Prevalence of Vitamin D3 deficiency among pediatric patients with idiopathic nephrotic syndrome in remission - A cross-sectional observational study from Vadodara, Gujarat

Background: Vitamin D deficiency occurs in nephrotic syndrome (NS) through various mechanisms, resulting in loss of both, Vitamin D binding protein and 25-(OH) D, in the urine leading to the risk of bone disorders. Objectives: The objectives of the study were to detect the prevalence of Vitamin D deficiency in children with idiopathic NS during remission. Methods: This study was conducted from April to November 2016 at the pediatric nephrology clinic at a tertiary care hospital in Vadodara. A total of 34 children were enrolled with idiopathic NS in remission, of which 14 had first attack of NS and ten of Frequently Relapsing Nephrotic Syndrome (FRNS) and Infrequently Relapsing Nephrotic Syndrome each. Vitamin D levels were measured using serum levels of 25-(OH) D by chemiluminescence method. Results: Vitamin D deficiency was observed in 28 of 34 (82%) children; of which, 16 (47%) had severe deficiency and 12 (35.2%) had mild to moderate deficiency. Children with the first attack of NS had a median Vitamin D level of 8.17 ng/ml (interquartile range [IQR] 2.9–28), IFRNS had a median of 6.8 ng/ml (IQR 2.9–33), and FRNS had the lowest median of 5.3 ng/ml (IQR 2.9–16). Although there were differences among all the 3 groups, differences were not statistically significant (Kruskal–Wallis 4.89, p=0.08) which showed decreased levels of Vitamin D. Conclusion: High prevalence of Vitamin D deficiency was observed in all 3 groups of idiopathic NS; the lowest being in FRNS. There was no significant association with lower levels of Vitamin D and relapses in NS. More research is needed to assess Vitamin D deficiency and to ensure the effect of Vitamin D supplementation for children with NS

“When treatment is more challenging than the disease” : a qualitative study of MDR-TB patient retention.

CAPRISA, 2016.Abstract available in PDF file

Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries ‐ a systematic review and meta‐analysis

OBJECTIVE: To summarise latent tuberculosis infection (LTBI) management strategies among household contacts of bacteriologically confirmed pulmonary tuberculosis (TB) patients in high‐TB burden countries. METHODS: PubMed/MEDLINE (NCBI) and Scopus were searched (January 2006 to December 2021) for studies reporting primary data on LTBI management. Study selection, data management and data synthesis were protocol‐driven (PROSPERO‐CRD42021208715). Primary outcomes were the proportions of LTBI, initiating and completing tuberculosis preventive treatment (TPT). Reported factors influencing the LTBI care cascade were qualitatively synthesised. RESULTS: From 3694 unique records retrieved, 58 studies from 23 countries were included. Most identified contacts were screened (median 99%, interquartile range [IQR] 82%–100%; 46 studies). Random‐effects meta‐analysis yielded pooled proportions for: LTBI 41% (95% confidence interval [CI] 33%–49%; 21,566 tested contacts); TPT initiation 91% (95% CI 79%–97%; 129,573 eligible contacts, 34 studies); TPT completion 65% (95% CI 54%–74%; 108,679 TPT‐initiated contacts, 28 studies). Heterogeneity was significant (I (2) ≥ 95%–100%) and could not be explained in subgroup analyses. Median proportions (IQR) were: LTBI 44% (28%–59%); TPT initiation 86% (60%–100%); TPT completion 68% (44%–82%). Nine broad themes related to diagnostic testing, health system structure and functions, risk perception, documentation and adherence were considered likely to influence the LTBI care cascade. CONCLUSION: The proportions of household contacts screened, detected with LTBI and initiated on TPT, though variable was high, but the proportions completing TPT were lower indicating current strategies used for LTBI management in high TB burden countries are not sufficient

Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review

BackgroundEarly and accurate diagnosis of tuberculosis is a priority for TB programs globally to initiate treatment early and improve treatment outcomes. Currently, Ziehl–Neelsen (ZN) stain-based microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LED-FM) are used for diagnosing pulmonary drug sensitive tuberculosis. Published evidence synthesising the cost-effectiveness of these diagnostic tools is scarce.MethodologyPubMed, EMBASE and Cost-effectiveness analysis registry were searched for studies that reported on the cost-effectiveness of GeneXpert and LED-FM, compared to ZN microscopy for diagnosing pulmonary TB. Risk of bias was assessed independently by four authors using the Consensus Health Economic Criteria (CHEC) extended checklist. The data variables included the study settings, population, type of intervention, type of comparator, year of study, duration of study, type of study design, costs for the test and the comparator and effectiveness indicators. Incremental cost-effectiveness ratio (ICER) was used for assessing the relative cost-effectiveness in this review.ResultsOf the 496 studies identified by the search, thirteen studies were included after removing duplicates and studies that did not fulfil inclusion criteria. Four studies compared LED-FM with ZN and nine studies compared GeneXpert with ZN. Three studies used patient cohorts and eight were modelling studies with hypothetical cohorts used to evaluate cost-effectiveness. All these studies were conducted from a health system perspective, with four studies utilising cost utility analysis. There were considerable variations in costing parameters and effectiveness indicators that precluded meta-analysis. The key findings from the included studies suggest that LED-FM and GeneXpert may be cost effective for pulmonary TB diagnosis from a health system perspective.ConclusionOur review identifies a consistent trend of the cost effectiveness of LED-FM and GeneXpert for pulmonary TB diagnosis in different countries with diverse context of socio-economic condition, HIV burden and geographical distribution. However, all the studies used different parameters to estimate the impact of these tools and this underscores the need for improving the methodological issues related to the conduct and reporting of cost-effectiveness studies.</div

CLINICAL PROFILE AND OUTCOME OF CRITICALLY ILL PREGNANT FEMALES WITH H1N1 INFLUENZA

BackgroundRecord based review of the 2009 H1N1 Influenza pandemic suggests that pregnant women are at higher risk for hospitalization and death due to H1N1 Influenza.AimsTo study the clinical profile and outcome of critically ill pregnant females admitted in intensive care unit (ICU) with real-time recombinant polymerase chain reaction (rRT-PCR) proven positive H1N1 cases.Methods  A retrospective record-review based study was conducted at Sir SayajiRao General Hospital (SSGH) and Medical College, Vadodara on data of confirmed rRT-PCR H1N1 pregnant females admitted during the pandemics of 2010and 2015. Demographics, clinical profile and laboratory investigations were recorded and outcomes (survived or expired) were analysed.Results  There were a total of 20 H1N1 positive pregnant females requiring ICU admission. With equal demographic distribution among rural and urban population, cough and fever were the most common presenting complaints. 65 per cent were in third trimester, the subgroup which also had the highest mortality. Mean days from onset until presentation was 5.05 days. 12 (60 per cent) patients’ required invasive mode of ventilation and all died. Average hospital stay was 7 days. Foetus had favourable outcome in patients who recovered from H1N1 acute illness.ConclusionPregnant females in our study had 60 per cent mortality. Thus, awareness, early diagnosis and treatment should be provided to them. Guidelines, policy changes and government protocols are required specifically for pregnant females with H1N1 Influenza A infection. Our study was an observational study and comparisons with non-pregnant females were not done, conclusions applicable to entire pregnant population was not derived

Clinical profile and outcome of critically ill pregnant females with H1N1 influenza

BackgroundRecord based review of the 2009 H1N1 Influenza pandemic suggests that pregnant women are at higher risk for hospitalization and death due to H1N1 Influenza.AimsTo study the clinical profile and outcome of critically ill pregnant females admitted in intensive care unit (ICU) with real-time recombinant polymerase chain reaction (rRT-PCR) proven positive H1N1 cases.Methods  A retrospective record-review based study was conducted at Sir SayajiRao General Hospital (SSGH) and Medical College, Vadodara on data of confirmed rRT-PCR H1N1 pregnant females admitted during the pandemics of 2010and 2015. Demographics, clinical profile and laboratory investigations were recorded and outcomes (survived or expired) were analysed.Results  There were a total of 20 H1N1 positive pregnant females requiring ICU admission. With equal demographic distribution among rural and urban population, cough and fever were the most common presenting complaints. 65 per cent were in third trimester, the subgroup which also had the highest mortality. Mean days from onset until presentation was 5.05 days. 12 (60 per cent) patients’ required invasive mode of ventilation and all died. Average hospital stay was 7 days. Foetus had favourable outcome in patients who recovered from H1N1 acute illness.ConclusionPregnant females in our study had 60 per cent mortality. Thus, awareness, early diagnosis and treatment should be provided to them. Guidelines, policy changes and government protocols are required specifically for pregnant females with H1N1 Influenza A infection. Our study was an observational study and comparisons with non-pregnant females were not done, conclusions applicable to entire pregnant population was not derived

Polycystic ovarian syndrome among young women of a university in central Gujarat – A cross-sectional study

Background: Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrinological disorders affecting 6%–8% of women in reproductive years. An early liberal PCOS screening appears to be a cost-effective strategy, benefiting earlier diagnosis and intervention. Objectives: The objectives are to measure the prevalence of PCOS and factors associated with PCOS among young girl students of a University in Central Gujarat. Materials and Methods: All consenting girl medical students enrolled in MBBS curriculum during 2013–2017 were given a self-administered questionnaire (for signs and symptoms of PCOS), taking due prior permissions; during January 2018–June 2019. Using Rotterdam (2006) criteria, those who were screened for PCOS were subjected to abdominal ultrasonography (USG) and if required, laboratory investigations (random blood sugar, thyroid-stimulating hormone, and free testosterone). The proportion of young women having PCOS as per the Rotterdam and European Society for Human Reproduction and Embryology (EHSRE) Criteria are reported. Results: The study enrolled 308 girl medical students. More than one-tenth of the study participants (11.7%, 36/308) had confirmed PCOS (Rotterdam Criteria). As per the EHSRE criteria, 24/36 had classic PCOS, 11/36 had ovulatory phenotype, and 01/36 had the non-hyperandrogenic phenotype PCOS. USG was required in 123/308 (39%); of which 91 consented and 16/91 (18%) had conclusive PCOS. Twenty-three girls required laboratory investigations, of which two had abnormal values suggestive of PCOS. Irregular menses and hirsutism were significantly associated with the PCOS (P < 0.05). Conclusion: The proportion of young medical students with PCOS was 12%. Irregular menses and hirsutism were significantly associated with PCOS

A case control study of risk factors of coronary heart disease among patients admitted at tertiary hospital in western India

BackgroundCoronary heart disease (CHD) is a major cause of death in the world. In this study, various risk factors of CHD were explored.AimsTo find out association of CHD with its risk factors in Western India.Methods A 100 cases of first episode of Acute Coronary Syndrome (ACS) patients and 200 age and sex matched controls from medical wards of a government run tertiary care hospital were interviewed through modified WHO STEPS questionnaire along with physical examination and anthropometric measurements. Data was cleaned and analysed through SPSS.Results On bivariate analysis current smoking status [OR=2.906 (1.69–4.98)], BMI [OR=2.6492 (1.49–4.72)], waist circumference [OR=1.7051 (1.01–2.88)] and positive family history [OR=2.0457 (1.07–3.91)] were found to be significantly associated with ACS cases. On multivariate analysis, BMI [OR=2.612 (1.376–4.959)] and current smoking status [OR=3.005 (1.791–5.042)] were found to be significantly associated with ACS cases.ConclusionOut of conventional risk factors, BMI and current smoking status were the only risk factors which had positive association with CHD in this study