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Background: Chronic kidney disease (CKD), due to increasing frequency and prevalence, has become one of the leading public health issues. The Kidney Disease Outcome Quality Initiative (KDOQI) defines CKD as kidney injury or a reduction in the glomerular filtration rate (GFR) to <60 mL/minute/1.73 m2 for at least 3 months. This study aims to compare the effects of decreased renal function on thyroid profile and lipid profile in CKD patients. Materials and methods: This is a prospective cross-sectional observational study conducted among the patients attending Outpatient Department/Inpatient Department (OPD/IPD) at the School of Medical Sciences & Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India, in known cases of CKD, irrespective of the treatment/stage of CKD. All patients of >18 years of age with CKD were included in the study. Result: A total of 200 patients who met the inclusion criteria were included after obtaining detailed informed consent, of which 100 were cases and 100 were controls. The mean age of patients in the study was 47.74 years, with the mean age in patients with CKD 52 years, and the control was 43 years. The mean level of triglycerides (TGs) was significantly higher among the cases, and the high-density lipoprotein (HDL) was significantly lower among cases compared to controls (p < 0.05). Pearson’s correlation between thyroid-stimulating hormone (TSH) with creatinine showed a weak albeit significant positive association (r = 0.200; p < 0.05). Conclusion: Our study shows a higher incidence of alteration in thyroid profile and dyslipidemia among the patients with CKD compared to controls. There is a necessary need to screen routinely for hypothyroidism and dyslipidemia among patients with CKD. Importantly, thyroid hormone levels and their effects on the progression of CKD have not been studied exhaustively.
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Fiberoptic bronchoscopy (FOB) has simplified the direct examination of the lungs and is widely used for diagnosis and therapy. Fiberoptic bronchoscopes occupy a significant proportion of cross-section area of central airways, which can affect lung mechanics and gas exchanges that may lead to desaturation and cardiac arrhythmia. This makes bronchoscopy in critically ill patients with respiratory failure even more challenging. Use of noninvasive mechanical ventilation (NIV) may help to avoid use of invasive mechanical ventilation in selected patients with acute respiratory failure. It has been shown to be useful in hypoxemic patients to facilitate bronchoscopic examination for bronchoalveolar lavage, bronchial brushing, endobronchial biopsy (EBB), and transbronchial lung biopsy (TBLB). Noninvasive mechanical ventilation has also been used to facilitate other endoscopic procedures including transesophageal echocardiography (TEE) and upper gastrointestinal endoscopy for diagnostic and therapeutic interventions in hypoxemic patients. Endobronchial ultrasound (EBUS) bronchoscope, having a wider diameter than a conventional bronchoscope, may have a more pronounced effect on lung mechanics and gas exchanges, and its use in patients on NIV has not been reported. Contraindications of EBUS are mostly relative and similar to FOB. There are several studies suggesting the safety of NIV-supported FOB in hypoxemic patients. We describe our experience of the first two EBUS bronchoscopies and transbronchial needle aspiration (TBNA) was done in hypoxemic patients with NIV support.
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Histoid leprosy is a rare variant of lepromatous leprosy, may occur de novo or may occur in cases earlier treated with dapsone monotherapy. Demographic, clinico-histopathological and treatment details of biopsy proven cases of histoid leprosy, collected retrospectively from the leprosy clinic of tertiary care hospital of SMS Medical College, Jaipur. During the study period of 5 years (2011-2016), 28 (2.98 %), patients had histoid leprosy among total 937 patients of leprosy. Most were in 21 – 40 years of age group with M: F ratio 2.5: 1. Histoid lesions developed with primary diagnosis of lepromatous leprosy in (71.4%) and de novo in (28.6%). Predominant site of involvement was upper extremity (85.7%) and most common presentation was subcutaneous nodules, Nerve thickening seen in (85.7%), and ulnar nerve being most common. Neuritis and disabilities were present in 6 and 16 patients respectively. Type 2 reaction seen in17.9% (5/28) patients. Biopsy and slit skin smear of all cases were done. Most (25/28) cases responded well to standard one-year multibacillary drug therapy (MDT), it had to be extended in three cases up to 2 years. Histoid leprosy may occur de novo or may be due to inadequate therapy, resistant strains, earlier dapsone monotherapy. Although India as whole has achieved leprosy elimination in January 2006, however new cases continue to be reported. Occurrence of histoid leprosy specially with changed morphology of the lesions and poor histopathological correlation needs to be investigated as these cases may be important source of infection even in low endemic situations.
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Introduction: The basic requirements for human survival include air, food, and water; a decrease in quality of which has a deep impact on health. An increase in population with increasing globalization, industrialization, and increased energy demand has led to increased air pollution in cities world over. Multiple national programs to improve air quality have been unsuccessful. Coronavirus disease 2019 (COVID-19) pandemic-led lockdown is a large-scale experiment that is unprecedented and could not have been done at regular times. Indirect effects include cutting down emissions from industries, vehicles, and diesel generators. Materials and methods: In this ambispective observational study, we compared the air quality index (AQI) and levels of other pollutants in the two cities of Delhi and Kanpur during the period of the lockdown, the same period during the preceding year, and during the rainy season. Results: It was observed that the cities of India with notoriously polluted air, i.e., Delhi and Kanpur, had unprecedented improvement in air quality during lockdown (Delhi, AQI: 86.91 � 32.38 vs 249.36 � 60.25 and Kanpur, AQI: 81.60 � 38.54 vs 137.06 � 46.74). The improvement was even better than the preceding year's monsoon for Delhi. The AQI was comparable in both cities during the lockdown. Conclusion: The AQI was falling in the 搒atisfactory� range in both Delhi and Kanpur during the lockdown. This may, in turn, favorably unfold a reduction in the incidence, progression, and exacerbation of respiratory illnesses. This is an eye-opening change and calls for urgent action to maintain the same. Timely and well-framed steps should be sought; a revolutionary carbon-free and green energy economic model is much needed. Most air pollution is preventable and can be managed by humans if a stringent action plan is rolled out and implemented sternly by government agencies.
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Objective: The present study is designed to investigate the profile of different allergen sensitivities by skin prick test in patients with nasobronchial allergy (NBA). Materials and methods: A total of 130 patients of NBA were included in the study. Each NBA patient was subjected to the skin prick test with 44 allergens. Results: Out of 130 patients, 98 patients (75.4%) had both bronchial asthma and allergic rhinitis, 11 patients (8.5%) had allergic rhinitis, and 21 patients (16.2%) had bronchial asthma alone. The age of patients ranged from 12 to 60 years, with mean age 26.4 � 10.24 years. The most common allergen came out to be insects (26.2%) followed by dust mites (20.7%), dusts (7.4%), pollens (5.9%), fungi (5.2%), danders (3.8%), and silk (2.2%). Common insect antigens were moth and mosquito (28.9%) followed by the cockroach, housefly (24.4%), and honeybee (18.9%). Common dust allergens were grain dust and house dust. Among pollens, Amaranthus spinosus and Cassia siamea (13.3%) followed by Brassica campestris (12.2%) and Holoptelea integrifolia (10%) were common. Among fungi, Aspergillus fumigatus and Aspergillus niger were common allergens. Conclusion: Common allergens in patients of NBA were identified. Allergen-specific immunotherapy can be a viable option for these patients.
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Background: Alcohol is the most common and cheapest recreational drink in the world. It is both a chemical and psychoactive drugs. Aim and Objective: The aim of the study is to determine the lipid profile in chronic alcoholics. Materials and Methods: The study group comprised chronic alcoholics among families, relatives, friends neighborhood workplace, and those attending health clinics. The subjects were 40 alcoholics within the age group of 30–50 years with lean body, normal blood pressure, no history of surgery, tuberculosis, diabetes mellitus, obesity, drug intake (steroids or immunosuppressive drugs), debility, and disability. The daily consumption of alcohol was about 50–100 g/day for 3–4 days a week, amounting to 50% of total calorie consumption. The questionnaire was used to detect alcoholism. Results: The results showed rise in triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein. Conclusion: The study shows the effect of alcohol to cause gross dyslipidemia and its toxic effects in the tissues. The therapeutic recommendation of alcohol for healthy heart is not recommended as overall dyslipidemia offsets it.
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Desmoplastic small round cell tumor (DSRCT) is a very rare diagnosis with about 200 cases reported in literature. DSRCT is a recently described histopathological entity by Gerald and Rosai in 1989. Abdominopelvic cavity especially peritoneum is the most common site. We report a case of a huge omental DSRCT with lymph node metastasis which was initially misdiagnosed as gastrointestinal stromal tumor on radiology. A 26-year-old male presented with complaints of upper abdominal swelling associated with constant dull pain. On examination there was a large 15 × 12 cm intraabdominal mass in the epigastric and umbilical region. Imaging studies were suggestive of neoplastic mesenchymal etiology. Image-guided fine-needle aspiration cytology (FNAC) was suggestive of mesenchymal neoplastic etiology. On laparotomy, there was a huge 20 × 15 cm mass arising from omentum with multiple omental and mesenteric seedlings and mesenteric, peripancreatic and perigastric lymphadenopathy. The patient underwent debulking surgery with uneventful post-operative recovery. Histopathological examination with immunohistochemistry revealed a diagnosis of DSRCT of omentum and small bowel mesentery with lymph node metastasis. Patient then received adjuvant chemotherapy with multiple chemotherapeutic drugs as per P6 protocol and has stable disease at 1 year follow up.
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Background: To decrease morbidity in patients undergoing hysterectomy for benign lesions, oophorectomy should not be done. Aims and Objectives: This study aims to compare the effects of surgical and natural menopause on menopausal symptoms and musculoskeletal complaints in menopausal women. Materials and Methods: This study was conducted in gynecology outpatient department from June 2019 to June 2020. A total of 200 postmenopausal women were selected between the age group of 40 and 55 years and then divided into two main groups – Group A (100), that is, natural menopause and Group B (100), that is, surgical menopause. Interviews were conducted about menopausal symptoms, using a standard questionnaire and were modified for yes or no response. The women were asked about symptoms such as hot flashes, sweating, vaginal dryness, dryness of skin, decreased libido, poor memory, depression, and musculoskeletal pain. Results: The study showed that menopausal symptoms and musculoskeletal pain were more common in women with surgical menopause as compared to women with natural menopause. The rate of hot flashes and sweating was more in surgical menopause group, that is, 81% and 82%, respectively, as compared to 52% and 50%, respectively, in natural menopause group. The musculoskeletal pain was more significant in Group B as compared to Group A, especially low back and upper back which were present in 55% and 42%, respectively, in Group B as compared to 43% and 41%, respectively, in Group A. Conclusion: As the menopausal symptoms and musculoskeletal pain are more common in patients with surgical menopause thereby increasing the morbidity, so oophorectomy should not be done in patients who are undergoing hysterectomy for benign lesions. Therefore, treatment of osteoporosis and hormone replacement therapy is recommended after surgery to decrease the menopausal and musculoskeletal symptoms within the 1st year of menopause.
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Background:Palliative radiotherapy offers significant relief in the huge physical distress of patients with bony metastasis. The enormous potential of conformal techniques has not been tested in palliative settings. However,the increasing life span of patients with metastatic disease demands to optimize the radiotherapy techniques to provide maximal durable symptomatic relief. Despitean increase in the utilization of the 3DCRT technique for palliative bony metastasis, the optimal beam arrangement remains unknown. Materials and Methods:Ten patients of vertebral bony metastasis were retrospectively selected and four virtual 3DCRT plans were generated for each patient. The field approaches were a single field, two fields, three fields and five field approaches. For PTV, D90, D50, Dmean, Conformity index (CI) were evaluated.Dmean was evaluated for the esophagus, bowel, kidneys, and combined lungs. Dose-volume histograms were computed for the various treatment plans and compared. Statistical analysis was done by ANOVA test. Results:A total of forty radiotherapy plans were generated. PTV parameters were significantly better with two field plans over one field plans in terms of D90 (p= 0.002), D50 (p= 0.02), Dmean(p=0.0009). Dmeanwassignificantly better with three field approach compared to two field approach (p=0.0006). The Dmeanwas significantly increased for organs at risk in two fields and three field plans.Five field approach did not showan advantage in terms of dosimetry of PTV but there was a significant rise in the dose to Organs at risk (OAR’s). Conclusion:The three field plans showed better dose distribution to the PTV with an acceptable increase in the dose to OAR’s.
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Purpose: To evaluate the frequency and the association of Thrombospondin 1 (THBS1) gene single nucleotide polymorphisms (SNPs) in Asian Indian patients with optical full thickness corneal grafting surgery. Methods: Prospective case朿ontrol analysis of optical penetrating keratoplasty patients with and without immune rejection and controls for genotyping of 3 THBS1 gene SNPs (rs1478604 A>G; rs2228261 C>T; rs2228262 A>G) by Amplification Refractory Mutation System-Polymerase Chain Reaction (ARMS PCR). Results: Among 58 patients [45 with immune allograft rejection (DNA isolation was possible in 38 samples) and 13 without immune corneal allograft rejection] and 65 controls, allele frequencies observed for rs1478604 (A>G) are A: 69.7% and 72.6%, G: 30.2% and 27.3%; for rs2228261 (C>T) are T: 70.2% and 62.3%, C: 29.7% and 37.6%; and for rs2228262 (A>G) A: 97.4% and 98.4%; G 2.5% and 1.5% respectively. Genotype frequencies were rs1478604 (A>G) AA: 57.8% and 59.3%, AG 23.6% and 26.5%; GG 18.4% and 14%; for rs2228261 (C>T) TT: 40.5% and 33.8%, TC: 59% and 56.9%, CC: 0% and 9.2%; for rs2228262 (A>G) AA: 94.8% and 96.8%, AG: 5.1% and 3.1% in rejection and controls respectively. The allele and genotype frequency for the 3 described THSB1 SNPs did not show any difference between the corneal graft immune rejection patients and controls. Conclusion: Asian Indian population evaluated for THBS1 gene SNPs by ARMS PCR genotyping in Asian Indian population did not show any genetic association to immune rejection occurrence in our study.
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Purpose: To find out the sociodemographic, sociocultural, and socioeconomic factors leading to delay in pediatric cataract surgery and its impact on final visual outcome. Methods: A prospective interview-based analytical cohort study was conducted on 156 children aged 0� years with either unilateral or bilateral congenital/developmental cataracts. Caregivers were interviewed using a pretested validated questionnaire. Time intervals between recognition by a caregiver to consultation were denoted as Delay-1 and between consultations to surgical intervention as Delay-2. Spearman's rank correlation was used to determine the presence of correlation between causes of delay and visual outcome. Results: The mean age of presentation was 7.78 � 4.34 years. Mothers were the first informant of the problem (n = 110, 70.5%). Out of 156 children, only 8 (5.1%) children presented to the hospital within 1 month by caregivers and 26 (16.7%) children underwent surgery within 2 months of advice. About 22 (14.1%) children had total cumulative delay of 1�months, 11 (7%) had delay of 6� months, and 115 (73.71%) had delay of >12 months. The most common cause identified for Delay-1 was unawareness in 41 cases (26.28%), however, for Delay-2 major factor responsible was cost (n = 38, 24.35%). The median preoperative visual acuity was 1.31 logMAR and median postoperative visual acuity at 4 weeks was 0.61 logMAR. (P < 0.001) Less age at surgery, upper socioeconomic status, less time delay, and better preoperative vision were positively correlated to better visual outcomes. Conclusion: Delay in presentation for childhood cataract surgery remains a significant problem in central rural India. Delay in surgery is multifactorial which includes unawareness, cost, misdiagnosis, self-treatment, distance from the hospital, lack of family support, and poor socioeconomic status.
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Childhood blindness is one of the priority targets of Vision 2020—Right To Sight due to its impact on the psychological and social growth of the child. An extensive search was performed to locate research papers on childhood blindness prevalence and its causes in the community based and blind schools, respectively, conducted from 1990 onward up to the present. Cross references were also manually searched along with expert consultation to enlarge the reference data. A total of five community-based studies on the prevalence including two refractive error studies conducted all over India in children less than 16 years were found. The causes of childhood blindness from the available blind school studies revealed that causes of childhood blindness have mainly shifted from corneal causes to whole globe abnormalities. This article highlights that though with the availability of proper healthcare facilities, the trend is changing for the causes but still a lot of effort in the form of timely neonatal eye care facilities, pediatric surgical services and proper refraction strategies is required.
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Purpose: Barrett Universal II (BU-II) is considered as one of the most accurate intraocular lens (IOL) power calculation formulas; however, there is no literature studying the same in Indian population. The aim of this study was to evaluate the accuracy of BU-II formula in prediction of IOL power for cataract surgery in Asian Indian population. This was an institutional, prospective, observational study. Methods: Patients with senile cataract who underwent phacoemulsification with posterior chamber IOL implantation were enrolled in the study. Biometry data from Lenstar-LS900 was used and IOL power was calculated using four IOL formulas: modified SRK-II, SRK/T, Olsen, and BU-II. Primary outcome was measured as the prediction error in postoperative refraction for each formula and secondary outcome was measured as the difference in mean absolute errors between the four formulas. SPSS Version-21 with P < 0.05 considered significant. Results: A total of 244 eyes were included in the study and were divided into three groups in accordance to axial length (AL): Group 1 (AL: 22�.5 mm; N = 135), Group 2 (AL <22 mm; N = 53), and Group 3 (AL >24.5 mm; N = 56). BU-II formula gave the lowest mean absolute error (0.37 � 0.27D) and median absolute error (0.34) in predicted postoperative refraction in the entire study population. When compared with the other formulas, mean absolute error was significantly lower in all three groups (P < 0.0005) as well, except for Olsen formula in the normal AL group, where the results were comparable (P = 0.742). Conclusion: BU-II performed as the most accurate formula in the prediction of postoperative refraction over a wide range of ALs.
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Background & objectives: Dengue virus (DENV) transmission is known to be influenced by the environmental conditions. During 2017, the Viral Research and Diagnostic Laboratories (VRDLs) tested 78,744 suspected dengue fever (DF) patients, of whom, 21,260 were laboratory confirmed. The objectives of the study were to evaluate the hypothesis that spatial heterogeneity existed for DF patients and to identify significant determinants of DENV transmission in various districts across the Indian States during 2017. Methods: Laboratory confirmed DF cases were analysed from 402 districts spread across the Indian States. The determinants for DF transmission included in the model were population density, proportion of population living in rural areas, proportion o f forest cover area to the total geographical area, proportion of persons not able to read and write and who were aged greater than seven years; the climatic variables considered were minimum, maximum and average temperature, precipitation and cumulative rainfall. The spatial heterogeneity was assessed using spatial regression analysis. Results: DF cases showed strong spatial dependency, with Moran's I=4.44 (P <0.001). The robust measure for spatial lag (6.55; P=0.01) was found to be the best model fit for the data set. Minimum temperature and cumulative rainfall were significant predictors. Interpretation & conclusions: A significant increase in the number of dengue cases has occurred when the minimum temperature was 23.0-25.8癈 and the cumulative rainfall 118.14-611.64 mm across the Indian districts. Further in-depth investigations incorporating more number of demographic, ecological and socio-economic factors would be needed for robust conclusions.
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Purpose: To ascertain if ultrasound (USG) B-scan examination of the optic nerve head (ONH) can be a useful tool to diagnose and quantify glaucomatous cupping. Methods: A cross-sectional observational study of 48 eyes of 48 patients with clear ocular media and cup-disc ratio of (CDR) ?0.6 were included. The disc was studied by + 90D examination, USG B-scan and ONH Optical coherence tomography (OCT) by three masked observers. Observer-1 assessed the clinical CDR, observer-2recordedopticcup diameter on USG B-scan and observer-3performed ONH OCT to note the software computed average CDR. Measurements of cupping obtained by these 3 methods were compared and their relative strengths determined. The interdependency between variables was further studied using regression analysis. Results: Clinically assessed disc ratios of 0.6, 0.7, 0.8, 0.9, and total corresponded to USG cup measures of 1.02 ± 0.11 mm, 1.23 ± 0.14 mm, 1.35 ± 0.072 mm, 1.45 ± 0.084 mm, 1.75 ± 0.15 mm and OCT average CDR of 0.62 ± 0.087, 0.68 ± 0.060, 0.75 ± 0.078, 0.81 ± 0.036, 0.89 ± 0.038, respectively. There was an excellent correlation between the three arms, with Pearson's co-efficient (r) of 0.87, P < 0.001 between clinical and USG cupping; r = 0.89, P < 0.001 between clinical and OCT cupping; and r = 0.88, P < 0.001 between USG and OCT cupping. A relation of y = 1.64x + 0.03 was obtained between them, where y stands for USG cup diameter and x stands for the observed clinical CDR. Conclusion: Ultrasonographic measurement of optic cup diameter corresponds well to clinical ONH cupping. Therefore, it can reliably be used in quantifying ONH cupping in cases of media opacities which preclude optic disc visualization.
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Background: Prostate carcinoma screening tests usually include digital rectal examination (DRE) and prostate-specific antigen (PSA) levels. If these tests detect some abnormality, further evaluation is recommended using transrectal ultrasound (TRUS), TRUS guided biopsy, or magnetic resonance imaging (MRI). MRI is a preferred tool among three as its noninvasive and has high sensitivity and specificity. In MRI, most of the medical centers perform multi-parametric MRI. The present study is an endeavor to evaluate the feasibility of using biparametric study for detection of prostate cancer; thereby reducing the scan time and avoiding the use of contrast. Objective: The objective of the study was to compare the diagnostic efficacy of using biparametric MRI (T2-weighted imaging [T2WI] and Diffusion-weighted images [DWI]) for detection of carcinoma prostate as compared to multiparametric MR study which in addition also includes dynamic contrast-enhanced (DCE) and spectroscopic MRI sequences. Materials and Methods: This prospective cross-sectional study included 60 patients suspected to have prostate cancer on the basis of PSA levels and DRE. All the patients underwent pre-treatment MRI on 1.5 T scanner followed by TRUS guided biopsy. MRI protocol included T1-weighted images, T2W, DWI, DCE MRI, and MR spectroscopy. The diagnostic performance of T2WI + DWI and multi-parametric MRI for diagnosis of prostate cancer was determined and compared with each other using histopathology as the gold standard. Results: The sensitivity for detection of carcinoma prostate for biparametric MRI (T2WI + DWI) is 63.3%, specificity 78.95%, positive predictive value (PPV) 86.6%, and negative predictive value of (NPV) 50.00%. The sensitivity of multiparametric MRI was 78.05%, specificity 68.42 % with PPV 84.2%, and NPV of 59.09%. Conclusion: For the detection of prostate cancer biparametric (DWI/T2WI) and multi-parametric MRI both showed comparable results. Multi-parametric MRI involves the administration of intravenous contrast and requires longer acquisition time; T2/DWI is faster and non-contrast sequences and is workhorse sequence in the detection of prostate cancer.
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Corneal blindness is one of the major causes of reversible blindness, which can be managed with transplantation of a healthy donor cornea. It is the most successful organ transplantation in the human body as cornea is devoid of vasculature, minimizing the risk of graft rejection. The first successful transplant was performed by Zirm, and since then, corneal transplantation has seen significant evolution. It has been possible because of the relentless efforts by researchers and the increase in knowledge about corneal anatomy, improvement in instruments and advancements in technology. Keratoplasty has come a long way since the initial surgeries wherein the whole cornea was replaced to the present day where only the selective diseased layer can be replaced. These newer procedures maintain structural integrity and avoid catastrophic complications associated with open globe surgery. Corneal transplantation procedures are broadly classified as full-thickness penetrating keratoplasty and partial lamellar corneal surgeries which include anterior lamellar keratoplasty [sperficial anterior lamellar keratoplasty (SALK), automated lamellar therapeutic keratoplasty (ALTK) and deep anterior lamellar keratoplasty (DALK)] and posterior lamellar keratoplasty [Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK)] broadly.
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Scrub typhus is largely ignored in India particularly during outbreaks of viral fever. The disease course is often complicated leading to fatalities in the absence of treatment. However, if diagnosed early and a specific treatment is initiated, the cure rate is high. We report here five cases of scrub typhus to highlight the fact that high clinical suspicion for such a deadly disease is an absolute necessity.