Deteriorating human microbiome – An emerging global health challenge

The study of human microbiome and its relationship with health and disease is one of the most exciting areas of research in health all over the world, especially after the failure of human genome project to deliver its expected results. Our body is composed of 30 trillion human cells. But it is host to close to 100 trillion bacterial and fungal cells. 70 – 90% of all cells in our body are non human. They reside on every inch of our skin, in our nose, mouth, ears, in our oesophagus, stomach and most abundantly in our gut. They are not a random phenomenon but have co-evolved with us humans over millions of years.  Collectively these bacteria weigh about 3 pounds. The more we read about research on microbiome or microbiota, the name given to all these friendly symbiotic partners, the more we get interested in their role in health and disease. According to Martin J.  Blaser, director of the Human Microbiome Program, who has also served as the president of Infectious Disease Society of America, in his best seller ‘Missing Microbes' (1), “It is our microbiome that keeps us healthy and parts of it are disappearing. The reason for this disaster is all around us – overuse of antibiotics in humans and animals, caesarean sections and widespread use of sanitizers and antiseptics, to name just a few.

Seven Health Sins

As we all know, health cannot be sold or purchased by anyone anywhere. According to the holistic concept of health which is based on ‘Bio-psycho-social model’, a person can only be healthy if he/she is able to maintain a harmonious balance between physical, mental/emotional, social and spiritual dimensions of self. No doctor or hospital however big they may be, can give health to anyone until and unless a person chooses to be healthy by making the right choices in his day to day behavior. Adolescence is the time when a person learns to make the choices about his daily behavior. Therefore, giving them the correct information about the routine behavior is of paramount importance for everyone concerned with health including public health experts. One such concept has been developed by the author as ‘Seven Health Sins’ which he has been sharing with the adolescents in the schools as well as the first-year medical students

Why do we need Lifestyle Medicine?

“While the search for the magic bullets continues, other studies are revealing that the environment in which the individuals’ lives and his manner of living are of great importance in determining his susceptibility to the diseases of modern times.” Rene Dubos (Mirage of Health-Utopias, Progress, and Biological change, 1959)(1) This quote by one of the greatest microbiologist of 20th century is even more relevant today where Non-communicable diseases have taken the center stage in the world as well as in India. The impact of NCD’s in India is quite alarming. NCD’s account for 60%of all deaths and 53% of disease burden, over 20% of the population in India has at least one chronic disease, NCD’s are estimated to cost India 62 million during the period 2012 – 2030.(2) Most of these NCD’s are related to some common risk factors like lack of physical activity, tobacco use, alcohol abuse, unhealthy diet, stressful lifestyle, lack of adequate sleep. That is the reason NCD’s are now being called as lifestyle diseases and interestingly, most of the  NCD’s are preventable (and some of the important ones also reversible in early stages) through lifestyle approaches also being called as ‘Lifestyle Medicine’

Study of functional outcome of total hip arthroplasty in a series of cases of hip pathologies done in rural population

Background: The objective of the study was to assess the functional outcome of total hip arthroplasty (THA) done in a series of cases of hip pathologies rural population.Methods: A retrospective randomized controlled study conducted in 50 cases of hip arthritis (38 males and 12 females)  treated with uncemented THA for an average follow-up of  2 years  at department of orthopedics MGM Medical College, Kamothe, Navi Mumbai. Harris hip scoring system was used for the functional scoring and the postoperative radiographs were assessed by Gruen zones for the femoral component and DeLee and Charnley zones for the acetabular component. All patients were evaluated pre operatively and post operatively 3 months 6 months, 12months, 2years with Harris Hip score.Results: 81% of our patients scored 85 points or better for a rating of excellent by Harris hip score system. 90% patients had little /no pain post operatively, whereas walking ability improved and was unlimited in 80% of the patients post operatively. Harris hip score improved from 40 to 80. 80.5% -excellent, 13.80% -good, 5.7% -fair results. Poor results were not seen in any patient.Conclusions: THR provided excellent pain relief, adequate stability, and remarkable range of motion in severely painful, refractory hip. A significant improvement was seen at two year follow-up.

Manual of 3D Echocardiography Manual of 3D Echocardiography Amuthan V. ed. Jaypee brothers medical publishers [P] ltd, New Delhi 2013.

Unknow

Job Burnout Assessment Among Officer Grade Bank Employees of Meerut District

Background: India is in a transitioning state and so is it’s banking sector with wide socioeconomic differences and rapidly growing economy. In order to ensure smooth implementation of these policies, bank employees in banks are required to put in extra labor and hours of work and the fact that policies keep on changing time to time are a constant stressors in bank employees which may lead to burnout. Methods and Material: This was cross sectional study carried out among of Officer grade bank employees of urban block Meerut district situated in Uttar Pradesh. A total of 216 samples were collected through self-designed and semi structured questionnaire which included socio demographic profile and Shirom-Melamed Burnout Questionnaire (SMBQ) for assessing burnout.  The simple random sampling technique was applied through computer random tables method  for selection of banks and data was analyzed through SPSS19 and Microsoft excel .Results: 19.4% bank officers have pathological burnout and 55.1% of bank officers who are at brink of developing burnout. Conclusions: The Physical fatigue factor was found to be the least responsible for burnout in our study and the prevalence of burnout was found significantly more among married bank officers, living with nuclear type of family

Factors influencing control of convulsive status epilepticus in children

Background: Convulsive status epilepticus (CSE) is an important cause of morbidity and mortality in pediatrics. Objectives: The objectives of the study were to examine the influence of any clinical factor on control of CSE in children. Methods: Cases of CSE in the age group of 1 month–12 years, admitted to the emergency ward of a tertiary care hospital, over a period of 1 year, were studied, prospectively. Only those cases that were actively convulsing at arrival were enrolled. Difficult cases were shifted pediatric intensive care unit and were put on mechanical ventilator as needed. After initial stabilization, detailed case-work up and appropriate investigations to find the etiology were done. The data were analyzed statistically and p<0.05 was considered as statistically significant. Results: The data of 50 cases that fulfilled the enrolment criteria were analyzed. Convulsions in the majority of the cases could be controlled within 30 min. Out of the study patients, 39 cases (78%) needed >1 drug for controlling the convulsive episodes. Control was extremely difficult in 10 (20%) of the cases while 3 (6%) cases died. The time needed to control the episodes showed significant correlation with several clinical factors, namely focal seizure with impaired consciousness, multiple episodes of convulsion (discrete type), focal deficit, Glasgow Coma Scale score <9, abnormal neuroimaging finding, central nervous system infections (meningitis and encephalitis together), and prolonged duration of convulsions before arrival at the emergency ward. However, on multivariate analysis prolonged duration of convulsion before arrival at emergency was found to be the most significant predictor of time needed to control the episodes. Conclusion: Prolonged duration of convulsion before arriving at the hospital can be considered to be a predictor of difficult control of CSE in children

Successful live birth after heterotopic ruptured cornual pregnancy with twin intrauterine gestation in an in vitro fertilization conception

Heterotopic pregnancies, especially in the cornual region which were a rarity till recent times, have become a more common occurrence due to increasing practice of assisted reproduction. Optimal management of such cases is imperative to manage the risk of hypotension and shock in case of rupture and to judiciously preserve the intrauterine pregnancy. Here we are reporting a case of IVF conception of twin intrauterine pregnancy with a cornual heterotopic pregnancy. Patient presented to the emergency department with features of acute abdomen, haemoperitoneum and shock. Ultrasound findings were suggestive of rupture of cornual heterotopic pregnancy, 1500 ml haemoperitoneum with live twin intrauterine gestation. Patient was resuscitated with iv fluids blood transfusion. Immediate laparotomy was done and cornual site repaired and covered with an omental patch while preserving the intrauterine gestations. Thereafter, pregnancy was carefully monitored with a high index of suspicion for rupture of site of cornual repair with advancing gestational age. Patient was readmitted at 24 weeks with pain abdomen and cornual site was found to be 4mm in thickness. She was managed conservatively till 27 weeks when she had preterm rupture of membranes and emergency LSCS was done. She delivered healthy twin male babies, 780 gmb and 795 gm respectively. This case demonstrates that cornual heterotopic pregnancy is a diagnosis which may be easily missed and can present as a life-threatening complication if it ruptures and significant intraperitoneal bleeding occurs. However, it is possible to successfully manage these cases with timely intervention, proper uterine reconstruction and monitoring of intrauterine gestation

SELF-REPORTED HEALTH, ILLNESS AND SELF-CARE AMONG DOCTORS OF MEERUT

Abstract: This document provides insight on lifestyle and healthcare status of doctors based on key findings from a survey conducted in Meerut City, (U.P.) India. Objectives: 1.To study the lifestyle pattern among the doctors of Allopathy and Ayurveda & teachers of local private Medical college, local private Dental college. 2. To study the (self-reported) prevalence of common non-communicable diseases in the same. 3. To know the pattern of healthy lifestyle practices adopted by the doctors. Material & Methods: The Cross-sectional study was conducted with the help of a pre-designed and pre-tested questionnaire which was filled by the faculty of local private Medical College, Dental college, Ayurvedic doctors and local practicing doctors of allopathy and Ayurveda. Verbal consent was implied. A purposive sample of 240 doctors [60 each from Medical and Dental colleges and 60 each from allopathy private practitioners (p.p.allo.) and ayurvedic private practitioners (p.p.ayur.)] were given the questionnaire-and response rate was 84%. The data was entered in Microsoft excel 2007 to know the frequency of the various lifestyle pattern. Results: 47.5% of the doctors had raised B.M.I. (Body Mass Index- more than 25); 21% of the doctors were smokers, 10% were current drinkers and 32% were hypertensive. Only 2.5% were found to be diabetic in our study. About 52% of the doctors exercised regularly. 32.5% were trained for yoga. Conclusion:This study implies that a large proportion of doctors themselves do not follow the healthy lifestyle and are having lifestyle diseases like obesity, hypertension etc. Interestingly, there was not much difference between doctors doing private practice or teaching in Medical/Dental College

Comparative study of the outcome of pediatric femur diaphyseal fractures treated with titanium elastic nails vs. compression plates

Background: A variety of methods have been described for the management of femur diaphyseal fractures in children between ages of 5 to 12 years. Some of the techniques include closed reduction and internal fixation (CRIF) with elastic nails, open reduction and internal fixation (ORIF) with compression plates, external fixators and skeletal traction with spica casting. This study was done to compare the outcome and complications of diaphyseal femur fractures in pediatric age treated with CRIF with Titanium elastic nails vs. ORIF with compression plates.Methods: The study was a prospective, clinical study.  A total of 60 patients were studied. 30 patients were treated with CRIF with titanium nails and 30 patients were treated with ORIF with compression plates. Every patient operated was followed up at 3 weeks, 6 weeks, 3 months, 6 months and 3 monthly thereafter until implant removal.Results: Only 1 wound healing complication was noted in the TENS nail group which was skin irritation at the site of pin insertion. In the compression plating group, 6 patients developed wound complications, including superficial infections, deep infections and keloids. The range of movements at knee joint in the two groups was compared.  Only 1 patient had a significant loss of flexion with ROM of less than 100 degrees in the TENS nail group. In the plating group 4 patients had a significant loss of flexion with ROM of less than 100 degrees. Limb length discrepancies were seen in 3 patients in the TENS nail group whereas the compression plating group showed 1 patient. 2 patients in the TENS group developed an angular deformity due to premature weight bearing.  3 patients in the compression plating group developed deformities at the fracture site. The average time for fracture union in the compression plate group was 10.7 weeks and was 14.7 weeks in the patients treated with TENS nail. Conclusions: No single fixation method can be considered superior in all types and patterns of pediatric diaphyseal femur fractures. Titanium elastic nails can be considered a better implant for treating pediatric femur fractures when compared to compression plates due to the lesser rates of surgical wound complications, better range of movements at knee joint and overall lesser complication rate as was recorded in this study