bluuebunny/crossref_metadata_2025 huggingface dataset:
How to get Accuracy in Intraocular Lens Calculation in Normal and Extreme Cases
Authors: Alpins Noel ,   NewVision Clinics, Cheltenham, Victoria, Australia
Published: August 2017

With so many toric intraocular lens (IOL) calculators available online it is important for the doctor to know what is included to improve the accuracy of the toric IOL recommended. Does it allow for long eyes, short eyes, personalised IOL constants, posterior corneal power, and what are the options available after a refractive surprise? There is more to toric IOL calculation than just the question, ‘which is the best formula?’ The calculator features also need to be taken into account.
Surface Ablation Techniques for Myopia – A Review of the Advances Over the Past 25 Years
Authors: Hjortdal Jesper ,   Department of Ophthalmology, Aarhus University Hospital NBG, Aarhus, Denmark
Published: August 2017

Photorefractive keratectomy for correction of myopia was the first excimer laser-based technique to be developed. During the last 25 years, excimer lasers have improved technologically, several variations of the technique have been developed and pre- and postoperative pharmaceutical therapies have been investigated. This review article summarises these developments and the published meta-analyses on comparison of surface ablation techniques and laser in situ keratomileusis. The main conclusion is that there seem to be no differences between the clinical results obtained with the different variations of surface ablation techniques.
Ultrasound Cycloplasty in Glaucoma – Mechanisms of Action and their Possible Impact on Intraocular Pressure
Authors: Lim Kin Sheng ,   Ophthalmology Department at St Thomas’ Hospital, London, UK
Published: August 2017

Ultrasound cycloplasty (UCP) is a procedure based on high-intensity focused ultrasound (HIFU) for refractory and non-refractory glaucoma in cases for which surgery is not suitable. UCP may bring about a reduction in intraocular pressure (IOP) via multiple mechanisms of action that result in a decrease in aqueous humour production and increase in aqueous humour evacuation. UCP appears to have a favourable safety profile compared with cyclo-destructive methods, with no phthisis bulbi, no induced cataract, and no persistent hypotony. In 103 patients with refractory and non-refractory glaucoma who underwent UCP, 94 (91%) achieved an initial reduction in IOP, and in 65 patients (63.1%), treatment success was achieved whereby the IOP remained low. However, in 22 patients (21.4%), at 3 months, the IOP rose to near the original level, indicating treatment failure: ‘early failure’. In the remaining 7 patients (6.8%), a slow rise in IOP occurred over 6 months following the procedure: ‘late failure’. The differences in IOP changes in these 94 patients may be in part explained by: (i) a reduction in the uveoscleral–transscleral openings in some patients, leading to an eventual rise in the initially decreased IOP; (ii) a possible re-epithelialisation of the ciliary processes taking place in some cases; and/or (iii) that the circumference of 160° UCP treatment might not be sufficient for all patients. The first 3 months following the UCP procedure are therefore critical since treatment success or failure is determined within this timeframe.
An Evidence-based Approach to Using Intravitreal Steroids in the Management of Diabetic Macular Oedema
Authors: Ozturk Mehmet ,   Royal Free London NHS Foundation Trust, London, UK, Harris Martin L ,   Royal Free London NHS Foundation Trust, London, UK, Mehta Hemal ,   Royal Free London NHS Foundation Trust, London, UK
Published: August 2017

Diabetic macular oedema (DMO) is the leading cause of acquired visual loss in the working age population. The landscape for DMO treatment has changed significantly over the past decade. Macular laser has been reported to reduce the risk of moderate visual loss in seminal clinical trials from the 1980s, but relatively few patients achieved visual gain. With the advent of intravitreal pharmacotherapy it is now possible to achieve visual gains in the majority of patients. Intravitreal anti-vascular endothelial growth factor (VEGF) agents are now a first-line treatment option in centre-involving DMO. This review assesses clinical trial and more recent real-world evidence to guide clinicians as to when intravitreal steroids should be considered in the management of DMO. In particular, intravitreal steroids can be considered in pseudophakic patients, or those due to undergo cataract surgery, in patients unable to attend for regular intravitreal procedures, and non-responders to intravitreal anti-VEGF therapy. Assessing clinical trial data, the dexamethasone implant appears to have a more predictable intraocular rise profile than triamcinolone or fluocinolone with a lower requirement for incisional glaucoma surgery. There is a need for consensus regarding real-world outcome measures for intravitreal steroids in the management of DMO to allow easier comparison across studies.
Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnoea
Authors: McNicholas Walter T ,   Department of Respiratory and Sleep Medicine, St Vincent’s University Hospital, School of Medicine, University College Dublin, Dublin, Ireland
Published: August 2017

The overlap syndrome (OS) of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) is common but often missed in clinical practice. Different clinical COPD phenotypes influence the likelihood of co-existing OSA with the predominant emphysema phenotype being protective whereas the predominant chronic bronchitis phenotype promotes the development of OSA. The management of OS differs from COPD alone, particularly the use of nocturnal positive airway pressure (PAP), and patients with OS not treated with PAP have a worse prognosis, which underlines the importance of correct diagnosis.
Asthma and Gastroesophageal Reflux Disease in Children – Completing the Puzzle
Authors: Benedictis Fernando Maria de ,   Salesi Children Hospital Foundation, Ancona, Italy, Tocco Anna Maria ,   Division of Pediatrics, Ospedale Santo Spirito, Pescara, Italy, Lombardi Giuliano ,   Division of Pediatrics, Ospedale Santo Spirito, Pescara, Italy
Published: August 2017

Many findings support a possible association between gastroesophageal reflux disease (GERD) and asthma in children, but there is not enough evidence to support the causality of this association. Longitudinal studies with long-term follow-up are urgently required to cover the many gaps that persist in this area. Treatment of GERD with proton pump inhibitors (PPIs) in children with uncontrolled asthma does not substantively improve asthma outcomes but large, controlled trials in children symptomatic of both asthma and GERD are lacking. Since there are significant safety concerns for long-term PPIs use in children, physicians should carefully balance their therapeutic decisions in individual cases.
She lures, she guides, she quits : Femile characters in Tim Winton's "The Riders"
Authors: Baines Alarcos Mª Pilar
Published: August 2017

Tim Winton is an Australian writer whose male characters often defy the traditional concept of masculinity. As for the notion of femininity, however, this kind of defiance is not displayed. In this essay, I study the presentation of the female protagonists in The Riders in order to illustrate this point, bearing in mind the Australian social and cultural context that surrounds them. Winton’s fictional women, no matter whether they are strong or weak, are normally depicted according to female archetypes. This leads to their negative portrayal as ambivalent beings, thus making them unreliable and even dangerous, as is the case of Jennifer and Irma. In contrast, Billie is a positive female character. She, who is also significantly a child, combines both feminine and masculine qualities. It is precisely this characteristic that enables her to be her father’s protector.
The language of wounds and scars in Edwige Danticat's "The Dew Breaker" : a case in trauma symptoms and the recovery process
Authors: Ibarrola Armendáriz Aitor
Published: August 2017

This article examines the representation of a violent and traumatizing past in Edwidge Danticat’s The Dew Breaker (2004), a collection of short stories that depicts the effects of a torturer’s atrocious crimes on the lives of his victims and their descendants. The contribution argues that this work of fiction by the Haitian-American writer is structured upon the principle that traumatic experiences can only become intelligible – and, therefore, “representable” – by considering the severe psychical wounds and scars they leave on the victims. These scars habitually take the form of paranoia, nightmares, ghostly presences, schizophrenia, and “dead spots” that have a very difficult time finding their place in the protagonists’ consciousness and language. In spite of the fragmented and discontinuous character of these representations, the writer manages to unveil the kind of psychological and social dysfunctions that often surface when people have not fully accepted or assimilated aspects of the past that keep itching in their unconscious. However, despite the prevailingly bleak tone of the stories, Danticat still leaves some room for hope and recovery, as many of the victims find ways to come to terms with and overcome those individual and collective dysfunctions.
Rulers agains writers, writers against rules : the failed promise of the public sphere in postcolonial Nigerian fiction
Authors: Kehinde Ayo
Published: August 2017

Various literary critics have dwelt on the nature, tenets and trends of commitment in Nigerian literature. However, there is paucity of studies on the imaginative narration of the impediments facing the actualization of the public sphere in postcolonial Nigeria. This paper examines the strategies and techniques of representing the failed promise of the public sphere in postcolonial Nigerian fiction, using the examples provided by Chinua Achebe’s Anthills of the Savannah, Ben Okri’s The Famished Road and Chimamanda Ngozi Adichie’s Purple Hibiscus. The methodology involves a close reading of the selected texts, using Jurgen Habermas’ Public Sphere as analytical concept. In the selected novels, Nigeria is depicted as a country where the rulers disallow the existence of the ‘public sphere’, which is supposed to provide a liminal space among the private realms of civil society and the family, as well as the sphere of public authority. This is disclosed in the refusal of the characters, who typify the rulers, to disregard status altogether.
Fallen women and the London Lock Hospital Laws and By-Laws of 1840 (revised 1848)
Authors: Romero Ruiz María Isabel
Published: August 2017

The nineteenth century witnessed a huge increase in both private and public institutions to control and to contain two elements deemed to be the most dangerous in British society: the prostitute and the fallen woman. These individuals were considered deviant at a time when the middle-class exercised philanthropy supporting the double standard code of morality. Charity and state intervention were carried out by two kinds of institutions which were closely connected: lock hospitals and lock asylums. However, the role of lock hospitals was to cure venereal disease, whereas the role of the lock asylums was the reformation and instruction of these women. As a consequence, this paper seeks to examine the importance of the London Lock Hospital and Asylum Laws and By-laws of 1840, especially in relation to female patients and penitents, so as to ascertain the roles of these two institutions in the reproduction of the moral standards of the middle-class and of the religious discourse of the time. We shall see that these regulations reflect the ideas of industriousness, repentance and atonement for these women’s past lives, emphasizing the differences between the sexes as far as sexual and moral behaviour were concerned.
Conceptualization of events, semantic relations between constructions and topology : a catastrophe theoretic study of "get" and "be"
Authors: Marín Arrese Juana Isabel
Published: August 2017

The existence of syncretisms in the marked coding patterns for variations in the domains of transitivity and voice presumably indicate the interrelation between constructions involving different event views and voice alternations and voicerelated phenomena, such as inchoative and stative resultative morphosyntax. This paper will examine deviations from the prototypical event view, variations in transitivity and their relation to voice distinctions in constructions with be and get. It will be argued that the relations between these constructions and the position they occupy in semantic space are best understood in terms of the interaction between the conceptual status of participants as 'controller' or 'affected' (Klaiman 1988) and the conceptual property 'relative elaboration of events' (Kemmer 1993; 1994), correlating with different event views (Croft 1990; 1994).
The contribution of cognitive anthropolinguistics to educational linguistics
Authors: Martín Morillas José Manuel
Published: August 2017

In this paper it is argued that, despite the welcome psycho-social emphasis in educational linguistic theories witnessed in recent decades, and with it, a rapprochement of the social sciences to the psychological sciences, the relationship between these fields has not gone far enough. The actual challenge is a move towards the unification of the social, psychological and language sciences (anthropology and sociology; cognitive science; and linguistics). A step in this interdisciplinary direction is offered by the discipline called 'cognitive anthropolinguistics', and its central concept of 'cultural cognition'. The paper discusses the implication of this concept for the field of educational linguistics, followed by a brief illustration of a cognitive-cultural application of that concept, namely the concept of 'ethnic stereotype', as part of a socio-cultural guide for a cross-cultural pedagogical grammar.
The metaphorical use of "on"
Authors: Navarro Ferrando Ignasi
Published: August 2017

An attempt is made at refuting the idea that figurative uses of prepositions are chaotic. Figurative uses of the preposition on are explained as the result of metaphorical mappings from the physical domain onto abstract domains. The semantic structure of this preposition in the source domain is explained as a conceptual schema (support), which is formed as a combination of three more basic image schemas, namely, the contact schema, the control schema, and the force downwards schema. The Invariance Principle guarantees the preservation of the logic of these image schemas in target domains. The selection of a particular target domain is, therefore, motivated.
Lexical structure, lexical concepts and metaphorical concepts : the case of "change" verbs in English
Authors: Sánchez García Jesús M.
Published: August 2017

The aim of this paper is twofold: (i) To examine some of the notions current in the FLM (L. M. Mingorance¿s Functional Lexematic Model of semantic description) concerning lexical structure and knowledge, in the light of the cognitive paradigm; and (ii) to analyse some of the connections that can be established between the English lexico-conceptual domain of CHANGE verbs and other domains via the definitional structure of such lexical concepts as those of change verbs -as structured by the FLM-, in order to identify the underlying metaphorical concepts and processes involved.
Risk factors for severe acute malnutrition in under-five children attending nutritional rehabilitation centre of tertiary teaching hospital in Karnataka: a case control study
Authors: Prashanth M. R. , M. R. Savitha , B. Prashantha
Published: August 2017

Background: To determine and analyse the risk factors leading to severe acute malnutrition (SAM) in children under 5 years of age attending nutritional rehabilitation centre of our hospital.Methods: This questionnaire based case control study was conducted from January 2016 to December 2016 on SAM children. For comparison children attending outpatient department without any evidence of malnutrition were included. These SAM children were admitted to the nutritional rehabilitation centre of Cheluvamba Hospital attached to Mysore Medical College and Research Institute, Mysore, Karnataka.Results: A total of 103 SAM cases were compared with 100 controls. The sociodemographic risk factors were age less than 2 yrs, more family members (55.3% had 5 to 8 members), Birth spacing less than 2 years (39.8%), open air defecation (37.9%) and living in kucha house (32%). The dietary risk factors which were statistically significant were poor appetite (33%), prelacteal feed (19.4%), lack of exclusive breast feeding (42.7%), discontinuing breast feed before 2 years (74.8%), receiving complementary feed before 6 months (67%), bottle feeding (32%), calorie deficit (79.6%), protein deficit (66%) and feeding difficulty (17.5%).Conclusions: The social risk factors identified in this study were large family size, low income, more number of siblings and living standards like type of house, open air defecation. The nutritional risk factors were giving prelacteal feed, not giving exclusive breast feeding until 6 months, starting complementary feed before 6 months and giving food low in calories and protein.
Role of zinc supplementation in acute respiratory tract infections in children aged 2 to 60 months
Authors: Nair Bindu T. , Bhunia Rabindra , Sharma Kuldeep Kumar
Published: August 2017

Background: Zinc has a major role in improving immune function and decreasing morbidity in various infectious diseases like acute respiratory tract infections, diarrhoeal diseases etc. The objective of the study was to study the effect of zinc supplementation on clinical manifestations, progress of illness and duration of acute respiratory infections.Methods: A randomized double blind controlled study was conducted in the Paediatric ward of a tertiary care hospital in New Delhi in 50 children aged 2 to 60 months. Children with previous episodes of wheezing, severe malnutrition, congenital heart diseases, pneumonia, history of taking multiple micronutrient formulations or zinc for any intercurrent illnesses like diarrhoea in the previous month prior to admission and history of any known immuno-deficiency disease or on any immunosuppressive medications(steroids) or anti malignancy treatment were excluded. Both placebo (syrup base) and zinc syrup (20 mg/5 mL elemental zinc as zinc sulfate) were given orally for a period of 14 days to the respective groups. Statistical analysis used: Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.). Chi-square test was done for qualitative variables and t-test was used for quantitative variables. P<0.05 was considered as statistically significant.Results: The mean age of zinc group was 22.77 months (SD - 5.74) and that of placebo group was 22.86 months (SD - 5.88) with a p value of 0.98 which was not statistically significant. There were no significant differences in the clinical features in the two groups before starting therapy or after treatment at 24, 48 and 72 hours (P>0.05).Conclusions: Zinc supplementation during episode of ARI did not show any substantial benefit in reducing duration or morbidity in children aged 2-60 months.
Clinical study of neonatal septicemia with reference to early indicators of sepsis
Authors: Kishore E. , S. V. S. Sreedhar
Published: August 2017

Background: The use of CRP (C-reactive protein) in early diagnosis of neonatal septicemia. The usefulness of CRP in early detection of neonatal septicemia/meningitis and urinary tract infection was studied in a neonatal unit using a semi-quantitative latex-agglutination as a rapid screening method and electroimmuno assay as reference method for CRP determination.Methods: The present study was conducted among 150 patients 218 samples were taken for serum globulin determinations. Additionally, all infants born at the hospital throughout August 2016 to February 2017 with a designation of blood disease, infectious disease or tract infection (UTI) were retrospectively studied. Depending on the clinical course and therefore the results of the culture the 110 infants were divided into four groups.Results: The 110 infants in 92% of non-infected infants CRP was 16 mg/l and 80% had CRP <10 mg/l up to 3 days of age. After 3 days of age 93% had CRP <12 mg/l. The initial CRP level was increased in 9 out of 11 patients (82%) with bacterial septicemia. Low CRP was seen in one patient with total agranulocytosis and septicemia from Streptococcus type B and in one patient with Staphylococcus albus sepsis. A rise in CRP was also seen in very pre-term infants with septicemia. Increased initial CRP was uncommon in neonatal urinary tract infection (2 of 9) but a rise was seen in 3 additional patients.Conclusions: A comparison between CRP, total neutrophil blood cell count and hand neutrophil count as diagnostic parameters was in favor of CRP at this early stage of infection. CRP is of definite value as an aid in early diagnosis of neonatal septicemia and bacterial meningitis.
To study the role of probiotics in the prevention of necrotizing enterocolitis in preterm neonates
Authors: Arora Sunita , Khurana Mandeep Singh , Saini Ritish
Published: August 2017

Background: Necrotizing enterocolitis is defined as an inflammatory bowel necrosis in premature infants and is major cause of morbidity and mortality in neonatal intensive care units throughout the world. We aim to study the role of probiotics in reducing incidence and severity of necrotizing enterocolitis in preterm neonates ≤34 weeks and its role on secondary outcomes like mortality, time to reach full feeds, daily weight gain, days of hospitalization and effect on nosocomial infections.Methods: This study was a prospective randomized controlled interventional trial conducted in SGRDIMSAR, Amritsar. A sample size of 150 was selected. 75 were randomized to test group and 75 to control group by simple random sampling.Results: The incidence of NEC was significantly lower in the test group compared with the control group (1 of 75 neonates vs 12 of 75 neonates; p=0.001). The severity of NEC, nosocomial sepsis and mean duration of hospital stay was significantly lower in the test group. Daily weight gain was significantly higher in the test group. There was no significant difference in mean age of onset of NEC, mortality and mean age to reach full feeds in two groups.Conclusions: Incidence and severity of NEC was less in the probiotic group. Daily weight gain was better, nosocomial sepsis and mean duration of hospital stay were less in the probiotic group.
Efficacy of urine screening and culture methods in childhood urinary tract infections and analysis of the causative pathogens
Authors: J. Kavitha , D. Anuradha , M. A. Aravind , J. Ganesh
Published: August 2017

Background: Urinary tract infection (UIT) is common in infants and children causing significant morbidity and long- term complications. In infants and young children symptoms and signs of UTI tend to be non-specific A presumptive diagnosis can be supported with a microscopic examination of a urine specimen. Definitive diagnosis requires a semi-quantitative culture of urine. There has been growing interest in developing efficient technology, that can rapidly and accurately diagnose UTIs and guide the clinician on antibiotic preference for maximum therapeutic benefit.Methods: This prospective hospital-based study was conducted in patients from 2-12 years in a tertiary care hospital. Screening and confirmation of urinary tract infections by urine microscopy and urine culture and comparison, with an analysis of the bacterial strains and antibiotic sensitivity patterns was also done.Results: Among the 214 culture positive patients analysed in the study 64 were 2-5years of age and 150 belonged to 5 -12 years. 128 (59.5%) were boys and 86 (40.2%) were girls. Proteinuria was observed in 68 children (31.8%). Significant pus cells of >5/hpf was present in 77 (36%). E. coli was the commonest organism in 98 children (45.8%) with 100% of organisms were sensitive to amikacin.Conclusions: Over the years, the causative organisms of UTI in India have remained fairly constant but drug sensitivity has changed according to antibiotic usage. In the present era, the emergence of resistant strains poses a significant threat that can be ameliorated by rational and judicious antibiotic use.
Impact of mode of transport on the outcome of extramural newborns in a tertiary care centre
Authors: Thenmozhi M. , Sathya J.
Published: August 2017

Background: Neonatal transport system in our country is a major gap in holistic newborn care and acute neonatal physiology deranged during neonatal transport which adversely affects the mortality and morbidity of sick newborns. To determine the effect of mode of transport on outcome of extramural newborns. To determine the effect of mode of transport on extramural newborns outcome at the level of tertiary care center.Methods: This is a prospective cohort study carried out in chengalpattu medical college and hospital, NICU over a period of 6 months. Inclusion criteria were all admitted extramural babies, readmitted intramural babies and those babies died while transport. Exclusion criteria were those babies born in the institution of study. A predesigned and tested proforma was used to record the required information for the study at the time of admission. Data was analysed and tabulated, for analysis of data software STATISTIX was used.Results: Out of 490 newborns 11% were died, 84% were discharged and 2.45% were gone against medical advice. About the mode of transport was 60% by Ambulances, 10.6% by Auto, 22% by Bus and 6.8% by Car.Conclusions: The study concludes that even though the mode of transport accompanied by a health personnel no difference in the outcome of babies. So, we suggest well trained and equipped transport system to improve the outcome.
Association of gastro esophageal reflex with chronic asthma and its significance: a prospective study
Authors: Daruru Rangnath , Mahadevan Shanker , Kokiwar Prashant R.
Published: August 2017

Background: Many studies have reported that gastro esophageal reflux is significantly more common in asthmatics than in control populations and this appears to apply particularly in childhood. To study the incidence of gastro esophageal refluxes in children which chronic asthma. To identity the clinical characteristic in children with chronic asthma and GER, which would predict reflux, related asthma?Methods: It is a prospective study of association of GER and chronic asthma using Radio nuclide scintigraphy carried at General pediatric in-patient wards of Niloufer hospital, Hyderabad. A Total of 50 patients with chronic asthma and 15 healthy children were evaluated.Results: Our study showed an incidence of Gastro Esophageal Reflux (GER) in 42% of chronic asthmatic children. High incidence of reflux (47.6%) under 4 years of age. No significance difference in the incidence of GER in children with seasonal verus Non-Seasonal asthma. About 50% of children with GER had no symptoms i.e. they had silent reflux. Nocturnal symptoms were significantly higher in asthmatic children with Ger (54.8%) than asthmatic children without GER (21%). Children with reflux related asthma suffered more morbidity in terms of recurrence of attacks, severity of chronic asthma (moderate persistent) and sleep disturbance as compared to children with no reflux. Presence of atopic signs was significantly higher in patients with asthma without GER.Conclusions: GER should be considered as a potentially important contributing factor in any patient with poorly controlled asthma. The asthmatic patient most likely to experience measurable benefit from anti-reflux therapy is the patients with significant nocturnal asthma and who have symptoms of both asthma and of reflux.
A study on validity of C-reactive protein in deciding the duration of antibiotic therapy in suspected neonatal bacterial infection
Authors: Siddaiah Prashanth , Shetty Pradeep Nanjappa , N. W. Krishna , Jagadeeshwara Sowmya
Published: August 2017

Background: Neonatal septicemia is defined as generalized bacterial infection of newborns documented by positive blood culture in first four weeks of life. Objective of present study was to determine whether C-Reactive protein can be used as a parameter to identify the time point when antibiotic treatment can safely be discontinued in a defined major subgroup of neonates treated for suspected bacterial infection.Methods: A total of 50 neonates with birth weight more than 1500gms with suspected septicemia were enrolled in the prospective study. Serum CRP were determined 24-48 hours after the first dose of antibiotics. If CRP was less than 6mg/l, infants were considered unlikely to be infected and the antibiotic treatment was stopped. If CRP was more than 6mg/l, antibiotics were continued and CRP measured on alternative days in one subgroup (2a) and on seventh day in another subgroup (2b). CRP was the single decision criterion to stop the antibiotic therapy. Negative predictive value with respect to further treatment was determined.Results: Duration of antibiotic therapy could be reduced to less than seven days in 54% cases and < 72 hours in 48% cases.Conclusions: Negative predictive value of serial CRP is 100% in deciding the duration of antibiotic therapy in suspected neonatal septicemia.
Comparison of morbidity and mortality between serologically positive and serologically negative dengue cases
Authors: Matti Mahantesh , Maralihalli Mahesh B. , Dinesh Shilpa
Published: August 2017

Background: Dengue is most common arboviral disease caused by 4 types of dengue viruses. In most of the hospitals laboratory diagnosis is made by dengue serology using Rapid Immunochromatographic Test for NS1Ag, IgM and IgG antibodies. We found more morbidity and mortality in suspected dengue cases whose serology was negative for dengue.Methods: Children with clinical features suggestive for case definition for dengue, who belonged to group C of World Health organisation (WHO) guidelines for dengue fever (severe dengue), were included. They were categorised into dengue positive and dengue negative groups. The clinical features and complications of the disease between the two groups were compared.Results: 98 cases (77.8%) were serologically positive for dengue and 28 (22.2%) were negative. 39% of the patients with dengue negative serology developed hypotensive shock in comparison to 18% of dengue positive cases, mortality in serology negative cases (21%) was significantly higher than positive cases (8%).Conclusions: We could not find the reasons for more morbidity and mortality in seronegative dengue group, we stress up on improving the sensitivity and specificity of rapid diagnostic tests. More caution need to be taken for serology negative dengue cases. Epidemiological studies directed to find circulation of other viruses which causes dengue like symptoms should be made.
Study of iron deficiency as a risk factor for first episode of simple febrile siezure
Authors: Kumawat Rakesh , Garg Pukhraj , Karnawat B. S. , P. Verma Ishwari , Arora Akansha , Sonkaria Mukesh
Published: August 2017

Background: Febrile seizure are seizure that occur between the age of 6 month to 60 months with a temperature of 100.4f or higher, that are not the result of central nervous system infection or any metabolic imbalance and that occur in the absence of a history of prior afebrile seizure. Febrile seizures are the commonest cause of seizures in children, occuring in 2-5% of children. The maximum age of febrile convulsion occurrence is 14-18 months, which overlap with the maximum prevalence of iron deficiency anaemia which is 1-2 year old. 7 So far, the dilemma of cause of febrile seizure could not be solved. Standard text book still mention iron deficiency is associated with an increased risk of febrile seizure, thus screening for that problem and treating it appears appropriate.Methods: This case control study was done from June 2015 to December 2016. 60 cases of first episode of simple febrile seizure in age group of 6 month to 5 years were included in the study. A control group was selected from age and sex matched children admitted with febrile illness but without seizure. In all cases detailed clinical history, anthropometry, clinical sign of iron deficiency, CNS examination, CBC, PBF, Red cell indices, serum iron, serum ferritin and serum TIBC level was done. These were analysed in three groups mild, moderate, severe deficiency of anemia. A clinical correlation is tried to establish between overt and subtle iron deficiency with seizure.Results: Majority of subjects with first episode of simple febrile seizure were males (63.3%). Majority of cases of febrile seizure occur in the 6-24 months age group (83.3%). Incidence of anemia among case group subjects was 90.0% whereas the same in control group was 30 %. Mean RDW and TIBC levels in cases were significantly higher as compared to that in controls. MCV, Mean Serum ferritin and Serum Iron levels in cases were significantly lower as compared to that in controls.Conclusions: The findings in present study established an association between iron deficiency anemia and first episode of simple febrile seizures.
A diagnostic dilemma of two rare stroke mimics in a pediatric patient
Authors: Chencheri Nidheesh Cheeyancheri , Kashyape Pawan Subhash , Khamis Sonia , Elamin Agna Maha Mohammed
Published: August 2017

A seven and half year-old male patient presented with clinical symptoms suggestive of stroke. However, the MRI showed atypical lesions in non-vascular distribution and with varying ages. This led to extensive investigations, which suggested a differential diagnosis of CNS neurosarcoidosis and primary CNS vasculitis. Both these are exceedingly rare conditions needing tissue diagnosis and prolonged immunosuppression
Ewing’s sarcoma of fifth metacarpal with lung metastasis in a child: an unusual presentation
Authors: Singh Nidhi N. , Gupta V. , Singh Ashutosh K.
Published: August 2017

Ewing’s sarcoma is the second most common bone tumour second only to osteosarcoma which represents a family of malignancies of neuroendothelial origin, which are highly aggressive and poorly differentiated. The most frequent sites involved are shaft of long bones such as femur, tibia and flat bones such as pelvis and vertebra. Ewing’s sarcoma of small bones of hands is very rare and distant metastasis with hands as the primary is even rarer. Here we describe the course of a 11-year-old male who presented with ewings sarcoma of fifth metacarpal who presented with lung metastasis without local recurrence of the disease after primary surgery and later succumbed to his illness.
Hypothyroidism presenting with development delay, failure to thrive, and pituitary adenoma
Authors: Singh Jatinder , Bhardwar Vaneeta , Mittal Daaman
Published: August 2017

Pituitary enlargement secondary to primary hypothyroidism (PH) is a known but uncommon occurrence, and is also difficult to distinguish on CT and MRI from primary pituitary tumors. Following adequate hormone replacement with L-thyroxine, both symptoms and pituitary hyperplasia are reported to regress within a few months. It is important to recognize this condition so as to avoid unnecessary surgery.
Study of maternal profile in children admitted to nutritional rehabilitation centre at a tertiary hospital
Authors: B. M. Nagabhushan , J. Poornima , R. Premalatha
Published: August 2017

Background: Study of maternal profile in children affected with severe acute malnutrition is very essential. Maternal nutritional status, social and educational status and her medical conditions have direct impact on malnutrition of children. Small efforts to study the maternal profile for one year in our nutritional rehabilitation centre.Methods: A one-year prospective study was carried out in a nutritional rehabilitation centre, Department of paediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India, from September 2015 to August 2016. All maternal details were recorded. All mothers were examined for height weight BMI, checked for vitals and underlying medical conditions. Anaemia is confirmed by laboratory test.Results: Out of 302 mothers enrolled for study, majority were 23 plus or minus 5 years aged mothers. More than 33.7% mothers were under weight. Around 8% mothers were pre-obese and obese. Nearly 88% mothers were found to have anemia, 39% mothers had mild anemia, 30% had moderate anemia, 30% had severe anemia. Hypertension, hypothyroidism, tuberculosis and gynecological problems were other major medical illness seen in these mothers. Majority of the mothers were primigravida (42.38%), around 22% mothers were having birth order more than 3 children. Nearly 78% mothers were not practicing any family planning, only 21% mothers were aware and practicing family planning. Nearly 45% mothers were educated less than high school education. Only few mothers (18%) have studied till post-graduation.Conclusions: In the study majority of the mothers were found to be under weight, nearly 88% mother had anaemia, several underlying medical conditions were detected in mothers, most of the mothers were not practicing family planning, majority of the mothers were studied below high school education.
Applying multi-theory model of health behaviour change to address implicit biases in public health
Authors: Sharma Manoj
Published: August 2017

A person receiving public health services should not receive a lesser standard of service because of his/her race, gender, age, colour, national origin, disability status, occupation or any other extraneous characteristics. However, sometimes our perception based on these hidden linkages (unconscious, irrepressible, or irrational connotations) may influence our judgements resulting in unfairness which are referred as implicit biases. Such biases can result in poorer quality of care. In public health, where the ultimate motive is to ensure social justice, these implicit biases are thus quite deleterious. The purpose of this article was to examine the implicit biases in public health practice and develop recommendations for education, training and research in this discipline using the application of a novel behavioural theory, multi-theory model (MTM) of health behaviour change. A review of literature in the MEDLINE, CINAHL, Google Scholar, and ERIC databases was performed to prepare this article. The constructs of participatory dialogue in which advantages outweigh disadvantages, behavioural confidence, and changes in physical environment were discussed to initiate behaviour change devoid of implicit biases. The constructs of emotional transformation, practice for change and changes in social environment were discussed to sustain behaviour change devoid of implicit biases. Educational interventions based on MTM need to be adopted by Schools of Public Health in education of public health students and training of public health professionals. Such efforts will reduce implicit biases in the discipline of public health and improve quality of care.
Models to predict H1N1 outbreaks: a literature review
Authors: Mutalik Anirudh V.
Published: August 2017

With high mortality and panic association, policy- makers face the difficult task of making appropriate and timely decisions to mitigate the serious adverse effects over a short period of time during H1N1 influenza outbreak. Mathematical models predict the number of the cases and thus provide an insight for preparedness during outbreak. The objective was to identify various mathematical models used in prediction of H1N1 outbreaks till date and to compare the usefulness of these models in providing magnitude of H1N1 outbreaks. Hence a secondary data analysis of literature review was done. The literature search was conducted using PubMed and Google scholar, restricting it to articles published until May 2015. The key parameters were set for selection of articles and hence a total of 31 articles has been reviewed. Of each article included in the review, the following data was recorded: year of the study, year of pandemic referring to, country, described mathematical model with results of study The SEIR model is most commonly used mathematical model. SIER model takes all factors in a epidemic phase of an individual i.e. Susceptible – Exposed – Infective – Recovered. While studies which utilised SIER model with the combination of other models found the other factors which influence the occurrence of H1N1 outbreaks and also helped in prediction and prevention of number of cases during outbreak. The SEIR models in combination utilised secondary models such as social networking, global network and total layered containment. The literature review suggests that probable use of mathematical model along with some secondary models will help in better prediction and prevention of number of cases during outbreak.
Socio-demographic determinants of under-five mortality in rural Agra
Authors: Kumar Krishan , Srivastava Rajiv , Mishra S. K.
Published: August 2017

Background: One of the most important indicator or index of socio-economic development of a country or region is infant mortality rate. The present study was undertaken to assess the quantum of childhood mortality and to find out the social factors associated with these deaths by verbal autopsies. Methods: This one year cross-sectional study was undertaken in a purposively selected community Development Block Sainyan, district Agra among children aged between 0-5 years using multistage random sampling technique. Suitable statistical methods were applied. Results: Out of total 8355 families surveyed, a total of 185 deaths were reported among children. Number of deaths was higher among those belonging to nuclear family and lower socioeconomic status. The neonatal mortality rate was estimated to be 33.55/1000 live births. The post neonatal mortality rate was found to be 40.78/1000 live births and infant mortality rate was 74.33/1000 live births. Mortality rate in 1-5 year age group children was 10.6/1000 same age group children, while 0-5 yrs. mortality was estimated to be 22.39/1000 children of same age group. Out of 185 children who died, 52.7% were unimmunized and another 35.67% were partially immunized. Conclusions: Female education and socioeconomic well-being should be strengthened.
Awareness of sexually transmitted infections and cervical cancer among husbands in urban slums of Mumbai, India
Authors: Naik D. D. , Donta Balaiah , Iddya Umesh , Nair Saritha
Published: August 2017

Background: Cervical cancer is the most common cancer among women, 80 percent of cervical cancer cases present with an advanced stage of the disease when cure is impossible. This may be due to lack of awareness and knowledge, lack of access to proper treatment including screening facility. Cervical cancer does not always cause symptoms during initial stage. Pap smear test helps in early diagnosis of cervical cancer and hence is successful in treatment. In recent years, there has been a growing interest in involving men into reproductive health to improve health outcomes as often husband is the leading decision maker in almost all the areas. The present paper examines the knowledge, attitude, practice and health seeking behaviour about sexually transmitted infections (STIs) and cervical cancer among husbands in a slum community of Mumbai. Methods: Baseline data from an intervention study entitled “Enhancing knowledge and promoting health seeking behaviour of couples on sexually transmitted infections and cervical cancer in urban slums of Mumbai” is used for this article. This data was collected from a random sample of 1958 husbands whose wives age was between 18-49 years, through a semi-structured interview schedule from two urban slums of Mumbai. Information was collected on socio-economic and demographic characters, awareness and symptoms of STIs and Cervical cancer, and health seeking behaviour. Results: About 76 percent husbands heard about the infections transmitted through sexual intercourse, 95.4 percent were aware of cancer whereas only 8.5 percent husbands were aware of cervical cancer and 0.3 percent were aware of Pap smear to detect the cervical cancer. About 3 percent husbands experienced at least one symptom of STIs six months prior to survey, 7.3 percent husbands reported of having sexual partner other than spouse. Most husbands were not aware of STIs symptoms specific to wives. Conclusions: There is a need for disseminating knowledge regarding STI symptoms, cervical cancer and Pap smear test for early detection of cervical cancer as well as promoting better health seeking behaviour with respect to cervical cancer and STIs. Considering sensitivity of the topic it is necessary to design separate programmes for men.
Assessment of prevalence of depression and anxiety and factors associated with them in undergraduate medical students of Dr. S. N. Medical College, Jodhpur
Authors: Hakim Afzal , Tak Himani , Nagar Savitri , Bhansali Suman
Published: August 2017

Background: Anxiety and depression are worldwide problems which reflect the mental health of the population. A lot of researches have reported anxiety and depression among medical students as they are going to suffer from academic stressors such as information input overload, lack of leisure time and academic evaluation. The present study was aimed to assess the prevalence of anxiety and depression in undergraduate medical students; to find association between presence depression/anxiety and socio-demographic factors; to find correlation between depression and anxiety scores. Methods: The cross-sectional study was carried out at Dr. S. N. Medical College, Jodhpur. 426 undergraduate students were selected by simple random sampling. After obtaining informed written consent, students were given self-reporting questionnaire which included socio-demographic details, PHQ-9 and GAD-7. Results: 247 (57.98%) students were found to have depression. 103 (24.17%) students scored ≥10 on PHQ-9 indicating a need for further clinical evaluation. Anxiety was found to be present in 202 (47.41%) students. Presence of depression was associated with history of mental illness in family, any co-morbidities present in student and type of family. Anxiety was associated with medium of language students studied until senior secondary education and type of family. Significant positive correlation was observed between depression and anxiety scores. Conclusions: There is a need for conducting regular psychiatric evaluations and counselling for medical students so that presence of mental disorders can be detected early in their course prompting immediate treatment.
A study on knowledge of anganwadi workers about integrated child development services at three urban health centers
Authors: Baliga Sulakshana Shridhar , Walvekar Padmaja R.
Published: August 2017

Background: Most of the studies have been concentrated on the nutritional and health status of the beneficiaries of ICDS. Less focus has been shifted over to assess the knowledge and awareness among AWW regarding recommended ICDS programmes, who are actually the main resource person. Methods: A cross-sectional study was undertaken among 76 anganwadi workers from all 76 anganwadi’s under the three urban health centers. For Anganwadi workers' knowledge assessment, a scoring system was developed. The knowledge assessment score from each A WW was calculated based on the responses to a questionnaire containing 30 questions. Results: 88.16% of anganawadi workers had better knowledge on immunization and supplementary nutrition and only 45.39% of them had knowledge regarding referral services. No relationship was found between the educational\qualification of the worker and her knowledge about different services provided by her (p=0.660). Conclusions: Out of total 18 (23.7%) of AWWs had poor knowledge of health services provided, 20 (26.3%) had average knowledge and 38 (50%) had good knowledge. The knowledge had no relation with experience and their educational qualification. This difference was not found to be statistically significant.