Quality of life and its determinants among people living with HIV attending an antiretroviral treatment center in Delhi, India.

BACKGROUND: With universal access to antiretroviral treatment (ART), the management of people living with human immunodeficiency virus (PLHIV) encompasses holistic, comprehensive care. Despite being a vital goal of care, quality of life (QOL) assessment of PLHIV in India is neglected. OBJECTIVES: This study assessed the QOL and its determinants among PLHIV accessing services through ART centers. METHODS: The cross-sectional study was conducted from November 2015 to February 2017 among 109 PLHIV attending an ART center in New Delhi. Sociodemographic and clinical profile characteristics were ascertained. QoL was evaluated using the medical outcomes study HIV health survey questionnaire; physical health summary (PHS), and mental health summary (MHS) scores were calculated. Depression was evaluated with the becks depression inventory and social support using the multidimensional scale of perceived social support. Chi-square test, Student's t-test, and analysis of variance were used as test of significance. RESULTS: The overall QOL was: PHS-48.04 ± 8.27 and MHS 42.43 ± 8.79. PHS scores were significantly higher among PLHIV with older age (P = 0.04), higher formal education (P = 0.022), early HIV disease (P = 0.006), higher CD4 counts (current, peak and nadir: P =0.024, 0.008, and ≤0.001, respectively), receiving ART (P = 0.05), with better social support (P = 0.012) and without depression (P ≤ 0.001). Similarly, MHS scores were better in PLHIV with greater formal education (P = 0.009), early HIV disease (P = 0.046), without depression (P ≤ 0.001). CONCLUSION: Depression and social support mechanisms emerged as two key determinants of QOL. Older age, higher education, less advanced disease, and ART were predictive of better QOL.

Asymptomatic Cryptococcal Antigenemia in People Living with HIV (PLHIV) with Severe Immunosuppression: Is Routine CrAg Screening Indicated in India?

BACKGROUND: Cryptococcal meningitis (CM) is a common, life-threatening opportunistic infection (OI) among people living with HIV (PLHIV) in India. Serum Cryptococcal antigen (CrAg) positivity is predictive of future occurrence of CM and pre-emptive treatment reduces its mortality. Routine CrAg screening among PLHIV is not adopted by India's national programme. This study evaluated the prevalence of CrAg and assessed CrAg positivity in predicting all-cause mortality among PLHIV. METHODS: This prospective study was conducted in a tertiary care, public health facility in New Delhi, India. Prevalence of CrAg was assessed in 128 ART naive adult PLHIV with CD4 < 100 cells/mm3 using a latex agglutination test. Age, gender, weight, body mass index (BMI), CD4 count, haemoglobin, serum albumin, and presence of other OI were evaluated as determinants of CrAg positivity. Subjects were followed up for occurrence of CM and mortality (all-cause) at 12 weeks and 6 months. RESULTS: The mean age of the subjects was 36.2±9.48 years, 73.4% were men, 21.09% women and 5.46% were transgender. The mean BMI was 18.4±2.53 kg/m2 and 64% of subjects belonged to the lower socio-economic strata. Mean CD4 counts of the subjects was 54.9±26.58 cells/mm3 and 42.97% had CD4 < 50 cells/mm3. The prevalence of CrAg in the subjects was 3.125 % (4/128). None of the factors assessed showed statistically significant difference between the 2 groups, though CD4 count <50 cells/mm3, low serum albumin and presence of oral candidiasis had a stronger association with CrAg positivity. None of the subjects developed CM during follow up. At 12 weeks, 3/4 (75%) CrAg positive patients were alive compared to 118/124 (95.16%) of CrAg negative subjects. At 6 months, 50% (2/4) CrAg positive patients had died compared to 10.48% (13/124) CrAg negative (p<0.01). CONCLUSIONS: Though CrAg prevalence in PLHIV with CD4<100 cells/mm3 is moderate, asymptomatic CrAg positivity among PLHIV with CD4 < 100cells/mm3 is significantly associated with higher all-cause mortality. CrAg testing is very cost effective and India's National AIDS Control Programme should seriously consider routine screening among the severely immunosuppressed PLHIV.

Ectopic parathyroid adenoma presenting as facial expansile growths.

BACKGROUND: Giant cell reparative granuloma of the facial skeleton is a rare presentation of hyperparathyroidism. METHODOLOGY: A 17-year-old girl presented with progressive expansile bony growths of the mandible and maxilla. The case was investigated using biopsies, blood tests, imaging, and surgery. RESULTS: Biopsies confirmed giant cell reparative granuloma. Blood testing revealed very high parathyroid hormone levels, and brown tumours due to primary hyperparathyroidism weresuspected. Surgical removal of an ectopic adenoma led to correction of the endocrine condition. CONCLUSIONS: To our knowledge, this is the first reported case of multiple brown tumours of the facial skeleton due to an ectopic parathyroid adenoma. Diagnostic pitfalls and therapeutic challenges are described.

Advanced female urethral adenocarcinoma: A case report.

ABSTRACT: Urethral cancer in females is a rare occurrence. Although initially believed to be derived from skene glands, there is no consensus on the cell of origin. Squamous cell carcinoma is the most common, whereas adenocarcinoma is the least common. We report the case of a 58-years-old lady with a history of voiding lower urinary tract symptoms, later requiring a suprapubic cystostomy for retention. Cystoscopy and biopsy showed prostate-specific antigen (PSA) negative adenocarcinoma and postiron emission computed tomography (PETCT) showing pelvic and inguinal nodal metastasis. The patient underwent neoadjuvant chemotherapy followed by anterior exenteration with pelvic lymphadenectomy and ileal conduit. Final histology showed ypT4 yN1 adenocarcinoma, not otherwise specified.

Assessment of risk factors in pyogenic liver abscesses in children.

Background: Pyogenic liver abscess (LA) is a significant contributor to morbidity and mortality in developing countries like India. The risk factors predisposing to the LA specifically in children are not known. Studies done in the past largely remain inconclusive and have identified only probable causes. The cause of LA in children with no coexisting illness remains unknown. Methodology: This prospective observational study was conducted at a tertiary teaching hospital located in New Delhi, India. All children between 2 months and 12 years of age with sonographically confirmed LA presenting to the hospital were included and managed with appropriate intravenous antibiotics and relevant investigations. Results: A total of 52 children were included. The mean age was 6 years and 4 months, and the male: female ratio was 1.4:1. Around 50% of the patients were malnourished. Fever, abdominal pain and loss of appetite were the most common symptoms. Nine patients (17%) were managed conservatively, 13 (25%) needed percutaneous needle aspiration and 30 (57.69%) required drainage using a pigtail catheter. Poor socioeconomic status and anaemia were found to be the most commonly associated risk factors. Selective immunoglobulin A (IgA) deficiency was the most common primary immunodeficiency disorder followed by T-cell defect. On multivariate analysis, it was seen that in those with clinical icterus, gamma-glutamyl transferases >350 IU/m, and those with impending rupture, the time to defervescence was significantly different (P = 0.05). Conclusion: Poor socioeconomic status causing malnutrition emerged as a significant risk factor for LA in children. Selective IgA deficiency was the most common immunodeficiency seen in a few children. Adopting a conservative approach like aspiration and percutaneous drainage led to lower mortality and good recovery rates.

Filaggrin Gene Mutation in Pediatric Patients with Atopic Dermatitis: A Look into Indian Gene Pool, a Pilot Study.

Background: Mutations in the filaggrin (FLG) gene has been reported to be an indicator of poor prognosis of atopic dermatitis (AD). It has been reported that there is a considerable variation in the mutations detected in the FLG gene in different ethnicities. Aim: To detect the presence of mutations in the FLG gene in pediatric subjects with atopic dermatitis (AD) and to compare the detected mutations with those already reported from different ethnicities. Materials and Methods: Genomic DNA extracted using standard procedure from peripheral venous blood of 30 patient and 15 control samples. Sequence analysis of the FLG gene carried out and detected changes was then cross referenced with those mutations already reported to check for novelty of detected changes. Results: Amino acid changes were detected in 28 of the patient samples and in none of the control samples indicating that changes in the FLG gene were more common in the patient group than the control group (Fishers exact test, P < 0.0001). The most commonly reported mutations R501X and 2282del4 were not detected. Only 5 of the detected 22 amino acid changes H2507Q, L2481S, K2444E, E2398Q, and S2366T have been previously reported and are not clinically significant; however, in one patient a stop codon was detected (S2366STOP). P2238N, R2239W, and V2243L detected in 70% of the samples and S2231E detected in 67% of the patient samples have not been reported so far and their clinical significance is yet to be analyzed. Conclusion: Analyses of mutations already reported showed that the changes detected from this study are novel to Indian traits. While this adds on to the minimal data available from the Indian subcontinent further analyses has to be carried out to analyze the pathogenicity of these detected changes on larger samples sizes. Aim: To detect the presence of mutations in the FLG gene in pediatric subjects with atopic dermatitis (AD) and to compare the detected mutations with those already reported from different ethnicities.

Ternary Cobalt (II)-Metformin-Glycine/Histidine/Proline Complexes: Multispectroscopic DNA, HSA, and BSA Interaction and Cytotoxicity Studies.

The synthesized water-soluble ternary complexes [Co(met)(gly)(Cl)2] (1), [Co(met)(hist)(Cl)2] (2), and [Co(met)(pro)(Cl)2] (3), (met = metformin, gly = glycine, hist = histidine, and pro = proline) were evaluated using spectro-analytical techniques, and the stereochemistry of the complexes was determined to be octahedral. UV-Vis absorption, competitive DNA-binding experiments using ethidium bromide (EB) by fluorescence, fluorescence emission studies, viscosity studies, and gel electrophoresis techniques were all employed to explore the binding characteristics of the cobalt (II) complexes with CT-DNA and groove-binding mechanism established. The salt-dependent association of the complexes to CT-DNA was investigated using UV-Vis spectrophotometric analysis. The association of the cobalt (II) complexes with BSA and HSA was explored by utilizing UV-Vis absorption and fluorescence spectroscopy approaches. The findings show that the complexes exhibit adequate capacity to quench BSA and HSA fluorescence and that the binding response is mostly a static quenching mechanism. The cytotoxicity of the complexes has also been appraised with the human breast adenocarcinoma cell lines (MCF-7) and (MDA-MB-231) by utilizing the MTT assay. For each cell line, the IC50 values were computed. In both cell lines, all the complexes were active.

Adverse drug reactions in children and adolescents on daily antitubercular regimen: An observational longitudinal study.

OBJECTIVES: Subsequent to introduction of daily fixed dose combination (FDC) regimen with increased dosages and inclusion of ethambutol in continuation phase of antitubercular therapy (ATT) in India, this study was done to evaluate adverse drug reactions (ADRs) in children and adolescents. METHODS: Longitudinal observational study conducted in tertiary teaching hospital. Children (1 month-18 year), with newly diagnosed drug sensitive tuberculosis, started on daily FDC regimen of ATT, were included. Participants were followed up at 2 weeks, 8 weeks and 6 months. Division of AIDS (DAIDS) severity grading and World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality assessment was done. RESULTS: In 99 participants, 29 experienced ADRs. Most commonly ADRs involved hepatobiliary (11.1%) and gastrointestinal (8.1%) systems. Grade 3 severity noted in 35.5% ADRs. Certain causality classified in 19.3%. Presence of ADRs was significantly higher in participants with vs without malnutrition [40.5% vs 21.1% (p = 0.036)]. Tendency for more severe ADRs noted in participants with vs without malnutrition [Grade 3 ADRs out of all ADRs: 64.7% vs 0% (p < 0.001)]. CONCLUSION: Incidence and severity of ADRs has increased after introduction of daily FDC of ATT. Most common ADR observed were hepatobiliary. Malnutrition and less weight for age were risk factors for occurrence and severity of ADRs.

Plasmodium riboprotein PfP0 induces a deviant humoral immune response in Balb/c mice.

Passive immunization with antibodies to recombinant Plasmodium falciparum P0 riboprotein (rPfP0, 61-316 amino acids) provides protection against malaria. Carboxy-terminal 16 amino acids of the protein (PfP0C0) are conserved and show 69% identity to human and mouse P0. Antibodies to this domain are found in 10-15% of systemic lupus erythematosus patients. We probed the nature of humoral response to PfP0C0 by repeatedly immunizing mice with rPfP0. We failed to raise stable anti-PfP0C0 hybridomas from any of the 21 mice. The average serum anti-PfP0C0 titer remained low (5.1 ± 1.3 × 104). Pathological changes were observed in the mice after seven boosts. Adsorption with dinitrophenyl hapten revealed that the anti-PfP0C0 response was largely polyreactive. This polyreactivity was distributed across all isotypes. Similar polyreactive responses to PfP0 and PfP0C0 were observed in sera from malaria patients. Our data suggests that PfP0 induces a deviant humoral response, and this may contribute to immune evasion mechanisms of the parasite.

Metformin-Derived Water-Soluble Cobalt Complexes: Thermal, Spectroscopic, DNA Interaction, and Molecular Docking Studies.

Novel three water-soluble cobalt (II) complexes of type [Co(metf)(o-phen)2]Cl2 (1), [Co(metf)(opda)2]Cl2 (2), and [Co(metf)(2-2'bipy)2]Cl2 (3) (Metf, metformin; o-phen, ortho-phenanthroline; opda, ortho-phenylenediamine; 2,2'-bipy, 2,2'-bipyridine) were synthesized and characterized by various analytical and spectral techniques. Based on these studies, octahedral geometry is assigned to these complexes. The stability of the complexes has been calculated from quantum chemical parameters using HOMO-LUMO energies. Thermal degradation pattern of the compounds was studied and Coats-Redfern method is used to determine kinetic parameters for complexes 1, 2, and 3 from thermal studies. The DNA interaction of these complexes was investigated by absorption, emission, and viscosity studies. From the spectral data, it was concluded that the complexes bind to DNA through groove mode of binding. The intrinsic binding constants (Kb) from absorption spectroscopy were 2.49 × 104, 2.48 × 104, and 2.64 × 104 M-1 for 1, 2, and 3, respectively, and Stern-Volmer quenching constants (Ksv) from emission spectroscopy were 0.21, 0.20, and 0.13, respectively. These complexes were screened for nuclease activity of pUC19 DNA, in the presence of H2O2. Discovery studio 2.1 software was used to evaluate binding affinity and interaction pattern of complexes with B-DNA receptor protein and the maximum dock score is seen for complex 2.

Nickel-Metformin Ternary Complexes: Geometrical, Thermal, DNA Binding, and Molecular Docking Studies.

Novel three nickel(II) complexes of type [Ni(metf)(o-phen)2]Cl2 (1), [Ni(metf)(opda)2]Cl2 (2), [Ni(metf)(2-2'bipy)2]Cl2 (3), (Metf = metformin, o-phen = ortho-phenanthroline, opda = ortho-phenylenediamine, 2-2' bipy = 2-2' bipyridyl) were synthesized and characterized by various analytical and spectral techniques. Based on these studies, octahedral geometry is assigned to these complexes. The DNA binding properties of these complexes were investigated by absorption, emission, and viscosity studies. From the spectral data, it was concluded that the complexes bind to DNA through groove mode of binding. The intrinsic binding constants (Kb) from absorption spectroscopy were 1.60 × 104, 3.57 × 104, and 5.70 × 104 M-1 for 1, 2, and 3, respectively, and Stern-Volmer quenching constants (Ksv) from emission spectroscopy were 0.11, 0.87, and 0.24, respectively. Thermal degradation pattern of the compounds was studied and Coats-Redfern method is used to determine kinetic parameters for complexes 1, 2, and 3 from thermal studies. The software Discovery Studio 2.1 was used to assess the binding affinity and interaction pattern of complexes with the B-DNA receptor protein and complex 1 has the highest dock score.

Unintentional Injuries Among Under-five Children in a Rural Area in Delhi.

OBJECTIVE: To determine the prevalence of unintentional injuries and its associated factors among under-five children in Rural Delhi. METHODS: This community based cross-sectional study was conducted in Pooth Khurd village of Delhi during 2018 among under-five children and their care givers. Primary caregivers of the child in the randomly selected households were interviewed using a semi-structured pretested questionnaire. Data related to unintentional injuries in past 12 months and its associated factors were collected. RESULTS: Unintentional injuries were prevalent in 29.3% (95% CI: 25.8-32.9) of the 650 under-five children included. Male children had 1.4 times increased prevalence of injuries (aPR=1.4, 95% CI: 1.1-1.7). As the age increases from 2 years to 5 years the prevalence of injuries increased constantly from 29% to 50%. The prevalence of unintentional injuries was significantly higher among children of working mothers (aPR=1.7, 95% CI: 1.4-2.1), family with more than 3 children (aPR=1.6, 95% CI:1.1-2.4), household without a separate kitchen (aPR=1.6, 95% CI:1.2-2.2) and household with inadequate lighting (aPR=1.8, 95% CI:1.4-2.3). CONCLUSIONS: The factors significantly associated with unintentional injuries were male gender, higher age of the children, maternal occupation, increased number of children in the family, not having a separate kitchen and inadequate lighting.

Posaconazole.

Posaconazole is a novel second-generation Triazole oral antifungal agent. It is highly effective in the prophylaxis of invasive fungal infections in immunocompromised patients. It is used as a first-line agent as well as for salvage therapy in invasive fungal infections including aspergillosis, oropharyngeal and esophageal candidiasis. It has a good adverse effect profile. With the rising incidence of invasive fungal infections due to the HIV pandemic and medical advancements in transplantation and cancer therapy, these features make posaconazole a valuable addition in the family of antifungal agents.

Deflazacort.

Conventional oral steroids like prednisolone have various adverse effects both during short-term and long-term use. Hence a search for an alternative oral steroid with fewer side-effects is underway throughout the world. Deflazacort, an oxazoline derivative, is a step in this direction. The number of large randomized trials using deflazacort for steroid-responsive disorders in children is limited. Use of deflazacort has been explored largely in patients with Duchenne's muscular dystrophy. Preliminary data suggest reduced osteoporosis, lesser growth retardation and weight gain with use of deflazacort, as compared to other steriods. In view of the limited data demonstrating superiority of deflazacort over the available oral steroids and its prohibitive cost, it is early to advocate widespread use of this drug in children.

Granulomatous cheilitis secondary to tuberculosis in a child.

Granulomatous cheilitis is a chronic granulomatous inflammation of the lips that can be secondary to various etiologies. A few infectious agents including Mycobacterium tuberculosis have been implicated in its etiology. It can be the clinical presentation of a tuberculide resulting from a hypersensitivity reaction to an underlying focus of tuberculosis such as pulmonary tuberculosis. This case report describes a child with granulomatous cheilitis with pulmonary tuberculosis, who responded to anti-tubercular treatment. This is probably the first pediatric case of this rare condition.

Mucormycosis: an unusual masquerader of an endobronchial tumour.

Pulmonary mucormycosis is a life-threatening invasive fungal infection usually seen in the background of immunosuppression, haematological malignancies, or uncontrolled diabetes. Immunocompetent hosts can also be affected. Isolated endobronchial mucormycosis is rare with only a few cases reported in the literature. Here, we present a case of an endobronchial mass masquerading as a tumour that was later diagnosed as invasive mucormycosis by histopathological examination.

Clinical spectrum of fever of unknown origin among Indian children.

BACKGROUND: Fever of unknown origin (FUO) is an important cause of morbidity and mortality in children, especially in tropical and developing countries. AIM: To determine the aetiology and outcome of FUO in Indian children. METHODS: A hospital-based, prospective, observational study was conducted over a 1-year period (2006-2007). Children aged > or =3 months to 12 years who qualified for the definition of FUO were recruited. Initial evaluation included complete blood count, peripheral smear for malarial parasites, erythrocyte sedimentation rate (ESR), urine analysis and culture, blood culture, tuberculin test and chest X-ray. RESULTS: Of 49 patients evaluated, a diagnosis was reached in 43 (88%). Infections were the predominant cause of FUO in 34 patients (69%). Enteric fever was the most common infection (14), followed by visceral leishmaniasis (10) and tuberculosis (5). The next most common cause was malignancy (6, 12%). Among the six undiagnosed patients, spontaneous resolution occurred in five whereas one child continued to be febrile without an established cause at the end of the study. CONCLUSION: Repeated, thorough clinical examination and carefully selected laboratory examinations proved useful in the diagnosis of FUO. Serology (e.g. enteric fever) and bone marrow examination (e.g. leishmaniasis, malignancy) were the most useful diagnostic tests.

The clinical spectrum of chronic liver disease in children presenting to a tertiary level teaching hospital in New Delhi.

We report on the clinical spectrum of chronic liver disease (CLD) in children presenting to a tertiary level teaching hospital. Children aged <14 years with suspected CLD presenting to the paediatric gastroenterology department of Maulana Azad Medical College between January 1999 and December 2004, were prospectively studied. They were all given liver function tests, abdominal ultrasonography, endoscopy, viral markers and were checked for Wilson's disease, autoimmune hepatitis and liver biopsy wherever feasible. Other tests for metabolic liver diseases were done when indicated. CLD was diagnosed in 174 children over the six-year period. Cryptogenic cirrhosis was the most common entity, followed by hepatitis B-induced liver disease and Wilson's disease. Most patients presented late with evident portal hypertension.