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In 2021 an estimated 74 million individuals had diabetes in India, almost all type 2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed and more 90% have dyslipidemia that is associated with accelerated development of atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes have multiple features that distinguish them from patients with diabetes in Western populations. These include characteristics such as earlier age of onset, higher frequency of features of the metabolic syndrome, more prevalent risk factors for ASCVD, and more aggressive course of ASCVD complications. In light of the unique features of diabetes and diabetic dyslipidemia in individuals of Indian descent, the Lipid Association of India developed this expert consensus statement to provide guidance for management of diabetic dyslipidemia in this very high risk population. The recommendations contained herein are the outgrowth of a series of 165 webinars conducted by the Lipid Association of India across the country from May 2020 to July 2021, involving 155 experts in endocrinology and cardiology and an additional 2880 physicians.

Background Due to waning immunity following primary immunization with Covid-19 vaccines, booster doses may be required. The present study assessed a heterologous booster of SII-NVX-CoV2373 (spike protein vaccine) in adults primed with viral vector and inactivated vaccines. Methods In this Phase 3, observer-blind, randomized, active controlled study, a total of 372 adults primed with ChAdOx1 nCoV-19 (n = 186) or BBV152 (n = 186) at least six months ago, were randomized to receive a booster of SII-NVX-CoV2373 or control vaccine. The control group received homologous booster of ChAdOx1 nCoV-19 or BBV152 depending upon the prime cohort. Anti-S IgG and neutralizing antibodies were assessed at baseline (day 1), day 29, day 91 and day 181 for immunogenicity assessments. Solicited reactions were collected for one week after vaccination. Unsolicited adverse events (AEs) were collected for 28 days while serious adverse events (SAE) and adverse events of special interest (AESI) were reported throughout the six-month study duration. (Identifier: CTRI/2022/04/042017) Results In both the ChAdOx1 nCoV-19 primed group and BBV152 primed group, 186 participants each received the study vaccines. In the ChAdOx1 nCoV-19 Prime cohort, at 28 days after the booster dose, there was a 3.9- to 5.1-fold-rise and 1.9- to 2.8-fold-rise in anti-S IgG and neutralizing antibody titres from the baseline in the SII-NVX-CoV2373 group and the ChAdOx1 nCoV-19 group, respectively. The same responses for the BBV152 prime cohort was 7.4- to 10.4-fold-rise and 1.5- to 2.5-fold-rise in the SII-NVX-CoV2373 group and the BBV152 group, respectively. There was 86.96% (95% CI 78.32, 93.07) to 94.57% (95% CI 87.77, 98.21) and 37.63% (95% CI 27.79, 48.28) to 79.57% (95% CI 69.95, 87.23) anti-S IgG and neutralizing antibody seroresponse (2-fold-rise from baseline) in the SII-NVX-CoV2373 group and ChAdOx1 nCoV-19 group, respectively. The same was 94.51% (95% CI 87.64, 98.19) to 98.90% (95% CI 94.03, 99.97) and 20.43% (95% CI 12.77, 30.05) to 74.19% (95% CI 64.08, 82.71) in the SII-NVX-CoV2373 group and BBV152 group, respectively. No SAE or AESI was caused by the study vaccines. Conclusion SII-NVX-CoV2373 showed a numerically higher boosting effect than homologous boosters in adults primed with ChAdOx1 nCoV-19 and BBV152. The vaccine was also safe and well tolerated.

Various studies have reported the association of cognition and depression with diabetes. Literature suggests that metformin and sitagliptin used to control hyperglycemia in type 2 diabetes mellitus (T2DM) possess a beneficial effect on neurological symptoms associated with diabetes. However, there are scarce data in the clinical setting. Thus, this study aims to compare depression, cognitive impairment, and quality of life (QoL) of newly diagnosed T2DM patients with those of healthy individuals. Further, the impact of metformin alone or in combination with dipeptidyl peptidase-4 inhibitors on cognition, depression, and QoL of T2DM patients was also compared with newly diagnosed T2DM patients.This was a prospective observational study in 120 subjects. The subjects were equally divided into four groups: healthy controls, newly diagnosed T2DM patients, and T2DM patients taking either metformin alone or in combination with sitagliptin. We assessed cognition using Mini-Mental State Examinations (MMSE), depression using Hamilton Depression Rating Scale (HAM-D), and health status using Short-Form Health Survey-36 (SF-36).No significant change in MMSE score was observed among the groups. However, a significant increase in the HAM-D score of newly diagnosed patients (p0.001), T2DM patients receiving metformin alone (p0.05), and in combination with sitagliptin (p0.001) was observed as compared to healthy controls (p0.001). Also, a statistically significant increase in HAM-D score was observed in patients receiving sitagliptin in combination with metformin as compared to metformin alone (p0.01). A decrease in SF-36 scores was observed in all groups as compared to healthy controls.To conclude, this preliminary study indicates that T2DM patients are most likely to suffer from depression and impaired QoL. Moreover, both the conventional and recent antidiabetic agents might lead to neurobehavioral complications and adverse impact on the QoL of these patients. Thus, we warrant the assessment of cognitive functions, depression, and QoL in patients receiving metformin and sitagliptin.

Infections caused by vancomycin-resistant Enterococci are difficult to treat given the limited therapeutic alternatives. Different gene clusters are known to confer vancomycin resistance. vanA and vanB genes are transferable and are clinically relevant. This cross-sectional study aimed to identify the vancomycin-resistant genotypes in the strains causing urinary tract infection and also to test the in vitro efficacy of linezolid and pristinamycin against the vancomycin-resistant isolates.Antimicrobial resistance profile of 118 enterococcal isolates was evaluated. Minimum inhibitory concentration of vancomycin, teicoplanin and high-level gentamicin (HLG) was determined by micro broth dilution. The vancomycin-resistant isolates were tested against linezolid and pristinamycin by micro-broth dilution and E strip method. The presence of vancomycin-resistant genes was detected by multiplex polymerase chain reaction and was sequenced and analyzed.Most commonly isolated species were Enterococcus faecalis (76.9%) and Enterococcus faecium (16.9%). It was found that 43 per cent of the isolates were resistant to HLG and 16.9 per cent to vancomycin. Higher resistance was seen against fluoroquinolones, erythromycin, tetracycline and β-lactam drugs. However, 5.08 per cent strains were resistant to tigecycline. All vancomycin-resistant strains were sensitive to pristinamycin and one was resistant to linezolid. vanA and vanB gene were found in 15 and five isolates, respectively. The gene sequences were submitted to NCBI gene bank and accession numbers were obtained.The present study showed prevalence of vanA and vanB genes carrying Enterococcus in a tertiary care centre in north India. The emergence of resistance against drugs such as tigecycline and linezolid is a topic of concern as it will be a therapeutic challenge for physicians.

Enterococci are known to cause life-threatening infections which are difficult to treat as the organism harbors innate resistance to many antibiotics and can amass resistance toward many others through plasmid-mediated genetic exchange.The study evaluates the drug susceptibility profile of various Enterococcus species isolated from various patient specimens submitted for bacteriological analysis and check the incidence of aac(6') Ie-aph(2") Ia gene.This in vitro cross-sectional study was executed at bacteriology laboratory of a 470 bedded hospital in New Delhi.Drug susceptibility testing was carried out on enterococcal isolates. High-level gentamicin-resistant (HLGR) isolates detected by micro broth dilution assay were then subjected to molecular detection of aac(6') Ie-aph(2") Ia gene.The level of significance was established by Chi-square test.Among the 182 enterococcal stains detected, 76.9% were Enterococcus faecalis and 20.3% were Enterococcus faecium. 12.08% strains were vancomycin resistant. 39% expressed resistance toward high-level gentamicin (HLG) and this finding was significantly higher in E. faecium than E. faecalis. HLGR strains expressed a higher degree of resistance to other drugs in contrast to non-HLGR isolates. In 67 out of 71 HLGR isolates the bifunctional gene was detected.Considerable presence of HLG and vancomycin resistance in the clinical isolates is alarming and should be taken seriously. The study shows high dissemination of aac(6')-Ie-aph(2")-Ia gene among Enterococci isolated from the region.

Both diabetes mellitus and osteoporosis constitute a notable burden in terms of quality of life and healthcare costs. Diabetes mellitus affecting the skeletal system has been gaining attention in recent years and is now getting recognized as yet another complication of the disease, known as diabetic bone disease. As this condition with weaker bone strength increases fracture risk and reduces the quality of life, so much attention is being paid to investigate the molecular pathways through which both diabetes and its therapy are affecting bone metabolism. Out of many therapeutic agents currently available for managing diabetes mellitus, metformin is one of the most widely accepted first choices worldwide. The purpose of this review is to describe the effects of biguanide-metformin on bone metabolism in type 2 diabetes mellitus including its plausible mechanisms of action on the skeleton. In vitro studies suggest that metformin directly stimulates osteoblasts differentiation and may inhibit osteoclastogenesis by increasing osteoprotegerin expression, both through activation of the AMPK signaling pathway. Several studies in both preclinical and clinical settings report the favorable effects of metformin on bone microarchitecture, bone mineral density, bone turnover markers, and fracture risk. However, animal studies were not specific in terms of the diabetic models used and clinical studies were associated with several confounders. The review highlights some of these limitations and provide future recommendations for research in this area which is necessary to better understand the role of metformin on skeletal outcomes in diabetes.

Kanchan Tyagi,1 Nidhi Bharal Agarwal,2 Prem Kapur,3 Sunil Kohli,3 Rajinder K Jalali4 1Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India; 2Centre for Translational and Clinical Research, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, 110062, India; 3Hamdard Institute of Medical Sciences and, Research, HAH Centenary Hospital, New Delhi, 110062, India; 4Physician and Healthcare Consultant. Formerly, Sun Pharmaceuticals Industries Limited, Gurgaon, 122015, IndiaCorrespondence: Nidhi Bharal AgarwalCentre for Translational and Clinical Research, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, 110062, IndiaTel +91 9818334770Email nidhi.bharal@gmail.comPurpose: Type 2 diabetes mellitus (T2DM), a metabolic disorder, remains associated with a physiological impairment affecting large populations worldwide. Onset of T2DM is multifactorial where obesity and abnormal basal metabolic rate are considered most critical. Of people diagnosed with T2DM, about 80% are also obese. It is also reported that obese individuals have an increased odds of developing depression, whereas T2DM is estimated to increase the incidence by two-fold. The preponderance of research data demonstrates that T2DM alters the serum level of cortisol and adiponectin which are known to be associated with neuronal physiology. The study explored, how a metabolic disorder like T2DM is linked with the altered plasma level of cortisol and adiponectin, the risk factors for stress and depression.Patients and Methods: A cross-sectional population study was conducted in T2DM patients using a bimodal approach. First approach used questionnaires, (1) Patient Health Questionnaire (PHQ-9) and (2) Stress Coping Inventory Questionnaire (SCQ) to assess signs and symptoms of depression and stress, respectively, in T2DM patients. In the second approach, robust biochemical analysis was conducted for serum adiponectin and cortisol levels.Results: An association of T2DM in stress and depression was evaluated in 158 subjects (105 T2DM obese patients and 53 healthy controls). A lower PHQ-9 score and adiponectin levels were seen in T2DM obese patients compared to healthy controls (p< 0.05). Further, results also depicted a lower adiponectin levels in T2DM obese patients with depression compared to T2DM obese patients without depression (p< 0.05). The study did not find a significant difference in cortisol serum levels among the T2DM and control groups. However, a higher level of serum cortisol was reported in T2DM obese patients with depression over those T2DM obese patients who lacked depression (p< 0.05).Conclusion: The findings suggest that T2DM obese patients might have a higher risk of developing stress and depression. Further, biochemical parameters, adiponectin and cortisol, might be the potential biomarkers for T2DM and may help in early diagnosis of these comorbid conditions.Keywords: type 2 diabetes mellitus, depression, stress, PHQ-9, SCQ, adiponectin, cortisol

Background India bears a high burden of both dengue and malaria. An early distinction between the two could be invaluable in reducing mortality and morbidity. The objective of this study is to identify clinical, biochemical, and radiological parameters for the same, which could aid early detection and treatment of both diseases. Methods A cross-sectional study was conducted at a tertiary care hospital in South Delhi, India. 100 pre-diagnosed patients each of dengue and malaria were studied. Features on clinical examination, and results of radiological and biochemical investigations were recorded. Continuous variables were compared using t-test, whereas categorical variables were subjected to chi-square test. P-value of ≤0.05 was taken as significant. Results All patients presented with short pyrexia (fever Conclusion The study concludes that a distinction between dengue and malaria can be made on the basis of their clinical, radiological and biochemical findings.

Background: Co-morbid diabetes and depression are prevalent chronic conditions negatively affecting quality of life (QoL). Inflammation has been considered as an integral mechanism in patients with both diabetes and depression. Objective: The aim of the present study was to investigate depression and its association with interleukins (IL)-1β and IL-9 in type 2 diabetic patients (T2DM) and controls. The QoL in diabetic patient was also assessed. Methods: Eighty subjects were included, distributed among three groups: Group 1 - Healthy controls; Group 2 - T2DM patients without depression; Group 3 - T2DM patients with depression. Depression and QoL were assessed using Patient Health Questionnaire (PHQ-9) and The Audit of Diabetes-Dependent QoL (ADDQoL), respectively. IL-1β and IL-9 were measured in serum samples of all the patients using ELISA kit. Results: The PHQ score in the Group 3 was significantly higher as compared to Group 1. The ADDQoL scores in the Group 3 were significantly higher as compared to Group 2. Levels of IL-9 and IL-1β were elevated in Group 3, as compared to the other groups. Conclusion: This study showed positive association between depression and IL-1β, IL-9 in T2DM patients. Additionally, the diabetic patients have poorer quality of life, which is further worsened by the presence of depression. Thus, routine assessment for the presence of depression is suggested in T2DM patients. RESUMO Introdução: O diabetes e a depressão comórbidas são condições crônicas prevalentes que afetam negativamente a qualidade de vida (QdV). A inflamação tem sido considerada como um mecanismo integral em pacientes com diabetes e depressão. Objetivo: Investigar a depressão e sua associação com interleucinas (IL)-1β e IL-9 em pacientes diabéticos tipo 2 (DM2) e controles. A QdV em diabéticos também foi avaliada. Métodos: Foram incluídos 80 indivíduos, divididos em três grupos: Grupo 1 - controles saudáveis; Grupo 2 - pacientes com DM2 sem depressão; Grupo 3 - pacientes com DM2 com depressão. A depressão e a QdV foram avaliadas usando o Questionário de Saúde do Paciente (Patient Health Questionnaire - PHQ-9) e a auditoria de QdV dependente de diabetes (Audit of Diabetes-Dependent Quality of Life - ADDQoL), respectivamente. IL-1β e IL-9 foram medidas em amostras de soro de todos os pacientes utilizando kit de ELISA. Resultados: O escore do PHQ no grupo 3 foi significativamente maior em comparação ao grupo 1. Os escores de ADDQoL no grupo 3 foram significativamente maiores em comparação ao grupo 2. Os níveis de IL-9 e IL-1β foram elevados no grupo 3, como em comparação com os outros grupos. Conclusão: Este estudo mostrou associação positiva entre depressão e IL-1β, IL-9 em pacientes com DM2. Além disso, os pacientes diabéticos têm pior QdV, o que é ainda piorado pela presença de depressão. Assim, a avaliação rotineira da presença de depressão é sugerida em pacientes com DM2.

Background: India introduced BBV152/Covaxin and AZD1222/Covishield vaccines from January 2021. We estimated effectiveness of these vaccines against severe Coronavirus disease 2019 (COVID-19) among individuals aged >=45 years. Methods: We did a multi-centric, hospital-based, case–control study between May and July 2021. Cases were severe COVID-19 patients and controls were COVID-19 negative individuals from 11 hospitals. Vaccine effectiveness (VE) was estimated for full (2 doses ≥14days) and partial (1 dose ≥21 days) vaccination; duration between two vaccine doses and against the Delta variant. We used a random effects logistic regression model to calculate adjusted odds ratios (aOR) with 95% CI after adjusting for relevant known confounders. Findings: We enrolled 1,143 cases and 2,541 controls. The VE of full vaccination was 80% (95% CI: 73%-86%) with AZD1222/Covishield and 69% (95% CI: 54%-79%) with BBV152/Covaxin. The VE was highest for a gap of 6-8 weeks between two doses of AZD1222/Covishield (92%, 95% CI: 82%-96%) and BBV152/Covaxin (92%, 95% CI: 26%-99%). The VE estimates were similar against the Delta strain and sub-lineages. Interpretation: BBV152/Covaxin and AZD1222/Covishield were effective against severe COVID-19 among the Indian population during the period of dominance of highly transmissible Delta variant in second wave of pandemic. An escalation of two-dose coverage with COVID-19 vaccines is critical to control the pandemic in the country. Funding Information: Indian Council of Medical Research Declaration of Interests: None to declare. Ethics Approval Statement: We obtained written informed consent from all the participants or their legally authorized representatives. Study procedures were approved by the Institutional Human Ethics Committees of all participating institutions.

BackgroundThe vast variation in COVID 19 mortality across the globe draws attention to potential risk factors other than the patient characteristics that determine COVID-19 mortality.Subjects and MethodsWe have quantified and analyzed one of the broadest set of clinical factors associated with COVID-19-related death, ranging from disease related co-morbities, socioeconomic factors, healthcare capacity and government policy and interventions. Data for population, total cases, total COVID mortality, tests done, and GDP per capita were extracted from the worldometers database. Datasets for health expenditure by government, hospital beds, rural population, prevalence of smoking, prevalence of overweight population, deaths due to communicable disease and incidence of malaria were extracted from the World Bank website. Prevalence of diabetes was retrieved from the indexmundi rankings. The average population age, 60+ population, delay in lockdown, population density and BCG data were also included for analysis. The COVID-19 mortality per million and its associated factors were retrieved for 56 countries across the globe. Quantitative analysis was done at the global as well as continent level. All the countries included in the study were categorized continent and region wise for comparative analysis determining the correlation between COVID 19 mortality and the aforementioned factors.ResultsThere was significant association found between mortality per million and 60+ population of country, average age, prevalence of diabetes mellitus, and case fatality rate with correlation and p value (p) of 0.422 (p 0.009), 0.386 (p 0.0186), −0.384 (p 0.019) and 0.753 (p 0.000) respectively at 95% CI.ConclusionThe study observations will serve as a evidence based management strategy for generating predictive model for COVID-19 infection and mortality rate.

PURPOSE: Methylglyoxal (MGO) and MGO related advance end product (AGE) are thought to contribute to the development of diabetes and its complications. The present study was intended to determine plasma MGO and sRAGE levels in T2DM patients and to assess the relationship between MGO and other parameters, such as sRAGE and oxidative markers. METHODS: The study was carried out in 100 control and T2DM subjects. Methylglyoxal, sRAGE, HbA1c, and other markers were measured by using a standard protocol and the relationship between variables was analyzed using Spearman’s correlation analysis. RESULTS: Plasma MGO levels in patients with T2DM (221.1 ± 9.50 ng/mL) were significantly higher than in control subjects (121.1 ± 6.52 ng/mL, P 10%), the sRAGE level was 6.2 ± 0.42 ng/mL and was not statistically significant as compared to control healthy group (> 0.05). Moreover, we have not found any correlation between MGO and other markers (p > 0.05). CONCLUSIONS: The findings of the present study showed that increased plasma MGO level is significantly associated with the HbA1c levels in T2DM patients. Moreover, the study shows that plasma sRAGE level is significantly augmented at increased level of glycation (HbA1c > 10%) in T2DM patients.

Considering the current pandemic of COVID-19, it is imperative to gauge the role of molecular divergence in SARS-CoV-2 with time, due to clinical and epidemiological concerns. Our analyses involving molecular phylogenetics is a step toward understanding the transmission clusters that can be correlated to pathophysiology of the disease to gain insight into virulence mechanism. As the infections are increasing rapidly, more divergence is expected followed possibly by viral adaptation. We could identify mutational hotspots which appear to be major drivers of diversity among strains, with RBD of spike protein emerging as the key region involved in interaction with ACE2 and consequently a major determinant of infection outcome. We believe that such molecular analyses correlated with clinical characteristics and host predisposition need to be evaluated at the earliest to understand viral adaptability, disease prognosis, and transmission dynamics.

We are witnessing the severe third outbreak mediated by coronaviruses affecting global public health with unprecedented economic consequences. A better understanding of its phylogenetics, exploration of sequence features and mutational changes could unveil its genealogy to gain insights into the mechanism of transmission and development of possible interventions. Our comparative genomic analyses of >160 isolates of SARS-CoV-2 reveal phylogenetic kinship with other coronaviruses and emergence of evolutionary divergence in clinical isolates. t-SNE-based clustering revealed different clades but no continent specific clusters. Amino acid substitutions at RBD of spike protein provide possible reasons for rapid transmission. Few proteins specific to SARS-CoV-2 were identified which could have implications as therapeutic targets and diagnostic biomarkers. Virtual screening identified repurposed drugs, known nutraceuticals, for specific interventions. These phylogenetic observations reveal the ancestry and computational studies reveal the emergency measures to interject this emerging pathogen that pose threat to whole of mankind.

Background. Many people with diabetes, who practise Islam, are passionate about fasting during Ramadan despite their medical condition and exemption from the religion. These patients are at risk of hypoglycaemia, hyperglycaemia, diabetic ketoacidosis, dehydration and thrombosis. We evaluated the acceptability of an individualized management plan for such people. Methods. We conducted a survey to assess the knowledge and ability of patients to manage their diabetes while observing the fast during Ramadan. Then, the acceptance of an educational intervention was assessed among patients, which was provided 1 month before Ramadan. Patients were followed up at 2 weeks into and after Ramadan. Results. Of the survey population, only 14.7% of patients volunteered for pre-Ramadan assessment and 97.5% of patients recollected suffering from symptoms suggestive or hypoglycaemia or hyperglycaemia. Following the intervention, 17 of 50 patients did not fast; 26 patients followed dietary advice, while 7 patients did not. Symptoms suggestive of hypoglycaemia and hyperglycaemia were reported by 21 of 33 patients who fasted and 21 of 28 patients reported lower body weight. Insulin and hypoglycaemic drugs were changed from morning to evening dosing in 41% of patients while 18% of patients had their drugs stopped. Conclusion. An educational intervention generated awareness among the patients and helped 43 of 50 patients in making rational decisions about control of diabetes during Ramadan.

Introduction: India plays host to a number of vector-borne diseases, including dengue and chikungunya. Both diseases demonstrate a synchronised peak, and present with similar findings. An early accurate distinction between them is valuable for effective treatment and prevention of complications. Currently used diagnostic methods estimate either antibodies or antigens; the former are absent in the first week of disease, and testing for the latter is expensive. Aim: To compare clinical profiles (history, examination) and laboratory parameters of patients with dengue fever and chikungunya fever. Materials and Methods: Pre-diagnosed patients of dengue (50) and chikungunya (50) were studied to elicit patterns in clinical, haematological and biochemical profiles which may be used for differentiation. The time taken for resolution of symptoms, and complications, were studied prospectively. The data were analysed using Z-test. Results: In both the diseases, patients present with short pyrexia (3 times) elevations were significant for dengue. Conclusion: It may be concluded that the two diseases, despite their synchronised peak during post-monsoon season, and overlapping presenting symptoms, can be distinguished on the basis of clinical profiles of the patients, and a few basic laboratory tests. On studying a larger sample size, the presence of these associations could be determined with more certainty.

Extrapulmonary tuberculosis (EPTB) is an uncommon form of chronic infection, which does not present with the typical signs and symptoms of pulmonary tuberculosis. Most extrapulmonary forms of tuberculosis affect organs with suboptimal conditions for bacillary growth. Therefore, extrapulmonary tuberculosis generally has an insidious presentation, a slow evolution, and paucibacillary lesions and/or fluids. Access to the lesions through secretions and body fluids is not always possible; therefore, invasive techniques may be necessary to obtain material for diagnostic investigation. Oral tuberculosis lesions are infrequent and their occurrence is usually secondary to pulmonary involvement. Here is an unusual presentation of oral TB which was unraveled incidentally during a routine dental extraction.

Background: Pancytopenia is a condition in which all three cell lines i.e. erythroid, myeloid and megakaryocytic are affected resulting in anaemia, leukopenia and thrombocytopenia. It can be a manifestation of a wide variety of disorders which primarily or secondarily affect the bone marrow. Early diagnosis of these conditions will help in implementing the appropriate treatment. The objective of the study was to know the clinical presentation and etiology of patients presenting with pancytopenia.Methods: A one year study from April 2016 to March 2017 was conducted in the department of medicine at a tertiary care centre. Total 32 patients with pancytopenia were studied to determine their clinical features and etiology through relevant investigations.Results: Our study revealed megaloblastic anaemia (46.87%) as the most common cause of pancytopenia, followed by malaria (12.5%). Other causes included hypothyroidism (6.2%), hypersplenism (6.2%), drugs (12.5%) and miscellaneous (9.43%).Conclusions: Megaloblastic anaemia was found to be the major cause of pancytopenia in patients. Other causes of pancytopenia were malaria, drugs, hypersplenism and hypothyroidism. These should be kept in mind while evaluating patients with pancytopenia.

Background: Liver abscess has shown a major change in demographics, etiology, diagnosis, and treatment over the past 100 years. The modern diagnostics like ultrasound and computed tomography to locate and drain the abscess have reduced the mortality to 2-12%. However, due to the complications of liver abscess especially the amebic ones the morbidity is still high. This study aims to study the correlation of various LFT parameters with abscess volume for early detection of high risk patients and early treatment thus reducing morbidity.Methods: The study was conducted over a period of 6 months on 50 patients of liver abscess. History and physical examination was done. All patients were subjected to complete hemogram, liver function test, coagulation profile (PT/INR) and USG abdomen. The data was recorded and compiled in excel sheets and analyzed using correlation coefficient (R) method.Results: The mean age of the patients was 41.2 years with male preponderance. Amoebic liver abscess (88%) was predominant over pyogenic liver abscess (12%). Alcoholism (48%), smoking (42%) and diabetes mellitus (18%) are main predisposing factors in case of liver abscess. Hepatomegaly was found in 88% cases. Elevated ALP, low albumin, increased PT INR points to the diagnosis of liver abscess. Complications seen were pleural effusion (10%) and ascites (4%). On analysis, liver abscess size is significantly positively correlated with INR, ALP, liver enzymes, and negatively correlated with serum albumin level.Conclusions: Liver abscess size was found to be positively correlated with INR and alkaline phosphatase (ALP), liver enzymes (SGOT, SGPT) and negatively correlated with serum albumin levels. There was no correlation of abscess size and bilirubin levels. Hence, LFT can be used to estimate the liver abscess size and predict the severity and prognosis of patient.

OBJECTIVES—To evaluate the relation between exposure to ground radon levels and leukaemia among children using existing population and disease registers. DESIGN—Ecological correlation study. SETTING—The county of Östergötland in Sweden. METHODS—Every child born in the county between 1979 and 1992 was mapped to the property centroid coordinates by linking addresses in the population and property registers. Population maps were overlaid with radon maps and exposure at birth and each subsequent year was quantified as high, normal, low or unknown. This was analysed with data from the tumour registry. Standardised mortality ratios (SMRs) were calculated using the age and sex specific rates for Sweden for the year 1995. RESULTS—90 malignancies occurred among 53 146 children (498 887 person years) who formed the study population. SMRs for acute lymphatic leukaemia (ALL) among children born in high, normal and low risk areas were 1.43, 1.17 and 0.25 respectively. The relative risk for the normal risk group and high risk group as compared with the low risk group was 4.64 (95% CI 1.29, 28.26) and 5.67 (95% CI 1.06, 42.27). The association between ALL and continued residence at normal or high risk areas showed a similar trend. No association between radon risk levels and any other malignancy was seen. CONCLUSION—Children born in and staying at areas where the risk from ground radon has been classified as low are less likely to develop ALL than those born in areas classified as normal and high risk. Keywords: leukaemia; cancer; radon; ionising radiation; Geographic Information Systems

Impact of a health informatics research project on the management and delivery of primary health care, focusing on maternal and child health care (MCH), was reported earlier in 1992, with encouraging results in terms of increased antenatal care coverage and decrease in Immunisation drop-outs. The software (MCHS) was based on essential data sets (EDS) to assist the care providers in information management for MCH care. The site was revisited after four years to evaluate the status of the project and to ascertain whether computers were still in use and was the dispensary staff using the MCHS package or not? The results are presented in this paper to demonstrate that ‘information is a difference that makes a difference’. Information generated by the MCHS acted as a catalyst for behavioural change in the community from indifferent users to active users of the health care services. This is reflected by the increased acceptance of antenatal care, 80% fully immunised child (FIC) and participation in other primary health care activities.

Aerial distance from the dependent Primary Health Center is a crude but objective measure of geographical accessibility to Primary Health care facilities. This report describes a method for calculation of distances between the PHC and the population it serves using the data available from the local health authorities and the Swedish Central Statistical Bureau. The Swedish annual population registration records of 1991 and the property register available with the Central Statistical Bureau of Sweden formed the main data sources. By coupling the address in the population register to the property register each individual was mapped to the centroid of a property. The location of the PHCs as well as the areas covered by each were obtained from the local health authorities and mapped. By intersecting the population coverage with the PHC coverage the population for each PHC area was identified. Subsequently the distance to the PHC was calculated for each individual (property centroid). The population maps so generated can be linked to other databases to visualize and analyze the spatial dimension of health and disease. The methodology can be adapted for use with postal code districts, census enumeration tracts, or any other small area.

Reports on autonomic dysfunction associated with obesity in adolescent population are limited and also are conflicting. Therefore in the present study, we have evaluated the difference in autonomic function between the obese and nonobese adolescents. Sixty-five adolescent subjects aged between 17 and 19 years were selected from HAHC Hospital, Jamia Hamdard. Based on their body mass index, these subjects were divided into a nonobese group ( n = 54) and obese group ( n = 11). Autonomic function tests for assessing parasympathetic function (such as heart rate response to immediate standing and standing to lying ratio) and sympathetic function (such as blood pressure response to immediate standing and cold pressor test) were employed. There was no difference in sympathetic and parasympathetic function between the obese and nonobese adolescents. Therefore, the findings of the present study suggest that the autonomic dysfunction was not statistically significant in the studied adolescent population.

Objective: to identify and link populations and individuals that live within high risk areas. Design: census registers and disease registers which contain data on individuals can only give aggregate statistics relating to postal code districts, town, county or state boundaries. However environmental risk factors rarely, if ever, respect these man-made boundaries. What is needed is a method to rapidly identify individuals who may live within a described area or region and to further identify the disease(s) occurring among these individuals and/or in these areas. Method: this paper describes a method for linking the standard registers available in Sweden, notably the residence-property addresses they contain and the geographical coordinate setting of these, to map the population as a point coverage. Using standard GIS methods this coverage could be linked, merged or intersected with any other map to create new subsets of population. Representation of populations down to the individual level by automatised spatialisation of available census data is in its simplicity a new informatics method which in the designated GIS medium adds a new power of resolution. Results: we demonstrate this using the radon maps provided by the local communes. The Swedish annual population registration records of 1991 for the county ofOstergotland and the property register available at the Central Statistical Bureau of Sweden formed the main data sources. By coupling the address in the population register to the property register each individual was mapped to the centroid of a property. By intersecting the population coverage with the radon maps, the population living in high, normal or low risk areas was identified and then analysed and stratified by commune, sex and age. The resulting tables can be linked to other databases, e.g. disease registers, to visualise and analyse geographical and related patterns. The methodology can be adapted for use with any other environmental map or small area. It can also be expanded to the fourth dimension by linking likewise available migration information to generate immediately coordinate-set, accumulated exposition and similar data.

In our attempt to develop an “Essential Data Set” for a computer based information system to support Maternal & Child Health Care services an analysis of Swedish maternal care services was undertaken. The present study analyses the information system in the domain of maternal and child health care at the primary health center level with a view to identify areas where a computer-based medical record could effect improvements. The study showed that even in a well organized maternal care service as in Sweden lacunae exist in the information system. The paper forms, called MHV1, MHV2, MHV3 and FV1, though well designed, were incomplete in a large number of the cases. The MHV1 forms were completed in less than 45%, the MHV 2 form in 87.5% and the FV1 form in 70% of the cases. Certain elements of the data set were less likely to be completed than others. Another weak spot was the inaccessibility of the paper records during off-hours. These deficiencies could be eliminated by the use of a computerized medical record based on an essential data set.