Knowledge, attitude, and practice towards obesity among the general public in community settings of Tirupati: a cross-sectional study

Background: Obesity and overweight are strongly linked to developing diabetes, hypertension, myocardial infarction, stroke, and endocrine disorders. Knowledge, attitude, and practicesof the public are crucial in limiting the burden of obesity in the Indian community. The current study aims to assess the KAP of obesity among the general public of India. Methods: A community-based cross-sectional survey was conducted in the rural and urban areas of Tirupati city. Adults aged 18 years or above who are willing to participate, were included. A total of 300 subjects were enrolled and data was collected by using a pre-validated questionnaire. Variables like weight, height and KAP scores were obtained. Chi-square tests were used to associate demographics with good KAP towards obesity.Results: The findings show that more than half of the participants have good knowledge, and a positive attitude, but the practices are not optimal in dealing with obesity and management. Participants’ ages more than 40 years, presence of comorbidity, risk factors, and social habits are significantly associated with obesity and overweight. Obese are having goodknowledge but normal-weight people are significantly associated with a positive attitude. Participants of normal weight, no risk factor, and no habits were significantly associated with rational practices.Conclusions: The study concludes that the participants had good knowledge and attitude toward obesity but the participants failed to practice controlling and preventing obesity. However, more efforts are required in creating awareness and educating the general population regarding physical activity, diet, and lifestyle in preventing obesity and its associated complications.

A Study On Mortality In Perforated Peptic Ulcer

NSAIDs are responsible for most of the perforated peptic ulcers. Patients with perforated peptic ulcer have a hospital mortality risk of 10% to 20%. It is a significant problem for India, so this study was done to determine the magnitude and management of mortality risk. Astudy of 132 cases of perforated peptic ulcer admitted in government general hospital, Kurnool, Andhrapradesh, India from August 2017 to July 2019 was carried out. Alcohol(38.6%), smoking and NSAIDs are important etiologic factors for peptic ulcer. The mortality in perforated peptic ulceration is 33.3%. Risk of mortality was associated with shock at presentation and time delay in presentation. Aperforated peptic ulcer is a surgical emergency. It is a life-threatening condition which requires early diagnosis and immediate surgery — delayed management results in mortality. Most require surgery with omental pedicle patch. Mortality is high with a time delay to the presentation, medical comorbidities, shock at the time presentation and old age (>60yrs)

Proximal fibular osteotomy in the treatment of medial osteoarthritis of the knee: A narrative review of literature

Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.

Subcutaneous Glomus Tumor Of Chest Wall

Glomus tumors are known to occur in the subungual region of fingers. Extradigital occurrences have been reported in the past but are rare. Occurrence in the anterior chest wall has not been reported. We report a case of subcutaneous glomus tumor occurring in the anterior chest wall in a 47-year-old gentleman, suffering from pain for 2 years without diagnosis, who was successfully treated by excision biopsy

Fractured retained Double-J stents presenting as urethral foreign body

Background: In few studies, Dexmedetomidine was used an adjuvant to local anesthetics in peripheral nerve blocks Aim: This study was aimed to examine the effect of adding Dexmedetomidine to Bupivacaine 05% during the femoral sciatic nerve blocks and to evaluate its effect in prolonging post-operative analgesia Materials and methods: This was a prospective, double blinded, randomized study which consisted of 80 patients, Patients were randomly allocated into two groups (40patients each): In group BD, (Bupivacaine-Dexmedetomidine hydrochloride), one mL, containing 100 μg, was added to 39 mL of Bupivacaine 05% In group B; 1 mL of normal saline was added to the same volume of Bupivacaine 05% Results: There were no statistically differences between the two groups in demographic data and surgical characteristics The onset time of sensory block, motor block and surgical anesthesia time were significantly shorter in group BD when compared to group B The durations of sensory block, motor block and analgesia were longer in BD group when compared to group B Systolic arterial pressure (SAP) and heart rate were significantly lower in group BD when compared to group B from 10 to 90minutes after initiation of block (P<005), diastolic arterial pressure was similarly lower in group BD at 45, 60, and 90 minutes following initiation of block Conclusion: This study showed that a prolonged duration of analgesia was associated with addition of Dexmedetomidine 100μg to bupivacaine 05% during US-guided combined femoral and sciatic block for below knee surgery and is also associated with significant bradycardia requiring treatment

Study of post-operative pain incidence in patients with inguinal hernioplasty

Background: Continued chronic pain after inguinal hernioplasty is the most important current issues. Factor responsible for pain development mechanisms are still unclear. Influence of age as well as other factors is still controvertible. Objectives: To study the incidence of occurrence of postoperative pain in relation to age and duration of hernia. Materials and methods: A cross sectional prospective study includes 220 patients between 18-80 years. Participants willing for scheduled follow up of 7th, 30th, 90th and 180th day were considered for this study. All patients were explained for surgery and probable complications. Results: Study of chronic pain had shown that 12 (10.9%) had mild pain, 2 (1.4%) had mild pain but occasional taking drugs and 2 (1.4%) had moderate pain but not taking any drug on 90th day. On 180th day, 7 (6.4%) had chronic pam of which 6 (5.5%) had mild pain while 2 (0.9%) patients had moderate pain but none of the patients were taking any analgesics. Conclusion: There was significant association between age of the patients and pain. Chronic pain and the severity of pain decrease with advancing age.

The diagnostic efficiency of sigmoidoscopy in patients with bleeding per rectum

Background: Rectal bleeding is the most common symptom of large bowel pathology which comprises 14 to 19% in adult population. Sigmoidoscopy is a feasible and safe method for diagnosing colorectal problems than colonoscopy and proctoscope. Aim: The present study was an attempt to evaluate the patients with bleeding per rectum sigmoidoscopically and to select the best possible approach to treat the underlying pathology. Materials and methods: A total 54 patients with bleeding per rectum were considered from outpatient department form April 2013 to April 2015 and all the subjects were undergone for routine blood, urine and stool investigations, and sigmoidoscopic investigation. Results: A total of 26 cases were examined sigmoidoscopically for rectal bleeding in that 73.08% cases were able to confirm as definitive source of bleeding and 26.92% cases have other lesions which could not be detected by sigmoidoscope. Conclusion: Sigmoidoscopy has a very high diagnostic yield and would be recommended in the workup of patients presenting with bleeding per rectum. Haemorrhoids followed by ulcerative colitis were the leading cause of bleeding per rectum in this study.

Feasibility of Laparoscopy as a diagnostic modality in bowel pathologies

Background: As the laparoscopic management in bowel surgeries of abdomen grows as a tool in the armamentarium of the acute care surgeon, it is critical that outcomes are tracked to aid surgeons in making evidence-based decisions with regards to management of their patients. Aim: To study the feasibility of laparoscopy as a diagnostic modality and to assess the feasibility of laparoscopic intervention in various bowel pathologies in comparison to open surgery. To analyse the outcomes of laparoscopic surgery in compared to those treated by open surgery. Material and methods: A total 110 cases (Females 45% and Male 55%) of different Intestinal Pathologies from November 2013 to November 2015 were considered. For laparoscopy 80 Therapeutic cases and 30 diagnostic cases were included. All the cases were undergone for routine blood and urine investigation, ECG, X-ray, USG abdomen and Barium meal. Results: The commonest intestinal pathology in our study was acute Appendicitis (23.6%). Majority of the cases were seen in the age group of 26-40 years (40%). The mean operative time for laparoscopic appendectomy was 23 minutes and 25 minutes in open approach. Conclusion: Laparoscopy is safe and effective in the treatment of Bowels of abdomen. Tertiary centers with adequate minimally invasive skills should establish laparoscopy as the primary surgical technique in the treatment of this condition.

Headscarf (hijab) pin aspiration: effects of fashion phenomenon in Islam girls

Background: Foreign body aspiration is a common life threatening emergency, but, largely a preventable problem. The object aspirated depends on various factors, such as age, sex, occupation, geographical area, socio-cultural factors, economic status, and nutritional habits. In recent years some traditional/social habits and fashion trends of using headscarf/ hijab pins have become a discrete category of foreign body aspiration in young Muslim/Islam girls wearing headscarves. Objective: To highlight the increasing number of cases coming to clinical attention with headscarf pin aspiration. India having a growing population which is young and fashion oriented, the awareness of this problem needs to improve. Discussion: In recent times young adolescent Muslim girls use multiple matching small headscarf pins to fix the hijab as a fashion trend. Adolescent girls and adults tend to hold the headscarf pin between their lips while wearing the headscarves using their two hands to secure the veil. Lack of concentration or activities such as laughter, talking, and coughing predisposes them to aspiration, especially in young teenage groups where they lack experience in such manoeuvres. Conclusion: Accidental foreign body aspiration to a large extent is a preventable problem and more so in the case of headscarf pin. Appropriate interventions need to be planned as more young population is getting involved.

Marfan Syndrome with Spontaneous Rupture of Aneurysm of Common Iliac Artery.

Marfan syndrome rarely presents with peripheral artery and pulmonary artery aneurysms. We are presenting a case of a fifteen-year-old boy who presented to us with progressive lower abdominal pulsatile swelling with bruit in the right inguinal region for one month. He had typical marfanoid habitus, though there was no history of similar illness in family. CT angiogram revealed the presence having giant right common iliac aneurysm along with interlobar pulmonary artery aneurysm. He had spontaneous rupture of aneurysm in right common iliac artery.

Myocardial FFR (Fractional Flow Reserve) in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience.

RESEARCH ARTICLE January-March 2013 | Volume 1 | Issue 1 | Page: 4-11 Myocardial FFR (Fractional Flow Reserve) in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience Jagadish H. Ramaiah*, Raghu T. Ramegowda, Srinivas B. Chikkaswamy, Manjunath C. Nanjappa Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore - 560069, Karnataka, INDIA Correspondence to: Dr. Jagadish H. Ramaiah, Email: jagadishhr@rediffmail.com Background: The clinical significance of coronary artery stenosis of intermediate severity can be difficult to determine. The management of intermediate coronary lesions, defined by a diameter stenosis of ≥40% to ≤70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Myocardial fractional flow reserve (FFR) is an index of the functional severity of coronary stenosis that is calculated from pressure measurements made during coronary angiography. The objective of the study is to evaluate the usefulness of FFR in patients with angiographically intermediate coronary artery stenosis. Methods: 20 patients with intermediate coronary stenosis and chest pain of uncertain origin. The Exercise Electrocardiography (TMT), Myocardial Perfusion Imaging study (MPI), Quantitative Coronary Angiography (QCA) were compared with the results of FFR measurements. Results: 20 patients were undergone FFR measurement during the study period. With the mean age of 57.25±11.2 and male patients were 16 (80%), female patients 4 (20%), in all 13 patients with an FFR of <0.75, reversible myocardial ischemia was demonstrated unequivocally on at least one noninvasive test. In contrast, 5 of 7 patients with an FFR of >0.75 tested negative for reversible myocardial ischemia on TMT and MPI study. No revascularization procedures were performed in 7 (35%) patients, and no adverse cardiovascular events were noted in all these patients during 6 months of follow-up. Conclusions: In patients with coronary stenosis of intermediate severity, FFR appears to be a useful index of the functional severity of the stenosis and the need for coronary revascularization

Self- Ligating Brackets - A Review.

Self-ligating brackets are ligatureless bracket systems that have a mechanical device built into the bracket to close off the edgewise slot. These brackets secure passive or active ligation mechanism that ensures consistent full bracket engagement. Reduced friction between archwire and bracket allows more rapid tooth movement. This results in good control of tooth position through an adequately dimensioned bracket. A review of self-ligation in general has been highlighted in this article

Light chain immunofluorescence in various nephropathies.

Context: Light chain immunofluoresence (IF) in renal biopsy is routinely used in the diagnosis of light chain deposition disease (LCDD), amyloidosis and cast nephropathy. Light chain predominance has also been reported in certain glomerulopathies like IgA nephropathy. However, pathogenesis of this pattern of deposition in various glomerulopathies is uncertain. Aim: To discuss the pathogenesis and utility of light chain IF in nephropathies. Setting and Design: Retrospective study. Materials and Methods: The pattern of light chain IF and light microscopic diagnosis in 306 cases of various nephropathies was reviewed. Direct IF was done in all these cases with commercial fluorescence (Fluoresciene Isothiocynate ) conjugated polyclonal rabbit anti-human antisera against IgM, IgG, IgA, C3, C1q, kappa and lambda light chains. Results: Light chain deposits were seen in 240 (78.43%) cases. In IgA nephropathy, lupus nephritis and post-infectious glomerulonephritis (PIGN), lambda positivity was more as compared to kappa. Light chain deposits in LCDD and membranous nephropathy were more kappa type. The IF pattern in amyloidosis was not consistent. Conclusion: The pathogenesis of light chain predominance in glomerulopathies is not clear and it depends on isoelectric point and size of the immune complex. Light chain IF should be performed routinely in all the renal biopsies.

Symptomatic primary hyperparathyroidism: a retrospective analysis of fifty one cases from a single centre.

OBJECTIVE: Widely prevalent vitamin D deficiency and delayed diagnosis contributes to severe symptomatic primary hyperparathyroidism in India. We analysed fifty one consecutive patients of primary hyperparathyroidism managed at our centre. All of them were symptomatic. DESIGN: Retrospective analysis. MATERIAL AND METHODS: Fifty one consecutive cases of symptomatic primary hyperparathyroidism, presenting to our centre from January 1994 to May 2007 were retrospectively analyzed. Clinical presentation, biochemical, radiological and details of underlying parathyroid lesion were noted. RESULTS: A total of 51 cases of primary hyperparathyroidism were studied. Mean age was 39.5 +/- 11.5 yrs (Range 13 to 70 years, Female: Male 2:1). Mean duration of symptoms was 35.8 + 29.1 months. Bone pains and painful proximal myopathy were the commonest presentation (24/51), followed by pathological fractures in 12 cases. Distal Renal tubular acidosis was diagnosed in 4 cases, 3 of whom normalized after surgery. At initial evaluation, twenty one patients had elevated alkaline phosphatase with normal calcium levels indirectly suggesting associated vitamin D deficiency. Low serum levels of 25-hydroxy vitamin D were documented in five of them. Parathyroid carcinoma was diagnosed in 3 patients. Ectopic parathyroid adenoma was seen in 7 cases (3 mediastinal, 3 intrathyroidal, 1 near left carotid sheath). All the cases responded well to surgical excision. CONCLUSION: Lack of universal screening for hypercalcemia, normocalcemia contributed by associated vitamin D deficiency and lack of awareness about unusual presentations of primary hyperparathyroidism led to delayed diagnosis in our patients. Delayed diagnosis and associated vitamin D deficiency in our patients contributed to greater severity of symptomatic primary hyperparathyroidism.

Enteral feeding by fistuloclysis in a midjejunal fistula.

Enterocutaneous fistulas are potentially life-threatening complications of gastrointestinal surgery. Nutritional support is the mainstay of management. We report a 32-year-old man who developed an enterocutaneous fistula following surgery for ulcerative colitis. Enteral feeding was attempted by introducing a Foley's catheter through the midjejunal fistula.

Comparison of improvement in quality of life score with objective parameters of pulmonary function in Indian asthmatic children receiving inhaled corticosteroid therapy.

This prospective, hospital based, descriptive study was designed to compare improvement in quality of life (QOL) score with objective measures of pulmonary function in children with persistent bronchial asthma receiving inhaled corticosteroid (ICS) therapy. QOL score (measured by an indigenous tool), forced expiratory volume in first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR) and asthma symptom score were measured in 20 newly diagnosed children with persistent asthma- before, during and eight weeks after ICS therapy. There was a significant improvement in all parameters compared at each follow up visit and at termination of the study (p less than 0.05). The magnitude of improvement in QOL was similar to improvement in objective measures of pulmonary function; although these changes were not similar to changes in asthma symptom score. Improvement in QOL score is likely to be a sensitive measurement of functional improvement in asthmatic children on treatment; however subjective sensation of improvement lags behind objective measures.

Paradoxical embolism through patent foramen ovale causing cerebellar infarction in a young boy.

A previously healthy young boy who suffered an acute stroke involving superior cerebellar artery circulation is presented here. Echocardiography revealed a patent foramen ovale through which paradoxical embolism had probably occurred. Low dose aspirin was started and surgical closure was planned to prevent further recurrences.

Evaluation of ParaHITf strip test for diagnosis of malarial infection.

This study sought to determine whether dip stick strip test containing antibody for Plasmodium falciparum histidine rich protein-II (PfHRP-II) antigen could be used for identification of P. falciparum and P. vivax malaria in man. The results obtained were also compared with the results of standard microscopic examination. A total of 150 cases were included for the study. Fifty cases were non-febrile cases with no history of malaria acting as control group and the rest 100 cases were having fever and formed the test group. All the cases in the control group was found to be negative for both microscopic examination and strip test. In the test group, all samples that showed positive for P. falciparum by microscopy was also found to be positive for strip test. Whereas, all those samples that were positive for P. vivax in microscopic examination was found to be negative for strip test indicating species specificity of the strip test. In addition, two other cases that were negative for microscopic examination were found to be positive for the strip test. Statistical analysis was done to compare the validity of the results of strip test with that of the results of microscopic examination.

Pure red cell aplasia associated with carbamazepine.

Therapeutic indications for carbamazepine have grown in recent years and more and more patients are taking this drug for various neurological and psychiatric disorders. Though haematological complications like aplastic anaemia etc., due to carbamazepine therapy are well known pure red cell aplasia is exceedingly rare. A 33 year old man was diagnosed to have pure red cell aplasia with positive Coomb's test following 5 months of carbamazepine therapy. He recovered completely. Carbamazepine induced pure red cell aplasia is a reversible condition if recognised early.