Metabolic syndrome and its correlates: A cross-sectional study among adults aged 18� years in an Urban Area of West Bengal

Background: The prevalence of metabolic syndrome (MetS) is increasing dramatically of late, across all ages irrespective of gender, socioeconomic status, and ethnicity. People with MetS have twice the likelihood of developing and dying from cardiovascular disease and more than seven times the risk of developing diabetes. Objectives: This study was undertaken to determine the prevalence of MetS among adults who were in their first three decades of adulthood and to find out the risk factors of MetS among them. Methods: This was a community based cross-sectional study among 388 subjects aged 18� years selected by multistage random sampling in an area of Kolkata, India, from November 2016 to October 2018 over 2 years. Data collection was done using a structured questionnaire along with anthropometry, blood pressure measurement, and relevant blood tests. Physical activity was classified by the International Physical Activity Questionnaire Short-Form questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (version 16.0), and descriptive statistics were calculated as frequency and percentage. Logistic regression was done to determine the strength of association between MetS and different risk factors. Results: The prevalence of MetS was 44.6% (35.4% in males and 55.6% in females), and female gender, poor economic status, sedentary lifestyle, poor diet, and addiction of tobacco were found to be the risk factors of MetS in the final model using multivariable logistic regression. Conclusion: This research revealed the high prevalence of MetS in the community. The effective primordial and primary level of prevention along with prevailing secondary or tertiary level of prevention should have been employed to curtail the epidemic of MetS.

Community perception and risk reduction practices toward malaria and dengue: A mixed-method study in slums of Chetla, Kolkata

Background: Globally, vector-borne diseases account for 17% of infectious disease burden. In India, despite accelerated efforts, both malaria and dengue are major public health concern. Understanding local community perspectives is essential to strengthen ongoing program activities. Objectives: The study aimed to assess the community perceptions and risk reduction practices toward prevention and control of malaria and dengue at slums of Chetla in South Kolkata and to explore the perspectives of relevant local stakeholders in this regard. Methods: This cross-sectional study with mixed-method design was conducted from June to September 2018. Quantitative data were collected in 288 sampled households through face-to-face interview of respondents and environmental checklist, whereas, qualitative exploration was done with five key informant interviews. Quantitative data were analyzed using SPSS version 16 Software. Qualitative data were analyzed thematically using “cut and sort” processing technique. Results: In household survey, majority had unsatisfactory knowledge (68.4%), attitude (64.2%), and practices (62.8%) regarding diseases prevention/control, which was further substantiated by qualitative findings. The use of electric fans (79.5%), mosquito repellents (53.8%) were predominant practices; however, only a few used bed nets regularly (26.0%). Reportedly, “heat” and “poor ventilation” were key reasons behind reluctance to use bed nets. Multivariable regression analysis revealed that increasing age, proximity to a nearby canal, and unsatisfactory knowledge significantly predicted unfavorable attitude, whereas, respondents' gender and unfavorable attitude significantly predicted poor practices. Conclusions: Intensified social behavior change communication with active community participation is the need of the hour to prevent malaria and dengue occurrence and future outbreaks.

An epidemiological study on sociodemographic and antenatal factors associated with low birth weight in a tertiary care hospital of Kolkata, West Bengal

Background: Birth weight is a critical determinant of child survival and growth and a valuable indicator of maternal health, nutrition, and quality of life. Antenatal care (ANC) provides an array of available medical, nutritional, and educational interventions intended to reduce the incidence of low birth weight (LBW). Objective: This study was done to find out the sociodemographic and antenatal factors associated with LBW among babies delivered in a tertiary care health facility in Kolkata. Materials and Methods: It was a cross-sectional institution based observational study conducted from November 2016 to October 2018 among 410 postnatal mothers in the postnatal ward of the Department of Obstetrics and Gynaecology, Medical College, Kolkata, West Bengal. Data were obtained by interview method along with record analysis (medical and hospital records). Dependent variable was LBW (<2.5 kg). Ethical clearance was obtained from Local Ethics Committee of All India Institute of Hygiene and Public Health Kolkata and Medical College, Kolkata. Results: Out of 410 babies, 112 (27.3%) were LBW. Out of 112 LBW babies, 59 (52.7%) were preterm (<37 weeks); 51(45.5%) were term (37–42 weeks), and 2 (1.8%) were post-term (>42 weeks). Multi-variable logistic regression showed LBW to be significantly associated with poor economic status (below middle class), mothers who belonged to nuclear family, delayed registration (≥12 weeks), anemia in pregnancy, pregnancy-induced hypertension, gestational diabetes mellitus, weight gain in kg less than normal (i.e., below 9 kg), and poor consumption of specific nutritional supplements. Conclusion: Poor economic status and inadequate ANC continue to remain the most important factors for LBW. A good quality ANC package will ensure prevention of LBW babies.

Dyslipidemia and its predictors among adult population: A community‑based study

Background: Dyslipidemia is a key independent modifiable risk factor for cardiovascular disease (CVD) and one of the main causes of the disease burden in developed and developing countries. Objectives: The objectives of this study were to elicit the proportion of dyslipidemia and its risk factors among the adult population of North 24 Parganas, West Bengal. Materials and Methods: This community-based cross-sectional study was conducted among 360 adults during August–October 2017 in Habra, an urban area of West Bengal, India. Sociodemographic data were obtained from structured questionnaire, followed by anthropometric measurement, fasting glucose, and lipid profile estimation. Assessment of dyslipidemia was determined according to the National Cholesterol Education Program Adult Treatment Panel (III) guidelines. Descriptive statistics and logistic regression were performed to analyze the data using SPSS 16 version. Results: The mean (standard deviation) age of the participants was 43.1 (±12.4) years. About 37.5% were found to have dyslipidemia. Variables which continued to remain significant in the multivariable analysis were less physical activity (adjusted odds ratio [AOR] = 2.75 [1.41, 5.39]), ever user of tobacco (AOR = 2.36 [1.12, 4.97]), hypertension (AOR = 2.52 [1.11, 5.71]), abnormal waist-hip ratio (AOR = 43.85 [21.62, 88.92]), and diabetes (AOR = 2.51[1.20, 6.69]) when adjusted for other variables in the multivariable analysis. Conclusion: Dyslipidemia is a known risk factor for CVD. Therefore, all steps must be taken for control and prevention of this disorder.

Exposure to indoor air pollution and its perceived impact on health of women and their children: A household survey in a slum of Kolkata, India

Background: One's house is believed to be the safest and the healthiest place to live in. Indoor air pollution (IAP) means the presence of unwanted substances in the indoor air at concentration toxic to health. Objective: The objective of this study is to study the presence of IAP, its associated factors and impact on health of women residing in an urban slum of Kolkata, West Bengal, India. Methods: It was a cross-sectional study done from January 2017 to March 2017 among 120 households of a slum. Data were collected using a pre-designed pre-tested schedule from the homemaker of the households. All analyses were conducted with R: A Language and Environment for Statistical Computing. Results: About 60% households used kerosene as cooking fuel predominantly. Smoke from the neighbouring houses troubled 57.5% respondents. More than 60% houses were overcrowded and more than 70% houses were poorly ventilated. IAP-related symptoms such as irritation in the eye, suffocation, dry cough significantly correlated with the presence of IAP sources and its contributory factors. Of 120, 78 (65%) perceived the presence of IAP in their houses. Lower per capita income (PCI), ground floor, and joint family were found to have higher odds of sources of IAP. Younger age, lower PCI, and ground floor were found to be strongly associated with higher contributory factors of IAP. Conclusion: The present study found that the majority of the households were exposed to IAP due to kerosene, neighborhood smoke while overcrowding and ill-ventilation accentuated it. Effective intervention with intersectoral coordination is the need of the hour.

Sun exposure and Vitamin D in rural India: A cross-sectional study

Background: Vitamin D deficiency/Vitamin D Insufficiency (VDI) is now recognized as a pandemic. Cutaneous exposure to ultraviolet-B causes photolysis of epidermal 7-dehydrocholesterol, converting it to pre-Vitamin D3 (precholecalciferol), which then undergoes isomerization to form the stable hormone Vitamin D3. Objectives: The objectives of the study is to determine the status of Vitamin D level among the adults residing in a rural area of West Bengal and to find out the optimal cutoff of the sun exposure for Vitamin D sufficiency. Methods: This study was a rural community based cross-sectional study. It was done from May 2016 to April 2017 among 197 adults residing in a rural block of West Bengal. Data were collected by interviewing the respondents with the help of a structured pre-tested pre-designed schedule. After interviewing, every individual was examined for height and weight and blood was collected for serum Vitamin 25-(OH) D. Receiver Operating Characteristic (ROC) curves were utilized to find out optimum cut-off for sun exposure using Youden's index. Binary logistic regression was performed to find out the associates of high sun exposure. All analysis was done using R. Results: Overall VDI was found in 133 (67.5%). Among them, 102 (51.8%) were female. On ROC curve for veritable sun exposure for Vitamin D sufficiency, area under curve was 0.7841 which signifies veritable sun exposure as a good screening tool. Conclusion: Proper information, education, and communication material regarding various aspects of sun exposure and Vitamin D should be prepared with due consultation of field experts and disseminated to increase awareness among the community.

An Epidemiological Study on Burden of Psychological Morbidities and Their Determinants among Undergraduate Medical Students of a Government Medical College of Eastern India

Background: Medical education can impose a significant amount of psychological stress and strain on undergraduates. In India, there are limited shreds of evidence regarding the magnitude of different psychological morbidities (i.e. stress, anxiety and depression) among medical undergraduates.

Knowledge regarding snake bite in rural Bengal – Are they still lingering on myths and misconceptions.

Introduction: Snake bite is a very common problem in rural India which even today leads to a large number of deaths. This is because the uninformed community members take recourse to harmful traditional healing measures which cause loss of vital time which is very important for the survival of the patient. Objectives: To assess the knowledge of the study population on snake bite and to elicit any association of this knowledge with their demographic and socioeconomic characteristics. Material and methods: An observational, cross-sectional study was done in a village in the Singur Block of Hooghly district of West Bengal. The head of the family or in his absence the senior most members was interviewed with a pre-designed, pre-tested schedule. Results: Farming was the occupation of the majority (36%) followed by business (20.6%) and service (17.7%). 45% belonged to the social class I and II (modified B.G. Prasad) while 39% were in the social class IV and V. Only 58.85% of the study population were aware that the incidence of snake bite can be reduced. 68% were aware of immobilisation of the affected part was the initial first aid measure and only 4% had the correct knowledge that application of collar was unnecessary and harmful. . Correct knowledge on the availability of specific treatment was present among 85.1% and 77.1% knew where specific treatment is available. Education OR 2.51 (1.26 – 5.00), Occuption OR 4.44 (2.35-8.40), PCI OR 2.05 (1.12-3.76) were significantly associated with good knowledge. Conclusion: There is a paucity of knowledge on different domains of snakebite. Hence dissemination of correct knowledge is necessary to remove their misconceptions.

Possibilities of Developing New Formulations for Better Skin Protection from a Traditional Medicinal Plant Having Potent Practical Usage.

Aims: Natural products obtained from different types of plants have made an important impact since ancient times throughout Asia. Since wood of Hesperethusa crenulata (Roxb.) Roem has been used traditionally by women in Southeast Asia for protection against sunlight and other harmful environmental factors, present study was aimed to determine antioxidant and antimicrobial properties of water extract of H. crenulata wood. Methodology: Wood was powdered, soaked in water, macerated, extracted fluid was lyophilized and tested for antioxidant and antimicrobial properties following standard techniques. The IC50 values were calculated from regression equations prepared from concentrations of extract and inhibition percent of free radical formation. The extract was screened for antimicrobial action following international guidelines against 44 organisms. Results: In DPPH assay system IC50 value was 344.74 μg/ml, the same for superoxide scavenging assay was 326.13μg/ml, while in hydroxyl radical scavenging system it was 999.85 μg/ml. Among 32 strains of staphylococci 10 strains were inhibited at 25 -50 μg /ml level of the extract, 6 strains at 100 μg /ml, 4 at 200 μg /ml and the remaining 12 strains were resistant. Strains of Bacillus spp and Vibrio vulnificus were rather sensitive to the extract, while E. coli and Pseudomonas aeruginosa were resistant. Thus the extract was inhibitory for bacteria known to invade human skin. Conclusions: The distinctly beneficial properties of the wood of H. crenulata indicate its usefulness as a highly active agent for the protection of skin against invasion by microorganisms and free radicals including those that may come from the sunlight.

Reference ranges for lymphocyte subsets in adults from western India: Influence of sex, age and method of enumeration.

Background: The enumeration of absolute CD4 counts is of primary importance, since therapeutic protocols for HIV1 patients are based on these. Aims: To establish reference ranges for the CD4 and CD8 T-lymphocytes in the Indian population. Settings and Design: Enumeration of absolute numbers and percentages of lymphocyte subsets was performed in 252 healthy adult Indians. Methods and Materials: The assays for SPT were carried out using the Beckman EPICS XL-MCL flow cytometer and the cytostat tetraCHROME reagent containing CD45/CD8/CD4/CD3 monoclonal antibodies. For comparison with DPT the absolute lymphocyte count was obtained using the Coulter STK-S fully automated hematology analyzer. Statistical Analysis: Regression analysis and Students t test were used for data analysis. Results: Median values were as follows; absolute CD3 counts 1446 cells/mm3 (total), 1361 cells/mm3 (males) and 1511 cells/mm3 (females); absolute CD4 counts are 771 cells/mm3 (total), 705 cells/mm3 (males) and 839 cells/mm3 (females); absolute CD8 counts are 555 cells/mm3 (total), 552 cells/mm3 (males) and 561 cells/mm3 (females). The median CD4/CD8 ratio for the total samples was 1.34, for males 1.22 and for females 1.49. Conclusions: In this study we have established reference ranges for normal Indian adults using the fully automated Single Platform Technology. The lymphocyte subsets values of our population are closer to those of the population from Botswana and China rather than the Western population. The absolute CD3 and CD4 counts and the CD4:CD8 ratio are higher in females than in males. Consistently higher values are obtained by the DPT as compared to the SPT.

An epidemiological study of low birth weight newborns in the district of Puruliya, West Bengal.

BACKGROUND: A community-based epidemiological study on birth weight of newborns was undertaken in the rural domain of a backward district of West Bengal. OBJECTIVES: To find out the magnitude of low birth weight (< 2.5 kg.) newborns and to highlight association, if any, of the socio-demographic, maternal and obstetric factors with birth weight of newborns. METHODS: The study was undertaken in 30 sub-centre areas (cluster), selected by '30 clusters sampling technique', in the rural area of Puruliya district. An adequate sample of 512 newborns (466 plus 10% extra allowance) delivered in those selected clusters (17 consecutive deliveries in each cluster) were to be studied. But, due to inability to record birth weight within 48 hours (in home deliveries) and other reasons, 487 newborns were included in assessing magnitude of the LBW problem. In-depth information on several variables was obtained from 439 mothers of the newborns. Health Workers (F), Anganwadi Workers, Trained dais and Health Supervisors -(F), specially trained for the survey, collected information by using pre-designed and pre-tested proforma. RESULTS & CONCLUSION: The incidence of LBW was 31.3%. Among different variables studied, statistically significant association was found in case of educational level of mothers and also place of delivery of newborns. More such community-based studies should be conducted

A study on catch up growth among low birth weight infants in an urban slum of Kolkata.

OBJECTIVES: To study the catch up growth among low birth weight infants in relation to the normal birth weight counterparts in first six months of age. METHODS: A longitudinal community based study was done in 2004 -05 in an urban slum of Chetla, Kolkata among 126 singleton live born babies. Growth pattern of these babies was followed up at 15+/-5 days interval by house visit till six months of age. RESULTS: The incidence of low birth weight babies was 28.6%. 86.1% LBW infants caught up in length at 3rd month, 63.9% in chest circumference at 4th month, 66.7% in head circumference at 5th month, while 72.2% in weight at 6th month. Regular growth monitoring is essential for LBW babies to detect signs of growth faltering at the earliest.

Thrombophilic conditions in non-cirrhotic portal vein thrombosis.

OBJECTIVE: To study the prevalence of thrombophilic conditions in patients with acute and chronic portal vein thrombosis (PVT) and to compare it with those in patients suffering from deep vein thrombosis (DVT) after lower limb arthroplasty and in healthy subjects. METHODS: Twenty-six patients with spontaneous PVT (20 chronic, 6 acute) with normal liver function and not receiving anticoagulants were evaluated for thrombophilic conditions. Levels of protein C, protein S and antithrombin were compared with those in 50 healthy controls. Factor V gene 'Leiden' mutation (FVL) and high homocysteine levels were looked for in patients with PVT and in 18 patients developing post-arthroplasty lower limb DVT despite anticoagulation. RESULTS: Of 26 patients with PVT, 19 had at least one thrombotic condition (acute PVT 5/6, chronic PVT 14/20) and 12 had more than one such condition; in comparison, of 18 patients with DVT, eight had one thrombophilic condition and one had two such conditions (p=0.03). Patients with PVT had significantly lower levels of protein C, protein S and antithrombin than healthy subjects and those with DVT. Six patients had Factor VIII levels above 150%; four had elevated homocysteine levels and three had detectable anti-cardiolipin antibodies. Three patients with PVT (acute 2, chronic 1) were heterozygous for FVL mutation. CONCLUSIONS: Underlying thrombophilic conditions are common in Indian patients with spontaneous PVT. In many patients, multiple thrombophilic conditions are present and these may play a role in the pathogenesis of PVT.

Primary neurological manifestations of lung cancer--a retrospective analysis of 8 patients.

Neurological manifestations are reported in 5 to 10% of cases of lung cancer. We present a series of 216 consecutive patients of lung cancer of which 8 patients presented first with neurological manifestations without overt respiratory symptoms. The present study aimed to identify the number of patients of lung cancer presenting with primary neurological symptoms, the nature of the presentations, and the outcome of these patients among 216 patients who presented over a 2 year period in the Institute of Postgraduate Medical Education and Research, Kolkata. Out of 8 patients, 3 patients presented with seizures, 3 patients with hemiparesis and 2 patients with paraparesis. Thus, 3.7% (8/216) of patients in our series presented with a neurological manifestation. We concluded that primary neurological manifestations are rare in lung cancer. The lungs should be the first site of evaluation in a case of a cerebral metastasis with an unknown primary.

Myelodysplasia and acute myeloid leukaemia in a case of rheumatoid arthritis with secondary amyloidosis treated with chlorambucil.

Immunosuppressive therapy related secondary haematologic malignancy is well reported. A 52 years lady with established rheumatoid arthritis developed reactive amyloidosis. This was initially treated with colchicine and cyclophosphamide and later with chlorambucil. Ten months after stopping chlorambucil she developed pancytopenia and vitamin B12 deficient megaloblastic anaemia. The pancytopenia was refractory to vitamin B12 supplements and a repeat bone marrow confirmed myelodysplasia (FABI RAEB-T). Within three weeks of this diagnosis she evolved into acute myeloid leukaemia and expired due to refractory thrombocytopenia and uncontrolled bleeding. This case stresses the need for long term follow up of RA patients treated with alkylating agents.

People living with HIV infection / AIDS - A study on lymph node FNAC and CD4 count.

Between July 1997 and December 2000, 1616 HIV seropositive persons were identified by Western Blot test at the School of Tropical Medicine, Kolkata. Four hundred seventy two (29.2%) of them had generalized lymphadenopathy. CD4 count could be done in only 54 of these 472 subjects (11.4%). These 54 patients, consisting of 40 males (74%) and 14 females (26%) were the subjects of the study. Their mean age was 29.5 years. In all these subjects, FNAC was done from the enlarged lymph nodes (non-inguinal). Reactive hyperplasia was seen in 30 cases (55.5%) whose absolute CD4 count varied between 411-945 cells/microL (median value 670 cells/microL). Evidence of tuberculous lymphadenitis was detected in 22 (41%) with CD4 counts varying between 113 and 422 cells/microL (median value 212 cells/microL). Non-Hodgkin lymphoma was diagnosed in 2 cases (3.7%) with CD4 count 79-113 cells/microL. All patients had evidence of HIV-1 infection, excepting one case of dual infection (HIV-1 and 2).

Profile of glaucoma in a major eye hospital in north India.

PURPOSE: To study the clinical profile and distribution of various subtypes of glaucoma in a referral practice in North India. METHOD: A retrospective analysis was done of 2425 patients who attended the glaucoma clinic in a tertiary eye-care centre for five years from January 1995 to December 1999. A detailed history was obtained and a thorough examination was performed, including gonioscopy, disc assessment, applanation tonometry and automated perimetry. Diurnal variation of IOP and provocative tests for glaucoma were done where applicable. RESULT: Primary angle closure glaucoma (PACG) was the most common glaucoma subtype. The primary open angle glaucoma (POAG) to the PACG ratio was 37:63. Chronic angle closure glaucoma (CACG) was the most common PACG subtype. The majority of CACG cases were relatively asymptomatic. Male dominance was seen for POAG, juvenile open angle glaucoma (JOAG), CACG, normal tension glaucoma (NTG) and secondary glaucomas. Female dominance was seen for ocular hypertension (OHT), acute or intermittent ACG and developmental glaucomas. The mean age in years at presentation was POAG:60.54 years (males 61.54 years, females 59.01 years) and PACG: 55.13 years (males 57.25 years, females 53.60). The three common secondary glaucomas were: glaucoma secondary to adherent leucoma, aphakic and pseudophakic glaucomas and traumatic glaucomas. Advanced glaucoma was detected in 42 to 53% of patients and bilateral blindness in 8 to 14% of patients in various subtypes. CONCLUSION: Compared to Caucasians, glaucoma patients in North India seem to present nearly a decade earlier and the disease is more advanced at presentation. While PACG is the most commonly encountered glaucoma, NTG and exfoliative glaucoma are relatively rare.

Telomere, telomerase, tumorigenesis and therapy: an overview.

The ends of chromosome in higher eukaryote are termed telomere. The DNAs present at that part of chromosome is called telomeric DNA. Telomeric DNA consists of tandemly repeated DNA sequences. The replication of the ends of chromosomes is not controlled by conventional DNA polymerases rather a special kind of enzyme is involved in this process. It is a ribonucleoprotein and known as telomerase. Cells in senescence stage face telomeric crisis that leads to loss of telomeric ends. Surveillance turns to procancer cells with increased telomerase activity which is a later consequence. Based on these facts a key diagnostic approach has been developed for detection of tumour. A novel therapy for tumour repression has been developed using telomerase inhibitors. However, these inhibitors are very much effective for solid tumour therapy and conceptually will not work on hematological malignancies.