Search

Background: Malaria is a major public health problem in India. Malaria is commonly associated with thrombocytopenia, but its significance is not well established. A prospective study was conducted to correlate the presence and severity of thrombocytopenia with types and severity of malaria. Material and Methods: This prospective observational study was performed in the Department of General Medicine at a tertiary care center of north India from January 2019 to June 2020. A total of 100 adult patients found positive for malaria parasites on peripheral smear examination were enrolled for the analysis. Results: The incidence of thrombocytopenia was seen in 80% of total malaria patients. There was a significant (P = 0.0001) association of severity of thrombocytopenia with symptoms and signs of malaria except for rigor. There was no significant (P > 0.05) association of severity of thrombocytopenia with age. There was a significant (P = 0.003) association of severity of thrombocytopenia with M antigen. The analysis of variance showed that there was a significant (P = 0.0001) difference in Lung Function Test (LFT) and Kidney Function Test (KFT) parameters with severity of thrombocytopenia; whereas in blood parameters, only red blood cell counts were associated significantly with the severity of thrombocytopenia. Conclusion: Thrombocytopenia is a frequent overall manifestation of both falciparum and vivax malaria. Severe thrombocytopenia is identified in all age groups, commonly in males, and increases the risk of death from falciparum or vivax malaria, particularly in those with concurrent severe anemia. Early diagnosis and prompt treatment of malaria reduces the complications and adverse outcomes of the disease. [ABSTRACT FROM AUTHOR]

In view of India unlocking, to secure a large population of this country, the healthcare facilities delivering primary care as well standalone health facilities need to be secured from impacts of COVID-19 pandemic. This document dwells on the broader guidelines for primary care practitioners/standalone private health facilities/frontline healthcare facilities to mitigate the impact of COVID-19 Pandemic. The authors understand that the situation is evolving, so the guidelines too will keep evolving. [ABSTRACT FROM AUTHOR]

The outbreak of the new coronavirus in Wuhan, Chinese Hubei City (COV-2) was also known as COVID-19 and has spread to more than 213 countries, zones or territories worldwide, and is an emergency of international public health with no antiviral drugs or vaccines; and, also, the presencouragement of the disease has become a global public health emergency. This novel coronavirus is now the seventh member of the coronaviridae family, known for infecting humans and showing evidence of causing gastric symptoms, and has the potential to be transmitted through the fecal-oral route according to a new report published online by physicians at Shanghai Jiao Tong University (Gastroenterology. 2020 March 3. doi: 10.1053/j.gastro. 2020.02.054). Here we identify the efforts to compile and disseminate the COVID-19 epidemiological information on Its potential G.I. Demonstration of news media and social networks, and few newspapers recently published. Physicians should know, how GI manifestation discussed in different publications to suspect CORONA virus infection in that patients who does not have any upper and lower respiratory tract symptom and intervein to discuss the disease severity and duration. It will increase the threshold of suspicion of physician toward Covid-19 disease. [ABSTRACT FROM AUTHOR]

Background: In April 2018, the Government of India launched 'Nikshay Poshan Yojana' (NPY), a cash assistance scheme (500 Indian rupees [~8 USD] per month) intended to provide nutritional support and improve treatment outcomes among tuberculosis (TB) patients. Objective: To compare the treatment outcomes of HIV-infected TB patients initiated on first-line anti-TB treatment in five selected districts of Karnataka, India before (April–September 2017) and after (April–September 2018) implementation of NPY. Methods: This was a cohort study using secondary data routinely collected by the national TB and HIV programmes. Results: A total of 630 patients were initiated on ATT before NPY and 591 patients after NPY implementation. Of the latter, 464 (78.5%, 95% CI: 75.0%–81.8%) received at least one installment of cash incentive. Among those received, the median (inter-quartile range) duration between treatment initiation and receipt of first installment was 74 days (41–165) and only 16% received within the first month of treatment. In 117 (25.2%) patients, the first installment was received after declaration of their treatment outcome. Treatment success (cured and treatment completed) in 'before NPY' cohort was 69.2% (95% CI: 65.6%–72.8%), while it was 65.0% (95% CI: 61.2%–68.8%) in 'after NPY' cohort. On adjusted analysis using modified Poisson regression we did not find a statistically significant association between NPY and unsuccessful treatment outcomes (adjusted relative risk-1.1, 95% CI: 0.9–1.3). Conclusion: Contrary to our hypothesis and previous evidence from systematic reviews, we did not find an association between NPY and improved treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Hypoxemia-induced endothelial dysfunction leads to microalbuminuria. Microalbuminuria (MAB) has also been used as a parameter to assess the risk of cardiovascular events in an individual. The aim of this study was to observe the relationship of MAB in patients with chronic obstructive pulmonary disease (COPD) and to correlate MAB with different stages of COPD. Materials and Methods: This cross sectional study included 140 patients with COPD selected according to GOLD guidelines based on COPD test assessment score and the number of exacerbations who had smoking pack years of more than 10 years. Urine albumin creatinine ratio (UACR) more than 30 mg/gm represents MAB. Results: The UACR increases as the severity of groups of COPD increases with significant differences in UACR values among different COPD groups. Significant differences were seen among various groups of COPD when compared for different clinical parameters such as SPO2, PaO2, PaCO2, pH, and C-reactive protein (CRP). Pearson correlation analysis revealed that UACR was significantly inversely related with PaO2 (r = -0.514, P < 0.001), SPO2 (r = –0.397, P < 0.001) and FEV1 (r = –0.441, P < 0.001) and it was significantly positively correlated with PaCO2 (r = 0.675, P < 0.001). Conclusion: This study indicates that there is strong relationship of MAB in patients with COPD and the levels of MAB increase as the severity of COPD increases due to hypoxia and endothelial dysfunction. As MAB is a marker for cardiovascular risk, patients with COPD can be routinely evaluated for the urine test of MAB specially who are at increased risk for cardiovascular events. [ABSTRACT FROM AUTHOR]

Context: Urodynamic study (UDS) and ultrasonography (USG) both are established investigations to assess the patients of benign prostatic hyperplasia (BPH). It is known that the prostate mass (PM) and post-void residual urine volume (PVR) are not significantly related to the patients' symptoms and degree of obstruction; however, the relation between the UDS, USG and patient's International Prostate Symptom Scoring (IPSS) has not been defined. Aims: To correlate the urodynamic parameters with IPSS, PM and PVR in patients with lower urinary tract symptoms (LUTS) suggestive of BPH. Settings and Design: An observational study carried out as a thesis project. Methods and Materials: Thirty male patients aged more than 40 years with LUTS suggestive of BPH were selected and underwent USG, UDS and IPSS. In UDS, the parameters studied were the maximum flow rate (Qmax), detrusor pressure (Pdet) and bladder compliance (BC). PM and PVR were studied in the USG. Statistical Analysis Used: IBM Statistical Package for the Social Sciences (SPSS) software version 16 (SPSS Inc., Chicago, USA). Pearson's correlation and two-sided significance levels were determined. Results: 1. Significant negative correlation between Qmaxand PVRUSG (r = −0.404, P= 0.027); PMUSG (r = −0.655, P= <0.001) and IPSS (r = −0.563, P= 0.001). 2. Significant positive correlation between Pdetand PVRUSG (r = 0.535, P= 0.002); PMUSG (r = 0.719, P= <0.001) and IPSS (r = 0.649, P= <0.001). 3. Significant negative correlation between BC and PVRUSG (r = −0.490, P= 0.006); PMUSG(r = −0.654, P= <0.001) and IPSS (r = −0.667, P= <0.001). Conclusions: UDS has a significant correlation with IPSS and USG findings and urodynamic parameters give a more specific diagnosis in BPH patients when it is combined with USG and IPSS. [ABSTRACT FROM AUTHOR]

REFERENCES 1 Sureka B, Tak V, Nag VL, Rani R, Garg MK, Misra S. Suraksha Chakra: A new scoring system to protect the healthcare workers from COVID. Such basic points need to be taken into consideration when designing hospital wards, catering not only to COVID patients but also to non-COVID patients. Einstein archives 29-041 Sureka I et al. i [[1]] modelled a suraksha chakra (safety circle) by designing a new scoring system to protect healthcare workers from COVID. [Extracted from the article]

REFERENCES 1 Garg S, Singh MM, Deshmukh CP, Bhatnagar N, Borle AL, Kumar R. Critical interpretative synthesis of herd immunity for COVID-19 pandemic. I "The good physician treats the disease; the great physician treats the patient who has the disease." i Sir William Osler (1849-1919) Dear Editor, Suneela Garg I et al. i [[1]] construct a critical interpretative synthesis of herd immunity for coronavirus disease-2019 (COVID-19) pandemic in March 2021 issue of the journal. There the authors state that (among) possible reasons for reinfections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were variable immune responses of (different) patients, re-exposure of to a new strain of virus or false-positive test results. [Extracted from the article]

REFERENCES 1 Gupta N, Anwar A, Varun N, Paneesar S, Nigam A. Adolescent sexual behaviour and its determinants: A hospital-based study. Dear Editor, Gupta I et al. i analyse adolescent sexual bahaviours and its determinants by conducting a hospital-based study.[[1]] Because of higher exposure to modern day communication devices, adolescents have access to those contents which were inaccessible just a generation ago. The researchers state that they assess for the first-time the route of intercourse, frequency of sexual activity and place preferred by the adolescents to engage in the lustful exercise. [Extracted from the article]

Objectives: The present study aimed to assess the validity of Indian Diabetes Risk Score (IDRS) and its association with body mass index (BMI) and glycosylated hemoglobin (HbA1c) for screening of diabetes and obesity. Methodology: A cross-sectional study was designed, and samples were randomly enrolled from Lucknow and its adjoining areas. Totally, 405 subjects were included in the study. We used diabetes risk factors (age, waist circumference, physical activity, and family history of diabetes) for screening of diabetes and abdominal obesity (AO) and BMI for screening of general obesity. HbA1c was used for confirming the diabetes patients in this population. Statistical analysis was applied to all data using SPSS software (version 20.0). P < 0.05 was considered statistically significant. Results: All 405 subjects were assessed for diabetic risk factors, BMI, and glycated hemoglobin. Of these, 56.3% subjects were aged =50 years. 1° and 2° AO was found in 47.9% and 40% subjects, respectively. About 27.1% subjects were found to have sedentary lifestyle, and 72.6% were found to have no family history of diabetes. According to IDRS, 272 subjects (67.2%) were found at high risk of diabetes (score =60). Based on BMI calculation, 198 subjects were obese, of which 79.3% were found at high risk for diabetes. A significant association was found between subjects with higher risk score and BMI (P < 0.001). Assessment of HbA1c showed that 97 (23.9%) were prediabetic and 204 (50.4%) were diabetic, of which 63.9% and 77%, respectively was at high risk for diabetes as per IDRS. A significant association was found between subjects with higher risk score and HbA1c (P < 0.001). Conclusion: Our study fully supports the validity of IDRS, as it can be used as a cost-effective tool for primary mass screening of diabetes. Moreover, its combination with BMI value and HbA1c can be used for strict monitoring for diabetes and obesity at primary health care centers to reduce the early development of diabetes complications and severe obesity comorbidities. [ABSTRACT FROM AUTHOR]

Association of gestational diabetes with maternal disorders of glucose metabolism and childhood obesity. Dear Editor, Puneeta Gupta et al. underscore one of the drawbacks of modern medical science, or of the way it's now practised: unnecessary, costly, avoidable and potentially harmful care.[[1]] They correctly state that at the beginning, medical science used to deal with only diseased patients by diagnosing and treating them. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes mellitus. [Extracted from the article]

Risk factors and outcome among COVID-19 exposed and quarantined healthcare workers: A study on the status of existing practices of standard precautions. Dear Editor, Kumar et al. analyze risk factors and outcome among Covid-19 exposed and quarantined healthcare workers. [Extracted from the article]

J Family Med Prim Care 2020;9:4505-6. 2 Yasir S, Kumar H. India bans 118 Chinese apps as Indian soldier is killed on disputed border. India - a tale of one country, but stories of many states. "Where the mind is without fear & the head is held high" - Rabindranath Tagore (1861-1941) in Gitanjali, Nobel Laureate in Literature 1913 Dear Editor, On this Independence Day of India, Raman Kumar narrates story of indefatigability, resilience & diversity of our civilization.[[1]] Recent past saw invasion & then occupation of our land & people & only 73 years ago we got freedom from those colonial masters. [Extracted from the article]

REFERENCES 1 Garg S, Gangadharan N, Bhatnagar N, Singh MM, Raina SK, Galwankar S. Telemedicine: Embracing virtual care during COVID-19 pandemic. - Albert Einstein, Nobel Laureate in Physics (1921), aphorism 1945-46, Einstein archives 36-570 Dear Editor, Garg et al. inform us the benefits & pitfalls of embracing virtual care during Covid-19 pandemic. [Extracted from the article]