Nutrition assessment of elderly residing in urban areas and urban slum: A hospital based comparative study

Background: In Maharashtra the elderly population is 9.9 % of the total state population (Census 2011). There is a need to highlight the nutritional problems being faced by the elderly in India. Early detection of malnutrition and timely interventions can help to reduce morbidity in the long run. Aims &Objectives: To find the prevalence of malnutrition in elderly and compare nutritional status of elderly residing in an urban area and urban slum. Material & Methods: This was a cross sectional hospital-based study. Data was collected from the civil OPD and ex-service men OPD of the hospital each having a catchment population from urban slum and urban area respectively. A total of 331 patients > 60 years of age were included. Nutritional status was assessed using the MNA, MUST and GNRI. Serum albumin levels were measured using colorimetric method. Results: The overall prevalence of malnutrition and at risk as per MNA score was 168 (50.7%). Out of 331 subjects, 209 belonged to urban slums and remaining 122 were from urban area. The gender and age distribution were comparable in both groups. The mean BMI of subjects from slum area was significantly lower as compared to urban group (22.3+ 5.3 vs 26.3+ 4.5) p<0.001. Proportion of elderly who had MNA score below 24 was significantly higher in the slum area (p<0.05). Proportion of elderly with mid arm circumference and calf circumference below the cut off of 22 cm and 31 cm respectively was significantly higher in slum area (p<0.05). Serum albumin levels were comparable in both groups. Mean BMI of elderly in urban area was >25Kg/m2. Conclusion: The overall prevalence of malnutrition was high. The nutritional status of elderly in urban slum was significantly worse than that of elderly in urban area.

Esophageal Foreign Body in a Neonate: An Unusual Age of Presentation.

Ingestion of foreign bodies in neonates is very rare and can be life threatening. We describe a 20 days old neonate presented with vomiting, drooling of saliva and poor feeding tolerance. Chest radiograph showed a metallic foreign body in superior mediastinum. Foreign body was removed by rigid oesophagoscopy. The case describes the unusual age of presentation of foreign body and options available to remove these foreign bodies in neonates.

Indirect hyperbilirubinemia with indinavir.

Indinavir is a protease inhibitor used in the treatment of HIV infected individuals and as post-exposure prophylaxis. Indinavir is associated with various adverse effects including gastrointestinal, a lipodystrophy syndrome and nephrolithiasis. We describe indirect hyperbilirubinemia as an adverse effect of indinavir in a person on post-exposure prophylaxis (PEP).

Effect of intraesophageal acid instillation on airway reactivity in patients with asthma.

OBJECTIVE: To study the change in airway reactivity due to presence of acid in lower esophagus and its reversibility by antacid. METHOD: In this double blind study 12 subjects with asthma and gastroesophageal reflux received acid (N/10 hydrochloric acid) and antacid (mixture of magnesium trisilicate and aluminum hydroxide) perfusion in lower esophagus via a nasogastric tube. The four combinations were antacid-antacid (control), antacid-acid, acid-antacid and acid-acid. Airway reactivity (Histamine PD20) was recorded after each perfusion. RESULTS: Histamine PD20 significantly decreased (airway reactivity increased) (p < 0.05) with all three combinations containing acid as compared to control. No significant difference in airway reactivity was observed if the antacid was given before or after the acid. CONCLUSION: Presence of acid in lower esophagus can increase airway reactivity. This effect lasts longer than the presence of acid in esophagus itself.

Aetiology of chronic diarrhoea in tropical children.

AIM: We studied the causes and presentations of chronic diarrhoea in post-weaned children. METHODS: Forty seven children (6 months to 12 years) with diarrhoea of more than 2 weeks duration were recruited and subjected to detailed clinical examination and investigations. RESULTS: Primarily on the basis of history, clinical examination and duodenal biopsy, children could be classified into 5 groups namely tropical enteropathy (46.8%), irritable bowel syndrome (10.6%), giardiasis (14.8%), celiac disease (6.8%) and non specific diarrhoea (21.8%). Children with tropical enteropathy improved with broad spectrum antimicrobial therapy, those with irritable bowel syndrome and non specific chronic diarrhoea with dietary interventions while children with celiac disease required definite withdrawal of gluten from diet.

Poisoning in children: Indian scenario.

The retrospective data on childhood poisoning from eight regional hospitals in India has been reviewed. The demographic features and types of poisonings encountered have been compared. The analysis of the data indicated that pediatric poisonings constituted 0.23-3.3% of the total poisoning. The mortality ranged from 0.64-11.6% with highest being from Shimla. Accidental poisoning was common involving 50-90% of children below 5 years of age and males outnumbered the females. Suicidal poisoning was seen after 13 years of age and was due to drugs and household chemicals. One of the hospitals in Delhi recorded a very high incidence (66.6%) of drug poisoning in children. The drugs consumed belonged to phenothiazines, antiepileptics and antipyretics. Iron poisoning was seen in younger children. Kerosene was one of the causes of accidental poisoning at all hospitals except Shimla and rural Maharashtra were probably wood charcoal is widely used. Pesticide poisoning was more prevalent in Punjab and West Bengal whereas plant poisoning was very common in Shimla. Significant number of snake envenomation has been recorded from rural Maharashtra. Other less common accidental poisonings in children included alcohol, corrosives, heavy metals, rodenticides, detergents and disinfectants. Thus various regions in the country showed some variation in types and frequency of childhood poisoning which could be attributed to different geographical and socio-economic background.

Telephone mouthpiece as a possible source of hospital infection.

A bacterial culture from telephone mouthpiece showed that 47 percent of the instruments carried pathogenic bacteria. Wiping with a disinfectant swab reduced the number of contaminated telephones. But for complete elimination of bacterial contamination changes in design of mouthpiece holes or type of instrument or using a polythene plastic cover over mouthpiece is recommended.

Prevalence of transfusion associated infections in multitransfused children in relation to mandatory screening of HIV in donated blood.

Any change in risk behavior related to acquisition of human immunodeficiency virus (HIV) infection is likely to reduce simultaneously the risk for other agents transmitted through identical routes. A study carried out in the city of Delhi, India on the load of transfusion associated infections among multitransfused (MT) children in relation to mandatory screening of HIV infection in donated blood indicated unchanged prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) infections among the group of MT children transfused after the implementation of mandatory screening of HIV infections in blood banks, i.e. post-implementation period (prevalence of HBV, HCV and HDV being 32.8%, 31.3% and 1.6% respectively) compared to a group of MT children transfused over a similar duration before the implementation of mandatory screening i.e. pre-implementation period (prevalence of HBV, HCV and HDV being 28.1%, 26.6% and 1.6% respectively). However, reduction could be recorded in the prevalence of IgM and IgG classes of antibodies to both CMV and HSV-2 infections among MT children receiving transfusion during the post-implementation period (prevalence of 3.1% and 37.1% for CMV IgM and CMV IgG respectively; prevalence of 3.1% and 25% for HSV-2 IgM and HSV-2 IgG, respectively) compared to the group of MT children transfused in the pre-implementation period (prevalence of 15.6% and 56.3% for CMV IgM and CMV IgG respectively; prevalence of 18.8% and 45.2% for HSV-2 IgM and HSV-2 IgG, respectively). These reductions were statistically significant (p values < 0.02 and < 0.05 for CMV IgM and CMV IgG; p values < 0.01 and < 0.02 for HSV-2 IgM and HSV-2 IgG respectively). These observations were in accordance with the recorded reduction in the prevalence of CMV and HSV-2 infections and unaltered prevalence of HBV, HCV and HDV infections in the group of donors donating blood during the post-implementation period compared to those donating in the pre-implementation period. Study of epidemiological risk factors among blood donors showed a change in behavior towards safer sex practice with only 13.0% of donors in the post-implementation period having history of sex with one or more female commercial sex workers during their donation periods compared to 41.5% of donors in the pre-implementation period having similar history (p < 0.001). However no change could be recorded in the proportion of donors donating at frequency higher than the permissible guidelines among the two groups. The present study points out nosocomial transmission as well as limitations in the existing guidelines for screening of infectious agents in blood banks as possible incriminating factors towards acquisition of hepatitis virus infections in blood donors as well as in MT children.

Clinical spectrum of chronic liver disease in north Indian children.

Recent advances in serodiagnosis of hepatotropic viruses have revolutionized the approach to diagnosis and understanding of chronic liver disease (CLD). There are few studies on CLD in children from India. The present study was planned to define the clinical spectrum of CLD in children, its histopathology and seroepidemiology. Forty children with clinical features satisfying the criteria for diagnosing chronic liver disease were studied. All underwent routine laboratory investigations, liver function tests and ultrasound scan of the abdomen. Liver biopsy, upper GI endoscopy and other special investigations were done wherever indicated. The most common presenting features were jaundice (70%), fever (67%), and abdominal distention (60%). On examination hepatomegaly and icterus (80% each) and splenomegaly (67%) were the commonest findings. Serum transaminases were raised in 62.5% of children while prothrombin time was prolonged in 75% patients. Oesophageal and/or gastric varices were seen in 13 out of 29 patients subjected to upper GI endoscopy. Hepatitis B surface antigen (HbsAg) was positive in 5 children (12.5%) while 3 (7.5%) tested positive for anti HCV antibody. The commonest histopathological diagnosis was infantile cholangiopathy (20%) followed by cryptogenic cirrhosis and idiopathic chronic active hepatitis (17.5% each). The study suggests that the incidence of chronic hepatitis B and C is rather low in childhood. However larger and longer studies are required to delineate the exact incidence of these conditions in childhood and their progression in adolescence and early adulthood.

Does B.C.G. vaccination prevent or postpone the occurrence of tuberculous meningitis?

The reported efficiency of B.C.G. vaccine in prevention of primary childhood or sputum positive adult tuberculosis vary widely but it is believed to offer significant protection against hematogenous forms of tuberculosis. The present hospital-based, case control study was aimed at evaluation of impact of B.C.G. vaccination on one of the hematogenous forms of tuberculosis i.e. Tuberculous meningitis (TBM). Records of cases of TBM admitted in the pediatric wards of Lok Nayak Hospital, Delhi, over one year were analyzed retrospectively for B.C.G. positivity status and age distribution. The results were compared with similar data obtained from a control group comprising of non-TBM cases in pediatric wards of same hospital, recruited on 2 days, separated by an interval of three weeks. No statistically significant difference was found in B.C.G. positivity status of cases and control groups. However, there was an obvious trend in age distribution among cases of TBM with respect to the B.C.G. status, with a significantly higher proportion of B.C.G. vaccinated children in over 5-year age group, as compared to those in under 5 year age group. The results, therefore, indicate probable effectiveness of B.C.G. against TBM only for a limited duration i.e. single B.C.G. immunization only postpones rather than prevent the occurrence of TBM.

Hepatitis B--potential of perinatal transmission in India.

To estimate the frequency of perinatal hepatitis B virus (HBV) infection, 850 pregnant females were tested for HBsAg and HBeAg using RPHA kits. Frequency of HBsAg positivity was 4.6% by RPHA and 6.34% by micro-ELISA. HBeAg was detected in 18% of the HBsAg positive pregnant females. Presuming a perinatal HBV infection rate of 90% amongst infants born to HBsAg and HBeAg positive pregnant females and 17% amongst infant born to HBsAg positive but HBeAg negative mothers, we estimated that 1.17% to 1.64% infants out of 24 million births occurring annually in this country would be infected with HBV. In other words every year 2.8 to 3.9 lakh infants are being infected by HBV perinatally, 90% of whom will eventually develop chronic HBV infection. Urgent control measures are necessary to circumvent this problem.

Visceral leishmaniasis control in India through primary health care system--a successful experiment of district level planning.

A model district action plan for control of Visceral Leishmaniasis a serious public health problem in north-east Bihar was developed in late 1989 and implemented in 1992 in district Vaishali. A two years implementation resulted in decline in cases and deaths due to Visceral Leishmaniasis to the extent of 65.32% and 46.51% respectively in 1993 as compared to 1992 and 41.13% and 44.93% respectively in 1994 as compared to 1993 with an overall decrease of 79.58% in case and 70.54% in deaths in 1994 as compared to 1992. The implementation of action plan not only established declining trends in morbidity and mortality due to Visceral Leishmaniasis in the district but also successfully contained the cases unresponsive to first line treatment with Sodium Stibogluconate by reducing the prevalence of such cases from 12.42% in 1992 to 8.59% in 1994. Various components of the action plan, implementation strategy and consequent impact on disease situation are presented in this paper.

Determinants of symptomatic giardiasis in childhood.

Giardia has been frequently implicated as a causative agent for acute as well as chronic diarrheal diseases in children. The present study was aimed at exploring the determinants of manifestations of Giardiasis in childhood, in relation to various host and parasite related factors. A total of 200 children with acute (100), chronic (50) or without (50) diarrhea in last 15 days were recruited for the study and evaluated with regards to nutritional status, serum immunoglobulins, secretory IgA levels, presence of Giardia in stool/duodenal aspirate/duodenal biopsy specimen and for associated infections. Lysates from acute giardiasis cases were further studied for zymodeme (banding) pattern. After correlation of all investigations, humoral immune defect in the host was found to be the major determinant of whether the Giardial infestation would be symptomatic or not, while associated bacterial infections and zymodeme patterns were not found to be important in determining the pathogenicity or presentation of giardiasis.

Does Rota virus infection cause persistent diarrhoea in childhood?

Rota virus is the commonest agent for infectious diarrhoea in childhood. Whether an acute diarrhoea episode due to Rota virus constitutes a risk factor for persistence of diarrhoeal episode has not been well evaluated. This study aimed at evaluating the role of antecedent Rota virus infection in the causation of persistent diarrhoea. One hundred twenty children with acute watery diarrhoea were investigated for evidence of recent Rota virus infection and were followed up for 2 weeks to determine the proportion developing persistent diarrhoea. Rota virus antigen in stool and IgM class antibodies in serum were detected in 33 (27.5%) of the cases, only 2 (6.06%) of whom developed persistent diarrhoea. On the other hand 11.3% children without evidence for antecedent Rota virus infection developed persistent diarrhoea. The prevalence of Rota virus antigen in stools of children who developed persistent diarrhoea was 16.7%. In another group of 25 children with persistent diarrhoea definite evidence for a Rota virus infection was detected in only 2 (8%) cases. It was therefore concluded that antecedent Rota virus infection does not increase the risk for abnormal prolongation of an episode of acute diarrhoea.