Blood transfusion trends in obstetrics and gynaecology: an Uttar Pradesh government medical college-based study

Background: Blood transfusion holds utmost importance in comprehensive obstetric care and Gynaecology. The present study has been done to evaluate the indications of blood transfusion in the Obstetrics and Gynaecology Department. Methods: The retrospective observational study was conducted between April 2023 to April 2024 in Department of Obstetrics and Gynaecology, Government Medical College, Saharanpur. Results: A total of 257 units of Blood was transfused between April 2023 to April 2024 in Obstetrics and Gynaecology Department. 60.6% transfusion were in age group 21-30 years. 48.26% transfusion were in hemoglobin 7-9 gm/dl. Most common blood group transfused was B positive 40.79% and 85.2% transfusion were packed red blood cell, 84.07% had single unit blood transfusion, 57.25% had transfusion for anemia in pregnancy, 36.84% transfusion were for abnormal uterine bleeding. Conclusions: Prevalence of anemia in reproductive age group is an important reason for blood transfusion in obstetrics and gynaecology. Hence emphasis should be to treat anemia through drugs to reduce unnecessary transfusion especially single unit transfusion.

Comparison of early and late diagnosis impact of type 2 diabetes on cognitive function: a pilot study

Background: Type 2 diabetes mellitus (T2DM) is known to be associated with cognitive impairment, but the Impact of the timing of diagnosis on cognitive function remains unclear. This pilot project aims to assess the cognitive function of people diagnosed with T2DM at an early vs. late stage. The study will examine several cognitive domains, such as attention, memory, executive function, visuospatial skills, and sensorimotor abilities. Methods: We recruited 80 adults diagnosed with T2DM, evenly split into 2 groups-one with early diagnosis (?5 years) (n=40) and other with late diagnosis (?6 years) (n=40) depending on when their disease was identified. Both groups underwent evaluation for demographic and clinical factors. Cognitive function was assessed using mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and Addenbrooke's cognitive examination (ACE-III). Specific domain of cognition wasmeasured as span of attention (Tachitoscope), memory (PGI Battery scale), executive function (Stroop test), visuospatial function (Corsi block test), sensorimotor abilities (auditory /visual reaction time), and intelligence (Koh抯 Block design test). Results: Preliminary findings suggest that the early diagnosis group showed significantly average cognitive performance compared to the late diagnosis group. They also showed improved metabolic control and increased levels of physical activity. Individuals in the early diagnosis group had higher educational levels and socioeconomic status, potentially leading to improved disease detection and more effective health management. Conclusions: These findings indicate that identifying T2DM at an early stage, help in preserving cognitive function as compared to a diagnosis made at a later stage.

Feto-maternal outcome in term and late term pregnancies following induction of labour with misoprostol

Background: Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of achieving vaginal delivery of the feto-placental unit. It is a common obstetric procedure which is indicated when the benefits to mother or fetus outweigh the benefits of continuing the pregnancy. Most common indication for induction is postdated pregnancy.Methods: Longitudinal Study carried out in department of obstetrics and gynaecology, RIMS, Imphal, Manipur, conducted for duration of two calendar years, with effect from January 2021 in 168 primigravidas who had reached full term or late term pregnancy admitted in ante-natal ward of RIMS, Obstetrics and Gynaecology department.Results: Study was conducted on 168 pregnant women, most of the participants belonged to the age group of 18-34 years (77.9%). Vaginal delivery was the most common mode of delivery (64.8%). Most of the babies (72%) delivered were having birth weight of between 2.5 kg to 3.9 kg. PPH and uterine hyperstimulation are comparatively more in the late term pregnancy as compared to full term pregnancy. Meconium-stained liquor was slightly more in late term pregnancy group as compared to full term pregnancy. Babies delivered by full term pregnant women were having better APGAR score in 1 minute and 5 minutes than the babies delivered by late term pregnancy.Conclusions: Late term Pregnancy is comparatively common in low socio-economic group. The CS rate is comparatively high in Late term pregnancy as compared to Full Term Pregnancy. Poor APGAR score is highly associated with Late term Pregnancy outcome.

Enhancing Nutrient Content and Uptake in Chickpea through Phosphorus and PSB Inoculation in Custard Apple Based Agri-horti System

The field experiment was conducted during the Rabi season of 2018-19 at the Agricultural Research Farm of Rajiv Gandhi South Campus, Banaras Hindu University, Barkachha, Mirzapur, Uttar Pradesh, India. This study aimed to investigate the effects of varying levels of phosphorus and inoculation with Phosphate Solubilizing Bacteria (PSB) on nutrient content and uptake in chickpea (Cicer arietinum L.) in a custard apple-based agri-horticultural system. The experimental design employed a Factorial Randomized Block Design with three replications and twelve treatments, resulting in a total of 36 plots. The treatments ranged from different levels of phosphorus and PSB inoculation, denoted as T1 to T12. The study assessed the impact of these treatments on nitrogen (N), phosphorus (P) and potassium (K) content in grain and straw, as well as their uptake by chickpea. Findings reveal that higher PSB levels and phosphorus applications led to increased nitrogen and phosphorus content and uptake in both grain and straw, demonstrating a significant synergistic effect. Conversely, potassium content and uptake exhibited limited response to PSB inoculation. Moreover, protein content and yield in grain and straw significantly improved with these treatments.

Efficient Use of Nano-fertilizer for Increasing Productivity and Profitability along with Maintain Sustainability in Rice Crop: A Review

The need for food and the expanding global population have put enormous pressure on agriculture to increase crop yield while preserving sustainability. Since rice is a staple diet for millions of people, novel methods are needed to increase yields without harming the environment. The possible advantages of using nano fertilizers in rice farming are examined in this abstract in order to raise yields, increase farmer profitability, and ensure long-term sustainability. Nano-sized carriers created for effective nutrient delivery to crops are called nano fertilizers, an innovative application of nanotechnology in agriculture. Their special qualities, such as their large surface area and regulated release mechanisms, allow for the targeted supply of nutrients to rice plants, improving nutrient uptake and utilization. Nano-fertilizers successfully optimize nutrient availability as a consequence, increasing crop output. According to studies, using nano fertilizers in rice farming increases grain yields because plants are better able to absorb and assimilate nutrients. The crop's resistance to environmental challenges and disease strains is strengthened as a result of this enhanced nutrient utilization, which also boosts yield and contributes to sustainable rice farming practices. Furthermore, nano fertilizers offer cost-effectiveness and increased profitability for farmers. Despite their initial higher cost, the efficient nutrient delivery of nano fertilizers reduces the overall application rate required compared to conventional fertilizers. This reduction in input costs translates to improved profitability for farmers, promoting economic sustainability in rice production.

Efficacy of Insecticides against Major Insects of Tomato in Manipur

A field experiment was conducted to evaluate the efficacy of some insecticides viz., Emamectin benzoate 5% SG (11 ga.i./ha), imidacloprid 17.8% SL (22.5 g a.i/ha), Neem oil (3 ml/l), Beauveria bassiana (0.2 ml/l), fipronil 5% SC (50 g a.i/ha) against major pests of tomato (Lycopersicon esculentum Mill.). There were six treatments arranged in randomized block design with four replications. Fruit borer, whiteflies, aphids and leaf miner were found to be the major insect pests of tomato. Among the insecticide used, imidacloprid 17.8% SL was found to be the most effective for management of sucking pest viz., Whiteflies, Aphids, Thrips, Mealybugs, Jassids while emamectin benzoate was found more effective on tomato fruit borer. Beauveria bassiana was found least effective against all the insect pests.

Efficacy of Nano Fertilizers on Yield, Attributes and Economics of Wheat

The present investigation was carried out to study the effect of foliar application of nano-fertilizers N and P on yield, and the economics of wheat in Semi-arid and sub-tropical region of Central Plain Zone of Uttar Pradesh. The experiment was laid out in triplicate following a randomized block design with twelve treatments comprising foliar application semi-different doses of Nano N and P. Foliar application of 1st spray of Nano N and P at 30 days after sowing (DAS) + 2nd spray of Nano N and Zn at 45 DAS along with 75% recommended dose of fertilizers (RDF) significantly (P=0.05) increased yield and have better economics. Foliar application of nano-fertilizers leads to significant improvement of crop productivity of wheat in Semi- arid and sub-tropical region of Uttar Pradesh. Moreover, the foliar application of nano-fertilizers, i.e., Nano N has direct role in increasing yield as nutrient get easily available to plant in case of foliar spray.

Assessment of Water Quality in Ganga River Ghats of Varanasi District, Uttar Pradesh, India

Water is the most vital biosphere component since it sustains all life, circulates and cycles nutrients. Water is also necessary for power generation, navigation, agricultural irrigation and sewage disposal. The increasing water demand is a result of the rising population and industrialization and has severely compromised water quality. Water quality assessment is the most important process for evaluating the chemical characteristics of water bodies. To assess whether the water is suitable for a variety of uses after locating any pollutants, contaminants, or other potentially hazardous compounds that may be present in the water. A systematic study was conducted to assess the water quality in the Ganga river in the Ghats of Varanasi district of Uttar Pradesh, India, from January to March 2019. The assessment involves water samples from different Ghats along the river, namely Babua Pandey Ghat (G1), Digpatia Ghat (G2), Chausatti Ghat (G3), Ranamahal Ghat (G4), and Darbhanga Ghat (G5). The analytical data from various physico-chemical parameters indicates that the pH values were found to be near neutral, electrical conductivity (EC) did not differ significantly, Ca+Mg varied from 22.80 to 28.40 mg/L, Cl- was found to be 2.40 to 3.20 mg/L, Na+ varied from 1.0 to 1.10 mg/L, K+ and SO42- showed a similar trend, TS was varied from 400 to 1200 mg/L, DO varied from 5.80 to 7.30 mg/L, COD varied from 16.0 to 22.40 mg/L, NO3- varied from 25.27 to 29.60 mg/L, B varied from 4.90 to 5.80 mg/L, SAR is 0.27 to 0.33 mg/L, The Bureau of Indian Standard (BIS) has been considered to assess the suitability for drinking and other purposes and It concluded that some of the parameters were almost constant for all the five Ghats samples, like Na+ and K+ content, while other parameters varied. Out of thirteen parameters, only three (NO3-, B, and Cl-) showed an increasing trend.

Smartphone based 12 lead ECG as decision support in STEMI: a prospective, cross sectional study, non-randomised, single blinded and single-center study

Background: When a severe heart attack called a ST segment elevation myocardial infarction (STEMI) is not treated, heart muscle is killed per minute. Hence, early detection and treatment are essential for patient survival. The objectives of this study were to evaluate the accuracy for detection of (a) the ST elevation myocardial infarction of smartphone 12 lead ECG system in comparison to 12 lead gold standard hospital ECG machine; and (b) classification of STEMI in smartphone ECG and hospital ECG. Methods: This prospective, cross sectional study, non-randomised, single blinded and single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from 30 May 2022 to 17 January 2023. All patients (n=154) with chest pain, shortness of breath, palpitation under the observations before and after the Percutaneous coronary intervention (PCI) like Coronary angioplasty, bypass surgery were enrolled from Critical care unit (CCU) and intensive critical care unit (ICCU). Results: Mean age (SD) was 53.90±11.7 years. The male gender (83.12%) shows the maximum frequency than female gender. True positive cases derived from confusion matrix for 12 lead standard ECG and smartphone ECG in comparison to cardiologist diagnosis was 113 as compared to 129 from 12 lead Gold standard. Sensitivity of smartphone Spandan ECG (87.5%) was comparable to gold standard 12 lead ECG (98.4%). And, specificity and PPV of smartphone Spandan ECG was recorded to be better than gold standard 12 Lead ECG. STEMI was detected correctly in 132 (86.3%) cases and 141 (80.85%) cases by smartphone ECG and 12 lead Gold standard, respectively. Conclusions: Spandan ECG device scored a high accuracy and sensitivity. The overall accuracy of smartphone ECG in detecting the STEMI increased by 5.45%, i.e. the significance rise in accuracy of computer interpretation when compared to the cardiologists’ diagnosis.

Accuracy of smartphone based electrocardiogram for the detection of rhythm abnormalities in limb lead: a cross sectional study, non-randomised, single blinded and single-center study

Background: For the identification of arrhythmia and abnormal instances, researchers are examining the reliability of the interpretation offered by smartphone-based portable ECG monitors. The indicator of an unclear alteration in the electrical activity of the heart is a cardiac abnormality. As a result, its early and accurate identification can avoid myocardial infarction and even sudden cardiac death. Objectives of this study were to evaluate and validate the Spandan 12 lead ECG interpretation for accuracy in detection of the cardiac arrhythmias in comparison to the cardiologist diagnosis, and to evaluate the accuracy of the arrhythmia detection of Spandan ECG in comparison to the 12 lead ECG machine. Methods: This cross-sectional study, non-randomised, single blinded and single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from 1st August 2022 to 31st January 2023. All patients (n=312) visiting the electrocardiogram (ECG) room at the department of cardiology of the SMIH, Dehradun with the prescription of ECG screening during the study period were included in the study were included in the study. Results: In total, 1528 patients with or without a history of cardiovascular disease were enrolled from outpatient and emergency departments of cardiology. A final total of 312 participants considered for accuracy of interpretation of cardiac arrhythmias detected by the standard 12 lead ECG and smartphone ECG in comparison to cardiologists’ diagnosis. Mean age (SD) was 53.90±14.52 years. The male gender (68.78%) showed the maximum frequency than female gender. True Positive cases derived from confusion matrix for 12 lead standard ECG and smartphone ECG in comparison to cardiologist diagnosis was 264 as compared to 273 from 12 lead gold standard. Sensitivity of smartphone Spandan ECG (81.23%) was comparable to gold standard 12 Lead ECG (81.49%). And, specificity, PPV and NPV of smartphone Spandan ECG was recorded to be better than gold standard 12 Lead ECG. Arrhythmia was detected correctly in 403 (70.8%) cases and 431 (61.86%) cases by smartphone ECG and 12 lead gold standards, respectively. Conclusions: Spandan ECG device scored a high accuracy and sensitivity and high specificity. The overall accuracy of smartphone ECG in detecting the rhythm abnormalities increase by 9%, the significance rises in accuracy of computer interpretation when compared to the cardiologist’s diagnosis.

Comparison of prevention of parent-to-child HIV transmission programme & national biennial HIV sentinel surveillance data for tracking HIV epidemic in India

Background & objectives: HIV sentinel surveillance (HSS) among antenatal women in India has been used to track the epidemic for many years. However, reliable tracking at the local level is not possible as ANC sentinel sites are limited in number and cover a smaller sample size at each site. Prevention of parent-to-child-transmission (PPTCT) programme data has a potential advantage due to better geographical coverage, which could provide more precise HIV case estimates; therefore, we compared HSS ANC data with PPTCT programme data for HIV tracking. Methods: Out of the 499 surveillance sites, where HSS and PPTCT programme was being conducted in 2015, 210 sites (140 urban and 70 rural) were selected using a stratified random sampling method. HSS (n=72,981) and PPTCT (n=112,832) data records were linked confidentially. The sociodemographic characteristics of HSS and PPTCT attendees were compared. HIV prevalence from HSS ANC was compared with the PPTCT programme data using Chi-square test. State- and site-level correlation of HIV prevalence was also done. Concordance between HSS and PPTCT HIV positivity was estimated using kappa statistics. Results: The age distribution of HSS and PPTCT attendees was similar (range: 23 to 27 yr); however, HSS ANC participants were better educated, whereas PPTCT recorded a higher proportion of homemakers. The correlation of HIV prevalence between HSS and PPTCT was high (r=0.9) at the State level and moderate at the site level (r=0.7). The HIV positivity agreement between HSS ANC and PPTCT was good (kappa=0.633). A similar prevalence was reported across 26 States, whereas PPTCT had a significantly lower prevalence than HSS in three States where PPTCT coverage was low. Overall HIV prevalence was 0.31 per cent in HSS and 0.22 per cent in PPTCT (P<0.001). Interpretation & conclusions: High-quality PPTCT programme data can provide reliable HIV trends in India. An operational framework for PPTCT-based surveillance should be pilot-tested in a phased manner before replacing HSS with PPTCT.

Correlation of HRCT Scoring System with PFT Parameters in Interstitial Lung Disease Associated with Systemic Sclerosis Patients

Objectives. Interstitial lung disease (ILD) with features of pulmonary fibrosis and honey-combing is a significant cause of morbidity and mortality in patients with systemic sclerosis (SSc). High resolution computed tomography (HRCT) is the established non-invasive gold standard technique for the diagnosis of SSc related ILD. The present study was designed to characterise HRCT features of ILD in SSc and to correlate pulmonary function test (PFT) parameters with HRCT semi-quantitative scores. Methods. This is an observational, cross-sectional study including 36 patients of SSc who underwent HRCT chest. All the patients were females. Severity and extent were assessed using four HRCT features: ground-glass opacity (GGO), mixed GGO and reticular opacity, reticular fibrosis and honey-combing. Thirty-three patients were able to perform PFT. Total HRCT score, inflammatory index and fibrosis index were correlated with PFT parameters. Results. Interstitial lung disease was found in 33 patients (91.6%), 24 patients (66.6%) had mixed GGO along with reticular inter-lobular septal thickening. Majority of the patients (64%) had non-specific interstitial pneumonia (NSIP) pattern. Usual interstitial pneumonia (UIP) pattern was seen in 25% of the cases. One patient had overlapping features of both UIP and organising pneumonia. There was predominant lower lobe involvement. Among the 33 patients who were able to perform PFT, 85% had abnormal results (predicted forced vital capacity [FVC]<80%). Total HRCT score showed significant negative correlation with PFT parameters 枛 FVC (r=�48, P=0.004) and forced expiratory volume in one second (FEV1) (r=�28, P=0.1), respectively. The ratio of FEV1 and FVC had significant positive correlation with total HRCT score (r=0.5, P=0.002). Inflammatory index and fibrosis index had significant negative correlation with predicted FVC% (P<0.05). Conclusions. Mixed pattern (GGO and reticular opacity) was the most common HRCT finding. HRCT semi-quantitative scoring system is sensitive in assessing the severity and extent of ILD qualitatively and quantitatively in SSc patients.

Impact of examination stress on response time in first-year medical students

Background: Stress has been seen to deteriorate normal physiological functions as well as the psychological functions of the brain. Medical students face a range of enduring normative stressors in the form of academic demands. This brings upon an amount of stress on the students which is related to the examinations and concerns with achieving high grades consequently referred to as academic-related stress. Thus, it becomes crucial to set upon a tool for measuring this stress in order to present methods for overcoming it. In the present study, one such method is evaluated by assessing the reaction time of first-year medical entrants. Material and Methods: The effect of stress on response time in 50 normal healthy medical students of Sawai Man Singh Medical College, Jaipur in the age group of 18 to 21 years was explored in the study. Visual Reaction Time was recorded through the computer program. Results: There was an increase in visual reaction time for the red color in both the sexes during stressful situations as compared to stress-free situations. While a decrease in Visual Reaction Time was seen for green color. A decreased auditory reaction time for both sexes was seen in stressful situations. Conclusion: The results revealed that stress within a limit facilitates positive feedback to Central Nervous System information processing consequently decreasing the reaction time.

Thyrotoxic periodic paralysis: A retrospective, observational study from India

Background & objectives: Thyrotoxic periodic paralysis (TPP) is an endocrine emergency presenting with acute-onset flaccid paralysis in a patient having thyrotoxicosis accompanied by hypokalaemia. This study was conducted to evaluate the clinical profile of patients with TPP presenting to three centres in India. Methods: This retrospective, observational study was conducted at three tertiary care Armed Forces medical centres, located at Lucknow, Kolkata and Delhi. The history, clinical features, treatment details and outcomes were evaluated. Results: Of the 244 patients with thyrotoxicosis, 15 were diagnosed with TPP and included in the study. These 15 patients (14 male and 1 female) had 32 episodes of TPP which were analyzed. The mean age was 30.2�2 yr (range: 21-39), and overt thyrotoxicosis was seen in all patients except one who had subclinical hyperthyroidism. Graves' disease was the most common cause of thyrotoxicosis (13/15) and the remaining two patients had subacute thyroiditis and gestational thyrotoxicosis. Hypokalaemia (serum potassium <3.5 mmol/l) was seen in 12 patients, and the mean serum potassium was 3.2�9 mmol/l (range: 2.1-4.9). All patients had flaccid weakness, predominantly involving the lower limb with no bulbar, respiratory or cranial nerve involvement. The average duration of paralysis was 10.6�7 h (range: 3-28 h). Interpretation & conclusions: Our study demonstrated an early age of presentation and presence of clinical and biochemical thyrotoxicosis in majority of patients with TPP. Hypokalaemia may not always be evident in patients with TPP.

To Study the Prevalence of Different Forms of Thyroid Dysfunctions, Their Risk Factors and Clinical Implications in Cases of Type 2 Diabetes Mellitus, Presenting at Tertiary Care Hospital of Kumaon Region of Uttarakhand

Diabetes mellitus and thyroid disorders are the most common endocrine disorders worldwide. Various studies have found that diabetes and thyroid disorders mutually influence each other and both disorders tend to coexist. Objective: To study the prevalence of different forms of thyroid dysfunctions, their risk factors and clinical implications in cases of type 2 diabetes mellitus. Methods: The study was conducted on 300 patients of Type 2 diabetes mellitus. All the patients were evaluated for thyroid dysfunction by testing thyroid profile (T3, T4 and TSH). The correlation of prevalence of thyroid disorder with gender distribution, age distribution, HbA1C, duration of diabetes, hypertension, BMI, microvascular complication and dyslipidaemia was done. The observations and interpretations were recorded and results obtained were statistically analysed. Results: There was a high prevalence (20%) of thyroid disorders in patients of type 2 diabetes mellitus. Most common was subclinical hypothyroidism (11.66%) which was further found to be more in females, in middle to elderly patients, less than 5 years duration and patients with normal BMI. Conclusion: Screening for thyroid disorders should be done in all diabetic patients. Treatment of thyroid disorder in diabetics may be beneficial for their glycemic control and prevention of progression of microvascular complication.

A Study of Clinical, Biochemical Profile and Risk Factor of Patients with Chronic Hepatitis C Virus Infection in Tertiary Care Centre in Kumaun, Uttarakhand

Chronic Hepatitis C virus (HCV) infection is a major public health problem. It is a major cause for cirrhosis and hepatocellular carcinoma worldwide. HCV infection is recognized now days as a disease of global importance. It is considered a major health and economic burden in adults as well as children in both developing and developed countries. Objectives: To study the Clinical presentation, biochemical profile and risk factor of chronic hepatitis C virus infected patients. Methods: This prospective observational study was carried out in the Department of Medicine at STH, Haldwani, from August 2016 to July 2018.During these study period 110 patients with Chronic HCV infection were analyzed. Results: Out of 110 patients 60 (54.54%) were male and 50(45.45%) were female. Injection drug use (IDU) was the most common risk factor of HCV infection (20.90%). The abdominal discomfort symptoms seen in majority of patients (70%) followed by a fatigue (62.72%).and fever (60.90%). Males exhibiting more symptoms in comparison to females. Conclusion: Viral hepatitis is an important heath care problem in India as it occurs epidemically and sporadically. The variability in nature of the disease regarding its onset, presenting symptoms, clinical course and development of complications are important aspects. So, it is very essential for health care professionals to be aware of all aspects of it so that it is detected and treated early.

Platelet-Rich Plasma (PRP) Therapy in Dermatology

Platelets present in the human blood produces a wide range of hormones. The activated forms of platelets are actively motile and their motility is clearly shown by the author in a video recorded through a simple microscope and uploaded in YouTube (Moving platelets & PRP_Dr Lokendra Yumnam at www.youtube.com/watch?v=du4nav0Fvy). The platelet-rich plasma can be prepared easily at any side-laboratory attached to the Dermatology OPD. The same may be used in treatment of many skin conditions previously thought to be very difficult to be treated. The author presents results of administering one PRP therapy in patients with androgenic alopecia, disfiguring lesions on face, recalcitrant ulcers including ulcers in leprosy patients, lichen sclerosus, vitiligo and also enhancing skin-graft uptake in scars. The results of PRP therapy in many refractory skin conditions are promising. More researches need to be taken up in this form of magical therapy. This may open up new avenues in the successful treatment of many skin conditions which are hitherto considered to be non-treatable.

Nose and Paranasal Sinuses: Profile of Fungal Infections

Background: Fungal infections of the nose and paranasal sinuses present with a spectrum of clinical manifestations which is mainly determined by the complex interplay of the pathogenicity of the fungus and the host immune system. In India, most of the fungal infections of the nose and paranasal infections are reported from the southern states although high incidences of paranasal sinusitis are also reported from other states of the country. Data regarding the above from the north-eastern part of the country is hardly available. Hence, it was felt important to make an effort to recognize and detect the presence of fungal infection in this part of the country. Aims & objectives: The present study was conducted to find out the incidence of fungal infections of the nose and PNS among all patients having allergic or infective disorders, to study the various risk factors associated with it, to study the clinical profile of the patients and also to assess the prognosis after treatment. Methods: A prospective study was taken up during the period Feb 2003-Oct 2004 in the Otorhinolaryngology Department of the Regional Institute of Medical Sciences (RIMS), Imphal, Manipur. All the patients attending the OPD and IPD of the department because of chronic allergic and infective disorders were the study subjects. Detailed information on socio-demography and clinical history were collected by using a semi-open interview schedule. Next, a thorough physical examination and examination of the ear, nose and throat were done. Appropriate routine investigations and a thorough fungal study were performed using representative specimens in collaboration with the Department of Microbiology of the same institute. Results: The fungal infection rate was found to be 4.61% (M=4.84% and F=4.21%). This rate went up as high as 17.85% among immuno-compromised patients. The main fungal species identified were Candida (53%) and A. niger (27%). Mucor and Fusarium species were also found. Among the immuno-compromised patients Candida was the commonest species found (93%) whereas among the immune-competent patients A. niger was predominantly found (47%). Nasal obstruction, congested nasal mucosa, epistaxis, nasal discharge and maxillary sinus tenderness were the common clinical findings. Depending on the case-wise merits three-fifths of the cases were given surgical treatment whereas the remaining two-fifths were treated conservatively with medications only. All the cases were either cured or showed improvement. Conclusion: Fungal infection of the nose and PNS in this part of the country was found in 4.61% of patients with chronic allergic and/or infective disorders of the nose and PNS. The common fungi infecting were Candida, A. niger, Mucor and Fusarium. The fungal infection rate was almost six-times increased in immune-compromised patients compared to normal patients. A. niger was predominantly associated with immune-compromised status.

A Microbiological Study of Nasal Packs

Background: Nasal packing is the commonest mode of achieving haemostasis for nasal bleeds. The packs are usually removed after 24 hours but sometimes they have to be kept for two-three days. Out of all the materials used for the purpose, the conventional packing using cotton tape remains the commonest and the easiest. One of the commonest complications of nasal packing is infection. The present study was done to work out the bacterial flora of anterior and posterior nasal packs with different types of antibiotics-soaked packs, duration of pack and type of nasal packing. Further the study aimed to find out the effectiveness of drugs used in nasal packing. Methods: A prospective study was taken up in the Department of Otolaryngorhinology, JNIMS, Imphal, Manipur in which all the patients who attended the OPD or got admitted in the IPD of the otolaryngorhinology department during the period Nov 2012 to Oct 2014 were the study subjects. All nasal packs irrespective of site, disease or duration of usage from these patients were collected with due precaution to avoid contamination during removal. Then the middle part of the pack was cut and collected in sterile bottle under total asepsis. These packs were immediately transported to the Department of Microbiology, JNIMS for full bacteriological examination and sensitivity testing. Results: Out of a total of 120 nasal packs investigated, 98 packs (81.7%) showed bacterial growth. Packs removed after 72 hours showed 100% growth of organisms whereas packs removed within 48-72 hours, within 24-48 hours and packs removed within 24 hours of use respectively showed 92.9%, 59.1% and 76% growth of organisms. Pseudomonas aeruginosa was the most predominant one (41; 34.2%) followed by Staphylococcus aureus (37; 30.8%) and Klebsiella pneumonia (4; 3.3%) in the packs having single infections. Pseudomonas and Klebsiella co-infection was the commonest among packs with mixed infections. Plain gauze and Abgel packs showed 100% growth of micro-organisms which was followed by Betadin (95.6%), Neosporin (94.4%), Soframycin (60.4%). Liquid paraffin-soaked packs did not show any growth. The in-vitro chemo-sensitivity testing showed that almost all the different types of bacteriae isolated were sensitive to Garamycin (85.7%-100%). Cloramphenicol sensitivity was 79% for Pseudomonas, 60% for Staphylococcus and 21% for Klebsiella infection. Other antibiotics gave not so encouraging results especially in Proteus infection. Conclusion: Only a small proportion of nasal packs (18%) remain sterile after use, the chance of culture positivity being higher for posterior nasal packs compared to anterior ones and also depending upon to the duration of use, all packs after 72 hours of use becoming invariably positive. Medication of the packs with antibiotics or antiseptics does not help much in preventing micro-organism growths. Pseudomonas aeruginosa and Staphylococcus aureus are the leading causes of infection. Gentamycin/Garamycin is emerging as the most sensitive antibiotic against the culprit organisms. Drugs which were previously effective against microbes are now only partially sensitive or not effective at all. It is important to caution clinicians and microbiologists to keep a close watch on the sensitivity pattern of the organisms.

A Study of Thyroid Dysfunction in Diabetes Mellitus

Background: The prevalence of thyroid dysfunctions is encountered high in known diabetic patients. It is quiet commonly understood that patients who has one autoimmune problem generally tends to develop another. Materials and methods: Three hundred twenty known diabetic patients who attended the Department of Internal Medicine were taken up for the study. This study was done in the Department of Internal Medicine, Deccan Medical College, Hyderabad. Results: Both hypothyroidism and hyperthyroidism was significantly seen in known diabetics. Conclusion: Hypothyroidism was the most common kind of thyroid disorder encountered in our study.