Vol 5, Issue 3, Jul-Sep, 2015

Pregnancy induced hypertension (PIH) is a multi-system disorder and common complication occurring during pregnancy responsible for maternal and fetal mortality and morbidity. PIH also exerts its infl uence on the eye and visual pathways. Common ocular symptoms being blurring of vision, photopsias, scotomas, diplopia and in severe cases blindness. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent PIH and its complications. The review discusses the after effects of medical management of PIH on the retina. Key words: Hypertensive disorders of pregnancy, pre-eclampsia, eclampsia, retina, blood pressure, autoregulation

Context: Psoriasis is one of the common chronic and recurrent infl ammatory skin disorders. The infl ammatory exudates in psoriasis are responsible for various lipid abnormalities as well as trigger a pro-oxidant and antioxidant imbalance resulting in copious generation of oxygen metabolites and proteases which may induce oxidative and proteolytic damage to plasma constituents and circulating red blood cells (RBCs) Aims: The aim was to evaluate dyslipidemia and erythrocyte oxidative stress as markers in plaque psoriasis. Materials and Methods: The study was performed on 120 male subjects, out of which 60 were patients of a moderate form of plaque psoriasis and 60 healthy age-matched controls. We evaluated lipid profi le, RBC morphological indices such as total RBC count, hematocrit, hemoglobin concentration, hematimetric indices, osmotic fragility, and reticulocyte count. We also evaluated antioxidant defenses catalase, superoxide dismutase, glutathione peroxidase (GPX), and oxidant malondialdehyde (MDA) levels. Statistical Analysis Used: Independent sample t-test was used to compare the means between two groups. Results: Psoriasis patients showed a signifi cant rise (P < 0.001) in total cholesterol, low-density lipoproteins (LDL), very LDL and triglycerides. The morphological indices of RBC presented with signifi cantly reduced (P < 0.05) RBC count, Hb concentration and Hematocrit, signifi cant increase (P < 0.05) in reticulocyte index and osmotic fragility. The antioxidant enzyme GPX activity was signifi cantly lower while the oxidant MDA levels were signifi cantly higher in patients with psoriasis (P < 0.001). Conclusions: Evaluation of the changes in RBC morphology, lipid profi le, and antioxidant enzymes may be considered as biomarkers in predicting the severity of plaque psoriasis. Key words: Antioxidant enzymes, lipid peroxidation, lipid profi le, osmotic fragility, oxidative stress

Context: Dengue epidemic causes a wide spectrum of illness ranging from mild asymptomatic illness to severe fatal dengue. The cumulative dengue diseases burden has attained an unprecedented proportion in recent times with a sharp increase in the size of the human population at risk. Aims: Use of the WHO criteria (2012) for triage of dengue patients in an epidemic in a developing country with resource crunch of trained manpower and infrastructure. Settings and Design: The study was a retrospective and descriptive study carried out in a tertiary center in New Delhi, India during the dengue epidemic of 2013. Materials and Methods: Triage of dengue cases were done in an outpatient department setting as per latest WHO guidelines 2012 and only those cases with danger signs or severe dengue were admitted. A combination of serological studies involving nonstructural protein 1 antigen, IgM and IgG antibodies were used for diagnosis. Statistical Analysis Used: Statistical analysis was done by SPSS version 19 and P < 0.05 was considered signifi cant. Results: We studied the clinical, biochemical and serological profi le of the inpatients retrospectively. Active participation of parents has to be utilized to augment the monitoring of patients in a developing country with manpower and infrastructure resources crunch. Conclusion: In a developing country like India, with an ever exploding population, an epidemic of dengue causes a severe manpower and resources’ crunch. Use of the WHO criteria for triage of dengue patients in an epidemic can help in effective management of dengue cases in an epidemic situation. Key words: Acute respiratory distress syndrome, developing country, encephalitis, gangrene, resource crunch, severe dengue

Introduction: The Ebola virus disease (EVD) outbreak in West Africa in 2014 has affected >8 countries in the world and claimed >6000 lives so far. Health professionals are at increased risk of acquiring infection while attending to patients. Aims and Objectives: The present study aimed to determine the awareness about epidemiology of and role of personal protection measures from EVD among junior doctors of a tertiary hospital in Delhi, India. Materials and Methods: A self-administered questionnaire was used to collect information from the study participants. A total of 225 out of 370 junior doctors were included in the study. Results: All the study participants had heard about EVD, but only four-fi fth of them were aware of the correct route of transmission and source of infection of EVD. Only 40% of the study participants knew that reservoir of infection of EVD existed. >80% of the study participants felt the need for quarantine and restriction on travel to affected areas for control of the spread of EVD outbreak. Only 64% of the study participants knew that presently only supportive management exists for EVD and no approved vaccine is available. Almost 90% of the study participants emphasized on the role of personal protection in the prevention of the spread of EVD. Conclusion: The knowledge of junior doctors was sub-optimal and despite the stress on universal work precautions, not all felt the need to follow them for this disease which has such a high case fatality rate. Key words: Ebola, health care workers, outbreak, personal protection, West Africa

Context: Teenage pregnancy is dangerous for the mother, child and the community, and teenage girls are twice as likely to die of pregnancy and childbirth related complications as opposed to older women. Aims: (1) To know the outcomes of teenage pregnancies. (2) To study the sociodemographic profi le of teenage pregnancies. Study Design: A longitudinal study. Study Setting: Vantamuri Primary Health Centre-Rural fi eld practice area of Jawaharlal Nehru Medical College Belgaum. Materials and Methods: A total of 144 teenage pregnant women, aged between 15 and 19 years were selected and information on sociodemographic variables, and pregnancy outcome was recorded in 3 visits. Statistical Analysis: Percentages and Ratios, Chi-square test to fi nd an association between various study variables. Results: In the current study majority, 66.0% participants were of 18-19 years age, 90.3% adolescents were housewives and 53.5% had studied high school and beyond. The mean age of marriage was 16 years, and 79.2% of them were primigravidae. Traditional practice (68.8%) was the commonest reason for early marriage, and family pressure (46.5%) was the often cited reason for early pregnancy. Live births were noted in 93.1% teenagers, stillbirths and abortions were present in 4.8% and 2.1% teens respectively. Age and previous pregnancies affected the outcome. Conclusion: The mean age of participants was 17.8 years, and that of marriage was 16 years and this occurrence of pregnancy in teenage leads to adverse outcomes. Thus, periodic Information, Education and Communication activities have to be held, and child marriage act has to be strictly enforced to improve their health. Key words: Outcome, rural south India, teenage pregnancy

Introduction: Maternal health issues continue to be a forefront of national and global health policies. Janani Suraksha Yojana (JSY) was launched under the umbrella of National Rural Health Mission to increase the number of institutional deliveries and decrease the maternal and neonatal mortality. Objective: The aim was to assess the utilization of maternal health care services including JSY among the mothers of underfi ve children in a slum at Baghbazar, Kolkata. Materials and Methods: A descriptive, cross-sectional study was conducted at Baghbazar slum, which is under the Urban Training Centre of R.G. Kar Medical College, Kolkata from 1st to 28th February, 2014. A total of 72 mothers of under-fi ve children were interviewed using a predesigned, pretested and semi-structured schedule. Results: About 74% mothers were in the age group of 20-30 years and 56.8% mothers were from class IV socioeconomic status (Modifi ed Prasad scale, 2013). Illiterate mothers were 4.2%. Three-fourth of the mothers heard about JSY. Around 47% mothers got cash benefi t. Lack of eligibility document (42.1%) and ignorance (34.2%) were main causes of nonreceiving of the benefi t. About 76% mothers had antenatal registration within the fi rst trimester. About 99% were institutional deliveries. At least one postnatal check-up was received by 77% mothers. Only 33.3% mothers initiated breast feeding within 1 hr of delivery. Natural method (30.6%) and condom (30.6%) were main contraceptive methods accepted by them at the time of conducting study. Conclusion: Information, Education and Communication activities should be carried out to increase awareness regarding JSY utilization. Key words: Antenatal, cash benefi t, Janani Suraksha Yojana, slum

Introduction: Optimal infant and young child feeding (IYCF) practices are fundamental for the survival, health, growth, and development of children. It is important to study factors that determine these practices in a community. The present study is designed to assess the prevalence of optimal IYCF practices and its determinants in an urbanized village of Delhi. Materials and Methods: Mothers of children 0-23 months of age were interviewed using a structured and semi open-ended questionnaire to record information on IYCF practices. Results: A total of 194 children were included in the study. Breastfeeding (BF) was initiated within 1 h of birth in 49.5% of children. Early initiation of BF was signifi cantly higher in children born in government institutions, normal births and in families with higher income. Prelacteal feeds were given by 47.4% of mothers, children born at home and private institution and caesarean births received prelacteal feeds more often. Colostrum was given by 79.4% of the mothers. Children born in the government institution were more likely to receive colostrum (P < 0.05). The prevalence of exclusive BF (EBF) for 6 months or more was 56.5%. It was higher in children of fi rst birth order and institutional births (P < 0.05). Complementary feeding was started at 6 months in 54.6% of these children. Children of mothers with higher education and boys were more likely to be started on timely complementary feeding than girls. Conclusions: The IYCF practices in the area were not satisfactory, although better than the national average. Early initiation and EBF for 6 months were higher in children born in government institutions. Thus, awareness about IYCF practices has to be increased among the health personnel in the public and private sectors and mothers. Key words: Complementary feeding, exclusive breastfeeding, infant and young child feeding, initiation of breastfeeding

Context: Fluorosis is an important public health problem in few pockets of some states of India. Aim: The aim was to study the prevalence of fl uorosis, mapping the deformities, the type and severity of deformities and to assess the fl uoride concentration in prime drinking water sources in the Dimrapal village of Bastar region. Materials and Methods: A cross-sectional study of the Dimrapal village was done by door to door visit and on-site clinical examination of the study population was carried out. This was followed by collection of drinking water samples in selected paras for estimating fl uoride levels. Statistical Analysis Used: Analysis was done using prevalence rate, Chi-square test, mean and standard deviation. Results: Overall prevalence of fl uorosis cases was found to be 23.10%. The prevalence of dental fl uorosis was 12.6% that of skeletal fl uorosis was 28.8%, and the combined prevalence of dental and skeletal fl uorosis was 1.8%. Dental fl uorosis was found to be very common in children and teenagers. Skeletal fl uorosis was found to be more common in age group above 45 years, however, it was lower in the children’s (6-12) irrespective of the gender. The fl uoride level in surveyed ground water sources from various para ranged from 0.1 to 7.30 ppm. Key words: Dental fl uorosis, genu varum, genu vulgum, prevalence, skeletal fl uorosis

Background: Approximately 85% of all diabetes-related lower-extremity amputations are preceded by foot ulcers. Diabetic foot ulcers are at high risk of infection secondary to high glucose levels and poor tissue perfusion. Aims of the Study: To identify the microbial pathogens and the antimicrobial sensitivity pattern of the bacterial isolates involved in the different grades of diabetic foot ulcers. Materials and Methods: Pus samples from 104 diabetic foot ulcers were processed for aerobic, anaerobic, and fungal culture. Antimicrobial sensitivity was performed as per clinical and laboratory Standards Institute guidelines. Results: Aerobic (81.66%), anaerobic (14.79%), and fungal (3.55%) isolates were obtained on culture with Gram-negative bacilli (78.98%) being isolated more than the Gram-positive cocci (21.01%). Proteus mirabilis was the most common isolate (26.08%) while Bacteroides fragilis and Peptococcus sp. were the common anaerobes obtained. 56.73% of patients had polymicrobial infection, and 23.08% of staphylococci were methicillin resistant Staphylococcus aureus. In hospitalized patients and amputees, infections were often polymicrobial (74.32%) involving anaerobic and fungal pathogens. Multi-drug resistance was seen in 28.26% of isolates. Conclusion: Our study showed polymicrobial diabetic foot infections. The isolation pattern varied according to the grade of ulcer with S. aureus being predominant in Wagner I diabetic foot and Gram-negative organisms and anaerobes being isolated as the foot grade advanced to gangrene. Management of early stages includes treatment with oral quinolones/cloxacillin/cephalosporins. Imipenem monotherapy or third-generation cephalosporins with beta lactamase inhibitors plus an anti-anaerobe drug are regimens that can be used for the advanced stage of the disease. Key words: Amputation, anaerobes, Gram-negative bacilli, polymicrobial

The aim of the study is to determine the presence, type and nature of bacterial contamination on paper currency and coins in circulation. Total 96 paper currency and 48 coins of different denominations were randomly collected from butcher shop, vegetables seller, auto rickshaw and rickshaw man, chemist store, tuberculosis chest outpatient department (OPD) and general OPD from the different areas of Lucknow city in a sterile paper bags. A total of 249/92 bacteria, 49/24 fungal isolates and 1/0 parasite were obtained from the paper currency and coins respectively. Different bacterial species were isolated with the most common isolates being Bacillus species (60.41%, 47.91%) and followed by Escherichia coli (41.66%, 35.41%), Proteus species (39.58%, 42.0%), Klebsiella pneumoniae (35.41%, 12.5%), Coagulase-negative Staphylococcus (28.12%, 31.25%), Staphylococcus aureus (20.83%, 23.1%), Diphtheroids (17.70%, 0%), Enterococcus species (11.45%, 0%), Streptococcus pyogenes (11.45%, 0%), Salmonella species (2.08%, 0%), Shigella species (1.04%, 0%) and acid fast Bacilli (2.08%, 0%). Different fungus that is, Aspergillus species (27.08%, 37.5%), Candida albicans (13.54%, 12.5%), Cladosporium cladosporioides (9.37%, 0%) and Ascaris egg (1.04%, 0%) were found in paper currency and coins respectively. These results suggest that the currency is commonly contaminated with microbes, and this contamination may play a role in the transmission of antibiotic resistant or potentially harmful organism. This work seeks to confi rm microbial contamination of currency and also introduces the nature and levels of contamination of the Indian currency. The distribution of contamination was unexpectedly higher in unexpected locations, indicative of our wide ignorance and indifference toward contamination through this route. Key words: Contamination, currency, Indian

Cerebral hydatid disease is an uncommon presentation of echinococcosis representing 1-2% of all Echinococcus granulosus infestations. Most of the cases are seen in children. Primary multiple hydatid disease of the brain in adults is a rare entity. We report here a case of 35-year-old male with primary cerebral hydatid disease without extracranial lesions. Key words: Echinococcosis, intracranial, primary hydatid cyst

A few cases of mild to moderate, gradual and reversible sensorineural hearing loss (SNHL) with prolonged doses of nonsteroidal anti-infl ammatory drugs has been reported. We present a case of sudden irreversible SNHL in a 60-year-old female after taking a single dose of diclofenac. The patient was a known case of diabetes mellitus and hypertension and was on regular treatment. We postulate that the patient’s hearing loss was the result of diclofenac’s ototoxic effects which may have been potentiated as a result of her long standing diabetes, hypertension and old age. Accordingly, we recommend the cautious use of diclofenac in patients with underlying diseases where diclofenac induced ototoxicity could potentially result in adverse otologic consequences. Key words: Adverse drug reactions, diclofenac, nonsteroidal anti-infl ammatory drugs, sensorineural hearing loss