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Almost one-fourth of India's oilseed production is contributed by Brassicas. The Indian mustard [ Brassica juncea ] crop is affected by several biotic stresses in India, including aphid, white rust, Alternaria blight and Sclerotinia rot, which affect crop yields. Field trials were conducted at three locations during three crop seasons (2013–16) to evaluate treatments appropriate for mitigation of crop stresses and to obtain accurate assessments for seed yields and economic benefits as a part of a prioritized component-wise Integrated Pest Management strategy for the oilseed Brassica crop. The records from diverse sites and seasons concerning infestations by biotic stresses were assembled and scrutinized. The highest reduction in the severity of white rust disease was observed due to seed treatment by metalaxyl M 31.8 ES @ 6 ml/kg seed in one experiment and by a foliar spray of a combination of mancozeb 68% + metalaxyl 4% @ 1.7 g a.i./l in another trial, the latter being economically inferior to other fungitoxicants. The highest incremental benefit cost ratio (IBCR) was noted with the treatment of seed by an aqueous extract of garlic bulb (2% w/v) in one trial and by application of Trichoderma harzianum @ 1 g/l in another trial over sprays on crop foliage over two years and over three levels of nitrogen. Thiamethoxam 25 WG @ 1 g a.i./10 l ranked better than all other spray treatments in decreasing population of aphid in the top 10 cm main shoot at two sites. Pre-sowing application of T. harzianum @ 2.5 kg/ha soil provided better mustard seed yield in combination with spray with thiamethoxam 25 WG @ 1 g a.i./10 l on crop foliage and treatment of seed with T. harzianum @ 10 g/kg seed. Though the seed yield of mustard crop was the best with the integration of applications of T. harzianum on seed, to the soil along with spray of thiamethoxam 25 WG @ 1 g a.i./10 l on crop foliage at 50 days after sowing, it did not give the highest IBCR (16.6) among treatments. Contrastingly, treatment of seed with T. harzianum alone gave the highest IBCR (112.6), where the seed yield was relatively much lower (1469 kg/ha) whilst treatment of seed with fresh aqueous extract of garlic bulb @ 2% w/v also provided a high (80.4) IBCR. This paper highlights the impact of input costs, which allows growers to decide inputs based on the prevalence of biotic stress(es), the decision on intervention based on the importance of the same with an idea about the resultant quantifiable and monetary impact. • Impact of input costs. • Helps decide inputs based on prevalence of biotic stress(es) with quantifiable impact. [ABSTRACT FROM AUTHOR]

The present study was carried out at the Research Farm of S.G. College of Agriculture and Research Station, Kumhrawand, Jagdalpur (C.G.), Indira Gandhi Krishi Vishwavidyalaya, Raipur (Chhattisgarh) during Rabi 2013-14. Experimental materials comprised 30 F1 from a 6 x 6 diallel crosses was grown in Randomized Complete Block Design with three replications with the objectives to estimate the genetic variability, heritability, genetic advance. Analysis of variance revealed presence of sufficient variability present as per different biometrical analysis except for days to maturity and oil content (%). Relative magnitude of phenotypic co-efficient of variation was higher than the genotypic co-efficient of variation. The high GCV and PCV were observed for only two traits viz. number of branches per plant and harvest index (%). The traits plant height (cm), siliqua length (cm), number of siliquae per plant and seed yield per plant had moderate GCV and PCV. The highest heritability estimates were observed for the traits erucic acid content followed by plant height, branches per plant, seed yield per plant, siliqua length, days to 50% flowering and harvest index (%). Genetic advance as percentage of mean was observed high for the character number of siliquae per plant, followed by seed yield per plant, days to maturity and plant height. [ABSTRACT FROM AUTHOR]

Work-life integration issue has become an agenda of board room meetings across the globe especially in India. A working person has multiple roles to play at a time at personal as well as organizational fronts; each demanding different skills and anticipations. When such role demands overlap and get clashed, serious problems are faced by the employees. Moreover, in sales, the performance pressure is high leading to work stress reflected in personal life. This research paper is an attempt to delve into the issue of work-life integration issues with reference to young women working as school teachers in private schools of Mumbai. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of various neurological diseases in HIV infected patients on antiretroviral treatment with patients not on antiretroviral treatment. Design and Methods: A total of 80 patients (40 on ART and 40 without ART) with various neurological manifestations and having HIV infection admitted in a tertiary referral hospital were evaluated. They underwent detailed history, physical examination and laboratory investigation which included CD4 count, blood sugar,CBC, ESR, Serum B12, Serum antitoxoplasma IgG Ab (if suspecting Toxoplasmosis), CSF study , CNS imaging ( focal CNS disorders, PML, ADC & meningitis) and EMG NCV study (if neuropathy, radiculopathy). Statistical analysis was done by using version 13 of SPSS software. Chi square test and t test were used as per applicability. Results: In the ART group DSN (distal sensory predominant neuropathy, 38%) was the most common diagnosis followed by tuberculosis (all forms, 28%) whereas in the non-ART group tuberculosis was the most common diagnosis (35%). The incidence of DSN and PML (38% and 7% respectively) was more in ART group compared to non-ART group (7% & 2%) which was statistically significant for DSN. Also, 60% of the patients of ART group had infective etiology compared to 85% of non- ART group which was statistically significant. Conclusions: Incidence of DSN was higher in the ART group because antiretroviral drugs by themselves are known to cause a similar neuropathy, whereas the incidence of opportunistic infections was lower in the ART group may be due to the improvement of immune status by HAART. [ABSTRACT FROM AUTHOR]

Introduction Depression and diabetes are highly prevalent worldwide and often co-exist, worsening outcomes for each condition. Barriers to diagnosis and treatment are exacerbated in low and middle-income countries with limited health infrastructure and access to mental health treatment. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study tests the sustained effectiveness and cost-effectiveness of a multi-component care model for individuals with poorly-controlled diabetes and depression in diabetes clinics in India. Materials and methods Adults with diabetes, depressive symptoms (Patient Health Questionnaire-9 score ≥ 10), and ≥ 1 poorly-controlled cardiometabolic indicator (either HbA1c ≥ 8.0%, SBP ≥ 140 mm Hg, and/or LDL ≥ 130 mg/dl) were enrolled and randomized to the intervention or usual care. The intervention combined collaborative care, decision-support, and population health management. The primary outcome is the between-arm difference in the proportion of participants achieving combined depression response (≥ 50% reduction in Symptom Checklist score from baseline) AND one or more of: ≥ 0.5% reduction in HbA1c, ≥ 5 mm Hg reduction in SBP, or ≥ 10 mg/dl reduction in LDL-c at 24 months (12-month intervention; 12-month observational follow-up). Other outcomes include control of individual parameters, patient-centered measures (i.e. treatment satisfaction), and cost-effectiveness. Results The study trained seven care coordinators. Participant recruitment is complete – 940 adults were screened, with 483 eligible, and 404 randomized (196 to intervention; 208 to usual care). Randomization was balanced across clinic sites. Conclusions The INDEPENDENT model aims to increase access to mental health care and improve depression and cardiometabolic disease outcomes among complex patients with diabetes by leveraging the care provided in diabetes clinics in India ( clinicaltrials.gov number: NCT02022111 ). [ABSTRACT FROM AUTHOR]

The management of edema requires a systematic approach to screening, diagnosis, and treatment, with an essential initial assessment to differentiate between generalized and localized edema. The Association of Physicians of India (API) aimed to develop the first Indian Edema Consensus (Edema India), offering tailored recommendations for screening, diagnosing, and managing edema based on the insights from the expert panel. The panel suggested when evaluating edema symptoms, important factors to consider include the patient's current illness, medical history, risk factors, family history, and medications. Key diagnostic investigations for edema include complete blood count, cardiovascular imaging and markers, deep vein thrombosis (DVT) assessment, along with renal, hepatic, and thyroid function tests. Edema management involves a combination of pharmacologic and nonpharmacologic interventions, including limb elevation, physiotherapy, compression therapy, fluid removal, diuretics (loop diuretics: first-line therapy), and a sodium-restricted diet. The panel believed that educating patients could foster a preventive mindset, helping to prevent the worsening of edema., (© Journal of the Association of Physicians of India 2024.)

Background: Since the implementation of various maternal health programs, Maternal Mortality Ratio (MMR) has significantly declined in India through improvements in maternal health services. However, inequality persists at the regional and socio-economic levels. In light of this, the present study aims to assess the existing regional disparities in utilising various government initiatives for safe motherhood in India., Methods: National-level datasets such as National Family and Health Surveys (NFHS-3 (2005-06); NFHS-4 (2015-16) and NFHS-5(2019-21); Health Management Information System (HMIS), 2019-20; Sample Registrar System (SRS), 2001-2018) were used in the study. In addition, composite Index and inequality measures (Range, Ratio, and Gini) were calculated to examine inequality. At the same time, the Pearson correlation was used to investigate the correlation between various components of maternal health services and Maternal Mortality Rate (MMR)., Results: The composite index score (0.65) reflects that India is still far behind the targets of the utilisation of maternal health care services. Within the utilisation of services, the Gini coefficient reveals that the least inequality was recorded in skilled birth assistance deliveries (0.03) and institutional deliveries (0.04). In contrast, the highest inequality was recorded in receiving Iron and Folic Acid (IFA) Tablets for 100 days (0.19) and four Antenatal Care (ANC) visits (0.13) among selected states. Based on the composite score for maternal health utilisation, Kerala, Tamil Nadu, Andhra Pradesh, Odisha, and Delhi were amongst the best performers, whereas Bihar, Jharkhand, Uttar Pradesh, and Assam were amongst the worst performers., Conclusion: This indicates that the government's single-minded focus on enhancing institutional deliveries and skilled health-assisted deliveries has detracted from other essential interventions related to maternal health. Therefore, the states with the utilisation of maternal services need to initiate immediate action to increase the ANC and Post-natal Care (PNC utilisation with more attention towards better implementation of existing ANC programmes by the government., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Mehta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Hepatocellular carcinoma (HCC) is the most common cause of, and accounts for almost 90% of all liver cancers. Data from India is limited especially due to cancer not being a reportable disease and in view of wide variation in diagnostic modalities. This document is a result of a consensus meeting comprising Hepatologists, Interventional Radiologists, Hepatobiliary surgeons, medical and surgical Oncologists nominated by the Association of Physicians of India and Gastroenterology Research Society of Mumbai. The following Clinical Practice Guidelines for practicing physicians is intended to act as an up to date protocol for clinical management of patients with hepatocellular carcinoma. The document comprises seven sections with statements and sub-statements with strength of evidence and recommendation., (© Journal of the Association of Physicians of India 2011.)

Aims: The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB., Methods: A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in light of the final diagnosis., Results: The final diagnosis was tuberculous spondylodiscitis in 250 patients (88%) and pyogenic spondylodiscitis in 22 (7.8%). Six (2.1%) had a noninfectious condition-mimicking infectious spondylodiscitis, and six (2.1%) had no definite diagnosis and improved without specific treatment. The diagnosis was made by image-guided biopsy in 152 patients (56%) with infectious spondylodiscitis. Biopsy was contributory in identifying 132/250 patients (53%) with tuberculous spondylodiscitis, and 20/22 patients (91%) with pyogenic spondylodiscitis. Histological examination was the most sensitive diagnostic modality, followed by Xpert MTB/RIF assay., Conclusion: Image-guided biopsy has a reasonably high diagnostic yield in patients with suspected infectious spondylodiscitis. A combination of histological examination, Xpert MTB/RIF assay, bacterial culture, and sensitivity provides high diagnostic accuracy in a country in which TB is endemic. Cite this article: Bone Joint J  2022;104-B(1):120-126.

Introduction: A waterborne outbreak of hepatitis E virus occurred in the Jamshedpur city of Jharkhand from March 2018 to October 2018. The aim of the present study is to study the hepatitis E virus outbreak clinically, serologically and etiologically., Methods: Five hundred and eighty-four clinically and biochemically documented cases were screened for the hepatotropic viral markers (HepatitisA, B, C, and E) by the ELISA. Demographic data such as gender, age, clinical diagnosis, location, outcome and time of admission were extracted from the online hospital management system. Water samples from the affected area were tested for HEV RNA detection. Genotyping of HEV virus was carried out by sequencing and phylogenetic analysis., Results: Hepatitis E genotype 1 was confirmed as the major etiological agent in this outbreak due to the faecal contamination of drinking water supply while establishing illegal water connections. Mixed infection of HEV-HAV (5.31%) or HEV-HBV (0.91%) was also detected in the present series of acute viral hepatitis., Conclusion: The study highlights the importance of screening for both enterically transmitted hepatotropic viral markers as well as the parenterally transmitted hepatotropic viral markers during the outbreaks of acute viral hepatitis., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Study Design: Cross-sectional, observational., Objectives: (i) To develop a cross-culturally adapted Hindi translation of the Scoliosis Research Society (SRS)-22r (refined) questionnaire and (ii) validate it in Hindi-speaking Indian patients with adolescent idiopathic scoliosis (AIS)., Background Data: Health-related quality of life (HRQoL)-based questionnaires have superseded objective clinical and radiological measurements as tools to assess the outcome of health-related interventions. The SRS-22r is an extensively validated HRQoL-based questionnaire for AIS patients and has been adapted and translated in other languages., Methodology: A Hindi version of SRS-22r was developed in accordance with standard guidelines for cross-cultural adaptation. The final Hindi version was administered to 108 AIS patients. Subsequently, 58/108 patients answered the Hindi version again after 10-14 days. Another 50/108 bilingual patients answered the original English version after 10-14 days. In addition, 52/108 patients answered a previously validated Hindi version of Short Form (SF)-36 health survey. Content analysis, floor/ceiling effects, internal consistency, test/retest reproducibility and concurrent validity with the English version and the SF-36 questionnaire were determined for the Hindi version of SRS-22r., Results: High ceiling effect was noted for the pain and satisfaction with management domains of Hindi version of SRS-22r. Overall internal consistency was good (Cronbach α = 0.77)-all domains, except the function domain (α = 0.61) had good or excellent internal consistency. The test/retest reliability for all domains was excellent (intraclass coefficient/ICC > 0.80). The concurrent validity with the English version showed an excellent correlation for all domains (ICC > 0.80). Concurrent validity with SF-36 showed good correlation between relevant domains of SRS-22r and SF-36, except for the self-image and satisfaction with management domains of SRS-22r., Conclusion: Based on the results proving its reliability and validity, the adapted Hindi version of SRS-22r can be effectively used in Hindi-speaking, Indian AIS patients., Level of Evidence: 3.

Mucormycosis is an angio-invasive infection, predominantly acquired by inhalation of sporangiospores from the environment. However, the burden of Mucormycetes sporangiospores in the air is not well studied. We aimed to estimate the burden of Mucormycetes spores in the outdoor and indoor (hospital) environment across different seasons in north India. A total of 380 air samples from outdoor (n = 180) and indoor (n = 200) environment were included in the study. Air samples were suctioned using air sampler (100 l/min) and cultured on Dichloran Rose Bengal Chloramphenicol (DRBC) with benomyl for selective isolation of Mucormycetes. The isolates were identified by phenotypic and genotypic methods. The mean spore count (±SD) of Mucormycetes (cfu/m3) in outdoor samples varied from 0.73 (±0.96) to 8.60 (±5.70) across different seasons. In hospital, the mean spore count varied from 0.68 (±1.07) to 1.12 (±1.07) and 0.88 (±1.01) to 1.72 (±2.17) for air-conditioned wards and non-air-conditioned wards, respectively. Rhizopus arrhizus was the predominant agent isolated from both indoor and outdoor environment followed by Cunninghamella species. We also report a single isolate of the rare mucormycete agent, Apophysomyces variabilis from outdoor environment. The present study highlights the presence of low spore burden of Mucormycetes in outdoor and hospital settings in north India. This study also reports the first isolation of A. variabilis from air samples in the Indian subcontinent., (© The Author(s) 2019. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

Background: Early childhood caries (ECC) has reached epidemic proportions affecting millions of children worldwide. Its prevention becomes imperative owing to the significant morbidity and financial implications involved with its treatment. The Integrated Child Development Scheme (ICDS), launched in India to provide mid-day meals, pre-school education and primary healthcare to children, can be utilised to counsel and deliver oral health education to mothers. The purpose of the study is to compare the effect of an oral health care package (OHCP) with usual care on the change in dental disease status among 1 to 3-year-old children at Anganwadi centres (AWC) in periurban areas of Chandigarh and rural areas of Cuttack, Orissa over a follow-up period of three years., Methods: Two geographically distant ICDS blocks would be selected at each of the two study sites and would be randomly allocated to intervention and control group. Closely located AWCs under each of the selected blocks shall constitute the study setting. OHCP would be delivered to the mothers of the 1-6-year-old children enrolled in the AWCs of the experimental group whereas mothers under control group would receive usual care advice available at the AWCs., Discussion: ECC prevention had conventionally focused upon testing effectiveness of programs targeting behaviour change among the caregivers and children, but surprisingly minimal efforts have been made to seek translation of these efforts into reduction of ECC at the community level. The present study has two components; testing effect of altering maternal and child behavioral aspects on ECC incidence through cohort follow up of 1-3-year-old children for three consecutive years and cross-sectional follow up of all available 1-6-year old children at the selected AWCs at regular intervals to look for change in prevalence of ECC at community level. In other regions of the world surveys of ECC prevalence before and after the intensive educational programs have shown a significant reduction in ECC prevalence. A similar decline can be anticipated through this program., Trial Registration: This trial has been prospectively registered at Clinical Trials Registry, India (CTRI/2019/02/017556, 08 February 2019).

Rhipicephalus (Boophilus) microplus (Acari: Ixodidae), is one of the most important ectoparasite of cattle, responsible for causing severe economic losses in the tropical and subtropical regions of the world. The development of resistance to most of the commonly used chemical acaricides has stimulated the search for new herbal products as an eco-friendly tick control alternative. The aim of the present study was to evaluate the in vitro acaricidal activity of essential oils (EOs) of cloves (Syzygium aromaticum), bark of cinnamon (Cinnamomum zeylanicum) and leaves of lemon grass (Cymbopogon citratus) against unfed larvae of R. (B.)microplus by larval packet test. Also, various combinations were prepared by mixing of equal concentrations of any two and all three EOs and used to study the effects of interactions of mixtures against larvae of R. (B.) microplus. The lethal concentrations at 50% (LC 50 ), 90% (LC 90 ) and 99% (LC 99 ) with 95% confidence limits (CL) were estimated by Probit analysis using PoloPlus. The computer software, CompuSyn, was used for determining the effects of interactions (synergistic, additive or antagonistic) of EO mixtures by calculation of Combination index (CI) and Dose-reduction index (DRI). Among the individual and mixture of two EOs, cinnamon EO and cinnamon EO + lemon grass EO combination showed highest acaricidal activity against R. (B.) microplus larvae. Further, the combination of cinnamon EO + lemon grass EO showed high synergism with CI value of 0.381, followed by cinnamon EO + clove EO showing moderate synergism whereas, clove EO + lemon grass EO showed only additive effect, with favorable dose reduction for each constituent drug in all three combinations. The combination of all three EOs (1:1:1) showed high synergism (CI value of 0.376) and favorable dose reduction (DRI index of 8.19, 25.64 and 4.64 for clove, cinnamon and lemon grass EOs, respectively) against R. (B.) microplus larvae., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Osteoporosis and fragility fractures have become a major healthcare challenge globally in the recent years. However, this problem has only recently been accorded its due importance in developing countries such as India. India is a model case study for the management of osteoporosis and fragility fractures in a resource-limited setting, as it harbors a large geriatric population and has the highest prevalence of osteopenia globally. It is imperative to identify the myriad factors contributing to poor bone health and understand the many hurdles encountered to tackle this healthcare problem in a developing country. Innovative methods for managing fragility fractures are commonly seen. Collaborative multidisciplinary care and structured, evidence-based management has finally found its place in India with the establishment of a regional fragility fracture network. This chapter outlines the current status of management of fragility fractures in India by focusing on the disease burden, hurdles, innovative treatment methods, and the challenges lying ahead., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: The Medical Council of India has recommended microteaching for training medical graduates to improve their teaching efficiency. We assessed the effectiveness of microteaching on teaching skills of resident doctors through objective and subjective methods., Methods: We obtained data from three microteaching sessions in which 10 resident doctors participated. Seven core teaching skills of the participants were compared between two training sessions using the paired t-test. Only 4 residents who had participated in the training sessions appeared for the semester examination. We compared the performance of the 'trained' residents (π = 4) with the 'naïve' residents (n = 6) who were getting exposed to microteaching for the first time during the semester examination using the Mann-Whitney test., Results: Participants scored significantly high in the second training session compared to the first one. All the participants perceived the training sessions to have a positive effect on their teaching skills. In the semester examination, 'trained' residents performed significantly better than their 'naïve' counterparts., Conclusions: Microteaching not only improved the teaching skills of the residents but also helped them perform well in their semester examination held 10 months later. Our results indicate that microteaching can be an effective teacher training technique for residents., Competing Interests: None

Background: About 40-50% of patients undergoing coronary artery bypass graft (CABG) surgery have diabetes. The prevalence of impaired glucose tolerance (IGT) is also high in this group, however, incidence of new diabetes following CABG surgery is unknown., Objectives: To determine incidence of new diabetes and the impact on ICU and hospital stay in patients undergoing CABG surgery in India, we performed a registry-based study., Methods: Prospectively collected data among consecutive adult cardiac surgical patients who underwent CABG surgery at a single hospital were analyzed. Descriptive statistics are reported., Results: We recruited 1559 consecutive patients (men 1355, women 204) and analyzed data among 933 non-diabetic patients. Patients with known diabetes (n = 626, 40%) were excluded. 57 (6.1%) of the 933 non-diabetic patients developed persistently high glucose levels at discharge with incidence rate of 61 + 5/1000. Patients who developed diabetes had similar age and body mass index vs those who did not, but had greater preoperative IGT (44.6 vs 13.7%) and more time-period in intensive care unit (102.0 + 75 vs 80.2 + 29 hours) as well as in hospital (11.7 + 5.7 vs 9.6 + 2.4 days) (p < 0.001)., Conclusion: In a significant proportion of non-diabetic patients diabetes is unmasked after CABG. This is more likely in those with impaired glucose tolerance and prolonged period in intensive care and hospital., (Copyright © 2018 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

We performed a retrospective analysis of 146 chronic total occlusion CTO patients to evaluate the antecedents of success and failure in CTO - Percutaneous Coronary Intervention (PCI) in Indian patients. The study aimed to identify the technical success rate, analyse immediate patient outcomes, and understand the factors impacting the successful outcomes. Our results showed that J-CTO (Multicenter CTO Registry of Japan) scores correlate well with the success rates of CTO-PCI and two most important factors deciding failure are lesion length more than 20 mm and lesions with calcification. Most important step to success of CTO is wiring, once wire crosses the segment, success rates of the procedure is around 97%. The wire escalation strategy has to be modified once the initial soft (polymer) wire fails, it's reasonable to use high tip load wire like conquest pro without the use of intermediate wires (except in presence of tortuosity). At 1 year follow up of these patients, there was a statistically significant drop in angina class and major adverse cardiac event rates in the successful CTO group., (Copyright © 2018 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Background: Tobacco use is the foremost preventable cause of death and disease in the world today and work strain might be related with nicotine dependence by its provoking effect., Objective: To assess the association between occupational stress and nicotine dependence., Material and Methods: A cross sectional survey was conducted among 200 subjects visiting a satellite dental clinic of Swami Devi Dyal Hospital and Dental College, Barwala, Panchkula, India. Nicotine dependence was measured using the Fagerstrom Test for Nicotine Dependence (FTND). The extent of the stress factors experienced at work was assessed using the Effort-Reward Imbalance scale (ERI). Chi-square test and multiple logistic regression analysis were employed for statistical analysis. Confidence level and level of significance were set at 95% and 5% respectively., Results: The results of bivariate analysis revealed association of occupational stress with age, marital status, educational status, level of nicotine dependence, frequency of cigarette smoking and religious attendance. However, multivariate analysis elicited the significant association of occupational stress with only two variables, level of nicotine dependence and frequency of smoking., Conclusion: Occupational stress was found to be associated with nicotine dependence in the present study implying a need of other tranquil measures to be incorporated for the relief of work related stress.

Background: Depending on various pathological factors, non muscle invasive bladder cancer (NMIBC) shows varying degrees of recurrence. The aim of this study was to determine the incidence of recurrence of NMIBS in our centre, study the influence of intrinsic tumour characteristics like grade, stage, size and number, and compare our results with data in the published literature., Materials and Methods: A hospital based retrospective study was conducted on patients who underwent treatment for NMIBC from 2011 to 2014. The factors studied were number, size, grade, stage and site for correlation with recurrence. Statistical analysis was performed using Medcalc version 12, using Pearson's Chi square test to ascertain associations between variables., Results: A total of 73 patients with NMIBC were studied of which 48 (65.8%) had low grade and 25 (34.2%) had high grade tumours. Some 38 patients (52.1%) had Ta tumours, 34 (46.6%) had T1 and one had CIS. Mean follow up was 34.3 months. Recurrence rates were found to be 33.3% in low grade and 52.0% in high grade tumours. The overall recurrence rate in our centre was 39.7%. Significant correlations were seen between stage and recurrence, with a rate of 15% for Ta and 63.3% for T1 tumours. Fourteen out of 21 bladder cancers (66.6%) with multiple tumours demonstrated recurrence (p=0.006). Grade, size and site had no influence., Conclusions: In our study, recurrence of NMIBC was found to be directly proportional to stage and number of primary tumours, but not grade, size and site. The incidence of recurrence of NMIBC both stage wise and grade wise in our centre was also low compared to the data in the published literature.

A 42 year old man presented with classical presentation of Acute ST elevation MI of 2 hours duration. His CAG revealed a spared LMCA with a totally occluded LAD in proximal segment, for which he underwent a successful PAMI with DES to LAD. 2 days later he developed high grade fever, elevated inflammatory markers (ESR/CRP) with a dull aching pain in root of neck. On evaluation of brachiocephalic vessels, CT Aortogram suggested a diagnosis of acute onset Non-Specific Aortoarteritis. Nonspecific Aortoarteritis in young males is an uncommon presentation, though associated coronary artery involvement is known, but its presentation as an Acute MI is a rare phenomenon.

Introduction: Most western patients who have not had a previous operation and present with biliary obstruction are thought to have a malignant lesion. However in our country where the disease is common, we found that some of these patients had a tuberculous cause which considerably altered their management as well as their prognosis. We herein present our experience of these patients whom we had operated with a preoperative diagnosis of biliary tract malignancy and discuss, retrospectively, how they might have been detected before operation to have tuberculosis., Methods: Between August 1996 and June 2010, we operated on 209 patients with a preoperative diagnosis of carcinoma of the gallbladder and common bile duct. Seven out of these 209 patients had biliary tuberculosis. We retrospectively analyzed the clinical features of these patients from our prospectively maintained database., Results: There were four males and three females who had a mean age of 54 (32-65) years. The bile duct was involved in four and gallbladder in three patients. In contrast to those with malignancy, patients with tuberculosis had a longer history (122 vs 44 days), an abdominal mass was present less frequently (28% vs 57%), the serum bilirubin was lower (1.6 vs 6 mg/dl), and they also had evidence of tuberculosis elsewhere in the body (28.5%). There was no operative mortality in biliary tract tuberculosis in contrast to 7.5% in biliary tract malignancy., Conclusion: Though tuberculosis of the biliary tract is rare, it needs to be considered in the differential diagnosis of patients with biliary obstruction especially in countries where the disease is endemic.

Anemia is a global problem of immense public health significance. Iron deficiency anemia is the most common nutritional disorder seen all over the world, more in the developing countries, particularly, affecting young children of 6-24 months of age, adolescents, women of reproductive age group and pregnant/ lactating women. Basic approach in prevention of IDA should include education and associated measures to increase the dietary intake of iron, dietary modification to enhance the iron absorption, fortification of food articles, in addition to control the infection and worm infestations. Supplemenldelim 1, of medicinal iron is key to success which can be achieved by daily or intermittent (biweekly/weekly) administration of oral iron to the target group. Reduction of nutritional anemia should receive top priority through proper planning by using better utilization of existing health infrastructure.

Objective: The objective of the study was to compare 3 different approaches for increasing clients' understanding of contraceptive effectiveness., Study Design: We randomized 900 reproductive-age women in India and Jamaica to 1 of 3 charts presenting pregnancy risk., Results: The most important reason for choosing a contraceptive was how well it prevents pregnancy (54%) followed by few side effects (17%). At baseline, knowledge about contraceptive effectiveness was poor. About half knew oral contraceptive pills are more effective than condoms (46%) and intrauterine devices are more effective than injectables (50%). All 3 charts improved knowledge significantly (P < .01) for these 2 questions. No chart improved knowledge better than any other (P > .05). The chart ranking contraceptive methods on a continuum was judged slightly easier to understand than the other 2 charts., Conclusion: Only with accurate understanding of pregnancy risk can clients make informed choices. Our results have already informed a global handbook for family planning providers to use the chart ranking contraceptive methods on a continuum.

Thirty four healthy young volunteers (22 men, 12 women; age 25.7 +/- 5.8 years; BMI 20.8 +/- 2.3 kg/m2) participated in a randomized controlled cross-over trial on the effect of consuming one boiled egg every day for 8 wk on the serum lipid profile. The only significant change after 8 wk of egg consumption was an elevation of the total cholesterol/HDL cholesterol ratio. However, scrutiny of individual responses revealed that twelve of the subjects (10 men, 2 women) had a greater than 15% rise in the LDL cholesterol level after 8 wk of egg consumption. These subjects, considered hyperresponders, showed significant increases (P < 0.025) at both 4 wk and 8 wk after egg consumption in total cholesterol and LDL cholesterol levels, and at 8 wk in total cholesterol/HDL cholesterol ratio. The remaining 22 hyporesponders showed no change in any of the variables measured at 4 wk or 8 wk after egg consumption. In view of the high nutritional value of eggs, a blanket ban on eggs is not justified. However, since up to one-third of the population may be hyperresponders, knowing the response of an individual is important before making the egg a regular item of the diet.

Although Listeria monocytogenes infection occurs in sporadic and epidemic forms throughout the world, there are certain countries (especially Asian countries) that have reported only a few cases or failed to report even a single case. During her third visit at 17(+5) weeks of gestation, a 22-year-old primigravida presented with the complaint of an acute painful abdomen, leaking per vaginum and low-grade fever for the 2 preceding days. On ultrasonography, a single live fetus with no amniotic fluid was seen and the pregnancy was therefore terminated. L. monocytogenes was isolated from a high vaginal swab.

Objective: To compare 2 important techniques of blood conservation, use of a cell saver and low-dose aprotinin, in terms of blood loss and homologous blood usage in patients undergoing cardiac valve surgery., Design: Prospective, randomized., Setting: Tertiary care hospital., Participants: Sixty adult patients undergoing elective valve surgery., Interventions: The patients were divided into 3 groups of 20 each. In group 1, aprotinin in the dose of 30,000 KIU/kg was added to the pump prime, with a further dose of 15,000 KIU/kg added at the end of each hour of cardiopulmonary bypass. In group 2, a cell-saver system was used to collect all blood at the operation site for processing in preparation for subsequent reinfusion. Group 3 patients acted as a control group and underwent routine management, which included collection of autologous blood during the pre-cardiopulmonary bypass period. A hemoglobin of <8 g/dL was considered as an indication for bank blood transfusion in the postoperative period., Measurements and Main Results: The chest tube drainage was significantly less in group 1 compared with groups 2 and 3, with total drainage (median [interquartile range]) amounting to 250 mL [105 to 325 mL] vs. 700 mL [525 to 910 mL] in group 2 and 800 mL [650 to 880 mL] in group 3 (p < 0.001). The patients in groups 1 and 2 required significantly less bank blood (median [interquartile range]) as compared with group 3 (350 mL [0 to 525 mL], 350 mL [0 to 350 mL], and 1050 mL [875 to 1050 mL]; p < 0.001), respectively. Cell saver provided 410 +/- 130 mL of hemoconcentrated blood in group 2. The average preoperative hemoglobin concentration was 11.3 g/dL, and it was around 9 g/dL on the 7th postoperative day. The hemoglobin concentration at various stages during hospitalization in all 3 groups was similar., Conclusions: Low-dose aprotinin and a cell saver are effective and comparable methods of blood conservation. Aprotinin helps by decreasing the postoperative drainage, and a cell saver helps by making the patient's own blood available for transfusion., (Copyright 2001 by W.B. Saunders Company.)

In order to clarify the role of thrombolytic therapy for treatment of prosthetic valve thrombosis, all cases admitted in the intensive care unit (ICU), between March 1987 and March 1997 with the diagnosis of prosthetic valve thrombosis and treated with streptokinase, were analysed. In total, 42 patients with clinical and echocardiographic evidence of left side tilting disc prosthetic valve thrombosis were treated. All the patients had only mitral valve prosthesis involvement. Streptokinase was administered as a bolus of 2.5 lac units over 30 minutes followed by 1 lac units/hour for 48-72 hours. Thirty-seven (88%) patients had successful thrombolysis. Overall mortality occurred in 9.5 percent patients due to systemic embolism and bleeding complications. Serial clinical, radiological and echocardiographic studies showed successful thrombolysis in 88 percent patients. This study demonstrates that streptokinase therapy is safe and effective first line treatment for left-sided prosthetic valve thrombosis and surgery should be reserved for those patients who fail to respond to thrombolytic therapy.

Multiple dust allergy in a study of 100 patients of nasobronchial hypersensitivity has been demonstrated by skin testing in Chandigarh and successfully desensitised over a 3-year period. The results are discussed and the multiple factors involved postulated.

The glycaemic index (GI) and the triacylglycerol response were measured in thirty non-insulin-dependent diabetes mellitus patients given 50 g portions of five different conventional Indian meals containing semolina (Triticum aestivum) cooked by two different methods, or combinations of semolina and pulse (black gram dhal (Phaseolus mungo), green gram dhal (Phaseolus aureus) or Bengal gram dhal (Cicer arietum)). There were no significant differences among meals in mean GI except for meals based on roasted semolina or semolina-black gram dhal. Compared with the blood glucose response for a 50 g glucose load, only meals based on steam-cooked semolina and semolina-Bengal gram dhal elicited a significantly lower response at 1 h postprandially, and only meals based on semolina-black gram dhal at 2 h postprandially. No significant differences were found among the meals in the triacylglycerol-response.

The glycemic index (GI) was determined in 36 non-insulin-dependent diabetes mellitus patients who were fed 50 g carbohydrate portions of six Indian conventional foods, including rice, a combination of rice-legume (Bengalgram, peas, and greengram), and a combination of rice-dal (greengram dal and redgram dal -- dal is dehusked and split legume). In addition to the GI, triglyceride (TG) responses of these foods were also determined. A higher GI was obtained for rice and for rice with peas; all other combinations yielded lower glycemic indices. However, all the foods produced significantly lower blood glucose response 2 hours postprandially as compared with blood glucose responses to a 50 g glucose load for the same group. No significant difference was observed for TG responses to the different foods.

A school survey covering 21,412 students attending 30 primary and secondary schools in Surat city and 25 primary and secondary schools in surrounding villages was carried out. The overall prevalence rate of leprosy was 0.12% and it was significantly higher in rural area. Prevalence of leprosy did not show any association with the age of students but male preponderance was observed. Prevalence rate increased significantly with deterioration of socio-economical condition and home sanitary condition. B.C.G. vaccination seemed to protect against leprosy in rural area. Majority of the cases (92.3%) were non-lepromatous type. Single skin lesion was seen in 15.4% cases only. Nearly 1/3 of the total skin lesions were observed on the area of skin covered by clothes.

The present study includes the analysis of case-control study and hospital records of leprosy patients. 26 cases of leprosy were detected through examination of 21,412 school children of 5-19 years age, attending 30 and 25 schools in urban and rural area respectively of Surat District. Matched controls of these leprosy cases were selected from their healthy class-mates by employing certain criteria. Home visits paid to these 24 cases and their controls revealed a positive family history in 50% (12/24) of affected students. Case detection rates were 17.9% and 0.0% among the contracts of affected students and their controls respectively. Out of 26 cases, 16 (61.5%) were detected for the first time (undetected cases). However, record analysis revealed that only 32.6% and 39.5% of the detected cases of school going age, were attending schools in rural and urban area respectively. School survey and contact survey of child cases, in spite of certain limitations, can be considered as a useful, cheap and rapid method for detection of leprosy cases in the community.

An industrial area with poor sanitation and inhabited by migrant, male predominant population, situated South to Surat City, experienced an outbreak of pyogenic meningitis during 1985-87. A total of 197 cases of meningitis with 34 deaths were reported during a period of 1 1/2 years. Neisseria meningitidis was the predominant pathogen isolated from 66 out of 138 CSF samples. Recently migrated males of productive age groups drawn from the States of Uttar Pradesh and Orissa were predominantly affected. Male to female ratio was found to be 7.2:1. Nearly 2/3rd of the cases were reported during the dry colder months of winter and spring. Pregnancy and childbirth appeared to be important predisposing factors in females. Nine cases were reported from the family contacts of cases. Majority of the cases were labourers doing manual work.