Pattern of socio-economic and health aspects among TB patients and controls.

BACKGROUND: Socio-economic and health-related factors have a significant impact on tuberculosis (TB) incidence among population residing in resource-scare settings. OBJECTIVE: To evaluate the pattern of socio-economic and health-related factors among TB patients and control in Delhi, India. METHODS: The present cross-sectional study was performed among 893 TB patients (or cases) and 333 healthy disease-free controls. The data for the present study was obtained from several district TB centres in north, west and south Delhi. The collected data was edited, coded and statistical analysed with the help of SPSS 20.0 version. RESULTS: Illiteracy and primary education were significant risk factors being associated with a TB. Rented housing condition had an odds ratio (OR) of 1.4 (95% confidence interval [CI]: 1.09-1.89) compared to owned housing condition. 3-5 individuals per room were 3 times more likely to be associated with a case of TB (95% CI: 2.49-4.41). Migrant individuals were 13 times more likely to be associated with a case of TB (95% CI: 8.77-19.78) in comparison to settled population. Daily consumption of non-vegetarian food also significantly contributed to case of TB with an OR of 3.4 (95% CI: 2.51-4.72). Loss of appetite and family TB served as significant health-related factors associated with TB risk. CONCLUSION: Lower educational status, rented household, individuals per room (as a measure of overcrowding) and migratory status served as prominent risk factors for TB disease. Preference and frequency of non-vegetarian food being consumed, night sweating, weight loss, loss of appetite, earlier TB and family TB were principle health-related risk factors associated with TB disease.

Natural selection among coastal populations of India: trend and extent.

BACKGROUND: Coastal populations have always been exposed to socio-cultural and natural vulnerability. The correlates between these coastal populations and their selection potentials have not been previously described. AIM: To describe selection potentials, their trend and extent among coastal and non-coastal populations of the Indian continent. SUBJECTS AND METHODS: Data on fertility and mortality differentials among five coastal populations were collected from 448 women of Orissa and Goa. Selection potential was computed. In addition, 48 studies among 100 different populations of India were reviewed for similar parameters, for comparison. RESULTS: Total index of selection (I(t)) varied from 0.221-0.417 in the population of Orissa; whereas the population of Goa showed a moderate index of selection. Regression analysis showed that among the coastal population the contribution of index of mortality (I(m)) is higher (92.5%) in total selection index (I(t)) as compared to non-coastal populations (56.4%). After 1991, there was a radical shift in the role of mortality in the entire region. Simultaneously, the selection intensity (I(t)) has gradually declined. CONCLUSION: There is a significant difference in the extent and process of natural selection among coastal and non-coastal populations. Mortality is playing a greater role in the total selection intensity of coastal populations, although the trend is declining in the entire region and reversal in the roles of I(m) and index of fertility (I(f)) is witnessed.

Investigation of outpatients referred to a chemical pathologist with potential pseudohyperkalaemia.

BACKGROUND: Pseudohyperkalaemia is when the in vitro blood potassium concentration is artefactually raised while the in vivo concentration is normal. With unexplained hyperkalaemia, pseudohyperkalaemia needs to be excluded to avoid unnecessary and potentially detrimental therapy. There are numerous causes, but no systematic approach for the investigation of outpatients with potential pseudohyperkalaemia exists in the literature. AIMS: To evaluate the in-house protocol. METHODS: Patients referred for investigation of potential pseudohyperkalaemia underwent an outpatient based protocol which is designed to determine whether the cause was due to delayed blood separation, clotting, centrifugation or a haematological abnormality. RESULTS: 32 patients with serum potassium of 5.5-7.1 mmol/l were referred. All patients had pseudohyperkalaemia; the most frequent causes were full blood count (FBC) abnormalities (28%), time >4 hours from sampling to centrifugation (28%) and sample clotting (25%). Anaemia was more likely to be found in male patients. CONCLUSION: Before a problem can be treated, it must be confirmed and its aetiology identified. A systematic approach to investigate potential pseudohyperkalaemia has been presented. This confirmed the clinician's suspicion of pseudohyperkalaemia and in the majority of patients the aetiology was also identified. The use of serum and plasma potassium with an FBC in the initial investigation will identify whether clotting or a haematological abnormality is the cause in about half of the cases. Assay of whole-blood potassium is less important as centrifugation is a rare cause. Time to centrifugation is likely to play a major part in the majority of the remaining cases.

Tracing the response of subcutaneous fat accumulation in two generations of males.

The present study included 414 adolescent boys aged 11-17 years and their fathers who volunteered as subjects. All the subjects belonged to Punjabi speaking Khatri, an endogamous urban population residing in Delhi, India. A set of five skinfold thicknesses: biceps, triceps, subscapular, suprailiac and medial calf along with body weight and stature were taken on all the subjects to report the pattern of subcutaneous fat distribution and responsiveness of different skinfold sites to fat deposition with variation in total body fat content. It has been noticed that 16- and 17-year-old sons assumed the pattern of subcutaneous fat distribution of their fathers, which was in favour of trunkal fat. Responsiveness of the five skinfold sites towards deposition of fat varied from site to site in various age groups with suprailiac skinfold sites found to be the most responsive followed by subscapular site. The sensitivity of skinfold sites to fat deposition with increase in weight was found to be greater in middle aged men (fathers) than growing boys (adolescent sons).

Vascularised bone grafting in the management of scaphoid non-union - a review of 34 cases.

We reviewed the outcomes of 34 patients who had undergone vascularised bone grafting for a chronic scaphoid non-union. Mean age was 27 years (range 16-46 years). The dominant hand was involved in 17 cases. Eleven patients were smokers. In 18 cases the fracture involved the proximal and in 16 cases the middle third of the scaphoid. In 26 patients the proximal scaphoid fragment was deemed avascular. Sixteen patients had previously undergone scaphoid fixation and non-vascularised bone grafting. At a follow-up of 1 to 3 years (mean 1.6 years), 15 of the 34 scaphoid non-unions had united. Injury to the dominant hand and duration of the non-union significantly increased the risk of failure. Persistent non-union was more common in proximal third fractures and in the presence of an avascular proximal pole but these findings did not reach statistical significance.

The Joint British Societies' algorithm for the diagnosis of diabetes mellitus in routine clinical practice.

The diagnosis of diabetes mellitus (DM) requires a logical approach to identify new cases while not subjecting every patient to an oral glucose tolerance test (OGTT). The Joint British Societies' (JBS2) have recommended an algorithm for the diagnosis of DM. We retrospectively obtained the results of 100 OGTTs requested by primary care physicians, along with previous glucose results and whether the patient was fasting or not with a view to determining how many OGTTs could be avoided by following the recommended algorithm. We found that 47% of the OGTTs could have been avoided, of which the algorithm would have identified all but 4%. Two cases of DM and eight cases of impaired glucose tolerance (IGT) would have been missed. We conclude that following the JBS2 algorithm for the diagnosis of DM will significantly reduce the number of OGTTs, with only a few patients with IGT or DM being missed when such a policy is used.

Histopathological changes in cases of aluminium phosphide poisoning.

Of a total of 205 poisoning deaths in our hospital in 2003, 83 cases were due to Aluminium phosphide poisoning and were further analyzed. Most vulnerable age group was 21-40 years and M:F ratio was 2:1. On naked eye examination, almost all the vital organs were found to be congested. On microscopic study, the liver showed central venous congestion, degeneration, haemorrhage, sinusoidal dilation, bile stasis, centrilobular necrosis, Kupffer cell hyperplasia, infiltration by mononuclear cells and fatty change. Microscopy of the lungs revealed alveolar thickening, oedema, dilated capillaries, collapsed alveoli and haemorrhage. In the kidney, changes were degeneration, infiltration, tubular dilation and cloudy swelling. Changes in the brain included congestion and coagulative necrosis and in the stomach, congestion and haemorrhage. Easy availability of this cheap and highly toxic substance was responsible for the sudden spurt of poisoning with aluminium phosphide.

Fertility and mortality differentials among the population groups of the Himalayas.

Selection potential based on differential fertility and mortality has been computed for 24 Himalayan populations classified into four groups: Himalayan populations with Asian affinities (HPA), Brahmans, Rajputs, and Scheduled Castes (Shilpkars). Irrespective of the methodology followed, the total index of selection was found to be highest (0.794) in Barbatiyas (HPA) and lowest (0.428) in Rajputs. The relative contribution of fertility component (If) to the index of total selection (It) is higher than the corresponding mortality component (Im) in all 24 groups. An analysis of correlation and regression on different components of the indices of selection performed among these 24 Himalayan populations revealed that the contributions of If in determining It are stronger than Im. Further, both If and Im are strongly associated with It and account for 76% and 67% of total variability in It, respectively. Examination of the relationship of the selection potential with the differential altitude and social categories showed a decrease in the index from high altitude to low altitude. Similarly, an inverse relationship was found between various indices and social categories. Himalayan populations with Asian affinities (HPA) in the present study reveal higher values of selection potential. Interestingly, these populations invariably reside in high altitude areas where health and communication infrastructures are poorly developed. Thus, the differential pattern of fertility and mortality among the Himalayan populations indicates that they are passing through a stage of transition, as is evident from the decrease in various selection indices. It is also apparent that groups that are less developed socioeconomically, as well as those inhabiting high altitude regions, are lagging behind in this process.

Prospective study of pattern of breast diseases at Nepalgunj Medical College (NGMC), Nepal.

INTRODUCTION: Patients of breast diseases of female are very common cases attending surgical out patient department for treatment at NGMC, Banke, Nepal. OBJECTIVES: To find out the magnitude of the breast diseases, its frequency distribution in different age group among the patients attending surgical OPD for surgical consultation. MATERIAL AND METHOD: This is a prospective study conducted at NGMC, Nepalgunj, Nepal. Patients attending surgical OPD for one or another breast problem were included. They were assessed clinically and their diagnosis was confirmed by cytological (FNAC) or histopathological (biopsy) examination. Then they were subjected to appropriate treatment. It must be mentioned at the outset that no clinical mammography could be done in the case of this study as these facilities are not available at NGMC. RESULTS: 264 cases of breast disease were diagnosed. This includes 232 female and 32 male patients. The ratio between benign and malignant lesions was 13.6:1. The benign breast diseases (BBD) were the commonest lesions of the breast found in this study (93.2%) whereas malignant lesion was infrequent (6.8%). Among BBD, the commonest lesion was fibroadenoma (32.57%) followed by breast abscess (24.19%), Aberration of Normal Development and Involution (ANDI) which was 16.63% and gynecomastia (11.34%). 18 cases (6.80%) were of malignant lesion. This includes 16 female and 2 male cases. The common ages for BBD were, 20-40 years for fibroadenoma, 15-40 years for breast abscess, 18-40 years for ANDI and 10-19, 50-59 for gynecomastia respectively, whereas carcinoma breast was common in the age group of forties and fifties. CONCLUSION: We conclude from this study that BBD were the most frequent breast lesion. Among the BBD fibroadenoma was the commonest lesion. Breast carcinoma cases were less frequent and reached to the hospital in very late stage of the disease.

Role of curcumin in idiopathic inflammatory orbital pseudotumours.

The present report, describes for the first time the clinical efficacy of curcumin, the active constituent of rhizomes of Curcuma longa, in the treatment of patients suffering from idiopathic inflammatory orbital pseudotumours. Curcumin was administered orally at a dose of 375 mg/3 times/day orally for a period of 6-22 months in eight patients. They were followed up for a period of 2 years at 3 monthly intervals. Five patients completed the study, out of which four recovered completely and in one patient the swelling regressed completely but some limitation of movement persisted. No side effect was noted in any patient and there was no recurrence. It is suggested that curcumin could be used as a safe and effective drug in the treatment of idiopathic inflammatory orbital pseudotumours.

Seroepidemiology of hepatitis A in Delhi.

A prospective study was done to determine the age specific prevalence of antihepatitis A antibodies (anti HAV Abs) among children in Delhi. Four hundred and twenty children aged 0-12 years attending outpatient department for vaccination or any minor illness were studied. Sera was tested by ELISA for anti HAV Abs using a commercial kit (Hepvase A 96 TMB). Thirty samples of cord blood were similarly analyzed. All samples of cord blood were positive for anti HAV Abs. Prevalence of anti HAV Abs was 80% by 5 years of age. The most vulnerable age group was 0.5-1.5 years (anti HAV Ab positivity). Cord blood had 100% positivity. Univariate and multivariate analyses taking anti HAV antibody positivity as dependant variable demonstrated that age and father's education (socioeconomic status) significantly affect prevalence of anti HAV Abs. Sex, water supply, history of jaundice in self or family did not have any significant effect on anti HAV antibody positivity. Prevalence of anti HAV antibodies is 80% by 5 years of age. Further studies in different strata of society and different regions in the country are required to assess the need and age for vaccination.

Alterations in antioxidant status during neonatal sepsis.

Septicaemia is a major threat to survival during the early stages of life. There are several reports that suggest that reactive oxygen species (ROs) play a role in a wide variety of diseases. We estimated the activity of xanthine oxidase (XO), malondialdehyde (MDA) content, creatine phosphokinase (CPK) activity, activities of key enzymatic antioxidants, such as superoxide dismutase (SOD), glutathione peroxidase (GPx) and peroxidase (PO), and non-enzymatic antioxidants, viz. uric acid (UA) and albumin (ALB), in 30 neonates with sepsis and 20 age-matched controls. The babies were categorized as preterm/term, early onset/late onset, and shock/without shock, as per clinical and laboratory investigations. The study was carried out to evaluate the status of antioxidant enzymes and non-enzymatic antioxidants with a view to suggesting the introduction of antioxidant therapy in neonatal sepsis. The activities of serum XO, CPK, SOD and GPx, and the content of MDA were found to be significantly elevated in the neonates with sepsis when compared with controls. Conversely, the activity of PO and the levels of UA and ALB were decreased. The septic, full-term neonates registered significantly higher CPK activity (70%) than the preterm septic neonates. However, infants with late-onset and shock sepsis had a significant decrease in CPK activity (p < 0.05) compared with their corresponding sub-groups. Likewise, UA levels were found to be 28% depressed (p < 0.05) in the babies with late-onset sepsis and 51% increased (p < 0.001) in babies with shock compared with their respective sub-groups. Neonates with septic shock also registered a significant elevation in GPx activity (28%) compared with those without shock. This study suggests increased production of ROs in neonates with sepsis, as evidenced by the positive regulation of XO, SOD and GPx activity. The elevation of antioxidant enzymes, however, was not so effective as to protect from cellular damage and thereby result in higher MDA production. It is evident that antioxidant therapy might be useful in the management of neonates with sepsis but further detailed clinico-biochemical investigations are required to define effective antioxidant therapy.

Fertility and mortality differentials among selected tribal population groups of north-western and eastern India.

Selection potential based on differential fertility and mortality has been computed for six tribal groups inhabiting different geo-climatic conditions, namely: Sahariya, Mina and Bhil of the State of Rajasthan, north-western India, and Munda, Santal and Lodha of the State of West Bengal, eastern India. Irrespective of the methodology, the total index of selection was found to be highest among Lodhas (0.668), followed by Sahariyas (0.524), Santals (0.462), Bhils (0.386), Mundas (0.353) and Minas (0.334). Incidentally, Lodha and Sahariya are two of the seventy-four notified primitive tribal groups of India, and these two study populations show the highest index of total selection, mainly because of a higher embryonic and postnatal mortality. The relative contribution of the fertility component to the index of total selection is higher than the corresponding mortality component in all tribal groups. The analysis of postnatal mortality components indicates that childhood mortality constitutes the bulk of postnatal mortality, suggesting that children under 5 years need better health care in these tribal groups.

PIP: Selection potential based on differential fertility and mortality has been computed for six tribal groups inhabiting different geoclimatic conditions; namely, the Sahariya, Mina, and Bhil tribes in Rajasthan, northwestern India, and the Munda, Santal, and Lodha tribes in West Bengal, eastern India. Irrespective of the methodology, the total index of selection was found to be highest among the Lodhas (0.668), followed by the Sahariyas (0.524), the Santals (0.462), the Bhils (0.386), the Mundas (0.353), and the Minas (0.334). Incidentally, the Lodhas and Sahariyas are two of the 74 notified primitive tribal groups of India, and these two study populations show the highest index of total selection, mainly because of a higher embryonic and postnatal mortality. The relative contribution of the fertility component to the index of total selection is higher than the corresponding mortality component in all tribal groups. The analysis of postnatal mortality components indicates that childhood mortality constitutes the bulk of postnatal mortality, suggesting that children under age 5 years need better health care in these tribal groups.

Association of genetic markers with coronary heart disease (myocardial infarction)--a case-control study.

A case-control study was carried out on patients of myocardial infarction selected from coronary care unit of Lok Nayak Jai Prakash Narayan Hospital, Delhi. The study was carried out to determine the association of haptoglobin (Hp), transferrin (Tf) and complement component 3 (C3) polymorphism with myocardial infarction. The frequency of allele Hp1 was found to be 0.159 in cases studied and 0.058 in controls. The frequency of gene TfC was found to be 0.987 in cases of study and 0.992 in controls. Similarly, frequency of CS3 gene was found to be 0.985 and 0.990 in cases studied and controls respectively. The comparison between cases studied and controls with respect to TfC and CS3 polymorphism was found to be statistically non-significant while the comparison between cases studied and controls for Hp polymorphism was found to be statistically significant (chi 2 = 21.88, p < 0.01).

Plasmodium falciparum: drug-resistant malaria complicating leukemias and lymphomas in children.

The present communication deals with drug-resistant Plasmodium falciparum malaria complicating hematologic malignancies (leukemias, n = 24, and lymphomas, n = 7) in children. Of 50 cases of hematologic malignancies, 31 patients were microscopically diagnosed as having P. falciparum infection (MP +). Initially, all the patients were treated with chloroquine. The results of primary treatment showed chloroquine resistance in 16 (51. 62%) cases. Of these 16 chloroquine-resistant cases, 13 were secondarily treated with a combination of pyrimethamine plus sulfamethopyrazine. The results of secondary treatment also revealed resistance to pyrimethamine plus sulfamethopyrazine in 6 of 13 (46. 10%) cases. The 6 pyrimethamine plus sulfamethopyrazine-resistant P. falciparum cases were finally cured by quinine therapy, against which no resistance was encountered. Conversely, in the control group comprising 38 cases of P. falciparum without malignancy, the incidence of chloroquine resistance was found in only 9 cases, which is rather low (23.70%). Of these 7 chloroquine-resistant cases, 5 were found to be sensitive to pyrimethamine plus sulfamethopyrazine treatment, while the 2 nonresponders were finally cured with quinine. The overall results of this study show a high prevalence of chloroquine resistance among clinical cases of falciparum malaria (25/69; 30.6%). Among the nonresponders (n = 20) 40% of cases were also resistant to the pyrimethamine plus sulfamethopyrazine combination. There was no resistance to quinine.

Efficacy of curcumin in the management of chronic anterior uveitis.

Curcumin, obtained from rhizomes of Curcuma longa, was administered orally to patients suffering from chronic anterior uveitis (CAU) at a dose of 375 mg three times a day for 12 weeks. Of 53 patients enrolled, 32 completed the 12-week study. They were divided into two groups: one group of 18 patients received curcumin alone, whereas the other group of 14 patients, who had a strong PPD reaction, in addition received antitubercular treatment. The patients in both the groups started improving after 2 weeks of treatment. All the patients who received curcumin alone improved, whereas the group receiving antitubercular therapy along with curcumin had a response rate of 86%. Follow up of all the patients for the next 3 years indicated a recurrence rate of 55% in the first group and of 36% in the second group. Four of 18 (22%) patients in the first group and 3 of 14 patients (21%) in the second group lost their vision in the follow up period due to various complications in the eyes, e.g. vitritis, macular oedema, central venous block, cataract formation, glaucomatous optic nerve damage etc. None of the patients reported any side effect of the drug. The efficacy of curcumin and recurrences following treatment are comparable to corticosteroid therapy which is presently the only available standard treatment for this disease. The lack of side effects with curcumin is its greatest advantage compared with corticosteroids. A double blind multi-centric clinical trial with this drug in CAU is highly desirable to further validate the results of the present study.

Status of antioxidants and other biochemical abnormalities in children with dengue fever.

During an outbreak of dengue fever in 1996, 66 children between 45 days and 12 years of age with dengue fever and 25 healthy controls were studied for antioxidants and other biochemical abnormalities. As per World Health Organization (WHO) criteria, 14 children were classified as having classical dengue (DEN), 42 with dengue haemorrhagic fever (DHF), and 10 (including three who died) as having dengue shock syndrome (DSS). Superoxide dismutase (SOD), glutathione peroxidase (GPX), and albumin (ALB), the three main antioxidants studied, were found to be abnormal in 96, 94, and 40 per cent of the cases respectively. The levels for aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine phosphokinase (CPK), total protein (TP), total cholesterol (CHO), and triglycerides (TGL) were abnormal in 79, 50, 30, 93, and 67 per cent of the cases respectively. Among the different groups of dengue the abnormalities were more marked in children with DSS than in those with DEN and DHF, especially with respect to ALB, TP, TGL, AST, ALT, and CPK (p < 0.005). This preliminary report of dengue confirms the assumption of free radical generation and alteration in antioxidant status during acute illness. However, to understand their complex interaction in disease progression and therapeutic utility, further studies are required.

Serum TNF-alpha and free radical scavengers in neonatal septicemia.

Tumor necrosis factor-alpha (TNF-alpha) and free radicals have been implicated in the pathogenesis of neonatal septicemia and its complications. This case control study was conducted between November 1996 to July 1997 to determine the levels of TNF-alpha and free radical scavengers viz. superoxide dismutase (SOD) and glutathione peroxidase (GPX) in the serum of 30 septic neonates and 20 healthy controls. Patients with neonatal sepsis registered significantly higher levels of TNF-alpha, SOD and GPX in comparison to controls (p < 0.05). The neonates with septic shock had five fold increase in TNF-alpha levels (2262 +/- 605.8 pg/ml) as compared to those without shock (738.8 +/- 728.8 pg/ml). There was no statistically significant difference in levels of antioxidant enzymes between neonates with shock and without shock. The levels of TNF-alpha and antioxidant enzymes were not affected by the type of organism isolated in blood culture.