Certified that the dissertation titled “A COMPARATIVE STUDY ON THE RISK FACTOR, CLINICAL PROFILE, AND OUTCOME OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS OF AGE LESS THAN AND MORE THAN 40 YEARS” is a bonafide work of the candidate Dr.M.GEETHA, post graduate student, Department of General Medicine, Kilpauk Medical College, Chennai – 10, done under my guidance and supervision, in partial fulfillment of regulations of The Tamilnadu Dr. MGR Medical University for the award of M.D. Degree Branch I, (General Medicine) during the academic period from May 2007 to March 2010.
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years of age were considered young and >40 years as old. An additional 10% patients were recruited to account for any potential information loss and dropouts. Informed consent was obt ained from all the su bjects. AMI was diagnosed based on presenting symptoms, cardiac enzymes, and electrocardiography (ECG) changes. Patients with history of any prior cardiac-related surgery were excluded. Coronary angiography (CAG) and primary PCI in all patients were performed by interventional
Erythrocytes are extravasated from microvessels which are disrupted in lesions which are more advanced leading to deposition of heme which is an iron source which catalyzes the reaction by fenton chemistry in the extracellular space. As a result of proteoglycan binding delaying the transit of lipoproteins enzymes myeloperoxidase and phospholipases have an increased opportunity for lipoprotein modification . The production of oxidized phospholipids by this mechanism leading to production of biologically active species that are capable of eliciting an inflammatory response in the intrinsic vascular wall cells and leukocytes. The link between, lipoprotein particle accumulation in early atherosclerotic lesion and pro inflammatory reactions which amplify and sustain the process of atherosclerosis is the response to retention of particles in the vessel wall.
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Injuries can occur at any age and the causes may vary from one age group to another group. In case of children , injuries are due to dangerous games and sharp pointed toys more commonly, while in adults they are mostly industrial injuries. In farmers, agriculture related injuries are quite common. Men are more likely to sustain an eye injury than women.
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Furthermore, some epileptic seizures have symptoms that are frequently misdiagnosed as psychogenic. Frontal lobe complex partial seizures often last less than 1 minute and sometimes include rocking, kicking, "bicycling," pelvic thrusting, genital manipulation, and cursing. Their lack of postictal symptoms also makes frontal lobe seizures difficult to differentiate from psychogenic seizures.
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performance styles were essentially anti-naturalistic because of their deployment of a restricted and formal system of dramatic gestures , the new performance style allowed film melodramas to adopt a more complex sentimentality in service to its ambitions as dramatic art. Slapstick benefited from the shift in performance style because the naturalism and seriousness imputed to the new gestural regime made it an ideal vehicle for jabs at the suffocating affects and mores of bourgeois propriety. Severing the connection between physical performance and the characters and narrative actions that could be represented openly onstage also meant that stage and screen gestures attained a new freedom to expose subjectivities and situations that could not be proclaimed openly for reasons of moral and legal censure. Chaplin was the comedian who took this the furthest, in part because his oscillation between romantic sentimentality, close sociological observation, and physical buffoonery positioned him between melodrama and the technical virtuosity of Buster Keaton or committed vulgarity of Stan Laurel and Oliver Hardy. The chapter also provides an overview of factors that militate in favour of reading Chaplin’s Tramp character as queer, or at least as sometimes or potentially queer. Quasi-ethnographic research and a series of pamphlets and speaking engagements in England and the United States by “self-titled tramp authority” Josiah Flynt Willard, raised awareness among turn-of-the-century Americans about the propensity of tramps to seduce young boys into sexual servitude with stories about the freedom of life on the road. 46 Chaplin’s signature moustache may also have implicated him in vice, or at least a suspicious rejection of the professional and domestic respectability of middle-class men. In broader terms, the constellation of affects that established critical appreciation of other stars as queer were also part of Chaplin’s star text, serving to establish him as the sensitive and artistic other to his contemporaries in slapstick.
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Further clinical signs of gonarthrosis are crepitus, pal- pable osteophytes, coarsening of joint contour, varus or valgus deformity, and joint instability. Because almost 40% of patients with OA are asymptomatic, Kellgren and Lawrence introduced a set of radiologic criteria in 1957. A more specific classification was developed in 1986 by the American Rheumatism Association (ARA), now called the American College of Rheumatology (ACR). These criteria have been validated and include several clinical and radiographic examinations . As long as no cure exists, the main emphasis of OA treatment is analge- sia, through either increasing mobility or medication administration. Initially, non-pharmacologic therapies are attempted, followed by the addition of medication, and ultimately surgical intervention [12-14].
PREVALENCE OF URINARY TRACT INFECTION IN FEBRILE CHILDREN LESS THAN 5 YEARS OF AGE” submitted by Dr.K.Visalakshi, MBBS, to The Tamilnadu Dr.M.G.R. Medical University, Chennai, in partial fulfilment for the award of M.D (Paediatrics) is a bonafide work carried out by her under my guidance and supervision during the academic year 2013-2016. This dissertation partially or fully has not been submitted for any other degree or diploma of this university or other.
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The present study revealed that Rotavirus A infection was 28%. This study is similar to other studies con- ducted by Sherchand et al. (35.4%) , Dhital et al. (22.9%) , Ansari et al. (25.9%) , Pun et al. (23.5%) , Saeed et al. (22%)  and Akran et al. (28.9%)  while Reither et al. (55%)  reported slightly higher positivity rate. Although, improvements in nutrition hy- giene, increased awareness among caretakers and the use of oral rehydration therapy contributed to declining the incidence of diarrheal diseases over the past years in Nepal, this result revealed that Rotavirus A infection remained high among diarrheal children .
tal and includes very complex cases, which, on the other hand, have been treated by highly specialised surgeons. Another important factor that can be modified is the pros- thetic component. Uncemented components are gener- ally much less likely to fail than cemented ones. However, our results appear to be in contrast with those of other reg- isters . Nevertheless, reading the data more carefully reveals that as experience using uncemented components increases, the difference in results between the two types of prostheses decreases, and the efficacy of uncemented prostheses is highlighted especially with regards to young [12,17] or middle-aged patients .
In India, poverty is a major issue people suffer from poor infrastructure. Only 84 per cent of the population has access to clean drinking water and only 21 per cent to adequate sanitation facilities. The literacy rate continues to be low around 73 per cent for men and about 48 per cent for women. The access to quality health care is also a concern. At present the life expectancy rate is relatively low at 65.7 years for men and 67.9 years for women. It is estimated that 2.4 million people live with HIV/AIDS (2009 est.). Simply the priority of a family living in poverty is to survive. Any additional income from a child working gives them a better chance of having enough food and shelter.
Mass drug administration with azithromycin for tra- choma control has shown benefit elsewhere. One study in Gambia, evaluated malaria indices in children aged 5–14 years following MDA of azithromycin for trachoma . Four villages were randomly selected to undergo community wide (i.e. all residents) MDA with three doses of azithromycin. Four control villages underwent 6 weeks of daily topical tetracycline. At day 28 following treat- ment, there was a significant reduction in P. falciparum, Plasmodium malariae, febrile parasitaemia and rates of palpable splenomegaly in those who received the three doses of azithromycin. Similarly, a cluster randomized trial in Niger showed significantly lower rates of para- sitaemia in those communities that underwent two vs. single mass distribution of azithromycin 4–5 months post-treatment .
Nasopharyngeal carriage of S. pneumoniae always pre- cedes disease and serves as a reservoir for the transmission of the pathogen . Although there are more than 90 known pneumococcal serotypes, about 20 serotypes ac- count for over 75% of the IPD cases . Each serotype differs in prevalence, age group infected, geographical distribution, and antimicrobial resistance patterns [11-15]. Local knowledge of circulating serotypes and their anti- microbial susceptibility profiles is therefore imperative for the development of effective vaccine strategies and treatment protocols [7,16]. Several vaccines have been developed including a 23-valent polysaccharide vaccine (PPV-23, Pneumovax®, Merck) used to immunize the elderly and children over two years of age. For children under two years of age, a 10-valent pneumococcal
Results: Of the 1087 episodes of AGE registered, 33.89 % were RVGE positive. The estimated incidence of RVGE, was 40.3 (95 % CI 36.1 – 44.8) episodes per 10,000 child-months in children ≤ 3 years of age and the 5-month (December-April) seasonal RVGE incidence rate was 2.01 [1.81 – 2.24] per 100 children. No vaccination and attending a day care centre were the main risk factors for RV infection. RVGE infected children presented more frequently with fever (63.9 % vs. 45.1 %, p = 0.009), vomiting (61.2 % vs. 44.3 %, p = 0.015), suffered more dehydration, and were hospitalised and went to the emergency room more often (41.7 % vs. 15.7 %, p <0.001) than non-RVGE infected ones. Children were usually more tired (77.5 % vs. 54.2 %, p <0.001), tearful, (47.2 % vs. 34.8 %, p <0.001), and easily irritated (76.5 % vs. 59.8 %, p <0.001), and parents were more concerned (41.7 % vs. 15.7 %, p <0.001) and suffered more working rhythm disturbances (39.0 % vs. 22.9 %, p <0.001). The cost for families of RVGE cases was significantly higher than the cost of non-RVGE infected ones (47.3 vs 36.7 euros, p = 0.011). Vaccinated children suffered less clinical symptoms and no hospitalization. Therefore, vaccination decreases the psychosocial stressors caused by the disease in the family.
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We cannot conclude with certainty from our study that antenatal corticosteroids contributed to the higher IQ and height SD scores in the group so exposed because of the nonrandomization of therapy between the groups. However, because corticoste- roids enhance the survival of smaller or more imma- ture children and because outcomes such as IQ and growth vary negatively with weight or gestational age at birth, complete cohorts of survivors from the randomized, controlled trials may differ in their peri- natal characteristics between those exposed and those unexposed to antenatal corticosteroids. The corticosteroid groups could be lighter or more im- mature at birth, as was the case in the follow-up study from Auckland, 3,4 and hence, IQ and growth
high burden of malaria-related illness as reported by the care- takers. In the 2 weeks before the survey, > 20% had sought health care for their child because of a febrile illness, and more than one third of children had been treated with anti- malarials. Wide-scale treatment with partially effective ma- laria drugs may not clear most infections but will lower para- site densities. Based on rapid malaria test results, the preva- lence of malaria infection was somewhat higher than those based on slides (72.3%). This difference could be explained by recent treatment of clinical illness resulting in clearance of a (small) subset of malaria infections in the last week. As such, the observed clinical malaria prevalence may be an un- derestimation of the true burden of clinical illness caused by malaria. The majority of clinical malaria cases also occurred below the age of 2 years, whereas parasite prevalence in- creased until 2–3 years of age before leveling off and remain- ing high.
There is an increased incidence of intrauterine growth retardation in developing countries. For example, in India alone the mean full term birthweight is <2.7 kg, which is almost 1 kg lower than in the European population. It has been postulated that the low birth weight contributes to CVD and metabolic syndrome in Indians. In Pune Children’s Study, CVD risk factors were followed up in 201 children born in a single institution. At the age of 4 years, lower birth weight children had higher plasma insulin and glucose concentrations after an oral glucose load and higher IGF-I concentrations. On further follow up at the age of 8, there was an inverse relationship between birth weight and the incidence of metabolic syndromes. An interesting feature of this study is that the most adverse risk profile was found in children who were small at birth but had a high weight and fat mass at 8 years. All these data suggest that insulin resistance was associated with an increased body mass in children which is further exacerbated by low birth weight.
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Access permitting participation also blended in the settings of interview as specific tasks oriented dialogue. With Geoff for instance after capturing a lengthy and overwhelming life story account dialogue turned to individual and collaborative practice and the possibility of redesigning the label website began focusing interaction, opening up site boundaries and creating connections between them (i.e. as the experienced General MIDI was invited in by Geoff to help redesign the site). Through doing so strategies and settings common within the case was shown experienced through an array of different tactics between the sites, and therefore thickened understanding of the relational settings of practice. Similarly with a.P.A.t.T. group dialogue over a series of encounters was oriented around the task of recompiling their Wikipedia entry as my own human resource and writing ability was absorbed. As study of a.P.A.t.T. gave way to greater access to a wider milieu of musical entrepreneurs in Liverpool extending out of the site boundaries into thickness of musical entrepreneurship in the Mersey basin, focused interviews were exchanged for make do recordings of meetings and brief encounters, and I played active role in meetings by designing tactical statements to pass authorities. Informal interviews, moments of focused group interaction, throwaway citations and authorisations were recorded by any means possible. The site was thickened by citing the wider case and those not operating within the site but inherent to its significance. As friendship developed with a.P.A.t.T. and Davies, and study gave way to more ordinary encounters, active participation completely limited any ability to retrieve unbiased description. Participation could not be distinguished from naturalistic setting, nor should it have been (Marcus 1998; Denzin & Lincoln 2008).
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. These children are in a even more difficult situation than ones with separated parents. The living parent may marry for the second time and the arrival of the newcomer may mean end of the world to the child. If the living parent falls sick, the child may be forced to take care of him/her, the other siblings and the entire family. In addition the child can suffer all the disadvantages already mentioned for the children with separated parents.
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Doubt and uncertainty are the main concerns of the play and the characters, with their major quest to be to know one another. The signifiers used by the guards such as "long live the King", "He", "A piece of him" as the introduction of themselves are illusive and playful. They foreshadow Hamlet's quest for "What a piece of work is a man!" In his quest to know Claudius, who has baffled him by being "more than kin and less than kind" to him, hamlet uses signifiers or tropes such as "The mouse-trap." Yet a man is not known, in an Existential sense, until he is dead, since man's existence precedes his essence, and his so- called self being just a bubble, he is no more than the totality of his deeds. It is thus meaningful and perhaps symbolic that Polonius' identity is revealed only after his death by Hamlet, when his report card of his deeds, like anybody else, is completed, his self is determined and defined, and people's final judgments of him are decided.