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Patel M.,Swasthya Hospital | Patel I.M.,Swasthya Hospital | Patel Y.M.,Swasthya Hospital | Rathi S.K.,Medical Institute and Research Center
Journal of Health, Population and Nutrition | Year: 2012

This cross-sectional study assessed the current situation of and factors associated with consumption of diabetic diet among 399 type 2 diabetes mellitus (T2DM) subjects from Ahmedabad, Western India. The study was performed with diagnosed (at least one year old) diabetic subjects who attended the Department of Diabetology, All India Institute of Diabetes and Research and Yash Diabetes Specialties Centre (Swasthya Hospital), Ahmedabad during July 2010-November 2010. The subjects completed an interviewer-administered questionnaire. The questionnaire included variables, such as sociodemographic factors, family history of diabetes, behavioural profile, risk profile (glycaemic status, hypertension, and obesity), and diet-related history (consumption of diabetic diet, consumption of low fat/skimmed milk, method of cooking, and sources for diet advice). Blood pressure, body mass index, glycosylated haemoglobin (HbAlc) level, and fasting lipid profile were measured. All analyses including multivariate logistic regression were conducted using SPSS, version 11.5. In total, 399 T2DM subjects (65% male, 35% female) with mean age of 53.16±7.95 years were studied. Although 73% of T2DM subjects were consuming diabetic diet, the good glycaemic control (HbAlc level <7%) was achieved only in 35% of the subjects. The majority (75%) of the subjects had a positive family history of diabetes, and 52% were obese. In 77%, the main source of dietary advice was doctor. In 36%, the main methods of cooking were: boiling and roasting. The final multivariate model showed that visit to dietician, level of education, intake of low fat, and family history of diabetes were independent predictors for diabetic diet consumption among T2DM subjects. However, longitudinal and cohort studies are required to establish the association between consumption of diabetic diet and glycaemic control.

Kar N.,Black Country Partnership NHS Foundation Trust | Arun M.,JSS Medical College | Arun M.,Kasturba Medical College | Mohanty M.K.,All India Institute of Medical Sciences | Bastia B.K.,Medical Institute and Research Center
Indian Journal of Psychiatry | Year: 2014

Background: Lethality of suicidal attempt provides useful information regarding the behavior. There is a perceived need for a clinically useful scale that can be easily adapted to various methods and circumstances of attempt. Aims: The study intended to develop and test utility of a scale for measuring lethality that can reflect overall clinical observation taking into account various indicators of lethality and which can be used across clinical scenarios involving different methods. Settings and Design: Cross-sectional study in a hospital. Materials and Methods: The scale for assessment of lethality of suicide attempt (SALSA) has two components: The first component has four items indicating seriousness of the attempt and its likely consequences and the second component is the global impression of lethality. All the items are scored from 1 to 5, higher scores suggestive of increased lethality. SALSA was used to evaluate lethality of 82 consecutive suicide attempters; and it was compared with lethality of suicide attempt rating scale (LSARS) and risk-rescue rating scale. Statistical Analysis: Chi-square, t-test, analysis of variance, Cronbach′s alpha, binary logistic regression. Result: There was significant correlation of SALSA score with that of LSARS (r: 0.89) and risk score of risk-rescue rating (r: 0.93, P < 0.001); and negative correlation with rescue score (r:-0.569; P < 0.001). Internal consistency reliability of SALSA was high (Cronbach′s alpha: 0.94). Lethality scores of SALSA differentiated known groups with different lethality, e.g. deceased and survived; attempters with different levels of medical intervention: In-patient only, intensive care, ventilator support. SALSA score significantly predicted the lethal outcome (odds ratio: 3.2, confidence interval: 1.12-8.98). Conclusion: SALSA is a useful instrument for assessment of lethality of suicidal behaviors during clinical evaluations considering the ease of administration, its ability to differentiate clinical groups with known variations of lethality and clinical outcomes.

Patel D.A.,Civil Hospital | Gupta P.A.,Civil Hospital | Kinariwala D.M.,Civil Hospital | Shah H.S.,GMERS Medical College | And 2 more authors.
Journal of Global Infectious Diseases | Year: 2012

Background: Most outbreaks of viral hepatitis in India are caused by hepatitis E. Recently in the year 2009, Modasa town of Sabarkantha district in Gujarat witnessed the outbreak of hepatitis B. Purpose: An attempt was made to study the outbreak clinically and serologically, to estimate the seropositivity of hepatitis B Virus among the cases and their contacts and to know the seroprevalence of hepatitis B envelope antigen (HBeAg) and IgM antibody against hepatitis B core antigen (IgM HBcAb) out of all the Hepatitis B surface Antigen (HBsAg) positive ones. Materials and Methods: Eight hundred and fifty-six (856) cases and 1145 contacts were evaluated for hepatitis B markers namely HBsAg, HBeAg and IgM HBcAb by enzyme-linked immuno Sorbent Assay (ELISA) test. Results: This outbreak of viral hepatitis B in Modasa, Gujarat was most likely due to unsafe injection practices. Evidence in support of this was collected by Government authorities. Most of the patients and approximately 40% of the surveyed population gave history of injections in last 1.5-6 months. Total 664/856 (77.57%) cases and 20/1145 (1.75%) contacts were found to be positive for HBsAg. 53.41% of the positive cases and 52.93% of the positive contacts were HBeAg-positive and thus in a highly infectious stage. Conclusions: Inadequately sterilized needles and syringes are an important cause of transmission of hepatitis B in India. Our data reflects the high positivity rate of a hepatitis B outbreak due to such unethical practices. There is a need to strengthen the routine surveillance system, and to organise a health education campaign targeting all health care workers including private practitioners, especially those working in rural areas, as well as the public at large, to take all possible measures to prevent this often fatal infection.

Tripathi S.,Medical Institute and Research Center | Shah R.,Medical Institute and Research Center | Sharma D.C.,GMERS Medical College
Journal of Anaesthesiology Clinical Pharmacology | Year: 2012

Aim: To evaluate and compare the analgesic activity of fixed dose combinations (FDC) of Paracetamol with Diclofenac sodium and Paracetamol with Tramadol on different human pain models in healthy human volunteers. Materials and Methods: A randomized double blind crossover study was carried out in 30 healthy human volunteers using three pain models; cold-water stress test, radiant heat method, and BP cuff inflation method. The subjects were randomized into two groups of 15 each, group A received FDC of Paracetamol 500 mg with Diclofenac sodium 50 mg and group B was given a FDC of Paracetamol 375 mg and Tramadol 50 mg. All the volunteers were tested on three pain models. Observations for pain tolerance were recorded at baseline and at the interval of 30, 60, 120, and 180 minutes after drug administration. Crossover was done after a washout period of 7 days. The results of both the study periods were analyzed using an independent t-test. Results: Mean age of the participants was 231 years and the male:female ratio was 2:1. In the radiant heat method, paracetamol with tramadol combination treatment showed a significant increase in pain tolerance at 2 hours and 3 hours (P 0.028 and 0.055 respectively) compared to paracetamol with diclofenac combination. Other two pain models did not show any significant difference in the study groups. Conclusion: Paracetamol with tramadol combination was more effective than paracetamol with diclofenac sodium combination on the radiant heat model. In human pain models, there is an incomplete understanding of mechanisms and activated pathways are not precisely determined that needs further evaluation.

Desai P.,Medical Institute and Research Center | Patel S.,Medical Institute and Research Center | Shah R.,Medical Institute and Research Center | Desai S.,Medical Institute and Research Center
Journal of the Indian Medical Association | Year: 2013

To analyse various cough and cold formulations available in the Indian market and to study their pharmacological rationale and cost effectiveness, a cross-sectional, observational study was carried out for evaluation of the drugs listed in Current Index of Medical Specialities (CIMS) India, September 2010.The formulations were assessed for their total number, type of dosage form, number of constituents in each formulation, their pharmacological group and rationality. The total daily cost and its association with type of dosage form was analysed. Out of a total 1297 preparations evaluated, 94% were fixed dose combination. The mean number of constituents was 3.20±1.03. Liquid oral formulations were largest in number (64.4%). The formulations contained various antitussives (30.30%), expectorants (33.92%), antihistamines (71.09%), mucolytics (35.62%), decongestants (56.28%), bronchodilators (16.81%) and analgesics/antipyretics (31.30%). None of the preparation was listed in the Model list of Essential Medicines, WHO(March 2011) under section 25 of "Medicines acting on the respiratory tract". Only 2% of the preparations had pharmacological rationale for their use in cough and common cold; 9.6% were containing more than one ingredient of the same pharmacological group and 6.85% were containing both antitussive and expectorant having opposing action. Highest number of preparations(36.85%) was having cost of therapy of Rs 6-10 per day. Liquid oral dosage forms had significantly higher cost than solid dosage form (p<0.0001) and topical nasal dosage forms had significantly higher cost than liquid (p<0.03) and solid (p<0.001) dosage forms. It is conducted that various cough and cold medicines available in Indian market lacked therapeutic rationale for their use, leading to wasteful expenditure.

Shah P.S.,Baroda Medical College and SSG Hospital | Kataria L.,Medical Institute and Research Center
Internet Journal of Mental Health | Year: 2010

Background: Social phobia even though being a common psychiatric disorder is still under recognized and under treated. We study prevalence, severity, disability and quality of life with respect to social phobia among university students in India.Methods: A stratified sample of 380 undergraduate university students was assessed to identify the extent of social phobia, its correlates as well as resulting disability and quality of life.Results: Social phobia was found in 19.5% of participants, in varied degrees of severity and correlated with various faculties in university, resulting in significant disability in work, social life, and family life, as well as impairment in quality of life. 'Acting, performing or giving a talk in front of an audience' was the most commonly feared/avoided situation. Students reported various clinical manifestations affecting academic, social and interpersonal areas.Conclusions: High prevalence and marked impact on life demands stringent efforts to recognize and treat social phobia. Copyright Internet Scientific Publications, LLC., 1996 to 2010.

Rawal S.V.,Medical Institute and Research Center
Indian Journal of Tuberculosis | Year: 2014

Background: Tribal population resides in difficult to reach terrain. It is vital to know, in context of “Universal care approach”, whether they are equitably benefited by RNTCP. Objective: To compare RNTCP performance in tribal areas with non-tribal areas and to detect whether the difference in performance indicators is statistically significant. Methods: A comparative analysis of RNTCP performance indicators like total case detection rate, new smear positive case detection rate, etc., was carried out using annual data of last three years in tribal and non-tribal areas. T-test was applied to confirm statistically significant difference. Results: The performance of tribal area is better in terms of suspects examined per lakh population per year, total case detection rate, NSP case detection rate and success rate. The difference was close to statistically significant difference at 95% confidence limit and the difference was significant at 90% confidence limit. The extra-pulmonary case notification rate was significantly higher in non-tribal areas with understandable reasons. Conclusion: Significantly high previously treated smear positive case notification rate in tribal area is a matter of concern .The incentives to tribal areas appear to reap better results and these need to be supported and sustained. © 2014, Tuberculosis Association of India. All rights reserved.

Shah R.,Medical Institute and Research Center | Gajjar B.,Pramukhswami Medical College | Desai S.,Medical Institute and Research Center
National Journal of Physiology, Pharmacy and Pharmacology | Year: 2012

Aims & Objective: To study the adverse drug reaction profile, its causality, severity, associated risk factors and preventability in geriatric patients in a tertiary care teaching rural hospital. Materials and methods: Four hundred geriatric patients from various inpatient and outpatient departments were observed for occurrence of adverse drug events (ADEs) during August 2007 to October 2009. ADEs were either spontaneously reported or elucidated from personal interviews and analyzed. Results: In forty seven (11.75%) patients, 57 events occurred of which 75.43% occurred in indoor and 24.56% in outdoor patients. Most patients (74.46%) were in the age range of 65 to 74 years. The male to female ratio was 1.47: 1. Majority of ADEs involved gastrointestinal system (43.85%), followed by cardiovascular system (14.03%), endocrine system (12.28%) and skin and mucous membranes (12.28%). 142 drugs were suspected to cause these ADEs. Chemotherapeutic agents were the most commonly suspected drugs followed by cardiovascular drugs, drugs acting on CNS and steroids. On assessing causality, majority of events were rated as 'possible' by both WHO-UMC (66.66%) and Naranjo's criteria (68.42%). Severity assessment (Hartwig scale) showed that 19.29%, 68.42% and 12.28% ADEs were severe, moderately severe and mild respectively. Risk factors for ADR development found were socioeconomic status (p=0.000), number of diseases suffered (p=0.002), number of medicines taken per day (p=0.000), compliance (p=0.048) and inappropriate prescribing (p=0.004). 36.84% ADRs were definitely preventable and 17.54% were probably preventable by modified Schumock and Thornton scale. Conclusion: ADRs is a major problem prevalent in geriatric patients and is significantly associated with socioeconomic status, number of diseases, number of medicines consumed per day, compliance to therapy and inappropriate prescribing.

Shah R.B.,GMERS Medical College | Desai S.V.,Medical Institute and Research Center | Gajjar B.M.,Pramukh Swami Medical College | Shah A.M.,GMERS Medical College
Drugs and Therapy Perspectives | Year: 2013

Background: Noncompliance to drug therapy, a common problem in geriatric patients, adversely affects disease outcomes. In India, data addressing noncompliance in elderly patients, the factors responsible for it and possible solutions for the problem are very limited. Objective: To evaluate the prevalence of drug noncompliance among Indian geriatric patients, explore factors affecting it and examine the impact of educating patients about importance of adhering to drug therapy. Study design: A total of 200 geriatric patients from various outpatient departments were randomly recruited. Baseline information related to diseases and drug therapy were recorded using a structured case-record form that included a questionnaire for evaluation of drug compliance. Patients were randomly divided in two groups of 100 individuals; the interventional group received education about the importance of drug compliance and related issues, and the control group did not. Changes in compliance were evaluated at a follow-up visit 7-14 days later. Results: Noncompliance to drug therapy was reported in 77.5 % of patients, and was significantly associated with socioeconomic status, prescription-related factors (number of medicines prescribed, purchasing drugs from same pharmacy, patients' particularity in taking medicines on time, instructions given by doctors); and drug-related factors (frequency and duration of administration, skewed instructions for use, physical difficulties in taking drugs, price of drug as perceived by patient, cost of therapy, risk of adverse drug reactions as perceived by patient). At follow-up, compliance had significantly improved in the group who had received education relative to the group who did not. Conclusion: Educating geriatric patients about their disease and drug therapy, and the importance of compliance to therapy may improve their short-term compliance behaviour. © 2013 Springer International Publishing Switzerland.

PubMed | Medical College Baroda and Medical Institute and Research Center
Type: | Journal: BMJ case reports | Year: 2015

A 30-year-old afebrile woman presented with anorexia, yellowish discolouration of the sclera and bilateral pedal oedema. Blood investigations revealed severe anaemia, raised erythrocyte sedimentation rate and thrombocytopaenia. Liver function tests were abnormal with raised bilirubin, alanine transaminase and prothrombin time. Chest roentgenogram was negative for tuberculosis. Abdominal ultrasonography (USG) revealed coarsened echotexture of the liver with surface nodularity. Contrast-enhanced CT scan revealed heterogeneity with surface and parenchymal nodularity scattered throughout the liver parenchyma. USG-guided liver biopsy was performed, which showed changes in granulomatous hepatitis with positive Ziehl-Neelsen staining for acid-fast bacilli. The patient was started on antituberculous drugs. After completion of the antituberculous regimen, the patient made an uneventful recovery with normal range of aspartate aminotransferase, serum albumin and prothrombin time. In summary, isolated liver tuberculosis is rare and a high index of suspicion is required in a patient from an area where tuberculosis is endemic, after excluding other common diffuse liver pathologies.

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