The Risk of Acute Myocardial Infarction in Patients With Gastroesophageal Reflux Disease

Background/Aims@#A number of inflammatory mediators have been documented to be elevated in gastroesophageal reflux disease (GERD). Similar inflammatory mediators are involved in coronary artery disease. Thus, the aim of the study is to determine if GERD is a risk factor for developing acute myocardial infarction (AMI). @*Methods@#We used Explorys, a private cloud-based data store to which a number of health care systems feed information. We identified a cohort of GERD patients who have undergone an esophagogastroduodenoscopy compared to those without GERD. Incidence of AMI was studied after statistically controlling for known AMI risk factors. @*Results@#Total of 200 400 patients were included in the GERD group and 386 800 patients in non-GERD group. The primary event of AMI occurred in 17 200 patients in the GERD group (8.6%) vs 24 300 in non-GERD group (6.3%). Using logistic regression analysis and controlling for 6 major risk factors which included male gender (OR, 1.09; 95% CI, 1.07-1.11; P < 0.001), hypertension (OR, 6.53; 95% CI, 6.21-6.88; P < 0.001), hyperlipidemia (OR, 3.08; 95% CI, 2.96-3.20; P < 0.001), diabetes mellitus (OR, 1.72; 95% CI, 1.69-1.76; P < 0.001), obesity (OR, 1.02; 95% CI, 1.00-1.04;P = 0.044), and smoking (OR, 1.38; 95% CI, 1.35-1.41; P < 0.001). The odds of developing AMI in the GERD population was 1.11 (95% CI, 1.08-1.13;P < 0.001). GERD had higher odds of developing AMI than male gender or obesity in our study. @*Conclusions@#This study demonstrated that GERD is a risk factor for AMI, higher than male gender and obesity. However, the increased risk may be clinically insignificant.

Review on Hepatitis B – A Challenging Health Problem

Background: Hepatitis B Virus is one of the major global health problems. Even though there is a vaccine for prevention of HBV exists, still HBV is a major concern and research works are still undergoing because HBV is highly contagious and can cause second most deadly cancer. Aim: We have undertaken this study, as we noticed there is an increase in number of HBV positive patients. Here we have tried to create awareness about HBV to general population. Methods: A Retrospective study has undertaken on Hepatitis B samples for a study period of 2015 to 2018. Data related to this study was collected from laboratory and hospital documentations. Depending on clinical condition, all the patients with or without symptoms from different departments were subjected to Hepatitis B testing by ICT method. Results: There is an increasing prevalence of Hepatitis B noted. In 2015, 0.61% cases were HBV positive in 2016, 0.62% were positive in 2017, 0.52% positive cases were observed; Where as in 2018 1.12% of HBV positive cases. Out of 640 HBV positive patients, 399 (62.3%) were females and remaining 241 (37.6%) were males. There is no major difference noted in prevalence of HBV among different age groups and sex during the study period of each year. Conclusion: State Health authorities should provide resources and guidelines for high quality testing and treatment of HBV. Testing measures need to improved and standardise in all health sectors and blood banks.

Identification Of Non– Fermenter Gram Negative Bacilli (NFGNB) From Various Clinical Isolates With Special Reference To Carbapenem Resistance In Various Isolates.

Non Fermenter Gram negative bacilli (NFGNB) has emerged as important hospital pathogens they are more significant as they are found to be multi drug resistant. Resistance to carbapenems is common among NFGNB. AIMS & OBJECTIVES: To isolate & identify NFGNB from various clinical samples and to detect resistance to carbapenem in isolates resistant to Imipenem. MATERIAL & METHOD: NFGNB isolated from various samples were speciated using standard tests. Isolates resistant to Imipenem were subjected to detection of MBLs(Metallo-β-lactmase) and Amp-C. RESULTS: Out of 1566 samples received, NFGNB were 200. Among them 112 were Pseudomonas aeruginosa from which 31 were found to be resistant to Imipenem, of which 3 were MBLproducer by Modified Hodge test while 4 were MBLproducer by EDTAdisc synergy test. Out of 200 NFGNB 71 were Acinetobacter baumanii, of which 23 were found to be resistant to Imipenem, of which 6 were MBLproducer by Modified Hodge test, while 4 were seen to be MBL producer by EDTAdisc synergy test. Nineteen isolates of Acinetobacter baumanii were found to be resistant to cefoxitin of which 6 were found to be Amp-C producer by Amp-c disc test. None of the Pseudomonas aeruginosa were Amp-C producer. Other NFGNB isolated were either sensitive to Imipenem or if resistant were not MBLor Amp-C producer.

Mitochondrial control region and GSTP1 polymorphism associated with familial urinary bladder cancer in Karbi-Anglong tribe of Assam, Northeast India

Background: Multiple studies have suggested that subjects with glutathione S-transferase P1 [GSTP1]-mutations are at high risk for urinary bladder cancer [UBC]

Methods: In the present study, we evaluated the mutations in GSTP1 and mitochondrial D-loop genes in two unrelated familial bladder cancer patients belonging to Karbi Anglong Assam tribe. Mitochondrial D-loop and nuclear GSTP1 polymorphic region were amplified and sequenced for all the family members and patients. Two SNPs in the GSTP1 gene for amino acid substitutions at codons 105 [Ile-Val] and 114 [Val-Ala] were genotyped by PCR-RFLP-based methods

Results: mtDNA D-loop sequence variations were found and there were A and C insertions common at positions 235 and 309, respectively for both the families. Two sequence differences were identified in urinary bladder cancer samples in GSTP1 gene. These two heteroplasmic mutations were found at positions 11qG3037G/A and 11qC3038C/A in patient, father, mother, brother and son, but not in the sister and wife samples in family 2. The GSTP1, 105Ile >Val is most susceptible to inherited UBC risk for these ethnic families. The samples from families 1 and 2, including healthy subjects were placed in macrohaplo group L3e, except the wife [macrohaplo group F1c1a] of patient in family 1, and the wife and son [haplo group M] of the patient in family-2

Conclusion: A strong familial nuclear GSTP1 sequence variation and mitochondrial control region was observed in this study for familial urinary bladder cancer. This could afford early recognition of patients at risk of developing micro- or macroscopic, pathological lesions as well as the introduction of preventive measures for familial bladder cancer

Estimating the burden of 'weighing less': A systematic review and meta-analysis of low birth-weight in India.

Background. The National Family Health Survey-3 (NFHS- 3; 2005–06) reports that the prevalence of low birth-weight babies is 22% in India. This old figure is probably an underestimate as this nationwide survey acquired information on birth-weight of only 34% of babies. We aimed to make a fresh estimate of the proportion of low birth-weight babies. Methods. A systematic search was done through PubMed, Google Scholar, Cochrane Library, Medline, IndMed, Embase, WHO and Biomed Central databases. Studies published from 2004 to 2014 were included. Study quality was assessed using the adapted Mirza and Jenkins checklist. An ‘adjustment’ of 24% was applied to the published estimates where data were collected through records or through a combination of records and anthropometry. The adjustment was done to account for the heaping of birth-weight data at 2500 g. Metaanalysis using both random and fixed effects model was done to derive an estimate. Results. Nineteen studies with 44 133 subjects were included in the review. The pooled estimate for the prevalence of low birth-weight was 27% (95% CI 24%–30%) and the ‘adjusted’ pooled prevalence was 31% (95% CI 28%–33%). The prevalence in urban and rural areas was 30% (95% CI 23%– 38%) and 26% (95% CI 22%–30%), respectively. Regionwise estimates revealed that the prevalence at 33% was comparatively higher in eastern regions (95% CI 29%–37%). Conclusion. The pooled prevalence of low birth-weight is higher than that reported by NFHS-3. Updated estimates should be used to guide future interventions and policies. Natl Med J India 2016;29:73–81

Status of multidrug resistant tuberculosis [MDR-TB] among the Sahariya tribe of North Central India

Background: The incidence/prevalence of tuberculosis [TB] is reported to be high in the Sahariya tribe of North Central India. The outbreaks of different drug-resistant isolates of Mycobacterium tuberculosis emphasized the need for continuous monitoring of resistance to anti-tuberculosis drugs. This study aimed to assess the profile of multidrug resistant TB among the Sahariya tribe and their non-tribal neighbors for first line drugs through field-based investigations.

Methodology: A total of 274 sputum positive pulmonary TB individuals were enrolled and studied for their drug susceptibility profile by the proportion method. Results: A total of 21 cases from Sahariya and 6 from non-tribes were identified with MDR-TB. Thus Sahariya tribe showed a 1.95-fold increased risk of developing drug resistance than non-tribes. Significant differences were observed for developing drug sensitivity between Sahariya males and females when analyzed for resistance developed to any drug and overall drug resistance vs. sensitive isolates, respectively

A 4.46-fold risk was found for MDR-TB among the smokers of Sahariya tribe, whereas, the non-tribes did not show any significant association

Conclusion: The drug susceptibility profile developed in the present study indicates that drug-resistant tuberculosis is emerging as a serious public health concern in Sahariya tribe. Urgent and effective control measures and better management policies are needed for the prevention of MDR-TB in the tribe

A community-based study of menstrual hygiene practices and willingness to pay for sanitary napkins among women of a rural community in northern India.

Background. Hygiene-related practices of women during menstruation are of paramount importance. There is a lack of sizeable literature on menstrual practices from northern India. We documented the menstrual hygiene practices of rural women and assessed their willingness to pay for sanitary napkins. Methods. A cross-sectional study was done in villages under the Comprehensive Rural Health Services Project (CRHSP), situated in Ballabgarh, Haryana. The study participants were women in the age group of 15–45 years. Nine villages were selected randomly while the number of respondents in each selected village was decided through the probability proportionate to size sampling method. The households were selected using systematic sampling. One woman was interviewed in each household using a pre-tested questionnaire. Results. A total of 995 women were interviewed. A majority of them (62%) were unaware of the reason(s) for menstruation. The role of the health sector in providing information regarding menstruation was low as only a few women (1.5%) had got information from the auxiliary nurse midwife (ANM)/health worker (HW). For the majority of women, besides religious activities, other routine activities did not suffer during menstruation. Only 28.8% of women were using sanitary napkins and of those who did not use napkins, only one-fourth (25.3%) were willing to buy them. The mean (SD) price per napkin that these women were ready to pay was `0.54 (0.43), equivalent to US$ 0.01. Conclusion. Women in the reproductive age group should be provided with appropriate information about menstruation, and they should be told about the advantages of using sanitary napkins. Health sector functionaries should play a proactive role in the delivery of such information.

Perception of fever and management practices by parents of pediatric patients.

Background: The febrile child is a common pediatric presentation in both primary care and the emergency department. An assessment of parents’ perception to recognize fever in their child, as well as management practices was the focus of this study. Methods: The study was done prospectively in which interviews were taken by researchers. One hundred and sixty four parents, whose children were less than 14 years old, had fever as one of the presenting complaints and admitted in pediatric department of Rama medical college & research center, Kanpur, were included in this study. Results: Majority of the parents 114 (69.51%) managed the fever initially at home. Only a few parents (17.07%) correctly managed the fever by taking their children to hospital or to a qualified practitioner, rest of the parents primarily rely on local medical store or unqualified practitioner. Conclusion: Parents need to be educated, when they consult health facilities especially during vaccination visits. Decreased appetite was the most common presenting complaint along with fever in children and it should be taken as a significant factor during health education of fever for early and appropriate consultation.

Clinical and genetic aspects of generalized aggressive periodontitis in families of Tumkur district of Karnataka, India.

Background: Aggressive periodontitis (AP) is a complex disease whose phenotype is determined by genetic and environmental influences on the affected individuals. About 45% of the adult population in India has periodontitis. In Tumkur district of Karnataka, India, consanguineous first cousin and uncle-niece marriages are common, with a high incidence of AP. These discrepancies in the expression of periodontal disease directed us to find genetic etiology with respect to the Tumkur population. The clinical and genetic aspects of AP from this area have been presented in this paper. Materials and Methods: A total of nine families were ascertained at the Department of Periodontics, Sri Siddhartha Dental College and Hospital (Sri Siddhartha University), Tumkur. The clinical and radiographic data were gathered according to 1999 Consensus Classification of Periodontal Diseases. Peripheral blood samples were collected for total genomic DNA isolation using a Wizard TM Genomic Purification Kit (Promega, USA). The homozygosity mapping was carried out in a large consanguineous family to map a novel locus using autosomal markers from the CHLC/Weber Human Screening Set 10 (Research Genetics Inc., USA) at Indian Institute of Sciences, Bangalore. Results: The pedigree analysis suggested that the disorder is segregating as an autosomal trait. The homozygosity mapping failed to identify a locus for generalized AP in the family. Conclusion: The disorder may not be segregating as an autosomal recessive trait and we could have been misled by consanguinity in the family. It could be a multifactorial trait, or it could be still segregating as an autosomal recessive trait, but the region of homozygosity could be small and we failed to detect it using microsatellite markers. Therefore, SNP-marker-based analysis is warranted in future.

Oral manifestations of lipoid proteinosis: a case report and literature review

Lipoid proteinosis is an uncommon autosomal recessive metabolic disorder that presents in early life with hoarseness and pox-like acneiform scars involving the skin and mucous membranes. Previous studies have attributed the prevalence of lipoid proteinosis to consanguineous parents. This paper reports a classical case of lipoid proteinosis with oral manifestations but without a history of consanguinity

Public health approach to address maternal mortality.

Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC) would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY) that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women's health.

Intraoral venous malformation with phleboliths

The most common type of vascular malformation is the venous malformation and these are occasionally associated with phleboliths. We report a case of a 45 year old woman with intraoral venous malformation with phleboliths

Multicystic dysplastic kidney - A need for conservative and long term approach.

Objective. We retrospectively studied our cases of Multicystic Dysplastic Kidney (MCDK). The review was aimed at identifying the pattern of the disease in Indian Scenario and the required management thereof. Methods. We studied the clinical, radiological and nuclear scan findings of 22 patients with unilateral MCDK. They were diagnosed and/or treated in our unit from 1999 to 2007. The diagnosis was achieved by Ultrasound and further confirmed by DMSA scans. Other ancillary investigations like Micturating cystourethrogram were done if indicated. These patients were followed and followup investigations consisted of renal ultrasound, blood pressure measurement, and urinalysis and blood biochemistry. Results. A total of 22 patients (18 boys and 4 girls) with unilateral MCDK were investigated and followed for a mean period of 41 months. MCDK was detected on antenatal ultrasound only in 12(55%) and postnatally in 10(45%) babies. Mean age for postnatal diagnosis was 20 months. Follow up ultrasound revealed complete involution of MCDK in 3 patients and partial regression in 11 patients. The size of dysplastic kidney was unchanged in 4 patients and a further 4 patients underwent nephrectomy. Indications of nephrectomy were parental anxiety in 2, hypertension in 1 and palpable mass in 1. Conclusion. Large proportion (45%) of patients in presented series are diagnosed post natally contrary to western world where more than 80% are diagnosed antenatally. Uncomplicated isolated MCDK carry good prognosis with nephrectomy required in only a few patients. Association with other urological anomalies in ipsilateral/contralateral genitourinary tract is important to identify as they have worse outcome in terms of ultimate renal function. All patients with simple/complex unilateral MCDK should be advised long term follow up for the possible development of hypertension and/or hyper infiltration injury.

Sodium nitroprusside relaxes goat coronary artery through activation of calcium-dependent K+ channels.

In the present investigation we have examined the hypothesis that calcium-dependent K+ channels (K(Ca)) are involved in the sodium nitroprusside (SNP)-induced vasodilatation of goat coronary artery. SNP (10(-9)-3 x 10(-6) M), added cumulatively, relaxed K+ (30 mM)-contracted coronary artery ring segments in a concentration-dependent manner with an EC50 of 1.32 x 10(-7) M (95% CL, 0.93-1.86 x 10(-7) M; n = 21). K(Ca) blocker, tetraethyl ammonium (1 mM) caused a rightward shift in the concentration-response curve of SNP with a corresponding increase in EC50 (1.62 x 10(-6) M; 95% CL, 0.44-6.02 x 10(-6) M, n = 4) of nitro vasodilator. Lowering of extra cellular Ca2+ in the physiological saline solution to 1/4 of normal selectively attenuated the vasorelaxant response of SNP, thereby causing an increase in its EC50 (2.4 x 10(-6) M; 95% CL, 1.23-4.68 x 10(-6) M, n = 4). Exposure of the tissues to high K+ (80 mM) solution, a protocol adopted to reduce the K+ gradient across the cell membrane, markedly inhibited the coronary artery relaxations induced by SNP (EC50, 2.54 x 10(-6) M; 95% CL, 1.31-4.91 x 10(-6) M, n = 4), when compared with tissues contracted with low K+ (30 mM) solution (EC50 7.9 x 10(-8); 95% CL, 4.4 x 10(-8)-1.44 x 10(-7) M, n = 6). The results suggested that a major component of SNP-induced relaxation of goat coronary artery was mediated by K(Ca) channels.