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Background: Prevalence of undernutrition among infants <6 months are very high in India. WAZ is the most sensitive predictor of mortality among infants <6 months as compared to other anthropometric parameters. However, taking weight and calculating z-score in the community setting have many challenges. Taking mid upper arm circumference (MUAC) is more feasible in a field setting. Methodology: A cross-sectional study was conducted with 419 infants <6 months in a tertiary care hospital in India to identify appropriate MUAC cutoffs for identifying underweight (WAZ<-2) and severe underweight (WAZ<-3) among infants <6 months by calculating sensitivities, specificities and Youden indices. Cohen kappa coefficients were calculated to assess agreements between MUAC and WAZ cutoffs. Results: The MUAC cut-offs for underweight and severe underweight were calculated as 11cm (Youden Index: 0.503; sensitivity: 83.4%; specificity: 66.9%) and 10.9cm (Youden Index: 0.504; sensitivity: 76.3%; specificity: 74.1%), respectively. Kappa coefficients to diagnose underweight with MUAC<=11cm was highest at 0.48. Conclusions: The MUAC cut-off of 11cm could reliably be used to screen infants <6 months with underweight and severe underweight for providing appropriate care in the Indian settings.
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Background: The epidemic of coronavirus disease 2019 (COVID-19) has been rapidly spreading on a global scale affecting many countries and territories. There is rapid onset of generalized inflammation resulting in acute respiratory distress syndrome. We, thus, aimed to explore the potential of immune-inflammatory parameters in predicting the severity of COVID-19. Materials and Methods: Age, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Lactate Dehydrogenase (LDH), C-reaction protein (CRP), and procalcitonin (PCT) of 611 patients with laboratory-confirmed COVID-19 were investigated and compared. Patients were divided on the basis of severity and survival into two groups. Data were expressed as mean or median values and percentages. The receiver operating characteristic curve was applied to determine the optimal cut-off values of these biomarkers. Results: The median age was 50 years and the male to female ratio was 3.7:1. The mean NLR, LMR, PLR, LDH, CRP, and Procalcitonin for the non-severe group were 4.16, 10.8, 133.7, 666.1, 49.9, and 0.15, respectively. In the severe group mean values of the above-mentioned immune-inflammatory markers were 17.8, 4.69, 268.2, 1277, 158.6, and 3.05, respectively. Elevated levels were significantly associated with disease severity. In ROC curve analysis, NLR had the largest area under the curve at 0.923 with the highest specificity (0.83) and sensitivity (0.88). Conclusion: This study shows that NLR, PLR, LDH, CRP, and Procalcitonin may be a rapid, widely available, useful predictive factor for determining the severity of COVID-19 patients.
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Nutrition is a development indicator. It indicates advancement in health, education, employment, women’s empowerment, poverty, inequality reduction, and it can help in building peaceful, secure, and stable societies.” It is one of the important components which is directly or indirectly related to Sustainable Development Goals (SDGs). Multiple factors such as education, economic status, occupation, water, sanitation, hygiene, etc are interlinked with nutrition. In this article, we have emphasized the relationship of various SDGs with nutrition. Global and multi-sectorial involvement is required in the battle with malnutrition. Adequately nourished people are more productive and active. By breaking the cycles of hunger and malnutrition, we can create a path for achieving SDGs.
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In recent years there is a rapid rise in coming out of sexual and gender minority adults to their family members and society. Unfortunately, studies on unmet health needs of transgenders with a special focus to mental health is under-researched in India. The current paper aimed to explore about the mental health of transgenders and a literature search was done using PubMed, Google Scholar, and Scopus databases for the following medical subject headings (MeSH) key terms “transgender”, “mental Health”, “social stigma”, “LGBT”, “gender dysphoria”, “genderqueer”, “intersex”, “MSM”, “hijra”, “gay”, “lesbian”, “bisexual”, and “homosexual”. Transgender individuals were found to show high rates of mental health concerns. The most common mental health problems that we have shown in this review article are depression, obsessive-compulsive disorders, generalized anxiety disorders, suicidal attempts and bipolar disorders. Transgender people are at more risk for mental health problems than their heterogenous counterparts. The intervention program to eliminate or reduce these problems needs to be planned carefully, considering all the determinants
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Introduction: Adenomatoid odontogenic tumor (AOT) is a rare epithelial odontogenic tumor of jaws. It is a benign, painless, non-invasive, slow-growing lesion, with a frequency of 2.2-7.1%. Upon clinical examination it can be misdiagnosed as an odon- togenic cyst. AOT affects young individuals with a female predominance, occurs mainly in the second decade, more common in anterior maxilla and usually surrounds the crown of unerupted tooth mostly impacted canine. AOT has three clinical subtypes named as follicular, extrafollicular, and peripheral. Clinical presentation: This case report represents a 20 years old female patient with the chief complaint of swelling on the right upper anterior region for 8 months. Management and prognosis: After surgical excision and histopathological evaluation it is diagnosed as a rare case of extrafol- licular variant of intraosseous AOT.
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Background: Oral Contraceptive use, BP and BMI are strongly associated variables in terms of socio economic conditions. Oral Contraceptives are an important and widely accepted contraceptive modality used throughout the world. Aim & Objective: This study aims to examine the effects of socio-economic factors on Body Mass Index (BMI), Blood pressure (BP) and contraceptive use by reproductive age-group females of Uttarakhand. Settings and Design: This study utilizes nationwide data from the Fourth National Family Health Survey (NFHS-IV). Methods and Material: Information was collected from Indian Institute of Population Sciences (IIPS) Mumbai and 17,300 women of Uttarakhand were considered for this study. Statistical analysis used: For inter age-group comparisons of blood pressure, BMI and socio-demographic indicators, analysis of variance (ANOVA) technique has been used. Results: The variation in mean age at menarche was found to be significant (p< 0.01, ANOVA). The numbers of live births over the women's total lifetime were lower in the younger age groups (p<0.01, ANOVA). Conclusions: The important findings of present study were that the use of contraceptive tended to have increased BMI and elevated blood pressure, even though the magnitude of these was little (equal to 4% and 40% respectively).
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Background:Clinical features of COVID infection are varied and sometimes non-specific. Anosmia is one such clinical feature, for which limited evidence is available.Material And Methods:Subjects were contacted via telephonic interviews and data was collected regarding their perceptions about COVID infection.Result:Prevalence of anosmia in our study was 12.8% overall but significantly more (18%) in hospitalised patients/symptomatic. More than 30% of patients were having anosmia as their first symptom. Anosmia was more in patients having co morbidities.Conclusion:Loss of smell is one of the important clinical features of COVID infection. Anosmia may be the sole or fir st symptom in COVID.
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Purpose: To evaluate the clinical factors associated with repeat Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP) in cases of failed DSAEK. Methods: Retrospective observational study of cases with failed DSAEK admitted to our center for a repeat keratoplasty over 5 years (January 2013–Decemeber 2017) was undertaken. Demographic and perioperative details of all cases and type of repeat keratoplasty were recorded. Logistic regression analysis was performed to analyze the factors affecting the type of repeat keratoplasty. Results: total of 94 eyes with failed DSAEK were evaluated. Repeat DSAEK was performed in 66% and PKP in 34% of cases. Significantly increased odds for requiring PKP were observed in association with stromal scarring [odds ratio (OR) = 2.9, P = 0.018)], trainee surgeons (OR = 4.05, P = 0.008), intraoperative complications (OR = 4.58, P = 0.003), scleral fixated intraocular lens or anterior chamber intraocular lens in situ (OR = 33.8, P < 0.001), secondary glaucoma (OR = 3.02, P = 0.015), peripheral anterior synechiae (OR = 8.6, P < 0.001), preoperative corneal thickness (OR = 1.01, P < 0001), time to primary surgery (OR = 1.03, P = 0.03), post-DSAEK host thickness (OR = 1.01, P < 0.001), and time interval from graft failure to regraft (OR = 1.18, P < 0.001). All eyes with congenital hereditary endothelial dystrophy, bee-sting-induced corneal decompensation, Axenfeld-Rieger syndrome, and multiple failed grafts underwent secondary PKP. All cases (nine eyes) that required surgical intervention for secondary glaucoma underwent secondary PKP (P < 0.001). Conclusion: Repeat DSAEK is feasible in up to two-third of cases of failed DSAEK. A PKP is required in one-third of cases, and various preoperative, intraoperative and postoperative factors are associated with unsuitability for repeat DSAEK.
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Lower Urinary tract symptom (LUTS) is a common presentation among elderly male patients in urology clinical practice. International Prostate Symptom Score (IPSS) have contributed much to the objective and quantitative evaluations of LUTS in terms of the elucidation of its pathogenesis and changes accompanied with treatments. Aim: The objective of this study was to evaluate the relationship between IPSS and prostate volume in patients with LUTS. Methods: This prospective study included 58 male patients with lower urinary tract symptoms (LUTS). The IPSS was evaluated using questionnaire and the prostate volume of each patient was then estimated by transabdominal ultrasound. Results: There is a significant relationship between IPSS and prostate volume measured through trans-abdominal ultrasonography. The Total IPSS increases with the prostate volume, as a significant positive relationship between IPSS total score and prostate volume was recorded. Conclusion: There is a significant positive relationship between IPSS total score and prostate volume
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Closure of the abdominal wall is a routine procedure and one of the first things a surgeon is taught in his career. Secure wound closure is an essential requirement for an uncomplicated and expedient recovery after an abdominal operation. Methods: We assessed, wound infection rates in 320 patents in the four randomized groups according to the suture and technique of closure used. Patients were followed for a period of 2 weeks and using well set definition were placed in infected, uninfected and burst abdomen. Results: Older age, male sex, diabetes, anemia malnutrition and sepsis were found to be highly significant risk factor for wound infection. Suture material (Prolene vs Vicryl) and technique (continuous vs interrupted) arms did not showed statistically significant differences outcomes in regard to wound infection rates, however there appears to be less incidences of wound sinus formation with delayed absorbable sutures(Vicryl). Conclusion: Closure of a mid-line laparotomy wound can be done by using either Prolene or Vicryl suture material, with either continuous or an interrupted fashion. Continuous technique is time saving and delayed absorbable suture (Vicryl) results in less wound sinus formation.
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Childhood leprosy is an important marker of the status of any ongoing leprosy control programme because it is an indicator of active disease transmission in the community. Studies pertaining to proportion and characteristics of paediatric cases from Bihar are few in number. Hence, present study was carried out to know the scenario of childhood leprosy. A retrospective analysis of 4 year records of leprosy patients aged up to 14 years in a tertiary care hospital of Bihar, was carried out from June 2014 to May 2018. A total number of 72 (9.31% of total leprosy) cases of childhood leprosy reported to AIIMS, Patna, Bihar, India during this 4-year period. The majority of cases belonged to the age group of 11-14 year (84.72%) with a male preponderance. Borderline tuberculoid was the commonest clinical type (44%) followed by tuberculoid type (29%). Borderline lepromatous, Indeterminate form, Histoid leprosy and Pure Neural type was seen in 2, 4, 1, 2 cases respectively. Multibacillary (MB) cases constituted a total of 39 (54.16%), while remaining 33 (45.83%) were of paucibacillary (PB) type. A solitary skin lesions either a hypo-pigmented or an erythematous patch with decreased sensation with or without thickened nerve was the most frequent manifestation in 34 cases (47.22%) followed by 2-5 skin lesions in 29 (40.27%) and more than 5 skin lesions or diffuse infiltration in 9 (12.5%) patients. Although nerve thickening was seen in 32 (44%) cases, neuritis and lepra reactions were less common. Disability was noted in 15.27% cases (Grade1 disability in 2.7% and Grade 2 disability in 12.5%). History of contact was found in 51.38% cases. Continuous and sustained efforts for early case detection of leprosy cases in the community in general, and a close follow-up of susceptible children amongst household contacts of leprosy cases will be desirable to treat these cases of childhood leprosy early before they develop any disability. Intense efforts are thus required to achieve the target of zero disability in child leprosy cases set in the Global Leprosy Strategy 2016-2020.
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In December 2005, National leprosy Eradication Programme of India announced elimination of leprosy as a public health problem at national level. However, a significant number of new cases continue to be diagnosed in India. This study was carried out in Department of Dermatology, Venerology and Leprology, AIIMS, Patna where we have retrospectively analysed the clinicoepidemiological profile of of registered cases of leprosy between January 2016 and December 2017. Out of 464 fresh / default leprosy patients who reported to our department, a majority proportion (24.35%) belonged to 30 to 39 years age group followed by 20-29 yr (23.49%) 40-49 yr (19.39%), remaining belonged to other age groups. There was male preponderance. By occupation most of patients were farmers and labourers. Borderline Tuberculoid (29.41%) was the most frequent morphological type, but the proportion of Lepromatous Leprosy (21%) was significant. Overall, multi-bacillary leprosy (80.17%) cases were the most dominant type. 34.91% patients presented in reaction, among these Type 1 in 40.74% and type 2 in 59.25%. Disabilities were found in 172 (37.06%) patients with Type 1 disabilities in 76 (16.37%) patients and Type 2 disabilities in 96 (20.68%) patients. Clinically thickened peripheral nerve enlargements were recorded in 421 patients (90.73%). Ulnar nerve was found to be the most commonly involved nerve. History of contact was present in 10.34% of cases. 296 (63.79%) patients belonged to rural area whereas 168 (36.28%) belonged to urban area. Very high proportion of multi-bacillary cases, reactions and also high disability rates indicate the need for in depth studies at community level and appropriate remedial public health measures.
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Purpose: To compare the outcomes of two techniques, for preparation of microkeratome-assisted ultrathin grafts for Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods: The study involved 20 eyes of 20 patients with pseudophakic bullous keratopathy, randomized into two groups. Group 1 eyes underwent microkeratome-assisted DSAEK using the single-pass technique for lenticule preparation, whereas group 2 eyes underwent microkeratome-assisted DSAEK using the double-pass technique. Patients were followed up till 6 months, postoperatively. Best-corrected visual acuity (BCVA) at final follow-up was considered as the primary outcome measure, whereas graft thickness (GT) contrast sensitivity and endothelial cell loss were considered as the secondary outcome measures. A P value of <0.05 was considered as statistically significant. Results: Baseline characteristics of two groups were comparable. The mean central GT was comparable in both groups at 6 months follow-up [group 1: 98 ± 24.46 ?m, group 2: 129 ± 31.46 ?m (P = 0.18)]. Both groups fared equally in terms of BCVA (P = 0.33). Contrast sensitivity was significantly better in group 1 eyes (P = 0.045). A statistically significant negative correlation was found between postoperative BCVA and postoperative GT (R = ?0.728, P = 0.016). The percentage endothelial cell loss was slightly higher in group 2 eyes, although not statistically significant. Two eyes in group 2 experienced complications during lenticule preparation. None of the eye experienced any complication in the postoperative period. Conclusion: Both techniques provided grafts with comparable thickness and endothelial cell loss and were associated with comparable BCVA, at final follow-up visit. The contrast sensitivity was, however, better in eyes receiving grafts prepared with the single-pass technique.
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Purpose: Bilateral eye surgery in the same session may be required for advancing stage 4 retinopathy of prematurity (ROP). The purpose of this study was to evaluate the outcomes of immediate sequential bilateral vitreoretinal surgery (ISBVS) in stage 4 ROP. Methods: In a retrospective interventional study at a tertiary care center, 60 eyes of 30 infants who underwent ISBVS for stage 4 ROP between December 2015 and May 2017 were studied. In cases with clear retrolental access, 25G or 27G lens sparing vitrectomy (LSV) was performed and in the rest 25G lensectomy with vitrectomy (LV) was performed through clear corneal entries. The final anatomical outcome measures were the status of tractional retinal detachment (TRD) and macular status. Results: The mean gestational age was 28.4 ± 2.0 weeks and birth weight was 1214.5 ± 329.7gms. The mean postconceptional age at surgery was 40.8 ± 2.2 weeks. Stages 4a and 4b were present in 86.7% and 13.3% eyes respectively. LSV was performed in 95% eyes whereas LV was performed in the rest. None of the eyes developed lens touch, choroidal hemorrhage, postoperative hypotony, corneal decompensation, or endophthalmitis. At last follow-up (mean 45 weeks, range 20–68 weeks), macula was attached in 90% eyes with the TRD resolved completely in 61.7% eyes and significantly decreased in another 25% eyes. Sequalae included macular drag, epiretinal membrane, and progression to fibrotic stage 5 disease. Conclusion: ISBVS is safe and effective for bilateral stage 4 ROP and should be recommended in rapidly progressive cases.
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Background: Cystoisospora is a well-known opportunistic enteric parasite among human immunodeficiency virus (HIV) seropositive patients but there is a paucity of data among HIV negative patients. This study investigated Cystosporiasis on both HIV positive and negative patients, with or without diarrhea, presenting to a tertiary care and super specialty center of northern India. Methodology: Oocysts of Cystoisospora were detected on light microscopy, by modified Kinyoun staining of stool specimens, over an 11-year study period. Results: Of the 10,233 stool specimens evaluated, Cystoisospora was detected in 64 patients, 37 (57.81%) of whom were HIV positive. Year-wise analysis showed an overall declining trend of cystoisosporiasis. Maximum cases were detected in May and June in HIV positive patients and February and September among HIV negative patients. Among HIV positive patients, the mean CD4 count was 152.04 � 81.12cells/?L, mean absolute eosinophil count (AEC) was 229.16 � 175.62 cells/?L and 12.5% patients had mild eosinophilia. Tuberculosis was the most common co-morbidity. Dual infections of Cystoisospora with Cryptosporidium and Giardia were also seen. Among HIV negative patients, eight had primary autoimmune disorders, seven were solid organ transplant recipients and the rest had chronic bowel diseases. The mean AEC was 485.47 � 414.88 cells/?L, with 14.81% patients showing mild and 11.11% showing marked eosinophilia. Dual infection with Giardia was seen. Recurrent cystoisosporiasis was noted, despite cotrimoxazole treatment in a single case. Conclusion: The epidemiology of cystoisosporiasis differs between HIV seropositive and seronegative patients in terms of year-wise and month-wise trends, co-infections and most importantly, AECs.
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Primary subcutaneous leiomyosarcoma (LMSs) are uncommon of all soft tissue malignancies. Its frequency is about 1% to 2%, with a predilection for middle age, and found more frequently in the lower extremity. They can be of two types according to its primary site of origin: deep subcutaneous and superficial cutaneous. The physical appearance of this tumour resembles more with benign condition and can easily be mistaken for nonmalignant condition. Hence, it is important to diagnose it correctly and it is important to differentiate it from other spindle cell neoplasm. A case of giant subcutaneous leiomyosarcoma is presented here which was found around knee in lower extremity. The diagnosis was suspected by histopathology and confirmed by immunohistochemistry.
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Congenital complete heart block in utero has become diagnosed more frequently with the clinical use of fetal echocardiography. Autoimmune-associated congenital complete heart block (CHB) is a rare but important disease that can now be diagnosed in utero using fetal echocardiography1,2,3,4. The overall incidence of isolated CHB has been reported to be approximately 1:15,000 to 20,000 live births5. Several reviews have shown that children diagnosed prenatally have an increased mortality compared to those diagnosed immediately after birth or later in childhood1,2,3,4. At birth, some neonate with complete heart block may remain asymptomatic and may not require a pacemaker but majority require pacemaker to increase the heart rate. We report a rare case of idiopathic congenital complete heart block in a newborn male.
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Gall bladder distension with acute viral acalculous cholecystitis is an extremely rare event especially with Hepatitis E infection in paediatric cases with a high incidence of perforation, gallbladder necrosis and mortality. We report a four year old male child presenting with fever, vomiting, pain abdomen, mild hepatosplenomegaly and tenderness in right hypochondrium. Laboratory investigations revealed hyperbilirubinemia and elevated liver enzymes, but there was no evidence of bacterial or parasitic infection. Serology for viral hepatitis suggested acute Hepatitis E infection. Ultrasonographically distended inflamed gallbladder without calculous was observed. Finally acute acalculous cholecystitis due to Hepatitis E virus was diagnosed and the child responded to the conservative management.
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We report a case of Fahrs disease in a 15year old girl presented to us with focal seizure with secondary generalisation. Clinically there were no abnormal findings. The CT scan (brain) showed multiple symmetric and extensive calcifications in the basal ganglia, thalamus, and dentate nucleus, subcortical white matter of cerebral and cerebellar areas. Presently the child is under followup with good seizure control with carbamezpine. This rare case of idiopathic Fahr’s disease in a child, which has never been reported in Indian literature has been brought out to highlight this unusual condition and its differentiation from the commoner Fahr’s syndrome.
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BACKGROUND: Under normal circumstances, there is a steady balance between the production of oxygen derived free radicals and their destruction by the cellular antioxidant system inside the human body. However, any imbalance between the levels of these oxidants and antioxidants might cause DNA damage and may lead to cancer development. The aim of this study was to evaluate the level of antioxidants and free radicals in blood and tissue of cancer patients and compare these levels at different TNM stages to derive the possible role of free radicals and antioxidant enzymes in the etiology of breast cancer. MATERIALS AND METHODS: This study includes 30 patients suffering from cancer breast and 20 patients as controls who had benign breast diseases. Circulating lipid peroxide (Malonyldialdehyde [MDA]) levels and activities of the defensive enzymes (Superoxide Dismutase [SOD] and Catalase [CAT]) were estimated in the blood and breast tissue of these patients. RESULTS: Increased levels of free radicals and low levels of antioxidants were observed in malignant tissue. An elevated lipid peroxide concentration was found in the tissue of all the cancer breast patients as evidenced by an increase in the mean MDA level seen with increasing TNM stage of carcinoma breast. Levels of antioxidants SOD and CAT were decreased in cancer patients. CONCLUSION: The results of our study suggest that free radical activity is enhanced in cancer breast patients while the antioxidant defense mechanism is weakened. This activity is enhanced with the increasing severity of cancer as depicted in different TNM stages of breast cancer.