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1.
J Assoc Physicians India ; 67(10): 61-64, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571455

RESUMO

Background: As per WHO Global TB report (2018), 10.0 million people developed TB in 2017. India accounted for 20 % of world cases. Globally, 3.5 % of new cases and 18% of previously treated cases had MDR-TB. Corresponding figures for India are 2.8 % and 12 %. Among cases of MDR-TB in 2017, 8.5% were estimated to have XDR-TB. Drug resistant TB cases are on rise and needs planning and research for its treatment and control. Materials and Methods: A retrospective study was conducted on MDR-TB and XDR-TB patients to evaluate social and demographic profile of these patients in Bihar. Results: A total of 700 (530 males and 170 females) MDR-TB and 51 (40 males and 11 females) XDR-TB patients were analyzed, which revealed 293 (41.86 %) patients of MDR-TB and 23 (45.10 %) patients of XDR-TB in the age group of 15 to 25 years. Mean age of MDR-TB patients in this age group was 20.52 years and for XDR-TB 21.17 years. Conclusion: Drug Resistant Tuberculosis Control Programme should focus adequately on youth in state of Bihar, India.


Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Antituberculosos , Demografia , Tuberculose Extensivamente Resistente a Medicamentos/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Estudos Retrospectivos , Adulto Jovem
2.
Mymensingh Med J ; 28(4): 920-924, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599261

RESUMO

The diagnosis of mycotic lung infection in pulmonary TB patients remains misdiagnosed because of its non-specific clinical manifestations which mimics the symptoms of TB. Physicians have to rely on the investigation but as radiology and pathology cannot probe the appropriate diagnosis, conventional microbiology or PCR testing continue as an essential mode for the diagnosis. In developing country like India PCR is not cost effective. Thus, Direct microscopy by KOH (10%), Gram's staining & Culture remains only option for identification. A three-year cross-sectional study was carried out in the Department of Microbiology, Maharishi Markandeshwar Institute of Medical Science & Research, Mullana, India from August 2015 to August 2018. On 300 LED positive sputum samples collected from previously treated cases of pulmonary TB. Early morning sputum was collected and subjected to KOH 10%, Gram's staining afterwards cultured on Sabouraud Dextrose Agar and species identification was done by LPCB preparation. In 300 LED smear positive samples, the dominant pathogens were C. albicans (43.3%), followed by C. non-albicans (26.7%), A. fumigatus (21.7%) etc. ATT administration for 5-8 months' duration of illness showed highest fungal infection (45%) and maximum growth of fungus was seen in the Autumn season (45%). The co-occurrence of fungi with tubercle bacteria adds fatal consequences thus routine screening is recommended for proper diagnosis and early treatment of mycotic infection in the patients of Pulmonary TB on ATT.


Assuntos
Coinfecção , Tuberculose/microbiologia , Estudos Transversais , Fungos , Humanos , Índia/epidemiologia , Sensibilidade e Especificidade , Tuberculose/epidemiologia
3.
Niger J Clin Pract ; 22(10): 1372-1377, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607726

RESUMO

Objectives: The aim of the study is to compare the pre- and post-operative symptomatology, endoscopic findings, and nasal patency and to evaluate the postoperative outcomes of conventional compared to endoscopic septoplasty (ES). Materials and Methods: This prospective study was conducted at Rajindra Hospital, Patiala, Punjab, India, on 50 patients aged between 18 and 60 years having symptomatic deviated nasal septum and refractory to medical treatment. The patients were divided into two groups: Group A, which included 25 patients in whom conventional septoplasty (CS) was performed, and Group B, which included 25 patients in whom ES was conducted. The postoperative assessment was carried out at once weekly for 1 month and twice weekly for another 2 months. Results: Nasal obstruction was relieved in 79.1% cases belonging to Group A and 91.3% cases to Group B. Headache was relieved in 62.5% cases belonging to Group A and 93.3% cases to Group B. Postnasal drip was relieved in 73.3% cases in Group A and 94.1% cases in Group B. The results were found to be statistically significant. An improvement in visual analog scale score was observed in both groups, but statistically significant difference was seen at 2nd and 4th week. Postoperative nasal patency improvement was observed in both groups by the Gertner plate, and the results were found to be statistically significant. Postoperative hemorrhage was observed in 24% cases in Group A and 12% cases in Group B. Septal perforation, septal hematoma, and mucosal tear were observed in 4%, 4%, and 8% of cases, respectively, in Group A. No such complication was reported in Group B. Conclusion: ES is more effective in terms of relief of symptoms and improvement of nasal patency. It is best for isolated spur, posterior deviation, and revision surgery, but anterior caudal dislocation is best handled with CS. Both these techniques should be taken as an adjuvant to each other.


Assuntos
Endoscopia/métodos , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Rinoplastia/métodos , Adolescente , Adulto , Endoscopia/efeitos adversos , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/epidemiologia , Deformidades Adquiridas Nasais/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Período Pós-Operatório , Estudos Prospectivos , Rinoplastia/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
4.
J Assoc Physicians India ; 67(9): 24-26, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561683

RESUMO

Introduction: Hypertension is one of the most challenging health problems in the world. Hypertension is closely related to kidney diseases. Microalbuminuria is a reflection of early kidney dysfunction and a marker of asymptomatic preclinical disease which precedes and predicts the occurrence of major morbid events. Aims and objectives: To investigate the relationship between microalbuminuria and LVH in patients with primary hypertension. To establish microalbuminuria as an independent risk factor for increased Left Ventricular Mass Index in patients with Primary Hypertension. Methods: This was a cross-sectional prevalence, analytical study conducted for a period of two years in a tertiary care teaching hospital in Western India. 126 patients diagnosed as primary hypertension, according to JNC 7 criteria were included in the study. Left ventricular Mass Index was measured using 2 D Echo Machine using the formula of Left ventricular mass. Multiple logistic regression was conducted to find out independent correlation of Left Ventricular Hypertrophy. Results: Mean age was 64.32 years in patients without LVH while it was 63.85 years in patients with LVH. Serum creatinine, albumin-creatinine ration and Microalbuminuria were independently correlated with the Left Ventricular hyper trophy. Multiple logistic regression concluded that presence of microalbuminuria increases risk of LVH 2.04 times more as compared to absence of microalbuminuria. Serum creatinine level was higher in patients with LVH compare to patients without LVH. patients with Microalbuminuria were higher in LVH group compare to non LVH group and this difference was statistically significant. Conclusion: This study demonstrates that microalbuminuria has an independent correlation with Left Ventricular Mass Index and hence an independent risk factor for increased cardiovascular morbidity and mortality.


Assuntos
Albuminúria/microbiologia , Hipertensão/epidemiologia , Idoso , Estudos Transversais , Humanos , Hipertrofia Ventricular Esquerda , Índia/epidemiologia , Prevalência
5.
J Assoc Physicians India ; 67(9): 27-29, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561684

RESUMO

Introduction: Hepatitis B (HBV) and Hepatitis C (HCV) are two common viral infections causing cirrhosis. Aim: The aim of this study was to find the seroprevalence of HBV and HCV along with occurrence of co-infection of HBV and HCV in patients attending a tertiary care hospital. Materials and Methods: The study was done for a period of one year (January to December 2016) in the Department of Microbiology, Medical College, Kolkata. After obtaining ethical clearance and informed consent from the patients, serum samples were collected from all patients referred to Department of Microbiology for antibody to HCV and Hepatitis B surface antigen (HBsAg) screening. ELISA was performed for anti HCV antibody and HBsAg. The results and relevant clinical information were noted and analysis was done. Results: A total of 10802 samples were received, of which 316 (2.92 %) were HBsAg positive, 115 (1.06%) were HCV antibody positive and a total of 7 (0.07%) patients were positive both for HBsAg and Anti HCV antibody. There was male preponderance. Anti HCV antibody was more common in age below 10 years and in thalassemia patients. Out of 7 patients positive for both, 5 patients were on regular blood transfusion due to beta thalassemia and 2 patients had history of chronic liver disease. Conclusion: In this study, it was found that there was seroprevalence of 2.92 % of HBsAg, 1.06% of HCV antibody and 0.07% positive both for HBsAg and HCV antibody among the patients of a tertiary care centre in Eastern India.


Assuntos
Coinfecção , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Estudos Soroepidemiológicos , Centros de Atenção Terciária
6.
J Assoc Physicians India ; 67(9): 38-41, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561687

RESUMO

Objectives: The present study was aimed at assessing Association of Maternal Risk Factors to congenital anomalies of infants. Material and Methods: This community based retrospective and cross-sectional study was carried out in 23 rural sub-centres of block Beri, district Jhajjar (Haryana, India) among 920 mothers. A predesigned pretested semistructured questionnaire was used to collect information. Univariate analysis along with logistic regression analysis was performed. Results: The prevalence of congenitally malformations was 1.2%. Most common congenital malformations were cleft lip/palate (18.18%) and hydrocephalus (18.18%). Mothers with < 3 years gap between pregnancies had higher prevalence (1.7%) of congenital malformations in live births. Mothers with previous history of congenital malformation (8.3%) and abortions (13.6%) had higher prevalence of congenitally malformed babies with 2.6 and 4 times higher odds of having a malformed baby. Conclusion: The study concluded that mothers with risk factors like extreme of ages, illiteracy, bad obstetric history, history of previous congenitally malformed baby are at increased risk of fetal congenital malformation.


Assuntos
Anormalidades Congênitas/epidemiologia , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Lactente , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco
7.
Niger J Clin Pract ; 22(9): 1208-1212, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489855

RESUMO

Background: The upper aerodigestive tract (UAT) includes the nose and paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands. Cancers of the UAT constitute approximately 4% of all malignancies. In this study, the varied nature of the UAT cancers was studied to find out their incidence, etiology, and clinicopathological correlations. Materials and Methods: This prospective, observational, and clinicopathological study was conducted on 100 patients who were presented at outdoor in the Department of ENT, Government Medical College/Rajindra Hospital, Patiala, Punjab, India, from October 2016 to October 2018. Proven cases of UAT cancers were taken up and reviewed to gather data on multiple clinicopathological variables, such as age, sex, predisposing factors, and site of pathology. Histopathological differentiation was noted after conducting a biopsy. Results: Most patients of UAT cancers were in the age group of 40-70 years. Maximum incidence was among males (82%) compared to females (28%). The most common predisposing factor was alcohol + smoking (28%), followed by alcohol + chewing tobacco (25%). The most common symptom in the oral cavity was ulcer and odynophagia (38%) each. In oropharyngeal cancers, dysphagia (92%) was the most common symptom. In laryngeal cancers, dyspnea (68%) and hoarseness of voice (32%) were the most common. The most common site involved in UAT cancers was the oral cavity (31%), followed by oropharynx (28%), larynx (22%), hypopharynx (7%), and salivary gland (5%). The most common histopathological type was squamous cell carcinoma (SCC) (90%). Most of the ulceroproliferative and exophytic growth was moderately differentiated SCC on histopathology. Conclusion: Studies are essential for education and awareness aimed at reducing exposure to habit-forming substances.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Laríngeas/patologia , Neoplasias Bucais/patologia , Neoplasias Otorrinolaringológicas/patologia , Fumar/efeitos adversos , Fumar Tabaco/efeitos adversos , Tabaco sem Fumaça/efeitos adversos , Adulto , Idoso , Carcinoma de Células Escamosas/epidemiologia , Causalidade , Feminino , Humanos , Incidência , Índia/epidemiologia , Neoplasias Laríngeas/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/epidemiologia , Neoplasias Otorrinolaringológicas/epidemiologia , Estudos Prospectivos , Distribuição por Sexo
8.
J Assoc Physicians India ; 67(7): 22-24, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31559763

RESUMO

Background: Cardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Along with traditional cardiovascular risk factors and systemic inflammation, metabolic syndrome (MetS) contributes to CVD and increased mortality in patients with RA. In this study we determine the prevalence of MetS in RA patients presenting to a tertiary care centre in north India. Methods: This is a case control study involving 114 patients of RA with disease duration of ≥1 year and 114 healthy controls who are age and sex matched. Components of MetS were assessed in all the subjects and disease activity of RA was determined by DAS28-ESR. MetS was defined according to modified ATP-III criteria and consensus definition of metabolic syndrome for adult Asian Indians. Results: Women constituted 81.6% in RA group and 80.5% in control group. Mean age of subjects was 44.81±12.7 years in RA group and 43.27±12.6 years in control group. According to modified ATP-III criteria, 36 (31.6%) RA subjects and 17 (14.9%) controls had MetS (p=0.03). According to the consensus definition of metabolic syndrome for adult Asian Indian criteria, 40 (35.1%) RA subjects and 18 (15.8%) controls had MetS (P=0.01). There was no significant difference in disease activity between subjects of RA with or without MetS (p=0.276). Conclusion: The prevalence of MetS was higher in RA subjects compared to controls. There is no association of MetS with disease activity in our cohort. Larger studies are needed to determine the relation between MetS and disease activity.


Assuntos
Artrite Reumatoide/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Centros de Atenção Terciária
11.
Lancet ; 394(10203): 1011-1021, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31378394

RESUMO

BACKGROUND: Hypertension is the most common medical disorder in pregnancy, complicating one in ten pregnancies. Treatment of severely increased blood pressure is widely recommended to reduce the risk for maternal complications. Regimens for the acute treatment of severe hypertension typically include intravenous medications. Although effective, these drugs require venous access and careful fetal monitoring and might not be feasible in busy or low-resource environments. We therefore aimed to compare the efficacy and safety of three oral drugs, labetalol, nifedipine retard, and methyldopa for the management of severe hypertension in pregnancy. METHODS: In this multicentre, parallel-group, open-label, randomised controlled trial, we compared these oral antihypertensives in two public hospitals in Nagpur, India. Pregnant women were eligible for the trial if they were aged at least 18 years; they were pregnant with fetuses that had reached a gestational age of at least 28 weeks; they required pharmacological blood pressure control for severe hypertension (systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg); and were able to swallow oral medications. Women were randomly assigned to receive 10 mg oral nifedipine, 200 mg oral labetalol (hourly, in both of which the dose could be escalated if hypertension was maintained), or 1000 mg methyldopa (a single dose, without dose escalation). Masking of participants, study investigators, and care providers to group allocation was not possible because of different escalation protocols in the study groups. The primary outcome was blood pressure control (defined as 120-150 mm Hg systolic blood pressure and 70-100 mm Hg diastolic blood pressure) within 6 h with no adverse outcomes. This study is registered with ClinicalTrials.gov, number NCT01912677, and the Clinical Trial Registry, India, number ctri/2013/08/003866. FINDINGS: Between April 1, 2015, and Aug 21, 2017, we screened 2307 women for their inclusion in the study. We excluded 1413 (61%) women who were ineligible, declined to participate, had impending eclampsia, were in active labour, or had a combination of these factors. 11 (4%) women in the nifedipine group, ten (3%) women in the labetalol group, and 11 (4%) women in the methyldopa group were ineligible for treatment (because they had only one qualifying blood pressure measurement) or had treatment stopped (because of delivery or transfer elsewhere). 894 (39%) women were randomly assigned to a treatment group and were included in the intention-to-treat analysis: 298 (33%) women were assigned to receive nifedipine, 295 (33%) women were assigned to receive labetalol, and 301 (33%) women were assigned to receive methyldopa. The primary outcome was significantly more common in women in the nifedipine group than in those in the methyldopa group (249 [84%] women vs 230 [76%] women; p=0·03). However, the primary outcome did not differ between the nifedipine and labetalol groups (249 [84%] women vs 228 [77%] women; p=0·05) or the labetalol and methyldopa groups (p=0·80). Seven serious adverse events (1% of births) were reported during the study: one (<1%) woman in the labetalol group had an intrapartum seizure and six (1%) neonates (one [<1%] neonate in the nifedipine group, two [1%] neonates in the labetalol group, and three [1%] neonates in the methyldopa group) were stillborn. No birth had more than one adverse event. INTERPRETATION: All oral antihypertensives reduced blood pressure to the reference range in most women. As single drugs, nifedipine retard use resulted in a greater frequency of primary outcome attainment than labetalol or methyldopa use. All three oral drugs-methyldopa, nifedipine, and labetalol-are viable initial options for treating severe hypertension in low-resource settings. FUNDING: PREEMPT (University of British Columbia, Vancouver, BC, Canada; grantee of Bill & Melinda Gates Foundation).


Assuntos
Anti-Hipertensivos/administração & dosagem , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Labetalol/administração & dosagem , Metildopa/administração & dosagem , Nifedipino/administração & dosagem , Administração Oral , Adulto , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Resultado do Tratamento , Adulto Jovem
12.
BMC Public Health ; 19(1): 1034, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370827

RESUMO

BACKGROUND: Inappropriate complementary feeding practices significantly contribute to undernutrition among children under 2 years of age in India. However, there is limited up-to-date evidence on the prevalence and factors associated with complementary feeding practices to guide policy actions at the subnational level in India. We investigated the regional prevalence and factors associated with complementary feeding practices in India. METHODS: This study used a sample of 69,464 maternal responses from the 2015-16 National Family Health Survey in India. The prevalence of complementary feeding indicators was estimated using data for each administrative region, namely: North (n = 8469), South (n = 12,828), East (n = 18,141), West (n = 8940), North-East (n = 2422) and Central (n = 18,664). Factors associated with complementary feeding by region in India were investigated using logistic regression Generalized Linear Latent and Mixed Models (GLLAMM) with a logit link and binomial family that adjusted for clustering and sampling weights. RESULTS: The study showed a wide variation in the prevalence of introduction of solid, semi-solid or soft foods (complementary foods) among infants aged 6-8 months in regional India; highest in the South (61%) and lowest in the Central and Northern regions (38%). Similarly, minimum dietary diversity (MDD) was highest in the South (33%) and lowest in the Central region (12%). Both minimum meal frequency (MMF) and minimum acceptable diet (MAD) varied substantially across the regions. The factors associated with complementary feeding practices also differed across Indian regions. Significant modifiable factors associated with complementary feeding practices included higher household wealth index for the introduction of complementary foods in the North and Eastern India; higher maternal education for MMF and MDD in the North and Central regions; and frequent antenatal care visits (≥4 visits) for all indicators but for different regions. CONCLUSION: Our study indicates that there are wide differences in regional prevalence and factors associated with complementary feeding practices in India. The improvement of complementary feeding practices in India would require national and sub-national efforts that target vulnerable mothers, including those with no education and limited health service contacts.


Assuntos
Comportamento Alimentar , Fenômenos Fisiológicos da Nutrição do Lactente , Mães/psicologia , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Mães/estatística & dados numéricos , Gravidez , Prevalência , Fatores de Risco , Fatores Socioeconômicos
13.
BMC Public Health ; 19(1): 1045, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382936

RESUMO

BACKGROUND: Undernutrition is a serious health problem and highly prevalent in developing countries. There is no as such confirmatory test to measure undernutrition. The objective of the present study is to determine a new Composite Score using anthropometric measurements. Composite Score was then compared with other methods like body mass index (BMI) and mid-upper arm circumference (MUAC) classification, to test the significance of the method. METHODS: Anthropometric data were collected from 780 adult Oraon (Male = 387, Female = 393) labourers of Alipurduar district of West Bengal, India, following standard instruments, and protocols. Nutritional status of the study participants were assessed by conventional methods, BMI and MUAC. Confirmatory factor analysis was carried out to reduce 12 anthropometric variables into a single Composite Score (C) and classification of nutritional status was done on the basis of the score. Furthermore, all the methods (BMI, MUAC and C) were compared and discriminant function analysis was adopted to find out the percentage of correctly classified individuals by each of the three methods. RESULT: The frequency of undernutrition was 45.9% according to BMI category, 56.7% according to MUAC category and 51.8% according to newly computed Composite Score. Further analysis showed that Composite Score has a higher strength of correct classification (98.7%), compared to BMI (95.9%) and MUAC (96.2%). CONCLUSION: Therefore, anthropometric measurements can be used to identify nutritional status in the population more correctly by calculating Composite Score of the measurements and it is a non-invasive and relatively correct way of identification.


Assuntos
Antropometria/métodos , Desnutrição/diagnóstico , Avaliação Nutricional , Adulto , Braço/anatomia & histologia , Índice de Massa Corporal , Feminino , Humanos , Índia/epidemiologia , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Reprodutibilidade dos Testes
14.
J Glob Health ; 9(2): 020413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448114

RESUMO

Background: Past studies have demonstrated how single non-communicable diseases (NCDs) affect health care utilisation and quality of life (QoL), but not how different NCD combinations interact to affect these. Our study aims to investigate the prevalence of NCD dyad and triad combinations, and the implications of different NCD dyad combinations on health care utilisation and QoL. Methods: Our study utilised cross-sectional data from the WHO SAGE study to examine the most prevalent NCD combinations in six large middle-income countries (MICs). Subjects were mostly aged 50 years and above, with a smaller proportion aged 18 to 49 years. Multivariable linear regression was applied to investigate which NCD dyads increased or decreased health care utilisation and QoL, compared with subjects with only one NCD. Results: The study included 41 557 subjects. Most prevalent NCD combinations differed by subgroups, including age, gender, income, and residence (urban vs rural). Diabetes, stroke, and depression had the largest effect on increasing mean number of outpatient visits, increasing mean number of hospitalisation days, and decreasing mean QoL scores, respectively. Out of the 36 NCD dyads in our study, thirteen, four, and five dyad combinations were associated with higher or lower mean number of outpatient visits, mean number of hospitalisations, or mean QoL scores, respectively, compared with treating separate patients with one NCD each. Dyads of depression were associated with fewer mean outpatient visits, more hospitalisations, and lower mean QoL scores, compared to patients with one NCD. Dyads of hypertension and diabetes were also associated with a reduced mean number of outpatient visits. Conclusions: Certain NCD combinations increase or decrease health care utilisation and QoL substantially more than treating separate patients with one NCD each. Health systems should consider the needs of patients with different multimorbidity patterns to effectively respond to the demands on health care utilisation and to mitigate adverse effects on QoL.


Assuntos
Países em Desenvolvimento , Multimorbidade/tendências , Doenças não Transmissíveis/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Adolescente , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Federação Russa/epidemiologia , África do Sul/epidemiologia , Adulto Jovem
15.
Prev Vet Med ; 169: 104696, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31311632

RESUMO

Canine babesiosis is a serious disease among tick-borne haemoprotozoan diseases, globally. The present study was envisaged for carrying out thorough investigation of the disease among working dogs of organised kennels situated in different agro-climatic zones of India as comprehensive understanding of the disease from this country was pertinently lacking. During the study period of three years (2012-2014), 330 dogs suspected for babesiosis were examined for clinicopathology by their physical examination, haematological and biochemical parameters estimation, while the detection of apicomplexan parasites was confirmed by using various diagnostic techniques i.e. by conventional microscopy, by two different Babesia specific 18S rRNA based PCR protocols (conventional/simple PCR and nested PCR assays) followed by sequencing of obtained PCR amplicons for Babsesia spp. identification. Out of 330 clinical cases screened 5.15% (17/330), 9.09% (30/330) and 15.45% (51/330) were found to be positive in microscopic examination, simple- and nested- PCR assay, respectively. Comparative statistical analyses of these diagnostic assay results revealed that significant difference exists among the three diagnostic methodologies and thus it is recommended that the nested PCR technique be relied upon as a screening molecular assay and also for epidemiological studies of the disease in this country. Phylogenetic analysis based on 18S rRNA depicted the monophyletic nature and clonal expansion among all the B. gibsoni, under study. Sequencing results of PCR amplicons revealed that B. gibsoni has predominantly established itself over B. vogeli as former was incriminated in 47 cases while latter was confirmed in only four animals. Based on the clinical severity, these 51 affected animals were classified into three main groups' of 17 animals each viz., apparently healthy-, simple or uncomplicated babesiosis- and atypical or complicated babesiosis- group. Haematological and biochemical profiling of these dogs confirmed the characteristics findings of infection by both the Babesia spp. It was observed that the infection by small form of Babesia (B. gibsoni) is posing a significant therapeutic challenge and chemosterilization by commonly prescribed anti-protozoal drugs was not achieved as clinical relapses were often observed. The clinical signs, sequence based confirmation and severity of the infection suggested that there is a positive selection of B. gibsoni (smaller form) over B. vogeli (larger form) in this country and raises serious concerns as prognosis in former is considered to be poor compared to latter. Thus, these findings have opened new paradigms for planning of pragmatic control strategies against this emerging canine health problem.


Assuntos
Babesia/genética , Babesiose/epidemiologia , Babesiose/genética , Doenças do Cão/epidemiologia , Doenças do Cão/genética , Animais , Babesia/isolamento & purificação , Babesiose/sangue , Babesiose/patologia , Doenças do Cão/sangue , Doenças do Cão/parasitologia , Cães , Feminino , Abrigo para Animais , Índia/epidemiologia , Masculino , Epidemiologia Molecular , Técnicas de Amplificação de Ácido Nucleico/veterinária , Reação em Cadeia da Polimerase/veterinária , RNA Ribossômico 18S/genética , Análise de Sequência de DNA
16.
J Assoc Physicians India ; 67(4): 47-51, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31299839

RESUMO

Introduction: HIV Associated Neurocognitive Disorder (HAND) is still prevalent even in the ART (Anti-Retroviral Therapy) era. It may have some association with CD4 counts and Anti-Retroviral Therapy. The prevalence of HAND in HIV-patients, was, therefore studied in the context of ART and CD4 counts. Methods: Modified Mini Mental State Examination scores of 200 (65% males) HIV-positive patients and 200 controls were analyzed in the context of ART and CD4 counts. Results: Maximum number of participants were educated between 8th-12th class (89.5%), aged between 25-50 years (81.5%) and a higher proportion of males had a CD4 count <500 (69.2%) (p=0.007). Using 3MS, 21% patients (mean 76.24±1.51) and none of the controls were found to be neurocognitively impaired. Mean scores of patients with CD4 counts<500(82.54±5.58) were lesser in comparison to those of patients with CD4 counts>500 (p<0.001). Those with an ART duration of <48 months had a lower score in comparison to those with an ART duration of >72 months (p=0.005).Most decrease from maximum value was seen in similarities (48.3 %), second recall (36.1 %), repetition (33.4 %), copying two pentagons (28.3 %), read and obey (24.0 %), mental reversal (22.7 %) and first recall (21.3%) parameters of Modified Mini Mental State Examination. Conclusions: HAND was less prevalent in the present study in comparison to past literature. CD4 counts and ART duration had an inverse association with the degree of cognitive impairment. The parameters of Modified Mini Mental State Examination showing maximum impairment may be compiled to form a short screening questionnaire.


Assuntos
Infecções por HIV/epidemiologia , Transtornos Neurocognitivos/epidemiologia , Adulto , Idoso , Contagem de Linfócito CD4 , Feminino , HIV , Infecções por HIV/sangue , Infecções por HIV/terapia , Humanos , Índia/epidemiologia , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Transtornos Neurocognitivos/sangue , Transtornos Neurocognitivos/tratamento farmacológico , Prevalência
17.
J Assoc Physicians India ; 67(3): 42-45, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31304705

RESUMO

Objectives: The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected adult population and to define HIV and antiretroviral-related factors associated with vitamin D deficiency. Methods: This observational analytical study was conducted on 475 adult patients on follow up at Apex Immunodeficiency Center of Base Hospital, Delhi Cantt. We estimated the prevalence of vitamin D insufficiency/deficiency(<30 ng/ml). Age, gender, BMI, CD4 count, plasma viral load, HBV/HCV coinfection, smoking status, time since diagnosis of HIV infection and selected liver enzymes were recorded. Antiretroviral therapy regimen was taken into account and its relationship with vitamin D levels were noted. Results: Vitamin D insufficiency/deficiency was noted in 92.63% of patients out of which 65.68 % were males. Median age of vitamin D sufficient group was slightly higher(52.11 vs 49.95). Patients with higher body mass index (BMI) had a slightly higher rates of Vitamin D insufficiency(24.2 vs 22.3). More the time interval from the date of diagnosis higher were the chances of deficiency/insufficiency. Co-infected patients with hepatitis B and C had sufficient vitamin D levels in 71.92% patients. Efavirenz(66.93%), nevirapine(79.02%), tenofovir(64.84%) and ritonavir(84.90%) containing regimens had consistently low levels of vitamin D. Abnormal liver enzymes viz alanine aminotransferase, alkaline phosphatase and gamma glutamyl transferase were associated with higher rates of deficient vitamin D levels. Conclusions: Vitamin D deficiency is very high in HIV patients on antiretroviral therapy. . Efavirenz (EFV), Nevirapine (NVP), Tenofovir (TDF) and Protease Inhibitors (PI's) were associated with high levels of deficiency/insufficiency of vitamin D levels. Vitamin D supplementation as a global strategy in all HIV positive patients on antiretroviral therapy is advocated.


Assuntos
Infecções por HIV/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adulto , HIV , Humanos , Índia/epidemiologia , Masculino , Prevalência , Vitamina D
18.
J Assoc Physicians India ; 67(3): 70-74, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31304711

RESUMO

Background: Pandemic influenza (H1N1) 2009 emerged in April 2009 and spread widely in India. Although an unprecedented number of cases required intensive care, comparative community-based studies with seasonal influenza strains have not shown any significant differences in clinical symptoms or severity. Methods: The authors performed active surveillance on confirmed influenza-related admissions and compared the clinical profile of patients with pandemic (H1N1) 2009 influenza and patients with seasonal influenza at a tertiary care hospital in Shimla, Himachal Pradesh. Results: A total of 309 patients with flu like illness (category-C) admitted at IGMC were tested for influenza A infection and 58 (18.77%) patients had laboratory confirmed influenza A infection. Out of 58 patients, 22 with pandemic A (H1N1) and 36 with seasonal influenza A infection were analyzed. Compared with seasonal influenza, pandemic A (H1N1) patients were more likely to have sore throat (68.2% vs 16.7%, p=0.001),g.i.t symptoms (63.6% vs 16.7%, p=0.001),myalgia (36.4% vs 13.9%, p=0.047), radiologically confirmed pneumonia(81.8% vs 55.6%, p=0.042), multifocal changes on CXRs (72.7% vs 36.1%, p=0.012) and hypothyroidism as a risk factor(22.7% v 0%, p= 0.002) Patients with pandemic A (H1N1) were more likely to receive oseltamivir (91.3% vs 40.2%, p=0.002). ARDS was the major reason for intensive care unit admission in both the groups. There were no statistical significant differences in the other clinical features, comorbidities, rate of intensive care unit admission and mortality. Conclusions: The clinical features and outcomes of pandemic (H1N1) 2009 influenza and current circulating seasonal influenza A strains were comparable in hospitalised patients. However, since both seasonal and pandemic influenza can lead to significant morbidity and mortality, the impact of pre-existing seasonal influenza should not be underestimated during the pandemic period.


Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Humanos , Índia/epidemiologia , Oseltamivir , Estações do Ano
19.
J Assoc Physicians India ; 67(4): 20-22, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31309789

RESUMO

Background: Hepatitis E Virus (HEV) infection is a major concern regarding morbidity and mortality among pregnant women especially in developing countries. The objective of this study was to determine the characteristics and obstetric outcomes in pregnant women with Acute Hepatitis E Virus Infection in tertiary care hospital of Himachal Pradesh. Methods: Prospective observational study has been done in the department of Obstetrics and Gynaecology and department of Medicine and Emergency Medicine among all the pregnant women who were sero-positive for hepatitis E viral marker in two consecutive years. Information regarding basic characteristics of pregnant women and obstetric outcome has been collected. Results: Among 30 pregnant women with hepatitis E viral infection, a case fatality ratio of 8.0% for hepatitis E infection was found. 13.3% of the pregnancies ended up as intra uterine death. Most common age group affected was below 25 years. Mode of delivery among 70% of the women was normal vaginal delivery though 30% women delivered prematurely. Conclusions: This prospective case series of 30 pregnant women with acute hepatitis E viral infection, indicate poor maternal, obstetric and foetal outcome among pregnant women with hepatitis E viral infection.


Assuntos
Vírus da Hepatite E , Hepatite E/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Feminino , Hepatite E/diagnóstico , Humanos , Índia/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Resultado da Gravidez , Estudos Prospectivos , Centros de Atenção Terciária
20.
J Assoc Physicians India ; 67(4): 38-40, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31309794

RESUMO

Introduction: Eschar is one of the most important clinical sign which helps in early diagnosis, and consequently initiation of specific treatment and prevention of complications in scrub typhus. Aims: To study the prevalence and distribution of eschar in scrub typhus and comparison of clinical manifestations and complications among patients with or without eschar. Methodology: A retrospective hospital based study in patients aged ≥ 18 years admitted to a tertiary care centre in north-eastern India. Scrub typhus was diagnosed based on clinical features supported by serological tests (Immunochromatographic card test, IgM ELISA and Weil Felix test). Chi square test was used for comparing variables. A 'p value' <0.05 was considered as statistically significant. Results: A total of 129 patients of scrub typhus were included in the present study. Male to female ratio is 1.93:1 with the commonest age group being 18-30 years followed by 30-40 years. Eschar was found in 24.8% patients with 9.3% having multiple eschars and the rest had single eschar. Eschar was most commonly found in the inguinal region (28.57%) followed by trunk (25.75%) and lower limbs (22.85%). Presence of multi-organ dysfunction (p=0.008), hepatitis (p=0.005) and lymphadenopathy (p<0.01) were significantly higher in those patients who had eschar. Conclusion: The common sites of distribution of eschar are the inguinal region, lower limbs and trunk and multiorgan dysfunction is more commonly associated with eschars.


Assuntos
Tifo por Ácaros/epidemiologia , Adolescente , Feminino , Hepatite A/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Estudos Retrospectivos , Testes Sorológicos
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