Determinants of patients’ delay with disability in the diagnosed leprosy cases in the three major states of India: A case-control study

Background: Skin lesions are the most common early symptoms of leprosy, often ignored by patients at an early stage and misdiagnosed as other dermatological diseases by healthcare personnel, leading to delay in diagnosis and treatment of leprosy precipitating permanent neurological deficit, deformities and serious disabilities. Aims: The objective is to evaluate the duration of delay and factors responsible for the delay in reporting of patients, among the newly detected leprosy cases (Grade 1 and Grade 2 disability patients). Methods: A case-control study was conducted during 2014–2016 in three major states of India (Delhi, Gujarat and West Bengal) in 140 randomly recruited newly registered adult leprosy patients (aged 18 years and above) with Grade 2/1 disabilities (cases) and 140 Grade 0 disability patients (controls) in each of these Indian states. Results: It is established that the major contributors for the delay in the early diagnosis of leprosy have been patient-related factors. The median patient delay in the three states of Delhi, Gujarat and West Bengal were five months (0.7–1.8), 2.8 months (2–14) and 12 months (2–24), respectively. Limitations: The study design is case-control and has an inbuilt reporting bias due to the retrospective nature of data collection but the data collection was carried with caution to reduce the recall bias. As the study is carried out in three states, generalisation of interpretation was cautiously executed. The matching ratio of cases and controls was 1:1 in this study, but we could not increase the controls due to operational feasibility during the conduct of the study. Conclusion: Patient delay is a crucial factor responsible for the disability among new leprosy cases. A higher patient delay in these three states reflects that the community is not aware about the signs and symptoms of leprosy. Reducing patient delay is very important for reducing disabilities in the newly diagnosed cases.

Primary diffuse large B-cell lymphoma of the CNS, with a "Lymphomatosis cerebri" pattern

We describe an unusual case of lymphomatosis cerebri in a middle-aged lady presenting with rapid-onset dementia. The lymphomatous infiltrate, instead of forming mass lesions, percolated throughout the brain parenchyma, which is often missed on a stereotactic biopsy and hence warrants caution and awareness about this entity. The nonspecific symptoms at presentation and a variable picture at imaging make this entity diagnostically challenging.

Anthropometric Correlates Of Sonographically-determined Normal Portal Vein Diameter: Results From A Study Conducted In Rajasthan, India

Background: Dilatation of portal vein is predictive of portal hypertension and therefore requires accuratestandards for normal measurements. Despite several studies to determine portal vein diameters, there existconsiderable variations across communities. Moreover, body builds have been found to correlate with differentdiseases.Purpose of study: We conducted a study among 200 normal participants belonging to Rajasthan in order toobtain data on sonographically measured diameters of portal vein and determine the association betweenportal vein diameters and age, sex, anthropometric measurements like height, weight, chest circumference,circumference at the transpyloric plane, circumference at the umbilicus and circumference at the hip.Results: We found that the mean portal vein diameter assessed ultrasonographically was 10.2 mm (SD 1.47 mm),with diameter ranging from 8.0 mm to 14.5 mm. Although, there was no statistically significant difference inportal vein diameter among the various age groups, a statistically significant difference was found betweenmales and females. Portal vein diameter showed a statistically significant, positive correlation, albeit poor withanthropometric measurements, viz. weight, chest circumference, circumference at transpyloric plane,circumference at umbilicus and circumference at hip. A strong positive correlation was found between portalvein diameter and height of the study subjects (r = 0.40). On linear regression analysis, this relationship wasfound to be statistically significant, with an increase in portal vein diameter of 0.06 mm for every increase of oneunit (1 cm) in height.Conclusion: The upper limit of normality of portal vein diameter was found to be 14.5 mm. Width of portal veinsdetermined by sonography is indirect indicator of portal pressure responsible for development of varices, andprompt further investigation

Forecasting incidence of dengue in Rajasthan, using time series analyses.

Aim: To develop a prediction model for dengue fever/dengue haemorrhagic fever (DF/DHF) using time series data over the past decade in Rajasthan and to forecast monthly DF/DHF incidence for 2011. Materials and Methods: Seasonal autoregressive integrated moving average (SARIMA) model was used for statistical modeling. Results: During January 2001 to December 2010, the reported DF/DHF cases showed a cyclical pattern with seasonal variation. SARIMA (0,0,1) (0,1,1) 12 model had the lowest normalized Bayesian information criteria (BIC) of 9.426 and mean absolute percentage error (MAPE) of 263.361 and appeared to be the best model. The proportion of variance explained by the model was 54.3%. Adequacy of the model was established through Ljung-Box test (Q statistic 4.910 and P-value 0.996), which showed no significant correlation between residuals at different lag times. The forecast for the year 2011 showed a seasonal peak in the month of October with an estimated 546 cases. Conclusion: Application of SARIMA model may be useful for forecast of cases and impending outbreaks of DF/DHF and other infectious diseases, which exhibit seasonal pattern.

A two-site hospital-based study on factors associated with nonadherence to highly active antiretroviral therapy.

Objectives : To describe the pattern of adherence to Highly Active Antiretroviral therapy (HAART) and ascertain the factor(s) associated with nonadherence. Methods: This was a cross-sectional, two-site, hospital-based study. The study was undertaken in 2005; as a result of phased roll out of free HAART as part of National AIDS Control Program, patients at Lok Nayak Jai Prakash (LNJP) hospital were receiving free HAART, while patients at All India Institute of Medical Sciences (AIIMS) had to bear out-of-pocket expenses for HAART. Adherence was defined as not having missed even a single pill over the previous 4-day period on self-reporting. Results: Adherence at AIIMS was 47%, whereas it was 90% at LNJP. The difference was statistically significant. Multivariate analysis showed that nonadherence was associated with not having been told about the importance of HAART, having to pay out-of-pocket for HAART and reported continued risk behavior post HAART. Conclusion: With the provision of free HAART, adherence is likely to be high. Emphasis should be given on simultaneous recruitment of counselors, and physicians should be made aware about the need to inquire and counsel patients against continued risk behavior.

Prevalence of risk factors for non-communicable disease in a rural area of Faridabad district of Haryana.

BACKGROUND & OBJECTIVES: To estimate the prevalence and levels of common risk factors for noncommunicable disease in a rural population of Haryana. METHODS: The study involved a survey of 1359 male and 1469 female respondents, aged 15-64 years. Multistage sampling was used for recruitment (PHCs/sub-centres/villages). All households in the selected villages were covered, with one male and one female interviewed in alternate household. WHO STEP-wise tool was used as the study instrument which included behavioural risk factor questionnaire and physical measurements of height, weight, waist circumference and blood pressure. The age adjusting was done using rural Faridabad data from Census 2001. RESULTS: The age adjusted prevalence of daily smoked tobacco was 41% for men and 13% for women. Daily smokeless tobacco use was 7.1% and 1.2% for men and women respectively. The prevalence of current alcohol consumption was 24.6% among men and none of the women reported consuming alcohol. The mean number of servings of fruits and vegetables per day was 3.7 for men and 2.7 for women. The percentage of people undertaking at least 150 minutes of physical activity in a week was 77.8% for men and 54.5% for women. Among men 9.0% had BMI > or = 25.0 compared to 15.2% among women. The prevalence of measured hypertension, i.e. > or = 140 SBP and/or > or = 90 DBP or on antihypertensive drugs was 10.7% among men and 7.9% among women. CONCLUSION: The study showed a high burden of tobacco use and alcohol use among men, inactivity and overweight among women and low fruit and vegetable consumption among both sexes in rural areas.

Self-medication among residents of urban resettlement colony, New Delhi.

A cross-sectional survey on the practice of self-medication was carried out in September 2005, among 1928 residents of urban resettlement colony in New Delhi. Prevalence of self-medication among those who had suffered some illness episode in the last one month was 31.3%. Head/ joint/body ache were the most common symptoms for which self-medication was practiced. Chemists were the main source of prescription for self-medication. Time and money factor were identified as the major reasons for not seeking doctor's advice and taking self-medication instead. It was of concern that about 87% users were not aware of side effects of self-medication.

Efficacy of splinting and oral steroids in the treatment of carpal tunnel syndrome: a prospective randomized clinical and electrophysiological study.

OBJECTIVE: To study the efficacy of splinting and oral steroids in the management of carpal tunnel syndrome (CTS). DESIGN: Prospective, randomized, open-label, clinical and electrophysiological study with 3-month follow-up. MATERIALS AND METHODS: Forty patients with CTS were randomly divided into splint group (N-20), wearing splint in neutral position for 4 weeks; and steroid group (N-20), who received oral prednisolone 20 mg/day for 2 weeks followed by 10 mg/day for 2 weeks. Clinical and electrophysiological evaluations were done at baseline and at 1-month and 3-month follow-up. Independent 't' test and paired 't' test were used for statistical analysis. OUTCOME MEASURES: Primary outcome measure was the symptom severity score and functional status score. Secondary outcome measures were median nerve sensory and motor distal latency and conduction velocity. RESULTS: At the end of 3 months, statistically significant improvement was seen in symptom severity score and functional status score in both groups (P<0.001). Median nerve sensory distal latency and conduction velocity also improved significantly in both the groups at 3 months. Improvement in motor distal latency was significant (P=0.001) at 3 months in steroid group, while insignificant improvement (P=0.139) was observed in splint group. On comparing the clinical and electrophysiological improvement between the two groups, except for the functional status score, there was no significant difference at 3-month follow-up. Improvement in functional status score was significantly more in steroid group (P=0.03). CONCLUSION: There was significant improvement in both groups, clinically as well as electrophysiologically, at 3 months. On comparing the efficacy of the two treatment methods, except for the functional status score, there was no significant difference between the two groups.

Retinal arterial occlusion in Takayasu's arteritis.

Takayasu's arteritis is an auto-immune disorder of the large and medium-sized arteries, commonly involving the heart and its main vessels. It is now recognised that the inflammatory process of the large arteries affects regions of the walls supplied by the vasa vasorum, suggesting that primary small vessel involvement may contribute to the development of the clinico-pathological features of Takayasu aorto-arteritis. Classical ophthalmic features of the disease result from reduced ocular perfusion, which manifests as hypoxic retinal changes such as microaneurysms, arterio-venous anastomosis and non-perfused areas. Branch retinal artery occlusion has not been previously described in this condition. This case illustrates retinal arterial occlusion as the presenting feature of Takayasu's arteritis.

Transcranial magnetic stimulation: role in the evaluation of disability in multiple sclerosis.

BACKGROUND: In patients with multiple sclerosis (MS), transcranial magnetic stimulation (TMS) has shown significant prolongation of central motor conduction time (CMCT). Abnormal CMCT may reflect sub-clinical involvement of motor pathways and correlate with clinical motor disability. OBJECTIVE: To determine the diagnostic yield of TMS in MS and the possible correlation of TMS abnormalities with clinical disability. MATERIALS AND METHODS: Thirty patients with clinically definite MS presenting in acute relapse or with progressive disease course and 30 healthy controls were evaluated. TMS parameters evaluated included threshold intensity, motor evoked potentials (MEP) amplitudes and latencies and CMCT. Reassessment studies were done after three months. STATISTICAL ANALYSIS: Student t-test, Mann-Whitney U test and Spearman's rank correlation test were used to assess the relationships. RESULTS: Patients with MS had significantly higher threshold intensities, prolonged CMCT and reduced MEP amplitudes as compared to controls. Abnormalities in at least one parameter were observed in 86.7% of patients. When inter-side asymmetries in MEP latency and/or in CMCT were considered, the diagnostic yield increased to 96.7%. The diagnostic yield was 74.7% for visual evoked potentials, 13.3% for brainstem auditory evoked response and 10% for cerebrospinal fluid oligoclonal band. One MS patient without pyramidal or cerebellar dysfunction had prolonged CMCT. CMCT abnormalities correlated significantly with the degree of pyramidal signs, limb ataxia, intention tremor, dysdiadokokinesia and overall cerebellar score. In patients who had clinical improvement, follow-up studies showed improvement in CMCT parameters. CONCLUSION: TMS is a highly sensitive technique to evaluate cortico-spinal conduction abnormalities in MS that may have no clinical correlate and in monitoring the course of the disease. The effects of cerebellar dysfunction on TMS results need further evaluation.