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To assess the prevalence of myopia and its risk factors in rural school children. Children in classes 4–7 of eight randomly selected schools (five government and three private) in rural Haryana, with unaided vision

Introduction Bacillus Calmette-Guerin (BCG) vaccination is given as a part of the national immunization schedule in India and its most common complication is BCG lymphadenitis. The reported incidence of BCG lymphadenitis ranges from 0.1 to 9.9% in various studies. In our country, though most babies get BCG vaccination during the neonatal period, the incidence of BCG lymphadenitis is not studied well. Aims To study the incidence of lymphadenitis following BCG vaccination at tertiary care hospital in North India. Methods It was a prospective longitudinal observational study. All newborns weighing ≥1.5 kg at birth without any significant illness who received BCG vaccination at our institute were enrolled and followed up for 16 weeks after vaccination. Babies were examined at 6, 10 and 14 weeks for the development of lymphadenopathy. Meta-analysis of studies evaluating incidence of BCG adenitis in children was also performed. Results Out of 817 babies vaccinated during the enrolment period, 605 babies could be followed up till 16.2 ± 0.9 weeks post BCG vaccination. One case of BCG lymphadenitis was detected at 14 weeks. Thus, the observed incidence of BCG lymphadenitis was 0.16% (95% CI of 0.004%–0.92%). Meta-analysis of 21 studies showed mean incidence estimate of 0.336% (95% CI: 0.315%–0.358%) using fixed effect model whereas random effect model showed mean incidence of 4.45% (95% CI: 3.02%–6.15%). Conclusion The lower incidence of lymphadenitis in our study can probably be attributed to a less immunogenic vaccine (Danish 1331), proper technique, experience of the vaccinator and good storage facilities available at our institute.

Background The burden of gestational diabetes mellitus (GDM) appears to be increasing in India and may be related to the double burden of malnutrition. The population-based incidence and risk factors of GDM, particularly in lower socio-economic populations, are not known. We conducted analyses on data from a population-based cohort of pregnant women in South Delhi, India, to determine the incidence of GDM, its risk factors and association with adverse pregnancy outcomes (stillbirth, preterm birth, large for gestational age babies) and need for caesarean section. Methods We analyzed data from the intervention group of the Women and Infants Integrated Interventions for Growth Study (WINGS), an individually randomized factorial design trial. An oral glucose tolerance test (OGTT) was performed at the time of confirmation of pregnancy, and for those who had a normal test (≤140 mg), it was repeated at 24–28 and at 34–36 weeks. Logistic regression was performed to ascertain risk factors associated with GDM. Risk ratios (RR) were calculated to find association between GDM and adverse pregnancy outcomes and need for caesarean section. Results 19.2% (95% CI: 17.6 to 20.9) pregnant women who had at least one OGTT were diagnosed to have GDM. Women who had prediabetes at the time of confirmation of pregnancy had a significantly higher risk of developing GDM (RR 2.08, 95%CI 1.45 to 2.97). Other risk factors independently associated with GDM were woman’s age (adjusted OR (AOR) 1.10, 95% CI 1.06 to 1.15) and BMI (AOR 1.04, 95% CI 1.01 to 1.07). Higher maternal height was found to be protective factor for GDM (AOR 0.98, 95% CI 0.96 to 1.00). Women with GDM, received appropriate treatment did not have an increase in adverse outcomes and no increased need for caesarean section Conclusions A substantial proportion of pregnant women from a low to mid socio-economic population in Delhi had GDM, with older age, higher BMI and pre-diabetes as important risk factors. These findings highlight the need for interventions for prevention and provision of appropriate management of GDM in antenatal programmes. Clinical trial registration Clinical Trial Registry – India, #CTRI/2017/06/008908 (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339&EncHid=&userName=society%20for%20applied%20studies).

PURPOSE The incidence of symptomatic brain metastasis at diagnosis in non–small-cell lung cancer (NSCLC) is 5%-10%, and up to 40% develop during the disease course. There is a paucity of data supporting the role of brain imaging at diagnosis in asymptomatic cases particularly from resource-constraint settings. Here, we present our experience of mandatory baseline brain imaging with contrast-enhanced computed tomography (CECT) scans of all patients with NSCLC. MATERIALS AND METHODS This was a prospective observation study of patients with NSCLC with mandatory baseline brain CECT and a CNS examination. All histology proven patients with NSCLC diagnosed between January 2018 and October 2019 were included irrespective of stage. RESULTS A total of 496 patients were enrolled. The median age was 57 years (range, 23-84) with majority being males (75%) and smokers (66%). The prevalence of epidermal growth factor receptor mutations and anaplastic lymphoma kinase fusions was 33.4% and 12%, respectively. Brain imaging leads to upstaging in 7% cases. The prevalence of brain metastases was 21% (n = 104), with half being asymptomatic (51%). Factors associated with higher proportion of brain metastasis were young age (≤ 40 years), adenocarcinoma histology, poor Eastern Cooperative Oncology Group performance status (3 and 4), and high neutrophil-lymphocyte ratio (NLR) (> 2.5). After a median follow-up of 10.8 months (95% CI, 7.33 to 12.73), the median overall survival was 7.46 versus 12.76 months (hazard ratio 0.67; 95% CI, 0.46 to 0.96; P = .03) in patients with and without brain metastases, respectively. On multivariate analyses, high NLR and molecular graded prognostic assessment affected the overall survival significantly. CONCLUSION In our study, 21% of patients had brain metastasis at diagnosis detected with a mandatory baseline brain imaging with CECT. NLR and molecular graded prognostic assessment are significant predictors of survival in patients with brain metastasis.

PURPOSE The outcomes of patients with myeloma from developing countries are often lacking because of poor record maintenance. Publications from such settings are also limited because of the retrospective nature of the data collection. Information technology can bridge these gaps in developing countries with real-time data maintenance. We present the real-time survival data of the patients with myeloma from a tertiary care center in North India using one such indigenously built software. PATIENTS AND METHODS These are real-time data of all patients with myeloma presenting to a tertiary care center from North India. The patient characteristics (demographics, baseline disease characteristics, risk stratification, and outcomes) were recorded contemporaneously. The survival of the study population was analyzed and grouped based on various disease characteristics at diagnosis. RESULTS The median age of the study population (N = 696) was 65.9 (34.9-94.9) years with male predominance (65%). The median follow-up was 3.7 years (0-18.6 years) with the median overall survival (OS) not achieved. The OS of the study population at 1, 3, and 5 years was 94% (n = 558), 87.5% (n = 394), and 83.1% (n = 267), respectively. Most of the patients presented in advanced stages based on International Staging System (III:70%). On Kaplan-Meier analysis, the presence of weight loss ( P = .01), renal dysfunction ( P = .047), and anemia at diagnosis ( P = .004) had a significant impact on survival. On Cox proportional model univariate analysis, the presence of renal dysfunction, anemia, and weight loss had the significant hazard ratio of 1.68 (1-2.82, P = .049), 3.18 (1.39-7.29, P = .0063), and 2.81 (1.22-6.42, P = .014), respectively, whereas on multivariate analysis of hypercalcemia, renal disease, anemia, and bone disease (CRAB) features, only anemia was found to have a significant hazard ratio of 2.56 (1.01-6.47, P = .046). CONCLUSION The real-world data show OS comparable with the published western literature. Only anemia was found to have significant impact on survival. The use of such software can aid in better data-keeping in resource-constrained settings.

Homeless Persons with Mental Illness (HPMI) represent one of the most marginalized communities of the society. The psycho-social impact of the Coronavirus pandemic has been significant on the entire population but causes more suffering in the vulnerable population. During the initial phase of the pandemic in India, strict measures were taken to contain the infection that led to certain unique challenges for HPMI and in their reintegration with society. The series of cases highlight the multiple facets of problems faced and ways to counter them so as to effectively rehabilitate HPMI, with focus on the pandemic at hand. The involvement of a multidisciplinary team, utilization of technological advances and promoting effective liaison with various public sectors are suggested as the way forward.

Background: Orthorexia is a term used for “obsession for healthy and proper nutrition”. ON is a recently identified disorder and prevalence studies are mainly limited to Eurasian and Scandanavian countries. There is a paucity of literature currently available for Asian population and more specifically for the Indian population. Therefore, the present study was designed to estimate the prevalence of Orthorexia Nervosa in Indian population. To estimate the prevalence of ON in young North Indian population and to highlight its characteristics. Materials and Methods: The study population consisted of 448 young students (males=173, females=275). The ORTO-15 questionnaire developed by Donini et al. was used to determine the prevalence. Subjects who scored below 40 were classified as having ON. Result : Mean score of the participants in the ORTO-15 was using a 40 point threshold. A total of three fourth of the young students in the study group exhibited orthorexic tendency. Conclusion: High prevalence of ON in young students necessitates that Orthorexia Nervosa trends in general population be assessed in Indian subcontinent for better understanding of eating disorders and its interplay with socio-cultural diversities. Keywords: Eating disorder, Orthorexia Nervosa, Young students

BACKGROUND Liver abscess has been recognised since the time of Hippocrates. Liver abscess is defined as collection of purulent material in liver parenchyma. They are usually caused by bacterial and amoebic infections, and less commonly, by other protozoal and helminthic organisms. Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. The purpose of this study was to evaluate culture sensitivity pattern (Blood & Pus) of liver abscess in children. METHODS This prospective observational study was conducted in the Department of Paediatrics, Chacha Nehru Bal Chikistalaya, Delhi from July 2016 –to August 2017. This study has got Institutional Ethics Committee approval (Regd No: IEC/MAMC/78, Dt: 26/07/2016). All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children. Their clinical characteristics, radiological features, laboratory data, clinical management, and outcomes were analysed. RESULTS In our study, out of 70 patients, 3.2 % patients showed growth in the blood culture. Organsims isolated were Methicillin resistant Staphylococcus aureus (MRSA) 1.4 % (1), Salmonella typhi 1.4 % (1), staphylococcus coagulase negative 1.4 % (1). Out of 70 patients of liver abscess enrolled in the study, 36 patients underwent aspiration of pus from the abscess. Out of 36 aspirated cases, gram positive cocci was identified in 1 (1.4 %) patient. In our study, no acid fast bacilli was identified and no fungal culture showed growth of organism. Out of 70 cases of liver abscess, 10 were found to be amoebic liver abscess. In our study, all the 70 patients were started on empirical antibiotics. Out of 70 patients, surgical intervention was done in 36 patients. In our study all the patients were started on empirical antibiotics according to hospital protocol. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Organisms recovered from liver abscesses vary greatly. Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess, but this was replaced by IV broad-spectrum antibiotics and imaging-guided percutaneous drainage. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Culture-Sensitivity, Children

Tropical pyomyositis is characterized by deep suppurative skeletal muscle infection most commonly by Staphylococcal Aureus (S. aureus) with increasing incidence of infection by community acquired methicillin resistant S. aureus(CA-MRSA). The initial clinical presentation is generally non-specific and requires a high index of suspicion. We report the clinical course of a child from subtropical area of North India who developed multiple deep pyogenous collections, complicated with CA-MRSA septicaemia and followed by unusual complications consistent with Guillain-Barré Syndrome.

BACKGROUND Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. Diagnosis of liver abscess can be challenging and is often delayed; a high index of suspicion is necessary in children with risk factors. Children have unique set of predisposing causes for liver abscesses. The purpose of this study was to assess the clinical, demographic, and etiological profile of liver abscess in children between 1 month to 12 years of age. METHODS This is a prospective observational study conducted in the Department of Pediatrics, Chacha Nehru Bal Chikistalaya (An Autonomous Institute under Govt. of NCT (National Capital Territory) of Delhi, affiliated to University of Delhi), Delhi from July 2016 to August 2017. All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children aged less than 7 years. Informed assent was taken from children aged more than 7 years, along with written and informed consent from their parents/guardians. Their clinical characteristics, radiological features and laboratory data were analysed. RESULTS Most common age group suffering from liver abscess was 5 - 10 years with male preponderance. Majority of the children belonged to lower socio-economic class and half of them were suffering from malnutrition. Most common clinical presentation of children suffering from liver abscess was fever with pain abdomen and tender hepatomegaly. Majority of the children had leucocytosis, high level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Deranged liver function test with coagulopathy was noted in more than half of the children suffering from liver abscess. Commonest bacterial pathogen was methicillin resistant Staphylococcus aureus followed by Salmonella typhi, Stenotrophomonas maltophilia, coagulase negative Staphylococcus aureus and Staphylococcus hominis. Entamoeba histolytica is a common parasitic agent causing liver abscess in children. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Most cases involve a single lesion on right lobe of the liver. Methicillin resistant Staphylococcus aureus followed by Salmonella typhi are the two most common pathogens. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Children

INTRODUCTION: Malnutrition, among children can lead to various morbidities, and some of its consequences can be fatal. AIM: To assess Hygiene with Nutrition & Morbidity among school children in district Ambala, Haryana, India. MATERIALS AND METHOD: Data was collected through a health check-up program for primary school children studying in class I and class III (aged only between 6-9 years) using a pre-tested and pre-designed questionnaire, weighing scale, measuring tape and dental screening instruments. The investigators were duly standardized and concerned instruments were duly calibrated. No names and personal information was collected and before the student was sent for examination, his I-card was removed. Data cleaned and analyzed using SPSS version 22.0. Shapiro wilk-test for data normalcy revealed a parametric distribution of the data and hence, the student’s t-test and multiple logistic regression were applied. RESULTS: The study included 216 males and 106 females, and the maximum unfavourable score (unclean hands, feet and skin) was observed in 40.1% of the children. Difference between favourable and unfavourable scores with OHI-S ≤2 was found to be 65.3% (p=0.02) and maximum students (68.9%), reported having a good favourable OHI-S score (p=0.01). It was observed that maximum males (43.1%) and females (48.1%) belonged to the “Normal” category of BMI, while lesser females (6.7%) were overweight in comparison to their male counterparts. Multivariate logistic regression revealed that OHI-S scores were significantly associated with BMI status (p=0.05) of the children, indicating that children with higher BMI scores have a tendency to have “fair” and “poor” OHI-S scores. CONCLUSION: Based on the results, appropriate measures can be undertaken to ensure that schools as well as healthcare professionals undertake more stringent measures to educate parents, children as well as teachers regarding the relationship between poor oral health and increased BMI values.

BACKGROUND Chronic kidney disease (CKD) encloses a continuum of pathophysiological processes associated with deranged kidney function and a progressive decrease in glomerular filtration rate (GFR). There are many anatomic similitudes between cochlea and kidney at an ultra-structural level and antigenic level along with comparable physiological mechanisms, specifically, the active fluid and electrolytes transport in the cochlea and the kidney. The purpose of the present study was to determine the proportion, type and degree of hearing loss in patients with renal disease and its comparison according to the stage of CKD. METHODS The study was conducted on 60 patients of chronic kidney disease labelled as stage 3, 4 and 5 on the basis of GFR. An audiogram charted by pure tone audiometry was used to find the degree of hearing loss and its comparison in patients with moderate, severe and end stage CKD was done. The data was collected and analysed statistically. RESULTS The mean age of patients was 55.58 +/- 11.36 years and the mean duration of CKD was 15.61 months. 90 % patients of CKD had sensorineural hearing loss while 10 % had hearing sensitivity within normal limits. In the present study, mild degree hearing loss and high frequency hearing loss was found to be predominant constituting 68.3 % (n = 41) and 58.3 % (n = 35) respectively. Mild degree of hearing loss was a predominant finding irrespective of the stage and duration of CKD. CONCLUSIONS Sensorineural hearing loss was found predominantly amongst the CKD patients in our study population. Mild degree hearing loss was predominant but there was no correlation between stage of CKD and degree of hearing loss. While there was a significant correlation between degree of hearing loss with duration and haemodialysis amongst the non-diabetic CKD patients. KEYWORDS Chronic Kidney Disease, Sensorineural Hearing Loss

Background: Uveitis encompasses many conditions, all characterized by inflammation of the uvealtract either directly or indirectly. It can occur at any age but predominantly affects patients in theworking-age group. Objective: To report the clinical pattern of Uveitis in North India. Settings andDesign: A prospective study in a regional eye institute. Methods: After taking informed consent,100 patients with Uveitis aged 20–60 years were recruited from eye OPD between 2012- 2014.Detailed history, complete ophthalmic examination, standard diagnostic laboratory tests andradiographic studies wherever required were made. Statistical analysis used: Descriptive.Results: The mean age being 41.55 years. There were 57% males and 43% females with 32%acute uveitis and 68% chronic uveitis cases. Anterior Uveitis was seen in 83% of patients, followedby posterior Uveitis (7%), pan-uveitis (6%) and intermediate Uveitis (4%). A definite associationwith the systemic disease was determined in 27% of cases. The most frequently observed systemicdiseases were ankylosing spondylitis, Tuberculosis and herpes zoster ophthalmicus (6% cases each).This was followed by HIV (3%), sarcoidosis (3%), ulcerative colitis (2%) and endophthalmitis (1%).No specific aetiology or association with systemic diseases could be established in 73% of cases. Inmost cases, the systemic disease was not suspected before eye involvement and was recognizedonly after the subsequent diagnostic procedures. Conclusion: The etiological diagnosis of Uveitis isoften challenging as there are marked variations in ocular and systemic signs and symptoms. Asignificant number of cases may unfold with the evolution of advanced techniques.

Background: Bicytopenia and Pancytopenia are relatively common presentations in adults as compared to paediatric patients. Clinical features present in different manifestations in children with Pancytopenia/Bicytopenia, which can range from bone marrow suppression temporarily to marrow infiltration by life-threatening malignancies. Aim: To study the clinical and haematological profile in the paediatric age group withCytopenias. The study aims to analyze the severity of hematological findings as per causative factors in patients with Pancytopenia and Bicytopenia. Methods: Prospective Observational Study conducted in the Department of Paediatrics in Dr.RPGMC Tanda Himachal Pradesh (INDIA). The study included all patients except those falling in the exclusion criteria.It was performed after oral and written informed consent.A total of 50 children admitted with bicytopenia and pancytopenia were enrolled from March 2013 to March 2014. Results: Infection was the commonest etiology observed in 22(44%) patients with bicytopenia and pancytopenia. Bicytopenia was seen in 14 (20%) and pancytopenia in 8 (16%) cases with infection. Scrub typhus was the commonest Infection seen in 18(32%).Leukaemia was notedin 11(22%) cases. Conclusions: The commonest age group affected was 11-15 years with female domination with a Male: Female ratio of 0.78:1. The commonest symptom was fever 37(74%) then generalized weakness in 29 (58%) cases.Pallor was the most common sign in 43(86%) followed by Hepatomegaly 32(64%), Lymphadenopathy 30(60%), and Splenomeagly in 29 (58%) patients. Infection was the commonest etiology followed by leukemia and megaloblastic anaemia. Scrub typhus was the commonest infection encountered in the present study.

Introduction: Anorectal malformations (ARM) have been a source of concern for centuries. The reported incidence of ARM is 1 in every 2500 to 5000 live births but maybe even more frequent in certain 1,2 developing countries . Although ARM comprise approximately 0.2-0.3% births. They have been reported to comprise up to 3,4,6-24 1.2% of reported birth defects. Approximately 36.4% are isolated lesions and 63.6% are associated with other anomalies . ⁵ Studies demonstrated several mutations of HLXB9 associated with ARM . 33 patients with intermediate 25 Method and Material: ARM were included A thorough perineal examination, complete haemogram, urine analysis, colposcopy and . radiological studies were conducted. Patients underwent PSARP, the comparison of late complications and functional outcome at the end of 1 year follow- up in ARM patients with and without stula was done. Fischer Exact Test was done for getting Two tailed P- value. Observation and Results: Out of 33 patients 16 males were without stula and 17 males were with rectourethral stula. 33 patients underwent PSARP, 8 cases (24.24%) had early complications. Late complications in 12 cases (36.36%). No postoperative complications were recorded in 13 (39.39%) children. At end of follow-up, 31 remaining patients (including patients with supercial wound infection) had normal looking perineal body and anus with good contraction. No recurrence of stula, stenosis of anus or anterior displacement of rectum. PSARP is a useful procedure for the correction Conclusion: of ARM in children in developing countries and quality of life depends on clinical status of patient and age at the time of presentation. No signicant statistical differences in quality of life was seen in patients with stula vs patients without stula post PSARP

BACKGROUND Chronic kidney disease (CKD) includes a spectrum of different pathophysiology processes associated with abnormal kidney function, and a progressive decline in GFR. Progression of CKD is associated with having a number of complications, including thyroid dysfunction, dyslipidaemia, and cardiovascular diseases. METHODS The present study was conducted among 60 CKD patients (cases) and 60 healthy controls to compare their thyroid and lipid profile, who attended the Department of Medicine in SGRDIMSR, Sri Amritsar from January 2019 to December 2020.These 60 CKD patients were grouped as group A. Group A was further divided into various stages as per KIDGO staging according to GFR. 60 healthy individuals were taken as controls and were kept as Group B. Demographic features (age and sex) and medical history of diabetes mellitus, hypertension were noted and blood samples (5mL) were analysed for blood urea, serum creatinine, free triiodothyronine (T3), free thyroxine (T4), thyroid stimulating hormone (TSH), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low density lipoprotein (VLDL) and triglycerides. RESULTS Thyroid dysfunction was observed in patients of CKD, the most common being overt hypothyroidism (56.6 %) followed by subclinical hypothyroidism (16.6 %), low T3 (15 %), and hyperthyroidism (1.6 %). Hypercholesterolemia, low HDL, elevated LDL, VLDL and triglyceride levels were observed in 74.9 %, 85.0 %, 38.3 %, 41.6 % and 76.6 % patients, respectively. Patients with CKD with 5 had significantly higher risk of having thyroid dysfunction and dyslipidaemia as compared to patients with stage 3 and 4. CONCLUSIONS Thyroid dysfunction and dyslipidaemia were common in patients with CKD. Prevalence of hypothyroidism, dyslipidaemia increases with progression of CKD. Hence early detection of thyroid dysfunction and dyslipidaemia is imperative to improve mortality and morbidity of CKD patients. KEYWORDS Chronic Kidney Disease, Dyslipidaemia, Thyroid Dysfunction

INTRODUCTION: Anal stula represents an important aspect of colorectal practice, being a distressing condition for the patient and sometimes a challenge for the surgeon. Successful surgical management of anal stulas requires accurate preoperative assessment of the course of the primary stulous tract and the site of any secondary extension or abscess. Fistula-in-ano has various types of clinical presentations. With time newer techniques have also evolved. Here we comparing the various treating modalities by classifying them as sphincter preserving and sphincter cutting surgeries. AIMS AND OBJECTIVES : To compare the outcome, duration of wound healing, recurrence rate, and complications after sphincter preserving and sphincter cutting surgeries. MATERIAL AND METHODS: A total 100 patients were taken up for the study after ethical clearance and proper informed consent. Group A (n=50) patients were selected for sphincter preserving surgeries (VAAFT+FILAC+LIFT, VAAFT+FILAC, LIFT). Group B (n=50) patients were taken up for sphincter cutting procedures (stulectomy and stulotomy). Simple fistulas, and those associated with tuberculosis, IBD, carcinomas, or with perianal injury were excluded from the study. Rectovaginal and anovaginal stulas, patients with history of incontinence, or anal sphincter impairment were also excluded. RESULTS: 66% patients were males and 34% were females. (1.94:1). Mean age of patients was 41.01+12.35 between 20-70 years. Transphincteric stula was the most common type (61%, n=61) and perianal discharge was the most common presentation. (100%, n=100). Primary healing rate at 3 months in sphincter preserving surgeries was 84%, and 66% in cutting surgeries (p

Objectives: Intrahepatic cholestasis of pregnancy (IHCP) is the most common reversible form of hepatic disease in pregnancy. The risk of sudden intrauterine infant death is major threat as none of the fetal monitoring proved effective for its prevention. This study was conducted to know the prevalence of IHCP along with fetal and maternal outcome in North Indian population. Material and Methods: This case–control study was conducted over a period of 6 months. One hundred pregnant patients were recruited in each group. Patients with IHCP were included in case group whereas apparently healthy pregnant women with singleton pregnancy were included in control group. Bile acids were done only once at the time of initial visit whereas liver enzymes were done at initial visit and subsequently weekly for total 3 times. All cases of IHCP were started on ursodeoxycholic acid (UDCA) with a dose of 10–15 mg/kg/day throughout pregnancy and three doses of 10 mg Vitamin K by intramuscular route were also given. Fetal and maternal outcomes were compared between both the groups. Total numbers of deliveries in that time period were also noted to find out the prevalence of disease. The tests of two or more proportions were done using Fisher’s exact test and Chi-square test. P < 0.05 was considered statistically significant. Results: The prevalence of IHCP was 4.08% in our population, however, women from urban area had higher incidence of cholestasis than rural population. History of recurrent disease was found in 30% of women. Out of 100, 96% presented with itching and only 57–58% had raised liver enzymes levels. In 89% of patients (89/100), bile acids levels were >14 μmol/l. During follow-up, SGOT and SGPT levels were significantly improved over 2-week interval while on treatment with UDCA; however, levels were still on higher side. There was no correlation found between cholestasis of pregnancy with preterm labor and meconium-stained liquor in the present study. Comparable results were found in terms of respiratory distress syndrome and NICU admission, whereas significant high incidence of neonatal jaundice found in the control group. Conclusion: Itching over whole body was the predominant presenting complaints of cholestasis of pregnancy. Diagnosis should be supported by bile acids in women with normal liver enzymes to decrease the cost of investigations. Early termination of pregnancy between 36 and 37 weeks can be considered in women with bile acids >40 μmol/L and in non-compliant patients on UDCA treatment.

Gestational diabetes mellitus (GDM) increases pregnancy complications and future development of diabetes. Success of initiatives to increase GDM awareness depends upon the knowledge level of healthcare providers and antenatal women. It is a descriptive, cross-sectional study done in a teaching hospital in North India. Two pre-tested, semi-structured questionnaires assessing the basic and advanced knowledge on GDM were used. Participants included antenatal women, undergraduate trainees who filled the level 1 questionnaire, and postgraduate residents, MBBS 3rd professional students, who filled the level 2 questionnaire. The level of awareness was compared across groups using chi-square. Kruskal–Wallis H test was applied to check if the distribution of scores varied significantly across the three groups for both levels. A total of 1402 study subjects filled the level 1 questionnaire (nursing and paramedic students 680/1402, 48.5%; MBBS 1st and 2nd professional students 422/1402, 30.1%; antenatal women 300/1402, 21.4%) and 500 study subjects (postgraduate residents: obstetrics 50/500, 10%; physiology 25/500, 5%; medicine 25/500, 5%; MBBS 3rd professional students 400/500, 80%) were asked level 2 questionnaires. Antenatal women had significantly better basic knowledge than medical and paramedic trainees (p

BACKGROUND Chronic liver diseases frequently are associated with haematological abnormalities. Anaemia occurs in about 75% of patients with chronic liver disease. The most common type of anaemia seen in liver cirrhosis is normocytic normochromic anaemia, due to the chronic inflammatory state, blood loss from oesophageal and rectal varices. The purpose of this study was to study the haematological manifestations in patients with chronic liver disease. METHODS A cross-sectional observational study was conducted at Sri Guru Ram Das Institute of Medical Sciences and Research (March 2019 - March 2020). Total of 90 patients with chronic liver disease were included in the study. The population was divided into 2 groups based on the model for end-stage liver disease (MELD) score and the various haematological abnormalities were assessed in these 2 groups. Similarly, haemoglobin (Hb) levels were assessed in 3 groups based on the ChildTurcotte-Pugh (CTP) classification. RESULTS There was a significant correlation between hemoglobina and CTP class (P < 0.001), with the lowest haemoglobin levels in CTP class C group. The correlation coefficient of MELD score and haemoglobin was -0.504 which was significant statistically. Thus, confirming the fact that haemoglobin levels decreases with the progress in the severity of liver cirrhosis. Of 39 patients with haemoglobin < 8 g/dl, 5 (12.8 %) had a MELD score of < 12, whereas 34 patients (87.2 %) had a MELD score of > 12 and was statistically significant (P < 0.0001). Leukocytosis was observed in 41 patients and leucopoenia in 14 patients. The mean prothrombin time was 20.4 seconds and 80 % of the patients had prothrombin time prolonged by more than 6 sec indicating liver damage alters coagulation profile. CONCLUSIONS We found an association between anaemia and indicators of advanced liver disease such as a higher MELD and CPS scores. This study inferred that levels of haemoglobin decrease as the severity of liver disease progresses. Thus, this measure can be used in the initial assessment of cirrhosis patients that needs urgent identification and correction to reduce morbidity and mortality. KEYWORDS Anaemia, Liver Cirrhosis, Model for End-Stage Liver Disease Score, Child-TurcottePugh Class

Timely recognition of autism in children is integral to improve developmental outcomes. This study used mixed-methods (84 case-registers and 20 in-depth interviews with caregivers of children with a diagnosis of autism) to explore the extent to which the nature of parental concerns and prior knowledge of developmental disorders impact the time between symptom recognition and autism diagnosis, and the contextual family, societal and health-system related factors that impede the autism help-seeking pathway. Lack of awareness of age-appropriate child developmental milestones, apparent amongst the community and health professionals, contributed to a 1.5-year delay between parental concerns and autism diagnosis. Recommendations to shorten this help-seeking pathway include harnessing the potential of non-specialist workers to increase awareness and enable developmental monitoring of young children through scalable tools.

Background: The present study was conducted with the aim to determine the pattern of distribution and to detect any association of transfusion transmitted infections (TTI) with ABO and Rh blood groups. Materials and Methods: A retrospective study was conducted at the blood bank of our hospital over a period of two years. A total of 36,614 healthy donors were included in the study. All the donor blood bags were screened for HbsAg, HIV, HCV, Syphilis and Malaria. The most common blood group was B positive (34.91%) while the least common was AB negative (0.61%). The total seroreactivity of TTI was 5.59%. Out of the total, 2.38% cases were reactive for HBsAg, 1.27% for anti HCV, 0.35% for HIV, 1.29% for syphilis and 0.29% for Malaria. Maximum seroreactivity was seen in blood group B positive (1.79%) followed by O positive (1.54%) and then A positive (1.28%). A significant association was seen between Rh positive blood group and HBsAg seropositivity (P value of 0.0459). In syphilis positive donors, there was significant association between syphilis infection and AB blood group with a P value of 0.0331. Conclusion: This study provides the prevalence of ABO and Rh blood group and also their association with the transfusion transmitted infections (TTI). This study shows a significant association between Rh positive blood group and HBsAg and also significant association was seen between AB positive blood group and syphilis infection. Keywords: ABO, Rh, Blood group, TTI.

INTRODUCTION: Autism Spectrum Disorder is a neurodevelopmental disorder characterized mainly by deficits in social and communication patterns. Aberrant gene environment interactions during fetal development leads to formation of minor physical anomalies such as abnormal palmar creases commonly seen in autism spectrum disorder. AIM: To compare the prevalence of abnormal palmar creases in children with autism spectrum disorder and typically developing children. METHODOLOGY:It was a case controlled cross sectional study conducted in departments of Psychiatry and Pediatrics of Pt. B.D. Sharma, PGIMS Rohtak. Fifty children of age 4-16 years with diagnosis of autism spectrum disorder (case group) and fifty typically developing children (control group) were recruited. A digital camera of 13 megapixels was used to click photographs of the palms of children. Palmar crease patterns of fifty children with diagnosis of autism spectrum disorder were compared with the control group. RESULTS:The prevalence of abnormal palmar creases in case group was higher (47%) than in control group (14%).The prevalence of Simian crease in case group was double (22%) as compared to one in control group i.e. 11%. The prevalence of Sydney crease in case group was 21%, while in control group it was only 3%. The prevalence of Suwon crease in case group was 4%,while it was not seen in control group. CONCLUSION:Children with abnormal palmar creases help in early screening of neurodevelopmental disorders such as autism spectrum disorder helping in early management of these children leading to better outcomes and alleviation of parental stress and burden

BACKGROUND Cirrhosis is a chronic disease of liver marked by degeneration of cells, inflammation and fibrous thickening of the tissue. It is a common cause of morbidity and mortality. Globally, the incidence of liver cirrhosis is on the rise. Therefore, the exact knowledge of aetiology, mode of clinical presentation, and pattern of development of complications of cirrhosis will help in optimal and costeffective control measures of this disease. We undertook this study to evaluate the cause and mode of presentation of patients with liver cirrhosis presenting in a tertiary care hospital of North India. We also wanted to determine biochemical changes in liver cirrhosis. METHODS This observational prospective study was conducted in the Department of Medicine over a period of one year, it included 122 cirrhotic patients of both sexes between 18 and 75 years irrespective of aetiology who fulfilled inclusion criteria. After detailed medical history and thorough physical examination, relevant laboratory investigations, ultrasound of abdomen, and upper GI endoscopy was done. Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease ( MELD) score was calculated. The recorded data was analysed statistically. RESULTS Out of 122 patients, 85.2 % were males and 14.8 % were females. Maximum number of patients 33.60 % were in 41 - 50 years of age. Alcohol was found to be the most common aetiological factor in 80.3 % patients. The most common presenting symptom was abdominal distension in 89.9 % patients. Various complications such as spontaneous bacterial peritonitis was present in 13.9 %, anaemia in 93.4 %, thrombocytopenia 75.4 %, deranged international normalized ratio (INR) 78.6 %, deranged renal function 45.9 %, hyponatremia in 35.2 % patients. Maximum number of patients 72.9 % were in CTP class C. 68 % patientshad MELD score > 14. CONCLUSIONS Males are mainly affected by liver cirrhosis due to excessive alcohol consumption therefore proper preventive measures have to be taken. The raised total leucocyte count (TLC), serum bilirubin, serum creatinine, decreased serum albumin, serum sodium and coagulopathy were found to be poor prognostic markers. KEYWORDS Cirrhosis, Aetiology, Complications, Prognosis

BACKGROUND Obstetric practitioners routinely deal with antenatal patients who have high risk of developing established coagulopathy, which leads to a very high incidence of maternal morbidity and mortality. We wanted to assess the role of blood components in preventing disseminated intravascular coagulation (DIC) in highrisk patients and determine the amount of blood components required along with the rate of improvement in the DIC score, during treatment of high-risk obstetric patients of DIC and in patients with established DIC. METHODS This is an interventional study. 274 obstetric patients who were at high risk for developing DIC and / or with established DIC admitted during the 20 months study duration were included in the study. Patients were categorized in to three groups based on the DIC score according to ISTH scoring system in to non-overt and overt DIC groups. Those with DIC score < 5 were grouped as IA and IB randomly and those with DIC score > / = 5 were grouped as II. Software used was ANOVA using variance ratio F test for testing the significance between groups and chisquare test was used to find out the association between the groups or parameter. RESULTS Prophylactic transfusion of blood components showed faster rate of improvement than control group. Average consumption of blood components was more in patients of established coagulopathy as compared to non-overt group. CONCLUSIONS Transfusion of blood components can prevent overt DIC in high-risk patients. KEYWORDS DIC - Disseminated Intravascular Coagulation, PPH - Post Partum Haemorrhage, Coagulopathy, Component Therapy

Background and aims Previous studies suggest that body composition and handgrip strength are significantly altered in individuals with type 2 diabetes mellitus. Only few studies are available in prediabetic individuals. The aim is to study the change in body composition in adult individuals with prediabetes and compare it with age and sex-matched normoglycemic individuals. Methods 100 diagnosed cases of prediabetes and 100 age and sex-matched normoglycemic controls were recruited in the study. Body composition was assessed with Omron HBF 510w and Slim guide skinfold caliper. Handgrip strength was assessed with Camry digital dynamometer. Results Out of 100 subjects with prediabetes; 53 were female and 47 were male. In this study, there was higher mean body fat percentage (29.37 ± 5.65 vs 25.46 ± 5.27) and visceral fat (11.21 ± 1.92 vs 7.27 ± 2.82) in individuals with prediabetes compared to normoglycemic individuals. Also, there was a lower mean of skeletal muscle percentage (27.21 ± 4.32 vs 31.19 ± 4.63) and handgrip strength (29.61 ± 6.38 vs 33.75 ± 6.8) in individuals with prediabetes compared to normoglycemic individuals. In this study, body fat percentage was positively correlated (r = 0.3385) with prediabetes. The skeletal muscle percentage (r = −0.40721) and handgrip strength (r = −0.301) were negatively correlated with prediabetes. Conclusions It can be concluded that there is a significant change in body composition and handgrip strength in the individuals with prediabetes, and changes in body composition and handgrip strength can be included as a primary care strategy to motivate lifestyle modifications.

Background: Population based Cancer Registries(PBCRs) are hallmark of cancer surveillance and cancer control activity .The value of cancer registries rely heavily on underlying quality of their data. Current study assessed data quality of four new PBCRs of Chandigarh, SAS Nagar, Mansa and Sangrur covering a total population of 4.5 millions on three quality parameters i.e. comparability, validity and completeness as recommended by International Agency of Research on Cancer(IARC), Lyon, France. Methods: For assessing comparability, data of the registries were reviewed in terms of system of classification and coding, definition of incidence date and rule for multiple primaries. For assessing validity (Accuracy) four different methods i.e. re-abstraction and re-coding, percentage morphologically verified cases (MV%), percentage of death certificate only (DCO%) cases and percentage of cases with other and unspecified sites (O and U%) were used. For assessing completeness of coverage, different semi-quantitative methods were used. Results: Re-abstraction done for 10% of the total incident cases yielded overall percentage agreement of 97.4%, 97.2%, 95.4% and 94.9% for PBCR Chandigarh, SAS Nagar, Mansa and Sangrur respectively. MV% was found to be 96.3% for PBCR Chandigarh, 92.8% for PBCR SAS Nagar , 89.3% for PBCR Mansa and 82.9% for PBCR Sangrur. Percentage of DCO cases and O and U cases were 1.4% and 2.8% for PBCR Chandigarh, 3.9% and 5.3% for SAS Nagar, 6.4% and 16.4% for Mansa and 6.3% and 8.3% for Sangrur. Completeness assessed through the various methods showed good level of completeness at PBCR Chandigarh and SAS Nagar and somewhat lower but acceptable level of completeness at PBCR Mansa and Sangrur. Conclusions: All the four PBCRs are comparable internationally. PBCR Chandigarh and SAS Nagar, predominantly urban registries, have higher accuracy of their data and good completeness levels as compared to predominantly rural registries of Mansa and Sangrur. Cancer estimates given by all the four registries are reliable and data from these registries can be utilized for planning cancer prevention and control activities in the region.

Background: Lichen planus pigmentosus can have a negative impact on the quality of life; however, this has not been studied in detail. Objectives: To study the quality of life in patients with lichen planus pigmentosus and compare it with patients with vitiligo and melasma. Methods: This was a cross-sectional study conducted in a tertiary-care center in north India from January 2018 to May 2019. Patients ≥ 18 years of age with lichen planus pigmentosus (n = 125), vitiligo (n = 113) and melasma (n = 121) completed the Dermatology Life Quality Index (DLQI) questionnaire and answered a global question on the effect of disease on their lives. In addition, patients with vitiligo completed the Vitiligo Impact Scale (VIS)-22 questionnaire, while those with lichen planus pigmentosus and melasma filled a modified version of VIS-22. Results: The mean DLQI scores in patients with lichen planus pigmentosus, vitiligo and melasma were 10.9 ± 5.95, 9.73 ± 6.51 and 8.39 ± 5.92, respectively, the difference being statistically significant only between lichen planus pigmentosus and melasma (P < 0.001). The corresponding mean modified VIS-22/VIS-22 scores were 26.82 ± 11.89, 25.82 ± 14.03 and 18.87 ± 11.84, respectively. This difference was statistically significant between lichen planus pigmentosus and melasma, and between vitiligo and melasma (P < 0.001 for both). As compared to vitiligo, patients with lichen planus pigmentosus had a significantly greater impact on “symptoms and feelings” domain (P < 0.001) on DLQI, and on “social interactions” (P = 0.02) and “depression” (P = 0.04) domains on VIS-22. As compared to melasma, patients with lichen planus pigmentosus had significantly higher scores for “symptoms and feelings,” “daily activities,” “leisure” and “work and school” domains of DLQI, and all domains of VIS-22. Female gender was more associated with impairment in quality of life in patients with lichen planus pigmentosus, while lower education, marriage, younger age and increasing disease duration showed a directional trend. Limitations: Use of DLQI and modified version of VIS-22 scales in the absence of a pigmentary disease-specific quality-of-life instrument. Conclusion: Patients with lichen planus pigmentosus have a significantly impaired quality of life. The psychosocial burden of lichen planus pigmentosus is quantitatively similar to that of vitiligo, but significantly greater than melasma.

Aim: To study the microbiological and epidemiological profile of patients with suppurative corneal ulcer presenting in a rural referral center situated in a Sub-Himalayan territory of north India. The study was conducted to evaluate the epidemiology and frequency of mycotic keratitis among the patients of suppurative corneal ulcer and to identify various fungal species as etiological agents. Methods: Corneal scrapings from 56 patients of suppurative corneal ulcers were subjected to direct microscopy and culture. Results: Of the 56 cases of suppurative corneal ulcer investigated, fungal etiology was identified in 18 (32%) cases. Most of the patients (82.1%) worked in agriculture. Trivial trauma with vegetative matter was the most common predisposing factor. Fusarium and Acremonium species were the most common fungi isolated, followed by Aspergillus. Four cases of rare mycotic keratitis caused by Paecilomyces lilacinus, Scedosporium apiospermum, Monilia sitophila, and Ulocladium species were detected. Four cases were smear positive (10% KOH wet mount) but culture negative. Analysis of KOH wet mount was done using culture as gold standard. The sensitivity and specificity of KOH wet mount was 71.43% and 90.48%, respectively. Conclusion: Direct microscopy and culture has a greater diagnostic value in the management of suppurative corneal ulcer. The authors have observed changes in the pattern of organisms identified as cause of fungal keratitis in the region. Rare species of fungi may also be detected if corneal scrapings are collected for direct microscopy and culture from all the cases of suppurative corneal ulcers greater than 2 mm.

Fungal infections are a growing cause of concern in both hospital and non-hospital settings all over the world. Fungal infections are often characterized by the location of the infection. These may be referred to as superficial, subcutaneous, or systemic, which is also referred to as deep-seated. Dermatomycosis are superficial fungal infections of the skin & or its appendages.This study was undertaken to determine: 1) The predominant dermatophytes and non dermatophytes causing dermatomycosis. 2) The clinicomycological profile of dermatomycosis.641 samples from clinically suspected cases of dermatomycosis including the skin, hair, and nail samples were collected. All the relevant clinical, demographic, and epidemiological details were noted. Samples were then subjected to direct microscopy and fungal culture.Of the total 641 cases, 337 (52.6%) were males and 304 (47.4) were females (Table 1). The most commonly affected age group was 20–39 years (51%). Out of total, 340 (53%) were nail samples, 283 (44.1%) were skin samples, and 18 (2.9%) were hair samples. Onychomycosis was the commonest clinical presentation (48.8%) followed by Scaly skin lesions (13.1%). Moreover, Tinea corporis was seen in 10.3%, Tinea cruris in 5.3% cases. KOH wet mount was performed on all 641 samples with 230 (35.9%) showing positive results. Whereas, 312 (48.7%) were positive by culture. the most common Fungi isolated in our study were Dermatophytes n=154 (49.4%), followed by Non-dermatophyte molds (NDMs) n=93 (29.8%) and Yeasts n=65 (20.8%).A combination of direct microscopy and culture was found to be superior than direct microscopy and culture alone. The recovery of NDMs and yeasts from routine dermatological samples in addition to the usual suspects, dermatophytes, also increases the awareness and suspicion among clinicians and mycologists to look beyond dermatophytes as the lone cause of superficial skin infections. Additionally, given the geographical location of Kashmir valley and its temperate climate with extremely cold winters (November to March) and a relatively milder summer with moderate humidity levels, when compared to the rest of northern Indian states doesn’t make it a suitable environment for fungal infections, more so the superficial mycosis. That said, people at risk are always vulnerable to develop fungal infections.

Recurrence of amebic liver abscess (ALA), once considered unusual, is increasingly being reported, despite proper management. Realizing the endemicity of ALA in the study setup, this 2-year follow-up study was conducted to investigate the recurrent cases and study the associated factors. A total of 101 confirmed cases of ALA were followed up for a period of 2 years. Recurrent cases were studied for associated bacterial flora, presence of resistance genes (nim), level of matrix metalloproteinase 3 and MMP-9, and genotypes of Entamoeba histolytica and statistically compared with the nonrecurrent cases as controls. Recurrence rates of 8.9% (nine patients) were detected. The presence of Prevotella along with an increased level of MMP-9 in abscess fluid and large size of abscesses (11 × 10.8 cm) was found to be significantly associated with recurrence in ALA. Among the nine cases, the presence of nimE gene was detected in two (22.2%) patients. The genotyping of E. histolytica strains showed that in seven (77.7%) cases, the genotype of E. histolytica was the same in the primary and recurrent samples. This study reports a high rate of recurrence in the cases of ALA, hinting toward the gradual development of clinical resistance toward the commonly used drug. The presence of nim gene and Prevotella in abscess fluid along with increased MMP-9 levels and large abscess size could be important predictors of recurrent ALA.

Background:Few studies have focused on magnetic resonance imaging (MRI) brain findings associated with functional mobility in cerebral palsy.Objective:To determine association between MRI findings and Gross Motor Functional Classification System (GMFCS) levels in cerebral palsy.Methods:Prospective-observational study conducted in Pediatric Neurology Clinic at a public teaching hospital, Northern India. First 3 new cases of cerebral palsy were enrolled on particular neuro-clinic day per week for 1 year. Functional mobility was classified according to GMFCS. Association between MRI findings, cerebral palsy type, and GMFCS levels were evaluated using χ2test.Results:A total of 138 cases (mean age 2.71 [SD = 1.91] years; male [64.5%]) were enrolled. Reported types of cerebral palsy were as follows: spastic quadriplegia (47.8%), spastic diplegia (28.35%), spastic hemiplegia (11.6%), extrapyramidal (6.5%), and ataxic/hypotonic (5.8%). GMFCS were classified into level 1 (13%), level 2 (7.2%), level 3 (4.3%), level 4 (10.9%), and level 5 (64.5%). Spastic quadriplegia and extrapyramidal cerebral palsy were significantly associated with higher (severe) levels (IV and V), whereas spastic diplegia and hemiplegia were significantly associated with lower (mild) levels (I-III) of GMFCS. MRI features of periventricular white matter injury, deep gray matter injury, basal ganglia and thalamic changes, and superficial gray matter injury were significantly associated with severe levels of GMFCS (V and IV). MRI was normal in 8 children (5 = mild category, 3 = severe category).Conclusion:Severe cerebral palsy is most often associated with spastic quadriplegia, extrapyramidal cerebral palsy, superficial gray matter lesions, deep gray matter lesions, and periventricular white matter injury. This information is useful for anticipating and addressing the needs of children with cerebral palsy and for prognostication.

Objective: The objective of the study was to monitor the adverse drug reactions (A.D.Rs.) associated with antihypertensive drugs. Methods: All patients coming to the department with blood pressure systolic above 120 mmHg and diastolic above 90 mmHg and prescribed hypertensives will be screened for the study. Results and Discussion: A total of 136 patients were observed during the study. Out of 136 patients, 23 (17%) A.D.Rs. were recorded. A study conducted by Ramesh et al. in the Indian capital reports that 22.3% of the patients experienced A.D.Rs. Conclusion: Furthermore, any appearance of A.D.Rs. due to side effects of the drugs or due to bad control and patients non-compliance, it was treated mainly by decreasing the doses of the drugs, switching them to another active substance from the same pharmacological group, or by adding more active substances from different pharmacological groups in lower dosages to achieve the B.P goals.

Background: Cardiovascular disease is the leading cause of death in India. Our aim is to study the clinical, epidemiological profile and in-hospital outcomes of patients presenting with acute coronary syndrome. Methods: We did a prospective single center observational study of the 1203 patients presenting with ACS to a tertiary referral center in North India over a period of one year (July 2018–June 2019). Results: The mean age of study population was 58.4 ± 12.5 years. STEMI and NSTE-ACS accounted for 69.9% and 31.1% respectively. 62.1% of our patients were from rural background. The median time to hospital admission was 600 min for STEMI patients, thrombolysis was performed in 52% of cases. Cardiogenic shock at presentation was noted in 18%. Coronary angiography and percutaneous coronary intervention were done in 1062 (88.3%) and 733 (60.9%) patients respectively. The overall in-hospital mortality was 7.6%. STEMI patients had higher mortality than NSTE-ACS (8.9% vs 4.5% p

Information on vitamin D deficiency in prepubertal children is scarce. The authors studied calcium intake, sunlight exposure, serum calcium, alkaline phosphatase, 25-hydroxyvitamin (25OHD), and intact parathormone (iPTH) in the children (N = 135) attending the pediatric endocrinology clinic (declared normal after evaluation) and their healthy siblings. Serum 25OHD

Anuj Sharma, Sonia Phulke, Anugya Agrawal, Isha Kapoor, Rakesh Kumar Bansal Department of Ophthalmology, Government Medical College and Hospital (GMCH-32), Sector 32, Chandigarh, 160030, IndiaCorrespondence: Sonia PhulkeDepartment of Ophthalmology, Government Medical College and Hospital (GMCH-32), Sector 32, Chandigarh, 160030, IndiaTel +91-9876641140Email soniavaidya2010@yahoo.comAim: To assess the demography, magnitude, and type of corneal astigmatism in patients undergoing cataract surgery in North India.Methods: It is a clinic-based, cross-sectional, observational study. Keratometric values and demographic data were collected for eligible patients who had undergone phacoemulsification at a tertiary eye care center between January 2010 and December 2017, using a non contact, optical low coherence reflectometry (OLCR).Results: A total of 3597 eyes were recruited for the study. There were 1810 (50.3%) females and 1787 (49.7%) males. The mean age was 59.121± 15.19 (range 5– 100 years). A total of 3559 eyes were qualified for astigmatism analysis. The mean corneal astigmatism among all patients was 1.17± 1.15 D (range 0– 12.5 D). There was no astigmatism in 99 eyes (2.78%), with-the-rule (WTR) in 1062 eyes (29.83%), against-the-rule (ATR) in 1843 eyes (51.72%) and oblique astigmatism (OA) in 555 eyes (15.59%). The tendency of a gradual change from with the rule (WTR) to against the rule (ATR) astigmatism was noted as the age advanced.Conclusion: In the present study around 56.69% of eyes had corneal astigmatism of < 1.0 D that can be managed by simple cost-effective keratorefractive procedures especially in developing countries. However, our 40.49% patients had > 1.0 D of corneal astigmatism, which may benefit by toric intraocular lenses.Keywords: corneal astigmatism, cataract, phacoemulsification

With an increasing number of children with congenital heart disease (CHD) undergoing corrective treatments, improved pediatric intensive care, better antimicrobial treatments, and a relative decrease in rheumatic heart disease over the years, the epidemiology of pediatric infective endocarditis in India may be undergoing a change. The study was done in the department of pediatrics of a tertiary care teaching hospital of North India. A retrospective analysis of case records of children (

Background The majority of nosocomial infections in the hospital setting are found in intensive care units (ICUs). The present study was undertaken to determine the incidence, risk factors, causative microorganisms, and outcome of various ICU-acquired infections. Materials and methods The patients admitted to the ICU of a teaching hospital in North India were prospectively studied. Detailed history, clinical examination, acute physiology and chronic health evaluation score II, simplified acute physiology score II, sequential organ failure assessment score, and baseline investigations were recorded. Patients were assessed daily till 14th day for nosocomial infection as per Centers for Disease Control and Prevention (CDC) guidelines and were followed till death or discharge. Incidence, risk factors, and outcome parameters were calculated using Student t-test, Chi-square test, and stepwise multivariate logistic regression model. Results The overall incidence rate of ICU infections was 27.9%. The most common ICU-acquired infection was ventilator-associated pneumonia followed by catheter-related bloodstream infection and catheter-associated urinary tract infection. Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae were implicated in most of the infections. ICU length of stay (LOS) >7 days, neurological dysfunction, endotracheal intubation, ischemic heart disease, and use of antacids/H2 blockers were significantly associated with ICU-acquired infections. The mortality rate was 32.8 and 28.8% in patients with and without ICU infections, respectively (p = 0.531). The ICU LOS (19.23 ± 12.79 days) was significantly higher in the ICU infections group (p

Purpose: This was a population-based study to determine the prevalence and causes of visual impairment in children less than 16 years in Urban North India. Methods: This cross-sectional study was conducted in 40 clusters of urban Delhi. 20,955 children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. Unaided visual acuity of enumerated children aged over 2 years was assessed by using Lea symbols chart in 3-5 years age group and logMAR tumbling E charts for the 6-15 years age group. For children aged 0-2 years, fixation and following to torch light was assessed. All the children with unaided visual acuity of

Background: The symptoms of autism manifest at an early age in children and are likely to results in lifelong disability. Early identification and institution of early intervention remain the mainstay in the management of autism. However, related community surveillance studies are limited in the literature. Methods: The present study was designed to assess the prevalence of “at risk for autism” among children aged 18–36 months in a semi-urban community of Rohtak, Haryana, India. This cross-sectional study was conducted among 548 children. The eligible children were screened using the Hindi version of the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). Results: The prevalence of at-risk symptoms of autism was 0.55% and 6.57% as per M-CHAT-R score of >7 and >3–7, respectively. Most of the cases in the moderate-risk category were having M-CHAT-R score of 3–5 (n = 32, 82%). Conclusion: The study provides preliminary data on the prevalence of caregiver-reported autism using the Hindi version of M-CHAT-R in a semi-urban community of North India. The Hindi version of M-CHAT-R could be a viable community surveillance tool for identifying toddlers at risk for autism in this setting.

Objective: Anemia and iron deficiency (ID) are common in patients with chronic systolic heart failure (HF). The study was planned to find out the prevalence of anemia and ID in patients of chronic HF among patients admitted in a tertiary care hospital from Himachal Pradesh, India. Methods: This was a hospital-based open cohort observational descriptive study conducted on patients diagnosed with chronic HF. The study period was of 1 year. HF was defined on the basis of 2016 ESC Guidelines for diagnosis and treatment of acute and chronic HF. Anemia was diagnosed on the basis of WHO definitions (

Introduction: Superficial mycoses refer to the disease of skin, hair and nail caused by fungi, are a serious problem due to deficient sanitation and education. This group includes dermatophytoses, non dermatophytic molds and Candida spp. Microscopic detection of fungal elements using wet mount preparation of 10% and 40% potassium hydroxide (KOH) is a rapid and precise tool for laboratory diagnosis. Objectives: This retrospective study was conducted to evaluate the sensitivity of wet preparation direct microscopy using potassium hydroxide for early detection of fungal elements from various clinical specimens and thereby helping the clinicians in initiating the appropriate antifungal treatments. Materials and Methods: All clinical specimen like skin and nail scrapping from patients suspected of superficial mycoses were subjected to KOH examination for screening and detection and positive samples were cultured on SDA (Sabouraud’s Dextrose Agar) medium for identification. Results: A total of 5734 samples of clinically suspected patients of superficial mycoses attended the tertiary care teaching hospital between September 2013 and August 2017 were included. 3165 patients (55%) were found to be positive by KOH examination. In the present study the most common clinical type was tinea cruris (74.3%) followed by tinea corporis (22.6%) in the patients attending tertiary health care centre. Conclusion: Clinical finding and wet mount with KOH can be believed upon as the single most important rapid and sensitive tool for early diagnosis of superficial mycoses. Since there is a high incidence of superficial mycoses in rural people coming to the tertiary heath care facilities therefore preventive and early screening measures are need of hours. Keywords: Potassium hydroxide preparation, Superficial mycoses, Tinea spp.

The WHO 2016 update on lymphoid neoplasms incorporates criteria independent of tissue architecture in the diagnosis and sub-classification of non-Hodgkin lymphoma. Thus, lymphoid neoplasms with characteristic immunophenotypes and/or cytomorphology could be classified with FNA material with appropriate use of ancillary methods. We analysed the efficacy of cytomorphology and cell block immunocytochemistry (CB-ICC) in in diagnostic workup of non-Hodgkin lymphoma diagnosis on FNA material. 65 clinically suspected cases of lymphoma presenting with lymphnode enlargements were analysed. FNAC and CB-ICC were performed and compared with the subsequent biopsy. The sensitivity, specificity, PPV and NPV of CBICC in the diagnosis of NHL were 84.6%, 75%, 95.6%, and 42.8%, respectively in our study. We also observed that use of CB-ICC can have significant logistic implications in patient management in terms of reducing the turn-around time to diagnosis and improving the accuracy in diagnosis on FNAC. ICC on cell blocks can easily be done on FNA material and is a very useful adjunct to FNAC in establishing the diagnosis in a suspected case of NHL especially when a biopsy is not available. Keywords: Cell block immunocytochemistry, NHL, FNAC, Ancillary methods.

Introduction: Infertility is defined as the failure to achieve clinical pregnancy after 12 months or more of regularly unprotected sexual intercourse. According to a systematic analysis of National Health Survey-2010, approximately 10.5% of women around the world experienced secondary infertility and roughly 2% experienced primary infertility. Objectives: To analyse the risk factors for infertility in eastern part of North India. Materials and Methods: This cross-sectional, analytical pilot study was done from January 2018 to March 2018 as a schedule based survey involving 65 couples with infertility attending Sir Sunderlal hospital, Varanasi, U.P., that primarily caters to patients from eastern part of north India. Sixty valid couples were analysed. Results: Seventy per cent couples resided in eastern U.P. and 60% belonged to middle socioeconomic status. Treatment was sought ? 3 years by 86.7%. Among a total number of 60 females partners in their reproductive age (15-49 years), 31 (51.7%) had primary infertility and 29 (48.3%) had secondary infertility. The age group of 27-38 years comprised of 53.3% females and 65.6% of these had secondary infertility. Those females with regular menstrual cycles had a predominance of primary infertility (70%) and irregular cycles was associated more with secondary infertility (66.7%). Conclusion: Association of primary and secondary infertility was found with age & menstrual irregularity, hence these may be considered as risk factors. BMI and amount of menstrual flow were not significantly associated with either types of infertility and need further evaluation in a larger study. Keywords: Primary infertility, Secondary infertility, Risk factors, North India.

Background Autism is a neurodevelopmental disorder and can be early detected with the aid of screening tools. Chandigarh autism screening instrument (CASI) is a newly developed tool to screen autistic symptoms among children aged between 1.5 to 10 years in the north Indian Hindi speaking population. Objective In this study, we evaluated the caregiver report of autistic symptoms in preschool children (3–6 years) attending selected schools of Rohtak. Materials and Methods The index study was conducted among 225 caregivers of school-going children aged between 3 to 6 years. Social and communication disorders checklist (SCDC-Hindi) and CASI was used to measure autistic symptoms. The modified Kuppuswamy scale was used for assessing the socioeconomic status of the caregivers. Results The autistic symptoms varied from 2.2 to 18.7%, depending upon the CASI (cutoff score of 10) and SCDC (cutoff score of 9) measurements. The items in the shorter four-item version (CASI Bref) of CASI were found to be the predictors of autistic symptoms in this population. Children’s gender, age, and socioeconomic status were not found to have any association with autistic symptoms in this setting. Conclusion The study provides preliminary evidence in relation to the CASI-linked screening for autistic symptoms among preschool children. The shorter version of CASI (CASI Bref) can be an efficient quick screener for autistic traits, but the full version of CASI needs to be validated as per age-appropriate autism screening tools.

Introduction: Dengue virus infection is a major public health issue prevalent in tropical and sub-tropical countries all over the world mostly in urban and semi-urban areas. WHO estimates about 50-100 million dengue infections worldwide every year. The present study is aimed to assess the prevalence and seasonal distribution of dengue disease during three consecutive years from 2016-2018 at a tertiary care centre of North India. Method: This is an observational retrospective study conducted on total 6,481 clinical suspected cases referred from indoor and outdoor departments of Medicine and Pediatrics of one of the medical colleges of Agra during the period from 1st January 2016 to 31st December 2018. Results: The maximum positivity was recorded in the year 2016 (16.66%), followed by 2017 (14.07%) and 2018(13.56%).Our study shows male preponderance with maximum cases in the year 2018 was recorded in the month of October (22.75%) whereas the lowest in the month of May (1.96%). Most of the cases were in the age group 0-30 years with a male preponderance. The outbreak occurred during the months of August to November indicating vector transmission in the monsoon and post-monsoon season. Conclusion: From the analysis, this study reflects that the numbers of dengue cases in 2016 were maximum and outnumbered the dengue cases among three consecutive years from 2016 to 2018. The peak in dengue positivity was observed during September to October. As this disease affects the population in the monsoon and post monsoon months therefore continuous monitoring of dengue infection is important during the post-monsoon season.