Vitamin D is a prohormone which is converted into its active hormonal form 1,25-dihydroxyvitamin D3 (1,25(OH)₂D₃) in order to activate targeted genes to engender its biological actions. Through both 1,25(OH)₂D₃-dependent and 1,25(OH)₂D₃-independent Vitamin D receptor, it actions may involve more than one single receptor and ligand. Vitamin D plays important, pleiotropic role primarily in the maintenance of calcium and phosphate homeostasis by influencing the balance between bone resorption and formation. However, its influence goes far beyond the regulation of mineral homeostasis as diverse activities of Vitamin D assure through both genomic and nongenomic pathways, and it has a physiological value upon vascular health. It has been shown to protect against endothelial dysfunction, vascular smooth muscle cell proliferation and migration, and modulation of the immune system as well as the inflammatory response. In addition, vitamin D has been shown to have systemic effects on insulin resistance, dyslipidemia, and hypertension. Although some vitamin D is essential for cardiovascular health, excess may have detrimental effects, particularly on elastogenesis and inflammation of the arterial wall. This review explores the physiological role of vitamin D in vascular health protection.

BACKGROUND: Healthy dietary practice is an important lifestyle modification and one of the key adjuncts to pharmacotherapy in the management of diabetes and hypertension. AIM AND OBJECTIVE: This study aims to describe the awareness regarding healthy dietary practices among diabetic and hypertensive patients in a rural health center, and to identify the barriers to dietary modifications and compliance among them. MATERIALS AND METHODS: Eight focus group discussions (FGDs) were conducted in this qualitative study among diabetic and/or hypertensive patients (homogenous groups, with 6–10 members) both in the special clinic as well as in the community setting of Ramanathapuram, in rural Puducherry. Verbatim group transcriptions were analyzed by systematic text condensation. RESULTS: Four themes – “awareness toward dietary modification,” “compliance to dietary modification,” “family support in following dietary modification,” and “barriers faced in following dietary modification” emerged after the analysis of all FGDs. Most of the patients were aware regarding the dietary modifications, but few comply with the modifications due to the barriers such as lack of time, financial constraints, and inadequate family support. Other barriers in following the dietary changes include fear of taboo in social gatherings and inability to deviate from traditional food habits. CONCLUSION: Despite good awareness, compliance to healthy dietary practices was poor owing to several barriers. Nutrition education sessions need to be conducted considering locally available resources and addressing the commonly encountered barriers in a simple and comprehensible manner involving family members/caregivers in addition to the patients.

INTRODUCTION: Body image perception refers to an individual's idea about his/her body. Dissatisfaction regarding body image may have a major impact on one's psychological well-being and may be a risk factor for eating disorders. This is generally seen to be more prevalent among growing individuals, namely, adolescents, and this study was conducted to assess the prevalence, find the underlying risk factors, and assess means to manage the conditions effectively to prevent an adverse impact on mental health and well-being. This study was aimed at estimating the prevalence of body image dissatisfaction among adolescents and to make a comparison of these findings among male and female adolescents, and also between the early, middle, and late teens. METHODOLOGY: A total of 309 adolescents (M = 128, F = 181; age range 10–19 years; and mean age = 15.2) were assessed using anthropometric measurements, Body Mass Index calculation, and body image perception questionnaire. This information was correlated with the self-esteem scores of these individuals using Rosenberg's Self-Esteem Questionnaire. RESULTS: Both males and females were found to be equally concerned about their appearance and body shape (51.46% and 48.53%, respectively). Among these, we found that the middle (14–16 years) and late teens (17–19 years) had higher scores of body image dissatisfaction compared to early teens (10–13 years). Majority (62.38%) of the early teens was unconcerned with their body shapes. Not only overweight but also even underweight adolescents had higher body shape dissatisfaction with 64.72% perceiving their body shape wrongly. Mental health and self-esteem scores were shown to have a positive correlation with body dissatisfaction indicating that those who were dissatisfied with their body were more likely to have lower self-esteem (p = 0.036). CONCLUSION: The present study found that majority of the adolescents has body dissatisfaction, which negatively affects their self-esteem.

BACKGROUND: Early identification of people at increased risk of disease who could benefit from prompt intervention can prevent the onset or control the severity of the disease. This study investigated the knowledge and perceived barriers of dental patients toward screening for medical conditions within a dental setting. MATERIALS AND METHODS: Consenting participants (n = 500) who presented in the Dental Department of Lagos State University Teaching Hospital were recruited using a simple random sampling method. An interviewer-administered questionnaire was used to obtain sociodemographic information as well as the respondents' knowledge, attitudes, and perceived barriers regarding screening for medical conditions by a dentist. Data entry and analysis were done using SPSS version 19 and P < 0.05 was considered statistically significant. RESULTS: Majority of respondents were aged <40 years, were females, and had at least 12 years of education. Most of them (63.4%) had poor knowledge on the risk factors predisposing them to medical conditions and on the oral complications of systemic diseases (57.6%). Majority of the respondents (64.6%), however, had a positive attitude toward screening for medical conditions in a dental clinic. The barriers they envisaged for screening in the dental setting were cost (67.2%) and increased waiting time (65%) for screening. CONCLUSION: The study participants had a positive predisposition toward screening for medical conditions in the dental clinic even though they had concerns about payment and extra time spent for screening. Opportunistic screening for medical conditions is recommended for consenting high-risk patients identified during dental visits. Adequate budgetary allocation to the National Health Insurance Scheme should also be made to address the financial constraints that patients have.

BACKGROUND: Metronomes are commonly used by musicians for maintaining desired tempo. It is being used in various physiological tests for decades. Software application-based metronomes are available free of cost for Android devices. AIM: The aim of the study was to evaluate the applicability of android application-based metronome for physiological tests. MATERIALS AND METHODS: “Study of Human Fatigue by Mosso's Ergograph” and “Queens College Step Test for V.O_{2 max}measurement” were carried out in control group (n = 7) aided with mechanical metronome and in the test group (n = 7) with android application metronome. Ratio of error events to total events were recorded for each test. The sound pressure level (SPL) (dB) was measured for mechanical and android application metronome for comparison. STATISTICAL ANALYSIS: Data were expressed in mean and standard deviation. Unpaired t-test was used to compare mean of study and control group. RESULTS: The ratio of error in synchronized flexion to total flexion events of finger in “Study of Human Fatigue by Mosso's Ergograph” with mechanical metronome (0.047 ± 0.008) was significantly (P = 0.0003) higher than android application metronome (0.026 ± 0.007). The ratio of error in steps to total steps in “Queens College Step Test for V.O_{2 max}measurement” with mechanical metronome (0.012 ± 0.007) and android application metronome (0.013 ± 0.005) was not significantly different (P = 0.8818). The SPL of mechanical metronome was lower (53.04 ± 2.79 dB) than mobile device application-based metronome (65.19 ± 2.61 dB) (P < 0.0001) in similar ambience. CONCLUSION: Android application-based metronome is better than mechanical metronome for tests requiring lower beats per minute. It may be considered as an alternative to mechanical metronome.

INTRODUCTION: In spastic diplegic Cerebral Palsy, there is weakness of lower limbs especially in Gluteus Maximus. Biomechanically gluteus maximus tilts the pelvic posteriorly. So in spastic diplegic cerebral palsy there is anterior pelvic tilt which cause postural abnormality and difficulty in walking. AIM OF THE STUDY: To evaluate the effect of Neuro-muscular electrical stimulation (NMES) and functional strengthening exercises on gluteus maximus strength and pelvic obliquity. METHODOLOGY: 30 children with spastic diplegic cerebral palsy were fulfilling the inclusion criteria were taken into the study and assigned into 2 groups with 15 subjects in each group ranged from 3-12 years. Group 1: (3 girls and 12 boys) received NMES with conventional exercises. Group 2: (1 girl and 14 boys). received only conventional strengthening exercises. All the subjects underwent an initial baseline assessment of gluteus maximus isometric strength by modified sphygmomanometer and pelvic tilt by modified pelvic inclinometer. Total duration of treatment was 5 days per week for 6 weeks. DATA ANALYSIS: The data was analysed using SPSS version 16, between groups difference for gluteus maximus strength and pelvic inclination was done by using 2X2 ANOVA and within group difference analysis was done using Multivariate test and Mauchly's sphericity test. RESULTS: Results of the study suggested that both the control group and experimental group had a significant improvement after treatment for 6 weeks. However, the experimental group showed greater change as compared to control group. CONCLUSION: The NMES with conventional exercises are more effective than conventional strengthening exercises alone to improve gluteus maximus strength and pelvic obliquity.

INTRODUCTION: Leptospirosis is a zoonotic disease with clinical manifestations, ranging from subclinical infection to fulminant disease. OBJECTIVE: To study the seroprevalence, various epidemiological risk factors, and diagnostic aspects of leptospirosis. MATERIALS AND METHODS: One hundred and seventy-one clinically suspected individuals were enrolled in the study at Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, during January 2013–May 2014. A detailed history of patients was taken on a predesigned pro forma. Blood sample was collected from the patients, and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR), and microscopic agglutination test (MAT) were done for diagnosis. The patients' details were also scored according to the modified Faine's criteria. RESULTS: Of 171 patients, 24 (14.1%) cases were diagnosed positive by IgM ELISA. Contact with dirty surroundings, fieldworkers, history of animal contact, and use of public bathing facilities/ponds were associated with 20 (83.3%), 20 (83.3%) 19 (79.2%), and 18 (75%) cases, respectively. Fifteen (62.5%) cases were diagnosed during July–September (P = 0.004). Fever, myalgia, and abdominal pain were the common symptoms. Calf tenderness was seen in 22 cases (P < 0.0001). Of 24 seroreactive cases, 20 (83.3%) cases were positive by PCR. MAT was performed for only 15 serologically reactive patients. A titer of 1:40 was observed in only two cases. Faine's score (Part A + Part B + Part C) was calculated for all ELISA-reactive patients. Only one case had score between 20 and 25 and the rest had >25. CONCLUSIONS: Dirty surroundings, fieldworkers, animal contact, and heavy rainfall are the major epidemiological risk factors for leptospirosis. Modified Faine's criteria may play a useful role in diagnosis for a patient with low clinical score.

INTRODUCTION: The exponential rise in the prevalence of hypertension signals the urgent need to focus the attention on hypertension prevention and management strategies for the vulnerable groups. OBJECTIVE: The objectives of the study were to explore children's conceptualization of hypertension and to track its changes in complexity or divergence along classes. METHODS: A mixed methods approach combining qualitative and quantitative techniques was adopted. A total of 776 students of 6^th to 12^th standard from the schools catering to the need of lower socioeconomic status were recruited. A simple tool with a single open-ended question – “What do you know about hypertension/high blood pressure?” was administered. The responses were coded appropriately and content analyses of the responses were carried out following thematic method. RESULTS: Four broad themes, namely, definition, causes, consequences, and management of hypertension emerged out of content analyses. About 22.57% of responses indicated misconceptions on hypertension. Children's understanding of hypertension, in general, was found to be inadequate. A new method of measuring the conceptual complexity of responses of each class by computing “entropy” values, or “divergent index” indicated progressive increase in complexity of conceptualizing hypertension across classes. CONCLUSION: The need for enhancing children's knowledge of hypertension through curriculum and public health programs is emphasized in view of children constituting the vulnerable group with reference to future projections

BACKGROUND: Diabetes mellitus is a metabolic disorder which can predispose to cognitive impairment. It is important to screen diabetic patients for cognitive dysfunction in the routine clinical management. Our study aimed at comparative evaluation of commonly used cognition assessment tools such as Mini Mental State Examination (MMSE) and Rowland Universal Dementia Assessment Scale (RUDAS) in diabetes patients. METHODS: The study was conducted as a prospective case–control design in a tertiary care teaching hospital from March to October 2015. After obtaining written informed consent, the data on demographic details, duration of diabetes, and glycemic control marked by glycated hemoglobin were recorded. A total of 101 previously diagnosed type-2 diabetes patients and an equal number of age-, gender-, and literacy-matched controls without diabetes were administered the MMSE and RUDAS cognition scales in a one-to-one interview by a trained diabetic educator who was blinded to the groups. RESULTS: The study revealed that there was a significant difference in cognition scores between the diabetic patients with short duration (<5 years) and those with a longer history of diabetes (≥5 years) only in the MMSE scale using independent sample t-test (P = 0.018), unlike the RUDAS in which the difference was insignificant (P = 0.235). Similarly, there was also a significant correlation between glycemic control and cognition scores in the MMSE (P = 0.03), but not in the RUDAS scale (P = 0.083). CONCLUSION: MMSE scale has been proved to be advantageous over the RUDAS as a screening tool for cognition assessment in diabetes patients.

INTRODUCTION: Hand is an important medium of infection transmission. This is further worsened in the hospital setting where sources of contamination are abundant. Nurses play a vital role in patient care, and while doing so, they are often exposed to health hazards. Therefore, they may act as conduits for transmitting infectious diseases to themselves, family members, and other patients. Good hand hygiene is a prerequisite for infection control; therefore, the objective of this study is to determine the knowledge and practices of hand hygiene among nurses in our institution. MATERIALS AND METHODS: This was a cross-sectional study involving 113 nurses and it was conducted over 12 weeks; it was questionnaire based, which was pretested and self-administered. Convenience sampling was adopted. RESULTS: Data from 96 (85%) respondents consisting of 41 (42.7%) males and 55 (57.3%) females with male:female ratio of 0.7:1 were analyzed. All respondents reported using water and soap for hand-washing. Furthermore, majority (59%) of the respondents were not aware of the five moments of hand hygiene. Although majority (76%) reported adhering to the principles of good hand hygiene, 54.2% of the respondents could not correctly mention the steps of hand-washing technique. Sixty-six (68.8%) respondents wash their hands before attending to patients; however, almost all (99%) of the respondents wash their hands after attending to patients and after removing hand gloves. Similarly, all respondents wash their hands after using the restroom. CONCLUSION: The act of hand-washing is common among respondents in this study; however, the major challenge is with practicing the correct technique involved in hand-washing. Furthermore, knowledge of the critical moments of hand-washing was also deficient among most of the respondents.

OBJECTIVES: Canalith repositioning therapy (CRP) is usually effective treatment in benign paroxysmal positional vertigo (BPPV). However, still, some patients present residual dizziness after successful and effective repositioning maneuver. The objective of this study was to evaluate the therapeutic effect of Ginkgo biloba extract on residual dizziness after canalith repositioning maneuver in patients of BPPV. G. biloba is a phytomedicine which enhances the blood supply to inner ear and brain. MATERIALS AND METHODS: Ninety-two patients with BPPV were divided into two treatment groups, Ginkgo biloba group and Non-Ginkgo biloba group. In this prospective study, the Ginkgo biloba group received the similar CRP as the non-Ginkgo biloba group, with addition of G. biloba treatment after CRP. The duration of residual dizziness of Ginkgo biloba group and non-Ginkgo biloba group were compared. The scores of dizziness handicap inventory of these two groups were also compared. RESULTS: The duration of residual dizziness of Ginkgo biloba group was shorter than non-Ginkgo biloba group. There were no significant differences in the dizziness handicap inventory scores in the 1^st week, whereas many significant differences in 2^nd, 3^rd, 4^th, 5^th, 6^th, 7^th, and 8^th weeks. CONCLUSION: This study demonstrates that G. biloba can significantly minimize the residual dizziness after successful therapy with repositioning maneuver in patients of BPPV.

BACKGROUND: Scrub typhus is a zoonotic rickettsial illness caused by Orientia tsutsugamushi and has been reported from Southeast Asia, the Asian Pacific Rim, and Australia. It is an emerging pathogen in Southern India, especially in the urban setting. The objective of this study was to identify scrub typhus infection among febrile patients and to identify clinical manifestations related to the disease. METHODS: In this prospective cross-sectional study, febrile patients who presented to the Department of Experimental Medicine at the Tamil Nadu Dr. M.G.R. Medical University between November 2015 and February 2016 were enrolled. Demographics and clinical manifestations were recorded using a semi-structured questionnaire. Serum was separated from 2 ml of blood sample for testing. The Scrub Typhus Detect ELISA test was performed as per manufacturer's instructions. Statistical data analysis was done. RESULTS: A total of 100 patients were enrolled and their age ranged from 4 to 80 years with a mean of 30 years. Nearly 56% were males. Ig M antibodies for O. tsutsugamushi were present in 23% of cases. Most (65%) of the positive patients were females. About 48% positives for scrub typhus were 4–20 years old. Clinical presentations in these patients were fever (100%), myalgia (73.9%), headache (65.2%), nausea (60.9%), cough (60.9%), abdominal pain (52.2%), vomiting (47.8%), breathlessness (39.1%), diarrhea (34.8%), and decreased urine output (26.1%). Eschar was seen in 7 patients of whom 2 were positive for scrub typhus. CONCLUSIONS: In this study, 23% of febrile patients were positive for scrub typhus infection. Therefore, it needs to be included in the differential diagnosis of febrile illnesses in Chennai city.

Complex partial seizures occur when an epileptic discharge arises from a localized region of a cerebral hemisphere along with involvement of some degree of impaired consciousness. They have varied clinical presentations and mimic many clinical syndromes. We hereby report a case of a 39-year-old man who presents with symptoms suggestive of mania and was treated with antipsychotics with minimal improvement in symptoms. Subsequently, following a detailed evaluation, he was diagnosed to have temporal lobe epilepsy. The case presents the diagnostic dilemma involved in dealing with atypical presentations of epilepsy.

Burkitt's lymphoma is the most common B-cell lymphoma of childhood rarely localized to the gastrointestinal tract. Further, intussusception secondary to Burkitt's lymphoma is an uncommon presentation. We describe an unusual case of intestinal Burkitt's lymphoma in a 4-year-old boy who presented to the emergency department with intermittent colicky pain. Imaging studies were suggestive of intussusception which was reduced on exploratory laparotomy. Gross examination of the resected bowel revealed a gray-white to pink fleshy tumor encompassing 90% of the ileocecal valve circumference. Histopathology supplemented with immunohistochemistry was suggestive of Burkitt's lymphoma. Owing to rather nonspecific clinicoradiological features, its preoperative diagnosis remains a challenging task for the pediatric surgeons as well as radiologists.