Clustering of non-communicable disease risk factors among adolescents in urban and rural Rajasthan

Background: Non communicable diseases (NCDs) are primarily driven by the modifiable risk factors that often emerge during the childhood/adolescence and contribute towards majority of premature deaths during adulthood. This study aimed to assess the prevalence of multiple NCD risk factors and the associated factors among adolescents in urban and rural areas of Rajasthan. Methods: It was a community-based cross-sectional study conducted among 430 school going adolescents. A self-administered questionnaire adapted from STEPS survey format of the WHO and indian adolescent health questionnaire was used; anthropometric measurements were taken using standard procedure. Presence of two or more risk factors in one individual was considered as clustering of NCD risk factors. Results: Prevalence of two risk factors (Dyads) was 48.8% (urban) and 33% (rural), three or more risk factors were found in about 12.1% urban and 7.9% rural adolescents. For “Dyads”, males had OR 3.58 (95% CI 1.9- 6.4) and OR 4.1 (95% CI 2.6-7.9) in urban and rural areas, respectively. The risk of clustering was higher with increasing age [Dyad: OR 1.26 (CI 1.1-5.73) in urban, OR 2.2 (CI 1.56-3.7) in rural; ? 3 risk factors: OR 2.3 (CI 1.98-4.11) in urban, OR 1.52 (CI 1.21-4.9)]. Conclusions: Clustering of the risk factors was prevalent among urban as well as rural adolescents emphasizing the importance of developing primary prevention strategies which can be effective across all demographic and socioeconomic backgrounds.

A study of COVID-19 infection, severity and associated factors among the patients admitted at a tertiary care center in southern Rajasthan

Background: Since December 2019, there has been various outbreaks of corona virus disease 2019 (COVID-19) disease. Whole world is combating this virus, but its reported clinical characteristics as well as outcomes vary greatly amongst studies. This study was conducted to study the clinical features, laboratory findings, comorbidities and severity of the disease among the patients admitted in tertiary care centre in Rajasthan. Methods: It was a hospital-based cross-sectional study conducted from 1st January 2021 to 30th June 2022 in a tertiary care hospital in Udaipur, Rajasthan. All the patients diagnosed with the help of reverse transcription polymerase chain reaction (RTPCR) for COVID-19, during the study period were included in the study. After taking consent, pre designed questionnaire was used to collect the personal, demographic and clinical information. Radiological, laboratory and mortality data were collected from hospital record. Results: A total of 400 patients were included in the study. Mean age of the patients was 46.83±17.09 years. Fever (88%) and cough (80%) were the most common symptoms followed by breathlessness (65.8%). About 31.8% (127) patients were found to have severe covid. Severity was found to be significantly associated with increasing age, urban area, breathlessness, co morbidities and D dimer, CRP and IL-6 levels (p value <0.05). Conclusions: India being a diverse country with a range of sociodemographic characteristics existing within the population, needs a robust approach to control the COVID 19 pandemic. This study presents the factors associated with severe disease and can help to formulate preventive and control strategies.

A perspective on Master of Public Health (MPH) Graduates in India: Current role and way head

The public health sector of any country deals on the forefront and utilizes the multidisciplinary approach. In India the Masters of Public Health graduates are trained in unstandardized manner and lack a regulatory body. The gap created in serving the unserved can easily be fulfilled by utilization of this workforce in systematic manner, The emerging competition in the field, undervalued sector in terms of monitory benefits, poor demand and limited training institutions for MPH graduates along with the contribution of MPH during COVID 19 pandemic has been emphasized in the article. The perception of those working in the field has been highlighted with the way ahead of MPH program in India.

Spectrum of MRI abnormalities in pediatric seizures

Background: Seizure is a pediatric emergency. Accurate determination of the etiology of seizures is very important to start an effective treatment. The study aims to determine the spectrum of Imaging abnormalities by Magnetic Imaging Resonance (MRI) in children who presented with seizures. Methods: It is a hospital-based prospective observational study which was carried out in Government Medical College and Rajindra Hospital, Patiala. This study included 50 pediatric patients in the age group between 0 months to 18 years who were referred to the Department of Radiodiagnosis for brain MRI between October 2017 to September 2019. Results: Neuroimaging abnormality was found in 19 (38%) cases. 31 (62%) patients had no abnormal finding. The most common imaging findings were inflammatory granuloma in 5 (10%) patients. Other findings were- Hypoxic-ischemic injury (HII) in 4 (8%), Mesial temporal sclerosis in 2(4%), cerebral atrophy in 1(2%), Hemorrhage in 1(2%), Tuberous sclerosis in 1(2%), Focal cortical dysplasia in 1(2%), Lissencephaly in 1 (2%), Joubert syndrome in 1(2%), and Arachnoid cyst in 1 (2%) patients. Conclusion: The MRI was able to identify brain lesions in 38% of pediatric patients who presented with seizures. The study revealed inflammatory granuloma as the commonest cause of seizures in children, followed by Hypoxic-Ischemic Injury. Early recognition of potentially treatable diseases helps in timely treatment and arrest of disease progression. It is recommended to use MRI as a primary investigation during the evaluation and management of pediatric seizures.

Role of Multiparametric MRI in Diagnosis of Prostate Cancer

Aims: The main objectives of our study were to evaluate the role of Multiparametric MRI (mp-MRI) in diagnosis of carcinoma prostate and to compare the various MRI sequences used in MRI in evaluating carcinoma prostate with histopathological diagnosis kept as reference standard. Materials and Methods: This prospective cross-sectional study of 40 patients was performed by using various sequences used in mp-MRI i.e. T2 weighted imaging (T2WI), Diffusion Weighted Imaging (DWI), Magnetic Resonance Spectroscopy (MRS) and Dynamic Contrast Enhanced study (DCE). Findings of mp-MRI sequences were compared with histopathological diagnosis. Statistical analysiswasperformed using SPSS computer statistical program for window release 16. Results: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DCE in diagnosing carcinoma prostate were 88.89%, 50.00%, 94.12% and 33.33% respectively where assensitivities, specificities, PPVs, NPVs of DWI and MRS were same in our study i.e. 94.44%, 75.00%, 97.14% and 60.00%respectively. Overall sensitivity, specificity, PPV, NPV of mp-MRI by combining these sequences were found to be 97.22%, 75%, 97.22% and 75% respectively. Diagnostic accuracies of DWI, DCE and MRS were 92.5%, 85% and 92.5% respectively and overall diagnostic accuracy after combining these sequences in mp-MRI was 95%. Conclusions: mp-MRI including all the sequences has very good role in evaluation of carcinoma prostate. Diagnostic accuracy of mp-MRI increases when all sequences used together to assess prostatic lesions, so all the sequences should be used together in prostate cancer evaluation rather than using individual sequences.

Neonatal Septicemia due to Acinetobacter species and their Antimicrobial Susceptibility Pattern.

Background and Objectives: Sepsis remains a clinical challenge in the Indian intensive care nurseries. Neonatal sepsis due to Acinetobacter species has been reported in recent years. Because of their multidrug resistance pattern, Acinetobacters pose a challenge regarding management of patients. The present study was therefore undertaken to find out the prevalence of Acinetobacter species in cases of neonatal septicemia and also to find out the antimicrobial susceptibility pattern of all Acinetobacter isolates. Methods: Eighty Acinetobacter isolates from blood culture samples from neonates with signs and symptoms of septicemia were speciated by standard biochemical tests and their antimicrobial susceptibility testing was done by Kirby Bauer Disk Diffusion (KBDD) method according to CLSI guidelines. Results: Incidence of neonatal septicemia due to Acinetobacter species was 9.18% out of total blood culture positive samples and predominant species was Acinetobacter baumanii (67.5%), followed by Acinetobacter junii (20%). Acinetobacter species showed maximum susceptibility to netilmicin (86.25%), followed by imipenem (70%). Acinetobacter junii showed greater susceptibility than Acinetobacter baumanii. Conclusion: This study indicates that neonatal sepsis due to Acinetobacter species is on the rise. Acinetobacter baumanii is multiresistant type and has direct bearing on mortality, so it highlights the importance of formulating a proper antibiotic policy in every hospital in cases of neonatal sepsis. The differences in resistant patterns among isolates emphasizes the need for differentiating A. baumanii from other Acinetobacter species by special biochemical tests.

Hichrom candida agar for identification of candida species.

Chromogenic media are frequently used in direct and rapid identification of yeasts because different Candida species produce unique colors on these media. We used 60 isolates of Candida species including 30 C. albicans, 10 C. parapsilosis, 11 C. glabrata, five C. tropicalis, and four C. dubliniensis, isolated from various clinical specimens, to evaluate the performance of HiChrome Candida agar. These strains had been identified by germ tube test, morphology on cornmeal agar, chlamydospore formation on tobacco agar and sugar assimilation tests. The sensitivity and specificity results were: C. albicans (96.55 and 96.42%); C. parapsilosis (80 and 98.03%), C. glabrata (90.90 and 88.23%), C. tropicalis (100 and 100%) and C. dubliniensis (60 and 96.55%) respectively. HiChrom Candida agaris medium has been useful and capable of presumptive, rapid identification of Candida species within 48 hours.

Diarrheagenic E. coli in hospitalized patients: Special reference to Shiga-like toxin producing Escherichia coli.

Purpose: This study was conducted to study the prevalence of diarrheagenic Escherichia coli (DEC) in dysentery cases with special reference to Shiga-like toxin producing Escherichia coli (STEC). Methods : During a two-year period, 1066 stool samples were collected from hospitalized patients with diarrhea and dysentery. After taking detailed clinical history and observing the gross and microscopic findings of the stool samples, they were cultured on MacConkey and Sorbitol MacConkey agars and E.coli isolates were identified by standard biochemical tests. Results: Of the 100 E.coli strains isolated in pure culture and sent for sero typing to Central Research Institute (CRI), Kasauli, 43% were found to be DEC, giving an isolation rate of 4.03%. Results of sero typing showed 37.21% STEC which were more common in children. Abdominal pain and stool with mucus flakes were statistically significant parameters (p less than 0.01) in patients with dysentery due to E.coli strains. Though E.coli O157 was not encountered, it was seen that 25% of STEC did not ferment sorbitol. The DEC strains showed maximum in vitro sensitivity to amikacin (83.72%) and all strains were resistant to nalidixic acid. Antibiotics along with ORS and intravenous fluids had to be given in 68.42% patients. As complications, about 16.67% of children developed hemolytic uremic syndrome (HUS),and 10.53% of patients developed acute renal failure. No mortality was reported. Conclusion: Though Enterohemorrhagic E.coli (EHEC) O157:H7 was not encountered in this study, STEC caused by E.coli non O157 was reported. STEC is also known to cause hemorrhagic colitis (HC) and HUS. In this study HUS was reported in 16.67% children. Therefore, proper isolation and identification of STEC is essential in a tertiary care centre, to initiate prompt management and reduce morbidity and mortality in children.

Uncommon presentation of pulmonary aspergilloma.

Cases of pulmonary aspergilloma without any predisposing factors are rarely reported. Clinical presentation varies from case to case. Here, we report a case of pulmonary aspergilloma in a 60-year-old male patient who was admitted to the Intensive Respiratory Care Unit with spontaneous pneumothorax. The patient had a history of dyspnea on exertion since 9 months and mild haemoptysis since the last 6 months. A computerised tomographic scan of the lungs showed a lesion in the left main bronchus along with obstructive emphysema of the right lung, moderate pneumothorax and mediastinal emphysema. Bronchoscopy was performed and the biopsy samples were processed for histopathological examination and culture on Sabouraud's dextrose agar, which yielded growth of Aspergillus flavus. Repeat sputum samples also yielded the growth of A. flavus . The patient responded to intravenous liposomaamphotericin B and intercostal drainage.

Cerebral Candida abscess in an infant.

Brain abscess is uncommon in the pediatric population. Here, we report one such case due to Candida albicans in one-year-old infant, without any predisposing factors. The child presented with progressively increasing size of head circumference. The diagnosis was confirmed by CT scan of brain and microbiological investigations on the drained pus material. The patient responded to combination of surgery (drainage) and intravenous amphotericin B. Neurological development six months after hospital discharge was normal. The organism being a rare cause of cerebral abscess in pediatric population is reported here.

A case of tuberculous pericardial effusion.

Tuberculosis accounts for up to 4% of acute pericarditis and 7% cases of cardiac tamponade. Prompt treatment can be life saving but requires accurate diagnosis. We report a case of 30-year-old male who presented with fever, chills, and dry nonproductive cough since one month. The case was diagnosed by radiological findings, which were suggestive of pulmonary tuberculosis, followed by acid fast staining and culture of the aspirated pericardial fluid. The patient was responding to antitubercular treatment at the last follow up.

Phaeohyphomycosis of subcutaneous tissue caused by Phaeoacremonium parasiticum.

Though Phaeoacremonium parasiticum is an unusual cause of human disease, subcutaneous infection, eumycetoma, osteomyelitis, arthritis and even disseminated diseases, such as fungemia and endocarditis have been reported. Here, we report a case of subcutaneous abscess on the forearm due to P. parasiticum in a 26-year-old woman. There were no obvious predisposing factors. The patient was treated with surgical debridement followed by intravenous amphotericin B and itraconazole to which she responded well. We report this case, being rare and the first from India.

Tuberculous synovitis in a HIV positive patient.

Tuberculosis of the appendicular skeleton is an uncommon infection by tubercle bacilli. Thirty percent of the skeletal tuberculosis involves joints, the knee being the third most common joint affected. We report a case of tubercular synovitis of the knee joint in a 30-year-old HIV seropositive male. The diagnosis was done by Ziehl-Neelsen stain and culture on Lowenstein Jensen medium, of the synovial fluid along with the X-ray findings of the knee joint. The X-ray of the chest showed findings suggestive of pulmonary tuberculosis. The patient was responding well to the antitubercular treatment at the last follow up.