GB Pant Hospital Research Articles

Difference in the epidemiological and clinical profiles of mortality between the first and second waves of COVID-19 pandemic in a tertiary care hospital of Andaman and Nicobar Islands

BACKGROUND: The Andaman and Nicobar Islands reported the first coronavirus disease 2019 (COVID-19) case on March 26, 2020. This study aimed to describe the epidemiological and clinical profiles of COVID-19 mortality that occurred during the first and second waves of COVID-19 pandemic and to compare the differences between them. MATERIALS AND METHODS: This was a retrospective cohort study carried out among COVID-19 patients admitted at GB Pant Hospital, Port Blair. Socio-demographic and clinical details were retrieved from the case records using structured proforma. Comparison of the study variables between the first and second waves was done by using Chi-square test using SPSS version 20. RESULTS: The first wave had total cases of 4994 and 62 deaths, and the second wave had 2734 cases and 67 deaths. The case fatality among COVID-19 cases during the first and second waves of the pandemic was 1.24% and 2.45%, respectively. There was no significant age and gender difference of patients between the two waves. Those who had co-morbidities during the first wave were 52 (83.8%), and those who had co-morbidities during the second wave were 45 (67.2%). The median duration of hospital stay in days during the first and second waves of the pandemic was 4 and 6 days, respectively. CONCLUSION: There was no significant difference in the age and gender distribution between the two waves; however, those who died during the second wave had a significantly higher percentage of co-morbidities. Therefore, health policy makers should develop a targeted approach to provide appropriate education, support, and awareness of patients with underlying diseases and allocate health care resources accordingly.

ETIOLOGY AND RISK FACTORS FOR NEONATAL ADMISSION WITH RESPIRATORY DISTRESS: A TERTIARY CARE HOSPITAL-BASED STUDY

Objective: Respiratory disorders are the most common cause of admission for neonatal intensive care unit whose incidence ranges from 4% in term babies and 20% in post-terms to 30% in pre-terms. The incidence increases with decreasing gestational age and birth weight. Severity of distress is assessed by scoring systems. There is no study conducted in this tertiary center; for this reason, we took this study to identify the etiology and risk factors for neonates admitted. Methods: This was a hospital-based prospective study done at a tertiary care center in NICU of GB Pant hospital, Srinagar, for a period of 6 months between January 2020 and June 2020. A total of 320 babies were taken up for the study with 187 (58.4%) male and 133 (41.6%) female babies. Respiratory distress was defined as having any two signs of respiratory rate of >60 breaths/min, subcostal or intercostal retractions, nasal flaring, grunting, with or without cyanosis. Results: A total of 320 babies were included in the study with 58.4% male babies and 41.6% female babies. 65% were born by cesarean section and 35% by vaginal delivery. 71.8% babies were born at term and 28.2% babies pre-term. 32.5% had birth weight of <2.5 kg and 67.5% had more than 2.5 kg. 95.62% had a respiratory cause of distress with 60.9% TTN, 27.8% RDS, 6.25% MAS, and 0.62% congenital pneumonia. Only 4.37% cases had a non-respiratory cause with 2.5% sepsis, 1.25% congenital heart disease, and 0.62% congenital diaphragmatic hernia as cause of respiratory distress. Conclusion: 95.62% cases of distress had a respiratory cause with TTN and RDS accounting for a majority of the cases both of which can be easily averted by taking necessary preventive measures by assessing the antenatal risk factors or managed effectively by identifying the cases early on post-partum.

Validity and Reliability of the European Organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 in Indian Patients With Corrosive-Induced Benign Refractory Esophageal Strictures.

Background The European organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 (EORTC QLQ-OG 25) is designed for patients with esophagogastric cancer. Its performance has never been tested with benign disorders. A health-related quality-of-life questionnaire does not exist for patients with benign corrosive-induced esophageal strictures. Hence, we evaluated the EORTC QLQ-OG 25 in Indian patients with corrosive strictures. Methods The English or Hindi version of QLQ-OG 25 was administered to 31 adult patients undergoing outpatient esophageal dilation at GB Pant hospital, New Delhi. These patients had refractory or recurrent esophageal strictures due to corrosive ingestion and had not undergone reconstructive surgery. Score distribution was analyzed, and item performance was determined based on floor and ceiling effects. Convergent validity, discriminant validity, and internal consistency were checked. Results The average time to finish the questionnaire was 6.70 minutes. Most scales fulfilled convergent validity (corrected item-total correlation >0.4), barring the Odynophagia scale and one item of the Dysphagia scale. Most scales exhibited divergent validity except for odynophagia and one item of dysphagia. Cronbach's alpha was >0.70 for all scales except odynophagia. Responses to questions evaluating taste, cough, swallowing saliva, and talking were highly skewed and had prominent floor effects. Overall, the questionnaire demonstrated good internal consistency, convergent validity, and divergent validity in benign corrosive-induced refractory esophageal strictures patients. Conclusion The EORTC QLQ-OG 25 can be satisfactorily used in patients with benign esophageal strictures to assess health-related quality of life.

CLINICAL CHARACTERISTICS, MANAGEMENT PRACTICES AND IN-HOSPITAL OUTCOMES OF SCRUB TYPHUS PATIENTS IN A TERTIARY CARE CENTER IN THE NORTH EASTERN STATE, TRIPURA

Background- With the changing epidemiology, scrub typhus is now among the commonest causes of AFI in India and a high suspicion should be maintained, and an early diagnosis and promt management is warranted to prevent complications. Objective - Clinical characteristics, management practices and in-hospital outcomes of scrub typhus patients. Methods- a Cross-sectional retrospective study was conducted among 110 scrub typhus patients attending Agartala Government Medical College and GB Pant Hospital, a tertiary care centre of Tripura in last one year period. Their clinical profile, laboratory studies and management has been recorded and data has been evaluated with SPSS 21.0 for windows with p- value <0.05. Results- the commonest presenting symptoms of scrub typhus are high-grade fever with chills , headache and it most commonly effects farmers. Most commonly effected age group was 40-50 years of age. Most of the patients were from West Tripura followed by Khowai Tripura and least patients were from North Tripura. Predominately it occured in September, October and November i.e. in post monsoon period. The pathognomonic eschar was present in 43% patients and rarest presentation was paraparesis (0.9%). Lymphadenopathy (9%), neck rigidity (6%), hepatomegaly (10%), splenomegaly (4%), acute respiratory distress syndrome was seen in 14% patients. Hepatic involvement was the most common complication seen in our study (42%). Anemia was present in 25% and thrombocytopenia was present in 22% patients. Subside of fever to doxycycline injection seen in 73% on day1 and 84% on day2. 19% Patient required icu admission. 9% developed ARDS and 6% required ET tube intubation and mechanical ventilation. 6% developed hypotension requiring inotropic support. 4% developed severe thrombocytopenia(<10,000) required platelet transfusion. 11% developed acute kidney injury requiring haemodialysis. Survival rate were 93% and mortality 7%. In conclusion, scrub typhus became the leading infectious cause of acute febrile illness in North eastern state, Tripura. A high suspicion should be maintained, and an early diagnosis and promt management is warranted to prevent mortality and morbidity of patients.

Endotracheal bleed after intra cardiac repair in tetralogy of fallot patients: a diagnostic challenge

Background: Tetralogy of Fallot (TOF) is the most common congenital cyanotic heart disease (CCHD) in children. With the development and advancement of paediatric cardiac surgery and intensive care units, a large number of TOF are presenting for cardiac surgery. Operated TOF may suffer from endotracheal (ET) bleeding in postoperative period which results in delayed extubation of patients. ET bleeding is multifactorial with MAPCAs, coagulopathy residual VSD, and high LA pressure being usual causes. The objective of this study was to evaluate those children of TOF who suffered from ET bleeding, their causes and management after intracardiac repair.Methods: This was a single center retrospective study that included patients with a diagnosis of TOF. Total of 27 patients were operated at GB Pant Hospital, Department of CTVS from February 2021 to November 2021. After taking ethical approval we conducted a retrospective study to analyse the cause of endotracheal bleed. Statistical analyses were performed using STATA software version (16.0). Continuous variables were presented as mean±standard deviation (SD) or median (interquartile range [IQR]. Inclusion criteria was- all diagnosed case of tetralogy of fallot patient with age –1.5-8 years, both male and female. Exclusion criteria was- patients having co-morbidities, like juvenile diabetes, hypothyroidism, syndromic patients.Results: Endotracheal bleed noted in majority of patient in those MAPCAs were not coiled, not able to be ligated intaoperatively, they bleed in postoperative period which further delayed extubation of patients. Of the patients with Endotracheal bleed none had a residual cardiac defect. Post-operative mortality was 1/27.Conclusions: We hereby conclude that cause of endotracheal bleed after intracardiac repair of tetralogy of fallot patients can be due to left uncoiled, non- ligated major aorto-pulmonary collateral arteries (MAPCAs).

Tension Band Wiring for Fracture Patella Outcome with 3 K Wire versus 2 K Wire

Introduction: Fractures of the patella constitute almost 1% of all skeletal injuries, resulting from either direct or indirect trauma. Many forms of internal fixation for patellar fractures have been described in the literature but perfect anatomical reduction during surgery has an excellent outcome irrespective of the method of fixation used. The conventional method of patellar tension band wiring is always done with the help of two parallel Kirschner wires. Here, in our study, we intended to see whether the use of 3 parallel Kirschner wires in comparison to conventional one results in a superior functional outcome. Methods: A prospective observational study was carried out in ANIIMS and GB Pant hospital Port Blair from November 2016 to November 2019 on 44 patients of patellar fracture operated by tension band wiring with 22 patients in 2 parallel Kirschner wires and 3 parallel Kirschner wires groups respectively. Results: 44 patients were followed up postoperatively for 1 year and assessed by Lysholm knee score for pain status and working status and other variables. The mean age of the participants was 40.27 years (41.86 in two Kirschner wire group and 38.68 in three Kirschner wire group) in our study. Lysholm knee score, pain status, or working status was not significant throughout the mean follow-up periods for both groups. Conclusions: We found no significant difference between patellar TBW in 3 Kirschner wire and 2 Kirschner wire groups. However small sample size limits our study.

Accuracy of Two-dimensional Ultrasound and Magnetic Resonance Imaging in Diagnosis of Foetal Congenital Anomalies in a Tertiary Care Hospital- A Cross-sectional Study

Introduction: Ultrasound screening for foetus congenital malformations is the mainstay in diagnosis and is commonly performed at 19-22 weeks gestation. Magnetic Resonance Imaging (MRI) is known as a problem solving tool which is used for answering a specific question. Both ultrasound and foetus MRI are highly sensitive and specific in diagnosis of congenital anomalies of the foetus with high agreement between both modalities. Aim: To determine the accuracy of Ultrasound Sonography (USG) and High Field 3 tesla MRI in diagnosis of different types of foetal Central Nervous System (CNS) and non CNS congenital abnormalities. Materials and Methods: A cross-sectional study was conducted in the Department of Radiodiagnosis at Agartala Government Medical College and GB Pant Hospital from June 2017 to May 2019. A total of 65 cases with ultrasound diagnosis of foetus abnormalities were examined by 3 Tesla MRI. MRI were performed within 15 days after USG detected anomalies. Statistical analysis was done using Chi-square test. Results: In cases with foetus anomalies high field MRI provided detailed findings leading to a more refined diagnosis. CNS anomalies were more as compared to other anomalies. Some of the antenatal findings were confirmed in some cases following termination of pregnancy and some were by postnatal examination. Among them chest anomalies was least common i.e., 1.5%. sensitivity of MRI was 88.13%, specificity was 66.66%, Positive Pressure Ventilation (PPV) was 96.29%, Negative Predictive Value (NPV) was 36.36% and USG sensitivity was 82.43%, specificity and 77.77%, PPV was 95.83%and NPV was 41.17%. Conclusion: High field MRI should be used as a second line of investigation in patients with foetus abnormalities diagnosed by ultrasound for confirmation of diagnosis and selecting the treatment protocol. In cases of fatal abnormalities, a confirmed diagnosis made before 20 weeks of pregnancy may help by terminating the pregnancy.

Validity of Computed Tomography in Evaluation of Acute Ischaemic Stroke in Comparison to Magnetic Resonance Imaging: A Cross-sectional study

Introduction: Cerebrovascular disease represents a major reason for mortality and morbidity worldwide. Imaging plays a pivotal role in the management of stroke patients. Haemorrhagic stroke diagnosis is straightforward using a Computed Tomography (CT) scan whereas early ischaemic strokes are sometimes difficult to diagnose by imaging. The use of Magnetic Resonance Imaging (MRI) may diagnose ischaemic stroke more convincingly; however MRI remains less available, time consuming and complicated. Unenhanced CT can be performed quickly; can help to identify early signs of stroke. Aim: To determine the validity of CT in the evaluation of acute ischaemic stroke compared to MRI for early diagnosis. Materials and Methods: The study was a cross-sectional study conducted in the Department of Radiodiagnosis, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura, India. The study period was from December 2018 to December 2020 and included 70 patients. The instruments used were SIEMENS 128 slice CT-SOMATOM model definition AS and SIEMENS 3.0 Tesla MRI-SKYRA model. Statistical Package for Social Sciences (SPSS) for Windows, version 25.0 (SPSS Inc, Chicago, USA) was used for data analysis. Results: Out of all patients (n=70) 63 patients were ultimately found to have infarction. Out of these 63 cases of infarction 69.84%(n=44) were male and 30.16% (n=19) were female. Sensitivity of CT scan was 87.3%, specificity was 71.4%, positive predictive value was 96.4%, negative predictive value was 38.4% and accuracy was 85.7%. The p-value was 0.002. In all patients who presented before six hours (n=15) showed decreased creatinine value during Magnetic Resonance Spectroscopy (MRS) in the lesion area compared to the normal side of brain. None of the patients showed variation in the lactate value. Those presenting after 6 hours (n=48), creatinine was reduced in all the cases (100%), Choline was increased in 89.6%. Conclusion: Sensitivity and specificity of CT scan is lower than MRI. Diffusion-Weighted Imaging (DWI) has 100% sensitivity in diagnosing acute infarction.

An Autopsy Study of Brought Dead Cases at a Tertiary Care Hospital in Port Blair, Andaman and Nicobar Islands

Introduction: Brought dead cases are considered as Medico-legal Cases which require investigation by lawenforcing authorities, to know the cause of death and then decide whether it is a Natural/Unnatural death.The doctor’s post mortem report gives direction to the police in their investigation.Method: All cases during the study period i.e. from 1st Jan 2019up to 31st Dec 2019 were that were broughtdead to GB Pant Hospital (GBPH), which is a tertiary care hospital attached to ANIIMS were included. Allthese cases were retrospectively analysed under various parameters.Results: The present study reveals that out of 223 cases, 58 were brought dead to GBPH. Out of these in 57cases the death was due to a Natural cause and in only one case it was due to an unnatural cause.

Clinicoepidemiological and laboratory profile of children with severe acute malnutrition admitted to a tertiary care centre

Background: Severe Acute Malnutrituon (SAM) is a form of malnutrition where there is an imminent threat of death to the child. The chances of complications are very high and in most case child requires hospitalization for stabilization and rehabiliatation. Objective of study the clinicoepidemiological and laboratory profile of children with severe acute malnutrition (SAM) admitted to a Nutritional Rehabilitation Centre (NRC) of our hospital.Methods: A retrospective chart review of admitted patients. Nutritional Rehabilitation centre (NRC) at GB Pant Hospital Government Medical College Srinagar over a one year period between June 2017 and June 2018.Results: Total of 187 patients of SAM was admitted in NRC during the study period. One hundred and eight (57.7%) were males and 79(42.3%) were females .Patients were equally among various districts. Infants (<12months) constituted the majority of admissions (54.5%). Marasmus was by far the commonest phenotype presenting as SAM (85.5%).Respiratory comorbidity was the commonest present in about 41 (26.3%) followed by daiarrhea in 32(20.5%). Delayed initiation of complimentary feeding was found in 75(40.1%) while early weaning was found in another 55 children (29.4%). Birth order more than three was present in 92 children (49%). Mother’s literacy status had a direct bearing on the prevalence of SAM. Most of the children were from rural background (75%).Most belonged to low economic and income class as around 65.2% had a very meager family income.Conclusions: SAM is more common in Infants and in children from rural background. It is highly associated with faulty feeding practices including lack of breast feeding and presence of mixed and faulty feeding. It is also associated with increasing birth order, low maternal education and low family income Pneumonia and diarrhea are leading comorbidities. Hypoglycemia and hypothermia are leading complications. Marasmus is the commonest phenotype.

Prevalence of cryptococcal meningitis in a tertiary care centre.

Background: Cryptococcal meningitis has emerged as an important opportunistic central nervous system (CNS) infection in Human Immunodeficiency Virus (HIV) positive patients. It is associated with a high mortality rate. Hence early diagnosis is necessary to start appropriate treatment. Cryptococcosis is generally found in association with acquired immunodeficiency syndrome (AIDS) although it has been reported to cause disease in HIV-seronegative patients also. Objective:Prevalence of Cryptococcal meningitis in a tertiary care centre. Material & Methods: A total of 93 Cerebrospinal fluid samples from suspected cases of fungal meningitis were received in the microbiology department of GB Pant Hospital(GIPMER) from January to June 2018. Samples were subjected to direct microscopy- wet mount, India ink preparation and Gram stain, Cryptococcal antigen detection(Latex agglutination), and Fungal culture. In vitro susceptibility of Cryptococcus isolates to Fluconazole, Voriconazole, 5- Flucytosine and Amphotericin B was performed using standard broth microdilution method. Results: Out of 93 CSF samples, 6 were positive for India ink preparation and showed gram positive budding yeast cells by gram staining. All 6 samples were positive for the cryptococcal antigen test and fungal culture. Five were identified as C. neoformans and one C. gatti. All strains were susceptible to Amphotericin B. Four patients were HIV reactive and succumbed to the diseaseduring treatment. Two patients were found to be coinfected with Hepatitis B virus. Ashish Bajaj1, Bibhabati Mishra2, Poonam S Loomba2, Archana Thakur3, Abha Sharma4, Prachala G Rathod1, Madhusmita Das1, Ashna Bhasin1 1Senior Resident, 2Director Professor, 3Director Professor & Head, 4Assistant Professor, Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India ABSTRACT Cryptococcal meningitis has emerged as an important opportunistic central nervous system (CNS) infection in immunosuppressed patients.It is associated with a high mortality rate(>30%) in immunosuppressed patients especially those infected with HIV, hence early diagnosis is necessary to start appropriate treatment. Prevalence of cryptococcal infection is increasing in developing nations including India as per some recent studies.(1) Conclusion: Index of suspicion of Cryptococcus infection as a possible cause of meningitis must be considered in chronic meningitis cases. Microscopy (India ink preparation) may be used as a cheap and rapid diagnostic tool.

Breast cancer in Andaman and Nicobar Islands: A retrospective analysis.

Breast cancer is the most common cancer in India among women. This study was conducted to describe the demographic, clinical, histopathological, endocrinological and survival pattern of breast cancer patients in Andaman and Nicobar Islands. The study was done in Medical Oncology department of GB pant hospital. Data was retrieved from the case sheets of patients who consulted from 1st February 2015 to 31st January 2018. As this hospital is the only referral hospital, the patients are representative of all cancer patients in the Island, and the population base is well defined. During the study period, 85 breast cancer patients were treated. Of the 82 female patients, the standardized incidence rates in 2015, 2016 and 2017 were 8.82, 13 and 14.42 per 100,000 women respectively. The prevalence and mortality rates in 2015, 2016, 2017 were 14.88, 27.96, 40.37, and 1.1, 2.74, 0.55 per 100,000 women respectively. Metastasis was detected at the time of diagnosis in 18.8% of patients. Estrogen receptor (ER) and progesterone receptor (PR) positivity was reported in 55.9% of patients, HER 2 positivity in 28.1% and triple negativity in 27.3%. The overall survival at 12, 24, and 36 months follow-up were 88.9%, 84.3% and 52.7% respectively. In univariable analysis, the hazard ratios were significantly higher for patients with metastasis and diagnosis before 2015. As compared to the country, breast cancer incidence was lower in the Islands with better survival. Stage at diagnosis was the most important factor determining survival in these patients.

Morbidity and mortality pattern of very low birth weight and extremely low birth weight neonates in a tertiary care hospital

Background: Although the mortality and morbidity rates for Very Low Birth Weight (VLBW) and Extremely Low Birth Weight (ELBW) neonates have improved over last few decades, they still remain highly vulnerable groups. This study determines the neonatal morbidity and mortality within first four weeks of life in VLBW and ELBW neonates.Methods: It was a hospital based prospective study conducted in the department of paediatrics at GB Pant hospital, an associated hospital of Government Medical College Srinagar. All included neonates were evaluated in neonatology section and were followed up to 4 weeks of life. Standard protocols were used for management of these neonates.Results: A total of 116 neonates were included in the study. Among the 116 neonates 82 (70.69%) were VLBW and 34 (29.31%) were ELBW. 28 (34.14%) VLBW and 18 (52.94%) ELBW neonates died. Among the morbidities Respiratory Distress Syndrome was found in 35.37% of VLBW and 70.59% of ELBW neonates, out of which 12.20% VLBW and 20.58% ELBW neonates developed Bronchopulmonary dysplasia. Perinatal asphyxia was found in 20.73% of VLBW and 29.41% of ELBW neonates and Pathological apnea occurred in 28.04% VLBW and 85.29% ELBW neonates. 40.24% VLBW and 73.53% ELBW neonates developed clinically significant jaundice requiring treatment. Clinical sepsis was found in 43.90% VLBW and 67.65% ELBW neonates while as culture proven sepsis was found in 26.83% VLBW and 41.18% ELBW neonates. Intra ventricular haemorrhage was found in 15.85% VLBW and 52.94% ELBW neonates. Necrotizing enterocolitis developed in 18.29% VLBW and 35.29% ELBW neonates. Retinopathy of prematurity was found in 21.95% VLBW and 26.47% ELBW neonates. Patent ductus arteriosus was found in 14.63% VLBW and 32.35% ELBW neonates.Conclusions: Present study has shown Respiratory distress syndrome, perinatal asphyxia and sepsis as the predominant causes of neonatal morbidity and mortality and these are preventable with a proper health care system and policy directed to the primary prevention.

Socio-demographic correlates of stunting among children in Port Blair, India

Background: Stunting or low height-for-age is failure to reach linear growth potential, and is a key indicator of chronic under nutrition. The objectives of the study were to assess the status of stunting among children attending outpatient department and to evaluate the demographic profile of such children.Methods: A hospital based cross sectional study conducted over a period 6 months from August 2015 to January 2016 among children within age group of 2 to 12 years attending outpatient department of GB Pant Hospital, Port Blair. Height-for-age z-scores (HFAz) was generated using the WHO Anthro software (version 3.2.2).Results: Overall 444 students’ were included in the study which included 213 male children (48%) and 231 female children (52.0%). Out of this 21.70% children were stunted and 6.3% children were severely stunted. Among the socio demographic factors shunting and severe stunting is seen among lower/upper lower class (82.14%) followed by middle/lower middle class.Conclusions: Collective effort by government, non-government organizations is required to plan long term and short term strategies addressing the risk factors.

Esophageal tuberculosis: Uncommon of common.

Background and AimEsophageal involvement in tuberculosis (TB) is rare and is usually secondary. Data on esophageal TB are scarce. We aimed to analyze clinical and endoscopic features and outcomes of treatment in esophageal TB.MethodsWe retrospectively identified patients with esophageal TB from January 2014 to December 2016 at GB Pant Hospital. Well‐defined granuloma with or without caseation and/or acid‐fast bacilli on staining either from esophageal biopsy or the adjacent mediastinal lymph node fine‐needle aspiration cytology (FNAC) specimen, along with clinical features and response to antitubercular therapy (ATT), were collectively considered to diagnose definite TB. Treatment received and response to therapy were documented and analyzed.ResultsA total of 19 patients had definite esophageal TB, and the median age of patients was 39 years (14–65 years) and 10 (52.6%) patients were female. The most common presenting symptom was dysphagia (n = 16, 84%) followed by odynophagia (n = 8, 42%). On endoscopy, the mid‐esophagus was the most common site of involvement, and findings included ulcers (n = 17), elevated lesions (n = 9), and fistulae (n = 4) in patients. The mediastinal lymphadenopathy was present in all patients, with parenchymal lesions seen in three patients. The endoscopic mucosal biopsies were diagnostic in 11 patients, and in the remaining 8 patients, endoscopic ultrasound‐guided FNAC from the mediastinal lymph nodes was diagnostic. A total of 18 patients completely responded to ATT, and 1 patient had partial response with persistent fistulae requiring additional treatment.ConclusionEsophagus involvement is rare in TB; endoscopic mucosal biopsy and EUS‐guided FNAC is diagnostic, and the response to ATT is excellent.

Platelet indices in diabetics and influence of glycemic control – a hospital based study in North-East India

Introduction: Platelets from patients with type 1 and type 2 diabetes exhibit enhanced platelet aggregation activity early in the disease course that may precede the development of cardiovascular diseases. Both atherosclerosis and thrombosis appear to contribute significantly to the increased cardiovascular risk of diabetic patients. Platelet indices include mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR). This study was undertaken with the aim to find out the differences in platelet indices between diabetics and non-diabetics and also between patients with controlled and uncontrolled diabetes mellitus in a tertiary health care centre in North East India. Methods: This is a cross sectional study conducted in Agartala Government Medical College and GB Pant Hospital (AGMC & GBP Hospital). 100 cases and 100 controls were selected from the Diabetes clinic of Medicine out patient department (OPD) and Medicine wards. Platelet indices and HbA1C levels of these cases and controls were measured. Platelet indices were measured by a 3-part differential hematology auto-analyzer and HbA1C by High Performance Liquid Chromatography (HPLC) method. Blood glucose levels were estimated by oxidase-peroxidase method. Results: Platelet indices were found to be significantly higher among diabetics compared to non-diabetics and also they were found higher among patients with poor glycemic control with HbA1C>7% in comparison to patients with good glycemic control with HbA1C<7% (P value <0.05). Conclusions: Platelet indices are significantly increased in diabetics and the extent of increment is more in diabetics with poor glycemic control.

APOLIPOPROTEIN B / A1 RATIO AS RISK PREDICTOR OF ANGIOGRAPHICALLY PROVEN ATHEROSCLEROSIS

30Jun 2016 APOLIPOPROTEIN B / A1 RATIO AS RISK PREDICTOR OF ANGIOGRAPHICALLY PROVEN ATHEROSCLEROSIS Anita Devi , Ritu Singh and Sanjay Tyagi. Senior Resident, Deptt of Biochemistry, Lady Hardinge Medical College, New Delhi. Professor, Deptt of Biochemistry, Lady Hardinge Medical College. Director Professor & HOD, Deptt of Cardiology, GB Pant Hospital, New Delhi.

Assessment of Knowledge and Practice of Mothers of Children under Five regarding Zinc Therapy in Childhood Diarrhea

ABSTRACT Aim Zinc is now considered as an important treatment intervention along with low-osmolarity oral rehydration salts in diarrhea. But awareness about the use of zinc remains low. The present study was conducted with an objective of assessing knowledge and practice of mothers of under-5 children about zinc supplementation in diarrhea. Materials and methods A hospital-based cross-sectional study was carried out in the Paediatric Outpatient Department Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura, India, with a sample size of 700 mothers of under-5 children over 2 months. Convenience sampling technique was employed and the data were collected in a structured, interview schedule. Descriptive statistics and tests like chi-square test were used for analysis. Results Only 1.9% of all the respondents (13 out of 700) had heard about zinc therapy in diarrhea. Out of them, 11 mothers had actually used zinc in practice and 7 could tell the duration of therapy. None of them were aware of what benefit is conferred by zinc in an episode of diarrhea. An association between knowledge levels and educational status and occupation of mothers was found to be statistically significant. Conclusion The study reaffirmed the abysmally low level of awareness about zinc supplementation among mothers. Therefore, health education can be used as a tool to promote knowledge and practice of zinc supplementation in diarrhea to reduce mortality and morbidity. How to cite this article Dhar DK, Majumder N, Paul D. Assessment of Knowledge and Practice of Mothers of Children under Five regarding Zinc Therapy in Childhood Diarrhea. Int J Adv Integ Med Sci 2016;1(4):169-172.

Study of TNF-α Polymorphism (308G/A) and the Role of NF-κB as an Novel Marker of Severity of Atherosclerosis: A Pilot Study in Indian Population

Background: Biallelic polymorphism of A/G variation at position 308 in the promoter region of TNF-α gene is an important genetic factor causing high TNF-α transcription which could influence the clinical outcome of atherosclerosis. Studies have also implicated the role of NF-κB in atherogenesis by regulating genes involved in the inflammatory response and insulin sensitivity. Material and Method: 50 cases of angiographically significant atherosclerosis (>50% obstruction in coronary arteries) and 50 age, sex, BMI matched patients with insignificant atherosclerosis (>50% obstruction) on angiography were selected from GB Pant Hospital. Polymorphism was studied by amplifying DNA using PCR and amplified segments were digested by restriction enzyme Nco-I and followed by RFLP. Serum NF-κB, TNF-α levels were estimated by sandwich ELISA. Results: The mean serum NF-κB and TNF-α levels were significantly (p=0.04, 0.000 respectively) raised in cases as compared to controls. Upon binomial logistic regression analysis, NF-κB emerged as the best predictor of severity of atherosclerosis (Odds ratio=27) among other markers. Our results showed no intergenotypic variation of 308-G/A polymorphism of the TNF-α gene between cases and controls. Conclusion: Our study establishes NF-κB as an emerging biomarker of severity of atherosclerosis in Indian population. No intergenotypic variation between cases and controls indicates that significantly high levels of TNF-α in the cases is attributed to cause other than polymorphism in Indian population. High prevalence of chronic low grade inflammation in population could be postulated as the possible cause.

An Analysis of the Origins, Subjects, and Awards Received for Presentations at the Annual IASG Conferences (2009-2013).

s presented at scientific meetings are important for making ongoing research more widely known and may also reflect the quality of the parent institution's standard of patient care. We analyzed the abstracts presented at the annual meetings of IASG for the past 5years for (i) medium of presentation (oral/poster/videos), (ii) subjects discussed, (iii) institution of origin, (iv) whether a prospective/ retrospective study or a case report, (v) changing trends, and (vi) awards received. Of the 1340 abstracts analyzed, there were 18.5% oral, 74.9% posters, and 6.5% videos presented from 205 in 2009 to 388 in 2012. The main organs discussed were the liver (19.3%) pancreas (18.8%), and biliary system (14.4%). Sixty percent was from the private sector with Sir Ganga Ram, SGRH (95) and the Apollo Hospital, New Delhi (60), being the most prolific. From public institutes, the abstracts were predominantly from PGIMER, Chandigarh (39) and GB Pant Hospital (37). Thirty-three percent was from DNB and 25% from M.Ch GI Surgery centres and 42% was from others (most of these were as posters). There were 1016 (75.8%) prospective/retrospective studies and 324 (24.2%) case reports. Presentations, especially those related to liver transplantation, showed an increase. The main awards were won by SGRH (8); AIIMS, New Delhi (7); and JIPMER, Puducherry (6). Over the last 5years, abstracts presented at the IASG have increased in number especially those dealing with the hepato-pancreatico-biliary system and liver transplantation. Most presentations were from "academic" departments, and similar analyses may inform us where we are heading and stimulate healthy competition.