Acute respiratory distress syndrome in Plasmodium vivax malaria. A case-control study of comparison between ARDS and non-ARDS patients in P. Vivax malaria

Background: Plasmodium vivax was conventionally considered to be a benign parasite for centuries but in the recent years have proved to be a virulent parasite causing severe malaria. Acute respiratory distress syndrome (ARDS) is one of such severe complications with a significant morbidity and mortality. The objective of this study was to find the prevalence of ARDS and identify the associated factors that could potentially lead to ARDS in patients with vivax malaria. Methods: A retrospective case-control study was conducted at a tertiary hospital in New Delhi. 329 patients with an established diagnosis of Plasmodium vivax mono-infection were identified using hospital medical records, the associated factors were evaluated and compared to calculate the odds of developing ARDS. All patients were categorized into ARDS cases and non-ARDS controls. Results: The incidence of ARDS was 7% with a female sex predominance (60.86%). Mean urea (71.5 mg/dl), creatinine (2.7 mg/dl), and AST (97.8 units/l) elevation in addition to decreased hemoglobin (7.7 gm/dl) and platelets count (38,217 cells/µl) proved to be significantly associated with ARDS in our study. Conclusions: Plasmodium vivax is a virulent parasite and can cause severe malaria even in the setting of isolated infection. Cytokine mediated diffuse inflammatory response is a postulated pathophysiology causing ARDS.

Clinico-epidemiological study of safe and unsafe chronic suppurative otitis media

Introduction: Chronic Suppurative Otitis Media (CSOM) remains one of the most commonest chronic infectious diseases worldwide particularly in children and adolescents. India has been classified as the high prevalence country with national prevalence of 4%. Knowledge of differential regional prevalence of risk factors is required for adequate health education of masses and for customised preventive and control measures in respective areas. Aims: To study the clinical and sociodemographic profile of patients with CSOM. Methods: The study was carried out in the department of Otorhinolaryngology, Jawaharlal Nehru Medical College, AMU, Aligarh from November, 2017 to December, 2019. Patients with CSOM attending the otorhinolaryngology OPD and those admitted in IPD were included in the study. Results: A total 200 cases of chronic suppurative otitis media including both safe (mucosal) and unsafe (squamous) type were studied. The mean age of participants was 22.8 ± 15.18 years. Of the total participants, 111 (55.5%, 95% CI 48.6 to 62.2) were males, 89 (44.5%, 95% CI 37.8 to 51.4) were females and the majority (60.5%, 95% CI 53.6 to 67) of them were from rural background. Around onefourth of the patients were illiterate (23%, 95% CI 17.7 to 29.3) and the patients mostly belonged to lower side (lower middle, upper lower and lower) of the spectrum of Kuppuswamy socioeconomic classification. The distribution of age-group, gender and laterality (side of involvement) was similar (P>0.05) in both safe and unsafe type. Overall, 151(75.5%, 95% CI 69.9 to 80.9) patients were found to have conductive hearing loss, 30 (15%, 95% CI 10.7 to 20.6) with mixed and 19 (9.5%, 95% CI 6.2 to 14.4) did not have any hearing loss at presentation. The distribution of patients with regards to hearing loss was found to be similar in both safe and unsafe groups (P = 0.311). Conclusion: CSOM particularly afflicts younger age populations from rural background with poor socioeconomic status. Appropriate timely interventions in the form of health promotion, education about the risk factors and improvement in the living conditions will result in decrease in incidence and prevalence of the disease. Moreover, knowledge of symptoms and signs of the disease is likely to result in early seeking of healthcare and hence better treatment outcomes and prevention of complications.

A Statistical Analysis and Comparison of the spread of Swine Flu and COVID-19 in India

@#Introduction: The world is currently experiencing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [COVID-19], however, this is not a new phenomenon; it occurred in 2009-2010 in the form of novel influenza A. (H1N1). The H1N1 virus primarily afflicted people between the ages of 26 and 50, but SARS-CoV-2 primarily afflicted those over the age of 60, increasing the number of deaths owing to their weakened immunity. The report provides a case study of the impact of H1N1 and SARS-CoV-2 in India. Methods: Data is obtained from The Hindustan Times newspaper, GoI press releases and World Health Organization (WHO) reports. Results: The incidence rate was initially low and it was only by the 10-15th week that it started increasing. There is an initial upward trend before levelling out followed by a second wave and third wave. COVID-19 exhibited a steeper growth, where the steps taken by the Government were ineffective leading to higher death cases. Kerala was affected due to the travellers returning from the Middle East, while Maharashtra and Delhi saw large incidence rates due to the migrant influx and communal gathering. Conclusion: The most effective and practical approach is to test the symptomatic patients and aggressive testing to contain the transmission. Awareness campaigns to educate the public about social distancing and personal hygiene is more practical. There is still scope of improvement with regards to the public health care support, preparedness and response. Lockdown measures could have been avoided if the initial screening was conducted properly.

Audit of 1000 consecutive cases of sutureless cataract surgery in children above two years of age

Purpose: To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods: It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results: Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion: Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.

Comparative study of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss

Background: To compare the role of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss and assess the effectiveness of low dose aspirin and low molecular weight heparin in having a better obstetric outcome.Methods: This study was conducted in a private hospital in Mahabubnagar from June 2017 to May 2019. A total of 80 pregnant ladies who had previous 2 and or more pregnancy losses in the early (before 20 weeks) or late (after 20 weeks) pregnancy period was included in the study. 80 pregnant women with idiopathic/unexplained recurrent pregnancy loss were properly evaluated in regard to the history of previous period of gestation of loss, previous scans in regard to documentation of fetal pole and gestation, cardiac activity, anomaly scan and growth scan and any special investigations in previous pregnancies and present pregnancy.Results: A total 80 pregnant women with previous 2 and more unexplained pregnancy losses who were evaluated and found negative with major causes of pregnancy losses half of them (40) were treated with low dose aspirin alone and the other 40 women were treated with a combination of low dose aspirin (75 mg) and low molecular weight Heparin (20 mg) daily low molecular weight heparin till term. The aspirin alone group had 82.5% live birth rate and the combination group had 92.5% live birth rate which is quite satisfactory and more than the Aspirin alone group.Conclusions: Use of combination of low dose aspirin and low molecular weight heparin seems to be a good choice of drugs in treating the unexplained recurrent pregnancy losses than low dose aspirin alone.

Burden of care perceived by the principal caregivers of autistic children and adolescents visiting health facilities in Lucknow City

Background: Autism is extraordinarily difficult for families to cope with for various reasons. Perceived burden and care for the child with autism, available forms of social support, and the interactions between the autistic child and other family members are areas of significant concern for families. Objective: The objective of this study was to determine the burden of care perceived by the principal caregivers of autistic children or adolescent visiting health facilities in Lucknow city. Methods: The cross-sectional study was conducted from October 2016 to September 2017 with a sample of 90 principal caregivers (aged <60 years) of autistic children and adolescents aged 3–19 years and diagnosed with autism, attending government and private health facilities providing treatment for autism in Lucknow, Uttar Pradesh, India. Validated tools were used to assess the burden of care and disability level of autistic children. Data were analyzed using the software SPSS version 16. Results: The caregivers of autistic children and adolescents perceived the burden of care in different domains in varying extent with “caregiver's routine” and “taking responsibility” domains affected the most. The burden perceived was found to be affected by the permanent residence of caregiver, rural/urban dwelling, type of family, socioeconomic status, age at which diagnosis was made, knowledge about autism and the severity of autism. Conclusions: Availability and easy accessibility of autism treatment facilities must be the most probable reason for less burden perceived in three domains, by caregivers of urban settings and those belonging to Lucknow. Furthermore, better knowledge on autism and family and friends' support led to decrease in the burden perceived by the caregivers in various domains. Thus, it was found that the burden perceived can be reduced by universal availability of evidence-based early diagnosis and treatment of autism and improving the knowledge of caregivers about autism.

Kilovoltage cone-beam computed tomography imaging dose estimation and optimization: Need of daily cone-beam computed tomography

Aim: The aim of the present study was to access the need of daily cone-beam computed tomography (CBCT) and the requirement of in-house protocols of image acquisition frequency to reduce unnecessary exposure to the patients undergoing radiotherapy treatment. Materials and Methods: The dose delivered during CBCT procedure (On-Board Imager, Trilogy, Varian medical system, Inc., Palo Alto, California) was assessed for pelvic and head and neck region. For dose estimation, cylindrical polymethyl methacrylate phantoms of 15 cm length, 16 cm, and 32 cm diameter were used to simulate the patient's head and neck and pelvic region thickness, respectively. More than 10 cm scatterer was added on either end of this phantom. Calibrated Ionization chamber DCT10 LEMO SN 1685 iba, dosimetry, Germany (10 cm active length) was used to measure the dose Index. The doses known as cone-beam dose index (CBDI100) were estimated for all the scanning protocols (kV and mAs setting) available on the machine. In this study, image acquisition frequency to correct the setup error was optimized. In-house protocol for image acquisition frequency during treatment has been suggested to reduce the dose. It was based on the principle of as low as reasonable achievable. Results: Optimized dose protocol observed was the “standard dose head” for which the CBDI100 was 2.43 mGy. Whereas for pelvic imaging, single protocol of 125 kV, 80 mA was available by which a dose of 7.61 mGy is likely to be received by the patient during scan. Maximum shift of 6 mm in lateral direction was observed to the patient of Pelvis region and 5 mm was observed in the longitudinal direction for the H and N patients. Angular shift measured in patient position was 3.8° and 3.1° for H and N and pelvic region, respectively. Conclusion: Three consecutive-day CBCT-imaging at the beginning of the treatment followed by once weekly CBCT and two-dimensional (2D) imaging in remaining days of treatment can be an optimized way of imaging for the patient having malignancy in the region of pelvic and abdomen. For H and N, once in a week, CBCT with standard dose head protocol, followed by 2D-imaging in remaining days can be an optimized way of imaging.

Management protocols for chronic heart failure in India

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

Liver function test as a marker for acute appendicitis

Background and Objectives: Acute appendicitis is one of the commonest surgical emergencies of the abdomen worldwide. Even with the availability of current imaging investigation like USG , CT scan and MRI, the diagnosis is still a problem. Delay in diagnosis increases mortality and morbidity. Liver function test is one of the biochemical parameters being assessed as a marker of acute appendicitis and may also predict the severity of the inflammation. However the available literature is limited and views are conflicting. In this study, it is proposed to access the validity of using liver function test to predict the appendicitis and its severity.Material and Methods: This is a prospective study of 80 cases of operated patients of acute appendicitis in Universal College Of Medical Sciences, Bhairahawa, Nepal during the period from 6th May 2013 to 6th July 2014. Data were collected from the patient by their clinical history, examination and investigations, Liver function test and ultrasound. Post operative follow up was done to note for complications and histopathology findings. Data collection was compiled in a systemic way in preformed proforma and analyzed.Results: Out of 80 patients, 44(55%) were male and 36(45%) were female. Total serum bilirubin was elevated in 29 (36.25%) of the patients. Rise in serum bilirubin was mixed type with direct bilirubin Predominance. In Liver enzymes ALT, AST, ALP were raised in 32.5%, 28.75% and 82.5% respectively. Hyperbilirubinemia has the specificity (80 %) sensitivity (37.33%) with good positive predictive value of 96.55%. Similarly sensitivity and specificity of direct bilirubin (90.67%, 20.00%), Indirect bilirubin (16.00%, 80%), AST/SGOT (30.67%, 100%), ALT/SGPT (34.67%, 100%) ALP (84.00%, 40%) respectively. The positive predictive value for direct bilirubin, indirect bilirubin, AST/SGOT, ALT/SGPT and ALP are 94.44%,92.31%,100%,100% and 95.45% respectively.Conclusion: Liver function test is a marker for acute appendicitis and its complication with a good positive predictive value. Liver function test should be used together with clinical examination and other laboratory investigations in the assessment of patients with suspected acute Appendicitis.

Evaluation of salivary glucose, amylase, and total protein in Type 2 diabetes mellitus patients.

Background: Diabetes mellitus is a complex multisystem metabolic disorder characterized by a deficit in the production of insulin. The oral complications of uncontrolled diabetes mellitus are devastating. Saliva is an organic fluid that can be collected noninvasively and by individuals with limited training. These reasons create an interest in evaluating the possibility of using saliva as a diagnostic tool. Aims and Objectives: The aim of this study was to determine, if saliva can be used as a noninvasive tool to monitor glycemic control in Type 2 diabetes. Comparative assessment of salivary (glucose, amylase, total protein levels) in patients with Type 2 diabetes and controls. Materials and Methods: A total of 40 individuals, 20 with Type 2 diabetes and 20 controls of age group 40–60 years were selected for the study. Diabetic status was assessed by estimating random blood glucose levels. Unstimulated saliva was collected from each participant and investigated for glucose, amylase, and total protein levels. Salivary glucose estimation was performed using glucose‑oxidase method, amylase by the direct substrate kinetic enzymatic method, and total protein by pyrogallol red dye end point method. All the parameters were subjected to statistical analysis using SPSS version 20.0. Results: Significantly higher salivary glucose, lower amylase, and total proteins were observed in patients with Type 2 diabetes than controls. There was no significant correlation between salivary and blood glucose levels. Conclusion: These results suggest that diabetes influences the composition of saliva. Since a significant correlation was not observed between salivary and blood glucose levels, further research is needed to determine salivary glucose estimation as a diagnostic tool for diabetes mellitus.

Chylous Ascites Due to Tuberculosis: A Case Report and Review of Literature.

Chylous ascites (CA) is an uncommon clinical condition and occurs as a result of disruption of abdominal lymphatics either due to trauma or secondary to obstruction. We report a case of CA associated with disseminated tuberculosis.

Studies on mycorrhizal inoculation on dry matter yield and root colonization of some medicinal plants grown in stress and forest soils.

Five medicinal plants viz. Abelmoschatus moschatus Linn., Clitoria ternatea L., Plumbago zeylanica L., Psorolea corylifolia L. and Withania sominifera L. were grown in a polypot experiment in five soils representing coal mine soil, copper mine soil, fly ash, skeletal soil and forest soil with and without mycorrhizal inoculations in a completely randomized block design. Dry matter yield and mycorrhizal root colonization of plants varied both in uninoculated and inoculated conditions. The forest soil rendered highest dry matter due to higher yield of A. moschatus, P. zeylanica and P. corylifolia while fly ash showed lowest dry matter without any inoculants. P. cernatea were best in coal mine soil and W. sominifera in copper mine soil without mycorrhizal inoculation. The mycorrhiza was found to enhance the dry matter yield. This contributed minimum 0.19% to maximum up to 422.0% in different soils as compared to uninoculated plants. The mycorrhizal dependency was noticed maximum in plants grown in fly ash followed by coal mine soil, copper mine soil, skeletal soil and forest soil. The mycorrhizal response was increased maximum in W. sominifera due to survival in fly ash after inoculation followed by P. corylifolia and P. cernatea. Percent root colonization in inoculated plant was increased minimum of 1.10 fold to maximum of 12.0 folds in comparison to un-inoculated plants .The native mycorrhiza fungi were also observed to colonize 4.0 to 32.0% roots in plants under study. This study suggests that mycorrhizal inoculation increased the dry matter yield of medicinal plants in all soils under study. It also helps in survival of W. sominifera in fly ash.

Angioplasty of degenerated saphenous vein grafts--role of covered stents.

To study the safety and efficacy of covered stents in angioplasty of saphenous vein grafts a retrospective study was carried out among 12 consecutive cases admitted at the cardiology unit of Nizam's Institute of Medical Sciences during last 3 years. Angioplasty of saphenous vein grafts is a challenging task due to the different nature of the disease in vein grafts compared to the native coronary arteries. The lesions in vein grafts are more often diffuse and have considerable loose atherothrombotic material that is prone for distal embolisation, resulting in slow flow/no reflow and myocardial damage. Use of covered stents for saphenous vein grafts appears to be feasible and safe.

Antiviral profile of Nyctanthes arbortristis L. against encephalitis causing viruses.

The ethanolic extracts, various fractions and two pure compounds isolated from the plant N. arbortris were tested against Encephalomyocarditis Virus (EMCV) and Semliki Forest Virus (SFV). Pronounced in vitro virus inhibitory activity was observed with the ethanolic and n-butanol fractions as well as with the pure compounds arbortristoside A and arbortristoside C. In addition, ethanolic extracts and n-butanol fraction protected EMCV infected mice to the extent of 40 and 60% respectively against SFV at a daily dose of 125 mg/kg body weight.

Heavy metals in water of the rivers Hooghly and Haldi at Haldia and their impact on fish.

The paper deals with the measurement of five heavy metals viz., Cd, Cu, Mn, Pb and Zn in water of the rivers Hooghly and Haldi at Haldia during June 1999 to October 2002. The industrial effluent out fall (OF) at Patikhali, Haldia was also taken as sampling site along with above out fall (AOF) and below out fall (BOF) sites. Most of the metals exhibited their least concentration at the sampling site above the Haldia industrial area of river Hooghly. The average concentrations of the studied metals were Cd 2-14, Cu 5-19, Mn 8-88, Pb 17-41 and Zn 22-37 microg l(-1). Comparison of the data with the Criterion Continuous Concentration (CCC) of USA revealed that Cd, Cu and Pb were the pollutants present at alarming level to disturb the aquatic life process in the zone. The effect was found to reflect on the tissue level aberrations in the residential fishes. The other two metals viz., Mn and Zn were probably less harmful to the aquatic ecosystem. In India, necessity is felt to develop the CCC values, which will be more appropriate for protection of aquatic environment than comparing with drinking water standards.

Prehospital delay in patients hospitalized with acute myocardial infarction in the emergency unit of a North Indian tertiary care hospital.

BACKGROUND: Prompt treatment of patients presenting with acute myocardial infarction decreases the incidence of death from early arrhythmia, and maximizes the potential benefit of thrombolytic therapy. Prehospital delay has been identified as a major obstacle to the widespread use of thrombolytic therapy. The aim of the present study was to examine the extent of, and factors associated with, delay in seeking medical care (usually thrombolytic therapy) in patients with acute myocardial infarction. METHODS AND RESULTS: The study was conducted in patients visiting the medical emergency unit of the Nehru Hospital, Post Graduate Institute of Medical Education and Research, Chandigarh. A total of 104 patients diagnosed with acute myocardial infarction were interviewed using a pre-designed proforma. Pain-to-door, and door-to-drug times, were the main outcome measures. The corrected mean (SEM) and median (range) pain-to-door times were 8.5 (0.8) hours and 5.2 (0.5-24) hours, respectively. Out of 104 patients, 38 did not receive thrombolytic therapy. In those who did not receive thrombolytic therapy, prior therapy at local health centers, lack of knowledge of symptoms, and transportation problems were the main reasons for hospital delay. The mean (SEM) and median (range) of door-to-drug times were 1.2 (0.1) hours and 1 (0.2-3.5) hours, respectively.

Vesicoureteric reflux and reflux nephropathy.

Reflux nephropathy i.e. renal scarring associated with vesico-ureteric reflux (VUR) and urinary tract infection (UTI) was originally considered an acquired disease. The renal scarring seems to get worse with recurrent urine infections especially in the young. Therefore, in the past much effort was undertaken to correct the VUR surgically and minimize the number of recurrent urinary tract infections by antibiotic prophylaxis with the hope of reducing if not arresting the onset of complications that follow i.e. hypertension and renal failure. However, it is now becoming clear that reflux nephropathy encompass at least two major categories of disease; "acquired" renal scarring secondary to UTI and VUR predominantly affecting females and "congenital" scarring with dysplastic features associated with prenatal VUR but with no infection and predominantly affecting boys. The latter is much less common but is disproportionately represented in the group of patients with reflux nephropathy that go on to develop renal failure. Unfortunately, the susceptibility to renal scarring, the onset of hypertension and progression to renal failure seems to be significantly influenced by genetic factors and hence measures undertaken to prevent recurrence of UTI may not change the ultimate outcome although it will certainly improve the comfort of the individual. Therefore, the extensive investigation and management routines adopted today in these children may not be cost-effective in preventing end stage renal disease in VUR. The progression to renal failure, however, can be delayed but not halted with adequate control of high blood pressure and hence the need for life long follow-up.

Elective coronary artery stenting--immediate and follow up results.

Elective coronary artery stenting was performed in 242 consecutive patients in our centre for complex lesions (Type B, C), proximal lesions, restenotic lesions, total occlusion and venous grafts. The procedural success rate was 94.21%. Three patients (1.23%) required emergency coronary artery bypass surgery. Acute and sub-acute thrombosis rate was 1.26% and 4.13%, respectively. There was one in-hospital death (0.41%). 164 patients were followed up clinically for a mean period of 11 +/- 6 months (range 1 month to 30 months). Angiographic follow up was done in 68 patients with a restenosis rate of 16.17%.