Chronic musculoskeletal pain in older people

Musculoskeletal pain is a common and debilitating symptom in older adults. However, its importance is often underestimated. In this review article, we discuss its proper evaluation and management. Pain evaluation includes detailed history taking, physical examination, imaging, and laboratory investigations. Management of musculoskeletal pain requires a multidomain approach including nonpharmacological, pharmacological, and surgical modalities. A step-wise approach recommended by the World Health Organization can be used for pain management. Common musculoskeletal conditions causing pain are osteoarthritis, low?back pain, gout, pseudogout, rheumatoid arthritis, polymyalgia rheumatica, and fibromyalgia.

Orthostatic hypotension: An overlooked but clinically decisive entity

Orthostatic hypotension (OH) is defined as a drop of >20 mm Hg of systolic or >10 mm Hg of diastolic blood pressure (BP) within 3 min of standing from lying position. It is a common geriatric syndrome caused by impaired orthostatic response of BP. Its clinical manifestation can range from dizziness to syncope. It is a common cause of recurrent falls and fracture in older adults. Its etiology ranges from neurological causes such as Parkinson and diabetes to hypovolemia. Drugs, especially cardiovascular drugs are also frequently identified as the cause of OH. The management of OH is primarily nonpharmacological including medication review, dietary, and lifestyle modifications. However, in partially responsive or resistant cases, medications such as fludrocortisone, midodrine, droxidopa, etc., are also used.

Seroprevalence of hepatitis C virus among patients at a tertiary health care centre in Rajasthan, India

Background: To ascertain the prevalence of Hepatitis C infection among patients visiting a tertiary care center in Jaipur, Rajasthan.Methods: An observation analytic study was done at a tertiary care center affiliated to Medical College with retrospective analysis of the hospital data of two calendar years. During this period HCV infection screening (anti-HCV) was offered to every suspected patient admitted in hospital and every pregnant women visiting antenatal care clinic.Results: The study prevalence of HCV infection was 0.05% (13/25311). The prevalence was more in female (0.03%) than male (0.02%). The study prevalence of anti-HCV among pregnant female was 0.02% (3/16224). Maximum positive cases (4/13, 30.77% positive cases) were in the age group of 21-30 years (sexually active group) and >50 years age group while minimum positivity was found in children (00 case, 0-20 years age).Conclusions: In this study, prevalence of HCV infection was 0.05%. The study prevalence of HCV among pregnant females was 0.02%. Maximum positive cases (4/13, 30.77% positive cases) were in the age group of >50 years and 21-30 years. This study aids in view to strengthen proper screening for HCV infection to reduce HCV related morbidity and mortality

Comparative lipid profile study between ischemic and haemorrhagic stroke

Background: Stroke is one of the major global health problems. Stroke is the most common clinical manifestation of cerebrovascular disease of which more than 99% are due to arterial involvement and less than 1% due to venous involvement in the form of Cerebral Venous Thrombosis (CVT). Among arterial causes 85% are due to infarction and 15% due to haemorrhage.1,2 There is  difference in serum lipid levels in subtypes of strokes to guide lipid-lowering therapy which can reduce incidence of stroke and stroke related mortality by adapting primary and secondary preventive measures.3,4  Authors have endeavoured to correlate severity of lipid derangement and stroke.Methods: In this study 64 consecutive eligible ischaemic stroke cases and 64 eligible hemorrhagic stroke cases would be included. Cases of strokes will be divided into ischaemic and hemorrhagic as per clinical features and with help of brain imaging by CT scan and MRI at the time of admission and 8 hour fasting lipid profile was collected from all cases. All this information will be filled in preformed format.Results: Serum lipid profile of two categories of stroke showed raised serum total cholesterol in 39.1% patients of ischaemic stroke in contrast to 18.8% patients with haemorrhagic stroke (p=0.019).Stroke patients showed raised in LDL cholesterol in 29.7% patients of ischaemic stroke in contrast to 9.4% patients with haemorrhagic stroke, (p=0.007).Conclusions: Based on the finding of our study we conclude that ischemic stroke patient had higher lipid derangement as compare to haemorrhagic stroke in terms of raise total cholesterol, LDL cholesterol and decrease HDL cholesterol.

Human immunodeficiency virus and HBV co-infection: independent entities, together by coincidence?

Background: To ascertain the prevalence of HBV among HIV-infected, treatment- naïve patients visiting a tertiary care centre in Jaipur, Rajasthan, India.Methods: An observation analytic study was done at a tertiary care centre affiliated to medical college with retrospective analysis of the hospital data of 30 calendar months. During this period routine diagnostic screening of HIV infection and HBV infection was offered to every suspected patient admitted in hospital and every pregnant woman visiting antenatal care clinic. Patients with documentary evidence of HIV infection and history of Hepatitis B vaccination in last 30 days are not screened for these infections at our centre. The HIV screening was done as per NACO guidelines. The HBV screening was done using commercially available enzyme linked immunosorbent assay kits (ELISA) for detection of surface antigen (HBsAg).Results: The study prevalence of HIV infection was 0.11% (40/35289). The prevalence was more in male (0.45%) than females (0.06%). HBV was not detected in any of the HIV positive patient in this study. The study prevalence of HIV among pregnant females was 0.05% (10/22026).Conclusions: In this study, prevalence of HIV infection was 0.11%. The study prevalence of HIV among pregnant females was 0.05%. Other than pregnant women, maximum positive cases (13/30, 43.33% positive cases) were in the age group of 25-34 years (sexually active group). No patient had HIV and HBV co-infection.

Comparative Analysis Of Suspected Cases Of H1n1 In Less A More Than 60 Years Of Patients Admitted In The Swine Flu Isolation Ward Of Tertiary Care Centre At S.M.S. Medical College & Attached Hospitals, Jaipur, India

BACKGROUND: Influenza is truly an international disease. It occurs in all countries and affects millions of people every year. The Influenza A H1N1 in humans can be a mild illness or in some people it may result in serious, even life-threatening complications such as pneumonia, acute bronchitis, worsening of chronic conditions, respiratory failure and death. OBJECTIVE:- [1]To study profile of suspected cases of H1N1 in less a more than 60 years of patients admitted in the swine flu isolation ward of tertiary care centre at S.M.S. Medical College & Attached Hospitals, jaipur, [2]To study the variation in clinical presentation if any METHODOLOGY:This was a cross sectional observational study carried out in jaipur district of Rajasthan state, India. All suspected H1N1 virus infected 150 cases admitted in the swine flu isolation ward of tertiary care centre at S.M.S. Medical College & Attached Hospitals, jaipur during the period of 1st January to 31th December,2015 after taking verbal and written consent of the patients were enrolled in study. Before conducting the study approval was obtained from institutional ethical committee for human research.Data safety and confidentiality was also given due consideration. A predesigned semi-structured Performa was used. Detailed demographic and clinical data were recorded.Data was statistically analyzed using SPSS 24 software RESULTS: Out of total 150 cases, 88(58.67%) were >60 years of age groups as compared to 62 cases (41.33%) were <60 years of age. No significant difference was observed according to gender among the groups. Males were more 1.526 times in >60 years of age group as compared to females, 1.526 (0.794 to 2.933).Slightly higher in rural area as compared to urban as Odds ratio (95% Cl)1.260(0.650 to 2.443). According to clinical features fever cough coryza, headache diarrhea were observed more in >60 years of age groups as compared to <60 years of age group. Shortness of breath was less in >60 years of age groups as compared to <60 years of age group (P=0.016S) TLC <4000, <1.4 PLT was less in >60 years of age groups as compared to <60 years of age group (14.29 % vs 85.71%) (P<0.001S). RT PCR (1=positive) was 17.33% in >60 years as compared to 82.67% in <60% years. (P<0.001S).The Wald criteria demonstrated that TLC<4000 and platelet count <1lakh The difference was statistically significant (P<0.05) CONCLUSIONS: Influenza H1N1 infection was more common in older age group, more common in rural areas as compared to urban areas. During this epidemic almost 50% of H1N1 positive cases were in severe category and required ICU care and mechanical ventilation and they all had significant respiratory involvement in form of pneumonia, acute respiratory distress syndrome (ARDS) and respiratory failure with high mortality rate even at tertiary care hospital