Risk Factors Linked to Development of Cardiomyopathy in Adults with Beta- Thalassemia Major in a Tertiary Care Hospital

Beta-thalassemia major is a genetic disorder adversely affecting the life of the patient and the whole family. Repeated blood transfusions are required to maintain the hemoglobin level, which create a state of iron overload in the body leading to ectopic iron deposition in the heart, liver, pancreas and other organs. Thalassemia cardiomyopathy is the most dreaded complication of this resultant iron overload. The present study was a cross-sectional study involving 77 patients with thalassemia major, whose age, body mass index (BMI), blood pressure (BP), hemoglobin, serum ferritin levels were correlated with their twodimensional echocardiographic findings. Out of the total 77 patients, 63 had diastolic dysfunction, 6 had systolic dysfunction and remaining 8 had normal left ventricular function. The mean age of the patients was 22.42 years and their mean BMI was 16.82. Patients with systolic dysfunction had lower hemoglobin and higher serum ferritin levels as compared to other patients. The study concluded that cardiac dysfunction is seen more in younger age, higher BMI, lower BP, low hemoglobin levels and raised serum ferritin levels. Thus, early intensive iron chelation therapy should be provided to all the patients to curb this dreaded complication

Serum lactate dehydrogenase: a prognostic factor in pre-eclampsia

Background: Pre eclampsia is responsible for significant maternal and perinatal morbidity and mortality worldwide .Serum LDH level is a useful biomarker for cellular injury which may reflect the severity of pre eclampsia and its level might be a guideline for management of patients. The aim of study was to find out the role of serum LDH in prediction of adverse outcome of pre eclampsia, severity of disease and occurrence of complications.Methods: This prospective observational study was conducted in the department of Obstetrics and Gynecolog, RIMS, Ranchi, Jharkhand, India. A total of 300 cases were studied.150 cases were non severe preeclamptic and 150 cases were severe pre eclamptic patients. Serum LDH was done in both non severe and severe eclamptic patients .Data entry was done in Microsoft excel 2007. Results were analysed by chi square test.Results: Higher LDH levels had significant correlation with high blood pressure as well as poor maternal and perinatal outcome.Conclusions: High serum LDH level correlate well with the severity of disease and poor outcome in patients of pre eclampsia. Detection of high risk patients with increased levels of LDH mandate close monitoring and management to prevent maternal and fetal morbidity and mortality

Can Levothyroxine Be Taken as Evening Dose? Comparative Evaluation of Morning versus Evening Dose of Levothyroxine in Treatment of Hypothyroidism

152 drug naïve primary hypothyroid patients were divided into morning (Group 1) and evening (Group 2) dosing group and evaluated for change in biochemical profile, physical functioning and Quality of Life during the course of 12 weeks of study. At the end of 12 weeks 70 (90.90%) subjects in Group 1 and 72 (96%) in Group 2 achieved euthyroidism. On evaluation clinical symptoms and total clinical scores improved in both the groups at the end of 6 and 12 weeks. Significant improvement in thyroid profile was seen in both the groups at the end of 6 and 12 weeks (P value <.0001). On intergroup comparison, no significant difference in thyroid profile was seen at 6 and 12 weeks between the morning and the evening dose group. Similar dose of levothyroxine was required to achieve euthyroidism in both the groups. Though an early restoration of euthyroidism was seen in evening group, the difference when compared to the morning group was not statistically significant. On assessment of QoL, statistically significant improvement in various parameters was seen in both the groups. Hence, from the study we inferred that evening dose is as efficacious as morning dose and provides an alternate dosing regimen

Comparison between simultaneous versus staged bilateral total knee arthroplasty: a prospective, randomized, controlled study

Background: Bilateral total knee arthroplasty (TKA) is a common procedure nowadays. Although, staging of surgery is a subject of debate. We conducted a study to compare safety and functional outcomes of simultaneous and staged bilateral TKA.Methods: Our study includes total 70 patients of symptomatic severe bilateral osteoarthritis, underwent simultaneous or staged bilateral TKA during 2015 to 2019. 35 patients were randomly allotted for each procedure. The postoperative evaluations were done according to Knee Society Score at one, three, six and 12 months and yearly thereafter for 2 years following a simultaneous bilateral TKA (group A) and the second procedure in the staged bilateral TKA (group B).  In the staged group, the patients were followed at monthly intervals until the second procedure. The categorical variables were statistically significant when p value &lt;0.05.Results: As compared to staged procedure (group B), estimated blood loss was significantly less in simultaneous TKA (group A). Although, blood transfusion rate was significantly high in group A. The length of hospital stay was significantly shorter in group A. Overall complication rate (inpatient and/or 90 days readmission) was not significantly higher in group A. Knee infection rate was significantly lower in simultaneous TKA group. There was no revision of surgery and no mortality in any of our study group within 2 years of follow-up.Conclusions: Simultaneous bilateral TKA is safe and cost-effective procedure with acceptable complication rates for bilateral symptomatic end stage knee osteoarthritis

Gas Under Right Hemidiaphragm: A Rare Presentation of Unruptured Liver Abscess

A perforated liver abscess mimics hollow viscus perforations. It may be accompanied by pneumoperitoneum and peritonitis. A hollow viscus perforation appears to be the most common cause of gas under diaphragm. In about 10% of the cases, it can be due to rare abdominal and extra-abdominal causes. One of the causes could be intra-abdominal infection caused by gas-forming organisms. We are reporting a rare case of pneumoperitoneum resulting from an unruptured liver abscess in an old male with no comorbidity. An unruptured pyogenic right lobe liver abscess in a 70-year-old male was accompanied by X-ray flat plate abdomen features suggestive of free gas under the right hemidiaphragm. Culture of the pus drained from liver abscess grew Klebsiella sensitive to piperacillin and tazobactam, and antibiotic treatment was administered

Evaluation of Integrated Childhood Development Services (ICDS) program implementation in an urban slum of Delhi, India

Background: The Integrated Childhood Development Services (ICDS) scheme is India’s foremost program imparting comprehensive and cost-effective services to meet the multi-dimensional needs of children. Following a populist approach, the program has now increased its umbrella coverage to reproductive age, pregnant and lactating women. The impact of such development and existing program performance remain debatable due to the paucity of evaluation research.Methods: A mix-methods descriptive case study was done using adapted ICDS monitoring tool in a pre-identified slum. The slum was purposely chosen for its intensive habitation of the poor and marginalized population. Primary data were collected through personalized interviews with program staff, health functionaries, and community representatives. Secondary data were collected from records available at Anganwadi centre (AWC). The data were triangulated and analyzed with results being expressed in narrative, simple proportions and percentages.Results: The mean coverage of ICDS services was 58.3%. Maximum coverage recorded for Supplementary Nutrition (SN) and minimal for Nutrition and Health Education (NHE). SN, immunization, Pre-school education (PSE) and growth monitoring (0-3 years) were regularly held. Maternal and child health services were unsatisfactory. Poor community perception reported for AWC and ICDS services with exception of SN.Conclusions: Present case study unveils poor infrastructure, coverage and community participation for ICDS services. Immunisation and referral networking is often dysfunctional reflecting the need for enhanced intersectoral cooperation. Adapted tools could serve as an effective strategy for evaluating and facilitating need-based improvements

Serum zinc levels in decompensated liver disease and its correlation with hepatic encepalopathy.

The purpose of this study to assess serum Zinc levels in DCLD patients with various stage of hepatic encephalopathy and determine the role of Zinc deficiency in precipitation of hepatic encephalopathy. MATERIAL AND METHODS: The descriptive cross sectional study was conducted at Rajiv Gandhi Government General Hospital and Madras Medical College Chennai Total 75 cases, all patients above 20 year of age, both sex and diagnosed cases of DCLD, admitted in hepatic encephalopathy. All cases were further evaluated for serum Zinc and all patients were divided according to stage of hepatic encephalopathy and class of liver cirrhosis. The data was analyzed with statically soft ware (SPSS) and the p-value <0.001 was considered as statically significant. RESULT: In our study showed 96% male and 4% female, predominantly affected group between 30-50 year of age (63%). Most common aetiology was alcohol abuse (90%), more than 10 year duration. All DCLD patients in HE had low serum Zinc, low serum Zinc significantly associated with worse grade of HE and advanced class of liver cirrhosis (p-value 0.001). Our study also shown those patients have low serum albumin significantly associated with low serum Zinc (p-value 0.029) CONCLUSION: The inferences attained from the study are all patients in DCLD with hepatic encephalopathy identified low serum Zinc. More drops in serum Zinc is correlated with worse grade of HE, low serum Zn indirect precipitating factor of HE. Low Zn level also associated with higher class of cirrhosis and low albumin Short term Zn supplementation may be useful in prevention and treatment in HE patients

Micro-Mechanics of Re-entrant Hexagonal Auxetic Structures and Its Blast Resistance

Auxetics are mechanical meta-materials which exhibit negative Poisson’s ratio. In here, first study is focused on blast resistance of sandwich beams with an auxetic core having re-entrant hexagonal topology. We implemented the Fleck and Deshpande’s three stage momentum transfer model to estimate the dynamic structural response of auxetic cored sandwich beams

Association of sociodemographic characteristics with KAP regarding menstrual hygiene among women in an urban area in Delhi

Introduction: Menstruation despite being a natural process is linked with several misconceptions and false practices, which sometimes results in adverse health outcomes. The aim of this study was to assess knowledge, attitude, and practices regarding menstrual hygiene and their association with sociodemographic determinants among women in an urban area of Delhi.Materials and Methods: A community‑based cross‑sectional survey was conducted for a period of 1 year among 350 women age 18–45 years residing in an urban resettlement colony in Delhi. Semi‑structured questionnaire containing questions regarding subject’s demographic profile, their knowledge, attitude, and practices pertaining to menstrual hygiene was used. It had seven questions regarding knowledge and eight questions each about attitude and practices regarding menstrual hygiene, respectively. A 5‑point Likert scale was used to assess women’s responses to attitude questions. Practices satisfactory or unsatisfactory were based on UNICEF guidelines. Data were analyzed using SPSS software version 17.Results: The mean age of women was 26.53 ± 0.295 years. More than three‑fourths (88.3%) women had good knowledge, whereas only 32.3% of women had a positive attitude regarding menstrual hygiene. More than two‑thirds of the women were using sanitary pads as menstrual absorbent. Significant association was seen between knowledge and subject’s marital status (P = 0.034) and subject’s occupation (P = 0.046). A significant association was observed between attitude and socioeconomic status of the participant (P = 0.001).Conclusion: These findings indicate the need for education about healthy menstrual practices. Health education is an essential requirement to fill the knowledge gap to promote accessibility, availability, and sanitary facilities and products.Keywords: Attitude; knowledge; menstrual hygiene; practice

Comparative degradation analysis of accelerated-aged and field-aged crystalline silicon photovoltaic modules under Indian subtropical climatic conditions

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