A Randomized Controlled Trial on Comparison of Clinical Outcome in Uncomplicated SAM Managed with and without Antibiotics.

OBJECTIVES: To assess the clinical outcome of management of uncomplicated severe acute malnutrition (SAM) at community level with antibiotics vs. without antibiotics. METHODS: A randomized controlled trial was conducted on children aged 6 to 59 mo with uncomplicated SAM, selected randomly from rural areas of Kanpur. A total of 100 children were enroled and were randomized into two groups, the intervention group who were given antibiotics for a week and the control group who were not given antibiotics. Rest of the management was same. Demographic, clinical and anthropometric details of each child were taken. RESULTS: Gender and socio-economic status was comparable in both the groups. Anthropometric parameters (mean weight for age, height for age and weight for height) in both the groups were not significantly different at the time of enrolment and also at two weeks follow-up. At 2 wk follow-up, weight/height Z score in the intervention and control group were -1.29±0.84 and -1.45±0.93, respectively (p value = 0.436). CONCLUSIONS: It was concluded that whether antibiotics were given or not in the management of children with uncomplicated SAM, improvement in clinical and anthropometric parameters was seen without any significant difference.

Intrastromal keratopigmentation: a boon for unsightly corneal scars.

PURPOSE: The aim of this study was to improve cosmesis in patients with corneal opacity (CO) using newer organic micronized pigments. METHODS: Settings: Tertiary Care eye center, Design: Retrospective study. INCLUSION CRITERIA: Patients with unsightly corneal scars not suitable for keratoplasty, eccentric corneal opacity not requiring keratoplasty, or lenticular opacity/anterior or posterior capsular opacities in non-seeing eyes. Micronized organic pigment was used for keratopigmentation by the intrastromal pocket technique (ISPT) in deep corneal opacities and lenticular opacities, whereas the intrastromal needle puncture technique (ISNT) was used in superficial opacities or corneoiridic scars. The records of 463 patients were reviewed and analyzed for the duration of the past 7 years. RESULTS: Two hundred and ninety-three (63.2%) patients underwent ISNT, eight underwent combined technique, and the rest underwent ISPT. The postoperative follow-up period showed more watering and redness in the needle puncture technique (p > 0.001), which resolved in 70.4% of patients by the end of 4 weeks. Repeat procedures were required in 5.3% of the patients with ISNT. The patient's satisfaction grading showed excellent levels in 375 (80.9%) patients, 45 (9.7%) had good satisfaction levels, and the rest had average satisfaction levels. CONCLUSION: Intrastromal keratopigmentation is a boon for unsightly corneal scars and gives respite to the patients from the social stigma.

Risk Factors of Recurrence of Febrile Seizures in Children in a Tertiary Care Hospital in Kanpur: A One Year Follow Up Study.

BACKGROUND: Febrile seizures are commonly seen in children and about one-third of the children develop a recurrence of febrile seizures. OBJECTIVES: The main objective is to study the risk factors associated with recurrence of febrile seizures in Indian children. METHODS: This prospective, longitudinal study was carried out in the Department of Pediatrics, GSVM Medical College, Kanpur. All children, 6 months to 5 years of age, attending the department from February 2015 to January 2016 presenting with first febrile seizures were included in the study and followed up for recurrence. RESULTS: Of 528 children, 174 (32.9%) had recurrence and 354 (67.1%) had a single episode of febrile seizures. Recurrence was more in children <18 months (41.3%) as compared to children ≥18 months (24.1%). Children with temperature 101°F during the seizure had a recurrence rate of 52.5% while recurrence was seen in only 17.2% in children with temperature ≥105°F. There was a significant declining trend of recurrence with increase in temperature. Recurrence was significantly more common in children with a family history of febrile seizures (45.5%) as compared to those without family history (27.8%). Multiple logistic regression analysis revealed that younger age at onset of first seizure, lower temperature during the seizure, brief duration between the onset of fever and the initial seizure, and family history of febrile seizures were risk factors significantly associated with recurrence of febrile seizures in children. CONCLUSION: Younger age at first seizure, short duration of fever before the onset of first febrile seizure, lower temperature at onset, and family history of febrile seizures are risk factors of recurrence of febrile seizures in children.

Anthropometric indicators as predictor of pre-diabetes in Indian adolescents.

INTRODUCTION: In India, there are approximately 41 million diabetics to date. Impaired glucose tolerance or pre-diabetes may occur as early as adolescence. OBJECTIVE: To find out the cut-off values of body mass index (BMI) and waist circumference to predict pre-diabetes in adolescents in north India. METHODS: A cross-sectional study was conducted among 526 students aged 17-19 years, in the Institute of Paramedical Sciences, Chatrapati Shahuji Maharaj University, Kanpur. A pre-tested questionnaire was used and the diagnostic criteria of the American Diabetic Association were applied. Receiver operating characteristic(ROC) analysis was used to assess the cut-offs of BMI and waist circumference for predicting prediabetes. RESULTS: ROC analysis showed that BMI is a good predictor of prediabetes for both boys and girls.Area under the ROC curve was 0.828 for boys and 0.838 for girls, respectively. The cut-off values of BMI for predicting prediabetes were identified as ≥22.8kg/m2 in boys and ≥20.5kg/m2 in girls. Upon ROC analysis for waist circumference, it was observed that it was a good predictor of prediabetes both for boys (area under the curve 0.804) and girls (area under the curve 0.795). The cut-offs for waist circumference for predicting prediabetes were found to be ≥82.5cm for boys and ≥80.3cm for girls. CONCLUSION: BMI and waist circumference estimation can be done for early detection of prediabetes in adolescents for further diagnostic evaluation and management.

Increment in vitamin D level and bone mineral accrual in children with vitamin D deficiency.

PURPOSE: To compare different regimens of vitamin D with respect to its serum increment levels and bone mineral accrual in vitamin D-deficient children. METHODS: Children identified as being vitamin D deficient (serum levels<20 ng/mL) were divided into 3 treatment groups by stratified block randomization (group 1, 4,000 IU/day of vitamin D3 plus 50 mg/kg/day calcium for 12 weeks; group 2, 30,000 IU/wk of vitamin D3 plus 50 mg/kg/day calcium for 12 weeks; and group 3, 300,000 IU of vitamin D3 once intramuscularly plus 50 mg/kg/day calcium). After regimen completion, each child received a maintenance dose of 400 IU/day vitamin D3 plus 50 mg/kg/day calcium. Their serum vitamin D level was measured after 3 and 12 months. Total body less head bone mineral concentration (BMC) and total body less head bone mineral density (BMD) were measured after 12 months. RESULTS: The mean increment in serum vitamin D levels from baseline to 3 months was significantly higher in group 3 than in groups 1 and 2, but the levels from 3 to 12 months were almost similar among all 3 groups. There were no significant differences among the 3 groups with respect to percentage increase of BMD and BMC. CONCLUSION: The injectable form of vitamin D was more efficacious than the oral forms in increasing the serum level to the normal range. All 3 regimens were equally effective in increasing the BMC and BMD. The 400 IU/day maintenance dose was sufficient to keep the serum level within the normal range.

A study on assessment of symptoms and functionality in DOTS cured patients in two districts of Garhwal, Uttarakhand.

BACKGROUND: In 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease. India has achieved the target of a case detection rate of 70% and a cure rate of 85% through the nationwide Directly Observed Treatment Short Course (DOTS) strategy. Tuberculosis may generate residual lesions in the course of its pathology, which impair the functionality of the patient even after achieving "cure" or "treatment completion". AIMS: To assess the presence of symptoms and functionality of tuberculosis patients who had completed the treatment or had been declared as cured under Revised National Tuberculosis Programme (RNTCP). METHODS: The present study was a cross sectional study. It was conducted in the two Tuberculosis Units (TUs) of Rudraprayag and Pauri in Garhwal region of Uttarakhand among the people who had completed treatment under DOTS or had been declared as cured under RNTCP in last one year. RESULTS: Even at the completion of the treatment about 37% had cough, 25% had expectoration, 6% had hemoptysis, more than 50% had chest pain and 65% had breathlessness. The mean distance walked by the participants in six minutes was 363.5 ± 58.2 m with a range of 245-490 m. CONCLUSIONS: The persistence of symptoms indicate that the functionality of DOTS cured patients remains compromised even after days and months of treatment completion, thereby necessitating measures for the improvement of the overall health of the patients rather than just the microbiological cure.

Correlation between hypertension and hyperglycemia among young adults in India.

AIM: To assess the correlation between blood pressure levels and fasting plasma glucose levels among young adults attending Chatrapati Shahuji Maharaj University, Kanpur, India. METHODS: The present study was cross-sectional in nature, conducted among students in the Institute of Paramedical Sciences, Chatrapati Shahuji Maharaj University, Kanpur. Study subjects included 185 young adults. Among them, 94 were males and 91 were females, in the age group 17 to 19 years. RESULTS: Mean age among males was 18.5 ± 1.5 years and among females was 17.9 ± 1.8 years. Of the total 185 study subjects, 61 (32.9%) were classified as pre-diabetic and 20 (10.8%) as pre-hypertensive. Mean waist circumference, systolic blood pressure and serum high density lipoprotein did not vary significantly between normoglycemic and pre-diabetic subjects. However, the mean diastolic blood pressure of pre-diabetics (82 ± 5 mmHg) was significantly higher than normoglycemics (79 ± 6 mmHg). Mean serum cholesterol, serum triglycerides, serum low density lipoprotein (LDL) and serum very low density lipoprotein was also higher among pre-diabetic subjects in comparison to normoglycemic subjects and the difference was statistically significant. Upon multiple linear regression analysis, it was observed that body mass index (BMI) (ß = 0.149), diastolic blood pressure (ß = 0.375) and serum LDL (ß = 0.483) were significantly associated with fasting plasma glucose. Multiple linear regression with diastolic blood pressure as the outcome variable showed that BMI (ß = 0.219), fasting blood glucose (ß = 0.247) and systolic blood pressure (ß = 0.510) were significantly associated. CONCLUSION: A significant prevalence of pre-diabetes and pre-hypertension in young adults is a matter of concern therefore all young adults need to be targeted for screening of diabetes and hypertension and lifestyle modification.

Cut-off of body mass index and waist circumference to predict hypertension in Indian adults.

AIM: To determine the cut-off values of body mass index (BMI) and waist circumference to predict hypertension in adults in north India. METHODS: A community based cross-sectional study was conducted in 801 subjects in Kanpur, aged 20 years and above, using multistage stratified random sampling technique. A pre-tested structured questionnaire was used to elicit the required information from the study participants and the diagnostic criteria for hypertension were taken according to the Seventh Joint National Committee Report on Hypertension (JNC-7). Receiver operating characteristic (ROC) analysis was used to estimate the cut-off values of BMI and waist circumference to predict hypertension. RESULTS: The ROC analysis revealed that BMI is a good predictor of hypertension for both men (area under the ROC curve 0.714) and women (area under the ROC curve 0.821). The cut-off values of BMI for predicting hypertension were identified as ≥ 24.5 kg/m(2) in men and ≥ 24.9 kg/m(2) in women. Similarly, the ROC analysis for waist circumference showed that it is a good predictor of hypertension both for men (area under the ROC curve 0.784) and women (area under the ROC curve 0.815). The cut-offs for waist circumference for predicting hypertension were estimated as ≥ 83 cm for men and ≥ 78 cm for women. Adults with high BMI or high waist circumference had a higher prevalence of hypertension, respectively. CONCLUSION: Simple anthropometric measurements such as BMI and waist circumference can be used for screening people at increased risk of hypertension in order to refer them for more careful and early diagnostic evaluation. Policies and programs are required for primary and secondary prevention of hypertension.

Clinical predictors of hypoxemia in Indian children with acute respiratory tract infection presenting to pediatric emergency department.

BACKGROUND: In developing countries, facilities for measuring arterial oxygen saturation are not available in most settings, which make it difficult for health providers to detect hypoxemia in children with acute respiratory tract infection (ARI). Most health providers rely on symptoms and signs to identify hypoxemia and start oxygen therapy. Therefore, this study was conducted to determine the clinical predictors of hypoxemia in children with ARI. METHODS: It was a cross-sectional study carried out at the Pediatric Emergency Department of GSVM Medical College, Kanpur, India in children in the age group between 2 months and 5 years, presenting with ARI. All children with ARI attending the pediatric emergency department from April 2007 to September 2008 were included in the study. Clinical signs and symptoms including fever, cough, nasal flaring, inability to feed/drink, cyanosis, chest wall retraction, wheezing, grunting, tachypnea and crepitations were noted and oxygen saturation (SpO(2)) was measured. Hypoxemia was defined as SpO(2) <90%. RESULTS: Of the 261 children included in the study, 62 (23.8%) had hypoxemia. Chest wall retraction (sensitivity=90%), crepitations (sensitivity=87%), nasal flaring (sensitivity=84%), tachypnea (sensitivity=81%) and inability to feed (sensitivity=81%) were observed to be the most sensitive indicators of hypoxemia while the best predictors were cyanosis [positive predictive value (PPV)=88%] and nasal flaring (PPV=53%). CONCLUSIONS: Chest wall retraction was found to be the most sensitive indicator, and cyanosis was the most specific indicator for hypoxemia. Of all the clinical signs and symptoms of hypoxemia, none had all the attributes of being a good predictor. A new hypoxemia score has been designed using a combination of clinical signs and symptoms to predict the need for supplemental oxygen therapy.

Prevalence of isolated diastolic hypertension and associated risk factors among adults in Kanpur, India.

BACKGROUND: Isolated diastolic hypertension (IDH) is a largely unrecognized subtype of hypertension, more commonly seen in the younger age group. AIMS: (1) To determine the prevalence of IDH in the adult population of Kanpur district. (2) To study the associated risk factors of IDH. METHODS: A community-based cross-sectional study was conducted in 801 subjects, aged 20 years and above, using multistage stratified random sampling technique. RESULTS: The prevalence of IDH was 4.5%, which was 6.2% in men and 3.1% in women. A significant proportion of IDH was seen in the 40-49 years age group. Multivariate logistic regression analysis of the associated risk factors showed that gender, physical activity and BMI were significantly associated with IDH. CONCLUSION: Isolated diastolic hypertension is an emerging problem in developing countries. IDH is more common among men, sedentary individuals and those with a higher BMI.

Childhood obesity in India: a meta-analysis.

Developing countries are now facing the double burden of childhood underweight and obesity. Childhood obesity is a recent epidemic with a high magnitude in India. Therefore, the authors decided to assess the prevalence of overweight and obesity among Indian children. Studies were identified through computer-based and manual searches. Estimates of prevalence were studied using random effects meta-analysis. Nine studies including 92,862 subjects were identified and analysed. The prevalence of overweight was estimated to be 12.64% (95% CI 8.48-16.80%) and that of obesity to be 3.39% (95% CI 2.58-4.21%). Current evidence suggests that policies and interventions for children should prioritize reduction of obesity and overweight.

Morbidity profile and seasonal variation of diseases in a primary health center in kanpur district: a tool for the health planners.

OBJECTIVE: The objective of this study was to determine the morbidity profile of patients being treated at the Primary Health Center, their distribution according to gender, and the seasonal trend of diseases. MATERIALS AND METHODS: The study was done retrospectively using secondary data, over a period of 1 year from June 2007 to July 2008, at the OPD of the Primary Health Center at Patara in Kanpur District, India. The study was aimed to study the pattern of diseases according to the classification provided by the Government of India. The data were collected from the OPD registers of the consultant medical officer, and the diagnosis was classified into communicable diseases, nutritional and metabolic disorders, infectious diseases, obstetric complications, and other diseases including injuries. RESULTS: A total of 6838 patients had been treated at the OPD, which included 2707 males and 4131 females. It was observed that, while communicable diseases constituted about half of the total burden of the diseases with skin infections being the commonest; the non-communicable diseases constituted about one-fifth of the total disease burden. Significant gender differences were evident in the prevalence of certain diseases such as worm infestation, acute respiratory tract infection, urinary tract infection, reproductive tract infection, chronic obstructive pulmonary disease, gastritis, arthritis/gout, falls/injuries/fractures, anemia, pyrexia of unknown origin, and snake bite. Most of the diseases were observed to have a seasonal variation, with the communicable and infectious diseases peaking in the monsoon months. Surprisingly, the non-communicable diseases such as gastritis and falls and injuries also showed a seasonal variation. CONCLUSION: Many diseases have a seasonal variation and the burden of these diseases could be reduced if we devise measures to detect the changes in their trend through the implementation of surveillance programs in this part of the world, as has been carried out in other countries. The knowledge of the burden of the diseases would also assist the health administrators in judicious allocation of the resources.

Association of angiotensin-converting enzyme, methylene tetrahydrofolate reductase and paraoxonase gene polymorphism and coronary artery disease in an Indian population.

BACKGROUND: Coronary artery disease (CAD) and cancer remain the leading causes of death in most developed countries. Elucidating the genetic components that contribute to their pathogenesis is challenging. In this case-control association study, we examine the association of single nucleotide polymorphisms (SNPs) in paraoxonase 573 A/G genes, methylene tetrahydrofolate reductase (MTHFR) 677 C/T and angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with CAD independently, as well as synergistically, in a north Indian population. METHODS AND RESULTS: Patients with at least 50% stenosis of at least one major coronary artery were classified as cases. The controls had no myocardial infarction. Polymerase chain reactions (PCR) followed by restriction fragment length polymorphism (RFLP) analyses were carried out to determine the SNPs. No significant association of the polymorphisms of the ACE or MTHFR genes with the risk of CAD was observed. However, the allele frequencies of the 573 A/G polymorphism of the paraoxonase gene differed significantly among cases and controls before and after controlling for confounding factors. The frequencies of AG vs AA genotypes and GG+AG vs AA genotypes also differed significantly in the two groups (p = 0.0002). The interaction of paraoxanase with both MTHFR and ACE independently showed significant positive associations. CONCLUSIONS: The identification of 'at risk' individuals by genetic mapping of susceptible genes for effective control of other host factors will be a very effective and practical approach for prevention, as well as the development of improved therapy for patients.

Prevalence and determinants of obesity in the adult population of Kanpur district -- a population-based study.

Worldwide, obesity is the most prevalent form of malnutrition. It is one of the most significant contributors to ill health and an indirect cause of morbidity and mortality resulting from hyperlipidaemia and glucose intolerance. Very few studies on the prevalence of obesity have been reported from developing countries like India. The present study was therefore undertaken to determine the prevalence of obesity and its predictors in the Indian community. The objectives are: (1) To determine the prevalence of obesity, (2) to study the relationship of obesity with age, (3) to identify the predictors of obesity. This community-based cross-sectional study was conducted on 801 subjects, aged 20 years and above in Kanpur District, using multistage stratified random sampling technique. Data was analysed using the software statistical package for social sciences 10.0.1 for windows. Prevalence of obesity was found to be 4.7%. An increase in body mass index was seen with increasing age. A higher prevalence of obesity was seen in the urban population and in women. Age, gender and daily intake of saturated fatty acids were found to be the main predictors of the obesity. An increase in the level of physical activity resulted in a decrease in the prevalence of obesity (odd's ratio = 0.36). Obesity is an emerging public health problem in the Indian population which indicates that intervention at the primary healthcare level, especially in diet and activity, are important for its prevention.

Isolated Systolic Hypertension and its Determinants - A Cross-sectional Study in the Adult Population of Lucknow District in North India.

OBJECTIVES: 1) To determine the prevalence of isolated systolic hypertension (ISH) in the adult population of Lucknow district. 2) To study the determinants of ISH especially the relationship with age. MATERIALS AND METHODS: A community-based cross-sectional study was conducted in four randomly selected areas of Lucknow district. A total of 800 subjects, aged 20 years and above, 400 from urban and 400 from rural area of Lucknow district were included in the study. The statistical tools used for analysis were Pearson's Chi-square test and multiple logistic regression. RESULTS: The prevalence of ISH according to JNC-7 criteria was 4.3%, which was 5.1% in men and 3.6% in women. A significant increase in the prevalence of ISH was seen with an increase in age. Multivariate logistic regression analysis of the determinants showed that age, BMI and smoking were significant independent risk factors of ISH. CONCLUSIONS: Given the risk of cardiovascular disease associated with ISH, the findings of this study emphasize the need for further research to document the impact of modifiable risk factors of ISH and the effect of hypertension screening and specific health promotion in bringing down the burden of ISH and related cardiovascular morbidity.

Caroli's syndrome with ureterovesical calculi in a young child.

An 18-month-old boy was admitted with fever, abdominal pain, and hepatomegaly. CT scan revealed dilatation of intrahepatic biliary radicals with central dot sign, bilateral nephrocalcinosis, multiple ureteric and urinary bladder stones and right-sided obstructive hydroureteronephrosis due to a ureterovesical calculus of about 1.5 cm. Liver biopsy showed early hepatic fibrosis.

Prevalence and determinants of hypertension in the urban and rural population of a north Indian district.

BACKGROUND: Hypertension is a major contributor to the cardiovascular morbidity and mortality in industrialized countries. Reports suggest that hypertension is rapidly increasing in developing countries like India. Non-communicable diseases are likely to overshadow infectious diseases in the coming years and pose a heavy strain on health budgets in our country. In this study we have tried to study the prevalence of hypertension in a north Indian population based on the recently formulated criteria of the JNC-7 and to identify the determinants of hypertension. OBJECTIVES: (1) To determine the prevalence of hypertension in the urban and rural population of Lucknow District. (2) To study the relationship of hypertension with age. (3) To study the determinants of hypertension in the urban and rural population of Lucknow District. SETTING AND DESIGN: A community-based cross-sectional study was conducted in four randomly selected areas in urban and rural parts of Lucknow district, respectively. Two-stage stratified random sampling technique was used. METHODS: We studied 800 subjects (355 men, 445 women) aged 20 years and above, 400 from urban area and 400 from rural area of Lucknow district. A pre-tested structured questionnaire was used to elicit the required information from the study participants and the diagnostic criteria for hypertension were taken according to the Seventh Joint National Committee Report on Hypertension (JNC-7). STATISTICAL ANALYSIS: Pearson's Chi-square test, Student's t-test, and multiple logistic regression. RESULTS: The prevalence of hypertension was 32.8% in the urban population and 14.5% in the rural population. The mean blood pressures were 128.4 +/- 18.8 mmHg systolic and 82.6 +/- 10.2 mmHg diastolic in urban area and 120.5 +/- 16.1 mmHg systolic and 77.8 +/- 8.8 mmHg diastolic in rural area. A significant correlation of blood pressure with increasing age was seen. In urban area, hypertensives were less physically active, and more likely to smoke and consume alcohol. About 9.2% of the hypertensives had coexisting diabetes mellitus. Mean weight, BMI and waist circumference of hypertensives was significantly higher, whereas there was no significant difference between mean heights. In rural area, similar association was seen except alcoholism and diabetes. Multivariate logistic regression showed that regardless of area, age and gender, were significant risk factors of hypertension. In the urban population, diabetes (OR = 6.917) and BMI (OR = 1.195) and in the rural population, physical activity (OR = 0.483) and waist circumference (OR = l.094) were significantly associated. CONCLUSIONS: A high prevalence of hypertension was seen in the urban and rural population of a north Indian district Risk factors of hypertension were age and gender in urban as well as rural population. Diabetes, higher BMI values, decreased level of physical activity and increased waist circumference also significantly contributed to the risk of hypertension, which necessitates intervention at the primary health care level for its prevention.