Profile of Patients with Periodontal Disease: A Descriptive Study.

Background: The most common form of periodontal disease has been defined as “an inflammatory process affecting one or more of the supporting tissues of teeth – the gingival tissue, the periodontal membrane and the alveolar bone. In this study the index used for assessing the periodontal status of the population was Community Periodontal Index of Treatment Needs (CPITN). Methods: Study subjects included patients diagnosed to have periodontal disease and a total of 200 patients were selected for the study. Results: In this study, 21% of patients were smokers, 12% of patients consumes smokeless tobacco, 26% of patients were alcoholics and 30% of patients had bad practices of oral cleaning. Conclusion: Modifiable risk factors were more commonly associated with periodontal disease.

Fever of Unknown Origin (FUO) in HIV Infection in the Era of Antiretroviral Treatment (ART) in India: Development of a Simple Diagnostic Algorithm.

Objective: Fever of unknown origin (FUO) is a challenging problem among people living with HIV (PLHIV). With increasing access to Anti-retroviral treatment (ART), the spectrum of causes of FUO has evolved in the developed world. This study evaluated the etiology of FUO among PLHIV in the era of ART in India. Methodology: This prospective study was conducted at a tertiary-care institution in New Delhi, India. Sixty four PLHIV with a diagnosis of FUO were assessed by detailed clinical evaluation and immunological assessment. Specific investigations to identify the etiology of fever: microbiological and radiological investigations, bone marrow and histopathological examination of biopsies were performed. A simple diagnostic algorithm for FUO was developed based on the findings. Results: Sixty five episodes of FUO were studied. Seventy percent of subjects were men, 76% were <40 years of age, and 39% were receiving ART. The mean CD4 count was 156.57±178.43 cells/mm3 (5 to 1144 cells /mm3) and 23% patients had CD4 counts <50 cells/mm3. The mean duration of fever was 11.26±8.54 weeks. Infections were the most common cause for FUO, with Tuberculosis the most common (61.54%), particularly disseminated tuberculosis (41.54%). Cryptococcal meningitis (7.69%), bacterial pneumonia (4.62%), pyogenic abscesses (4.62%), Pneumocystis jirovecii pneumonia (PCP) (3.08%), visceral leishmaniasis (3.08%) were other infections observed. Non-infectious etiologies including lymphoma (4.62%) and progressive multifocal leucoencephalopathy (PMLE) (3.08%) were also seen. The etiology remained undiagnosed in 6.15% episodes. Importantly, two or more concurrent etiologies of fever were seen in 60% of patients. Conclusion: Infections especially Tuberculosis remain the most common cause of FUO in PLHIV even in the era of ART in developing countries like India. Multiple concurrent infections and a rising trend to non-infectious causes are being observed. A simple diagnostic algorithm will help diagnose majority of FUO even at the peripheral centers.

Zinc Supplementation for Prevention of Acute Respiratory Infections in Infants: A Randomized Controlled Trial.

Objective: To study the effect of 2 weeks of prophylactic zinc supplementation on incidence and duration of acute respiratory infections. Design: Randomized double blind controlled trial. Setting: Community based; urban resettlement area in North- East Delhi, India. Participants: 272 children aged 6-11 months with acute respiratory infections. Children receiving zinc supplement within the past 3 months, severely malnourished, immuno-deficient, on steroid therapy, with severe illness requiring hospitalization, or children of families likely to migrate from the study area were excluded. Intervention: Placebo (syrup base) or zinc (20 mg/5 mL elemental zinc as zinc sulfate) orally given for a period of 2 weeks. Main outcome measure(s): Incidence, type and duration of acute respiratory infections, and adverse effects. Results: No effect on incidence of acute respiratory infections was noted. A decrease of 15% (0.78-0.94) in days and 12% (0.78- 0.94) in duration of episode in acute respiratory infections was observed. Incidence of acute lower respiratory infections decreased by 62% (0.26-0.36) and the effect remained for full five months of follow up. There were no drop outs due to side effects. Conclusions: Prophylactic zinc supplementation for two weeks may reduce the morbidity due to acute lower respiratory infections but not overall rate of acute respiratory infections in infants aged 6-11 months in similar populations.

Salmonella Paratyphi B bacteremia in Systemic Lupus Erythematosus with an unusual presentation- a case report.

Background- Systemic Lupus Erythematosus (SLE) is an inflammatory and multisystem autoimmune disorder. Patients of SLE are at increased risk of infections owing to underlying immunological derangements and to the use of therapeutic regimens like immunosuppressive agents. Among the bacterial infections presenting as bacteremia in these patients, non typhoidal and typhoidal salmonellosis are commonly encountered. We report a rare case of Salmonella Paratyphi B bacteremia in a patient with juvenile onset SLE on treatment with corticosteroids.

Cardiac Abnormalities in HIV Infected Children Presenting to a Tertiary Level Teaching Hospital at New Delhi.

Aims: The aim of our study was to study the prevalence of various cardiac abnormalities in HIV positive children. Study Design: Cross sectional observational study. Place of Study: Antiretroviral treatment clinic of Maulana Azad Medical College and associated Lok Nayak Hospital and Department of Cardiology at G.B.Pant Hospital ,New Delhi . Duration of study : March 2009 to Mar 2010. Methodology: Sixty perinatally acquired, HIV-positive children asymptomatic for cardiac disease in age group of 0-12 years were evaluated for cardiac abnormalities by echocardiography. All children were classified according to the WHO clinical staging for HIV-positive children and also divided into immunologic category as per the age-specific CD4-T lymphocyte count. Results: Sixteen (26.6%) children had evidence of cardiac abnormalities on echocardiography. Twelve (20%) patients in WHO stage III and IV had significant abnormal echocardiographic findings. The major echocardiographic findings seen were left ventricular dilatation in 4 (6.7%) and left ventricular diastolic dysfunction in 3 (5%) children. Conclusions: A baseline echocardiographic study should be done in all patients with symptomatic HIV infection at first contact. Serial echocardiographies should be done to determine the evolution of cardiac disease in HIV infected children. Echocardiographic abnormalities are present even in HIV- infected children who are asymptomatic for cardiac dysfunction.

Demographic and clinical features of orphans and nonorphans at a pediatric HIV centre in north India.

Objective. To determine the prevalence of orphanhood among HIV positive children and to compare their social and demographic and clinical characteristics with that of HIV-positive non-orphans. Methods. From February 2008 through March 2009, data was collected from 148 children registered at the antiretroviral (ART) clinic of a tertiary care hospital in Delhi, on their demographic profile, HIV status of parents, orphan status and cause of parental death, mode of transmission of the infection, current caregiver, school enrolment and clinical and immunologic parameters of HIV infection at presentation. Results. The prevalence of orphanhood was 49.3%. Majority of the orphans were paternal orphans. The primary caregiver was either the surviving parent or extended family members. The orphans were older at presentation and had shorter mean duration of follow-up. They lagged behind the non-orphans in immunisation, nutritional status, school enrolment and attendance and socioeconomic status. They presented more frequently with severe immunosuppression and had a higher prevalence of opportunistic infections. There was no significant difference between the orphans and the non-orphans in the WHO clinical stage of presentation and adherence to ART. Conclusions. The prevalence of orphanhood among the HIV-positive children is high. Although extended family is a cornerstone for care of HIV-positive orphans, these families are overwhelmed by the added responsibility of these children. Larger community-based studies are needed to determine the true magnitude of orphanhood and to evolve methods to socially and financially support the families taking care of these children.

Detecting protein losing enteropathy by Tc-99m dextran scintigraphy: a novel experience.

OBJECTIVE: To evaluate protien using enteropathy by Tc-99m dextran scintigraphy. METHODS: Methods for detecting protein loss from the intestine revolve around fecal nitrogen excretion, the clearance of alpha-1 antitrypsin in stools and by endoscopic biopsy. RESULT: The diagnosis of protein-losing enteropathy (PLE) can also be established by a scintigraphic method that is noninvasive, simple and requires no patient preparation or motivation. This diagnostic modality can also delineate the site of protein loss, thereby offering a targeted approach, and if need be, surgery. Radiolabelling of a non-protein, noncolloidal, nonparticulate and biofriendly molecule like dextran with Technetium-99m for imaging enteric protein loss was utilized in imaging eight children with PLE. CONCLUSION: The results were encouraging. The authors advocate the use of this diagnostic tool in identifying patients with PLE, particularly in the pediatric age group.

Gastrooesophageal reflux in infants and children in north India.

OBJECTIVES: To assess the prevalence of gastrooesophageal reflux disease (GERD) as suggested by the symptom profile in babies ranging in age from 1 month to 2 years. METHODS: Six hundred and two babies were recruited from the well baby clinic for hospital delivered babies and from the childrens OPD of a tertiary care hospital. Children with acute severe illness needing hospitalization were excluded from the study. The primary care taker of each baby was interviewed using a questionnaire (IGERQ) designed by Orenstein et al and the I-GERD score obtained was used to assess for likelyhood of GERD. Upper gastrointestinal (GI) endoscopy was carried out and an oesophageal biopsy was taken in clinically suspected cases of GERD (IGERD > 5). RESULTS: Sixty one (10%) of the 602 subjects had an I-GERD score of > 5 suggestive of GERD. Regurgitation was present in 56 of these 61 subjects and also in 106 of the 541 normal subjects. 112 of 205 infants aged 1-6 months had regurgitation and 25 (22.2%) of these regurgitant infants had a score suggestive of GERD. Only 30 of the 202 infants aged 6-12 months and 20 of the 195 babies aged 12-24 months had regurgitation, however 14 of the 30 (46.5%) and 17 of the 20 (85%) regurgitant babies had an I-GERD score suggestive of GERD. Upper GI endoscopy was carried out in 31 babies with a score > 5 and endoscopic oesophagitis was detected in 16 (51.6%). Oesophageal biopsies were taken in 25 of these cases and showed histological evidence of reflux oesophagitis in 23 (92%). CONCLUSION: GERD is fairly common under 2 years of age as observed by symptom evaluation using the I-GERD score. Regurgitation when present beyond 6 months of age with no other identifiable cause needs evaluation. Upper GI endoscopy and oesophageal biopsy is a useful means of demonstrating reflux oesophagitis in babies with a symptom profile suggestive of GERD.