A clinical study to evaluate the Upashayatmaka effect of Trikarshika Kwatha in Amavata (Rheumatoid Arthritis)

Background: Amavata is the disease which is caused due to the involvement of Ama and Vata. Rheumatoid Arthritis is having significant parlance with Amavata in terms of the symptoms produced in the body. The prevalence of Rheumatoid Arthritis is approximately 0.8% of the population. Women are affected approximately three times more often than men. Objectives: To carry out comprehensive literary work covering classical and modern aspect of Amavata and to evaluate the Upashayatmaka effect of Trikarshika Kwatha in Amavata. Methodology: A Single group open labelled clinical study with pre and post test design was carried out in 30 subjects of Amavata aged 16-70 years. Patients were analyzed and selected accordingly who fulfilled the diagnostic and inclusion criteria. Trikarshika Kwatha 48ml twice a day before food was given for 15 days. Detailed proforma was prepared to assess the observation. Results: All the parameters were highly statistically significant with p<0.001 except RA Factor which was statistically insignificant throughout the study. Conclusion: Trikarshika Kwatha proved beneficial in reducing the symptoms of Amavata

Lower vaccine uptake amongst older individuals living alone: A systematic review and meta-analysis of social determinants of vaccine uptake.

INTRODUCTION: Vaccination is a key intervention to reduce infectious disease mortality and morbidity amongst older individuals. Identifying social factors for vaccine uptake enables targeted interventions to reduce health inequalities. OBJECTIVE: To systematically appraise and quantify social factors associated with vaccine uptake amongst individuals aged ?60years from Europe. METHODS: We searched Medline and Embase from inception to 24/02/2016. The association of vaccine uptake was examined for social factors relevant at an individual level, to provide insight into individuals' environment and enable development of targeted interventions by healthcare providers to deliver equitable healthcare. Factors included: living alone, marital status, education, income, vaccination costs, area-level deprivation, social class, urban versus rural residence, immigration status and religion. Between-study heterogeneity for each factor was identified using I2-statistics and Q-statistics, and investigated by stratification and meta-regression analysis. Meta-analysis was conducted, when appropriate, using fixed- or random-effects models. RESULTS: From 11,754 titles, 35 eligible studies were identified (uptake of: seasonal influenza vaccine (SIV) only (n=27) or including pneumococcal vaccine (PV) (n=5); herpes zoster vaccine (n=1); pandemic influenza vaccine (n=1); PV only (n=1)). Higher SIV uptake was reported for individuals not living alone (summary odds ratios (OR)=1.39 (95% confidence interval (CI): 1.16-1.68). Lower SIV uptake was observed in immigrants and in more deprived areas: summary OR=0.57 (95%CI: 0.47-0.68) and risk ratio=0.93 (95%CI: 0.92-0.94) respectively. Higher SIV uptake was associated with higher income (OR=1.26 (95%CI: 1.08-1.47)) and higher education (OR=1.05 (95%CI: 1-1.11)) in adequately adjusted studies. Between-study heterogeneity did not appear to result from variation in categorisation of social factors, but for education was partly explained by varying vaccination costs (meta-regression analysis p=<0.0001); individuals with higher education had higher vaccine uptake in countries without free vaccination. CONCLUSIONS: Quantification of associations between social factors and lower vaccine uptake, and notably living alone (an overlooked factor in vaccination programmes), should enable health professionals target specific social groups to tackle vaccine-related inequalities

Tuberculous Orbital Abscess Associated with Thyroid Tuberculosis

Purpose: To report an unusual presentation of tuberculosis. Case Report: A six-year old boy presented with left upper lid swelling of 15 days′ duration and an asymptomatic midline neck mass from 2 months ago. Imaging studies, and microbiologic tests which demonstrated acid-fast bacilli in the fine needle aspirate of the thyroid mass, both confirmed a diagnosis of cold tuberculous thyroid abscess with presumed hematogenous spread to the orbit. The patient demonstrated marked improvement of both lesions with antitubercular drugs. Conclusion: This case illustrates a very rare association of orbital and thyroid tuberculosis

A Positive Deviance Inquiry on Effective Communicative Practices of Rural Indian Women Entrepreneurs

Why do some rural women entrepreneurs in India succeed despite low levels of literacy, staggering household responsibility, unsupportive social structures, and oppressive cultural practices? The present article employed the Positive Deviance (PD) approach to identify the effective communication practices of rural women entrepreneurs in Uttar Pradesh, India, who succeed against overwhelming odds. Starting with an initial pool of 21,024 rural Indian women who received microloans for income-generation, and through several sieving rounds of focus group conversations with over 1,100 women, 24 PD women entrepreneurs were identified. A variety of participatory processes and liberating structures—Discovery and Action Dialogues (DADs), improvisational theater and prototyping, personal storytelling, and card-sorting games—were employed to identify the highly uncommon practices of PD entrepreneurs. These uncommon practices included micro interpersonal behaviours to connect deeply with customers, personalised branding of their businesses, daily diary jottings to monitor sales and profits, reframing value propositions to persuade customers, and others.publishedVersio

Risk factors for developing acute kidney injury in older people with diabetes and community-acquired pneumonia: a population-based UK cohort study.

BACKGROUND: Acute kidney injury (AKI) is being increasingly recognised in ageing populations. There are a paucity of data about AKI risk factors among older individuals with diabetes and infections, who are at particularly high risk of AKI. The objective of this study was to evaluate the risk factors for developing acute kidney injury (AKI) amongst older patients with diabetes and community-acquired pneumonia (CAP) in England, and whether the impact of underlying kidney function varied with age. METHODS: This was a population-based retrospective cohort study over 7 years (01/04/2004-31/3/2011) using electronic health records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. The study population comprised individuals with diabetes aged ≥65 years with CAP. Associations between demographic, lifestyle factors, co-morbidities and medications and development of AKI within 28 days of CAP were explored in a logistic regression model. RESULTS: Among 3471 patients with CAP and complete covariate data, 298 patients developed subsequent AKI. In multivariable analyses, factors found to be independently associated with AKI included: male sex (adjusted odds ratio, aOR: 1.56 95% confidence interval (CI): 1.20-2.04), hypertension (aOR1.36 95% CI 1.01-1.85), being prescribed either angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor-blockers (aOR: 1.59 95% CI: 1.19-2.13), or insulin (aOR: 2.27 95% CI: 1.27-4.05), presence of proteinuria (aOR 1.27 95% CI 0.98-1.63), and low estimated glomerular filtration rate (eGFR). The odds of AKI were more graded amongst older participants aged ≥80 years compared to those of younger age: for eGFR of ≤29 mL/min/1.73m2 (vs 60 ml/min/1.73m2) aOR: 5.51 95% CI 3.28-9.27 and for eGFR 30-59 mL/min/1.73m2 1.96 95% CI 1.30-2.96, whilst any eGFR < 60 ml/min/1.73m2 was associated with approximately 3-fold increase in the odds of AKI amongst younger individuals (p-value for interaction = 0.007). CONCLUSIONS: The identified risk factors should help primary care and hospital providers identify high risk patients in need of urgent management including more intensive monitoring, and prevention of AKI following pneumonia

Protection of mice against Plasmodium berghei infection by a tuftsin derivative

In Plasmodium berghei infections, the mortality rate and parasitaemias were significantly reduced and the mean survival time was considerably enhanced by pretreating the animals with a tuftsin derivative, Thr-Lys-Pro-Arg-NH-(CH2)2-NHCOC15H31. This effect of the modified tuftsin was further increased upon its incorporation in the liposome bilayer. These results indicate that tuftsin and its derivatives may prove useful in enhancing nonspecific host resistance against protozoan infections

Comparative analysis of conventional and real time PCR for detection of haemoparasites in dogs

9-15Ehrlichiosis and babesiosis are the most pathogenic tick-borne diseases of dogs worldwide. The present study reports that the development of SYBR green based real time PCR (RT-PCR) protocols with novel primers targeting small subunit ribosomal RNA genes to detect natural infections of Ehrlichia canis, Babesia vogeli and B. gibsoni in dogs and its comparison with conventional PCR. Statistical analysis revealed that RT- PCR is more superior to conventional PCR assay to detect low level rickettsaemia (p < 0.05). The high prevalence of these pathogens in the study population also warrants immediate attention to the adoption of efficient and sustainable control strategies

Reducing the burden of Tuberculosis: an emphasis on improving awareness among caregivers

Background: Tuberculosis (TB) is one of the common communicable disease affecting human beings since ancient times. Though effective chemotherapy emerged during 20th century had raised hope towards eliminating TB burden, it still remains as a distant goal. Awareness about TB among close contacts of active disease is of paramount importance in preventing its spread and promoting early diagnosis and treatment. This study aimed to assess the knowledge about tuberculosis among caregivers of tuberculosis patients.Methods: This was a cross sectional study that enrolled 300 subjects who were then caregivers of tuberculosis patients admitted in the Department of Pulmonary Medicine. Subjects were interviewed according to a predesigned panel of questions meant to assess their basic knowledge and perceptions about tuberculosis symptomatology, diagnostic modalities, treatment and prevention.Results: About 90.3% (n=271) of subjects had heard about TB previously and about 37.7% (n=113) considered themselves to be well aware of it. Most of them believed TB to be communicable (90.3%, n=271). Majority believed that TB affects lungs only (n=206, 68.7%), with most commonly perceived symptom being cough (n=285, 95%). Knowledge regarding disposal of sputum was poor (n=110, 36.7%). About 168 (56%) subjects considered usage of face mask by the patient as an effective tool for TB prevention.Conclusions: Caregivers of tuberculosis patients lack proper knowledge about major aspects of the disease. Public awareness and care giver education programs needs to be implemented along with standard TB care to reduce transmission of TB among close contacts

THE MANAGEMENT OF PRIMARY DYSMENORRHOEA (KASHTARTAVA) - A PROSPECTIVE MULTICENTRIC OPEN OBSERVATIONAL STUDY

Objective: To evaluate the clinical usefulness of Rajahpravartini vati in the management of primary dysmenorrhoea (Kashtartava) and changes in the quality of life of the subjects. Study design: A multi-centric prospective single arm observational study. Setting and participants: 359 subjects aged between 16 - 35 years suffering from painful menstruation at least for three consecutive regular menstrual cycles were included in the study. Intervention: Rajahpravartini Vati a classical Ayurvedic formulation was administered 250 mg b.d. with lukewarm water for 90 days followed by subsequent 90 days without intervention. Outcome measures: The management of menstrual pain assessing by 10 points Visual Analogue Scale and improvement in the quality of life using SF-36 (RAND) questionnaire. Results: The mean VAS score of pain at baseline was 6.94±1.98, decreasing to 1.7±2.22 at 90th day which further decreased and maintained to 1.24±1.9 up to 180th day. Associated symptoms like nausea, vomiting, constipation, giddiness, breast tenderness, diarrhea, headache and fainting were completely relieved. The improvements of quality of life in 8 domains viz. pain, general health, physical functioning, social functioning, emotional wellbeing, energy/fatigue, limitation due to physical health and emotional problems at the end of 90th day of intervention was also significant (p&lt;0.001) in comparison to baseline. No adverse event occurred during the treatment period. Conclusion: Rajahpravartini Vati has shown a positive role for the treatment of dysmenorrhoea and to improve the quality of life of the subjects

Zoster vaccination inequalities: A population based cohort study using linked data from the UK Clinical Practice Research Datalink.

OBJECTIVE: To quantify inequalities in zoster vaccine uptake by determining its association with socio-demographic factors: age, gender, ethnicity, immigration status, deprivation (at Lower-layer Super Output Area-level), care home residence and living arrangements. METHOD: This population-based cohort study utilised anonymised primary care electronic health records from England (Clinical Practice Research Datalink) linked to deprivation and hospitalisation data. Data from 35,333 individuals from 277 general practices in England and eligible for zoster vaccination during the two-year period (2013-2015) after vaccine introduction were analysed. Logistic regression was used to obtain adjusted odds ratios (aOR) for the association of socio-demographic factors with zoster vaccine uptake for adults aged 70 years (main target group) and adults aged 79 years (catch-up group). RESULTS: Amongst those eligible for vaccination, 52.4% (n = 18,499) received the vaccine. Socio-demographic factors independently associated with lower zoster vaccine uptake in multivariable analyses were: being older (catch-up group: aged 79 years) aOR = 0.89 (95% confidence interval (CI):0.85-0.93), care home residence (aOR = 0.64 (95%CI: 0.57-0.73)) and living alone (aOR = 0.85 (95%CI: 0.81-0.90)). Uptake decreased with increasing levels of deprivation (p-value for trend<0.0001; aOR most deprived versus least deprived areas = 0.69 (95%CI: 0.64-0.75)). Uptake was also lower amongst those of non-White ethnicities (for example, Black versus White ethnicity: aOR = 0.61 (95%CI: 0.49-0.75)) but was not lower among immigrants after adjusting for ethnicity. Lower uptake was also seen amongst females compared to men in the catch-up group. CONCLUSIONS: Inequalities in zoster vaccine uptake exist in England; with lower uptake among those of non-White ethnicities, and among those living alone, in a care home and in more deprived areas. Tailored interventions to increase uptake in these social groups should assist in realising the aim of mitigating vaccination inequalities. As care home residents are also at higher risk of zoster, improving the uptake of zoster vaccination in this group will also mitigate inequalities in zoster burden