Vol 2, Issue 2, Apr-Jun, 2012

Pioglitazone belongs to thiozolidinediones (TZD) class of anti diabetic agents used either as monotherapy or in combination with metformin, sulfonylureas or insulin in treatment of diabetes mellitus. The pioglitazone increase insulin sensitivity by increasing glucose utilization in adipose tissue, muscle, and liver and also by decreasing glucose production.1 The exact mechanism as to how pioglitazone exerts its effect is not fully understood. It binds to one or more peroxisome proliferator-activated receptors (PPARs), which regulate gene expression.2 PPARs are part of the steroid and thyroid super family of nuclear receptors found mostly in adipose tissue, pancreatic beta-cells, vascular endothelium, and macrophages while PPAR-alpha is expressed mostly in liver, heart, skeletal muscle, and vascular walls.

The α-thalassemias are the most common inherited disorders of hemoglobin (Hb) synthesis due to deletions or point mutations. Alpha globin is made by four genes, two on each strand of chromosome 16. Individuals who have one or two abnormal alpha globin genes have alpha thalassemia trait. It is commonly found in Africa, the Middle East, India, Southeast Asia, southern China, and occasionally the Mediterranean region. When a person has only one functional alpha globin gene, they have Haemoglobin H disease, require regular medical care and may experience lifelong anaemia of mild to moderate degree. When a person has no alpha globin genes, they have a severe condition called Hb Bart’s hydrops fetalis. It affects a foetus long before birth, resulting in death during pregnancy or shortly after birth. Those with Haemoglobin H disease may require blood transfusions to correct anaemia. There is no treatment or cure for Hb Bart’s hydrops fetalis. Key words: α-thalassemias; Haemoglobin H disease; Hb Bart’s hydrops fetalis; blood transfusions

Context: The idea of Medical Savings Account (MSA) was conceived with the objectives to reduce moral hazard, decrease cost of health care, enhance individual responsibility and improve efficiency. However, it is important to note that no implementation of an MSA healthcare policy framework has been perfect. Aims: This paper looks at the broader context of current health policies in different countries and analyzes the reasons why MSAs were incorporated into action and the effects of these implementations. Methods and Material: Secondary literature review was done to analyse the theoretical and empirical evidence with respect to MSAs. Results: Conceptually, MSAs can help eliminate the unnecessary overuse of healthcare by placing more of the financial burden onto the consumer, whereby encouraging individual responsibility. However, for true choice to be provided there needs to be an excess capacity in the system and, in addition, a workforce that is responsive to the diversity of patient’s wishes. From an economic perspective, the notion that MSA has an instrumental value in achieving an optimum allocation of resources is based on the standard economic theory of markets with its assumptions which do not always hold true in the real world. Hence, efficiency may be compromised by giving ‘voice’ to choice. Conclusions: There are drawbacks with all financing systems of healthcare, and MSAs are no exception. Future researchers should consider conducting further studies to see if quality and access to necessary healthcare has improved within an MSA system and if adding supply-side regulations in conjunction with an MSA system produces better results than each would individually. Key words: Medical Saving Account (MSA); efficiency, consumer choice Key Messages: MSAs increase consumer choice through delegating power to the patient in choosing types of services and physicians. However, the benefits of choice must ultimately be weighed against its costs. Hence, efficiency may be compromised by giving choice to consumer.

Background: – Acute respiratory infections and diarrhoeal diseases are important causes of morbidity in children worldwide. IMNCI component is addressing these two illnesses in a major way and is concentrating on health care practices of community. Objective: – to find out their health seeking behaviour. Methodology: – A community based , cross-sectional study was conducted in the Mollasimla village of Hooghly district of West Bengal using 2 weeks recall for acute illnesses. Results – It was found that 56.8%, 23.8% and 18.9% children suffered from ARI, fever and diarrhea respectively. Overall treatment rate was above 93% and most of the children were treated in hospitals and health centre. Conclusion: – Acute illnesses are still largely prevalent in the rural community. As mothers are the first care givers, they should be made aware of the preventive measures and the need for seeking treatment. Key words: acute childhood illnesses; diarrhea; ARI health seeking behavior; under five children

Background: Awareness and perception regarding health insurance was still very preliminary. Although health insurance is not a new concept and people are also getting familiar with it, yet this awareness has not reached to the level of subscription of health insurance products. Insurance as not been able to make inroads in the rural areas because of key reasons such as high cost of delivery and low awareness among the rural population about insurance products. There is a felt need to provide financial protection to rural families for the treatment of major ailments, requiring hospitalization and surgery. The present study is an effort in the area of health insurance to assess the individuals’ awareness level and willingness to join and pay for it. The present study is an effort to examine what are the reasons behind those who have not in favour of subscription. Methods: Nandagudi a village in Bangalore rural district was selected because the Rural Health Training Centre of MVJ Medical College & RH is located. The houses were listed and by using systematic random sampling every 2nd house was included in the study. 331 houses were interviewed. The interview was taken either from the head of the family or the family member who takes financial decisions in the house. Data was collected and analysed. Findings were described in terms of proportions and percentages. Statistical analysis was performed by SPSS statistical package. Results: In our study population majority were males (94.9%), Hindus (60%), literate (85%),and manual workers (79.5%).Only one third of the houses were aware of health insurance but only 22% had health insurance coverage. The coverage was not for all family members. The subscription depended on education, socio–economic status, type of family. The willingness to pay a premium was Rs 500 per year in 31% of the families. It was observed that the main barriers for the subscription of health insurance were low income or uncertainty of income (43%), are not reliable (27%), not taken by friends or relatives (18%), prefer to invest somewhere else (11%), not adequate knowledge regarding its benefits (16%), do not feel the need (29%). Key words: Health insurance; awareness; willingness to pay; out of pocket expenditure

Background and Objectives: The transition from childhood to adulthood occurs during adolescence period which is characterized by major biological changes like physical growth, sexual maturation and psycho-social development. During this phase of growth the girls first experience menstruation and related problems which is marked by feelings of anxiety and eagerness to know about this natural phenomenon. Present study was undertaken to determine health status of adolescent girls by studying morbidity patterns amongst them and to know treatment seeking behaviour of adolescent girls. Methods: This one year community based cross-sectional study was done at village Peeranwadi, PHC Kinaye, Belgaum. Four Hundred (400) adolescent girls were selected randomly from each block. Study was approved by Institutional Ethics Committee, Jawaharlal Nehru Medical College, Belgaum. Written informed consent was obtained from all participants. Information on socio-demographic variables, history regarding illness one month prior and treatment seeking behavior were recorded. Haemoglobin estimation was done by cyanmethaemoglobin method. Results: Majority (82.25%) had age between 10 to 14 years and mean age of study population was 12.9±2.06 years and 98.5% were literates. Of 400 adolescent girls, 51% had attained menarche. The mean height, weight and BMI was less among 10 to 14 years compared to 15 to 19 years (p=0.000). In this study 15 (3.75%) were married and of them 60% were pregnant and all had registered for antenatal care. Most common morbidity reported in last one month was GI infections (14.75%), fever (12.75%) and dysmenorrhoea (12%). Prevalence of anaemia was 75% and 49.75% had mild, 20.75% had moderate and 4.5% had severe anaemia. 61.25% had taken treatment of which 74.69% visited health facility for treatment, 19.21% took home remedy and 6.12% did not take any treatment. The place of treatment was decided by themselves in 20.81% whereas 78.78% family members were decision makers. Conclusion and interpretation: In this study almost 75% of the girls were anaemic. Their status of anaemia is likely to worsen during pregnancy leading to complications including post partum haemorrhage. Although their literacy status and health seeking behaviour was on the better side, it needs to be still improved. Key words: Adolescent Girls; Adolescent Health; Morbidity Pattern; Treatment Seeking Behaviour

Aims & Objectives: Meningococcal disease is known to cause varying clinical prognosis ranging from asymptomatic to fatal infection. Factors contributing to the two conditions are unknown. Limited data available on meningococcal disease from India, prompted us to carry out the present surveillance study from hospitals in India during 2005–2011. Data from the different districts was obtained from the IDSP (Integrated Disease Surveillance Project), National Centre for Disease Control (NCDC). Samples were diagnosed for meningococcal meningitis using microscopy of CSF and latex agglutination. Results: The percentage positivity of the samples rose from nil to 13.6% in 2005, reached a maximum of 18.2% in 2006, declined to 15.7% in 2007, 11.6% in 2008 and finally came down to 4.4% by November 2009, 1.6% in 2010 and 1.5% in 2011. In the samples comprising both CSF and blood (for culture and/ or serology), positivity rate was much higher ranging from 20% to 30.5%, when compared with single samples like CSF alone (positivity 17.6 to 24.9%) or blood alone (positivity 5.3% to 10.5%) during the peak epidemic period (2005–2007). Interpretation: Using sample combinations like CSF and blood (for culture and/or serology), we were able to pick larger number of samples who were meningococcal disease positive as compared to the cases where single samples of CSF or blood were obtained. Keywords: Meningococcal Disease; Surveillance; Microscopy; Latex agglutination

Aims and Objectives: Reaction time is a good test to study conduction along nervous pathway and reaction time to auditory and visual stimuli is decisive factor for animal s survival. Methodology: This study was carried out in 92 healthy medical students of both the sexes. Low and high frequency pure sounds were used for auditory reaction time (ART). Green and blue monochromatic light were used for Visual reaction time (VRT). It was carried out with simple and test options under standard conditions. Results and interpretation: The observations revealed prolonged reaction time (RT) to visual stimuli as compared to auditory stimuli, Female disadvantage in reaction time in all tests & prolonged response time for choice test as compared to simple test. Key words: Auditory; choice; reaction time; visual

BACKGROUND: Hypertension is the commonest risk factor for cardiovascular disorder and though it is preventable diseases by very easy means like avoidance of risk factors and regular blood pressure screening and treatment but still very neglected. There is a paucity of data on the prevalence of hypertension in rural India and this study was done to determine the same amongst rural population in the field practice area of S.R.T.R. Medical College, Ambajogai,Beed, India OBJECTIVE: To find out the prevalence of hypertension among adults of the rural community and to classify them according to the classification given by JNC7. Study design: community based cross sectional study. Study area: Village Chanai, the field practice area of Department of Preventive and Social Medicine, S.R.T.R. Medical College, Ambajogai, Beed, Maharashtra, India Study population: whole the population of village Chanai i.e.2235 aged 18 years and above was screened by house to house survey for hypertension. 39 subjects were excluded according to exclusion criteria and finally 2196 study subjects were included in the study. Inclusion Criteria: All population of selected village above 18 years of age. Exclusion Criteria: 1. All pregnant women, 2. Subjects who were not willing for the interview or examination. Two readings of blood pressure were taken 3 minutes apart and the average was noted with standardized mercury sphygmomanometer throughout the study. OBSERVATIONS: Overall prevalence of hypertension was found to be 12.75% and it increased significantly with the age. Sexwise prevalence was slightly higher in males i.e.13.10% whereas it was 12.52% in females and it also increased in both sexes with age. Most of the cases of hypertension i.e.55.71% belonged to stage II of hypertension in both male and female. CONCLUSION AND RECOMMENDATION: Prevalence of hypertension in village Chanai rose by double in merely seven years i.e. from 5.92% to 12.75%. Most of the patients had first time exposed to the blood pressure recording procedure during the study and diagnosed as hypertensive indicating the lack of awareness about warning symptoms, risk factors, importance of BP screening and ideal time of BP screening. So there is a need for strengthening health & nutritional education programs promoting hypertension awareness, and emphasizing preventive measures. Multipurpose health workers can be trained for detection and monitoring of hypertension. Community interventional programs targeting the 1st degree blood relatives of the cases of hypertension should be given priority. Key words: Hypertension; Blood pressure; Prevalence; Adults; Rural India; JNC7.

Background & objectives: Human physical variability has been a subject of interest for the scientists since a very long time. Being a powerful descriptive means of the human face, anthropometric nasal landmarks are used to compare two groups of population. Method: Anthropometric study of nasal parameters of two ethnic groups of Rajasthan state was carried out on 200 native respondents. Hundred were Jats and hundred were Sindhis. The age of subjects ranged from 19–25 years. Nasal height and nasal breadth were taken by using spreading calliper and the nasal index calculated. Results: The data collected was statically analysed and the result shows that mean nasal height for Jats and Sindhis were 56.42±3.70 & 55.84±4.61 respectively. Nasal breadth for Jats and Sindhis were found as 38.42±2.86 & 39.24±3.38 respectively. Conclusion: Thus the Jats fall within Leptorrhine type with nasal index 68.09 and Sindhis fall within the Mesorrhine type with nasal index 70.72 that showed significant relationship. Study is providing a useful baseline and an anthropometric data that will be of clinical and surgical interest. Key words: nasal height; nasal breadth; nasal index

Objective: ESBLs pose a major threat in clinical therapeutics. In the present study we have tried to do clinical analysis of one hundred ESBLs producing Enterobacteriaceae isolates from various clinical specimens from patients admitted in critical care areas. Methods: ESBLs detection was done by CLSI, DDS and Vitek methods. Clinical analysis of each patient was done by regularly visiting in CCA and reviewing patient’s status and medical records. Results: All of the 13 patients on foley’s catheter grew ESBLs positive isolates and amongst 10 non catheterized patients, 9 grew ESBLs negative isolates. Thirteen out of 14 patients on CVP/arterial line grew ESBLs positive isolates. Out of 24 patients who underwent surgery, 22 grew ESBLs positive isolate. Forty seven out of 68 patients who were on 3rd or 4th generation cephalosporins within last 1 month of giving the sample grew ESBLs positive isolates. Conclusion: We have found a statistically significant (p<0.0.05) relationship in between foley’s catheterization and production of ESBLs from urinary isolates. There was no statistically significant association in between CVP/arterial line and blood culture isolates. We did not find difference in mortality rates in between patients infected with ESBLs positive or negative isolates. The mortality in patients was associated with their primary illness or associated co-morbid conditions. We found that the detection of ESBLs is important for the de-escalation of therapy thereby saving net cost of treatment. Key words: ESBLs; critical care area; Enterobacteriaceae