Study on sociodemographic variables associated with Vitamin B12 deficiency in symptomatic patients attending fever outpatient department, Civil Hospital, Ahmedabad

Background: B12 deficiency is extremely common in India. Deficiency has varied manifestations and causes a range of disorders such as anemia, gastrointestinal, and neuropsychiatric manifestation and affects all age groups. Objectives: The aim of the study is to assess the clinical and sociodemographic variables associated with Vitamin B12 deficiency among symptomatic patients and to correlate the symptoms with serum level of Vitamin B12 deficiency. Materials and Methods: A cross-sectional observational study carried out among 97 patients attending fever outpatient department at civil hospital, Ahmedabad. Patients were interviewed with pretested questionnaire and were subjected for biochemical estimation of Vitamin B12, mean corpuscular volume, and hemoglobin. Results: Median age of attendees was 25 years (range: 13–64). Three out of eight symptoms were weakness (96.9%), tingling and numbness in hand and feet (60.8%), and fatigue (57.7%). All the patients who were tested on the basis of symptoms were found to be having Vitamin B12 insufficiency (<300 pg/ml). 46.3% were having severe deficiency (<150 pg/ml). Out of severely Vitamin B12 deficient patient, 47.8% were having any type of anemia. Study did not find any significant association (P < 0.05) between gender, diet, water supply, and level of Vitamin B12, whereas there was a significant association between religion and severity of Vitamin B12 deficiency (χ2 = 6.09, P < 0.05). Conclusion: All the patients need to be clinically screened for symptoms of B12 deficiency, and even the mild symptomatic patients should be treated to prevent the severe form of deficiency or neuropsychiatric manifestations. This will also reduce the unnecessary burden on laboratory.

Assessment of psychiatric illness and other comorbidities associated with patients attending obesity clinic in Ahmedabad

Background: Psychosocial impact of obesity is of concern in the present world but remains less studied compared to its physical consequences. People who take treatment for obesity are reported to be positively associated with psychiatric illnesses and also personality characteristics or psychological conditions influence the obesity treatment. Objective: The objective of this study was to study the prevalence of psychiatric illness and comorbid conditions among people with overweight and obesity and to find out factors associated with psychiatric illness. Materials and Methods: A cross-sectional study was conducted in private obesity clinic, Ahmedabad. A total of 103 people attending obesity clinic were studied. Self-structured questionnaire and Hospital Anxiety and Depression Scale (HADS) were used. Results: Of 103, 87.5% (91) were female. Mean age of people attending obesity clinic was 35 ± 9.2 years. About 67.3% were housewife and 92.2% were educated up to secondary or above. Thirty-eight (38.8%) and 59 (57.2%) of 103 were found to be having overweight and obesity, respectively. About 69% of people with obesity belong to Grade 1 and 31% belong to Grade 2 and 3. Psychiatric illness was observed among 38.8% (40) of the obesity clinic attendees. Of 40, 32.5% were found to have abnormal level of HADS score and needed intervention. Of 103, 45.6% had comorbid conditions such as joint associated problems (25%), hypertension (16.5%), and hypothyroidism (14%). Among overweight and obese with comorbidities, 48.9% had psychiatric illness. Psychiatric illness was observed among 37% of people with duration of obesity >5 years. The study did not find any significant association between overweight and obese having comorbid conditions (z = 0.63, P > 0.05) and duration of obesity (z = 0.44, P > 0.05) with psychiatric illness. Conclusion: Both comorbidity and psychiatric illness are highly prevalent among obese people. This indicates early detection and intervention for both to decrease the morbidity and mortality among obese and overweight.

Racial disparities in incidence & survival of Kaposi's sarcoma in the United States

Background & objectives: In the United States (US), Kaposi's sarcoma (KS) is usually seen in the patients affected by human immunodeficiency virus (HIV). The racial differences in the incidence rates and survival of patients with KS have been reported in the US. We undertook this study to analyse the disparities in the race-specific incidence rate and survival of KS patients of two different races in the US based on SEER (Surveillance, Epidemiology and End Results) database. Methods: Data on KS patients of African-American (AA) and non-Hispanic White (NHW) races who were diagnosed during 1973-2013 were extracted from SEER database to estimate the incidence rates and survival of KS patients. Results: A total of 18,388 NHWs and 3,455 AAs were diagnosed with KS. The age-adjusted incidence rate (AAIR) of KS in patients aged 20-44 yr was 3.8 times higher in AAs than in NHWs. The decline in AAIR of KS among NHWs started during 1989-1994 and preceded decline in the AAIR of AAs. After introduction of highly active antiretroviral therapy (HAART), the incidence continued to decline, but the decrease in the AAIR in AAs [annual percentage change (APC): ?6.2; 95% confidence interval (CI): ?8.8 to ?3.5] was slower than that in NHWs (APC: ?10.9; 95% CI: ?12.6 to ?9.1). The hazard ratio for all-cause mortality in KS patients of the AA race increased from 1.1 (95% CI: 1-1.2) in 1981-1995 to 1.55 (95% CI: 1.4-1.7) in 1996-2013 as compared to those of the NHW race. Interpretation & conclusions: Several significant racial disparities that emerged after HAART introduction in the incidence and survival of KS patients continued to persist, despite improvement in care of patients with HIV. Further studies need to be done to find out the underlying factors leading to these disparities.

Role of diffusion weighted MRI in characterization of renal diseases

Background: MRI has the unique ability to show both structure and function objectively without any radiation exposure to the patient. Apparent diffusion coefficient (ADC) is a quantitative parameter that combines the effects of capillary perfusion and water diffusion. Renal parameters have shown inverse relationship with the ADC values in these studies. So, ADC values have a potential to serve as a marker of renal function. The aim of the present endeavor was to study the role of DW MRI in characterization of renal function and to find out the clinical use of DW MRI in renal diseases; and establish the relationship between renal function assessed by eGFR and that by DW MRI calculated in terms of ADC values in various renal diseasesMethods: Total 30 patients were included in the study. The study was carried out in department of radiodiagnosis at Dr. RPMGC Kangra. 1.5 Tesla MRI machine was used. The ADC value was calculated at upper, mid and lower pole of each kidney and the mean was taken. Then the mean of right and left kidneys was taken to calculate the mean ADC of the patient.Results: Serum creatinine in present study ranged from 0.67 to 13.9mg/dl, with mean value of 7.28mg/d. Serum urea ranged from 22 to 293mg/dl with the mean of 119.6mg/dl. There was significant inverse correlation occurred between ADC values and serum urea (r=-0.43, p=0.02). There was significant inverse correlation between ADC values and serum creatinine (p=0.01) and a positive correlation between eGFR and ADC values (r=0.14, p=0.47).Conclusions: ADC values consistently decreased with increasing stage of renal failure, so these can be used as an indirect maker of renal function. Authors conclude that lower would be the ADC value more advanced would be the stage of renal failure. DW MRI can also be detect early stages of renal failure even when the serum maker are within normal range.

The spectrum of perforation peritonitis - central India experience.

Introduction: Peritonitis secondary to gut perforation is one of the most common surgical emergencies in India and is associated with high morbidity and mortality. The aim of this study was to recognize the spectrum of perforation peritonitis as managed at Govt. Chhattisgarh Institute of Medical Sciences hospital Bilaspur Chhattisgarh, in central India. Method: A retrospective analysis of 618 patients was done,in terms of clinical presentation, duration, seasonal variation, operative findings and post operative morbidity and mortality, admitted at Chhattisgarh Institute of Medical Sciences hospital Bilaspur. Chhattisgarh, over a period of 03 years. All the patients had undergone emergency laprotomy and the site of perforation was identified. Results: The most common site of perforation was prepyloric (393 cases. 63.6%).In 22.16% of the cases the perforation was associated with typhoid fever and in 2.7% cases with abdominal Koch’s. Trauma however showed perforation in only 5.6% cases, mainly jejunal. The overall mortality was 12.13%. Conclusion: Non traumatic upper gastrointestinal perforation peritonitis is common in our place. In contrast to the west, where lower gastrointestinal tract perforations predominate, in India upper gastrointestinal tract perforations constitute the majority of cases.

Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study.

Routine use of steroids in the treatment of bacterial meningitis remains controversial. A prospective placebo controlled double blind study of dexamethasone was carried out in 40 patients (age>10 years) of acute bacterial meningitis. The patients were randomly assigned to receive either placebo (n=20) or dexamethasone (n=20) in addition to injection ceftriaxone 100 mg/kg/day (maximum 4 gm/day) for 14 days. Dexamethasone sodium phosphate was given in dose of 0.6 mg/kg/day in 4 divided doses, for first 4 days of therapy. First dose of dexamethasone was given 15 minutes prior to first dose of ceftriaxone. Baseline demographics, clinical and laboratory features of the two groups were similar. Clinical improvement of signs of meningeal irritation was rapid in dexamethasone group than in the placebo group, but no significant difference was observed regarding resolution of fever, headache and vomiting. Secondary fever (mean+/-SD 15.00), gastrointestinal tract bleeding (mean+/-SD 15.00) and psychiatric manifestations (mean+/-SD 10.00) were more common in dexamethasone group. Neurological complications and hearing loss were more common and severe in placebo group as compared to the dexamethasone group (p<0.05). It is concluded that dexamethasone may be beneficial in some aspects of bacterial meningitis, in adults. A study with a larger number of cases in each group is recommended.

Proteinuria in essential hypertension.

Porteinuria was quantitatively measured in twenty-five controls and eighty-one newly detected patients of essential hypertension without renal insufficiency. Hypertension was treated with enalapril, enalapril and nifedepine and nifedepine alone. Mean proteinuria was more in patients of hypertension as compared to controls (P < .001). Proteinuria decreased significantly (P < .001) after six weeks of control of hypertension. Patients treated with enalapril alone had maximum reduction in proteinuria than those with enalapril and nifedepine, and nifedepine alone.

Stressful family life events and nonspecific somatic complaints in school children.

The relationship between stressful family life events and somatic complaints in 477 school children was studied. There was a significant association between life events and somatic complaints, with a general trend for somatic complaints to increase in almost direct proportion to the number of family life events. Overall occurrence of these nonspecific symptoms was more in girls. The somatic complaints were significantly more in children from nuclear families and of illiterate or poorly educated mothers. No significant association was observed between somatic complaints and number of children in the family or socio-economic status. Assessment of psychodevelopmental tasks and family environment during routine check up of children by the school health teams and their appropriate training in this field should be stressed upon.

Bacteriological study of meningococcal meningitis.

One hundred and thirty samples of cerebro spinal fluid were collected from patients admitted with suspected signs and symptoms of meningococcal meningitis (M. meningitis) during the period from January 1986 to April 1989 and were processed for gram's staining, cultivation and latex agglutination tests for detection of polysaccharide antigen in the CSF. Totally 41.5% of turbid and hazy spinal fluid were positive for N. meningitidis by smear examination. Only 24.6% were positive by culture but 61.5% of sample were positive by latex agglutination tests. All the strains were sensitive to all antibiotics except one strain which was resistant to penicillin but it was sensitive to rifampicin.