Timing of Mycobacterium tuberculosis exposure explains variation in BCG effectiveness: a systematic review and meta-analysis.

RATIONALE: The heterogeneity in efficacy observed in studies of BCG vaccination is not fully explained by currently accepted hypotheses, such as latitudinal gradient in non-tuberculous mycobacteria exposure. METHODS: We updated previous systematic reviews of the effectiveness of BCG vaccination to 31 December 2020. We employed an identical search strategy and inclusion/exclusion criteria to these earlier reviews, but reclassified several studies, developed an alternative classification system and considered study demography, diagnostic approach and tuberculosis (TB)-related epidemiological context. MAIN RESULTS: Of 21 included trials, those recruiting neonates and children aged under 5 were consistent in demonstrating considerable protection against TB for several years. Trials in high-burden settings with shorter follow-up also showed considerable protection, as did most trials in settings of declining burden with longer follow-up. However, the few trials performed in high-burden settings with longer follow-up showed no protection, sometimes with higher case rates in the vaccinated than the controls in the later follow-up period. CONCLUSIONS: The most plausible explanatory hypothesis for these results is that BCG protects against TB that results from exposure shortly after vaccination. However, we found no evidence of protection when exposure occurs later from vaccination, which would be of greater importance in trials in high-burden settings with longer follow-up. In settings of declining burden, most exposure occurs shortly following vaccination and the sustained protection observed for many years thereafter represents continued protection against this early exposure. By contrast, in settings of continued intense transmission, initial protection subsequently declines with repeated exposure to Mycobacterium tuberculosis or other pathogens.

Prevalence of Hypertension among Urban Poor with and without Diabetes - A Study from South India.

OBJECTIVE: Hypertension and Diabetes are considered as two leading risk factors of mortality in the world. According to an ICMR-INDIAB study, prevalence of hypertension in Tamil Nadu was higher in urban population than the rural population. Hence this study was planned to estimate the prevalence and distribution of hypertension among the urban poor with and without diabetes. METHODS: A community based cross-sectional study was conducted among two backward communities in North Chennai, Tamil Nadu. A total of 330 participants with and without diabetes, were recruited after screening 1272 subjects and self reported diabetes cases of 235. Measurement of blood pressure was done in both groups based on American Heart Association (AHA) criteria and diagnosis of diabetes was made based on the previous history of diabetes and WHO criteria. RESULTS: Prevalence of hypertension (Stage II) among the people with diabetes and without diabetes was reported 44.8%, and 42.6% respectively (p= 0.046). Obesity and overweight were significantly associated with prevalence of hypertension among people with diabetes (p= 0.021). Distribution of stage II hypertension among males and females were 46.2% and 42.80% respectively. There was significant gender difference in the prevalence of HTN (p = 0.043). CONCLUSION: Prevalence of hypertension was found to be higher among the diabetic group compared to the non- diabetic group (44.8% vs 42.6%), though the difference between the two was not very substantial. We therefore conclude that half of the urban poor are hypertensive even if they are not diabetic.

A cohort study of gestational diabetes mellitus and complimentary qualitative research: background, aims and design.

BACKGROUND: Women with gestational diabetes mellitus (GDM) and their offsprings are at increased risk of future type 2 diabetes and metabolic abnormalities. Early diagnosis and proper management of GDM, as well as, postpartum follow-up and preventive care is expected to reduce this risk. However, no large scale prospective studies have been done particularly from the developing world on this aspect. The objective of this study is to identify and follow a cohort of pregnant women with and without GDM and their offspring to identify determinants and risk factors for GDM, for various pregnancy outcomes, as well as, for the development of future diabetes and metabolic abnormalities. METHODS: This is a prospective cohort study involving pregnant women attending prenatal clinics from urban, semi-urban and rural areas in the greater Chennai region in South India. Around 9850 pregnant women will be screened for GDM. Socio-economic status, demographic data, obstetric history, delivery and birth outcomes, perinatal and postnatal complications, neonatal morbidity, maternal postpartum and offsprings follow-up data will be collected. Those diagnosed with GDM will initially be advised routine care. Those unable to reach glycaemic control with diet alone will be advised to take insulin. Postpartum screening for glucose abnormalities will be performed at months 3 and 6 and then every year for 10 years. The offsprings will be followed up every year for anthropometric measurements and growth velocity, as well as, plasma glucose, insulin and lipid profile. In addition, qualitative research will be carried out to identify barriers and facilitators for early GDM screening, treatment compliance and postpartum follow-up and testing, as well as, for continued adherence to lifestyle modifications. DISCUSSION: The study will demonstrate whether measures to improve diagnosis and care of GDM mothers followed by preventive postpartum care are possible in the routine care setting. It will also map out the barriers and facilitators for such initiatives and provide new evidence on the determinants and risk factors for both GDM development and occurrence of adverse pregnancy outcomes and development of future diabetes and metabolic abnormalities in the GDM mother and her offspring.

Pre-sensitization with tuberculosis and non-tuberculosis mycobacteria and its impact on TB incidence in different age groups: Chengalpattu BCG trial revisited.

Individuals pre-sensitized with Mycobacterium tuberculosis (MTB), non-tuberculosis mycobacteria, and its impact on TB incidence are relatively unexplored in a high TB burden setting. We conducted secondary data analysis of a double-blind, randomized Chengalpattu BCG trial, India. Induration to Purified Protein Derivative (PPD)-S and PPD-B were proxies for exposures to MTB and M. intracellulare respectively. Optimum cut-off for PPD-S and B were determined using Receiver-Operating Characteristic curves and induration ≥12 mm for PPD-S and ≥10 mm for PPD-B were considered strong reaction. Incidence rates of culture positive pulmonary TB per 100,000 person-years (PY) were calculated. Of 270,043 individuals with skin test results, children <14 years (n = 109,383, 64% showed strong-reaction to PPD-B and 17% to PPD-S) and adults between 25 and 34 years (n = 40,292, 98% were strong reactors to PPD-B and 73% to PPD-S). Overall incidence rate was lower in individuals with PPD-S < PPD-B (136, 95% CI: 130-141/100,000 PY) compared to individuals with PPD-S > PPD-B (447, 95% CI: 427-468/100,000 PY). Incidence rates of culture positive pulmonary TB was affected by early age of exposure to cross-reactive mycobacterial antigens represented by PPD-B and exposure to MTB represented by PPD-S during adolescence and early adulthood.

Level of urbanization and noncommunicable disease risk factors in Tamil Nadu, India.

OBJECTIVE: To investigate the poorly understood relationship between the process of urbanization and noncommunicable diseases (NCDs) through the application of a quantitative measure of urbanicity. METHODS: We constructed a measure of the urban environment for seven areas using a seven-item scale based on data from the Census of India 2001 to develop an "urbanicity" scale. The scale was used in conjunction with data collected from 3705 participants in the World Health Organization's 2003 STEPwise risk factor surveillance survey in Tamil Nadu, India, to analyse the relationship between the urban environment and major NCD risk factors. Linear and logistic regression models were constructed examining the relationship between urbanicity and chronic disease risk. FINDINGS: Among men, urbanicity was positively associated with smoking (odds ratio: 3.54; 95% confidence interval, CI: 2.4-5.1), body mass index (OR: 7.32; 95% CI: 4.0-13.6), blood pressure (OR: 1.92; 95% CI: 1.4-2.7) and low physical activity (OR: 3.26; 95% CI: 2.5-4.3). Among women, urbanicity was positively associated with low physical activity (OR: 4.13; 95% CI: 3.0-5.7) and high body mass index (OR: 6.48; 95% CI: 4.6-9.2). In both sexes urbanicity was positively associated with the mean number of servings of fruit and vegetables consumed per day (P < 0.05). CONCLUSION: Urbanicity is associated with the prevalence of several NCD risk factors in Tamil Nadu, India.

Prevalence of Diabetes Mellitus and Exposure to Suspended Particulate Matter.

BACKGROUND: Evidence from various epidemiological studies has shown an association between particulate matter 2.5 (PM2.5) and diabetes mellitus. A prospective study from the United States reported that exposure to PM2.5 alters endothelial function, and leads to insulin resistance and reduction in peripheral glucose uptake. There is a paucity of data on the relation between air pollution and diabetes in low- and middle-income countries. OBJECTIVES: To estimate the prevalence of type 2 diabetes among people living in areas with higher exposures of suspended PM2.5 compared to people living in areas with lower exposures in Chennai, Tamil Nadu, India. METHODS: A cross-sectional study was carried out in two areas of Chennai city. The PM2.5 affecting vulnerable areas were stratified from a list of air quality monitoring stations in Tamil Nadu Pollution Control Board and Central Pollution Control Board. The highest and lowest areas of exposure were selected from the list. Households were randomly selected for the study. A total of 201 (67 male, 134 female) individuals from a high exposure area (HEA) and 209 (76 male 133 female) individuals from a low exposure area (LEA) were recruited for the study. Adults over 18 years of age were screened for random capillary blood glucose (RCBG) by glucometer (OneTouch Ultra). RESULTS: The prevalence of diabetes (34.8% vs 19.6% p =0.001) was 77.5% higher among people living in areas of high particulate matter exposure compared to people living in less exposed areas. Multivariable logistic regression analysis showed that age, gender, residential area, and family history of diabetes were significantly associated with the prevalence of diabetes (p<0.05). CONCLUSIONS: The present study indicates a link between high levels of exposure to PM2.5 and diabetes mellitus. Further prospective studies on populations exposed to elevated pollution are needed to establish whether this association has a causative link. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study was approved by the Ethics Committee of the Prof. M Viswanathan Diabetes Research Centre, Chennai, India. COMPETING INTERESTS: The authors declare no competing financial interests.

Prevalence of gestational diabetes mellitus in South India (Tamil Nadu)--a community based study.

AIM: Women diagnosed to have Gestational Diabetes Mellitus (GDM) are at increased risk of developing diabetes in future. Thus, diagnosis of GDM is an important public health issue. In a random survey 16.2% of pregnant women were found to have GDM in the Chennai urban population. Hence we undertook a planned community based study to ascertain the prevalence of GDM. MATERIALS AND METHODS: We conducted a prospective screening for GDM in the urban, semi urban and rural areas. All pregnant women irrespective of gestational weeks underwent a 75 g glucose challenge test in the fasting state. Diagnosis of GDM was made if the 2 hr plasma glucose was > or = 140 mg/dl (WHO criteria). RESULTS: A total of 4151, 3960 and 3945 pregnant women were screened in urban, semi urban and rural areas, respectively. GDM was detected in 739 (17.8%) women in urban, 548 (13.8%) in semi urban and 392 (9.9%) in rural areas. Out of 1679 GDM women, 1204 (72%) were detected in first visit and the remaining 28% in subsequent visits. A significant increase (P < 0.0001) in the prevalence of GDM was observed with family history of diabetes, increased maternal age and BMI. A trend for increased prevalence of GDM was observed in women with less physical activity, however, not statistically significant. CONCLUSION: In this community based study, the prevalence of GDM varied in the urban, semi urban and rural areas. Age > or = 25 years, BMI > or = 25 and family history of diabetes were found to be risk factors for GDM.

A profile of bacteriologically confirmed pulmonary tuberculosis in children.

OBJECTIVE: To describe the clinical profile of children with bacteriologically confirmed tuberculosis. STUDY DESIGN: A multicentric study was conducted in three hospitals in Chennai city between July 1995 and December 1997. Children aged 6 months to 12 years with signs and symptoms suggestive of tuberculosis were investigated further. Clinical examination, chest radiograph, tuberculin skin test with 1 TU PPD and, sputum or gastric lavage for mycobacterial smear and culture were done for all and, lymph node biopsy when necessary. RESULTS: A total of 2652 children were registered and tuberculosis was bacteriologically confirmed in 201. Predominant symptoms were history of an insidious illness (49%), fever and cough (47%), loss of weight (41%) and a visible glandular swelling (49%). Respiratory signs were few and 62% were undernourished. Over half the patients with confirmed TB had normal chest X-ray. Abnormal X-ray findings included parenchymal opacities in 47% and hilar or mediastinal lymphadenopathy in 26%. The prevalence of isoniazid resistance was 12.6% and MDR TB 4%. CONCLUSIONS: Children with tuberculosis present with fever and cough of insidious onset. Lymphadenopathy is a common feature even in children with pulmonary TB. A significant proportion of children have normal chest X-rays despite positive gastric aspirate cultures. Drug resistance rates in children mirror the pattern seen in adults in this geographic area.

Anthropometric cut points for identification of cardiometabolic risk factors in an urban Asian Indian population.

The aim of this study was to determine the anthropometric cut points for risk of cardiometabolic risk factors in an urban Asian Indian population. The Chennai Urban Rural Epidemiology Study representatively sampled 26001 individuals aged 20 years or older and detailed measures were obtained in every 10th subject: 90.4% (2350/2600). An oral glucose tolerance test was performed in all individuals except self-reported diabetic subjects. Anthropometric measurements such as body mass index (BMI) and waist circumference (WC) were obtained and serum lipid estimations were done in all subjects. Sensitivity, specificity, and distance on receiver operating characteristic curve were used to determine the optimal cut points for BMI and WC with cardiometabolic risk factors. Maximum sensitivity and specificity of BMI for all cardiometabolic risk factors such as diabetes mellitus, prediabetes, hypertension, hypertriglyceridemia, hypercholesterolemia, and low high-density lipoprotein cholesterol ranged from 22.7 to 23.2 kg/m(2) for men and 22.7 to 23.8 kg/m(2) for women, and that of WC ranged from 86 to 88.2 cm for men and 81 to 83.8 cm for women. The optimal BMI cut point for identifying any 2 cardiometabolic risk factors was 23 kg/m(2) in both sexes, whereas that of WC was 87 cm for men and 82 cm for women. The study validates the World Health Organization Asia Pacific guidelines of BMI of 23 kg/m(2) for the designation of overweight; WC of 87 cm for men and 82 cm for women appear to be appropriate cut points to identify cardiometabolic risk factors including prediabetes in urban Asian Indians.

Gestational diabetes mellitus manifests in all trimesters of pregnancy.

Screening for GDM is usually performed around 24-28 weeks of gestational age. We undertook a study to estimate the prevalence of glucose intolerance during different trimesters, as data in this aspect is sparse. A total of 4151 consecutive pregnant women irrespective of gestational weeks attending antenatal health posts across Chennai city underwent a 75 g OGTT recommended by WHO and diagnosed GDM if 2 hr PG value > or =140 mg/dl. Women who had normal OGTT at the first visit were screened with a repeat OGTT at the subsequent visits. Among the screened, 741 women (17.9%) had 2 hr PG> or =140 mg/dl and were identified to have gestational diabetes. Analysis based on gestational weeks revealed that out of the 741 GDM women, 121 (16.3%) were within 16 weeks, 166 (22.4%) were between 17 and 23 weeks and 454 (61.3%) were more than 24 weeks of gestation. Observation in this study was that 38.7% developed gestational diabetes even prior to 24th week of gestation. Out of the total 741 GDM women, 214 (28.9%) were diagnosed on repeat testing at subsequent visits. Glucose intolerance occurs in the early weeks of gestation. Women who had normal glucose tolerance in the first visit require repeat OGTT in the subsequent visits.

Areca nut use among rural residents of Sriperambudur Taluk: a qualitative study.

OBJECTIVE: The main objective of the study was to understand the perceptions of the residents of rural part of Sriperambudur Taluk, regarding areca nut use. This article discusses the findings of in-depth interviews and focus group discussions at rural part of Sriperambudur Taluk. MATERIALS AND METHODS: A community-based survey was conducted using qualitative methods. Out of 168 villages, 11 were randomly chosen. Fifteen in-depth interviews and five focus group discussions were conducted. Only those above 10 years of age and who used areca nut either in processed or un-processed form were included in the study. RESULTS: Among different forms of areca nut products, the use of Hans, which is a commercial flavored product containing areca nut, tobacco and other ingredients is believed to be the most prevalent habit in all the age groups. Chewing areca nut is the initiating habit, leading to other habits such as smoking and consuming alcoholic beverages. Residents less than 30 years of age chew areca nut products for fun or because of peer pressure whereas the 30 to 50 year olds get habituated due to reasons such as boredom and family problems. Although there is awareness regarding the ill-effects of tobacco use, there is not much awareness regarding areca nut. According to the residents, the community has not given enough thought regarding areca nut products and therefore no action has been taken to mitigate this high-risk behavior. CONCLUSION: It is the perception of the community that there is an increasing trend in the use of areca nut especially the commercial forms such as Hans , in rural Tamilnadu. Habit gets initiated at a very young age; therefore age specific intervention programs should be implemented. Periodic research should be conducted to better understand the changing trends of chewing areca nut products.

Community empowerment--a successful model for prevention of non-communicable diseases in India--the Chennai Urban Population Study (CUPS-17).

BACKGROUND AND OBJECTIVE: Randomized clinical trials have documented that lifestyle changes through physical activity can prevent diabetes. However there is no data whether such strategies are applicable at community level, that is, in a real life setting. This study demonstrates the first attempt in India, to our knowledge, of increasing physical activity through community empowerment in an attempt at primary prevention of non communicable diseases. METHODS: The Chennai Urban Population Study [CUPS] was conducted in the year 1996 in two residential areas: a middle income group the Asiad colony at Tirumangalam, and a low income group at Bharathi Nagar in T. Nagar. The Asiad colony was selected for this study. Of the 524 eligible individuals available at baseline in 1998 [age > or =20 years], 479 individuals consented for the study (response rate: 91.4%). After seven years, in 2004, the number of eligible individuals increased to 712 of whom 705 consented for the study (response rate:99%). Education regarding the benefits of physical activity was provided by mass awareness programmes like public lectures and video clippings. Both at baseline and during follow-up, details about the physical activity were collected using a validated questionnaire, which included job related and leisure time activities, and specific questions on exercise. Study individuals were then graded as having light, moderate and heavy physical activity using a scoring system. RESULTS: In response to the awareness programmes given by our research team, the colony residents constructed a unique public park with their own funds. Though the occupation grades did not change, there was a significant change in the pattern of physical activity. At baseline, only 14.2% of the residents did some form of exercise. more than three times a week, which presently increased to 58.7% [p < 0.001]. The number of subjects who walked more than three times a week increased from 13.8% at baseline to 52.1% during follow-up [p < 0.001]. CONCLUSION: This study is a demonstration of how community empowerment with increased physical activity could possibly lead to prevention of diabetes and other non communicable diseases at the community level. This study also highlights the importance of sharing the results of research studies with the community.

Need for testing glucose tolerance in the early weeks of pregnancy.

AIMS: This observational study aims to determine the frequency of occurrence of glucose intolerance in the early weeks of pregnancy. MATERIALS AND METHODS: New World Health Organization 2013 guidelines recommends "A Single Step Procedure" (SSP) as an option for diagnosing gestational diabetes mellitus (GDM). Pregnant women attending 131 prenatal clinics across India for the first time underwent SSP consisting of administration of 75 goral glucose irrespective of the last meal timing and to diagnose GDM with 2 h plasma glucose (PG) value ≥7.8 mmol/L (7.8 mmol/L). RESULTS: In a cohort of n = 11,785, the number of pregnant women who underwent the test in first, second, and third trimesters were 4300, 4632, and 2853, respectively. Documented blood glucose values were available for 9282 pregnant women and in them, diagnosis of GDM was made in 740 (8%). Among them, 233 (31.5%), 320 (43.2%), and 187 (25.3%) were in the first, second and third trimesters, respectively. Positive family history of diabetes (43%) and history of fetal loss in previous pregnancy (27%) was more common in women diagnosed with GDM in the first trimester compared to GDM diagnosed in the second or third trimester. CONCLUSION: Manifestation of GDM in the early weeks of gestation is quite common.

Awareness and knowledge of diabetes in Chennai--the Chennai Urban Rural Epidemiology Study [CURES-9].

BACKGROUND AND AIM: There are virtually no epidemiological studies from India assessing the level of awareness of diabetes in a whole population. The aim of the present study was to assess the awareness of diabetes in an urban south Indian population in Chennai. METHODS: The Chennai Urban Rural Epidemiology Study (CURES) is an ongoing population based study conducted using a systematic sampling method on a representative population (aged > or = 20 years - 26001 individuals) of Chennai [formerly Madras], the largest city in Southern India. A structured questionnaire was used to obtain information related to demography, education and medical history. The questionnaire included five questions on diabetes awareness. RESULTS: Of the total 26,001 individuals, only 75.5% (19642/26001) of the whole population reported that they knew about a condition called diabetes or conversely nearly 25% of the Chennai population was unaware of a condition called diabetes. 60.2% (15656/26001) of all participants and 76.7% (1173/1529) of the self reported diabetic subjects knew that the prevalence of diabetes was increasing in India. Only 22.2% (5764/ 26001) of the whole population and 41.0% (627/1529) of the known diabetic subjects were aware that diabetes could be prevented. Knowledge of the role of obesity and physical inactivity in producing diabetes was very low, with only 11.9% (3083/26001) of study subjects reporting these as risk factors for diabetes. Only 19.0% (4951/26001) of whole population knew that diabetes could cause complications. Even among the self reported diabetic subjects, only 40.6% (621/1529) were aware that diabetes could produce some complications. CONCLUSION: Awareness and knowledge regarding diabetes is still grossly inadequate in India. Massive diabetes education programmes are urgently needed both in urban and rural India.

Computerized tomography detects pulmonary lesions in children with normal radiographs diagnosed to have tuberculosis.

This report is based on observations during the conduct of a larger study to develop diagnostic criteria for childhood tuberculosis (TB). Of 201 children confirmed to have pulmonary or lymph node TB, 84 had normal chest radiographs. Computerized tomography (CT) of the chest was performed in nine of them, seven of whom had normal chest radiographs while two had visible calcification. Eight of the nine children had definitive lesions detected by computerized tomography of the chest. While five children had primarily hilar lymph node enlargement, three had pulmonary parenchymal lesions. The use of more sensitive diagnostic tests like computed tomography helps to detect tuberculosis lesions not otherwise visualized on chest radiographs. This report highlights the difficulty in excluding active tuberculosis in children. More studies are required on the role of CT scans in the diagnosis of tuberculosis in children.

Does effect of BCG vaccine decrease with time since vaccination and increase tuberculin skin test reaction?

The protective efficacy of BCG was studied for over 15 years, from 1968, in South India. A secondary analysis of data was performed to investigate the relationship between Bacille Calmette-Guérin (BCG) and tuberculosis (TB) disease and between BCG and positive tuberculin skin test for different time periods among children aged less than 10 years. A randomized controlled trial was conducted, where 281,161 persons were allocated to receive BCG 0.1mg, BCG 0.01mg or placebo. Tuberculin skin test was performed at baseline and at 4 years after BCG vaccination. Surveys were conducted every 2.5 years to detect all new cases of culture-positive/smear-positive TB occurring in the community over a 15-year period. Relative risk (RR) was obtained from the ratio of incidence among the vaccinated and the placebo groups. Among those children vaccinated with 0.1mg of BCG, the RR for TB was 0.56 (95% CI: 0.32-0.87, P=0.01) at 12.5 years but increased to 0.73 later. Similar pattern was seen with 0.01mg. The increase in the number of skin test positives with 0.1mg of BCG was 57.8%, 49.4% and 34% for cut-off points at ≥10mm, ≥12mm and ≥15mm, respectively. The study suggests that the effect of BCG may decrease since vaccination and the tuberculin positive was higher at post-vaccination test period due to BCG.

Treatment-seeking behavior and compliance of diabetic patients in a rural area of south India.

India, being a rural country, has unique problems regarding the treatment compliance of diabetic patients. This community-based study was undertaken in a rural primary health center area near Chennai (Madras) in order to better understand treatment-seeking behavior, compliance patterns, and reasons for noncompliance among rural diabetics. Compliance was indirectly measured through patient interviews and drug use charts. Of the 112 patients interviewed, 72% had some symptoms at the time of diagnosis, and the majority of them were diagnosed in government health centers. Noncompliance was seen in 57% of the 112 patients interviewed, and reasons were elicited. Interruption of treatment was significantly associated with lack of education. The study identified the lack of a patient-friendly, flexible health care system as the primary reason for noncompliance.

Autoimmune diabetes in 26 villages outside Madras.

Autoimmune diabetes is one of the most common chronic diseases in the world. Autoantibodies against major antigens GAD65 and IA-2 as well as some minor antibodies are markers for autoimmune diabetes already several years before clinical onset in most populations. Screening the population for these autoantibodies can help identify subjects at risk for developing type 1 diabetes. In our study we screened 20,903 inhabitants in 26 villages outside Madras for diabetes. Among them 3.64% were detected to be diabetic. The aim of our study was to detect the presence of glutamic acid decarboxylase (GAD65), tyrosine phosphates (IA-2) and tissue transglutaminase (TTG) antibodies. We studied 169 individuals from this population, 75 of them were diagnosed as diabetics, based on presence of sugar in the urine and an elevated blood sugar, 58 had hypertension, and 36 were healthy subjects. We used radioimmunoassay with in vitro translated and transcribed human recombinant 35S-GAD65, IA-2 and TTG antigens. We observed presence of GAD65Ab in 10%, IA-2Ab in 5%, and TTGAb in 5% in diabetic subjects, while the healthy subjects and people with hypertension didn't carry any of these antibodies. We conclude that prevalence of autoimmune diabetes mellitus based on antibody screening in this population is significantly high.

Predictors of spontaneous bleeding in Dengue.

OBJECTIVE: To identify the predictive factors for spontaneous bleeding manifestations in Dengue illness in infants and children. METHODS: 60 cases of Dengue viral infection with spontaneous skin and or mucosal bleed were compared with 72 cases without spontaneous bleed. The protean bleeding manifestations in dengue infection were recorded. Various clinical and laboratory parameters were analyzed using univariate and logistic regression analysis. RESULTS AND CONCLUSION: Prothombin time was abnormal only in cases with spontancous bleed. A combination of (a) biphasic pattern of fever, (b) hemoconcentration, (c) platelet count less than 50,000/mm3 and (d) elevated ALT had a sensitivity of 79.2%, specificity of 64.7% with a positive predictive value of 70% and a negative predictive value of 75% in predicting spontaneous bleeding in dengue.