Efficacy of foam sclerotherapy in treatment of grade I and grade II bleeding hemorrhoids at Nalanda Medical College and Hospital, Patna

Background: Sclerotherapy is the treatment of choice for first and second grade haemorrhoidal disease. The aim of this study is to assess the efficacy and safety of polidocanol foam for haemorrhoidal disease.Methods: A total of 50 patients were treated with foam sclerotherapy (polidocanol 3%). Patients who presented with complain of bleeding per anum and diagnosed with first and second grade hemorrhoidal disease were included. Patients without bleeding per anum were not included. The primary objective was the stopping of perianal bleeding after one sclerotherapy session. Sclerotherapy was repeated at 2-week intervals until patients were free of bleeding. The final follow-up was 12 weeks after the last sclerotherapy session.Results: After one foam sclerotherapy session, 82% of patients (41 out of 50) were treated successfully. After second sclerotherapy, 98% of the patients (46 out of 50) were treated successfully. 2% of the patients received third sclerotherapy.Conclusions: In the treatment of first and second grade haemorrhoidal disease, polidocanol 3% foam is very effective and safe. The results of this study show that foam sclerotherapy is a new, innovative, effective and safe non-surgical treatment option for haemorrhoidal disease.

Analysis of bacterial diversity associated with polyketide synthase (PKS) gene in brackish metagenome of TsoKar Lake of Ladakh, India

Aim: To explore bacterial diversity associated to polyketide synthase (PKS) genes in the TsoKar brackish metagenome.Methodology: The metagenomic DNA of TsoKar water and sediment samples were isolated and amplified using pks specific degenerate primers. PCR amplified products were analysed using Ion Torrent PGM platform and revealed a total of 2,11,030 reads with 534 contigs and 55% of G+C content. The results of BLASTx was further analyzed for species diversity using MEGAN5 software. Results: Halomonas was found to be the dominant phyla followed by Cyanobium, Acinetobacter and Burkholderia, respectively, along with majority of uncultured microorganisms present in TsoKar metagenome. Since TsoKar is a brackish water lake, and brackish aquatic ecosystems are a major hub of diverse microbes was also revealed in this study. TsoKar metagenomic sequence with accession number SRR8381943 was deposited in SRA database. Interpretation: TsoKar Lake is considered as one of the most important biosphere reserves. The results of this study confirm that this unique niche harbors good bacterial diversity associated with polyketide synthase genes, which justifies the idea of bioprospecting such niches for the discovery of novel metabolites like antimicrobial compounds using next-generation sequencing approach

Molecular typing of mealybug Phenacoccus solenopsis populations from different hosts and locations in Punjab, India.

True identity and existence of genetic variability in mealy bug from different regions holds immense significance for adopting appropriate control measures along with predicting the development of any biotypes. Mealy bug, Phenacoccus solenopsis adults were collected from four host plants i.e., Gossypium hirsutum – cotton (C), Abelmoschus esculentus – okra (O), Pennisetum glaucum – Napier Bajra (B) and a weed – Parthenium hysterophorus (P) in five cotton growing districts i.e., Abohar, Bathinda, Mansa, Muktsar and Faridkot of Punjab state. Variability among different populations was investigated through comparative analysis of four different RAPD markers. The genetic similarity dendrogram established that irrespective of the host plant and the collection site, 20 mealybug populations were distinguishable into two major clades that were related to each other by 68 %. Clade 1 included populations from Abohar district; it also included a single population each from Muktsar and Bathinda districts. The populations from all the other districts were grouped under Clade 2 with genetic similarity of 78 % Even under Clade 2, individual populations appeared to exist in location specific sub-clades. Thus, there is great possibility of development of biotypes which may differ in resistance to insecticides and host plant specificity.

One-step purification and characterization of cellulase-free xylanase produced by alkalophilic Bacillus subtilis ash

A purificação de uma etapa e caracterização de uma xilanase livre de celulase de uma linhagem recentemente isolada alcalofílicos e moderadamente termofílico de Bacillus subtilis ASH. Xilanase foi purificada à homogeneidade de 10,5 vezes, com ~ por cento de recuperação 43 através de cromatografia de troca iônica através de CM- Sephadex C -50. A enzima purificada revelou uma única banda no gel SDS-PAGE com uma massa molecular de 23 kDa. Ele mostrou um pH ótimo de 7,0 e manteve-se estável na faixa de pH 6,0-9,0 . A temperatura ótima para atividade da enzima foi 55 º C. A xilanase purificada não perder nenhuma atividade até 45 º C , no entanto, manteve 80 por cento e 51 por cento de sua atividade após pré-incubação a 55 º C e 60 º C , respectivamente. A enzima obedecido Michaelis- Menton cinética para xilano de madeira de bétula com aparente km 3,33 mg / ml e Vmax 100 UI / ml. A enzima foi fortemente inibida por Hg2 +, Cu2 + , enquanto reforçada por Co2 + e Mn2 +. A enzima purificada pode ser armazenado a 4 º C por seis semanas sem nenhuma perda de atividade catalítica. A purificação mais rápido e econômico da xilanase livre de celulase de B. subtilis ASH por um passo-a processo juntamente com a sua estabilidade sensível a alta temperatura e pH alcalino torna potencialmente eficazes para aplicações industriais.

Apparent hypocortisolism in an infant with prolonged hyperinsulinism.

We report a case of transient hyperinsulinism with hypocortisolemia in a preterm small for date neonate with recurrent hypoglycemia and perinatal stress. Investigation revealed increased Insulin level with subnormal cortisol level even during hypoglycemia. Hypoglycemia resolved by its own by 22nd day of life with normal insulin and cortisol level thereafter.

Hepatitis B and C Virus Infection in an Urban Slum of Northern India.

A community based cross sectional study was conducted in an urban slum amongst males to assess the magnitude of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections among males between 20-50 years of age. All of the 288 males who were contacted had agreed to participate in the study. However, the information could be collected from a total of 260 subjects, using a pretested, pre-coded schedule included socio-demographic characteristics. Serological tests were done for Hepatitis B and C. The data were analyzed using EPI-INFO 3.2.2. Proportion of persons tested serologically positive for Hepatitis B and C in the present study was observed to be 10.38% and 1.15%, respectively. Higher proportion for hepatitis Band C was observed amongst those Muslims, below 35 years of age, stay in the area for less than 5 years, Illiterates, unstable occupation, staying away from home and those with no history of blood transfusion or donation; however the difference was not statistically significant. There is a need to carry out more community based studies amongst such populations at risk in order to assess the true prevalence and risk factors for appropriate intervention.

Effectiveness of HIV Counseling Services on Knowledge, Attitude, Behavior and Practice (KABP) Among Pregnant Women Attending PPTCT Program.

Counseling services is an important component of National AIDS Control Program which aims at creating awareness and promoting changes in reducing high risk behavior against HIV/AIDS. Pregnant women attending antenatal clinics are being counseled about HIV/AIDS under prevention of parent to child transmission (PPTCT) program. The objective of this study was to assess (KABP) regarding HIV/AIDS among pregnant women attending PPTCT program before and after counseling at Lok Nayak Hospital, New Delhi. A Quasi-experimental study was conducted. Data was collected by interviewing 600 pregnant women attending ANC clinic during May 2006 to May 2007 using a pre-test and post-test interview schedule. About 69.2% of the pregnant women had heard about AIDS before the counseling. Knowledge regarding mother to child transmission of HIV was 53.5%. 38.2% knew that mother to child transmission can be reduced by drugs. The knowledge of pregnant women about AIDS was significantly different in pre-test (mean score =15.3) and post test (mean score=35.6) (P<0.0001). Attitude of study participants towards people living with HIV/AIDS (PLWHA) indicated that individual. with HIV should be allowed to work (79.9%) and all commercial sex workers should compulsorily be tested for HIV (55.1%). There was significant difference between in pre-test and post-test attitude about PLWHA and HIV testing (p<0.0001). The condom use among the study participant significantly improved after counseling (1.2% in pre-test and 58.6% after counseling) (p<0.0001). Counseling services were effective in increasing knowledge and changes in attitude and behavior among pregnant women and the efforts needs to be sustained.

Assessment of Quality of Life among HIV Positive People Attending Tertiary Hospital of Delhi, India.

As per global HIV/AIDS estimates, a total of 33 million [30.3 – 36.1 million] People were living with HIV in 2007. The world's second-most populous country, India, is experiencing a highly varied HIV epidemic, which appears to be stable or diminishing in some parts while growing at a modest rate in others. Quality of life (QOL) of HIV/AIDS patients is becoming an important component of overall assessment of health care and management in health care settings. It is one of the indicators effectiveness of management of PLHAS . The objective of this study was to determine the QOL of patients with HIV/AIDS in New Delhi. Purposive sampling was used to identify subjects from the antiretroviral therapy clinic (ART) in Lok Nayak hospital. 180 patients were interviewed with the WHOQOL-HIV instrument. This questionnaire included demographic data, multi-item scales and six domains namely physical, psychological, level of independence, social relationships, environment and spirituality religion. Study subjects were aged between 20-56 years. Mean age of all study subjects was 33.85±7.01 years, comprising of 34.4 females. More than 50% of the total subjects had received less than secondary school education. All domains have higher scores for women than men except the psychological domain. Correlation of scores of six domains with overall QOL score and among individual domains was statistically significant. Younger people showed poorer QOL and level of education correlated positively with all domains of QOL. Overall results indicate that quality of life of AIDS attending Lok Nayak hospital is satisfactory.

Impact of health education intervention on knowledge and community action for malaria control in Delhi.

Malaria affects millions of people in India despite decades of efforts to control it. It has acquired greater importance in last two decades due to emergence of vector resistance, poor quality of care and low utilization of services. The study was conducted to improve the management of malaria by IEC and training activities in slum areas of Delhi. The baseline and post intervention data on knowledge, attitude, behavior and practices (KABP) regarding malaria was collected from 601 and 593 subjects respectively from two zones of Municipal Corporation of Delhi (MCD). At the same time, knowledge and skills regarding management of malaria were assessed among 15 health workers working in these two zones of MCD. An intervention package in the form of health education material for the community and training modules for the workers were designed and implemented. Post intervention data were collected. The knowledge about cause of malaria, season of malaria and breeding places of mosquito increased among community members after the intervention, which was found to be statistically significant. Similarly, more people were aware about the methods of prevention of mosquito breeding after the intervention. Methods like mosquito coil (post-64.92% vs pre-55.41%) and bet nets (post-24.96% vs pre-14.47%) were used by more people in post intervention phase. The Interval between onset of symptoms and seeking treatment decreased after the intervention from 1.66 days to 1.37 days. Among the workers, knowledge and skills regarding malaria management improved after the intervention. More blood slides were made, side effects of the treatment were explained to the patients and better compliance to treatment was observed in post intervention phase. IEC activities using attractive pamphlets to the community and on-job training of workers improves management of malaria and should be used more frequently more so in the slum areas for the success of the National Anti-Malaria Program.

"Knowledge, attitude, behavior and practice (KABP) regarding HIV/AIDS among pregnant women attending PPTCT programme in New Delhi".

In India, several thousand HIV-infected babies are expected to be born every year. Despite effective intervention, the identification of HIV infected pregnant women prior to delivery is a major problem. KABP and acceptance of rapid screening of women for HIV among pregnant women attending ANC clinic and availing Voluntary Counselling and Confidential Testing services was assessed. The study was done among 90 pregnant women. There was no significant difference between one's husbands's job and income with respect to pregnant women's awareness of risk factors except that of tattooing. Education level had significant bearing on awareness level. Attitude about PLWHA indicates that 29% of the participants believed individuals with HIV shouldn't be allowed to get married, while 31% saying that they should not be allowed to have children. Participants supported compulsory HIV testing for pregnant women (39%) and couples before marriage. Almost 96% of participants had unprotected sex, though 41% casually used condom. All denied herself or her husband indulging in extramarital sex. The country is about to embark on its prevention of mother to child transmission (PMTCT) programme. This study throws some light on the level of knowledge acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries.

A rare case of trypanosomiasis in a two month old infant in Mumbai, India.

Human Trypanosomiasis is a rare occurrence in India. In the cases reported so far the disease causative species have been the species infective to animals viz., Trypanosoma lewisi and Trypanosoma evansi. These animal species usually non pathogenic in humans can acquire the desired virulence and emerge as human pathogens causing serious disease, in the right combination of environmental, host related and organism related factors. We report here a case of trypanosomiasis caused by the rodent parasite T. lewisi in a two months old infant in urban Mumbai. Under the fastly changing environmental scenario there is an urgent need to be prepared for the emerging zoonoses. Any unusual disease occurrence in a given geographical area acquires a special significance in this context and should be reported to assess its public health importance and be prepared to deal with the consequent challenges posed, if any.

Prevalence and awareness about sexually transmitted infections among males in urban slums of Delhi.

BACKGROUND: India is at present facing an emergence of sexually transmitted infections (STIs) and human immunodeficiency virus. Community-based studies on the prevalence of STIs among males are scanty. AIM:(i) To study the prevalence of STIs and (ii) to assess the level of awareness about STIs among males belonging to the reproductive age group residing in an urban slum. SETTING AND DESIGN: This is a cross-sectional study conducted in selected areas of Delhi, using a camp approach. MATERIALS AND METHODS: One hundred ninety-six males in the reproductive age group were interviewed regarding their awareness about STIs, past history and present complaints of any symptoms suggestive of an STI. This was followed by a clinical examination. Required samples were also collected for microbiological tests. STATISTICAL TESTS: Simple proportions and Chi-square test. RESULTS AND CONCLUSIONS: As many as 70% of the study participants were unable to mention even one symptom of an STI. About 73.4% of the study participants stated that staying in a monogamous relationship could help prevent STI, while only 39.2% were aware that condoms could afford protection against an STI. As many as 8.7% complained of urethral discharge, while 5.6% complained of itching, 2.5% reported presence of genital ulcer and 1.0% complained of groin swelling. We found a seroprevalence rate of 1.5% for trichomoniasis and 3.6% for syphilis. Thus the overall awareness level about STIs and their prevention was rather low. Poor treatment-seeking behavior was also observed. The actual prevalence rate in the general population might be higher due to the likelihood of presence of an asymptomatic infection. The present study calls for a multipronged approach which also includes targeted interventions and strategies to be adopted in the reproductive health programs for males who have been neglected by the program managers so far.

TLC-spectrophometric separation and trace determination of monocrotophos and dichlorvos in enviromental and biological samples.

Organophosphorus insecticides, monocrotophos and dichlrovos are increasingly being used in agriculture to control insects on a wide range of crops. Their ready access has resulted in misuse in many instances of homicidal and suicidal poisoning cases. This paper describes about a chromogenic spray reagent for the detection/determination of monocrophos and dichlrovos in environmental and biological samples by TLC and spectrophotometric method. Monocrotophos and dichlorvos on alkaline hydrolysis yield N-methyl acetoacetamide and dichlroacetaldehyde respectively, which in turn react with diazotized p-amino acetophenone to give red-violet and red coloured compounds. Other organophosphorus insecticides do not give this reaction. Moreover, organochlorine and synthetic pyrethroid insecticides and constituents of viscera (amino acids, peptides, proteins etc), which are generally coextracted with the insecticides, do not interfere. However, phenolic compounds and hydrolysed product of carbamate insecticides may interfere and differentiate from monocrotophos and dichlrovos by Rf values. The lower limit of detection is 0.2 mg for monocrotophos and 0.1 mg for dichlorovos. The absorption maxima of the reddish-violet and red colour formed by monocrotophos and dichlrovos, are measured at 560 nm and 540 nm respectively. Beer's Law is obeyed over the concentration range of 1.2 to 6.8 mg and 6.2 to 35 mg in the final solution volume of 25 mL. The molar absorptivity and Sandell's sensitivity of monocrotophos and dichlrovos were found to be 7.1 x 10(5) (+100) 1 mole(-1) cm(-1) and 0.008 mg cm(-2), 1.2 x 10(5) 1 mole(-1) cm(-1) and 0.003 mg cm(-2) respectively. The standard deviation and relative standard deviation were found be +/- 0.005 and 2.05% +/- 0.007 and 2.02% respectively. The developed method has been successfully applied to the detection and determination of monocrotophos and dichlrovos in environmental and biological samples.

Increasing access to cataract surgery in a rural area--a support strategy.

The objectives of the study were to elicit the reasons for not undergoing cataract surgery from those having cataract, aged 50 years and above, in a village community and, develop, implement and assess a support strategy for getting cataract surgery done. The leading reasons identified were monetary constraints (18.8%), transport difficulty (17.4%), lack of awareness about cataract in the eyes (17.4%) and lack of escort (14.5%). Based on the identified reasons, patients were transported in groups to a government eye hospital for free surgery after completion of required pre operative formalities at the village health center itself. Out of 65 eligible individuals, 66.2% underwent surgery. The success of the approach was evident by perceived improvement in vision in 88.4% operated patients, occurrence of only few minor complications and a satisfactory hospital experience being reported by all.

The Spectrum of Renal Osteodystrophy: A Clinical, Biochemical, Radiological and Histopathological Study

The chief mineral source of Jammu province is bauxite, an aluminium ore, so a possibility of water being heavily polluted with aluminium is prevalent. Hence, in an effort to relate this regional geographical aspect with aluminium bone disease (ABD) in chronic renal failure (CRF), 50 cases of CRF were prospectively evaluated. Patients were subjected to a thorough history and clinical examination. Biochemical parameters along with raiological skeletal survey and iliac crest bone biopsies were undertaken. Sixty-eight per cent of CRF patients were also consuming aluminium containing phosphate binders (ACPB) at that time. The study revealed an occurrence of ABD in 10% of CRF patients. It was found predominantly superimposed upon osteomalacia (8%) and mixed osteodystrophy (2%). Superimposed ABD on osteomalacia was found more frequently in pre-dialysis (10.8%) than after haemodialysis group (7.69%). Moreover, the incidence of ABD superimposed on osteomalacia and mixed osteodystrophy was higher in the ACPB group (14.7%) than the post-haemodialysis group (7.69%). Correlating, the pre-dialysis, post-haemodialysis and ACPB ingestion status of CRF patients on one hand and histologically proven ABD on the other, it was deduced that the majority of cases of CRF having ABD was seen in ACPB ingestion group (14.7%) followed by pre-dialysis (10.8%) and post-haemodialysis (7.69%) groups. Thus it was concluded that in the present work, ACPB ingestion was the major source of aluminium deposition in bones of patients with CRF rather than the water used in dialysis or possible pollution of drinking water with aluminium in our province.