Evaluation of risk factors for non-alcoholic fatty liver disease in India: A systematic review and meta-analysis.

INTRODUCTION: NAFLD is emerging as an important cause of liver disease in India. It is estimated that 16-32% of general population in India (nearly 120 million) has NAFLD. OBJECTIVE: This study aimed to identify the risk factors of NAFLD and to identify the association of lifestyle (dietary and physical activity), genetic, and environmental factors with NAFLD in India. MATERIALS AND METHODS: A systematic literature search was conducted using an international electronic database: PubMed (MEDLINE) and Google Scholar from the date of inception 31st March 2021 to 28th September 2021. We included studies examining patients with NAFLD: Adults above 18 years of age. Studies with or without a control population were both eligible. The studies with a diagnosis of NAFLD based solely on abnormal liver tests were excluded. We tried to get unpublished data but they were not of the quality of inclusion. Meta-analysis was performed using the software STATA 14.2 (StataCorp, College Station, TX, USA). For each of the studies, the standard error was calculated using the reported number of outcomes and the sample size. A forest plot was used to graphically represent the study-specific and pooled prevalence estimates for overall and subgroup analysis. RESULTS: In a systematic review and meta-analysis of 8 studies including data from over 1800 individuals, we found that among components of lipid profile, LDL and HDL had a negative effects on NAFLD while triglycerides had a positive effect on NAFLD. CONCLUSION: Type 2 Diabetes Mellitus, Hypertension, and Obesity were the potential risk factors for NAFLD but the evidence generated was only from single studies.

Prevalence, severity and risk factors of allergic disorders among people in south India.

BACKGROUND: Allergic disorders are not usually life-threatening conditions but they impair the person's ability to function. It thus adversely affects the psychological wellbeing and quality of life. These implications of allergic disorders can be minimized if strategies are planned for its early identification followed by appropriate interventions. OBJECTIVES: To find out the prevalence and risk factors of allergic disorders. METHODS: Data was collected by house to house survey among participants aged 18 years and above using a standardized allergy assessment questionnaire. RESULTS: Mean age of the 400 participants was 42.8±14.7 years. Majority 105(26.2%) were in the age group 36 to 45 years. Majority were females 287(71.7%) and were house wives 217(54.2%). Majority of participants were of upper socio economic class 98(44.7%) out of 219 and majority were from urban areas 326(81.5%). The prevalence of allergy among participants was found to be 115(28.7%). Out of these 115, 37(32.2%) had possibility of allergy, 60(52.2%) had probability of allergy and the rest 18(15.6%) had very high likelihood for allergy. People residing in semi urban areas had increased risk of allergy (p=0.024) than those from urban areas. The prevalence of asthma was 30(7.5%) and skin allergy was 23(5.8%). Most common precipitating factors for allergy were dust exposure 103(25.8%) followed by seasonal changes 71(17.8%). Family history of allergy was associated with allergy among participants (p<0.001). Usage of firewood was associated with symptoms of respiratory allergy among participants (p=0.01). CONCLUSION: The study revealed some important determinants of allergic disorders which have important implications to frame appropriate prevention and health educational strategies.

Assessment and determinants of emotional intelligence and perceived stress among students of a medical college in south India.

Emotional intelligence (EI) is the ability to identify, assess, and control the emotions of oneself, of others, and of groups. Stress resulting from having to meet professional demands is common in the medical student's life. The perceived stress (PS) can be either an input or an outflow of EI or the lack thereof. This study was done to assess EI levels and to find out its association with sociodemographic variables and PS among medical students. Data were collected using a self-administered questionnaire from 198 first-year and 208 second-year medical students. EI scores were found to increase with age (r = 0.169, P = 0.004). PS scores were found to be higher among first-year students (P = 0.05). PS scores were found to decrease with increase in EI scores (r = -0.226, P < 0.001). Hence, if sufficient measures to improve EI are provided in the beginning, it would make students more stress-free during their training years at medical schools.

Assessment of morbidity pattern, quality of life and awareness of government facilities among elderly population in South India.

BACKGROUND: This study was done to assess the determinants of morbidity pattern, quality of life (QoL) and awareness of elderly about various government schemes and social security legislations. MATERIALS AND METHODS: Data was collected by house to house survey among participants aged 60 years and above using a structured interview schedule. The QoL was assessed using Kannada version of WHOQOL-BREF instrument following language validation. RESULTS: Mean age of 206 participants was 69.6±6.7 years. Half of them were males and majority were graduates 54 (26.2%). Morbidity was present among 194 (94.2%) participants (95% CI 89.5-98.9%), most common being hypertension 96 (46.6%). Morbid conditions were seen more among less educated (P = 0.007). Only 68 (33%) were under medical insurance coverage, 17 (8.3%) were under old age government pension and 74 (35.9%) were under retirement pension scheme. Social relationships, psychological health and environmental domain scores were associated with socio-economic status. Social relationship domain score was significantly better among well educated participants and those without morbidities. Level of ambulation was significantly associated with QoL scores in all domains (P < 0.001). Majority of the participants 132 (64.1%) had moderate level of awareness about government facilities for senior citizens. Awareness level was significantly better among males (P < 0.001), well educated (P < 0.001), better socio-economic status respondents (P < 0.001) and those currently working (P = 0.026). CONCLUSION: Health status of elderly needs improvement which would also improve their QoL. Awareness about various government schemes needs to be enhanced to improve its utilization. The results of this study are expected to help policy makers in planning comprehensive services for elderly residing in this area.

Fast Food Consumption Pattern and Its Association with Overweight Among High School Boys in Mangalore City of Southern India.

CONTEXT: Fast foods are quite popular among children owing to taste, appearance and hype created by mass media. However, the increased incidence of lifestyle disorders seen now-a-days at an early age could be attributed to fast foods. AIM: This study was done to assess the awareness of health hazards, consumption pattern of fast foods and to find out its association with overweight among high school students. SETTINGS AND DESIGN: This cross-sectional study was done among boys of 3 private schools in Mangalore city in March 2012. MATERIALS AND METHODS: Data was collected using a semi-structured self-administered questionnaire. STATISTICAL ANALYSIS: Chi-square test, one-way ANOVA and binary logistic regression analysis was used for analysis. P-value ≤ 0.05 was considered as statistically significant association. RESULTS: Mean age of boys was 13.5±0.9 years. Out of 300 participants, 41(13.7%) were overweight and 8 (2.7%) were obese. 292(97.3%) were fast food users of which 42(14.4%) consumed it every day. Majority of participants were introduced to fast foods through television commercials 193(64.3%). 73(57%) developed this habit as they were bored with home food. Awareness of harmful effects of fast food consumption was known to 186(62%) students and this was found to be associated with the perceived need to control its usage (p<0.001). Parental consumption of fast foods was found to influence fast food consumption among children (p=0.024). As many as 68(22.7%) and 206(68.7%) children were not eating vegetables and fruits respectively every day. Increased frequency of fast food consumption in a week was found to be associated with overweight or obesity among children after adjusting the effects of confounders (p=0.003). CONCLUSION: Awareness on health hazards of fast foods needs to be taught at schools so as to minimize its consumption. Parents have to set an example themselves by not eating fast foods and improving home food to support discouragement of fast foods. This would minimize life style disorders among children to a greater extent.

Assessment of menopausal symptoms among women attending various outreach clinics in South Canara District of India.

INTRODUCTION: Menopausal symptoms experienced by women are known to affect their quality-of-life. The symptoms experienced at menopause are quite variable and their etiology is found to be multifactorial. This study was hence done to assess the pattern and severity of menopausal symptoms and to find out the factors associated with these symptoms. MATERIALS AND METHODS: This cross-sectional study was conducted in various outreach clinics of Kasturba Medical College, Mangalore. Women in the age group of 40-65 years were included in the study by convenient sampling method. Data regarding menopausal symptom was obtained by interviewing each participant using the menopause rating scale questionnaire. RESULTS: Mean age of the participants were 54.2 ± 7.2 years and mean age of attainment of menopause was 48.4 ± 4.5 years. Mean duration of menopause was found to be 7.5 ± 5.3 years. Commonest symptom reported was joint and muscular discomfort and physical and mental exhaustion seen in 94 (85.4%) participants. The mean number of symptoms reported by participants was 7.6 ± 2.8. Educated women reported significantly more symptoms (F = 2.218, P = 0.047). Somatic and urogenital symptoms were more among perimenopausal women and somatic symptoms were more among postmenopausal women. Fifty-eight (52.7%) participants had one or more severe symptoms. Severe symptoms were most among premenopausal women. CONCLUSION: The high proportion and severity of menopausal symptoms observed in this study group proves that menopausal symptoms are common and cannot be ignored. More of menopausal clinics are needed for awareness generation, early recognition and treatment of related morbidities.

Skin diseases and conditions among students of a medical college in southern India.

INTRODUCTION: Skin diseases are a common problem among young adults. There is paucity of data about it among medical students. This study aimed to find out the pattern of skin disorders and to describe their association with various socio-demographic factors among medical students. MATERIALS AND METHODS: This cross-sectional study was conducted in June 2011 in a medical college in Mangalore, Karnataka. Two-hundred and seventy eight medical students were chosen from the 4(th), 6(th) and 8(th) semester through convenient sampling method. Data on hair and skin morbidities suffered over past 1 year and its associated factors were collected using a self-administered questionnaire. RESULTS: Most of the participants 171 (61.5%) were of the age group 20-21 years and majority were females 148 (53.2%). The most common hair/skin morbidities suffered in the past one year were acne 185 (66.6%), hair loss 165 (59.3%), and sun tan 147 (52.9%). Fungal infection (P = 0.051) and severe type of acne (P = 0.041) were seen significantly more among males while hair morbidities like hair loss (P = 0.003), split ends of hairs (P < 0.0001) and dandruff (P =0.006) were seen significantly more among female students. Patterned baldness (P = 0.018) and sun tan (P < 0.0001) were significantly more among non-Mangalorean students than native Mangaloreans. Presence of dandruff was significantly associated with hair loss (P = 0.039) and usage of sunscreen was found to protect from developing sun tans (P = 0.049). CONCLUSION: Skin disorders, particularly the cosmetic problems are very common among medical students. Gender and place of origin were found to significantly influence the development of certain morbidities.

Pattern of seizure cases in tertiary care hospitals in Karnataka state of India.

BACKGROUND: The prevalence and incidence of epilepsy is higher in developing countries than in developed countries. Understanding pattern and risk factors of seizure cases will help in suggesting appropriate preventive measures. OBJECTIVES: This study was carried out to assess the pattern of seizure, its management and compliance with treatment. MATERIALS AND METHODS: Data from medical records of seizure cases in three tertiary care hospitals of Mangalore city in south India admitted from January 2006 to December 2011 were collected and analyzed. RESULTS: Nearly half (44.4%) of the 196 cases belonged to productive age group (15-45 years) and 2/3(rd) (60.7%) were males. Majority (>80% cases) were unskilled workers and of low socio-economic status groups. Family history of seizures was present in 8.4% cases. Mean age of onset of seizure was found to be 19.9 years. Proportion of generalized tonic clonic seizure cases was 78.1%. Secondary seizures were seen in 66 (33.7%) cases with the most common cause being trauma to the head (24.2%). Refractory seizures were present in 2.7% cases. Monotherapy was the most commonly followed treatment regimen and phenytoin was the most popular anti-epileptic drug (AED) used. Non-compliance with AEDs was seen in 18.1% cases and was more among patients on polytherapy (P = 0.032). CONCLUSION: Seizure manifestations and treatment compliance vary widely in the studied population. In depth analysis of each seizure type will give more information about the factors associated with it.

Proportion of depression and its determinants among type 2 diabetes mellitus patients in various tertiary care hospitals in Mangalore city of South India.

BACKGROUND: Depression is found to be common among patients with diabetes and it is associated with poor outcomes in disease control. This study was carried out to find out the proportion and determinants associated with depression among patients with established type 2 diabetes mellitus (T2DM) in various tertiary care hospitals in Mangalore city of south India. MATERIALS AND METHODS: This study was conducted in one government and three private tertiary care hospitals in Mangalore in December 2010. All consenting patients with confirmed diagnosis of T2DM were interviewed and screened for depression by administering the 9-item PRIME-MD Patient Health Questionnaire (PHQ-9). RESULTS: Of the 230 T2DM patients, 119 (51.7%) were males. The mean age of all participants was 53.61 ± 10.7 years. The median duration of T2DM was found to be 12.1 ± 7.35 years. Among the participants, 71 (30.9%) met the criteria for moderate depression, 33 (14.3%) for severe depression, and the remaining 126 (54.8%) had no clinically significant depression. Only 26 (11.3%) patients were already aware that they were depressed, of whom just 3 had taken medical consultation. Among the risk factors, depression was found to be significantly associated with older age, female gender, low socioeconomic status, unskilled and retired employment status, having complications due to T2DM or comorbidities like hypertension and coronary artery disease, being overweight and being on insulin syringe injections. CONCLUSION: This study found a high proportion of depression among patients with T2DM. Therefore the care of individuals with diabetes mellitus (DM) should include the screening and possible treatment of depression in order to achieve and sustain treatment goals.

Clinical spectrum of rheumatic Fever and rheumatic heart disease: a 10 year experience in an urban area of South India.

BACKGROUND: Rheumatic fever (RF) is an important problem concerning developing countries like India. Rheumatic heart disease (RHD) is one of the most readily preventable chronic diseases. AIM: This study was done to find out the clinical profile, risk factors, compliance with treatment and outcome among RF/RHD cases so as to suggest better case management strategies. MATERIALS AND METHODS: Clinical records of 51 RF and 71 RHD cases admitted in tertiary care hospitals in Mangalore between 2001 and 2010 were reviewed retrospectively. RESULTS: Mean age of RF cases were 17.4 ± 12.1 years and RHD cases were 33.2 ± 18.6 years. More than half of RF and RHD cases were males. Commonest risk factors among RF cases were poor socioeconomic status (60.4%), history of upper respiratory tract infection before disease onset (58.8%) and undernutrition (35.3%). Commonest clinical manifestation among RF cases was fever 39 (76.5%) followed by polyarthritis 34 (66.7%). Commonest valvular lesions among RHD cases was mitral stenosis with mitral regurgitation found in 42.9% cases. Compliance of patients with prophylactic antibiotics was found to be 37 (30.3%). Mortality rate was significantly more among RHD cases (P = 0.0399). CONCLUSIONS: Improvement of socioeconomic and nutritional factors is an important task required for primary prophylaxis and of compliance for secondary prophylaxis of RF.

Infant rearing practices in South India: a longitudinal study.

BACKGROUND: Rearing practices are a major determinant of nutritional and health status of infants. Therefore these practices need to be better understood. OBJECTIVES: To find out infant rearing practices in the study area. MATERIALS AND METHODS: A longitudinal study was conducted on a birth cohort of 194 infants. Information on rearing practices and anthropometric measurements were recorded every month for a period of 1 year. RESULTS: Only 67 (34.5%) newborns were breast fed within half an hour of delivery. Prelacteal feeds was given to 65 (33.5%) newborns and this was seen more among home deliveries (P=0.018). Demand feeding was practiced by 169 (87.1%) mothers. Exclusive breast feeding (EBF) for 6 months was practiced by 81 (41.7%) mothers. Bottle feeding was seen in 7 (3.6%) cases. Weight gain during infancy was found to be maximum when infants were EBF for 6 months (P<0.001) and weaned with semi-solid and solid diet alone in the following 6 months (P=0.002). Gain in all anthropometric measurements was more in the initial 6 months of infancy compared to latter. Four (2.1%) infants were malnourished. Oil massage before bath was practiced by 189 (97.4%) mothers. Over 50% mothers practiced oil application to eyes or ears of infants. Delayed initiation of bath (beyond 1week) was seen in 15 (7.7%) cases. CONCLUSION: Faulty rearing practices need to be corrected in order to improve the health status of infants.

A study of the socio-demographic profile and treatment outcome of paediatric tuberculosis patients in Bangalore Mahanagar Palike area.

BACKGROUND: Tuberculosis (TB) continues to be one of the most devastating and widespread infections in the world. Of the nine million annual tuberculosis cases, about one million (11%) occur in children (under 15 years of age). Childhood tuberculosis is a neglected aspect of the tuberculosis epidemic. OBJECTIVES: To know the socio-demographic profile, type of tuberculosis and treatment outcome in paediatric tuberculosis patients METHODOLOGY: The study was conducted in nine Tuberculosis units of Bangalore city from January 2009 to December 2009. Five Tuberculosis units from the nine tuberculosis units were selected by simple random sampling, paediatric patients diagnosed as having TB and registered under RNTCP were included in the study till the sample size of 209 was reached. Data regarding socio-demographic profile and type of TB was collected and the patients were followed up to assess treatment outcome. RESULTS: Most of the patients coming to the RNTCP centres belong to the under-privileged group. Most of the patients were in the age group of 1 to < 6 years, (37.7 %), male to female ratio was observed to be 0.6:1. Majority of the patients lived in nuclear families (73.2%), belonged to low socio-economic status (95.5%) and dwelled in overcrowded houses (89.5%). 23% reported history of contact with tuberculosis patients. More than half of the patients (57.4%) were undernurished. In the study, 56.5% had pulmonary TB and 43.5 % had extra-pulmonary TB. 94.7% of the patients completed treatment. CONCLUSION: Paediatric tuberculosis still continues to be a major problem in one-five years of age who are undernourished and belonging to low socio-economic status.