A panoramic view of a cohort of obstructive sleep apnea patients on positive airway pressure therapy using cloud based telemonitoring devices

Background

Positive airway pressure therapy is mainstay of treatment of obstructive sleep apnea (OSA). But long-term compliance with is poor with such therapy. A proactive and vigilant management may improve the PAP therapy usage. Cloud-based telemonitoring PAP devices offer an opportunity for proactive monitoring and prompt interventions related to PAP troubleshooting. This technology is also used in India for adult OSA patients. But we lack our own data on behavior of Indian patients as a cohort on PAP therapy. The present study is an attempt to look at the behavior a cohort of PAP users in OSA.

Methodology

This study was planned as a retrospective analysis of data of OSA patients who were using a cloud-based PAP devices. First 100 patients were chosen for data retrieval that who was on this therapy. The data was obtained for those patients who were on PAP for at least 7 days and maximum follow-up was available up to 390 days. Descriptive statistical analysis has been carried out in the present study.

Results

The number of male and female patients was 75 and 25, respectively. Overall good compliance was present in 66% of patients. 34% of patients were not compliant with PAP during follow-up. The compliance was statistically same in both the sexes (P = 0.8088). Incomplete data recovery was present in 17 patients and 11 (64.70%) were non-compliant among them. In the initial, 60 days non-compliant patients were more than compliant patients. The difference was lost in 60 to 90 days of use. The air leak was present more in the compliant group than non-compliant group (P = 0.0239). 75.75% of compliant patients had achieved AHI control, whereas 35.29% of non-compliant patients also achieved AHI control. But overall, AHI control was poor in non-compliant patients and 61.76% of non-compliant patients had an AHI uncontrolled.

Conclusions

We conclude that 3/4th of the compliant patients achieve AHI control while 1/4th didn't. This 1/4th population needs further exploration to determine the causes of poor AHI control. Cloud-based PAP devices give an easy opportunity to monitor patients of OSA. It gives an instant panoramic view of behavior of OSA patients on PAP therapy. The compliant patients can be tracked, and non-compliant patients can be segregated quickly.

Conversion of clinically isolated syndrome to multiple sclerosis: a prospective multi-center study in Eastern India

Background

In White populations more than 60% of clinically isolated syndrome (CIS) convert to multiple sclerosis (MS) on a long-term follow-up; several predictors for conversion have been identified.

Objective

This study aimed to determine the conversion rate and the predictors of conversion from CIS to MS (McDonald 2010) among Indians. The other objective was to evaluate the diagnostic accuracy of the new McDonald 2017 criteria in prediction of a second clinical attack.

Methods

Clinical and demographic data of CIS cohorts were collected. Baseline investigations included cerebrospinal magnetic resonance imaging (MRI) with contrast and cerebrospinal fluid (CSF) testing for oligoclonal band (OCB). Follow-up clinical and MRI examinations were performed annually for at least 24 months.

Results

Of the 82 subjects (age range 15-58 years), 36 (43.9%) converted to MS; 31/82 (37.8%) converted in 24 months. The predictors for conversion were earlier age of onset, CSF-OCB, cerebral MRI T2 lesion count, and periventricular and juxtacortical location of lesions. Twenty-two (26.83%) CIS fulfilled the McDonald MS 2017 criteria at baseline.

Conclusion

In this first prospective study of CIS in India, the risk factors for conversion are similar but the conversion rate to MS is lower than that in the western nations.

Further enhancement of light extraction efficiency from light emitting diode using triangular surface grating and thin interface layer

Analysis has been done of improvement of forward directional light extraction efficiency of light emitting diodes (LEDs) by surface patterning of different types of one-dimensional profiles on indium-zinc-oxide films developed recently by our group using sol-gel technique. Finite-difference time-domain simulations by MEEP software have been used for this purpose. From the analysis, it is found that the patterned film is suitable for near-infrared LED. The optimized structure, which gives maximum improvement at around 1.040 μm wavelength, is determined and fabricated using soft lithography. Further enhancement of the light output of the LED with the fabricated gratings is possible by introducing an interlayer within the top contact layer. The mathematical formulation of the coupling of light in structured/multilayered surfaces is also discussed.

Day-case minimally invasive excision of a giant mediastinal parathyroid adenoma

Inferior parathyroid adenomas in the mediastinum can be a troublesome cause for hypercalcaemia, requiring a full collar incision or, occasionally, a sternotomy. We report a case of a giant parathyroid adenoma in a 61-year-old woman on warfarin, which we excised via a minimally invasive transcervical approach after radiological localisation. The procedure was performed as a day case and, at six weeks, the patient had recovered fully with biochemical resolution of hypercalcaemia. This case demonstrates that focused transcervical excision of giant parathyroid adenomas is a viable option and should be considered prior to neck exploration or sternotomy.

Contraceptive practices and associated social covariates: an experience from two districts of West Bengal, India

Background Contraceptive practice acceptable to Indian society is said to be associated with socio-economic status, education, practice of the area and other factors. Population stabilization and a gradual lowering of population growth is the basic aim behind contraceptive practice. Objectives The study was conducted to assess current status of contraceptive practice and social covariates (age, type of family, religion, socio-economy, education, etc). Materials and Methods A community based cross-sectional study was conducted among four thousand eligible couples in Howrah and Paschim Midnapore districts of state of West Bengal, India from March to September 2009. By stratified multistage random sampling technique, 32 areas were selected from two districts; villages of sub-centre zone and wards of municipality; from each selected area; 125 eligible couples were interviewed by house to house survey. Results The contraceptive acceptance (prevalence) rate (CAR) by any method was 65.3 percent and couple protection rate (CPR) by approved methods was 58.4 percent in these two districts of West Bengal. In Paschim Midnapore district CAR was higher (67.4%) than Howrah district (63.3%). Similarly in Howrah district CPR was less (54.3%) than Paschim Midnapore district (62.6%). Type of family, age and literacy status of female partners, religion and social class were associated with adoption of family planning methods by the eligible couples with inter-district variation. Conclusion Area specific multipronged tailor-made interventions are needed through Behaviour Change Communication (BCC) for promotion of acceptance of both the temporary & permanent methods of contraception at the appropriate time to achieve small family norm.

Effect of exogenous growth-hormone-releasing factor on blood metabolites and minerals in late maturing buffalo heifers (Bubalus bubalis)

Previous studies have suggested that growth-hormone-releasing factor (GRF) enhanced growth and advanced puberty onset along with hormonal changes in buffalo heifers (Bubalus bubalis). However, it is not known to what extent exogenous GRF could influence blood metabolites and minerals to bring about puberty in buffalo heifers. Therefore, we planned to investigate the effect of exogenous bovine GRF (bGRF) on blood metabolites and minerals in buffalo heifers during a 3-month pre-treatment period, 9-month treatment period and 1-month post-treatment period. Six buffalo heifers were treated intravenously with bGRF (10 mug per 100 kg body weight) at 15-day interval for 9 months. Another six buffalo heifers of weight- and age-matched received requisite amount of vehicle (0.9% NaCl solution) during the same period. Exogenous bGRF enhanced (p < 0.01) plasma non-esterified fatty acids (NEFA) concentrations in treatment group when compared with control group during the treatment and post-treatment period, while plasma alpha-amino nitrogen (AAN) concentrations showed a decreasing trend (p < 0.05) in the treatment group when compared with the control group during the treatment and post-treatment periods. The plasma inorganic phosphorus (Pi) was found to be higher (p < 0.05) in the treatment group animals in comparison with the levels recorded in the control group animals during the treatment as well as post-treatment periods. However, there was no change (p > 0.05) in plasma glucose and calcium concentrations between the two groups. Plasma NEFA was found to be positively correlated with plasma growth hormone (GH); however, it was only significant for the treatment group (r = + 0.76; p < 0.05). Plasma AAN in the treatment group exhibited negative correlation with plasma GH (r = 0.72; p < 0.05), while plasma AAN and GH were recorded to be positively correlated in the control group (r = 0.47; p < 0.05). The present findings suggest that exogenous bGRF induces GH release that increases plasma NEFA and Pi and decreases AAN concentrations, which probably help to reach a certain physiological state that initiates events necessary for bringing about puberty in buffalo heifers.

Effects of growth hormone-releasing factor on growth hormone response, growth and feed conversion efficiency in buffalo heifers (Bubalus bubalis)

The aim of this study was to determine the benefits of growth hormone-releasing factor (GRF) on growth and feed conversion efficiency (FCE) in buffaloes. Twelve Murrah buffalo heifers (Bubalus bubalis) of mean age 24.8 months and mean body weight 302.4kg were divided into two groups (treatment and control) with six animals in each group. The buffaloes were given intravenous injections of bovine GRF (bGRF) at a dose rate of 10microg/100kg body weight or an equal volume of saline at 15-day intervals for a period of 9 months. Plasma growth hormone (GH) responses to bGRF challenge were measured in blood samples collected at 90-day intervals on days 1, 90, 180 and 270 and samples were taken at -60, -30, 0, +10, +20, +30, +60, +120 and +180min relative to bGRF injection. Blood samples were also collected weekly by jugular venepuncture for the quantification of plasma GH. The average growth rate (AGR) and FCE of all animals were recorded at 15-day intervals. Plasma GH concentrations increased (P=0.001) steadily following bGRF challenge, peaking 10-20min after challenge and declining to baseline by 180min. In the treatment group, there were no significant differences (P>0.05) in either the peak heights of the GH response or the area under the curve (AUC) of the GH response after bGRF challenge on any of the four occasions of intensive bleeding. There were overall increases in plasma GH concentrations (P<0.01), AGR (P<0.01) and FCE (P=0.05) in the treatment group compared with the control animals. The study showed that GH responsiveness to administration of bGRF at 15-day intervals over 9 months of treatment remained unchanged in buffalo heifers. Exogenous bGRF treatment for a long period can therefore enhance GH release leading to higher growth rates and better feed conversion efficiency in buffalo heifers.

Growth hormone-releasing factor (GRF) induced growth hormone advances puberty in female buffaloes

Exogenous bovine growth hormone-releasing factor (bGRF) at the dose rate of 10 microg/100 kg body weight was administered intravenously (i.v.) to six Murrah buffalo heifers as treatment group, while another six buffalo heifers served as control group which received the vehicle (0.9% NaCl solution) at an interval of 15 days for a period of 9 months to study the effect of bGRF on puberty onset associated with temporal hormonal changes in peri-pubertal buffalo heifers. Blood samples were collected at 3-day interval from all the animals during the experimental period and plasma harvested was assayed for growth hormonal (GH), luteinizing hormone (LH) and progesterone. The day that plasma progesterone was greater than 1.0 ng/ml for three consecutive sampling days was defined as the day of puberty. Exogenous bGRF administration increased (P = 0.02) plasma GH concentration in treatment group over control group during the treatment of bGRF as well as during the peri-pubertal period. Plasma progesterone concentrations increased transiently earlier (P = 0.05) by 58.5 days in bGRF-treated buffaloes than that in the control group. However, plasma LH concentrations were unaffected by the treatment of bGRF (P = 0.48). Both plasma GH and LH in the buffalo heifers increased (P < 0.01) over time preceding puberty and the higher hormonal concentrations were maintained during the onset of puberty, and thereafter, the concentrations of both the hormones declined (P < 0.05) after puberty. GH and LH were positively correlated both before puberty (r = +0.59 and +0.63; P < 0.05 for control and treatment group, respectively) and after puberty (r = +0.42 and +0.46; P < 0.05 for control and treatment group, respectively) indicating the interaction and/or close relationship of GH and LH in the mechanism of puberty in buffalo species.

Peripheral patterns of growth hormone, luteinizing hormone, and progesterone before, at, and after puberty in buffalo heifer

Buffalo, the premier dairy animal in India, suffers from slow growth rate, delayed puberty, and silent heat. It is not known whether the delay in puberty in such animals is due to the delay in expression of hypothalamus-pituitary-gonadal functions. To determine the changes in growth hormone (GH), luteinizing hormone (LH), and progesterone before, at, and after puberty of Murrah buffalo heifers, six Murrah buffalo heifers (21.92 +/- 1.09 months of age, 269.67 +/- 7.97 kg body weight) were assigned to well-ventilated individual pens and fed a roughage-concentrate diet to provide weight gain of 0.4 kg/day. Blood samples were collected at 3-day intervals during a period of 12 months, and plasma harvested from blood samples was assayed for progesterone, LH, and GH. The day that plasma progesterone was greater than 1 ng/mL for three consecutive sampling days was defined as the day of puberty. Heifers attained puberty at an average age of 31.53 +/- 0.88 months with a body weight of 380.67 +/- 6.42 kg. Progesterone levels were very low (0.20 to 0.30 ng/mL) during the pre-pubertal period. There were two distinct elevations before the day of puberty onset. Plasma LH and GH concentrations increased (P < 0.05) during the months preceding puberty and were highest during the month before puberty. GH and LH were positively correlated (P < 0.05) prior to (r = +0.59) as well as after puberty (r = +0.42). A positive correlation (P < 0.05)between LH and body weight during the pre-pubertal period (r = +0.61) and thereafter, negative correlation (P < 0.05) during post-pubertal period (r = -0.64) was noted. GH and body weight showed positive correlation both before puberty (r = +0.92, P < 0.01) and after puberty (r = +0.32, P < 0.05). Results suggest that both GH and LH are equally important and vital cues in inducing onset of ovarian functions in buffalo heifers.

Impact of blast induced transitory vibration and air-overpressure/noise on human brain--an experimental study

Human response to blast induced ground vibration and air-overpressure/noise is a major concern of current mining activity. This is because the fact that mines are fast transgressing the habitats and people are getting educated. Consequently the response of humans is changing and expectedly will increase in days to come with no viable and economic alternative to blasting--an essential component of mining. The response of humans can be purely physiological or psychological in nature or combination of both depending upon the situation and conditions of mining. Where physiological response is documented in terms of effects on ears and lungs there is a meager amount or no literature available regarding effects of blasting on the brain. Moreover, the studies on transitory phenomenon like the effects of blasting on humans are rare in comparison to the whole body vibration studies. This study was designed to address the issues as a precursor to a major initiative. The preliminary investigations conducted with the monitoring of EEG responses of humans to vibration and air-overpressure/noise due to blasting revealed that there is no major response of the brain to transitory vibrations and noise.

A study of relapse after MDT in a district in West Bengal, India

A study was undertaken to estimate the magnitude of the problem of relapse and to identify factors responsible for relapse in leprosy units that were delivering MDT in Purulia District of West Bengal. From records patients were classified as "Relapse" or "Not relapse". "Not relapse" patients were selected by simple random sampling from the Surveillance Register and were matched according to age, sex, and the leprosy control unit. 128 cases ("Relapse") and 128 controls ("Not relapse") were interviewed in the clinic using a pre-tested questionnaire. Details of methods to identify and confirm relapse were circulated to all reporting units for ensuring uniformity and reliability. NGOs covered 42% of the population, while the State Government covered the remaining. The patients had been followed up after completion of treatment for a period of two years in PB leprosy and for five years in MB leprosy. The study revealed that the relapse rate was 1.71/1000 person-years for original PB cases and 0.76/1000 person-years for original MB cases. The study also showed that history of contact with an active leprosy patient and irregular treatment led more PB cases to relapse than control cases. All patients with an initial BI of 3+ relapsed with a BI of 1+ or 2+.

Epidemiology of undernutrition

OBJECTIVE

The present study was undertaken to find out the magnitude of the problem of under nutrition among the children under 5 years of age and also to identify the important factors influencing the nutritional status of the children.

METHODS

30 cluster sampling technique had been applied in the study. A total of 600 children below five years of age were covered. Twenty under five children from each cluster were chosen for the study which was carried out during January to February '97. As per IAP criteria a total of 60.29% children were undernourished and 3.92% were severely undernourished. According to NCHS standard 46.57% & 6.86% children had weight below-2SD and -3SD respectively.

RESULTS

A statistically significant relationship was found between the different age groups and nutritional status of under 5 children. Severe degree of malnutrition had highest prevalence under two years of age. The influence of variables like age, sex, religion, literacy status of parents and morbidity of the children were significantly associated with malnutrition.

CONCLUSION

Practice of exclusive breast feeding, introduction of timely complementary feeding, education for maintaining personal hygiene, proper implementation of UIP immunization, periodic deworming, standard case management of diarrhoea and ARI as well as continuation of feeding during illness may reduce malnutrition of under-five children.

Mass DEC campaign for filariasis in a hyper endemic district of West Bengal

As a part of the on-going National Filaria Control Programme, National Filaria Day was observed in Purulia district of West Bengal on 26th Nov 2000 with an extensively organized mass DEC consumption campaign preceded by IEC activities and followed by mopping up operations. In all 81.07% of the targeted population was covered, females (84.3%) being more available than males (78.3%). Percentage of coverage declines with increase in age. Municipalities and notified areas had less coverage as well as supervised consumption than in other areas. Consumption was highest in Balarampur block (88.6%). Supervised consumption among surveyed population was highest in Bandwan (56.0%). Overall patient compliance was very good, with side effects of vomiting, dizziness, headache and fever being 2.12% only among surveyed population. Disease prevalence among population covered showed 0.1% hand swelling, 0.6 to 0.8% leg swelling, while 1.1% of males had hydrocele.

Effectiveness of training on infant feeding practices among community influencers in a rural area of west Bengal

Total 34 Influencers were trained in a subcentre area of South 24-parganas district of West Bengal. Knowledge was imparted to community influencers on infant feeding practices through lecture, group discussion, question-answer session and hand-on-training by trained health workers. Pre-assessment was done before initiation of training. Repeat training was conducted at frequent intervals within a period of 3 months. Mean score of knowledge of influencers during pre-training assessment was 13.3 and improved thereafter-following training to 20.8 (1st assessment), 20.6 (2nd assessment), 23.7 (3rd assessment) and 25.2 (final-assessment). Repeat training had also desired impact.

OEIS complex with craniofacial anomalies--defect of blastogenesis?

We report on a 31-week fetus with hydrocephalus, hypertelorism, microtia, short neck, vertebral and rib defects, scoliosis, omphalocele, exstrophy of bladder, absent external genitalia and pubic rami, imperforate anus, diaphragmatic hernia, defective lobulation of lungs, single kidney, bicornuate uterus, and flexion deformities of the limbs. Similar extensive anomalies in the rostral and caudal regions were described by Russell et al. [Pediatrics, 67:176-182, 1981] and Stewart et al. [Am J Med Genet, 45:426-429, 1993]. The patients described by them had a combination of the oculo-auriculo-vertebral sequence (OAV) and caudal deficiency sequence, whereas the patient reported here can best be described as a combination of OAV and OEIS (omphalocele, exstrophy of bladder, imperforate anus, spinal defects) complexes. The widespread malformations seen in our patient may be the result of an error during blastogenesis.

An outbreak of viral hepatitis in a housing complex of north Calcutta

In a housing complex of North Calcutta, a sudden outbreak of hepatitis occurred between September 1988 and January 1989. Of 620 residents, 8.5 per cent were affected. Majority of the cases occurred among the adult population and the case fatality rate was 3.8 per cent. The epidemic was common source with peak incidence in the month of November. The source of infection was most likely drinking water supplied by the Municipal Corporation which was found to be contaminated by faecal coli. Epidemic was suspected to be caused by enterically transmitted Non A Non B hepatitis virus as the serological testing of all 18 blood samples were negative for anti-HAVIgM titre and only one sample was positive for HBsAg.

Preaxial brachydactyly with abduction of thumbs and hallux varus: a distinct entity

We describe a father and his daughter who had a unique pattern of preaxial brachydactyly, and unusual facial appearance. Both had short broad abducted thumbs and halluces. The second digits of both hands were also short and broad and those of feet were medially angulated. The radiographic findings were short first metacarpals and first metatarsals and hypoplastic phalanges of first two digits of hands and feet. A similar pattern of brachydactyly was described by Christian et al. [1972: Am J Hum Genet 24:694-701] and Mononen et al. [1992: Am J Med Genet 42: 706-713]. Our patients differ from those described by Christian et al. in that they did not have any mental retardation and from those of Mononen et al. by the absence of short stature and epiphyseal and metaphyseal changes. The heterogeneity of this new type of brachydactyly remains to be resolved.