The Pattern of Health-Seeking Behavior among Juang Tribe- A Particularly Vulnerable Tribal Group of Odisha, India.

Introduction: Social and economic position, environment, access to healthcare, ethos, and worldview are all important determinants of people's health-seeking behavior. Tribal communities in India oscillate between their emic rationale for the cause and treatment of health concerns on the one hand and affordable modern methods on the other. The present article is based on a study conducted among the Junag tribe of Odisha to understand their acceptance and preference for traditional or modern healthcare systems and the reasons for these choices. Material and Methods: Purposive sampling, a pre-structured schedule, an observation approach, case studies, and interviews with community members have been used to gather the primary data used in the study. Result: The study identified a diverse pattern of health-seeking behavior. From the four villages, 70% of respondents combined into cluster-1 preferred the traditional healthcare system, mostly for geographical and cultural reasons, as opposed to 95% of respondents from the villages in cluster-2, who preferred modern healthcare services because they were more easily accessible and involved modern healthcare providers. Conclusion: In this research work, it has been found that the Juang tribe is in a transitional phase and uses a hybrid approach to health seeking. Moreover, it has also been discovered that important variables including cultural attitudes and the affordability of contemporary healthcare services have influenced people's decisions toward healthcare systems.

Role of magnesium alone or in combination with diltiazem and/or amiodarone in prevention of atrial fibrillation following off-pump coronary artery bypass grafting.

Objectives: In this study the authors have tried to examine the role of magnesium alone or in combination with diltiazem and / or amiodarone in prevention of atrial fibrillation (AF) following off-pump coronary artery bypass grafting (CABG). Background: AF after CABG is common and contributes to morbidity and mortality. Various pharmacological preventive measures including magnesium, amiodarone, diltiazem, and combination therapy among others have been tried to lower the incidence of AF. Most of the studies have been performed in patients undergoing conventional on-pump CABG. In this uncontrolled trial, efficacy of magnesium alone or in combination with amiodarone and / or diltiazem has been studied in patients undergoing off-pump CABG. Methods: One hundred and fifty patients undergoing off-pump CABG were divided into 3 groups, Group M (n=21) received intraoperative magnesium infusion at 30mg/ kg over 1 hour after midline sternotomy; Group MD (n=78) received magnesium infusion in similar manner with diltiazem infusion at 0.05 µg/kg/hr throughout the intraoperative period; Group AMD (n=51) received preoperative oral amiodarone at a dose of 200 mg three times a day for 3 days followed by 200 mg twice daily for another 3 days followed by 200 mg once daily till the day of surgery along with magnesium and diltiazem infusion as in other groups. AF lasting more than 10 min or requiring medical intervention was considered as AF. Results: The overall incidence of postoperative AF was 12.6% with 11.7% in group AMD, 19% in group M, and 11.5% in group MD, which was not statistically significant. Conclusions: It is concluded that the use of amiodarone and/or diltiazem in addition to magnesium did not result in additional benefit of lowering the incidence of AF.

Perioperative management of a patient with double orifice mitral valve with supramitral ring with subaortic membrane with ventricular septal defect and severe pulmonary hypertension: Report of a rare case.

Double-orifice mitral valve (DOMV) is an unusual congenital anomaly characterized by a mitral valve with a single fibrous annulus with two orifices or rarely two orifices with two separate mitral annuli opening into the left ventricle. We present a first report of a patient with a DOMV with supramitral ring (SMR), subaortic membrane (SAM), a large ventricular septal defect (VSD) with more than 50% aortic override, and severe pulmonary arterial hypertrophy (PAH). This patient underwent excision of the SAM, and SMR, with closure of the VSD together under cardiopulmonary bypass (CPB). However postoperatively, the patient developed an irreversible fatal pulmonary hypertensive crisis (PHC), immediately after transferring the patient to the cardiac intensive care unit from the operating room (OR). The PHC was refractory to intravenous and inhaled milrinone and nitroglycerine and intravenous adrenaline, dobutamine, norepinephrine, vasopressin, patent foramen oval (PFO), and CPB support. The management of DOMV and perioperative pulmonary hypertension is discussed.

Epidemiology and risk factors for multidrug-resistant bacteria in critically ill patients with liver disease.

BACKGROUND AND AIMS: The critically ill patients with liver disease are vulnerable to infections in both community and hospital settings. The nosocomial infections are often caused by multidrug-resistant (MDR) bacteria. The present observational study was conducted to describe the epidemiology, course, and outcome of MDR bacterial infection and identify the risk factors of such infection in critically ill patients with liver disease. MATERIALS AND METHODS: A retrospective observational study was conducted on 106 consecutive critically patients with liver disease admitted in the Intensive Care Unit between March 2015 and February 2017. The MDR and non-MDR (non-MDR) groups were compared and the risk factors identified by multivariate analysis. RESULTS: Out of the 106 patients enrolled in the study, 23 patients had infections caused by MDR bacteria. The MDR-infected patients had severe liver disease (Child-Pugh score 11 ± 2.3 vs. 7 ± 3.9; P = 0.04), longer duration of antibiotic usage (6 ± 2.7 days vs. 2 ± 1.5 days; P = 0.04), greater use of total parenteral nutrition (TPN) (73.9% vs. 62.6%; P = 0.04), and more concurrent antifungal administration (60.8% vs. 38.5%; P = 0.04). The mortality was higher in MDR group (hazard ratio = 1.86; P < 0.05). The independent predictors of MDR bacterial infection were Child-Pugh score >10, prior carbapenem use, antibiotic use for more than 10 days, TPN use, and concurrent antifungal administration. CONCLUSION: The study demonstrated a high prevalence of MDR bacterial infection in critically ill patients with a higher mortality over non-MDR bacterial infection and also identified the independent predictors of such infections.

Allele frequencies of PON1 Q192R polymorphism in four populations of India.

The allelic distribution at Paraoxonase 1 (PON1) Q192R polymorphism determines differential sensitivity towards certain organophosphate pesticides. The alleles Q (Glutamine) and R (Arginine) at amino acid position 192 are responsible for the lower and higher activity of the enzyme towards paraoxon respectively, making knowledge of this distribution in different populations vital. This study reports the genotype and allele frequencies of the Gln192Arg polymorphism of PON1 in four populations of India, comprising two caste and two tribal groups hitherto unexamined for this polymorphism. The R allele frequencies in Jat, Meo, Santhal and Zeliangrong populations were found to be 0.47, 0.45, 0.54 and 0.51 respectively. The gene diversity analyses show a high genetic differentiation at this locus indicative of the role of populations' history and other evolutionary forces. A comparison with allele frequencies among 106 populations from different continents showed a concordance with their geographic distribution which will have repercussions in policies targeting pesticide usage.

Y chromosome haplogroup distribution in Indo-European speaking tribes of Gujarat, western India.

The present study was carried out in the Indo-European speaking tribal population groups of Southern Gujarat, India to investigate and reconstruct their paternal population structure and population histories. The role of language, ethnicity and geography in determining the observed pattern of Y haplogroup clustering in the study populations was also examined. A set of 48 bi-allelic markers on the non-recombining region of Y chromosome (NRY) were analysed in 284 males; representing nine Indo-European speaking tribal populations. The genetic structure of the populations revealed that none of these groups was overtly admixed or completely isolated. However, elevated haplogroup diversity and FST value point towards greater diversity and differentiation which suggests the possibility of early demographic expansion of the study groups. The phylogenetic analysis revealed 13 paternal lineages, of which six haplogroups: C5, H1a*, H2, J2, R1a1* and R2 accounted for a major portion of the Y chromosome diversity. The higher frequency of the six haplogroups and the pattern of clustering in the populations indicated overlapping of haplogroups with West and Central Asian populations. Other analyses undertaken on the population affiliations revealed that the Indo-European speaking populations along with the Dravidian speaking groups of southern India have an influence on the tribal groups of Gujarat. The vital role of geography in determining the distribution of Y lineages was also noticed. This implies that although language plays a vital role in determining the distribution of Y lineages, the present day linguistic affiliation of any population in India for reconstructing the demographic history of the country should be considered with caution.

Distribution of beta-globin haplotypes among the tribes of southern Gujarat, India.

The present study was carried out in Indo-European speaking tribal population groups of southern Gujarat (India) to elucidate the allelic and haplotypic content of ß-globin system in individuals with HbAA genotypes. 6 neutral restriction sites of the ß-globin system were analysed and various statistical parameters were estimated to draw meaningful interpretations. All the 6 sites were found to be polymorphic and most were in Hardy-Weinberg Equilibrium in the studied group. Haplotypes were constructed using two different combinations of the 6 restriction sites analysed. Analysis of the 5 sites revealed a set of three predominant haplotypes, '+----', '-++-+' and '-+-++'; and haplotypes '+--', '++-' and '+++' were found to be the most frequent when the 3 sites were used to construct the haplotypes. Haplotypic heterozygosity levels (>83%) observed in the present study group were comparable to those observed in African and Afro-American populations and greater than other world populations. All the ancestral haplotypes, +-----, -++-+, -+-++ and ----+ were found in the study group. The distribution pattern of various haplotypes was consistent with the global pattern. The paucity of comparable data from other Indian populations restricted one from making interpretations about the study group's relationships with other Indian populations but the results were indicative of older population histories or experience of gene flow by the study group and their affinities with populations of southern India.

Genomic congruence of Indo-European speaking tribes of western India with Dravidian-speaking populations of southern India: A study of 20 autosomal DNA markers.

BACKGROUND: Due to its geographic location, Gujarat has played a major role in assimilation of different cultures with those of the subcontinent of India and is home to a number of Indo-European speaking tribes. AIM: This study examined the genetic structure and extent of gene differentiation in eight Indo-European speaking tribal populations of southern Gujarat in western India. It also determined if there was any residual effect of linguistic and cultural assimilation of Indo-European speaking groups on the genomic profile of the tribes under study. METHODS: Twenty autosomal DNA markers (Alu InDels and Restriction Fragment Length Polymorphisms) were analysed. RESULTS AND CONCLUSIONS: Average heterozygosity levels were high and degree of gene differentiation (G(ST) = 2%) was small, indicating that genetic drift may not have played a major role in bringing out a characteristic genetic differentiation in these groups. The genetic structure of the populations revealed that neither of these groups was overtly admixed nor completely isolated. Other analyses undertaken on the population affiliations revealed only a slight influence of Indo-European speaking populations on the tribal groups of Gujarat, but there was an overwhelming influence of Dravidian speaking groups of southern India, suggesting that genetic affinities may not necessarily be dependent on linguistic similarities.

Haptoglobin polymorphism among the tribal groups of southern Gujarat.

BACKGROUND: Gujarat is located at the western most point of the Indian subcontinent. Valsad and Surat districts are part of the 'tribal belt'of Gujarat and constitute 29.1% of total tribal population of Gujarat. These tribal populations are a rich source of gaining insights in the patterns of genetic diversity and genetico-environmental disorders against the back drop of their ecological, historical and ethnographic aspects. AIM: The objectives were to find out a) the genetic diversity among the tribes of Gujarat with reference to haptoglobin (Hp) locus b) the relationship between Hp polymorphism and sickle cell anemia/trait. MATERIALS AND METHODS: 431 individuals belonging to eight tribal groups were studied for Hp polymorphism using polyacrylamide disc gel electrophoresis (PAGE). Hb*S was screened by dithionate tube turbididy (DTT) test and confirmed using cellulose acetate membrane electrophoresis (CAME). STATISTICAL ANALYSIS: Allele frequency was calculated by direct gene counting method. Average heterozygosity and gene diversity were computed using software DISPAN. Analysis of molecular variance (AMOVA) was estimated using software ARLEQUIN version 3.1. RESULTS AND CONCLUSIONS: Pattern of allele frequency distribution showed preponderance of Hp(2) allele in all the eight tribal groups, which is in accordance with its frequency in different populations of Indian subcontinent. Total average heterozygosity (H(T)) was found to be low (0.160) but the level of genetic differentiation (G(ST)) was found to be moderately high (5.6%). AMOVA analysis indicated least among group variance between west and south Indian populations (-0.04%) indicating the affinities of the tribes of Gujarat with that of Dravidian speaking groups. Analysis of Hp phenotypes among sickle cell anemia/ trait individuals revealed a high frequency of Hp 0-0 phenotype (92.7%) among SS individuals as opposed to only 9.7% among AS individuals, reaffirming the selective advantage of HbAS state in relation to hemolytic disorders.

Genomic and linguistic affinities: a study of allelic and haplotype diversity at DRD2 locus among the tribes of Gujarat, western India.

Do genetic and linguistic affinities necessarily go hand in hand? An attempt has been made in the present work to explore this dimension of population structure using three evolutionarily important TaqI sites (TaqI A, TaqI B, and TaqI D) on the dopamine receptor D2 (DRD2) locus. For the first time, DNA samples from 612 unrelated individuals belonging to 11 Indo-European-speaking tribal population groups of Gujarat, western India, have been analyzed for these three sites. All the three sites are found to be polymorphic with greater interpopulation variation seen at the TaqI B site. The average heterozygosity for the haplotype system has been found to be high in the populations under study. Most of the populations share six of the eight haplotypes pointing toward underlying genetic uniformity, which is further reaffirmed by regression analysis of heterozygosity on genetic distance. The frequency of ancestral haplotype B2D2A1 is found to range between 1.9% and 15.9%. Linkage disequilibrium between TaqI B and TaqI D sites and between TaqI B and TaqI A sites is statistically significant in all but one population. Our findings reveal strong affinities between Indo-European-speaking tribal groups of Gujarat and Dravidian-speaking tribal groups of South India, suggesting that genetic affinities may not necessarily be dependent on linguistic similarities.

Left atrial thrombus formation immediately after mitral valve replacement: a case report.

Mechanical dysfunction from valve thrombosis is a dreaded complication of valve replacement surgery, usually presenting months to years after the procedure. Here we report acute deterioration of prosthetic valve function due to intraoperative obstruction by a thrombus.

Orthodontic intervention to resolve periodontal defects: An interdisciplinary approach.

In the new era of esthetics, Orthodontic therapy has gained tremendous acceptance by adults. However,treating adults is more challenging as they present with multiple periodontal problems compromising orthodontic treatment. Hence, to provide optimal treatment to adult patients an active interaction between orthodontist and periodontist is imperative.This article addresses the dilemmas encountered during the treatment of orthodontic patients with periodontal defects.

Comparison of Midazolam and Propofol for BIS-Guided Sedation During Regional Anaesthesia.

SUMMARY: Regional anaesthesia has become an important anaesthetic technique. Effective sedation is an essential for regional techniques too. This study compares midazolam and propofol in terms of onset & recovery from sedation, dosage and side effects of both the drugs using Bispectral Index monitoring. Ninety eight patients were randomly divided into two groups,one group recieved midazolam infusion while the other recieved propofol infusion until BIS reached 75. We observed Time to reach desired sedation, HR, MABP, time for recovery, dose to reach sedation and for maintenance of sedation and side effects if any. The time to reach required sedation was 11 min in Midazolam group(Group I) while it was 6 min in Propofol group(Group II) (p=0.0). Fall in MABP was greater with propofol. Recovery in with midazolam was slower than with propofol (18.6 +/- 6.5 vs 10.10+/-3.65 min) (p=0.00). We concluded that both midazolam and propofol are effective sedatives, but onset and offset was quicker with propofol, while midazolam was more cardiostable.