Endoscopic Posterior Approach for Cervical Myelopathy and Radiculopathy Using Tubular Retractor: Our Experience, Surgical Technique, and Literature Review.

BACKGROUND: Endoscopic posterior approach can effectively decompress cervical root and cord secondary to posterior compression. We present our experience in 229 patients using tubular retractor, and the relevant literature is reviewed. METHODS: Retrospective analysis of multilevel myelopathy and or radiculopathy was performed. Indications for posterior approach was primary posterior compressions at cord and or root. Combined compression from posterior side and mild to moderate anterior pressure with acceptable lordosis were also decompressed. Bilateral cord decompression and foraminotomy for radiculopathy was performed using tubular retractor. RESULT: Myelopathy and radiculopathy were present in 220 and 9 patients, respectively. A total of 53 foraminotomy procedures were performed in 36 patients. All patients showed improvement, with the mean preoperative Nurick grade decreasing from 2.72 ± 0.799 to 0.78 ± 0.911 after surgery. There was significant improvement in postoperative Nurick grades compared with preoperative grades (Z-value = 13.306, P < 0.0001). Operative results were better in patients with good preoperative Nurick grades (grades 1 and 2) compared with those with poorer grades (grades 3 and 4). Minor bleeding, small dural tear, and root injury were observed in 42, 4, and 8 patients, respectively. CONCLUSIONS: Endoscopic approach was effective and safe for root and cord decompression. This study was limited by its single-center, retrospective design, exclusion of some eligible patients, a short postoperative Nurick grade assessment period of 6 months, and absence of a comprehensive long-term postoperative biomechanical assessment. To validate these results, a prospective multicenter study addressing these limitations is needed.

Prevalence of Childhood Obesity in Indian Expatriate Children in Dubai: A Cross-Sectional Analytical Study.

Background Childhood obesity is one of the most prevalent nutritional disorders affecting children across the world, which further leads to diabetes, hypertension, coronary artery disease, and fatty liver disease in adulthood. The magnitude of this problem among Indian expatriates in the United Arab Emirates (UAE) has not been investigated before. This study delves into the prevalence of childhood obesity among this demographic and also provides a comparative analysis of the prevalence of obesity in UAE citizens and children in India. Methodology This is a cross-sectional study that investigates the prevalence of obesity in 3,698 students of a single Indian school in the UAE. Anonymous anthropometric data of these children of age range four to 18 years were analyzed. The International Obesity Task Force (IOTF), World Health Organization (WHO), and Centers for Disease Control (CDC) reference methods were used to calculate the prevalence of overweight, obesity, and extreme obesity. Results According to CDC guidelines, the prevalence of body mass index (BMI) ≥ 85th percentile, ≥ 95th percentile, and ≥ 99th percentile stands at 32.74%, 13.68%, and 5.1%, respectively. Children particularly boys aged more than 10 years are at a higher risk of being overweight, obese, and extremely obese (p = < 0.05). In children aged 10 years or less, as the age increases, they tend to have a higher BMI percentile and this is particularly prominent in boys (Pearson correlation coefficient 0.227). Conversely, in those over the age of 10 years, the BMI percentile decreases with age, particularly noticeable in girls, albeit without statistical significance. Conclusion Approximately one-third of school-aged Indian expatriates in the UAE are overweight, obese, or extremely obese. Our study, when contrasted with earlier studies, reveals that Emirati teenagers exhibit a higher prevalence of overweight and obesity compared to their Indian counterparts in the UAE. Similarly, the prevalence of childhood obesity among Indian expatriates in the UAE surpasses that among children residing in India.

Health profile of people living in the Gare Palma mining area of Tamnar block, Raigarh, Chhattisgarh, India.

Introduction: A community-based health survey was conducted in Tamnar block, Raigarh district of Chhattisgarh, India. Methodology: A total of 909 individuals (adults) were selected from 909 households from 33 sampled villages from March 2019 to February 2020. All individuals were clinically examined, and observations were recorded. Results: Among adults older than 18 years, hypertension was observed in 21.7%. Type II diabetes was observed in only 4.0% of individuals. Tuberculosis was seen in 23 (2.5%) individuals. Discussion: Common morbidities were similar in tribal and non-tribal communities living in the same area. For communicable diseases, being male, having nutritional deficiencies, and smoking were independent risk factors. For non-communicable diseases, the independent significant risk factors identified were being male, an altered body mass index, disturbed sleep, smoking, and nutritional deficiencies.

Wrangle with hypertension: lowered salt intake may not compromise iodine status among tribes of Central India.

OBJECTIVES: The most important risk factor of cardiovascular disease is hypertension and high salt intake contributes to high blood pressure. However, to prevent iodine deficiency disorders, the iodisation of salt is a proven strategy. So, on one hand, we suggest people reduced salt consumption but on the other hand, we also fear an increase in the prevalence of iodine deficiency disorders. In the present study, we investigated the possibility of salt intake at WHO recommended levels resulting in higher or lower iodine status in India by assessing the urinary iodine status and its relation with blood pressure. DESIGN: It was a cross-sectional study. SETTING: It was a community-based study. PARTICIPANTS: We collected 24-hour urine samples for estimation of iodine concentrations in urine from 411 adult hypertensives in the Mandla district of central India. Urinary iodine was estimated using Thermo ORION make ion-selective electrodes. RESULTS: The median urinary iodine excretion was 162·6 mcg/l. Interestingly 371 (90·26 %) subjects were observed with > 200 mcg/l urinary iodine concentration level indicating iodine sufficiency. Individuals with high urine Na significantly had high blood pressure as compared with individuals with low urinary Na excretion (P < 0·01). There is a higher probability of high urine iodine levels among individuals with higher urine Na levels. CONCLUSION: The study revealed that 90 % of the population were excreting excessive iodine in urine, which is more than adequate iodine uptake. This excess uptake enables a scope for reduction in salt intake to control hypertension.

High prevalence of hypertension and its selected risk factors among adult tribal population in Central India.

A community based cross-sectional study was carried out to assess the prevalence of hypertension and associated risk factors like salt intake, 24-h urinary sodium excretion and body mass index (BMI) among tribal population of Mandla District, Central India. A total of 3090 individuals, from 1258 house hold drawn from 33 sampled villages and 12 urban wards were studied for blood pressure measurements and clinical examination, while 414 urine samples were collected for estimation of 24-h sodium excretion. Bivariate and multivariate logistic regression were used to assess the associations of BMI, urinary sodium output and other risk factors with hypertension. Across the sample, 28.2% of males and 23.6% of females had either stage-I or stage-II hypertension. More than 8% of subjects <30 years were hypertensive. The prevalence of hypertension shows a strong association with the increase in BMI and tribals with BMI > 25 were considerably more to have high blood pressure. Salt intake is directly related to the hypertension. The prevalence of hypertension was significantly greater among those whose salt intake was more than 10 g per day. A positive association between urine sodium excretion and blood pressure was observed. The results of the present study show that the tribal population is also affected by the life style diseases at par with the non-tribal population.

Cardiovascular disease among patients with type 2 diabetes: Role of Homocysteine as an inflammatory marker.

It is known that inflammation has a role in the pathogenesis of cardiovascular diseases; measurement of inflammatory markers improves the risk prediction of cardiovascular diseases. Hyperhomocysteinemia has been correlated with the occurrence of blood clots, heart attacks and strokes; though it is unclear whether hyperhomocysteinemia is an independent risk factor for these conditions. In the present study, we aimed to evaluate the role of homocysteine in type 2 diabetes patients with cardiovascular disease in a population of Madhya Pradesh India. Total 100 type 2 diabetes patients were included in the study, of these 50 had angiographically proven cardiovascular disease and 50 had no evidence of it. High sensitivity C-reactive protein, fibrinogen, and lipoprotein (a) were measured in serum. Homocysteine, blood glucose in plasma, erythrocyte sedimentation rate, glycated haemoglobin were measured in whole blood. A albumin excretion rate, creatinine clearance rate were measured in the urine sample for renal function. It was shown that, levels of homocysteine and other inflammatory markers were elevated significantly in the group II (n = 50). A correlation between hyperhomocysteinemia and inflammatory markers in patients with impaired renal function was observed. It was concluded that impairment of renal function is a key factor that affects homocysteine level.

Antifungal susceptibility of clinical and environmental Cryptococcus neoformans and Cryptococcus gattii isolates in Jabalpur, a city of Madhya Pradesh in Central India.

In this study, we present antifungal susceptibility data of clinical and environmental isolates of Central Indian Cryptococcus neoformans (Serotype A, n = 8 and n = 50 respectively) and Cryptococcus gattii (Serotype B, n = 01 and n = 04 respectively). Susceptibilities to fluconazole, itraconazole and ketoconazole were determined by using NCCLS broth micro-dilution methodology. The total number of resistant strains for fluconazole in case of C. neoformans and C. gattii showed a significant difference by using chi-square test (p < 0.05*), while considering fisher's exact p value was nonsignificant (p > 0.05). However, the total number of resistant strains for itraconazole and ketoconazole was not found statistically significant. A comparison of geometric means of clinical and environmental strains of C. gattii and C. neoformans was not found statistically significant using student 't' test (p value > 0.05 NS). Though less, the antifungal data obtained in this study suggests that primary resistance among environmental and clinical isolates of C. neoformans and C. gattii against tested antifungal was present and C. gattii comparatively was less susceptible than C. neoformans var. grubii isolates to fluconazole than to itraconazole and ketoconazole. A continuous surveillance of antifungal susceptibility of clinical and environmental isolates of C. neoformans and C. gattii is desirable to monitor the emergence of any resistant strains for better management of cryptococcosis patients.

Antifungal susceptibility of clinical and environmental Cryptococcus neoformans and Cryptococcus gattii isolates in Jabalpur, a city of Madhya Pradesh in Central India

In this study, we present antifungal susceptibility data of clinical and environmental isolates of Central Indian Cryptococcus neoformans (Serotype A, n = 8 and n = 50 respectively) and Cryptococcus gattii (Serotype B, n = 01 and n = 04 respectively). Susceptibilities to fluconazole, itraconazole and ketoconazole were determined by using NCCLS broth micro-dilution methodology. The total number of resistant strains for fluconazole in case of C. neoformans and C. gattii showed a significant difference by using chi-square test (p < 0.05*), while considering fisher's exact p value was nonsignificant (p > 0.05). However, the total number of resistant strains for itraconazole and ketoconazole was not found statistically significant. A comparison of geometric means of clinical and environmental strains of C. gattii and C. neoformans was not found statistically significant using student ‘t’ test (p value > 0.05 NS). Though less, the antifungal data obtained in this study suggests that primary resistance among environmental and clinical isolates of C. neoformans and C. gattii against tested antifungal was present and C. gattii comparatively was less susceptible than C. neoformans var. grubii isolates to fluconazole than to itraconazole and ketoconazole. A continuous surveillance of antifungal susceptibility of clinical and environmental isolates of C. neoformans and C. gattii is desirable to monitor the emergence of any resistant strains for better management of cryptococcosis patients.

Cardiovascular Diseases Risk Prediction by Homocysteine in Comparison to other Markers: A Study from Madhya Pradesh.

INTRODUCTION: Atherosclerosis is associated with increased inflammatory activity and risk of vascular disease. However, the factors that promote inflammation are not apparently clear. In the present study we aimed to evaluate levels of homocysteine in comparison with other markers including inflammatory risk predictor of cardiovascular disease. METHODS: A total of 200 patients were included in the study, of these 100 were angiographically proven cardiovascular disease patients and 100 were not suffering from any cardiovascular disease. Levels of homocysteine, hs-CRP, lipoprotein(a), HbA1c and blood lipid were measured along with anthropometric and demographic parameters. RESULTS: Levels of homocysteine and other markers were significantly increased in diseased group in comparisons to control. CONCLUSION: There is a very high sensitivity, specificity, and accuracy with 89% positive predictive value and 39.48 odds ratio for homocysteine in cardiovascular patients when compared to other risk factors.

Trends in Maternal Mortality and Impact of Janani Suraksha Yojana (JSY) on Maternal Mortality Ratio in a Tertiary Referral Hospital.

OBJECTIVE: To analyse the impact of Janani Suraksha Yojana (JSY) on Maternal Mortality Ratio (MMR). DESIGN: Retrospective analysis of maternal mortality. METHODS: Analysis of all maternal deaths between January 2001 and December 2009. RESULTS AND DISCUSSION: The total number of deliveries has been steadily rising from 1,685 in 2001 to 3,957 in 2009. The MMR doubled from 1,500/100,000 live births in 2001 to 3,000/100,000 live births in 2006, then declined to 2,464/100,000 live births in 2009. Implementation of the various maternity benefit schemes has had no significant impact on the profile of dying mothers-admission-to-death interval. Deaths due to anemia and eclampsia have significantly increased (P < 0.05), whereas due to sepsis (P < 0.001) and hemorrhage (P < 0.05), deaths have significantly decreased. Almost 96 % of dying subjects received inadequate antenatal care. However, significantly less number (P < 0.001) of women are delivering at home. CONCLUSIONS: There is a need to stress the importance of good antenatal care in reducing MMR.

Oesophageal dilatation on high-resolution CT chest in systemic sclerosis: what does it signify?

OBJECTIVE: To evaluate the significance of oesophageal dilatation on high-resolution CT (HRCT) chest in patients with systemic sclerosis. METHODS: We retrospectively retrieved the database of patients with systemic sclerosis seen at our hospital between January 2008 and January 2009. A total of 50 patients (46 women and four men) who had HRCT chest, pulmonary function testing and echocardiography within 1 month were included in the study. Peak pulmonary artery (PA) pressures and pulmonary function testing were charted. The HRCT chest was interpreted by a chest radiologist. Oesophageal dilatation was defined as a luminal coronal diameter of ≥9 mm in infra-aortic oesophagus. Extent of ground glass, reticulation and honeycombing was objectively scored. RESULTS: Statistical analysis using independent t-test showed that diffusion capacity of carbon monoxide was significantly lower (P = 0.042) and peak PA pressures were significantly higher (P = 0.045) in patients with oesophageal dilatation (n = 29) as compared with those without oesophageal dilatation (n = 21). The two cohorts had no significant difference in their total lung capacity and HRCT determined extent of interstitial lung disease. CONCLUSION: Patients with oesophageal dilatation on HRCT chest had significantly lower diffusion capacity of carbon monoxide and higher peak PA pressures, which suggest that these patients tend to have more severe pulmonary vascular disease.

Significance of platelet volume indices and platelet count in ischaemic heart disease.

BACKGROUND: Ischaemic heart disease is mainly caused by atherosclerosis and its complications. Platelets and their activity have an important role in initiation of atherosclerotic lesions and coronary thrombus formation. Larger platelets are enzymatically and metabolically more active and have a higher potential thrombotic ability as compared with smaller platelets. AIMS: To study the changes in platelet volume indices and platelet count in ischaemic heart disease and assess their usefulness in predicting coronary events. METHODS: This was a comparative study of 180 patients (60 patients with stable angina, 60 with acute coronary syndrome and 60 with non-cardiac chest pain). Blood venous sample were drawn from all subjects after admission (within 30 min) and collected in standardised EDTA sample tubes. Platelet count and volume indices were assayed within 30 min of blood collection, using Sysmex KX21-N autoanalyzer. RESULTS: The platelet count was significantly lower in patients with acute coronary syndrome (201.28 x 10(9)/l) as compared with patients with stable angina (267.07 x 10(9)/l) and those from the normal population (256.65 x 10(9)/l) (p<0.001). In addition, patients with acute coronary syndrome had higher platelet volume indices (10.97) compared with patients in the stable angina (10.03) and normal population groups (9.12) (p<0.001). CONCLUSIONS: Patients with acute coronary syndrome had higher platelet volume indices and lower platelet counts compared with those with stable angina and the normal population. Measurements of platelet volume indices and platelet count may be of some benefit in detecting those patients at higher risk for acute coronary events.