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The outcome for children with rheumatic diseases has been dramatically altered by the use of biological therapies. Increasing use of these agents will need careful monitoring for long term safety, particularly in children. Current data on safety of these drugs stem exclusively from Western literature. There is clear need for a registry of all children with rheumatic diseases who are commenced on biological agents to ensure appropriate pharmacovigilance. In this perspective, we discuss the need for and the role of a biologics registry for children with rheumatic diseases in India.
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Objective To determine the outcomes in children with MIS-C receiving diferent immunomodulatory treatment. Methods In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case defnition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in diferent treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone. Results The data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case defnition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred ffty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19–25.0), p<0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n=45), and IVIG plus steroid (n=84) groups (p=0.515). Conclusion While no signifcant diference was observed in the frequency of occurrence of the primary outcome in diferent treatment groups, data from adequately powered RCTs are required for defnitive recommendations.
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COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, efforts were initiated to develop safe and effective vaccines. Till date, 11 vaccines have been included in the WHO’s emergency use list. The emergence and spread of variant strains of SARS-CoV-2 has altered the disease transmission dynamics, thus creating a need for continuously monitoring the real-world effectiveness of various vaccines and assessing their overall impact on disease control. To achieve this goal, the Indian Council of Medical Research (ICMR) along with the Ministry of Health and Family Welfare, Government of India, took the lead to develop the India COVID-19 Vaccination Tracker by synergizing three different public health databases: National COVID-19 testing database, CoWIN vaccination database and the COVID-19 India portal. A Vaccine Data Analytics Committee (VDAC) was constituted to advise on various modalities of the proposed tracker. The VDAC reviewed the data related to COVID-19 testing, vaccination and patient outcomes available in the three databases and selected relevant data points for inclusion in the tracker, following which databases were integrated, using common identifiers, wherever feasible. Multiple data filters were applied to retrieve information of all individuals ?18 yr who died after the acquisition of COVID-19 infection with or without vaccination, irrespective of the time between vaccination and test positivity. Vaccine effectiveness (VE) against the reduction of mortality and hospitalizations was initially assessed. As compared to the hospitalization data, mortality reporting was found to be much better in terms of correctness and completeness. Therefore, hospitalization data were not considered for analysis and presentation in the vaccine tracker. The vaccine tracker thus depicts VE against mortality, calculated by a cohort approach using person-time analysis. Incidence of COVID-19 deaths among one- and two-dose vaccine recipients was compared with that among unvaccinated groups, to estimate the rate ratios (RRs). VE was estimated as 96.6 and 97.5 per cent, with one and two doses of the vaccines, respectively, during the period of reporting. The India COVID-19 Vaccination Tracker was officially launched on September 9, 2021. The high VE against mortality, as demonstrated by the tracker, has helped aid in allaying vaccine hesitancy, augmenting and maintaining the momentum of India’s COVID-19 vaccination drive
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Conservation tillage has proven advantageous in improving soil health and productivity. However, the greenhouse gases (GHGs) emission and intensity from different conservation tillage and nutrient management systems under Indian conditions are less understood. Therefore, here, we compared the effect of tillage and nutrient management on GHGs emissions, net global warming potential (NGWP), and greenhouse gas intensity (GHGI) from a field experiment under five years in a soybean-wheat cropping system in the Vertisols. The tillage treatments comprised of reduced tillage (RT) and no tillage (NT). The three nutrient management treatments included application of 100% NPK (T1), 100% NPK + 1.0 Mg FYM-C ha-1 (T2), 100% NPK +2.0 Mg FYM-C ha-1 (T3). The results showed significantly higher SOC sequestration under NT (1388 kg ha-1 yr-1) followed byRT (1134 kg ha-1 yr-1) with application of FYM (2.0 Mg C ha-1) (T3) every year. Across tillage, integrated nutrient management(T2 and T3) lowered NGWP and GHGI compared to NPK (T1). The GHGI of NT system was less by 33% compared to RT. The results suggest that GHGs mitigation and sustained food production in the soybean-wheat system can be achieved in NT and RT with integrated use of organic and inorganic fertilizer as the major component of nutrient management.
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Pediatric glioblastoma (pGBM) is a rare entity accounting for only approximately 3% of all childhood brain tumors. Treatment guidelines for pGBM have been extrapolated from those in adult glioblastoma. Rarity of pGBM and underrepresentation of pediatric population in major studies precludes from defining the ideal treatment protocol for these patients. Maximum safe resection is performed in most of the cases followed by postoperative radiotherapy in children over 3 years of age. Benefit of temozolomide is unclear in these patients. Here, we present the clinicopathological details and outcome of six pGBM patients treated at our institute in 2018–2019.
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Pediatric glioblastoma (pGBM) is a rare entity accounting for only approximately 3% of all childhood brain tumors. Treatment guidelines for pGBM have been extrapolated from those in adult glioblastoma. Rarity of pGBM and underrepresentation of pediatric population in major studies precludes from defining the ideal treatment protocol for these patients. Maximum safe resection is performed in most of the cases followed by postoperative radiotherapy in children over 3 years of age. Benefit of temozolomide is unclear in these patients. Here, we present the clinicopathological details and outcome of six pGBM patients treated at our institute in 2018–2019.
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Background: The Government of India by National Health Policy 2017 has set the target of relative reduction in prevalence of current tobacco use by 15% and 30% by 2020 and 2025 respectively. The Union health ministry had notified to mandatory display new health warnings to be covering 85% of the principal display area on all tobacco products (1 April 2016).Methods: This was an observational descriptive study with cross sectional in design carried out at Baghbazar slum in Kolkata with objective to study the smoking pattern, knowledge about health warning symbols (HWS) on tobacco products among the study population and to assess their motivation to quit and influence of HWS on their motivation. A total 66 smokers were interviewed using predesigned and pre tested questionnaire and analysis done using SPSS version 1.Results: About 83.3% study subjects were presently smoking and they were smoking daily, about 10 cigarette and bidi was smoked daily (median) and median duration without smoking was 1 month. About 63.6% study subjects were highly motivated to quit smoking. Health warning was definitely motivating them to quit smoking (p=0.01) but it was not resulting in actual quitting smoking (p=1.000). The main reason for motivation for quitting smoking was self-health related factor (84.6%).Conclusions: Health warning on cigarette packets increased the awareness about ill effects of smoking and motivated the smokers to quit smoking but not compelling them to quit smoking. Mostly those who were motivated to quit smoking were actually thinking about quitting due to other reasons.
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Purpose: The study purpose included dosimetric comparison of cobalt 60 (60Co) and iridium 192 (192Ir) high dose rate (HDR) source used in brachytherapy treatment of cervical cancer. Materials and Methods: Computed tomography (CT) scans for 15 patients of carcinoma of uterine cervix using 3-mm slice thickness were considered for the study The contouring of high-risk clinical target volume (HRCTV), bladder, and rectum on CT images was done as per the GEC ESTRO guidelines with the help of magnetic resonance imaging images in the treatment planning system. All parameters were kept the same for 60Co (3.5 mm active length, 0.5 mm active dia, Bebig) and 192Ir (3.5 mm active length, 0.6 mm active dia, Bebig) HDR source with 2.5-mm step size and dose prescription to Point A. As per the International Commission on Radiation Unit (ICRU)-89 guidelines, the dose–volume parameters such as D50(Gy), D90(Gy), and D98(Gy) for HRCTV and D0.1cc (Gy), D1cc (Gy), D2cc (Gy), and D5cc (Gy) to the bladder and rectum were calculated for both the HDR sources. Results: The difference in dose–volume histogram parameters such as D50,D90,and D98 of HRCTV was 3.19%, 1.13%, and 0.50%, respectively, for the two radioisotopes. The difference in dose values of D0.1cc, D1cc, D2cc, D5cc, and ICRU reference points of bladder was –0.58%, –0.67%, –0.99%, –0.94%, and –1.75%, respectively. On the other hand, dose difference for D0.1cc, D1cc, D2cc, D5cc, and ICRU reference points of rectum was 0.67%, 0.26%, 0.56%, 0.63%, and –0.33%, respectively. Conclusions: The present study results show that all the dose parameters of HRCTV, bladder, and rectum with 60Co were comparable with those of 192Ir HDR source. The isodose distribution is more bulge out for 60Co in cranial-caudal direction compared to that of 192Ir. However, these differences can be reduced by treatment planning optimization techniques. The clinical plan evaluation in each slice and plane is necessary to explore the logistic and financial benefits of miniaturized 60Co source over 192Ir HDR source
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Background: Visual symptoms are a common occurrence following mTBI. Among visual symptoms, Visual photosensitivity is a frequent manifestation post mTBI, which can disrupt the normal lifestyle of any individual resulting in social and professional distress. Post traumatic amnesia is one of the markers of severity in mTBI. Authors have studied the association between visual photosensitivity and post traumatic amnesia following mTBI. The aim of this study is to find out the association between Visual Photosensitivity and post traumatic amnesia in patients with mild traumatic brain injury.Methods: Hospital based prospective, analytical, observational study. A total of 300 patients with the diagnosis of mTBI were studied. Diagnosis of mTBI was based on the WHO Operational criteria for clinical identification of mTBI.VLSQ-8 Questionnaire was used in this study to diagnose and monitor the progress of visual photosensitivity in patients with mTBI. The Galveston Orientation and Amnesia Test (GOAT) was applied to assess post traumatic amnesia. The study period was from July 2017 to March 2019. Each patient with mTBI who developed visual photosensitivity was followed up for 1 year after the appearance of their symptoms.Results: Thus the main observations of this study were (i) There is a strong possibility of developing visual photosensitivity among the group of patients who presented with the history of post traumatic amnesia following mild traumatic brain injury (p=0.0008)(ii) if a patient with mild traumatic brain injury suffers from visual photosensitivity, possibility of his/her symptoms persisting beyond 6 months increases significantly if there is history of post traumatic amnesia (p=0.0001).Conclusions: This result will help in providing information regarding prognosis of visual photosensitivity following mild traumatic brain injury.
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Background: Abdominal injury constitutes a significant portion of all blunt and penetrating body injuries. Computed tomography is an important and fast technique which gives rapid information on the type of abdominal injury and helps in management of the patient accordingly. The aim of the present study was to evaluate the usefulness of Multidetector Computed Tomography (MDCT) in detection of intra-abdominal injury in patients with blunt abdominal trauma and to provide information that could accurately determine choice of management (non- operative versus operative). And to correlate the computed tomography (CT) findings with either clinical observation, follow up CT scan (if required) or surgical findings (wherever applicable).Methods: A total of 50 patients with abdominal trauma who underwent computed tomography (CT) examination were included. CT findings were compared with surgical findings in operated cases, and in the rest CT findings were compared by clinical outcome.Results: Among the 50 cases studied, all 50 had positive CT findings of abdominal trauma, out of which 24 patients underwent surgery and the remaining were managed conservatively. The age group of the patients was ranging from 8 to 66 years with male predominance. In this study the commonest organs affected were liver and spleen accounting for 48% and 44% respectively.Conclusions: Computed tomography is an important and highly sensitive imaging modality for diagnosis of organ injuries in patients with abdominal trauma and accordingly deciding the management of patient.
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Background: Paranasal sinuses are air filled spaces present within the skull and facial bones. Paranasal sinuses region anatomy is highly variable. Knowledge of these variations is very important for radiologists as well as endoscopic surgeons for preoperative evaluation to avoid damage to adjacent vital structures. CT is the best modality to delineate the sinus anatomy as well as soft tissue structures. Thus, this study was undertaken to evaluate the anatomical variations of paranasal sinus region and ascertain their clinical importance.Methods: A total of 142 patients, those referred from various outdoor/indoor departments with the symptoms related to nose and paranasal sinuses were included. Detailed history, appropriate clinical examinations, biochemical investigations and X-ray PNS were recorded. Unenhanced CT scan of the PNS was performed for these patients in the axial planes and reformatted coronal planes. Observation was made and analysed using descriptive tools and scientific methods.Results: Deviated nasal septum was the most common variation followed by middle concha bullosa, Paradoxical middle turbinate, curved uncinate process, overpneumatized ethmoidal bulla, superior concha bullosa, prominent Agger Nasi cells, haller cells, onodi cells, maxillary sinus septae and pneumatization of uncinate process. Incidence of anatomical variation was 75% among the patients showing PNS mucosal changes while it was 94% among patients showing no mucosal changes. Chi square statics revealed that presence of anatomical variation does not mean a predisposition to mucosal changes.Conclusions: The presence of anatomical variants does not indicate predisposition to sinus pathology but may predispose to increased risk of intraoperative complications. It is important to pay close attention to anatomical variations in the preoperative evaluation to avoid possible complications.
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Background: The objectives are to identify and study structural abnormalities in the brain that associated with seizures, spectrum of findings in patients with seizures, classify seizure type and syndrome and to evaluate role of MRI in postoperative seizures.Methods: A total of 110 patients, those referred from various outdoor/indoor departments with the history of seizure were included after fulfilling the inclusion criteria. Detailed history, appropriate clinical examinations and biochemical investigations were recorded. All MRI scans were performed on a 1.5 T Philips Achieva. Sequences were used according to MR Imaging protocol of seizures. Observation was made and analysed using descriptive tools and scientific methods.Results: Among 110 patients’ majority (41%) were normal, 20% had cerebral infarct with gliosis followed by NCC 7.2%, atrophy 5.45%, tuberculosis 11%, venous thrombosis 3.64%, developmental malformations 3.64%, glioma 1.82%, cavernoma 1.82%, tuberous sclerosis 1.82%, meningioma 0.91%, cerebral abscess 0.91% and Sturge-weber syndrome 0.91%. Most of the patients with cerebrovascular causes and male predominance 61.8%.Conclusions: The present study was a prospective study. Spectrum of MRI findings related to vascular, developmental, infection and neoplasm was identified. MRI is noninvasive modality with no radiation hazard, excellent gray white matter resolution and multiplanar imaging capability. MRI helps in detection of subtle lesions responsible for seizures. Present study observed that MRI with appropriate imaging protocols add sensitivity and specificity in evaluation of seizures.
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Background: Use of sunscreens on the face is becoming popular, and patients with melasma are prescribed sunscreen for use on the face. Results of a few Western studies on the effect of sunscreen use on serum vitamin D concentration are not applicable to Indian conditions. Aims: To examine the effect of use of a high sun protection factor (SPF 50+, PA++++) sunscreen on face in patients with melasma on serum concentration of 25-hydroxyvitamin D. Methods: Forty-five Indian patients (Fitzpatrick skin types III and IV) with melasma were advised to use a sunscreen with SPF 50 + for 3 months, 43 (33 female, 10 male; age 32.9 ± 8 years) completed the study. Patients staying outdoor for <4 hours applied sunscreen once daily after bath. Patients staying outdoors for >4 hours reapplied sunscreen 4 hours after first application. Patients were provided a container to measure the amount of sunscreen for use, which was approximately equal to recommended thickness. Compliance was tested by weighing the used tubes and tubes in use during monthly visits. Serum concentration of 25-hydroxyvitamin D was tested before and after the study period. Results: Amount of sunscreen advised (100.5 ± 29.2 ml) and the actual amount used (96.6 ± 27.9 ml) were similar (P = 0.53, t-test). The difference between serum concentrations of 25-hydroxyvitamin D at the baseline (19.20 ± 9.06 ng/ml) and at 3 months (18.91 ± 8.39 ng/ml) was not significant (P = 0.87, paired t-test, 95% confidence interval of difference −3.33 to 3.92). No correlation was found between the amount of sunscreen used and the percentage change in serum 25-hydroxyvitamin D concentration at 3 months (rho = 0.099, P = 0.528, Spearman's rank correlation). Limitations: Longer duration of application and a larger sample size may detect minor differences in vitamin D concentration. Conclusion: Using a high SPF sunscreen on the face, along with physical photoprotection advice, in patients with melasma for 3 months does not influence serum 25-hydroxyvitamin D concentration in Indian conditions.
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Background: Juvenile nasopharyngeal angiofibroma (JNA) is a tumor that shows a predictable spreading pattern. This study showed the characteristic MRI findings and its pattern of spread of JNA for diagnosis.Methods: This study consisted of 6 cases of JNA for diagnosis and pattern of spreading by using MRI as modality of choice.Results: The total patients included in study were 6 with age range from 9-20 years and all were male. The classification system used in the study was Radkowski and Onerci system. The tumor showed isointensity to muscle and hyperintensity on T1 and T2 sequences respectively on MR imaging. All lesions had internal signal void regions and showed intense enhancement after IV contrast administration. Diffusion restriction was not an associated features however high values of ADC were noted. The MR angiography of three patients showed blood supply of tumor was mainly from the internal maxillary branch of external carotid artery. The treatment was surgical excision of tumor which was decided on MRI Diagnosis and pattern of Extension described in Radiological report.Conclusions: MRI is a modality of choice for diagnosis and extension of JNA based on clinical and radiological findings, without performing a biopsy.
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Objectives: To develop and assess Pediatric AppropriatenessEvaluation Protocol for India (PAEP-India) for inter-rater reliabilityand appropriateness of hospitalization.Design: Cross-sectional study.Setting: The available PAEP tools were reviewed and adaptedfor Indian context by ten experienced pediatricians followingsemi-Delphi process. Two PAEP-India tools; newborn (?28 days)and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness ofadmission and inter-rater reliability between assessors.Participants: Two sets of case records were used: (i) 274cases from five medical colleges in Delhi-NCR [?28 days (n=51);>28 days to 18 years (n=223)]; (ii) 622 infants who werehospitalized in 146 health facilities and were part of a cohort (n=30688) from two southern Indian states.Interventions: Each case-record was evaluated by twopediatricians in a blinded manner using the appropriate PAEP-India tools, and ‘admission criteria’ were categorized asappropriate, inappropriate or indeterminate.Main outcome measures: The proportion of appropriatehospitalizations and inter-rater reliability between assessors(using kappa statistic) were estimated for the cases.Results: 97.8% hospitalized cases from medical colleges werelabelled as appropriate by both reviewers with inter-rateragreement of 98.9% (k=0.66). In the southerm Indian set ofinfants, both reviewers labelled 80.5% admissions as appropriatewith inter-rater agreement of 96.1% (k= 0.89).Conclusions: PAEP-India (newborn and child) tools are simple,objective and applicable in diverse settings and highly reliable.These tools can potentially be used for deciding admissionappropriateness and hospital stay and may be evaluated later forusefulness for cost reimbursements for insurance proposes.
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Duloxetine hydrochloride (DXH) suffers from poor solubility and thereby poor absorption, which ultimately leads to poor bioavailability. In present study, an attempt has been made to formulate and characterize duloxetine hydrochloride (DXH) complex, using β-cyclodextrin (β-CD) and different hydrophilic polymers in order to enhance its solubility and dissolution rate. Phase solubility study was used to investigate the interaction of the drug in binary systems (DXH-β-CD) as well as ternary systems (DXH-β-CD-hydrophilic polymer). It was observed that solubilization of DXH by β-CD was further enhanced by using HPMC K4M at 0.1% w/v concentration. Several methods were used to prepare ternary complex of DXH-β-CD-HPMC K4M. Ternary complex prepared by co-evaporation method containing DXH-β-CD-HPMC K4M in the ratio of 1:1.10:0.01 has shown the fastest dissolution rate (53.65 ± 2.83% in 5 min) as compared to pure DXH (3.03 ± 1.88% in 5 min) as well as other methods used to prepare these complexes. The prepared ternary complex system was characterized by the help of X-ray powder diffraction studies, differential scanning calorimetry and scanning electron microscopy. It was observed that enhancement in solubility as well as dissolution rate of DXH was due to formation of ternary complex system.
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Objectives: To determine the efficacy of oral zinc for treatment of idiopathic neonatal hyperbilirubinemia in near-term and term (35- 41 weeks) neonates. Design: Randomized placebo-controlled trial. Setting: Tertiary-care teaching hospital Participants: Eighty newborns with idiopathic neonatal hyperbilirubinemia. Intervention: Neonates were randomized to receive either oral zinc sulfate (10 mg/d) or placebo for 7 days. Main outcome measures: Primary: total serum bilirubin levels at 48 (±12) h, 96 (±12) h and 144 (±12) h after intervention. Secondary: duration of phototherapy, and serum zinc and copper levels. Results: Baseline mean (SD) total serum bilirubin levels were 14.8 (3.8) and 14.4 (3.5) mg/dL in zinc and placebo groups, respectively. No significant differences were observed in total bilirubin levels between the two groups after the intervention. Mean (SD) total serum bilirubin levels in zinc and placebo groups were 13.9 (2.5) vs. 13.4 (1.9) mg/dL (mean difference 0.566; 95% CI -0.535, 1.668, P=0.038) at 48 h, 13.1 (2.7) vs. 12.8 (2.3) mg/dL (mean difference 0.234; 95% CI -1.011, 1.479, P =0.708) at 96 h and 8.0 (2.0) vs. 8.6 (1.2) mg/dL (mean difference -0.569, 95% CI -1.382, 0.242, P=0.166) at 144 h. Although the mean duration of phototherapy in the zinc group was less by 21.3 h (95% CI 11.6, 30.9, P=0.052), the difference was not significant. Postintervention, serum zinc levels were significantly higher in the zinc-supplemented group while serum copper levels were comparable between the two groups. Conclusions: Oral zinc sulfate, in a dose of 10 mg/day, is not effective in the management of idiopathic neonatal hyperbilirubinemia.
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Objective:To describe profile and outcome in children with significant pericardial effusion. Methods: Hospital records of 25 children admitted with significant pericardial effusion during January 2010 to March 2013 were analyzed. Results: Thirteen (52%) children had tubercular, 6 (24%) had bacterial, 3 viral, 2 recurrent idiopathic and one had malignant pericardial effusion. Only 3 children in our series required surgical drainage. Conclusions: Echocardiography guided percutaneous pericardiocentesis and pigtail catheter placement was found to be safe and effective.
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Tephrosia purpurea (L.) Pers. is popularly known as 'Sarapunkha' in classical Ayurvedic texts. It is a perennial plant belonging to the family Fabaceae, and occurs throughout the Indian subcontinent. T. purpurea is traditionally used to treat splenomegaly, cirrhosis, cough and cold, abdominal swelling and as an antidote in the Ayurvedic system of medicine. Phytochemical investigations indicate the presence of semiglabrin, pongamole, lanceolatins A and B, rutin, lupeol, and β-sitosterol. Flavonoids including (+)-tephrorin A and B, (+)-tephrosone, an isoflavone, 7, 4'-dihydroxy-3', 5'-dimethoxyisoflavone and a chalcone, (+)-tephropurpurin were isolated from the whole plant. Pharmacological activities of different parts of the plant reported include anti-inflammatory, antiulcer, antimicrobial, antioxidant, antiallergic, antidiabetic, hepatoprotective, antitumor and insect repellent activity. In the present review, the literature on the phytochemical and pharmacological investigations of Tephrosia purpurea (L.) Pers. are summarized to August, 2012.