Vol 8, Issue 3, Jul-Sep, 2018

Old age and palliative care go hand-in-hand. World Health Organization and Worldwide Palliative Care Alliance estimate suggest that among adults in need of palliative care, 66% to 69% are elderly over 60 years of age.1 Among conditions requiring palliative care1 Alzheimer’s, Parkinson’s, chronic respiratory diseases, cardiovascular diseases, diabetes, rheumatoid arthritis and cancer are common amongst the elderly. Old age related weakness in absence of any other medically diagnosed condition though not listed anywhere in the literature available as requiring palliative care will constitute a major proportion of the need of palliative care services in India. In a study done in urban areas of Puducherry to estimate the need of palliative care in the general population, it was found that 9 out of 22 people (44%) in need of palliative care were suffering from only old age related weakness.2 The assessment was based on three questions. First, is there anyone in your family who is bedridden? Second, is there anyone in your family who is unable to go to work because of a physical illness? And third, is there anyone in your family who is not well and needs help to look after his/her activity of daily living? On an average, at 60 years of age, people in India are expected to live for another 18 years.3 So, whether or not, elderly are suffering from any of the conditions requiring palliative care, they will be in need of palliative care services as they are living longer with frailty and problems, which are psychosocial and also spiritual. But in the health programme for the elderly, NPHCE (National Programme for Health Care of the Elderly), which was launched in 2010-11, there is no mention of palliative care.

The paper examines 1970 Indian publications on Leishmaniasis research, as covered in Scopus database during 2008-17, registering an annual average growth rate of 17.68%, global publication share of 12.32%, international collaborative publication share of 26.85% and qualitative citation impact averaged to 17.28 citations per paper. The top 10 most productive countries individually contributed global share from 4.13% to 22.95% with largest global publication share coming from Brazil (22.95%), followed by USA (17.78%), India (12.32%), U.K., Iran and Spain (from 7.21% to 8.20%), France. Germany, Italy and Switzerland (from 4.13% to 5.95%) during 2008-17. Together, the 10 most productive countries accounted for 95.57% share of global publication output during 2008-17. Seven of the top 10 countries scored relative citation index above the world average of 1.32: Switzerland (2.17), Italy (2.0), U.K. (1.93), France (1.86), USA (1.80), Spain (1.58) and Germany (1.43) during 2008-17. Medicine, among subjects, accounted for the highest publications share (55.43%), followed by biochemistry, genetics and molecular biology (32.94%), immunology and microbiology (31.68%), pharmacology, toxicology and pharmaceutics (20.81%), chemistry (7.77%) and agricultural and biological sciences (7.56%) during 2008-17 The top 15 most productive Indian organizations and authors together contributed 78.38% and 57.06% respectively as their share of Indian publication output and 95.86% and 52.23% respectively as their share of Indian citation output during 2008-17. Among the total journal output of 1603 papers, the top 15 journals contributed 26.17% share to the Indian journal output during 2008-17. 20 papers registered from 102 to 5725 citations per paper, which together received 211897 citations, leading to an average of 594.85 citations per paper during 2008-17. Key words: Leishmaniasis research, Indian publications, Scientometrics, Bibliometrics.

Introduction: Vestibular dysfunction is either unilateral or bilateral. These depict similar signs and symptoms. Here patient primarily complains of head movement induced dizziness and imbalance. The present study compared the customized vestibular rehabilitation therapy (VRT) in unilateral and bilateral vestibular lesion patients. Method: The subjects were assigned into two groups by purposive sampling (n=10 each). Group A was Unilateral and group B was Bilateral Vestibular Lesion. Both were given customized vestibular rehabilitation therapy. The twelve days protocol included gaze stability (two mins), dizziness (thirty secs hold, three repetitions) and balance improvement progression exercises (five repetitions each) with thirty secs rest interval in between. Student t test was used for analysis. Patients were evaluated for dizziness and risk of fall using Dizziness Handicap Inventory (DHI) and Fall Efficacy Scale (FES). For the assessment of balance, Tandem Walk, Limit of Stability and Clinical Test of Sensory Interaction on Balance (CTSIB) sub-parameters were evaluated using Balance Master. Result: The vestibular rehabilitation therapy was effective for functional domain of dizziness and FES in both unilateral and bilateral lesion patients. In unilateral lesion patients even physical domain of dizziness, reaction time (RT), end point excursion (EPE) and directional velocity (DCL), sub-parameters of limit of stability and step width, speed, end sway sub-parameters of tandem gait also improved. In bilateral vestibular lesion, only the sway velocity in CTSIB showed improvement. Conclusion: Customized Vestibular Rehabilitation Therapy was effective in improving dizziness and risk of fall greater than balance in unilateral and bilateral vestibular lesion patients. Key words: Balance Master, Dizziness Handicap Inventory, Fall Efficacy Scale, Vestibular Dysfunction.

Introduction: Medical care for patients with diabetes mellitus Type 2 is expensive, particularly in the presence of complications. Indeed, in the era of the National Health Security Program the effectiveness and efficiency of medical care provision has been regarded paramount. This study aimed to identify the difference of cost-effectiveness among the prescription of oral anti diabetic therapy, oral and oral, insulin, oral and insulin, and oral, oral, and insulin. Methods: This study was a retrospective study utilizing the out patients medical record of self paid participant of NSS in a hospital in Yogyakarta diagnosed with type 2 diabetes mellitus. Results: there are three types of anti diabetic drugs which have minus values in the ICER, namely Sulfonylureas, the combination of Biguanides, Sulfonylureas, and Thiazolindinedione, and the combination of Sulfonylureas and Biguanides. Conclusion: the combination of Sulfonylureas and Biguanides, which is a combination of oral and oral anti diabetic therapy, is the most costeffective medication with the ICER (Incremental Cost-Effectiveness Ratio) values of Rp -170,2081 Keywords: Cost-Effective, ICER

Background: Cancer of the uterine cervix is preventable and early detection is key to its cure. Screening methods for cervical cancer are available, however, the centres offering to screen are inadequate. The main obstacle for the success of screening efforts in women is the lack of awareness, hence a stigma about the screening procedure and the disease, not just in rural areas but also in a large group of the urban and semi-urban population. The purpose of this manuscript is to share our experiences during health camps conducted for screening women for cervical cancer, strategies adopted, leading to better compliance and complete evaluation in these women. Design and Methods: Health camps were organized for women’s screening and we observed a steady improvement in their participation over a period of time, at rural and peri-urban areas close to the Hyderabad. Creating awareness, training para-medical staff, involving local voluntary bodies for conducting Pap testing and HPV subtyping, gave us optimal leads to manage these patients appropriately and recommend a suitable follow-up. Results and Conclusion: Taking a lead from studies like this and others, conducting national screening programs along with counselling for awareness of such tests and their implications to maintain good health, the burden of cervical cancer can be reduced in India. Key words: Uterine cervix, High risk HPV sub-types, Cervical screening, Cervical Cancer.

Background: Measles has been a major public health concern leading to death among children despite availability of safe and cost-effective vaccines. Global push to improve vaccine coverage resulted in an 84% reduction in deaths. However, data from the year 2016 still reveals that there were 89, 780 measles deaths globally.1 Aim: To study the epidemiological determinants influencing measles in children previously immunized with measles vaccine. Objectives: To determine the proportion of measles infected cases with history of prior measles immunization. To compare clinical profile of patients with and without history of prior measles immunization. Setting and design: Record based, Retrospective Cross sectional Study. Materials and Methods: A retrospective study was conducted using hospital records from an infectious disease hospital situated in Greater Mumbai. The study was carried out over duration of 1 year. Records of all cases admitted for measles from January 2013 to December 2013 were studied in detail. Sampling technique used was universal sampling. Total sample size was 471. Majority of the cases were admitted based on the WHO clinical definition while for a few suspicious cases Measles specific IgM was carried out. Statistical analysis used: Chi square test. Results: Out of 471 case records reviewed for measles, 47% children were vaccinated for measles. Percentage of undernourished children who received the immunization was 48%. A statistically significant association was observed for age, gender and duration of disease amongst those who were immunized for measles (p<0.01). Conclusion: A significant percentage of children despite immunization suffered from measles. Age, gender and nutrition were found to play a vital role in acquisition of measles both in the vaccinated and unvaccinated children. Key words: Retrospective study, Record based, Measles immunization.

Background: Patients who suffer from major depressive episodes and bipolar disorder often exhibit pharmaco-resistance. Therefore, novel treatment methodologies are being proposed to treat the disease or provide symptomatic relief. VNS and DBS are two such techniques, both of which utilize neurostimulation to achieve therapeutic relief. However, it is necessary to establish the comparative efficacies of these methods in treating MDD in patients. Objective: To assess the relative difference in the efficacy of VNS versus DBS for treatment of Major Depressive Disorder and bipolar depression and to provide evidence for the superior technique. Methods: To compare the efficacy of VNS versus DBS for the reduction of depressive symptoms in patients who meet the criteria for a major depressive episode, we conducted a meta-analysis of studies of the subject. Twenty-six studies were selected, consisting of 1160 patients who were treated with either VNS (Mean age = 47.75 years old, mean duration of illness = 22.86 years) or DBS (Mean age = 33.11 years old, mean duration of illness = 9.9 years) treatment arms and analyzed them to determine the amount of improvement in mood. The primary outcome measures were evaluated in terms of change between pre-test and post-test scores over a period of three months, as measured by HDRS and MADRS rating scales. Results: A comparison of the summary effect size produced by VNS (HDRS = 1.247, MADRS = 1.110) to that produced by DBS (HDRS = 2.063, MADRS = 1.996) seems to demonstrate that DBS is the more effective treatment. The effect size for VNS was lower than that of DBS groups, indicating that DBS is more effective than VNS. The finding is corroborated by the tests of heterogeneity; while the VNS group of studies indicated a high level of heterogeneity Vs. DBS group indicated insignificant level of heterogeneity. Conclusion: Current meta-analysis demonstrates that Deep Brain Stimulation (DBS) is a better treatment modality for Major Depressive Disorder and Bipolar Depression than Vagus Nerve Stimulation (VNS). However, as the VNS and DBS groups differed concerning the clinical profiles of the patients (both in terms of age and regarding the duration of the illness. Research studies with larger, synchronous sample sizes and control groups are required for a meta-analysis to draw a steadfast conclusion. Key words: VNS, DBS, Major Depressive Disorder, Bipolar Depression, Neuro-modulation.