and in the age group of 45 to 55 years (p<0.001). The multinomial logistic regression analysis revealed that sex, age >55 years and BMI >23 kg/m2 were significantly associated with pre-HTN and HTN.Conclusions: The prevalence of both prehypertension and hypertension is high in rural Haryana. This makes the people of this area vulnerable to several chronic diseases. The findings warrant urgent measures to lower the risk factors in rural communities. So, programs are needed to improve the surveillance systems and implementation of community based screening programs for early detection of hypertension.

Obstetric outcome of induction of labor using prostaglandin gel in patients with previous one cesarean section

OBJECTIVE: After globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains. METHODS: All patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis. RESULTS: Both groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2. CONCLUSION: This study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.

Metabolic syndrome among students of BPSGMC for Women Khanpur Kalan, Sonepat

Background: A quarter of the world’s adult population has Metabolic Syndrome (MetS) and this condition is appearing with increasing frequency in children and adolescents due to the growing obesity epidemic within this young population. Objective: To determine the prevalence of metabolic syndrome (MetS) in the apparently healthy female medical students in BPSGMC for Women Khanpur Kalan, Sonepat and to find the risk factors associated with these conditions among the study subjects. Methods: This cross-sectional study was conducted in rural BPS Government Medical College for Women, Khanpur Kalan, Sonepat from April 2018 to September 2018 for a period of six months. The study population included all the undergraduate medical students of 2016 and 2017 batches. Semi-structured and pretested questionnaire was used to collect the data regarding demographic characteristics, anthropometric parameters and biochemical markers using standardized methods. MetS was defined as per National Cholesterol Education Programme Adult Treatment Panel (NCEP ATP III) criteria modified in 2004. Statistical analysis was carried out with R v 3.5.1 Results: The prevalence of metabolic syndrome was 9.8%. It was 7.7% in 17-19 years age group and 11.2% in 20-23 years age group. All the study subjects with MetS had abdominal obesity. MetS was significantly associated with elevated blood pressure, fasting plasma glucose ≥100 mg/dl, serum triglyceride ≥150 mg/dl and serum HDL cholesterol level <50 mg/dl. Conclusions: Metabolic syndrome exists in significant number among apparently healthy female medical students. Policy makers and healthcare providers can develop effective lifestyle interventions such as diet and physical activity for addressing the risk factors for metabolic syndrome.

The relationship between test anxiety and academic performance among undergraduate medical students

Background: Undergraduate medical education comprises strenuous study and training for five and half years. Mental health of medical students remains affected throughout this period. Objective: To assess the test anxiety in the undergraduate medical students and to find out the relationship between the test anxiety and academic performance in the students. Methods: This cross-sectional study was conducted in a Rural BPS Government Medical College for Women, Khanpur Kalan, Sonepat. The study population included all the undergraduate medical students enrolled from 2012 to 2016. Data pertaining to various socio-demographic characteristics were obtained by interview technique using a pre-designed, pre-tested questionnaire ensuring privacy and confidentiality and reviewing academic records. Nist and Diehl test anxiety questionnaire was used to determine the anxiety score of students. Statistical analyses were carried out with R v 3.5.1. Results: A total of 240 students participated in the study. More than one quarter (26.3%) of the students did not suffer from test anxiety, 62.9% students exhibited healthy test anxiety and 10.8% of the students experienced unhealthy test anxiety. In relation to academic performance of the respondents, 4 (12.5%), 47 (24.9%) and 12 (63.2%) of respondents who performed fair, good and excellent respectively had no anxiety level as against those who had healthy anxiety and unhealthy anxiety level and these differences were statistically significant. Conclusions: Text anxiety is significantly associated with academic performance. These findings suggest the need of healthcare provision to prevent unhealthy test anxiety among medical students, as it decreases the academic performance.

Diversity of Plant Species in The Steel City of Odisha, India: Ethnobotany and Implications for Conservation of Urban Bio-Resources

ABSTRACT The vegetation of the Steel City (Rourkela) of Odisha, India has high ethnobotanical values by virtue of its rich floral diversity. People in the urban area are highly dependent on the plants available in and around the city for their primary needs. The present study highlights the use of local flora, explore, identification, ethnobotany and conservation of wild and cultivated plant species in the city of Rourkela, Odisha, India. It also pays heed to the proper utilization of urban flora as a way of highlighting its ethnopharmacological importance. A field survey was conducted to collect information about floral diversity in and around the city. Data on the use of plants was collected with a semi-structured questionnaire and from the peer-reviewed literature. A total of 154 plant species, belonging to 128 genera and 55 families, were identified, along with their botanical name, vernacular name, family and habitat. Of these plant species, 53 are medicinal, 43 are ornamental, and 33 are edible, while 23 are weeds. Paderia foetida and Saraca asoka fall into the RET (rare, endangered and threatened) group and are very effective against various diseases. Traditional uses of local plants in an urban area like Rourkela are very interesting. This shows that, not only rural and tribal areas are rich in useful bio-resources but so are urban or semi-urban areas. The documentation of all useful flora with ethnomedicinal potential is helpful in conserving plant biodiversity as well as in environmental studies along with potential applications in drug discovery and oriental medicine.

Antioxidant activity, antibacterial potential and characterization of active fraction of Dioscorea pentaphylla L. tuber extract collected from Similipal Biosphere Reserve, Odisha, India

ABSTRACT Dioscorea pentaphylla L., a wild tuber is used both as food and medicines among different ethnic groups of Similipal Biosphere Reserve, India. Tubers are used against skin infections. In order to establish and confirm tribal claims, methanol extract was subjected to fractionation. The active fraction (DP1) was subsequently used for further purification and NMR (Nuclear magnetic resonance) characterization. The phytochemical analysis revealed the presence of saponin groups. The antibacterial activity of DP1 was done against selected bacterial strains (Salmonella typhi, Shigella flexneri, Streptococcus pyogenes, Streptococcus mutans and Vibrio cholerae) using DD (disc diffusion), AWD (agar well diffusion) and broth dilution assay. The activity was compared with antibiotics Penicillin and Kanamycin. It was observed that DP1 showed significant inhibitory activity against the tested bacteria. The characterization of DP1 through NMR analysis and presence of proton in carbon position at C-3, C-19, C-18, C-21 and C-27 was same as the known compound "Diosgenin". Therefore, isolated compound was confirmed to be Diosgenin. The study for the first time showed that, diosgenin present in D. pentaphylla tuber was responsible for antibacterial and antioxidant potential. Present study highlights the importance of Dioscorea species as sources of diverse secondary metabolites for the isolation of active compound(s).

Evaluation of Medicinal Values of Gymnopetalum chinense (Lour.) Merr., a Lesser Known Cucurbit from Eastern Ghats of India

ABSTRACT >The in vitro antimicrobial activity of Gymnopetulum chinense (Cucurbitaceae), a lesser known climber of Eastern Ghats and recently recorded species from Odisha, India was studied against five selected human pathogenic bacteria (Streptococcus mutans, S. pyogenes, Vibrio cholerae, Shigella flexneri and Salmonella typhi), by agar well diffusion (AWD), disc diffusion (DD) and broth dilution methods. Different solvent extracts were prepared from the leaves of G. chinense using various solvents viz. n-hexane, chloroform, methanol, acetone and aqueous. The nomenclature, detailed description and photographs of the plant are provided to facilitate its easy identification. The leaf extract showed presence of phenolic compounds, tannin, saponin, flavonoids and glycosides. It was examined that methanol extract showed highest zone of inhibition (16.66 mm) against S. pyogenes using DD assay. Similar results were examined as lowest MIC values were found with methanol leaf extract against S. pyogenes and S. mutans (200 µg/ml). Present study showed first report of this plant as natural antibacterial agents and highlights the importance of G. chinense in curing the bacterial infections.

Problem-based learning versus lecture-based learning in pharmacology in a junior doctor teaching program: a crossover study from northern India.

Background: The undergraduate MBBS training in our country is still in the traditional mode. The main part of the curriculum consists of lecture, tutorial, practical and ward teaching classes with a limited number of problem based session. The objective of the study was undertaken to compare PBL with LBL in terms of students’ knowledge retention in the subject of Pharmacology in undergraduate medical training. Methods: The current survey was planned and executed by the Department of Pharmacology in collaboration with Medical Education Unit, MSDS Medical College, Fatehgarh in the batch currently posted in the Department of Pharmacology for practical classes. Fifty MBBS students posted were enrolled for the study and were divided in 2 groups. One of the topics was presented as LBL for the first group and as PBL for the second group. The other topic was presented as PBL for the first group and as LBL for the second group. Intervention and control groups were taken as those used PBL and LBL respectively. T test was used to compare mean scores obtained by students in the intervention and control groups. Results: Mean scores obtained by students in the intervention group (topics learnt with PBL) were higher (3.80 Vs 2.84) than mean scores obtained by students in the control group (topics learnt with LBL). Mean scores obtained by students in the intervention group were higher (3.72 Vs 2.96) than mean scores obtained by students in the control group. Conclusions: The current study indicates usefulness of Problem-based learning (PBL) over Lecture-based Learning (LBL) in terms of retention of knowledge. However further studies involving more number of students are warranted in order to generate stronger evidence on this tool for improving medical education in our setup.

A prospective study of incidence and assessment of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school.

Background: The wide and indiscriminate use of drugs has increased the incidence and the modes of presentation of cutaneous drug reaction. Understanding the nature of ACDRs may help narrow down the search for the offending agent. Aim- The study aimed to evaluate incidence, assessment of causality, severity and preventability of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school. Material and methods: The current survey was executed by the department of Pharmacology in collaboration with Department of Dermatology, MSDS Medical College, Fatehgarh among 7692 patients attending Dermatology OPD during March-December 2014. CDSCO ADR Reporting Form, WHO causality assessment scale, Hartwig and Siegel’s Assessment scale and Modified Schomock and Thronton’s preventability assessment scale were used as study tools. All the doctors, residents, interns and students were encouraged to notify any suspected ACDRs. Patients were screened and recruited if they presented with visible skin lesions suspected to be drug related. As per Modified Schumock and Thornton Scale, 43.5% of ACDRs were ‘Definitely preventable’ followed by ‘Probably preventable’ (30.4%) and ‘Not preventable’ (26.1%). Results: 23 patients (0.3%) were detected to have one or other type of ACDRs. Fixed drug eruption was most common form (34.8%) of ACDRs followed by Acneform eruption and Urticaria in 21.7% and 13% respectively among study subjects. The most common drugs responsible for ACDRs were prednisolone, betamethasone and isoniazid for Fixed drug eruption, while matronidazole, cotrimoxazole and paracetamol for acneform eruption. Antimicrobials, other steroids and NSAIDs were responsible for other spectrum of ACDRs. On assessment of Causality of ACDRs, it was noted that more than half (52.2%) of them fall under probable category. Severity assessment of ACDRs revealed that majority (65.3%) of them was moderate in nature. Conclusion: Awareness on part of the physician can help in timely detection of cutaneous reactions, thereby restricting damage from them. Pharmacovigilance activity is significantly effective in increasing the reporting of ADRs. Study with long-term follow-up and monitoring of the patients with bigger sample size is warranted.

A rapid appraisal of factors influencing utilization of primary eye health services among the residents in a rural community.

Background: Identification of factors affecting utilization of primary eye health services would help the government and other eye care providers to address inequity issues in their eye care program. Aim: Therefore this study was planned to find out barrier to utilization of eye health services among people living in rural western Uttar Pradesh. Material and methods: The current community based cross-sectional survey which involved both qualitative and quantitative methods, was conducted among the residents. A total of 216 study subjects participated in the study. Factors in the supply side influencing utilization of eye health services by people from the community were sought through Focus Group Discussion (FGD) and Key Informant Interview (KII). Results: Almost 80% of the respondents had agriculture as their major occupation and > 1/4th were from lower caste community. Regarding the seeking of eye care services, 52.4% respondents who gave a positive history of an eye problem in the family told they attended the nearest health facility; CHC, PHC or SC while 19.2% did actually go to the eye health center. Only 4.8% respondent did not seek any service. Among 112 respondents who were aware of one or other eye diseases, 74.6% identified dirty things fallen into the eyes as the cause of an eye problem followed by 50.3% of the respondents who pointed out injury to the eyes as the culprit. For emergency problem in the eyes 79.2% respondents told that they sought services from health facilities without delay, while 15.4% gave priority to starting household treatment. Conclusion: Raising awareness of the community about eye diseases and the services available together with strengthening of primary eye health services available at the local health facilities could help bring eye health services in closer proximity to the rural population.

A study on perceptions about eye health care and promoting factors for eye donation among medical students from a tertiary care teaching hospital.

Background: Voluntary eye donation depends on the awareness levels of various stakeholders in the community. Today’s medical students are tomorrow’s stakeholders of the community. Medical professionals can enhance eye donation rates by educating and motivating the relatives in case of patient's death. Aim: Hence the present study was undertaken with an objective of assessing the promoting factors for eye donation among medical students. Material and methods: The present descriptive cross sectional study was carried out among undergraduate students of a medical college in western Uttar Pradesh in the month of February 2014 using pretested self administered questionnaire. Results: 77% students knew about eye donation. 51% of them were willing to donate their eyes. Only 39% students knew that the ideal time for eye donation is within 6 hours of death. 64% had knowledge about vitamin A’s important role in prevention of childhood blindness. TV, newspaper or other media were the most important channels of getting information for majority (60%) of the students. Regarding perceived promoting factors for eye donation by them, noble cause (57%), pleasure to help the blind (51%) and inspired by advertisement on television (42%) were 3 top most promoting factors. Conclusion: Inclusion of different preventive and promotive aspects of corneal blindness along with basic eye health care into the course curriculum is the need of the hour.

Prevalence and clinical evaluation of Pressure Ulcers using Braden scale from orthopedics wards of a tertiary care teaching hospital.

Background: The need for research into bed sores in orthopedic patients is evident from the increased number of beds they occupy and the considerable morbidity from pressure sores in orthopedic wards. Objective: To analyze and ascertain the prevalence and clinical evaluation of Pressure Ulcers from orthopedics wards of a tertiary care teaching hospital. Material and methods: The present prospective study was conducted by the Department of Orthopedics of a tertiary care teaching hospital from July 2009 to August 2014 among 228 patients seeking care for trauma to proximal femur, hip joint, pelvis and undergone elective surgery or surgery for removal of old implants. Braden scale was used for predicting pressure ulcers in the study subjects. All patients showing the potentiality of developing clinical signs of bed sores were selected and put on the study list. Patients aged ≥ 80 years, sick patients due to terminal illnesses and the worst pressure sores were excluded from the study. Results: Out of total 228 study subjects, 61 subjects developed pressure ulcers giving a prevalence of 26.75%. According to Braden Scale, 16.39% of patients were at high risk for developing the pressure ulcers. 68.85% of ulcer patients were treated for trauma mostly for fracture hips, pelvis or proximal femur or spine. Majority of patients (60.66%) developed pressure ulcers after the second week of admission. The lengths of stay of patients with bed sores exceed the stay of non sores patients on orthopedic wards by several times. Sacrum was the most commonly affected part of body. Conclusion: The findings of the current study highlight the multi-factorial etiology of pressure ulcers and they are preventable. Its prevention would require multidimensional approach including the collaboration of all the nursing and surgical staff. Frequent patient turning, close monitoring and frequent skin checks would delay the onset of pressure ulcers.

Prevalence of microbial infection and strategic pattern of antimicrobial resistance among intensive care unit patients in a tertiary care teaching hospital from rural Northern India.

Background: Better management of patients cannot be ensured and the antibiotic policy cannot be designed till one knows the profile of prevalent strains along with their antimicrobial resistance pattern. Objective: To assess the strategic patterns of the organisms and its resistance patterns that were isolated from the patients admitted in various ICUs in a tertiary care hospital. Material and methods: The present study was undertaken based on reports of bacterial isolates of various clinical specimens from different ICUs of a tertiary care teaching hospital, that were submitted to the Microbiology laboratory for culture and sensitivity during the period of October 2012 to September 2014. All the organisms were identified morphologically and biochemically by standard laboratory procedure and antibiotic susceptibility pattern was determined by disc diffusion methods. Results: Out of the total samples (2920) received; organisms were isolated from 66.57%. One organism was isolated in 71.19% samples whereas 2 or more organisms were obtained in 28.8% were obtained in 28.8% samples. The most frequently isolated bacteria were P. aeruginosa (38.17%). Among P. aeruginosa, tobramycin had the highest susceptibility rate (94.2%) followed by meropenem (93.93%), carbenecillin (79.11%), and levofloxacin (73.45%). Most of the frequently isolated organisms like K. pneumoniae, Acinetobacter anitratus, Enterobacter were highly resistant to ampicillin, cephalexin, cefepime, ciprofloxacin. Conclusion: Appropriate antibiotic utilization in ICU is crucial not only to ensure an optimal outcome, but also to prevent the emergence of multi drug resistance. Antibiotic policies and effective surveillance are needed for better management of ICU infections with resistant organisms, Alteration and rotation in antibiotic prescribing patterns would decline the antibiotic resistance.

A prospective comparative trial of collagenase and metronidazole in the topical management of diabetic foot ulcer.

Objective: To assess the efficacy of metronidazole and collagenase combination in the treatment of diabetic foot ulcers with regard to the reduction of slough formation, enhancement of granulation tissue and re-epithelization. Study design: Prospective, comparative study. Place and duration of study: Surgery department of a tertiary care teaching centre of rural Haryana, from January 2011 to February 2013. Methodology: The patients who were admitted for diabtic foot ulcers at Surgery Department of a tertiary care teaching centre during the study period were screened. 42 patients in the test group were treated with topical dressings of collagenase and metronidazole. The control group of 40 patients was treated with conventional topical dressings and bed side debridement. Ulcer's status was noted using visual score. Results: The number of patients with no necrotic tissue was significantly higher in test group at 3rd, 4th, 5th, 6th and 7th weeks than control group. Granulation tissue was significantly higher in test group at 3rd, 4th, 5th and 6th week. The test group patients had a faster wound bed preparation resulting in faster wound cover using secondary suturing, S.S.G., flap cover at the third week itself. Conclusion: Combination of collagenase and metronidazole topical application enhanced wound healing of diabetic foot ulcer as compared to conventional treatment modalities.

Updated BG Prasad Socioeconomic Classification, 2014: A Commentary.

Modified BG Prasad socioeconomic scale is widely used to determine the socioeconomic status of study subjects in health studies in India. It is an income-based scale and, therefore, has to be constantly updated to take inflation and depreciation of rupee into account. The Consumer Price Index (CPI) for industrial workers (IW) is used to calculate updated income categories for January 2014. Details of the calculations involved will enable young researchers to calculate specific income categories for their research work. State-specific CPI values are also available on the Department of Labour website and should be used to determine more accurate income categories for the study area.

Do joint national committee VII criteria also need to take non pharmacological measures into consideration? – Empirical evidence from slum resettlement colony from Delhi.

Background: Currently Joint National Committee (JNC) VII criteria are used worldwide to diagnose hypertension but it does not take non pharmacological measures into consideration. Also, it does not consider Indian system of medicine. Objectives: To assess whether JNC VII in its present form is valid to diagnose hypertension correctly or revision is required especially for Indian communities where such practices are prevalent. Material and methods: The present community based cross-sectional study was carried out in nand nagri, a slum resettlement of East Delhi which comes under field practice area of the Department of Community Medicine, UCMS, Delhi from August 2010 to February 2012. Total 310 subjects aged 20- 59 years were selected through multistage systematic random sample. Though the blood pressure cut-offs considered in our criteria was similar to the JNC VII cut-offs (SBP ³140 mmHg and or DBP ³90 mmHg), the difference was in the last part of JNC VII definition of hypertension i.e. treatment by anti hypertensive medicines; our criteria comprised of this statement as “any anti hypertensive measure”. Chi-square (χ²) test was applied for analysis. Results: Overall 54 were found to have hypertension by JNC VII criteria whereas 61 by our criteria. Seven patients who were not hypertensive by JNC VII but hypertensive by our criteria and the difference was found to be statistically highly significant (p<0.001). Exercise was the most common non pharmacological measure adopted by male gender where as in females, salt restriction was the most common measure adopted Conclusion: Our study emphasized inclusion of non-drug therapy measures into consideration while making diagnosis of hypertension in our setup.