Association between vitamin B12 and non-alcoholic fatty liver disease: a case control study in Katra Jammu

Background: Non-alcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease in developed countries and obesity contributing maximum to the disease load. A reduction in the energy content of diet, alone, may not prevent NAFLD, nor could alleviate it. Recent studies are bringing to light the association, importance and role of dietary vitamins and liver fat accumulation. Vitamin B12 is involved in the metabolism of every cell of the human body. It is a cofactor in DNA synthesis and in both fatty acid and amino acid metabolism. Still, the influence of vitamin B12 deficiency on NAFLD has not been studied much.Methods: A case control observational study was conducted in the department of medicine, community health center, Katra during the period of August 2018 to July 2019. The study was conducted on 150 NAFLD patients and 50 aged and gender-matched healthy controls. Patients showing ethanol consumption, liver cirrhosis, DM, pancreatitis, renal failure or cancer were excluded.Results: Patients and controls almost matched in all clinical examinations like fever, jaundice, nausea, but vitamin B12 levels were significantly low among cases and stood at 377.60±181.43 pg/ml as against 548.28±285.70 for controls, but still remained within the reference range. Vitamin D levels were also found to be lower among cases. B12 deficiency is extremely common in India with an estimated prevalence of 47% and more males tend to have NAFLD than females.Conclusions: For better management of the disease, vitamin B12 levels should be assessed in all NAFLD patients

Anemia among women of reproductive age: a cross sectional study in Sub district hospital, Akhnoor

Background: Anemia in pregnancy can increase the risk of having a pre-term delivery/babies, which may further lead to low birth weight and sometimes death. Anemia is more prevalent in Asia, with half of the all-anemic women living in Indian subcontinent itself. The objective of the study was to estimate the prevalence of anemia among women in the reproductive age group (15-49) in a rural population set up of Akhnoor.Methods: A population based cross-sectional study was conducted in Sub district hospital, Akhnoor, Jammu, J and K, India, over a period of 6 months from September 2020 to February 2021, on a total of 320 women in the reproductive age group of 15 to 49 years.Results: A total prevalence of 59.06% was found with highest among pregnant females. Out of this total anemic patient 59.78% (113/189) were mild anemic, and 40.22% (76/189) were either moderately anemic or severe. High prevalence of anemia was seen among illiterate women (68.89%). Prevalence was also significantly associated to excessive/ scanty menstruation. Besides, menstrual cycle more than 35 days and less than 21 days were found to be at higher risk of anemia (60.53% and 83.33%). Underweight women were also found at higher risk of anemia (69.52%). Only 88 out of 320 women studied had completed the course of IFA tablets.Conclusions: Several socio-demographic, menstrual, dietary, environmental, and behavioral factors were associated with anemia. Women of reproductive age should be motivated to include food fortification or iron supplementations in their diet

Prevalence of neuropathy in type 2 diabetic patients at sub-district hospital Akhnoor

Background: Type 2 diabetes mellitus (T2DM) is a progressive disease and hampers the quality of life of the patients due to micro and macro-vascular complications associated with it, like: neuropathy. Peripheral neuropathy leads to numbness, loss of sensation, and sometimes pain in the feet, legs, or hands.Methods: A cross sectional study was conducted among 200 randomly selected T2DM patients of either gender presenting to the medicine outpatient department (OPD) of sub district hospital Akhnoor from August 2020 to February 2021.Results: Almost half of the participants having duration of DM for more than 10 years and a mean age of 56.8±12.2 years. Based on the Michigan neuropathy screening instrument (MNSI) assessment, 41% of study participants had a score of ≥6 in the history questionnaire. The most frequently reported symptoms among patients were numbness and pain while walking, which was present in 80.5% and 70.5% of study participants, respectively. Around 32-40.5% of T2DM patients were found to suffer from peripheral neuropathy in our study. A significantly higher prevalence of diabetic peripheral neuropathy (DPN) was found among males (43.7%) than females (37.1%).Conclusions: Early detection of DM and appropriate intervention and effective control is important for effective management among patients, especially with higher body mass index (BMI), obesity or with advancing age.

HIV associated neurocognitive dysfunction and its association with CD4 count in HIV positive patients-a hospital based study

Background: The main objective of the present work was to study the neurocognitive dysfunction in HIV positive patients and to determine its relation with CD4 count. Further, an attempt has also been made to study the relationship of neurocognitive dysfunction with cART regimen.Methods: The study was a prospective observational study, conducted over a period of one year (from July 2012 to June 2013) in the Department of Medicine in collaboration with the Department of Psychiatry at Indira Gandhi Medical College and Hospital, Shimla.Results: HIV associated neurocognitive dysfunction (HAND) was found in 39.04% patients. Mean duration from diagnosis of HIV to detection of HAND was 3.77 ± 1.7 years. Mean nadir CD4 cell count was 126.1/mm3. 39.04% patients (n=41) were found to have HIV associated neurocognitive disorder out of 105 screened patients. 95.1% patients (n=39) had asymptomatic neurocognitive impairement, 4.9% patients (n=2) had mild cognitive impairment and 2.08% patients (n=1) had HIV associated dementia. Out of 41 patients having HIV associated neurocognitive disorder, 68.3% patients (n=28) were having CD4 count less than 150. Those having CD4 count less than 150/mm3 had scored less on dementia scales indicating severe disease. 31.7% patients (n=13) were having HIV associated neurocognitive disorder (HAND) and CD4 count was more than 150/mm3.Conclusions: The conclusion of the study is that HIV associated neurocognitive disorder is common and asymptomatic neurocognitive impairement is the commonest type of HIV associated neurocognitive disorder in HIV positive patients. It can be detected while patient is asymptomatic with help of simple neurocognitive tests. Although few studies reported higher prevalence of HIV associated neurocognitive disorder among patients on certain combined antiretroviral therapy (cART) regimen but our study didn’t indicate any such association

Three Tier Screening Tool and Second Triage to Minimize the Spread of COVID-19 in Emergency Department of a Tertiary Hospital in India

Introduction: Since the outbreak of Coronavirus on December 31, 2019 in Wuhan, Hubei Province, People’s Republic of China, the number of cases from China that have been imported into more than 180 countries and regions around the world. Objective: The goal of this study is to flatten the curve of new infection, through nosocomial transmission by health care system along with early identification of asymptomatic COVID-19 cases. Methods: A Survey was conducted over a period of 35 days. A total of 1709 individuals were screened (647 patients and 1062 patient attendees) coming to emergency Department. The waiting area of Emergency Care was divided into 3 screening zones and a separate second triage is established. The individuals entering are ensured that they are screened at all the 3 zones. Individuals were divided into two Groups after screening: Group A (suspected COVID-19) and Group B (unsuspected COVID-19). In Acute emergencies, the patient was directly treated at second triage. Results: A total of 1709 individuals, 247 in Group A (Suspected COVID-19) and 1462 in Group B (Unsuspected COVID-19). Among 247 individuals, 141 were males and 106 were females. Age ranged from 14-72 years with a mean age of 46.7years. Among 247 individuals (Group A), 81 were patients, of which one case was found to be COVID-19 Positive. Two Health care workers (HCW’s) found to be positive. Conclusion: Challenges from the widespread pandemic underscores the importance of early implementation of a second triage and vigorous screening for all the individuals to minimize the spread of infection, failing which pandemic infection may turn into an epidemic

Characterization of protective epitopes in a highly conserved Plasmodium falciparum antigenic protein containing repeats of acidic and basic residues

The delineation of putatively protective and immunogenic epitopes in vaccine candidate proteins constitutes a major research effort towards the development of an effective malaria vaccine. By virtue of its role in the formation of the immune clusters of merozoites, its location on the surface of merozoites, and its highly conserved nature both at the nucleotide sequence level and the amino acid sequence level, the antigen which contains repeats of acidic and basic residues (ABRA) of the human malaria parasite Plasmodium falciparum represents such an antigen. Based upon the predicted amino acid sequence of ABRA, we synthesized eight peptides, with six of these (AB-1 to AB-6) ranging from 12 to 18 residues covering the most hydrophilic regions of the protein, and two more peptides (AB-7 and AB-8) representing its repetitive sequences. We found that all eight constructs bound an appreciable amount of antibody in sera from a large proportion of P. falciparum malaria patients; two of these peptides (AB-1 and AB-3) also elicited a strong proliferation response in peripheral blood mononuclear cells from all 11 human subjects recovering from malaria. When used as carrier-free immunogens, six peptides induced a strong, boostable, immunoglobulin G-type antibody response in rabbits, indicating the presence of both B-cell determinants and T-helper-cell epitopes in these six constructs. These antibodies specifically cross-reacted with the parasite protein(s) in an immunoblot and in an immunofluorescence assay. In another immunoblot, rabbit antipeptide sera also recognized recombinant fragments of ABRA expressed in bacteria. More significantly, rabbit antibodies against two constructs (AB-1 and AB-5) inhibited the merozoite reinvasion of human erythrocytes in vitro up to ~90%. These results favor further studies so as to determine possible inclusion of these two constructs in a multicomponent subunit vaccine against asexual blood stages of P. falciparum

Characterization of protective epitopes in a highly conserved Plasmodium falciparum antigenic protein containing repeats of acidic and basic residues

The delineation of putatively protective and immunogenic epitopes in vaccine candidate proteins constitutes a major research effort towards the development of an effective malaria vaccine. By virtue of its role in the formation of the immune clusters of merozoites, its location on the surface of merozoites, and its highly conserved nature both at the nucleotide sequence level and the amino acid sequence level, the antigen which contains repeats of acidic and basic residues (ABRA) of the human malaria parasite Plasmodium falciparum represents such an antigen. Based upon the predicted amino acid sequence of ABRA, we synthesized eight peptides, with six of these (AB-1 to AB-6) ranging from 12 to 18 residues covering the most hydrophilic regions of the protein, and two more peptides (AB-7 and AB-8) representing its repetitive sequences. We found that all eight constructs bound an appreciable amount of antibody in sera from a large proportion of P. falciparum malaria patients; two of these peptides (AB-1 and AB-3) also elicited a strong proliferation response in peripheral blood mononuclear cells from all 11 human subjects recovering from malaria. When used as carrier-free immunogens, six peptides induced a strong, boostable, immunoglobulin G-type antibody response in rabbits, indicating the presence of both B-cell determinants and T-helper-cell epitopes in these six constructs. These antibodies specifically cross-reacted with the parasite protein(s) in an immunoblot and in an immunofluorescence assay. In another immunoblot, rabbit antipeptide sera also recognized recombinant fragments of ABRA expressed in bacteria. More significantly, rabbit antibodies against two constructs (AB-1 and AB-5) inhibited the merozoite reinvasion of human erythrocytes in vitro up to ∼90%. These results favor further studies so as to determine possible inclusion of these two constructs in a multicomponent subunit vaccine against asexual blood stages of P. falciparum

Massive Liver Abscess Caused by Multidrug Resistant Citrobacter freundii

Pyogenic liver abscess is a disease entity that may follow infections of the biliary tract, blood stream and intra abdominal conditions like appendicitis, diverticulitis etc. Co- morbid conditions like diabetes mellitus, renal disease, malignancy, immune suppression etc. may contribute to the development of an abscess and affect the overall outcome of liver abscess as well. Escherichia coli and Klebsiellapneumoniae have been reported to be the most common isolations from these cases. Citrobacter infections usually occur in patients with some underlying co- morbidities and mostly in hospitalized patients. Recently, an increased emergence of multi- drug resistant strains is presenting a challenge to clinicians and microbiologists.Here, we report a case of massive liver abscess in an immunocompetent patient caused due to Citrobacterfreundii resistant to gentamicin, ciprofloxacin, cotrimoxazole, amikacin, ceftriaxone and piperacillin-tazobactam. It showed in vitro sensitivity to meropenem and aztreonam only

Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

Background: Labour analgesia has been recommended but sufficient data on use of labour epidural analgesia with ropivacaine and fentanyl combination during labour is not available.Methods: A comparative study was conducted on 40 high risk labouring partuirents, randomly allocated to group A (iv tramadol) and group B (epidural analgesia with ropivacaine plus fentanyl). Assessments were done for fetal heart rate abnormality, mode of delivery, duration of labour, and Apgar score. The VAS score, patient satisfaction score, and complications were recorded.Results: Group A had more number of instrumental deliveries compared to group B, the later had higher number of caesarean sections. No difference was observed in vaginal deliveries in both the groups. Pain relief was significant in patients of epidural group. The neonatal outcome was same in both the groups. Significant number of patients had a higher degree of satisfaction score in group B compared to group A.Conclusions: Tramadol and epidural analgesia in labour are safe and effective. Patient satisfaction is significantly higher in epidural group as compared to the tramadol group