Prevalence of Childhood Obesity in an Affluent School in Telangana Using the Recent IAP Growth Chart: A Pilot Study.

AIMS AND OBJECTIVES: To study the prevalence of obesity in children in an affluent school in Hyderabad, Telangana, using the recent Indian Academy of Paediatrics (IAP) growth charts and to compare the same with the Centre for Disease Control and Prevention (CDC) charts. METHODS: A cross-sectional study was conducted in an affluent school of Hyderabad in January 2018. After getting appropriate permission, anthropometry measurements of the school children were done. The data were collected from students of Classes 4-10. Each class had three sections. Each section had around 25-30 students. Body mass index (BMI), calculated as weight (kg)/height2 (m2) was used to classify the participants using age- and gender-specific cut-points as per CDC growth charts and the recent IAP charts. RESULTS: A total of 544 students were studied. About 52% were boys (n = 288) and 48% were girls (n = 256). Using the IAP charts, 24.6% were obese and 35.8% were overweight. Using the CDC criteria, the prevalence of obesity and overweight was 15.4% and 26.1%, respectively. The mean BMI in the obese group was 25.6 ± 3.5 kg/m2 and in the overweight group was 21.1 ± 1.9 kg/m2. The prevalence of obesity and overweight was more in girls (obesity 32.8% versus 17.3% and overweight 44.5% versus 28.1%, respectively). The highest prevalence of childhood obesity was seen in the 8-10 years age group. CONCLUSIONS: Our study reflects the increased prevalence of obesity and overweight in the adolescent age group, using the recent IAP criteria.

Experience with Splenic Abscess from Southern India.

INTRODUCTION: Splenic abscess is a rare entity with potentially life threatening complications. Sparse recent published data are available documenting the aetiological profile and management of patients with splenic abscess from India. AIM: To study the clinical profile of splenic abscess. MATERIALS AND METHODS: We retrospectively collected data from case records of admitted patients with splenic abscesses, to Nizam's Institute of Medical Sciences and Hospital which is a multispecialty, tertiary care referral hospital over a period of 15 months (from March 2014 to May 2015) and parameters studied were age, sex, symptoms, signs, risk factors, investigations like Ultrasound, CT scan, blood & microbiological culture, treatment and outcome. RESULTS: Most common presenting symptom was fever (90%). Mean age was 33.5 years. Five patients (55%) had risk factors like HIV, leukaemia and diabetes. From pus culture Escherichia coli was the most common organism (22%) grown. Staphylococcus saureus, Enterococcus faecium were seen in one each, blood culture grown Cryptococcus neoformans, Pseudomonas aeroginosa in one each, Plasmodium falciparum was seen on peripheral smear in one. Three were empirically treated as disseminated koch's. Another was treated as possible infective endocarditis. All were given antimicrobials, five (55%) were treated with antimicrobials alone, three (33%) with PCD (Per Cutaneous Drainage) and one (11%) with sub-total splenectomy. All patients recovered. CONCLUSION: With early diagnosis and increased use of ultrasound guided procedures like aspiration or drainage, spleenectomy can be avoided. Optimal treatment for splenic abscess is yet to be defined and customized to each patient.

Association of serum interleukin-6, interleukin-8, and Acute Physiology and Chronic Health Evaluation II score with clinical outcome in patients with acute respiratory distress syndrome.

BACKGROUND AND AIM: Studies on potential biomarkers in experimental models of acute lung injury (ALI) and clinical samples from patients with ALI have provided evidence to the pathophysiology of the mechanisms of lung injury and predictor of clinical outcome. Because of the high mortality and substantial variability in outcomes in patients with acute respiratory distress syndrome (ARDS), identification of biomarkers such as cytokines is important to determine prognosis and guide clinical decision-making. MATERIALS AND METHODS: In this study, we have included thirty patients admitted to Intensive Care Unit diagnosed with ARDS, and serum samples were collected on day 1 and 7 and were analyzed for serum interleukin-6 (IL-6) and IL-8 by ELISA method, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring was done on day 1. RESULTS: The mortality in the patients observed with ARDS was 34%. APACHE II score was significantly higher in nonsurvivors as compared to survivors. There were no significant differences in gender and biochemical and hematological parameters among the survivors and nonsurvivors. Serum IL-6 and IL-8 levels on day 1 were significantly higher in all the ARDS patients as compared to healthy controls and these levels were returned to near-normal basal levels on day 7. The serum IL-6 and IL-8 levels measured on day 7 were of survivors. As compared to survivors, the IL-6 and IL-8 levels were significantly higher in nonsurvivors measured on day 1. Spearman's rank correlation analysis indicated a significant positive correlation of APACHE II with IL-8. By using APACHE II score, IL-6, and IL-8, the receiver operating characteristic curve was plotted and the provided predictable accuracy of mortality (outcome) was 94%. CONCLUSION: The present study highlighted the importance of measuring the cytokines such as IL-6 and IL-8 in patients with ARDS in predicting the clinical outcome.

Assessment of Oxidative Stress Markers and Carotid Artery Intima-Media Thickness in Elderly Patients Without and with Coronary Artery Disease.

We aimed to assess whether measuring carotid intima-media thickness (CIMT) and oxidative stress markers such as protein carbonyls, malondialdehyde, nitrate and glutathione in plasma of elderly patients without and with coronary artery disease (CAD) identifies early risk for CAD. A total of 50 cases with cardiovascular risk factors over the age of 60 years without CAD, and 50 patients with angiographically documented CAD over the age of 60 years were included in the study. Control group consists of 200 healthy individuals without the risk factors. Demographic details were obtained from all the subjects and CIMT measured by high frequency ultrasound and oxidative stress markers such protein carbonyls, malondialdehyde and total glutathione were determined in plasma by spectrophotometric methods. The distribution of cardiovascular risk factors in without CAD and CAD cases were smokers (16 vs 56 %), hypertension (26 vs 64 %), diabetes (16 vs 56 %) and dyslipidemia (18 vs 58 %) and positive family history (4 vs 38 %). None of the control group had any cardiovascular risk factors. Among the CAD cases, 16 % had single vessel disease, 44 % had double vessel disease and 40 % had triple vessel disease. The CIMT was significantly increased in CAD cases as compared to cases without CAD and healthy controls. On the other hand, CIMT was significantly increased in cases without CAD as compared to healthy controls. CIMT also increased with the duration of diabetes in patients without CAD and severity of disease in CAD cases. The levels of oxidants like plasma malondialdehyde, protein carbonyls, were significantly elevated and antioxidant glutathione levels and nitrate levels were significantly reduced in cases with and without CAD as compared to healthy controls. Oxidative stress markers and CIMT was found to be significantly increased in patients with cardiovascular risk factors like diabetes, family history of CAD, dyslipidemia, hypertension and smoking when compared to patients without risk factors. In patients with diabetes, CIMT increased as duration of disease increases and also in poorly controlled diabetes. In CAD group, when number of vessel involvement (severity of coronary disease) increases, the CIMT also increases confirming that CIMT is a quantifiable risk factor for CAD.

Outbreak of scrub typhus in Andhra Pradesh--experience at a tertiary care hospital.

AIM: To describe the clinical features, laboratory manifestations, complications in patients diagnosed with scrub typhus at a tertiary care hospital in south India. MATERIAL AND METHODS: All cases of acute onset fever diagnosed to have scrub typhus August 2011 to December 2012 were analysed. Cases of scrub typhus confirmed by the well felix test with a titre of 1 in 80 or more and a positive immunochromatography test were studied. RESULTS: 176 confirmed cases of scrub typhus were studied over a period of 18 months. Majority (96%) of patients are from rural background. Farmers constituted 60% of the patients. Most common symptoms were due to the involvement of respiratory tract in the form of cough in 94 (53%) patients followed by breathlessness in 84 (47.7%). Signs of consolidation were seen in 80 (45.5%). Central nervous system involvement in the form of altered sensorium was seen in 43 (24.4%) and seizures in 11 (6.3%) patients. Eshcar was seen in 23 (13%) patients. Transaminases were elevated in 153 (86%) patients, serum alkaline phosphatase in 110 (62.5%) patients. Renal failure was seen in 49 (27.8%) cases and respiratory failure was seen in 11 (6.2%). Eight (4.5%) patients died in our study. CONCLUSION: Scrub typhus should be suspected in patients with rural background with fever and multi system involvement. The predominant symptoms were cough and breathlessness. Central nervous system abnormalities in the form of altered sensorium was seen in 43 (24.4%). Most common laboratory abnormality noted in our patients with scrub typhus was elevated liver enzymes which were seen in 153 (86%) cases.

A rare presentation of progressive disseminated histoplasmosis in an immunocompetent patient from a non-endemic region.

Histoplasmosis is an important systemic fungal infection in endemic areas. In India, the disease has been reported from several parts of the country, most cases being from eastern India considered to be endemic for the disease. There have been very few cases reported from the state of Andhra Pradesh, in the southern part of India. We report a case of progressive disseminated histoplasmosis presenting with bleeding manifestations in an immune competent patient from the state of Andhra Pradesh.

Hepatitis B and/or C co-infection in HIV infected patients: a study in a tertiary care centre from South India.

BACKGROUND & OBJECTIVES: Co-infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in human immunodeficiency virus (HIV) infected individuals results in increased hepatic complications. We undertook this study to evaluate the presence of HBV and HCV in HIV infected individuals attending a tertiary care centre in southern India. METHODS: A total of 120 cases with HIV infection and 120 healthy adult control subjects were included in the study. Samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies by enzyme linked immunosorbent assay (ELISA) method. HBsAg and anti-HCV positive serum samples were further tested for the presence of hepatitis B e antigen (HBeAg), anti-HBe antibodies, HBV-DNA and HCV-RNA. RESULTS: The most common mode of transmission was sexual promiscuity (79%), followed by spouse positivity (15%) and history of blood transfusion (6%). HBsAg and anti-HCV were positive in 18 (15%) and 10 (8.3%) HIV infected patients; the corresponding figures in healthy controls being 2 (1.6%) 0 (0%) (P<0.0001). Among HIV infected patients, presence of HBeAg and anti-HBe antibodies was seen in 33.3 and 55.5 per cent, respectively; both HBeAg and anti-HBe antibodies were negative in 11.1 per cent. HBV DNA and HCV RNA were positive in 10 of 18 and in all anti-HCV positive samples. Triple infection with HBV, HCV and HIV was seen in three patients. CD4+ T-lymphocyte count less than 200/µl was seen in 22 of 28 co-infected cases. INTERPRETATION & CONCLUSIONS: The findings of our study showed presence of HBV (15%) and HCV (8.3%) co-infections in HIV positive patients which was higher than that seen in HIV negative controls. Co-infection with HBV and HCV is a common problem in HIV infected patients in India. Hence, all HIV patients need to be routinely tested for markers of HBV and HCV infection.

Burkholderia pseudomallei: an uncommon cause of bacteraemic pneumonia in a diabetic.

A 55-year-old woman presented with fever, breathlessness and shock. She was diagnosed to have diabetes mellitus (Type 2) after admission. Blood culture grew Burkholderia pseudomallei. The patient responded to intravenous ceftozidime for two weeks and a prolonged course of six months with cotrimoxazole and doxycycline.

Effect of NCB-02, atorvastatin and placebo on endothelial function, oxidative stress and inflammatory markers in patients with type 2 diabetes mellitus: a randomized, parallel-group, placebo-controlled, 8-week study.

BACKGROUND AND OBJECTIVE: Hyperglycaemia leads to increased oxidative stress resulting in endothelial dysfunction. ACE inhibitors, antioxidants and HMG-CoA reductase inhibitors (statins) have been shown to improve endothelial function. The aim of this study was to compare the effects of NCB-02 (a standardized preparation of curcuminoids), atorvastatin and placebo on endothelial function and its biomarkers in patients with type 2 diabetes mellitus. METHODS: A total of 72 patients with type 2 diabetes were randomized to receive NCB-02 (two capsules containing curcumin 150 mg twice daily), atorvastatin 10 mg once daily or placebo for 8 weeks. Endothelial function assessment was performed at baseline and post-treatment using digital volume plethysmography (salbutamol [albuterol] challenge test) to measure change in reflective index, an indicator of arterial vascular tone. Blood samples were similarly collected at baseline and post-treatment for estimations of malondialdehyde, endothelin-1 (ET-1), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNFalpha). Pre-and post-treatment safety assessments were also conducted. ANOVA and paired t-test evaluations were used for comparison. RESULTS: A total of 67 patients completed the study. At baseline, there was no significant difference in the various parameters tested. In all three groups, the change in reflective index at baseline was <6% as assessed by the salbutamol challenge test, indicating the presence of endothelial dysfunction. Compared with baseline, there was a significant improvement in endothelial function after treatment with atorvastatin (mean +/- SD: -3.63 +/- 3.17% vs -8.95 +/- 6.80%, respectively) and NCB-02 (-2.69 +/- 3.02% vs -8.19 +/- 5.73%, respectively). Similarly, patients receiving atorvastatin or NCB-02 showed significant reductions in the levels of malondialdehyde, ET-1, IL-6 and TNFalpha. No significant improvements were obtained in patients administered placebo. CONCLUSION: NCB-02 had a favourable effect, comparable to that of atorvastatin, on endothelial dysfunction in association with reductions in inflammatory cytokines and markers of oxidative stress. Further studies are needed to evaluate the potential long-term effects of NCB-02 and its combination with other herbal antioxidants.

Clinical and aetiological profile of hepatoma at a tertiary care centre.

Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. Infection with the hepatitis B virus (HBV) is one of the high-risk factors for the development of HCC, particularly in Asia and Africa. Other risk factors include hepatitis C virus (HCV) infection and, to a certain extent, exposure to a liver-specific carcinogen such as aflatoxin B, and alcohol consumption. In the present retrospective study, we analysed the clinical profile and aetiological role of HBV and HCV in HCC. A total of 40 cases of HCC (33 males and 7 females, age range 22-80 years) were seen from January 1999 to June 2001 at our institute. A detailed history of age, sex, past history of liver disease, clinical symptoms and presenting complaints was recorded. The most common presenting complaints were abdominal distention, pedal oedema and pain abdomen. Underlying cirrhosis of the liver was seen in 30 cases (75%), Child's A in 6, Child's B in 11 and Child's C in 13 cases. A history of alcoholism was present in 6 patients. All the patients were tested for HBsAg and anti-HCV by ELISA. HBsAg and anti-HCV was positive in 19 (47.5%) and 8 patients (20%), respectively. The diagnosis in the majority of cases was derived by FNAC and in a few by imaging techniques plus alfa-fetoprotein (AFP) evaluation. The diagnosis was confirmed by FNAC in 34, CT scan and AFP in 2, and ultrasound abdomen and AFP in 4 cases. We conclude that viral infection (HBV > HCV) is still a major aetiological factor and the incidence of HCV infection appears to be increasing. The majority of the cases of HCC studied had a cirrhotic background.