Knowledge & Utilization of Rashtriya Swasthya Bima Yojana & Mukhyamantri Amrutam Yojana in a Block of Gandhinagar, Gujarat

Background: Major illness requiring hospitalization in poor family makes the family poorer with further tragic outcomes. In that view, Rashtriya Swasthya Bima Yojna (RSBY) by GOI and Mukhyamantri Amrutam (MA) Yojna by Gujarat Government were launched for Below Poverty Line families. Aims & Objectives: To assess knowledge and utilization regarding these two schemes amongst the registered families. Material & Methods: A community-based survey was carried out in a block of Gandhinagar using 30 clusters sampling. Sample size was calculated taking RSBY utilization rate 2.0%. Results: 98.4% had RSBY card & 83.7% had MA card. Common reasons for not having card were either “card not issued/people did not go to collect card” or “were unaware about the schemes/ card”. Only 1.5% families had valid RSBY cards. Knowledge regarding both the schemes (when & where to use, benefit amount etc.) was very poor (20- 25%). RSBY & MA utilization among valid card holders for last 1 year was 1.2% & 0.2% per enrolled member respectively in last 1 year. In both RSBY & MA, 30 – 40% beneficiaries had out of pocket expenditure, mainly towards transport & food. Few had towards medicines and/or investigations. However, most were satisfied with the services. Conclusion: Looking to the poor knowledge, it is important to carry out IEC activities to make people aware about the schemes which will help increase the utilization.

Insertion of an intrathecal catheter following a recognised accidental dural puncture reduces the need for an epidural blood patch in parturients: an Australian retrospective study

BACKGROUND

There is no clear consensus about how best to prevent post-dural puncture headache (PDPH) following an accidental dural puncture in parturients. Our primary objective was to investigate whether the insertion of an intrathecal catheter following accidental dural puncture reduces the incidence of PDPH and therapeutic epidural blood patch.

METHODS

Anaesthetic records from January 2009 to December 2015 were reviewed retrospectively and parturients who had an accidental dural puncture and/or PDPH were identified. Data from those with a recognised dural puncture in whom an intrathecal catheter was inserted at the time of accidental dural puncture (ITC group) were compared to those without an intrathecal catheter (non-ITC group), as were outcomes of patients with an intrathecal catheter for ≥24 hours compared to <24 hours.

RESULTS

Of 94 recognised accidental dural punctures, 66 were in the ITC group (37 for ≥24 h) and 28 in the non-ITC group. In the ITC group, 22 (33.3%) required an epidural blood patch in comparison to 19 (67.9%) in the non-ITC group (P <0.01, 95% CI 12.5 to 52.0). In the ITC group, 62 (93.9%) developed PDPH in comparison to 28 (100%) in the non-ITC group (P=0.186, 95% CI -6.55 to 14.57). Intrathecal catheter insertion for ≥24 h obviated the need for an epidural blood patch in 28 (75.7%) parturients, compared to 13 (59.1%) if <24 h (P=0.184, 95% CI -7.08 to 39.72).

CONCLUSION

Inserting an intrathecal catheter after a recognised accidental dural puncture significantly reduced the need for an epidural blood patch.

Evaluation of Surface Roughness of Nanofilled Composite Restorations after Simulated Tooth Brushing using Various Dentifrices

Background Teeth restored with direct composite resin are constantly exposed to specific challenges of the oral cavity. These challenges can modify the material properties and, when associated with daily brushing, eventually change its surface roughness, allowing bacterial growth and retention of extrinsic pigments. Dentifrices plays an important role in dental wear (abrasion) and over time, can also cause an increase in the surface roughness of restorative materials. Objective To assess the effect of dentifrices on the longevity of direct nanofilled composite resins restorations as far as wear and roughness is concerned. Method Class V cavity were prepared on 90 extracted human teeth and restored with Filtek Z350 composite. Teeth were randomly divided into 6 experimental groups of 15 each labelled as Group-1 (Colgate Dental cream) Group-2 (Colgate Active Salt toothpaste), Group-3 (Pepsodent Regular toothpaste), Group-4 (Dabur red toothpaste), Group-5 (Dabur Lal tooth powder) and Group-6 Control (water). The samples were fixed on tooth brushing machine and subjected to mechanical tooth brushing using various dentifrices according to respective groups in 3 phases and reading of surface roughness (Ra) was recorded. Result Surface roughness (Ra) had increased in following order: Group 6 < Group 3 < Group 2 < Group 1 < Group 4 < Group 5. All the tooth pastes were compared, their behaviour was found to be similar as there was no statistically significant difference amongst them. Though all of them were inferior to control group and the difference was statistically significant. Whereas the only tooth powder Dabur lal tooth powder gave the maximum roughness when compared with the other tooth pastes and the difference was statistically significant. Conclusion With increase in time of brushing there was increase in surface roughness in all the 5 dentifrices among them Ra was maximum for Dabur lal tooth powder.

Assessment of Automatic Thoughts in Patients with Depressive Illness at a Tertiary Hospital in Nepal

INTRODUCTION

Cognitive functions have significant influence on psycho-social and general wellbeing. The quality, content and processing of negative thoughts initiate depressive symptoms; i.e. low mood, decreased self-worth and diminished interest in pleasurable activities. The study assessed the automatic thoughts of patients having depressive illness and evaluated and compared the changes after therapy; i.e. Psychotherapy and pharmacotherapy.

METHODS

Diagnosed cases of depressive illness (n=135), according to ICD-10 and study criteria, attending the out-patient clinic of Department of Psychiatry and Mental Health, Tribhuvan University Teaching Hospital, were included. Beck Depression Inventory was used to screen level of depressive symptoms. Automatic thoughts were assessed by the Automatic Thought Questionnaire-Revised before initiating therapy and after completion of therapy for comparison. Depressive patients received either of the three treatment procedures after randomization of the study sample into three different treatment groups; i.e. Cognitive behavior therapy, pharmacotherapy or combined therapy receiving both cognitive behavior therapy and pharmacotherapy.

RESULTS

Among the total 135 patients, 53 (39.3%) had moderate, 47 (34.8%) had severe depressive and 35 (25.9%) had mild depressive symptoms before therapeutic interventions. Negative automatic thoughts were significantly present in depressed patients and reduced after all three interventions. Negative automatic thoughts of hopelessness, anxiety and inability coping were significantly reduced after therapy.

CONCLUSIONS

Automatic negative thoughts were significantly correlated with depressive disorder. Combined therapy CBT with pharmacotherapy or CBT alone was found to be more effective in modifying automatic negative thoughts than pharmacotherapy alone, ultimately reducing depressive symptoms to a significant degree.

Caregiving Burden Among Family Members Of People With Mental Illness

Background: Presence of a person with mental disorder in family is often associated with some objective and subjective burden on family members, especially those who have a caregiving role. The present study aimed to assess the levels of caregiving burden among family members of people with mental illness.Method: This is a descriptive cross-sectional study in a sample of 56 family caregivers of people with mental illness. Sample was selected using purposive sampling method and their caregiving experience was assessed by using Burden Assessment Schedule.Result: Among the 56 caregivers, 48.2 % had moderate level of burden and 32.1% had severe level of burden. Highly significant difference was observed in the distribution of burden according to level of burden but no significant gender difference was found in the distribution of burden in total and in different domains of BAS. Highly significant burden was found among married and spouse caregivers.Conclusion: As moderate to severe level of caregiving burden was reported by the family caregivers, it is recommended that family intervention should focus on strengthening coping behaviors and social support system to manage caregiving stress.

Belatacept Conversion in an HIV-Positive Kidney Transplant Recipient With Prolonged Delayed Graft Function

We report an HIV-positive renal transplant recipient with delayed graft function who was converted from tacrolimus to belatacept in an attempt to improve renal function. The patient had kidney biopsies at 4 and 8 weeks posttransplant that revealed acute tubular necrosis and mild fibrosis. After 14 weeks of delayed function, belatacept was initiated and tacrolimus was weaned off. Shortly after discontinuing tacrolimus, renal function began to improve. The patient was able to discontinue dialysis 21 weeks posttransplant. HIV viral load was undetectable at last follow-up. To our knowledge, this is the first report of belatacept use in a patient with HIV.

A study on metabolic prowess of Pseudomonas sp. RPT 52 to degrade imidacloprid, endosulfan and coragen

A bacterial strain identified as Pseudomonas sp. RPT 52, was isolated from an agricultural field by soil enrichment technique. The bacterial strain was able to metabolize three different chlorinated pesticides; imidacloprid, endosulfan and coragen (belonging to neonicotinoid, organochlorine and anthranillic diamide categories, respectively). RPT 52 was able to degrade 46.5%, 96.6%, 92.7% and 80.16% of 0.5 mM of imidacloprid, endosulfan α, endosulfan β and coragen, respectively, in minimal medium over a period of 40 h, when provided as sole source of carbon and energy. Degradation kinetics showed that imidacloprid, endosulfan α and endosulfan β followed first order kinetics whereas coragen followed zero order kinetics. Toxicity studies show reduction in toxicity of the parent compound when degraded by RPT 52. Laboratory scale, soil microcosm studies showed that strain RPT 52 is a suitable candidate for bioremediation of endosulfan and coragen contaminated sites. Thus, RPT 52 holds potential for toxicity reduction in the affected environment.

Cognitive Dysfunctions in Patients with Alcohol Dependence Syndrome in a Tertiary Hospital in Kathmandu

INTRODUCTION

Alcohol dependence is a chronic disorder, accompanied by neuropsychological deficits. Patients with alcohol dependence were evaluated to identify the cognitive dysfunctions.

METHODS

The study followed descriptive design and recruited participants (N=62) from inpatient services of the Department of Psychiatry and Mental Health by convenient sampling. Participants were evaluated with the Severity of Alcohol Dependence Questionnaire, Frontal Assessment Battery and PGI Memory Scale for the severity of alcohol dependence, executive impairments and memory dysfunctions respectively once they had completed alcohol detoxification.

RESULTS

Total duration of alcohol consumption was 13.93 ± 8.74 years, period of dependence was 2.97 ± 2.23 years and 56.5% had moderate level of dependence. 33.9% of the participants had executive impairments particularly in conceptualization, programming and mental flexibility. 38% of variance in executive dysfunction was explained by illness variables, where period of alcohol dependence and education were significant predictors. 54.8% had significant memory dysfunction particularly in visual retention, remote memory, verbal retention of dissimilar pairs and delayed recall. Memory dysfunction differed significantly among the age groups (F=10.22, p<0.01) and age was a significant predictor (β=.542, p<0.001). 19% variance in memory dysfunction was explained by illness variables, where duration of alcohol consumption was a significant predictor (β = .485, p<0.01).

CONCLUSION

Findings indicate that cognitive dysfunctions are prevalent among patients with alcohol dependence. Hence, routine neuropsychological assessment is of particular importance for early detection and remediation of underlying deficits, which completes the treatment of alcohol dependence.

Donor-derived Strongyloides stercoralis infection in solid organ transplant recipients in the United States, 2009-2013

Infection with Strongyloides stercoralis is typically asymptomatic in immunocompetent hosts, despite chronic infection. In contrast, immunocompromised hosts such as solid organ transplant recipients are at risk for hyperinfection syndrome and/or disseminated disease, frequently resulting in fatal outcomes. Infection in these recipients may result from reactivation of latent infection or infection through transmission from an infected donor. We describe the Centers for Disease Control and Prevention's experience with seven clusters of donor-derived infection from 2009 to 2013. Six of the seven (86%) donors were born in Latin America; donor screening was not performed prior to organ transplantation in any of these investigations. Eleven of the 20 (55%) organ recipients were symptomatic, two of whom died from complications of strongyloidiasis. We also describe the New York Organ Donor Network (NYODN) experience with targeted donor screening from 2010 to 2013. Of the 233 consented potential donors tested, 10 tested positive for Strongyloides antibody; and 18 organs were transplanted. The majority (86%) of the donors were born in Central or South America. Fourteen recipients received prophylaxis after transplantation; no recipients developed strongyloidiasis. The NYODN experience provides evidence that when targeted donor screening is performed prior to transplantation, donor-derived infection can be averted in recipients.

The Nck-interacting kinase NIK increases Arp2/3 complex activity by phosphorylating the Arp2 subunit

The nucleating activity of the Arp2/3 complex promotes the assembly of branched actin filaments that drive plasma membrane protrusion in migrating cells. Arp2/3 complex binding to nucleation-promoting factors of the WASP and WAVE families was previously thought to be sufficient to increase nucleating activity. However, phosphorylation of the Arp2 subunit was recently shown to be necessary for Arp2/3 complex activity. We show in mammary carcinoma cells that mutant Arp2 lacking phosphorylation assembled with endogenous subunits and dominantly suppressed actin filament assembly and membrane protrusion. We also report that Nck-interacting kinase (NIK), a MAP4K4, binds and directly phosphorylates the Arp2 subunit, which increases the nucleating activity of the Arp2/3 complex. In cells, NIK kinase activity was necessary for increased Arp2 phosphorylation and plasma membrane protrusion in response to epidermal growth factor. NIK is the first kinase shown to phosphorylate and increase the activity of the Arp2/3 complex, and our findings suggest that it integrates growth factor regulation of actin filament dynamics.

Severe microbial keratitis and associated perforation after corneal crosslinking for keratoconus

PURPOSE

To report two cases of microbial keratitis with subsequent corneal perforation immediately following corneal collagen crosslinking (CXL).

METHODS

Retrospective case note review.

RESULTS

First case was a 19 year old female presented with staphylococcal corneal abscess 3 days post CXL procedure. Corneal perforation occurred during hospital admission and was successfully treated with corneal gluing. Microbial keratitis eventually resolved, with both topical and systemic antibiotics therapy, resulting in a vascularized corneal scar. Second case was an 18 year old male whom developed Methicillin Resistant Staphylococcus aureus (MRSA) corneal abscess 5 days after CXL procedure for progressive keratoconus. Corneal perforation occurred 48 h after presentation and patient underwent uneventful corneal gluing. Although infective keratitis was successfully treated with topical therapy, patient had visual outcome of count fingers due to scarring.

CONCLUSIONS

CXL has been widely used in the treatment of corneal ectatic conditions and complications, such as infective keratitis, are uncommon post procedure. We present two cases of severe microbial keratitis with subsequent corneal perforation within 7 days of CXL. The exact mechanism for the accelerated keratolysis process is unclear. Nonetheless, patients should be well-informed of such potentially devastating complication.

Transmission of methicillin-resistant Staphylococcus aureus via deceased donor liver transplantation confirmed by whole genome sequencing

Donor-derived bacterial infection is a recognized complication of solid organ transplantation (SOT). The present report describes the clinical details and successful outcome in a liver transplant recipient despite transmission of methicillin-resistant Staphylococcus aureus (MRSA) from a deceased donor with MRSA endocarditis and bacteremia. We further describe whole genome sequencing (WGS) and complete de novo assembly of the donor and recipient MRSA isolate genomes, which confirms that both isolates are genetically 100% identical. We propose that similar application of WGS techniques to future investigations of donor bacterial transmission would strengthen the definition of proven bacterial transmission in SOT, particularly in the presence of highly clonal bacteria such as MRSA. WGS will further improve our understanding of the epidemiology of bacterial transmission in SOT and the risk of adverse patient outcomes when it occurs.

Item and Test Analysis to Identify Quality Multiple Choice Questions (MCQs) from an Assessment of Medical Students of Ahmedabad, Gujarat

BACKGROUND

Multiple choice questions (MCQs) are frequently used to assess students in different educational streams for their objectivity and wide reach of coverage in less time. However, the MCQs to be used must be of quality which depends upon its difficulty index (DIF I), discrimination index (DI) and distracter efficiency (DE).

OBJECTIVE

To evaluate MCQs or items and develop a pool of valid items by assessing with DIF I, DI and DE and also to revise/ store or discard items based on obtained results.

SETTINGS

Study was conducted in a medical school of Ahmedabad.

MATERIALS AND METHODS

An internal examination in Community Medicine was conducted after 40 hours teaching during 1(st) MBBS which was attended by 148 out of 150 students. Total 50 MCQs or items and 150 distractors were analyzed.

STATISTICAL ANALYSIS

Data was entered and analyzed in MS Excel 2007 and simple proportions, mean, standard deviations, coefficient of variation were calculated and unpaired t test was applied.

RESULTS

Out of 50 items, 24 had "good to excellent" DIF I (31 - 60%) and 15 had "good to excellent" DI (> 0.25). Mean DE was 88.6% considered as ideal/ acceptable and non functional distractors (NFD) were only 11.4%. Mean DI was 0.14. Poor DI (< 0.15) with negative DI in 10 items indicates poor preparedness of students and some issues with framing of at least some of the MCQs. Increased proportion of NFDs (incorrect alternatives selected by < 5% students) in an item decrease DE and makes it easier. There were 15 items with 17 NFDs, while rest items did not have any NFD with mean DE of 100%.

CONCLUSION

Study emphasizes the selection of quality MCQs which truly assess the knowledge and are able to differentiate the students of different abilities in correct manner.