Screening of type 2 diabetes mellitus patients for their macrovascular complications in tertiary care hospital

Background: Type2 diabetes is characterized by a long asymptomatic period commonly to be diagnosed when complications appear. The risk factors associated with diabetes are age, hypertension, dyslipidemia, smoking, alcohol, obesity & others. The role of early detection and adequate treatment of diabetes and related complications patients and health services is the basis for present study.Methods: The present study was conducted at S.N. Medical College, Agra, India on 86 consecutive newly diagnosed cases of type 2 diabetes. All individuals aged ≥ 20 years of age, who were not known diabetic, presenting to medicine department were included in the study for the targeted and opportunistic screening duration of January 2011 to June 2012.Results: The prevalence rates of vascular complications in this study group were analyzed statistically. The findings are the mean age was 54.27±9.27 years. 72.09% of newly diagnosed type 2 diabetes patients were aged above 50 years. Maximum number of patients were overweight (37.20%) followed by obese (32.55%). Hypertension was present in 30.23%, prevalence of CAD was 9.30%, and none had evidence of PVD and Cerebrovascular disease.Conclusions: Macrovascular complications were present in 9.30% of asymptomatic newly diagnosed type 2 diabetes patients. In the study present study found that there was a significant association of these risk factors were identified and treated as early as possible to decrease the progression of vascular complications.

Role of Serum Iron and Serum Calcium in Patients of Cholelithiasis

Gangetic plains are known to have a very high incidence of cholelithiasis, the eiopathogenesis of which cannot be ascertained. Aim: to conduct a study to find a correlation, if any between the incidence of gallstone disease and the serum Iron and serum Calcium levels of patients and compare it with controls. Methods: 50 patients and 50 controls were taken and serum Iron and serum Calcium of both were evaluated. The distribution of age, sex and gender were taken as factors. Results and conclusion: The number of female patients was higher than the males but no strong association could be proven in the study. Among the symptoms dyspepsia had the highest incidence but could not be taken as a reliable marker for the diagnosis of cholelithiasis clinically. Hence, ultrasonography remains a very important tool for the diagnosis of the diasease .The role of serum Iron and serum Calcium in the etiopathogenesis could not be established. There was however a strong correlation of previous surgery in the formation of new gallstones .The family history was a strong factor for the formation of new gallstone disease however, the association was not established in this study. Gallstone disease had stronger association with anaemia than with serum Serum Iron. Calcium levels were comparable between the cases and the controls.

Analysis of the Functional Outcome of Limb Length Discrepancy after Total Hip Replacement

Background: The Aim of the study was to analyze the functional outcome of limb length discrepancy after total hip replacement. . Methods: It is a Prospective study on 21 patients who underwent total hip replacement with different hip pathology between November 2015 and October 2017. Results: 13 males and 8 females patients with a mean age of 35.31±7.42 (21-50) were followed up for a time of 12months. Limb length discrepancy and hip function of 21 patients who underwent primary total hip arthroplasty were assessed before surgery and 1month, 3 month and 12 month after surgery. Limb length discrepancy was evaluated before and after surgery by clinical and radiological method, Functional outcome assessed by using the Oxford hip score (OHS) and Harris hip score(HHS). Preoperatively all patients had shorter limb length as compared to contra lateral side. Postoperatively in 42.9% (9/21) the limb operated on was longer, in 19 %( 4/21) of cases limb operated on was shorter and in 31 %( 8/21) postoperative limb length were equal. Postoperatively limb length discrepancy was present in 61.9 %( 13/21) & was perceived by 53.8 %( 7/13 of cases) when either shortening or lengthening exceeded 10mm. Oxford hip score (OHS) and Harris hip score (HHS) were significantly increased at subsequent follow up (at 1, 3 and 12 months). Functional scores (OHS and HHS) were excellent in patients with equal limb length as compared to those having shorter or longer limb length. Conclusion: Patient with limb length discrepancy had negative influence in relation to limping and pain. Patients should be counseled preoperatively about possible limb length differences and associated symptoms.

A prospective study of wound infection among post‑discharge patients at a level 1 trauma centre of India.

Background and Aim: To study the rate of wound infections in the post‑discharged patient population and to assess the usefulness of post‑discharge surveillance. Methods: A prospective surveillance of all the post‑discharged trauma patients was done during a period of 6 months. Discharge instructions were given to all the patients regarding identification of the signs and symptoms of wound infections. They were telephonically followed up after a week to enquire about the wound condition and followed up in the outpatient department (OPD). Microbiology culture samples of those showing any signs and symptoms of infections were sent and their antimicrobial therapy, any change in the treatment schedule and the length of their hospital stay were noted. Factors such as wound class, type of surgeries and readmissions were noted. Results: A total of 281 postdischarge patients were enrolled, of which 101 were completely followed up for wound infections. Males were predominant (89%). Of the 101 patients, 42 (41.6%) patients wound showed infection during the intense follow‑up in the OPD. However, 59 patients (59/101, 58.4%) showed wound swab culture positivity before discharge. These 42 patients developed signs and symptoms of infection post‑discharge; 23 (22.7%) of them had change of antibiotic therapy during the follow‑up period due to culture positivity. Acinetobacter sp., Staphylococcus aureus and Klebsiella pneumoniae were the predominant organisms isolated in the study. A total of 45 patients (44.5%) had to be readmitted due to wound site infections. Conclusions: Wound infections are common after discharge among trauma patients highlighting the importance of active surveillance and participation of patients.

Detecting mutation pattern of drug‑resistant Mycobacterium tuberculosis isolates in Himachal Pradesh using GenoType® MTBDRplus assay.

Context: Tuberculosis (TB) is a major public health problem in India and a principal cause of death in adults, especially among the economically productive age group. India accounts for one‑fifth of the global burden of TB. It is estimated that about 40% of Indian population is infected with TB bacillus. The GenoType® MTBDRplus molecular method allows rapid diagnosis of the clinical samples and detection of the most common mutations in the genes associated with rifampicin (R) and isoniazid (H) resistance. Aims: To study the drug resistance and mutational patterns in multidrug‑resistant (MDR) suspects clinical strains using GenoType® MTBDRplus assay. Subjects and Methods: A total of 770 sputum samples of the MDR‑TB suspects were included in this study, which were received at Intermediate Reference Laboratory, Government TB Sanatorium, Dharampur, Solan, Himachal Pradesh from the Designated Microscopy Centres of Himachal Pradesh for the culture and susceptibility testing. All the 521 Mycobacterium tuberculosis complex (MTBC) strains were subjected to GenoType® MTBDRplus (HAIN Lifescience) assay to detect molecular resistance pattern to first line anti‑tubercular drugs (isoniazid and rifampicin). Results: Of 770 samples, 556 (72.20%) were from male and 214 (27.80%) were from female. Among the 521 MTBC strains, 19.76% were found to be MDR and mono‑resistance to isoniazid and rifampicin was detected in 8.63% and 6.14% strains respectively. About 74.81%, 76.35% and 5.40% strains harboured known mutation in rpoB, katG and inhA genes respectively. Conclusions: In rpoB gene, the most common mutation is associated with S531 L region. The GenoType® MTBDRplus assay is a rapid test for the detection of the most common mutations in MDR‑TB strains. In our study, unknown rpoB gene mutations were found in 25.18% strains that may further be detected by gene sequencing.

Spontaneous rupture of a congenital umbilical hernia in an infant: a rare complication.

Umbilical hernia is not uncommon in children. Most of these hernias close spontaneously as the children grows; they are often remarkably free from complications. Though in no way affecting the accepted principles of management of umbilical hernia, we feel that this case of spontaneous rupture is worth recording. To report a case of spontaneous rupture of a congenital umbilical hernia with evisceration of small intestines in a 45-day-old 3.5 kg female infant.

Transoral migration of peritoneal end of ventriculoperitoneal shunt with perforation of gastro-esophageal junction: a case report of a rare complication.

A rare complication of ventriculoperitoneal (VP) shunt is presented. A 11-year old boy presented with a tube coming out of the mouth. He had multiple VP shunt done earlier. Clinical features, laboratory investigations and imaging studies showed that the peritoneal end had perforated the gastro-oesophageal junction and then prolapsed trans-orally. The shunt was removed and he made an uneventful recovery. Though migration of the peritoneal end of the shunt tube into various organs is known, to our knowledge, only six/seven cases have been reported in the English literature of a shunt tube coming out of the mouth and this is the next. The management of this very rare problem is discussed.

An experimental study on the effect of isoniazid on the efficacy, plasma concentration and toxicity of paracetamol in Albino rats.

Background: Paracetamol is used for symptomatic treatment of fever and pain with isoniazid and other anti-tubercular drugs in patients of tuberculosis. Literature has conflicting data regarding their interaction. Some studies show that isoniazid increases oxidative metabolism of paracetamol whereas some other suggest that isoniazid has an inhibitory effect. The present study was conducted to find out the possible interaction between paracetamol and isoniazid. Methods: The study was undertaken on Wistar strain of Albino rats. Group I and Group II animals were treated with paracetamol (500 mg/kg) and the combination of paracetamol (500 mg/kg) and isoniazid (30 mg/kg) respectively for 2 months. Blood samples were taken before and during the study for biochemical and histopathological studies of liver and renal functions and plasma paracetamol concentration was also evaluated. Results: Isoniazid decreased the plasma paracetamol concentration without affecting its analgesic activity. However, the hepatotoxic and nephrotoxic effects of paracetamol were found to be further aggravated by isoniazid co-administration. Conclusion: Isoniazid potentiates the hepatotoxic and nephrotoxic effects of paracetamol possibly due to hepatic enzyme induction by isoniazid.

Screening of the Antibacterial Activity of Amorphophallus Campanulatus from Bastar Region of Chhattisgarh, India.

The present study was aimed to evaluate the antibacterial activity of Amorphophallus campanulatus (family: Araceae) commonly known as jangli suran. The root, stem and leaf of A. campanulatus, extracted successively with polar (aqueous, methanol), dipolar (acetone) and non polar (chloroform) solvents, yielded more phyto compounds in case of root followed by stem and leaf. The extracts were assessed for their antibacterial activity against both gram positive and gram negative bacteria viz., Bacillus cerus, Bacillus subtilis, Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Proteus vulgaris, Pseudomonas aeruginosa and Klebsiella pneumoneae. The gram positive bacteria were found to be more sensitive than gram negative bacteria. The inhibition of both gram positive and gram negative bacteria by the extracts indicate the presence of broad spectrum antibiotic potential. The root extract of the plant was found to be more effective in inhibiting the bacterial growth as compared to stem and leaf. The methanol root extract of the plant showed maximum inhibition against all gram positive and one gram negative Pseudomonas aeruginosa bacteria followed by acetone and chloroform. The highest activity index was recorded in methanol extract of root in Pseudomonas aeruginosa. The results were promising and supported the use of plants root by traditional healers in curing several ailments.

Planting geometry to optimize growth and productivity in faba bean (Vicia faba L.) and soil fertility.

Faba bean (Vicia faba L.) responses to alteration of its ambient environment leads to certain modification in the crop phenology, yield attributes and economic yield. To know the extent and pattern of response by faba bean to alterations, a two year field experimentation was carried out with two crop establishment methods (i) flatbed planting (ii) raised bed planting, four planting geometry (i) 30X20 cm(ii) 30X30 cm (iii) 30X45 cm and (iv) 45X45cm and three seeding depth. All the treatment (two crop establishment methods, four planting geometry and three seeding depth) were combined together consisting twenty four treatments, were organized in factorial experiment in complete randomized block design (CRBD) with three replications. Data were recorded on growth and development; yield attributes and yield. Soil analysis was done and finally statistical tool were applied to come in to valid conclusion. Raised bed planting proves superior over flatbed in case of seed yield. Square planting architect with 30 cm apart prove better (3690.9 kg ha-1) than other tested planting geometry. Seeding at 10 cm depth showed, significant improvement in seed yield per plant and per ha over other two tested seeding depth. Phosphorus availability was significantly higher in raised bed planting (36.9 kg ha-1). However, available K (kg ha-1) was significantly influenced by planting geometry and seeding depth. It was maximum (155.2 kg ha-1) with 30X 45 cm plant geometry, proved significantly higher than 30X20 cm and 30X30 cm and at par with 45X45 cm planting.

Rosai-Dorfman disease with sinonasal mucosal involvement.

Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy (SHML) is a rare benign disorder that typically manifests as massive lymphadenopathy and systemic symptoms. The authors report a 27-year-old man who presented with nasal mass and generalised cervical lymphadenopathy. Cytological and histopathological examination of lymph nodes demonstrated lymphophagocytosis (emperipolesis) consistent with a diagnosis of RDD. There was remarkable regression in the size of nasal polyps and lymph nodes after systemic corticosteroids. The clinical and histological aspects of the disease are discussed as a rare cause of generalised lymphadenopathy.

Comparison of the health-promoting orientation of three tertiary care hospitals of India.

Background. Hospitals have been considered as places for the provision of curative services. Nowadays, services related to health promotion are also sought to be provided through hospitals. We compared the health-promoting hospital (HPH) orientation of the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh with two other tertiary care hospitals in India, which have been declared HPH by WHO. Methods. The score obtained by PGIMER as an HPH as per the WHO standards tool was compared with that of two other tertiary care hospitals in India. A short survey was also conducted of patients visiting PGIMER for their treatment through a selfadministered, pretested questionnaire. A statistical test for difference in proportions was applied. A SWOT analysis was done to assess how PGIMER performed as an HPH. Results. The HPH score of PGIMER was significantly lower (35/80) than that of the other two hospitals. There was no formal HPH policy in PGIMER. One-third of the patients interviewed were not satisfied with the overall preventive and health-promoting services of PGIMER. Apart from the parameters of the HPH standards, PGIMER seemed to satisfy the expectations from it being an apex medical institute. Conclusion. In view of its low score as an HPH, PGIMER should frame an appropriate HPH policy and devise strategies to provide leadership to other hospitals in India.

Aetiology of global developmental delay in young children: Experience from a tertiary care centre in India.

Background. Global developmental delay is a common reason for referral to a paediatrician. We examined the aetiological yield of an extensive diagnostic work-up in young children with developmental delay in a tertiary referral centre. Methods. To assess the diagnostic possibilities, we systematically examined 100 consecutive children with global developmental delay (<5 years of age) who visited the paediatric outpatient department over a period of 18 months. An association between the presence of features at initial contact and aetiology was analysed by the 2-tailed Fisher exact test and chi-square test. Results. Of the 100 children, 65 were <2 years of age (mean age 23.6 months) at presentation. The presence of birth asphyxia, sepsis, seizures, abnormal neurological findings, and dysmorphism were significant predictors of aetiology. Four diagnostic categories—chromosomal disorders including Down syndrome, hypoxic–ischaemic encephalopathy, multiple malformation syndromes and cerebral dysgenesis—were the most common causes of global development delay in 20%, 15%, 14% and 11%, respectively. Moderate delay was seen in 42%, severe in 33% and mild in 25% of the patients. The aetiological yield did not differ with the severity of global developmental delay. Additional investigations such as neuroimaging, cytogenetic analysis, metabolic tests and specific molecular tests contributed to a diagnosis in 73% of the children, while in 23% these were the sole means of arriving at a diagnosis. Neuroimaging for a specific indication was almost twice more likely to yield an aetiology when compared with neuroimaging performed as a screening tool (65% v. 35%; p=0.003). Conclusion. The aetiological yield in this selected cohort with global developmental delay was 73%. A step-wise investigational approach is justified in all children with developmental delay, regardless of the severity of delay or the absence of findings on history and physical examination. This study is an attempt to formulate an investigative approach in a child with global developmental delay, especially in developing countries where advanced molecular and cytogenetic studies are not routinely available.

Physical growth in children with reflux nephropathy with normal or mildly impaired renal function.

Ten children aged 11 months to 10 years (means 5.7 years) with reflux nephropathy, vesicoureteric reflux (VUR) and normal or mildly impaired renal function having GFR more than 50 ml/min/1.72 m2, were included in the study. The hematological and biochemical parameters were within normal limits. Height standard deviation score (HZ score) was reduced at entry and, decreased further during follow-up (-2.2 and -2.6 at 0 and 12 months, respectively). Weight for height index (WHI) improved significantly (p=0.0004) during follow-up. The basal and stimulated peak growth hormone levels of these patients were found to be elevated, 18.53 ± 11.36 μg/L and 34.20 ± 5.86 μg/L, respectively. The IGF-1 levels were low ranging from 45.00 to 84.40 ng/dl (mean ± SD 61.54 ± 10.21 ng/dl) compared to 51.80 to 247.50 ng/dl (mean ± SD111.20 ± 70.24 ng/dl) in age and sex matched controls, indicating partial insensitivity to growth hormone.