Global Journal For Research Analysis (GJRA)
Global Journal For Research Analysis (GJRA) is a double reviewed monthly print journal that accepts research works from scholars, academicians, professors, doctorates, lecturers, and corporate in their respective expertise of studies. Work after publication will be retrievable on the website bifurcated based on issues of the month and its publication date. The journal is published on every 15th of the Month
A PROSPECTIVE RANDOMISED COMPARITIVE DOUBLE BLIND STUDY TO DETERMINE THE DURATION OF ANALGESIA OF BUPRENORPHINE AND DEXAMETHASONE AS ADJUNCTS TO BUPIVACAINE IN SCIATICO-POPLITEAL AND SAPHENOUS NERVE BLOCK FOR BELOW KNEE SURGERIES.
BACKGROUND: Adjuvants to local anaesthetics improve the block properties and reduce opioid consumption. This study compared combination of local anaesthetic bupivacaine with buprenorphine and dexamethasone in ultrasound guided sciatico-popliteal and saphenous nerve block for below knee surgeries. STUDY DESIGN: A prospective, double-blind, randomized, comparative study. MATERIAL AND METHODS: 82 patients posted for elective or emergency below knee surgeries were randomly divided into 2 groups. Group X received 25ml block solution made up of 2mg/kg of 0.5% bupivacaine with 2mcg/kg buprenorphine and normal saline and group Y received 25ml block solution made of 2mg/kg of 0.5% bupivacaine with 0.1mg/kg dexamethasone and normal saline. Onset of sensory block, onset of motor block, duration of analgesia, hemodynamic parameters, and side effects were noted in each group. RESULTS: The mean time of onset of sensory block was earlier in group X (6.730±1.871 min) as compared to group Y (11.340±3.038min). The mean time of onset of motor block was also rapid in group X (9.000±2.121 min) than in group Y (13.020±2.286min). The mean total duration of analgesia was longer in group Y (1098.000±169.216) as compared to group X (794.070±145.084). There was no significant difference in the mean duration of motor block between the groups. Both the groups were hemodynamically stable, and no significant side effects were noted. CONCLUSIONS: Onset of sensory and motor blockade was faster in the buprenorphine group, however duration of analgesia was much longer in the dexamethasone group without any significant side effects.
Copyright (c) 2020 Global Journal For Research Analysis (GJRA)
DURATION OF INTENSE PARALYSIS FOLLOWING INDUCTION OF NEUROMUSCULAR BLOCKADE USING CISATRACURIUM VS ATRACURIUM AS ASSESSED BY TRAIN OF FOUR STIMULATION: A PROSPECTIVE RANDOMISED COMPARATIVE DOUBLE BLIND STUDY
BACKGROUND: This study was undertaken to determine the duration of intense muscle paralysis after the initial paralyzing dose of Cisatracurium and Atracurium which are intermediate acting non-depolarizing neuromuscular blocking agents. METHODS: After obtaining informed consent, 84 ASA 1 and 2 patients, 18 to 58 years scheduled for elective surgery under general anaesthesia with paralysis were included in the study. Patients were randomized to receive either Atracurium 0.5 mg /kg or Cisatracurium 0.1 mg /kg to facilitate tracheal intubation. Premedication and induction were similar for all patients .The duration of intense paralysis was assessed by delivery of supramaximal Train Of Four (TOF) stimuli on the adductor pollicis using a peripheral nerve stimulator.The time between disappearance of the response and reappearance of the first twitch in TOF was taken as the duration of intense paralysis. RESULTS: There was a statistically significant difference in the duration of intense paralysis between the two drugs. The duration of intense paralysis of Cisatracurium was longer than Atracurium with no statistical difference in onset of action. CONCLUSION: Although both Atracurium and Cisatracurium are intermediate acting non-depolarizing drugs Cisatracurium provides longer duration of intense paralysis than Atracurium.
COMPUTED TOMOGRAPHY (CT) SCAN EVALUATION OF STROKE PATIENTS IN RADIODIAGNOSIS DEPARTMENT OF RIMS, RANCHI
Introduction: Advances in care in the course of recent years have extraordinarily improved the result for stroke patients with a decrease in mortality and more patients at last accomplishing autonomy. Computerized Tomographic (CT) scanning is the gold standard when it comes to choosing for the imaging modality in patients coming in emergency department with stroke presenting with some neurologic deficit or other associated features. Methodology: A cross sectional study of the available CT records for patients coming with stroke in RIMS Ranchi was evaluated from Feb 2018-Aug 2018 after seeking appropriate clearance. Data thus collected were analyzed using SPSS version 16 using standard statistical methods like mean, standard deviation, chi square test of significance etc. P values of <.05 were considered to be of statistical significance. Results: A total 275 patients were included in the evaluation . In this study we found that the average age for male particiapnts were 55.75 ±7.99 while females were having a mean age 53.07 ± 11.85 . 25% of the patients with Stroke were not diagnosed as hypertension cases while most patients recorded a GCS in mild category (44% ), while more stroke incidents were infarct in nature ( 51%) followed by hemorrahgic incidenes (21%) . Cerebrovascular incidents were right side (51%) on location while mixed location findings were (21% ). Conclusion: Our investigation shows that Ischemic stroke is comoner than hemorrhagic in patients and greater part happened in the older patients. Computer Tomography (CT ) is an exceptionally valuable instrument in making the analysis of stroke just as separating hemorrrhage from ischemia which is useful in treatment of stroke patients.
SEPSIS AS A MORTALITY INDICATOR IN ACUTE KIDNEY INJURY PATIENTS IN ICU
Sepsis is an extreme and dysregulated inflammatory response to infection that is distant from the primary site of infection resulting in end-organ damage. Appearance of acute kidney injury (AKI) during sepsis raises patient morbidity, predicts higher death rates, has a significant effect on functions of multiple organs, is associated with a prolonged duration of stay in the intensive care unit, and hence warrants appropriate healthcare resources. Pathophysiology, diagnostic procedures and appropriate therapeutic interventions in sepsis are still highly debatable despite impressive advances in several medical fields. The overwhelmingly high mortality rate of sepsis is not reduced despite multiple immunomodulatory agents showing promise in preclinical studies. Major obstacles to progress in understanding, early diagnosis, and implementing effective therapeutic modalities in sepsis-induced AKI comprise minimal histopathological data, few animal models closely emulating human sepsis, and a relative lack of specialized diagnostic tools. Here we analyse 100 ICU patients who developed AKI and sepsis as a major etiological factor as well as mortality indicator.
TO STUDY THE OUTCOME AND COMPLICATIONS OF SNODGRASS URETHROPLASTY IN HYPOSPADIAS REPAIR USING SPONGIOPLASTY AS AN ADDITIONAL COVER
Aim: To study the result and complications encountered in the Snodgrass urethroplasty for hypospadias repair using spongioplasty as additional cover. Materials and Methods:This study was done to follow and evaluate the outcome of hypospadias in whom Snodgrass urethroplasty along with spongioplasty was done. All cases were studied after proper sampling (n=30) between November 2016 to April 2018. The patients were called for follow-up every week for two weeks, at three months and after one year. The minimum period of follow-up in this series was of three months. The clinical details of the patients were recorded according to the Proforma. Results: Out of 30 patients who had Snodgrass repair with spongioplasty, 01 were with significant chordee which was corrected after degloving and 29 were without chordee. Out of total 30 patients who had Snodgrass urethroplasty, 24 patients urethral plate was well formed and grooved, whereas 6 patients had wide and flat urethral plate. Among 30 patients, 24 patients were operated within 1 hrs and 6 patients were operated in more than 1 hrs to 1.25 hrs. In our study of 30 patients hospital stay was of up to 10 days in 18 patients and 11 days in 12 patients. Meatal stenosis was noted as a common complication. The incidence noted was 10% (3 out of 30 cases). Waterproofing with well vascularized spongioplasty prevent from meatal stenosis. Meatal stenosis itself increases resistance in urinary flow and predispose to fistula formation which is a dreaded complication of hypospadias surgery. In 1 case it was associated with urethra cutaneous fistula. In rest 2 cases it was improved by dilatation with feeding tube 8 Fr. In our study of 30 cases, 3 patients developed urethro-cutaneous fistula out of which all 3 healed conservatively. 3 patients developed fistula in patients with distal penile hypospadias, In all three a small coronal fistula was noticed on first follow-up. At the time of discharge they did not have a fistula. Meatal stenosis was observed with one of them,when the fistula was noticed. With regular dilatation of the meatus for a period of 3 months the fistula closed spontaneusly. 2 cases had urethrocutaneous fistula corresponding to incidence of double stream. In our study of 30 cases we achieved satisfactory cosmetic appearance post surgery in 27 cases (90%). Poor cosmetic results were achieved in 3 cases (10%) in the form of torsion, necrosis and residual edema each in different patients. Conclusion: Spongioplasty is a simple method to provide additional covering to the constructed neourethra, which achieves the goal of non-crossing suture lines and maximum vascularity.
Type 2 diabetes mellitus (T2DM) is characterized by relative insulin deficiency, decreased peripheral and hepatic sensitivity to insulin and raised plasma glucose levels1. T2DM treatment begins with lifestyle interventions, before progressing to pharmacological interventions with advancing disease. Despite the introduction of numerous anti-hyperglycemic medications, many patients with T2DM require insulin, and basal insulin continues to be frequently used either as first-line insulin treatment or as part of multiple daily injection regimens 2. Oral hypoglycemic agents are effective agents for diabetes management, although secondary drug failure rates of 5-10% are bothersome. The disappointing results with monotherapy especially the worsening metabolic control is often seen within five years after the initiation of an oral hypoglycemic agent, with more than 50% patients requiring shifting to the insulin-based regimen to achieve optimal glycaemic control3. Basal insulin therapy is recommended if lifestyle modifications and oral antidiabetic agents fail to maintain HbA1c levels <7.5% and has been shown to improve glycemic control4. This highlights the fact that adequate basal insulin levels are an essential component of diabetes management. The ideal basal insulin should provide a sustained level of insulin, mimicking physiological basal insulin secretion, reproduce physiological basal insulin secretion, thereby restoring glycemic control, without hypoglycemia1. Such therapy should have relatively flat/constant insulin concentration profile over time, no pronounced peak, duration of action of at least 24 h, low within-patient variability in fasting plasma glucose (FPG), a favorable safety profile, including low risk of hypoglycemia and weight gain, and be easy to administer and titrate2. However, traditional insulin does not fully accomplish this goal. This stimulated the search for insulins with a more prolonged duration of action that could better replicate the physiological basal insulin secretory response5. This eventually led to the development of basal insulin-like, Neutral (porcine) protamine Hagedorn (NPH) insulin, Lente insulin, insulin detemir, etc. Still, all these variants are also not able to achieve the desired therapeutic insulin levels. For instance, NPH insulin, intermediate-acting insulin, has a duration of action that is considerably less than 24 h and an activity profile that peaks 3–5 h after administration. NPH insulin administered at bedtime results in high insulin levels when insulin requirements are low. This activity profile is not ideal as it increases the risk of nocturnal hypoglycaemia1.
ROLE OF TELMISARTAN IN DIABETIC NEPHROPATHY A NOVEL TREATMENT AVENUE
Globally, the prevalence of diabetes mellitus is continuously escalating. The complications of chronic diabetes mellitus include retinopathy, neuropathy, nephropathy, cardiomyopathy, and vasculopathy. Diabetes mellitus is the leading cause of renal failure and approximately 20-30% of all diabetic subjects develop evidence of diabetic nephropathy manifesting from microalbuminuria to macroalbuminuria and renal failure. Nephropathy is one of the major complications of uncontrolled diabetes mellitus. The renal pathologic alterations of diabetic nephropathy are associated with glomerular basement membrane thickening, mesangial cell expansion, glomerulosclerosis, interstitial fibrosis, podocyte loss, and tubular atrophy. These renal alterations during diabetic nephropathy could result in albuminuria, a decrease in glomerular filtration rate (GFR) and an increase in serum creatinine and urea nitrogen levels1. The renin-angiotensin system (RAS) plays a pivotal role in the pathogenesis of diabetic nephropathy2.
ADDITION OF VOGLIBOSE TO THE DUAL COMBINATION THERAPY OF GLIMEPIRIDE AND METFORMIN IN THE MANAGEMENT OF TYPE 2 DIABETES
Type 2 diabetic patients are often treated with a combination of antidiabetic agents. The need to use drugs with different and complementary mechanisms of action frequently arises in daily clinical practice. There are several reasons to do this; namely, the disease itself is progressive, with the deterioration of glycemic control over time, and monotherapeutic attempts to achieve and maintain glycemic control often fail in the long run1. Some patients do not accept insulin treatment because of the fear of needles and injections, the fear that the complications of diabetes are caused by insulin, and other false beliefs, and are willing to take as many anti-diabetic pills. Several pharmacological agents have been developed to treat patients with type 2 diabetes mellitus. They either improve insulin resistance (biguanides and thiazolidinediones), stimulate insulin secretion from the β-cell (sulphonylureas and metaglinides), or decrease glucose absorption from the gut (α-glucosidase inhibitors)2. Metformin monotherapy is initially recommended along with lifestyle modifications (increased physical activity and weight loss) for glycemic management of type 2 DM. However, if glucose levels are not controlled in patients with type 2 diabetes, other classes of antidiabetic agents are then additionally required. Coadministration of glimepiride and metformin has been used to achieve glucose control3.
COMBINATION OF EMPAGLIFLOZIN AND LINAGLIPTIN: NOVEL AGENTS FOR MANAGING DIABETIC KIDNEY
The number of patients with type 2 diabetes is rapidly increasing, and type 2 diabetes is one of the most common chronic diseases. Diabetic kidney disease (DKD) is among the most important complications of diabetes and often leads to the need for renal replacement therapy, including dialysis and renal replacement1. Thus, patients with diabetes represent a significant global health burden. The increasing incidence and prevalence of DKD places significant health burdens on patients and costs on our already stressed healthcare system2. The Diabetes Control and Complications Trial (DCCT), performed in patients with type 1 diabetes, and the United Kingdom Prospective Diabetes Study (UKPDS), in patients with type 2 diabetes, revealed that intensive glycemic control might inhibit the progression of DKD. Thus, hyperglycemia could be a major factor in the progression of DKD. However, DKD develops despite good glycemic control. Thus, novel therapeutic agents beyond those for glycemic control in patients with DKD are needed1. There are about 200 million people in the world with DKD in different stages, and hypertension, arteriosclerosis and diabetes mellitus are responsible for over 50% of end-stage renal disease. About 40% of patients with (diagnosed or not) diabetes mellitus has an advanced stage of kidney disease, often because of serious deficiencies in the management of the disease itself. In patients with diabetes mellitus, kidney disease occurs and often develops insidiously; the main renal dysfunctions are due to the thickening of the glomerular basement membranes, the formation of microaneurysms and the development of mesangial nodules3. The onset of a clinically documented diabetic nephropathy is generally preceded by the appearance of proteinuria greater than 500 mg/day4. Conventional therapies used in patients with type 2 diabetes mellitus include medications such as metformin, sulphonylureas, thiazolidinediones, meglitinides, and insulin. Except for pioglitazone, which is a thiazolidinedione, all other drugs require dose adjustments and an immediate suspension in patients with a reduction in the glomerular filtration rate (eGFR). In these cases, in fact, there is the risk of development of lactic acidosis (metformin) or hypoglycaemic episodes (sulfonylureas, meglitinides, and insulin)3.
FETOMATERNAL OUTCOME OF ANEMIA IN PREGNANCY
Objective: To determine the frequency of women having pregnancy with severe anemia, its maternal complications and feto-maternal outcome. Study Design: D A total of 186 pregnant women was included from Obstetrics and Gynecology Department of M.L.B. Medical College Jhansi. The study was conducted from March 2019 to August 2019 to all the women admitted for delivery with gestational age ≥ 34 weeks. Results: Thirty-five (19%) women were diagnosed with anemia among which 12(6.5%) women had severe anemia, 4(2.2%) had mild, and 19(10.2%) had moderate anemia. The frequency of PIH (37.14%), PPH (17.14%), Low birth weight (62.68%) and APGAR score<7 (60%) was noted higher in anemic patients. Conclusion: There were significantly higher maternal complications among anemic women as compared with non-anemic women. The fetal complications that is Low Birth Weight and APGAR <7 at 5 minute has also been found significantly associated with maternal anemia.
SURGICAL ANATOMY OF EXTERNAL LARYNGEAL NERVE IN RELATION TO THYROID SURGERY : OUR EXPERIENCE
Objectives - To Study Surgical Anatomy of External Laryngeal Nerve and it’s variation in relation to Thyroid Surgery. Methodology – A Non-randomized prospective Study was conducted in patients undergoing Thyroid surgery in SAIMS, Indore. The ELN was identified and preserved intra operatively. The function of Nerve was assessed and documented by pre op & post op EGG and Video laryngoscopy. Results- Intraoperative identification of ELN leads to almost negligible changes in voice quality. A permanent drop in Fundamental Frequency (Fo) was seen in significant number of patients when the nerve was not identified during surgery. Conclusion - Today in the era of 21st century where we are reaching new horizons, efforts to further refine thyroid surgery continues. Good range of voice is not only important for Singers but for Teachers, Politicians, RJ, public speakers etc too. An attempt to preserve External Laryngeal Nerve should be done to preserve Voice Quality as an integral part of surgery.
In this modern era of globalization people are very busy in their own work and focuses only on his career as a result they do not care about their health to save time they eat instant, packaged food or unhealthy food resulting many peoples are suffering from so many digestive problems like loss of appetite, weak digestion constipation, diarrhea, piles etc. Ayurveda, traditional system of Indian medicine is very rich about herbal medicine, Bilva is very useful& common herbal medicine. The word Bilva is derived from ‘bil’ to split. Ya– ska derived this word from bhr. ‘to support’ or ‘to nourish’, or from bhid ‘to split’. Bilva consists of dried stem bark of Aegle marmelos Corr. (Fam. Rutaceae), an armed, medium sized tree occurring in the plains and upto 1000 m in the hills as well as cultivated throughout the country, particularly in sacred groves.1Bilva has been conserved since ages.2 More than 15 synonyms of Bilva are depicted in Ayurvedic texts, like Shandilya, Shailush, Shreephal, Maloor, Gandhgarbh, Kantaki, Sadaphala, Mahakapittha, Granthil etc.3 Bilva (Aegle marmelos Corr.) belongs to Plantae kingdom, Geraniales order and Rutaceae family4. Vernacular names of Bilva are Bela or Bilva in Bangala, Bael or Baela in Marathi, Vilvam in Tamil, Bill or Billum in Gujarati, Bela in Oriya, Maredu in Telugu, Belin Urdu and Bengal quince in English5.
COMPARATIVE EVALUATION OF APICAL EXTRUSION OF DEBRIS DURING ROOT CANAL PREPARATION USING FOUR DIFFERENT FILE SYSTEMS
The success of root canal therapy is determined by proper access cavity preparation, biomechanical preparation and three dimensional obturation. Microorganisms that are apically extruded during chemo-mechanical preparation causes the host to be compromised by a more number of irritants than before. The aim of this invitro study is to quantitatively evaluate the apically extruded debris during the root canal instrumentation using Protaper Hand, Protaper Next, Protaper Gold, Wave one single file systems. 60 freshly extracted human mandibular incisors were selected and divided into four groups according to the file system used for biomechanical preparation. Apical extrusion of Debris was seen in all groups during the root canal preparation procedure regardless of the instrument or the preparation technique used. Protaper hand file extruded greatest amount of debris whereas Protaper next extrude less amount of debris when compared to that of other file systems (P< 0.05).
NON-SURGICAL ENDODONTIC TREATMENT OF EXTRAORAL OROCUTANEOUS SINUS TRACT: A CASE REPORT
The development and progression of endodontically induced periapical lesions is clearly associated with the presence of microorganisms in the root canal system. The present case report discusses diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin in relation to a mandibular right permanent first molar with closed apex (diagnosed as non-suppurative periradicular periodontitis with an extraoral cutaneous sinus tract opening in the left side of mandibular posterior region). Conservative endodontic therapy was performed using triple antibiotic paste as intracanal medicament. Patient responded well with the treatment approach and the cutaneous lesions was healed uneventfully. In the absence of any clinical symptom complete obturation was done in mandibular right first permanent molar. Patient was kept on regular follow-up.
A CASE REPORT OF VASCULAR ECTASIAS OF GI TRACT PRESENTING AS OCCULT GASTRO-INTESTINAL BLEED DIAGNOSED ON CAPSULE ENDOSCOPY
Obscure GI bleed is a condition when there is definitive Gastro-Intestinal(GI) bleed, whose source remains elusive despite an initial negative Upper-GI endoscopy and a colonoscopy1. Occult GI bleed can occur anywhere in the GI tract. But the diagnosis becomes extremely tricky when endoscopic reports are negative for gross bleeds. The newer diagnostic modalities like Capsule Endoscopy (CE ) thus perfectly fit into this vacuum of diagnostic modalities. We report one such case diagnosed by Capsule Endoscopy.
FREQUENCY OF ABNORMAL KIDNEY FUNCTION TESTS IN PATIENTS WITH DIABETES MELLITUS TYPE 2
Background –In this study, we determined frequency of abnormal kidney function tests in patients with diabetes mellitus type 2 and its glycemic profile .Method- This is an prospective study on patients diagnosed with diabetes mellitus type 2 in Geetanjali Medical College and Hospital, Udaipur.83 cases were included in the study.Kidney function tests along with other blood routine tests were done.Results The mean creatinine with standard deviation was 1.453±1.337 .The mean uric acid with standard deviation was 6.06±1.37 . The mean RBS with standard deviation was 240.70±97.64 . There was no statistically significant difference among the mean of normal and abnormal KFT patients for Hb, TLC, PC, Na, k, Cl and RBS as their p value was >0.05. However, there was statistically significant difference among the mean values of normal and abnormal KFT patients as the p value for the following was <0.05. Conclusion- This study concludes that biochemical parameters of kidney functions are associated with a worsening in insulin action and predicts the development of Type 2 diabetes. The study also revealed that in order to prevent the progression of diabetes mellitus to diabetic nephropathy, vigilant monitoring of serum urea and creatinine would help in the early diagnosis of renal failure and could make treatment possible.
CORRELATION BETWEEN SERUM PROLACTIN LEVEL AND ACUTE ISCHEMIC STROKE
Background- In this study, we determined serum prolactin level in patients with acute stroke and assessed its relationship with disease severity. Method- This is an observational, case control study on patients diagnosed with acute ischemic stroke in Geetanjali Medical College and Hospital, Udaipur.50 cases and 50 controls were included in the study.Serum prolactin level along with other blood routine tests were done.Results- The mean age group in cases was 60.04±2.04 years and in control was 48.76±2.399 years. Male preponderance was seen in both cases and control.Mean serum prolactin level in cases was 39.678±5.488 and in control was 9.998±0.942 ng/ml, this difference was statistically significant at p value of <0.05. The correlation between serum uric acid levels and severity of stroke on basis of GCS score was not significant. Conclusion- This study concludes that Serum prolactin level can be used as pathological biomarker in patients of acute ischemic stroke but of severity of disease cannot be predicted by its levels.
PATTERN OF CAUSE OF DEATH IN UNCLAIMED/ UNIDENTIFIED /UNKNOWN DEAD BODIES : A TWO YEAR RETROSPECTIVE STUDY.
Patna is one of the largest city (both in terms of population and area) as well as the capital city of Bihar. Every year thousands of people from different regions of Bihar throng to the capital city in search of job. When these people die without any identifying document, it is very difficult to establish their identity and cause of death as their past medical and other histories are not known. The present 2 yrs. of retrospective study was undertaken to find the cause of death and its pattern in unknown/unidentified/ unclaimed dead bodies brought for autopsy at Nalanda Medical College & Hospital (NMCH), Patna, between Jan 2016 to Dec 2017. A total of 829 cases were brought for medico-legal autopsy of which unknown cases accounted for about 14.95%. The manner of death was certified as natural in 32.25% of cases in which chest and abdominal disease combined were mainly responsible with a predominant pathology in the lungs (80% cases). Of all unnatural deaths (63.70%), road/rail accident injuries were most common (21.77%) cause of death followed by drowning (20.96%). There was a clear predominance of males cases (66.93%) over female one. The government should take initiatives at large to prevent unnatural deaths in unidentified or unknown persons. The study suggest an urgent need for creation of a National Missing Person Database as well as DNA database to aid the identification of unidentified/unclaimed/unknown bodies.
DENGUE AND ENTERIC FEVER CO-INFECTION : A KNOWN ENTITY?
Introduction In this paper, we describe five cases of Dengue fever and Enteric fever co-infection. Material and Methods The study design used was a cross sectional descriptive study. Results All the five cases which occurred during the period of study were confirmed by blood culture for salmonella typhi and NS1 Antigen for dengue fever. There were no complications or fatalities. Discussion Co-infection with Dengue and Enteric fever has been reported by several workers in India as well as abroad. In our study we have reported five cases of culture positive Salmonella typhi out of eleven cases of dengue fever. Recommendations While dealing with cases of dengue, co-infection with enteric fever should always be kept in mind. Conclusion: The workers emphasize that the risk factors predicting the presence of such co-infections, if identified, will certainly go a long way in controlling the incidence of dengue and typhoid co-infection.
THE STUDY OF SERUM CALCIUM LEVEL IN ESSENTIAL HYPERTENSION IN COMPARISION WITH NORMOTENSIVE SUBJECTS
Hypertension is one of the leading causes of death and disability among adults all over the world and emerging health problem in India. Alterations in the intracellular free Calcium regulation as well as disturbances of extracellular calcium homeostasis have been observed in patients with essential hypertension. To study the levels of serum Calcium in patients with primary hypertension and correlate the serum Calcium levels with severity of disease. Information for the study was collected from patients admitted to S.NIJALINGAPPA MEDICAL COLLEGE AND HANGAL SHRI KUMARESHWAR Hospital and Research center, Bagalkot from April 2018 to August 2019. Patients met inclusion criteria were studied. A Comparative Study was done. Serum calcium was done in total 164 patient which were divided equally in 3 groups Stage I Hypertensives, Stage II Hypertensives, and Controls, 41 patients in each groups of Hypertension and 82 patients in control group, results were obtained compared. In patients of Essential hypertension mean serum Calcium levels were found to be low in comparison to Normotensives. Further, Stage II Hypertensive patient has more reduced levels of serum calcium than Stage I hence low Serum Calcium levels were associated as the severity of the disease increases.
˝EVALUATE THE STATUS OF SERUM 25-HYDROXYVITAMIN D WITH URINARY ALBUMIN CREATININE RATIO AND TO SEE ITS ASSOCIATION WITH ECG CHANGES IN CHRONIC KIDNEY DISEASES
Aims: Evaluate the status of serum 25-Hydroxyvitamin D with Urinary Albumin Creatinine Ratio and to see its association with ECG changes in chronic kidney diseases. Study Design: Cross-sectional study. Place and Duration of Study: Department of Biochemistry, Department of Medicine, Department of Nephrology Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh between June 2019 to November 2019. Methodology: 100 known or newly diagnosed CKD patients above 18 yrs of age were included. Patients on dialysis, Vitamin D therapy, obstructive nephropathy, gout, or having H/O IHD were excluded from the study. eGFR was calculated by CKD-EPI formula and patients were grouped into various stages of CKD based on KDOQI classification. Spot urinary albumin(immunoturbidimetric method) and urinary creatinine(buffered kinetic Jaffes reaction) were done on Cobas Integra 400 Plus and ACR was determined. Albuminuria (ACR) categories in CKD were listed as A1 : <30mg/g ; A2: 30-300mg/g and A3: >300mg/g Quantitative determination of total 25‑hydroxyvitamin D in human serum was done on Cobas e411 based on electrochemiluminescence binding assay. 25-OH vitamin D deficiency , insufficiency and sufficiency were defined as levels <30 nmol/L , 30-50 nmol/L and > 50 nmol/L.12 lead ECG was done at the time of admission and interpretation done by a qualified physician based on accepted standard criteria. Result: Out of 100 CKD patients 45 were in stage V, 36 in stage IV,14 in stage III and 5 were in stage II. 94% of patients were found to have vitamin D deficiency. 72% had vitamin D <30 nmol/L out of which 88.8% patients were in Stage IV and stage V CKD. Mean ACR was 344.9±163.5. A significant association was observed (p<0.05) between ACR and Vitamin D as well as severity of CKD and Vitamin D deficiency. ECG abnormalities were observed in 75% patients with 57% ECG abnormality present in CKD patients with vitamin D <30nmol/L. Significant association (p<0.05) was observed between Vitamin D status and ECG abnormalities. Conclusion: 25-hydroxyVitamin D has been observed to have a renoprotective as well as cardioprotective role in CKD patients. This study can be of immense utility for alleviating progression and cardiovascular risk in CKD patients
CYTOMORPHOLOGICAL SPECTRUM OF SALIVARY GLAND LESIONS: A ONE YEAR STUDY
FNAC has a good sensitivity, specificity and accuracy in early diagnosis and management of salivary gland lesions. The present study was carried out on 65 patients presenting with palpable enlarged salivary mass or nodule in the Cytopathology section over a period of one year from January 2019 to December 2019 with the aim of categorizing the lesions among females and males, studying age incidence & site. Most common age group involved was 41-50 years and male showed predominance over females. Parotid gland was the commonest gland involved. Pleomorphic adenoma (38.4%), mucoepidermoid carcinoma (6.1%), sialadenitis (4.6%) were the most common benign, malignant and inflammatory lesions respectively in the present study. FNAC for palpable salivary gland lesions is a diagnostic and therapeutic asset.
EVALUATION OF THE PRACTICE OF SELF MEDICATION AMONG OUTPATIENTS AT NALANDA MEDICAL COLLEGE, A TERTIARY CARE TEACHING HOSPITAL OF PATNA
BACKGROUND: There is no separate over the counter (OTC) category in India. Drugs that are not included in the list for prescription-only drugs are pictured as non-prescription drugs. Prescription-only drugs are those that fall under Schedule H, H1 & Schedule X of drugs and cosmetics rules 1945.The OTC Drug market is increasing internationally and India ranks 11th in the global OTC market. In spite of the existing rules & regulations, in the absence of a clear definition & legal recognition to OTC products & ease of access to various medications, it seems difficult to curb the rising tendency towards self-medication which is highly prevalent in India. OBJECTIVE: To evaluate the practice of self-medication and find out the indications, reasons, category of drugs used, source of information for self-medication, knowledge about the purchased medicine and public opinion regarding self-medication practice in a tertiary care hospital of Patna. MATERIALS AND METHODS: A questionnaire based cross sectional observational study was carried out at Nalanda Medical College & Hospital, Patna among 602 patients for a period of 4 months from April 2019 to July 2019. Descriptive data analysis was done and reported in frequencies and percentage. RESULTS: Prevalence of self-medication in our study was found to be 55%. Frequency of self-medication was found to be once in 39% of the patients. Main reason for self-medication was cost effectiveness(25%) followed by previous experience(24%), the indications most commonly being pain(32%) followed by respiratory infections(17%). We found analgesics (34%) to be the most commonly used drug for self-medication. Around 30% of the patients had some knowledge about the medicines purchased. Most of them(61%) believed that it is an acceptable practice in case of minor illness. CONCLUSION: Self-medication appears to be a double-edged sword. Our study reflects the prevalence and practice of self-medication in this area. Imparting knowledge about frequently used medications, conditions to be considered as a minor illness, the upsurge of antibiotic resistance, importance of package inserts & expiry dates, advantage of consulting a medical practitioner in contrast to a pharmacist at medical stores and pros & cons of self-medication as a whole, would definitely help balance this concept.
SIGNIFICANCE OF SEROLOGICAL MARKERS AND PLATELET COUNT IN DIAGNOSING DENGUE INFECTION WITH SPECIAL REFERENCE TO NS1 ANTIGEN
INTRODUCTION: Dengue , a viral infection with a potentially fatal outcome ,it has become an endemic in India and its outbreak occurs every year. since the mainstay of diagnosis is antibody detection which has high false positive and false negative values, newer parameters are upcoming for diagnosis. AIM: To study the importance of newer accessory parameter platelet count in diagnosing dengue infections MATERIALS AND METHODS: This is a retrospective study conducted in general medicine department of S Nijalingappa medical college and HSK hospital, Bagalkot. 4ml blood sample collected from admitted patients suspected with dengue fever and the samples screened for NS1 antigen by immunochromatography method and was compared to the platelet count. STATISTICAL ANALYSIS : Appropriate statistical tests and software were used and calculated accordingly RESULTS : Out of 152 samples tested , 36 were positive for NS1 antigen and 25 were positive for IgM and these were compared to platelet counts of the respective patient CONCLUSION : Inclusion of NS1 antigen in the diagnosis algorithm increases the chances of early diagnosis and helps in anticipating fatal complications associated with dengue. Thrombocytopenia was found more consistently in patients with dengue positive than with dengue negative.
METEOROLOGICAL RELEVANCE OF UTTARAYANA KALA AND DAKSHINAYANA KALA
Rithucharya is one of the important concepts explained in Ayurveda. It deals with comprehensive management of diet pattern, behavior and lifestyle modification in relation to change in the seasons. In short, Ritucharya is the seasonal regimen, rules and regulation to what to do and what not during season and seasonal changes. If one follow the regimens prescribed under each and every rithu such person is never inflicted with seasonal diseases or disorders and he always remains as a healthy person. As we know that there are two Ayana or Solstices are there in one year or we can say that Sun changes its position twice every year. These changes are known as Uttarayana i.e. summer Solstice and Dakshinayana i.e. winter solstice. Meteorology is the study of weather and climate. The weather has found to have a profound effect on human health and well beings.
CU-SIL DENTURES- AN ALTERNATIVE TREATMENT OPTION FOR MANAGEMENT OF FEW REMAINING NATURAL TEETH
The main responsibility of the dentist is to rehabilitate the patient whilst preserving the remaining natural dentition. It has long been proven that the presence of teeth helps to preserve the alveolar ridge in its place. The current trend in prosthodontics is to rehabilitate the patient using a conventional removable partial denture or to remove the natural teeth and replace it with a complete denture. A conventional RPD will have deleterious effects on the periodontium of the natural teeth. Complete dentures will lead to alveolar bone loss and loss of proprioception. Transitional dentures are like a bridge which help the patient to transition from a dentulous state to an edentulous state. They will have all the benefits of preserving natural teeth while eliminating the ill effects of a complete denture. Cu-sil denture is a type of transitional denture which involves making holes in a complete denture through which the natural teeth emerge. This case report discusses a simple and cost-effective method of processing a Cu-sil denture.
TREATMENT OF EARLY HEAD AND NECK MALIGNANCIES USING CO2 LASER : OUR EXPERIENCE
Introduction: :Since 1970s,CO2laser has been an effective method of treatment of several types of Head and Neck lesions. Because of the precise cutting and superficial well delineated effect of the CO2 laser, it is widely used in laryngology for delicate phonatory surgery,benign lesions, precise excision of carcinoma in situ or early (T1) tumors, and vaporization of bulky obstructing carcinoma of the upper airway. Objective: To check efficacy of transoral CO2laser in treatment of early head and neck cancers. Material and method:Total of 197 patients with both malignant and non malignant lesions were treated with CO2 laser from January 2016 to December 2017 .Out of these, 22 patients who had early HNcancers(18laryngeal cancers,4tongue cancers were treated with CO2 laser.In all patients history,examination and relevant investigations were done for TNM Staging of the tumor and were treated with transoral CO2laser .Type of procedure,any intraoperative or postoperative complication was documented. Result:Out of 18 patients of carcinoma larynx,4 underwent type1 cordectomy,9 underwent type2 cordectomy and 4 underwent type3 cordectomy and 1 patient underwent type 4 cordectomy depending on depth of lesion. All 4 patients of carcinoma tongue underwent wide local excision with supra omohyoid neck dissection. HPE of all cases showed tumor free margins..All patients are under regular followup . 2 patients with Ca larynx had reccurence. Conclusion:Our study showed that CO2laser is treatment of choice for early HNcancers.
AN APPRAISAL OF THE FUNCTIONING OF SEZ IN INDIA
Variously known as free trade zones, special economic zones, bonded warehouse , free ports , customs zones and maquiladoras , these are , in fact , exports promotion zones which are defined by international labour organization (ILO) as industrial zones with special incentives set up to attract foreign investors , in which imported material undergoes some degree of processing before begin re-exported. A special economic zone (SEZ) is thus a specifically delineated duty free enclave , which is deemed to be foreign territory for the purposes of trade opperations and duties and tariffs.
A COMPARATIVE STUDY OF EFFICACY OF ITRACONAZOLE VERSUS TERBINAFINE AND THEIR COST EFFECTIVENESS IN THE TREATMENT OF RESISTANT DERMATOPHYTOSIS OF SKIN AT NALANDA MEDICAL COLLEGE, A TERTIARY CARE TEACHING HOSPITAL OF PATNA.
Background- Dermatophytoses are common fungal infections prevalent in hot and humid climate. Itraconazole and Terbinafine are commonly used antifungal agents for the treatment of dermatophytoses. However, increased resistance is being seen with conventional doses of these drugs. Also, these infections are more common among low socio-economic population. Therefore, this study has been undertaken to compare the efficacy and cost effectiveness of Itraconazole and Terbinafine in increased dosages in resistant dermatophytoses of skin. Objectives- To compare the efficacy of Itraconazole and Terbinafine in increased dosages in resistant dermatophytoses of skin and to select cheaper drug among them. Materials and Methods- In this open, parallel, prospective, comparative study, 200 patients of Tinea cruris and Tinea corporis diagnosed clinically and confirmed by potassium hydroxide (KOH) test, were randomly and equally divided into two groups. Group I patients received Itraconazole 200mg twice daily while group II patients received Terbinafine 250mg twice daily for 4 weeks. Patients were evaluated at the end of 2 and 4 weeks.At the end of 4 weeks KOH test was repeated to evaluate mycological cure. Results- At the end of 4 weeks mycological and clinical cure was seen in 92% patients in group I while 75% patients in group II. Mild adverse effects like headache, taste disturbances and gastrointestinal upset were observed in few patients of both groups but none was significant enough to discontinue therapy. Cost of therapy was more with Itraconazole than that of Terbinafine. Conclusion- High dose Itraconazole therapy is more effective than high dose Terbinafine therapy in resistant dermatophytoses. However cost of therapy is more in case of Itraconazole. But Terbinafine has higher failure rates and the duration of treatment may require longer, thereby reducing the cost difference. Therefore, Itraconazole seems superior to Terbinafine in the treatment of resistant T.corporis and T. cruris infection in higher doses.
ELECTROMYOGRAPHIC SYNCHRONIZATION IN THE FABRICATION OF DYNAMIC 3D PRINTED HAND PROSTHESIS- AN ORIGINAL STUDY
Aim: To fabricate a dynamic hand prosthesis using simple sensomotors and programming it using electromyographic synchronization to achieve functional movements at minimal cost. Materials and methods: The primary design of the prosthesis was done digitally and it was simulated using 3-D printing and milled with light weight polyurethane material. For incorporating the dynamic movements into the prosthesis, motors and electromotors (flex sensomotors) which worked based on the hex code programming were used. These additives allowed free movements and functional movements in the prosthesis. Using electromyography (EMG) healthier neuromuscular coordination was synchronized from a volunteer to the prosthesis. Electromyography worked based on the recording of muscle amplitude in microamperes with two sensors. One sensor transmitted the actual amplitude levels of healthier muscular movements while the other sensor intensified or deranged the value based on the muscle threshold of the individual. The amplitude values were recorded in C code programming format, which is human interfacing language. This was then compiled into the assembly programming for the ease of evaluation. Results: Based on the design, functional and dynamic movements were obtained in the hand prosthesis, using the synchronized EMG signals, which improved the efficiency of rehabilitation. Conclusion: Functionally active hand prosthesis at minimal cost will pave way for rehabilitating patients and improving their quality of life.
DEVELOPING POSITIVE ATTITUDE THROUGH BHAGAVAD GITA
One of the greatest contributions of India to the world is the Srimad Bhagavad Gita. Gita was spoken when there was deep crisis. The war was not with the words. It was a war where people were ready to kill each other. Gita was preached by Lord Krishna to motivate Arjuna in the battlefield of Kurukshetra when Arjuna got depressed when he saw his relatives with whom he has to fight. It is a divine book containing unlimited knowledge. It contains transformative powers at the human and society level. The verses (shlokas) and teachings of Gita can act as life-changing lessons. In this conversation four characters are involved : Krishna, Arjuna, Sanjay and Dhritrashtra. The whole conversation is of 48 minutes (one muhurta). It contains 18 chapters and 700 shlokas. One thing which is common between all persons who have become successful in this world is their ability to overcome challenges in life. By applying the principles of Bhagavad Gita we can overcome challenges of our life and become successful. Anyone can apply the principles of Gita in his/her life and overcome challenges and become successful. The paper focuses on how to develop positive attitude in life through the teachings of the Bhagavad Gita.
DETECTION OF PATHOGENS IN ICECREAMS PRODUCED BY LARGE-SCALE MANUFACTURERS IN MUMBAI CITY.
A study of the microbial quality of ice cream serves to indicate whether or not manufacturers employ proper sanitary procedures in the preparation of these products and the potential risk of acquiring food borne pathogens on their consumption. The present study was undertaken to assess if the bacteriological quality of ice creams sold by five large-scale manufacturers in Mumbai city conformed to microbial standards and were free of pathogenic bacteria. Tests were carried out for the detection of Staphylococci, E.coli, Pseudomonas, Shigella and Salmonella. While most of the ice cream samples produced by four manufacturers showed presence of these organisms, only one of the commercially available brand of ice cream conformed to the accepted standards. E.coli, a faecal coliform was found to be the most common pathogen present.
STATISTICAL EVALUATION OF FORECASTING METHODS.
In this paper some systematic steps were used for forecasting. Generate forecasts for data with different patterns: level, trend, seasonality, and cyclical.Describe causal modeling using linear regression Compute forecast accuracy .Explain how forecasting models should be selected, Decide what needs to be forecast.Level of detail, units of analysis & time horizon required.Evaluate and analyze appropriate data.Identify needed data.Select and test the forecasting model, Cost, ease of use & accuracy,Generate the forecast accuracy over time.
DIETARY ASSESSMENT METHODS- A LITERATURE REVIEW.
The goal of dietary assessment is to identify appropriate and actionable areas of change in the patient's diet and lifestyle and to improve patient health and wellbeing. Patients with complex dietary concerns should receive a comprehensive assessment by a dietitian. Specific dietary and nutritional counseling recommendations will depend on the patient's comorbidities. Diet records, diet-history questionnaires, 24-h recalls, or food-frequency questionnaires (FFQs) are the most common methods to get individual dietary intakes.
ATTENUATION OF HEMODYNAMIC RESPONSE TO ENDOTRACHEAL INTUBATION USING ORAL IVABRADINE - A PROSPECTIVE RANDOMISED CONTROLLED DOUBLE BLIND STUDY
BACKGROUND:Rapid and dramatic hemodynamic changes which adversely affect the patient may occur during laryngoscopy and intubation. The present study evaluates the effect of oral ivabradine on the hemodynamics during laryngoscopy and endotracheal intubation in patients undergoing surgical procedures under general anesthesia with ETT. STUDY DESIGN: A prospective, randomized, controlled, double-blind study. MATERIAL AND METHODS : 90 ASA I and II patients who underwent elective surgeries under general anaesthesia at Dr Jeyasekharan Hospital and Nursing Home, were randomly divided into two groups of 45 each. Group A received Tab Ivabradine 5 mg and group B received Tab B complex.The hemodynamic parameters namely HR,SBP,DBP and MAP were monitored prior to the study drug as baseline and at the following time intervals ;after induction, after intubation, ,after 1,3,5,8 and 10 minutes after intubation. RESULTS: HR was significantly lower in the ivabradine group compared to control group at all time interval after study drug. SBP,DBP&MAP were significantly lower in the Ivabradine group compared to control group after induction, after intubation, and 1,3,5,8 and 10 minutes after intubation. CONCLUSIONS: Ivabradine given before intubation prevents significant rise in HR and SBP, DBP, MAP compared to placebo in patients during laryngoscopy and endotracheal intubation.
A COMPARATIVE ANALYSIS OF LIFE SATISFACTION, PHYSICAL AND MENTAL STRESS IN INDIANS VERSUS INDIAN EXPATRIATES WORKING IN OMAN
Objective Over the years, there has been a significant increase in the number of Indian migrants in the country of Oman. The Indians working and living there are diverse in terms of the economic strata; therefore, the living and working conditions are also very different. There is a lack of studies focusing on the Indian population, working in abroad more specifically on their lifestyle and its impact on mental and physical health. Hence a need was felt to understand the mental and physical aspect and life satisfaction of the Indian population working and living in Oman. Methodology 200 (Office Workers in India-52, Office Workers in Oman-52, Labors in India-48, Labors in Oman-48) 1. Perceived Stress Scale 2. Satisfaction with Life Scale (SWLS) 3. Musculoskeletal Discomfort Form Researcher’s Assisted Questionnaire Results: The findings of present study show that among the total 104 office workers, 66% of office workers in India had higher stress level as compared to 34% of Indian office workers in Oman, in case of life satisfaction, 62% of Indian office workers in Oman were better satisfied with life as compared to 38% of office workers in India. Considering the labor population, among the total 96 labors 53% of Indian labor in Oman had high stress level as compared to 47% of labors in India, in case of life satisfaction, 57% of labors in India were better satisfied with life as compared to 43% of Indian labors in Oman. Office workers reported discomfort in the neck and back region whereas the labor population reported discomfort in knee, shoulder and ankle regions. Providing support to family, dissatisfaction with the job and heavy workload are some of the reasons that the Indian population recognized as factors contributing to their stress and level of life satisfaction. The non-resident population acknowledged facts such as having family support, good living conditions and job satisfaction as factors contributing to their stress and satisfaction with life. Conclusion: Considering mental stress, the office workers in India have high stress level as compared to the office workers in Oman. On the other hand, the labors working both in India and Oman are facing high stress levels. It was found that in case of life satisfaction, the office workers in Oman are more satisfied with life than the office workers in India whereas, the labors working in Oman are less satisfied with life as compared to the labors working in India. It was found that the neck and lower back areas are more affected among the office workers and the knees, shoulders and ankles are the areas of discomfort among the labors.
A COMPARATIVE EVALUATION OF ORAL MELATONIN, (I.V) DEXMEDETOMIDINE AND COMBINATION OF BOTH FOR ATTENUATION OF HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION IN MIDDLE EAR SURGERY
Introduction : Airway management is the evaluation, planning, and use of medical procedures and devices for the purpose of maintaining or restoring ventilation in a patient. Endotracheal intubation is required to provide a patent airway when patients are at risk for aspiration, when airway maintenance by bag mask is difficult, and for prolonged controlled ventilation. This research aimed to investigate the impact of Melatonin with Dexmedetomidine in mitigating cardiovascular responses to laryngoscopy and endotracheal intubation in candidate supporting voluntary operation. Aim and Objective : To compare the role of Oral melatonin with (i.v) Dexmedetomidine alone and in combination of both for attenuation of haemodynamic responses during Laryngoscopy and intubation and compare the effect on haemodynamic parameters - Heart rate, Systolic blood pressure; Diastolic blood pressure; Mean arterial pressure and SpO2. Methods and methods : This study was a randomized prospective double blinded study conducted in Department of Anaesthesiology and Critical Care, MLB medical College, Jhansi (UP) in patients posted for elective middle Ear surgeries during the period of March 2018 to October 2019 and minimum 150 patients were selected for the study. Following the approval from the Ethical committee, ASA I and II patients between the age of 20 to 50 years of either gender and surgery requiring general anaesthesia for duration longer than 30 min, patients with normal airway with MPG I and MPG II, >90 degree neck movement, no buck teeth undergoing elective surgeries for middle EAR were included in this study. Exclusion criteria were diabetes, hypertension, psychiatric illness, intake of antipsychotics, sedatives and antiepileptic drugs, sleep disorders, obesity and drug allergy. Result and Conclusion : Both Melatonin (6mg) and Dexmedetomidine (1mg/kg) can attenuate the haemodynamic changes during laryngoscopy and intubation. In Dexmedetomidine large dose (1mg/kg) there were more cases of hypotension and bradycardia are seen, than in comparison of (0.5 mg/kg) of Dexmedetomidine. Combination of Melatonin (6mg) and Dexmedetomidine low dose (0.5mg/kg) can attenuate the haemodynamic changes during laryngoscopy and intubation better than alone use of melatonin(6mg) and Dexmedetomidine (1mg/kg).
EFFICACY OF VITAMIN D3 SUPPLEMENTATION IN DIABETIC CHILDREN: A COHORT PROSPECTIVE STUDY
Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia due to defect from insulin secretion, insulin action, or both. Despite intensive diabetes management, less than a fifth of diabetic patients achieve the recommended HbA1c target. This cohort prospective design study was conducted in the pediatric endocrinology division of Haji Adam Malik Hospital Medan from March- October 2019. A total of 14 children were enrolled in this study. This study result showed increase of 25(OH)D level from 18.6±5.6ng/mL to 27.3±5.9ng/mL (p=0.00) and decrease of HbA1c level from 9.8%±1.9 to 7,0%±1.1 (p=0.00). This study found a negative correlation between the HbA1c value and 25(OH)D level (r-0.83;p=0.00). The management of DM with standard medication plus vitamin D supplementation showed a satisfactory result and is expected to become a routine recommendation in the management of children with DM.
ANALYSIS FACTORS RELATED TO THE DEVELOPMENT OF TODDLER
Background: Toddler age entered in the golden age stage because the development and growth at that stage affect the subsequent development. Early childhood development is one of the programs in the Sustainable Development Goals to be a priority to be achieved in 2030. Many factors can influence children's development. Health professionals and parents need to understand this to avoid factors that can cause children to experience developmental delays. Objectives: to find factors related to the development in toodler. Methods: A present cross sectional study was conducted from April to September 2019 in Public Health Depok 1 Sleman, Indonesia. Sampling method employed was Acidental sampling with 60 respondent. Factors the influence development in toddler colleted by questionnaire and tooddler development was assessed using the pre development screening questionnaire from the ministry of health. Multivariate analysis used logistic regression tests and bivariate analysis used the fisher test. Results: The logistic regression test results showed that the education level of the mother had a value of p = 0.017 and OR 0.077. The nutritional status of children shows the value of p = 0.032 and OR 0.98. Conclusion: There is a relationship between the level of mother's education and the nutritional status with the development in toodlers. Children with low-educated mothers have a 0.077 fold risk of developing developmental problems and children who have less nutritional status have a 0.098 fold risk of developing developmental problems. Health workers need to educate the factors that can influence children's development to parents.
IMPLICATIONS OF THYROID DYSFUNCTION ON LIVER ENZYMES
BACKGROUND: The liver has an important role in thyroid hormone metabolism. Normal level of thyroid hormones also important for normal hepatic function [1].Thyroid disorders often accompany abnormal serum enzyme levels and disturbances in liver functions. Thyroid diseases may be associated with elevation of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase(ALP).[2] Thyroid hormones regulate the basal metabolic rate of all cells including hepatocytes, and hence, modulate hepatic function; the liver in turn metabolizes the thyroid hormones and regulates their systemic endocrine effects .[3] Thyroid dysfunction may perturb liver function .So, the objective of this study is to evaluate the changes in liver function in thyroid dysfunction. AIMS: Aim of the present study is to determine the biochemical markers of liver function test ie Aspartate transaminase (AST), Alanine transaminase (ALT) and Alkaline phosphatase (ALP) in patients with thyroid dysfunction and to evaluate the effect of altered thyroid hormones on liver function tests . Also to find their possible correlation ie Pearsons correlation between Liver specific enzymes & thyroid hormones in patients attending clinical biochemistry OPD at tertiary care Unit, IGGMC,Nagpur. Materials & Methods – This study include about 100 patients attending clinical Biochemistry OPD, IGGMC, Nagpur for routine thyroid test. Estimations of thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH) done & Liver specific enzymes like activities of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) estimated in all patients..Collected sample was analysed for liver enzymes, run on Autoanalyser EM 460 in clinical Biochemistry Laboratory,IGGMC,Nagpur. Thyroid tests was run on Elisa reader & washer . Serum values of Thyroid stimulating hormone (TSH), thyroxine (T4) and tri-iodo thyronine (T3) were assayed by ELISA tests and values were compared & correlated with Liver enzymes level .The data was analysed & Pearsons Correlation was obtained, p value <0.05 considered as significant. RESULTS: Results of our study shows Positive Pearsons correlation between TSH & Liver enzymes in thyroid dysfunction while there is Negative Pearsons correlation between T3,T4 with Liver enzymes. P value is found to be statistically significant ie <0.05 . CONCLUSIONS: Thyroid dysfunction patients should be regularly checked for biochemical parameters of Liver enzymes. It can be concluded that thyroid hormones altered liver function tests. It is thus recommended that liver function tests interpretation in thyroid dysfunction must be advised to prevent progression of disease.
A VARIOUS ASPECT OF HIJRAS LIFE IN MYTHOLOGICAL BACKGROUND
In this study we are going to show the various phases, life style and aspect of hijras with the correlation in our Hindu mythological background. Hijras are generally considered as a Devine, sub demi gods, they have some spiritual power, blessing towards the human welfare, good wishes, luck etc, These powers given by god to him. They are known as a God child, made for some purpose and aim towards the community of living entity. The people of this community also maintain a equilibrium between human entity and nature. There is various cultural aspect of these kind of people regarding to the rituals and workship in our community. God made everyone as a unique character to act their role in this universe. Similarly, these community of people also made for some has some unique characters, features in respect to their god creature. Hindu mythology gives a unique significant value of hijras in human welfare. But there is some social stigma, rejections, discrimination which affects the social, economic, health status of these community of people in our India.