A comparison of the quality of images of chest X-ray between handheld portable digital X-ray & routinely used digital X-ray machine

Background & objectives: Chest X-ray (CXR) is an important screening tool for pulmonary tuberculosis (TB). Accessibility to CXR facilities in difficult-to-reach and underserved populations is a challenge. This can potentially be overcome by deploying digital X-ray machines that are portable. However, these portable X-ray machines need to be validated before their deployment in the field. Here, we compare the image quality of CXR taken by a newly developed handheld X-ray machine with routinely used reference digital X-ray machine through the conduct of a feasibility study. Methods: A total of 100 participants with suspected pulmonary TB were recruited from the outpatient departments of a medical college and a community health centre in Agra. Each participant underwent CXR twice, once with each machine. Both sets of de-identified images were independently read by two radiologists, who were blinded to the type of X-ray machine used. The primary outcome was agreement between image qualities produced by these two machines. Results: The intra-observer (radiologist) agreements regarding the status of the 15 CXR parameters ranged between 74 per cent and 100 per cent, with an unweighted mean of 87.2 per cent (95% confidence interval: 71.5-100). The median Cohen’s kappa values for intra-observer agreement were 0.62 and 0.67 for radiologists 1 and 2, respectively. In addition, on comparison of the overall median score of quality of the image, the handheld machine images had a higher score for image quality. Interpretation & conclusions: The current study shows that a handheld X-ray machine, which is easy to use and can potentially be carried to any area, produces X-ray images with quality that is comparable to digital X-ray machines routinely used in health facilities.

Milk Production Function and Resource use Efficiency in Rajasthan

The study was undertaken in Rajasthan with the objective to examine the input-output relationships and assess the resource use efficiency in milk production. The study covered 60 dairy households. The results of Cobb-Douglas production function revealed that concentrate had positive and significant influence on returns from buffalo, crossbred cow and local cow milk. Green fodder and labour were also significantly influenced the returns from buffalo, crossbred and local cow. The results of resource use efficiency and marginal value productivity of inputs indicated that inputs were not optimally utilized by dairy households. The green fodder, dry fodder, concentrate and labour in buffalo, concentrate and labour crossbred cow milk production and green fodder in local cow milk production were found to be over utilized in study area resulting higher per litre cost of milk production on these species.

Recent Prescribing Trends of Anti- Microbial Agents and their Sensitivity Pattern in an Intensive Care Unit of a Tertiary Care Teaching Hospital

Background: Due to the injudicious and indiscriminate use of Anti-Microbial Agents (AMAs) among hospitalized patients especially in ICUs, it is extremely imperative to monitor and refine the prescribing pattern of antibiotics regularly. Hence an effective surveillance team consisting of a physician, a pharmacologist and a microbiologist should develop and implement an antimicrobial stewardship program based on the local antibiogam to increase the therapeutic benefits and curb the menace of Anti-Microbial Resistance (AMR). Aims:-To study the prescribing pattern of Anti-Microbial Agents and to evaluate the antimicrobial sensitivity pattern of common bacterial isolates in Medical ICU (MICU) of a tertiary care hospital. Methods: After taking approval from the Institutional ethical committee, this prospective observational study was conducted in the department of Pharmacology and Microbiology over a period of six months. Patient records were reviewed and analyzed to assess the prescribing pattern of antibiotics and Culture-sensitivity reports of various specimen from MICU were collected to determine the antibiotic sensitivity pattern. Results: Ceftriaxone (26%) was the most commonly prescribed drug followed by Metronidazole (16%). Fixed drug combinations such as Piperacillin+Tazobactam (14%), Amoxicillin + clavulanic acid (10%) and Cefoperazone + Sulbactam (8%) were also frequently used. The most predominant organism isolated was Klebseilla species (25%) followed by Acenitobacter species (19.4%). Colistin /Imipenem and Vancomycin/Linezolid depicted100% sensitivity for Gram-Negative (GNIs) and Gram-Positive Isolates (GPIs) respectively. Conclusions: The need of the hour is to preserve the power of the almost exhausted antimicrobial armamentarium against the rampantly emerging multidrug resistant organisms.

Term Pregnancy in an Achondroplastic Dwarf: A Case Report.

Achondroplasia is a rare disorder occurring in 1 in 15,000 to 1 in 40,000 live births. However, it is the commonest disorder among more than 100 different types of dwarfism. It is inherited as an autosomal dominant trait but most cases (80%) are due to mutations of fibroblast growth factor receptor 3 (FGFR3). These individuals have normal mental and sexual development and life-span may also be normal. However, problems such as pre-eclampsia, polyhydramnios, respiratory compromise, contracted pelvis necessitating lower-segment cesarean section, prematurity and fetal wastage, etc., have been reported. General anesthesia is preferred to regional anesthesia because of spinal abnormalities. The aim of this report is to describe the surgical management of these patients discussing the surgical consideration and emphasizing the difficulties encountered. Such a patient is considered high-risk in terms of anesthesia and obstetric outcome. A case of achondroplasia with pregnancy is reported. A 28-year-old achondroplastic parturient underwent cesarean section under general anesthesia for contracted pelvis. We did not encounter problems related to cesarean section. The most important point is the careful preoperative assessment. Anesthesia plan should be specified to individual basis.

A multi-centric open clinical trial to evaluate the usefulness of 13 predefined homeopathic medicines in the management of acute rhinitis in children

Aims: The study aimed to evaluate the effect of a group of homeopathic medicines in children with acute rhinitis. Materials and methods: In this multi-centric open clinical trial, a total of 784 children (408 males; 384 females) aged 6 months to 15 years, presenting symptoms of acute rhinitis were enrolled from 7 Institutes/ Units under the Central Council for Research in Homeopathy (India). Symptoms were assessed using an acute rhinitis symptom score (ARSS). A total of 13 homeopathic medicines were shortlisted after repertorizing the nosological symptoms of acute rhinitis in children and the results were analyzed. The medicines were prescribed in dilution 6c (10-12) and doses were repeated from few minutes to few hours as per the need of the case. Appearance of any change (improvement or worsening) was followed by placebo / change in dilution or change in medicine according to the response of the patient. The follow up period was up to the 7th day of illness. Results: Out of 784 children enrolled, 638 children were followed up and analyzed. A significant change in the score from the baseline (p<0.05) was observed. Twelve medicines were found to be useful in 638 children suffering from acute rhinitis and among them Nux-v (n=109), Merc (n=106) and Bell (n=88) were the most useful. No complications were observed during the treatment. Adverse events in the form of hyperpyrexia were observed in 2 children only. Conclusion: This study indicates the usefulness of homeopathic medicines in the management of acute rhinitis of children; controlled studies are needed to investigate their efficacy and effectiveness.

Objetivos; este estudo objetivou avaliar o efeito de um grupo de medicamentos em crianças com rinite aguda. Materiais e métodos: neste estudo multicêntrico aberto, foram recrutadas 784 crianças (408 masculinas; 384 femininas) com idade entre 6 meses e 15 anos apresentando sintomas de rinite aguda e que consultaram 7 institutos/centros sob o Conselho Central de Pesquisa em Homeopatia (Índia). Os sintomas foram avaliados através de um escore para sintomas de rinite aguda (ARSS). Um total de 13 medicamentos homeopáticos foi estabelecido após repertorização dos sintomas nosológicos da rinite aguda em crianças e os resultados foram analisados. Os medicamentos foram prescritos na diluição 6cH (10-12) e as doses foram repetidas de minutos a horas segundo a necessidade em cada caso. O aparecimento de qualquer mudança (melhora ou piora) foi seguido pela prescrição de placebo ou mudança da diluição ou do medicamento, de acordo com a resposta do paciente. O período de acompanhamento foi até o 7º dia da doença. Resultados: dentre as 784 crianças recrutadas, 638 foram acompanhadas e analisadas. Houve mudança significativa no escore (p<0,05) por comparação ao ingresso. Doze medicamentos foram úteis em 638 crianças com rinite aguda, entre eles Nux-v (n=109), Merc (n=106) e Bell (n=88) foram os mais úteis. Não foram observadas complicações durante o tratamento. Efeitos adversos sob a forma de hiperpirexia foram observados somente em 2 crianças. Conclusão: este estudo indica a utilidade dos medicamentos homeopáticos no manejo da rinite aguda em crianças; são necessários estudos controlados para determinar sua eficácia e efetividade.

Objetivos: este estudio buscó evaluar el efecto de un grupo de medicamentos homeopáticos en niños portadores de rinitis aguda. Materiales y métodos: en este estudio multicéntrico abierto fueron reclutados 784 niños (408 niños; 384 niñas) de edad entre 6 meses y 15 años que consultaron con síntomas de rinitis aguda en 7 institutos/centros dependientes del Consejo Central de Investigación en Homeopatía (India). Los síntomas fueron evaluados mediante un score para síntomas de rinitis aguda (ARSS). Fueron listados 13 medicamentos homeopáticos después de repertorización y análisis de los síntomas de rinitis aguda en niños. Los medicamentos fueron prescritos en la dilución 6cH (10~12) y las dosis fueron repetidas desde minutos a horas según la necesidad en cada caso. La aparición de todo cambio (mejoría o empeoramiento) fue seguida de prescripción de placebo/cambio de la dilución o del medicamento según la respuesta del paciente. Los pacientes fueron acompañados hasta el 7º día de tratamiento. Resultados: De 784 niños reclutados, 638 fueron acompañados y analizados. Fue observado cambio significativo en el score (p<0,05). Doce medicamentos se mostraron útiles en 638 niños portadores de rinitis aguda; entre ellos, Nux-v (n=108), Merc (n=106) y Bell (n=88) fueron los más útiles.

Association of SP-D, MBL and I-NOS genetic variants with pulmonary tuberculosis.

Background: Pulmonary tuberculosis is caused by Mycobacterium tuberculosis . It is a multifactorial disease with both host as well as pathogen factors contributing to susceptibility and protection from the disease. Various reports have highlighted important roles of lung surfactant protein D (SP-D), mannan-binding lectin (MBL) and I-NOS in innate immune defense against M. tuberculosis Aims : The present study investigated the role of polymorphisms in three candidate genes encoding Lung surfactant protein D, Mannan binding lectin and Inducible Nitric oxide synthase, in susceptibility and protection to pulmonary tuberculosis. Settings and Design : A case-control association study of SNP's in lung surfactant protein D (SP-D), mannan-binding lectin (MBL) and I-NOS with pulmonary tuberculosis in Indian population was carried out. This involved sequencing of all the coding exons of lung surfactant protein D (SP-D) , while, exon 1 (collagen region) and exon 4 (carbohydrate recognition domain) of mannan-binding lectin (MBL) and exons 2, 8 and 16 of I-NOS and their flanking intronic regions for single nucleotide polymorphisms in DNA samples isolated from 30 pulmonary tuberculosis patients and 30 controls of Indian population. Statistical analysis: Various allele frequencies were calculated using online two by two table (home.clara.net/sisa/). Odds ratio and P values were calculated at 95% confidence interval (CI). Results : A total of fourteen single nucleotide polymorphisms (5 in SP-D , 5 in MBL and 4 in I-NOS ) were observed of which four (G459A SP-D , G274T I-NOS , G1011A and T357G MBL ) have not been reported earlier. Four single nucleotide polymorphisms viz. G459A of exon 7 of SP-D ( P =0.00, odds ratio (OR) = 4.96, 2.18 P = 0.00 or= 3.85 1.66 P =0.00 or=4.04, 2.20< OR<7.42) and G274T of intron 16 of I-NOS ( P =0.00 or=4.46, 2.40 Conclusion: The present study has led to identification of 4 SNP's in SP-D , MBL and I-NOS associated with pulmonary tuberculosis in Indian population.

Detection of Mycobacterium leprae DNA for 36kDa protein in urine from leprosy patients: a preliminary report

Pesquisamos o DNA do Mycobacterium leprae para proteína 36 kDa na urina usando a técnica do PCR específica para M. leprae. Um número limitado de 16 pacientes (dos quais 11 tinham hanseníase multibacilar e cinco hanseníase paucibacilar) e oito indivíduos saudáveis foram incluídos neste estudo. O número de amostras de urina positivas pelo PCR foi de 36,4% (4/11) em pacientes com hanseníase multibacilar e 40% (2/5) em pacientes com hanseníase paucibacilar. Nenhuma das amostras de indivíduos saudáveis foi positiva. Até onde chega o nosso conhecimento, os resultados indicam, pela primeira vez, a presença de DNA do M. leprae na urina de pacientes com hanseníase. Outro fato importante obtido através do exame é que entre os pacientes tratados 66.6% (4/6) eram positivos enquanto entre os não tratados somente 20% (2/10) foram positivos. Pelos presentes dados indicativos parece que o tratamento melhora os resultados do PCR em amostra de urina. Assim, o acesso a estes dados prova ser útil no monitoramento da resposta ao tratamento de pacientes individuais e precisa ser melhor avaliado com um grande número de pacientes.