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Background and purpose: No previous study has assessed the frequency and clinical– radiological characteristics of patients with diabetes mellitus (DM) and acute onset non-choreic and nonballistic movements. We conducted a prospective study to investigate the spectrum of acute onset movement disorders in DM.Methods: We recruited all the patients with acute onset movement disorders and hyper-glycemia who attended the wards of three hospitals in West Bengal, India from August 2014 to July 2021.Results: Among the 59 patients (mean age = 55.4± 14.3 years, 52.5% men) who were included, 41 (69.5%) had choreic or ballistic movements, and 18 (30.5%) had nonchoreic and nonballistic movements. Ballism was the most common movement disorder (n= 18, 30.5%), followed by pure chorea (n= 15, 25.4%), choreoathetosis (n= 8, 13.6%), tremor (n= 5, 8.5%), hemifacial spasm (n= 3, 5.1%), parkinsonism (n= 3, 5.1%), myoclonus (n= 3, 5.1%), dystonia (n= 2, 3.4%), and restless leg syndrome (n= 2, 3.4%). The mean duration of DM was 9.8 ± 11.4 years (89.8% of the patients had type 2 DM). Nonketotic hypergly-cemia was frequently (76.3%) detected. The majority (55.9%) had no magnetic resonance imaging (MRI) changes; the remaining showed striatal hyperintensity. Eight patients with MRI changes exhibited discordance with sidedness of movements. Most of the patients (76.3%) recovered completely.Conclusions: This is the largest clinical series depicting the clinical–radiological spectrum of acute onset movement disorders in DM. Of note was that almost one third of patients had nonchoreic and nonballistic movements. Our findings highlight the importance of a capillary blood glucose measurement in patients with acute or subacute onset movement disorders, irrespective of their past glycemic status.

Wilson disease (WD) is characterized by a wide variety of clinical manifestations. Our study aimed to correlate genotype with clinical and radiological features in Indian WD patients. We conducted a descriptive observational study in a tertiary care neurology referral center of eastern India over a period of 2 years. Demographic data collection, clinical examination and relevant investigations were done for all WD patients meeting the inclusion criteria. Based on previous reports of mutation hotspots for WD in Eastern India, we performed PCR-Sanger sequencing of selected exons of ATP7B gene. To understand the role of each of these covariates on the occurrence of common mutation, we applied a logistic regression as well as random forest in a supervised learning framework. Fifty-two WD patients were included in the study. c.813C > A (p.C271X) was the commonest identified mutation. The statistical methods applied to our data-set reveal the most important features for predicting common mutation or its absence. We also found that the state-of-the-art classification algorithms are good at predicting the absence of common mutation (with true positive rates being 0.7647 and 0.8823 for logistic classifier and random forest, respectively), but predicting the occurrence remains a harder modeling challenge. WD patients in eastern India have significant genotypic and phenotypic diversity. Statistical methods for binary classification show some early promise of detecting common mutations and suggest important covariates, but further studies with larger samples and screening of remaining exons are warranted for understanding the full genetic landscape of Wilson disease.

Objectives We aimed to evaluate blood pressure (BP) in Indian children who had similar demographic characteristics but hailed from different altitudes. Methods BP of school going children, aged 5 to 12 years, at five different locations varying in altitude (near sea level: n = 425; 2000 feet: n = 244; 4000 feet: n = 248; 6000 feet: n = 242 and 8000 feet: n = 250) was measured in a mountainous district in Himalaya. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded by aneroid sphygmomanometer in the sitting posture using a calibrated instrument and four trained resident doctors. The average of three readings was taken. Results Of the 1229 children whose data were analyzed, 50.4% were boys. SBP showed a progressive rise from 99.5 (4.00) mmHg [mean (standard deviation)] at near sea level to 106.7 (4.17) mmHg at 8000 feet. Similarly, DBP showed a rise from 60.1 (3.67) mmHg to 66.8 (4.58) mmHg over the same altitude range. Analysis of covariance for BP variation with altitude, with age as covariate, indicated a modest but statistically significant rise in both SBP and DBP with altitude. Higher BP values was noted among children residing at higher than at lower altitude (0.8% at sea level to 18.8% at 8000 feet). Correlations between SBP and DBP values and height and weight, though positive and significant at p Conclusions These data will help in correct interpretation of BP readings in children residing at high altitude.

We aimed to evaluate joint mechanics in newborn by goniometric assessment of major joints in healthy babies born at different gestational ages (GAs).An institution based observational study was carried out on healthy newborn babies within two days of birth. Study subjects were born at 28-41 completed weeks of gestation. The major joints of upper and lower limbs were assessed with manual goniometer for joint angles in relation to specific passive movements and range of motion (ROM) calculated where applicable. All measurements were made by a single observer with careful consideration of plane of movement and axes involved. Strength of association between joint angles and GA was quantified by Pearson'sSix major joints (shoulder, elbow, wrist, hip, knee, and ankle) were evaluated on either side in 433 babies. No significant differences were found between male and female babies and left or right side of the body. For most joints, a secular declining trend of joint angle or ROM was noted with good to strong inverse correlation with GA. The strongest associations were for flexion-extension ROM and adduction-abduction ROM at shoulder, palmar flexion at wrist and dorsiflexion at ankle joint withThe reading of a specific joint angle in the newborn infants was found to be dependent on GA. Precise calibration of gestation appropriate joint angles had laid down the foundation for functional assessment of multimodal joint mechanics.HighlightsEvaluation of newborn joint angles require stringent attention toward the plane and axis of the particular joint movement being assessed.Major joint angles and range of motion in newborn infants were observed to follow a secular declining trend according to the gestational age.Precise estimation of gestation appropriate joint angle will be helpful to understand the mechanics of musculoskeletal medicine in newborn.

AIM The purpose of this study was to investigate the changes in joint cartilage thickness in different subtypes of juvenile idiopathic arthritis (JIA) using ultrasound, comparing them with healthy children and to evaluate the relationship with disease duration and inflammatory markers. METHODS We conducted a cross-sectional study comprising of 27 cases of JIA and 54 age- and sex-matched healthy children. Bilateral wrist, knee and ankle joint cartilage thicknesses were measured by ultrasound as per European League Against Rheumatism standard guidelines and compared them between JIA subtypes as well as between cases and control. RESULTS Descriptive analysis of the whole cohort revealed the mean age of the study population was 8.3 ± 3.2 years with mean cartilage thicknesses at the wrist, knee and ankle being 1.40 ± 0.89 mm, 1.57 ± 0.78 mm and 1.41 ± 0.85 mm, respectively. The median cartilage thicknesses of wrist, knee and ankle joints of JIA cases (n = 27) and healthy controls (n = 54) were 1.01, 1.35, 1.05 and 1.95, 2.00, 1.95, respectively. The joint cartilage thickness was significantly reduced in JIA in comparison to the healthy cohort (P

INTRODUCTION Clinical spectrum of Moyamoya angiopathy (MMA) differs across populations with different ethnicity. This study, the largest one done among Indian population was undertaken to assess clinico-radiological profile of MMA patients in eastern India. METHODS A single centre cross-sectional study was undertaken among 76 MMA cases. Each patient was evaluated for epidemiological, clinical and radiological characteristics. SPSS 25 was used for statistical analysis. P

To generate data of electrocardiogram (ECG) parameters according to gestational age in Indian newborns. An observational study was carried out over 7 months in neonatology unit of a tertiary care teaching hospital. Following auscultation, ECG parameters were recorded simultaneously in 12 leads, on third day of life, in hemodynamically stable neonates. Data from 364 babies were analyzed, keeping at least 30 records for each gestational age between 30 to 42 weeks. There was no difference in mean heart rate recorded through auscultation and ECG traces. The mean (SD) values recorded were: P wave duration 0.04 (0.01) s, P wave amplitude 1.3 (0.4) mm, T wave duration 0.07 (0.02) s, T wave amplitude 1.1 (0.6) mm, PR interval 0.09 (0.02) s, QRS duration 0.04 (0.01) s, QT interval 0.26 (0.02) s, QTc 0.4 (0.03) s and QRS axis 127 (22) degree. Gestation age-wise percentile charts of different ECG parameters were generated. These gestational age-wise percentile charts of different ECG parameters for Indian newborns can be used as reference for neonatal ECG.

The aim of this study was to assess the clinico-laboratory parameters, complications and therapeutic responses in children with scrub typhus in Eastern India.In this prospective, observational study, all children (age,12 years) with suspected scrub typhus with a compatible clinical scenario were enrolled consecutively over six months. Cases confirmed by means of a positive IgM serology or a positive Weil-Felix reaction (OXK = 1/80 or above) were administered enteral doxycycline (4.5 mg/kg/day).Out of 94 recruited children, 61 had confirmed scrub typhus (mean age = 6.1 years, M:F = 1.1:1) with or without complications and having a considerably higher incidence of neurological presentation (meningoencephalistis n = 21, 34.4%). The most frequent manifestations included vomiting (n = 39, 63.9%), abdominal pain (n = 33, 54.1%), lymphadenopathy (n = 36, 59%), hepatosplenomegaly (n = 32, 52.5%), pedal edema (n = 32, 52.5%) and eschar formation (n = 30, 49.2%). Low hemoglobin levels, leukocytosis, thrombocytopenia, hypoalbuminemia, hyponatremia, increased liver enzymes and increased C-reactive protein were associated with delayed defervescence (48 h).Scrub meningoencephalitis, with a notably higher incidence, showed favorable therapeutic response. Prompt and empiric doxycycline therapy could be lifesaving.

To evaluate utility of a new Extended Sick Neonate Score (ESNS). to predict ‘inhospital mortality’ and compare with Score for Neonatal Acute Physiology – Perinatal Extension II (SNAPPE II) and Sick Neonate Score (SNS). Prospective observational study. All extramural sick newborns transported to the neonatology unit of a tertiary care teaching hospital over a period of one year. Correlation between ESNS, SNAPPE-II and SNS scoring, and sensitivity/specificity of each score to predict mortality were determined. 961 newborns were enrolled in the study. ESNS, SNAPPE II and SNS were strongly correlated, even when stratified by gestation. ESNS of ≤11 had the best sensitivity (85.9%) and specificity (89.8%). For preterms, ESNS ≤12 had the best sensitivity (92.3%) and specificity (76.7%). ESNS can predict ‘in-hospital mortality’ outcome with satisfactory sensitivity and specificity.

Context: Hyperglycemia has been found to occur during myocardial infarction and cardiac surgery even in nondiabetic patients. These being essentially stressful processes associated with hypoperfusion, we decided to find a possible relationship between the occurrence of global tissue hypoperfusion (GTH) and elevated blood glucose level in adult nondiabetic patients undergoing elective off-pump coronary artery bypass grafting (CABG). Aims: This study aims to observe for the occurrence of global tissue hypoperfusion and its effect on blood glucose level and whether raised blood glucose level can be used as a marker for GTH. Design: Prospective, observational study. Settings: Cardiothoracic operation theater and intensive care unit of a tertiary care teaching hospital. Materials and Methods: The occurrence of global tissue hypoperfusion were detected with the help of combined markers of mixed venous oxygen saturation and arterial lactate level at various perioperative study points together with arterial blood glucose level. Blood glucose level compared between the patients with and without GTH. Statistical Analysis Used: Numerical variables were compared between groups by Student's t-test and categorical variables by Fisher's exact test. Two-tailed P ≤ 0.05 was considered for statistically significant. Results: The incidence of GTH was 67%. Blood glucose level was raised in patients with GTH at some study time points but with poor sensitivity and specificity values. Conclusions: Global tissue hypoperfusion is a common occurrence in even nondiabetic patients undergoing elective off-pump CABG. A relationship exists between rise in blood glucose level and global tissue hypoperfusion in such patients, although it cannot be viewed as marker of the same.

To measure Penile length (PL) and Testicular volume (TV) in newborn boys for assessing genital abnormalities.In a tertiary care setting, measurements of PL and TV were recorded from 480 babies born on alternate days except the weekend, at 24 to 72 h of life by one investigator with the same set of instruments. The penis was stretched to the point of increased resistance and the distance from the tip of the glans penis to the pubic ramus was measured as the stretched PL. Testicular volume was measured by a Prader orchidometer. Improvised beads made of plasticine were used for recording volumes1 ml.In the study cohort, 365 (76.04 %) were term babies. The mean PL was 34 ± 4.7 mm for the whole cohort while the corresponding value for mean TV was 0.6 ± 0.2 ml. The gestation age-wise percentile charts of PL and TV have been generated. There was modest positive correlation between PL and TV. Positive correlation was also observed between PL and TV and birth weight, body length, and head, chest and arm circumference. Both PL and TV showed statistically significant increase with gestational age. By the index data, the cut-off for suspecting abnormal penile length should be24.5 or45.5 mm for term babies.The normative values generated can serve as reference standard in the diagnosis of penile length abnormalities in Indian babies and in clarifying issues of ambiguous genitalia and maldevelopment of male external genitalia.

Objectives: To study medicine prescribing pattern for chronic kidney disease (CKD) patients on maintenance hemodialysis. Materials and Methods: This prospective observational study was conducted in hemodialysis unit of a teaching hospital with adult CKD patients on maintenance hemodialysis. Patients' clinical profile, drug-use pattern, and medication-related problem data were captured in a structured case report form and the data were analyzed descriptively. Adherence level was assessed by Morisky Medication-Taking Adherence Scale 4-item. Results: Data from 100 patients recruited over 6 months have been analyzed. The median (interquartile range [IQR]) age was 51 (42-57) years; 57% were male, mean [standard deviation (SD)] urea level was 160.11 (70.32) mg/dL, mean (SD) creatinine level was 8.73 (5.29) mg/dL. A large number (46%) were suffering from diabetic nephropathy. The common comorbidities were anemia (89%) followed by hypertension (85%). The median (IQR) number of drugs per prescription was 10 (9-13), with the bulk being cardiovascular drugs (23.41%) followed by gastrointestinal drugs (15.76%) and vitamins (12.29%). The median (IQR) number of potential drug-drug interaction per prescription was 2 (2-3). The incidence of adverse drug reactions (ADRs) was 46% with hyponatremia being most common (32%), followed by hypoglycemia (16%) and hypokalemia (10%). Adherence level was low in the majority (64%) of patients. Conclusions: There is a high incidence of polypharmacy along with significant medication-related problems such as high drug-drug interactions/prescription, high incidence of ADRs, and low adherence.

A prospective observational study was conducted in a tertiary care hospital to study clinicoepidemiological profile of potentially rabid animal bite cases from rural India. Total of 308 children (median age 6 years) admitted to hospital, were recruited over 1 year and followed up till completion of antirabies vaccine course. Dog was the commonest (77.27%) offending animal. Of the exposures, 66.88% were scratches, 88.96% were unprovoked and 27.27% were categorized as Class III. The median times to wound toileting and reporting to health facility were 1 and 6 h, respectively. Majority received prompt PEP in hospital, and RIG was administered in 34.55% of Class II and 90.48% of Class III exposures. Compared with their older counterparts, children aged

OBJECTIVES: Cytochrome P450 2D6 (CYP2D6) enzyme metabolizes a quarter of prescription drugs. Polymorphisms of CYP2D6 gene and resultant phenotypic variations in metabolic activity have been described in various populations. We assessed the prevalence of CYP2D6 activity phenotypes, employing dextromethorphan (DXM) as probe drug in subjects with at least two parental generations residing in eastern India. MATERIALS AND METHODS: Unrelated healthy subjects took 60 mg DXM after fasting overnight. Blood samples were collected 3 h after dosing and plasma separated. DXM and its primary metabolite dextrorphan (DXT) were measured by liquid chromatography with tandem mass spectrometry. The DXM-to-DXT metabolic ratio (MR) was obtained for each subject. Histogram of MR values suggested bimodal distribution. A polynomial regression equation derived through probit analysis was solved to identify the antimode of the MR values. Subjects with log(MR) < antimode were extensive metabolizers (EMs). Log(MR) ≥ antimode indicated poor metabolizers (PMs). RESULTS: We evaluated the results from 97 participants. The median MR was 0.209 (interquartile range: 0.090–0.609), while the antimode for MR was 3.055. From these, it was inferred that three subjects were PMs, while the rest were EMs. CYP2D6 polymorphism prevalence is low (3.09%; 95% confidence interval: 0.35%–6.54%) in the population of eastern India and matches the prevalence in other zones of the country. CONCLUSIONS: Differences in CYP2D6 activity has treatment implications and may lead to adverse events or therapeutic failure. Phenotyping of subjects receiving CYP2D6 metabolized drugs may help clinicians personalize treatment and avert adverse drug-drug interactions. However, the frequency of the PM phenotype is low in India, and routinely phenotyping for CYP2D6 activity will not be cost-effective. We cannot recommend it at this stage.

To establish the normative blood pressure (BP) values in healthy Indian neonates using oscillometric method, and to develop BP percentile charts. Prospective observational study. Neonatal unit of a teaching hospital in Eastern India. 1617 hemodynamically stable inborn neonates without birth asphyxia, major congenital anomaly, maternal complications (e.g. preeclampsia, hypertension, diabetes) or critical neonatal illness. Quite state measurements of systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were recorded by oscillometric method on day 4, 7 and 14 of postnatal life. The averages of three readings at 2-minute intervals were used. Percentile charts (providing 5th, 10th, 25th, 50th, 75th, 95th, and 99th percentile values) have been developed. SBP, DBP and MAP showed a steady rise from day 4 to day 14, and were comparable between males and females, but were significantly lower in preterms than in term neonates Normative neonatal BP data along with gestational age-wise percentile charts shall be of help for decision-making and planning for sick newborns.

Prospective observational study was conducted in a tertiary care hospital of India over 8 months to measure blood pressure (BP) in healthy term and preterm neonates using oscillometric method and explore the associations with gestational age and birth weight. Consecutive BP measurements were taken by standard oscillometric method on 1617 neonates on day 4, 7 and 14 of life. Mean birth weight was 2.7 ± 0.46 kg, and mean gestational age was 38.2 ± 2.12 weeks. The mean arterial pressure (MAP) on day 4, 7 and 14 were 59.3 ± 7.33, 63.2 ± 6.55 and 66.4 ± 6.13 mmHg, respectively. Larger and mature newborns had significantly higher BP than those who were smaller and premature. Birth weight more strongly correlated with MAP than gestational age. Predictive equations linking MAP with gestational age and birth weight were deduced, which can be used for judicious fluid inotrope management.

Active pulmonary tuberculosis (APTB) is associated with a failure of the host immune system to control the invading Mycobacterium tuberculosis (Mtb). The objective of this study was to quantify and assess the role of serum inflammatory cytokines in active pulmonary tuberculosis patients following anti-tuberculosis drug (ATD) therapy. Blood samples were collected from APTB patients and normal healthy subjects (NHS) (total n = 204) at baseline and 2, 4 and 6 months post-therapy and the abundance of serum inflammatory cytokines were measured by cytokine specific ELISA. Compared to NHS, APTB patients at baseline had higher levels of serum pro-inflammatory cytokines IL-12p40 (P < 0.001), IFN-γ (P < 0.001), TNF-α (P < 0.01), IL-1β (P < 0.001) and IL-6 (P < 0.001) and anti-inflammatory cytokines IL-10 (P < 0.001) and TGF-β1 (P < 0.001) while there was no change in the level of IL-4. In APTB patients, the serum levels of IFN-γ, TNF-α, IL-6 and TGF-β1 directly relate to the bacterial load while the TNF-α, IL-1β, IL-6 and TGF-β1 relate to radiological severity. At baseline, the IL-6 level in NHS and APTB patients differed most and following ATD therapy, this level rapidly decreased and stabilized by 4-month in APTB patients. It is concluded that a subtle reduction in the serum level of IL-6 of the APTB patients following ATD therapy might play a vital role in immune-protection of the host against Mtb infection and hence the serum IL-6 level can be a useful marker to diagnose the effectiveness of therapy in the patients.

Objectives Musculoskeletal ultrasound (MSUS) has a crucial role in clinical assessment and monitoring of patients with rheumatologic diseases. Early detection of joint cartilage destruction is difficult. MSUS is a cheap, noninvasive, nonhazardous bedside tool that can be used for detection of cartilage damage. We aimed to generate normative data of joint cartilage thickness of children in our population using this tool. Methods Healthy children, aged between 2 and 12 years, not suffering from any joint disorders and not on any chronic medication were recruited. The thickness of joint cartilage at wrist, knee and ankle were measured by ultrasound as per European League Against Rheumatism standard scan criteria. The scans were done by a single observer. Results Data of 409 children revealed median cartilage thickness at right wrist, knee and ankle joints as 2.20 (interquartile range [IQR] 1.60-3.00) mm, 2.40 (1.80-3.10) mm and 2.20 (1.80-3.00) mm, respectively. The right-left differences were not statistically significant except at the knee joint. Comparison between genders showed that boys had marginally thicker cartilage than girls at all three joints; this difference was statistically significant for the knee and ankle joints, but not at the wrist. Joint cartilage thickness showed a steady decline with age. Conclusions Measurement of joint cartilage thickness in children with MSUS and comparison with these normative values can help in better screening for joint-related disease in children.

Objectives: Antimicrobials are frequently used in tertiary care hospitals. We conducted an observational study on children admitted to a teaching hospital in Eastern India, to generate a profile of antimicrobial use and suspected adverse drug reactions (ADRs) attributable to them. Materials and Methods: Hospitalized children of either sex, aged between 1 month and 12 years, were studied. Baseline demographic and clinical features, duration of hospital stay, antimicrobials received in hospital along with dosing and indications and details of suspected ADRs attributable to their use were recorded. Every patient was followed up till discharge, admission to the Pediatric Intensive Care Unit, or death. Results: Over the 1 year study period, 332 admissions were screened. The prevalence of antimicrobial use was 79.82%. The majority of the 265 children who received antimicrobials were males (61.10%) and hailed from rural and low socioeconomic background. Median age was 36 months. Six children died, 43 were transferred out, and the rest discharged. In most instances, either 2 (40%) or a single antibiotic (39.6%) was used. Ceftriaxone, co-amoxiclav, amikacin, vancomycin, and ampicillin were predominantly used. Antivirals, antimalarials, and antiprotozoals were used occasionally. Average number of antimicrobials per patient was 2.0 ± 1.27; the majority (84.1%) were by parenteral route and initial choice was usually empirical. Prescriptions were usually in generic name. The antimicrobial treatment ranged between 1 and 34 days, with a median of 7 days. Six ADRs were noted of which half were skin rash and the rest loose stools. Conclusions: The profile of antimicrobial use is broadly similar to earlier Indian studies. Apparent overuse of multiple antimicrobials per prescription and the parenteral route requires exploration. Antimicrobials are being used empirically in the absence of policy. ADRs to antimicrobials are occasional and usually mild. The baseline data can serve in situation analysis for antibiotic prescribing guidelines.

To evaluate the growth pattern in children with juvenile idiopathic arthritis and its subtypes in comparison with age, sex and temporally matched controls.Prospective study.Pediatric rheumatology clinic of a tertiary care hospital in Eastern part of India.Seventy-five children (2-12 years) diagnosed as juvenile idiopathic erthritis by International League of Associations for Rheumatology criteria and 75 age- and sex- matched controls.Weight, height and body mass index were recorded at six monthly interval in both groups over a period of 3 years.weight, height and body mass index.Subtype distribution of juvenile idiopathic arthritis was: oligoarthritis (49%, n=37), rheumatoid factor negative polyarthritis (27%, n=20), rheumatoid factor positive polyarthritis (8%, n=6), systemic onset (15%, n=11) and enthesitis related arthritis (1.3%, n=1). Anthropometric parameters in children with juvenile idiopathic arthritis were not significant different from controls. Comparison between the subtypes showed significant differences in height (P=0.011), weight (P=0.005), and growth velocity (P=0.005), but not in body mass index. Systemic onset disease led to significant restriction in height (P=0.018; 95% CI 2.13-33.77) and weight (P=0.008; 95% CI 1.47-14.43) compared to controls. Growth velocity was significantly affected in rheumatoid factor positive polyarthritis (P=0.003; 95% CIO. 46-3.14).Children with juvenile idiopathic arthritis do not have significantly lower values of anthropometric parameters compared to controls. Significant restriction in height and weight is seen in systemic onset disease, and growth velocity is significantly reduced in rheumatoid factor positive subjects.

OBJECTIVES: The objective of this study was to carry out a head-to-head comparison of topical sucralfate combined with mupirocin versus mupirocin alone in the treatment of chronic skin ulcers with respect to both effectiveness and safety. MATERIALS AND METHODS: A parallel-group, open-label, randomized, controlled trial (CTRI/2015/12/006443) was carried out with patients suffering from skin ulcers of Wagner grading 1 or 2 persisting for over 4 weeks. Ninety-six patients were recruited in total, and the modified intention-to-treat analysis dataset included 44 participants treated with mupirocin 2% and 46 treated with combined mupirocin 2% and sucralfate 7% ointment. Both medications were applied topically thrice daily for 6 weeks. Ulcer area assessed using millimeter graph paper and wound infection score assessed on a three-point scale were effectiveness measures. Treatment-emergent adverse reactions that were reported by patients or observed by the investigators were recorded. RESULTS: The median ulcer area was significantly reduced in the combined treatment group at the end of treatment. Clinically, 41.3% of the participants in the combined group showed complete ulcer healing at 6 weeks compared to 18.18% in the mupirocin alone group (P = 0.022). The wound infection score declined significantly from baseline by the end of 3 weeks of treatment in both the groups. The frequency of qualitative wound attributes, namely pain, discharge, and erythema, remained comparable between the groups except for discharge which disappeared completely from all remaining ulcers in the combined group but was still present in 11.36% of the participants treated with mupirocin alone (P = 0.025) at 6 weeks. Adverse events were few, all local, mild, and tolerable. CONCLUSIONS: The wound healing effect of topical sucralfate adds to the antimicrobial effect of mupirocin toward the overall improvement of chronic skin ulcers. The effect of combined topical treatment needs comparison with other topical medications and wound healing strategies.

To delineate the spectrum of clinical presentation and system involvement in childhood Polyarteritis Nodosa (PAN) in a multicentre follow up.This prospective observational study included all children less than 12 y attending pediatric rheumatological clinic of four different institutes in West Bengal or admitted with rheumatological symptoms and were diagnosed as childhood PAN by ACR and EULAR/PRES/PRINTO criteria. During the study period of 8 y, 15 cases were categorized as childhood PAN with organ involvement. The children diagnosed as microscopic polyangiitis or cutaneous PAN were excluded.The mean age of presentation was 8.6 ± 2.09 y with male to female ratio of 7:8. All had prolonged fever, severe myalgia, skin involvement and elevated acute phase reactants. Hypertension (93 %) and peripheral neuropathy (46 %) were notable findings. Nine had typical peripheral gangrene with ulceration, whereas rash of livedo reticularis was seen in 6 patients. None had renal, pulmonary or testicular involvement. Diagnosis was established in all patients by skin biopsy which showed necrotizing vasculitis of the medium sized vessels. The clinical presentations and diagnostic parameters were compared between the genders and no statistically significant difference was noted. All patients required corticosteroids while 10 patients needed additional immunosuppressives where there were uncontrolled symptoms of peripheral neuropathy or progressive gangrene despite treatment with corticosteroids. Cyclophosphamide was used most commonly (n = 7). Two required methyl prednisolone. Two children were lost to follow up. One patient had two relapses within three years. No mortality was observed.This multicentric study on childhood PAN, first of its kind from India, demonstrated a distinctive pattern of system involvement and clinical presentations.

Objective Post-stroke depression (PSD) is a disabling entity among stroke survivors (SS). Longitudinal studies on PSD, essential to determine its prognosis, are lacking from developing countries. This prospective study was undertaken to assess the prevalence, natural history, and correlates of depression among SS in an Indian community. Methods From a community based stroke registry, SS were assessed annually for cognition, disability, and depression using Bengali validated scales. PSD was diagnosed if score on geriatric depression scale was greater than or equal to 21. Complex sample strategy was considered when calculating prevalence of post stroke depression. An age- and sex-matched case–control study was undertaken to determine the odds of depression in SS. Results Prevalence of PSD was 36.98% (95% confidence interval [CI]: 31.89%–42.06%) among 241 patients assessed at baseline. About 17% developed depression annually and a similar proportion had spontaneous improvement. Peak rate of PSD was beyond 3 months and continued up to 18 months after stroke. Compared to the non-depressed group, PSD subjects were significantly older, had higher age at first stroke, less education, lower socioeconomic status, and greater cognitive impairment and disability. Education had a protective role. Mortality in PSD was nearly twice that in non-depressed patients, though not significant statistically (hazard ratio: 1.84; 95% CI: 0.90–3.77). Compared with controls, odds ratio of PSD was 19.95 (95% CI: 10.09–39.47). Conclusions Approximately one-third of SS develop PSD, similar to developed countries. Prevalence remains stable annually. Delayed peak of PSD suggested later realization of underlying disability. Predictors of PSD have been described and higher literacy was protective in this study.

There is no previously published well-designed study on long-term outcome of stroke from India. The present study has examined the case fatality rate and survival pattern in patients with stroke in a stratified, randomly selected sample from a large Indian metropolitan area. This prospective study was conducted over 7 years (March 2003 to February 2010) using a validated questionnaire administered by a field team and headed by a neurologist. A cross-sectional house-to-house survey was repeated twice yearly. A verbal autopsy was performed to assess cases of death. The Kaplan-Meier method was applied for survival analysis. A cohort of 763 stroke cases were followed up. The overall stroke fatality was approximately 59% at 5 years and 61% at 7 years. Early fatality was 33% within 7 days and 42% within 30 days. Men were at greater risk of death than women. Logistic regression analysis revealed male sex and diabetes to be important predictors of fatality. The majority of deaths were attributable to the index stroke (70%), followed by recurrent stroke (19%) and cardiovascular causes (7%). Beyond the first year, recurrent stroke was by far the most common cause of death. Median survival time exceeded the 84-month observation period when 30-day fatalities were excluded. Early stroke fatality is higher in this study compared with reports from developed countries, but long-term survival is similar. Beyond 1 year, the causes of stroke fatality are similar to that reported in other Asian populations. Access to acute stroke care and appropriate preventive strategy are urgently needed to reduce early stroke fatality in India.

Background/Aims: The disability-adjusted life year (DALY) is a new time-based measure of disease burden incorporating both disability and mortality. Our study aims to determine the DALYs lost due to stroke using a direct methodology and the implications. Methods: A population-based, house-to-house, 2-stage, prospective study on stroke was conducted over 7 years in Kolkata, India, on 100,802 randomly selected subjects to capture the incident cases of first-ever stroke and those with fatal stroke. The data were utilized to estimate years of life lost due to premature mortality (YLLs), years lived with disability (YLDs) and DALYs lost. Results: Over 7 years, there were 763 incident cases of first-ever stroke; of these, 320 had a fatal stroke within 30 days and 443 were stroke survivors. The overall DALYs lost due to stroke were computed as 795.57 per 100,000 person-years (730.43 in men and 552.86 in women). The overall YLL and YLD values were 593.14 and 202.43 per 100,000 person-years, respectively. The YLLs comprised 74.5% of the total DALYs. Conclusions: This is the first study in India where DALYs lost due to stroke were derived by a direct method. High YLL values demand urgent measures for controlling premature stroke death.

Post kala-azar dermal leishmaniasis (PKDL), a dermal sequel of visceral leishmaniasis presents with macular or polymorphic lesions. As immunological variations between these two forms have not been delineated, we evaluated levels of antileishmanial total Ig, IgG and its subclasses, IgM, IgE, IgG avidity, cytokines IL-10, IL-4, IL-13 and expression of CD19. The levels of Ig and IgG in polymorphic PKDL were higher than macular PKDL, while significant curtailment in levels of Ig, IgM and IgG following treatment was evident only in polymorphic PKDL. With regard to IgG subclasses, IgG1 and IgG3 were significantly raised in polymorphic PKDL, whereas in macular PKDL only IgG1 was elevated; treatment decreased levels of IgG1, IgG2 and IgG3 only in polymorphic PKDL; IgE levels were raised in both groups but no marked alterations occurred following treatment. The avidity of IgG was higher in polymorphic PKDL and correlated with duration of disease. IL-10 was higher in polymorphic PKDL and decreased significantly after treatment, whereas in macular PKDL IL-4 predominated. Taken together, in PKDL the humoral immune response was greater in the polymorphic variant than the macular form suggesting that serological markers may have a role in monitoring polymorphic PKDL.

Objective To study the prevalence and pattern of musculosketetal abnormalities in school-going children living in the hilly and foothill regions of the Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine (pGALS) screening tool. Methods Total of 3608 children, aged 3–12 years were enrolled from 16 schools (5 in the hills) in the eastern Himalayan region. After the three screening questions, the pGALS maneuvers were administered. Subjects were shown a video on pGALS before the actual testing. Those detected to have abnormality were probed in greater detail and referred for treatment as necessary. Results The pGALS examination was completed in 3463 children with a median time of 3 min (range 1.9–5.4 min). The abnormality pattern was in the order: growing pains (38.86%), hypermobility (25.54%), mechanical pains (24.46%) and others (11.14%). Among mechanical pain, back and neck problems occurred with a similar overall frequency of 7.61%. Similar order was observed considering only children from the pains. However, in hill children, the proportion of mechanical problems (32.28%) exceeded proportion of hypermobility (23.62%). Asymptomatic hypermobility was more common than symptomatic hypermobility. Maximum prevalence of hypermobility was in 6–9 year age group. Of the 94 children with hypermobility, 55.32% had some kind of joint pain. Conclusions Pediatric Gait, Arms, Legs, Spine is an acceptable screening tool for musculoskeletal abnormalities in apparently healthy children. Growing pain is the commonest musculoskeletal complaint while hypermobility is the commonest physical abnormality in school-going children in the Eastern Himalayas. Asymptomatic hypermobility is more common than symptomatic hypermobility.

Objective: Atypical antipsychotics are increasingly drugs of first choice in schizophrenia. Amisulpride, a new atypical antipsychotic, is reported to be effective for both positive and negative symptoms of schizophrenia in Western countries but Indian experience is limited. The aim of the present study was therefore to conduct a trial of amisulpride versus olanzapine in Indian schizophrenia patients. Methods: Eighty adult patients of either sex were randomized to receive standard doses of the two drugs orally, in a single blind manner, for 12 weeks, with follow up at 4 and 8 weeks. Effectiveness was assessed by changes in scores on the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), and physician-administered Clinical Global Impression (CGI) scale. Tolerability was assessed by treatment-emergent adverse drug reactions (ADRs). Results: Evaluable were 39 patients on amisulpride and 38 on olanzapine. The groups were comparable at baseline with respect to demographics, illness duration and rating scores. Final BPRS score was lower for olanzapine (33.2 ± 9.44) than for amisulpride (37.7 ± 9.67). SAPS and SANS scores and CGI rating improved individually in both arms but remained comparable between groups throughout the study period, but olanzapine reduced SAPS score to a greater extent. ADRs were encountered in 67.5% and 47.5% of patients (p = 0.113) on amisulpride and olanzapine, respectively. Tremor and insomnia were more frequent with amisulpride, while olanzapine caused more weight gain and sedation. No serious ADRs occurred. Conclusions: Amisulpride, although comparable to olanzapine on some measures, did not match the improvement seen with the latter drug in BPRS and SAPS scores. Despite differences in ADR profiles, overall tolerability was satisfactory for both drugs. In Indian patients, amisulpride should therefore be an alternative to olanzapine to a limited extent, such as when weight gain and sedation are undesirable.

OBJECTIVES: To assess efficacy and safety of oxaceprol, a hydroxyproline derivative with putative mechanism of action different from traditional nonsteroidal anti-inflammatory drugs, in symptomatic knee osteoarthritis, in comparison to tramadol. MATERIALS AND METHODS: A parallel group, double-blind, randomized controlled trial was conducted with ambulatory patients over 50 years age suffering from knee osteoarthritis causing pain of at least moderate intensity. Patients were randomized to receive either oxaceprol 200 mg thrice daily or tramadol 50 mg thrice daily for 12 weeks. The primary efficacy variable was symptom relief as assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) version 3.1 for pain, stiffness, and physical function. Responder rate (50% pain relief), patient's Clinical Global Impression (CGI), and rescue medication use were other outcomes measured. Vital signs, routine blood counts, tests of hepatorenal function and treatment-emergent adverse events were recorded for safety assessment. RESULTS: From 91 patients recruited, 43 on oxaceprol and 36 on tramadol were evaluable. The WOMAC scores declined significantly from baseline in each arm but remained comparable between groups throughout the 12-week study period. The CGI ratings and 50% responder rates were also comparable at the final visit. Differences in dose up-titration and rescue medication requirements were statistically nonsignificant. So also were the adverse event counts. Compliance was satisfactory in both groups. CONCLUSIONS: Efficacy and tolerability of oxaceprol were comparable to tramadol, and the drug can be considered as an alternative to low-potency opioids in the management of knee osteoarthritis.

There is no prospective study of mild cognitive impairment (MCI) in India. This study aims to determine the prevalence rate of dementia and to prospectively analyze a group of patients with MCI. A door-to-door cross-sectional cluster survey was conducted in Kolkata, India, among those aged >50 years to estimate the prevalence rate of dementia. Then annual assessment of cognitive function using a validated questionnaire battery was undertaken among 21 elderly individuals with memory complaints for 4 consecutive years. A total of 53,907 persons were surveyed. The crude prevalence rates of dementia were 0.62% (95% CI 0.44–0.84) and 1.25% (95% CI 0.87–1.74) among those >50 and >60 years of age, respectively. The weighted prevalence rate among those above 50 years was 0.95% (95% CI 0.68–1.29). Alzheimer’s disease was the commonest subtype (55%) followed by vascular dementia (36%). In a prospective study, MCI remained static, converted to dementia or reverted to normalcy. There was also transition from one subtype of MCI to another. A similar outcome of MCI is also noted in Western nations. However, the prevalence rate of dementia in Eastern India remained quite low.

Increase in aging population is expected to lead to increasing prevalence of dementia in India. In this study, we aimed to determine prevalence, incidence, and mortality of dementia and its subtypes and assess dementia burden in terms of disability-adjusted life years (DALY).A community study was conducted over 5 years (2003-2008) in Kolkata, India, on 100,802 (males 53,209) randomly selected subjects to assess prevalence and capture data on incident cases and deaths. Standard case definitions were used. The data were used to estimate years of life lost (YLL) due to premature mortality, years of life lived with disability (YLD), and DALY, based on Global Burden of Disease 2010 approach.During 2003-2004, there were 103 (men 55) cases of dementia. The prevalence was 1.53% (age adjusted 1.12%) at age ≥65 years. In those ≥55 years age, average annual incidence rate of dementia was 72.57 per 100,000. All-cause standardized mortality ratio in dementia cases was 4.74 (men 6.19, women 3.03). The burden of dementia in 2007-2008 revealed that overall YLL was 47.13 per 100,000 and YLD ranged from 1.87 to 16.95 per 100,000 depending on the clinical severity of dementia. The overall DALY lost per 100,000 due to dementia for the year 2007-2008 was 74.19.This community study revealed a low prevalence and incidence of dementia with consequent low DALY-derived burden of illness compared with many industrialized nations. YLL formed major component of DALY indicating premature mortality to be an outcome of dementia burden. Copyright © 2016 John WileySons, Ltd.

Background Disability-adjusted life year (DALY) is a time-based measure of disease burden incorporating both disability and mortality. Our study aimed to determine the DALY lost from epilepsy in an Indian metropolis. Methods A population-based prospective study on epilepsy was conducted over 5 years (2003–8) in Kolkata, India, on randomly selected 100,802 subjects (males 53,209, females 47,593) to assess prevalence as well as to capture incident cases of epilepsy and those incident cases that died. Standard case definitions were used. The data were used to estimate years of life lost (YLL) due to premature mortality, years of life lived with disability (YLD), and DALY, utilizing the prevalence-based Global Burden of Disease (GBD) 2010 approach. Age- and gender-specific figures were computed. Results During 2003–2004, a total of 476 subjects with active epilepsy were detected and the age-adjusted prevalence rate was 4.71 per 1000. Over 5 years, there were 197 incident cases of epilepsy of whom 26 died. The age-adjusted annual incidence rate of epilepsy was 38.3 per 100,000. The all-cause standardized mortality rate (SMR) of epilepsy was 2.4. The burden of epilepsy in the year 2007–8 revealed the overall YLL was 755 per 100,000, and the overall YLD ranged from 14.45 to 31.0 per 100,000 persons depending on the clinical severity of the epilepsy. Both YLL and YLD values were higher in males than in females. The overall DALY lost due to epilepsy in 2007–8 was found to be 846.96 (males 1183.04, females 463.81) per 100,000. Conclusions This is the first study in India to determine the DALY of epilepsy using GBD 2010. The results reveal a substantial burden of epilepsy in our setting. Similar such studies are needed in other parts of India in both urban and rural settings.

Post-kala-azar dermal leishmaniasis (PKDL) is a chronic dermatosis that generally occurs after apparent cure of visceral leishmaniasis caused by Leishmania donovani. In view of the prolonged treatment regimens necessary for PKDL, noncompliance is a major limitation; an optimal regimen is yet to be defined, but 12 weeks of therapy with miltefosine is generally recommended. We performed a single-arm open-label trial of miltefosine administered daily for 16 weeks in 27 patients in Kolkata with PKDL. After 4 weeks of treatment, nine patients were lost to follow-up because of unacceptable side effects, including severe abdominal pain, nausea, and vomiting. Of the 18 remaining patients, seven completed 12 weeks of therapy and 11 completed 16 weeks of therapy. Three of the seven who received 12 weeks of therapy and none of the 11 who received 16 weeks of therapy experienced disease relapse. Our results suggest that a 16-week course of miltefosine is required for reliable cure of PKDL. Further, the study highlighted the urgent need for a multicentric randomized controlled trial of 12 versus 16 weeks of treatment with miltefosine for PKDL so as to achieve the goal of elimination of leishmaniasis in south Asia.

Background: Headache is common in communities; however, epidemiological research regarding its prevalence is infrequent in India. Aim: We planned to study the prevalence of migraine, its disease burden, and the associated risk factors. Setting and Design: This is an urban community study conducted in Kolkata with a cross-sectional and nested case-control design. Materials and Methods: The criteria to study headache among a representative sample (aged 20–50 years) was based on the International Classification of Headache Disorders-II. Sex- and age-matched controls without headache were evaluated for putative risk factors. The disease burden was measured as disability adjusted life years (DALY). Results: Screening of 2421 individuals revealed that the 1-year prevalence of migraine was 14.12%. Education, environmental exposure, travel, and oral contraceptives determine approximately 75% of the underlying risks. DALY showed maximum burden among women in the age range of between 30 and 34 years. Conclusion: The community-based prevalence of migraine in India is similar to that observed in other countries except Africa. The burden was maximum among women. The risk factors responsible for migraine should be addressed and institution of public health measures are warranted.

Approaches to monitoring of sepsis have traditionally relied upon the pro-inflammatory component of the sepsis response. This study evaluated the diagnostic and prognostic potential of the ratio of neutrophilic CD64 (nCD64) and monocytic HLA-DR (mHLA-DR) median fluorescence index in monitoring of neonatal sepsis.Blood from 100 neonates suspected of sepsis and 29 healthy controls was collected on clinical suspicion of sepsis, and the expression of nCD64, mHLA-DR was evaluated by Flow Cytometry; thereby, a derived parameter "Sepsis index," SI = nCD64/mHLA-DR × 100 was estimated.At day 1, sensitivity and specificity to detect sepsis using nCD64 was 73.01% and 89.18%, respectively, while for SI it was 73.01% and 72.22%, respectively. On Kaplan-Meier analysis, neonates with SI cut-off showed a higher 30 day-mortality than those with low SI (P = 0.096). On multivariate analysis, the factor associated with mortality in our cohort was Apgar score ≤3, while SI showed a trend toward significance.At day1, nCD64 is useful for the diagnosis of neonatal sepsis whereas mHLA-DR is beneficial for monitoring patients at a later time point. The SI is a marker of moderate diagnostic sensitivity and supplements the current arsenal of laboratory investigations to detect neonatal sepsis. As a marker of prognosis, a high SI shows a trend towards greater mortality. © 2015 Clinical Cytometry Society.

Stroke survivors (SS) are rising with higher incidence of stroke in developing countries. In addition to physical impairment, other factors such as cognition, social interaction, and depression determine the functional outcome after stroke. Considering the paucity of data from developing countries, we planned to determine the change in various functional parameters among SS. This community-based prospective study was carried out in Kolkata, India among 283 SS between 2006 and 2010. Functional outcome was assessed at baseline and at 3 annual follow-up visits using validated tools. A stepwise regression analysis was performed with demographic and stroke-related covariates against various measures of functional outcome. Result showed that mean Barthel Index score at baseline was 76.4 ± 30.8. Bengali version of mental status examination and Geriatric Depression Scale scores trended down over time with a negative regression coefficient of −.2061 (standard error [SE], .0937) and −.4488 (SE, .2145). Other outcomes did not change. Female gender, depression, and cognitive dysfunction had an unfavorable impact, whereas education correlated positively. In conclusions female gender and neuropsychiatric disturbances showed poor functional outcome compared with education, which correlates with better outcome. This information will be helpful for patients in developing countries for planning stroke rehabilitation.

To evaluate lung function in juvenile idiopathic arthritis (JIA) patients. This was a case control study carried out at Institute of Post-Graduate Medical Education & Research, Kolkata, involving JIA patients between 5 and 12 y. They were diagnosed and classified on the basis of International League of Associations for Rheumatology (ILAR) criteria and compared with same number of age, sex, height and weight matched controls. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, forced expiratory flow between 25 and 75 % of vital capacity (FEF25–75%) and peak expiratory flow rate (PEFR) of cases were compared to those of matched controls. Among 36 JIA patients initially recruited, 9 were excluded. Of the remaining 27 patients, male: female ratio was 17:10. Mean age, height and weight of JIA patients were 9.15 y, 124.67 cm and 23.78 kg respectively. Six patients had oligoarthritis, 3 had rheumatoid factor positive (RF+) polyarthritis, 10 had rheumatoid factor negative (RF-) polyarthritis and 8 had systemic JIA. Eleven patients had active disease and 15 patients required methotrexate. None had respiratory symptoms. Mean duration of the disease was 2.96 y. Mean FVC and FEV1 were significantly less in JIA patients compared to controls (p value = 0.0003 and 0.0007, respectively). FEV1/FVC in both the groups was similar (p value = 0.96). Mean Z scores for FVC and FEV1 were significantly higher in JIA patients (p value = 0.0064 and 0.0030, respectively). Spirometry in JIA patients demonstrated statistically significant restrictive pattern of alteration in pulmonary function.

To assess clinico-anthropometric profile of hospitalized children and their apparently healthy siblings from the Darjeeling tea garden.This was a descriptive, cross-sectional study, done at North Bengal Medical College, West Bengal, India over a period of 6 mo. Consecutively admitted 157 children and their 301 apparently healthy siblings were included. Clinical diagnosis, height/length, weight, BMI were recorded.Children (n = 157) were mostly admitted for gastroenteritis (36.3 %), respiratory infections (26.75 %), meningo-encephalitis (14.0 %). Among 301 siblings, 30.56 % had nutritional anemia, worm infestation, giardiasis etc. Severe (-3 Z-score) stunting and wasting were noted in 10 (6.37 %) and 19 (12.1 %) hospitalized children respectively. A quarter of all siblings suffered from moderate malnutrition (stunting 24.92 %, wasting 29.57 %). Distribution of malnutrition in each anthropometric parameter was statistically significant (p 0.05) in sick children compared to non-admitted siblings. Intergroup comparisons for both sexes were statistically significant for all parameters except in length/height for age for females. Moderate malnutrition (-2 Z-score) was related to low BMI in 45 % (n = 71) of sick and 27 % (n = 83) of apparently well children.The present study, first of its kind, delineated specific pattern of illness in sick and apparently healthy tea garden children. Malnutrition is statistically significant co-morbid associate in both the groups. Public health policy targeting these children is needed.

Chronic urticaria (CU) is characterized by frequent appearance of wheals for ≥ 6 weeks. This study was undertaken to compare effectiveness and safety of olopatadine, a newer antihistamine with additional anti-inflammatory properties, in treating CU in comparison to the established second-generation antihistamine levocetirizine.A single center, assessor-blind, randomized (1:1), active-controlled, parallel group, Phase IV trial (CTRI/2011/08/001965) was conducted with 120 adult CU patients of either sex. Subjects received either olopatadine (5 mg b.i.d.) or levocetirizine (5 mg/day) for 9 weeks, continuously for first 4 weeks and then on demand basis for last 5 weeks. Primary outcome measures were urticaria activity score (UAS) and urticaria total severity score (TSS). Routine hematological and biochemical tests and treatment-emergent adverse events were monitored for safety.Data from 54 subjects on olopatadine and 51 on levocetirizine were analyzed for effectiveness. UAS and TSS values declined significantly with both drugs over the treatment period but the reduction was greater with olopatadine. Adverse event profiles were comparable with sedation being the commonest complaint.Olopatadine is a safe and more effective alternative to levocetirizine in the treatment of CU.

Objective: Epidermal dermatophyte infections most commonly manifest as tinea corporis or tinea cruris. Topical azole antifungals are commonly used in their treatment but literature suggests that most require twice-daily application and provide lower cure rates than the allylamine antifungal terbinafine. We conducted a head-to-head comparison of the effectiveness of the once-daily topical azole, sertaconazole, with terbinafine in these infections. Materials and Methods: We conducted a randomized, observer-blind, parallel group study (Clinical Trial Registry India [CTRI]/2014/09/005029) with adult patients of either sex presenting with localized lesions. The clinical diagnosis was confirmed by potassium hydroxide smear microscopy of skin scrapings. After baseline assessment of erythema, scaling, and pruritus, patients applied either of the two study drugs once daily for 2 weeks. If clinical cure was not seen at 2 weeks, but improvement was noted, application was continued for further 2 weeks. Patients deemed to be clinical failure at 2 weeks were switched to oral antifungals. Results: Overall 88 patients on sertaconazole and 91 on terbinafine were analyzed. At 2 weeks, the clinical cure rates were comparable at 77.27% (95% confidence interval [CI]: 68.52%–86.03%) for sertaconazole and 73.63% (95% CI 64.57%–82.68%) for terbinafine (P = 0.606). Fourteen patients in either group improved and on further treatment showed complete healing by another 2 weeks. The final cure rate at 4 weeks was also comparable at 93.18% (95% CI 88.75%–97.62%) and 89.01% (95% CI 82.59%–95.44%), respectively (P = 0.914). At 2 weeks, 6 (6.82%) sertaconazole and 10 (10.99%) terbinafine recipients were considered as “clinical failure.” Tolerability of both preparations was excellent. Conclusion: Despite the limitations of an observer-blind study without microbiological support, the results suggest that once-daily topical sertaconazole is as effective as terbinafine in localized tinea infections.

Chronic venous ulcer can often be associated with asymptomatic peripheral arterial disease (PAD), which usually remains undiagnosed adding significantly to the morbidity of these patients. The Ankle‐Brachial Pressure Index (ABPI) is suggested for PAD evaluation. Many PAD studies were conducted in western countries, but there is a scarcity of data on the prevalence of PAD in clinical venous ulcer patient in developing countries. We conducted a study in a tertiary care hospital of eastern part of India to find out the prevalence of PAD in venous ulcer patients, and also to find the sensitivity of ABPI as a diagnostic tool in these patients. We evaluated clinically diagnosed patients with venous ulcer using ABPI and Colour Doppler study for the presence of PAD. Possible associations such as age, sex, body mass index (BMI), smoking, hypertension and atherosclerosis were studied. All results were analysed using the software Statistica version 6. PAD was present in 23 (27·71%) patients. Older age, longer duration, smoking, high BMI and hypertension were found to be significantly associated with PAD. A very strong level of agreement was found between venous Doppler and ABPI. Assessment for the presence of PAD is important in all clinically diagnosed venous ulcer patients. ABPI being a simple, non‐invasive outpatient department (OPD)‐based procedure, can be routinely used in cases of venous ulcer to find out the hidden cases of PAD even in developing countries.

Objectives: Incidence of postoperative nausea and vomiting (PONV), without active intervention, following laparoscopic cholecystectomy is unacceptably high. We evaluated the effectiveness of intravenous (IV) palonosetron in counteracting PONV during the first 24hrs following laparoscopic cholecystectomy, using ondansetron as the comparator drug. Materials and Methods: In a randomized, controlled, single blind, parallel group trial, single pre-induction IV doses of palonosetron (75mcg) or ondansetron (4mg) were administered to adult patients of either sex undergoing elective laparoscopic cholecystectomy. There were 49 subjects per group. The pre-anesthetic regimen, anesthesia procedure and laparoscopic technique were uniform. The primary effectiveness measure was total number of PONV episodes in the 24 hrs period following end of surgery. The frequencies of individual nausea, retching and vomiting episodes, visual analog scale (VAS) score for nausea at 2, 6 and 24hrs, use of rescue antiemetic (metoclopramide), number of complete responders (no PONV or use of rescue in 24 hrs) and adverse events were secondary measures. Results: There was no statistically significant difference between the groups in primary outcome. Similarly, the frequencies of nausea, retching and vomiting episodes, when considered individually, did not show significant difference. Nausea score was comparable at all time points. With palonosetron, 14 subjects (28.6%) required rescue medication while 13 (26.5%) did so with ondansetron. The number of complete responders was 14 (28.6%) and 16 (32.7%), respectively. Adverse events were few and mild. QT c prolongation was not encountered. Conclusion: Palonosetron is comparable to ondansetron for PONV prophylaxis in elective laparoscopic cholecystectomy when administered as single pre-induction dose.

Objectives: To assess the efficacy and safety of NSF-3, a polyherbal sedative-hypnotic (containing standardized extracts of Valeriana officinalis, Passiflora incarnate and Humulus lupulus), in comparison to zolpidem in primary insomnia. Materials and Methods: The present study was designed as a parallel group, double- blind, randomized, controlled trial and registered with Clinical Trials Registry-India (CTRI/2011/12/002197). Patients diagnosed with primary insomnia with a perceived total sleep time of 7 were included. They were treated with either NSF-3 (one tablet) or zolpidem (one 10 mg tablet) at bedtime for two weeks. Total sleep time, sleep latency and number of awakenings per night were assessed using a sleep diary. Quality of life and daytime sleepiness were evaluated by insomnia severity index and Epworth sleepiness score respectively. Vital signs, routine blood counts, liver and renal function tests, and treatment emergent adverse events were recorded for safety assessment. Results: A total of 91 subjects were recruited, of which 39 in each group completed the study. There was significant improvement in total sleep time, sleep latency, number of nightly awakenings and insomnia severity index scores in both groups. However, no statistically significant difference was observed between the groups. Epworth sleepiness scores did not change significantly over the study period. Although 12 treatment emergent adverse events were reported with NSF-3 and 16 with zolpidem (commonest was drowsiness in both), most were mild and no serious adverse events were encountered. Conclusions: NSF-3 is a safe and effective short-term alternative to zolpidem for primary insomnia. It remains to be explored whether the benefits are sustained and whether there is dependence liability with this formulation upon long term use.

The frequency of cognitive dysfunction among community stroke survivors (SS) is not known in India. This prospective study investigated the prevalence of poststroke mild cognitive impairment (psMCI) and poststroke dementia (psDem), the annual progression rate to dementia, and pertinent risk factors in a sample population of SS in Kolkata, India between September 2006 and July 2010. From a community-based stroke registry, 281 SS were assessed at baseline year after excluding attrition due to various causes. Validated cognitive tools were applied by trained field workers under supervision of a neuropsychologist. The assessment was repeated annually for consecutive three years. The mean follow-up period was 1.89 years (range, 1-3 years). The period prevalence rate of psDem was 13.88% (95% confidence interval [CI], 9.91%-18.90%) at baseline, and the average annual progression rate to dementia was 3.53% (95% CI, 2.09%-5.58%). Compared with subjects without dementia, those with psDem were significantly older at first-ever stroke and more likely to have cortical atrophy. The period prevalence rate of psMCI was 6.05% (95% CI, 1.45%-13.64%) at baseline, and 10.6% (95% CI, 4.57%-20.88%) of these subjects converted to psDem annually. Survival analysis of psDem patients showed a greater risk of death in psDem SS as compared to nondemented SS (hazard ratio, 2.65; 95% CI, 1.72-6.15). Our data suggest that the overall prevalence of psDem is higher than that of psMCI, possibly related to nonexclusion of prestroke dementia, but that the average annual progression rate of SS to psDem and that of psMCI to psDem are comparable. Older age at first-ever stroke and cortical atrophy are associated with increased risk for dementia among SS.

To evaluate the effectiveness and safety of zinc supplementation as adjuvant in treatment of pneumonia.Ninety-eight children with acute bacterial pneumonia, aged between 2 months to 5 years, were studied in a randomized controlled single blind design. They received either zinc supplementation, as zinc acetate syrup, or placebo, as vitamin B-complex syrup, for 14 days, concomitantly with antimicrobial treatment (49 per group). Chest radiograph and blood tests were done for confirmation of diagnosis and severity of pneumonia was assessed by breathing rate, chest in-drawing and body temperature. Potentially immunosuppressed children or those with serious comorbidity were excluded. Follow-up was done daily while subjects were admitted (generally 7 days) and the final assessment made on the 14th day on out-patient basis.Children enrolled in zinc and placebo groups were of comparable age [17 ± 10 and 10 ± 30 months (median ± interquartile range) respectively] and sex distribution [34 (69.4%) vs 31 (63.3%) males respectively]. Duration of illness at diagnosis was also comparable. Patients supplemented with zinc showed no difference in clinical cure rate at 14 days when compared with placebo. Fast breathing was present after 1 wk of treatment in 49% subjects in zinc supplemented vs 43% on placebo (p = 0.685). There was also no difference in breathing rate at study end. Regarding fever, the mean temperature was99°F in both groups at study end. Hemoglobin, total leukocyte count, standard liver function tests and creatinine showed no difference between groups either at baseline or at study end. There were no treatment emergent adverse events attributable to zinc.Though well tolerated; the addition of zinc does not improve symptom duration or cure rate in acute bacterial pneumonia in under-five children.

Background and Purpose— Stroke causes significant caregiver (CG) stress, which is under-reported in India. This study assesses the financial, physical, psychological, and family burden on CG of stroke patients in an urban community. Methods— Cross-sectional survey of stroke patients and CG were selected from a community-based registry using validated scales through face-to-face interviews. Results— Data were available from 199 stroke survivors and a similar number of CG. Increased workload, related anxiety and depression, and sleep disturbance were reported by 70%, 76%, and 43% of CG, respectively, whereas >80% reported financial worry, which was greater among slum dwellers and less educated families. CG of patients with dementia and depression experienced greater stress. Female CG received more appreciation and family bonding was well-maintained. Conclusions— Financial stress was prominent and common among the socioeconomically weaker section. Psychological stress is similar to that of other studies. Women CG received greater appreciation. Family bonding was well-preserved in contrast to that of a western report.

This study aimed to determine the prevalence, incidence, and mortality rates of epilepsy in the city of Kolkata, India. This is the first such longitudinal study in a heterogeneous urban Indian population.A two-stage door-to-door survey of a stratified random sample was undertaken within the municipal limits of Kolkata. Trained field workers detected and interviewed the cases using a simple screening questionnaire, and the detailed follow-up was done by neurologists. The survey was conducted annually for five consecutive years from March 2003 through February 2008.A total of 52,377 (52.74% men) individuals were screened. There were 309 prevalent and 66 incident cases of active epilepsy. The prevalence and average annual incidence rate (AAIR) with 95% confidence interval (CI), age-standardized to World Standard Population, were 572.8 (509.79-641.54) per 100,000 and 27.27 (21.03-34.80) per 100,000 per year, respectively. The age-specific incidence rates of epilepsy showed bimodal distribution. During the 5-year period, 20 cases of active epilepsy died. The average annual mortality rate (AAMR) was 7.63 (95% CI 4.45-11.26) per 100,000 population per year. Compared to the general population of Kolkata, the all-cause standardized mortality ratio (SMR) for persons with epilepsy was 2.58 overall (men 3.67; women 1.77). There was no significant difference between slum and nonslum dwellers in epidemiologic parameters.The AAIR of epilepsy is comparable to that observed in developed countries, but AAMR is higher. The all-cause SMR for epilepsy relative to the general population is, however, similar to that of developed nations.

This work concerns the investigation of executive functions in patients with focal brain lesion. In order to identify the underlying substrates for executive functions, 54 patients with focal cortical (n=30), subcortical (n=13) and cerebellar damage (n=10) (M=9; F=1) in the age range of 24-65 years with a minimum of Class V education have been investigated. The patients were admitted to the Department of Neuromedicine of Bangur Institute of Neurology, Calcutta. Each patient with focal lesion was matched with a healthy normal subject controlling for age and education. The socio-economic background was also taken into consideration. Controls were selected from the families of other patients admitted to the institution and also from individuals who volunteered to act as controls. Here too, rigid criteria have been followed to select the normals. Mini Mental State Examination (MMSE) and General Health Questionnaire (GHQ) were administered to screen out the neurological and psychiatric abnormalities in selection of normal control and Wisconsin Card Sorting Test (WCST) was administered to find out the executive function, in terms of set-shifting ability. Since standard anatomical groupings can obscure more specific brain-behavior relations, group-comparison design does not always allow determination of the effective lesion responsible for a particular deficit (Godefroy et al., 1998). The Classification and Regression Tree (CART) analysis has been used to determine the brain-behavior relationships. The result reveals that the frontal lobes are essential determinants of set-shifting capacity. However, for optimal execution of set-shifting function, the frontal lobes require participation of other cortical, subcortical and cerebellar regions. The result has been discussed in the light of the existing theories and research reports.

To ascertain the prevalence of active epilepsy, febrile seizures (FS), cerebral palsy (CP) and tic disorders (TD) in aged 19 years or less. This was a cross-sectional observational study conducted as a two-stage door-to-door survey of a stratified randomly selected population in 2003-04. Trained field workers screened the population followed by case examination by the field neurologist. A total of 16979 (male 8898, female 8081) subjects aged ≤ 19 years were surveyed. The prevalence rates per 100,000 population of active epilepsy, FS, CP and TD with 95% confidence intervals are 700.87 (580.60–838.68), 1113.14 (960.07–1283.59), 282.70 (CI 208.43–374.82) and 35.34 (12.96–76.92) respectively. Active epilepsy prevalence shows a rising trend and that of other disorders a declining trend with age. Of the epileptics who had brain CT scans, 23.4% showed single or multiple lesions suggestive of neurocysticercosis. Regarding treatment, 23.5% of the epileptics never received any antiepileptic drugs. Among those with history of FS, 9.5% developed epilepsy later on. The prevalence of FS among slum dwellers is lower than in the non-slum population. Among CP cases, 39.6% gave history of birth anoxia, 16.7% kernicterus and 31.3% epilepsy. Prevalence of CP is significantly associated with lower education status. The prevalence of CP and TD is lower than reported from western countries. CP prevalence is also comparatively lower than in many community studies from India. Compared to western nations, higher proportion of FS cases develops epilepsy. A third of the CP cases have seizures which is higher than in many Indian studies. Birth anoxia is a common cause of CP and educational underachievement is frequent.