Behavioral Risk Factors of HBV Infection and its Association with HBs Ag Positivity among Residents of Kaza Sub- division of District Lahaul & Spiti in Himachal Pradesh

Background: Chronic viral hepatitis is a major global public health problem, an important cause of morbidity and mortality. We conducted this study to evaluate the behavioral risk factors of HBV infection and its association with HBsAg positivity among residents of Kaza sub-division of district Lahaul & Spiti in Himachal Pradesh. Material & Methods: The study was carried out by the Gastroenterology, Community Medicine, and Microbiology Department at Indira Gandhi Medical College Shimla at Kaza, a subdivision of Lahaul & Spiti. The cluster sampling technique was used to get the desired sample size of 4000. Forty clusters were chosen using a probability proportionate to size sampling method, and 100 research participants were added to each cluster using a simple random sampling method. The data was gathered using a pre-tested interview plan. A blood sample of 5ml from each study participant was obtained, and its HBsAg content was examined. Results: In our study, 2.7% of the interviewed respondents’ parents were positive for hepatitis B and 3.7% reported one positive family member. Injectable drug use was reported by 1.6 (68/4231). Among these users 8.8% (6/68) shared needles with other IDUs in last 12 months and 35.3% (24/68) used a common container to draw up drug solution. Sexual intercourse was reported to be experienced by 15.5 (655/4231) and 12.2% either did not disclose or were children. Out of those who ever experienced sexual/penetrative intercourse 38.3% (251/655) had reported it with someone else other than a spouse. Majority of these had two partners other than a spouse (30.3%; 76/251). Around 30% (195/655) reported of using a condom in their last intercourse. Body piercings or a tattoo from someone who doesn’t sterilize his or her equipment, including local treatment from lamas, was prevalent among 16.3% of the population (689/4231). Acupuncture was taken as a remedy for any medical condition by 9% of participants. Regression analysis also revealed that one infected family member emerged as an independent factor associated with HBsAg positive test after adjusting for confounders. Conclusion: Our study provided much important information concerning hepatitis B risk factors in this tribal group. Health education about behavioral risk factors among this tribal population should be the main intervention that might help limit the spread of these blood-borne infections.

Prevalence of Smartphone Addiction and its Relation with Depression among School-going Adolescents

Background: Smartphone addiction among adolescents is an increasingly recognized problem worldwide. It affects the psychological well-being of an individual. Aim and objective: The current study aimed to assess smartphone addiction’s prevalence and its relation to depression among adolescents. Methods: This cross-sectional study was conducted among 400 school-going adolescents. Smartphone Addiction Scale - Short version (SAS-SV) and Patient Health Questionnaire (PHQ-9) were used to assess the prevalence of smartphone addiction and depression. Data were analyzed using Epi info software for windows (CDC, Atlanta). Statistical significance was set at p < 0.05. Results: The mean age of study participants was 14.4 years (SD=1.5 years). The prevalence of smartphone addiction was 23%, while depression was present among 45% of the study participants. Comparatively higher duration of smartphone use was significantly associated with smartphone addiction. Depression was significantly higher among smartphone addicts (77.2%) as compared to their counterparts (35.4%). Conclusion and Recommendation: The smartphone usage of adolescents, if not monitored, could lead to its addiction and thus increase the risk of depression among them. To prevent smartphone addiction, limiting children’s screen time is recommended. In this regard, parents can play a pivotal role by becoming responsible digital role models for their children.

Effect of low volume background instrumental flute music on visual reaction time: a cross sectional interventional study

Background: Music is believed to affect the cognitive function. However, there is conflicting evidence about the effect of background music on the same. Few studies have been done on the effect of instrumental music on cognition. Aim and Objective: The aim of our study was to study the effect of low-volume instrumental music on visual reaction time (RT). Materials and Methods: Visual RT (simple reaction time [SRT] and choice reaction time [CRT]) using Deary–Liewald software was recorded in 48 medical students aged 18–21 years, without, and then with low-volume background instrumental flute music. Results were compared with regard to change in mean values of SRT, CRT, and mean central processing time. Data were analyzed statistically using unpaired t-test and statistical significance (P < 0.05) was sought. Results: We did not find any statistically significant change in visual RT after subjecting the students to low-volume background instrumental music. Conclusion: Background instrumental does not significantly affect visual RT but this should be further analyzed.

Prevalence And Predictors of Exposure to Second-Hand Smoke Among Never-Tobacco Smokers

Background: Exposure toSecond-hand tobacco smoke (SHS) harms health. It is a risk factor for various diseases like asthma, hypertension, diabetes, heart disease and lung cancer. This study aimed to deter-mine the prevalence and predictors of second-hand tobacco smoke among adult never-smokers.Methods: A cross-sectional study was conducted among 220 participants aged 18 years and above. A pre-tested questionnaire was used to elicit information regarding exposure to second-hand smoke at the home, workplace and various public places. The data was analysed using the Epi Info software for win-dows. Results: The second-hand smoke exposure at home and workplace was 11.4% and 19.1%, respectively. The SHS exposure at bus stops, public transport, government buildings and health care facilities was 33.3%, 13.0%, 7.6% and 3%, respectively. The in-home study participants with a current tobacco smok-er, family member and/or friend had comparatively higher exposure to second-hand tobacco smoke. In the workplace and or public places, male study participants and illiterate individuals had higher expo-sure to second-hand tobacco smoke. Conclusion: The observed level of SHS exposure among non-smokers is a public health concern. Family members should not allow anyone to smoke in their home environment. The public health law prohibit-ing tobacco smoking in workplaces and public places needs further strengthening.

Biomedical Waste Management in Leh District

The aim of this study was to find out how Biomedical Waste (BMW) is disposed of in the Leh district and whether the healthcare facilities are following BMWM Rules 2016. A total of 19 health care facilities from Leh district were selected for this study. The data were collected through a semi-structured questionnaire from June 2021-August 2021. After analysis, it was found that all the health care facilities are involved in the disposal of BMW inside their premises. There is no involvement of the municipality or CBMWTF in handling BMW in Leh district. All the healthcare facilities have adopted the BMWM Rules 2016 but only partially.

A Review on Pharmacological and Therapeutic Potential of Aloe barbadensis Miller

Aloe vera, a popular succulent perennial medicinal plant with a wide range of phytochemicals that have shown various pharmacological activities including anti-oxidant, antimicrobial, antidiabetic, wound healing promotion and so on. Acemannan, aloe-emodin, aloin, aloesin, and emodin are widely investigated active constituents that show various pharmacological activities. Thus, the purpose of this review is to highlight previous pharmacological studied conducted in vivo, in vitro and human assays over the past decades. As current pharmacological research is focused on anticancer and neurological action, it would be interesting and important to study the main compounds present in Aloe vera for therapeutic purposes.

Prenatal diagnosis of anencephaly and acrania in pregnant females – Report series of eight cases

Acrania and anencephaly are characterized by the partial or complete absence of skull and brain tissue. Due to this, the neural tissue is exposed and it leads to non-function of few parts of the hemispheres. A total of eight cases of acrania and anencephaly were included in the report. Five cases were acrania and three cases were anencephaly. Both cases were diagnosed between 15 and 24 weeks of gestation period. In the present report, all the pregnant women carry fetuses with neural tube defects. Out of five acrania cases, there is a partial or complete absence of cranium in all the cases, and in one case, there is a twin intrauterine gestational sac that was noted. However, out of twin sac, the first one is having a good heart rate (155 bpm) and the second fetus is having no cardiac activity, i.e., early fetal demise. On the other hand, out of three anencephaly cases, two anencephaly cases were diagnosed with partial absence of the fetal brain and the complete absence of the cranium, and in one case, there is a partial absence of cerebral parenchymal tissue above the orbit with the absence of cranial vault. By the use of ultrasonography, we can diagnose the anencephaly and acrania at a very early stage without any side effects. The cause of anencephaly and acrania is dependent on the number of factors one of which is a folic acid deficiency. Sentence is reviewed and corrected): It is always better to consume the folic acid supplements that are advised by the physician during the planning of pregnancy to avoid the congenital anomalies of the fetus like anencephaly and acrania. The ultimate focus of the study is to evaluate the morphology of the fetus in case of anencephaly and acrania which could lead to the early detection of abnormalities and also to create awareness among people to take folic acid supplements to eschew such abnormalities.

Development of Fibre Enriched Chicken Nuggets Using Combination of Wheat Bran with Dried Apple Pomace or Dried Carrot Pomace

This investigation was conducted to evaluate the effect of incorporation of wheat bran (WB) with dried apple pomace (DAP) or dried carrot pomace (DCP) on quality attributes of chicken nuggets. Raw emulsion was stuffed in rectangular moulds, cooked in electric oven at 165°C for 40 minutes and nuggets were prepared by slicing cooked emulsion to 2-3 cm3 size. Colour scores increased with increase in DAP level in WB + DAP treated nuggets. A steady decrease in scores for all other sensory attributes was noticed in both WB + DAP and WB + DCP treated nuggets with increase in fibre level. Hardness and shear press value increased whereas springiness and cohesiveness decreased with increase in fibre level. Gumminess and chewiness of WB + DAP treated nuggets increased with increase in fibre level while gumminess and chewiness of WB + DAP treated nuggets showed a variable trend. Cooking yield and emulsion stability of fibre enriched nuggets were significantly higher whereas moisture, protein, cholesterol content and pH were significantly lower than control. Insoluble, soluble and total dietary fibre content increased drastically in treated nuggets. Thiobarbituric acid reacting substance (TBARS) value and microbial counts increased significantly during refrigerated storage in all the products. It is concluded that healthier and dietary fibre enriched chicken nuggets with refrigerated storage stability up to 15 days can be prepared using combination of wheat bran (2%) with dried apple pomace (6%) or dried carrot pomace (4%) each

Outcome of community based planned intervention targeting perceptions, attitudes and health seeking behaviour regarding cancers in New Delhi, India

Background: Cancer prevention and control needs to be based on effective implementation of all approaches. Community as well as individual level interventions to increase knowledge and early reporting have shown effectiveness. A community-based intervention trial was conducted to design, implement and test short-term outcomes of evidence based preventive strategies.Methods: A mixed methods, three phased study was conducted in three districts of Delhi, which were selected by a random process. Two randomly selected districts out of these three were intervention districts while third was the control. A total sample of 500 in each district was studied in quantitative pre and post -intervention phases. Multistage, stratified, cluster sampling was utilized. Pre-tested and validated tools were used.Results: Post intervention, statistically significant higher scores were observed in all domains in intervention districts as compared to control (p<0.01). Though comparison of slum versus non-slum showed significant increment in knowledge and practice scores, with higher scores for non-slum respondents, the attitudes were very similar (p>0.05). The increment score changes between males and females was similar in all classes of society versus control district. Comparison within the intervention and control groups revealed increased scores in intervention districts and decreased scores in control district, in all domains (p<0.05).Conclusions: Our study has helped in understanding the determinants of perceptions, attitude and practices regarding cancer in the community, This, helped in formulating the need-based intervention strategies. Testing the short-term outcome of intervention showed it to be effective.

Correlation of Leptin and Vaspin Serum Concentration in Newly Diagnosed Type 2 Diabetes Mellitus

Objectives : The aim of the study was to explore the correlation of circulating leptin and vaspin levels with lipid profile, fasting blood sugar, HbA1c and anthropometric variable as inflammatory markers between diabetic patients and non - diabetic subjects. Material and Methods: This study was conducted with 120 newly diagnosed type 2 diabetes mellitus (T2DM) patients with age - matched 120 non - diabetic sub jects as controls. Results: We found that there is significant increase in the parameters like serum Leptin, Vaspin, FBS, PPBS, HbA1c and lipid profile (TC, TG & VLDL). No significant differences were found between BMI, LDL & HDL parameters of T2DM patient s compared to non - diabetic subjects. The results have been shown a significant positive correlation between Vaspin and Leptin in T2DM patients, (r = .755) and ( P ?0.01 ) as compared to controls. The body mass index was positively correlated with Vaspin in T2DM patients, (r = .50) and ( P <0.01 ) and with leptin in T2DM patients, (r = .265) and ( P <0.01) . A positive correlation had also observed between vaspin and LDL in T2DM patients, (r = .189) and ( p <0.05 ). We also found that significant increased leve l of leptin and vaspin in females compared to males in our study group. Conclusions: Serum leptin and vaspin level is positively associated with BMI and LDL and negatively correlated with fasting blood sugar, post - prandial glucose, HbA1c, VLDL and age.

Resource optimization through process re-engineering of inhalational therapy unit at a tertiary care public hospital

Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment.

Prevalence and predictors of self-reported risk behaviors among male injecting drug users

Background: Unsafe injecting drug use is a documented risk factor for the transmission of human immunodeficiency virus infection. Harm reduction strategy aims at reducing this deleterious consequence. Objectives: To study the prevalence and predictors of injecting as well as sexual risk behavior among male injecting drug users (IDUs). Methods: A cross-sectional study was conducted among 250 male IDUs from January 2017 to March 2018. Risk behavioral data were collected after obtaining informed consent of the study participants. This included information on sharing, reusing needles/injections, and sexual behavior. Descriptive statistics and logistic regression model was run using the Epi Info software version 7.2 for Windows. Results: In the past one month, 25.3% had shared needles/syringes by either borrowing or lending or both. Inconsistent condom use during sexual intercourse with a regular, casual, and paid sex partner was practiced by 64.7% (77/119), 65.8% (48/73), and 45.0% (18/40), respectively. The binary logistic regression analysis revealed that unsafe injecting drug behavior was higher among daily users: (OR = 3.0 [1.3–6.6]) and comparatively lower among those who preferred to avail needles/syringes from Needle Syringe Exchange Program (OR = 0.4 [0.2–0.9]); as compared to their counterparts. Conclusions: The findings suggest that IDUs in the study area are engaging in risk behaviors. Behavior change communication and harm reduction strategy should be strengthened.

Salvaging Exposed Cardiac Pacemakers Using Sub–Pectoral Pocket And Negative Pressure Wound Therapy

Introduction: Permanent cardiac pacemakers implanted over chest wall are prone to exposure and infection. The management of exposed pacemaker implants are controversial, and most of the time exposed devices are removed and a second device is implanted in an additional operation after days to weeks. Methods: Between Apr 2014 and Mar 2018, 24 patients were managed for exposed cardiac pacemakers. Most patients were operated within 14 days from exposure. All patients received perioperative appropriate antibiotics. In the absence of clinical signs of infection, NPWT was started for patients where there was more than one gauze piece soakage in 24 hours. Once soakage was less than 10 ml/day, implant was covered with local skin flap or placed in a sub–pectoral pocket and NPWT applied over the suture line. Mean follow–up post salvage procedure was 20 months. Results: Twenty two devices were saved. Only one grossly infected pacemaker was removed. In another patient implant got infected and exposed after four months of re–implantation and has to be removed and replaced. Conclusions: This protocol allows salvage of exposed permanent cardiac pacemaker implants even several days after exposure. A combination of NPWT and sub–pectoral muscle placement lead to salvage of the implant, saving cost and morbidity to the patient.

Rehabilitation of Exenterated Right Eye: A Prosthetic Challenge

Background: Facial defects can be acquired or congenital, but irrespective of etiology, any maxillofacial structure if damaged or missing will result in an unaesthetic and unappealing personality of individual. Orbital defects are very evident and effect the appearance and social front of the individual. Many modalities are available to rehabilitate the defect of an orbit but prosthetic rehabilitation with silicone prosthesis is a simple and effective approach. Retention is generally achieved by engaging available undercuts or using mechanical accessories or skin adhesives etc. This case report describes successful rehabilitation of right orbital defect using a non-surgical approach with room temperature vulcanized silicone and skin adhesives. Case Report: A 45 yr old male reported with, chief complaint of missing right orbit and unaesthetic appearance secondary to gunshot wound. Patient was not ready for any more surgical procedures or additional accessories and available retentive undercuts were minimal. Hence, conventional silicone prosthesis was made using stock eye shell and room temperature vulcanized silicone retained with skin adhesives. The approach was simple to a complex problem and gave reliable result in very limited time. Conclusion: With extensive orbital defect, rehabilitation is difficult and complex as retention is compromised and it is difficult to match the shade of the prosthesis.This case represents a simple and predictable approach to a case of exenterated right orbit with conventional roomtemperature vulcanized silicone and silicone skin adhesives.

Rehabilitation of Exenterated Right Eye: A Prosthetic Challenge

Background: Facial defects can be acquired or congenital, but irrespective of etiology, any maxillofacial structure if damaged or missing will result in an unaesthetic and unappealing personality of individual. Orbital defects are very evident and effect the appearance and social front of the individual. Many modalities are available to rehabilitate the defect of an orbit but prosthetic rehabilitation with silicone prosthesis is a simple and effective approach. Retention is generally achieved by engaging available undercuts or using mechanical accessories or skin adhesives etc. This case report describes successful rehabilitation of right orbital defect using a non-surgical approach with room temperature vulcanized silicone and skin adhesives. Case Report: A 45 yr old male reported with, chief complaint of missing right orbit and unaesthetic appearance secondary to gunshot wound. Patient was not ready for any more surgical procedures or additional accessories and available retentive undercuts were minimal. Hence, conventional silicone prosthesis was made using stock eye shell and room temperature vulcanized silicone retained with skin adhesives. The approach was simple to a complex problem and gave reliable result in very limited time. Conclusion: With extensive orbital defect, rehabilitation is difficult and complex as retention is compromised and it is difficult to match the shade of the prosthesis.This case represents a simple and predictable approach to a case of exenterated right orbit with conventional roomtemperature vulcanized silicone and silicone skin adhesives.

Delayed Onset Sciatic Nerve Palsy Secondary to Wound Hematoma following Anticoagulant Therapy Post-Bipolar Hemiarthroplasty - an Uncommon Complication: A Case Report

@#A 58-year old female patient presented to us with a three months’ old fracture of the neck of femur. She underwent bipolar hemiarthroplasty. In the immediate postoperative period, she developed deep vein thrombosis for which she was started on anticoagulant therapy. Patient had persistent discharge from the wound since then and underwent regular dressings. On the eighth post-op day, she developed sciatic nerve palsy secondary to wound haematoma. The haematoma was decompressed immediately and she had a dramatic improvement in pain but her neurological deficit persisted. The wound healed completely without any complications. At three months follow up, she had recovered completely with grade 5/5 power in ankle and foot and full sensory recovery in the sciatic nerve distribution. She was ambulating comfortably with a walker. At final follow up around 20 months post-operation, she was pain-free and walking without any support. The wound had healed completely.

The Scope Of Ayurvedic Medicine And Therapy In The Managment Of Infertility

Infertility is described as an inability to conceive despite unprotective sex for duration of one year or more. Male, female or both can be a victim for this disorder. There may be many biological causes of infertility including some can be treated with medical or surgical intervention. Ayurveda consider this problem as a cause of deterioration of quality of four factors i.e., time of ovulation, female health in context of reproductive system, quality of sperm and ovum and female抯 proper nutrition. There are different treatment methods and medicines used according to the deficit in male, female or in both. Vajikaran drugs like Ashwagandha, Madhuyasthi, Vidarikanda, Gokshura etc., are used in male fertility problems and Satavari, Punarnava, Dasmoola, Aloevera etc., used in female infertility problems. The purificatory procedures like Vamana, Virechana, Basti etc., are also found very effective to improve the quality and strength of required reproductive factors in both sexes. The effect of Uttar basti is also evidenced in different researches to treat female infertility.

Diagnostic accuracy of Xpert MTB/RIF assay in extrapulmonary tuberculosis

Introduction: The WHO endorsed Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay, has been evaluated for pulmonary TB in a number of studies but very few have investigated it for extrapulmonary specimens. The present study evaluates the performance of Xpert MTB/RIF assay in the diagnosis of extrapulmonary TB (EPTB). Aim and Objectives: The aim of the study is to determine sensitivity and specificity of Xpert MTB/RIF assay for diagnosis of EPTB and RIF resistance in comparison to culture on Lowenstein–Jensen (LJ) medium and proportion method (PM), respectively. Materials and Methods: A total of 738 specimens from clinically suspected cases of EPTB were subjected to Ziehl–Neelsen staining, Xpert MTB/RIF assay and culture on LJ medium. PM was done on MTB isolates. Results: The sensitivity, specificity of Xpert MTB/RIF assay for diagnosis of EPTB were 84.91% (95% confidence interval [CI] 72.41%–93.25%) and 86.72% (95% CI 83.94%–89.17%) and for RIF resistance detection were 60.00% (95% CI 32.29%–83.66%) and 94.74% (95% CI 73.97%–99.87%), respectively. Among culture-positive cases, the sensitivity of Xpert MTB/RIF assay was 94.12% in smear positive and 80.56% in smear-negative cases. Xpert MTB/RIF showed maximum sensitivity of MTB detection from lymph node specimens (100% [95% CI 54.07%–100.00%]) and other body fluids (100% [95% CI 15.81%–100.00%]). Conclusion: The present study establishes Xpert MTB/RIF assay as a promising tool in the rapid diagnosis of EPTB and detection of RIF resistance.

Drug utilization study in diabetic patients seeking medical treatment in a north Indian rural medical college hospital

Background: Diabetes Mellitus is a chronic disease and its life-long management causes burden on lifestyle and financial condition of the patients. Drug utilization studies provide useful insights into the current prescribing practices.Methods: To evaluate the drug utilization pattern of anti-diabetic drugs in diabetic patients. A prospective observational study was carried out in adult diabetic patients visiting the Wards and Outpatient Department of General Medicine of a tertiary care hospital. The demographic data and utilization of different classes of anti-diabetic agents as well as individual drugs were analyzed.Results: In 125 patients (Male-65, Female-60), a total of 379 drugs (average 3.032±2.05) were used per day, out of which 76 (20.05%) were rational fixed dose combinations (FDCs) and 261 (68.86%) were prescribed from National List of Essential Medicines (NLEM) 2015. The number of drugs prescribed to be ingested was 326 (86.01%) and 63 (16.62%) were injectables.Conclusions: It was found that the prescription tendencies of the doctors were quite rational. More improvement can be done by sensitizing them to prescribe more drugs from NLEM. The limitations in the affordability of rural population should be taken care of while prescribing drugs for this chronic disease.

Retromandibular Approach for Subcondylar Fractures: A Prospective Study

Background: Condylar fractures accounts for 25-50% of all mandibular fractures. It can be extracapsular or intracapsular, nondisplaced, displaced, deviated, or dislocated from the disc. Objective: To evaluate the retromandibular transparotid approach for open reduction & internal fixation of subcondylar fractures for post-operative occlusal status, stability of fixation & postoperative complications. Material and Methods: The prospective study was performed on 24 patients (18 male and 8 females) sustaining 26 subcondylar fractures who were treated surgically utilizing retromandibular transparotid incision. Results: The most common etiology of injury was road traffic accidents in 62.5% patients. Satisfactory anatomic reduction and occlusion was achieved in all patients. The incidence of transient facial nerve injury was 16.67%. The facial nerve returned to normal function in 3 months in all the 4 affected patients. Conclusion: The incision provides easy visualization of the subcondylar region from the posterior edge of the ramus to the sigmoid notch, allows the perpendicular placement of screws to the fracture site, with minimal post operative complications and satisfactory esthetic results.