Predictors of Practice of breast self-examination among women in District Ambala (Haryana)

Background: Breast cancer is the most common cancer among women and its early detection is critical to improve survival. Breast self-examination is a cheap, basic and non-intellectual method to detect breast cancer. Aims and objectives: 1To determine the knowledge, attitude and practices regarding breast self-examination2. To explain the various factors which affect the practice of BSE Material and Methods: The present study was carried out among 300 women residing in rural and urban areas of district Ambala using a self-designed pretested semi-structured questionnaire. Results: In this study 127 (42.3%) of the participants had heard of BSE and 107 (35.7%) of the participants knew how to perform BSE. Overall, 47.7%, 30.3%, and 22% of the study participants had poor (<50%), medium (50–75%), and good knowledge (>75) on BSE, respectively. Educational qualification, knowing the three positions to perform BSE, knowing how often should BSE be done, taught how to do BSE, BSE is a useful tool to detect breast cancer were seen to be significantly associated with practice of BSE. Conclusion: This study elucidates that the knowledge as well as practice of BSE was significantly low in the population. This study provides insights into the various factors which affect the practice of BSE

Factors affecting compliance to hypertension medication: A study from North India

Background: Hypertension is an important health problem globally. One of the main causes of uncontrolled hypertension is the failure on the part of the patient for not taking the prescribed drugs. Objectives: This study was conducted to study the level of adherence to antihypertensive medication and to determine multiple factors which affect it. Materials and Methods: This community-based cross-sectional study was conducted in the field practice area of the department of community medicine. The study subjects were 700 patients aged 18 years and above diagnosed with hypertension for at least 1 year who had been prescribed antihypertensive treatment. Results: In this study, it was found that of the 700 participants, 57.3% were adherent to antihypertensive drugs. Factors significantly associated with adherence to hypertensive medication included being literate, socioeconomic Classes 1 and 2, taking only one hypertensive medication, monthly cost of drugs <500, being aware of hypertensive complications and complications of not taking drugs regularly, perception of current health status, and knowledge about worsening of health condition on stopping the treatment. Conclusions: Many factors such as literacy, socioeconomic factors, and awareness of consequences impact the adherence to treatment and hence the treatment outcomes. Community support and financial help can improve the same. It is imperative that all hypertensive patients receive repeated counseling to continue therapy. Financial support is an important issue which needs to be addressed.

A cross-sectional study of anemia among urban and rural adolescent girls in district Ambala, Haryana

Background: Anemia is a continuously rising threat to not only present but also future generations as well and Indians are under high risk, especially adolescent girls. The anemic adolescent girls grow into adult women with compromised growth, both physical and mental. These women have low pre-pregnancy weight and are more likely to die during childbirth and deliver low birth weight babies. Objectives: The objectives of this study were to find the prevalence of anemia in urban and rural adolescent school-going girls 10–16 years of age, among adolescent girls of district Ambala, Haryana. Materials and Methods: A community-based cross-sectional study was conducted in government and private schools of district Ambala. This study was conducted among 300 adolescent girls, 10–16 years of age studying in government and private schools of Ambala. The blood samples were taken from the students and hemoglobin was measured. Data were collected by interviewing the study subjects using a self-designed, pre-tested semi-structured questionnaire. Results: Overall prevalence of anemia was found to be 69.7%. Conclusion: The prevalence of anemia was very high among adolescent girls. This indicates a need to educate them about anemia and its risk factors. Regular screening of school students to rule out anemia is the need of the hour.

Determinants of immunization coverage among 12-23 months children: A study from Haryana

Background: Immunization is safe, powerful and proven tool for elimination and controlling various highly infectious diseases and in spite of every possible effort put by the Government still there is a big gap between reported and evaluated coverage. Aims & Objectives: To find out the immunization coverage and its determinants among children in the age group 12 – 23 months in urban and rural area of district Ambala. Material and Methods: It was a cross sectional study carried out by WHO recommended 30 by 7 cluster survey technique. Results: It was observed that overall 83.1% children were fully immunized, 14% were partially immunized and 2.9% were unimmunized. In present study Educational status of mothers, Occupation of mothers, Religion, Sex, Monthly Family Income and Caste were found to be significantly associated with immunization coverage. “Fear of side effects” of vaccination was found to be the main reason for failure to fully immunize the child. Conclusion: To conclude, immunization coverage was found to be reasonably but still there is a lot of scope for improvement.

High degree of fluoroquinolone resistance among pulmonary tuberculosis patients in New Delhi, India

Background & objectives: The fluoroquinolones (FQs) group of antibiotics is the backbone drugs for the management of drug-resistant tuberculosis (TB). In routine clinical practice, drug susceptibility testing (DST) for FQs is not performed, and the patients are empirically treated. A limited information exists regarding FQs resistance among pulmonary TB cases. The present study was conducted to determine the FQs resistance among drug sensitive and drug-resistant pulmonary TB patients in a tertiary care centre in north India. Methods: A total of 1619 sputum/smear-positive specimens of pulmonary TB patients were subjected to DST for first-line drugs (FLDs) and second-line drugs. In addition, FQs DST was also performed using automated Mycobacterial Growth Indicator Tube-960 liquid culture technique. The immuno-chromatographic assay was performed to distinguish Mycobacterium tuberculosis complex (MTBC) from non-MTBC. Results: Mycobacterium tuberculosis (Mtb) was isolated in 1499 sputum specimens; 1099 culture specimens were sensitive to FLDs, 249 grew as multidrug-resistant (MDR) Mtb and the remaining 151 isolates revealed any drug resistance to FLDs. While FQs monoresistance among the FLD sensitive isolates was 3.1 per cent (35/1099), 27.3 per cent (68/249) among MDR Mtb isolates had additional FQs resistance. Interpretation & conclusions: FQs resistance among drug sensitive and MDR Mtb isolates was high in Delhi, India. Based on these findings, it is recommended that the DST for FQs should be routinely performed to avoid further amplification of drug resistance.

In vitro studies reveal antiurolithic effect of Terminalia arjuna using quantitative morphological information from computerized microscopy

ABSTRACT Purpose: For most cases, urolithiasis is a condition where excessive oxalate is present in the urine. Many reports have documented free radical generation followed by hyperoxaluria as a consequence of which calcium oxalate (CaOx) deposition occurs in the kidney tissue. The present study is aimed to exam the antilithiatic potency of the aqueous extract (AE) of Terminalia arjuna (T. arjuna). Materials and Methods: The antilithiatic activity of Terminalia arjuna was investigated in vitro nucleation, aggregation and growth of the CaOx crystals as well as the morphology of CaOx crystals using the inbuilt software ‘Image-Pro Plus 7.0’ of Olympus upright microscope (BX53). Antioxidant activity of AE of Terminalia arjuna bark was also determined in vitro. Results: Terminalia arjuna extract exhibited a concentration dependent inhibition of nucleation and aggregation of CaOx crystals. The AE of Terminalia arjuna bark also inhibited the growth of CaOx crystals. At the same time, the AE also modified the morphology of CaOx crystals from hexagonal to spherical shape with increasing concentrations of AE and reduced the dimensions such as area, perimeter, length and width of CaOx crystals in a dose dependent manner. Also, the Terminalia arjuna AE scavenged the DPPH (2, 2-diphenyl-1-picrylhydrazyl) radicals with an IC50 at 13.1µg/mL. Conclusions: The study suggests that Terminalia arjuna bark has the potential to scavenge DPPH radicals and inhibit CaOx crystallization in vitro. In the light of these studies, Terminalia arjuna can be regarded as a promising candidate from natural plant sources of antilithiatic and antioxidant activity with high value.

Acute Myeloid Leukemia Presenting as Acute Bulbar Palsy.

Myeloid Sarcoma1 (also termed as chloroma, granulocytic sarcoma, extra medullary myeloid tumor) is a rare extra medullary tumor composed of immature myeloid cells (myeloblast)2. It is usually associated with leukemia or other myeloproliferative disorder. Myeloid Sarcoma in the central nervous system, around the brain stem is the commonest site of presentation and require high suspicion for diagnosis. We report a forty years male patient with history of dysphagia, dysphonia for last two months. MRI showed chloromas around the brain stem. Laboratory investigations revealed the presence of AML. This is a rare case of Myeloid Sarcoma around the brain stem in a patient of AML.

Subacute Sclerosing Panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a rare, invariably fatal degenerative disease of central nervous system developing after measles infection. Neurological symptoms are initial presenting symtoms but rere reports of pure psychiatric symtoms preceding neurological symtoms have been reported.. We here report a case of 18 years old male patient suffering from Subacute sclerosing panencephalitis (SSPE) who initially had behavioural changes and then subseqently devloped neurological symptoms.

Tuberculosis of the ilium: a case report.

A twenty year old man presented with pain in the upper part of right hip. CT scan showed multiple osteolytic areas in the right ilium, suggesting malignancy. CT guided needle biopsy was done and diagnosis of tuberculosis was made. The patient was cured with medical management only. Isolated tuberculosis of the ilium is an extremely rare condition. It is important to have a high clinical suspicion to diagnose early and manage the patient without surgical intervention.

Tubercular Osteomyelitis of Mandible.

Tubercular osteomyelitis of mandible is an extremely rare condition, particularly in comparison to pyogenic infections and neoplastic diseases involving the mandible. We report a case of tubercular osteomyelitis of mandible in an old chronic smoker woman initially suspected of neoplasia, proved later on as primary tubercular osteomyelitis in absence of a primary focus.

Role of anti-depressant fluoxetine in the puva treatment of psoriasis vulgaris.

Severity of Psoriasis Vulgaris is known to be modified by psychological stress. The objective of this study was to evaluate the role of Fluoxetine in the PUVA treatment of Psoriasis. Twenty patients with progressive disease having more than thirty per cent body area involvement were included in a randomized, double blinded, placebo-controlled, age and sex matched study. All patients were on PUVA treatment; half of the patients were given Fluoxetine 20 mgms daily whereas the other ten were given placebo. Assessment was done by Psoriasis Area and Severity Index (PASI) scoring after every 5 exposures of PUVA treatment till 20 treatments. All ten patients who took Fluoxetine along with PUVA treatment showed better response and quicker remission. Fluoxetine may be used as an adjuvant in PUVA treatment of Psoriasis.

Incidence of HIV infection & its predictors in blood donors in Delhi.

The concurrence of human immunodeficiency virus (HIV) infection with hepatitis B virus (HBV) and syphilis and the trend that these infections have followed in blood donors during the last eight years from 1989 to 1997 were studied at a Zonal Blood Testing Centre in New Delhi. Overall, HIV was positive in 0.068 per cent blood donors in this period. A significant rise was found in HIV infection (particularly in a small subgroup of voluntary donors) after 1995 and in VDRL reactivity after 1993. However, no significant increase was found in hepatitis B surface antigen (HBsAg) positivity. HIV seroprevalence in replacement donors, which represents the low risk general population, increased gradually from 0 in 1991 to an average of 0.060 per cent in 1997. HbsAg and VDRL reactivity was present in 12.2 and 11.8 per cent of HIV positive cases while it was present in 1.2 and 2.3 per cent of HIV negative cases respectively. HBsAg was found 10.4 times and VDRL reactivity 5.9 times more often in HIV positive donors as compared to HIV negative donors. Thus, HIV infection is likely to be more prevalent in communities with a high HBsAg positivity and VDRL reactivity.

Predictors of outcome in fulminant hepatic failure in children.

OBJECTIVE: To identify the predictors of outcome in fulminant hepatic failure (FHF) in children. STUDY DESIGN: Prospective cohort study. METHODS: 41 children with FHF were studied. Patient characteristics and findings on examination at the time of hospitalization were noted. Serum biochemistry and screening for hepatotropic viruses (A, B and C) were done in each patient. Patients were treated using a predefined protocol and followed up till death or discharge. Univariate and multivariate analysis was done to find the predictors of outcome. RESULTS: Hepatitis B was the commonest cause of FHF (11 children; 26.9%). Markers for hepatitis A and C viruses were present in one and two patients, respectively. Serology was negative in 27 children (65.9%), of whom two had history of ingestion of hepatotoxins (antitubercular drugs). The overall mortality was 61%. Irrespective of etiology, the following factors were associated with poor outcome on univariate analysis: presence of gastrointestinal (GI) hemorrhage, serum bilirubin more than 10 mg/dL, age 6 years or less, coma of grade 3 or more, presence of infection, prolongation of prothrombin time > 8 s over control, prothrombin concentration < 50%, hypoglycemia (blood glucose < 45 mg/dL), hyponatremia (serum sodium < 125 mEq/L) and hyperkalemia (serum potassium > 5.5 mEq/L). On multiple logistic regression analysis, presence of GI hemorrhage (p = 0.005), degree of coma (p = 0.02) and serum bilirubin level (p = 0.025) were identified as independent predictors of mortality.

Low-dose intravenous diltiazem--efficacy and safety in supraventricular tachyarrhythmias.

Intravenous diltiazem has been used to rapidly reduce ventricular rate in patients with supraventricular tachyarrhythmias (SVTs). This study assesses the efficacy and safety of a low-dose (0.1 mg/kg) intravenous bolus of diltiazem on the heart rate and blood pressure. Fifteen consecutive patients were treated for 21 episodes of atrial fibrillation, sinus tachycardia or ectopic atrial tachycardia. The bolus dose reduced the heart rate significantly in all patients with atrial fibrillation within 5 min (173 +/- 21 to 144 +/- 27 beats/min, p < 0.05) with the maximum response seen at 10 min (128 +/- 26.7 beats/min, p < 0.05). However, patients with sinus tachycardia showed a significant decrease in heart rate only at 15 min (147 +/- 12 to 123 +/- 15 beats/min, p < 0.05). One patient with ectopic atrial tachycardia required maintenance infusion of diltiazem. Conversion to sinus rhythm was observed in another patient with atrial fibrillation. The drug was well tolerated with no significant hypotension, bradyarrhythmia or aggravation of pre-existing congestive heart failure. It is concluded that Indian patients require a lower dose of intravenous diltiazem as compared to Western ones (0.1 mg/kg versus 0.25-0.33 mg/kg) which gives a prompt, effective and safe response in patients with SVTs.