Comparison of Creatine Kinase-MB, Troponin-I, Troponin-T, Triiodothyronine, Thyroxine, Apoprotein-B and Homocysteine between Non-smokers, Smokers at High Altitudes, and Smokers at Sea Level.

Earlier diagnosis of heart disease can occur via awareness of biochemical changes. Keeping this in view, we wanted to determine if there was any difference between biochemical heart parameters between non-smokers (the control group), smokers who live at a high altitude, or smokers who live at sea level. There were 180 participants categorised into three groups, A, B, and C, depending upon their smoking/non-smoking classification, or distance from sea level. Blood samples were taken as per requirements to check levels of creatine kinase-MB, troponin-I, troponin-T, Triiodothyronine (T3), Thyroxine (T4), Apolipoprotein B (apo-B), and homocysteine, and subjected to enzyme-linked immunoassay (ELISA) investigations. Creatine kinase-MB, troponin-I, troponin-T, T3, thyroxine, apoprotein-B, and homocysteine all exhibited a noteworthy difference (p≤0.01) when compared between non-smokers and smokers (either at a high altitude or sea level), but only troponin I and T3 showed a noteworthy difference when compared between smokers at a high altitude versus at sea level (p≤0.01) as follows: Creatine kinase-MB, p=0.434; troponin-I, troponin-T, p=0.208; T3, p≤0.01; thyroxine, p=0.190; apoprotein-B, p=0.008; and homocysteine, p=0.039. It has been found that significant differences exist between smokers and non-smokers regarding cardiovascular (CV) pathology, whether the person resides at a high altitude or sea level. However, additional studies should be performed to find the correlation between smokers at a high altitude versus and smokers at sea level, which can change the treatment methods at high altitudes and pave the way for finding new medicines.

Screening of the antioxidant and antibacterial effects of extracted essential oils from Thunbergia coccinea, Acacia polyacantha, Polygonum micrpcephallum, Abies spectabilis and Clerodendrum colebrookianum.

During the previous few decades, it has been seen that there is a rapid emergence of pathogens resistant to multiple antibiotics. This has now become a global crisis. Some unexplored or less explored plants also provide some antibacterial, bactericidal and antioxidant properties. The antibacterial, bactericidal effects of extracted essential oils (EEOs) of Thunbergia coccinea, Acacia polyacantha, Polygonum micrpcephallum, Abies spectabilis and Clerodendrum colebrookianum was tested in comparison with standard antibiotics. The methods chosen were disc diffusion and deduction of minimum inhibitory concentration (MIC) by microbroth dilution assays of the EEOs against the bacterial strains.The antioxidant activity was found out utilizing DPPH free radical scavenging assay, MDA, Hydrogen peroxide radical inhibition assay and Superoxide radical inhibition assay (O 2 -). Some commonly used standard antibiotics (metronidazole, amoxicillin, clarithromycin, rifampicin, clindamycin and oxacillin,) were utilized to compare the EEO antibacterial action. Clerodendrum colebrookianum (85.17 ± 3.06 µg MDA/g extract) had a reasonable MDA. Acacia polyacantha in MIC had values of 3.86 ± 0.25 to 6.20 ± 0.16. Polygonum micrpcephallum had excessive H2O2 (48.27 ± 2.4 5%). The antibacterial actions determined by the paper disc­diffusion technique of the EEO extracted from these plants showed that most had some antibacterial actions. Also, it was seen that the bactericidal action of the EEO extracted from E. alba was most potent against S. pyogenes (4.06 ± 0.15). The extract of the plant at varying concentrations (20, 40, 60, 80 and100 mg/mL) demonstrated noteworthy (P< 0.001) anthelmintic action in an effective change when the dose was adjusted. In conclusion, most of the tested plants contain a medicinal value, which can be utilized in the future to supplement artificial medicines and cure emerging diseases that create havoc for mankind.

The Impact of Body Resistance Training Exercise on Biomedical Profile at High Altitude: A Randomized Controlled Trial.

BACKGROUND: Obesity causes different diseases, eventually. In our study, the results of resistance exercises were examined on selected biochemical markers in Abha City, Saudi Arabia, which is at the height of 2,270 meters above sea level. METHODS: A randomized controlled research was conducted with 60 participants equally divided into three groups, 20 subjects in each group: group 1 was composed of obese people who received resistance training exercise, group 2 was composed of the obese control group who did not receive resistance training exercise, and group 3 was composed of normal individuals who received resistance exercise training. The resistance exercises were done in the 6th and 12th weeks. Biochemical blood tests were done. RESULTS: Comparing to the control group, glucose decreased very little with insulin also showing little difference. It has been seen that TC, TG, and LDL reduced to a reasonable extent after resistance exercise, while HDL was increased (p ≤ 0.01). Plasma urea and creatinine showed no differences. Interleukin-6 and leptin decreased significantly (p ≤ 0.01), while there was a significant elevation in adiponectin and testosterone (p ≤ 0.01) once comparing group 1 with group 2 and group 3. CONCLUSION: We have seen that resistance exercise helps in reducing lipid profile which will result in a decrease of the cardiac and related risk factors when conducted in obese patients in high-altitude regions. Also, alterations of the levels of interleukin-6, leptin, adiponectin, and testosterone showed that resistance exercise is of benefit and favourable in obese persons in high-altitude regions, which can also pave the way for added development of drugs related to the above parameters.

Exploratory study on the operational issues faced in collection, transportation, and laboratory testing related to COVID-19 in remote areas of selected EAG states of North East and East India.

BACKGROUND: COVID-19 ongoing pandemic has proved beyond doubt that all countries in the world from high income to low- and middle-income countries were unprepared with under-diagnosed and underreported losses of precious human lives on already overstretched healthcare delivery infrastructure. Thus, the urgent need of the hour is to understand and identify the operational issues and challenges encountered in the sample collection process and also at the testing labs in order to respond at the earliest. This early and effective response will help not only to address the identified issues in the whole chain of sample collecting to test result communication but also it will help to improve the functioning of the entire system involved in this process. OBJECTIVES: The present study was undertaken to identify the issues faced during various steps involved in laboratory testing as part of the COVID-19 control activities in selected remote districts of North East and East India. Further, perceived adequacy of human resources, equipment, diagnostic kits, and other essential consumables including PPEs vis-a-vis the load of samples received from the catchment areas of the testing laboratories were also explored. METHODS: The study was a qualitative research using in-depth interview method to collect and collate the data from the chain of personnel involved in sample collection, storage, transportation, and testing by recorded telephonic interview by state-level collaborators as per the study protocol. The respondents were recruited from randomly selected sites of remote districts for sample collection, storage, transportation, and dedicated testing labs in six states of North East and Eastern India. The study findings were analyzed by two-dimensional scaling and hierarchical cluster analysis to get the collective picture involving transcription, preliminary data scrutiny, content analysis, and interpretation of the verbal IDI; classified and summarized by triangulation; free listing and pile sorting of suggestions. RESULTS: The entire laboratory testing related human resources has been working on war-footing round-the-clock to fulfil the expectation of the stakeholders and maintaining high quality despite the ever-increasing load of sample testing in both the public and private sectors. The findings indicated that the healthcare workers from all levels of laboratory diagnosis have taken it as a challenge to control the pandemic even with limitations of logistics to capacity building. Positive suggestions to improve laboratory services were to increase human resources, infrastructure, IT with the robust mechanism of monitoring and supervision. CONCLUSIONS: Upgradation of laboratory capacities and expertise in public health has become one of the points of concern to contain the COVID-19 pandemic of the new millennium.

Prevalence of diabetes mellitus amongst rural hilly population of North Eastern India and its relationship with associated risk factors and related co-morbidities.

CONTEXT: Diabetes has emerged as pandemic health problem and its prevalence is increasing at an alarming rate. AIMS: The aim of the following study was carried out to understand the prevalence of diabetes mellitus, its associated risk factors and related co-morbidities amongst persons residing in rural hilly terrain of Upper Siang district of Arunachal Pradesh, India. SETTINGS AND DESIGN: Population based cross-sectional study on 1370 participants in the field practice area of a private Nursing School in Yingkion in Upper Siang district of Arunachal Pradesh, India was conducted during April 2009-March, 2010. MATERIALS AND METHODS: The clinico-social data related to diabetes was gathered by personal interview. Body weight, height, waist circumference and blood pressure were measured and blood glucose was estimated in fasting venous blood samples. RESULTS: Diabetes mellitus was observed among 19.78% of the participants with additional 12.04% patients with impaired glucose tolerance (IGT). Diabetes mellitus was most prevalent among 50-59 years age group (32.10%). Hypertension was observed among participants with diabetes and IGT was 65.13% (hypertensive diabetics) and 53.94% (diabetics only). Mean body mass index and associated family history was added risk factors in prevalence of diabetes. CONCLUSIONS: Effective primary prevention strategies are to be intensified among the high-risk population groups to promote awareness through behavior change communication.

An epidemiological study of newly diagnosed sputum positive tuberculosis patients in Dhubri district, Assam, India and the factors influencing their compliance to treatment.

CONTEXT: Tuberculosis (TB) affects the economically productive age group and has emerged as a disease of significant socio-economic global burden. AIMS: The aim of this study is to identify epidemiological factors responsible for TB and the clinico-social correlates influencing their compliance. SUBJECTS AND METHODS: All new smear positive TB (NSP-TB) patients registered in Dhubri District Tuberculosis Center-Tuberculosis Unit during 2007 in Assam were included in this study. The study was performed by interview technique using a pre-tested questionnaire. RESULTS: Nearly 90.76% of the participants were in the age group of 15-55 years and were predominantly unskilled workers and sole earning member of their family. 83.33% of the patients had symptoms of cough for more than 3 weeks and most of them (98.15%) lived in overcrowded houses. More than half of the patients had X-ray examination as their initial approach to diagnosis. More males (59.18%) than females (40.82%) reported to the health institution within first 6 weeks after the onset of symptom and among them 91.84% were declared cured after completion of therapy and while, only 40% of the patients initiating treatment after 6 weeks of the onset of symptoms were declared cured after completion of therapy. CONCLUSIONS: The prevalence of NSP-TB cases was more among the illiterate and underprivileged population who needs counseling and motivation for early intervention.

Assessment of impact of small group teaching among students in community medicine.

BACKGROUND: We conducted a study to assess the impact of small group teaching (SGT) among students by feedback analysis to identify intricacy so that learning can be facilitated. MATERIALS AND METHODS: This cross-sectional study was undertaken among 182 MBBS students studying at a teaching hospital at Gangtok. Students were provided with a questionnaire following an assignment on a scheduled topic. Students were asked to provide feedback on the modes of teaching-learning practiced in community medicine with the parameters of evaluation including assessment of presentation by faculty member in reference to relevance, sequencing, depth, interaction, etc., to the overall rating of presentations in different teaching-learning methods. RESULTS: The faculty members were on the positive evaluation by the students in the SGT, which was preferred over lectures as the teaching-learning methods. Among SGTs "tutorials" were graded better than "practical", "seminar" and "field posting" on the basis of longer duration at a stretch. Among the parameters for evaluation, relevance, depth, and interaction in regard to scheduled topic of presentations, the rating was significantly higher in SGT than different other teaching-learning methods. Largely the students noted that the time devoted and number of hours/sessions allotted for each topic was adequate. CONCLUSION: All forms of SGT were on the positive appraisal by the students on their learning experience and were considered as a comprehensive tool for in-depth teacher-student interaction.

Clinico-pathological correlates of incidentally revealed thyroid swelling in Bihar, India.

BACKGROUND: Global prevalence of thyroid cancer has been on the rise in recent decades. OBJECTIVES: To study the clinical presentations to reach an agreement for diagnosis and optimal management of incidentally revealed thyroid swellings for early diagnosis. MATERIALS AND METHODS: A prospective study was carried out on 178 cases of incidentally detected thyroid swelling attending a tertiary care teaching institute of Kishanganj Bihar. All the cases were subjected to a thorough clinical examination followed by evidence-based interventions. Fine needle aspiration cytology was done in all the cases preoperatively as out-patients basis and histopathologically confirmed postoperatively. RESULTS: The highest incidence of thyroid swelling (75.84%) was found in the age group of 20-40 years; a female preponderance was noted in the ratio 4:1. The duration of swelling ranged from six months to three years. Difficulty in swallowing and breathing was complained by 23 (12.9%) and 18 (10.1%) of the patients respectively. Typically the swellings were located in the right lobe. Commonly the subjects in our study were in euthyroid state (90%) and were with firm swellings (66.7%). Follicular and anaplastic carcinoma was important postoperative cytological findings. Majority of surgical intervention was hemithyroidectomy (55.06%). CONCLUSION: Incidentally revealed thyroid swelling was quite high in eastern India for which we need a consensus line of intervention.

The quest for an Indian blood law as of blood transfusion services regulatory framework.

BACKGROUND: Blood transfusion services are a vital part of the national health delivery system. The responsibility for ensuring a continuous supply of blood rests with health administrators, who need to galvanize entire communities towards regular and non-remunerated blood donation. OBJECTIVE: The present study aimed to examine the prevailing global regulations and practices related to blood transfusion and press the case for a dedicated blood law in India. MATERIALS AND METHODS: We attempted a comprehensive, annotated assembly of published studies on blood transfusion services in India. DATA ABSTRACTION AND SYNTHESIS: Laws related to blood transfusion services exist in India as a part of the Drugs and Cosmetics Law. In the developed world, most blood donors are unpaid volunteers who give blood for a community supply. In order to augment safe blood transfusion services in India, we have to develop operational legal guidelines on recruitment and retention of voluntary blood donors to direct related organizations for this imperative activity. CONCLUSION: Several factors, such as political will and a professional and ethical approach can help in formulating a common vision, building trust, by providing optimum information towards a social movement for the rational blood transfusion services. We have to come together for a dedicated blood law in order to improve the quality of blood transfusion services in India.

Glucose indices, frank and undetected diabetes in relation to hypertension and anthropometry in a South Indian rural population.

Diabetes has emerged as one of the world's biggest health problems and its prevalence is increasing at an alarming rate. This study was conducted to find out the magnitude of frank and undetected diabetes mellitus, including impaired glucose tolerance (IGT) among persons in rural Karnataka, and its relationship with associated risk factors like hypertension and anthropometry. This was a population-based, cross-sectional study on 1370 participants in the field practice area of KBN Medical College, conducted from April 2009 to March, 2010. Diabetes mellitus was noted among 19.78% of the participants, with an additional 12.04% with impaired glucose tolerance. Hypertension observed among participants with diabetes and impaired glucose tolerance was 65.13 and 53.94%, respectively. Effective primary prevention strategies have to be intensified among high-risk population groups, to promote awareness through behavior change communication.

Evaluating ranitidine, pantoprazole and placebo on gastric pH in elective surgery.

BACKGROUND AND AIM: Concern about the grim nature of postoperative acid aspiration syndrome grew among the anesthesiologist over the years warranting the need for pre-emptive intervention. The aim of the study is to compare the effects of preoperative oral ranitidine versus pantoprazole given in regulating gastric pH in elective surgery. METHODS: This prospective, parallel group, controlled, randomized, single-blind study was conducted at a tertiary care postgraduate teaching institute at Kolkata, involving 120 participants of either sex, aged 18-60 years of American Society of Anesthesiologists physical status I and II, who were scheduled for elective surgery under general anesthesia lasting for more than 2 h. The participants were divided into three groups. In group A (n=40) participants received placebo tablet, in group B (n=40) participants received ranitidine tablet while in group C (n=40), participants received pantoprazole tablet and their gastric pH estimated serially. RESULTS: The participants in the three groups were comparable in terms of age, sex, body weight, duration of surgery and type of surgery distribution. In regard to changes in gastric pH trends, there was no statistically significant difference between serial pH values in group A (Friedman test; P>0.05) and group C participants. (P>0.05). However, the mean preoperative gastric pH values (7.140±.7652) were significantly lower than mean pH values (7.253±.7514) after 2 h postoperatively in group B participants (P<0.05). CONCLUSION: From the observations and analyses of the present study, it can be inferred that ranitidine is more effective than pantoprazole to raise the gastric pH for prevention of aspiration pneumonitis.

Spectrum of Guillain-Barré syndrome in tertiary care hospital at Kolkata.

OBJECTIVE: In childhood Guillain-Barré syndrome (GBS), the clinical profiles using intravenous immunoglobulin (IVIg) in addition to supportive care were studied. MATERIALS AND METHODS: This was a retrospective analysis of 139 children with severe GBS admitted to our respiratory care unit managed with the IVIg as an adjunct intervention to conventional supportive and respiratory care. RESULTS: In our case series of 139 cases, motor weakness was the most common presenting feature. Antecedent illness was found in 66.7% of cases in the preceding two weeks, which included nonspecific illness, acute respiratory infection, diarrhea, and chickenpox. At onset, sensory symptoms (pain and paresthesia) were noted in 59% of the cases and limb weakness in 77%. On admission, a majority (61.54%) were in Hughes neurological disability grading stage V; all had limb weakness at the peak deficit, autonomic disturbance was seen in 35.8%, and bulbar palsy in 52%. Duration of illness was less than three weeks in 67% of cases. The mean duration of ventilation was 21.5 days (range, 5-60 days). CONCLUSIONS: Male preponderance and motor weakness was the most common presenting illness and a majority achieved full recovery in our series. Although IVIg may be useful in the treatment of GBS, the key issue is excellent intensive care unit management.

Obesity in Kolkata children: Magnitude in relationship to hypertension.

BACKGROUND: Limited data is available from India regarding the distribution and profile of childhood obesity and hypertension. MATERIALS AND METHODS: A population based cross-sectional study was conducted in the urban schools of Kolkata. Using stratified random sampling method, 979 participants were selected. Body mass index (BMI) status and blood pressure (BP) were estimated using standard protocol and their various correlates regarding sociodemographic characteristics were looked into. RESULTS: Majority (38.92%) of the study population were in the preadolescent group followed by adolescent group (33.40%). Male constituted 52.09%, overweight was more prevalent among preadolescent age group (22.57%). Overall 27 cases of prehypertension were found of which 19 (70.37%, n=27) were in the adolescent age group. There was no significant association between ages with increased BMI status. We detected total 15 cases (1.53%) of hypertension in our study population and three-fourths of them were from adolescent age group. However, significant association was seen between high BP with increasing age. Average fast food intakes and screen time was higher in obese as compared to their normal peers. Upper and upper-middle social status contributed to higher number of obese/overweight and hypertensive children and was the significant risk factor. CONCLUSION: Childhood obesity and hypertension were found to be common in the city of Kolkata which suggest the need for greater public awareness programs on these morbidities.

Fine needle aspiration cytology as the primary diagnostic tool in thyroid enlargement.

BACKGROUND: In the preoperative decision-making of the thyroid swellings, fine needle aspiration cytology (FNAC) is becoming an ever more vital tool. OBJECTIVES: To compare the advantage of preoperative FNAC of thyroid swellings with postoperative histopathology to reach a consensus protocol as a simple procedure for diagnosis and optimal management of thyroid swellings. MATERIALS AND METHODS: A prospective study of preoperative FNAC was carried out on 178 incidental thyroid swellings attending a tertiary care centre in Kishanganj, Bihar. Evidence-based surgical interventions were done, irrespective of FNAC findings and diagnosis was confirmed by histopathological examination (HPE) postoperatively in all the cases. RESULTS: In the FNAC, preponderance of the cases (75.84%) was colloid goitre followed by granulomatous thyroiditis; follicular carcinoma was noted in 7.30 percent and anaplastic carcinoma in 3.37 percent of cases. Histopathological examination showed colloid goitre predominantly (76.97%), followed by follicular carcinoma (8.99%). The overall prevalence of malignancy was 11.24 percent diagnosed by HPE and 9.55 percent by FNAC. In our FNAC series sensitivity of was 90 percent while specificity was 100 percent; accuracy was 98.88 percent. Predictive value of a positive test and negative tests was 100 percent and 98.75 percent respectively. CONCLUSION: The study highlights that FNAC should be treated as a first-line diagnostic test for thyroid swellings to guide the management though this is not a substitute for HPE as a need to improve primary healthcare in India.

Evaluation of Ondansetron-induced QT interval prolongation in the prophylaxis of postoperative emesis.

BACKGROUND: To avert nausea and vomiting the 5-Hydroxytryptamine3 (5-HT3) antagonists have become the first line of treatment ifassociated with cardiovascular effects andappear to cause QT prolongation. OBJECTIVE: Evaluate the effect of 1 mg, 4 mg, and 8 mg bolus doses of intravenous Ondansetron, relative to placebo, in prevention of postoperative nausea and vomiting (PONV) and to find out the changes of QT interval corrected for heart rate (QTc). MATERIALS AND METHODS: This prospective randomized, placebo-controlled, double-blind study was carried out among 136 adult participants of both sexes in a tertiary care postgraduate teaching institute at Kolkata. mg, 4 mg or 8 mg inj. Ondansetron was diluted to 10 ml with normal saline, was infused 30 min before extubation in relation with a control group. Time to first rescue antiemetic medication and in QTc interval at different time intervals, in each group was noted in different in the various surgical operation theaters (OTs). RESULTS: Requirement of the first rescue antiemetic in the postoperative period between 60 to 120 min in the mg, 4 mg or 8 mg Ondansetron groups was in 28%, 24% and 7% participants respectively; between 120 to 240 min in 63%, 72% and 57% respectively; and within 360 min in 9%, 4% and 36% respectively. Significant and maximal QTc prolongation was observed in the participants with mg or 8 mg Ondansetron 3 and 5 min of drug administration. CONCLUSIONS: One mg Ondansetron in healthy adult participants can effectively prevent PONV causing no or insignificant prolongation of QTc interval.

An application of Indian public health standard for evaluation of primary health centers of an EAG and a Non-EAG state.

National Rural Health Mission (NRHM) has provided the opportunities to develop a standard for Sub centers, PHCs and CHCs in the country, popularly known as Indian Public Health Standards (IPHS). The study was carried out to find out and compare to what extent the IPHS were followed by the PHCs in the selected districts of both the Empowered Action Group (EAG) state of Assam and non EAG state of Karnataka. It was a Cross sectional observational study conducted during September-October 2008 where the quality of care and services provided in the selected PHCs as per the IPHS norms was assessed. All the PHCs in both the studied districts were rendering the assured services of OPD, 24hrs general emergency service and referral services while 24 hour delivery services were being provided by 80% of the PHCs of the selected districts of both the states. Functional labor rooms were available only in 80% and 90% of the studied PHCs in Assam and Karnataka respectively. Basic laboratory facilities, for routine blood, urine and stool examination were available in 80% of the studied PHCs in the non-EAG state of Karnataka while it was only in 20% of the studied PHCs of the EAG state of Assam. The findings of the present study revealed important deficiencies as per IPHS norms in the studied PHCs of both Assam and Karnataka.

Hand washing practices in two communities of two states of Eastern India: an intervention study.

BACKGROUND: Public health importance of hand washing as well as its importance in reduction of communicable diseases such as diarrhea and acute respiratory infections have been highlighted in many studies worldwide. OBJECTIVE: This study was designed to study the hand washing practices followed in two urban slums as well as to assess and compare the status of different components of hand washing at the pre- and post-intervention phases. MATERIALS AND METHODS: A community-based cross-sectional intervention study on hand washing practices was carried out at two urban slums situated in two states of Eastern India with similar sociocultural and linguistic background. The study was carried out by using an interview technique as well as observation of hand washing practices. Interpersonal communication for behavioural change was chosen as a method of intervention. RESULTS: The majority (>90%) practiced hand washing after defecation in both the study areas. However, hand washing following all six steps and for stipulated time period was seen to be poor before intervention. Significant improvement was observed in all the aspects of hand washing after intervention in both the areas. The poor practice of hand washing was observed in some situations and needed attention. Use of soap and clean material for drying hands after hand washing was poor initially followed by improvement after intervention. CONCLUSION: Based on the findings of the study, it could be suggested that Behaviour Change Communication program should be further planned with emphasis on different components of hand washing with a final objective to bring down the incidence of target diseases.