Incidence and Determinants of Low birth weight babies at rural tertiary care hospital in central Uttar Pradesh

Background: An infant’s birth weight is a reliable index of intrauterine growth and a sensitive predictor of newborn chances of survival, growth and long-term physical and psychosocial development. Low birth weight has been defined as birth weight <2.5 kg regardless of gestational age. The incidence of low birth weight (LBW) in India varies between 25–30% and of which 60–65% are because of intrauterine growth retardation. Aim & Objective: To determine the incidence and various determinants of low birth weight among babies delivered at rural tertiary care hospitals in central Uttar Pradesh. Methods and Material: The study was conducted at UPUMS, Saifai, Etawah, among pregnant women who delivered babies from 1st January 2018 to 31st December 2018. Details regarding age of the mother, gravida, parity, gestation period, presence of complications, the procedure for delivery and birth weight of the newborn were recorded and analyzed using SPSS software (version 23) Results: A total of 7615 deliveries were conducted (53.2% were males, 46.8% were females). The mean birth weight of babies was 2.65 Kg with S.D ± 0.52. Preterm babies were 32% while 67% were term babies and 23% of babies were low birth weight. There was a statistically significant association between birth weight of babies and factors like age of mother, parity of mother, gestation period, and presence of complications during the antenatal period. Conclusions: Prompt identification of high-risk factors, prevention of premature delivery, increasing the use of health services during pregnancy and management of the risk factors would reduce the incidence of low birth weight.

Prevalence and Pattern of Substance Abuse among 18 to 60 years Male in a Rural Area of District Etawah, Uttar Pradesh

Abstract: Adolescent and young people’s behavior is of major concern due to Substance abuse. According to WHO, Substance abuse is consistently or sporadic drug use inconsistent with or unrelated to acceptable medical practice. Globally, alcohol and tobacco as a risk factors cause 4.0% and 4.1% of the overall burden of disability respectively. Objective: To determine the prevalence of substance abuse among 18 to 60 years’ male in rural Etawah and to identify type and pattern of substance abuse. Material and Methods: It was a community based cross sectional study carried out in five block of district Etawah for a period of one and half year. 1500 participants were interviewed using pre designed pre-tested questionnaire and data regarding socio demographic profile and pattern of abuse were collected. Data was entered in Microsoft excel sheet and analyzed by SPSS version 24 using appropriate statistical test. Result: Among 1500 participants, majority were below 30 years of age (i.e. 42.8%). In this study prevalence of Substance use among was 47% [707/1500]. Among all the other substance use, smokeless tobacco showed highest prevalence. Conclusion: Substance use is common in both urban as well as in rural area. So there is a need to educate and aware people regarding bad effects of drug abuse.

Patient satisfaction level in outpatient department in a private dental hospital

Background: In the dental field, patient satisfaction played a very important role, specifically finding the strength and weakness in the dental clinic. It also assists in improving the quality of treatment as well as better future planning of treatment. Objective: The present study was planned and conducted with an objective to assess the level of satisfaction among patients attending the outpatient department in a private dental hospital. Materials and Methods: A prospective, cross-sectional, and questionnaire-based study was undertaken in a private dental hospital. Patients of age more than 18 years and of both gender attending outdoor patient department were included in the study. For the purpose of this survey, consecutive sampling was carried out until a sample size of 200 was achieved. The patient satisfaction was assessed using dental satisfaction survey 2002 – questionnaire. Results: Among 31 items, none of the respondents indicated strong agreement or disagreement for 30 items, only for one item, item no. 14 regarding the explanation of cost, respondents indicated strong agreement (106, 53.00%). More than 40% of respondents indicated strong agreement (indicating satisfaction) with the statement for seven items. None of the items have <10% of respondents indicated strong agreement. The respondents expressing strong disagreement (indicating dissatisfaction) with any statement was <10% on 23 of the 31 items. The inter-item reliability of all 31 items of the questionnaire was tested, and the overall satisfaction scale (all items 1–31) produced a high Cronbach’s alpha value of 0.92. Conclusion: Patients’ satisfaction was observed not only for overall satisfaction but also in all sub-scales – context, content, outcome, cost, and facilities.

Association of Anemia with Cerebral Venous Thrombosis in Puerperium and its Pattern of Recovery

Background: Anemia is often considered to be a risk factor for cerebral venous thrombosis (CVT). We investigated the association between anemia and CVT. Methods:  42 postpartum /puerperal females were studied retrospectively for various factors like anemia, conscious level at admission, place of delivery (home or hospital) and their neurological sequel was measured at the time of discharge. Platelets counts were also noted (to rule out thrombocytosis). Anemia was defined according to World Health Organization criteria: non- pregnant women hemoglobin < 7.5 gm/dl, pregnant women < 6.9gm/dl. Modified Rankin Score (mRS) was taken as a scale for recovery. Results: Patients with CVT were younger (mean age 28). Anemia was more frequent in 32.7%. Hemoglobin as a continuous variable was inversely associated with CVT. Platelets counts, BT CT were normal hence no thrombocytosis was seen. No gross increase in WBC count was noted indicating absence of sepsis (puerperal). Outcome was favorable in 83% patients. N=4 (7%) patients died. Conclusions: We concluded that there is a positive correlation with increased levels of HbA1c and FBS (p˂0.001) in diabetic postmenopausal women and knee osteoarthritis. we found a significant association of severe anemia and CVT in patients of CVT of non-infectious origin, although the exact mechanism leading to hypercoagulability remains unclear and had poor prognosis.

Clinical Profile of Multiorgan Involvement in Malaria.

Background and aims: In view of high incidence, increasing morbidity and mortality due to malaria in an endemic area like Bikaner, it was planned to study the clinical profile of multiorgan involvement in Plasmodium vivax, Plasmodium falciparum and mixed type of malaria. Material and methods: Prospective data were collected from 201 adult patients with multiorgan involvement, admitted in classified malaria ward and confirmed by asexual parasitemia in peripheral blood film. Results: Prevalence of renal failure was 57.7%, cerebral malaria 47.8%, jaundice 41.8%, severe anemia (hemoglobin [Hb] ≤5 g/dl) in 31.8%, severe thrombocytopenia, shock, septicemia in 19.9%, 12.4%, 8.96%, respectively. Out of this P. vivax was associated with renal failure in 10.4%, with cerebral malaria in 7.46%, with jaundice in 9.5% and with severe anemia in 3.5%. Multiorgan dysfunction was a major cause of death in 25.87% patients (18.4%, P. falciparum 6%, P. vivax 1.5%, mixed). Acute respiratory distress syndrome (ARDS) was found in 14 (7%) of patients out of which 13 expired. Conclusion: P. vivax which was previously considered to be benign, has now turned to be malignant. ARDS came out with the worst outcome. Early institution of dialysis and use of antimalarial drugs aggressively can result in better prognosis.

A study on pulmonary manifestations in patients with malaria from north-western India (Bikaner).

Background & objectives: Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) are responsible for most of the global burden of malaria. With changing spectrum of clinical presentation in malaria, pulmonary system involvement has always been under diagnosed. The present study was planned to estimate the pulmonary system involvement in patients with malaria from north-western India (Bikaner). Study design & description of the patients: Our study was conducted during 2007 to 2009 in 200 cases of severe malaria [Pf , Pv, and mixed (Pf + Pv)] with pulmonary involvement. It included adult patients of both sexes (145 males and 55 females) belonging to all age groups. The diagnosis of Pf and Pv was confirmed by demonstrating asexual form of parasites in peripheral blood smear and OptiMal test. Main outcome measures: Pulmonary involvement was observed in 30% (60/200) patients among which cough in 24% , dyspnea in 12%, acute respiratory distress syndrome (ARDS) in 7% , bronchitis in 3% and pneumonia in 1.5% were the major clinical manifestations of malaria. Metabolic acidosis and low oxygen saturation was observed in 7% patients. Chest X-ray abnormality in 11.5% patients, 7% had bilateral infiltrates, 1.5% had inflammatory patch and 3% had findings suggestive of bronchitis. Spirometry findings showed 17% patients had early small airway obstruction. All the patients with ARDS had poor disease outcome. Results & conclusion: Our results suggest that pulmonary system involvement was observed in patients infected with Pf and Pv. If these clinical presentations are ignored, it may lead to delay in diagnosis and can alter the outcome and prognosis of the disease. Therefore, early diagnosis of malaria induced ARDS can significantly affect the outcome.

Serological aspects of Dengue fever and its correlation with clinical features in a recent febrile outbreak.

The study was done to assess correlation between serology and clinical features of Dengue fever at Burdwan Medical College, where after clinical examination, blood samples were processed by E.I.A. Of 139 cases, mostly between 1 to 20 years, Male-Female ratio was 80:59. Bleeding manifestation was observed only in 3 cases, and Lymphadenopathy, Myocarditis were uncommon features. Few patients have biphasic temperature. Fever and severity of symptoms did not have correlation. Patients' blood was examined for Dengue viruses, with only 44.6% positivity. Correlation exists between illness duration and antibody titer. [r = 0.41; (P < 0.01)]. Fever other, than Dengue also exhibited similar symptoms, but optical density in EIA test was less. As high fever with similar symptoms may be due to causes other than Dengue, thorough search for other viral infection namely Chikungunya should be done in endemic areas also.

Hospital-based case series of 175 cases of serologically confirmed brucellosis in Bikaner.

OBJECTIVE: To study the clinical spectrum of brucellosis in Bikaner (Northwest India). METHODS: A total of 175 cases were diagnosed as brucellosis during the period of six year (June 1997 to May 2003). They were studied for clinical profile and treated by rifampicin and doxycyclin and additionally streptomycin for initial 14 days in patients of neurobrucellosis. These patients were followed up to 3 months. RESULTS: Patients of brucellosis presented with a wide spectrum of clinical manifestations. Out of 175 cases 155 were from rural area. Age ranged between 12-60 years (124 males, 51 females). Analysis of risk factors revealed history of raw milk ingestion (86.86%), occupational contact with animals (81.14%), handling of infected material (62.28%), household contact (16%) and 2 patients were veterinarian. Joint pain (83.43%) and fever (77.71%) were the commonest presenting feature. Sacroiliac joint was most commonly involved (46.86%). 31 cases had involvement of multiple joints. Other mode of presentation were neurobrucellosis (18.86%), manifested as polyradiculoneuropathy, myeloradiculopathy, meningoencephalopathy and polyradiculomyeloencephalopathy; predominant pulmonary involvement (4.0%) presented as bronchitis, pneumonia and pleural effusion; epididymoorchitis, infective endocarditis, nephrotic syndrome and recurrent abortion. All patients responded well to the treatment. CONCLUSION: Brucellosis is an important emerging zoonotic disease but it is often under-diagnosed due to lack of suspicion and diagnostic facilities despite the fact that cattle farming (an important high risk group) is one of the main occupation in rural area. This report should infuse the awareness about this reemerging disease specifically in high-risk group.

Cardiovascular risk factors in tobacco-chewers: a controlled study.

BACKGROUND : Influence of habitual tobacco chewing on cardiovascular risk has not been well studied. To determine prevalence of major cardiovascular risk factors in subjects who habitually chew tobacco we performed a controlled study. METHODS : A population based case-control study was performed in Bikaner in North-western India where the prevalence of tobacco-chewing is high. Successive 200 subjects who agreed to participate in the evaluation and had a history of isolated tobacco-chewing (range 10-60 years) were enrolled (Group III). The prevalence of major coronary risk factors- obesity, truncal obesity, hypertension, fasting hyperglycemia, and lipid levels were estimated using current guidelines. Electrocardiogram was also performed in all subjects. Chest radiography and treadmill stress test was done in subjects when indicated by symptoms. 200 age- and gender-matched controls who did not use tobacco in any form (Group I) and 200 subjects who had history of smoking bidis or cigarettes for more than 10 years (range 10-55 years) (Group II) were also evaluated. RESULTS: The body-mass index and obesity were lowest in smoker group. Tobacco chewers had a significantly higher (p<0.001) systolic blood pressure (BP), diastolic BP, resting heart rate, total cholesterol, LDL cholesterol and triglycerides as compared to controls and was similar to smoker group. There was a significantly greater (p<0.01) prevalence of hypertension, hypercholesterolemia, hypertriglyceridemia, radiographic cardiomegaly and positive stress test in Group III as compared to controls. Prevalence of these risk factors was similar among Group II and Group III subjects. HDL cholesterol levels were the lowest in tobacco-chewing group (44.3+/-8.1 mg/dl) as compared to the Group I (48.4+/-7.8) and Group II (47.4+/-7.5) (p<0.001). CONCLUSIONS : There is a significantly greater prevalence of multiple cardiovascular risk factors obesity, resting tachycardia, hypertension, high total and LDL cholesterol, and low HDL cholesterol, and electrocardiographic changes in tobacco users, chewing or smoking, as compared-to tobacco non-users. Chewing tobacco is associated with similar cardiovascular risk as smoking.

The changing spectrum of severe falciparum malaria: a clinical study from Bikaner (northwest India).

BACKGROUND & OBJECTIVES: Recently there were reports from all over India about changing spectrum of clinical presentation of severe malaria. The present study was planned to study the same in the northwest India. METHODS: This prospective study was conducted on patients of severe malaria admitted in a classified malaria ward of a tertiary care hospital in Bikaner, Rajasthan (northwest India) during 1994 and 2001. It included adult patients of both sexes belonging to all age groups. The diagnosis of Plasmodium falciparum was confirmed by demonstrating asexual form of parasites in peripheral blood smear. All patients were treated with i.v./oral quinine. The specific complications were treated by standard WHO protocol. The data for individual complications for both the years were analysed by applying chi-square test. RESULTS: In a prospective study in 1994 the spectrum of complication was dominated by cerebral malaria (25.75%) followed by jaundice (11.47%), bleeding tendencies (9.59%), severe anaemia (5.83%), shock (5.26%), Acute respiratory distress syndrome-ARDS (3.01%), renal failure (2.07%) and hypoglycemia (2.07%) whereas in 2001 it was dominated by jaundice (58.85%) followed by severe anaemia (26.04%), bleeding tendencies (25.52%), shock (10.94%), cerebral malaria (10.94%), renal failure (6.25%), ARDS (2.08%) and hypoglycemia (1.56%). The sharp difference for presence of jaundice and severe anaemia in 2001 and cerebral malaria in 1994 was statistically significant. Similarly, the important cause of mortality in 2001 was multiple organ dysfunction syndrome (71.10%) with predominant presentation of jaundice and renal failure, whereas in 1994, it was cerebral malaria (77.96%). INTERPRETATION & CONCLUSION: The observation of changing spectrum of severe malaria in this study and a significant increase in presentation with jaundice as an important manifestation is highly essential for primary, secondary and tertiary level health care providers for proper diagnosis and management.

Mast cell profile in uterine cervix.

Mast cell profile was studied in 50 neoplastic and 50 non-neoplastic conditions of the uterine cervix. The mean number of mast cells decreased to 44.8 in chronic cervicitis with ulceration, whereas the highest number of mast cells was observed in cervical polyp with a mean of 250. The mean number of mast cells was also higher in papillary endocervicitis (102.57) and chronic cervicitis (103.8). Mast cells were found in close proximity to the cervical glands and around blood vessels in non-neoplastic lesions. Mast cell count in carcinoma of cervix ranged from 0 to 210 per 10 HPF with a mean of 48.08. When the invasion by tumour was extensive the total count of mast cells was lower when compared to minimal invasion. The distribution of mast cells was found to be around the tumour deposits. Comparison of mast cell densities in neoplastic and non-neoplastic conditions revealed an increase in chronic inflammatory processes, while in cancers there was diminution in number or total absence of mast cells. There is no conclusive correlation between the age of the patients and the density of mast cells. An inverse relationship existed between the mast cell population and degree of anaplasia as well as of mitotic figures.

Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study.

Routine use of steroids in the treatment of bacterial meningitis remains controversial. A prospective placebo controlled double blind study of dexamethasone was carried out in 40 patients (age>10 years) of acute bacterial meningitis. The patients were randomly assigned to receive either placebo (n=20) or dexamethasone (n=20) in addition to injection ceftriaxone 100 mg/kg/day (maximum 4 gm/day) for 14 days. Dexamethasone sodium phosphate was given in dose of 0.6 mg/kg/day in 4 divided doses, for first 4 days of therapy. First dose of dexamethasone was given 15 minutes prior to first dose of ceftriaxone. Baseline demographics, clinical and laboratory features of the two groups were similar. Clinical improvement of signs of meningeal irritation was rapid in dexamethasone group than in the placebo group, but no significant difference was observed regarding resolution of fever, headache and vomiting. Secondary fever (mean+/-SD 15.00), gastrointestinal tract bleeding (mean+/-SD 15.00) and psychiatric manifestations (mean+/-SD 10.00) were more common in dexamethasone group. Neurological complications and hearing loss were more common and severe in placebo group as compared to the dexamethasone group (p<0.05). It is concluded that dexamethasone may be beneficial in some aspects of bacterial meningitis, in adults. A study with a larger number of cases in each group is recommended.

Outbreak of polyarthritis with pyrexia in Western Rajasthan.

AIM: To establish the etiology of recent out break of polyarthritis which occurred in Kanvari village of Churu district of Rajasthan in August, 1999. METHODOLOGY: Forty eight patients of polyarthritis were studied by Hb, TDLC, ESR, CRP, throat swab Gram's stain and culture, blood culture, ASO titer, rheumatoid factor, Rose Bengal plate agglutination test, standard tube agglutination test for brucellosis, widal test, urine examination, X-ray chest, ECG and X-ray of the affected joint. RESULTS: Forty eight patients presented with acute polyarthritis with low grade fever of 1-2 week duration. Most common joint involved was sacroiliac joint (52.08%). Most of patients had multiple joint involvement (93.75%). The Rose Bengal plate agglutination test and standard tube agglutination test for brucella were positive in high titres in 44 (91.60%) patients. All the patients were treated with therapy for brucellosis and followed up for 12 weeks and responded well without complications. CONCLUSION: In case of polyarthritis possibility of brucellosis should always be kept in mind.

Leiomyoma of the kidney--report of two cases.

Renal leimyoma is an uncommon benign tumour, which pose a challenging diagnostic and therapeutic problem. When multiple (leiomyomatosis) they are preoperatively mistaken for malignant tumors. We herein-present one case of renal leiomyomatois developing in a 50 year old male, which was clinically diagnosed as renal cell carcinoma and one case of renal leiomyoma in a 37 year old male.

Alcohol consumption and hypertension.

The effect of acute alcohol consumption was studied in healthy subjects (Group-I) and in nondrinking hypertensive (Group-II) and in regularly drinking hypertensive patients (Group-III). All subjects consumed alcohol (1gm/kg body weight daily) for 5 days, then abstained for 5 days. Blood pressure was recorded in standing and supine position every morning. Group-I showed no significant difference in blood pressures during and after alcohol consumption. Group-II showed a statistically significant increase in the supine and standing systolic/diastolic and mean blood pressure when consuming alcohol (P < 0.01) as compared to the period of abstinence. In Group-III, hypertensive patients who drank regularly showed significant decrease in systolic blood pressure in the period of abstinence during standing (p < 0.02) as well as in supine position (p < 0.001) and diastolic and mean blood pressure reduction in standing and supine position (p < 0.01) as compared to the period of drinking.

Role of QT interval at onset of acute myocardial infarction in predicting early phase ventricular arrhythmia.

In this study, the QTc interval was determined in 51 patients of acute myocardial infarction and the incidence of ventricular arrhythmias in them was noted. It was found that the QTc interval was prolonged (more than 0.44 sec) in all the 33 patients who developed ventricular arrhythmias, while it was below 0.44 sec in all the 18 patients who did not develop ventricular arrhythmia.

Coagulation disorder following viper bite in Orissa.

Forty-three cases of viper bite were studied for coagulation disorder of which 34 (79.1%) cases had bleeding manifestations from one or more sites, haematuria being the commonest (46.5%). Disseminated intravascular coagulation was the predominant coagulation abnormality. Administration of snake venom antiserum resulted in prompt recovery from coagulation disorder. However, natural recovery from coagulation abnormality did occur though took longer time.

An epidemiologic study of intermittent acute porphyria in Maheshwari community of Napasar, Bikaner (Rajasthan)

An epidemiologic study of intermittent acute porphyria in the Maheshwari community of Napasar, Bikaner (Rajasthan) was conducted. Twelve cases were detected among 1900 persons belonging to ten families surveyed (prevalence 1:408). The disease was more common in females and the maximum number (4 cases) was encountered in the age group 21-30 years. The disease was more common in Mundhra (4 cases) and Mohata (3 cases) subcastes.