Assessment of factors affecting response of direct-acting antivirals in chronic hepatitis C patients.

Background: Hepatitis C virus (HCV) is a universally prevalent pathogen and a major cause of liver-related morbidity and mortality worldwide. The evolution of antiviral therapy for HCV has rapidly progressed from interferon (IFN)-based therapies to IFN-free combinations of direct-acting antivirals (DAAs). Aims: This study aims to assess the response of DAAs in chronic hepatitis C (CHC) patients and to study the various factors affecting the response of DAAs in CHC. Settings and Design: This longitudinal observational study spanning over a year was conducted in the Medicine department of a tertiary care teaching hospital. Materials and Methods: The study was conducted on 400 adult CHC patients, diagnosed by a positive anti-HCV antibody test and a detectable viral load (HCV RNA) by real time polymerase chain reaction (RT-PCR), registered for treatment with DAAs. The first 400 patients satisfying the eligibility criteria were enrolled by non-probability consecutive sampling. All the participants were treated as per the National Viral Hepatitis Control Programme (NVHCP) guidelines. Repeat HCV viral load was done at or after 12 weeks of completion of anti-viral therapy to ascertain sustained virological response (SVR). Various factors which might predict treatment response were analyzed. Statistical Analysis Used: The continuous variables were expressed as mean and standard deviation, while the categorical variables were summarized as frequencies and percentages. The Student's independent t-test was employed for the comparison of continuous variables. The Chi-square or Fisher's exact test, whichever is appropriate, was employed for the comparison of categorical variables. Multivariate Logistic Regression was used to identify the independent predictors of treatment nonresponse. A P < 0.05 was considered statistically significant. Results: The mean age of the subjects was 42.3 ± 15.23 years with a male-to-female ratio of 1.96:1. Most of the patients (80.5%) were non-cirrhotic; among 19.5% cirrhotic, 13% were compensated while 6.5% were decompensated cirrhotic. The overall SVR done at or after 12 weeks of completion of treatment was 88.75%. Age, gender distribution, occupation, socioeconomic status, educational status, body mass index, treatment regimen, duration of treatment, and baseline viral load did not alter the treatment response. Among comorbidities, only diabetes mellitus (DM) and human immunodeficiency virus (HIV) co-infection adversely affected the treatment response (P = 0.009 and P < 0.001, respectively). Intravenous (IV) drug abuse was significantly associated with treatment failure (P < 0.001). The presence of liver cirrhosis (P < 0.001), thrombocytopenia (P < 0.001), elevated transaminases (alanine transaminase: P = 0.021, aspartate transaminase: P < 0.001), and previous treatment experience (P = 0.038) were other significant predictors of treatment failure. Conclusions: DAAs are highly efficacious drugs in the treatment of CHC with a high rate of treatment response. Significant predictors of CHC treatment failure included comorbidities especially DM and HIV co-infection, IV drug abuse, presence of liver cirrhosis, thrombocytopenia, elevated transaminases, and previous treatment experience. However, independent predictors of treatment nonresponse observed in this study were thrombocytopenia, IV drug abuse, and liver cirrhosis.

Résumé Contexte: Le virus de l'hépatite C (VHC) est un agent pathogène universellement répandu et une cause majeure de morbidité et de mortalité liées au foie dans le monde. L'évolution de la thérapie antivirale pour le VHC a rapidement progressé des thérapies à base d'interféron (IFN) à des combinaisons sans IFN de médicaments à action directe antiviraux (AAD). Objectifs: Cette étude vise à évaluer la réponse des AAD chez les patients atteints d'hépatite C chronique (HCC) et à étudier les différents facteurs affectant la réponse des AAD dans les CHC. Cadres et conception : Cette étude observationnelle longitudinale s'étalant sur un an a été menée dans le département de médecine d'un hôpital universitaire de soins tertiaires. Matériels et méthodes: L'étude a été menée sur 400 patients adultes atteints d'HCC, diagnostiqués par un test d'anticorps anti-VHC positif et une charge virale détectable (ARN du VHC) par réaction en chaîne par polymérase en temps réel, inscrit pour le traitement par DAA. Les 400 premiers patients répondant aux critères d'éligibilité ont été enrôlés par échantillonnage consécutif non probabiliste. Tous les participants étaient traités conformément aux directives du programme national de contrôle de l'hépatite virale. La charge virale répétée du VHC a été effectuée à ou après 12 semaines d'achèvement traitement antiviral pour déterminer la réponse virologique soutenue (RVS). Divers facteurs susceptibles de prédire la réponse au traitement ont été analysés. Analyse statistique utilisée: les variables continues ont été exprimées sous forme de moyenne et d'écart-type, tandis que les variables catégorielles ont été résumés sous forme de fréquences et de pourcentages. Le test t indépendant de Student a été utilisé pour la comparaison des variables continues. Le chi carré ou Le test exact de Fisher, selon le cas, a été utilisé pour la comparaison des variables catégorielles. La régression logistique multivariée a été utilisée identifier les prédicteurs indépendants de la non-réponse au traitement. A P < 0.05 était considéré comme statistiquement significatif. Résultats: L'âge moyen des sujets était de 42.3 ± 15.23 ans avec un ratio hommes-femmes de 1.96:1. La plupart des patients (80.5%) étaient non cirrhotiques ; parmi 19.5% de cirrhose, 13% étaient compensés alors que 6.5% étaient cirrhotiques décompensés. La RVS globale effectuée à 12 semaines ou après la fin du traitement était 88.75%. Âge, répartition par sexe, profession, statut socio-économique, niveau d'instruction, indice de masse corporelle, schéma thérapeutique, durée du traitement, et la charge virale de base n'a pas modifié la réponse au traitement. Parmi les comorbidités, seuls le diabète sucré (DM) et l'immunodéficience humaine la co-infection par le virus (VIH) a affecté négativement la réponse au traitement (P = 0.009 et P < 0.001, respectivement). L'abus de drogues par voie intraveineuse (IV) a été significativement associée à l'échec du traitement (P < 0.001). La présence de cirrhose du foie (P < 0.001), thrombocytopénie (P < 0.001), élévation les transaminases (alanine transaminase: P = 0.021, aspartate aminotransférase: P < 0.001) et l'expérience de traitement antérieure (P = 0.038) étaient d'autres facteurs prédictifs significatifs d'échec thérapeutique. Conclusions: les AAD sont des médicaments très efficaces dans le traitement de l'HCC avec un taux de traitement élevé réponse. Les facteurs prédictifs significatifs d'échec du traitement des CHC comprenaient les comorbidités, en particulier la co-infection par le diabète et le VIH, l'abus de drogues par voie intraveineuse, la presence de cirrhose du foie, de thrombocytopénie, d'élévation des transaminases et d'antécédents de traitement. Cependant, des prédicteurs indépendants du traitement les non-réponses observées dans cette étude étaient la thrombocytopénie, l'abus de drogues intraveineuses et la cirrhose du foie. Mots-clés: Cirrhose, antiviraux à action directe, virus de l'hépatite C, toxicomanie par voie intraveineuse, réponse virologique soutenue, thrombocytopénie.

Assessment of Cardiovascular Parameters on Submaximal Treadmill Exercise in Obese versus Nonobese Adults.

Background: Obesity and overweight, irrespective of metabolic status, confer an increased risk of adverse consequences including cardiovascular diseases (CVDs). The mechanisms underlying altered cardiovascular responses in obese individuals during and after submaximal treadmill exercise are the subjects of great interest to public health. After graded exercise, delayed heart rate recovery (HRR), exaggerated blood pressure (BP) response, and prolongation of QT interval are the powerful predictors of cardiovascular morbidity and mortality that may facilitate timely identification of individuals at risk of CVD and help to evaluate the effectiveness of treatment interventions. Aim: To compare the cardiovascular parameters on submaximal treadmill exercise in obese and nonobese adults. Materials and Methods: This study was conducted on 80 subjects, 40 obese (cases) and 40 normal-weight individuals (controls), belonging to the age group of 18-60 years. Each participant was subjected to submaximal treadmill exercise according to the Bruce protocol. Heart rate (HR), systolic BP and diastolic BP (SBP and DBP), mean arterial pressure (MAP), QT and corrected QT (QTc) intervals, and rate pressure product (RPP) were measured preexercise, immediately after exercise, and during passive recovery at 1 min and 5 min after exercise. The Chi-square test and Mann-Whitney U-test, whichever is appropriate, were employed for the comparison of variables between the two study groups. P < 0.05 was considered statistically significant. Results: Mean HR immediately after exercise, at 1 min and 5 min postexercise was significantly higher in obese when compared to nonobese participants (P = 0.006, P = 0.001, P = 0.001) despite similar resting HR in both the groups (P = 0.874). Mean SBP, DBP, MAP, and RPP were significantly higher in obese in comparison to nonobese subjects in all stages, i.e. before exercise, immediately after exercise, at 1 min and 5 min after exercise. QT and QTc intervals were also found to be significantly greater in obese than nonobese subjects in all stages (P = 0.001 each). Conclusion: Obese subjects had higher resting BP (SBP, DBP, and MAP), QT/QTc interval, RPP, and increased response to submaximal treadmill exercise activity. Delayed HRR after exercise was also noted in obese subjects which indicates that obese populations are at risk of developing CVDs due to alteration in autonomic functions with sympathetic hyperactivity.

Study of lipid profile in young patients (age 40 years or below) with acute coronary syndrome.

Background: Acute coronary syndrome (ACS) refers to a group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina, non-ST segment elevation myocardial infarction and ST-segment elevation myocardial infarction. Aims and Objectives: To study the incidence of lipid profile abnormalities in young patients (age 40 years or below) with ACS with clinical and cardiovascular risk profile. Material and Methods: The study was conducted on 223 young patients of acute coronary syndrome with age 40 years or below. 89 young patients with acute coronary syndrome having lipid abnormalities were further followed up after 1 month. Results: Majority of patients (55.15%) in the study population belonged to 35-40 years age group. Mean age of study population was 35.65 + 4.62 years with 90.13% males and 9.86% females. Main presenting symptom was precordial chest pain in 93.72% patients. Smoking was the commonest risk factor in young adults (81.7%). Other risk factors like diabetes, hypertension, family history were less common in young adults. Drug addiction was also higher in younger population (16%). Majority of young adults with acute coronary syndrome had more than 1 (47.53%) risk factor. Majority of patients were in Killip class I (86.9%) and only few patients (13.1%) had Killip class II or above. ST elevation myocardial infarction was far more common than NTEMI/USA and was found in 164 (73.5%) patients. Most common type of infarction was anterior wall myocardial infarction (62.80%). Majority of young patients had negative TMT, so it suggests that ACS in younger population has lesser complications during presentation, hospital stay and on follow-up. Conclusion: ACS in young continues to increase in Indian subcontinent. Younger patient with an ACS have different clinical characteristics and a different prognosis than older patients. The extent of CAD and degree of myocardial necrosis has influence on presentation and subsequent MACE in ACS and in this study, it appears dyslipidemia do not play any significant role in influencing extent of CAD and has little effect on outcome whether during acute stage or on immediate follow-up after ACS.

Clinico-hematological profile of pancytopenic adult patients in a tertiary care teaching hospital.

OBJECTIVE: The causes of pancytopenia vary in different populations depending on age, gender, nutrition, geographic location, standard of living, and exposure to certain infections and drugs. As the severity of pancytopenia and its underlying etiology determine the management and prognosis, identifying the correct etiology in a given case is crucial and helps in implementing timely and appropriate treatment. The objectives of this study were to study the clinical profile and hematological parameters of pancytopenic adults and to identify different etiologies of pancytopenia. This observational study was conducted in the Medicine department of a tertiary care teaching hospital. MATERIALS AND METHODS: The study was conducted on 100 adult patients aged 18-65 years presenting with pancytopenia. All the participants were subjected to detailed clinical examination and relevant investigations including bone marrow (BM) examination. Categorical variables were presented in number and percentage (%). Qualitative variables were correlated using the Chi-square test. A P =0.05 was considered statistically significant. RESULTS: A female preponderance was observed, and the majority of patients were aged between 18 and 40 years. The most common clinical features were generalized weakness, fever, and pallor. Seventy-four percent of patients were vegetarians; 58% had vitamin B12 deficiency, 25% had folic acid deficiency and 19% had a deficiency of both. The most common cause of pancytopenia was megaloblastic anemia (MA) (37%), followed by dimorphic anemia (DA) (26%), aplastic anemia (AA) (20%), and hematological malignancies (11%). CONCLUSION: MA, DA, and AA are the most prevalent etiologies of pancytopenia. BM examination is of utmost importance in the definitive diagnosis of pancytopenia and is useful in initiating timely treatment as a significant number of causes of pancytopenia are potentially curable.

Clinical and laboratory profile of patients with presumptive clinical diagnosis of acute bacterial meningitis and its short-term complications.

Background: Worldwide, one million cases of bacterial meningitis are estimated to occur and 200,000 of them die annually. Case fatality rates vary with age at the time of illness and the species of bacterium causing infection. In view of variable clinical features and complication rates in various studies, the present study was planned to assess the clinical and laboratory profile of patients with acute bacterial meningitis and analyze the therapeutic response and short-term sequelae. Materials: This study was conducted in the department of pediatrics at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak. A total of 50 pediatric patients with signs and symptoms of acute bacterial meningitis who satisfied the inclusion or selection criteria were enrolled in the study. Appropriate statistical tests were applied for analysis and trial registry was done with PGIMS. Results: In the present study, slightly more males (54%) were found than females (46%). The sequelae and mortality were 33.3%, 26.1% and 7.4%, 8.7% in males and females, respectively. There were higher chances of sequelae or mortality in males as compared to females (OR 1.289, 95% CI 0.073-6.11, P > 0.05). Predominant cells were polymorphonuclear (PMN) cells except in >120 months age group where both PMN (50%) and mononuclear (50%) cells were equally visualized. Mean CSF protein was slightly higher in 2-24 months age group. Conclusion: We compared the group with sequelae with the group with no sequelae and found neurological deficit (P < 0.01), and presence of complications (P < 0.01) were significantly associated with sequelae.

Utility of special drive campaign on substance use disorders in hard-to-reach communities in the fast urbanizing town of Solan, India.

AIMS: Special drive campaigns on substance use disorders (SUDs) in India are usually organized in educational institutes, non-governmental organizations, or few selected localities. Hard to reach communities of construction, prison, and industrial sites quite often remain uncovered. MATERIALS AND METHODS: During a month-long special drive in 2019, under a cross-sectional study, we reached these communities of Solan town through awareness camps and incorporated standardized screening tools for evaluating morbidity patterns of SUDs. RESULTS: Statistically significant relationship existed between 360 participants (90.8% males, 9.2% females; mean age of 33 years) and their educational levels with χ2 (1, n = 360) =130.59, P = 0.000. Fagerstrom's scale inferred very high nicotine dependence in 10.6%, 7.9%, and 2.4% of prisoners, industrial workers, and laborers, respectively. Whereas, Fagerstrom scale for smokeless tobacco revealed 31% of significant dependence potential amongst laborers. Alcohol use disorder identification test revealed 28 persons with harmful alcohol dependence. Drug abuse screening test revealed 13.6% of prisoners having moderate level drug abuse potential. The Kruskal-Wallis test showed a statistically significant difference, in levels and potential of substance use in construction, prison, and industrial sites. CONCLUSION: The study proved the utility of special drives in evaluating SUDs morbidity patterns in hard-to-reach communities.

Comparative study on fasting and postprandial lipid profile in type 2 diabetes mellitus.

CONTEXT: Postprandial dyslipidemia plays a vital role in the pathogenesis of atherosclerosis and possible macrovascular complications in type 2 diabetes mellitus (DM). AIMS: To assess and compare the fasting and postprandial lipid profiles in type 2 DM patients. SETTINGS AND DESIGN: This case-control study was conducted in the Medicine department of a tertiary care teaching hospital. METHODS AND MATERIALS: The study included 100 subjects; 50 type 2 diabetic patients and 50 healthy age- and gender-matched controls. Fasting and postprandial lipid levels were estimated in all the subjects and compared. STATISTICAL ANALYSIS USED: The Student's t-test and the analysis of variance (ANOVA) test were used for comparison between two and more than two groups, respectively, for normally distributed data. RESULTS: Mean total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), and very low density lipoprotein (VLDL) levels were significantly higher and high density lipoprotein (HDL) level was significantly lower in the diabetics in comparison to the controls in both fasting (200.82, 172.59, 126.20, 37.63, and 40.74 mg/dL in diabetics versus 179.90, 98.03, 109.54, 19.60, and 50.46 mg/dL in controls) and postprandial states (223.75, 232.99, 139.19, 46.52, and 40.54 mg/dL in diabetics versus 185.36, 102.20, 110.36, 20.24, and 48.96 mg/dL in controls). The mean postprandial TC and TG levels (223.75, 232.99 mg/dL) in diabetics were significantly higher when compared to their fasting values (200.82, 172.59 mg/dL) in these patients. CONCLUSIONS: Type 2 DM patients show significant postprandial lipid abnormalities particularly postprandial hypertriglyceridemia. Raised postprandial lipid parameters highlight that estimating lipids in the postprandial state is equally important as is estimation of lipids in the fasting state in type 2 DM.

Role of serum ferritin as a prognostic marker in acute ischemic stroke: A preliminary observation.

Background: Acute ischemic stroke is an important cause of morbidity and mortality. Search has been on to find out the factors which can help in formulating the prognosis of acute ischemic stroke. One of the prognostic indicators, which has gained great clinical interest in recent times, is serum ferritin. Aims: To assess the serum ferritin levels in patients with acute ischemic stroke and to study the role of serum ferritin as a prognostic marker in these patients. Materials and Methods: This prospective, observational study was conducted on 50 patients of acute ischemic stroke aged ≥18 years who presented within 48 hours of onset of symptoms. Clinical severity of stroke was assessed at admission and on the 6th day using Canadian Stroke Scale (CSS), and serum ferritin levels were measured at admission and on the 6th day in all these subjects. Results: The mean serum ferritin levels at admission in patients with "more severe stroke" (CSS score at admission ≤7) and "less severe stroke" (CSS score at admission >7) were 282.77 ± 120.53 and 205.12 ± 110.96 ng/mL, respectively. The mean serum ferritin levels at admission were 173.71 ± 109.69 ng/mL in subjects who did not deteriorate and 336.86 ± 57.28 ng/mL in those who deteriorated, while the mean serum ferritin levels on the 6th day were 193.29 ± 101.88 and 343.95 ± 52.34 ng/mL in subjects who did not deteriorate and those who deteriorated, respectively. Conclusions: Serum ferritin has a significant positive correlation with the severity of acute ischemic stroke (P < 0.001), and the levels correlate with the outcome of the disease (P < 0.001); the patients with higher serum ferritin at admission tend to deteriorate more as compared to those with lower levels. Thus, serum ferritin can be used as a prognostic marker in acute ischemic stroke.

RésuméContexte: L'AVC ischémique aigu est une cause importante de morbidité et de mortalité. Des recherches sont en cours pour découvrir les facteurs qui peuvent aider à formuler le pronostic d'un AVC ischémique aigu. L'un des indicateurs pronostiques, qui a suscité un grand intérêt clinique ces derniers temps, est la ferritine sérique. Objectifs: Évaluer les taux sériques de ferritine chez les patients ayant subi un AVC ischémique aigu et étudier le rôle de la ferritine sérique comme marqueur pronostique chez ces patients. Matériel et méthodes: Cette étude observationnelle prospective a été menée sur 50 patients ayant subi un AVC ischémique aigu âgés de ≥18 ans et qui se sont présentés dans les 48 heures suivant l'apparition des symptômes. La gravité clinique de l'AVC a été évaluée à l'admission et au 6e jour à l'aide de l'échelle canadienne de l'AVC (CSS), et les taux sériques de ferritine ont été mesurés à l'admission et au 6e jour chez tous ces sujets. Résultats: Les taux moyens de ferritine sérique à l'admission chez les patients avec "AVC plus severe" (score CSS à l'admission ≤7) et "AVC moins severe" (score CSS à l'admission >7) étaient de 282.77 ± 120.53 et 205.12 ± 110.96 ng/mL , respectivement. Les niveaux moyens de ferritine sérique à l'admission étaient de 173.71 ± 109.69 ng/mL chez les sujets qui ne se sont pas détériorés et de 336.86 ± 57.28 ng/mL chez ceux qui se sont détériorés, tandis que les niveaux moyens de ferritine sérique au 6ème jour étaient de 193.29 ± 101.88 et 343.95 ± 52.34 ng/mL chez les sujets qui ne se sont pas détériorés et ceux qui se sont détériorés, respectivement. Conclusions: La ferritine sérique a une corrélation positive significative avec la gravité de l'AVC ischémique aigu (P <0.001), et les niveaux sont en corrélation avec l'issue de la maladie (P <0.001); les patients avec une ferritine sérique plus élevée à l'admission ont tendance à se détériorer davantage par rapport à ceux avec des niveaux inférieurs. Ainsi, la ferritine sérique peut être utilisée comme marqueur pronostique dans un AVC ischémique aigu.

Is coronavirus lockdown taking a toll on mental health of medical students? A study using WHOQOL-BREF questionnaire.

INTRODUCTION: The Quality of life is a broad-ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationship to salient features of their environment. The ongoing COVID-19 pandemic has resulted in many quarantine and isolation measures and lockdown of the nation for the foreseeable future. Although these initiatives are necessary to prevent the spread of coronavirus they may be causing adverse mental health effects. Medical students are backbone and future of the health system and the general public always looks up to them as a role model of society. With this background, this study aims to assess the quality of life among medical students during the lockdown period amid the COVID-19 pandemic. MATERIAL AND METHODS: A self-administered, pretested, questionnaire based on World Health Organization Quality of Life: Brief Version (WHOQOL-BREF) standard quality of life was used. For internal reliability and structural validity, Cronbach's alpha coefficient and confirmatory factor analysis (CFA) were calculated, respectively. t-test, one way ANOVA, and Pearson Chi-square test were used. RESULTS: The mean scores of domains of the present study were highest for the environmental domain (72.10 ± 13.0) followed by physical (67.23 ± 13.74), social (57.13 ± 20.1), and lowest for the psychological domain (52.10 ± 17.45). The level of internal consistency was found to be 0.883, which is considered as sufficiently reliable. One-third of the medical students were spending >6 h on-screen, and merely 15.6% were doing physical activity >1 h. CONCLUSION: It was found that during this time of crisis medical students were weaker in the psychological domain of Quality of Life among all the four domains. Physical activity and screen time was an important factor to the QOL of students, and it is likely that students would benefit from increased physical activity and minimizing screen time.

Levofloxacin-induced Desquamation: A Possible and Rare Case Report.

INTRODUCTION: Levofloxacin is a fluoroquinolone active against both gram-negative and gram-positive bacteria with a well-defined margin of safety and efficacy. It has various labeled adverse effects like other fluoroquinolones but its adverse effect like desquamation is rarely reported. METHODS: We present a case report of levofloxacin-induced desquamation in an Indian patient. CASE REPORT: A-38-year old female patient presented to the outpatient department, with chief complaints of peeling off her epidermal skin. Initially, Desquamation started on her greater finger, which slowly spread to her hand, feet, lower limbs as well as upper limb and neck region. She was prescribed Levofloxacin for respiratory tract infection. RESULTS AND DISCUSSION: Considering temporal relationship, upon causality assessment, (Adverse Drug Reaction) ADR was found to be likely, moderate and probable. The drug was withdrawn along with the initiation of supportive therapy and reaction subsided. CONCLUSION: Although adverse drug reactions like desquamation are not fatal, this induces anxiety in the patients and reduces patient's quality of life. This case report will help keep physicians vigilant about the current adverse drug reaction, helping in the early detection and management of ADR.

Evaluation of obstructive sleep apnea in metabolic syndrome.

BACKGROUND: Metabolic syndrome has become one of the most important public health problems with a growing prevalence in both developed and developing countries. Obesity is a major risk factor for obstructive sleep apnea (OSA), which is associated with significant cardiorespiratory morbidity. AIMS: The aims of this study were to find out the prevalence of OSA in patients with metabolic syndrome and to highlight the importance of assessment of OSA in these patients. METHODS: This cross-sectional analytical study was conducted on 100 subjects aged 30-60 years, comprising 50 cases of metabolic syndrome and 50 controls without metabolic syndrome. Overnight polysomnography was done in all the subjects. Prevalence and severity of OSA were assessed and compared between the two groups. RESULTS: Prevalence of OSA was significantly higher (66%) in patients with metabolic syndrome than in subjects without metabolic syndrome (12%). Out of 33 (66%) OSA patients with metabolic syndrome, 8 (16%) had mild OSA, 11 (22%) had moderate OSA, and 14 (28%) had severe OSA. Increasing severity of OSA was associated with higher mean levels of all the metabolic syndrome parameters except serum high density lipoprotein (HDL). CONCLUSIONS: OSA is highly prevalent in patients with metabolic syndrome. Also, the increasing severity of OSA is associated with poorer control of diabetes, hypertension, and dyslipidemia, which are all components of metabolic syndrome. Therefore, effective treatment of metabolic syndrome can prevent and control OSA in these patients. Similarly, reducing the severity of OSA (by early diagnosis and treatment) in patients with metabolic syndrome might help to optimize control of blood sugar, blood pressure, and serum lipids, thereby reducing the risk of cardiovascular disease. Therefore, the need for screening metabolic syndrome patients for OSA has been reinforced by this study.

Asymptomatic bacteriuria among the patients of type 2 diabetes mellitus.

BACKGROUND: Asymptomatic bacteriuria (ASB) is common in neonates, preschool children, pregnant women, elderly, diabetics, catheterized patients, and patients with abnormal urinary tracts or renal diseases. Though there is currently no consensus on treatment of ASB in various population groups, it is advisable to treat the same in patients with diabetes mellitus (DM). AIMS: To determine the prevalence of ASB in patients with type 2 DM and to study the spectrum of uro-pathogens causing ASB along with their antibiotic susceptibility profile. SETTINGS AND DESIGN: This prospective, observational study was conducted in the department of Medicine of a tertiary care teaching hospital. METHODS: The study was conducted on 100 patients with type 2 DM. Urine wet mount and gram stain examination was done for all to detect the presence of pus cells and bacteria in urine. Antibiotic sensitivity testing was performed in patients with significant bacteriuria to determine the sensitivity profile of isolated uro-pathogens. The data were analyzed to determine the association between diabetes and ASB. RESULTS: ASB was common among diabetics, as evident by a prevalence of 21%. Presence of ASB showed positive correlation with poor glycemic control. Escherichia coli (E. coli) was the most common organism causing ASB followed by Candida, Pseudomonas, Klebsiella, and Citrobacter. E. coli isolated from study patients was most sensitive to imipenem and nitrofurantoin (NFT). CONCLUSIONS: ASB is common among diabetics, with poor glycemic control being a significant risk factor. E. coli is the most common organism causing ASB in diabetics, and it is most sensitive to imipenem and NFT.

Impact of health education on knowledge, attitude, practices and glycemic control in type 2 diabetes mellitus.

BACKGROUND: Effective health education consequently improves knowledge, attitude, and practices (KAP) leading to better glycemic control and is widely accepted as an integral part of comprehensive diabetes care for affected individuals and their families in primary care settings. AIMS: To assess the impact of health education on knowledge, attitude, practices, and glycemic control in type 2 diabetes mellitus patients. SETTINGS AND DESIGN: This case control study was conducted in the department of Medicine of a tertiary care teaching hospital. METHODS: The study was conducted on 100 diabetic subjects aged more than 40 years comprising of 50 cases and 50 controls. Cases were given education on their disease, drugs, dietary, and lifestyle modifications along with patient education leaflet at baseline and at first follow-up, while controls received neither of these. Subjects were assessed for KAP by administering KAP questionnaire and for glycemic control by measuring glycated hemoglobin (HbA1C) at baseline and at the end of the study. RESULTS: In this study, end mean knowledge, attitude, practice, and KAP SUM scores of cases (10.28 ± 1.78, 3.46 ± 0.93, 3.14 ± 0.86, and 16.82 ± 3.40, respectively) showed significant increase from the baseline (3.86 ± 0.93, 1.00 ± 0.83, 0.40 ± 0.64, and 5.26 ± 2.10, respectively) compared to controls, accompanied by significant reduction in HbA1C of cases at the end of the study compared to the controls. CONCLUSIONS: Effective health education improves knowledge, attitude, and practices, particularly with regard to lifestyle modifications and dietary management, culminating into better glycemic control that can slow down the progression of diabetes and prevent downstream complications.

Impact of Additional Short Session of Video Training on Performance of Basic Life Support Skills in 2nd-Year Medical Students.

CONTEXT: Basic life support (BLS) is a core life-saving skill which everyone should know, but knowledge of BLS is poor even among medical students. AIMS: The aim of our study was to assess the knowledge regarding BLS among medical students and see impact of training and also to know whether a short session of video training made an impact on their cardiopulmonary resuscitation (CPR) skills. SETTINGS AND DESIGN: Ninety-two 2nd-year medical students were included in the study. MATERIALS AND METHODS: Their baseline knowledge regarding BLS was assessed before workshop with pretest 1. Following workshop posttest 1 and 1 month later, posttest 2 was conducted. A short duration video training on BLS was done after posttest 2 and its impact was assessed 2 months later with performance of CPR skills on a mannequin. STATISTICAL ANALYSIS USED: Data analysis was done using SPSS version 23.0. Pearson's Chi-square test was used to evaluate the differences between groups for categorized variables. Unpaired and paired t-test was used to calculate the difference of means for quantitative variables. RESULTS: There was significant improvement in knowledge regarding BLS after the workshop. Even after 1 month, though there was decline in knowledge, still it was significantly higher than the baseline. Short duration video training session did not lead to any improvement in BLS skills. CONCLUSIONS: BLS training should start early in medical curriculum with reinforcement at regular intervals. Single short duration video training session did not have any impact on improvement of skills.

Adult onset seizures: Clinical, etiological, and radiological profile.

INTRODUCTION: Adult onset seizure disorder is a major public health concern in terms of burden of disease, nature of illness, and its impact on individual, family, and community. This study was done to assess the clinical profile and etiology of adult onset seizures and correlates of clinical and radiological pattern. MATERIALS AND METHODS: This was a prospective cross-sectional hospital-based study conducted on 100 cases presenting with adult onset seizures. RESULTS: Adult onset seizures were most prevalent in the young and middle-aged adults than elderly; generalized seizures were more common than focal seizures. However, the incidence of generalized seizures showed a falling trend as the age advanced whereas focal seizures increased in incidence with advancing age. Overall, the most common etiology of seizures was stroke, followed by idiopathic and central nervous system infections; yet, most common etiology of adult onset generalized and focal seizures was idiopathic and stroke, respectively. Regarding etiology, among younger adults, idiopathic seizures were predominant, whereas among middle aged and elderly, stroke was the most common etiology. CONCLUSIONS: It is mandatory to deal carefully with each case of adult onset seizure with a tailor-made approach. Identification and awareness about the etiological factors and seizure type help in better management of these patients. Primary care physicians play a pivotal role in identifying patients with adult onset seizures and should encourage these patients to undergo neuroimaging so as to arrive at an appropriate etiological diagnosis. In the face of recent advances in neuroimaging techniques, the future prospective management of adult onset seizures appears bright and convincing.

Assessment of Vitamin D in Rheumatoid Arthritis and Its Correlation with Disease Activity.

BACKGROUND: Vitamin D is believed to have an immunomodulatory and anti-inflammatory action, and its deficiency has been linked with several autoimmune disorders, including rheumatoid arthritis (RA). The relationship between the severity of RA and serum levels of Vitamin D is a subject of immense interest and therapeutic implications. MATERIALS AND METHODS: This was a prospective, comparative study conducted on 100 participants, 50 cases of RA and 50 healthy controls, all in the age group of 18-75 years. Serum Vitamin D levels were measured and compared in cases and controls. Vitamin D levels in RA patients were also assessed in different stages of disease activity to assess the correlation between the two. RESULTS: Eighty-four percent patients of RA were Vitamin D deficient versus only 34% of controls. The serum Vitamin D levels were also significantly lower in the RA patients (mean value of 21.05 ± 10.02 ng/ml), as compared to the controls (mean value of 32.87 ± 14.16 ng/ml). There was a significant inverse correlation between serum Vitamin D levels and RA disease activity. The mean serum Vitamin D levels were 35.28 ± 9.0 ng/ml, 33.80 ± 4.1 ng/ml, 22.47 ± 6.18 ng/ml, and 14.21 ± 6.97 ng/ml in the remission, low disease activity, moderate disease activity, and high disease activity groups, respectively. CONCLUSIONS: Vitamin D deficiency is more common in RA patients and may be one of the causes leading to development or worsening of the disease.

Clinico-sonographical evaluation of idiopathic clubfoot and its correction by Ponseti method - A prospective study.

BACKGROUND: Objective evaluation of infant with clubfoot is required as conventional imaging modality is of limited usefulness. Ultrasound shows to be a promising technique for assessing deformity and monitoring of clubfoot correction. AIM: Study was done to evaluate the deformity sonographically; to assess the changes in these parameters after treatment by Ponseti method and to correlate these ultrasonographic variables with clinical Pirani score. MATERIALS AND METHODS: 82 feet in 54 children were observed. Clinical assessment was done using Pirani six point system and ultrasound machine with 7.5-12MHz linear transducer was used to measure several parameters and data obtained was assessed to derive correlation between sonographic parameters and clinical system. RESULTS: Medial malleolus navicular distance (MMN) measured on medial view, calcaneo-cuboid distance (CCD) and calcaneo-cuboid angle (CCA) measured on lateral view, talar length (TAL) measured on dorsal view and tibio-calcaneal distance (TCL) measured on posterior view showed statistical significance. Sonographic parameters correlated statistically with Pirani scoring system on measuring Pearson correlation coefficient. CONCLUSION: Ultrasound is a relatively simple, non invasive and widely available procedure that can improve pathomorphological documentation of nonossified clubfoot and its correction. LEVEL OF EVIDENCE: Level II prospective study, as per guidelines for authors.

Hypertension in Pregnancy: A Community-Based Study.

BACKGROUND: Hypertensive disorders during pregnancy occur in women with preexisting primary or secondary chronic hypertension, and in women who develop new-onset hypertension in the second half of pregnancy. The present study was undertaken to study the prevalence and correlates of hypertension in pregnancy in a rural block of Haryana. MATERIALS AND METHODS: This cross-sectional study was carried out in the all 20 subcenters under Community Health Center (CHC) Chiri, Block Lakhanmajra. All the pregnant women registered at the particular subcenter at a point of time of visit were included in the study. Appropriate statistical tests were used for analysis. RESULTS: A total of 931 pregnant women were included in the present study. Prevalence of hypertension in pregnancy was found to be 6.9%. Maternal age ≥25 years, gestational period ≤20 weeks, history of cesarean section, history of preterm delivery, and history of hypertension in previous pregnancy were found to be significantly associated with prevalence of hypertension in pregnancy. CONCLUSION: Nearly one in 14 pregnant women in rural areas of Haryana suffers from a hypertensive disorder of pregnancy. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent hypertensive disorders of pregnancy and its complications.

Giant cell tumour 2nd metatarsal-Result with en-bloc excision and autologous fibular grafting.

Giant cell tumour (GCT) of the small bones is relatively uncommon tumour. It occurs most commonly in the distal portions of femur and radius and proximal end of tibia. GCT of small bones presents at advanced stages with major bony destruction. These tumours represent more aggressive course; associated with increased local recurrence rates (40%) and metastasis. Various treatment modalities like en-bloc resection, cryosurgery, intralesional curettage with burring/phenolization or bone cement are available. In our case en-bloc resection with reconstruction using nonvascular autogenous fibular strut graft was used in patient of 2nd metatarsal GCT and a favourable functional outcome was observed.