Vol 5, Issue 1, Jan-Mar, 2015

Endobronchial tuberculosis (EBTB) is an infl ammation of the bronchial walls caused by tuberculous infection. The clinical, radiologic, and bronchoscopic presentation of EBTB is nonspecifi c and can be easily confused with other common pulmonary disorders. Its diagnosis requires isolation of Mycobacterium tuberculosis from bronchoscopic material. A high index of awareness of this entity and the early bronchoscopy in suspected patients are the cornerstones for establishing the diagnosis. The disease can occur in patients of all ages although it is more common in younger age group with a slight female preponderance. In recent years, a higher incidence has been reported in patients with human immunodefi ciency virus infection. Key words: Endobronchial tuberculosis, nonresolving pneumonia, tuberculosis

Obesity is a medical condition resulting from the accumulation of excess fat in the human body to the extent that it might have great harm effects on the human health by increasing the diseases lowering the average life expectancy. A person who has a body mass index (BMI) of more than 30 kg/m2 is classifi ed as obese; this is how obesity can be defi ned for adult, which is different than that in children. To account for variability by sex and age, BMI in children must be compared with sexand age-specifi c reference values (Centers for Disease Control growth chart). The terminology that is used for high BMI-for-age in children in has been based on the recommendation of an expert committee convened by federal agencies. Parents can be a good example for their children by modeling healthful eating behaviors and being physically active. Parents can also be effective advocates by being involved in efforts in their schools, and community to expand the access and availability of opportunities for physical activity and healthful eating. In the case of being an obese child, that means suffering from many health problems and obesity-related diseases such as elevated blood pressure, high cholesterol, diabetes and heart diseases. Diabetes is considered as one of the obesity-related diseases; type 2 diabetes in children has linked with obesity; when the pancreas starts to produce the insulin hormone, excess body fat will not allow child’s body to use the insulin as it should be which can lead to being a diabetic patient. Schools also play a vital role in teaching the students on how to eat properly and select the best meal with keeping their bodies flexible by doing physical activities. It is important in order to keep children away from being in disasters by having a lot of obesity-related diseases (e.g., heart attacks and diabetes), which can lead to premature death in obese children. Children must be healthy since those children growing up in today’s world are tomorrow’s future! Key words: Childhood, diabetes, diet, heart disease, obesity

Introduction: Birth weight is an important indicator of maternal and child health of the country. Various socioeconomic and maternal factors are responsible in determining birth weight. Hence, the present study was conducted to fi nd out the proportion of low birth weight (LBW) among the babies born at Agartala Government Medical College and Govinda Ballabh Pant Hospital and to reveal the relationship between various maternal factors and birth weight. Materials and Methods: The present study was conducted during the period from July 1, 2012 to August 31, 2012 among 305 mothers admitted in the postnatal ward selected by concurrent sampling. Descriptive statistics and Chi-square test were applied. P < 0.05 was considered to be statistically signifi cant. Results: Proportion of LBW was found to be 23.9% and it was signifi cantly higher among rural mothers (28.6%, P = 0.017), anemic (28.8%, P = 0.004), Venereal Disease Research Laboratory reactive (83.3%, P = 0.002) and mothers who delivered vaginally (32.8%, P = 0.001). LBW was signifi cantly lower among mothers who received iron and folic acid (IFA) tablets (22.4%, P = 0.007) and were immunized against tetanus (22.8%, P = 0.011). Conclusion: Adequate antenatal checkup, IFA supplementation, screening and treatment for syphilis, etc. are necessary for improving birth weight in this community. Key words: Anemia, antenatal care, iron and folic acid, low birth weight

Background: Asthma in the child population is one of the leading public health problems that accounts for immense hospitalization, morbidity, and mortality throughout the world with no exception of the Middle East, including Saudi Arabia. Reports in the literature emphasize on family management of this dreadful disease among the children. Aim: The aim of this study was to investigate the knowledge and perceptions of parents/guardians about childhood asthma. Materials and Methods: Likert scale questionnaire consisting of 90 questions was served to the parents/ guardians of asthmatic children. The questionnaire scores were correlated with the number of emergency department (ED) visits by asthmatic children (r = -0.239, P =0.046). Results: Our results showed a negative correlation between ED visits by asthmatic children and their parents/guardians’ knowledge of the disease. Conclusion: Although there is a trend between the ED visits by asthmatic children and the level of parents/guardians’ awareness, our results are not conclusive, hence; further studies with a larger sample size are recommended. Key words: Asthmatic children, emergency department visits, parents/guardians, perception

Background: Complementary and alternative medicine (CAM), includes a wide range of approaches such as herbal medicine, traditional therapies, mind-body intervention, etc. Although CAM is a common practice in India, it is not being integrated into the conventional medical system. There is a paucity of data regarding the usage and acceptance of CAM by patients. Objective: The aim was to determine the knowledge, attitudes, and practice toward CAM among patients and to correlate these findings with their demographic and professional characteristics. Materials and Methods: A cross-sectional, questionnairebased survey conducted in 100 patients attending out-patient department of a tertiary care teaching hospital. Results: Among the respondents, 79.0% were aware of CAM and 46.0 used it. Most common system used was Ayurveda (71.73%), and most common ailment for which it is used was arthritis (30.43%). Majority consulted quacks (43.47%); physicians (23.91%), friends and relatives (19.56%), and 15.21% took CAM as a self-medication. Thirty percent felt that CAM was based on scientific evidence, 25% felt it was safer than modern medicine that is significantly more in women when compared to men. Twenty-five percentage opined that CAM is more efficacious than modern medicine that is significantly more in respondents >40 years age. The most common advantages reported were complete cure, easy availability and no side-effects, whereas disadvantages include food restriction, expensive medication, symptomatic relief and effective for limited diseases. Conclusion: Majority of patients use CAM along with modern medicine without physician’s advice. Hence, healthcare professionals should be aware of this while taking clinical history and treating patients that may reduce drug interactions due to use of CAM particularly in the elderly population. Key words: Ayurveda, conventional therapies, traditional complementary and alternative medicine

Background: AIDS epidemic is major public health emergency and young people are bearing the main brunt of the new infection worldwide. MSM constitute a high risk group for sexually transmitted infections including HIV in many parts of the world. Objectives: To assess knowledge, attitude of HIV/AIDS and sexual practices among MSM residing in city of Belgaum. Methodology: Cross sectional study was conducted at Sweekar NGO for MSM. Based on the Sampling Procedure and inclusion Criteria 50% of MSM were selected for the study. Therefore the sample size for this study was 416. Data collection was done using pre-designed and pre-tested questionnaire. Results: A total of 416 MSM were interviewed by the trained peer workers. Majority of them (27.64%) were in 25-30 years of age. Majority of them had good knowledge of modes of transmission of HIV(90.38%), its prevention (98.09%), availability of treatment (89.66%). 61.30% were having good knowledge of symptoms. Friend was the fi rst sexual partner for 67.89% participants. Half of the participants were performing both anal and oral form sex. Conclusion: Although the knowledge of modes of transmission, symptoms, investigations, treatment and prevention of HIV/AIDS has been good among the MSM but prevention was not been practiced by most. NGOs working with MSM need to organize some interventions aimed at changing the harmful sexual practices into healthy practices. Key words: Condom use, HIV/AIDS, homosexual, knowledge, a􀄴 itude and practice

Background: Various autoimmune disorders are associated with pediatric-type-1 diabetes mellitus (DM), but are usually ill-defi ned and not usually suspected until the disease becomes advanced, and the prevalence of these autoimmune conditions is usually not very well defi ned in developing part of the world. Aim: To fi nd out the prevalence of various autoimmune disorders associated with pediatric-type-1 DM. Materials and Methods: Total of 164 patients were screened (90 males and 74 females) during the study period of 1-year, patients were evaluated for the clinical signs, biochemical investigations and family history of autoimmune disorders in a tertiary health care center in western Uttar Pradesh. Results: Autoimmune thyroiditis was found to be most commonly associated with type-1 diabetes, followed by the celiac disease, and Graves’ disease, others less commonly seen were pernicious anemia, juvenile rheumatoid arthritis and vitiligo. Conclusion: Autoimmune hypothyroidism was found to be signifi cantly associated with type-1 diabetes, timely identifi cation of these disorder are of paramount important for better glycemic control and to reduced the morbidity and mortality associated with the conditions. Key words: Autoimmune thyroiditis, celiac disease, pernicious anemia, type-1 diabetes mellitus

Background: The rising prevalence of diabetes mellitus (DM) in high tuberculosis (TB) burden countries may adversely affect TB control. Revised National Tuberculosis Control Program (RNTCP) prescribes the same TB treatment regimen that is used for non-diabetics to the diabetics. Under the program setting, there is a need for study on successful treatment outcome of TB patients with known DM. Objective: The aim was to analyze the TB treatment outcome in patients with known DM treated under RNTCP setting in an urban area. Materials and Methods: After cluster sampling among the 9 TB Units in Bengaluru 5 were selected randomly. 75 TB-DM patients and 150 TB without Diabetes were enrolled into the study and followed-up for their treatment outcome. Results: Of the 75 TB-DM patients 72% were males, and 28% were females. >90% of the patients were of age above 40 years old. Overall treatment outcome was 81% and 87% among TB-DM and TB without DM, respectively. It was not statistically signifi cant (Fisher’s exact test P = 0.3256). Conclusion: RNTCP’s directly observed treatment strategy (DOTS) regimen holds good for TB patients with and without DM. The DM co-morbidity did not signifi cantly change the TB treatment outcome. Hence, the current DOTS regime under RNTCP can be applied to the TB-DM co-morbid patients. Key words: Diabetes mellitus, directly observed treatment strategy, tuberculosis, tuberculosis-diabetes mellitus, Revised National Tuberculosis Control Program

Aim: Long-term health of the stomatognathic system as well as esthetic aspects is the therapeutic goals in patients with orofacial clefts (OFCs). The aim of this study was to assess the sociodemographic profi le of patients with OFCs in India. Materials and Methods: The study group consisted of 108 cleft patients. Subjects were divided into three groups. Group 1: Patients with cleft lip (CL), Group 2: Subjects with cleft palate and Group 3: Subjects with CL alveolus and palate (CLAP). A pretested interviewer administered questionnaire was used. Socioeconomic status (SES) was assessed using Pareek’s scale for the rural population and Kuppuswamy’s scale for the urban population. Results: Among the 108 study subjects, 69 (63.9%) were males, and 39 (36.1%) were females. 64 (59.2%) study subjects were residing in rural areas, and 44 (40.8%) were residing in urban areas. 29 (26.80%) from rural areas and 21 (19.50%) from the urban areas had a family income below Rs. 5001-10000. In rural areas, 47 (73.40%) study subjects belonged to the middle class and 17 (26.60%) study subjects belonged to the lower middle class. In urban areas, 20 (45.50%) study subjects belonged to the middle class and 24 (54.50%) study subjects belonged to the lower class. Conclusion: Most of the study subjects in rural areas belonged to middle SES, whereas in urban areas belonged to lower SES. Key words: Cleft lip, cleft patients, orofacial cleft, socioeconomic status

Aim: The aim was to identify the risk factors in developing metabolic syndrome among boys and girls aged 18-24 years in Mumbai city. Materials and Methods: A total of 200 samples were taken from different areas of Mumbai city. A lifestyle questionnaire was given containing questions like personal background and anthropometric measurements such as weight, height, body mass index (BMI), waist circumference and neck circumference were noted. Results and Discussions: The mean anthropometric measurements of 200 samples (100 boys and 100 girls) are as follows the mean age of the males in the study was found to be 21.26 ± 0.204 years and of females 21.31 ± 0.206 years. The mean differences in weight, height, and ideal body weight between males and females are as follows 75.3 ± 0.848 kg and 63.7 ± 0.735 kg, 171.37 ± 0.577 cm and 159.88 ± 0.552 cm, 71.39 ± 0.577 kg and 54.94 ± 0.544 kg. The mean waist circumference and neck circumference are as follows 87.88 ± 0.526 cm for males and 87.09 ± 0.559 cm for females and 37 ± 0.432 cm for males and 33.8 ± 0.456 cm for females. Conclusion: From the results, it can be concluded that BMI, neck circumference and waist circumference values are very higher than that of normal and this proves a basis that anthropometric measurements can be used to predict metabolic syndrome among young adults aged 18–24 years in Mumbai city. Key words: Abdominal obesity, anthropometric measurements, metabolic syndrome, Mumbai city, neck circumference, young adults

Context: Suicide is a major public health problem and ranks second among the leading causes of death in both genders in 15-34 years. Suicidal attempts are 20 times higher than the completed suicides. Aims: The aim was to identify background risk factors and precipitating factors for suicide attempts in Pondicherry district and to fi nd out the reporting status of suicide attempts. Settings and Design: Hospital-based descriptive study. Subjects and Methods: 200 subjects who have attempted suicide from JIPMER and Indira Gandhi Government Hospital and Post Graduate Institute Pondicherry were interviewed. Monthly data on attempted suicide were collected from Crime Record Bureau of Pondicherry and Villupuram district and Medical Records Department of these two hospitals was collected. Statistical Analysis Used: SPSS version 16.0 was used. Chi-square test was used to test the significance of the difference between two proportions. Results: Most common precipitating factor found among those who attempted suicide was verbal abuse, most often by parents (31.9%). The most common mode of suicide attempt was consumption of chemical poison in 56% of subjects followed by plant poison 41.5%. The suicide intention was high in 81.5% of subjects. No signifi cant difference in risk factors could be found between subjects from Pondicherry and villupuram district. It was found that there was gross under-reporting of attempted suicides to Crime Records Bureau. Conclusions: Measurement of suicide intention enables us to predict the future suicidal behavior in adults; individuals with a high suicide intent index pose a major public health problem. Hence, there is a need for opportunistic screening of those with suicidal ideations as well as counseling and follow-up of those with suicide attempts to prevent further attempts. Key words: Poisoning, Pondicherry, suicide a􀄴 empt, suicide intention, suicides, Tamil Nadu

Background and Purpose: The purpose of this study was to determine the incidence and risk factor of ischemic stroke subtypes by a mechanismbased classification scheme (Trial of ORG 10172 in Acute Stroke Treatment [TOAST]). Materials and Methods: This study was conducted in Indraprastha Apollo Hospital, New Delhi, between 01/01/2004 and 31/12/2006. Out of 361 admitted stroke patients, 244 (67.59%) ischemic stroke patients were analyzed retrospectively for incidence and modifi able risk factors for stroke in our region. The cause of ischemic stroke was classified according to the TOAST criteria. Results: Out of 244 patients 165 (67.6%) were male and 79 (32.4%) were female, the mean age at the time of stroke was 57.1 years, the incidence of different risk factors were as follows: 139 (56.9%, odds ratio 2.71) hypertensive, 85 (34.8%, odds ratio 2.4) diabetics, 95 (38.9%, odds ratio 3.12) smokers, 58 (23.7%, odds ratio 5.34) dyslipidemics, 44 (18.0%, odds ratio 1.43) coronary artery disease (CAD) patients, 14 (5.7%, odds ratio 1.22) patients have the transient ischemic stroke in the past, 13 (5.3%, odds ratio 1.43) were given the history of atrial fi brillation. The incidence rates of ischemic stroke subtypes were as follows: Determined causes; large artery atherosclerosis 141 (57.7%), lacunes 18 (7.7%), cardio-embolism 11 (4.5%), hypercoagulable state 8 (3.2%), un-determined causes; atherosclerosis and/or lacunes 25 (10.2%), embolism and/or two more hypercoagulable state/CAD) possible causes 7 (2.8%), negative evaluation in 34 (13.9%) patients. Ischemic stroke subtype according to the TOAST criteria was a signifi cant predictor for long-term survival. Conclusions: Our data indicate that large vessel disease is a major cause, and the hypertension, diabetes, smoking, hyperlipidemia are the most common risk factors for Ischemic stroke. Key words: Epidemiology, incidence, risk factors, stroke classifi cation

Introduction: Osteoarthritis (OA) of the knee is the most common type of arthritis of the elderly among Asians. Reports suggest that it affects the quality of life. Hence, this study was undertaken with the objective to know the impact of OA of the knee on 8 domains of health related quality of life (HRQoL) which include: (1) Physical functioning (PF), (2) role limitation due to physical health (RP). (3) Emotional well-being/mental health (MH), (4) role limitation due to emotional problems (RE), (5) energy/vitality, (6) social well-being (short form [SF]), (7) body pain, (8) general health. Materials and Methods: This cross-sectional study was conducted in primary care rural clinics situated on peripheral areas of Mangalore city. Total sample size was calculated to be 77. Patients who met the criteria of modifi ed American Rheumatologic Association Classifi cation for OA of knee were administered a SF- 36 questionnaire to measure the HRQoL in the local language version. Mean scores (with its standard deviation) across each domain was calculated. Results: Of 80 patients, 38 were males. OA affected HRQoL. Four out 8 factors had more impact on HRQoL (they are PF, RP, MH, RE). Duration of OA is an important determinant on HRQoL. Patients with newer onset of OA (<4 years) had less physical impact on (Domain, Mean) (PF, 54.36; RP, 13.5) and more motional/mental impact (MH, 28.23; RE, 59.13). With increasing duration (>4 years) of OA (Domain, Mean), the emotional impact (MH, 44.67; RE, 45.67) reduced but the physical impact (PF, 47.83; RP, 19.75) persisted/got worse. Conclusion: Osteoarthritis had impact on HRQoL. Duration of OA determines the kind of impact. With the onset of OA emotional/mental support would be needed in addition to the medical treatment. As the disease progresses, they tend to cope with emotional/mental problems even as the physical problems persist/increase. Key words: Geriatrics, health related quality of life, osteoarthritis, primary care

Background: Hypertension, complicating 5-10% of all pregnancies, is a leading cause of maternal and fetal morbidity, particularly when the elevated blood pressure is due to preeclampsia. The control of pregnancy-induced hypertension (PIH) appears diffi cult to achieve. Part of the reason for poor control of hypertension in these women might be limited PIH self-care knowledge. Aims: The aim was to fi nd out the association between PIH and knowledge, attitude, and preventive practices among pregnant women. Settings and Design: A cross-sectional study was carried out in Gynae O.P.D., of Sir Sundar Lal Hospital, Banaras Hindu University, Varanasi. Materials and Methods: The study was carried out in the month of September to October, 2013 on every Monday in Gynae O.P.D., of Sir Sundar Lal Hospital, Banaras Hindu University, Varanasi. The target population includes all pregnant women between the age group of 15-49 years, who attended antenatal clinic. The interview schedules were administered to the women. Respondents were assured of anonymity and confi dentiality to ensure honest response. Statistical Analysis Used: Statistical analysis will be done by Epi Info™ 7. Results and Conclusion: Finding of the study shows that >50% (60.49%) of women are unaware about hypertension. Those women belong to the age group of 20-30, and they also diagnosed with prehypertension. The overall incidence of Eclampsia is 13.58% in study population regarding PIH. Lack of exercise is a major cause to for hypertension. Pregnancies complicated by hypertensive disorders lead poor maternal and perinatal outcomes. Key words: Hypertension, preeclampsia, pregnancy-induced hypertension, risk factors, self-care knowledge

Aim: To detect the prevalence of ocular symptoms and other related problems experienced by IT professionals in OMR IT Corridor, Kelambakkam. Background: The dependence on the computer is rising with time. This will lead to numerous ill-effects in human beings out of which ocular manifestations play a prominent role (it is absolute necessary to know the hazards of the computer before we use it) previously done studies reveal that the awareness of ocular manifestation is less than 20%. Among the lesser known ocular manifestations, one of it is computer vision syndrome. Studies state that chorionic villus sampling (CVS) is one of the fast growing problems in the IT community that requires early identifi cation and prevention to save our younger generations. Thus, this study would provide the necessary detection of CVS in IT people and to know, which group of people requires counseling and which group requires treatment. Materials and Methods: This cross-sectional questionnaire study included IT professionals who attended the Department of Ophthalmology, Chettinad Medical College, Chennai during this study period. Questionnaire survey study data were collected in computer users regarding the demography, duration of computer use (hour per day), years of computer use, working distance from computer, level of top of screen from eye level, use of antiglare screen, brightness and contrast adjustment, taking breaks during computer use. Results: During this study period, 300 patients were randomly selected from various IT companies. In which, 186 (62%) males and 114 (38%) females were participated. They were having ocular complaints in descending order such as eye strain (69%), headache (56%), dryness (49%), irritation (47%), burning sensation (41%), blurred vision (39%), itching (32%), watering (29%), redness (21%), and double vision (16%) Interpretation: The data were analyzed using SPSS software. Key words: 20-20-20 rule, computer vision syndrome, IT professionals

Introduction: Yet, approximately 30% dwellers are internal migrants in India. Migrant is one who resides away from his/her native home due to variety of reasons. In Uttar Pradesh, these relatively immobile internal migrants generally comprise of Nomad, Brick kiln and Migratory construction workers. The present study was carried out with the objective of evaluating the achievements of fi rst phase of Special Routine Immunization Week (SRI week) in terms of improvement of immunization status of a community of internal migrants in Lucknow. Materials and Methods: The study was a community-based observational, which undertook relatively immobile internal migrant communities attributed to local administration of Community Development Block, Sarojininagar, Lucknow. The study was conducted during 24-30th April 2013, covering equal numbers of households (each 100) from the three type of communities selected randomly. An attempt of in-depth interview with the adult member was made to reveal the underlying issues of the study. Results: Of the three communities, migratory construction workers outnumbered in the literacy status (7.46%). The immunization coverage in all the three communities prior to the SRI week was 24.63% while post to the fi rst phase of SRI week was 81.12%, thereby achieving immunization by 56.49%. The present study also showed no relation between vaccination achievement during SRI week and literacy status of different communities. Conclusions: There is a need of having such sessions at regular intervals repeatedly as well as conducting focused studies on these groups to identify the various factors which are responsible for poor immunization coverage and keep them in mind while planning such special immunization activities. Key words: Intensifi cation of routine immunization, marginalized communities, special immunization weeks

Introduction: Essential medicines lists are a key instrument for improving quality and equitable access to health care. The National List of Essential Medicines of India 2011 is modeled on the WHO Essential Medicines List and Indian states (adopting the National List) are free to include other medicines as needed. Materials and Methods: National List of Essential Medicines of India 2011 contains a total of 287 medicines for provision at primary and secondary level of health facilities. The International Nonproprietary Name of these medicines was compared with the List of Essential Medicines (LEM) of three states, that is, Bihar, Rajasthan and Tamil Nadu for the inclusion patterns. Results: A large number of medicines from the National List of Essential Medicine (NLEM) were missing from the state LEM’s, especially Bihar. The sections on Anticonvulsants, Diuretics, Psychotherapeutic, Antiallergics and Oxytocics were comprehensively included by both Rajasthan and Tamil Nadu. Furthermore, the analgesic and anti-infective medicines were largely included. However, the sections of antidotes, diagnostic agents and ophthalmological preparations were grossly defi cient. Similarities were found across states in their patterns of both inclusion and exclusion of medicines. Conclusion: The analysis reveals that the extent of inclusion of NLEM medicines in state LEM’s is defi cient with variable patterns across states. This in turn has implications for drug availability, prescription patterns, and rational drug use. As some drugs are repeatedly there in NLEM but not included by states, a discussion based consultative approach for better coherence across the lists could lead to further optimization and utilization of LEM’s which would aid in improved access to medicines. Key words: Essential medicines, inclusion of medicines, India essential medicine list

Introduction: Asthma is a chronic infl ammatory disease of the airways and is on the increasing trend owing to air pollution and urbanization. The use of alternative ways of treatment that are as effi cacious as the standard treatment is the need of the hour. This study was conducted to study the effects of Buteyko breathing exercise on the newly diagnosed asthmatic patients. Materials and Methods: Totally, 100 newly diagnosed asthmatic patients attending Tagore Medical college out-patient department were randomly allocated into the interventional and the control group for a period of 2 months. The former were taught Buteyko breathing exercise while the control group was on standard asthma treatment. The effects were assessed using a pretested close ended Asthma Control Questionnaire and Pulmonary Function Tests. The results were given in mean with a standard deviation. Chi-square test was done to compare the results between the two groups and P < 0.05 is taken as signifi cant. The analysis was done by SPSS software version 13. Results: Among the 100 participants, majority of the participants were in the age group of 31-40 years. It was observed that there was an overall subjective improvement of asthma symptoms among the interventional group at the end of 2 months (which was statistically signifi cant) when compared to the control group. Also, there was an improvement in the pulmonary function in terms of peak expiratory fl ow rate in both the groups. Conclusions: The results of this study support the effectiveness of Buteyko breathing exercise over the standard treatment in the newly diagnosed asthmatic patients. Key words: Alternative treatment, asthma, pulmonary function test

Introduction: The risk of developing chronic diseases and general disability increases with aging, resulting in loss of functioning ability and decrease in performing optimally. Early diagnosis of impairment and disability may improve the quality of life of elderly and enable them to lead a full and productive life. The study is a part of a larger study done in an urban area of Delhi. Materials and Methods: Systematic random sampling was used to select a cross-sectional sample of the study subjects >20 years and above. Locomotor, Visual Hearing and Speech were assessed using the guidelines given in gazette of India, extraordinary, part II section. Visual disability was measured by the presenting visual acuity in the fi eld area using Snellens chart using WHO guidelines. Result and Conclusion: A total of 120 study subjects out of 1300 screened were in geriatric age group. The overall magnitude of the physical disability was 43.3% among elderly. Visual disability was most common form of disability (60%). Many study subjects were suffering from >1 disability, but treatment was sought only in 50% of disabilities. Treatment seeking for disabilities is an important and neglected issue leading to severe degree of disabilities that would be prevented if taken care of, in due time. A multidimensional approach for prevention is the need of the hour. Key words: Impairment, physical disability, treatment seeking, visual disability

Introduction and Background: Sickle cell disease (SCD) is an extremely challenging disease of global concern. The highest prevalence of SCD in Saudi Arabia is in the Eastern province. Compared to all other areas of Saudi Arabia, Al-Qatif area has the highest gene frequencies for HbS and glucose-6-phosphate dehydrogenase (G-6-PD) defi ciency genes. Objective: The objective of this study was to assess the knowledge and misconceptions about SCD of adults (≥18 years) with sickle cell anemia in Al-Qatif area, Eastern Province, Saudi Arabia, and study factors that may affect them. Materials and Methods: A cross-sectional study using a selfadministered questionnaire was distributed to 320 patients aged ≥18 years with sickle cell anemia, who attend the medical outpatient clinics in Qatif central hospital and primary care centers in the Qatif area, Eastern Province, Saudi Arabia. Result: A total of 300 participants completed their questionnaire. In general, 56.3% had poor knowledge of the disease. About 58.3% had good knowledge of the genetic transmission. The knowledge of 46.7% about the precipitating factors was poor. Moreover, 59.3% had poor knowledge of the diet of people with SCD and 81.3% had poor knowledge of the diet of people with G-6-PD defi ciency. Conclusion: Our study revealed signifi cant widespread misconceptions of patients with sickle cell anemia especially relating to their diet. Key words: Knowledge, misconception, sickle cell anemia, G-6-PD defi ciency

Introduction: Asthma is a common chronic disease that affects persons of all ages. People with asthma report impact on the physical, psychological and social domains of quality of life. Health-related quality of life (HRQoL) measures have been developed to complement traditional health measures such as prevalence, mortality and hospitalization as indicators of the impact of disease. Objective and Study Design: The objective of this study was to assess HRQoL in Bronchial asthma patients and to relate the severity of asthma with their quality of life. About 85 asthma patients were evaluated for HRQoL and their pulmonary function tests values were correlated with HRQoL scores. Results and Conclusion: It was found that asthma patients had poor quality of life. There was greater impairment in quality of life in females, obese and middle age patients indicating that sex, body mass index and age are determinants of HRQoL in asthma patients. Key words: Bronchial asthma, health-related quality of life, pulmonary function tests

Background: A woman’s contraceptive use is largely infl uenced by the dictates of her religious faith. Acceptance of family planning methods is usually found to be poor among Muslims. This study assesses how acceptance of contraception and contraceptive choices varies across various religious groups. Objectives: (1) To determine the prevalence of contraceptive use among various religious groups. (2) To study the contraceptive use pattern among different religious groups. Materials and Methods: The study was conducted among ever-married women (15-49 years) residing in the fi eld practice areas of Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh. The study was a community-based cross-sectional study. Current use and ever-use of contraceptives were assessed among women from various religious groups. The contraceptive choice among current users from different religious groups was studied in relation to use of spacing and terminal methods. Results: Current use of family planning methods was similar for Hindus (43.1%) and Muslims (44.1%). However, ever-use of contraception was found to be more among Muslims (72%) than Hindus (50.6%). Spacing methods were more popular among Muslim couples (84.3%) compared to Hindus (71.7%), whereas larger number of Hindu couples preferred terminal methods (28.3%) compared to Muslims (15.7%). Conclusions: Religion does play a role in the adoption of family planning and the specifi c method adopted for contraception. Key words: Contraceptive use, Hindus, Muslims

Context: Information on the pattern of mortality among alcohol users is important for advocacy and planning. The proportion of deaths attributed to alcohol is often underestimated. Aim: We determined the risk of mortality among alcohol using adult males compared with adult male nonalcohol users. Settings and Design: Cohort study was conducted in the population registry of lifestyle diseases cohort in a rural block in Kerala, India. Materials and Methods: During 2002-2007, trained fi eld workers conducted interviews, and underlying cause of death was coded by local physicians trained in verbal autopsy. Statistical Analysis: Risk ratios of death among men using alcohol and not using alcohol were calculated. Risk ratio of alcohol for various causes of mortality across various age groups was also determined. Log-rank test was done to compare the mortality of adult men using and not using alcohol. Results: Risk ratios of all-cause mortality in alcoholic men were 1.87 (1.45, 2.4) in 20-44 age group, 1.3 (1.07, 1.57) for 45-59 age group. Relative risks of alcohol use status for coronary heart disease mortality were 2.91 (1.67, 5.05) among 20-44 years and 1.49 (1.09, 2.03) among 45-59 years. Conclusion: Young and middle-aged male alcohol users (20-59 years) showed signifi cantly increased risk ratio of death. Alcohol users have a higher risk of coronary artery disease mortality and mortality from injuries. The results support a restrictive alcohol policy and screening for coronary artery disease in men using alcohol seeking care in treatment facilities. Key words: Kerala, Alcohol mortality, coronary mortality

Introduction: Hemoglobinopathies are common genetic disorders of hemoglobin, which can be prevented by population screening and offering genetic counseling. The cumulative gene frequency of hemoglobinopathies in India is 4.2%. The carrier state for β-thalassemia in India varies from 1% to 17% with an average of 3.2%. The present study was undertaken to fi nd out the burden of hemoglobinopathies and spectrum of this disorders among the blood donors. Materials and Methods: The study includes 975 students between 18 and 25 years who donated blood, were screened for β-thalassemia trait and related hemoglobinopathies by highperformance liquid chromatography (HPLC) using Bio-Rad variant. Samples were also run on a hemato analyzer for red cell indices and peripheral smear for red cell morphology. Results: A total of 41 donors showed abnormal hemoglobin fractions in HPLC. Out of these, 32 (3.3%) were diagnosed with β-thalassemia trait, 8 (0.8%) with Hb-D Punjab and 1 (0.1%) with Hb-S trait. The frequency of β-thalassemia trait in the student from different geographical regions varied from 0.8% to 4.44%, being the highest in those from Punjab and frequency of β-thalassemia trait in different caste groups varied from 0 to 4.74%, being the highest in the student from Jatt Sikh community. Conclusions: A universal approach of screening for β-thalassemia trait should be included as a part of standard blood testing among the college students, premarital and of the extended family of thalassemics. Population group with high gene frequencies requires screening programs as well as increased awareness and education program to control the birth of thalassemia major. Key words: Blood donor, hemoglobinopathies, high performance liquid chromatography, β-thalassemia trait

Objective: An attempt to analyze why in spite of prolonged perforation-operation (PO) interval mortality in patients of perforated duodenal ulcers is less in some patients and whether resuscitative measures in PO interval infl uences mortality particularly in a rural hospital. Materials and Methods: A retrospective analysis of 81 cases of perforated duodenal ulcers presenting in the surgical clinic in a rural medical college which is also a tertiary referral center. Resuscitation, if received in the PO interval was recorded, and a corrected score was calculated and compared statistically with the conventional Boey score. Results were analyzed using Microsoft Excel and SPSS 22 software. Results: Sample size of 81 patients had 70 referred and 11 direct patients. Six out of 11 direct patients succumbed (P = 0.545) and six out of 70 patients succumbed in the referred group (P = 0.086) suggesting that patients presenting directly to the tertiary center with a prolonged PO interval without any intervening resuscitation the prognosis is poor whereas a delayed PO with intervening medical intervention has a better prognosis. The PO interval was 23-168 h with a mean of 42.12 (standard deviation 26.86). Conclusion: In a rural referral center, the resuscitation done in the PO interval is signifi cant as the prognosis is better in the group of patients resuscitated in the PO interval even if there is a delay in the surgical intervention whereas the mortality is higher in those group of patients who have come directly to the center and subjected to surgical procedure, but without any resuscitation in the PO interval. Hence, resuscitation in PO interval is paramount for a better prognosis. Key words: Boey score, corrected Boey score, duodenal perforation, prognostic factors

Kikuchis-Fujimoto’s is a benign, self-limiting, cervical lymphadenitis, fi ne-needle aspiration cytology (FNAC) plays a very important role in the diagnosis and management of these patients. We present a case of 30-year-old female presenting with supraclavicular lymphadenopathy and fever, diagnosed as Kikuchis-Fujimoto’s lymphadenitis on FNAC with no recurrence or development of Lupus lymphadenitis even after 1-year of follow-up. Although Kikuchis-Fujimoto’s is a rare cause of lymphadenopathy, FNAC is an important tool in diagnosing this entity and differentiating from tubercular lymphadenitis and Lupus adenitis. Presence of cresentric nucleated histiocytes engulfed karryorrhectic debris and monocytoid cells aids in the diagnosing. A definitive diagnosis made on FNAC can avoid biopsy and unnecessary diagnostic and therapeutic interventions in these patients. However, a look out for recurrence and development of Lupus with regular followup and serological examination is imperative. Key words: Fine-needle aspiration cytology, kikuchis-fujimoto’s, lupus adenitis, tubercular adenitis

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, commonly manifesting as hypopigmented anesthetic patches with thickened nerves. Primary hyperpigmentation in leprosy is a rare manifestation. Literature search showed only few case reports of Hansen’s disease with single hyperpigmented patch and involvement of relatively immune zones like palms and soles. We report a case of leprosy presenting primarily as hyperpigmented patches over the trunk and extremities with involvement of palms and soles which is a rare presentation. Key words: Hyperpigmented patches, leprosy, palms and soles, trunk

Angiomyolipoma (AML) is a benign mesenchymal tumor, mostly seen in kidneys and usually in association with tuberous sclerosis. Extrarenal AML is uncommon, but sporadic cases have been reported at other sites. Here, we are presenting a case of extrarenal AML in the right lower extremity of a 70-year-old male with no evidence of tuberous sclerosis. Key words: Angiomyolipoma, extrarenal, lump, tuberous sclerosis

Dental offices that house and operate standard radiography equipment must process the X-ray fi lms using photochemical-fi xer, developer, and equipment cleaner. Each of these chemical solutions is unique and requires special handling and disposal procedures. There are a number of hazardous dental wastes that, when disposed of improperly, could cause harm to the environment. Examples include chemical solutions, lead foil fi lm backing, mercury, scrap dental amalgam, fl uorescent tubes, and batteries.[1] The fi xer that Dental offi ces use to develop X-ray is a hazardous material that should not be simply rinsed down the drain. Spent fixer solution contains approximately 4000 mg of silver/L.[2] Silver recovery unit should be used to recapture the silver from the fi xer, and once the container is full, a Certifi ed Waste Carrier should be contacted for recycling or disposal. The silver recovery unit cartridge should not be placed in the garbage. The de-silvered fi xer solution can be mixed with developer and water and disposed of down the sewer or septic system. A digital X-ray unit should be utilized to minimize the need for fi xer solutions. Spent developer is permitted to be discharged into the sewer or septic systems provided it is diluted with water. It contains a toxic substance hydroquinone when unused, it must be kept separate from dental wastewaters or any access to the local sewage or fresh water. Many cleaners for X-ray developer systems contain chromium, a toxic substance so the supplier should be asked for a cleaner that does not use chromium.