A study of contaminated sharp injury and associated morbidity among health care workers

Background: Needles are one of the biomedical waste materials generated during the treatment or procedure in the hospital. Improper handling, capping or disposal technique causes a major health hazard among the health care workers (HCWs). Needle stick injuries (NSIs) can occur accidentally at any time when people use, disassemble, or dispose needle. The aim of the present study were to find out the burden of chronic morbid condition due to NSIs to HCWs, to find out various risk factors responsible for causing chronic disease to HCWs and to suggest the prevention and control of needle stick injury among the HCWs.Methods: A cross-sectional study, conducted among HCWs. Sample size was estimated by using standard formula and 312 HCWs were taken in study. Equal number of respondent was taken from each group. The information has been collected and data entry has been done using specific software SPSS version 20.0.Results: Most of the HCWs were infected with hepatitis B (24.0%) followed by hepatitis C virus (8.7%) and HIV (1.9%) after the percutaneous injuries with needle of infectious patients during any intervention procedures of the patients.Conclusions: Occupational exposures to percutaneous injuries are substantial source of infections with blood borne pathogens among health-care workers because of the poor practice as well as not opting personal protective equipment’s during intervention process regarding preventive and control measures. These infections are highly preventable and should be eliminated.

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.

Immunoglobulin G4 related pancreaticobiliary disease: Report of two cases highlighting the diagnostic criteria

Two cases of immunoglobulin (IgG4)-related biliary and pancreaticobiliary disease are reported to define its diagnostic features. Case 1 presented with obstructive jaundice and showed IgG4-related disease (RD) involving right and left hepatic duct, common bile duct and gallbladder. Case 2 presented as periampullary mass. Both patients underwent surgical intervention. However, certain clinical and radiological features were present in these cases indicative of the possibility of IgG4-RD.

Optic nerve avulsion associated with central retinal artery occlusion following rotational globe injury

Avulsion of the optic nerve head is a rare and severe complication of ocular blunt trauma. Herein, we describe a case of 16-year-old boy, who presented with a rare combination of optic nerve avulsion associated with central retinal artery occlusion, following blunt trauma with a leather ball. This report highlights the potential blinding complication following rotational injury.

Identification of opportunistic enteric parasites among immunocompetent patients with diarrhoea from Northern India and genetic characterisation of Cryptosporidium and Microsporidia.

Purpose: Enteric parasitic infestation is a major public health problem in developing countries. Parasites such as Cryptosporidium spp., Cyclospora spp., Cystoisospora spp. and Microsporidia may cause severe diarrhoea among immunocompromised patients. There is scanty data on their frequency among immunocompetent patients. Accordingly, we studied the frequency of enteric opportunistic parasites among immunocompetent patients with diarrhoea from northern India; we also performed genetic characterisation of Cryptosporidia and Microsporidia among them. Patients and Methods: Stool samples from 80 immunocompetent patients with diarrhoea, and 110 healthy controls were examined. Parasites were detected by direct microscopy, modified acid-fast (Kinyoun’s) and modified trichrome stain. Polymerase chain reaction – restriction fragment length polymorphism was used for genetic characterisation of selected species such as Cryptosporidia and Microsporidia. Results: Enteric parasites were detected in 16/80 (20%) patients (mean age 28.8 ± 20 years, 45, 56% males) and in 2/110 (1.8%) healthy controls (P = 0.00007). Parasites detected were Cryptosporidium spp. (8/16, 50.0%), Cystoisospora spp. (4/16, 25%), Microsporidia (1/16, 6.25%), Cyclospora spp. (1/16, 6.25%) and Giardia spp. (1/16, 6.25%). One patient had mixed infection with Cystoisospora spp. and Giardia spp. The species of Cryptosporidia and Microsporidia detected were Cryptosporidium hominis and Enterocytozoon bieneusi, respectively. Parasites were more often detected in younger patients (≤20 years of age) than in older. Most of the parasite infected patients presented with chronic diarrhoea. Conclusion: Opportunistic enteric parasitic infestation was more common among immunocompetent patients with diarrhoea than healthy subjects. Special staining as well as molecular methods are essential for appropriate diagnosis of these parasites.

Seronegative invasive gastro‑intestinal cytomegalovirus disease in renal allograft recipients a diagnostic dilemma! – Tissue PCR the saviour.

Seronegative Invasive Gastro-intestinal cytomegalovirus disease in renal allograft recipients Background –CMV as oppurtunistic infection affecting the gastrointerstinal tract is the most common cause for tissue invasive CMV disease occuring in 10–30% of organ transplant recepients. Gastrointerstinal CMV disease can be diagnosed in presence of clinical suspecion along with histopathological findings (CMV inclusions) and presence of mucosal lesion(s) on endoscopic examination with collaborative evidences via molecular technique. Aims-Few cases of CMV infection affecting the gastrointerstinal tract show no evidences of dissemintion despite use of highly sensitive molecular techniques. We encountered 6 cases where in despite strong clinical suspecion of Gastrointerstinal CMV disease there were seronegative and endoscopic negative evidences for CMV, blind tissue biopsy yeilded positive results for CMV disease with excellent improvement with antiviral therapy. Conclusions-Blind biopsy specimen for tissue PCR could serve as saviour in an immunocompromised individiual who has a strong clinical symptomatology for GI-CMV disease in absence of viremia, normal endoscopy and histopathology, so that the early therapeutic interventions could help in excellent patient and graft survival.

Sildenafil improves six-minute walk distance in chronic obstructive pulmonary disease: A randomised, double-blind, placebo-controlled trial.

Background. Sildenafil has been found to improve exercise capacity and haemodynamic parameters in patients with various pulmonary disorders. This study was undertaken to evaluate its efficacy in severe chronic obstructive pulmonary disease (COPD). Methods. In this double-blind, randomised, placebo-controlled study, 37 patients with severe COPD received either sildenafil or placebo for 12 weeks. Distance covered in six-minute walk test (6MWD) was taken as primary end-point. Pulmonary artery pressure (PAP) was measured as secondary end point. Results. Thirty-three patients (15 in sildenafil arm and 18 in placebo arm) completed the study. Non-parametric tests were used for comparison. There was significant increase in 6MWD from baseline after three months of follow-up in sildenafil users (median change in distance covered in six-minute walk test (Δ6MWD)=190m) as compared to placebo users (Δ6MWD=0m, p< 0.05). The PAP decreased significantly (χ2=14.94, p<0.05) in sildenafil group after three months, while it did not change significantly among placebo group (χ 2=3.84, p>0.05). Conclusion. Sildenafil improved 6MWD and PAP in patients with severe COPD. This trial has been registered with Indian Council of Medical Research (ICMR) Trial Registry. [CTRI Registry Number: CTRI/ 2009/091/000017]

Perception of RTIs/STDs among women of reproductive age group in a District of Uttar Pradesh.

A cross sectional study was conducted during May-June 2010 among woman of reproductive age group (15-45 years) in the urban and the rural areas of Bareilly District to asses the level of awareness regarding RTIs/STDs. The two stage cluster sampling technique was adopted. A structured questionnaire was used to interview the study participants during the house to house surveys. Each woman of reproductive age of selected household was interviewed in private about her reproductive history, current knowledge, source of information and modes of transmission of RTIs/STDs. Statistical analysis was done with Epi Info computer software. Standard Normal Variate (SNV) Test for comparison of two groups’ proportion was done; z and p were calculated to know the significance of the proportions of two groups for comparison. Most of the women were aware of RTIs/STDs (80.32%) in urban areas whereas only 27.41% in rural areas were aware of these diseases. The television and radio was the main source of information in both rural (41.17% & 32.94%) and urban areas (TV-90.36%, Radio-48.19%).

Evaluation of primary immunization coverage in an urban area of Bareilly city using cluster sampling technique.

Infectious diseases are major cause of morbidity and mortality in children. One of the most cost effective and easy methods for the child survival is immunization. Objective of present study was to find out the various reasons for partial or non immunization of child and to assess the factors associated with immunization. The present cross sectional study was carried out in urban slums of Bareilly city from April 2010 to Aug. 2010 using 30 by 7 cluster sampling technique. A total of seven children aged 12-23 months were interviewed from each cluster on pre tested, predesigned schedule, thus giving us the sample size of 210.Chi square test was applied for statistical analysis. Two third children (61.9%) were found to be fully immunized. Immunization coverage was high for BCG (92.86%) and lowest for measles (62.38%). Most common reason (50%) for partial and non immunization of children was found to be ignorance on the part of parents. Religion, education of both mother and father was found to be significantly associated with immunization status. The need of the hour is to make routine immunization a “felt need” of the community. Increasing the knowledge and understanding of the caretakers of the young children about the essentiality and benefits of routine immunization would be a strong step forward in achieving the goals.

Lymphatic filariasis.

Lymphatic Filariasis / Elephantiasis is a disfiguring illness causing swelling: a chronic disease in which parasitic worms obstruct the lymphatic system, causing enlargement of parts of the body, e.g. the legs. We recently came across a young lady with an advanced stage of disease. Her agony and horrifying look of right leg propelled us to report her case in order to highlight the prevalence of disease and increase the awareness, so that necessary preventive measures can be taken up at an early stage for better community health.

Low framingham risk score despite high prevalence of metabolic syndrome in asymptomatic north-Indian population.

Background : Conflicting data exists regarding relationship between the Framingham risk score (FRS) and presence of metabolic syndrome (MS). Strong influence of age on FRS may further modify this relationship as prevalence of MS at younger age increases in South-Asian countries including India. However, only limited information is available about the prevalence of MS and its relationship with FRS in such populations at present. Methods : Clinical examination and biochemical investigations were performed in 1905 asymptomatic office executives who underwent routine health check-up at a tertiary care centre in India during the year 2005. Diagnosis of MS and FRS were based on the modified National Cholesterol Education Program- Adult Treatment Panel III guidelines. Results : Mean age of the subjects was 45.2 ± 10.3 years and 71.8% were males. MS was present in 47.5% (905 of 1905) subjects. Overall, 76.8% patients with MS had 10-year cardiovascular (CV) risk <10%, 20.6% had 10-20% risk and only 2.7% had >20% risk according to FRS. In the lowest age-quartile, 95.9% patients had 10-year risk <10%, 4.1% patients had 10-20% risk and none had >20% risk. In contrast, in the highest age-quartile, less than half of the patients had 10-year risk <10% and nearly half had 10-20% risk of CV events. Conclusions : Although the prevalence of MS is markedly high in young asymptomatic Indians, majority have low 10-year risk of CV events as estimated by FRS. These findings necessitate continued emphasis on detection of MS in these populations as reliance on FRS alone may result in underestimation of CV risk in them. ©

The neuroleptic malignant syndrome: A report of 14 cases from North India.

Neuroleptic malignant syndrome (NMS) is a rare, life-threatening but potentially treatable condition. This study was performed to investigate the clinical spectrum, antecedent events and outcome of NMS patients admitted in the Neurology department of a large teaching hospital of North India. Fourteen cases of NMS were taken after a thorough search during a three-year period (May 2000 to April 2003). The Incidence of NMS was 1.40/ 1000 patients treated with neuroleptics and mortality rate was 14.28%. Amongst the neuroleptics Haloperidol (parenteral) was implicated as a most common drug for NMS in 57% of patients. An association with coexisting precipitating illness was clearly recorded in 71.4% patients. All the recorded patients of NMS received 500-700 mg CPZ equivalent/day of neuroleptics. NMS as an indiosyncratic phenomenon was noticed in 28% patients. 85.7% responded to dopaminergic drugs along with supportive treatment and showed partial or complete recovery within 7-14 days. In those with partial recovery residual deficits included Parkinsonian features, depression and diaphoresis in a small percentage of patients.

Maternal and neonatal factors affecting physiological jaundice in western U.P.

Several maternal and fetal factors are responsible for neonatal jaundice, which is a common observation in large number of newborns. However, role of these factors in causation of this condition is not well established. Fifty pregnant mothers and their fifty two newborns were studied in the present study. Mothers with complicated pregnancy or septicemia at the time of delivery were excluded. In addition newborns with congenital or chromosomal abnormalities were excluded. Serum concentrations of bilirubin of all neonates were measured on days 1, 3 and 5. It was found to be lower on day 1, with a peak at day 3. The area under serum bilirubin level-time curve (AUC) for each neonate was also calculated. Fetal sex and birth weight were not found to significantly affect the neonatal hyperbilirubinemia. Newborn of bipara mothers were found to have significantly lower (P < 0.05) serum bilirubin level on day 1 as compared to primipara mothers only but higher (P < 0.05) on day 3 as compared to either primi or multipara mothers. Yet, AUC of serum bilirubin curve was significantly higher (P < 0.05) in newborns of bipara mothers than others. Significantly (P < 0.05) higher serum bilirubin on day 1 was also observed in preterm neonates than full term ones. However, maternal haemoglobin and mode of delivery were not shown to affect the neonatal bilirubin levels in these newborns.

Methotrexate induced accelerated nodulosis.

Methotrexate induced accelerated nodulosis (MIAN) is a rare but unique side effect of methotrexate therapy. There is paucity of data from our country about this entity. We analyzed 14 cases of MIAN and studied its association with gender, rheumatoid factor positivity and dose and duration of methotrexate. Fourteen patients (8 females), 12 with rheumatoid arthritis (8 seropositive), one each with juvenile idiopathic (JIA) and psoriatic arthritis (PsA) were detected to have MIAN during study period. All the patients presented with acute onset of multiple nodules. Radial border of fingers was the most commonly involved site. Disease was inactive in all but two patients at the time of appearance of MIAN. There was no association of MIAN with gender, rheumatoid factor positivity, disease duration, cumulative dose and duration of methotrexate therapy. Two patients each were treated with colchicine, D-penicillamine or hydroxy-chloroquine for 3-6 months without any response. We conclude that MIAN is a benign side effect of methotrexate treatment.

Nocardiosis in patients of chronic idiopathic thrombocytopenic purpura on steroids.

We present two cases of chronic idiopathic thrombocytopenic purpura (ITP) on prolonged steroid therapy who developed subcutaneous and brain abscesses due to Nocardia asteroides. The special diagnostic and therapeutic challenges encountered in the patients because of severe thrombocytopenia are being highlighted.

Eosinophilic fasciitis.

Eosinophilic fasciitis presents with skin thickening involving the extremities, and sparing the hands. Raynaud's phenomenon is usually absent. It can be precipitated by undue exertion and is characterized by eosinophilia and infiltration of skin and subcutaneous tissue by mixed inflammatory infiltrate including eosinophils. We present a young man who developed eosinophilic fasciitis following severe gymnastic activity.

Unusual haematological alterations in rheumatoid arthritis.

Three cases of rheumatoid arthritis (RA), presenting with refractory anaemia, thrombocytopenia and peripheral lymphocytosis respectively, were observed. In all the cases haematological manifestations were unrelated to disease activity or drug toxicity. These patients were detected to have pure red cell aplasia (PRCA) (normocytic normochromic anaemia, reticulocytopenia and absence of erythroid precursors in the bone marrow), immune thrombocytopenia (IT) (absence of splenomegaly and presence of increased megakaryocytes in the bone marrow) and multiple myeloma (MM) (lytic lesions on skull, paraproteinaemia and bone marrow plasmacytosis) respectively. PRCA and IT responded to glucocorticoids. Association with these three haematological alterations has rarely been reported. Our report highlights the need to regularly monitor blood counts in patients with RA.

Autoimmune hemolytic anemia associated with benign ovarian cyst: a case report and review of literature.

A 28-years-old female presented with severe autoimmune hemolytic anemia (AIHA), warm antibody mediated, and right side tubo-ovarian (TO) mass. There was sub-optimal response to immunosuppressive therapy (IST). Eight months later she underwent ovarian cystectomy which resulted in complete remission of AIHA without the need for IST. Pathological examination of the TO mass revealed benign ovarian cyst. Our case highlights the need to search for ovarian cyst/mass in females presenting with AIHA. Since immunosuppressive therapy is usually ineffectual in AIHA associated with ovarian cyst, it may be appropriate to contemplate surgery before embarking on IST in such cases.