Clinical and biochemical profile of scrub typhus patients with emphasis on liver dysfunction in a tertiary care centre in South Rajasthan

Background: Scrub typhus is a zoonotic infectious disease presenting commonly with acute febrile illness of variable severity and symptoms. It mimics other more prevalent tropical febrile illnesses such as dengue, malaria, and leptospirosis. Prevalence is high in and around Udaipur due to hilly terrains and agricultural farmlands. Multisystem involvement is common but liver dysfunction is a fatal comorbidity. Methods: In a retrospective observational study, we analyzed the clinical, biochemical, and demographic parameters of 85 patients of scrub typhus. The study population was distributed into four groups for abnormal liver chemistries based on American College of Gastroenterology (ACG) clinical guidelines: normal, borderline high, mild elevation, and moderate elevation. Results: Almost 80% of patients had abnormal liver chemistries including either serum bilirubin or transaminases. More than 30% of patients were categorized in group 2 and group 3 of the abnormal liver chemistries. Group 4 with moderate to severe liver dysfunction had 15.3% (n=13) patients. Thrombocytopenia and elevated blood urea and Creatinine were significantly seen in patients with both scrub typhus and liver dysfunction. Conclusions: Thus, in our study prevalence of hepatitis and jaundice with multiorgan failure in scrub typhus patients was significantly high. Timely identification of systemic complications and screening of liver chemistries on presentation is of utmost importance for better outcomes, among seriously ill patients.

Landuse impact on soil physical variability and erodibility in North Western subtropics of India

Aim: The study was conducted to determine the impact of landuse on soil physical properties and erodibility. Methodology: Representative soil samples were collected from surface and sub-surface soil depths. Soil physical properties and erodibility indices viz suspension percentage, dispersion ratio, clay/moisture equivalent ratio, erosion ratio, percolation ratio, clay ratio, erosion index and modified clay ratio were determined using standard procedures. Interrelationship among soil properties and erodibility indices were evaluated using Pearson correlation analysis (at 95% and 99% significance level). Results: Among landuse systems, the clay was highest in forest while least in soils under barren landuse. Lowest bulk density and highest value of maximum water holding capacity was found in forest soils. According to susceptibility to erosion, the landuse systems were found in the following order barren lands > cultivated systems (agriculture and horticulture) > forest lands. The ‘r’ values showed positive and highly significant correlations between sand content and bulk density with suspension percentage (SP), clay ratio (CR), modified clay ratio (MCR), dispersion ratio (DR), percolation ratio (PR), erosion ratio (ER), erosion index (EI) while negative and significant correlations of these erodibility indices were found with clay and porosity. Among the erodibility indices SP, DR, PR, ER and EI were positively and significantly correlated with each other. Interpretation: Physical quality of soil was higher in forest compared to other landuse systems. Erodibility of different landuse systems could be arranged in order barren lands > cultivated systems (agriculture and horticulture) > forests. The study was useful for suggesting remedial measures and landuse planning for future

A Prospective Study on Klinefelter Syndrome: A Basket of Multiple Systemic Disorders in a Tertiary Care Hospital

Background: When one or more extra X chromosome is added to a normal male karyotype (46-XY), then a new aneuploidy appears called Klinefelter Syndrome (KS). Every day approximately more than 50 new such cases are added in the male population of India. Traditionally they are lean, thin, tall, azoospermic, hypogonadic, infertile males with low social and educational profile. As the age advances level of testosterone decreases and many new symptoms of multiple systemic disorders appear in these cases. Methods: A well designed questionnaire of infertile males attending the above- mentioned OPD’s was filled with history, clinical examination and semen analysis (twice as per the WHO criteria).  Results: In our series of 500 azoospermic males, we encountered 56 classical KS cases (11.2 %) of 47-XXY karyotype, who were hypergonadotrophic hypogonadic and diagnosed with multiple diseases when evaluated in detail. Conclusions: Hence, every KS must receive androgen replacement therapy, which should begin at puberty and continue for lifelong that helps in preventing the development of high comorbidity rate and premature deaths because these are very high in such condition as compared to normal male population.

Vitamin D Status Among the Elderly Persons of South Rajasthan – A Prospective Observational Study

Background: Vitamin D a fat soluble unique micronutrient. Deficiency of vitamin D is widely prevalent in Indian Subcontinent despite wide exposure to sunlight round the year. Vitamin D is considered to be most under evaluated and under treated micronutrient round the world. Elderly persons are more prone to develop Vitamin D deficiency because of risk factors. Methods: This study was done to study the prevalence of vitamin D deficiency in healthy adults for southern Rajasthan and its correlation with gender, dietary habits and habitat (urban or rural residence).We evaluated apparently healthy adults of age more than 50 years presenting to hospital for routine evaluation or as accompanying person with patient between January to July 2015.The serum -25 OH CHOLECALCIFEROL (D2+D3) levels were estimated in all the subjects by COBAS e411 (Hitachi, Roche). Results: The study (Males 121, Females 83), aged 50 – 82 years shows normal level (20-32 nag/ml) in only 26% (53), while 74% (151) had <20ng/ml.  Women were more deficient (64%) than males (36%); vegetarians more [93% (140)] than non-vegetarians [7% (11)]; urban more 90% (51/56) than rural 69% (100/148). All those who received supplementation improved clinically and bio chemically. Conclusions: Despite abundant sunshine Vitamin D deficiency prevalence is very high among females, vegetarians and urban subjects, for which presumably conventional female over clothing, strict vegetarianism and urban crowdedness are responsible. Supplementation normalizes Vitamin D deficiency. Therefore, proper food fortification in healthy looking and diseased elderly persons is advised.

HAIR-AN Syndrome: Inside Story

15-year-old adolescent girl presented with weight gain, irregular menstrual cycle, skin lesions suggestive of acanthosis nigricans and hirsutism. On evaluation, she was found to have elevated testosterone levels with normal FSH, LH and fasting blood sugar, decreased glucose insulin index suggestive of Insulin resistance. In view of above features, diagnosis of hyperandrogenism-insulin resistance-acanthosis nigricans syndrome (HAIR-AN syndrome) was made. This syndrome is considered as a sub-type of polycystic ovary syndrome (PCOS). HAIR-AN syndrome has varied presentation and is usually seen by primary care physician, gynaecologist or dermatologist. Life style modification with weight reduction and drugs such as metformin helps in alleviating the symptoms. With limited resources in our country, diagnosis is frequently delayed leading to systemic complications. Early diagnosis and appropriate treatment would help in preventing complications of obesity, insulin resistance leading to coronary artery disease, Type 2 diabetes mellitus, hyperlipidemia. Depression and suicidal behavior may be associated with it and should be aggressively addressed in young adults suffering from HAIR-AN syndrome.

Dental caries prevalence and treatment needs among 12- and 15- Year old schoolchildren in Shimla city, Himachal Pradesh, India.

Context: Dental caries is one of the commonest oral diseases in children. Despite this fact, not many studies have been done on this issue among school children in Shimla. Aim: To assess the prevalence of dental caries and treatment needs among schoolchildren aged 12 years and 15 years in Shimla city, Himachal Pradesh, India. With this study we also aimed to establish reliable baseline data. Design: Cross-sectional study. Materials and Materials: This study was conducted among 12 - and 15 - year old schoolchildren in Shimla city, Himachal Pradesh-India. A sample of 1011 schoolchildren was selected by a two-stage cluster sampling method. Clinical recording of dental caries, was done according to WHO diagnostic criteria (1997). Statistical Analysis: The statistical tests used were the t- test, and the Chi-square test. Results: The prevalence of dental caries was 32.6% and 42.2% at 12 years and 15 years respectively. At 12 years of age, the mean Decayed Missing Filled Teeth was 0.62 ± 1.42 and it was 1.06 ± 2.93 at 15 years of age. Females had higher level of caries than males at both the ages. Dental caries was higher in children from government schools as compared to those from private schools. The 'decayed' component was the biggest contributor to the DMFT index. The highest treatment need at both ages was one surface restoration. Conclusion: The caries experience of 12- and 15- year-old children was low compared to WHO - 'recommended' values. Effective oral health promotion strategies need to be implemented to further improve the dental health of school children in Shimla city.

Prevalence of malocclusion and orthodontic treatment needs among 16 and 17 year-old school-going children in Shimla city, Himachal Pradesh.

Background: Many studies have been conducted in India to know the prevalence of malocclusion and the orthodontic treatment needs using dental aesthetic index (DAI), but no study so far has been conducted in Shimla city, Himachal Pradesh. Objective: To know the prevalence of malocclusion and orthodontic treatment needs among 16- and 17 year-old school-going children in Shimla city, Himachal Pradesh. Materials and Methods: The study was carried out on 622 (365 boys and 257 girls) school children, aged 16 and 17 years, from February 2009 to May 2009. Type III examination was conducted and the assessment of malocclusion was done according to the DAI. Results: 20.28% of the male and 24.52% of the female students in the sample were affected with malocclusion. The mean DAI scores of the male and female children were 22.26 and 21.79, respectively. Distribution of the four DAI grades was as follows: DAI-I (no abnormality or minor malocclusion) 79.58%, DAI-II (definite malocclusion) 16.39%, DAI-III (severe malocclusion) 3.69%, DAI-IV (very severe/handicapping malocclusion) 0.34%. Conclusion: The present study shows that 20.42% of the children examined had malocclusion which required treatment.

Comparative study of epidural administration of 10 ml of 0.1% bupivacaine with 2 mg butorphanol and 10 ml of 0.25% plain bupivacaine for analgesia during labor.

Analgesia during labor provided by two epidural drug regimens was compared in a double blind, randomized, prospective study. Group A (n = 12) received 10 ml bolus doses of 0.1% bupivacaine with butorphanol 2 mg while Group B (n = 8) received 10 ml of 0.25% plain bupivacaine. The objectives of this study was to compare, between the quality of an epidural labor analgesia using initial loading dose of 0.1% bupivacaine and 2 mg butorphanol with a initial loading dose of 0.25% bupivacaine. In Group A, incidence of motor block was 8.3% and that of prolong 2nd stage of labor was 16.7%, both were decreased in comparison with Group B, although they were not statistically significant. Hemodynamic variables were stable and no adverse neonatal and maternal outcome was observed in both groups. Addition of butorphanol to bupivacaine may be safe alternative to reduce motor block and decrease prolong 2nd stage for epidural labor analgesia.

Anaesthetic considerations of temporomandibular joint ankylosis with obstructive sleep apnoea: a case report.

The peroperative management of a 4 1/2 yr old child having bilateral recurrent temporomandibular joint (TMJ) ankylosis and obstructive sleep apnoea (OSA) is presented here. From the anaesthesiologist's point of view, the patient demands special considerations as regards difficulty in intubation, high sensitivity to all central depressant drugs, awake extubation, and post-operative maintenance of a clear airway. It is to be concluded that these conditions call for strict adherence to the basic principles of airway management and close observation extending into the post-operative period.

One and a half centuries of demographic transition in Nepal.

This paper examines the past and prospective demographic transition in Nepal. Sparse data from the pre-1961 censuses suggest that mortality decline began during 1930s and allow rough estimates of fertility and mortality levels prior to 1961. Fertility decline began sometime between 1961 and early 1980s, with the total fertility rate declining from about 6 to 5 children per woman by early 1990s. The four scenarios of future fertility decline and population growth presented in the paper help draw several conclusions. A continuation of the recent slow pace of fertility decline would result in a total population of slightly over 100 million by the end of the next century (Scenario I). More rapid decline, similar to the median experience of Asian countries, would reduce this growth to below 60 million (Scenario III). Still more rapid decline, close to the limit of what has been observed in countries that have experienced the most rapid declines, could reduce the growth to 40 million (Scenario IV). It is possible, if not at present particularly plausible, that very rapid decline might be achieved by a combination of smaller family sizes and rising age of childbearing. An approach to reaching zero population growth rapidly--and anything less than a doubling of current population--may be ruled out with a high degree of certainty (Scenario II and IV). A doubling of population to 40 million is the least possible growth that can be expected. At the current rate of fertility decline, population will increase to 100 million during this century. If a smaller population in this range is considered to be in the national interest, it is as important to work for more rapid fertility decline as it is to work for accommodation of a much larger population.