Study of growth differentiation factor-15 in polytransfused children with ?-thalassemia

Background: Ineffective erythropoiesis is a predominant feature in ?-thalassemia major (?-TM), causing marked erythroid expansion leading to highly raised levels of growth differentiation factor-15 (GDF-15), which, in turn, suppresses hepcidin production in liver resulting in increased iron absorption from gut. We aim to study the serum GDF-15 in polytransfused ?-TM patients and its correlation with serum ferritin and serum hepcidin. Method: Thirty-nine polytransfused ?-TM children aged between 5 and 17 years and 33 age- and gender-matched healthy controls were enrolled in the study. Complete blood count, serum GDF-15, serum ferritin, and serum hepcidin were performed. Results: The mean serum GDF-15, serum hepcidin, and serum ferritin levels were 638.65 ± 306.96 pg/ml, 108.21 ± 191.30 ng/ml, and 2274.60 ± 1216.08 ng/ml, respectively, which were significantly higher than control group (P < 0.001, P = 0.003, P < 0.001, respectively). There was significant positive correlation of GDF-15 with blood transfusions (r = 0.415, P = 0.009), positive correlation with serum ferritin (r = 0.653, P = 0), and significant negative correlation with serum hepcidin (r = ?0.508, P = 0.001). Conclusion: The findings of the present study suggest that GDF-15 is an important regulator of hepcidin in ?-TM patients. GDF-15 and serum hepcidin together can be used to monitor iron overload and its related complications in such patients.

Knowledge and attitude of peripheral health workers regarding Non-Communicable diseases in a Rural area of Rajasthan

Background: Mortality due to Non communicable disease (NCD) has increased from 50% to 60% in India from 2004 to 2014. Increasing mortality due to NCD has compelled Government of India to launch a national program (NPCDCS). This program has involved peripheral health workers hence this study was conducted to assess level of knowledge and attitude of peripheral health workers working in rural area of CHC Naila regarding NCDs. Methods: Present study was conducted at CHC Naila, Rajasthan, during June to Dec 2019. All (38) peripheral health staff working under CHC Naila were assessed and categorised regarding NCD and NPCDCS program. Results: Majority (77%) peripheral health workers had more than ten years of field experience. All have heard about NPCDCS program and type of NCDs covered under it. they were aware of sign & symptoms of common NCDs, however 18.42% of these were not aware of their role of community awareness about risk factors of NCDs and conducting regular screening. Conclusion: Though the level of awareness of health workers regarding type of NCDs, its consequences and risk factors was good however skill development training is needed so that they can screen people effectively and motivate them for healthy life style for optimum result.

A study of clinical and laboratory profile of dengue positive cases in hadoti region Rajasthan, India

 Background: Dengue fever is one of the most common arboviral mediated outbreaks reported with increased prevalence year after year with considerable morbidity and mortality in hadoti region. the aim to study various clinical and laboratory manifestations of Dengue fever admitted in MBS Hospital KOTA, with a diagnosis of Dengue fever according to WHO protocol from December 2018 to January 2020.Methods: Prospective observational study was undertaken among adult patients. 132 patients were studied and analysed. And diagnosis was confirmed with Dengue IgM ELISA test. Other routine investigations done were routine hematological and biochemical investigations.Results: A total of 132 cases, out of which 95 cases of Dengue Fever (DF), 34 cases of dengue hemorrhagic fever and 3 cases of Dengue Shock syndrome, out of which Male: Female ratio was 2.1. and mean age of presentation was 37. Fever and myalgia were the most common finding (100%) followed by arthralgia and headache. Pruritus was found in 21 cases (15.9%) which carried a significant difference between DF and DHF (p value <0.05). Among the laboratory features, thrombocytopenia and hematocrit were found to be statistically significant in DHF patients (p value <0.05). Mean platelet count was 0.71 lakhs/mm3. Leukopenia in 40(30.3%) cases. Raised Serum Aminotransferase level, AST (>40 IU/L) was seen in 39 cases (29.54%.). Pleural effusion was seen in 4 cases (3%), of which 3 cases of DHF and 1 case of DSS. Ascites in 6 cases (4.8%), all cases belong to DHF. Gall bladder wall thickening was seen in 28 cases (21.21%) of which 20 cases (54.04%) were of DHF. Melena was the most common bleeding manifestation. Skin rash was found to be positive in 40.5% cases. Hess test was positive in 4 cases (10.8% of DHF).Conclusions: Incidence of dengue fever is on the rise in hadoti region and one of the most important differential diagnosis of patients presenting with fever during monsoon and post monsoon seasons.

Evaluation of the sedative and anxiolytic effects of Midazolam and Clonidine as oral premedicant in paediatric patients undergoing elective surgery under general anaesthesia

Background: The preoperative period is stressful in the paediatric patients; oral premedications make the experience of anaesthesia and surgery more pleasant and less traumatic. Aim: To evaluate and compare the effects of midazolam and clonidine as oral premedicant for sedation, ease of parental separation, facemask acceptance at the time of induction of anesthesia, hemodynamic stability, postoperative recovery and complications. Materials and methods: Total fifty children of either gender belonging to ASA grade I and II between 2-8 years age scheduled for elective surgery under general anesthesia were randomly and equally divided in two groups, 25 patients in each. Group M received oral midazolam (0.5 mg/kg) and group C, oral clonidine (4 µg/kg) 90 minutes before induction of anesthesia. Drug acceptability score, sedation score and parental separation score at 60 minutes and 90 minutes after the test drug administration and facemask acceptance at the time of induction were recorded. Hemodynamic stability and postoperative recovery were also observed. Results: At 60 minutes after the test drug administration, the level of sedation and parental separation score were better in midazolam group while at 90 minutes, better in clonidine. Drug acceptability and Meena S, Bhati K, Meera. Evaluation of the sedative and anxiolytic effects of Midazolam and Clonidine as oral premedicant in paediatric patients undergoing elective surgery under general anaesthesia. IAIM, 2016; 3(5): 38-45. Page 39 quality of induction score, hemodynamic stability and postoperative recovery was better in clonidine group. Conclusion: We concluded that if we have proper time before induction, then oral clonidine is better sedative and anxiolytic drug, if not then oral midazolam is better sedative and anxiolytic drug in pediatric patients.

Epidemic of Scrub Typhus in Haroti Region of Rajasthan.

Scrub typhus is a rare form of disease caused by gram negative bacterium Orientia tsutsugamushi, of family Rickettsiaceae, transmitted by bite of infected trombiculid mite larva (chigger). The present prospective study is undertaken with the aim of the clinical manifestations, course, complications and outcome of scrub typhus in Haroti region of Rajasthan state during the recent epidemic. Method: This prospective study was conducted in indoor patients of MBS hospital and various private nursing homes in Kota city from August 2012 to November 2012. Twenty cases with positive Scrub typhus card test in the age group of 20 years to 60 years, comprising of 14 males and 06 females were included in the study group in clinically suspected cases with fever, rashes, cough with or without eschar and regional lymphadenopathy. Cases were studied in detail and followed up for improvement and any permanent damage or death. Results: Out of 20 patients, 16 patients improved and discharged from hospital in stable condition without any disability. 02 patients (10%) died because of late presentation and multiorgan involvement especially respiratory failure or meningoencephalitis. Conclusion: Haroti witnessed recent epidemic of Scrub typhus. Renal, respiratory and neurological complications were main cause of mortality and morbidity.

Aluminium Phosphide Poisoning.

Aluminium phosphide poisoning is a major cause of morbidity and mortality in northwest and central India. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. The mechanism of toxicity includes cellular hypoxia due to the effect on mitochondria, inhibition of cytochrome C oxidase and formation of highly reactive hydroxyl radicals. In India, most of the patients who come with Celphos poisoning succumb to its toxicity because of the considerable time gap between the ingestion of the poison and the initiation of proper treatment. This has led to widely prevalent scepticism among physicians while managing cases of Celphos poisoning. Due to no known specific antidote, management remains primarily supportive care. In most of the studies, poor prognostic factors were presence of acidosis and shock. The overall outcome improved in the last decade due to better and advanced intensive care management.

Impact on Morbidity & Mortality by Rodenticidal Poisoning.

Background : Rodenticidal poisoning is a very common clinical entity regularly encountered in outdoor & emergency department in various parts of India. This is the commonest type of poisoning. We present the prospective study of clinical profile, course, complication & outcome of various rodenticidal poisoning in 170 patients. Objectives : To determine the clinical symptoms, morbidity and mortality in various rodenticidal poisoning. To study the clinical profile & laboratory investigations. To study the course, complications & outcome. Methods : Study period was from 01 May 2011 to 30 April 2012. Historically and documented evidence of 170 patients of various rodenticidal poisoning admitted in the emergency, medical wards & I.C.U. under department of medicine, undergone for various laboratory investigations and imaging study. Statistical analysis was done in mean, range, standard deviation and percentage. Results : A total of 170 cases of various rodenticidal poisoning admitted in MBS hospital, Govt. Medical College, Kota were studied. The age of patients ranged from 10 to 65 years. Age groups were divided in four group, 10-18, 19-30, 31-45 & 45-65. Most common age group was ranged from 18-30 year. Most common gender was female (females 92 males 78). Mode of poisoning were suicidal, accidental & homicidal. Commonest mode of poisoning was suicidal uptake of poison. Route of poisoning was ingestion. Common presenting signs & symptoms were nausea & vomiting seen in 157(92.35%), Tachycardia in 156(91.7%), Tachypnoea in 137(80.62%), & Abdominal pain 129(75.8%). Few patients presented with Headache, Palpitation & Sweating. Deranged laboratory findings on day third of admission include Anemia in 21.76%, Leucocytosis in 20.59%, prolonged Prothrombin time (PT) in 16.47% & increased serum Bilirubin in 11.18%. Morbidity developed in 8 cases(4.71%), Of which four have Hemorrhagic complication ( e.g. Bleeding gums, Purpura Melena & Hematuria) by Dicoumarol , Bromadiolone and Brodifacoum. Three patients of Zinc phosphide poisoning produced cardiac insult and one patient of Barium carbonate poisoning developed cardiac arrhythmia. Transient arrhythmias and respiratory failure developed in other rodenticidal poisoning. All patients treated symptomatically and according to complications. Six cases of our study remained asymptomatic for two to three days then they developed delayed hemorrhagic complication ( Bleeding gums, Purpura, Melena & Hematuria). These patients had deranged liver function test (LFT) & prolonged Prothrombin time (PT). Mortality was seen in 1.76%( 3 cases). By Zinc phosphide in 2 patient and Barium carbonate in 1 patient. Conclusion : We concluded that bleeding, bruising & other hemorrhagic complications should be treated and monitored according to Prothrombin time (PT) & INR. Awareness should be increased especially for Zinc phosphide and arrhythmia produced by Barium carbonate.

Bone mineral density in children with steroid-sensitive nephrotic syndrome.

Objective. To observe the influence of prednisolone treatment on bone mineral density (BMD) in children with idiopathic nephrotic syndrome. Methods. Duel-energy X-ray absorptiometry of lumbar spine (L1-L4) was performed on 40 patients (18 first episode and 22 relapsers) of steroid sensitive idiopathic nephrotic syndrome. Results. Patients of first episode and relapsers had comparable values of mean age, weight, height, body mass index, serum calcium, phosphate, spine area, bone mineral content (BMC) and BMD. Relapsing nephrotic syndrome patients received significantly higher mean total cumulative dose of prednisolone in comparison to first episode (p<0.001). The BMD Z-scores were normal in 39 of 40 (97.5%) patients. On regression analysis, it was found that both BMC and BMD did not correlate with cumulative dose of prednisolone, when other co-variants such as age, weight, height and spine area were adjusted. Conclusion. Bone mineral density in steroid sensitive nephrotic syndrome is unaffected by cumulative dose of prednisolone therapy both in first episode as well as relapser group of patients.

Surveillance of bacteriological quality of natural water resources in rural areas around Kasauli Town, Distt. Solan, Himachal Pradesh.

A study was conducted to find out the bacteriological quality of water during the monsoon season in local areas around Kasauli Town, and to evaluate the management of water resources in rural areas. The water samples were collected from bowries and hand pumps. As there is no municipal water supply in majority of these areas, the local residents depends mainly on these natural resources without any treatment of water. All the 14 surface water samples collected from bowries were found bacteriologically polluted with total coliform count ranging from 35-1800+. The main contaminants isolated were atypical thermotolerant E. coli, Pseudomonas fluorescence, Enterobacter cloacae, Aeromonas liquifaciens, Citrobacter freundii and Pseudomonas pseudomaleii. Among seven hand pump samples, two were found to have Coliform count 80 and 250 respectively. These two water samples were found contaminated with Citrobacter freundii and E. coli &Aeromonas liquefaciens respectively. These bacteriological contaminations appear to be both from vegetative & human or animal excreta sources. The study therefore suggested that the water from these natural resources requires treatment either by boiling or chlorination before human consumption to avoid any outbreak.