Analysis of the Inter-basin Water Transfer Scheme in India: a case study of the Godavari-Krishna link

River basin managementRiver basin developmentDevelopment projectsWater availab ilityWater demandWater transferDamsCanalsCrop management

Using ‘Appreciative Inquiry’ in India to improve infection control practices in maternity care : a qualitative study

ACKNOWLEDGEMENTS The inputs and facilitation of field work from the Gujarat state government officials are acknowledged. We express our gratitude to the doctors, nurses and other health facility staff for actively participating in the study. Our special thanks to Dr. Pritam Pal for capacity building of the research team for appreciative inquiry and Mr. Sanjay Joshi for follow-up of the AI process. We appreciate the help of Dr. Purvi Shah in data collection and preparing transcripts for the study. The study was funded by the John D. and Catherine T. MacArthur Foundation.Peer reviewedPublisher PD

Pupillometric Assessment of Sleepiness in Narcolepsy

Purpose: Excessive daytime sleepiness is highly prevalent in the general population, is the hallmark of narcolepsy, and is linked to significant morbidity. Clinical assessment of sleepiness remains challenging and the common objective multiple sleep latency test (MSLT) and subjective Epworth sleepiness scale (ESS) methods correlate poorly. We examined the relative utility of pupillary unrest index (PUI) as an objective measure of sleepiness in a group of unmedicated narcoleptics and healthy controls in a prospective, observational pilot study. Methods: Narcolepsy (n = 20; untreated for >2 weeks) and control (n = 56) participants were tested under the same experimental conditions; overnight polysomnography was performed on all participants, followed by a daytime testing protocol including: MSLT, PUI, sleepiness visual analog scale (VAS), ESS, and the psychomotor vigilance test (PVT). Results: The narcolepsy and control groups differed significantly on psychomotor performance and each measure of objective and subjective sleepiness, including PUI. Across the entire sample, PUI correlated significantly with objective (mean sleep latency, SL) and subjective (ESS and VAS) sleepiness, but none of the sleepiness measures correlated with performance (PVT). Among narcoleptics, VAS correlated with PVT measures. Within the control group, mean PUI was the only objective sleepiness measure that correlated with subjective sleepiness. Finally, in an ANCOVA model, SL and ESS were significantly predictive of PUI as measure of sleepiness. Conclusion: The role of PUI in quantifying and distinguishing sleepiness of narcolepsy from sleep-satiated healthy controls merits further investigation as it is a portable, brief, and objective test

Maternal Health Situation in India: A Case Study

Maternal Health Services are one of the basic health services to be provided by nay government health system as pregnant women are one of the most vulnerable victims of dysfunctional health system, India, in spite of rapid economic progress is still farm away from the goal of lowering maternal mortality to less than 100 per 100,000 live births. It still accounts for 25.7% maternal deaths. The maternal mortality in India varies across the states. Geographical vastness and socio-cultural diversity make implementation of health sector reforms a difficult task. The chapter analyses the trends in maternal mortality and various maternal health programs implemented over the years including the maternal health care delivery system at various levels including the recent innovative strategies. It also identifies the reasons for limited success in maternal health and suggests measures to improve the current maternal health situation. It recommends improvement in maternal death reporting, evidence based, focused, long term strategy along with effective monitoring of implementation for improving Maternal Health situation. It also stress the need for regulation of private sector and proper Public Private Partnership (PPP) policy together with a strong political will for improving Maternal Health.

An Ayurvedic Management of Kitibha Kushta (Plaque Psoriasis) - A Case study

Skin disease makes a great impact as other serious medical conditions when assessed by effects on health-related quality of life. Skin diseases are ranked as the fourth most common cause of human illness, resulting in an enormous non-fatal burden. According to Global burden of diseases, skin and subcutaneous diseases are increasing at an alarming rate since few decades. Due to altered lifestyle, lack of physical exercise, unhygienic, mental stress, over eating, nutrition deficiency, skin diseases are commonly observed. All the skin diseases in Ayurveda  have been discussed under the broad heading of Kushta which is further divided into Mahakusta and Kshudra Kusta. Kitibha Kusta is included under Kshudra Kusta which simulates with signs and symptoms of Psoriasis. Psoriasis is chronic disorder which is commonly encountered in day today’s clinical practices accounting for wide spared prevalence. As it is relapsing in nature it requires treatment for long duration. In this case study, 41 years old male patient  had come to OPD of Agadatantra with chief complaint of Kandu (itching), dry silvery white patches over both the elbow, blackish discoloration over lower limbs, abdomen and back treated with Shodhana Chikitsa [Body purification] using Virechana Karma and Shamana Chikitsa using Panchatikta Guggulu Ghrta, Bilvadi Gutika, Manjista Choorna as Lepa and Marichadi Taila for application. Thus, this paper highlights a case study of Kitibha Kusta (Plaque Psoriasis) treated with Ayurvedic principles

Sourdough bread preparation using selected lactic acid bacterial starter cultures

The lactic fermentation of cereals is known to improve the food quality through the development of flavor, enhancement of the nutritional value and shelf life, and by removing toxic or antinutritional factors of food products. Lactic acid bacteria (LAB) strains are able to improve the shelf life of several food products. The efficiency of the LAB cultures determined in in vitro assays was confirmed in bread manufacture. The sourbread prepared using 50 per cent yeast and 50 per cent LAB starter (based on cell density) was found to be superior to the conventional bread in textural characteristics, flavor, appearance and even taste. It contained enough protein (10.15%) and the least fat value (7.68%). It scored the highest acceptability index of 81.70. These results point out the advantages of using selected LAB strains as starter cultures for sourdough fermentation

Prescription patterns of antihypertensive drugs in a tertiary care hospital in India

Background: The present study was conducted to analyze the prescribing patterns and utilization of antihypertensive drugs at a tertiary care center in India.Methods: A cross-sectional analysis of prescriptions of patients of essential hypertension attending outpatient department of a tertiary care hospital during the period of December 2011 to March 2012 was done. Hypertensive patients with co-morbidities were excluded from study. The data were analyzed to find out demographic characteristics of patients, number of drugs prescribed per prescription, drugs, which are commonly prescribed, antihypertensive drugs used concurrently, percentage of drugs prescribed by generic name and over all drug utilization frequency.Results: During the study period, 465 prescriptions for hypertension were analyzed. This study revealed that most of the patients were on combination of antihypertensive drugs (67.97%) while 31.18% patients received mono therapy. Among mono therapy drugs, calcium channel blockers (CCB) (31.03%) were prescribed most. Utilization of other major drug classes as mono therapy in decreasing order is angiotensin-converting enzyme inhibitors (28.28%), diuretics (17.93%), beta-blockers (11.72%) and angiotensin receptor blockers (10.34%). Among those who were treated with drug combinations, 64.24% received 2-drug, 25.95% received 3-drug regimen and 8.54% received 4-drug regimen. In combination therapy, 2-drug combination consisting of a CCB and a diuretic was most commonly (24.14%) prescribed.Conclusions: This study represents the current prescribing patterns for anti-hypertensive drugs and provides the baseline data for similar studies in future, as patterns in prescribing antihypertensive drugs keep changing

Prospective, randomized, double blind, placebo controlled clinical study to different doses of ketamine for prevention of shivering during spinal anaesthesia

Background: Ketamine has better effect than other drugs like pethidine, fentanyl, clonidine, tramadol, midazolam in prevention of shivering during anaesthesia and has a role in thermoregulation by different means. The objective of this study was to evaluate the safety, efficacy of Ketamine injection and to compare the different doses (0.25 mg/kg and 0.5 mg/kg) of inj. Ketamine in prevention of shivering in operative patients under spinal anaesthesia.Methods: The present study was a prospective, randomized, double blinded and clinical study conducted in L.T.M.M.C & L.T.M.G.H, Mumbai, India during January 2012 to September 2013. 120 patients with American Society of Anesthesiologist (ASA) physical status of I or II, between the age of 18 – 65 years of either sex and height 150-170 cms were randomly selected and included in the study as per eligibility.Results: The study suggests that prophylactic administration of injection Ketamine at doses of 0.25 mg/kg and 0.5 mg/kg was producing a significant antishivering effect but an incidence of sedation and hallucination was observed in the Ketamine 0.5 mg/kg receiving group throughout the perioperative period.Conclusions: From this study we can conclude that prophylactic dose of Ketamine 0.25 mg/kg i.v. has lesser side effects comparison to Ketamine 0.5 mg/kg i.v. in prevention of shivering in patients, undergoing surgical procedure under spinal anaesthesia

Pattern of Adolescent Growth Among the Brahmin Girls – Rural-Urban Variation

A cross-sectional study of adolescent growth was undertaken among the Brahmin girls residing in rural and urban areas of Sagar districts, Madhya Pradesh to evaluate the urban-rural differences. Six anthropometric measurements, such as weight, stature, sitting height, head circumference, upper arm circumference and chest girth are taken into consideration. Though the urban girls show consistently higher values of weight, stature, sitting height and chest girth than the rural girls, but in case of head circumference and upper arm circumference they show consistently lower values. The maximum increment occurs between the ages 13 and 14 years in all the six measurements in both rural and urban girls