Resultado da miotomia endoscópica peroral (POEM) em acalasia avançada em um seguimento mediano de 17 meses / Outcome of per oral endoscopic myotomy (poem) in sigmoid achalasia at a median follow up of 17 months

ABSTRACT Background: Advanced achalasia cardia (AC) represents the end stage in the natural history of AC. Role of per oral endoscopic myotomy (POEM) in this technically difficult subset is emerging. Methods: Retrospective review of the patients who had undergone POEM for advanced AC with sigmoid esophagus. We assessed the technical success, clinical success and adverse event rate. Pre and post POEM Eckardt score (ES), integrated relaxation pressure-4sec (IRP-4), lower oesophageal sphincter pressure (LESP) and height and width of barium column at 5 minutes were noted. Results: Of the 85 patients who underwent POEM for AC, 10 patients had advanced AC with sigmoid esophagus of which eight were sigmoid and two were advanced sigmoid. The clinical and technical success was 100% with significant reduction of ES, IRP-4, LESP and height and width of barium column at 5 minutes. One patient had a minor adverse event in the form of mucosal injury that was closed with hemoclips. At a median follow up of 17 months there was no recurrence. Conclusion: Our study demonstrates POEM to be a safe and effective modality of treatment in this technically difficult subset of AC with sigmoid morphology.

RESUMO Contexto: Acalasia cárdia avançada representa o estágio final na história natural do megaesôfago. Está emergindo o papel da miotomia endoscópica peroral (POEM) neste subconjunto tecnicamente difícil. Métodos: Foi realizada uma revisão retrospectiva dos pacientes submetidos a POEM para tratamento do megaesôfago avançado. Avaliamos o sucesso técnico, o sucesso clínico e a taxa de eventos adversos. O escore de Eckardt, pré e pós POEM, a pressão integral de relaxamento de 4 seg (IRP-4), a pressão do esfíncter inferior do esôfago e a altura e largura da coluna de bário em 5 minutos, foram anotadas. Resultados: Dos 85 pacientes submetidos a POEM para acalasia cárdia, 10 pacientes apresentaram acalasia cárdia avançado com esôfago com aspecto sigmoide, dos quais dois eram muito avançados. O sucesso clínico e técnico foi de 100% com redução significativa do escore de Eckardt, do IRP-4, da pressão do esfíncter inferior do esôfago e da altura e largura da coluna bário em 5 minutos. Um paciente teve um pequeno evento adverso na forma de lesão mucosa que foi fechada com hemoclipes. Em um seguimento mediano de 17 meses não houve recorrência. Conclusão: Nosso estudo demonstra que a POEM é uma modalidade segura e eficaz de tratamento neste subconjunto tecnicamente difícil de megaesôfago com morfologia sigmoide.

Prevalence and Associated Risk Factors of Depression among Housewives:A Cross Sectional Study from Rural Community of Rajasthan, India

Introduction : Depression is the leading cause of disease-related disability among women in the world today. Depression is a serious condition that can impact every area of women’s life. It affects social life, family relationships, career, and one’s sense of selfworth and purpose. To determine the prevalence andObjective: associated risk factors of depression among rural housewives aged 18–59 years. A community basedMethod: cross sectional study was carried out among 414 housewives in rural field practice area of Department of Community Medicine, Jhalawar Medical College, Jhalawar, Rajasthan. Participants were selected by simple random sampling technique. A pre designed semi structured proforma was used for collecting information on socio-demographic characteristics, medical history, family problems, personal history and obstetrical and gynecological history. Assessment of depression was done by using self-reported instrument Patient Health Questionnaire-9 (PHQ-9) Out of 414 Housewives, 63 (15.2%) were found to have depression. WithResults: increasing education level, there was a declining trend toward depression. Significantly higher rates of depression were observed among housewives reporting any debilitating ailments in one or more family members (31.2%), some unusual events occurred in family in past (56.2%), presence of any addiction in family members (22.7%) and debt on family (58.8%). Marriage at early age, having first pregnancy at early age, more than two children, menstrual irregularities and suffering from unable to conceive or infertility were the biological factors significantly associated with depression. Prevalence of depression was highConclusion: among housewives in rural community. Many social and biological factors were contributing towards high rate of depression among housewives

A study of expressed emotion, perceived stress and socio-demographic profile in patients of dissociative disorder

Background: Dissociation is understood as one of coping mechanism to deal with intense stressors. Individuals vary widely in their subjective response to a similar stressful event depending on number of factors including their family and social support system. So, authors tried to study the expressed emotion in patients of dissociative disorder along with other socio-demographic factors and its relation with perceived stress.Methods: This cross-sectional descriptive study was done on 100 patients with primary diagnosis of dissociative disorder. Hamilton depression rating scale (HAM-D) was used to assess comorbid Depressive symptoms and Hamilton anxiety rating scale (HAM-A) was used to asses comorbid anxiety symptoms. Perceived stress scale (PSS) was used to assess the perception of stress. Family emotional involvement and criticism scale (FEICS) was used to measure perceived criticism (PC) and intensity of emotional involvement (EI).Results: Mean perceived stress in this study was 25.8. Mean score for perceived criticism (PC) was 16.5 and emotional involvement (EI) was 15.7. Both measures of expressed emotions were significantly higher in females and subjects belonging to joint families and rural area. In this study perceived stress by subjects was significantly (p=0.001) correlated to perceived criticism (Pearson r = 0.78) and emotional involvement (Pearson r = 0.77).Conclusions: High perceived criticism and emotion over involvement of family member was associated with perceived stress in dissociation patients.

Levels of vitamin D in tuberculosis and comparison of vitamin D level in severe variant of tuberculosis like tubercular meningitis, miliary tuberculosis, disseminated tuberculosis with non severe variant of tuberculosis like pulmonary tuberculosis, tubercular lymphadenitis etc in paediatric age group

Background: Tuberculosis is deadliest disease killing nearly 2 million people every year. Before the etiologic cause of TB was determined by Koch, cod liver oil and sunlight, both sources of vitamin D, were used in treatment of tuberculosis. After discovery of antibiotics, anti-infectious value of vitamin D was ignored until increasing cost of antibiotics and rise in resistance led to the need to search for alternative and antibiotic-independent therapeutic strategies. This study shed light on vitamin D, which is very safe and inexpensive by adding vitamin D to antibiotic treatment, immune system can be boosted to help body to clear TB, rather than relying on antibiotics.Methods: A prospective, observational, comparative study in which 62 TB patients were taken and vitamin D level were estimated.Results: The results of study show that out of total 62 patients, 31 (50.00%) had deficient(<20ng/ml) vitaminD,23(37.10%) had insufficient(20-30ng/ml) vitamin D, 8(12.90%) had sufficient (>30ng/ml) vitamin D level. Out of 62 patients, 10(62.13%) had severe variety of TB and 52(83.87%) had' nonsevere TB. Among the 52 patients, 24(46.2%) had deficient vitamin D, 20(38.5%) had insufficient vitamin D and 8(15.4%) had sufficient vitamin D. Among the 10 patients with severe TB, 7(70.00%) had deficient vitamin D, 3(30.00%) had insufficient vitamin D and none had sufficient vitamin D level.Conclusions: Majority of children with tuberculosis demonstrated low serum levels of vitamin D (deficient and insufficient levels) suggest that vitamin D deficiency is' risk factor of tuberculosis and very low levels of vitamin D were noted in severe variant of TB then non severe suggest that in severe form of tuberculosis vitamin D levels were less compared to nonsevere variant.

LASER-Light Amplification by Stimulated Emission of Radiation

Laser, a device that stimulates atoms or molecules to emit lightat particular wavelengths and amplifies that light, typicallyproducing a very narrow beam of radiation. The emissiongenerally covers an extremely limited range of visible,infrared, or ultraviolet wavelengths. Many different types oflasers have been developed, with highly varied characteristics.Laser is an acronym for “light amplification by the stimulatedemission of radiation.” In that manner, they can confidentlymake appropriate decisions as to the best device to use on apatient (or the best device to purchase for a practice).

Nutritional status of children under five year of age: a cross sectional study in rural area of Jhalawar, Rajasthan

Background: Adequate nutrition is essential in early childhood to ensure healthy growth and development, proper organ functions and a strong immunity. Accurate assessment of nutritional status of children is a requisite in appropriate planning and effective implementation of nutrition interventions. The objective of this study is to assess nutritional status of children under five year of age in rural area and to identify the socio-demographic factors associated with under nutrition.Methods: A cross sectional study was conducted among children aged six months to five years in rural area of Jhalawar, Rajasthan. Nutritional status of the children was assessed by measurement of mid upper arm circumference and information like birth order of children, birth weight and number of siblings was collected using a pre-coded and semi structured questionnaire.Results: Moderate under-nutrition was present in 16.8% children. Under-nutrition was present among 9.9% male and 24.2% female children. 38.1% children with birth weight less than 2.5 kg were under-nourished. Proportion of under-nutrition was 27.7% among children with number of siblings more than 2 while it was only 11.1% among those with 2 or less number of siblings.Conclusions: Gender, number of siblings and birth weight of children were significantly associated with nutrition status of children.

End stage renal disease patients on haemodialysis profiled epidemiologically at medical college of sub-Himalayan region of India

Background: Mostly, end organ damage becomes the reason for morbidity and mortality among patients with non-communicable diseases (NCDs) due their chronicity. Derangement of renal function along with brain and heart damage are considered to be a significant problem of NCDs. The objectives of this study were on this background of end stage renal disease (ESRD) as a common complication for common NCDs, present study was planned to study the distribution of responsible NCDs.Methods: Over three-year period, all the cases reported GFR <15ml/min/1.73m2 were studied.Results: Total 100 patients (male:65) were studied with mean age of 51.0±13.0 years. Diabetes mellitus (38.0%), hypertension (28.0%), and glomerulonephritis (16.0%) were three leading cause for ESRD. Idiopathic cause was observed among 12.0% patients. Fifteen percent patients could not survive.Conclusions: NCDs mainly diabetes mellitus and hypertension observed to be most common cause for ESRD.

Clinical Evaluation of Demineralized Bone Matrix Allograft in Femur Fracture in Dogs

Eight clinical cases of dogs having femur fracture, were divided into two groups, A and B with four dogs (n=4) in each group. Group A animals were treated with intramedullary pinning (IMP) alone and group B were treated using IMP alongwith demineralized bone matrix (DBM) implantation at the fracture site. The efficacy of healing was evaluated on the basis of clinical evaluation, haemato-biochemical and radiographic parameters on the day of admission (day 0), followed by 7th, 15th, 30th, 45th and 60th post-operative days. The weight bearing was observed to be better in dogs of group A. Swelling was completely absent after 15th post-operative day in dogs of both the groups. The mean values of Hb, PCV, TLC and DLC showed a non-significant variation on subsequent post-operative days in both the groups. There was a significant increase in serum calcium up to 30th post-operative day and thereafter, followed a decreasing trend. The serum alkaline phosphatase values showed non-significant variation in group A while in group B animals significant increase observed on 15th, 30th and 45th post-operative day. Radiographically, the dogs of group B showed better radiographic union of fracture evidenced by early disappearance of fracture line than those of group A

Profile of Published Cochrane Systematic Reviews in Child Health From Low- and Middle-Income Countries

Objective: Setting priorities in health research is a challenge at the global and national levels.Use of evidence-based approach is uncommon and needs to be promoted in low-and middle-income countries (LMIC). We describe profile of Cochrane systematic reviews focussing onparticipation from LMIC. Methods:We searched six Cochrane review groups producingreviews relevant to child health in low- and middle-income countries for published Cochranesystematic reviews from 1 March, 2009 till 18 March, 2015 in the Cochrane Library. Results:A total of 669 Cochrane systematic reviews from six review groups were found. Lowproportion of lead authors from low- and middle-income countries was found in 4 out of 6review groups. About 50% of the reviews showed inconclusive evidence. 101/669 (15%)empty reviews were found needing more primary studies. Conclusions:The proportion ofCochrane authors from low- and middle-income countries is low. Capacity-building insystematic reviews and good quality primary research in these countries is warranted.

A study of tobacco and alcohol consumption among the elderly population residing in field practice areas of a Tertiary Care Institute

Introduction: Tobacco and alcohol use are serious public health problems in many countries including India because of the associated health hazards. It is essential to bring down the health related risk behaviors among elderly population for promotion and prolongation of healthy life. Objective: To assess health related risk behaviors viz. smoking, alcohol and tobacco consumption among the geriatric population and making comparison of rural and urban elderly people. Material and method: A pretested, semi-structured questionnaire pertaining to sociodemographic information and three common risk behaviour practices i.e. smoking, smokeless tobacco use and alcohol consumption was used for data collection. Results: Overall, 9.6% rural and 6.8% urban elderly were current alcohol users. 19.6% rural and 12.8% urban elderly were current smokers while 20.4% rural and 14.0% urban elderly were current smokeless tobacco users. Proportions of males were significantly higher among tobacco user elderly participants in both rural and urban areas. Proportions of rural elderly were significantly higher among tobacco chewers. Conclusion: Overall prevalence of health risk behaviors was high among the study population. No significant difference found between rural and urban elderly people in relation to habit of smoking and alcohol consumption.

A study highlighting the reluctant use of ORS by mothers of children under-5 years in field practice areas of Jhalawar Medical College, Jhalawar, Rajasthan

Introduction: Diarrhoeal disease is the second leading cause of death and accounting for 9% of all deaths among children under 5years worldwide in 2015. It is both preventable and treatable. Rehydration therapy is a critical intervention to save the lives of children during the episodes of diarrhoea. Objective: Study was conducted to identify the gap between knowledge and practices of ORS use in diarrhoea among mothers of under 5 year’s children and treatment practices during diarrhoea. Material and method: A cross-sectional study was conducted by using pretested, semi structured interview schedule, among 320 mothers, of children under 5years who suffered from diarrhoea within two weeks before study, in field-practice areas of UHTC and RHTC, Jhalawar Medical College, Jhalawar (Raj.) from February 2017 to July 2017. Results: Among 320 children, 50% children had diarrhoea of age >6 month to 24 months. Majority of mothers (41.5%) were educated up to secondary level. 95% mothers knew the ORS but exact knowledge about preparation and use of ORS was only 29.3%. Majority of mothers got knowledge from Doctors. ORS use was 88.7% in rural area and 85.6% in urban area. Use of Zinc preparation was 2.5% and antibiotics was 76.5% during diarrhoea. Statistically significant association was found between education of mother, vaccination of children for measles and supplementation of Vitamin A with the knowledge about ORS of mothers. Conclusion: In present study knowledge and use of ORS is fairly good but the correct preparation and use of ORS is only among 29%.

A concurrent parallel study to compare the efficacy and safety of oral iron chelators, defrasirox and defriprone in patients of beta thalassaemia major

Background: This study was planned to evaluate all the cases of ? thalassaemia major, already receiving one of the oral iron chelators for a comparison among the efficacy, safety and economy of deferasirox and deferiprone to establish the better option in an Indian scenario.Methods: We identified two groups of patients: 38 treated with deferasirox and 35 treated with deferiprone. Laboratory parameters such as serum ferritin, creatinine, SGPT, Hb, CBC and urine were recorded at the time of inclusion and at 1, 3 and 6 months after the inclusion. The primary outcome variable was serum Ferritin level at the start and at the end of study. Serum ferritin level was carried out by microparticle enzyme linked immunoassay.Results: Before the study, the mean hemoglobin level was 7.32±1.50mg/dL ranged from 4 to 10.8 in deferasirox group and 7.54±1.15mg/dL ranged from 5.5 to 8.8 in deferiprone group. At the time of inclusion, study population was characterized by a mean serum ferritin value of 4735.11±450.01 SE in deferasirox and 4315.97±340.75 SE in deferiprone group. After one month the mean serum ferritin increases to 4578.66±371.96 in deferasirox and 4388.82±316.16 in deferiprone group. After three month the mean serum ferritin reduces to 4295.60±377.37 in deferasirox and 3988.88±349.84 in Deferiprone group.Conclusions: Thus, we conclude that deferasirox and deferiprone are well tolerated, have few adverse effects and almost have a comparable effect in lowering of the patient's serum ferritin level. Deferiprone is more cost effective but needs a strict control on compliance owing to requirement in three divided doses per day.

Paediatric Dentist: The Difference Maker for Children Suffering from Speech and Language Delay

Child's overall development and cognitive ability depend on the speech and language development. A speech and language delay is usually associated with increased difficulty with reading, writing, attention and socialisation. The knowledge of delay in the speech and language development may help in intervention and assistance to the child at a young age, when the chances of improving the developments are more acceptable. This includes a variety of tests for the child, which needs to be integrated with the routine clinical practice to improve and help the child to overcome the developmental delay of language and speech. The paediatric dentist can play a vital role in this development by his/her skill all of which is aimed to the well-being of the child. This review highlights on the treatment integrations of paediatric dentists, which can help the child suffering from speech and language delay.

The Use and Abuse of Antimicrobial Agents in Dental Practice.

It’s been over 60 years since the wide spread use of penicillin saved millions of lives from infection. Today there is a rapid emergence of antimicrobial resistance and it’s on the increase with each passing day. The dentists are responsible for a large number of antimicrobials prescribed and thus have a part to play in the antimicrobial resistance also. The present article discusses how are the dental professionals prescribing habits differ from other medical professionals, how are they contributing towards antimicrobial resistance and what are the steps which can be taken to curb the overuse of antimicrobials by dentists.

Influence of sex on the profile of acute coronary syndrome: a tertiary care hospital based study from the Sub-Himalayan region in North India.

Background: Coronary events presents about ten years later in women than men. There exist distinct gender differences in terms of presentation of symptoms, validity of diagnostic tests and complications. Methods: The study was conducted in the department of medicine R.P. Govt. Medical College (RPGMC) Himachal Pradesh. Consecutive 300 patients of acute coronary syndrome from June 2011 to June 2012 were included in the study. Demographical profile was recorded with focused clinical examination and relevant investigation with lipid profile was done. Results: Among the study population of 300 individuals, 201 (67%) were males and 99 (33%) were females. The mean age among male patients was 61.3±11.7 years and in female patients the mean age was 65.6±11.20 years. 68.8% of females presented after 60 yrs of age. Dyslipidemia was the commonest risk factor followed by hypertension and obesity. 12.2% of female patients were smokers. Chest pain was the commonest presenting symptom seen in 82% cases. There was mean delay of 31.0±54.5 hrs in the presentation of females for treatment. ST Elevated Myocardial Infarction occurred less frequently in females. Conclusions: Acute coronary syndrome is more age dependent in females. The predominance of dyslipidemia, hypertension and obesity as risk factors gives a message for primary care physicians to create awareness for the prevention of Acute Coronary Syndrome. The atypical symptoms should be recognised early which should further prevent the delay in presentation.

Cytotherapy for Osteonecrosis of Hip.

Osteonecrosis of hip is a pathological condition that leads to collapse of the femoral head, & the need for total hip replacement (THR). Research has shown that at the cellular level there is decrease in osteoblastic activity & the local mesenchymal stem cells (MSC) population that leads to osteonecrosis of femoral head (ONFH). Cellular therapy could thus be used to improve the local cellular environment. Th is can be achieved by implanting bone marrow, containing osteogenic precursors into the necrotic lesion of the femoral head.

Pattern of Orthopaedic Injuries Among Patients Attending the Emergency Department in a Tertiary Care Hospital – An Analytical Study.

Introduction: Th is study was aimed at analyzing the pattern of Orthopaedic injuries among patients attending the Emergency department in a tertiary care hospital. Retrospective study was conducted in the Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre. Methods: Th e record analysis of injured patients seen at the emergency department over a 12 months period from June 2012 to may 2013 was done. Th e data was analyzed with special reference tothepattern of Orthopaedic injuries. Results: A total of 1110 records of injured patients that attended the emergency department were analyzed. Study showed that themajority of victims were in the age group of 11-44 years (n=909, 81.89 percent). 71.09 percent (n=789) were males and 28.9 percent (n=321) were females. Road traffi c accident was the most common cause of injuries being responsible for 59.72 percent, (n=663) followed by fall from height (22.5 percent, n=247). Study revealed that the most common presentation of injuries was fracture (68.64 percent, n=762) and the most common site was lower limbs in 48.16 percent cases, (n=367). Next most common site was upper limbs (28.08 percent, n=214) followed by pelvic fracture (10.01 percent, n=77), spine fractures (8.26 percent, n=63), facial fracture (2.88 percent, n=22) & Ribs fracture (2.49 percent, n=19). Th ere were 71.65 percent cases (n=546) of simple fracture and 28.34 percent cases (n=216) ofthecompound fracture. Th ere were 3.87 percent cases (n=43), of various dislocations, shoulder dislocation being the most common. Crush injury was seen in 7.5 percent cases. Most commonly associated visceral injury wasthehead injury in 17.20 percent cases (n=191). Conclusion: Fractures were the most common pattern of Orthopaedic injuries, frequently associated with head injuries. Research in to appropriate strategies for prevention of injuries, especially RTA is required in tertiary care hospitals.

Screening of antiangiogenic potential of twenty two marine invertebrate extracts of phylum Mollusca from South East Coast of India

Objective: To evaluate the antiangiogenic potential of twenty two marine invertebrate species of Phylum Mollusca from south east coast of India.Methods:Live specimens of molluscan species were collected and their methanolic extracts were evaluated for preliminary antiangiogenic activity using the in ovo chick chorio-allantoic membrane assay. The extracts were further evaluated for in vivo antiangiogenic activity using chemical cautery induced corneal neovascularization assay in rats and oxygen induced retinopathy assay in rat pups.Results:In the chick chorio-allantoic membrane assay, four methanolic extracts of marine molluscan species viz. Meretrix meretrix, Meretrix casta, Telescopium telescopium and Bursacrumena methanolic extracts exhibited noticeable antiangiogenic activity at the tested concentration of 200 μg whereby they significantly inhibited the VEGF induced proliferation of new blood vessels. Among these four extracts, the methanolic extract of Meretrix casta exhibited relatively higher degree of antiangiogenic activity with an inhibitiory percentage (64.63%) of the VEGF induced neovascularization followed by the methanolic extracts of Telescopium telescopium (62.02%), Bursa crumena (60.48%) and Meretrix meretrix (47.01%). These four methanolic extracts were further evaluated for in vivo antiangiogenic activity whereby the methanolic extract of Telescopium telescopium exhibited most noticeable inhibition (42.58%) of the corneal neovascularization in rats in comparison to the sham treated group, and also exhibited most noticeable inhibition (31.31%) of the oxygen induced retinal neovascularization in rat pups in comparison to the hyperoxia group that was observed for considerable retinal neovascularization.Conclusions:The significant antiangiogenic activity evinced by the extract of Telescopium telescopium merits further investigation for ocular neovascular diseases.