Cerebrospinal Fluid Lactate in Tubercular Meningitis: Diagnostic or Prognostic Marker?

Introduction/Background: Diagnosis of tubercular meningitis (TBM) continues to be a clinical challenge and available microbiological tests fail to attain the required accuracy standards. As a result, most guidelines for the diagnosis and management of TBM depend on clinical setting, cerebrospinal fluid (CSF) analyses including adenosine deaminase activity (ADA), and imaging to guide decisionmaking. Delay in diagnosis leads to high mortality and morbidity. As there is scarcity of data on CSF lactate in TBM and its role as a diagnostic and prognostic marker, study of CSF Lactate in TBM Patients was undertaken. Methods: In this hospital based cross sectional study all admitted patients of meningo-encephalitis aged more than 15 years who fulfilled the diagnostic criteria for TBM were included. Routine haematological and biochemical investigations were done in all the patients. The CSF analysis was done including all routine microscopic parameters, lactate, Gram's stain, AFB and culture. Patients included were classified as definite, probable, or possible TBM as per WHO diagnostic criteria and were classified into three clinical stages using criteria laid down by the British Medical Research Council. Results: Fifty five patients fulfilling the diagnostic criteria for tubercular meningitis were studied. Most of the patients were in stage II according to severity. An increase in CSF lactate and CSF ADA levels with increase in severity of clinical stage of TBM was observed. Other CSF parameters and imaging were not significantly different in various groups. Conclusion: CSF lactate levels of study patients were higher than normal and showed increasing trend from possible to definite diagnosis of TBM suggesting that CSF lactate could be a predictor of definite diagnostic class of TBM though more studies with large number of patients are needed to prove its utility as prognostic tool.

Uttar Pradesh Association of Physicians of India Position Statement: Betel Quid (Paan) and Diabetes.

Betel quid (paan) chewing is common in India, especially in Uttar Pradesh. Betel quid has multifaceted relationship with health, including metabolic and psychosocial health. The current recommendations have been released keeping in view the public health and clinical importance of this addictive behavior. The objective of this document is to offer clinical guidance for screening, diagnosis and management of co-occurring betel quid chewing among persons with Diabetes Mellitus (DM). The document aims to provide education and guidance to clinicians engaged in care and management of persons with DM, and improve access to treatment for co-occurring betel quid chewing among persons with DM. The current recommendation grades are based on published evidence, and categorized as strong, intermediate, weak and no evidence. The strength of these recommendations is based on the level of evidence.

Cardio-metabolic Risk Profile in Women with Previous History of Pre-Eclampsia.

INTRODUCTION: Preeclampsia is one of the leading causes of maternal and neonatal morbidity and mortality. However there is growing evidence that there are differences during the post partum period between subjects with prior preeclampsia and prior uncomplicated pregnancy and women with a history of preeclampsia are more likely to develop cardiovascular disease later in life. The aim of our study was to assess the cardio- metabolic risk profile in women with previous history of pre-eclampsia and to their counterparts who had normal pregnancy. METHODS & MATERIAL: In a hospital based case-control study, 50 women aged 20-45 years who had history of preeclampsia and equal numbers of age matched women who had normal pregnancy were included. Apart from routine anthropometric and biochemical parameters, they were assessed for insulin resistance, Hs CRP (High sensitive C reactive protein) and flow mediated vasodilatation (FMD). RESULTS: Significant difference was noted with regard to BMI and waist circumference, systolic and diastolic blood pressures, and HOMA-IR which were higher and HDL and FMD were lower in women the previous preeclampsia than women with normal pregnancy. The prevalence of various cardio-metabolic risk factors increased in with increase in duration from index pregnancy. CONCLUSION: Women with previous history of preeclampsia had adverse cardio-metabolic profile than those who had normal pregnancy. They had higher insulin resistance and endothelial dysfunction. They also have high prevalence of chronic metabolic disorders with increased duration since index pregnancy.

Uttar Pradesh Association of Physicians of India Position Statement: Tobacco Use and Metabolic Syndrome.

Tobacco use is one of the main preventable causes of mortality and morbidity worldwide. The global disease burden due to tobacco use is huge with projected mortality of eight million lives per year by 2030. Metabolic syndrome (MS) is defined as a constellation of cardiovascular and endocrine risk factors such as insulin resistance, obesity, raised blood pressure, and abnormal lipid profile. The relationship between tobacco use and MS has been well established. Also, the causal association between tobacco use and development of individual components of MS is well established. The Uttar Pradesh Association of Physicians of India (UP API) has drafted this position statement on managing tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). This position statement presents evidence-based recommendations as described below. Scope and purpose The objective of this position statement is to offer clinical recommendations for screening, diagnosis and management of tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). The purpose of this document is to aid in identification and treatment of maladaptive patterns of tobacco use i.e. tobacco use disorder (tobacco dependence, harmful use, abuse) in person with or at risk of developing MS. Intended Audience The position statement is targeted at the clinicians engaged in care and management of person with or at risk of developing Metabolic Syndrome (MS). This might also be of relevance to the policy makers considering the public health burden of both MS and tobacco use disorders.