Correlation of Leptin and Vaspin Serum Concentration in Newly Diagnosed Type 2 Diabetes Mellitus

Objectives : The aim of the study was to explore the correlation of circulating leptin and vaspin levels with lipid profile, fasting blood sugar, HbA1c and anthropometric variable as inflammatory markers between diabetic patients and non - diabetic subjects. Material and Methods: This study was conducted with 120 newly diagnosed type 2 diabetes mellitus (T2DM) patients with age - matched 120 non - diabetic sub jects as controls. Results: We found that there is significant increase in the parameters like serum Leptin, Vaspin, FBS, PPBS, HbA1c and lipid profile (TC, TG & VLDL). No significant differences were found between BMI, LDL & HDL parameters of T2DM patient s compared to non - diabetic subjects. The results have been shown a significant positive correlation between Vaspin and Leptin in T2DM patients, (r = .755) and ( P ?0.01 ) as compared to controls. The body mass index was positively correlated with Vaspin in T2DM patients, (r = .50) and ( P <0.01 ) and with leptin in T2DM patients, (r = .265) and ( P <0.01) . A positive correlation had also observed between vaspin and LDL in T2DM patients, (r = .189) and ( p <0.05 ). We also found that significant increased leve l of leptin and vaspin in females compared to males in our study group. Conclusions: Serum leptin and vaspin level is positively associated with BMI and LDL and negatively correlated with fasting blood sugar, post - prandial glucose, HbA1c, VLDL and age.

Resource optimization through process re-engineering of inhalational therapy unit at a tertiary care public hospital

Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment.

Drug utilization study in diabetic patients seeking medical treatment in a north Indian rural medical college hospital

Background: Diabetes Mellitus is a chronic disease and its life-long management causes burden on lifestyle and financial condition of the patients. Drug utilization studies provide useful insights into the current prescribing practices.Methods: To evaluate the drug utilization pattern of anti-diabetic drugs in diabetic patients. A prospective observational study was carried out in adult diabetic patients visiting the Wards and Outpatient Department of General Medicine of a tertiary care hospital. The demographic data and utilization of different classes of anti-diabetic agents as well as individual drugs were analyzed.Results: In 125 patients (Male-65, Female-60), a total of 379 drugs (average 3.032±2.05) were used per day, out of which 76 (20.05%) were rational fixed dose combinations (FDCs) and 261 (68.86%) were prescribed from National List of Essential Medicines (NLEM) 2015. The number of drugs prescribed to be ingested was 326 (86.01%) and 63 (16.62%) were injectables.Conclusions: It was found that the prescription tendencies of the doctors were quite rational. More improvement can be done by sensitizing them to prescribe more drugs from NLEM. The limitations in the affordability of rural population should be taken care of while prescribing drugs for this chronic disease.

Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs.

Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient’s length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ` 2,04,787 (US$ 3,413) and ` 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ` 1,48,200 (95% CI 55,716 to 2,40,685, P<0.01). Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

Prevalence of intestinal parasitic infections in HIV-infected individuals and their relationship with immune status.

Background and Objectives: Intestinal parasitic infection is a common entity in patients infected with human immunodeficiency virus (HIV). These infections may lead to fatal complications in the immuno suppressed individuals. The aim of the present study was to determine the prevalence of intestinal parasitic infections in HIV sero-positive patients and their relationship with the immune status of individuals. Materials and Method s: Fecal samples from 100 HIV sero-positive and an equal number of HIV sero-negative individuals were collected and examined for enteric parasites by direct microscopy. CD4 counts were carried out in only HIV sero-positive patients. Prevalence of intestinal parasites in patients with CD4 count <200 cells/μl, 200-499 cells/μl, and ≥500 cells/μl in HIV-infected patients were compared. Results: Enteric parasites were detected in 59.3% HIV-infected patients with CD4 count <200 cells/μl as compared with 23.5% in patients with CD4 count >200 cells/μl (P < 0.01). Prevalence of coccidian parasites was significantly (P < 0.01) higher (14%) in HIV sero-positive subjects compared with HIV sero-negative subjects (2%). Isospora belli (25%) was the most common parasite with CD4 count <200 cells/μl, followed by Cryptosporidium parvum (12.5%). Prevalence of intestinal parasitic infections was significantly higher in patients with diarrhea, 73.6% than without diarrhea, 25.9%, (P < 0.05). The mean CD4 count of HIV sero-positive patients presenting with diarrhea was significantly (P < 0.01) lower (181.26 ± 135.14) than without diarrhea (352.02 ± 204.03). Conclusion: This study emphasizes the need for routine screening of parasites especially in patients with lower CD4 count so as to decrease the morbidity by ensuring the early treatment of the cases.

Prevalences of simian, Sydney and Suwon creases and their association with each other, body sides, handedness, sex and anomalies/diseases/syndromes in a population of Central India / Prevalencias de liegues simiesco, de Sydney y de Suwon y su asociación entre ellos, lados del cuerpo, dominancia manual, sexo y anomalías/enfermedades/síndromes en una población de la India Central

The Simian and Sydney creases are variant palmar creases which have now drawn medical attention as their presence correlates strongly with numerous chromosomal anomalies and diseases. Works on these creases have been done on several human communities, racial and ethnic but no specific study is focussed out on the Indian populations. In this study 1000 Central Indian subjects (500 males and 500 females) aged between 5 to 70 years were randomly selected and examined by the authors. We found the prevalence of Simian, Sydney and Suwon creases in studied population of Central India is 14.4 percent, 3.6 percent and 2.4 percent respectively, which is a little higher than the figures for Asians and Caucasians claimed by earlier studies. There is no any association between these creases. The Simian crease is predominantly unilateral right side and associated with handedness. It is more common in males. The Sydney crease does not have unilateral or bilateral predominance and association with handedness but it is more common in females. The Suwon crease does not have unilateral or bilateral predominance and association with handedness but it is more common in males. There is no association of these creases with anomalies/diseases/syndromes. Conclusively this work draws attention to the importance of undertaking parallel investigations on every socio-cultural human group or population wherever possible.

Los pliegues simiescos y de Sydney, son pliegues palmares variantes que en la actualidad han llamado la atención médica, ya que su presencia se relaciona estrechamente con numerosas anomalías cromosómicas y enfermedades. Investigaciones sobre estos pliegues se han realizado en diferentes comunidades humanas, raciales y étnicas, pero ningún estudio específico se centra sobre las poblaciones indígenas. En este estudio 1000 sujetos de la India central (500 hombres y mujeres 500) entre 5 y 70 años fueron seleccionados al azar y examinados. Se encontró que la prevalencia de los pliegues Simiescos, de Sydney y de Suwon de la población estudiada es de 14,4 por ciento, 3,6 por ciento y 2,4 por ciento respectivamente, mayor que los porcentajes en asiáticos y caucásicos. No hay ninguna asociación entre estos pliegues. El pliegue simiesco es predominantemente unilateral derecho y se asocia con dominancia manual. Es más común en los hombres. El pliegue de Sydney no tiene predominio unilateral o bilateral, ni asociación con dominancia manual, pero es más común en las mujeres. El pliegue de Suwon no tiene predominio unilateral o bilateral, ni asociación con dominancia manual, pero es más común en los hombres. No existe ninguna asociación de estos pliegues con anomalías/enfermedades/síndromes. Se concluye la importancia de realizar investigaciones paralelas en todos los grupos humanos o socio-culturales de la población siempre que sea posible.

Effect of complete and skeleton photoperiods in baya weaver, Ploceus philippinus.

A study was performed to investigate the effects of complete and skeleton photoperiods on gonadal stimulation in baya weaver, Ploceus philippinus. In August 2003, five groups of acclimatized birds (n = 7 each) were exposed to 6L: 13D: 1L: 4D, 6L: 6D: 1L: 11D, 11L: 13D and 13L: 11D. Birds were refractory and their exposure to 6L:13D:1L:4D, 6L:6D:1L:11D, 11L:13D and 13L:11D did not evoke any response. This clearly indicates that the birds were insensitive to the stimulatory effects of these photoperiods and perceived them as short days. An attempt was made to test the responsivity by subjecting all these groups to long day exposure after 16 weeks of experiment. Under 16L: 8D, birds did not show a response during the first 4 weeks of exposure (week 16 to week 20), but thereafter there was a significant photoinduction except 11L:13D (week 24), but the rate and magnitude was different. Until the end of the experiment (32 weeks), all groups of birds had maximum testicular volume except 11L:13D. Birds pre-exposed to 6L:13D:1L:4D, 6L:6D:1L:11D, 11L:13D and 13L:11D responded to 16L:8D, which suggests that these photoperiods helped the birds in recovering their photosensitivity. The results from this experiment indicate that baya weaver interprets a light period depending when the light falls relative to its endogenous circadian system.

The effect of recent trauma on serum complement activation and serum C3 levels correlated with the injury severity score.

PURPOSE: The objective of this prospective pilot study was to estimate serum C3 levels and complement activation within 12 hours of injury and to correlate them with abbreviated injury score (AIS) so as to predict the outcome of injury in terms of mortality or sepsis. METHODS: The test group (n=30) of patients with < 12 hours of injury were assessed by the AIS-80 and compared with a control group (n=10). Serum C3 levels were estimated by the single radial immunodiffusion technique and complement activation by both two-dimensional and counter immuno-electrophoresis. Statistical analysis was performed using the correlation regression analysis and the minimum discrimination information statistics (MDIS) analysis. RESULTS: Serum C3 levels were not reduced in patients with injury severity score (ISS) < 12 (n=7). There was a statistically significant difference of serum C3 levels in patients with ISS between 12 and 29 (n=15) and in patients with ISS more than 29 (n=9). Complement activation also correlated well with ISS (p < 0.05). Complement activation and serum C3 levels were found to influence subsequent development of septic complications in the post injury period, being significantly lower in patients who developed septic complications. Complement alterations in trauma patients were a direct result of the trauma since they were not seen in patients undergoing surgery. CONCLUSIONS: ISS is a good prognosticator of outcome of trauma and serum C3 levels and complement activation are good predictors for mortality and development of septic complications in recently injured patients. These may prove to be effective parameters in the management of the patients with injury.

Gall bladder perforation and biliary peritonitis in a young pregnant lady.

A rare event of acute free perforation of gall bladder with biliary peritonitis in a case of calculous cholecystitis in a 28 years old pregnant lady occurring in the absence of the usual factors associated with gall stone disease is reported. The clinical features resembled acute appendicitis and a pre-operative diagnosis could not be made. It is suggested that a thorough attempt should be made to exclude conditions mimicking appendicitis, including those of the biliary system, on finding a normal appendix at emergency appendicectomy without hesitating to convert to full laparotomy if required.

Fasciolopsiasis--a persisting problem in eastern U.P.--a case report.

Fasciolopsiasis, or infection by the intestinal fluke, Fascilopsis buski, is endemic in the eastern states of our country. While it is by no means a rarity, especially in the rural set up, awareness regarding this common parasitic infestation is still a much-needed entity. The importance of a strong degree of suspicion and early diagnosis cannot be over emphasised, if a successful campaign is to be launched in its control. With this as our central theme, we proceed to report a case of and unsually heavy Fasciolopsis buski infection in our hospital, which had failed to be diagnosed in a semi urban setup in UP.

Experience in adult population in dengue outbreak in Delhi.

A dengue outbreak has recently hit the Indian capital. We studied the clinical profile of adult patients. Five hundred and sixty patients of dengue infection were admitted in a specially created ward according to the criteria laid down by WHO. Haematemesis (28.28%), epistaxis (26.78%) and malena (14.28%) were some of the common presentations. Similarly lymphadenopathy, especially cervical (30.89%), palatal rashes (26.96%) and hepatomegaly (23.75%) were the most commonly encountered findings on physical examination. Most of the cases were of dengue fever with haemorrhage and only 2.5% cases were classified under dengue haemorrhagic fever or dengue shock syndrome. The average hospital stay was 3.4 days but only 9.8 hours in the eleven patients who died, suggesting their late arrival in preterminal situation giving little time for resuscitation. Thrombocytopenia was not a feature and only 12.85% patients had platelet count less than 70,000/cmm. Most of the patients who were admitted with thrombocytopenia, showed normalization in their platelet counts in next few days. Serological examination demonstrated evidence of recent dengue infection in 41.17% patients. Few patients required blood or platelet concentrate transfusion. Eleven patients died, three due to DIC, one of intracranial haemorrhage and seven due to massive gastric haemorrhage. Rest of the patients recovered completely. Thus we can conclude that recent outbreak in Delhi was of dengue fever with haemorrhage and mortality was very low in patients who came early to the hospital.

Virulence & pathogenicity of Yersinia enterocolitica under different test systems.

Eight clinical isolates of Y. enterocolitica were tested for various pathogenicity and virulence markers. Seven of the eight strains gave positive results for Congo red magnesium oxalate (CRMOX) agar test and autoagglutination test at 37 degrees C. Seven strains bound crystal violet (CV) completely at 37 degrees C but not at 25 degrees C. One strain (Y1) bound CV partially. None of the strains showed pyrazinamidase activity indicating these strains to be virulent. Cells of all but one strains were aggregated by 1.8 M and 3.2M concentration of ammonium sulphate. A good correlation between these tests and virulence was observed.

Visceral larva migrans.

We present a case of visceral larva migrans which came as a complete histologic surprise. The patient was operated as a case of chronic cholecystitis and was found at operation to have multiple hepatic nodules. A cholecystectomy with a biopsy of the liver nodule was performed. Histopathologically a diagnosis of visceral larva migrans was made. To our knowledge this is the first case report of the disorder from India. A discussion based on the review of literature is presented.

Subacute sclerosing panencephalitis.

A retrospective study of 36 confirmed cases of subacute sclerosing panencephalitis (SSPE) was carried out to detect any variation in the clinical and EEG patterns previously described. There were 31 males and 5 females, aged 4 to 24 years. Onset of SSPE at or after 15 years of age was observed in 22.2% of cases. Rapid progression of the disease was observed in 52%. The first symptom was myoclonus in 61.6%, mental regression in 22.2% and generalised seizures in 11.1% of cases. Low positive measles antibody titres in the CSF were found in 36.1% of cases. EEG analysis revealed slow background in 69.2% and periodic complexes in 94.4% of cases. Atypical periodic complexes, focal abnormalities and paroxysms of bisynchronus sharp activity were also observed.

Neurocysticercosis in children.

Twenty seven cases (13 male, 14 female) in the age group of 3-12 years with cerebral cysticercosis were studied and followed up to 3.9 years (mean 1.85 +/- 0.91 years). Seizures (partial 76% and generalized 23.8%) was the feature in 21 patients (77.7%) and raised intracranial tension in 15 (55.5%). Five patients (18.2%) had meningoencephalitis, while 4 (14.8%) had obstructive hydrocephalus due to intraventricular cysts in the 4th ventricle. Twenty two patients received cysticidal drugs (praziquantel or albendazole), while 8 had surgical intervention (CSF diversion, cyst removal, subtemporal decompression or extirpation of the cortical cyst). Mortality was 18.2%. Survivors had epilepsy in 18 patients (81.8%), dementia in 2 (9%), mental subnormality in 6 (27.2%) and hyperkinesia in 12 (54.5%).

Hepatopulmonary amoebiasis. Efficacy of various treatment regimens containing dehydroemetine and/or metronidazole.

Thirty three patients with hepatopulmonary amoebiasis were studied. Pulmonary involvement was observed in 55%, pleuro-pulmonary lesions in 30%. Typical chocolate coloured sputum was obtained in 24% and pleural fluid in 21% of patients. Entamoeba histolytica were demonstrable in the sputum in only 6% and in the pleural fluid in 15%. The best therapeutic results were obtained with a combination of dehydroemetine and metronidazole. However, metronidazole was found to be nearly as effective as dehydroemetine, and metronidazole 400 mg and 800 mg were equally effective.