The Trend of COVID-19 Pandemic in India: A Methodical Comparison with Italy, UK, and the US

Introduction: To statistically compare the trends of epidemiological indicators of COVID-19 in India with Italy, the UK, and the US. Methodology: In this descriptive analysis, epidemiological indicators were calculated and their trends were plotted and compared statistically. Regression analysis was done to predict the fatalities. Results: The trends of total and active cases per million populations are rising in India and US, while Italy has achieved the plateau in the total cases per million populations, and active cases have been sharply declining with time. The UK is about to achieve the same. India has remained far behind the other three countries in the number of tests per million populations (p<0.05). In the initial phase, the test positivity rate of India was quite lower but has overtaken Italy and UK. India has always reported a higher recovery rate than US and lower than Italy. CFRs have achieved a plateau in Italy and UK, in US it is declining, while it remained almost constant in India throughout the pandemic. Testing was a significant covariate in predicting the fatalities. Conclusions: India was able to manage the initial phase of this pandemic due to early and strict government interventions and strong public health responses.

Assessment of available health services as per Indian public health standards at sub-centers of Vadodara district of middle Gujarat, India

Background: Setting standards are a dynamic process. To provide quality care at sub-centers (SC), Indian Public Health Standards (IPHS) standards are prescribed by Government of India. Objective: The objective of the study was to assess the availability of health services provided by SCs of Vadodara district. Materials and Methods: It was a cross-sectional study carried out at SCs of Primary Health Centres (PHCs) using IPHS standards as a checklist. The assessment was made by visiting 40 SCs of Vadodara district in Gujarat by a single observer. Descriptive statistics were used to present data. Results: About 36 (90%) of the SCs were located within the village and 38 (95%) SCs were easily accessible. The median distance of SC from PHC was 6 km. About 72.5% of SCs were having designated government building. About 52.5% SCs had a residential facility for frontline health workers. Availability for most of the drugs was very poor (below 25% age). Records of oral contraceptive pills usages were available in 34 (85%) of the SCs. The antenatal care services were improved by up to 25% in 10 SCs, while it was decreased to 25% in 13 SCs. Conclusion: The gaps existed in the availability of facilities and its standards at sub-centers. The availability of physical infrastructure and furniture was poor. There was worsening of the performance indicators in the majority of the components as compared to previous year records.

Optimizing treatment and analysis of prognostic factors for locally advanced nonsmall cell lung cancer in resource‑limited population.

BACKGROUND: Lung cancer most commonly presents in advanced stages in developing countries, where combined modality treatment using chemo‑radiotherapy (CTRT) is the standard of care. MATERIALS AND METHODS: A retrospective audit of patients of nonsmall cell lung cancer (NSCLC) treated at a single Institute from January 2008 to December 2012 was conducted. Various prognostic factors affecting disease‑free survival (DFS) and overall survival (OS) were studied by univariate and multivariate analysis. All patients were meticulously followed‑up clinically and telephonic contacts. RESULTS: Overall 171 patients of NSCLC were treated with definitive CTRT using concurrent chemotherapy in 66% patients and sequential therapy in 28% patients. The actuarial 2 years DFS was 17.5% and 2 years OS was 61.5%. Complete response to treatment resulted in significantly better DFS and OS. Definitive CTRT was very well‑tolerated in these patients with good compliance. CONCLUSION: Definitive CTRT, sequence being individualized depending on performance status and disease stage at presentation, is a feasible and effective treatment modality for locally advanced NSCLC patients in the developing world. Response to treatment is an important prognostic factor for treatment outcomes.

Limbal Squamous Cell Carcinoma in a Young Non‑Human Immunodeficiency Virus Patient and its Surgical Outcome: A Rare Case Report.

Ocular surface squamous neoplasia presents as a spectrum from simple dysplasia to carcinoma in situ to invasive squamous cell carcinoma (SCC) involving the conjunctiva as well as the cornea. SCCs are commonly seen in eye at the transitional zone of epithelium-the limbus and eyelid margin and usually seen in elderly patients or in young human immunodeficiency virus (HIV) positive patients. Limbal lesion spreads over the ocular surface and enters the fornices but rarely penetrates the globe. Wide total excision serves both therapeutic and diagnostic purpose. We report a rare case of 32 years old, non-HIV male patient who presented with complaints of painless, progressive mass in the right eye with mild visual blurring since 2 months. Slit lamp examination suggested the clinical diagnosis of limbal carcinoma for which a total excisional biopsy with fibrin glued conjunctival autograft was performed. Postoperatively with the confirmed diagnosis of SCC from histopathology, mitomycin - C 0.02% eye drops were prescribed for 4 weeks along with steroid- antibiotic combination in a tapering dose. Postoperatively no recurrence was seen, and good cosmetic improvement was noted.

Microscopic colitis in patients presenting with chronic diarrhea.

Aim: To investigate the prevalence of microscopic colitis among patients presenting with chronic watery diarrhea. Material and Methods: Colonic biopsies from 400 patients presenting with chronic watery diarrhea and other symptoms pertaining to lower gastrointestinal tract were studied. After a detailed clinical history and thorough physical examination full length colonoscopy was done using flexible colonoscope. Colonic biopsies were taken from abnormal and normal areas. Three to five micron thick sections were cut and stained with hematoxylin and eosin and Masson's trichrome stain to highlight sub epithelial collagen. Results: Fifteen out of 400 (3.7%) colonic biopsies from patients presenting with chronic diarrhea had evidence of microscopic colitis. Five out of fifteen biopsies (33%) were diagnosed as collagenous colitis, 10 biopsies (67%) had evidence of lymphocytic colitis; 14/400(3.5%) histologically normal biopsies were taken as controls to compare various demographic and risk factors. Ten out of 15 patients (67%) were clinically diagnosed as irritable bowel syndrome. In the remaining five an infective etiology was suspected. On colonoscopy12/15 (80%) had no abnormality and 3/15 (20%) had mild hyperemia. Conclusion: A possibility of microscopic colitis should be considered while examining colonoscopic biopsy of a patient with chronic watery diarrhea and normal colonoscopy to avoid the misdiagnosis that may affect the treatment of patients

Cryoglobulinemia presenting as acute polyneuropathy.

A 48 years male presented with acute axonal neuropathy and palpable purpura over bilateral lower limb, RA factor, and cryoglobulins were present in the serum. Nerve biopsy revealed myelinated fibre loss, axonal degeneration and necrotizing vasculitis of epineural vessels.

Management of chronic hepatitis B virus infection: a promising approach using small interfering RNA (siRNA).

Hepatitis B virus infection continues to be a major global health problem with an estimated 350 million carriers. The response to available treatment modalities is not impressive. The advent of RNA Interference--a phenomenon of sequence-specific degradation of RNAs mediated by double-stranded RNA--holds promise as a potential therapy for chronic hepatitis B virus infection. Synthetic preparations of short RNA (21-23 bp long) can be used to mediate this process of gene silencing with a lower immune response. The duration of suppression can be further increased by using a vector delivery system. Small interfering RNA (siRNA) has several advantages over conventional therapy, which include fewer side-effects, a lower chance of developing escape mutants and non-requirement of viral replication for its action. A potent knockdown of the gene of interest with high sequence specificity makes RNA interference a powerful tool that has shown antiviral effect against hepatitis B virus. However, the 'off-target effect', i.e. suppression of genes other than the intended target, poor siRNA stability, inefficient cellular uptake, widespread biodistribution and non-specific effects need to be overcome. The problem of long-term toxicity of siRNA should be addressed and an ideal vector delivery system needs to be designed before it can be put to clinical use.

Prevalence of goitre in 6 -12 years school-going children of Panchmahal district in Gujarat, India.

BACKGROUND & OBJECTIVE: Iodine deficiency disorders (IDDs) are one of the worldwide public health problems of today. IDDs are endemic in various districts of Gujarat. We undertook this survey in Panchmahal district of Gujarat to study the prevalence of goiter in a sample of school children, to asses the level of iodine in salt samples, and to determine median urinary iodine concentration in a sample of children. METHODS: In a cross-sectional study, 15,900 school-going children in the age group of 6-12 yr were studied from 10 talukas. A total of 15 clusters were selected by cluster sampling method. Goitre was assessed in the children and urine and salt samples were studied for iodine concentration. RESULTS: The overall prevalence of goitre was 20.5 per cent among the children examined. The median iodine concentration was 70 mg/l indicating mild iodine deficiency; also 61 per cent of the urine samples examined showed iodine insufficiency. Iodine content was found to be adequate in 54.3 per cent of salt samples. INTERPRETATION & CONCLUSION: Our study showed that goitre is still an important public health problem in the district. This calls for identification of factors to strengthen NIDDCP and the need to reimpose ban on sale of non-iodized salt in Gujarat.

Is conventional sphincterotomy possible in patients with common bile duct stones impacted at the ampulla of Vater?

BACKGROUND: Needle knife precut papillotomy has been used to gain access or remove impacted common bile duct stones at the ampulla of Vater. However, precut papillotomy is a risky procedure with high complication rates and is presumably best dealt with by the expert. We attempted to find out the feasibility of performing conventional endoscopic sphincterotomy in patients with impacted stones at the ampulla. METHODS: All patients undergoing endoscopic retrograde cholangiopancreatography for stones impacted at the ampulla between the years 2000 and 2005 were enrolled in the study. All attempts were made to achieve biliary cannulation through the conventional route including use of the long route or guidewire to cannulate the papilla. Needle knife papillotomy was resorted to only if attempts to cannulate the papilla through the conventional route failed. The success and complications of the procedures were recorded. RESULTS: Thirty-two patients were enrolled. The impacted bile duct stone could be removed in all the patients. Conventional endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy were performed in 23 patients with impacted stones. The long route had to be employed in seven patients while guidewire cannulation of the papilla was needed in four patients. Needle knife papillotomy was needed in only nine patients. None of the patients in whom the conventional route was employed developed complications, whereas bleed requiring endoscopic management was observed in three (33%) of the nine patients in whom needle knife papillotomy was performed. CONCLUSIONS: Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy can be performed by the conventional route in the majority of patients with impacted stones at the ampulla. This approach appears to be safer than needle knife papillotomy. However, needle knife papillotomy may be required in patients in whom biliary access cannot be gained through the conventional approach.

Jejunogastric intussusception--a rare cause of recurrent upper gastrointestinal bleeding: case report and review of literature.

Jejunogastric intussusception is a known complication following gastrojejunostomy. However, only occasionally have they presented with haematemesis and we are unaware of any case where it led to recurrent haematemesis. We describe a case where the patient developed recurrent upper gastrointestinal bleeding due to recurrent episodes of jejunogastric intussusception following gastrojejunostomy performed 12 years earlier for duodenal ulcer disease.

Prevalence of H. pylori in patients with gastric cancer.

The present study was taken with an aim to assess the prevalence of H. pylori in patients with gastric carcinoma and correlate it with gross appearance and histological type. Endoscopic biopsies from 54 patients with gastric carcinoma and 50 age and sex matched controls were taken after thorough upper gastrointestinal examination. Gross appearance of the tumour was noted and two biopsies each from the site of malignancy and from normal appearing areas were taken. Sections were stained with Haematoxylin & Eosin and Loeffler's methylene blue for histopathological details and presence of H. pylori. Prevalence of H. pylori in controls was slightly higher than the patients group (80% Vs 78%). Ulcerated type of gross appearance had maximum prevalence of H. pylori (88%). Prevalence of H. pylori was more in diffuse type of gastric cancer than intestinal type (86% Vs 68%). A significant association between H. pylori and grades of gastritis was noted (P < 0.01) in controls as well as in patient group but it failed to show a significant association with tumour grades, intestinal metaplasia, site of the tumour and age of the patients. So, it can be inferred that prevalence of H. pylori infection is not directly associated with pathogenesis of gastric cancer but it may act as a co-carcinogen by damaging the mucosa and thereby making it more susceptible to effects of carcinogen.

Clinico-epidemiological profile and validation of symptoms and signs of severe illness in young infants (< 60 days) reporting to a district hospital.

OBJECTIVES: To describe the clinical and epidemiological profile of infants less than 2 months of age reporting to a district hospital and to assess the ability of simple clinical symptoms and signs used by health workers to detect severe illness warranting hospital admission. METHODS: It was an observational study done at a general district hospital at Chandigarh, North India. Infants less than 2 months of age presenting to this hospital were enrolled. All infants were first evaluated by an auxiliary nurse midwife (ANM) to record a pre-determined set of symptoms and signs. A pediatrician who was blinded to the findings of the ANM did an independent assessment for severe illness needing urgent hospitalization. RESULTS: A total of 1268 infants were enrolled. Of these, 356 (28%) were below 7 days of age. Overall, regurgitation, vomiting and stool problems (25%) were the most common presenting complaints in the first 2 months of life, followed by jaundice (22%) and respiratory symptoms (15%). 112 (8.8%) infants were classified as having "severe illness requiring urgent hospital management" by the pediatrician. Nearly half (46%) of the admissions were because of jaundice while 17% each were due to sepsis and pneumonia / lower respiratory tract infection (LRTI). A history of not feeding well (OR 14.7, 8.0 and 11.3 in 0-6, 7-27 and 28-59 days age groups, respectively) and a respiratory rate >60/min (OR 21.5, 6.2 and 10.5 in 0-6, 7-27 and 28-59 days age groups, respectively) had significant positive predictive value to predict severe illness (except jaundice) in all the 3 age groups studied. In the second month of life, severe chest in-drawing (OR 4.6) was also a significant predictor. CONCLUSIONS: Simple clinical signs are useful in hands of health worker for identifying neonates with serious illness warranting hospital admission. These will be of use in the further development of clinical algorithms for the national integrated management of childhood illnesses.

Short course of oral prednisolone on disappearance of lesion and seizure recurrence in patients of solitary cysticercal granuloma with single small enhancing CT lesion: an open label randomized prospective study.

OBJECTIVE: To evaluate the effect of a short course of oral prednisolone on disappearance of lesion and seizure recurrence in newly diagnosed patients with single small enhancing CT lesion. METHODS: In this open-label, randomized, prospective follow-up study, 100 patients of new-onset seizures and a cysticercus granuloma presenting as single enhancing computed tomography detected lesion were randomly divided in two groups to receive either antiepileptic monotherapy (Group A) or antiepileptic drugs with oral prednisolone in a dose of 1 mg/kg body weight for 7 days and tapering off dose in next 3 days (Group B). Repeat CT scan was performed on 8th-12th week to know radiological state of lesion. The patients were followed up for 1 year for seizure recurrence. RESULTS: The majority of patients were in second decade. Male: female ratio 1.56:1. Mean number of seizure episodes was 4.33 +/- 3.50 in group A and 4.23 +/- 3.97 in group B. Partial seizure were the most common presentation (85%). 72% patients presented with single seizure or seizure in cluster. Solitary ring lesion was the commonest (69%) CT finding, most of them were located in parietal lobe (52%). Follow up CT scan showed complete resolution of lesion in 60.86% of total [group A (n = 47), 32 patients, 68.08%; group B (n = 45), 24 patients, 53.33%]. Significant difference in group A and B regarding lesion resolution was observed (chi2 = 5.926, d.f. = 1) p < 0.05. Clinical follow up showed seizure recurrence in group A - 5 patients (10.63%), in group B - 12 patients (26.66%). Statistically significant higher number of seizure recurrences were noted in group B as compared to group A (chi2 = 3.93, d.f. = 1) p < 0.05. CONCLUSIONS: Short-term oral prednisolone along with antiepileptic drugs helps in rapid resolution of single small enhancing lesions in patient with newly diagnosed seizure disorder with good clinical outcome.

Complementary feeding practices in rural area of district Agra.

The study was conducted to assess the prevailing complementary feeding practices. Strikingly 30.9 percent infants were not receiving complementary foods. 21.9 percent mothers initiated complementary feeding at the right age. This was significantly associated with the literacy status of the mothers (p<0.05). 87.1 percent infants were receiving family pot feeding. The complementary foods fed to the infants were mostly (88.6%) of semi-solid consistency. Demand feeding was being practiced by 66.7 percent mothers. The practice of cleaning hands before feeding was very poor with only 17.1%. Thus to conclude the complementary feeding practices were not satisfactory in the rural area of Agra and need to be improved.

Essentials of specifications for activated alumina in defluoridation technology.

Worldwide, fluoride occurs naturally in some aquifers at concentrations above the WHO guideline values or Bureau of Indian Standards or CPHEEO - MUD - GOI parametric values. Fluoride in excess of the permissible limits in drinking water causes a number of endemic conditions referred to collectively as "fluorosis". Endemic fluorosis remains a challenging national health problem in India and Rajasthan is one of the worst affected states in India though a wide range of chemical and physical defluoridation systems were evolved and tried. Still activated alumina is one of the most widely used and liked defluoridation material currently available. Boom in the advanced and versatile alumina technology has opened new vistas to avail the strong potential of selective alumina adsorbents which are application-specific. Non-regenerable and specialty alumina offer tremendous scope to defluoridate drinking water. Indian industries are manufacturing regenerable activated alumina for defluoridation of drinking water. In order to ensure application of an adsorbent, which caters the desired results with minimum interferences, health risks and long service life span, it is inevitable to draw out dimensions which define precisely the attributes of activated alumina. Specifications for activated alumina intended for defluoridation of drinking water, specific operating and performance requirements, and limitations expressed by critical analysis of cardinal characteristics pave way for adoption of acceptable specifications and code of practice at national level.

Giardia lamblia trophozoites in gastric biopsies.

To assess the prevalence of gastric giardiasis in gastric biopsies of patients with carcinoma stomach and in patients taking treatment for duodenal ulcer. Gastric biopsy specimens from 54 patients of carcinoma stomach and 100 antral biopsies from patients taking treatment for duodenal ulcer were included in the study. Sections were stained with haematoxylin and eosin, methylene blue and May Grunwald-Giemsa stains and examined for presence of Giardia lamblia trophozoites. Eight out of 54 (14.9%) biopsies of gastric carcinoma patients harboured trophozoites of Giardia lamblia. Associated H. pylori infection was present in all biopsies (8/8; 100%). Atrophy and intestinal metaplasia was present in 62.5% (5/8) and 25% (2/8) cases respectively. Sections from seven out of 35 patients (20%) taking treatment for duodenal ulcer showed presence of G. lamblia. H. pylori infection, gastritis and atrophy were found in 85.7% (6/7), 71.4% (5/7) and 28.6% (2/7) cases respectively. First gastric biopsy in these patients was negative for G. lamblia but 2nd and 3rd biopsies were positive. A careful search for G. lamblia trophozoites should be made while examining the gastric biopsies, especially in patients with carcinoma stomach, intestinal metaplasia, atrophic gastritis and those taking treatment for duodenal ulcer. This may help in indirect diagnosis of clinically unsuspected cases of intestinal giardiasis and may explain persistence of vague upper gastrointestinal tract (UGIT) symptoms despite clearance of H. pylori in patients on anti-ulcer therapy.

Etiological spectrum of non-traumatic myelopathies: experience from a tertiary care centre.

AIM: This study aimed to identify the clinical and radiological profile of non-traumatic myelopathies and various etiologies associated with them. MATERIAL AND METHODS: Two hundred and four patients of non-traumatic myelopathy were prospectively studied in different wards of Sir Sundar Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, from September 2002 to March2004. Patients underwent a detailed clinical evaluation followed by laboratory investigation and neuroimaging studies. RESULTS: Among 204 patients of non-traumatic myelopathy, 108 patients presented with paraplegia and 96 patients with quadriplegia. Tuberculosis was the commonest cause of compression paraplegia in this series and was observed in 42 cases (33.33%) while quadriplegia was seen in only 3 cases (2.38%). In the present study, acute transverse myelitis formed the major bulk of non-compressive myelopathy. CONCLUSION: Tuberculosis of spine was the most common cause of compressive myelopathy and among the non-compressive group acute transverse myelitis and SACD were the important etiology.

Polyneuropathy with osteosclerotic myeloma--POEMS syndrome.

A 55-years-old male, who presented with insidious onset gradually progressive sensorimotor polyneuropathy, POEMS-syndrome was diagnosed based on polyneuropathy, splenomegaly, hypothyroidism, the presence of IgG-monoclonal serum protein with osteosclerotic lesions and hyperpigmention of skin. Biopsy of the osteosclerotic lesion from the right superior pubic rami was consistent with plasmocytoma. Electrophysiological studies revealed demyelinating sensorimotor neuropathy and biopsy from sural nerve showed demyelinating neuropathy with secondary axonopathy. The patient showed improvement with radiotherapy. This is a rare systemic disease from the clinical spectrum of plasma cell dyscrasias with polyneuropathy. The importance of POEMS syndrome in the differential diagnosis of polyneuropathies has been emphasized.