Budgetary Allocation for Health Sector Projects in Local Bodies with Specific Reference to Noncommunicable Diseases Control

Background: The role of local self-government (LSG) bodies in planning community-level interventions for noncommunicable diseases (NCD) control is critical. An understanding of how much priority is given to NCD in decentralized health planning is needed. Objective: The objective of this study is to analyze the pattern of budgetary allocation for health sector projects at different levels of LSGs in Thiruvananthapuram, Kerala, with specific reference to NCD control. Materials and Methods: Secondary data analysis was done on economic review reports and reports on health sector projects obtained from LSG department with permission. The pattern of budgetary allocation of health projects in both urban and rural local bodies of Thiruvananthapuram district for 2019–2020 was studied. Results: The proportion of NCD projects in terms of number and budget allocation, respectively, among health sector projects for gram panchayaths(GP) was 47 projects (5.25%) and 63.19 lakhs (1.8%). Figures for block panchayaths(BP) were 13 (9%) and 98.10 lakhs(10.94%), for district panchayath (DP), 1 (0.9%) and 48 lakhs(3%), for municipalities 1 (1.6%) and 4.66 lakhs (1.2%), and for corporation were 1 (1.4%) and 3 lakhs (0.16%). Only 29 (40%) GP and 5 (45%) BP had at least one NCD project. At the GP level, 21% of projects were community?based interventions and 15% of projects were for cancer screening, mental health, and hospital?based NCD clinics each. Among local bodies with lower allocation for NCD projects, the amount allocated for construction and maintenance work in health institutions was higher. Conclusion: Decision-making in decentralized health planning needs an evidence-based realignment of priorities toward NCD.

Perceptions on COVID-19 Vaccination among People Aged more than 50 years in Urban Field Practice Area of Department of Community Medicine in a Tertiary Care Teaching Hospital, Hyderabad: A Reflection from Focus Group Discussions

Background: Despite several efforts to limit the viral transmission, the COVID-19 vaccine has been the only “the ray of hope” to end the pandemic. However, vaccine hesitancy could reduce coverage and hinder herd immunity. People’s intention to get vaccinated can be shaped by several factors, including risk perception which, in turn, is influenced by effect. The need to acquaint oneself to the beliefs, concerns, and circumstances of one’s own population in the community becomes important for successful implementation of the program. Therefore, the present study was conducted to gain insights into perceptions of vaccination. Objectives: The objective is to understand the felicitating factors and hindering factors for acceptance of vaccines by the population among people aged 50 years in urban field practice area of the Department of Community Medicine in a Tertiary care teaching hospital, Hyderabad. Subjects and Methods: Data were extracted from audio recording of five focus group discussions that were conducted in the urban field practice care of a tertiary care teaching hospital in Hyderabad through open-ended questions. Categories, subcategories, and themes were created by deductive approach. Results: The motivating factors for vaccine acceptance were found to be fear of getting disease, wanting to return normalcy, and trust in treating doctors, whereas, barriers were fear of death due to vaccine, opacity in vaccine details, anxiety, and misinterpretation of adverse events. Conclusion: Having a clear understanding about the belief system of the target population could help in designing the guidelines for vaccination program to escalate the immunization and increase the acceptance.

Identification and characterization of bacteria isolated from sago industrial effluent

Sago industrial effluent is highly organic and acidic in nature and generates pungent odour. As it is highly rich in organic compound starch that acts as the substrate hosting various bacterial communities, it plays an important role in the industrial and biomedical fields. The present study deals with isolation, identification and characterization of the unknown bacteria present in the sago industry effluent. A total of four bacteria were isolated from sago industrial effluent using nutrient agar medium. Based on the morphological, biochemical, 16S rRNA sequencing and phylogeny analysis, the isolated bacteria were identified as the species of Lysinibacillus, Pseudomonas and Brevibacillus. Indigenous bacteria isolated from the sago industrial effluent were studied to examine their compatibility and antagonistic activities (antibacterial and antibiotic) and their tolerance against five heavy metals (chromium, copper, iron, magnesium and zinc). All the four isolates found compatible with each other. Brevibacillus sp. demonstrated significant antibacterial activity against the tested pathogenic bacteria. Antibiotic sensitive assay showed that the isolates were highly resistant to the antibiotics ampicillin and penicillin, and highly sensitive to gentamycin, tetracycline and chloramphenicol. The isolated bacteria were resistant to the heavy metals within the limit of 0.2 to 0.8 mg L-1.

Substance abuse amongst the medical graduate students in a developing country.

Background & objectives: Substance abuse is found worldwide including among students. We carried out this study to estimate the prevalence of substance abuse among medical student studying in a medical college in north India. Methods: Using a validated questionnaire a cross-sectional survey was conducted among 230 undergraduate and postgraduate medical students in a private medical college. Results: The prevalence of substance abuse was 20.43 per cent (47/230) among medical students. An increase in substance abuse was observed in the latter years of medical education. A total of 43 of 47 (91.7%) students using these substances were aware of the ill effects. The most common reasons for substance use were relief from psychological stress (34/47, 72.4%) and occasional celebration (34/47, 72.4%). Of the 47 substance users, 28 (59.6%) made past attempts to quit the substance abuse. Interpretation & conclusions: Nearly one-fifth of medical students abuse at least one substance despite knowing the ill effects with the main predisposing factor being the psychological stress.

Nano Coated Lead Free Solders for Sustainable Electronic Waste Management

ABSTRACT Lead has been used in a wide range of applications, but in the past decades it became clear that its high toxicity could cause various problems. Studies indicate that exposure to high concentrations of lead can cause harmful damages to humans. To eliminate the usage of lead in electronic products as an initiative towards electronic waste management (e waste), lead free solders were produced with suitable methods by replacing lead. But lead free solders are not preferred as a substitute of lead because they are poor in their mechanical properties such as tensile strength, shear strength and hardness which are ultimately required for a material to resist failure.Nano-Structured materials and coatings offer the potential for Vital improvements in engineering properties based on improvements in physical and mechanical properties resulting from reducing micro structural features by factors of 100 to 1000 times compared to current engineering materials.

Anti-ulcer activity of arachidonic acid (PUFA) oils in different induced ulcer animal models.

Background: Ulcers of the lower part of the oesophagus, the stomach and the first part of the duodenum are also known as peptic ulcers. Peptic ulcers can affect people of any age, but they are more common as you get older. There is a focus on research for better tolerated and efficacious anti-ulcer agents. Methods: Effect of anti-ulcer activity of fish oil and Arasco oil was evaluated in different animal models of ulcers i.e. ethanol induced, water immersion and pyloric ligation techniques. The Superoxide dismutase activity in gastric tissue was also ascertained in two groups of animals. The animals received either fish oil (40 μl, PO), Arasco oil (40 μl, PO), omeprazole (20 mg/kg PO) or ranitidine (30 mg/kg PO). The gastro-protection was calculated based on ulcer index, pH and gastric juice volume. Results: The results of this study suggest that poly unsaturated fatty acid (PUFA) contained in fish oil and Arasco oil have moderate anti-ulcer activity although probably lesser in potency than the available anti-ulcer drugs like omeprazole and ranitidine. Conclusion: These results have shown that PUFA containing oils provided moderate gastrointestinal protection in all the induced ulcer models employed. Thus it can be concluded that PUFA containing oils like the Fish oil and Arasco oil have anti-ulcer properties and the mechanisms involved in these actions need to be investigated.

Utility of PET in unknown primary with cervical metastasis: A retrospective study.

Background: FDG-PET is recommended as an investigation in unknown primary tumors, but its definitive role and cost effectiveness are yet to be established. Aims: dditional value of FDG-PET over conventional imaging in unknown primary tumors with cervical metastasis. Setting and Design: Retrospective study in a tertiary level oncology centre. Materials and Methods: A total of 112 patients were divided into three groups; 53 with conventional modalities (either computed tomography or magnetic resonance imaging) (group I), 59 with FDG-PET (group II), and group III (subgroup of group II) with both (40 patients). Statistical Analysis: Sensitivity and specificity of both conventional modality and PET were calculated. Association between neck nodes and distant metastasis was analysed using multivariate logistic regression analysis. Results: Sensitivity and specificity for conventional modalities was 92.3% and 50% and sensitivity and specificity of FDG-PET was 92.8% and 71.4%, respectively. FDG-PET detected metastasis in 52.54% of patients. Multivariate logistic regression analysis showed statistically significant association between distant metastasis and multiplicity of nodes (N2b, N2c) (P = 0.007). Among all patients with low neck nodes in group II, FDG-PET detected primaries in 12 patients, 9 of which were infraclavicular (75%). FDG-PET added information to conventional imaging in 32.5% of patients and influenced an overall change in management in 38.9% of patients. Conclusions: FDG-PET is a valuable tool influencing change of management in unknown primary with cervical metastasis. It is recommended especially in the presence of low or multiple neck nodes in view of high incidence of infraclavicular primary and distant metastasis, respectively.

Evaluation of tolerability and efficacy of glucosamine with chondroitin in the treatment of knee osteoarthritis – a double blind multicentre randomized prospective comparative study.

There are few comparative studies conducted with glucosamine [GlcN1 (glucosamine sulfate with potassium chloride), GlcN2 (glucosamine sulfate plus chondroitin sulfate) along with ChoN3 (chondroitin sulfate alone)] in the treatment of knee osteoarthritis. In this study the treated groups were studied for alleviation of pain and joint stiffness with correlation of measurement of urinary pyridinium cross links such as pyridinoline (Pyr) and deoxypyridinoline (Dpyr). Hence, this study was eventually planned to evaluate the efficacy, safety and tolerability of glucosamine with chondroitin sulfate treated groups. Urinary pyridinium crosslinks such as Pyr and Dpyr measurement are used to monitor the clinical status as well as bone turnover of OA patients. These two collagen crosslinks measured in urine, which provides information both on the pathogenesis of OA as well as the rate of bone turnover. The results of this study suggest that GlcN2 and ChoN3 can relieve pain, improving functional ability and joint mobility so as to enhance the quality of life for osteoarthritis patients.

Fatal cellulitis caused by Apophysomyces elegans.

A case of cellulitis of the left lateral side of the face caused by the zygomycete Apophysomyces elegans in a healthy male following a road traffic accident is reported. The contaminated soil was the source of fungus. Broad aseptate fungal hyphae were seen in the necrosed tissues. Extensive tissue debridement and treatment with amphotericin B were not successful in controlling the rapid invasion of the tissues by the fungus. Patient developed angioinvasion, severe cellulitis and finally succumbed to the infection three weeks after admission.

Congenital epulis - congenital granular cell lesion: a case report.

Neumann first described congenital epulis (CE) of newborn in 1871. CE occurs at birth and has a striking predilection for females. It is most frequently located on the anterior maxillary alveolar ridge. CE clinically appears as a pedunculated protuberant mass. In cases with large lesions mechanical oral and nasal obstruction can impair fetal deglutition and neonatal respiratory efforts resulting in polyhydramnios prenatally or respiratory impairment postnatally. Histologically CE shows characteristic large cells with granular cytoplasm and spindle cells resembling fibroblasts. The exact histiogenesis is still uncertain, various theories of origin are epithelial, undifferentiated mesenchymal cells, pericytes, fibroblast, smooth muscle cells and nerve related cells. A newborn female child with CE in the maxillary alveolar ridge reported to our institution is presented with investigation, management and follow-up.

Nevoid basal cell carcinoma syndrome.

Binkley and Johnson first reported this syndrome in 1951. But it was in 1960, Gorlin-Goltz established the association of basal cell epithelioma, jaw cyst and bifid ribs, a combination which is now frequently known as Gorlin-Goltz syndrome as well as Nevoid Basal Cell Carcinoma Syndrome (NBCCS). NBCCS is inherited as an autosomal dominant trait with high penetrance and variable expressivity. NBCCS is characterized by variety of cutaneous, dental, osseous, opthalmic, neurologic and sexual abnormalities. One such case of Gorlin-Goltz syndrome is reported here with good illustrations.

Malignant melanoma of the oral cavity--case reports and review of literature.

Melanoma is a malignant tumor of melanocytes or their precursor cells. It is the third most common skin cancer and is one of the most biologically unpredictable neoplasms. Sunlight is an important etiological factor in cutaneous melanoma. Oral melanoma is relatively uncommon, exhibiting a definite predilection for palate and maxillary gingiva, and is twice as common in males as in females. We herewith report three cases of oral melanoma out of which two occurred on the palate and one in the maxillary gingiva. Their clinical presentations, histopathology and management are discussed.

Congenital hypomyelinating neuropathy.

An eleven-month-old baby born out of non-consanguineous parentage presented with history of delayed motor milestones. The weakness was predominantly distal; there was intercostal muscle weakness, generalized hypotonia and areflexia. The nerve conduction velocities were unobtainable in all the four limbs. Sural nerve biopsy was consistent with the diagnosis of congenital hypomyelinating neuropathy, a rare form of hereditary motosensory neuropathy.

Oculodermal melanocytosis--Nevus of Ota (with palatal pigmentation).

Nevus of Ota is a benign dermal melanocytosis, that involves facial skin as a macular discoloration, appearing as blotchy blue to blue gray. It involves the upper portion of the face, especially over the periorbital area. It also involves ocular structures such as episclera, sclera, conjunctiva, cornea, retina, uveal tract and also nasopharynx, auricular mucosa, tymphanic membrane and dura. Glaucoma and malignant melanoma are the two known ocular complications in patients with Nevus of Ota. 12-18% of these patients exhibits palatal pigmentation. Here we are reporting two cases of Oculodermal melanocytosis, one of which exhibited palatal pigmentation.

Dens in dente (dens invaginatus). Report of two unilateral and one bilateral case.

Dens invaginatus is a deep surface invagination of the crown or root that is lined by enamel. It is one of the developmental anomalies affecting the teeth. It commonly affects maxillary lateral incisor, followed by central incisor, premolar, canine and molar tooth. Maxillary teeth are more commonly involved than mandibular teeth. It usually occurs unilaterally although 43% occur bilaterally. The invagination within the tooth can be single, double and even triple has been reported. The affected tooth usually is thick, barrel shaped with a small round palatal opening to the invagination. It usually traps plaque, food debris and is prone for dental caries, which may lead to pulpal and periapical pathology. So if detected early the dens invaginatus should be prophylatically restored. Two unilateral and one bilateral case of dens invaginatus are reported here.

Supernumerary roots.

Supernumerary roots are one of the development anomalies pertaining to the tooth root morphology. It is generally well known that the deciduous and permanent anterior teeth have a single root. Maxillary molars have three roots and mandibular molars have two roots. Pertaining to the premolars, except for the maxillary first premolars all other premolars have a single roots. These supernumerary roots may be due to the disturbances of the Hertwig's epithelial root sheath forming the root. Cases have been reported where in both the deciduous and permanent dentition exhibiting supernumerary roots. Here with we are presenting cases of supernumerary roots in permanent teeth involving maxillary third molars, mandibular first, second molars and mandibular second premolars.

Isolation and identification of aeromonas from patients with acute diarrhoea in Kolkata, India.

Isolation of diarrhoea causing Aeromonas was carried out in the division of Active Surveillance, National Institute of Cholera and Enteric Diseases (NICED), Kolkata for a period of 12 months from January 1999 to December 1999. Out of 602 stool samples collected from patients with acute diarrhoea admitted in Infectious Diseases (ID) Hospital, Kolkata, 64 (10.6%) samples were identified positive for Aeromonas as the pathogen. The different isolated and identified species from patients with acute diarrhoea were A. hydrophila (60%), A. caviae (20%), A. veronii (10%), A. schubertii (4%), A. jandaei (3%), and A. trota (3%). Most of the isolated Aeromonas strains showed resistance to commonly employed antibiotics. All the clinical isolates of Aeromonas possessed virulence genes encoding for aerolysin and cytotonic enterotoxin genes. Except A. schubertii and A. jandaei, all the other species possessed the gene for haemolysis.

Regional odontodysplasia (Ghost teeth). A case report.

Regional odontodysplasia is a rare development anomaly affecting the teeth with an unknown etiology. This dental abnormality involves the hard tissues of the teeth that are derived from both epithelial (enamel) and mesenchymal (dentine & cementum) components of the tooth forming apparatus. Teeth in a region or quadrant of maxilla or mandible are affected to the extent that they exhibit short roots, wide open apical foramen and large pulp chamber, the thinness and poor mineralisation qualities of th enamel and dentine layers have given rise to a faint radiolucent image, hence the term "Ghost teeth". Both the permanent teeth and the deciduous teeth are affected. Females are more commonly affected than males. There is a maxillary predominance (2.5:1) with a predilection for the anterior teeth. Eruption of the affected teeth is delayed or does not occur. Because of the poor quality of the affected teeth, they cannot be rehabilitated for functional use therefore the treatment of choice is extraction with prosthetic replacement. However, necrosis and facial cellulitis appear to be a complication if these teeth are retained. A unique case of regional odontodysplasia affecting the entire right quadrant of mandible is reported here.