Multipronged effects of increased screen time on the nutritional imbalance: A cross-sectional study of students of Amritsar aged 6-16 years.

Background: Intense marketing of fast-food items impacts the eating habits among children and adolescents. Various studies suggest that increased screen time leads to increased fast-food consumption and decreased sleep duration, both of which are linked to obesity in growing age. Objectives: To assess screen time and dietary habits among the study group and to estimate their effect on sleep deprivation and obesity. Methods: This cross-sectional study was conducted from January 2019 to December 2019 in three schools in Amritsar selected by lottery method of simple random sampling. Out of 4,226 students, 355 overweight and obese students were interviewed regarding their dietary habits. An informed written assent was taken from the mothers. The information was collected on a semi-structured, pre-designed questionnaire by interviewing the mothers of students between 6 and 11 years of age and the students of 12-16 years. Results: 94.4% of students preferred fast foods to regular meals and 58.3% were in the habit of skipping breakfast. 59.4% had a history of daily intake of fast foods while 76.1% had a habit of consuming fast foods while watching television. Only 31.7% had an adequate sleeping pattern of 9-11 hours and 79.7% of the students had a screen time of over 3 hours. Conclusions: More the screen time, the more the chances of missing meals. Being awake for a long odd time leads to increased consumption of foods/snacks furthermore. Regarding the harmful effects of fast foods, the source of information was from schools, but only 41.4% were aware about these effects.

Prevalence of tobacco consumption and smoking and its effect on outcome among microbiologically confirmed new pulmonary tuberculosis patients on daily regimen of DOTS in Amritsar city.

Background: Tobacco consumption and smoking are causative factors that can create a favorable environment for tuberculosis and increase the morbidity and mortality attributed to it. Tobacco use is the leading global cause of preventable death (6 million deaths per year). This study compares the treatment outcome in pulmonary tuberculosis patients on DOTS daily regimen with respect to consumption of tobacco and smoking. Aims: 1. To study the prevalence of tobacco consumption and smoking among microbiologically confirmed new pulmonary tuberculosis patients. 2. To study the effect of tobacco consumption and smoking on the outcome of microbiologically confirmed new pulmonary tuberculosis patients. Material and Method: The prospective observational study was conducted on microbiologically confirmed new pulmonary tuberculosis patients enrolled during the first quarter of the year 2019 (i.e., from 01/01/2019 to 03/31/2019) at the four selected DMCs of Amritsar City. In total, 197 patients were included in the study depending on the inclusion and exclusion criteria. The prevalence of tobacco consumption and smoking at the start of treatment was noted and the effect on outcome was observed. Results: Prevalence of tobacco consumption and smoking was found to be 24.37% and 21.83%, respectively. In addition, 93.96% of non-tobacco consumers and 94.15% of non-smokers had favorable outcomes as compared to 83.34% of tobacco consumers and 81.4% of smokers, which is statistically significant. Conclusion: Tobacco consumption and smoking have significantly higher chances of unfavorable outcomes (loss to follow up, change in treatment regimen, and death) as compared to non-consumption and non-smoking.

Assessment of barriers and motivators to online learning among medical undergraduates of Punjab.

BACKGROUND: The current corona virus disease 2019 (COVID-19) pandemic has led to the disruption of academic activities including medical education which has made online learning only available options for continuing education worldwide. Online learning has its own limitations, which are further amplified if not implemented properly. Hence, there is a need to assess various barriers faced in the implementation of effective online learning. OBJECTIVES: The objective of the study was to identify the barriers and motivators in online learning among medical undergraduates. SUBJECTS AND METHODS: This internet-based cross-sectional study was conducted among medical undergraduates of Punjab. The data collection tool was a semi-structured self-made questionnaire prepared using "Google Forms," which was then circulated in the WhatsApp groups of the students. Received responses were imported to the Microsoft Excel sheet and statistical analysis was done. RESULTS: Out of the 592 participants, 533 (90%) faced some kind of problem in online learning. Major among them were lack of personal interaction with teachers (52%), distractions at home (43.6%), technology failure (43.2%), limited access to the Internet (39.2%), visual fatigue (38.5%), and increased workload (25%). Benefits perceived were the comfortable environment of home (41%), easy accessibility of recorded lectures (36.8%), and the opportunity to keep in touch with studies (35%). CONCLUSIONS: The online learning process is not a replacement for routine classroom teaching and clinical postings in medical education. However, it can supplement routine teaching, especially during current COVID-19 pandemic-like situations. Most of the students (90%) were facing some kind of difficulty in the online learning process due to unplanned and sudden shifts. Therefore, it is necessary to identify and eliminate the various barriers to make online learning effective.

Morbidity profile of under-5 slum dwellers of Amritsar city: A descriptive cross-sectional study.

CONTEXT: Children living in slums are deprived from basic necessities. Unhygienic environment and deficient nutrition hinder their growth and make them more prone to infectious diseases. AIMS: To study morbidity profile of under-5 children and determine social epidemiological factors associated with it. SETTINGS AND DESIGN: A descriptive cross-sectional study in urban slums of district Amritsar. METHODS AND MATERIAL: In total, 400 households each from four slums (1600 in total) were randomly selected. One to one interview with mother of each under 5 was conducted and information was recorded on pretested performa. Height and weight with haemoglobin estimation was done for each child. STATISTICAL ANALYSIS USED: Descriptive statistics (frequencies and proportions) and univariate logistic regression was applied to determine factors associated with under nutrition. RESULTS: Out of 1136 under-5, 50, 45 and 8% were stunted, underweight and wasted. Severe malnutrition was seen among 23%. In total, 79% had anaemia. About 69% suffered from one or more infectious disease in last 3 months. Anaemia, birth order >2, lower socio-economic status and suffering from any infectious disease in last 3 months were associated with malnutrition. CONCLUSIONS: Severe malnutrition and anaemia was high among under-5 of urban slums and 69% suffered from infectious disease in last 3 months emphasizing on addressal of health needs of under-5 residing in urban slums.

Fail-safe nano-formulation of prodrug of sulfapyridine: Preparation and evaluation for treatment of rheumatoid arthritis.

Aim of the present study was to give a second life to the long-abandoned drug, sulfapyridine (SP) for its anti-arthritic potential by design of nano-vesicular delivery system. For this, intra-articular delivery of its liposomal formulation was tried. As the prepared formulation exhibited rapid drug leakage, an arthritis responsive prodrug of SP showing lability towards synovial enzymes was synthesized to exploit the over-expression of arthritis specific enzymes. Prodrug (SP-PD) exhibited better retention in liposomes as compared to the drug, preventing its escape from synovium. Hydrolysis of SP-PD in human plasma and synovial fluid indicated its high susceptibility to enzymes. The liposomes of SP-PD exhibited larger mean size, less PDI and higher zeta potential as compared to those for SP liposomes. In arthritic rats, prodrug liposomes were found to reverse the symptoms of inflammation, including the levels of biochemical markers. Liposomes of bio-responsive prodrug, therefore, offer a revolutionary approach in the treatment of rheumatoid arthritis.

Treatment Outcomes of Patients Receiving Combination Antiretroviral Therapy under the National Acquired Immunodeficiency Syndrome Control Programme.

INTRODUCTION: The free antiretroviral therapy (ART) initiative of the Government of India was launched on April 1, 2004, since then it is being scaled up in a phased manner. The aim of this study was to analyze the treatment outcome of patients receiving first-line ART through the National Acquired Immunodeficiency Syndrome Control Programme of India. MATERIALS AND METHODS: This was an record-based retrospective analysis of data of patients who were put on ART from January 2009 to December 2009. RESULTS: Of the 548 patients (63.87% males; median age of 37 years), 55% of patients were employed and majority of them have low monthly income. Patients showed a significant improvement in clinical and functional status after staring ART therapy, as percentage of patients in clinical Stage 1 increased significantly (from 35.5% to 90.3%) and that of Stage 3 and 4 decreased drastically. Ninety percent of patients were working, and none was bedridden after 2 years of ART. Patients with >95% adherence to ART showed more improvement than those with <95% adherence (40% patients). The median increase in cluster of differentiation 4 (CD4) count was 134 cells/mm3 at 6 months, 185 cells/mm3 at 12 months, and 255 cells/mm3 at 24 months. Majority of patients died in clinical staging 4 with CD4 cell count <50 cells/mm3. Over 2 year's period, 20% patients died and 9.31% were lost to follow-ups (LFUs). CONCLUSION: Early detection, timely treatment, and long-term adherence are the keys for the success of ART programme in India; it is of utmost importance to do intense Information Education Communication/Behavioral Change Communication, regular monitoring, up-to-date record keeping, tracking of LFUs, and triangulation and data analysis for timely action and for consolidation of success made so far.

Morbidity Pattern, Availability and Utilization of Health Services: A Study among the Male Youth (15-24 Years) Living in the Slums.

BACKGROUND: Youth is considered as a healthy period but their health is greatly influenced by the hostile living conditions in the slums. When this is accompanied by poor health infrastructure, health risk escalates multiple times. OBJECTIVES: The objective was (1) to study the health problems of the male youth living in the slums and (2) to study the availability and utilization of health services for the male youth living in the slums. SUBJECTS AND METHODS: Study design: Cross-sectional study. Study population: Male youth (15-24 years). Study settings: Four urban slums of Amritsar city. Study period: January 1, 2017-December 31, 2017. Sample size: One thousand male youths. Inclusion criteria: Male youth (15-24 years) with consent. Exclusion criteria: Male youth (15-24 years) not given consent, not available at home on the third repeat visit, and mentally unstable or deaf or dumb. RESULTS: The morbidity pattern showed that 47.5% suffered from any disease during the past 3 months and 3.3% were hospitalized in the past 1 year. Majority of the cases were due to diseases of the respiratory system and gastrointestinal system. Private health sectors including chemist shops were utilized more in case of both outpatient (88.9%) and inpatient services (57.6%) as compared to public health sector. The private health facilities were within 500 m from majority (89.6%) of households in the slums of Amritsar city. CONCLUSIONS: Primary health care needs to be strengthened in the slums. Effective and easily accessible health-care services should be provided by the government at the doorsteps of slum households. The Information Education Communication/Behavior Change Communication activities regarding disease prevention should be strengthened to promote and protect good health.

A study of frequency distribution and some epidemiological features of reported cases and deaths of dengue in Ludhiana district during the year 2008.

There were 7337 cases and 50 deaths reported in the state of Punjab from 1997 to 2008 of which Ludhiana district of Punjab contributed 4973 cases and 32 deaths. Number of cases (2506) and deaths (13) reported were highest in Ludhiana in the year 2008. City/Area wise reporting of dengue cases in hospitals of Ludhiana in 2008 show that the disease is mostly prevalent in the urban areas but now has been reported from rural areas also as 2 cases have been reported from village Kumkalan, block Mangat, Ludhiana. Age wise distribution of the cases shows maximum incidence per lakh population in 31-50 years (52.06) followed by 16-30 years (49.00) and lowest in infants (0.36). The difference of incidence in various age groups has been found highly significant. Out of the 2988 cases reported from Ludhiana district, there were 1993 males, 989 females and no mention of the sex in 6 cases. The difference of incidence in males and females has been found highly significant. Month wise distribution of the cases shows maximum incidence per lakh population to be the highest in October (90.27) followed by November (33.39) and December (23.18). The difference of incidence in various months has been found highly significant. As the dengue is increasingly becoming an escalating problem it needs necessary control measures especially regarding BCC activities and appointment of Biologists at the district level in Punjab needs to be done.

Diagnostic values of tests for acromioclavicular joint pain.

BACKGROUND: This prospective study was performed to determine which clinical and imaging tests were most helpful for diagnosing acromioclavicular joint pain. METHODS: Of 1037 patients with shoulder pain, 113 who mapped pain within an area bounded by the midpart of the clavicle and the deltoid insertion were eligible for inclusion in the study. Forty-two subjects agreed to participate, and four of them were lost to follow-up. Twenty clinical tests, radiography, bone-scanning, magnetic resonance imaging, and an acromioclavicular joint injection test were performed on all patients. The patients were divided into two groups according to whether they had a > or =50% decrease in pain following the acromioclavicular joint injection. Statistical analysis, including multivariate regression analysis, was performed in order to evaluate the diagnostic effectiveness of the various tests. RESULTS: Acromioclavicular joint pain was confirmed in twenty-eight of the thirty-eight patients. The most sensitive tests were examination for acromioclavicular tenderness (96% sensitivity), the Paxinos test (79%), magnetic resonance imaging (85%), and bone-scanning (82%), but these studies had low specificity. In the stepwise regression model, with the response to the injection used as the dependent variable, bone-scanning and the Paxinos test were the only independent variables retained. Patients with a positive Paxinos test as well as a positive bone scan had high post-test odds (55:1) and a 99% post-test probability of having pain due to pathological changes in the acromioclavicular joint. The likelihood ratio for patients with one negative test and one positive test was indeterminate (0.4:1). Patients with both a negative Paxinos test and a negative bone scan had a likelihood ratio of 0.03:1 for having acromioclavicular joint pain, which basically rules out the disorder. CONCLUSIONS: The highly sensitive tests had low specificity, and the highly specific tests had low sensitivity. However, the combination of a positive Paxinos test and a positive bone scan predicted damage to the acromioclavicular joint as the cause of shoulder pain with a high degree of confidence.

Meniscal and chondral loss in the anterior cruciate ligament injured knee.

Rupture of the anterior cruciate ligament (ACL) of the knee is a commonly occurring injury in the athletic population. Associated meniscal and chondral injury is well recognised. This occurs both at the time of index injury and also secondarily over time in the ACL-deficient knee as a result of several related pathways culminating in osteoarthritis. ACL reconstruction is a well established surgical technique for treatment of symptomatic instability in ACL-deficient knees but the role of ACL reconstruction in the prevention of osteoarthritis remains unclear. This article reviews the contemporary literature on the pathophysiology of chondral and meniscal loss in ACL-injured knees and the role of current treatment techniques, including surgical reconstruction of ligamentous, meniscal and chondral pathology, in altering the natural history of the ACL-deficient knee.

Quadrupled bone-semitendinosus anterior cruciate ligament reconstruction: a clinical investigation in a group of athletes.

PURPOSE: The hypothesis of our study was that a quadrupled bone-semitendinosus (STB) graft could provide a clinically stable construct, allow recovery of normal limb strength, give high patient satisfaction with early return to active sports, and involve low donor-site morbidity. TYPE OF STUDY: Outcomes study. METHODS: Anterior cruciate ligament (ACL) reconstruction with an STB graft was performed on 80 athletes with isolated ACL injury from January 1996 to December 1999. Femoral fixation was obtained with EndoButton (Smith & Nephew, Andover, MA) and tibial fixation with Fastlok (Neoligaments, Leeds, England). At a mean follow-up time of 36 months (range, 24-52 months), patients were evaluated using standard knee scores (Noyes, Lysholm, Tegner, and International Knee Documentation Committee [IKDC] rating) and functional strength tests; postoperative pain rating; knee radiographs performed after surgery and at final follow-up; magnetic resonance imaging (MRI) at 3 to 6 months; isokinetic flexion-extension and internal-external rotation tests at 3, 6, and 12 months; and computed laxity analysis at final evaluation. RESULTS: At final evaluation, subjective knee rating was 87%, kneeling test was positive in 7%, and Werner score was 44 of 50 (range, 30-48). Lachman test was negative in 90% at final evaluation. Sensory changes were present in 30% at 3 months, and 10% had definite hyposthesia. Computed laxity analysis revealed 90% with less than 3 mm side-to-side difference. Isokinetic testing showed normal hamstring and quadriceps peak torques at 12 months. The one-leg hop test and vertical jump were normal by 6 months. At final evaluation, average Noyes score was 88 (range, 65-100); Lysholm score, 91 (range, 70-100); postoperative Tegner rating, 6.5 (range, 5-9); and preinjury Tegner rating, 7.5 (range, 7-10). IKDC score showed 72 knees normal or nearly normal, 7 abnormal, and 1 severely abnormal. Sixty-five percent of patients returned to the same preinjury sports level. CONCLUSIONS: The quadrupled bone-semitendinosus graft is a viable graft for ACL reconstruction and should be considered, especially for patients with extensor mechanism problems.

Patellar tendon versus quadrupled bone-semitendinosus anterior cruciate ligament reconstruction: a prospective clinical investigation in athletes.

PURPOSE: Patellar tendon and hamstrings are both used in anterior cruciate ligament (ACL) reconstruction, and comparisons have been reported with different results. The purpose of this clinical study was to compare the results of ACL reconstruction in athletes with 2 different graft types, both using bone-to-bone healing: bone-patellar tendon-bone graft and a quadrupled bone-semitendinosus graft. TYPE OF STUDY: Outcomes study. METHODS: From 1994 to 1997, 2 groups of 40 athletes who underwent ACL replacement with patellar tendon and quadrupled bone-semitendinosus grafts were prospectively evaluated. Preinjury activity level, age, and gender were comparable in both groups. All patients were operated on by the same surgeon within 5 months from injury and underwent group-specific rehabilitation programs. An independent examiner performed the final evaluations at 36 months. Review included clinical examination, radiographs, computed analysis, isokinetic and functional strength tests, and subjective and objective evaluation with standard knee scores. Additional procedures were recorded. Statistical analysis was performed with both parametric and nonparametric tests. RESULTS: Average surgical time was longer with the semitendinosus graft, and postoperative pain was higher in the patellar tendon group. Standard knee evaluation scores and subjective assessment revealed no significant differences. Isokinetic testing of flexion-extension and internal-external rotation showed lower quadriceps strength and a mild deficit of external rotation in the patellar tendon group and slightly lower flexor strength in the semitendinosus group at 12 months. Computerized laxity analysis showed no difference between the 2 groups with 90% of patients having less than 3 mm side-to-side difference, with a gender difference in the semitendinosus group. Kneeling pain was higher in patellar tendon group. CONCLUSIONS: The bone-patellar tendon-bone and quadrupled bone-semitendinosus autograft provide excellent grafts for ACL reconstruction. Both techniques are comparable regarding final stability, but in patients with extensor mechanism problems or those who engage in sports with a high incidence of patellar tendonitis, the semitendinosus graft should be considered.

Hamstring graft tibial fixation: biomechanical properties of different linkage systems.

This biomechanical study analyzed the mechanical properties of different linkage systems commonly used in hamstring tendon ACL reconstruction. Two kinds of tapes, 5-mm braided polyester (Mersilene) and 3-mm woven polyester (Orthotape), were connected to a particular staple in bovine bone sections in single- and double-loop constructs with five replicates of each. These constructs underwent straight pull tensile tests, residual tensile tests, and fatigue tests at a loading regime of 540,000 cycles at 25 Hz frequency, using an Instron tensile test machine. Protrusion heights of the constructs were measured. The double-loop Mersilene-Fastlok construct was weaker than either single-loop or double-loop Orthotape-Fastlok construct. The mean failure strength of double-loop Orthotape-Fastlok was 93% higher and its mean stiffness was 40% greater at failure than that of Mersilene-Fastlok. At a 150-N load Mersilene-Fastlok was stiffer, while at 300 N Orthotape-Fastlok was stiffer. The thickness of Orthotape-Fastlok resulted in 1 mm more device protrusion. In hamstring tendon ACL reconstructions with indirect fixation we advocate the use of woven polyester (Orthotape) with Fastlok as a linkage material over braided polyester (Mersilene) with Fastlok because of its superior strength and stiffness.

Patellar tendon anterior cruciate ligament reconstruction with conical press-fit femoral fixation: 5-year results in athletes population.

Bone-patellar tendon autograft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral conical press-fit fixation. A prospective study was performed on 40 consecutive active athletes who underwent ACL reconstruction with this technique by the same surgeon between November 1994 and September 1995 (mean follow-up 46 months, range 36-62). Results were evaluated by an independent examiner using radiography, computed tomography, subjective and objective evaluation, and isokinetic and functional strength tests. Assessment using the IKDC knee scoring revealed 85% of the patients with a normal or nearly normal knee joint; Tegner's score was 7.5 preoperatively and 6.0 postoperatively, with 60% of the athletes returning to the preinjury sport and level. No patients had instability, with 90% having less than 3 mm side-to-side difference on computerized analysis. The isokinetic test showed mild quadriceps deficit at 3 and 6 months, with no deficit at final follow-up; four patients complained of anterior knee pain and had a positive kneeling test. We found no graft dislocation. All cases showed radiological evidence of graft integration at 3 months time. Long-term results support this technique asx a simple, cost-effective, and reliable alternative for patellar tendon fixation in ACL reconstruction.