Frailty and chronic kidney disease: associations and implications / Fragilidade e doença renal crônica: associações e implicações

ABSTRACT Introduction: Frailty and its association with chronic kidney disease (CKD) has been established previously. The present study examined this association further by studying the distribution of frailty among groups defined by different stages of the disease. It also identified associated health deficits and explored their association with estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). Methods: A cross-sectional survey was conducted on 90 non-dialysis dependent CKD Stage 1-4 patients, recruited in three stratified groups of 30 participants each based on the stage of disease. Frailty was assessed using Fried's frailty criteria and associated health deficits were recorded using a pre-determined list. Depression was screened using a 4-point depression scale. Results: 21.1% of the participants were frail and 43.3% were pre-frail. The proportion of frailty in CKD groups A (Stages 1 and 2), B (Stage 3a), and C (Stages 3b and 4) was 10%, 13.3%, and 40%, respectively. The association of health deficits including co-morbidities, physical parameters, mental status, daily activities, etc. with UACR, eGFR, and CKD stages was not statistically significant. Nearly one in two frail participants was depressed compared with 14% among non-frail participants. Conclusion: The skewed distribution of 21% frail subjects identified in our study indicates an association between frailty and advancing kidney disease. Frail individuals had a lower eGFR, higher UACR, were more likely to be depressed, and had higher count of health deficits and poorer performance on Barthel Index of Activities of Daily Living and WHOQOL. Early identification of depression would improve care in these patients.

RESUMO Introdução: Fragilidade e sua associação com DRC foram estabelecidas anteriormente. O presente estudo aprofundou esta associação, estudando distribuição da fragilidade entre grupos definidos por diferentes estágios da doença. Também identificou déficits de saúde associados e explorou sua associação com taxa de filtração glomerular estimada (TFGe) e relação albumina/creatinina urinária (RAC). Métodos: Realizou-se uma pesquisa transversal em 90 pacientes com DRC Estágios 1-4 não dependentes de diálise, recrutados em três grupos estratificados de 30 participantes cada, conforme estágio da doença. Avaliou-se fragilidade usando os critérios de fragilidade de Fried e registraram-se os déficits de saúde associados usando uma lista pré-determinada. A depressão foi verificada utilizando a escala de depressão de 4 pontos. Resultados: 21,1% dos participantes eram frágeis e 43,3% eram pré-frágeis. A proporção de fragilidade nos grupos de DRC A (Estágios 1 e 2), B (Estágio 3a), e C (Estágios 3b e 4) foi de 10%, 13,3%, 40% respectivamente. A associação de déficits de saúde, incluindo comorbidades, parâmetros físicos, estado mental, atividades diárias etc. com RAC, TFGe e estágios da DRC não foi estatisticamente significativa. Cerca de um em cada dois participantes frágeis estava depressivo comparados com 14% entre não frágeis. Conclusão: A distribuição enviesada de 21% dos indivíduos frágeis identificados em nosso estudo indica associação entre fragilidade e doença renal progressiva. Indivíduos frágeis apresentaram menor TFGe, maior RAC, eram mais propensos a depressão, tinham maior índice de déficits de saúde e desempenho inferior no Índice de Atividades da Vida Diária de Barthel e WHOQOL. A identificação precoce da depressão melhoraria o atendimento desses pacientes.

A Study on the Impact of Diabetes Mellitus on the Severity of COVID-19-Associated Mucormycosis

Objectives: Diabetes mellitus (DM) seems the most common predisposing factor for rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to study the impact of DM on the severity of COVID-19-associated ROCM (CAM). Methods:?This was a retrospective analytical study performed over a period of 3 months to assess the impact of DM on the severity of CAM in 100 patients and association of clinical correlates of DM with severity of CAM. Statistical analysis:?The data collected using the study tools were converted into a computer-based spreadsheet and analyzed. The statistical analysis comprised a descriptive analysis that involved calculating means, standard deviations, and proportions. For calculating the significance of the difference of mean between two groups, Student's t-test was applied. In addition, chi-square test (or Fisher's t-test if applicable) was applied to study the significance of association of clinical correlates of DM with severity of CAM for categorical variables and t-test for continuous variables. Results:?The prevalence of DM was 67%. The average presenting blood sugar level was 245.9?±?99.86?mg%. Glycated hemoglobin level between 4.5 and 6.5% was observed in 57 patients and over 6.5% in 43 subjects. A high body mass index (BMI) of 25 and above was noted in 52 patients. A significantly higher level of presenting blood sugar and a longer duration of hospital stay was noted in patients having stage 3b or higher (p?<?0.05) when compared with those having stage 3a or below. No significant correlation was observed in patients in stage 3a or below and those presenting with stage 3b or higher in terms of BMI, waist to hip ratio, or total cholesterol levels. There was a strong correlation between blood sugar level at presentation, severity of DM with the severity of ROCM, and a strong inverse correlation noted between HDL level and severity of ROCM. Conclusion:?A poor metabolic control is associated with a higher risk of a severe disease with intracranial involvement.

Demographic and Clinical Profile of Patients Presenting with COVID-19-Associated Rhino-orbito-cerebral Mucormycosis at a Tertiary Care Center

Objectives?Individuals affected with rhino-orbito-cerebral mucormycosis (ROCM) associated with coronavirus disease 2019 (COVID-19) increased enormously in northern India during the second wave of the novel coronavirus disease. This study determined the demographic and clinical profile including the risk factors in patients presenting to a tertiary care hospital in northern India. Materials and Methods?This is a descriptive study involving patients admitted with COVID-19-associated ROCM and were managed from May 2021 to 20th July 2021. Statistical Analysis?The data was analyzed using SPSS (IBM SPSS Statistics 20, SPSS Inc., Chicago, Illinois, United States) software and Microsoft Excel (Version 16.49). The chi-squared and Fisher's exact tests were used to compare various outcomes. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results?One hundred and seventeen (117) patients (males: 70 [59.8%], females:47 [40.2%]) with the average age of 51.85?±?12.80 years presented with orbital involvement. Diabetes mellitus was noted in 100 (86.2%) patients. Of the available data from the records, oxygen supplementation for the management of COVID-19 was received by 37/108 (34.3%) patients for a median average duration of 11 days. Forty-eight patients of one-hundred-seventeen (60%) patients were treated with corticosteroids with a median duration of steroid administration being 10 days. The duration between onset of symptoms related to mucormycosis and diagnosis of COVID-19 was 0 to 75 days for 48 patients. Intravenous amphotericin B was administered in all cases. External sinonasal debridement was performed in 90 of 114 (78.9%) patients, retrobulbar amphotericin B injection was administered in 56 of 117 (47.9%), and orbital exenteration was performed in 17 of 117 (14.5%) of cases. Conclusion?Administration of corticosteroids and diabetes mellitus seem to be the major underlying causes for the development of COVID-19-associated ROCM. Prompt diagnosis and multidisciplinary management approach are essential for a reduction in mortality.

Assessment of health?related quality of life in cancer patients undergoing treatment using Health Utilities Index (HUI?3?) in East Delhi, India

Background: Health-related quality of life (HRQOL) is a construct that focuses on the capacity for living afforded by the health status of a patient. Measurement of HRQOL allows a composite estimation of the capacity for living of a patient and can help capture the suffering experienced by the patient due to adverse effects of therapeutic interventions. This study was conducted to understand the health-related quality of life of cancer patients undergoing various modalities of treatment to generate evidence source for need-based intervention, to assess patients diagnosed with cancers, using Health Utilities Index - 3 (HUI-3?) and assign them single-score values to gauge HRQOL and to measure the various domains of HRQOL and change in HRQOL after a period of three months of treatment. Methods: A descriptive, longitudinal study was conducted amongst patients aged more than 18 years, who were diagnosed with cancer at a tertiary care multispecialty hospital in New Delhi. They were administered a standardized HUI-3 Questionnaire? and their responses were recorded, simultaneously. Statistical significance for change in HRQOL score was assessed with paired t-test. Multivariate linear regression was used to identify the various correlates of HRQOL. Results: The mean (± standard deviation) overall HRQOL score for all participants was 0.71 (± 0.262) [range=-0.09 to 1.00]. A follow-up assessment was carried out after three months and changes in health scores were subsequently recorded. A significant decrease in mean overall HRQOL score was seen for the entire group after three months of having been administered treatment. Single-attributes of emotion and ambulation were maximally affected amongst cancer patients after three months of treatment. On linear regression analyses, baseline HRQOL was a significant correlate of HRQOL at follow-up after three months. Conclusion: Addressing the HRQOL of a cancer patient before starting treatment would address morbidity that might be present even after three months.

Immunoglobulin Profile and Lymphocyte Subsets in Preterm Neonates

Objective: We documented the immunological profile of neonates and mothers, and lymphocyte subsets at birth. Methods: Consecutively born preterm neonates (26 to 31 weeks gestation) at our level III neonatal unit, fulfilling the inclusion criteria were enrolled. Immunoglobulin levels were assessed in maternal blood and in cord blood along with T cell subsets. Results: A total of 115 neonates were enrolled. The mean cord levels for IgG, IgM and IgA, respectively were 5.34, 0.10 and 0.04 g/L and of B, T, NK and NK-T cells were 14%, 71%, 10% and 1%, respectively of total lymphocyte population. Cord IgG and IgA levels showed a significantly rising trend with increasing gestation (P=0.005 and 0.02, respectively) but not IgM and T cell subsets. Maternal immunoglobulins were similar in all gestations. Conclusion: The cord IgG and IgA increased with increasing gestation but not IgM in neonates.

Quality of life of head and neck cancer patients before and after cancer-directed treatment – A longitudinal study

Context: Head-and-neck cancer (HNC) is a major health problem worldwide and even disproportionately bigger in India. Their diagnosis and treatment create severe impact on the quality of life (QOL). We chose to study such patients because we were already reporting these cancers to the Indian Council of Medical Research as part of project titled “Pattern of care and survival studies.” Aims: The aim of the study is to assess and compare QOL of H and N cancer patients before and after the completion of cancer-directed treatment (CDT). Settings and Design: The present study was a hospital-based study conducted in the tertiary care hospital of Jammu with longitudinal study design. Subjects and Methods: All newly diagnosed HNC patients registered with the Department of Radiotherapy and ENT on inpatient or outpatient basis were included over a period of 6 months. Each patient was followed for 4–6 weeks after the completion of CDT. QOL was assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ C30) (general) and EORTC QLQ H and N-35 (specific) questionnaires. Statistical Analysis: Paired t-test was calculated to compare pre- and postmean scores. Pre- and post-Cronbach alpha reliability coefficient was also calculated. Results: The most frequent site was larynx followed by the oral cavity. Regarding both EORTC QLQ C-30 questionnaire and Global health status and EORTC H and N-35 specific questionnaires, the mean scores across all domains showed worsening of QoL from their baseline. The worsening was more severe in emotional function (functional scale), while physical, cognitive, and social functions were comparatively less affected. Pain, swallowing, speech, and mouth problems were most worsened. Conclusions: QoL showed worsening after CDT in all domains due to acute and subacute adverse effects of chemotherapy and radiotherapy in treatment course

Preoperative Versus Postoperative Chemoradiation in Stage III Cancer Rectum: A Single Institution Experience

The optimal management of locally advanced rectal cancer requires a multidisciplinary strategy involvingsurgical resection with total mesorectal excision and combined use of radiotherapy and chemotherapy. Thesequence of treatment can either be preoperative chemoradiation followed by surgery or upfront surgeryfollowed by postoperative chemoradiation. This study compared survival outcomes of these two aforementionedapproaches in 76 stage III rectal cancer patients, identified in the hospital database and treated between 2008and 2014. The median locoregional recurrence free survival in the preoperative group was 34 months whereasit was 33 months in the postoperative group (p=0.583). The median distant metastases free survival was 17months in the preoperative group versus 38 months in the postoperative group (p=0.039). The mean survivalin the whole cohort was 46.97 months with 27 deaths reported at the time of last follow up. The meansurvival in the preoperative group was 35.927 months versus 51.519 months in the postoperative radiotherapygroup (p=0.129). In our set of patients, the sequence of chemoradiation whether preoperative or postoperativedoes not lead to differential survival.

Neoadjuvant Vs Concurrent Chemotherapy Addition to Radiotherapy in Locally Advanced Carcinoma Nasopharynx: Analysis of Survival & Failure Patterns

Locally advanced nasopharyngeal cancer necessitates the use of both chemotherapy and radiotherapy foroptimal benefit. The current recommendation is to treat patients with stage IIB-IVB disease with concurrentchemoradiotherapy. The purpose of this study was to evaluate the survival outcome difference betweenconcurrent chemoradiation and neoadjuvant chemotherapy. Between January 2000 and December 2007,45 patients of nasopharyngeal cancer (stage IIB-IVB) were treated with curative intent in the DepartmentofRadiotherapy. 23 patients receivedneoadjuvant chemotherapy followed by radical radiotherapy and 22patients received concurrent chemoradiotherapy. The study cohort included 35 males and 10 femalessuffering from locally advanced carcinoma nasopharynx. Median age of the group was 52 years (range19-76 years). 2-year failure free survival in the concurrent chemoradiotherapy arm was 62% versus 38%in the neoadjuvant group (log rank p=0.197). Statistically significant difference was not observed in termsof failure free survival between the concurrent and neoadjuvant group.

Prevalence of gestational diabetes mellitus and its relationship with various risk factors in a tertiary care hospital in West Bengal with special reference to tribal population, India

Background: Gestational diabetes mellitus (GDM) is the most common medical complication and metabolic disorder of pregnancy. The aim and objective of this study was to determine the prevalence of GDM and its relationship with various risk factors with special reference to tribal population.Methods: The study was done in 200 patients between 24 and 28 weeks of gestation, attending antenatal outdoor in a tertiary care hospital of West Bengal.  These patients were given 75gm oral glucose irrespective of the last meal and their plasma glucose was estimated at 2hours. Patients with plasma glucose values ≥140 mg/dl were labelled as GDM. Patients who were diabetic before pregnancy or whose pre pregnancy body mass index was not known or was in labour or had chronic disease, were not included in the study.Results: Prevalence of GDM was 11% in whole population while it was 14.63% and 10.06% in tribal and non-tribal population respectively.  Prevalence of GDM and its correlation with most of risk factors in previous pregnancies was found to be significant in both non-tribal and tribal population. Family history of diabetes mellitus was the most prevalent risk factor in both non-tribal (9.4%) and tribal population (14.63%). There was no single most common risk factor among GDM patients found as there were multiple risk factors present with same frequency in both tribal and non-tribal population.Conclusions: The prevalence of GDM is 14.63% in the tribal population and 10.06% in non-tribal population which is not statically significant (P<0.407). The relation between the prevalence of GDM and risk factors was found to be significant for most of the risk factors.

Adjuvant Chemoradiotherapy Vs Neoadjuvant/Perioperative Chemotherapy in Resectable Gastro-esophageal Junction Adenocarcinomas- a Retrospective Analysis

We aimed to conduct the retrospective analysis of resectable Gastro-esophageal junctionadenocarcinomas treated at our facility with either adjuvant chemoradiotherapy (ACT) or neoadjuvant/perioperative chemotherapy (NACT) and investigate their impact on the clinical outcome.A total of79 patients of Gastro -esophageal junction adenocarcinomas completed treatment with curative intentbetween January, 2010 and December 2016 and were included in the analysis. 33 patients receivedadjuvant chemoradiotherapy after curative surgery as per Intergroup 0116 protocol. 46 patientsunderwent curative surgery after 3 cycles of neoadjuvant /perioperative chemotherapy as per UKMAGIC trial regimen. Statistical analysis was done with SPSS version 16 software.The patientsincluded 68 males and 11 females with age ranging from 22-81 years (median 60 years). The followup ranged from 6-71 months (median 14 months). The number of lymph nodes removed at surgerywas 5-25 (median 12). Only 6 patients were node negative in the whole cohort. The number ofpositive lymph nodes ranged from 1-9 in rest of the 73 patients. 12.65% (n=10) patients were diagnosedwith stage IIB, 44.3% (n=35) patients had stage IIIA, 29.1 %( n= 23) patients had stage IIIB and13.9% (n=11) patients had stage IIIC disease. In the adjuvant chemoradiotherapy group, out of 33patients, 7 were dead of disease and 12 were alive with disease at last follow up. In the neoadjuvant/perioperative cohort, out of 46 patients, 13 were dead and 16 were alive with disease. Mediandisease free survival in the adjuvant chemoradiotherapy group was 22 months versus 14 months inthe neoadjuvant/perioperative cohort. The difference was significant on Breslow analysis (GeneralizedWilcoxon, p=.014) and on Tarone Ware (p=.037) but not on Log rank (Mantel-Cox, p=.190) implyingmore of the early events in the NACT group. Hazards ratio for ACT vs. NACT was 0 .703(95% CI0.376-1.317, p=0.272). Hazard ratio for positive nodes was 1.125 ( 95% CI 0.96-1.318,p=0.145).Median DFS for the whole group was18 months(SE 2.912,CI 12.292-23.708) and meanDFS was 23.725 months (SE 2.452, CI 18.919-28.532). Patients receiving adjuvant chemotherapyafter surgery had median overall survival of 39 months versus 26 months in the neoadjuvant arm{p=.039, Wilcoxon Gehan statistic}.In our clinical set-up, adjuvant chemoradiotherapy seems to resultin better overall survival and disease free survival in resectable gastro-esophageal junctionadenocarcinoma though we should be cautious in interpreting retrospective and non-randomizeddata.

Changing trends in maxillofacial trauma: A 15 years retrospective study in the Southern Part of Haryana, India

The aim is to analyze the pattern of maxillofacial injuries and treatment outcomes in the past 15 years (2002–2016). Materials and Methods: One thousand eight hundred and fifty patients from two tertiary referral center hospitals were studied retrospectively in which the age, sex, etiology, site of fracture, and treatment modality was recorded. Results: One thousand two hundred and twenty-eight males and 622 females were operated between 2002 and 2016. Mean age was 29 ± 17.2 years. Maximum incidence was seen in the age group of 16–30 years in males, whereas in females, the predominance of trauma was seen in both 16–30 and 31–45 age groups. Road traffic accidents were responsible for the majority of fractures (42.2%), followed by assaults (26.4), sports injuries (17.6%), and fall (10.7%). Maximum fractures were of the mandible (53.5%) followed by midface (25.6%) and panfacial trauma (20.8%). Nearly 53.6% of patients underwent open reduction, and internal fixation (ORIF), 34.2% managed by the closed method and 12.1% were kept under observation. Conclusion: This study verified a young male predominance, a shift toward more assault related fractures, especially in females. Mandibular fractures were the most common of all. Moreover, the changing trend toward ORIF in the past 15 years.

Study of the Serum Levels of C-Reactive Proteins as an Indicator of Disease Activity in Pulmonary Tuberculosis and Monitoring Response to Treatment.

Background: Pulmonary Tuberculosis is caused by mycobacterium tuberculosis. C-reactive proteins (CRP) are produced in the body by liver in response to inflammation caused by Mycobacterial infection. Insufficient information is available in medical literature, correlating serum CRP levels to the severity of pulmonary tuberculosis. The present study was undertaken to correlate the validity of serum CRP levels to clinical findings. Severity of pulmonary tuberculosis, need for ventilator support, response to anti-tubercular therapy and mortality. Objectives: To correlate the serum CRP levels with clinical findings, mortality, radiological severity and response to anti-tubercular treatment in patients suffering from pulmonary tuberculosis. Methods: The present study was conducted in 50 new sputum positive pulmonary TB patients and 50 healthy individuals. The patients were evaluated for clinical and radiological findings, which were correlated to baseline CRP levels. CRP levels were measured at 2 months and after completion of treatment and correlated to treatment end results. Results: Mean baseline CRP levels in pulmonary tuberculosis patients were 55.32mg/L (range 16- 144mg/L).CRP levels among normal healthy individuals were 4.46 mg/L (range 2-8mg/L). CRP levels were significantly higher in TB patients with fever, tachycardia, tachypnea, hypotension, respiratory distress and the need for ventilatory support when compared to patients without these features. The study showed significant correlation between CRP levels and radiological extent of disease. Baseline CRP levels were significantly higher in mortality group when compared to survivor group.CRP levels showed progressive decline in patients who were cured. Conclusion: The CRP levels in pulmonary tuberculosis patients before initiating anti-tubercular therapy showed a positive correlation with features like presence of fever, tachycardia, tachypnea, hypotension, respiratory distress, need for ventilator support, radiological severity and in patients who died. Thus, serum CRP levels can be used as a surrogate marker for severity of pulmonary tuberculosis in the patients. This is probably the first study conducted in North India correlating CRP levels and disease severity of pulmonary Tuberculosis to the best of our knowledge.

Early detection of multidrug resistant (MDR) Mycobacterium tuberculosis in a single tube with in-house designed fluorescence resonance energy transfer (FRET) probes using real-time PCR.

Rapid and correct diagnosis is crucial for the management of multidrug resistance (MDR) in Mycobacterium tuberculosis (MTB). The present study aims at rapid diagnosis for identification of multidrug resistance tuberculosis (MDR-TB) using real-time PCR. FRET hybridization probes targeting most prominent four selected codons for rpoB526 and 531 and for katG314 and 315 genes were designed and evaluated on 143 clinical MTB isolates and paired sputa for rapid detection of MDR-TB. The results of real-time PCR were compared with gold standard L-J proportion method and further validated by DNA sequencing. Of the 143 MTB positive cultures, 85 and 58 isolates were found to be ‘MDR’ and ‘pan susceptible’, respectively by proportion L-J method. The sensitivity of real-time PCR for the detection of rifampicin (RIF) and isoniazid (INH) were 85.88 and 94.11%, respectively, and the specificity of method was found to be 98.27%. DNA sequencing of 31 MTB isolates having distinct melting temperature (Tm) as compared to the standard drug susceptible H37Rv strain showed 100% concordance with real-time PCR results. DNA sequencing revealed the mutations at Ser531Leu, His526Asp of rpoB gene and Ser315Thr, Thr314Pro of katG gene in RIF and INH resistance cases. This real-time PCR assay that targets limited number of loci in a selected range ensures direct and rapid detection of MDR-TB in Indian settings. However, future studies for revalidation as well as refinement are required to break the limitations of MDR-TB detection.

Awareness and Willingness Regarding Community Based Health Insurance in Urban Slums and Resettlement Colonies.

Health insurance is an efficient way to help people prepare for contingency health care. Health care would be more equitable under community-based insurance than the out-of-pocket system. Such a scheme is especially important for the marginalized population. Objective: To study the awareness and willingness to participate in a community-based scheme among the families. Study Design: Cross-sectional community based. Setting: Urban slums and resettlement colonies in East Delhi. Participants: Head of families or available adult member of 510 families. Statistical Analysis: Proportions, Chi square test. Results: Most of the families had a per capita income of Rs.200-600 per month. Average out-of-pocket expenditure on healthcare per person per month was Rs.38.50. Nearly one-fourth of the families had some hospitalization in past 6 months, with loss of man-days and loss of wages. More than three-fourths of the respondents were aware about ‘insurance’, believed that health insurance is beneficial, and expressed willingness to participate. There is a need for health insurance among this population, and with government assistance and proper planning and education, community-based health insurance can possibly help these families manage their health care costs better.

Clinical & biochemical profile of trichinellosis outbreak in north India.

Background & objectives: Trichinellosis is a parasitic infection caused by Trichinella nematodes, acquired from consumption of raw meat. However, data from Indian subcontinent are limited. The aim of this study was to investigate the clinical and biochemical profile of a suspected trichinellosis outbreak in a village in Tehri Garhwal district of Uttarakhand state in north India. Methods: Three index cases presenting as acute febrile myalgia syndrome with eosinophilia, after consumption of uncooked pork in a common feast, were confirmed as trichinellosis on muscle biopsy. A detailed epidemiological survey was carried out in the affected community and all the people who participated in the feast were investigated for clinical and biochemical profile. Results: A total of 54 patients were evaluated in the study. The type of pork consumed included uncooked in 24 per cent (n=13), open fire roasted in 39 per cent (n=21) and fried in 37 per cent (n=20). Clinical symptoms were found in those who consumed pork in uncooked or open fire roasted form (n=34). These included fever with chills and myalgia (100%), periorbital oedema (67%), dyspnoea (9%), and dysphagia (3%). Laboratory parameters studied in both symptomatic and asymptomatic patients showed eosinophilia in 90 per cent (n=41), raised ESR in 98 per cent (n=45), and an elevated creatinine phosphokinase (CPK) level in 85 per cent (n=39). All symptomatic patients were treated with a short course of oral steroids and albendazole therapy. Conclusions: Trichinella infection is not uncommon in India, and should be suspected in case of acute febrile myalgia especially in areas, where habits of consumption of raw meat is more prevalent.

A Study of Hypertension and Obesity Among the Adult Population in a Rural Area Near NCT Delhi.

Background: The burden of non-communicable diseases (NCDs) in India is substantial and is estimated to increase, in rural areas too. Objectives: To study hypertension and obesity among the adult population in a rural area near Delhi. Materials/methods: A complete enumeration of the total population was done in Mandola village of Uttar Pradesh by conducting a house to house survey. After collecting information based data, the height, weight and blood pressure of all available family members were recorded as per standard procedures. Results: Data was collected from a total of 1124 persons. While there were 15.5% current smokers, 4.4% were consumers of alcohol. The prevalence of current smoking was 35.4% among the males and 3.3% among the females. It was observed that 20.2% of the males and 27.2% females were obese. Among the females, obesity was more likely among the housewives (p<0.001) and those of older age (p<0.001). The proportion of hypertensives was 16.0% in males and 13.0% in females. Among the males, hypertension was more common among the smokers than non-smokers (18.5% vs. 14.5%) and among current alcohol users than non-users (22.4% vs. 15.1%). We found several subjects, of both genders, who had both hypertension as well as obesity. Conclusion: The present study has shown that the burden of NCDs such as hypertension and obesity is quite substantial in a rural population.

Glioblastoma Multiforme Metastasizing to Humerus and Craniospinal Axis.

Glioblastoma multiforme (GBM) is the most common malignant brain tumour. GBM metastasizing to humerus has never been reported. This is the first such case of recurrent GBM to be reported in medical literature with both extracranial and cerebrospinal dissemination. Our case amply demonstrated the need to keep vigil and high index of suspicion while interpreting the clinical and radiological findings in GBM wih a risk of CSF spread and systemic metastases.

Insights from animal models on the immunogenetics of leprosy: a review

A variety of host immunogenetic factors appear to influence both an individual's susceptibility to infection with Mycobacterium leprae and the pathologic course of the disease. Animal models can contribute to a better understanding of the role of immunogenetics in leprosy through comparative studies helping to confirm the significance of various identified traits and in deciphering the underlying mechanisms that may be involved in expression of different disease related phenotypes. Genetically engineered mice, with specific immune or biochemical pathway defects, are particularly useful for investigating granuloma formation and resistance to infection and are shedding new light on borderline areas of the leprosy spectrum which are clinically unstable and have a tendency toward immunological complications. Though armadillos are less developed in this regard, these animals are the only other natural hosts of M. leprae and they present a unique opportunity for comparative study of genetic markers and mechanisms associable with disease susceptibility or resistance, especially the neurological aspects of leprosy. In this paper, we review the recent contributions of genetically engineered mice and armadillos toward our understanding of the immunogenetics of leprosy.

Depression Among the Elderly Population in a Rural Community : A Study of its Prevalence and Correlates.

Background: The next few decades are expected to see an unprecedented increase in the number of older people needing mental health interventions in India. The elders living in rural areas represent a special risk group. Objective: To assess the magnitude of depression and its significant sociodemographic correlates among elderly. Setting: Rural community of Delhi, India. Participants: Elderly aged above fifty years, selected by cluster sampling. Tool: Geriatric Depression Scale (GDS). Statistical Analysis: Proportions, Chi square test. Results: Mean age of the sample population was 61.7 ± 8.2 years and included 58% females. It was found that 45 (35.7%) of the subjects had a score suggestive of depression. Poor sleep at night and tension at home, poor perception of own health, not receiving any financial support in the form of pension for self or spouse and poor nutritional indicators were found to be associated with depression. Depression was less common among those who had a positive approach, including doing some exercise daily (p=0.03) and doing yoga daily (p=0.026). Conclusion: The present study found a significant proportion of the rural elderly population to having depressive symptoms and several important risk factors were found to be associated with depression. Identification of these risk factors among the elderly population at higher risk for depression can help to plan for better care of the elderly.