Primary health center (PHC) is a first port of call to a qualified doctor of the public sector in rural areas. Standards are the main driver for continuous improvement in quality. The performance of PHCs can be assessed against the Indian Public Health Standards (IPHS) recommended for PHCs in early 2007. The overall objective of IPHS for PHCs is to provide health care, i.e., quality oriented and sensitive to the needs of the community. These standards would also help monitor and improve the functioning of the PHCs.

This study was carried out to assess (1) the infrastructure, equipments, instruments, staffing, and other facilities; (2) the services being provided at PHCs; (3) to find out the reasons for nonutilization of health services and suggest remedial measures for the same.

This was a cross-sectional study at two PHCs, namely Thatiya and Umerda of Tirwa block of Kannauj District selected randomly for assessment. Health care providers, mainly medical officers, were interviewed using pretested, precoded pro forma. Descriptive analysis was used as per study requirements.

It has been found that only outpatient department services were being provided with many missing components, such as one of the most important ones like maternal and child health and family planning. Physical infrastructure and facilities were inadequate at both the PHCs. Both of them were grossly underequipped and understaffed. Medical officers face their own problems; even basic amenities of life like water, electricity, canteen, etc., are lacking there.

Both the PHCs were not performing up to the expectations and standards of the Indian Public Health.

Masood A, Singh AK, Martolia DS, Midha T. Assessment of Indian Public Health Standards in the Primary Health Centers in a District of Uttar Pradesh, India. Int J Adv Integ Med Sci 2017;2(2):53-60.

The liver is the cornerstone of the coagulation system. The physiology of blood coagulation is closely linked to liver function as the liver synthesizes most of the factors of the coagulation cascade and fibrinolytic proteins.

The objective of this study was to evaluate coagulation abnormalities associated with chronic liver diseases and determine the coagulation abnormalities using various coagulation studies [prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time (BT), clotting time (CT), and platelet count].

This study included 300 patients clinically diagnosed with liver disease and who were divided into three categories – cirrhosis, hepatitis, and other liver diseases. The coagulation tests PT, APTT, BT, CT, and platelet count were performed and the results were evaluated in groups.

Out of the 300 patients, 156 were diagnosed with cirrhosis, 75 were of viral hepatitis, and 69 were of other liver diseases. About 62% (186/300) had prolonged PT. About 39.3% (118/300) had prolonged APTT. The BT was prolonged in 34% (102/300), while CT was prolonged in 10.6% (32/300). Thrombocytopenia was seen in 46% (138/300) patients.

We concluded that various abnormalities of coagulation tests vary greatly with different liver disorders, duration of the disorders, and their severity. Prolongation of PT and APTT in advancing liver cirrhosis indicates damage to the liver parenchyma resulting in decreased production of coagulation proteins with increased risk of bleeding tendencies, which can be detected before these ensue.

Bhatia G, Kaushik S, Kumar R, Kishore S, Bhatia U. Coagulation Profile in Liver Diseases: A Study of 300 Cases in a Tertiary Care Hospital in Uttarakhand, India. Int J Adv Integ Med Sci 2017;2(2):61-64.

Postoperative nausea and vomiting (PONV) is a well-known entity following surgical procedures and may result in serious complications including aspiration of gastric contents, prolonged recovery period, and impaired surgical wound healing. Laparoscopic surgery is a known risk factor for PONV. Also, the incidence of vomiting after ear nose throat (ENT) surgeries is relatively high.

Our aim of the study is to compare the effectiveness of ondansetron, palonosetron, ramosetron, and metoclopramide to prevent PONV in patients undergoing laparoscopic and ENT surgery under general anesthesia.

The present study was conducted on 120 adult patients scheduled for elective laparoscopic chole­cystectomy and ENT surgery under general anesthesia. All patients were randomized into four groups (O, P, R, and M) with 30 patients each and received injection ondansetron (4 mg), palonosetron (0.075 mg), ramosetron (0.3 mg), and metoclopramide (10 mg) intravenously during premedication. Patients were observed intraoperatively and 24 hours postoperatively for any episodes of nausea and vomiting. All the patients were observed for side effects, such as dizziness, headache, allergic reactions, etc.

Palonosetron is quite effective in prevention of PONV compared with ramosetron, ondansetron, and metoclopramide given intravenously for various surgical procedures under general anesthesia. Its effectiveness in PONV provides a new cost-effective agent to the present recital of antiemetic drugs.

Vinay V, Agrawal AP, Verma AP, Krishan G, Ahmad R, Hanjura S. A Clinical Comparative Study of Ondansetron, Palonosetron, Ramosetron, and Metoclopramide for Prevention of Postoperative Nausea and Vomiting in Patients undergoing Laparoscopic and ENT Surgery under General Anesthesia. Int J Adv Integ Med Sci 2017;2(2):65-69.

The present study was undertaken to observe the variations of the first rib and understand the significance of such variations.

Fifty first ribs obtained from the Museum of Anatomy Department of Rohilkhand Medical College & Hospital, Bareilly, Uttar Pradesh, India, were studied to see if any anomaly was present and check its incidence in the Indian population sample and draw clinical and other signi­ficances of such variations.

The findings are discussed and conclusions are drawn. Variations detected include absence of scalene tubercle, vascular groove on the superior surface, rudimentary head and tubercle of the rib, oblique ridge, and exostosis. Their incidence and significance are discussed.

The findings are of considerable clinical, regional, and racial significance.

Structural malformations of first rib are common, and when present may lead to compression of the neurovascular bundle at the root of the neck. Awareness of such anomalies is important for anatomists, radiologists, and thoracic surgeons dealing with this region.

Rashia S, Zaidi SHH. A Morphological Study of First Rib Anomalies. Int J Adv Integ Med Sci 2017;2(2):70-72.

Combined spinal–epidural analgesia to provide pain relief in labor has become the technique of choice. It provides benefits of both spinal analgesia and flexibility of an epidural catheter. In this study, we compared levobupivacaine with fetanyl and ropivacaine with fentanyl in terms of onset and duration of sensory blockade.

This was a double-blind randomized study on 60 parturients of American Society of Anesthesiologists status 1 and 2, all primipara with singleton pregnancy in active labor, were allocated randomly into two groups of 30 each. Group L received 3 mg of levobupivacaine intrathecally with 25 µg fentanyl followed by epidural top-ups of 14 mL levobupivacaine 0.125% with fentanyl 30 µg, whereas group R received 4 mg of ropivacaine intrathecally with 25 µg of fentanyl followed by epidural top-ups of 14 mL ropivacaine 0.2% with fentanyl 30 µg. Sensory and motor characteristics, hemodynamics, maternal and fetal outcomes, side effects, and complications were observed and analyzed statistically using Student's unpaired t-test and chi-squared test.

A rapid onset of analgesia in group L (4.67 ± 0.35) as compared with group R (5.57 ± 0.27) was observed. Duration of analgesia was also prolonged in group B (116.83 ± 6.91) as compared with group R (88.87 ± 5.10). Patients remained hemodynamically stable, and side effects and complications were comparable in both groups.

Levobupivacaine with fentanyl combination was found to be more promising in terms of onset and duration of labor analgesia as compared with ropivacaine and fentanyl combination.

Sharma YK, Agrawal M. Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study. Int J Adv Integ Med Sci 2017;2(2):73-77.

To evaluate the long-term efficacy, tolerability, and safety profile of iloperidone.

A 12 month, prospective, interventional, open label, flexible dose study was conducted on 50 drug naïve, first-episode patients aged 18 to 65 years, fulfilling the International Classification of Diseases-10 criteria for psychosis, for assessing long-term efficacy and adverse events, including biochemical parameters of iloperidone. Detailed clinical examination was carried out. Sociodemographic data and baseline parameters were recorded.

Two patients dropped out during the course of therapy. M/F ratio was 1.77:1. Mean age of patients was 28.76 ± 10.28 [mean ± standard deviation (SD)] years. Rural/urban ratio was 2.84:1.25. Patients were illiterate, 18 belonged to low socioeconomic class. It was observed that iloperidone was fairly efficacious not only in preventing relapse or aggravation of symptoms but also well restored the patient to almost near-normal till the end point. After 3 months, 20/48 (41.66%) patients showed significant weight gain that was evident. Mean total weight gain from baseline to end point was 2.89 kg and was statistically significant. There was significant rise in body mass index (BMI) but no patient crossed the upper normal limit. Iloperidone did not cause significant rise (p < 0.6955) in fasting blood sugar (FBS), and no significant alterations in total cholesterol (TC), triglyceride, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol were recorded. Dizziness was one of the earliest adverse events appearing within 2 to 3 days; others were insomnia, weight gain, increased appetite, anxiety, headache, sedation, etc.

On long-term basis, iloperidone is fairly efficacious and has favorable tolerability profile with modest weight gain and practically no alteration in FBS, and lipid profile as well as absence of extrapyramidal side effects.

Singh S, Singh HOK, Kuchhal A, Yadav A, Zaheer I. Long-term Effectiveness and Tolerability Profile of Iloperidone in Patients of Psychosis. Int J Adv Integ Med Sci 2017;2(2):78-84.

Psoriasis is an inflammatory skin disease, which may be persistent, disfiguring, and stigmatizing. The disease is frequent, with prevalence estimates ranging from 0.3 to 2.5%. It is characterized by thick, red, scaly lesion that may appear on any part of the body. Psoriasis is associated with significant psychological and psychiatric morbidity, experience of stigmatization, and decreased health-related quality of life (QOL).

The aims of this study were to estimate psychiatric morbidity and QOL in patients with psoriasis and to study the specified demographic, psychological, social, and illness-related correlates of psychiatric morbidity and QOL.

The study group consisted of 100 consecutive patients suffering from psoriasis and healthy controls. The assessment was done using General Health Questionnaire 12 items (GHQ-12), Psoriasis Area and Severity Index (PASI) scale, Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life BREF scale (WHOQOL-BREF). Patients were also subjected to clinical psychiatric examination. Only those subjects who scored ≥3 on GHQ-12 scale were administered HADS and WHOQOL-BREF.

This study revealed statistically significant association between number of relapses and depression score and between severity of skin lesions (PASI score) and depressive score.

Psoriasis markedly worsens the global well-being of patients and their cohabitants, who experienced an impairment of their QOL and higher levels of anxiety and depression.

Yaduvanshi R, Jaiswal A, Sharma CS, Kumar S, Ali R, Shrivastava RK, Rathoure PK. Psychiatric Morbidity and Quality of Life in Patients suffering from Psoriasis in a Tertiary Care Hospital. Int J Adv Integ Med Sci 2017;2(2):85-90.

Mohan S, Prajapati VK, Verma SK. Sterilization and Infection Control Measures in Dental Operatory. Int J Adv Integ Med Sci 2017;2(2):97-100.

Dharmshaktu GS, Singh P. Isolated Tuberculosis of Patella in a Child: A Case Report and Literature Review. Int J Adv Integ Med Sci 2017;2(2):101-103.

Gulati A, Kakkar V, Sharma C, Pareek M, Bishnoi S. Tuberculosis of Middle Ear. Int J Adv Integ Med Sci 2017;2(2):104-105.