Clinicopathological Study of Chronic Kidney Disease of Unknown Etiology in Odisha

Introduction: Chronic kidney disease (CKD) is emerging as a serious health problem in Odisha, India. A new form of severe CKD affecting adults, not due to traditional risk factors like diabetes, hypertension, glomerulonephritis, has been reported in Sri Lanka, Central America, and Egypt in the last two decades. This has been named CKD of unknown origin (CKDu), and it is fatal due to late recognition and rapid disease progression. The aim of the study was to elucidate the association between different sociodemographic, and biochemical parameters with renal morphology in CKD of unknown origin patients. Methods: A cross-sectional study was conducted on 124 consecutive patients with CKD from the period January 2018 to December 2018. Patients in the age group 18–60 years who met clinical criteria for CKD were included. Participants answered a questionnaire. After the necessary history, clinical evaluation, and blood and urine analyses, a kidney biopsy was undertaken. Kidney biopsy was feasible in 51 patients as the rest 61 patients had shrunken kidneys and 12 patients did not give consent. Patients with diabetes mellitus (DM), hypertension, glomerulonephritis, polycystic kidney disease, obstructive kidney disease or any other congenital diseases, snakebite, pregnancy, malignancy, gout, primary hyperparathyroidism, infectious diseases like human immunodeficiency virus (HIV), TB, Hepatitis B and C, malaria, syphilis, leprosy and coagulopathies were excluded. Among the 51 patients, 23 had CKDu, 25 had chronic glomerulonephritis and three biopsies were inconclusive. Results: The mean age of CKDu patients was 36.78 ± 9.85 years. Males (73.9%) were predominantly affected. A family history of CKD was seen in 82.6% of CKDu cases. Hyponatremia and hypokalemia were predominant biochemical abnormalities in our CKDu cases. Binary logistic regression showed rural residence, family history of CKD, exposure to smoke from burning coal, charcoal, or biomass fuels, low socioeconomic status, and low body mass index were strongly associated with CKDu. There was an increased risk of developing CKDu in persons with a family history of CKD [p = 0.003, odds ratio (OR)— 17.58], persons exposed to smoke from burning coal, charcoal or biomass fuels (p = 0.003, OR- 32.4), and patients with low socio-economic status (p = 0.001, OR- 15.87). Interstitial fibrosis (IF), interstitial inflammation with mononuclear infiltration, tubular atrophy (TA), and global glomerulosclerosis (GS) were pertinent histopathological findings in our study. Conclusion: There is no strong evidence for a single cause for CKDu, and multiple environmental, occupational and social factors are probably involved. We need to design consistent and comparative multisite studies to identify etiologies of CKDu, across high-risk populations that may help elucidate the importance of region-specific vs global risk factors.

Attitude and practice of self-medication among 2nd-year dental students in a tertiary care teaching hospital: A questionnaire-based cross-sectional study

Background: It is a common believe that self medication prevails more in medical students. Dental students do believe in self medication. With this background, current study aimed to determine the attitude and practice of self medication among dental students. Aim and Objective: To know prevalence, attitude and practice of self medication among dental students in a dental college. Materials and Methods: A descriptive cross-sectional study was conducted among 2nd year dental students in a tertiary care teaching hospital to assess attitude and practice regarding self-medication. Data were collected from 90 students using a semi-structured self-administered questionnaire. Results: The study finding revealed that overall prevalence of self medication is 86.67% among the participants. There is an increase in prevalence of self medication from 58.97 to 86.67% after joining to professional course. Most common source of self medication is senior抯 advice (92.30%) followed by book reference (83.33%). Most common disease for which self medication is used are fever, headache/body ache, cold/flu (100%) followed by acid peptic disease (92.30%). The use of self medication is more in communicable/infectious disease (91.02%) than noncommunicable disease (62.82%). Most commonly used drug for self medication are analgesics, antiallergics and antipyretics (100%) followed by antacid/PPI (84.61%). The prevalence of use of antibiotics among the participants are 73.07%. 26.29% participants use herbal medication as self medication. Most of the participants use self medication as and when basis (52.57%). Only 25.64% participant took full course of the medication and 21.79% participants use self medication for long term. Most of the participants strongly agree or agree for self medication in community and among dental students. About 54% disagree saying medicine should be prescribed by licensed medical practitioner. Conclusion: Attitude and practice of the students towards self-medication was positive and reason being dental students and influence of seniors. Since they are in the initial year of course with inadequate knowledge, awareness must be created about appropriate use and adverse drug reaction arising from self-medication.

Snake bite, a neglected menace: a prospective observational study in a tertiary care pediatric intensive care unit

Background: Snake bite is a neglected and underestimated public health problem in tropical and subtropical region. Snake envenomation is a well-known cause of morbidity and mortality in India. In 2009, WHO declared snake bite a neglected disease. Ophitoxaemia is an exotic term characterising the clinical spectrum of snake bite. Objective of this study was to know the outcome in paediatric snake bite cases in a tertiary care PICU (Paediatric Intensive Care Unit) with special reference to envenomation time and also to evaluate and analyse few atypical presentations of snake envenomation by proper history taking, physical examination and help start early intervention to prevent morbidity and mortality.Methods: A prospective observational study was done in Paediatric Intensive care unit of the hospital from June 2017 to June 2019.Results: Around 56.8% of 109 cases were non-poisonous snake-bites. Out of 47 cases admitted to PICU, 68.08% developed cellulitis at the site of bite with Staphylococcus aureus being the commonest organism isolated (56.25%). Anaerobes (bacteroides and clostridium) were also isolated in few cases. Edema at site of bite (hematotoxic) and ptosis(neurotoxic) were most common initial presentation. 36.17% of patients received ASV (Anti- Snake Venom) and first aid within 6 hours of snake bite. The morbidity and mortality were significantly less (p<0.05) as compared to those who didn't receive ASV. 12.76% of cases with normal CRT (Clot Retraction Time) presented with features of coagulopathy. DIC (58.33% of hematotoxic bites) and respiratory paralysis 68 (75% of neurotoxic bites) were the commonest complications. Renal replacement therapy was required in 6.38%, transfusion in 10.63% cases and case-fatality-rate was 12.7%. There were a few atypical presentations of snake bite mimicking Gullain-Barre syndrome, acute onset encephalitis with absent brainstem and pupillary reflexes, intracerebral hemorrhage and cortical blindness.Conclusions: Most snake bites are non-poisonous. Early first aid and ASV administration has better outcome. Fibrinogen levels are more reliable than CRT to diagnose coagulopathy. Acute presentations i.e, altered sensorium, paralysis, blindness and stroke like features should always be evaluated for snake envenomation in suspected cases to prevent morbidity and mortality.

Social Media in Relation to Politics in Odisha, India :An Overview.

Social media offers innovative opportunities for political actors, political institutions and the public to interact with one another. Most of the prominent political parties are getting attracted toward the use of social media for their election campaigns. Most of the prominent political parties are getting attracted toward the use of social media for their election campaigns. The use of social media by politicians for wooing the younger generation continues. In Odisha, Chief Minister Naveen Patnaik who has asked his party men to use social media to woo young voters, who constitute above 40 percent of the total electorate in the state, In an attempt to cash on the popularity of social media among the youths, the Odisha unit of Congress logged into social media by inaugurating social media unit ahead of 2014 Assembly election in Bhubaneswar. In Odisha, many members of parliament (MPs) and members of Legislative Assembly (MLAs) have created accounts on popular sites such as Facebook, Twitter and Orkut. The content posted on these sites may relate to policy issues and the official work of politicians or to aspects of their personal lives. We have also seen some candidates also campaign through the popular social network sites like Facebook, Twitter etc. in recent Urban Local Body (ULB) elections. However social media will become a an important platform for electoral campaign in future elections. No doubt Social media will a game changing platform in near future.

Rapid spread of Chikungunya virus infection in Orissa: India.

Background & objectives : A large number of cases of undiagnosed fever and joint pain were reported from different parts of the State of Orissa since February 2006. Epidemiological and laboratory investigation were carried out to confirm the cause of emerging illness, which was provisionally suspected as Chikungunya (CHIK) fever. Methods: Upon getting the reports of suspected CHIK like illness in different parts of the State, epidemic investigations were carried out in the outbreak affected villages. Case history was recorded, clinical examination undertaken and blood samples collected for seroconfirmation for CHIK IgM antibody using ELISA based kit. Simultaneously vector survey was also carried out. Results: With no previous record of CHIK infection in the State, the first outbreak was confirmed during February 2006. Subsequently, the infection spread to 13 of 30 districts in different episodes covering 79 villages till November 2007. Attack rate was 9-43 per cent in the different outbreaks with average seropositivity of 24 per cent to CHIK specific IgM. Morbidity was high though no deaths were recorded. Aedes aegypti and Ae. albopictus were identified as the possible vectors for transmission. Interpretation & conclusions : The report confirmed emergence of CHIK infection in the State of Orissa, India, and its spread to a larger geographic zone in a short period which warrants public health measures to control further spread.

Physical status of newborns and neonatal outcome.

OBJECTIVE: To determine the extent to which physical status at birth is associated with neonatal mortality and the causes of mortality vis-a-vis size at birth and gestational age. METHOD: 11,223 consecutive live births completing 26 weeks of gestation and weighing > or = 500 gm were included in the study. Birth weight and chest circumference were recorded as per WHO guidelines. Gestational age was calculated on the basis of L.M.P. and the new Ballard's score. Deaths occurring in the hospital within 28 days were recorded. Percentile values of gestational age specific birth weights were calculated separately for singletons and multiple births. Percentage of SGA was calculated with reference to WHO recommended values. Birth weight-gestational age-specific mortality rates were calculated at 2 wk and 500 gm intervals. RESULT: Low-birth-weight babies constituted 39.8% of the total, much in excess of WHO recommended figure of 15%. 76% deaths occurred among LBW babies and 56.2% among preterms. Mortality showed remarkable decline as the birth weight increased to 2,000 gm. The lowest mortality was among singletons weighing 2,500-3,000 gm and of 38-40 weeks gestation. Prevalence of SGA at 40 and 42 weeks were 73.7% and 83.6% respectively. But, if SGA babies not categorised as LBW were excluded, the values came down to 32% and 36% respectively. 36% of all deaths occurred during the first 24 hrs of birth; asphyxia and related causes contributing to 50% of it. CONCLUSION: Cut-off value of 2,000 gm instead of 2,500 gm for birth weight may be preferable in countries where most LBW babies are SGAs. Simultaneously, deaths in non-LBW babies due to perinatal causes contribute sgnificantly to total neonatal mortality and need due attention through sensitising obstetricians in essential newbom care and timely Intervention.

Observations on nocturnal activity and man biting habits of malaria vectors, Anopheles fluviatilis, An. annularis and An. culicifacies in the hill tracts of Koraput District, Orissa, India.

Biting and feeding behavior of malaria vectors were studied in nine villages (5 from Jeypore zone and 4 from Malkangiri zone) of Koraput District. Man biting catches comprised of 16 anopheline species including the incriminated vectors of this area: An. fluviatilis, An. annularis and An. culicifacies. An. fluviatilis was predominant and biting of this species recorded indoors throughout the year in both the zones. The period, during which the biting activity peaked, was different between the two zones and consequently the time of peak transmission was also different between the zones. The biting activity was at its peak between 21.00 and 03.00 hours in both the zones. However, in cold season the biting activity peaked in the first quarter of the night in Jeypore zone. The anthropophilic index (AI) of An. fluviatilis was 26.2% in Jeypore and 83.7% in Malkangiri and of An. culicifacies the AI was 0.4% in Jeypore and 7% in Malkangiri. Analysis of gonotrophic stages of night resting females indicated that in Jeypore zone, the majority of An. fluviatilis female left indoors for outdoor resting before the completion of gonotrophic cycle, but in Malkangiri, the females remained indoors till the end of the gonotrophic cycle. The presence of full-fed females in night resting catches in Jeypore village further suggested that the females do not leave the house immediately after taking blood meal but rest for some time.

Lambdacyhalothrin treated bed nets as an alternative method of malaria control in tribal villages of Koraput District, Orissa State, India.

A village scale trial was carried out to evaluate the efficacy of bed-nets impregnated with lambdacyhalothrin, at the dose of 0.025 g/m2, in reducing malaria transmission in villages of Koraput District of Orissa, India, inhabited by tribals. The nets were distributed before peak transmission season. There was an overall decline in the parasite rate in all the age groups, six months after the supply of impregnated nets while the same increased in control village and in a village where untreated nets were supplied. The vector densities (resting and man landing) were lower in the treated village as compared to untreated and control villages throughout the study period. The reduction in the parasite rate was consistent when the reimpregnation was done at six monthly interval and the same tend to increase when the gap between the two impregnations was increased to one year. Though malaria incidence was reduced, transmission was not completely interrupted during the study period, due to outdoor transmission. The insecticidal effect of bednets was retained upto six months. Washing of bednets by the community did not affect the efficacy. The acceptance and usage was better with impregnated nets as compared to ordinary nets.

Anopheline fauna of Koraput district, Orissa state, with particular reference to transmission of malaria.

The anopheline fauna was surveyed in Koraput district of Orissa, which is highly malarious. A total of 62,086 anophelines belonging to 22 species and two varieties were collected, including eight species of anophelines which are recognized malarial vectors in India. Anopheles sergenti, A. pulcherrimus, A. jeyporiensis var candidiensis and A. annularis var adiei was recorded for the first time in this area. A total of 24154 mosquitoes were dissected and 18 mosquitoes belonging to four species, A. fluviatilis. A. annularis, A. culicifacies and A. aconitus were found with the gut/gland infection.