Cost-effectiveness of the prevention of parent-to-child transmission guidelines of HIV in India.

Background: One of the modes of transmission of HIV infection in India is from mother-to-child. In 2014, Prevention of Parent-to-child Transmission (PPTCT) guidelines of HIV in India were implemented which included shifting from Option A to Option B and B+. The aim of the present study was to evaluate health and cost related outcomes after implementation of these new guidelines. Methods: A decision analytical model was used to compare the PPTCT Option A with the new WHO Option of B and B+. Transmissions in serodiscordant couples and infants at 18 months were considered as health outcomes. The estimation of the cost for PPTCT services and HIV treatment was done using Costing Tool for Elimination Initiatives (CTEI) developed by National Center for Global Health and Medicine (NCGM). Results: The reduction in transmission rates in HIV infants was 33%. In serodiscordant couples the reduction in risk of HIV transmission from Option A to Option B and B+ was 72% and 87%, respectively. The incremental cost-effectiveness ratio (ICER) per quality adjusted life years (QALY) gained by averting infant infection, and for both infant and partner was US$ 238 and US$ 181 for Option B and US$ 1265 and US$ 947 for Option B+, respectively. Conclusion: It was found that Options B and B+ are more cost-effective as compared to option A. This effectiveness further increases when prevention of partner infections in Option B and B+ is taken into account.

Abdominal and Chest Ultrasonography: A predictor for disease progression in nonsevere dengue.

Background: Dengue is one of the most rapidly spreading arboviral infections in the world. Ultrasound is well established in abdomino-thoracic evaluation of patients with dengue infection. The aim of this study was to explore the role of ultrasound in predicting occurrence of severe infection in dengue patients and in predicting deterioration in patients with nonsevere dengue. Methods: The serologically proven dengue patients who reported to hospital during the study period were divided into three categories based on the dengue infection severity score. Ultrasound findings of abdomen and chest in these patients were noted in the initial, as well as follow-up scans and inferences drawn. Results: 61% belonged to the category of Dengue Fever, 35% were in Dengue Hemorrhagic Fever category, and 4% had Dengue Shock Syndrome. Positive ultrasound findings were seen to be significantly higher in patients with severe dengue. Logistic regression analysis revealed the presence of pericholecystic fluid to be significantly associated with the severe disease, while the presence of gall bladder wall edema, ascites, and any ultrasound finding were significantly associated with the disease progression. The odds of a patient with severe dengue having gall bladder wall edema, ascites, or any ultrasound finding were 2.74, 2.04, and 2.619 times, respectively. Conclusion: Our study indicates that positive findings on ultrasound are significantly higher in severe dengue and also that ultrasound can be reliably used to identify the patients with nonsevere dengue who are likely to progress to severe dengue.

To Study the Role of Serum Homocysteine Levels and Ocular Involvement in Retinal Vasculitis.

Idiopathic retinal vasculitis is a chronic disease of unknown aetiology which results in ocular morbidity in patients of productive age group. Homocysteine has been implicated in various ocular conditions like age-related macular degeneration, retinal vein occlusions, diabetic retinopathy, and optic nerve diseases. We conducted a study to investigate the relation between serum homocysteine levels and retinal vasculitis at a tertiary care centre in North India. In this case-control study, 32 cases and 64 controls were included and the duration was from June 2017 to March 2019. Serum homocysteine of cases and controls was detected by reflectance photometry using VITROS Chemistry Products HCY 2 (Homocysteine) and the normal range of serum homocysteine as per this method was 6.60 to 14.80 micro mol per litre. Our study found that of the total 32 retinal vasculitis patients, serum homocysteine was raised in 65.62% (21 cases out of 32) and in 70.31% of control group (45 out of 64). Chi square test results showed that there was no significant association found between S. homocysteine levels and Reticular vasculitis (P: 0.64). The two groups were comparable in terms of the age with mean ± SD in cases being 33.47 ± 8.336 years and controls being 35.16 ± 8.568 years with a P value of 0.37 being statistically insignificant. The data collected was analysed using SSPS-16 (Statistical Package for Social Sciences Version 16) software and test of association was Odd's ratio. Power of study was 80% and P < 0.05 is considered statistically significant. We found that there is no significant association between raised serum homocysteine and retinal vasculitis (with P < 0.64). Odds ratio was 0.80(0.33-1.99) implying that the cases and controls were statistically significantly different with respect to homocysteine levels.

Scoring system for activation of critical care air transport team for aeromedical evacuation.

BACKGROUND: Our hospital began work on formulating its own critical care air transport team (CCATT) and patient transfer unit (PTU) in 2007. A total of 293 patients have been evacuated by air using the various models of the PTU from April 2008 to February 2017. This study has been undertaken to formulate a protocol for activation of CCATT for aeromedical evacuation that best suits our setup keeping in view the availability of electromedical equipment, manpower and aircrafts. METHODS: The study is a cross-sectional study involving patients who were air evacuated between January 2010 to February 2017. Statistical analysis tests were performed to compare and analyze the two scoring systems to find out the sensitivity and specificity of the two scoring systems and to find out the degree of agreement. RESULTS: The data using each scoring system were compared with actual requirement of CCATT based on recommendation of team leader of each CCATT mission and available data of each patient. It was observed that the old scoring system showed poor agreement with kappa coefficient of 0.162. The new scoring system based on modified early warning physiological score showed good agreement with kappa coefficient of 0.895. CONCLUSION: CCATT can be activated by peripheral medical echelons based on objective criteria rather than subjective ones so that optimal use of resources can be carried out not only in peace time but also during mass casualty scenarios such as natural calamities or war.

Impact of individualized nutritional counseling on infant and young child feeding practices.

BACKGROUND: Improper complementary feeding practices are common in India, thus leading to malnutrition. The objective was to compare complementary feeding practices of mothers with children aged between 6 months and 2 years before and after individualized nutritional counseling. METHODS: This before-and-after interventional study was carried out in a tertiary care teaching hospital between June 2018 and August 2018 on 30 mothers attending an immunization clinic. Feeding practices were assessed using interview techniques with the Breastfeeding Promotion Network of India Maharashtra checklist for Complementary Food Counseling (Diet Audit), and scoring was carried out. Baseline data included history of inclusion of items from food groups such as cereals; pulses; vitamins A, C, and D; vegetables/fruits; milk/dairy products; non-vegetarian items; and iron-rich foods; and consumption of baby feeds and junk foods. Individualized counseling was given to all study subjects, which lasted for 30-40 min. Models of various food items were shown to mothers. Feeding practices were reassessed after 4 weeks of one-to-one counseling. RESULTS: Feeding by mothers improved significantly in the form of items from the total number of groups from 4.3 (1.4) to 5.6 (1.3) after nutritional counseling (p: 0.001). Consumption of junk foods decreased significantly from 4.3 (2.8) to 2.6 (1.8; p: 0.001) and baby foods decreased from 0.8 (0.7) to 0.2 (0.4; p: 0.001). CONCLUSION: Individualized nutritional counseling of mothers can improve complementary feeding practices and ensure food diversification.

Correlation of visceral body fat with waist-hip ratio, waist circumference and body mass index in healthy adults: A cross sectional study.

BACKGROUND: Visceral Fat (VF) is the underlying culprit for cardiovascular diseases, type 2 diabetes, breast cancer, etc. VF can be estimated at present only by using expensive instruments as Bio Impedance Analyzer (BIA), DEXA scanner, etc. Measurement of Waist-Hip Ratio (WHR) can be used as a proxy for VF. Hence, the present study was done to assess the role of WHR as appropriate technology for assessment of VF. The aim of this study was to find correlation of Visceral Fat Area (VFA) with (WHR), Waist Circumference (WC) and Body Mass Index (BMI) in young healthy adults. METHODS: It was a descriptive cross-sectional study conducted on 215 healthy adults over one year in Western Maharashtra. Biospace 720 was used to assess VF. Data was analyzed by using software SPSS version 20.0. In body 720 was used to assess VF of subjects. RESULTS: Majority 155 (73%) were males and 57 (27%) were females. Nearly half (42% of males, 49% of females) had VFA above cut off value (i.e. 100 cm2) and 42% of males had WHR >0.9 and 56% of females had WHR >0.8. We found a very strong correlation between VFA and WHR (r = 0.936, p < 0.05) among males and females (r = 0.920, p < 0.05) and correlation between WC and BMI with VFA (r = 0.739, r = 0.758) for males, (r = 0.774, r = 0.605) for females was modest. CONCLUSION: There is a strong correlation between VF and WHR. Measurement of WHR is simple, handy, and inexpensive tool which can be used as a surrogate to measure VF.

Skin-to-skin contact at birth for vaginally delivered neonates in a tertiary care hospital: A cross-sectional study.

BACKGROUND: Neonates undergoing skin-to-skin contact (SSC) have shown to have better cardiovascular stability, improved duration of breastfeeding, temperature maintenance and bonding. The primary objective was to estimate the existing prevalence of SSC among mother-infant dyads in the first hour after vaginal delivery, and the secondary objective was to ascertain the factors affecting adherence of SSC after vaginal delivery. METHODS: This cross-sectional study was carried out in a tertiary care teaching hospital between September 2017 and December 2017. All mother-newborn dyads in the labour room were eligible for the study. Mothers with their newborns, who gave multiple births, or with major congenital malformations or those requiring any form of resuscitation or having respiratory distress or requiring observation in neonatal intensive care unit (NICU) were excluded. All included mother-newborn dyads, after exclusion, were observed for SSC, and the duration in each dyad was recorded. All enrolled mothers, the attending doctors and nurses were asked questions based on a prevalidated questionnaire for the possible barriers of implementation. RESULTS: Of a total of 164 mother-infant dyads studied, only 34 (20.7%) carried out SSC for more than 30 min. Sixty-two (37.8%) mother-infant dyads did not participate in any SSC. The commonest reason for non-adherence to SSC was unawareness about the practice in 82.25%, followed by pain and exhaustion after the labour process in 8%. CONCLUSION: The rate of SSC at birth is suboptimal, and the commonest reason is lack of awareness about this important step of essential newborn care.

Food poisoning outbreak in a religious mass gathering.

BACKGROUND: Food poisoning outbreaks are commonly seen in mass social events where food is prepared under temporary arrangements. This study reports a food poisoning outbreak in a city of western Maharashtra, India, where around 4000 people had consumed food during a religious community lunch and reported sick to the nearby hospital with complaints of diarrhea, abdominal cramps, fever with chills, and vomiting. METHODS: This was a retrospective-prospective study. Investigation of the food poisoning outbreak was conducted to identify the causes and recommend preventive measures. Interview method was used to elicit food history from the affected and non-affected persons. Inspection of the cooking area was conducted to find the likely source of contamination. RESULTS: A total of 291 patients reported sick after consumption of meal at a religious mass gathering. The range of incubation period was from 10 hours to 40 hours. Predominant features were diarrhea (100%), abdominal cramps (89%), fever with chills (81%), and vomiting (28.5%). Maximum relative risk of 14.89 was seen for green gram (moong dal) with 95% confidence interval of 2.16-102.6. Keeping the incubation period and clinical profile in view, the likely organisms are enteropathogenic Escherichia coli or Salmonella spp. CONCLUSION: Maintaining food safety during mass gatherings is a major challenge for public health authorities. The Food Safety and Standards Act (2006) in India brings the food consumed during religious gatherings such as 'prasad' and 'langar' under its purview and comprehensively addresses this issue.

'Jago Grahak Jago': A cross-sectional study to assess awareness about food adulteration in an urban slum.

BACKGROUND: Food adulteration includes various forms of practices, including mixing, substituting, concealing the quality of food, etc. One of the main causes for rampant adulteration is ignorance of consumer regarding their right and responsibilities resulting in faulty buying practices. Hence, the present study was done to assess the knowledge about adulteration among consumers in an urban slum. METHODS: A community-based cross-sectional study was done among residents of an urban slum over a period of 2 months. Adults responsible for purchasing groceries for the household were included. A sample size of 100 was taken and pilot-tested questionnaire was administered. All of them were made aware about adulteration. RESULTS: The mean age of the study subjects was 40.2 ± 11.7 years. Only 7% of the study subjects were illiterate. Good practices like checking of Food Safety and Standards Authority of India (FSSAI) logo (90%), Agmark logo (76%) and nutrition label (65%) are lacking among the majority. The most prominent source of knowledge about adulteration is mass media especially television (65%). Almost 40% of the study subjects are unaware about the consumer empowering initiative 'Jago Grahak Jago'. Factors which had a strong positive relationship with good practices like checking of nutrition label, FSSAI logo, Agmark logo, seal and expiry date are age, education status and socio-economic status (p value ≤ 0.05). CONCLUSION: Majority of study subjects are unaware about adulteration. 'Jago Grahak Jago' initiative which empowers the consumers has to be instilled in the minds of consumers. Awareness and motivation will lead to empowerment and end the menace of food adulteration.

Sense of coherence and self reported health amongst medical students: A cross sectional study.

BACKGROUND: In late 70s, Antonovsky proposed a salutogenic theory. This theory was based on the assumption that the human environment causes stress, and sense of coherence could serve as a stress-resisting resource. This study examined association between sense of coherence and self rated health of medical students. The aim of this study was to determine the association between sense of coherence and self reported health among medical students. METHODS: This was a cross-sectional analytical study conducted among medical students. The study tool used was a pre-designed, pre-tested, structured and self administered questionnaire (SOC scale and the SF 12 version 2 self-rated health measure). 172 medical students participated in the study. The data collected was entered into Microsoft Excel and analyzed using SPSS 20. All students were educated about sense of coherence after the study. RESULTS: Among the respondents, there were 99 (57.6%) female students, and 73 (42.4%) were male. The mean age of the students was 20.8 + 1.20 years. The mean (±SD) SOC scale score was 56.15 (±7.83). The mean self rated health score was 53.52 (±7.11). Pearson's χ2 test was used to determine the association and there was significant association between students SOC and self reported health (p < 0.000). CONCLUSION: There is a significant association between score of sense of coherence scale and self rated health among medical students.

A descriptive study of clinico-hematological profile of megaloblastic anemia in a tertiary care hospital.

BACKGROUND: Megaloblastic Anemia (MA) is a relatively common disease, yet the data on prevalence of MA remains scarce. This study was conducted to study the prevalence and clinico-hematological profile of MA. METHODS: This was a cross-sectional study done on 1150 adult anemic patients. All patients diagnosed to have MA were studied for clinico-hematological and etiological profile. Nerve conduction studies (NCS) were done in all. RESULTS: MA was present in 3.6% cases of anemia. Severe anemia was seen in 9.7% of anemic patients and 75% of MA cases (p < 0.05). Forty five percent of MA patients presented with pancytopenia. Vitamin B12 and folic acid deficiency were documented in 40% and 25% cases respectively while combined deficiency was noted in 35% of all MA cases. There was no co-relation between severity of anemia and deficiency of either of the vitamins (Fischer exact test: 0.530). Among MA patients, 35% were vegetarians while 65% consumed mixed diet. There was no association between vegetarian diet and Vit B12 deficiency (p = 0.3137). An additional etiology was more commonly found in patients on mixed diet [92%; 24/26] as compared to those on vegetarian diet [50%; 7/14] (p = 0.04). NCS was abnormal in 14 patients (35%). Overt clinical neuropathy was present in 12 cases of MA, while subclinical neuropathy was seen in 2 cases. CONCLUSION: MA is one of common causes of pancytopenia and severe anemia. Diet plays an important role in causation of MA in vegetarians. An alternative etiology is however, more likely to be found in patients on mixed diet. While overt neurological abnormalities are common in MA, subclinical neuropathy is uncommon.

Effectiveness of an intervention package on knowledge, attitude, and practices of food handlers in a tertiary care hospital of north India: A before and after comparison study.

BACKGROUND: Food-borne illnesses have been a recognized hazard for decades. Recent promulgation of Food Safety and Standards Act (FSSA), 2006, indicates the concern of our Govt. for food safety. Research on effectiveness of food safety interventions in our country is remarkably scarce. Hence, the present study was conducted in a tertiary care hospital of north India to create evidence-based results for food safety interventions. METHODS: The study was before and after intervention trial which was registered with CTRI. Data collection was paperless using a software. All food handlers (n = 280) working inside the hospital were recruited. Intervention package comprised Self-Instructional Manual in Hindi for food handlers, short film for sensitization of food handlers on food safety titled 'Gravy Extra', and a documentary titled 'Food Safety from farm to Fork'. Chi square test, paired t test, and Wilcoxon sign rank test were used. RESULTS: The mean age of food handlers was 35 ± 2 years. Majority (61.7%) of food handlers were educated less than 10th standard. Nearly 60% of them had up to five years of experience. At base line majority (68.9%) had a fair knowledge about food safety issues. There was a significant improvement in food safety knowledge and practice score of food handlers after the intervention (p < 0.05). Their attitude toward food safety changed in a positive direction (p < 0.05). CONCLUSION: The intervention package was useful in improving the knowledge, creating a positive attitude and enhancing the food safety practices of food handlers working inside a tertiary care hospital.

Performance of Indian Diabetes Risk Score (IDRS) as screening tool for diabetes in an urban slum.

BACKGROUND: India is diabetic capital of world, with maximum number of diabetic patients. There is large burden of undetected diabetic cases in community. There is increasing risk of diabetes in urban slum, because of illiteracy, lack of awareness, low socioeconomic status and unhealthy life style. Madras Diabetes Research Foundation (MDRF) has developed Indian Diabetes Risk Score (IDRS) to detect undiagnosed Type 2 diabetes. The aim of this article is to study the performance of IDRS as screening tool for undiagnosed cases of Type 2 diabetes and to find the prevalence of undiagnosed Type 2 diabetes in an urban slum. METHODS: Screening for diabetes was carried out in an urban slum. The sample size was 155 (assumed prevalence of undiagnosed diabetes 9%). IDRS tool comprising of two modifiable (waist circumference, physical activity) and two non-modifiable risk factors (age, family history) for diabetes was used to assess the risk of diabetes anthropometry data was obtained. Conformation of diabetes was done using blood sugar levels on fasting venous sample. RESULTS: Mean and SD for age of study subjects were 49.68 ± 14.80 years, BMI 26.60 ± 8.51 kg/m2, waist hip ratio (females) 0.87 ± 0.06 cm, waist hip ratio (males) 0.95 ± 0.06 cm, waist circumference (females) 89.99 ± 10.95 cm, waist circumference (males) 89.44 ± 10.9 cm. IDRS predicted the risk of diabetes mellitus with sensitivity of 95.12% and specificity of 28.95% in individuals with score >60. CONCLUSION: IDRS can be used as an effective tool for screening undiagnosed diabetes in the community.

To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women.

BACKGROUND: The prevalence of stress urinary incontinence (SUI) in the middle-aged Indian women is around 16%. The use of transvaginal tapes (TVTs) has revolutionised the surgical management of SUI. Patients who undergo placement of the tape via the transobturator route often complain of persistent thigh pain at the site of trocar insertion. The use of minimally invasive tapes with a single suburethral incision reduces surgical trauma by eliminating thigh incisions, while maintaining the cure achieved by conventional TVTs. The study was conducted to test the efficacy and safety of minimally invasive TVT-Secur tape placement for treatment of SUI in women. METHODS: 20 women with stress incontinence were implanted with TVT-Secur tapes and followed up for a year. RESULTS: The objective cure rate of SUI was 85% at the end of a year. The improvement in the patient satisfaction and Incontinence-specific QOL scores, of both Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7), was statistically significant at 95% and 99% confidence levels. There were no complaints of thigh pain; however, there were intraoperative complications in the form of bladder perforation in 5% (n = 1), urethral injury in 5% (n = 1) and urethral tape exposure in 10% (n = 2), at 3 months requiring tape sectioning. CONCLUSIONS: These cure rates and complications are comparable to the standard TVT implantations at the end of a year, without thigh pain; however, a greater number of patients and a longer follow-up is required to see whether the long-term cure is maintained or not, before recommending the same as a standard of treatment.

Low prevalence of anaemia among the wives of serving personnel in a military station: A community-based study.

BACKGROUND: Various studies in India have reported the prevalence of anaemia to be more than 50% among women of the reproductive age group. A community-based study was done to find out the prevalence of anaemia in non-pregnant, non-lactating wives of serving soldiers in a military station. METHODS: It was a cross-sectional study. The sample size was 600. Venous blood was collected for haemoglobin and ferritin levels. Analysis was done by SPSS 20. RESULTS: The mean age at marriage was 19.8 years (SD + 2.76). The average age at first childbirth was 20.88 years. Major symptoms reported were weakness (24.34%), giddiness (23.47%), fatigue (20.17%) and heavy bleeding (3.13%). Prevalence of anaemia in our study was 13.9%, which is much below the national prevalence. Prevalence of iron-deficient status was reported in 153 (26%) individuals. Out of these, 81 subjects were non-anaemic (Hb > 12d/dL) but were iron deficient (ferritin <15 µg/L). Sixty out of these 81 subjects reported presence of fatigue and 36 had weakness. Statistically significant associated observations of anaemia were low Body Mass Index, irregular menstrual pattern, shortened menstrual cycle and increased duration of bleeding (p < 0.05). Low ferritin levels were significantly associated with low BMI, not using Oral Contraceptive Pills and bleeding for more than 3 days during menstrual cycle (p < 0.05). CONCLUSION: The scenario of low prevalence of anaemia in women under the cover of the Armed Forces Medical Services represents an 'island of excellence'.

Impact of health education intervention on food safety and hygiene of street vendors: A pilot study.

BACKGROUND: Street foods are major source of food to millions of people. However, these are frequently associated with food-borne illnesses. It is imperative that street food vendors are educated to maintain hygiene and hence safety of food. With this background, a pilot study was undertaken to assess the impact of health education intervention on food safety and hygiene of street vendors. The aim of this study was to assess impact of health education intervention on food safety of street vendors. METHODS: It was a before and after study conducted in twenty street vendors of an urban area. Tool based on Bureau of Indian Standards (BIS) 2012 was prepared with scoring system to rate hygiene and sanitation of street vendors (score 0-156). Health education was given to all and scores of these vendors on same tool were reassessed after four weeks. RESULTS: Mean age of the study subjects was 35 ± 13.2 years. Highest score attained in BIS tool for food safety was 104 out of 156 (66.6%). No vendor was found to have achieved excellent score. Reasons for poor score were poor condition of vending cart, location, lack personal hygiene and incorrect and unsafe food handling practices. After intervention, it was observed that there was no significant improvement in overall score of vendors. However, scores in domains of personal habits, hygiene and food handling practices improved significantly after intervention (p < 0.05). CONCLUSION: The street vendors do not meet required standards given by BIS for food safety. Health education alone can only partly improve food safety practices of street vendors.

Correlates of hematuria on glomerular histology and electron microscopy in IgA nephropathy.

BACKGROUND: Hematuria is the most important clinical manifestation of IgA nephropathy. This study was undertaken with the objective to describe the spectrum of histological changes with reference to the Oxford classification and the ultrastructural changes in the glomerular basement membrane and to correlate them with hematuria. METHODS: 66 patients who underwent renal biopsy for IgA nephropathy were evaluated histologically by the Oxford system and also subject to electron microscopic examination for glomerular immune deposits, as well as alterations in the glomerular basement membrane. RESULTS: On comparing the histological scores generated by the Oxford classification with degree of hematuria, it was found that the status of 'endocapillary proliferation' and the status of 'tubular atrophy and interstitial fibrosis showed a significant correlation. Correlation of hematuria with location of the deposits, i.e. mesangial only, and mesangial with capillary wall deposits (subendothelial and subepithelial) did not show any association. Other alterations of the GBM were seen in 12 cases. The changes included thinning alone in 4 cases, thinning and lamellar splitting in 5 cases, and lamellar splitting alone in 2 cases. CONCLUSION: At presentation, endocapillary proliferation is one histological parameter which shows close association with hematuria.

Correlation of proteinuria with podocyte foot process effacement in IgA nephropathy: an ultrastructural study.

BACKGROUND: Proteinuria is an uncommon clinical manifestation of IgA nephropathy and is usually seen in cases with severe lesions like endocapillary proliferation. However, it is occasionally seen even with cases with mild glomerular manifestations and may even be of nephrotic range. PREDICTOR: Podocyte foot process effacement. OUTCOME: Severity of proteinuria. MEASUREMENTS: Podocyte foot process effacement was measured. Morphometric analysis was performed on transmission electron microscope images using a computerized digital photomicrograph system (BioWizard 4.2 Image analysis software, New Delhi, India). Proteinuria was measured quantitatively assigned into five grades. RESULTS: It was found that as the extent of proteinuria increased, the effacement ratio also increased, and this was most significant between "no" proteinuria and the rest of the categories. CONCLUSION: Nephrotic presentation in IgA nephropathy is a known phenomenon and in certain cases may show near normal glomerular morphology with severe foot process effacement on EM being the only significant finding to explain the proteinuria. Proteinuria in these cases shows a significant correlation with degree of foot process effacement. Renal biopsy is important in these cases because they are known to have a better prognosis and are usually steroid responsive.

A study on human leukocyte antigen class I molecules in paediatric bronchial asthma.

Childhood asthma, often associated with atopy, is more common in boys and may persist throughout life in 50% of cases. This case-control study was carried out to examine if any association of paediatric bronchial asthma with human leukocyte antigen (HLA) class I antigens. Thirty-six children with bronchial asthma diagnosed on basis of Global Initiative for Asthma (GINA) criteria and an equal number of healthy controls without history of bronchial asthma were studied. Low resolution HLA- ABC typing was performed by sequence specific primers (SSP) and the frequency of HLA-ABC antigens in the two groups was compared. Total serum immunoglobulin E (IgE) estimation was done as a marker of atopy by ELISA. The study included 24 boys and 12 girls aged 13 months to 11 yrs, of which 16 (44%) had positive family history. Serum IgE levels were elevated in 20 (55%) of the cases and 33% of controls with peak values of 4877 and 627 IU/ml, respectively. No statistically significant correlation was observed between childhood asthma and HLA class I antigens, however, a statistically significant correlation was observed between serum IgE levels and asthma, which was elevated in cases, as compared to normal population. Serum IgE levels did not show a linear trend, in that a direct correlation with the severity of disease was not observed.

Health promotion initiatives: An experience of a Well Women's Clinic.

BACKGROUND: Army Medical Corps provides comprehensive health care services to troops and their dependents. This approach is in consonance with the concept of Health Promoting Hospitals (HPH) initiative introduced by WHO in 1986. However, the concept is still at an infancy stage in civil health care system in India. This article describes the experiences and advantages of establishing a Well Women's Clinic (WWC) in a station of North India. METHODS: A system analysis approach was followed for analyzing input, process and output of the WWC during 2007-2009. Inputs included manpower and material i.e public health expert, non medical attendant and a nursing officer charts, poster, models, Television with Compact Disc (CD) player and CDs etc. Health promotion activities were conducted in the form of lectures, demonstrations, workshops, training, screening of movies, quiz, essay writing and declamation contests etc. RESULTS: Overall 385 lectures, 12 competitions, 07 training capsules were conducted. Coverage of target population was 92%. First aid training workshop trained 300 women. Six percent of the counseled women opted for tubectomy. Twelve new cases of diabetes and four new cases of hypertension were detected through screening. Seventy-two women were referred for dental treatment after a dental screening camp. CONCLUSION: Establishment of WWC using HPH approach was quite cost effective.