Enhanced photocatalytic and SERS performance of Ag nanoparticles functionalized MoS2 nanoflakes.

We report the preparation of Ag nanoparticles functionalized MoS2 nanoflakes by using the chemical reduction method followed by the hydrothermal method. Field emission scanning electron microscopy and elemental mapping reveals the uniform functionalization of Ag nanoparticles with MoS2 nanoflakes. High density of Ag plasmonic nanoparticles onto MoS2 nanoflakes demonstrates tremendously improved charge separation behavior in Ag-MoS2 nanohybrids. Photodecomposition capability of plasmonic Ag-MoS2 nanohybrids was explored by the decomposition of industrial pollutant molecules, showing a direct correlation between the Ag content over the MoS2 surface with their photodecomposition ability. The SERS-based detection profiles of the plasmonic were investigated by the ultra-low detection of MB molecules. The Ag-MoS2 nanohybrids SERS substrate manifests the detection of MB molecules solution up to a concentration of 10-9 M with an enhancement factor of 107. In the current study, we proposed and elucidated the probable efficient charge transfer mechanism for improved photocatalytic behavior and SERS-based sensing performance.

Enhanced sunlight driven photocatalytic activity of In2S3 nanosheets functionalized MoS2 nanoflowers heterostructures.

Visible light-sensitive 2D-layered based photocatalytic systems have been proven one of the effective recent trends. We report the preparation of a 2D-layered based In2S3-MoS2 nanohybrid system through a facile hydrothermal method, capable of efficiently degrading of organic contaminants with remarkable efficiency. Transmission electron microscopy (TEM) results inferred the attachment of 2D-layered In2S3 sheets with the MoS2 nanoflakes. Field emission SEM studies with chemical mapping confirm the uniform distribution of Mo, In, and S atoms in the heterostructure, affirming sample uniformity. X-ray diffraction, X-ray photoelectron spectroscopy, and Raman spectroscopy results confirm the appearance of 2H-MoS2 and ß-In2S3 in the grown heterostructures. UV-DRS results reveal a significant improvement in the optical absorbance and significant bandgap narrowing (0.43 eV) in In2S3-MoS2 nanohybrid compared to pristine In2S3 nanosheets in the visible region. The effective bandgap narrowing facilitates the charge transfer between MoS2 and In2S3 and remarkably improves the synergistic effect. Effective bandgap engineering and improved optical absorption of In2S3-MoS2 nanohybrids are favorable for enhancing their charge separation and photocatalytic ability. The photocatalytic decomposition efficiency of the pristine In2S3 nanosheets and In2S3-MoS2 nanohybrids sample is determined by the decomposing of methylene blue and oxytetracycline molecules under natural sunlight. The optimized In2S3-MoS2 nanohybrids can decompose 97.67% of MB and 76.3% of OTC-HCl molecules solution in 8 min and 40 min of exposure of sunlight respectively. 2D-layered In2S3-MoS2 nanohybrids reveal the tremendous remediation performance towards chemical contaminations and pharmaceutical waste, which indicates their applicability in industrial and practical applications.

Descriptive Epidemiology of Unintentional Childhood Injuries in India: An ICMR Taskforce Multisite Study.

BACKGROUND: Children 0-14 years constitute about 31.4% of Indian population, among whom the magnitude and risk factors of childhood injuries have not been adequately studied. OBJECTIVE: To study the prevalence of and assess the factors associated with unintentional injuries among children aged 6 month - 18 years in various regions. METHODOLOGY: This multi-centric, cross-sectional, community-based study was conducted at 11 sites across India. States included were Gujarat, Karnataka, Madhya Pradesh, Punjab, Sikkim, Tamil Nadu, Uttarakhand, and West Bengal between March, 2018 and September, 2020. A total of 2341 urban and rural households from each site were selected based on probability proportionate to size. The World Health Organization (WHO) child injury questionnaire adapted to the Indian settings was used after validation. Information on injuries was collected for previous 12 months. Definitions for types (road traffic accidents, falls, burns, poisoning, drowning, animal-related injuries) and severity of injuries was adapted from the WHO study. Information was elicited from parents/primary caregivers. Data were collected electronically, and handled with a management information system. RESULTS: In the 25751 households studied, there were 31020 children aged 6 months-18 years. A total of 1452 children (66.1% males) had 1535 unintentional injuries (excluding minor injuries) had occurred in the preceding one year. The overall prevalence of unintentional injuries excluding minor injuries was 4.7% (95% CI: 4.4-4.9). The commonest type of injury was fall-related (842, 54.8%) and the least common was drowning (3, 0.2%). Injuries in the home environment accounted for more than 50% of cases. CONCLUSIONS: The findings of the study provide inputs for developing a comprehensive child injury prevention policy in the country. Child safe school with age-appropriate measures, a safe home environment, and road safety measures for children should be a three-pronged approach in minimizing the number and the severity of child injuries both in urban and rural areas.

Sunlight mediated enhanced photocatalytic activity of TiO2 nanoparticles functionalized CuO-Cu2O nanorods for removal of methylene blue and oxytetracycline hydrochloride.

Metal free heterojunctions have shown promising applicability as potential photocatalyst materials. Like the commonly explored metal-non metal heterojunctions, semiconductor-semiconductor junctions are also capable of facilitating charge separation and improved lifetimes, leading to augmented surface reaction efficacy. However, unlike the metal carrying heterojunctions, they are much economical and easier to fabricate and tune. Through this study, we present a facile one step hydrothermal route to synthesize CuO-Cu2O nanorods/TiO2 nanoparticles heterostructures (CTHS) with their potential application as a low cost photocatalytic alternative. The average size of the synthesized heterojunction components, as estimated from transmission electron microscopy (TEM) evaluation was 13 and 5 nm respectively for the nanorod length and width, while the functionalizing TiO2 nanoparticles were averaged around 10 nm. Heterojunction formation was confirmed using Raman spectroscopy, X-ray diffraction, high resolution TEM, and elemental mapping. X-ray photoelectron spectroscopy data marked with presence of Cu+ and Cu+2 state of CuO in CuXO-TiO2 also supported junction formation. Optical characteristics of the heterojunction were studied using UV-vis diffuse reflectance spectroscopy and photoluminescence spectroscopy. Compared to TiO2 nanoparticles, CTHS exhibited superior sunlight-induced photodegradation activity. CuXO/TiO2 heterojunction could also remediate toxic waste water containing model antibiotic residue (Oxytetracycline hydrochloride, 0.4 mg/mL) and organic pollutant (methylene blue, 10 µM) in 20 and 60 min respectively. Ultra-fast degradation using a nonmetal heterojunction nanohybrid, like ours, finds negligible mention in literature. Improved visible light absorption and reduction in recombination rate for CuXO-TiO2 nanohybrids were ascribed as major contributing factors towards their enhanced photocatalytic potential. The charge separation mechanism for nanohybrids has been studied and elaborated in detail.

Perinatal Outcome in Pregnancies Associated with Hypertension: A Prospective Cohort Study in a Rural Tertiary Care Teaching Hospital of North India.

OBJECTIVE: The objective of the study is to know type of hypertension affecting pregnant women and impact on perinatal outcome. SUBJECT AND METHODS: This is a prospective cohort study; 120 women with hypertensive disorders of pregnancy (HDP) at gestation ≥28 weeks who delivered in our institute were enrolled. Sociodemography, gestational age, mode of delivery, APGAR, birth weight, fetal growth restriction (FGR), and perinatal outcome were recorded. Mean ± standard deviation or proportions, analysis of variance, Chi-square test, and odds ratio were used for statistical analysis. RESULTS: Preeclampsia (PE) was most prevalent hypertensive disorder of pregnancy (44.2%), followed by eclampsia (27.50%), gestational hypertension (23.3%), and chronic hypertension (CH) (5.0%). In PE group, 61.8% had FGR, 65.5% newborns were preterm, 74.6% had low birth weight, and 54.1% needed neonatal intensive care unit (NICU) admission. In eclampsia group, 42.9% had fetal growth restriction, 65.7% preterm, 80% low birth weight, and 78.6% NICU admission. PE women delivered more fetal growth-restricted babies with odd ratio of 2.37 (95% confidence interval [CI]: 1.15, 4.9) and at lower gestation with odd ratio of 2.00 (95% CI: 0.95, 4.21). Eclampsia group had more newborn with low APGAR 1 min, NICU admissions, and those requiring ventilator with odds ratio of 3.10 (95% CI: 1.37, 7.03), 4.48 (95% CI: 1.64, 12.24), and 4.09 (95% CI: 1.6, 10.46), respectively. Perinatal mortality was 10, 9, and 2 in eclampsia, PE, and gestational hypertension groups, respectively, with overall rate of 16.9%. PE and eclampsia comprised 71.70% of HDP but contributed 90.5% of all perinatal deaths. CONCLUSION: Preeclampsia-eclampsia is associated with increased risk of adverse perinatal outcomes as compared to gestational and CH, necessitating screening, vigilant antenatal care, timely intervention, and referral.

SARS-CoV-2 Detection in Gingival Crevicular Fluid.

Understanding the pathophysiology of the coronavirus disease 2019 (COVID-19) infection remains a significant challenge of our times. The gingival crevicular fluid being representative of systemic status and having a proven track record of detecting viruses and biomarkers forms a logical basis for evaluating the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The study aimed to assess gingival crevicular fluid (GCF) for evidence of SARS-CoV-2 in 33 patients who were deemed to be COVID-19 positive upon nasopharyngeal sampling. An attempt was also made to comparatively evaluate it with saliva in terms of its sensitivity, as a diagnostic fluid for SARS-CoV-2. GCF and saliva samples were collected from 33 COVID-19-confirmed patients. Total RNA was extracted using NucliSENS easyMAG (bioMérieux) and eluted in the elution buffer. Envelope gene (E gene) of SARS-CoV-2 and human RNase P gene as internal control were detected in GCF samples by using the TRUPCR SARS-CoV-2 RT qPCR kit V-2.0 (I) in an Applied Biosystems 7500 real-time machine. A significant majority of both asymptomatic and mildly symptomatic patients exhibited the presence of the novel coronavirus in their GCF samples. Considering the presence of SARS-CoV-2 RNA in the nasopharyngeal swab sampling as gold standard, the sensitivity of GCF and saliva, respectively, was 63.64% (confidence interval [CI], 45.1% to 79.60%) and 64.52% (CI, 45.37% to 80.77%). GCF was found to be comparable to saliva in terms of its sensitivity to detect SARS-CoV-2. Saliva samples tested positive in 3 of the 12 patients whose GCF tested negative, and likewise GCF tested positive for 2 of the 11 patients whose saliva tested negative on real-time reverse transcription polymerase chain reaction. The results establish GCF as a possible mode of transmission of SARS-CoV-2, which is the first such report in the literature, and also provide the first quantifiable evidence pointing toward a link between the COVID-19 infection and oral health.

Bimetallic Ag-Au alloy nanocubes for SERS based sensitive detection of explosive molecules.

We have fabricated Ag-Au alloy nanocubes using the galvanic replacement of silver nanocubes by aqueous HAuCl4 and investigated their morphological, structural, compositional and optical properties. The inter-diffusion between silver and gold at 100 °C leads to the formation of Ag-Au alloy nanocubes with hollow interiors. A broad tuning of the surface plasmon resonance (SPR) wavelength from 624 nm to 920 nm is obtained with the varying volume of HAuCl4. When excited at wavelength 785 nm, the bimetallic Ag-Au nanocubes with pinholes exhibit two-fold Raman intensity enhancement compared to pristine Ag nanocubes. The surface-enhanced Raman spectroscopy (SERS) substrate prepared with Ag-Au alloy nanocubes shows high-intensity enhancement factor of 1.9 × 107 for 11.2 wt% Au content. The SERS-active Ag-Au alloy nanocubes substrates were exploited for the detection of two explosive molecules; p-nitrobenzoic acid (PNBA) and picric acid (PA). Remarkable detection sensitivity and ultra-low detection limit of 1.7 × 10-14 M for PNBA and 4.1 × 10-11 M for PA were obtained, demonstrating the very high SERS detection capabilities of the as-prepared substrate.

Pulsed photoacoustic and photothermal response of gold nanoparticles.

Gold nanospheres and nanorods are promising agents for photoacoustic imaging and photothermal therapy. In this work, seed-mediated methods were optimized for the synthesis of gold nanosphere and nanorod collides of different sizes. Nanosecond pulse photoacoustic and photothermal analysis of these nanoparticles was carried out and compared with finite element simulation. The simulations were performed to quantify the size dependent photoacoustic signal enhancement for nanospheres and nanorods. The non-sphericity contribution of nanospheres was found to enhance the photoacoustic signal. Nanosecond pulse photoacoustic studies of nanorods of different aspect ratio were carried out. Nanorods of aspect ratio ∼4.8 were found to be the most efficient photoacoustic signal generators. Photoacoustic studies of nanorods at varying laser fluence were performed and threshold fluence of 5 mJ cm-2 was observed. Nanorods exposed to nanosecond laser pulses underwent size and shape variations which were confirmed by optical absorbance and transmission electron microscopy measurements. Simulations of nanorods of different aspect ratio and diameter were performed to investigate the photoacoustic signal enhancement and photothermal stability. The miniature size nanorod with a diameter of 10 nm and aspect ratio of 5 was found to be most appropriate in terms of photoacoustic signal generation and photothermal stability.

Evidence of oxygen defects mediated enhanced photocatalytic and antibacterial performance of ZnO nanorods.

Defect engineered one-dimensional (1D) ZnO nanostructures have found great interest in diverse fields, including water detoxification and environmental remediation. In this article, we report a facile, low-temperature hydrothermal synthesis of defect enriched ZnO nanorods at different pH conditions. The dimension of all the synthesized ZnO nanostructures was restricted to 1D with changes only in their aspect ratios, unlike previous reports where change in morphology accompanies the effect of pH. With an increment in the pH value of the reaction mixture, oxygen defect concentration was controlled and confirmed using XPS and Raman spectroscopy. Considerable increase in optical light absorption and reduction in the bandgap, as inferred from the UV-vis study, corroborating the pH-dependent enrichment of defect states in 1D ZnO. Superior photosensitivity of oxygen defect rich ZnO nanorods was utilized to study their sunlight-induced photocatalytic and bactericidal activity towards its application in wastewater treatment. Within 4 h and 30 min of sunlight exposure (900 W/cm2), a 100% bacterial population (S.aureus, 106 cells/m) killing and complete degradation of methylene blue dye (10µM) were achieved. Enhanced reactive oxidative species (ROS) formation due to the presence of additional oxygen defect states is ascribed to be the prime factor facilitating improved degradation efficiency. Additionally, during the optimization study, ZnO nanorods were found to be active against bacterial cells even in the absence of light opening avenues in antimicrobial food packaging and protective surface coatings.

Silver nanodendrites for ultralow detection of thiram based on surface-enhanced Raman spectroscopy.

Metal nanostructures with highly branched morphologies are attractive due to their fascinating plasmonic properties which are related to their unique morphological features. In this work a simple fabrication methodology is used for fabrication of surface-enhanced Raman spectroscopy (SERS) substrates composed of branched silver nanostructures with dendritic morphology. The high Raman intensity enhancement factor of the order ∼1010 was achieved which allows the detection of ∼zeptomole thiram molecules by SERS substrates. The appearance of new bands at 344 cm-1 and 1521 cm-1 provides an evidence of contribution of chemical enhancement in SERS. The observed spectral changes in SERS spectrum originate from the adsorption of the analyte on the metal surface and provide an insight into molecule-metal interaction in SERS. The extreme sensitivity of SERS substrates is discussed in terms of the distinction between electromagnetic and chemical enhancement mechanisms. Moreover, the highly sensitive SERS substrates were used for simultaneous detection of Rhodamine B and thiram molecules from their mixture with different individual concentrations demonstrating detection capabilities for the identification of pesticides with dye molecules.

Knowledge, attitude and practices relating to zoonotic diseases among livestock farmers in Punjab, India.

Zoonotic diseases cause significant health and economic impact in developing countries such as India. Many zoonotic diseases are prevalent in the livestock and as an occupational zoonosis in the livestock farmers in India. Lack of knowledge on the disease transmission, prevention and control measures is a potential high risk for the occurrence of zoonotic diseases in the livestock and its keepers in India. We conducted this study to understand knowledge, attitude and practices of livestock farmers regarding zoonoses. Five villages from each of the 22 districts of the state were conveniently selected (n = 110). Farmers available at village community sites were enrolled in the study and requested to complete a custom designed questionnaire (n = 558). In addition, livestock farmers attending basic livestock husbandry training were also surveyed (n = 301). Data from questionnaires was used to create three index variables: (a) knowledge score; (b) attitude score and (c) practice score. Association between demographic and other explanatory variables with knowledge score was evaluated using linear regression analyses. Similarly, the association between knowledge and attitude score with practice score was evaluated. Of the 859 participants, 685 (80%) livestock farmers had heard the term 'zoonoses' but only 345 (40%), 264 (31%) and 214 (25%) farmers were aware of the zoonotic nature of tuberculosis, Japanese encephalitis and taeniosis, respectively. For practices, 23% farmers reported consumption of raw milk and only 10% and 8% livestock farmers ever got their animals tested for brucellosis and tuberculosis, respectively. The low level of education and being a cattle farmer were negatively associated with the farmer's knowledge on zoonotic diseases. The attitude score was positively associated with the practice score of the participants. The results indicate need for educating the livestock farmers particularly those with a low level of education to reduce the health and economic impact of zoonotic diseases in India.

Factors affecting seasonal changes in blood pressure in North India: A population based four-seasons study.

OBJECTIVE: There are no community based, longitudinal, intra individual epidemiological studies on effect of weather and season on blood pressure (BP). We evaluated the effect of season and temperature on prevalence and epidemiology of BP in tropical climate. METHODS AND RESULTS: It was a longitudinal cross sectional survey of rural and urban subjects in their native surroundings. BP was measured in four different seasons in same subjects. A total of 978 subjects (452 rural and 521 urban) were included in the current analysis. Demographic characteristics such as age, gender, education, occupational based physical activity and body mass index (BMI) were recorded. Mean BP, both systolic and diastolic were significantly higher in winter season as compared to summer season. Mean difference between winter and summer was 9.01 (95% CI: 7.74-10.28, p<0.001) in systolic BP and 5.61 (95% CI: 4.75-6.47, p<0.001) in diastolic BP. This increase in BP was more marked in rural areas and elderly subjects. Prevalence of hypertension was significantly higher during winter (23.72%) than in summer (10.12%). CONCLUSION: BP increases significantly during winter season as compared to summer season. Increase is more marked in rural areas and elderly subjects. Seasonal variation in BP should be taken into account while looking at prevalence of hypertension in epidemiological studies.

Rhodium nanocubes and nanotripods for highly sensitive ultraviolet surface-enhanced Raman spectroscopy.

We report the shape- and wavelength-dependent ultrasensitive label-free detection of adenine on rhodium cube- and tripod-star-like nanoparticles (Rh NPs) using ultraviolet surface-enhanced Raman scattering (UV-SERS). Rh NPs immobilized on a silane-treated glass substrate probed at near-resonant and non-resonant wavelengths served as the SERS platform for the highly reproducible, stable, and real-time detection of adsorbed adenine molecules in the femtomolar region. The sensitivity of SERS-active Rh NPs displaying LSPR in the UV region was exploited for the 266 nm (DUV), 325 nm (UV) and 532 nm (visible) Raman excitation wavelengths. With the 266 nm and 325 nm DUV-UV excitation lines, for the Rh tripod geometry near or pre-resonant excitation being closer to the analyte absorption band combined with the intrinsic UV-LSPR resonant energy produced a SERS enhancement factor as high as 105 and accelerated photoinduced degradations compared to 532 nm for our substrates. Computational results consistent with the experiment clearly demonstrated that the NP SERS enhancement was sensitive to both the intrinsic optical properties of Rh in the UV region and the excitation closer to the LSPR peak producing larger EM enhancements. The wavelength-dependent correlations between the optical properties of the shape-tailored Rh NPs and SERS enhancements envisage the merit and demerit of DUV-UV excitation over visible excitation for Raman measurements. The as-fabricated SERS substrate could also be efficiently recycled using O2 plasma for the detection of other biomolecules. The use of oxide-free transition metal Rh and DUV-UV excitation thereby extends the improved generality of the SERS technique for ultrasensitive bimolecular detection and for gaining a comprehensive understanding of UV-SERS-based applications.

Severe Varicella Pneumonia in Adults: Seven Years' Single-center Experience from India.

CONTEXT: Varicella pneumonia is a rare but a serious complication of chickenpox in adults. There is paucity of data on varicella pneumonia from India. AIMS: The aim of this study is to describe the clinical manifestations, hospital course, treatment, and outcome of adult patients with severe varicella pneumonia. SETTINGS AND DESIGN: This was a retrospective, observational study of patients with severe varicella pneumonia attending a tertiary care teaching hospital. SUBJECTS AND METHODS: The cases of varicella were identified by a computerized search of the medical record for the period between January 2010 and December 2016. During this period, 137 patients got admitted with varicella of which 22 had severe varicella pneumonia. STATISTICAL ANALYSIS: Mean and standard deviation were computed. Fisher's Z-test of proportions and analysis of variance were applied. RESULTS: There were 17 (77.3%) men and 5 (22.7%) women. The mean age of the patients was 33.4 ± 10.8 years. History of contact with an infected person followed by high-grade fever and typical rash was present in all patients. Forty-five percent (10/22) of patients were immunosuppressed. All the patients received intravenous acyclovir. Forty-five percent (10/22) of patients received invasive mechanical ventilation. The various factors associated with the need for mechanical ventilation were partial pressure of oxygen:fraction of inspired oxygen ratio <150, quick sequential (sepsis-related) organ failure assessment (qSOFA) >2, and early bacterial coinfection. The mean Intensive Care Unit and hospital stay were 7 days (range; 1-16) and 9 days (range; 4-21), respectively. The overall mortality was 22.7% and reached 50% in those requiring invasive ventilation. The mortality was higher among patients with qSOFA >3, mean arterial blood pressure <60 mmHg, and severe acute respiratory distress syndrome at presentation. CONCLUSIONS: Patients with severe varicella pneumonia are at an increased risk of respiratory failure and death.

Serum Zinc Levels as a Predictor of Severity of Acute Diarrhea.

OBJECTIVE: To determine relationship between serum zinc levels and severity of diarrhea as determined by hydration status, duration of diarrhea and requirement for hospitalization. Also, to compare serum zinc levels in relation to rotavirus status. METHODS: A prospective observational study which included 254 children aged 6 mo to 5 y with diarrhea was conducted. RESULTS: Serum zinc levels could be estimated in 198 children. Median (IQR) serum zinc levels of study population were 73.5 (59.11-92.86)µg/dl. Median (IQR) of serum zinc levels in children with dehydration and without dehydration were 69.64 (54.57-81.62) and 82.86 (64.1-103.48) µg/dl respectively (p < 0.001). Median (IQR) of serum zinc levels in hospitalised and non-hospitalished children were 63.28 (51.81-85.37) and 74.86 (61.75-95.78) µg/dl, respectively (p 0.013). Median (IQR) of total duration of diarrhea was 4.8 (3.5-6.0) d and it did not correlate with serum zinc levels. Median (IQR) of serum zinc levels in children, with rotavirus diarrhea was 66.8 (49.7-82.48) and non-rotavirus diarrhea was 80.0 (62.42-100.12) µg/dl (p < 0.001). CONCLUSIONS: Children with dehydration and those with rotavirus diarrhea tend to have significantly lower serum zinc levels. Hospitalized children also have lower serum zinc levels than non-hospitalized children. Duration of diarrhea does not relate with serum zinc levels.

Evaluating the Efficacy of Levonorgestrel Intrauterine System and Danazol for Relief of Postoperative Pain in Endometriosis.

INTRODUCTION: Endometriosis is an oestrogen-dependent disorder, manifests during reproductive years and is associated with pain and infertility. There is considerable debate about the effectiveness of various interventions for pain relief. AIM: To evaluate the efficacy of Levonorgestrel Intrauterine System (LNG-IUS) and Danazol in postoperative pain relief for patients with endometriosis. MATERIALS AND METHODS: Hundred patients with diagnosis of endometriosis, who were treated laparoscopically, entered the study to receive either danazol (600 mg once daily) or LNG-IUS (inserted during immediate post operative period) postsurgery, for pain relief. Patients were analysed for pain relief according to VAS score and recurrence of disease using ultrasonography at third and sixth months of follow up. RESULTS: There were 50% patients in stage IV of endometriosis. Majority of them presented with complaint of infertility (49%) and pelvic pain (43%). It was observed that LNG-IUS was significantly more effective in relieving pain compared to danazol (65.2% vs 38.0%, p<0.05). Recurrence rate was significantly lower in LNG-IUS users compared to other group. CONCLUSION: LNG-IUS was found to be more effective in relieving pain compared to danazol.

Trend in prevalence of coronary artery disease and risk factors over two decades in rural Punjab.

OBJECTIVES: The burden of coronary artery disease (CAD) has increased in the last three decades in low-income and middle-income countries including India. CAD is responsible for 20% deaths in India. The burden of CAD has increased due to a higher prevalence of risk factors related to the changing lifestyle. We studied the change in prevalence of CAD and risk factors over 20 years in a rural area. METHODS: A rural population of adults over the age of 30 years from three villages of Punjab was surveyed for the prevalence of CAD and its risk factors in 1994 and 2014 using similar research methodology. CAD was diagnosed by Epstein and clinical criteria. Blood pressure, anthropometry, ECG and biochemical analysis were carried out. The findings of two surveys were compared with a look at the change in the prevalence of CAD and its risk factors over 20 years. RESULTS: The overall age standardised prevalence of CAD increased from 2.79% in 1994 to 4.06% (p<0.05) in 2014. There was a significant increase in the prevalence of several risk factors including sedentary lifestyle (8.2% vs 41.3%, p<0.001), hypertension (14.5% vs 26.5%, p<0.001), diabetes (4.7% vs 9.7%, p<0.001), obesity (16.6% vs 35.4, p<0.001) and hypercholesterolaemia (7% vs 9.6%, p 0.011). In contrast, cigarette smoking (8.9% vs 3%, p<0.001) and use of desi ghee (51.4% vs 28.5%, p<0.001) decreased. CONCLUSIONS: In a rural population of Punjab, the prevalence of several CAD risk factors like sedentary lifestyle, hypertension, diabetes, obesity and hypercholesterolaemia increased over 20 years. These changes in risk factors were associated with a modest increase in prevalence of CAD.

The Nutrition Paradox in India: The Coexistence of Undernutrition and Overnutrition.

Undernutrition and overnutrition pose a significant challenge in many developing countries, including India. While one of the millennium development goal was to eradicate poverty and hunger by 2015, leaving health service workers with a compounding dilemma of solving both undernutrition and overnutrition concurrently. Both undernutrition and overnutrition are linked with a range of adverse health conditions. The underweights are susceptible to poor maternal and infant health as well as childhood growth problems and compromised mental development, whereas obese are associated with chronic diseases as stroke, hypertension, cardiovascular diseases, type 2 diabetes, and certain forms of cancer. The prevalence of child undernutrition was 60% in 1990 which came to 40% in 2011. India still continues to have a larger share of stunted, underweight, and wasted children. The underweight rate was about 52% in 1992 and declined to 47% in 1998 and remained nearly almost same (46%) in 2005-2006. On the other hand, overnutrition is also becoming a major public health problem over the past several decades. Studies have shown an increase in overweight children and adults over the past 2 decades especially.

Clinical spectrum and outcome of pulmonary nocardiosis: 5-year experience.

BACKGROUND: Pulmonary nocardiosis is a rare but a life-threatening infection caused by Nocardia spp. The diagnosis is often missed and delayed resulting in delay in appropriate treatment and thus higher mortality. AIM: In this study, we aim to evaluate the clinical spectrum and outcome of patients with pulmonary nocardiosis. METHODS: A retrospective, 5-year (2009-2014) review of demographic profile, risk factors, clinical manifestations, imaging findings, treatment, and outcome of patients with pulmonary nocardiosis admitted to a tertiary care hospital. RESULTS: The median age of the study subjects was 54 years (range, 16-76) and majority of them (75%) were males. The risk factors for pulmonary nocardiosis identified in our study were long-term steroid use (55.6%), chronic lung disease (52.8%), diabetes (27.8%), and solid-organ transplantation (22.2%). All the patients were symptomatic, and the most common symptoms were cough (91.7%), fever (78%), and expectoration (72%). Almost two-third of the patients were initially misdiagnosed and the alternative diagnosis included pulmonary tuberculosis (n = 7), community-acquired pneumonia (n = 5), lung abscess (n = 4), invasive fungal infection (n = 3), lung cancer (n = 2), and Wegener's granulomatosis (n = 2). The most common radiographic features were consolidation (77.8%) and nodules (56%). The mortality rate for indoor patients was 33% despite treatment. Higher mortality rate was observed among those who had brain abscess (100.0%), HIV positivity (100%), need for mechanical ventilation (87.5%), solid-organ transplantation (50%), and elderly (age > 60 years) patients (43%). CONCLUSION: The diagnosis of pulmonary nocardiosis is often missed and delayed resulting in delay in appropriate treatment and thus high mortality. A lower threshold for diagnosing pulmonary nocardiosis needs to be exercised, in chest symptomatic patients with underlying chronic lung diseases or systemic immunosuppression, for the early diagnosis, and treatment of this uncommon but potentially lethal disease. Despite treatment mortality remains high, especially in those with brain abscess, HIV positivity, need for mechanical ventilation, solid-organ transplantation, and elderly.

Depression and anxiety among middle-aged women: A community-based study.

BACKGROUND: Anxiety and depressive disorders constitute a substantial proportion of the global burden of disease and are projected to form the second most common cause of disability by 2020. OBJECTIVE: To assess the level of depression and anxiety among middle age women and the possible factors behind it. MATERIALS AND METHODS: A total of 180 women aged 40-60 years were selected by proportionate sampling technique. Age, education, marital status, socioeconomic status, age at marriage, age at menopause, weight and height were noted. Zung-self-rating scales were used for calculating levels of depression and anxiety in these women. The data were analyzed by using statistical software SPSS. RESULTS: The level of syndromal depression and anxiety was found to be 86.7% and 88.9%, respectively. Most of the subjects had the moderate type of depression (49.5%) followed by mild (29.4%) and severe depression (7.8%). While in case of anxiety, most of the subjects (69.4%) had a mild form of anxiety and 17.8% had moderate anxiety level. A significant difference was observed in the level of depression with respect to marital status (P = 0.009) and in the level of anxiety with respect to age (P = 0.021) in the study subjects. On applying logistic regression, none of the factors studied were found to be significant variables for anxiety or depression in the study population. CONCLUSION: Depression and anxiety are prevalent among the middle-aged women in rural Punjab. Provision of mental health services in this group is essential.