Evaluation of Madras Diabetes Research Foundation-Indian Diabetes Risk Score in detecting undiagnosed diabetes in the Indian population: Results from the Indian Council of Medical Research-INdia DIABetes population-based study (INDIAB-15)

Background & objectives: Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India. Methods: Data were acquired from the Indian Council of Medical Research–INdia DIABetes (ICMR–INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS. Results: We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under

A Three Point Assessment Protocol for Tympanoplasty Outcomes: A Retrospective Analysis

Abstract Introduction The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. Objective The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. Methods A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. Results A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake (p = 0.021). Five of the six children who had graft rejection had bilateral disease. Conclusion A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.

A study of percutaneous injuries amongst health care workers in a tertiary care hospital

Background: Percutaneous injuries (PCI) pose a significant risk of occupational transmission of blood borne pathogens to health care workers (HCWs). Their incidence is considerably higher than current estimates, and hence a low injury rate should not be interpreted as a non-existent problem.Methods: This prospective observational study was conducted over a period of 1 year at a tertiary care teaching hospital in northern India. As soon as the HCW sustains a PCI, they were instructed to report to the emergency department where note was made of all the details in the post exposure reporting form.Results: The incidence of PCI in this study was found to be 4.3%. PCIs were reported maximum among nursing staff (63.41%) compared to doctors (36.58%). Majority of PCIs were reported within 1 hour of sustaining the injury (57.1%). Needle stick injury was the commonest injury sustained by HCWs (84.5%). 91.46% of HCWs were fully immunized against hepatitis B.Conclusions: Preventing PCI is an essential part of infection control program in a hospital. Stress must be laid for mandatory reporting of all PCI irrespective of the source.

Orbito-sinal foreign body.

Perforating injuries of the orbit involving the paranasal sinuses are uncommon. We report a case in which a large wooden foreign body lodged in the posterior orbit and maxillary sinus was surgically removed by a combined approach by ophthalmologists and ear, nose and throat surgeons.

Outpatient oral anticoagulant management--an audit of 82 patients.

OBJECTIVE: Use of oral anticoagulants for thrombotic diseases has been increasing steadily over the years. Management practices however, are far from uniform. We conducted a retrospective audit among outpatients on oral anticoagulant therapy to assess treatment practices and overall control of anticoagulation. METHODS: Case records of 82 patients who were on anticoagulant therapy for a minimum duration of three months were reviewed. Information on pre-therapeutic assessment of patients, therapeutic control and complications seen during the course of treatment was recorded. RESULTS: Case notes of 43 males and 39 females with a mean age of 47.5 +/- 14.6 years, on oral anticoagulant treatment were evaluated. Treatment duration ranged from 3 months to 7 years for a total of 258.7 patient treatment years. Pre-therapeutic assessment of patients was inadequate with only baseline hematological and renal parameters available for most patients. Of a total of 1631 prothrombin time ratios and International Normalized Ratios recorded, only 17.8% were in the therapeutic range with 73% being sub-therapeutic. Sixteen (19.5%) patients had treatment related complications. The number of thrombotic and hemorrhagic events per 100 patient treatment years was 3.4 and 2.7 respectively. CONCLUSIONS: Pre-therapeutic assessment of patients was inadequate. The overall therapeutic control was poor with patients in a state of underanticoagulation for most period of anticoagulant treatment. The complication rate was also unacceptably high. There is a need to reassess management practices of patients on long term oral anticoagulation with strict adherence to standard accepted guidelines to make this therapy more effective and safer for patients.

Autoimmune Disorders in Association with Hairy-Cell Leukaemia

Autoimmune diseases in the form of cutaneous leucocytoclastic Vasculitis (CLCV), polyarteritis nodosa (PAN), cerebral arteritis and cryoglobulinemia are uncommon associations of Hairy Cell Leukaemia (HCL). We report a case of a 55 year old male with HCL, carcinomatous meningitis, cryoglobulinemia and cutaneous leukocytoclastic vasculitis, which preceded the diagnosis of HCL, leucocytoclastic vasculitis was confirmed on skin biopsy, the cutaneous lesions regressed on steroid therapy.

Spectrum of acute viral hepatitis and its clinical outcome--a study from Ludhiana, Punjab.

This study was carried out to find the etiological spectrum and clinical profile of acute viral hepatitis in Ludhiana. Hepatitis E was encountered most frequently (44.56%) followed by hepatitis B (29.7%), whereas hepatitis D occurred least frequently (0.99%). The age group most commonly affected was 20-30 years(32,67%) followed by 30-40 years (23.76%). Males showed higher incidence as compared to females in the ratio of 62.4:37.6. The most frequent clinical features were anorexia and jaundice. The disease was found to be more common in urban set up(78.2%) than in rural regions (21.8%). Mortality was mainly because of fulminant hepatitic failure. In 1.98% of cases, etiology remained undecided. Total bilirubin and prothrombin time were found to be useful prognostic indicators.