Vol 5, Issue 4, Oct-Dec, 2015

The millennium development goals (MDGs) adopted during the millennium summit in 2000 gave an opportunity to improve the health and overall development. The MDG framework had 8 goals, 21 targets, and 60 indicators. Of these, three are directly related to health and have other interrelated goals and targets that influence health. The year 1990 is baseline, and the targets are to be reached by 2015. India’s progress towards health related MDGs is lagging in some areas, and more attention is needed to states and districts where the indicators are poor. The proportion of underweight children <3 years is around 40%. The under-five and infant mortality rate is 49 and 40/1000 live births in 2013, respectively. The country lags behind the maternal mortality ratio target of 109/100,000 live births. Regarding HIV, malaria, and tuberculosis, trend reversal had been achieved while providing basic sanitation facilities remains a big challenge. Key words: Goal 6, health, India, maternal mortality ratio, millennium development goal, under-five mortality

Background: In rural India, only a few studies have been undertaken to investigate the prevalence of cardiovascular disease (CVD). Most of the studies carried out on the urban population. Objectives: To investigate the prevalence of CVD risk factors in a rural community in West Bengal, India. Materials and Methods: A total of 1007 (645 males and 362 females) participants aged 20 years and above took part in the present study. Various anthropometric measures were undertaken using standard techniques. Metabolic profiles were measured using an auto-analyzer. Blood pressure (BP) was recorded according to standard protocol. Insulin was also measured, and homeostasis model assessment of insulin resistance was calculated accordingly. Results: The anthropometric measures are almost equal in male and female except SF4 and percentage of body fat, which are more in the female. It is observed that 52.53% population have high BP, 45.58% have high triglyceride (TG), 23.14% have high fasting blood glucose (FBG), 11.22% have high total cholesterol (TC), and 11.62% have low high-density lipoprotein (HDL). High TC is found more in female, but high TG, high FBG, and high BP are more in male, and low HDL is found almost equal in male and female. The prevalence of three CVD risk factors clustering is also significant in male and female. Conclusion: The present study showed that prevalence of CVD risk factors is considerably high in the study population and warranted early intervention to check progressive increase of CVD risk factors in the rural folk. Key words: Asian Indians, cardiovascular disease, diabetes, metabolic syndrome, obesity

Context: Despite policies to make health care accessible to all, it is not universally accessible. Frequent evaluation of barriers to accessibility of health care services paves path for improvement. Hence, present study is undertaken to evaluate the factors and public health policies influencing health care access to rural people in Chittoor District, Andhra Pradesh, which can be interpolated for other regions. Aims: To assess knowledge, perceptions, availing of public health care services, barriers to health care access in Chittoor District, Andhra Pradesh. Settings and Design: Cross-sectional, hospital-based survey in the Government Maternity Hospital (GMH), Tirupati, a tertiary care center. Materials and Methods: Fifty women delivered normally in GMH through convenient sampling technique. Data collected on standardized pro forma as per IMS Institute of Healthcare Informatics. Statistical Analysis Used: Is done through MS Excel 2007, Epi Info 7 (of Centres for Disease Control and Prevention, Atlanta, USA) and frequencies were described. Results: Distance, waiting hours, societal responsibility, nature of the illness, presumed commercialization of Medicare system, attitudes of health care providers, and loss of wages were not barriers for accessing health care. Accredited Social Health Activist (ASHA) and availability of ambulance services made great improvements in health care accessibility. Absenteeism of health care providers is a problem. Conclusions: Expanding the ambulance services and ASHA network will be an effective measure for further accessibility to health care. Absenteeism of health care providers needs correction. Key words: Accredited Social Health Activist, ambulance, barriers, health care accessibility

Background: Chronic dacryocystitis is an inflammation of the lacrimal sac which usually occurs because of the obstruction of the nasolacrimal duct. Objective: The primary objective of the study was to know its clinico-bacteriological profile. Materials and Methods: This prospective observational study was carried out over a period of one year to know the current bacterial flora involved in chronic dacryocystitis. All specimens were processed for isolation and identification of bacterial pathogens according to the standard microbiological techniques. The antibiotic susceptibility pattern was done by Kirby-Bauer disc diffusion method according to the Clinical Laboratory Standards Institute guidelines. Results: Among total 100 cases of chronic dacryocystitis, the highest percentage of infections in relation to age was noted in the age group of 50-60 years and the prevalence rate was higher in female patients compared with male. Out of total chronic dacryocystitis cases, 72% cases were found to be culture positive. Among positive culture, gram positive organisms were higher than that of Gram-negative. Staphylococcus epidermidis was the most frequently isolated and Streptococcus pyogenes was least isolated. The highest percentage of positive samples was found in the mucopurulent discharge followed by extensive purulent and clear fluid, respectively. In Grampositive isolates, chloramphenicol was the most sensitive followed by cefazolin, ciprofloxacin, ofloxacin, cephalexin, vancomycin, gentamycin, and tobramycin, respectively, whereas in Gram-negative isolate, chloramphenicol and nalidixic acid were equally effective followed by ofloxacin, gentamycin, cephalexin, cefazolin and ciprofloxacin, respectively. Conclusion: S. epidermidis was the most frequently isolated bacteria, and chloramphenicol was the most susceptible drug in Gram-positive and Gram-negative bacteria. Key words: Chronic dacryocystitis, clinico-bacteriological profile, lacrimal regurgitate

Introduction: Quality of life (QOL) of elderly often deteriorates due to many factors. This study was planned to find out the different domains of QOL of elderly people affected by socio-demographic factors. Materials and Methods: This was a community-based cross-sectional study conducted in Kolkata and Sonarpur area of West Bengal, India from January to December, 2013. The qQOL questionnaire developed by World Health Organization was used (BREF). The scores of QOL were assessed in the light of different socio-demographic characteristics. Results and Analysis: The QOL was significantly lower among people having more age, female, illiterate, financially fully dependent and those having lower socio-economic status. Conclusion: QOL is an important determinant of the living status of elderly and socio-demographic factors determine the QOL in this age group. Key words: Elderly, socio-demographic factors, quality of life

Introduction: Substance use has been a menace throughout the world for several centuries, and adolescents seem to be the most vulnerable group and the miasma of the slums adds to this multi-dimensional problem. Objectives: To study the prevalence and pattern of substance use among adolescents living in slum of Guwahati. Materials and Methods: A cross-sectional study was conducted among the adolescents living in slums of Guwahati, Assam, India during February to May 2014. Out of the total 90 slums, 23 slums were selected by cluster sampling method. For the selection of desired clusters probability proportionate to size method was applied. From each slum, equal number of boys and girls were interviewed to get a total of 414 study subjects. Statistical Analysis: Proportions and mean were used. Results: Prevalence of ever users was 37.68% and 35.02% were current users. Prevalence of substance abuse and dependence were 8.33% and 5.13% respectively. Gutkha (83.4%) was the most common substance used. The proportion of the substance users was found to increase significantly with age in both the sexes. The mean age of initiation of the abusive substances was 12.08 (±2.009) years for males and 12.38 (±1.803) years for females. The most common reason for initiation was peer pressure (73.1%). Shops were the main source of procuring substances. Conclusion: As significant number of adolescents is resorting to substance use, especially under the influence of peers, intensive peer group counseling is advocated. Strict implementation of legislations is emphasized, so that these young generation have no access to these dangerous substances. Key words: Adolescents, prevalence, slums, substance use

Introduction: Nutrition status prior to pregnancy is of vital importance. Inadequate iron stores bef ore conception is a major cause of iron deficiency.The primary objective of this research was to estimate the prevalence of anaemia and the secondary objective was to assess various epidemiological factors associated with anaemia. Methods: A community based, cross – sectional study was carried among 207 unmarried adolescent girls between 10 to 19 years, residing in urban field practice area of tertiary care hospital in Mumbai for one year. All study participants social demographic profile, diet history was collected. Findings of clinical examination, height and weight was recorded. Blood and stools samples were collected after obtaining verbal consent from their parents. Univariate and binary logistic regression analysis was done using SPSS 11.5 version. Results: The overall prevalence of anaemia was 78.3%. Prevalence of mild, moderate and severe anaemia was 64.2%, 36.2% and 0.6% respectively. Study participants with BMI <18.5 Kg/M2 had significantly higher prevalence of anaemia. 88.9% had no knowledge regarding anaemia. In logistic regression analysis body mass index, per capita income and intestinal parasites in stool were the variables independently associated with anaemia. Conclusions: The high prevalence of anaemia among adolescent girls indicates need for additional nutritional support, iron folic acid supplementation including prevention and control of worm infestation in urban communities. It would be desirable that action for improvement is initiated right at the adolescent stage, thereby ensuring adequate body stores of iron even before they marry and become pregnant. Key words: Epidemiological determinant, India, iron deficiency

Background: Diabetes and diabetic complications are becoming major “health problems” in India. Diabetes affects all tissues, causing neuropathy, vasculopathy, myopathy, etc. Retina is both vascular and sensory neural tissue, and perhaps the damage is also two-fold. Aims and Objectives: To study incidence of diabetic retinopathy (DR) in a cohort of diabetic patients with nerve conduction velocity (NCV) proven neuropathy. Materials and Methods: a total of 50 diabetic patients aged more than 30 years, with NCV — proven diabetic neuropathy were selected for the study from a Tertiary Care Hospital in semi-rural Maharashtra. Fundoscopy after midriasis and fluorescein angiography, where indicated were performed in all patients. Data were tabulated and analyzed by multivariate analysis and then subjected to regression analysis and anova. Results: Of cohort of 50, 38 patients had retinopathy (76%), mean age of patients with retinopathy was 55.3, a male preponderance was seen 72.7%. Conclusions: higher incidence of retinopathy was seen in diabetic patients with neuropathy more so in patients with sensory neuropathy. Thus making us reflect on the possibility: of DR also being a neuropathy, to begin with and whether neuroprotective agents will have a role in preventing and postponing DR. Key words: Fluorescein angiography, nerve conduction velocity, retinopathy

Background: The complaint of insomnia is one of the most common symptoms a physician encounters in his/her day-to-day practice. Though rarely present as the stand-alone problem, it accompanies other organic or psychological symptoms. Its incidence is on the rise in ever increasing stressful life of present times. Objectives: The objective was to study the prevalence and some sociodemographic factors associated with insomnia among the urban population of Kamarhati municipal area of district 24 Parganas (N) of the state West Bengal. Materials and Methods: The study was carried out at “Kamarhati” municipal area. Ten percent of householders of two randomly selected wards were surveyed. Self-reported sleep questionnaire insomnia symptoms questionnaire (ISQ) was administered to all adult members. Persons with a history of major psychiatric illness, regular shift work, daily alcohol consumption more than four units and on chemotherapy or radiotherapy were excluded from the survey. Results: ISQ identified 15.4% prevalence of insomnia. It was high in persons with co-morbid chronic physical illness (28.1%) compared to persons free from that (10.9%) (P < 0.001). Insomnia was significantly higher among people living in joint families than those living in a nuclear family. The prevalence of insomnia increases significantly with the increasing age (P < 0.05). Conclusion: Findings of this study showed that the prevalence of insomnia in urban India is high. Increased life expectancy, increased burden of chronic illnesses, changing lifestyle, uncertainty of urban life contributes to high prevalence of insomnia that in turn affects quality of life. Key words: Insomnia, insomnia symptom questionnaire, prevalence

Objectives: To assess treatment compliance of self-reported dog bite cases and to assess associated demographic and exposure factors. Materials and Methods: The present prospective study was conducted during January 2013 to July 2013 among 260 dog bite cases by purposive sampling at the outpatient department of a tertiary hospital. After obtaining verbal informed consent, a predesigned questionnaire was used. The assessment of treatment compliance of postexposure prophylaxis (PEP) regimen was considered on the basis of intramuscular anti-rabies vaccine (ARV) regimen by classifying completed PEP and defaulted PEP. At the end of PEP regimen of every participant, we obtained information about received ARV doses using telephone survey method. Data were analyzed using statistical software Epi info Version 7. Results: Of 260 dog bite cases, 76.5% cases were completed PEP. The majority, 22.3% cases from age group ≤10 years, 56.2% males, 48.1% from urban area, 25% had primary school education, 32.7% students, 53.8% had bite mark on lower limb, 58.5% were category III exposure, and 70.8% who had received previously immunization against rabies, were completed PEP. The bite due to 54.6% pet dog, 58.1% observable dog, 40% provoked bite, 71.9% cases who had not known about the rabid status of the dog, were completed PEP. The unconditional logistic regression analysis found that demographic and exposure factors were not independently associated with treatment compliance (P > 0.05) except literacy status (P < 0.05). The present study showed maximum completed PEP cases, however, it showed the demographic and exposure factors of dog bite cases were not independently associated with treatment compliance except literacy status. Key words: Completed postexposure prophylaxis, defaulted postexposure prophylaxis, dog bite cases, outpatient department, treatment compliance

Background: Anemia is a medical condition in which the red blood cells (RBCs) count and hemoglobin (Hb) are less than the normal range. The main causes of anemia are a decrease in RBCs, their destruction and decrease of Hb synthesis. A useful method for diagnosis and classification of anemias is based on the morphological appearance of RBCs on an ideal stained blood smear. The main terms used in such classification are normocytic normochromic, microcytic hypochromic and macrocytic anemia. Aim: The aim of this study is to determine the most common morphological pattern of anemia in Saudi anemic patients who were admitted at King Abdul-aziz Medical City-Riyadh. Materials and Methods: Retrospectively we evaluated the results of complete blood count (CBC) and peripheral blood picture (PBP) of all anemic patients attending during the year 2013 (from 1st January to 31st December). Results: Participants in this study included 150 patients (13 infants, 27 children, 12 youths, 52 adults and 46 old). The gender distribution showed 70 males and 80 females. The results of CBC and PBP showed that 113 (75.3%), 36 (24%) and 1 (0.7%) of the patients had normocytic normochromic, microcytic hypochromic and macrocytic pattern of anemia respectively. Conclusion: The normocytic normochromic pattern of anemia is highly frequent among this sample of Saudi patients while the macrocytic pattern of anemia is the lowest. According to gender groups microcytic hypochromic pattern of anemia is more common among females; malnutrition, increase of blood loss due to pregnancy or menstruation, and lack of iron absorption are the main causes, while the normocytic normochromic is highly frequent among males, which are mainly due to blood loss or chronic diseases. Key words: Anemia, hypochromic, macrocytic, microcytic, morphological patterns, normochromic, normocytic

Introduction: Mobile technology is changing the way we live, and it is beginning to change the way we learn. Current literature reviews have shown that research on mobile technology in medical education primarily focused on efficacy, of mobile devices as an educational tool and resource, infrastructure to support m-learning, benefits, challenges, and appropriate use. Objectives: To assess the perception of medical student for the utility of mobile technology in their learning experience and to find out different barriers in the application of mobile phone in medical education. Materials and Methods: The study was designed as a descriptive study to assess emerging patterns of mobile technology use by medical students across the academic year 2013–2014. Interview and focus group discussion was a method of data collection. Results: Mean age ± standard deviation of the current mobile was 3.45 ± 1.45 years. Mobile users were 302 (96.79%) and Smartphone users were 261 (83.61%). In the present study, 176 (56.41%) used for the academic purpose and 65 (20.83%) of the students preferred the same for an entertainment purpose. Gender-wise significant difference was observed in regards to Smartphone availability and daily Internet use for education purpose by female was more than male. Conclusion: The lessons learned from this study are-majority of the students use Smartphone mainly for communication, learning, and entertainment purpose. With increasing use of portable devices by students, it is logical to expect the next step to incorporate these devices in the learning environment and should, therefore, be appropriately considered for curriculum. Key words: Learning, medical students, mobile technology, perception

Background: Fungi have emerged as major causes of human diseases. Intensive Care Units (ICU), harbor almost all the risk factors for opportunistic fungal infections. Among these, Candida infections are very common with recent trends being rise in the non-Candida albicans (NCA) species along with an increase in resistance of these species to antifungal drugs. Aims: To characterize the Candida species from the clinical specimens of patients admitted in the ICU of Tertiary Care Centre in North-East India and to perform their antifungal susceptibility. Settings and Design: This retrospective study was conducted in the Department of Microbiology from January 2011 to December 2011. Materials and Methods: The following techniques were employed to characterize the isolates in the study – KOH mount, Gram’s stain, India ink preparation, culture on Sabouraud’s Dextrose Agar, Germ Tube test, Urea hydrolysis, morphology in Cornmeal Agar and chromogenic agar media, sugar fermentation and sugar assimilation tests and automated identification system, and the results were interpreted using standard protocols. Statistical Analysis Used: SPSS version 17.0 was used for all statistical computations and P < 0.05 was taken as significant. Results: Out of 85 Candida isolates, Candida tropicalis (38%) was the most common, in all age groups. Infections were more common in patients above 40 years and males were affected more than females. NCA species were more resistant to fluconazole than C. albicans. Conclusions: The study highlights the change in epidemiology in the species distribution of Candida and a rise in infections by NCA species as compared to those by C. albicans. Knowledge of the local species distribution of Candida along with their antifungal susceptibility is essential to initiate and optimize therapy and outcome, especially in an ICU setup, which harbors patients susceptible to fungal infections. Key words: Antifungal susceptibility, Candida species, Intensive Care Unit, non- Candida albicans species, North-East India

Background: Surveillance is the back bone of any disease control program. Communicable disease is a major cause of morbidity. Precise data on the pattern of communicable disease will enable us to identify the epidemic early so that timely response will be possible. Aims: (1) To find out the morbidity and mortality pattern of communicable diseases. (2) To study the disease trend and seasonality of acute respiratory infections (ARIs) and acute diarrheal diseases (ADD). Materials and Methods: Retrospective record-based descriptive study was done to find out the morbidity and mortality pattern of communicable disease and trend of seasonality. Five years surveillance data from 2009 to 2013 were collected and analyzed. Results: Maximum morbidity (47.6%) was observed in air borne diseases. ARI accounted for 53%, and pulmonary tuberculosis 27% of morbidity among air borne diseases. Admissions from water borne diseases were mainly done for ADD (47%), followed by hepatitis (34%). 90% of the morbidity from vector borne disease was due to dengue fever. ADD showed a rise during the summer season, and ARI showed peak during the rainy season. The difference in incidence observed between seasons for ADD and ARI were statistically significant (P = 0.001). Leptospirosis and chickenpox were present throughout the years. Increase in mortality from all communicable diseases was observed from the year 2011 onwards. 48% of mortality was due to air borne diseases such as pulmonary tuberculosis, pneumonia, and chickenpox. Conclusion: Maximum morbidity and mortality were due to airborne diseases. Incidence of ADD was more during the summer while ARI was more during the rainy season. Key words: Air borne diseases, communicable diseases, seasonal trend, surveillance, vector borne diseases, water borne diseases

Context: About 10,000 babies with β-thalassemia major are born every year in India, posing a major healthcare burden on the country. In clinically symptomatic individuals, monthly blood transfusions, chelation therapy and splenectomy are the mainstay of therapy at present. Aims: To objectively assess the impact of splenectomy on quality of life (QOL) of children with β-thalassemia presenting with symptomatic hypersplenism. Settings and Design: This is a prospective study of thalassemic children referred to pediatric surgical unit of a tertiary care hospital located in Maharashtra, India between January 2010 and December 2012. Materials and Methods: Of 360 cases registered at the thalassemia unit of the center during above defined period, 50 cases (35 males and 15 females) between 5 and 16 years underwent splenectomy. QOL was assessed objectively by means of the composite QOL index calculated by summing-up the responses to a 10-item, 4-point disease specific response scale devised, especially for purpose of the present study; preoperatively and 2 years postoperatively and comparison between the two was carried out. This is the first ever study of this kind. Statistical Analysis Used: Chi-square test was used for statistical analysis in the present study. Results: The mean preoperative QOL index of 13.5 rose to 31.3 (over a scale of 40) 2 years following splenectomy. The “P value” calculated by comparison between the preoperative and postoperative composite QOL index is >0.001 that is, statistically significant. Conclusions: Splenectomy has a definite role in the management of children with β-thalassemia, presenting with hypersplenism. Objective assessment of QOL indicates mean elevation of QOL index by 17.8, thus emphasizing significant impact of splenectomy on the overall QOL of these children. Key words: Child, Composite Quality of Life (QOL) Index, Packed Red Blood Cell (PRBC) Transfusion Requirement, Splenectomy, b-Thalassemia

Introduction: Dengue and Japanese encephalitis (JE) are flaviviruses causing significant morbidity and mortality worldwide. Previous studies had found an association between dengue infection and particular blood group antigen and also the susceptibility to aplastic anemia by dengue. Aims and Objective: The present study was conducted to find any association between dengue and JE immunoglobulin G (IgG) antibody with blood group antigen or anemia. Methodology: The study was conducted in 2 slums of Delhi in 2013 in the interepidemic period. 5 mL blood from 239 samples were taken and processed for IgG levels of dengue and JE and rest used to test hemoglobin and blood group. Results and Discussion: No association has been found between blood group types and dengue IgG antibody positivity (P = 0.42) or JE IgG antibody positivity (P = 0.148). Nor did anemia established any association with dengue (P = 0.185) or JE IgG antibody (P = 0.277). IgG status of dengue and JE could be used as proxy markers of any past subclinical infection (includes clinically manifested cases also). Further studies in large settings and other areas could be done to validate the results. This was the first study of its kind in such settings. Key words: Anemia, dengue, ELISA, Japanese encephalitis

Objective: To explore the feasibility of case-based payment (zero medical expense) for pulmonary tuberculosis (PTB) outpatients through the new rural cooperative medical system (NRCMS) in Hunan province. Materials and Methods: Cross-section and qualitative study were applied. All 131 counties of Hunan province were investigated to identify the current situation of medical security in tuberculosis (TB) patients by questionnaire and telephone interview. Thirty-six staff of nine pilot counties, which already implemented case-based payment were interviewed on their opinions of case-based payment, interviewees were from health bureau, NRCMS sectors and centers for disease control and prevention (CDC) of each county. Results: Outpatient PTB treatment for rural patients was covered by NRCMS in 118 of all 131 counties. Reimbursement models consist of proportional reimbursement, fixed amount reimbursement, and case-based payment. However, the proportion of proportional reimbursement has a range of 30-80%, the payment of amount reimbursement varies from 200 to 1500 RMB Yuan/case. Patients covered by proportional reimbursement and fixed amount reimbursement need to pay the medical expense of 588 Yuan/case and 463 Yuan/case respectively, comparing zero expenditure for patients of case-based payment. NRCMS need input about 17.8 million Yuan more per year to reimburse all rural PTB outpatients’ medical expenses, which only accounted for 0.12% of total NRCMS fund. In those counties, which already implemented case-based payment policy, the number of patients visited CDCs has increased dramatically, follow-up and treatment compliance improved obviously as well. Conclusion: Zero outpatient medical burden for rural TB patients is feasible and realizable through case-based payment under China’s NRCMS. Key words: Case-based payment, feasibility, outpatient, tuberculosis, zero burden

Context: Hospitals are prone to fire. Hospital fire management is also tricky as sick patients are not aware about the surroundings, and also they cannot move of their own. Thus, hospital staff is primarily responsible for taking appropriate and timely measures in case of the hospital fire. However, hospital staff lack knowledge and skills about fire safety. In addition, it is extremely difficult to organize fire drills in a hospital setting for skill improvement. Aims: To conduct fire drills using “digital fire” for skill building and compare it with the usual training method of using information booklets. Settings and Design: Interventional study using before and after study design using alternate interventions in hospital setting. Materials and Methods: Hospital staff (staff nurses, security personnel and hospital attendants) was divided into two groups of 119 persons in each group. Group I was administered information booklets and group II was given lecture demonstration and digital fire drill. Pretest and posttest knowledge and skill assessment was done in both the groups. Statistical Analysis Used: Mean score comparison, pre- and post-intervention, in the two intervention groups, using t-test. Results: Increase in the knowledge scores was significant and similar with both the interventions. However, increase in skill score was more with intervention II. Conclusions: Whereas, information booklets should be distributed and made available to all, it should be mandatory to have skill building demonstration sessions periodically in the hospitals. Digital fire can be used conveniently and effectively. Key words: Digital fire, fire safety, hospital, knowledge, skills, training method

Context: Coronary artery disease (CAD) is the leading cause of death. Early detection of myocardial ischemia can decrease morbidity and mortality due to CAD. Ischemia modified albumin (IMA) is a newer biomarker for early detection of myocardial ischemia in patients of acute coronary syndrome (ACS) as compared to cardiac troponin T (cTnT). Aims: The aim of this study was to test the utility of “IMA,” a new biomarker of myocardial ischemia, in the early diagnosis of ACS. Settings and Design: The cross-sectional study group consisted of 101 patients between the age group of 27 and 85 years having ACS and 100 control from a healthy population. Materials and Methods: Blood was collected from all the enrolled patients immediately after admission, and samples were analyzed for cTnT on the fully automated analyzer and IMA on a spectrophotometer. Statistical Analysis Used: Statistical analysis was carried out by calculation of the area under a curve using receiver operating characteristics (ROC) curve analysis for the IMA test in the 101 patients included in the study population. Results: ROC curve area for IMA was 0.89 (95% confidence interval 0.81-0.94). At the cut-off 95 U/ml, sensitivity, and specificity were 85% and 82% and positive predictive value and negative predictive value (NPV) were 88% and 78%, respectively. Conclusions: IMA is a useful ischemic marker for diagnosis of myocardial ischemia due to high sensitivity, and it also facilitates to rule out myocardial ischemia due to high NPV. Key words: Cardiac troponin T, coronary artery disease, myocardial ischemia

Introduction: Quality and safety of prescribing in older people remains a global healthcare concern. Inappropriate prescribing in the elderly population is now considered a major public health issue because of its direct association to morbidity, mortality and wastage of health resources. The study was initiated to study the prevalence of potentially inappropriate medications (PIMs) in elderly patients coming to seek health care in a tertiary care teaching hospital in Odisha. Materials and Methods: 2012 AGS Beers Criteria was used to analyse the inappropriateness of the prescriptions in 700 new as well as old patients of either sex who had completed 65 years of age as on 30th September 2013. Data obtained was analyzed with the help of SPSS version 20.0. Multivariate logistic regression was applied to find out the predictors of PIM. Results: 21.86% patients were prescribed at least one potentially inappropriate medication. Most of the drug use was seen in the age group of 65-74 years. Multivariate logistic regression analysis showed that increased number of concurrent medications use (OR: 1.95, CI: 1.19 – 3.01, P = <0.01) was the predictor of inappropriate medication use as per 2012 AGS Beers Criteria. Age, gender and co-morbidity did not influence the use of inappropriate drugs. Conclusion: Inappropriate prescribing to elderly patients is influenced by the total number of drugs prescribed to an elderly patient. There is a need to improve the prescribing pattern in elderly. This will reduce the occurrence of adverse drug reactions, cost of treatment, and increase compliance in elderly patients. Key words: Beers criteria (2012), elderly, potentially inappropriate medication

Introduction: Hemoglobinopathies are the most common hereditary disorders in India and pose a major health problem. A pilot study is carried out to find the prevalence of hemoglobinopathies in the Sindhi community of Jamnagar, district of Gujarat, India. Materials and Methods: The present cross-sectional study was undertaken among 109, apparently healthy Sindhi individual from community in Jamnagar, district of Gujarat, India from January to February 2015. All the samples were tested in automated hematology cell counter and cellulose acetate electrophoresis at alkaline pH. Hemoglobin and various red blood cell indices were derived on all samples. HbA2 level of ≥3.8% was taken as confirmatory of Beta-thalassemia trait (BTT). Result: Of 109 samples, BTT and sickle cell trait (SCT) were more common in 12–21 years of male and female, respectively. The overall prevalence of hemoglobinopathy was 21/109 (19.26%), comprised of 17 (15.59%) cases of BTT and 4 (3.66%) cases of SCT. Conclusion: Sindhi community has a high prevalence of hemoglobinopathy mainly BTT. Mass awareness and community screening of individual and proper counseling should be done to reduce the burden of disease. Key words: Automated hematology cell counter, beta-thalassemia trait, cellulose acetate electrophoresis, sickle cell trait

Introduction: Treating tibial metaphyseal fractures is still great challenge. However, two of most used techniques are locked intramedullary nail and minimally-invasive bridge plate. Minimally invasive plate osteosynthesis (MIPO) offers biological advantages. Reduced soft tissue dissection and exposition results in low surgical trauma and preservation of blood supply. Aim of study was to evaluate results of MIPO in treatment of metaphyseal fractures of tibia and to compare efficacy in treating metaphyseal fractures of tibia with other similar studies. Materials and Methods: This study was performed with 30 metaphyseal fractures of tibia with MIPO in hospitals attached to BMCRI. All cases were fresh fractures and traumatic. There were 12 proximal tibial and 18 distal tibial fractures. Temporary joint spanning external fixation was used for severe soft tissue injuries in 6 patients. All the fractures were stabilized by minimally invasive plating. Cases were followed up for an average of 14.1 months. Results: All fractures united. Proximal and disal tibia fractures united after an average of 6.3 and 6.6 months respectively. In proximal and distal tibia fractures, average range of motion achieved was 81.75° and 48.8° respectively. One patient with distal tibia fracture had a malunion with valgus alignment of more than 5°. Conclusion: Minimally invasive percutaneous plating facilitates in early mobilization of the patient which helps in healing of the fracture and prevents joint stiffness. It promotes early union as it does not disturb anatomy and physiology of vascularity at fracture site. There is minimal risk of infection and minimal blood loss. Key words: Distal tibia, infection, locking plate, minimally invasive plate osteosynthesis, plateau fracture, soft tissue

Introduction: To study usefulness of total creatine kinase (CK) as a screening tool in various neurological and psychiatric disorders in emergency setting of a tertiary care hospital. Materials and Methods: A 1-year retrospective study was conducted on 102 patients with complaints pertaining to neurological and psychiatric disorders in a tertiary neurosciences centre in a metropolitan city. Blood samples in plain vial were received in Emergency Laboratory and total CK levels were measured by automated analyzer and its correlation with various diseases was analyzed. Results: It was observed that CK activity was raised in various psychiatric conditions-acute transient psychotic disorder, alcohol dependence syndrome, delirium, psychosis, mental retardation, catatonia, bipolar affective disorder (BAD), depression and mania and also in neurological disorders-seizures, meningitis, myasthenia gravis (multiple sclerosis), Guillain-Barre syndrome, extra pyramidal syndrome, neuroleptic malignant syndrome and infarct. Conclusion: This study demonstrated that CK is a sensitive and an important screening parameter in diagnosis and monitoring of various neurological and psychiatric disorders in emergency setting. It is also helpful in identifying people at high risk for various neuro-psychiatric diseases. Key words: Creatine kinase, emergency laboratory, neuropsychiatric disorders, screening

Background: Admission of dengue fever/dengue hemorrhagic fever cases was on the rise during the monsoon period of 2013 in NRI Hospital and surrounding Districts of Coastal Andhra Pradesh. A number of deaths due to dengue fever were reported in the previous months. Hence, a clinical study of the dengue cases was done in the late monsoon for a period of 3 months since a large number of cases with bleeding manifestations were referred to our Hospital for platelets transfusion from the local hospitals and nursing homes. Aim: A Clinical study of dengue fever cases in the extended monsoon period and to evaluate the need for platelet transfusion in dengue fever cases. Retrospective Observational Study — Results: In the retrospective observational study, the diagnostic serotyping was done using rapid standard diagnostic kits. Eighty-four dengue seropositive were seen of which dengue fever cases were 55, dengue hemorrhagic fever were 27 and dengue shock syndrome were 2 cases only. Totally, 26 cases with dengue hemorrhagic fever whose platelet counts were below 50,000 cells/cu mm, were given random pooled donor platelet concentrates, while two cases of dengue shock syndrome were given single donor platelet concentrates, fresh frozen plasma and whole blood transfusion. Timely platelets transfusions in cases of dengue hemorrhagic fever and dengue shock syndrome helped to prevent severe hemorrhagic complications, and there were no deaths. Key words: Clinical study, dengue hemorrhagic fever, monsoon period, platelet transfusions

Introduction: Public healthcare system in India suffers from poor performance mainly due tothe severe shortage and high absenteeism of healthcare providers. The performance is further affected due to low productivity and competencies of the already existing healthcare providers. While management training (with a special focus on human resource issues) to address the shortage to healthcare providers has gained some importance in recent past, there has been a very limited focus on how to use the exiting workforce effectively. With this backdrop, training health providers in issues pertaining to team effectiveness becomes very crucial. The case study discusses some of the dimensions of team building, as well as processes involved in performance improvement including problem identification, prioritization, and problem-solving process as demonstrated by health system improvement teams (HSIT’s). Materials and Methods: HSIT’s have been constituted and are functional at 238 secondary level facilities in Rajasthani. The case writer interacted with five HSIT’s from two districts in Rajasthan. We were able to speak to about four to five members from each team for all the five facilities. The information for the case was gathered in two ways. The first was use of an instrument on team building that was given to each member of the team to gauge their individual perception about various team building aspects. The second was with the help of group discussions that were done with all the team members for each all the five teams. All those who were present and willing to be part of the discussion were given instruments and were included in group discussions. As this was an exploratory case study, the sample size was small and, therefore, the findings from group discussion and instruments have been presented together without any quantification of the data. Results: The findings of the case study indicate moderate team empowerment. While HSIT’s were clear about their respective roles and tasks, they could not establish a link between their own goals and team goals. Limited autonomy is available with very less autonomy to implement solutions that involve money or recruiting people. Most of the team members reported, high support received from senior teams for solving the problems. As far as the team performance improvement processes are concerned, teams reported good collaboration in form of improved and effective communication, and joint problem solving. Most of the team members reported that the decisions are taken based on the consensus of the whole group. Such teams rely on their intuitive power than any management tools for identifying and prioritizing problems. Conclusion: It can be said that performance improvement through HSIT’s is really a unique and innovative concept. There are some positive team building indicators reflected by HSIT’s that have resulted in better work reflected through regular and productive meetings; people having a chance to raise concerns in the meetings; improved communication channels and improvement in infrastructure. However, there are some weaknesses within the processes, as well as some team related aspects. More research a.

Leprosy is a nonfatal, chronic inflammatory disease caused by Mycobacterium leprae, whose clinical manifestations are largely confined to the skin, peripheral nervous system, upper respiratory tract, eyes, and testes. However, here we are reporting a case of leprosy in a 45-year-old male, who presented with bilateral inguinal lymphadenopathy. Left inguinal lymph node was excised surgically and was transported in 10% formalin. Sections were stained with Hematoxylin and Eosin and with modified Ziehl–Neelsen (ZN) technique and were examined under light microscope. Microscopic examination revealed aggregates of foamy histiocytes surrounded by plasma cell infiltrate. Modified ZN stain was performed which showed foamy histiocytes packed with acid-fast lepra bacilli. This report highlights the importance of systemic involvement in leprosy, especially the unusual presentation with lymphadenopathy. Hence, clinicians practicing in endemic areas should bear this fact in mind. Key words: Leprosy, lymphadenopathy, mycobacterium leprae

Nocardiosis is an infrequent infection that is often misdiagnosed or under-diagnosed because of its nonspecific clinical picture and infrequent occurrence. Speciation of nocardiae is of clinical importance because of the differences in antibiotic susceptibility patterns and virulence among the species. High level of clinical suspicion and alertness on the part of the laboratory are often required to diagnose these infections. Cases have been reported from other parts of the country, but these are the first series of documented cases from Central Kerala. Key words: Nocardia, Nocardiosis, Central Kerala

Mucormycosis or zygomycosis is a well described but a complex disease which appears unseemingly benign but is fatally malignant in its behaviour. Mucormycosis causes severe tissue destruction by endothelial invasion. Our pateint was 65 year old lady with palatal mucormycosis with uncotrolled diabetes who was treated successfully with systemic amphotericin B and surgical debridement which is the main stay of treatment of mucormycosis. Systemic amphotericin B has a lots of side effects like fever, shivering, hypotension, hypoxia, arrhythmia and mainly nephrotoxicity. Our aim is to highlight the need for early diagnosis and surgical debridement of necrotic tissues while keeping in mind the toxic effects of systemic amphotericin B and its interaction with anaesthetic agents. Key words: Mucormycosis, nephrotoxicity, systemic amphotericin B

We report a case of a 47 year old male who presented with panuveitis and disc oedema two weeks after an episode of dengue fever. He had complaints of headache with pain and defective vision in his right eye that had developed during his recovery from dengue fever. We treated him with topical steroid drops and subtenon steroid injections along with atropine eye drops. Oral prednisolone was started after 1 week on his review visit following which his symptoms resolved and vision improved. This case is being presented as panuveitis with disc oedema is a rare complication of dengue fever and also because the patient responded well to medical management with restoration of his vision. Key words: Dengue fever, disc edema, macular edema, panuveitis, steroid

Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) remain as an important cause of global burden of disease.[1] The prevalence of HIV infection that is, people living with HIV/ADIS (PLH/PLA/ PLHA) are globally increasing. According to the recent estimate, about 35 million people were living with HIV throughout the globe.[2] Although the prevalence is increasing, it is certainly evident that the number of new HIV infections were significantly declined.In the recent past, the increase of HIV prevalence is mainly attributed to the prevention of AIDS-related deaths by an effective anti-retroviral therapy (ART), which increases the lifespan of PLHA by immune restoration or preservation. Reportedly about 7.6 million cases of AIDS-related deaths were averted by ART between 1995 and 2013.[2] Furthermore, occurrence of persistent new HIV infections add up to the existing cases increases the PLH throughout the globe.