Comparison of prevention of parent-to-child HIV transmission programme & national biennial HIV sentinel surveillance data for tracking HIV epidemic in India

Background & objectives: HIV sentinel surveillance (HSS) among antenatal women in India has been used to track the epidemic for many years. However, reliable tracking at the local level is not possible as ANC sentinel sites are limited in number and cover a smaller sample size at each site. Prevention of parent-to-child-transmission (PPTCT) programme data has a potential advantage due to better geographical coverage, which could provide more precise HIV case estimates; therefore, we compared HSS ANC data with PPTCT programme data for HIV tracking. Methods: Out of the 499 surveillance sites, where HSS and PPTCT programme was being conducted in 2015, 210 sites (140 urban and 70 rural) were selected using a stratified random sampling method. HSS (n=72,981) and PPTCT (n=112,832) data records were linked confidentially. The sociodemographic characteristics of HSS and PPTCT attendees were compared. HIV prevalence from HSS ANC was compared with the PPTCT programme data using Chi-square test. State- and site-level correlation of HIV prevalence was also done. Concordance between HSS and PPTCT HIV positivity was estimated using kappa statistics. Results: The age distribution of HSS and PPTCT attendees was similar (range: 23 to 27 yr); however, HSS ANC participants were better educated, whereas PPTCT recorded a higher proportion of homemakers. The correlation of HIV prevalence between HSS and PPTCT was high (r=0.9) at the State level and moderate at the site level (r=0.7). The HIV positivity agreement between HSS ANC and PPTCT was good (kappa=0.633). A similar prevalence was reported across 26 States, whereas PPTCT had a significantly lower prevalence than HSS in three States where PPTCT coverage was low. Overall HIV prevalence was 0.31 per cent in HSS and 0.22 per cent in PPTCT (P<0.001). Interpretation & conclusions: High-quality PPTCT programme data can provide reliable HIV trends in India. An operational framework for PPTCT-based surveillance should be pilot-tested in a phased manner before replacing HSS with PPTCT.

Correlation of HRCT Scoring System with PFT Parameters in Interstitial Lung Disease Associated with Systemic Sclerosis Patients

Objectives. Interstitial lung disease (ILD) with features of pulmonary fibrosis and honey-combing is a significant cause of morbidity and mortality in patients with systemic sclerosis (SSc). High resolution computed tomography (HRCT) is the established non-invasive gold standard technique for the diagnosis of SSc related ILD. The present study was designed to characterise HRCT features of ILD in SSc and to correlate pulmonary function test (PFT) parameters with HRCT semi-quantitative scores. Methods. This is an observational, cross-sectional study including 36 patients of SSc who underwent HRCT chest. All the patients were females. Severity and extent were assessed using four HRCT features: ground-glass opacity (GGO), mixed GGO and reticular opacity, reticular fibrosis and honey-combing. Thirty-three patients were able to perform PFT. Total HRCT score, inflammatory index and fibrosis index were correlated with PFT parameters. Results. Interstitial lung disease was found in 33 patients (91.6%), 24 patients (66.6%) had mixed GGO along with reticular inter-lobular septal thickening. Majority of the patients (64%) had non-specific interstitial pneumonia (NSIP) pattern. Usual interstitial pneumonia (UIP) pattern was seen in 25% of the cases. One patient had overlapping features of both UIP and organising pneumonia. There was predominant lower lobe involvement. Among the 33 patients who were able to perform PFT, 85% had abnormal results (predicted forced vital capacity [FVC]<80%). Total HRCT score showed significant negative correlation with PFT parameters 枛 FVC (r=�48, P=0.004) and forced expiratory volume in one second (FEV1) (r=�28, P=0.1), respectively. The ratio of FEV1 and FVC had significant positive correlation with total HRCT score (r=0.5, P=0.002). Inflammatory index and fibrosis index had significant negative correlation with predicted FVC% (P<0.05). Conclusions. Mixed pattern (GGO and reticular opacity) was the most common HRCT finding. HRCT semi-quantitative scoring system is sensitive in assessing the severity and extent of ILD qualitatively and quantitatively in SSc patients.

Impact of examination stress on response time in first-year medical students

Background: Stress has been seen to deteriorate normal physiological functions as well as the psychological functions of the brain. Medical students face a range of enduring normative stressors in the form of academic demands. This brings upon an amount of stress on the students which is related to the examinations and concerns with achieving high grades consequently referred to as academic-related stress. Thus, it becomes crucial to set upon a tool for measuring this stress in order to present methods for overcoming it. In the present study, one such method is evaluated by assessing the reaction time of first-year medical entrants. Material and Methods: The effect of stress on response time in 50 normal healthy medical students of Sawai Man Singh Medical College, Jaipur in the age group of 18 to 21 years was explored in the study. Visual Reaction Time was recorded through the computer program. Results: There was an increase in visual reaction time for the red color in both the sexes during stressful situations as compared to stress-free situations. While a decrease in Visual Reaction Time was seen for green color. A decreased auditory reaction time for both sexes was seen in stressful situations. Conclusion: The results revealed that stress within a limit facilitates positive feedback to Central Nervous System information processing consequently decreasing the reaction time.

Thyrotoxic periodic paralysis: A retrospective, observational study from India

Background & objectives: Thyrotoxic periodic paralysis (TPP) is an endocrine emergency presenting with acute-onset flaccid paralysis in a patient having thyrotoxicosis accompanied by hypokalaemia. This study was conducted to evaluate the clinical profile of patients with TPP presenting to three centres in India. Methods: This retrospective, observational study was conducted at three tertiary care Armed Forces medical centres, located at Lucknow, Kolkata and Delhi. The history, clinical features, treatment details and outcomes were evaluated. Results: Of the 244 patients with thyrotoxicosis, 15 were diagnosed with TPP and included in the study. These 15 patients (14 male and 1 female) had 32 episodes of TPP which were analyzed. The mean age was 30.2�2 yr (range: 21-39), and overt thyrotoxicosis was seen in all patients except one who had subclinical hyperthyroidism. Graves' disease was the most common cause of thyrotoxicosis (13/15) and the remaining two patients had subacute thyroiditis and gestational thyrotoxicosis. Hypokalaemia (serum potassium <3.5 mmol/l) was seen in 12 patients, and the mean serum potassium was 3.2�9 mmol/l (range: 2.1-4.9). All patients had flaccid weakness, predominantly involving the lower limb with no bulbar, respiratory or cranial nerve involvement. The average duration of paralysis was 10.6�7 h (range: 3-28 h). Interpretation & conclusions: Our study demonstrated an early age of presentation and presence of clinical and biochemical thyrotoxicosis in majority of patients with TPP. Hypokalaemia may not always be evident in patients with TPP.

To Study the Prevalence of Different Forms of Thyroid Dysfunctions, Their Risk Factors and Clinical Implications in Cases of Type 2 Diabetes Mellitus, Presenting at Tertiary Care Hospital of Kumaon Region of Uttarakhand

Diabetes mellitus and thyroid disorders are the most common endocrine disorders worldwide. Various studies have found that diabetes and thyroid disorders mutually influence each other and both disorders tend to coexist. Objective: To study the prevalence of different forms of thyroid dysfunctions, their risk factors and clinical implications in cases of type 2 diabetes mellitus. Methods: The study was conducted on 300 patients of Type 2 diabetes mellitus. All the patients were evaluated for thyroid dysfunction by testing thyroid profile (T3, T4 and TSH). The correlation of prevalence of thyroid disorder with gender distribution, age distribution, HbA1C, duration of diabetes, hypertension, BMI, microvascular complication and dyslipidaemia was done. The observations and interpretations were recorded and results obtained were statistically analysed. Results: There was a high prevalence (20%) of thyroid disorders in patients of type 2 diabetes mellitus. Most common was subclinical hypothyroidism (11.66%) which was further found to be more in females, in middle to elderly patients, less than 5 years duration and patients with normal BMI. Conclusion: Screening for thyroid disorders should be done in all diabetic patients. Treatment of thyroid disorder in diabetics may be beneficial for their glycemic control and prevention of progression of microvascular complication.

A Study of Clinical, Biochemical Profile and Risk Factor of Patients with Chronic Hepatitis C Virus Infection in Tertiary Care Centre in Kumaun, Uttarakhand

Chronic Hepatitis C virus (HCV) infection is a major public health problem. It is a major cause for cirrhosis and hepatocellular carcinoma worldwide. HCV infection is recognized now days as a disease of global importance. It is considered a major health and economic burden in adults as well as children in both developing and developed countries. Objectives: To study the Clinical presentation, biochemical profile and risk factor of chronic hepatitis C virus infected patients. Methods: This prospective observational study was carried out in the Department of Medicine at STH, Haldwani, from August 2016 to July 2018.During these study period 110 patients with Chronic HCV infection were analyzed. Results: Out of 110 patients 60 (54.54%) were male and 50(45.45%) were female. Injection drug use (IDU) was the most common risk factor of HCV infection (20.90%). The abdominal discomfort symptoms seen in majority of patients (70%) followed by a fatigue (62.72%).and fever (60.90%). Males exhibiting more symptoms in comparison to females. Conclusion: Viral hepatitis is an important heath care problem in India as it occurs epidemically and sporadically. The variability in nature of the disease regarding its onset, presenting symptoms, clinical course and development of complications are important aspects. So, it is very essential for health care professionals to be aware of all aspects of it so that it is detected and treated early.

Platelet-Rich Plasma (PRP) Therapy in Dermatology

Platelets present in the human blood produces a wide range of hormones. The activated forms of platelets are actively motile and their motility is clearly shown by the author in a video recorded through a simple microscope and uploaded in YouTube (Moving platelets & PRP_Dr Lokendra Yumnam at www.youtube.com/watch?v=du4nav0Fvy). The platelet-rich plasma can be prepared easily at any side-laboratory attached to the Dermatology OPD. The same may be used in treatment of many skin conditions previously thought to be very difficult to be treated. The author presents results of administering one PRP therapy in patients with androgenic alopecia, disfiguring lesions on face, recalcitrant ulcers including ulcers in leprosy patients, lichen sclerosus, vitiligo and also enhancing skin-graft uptake in scars. The results of PRP therapy in many refractory skin conditions are promising. More researches need to be taken up in this form of magical therapy. This may open up new avenues in the successful treatment of many skin conditions which are hitherto considered to be non-treatable.

Nose and Paranasal Sinuses: Profile of Fungal Infections

Background: Fungal infections of the nose and paranasal sinuses present with a spectrum of clinical manifestations which is mainly determined by the complex interplay of the pathogenicity of the fungus and the host immune system. In India, most of the fungal infections of the nose and paranasal infections are reported from the southern states although high incidences of paranasal sinusitis are also reported from other states of the country. Data regarding the above from the north-eastern part of the country is hardly available. Hence, it was felt important to make an effort to recognize and detect the presence of fungal infection in this part of the country. Aims & objectives: The present study was conducted to find out the incidence of fungal infections of the nose and PNS among all patients having allergic or infective disorders, to study the various risk factors associated with it, to study the clinical profile of the patients and also to assess the prognosis after treatment. Methods: A prospective study was taken up during the period Feb 2003-Oct 2004 in the Otorhinolaryngology Department of the Regional Institute of Medical Sciences (RIMS), Imphal, Manipur. All the patients attending the OPD and IPD of the department because of chronic allergic and infective disorders were the study subjects. Detailed information on socio-demography and clinical history were collected by using a semi-open interview schedule. Next, a thorough physical examination and examination of the ear, nose and throat were done. Appropriate routine investigations and a thorough fungal study were performed using representative specimens in collaboration with the Department of Microbiology of the same institute. Results: The fungal infection rate was found to be 4.61% (M=4.84% and F=4.21%). This rate went up as high as 17.85% among immuno-compromised patients. The main fungal species identified were Candida (53%) and A. niger (27%). Mucor and Fusarium species were also found. Among the immuno-compromised patients Candida was the commonest species found (93%) whereas among the immune-competent patients A. niger was predominantly found (47%). Nasal obstruction, congested nasal mucosa, epistaxis, nasal discharge and maxillary sinus tenderness were the common clinical findings. Depending on the case-wise merits three-fifths of the cases were given surgical treatment whereas the remaining two-fifths were treated conservatively with medications only. All the cases were either cured or showed improvement. Conclusion: Fungal infection of the nose and PNS in this part of the country was found in 4.61% of patients with chronic allergic and/or infective disorders of the nose and PNS. The common fungi infecting were Candida, A. niger, Mucor and Fusarium. The fungal infection rate was almost six-times increased in immune-compromised patients compared to normal patients. A. niger was predominantly associated with immune-compromised status.

A Microbiological Study of Nasal Packs

Background: Nasal packing is the commonest mode of achieving haemostasis for nasal bleeds. The packs are usually removed after 24 hours but sometimes they have to be kept for two-three days. Out of all the materials used for the purpose, the conventional packing using cotton tape remains the commonest and the easiest. One of the commonest complications of nasal packing is infection. The present study was done to work out the bacterial flora of anterior and posterior nasal packs with different types of antibiotics-soaked packs, duration of pack and type of nasal packing. Further the study aimed to find out the effectiveness of drugs used in nasal packing. Methods: A prospective study was taken up in the Department of Otolaryngorhinology, JNIMS, Imphal, Manipur in which all the patients who attended the OPD or got admitted in the IPD of the otolaryngorhinology department during the period Nov 2012 to Oct 2014 were the study subjects. All nasal packs irrespective of site, disease or duration of usage from these patients were collected with due precaution to avoid contamination during removal. Then the middle part of the pack was cut and collected in sterile bottle under total asepsis. These packs were immediately transported to the Department of Microbiology, JNIMS for full bacteriological examination and sensitivity testing. Results: Out of a total of 120 nasal packs investigated, 98 packs (81.7%) showed bacterial growth. Packs removed after 72 hours showed 100% growth of organisms whereas packs removed within 48-72 hours, within 24-48 hours and packs removed within 24 hours of use respectively showed 92.9%, 59.1% and 76% growth of organisms. Pseudomonas aeruginosa was the most predominant one (41; 34.2%) followed by Staphylococcus aureus (37; 30.8%) and Klebsiella pneumonia (4; 3.3%) in the packs having single infections. Pseudomonas and Klebsiella co-infection was the commonest among packs with mixed infections. Plain gauze and Abgel packs showed 100% growth of micro-organisms which was followed by Betadin (95.6%), Neosporin (94.4%), Soframycin (60.4%). Liquid paraffin-soaked packs did not show any growth. The in-vitro chemo-sensitivity testing showed that almost all the different types of bacteriae isolated were sensitive to Garamycin (85.7%-100%). Cloramphenicol sensitivity was 79% for Pseudomonas, 60% for Staphylococcus and 21% for Klebsiella infection. Other antibiotics gave not so encouraging results especially in Proteus infection. Conclusion: Only a small proportion of nasal packs (18%) remain sterile after use, the chance of culture positivity being higher for posterior nasal packs compared to anterior ones and also depending upon to the duration of use, all packs after 72 hours of use becoming invariably positive. Medication of the packs with antibiotics or antiseptics does not help much in preventing micro-organism growths. Pseudomonas aeruginosa and Staphylococcus aureus are the leading causes of infection. Gentamycin/Garamycin is emerging as the most sensitive antibiotic against the culprit organisms. Drugs which were previously effective against microbes are now only partially sensitive or not effective at all. It is important to caution clinicians and microbiologists to keep a close watch on the sensitivity pattern of the organisms.

A Study of Thyroid Dysfunction in Diabetes Mellitus

Background: The prevalence of thyroid dysfunctions is encountered high in known diabetic patients. It is quiet commonly understood that patients who has one autoimmune problem generally tends to develop another. Materials and methods: Three hundred twenty known diabetic patients who attended the Department of Internal Medicine were taken up for the study. This study was done in the Department of Internal Medicine, Deccan Medical College, Hyderabad. Results: Both hypothyroidism and hyperthyroidism was significantly seen in known diabetics. Conclusion: Hypothyroidism was the most common kind of thyroid disorder encountered in our study.

Mayer-Rokitansky-Kuster-Hauser Type I Syndrome - A Case Report.

Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome is not uncommon as this is a part of the Mullerian agenesis. This is usually diagnosed during adolescent period when signs and symptoms of the ongoing changes in female body type are delayed. We present 17 years old adolescent female who presented with primary amenorrhoea as the normal menstruation did not start at puberty. She was diagnosed as MRKH Type I Syndrome on the basis of radiological investigations.

Radiological diagnosis of Cysticercosis of Breast - An unusual presentation.

Breast cysticercosis manifestation is usually uncommon and only a few cases have been reported in the literature. This manifests in the form of signs and symptoms which normally do not point towards the diagnosis. The radiological modalities always narrow down the gap between the complaints and the diagnosis. We present a case with cysticercus cysts in breast parenchyma as well as in both pectoral muscles which was suspected on ultrasonography (USG) and diagnosed on Magnetic Resonance Imaging (MRI). The patient responded to the medical treatment conservatively thus avoiding excisional biopsy. Follow up and repeat MRI has confirmed the cure of the complaints as well as the disease.

Reliable screening technique for evaluation of wild crucifers against mustard aphid Lipaphis erysimi (Kalt.).

Wild crucifers namely Arabidopsis thaliana, Brassica fruticulosa, B. rugosa, B. spinescens, B. tournefortii, Camelina sativa, Capsella bursa-pastoris, Crambe abysinnica, Cronopus didymus, Diplotaxis assurgens, D. gomez-campoi, D. muralis, D. siettiana, D. tenuisiliqua, Enatharocarpus lyratus, Lepidium sativum and Sinapis alba along with five cultivated Brassica species including B. rapa (BSH-1), B. juncea (Rohini), B. napus (GSC-6), B. carinata (DLSC-2) and Eruca sativa (T-27) were screened against mustard aphid Lipaphis erysimi (Kalt.) with a standardized technique under definite level of aphid pressure developed using specially designed cages. Observations have revealed that B. fruticulosa, B. spinescens, Camelina sativa, Crambe abysinnica and Lepidium sativum were resistant to mustard aphid L. erysimi with aphid infestation index (AII) ≤1. Capsella bursa-pastoris was highly susceptible to bean aphid, Aphis fabae during its vegetative stage (with 100% mortality). Other genotypes were found in the range of ‘susceptible’ to ‘highly susceptible’ with AII ranging 3-5.

Limnology and cyanobacterial diversity of high altitude lakes of Lahaul-Spiti in Himachal Pradesh, India.

Limnological data of four high altitude lakes from the cold desert region of Himachal Pradesh, India, has been correlated with cyanobacterial diversity. Physico-chemical characteristics and nutrient contents of the studied lakes revealed that Sissu Lake is mesotrophic while Chandra Tal, Suraj Tal and Deepak Tal are ultra-oligotrophic. Based on morphology and 16S rRNA gene sequence, a total of 20 cyanobacterial species belonging to 11 genera were identified. Canonical correspondence analysis distinguished three groups of species with respect to their occurrence and nutrient/physical environment demand. The first group, which included Nostoc linckia, N. punctiforme, Nodularia sphaerocarpa, Geitlerinema acutissimum, Limnothrix redekii, Planktothrix agardhii and Plank. clathrata, was characteristic of water with high nutrient content and high temperature. The second group, including Gloeocapsopsis pleurocapsoides, Leptolyngbya antarctica, L. frigida, Pseudanabaena frigida and N. spongiaeforme, occurred in oligotrophic water with high pH and low temperature. The distribution of third group of Cyanobium parvum, Synechocystis pevalekii, L. benthonica, L. foveolarum, L. lurida, L. valderiana, Phormidium autumnale and P. chalybeum could not be associated with a particular environmental condition because of their presence in all sampling sites. [Singh Y, Khattar JIS

Seroprevalence Of Hepatitis B Virus In Patients Admitted To Era’S Lucknow Medical College And Hospital

Hepatitis-B Virus infections are a serious global and public health problem. To assess the magnitude and dynamics of disease transmission and for its prevention and control, the study of its seroprevalence is important. A medical college catering to the needs of a large population represents an important centre for serological surveys. Available data, on the seroprevalence of these bloodborne pathogens is also very limited. A study was undertaken to estimate the seroprevalence of Hepatitis-B Surface Antigen (HBsAg) in both the sexes and different age groups in a hospital-based population. Serum samples collected over a period of 24 months from patients admitted to various IPDs of Era’s Lucknow Medical College and Hospital, Lucknow were subjected within the hospital-based microbiology lab for the detection of HBsAg using ELISA test. The seroprevalence of HBsAg was found to be 1.92%. The study throws light on the magnitude of viral transmission in the community in Lucknow city and provides a reference for future studies.

Accuracy of triple test score in the diagnosis of palpable breast lump.

Breast lump is a very sensitive issue for the patient so a reliable, non invasive and prompt diagnosis helps to lessen the associated anxiety and leads to early definitive treatment. The aim of this study was to evaluate the accuracy of Triple Test Score (TTS) as a clinical tool for the diagnosis of a palpable breast lump. This diagnostic test study was carried out in the Department of Surgery of Tribhuvan University Teaching Hospital. Of the 117 patients admitted with breast diseases from the breast clinic over thirteen months, 87 had breast lump. Fifty patients underwent Triple Test Score ( physical examination, mammography and fine needle aspiration cytology) and were categorized into benign, suspicious and malignant. This was later correlated with the histopathological findings. Nineteen patients with breast lumps interpreted by TTS as benign correlated with the histopathological findings whereas of 31 malignant lumps, 30 turned out to be malignant and one benign. This gives TTS an over all accuracy of 98% with 100% sensitivity, 95.2% specificity and positive predictive value of 96.7%. Carcinoma was seen in 29 (58%) cases in the age group of 35 to 70 years. The mean age at diagnosis of benign and malignant disease was 41.8 and 45.1 years respectively. In conclusion, TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.

Mammographic diagnosis of breast carcinoma: an institutional experience.

Mammogram is a common diagnostic modality for breast carcinoma. Diagnostic mammogram is available at only few centers in Nepal. The aim of this study was to determine the accuracy of diagnostic mammogram in Nepalese women suffering from breast carcinoma. A retrospective analysis of the breast carcinoma was carried out in the Department of Surgery, Tribhuwan University Teaching Hospital from October 1995 to October 2007. Out of 556 patients with histologically proven breast carcinoma, 378 patients (68%) had undergone mammography. Breast carcinoma was identified on mammography in 328 (87%) cases while 50 cases (13%) were reported as normal or benign lesions. Diagnostic mammogram had a sensitivity of 86.8%, a specificity of 98.6% with a positive predictive value of 68.8% and a negative predictive value of 99.5%. In mammographically missed breast carcinoma, 34% were less than 40 years of age (P<0.05), 60% were premenopausal (P<0.05) and 88% patients presented with a painless lump. The study shows that the diagnostic accuracy of the mammogram is very high. However, there is a chance of missing the breast carcinoma in young and premenopausal women.

Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) in a Tertiary-Care Hospital in Eastern Nepal.

Nosocomial infection is a major problem in the world today. Methicillin-resistant Staphylococcus aureus (MRSA) strains, usually resistant to several antibiotics, shows a particular ability to spread in hospitals and is now present in most of the countries. The aim of the present study was to determine the prevalence of MRSA infections and their antimicrobial susceptibility pattern in our hospital located in eastern Nepal. Identification of Staphylococcus aureus was confirmed by standard methods and the antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. Interpretation criteria were those of the national committee for clinical laboratory standards. During a period of one year, out of a total of 750 Staphylococcus aureus strains isolated from various clinical samples, 196 (26.14%) were found to be Methicillin-resistant. Seventy percent isolates of MRSA were from inpatient departments and amongst them only 10% of the isolates were from intensive care units (ICU). More than 65% of MRSA were found to be resistant to Penicillin, Cephalosporins, Ciprofloxacin, Gentamicin Erythromycin and Tetracycline, while 47.96% of them were resistant to Amikacin. Many MRSA strains were multidrug-resistant. However, no strains were resistant to Vancomycin. To reduce the prevalence of MRSA, the regular surveillance of hospital acquired infection, isolation nursing of patients who carry MRSA, monitoring of antimicrobial susceptibility pattern and formulation of a definite antibiotic policy may be helpful.