Vitamin D level as a predictor of pneumonia and asthma in children less than 5 years of age

Background: Childhood pneumonia is a global health problem .It the leading cause of death for children under the age of five years. 95% of all pneumonia cases under the age of five occurs in developing countries. Asthma remains the most common chronic disease of childhood in the world. The observation that vitamin D deficiency and asthma share risk factors such as urban residence, obesity and African American ethnicity has generated interest in exploring a link between these two conditions. This study was taken up to assess the role of vitamin D as a predictor of pneumonia and asthma in children less than 5 years of age.Methods: A prospective observational case control study was conducted in MLB Medical college, Jhansi from January 2015 to December 2016 (1 year 11 months). A total of 60 children including 30 asthma cases, 20 pneumonia cases and 10 controls, aged, 6-60 months were enrolled. Controls were healthy children attending outpatient services for immunization.Results: The mean age of the pneumonia patient was 1.5 years, while mean age in asthma patients was 3.1yrs. Ratio of male and female in pneumonia cases was1.5:1, while is asthma ratio was 2:1. In our study 45% pneumonia cases had deficient level of vitamin D (<20ng/ml) and mean level was 11.08±4.68 while 40% of control had deficient level of vitamin D and mean level was 16.04±1.61, p value was 0.0166 and there was significant difference in both the groups. In Asthma cases 53.33% patient had deficient level of vitamin-D and mean level was 10.62±2.908 as compared to 40% control (mean : 16.04±1.62) ‘p’ value was <0.0001 and was highly significant.Conclusions: Our study has illustrated that vitamin-D levels were significantly low in pneumonia and asthma patients as compared to control.

Etiological causes and epidemiological characteristics of patients with occupational corneal foreign bodies: A prospective study in a hospital-based setting in India

Purpose: Corneal foreign bodies (CFBs) due to occupational exposure have been largely ignored in Indian literature, especially nonmetal workers. Our study looks at a broad range of occupations and settings that contribute to CFB in our local Indian population. The study objective was to determine the occupations, level of education and demographics of patients presenting with CFB acquired during occupational work. Methods: Prospective hospital-based study at a tertiary eye hospital in Gurgaon, Haryana, India, within duration of 9 months. Patients presenting with CFB were asked a set of questions relating to their occupation, level of education, understanding of the potential complications of CFB, and demographics. Results: A total of 83 patients were included in the study. CFB were attributed only to males. 66% of patients were in the age group of 14--29 years. 30% of patients were in the age group 30--44 years and 4% of patients were between 45 and 60 years old. The metal work industry was responsible for 47% of presentations. The construction industry was responsible for 27% of presentations. Electricians and carpenters combined were responsible for 10% of presentations and 17% of presentations occurred in other sectors. Conclusion: CFB occur across a number of occupations in the construction industry, not just metallic workers. Among a population that is generally poorly educated and have nominal understanding of the impact that CFB can have on vision, occupational hazard education is necessary to address this problem.

Clinico-Epidemiological Study of Pericardial Effusion in Northern India

Background: Pericardial effusions may be discovered incidentally or as life-threatening scenario of cardiac tamponade. Hence, etiological identification of pericardial effusion proves crucial in-patient management. Aim: To assess the clinical presentation and etiology of pericardial effusion at a tertiary-care centre in India. Methods: This was a retrospective, observational, single-centre one-year hospital-based study. Data from 70 diagnosed cases of pericardial effusion from our tertiary-care centre in India from August 2016 to July 2017 was retrospectively reviewed. A diagnosis of pericardial effusion was confirmed based on findings from clinical history, examination, specific laboratory investigations, and radiological investigations. Pericardial fluid analysis was also performed. Results: The mean age of the patients was 46.87±14.40 years. Almost equal frequencies of men 36 (51.4%) and women 34 (48.6%) were observed. The most commonly observed signs/symptoms of patients diagnosed with pericardial effusion was raised jugular venous pulse in 39 (55.7%) patients, breathlessness in 36 (51.4%) patients, and tachypnea and tachycardia (heart rate >100 beats per minute) in 33 (47.1%) patients each. An etiology of tubercular effusion was common in 32 (44.4%) patients. On analyzing data according to the underlying etiology, the most frequent sign/symptom was raised jugular venous pulse in 20 (62.5%) patients diagnosed with tubercular effusion, tachypnea in 10 (52.6%) patients diagnosed with hypothyroidism and tachycardia in 12 (63.2%) patients with a diagnosis other than pericardial effusion or hypothyroidism. Conclusions: The high prevalence of tuberculosis in India warrants increased control and awareness of this infection.

Management protocols for chronic heart failure in India

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

A Study of Transverse Diameter of Lumbar Vertebral Canal in North Indian Population.

Lumbar spinal stenosis is a medical condition occurring due to reduction in the diameter of bony vertebral canal. The transverse diameter of the canal plays a significant role in determining diagnostic criteria for defining stenosis. The present study aims at defining baseline values of transverse diameter of lumbar vertebral canal in healthy north Indian population by radio-diagnosis. Fifty healthy subjects, within age range of 20-70 years were radio-imaged and transverse diameter of vertebral body and canal were assessed. There was a gradual increase in diameter from L1 to L5 vertebral levels. The means of transverse diameter of vertebral body and vertebral canal show no significant differences between genders and the results were compared with earlier published research work. There are subtle differences in morphometry of lumbar canal in different population group suggesting regional and ethnic differences.

The Evaluation of Effect of Phototherapy on Serum Calcium Level.

Jaundice is one of the most common problem that can occur in the newborn. The study group included 30 neonates (15 term and 15 preterm) and control group included 20 neonates (10 terms & 10 preterm). All had hyperbilirubinemia. The controls were fully matched with the study group. All the neonates included in the study group required management with phototherapy. The neonates in the control group were managed without phototherapy. Measurement of ionized serum calcium level was done before and after 48 hours of institution of phototherapy in study groups and controls. Before phototherapy, there was no statistical significant difference in mean serum calcium level in term & preterm neonates of both study & control group. After 48 hours of phototherapy in study group, a significant fall in calcium level in 66.6% of term & 80% of preterm neonates was observed. Whereas, no difference was observed in control group. It is suggested that calcium level be assessed in neonates treated with phototherapy for more then 48 hours and managed accordingly.

Troponin-T in unstable angina--a clinical and angiographic study.

OBJECTIVE: To examine the prognostic significance of Troponin-T in patients admitted with unstable angina and to study their angiographic morphology. DESIGN: Single centre, prospective study of in hospital events. SETTING: Intensive coronary care unit of a large municipal general hospital. SUBJECTS: 128 consecutive patients admitted with a diagnosis of unstable angina (Braunwald's classification). METHODS: Measurement of Troponin-T by qualitative assay at admission, coronary angiography between 5th to 7th day. MAIN OUTCOME MEASURES: In hospital adverse cardiac events--recurrent angina, new myocardial infarction or cardiac deaths. RESULTS: Fifty six (43.7%) patients had a positive test. The incidence of recurrent angina was significantly higher in the Trop-T positive group (57.1% vs 11.1%, p < 0.001). Six patients of this developed acute myocardial infarction subsequently whereas none of the patients in the Trop-T negative group developed acute MI (10.7% v/s 0%, p = 0.05). There were two deaths in the Trop-T positive group and none in the Trop-T negative group. 44 (78.5%) patients of the Trop-T positive group and 60 patients in the Trop-T negative group underwent coronary angiography. There was no significant difference in the incidence of single vessel disease (27.2% v/s 20%, p = NS) or multivessel disease (72.7% v/s 69.9%, p = ns). None of the patients with a positive Trop-T had normal coronary angiography whereas 6 patients in the Trop-T negative group had a normal coronary angiography (0% v/s 10%, p < 0.05). Patients with a positive troponin T test had a significantly higher incidence of type B lesions and a higher incidence of intracoronary thrombus. CONCLUSIONS: The in hospital outcome of Trop-T positive patients was significantly worse than patients with a negative test. Patients with a positive troponin T test had more complex coronary morphology and a higher incidence of intracoronary thrombus. We conclude that troponin-T can be used as a prognostic marker in patients with unstable angina.

Coronary stenting in diabetics: six months clinical and angiographic outcome.

The aim of this study was to assess the clinical and angiographic outcome of coronary stenting in diabetics as compared to non-diabetic patients. A total of 114 patients undergoing coronary angioplasty with stenting were prospectively evaluated. There were 30 diabetic (group A) and 84 non-diabetic (group B) patients. There were no significant differences in both the groups with respect to other risk factors and clinical characteristics. Both the groups were also comparable in terms of lesion morphology and stent types. The clinical endpoints were recurrent angina, reinfarction, cardiac death and need for target vessel revascularisation. The angiographic endpoint was angiographic restenosis at six months. There were 70 males and 44 female patients with a mean age of 55 +/- 12 years. Angiographic follow-up was completed in 85 (74.7%) patients which included 25 (83.3%) patients in group A and 60 (71.4%) in group B. Among clinical events at 30 days, the incidence of recurrent angina was 10.0 percent versus 8.3 percent (group A and B; p = NS) and incidence of reinfarction was 6.6 percent versus 5.9 percent (group A and B; p = NS), respectively. At six months, recurrent angina was seen in 16.6 percent versus 15.4 percent (p = NS) and reinfarction was seen in 10.0 percent versus 8.3 percent (p = NS) in group A and B, respectively. There were no deaths in either group. The angiographic restenosis rate was significantly higher in diabetics compared to non-diabetics (40.0% vs 23.3%; p = 0.02). The need for target vessel revascularisation was higher in diabetics as compared to non-diabetics (16.0% vs 6.6%; p = 0.03). We conclude that in spite of using coronary stents, the diabetics have higher restenosis rate and higher target vessel revascularisation rate than the non-diabetic patients.

Preconditioning the human myocardium with intracoronary adenosine.

This study was designed to study the role of adenosine in ischaemic preconditioning. The clinical, electrocardiographic and metabolic parameters of ischaemia were compared before and after intracoronary adenosine during percutaneous transluminal coronary angioplasty in 15 patients with significant stenosis of the left anterior descending artery. Baseline ischaemia was demonstrated by inflating the balloon of appropriate size at its nominal pressure for 30 seconds. Intracoronary adenosine was then administered in dose of 1000 to 6000 mgm/ml. The balloon was repositioned and inflated at nominal pressure for 180 seconds. As compared to 1st balloon inflation, the 2nd balloon inflation produced less severe chest pain, less ST segment deviation on the intracoronary ECG (7.40 +/- 3.94 vs 4.30 +/- 2.15 mm; p < 0.05) and lower coronary sinus lactate levels as compared to the first (0.28 +/- 0.06 vs 0.22 +/- 0.04 mmol/lit; p < 0.05). In conclusion, this study proves that by injecting intracoronary adenosine it is possible to precondition the human myocardium.

Adenosine-induced chest pain: is it due to myocardial ischaemia? Clinical, electrocardiographic, haemodynamic and metabolic study.

Adenosine has recently been demonstrated to be a mediator of angina in human beings. The present study was undertaken to document the presence or absence of myocardial ischaemia on clinical, haemodynamic, electrocardiographic and metabolic evidences after intracoronary administration of adenosine. Fifteen patients with chronic stable angina (12 males and 3 females), positive exercise stress test and documented significant stenosis of the left anterior descending coronary artery (LAD) were included in the study. The surface and intracoronary electrocardiograms (ECGs), pulmonary artery diastolic pressure and coronary sinus lactate levels were monitored at baseline and after intracoronary administration of adenosine in all patients. Adenosine was administered intracoronary in doses of 1000-8000 microgram depending on the provocation of chest pain. Typical angina was observed in all patients. There were no signs of ischaemia on surface or intracoronary ECG. There was no statistically significant difference between the pulmonary artery diastolic pressure and coronary sins lactate levels at baseline and post-adenosine administration (p > 0.05). It is concluded that intracoronary administration of adenosine produces chest pain in patients with chronic stable angina by mechanism other than myocardial ischaemia.

Coronary artery stenting in acute myocardial infarction.

Little information is available on the use of coronary stents to treat suboptimal results during direct angioplasty in acute myocardial infarction (AMI). In this study, we report 16 cases of AMI who underwent stent implantation in infarct-related artery for suboptimal results and their 6 months angiographic follow-up. Immediate angiographic success was achieved in all patients. The minimal luminal diameter increased from 0.06 +/- 0.12 mm to 2.89 +/- 0.12 mm (p < 0.001). One patient died in the hospital on day 8 due to subacute stent thrombosis. No patient required emergency bypass surgery. Two patients required blood transfusion for groin haematoma and one required intracoronary thrombolysis. All patients underwent exercise stress test at 1 month and at 3 months and coronary angiography at 4 months or earlier it indicated. At the end of 6 months follow-up, 4 patients had a positive exercise test and coronary angiography revealed angiographic restenosis in 3 and progression of disease in other vessels in 1 patient. We conclude that stent deployment is a viable option to treat suboptimal results after direct angioplasty in AMI.

Immunological profile in neonatal hyperbilirubinemia.

Thirty cases of neonatal hyperbilirubinemia of varying etiology, severity and duration; and twenty six normal healthy newborns were subjected to various tests of cellular and humoral immunity. The results revealed a significant depression of all the parameters of cellular immunity in neonatal hyperbilirubinemia of greater than or equal to 10 mg/dl as compared to the control values. The depression of immunological profile in these newborns was seen to be more pronounced with increasing duration and severity of jaundice. A limited assessment of the humoral immunity by the B cell count and serum immunoglobulin IgG levels, however, showed no significant difference from the control.