Sleep Quality and Daytime Sleepiness among Medical Undergraduate Students in Tamil Nadu: A Cross-sectional Study

Introduction: Sleep quality is strongly related to psychological and physical well-being. Medical students experience long duration of study period, academic over load, frequent exams, fear of failure and highly demanding lifestyle. They are vulnerable to poor sleep quality. Aim: To find the prevalence of sleep quality and daytime sleepiness and their associated factors among medical undergraduate students in Tamil Nadu, India. Materials and Methods: This was a cross-sectional study conducted among 367 undergraduate medical students from first year to final year of a Government Medical College, Chennai, Tamil Nadu, India. A self-administered questionnaire was used to collect data on socio-demographic characteristics, lifestyle behavioural factors, mobile phone usage and academic performance. Pittsburgh Sleep Quality Index (PSQI) and Epworth Daytime Sleepiness Scale (EDSS) were used to assess sleep quality and excessive daytime sleepiness, respectively. Descriptive statistics was used to express baseline characteristics. Chi-square test was be applied to test associated factor. Pearson correlation coefficient was used to find correlation between continuous variables. Results: Poor quality of sleep and excessive daytime sleepiness was found among 54.2% and 28.6% of students respectively. Poor sleep quality and excessive daytime sleepiness was significantly associated with increased duration of mobile phone usage (p=0.030 and p=0.009 respectively). Significant association was found between sleep quality and academic performance (p=0.004). Statistically significant correlation was found between sleep quality and duration of mobile phone usage (r=0.18, p=0.0001) as well as sleep quality and excessive daytime sleepiness (r=0.14, p=0.005). Conclusion: Prevalence of poor quality sleep and excessive daytime sleepiness was found to be high among medical students. Mobile phone overuse was significantly associated with poor sleep quality and excessive daytime sleepiness. Students with good quality of sleep had better academic performance when compared to poor sleepers. Excessive daytime sleepiness was found in increasing pattern among those with poor quality sleep

Hierarchal Bayes model with AlexNet for characterization of M-FISH chromosome images

The analysis of chromosomes is a significant and challenging task for clinical diagnosis and biological research. The technique based on color imaging is a multiplex fluorescent in situ hybridization (M-FISH), which was implemented to ease the exploration of the chromosomes. Thus, in this paper, we propose a novel quasi-Newton-based K-means clustering for the M-FISH image segmentation. Then, we use the expectation-maximization-based hierarchical Bayes model to characterize the M-FISH images. The contextual-based classification and region merging of chromosomal images is made to avoid any misclassification, and we made use of AlexNet, by modifying the activation functions of the sigmoid and softmax layer and for the optimum classification between the autosomal chromosomes and the sex chromosome. Finally, we conducted a performance analysis by measuring accuracy, recall, sensitivity, specificity, PPV, NPV, F-score, kappa, Jaccard, and Dice coefficient and compared with other existing methods and found that our proposed methodology can achieve more percentage of accuracy (6.96%) than the state of the art methods.

Lifestyle Behaviour among Undergraduate Medical Students in Tamil Nadu: A Cross-sectional Study

Introduction: Lifestyle related behavioural risk factors such as physical inactivity and nutrition transition like increased consumption of high‑fat and low‑fiber diet are found to be risk factors for Non Communicable Diseases (NCD) worldwide. Medical students are susceptible to poor eating habits, physical inactivity, lack of sleep or acquisition of new habits, such as smoking and alcohol. They have been shown to exhibit early risk factors for chronic diseases. Hence, it is essential to assess the lifestyle behaviour among medical students as they are future healthcare providers. Aim: To assess the lifestyle behaviour among the undergraduate medical students and to compare lifestyle behavioural factors between gender. Materials and Methods: A cross‑sectional study was conducted among 200 undergraduate medical students, selected by using random sampling method from first year to final year of a government medical college in Chennai, Tamil Nadu from June 2018 to August 2018. Self‑administered questionnaire was used to collect data regarding socio‑demographic profile and lifestyle behaviours such as dietary pattern, physical activity, sedentary behaviour, sleep duration, smoking and alcohol consumption. Descriptive statistics for qualitative data and Chi‑square test to test the proportions were used. Results: A total of 200 undergraduate medical students participated in the study. The mean age of the study participants was 20.2 years with a standard deviation of 1.34. Out of the 200 study participants, 132 (66%) were females and 68 (34%) were males. Skipping of meals was seen in 54% students. Vegetables and fruits intake ≤3 times/week were found in 25.5% and 63% students respectively. Smoking was observed in 3% and alcohol intake in 7.5% students. Lack of exercise was noted in 46%. Television viewing/mobile usage for >4 hours per day was observed in 30.5% students. Sleep duration of <6 hours/day was noted in 11%. Frequent carbonated drinks consumption (>3 times/week) was significantly higher in males (14.7%) as compared to females (5.3%). Inadequate exercise was significantly higher in females. Conclusion: Behavioural risk factors such as unhealthy diet, irregular eating habits, and physical inactivity were prevalent among the medical undergraduate students.

Standardisation of Rhenium-188 and determination of calibration factors for secondary standard and radionuclide calibrator

The use of Rhenium-188 for various therapeutic applications in the field of nuclear medicine has increased in recent years due to its favourable properties like decay scheme, cost effective availability and easy chemistry. Two independent measuring setups were used to standardise ¹⁸⁸Re radioactive solution. The modus operandi of standardisation was 4πβ-γ coincidence technique where the beta detection was done by proportional counting and liquid scintillation counting and the gamma detection was done by using NaI(Tl) detectors. The secondary standard, high pressure ionisation chamber type Centronic IG12, 20A was calibrated with the standardised ¹⁸⁸Re solution and the sensitivity coefficient (pA MBq^-1) was determined. To enhance the accuracy of the commercial radionuclide calibrator and to ensure that patients receive optimum dose of these radiopharmaceuticals, calibration number of the Capintec CRC-15β radionuclide calibrator was also verified. This paper presents the standardisation of ¹⁸⁸Re radioactive solution by primary methods and calibration of BARC secondary standard ionisation chamber system and a Capintec CRC-15β radionuclide calibrator.

Corrosion resistance of BIS 2062-grade steel coated with nano-metal-oxide mixtures of iron, cerium, and titanium in the marine environment

BIS 2062-grade carbon steel is extensively used for fishing boat construction. The steel is highly susceptible to corrosion on the hull and welding joints under marine environment. Here, we demonstrate the application of a novel multifunctional nano-metal-oxide mixture comprised of iron, titanium, and cerium as a marine coating to prevent corrosion. The electrochemical performance of nano-metal-oxide mixture coatings, applied over boat-building steel, was evaluated at 3.5% NaCl medium. The nano-mixture surface coatings showed an efficient corrosion resistance with increased polarization resistance of 6043 Ω cm2 and low corrosion current density of 3.53 × 10−6 A cm−2. The electrochemical impedance spectral data exhibited improvement in the polarization resistance of outermost surface and internal layers. The coating responded faster recovery to normal state when subjected to an induced stress over the coating. The nano-material in the coating behaves as a semiconductor; this enhanced electronic activity over the surface of the steel.

Successful multi-modal treatment of grade IV lymphedema in lymphatic filariasis: A case study

We present an integrated therapeutic approach performed on a 37 year old female with giant lymphedema (Grade IV) due to lymphatic filariasis of 27 years duration. Our therapeutic approaches consisted of a basic foot care program for two weeks, followed by a course of oral penicillin for a week including conservative treatment with complete decongestive therapy (CDT) together with respiratory physiotherapy and walking exercises. In addition, advanced surgical techniques with supra-fascial excision of alternate lumps in three stages over an interval of ten days followed by a nodo-venal shunt resulted in reversing the stage IV lymphedema condition. Over a ten year follow-up, the patient remains essentially unchanged confirming the success of the treatment without any recurrence or complications. Finally, by combining multimodal treatment, we were able to achieve a near normal limb in Stage III and Stage IV lymphedema of the lower limb in lymphatic filariasis.

Stress and Stressors among Medical Undergraduate Students: A Cross-sectional Study in a Private Medical College in Tamil Nadu

Background:

Medical education is perceived as being stressful, and a high level of stress may have a negative effect on cognitive functioning and learning of students in a medical school.

Objectives:

To (a) assess the perceived stress among medical undergraduate students, (b) identify the sources of stress, and (c) find an association of perceived stress with sociodemographic characteristics and various stressors.

Materials and Methods:

A cross-sectional study was conducted among medical undergraduate students in a private medical college in Tamil Nadu. A total of 750 medical students from 1^st year to final year were invited to participate in the study. Self-administered questionnaire was used to collect data regarding sociodemographic profile, perceived stress using perceived stress scale-14 and academic, psychosocial and environmental stressors. Descriptive statistics was used to describe the sociodemographic characteristics, sources of stress and perceived stress. Logistic regression analyses were carried out to assess determinants of stress.

Results:

The overall response rate was 93.33% (700 out of 750 students). The mean perceived stress score was 25.64 ± 5.44. Higher age-group, year of studying bachelor of medicine and bachelor of surgery, vastness of academic curriculum, fear of poor performance in examination, lack of recreation, loneliness, family problem, and accommodation away from home were important determinants of perceived stress.

Conclusions:

The perceived stress was higher among higher age group and final year medical students. Academic, psychosocial, and environmental stressors are associated with perceived stress. Reframing the academic curriculum and examination patterns, incorporating recreational and sports activities, and establishment of counseling cells in the institution is needed.

An overview of lymphatic filariasis lymphedema

Filariasis is caused by thread-like nematode worms and is classified according to their presence in the vertebrate host. The lymphatic group includes Wuchereria bancrofti, Brugia malayi, and Brugia timori. Lymphatic filariasis, a mosquito-borne disease, has been one of the most prevalent diseases in tropical and subtropical countries and is accompanied by a number of pathological conditions. It is estimated that currently (after 13 years of the MDA programme) there are an estimated 67.88 million LF cases that include 36.45 million microfilaria carriers, 19.43 million hydrocele cases, and 16.68 million lymphedema cases. Adult filarial worms reside in the lymphatics and lymph nodes and induce changes that result in dilatation of lymphatics and thickening of the lymphatic vessel walls. Progressive lymphatic damage and pathology results from the summation of the effect of tissue alterations induced by both living and nonliving adult parasites. In recent years, there has been rapid progress in filariasis research, which has provided new insights into the pathogenesis of filarial disease, diagnosis, chemotherapy, the host-parasite relationship, and the genomics of the parasite. We examined the clinical manifestations of the disease, diagnosis, treatment, immune responses, and management including review of pharmaceutical agents against filariasis. Details on infection, safety profile, and status in clinical practices are also reported.

Role of Community in Swachh Bharat Mission. Their Knowledge, Attitude and Practices of Sanitary Latrine Usage in Rural Areas, Tamil Nadu

BACKGROUND

In most developing countries, open defecation is the 'way of life'. This practice is considered as the most serious health and environmental hazard. Prime Minister of India launched the "Swachh Bharat Mission" to accelerate the efforts for achieving universal sanitation coverage and to put focus on sanitation.

OBJECTIVE

To find the knowledge, attitude and practices of sanitary latrines usage in rural area, Tamil Nadu.

MATERIALS AND METHODS

This was a cross sectional study conducted among rural population in Kuthambakkam village, Tamil Nadu. There were a total of 1175 households in Kuthambakkam village. These households were serially numbered and of these a sample of 275 households were selected for the study using simple random sampling technique by lottery method. A structured questionnaire was used to collect information regarding the background characteristics, their knowledge, attitude and practices towards sanitary latrines usage. Descriptive statistics were calculated for background variables, the prevalence of sanitary latrines usage and open air defecation. Association between factors responsible for open air defecation was found by using chi square test.

RESULTS

The prevalence of usage of household sanitary latrine and community latrines was 62.5% and 4.3% respectively. The prevalence of open air defecation among the study participants was 33.1%.Significant association was found between low standard of living and open air defecation practice.

CONCLUSIONS

To solve the problem of underutilization of sanitary latrines, planning and conducting Information Education Communication activities is very essential. Effective political and administrative support is needed to scale up the sanitation program.

Performance demonstration of 4πβ(LS)-γ coincidence counting system for standardization of radionuclides with complex decay scheme

A standardization of (134)Cs and (131)I was carried out in order to demonstrate the performance and applicability of the 4πβ(LS)-γ coincidence counting system for standardization of radionuclides with complex decay scheme. The coincidence analyzer, capable of analyzing coincidence between beta and two gamma windows simultaneously, was developed and used for the standardization. The use of this dual coincidence analyzer has reduced the total experimental time by half. The activity concentrations obtained using the 4πβ(LS)-γ coincidence counting system, a 4πβ(PC)-γ coincidence counting system, and the CIEMAT/NIST method are in excellent agreement with each other within uncertainty limits and hence demonstrates its performance for standardization of radionuclides decaying with complex decay scheme. Hence use of this 4πβ(LS)-γ coincidence counting system can be an alternative method suitable to standardize radionuclides with complex decay scheme with acceptable precision.

Denture bar-coding: An innovative technique in forensic dentistry

Denture markers play an important role in forensic odontology and also in identifying a person. A number of methods are there for identifying dentures from a less expensive technique to a more expensive technique. Out of different denture markers, the bar-coding system is a way of collecting data from the mobile. Even a huge amount of data can be stored in that. It can be easily incorporated during acrylization of the denture and thus could be helpful in identification. This article reviews the strengths of bar-coding and how easily it can be used in the routine procedure.

Development of liquid scintillation based 4πβ(LS)-γ coincidence counting system and demonstration of its performance by standardization of ⁶⁰Co

A single-vial, single-PMT 4πβ(LS)-γ coincidence counting system has been developed at the Radiation Safety Systems Division, BARC. It has advantages of simple sample preparation, higher counting efficiency and the absence of self absorption over the conventional proportional counter based 4πβ(PC)-γ coincidence counting system. The performance of the system is demonstrated by standardizing a (60)Co solution using the 4πβ(LS)-γ coincidence counting system, 4πβ(PC)-γ coincidence counting system and CIEMAT/NIST method and comparing the results obtained by each method. The detection efficiency of liquid scintillation counter of the 4πβ(LS)-γ coincidence counting system was varied by color quenching, by chemical quenching and by varying the bias voltage applied to the LSC PMT. For the proportional counter based 4πβ(PC)-γ coincidence counting system the detection efficiency was varied by source self absorption. The activity concentrations obtained using the 4πβ(LS)-γ coincidence counting system, the 4πβ(PC)-γ coincidence counting system and the CIEMAT/NIST method are comparable within the uncertainty limits.

Circulating microbial products and acute phase proteins as markers of pathogenesis in lymphatic filarial disease

Lymphatic filariasis can be associated with development of serious pathology in the form of lymphedema, hydrocele, and elephantiasis in a subset of infected patients. Dysregulated host inflammatory responses leading to systemic immune activation are thought to play a central role in filarial disease pathogenesis. We measured the plasma levels of microbial translocation markers, acute phase proteins, and inflammatory cytokines in individuals with chronic filarial pathology with (CP Ag+) or without (CP Ag−) active infection; with clinically asymptomatic infections (INF); and in those without infection (endemic normal [EN]). Comparisons between the two actively infected groups (CP Ag+ compared to INF) and those without active infection (CP Ag− compared to EN) were used preliminarily to identify markers of pathogenesis. Thereafter, we tested for group effects among all the four groups using linear models on the log transformed responses of the markers. Our data suggest that circulating levels of microbial translocation products (lipopolysaccharide and LPS-binding protein), acute phase proteins (haptoglobin and serum amyloid protein-A), and inflammatory cytokines (IL-1β, IL-12, and TNF-α) are associated with pathogenesis of disease in lymphatic filarial infection and implicate an important role for circulating microbial products and acute phase proteins.

Lymphatic filariasis afflicts over 120 million people worldwide. While the infection is mostly clinically asymptomatic, approximately 40 million people suffer from overt, morbid clinical pathology, characterized by swelling of the scrotal area and lower limbs (hydrocele and lymphedema). Host immunologic factors that influence the pathogenesis of disease in these individuals are not completely understood. Circulating microbial products such as LPS and markers associated with microbial translocation have been shown to play an important role in disease pathogenesis of certain infections like HIV. Similarly, proteins associated with the acute phase response and related cytokines also play an important role in pathogenesis. We have attempted to elucidate the role of the above mentioned factors in disease pathogenesis by comparing the plasma levels of the various markers in four groups of individuals: chronic pathology individuals with or without active filarial infection, asymptomatic, filarial infected individuals and uninfected, endemic normal individuals. We show that circulating levels of LPS, acute phase proteins and certain cytokines are significantly elevated in filarial disease with active infection but not in the other groups indicating that filarial infection induced increased production of these factors correlated with the development of filarial lymphatic pathology.

Attenuation of toll-like receptor expression and function in latent tuberculosis by coexistent filarial infection with restoration following antifilarial chemotherapy

Mycobacterium tuberculosis (Mtb) and filarial coinfection is highly prevalent, and the presence of filarial infections may regulate the Toll-like receptor (TLR)-dependent immune response needed to control Mtb infection. By analyzing the baseline and mycobacterial antigen–stimulated expression of TLR1, 2, 4, and 9 (in individuals with latent tuberculosis [TB] with or without filarial infection), we were able to demonstrate that filarial infection, coincident with Mtb, significantly diminishes both baseline and Mtb antigen-specific TLR2 and TLR9 expression. In addition, pro-inflammatory cytokine responses to TLR2 and 9 ligands are significantly diminished in filaria/TB-coinfected individuals. Definitive treatment of lymphatic filariasis significantly restores the pro-inflammatory cytokine responses in individuals with latent TB. Coincident filarial infection exerted a profound inhibitory effect on protective mycobacteria-specific TLR-mediated immune responses in latent tuberculosis and suggests a novel mechanism by which concomitant filarial infections predispose to the development of active tuberculosis in humans.

Lymphatic filariasis afflicts over 120 million people worldwide, while Mycobacterium tuberculosis infects over 2 billion people worldwide. Almost 90% of infected people harbor latent tuberculosis infection with no clinical manifestations. Toll-like receptors (TLRs), pattern-recognition receptors that are present on host immune cells, constitute an important facet of host immune response initiation against a variety of pathogens. Because lymphatic filariasis and tuberculosis are co-endemic in many parts of the world and because TLR modulation is an important feature of both infections, we examined the effect of coexisting filarial infection on TLR-specific immune responses in latent tuberculosis by comparing cellular immune responses to Toll ligands in individuals with latent tuberculosis with or without concomitant lymphatic filariasis. We first examined modulation of TLRs at the gene expression level and determined that downregulation of TLR2 and 9 is associated with coexisting filarial infection. We then determined that Toll ligand-induced pro-inflammatory cytokine production—which is crucial in host defense against TB—is diminished in the presence of filarial coinfection. Treatment of filarial infection restores cytokine production in individuals with latent TB. Thus, we conclude that coexisting filarial infections might significantly compromise essential immune responses in tuberculosis and that treatment of filarial infections would potentially confer tremendous benefit in combating tuberculosis.

Standardization of 192Ir solution at BARC

A radioactive solution of 192Ir was standardized at Bhabha Atomic Research Centre (BARC) under the international intercomparison programme of the Bureau International des Poids et Measures (BIPM) by 4pibeta-gamma coincidence and 4pigamma counting techniques, which are primary and secondary methods of standardization, respectively. The activity concentration of the 192Ir solution obtained by the efficiency extrapolation technique and as reported to BIPM was 203.15 kBq g(-1) with a combined uncertainty of +/-0.3%. The activity concentration determined by 4pigamma counting was 202.88 kBq g(-1) with a combined uncertainty of +/-1.3%. These measurement results are comparable within the uncertainty limits. Detailed uncertainty budget for both the primary and secondary methods are included.

National intercomparisons of 131I radioactivity measurements in nuclear medicine centres in India

National intercomparisons of activity measurements of 131I, a radioisotope widely used for diagnosis and therapy of thyroid related ailments, were initiated in 1979 as a quality assurance program, towards improving radiation safety procedures and related dosimetry in Nuclear Medicine Centres (NMCs) in India. Oral administration of a known quantity of radioiodine to patients requires accurate radioactivity measurements to be performed on a well-calibrated isotope calibrators. Under or over estimation of the activity due to a faulty or uncalibrated isotope calibrator could provide misleading results. Calibration of isotope calibrators and the traceablity of subsequent measurements to the national standards laboratory is one of the essential basic radiation safety requirement of the IAEA. In view of the stringent quality assurance requirements for activity measurements imposed by Atomic Energy Regulatory Board, a National Intercomparison Program was initiated and to date ten such intercomparison programs have been conducted by the Radiation Safety Systems Division, of the Bhabha Atomic Research Centre. This program has benefited the participants by making their measurements traceable to the National Primary Standards. Over the years there has been a marked increase in the number of NMCs participating in the intercomparison programs. As a result, the number of institution showing large deviation from the correct value has decreased considerably over the years. This program thus, has enabled participating NMCs to check their isotope calibrators so as to ensure proper delivery of radiation dose to the patients and hence to optimise patient exposure.