A Randomized controlled trial to assess the effectiveness of group-based Diabetes Self-Management Education (DSME) program on glycemic control and self-care activities among type-2 diabetics in South-East Delhi

Introduction: India has the second-largest population of diabetes globally. The long-term complications due to poor glycemic control are concerning. Diabetes Self-Management Education (DSME) is a fundamental component in managing diabetes better. Objectives: This study was conducted to compare the effectiveness of group-based DSME in achieving glycemic control and improving self-care practices among people with type-2 diabetes as against the usual care. Methods: A nonblinded parallel-arm RCT among adults (? 30 years) diagnosed with Type-2 DM. Written informed consent was taken from each patient before enrollment. The sample size is estimated to be 85 in each arm according to the formula for equivalence design for an RCT. Randomization was done using a computer-generated random number table. The control arm received usual care, while the intervention group received group-based DSME in addition to usual care. At the end of 6 months, the change in glycemic control and self-care activity scores were compared between the two arms. Results: A total of 139 individuals (intervention =69; control =70) were analyzed. The proportion of females (62.1%) was higher than males (37.9%). There was no statistically significant difference at baseline. At end line, HbA1c showed a reduction from 9.3% to 6.9% in the intervention arm (P<0.001), which was greater than that in the control arm (p=0.017). All the self-care components showed a statistically significant improvement, except the medication score. Conclusions: Group-based DSME effectively increases self-care practices among people with diabetes, resulting in better glycemic control.

A Mixed Method Study to Assess Notification of Tuberculosis Patients by Private Practitioners in New Delhi, India

Background: A staggering one million tuberculosis (TB) cases are missing from notification, most of them being diagnosed and treated in the private sector. To curb this issue, the Government of India declared TB as a notifiable disease and NIKSHAY was launched in 2012. However, even after years of implementation, as per the report published by TB India 2020, the proportion of private case notification of total TB cases is very low. Objectives: The objectives of the study were to assess the current practices related to TB Notification being followed by private practitioners of Delhi and to explore the enablers and barriers to TB notification among private‑sector treatment providers. Methods: This cross‑sectional study was done from January 2019 to January 2020. Six hundred doctors were line listed under the chosen TB unit, 375 gave consent and in depth interview was conducted among them. Data were collected on the reporting status and facilitators and barrier toward NIKSHAY reporting were assessed. For the qualitative component, focused group discussions were done. Results: Out of 375 private practitioners, over two‑third (68%) practitioners reported that they were not treating TB patients. Out of 108 doctors treating patients only 50% were reporting the cases. Major reason cited for not reporting was “don’t know how to” and major barrier considered was “lack of training.” Conclusion: Strategies such as training and retraining, and one‑to‑one sensitization of private practitioners to address barriers may enhance TB notification.

Posttransplant epithelioid inflammatory myofibroblastic sarcoma: A case report

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare entity and a novel variant of inflammatory myofibroblastic tumor (IMT), usually seen in children and nonsmoking young adults. Their occurrence in a posttransplant setting is still rare. These tumors are characterized by prominent epithelioid morphology, large histiocytoid “Reed Sternberg”-like cell, unique pattern of ALK immuno-reactivity, and aggressive clinical behavior. Their etiology and metastatic potential is controversial. In a post-transplant setting, many factors such as trauma, infections with EBV, HIV, Hepatitis C, mycobacteria, fungus, and chemotherapy-induced immunosuppression have been implicated in their etiology. We present the case of a 2-year-old female child who developed multiple omental and mesenteric tumor nodules, 8 months post liver transplant for progressive familial intrahepatic cholestasis (PFIC). Following a histopathological diagnosis of “mesenchymal neoplasm of possible malignant nature” on a trucut biopsy and frozen section, tumor debulking was performed. A final histological diagnosis of EMIS was made on the completely resected tumor. The patient remains in remission nearly 7 months after presentation, without any follow-up systemic chemotherapy. IMT after a solid organ transplant is rare, only 5 cases have been reported in the literature until now. Similar phenomenon has also been noted with hematopoietic stem cell transplant. However, to our knowledge, this case of EMIS in a post liver transplant patient is first of its kind.

Perceptions about abortion among college going late adolescent girls of Ranchi Women’s College, Ranchi, Jharkhand - A pilot study

Background: Increase in teenage pregnancy and illegal abortion have become a major concern in India and understanding adolescent sexual behavior still remains a challenge. Nearly 60% of abortion in India is illegal. Objectives: The objectives of this study were to assess the level of knowledge about abortion among late adolescent girls (16–19 years). Materials and Methods: A cross-sectional study was conducted among Bachelor of Arts 1st year students of Ranchi Women’s College, Ranchi. It included girls in the age group of 16–19 years. The duration of the study was 3 months (August–October 2018). A semi-structured questionnaire was used to collect the data. The descriptive statistics analysis includes percentage and mean with standard deviation. To assess the knowledge level scoring was done. Analysis of variance was done to test the difference in knowledge score. Ethical approval was obtained from the institutional ethics committee and permission was then taken from the principal of Ranchi Women’s College. Results: A total of 71 students gave assent/consent. The mean age of study subjects was 18.25 (0.68) years. Every student had heard about abortion, but still 19 of them thought abortion to be illegal in India. Of 22 students who claimed to know the gestational age up to which abortion can be done, only 5.6% had correct knowledge. Regarding the place where abortion must be done, 40.8% answered correctly. Most of the respondents (39.4%) mentioned rape to be the condition for legal abortion followed by risk of child abnormality. The common complication is known as bleeding and infection. Friends were the most common source of information. Only 2.8% of girls had satisfactory knowledge, the average and low knowledge being present in 33.8% and 63.4% of girls, respectively. Conclusion: This study seeks to determine the existing knowledge of teenagers which was found to be very low. This calls researchers to explore the existing knowledge gap and ways to reduce it at early stage so that maximum could be benefitted from MTP act.

Deciphering diversity in populations of various linguistic and ethnic affiliations of different geographical regions of India: analysis based on 15 microsatellite markers.

The extent of genetic polymorphism at fifteen autosomal microsatellite markers in 54 ethnically, linguistically and geographically diverse human populations of India was studied to decipher intrapopulation diversity. The parameters used to quantify intrapopulation diversity were average allele diversity, average heterozygosity, allele range (base pairs), and number of alleles. Multilocus genotype frequencies calculated for selected populations were utilized for testing conformity with the assumption of Hardy-Weinberg equilibrium. The exact test values, after Bonferroni correction, showed significant deviation amongst Gowda (vWA, Penta E); Dhangar, Satnami and Gounder (D8S1179); Hmar (FGA); Kuki and Balti (vWA) groups. Relatively low number of alleles and allelic diversity (base-pairs size) had been observed in populations of central India as compared with southern and northern regions of the country. The communities of Indo-Caucasoid ethnic origin and Indo-European linguistic family (Kshatriya of Uttar Pradesh) showed highest allelic diversity, as well as rare alleles, not reported in any other Indian populations. Analysis based on average heterozygosity was also found to be lowest among the populations of central India (0.729) and highest among the populations from north (0.777) and west (0.784) regions of the country, having Indo-Caucasoid ethnic origin and Austro-Asiatic linguistic affiliation. The maximum power of discrimination (85%-89%) had been observed at loci FGA, Penta E, D18S51 and D21S11, suggested high intrapopulation diversity in India. Genetic diversity revealed by STR markers was consistent with the known demographic histories of populations. Thus, the present study clearly demonstrated that the intrapopulation diversity is not only present at the national level, but also within smaller geographical regions of the country. This is the first attempt to understand the extent of diversity within populations of India at such a large scale at genomic level.

Genetic variation at minisatellite loci D1S7, D4S139, D5S110 and D17S79 among three population groups of eastern India.

Genetic variation at four minisatellite loci D1S7, D4S139, D5S110 and D17S79 in three predominant population groups of eastern India, namely Brahmin, Kayastha and Garo, are reported in this study. The Brahmin and Kayastha are of Indo-Caucasoid origin while the Garo community represents the Indo-Mongoloid ethnic group. The methodology employed comprised generation of HaeIII-restricted fragments of isolated DNA, Southern blotting, and hybridization using chemiluminescent probes MS1, pH30, LH1 and V1 for the four loci. All four loci were highly polymorphic in the population groups. Heterozygosity values for the four loci ranged between 0.68 and 0.95. Neither departure from Hardy Weinberg expectations nor evidence of any association across alleles among the selected loci was observed. The gene differentiation value among the loci is moderate (GST = 0.027). A neighbour-joining tree constructed on the basis of the generated data shows very low genetic distance between the Brahmin and Kayastha communities in relation to the Garo. Our results based on genetic distance analysis are consistent with results of earlier studies based on serological markers and linguistic as well as morphological affiliations of these populations and their Indo-Caucasoid and Indo-Mongoloid origin. The minisatellite loci studied here were found to be not only useful in showing significant genetic variation between the populations but also to be suitable for human identity testing among eastern Indian populations.

DNA aneuploidy in invasive carcinoma of the uterine cervix.

Forty cases of squamous cell carcinoma and twenty cases of adenocarcinoma of the cervix were subjected to DNA ploidy analysis to find out the frequency of aneuploid DNA pattern in different types of invasive carcinoma of the uterine cervix and their possible correlation with the clinical stage and age of the patients. From the DNA analysis an increasing trend of DNA aneuploidy was observed from well differentiated (63.6%) to moderately differentiated (70.8%) to poorly differentiated squamous cell carcinoma (83.3%). However, 85% adenocarcinomas of endocervix showed aneuploid DNA pattern. It indicates that aneuploidy increases with tumour dedifferentiation and further confirms the importance of DNA ploidy as a high risk indicator.

Interobserver agreement in the diagnosis of cervical smears.

The present study was carried out to reveal the magnitude of individual variation in the diagnosis of Pap smears between two cytoscreeners and their compatability with cytopathologists and subsequent final diagnostic comparison with biopsy in 1,17411 cervical smears collected from different hospitals of Delhi during ten-year period. Smears diagnosed as dysplasia at initial level by any one of the cytoscreeners were screened by cytopathologists for confirmation of diagnosis. An overall agreement of 94.9 percent was observed between two screens. 79.5 percent was agreement between screeners and cytopathologists. An agreement between cytology and histology in the diagnosis of dysplasia and malignancy were found to be 61.9 percent and dysplasia and malignancy were found to be 61.9 percent and 40.1 percent respectively. From the above study, it was observed that consistency among the two screeners was fairly acceptable. Keeping this observation in view, we can possibly practice two tier screening in place of three.

Predictive value of morphological nuclear parameters and DNA ploidy pattern in precancerous lesions of the uterine cervix.

To evaluate the supportive role of image cytometry and DNA ploidy analysis in the precancerous and cancerous lesions of the uterine cervix, the present study was performed on 45 cervical smears, initially diagnosed as dysplasia and malignant. Twenty normal and inflammatory smears were taken as a control for the study. Morphometric parameters and microphotometric DNA measurements were performed on 50 cells in each case. On the basis of nuclear area dysplastic lesions were categorised into two groups i.e. low grade lesions having nuclear area upto 85 sq. mu m and high grade lesions having nuclear area above 85 sq. mu m. The results were compared with DNA ploidy analysis. It is revealed from the study that 85.7% low grade lesions with diploid and polyploid DNA, value mostly regressed to inflammation and 78.5% high grade lesion with aneuploid DNA value progressed to malignancy. However, initial malignant cases having aneuploid DNA value exhibit invasive cancer during their follow up. It indicates that combination of morphometry and DNA cytometry can be used as an adjunct to cytologic diagnosis to predict the biologic outcome of the lesions.

Microphotometric DNA analysis in mild and moderate dysplasia of the uterine cervix: a retrospective study.

Twenty six cases of mild and moderate dysplasia of uterine cervix were retrospectively subjected to microphotometric study for nuclear DNA estimation in order to correlate their ploidy pattern with biological behaviour at initial presentation and during follow up intervals ranging from six months to six years (median-30.8 months). Of these, fourteen cases had progressed to malignancy, five persisted as dysplasia and seven had regressed to normalcy or inflammation. DNA value of these cases revealed aneuploidy in ten cases whereas polyploid and euploid DNA pattern were observed in eight cases each. Of the ten aneuploid cases eight (80.0 per cent) progressed to malignancy while two persisted as dysplasia. Of the sixteen polyploid and euploid cases, only six (37.8%) progressed to malignancy. However, five of these six cases developed aneuploidy during follow up or at the point of progression to malignancy. The findings indicate that aneuploidy in mild and moderate dysplasia cases is a reliable "high risk indicator".