Knowledge, Awareness and Health Seeking Behaviour among Hepatitis patients attending a Tertiary Care Hospital in Delhi

Introduction: People living with Chronic Viral Hepatitis in India often lack awareness about risk factors and prevention. Objective: Objective of this article is to assess the health seeking behaviour of viral hepatitis infected patients attending super specialty hospital in Delhi. Methods: Total 389 patients attending a super specialty hospital in Delhi were interviewed. Results: The first point of contact for the treatment of hepatitis was a private practitioner (71%). Before coming to ILBS, 77.4% visited a private practitioner, followed by (42.7%) Govt. facilities (PHC/CHC/DH/Medical College), 12% visited a AYUSH doctor, about 10% visited either a Vaidya or a Hakim. About 40% believed that HBV is curable and 36.2% respondents thought that HCV is curable. Our findings show that 7.2% respondents have been vaccinated for HBV infection in the past, 20.8% respondents have screened their families for Hepatitis B infections. Conclusion: Need to create awareness about myths, further screening of HBV and HCV infection, early diagnosis and treatment.

Comparison of circulating DNA in malignant neoplasia from diverse locations: Investigating a diagnostic role

Context: Circulating free DNA (cfDNA) analysis has emerged as novel noninvasive diagnostic biomarker in several solid tumors. Raised levels have been reported in several malignancies and may correlate with clinicopathological and treatment response. The current study was designed to assess the diagnostics of cfDNA in different tumor types of malignancies correlating with tumor (T), nodes (N), and metastases (M) stage. Design: Serum samples were collected from treatment naïve cases with histologically diagnosed tumors including 23 brain tumors, 48 breasts, 50 gallbladder carcinoma (GBC), 13 lungs, 68 oral squamous cell carcinoma (OSCC), and 25 normal controls. CfDNA was quantified with real-time polymerase chain reaction (PCR), Invasive ductal carcinoma (IDC) using beta-globin gene amplification. Cut off values for diagnostics were calculated using receiver operating curve analysis. Results: Contrary to other cfDNA studies where it was postulated that cfDNA would not cross the blood–brain barrier and reach the systemic circulation, we found detectable cfDNA in glioma with median (Q1–Q3) of 349.22 ng/ml (19.87–1276.58). Median cfDNA concentration in breast, gallbladder, lung, oral and normal controls was 328.72 (128.38–624.44), 778.50 (589.88–1864.35), 348.73 (194.67–483.61), 386.27 (47.88–959.67), and 74.12 (49.66–120.00), respectively. Grades I and II glioma had significantly lower levels compared to Grades III and IV (P = 0.0001). Significant difference in median cfDNA values in IDC and GBC was observed with increasing tumor grades, stage, T stage, nodal stage and metastasis and with stage of OSCC cases. Conclusion: CfDNA levels showed good diagnostic discrimination in glioma, GBC, breast, lung carcinoma, and OSCC. Significant increase in titers was evident with increase in cancer stage from I to IV in breast, GBC and OSCC.

Effect of salinity on lipid profile of Cyprinus carpio reared in inland saline water

Aim: The present study was undertaken to investigate the influence of different salinity levels on gonadal tissue and serum biochemical parameters of Cyprinus carpio reared in inland saline groundwater to standardize the optimal salinity level for better maturation and seed production.Methodology: A 90 days experiment was conducted in non-drainable rectangular earthen ponds (n= 8) to study the effects of different salinity (0, 5, 10 and 15 ppt) levels on distribution of lipid class profile in Cyprinus carpio reared in inland saline groundwater. Gonads and serum were collected on 15 days interval and lipid classes, cholesterol, phospholipid and triacylglycerol were analyzed by using extracted total lipid. Results: The concentration of different forms of lipids were significantly influenced by salinity and their concentration increased with development of maturity stages but lowest level was recorded at ovulation or spermiation stages. It was observed that significantly (p < 0.05) highest level of all lipids was found at 0 and 5 ppt compared to 10 and 15 ppt salinity. Interpretation: The present study revealed that various lipid class fatty acids varied according to salinity and maturity stages of C. carpio in inland saline groundwater. Further, it also indicated that C. carpio has a tendency to adapt, survive, tolerate and reproduce in inland saline environment salinity ranging from 0-15 ppt and was found optimal at 5 ppt based on the reproductive ability

Investigations on remedial role of Rauwolfia serpentina root extract against carbofuran formulation induced genotoxicity in Channa punctatus

Aim: To investigate the remedial potential of Rauwolfia serpentina root extract against genotoxic alterations induced by exposure of carbofuran formulation in freshwater teleost, Channa punctatus. Methodology: Ten days acclimatized fish were categorized in three groups, Group 1 (control), Group 2 (0.09 mg l-1 carbofuran formulation) and group 3 (0.09 mg l-1 carbofuran formulation +10 ppm ethanolic extract of Rauwolfia serpentina). Genotoxic alterations were recorded in terms of single cell gel electrophoresis (SCGE) and micronucleus (MN) assay in blood cells. The variation in comet tail length and micronuclei frequencies were compared among Group 1, 2 and 3 after 24, 48, 72 and 96 hr. Results: A significant (p<0.05) increase was observed in comet tail length and micronuclei induction in carbofuran formulation exposed group. The longest comet length and peak of micronuclei frequencies were observed after 96 hr of carbofuran formulation exposure. However, an appreciable and gradual decline in both frequencies of micronuclei and comet tail length were observed in group 3 (combined Carbofuran formulation and Rauwolfia serpentina root extract) in comparison to group 2 (Carbofuran formulation). Interpretation: The study, thus, demonstrates ameliorative potential of Rauwolfia serpentina root extract against carbofuran formulation induced genotoxicity in fish.

Outcome of patients of acute kidney injury in chronic liver disease

Introduction: Chronic liver disease (CLD) is also a common clinical problem afflicting mankind. Occurrence of Acute kidney injury in patients with chronic liver disease is frequent finding which makes prognosis of CLD even poorer. Material and methods: A prospective cohort observational study on 100 adult patients of chronic liver disease with AKI conducted over a period of 24 months from August 2016 to August 2018 at Sri Aurobindo medical college and postgraduate institute. Detailed clinical examination and biochemical tests were done. Univariate and multivariate logistic regression (odds ratio) analyses were used. Results: 87% were males and 13% were females. Maximum no. of patients found in AKI stage III 40% followed by stage I 36% then stage II 24%. Among these 31% patient recover after treatment, 26% partially recovered and 43% patient didn’t response to treatment. Overall 75% survived while 25% died in this study. Conclusion: Majority of Patients with Prerenal AKI had full recovery, as compared to HRS-AKI and intrinsic AKI where full recovery was less common. Patients in stage 1 AKI had more proportion of patients with full recovery than stages 2 and 3. Regarding outcome, Patients in stage 1 and stage 2 has higher survival rates as compared to stage 3, which is statistically significant.

Prevention of vertical transmission of HIV in India through service integration: lessons from Mysore District, Karnataka.

Meeting the needs of HIV‑positive pregnant women and their offspring is critical to India’s political and financial commitment to achieving universal access to HIV prevention, treatment, care and support. This review of the strategy to prevent vertical transmission of HIV in Mysore district, Karnataka, highlights the need to integrate prevention of parent‑to‑child transmission (PPTCT) and reproductive and child health (RCH) services. All key officials who were involved in the integration of services at the state and district levels were interviewed by use of semistructured protocols. Policy documents and guidelines issued by the Department of Health and Family Welfare and Karnataka State AIDS Prevention Society were reviewed, as were records and official orders issued by the office of District Health and Family Welfare Officer and District HIV/AIDS Programme Office, Mysore. Routine data were also collected from all health facilities. This review found that 4.5 years of PPTCT‑RCH integration resulted not only in a rise in antenatal registrations but also in almost all pregnant women counselled during antenatal care undergoing HIV tests. Based on the findings, we propose recommendations for successful replication of this strategy. Integration of PPTCT services with RCH should take place at all levels − policy, administration, facility and community. The increased demand for HIV counselling and testing resulting from service integration must be met by skilled human resources, sufficient facilities and adequate funds at the facility level.

A comparative study of the health record cards in primary schools of Delhi.

A comparative study was undertaken to understand the various measures required to strengthen and improve the health record cards (HRC) of various schools that subsequently help in improving the medical examination of children. By using a multi stage stratified random sampling method, 24 schools from Delhi, eight each from three broad categories of (i) corporation schools, (ii) other government schools, (iii) private schools were included in the study. The study finding revealed that in most of the government schools the health record cards were properly developed and structured as per the recommendations of various committee, though they are always in short supply.

Diabetic ketosis as a presenting feature of acromegaly.

Secondary diabetes mellitus is known to occur in acromegaly due to insulin resistance caused by growth hormone excess. However diabetes in acromegaly usually does not lead to ketosis. We describe here a case of acromegaly who presented in diabetes ketosis, which is unusual.

Cloning and sequencing of beta toxin gene of Clostridium perfringens type C.

A gene encoding beta toxin was amplified by polymerase chain reaction from C. perfringens type C isolate and cloned in pUC 19 vector. The nucleotide sequence was identical with C. perfringens type B beta toxin gene sequence. The Southern hybridization using labelled beta toxin gene probe revealed the presence of positive signals only in beta producing C. perfingens.

Immune complex mediated lesions in experimental Kala azar: an ultrastructural study.

Immune complexes play an important role in causation of renal lesions in various diseases. Circulating immune comlexes (CIC) are described in Kala azar. Role of CIC in pathogenesis of Kalaazar is discussed in present study. BALB/C mice were experimentally infected with L. donovani promastigotes. After visceralisation of infection, sera and kidneys of infected mice were preserved. Leishmanial antigen specific CIC could be demonstrated in 100% of infected mice by PEG ELISA, while they were absent in control mice. Ultrastructural pattern of renal lesions in infected mice showed presence of focal small electron dense deposits in glomerular basement membrane and subepithelial space, resembling immune complexes (humps). Rarely subendothelial and mesangial hypercellularity was present. These findings point towards a definite role of CIC in pathogenesis of renal lesions in Kalaazar.

Effect of Leishmania donovani antigens on superoxide anion generation by mice polymorph in vitro.

The present study was planned to study the effect of priming of BALB/c mice peritoneal polymorphs (PMNLs) by viable, heat killed and formaline fixed promastigotes of L. donovani and soluble extract of proteins of L. donovani promastigotes on their capacity to produce toxic oxygen radicals (TOR). TOR production was measured by superoxide dismutase (SOD), inhibitable cytochrome C reduction and nitroblue tetrazolium reduction tests. No significant stimulation or inhibition in SOD inhibitable cytochrome C reduction and nitroblue tetrazolium reduction was seen when PMNLs were primed by soluble leishmanial protein, and formalin fixed and denatured promastigotes for both 60 and 90 min. Priming of BALB/c mice peritoneal polymorphs with live promastigotes of L. donovani for more than 60 min produced approximately 30 per cent inhibition in superoxide generation as measured by both the tests (P < 0.05). The inhibition in superoxide generation by polymorphs may be one of the important escape mechanisms in the causation of the visceral leishmaniasis.

Cost of infant feeding in exclusive and partially breastfed infants.

OBJECTIVE: To compare the costs incurred on infant feeding between the mothers who exclusively breastfed their infants and those who introduced supplements up to 6 months of age. DESIGN: Longitudinal follow up. SETTING: Urban slums of south Delhi. METHODS: One hundred normal mother infant pairs fulfilling the prelaid criteria were recruited at the time of birth and followed up for determining the feeding practices. The cost of feeding was estimated at prevalent market prices in terms of food supplement and medical treatment of infant and additional nutritional intake of mothers. The differences in costs in exclusively and partially breastfed groups were analyzed at 3, 4, 5 and 6 months of age. RESULTS: There was a sharp decline of exclusive breastfeeding from birth to six months. The mean cost of infant feeding was Rs. 204/- per month in partially breastfed as compared to Rs. 106/- in exclusively breastfed at 6 months of age. The increased cost was largely attributable to supplementary food and the cost of feeding bottles. (83% of mothers used bottles). CONCLUSIONS: The mean cost of infant feeding is substantially higher in partially breastfed children.

An indirect immunoperoxidase assay for rapid serodiagnosis of visceral leishmaniasis.

An easy, inexpensive and rapid indirect immunoperoxidase assay for serodiagnosis of Kala-azar (VL) has been tried using whole promastigotes of L. donovani in dried smear form as antigen. A total of 138 sera were tested including sera from parasite positive cases of VL (32), normal controls from endemic (20) and non-endemic (20) areas, cases of tuberculosis (10), leprosy (10), amoebic hepatitis (10), malaria (10) and tropical splenomegaly (26). All the positive control sera were positive in very high dilutions of serum ranging from 1/500 to 1/64,000. None of the sera with other diseases were positive by this method except 3 cases with tropical splenomegaly were positive in low titres. No other cause could be established in these cases for splenomegaly. Sensitivity and specificity of the test were found to be 100 and 95.3% respectively. Predictive values of the negative and positive tests were 100 and 86.5% respectively.

Comparative study of short term results in two multidrug regimens in multibacillary leprosy.

Thirty lepromatous and Borderline lepromatous leprosy patients were treated with multidrug therapy in an open trial. Fifteen of them received the standard WHO multidrug regimen ie., rifampicin 600 mg and clofazimine 300 mg monthly, supervised, and dapsone 100 mg daily and clofazimine 100 mg on alternate days as self administered; the other 15 received a modified multidrug therapy regimen comprising of rifampicin 600 mg, clofazimine 100 mg and dapsone 100 mg daily for 21 days as suggested by the Indian Association of Leprologists, followed by the standard WHO regimen. The observation period was six months. Clinical, bacteriological, histological and immunological parameters were studied. The fall in morphological index was much faster in patients receiving modified multidrug therapy regimen compared to those receiving the standard WHO regimen. Otherwise, there was no difference between the two groups of patients. Five patients developed type I (upgrading) reaction with one developing ulnar nerve paralysis. No untoward effects of drugs were noted in the study subjects except for darkening of skin colour of all the patients.

Orthopaedic industrial injuries.

A study of 600 consecutive cases of industrial injuries, who came from power using mechanised industries at Jaipur was undertaken to determine the incidence, pattern and causes of industrial injuries. The study revealed that there were fewer injuries in the 18 to 25 years age group than in those over the age of 36. Most of the injuries involved the upper limbs (66.2%), of which nearly 41% resulted from entrapment of hands in machines and were serious. This reflected the lack of adequate safety measures where it is most required.

Multidrug therapy in hospitalised leprosy cases.

Fifty eight cases including 44 paucibacillary and 14 multibacillary leprosy diagnosed at Command Hospital SC Pune were hospitalised for the entire period of multidrug therapy. 76% cases belonged to high endemic states of India. Reactions occurred in 13 cases during treatment, type I in 10 and type II in three. 7 Multibacillary cases experienced reaction. 69% reaction patients developed reaction within two months of starting MDT and all of them were multibacillary. Usually it took 3-6 months for majority (61.5%) of reactions subside completely. In 65.5% paucibacillary patients activity subsided within twelve months, however 70.5% paucibacillary cases took more than six months to exhibit subsidence of activity. In 13 multibacillary cases activity subsided by 18 months though bacteriological negativity was obtained from fourth to twelve months.

Leprosy with pellagroid features (a case report).

A case of leprosy with pellagroid features is presented. Diagnosis of leprosy was confirmed by bacteriological and histopathological examination. A therapeutic trial with nicotinic acid did not result in any improvement. Occurrence of scaling in leprosy is discussed.

Study of finger print patterns in leprosy.

Finger print patterns of 150 male leprosy patients (100 paucibacillary and 50 multibacillary leprosy) were compared with 50 matched controls. Significant differences were found in finger print patterns of multibacillary leprosy patients and controls. No differences in dermatoglyphic patterns were observed between paucibacillary leprosy and controls. The total finger ridge count (TFRC) in both types of leprosy was slightly lower than controls. A significant difference in individual finger ridge count on digit 1 of right hand was noted in paucibacillary leprosy cases as compared to controls.