Metabolic syndrome burden, determinants and treatment status in an urban slum resettlement colony in Delhi, India.

BACKGROUND: Metabolic syndrome (MetS) in low-resource settings contributes to accentuated risk of cardiovascular disease, including stroke. The study objective was to estimate the prevalence, determinants and treatment status of MetS in an urban slum resettlement population in Delhi, India. METHODS: This study was conducted from February to May 2023. Multiphase sampling was conducted with 1910 individuals screened for abdominal obesity (AO), with 996 detected as having AO, of which, 400 were selected by simple random sampling and further evaluated for triglycerides (TGs), high-density lipoprotein (HDL) and fasting glucose levels. RESULTS: Among the 400 participants detected as having AO, 211 had evidence of MetS (52.75% [95% confidence interval 47.83 to 57.62]). The most prevalent combination of MetS clustering was for all five components (AO, diabetes mellitus [DM], hypertension [HTN], low HDL and high TGs; 14.69%), followed by AO, DM and HTN (12.32%). On adjusted analysis, the odds of having MetS was found to be independently associated with increasing age (≥40 y) but not sex. CONCLUSIONS: A high burden of MetS and suboptimal treatment status is prevalent in urban slum populations. Screening of individuals with AO, especially in those >40 y of age, can be an effective programmatic strategy for early diagnosis and management of MetS and its underlying components.

Role of simvastatin in prevention of vasospasm and improving functional outcome after aneurysmal sub-arachnoid hemorrhage: a prospective, randomized, double-blind, placebo-controlled pilot trial.

BACKGROUND: Vasospasm plays a major role in the morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The preliminary studies suggest that statins protect against cerebral vasospasm. OBJECTIVE: The aim of the study was to determine the role of simvastatin in preventing clinical vasospasm and improving functional outcome in patients with aSAH. METHODS: All patients with aSAH admitted within 96 h of ictus were randomized to receive either Simvastatin or placebo - 80 mg/day for 14 days. Thirty eight patients were recruited in the study- 19 received Simvastatin and 19 placebo. All the patients underwent surgical clipping of the aneurysm. The primary outcome of the study was the development of clinical cerebral vasospasm. The secondary outcomes included Glasgow Outcome Score (GOS), Modified Rankin Scale (MRS) and Barthel Index Score (MBI) at follow-up at 1, 3 and 6 months. RESULTS: 16% of the patients in the simvastatin group had high Middle Cerebral Artery velocities (> 160 cm/sec) on transcranial Doppler on one or more than one day during the study duration as compared to 26% of the patients in the placebo group (p = 0.70). Neurological deterioration occurred in 26% and 42% of the patients in simvastatin group versus placebo group, respectively (p = 0.31). There was an improvement in the functional outcome in the simvastatin group at 1, 3 or 6 months in the follow-up; however, this difference was not statistically significant. CONCLUSIONS: There was benefit of simvastatin in terms of reduction in clinical vasospasm, mortality or improved functional outcome, however, this was not statistically significant.

HIV and TB co-infection in Indian context.

This study was carried out in a Anti-Retroviral Therapy Clinic and TB center of a tertiary level hospital to find out socio-demographic correlates of HIV/TB individuals and risk factors of HIV/TB co-infection in Indian context. It is a case-control study comprising 420 subjects, 3 groups of 140 each. For a case group of HIV-TB co-infected subjects, two control groups, one comprising HIV patients (not having TB), and the other TB patients (not having HIV). Majority 267 (63.6%) males, 100 (71.4%) in case group (HIV/ TB), 74 (52.9%) in control group 1 (TB) and 93 (66.4%) in control group 2 (HIV). Mean (+/-SD) age of case-group was 34.91 (+/- 8.57) years. New TB cases were 213 (76.1%), more among control-group 1, compared to case-group. Multivariate analysis showed that risk of co-infection was 1.94 times higher among individuals aged >35 years. Difference statistically significant amongst those who were not on ART than who were on ART (p < 0.001). Those with CD4 counts <200 had 1.85 times risk of TB. Smokers had 1.92 times risk of TB. Co-infection higher in males, in age group 35-44 years, urban area, lower educational status and lower socioeconomic class. Current history of smoking significantly associated with co-infection. HIV status during TB infection was detected in 1/4th of study subjects. History of TB symptoms in family significantly associated with co-infection.

Neutralizing antibody responses to SARS-CoV-2: A population based seroepidemiological analysis.

This study (August-September 2021) estimated the seroprevalence of SARS-CoV-2 neutralizing antibodies in the general population of Delhi and correlated it with their anti-SARS-CoV-2 IgG levels. Samples were selected by simple random sampling method. The neutralizing capacity was estimated by performing a surrogate virus neutralization test (sVNT) (GenScript), Piscataway, NJ, USA. A total of 2233 (87.1%, 95% C.I. 85.7, 88.3) of the 2564 SARS-CoV-2 IgG seropositive samples had detectable SARS-CoV-2 neutralizing antibodies. In samples with S/CO â€‹≥ â€‹4.00, the neutralizing antibodies ranged from 94.5% to 100%. The SARS-CoV-2 neutralizing antibody seroprevalence strongly correlated with the S/CO range of IgG SARS-CoV-2 (r â€‹= â€‹0.62, p â€‹= â€‹0.002).

Telemedicine: Embracing virtual care during COVID-19 pandemic.

Telemedicine and related e-health facilities facilitate care from a distance through electronic information systems. COVID-19 pandemic is establishing telemedicine in the health care delivery system of countries. Telehealth is contributing significantly in health care delivery during the COVID-19 crisis. For mild-to-moderate symptoms of COVID-19 or any illness, telehealth services might represent a better, efficient way to receive initial care and perform triaging. Telemedicine also has a significant role in screening for COVID-19 symptoms and delivering routine needs and follow-up care. The large-scale adoption of telemedicine in public health care delivery is still not visible in low- and middle-income countries like India. Adoption by patients and healthcare professionals is limited and their concerns need to be addressed to ensure its utilization in future of the care continuum. In the current paper, we aim to review recent measures of Telemedicine adopted during the course of pandemic and its impact on public health in lower-middle income countries like India.

Wheat gluten as a pathogenic factor in schizophrenia.

Schizophrenics maintained on a cereal grain-free and milk-free diet and receiving optimal treatment with neuropleptics showed an interruption or reversal of their therapeutic progress during a period of "blind" wheat gluten challenge. The exacerbation of the disease process was not due to variations in neuroleptic doses. After termination of the gluten challenge, the course of improvement was reinstated. The observed effects seemed to be due to a primary schizophrenia-promoting effect of wheat gluten.

Anaplastic meningioma in an adolescent: a report of a rare case and brief review of literature.

OBJECTIVE: Anaplastic meningioma is an uncommon neoplasm in childhood and adolescence. Due to the rarity, treatment options for anaplastic meningioma in this age group are not clearly outlined. CASE: A 15-year-old boy presented with a left forehead swelling with a history of a left frontal tumor. Radiological investigations revealed a dura-based tumor with a large extracranial and a smaller intracranial component. Craniotomy with near-total excision of the tumor was performed. Histopathological examination of the tumor showed features of an anaplastic meningioma. The patient is currently receiving radiotherapy and chemotherapy. However, he has developed scalp swellings while on radiotherapy. CONCLUSION: Anaplastic meningioma is extremely rare in children. Extensive sampling is required to recognize the meningothelial nature of the tumor and immunohistochemistry helps in making an accurate diagnosis in such cases. Therapeutic interventions in such cases need to be closely monitored due to the aggressive behavior of this tumor.

Risk factors with breast cancer among women in Delhi.

BACKGROUND: The incidence of breast cancer is on the rise in India, breast cancer is the second most common malignancy in Indian women. AIM: The aim of this study was to find out the association of various risk factors with breast cancer among women in Delhi. SETTINGS AND DESIGN: This was a case-control study in Lok Nayak Hospital, Delhi. METHODS AND MATERIAL: 332 women were studied. Subjects were women with breast cancer (N = 115) and age matched Control subjects (N-217) without breast cancer, attending Lok Nayak Hospital during 2006. Subjects were interviewed using a pretested questionnaire. The risk factors studied were: age, parity, socioeconomic status, marital status, breast feeding, menarche, menopause, family history. STATISTICAL ANALYSIS: Data was expressed in proportion. RESULTS AND CONCLUSIONS: Age of the patient ranged from 25 to 80 years. In this study, 69 (60%) cases and 127 (58.5%) controls were illiterate, the mean duration sum of total breast feeding for all children was 6.58 years in cases and 7.4 years in controls (OR = 1.91; 95% CI, 1.17 - 3.13) (P P P< 0.05). There was a significant difference between breast cancer cases and controls in relation to place of residence, occupation, marital status, body mass index and breast feeding.

Effectiveness of HIV counseling services on knowledge, attitude, behavior and practice (KABP) among pregnant women attending PPTCT program.

Counseling services is an important component of National AIDS Control Program which aims at creating awareness and promoting changes in reducing high risk behavior against HIV/AIDS. Pregnant women attending antenatal clinics are being counseled about HIV/AIDS under prevention of parent to child transmission (PPTCT) program. The objective of this study was to assess (KABP) regarding HIV/AIDS among pregnant women attending PPTCT program before and after counseling at Lok Nayak Hospital, New Delhi. A Quasi-experimental study was conducted. Data was collected by interviewing 600 pregnant women attending ANC clinic during May 2006 to May 2007 using a pre-test and post-test interview schedule. About 69.2% of the pregnant women had heard about AIDS before the counseling. Knowledge regarding mother to child transmission of HIV was 53.5%. 38.2% knew that mother to child transmission can be reduced by drugs. The knowledge of pregnant women about AIDS was significantly different in pre-test (mean score = 15.3) and post test (mean score = 35.6) (P < 0.0001). Attitude of study participants towards people living with HIV/AIDS (PLWHA) indicated that individuals with HIV should be allowed to work (79.9%) and all commercial sex workers should compulsorily be tested for HIV (55.1%). There was significant difference between in pre-test and post-test attitude about PLWHA and HIV testing (p < 0.0001). The condom use among the study participants significantly improved after counseling (1.2% in pre-test and 58.6% after counseling) (p < 0.0001). Counseling services were effective in increasing knowledge and changes in attitude and behavior among pregnant women and the efforts needs to be sustained.

Hepatitis B and C virus infection in an urban slum of Northern India.

A community based cross sectional study was conducted in an urban slum amongst males to assess the magnitude of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections among males between 20-50 years of age. All of the 288 males who were contacted had agreed to participate in the study. However, the information could be collected from a total of 260 subjects, using a pretested, pre-coded schedule included sociodemographic characteristics. Serological tests were done for Hepatitis B and C. The data were analyzed using EPI-INFO 3.2.2. Proportion of persons tested serologically positive for Hepatitis B and C in the present study was observed to be 10.38% and 1.15%, respectively. Higher proportion for hepatitis B and C was observed amongst those Muslims, below 35 years of age, stay in the area for less than 5 years, Illiterates, unstable occupation, staying away from home and those with no history of blood transfusion or donation; however the difference was not statistically significant. There is a need to carry out more community based studies amongst such populations at risk in order to assess the true prevalence and risk factors for appropriate intervention.

Assessment of quality of life among HIV positive people attending tertiary hospital of Delhi, India.

As per global HIV/AIDS estimates, a total of 33 million [30.3 - 36.1 million] People were living with HIV in 2007. The world's second-most populous country, India, is experiencing a highly varied HIV epidemic, which appears to be stable or diminishing in some parts while growing at a modest rate in others. Quality of life (QOL) of HIV/AIDS patients is becoming an important component of overall assessment of health care and management in health care settings. It is one of the indicators effectiveness of management of PLHAS. The objective of this study was to determine the QOL of patients with HIV/AIDS in New Delhi. Purposive sampling was used to identify subjects from the antiretroviral therapy clinic (ART) in Lok Nayak hospital. 180 patients were interviewed with the WHOQOL-HIV instrument. This questionnaire included demographic data, multi-item scales and six domains namely physical, psychological, level of independence, social relationships, environment and spirituality religion. Study subjects were aged between 20-56 years. Mean age of all study subjects was 33.85 +/- 7.01 years, comprising of 34.4 females. More than 50% of the total subjects had received less than secondary school education. All domains have higher scores for women than men except the psychological domain. Correlation of scores of six domains with overall QOL score and among individual domains was statistically significant. Younger people showed poorer QOL and level of education correlated positively with all domains of QOL Overall results indicate that quality of life of AIDS attending Lok Nayak hospital is satisfactory.

Magnitude of domestic violence and its socio-demographic correlates among pregnant women in Delhi.

CONTEXT: Domestic violence is violation of basic human rights, and poses a threat to the physical, mental, and social health aspects of women and her children. The causation of domestic violence is precipitated by many risk factors. AIMS: Aim was to estimate the magnitude of domestic violence overall, and its sub-types, among pregnant women. The study also aimed to find the associated socio-demographic determinants of domestic violence among the subjects. SETTINGS AND DESIGN: The study was designed as a cross-sectional study to estimate the prevalence of domestic violence and to find socio-demographic correlates in its causation. A total of 1500 apparently healthy pregnant women, with gestation up to 20 weeks were interviewed. METHODS AND MATERIALS: A pre-tested semi-structured interview schedule was used to collect data on socio-demographic variables and details of domestic violence, after explaining the purpose of study to the subjects and obtaining informed consent. STATISTICAL ANALYSIS USED: Data was entered in Ms-Excel and IBM SPSS Version 25 was used for statistical analysis. RESULTS: The findings revealed overall prevalence of domestic violence to be 29.7%, with emotional and verbal type of violence being most common type. Caste, religion, literacy status of study subjects, and occupational status of spouses of study subjects were reported as significant correlates affecting the causation of domestic violence among the subjects. CONCLUSIONS: The findings highlight the burden and thus, stress for the need for effective involvement of all sectors in the elimination of domestic violence against women as a public health issue and develop zero-tolerance towards it.

Haemostasis and analgesia with autologous platelet-rich plasma in tonsillectomy.

OBJECTIVE: A single-centre, single-blinded prospective experimental study was conducted to determine the effectiveness of autologous platelet-rich plasma applied to the tonsillar bed post-operatively in reducing post-operative pain and haemorrhage. METHODS: Platelet-rich plasma, prepared prior to surgery, was applied with calcium gluconate to one randomly chosen tonsillar fossa. Pain and haemorrhage were analysed, using a visual analogue scale and a pre-defined grading scale respectively, four times on the day of surgery at 2-hourly intervals, and thrice on the following day. RESULTS: The pain score and haemorrhage grade on the test side were lower than on the control side. These findings were statistically significant. CONCLUSION: This pilot study, conducted in India, revealed valid positive results for a promising new technology. The manual preparation of platelet-rich plasma could be automated in the future to allow a larger sample size.

Synthesis and structure guided evaluation of estrogen agonist and antagonist activities of some new tetrazolyl indole derivatives.

Several regioisomeric tetrazolyl indole derivatives with structurally modified alkyl substituents at the tetracyclic indole nitrogen containing N-ethyl amino tetrazole moiety have been synthesized and screened for their ER binding affinity, agonist (estrogenic), antagonist (antiestrogenic) and anti-implantation activities. N-2 regioisomers were found to be moderately antagonists and one compound showed 100% contraceptive efficacy at 10 mg/kg dose. Molecular docking studies carried out in comparison to estradiol and raloxifene showed different binding modes of the two regioisomers to the binding site.

Quantification of bone mineral density to define osteoporosis in rat.

The diagnosis of osteoporosis centers on assessment of bone mass and quality. In the absence of evidence-based guidelines to assess bone status in laboratory animals and unsuitability of use of T-/Z-scores meant for clinical application in animal studies, most investigators involved in new drug research and development employ clinical biomarkers and kits to assess bone turnover rate and portray change in bone mineral density (BMD) as percentage of increase/decrease, making comparative assessment of the effect highly impractical. This study proposes threshold boundaries of BMD (rT-score) in colony-bred Sprague-Dawley rats, distinct from those used clinically. Boundaries were obtained keeping fixed Type-I error (alpha=0.025). Femur neck was considered best for defining bone status using BMD measured by dual-energy X-ray absorptiometry. Findings demonstrate that BMD-1.96 and <-0.80 rT-score as osteopenia. Performance of boundaries to ascertain bone status was examined through simulation under different physiological/ hormonal states viz. estrogen deficiency, ageing, estrus cycle, pregnancy, and lactation. The Area Under the Receiver Operating Characteristic curve of 0.98 obtained using BMD of femur neck, being close to unity, shows excellent ability of the proposed rT-score to effectively identify osteoporosis. Further studies using certain hierarchical measures of bone quality such as histomorphometry, mechanical testing etc. could supplement these findings. Since, unlike humans, most laboratory animals including rats only exhibit osteopenia and do not fracture their bones, the proposed thresholds are intended to serve as categorical tools to define bone quality and not to predict fracture risk.

Diarrhoeal outbreak of Vibrio cholerae 01 Inaba in Delhi.

V. cholerae O1 Eltor serotype Ogawa has been causing most of the cholera outbreaks in India till recently. However this communication reports the occurrence of Vibrio Cholerae O1 Inaba in Delhi in 2005, as a predominant causative organism of cholera in children. All strains isolated were sensitive to gentamicin and a high level of resistance towards nalidixic acid and amoxicillin was seen. There was no case fatality.

E-endocrinology: an update.

Internet, from a long time, has opened up a myriad resource of knowledge and applications for academicians, researchers and clinicians alike in all health care professions across the globe. Basic endocrinologists are exploring through bench-top protocols to understand endocrine system and to design therapeutic interventions. Clinicians are required to continuously look for new developments relating to investigation, diagnosis and therapeutic options in their everyday practice for better quality of life of patients. All these require managing a large body of information. Now, these innovative technologies have opened up newer avenues for endocrinologists. As internet is serving the backbone for modern technologies, it is of utmost necessity to use and refine internet applications for future endocrinologists. Increasingly, easy access to internet has dramatically reduced barriers in sharing information among basic and clinical endocrinologists. Considering the growing scope for endocrinologists in the use of internet, it is necessary to understand internet as a source of information and backbone of modern applications. This review illustrates the expanding roles of the internet for endocrinologists and provides a ready-to-use compilation of useful academic, research, clinical resources, and is expected to introduce, stimulate and guide endocrinologists into the realm of WWW.

Prevalence of bacterial vaginosis among women in Delhi, India.

BACKGROUND & OBJECTIVE: Bacterial vaginosis is the most common cause of vaginal discharge among women in reproductive age. Surveillance studies on bacterial vaginosis are mostly based on specialist clinic settings. As few population-based prevalence surveys of bacterial vaginosis have been conducted, we studied the prevalence of bacterial vaginosis in the urban and rural communities in Delhi, and to associate the presence of bacterial vaginosis with demographic profile, risk factors and presence of other reproductive tract infections (RTIs)/ sexually transmitted infections (STIs). METHODS: Vaginal specimens for Gram-stain evaluation of vaginal flora for diagnosis of bacterial vaginosis and culture of Trichomonas vaginalis and Candida spp, blood samples for HIV and syphilis serology, and urine for detection of Neisseria gonorrhoeae and Chlamydia trachomatis were collected from women (15-49 yr) from rural and urban areas. Information on demographic characteristics, risk factors and clinical symptoms was obtained. RESULTS: Bacterial vaginosis was diagnosed in 70 (32.8%) subjects. A high percentage though asymptomatic (31.2%) were found to have bacterial vaginosis. Highest prevalence was seen in urban slum (38.6%) followed by rural (28.8%) and urban middle class community (25.4%). All women with vaginal trichomoniasis were found to have bacterial vaginosis while 50 per cent of subjects having syphilis also had bacterial vaginosis.. INTERPRETATION & CONCLUSION: The study showed high prevalence of bacterial vaginosis. The asymptomatic women having bacterial vaginosis are less likely to seek treatment for the morbidity and thus are more likely to acquire other STIs. Women attending various healthcare facilities should be screened and treated for bacterial vaginosis to reduce the risk of acquisition of other STIs.

Perception of risk and potential occupational exposure to HIV/AIDS among medical interns in Delhi.

A cross sectional study was conducted among 129 medical interns of Maulana Azad Medical College, New Delhi for assessing the perceived levels of risk of acquiring HIV infection in the health care settings among medical interns, reasons for the same and their exposure to situations having potential of HIV transmission. Majority of the interns (68.3%) perceived themselves to be at a very high/high risk of acquiring HIV infection during their medical career. The common reasons for perceived risk of acquiring HIV infection were getting injuries due to needle pricks/cuts during surgical procedures (32.4%), frequent exposure to the blood/ secretions of patients (28.5%) and insufficient availability of gloves (17.6%). Some (23.2%) were of the opinion that students in future might lose interest in the medical profession due to increasing risk of HIV infection and few (3.1%) were even considering to leave the medical profession for the same reason. Majority of the interns (72.9%) had experienced needle pricks and more than half (53.7%) of them even had had blood splashes in their eyes/ nose/ mouth during surgical procedures. The findings of the study call for efforts for bringing a reduction in the risk perception of the interns through awareness campaigns and reorientation trainings, ensuring availability of gloves and other items necessary for observing universal work precautions and proper disposal of potentially contaminated articles.

"Knowledge, attitude, behavior and practice (KABP) regarding HIV/AIDS among pregnant women attending PPTCT programme in New Delhi".

In India, several thousand HIV-infected babies are expected to be born every year. Despite effective intervention, the identification of HIV infected pregnant women prior to delivery is a major problem. KABP and acceptance of rapid screening of women for HIV among pregnant women attending ANC clinic and availing Voluntary Counselling and Confidential Testing services was assessed. The study was done among 90 pregnant women. There was no significant difference between one's husbands's job and income with respect to pregnant women's awareness of risk factors except that of tattooing. Education level had significant bearing on awareness level. Attitude about PLWHA indicates that 29% of the participants believed individuals with HIV shouldn't be allowed to get married, while 31% saying that they should not be allowed to have children. Participants supported compulsory HIV testing for pregnant women (39%) and couples before marriage. Almost 96% of participants had unprotected sex, though 41% casually used condom. All denied herself or her husband indulging in extramarital sex. The country is about to embark on its prevention of mother to child transmission (PMTCT) programme. This study throws some light on the level of knowledge acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries.