A study of hepatitis A virus seropositivity among children aged between 1 and 5 years of age: Implications for universal immunization

Background

Hepatitis A virus (HAV) causes an enterically transmitted viral disease mainly affecting children and endemic in many developing countries, including India. There is an epidemiological shift with an increased incidence of symptomatic cases among children. This study was conducted to assess the seroprevalence of HAV among young children aged below 5 years and the need for universal immunization.

Method

This cross-sectional study was conducted at two tertiary care hospitals in Northern India, from Apr 2014 to Jul 2015, among healthy children aged between 1 and 5 years. The sample size was calculated based on the prevalence of HAV seropositivity of 40% among children aged <10 years [16-60%] and alpha error of 5%. Analysis of serum IgG against HAV was performed by enzyme-linked immunosorbent assay method, and results were analyzed.

Results

A total of 1084 children aged between 12 and 60 months were enrolled, with male-to-female ratio of 1.86:1. A total of 471 children (43.5%) were found to be positive for IgG against HAV. The seroprevalence of HAV was lower among younger children aged 12-23 months (odds ratio [OR] = 0.73, 95% confidence interval [CI] = 0.52-0.87, p = 0.03), which was statistically significant. Seropositivity of HAV was lower among boys and families consuming safe drinking water and having improved sanitation facilities.

Conclusion

The study observed lower seropositivity against HAV among younger children, making them susceptible of contracting the disease. Possible underlying risk factors were younger age, unsafe drinking water, poor sanitation, and low education status of parents. Therefore, vaccination may be recommended as optional vaccine at one year of age, along with improved public health efforts for safe drinking water, hygiene practices, and food safety.

Comparison of gait kinematics in total and unicondylar knee replacement surgery

INTRODUCTION

This study is aimed to compare kinematic gait data of patients who have undergone total and unicondylar knee replacement.

MATERIALS AND METHODS

This single-surgeon retrospective cohort study evaluated 13 patients with unilateral total knee arthroplasty (TKA) and 14 unicondylar knee arthroplasty (UKA). Gait analysis was carried out using a Vicon motion analysis system. The limits of knee flexion during stance phase, at heel strike and at loading response were measured.

RESULTS

The total range of motion of the UKA knees was significantly greater than the TKA knees. UKA knees exhibited significantly greater knee extension during the stance phase than the TKA knees. Unlike TKA, UKA knees demonstrated improved knee flexion during the gait cycle when compared to the contralateral non-operated knee. The hips also demonstrated near normal hip flexion in UKA patients. Predictably, UKA knees had significantly greater varus compared with TKA in the coronal plane. Spatiotemporal variables demonstrated similar walking speed and step length to aid a fair comparison between knee replacement groups.

CONCLUSIONS

The UKA knees moved more physiologically in the sagittal plane with a greater range of motion during gait. Despite having a stiff gait pattern, the patients undergoing TKA demonstrated a more neutral alignment in the coronal plane. Neither type of knee arthroplasty restored knee kinematics to those of the non-operated side.

Comparative evaluation of Myolaxin and EM LA cream for attenuation of venous cannulation pain: A prospective, randomised, double blind study

We evaluated the efficacy of topical Myolaxin (capsaican ointment, Geno, Mumbai) ointment over EMLA (eutectic mixture of lignocaine, prilocaine; Neon, Goa) cream for attenuating venous cannulation pain in this prospective, randomised, double blind study. Sixty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned into two equal groups. Group I (EMLA) received EMLA cream, whereas Group II (Myolaxin) received Myolaxin ointment. For both groups the cream was applied at the venous cannulation site (dorsum of the non-dominant hand) one hour prior to venous cannulation and was covered with an occlusive dressing. Following venous cannulation patients were asked if they felt pain during venous cannulation. If the answer was yes, they were asked to rate the severity of venous cannulation pain using a Visual Analogue Scale (VAS) of O-10. The incidence of venous cannulation pain was similar between groups: in the EMLA group 65% (18/28) compared to 67% (20/30) in the Myolaxin group (P=0.19). The severity of pain (median VAS with inter quartile range) was also similar between the groups: in the EMLA group 1.5 (3) compared to 1.5 (2) in the Myolaxin group (P=0.46). As the topical application of Myolaxin ointment is cheaper than EMLA and has similar efficacy, it may be a suitable alternative for reducing the incidence and severity of venous cannulation pain.

Pain during Injection of Propofol: The Effect of Prior Administration of Ephedrine

Propofol causes pain on intravenous injection in 28 to 90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. In a randomized, double-blind, placebo-controlled trial, we compared the efficacy of ephedrine 30 μg/kg pretreatment to lignocaine 40 mg for prevention of propofol-induced pain. Ninety-three adult patients, ASA 1 and 2, undergoing elective laparoscopic cholecystectomy were randomly assigned to three groups of 31 each. Group 1 received normal saline, group 2 received lignocaine 2% (40 mg) and group 3 received 30 μg/kg ephedrine. All pretreatment drugs were made up to 2 ml. Pain at the time of propofol injection was assessed on a four-point scale: 0=no pain, 1=mild pain, 2=moderate pain, and 3=severe pain. Twenty-seven patients (87%) of ephedrine pretreatment patients had pain during intravenous injection of propofol as compared to 24 (77%) in the normal saline group. In the lignocaine group, propofol-induced pain was observed in only 13 (42%) when compared with other study groups (P<0.05). Pretreatment with ephedrine 30 μg/kg did not attenuate pain associated with intravenous injection of propofol, nor did it improve haemodynamic stability during induction. However, pretreatment with 2% lignocaine (40 mg) was effective in attenuating propofol-associated pain.

Needle Aspiration and Cytology for Suspected Osteoarticular Tuberculosis in Children

Introduction: Early diagnosis of osteoarticular tuberculosis (OATB) is essential to prevent significant functional disability. There is no single test for diagnosis. Despite an array of investigations available, definitive diagnosis at early stage before starting antitubercular drugs is still a challenge. Materials and Methods: A cross sectional study was carried out between February 2016 and October 2017. All children less than 18 years of age with suspected osteoarticular tuberculosis were included. The cases were subjected to simple needle aspiration from whichever site was accessible. Multiple sample aspirations were done at site of involvement. Smears were prepared from the aspirated material.

Results: Ziehl-Neelsen staining for Acid Fast Bacilli (AFB) showed deep pink red rods under light microscopy. Features suggestive of tuberculosis can be seen by May-Grünwald-Giemsa (MGG) staining. Auramine-O staining method of detecting AFB under fluorescent microscope shows the bacilli as greenish yellow slender curved rods in dark background. Fluorescent microscopy has higher sensitivity and comparable specificity. In our study, microbiological confirmation of OATB could be done in 100% cases where the lesion could be accessed for aspiration. The molecular techniques are relatively more expensive and not available everywhere.

Conclusion: Meticulous search for AFB in a well stained smear using three different staining methods provides a direct evidence of infection over costly imaging especially in poor patients seen in resource limited settings.

Phytostimulatory effect of silver nanoparticles (AgNPs) on rice seedling growth: An insight from antioxidative enzyme activities and gene expression patterns

The knowledge on the mode of action, biocompatibility and ecological tolerance of silver nanoparticles (AgNPs) is gradually accumulating over the years with contradictory findings. Most of the studies indicated the toxic impact of AgNPs on plant growth and development, where induction of oxidative stress was considered to be one of the causal factors. The present study demonstrates the phytostimulatory effect of bio-synthesized silver nanoparticles (AgNPs) during seed germination and seedling growth of rice (Oryza sativa L., cv. Swarna) under in vitro condition. All the tested concentrations of AgNPs (10, 20, 40 ppm) promote both the shoot and root growth which was evident from the increased length and biomass of the seedlings. Exposure to AgNPs also significantly increased the chlorophyll a and carotenoid contents. The content and the pattern of distribution of phenolic metabolites among the different treatments are indicative of non-toxic impact of AgNP mimicking mild or no stress to the seedlings. Growth stimulation of rice seedlings by AgNPs was further supported by a low level of reactive oxygen species (ROS) concomitant with decreased amount of lipid peroxidation and H₂O₂ content, compared to control. In order to unravel the stimulatory impact of AgNPs on rice seedling growth, the present study also describes the AgNPs induced changes in antioxidative enzyme activity and related gene expression levels. Elevated levels of catalase (CAT), ascorbate peroxidase (APX) and glutathione reductase (GR) activities were recorded in all the AgNPs treated seedlings with improved growth. The activity of superoxide dismutase (SOD) was not significantly altered at low concentration of AgNPs. It appears that enzymes of ascorbate cycle, APX and GR are more active in ensuring protection against oxidative damage than SOD. There was significant up-regulation of CAT and APX gene expressions in seedlings exposed to AgNPs, whereas the expression level of CuZnSOD gene was decreased gradually with an increase in the concentration of AgNPs. The antioxidant enzyme activities and gene expression patterns coupled with the levels of H₂O₂ and lipid peroxidation indicates that the efficiency of redox reactions was increased in the presence of AgNPs and that accelerates the seedling growth.

Role of Technology (Breast Self Examination Animation Video) in Breast Cancer Screening in Indian Tribal Rural Women

Background: The Lifeline Express or Jeevan Rekha Express is World´s first hospital train run by the Impact India Foundation. It was developed in collaboration with the Indian Railways and Health Ministry and has been funded by Impact UK, international charitable sources, Indian corporate houses and individuals. It started on July 16, 1991; as of 2016 the service had completed almost 200 projects, benefiting over 900,000 rural Indians. Aim: This study aimed to study the role of superspeciality doctor (endocrine and breast surgeon) in this setting. Methods: The specialist surgeon was assigned a task screen and teach the importance of breast self examination in the rural setting. The women were divided into batches of 50 and were shown a PowerPoint presentation with a video on breast self examination. The screening was done by 2 female general surgeons and any kind of abnormal finding was consulted to the endocrine and breast surgeon. At the end of 15 minutes lecture on screening and breast self examination, the ladies were provided a pamphlet on breast self examination in their native language and also advised and requested to teach another 5 women in the community. Results: 1000 ladies were screened and taught them the importance of breast self examination. Each lady was requested to teach another 5 women in the community. Patients with breast cancer (6 ladies) were appropriately referred and treated in a tertiary referral hospital. 120 patients had mastalgia, treated with dietary measures and first line drugs evening primrose oil and vitamin E. 1 month telephonic follow-up revealed 60% ladies taught on a average 4 other ladies and was compliant. 2 patients who had abscesses was aspirated. Out of 6 patients with breast cancer 5 were locally advanced breast cancer (1 fungating breast cancer). The average duration of tumor was 34 ± 12 weeks. Other cancers like thyroid cancer and oral cancer were detected and treated appropriately. Conclusion: Technology with the intent to serve the rural community should be the motto to provide improved health care to the neglected rural women.

Vulnerabilities and risks of HIV infection among migrants in the Thane district, India

OBJECTIVES

To explore the vulnerabilities and risks of HIV infection among female migrants compared with male migrants in the Thane district of Maharashtra, India.

STUDY DESIGN

This is a cross-sectional epidemiological study.

METHODS

Data from 35,841 migrants (men 96.2% and women 3.8%) were collected using the web-based 'Migrant Service Delivery System.' The data were then analysed in SPSS, version 23.0. Statistical analysis, including Chi-squared test and multivariate logistic regression, was used to identify factors influencing HIV infection for both male and female migrants.

RESULTS

It was observed that 2.96% of female migrants had HIV infection compared with 0.77% of male migrants. We found that 12.1% of women consumed alcohol compared with 41.9% of men, and access to bars was 1.5% among women and 3.5% in men. We observed an even larger difference between men and women in their previous history of using brothels for sex; only 5.9% of female migrants reported previously having used brothels for sex, compared with 62.9% of male migrants. Approximately 12.3% of married women and 93.6% of married men had sex with someone other than their spouse. We found that 67.0% of married women and 73.9% of married men reported using a condom during their last sexual act compared with 60.9% of unmarried women and 68.1% of unmarried men.

CONCLUSIONS

In Thane, female migrants faced higher vulnerabilities and risks of HIV infection than male migrants. Consequently, innovative strategies are required to address these particular needs of female migrants.