Vol 4, Issue 2, Apr-Jun, 2014

Diabetes is leading cause for cardiovascular complication, drugs having cardioprotective and antihyperglycemic actions are constantly in search. Oral glucose elicits a three to four times higher peak insulin response compared with an equivalent dose of glucose, if infused intravenously. This is due to the reasons behind, the oral glucose causes a secretion of gut hormones, mainly the glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) which enhance the glucose-induced insulin release. In patients with type 2 diabetes mellitus (type 2 DM), glucose-induced insulin release is unsatisfactory or absent. Because of this type 2 DM patients are unable to adjust their insulin secretion as per the need exist. GLP-1 secretion (but not GIP secretion) is diminished in patients with type 2 diabetes. However, when the GLP-1 and GIP agonist are administered in patients with type 2 diabetes, they elicit insulin secretion resulting in lowering of blood glucose level. In addition to its insulin stimulatory effect, GLP-1 agonist also induces cardioprotective effects. It increases nuclear respiratory factor-2 (Nrf2) and heamoxigenase-1(Ho-1) in cell which have antioxidant and cardioprotective property. GLP-1 maintains islets integrity and reduces apoptotic cell death of human islet cells in culture. Improved understanding of the mechanism of action and clinical effects of incretin-based therapies would be useful in advancement of its appropriate use in clinical practices. Key words: Diabetes, GIP, glucagon-like peptide, nuclear respiratory factor-2, liraglutide

Background: Easily correctable refractive errors are the commonest cause of visual impairment in school children in India. Children who need but cannot afford spectacle correction are high in our country. Important factor for the success of the corrective services is compliance to spectacle wear. Objective: To assess the spectacle wear compliance among school children who were provided spectacle free of cost. To study the determinants of spectacle acceptance and reasons for non compliance. Materials and Methods: All (1378) government school children of 7-15 years age group in both rural and urban fi eld practice areas of a medical college in Bangalore were screened and students with refractive error were provided spectacles free of cost. An unannounced follow up was done after 3 months to assess compliance. Data was analyzed to determine the factors associated with spectacle wear compliance. Results: Among 36 boys and 47 girls who received spectacles free of cost, 31 were from rural and 52 from urban schools. 48(57.8%) children were actually wearing the spectacles at the time of follow up. 42(87.5%) compliant children reported improvement of performance in school related activities. Compliance was better in younger children and those from urban schools. Children of father with lower level of education and with power -0.5D were more likely to be non compliant. Conclusion: To achieve the goal of vision 2020 timely detection of refractive errors should be followed by cost effective intervention. The barriers to spectacle acceptance should be studied and addressed. Key words: Eye glasses, refractive errors, spectacle acceptance

Background: Rabies being 100% fatal disease, every individual is vulnerable to animal bite irrespective of age, sex and socio-economic status. Children are at greater risk. Though most of the bites are by pet animal and provoked, they are more severe, usually on proximal part of the body including face, neck and scalp and thus lifethreatening. Materials and Methods: A cross-sectional hospital based study in the anti-rabies vaccination (ARV) clinic from November to April 2013. Every new child below 15 years attending the out-patient department was interviewed along with his parents for demographic data, details of animal bite and treatment received and also myths following animal bite after taking an informed consent using a pre-designed proforma. The results were analyzed by proportion and percentages. Results: Prevalence of animal bite in children was found to be 32.98%. It was more in the age group of 5-10 years and rural children. Nearly 23.96% of children were having lacerated wound and 11.75% were having injury on head and face. About 31.12% of the children reported late by 24 h. Local cleaning of wound was not satisfactory in 66.82% of the children. ARV schedule was not completed by 8.99% of the children while anti-rabies serum was not received by 86.16% of children. Myths regarding restrictions of milk and rice were prevalent in 94.56% population. After counseling also 44.67% were reluctant to the advice. Conclusion: About one-third of cases being related to children, prevention and control strategies are needed to reduce it. Key words: Animal bite, anti-rabies clinic, children, immunoglobulins, provoked bites, rabies

Introduction: Cholera is a major infectious disease with epidemic potential, especially among communities living in congested urban slums and vast rural areas without proper sanitary facilities. Epidemiology of cholera showed remarkable changes soon after the identification of El Tor biotype of Vibrio cholerae in India in 1964. The classical biotype reported in earlier years was believed to have become extinct in the recent past. Presently, V. cholerae O1 belonging to the El Tor biotype is most common in India. Materials and Methods: A retrospective study was carried out in Department of Microbiology to study the epidemiological pattern of V. cholerae in South Gujarat. V. cholerae isolates were confirmed by various biochemical tests. Agglutination was done with antisera. All the isolates were sent to the National Institute of Cholera and Enteric Diseases, Kolkata for phage typing. Antibiotic susceptibility was carried out by Kirby Bauer disc diffusion technique. Result: 98% of the isolates were of El Tor biotype and 2% of non O1 non O139. 98.8% of the isolates were of Ogawa serotype, only 1.2% of Inaba. According to Basu and Mukerjee classification, T-2 phage was found in 76% isolates. T-4 phage was seen during 1995-1996 and 2002-2004 only. According to the new scheme classification, T-27 phage type was found in 74% isolates followed by T-25 (4%), T-19 (3.7%) and T-25 (3%). Conclusion: T-2 is predominant serotype found in South Gujarat region and was constant since 2005 onwards. El Tor biotype was found commonly and no isolation of classical biotype was seen. Data analysis will help for future studies. Key words: Antibiotic susceptibility, cholera, El tor, phage type, serotype

Introduction: Under-nutrition contributes to more than one-third of all deaths in children. It does this by diminishing children’s immunity and making illness more dangerous. The primary aim of the study is to assess the nutritional status of children aged from 0 to 14 years in a slum area of Kolkata and secondary aim is to determine the prevalence of under-nutrition and its association with various risk factors among the study population. Materials and Methods: Community-based cross-sectional analytical study was carried out in urban slum of Chetla, Kolkata involving children of age group (0-14 years) from February to May 2012. All children (120) were examined clinically; their anthropometric measurements such as weight, height, mid upper arm circumference (MUAC) were taken using the standard operating procedures, after obtaining verbal consent from their parents with the help of a predesigned and pre-tested schedule. The anthropometric data was analyzed using World Health Organization Anthro and Anthro Plus Softwares. Results: The overall prevalence of under-nutrition among the study population was found to be 54 (45%). Among infants 9 (25%) were underweight, 3 (8.3%) were stunted, 22 (61.1%) were wasted and 23 (63.9%) showed thinness. Among 1-5 years aged children, 18 (30.5%) were underweight, 17 (28.8%) were stunted, 17 (28.8%) were wasted, 12 (20.3%) had MUAC 12.5-13.5 cm and 17 (28.8%) showed thinness. Among 5-14 years aged children, 11 (44%) were underweight, 10 (40%) were stunted and 12 (48%) showed thinness. Conclusion: The nutritional status of children in Chetla slum is not satisfactory in spite of proper immunization coverage and institutional deliveries. Special emphasis should be given for promotion of nutritional education to the mothers. Key words: Anthropometry, Chetla, stunting, thinness, underweight, wasting

Context: Pneumonia is an inflammatory condition of the lung affecting the alveoli with the infection of microorganisms. Aim: The present study aims to fi nd out the case fatality of pneumonia based on the variables such as age, sex and year. Study Design and Settings: It is a retrospective study of five years conducted in medical college hospital at the Ernakulam district of Kerala State in India. Methods and Materials: The data were collected from the Medical Records department and analyzed by using Microsoft Excel. Statistical Analysis Used: ‘Z’ test was applied for finding out the difference in proportions. Result: Out of 5496 pneumonia cases, 3340 (60.77%) were males and 2156 (39.22%) were females. The proportion of males was higher than females. The proportion of pneumonia cases was higher in the low age group (0-5 years) than other age groups. Broncho-pneumonia (84.95%) was reported as the most dominant type of infection in the present study. Of 5496 cases, 79 deaths were reported with a case fatality rate of 1.43%. Case fatality rate among males (1.67%) was higher than females (1.06%) (P = 0.05). Case fatality rate of pneumonia in 0-5 years was 0.11% and 36.84% in 85 years and above. Case fatality of pneumonia increased from 0.55% in 2005 to 4.39% in 2010. Conclusion: The case infection of pneumonia is higher in low age groups due to associated risk factors while case fatality is higher in old age groups may be due to aging of organ systems and age-associated diseases. Key words: Age, case fatality, sex, year

Objective: Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. There is now convincing evidence that CKD can be detected using simple laboratory tests, and that treatment can prevent or delay complications of decreased kidney function, slow the progression of kidney disease and reduce the risk of cardiovascular disease (CVD). Currently, screening for CKD is accepted practice only in patients with hypertension or diabetes, but more widespread screening is increasingly proposed. We screened a sample of population on World Kidney Day on three consecutive years for detecting patients with CKD and to describe the natural course of the disease. Materials and Methods: Everyone aged ≥18 was invited to participate. The study population was general population from Varanasi were screened in OPAL hospital. The survey comprised an extensive questionnaire and a brief clinical examination, including analysis of serum creatinine concentration in all participants. We screened all the participants who had at least one risk factor for CKD (including hypertension, diabetes mellitus, or a family history of CKD). Urine dipstick tests were done and blood sample was obtained to detect proteinuria and measure serum creatinine concentration, respectively. Results: A total of 547 participants were enrolled of which all 547 subjects were included in the analyses. The mean serum creatinine was 0.9525 mg/dL (0.900 to 1.0050). A high serum creatinine level was demonstrated in 16 participants (2.92 %), and 191 (34.91 %) were demonstrated to have proteinuria. There was a significant correlation between CKD and age, DM, urine protein and serum creatinine. There was no significant correlation between serum creatinine level and urinary protein excretion (P = .001). There were no significant differences between CKD and gender. Conclusion: The study demonstrates that increasing age, diabetes mellitus, Serum creatinine and urinary protein were found significantly related to kidney disease with P value of 0.02, 0.0006, <0.0001, 0.0002, respectively, which means that there is a chance for the aged, diabetes patients and patients with elevated serum creatinine and urine protein to suffer with kidney disease with respect to the younger subject. Key words: Age, chronic kidney disease, diabetes

Background: Surgical site infections (SSI) are the most common nosocomial infection and frequently cause morbidity and mortality among inpatients of hospitals. The incidence varies from hospital to hospital. Several factors affect the development of SSI. Objectives: To study the incidence of and to identify the risk factors for Surgical Site Infections in the surgical wards of K.R.Hospital, Mysore. Materials and Methods: Study Period: July to August 2007 Study Subjects: One hundred and eighty patients who underwent various surgeries in the General Surgery department of K.R. Hospital Mysore. A predesigned and pretested proforma was used to collect the data. Surgical sites were examined and graded. Culture and sensitivity testing was done on infected wounds. Data was analyzed using SPSS 13 software. Results: Among 180 patients 39 (21.66%) developed surgical site infections (SSI). Of 39 SSIs 20 were grade 3 and 19 were grade 4 infections. SSIs were found more commonly among the aged, males, underweight and overweight, anaemics, diabetics, hypertensives, patients with longer pre operative waiting time, with multiple blood transfusions and without antibiotic prophylaxis. Age, Sex, BMI, Diabetes mellitus, Blood transfusion and pre operative waiting had univariate statistical significance. Gender, extreme BMI, Diabetes mellitus and Blood transfusion remained independent predictors of surgical site infection in multivariate analysis. Most of the SSIs yielded multiple organisms and Staphylococcus aureus was the predominant. Resistance to tetracycline was most common. Conclusion: The incidence of SSI is high. Gender, extremes of BMI, diabetes mellitus and blood transfusion are the important risk factors for it. Key words: K.R Hospital, Mysore, risk factors, surgical site infections

Background: Vitamin D insuffi ciency has been associated with several adverse health outcomes, including pregnancy outcomes, and is increasingly recognised as a public health concern. It is responsible for approximately 50,000 maternal deaths yearly worldwide, 25% of all cases of fetal growth restriction, and 15% of preterm births in developed countries. Objective: Vitamin D and magnesium sulfate act by altering the calcium levels so this study was conducted to see if vitamin D supplementation has any additive role to magnesium sulfate treatment in preeclampsia and in preventing its progression to eclampsia. Materials and Methods: This cross sectional study was conducted in the Department of Biochemistry, in collaboration with Department of Obstetrics and Gynecology, at MMIMSR, Mullana (Ambala), Haryana, India. One hundred and fifty pregnant females attending the Obstetrics clinic were selected for the study and were divided into three groups of fifty each. Group I (Control): Normotensive healthy pregnant females, Group II: Preeclamptic patients receiving magnesium sulfate therapy and Group III: Preeclamptic patients receiving magnesium sulfate therapy along with vitamin D supplementation (33000 IU once every two weeks, orally after 28 weeks up to 36 weeks). The samples were analysed for serum total calcium, ionized calcium, serum phosphorous, serum magnesium, serum albumin, serum alkaline phosphatase, serum creatinine and serum uric acid. Results: Mean levels of total calcium, ionised calcium, phosphorous, magnesium, albumin, alkaline phosphatase, creatinine and uric acid before and after delivery were calculated in all the three groups. Serum calcium (total and ionised), albumin and magnesium were decreased in preeclamptic women whereas serum phosphorous and uric acid were increased in preeclamptic. Vitamin D supplementation improved calcium status, uric acid level and albumin level were also improved. Conclusion: Vitamin D supplementation in early pregnancy improves the calcium status and reduces the severity of preeclampsia. Key words: Calcium, magnesium, pre-eclampsia, uric acid

Background: Lymphatic filariasis, commonly known as elephantiasis is the second cause of permanent, long-term disability in the world. It is one of the world’s most disabling and disfiguring disease. It prevents the afflicted from experiencing a normal working and social life, resulting in matrimonial handicap, inferiority of self and furthering the cycle of poverty. Currently, more than 1.4 billion people in 73 countries are at risk. It affects 750 million every year and in India, 450 million people are at risk. Materials and Methods: A pre-experimental one-group pre-test and post-test design was conducted on March 2013 by interviewing 30 adults of selected Villages, Dakshina Kannada, Karnataka, India. A pre-designed and pretested questionnaire was used to collect the pre-test and post-test data. Questions were based on the knowledge regarding filariasis. Results were analyzed statistically using percentage, proportions and Chi-square test. Results: In this study, 63.33% had average knowledge regarding filariasis in pre-test, while in post-test, 60% had good knowledge. The mean post-test knowledge score (17.53) was found to be significantly higher than mean pre-test knowledge score (12.9) at 0.05 level of significance (t29 = 2.045, P < 0.05). Conclusion: Structured teaching program increase the knowledge of filariasis among the adults. Health education should be a part of regular activity of community health services. Key words: Adults, filariasis, knowledge, structured teaching program

Bowen’s disease is a carcinoma in-situ of skin. It was first described by John T. Bowen. It usually present as a solitary lesion in elderly person over sun-exposed area. A case of multiple Bowen’s disease involving non-sun exposed areas of a person with clinical sign of chronic arsenicosis has been found. A 25-years-old man presented with multiple asymptomatic skin lesions all over the body for past six months. Since childhood, he lives in Kaliachak of Malda District in West Bengal. This area is known to contain arsenic in deep water. So he was exposed to arsenic since his childhood contaminated through water.