Background: Glaucoma is the leading cause of untreatable blindness throughout the world, and it is commoner in the black race; therefore, primary health care givers should have some knowledge of glaucoma. The aim of this study is to determine the knowledge of primary health care givers about glaucoma in Sagamu Local Government area of Ogun State. Materials and Methods: A cross-sectional descriptive study of primary care givers in Sagamu, Ogun Sate was carried out between March and May 2010. A structured, self-administered questionnaire was used to collect information on the awareness and knowledge of glaucoma from all registered primary health care givers working in Sagamu, Ogun State. The data was analyzed using SPSS 15. Results: One hundred and eighty-one workers responded (97.8%). There were 124 females (68.5%). Age range was 25 to 64 years, mean 41.2 ΁ 8.7 years. There were 68 (37.5%) physicians, 95 (52.5%) nurses, and 18 (10%) other workers. Ninety-seven percent of the workers were aware of glaucoma. Seventy-seven (42.5%) had good knowledge of glaucoma, while 104 (57.5%) had poor knowledge. Physicians were seven times more likely to know about glaucoma than nurses, while nurses were 4 times more likely to know about glaucoma than other community health workers, and these were statistically significant P < .0001. Younger age group between 25 and 34 years was 2.3 times likely to know of glaucoma than middle-aged. Conclusions: Though awareness of glaucoma was high, knowledge about glaucoma was, however, low among the study population. There is a need to sensitize all cadres of health staff, particularly the community health workers about glaucoma.

Context: There is limited data to support need of lumbar puncture among Indian children aged less than 5 years presenting with a first episode of fever and seizure. Aims: To determine the incidence and clinical predictors of meningitis among children aged 6-60 months presenting with a first episode of febrile convulsion. Settings and Designs: A prospective study was conducted on 35 children (6-60 months) with a first episode of febrile convulsion subjected to lumbar puncture in a tertiary care teaching hospital of North India. Materials and Methods: Clinical characteristics were compared between the two groups: Children with meningitis (n = 17) and children without meningitis (n = 18). Statistical Methods: Multivariate logistic regression was applied to assess the independent predictors of meningitis. Results: A total of 120 children were screened; 35 children subjected to lumbar puncture were finally enrolled. The mean (SD) age of enrolled children was 18.49 (10.79) months. The incidence of meningitis was 48.6% (17/35). Children with meningitis significantly had a higher proportion of children with high grade (temperature >104°F) fever (P = 0.005), received prior antibiotics (P = 0. 041), had lower hemoglobin levels (P = 0.04) and lower blood sugar levels (P = 0.03) as compared to children with no meningitis. On multivariate logistic regression, it was observed that high-grade fever was an independent predictor of meningitis (odds ratio: 0.03 [0.001-0.86] [P = 0.04]). Conclusion: We found that the presence of high-grade fever was an important predictor of meningitis among children aged 6-60 months presenting with a first episode of febrile convulsion.

Introduction: Assam is considered as a vulnerable state for malarial infection. Malarial patient exhibit several divergent values in their blood cell parameter as well as changes in concentration of normal serum ferritin level. The study was intended to observe the concentration of serum ferritin level and estimation of hematological feature among malaria patients in Assam. Materials and Methods: During the period from August 2012 to January 2013, a total of 77 blood samples have been collected from 77 individuals suspected with malaria from different malaria endemic districts of Assam. Results: A total of 36 cases were found to be malaria positive of which 25 were symptomatic and 11 were asymptomatic. Overall the percentage of parasitaemia was found 0.1-15%. Distribution of malaria cases was observed in all age groups and both the sexes. Hematological values among the malaria positive patients revealed that about 89% were having anaemia, 66.67% with Thrombocytopenia and 47% Lymphocytopenia. Iron deficiency anaemia was recorded in 63.87% of the patients. Other haematological status includes 30.56% individual with Granulocytosis and 50.00% subjects with low Mean platelet volume etc. Results also showed that the serum ferritin level in the malaria positive population ranged in from 70 ng/ml to 300 ng/ml, with a mean value of 114 ng/ml. Conclusion: In our study, hematological abnormality and low serum ferritin level is observed as an imperative marker for identification of malaria patients.

Aims: This study evaluated the influence of exposure to the hospital environment on methicillin-resistant Staphylococcus aureus (MRSA) carriage. The antibiograms of the MRSA isolates were examined. Materials and Methods: Nasal, throat, and web-space swabs were collected from 119 nursing students of the age group 18-23 years (exposed group) and 100 age-matched pharmacy students (nonexposed group). S. aureus was identified and antibiogram obtained as per Clinical and Laboratory Standards Institute (CLSI) guidelines. MRSA was detected by cefoxitin disc diffusion test and by growth on oxacillin screen agar as per CLSI guidelines. The presence of the mecA gene was confirmed by conventional polymerase chain reaction. Results: The MRSA carrier rates were 11.8% and 4% in the exposed and nonexposed groups, respectively. Association of exposure to the hospital environment with MRSA colonization was statistically significant. All MRSA isolates showed sensitivity to netilmicin, linezolid, tetracycline, vancomycin and teicoplanin. Among the exposed group, 71.4% MRSA isolates were resistant to ciprofloxacin, 64.3% to cotrimoxazole, 64.3% to erythromycin, 28.6% to gentamicin and 21.4% to clindamycin. Among the nonexposed group, 75% MRSA isolates were resistant to ciprofloxacin, 25% to cotrimoxazole, 25% to erythromycin, 25% to gentamicin and 25% to clindamycin. Conclusion: Exposure to the hospital environment was found to be a significant risk factor for MRSA carriage. Hospital-acquired MRSA (HA-MRSA) isolates showed greater resistance toward antimicrobials compared with community-acquired MRSA (CA-MRSA) isolates. This highlights the need for the appropriate institution of pharmacotherapy in cases of HA-MRSA and CA-MRSA infections and control of transmission by carriers.

Background: Monitoring the causes of death in patients with human immunodeficiency virus (HIV) in the era of expanding access to antiretroviral therapy in resource-limited settings has implications as more deaths are reported for reasons other than AIDS. Aims: To determine the causes of mortality in HIV-infected adults in Western Jamaica. Materials and Methods: Patients with HIV infection with a death certificate with a known cause of death between 2005 and 2010 were reviewed. Results: There were 189 patients. Co-morbidities were present in 25.3%. The mean age at death was 42.4 years. Early disease (World Health Organization [WHO] stages 1 or 2) was the presentation in 21.5% while 78.6% presented with advanced disease (WHO stages 3 or 4). The mean CD4 count at diagnosis was 95 cells/mm ³ . In patients presenting with early disease, 14.2% presented with sexually transmitted infections, 22.8% skin manifestations, and 14.2% lymphadenopathy. In patients presenting with late disease, 41.7% had Pneumocystis jirovecii pneumonia (PCP), 18.9% central nervous system (CNS) toxoplasmosis, 11.3% HIV-associated nephropathy, and 5% cryptococcal meningitis. At death, 72.6% were in WHO class 4, and 21.2% class 3. The average CD4 count at death was 75.5 cells/mm ³ . Overall, 55.2% of the patients had received highly active antiretroviral therapy. PCP accounted for 42.9% of deaths, 27.3% had CNS opportunistic infections, HIV nephropathy 16.4%, and 4.6% had malignancies. About 52.3% of patients died within 1 year of diagnosis with HIV, while 68.3% died within 2 years. Conclusion: Patients with HIV are presenting with late disease and dying of conditions that are AIDS-related. Efforts to improve early diagnosis and treatment are urgently needed in Jamaica.

Background: Ghrelin was initially recognized as an endogenous ligand of growth hormone secretagogue receptor and was implicated in the regulation of food intake, and promoting weight gain. Ghrelin has been shown to improve cardiac function in patients suffering from heart failure (HF) though various mechanisms. The aim of the review is to summarize the main findings in this field, with the purpose of promoting further studies on the role of ghrelin on the cardiovascular system. Materials and Methods: All publications describing trials, systematic reviews, meta-analyses and review papers published within 1999-2014 of ghrelin in animal models of HF were sought through electronic and manual searches. Results: The literature searches identified 126 references and ten trials meeting the inclusion criteria were included in this review. All studies were carried out on male rats and experimental model of HF. Ghrelin has been shown to reduce mortality, increase appetite and body weight, and was found to improve the cardiac function parameters. Review found deficient information about adverse effects of ghrelin. Ghrelin exerts cardioprotective effects through modulation of sympathetic nervous system, inhibiting autophagy, antiinflammatory effects and protection against ischemia/reperfusion injury. Conclusion: Ghrelin seems to have a beneficial effect in rat models of HF and can offer an effective therapeutic target for improving outcome in HF.

Background: Breakfast is one of the most integral components of an individual's diet, despite that breakfast skipping is widely prevalent. Proposed effects of breakfast on obesity (PEBO) have corroborative evidences from different countries, especially, regarding the effects of breakfast skipping on obesity. Habits and lifestyle factors like breakfast skipping maybe formed, changed or strengthened in the tender age of adolescence and can also serve as an early warning system of threats that may engulf larger populations. The study objectives were to find out the frequency of breakfast skipping in adolescents and PEBO, including associations with body mass index (BMI) status. Materials and Methods: This was a cross sectional study conducted in all the 13-15 years students who fulfilled the inclusion criteria in the schools affiliated to Aligarh Muslim University. The study was based on a pretested and validated questionnaire and the nutritional status/anthropometric records were measured by the now recommended World Health Organization multicentric growth reference standards 2007. Result and Conclusion: A total of 1416 students were studied, out of which frequency of breakfast consumption was found to be <2 times/week in 6. 21% of the study population, 3-5 times/week in 27.54% and 6-7 times/week in 66.24%. As far as PEBO is concerned, a decreased frequency of breakfast was found to have an association with obesity and overweight as well. Further, an association of breakfast skipping on the BMI Z scores was also found to be significant on analysis of variance and post-hoc tests. The high prevalence of breakfast skipping in India and PEBO is a big cause of concern for multiple reasons, and an intervention is urged.

Background: Intraventricular hemorrhage (IVH) is a major cause of death and the most important predictor of neurodevelopmetal disabilities in very low birth weight (VLBW) infants. Materials and Methods: Maternal, perinatal and infant data of 87 babies weighing <1500 g who had transfontanelle ultrasonography (TFU) scan were obtained to determine the prevalence, risk factors, features and outcome of IVH by multivariate analyses. Results: The prevalence of IVH was 24.1%. Gestational age <28 weeks; early onset sepsis (EOS) and severe birth asphyxia (SBA) at 5-min were associated with a greater risk of development of IVH. The use of antenatal steroids however reduced the risk. Respiratory distress, clinically identifiable seizures, temperature instability and acidosis, were more common in babies with IVH. Mortality rate was also significantly higher among them (P = 0.005). Babies with severe IVH were 23 times more likely to die than those without IVH (relative risk = 23.3, 95% confidence interval = 1.58-343.42, P = 0.010). Conclusion: The high-rate, morbidity and mortality of IVH emphasize the need for routine TFU scans among VLBW infants. Deliveries before 28 weeks, EOS, failure of antenatal steroids treatment and SBA contributed to the development of IVH. Aggressive prevention/management of these factors are necessary to reduce the burden of IVH in these high-risk neonates.

A 9-year-old girl entered to the emergency department with fever, dysentery, neurological signs, and renal failure following an epidemic of amebiasis. She had used 5 days metronidazole (30 mg/kg/daily) before she was affected to hemolytic uremic syndrome (HUS) and seizure, blindness, and ataxia. We hold using of metronidazole and by supportive therapy all symptoms alleviated and she left hospital in 8 ^th day, after 1-month she was healthy without need to use any drug. amebiasis may cause to HUS by different mechanisms, but metronidazole as a causing and defining of symptoms in HUS should be considered.

Pulmonary nocardiosis presenting as a fungal ball in a preexisting cavity is a rare presentation. We report such a case in a 18 yrs old male patient presented with cough with expectoration & episodes of haemoptysis with a past history of tuberculosis. Diagnosis was done by microscopic examination of the resected sample & confirmed on culture.

Hypoplastic leukemia, considered as a form of atypical leukemia has been rarely reported in the literatures. It usually affects elderly patients. Even though hypoplastic acute lymphoblastic leukemia has been reported in younger age groups, hypoplastic acute myeloid leukemia (AML) has been rarely reported in children and younger age groups. Here, we report three cases of AML with a hypocellular marrow in younger age groups.

Filariasis, a tropical parasite infection, is a common public health problem in the Indian sub-continent. Occurrence of filariasis with chronic myeloid leukemia (CML) is unusual though there are case reports of leishmaniasis, malaria, and other vector-borne diseases seen in association with leukemias. Filariasis co-existing with CML has not been documented to the best of our knowledge and hence definitely needs a space in literature. We report an incidental finding of bancroftian filariasis in a 35-year-old female already diagnosed as CML.

Splenic abscess is not an uncommon entity in tropics. In Indian subcontinent, where the incidence of enteric fever is high, abscess formation in spleen is frequently seen in clinical practice. In view of immunological functions, splenic preservation is preferred over splenectomy, especially in children and young adults. Medical management with antibiotics alone is considered inadequate for management of splenic abscess. Hereby, we report an unusual case of complete resolution of a florid splenic abscess with antibiotics alone without the need for any invasive intervention.

With booming medical tourism, Indian doctors are seeing a lot of patients from other countries for varied medical conditions. A citizen of Nairobi presented for treatment of his complaints consisting of severe episodic headache, with abdominal pain, spermatorrhea, decreased libido, constipation, and impotence. On detailed evaluation, he was found to have developed dependence to khat chewing; a social habit in his native country and his symptoms were attributed to effects of khat withdrawal. He improved after treatment with topiramate and escitalopram and lifestyle modification. Physicians need to be aware of various cultural habits of addiction in different parts of the world and their common presentations in view of globalization of health care.

A 19 year male presented with red eyes and periorbital rash after an episode of generalised tonic clonic seizure. Capillary leak secondary to Valsalva Manuever or vasoactive substance release are the suggested mechanisms.