Geographic information system-based mapping of air pollution & emergency room visits of patients for acute respiratory symptoms in Delhi, India (March 2018-February 2019)

Background & objectives: Studies assessing the spatial and temporal association of ambient air pollution with emergency room visits of patients having acute respiratory symptoms in Delhi are lacking. Therefore, the present study explored the relationship between spatio-temporal variation of particulate matter (PM)2.5 concentrations and air quality index (AQI) with emergency room (ER) visits of patients having acute respiratory symptoms in Delhi using the geographic information system (GIS) approach. Methods: The daily number of ER visits of patients having acute respiratory symptoms (less than or equal to two weeks) was recorded from the ER of four hospitals of Delhi from March 2018 to February 2019. Daily outdoor PM2.5 concentrations and air quality index (AQI) were obtained from the Delhi Pollution Control Committee. Spatial distribution of patients with acute respiratory symptoms visiting ER, PM2.5 concentrations and AQI were mapped for three seasons of Delhi using ArcGIS software. Results: Of the 70,594 patients screened from ER, 18,063 eligible patients were enrolled in the study. Winter days had poor AQI compared to moderate and satisfactory AQI during summer and monsoon days, respectively. None of the days reported good AQI (<50). During winters, an increase in acute respiratory ER visits of patients was associated with higher PM2.5 concentrations in the highly polluted northwest region of Delhi. In contrast, a lower number of acute respiratory ER visits of patients were seen from the ‘moderately polluted’ south-west region of Delhi with relatively lower PM2.5 concentrations. Interpretation & conclusions: Acute respiratory ER visits of patients were related to regional PM2.5 concentrations and AQI that differed during the three seasons of Delhi. The present study providessupport for identifying the hotspots and implementation of focused, intensive decentralized strategies to control ambient air pollution in worst-affected areas, in addition to the general city-wise strategies.

Significance of Siddha Thirithoda Balancing Food Stuffs

The Siddha system of medicine is an ancient medical system, which provides ‘Holistic Health’. The word ‘Siddha’ originated from the word ‘Siddhi’ meaning achievement of perfection, eternal bliss and accomplishment. The Siddha system evolved based on ninety-six tools (96 Thattuvam) which include physical, physiological, psychological and intellectual aspects of every human being. Among the 96 tools, the five elements i.e. Pancha bootham namely Earth, Water, Fire, Air and Space are the fundamental units of everything in the human body and the cosmos. There are three vital life factors (Vaatham, Pittam, Kabham) responsible for good health. There is a relationship between these to maintain the body’s healthy. Any increase or decrease in humour causes diseases. Thirthoda sama porutkal (TSP) maintains these humour when we are using our regular diet. This article details the TSP to maintain the body healthy.

Human Body and its Relation with Planets Siddha Perspective

Siddha system is the foremost traditional system, which was introduced by ancient Siddhar’s. According to Siddhar’s, nature is man, man is nature. Man is said to be microcosm and universe is macrocosm. The universe is made up of five elements namely Earth, Water, Fire, Air, and Space. Our body is also made up of five elements (Panchaboothas), three vital humors known as Vatham (air, space), Pitham (fire), Kabam (Earth, water), seven physical constituents are Saram (nourishing fluid), Senneer (blood), Oonn (muscles), Kozhuppu (adipose tissue), Enbu (bone), Moolai (bone marrow), Sukkilam/Suronitham (sperm/ovum) respectively. The universe has stars and planets. Each planet has an influence that reflects in our bodies. Thoughts were controlled by cosmic force in the universe. Nine planets in the universe correlate with the organs in the body Sun-Heart, Moon-Brain, Mercury-Lungs, Jupiter-Liver, Saturn-Spleen, Mars-Gall Bladder. This article explains how the planets have a connection with our human body.

Vulnerability To Health in A Ward of Bengaluru: Insights from A Mobile-Based Survey

Context/Background: Rapid urbanization has resulted in a growing number of people living in under-served areas with inadequate and overburdened infrastructure and services, worsening of environmen-tal factors. Sustainable Development Goal 11: “sustainable cities and communities”, highlights, there is an urgent need to re-orient the community development strategies by adopting economically & techno-logically sustainable models. Aims/Objectives: An application-based household survey to assess the vulnerability and Health condi-tions among the urban poor of slums in Bengaluru. Methodology: The tool for Vulnerability Assessment by Government of India was modified to develop a user-friendly tool for Community Health Workers in an Android–based smartphone application (Namma Samudaya). Data was collected through house-to-house survey. Results: A total of 3165 households (HHs) were surveyed. Among these, 54.2% of the HHs belong to vulnerable category and 45.8% to highly vulnerable group. Conclusions: Domain-wise analysis showed, Residential -25.2% of HHs were located besides polluted water Social - “No social support” and “disability” was reported by 3% of households each; Health-Related - Catastrophic Health expenditure in the past 1 year was reported by 40.4% HHs. The baseline information of slums & their geographic mapping obtained during the survey can be used as foundation for effective planning of health care services.

A radiobiological and dosimetrical comparison between simultaneous integrated and sequential boost intensity-modulated arc treatment of locally advanced head-and-neck cancer

Purpose: The study aimed to compare the radiobiological and dosimetric parameters between sequential boost (SEQB) and simultaneous integrated boost (SIB) treatment regimen using intensity-modulated arc therapy technique in locally advanced head-and-neck cancer (LAHNC) patients. Materials and Methods: A total of 24 previously untreated LAHNC patients were randomized into SIB (n= 11) and SEQB (n = 13) arms. The planning computed tomography data set was transferred to the treatment planning system. All the target volumes and organ at risk volumes were delineated. Single plan for SIB group and three plans (three phases) were generated for SEQB group of patients. Radiobiological and dosimetric parameters were compared. Results: The BED10(planned) value for high-risk (HR) planning target volume (PTV) was same in both groups, whereas for intermediate-risk (IR) PTV and low-risk (LR) PTV, the values were higher in SEQB arm than SIB arm. The V95 values were 100% for all the target volumes in both arms of patients. The average D100 value for gross target volume, HR PTV, and IR PTV was higher in SEQB arm than that in the SIB arm. The average D100 value for LR PTV was higher in the SIB arm compared to that of the SEQB arm. The BED10(achieved) was calculated using D100 values of target volumes. The difference of BED10(achieved) values between SEQB arm and SIB arm further increased than the BED10(planned) values for all target volumes. The maximum doses for spinal cord, spinal cord planning risk volume, and brain stem were within the tolerance dose in both groups of patients. The left and right parotid glands sparing was comparable in both groups of patients. Average integral dose was higher in the SIB group than SEQB group. The average total monitor unit per fraction was higher in the SEQB arm than that in the SIB arm. Conclusion: SIB regimen may be considered as more logical and efficient over SEQB regimen in the treatment of LAHNC with comparable radiobiological and dosimetric parameters

A prospective study: role of prophylactic antibiotics versus no antibiotics in elective laparoscopic cholecystectomy

Background: Elective gallbladder surgery is the most common abdominal surgical procedure. Antibiotic prophylaxis is a common conduct in open cholecystectomy, but there is ambiguity about the use of prophylactic antibiotics in laparoscopic cholecystectomy. Some surgeons suggest that the elimination of prophylactic antibiotics in patients undergoing elective laparoscopic cholecystectomy increase the incidence of postoperative infective complications but not to a statistically significant degree. The aim of this study was to evaluate the role of prophylactic antibiotics in laparoscopic cholecystectomy.Methods: A total of 100 patients were included and they were randomized in 2 groups of 50 each. Group A was given prophylactic intravenously (IV) antibiotic within 1 hour before surgery and group B was not given any antibiotics. Results were compared and data analyzed statistically using chi-square and t test. Complications in both the groups were compared.Results: Rate of surgical site infections were 6% (n=3) and 4% (n=2) in group A and B respectively; and the difference between them was not found statistically significant. All infections which occurred in present study were superficial surgical site infection. There was no evidence of deep-seated infections and none of the patients developed distant infection. There was no derangement in any of the biochemical parameter in this study.Conclusions: We were not able to demonstrate any significant benefit from addition of prophylactic antibiotics in elective laparoscopic cholecystectomy.

A cross sectional study to determine the reasons for non-utilization of reproductive and child health services in district Etawah

Background: The utilization of social services, including health services, has never been equitably distributed in the society. Cost, distance, attitude of health providers, and other factors put the secondary care and private sector facilities out of reach of most of the poor residents. The socioeconomic factors also have a complex relationship with some of the supply factors, and often in the scarcity of good data, it is very difficult to explain the poor utilization of reproductive and child health (RCH) services.Methods: A cross sectional study conducted on 80 recently delivered women at home in the villages covered under the selected subcentre to interview all recently delivered women to find out the reasons for non-utilization of RCH services. The data was collected by using pre designed semi-structured questionnaire.Results: Most of the participants belong to age group of 20 to 24 (55%) and joint family (51.3%). Main reason for not having institutional delivery was found to be long waiting time in hospital/lack of proper facilities (50%) followed by non-cooperative hospital staff (36.2%). The study showed that most common reason for not getting money under JSY was found to be non-issuance of JSY card (33.3%) and non-cooperative hospital staff (33.3%). It was found that non utilisation of contraceptive services was mainly due to objection by husband (45.5%).Conclusions: This study revealed lack of knowledge, no felt need and financial constraints as the most common reason for not utilizing the different RCH services.

A cross sectional study to ascertain various causes of neonatal mortality using verbal autopsy in Etawah district

Background: Neonatal death is defined as no. of deaths during the first 28 completed days of life per 1000 live births in a given year or period. Around 2.6 million deaths or roughly 46% of all under five deaths had occurred during this period in 2016 which means that 7000 newborn deaths occur each day. Most of the neonatal deaths occur on the first day and week accounting to about 1 million dying on the 1st day. Objective of this study was to ascertain various causes of neonatal mortality using verbal autopsy in Etawah district.Methods: The present study was a retrospective cross-sectional study carried out for a period of 1 year (July 17 to June 2018) using WHO verbal autopsy questionnaire by finding out the study subjects from medical information system of UPUMS, Saifai and district hospital, Etawah. A total of 89 neonatal deaths were found out of which 87 were interviewed by going to their residences to get the relevant information regarding the causes of deaths.Results: Most common cause of neonatal mortality came out to be low birth weight with prematurity 44 of 87 (50.6%), followed by birth asphyxia 23 of 87 (26.4%) and sepsis 8 of 87 (9.2%).Conclusions: Effective interventions should be incorporated into policy decisions to reduce neonatal mortality due to these causes.

Vascular Injuries Due to Penetrating Missile Trauma in Anti-Terrorism Ops

PURPOSE@#Penetrating vascular trauma though less common poses a challenge to all Surgeons. This study was designed to analyse the profile, management modalities of vascular trauma and the outcomes thereof at a Trauma Care Centre in a Tertiary care setting in hostile environment in India.@*METHODS@#A prospective review of all patients with arterial and venous injuries being transferred to the Trauma Center at out Tertiary Care Center between June 2015 and May 2018 was done. Demographics, admission data, treatment, and complications were reviewed.@*RESULTS@#There were a total of 46 patients with 65 vascular injuries, 39 arterial injuries and 26 venous injuries. The age range was 21 to 47 years. Nineteen patients had both arterial and venous injuries. A total of 42 cases presented within 12 hours of injury and complete arterial transections were found in 33 cases (80.49%). There were three mortalities (6.52%) and three amputations (8.33%). The overall limb salvage rate was 91.67% with popliteal artery being the commonest injured artery. Poor prognosticators for limb salvage were increasing time to present to the trauma centre, hypovolemic shock, multi-organ trauma and associated venous injuries.@*CONCLUSIONS@#Penetrating missile trauma leading to vascular injuries has not been widely reported. Attempting limb salvage even in cases with delayed presentation should be weighed with the threat to life before revascularisation and should preferably be done at a centre with vascular expertise. A team approach with vascular, orthopaedic, general surgeons, and critical care anaesthesiologists all aboard improve the outcomes manifold. Use of tourniquets and early fasciotomies have been emphasized as is the use of native veins as the bypass conduit. This is probably the largest study on penetrating Vascular trauma in anti-terrorism ops from the Indian subcontinent. It highlights the significance of prompt recognition and availability of vascular expertise in optimally managing cases of vascular trauma.

Demographic profile and fungal characteristics in patients of otomycosis in North Indian population- A Prospective study

Fungal infections such as otomycosis have been reported decades back. Distribution of this particular disease has been reported worldwide from the areas having a hot and humid environment especially tropical and subtropical zone. This study included 244 patients of suspected otomycosis from January 2017 to June 2018, in which the presence of fungal agents was determined by mycological examination. The mycological investigation revealed A. niger and Candida as predominant species. Incidence in the male population was higher than females. Otorrhea and pruritis were the common symptoms presented by patients. Several risk factors associated with otomycosis including moisture, broad-spectrum antibiotics and chemotherapeutic agents use, topical ear drops and frequent bathing or swimming was reported. Amphotericin B was found to be more sensitive followed by voriconazole during antifungal susceptibility testing. The objective of this study was to determine the prevalence of otomycosis with emphasis on involved etiologic agents and their antifungal sensitivity pattern.

Association of Fluid Overload with Mortality in Critically-ill Mechanically Ventilated Children

Objectives: To study the association of fluid overload withmortality and morbidity in critically-ill mechanically ventilatedchildren.Design: Prospective observational study.Setting: Pediatric Intensive Care Unit (PICU) of a tertiary carehospital, New Delhi, India.Participants: 118 children (age 1 mo - 15 y) requiring mechanicalventilation.Outcome measures: Primary: Association of fluid overload withmortality. Secondary: Association of fluid overload withoxygenation, organ dysfunction, duration of mechanicalventilation and PICU stay.Results: Cumulative fluid overload of ?15% was observed in 74(62.7%) children. About 50% of these children reachedcumulative fluid overload of ?15% within the first 5 days of PICUstay. The mortality was 40.5% in those with ?15% cumulative fluidcompared to 34% in the rest [OR (95% CI): 1.02 (0.97, 1.07)]. Onmultivariate analysis, after adjusting for confounders, cumulativefluid overload ?15% was associated with higher maximumPELOD (pediatric logistic organ dysfunction) score (Median: 21vs. 12; P = 0.03), longer median duration of mechanicalventilation (10 vs. 4 d; P <0.0001) and PICU stay (13.5 vs. 6 d; P<0.0001). There was no significant association of fluid overloadwith oxygenation index (P=0.32).Conclusion: There is no association of fluid overload withmortality. However, it is associated with poor organ function,longer duration of mechanical ventilation and PICU stay incritically-ill, mechanically ventilated children.

Moyamoya Disease: A Case Report With Typical Magnetic Resonance Imaging Findings

Moyamoya disease is an idiopathic non-progressive, non-atherosclerotic, and non-inflammatory vasculo-occlusive disease commonly affecting the supraclinoid internal carotid artery with resultant secondary changes which may include infarcts, ischemia, and multiple collaterals within the brain. The term Moyamoya disease is usually reserved for the idiopathic and rarely familial condition where etiology is not known, whereas the term Moyamoya syndrome is reserved for those conditions where etiology is known. Here, we present the case report of a Moyamoya disease and magnetic resonance imaging (MRI) findings with the review of the MRI features

Trichilemmal Cysts Of Scalp: Imaging Findings

A trichilemmal cyst is a cystic lesion that forms from the hair follicle. They are also known as Wens. They are smooth nodular mobile swellings of the scalp which may be tender or non-tender and may run in families. Usually multiple, they are common in the occipital scalp region but can also occur in chest, abdomen, back, vulva, and pubis. Here, we present the case report of a 45-year-old woman with multiple trichilemmal cysts of the scalp.

Galactomannan Antigen Test for Early Diagnosis of Invasive Aspergillus Infection in Pediatric Febrile Neutropenia

Invasive aspergillosis is a major concern in neutropenic patients.We studied the utility of Galactomannan antigen detection test inserum using ELISA technique for early detection of invasiveaspergillosis. Diagnostic accuracy of Galactomannan index (GMI)test was maximum at a cut-off of > 1.5 with a negative predictivevalue of more than 95%

Clinical And Radiographic Evaluation Of Diode Laser(810nm) Pulpotomyand Formocresol Pulpotomy-an Invivo Study

Objective : The purpose of this study was to investigate whether a diode laser pulpotomy could be an acceptable alternative to formocresol pulpotomy in primary molars. Method: A randomized, single-blind split mouth study was used with a sample of 10 patients with at least two primary molars indicated for pulpotomy were selected for the study.Twenty teeth were randomly divided into 2 groups- the formocresol group that where formocresol pulpotomy was carried out and the study group where a diode laser pulpotomy was carried out. All the teeth were followed up clinically and radiographically at 1, 3 and 6 months. Results: No failures were recorded in both the groups at 1 and 3 months follow-up; while 1 tooth in each of the groups showed a radiographic failure at 6-month follow-up. There was no significant difference between the 2 groups. Studies with larger sample size and longer follow-up periods are required to establish laser pulpotomy an acceptable method for primary molars.

Vitamin D Deficiency and Parathyroid Response in Critically-ill Children: Association with Illness Severity and Clinical Outcomes.

Objective: To determine the prevalence of vitamin D deficiency in critically ill children, and to study its association with parathyroid response, severity of illness and clinical outcomes. Design: Prospective observational study. Setting: Medical Pediatric Intensive Care Unit of a tertiary care centre of Northern India. Participants: 154 children in-patients: August 2011-January 2013. Main outcome measures: Vitamin D deficient children were (serum 25-hydroxy vitamin D <20 µg/mL) divided into "parathyroid-responder" [serum parathyroid hormone >65 pg/mL with 25(OH)D<20 µg/mL and/or calcium corrected for albumin <8.5 mg/dL] and "non parathyroid-responder.’’ Illness severity was assessed by Pediatric Index of Mortality-2 (PIM-2) score at admission. Biochemical parameters, illness severity scores and clinical outcomes were compared between parathyroid-responders and non-parathyroid-responders. Results: Vitamin D deficiency and hypocalcemia were observed in 125 (83.1%) and 91 (59%) children, respectively at admission. There were no differences in illness severity score at admission, mortality rate and length of stay between vitamin D-deficient children and 19.8% of non-vitamin D-deficient children. Among Vitamin D-deficient children, parathyroid-responders had higher PIM-2 score at admission compared to non-parathyroid-responder [12.8 (7.4,20.6) vs. 6.5 (2.5,12.2), P=0.01]. However, there were no differences in other clinical outcomes between two groups. Conclusion: Critically ill children have high prevalence of vitamin D deficiency. Parathyroid gland response secondary to hypocalcemia or vitamin D defiency is impaired in critical illness.

Detection of carboxylesterase and esterase activity in culturable gut bacterial flora isolated from diamondback moth, Plutella xylostella (Linnaeus), from India and its possible role in indoxacarb degradation

Abstract Diamondback moth (DBM), Plutella xylostella (Linnaeus), is a notorious pest of brassica crops worldwide and is resistant to all groups of insecticides. The insect system harbors diverse groups of microbiota, which in turn helps in enzymatic degradation of xenobiotic-like insecticides. The present study aimed to determine the diversity of gut microflora in DBM, quantify esterase activity and elucidate their possible role in degradation of indoxacarb. We screened 11 geographic populations of DBM in India and analyzed them for bacterial diversity. The culturable gut bacterial flora underwent molecular characterization with 16S rRNA. We obtained 25 bacterial isolates from larvae (n = 13) and adults (n = 12) of DBM. In larval gut isolates, gammaproteobacteria was the most abundant (76%), followed by bacilli (15.4%). Molecular characterization placed adult gut bacterial strains into three major classes based on abundance: gammaproteobacteria (66%), bacilli (16.7%) and flavobacteria (16.7%). Esterase activity from 19 gut bacterial isolates ranged from 0.072 to 2.32 µmol/min/mg protein. Esterase bands were observed in 15 bacterial strains and the banding pattern differed in Bacillus cereus – KC985225 and Pantoea agglomerans – KC985229. The bands were characterized as carboxylesterase with profenofos used as an inhibitor. Minimal media study showed that B. cereus degraded indoxacarb up to 20%, so it could use indoxacarb for metabolism and growth. Furthermore, esterase activity was greater with minimal media than control media: 1.87 versus 0.26 µmol/min/mg protein. Apart from the insect esterases, bacterial carboxylesterase may aid in the degradation of insecticides in DBM.

Effects of adding tocotrienol-tocopherol mixed fraction and vitamin C supplementation on coronary risk biomarkers in patients with hypercholesterolaemia with moderate coronary risk.

This study was a prospective clinical trial to investigate the effects of adding combined tocotrienol-tocopherol mixed fraction (TTMF) and vitamin C (TTMF+C) supplementation on coronary biomarkers in non-statin and statin treated patients with hypercholesterolaemia (HC) with moderate coronary risk. A total of 35 patients were randomised at baseline into one of two groups, (G1) TTMF+C (320mg TTMF plus 500mg vitamin C) alone daily and (G2) TTMF+C (320mg TTMF plus 500mg vitamin C) plus atorvastatin 10 mg daily. The entire supplementation were taken for 12 months. Fasting serum samples were taken at baseline, 2weeks, 3months, 6months and 12months post-randomisation and analysed for inflammatory biomarkers; high sensitivity C- reactive protein (hsCRP) and interleukin-6 (IL6). Combination of TTMF and vitamin C supplementation leads to neutral effects on lipid profiles and inflammation; with no added benefit in statin-treated HC patients with moderate coronary risk. This neutral effects may be attributed to the tocopherol composition in TTMF which could possibly attenuate any potential beneficial effects of tocotrienols. Clinical studies using pure tocotrienols in the absence of tocopherols would further confirm this.

ADRB2 Polymorphism and Salbutamol Responsiveness in Northern Indian Children with Mild to Moderate Exacerbation of Asthma.

Objectives: The primary objective was to determine the association between beta-2 adrenergic receptor (ADRB2) gene polymorphism (rs1042713, c.46A>G, p.Arg16Gly) and the response to inhaled salbutamol in North Indian children aged 5 to 15 years, with mild to moderate exacerbation of asthma. Methods: This cross-sectional study was done at a tertiary-care hospital in Northern India from June 2011 to May 2013. 120 children with asthma with mild to moderate exacerbation underwent spirometry at baseline and after administration of three doses of salbutamol. An increase in FEV1 ³15% was considered as positive response. Blood samples from these children were analysed for ADRB2 polymorphism (p.Arg16Gly). 94 non-asthmatic adult controls were also studied to determine the prevalence of ADRB2 polymorphism. Results: In asthmatic children, the frequency of AA, GG, AG genotypes were 24.2%, 24.2% and 51.7% compared to 20.2%, 20.2 % and 59.6%, respectively in the non-asthmatic adults. Salbutamol responsiveness showed no correlation with the studied ADRB2 polymorphism (p= 0.55). A trend towards greater bronchodilator responsiveness amongst AA genotype, compared to GG genotype was observed (Median change in percent predicted FEV1 14.5% and 7.5%, respectively). Conclusions: No correlation was found between salbutamol responsiveness and ADRB2 genotype in Northern Indian children with asthma with mild-to moderate exacerbation.

An outbreak of Japanese encephalitis after two decades in Odisha, India.

Sudden deaths in children due to acute encephalitis syndrome (AES) from a tribal dominated district of Malkangiri in Odisha, India, was reported during September-November, 2012. The investigation was carried out to search for the possible viral aetiology that caused this outbreak. Clinico-epidemiological survey and seromolecular investigation were carried out to confirm the viral aetiology. Two hundred seventy two suspected cases with 24 deaths were observed. The patients presented with low to moderate grade fever (87%), headache (43%), vomiting (27%), cold (18%), cough (17%), body ache (15%), joint pain (15%), rash (15%), abdomen pain (9%), lethargy (5%), altered sensorium (8%), convulsion (2%), diarrhoea (3%), and haematemesis (3%). Laboratory investigation showed Japanese encephalitis virus (JEV) IgM in 13.8 per cent (13/94) in blood samples and JEV RNA in one of two cerebrospinal fluid (CSF) samples. Paddy fields close to the houses, high pig to cattle ratio, high density (33 per man hour density) of Culex vishnui mosquitoes, low socio-economic status and low health awareness in the tribal population were observed. This report confirmed the outbreak of JEV infection in Odisha after two decades.