Worship Traditions in Pictorial Poetry

Praying to a deity for the sake of devotion is called worship. Tolkappiyam, the oldest book of Tamil, beautifully demonstrates that the deity has always been given priority in Tamil society. Even today, when we start an activity, it is customary for the Tamil community to start worshipping the deities of their clans and the deities of their choice. Worship arises from the lifestyle of the worshippers. Faith in God arises on the basis of the kind of social system a society has created and the system in which it receives its external necessities of life, such as food, clothing, and books. Just as the deities worshipped differed, so did the methods of worship in various ways. This can be understood from the literature created during the respective periods. That the worship of God was the first act of any action is evidenced by the fact that whatever kind of literature it may be, it began with the prayer to God. The pictorial poems, which are highlighted as one of the four poets sung together with the richness of literature combining painting, mathematics, and musical skills, are often sung in praise of God. Although there are many varieties of pictorial poems, among them, the types of pictorial poems that are in the form of bandham (a type) are the vehicles of God and are written in a form of worship associated with a God, which enriches the cult tradition of the Tamil community. In this way, the study identifies the pictorial poems arranged in the categories of Naga Bandham, Peacock Bandham, Anna Bandham, Vel Bandham, Ratha Bandham, Sivalinga Bandham, Malai Bandham, and Kamala Bandham

KNOWLEDGE REPOSITORIES AND KNOWLEDGEABLE ACTION

In spite of the importance of knowledge reuse much is still unknown about how knowledge management artifacts influence reuse in practice. In this paper we use the concept of scaffolding to explore how knowledge repositories influence knowledgeable action. We conceptualize anchoring and adjustment as the processes involved in the use of scaffolding such as knowledge repositories. By viewing reuse in terms of these mechanisms, we can begin to consider the reuse processes individually as involving (1) choice of document for reuse and (2) adaptation of the document’s suggested solution applied to a current problem. We suggest the document acts as an anchor to frame the current problem consistent with the problem solved in the document, and that the suggested solution is then adapted through the adjustment process to meet the needs of the current problem. We subsequently explore the factors that influence both anchor choice and adjustment

Evaluation of different types of chest symptoms for diagnosing pulmonary tuberculosis cases in community surveys

Background: Prevalence of tuberculosis (TB) is an important epidemiological index to measure the load of the disease in a community. A series of disease surveys were undertaken in rural community in Tiruvallur district in Tamilnadu, south India Objective: To investigate the yield of pulmonary tuberculosis (TB) cases by different symptoms status and suggest predominant symptoms for detection of cases in the community based surveys. Methods: Three disease surveys were conducted during 1999-2006, in a random sample of 82,000 adults aged > 15 years to estimate the prevalence and incidence of pulmonary TB. All subjects were screened for chest symptoms and chest radiography. Sputum examination was done among those who were either symptomatic or abnormal on X-ray or both. Cases observed through symptom inquiry were included for analysis. Results: In survey-I, 65.6% had cough of > 14 days and yielded 79.1% of the total cases. In surveys II and III, symptomatic subjects with cough contributed 69.5% and 69.2% of the cases respectively. In survey I, 26.8% had symptoms without cough but with at least chest pain > 1 month contributed 8.4% of total cases. The corresponding proportions in subsequent surveys were 29.3, 11.5%; and 23.4, 11.2% respectively. The number of symptomatics without cough and chest pain but with fever > 1 month was negligible. Conclusion: The relative importance of cough as a predominant symptom was reiterated. The yield of pulmonary TB cases from symptomatics having fever of > 1 month was negligible. Fever may be excluded from the definition of symptomatics for screening the population in community survey

Survival of tuberculosis patients treated under DOTS in a rural tuberculosis unit (TU), south India.

Objective: To estimate survival probabilities and identify risk factors for death of tuberculosis (TB) patients during treatment period. Methods: TB patients registered during May 1999 to December 2004 from a rural TB unit (TU) with a population of 580 000 in Tiruvallur district, South India, formed study population. Life table and Cox’s regression methods were used. Results: Of the 3818 TB patients who were initiated on treatment, 96, 94 and 97% of category – I, II and III respectively, were surviving after completion of treatment. Higher death rates were independently associated with patient’s age (45 years), previous history of treatment, alcoholism and initial body weight (<35 kgs). Conclusion: The survival probability was found to be similar in all patients irrespective of categorization. Necessary actions need to be initiated in the programme to improve body weight and abstain from alcoholism

Weight gain in patients with tuberculosis treated under directly observed treatment short-course (DOTS)

Set up: One Tuberculosis Unit (TU) in Tiruvallur district, Tamil Nadu, India where Tuberculosis (TB) patients treated under Directly Observed Treatment Short Course (DOTS) programme. Objective: To identify the effects of weight gain among TB patients at the end of treatment on different factors such as socio-economic and demographic characteristics, smoking and drinking habits, treatment under supervision, the type of DOTS centres and problems in taking drugs. Methods: TB patients registered between May 1999 and December 2004 formed the study population. Multiple regression method was used for the analysis. Results: Among 1557 smear-positive TB patients registered under DOTS programme, the changes in weight ranged from a loss of 4 kgs to a gain of 20 kgs at the end of TB treatment; the average change in weight was 3.22 kgs. The gain in weight at the end of treatment was associated with age (<45 years), DOT at government centres, no problems in taking drugs as reported by patients and cure rate. Conclusion: The findings showed that there is an association between gain in weight with DOT at government centres and cure of patients

Value of dual testing for identifying tuberculous infection

Setting: A rural community in Chingleput district in Tamil Nadu state in south India. Objective: To determine the value of dual testing with PPD-S and PPD-B for identifying subjects with a tuberculous infection. Design: About 240,000 subjects in rural south India, all of whom were tested initially with PPD-S and PPD-B, were followed up for 15 years, mainly by total population survey once in every 212 years. The incidence of culture-positive tuberculosis was estimated using life-table technique. Results: Among 17,530 subjects with an intermediate reaction (8–11 mm) to PPD-S at intake, 285 with an induration to PPD-S exceeding the induration to PPD-B by at least 2 mm, had a significantly higher incidence of culture-positive tuberculosis than the remaining (154 and 93 per 100,000), and similarly 481 who had an induration of o10mm to PPD-B compared to those with X10mm (131 and 93 per 100,000). These subjects may be regarded as having a tuberculous infection. Infection with non-tuberculous mycobacteria conferred protection of about 30% against the development of tuberculosis over a 15-year period. Conclusion: In subjects with an intermediate reaction (8–11 mm) to PPD-S, dual testing with PPD-B enabled identification of those with a tuberculous infection. Most of the reactions were due to non-tuberculous mycobacteria

Impact of BCG vaccination on tuberculin surveys to estimate the annual risk of tuberculosis infection in south India

Background & objectives: Annual risk of tuberculosis infection (ARTI) computed from prevalence of infection measures the extent of tuberculosis transmission in the community and it is used to monitor the tuberculosis control programme. This is usually derived from tuberculin surveys among children not vaccinated with BCG. This study explores whether the estimated ARTI among BCG vaccinated children is comparable to that of unvaccinated children. Methods: Three tuberculin surveys were undertaken among children aged <10 yr as part of assessing the impact of DOTS implemented in Tiruvallur district, south India. The prevalence of infection was estimated using the anti-mode method among vaccinated and unvaccinated children. The ARTI was computed separately and compared in all the three surveys. Results: The prevalence of infection among unvaccinated and vaccinated children in the first survey were 7.8 per cent (95% CI: 7.1-8.6) and 7.9 per cent (95% CI: 7.1-8.8) respectively (ARTI was estimated to be 1.6 per cent in both groups) and the difference was not statistically significant. The corresponding figures for children test read in the second and third surveys were 6.9 per cent (95% CI: 6.2-7.6) and 6.8 per cent (6.0-7.5) and; 6.0 per cent (5.2-6.7) and 6.0 per cent (5.5-6.5) respectively. The computed ARTI was respectively 1.4 and 1.2 per cent among unvaccinated children in the second and third surveys; and 1.4 and 1.2 per cent among vaccinated children in the second and third rounds. Interpretation & conclusion: There was no difference in the infection with Mycobacterium tuberculosis among vaccinated and unvaccinated children. BCG vaccinated children may thus be included for estimation of infection to assess the extent of transmission in the community as well as for monitoring purpose

Failure to initiate treatment for tuberculosis patients diagnosed in a community survey and at health facilities under a DOTS programme in a district of south India

We studied the proportion and fate of tuberculosis patients who were not initiated on treatment (initial defaulters) in Tiruvallur district of Tamilnadu, where DOTS strategy was implemented. These patients were visited to find out the reason for default. Treatment was not initiated in 57 (23.5%) of the 243 sputum positive cases diagnosed in a community survey and 156 (14.9%) of 1049 patients diagnosed in health facility. Men were more likely not to have treatment initiated. The common reasons stated for initial default were unwillingness, symptoms being mild, personal reasons and dissatisfaction. There is an urgent need to improve the patient’s perception of treatment and strengthen the health systems’ capabilities to reduce initial default

Quality of symptom elicitation in an epidemiological survey on tuberculosis

The quality of symptom elicited by health workers in an epidemiological survey on tuberculosis was assessed by again subjecting a 10% random sample of the persons interviewed, by the supervisory staff, independently. Three thousand four hundred and forty nine persons were thus interviewed twice. The overall estimates for overdiagnosis and under-diagnosis in the elicitation of symptoms by health workers were to the extent of 16% and 8% respectively, with minimal yield of sputum positivity from the discordant groups of persons. The additional load of 16% for sputum examination can thus be considerably reduced if health workers are well trained in symptom-elicitationscreening of the population and their work is monitored through spot supervisory checks

A Prospective study of functional outcome of bicondylar tibial plateau fracture managed with locking compression plate

INTRODUCTION: Tibial plateau fractures account for 1% of all fractures in adults and 8% in elderly. Fractures of tibial plateau more common in recent days due to increasing number of road traffic accidents. These fractures resulting from direct axial compression (valgus) and indirect coronal forces. The injuries span a wide spectrum, ranging from low energy unicondylar fractures to high energy bicondylar and comminuted fractures. In addition, in elderly with osteoporotic bones, even low energy injuries such as domestic falls may lead to complex tibial plateau fractures. Hence the treatment of proximal tibial fractures has become a challenge for the orthopaedic surgeons. LCP has the advantages of better distribution of forces along the axis of bone. They can be inserted with minimal soft tissue stripping using minimally invasive percutaneous plate osteosynthesis (MIPPO). Substantially reducing failure of fixation in osteoporotic bones. Reducing the risk of a secondary loss of intraoperative reduction by locking with screws to the plate. Unicortical fixation option. Better preservation of blood supply to the bone as a locked plating does not rely on plate bone compression. Provide stable fixation by creating a fixed angle construct and angular stability. LCP is technically mature and as it offers numerous fixation possibilities and has proven to worth in complex fracture situations and in osteoporotic bones. AIM OF THE STUDY: This prospective study aims at evaluating the functional outcome of schatzker type V and VI tibial plateau fracture treated by locking compression plate at Department of orthopaedics and Traumatology ,Govt Mohan Kumaramangalam Medical college and Hospital ,Salem Between May 2012 and August 2014. MATERIALS AND METHODS Our study was a prospective study, conducted at the Department of Orthopedics and Traumatology, Government Mohan Kumaramangalam Medical College and Hospital, Salem between May 2012 and August 2014. Inclusion Criteria: Schatzker type V and VI tibial plateau fractures, Age > 18 years, Closed fractures, Grade I compound fractures. Exclusion criteria : Age < 18 years, Grade II and III compound fractures, Associated with vascular injury, Pathological fractures. DISCUSSION: We presented the clinical study of surgical treatment of 27 proximal tibial plateau fractures treated with locking compression plate ..The analysis of the results made in terms of age of patients, gender distribution , Laterality of fracture ,mode of injury , analysis of the types ,medial condyle fracture planes ,primary bone grafting ,method of reduction and fixation ,pre operative external fixation , dual plating , associated injuries and complications . In our study maximum incidence involving tibial plateau fracture >40 yrs (81%) . Average age group in our study was 51.25 years compared to Gosling et al 2005 study (Average age group 51.5 years) CONCLUSION: At the end of our study, following conclusions could be drawn from the treatment of proximal tibial fracture with locking compression plate. Early mobilization is possible with LCP because of absolute stability given by the implant and this contributes to better knee range of motion . Medial condyle coronal fracture and small posteromedial fragment should be buttressed by posteromedial plating . LCP gives the promising results in osteoporotic bones .It prevents collapse of fracture both intraoperatively and postoperatively . Not all bicondylar fractures are same ,treatment should be precise to individual fracture pattern . Bicondylar tibial plateau fractures treated with locking compression plate have an excellent to good functional outcome with very minimal wound complication